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  • 1
    ISSN: 1600-0501
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract: In this study, the three-dimensional (3D) accuracy of navigation-guided (NG) socket drilling before implant installation was compared to the conventional free-hand (CF) method in a synthetic edentulous lower jaw model. The drillings were performed by two surgeons with different years of working experience. The inter-individual outcome was assessed. NG drillings were performed using an optical computerized tomography (CT)-based navigation system. CF drillings were performed using a surgical template. The coordinates of the drilled sockets were determined on the basis of CT scans. A total of n=224 drillings was evaluated. Inter-individual differences in terms of the surgeons' years of work experience were without statistical significance. The mean deviation of the CF drilled sockets (n=112) on the vestibulo-oral and mesio-distal direction was 11.2±5.6° (range: 4.1–25.3°). With respect to the NG drilled sockets (n=112), the mean deviation was 4.2±1.8° (range: 2.3–11.5). The mean distance to the mandibular canal was 1.1±0.6 mm (range: 0.1–2.3 mm) for CF-drilled sockets and 0.7±0.5 mm (range: 0.1–1.8 mm) for NG drilled sockets. The differences between the two methods were highly significant (P〈0.01). A potential benefit from image-data-based navigation in implant surgery is discussed against the background of cost-effectiveness.
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  • 2
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Paragangliome ; Computertomografie ; Magnetresonanztomografie ; Angiografie ; Key words Paraganglioma ; Computed tomography ; Magnetic resonance tomography ; Angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Paragangliomas of the glomus caroticum are relatively rare, but highly vascularized neoplasmas, which develop from chemoreceptors. They can be develop at anyage, but most often in the third or fourth decade of life. Paragangliomas grow very slowly and are most always of benign origin. There is a familial predisposition, and an autosomal-dominant transmission is presumed. They are commonly located in the jugular region; in rare cases a polytopic manifestation is found. We describe the case of a 47-year-old male patient who was referred to our department because of a progressive swelling of the neck on both sides. Contrast-enhanced computed tomography had displayed soft tissue tumors in the jugular regions. We performed an operative exploration, which showed a highly vascularized tumor. Histopathologic analysis revealed the diagnosis of a paraganglioma. An angiography of the neck and thoracic region, furthermore, revealed an additional paraganglioma in the anterior mediastinum. Using a surgical approach via lateral cervicotomies and thoracotomy the paragangliomas were extirpated. Our case report demonstrates the rare polytopic manifestation of paragangliomas. This perivascular neoplasms have to be removed before haemodynamic complications develop. The extent of this tumors is clearly illustrated by use of an angiography. Because of the familial predisposition, clinical and radiological examinations of relatives are mandatory.
    Notes: Einleitung: Paragangliome im Bereich des Glomus caroticum sind relativ seltene, stark vaskularisierte Neubildungen, die sich aus den Chemorezeptoren entwickeln. Sie werden in jedem Lebensalter festgestellt, vorzugsweise jedoch im 3. und 4. Lebensjahrzehnt. Paragangliome wachsen sehr langsam und sind in aller Regel gutartig. Die Erkrankung tritt bei einem Teil der Fälle familiär auf, wobei von einem autosomal-dominanten Vererbungsmuster ausgegangen wird. Meist beschränkt sich die Manifestation dieses Gefäß-assoziierten Tumors auf die Jugularregion, in seltenen Fällen ist auch ein polytopes Auftreten festzustellen. Fallbericht: Bei dem von uns vorgestellten Fall eines 47jährigen männlichen Patienten erfolgte die Zuweisung wegen einer progredienten Schwellung im Halsweichgewebe beidseits. Durch computertomografische Diagnostik waren im Bereich der Halsgefäßscheide deutlich kontrastmittelaufnehmende Raumforderungen aufgefallen. Zur histopathologischen Beurteilung wurden Biopsien durchgeführt, wobei intraoperativ ein stark vaskularisierter Tumor zur Darstellung kam. Histologische und immunhistochemische Untersuchungen führten zur Diagnose eines Paraganglioms. Eine zur Beurteilung der Tumorausdehnung durchgeführte Angiografie brachte eine weitere, im Bereich des Glomus pulmonalis lokalisierte, ebenso stark vaskularisierte Raumforderung zur Darstellung. Nach ergänzender kernspintomografischer Untersuchung der betroffenen Regionen erfolgte durch einen kombinierten hals- und thoraxchirurgischen Eingriff eine Exstirpation der Gefäßmißbildungen. Schlußfolgerungen: Unser Fallbericht weist auf die seltene Form des polytopen Auftretens eines Paraganglioms hin. Eine Exstirpation des Tumors sollte vor dem Auftreten hämodynamisch wirksamer Obstruktionen der umschlossenen Gefäße erfolgen. Darüber hinaus ist wegen der familiär gehäuften Manifestation auch eine Untersuchung der Verwandten indiziert.
