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Biomedical subjects

T Hierl

Publications and source records attributed to T Hierl.

At least 19 recordsLinked to original sources
PubMed2006

Differences and similarities of cytomegalovirus and pneumocystis pneumonia in HIV-negative immunocompromised patients thin section CT morphology in the early phase of the disease.

The purpose of this study was to assess CT morphology of pneumocystis pneumonia (PcP) and cytomegalovirus (CMV) pneumonia for specific characteristic features, similarities as well as differences, which might contribute to an early diagnosis and, therefore, influence patient management 58 patients were included, 31 with CMV pneumonia and 27 with PcP. All patients with CMV pneumonia had underlying haematological malignancies (n = 31) mainly treated by haematopoietic cell transplantation (HCT) (n = 26). Patients with PcP had haematological malignancies (n = 17) treated by HCT in 6, solid tumours (n = 5) and corticosteroid therapy (n = 5). Thin section CTs were analysed retrospectively by two radiologists. 18 CT morphological criteria were evaluated for presence or absence. Significance was calculated by chi2 test. Interobserver correlation was tested by kappa-statistic (K) Only 5 of the 18 features were found to have significantly different frequencies in the two entities. Apical distribution (p<0.01), mosaic pattern (p<0.01) and homogeneous structure of ground-glass opacities (GGO) (p<0.05) were found more frequently in PcP (each K: 0.7-0.9), whereas small nodules or unsharp demarcation of GGO and consolidation were typical of CMV pneumonia (p<0.05). Peripheral sparing, consolidation and septal thickening inter alia were found equally in both groups In conclusion analysis of craniocaudal distribution, demarcation and structure of infiltrates may be helpful in prioritizing differential diagnosis of CMV pneumonia or PcP. However, some features thought typical for one or the other entities appear with similar frequency in both groups in HIV-negative patients.

Adult↗
PubMed2003

[Functional and aesthetic outcome of nasal surgery in cleft lip palate patients].

Between June 1996 and November 2000 60 patients suffering from severe nasal dysplasia due to cleft lip and palate (CLP) underwent corrective nasal surgery. Diagnoses included 37 cases of unilateral CLP and 23 cases of bilateral CLP. Age ranged from 7 to 50 years. To assess functional outcome three different methods were used pre- and postoperatively with and without nasal decongestion: active anterior rhinomanometry, rhinoresistometry, and acoustic rhinometry. For the measurement of esthetic changes frontal, lateral, and caudal photographs were analyzed. Compared to a non-cleft population esthetic and functional impairment was evident preoperatively. Postoperatively a statistically significant improvement in nasal projection and configuration was seen. Concerning nasal respiration an improvement in nasal flow and hydraulic diameter was noted in the unilateral CLP group only, whereas a statistically nonsignificant average deterioration was found in the bilateral CLP group. No correlation existed between external nasal form or the change in nasal appearance and nasal function. Whereas the esthetic outcome of nasal surgery is covered by way of photo-analysis in many centers, a distinct lack of measuring the effects on nasal function can be stated. Without using objective methods, however, no data for improving surgical procedures and for internal quality control are at hand.

Adolescent↗
PubMed2002

[Distraction osteogenesis in the treatment of severe midfacial hypoplasia].

PATIENTS: Between May 1998 and May 2002, 38 patients suffering from severe midfacial retrusion and atrophy were treated by way of midfacial distraction osteogenesis. Diagnoses included cleft lip and palate (32 patients) and one case of Crouzon's disease. Ages ranged from 6-65 years. A total of 28 patients presented a velopharyngeal flap and nine patients were almost or fully edentulous. Using an extraoral halo device, distraction was performed after a subtotal Le Fort-I/II/III or modified quadrangular osteotomy. RESULTS: Distraction ranged from 9 to 31 mm (17 mm average). Following the primary operation, seven patients underwent a second intervention due to problems with the procedure or the device. Two patients needed a secondary Le Fort-I-osteotomy. With respect to velopharyngeal insufficiency, 21% showed a deterioration and 8% an improvement. Postoperatively, a decrease of 15-20% in the attained sagittal advancement was seen during the first 6 months. This was attributed to relapses and postoperative orthodontics. Thereafter skeletal stability was maintained. CONCLUSION: Distraction osteogenesis of the midface can be the method of choice in severe midfacial retrusion. Due to the difficult patient situation and the technical intricacies a higher complication rate has to be accepted than for conventional dysgnathia operations.

