[Indications for the surgical treatment of midfacial fractures in children]

A study of midfacial fractures in 28 children under 16 years of age treated at the Medical School Essen is reported. All children underwent surgical treatment. 18 patients with fractures of the zygomatic complex were treated by open reduction and miniplate osteosynthesis. 10 patients with blowout fractures were treated with "Lyodura"-implants. To prevent persistent diplopia an early surgical treatment is recommended. An adverse effect on the growth of facial bones has not been seen.

Morphological alterations of Xenopus oocytes induced by valine-14 p21rho depend on isoprenylation and are inhibited by Clostridium botulinum C3 ADP-ribosyltransferase

Microinjection of the constitutively active recombinant Val-14 p21rho A into Xenopus oocytes induced dramatic morphological changes with redistribution of pigments from the animal pole resulting in spotted oocytes. The effects induced by Val-14 p21rho A were regulated by progesterone in a dose-dependent manner whereas prior ADP-ribosylation of the rho protein blocked its activity. About 30 min after microinjection, p21 rho was associated with the plasma membrane. The membrane association of p21rho and its biological activity were inhibited by lovastatin, an inhibitor of the 3-hydroxy-3-methylglutaryl coenzyme A reductase. The findings suggest that membrane attachment and biological activity of p21rho depend on isoprenylation of the GTP-binding protein.

[The question of midface growth inhibition following retinoblastoma treatment in early childhood]

99 patients treated for bilateral retinoblastomas in the University Hospital of Essen between 1965 and 1983 were followed up for midface growth inhibition for an average period of 15 1/2 years. Depending on the type of treatment employed the patients were divided into four groups: Local tumor treatment using cryotherapy or laser techniques, ophthalmectomy alone, radiotherapy alone, and combined ophthalmectomy and radiotherapy. Statistically significant differences between the treatment groups were found regarding such symptoms as hypoplasia of the zygomatic bone, hypoplasia of the transversal orbit, hypoplasia of the temporal fossa, hypoplasia of the root of the nose as well as hypotelorism and enophthalmos. Combined surgery and radiotherapy caused the most severe growth disorders, followed by radiotherapy alone and ophthalmectomy alone. With local treatment detectable growth disorders were observed, if at all, only as a result of contralateral radiation scatter. Orthovoltage radiotherapy was found to produce growth disorders of significantly higher severity than megavoltage radiotherapy.

[Preoperative radio-chemotherapy and radical surgery for advanced carcinomas of the oral cavity. 4-year results of a prospective therapy study with DOSAK]

Based on the postoperative data evaluated in September 1989, the results of a regional prospective treatment study conducted by the DOSAK on preoperative radio-chemotherapy and radical surgery for carcinomas of the oral cavity and the oropharynx are presented. In the univariate analysis the histologic lymph node findings after pretreatment, the histologic grading, and the TPI correlated well with the survival rates. The multivariate analysis confirmed that the histologic demonstration of vital tumor cells in the neck lymph nodes after the end of pretreatment is of grat prognostic relevance. The histologic degree of differentiation, the demonstration of vital tumor cells in the primary tumor area after pretreatment and the length of time between radiotherapy and surgery were of secondary importance.

[Clinical features and treatment of cutaneous carcinoid]

An exemplary case of a 67-year-old patient with multiple cutaneous metastases of a pulmonary carcinoid primary tumor is presented. The cardinal symptom was severe painfulness of the skin tumors. With chemotherapy the tumor disease advanced. In presenting this case and providing a review of the literature, the primary importance of surgery even in the case of a metastasizing carcinoid is emphasized.

[Inverted papilloma: implications for the oral and maxillofacial surgeon]

7 patients with inverted papillomas of the maxillofacial area were subjected to a post-treatment evaluation. Inverted papillomas were found in maxillary and frontal sinuses, ethmoid cells, nasal septa and as isolated lesions in the mucosa of the mandibular alveolar process. Apart from an inverted papilloma, one patient also had a mucoepidermoid carcinoma. The tendency to recur correlated well with the surgical approach. Radical removal of the mucosa must be called for as primary therapy in the paranasal sinus area. In order to safely exclude a concurrent carcinoma, the entire resected material must be examined histologically.

[Taurodontism in patients with sex chromosome anomalies]

Out of a population of 61 patients with sex chromosome aberrations we could examine 25 patients with Klinefelter's syndrome and one female patient with triple X syndrome for taurodontism. Taurodontic molars were found in 6 out of 25 patients with Klinefelter's syndrome and in the patient with triple X syndrome.

Microinjection of alpha-toxin from Clostridium novyi type A promotes meiotic maturation in Xenopus laevis oocytes

Microinjection of purified alpha-toxin into Xenopus laevis oocytes induced meiotic maturation provided insulin was present in the medium. Induction of maturation as indicated by breakdown of the germinal vesicle depended on the amount of intracellular alpha-toxin (with a detection limit of 2 ng/oocyte) and on the concentration of insulin. The hormone concentrations used were inactive when given alone and so was alpha-toxin (1 micrograms/ml) applied from the outside. The results demonstrate an intracellular target for alpha-toxin whereas an extracellular target is apparently lacking in oocytes.