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  • 3
    ISSN: 1615-6692
    Keywords: Key Words Dilated cardiomyopathy ; Arrhythmia risk stratification ; Sudden death ; Schlüsselwörter Dilatative Kardiomyopathie ; Risikostratifikation für Arrhythmien ; Plötzlicher Herztod
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Marburger Kardiomyopathie-Studie (MACAS) wurde als prospektive Verlaufsbeobachtung konzipiert, um die Wertigkeit der folgenden potentiellen nichtinvasiven Arrhythmieprädiktoren bei über 200 Patienten mit dilatativer Kardiomyopathie (DCM) im Verlauf von fünf Jahren zu untersuchen: Stadium der Herzinsuffizienz nach der Klassifikation der New York Heart Association, linksventrikulärer enddiastolischer Diameter und Ejektionsfraktion, Linksschenkelblock und Vorhofflimmern im EKG, QTc- und JTc-Dispersion, abnormale Time-domain-Analyse und spektrale Turbulenzanalyse des signalgemittelten EKG, ventrikuläre Arrhythmien und Herzfrequenzvariabilität im 24-Stunden-Langzeit-EKG, Baroreflexsensitivität und Mikrovolt-T-Wellen-Alternans unter Belastung. Dieser Bericht beschreibt die Grundlagen von MACAS sowie die klinischen Charakteristika der ersten 236 Patienten, die von März 1996 bis Oktober 1999 eingeschlossen wurden. Die prognostische Bedeutung der potentiellen Arrhythmierisikoprä,diktoren in MACAS wird durch eine multivariate Cox-Analyse nach einem Verlauf von fünf Jahren bestimmt. Primäre Endpunkte sind die Gesamtmortalität und schwerwiegende arrhythmische Ereignisse, definiert als anhaltende Kammertachykardie, Kammerflimmern oder plötzlicher Herztod. Die Ergebnisse von MACAS werden wichtige Erkenntnisse liefern für die Konzeption zukünftiger Studien zur prophylaktischen Defibrillatortherapie bei dilatativer Kardiomyopathie.
    Notes: Abstract The Marburg Cardiomyopathy Study (MACAS) is a prospective observational study designed to determine the value of the following potential non-invasive arrhythmia risk predictors in more than 200 patients with idiopathic dilated cardiomyopathy (IDC) over a 5-year-follow-up period: New York Heart Association functional class, left ventricular end-diastolic diameter and ejection fraction, left bundle branch block and atrial fibrillation on ECG, QTc and JTc-dispersion on 12-lead ECG, abnormal time-domain analysis and spectral turbulence analysis of the signal-averaged ECG, ventricular arrhythmias and heart-rate variability on 24-hour Holter ECG, baroreflex sensitivity, and microvolt T wave alternans during exercise. This report describes the rationale of MACAS as well as the clinical characteristics of the first 236 patients enrolled between March 1996 and October 1999. The prognostic significance of the potential arrhythmia risk predictors in MACAS will be determined by multivariate Cox analysis at the end of 5-year follow-up. Primary endpoints are total mortality and major arrhythmic events defined as sustained ventricular tachycardia, ventricular fibrillation or sudden cardiac death. The results of MACAS will have important implications for the design of future studies evaluating the role of prophylactic defibrillator therapy in idiopathic dilated cardiomyopathy.