Adolescent↗
PubMed2001

Endoscopically assisted intraoral mandibular distraction osteogenesis.

Correct placement of intraoral devices for mandibular distraction osteogenesis is important to achieve the ideal vector of distraction. As visual inspection and intraoperative management in the inferior mandibular border or at the posterior ascending ramus is impaired, an endoscopically assisted method is presented. Since the introduction of this new technique operation time and ease have been significantly improved.

Adult↗
PubMed2000

[Hypercalcemia caused by generalized sarcoidosis].

HISTORY AND ADMISSION FINDINGS: A 70-year-old man with a 23-year history of recurrent nephrolithiasis was admitted for evaluation of hypercalcaemia (maximal calcium concentration 3.24 mmol/l). Physical examination on admission was unremarkable except for sensory neuropathy in the right foot. INVESTIGATIONS: Chest radiogram, subsequent transbronchial lung biopsy, gallium scintigraphy and magnetic resonance imaging (MRI) of the vertebrae indicated generalized sarcoidosis, predominantly affecting the mediastinum, lumbar vertebrae and nerves of the distal limbs. Parathormone level was reduced, while the levels of vitamin D metabolites were normal. TREATMENT AND COURSE: Serum calcium level became normal within 2 weeks of starting glucocorticoid treatment. CONCLUSION: Hypercalcaemia can occur in the course of sarcoidosis even in the absence of a elderly increased level of 1,25-dihydroxyvitamin D3. In this case the cause of the hypercalcaemia of a year's duration may have been due to lymphomacrophagocytic infiltration of the bone of several vertebrae as demonstrated by MRI of the vertebral columns but not by conventional radiography. In this case an increase in cytokine secretion by macrophages may have played an important role in addition to the level of 1,25-dihydroxyvitamin D3 at the upper limit of normal that, in view of the renal failure, could only have been caused by extrarenal production. Cytokines (e.g. interleukin-1 beta and tumour necrosis factor alpha) secreted by activated macrophages are among the most powerful stimulators of bone reabsorption.

Aged↗
PubMed2000

[Callus distraction of the mid-face in severe mid-face hypoplasia].

Callus distraction in the treatment of severe midfacial hypoplasia/atrophy may offer new therapeutical possibilities. Between May 1998 and March 1999, six patients underwent a subtotal Le Fort I-II osteotomy with subsequent distraction via a haloborne distractor (RED). Five patients suffered from CLP, four patients were totally or almost edentulous in the upper jaw. Corrections of sagittal discrepancies were possible in all cases (distraction 16-31 mm). No case of increased velopharyngeal insufficiency was seen. In one patient the halo had to be refixed. Three patients suffered from tension-like pain in the soft palate during distraction. Follow-up studies suggest the necessity for overcorrection of 20% in edentulous senior patients. Callus midfacial distraction is a promising new alternative to conventional orthognathic surgery in severe cases.

Adolescent↗
PubMed2000

A novel modular retention system for midfacial distraction osteogenesis.

Distraction osteogenesis of the midface offers new possibilities for the treatment of large sagittal discrepancies between the upper and lower jaws. The use of an extraoral halo-borne distractor, which allows free three-dimensional vector control, may cause problems in the connection between the midface and the distractor. To overcome these difficulties, we present a new modular retention system to gain bone anchorage whenever a toothborne appliance is not suitable. Distraction osteogenesis with an extraoral appliance is therefore possible even in edentulous elderly patients. We have used this system successfully in 11 patients.

Bone Plates↗
PubMed2000

Impact of short-time nasal intubation on postoperative respiration.

Until now few data on postoperative nasal respiration after nasal intubation is known which is of special importance for surgery, where postoperative intermaxillary fixation is necessary. This study was planned to acquire information about nasal breathing during the first postoperative week. Twelve patients treated for mandibular retrognathism were examined repeatedly by way of anterior active rhinometry, acoustic rhinometry, and rhinoresistometry before and after surgery over one week. In addition the subjective evaluation was checked on a visual analogue scale. Following intubation, significant changes in "objective" and subjective measurements of nasal respiration could be noted only on the second postoperative day. Comparing rhinomanometric and subjective data, a correlation could be found on postoperative day two only. In this study group short-time nasal intubation had no significant impact on postoperative respiration.

Adult↗
PubMed1999

[Osteo-anabolic estrogen therapy in a transsexual man].

