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  • 1
    Electronic Resource
    Electronic Resource
    Allergische Granulomatose mit Angiitis (atypisches Churg-Strauss-Syndrom) – seltene Differentialdiagnose großer mediastinaler Raumforderungen (1999)
    Springer
    Zeitschrift für Herz-, Thorax- und Gefässchirurgie 13 (1999), S. 83-88 
    Details
    ISSN: 0930-9225
    Keywords: Schlüsselwörter Mediastinaltumor ; atypisches Churg-Strauss-Syndrom ; allergische Granulomatose ; Key words Mediastinal tumor ; allergic granulomatosis ; atypical Churg-Strauss syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary We present a case of a young man with an extensive mediastinal tumor and the unexpected histopathological diagnosis of allergic granulomatosis and angiitis (AGA, Churg-Strauss-syndrome). A 24-year old man was admitted to our hospital due to a massive mediastinal tumor which was already infiltrating the middle and the upper lobe of the right lung, the thymus, and the pericardial sac. The most likely diagnosis at CT was thymus carcinoma. For that diagnosis the en-bloc resection of the thymus and the middle lobe was performed and completed by a mediastinal lymphadenectomy. Parts of the upper lobe of the right lung and a 15×10cm part of the pericardial sac needed to be resected as well.  The definitive histopathological result did not confirm a malignant process. After extensive immunhistochemical and molecular pathological investigations the most likely diagnosis was allergic granulomatosis associated with angiitis. Further investigations led to the diagnosis of an atypical Churg-Strauss syndrome. The problems with the clinical, histological, and immunhistochemical diagnosis are discussed and the rare conditions of the disease represented.
    Notes: Zusammenfassung In der vorliegenden Kasuistik wird über eine ausgedehnte mediastinale Raumforderung berichtet, als deren Ursache sich eine allergische Granulomatose mit Angiitis (Churg-Strauss) herausstellte.  Ein 24-jähriger Mann wurde wegen einer großen mediastinalen Raumforderung mit Infiltration von Mittellappen, rechtem Lungenoberlappen, Thymus und Perikard operiert. Nach CT-Kriterien war ein Thymuskarzinom am wahrscheinlichsten. Es wurde deshalb die en-bloc-Resektion von Thymus, Mittellappen, Teilen des rechten Lungenoberlappens, einem ca. 15×10cm großem Perkardanteil und der mediastinalen Lymphknoten ausgeführt.  Das definitive histologische Ergebnis konnte nach immunhistochemischen und molekularpathologischen Untersuchungen einen malignen Prozeß jedoch ausschließen, als endgültige histologische Diagnose fand sich eine allergische Granulomatose mit Angiitis. Nach umfangreicher Differentialdiagnostik wurde die Erkrankung als atypisches Churg-Strauss-Syndrom klassifiziert.  Die schwierige klinische, histologische und laborchemische Differentialdiagnose und die Spezifität des vorgestellten Krankheitsbildes werden dargestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003980050062
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  • 2
    Electronic Resource
    Electronic Resource
    Investigations on the performance of multiquantum barriers in short wavelength (630 nm) AlGaInP laser diodes (1999)
    Woodbury, NY : American Institute of Physics (AIP)
    Applied Physics Letters 74 (1999), S. 2158-2160 
    Details
    ISSN: 1077-3118
    Source: AIP Digital Archive
    Topics: Physics
    Notes: Al0.5In0.5P/Ga0.5In0.5P superlattice structures have been investigated as multiquantum barriers (MQB) in 630 nm band laser diodes in order to reduce thermal current losses. By inserting an optimized MQB, we have succeeded in improving both threshold currents and characteristic temperatures of such devices. However, the optimized dimensions of the MQB found experimentally deviated strongly from those predicted theoretically, indicating that the commonly used theoretical description assuming effective mass approximation, electron wave interference, and using transfer matrix calculation is not adequate. © 1999 American Institute of Physics.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1063/1.123786
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  • 3
    Electronic Resource
    Electronic Resource
    The relationship between auditory threshold and evoked otoacoustic emissions (1999)
    Springer
    European archives of oto-rhino-laryngology and head & neck 256 (1999), S. 177-188 
    Details
    ISSN: 1434-4726