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  • 4
    ISSN: 1615-6714
    Keywords: Open bite ; Segmented osteotomy ; Long-term stability ; Cephalometry ; Offener Biß ; Segmentosteotomie ; Langzeitstabilität ; Kephalometrie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Oberkieferosteotomie nach Schuchardt ist aufgrund ihrer engen Indikationsstellung eine eher selten angewandte Operationsmethode. Im Rahmen einer klinischen Nachuntersuchung überprüftenwir mit Hilfe einer kephalometrischen Verlaufsanalyse sowie durch Vergleich der klinischen Befunde das Langzeitergebnis bei 26 Patienten, die nach dieser Methode operiert worden waren. Die Ergebnisse dieser Studie zeigen, daß das Resultat der operativen Korrektur des frontal offenen Bisses weitgehend stabil geblieben ist. In drei Fällen (=11,5%) trat zwar postoperativ ein Teilrezidiv auf, jedoch verblieb gegenüber dem präoperativen Ausgangsbefund eine deutliche funktionelle und ästhetische Verbesserung. Die Oberkieferosteotomie nach Schuchardt ist somit bei richtiger Indikationsstellung ein geeignetes Operationsverfahren zur Korrektur des frontal offenen Bisses.
    Notes: Abstract Upper jaw osteotomy according to Schuchardt is a relatively rarely performed surgical procedure due to its narrow range of indications. Within the framework of a clinical follow-up examination using this method, we studied the long-term results in 26 patients, employing cephalometric analysis and analyzing the clinical findings. The results of this study show that the outcome of the operative correction of anterior open bite remained largely stable. Although partial relapse occurred in 3 cases (=11.5%), there was a significant functional and esthetic improvement in comparison with the preoperative initial findings. When indicated, upper jaw osteotomy according to Schuchardt is thus a suitable surgical technique for correction of anterior open bite.
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  • 5
    ISSN: 1520-5126
    Source: ACS Legacy Archives
    Topics: Chemistry and Pharmacology
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford, UK : Munksgaard International Publishers
    Dental traumatology 21 (2005), S. 0 
    ISSN: 1600-0595
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract –  The hazards of damage to teeth and their periodontal attachment during tracheal intubation are well known. Dental trauma represents the commonest single reason for complaints against anesthesiologists. In order to predict the possible risk of perianesthetic iatrogenic tooth luxation we evaluated the use of a measuring method (Periotest® technique), being well established for the diagnosis of periodontal disease. In 120 patients undergoing elective surgery, we compared the amount of tooth mobility before and after general anesthesia to different scores assessing the difficulty of tracheal intubation. Furthermore, the level of work experience of the intubating anesthetist was compared with the degree of postoperative tooth mobility. Changes of periodontal attachment could not be detected by the Periotest® technique. The Periotest® technique does not seem to have the ability to detect early periodontal changes associated with endotracheal intubation.
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  • 7
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: GRIMM, W., et al.: Reversal of Tachycardia Induced Cardiomyopathy Following Ablation of Repetitive Monomorphic Right Ventricular Outflow Tract Tachycardia. Radiofrequency catheter ablation was performed in four adults with myocardial dysfunction related to repetitive monomorphic ventricular tachycardia (RMVT) originating in the right ventricular outflow tract. Serial echocardiographic assessment of left ventricular function before and after radiofrequency catheter ablation of RMVT showed complete reversal of left ventricular dysfunction without arrhythmia recurrence during 31 ± 28 months follow-up.