[Preoperative irradiation, cisplatin sensitization and radical surgery of primarily operable carcinomas of the oral cavity. Results of a prospective DOSAK treatment study]

165 patients with carcinomas of the oral cavity or oropharynx, clinically appearing operable, were treated between 1985 and 1987 within the framework of a prospective multicenter study. The treatment concept consisted in preoperative irradiation with 32 Gy, cisplatin sensitization with 5 X 20 mg per m2 body surface area and subsequent radical removal of the primary tumor and the regional cervical lymph nodes. Regarding recurrence and survival rates the patient data were analyzed using one- and multi-dimensional statistical methods. The observed survival rates were compared with those assessed with the aid of the treatment-dependent prognosis index TPI (Platz et al. 1982). After 1 years the survival rates under the selected combination therapy were 12% and after 2 years 19% above the assessed survival rates under radical surgery alone.

The surgical approach to orbital space-occupying lesions

From January 1985 to April 1987, 60 patients with orbital space-occupying lesions were treated surgically. Orientation and spatial localization of the lesion had already been achieved preoperatively by means of imaging methods. The decision on whether to use a neurosurgical transcranial, or a facial surgical approach, was made on this basis. The less elaborate procedure in each case was given preference to obtain a representative tissue sample. The definitive planning of the operation was then carried out with knowledge of the histology: a transcranial operation alone or as an additional measure was only necessary in six patients. Either definitive tumour therapy could be performed with or without temporal osteotomy in the remaining 54 patients exclusively via an anterior orbitotomy, or further oncological treatment was commenced after histological verification of the diagnosis.

[Granular cell tumor of the orbit]

The authors report on the rare case of the intraorbital localisation of a granular cell tumour. Nature, histogenesis and biological behaviour of this lesion are discussed. The therapeutical consequences are presented.

Choice of surgical approach in orbital space occupations--an interdisciplinary problem

During the last two and a half years 60 patients with orbital space occupying neoplasms were treated surgically at the Department of Maxillo-facial Surgery of the University Clinic of Essen. With modern imaging techniques exact information on the location and extent of space occupation was available before the operation. Therefore the surgical approach could be optimized. Despite the various and sometimes inaccessible tumor locations, transcranial operation was only necessary in six patients. In the remaining 54 patients anterior orbitotomy allowed either a definitive tumor therapy or histological verification of the diagnosis.

[Arthropathy as an early symptom of hemochromatosis. Overview of the literature and 7 case reports]

In seven patients with hemochromatosis, arthropathy was an early symptom, or first clinical symptom, of the hemochromatosis. In all seven patients, serum iron, transferrin saturation, and parameters of storage iron (serum ferritin, Desferal-test) were clearly elevated. In 5 patients hemochromatosis was associated with the HLA loci A3 and B7. Bone scan proved a sensitive detection method for hemochromatosis arthropathy. In one case joint involvement was detected by bone scan prior to clinical symptoms. Parameters of iron metabolism correlated well with other organ manifestations of hemochromatosis. In contrast, joint involvement did not correlate with parameters of iron metabolism or severity of hemosiderosis of other organs, and was not relieved by phlebotomy. These 7 cases confirm that joint symptoms can be an early or leading symptom of hemochromatosis, can lead to early therapy and thereby prevent major organ damage. It remains undecided, however, whether the arthropathy is a consequence of iron storage or an independent disease which is genetically associated with hemochromatosis.

Pharmacokinetics of Metronidazole in pregnant women

Pharmacokinetic characteristics of metronidazole were studied in 19 pregnant women with Trichomoniasis urogenitalis who had been hospitalized for legal abortion. All patients received 250 mg or 1.0 g metronidazole (Vagimid) per os in a single or multiple dose. Peak levels were reached 1-2 h after application. Mean serum levels of metronidazole were somewhat lower in gravidae than those in nonpregnant women. The mean elimination half-life values were 5.7 and 7.7 h after intake of 250 mg and 1.0 g metronidazole, respectively. As suggested by our pharmacokinetic results, the dosage regimen for treatment of anaerobic bacteria infection or parasitic infection in pregnant women can be the same as in nonpregnant patients.

Diazepam treatment of socially isolated monkeys

Four rhesus monkeys were reared for the first eight months of life in total social isolation. One animal died during this period; the three remaining subjects were treated with diazepam in an isolation chamber, in their home cages, and in a playroom testing situation. Diazepam significantly decreased the self-disturbance behaviors of two subjects, and there was even the appearance of some social behaviors, although they were limited and not of the same quality as in nonisolated subjects. The authors discuss the implications of the data for understanding the significance of the social isolation syndrome in monkeys as a model for human psychoses.