    Keywords: Key words Otoacoustic emissions ; Distortion product ; emissions ; Hearing loss ; Audiometric configurations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to compare transiently evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emissions (DPOAE) in normal hearing ears (n = 44) and ears with cochlear hearing loss (HL) to obtain defined data on qualitative and quantitative correlations. In addition, we wanted to determine the reliability with which a clinical examiner could predict a typical, idealized audiometric configuration from TEOAE measurements. In the hearing-impaired subjects (n = 149), a 50% reduction of OAE incidence was caused by a mean HL of 10.5 dB for TEOAE compared to 27 dB SPL for DPOAE. A 90% incidence reduction was found at a mean threshold elevation of 33 dB for TEOAE and 51 dB for DPOAE. Correlation between TEOAE amplitudes and HL was in general rather low (r = –0.1 to –0.5), while DPOAE amplitudes showed a slightly better correlation with HL (r = –0.3 to –0.6). In general, efforts to derive an audiogram from evoked OAE have been more promising for DPOAE than for TEOAE. However, our studies showed that approximately 40% of the ears with HL could be categorized correctly into one of five typical audiometric patterns from TEOAE measurements. Additionally, a cochlear HL in or near the medium frequency range was much more likely to cause a reduction in TEOAE than an isolated low- or high-frequency lesion. Accordingly, TEOAE were often preserved in ears with isolated HL in the high or low frequencies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050136
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  • 4
    Electronic Resource
    Electronic Resource
    Confocal Laser Scanning Microscopy: A Nondestructive Subsurface Histotomography of Healthy Human Bone (1999)
    Springer
    Calcified tissue international 65 (1999), S. 8-10 
    Details
    ISSN: 1432-0827
    Keywords: Key words: Microscopy — Confocal methods — Bone — Human — Osteocytes.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine , Physics
    Notes: Abstract. Microscopy of bony tissue usually requires special treatment for decalcification and processing of thin sections. Confocal laser scanning microscopy (CLSM) allows the nondestructive histotomography of organic hard tissue. The aim of this study was to visualize healthy human bone structures and to correlate identical areas in CLSM and conventional light microscopy. Each sample of healthy human lower jaw (n = 20) was divided into three parts: (1) fresh, untreated bony blocks studied by CLSM; (2) MMA-embedded thin sections (without decalcification), HE stained and studied by CLSM and conventional light microscopy (correlation of identical areas); (3) decalcificated, HE stained, histological sections studied by conventional light microscopy. In untreated bony blocks, microstructures such as osteocytes and lamellae were identified by CLSM. These structures could be correlated with conventional light microscopy. In CLSM, subcellular structures cannot yet be interpreted, whereas cytoplastic processes of osteocytes were seen with high contrast. With CLSM, nondestructive histology of cortical bone can be obtained. The risk of artifacts due to pretreatment is minimized, and subsurface visualization does not affect the interpretation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002239900650
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  • 5
    Electronic Resource
    Electronic Resource
    Force measurements on hydrophobized silica surfaces by using AFM (1999)
    Springer
    Fresenius' journal of analytical chemistry 363 (1999), S. 206-208 
    Details
    ISSN: 1432-1130
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Force measurements between SiO2 surfaces with and without adsorbed phenyl groups in aqueous media using the atomic force microscope (AFM) are compared. An oxidized silicon tip and an oxidized silicon wafer were hydrophobized with phenyl groups, and the long-range attraction induced by hydrophobation is shown in force vs. distance curves. The observed differences prove that the silanol groups of the unmodified SiO2 surface are replaced by the phenyl groups.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002160051173
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  • 6
    Electronic Resource
    Electronic Resource
    Vulvar carcinoma: a retrospective analysis of 80 patients (1999)
    Springer
    Archives of gynecology and obstetrics 262 (1999), S. 99-104 
    Details
    ISSN: 1432-0711