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  • 8
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Unnecessary shocks by ICDs for rhythms other than sustained VT or VF have been described as the most frequent adverse event in ICD patients. To avoid unnecessary shocks for self-terminating arrhythmias, the third-generation Jewel PCD defibrillators 7202, 7219, and 7220 Plus use a specially designed VF confirmation algorithm after charge end. The purpose of this study was to determine the ability of this VF confirmation algorithm to recognize nonsustained VT, and to analyze the reasons for failure of the PCD device to abort shock therapy for nonsustained VT despite use of this VF confirmation algorithm. Analysis of stored electrograms of electrical events triggering high voltage capacitor charging in the programmed VF zone of the device showed 36 spontaneous episodes of nonsustained VT (227 ± 21 beats/mm) during 18 ± 7 months follow-up in 15 patients who had a Jewel PCD implanted at our hospital. Intracardiac electrogram recordings and simultaneously retrieved marker channels demonstrated that the ICD shock was appropriately aborted according to the VF confirmation algorithm in 24 (67%) of 36 episodes of nonsustained VT. Twelve episodes (33%) of nonsustained VT, however, were followed by a spontaneous ICD shock in 6 (40%) of the 15 study patients. The only reason for all 12 shocks for nonsustained VT was the inability of the device to recognize the absence of VT after charge end due to shortcomings of the VF confirmation algorithm: 11 of the 12 shocks for nonsustained VT were triggered by the occurrence of paced beats during the VF confirmation period and 1 shock for nonsustained VT was triggered by the occurrence of 2 premature beats after charge end. Thus, better VF confirmation algorithms need to be incorporated in future PCD devices to avoid unnecessary shocks for nonsustained VT.
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  • 9
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Early or localized forms of arrhythmogenic right ventricular dysplasia (ARVD) have been proposed as the arrhythmogenic substrate of repetitive monomorphic ventricular tachycardia (RMVT) originating in the right ventricular outflow tract in patients without any underlying cardiac abnormality on clinical examination and echocardiography. To further examine this hypothesis, magnetic resonance imaging (MRI) and signal-averaged electrocardiography (SAECG) were performed on 23 patients with RMVT and normal 12-lead standard ECG of conducted sinus beats. MRI was performed using ECG-gated turbo spin-echo images of the heart in order to detect signs of early or localized forms of ARVD, such as localized wall thickness reductions, signal intensity increase indicating adipose tissue infiltrates, and regional bulgings or aneurysms. MRI was normal in 22 (96%) of 23 study patients. In the remaining patient (4%), MRI demonstrated signal intensity increase in the intraventricular septum but not in the right ventricular outflow tract. Time-domain analysis of the SAECG was normal in 21 (91 %) of 23 patients and revealed ventricular late potentials in 2 study patients (9%). Frequency-domain analysis of the SAECG was normal in 22 (96%) of 23 patients and revealed ventricular late potentials in one study patient (4 %). We conclude that normal MRI findings of the heart and absence of ventricular late potentials in the SAECC in most patients with RMVT and otherwise normal ECG do not support the hypothesis that early or localized forms of ARVD create the arrhythmogenic substrate in the majority of these patients.
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  • 10
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The influence of the clinical presentation on the long-term outcome in 213 consecutive patients with ICDs, ECG storage capability, and nonthoracotomy leads, was analyzed. Sixty-six patients presented with cardiac arrest (CA), 81 patients with hemodynamically stable VT, and 66 patients with syncope (SY). Patient characteristics were: mean age CA 62, VT 61, SY 61 years; mean ejection fraction CA 31%, VT 29%, SY 30%; coronary artery disease CA 71%, VT 71%, SY 64% (all P 〉 0.05 Fisher's exact test); female gender CA 40%, VT 14%, SY 19% (CA vs VT and SY, P 〈 0.005); inducibility by programmed stimulation CA 50%, VT 84%, SY61 % (VT vs CA and SY, P 〈 0.001, CA vs SY, P 〉 0.05). During a mean follow-up of 14.5 months, 29 patients died; CA 12%, VT 14%, SY 9% (P 〉 0.05). Comparing Kaplan-Meier curves, no difference in the time course of overall mortality was found (log-rank P 〉 0.05). In the CA, VT, and SY groups, 543, 1,630, and 189 ICD therapies (including antitachycardia pacing, low energy cardioversion, and defibrillation) were observed, respectively. Actuarial analysis showed a shorter interval between implantation and first ICD therapy for VT versus CA and SY (log-rank P 〈 0.005). Patients presenting with VT experienced earlier and more frequent ICD therapies than patients with CA or SY independent of age, ejection fraction, and heart disease. No difference in overall mortality and time course of fatal events was observed among the three groups.
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