HISTORY AND ADMISSION FINDINGS: A 31-year-old man presented at the endocrinology out-patient clinic for the initiation of sex-change treatment. His manifestly transsexual male-to-female appearance was confirmed by a psychiatric-sexological expert report. The patient had been living as a woman for one year. Physical examination showed normal male physique with typical secondary hair growth and normal male genitals. INVESTIGATIONS: The serum testosterone level was at the upper limits of normal, that for oestrogen at the lower limit. Bone densitometry showed bone density at the upper limit of normal. Other laboratory tests were unremarkable. DIAGNOSIS, TREATMENT AND COURSE: During 30 months on cyproterone, 100 mg daily, bone mass fell at the rate of 5% per year. Bone biopsy revealed high turnover osteoporosis. Bone mass rose by 4% per year after the additional oral intake of oestradiol valerate, 2 mg daily. Osteoblastic cells, isolated from part of the biopsy tissue, with the patient's consent, was found to be stimulated by oestradiol in vitro. CONCLUSION: The described bone mass changes indicate the important role played by sex hormones in the maintenance of bone mass acquired during adolescence. The findings confirm that in males not only testosterone but also oestrogens has an anabolic effect on bone.

Adult↗
PubMed1999

[Callus distraction of the midface. Requirements for diagnostic imaging].

Callus distraction of the midface is a recently developed surgical method for treatment of atrophic or hypoplastic maxillae. The treatment planning is based on individual shaped models, being constructed with the help of computed tomographic data. Our experience is based on 10 patients (3 male/7 female; age: 11-55 years). The demands for imaging are reported. The following imaging procedure is recommended: 1. preoperative: lateral x-ray, orthopantomogram, spiral CT, 2. during the time of callus distraction with normaly takes 4 to 5 weeks: lateral x-ray (every 10 days), and 3. for follow up: lateral x-ray and spiral CT. The Radiation exposure caused by the repetitive images is calculated in detail.

Abnormalities, Multiple↗
PubMed1999

Callus distraction of the midface in the severely atrophied maxilla--a case report.

OBJECTIVE: This report introduces the possibilities of callus distraction in the extremely atrophied, edentulous midface in a cleft lip and palate patient. INTERVENTION: After a subtotal Le Fort II osteotomy, tension wires were fixed to the zygomatic buttresses and frontal sinus walls by way of titanium miniplates and mesh and connected to a rigid external distractor. Then distraction of the whole midface (1 mm/d) was performed. RESULTS: Even in severe atrophy a distraction of the maxilla of 20 mm was possible. Stability has been shown for more than 5 months. CONCLUSIONS: Rigid external midfacial distraction may be used in difficult cases for the correction of sagittal discrepancies where conventional orthognathic surgery is likely to be insufficient. Further investigations will concentrate on the long-term outcome.

Adult↗
PubMed1998

Regulation of interleukin-6 expression in human osteoblastic cells in vitro.

Interleukin-6 (IL-6) is a potent stimulator of bone resorption which has been demonstrated in a variety of in vivo and in vitro models. We investigated the regulation of IL-6 secretion in primary human osteoblastic cells (HOC) in vitro by cytokines known to play an important role in coupling bone formation to bone resorption. HOC were isolated from healthy adults who underwent selective orthopedic surgery and treated with cytokines released in the bone microenvironment during coupling i.e Interleukin-1beta (IL-1beta), Tumor Necrosis Factor alpha (TNFalpha), Transforming Growth Factor beta1 and 2 (TGFbeta 1 and 2) and Endothelin-1 (ET-1). Furthermore, we determined whether systemically-acting steroid hormones of gonadal and adrenal origin as well as glucocorticoids affect the local regulation of IL-6 secretion in primary HOC. To examine the effects of different steroid hormones on IL-6 production, HOC were exposed to estradiol (E2), dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and dexamethasone (Dexa) with and without a subsequent treatment of the HOC populations with cytokines. We observed that (1) IL-1beta and TNFalpha induced IL-6 in a dose and time-dependent fashion, (2) TGFbeta 1 and 2 enhanced basal and IL-1beta and TNFalpha induced IL-6 expression, (3) ET-1 elicited a dose-dependent stimulatory effect on IL-6 expression. (4) E2, DHT and DHEA alone and in combination with IL-1beta and TNFalpha elicited no reproducible dose-dependent effect on IL-6 production, whereas Dexa inhibited basal and IL-1beta and TNFalpha induced IL-6 expression dose dependently. In conclusion, IL-1beta, TNFalpha, TGFbeta 1 and 2 and ET-1 may participate in the regulation of bone resorption by stimulating IL-6 expression in HOC. Dexa inhibits the constitutive and cytokine stimulated IL-6 expression, whereas there is no in vitro evidence that sex steroids exert a major inhibitory effect on the osteoblastic secretion of IL-6 as demonstrated in a primary human bone cell model.