    Keywords: Key words: Vulvar carcinoma ; Retrospective analysis ; Outcome ; The role of radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We evaluated the files of 80 women who were treated for vulvar carcinoma. In 13 women radiotherapy was used as primary treatment, in 45 cases postoperatively and in 22 women because of local recurrence. Patients older than 60 years had a significantly worse 5-year survival rate (39%) than younger women (57%) (p=0.02). The 5-year survival rate for patients with negative nodes was 72% versus 46% for the N1- and 47% for the N2-status, respectively (p=0.027). The 5-year actuarial survival rate for patients with tumor manifestation in the clitoris was 77.9% versus 26.1% for patients with tumors in the labia majora (p=0.0044). There was no difference in survival in patients who had been treated with radical vulvectomy and bilateral groin dissection plus local radiotherapy when compared with patients who had been irradiated (whole pelvis) after tumor resection alone. The 5-year survival rates and the median survival time were identical in both groups (61%/62 months).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004040050236
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  • 7
    Electronic Resource
    Electronic Resource
    Veränderungen des nasalen Atemwegs durch transversale Distraktion des Oberkiefers (1999)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 3 (1999), S. 12-16 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Gaumennahterweiterung ; Distraktionsosteogenese ; Osteotomie ; Atemwegsdiagnostik ; Reflexionsakustische Meßverfahren ; Key words Rapid palatal expansion ; Acoustic impedance tests ; Distraction osteogenesis ; Airway diagnosis ; Maxillary surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Objective: To investigate nasal airway changes through transverse maxillary distraction osteogenesis by means of an objective, reliable, non-invasive investigation technique with special attention to nasal valve changes and widening of the posterior maxilla. Patients and intervention: Eight patients with a severe maxillary transversal deficit underwent surgically assisted rapid palatal expansion in local or general anesthesia. Before and after the distraction process, a transnasal series of acoustic measurements of nasal airway profile was performed under topical decongestion. Nasal volume was calculated by integration of the area profile. The cross-sectional area of the nasal valve was also determined. Results: A significant enlargement of nasal volume was recorded in all patients (P 〈 0.01: Wilcoxon signed rank test). The average increase measured 5 cm3 (23%). The increase in volume was recorded in all parts of the nasal cavity, indicating complete maxillary expansion even in the posterior segment. The nasal valve area raised from 0.56 to 0.70 cm2 (P 〈 0.01). Six out of eight patients reported striking improvement of nasal patency after maxillary distraction. Conclusion: Besides correction of the maxillary arch deformity, rapid palatal expansion contributes to improved nasal patency by resolving nasal valve constriction. Significant widening of the posterior nasal cavity was achieved, indicating a translational pattern of maxillary movement, although the pterygomaxillary junction was not touched in the osteotomy.
    Notes: Fragestellung: In dieser Untersuchung sollten die Auswirkungen der transversalen Distraktion des Oberkiefers auf den nasalen Atemweg durch ein nichtinvasives Untersuchungsverfahren beschrieben werden. Es wird damit untersucht, ob die chirurgische Gaumennahterweiterung eine Weitung auch der posterioren Oberkieferbasis erreicht und durch Vergrößerung des Nasenklappenquerschnitts eine Normalisierung der nasalen Ventilation gelingen kann. Material und Methode: Bei 8 Patienten mit hochgradigem Schmalkiefer wurde eine transversale Distraktion des Oberkiefers vorgenommen. Vor der Osteotomie und nach Abschluß der Distraktion wurde das Querschnittprofil des nasalen Atemwegs unter lokaler Schleimhautabschwellung reflexionsakustisch bestimmt. Nasenvolumina und Querschnittsfläche der Nasenklappe wurden berechnet. Ergebnisse: Bei sämtlichen Patienten konnte eine signifikante Zunahme des Nasenvolumens nachgewiesen werden (p 〈 0,01: Wilcoxon-Paardifferenzentest), im Mittel vergrößerte sich das Nasenvolumen um 5 cm 3 . Die Weitung betraf gleichermaßen den vorderen, den mittleren und den hinteren Nasenabschnitt. Der Querschnitt der Nasenklappe vergrößerte sich signifikant (p 〈 0,01) von 0,56 cm 2 auf 0,7 cm 2 . 6 von 8 Patienten berichteten über eine deutliche subjektive Verbesserung der Nasenatmung. Schlußfolgerung: Neben der Weitung des Zahnbogens schafft die chirurgisch unterstütze Gaumennahterweiterung anatomische Voraussetzungen zur Verbesserung der Nasenatmung am ehesten durch eine Erweiterung der Nasenklappe. Auch ohne Osteotomie der Sutura pterygomaxillaris kann eine signifikante Vergrößerung des posterioren Nasenvolumens erreicht werden. Daher ist eine Translationskomponente des Segmenttransports anzunehmen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100060050085
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  • 8
    Electronic Resource
    Electronic Resource
    Mikromorphologische Kieferveränderungen nach Bestrahlung (1999)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 3 (1999), S. 140-145 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Konfokale Laser-Scanning-Mikroskopie ; Dunkelfeldmikroskopie ; Bisbenzimidmarkierung ; Knochen ; Strahlenfolgen ; Radiogener Osteozytentod ; Key words Confocal laser scanning microscopy ; Microscopy ; Bisbenzimide labelling ; Bone ; Radiation effects ; Osteocytes ; Osteoradionecrosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Early radiation effects on human bone may lead to osteoradionecrosis (ORN). Direct bone cellular lesions [28] as well as fibrous degeneration of blood vessels [21] are considered to be pathologically relevant. Only few data on initial subclinical radiation effects are available. Patients were grouped according to the dose of radiation and clinical findings. Group 1: sound human bone of lower jaw, mostly collected during orthodontic surgery (n = 10 patients); group 2: specimens of lower jaw from patients with ORN (n = 12 patients); group 3: specimens of lower jaw from patients with head and neck cancer who were preoperatively treated with 36 Gy radiation; group 4: specimens of lower jaw from patients with head and neck cancer (n = 9) who were treated with 60–70 Gy radiation. Specimens were studied by confocal laser scanning microscopy (CLSM), by conventional light microscopy (DL) and by flourescence darkfield microscopy (DFM) after bisbenzimide staining (H 33258) of the viable cellular nuclei. For the correlating study of identical areas in CLSM and DL the specimens were prepared according to the sawing and grinding technique [8]. All the radiated bony specimens, regardless of the dose of radiation, showed areas of extensive or total loss of vitality of the osteocytes. This finding was also evident after 36 Gy and a short interval between radiation and sample collection (group 3). Additionally, in CLSM micromorphologic lesions of the lamellate structure were seen. With these results we can confirm the loss of vitality of the osteocytes as an initial radiation effect as described earlier [10, 23, 28]. In addition to these findings, alteration of the lamellate microstructure was found in the early phase after radiation. The functional and mechanical significance of these findings should be the subject of further studies.
    Notes: Für die infizierte Osteoradionekrose (IORN) des Kiefers werden unterschiedliche pathogenetische Mechanismen initialer Strahlenfolgen im Knochen diskutiert: Wichtige Parameter sind dabei die direkte Zellschädigung der Osteozyten [28] und die Gefäßfibrosierung [21]. Bislang liegen wenige Kenntnisse zum Ausmaß der initialen, subklinischen Veränderungen vor. 4 Probengruppen wurden anhand verschiedener Patientenkollektive definiert: Gruppe 1: gesunde Unterkieferproben meist von orthodontischen Operationen (n = 10 Patienten); Gruppe 2: Unterkieferproben mit manifester IORN (n = 12 Patienten); Grruppe 3: Unterkieferproben nach 36 Gy präoperativer Radio(chemo)therapie (n = 9 Patienten); Gruppe 4: Unterkieferproben nach 60–70 Gy Bestrahlung ohne Hinweise auf IORN (n = 9 Patienten). Alle Proben wurden histotomographisch mit konfokaler Laser-Scanning-Mikroskopie (CLSM), durchlichtmikroskopisch (DL) und dunkelfeldmikroskopisch (DFM) nach Fluoreszenzmarkierung des intakten Zellkerns (Bisbenzimid H 33258) untersucht. Korrelierende Histologien identischer Probenareale erfolgten an Trenndünnschliffen [8]. Als Ergebnisse wurden gefunden: 1. Alle unterschiedlich bestrahlte Knochenproben zeigten Areale mit weitgehendem bis vollständigem Verlust vitaler Osteozyten. Diese Strahlenfolge trat auch schon nach 36 Gy und kurzem Intervall bis zur Operation (Gruppe 3) auf. 2. Im CLSM zeigten sich zusätzlich mikromorphologische Veränderungen der lamellären Struktur, die zwischen den Probengruppen progredient waren. Hieraus können folgende Schlußfolgerungen gezogen werden: 1. Der vorbeschriebene Vitalitätsverlust der Osteozyten [10, 23, 28] konnte als sehr frühe, initiale, radiogene Läsion bestätigt werden. 2. Zusätzlich zeigten sich Veränderungen der lamellären Mikroarchitektur des Knochens als frühe und im Gruppenvergleich progrediente Strahlenläsion. Die mikromechanisch funktionelle Bedeutung dieser Veränderung muß in weiterführenden Untersuchungen eruiert werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100060050118