Aged↗
PubMed1997

Obstructive sleep apnoea syndrome: results and conclusions of a principal component analysis.

A cephalometric analysis according to Hasund, supplemented by special obstructive sleep apnoea syndrome (OSAS) parameters, was performed on 169 patients who had been referred from the sleep laboratory. Statistical analysis showed a correlation between specific cephalometric landmarks including posterior airway space (PAS), a soft palate length, hyoid position and posterior growth development of the mandible and OSAS severity. A principal component analysis differentiated between four subgroups of OSAS patients: (1) orthognathic obese subjects; (2) patients with a long soft palate and low-positioned hyoid; (3) retrognathic patients with narrow PAS; and (4) prognathic ones. Lateral cephalometry is an important contribution to OSAS diagnostics and oral and maxillofacial therapy procedures.

Adult↗
PubMed1997

High-resolution fluorescence in situ hybridization of human Y-linked genes on released chromatin.

Genes within the differential region of the human Y chromosome do not recombine, and therefore the determination of their location depends on physical mapping. Yeast artificial chromosome (YAC) contigs spanning the euchromatic region of the human Y have become a powerful tool for the generation of an overlapping clone map. With this approach, however, complete physical mapping is difficult in Y euchromatic regions that are rich in repetitive sequences. We have, therefore, made use of the fluorescence in situ hybridization technique as an alternative strategy for physically mapping the PRKY and AMELY genes as well as the TSPY, RBM and DAZ gene families to human Y chromosomes in prometaphase and to extended Y chromatin in interphase. From our results, the following order of gene sequences in interval 3 of the short arm of the human Y chromosome is suggested: TSPY major with few RBM sequences interspersed-PRKY-AMELY-TSPY minor with few RBM sequences interspersed-cen. On the long arm, RBM sequences appear to be distributed over wide regions of intervals 5 and 6 with few TSPY sequences interspersed. Distal to an RBM signal cluster, a large cluster of DAZ signals is located with only a few DAZ and RBM signals overlapping in between the two clusters.

Cell Cycle Proteins↗
PubMed1997

Gonadal and adrenal androgens are potent regulators of human bone cell metabolism in vitro.

Androgens stimulate bone formation and play an important role in the maintenance of bone mass. Clinical observations suggest that both gonadal and adrenal androgens contribute to the positive impact of androgenic steroids on bone metabolism. We investigated the mechanism of action of the adrenal androgen dehydroepiandrosterone (DHEA) and its sulfated compound dehydroepiandrosterone sulfate (DHEAS) on human osteoblastic cells (HOCs) in vitro. The DHEA- and DHEAS-induced effects were analyzed in parallel with the actions elicited by the gonadal androgen dihydrotestosterone (DHT). There was no qualitative difference between the effects of gonadal and adrenal androgens on HOC metabolism in vitro. Both were stimulatory as regards cell proliferation and differentiated functions, but the gonadal androgen DHT was significantly more potent than DHEA. The actions of DHT and DHEA on HOC proliferation and alkaline phosphatase (ALP) production could be prevented by the androgen receptor antagonist hydroxyflutamide and inhibitory transforming growth factor beta antibodies (TGF-beta ab), respectively, but were not affected by the presence of the 3 beta-hydroxysteroid dehydrogenase (3 beta HSD) and 5-alpha-reductase (5-AR) inhibitor 17 beta-N,N-diethylcarbamoyl-4-methyl- 4aza-5 alpha-androstan-3-one (4-MA). This indicates that DHT and DHEA (1) exert their mitogenic effects by androgen receptor-mediated mechanisms, (2) stimulate ALP production by increased TGF-beta expression, (3) that the action of DHT is not affected by the presence of 4-MA, and that (4) DHEA does not need to be metabolized by 3 beta HSD or 5-AR first to exert its effects on HOCs in vitro.

Adolescent↗