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  • 9
    Electronic Resource
    Electronic Resource
    Prognose und Prognosefaktoren enossaler Implantate im bestrahlten Kiefer (1999)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 3 (1999), S. S117 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Kaufunktionelle Rehabilitation ; Enossale Implantate ; Strahlentherapie ; Prognosefaktoren ; Kaplan-Meier-Analyse ; Key words Rehabilitation of masticatory function ; Enossal implants ; Radiotherapy ; Factors affecting prognosis ; Kaplan-Meier Analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In comparison to tumor patients not receiving radiotherapy, the rehabilitation of masticatory function after head and neck irradiation is limited due to radiation-induced caries, radioxerostomia, and the risk of osteoradionecrosis. This study focused on implants in the irradiated jaw and on the evaluation of the prognosis and the effect of potential factors on the prognosis. The retrospective study covered 197 implants (47 patients) from 1988 to 1997. The implant prognosis was determined by implant survival statistics (Kaplan-Meier). Losses not related to the implants were censored. In addition, groups were formed according to factors potentially affecting the prognosis. The significance of differences in the groups relative to survival were tested using the log-rank test. Twelve (6.1%) implants from a total of 197 were lost due to peri-implantitis, and eight (4.1%) due to possible biomechanical stress. A total of 52 losses (26.4%) due to death of patients and two (1.0%) due to resection of the jaw were censored; 111 (56.3%) implants remained at recall and the average interval was 33 months. The rates of implant survival (Kaplan-Meier) after 1 and 2 years were 95%, after 3 and 4 years 92%, and after 5 and 6 years 72%. The univariate analysis of group comparisons showed a significantly lower rate of loss after perimplant flap reconstruction (p = 0.036). There was no effect due to the doses of irradiation (p = 0.16), chemotherapy (p = 0.90), or peri-implant osteoplasty (p = 0.84). Although none of the implants inserted before radiotherapy had to be explanted, the implant survival difference in the very heterogeneous groups was not significant (preirradiation, n = 29; postirradiation: n = 156; p = 0.13). According to the literature, the rate of survival of teeth which were sound before radiotherapy (1 year, 75%; 5 years, 45%) was distinctly lower than the survival of enossal implants (1 year, 95%; 5 years, 72%). The high-quality rehabilitation of masticatory function with implant-based protheses is the preferred method of treatment for irradiated tumor patients. In addition, contraindications for enossal implants were ruled out for all studied factors affecting prognosis.
    Notes: Zusammenfassung Einleitung: Die kaufunktionelle Wiederherstellung nach Kopf-Hals-Bestrahlung ist gegenüber anderen Tumorpatienten durch Strahlenkaries, Radioxerostomie und Osteoradionekroserisiko zusätzlich limitiert. Es wurde der Frage der Implantatprognose und potentieller Prognosefaktoren im bestrahlten Kiefer nachgegangen. Material und Methode: Die retrospektive Studie erfaßte von 1988–1997 197 Implantate (47 Patienten). Die Implantatprognose wurde durch Überlebenszeitanalyse (Kaplan-Meier) bestimmt, wobei implantatunabhängige Verluste zensiert wurden. Außerdem erfolgte eine Gruppenbildung nach potentiell die Prognose beeinflussenden Parametern. Grupppenunterschiede in den Überlebensraten wurden mit dem Log-Rank-Test auf Signifikanz geprüft. Ergebnisse: Von 197 Implantaten gingen 12 (6,1%) durch Periimplantitis und 8 (4,1%) durch mögliche biomechanische Überlastung verloren. Zensiert wurden 52 Verluste (26,4%) wegen Versterbens und 2 (1,0%) wegen Kieferresektion. 111 Implantate (56,3%) verblieben im Recall; die gemittelte Nachkontrollphase betrug 33 Monate. Die Überlebensrate (Kaplan-Meier-Analyse) betrug nach 1 und 2 Jahren 95%, nach 3 und 4 Jahren 92% und nach 5 und 6 Jahren 72%. Die univariate Analyse der Gruppenvergleiche zeigte eine lokal signifikant niedrigere Verlustrate nach periimplantärer Weichteilplastik (p = 0,036). Bestrahlungsdosis (p = 0,16), Chemotherapie (p = 0,9) und periimplantäre Osteoplastik (p = 0,84) beeinflußten die Prognose nicht. Obwohl kein vor der Bestrahlung gesetztes Implantat explantiert wurde, war der Unterschied bei sehr inhomogenen Gruppenstärken (prä radiationem: n = 29; post radiationem: n = 156) nicht signifikant (p = 0,13). Schlußfolgerungen: Im Literaturvergleich ist die Überlebensrate prae radiationem gesunder Zähne (1 Jahr: 75%; 5 Jahre: 45%) deutlich schlechter als die Prognose enossaler Implantate (1 Jahr: 95%; 5 Jahre: 72%). Die funktionell hochwertige Restitutio des Kauorgans durch implantatgetragenen Zahnersatz ist damit auch für bestrahlte Tumorpatienten bestätigt. Eine Kontraindikation enossaler Implantation konnte daneben für alle untersuchten zusätzlichen Prognosefaktoren ausgeschlossen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014497
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  • 10
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    Electronic Resource
    Vergleichende Untersuchungen von Brånemark-Implantaten im bestrahlten und nicht bestrahlten Unterkiefer (1999)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 3 (1999), S. S125 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Enossale Implantate ; Mundhöhlenkarzinom ; Implantologische Rehabilitation ; Strahlentherapie ; Key words Dental implants ; Oral and oropharyngeal carcinoma ; Implant-supported prosthodontic rehabilitation ; Radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A comparative study was carried out of 276 Brånemark fixtures in the irradiated and nonirradiated anterior mandible with a mean follow-up period of 58.2 months. Postoperative radiotherapy with 60 Gy and 100% isodose for the anterior mandible using a 6-MV linear accelerator, conventional fractioning, and a split-course technique was administered in the irradiated patient group. HBO therapy was not applied. A statistical difference in the 5-year success rate between the irradiated and nonirradiated group was not found. Nevertheless, a significantly higher rate of perioperative soft tissue complications at implant insertion was seen in the irradiated group. The statistical analysis showed no significance for sex, interval between radiation and implant insertion (with a minimun of 10 months), or type of periimplant soft tissue (regional vs. flap). The prognosis for implants in the irradiated mandible was, however, statistically improved (n = 0.0035) when the healing period was longer than 4 months. Mobile periimplant soft tissue proved to be the main problem regardless of radiation load. Late complications have not been observed so far. The available results and clinical studies support a positive assessment of the regenerative potential of the irradiated mandible with regard to osteointegration of endosseous implants. A preceding radiotherapy up to 60 Gy should therefore not be considered as a contraindication for an implant/prosthetic rehabilitation.
    Notes: Zusammenfassung Die vergleichende Untersuchung bezieht sich auf 276 Brånemark-Fixturen im bestrahlten und nicht bestrahlten originären anterioren Unterkiefer bei einer mittleren Verweildauer von 58,2 Monaten. Bei den bestrahlten Patienten war eine postoperative Radiotherapie mit 60 Gy mit einer 100%-Isodose für den anterioren Unterkiefer unter Verwendung eines Linearbeschleunigers (6 MV) bei konventioneller Fraktionierung und Split-course-Technik erfolgt. Eine begleitende Therapie mit hyperbarem Sauerstoff hatte nicht stattgefunden. Eine statistische Differenz für die 5-Jahres-Erfolgsrate zwischen der bestrahlten und nicht bestrahlten Gruppe war nicht nachweisbar. Dennoch zeigte sich für den strahlenbelasteten Unterkiefer eine deutlich höhere Rate an perioperativen Weichteilkomplikationen bei der Implantatinsertion. Die univariate Analyse wies keine Signifikanz für das Geschlecht, das Intervall zwischen Bestrahlung und Implantation (bei einem Mindestintervall von 10 Monaten) sowie die Art des periimplantaren Weichgewebes (ortsständig vs. Lappenersatz) nach. Die Prognose der Implantate im bestrahlten Unterkiefer war jedoch bei Verlängerung der Einheilphase über 4 Monate hinaus statistisch günstiger (p = 0,0035). Als vorrangiges Problem ohne Bezug zu einer etwaigen Strahlenbelastung erwies sich das mobile periimplantäre Weichteillager. Spätkomplikationen sind bislang nicht aufgetreten. Die vorliegenden Ergebnisse und klinischen Studien geben Veranlassung zu einer positiven Einschätzung des regenerativen Potentials des bestrahlten Unterkiefers hinsichtlich einer Osseointegration enossaler Implantate. Eine vorangehende Strahlentherapie bis 60 Gy kann daher nicht mehr als absolute Kontraindikation für eine implantologisch-prothetische Rehabilitation gelten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014498
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