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Epilepsy and mental retardation are known to be associated with pathogenic mutations in a broad range of genes that are expressed in the brain and have a role in neurodevelopment. Here, we report on a family with three affected individuals whose clinical symptoms closely resemble a neurodevelopmental disorder. Whole-exome sequencing identified a homozygous stop-gain mutation, p.Gln19*, in the BATF2 gene in the patients. The BATF2 transcription factor is predominantly expressed in macrophages and monocytes and has been reported to modulate AP-1 transcription factor-mediated pro-inflammatory responses. Transcriptome analysis showed altered base-level expression of interferon-stimulated genes in the patients’ blood, typical for type I interferonopathies. Peripheral blood mononuclear cells from all three patients demonstrated elevated responses to innate immune stimuli, which could be reproduced in CRISPR–Cas9-generated BATF2−/− human monocytic cell lines. BATF2 is, therefore, a novel disease-associated gene candidate for severe epilepsy and mental retardation related to dysregulation of immune responses, which underscores the relevance of neuroinflammation for epilepsy.

The corrosion inhibition effect of the following organic additives: 2-butin-1,4-diol (BD), N,N′-dimethylthiourea (DMTU), N,N′-diethylthiourea (DETU) and N,N′-diisopropylthiourea (DITU), in steel pickling baths (sulphuric acid solutions) was studied by means of weight loss and electrochemical measurements like open circuit potential (OCP), polarization curves and impedance spectroscopy (EIS). A significant decrease in the corrosion rate was observed in presence of the investigated compounds depending on the nature and the concentration of the additives. The weight loss experiments show an inhibitory efficiency that reaches values beyond 98 %. The protective effect increases with the enlargement of the lateral chain size in the case of the thioureas. The electrochemical experiments show also a protective effect of the organic additives against corrosion. Their adsorptive behaviour is found to follow the Langmuir model.

Contains fulltext : 50576.pdf (Publisher’s version ) (Closed access) BACKGROUND: Mucosal dendritic cells (DC) play a crucial role in tolerance induction as seen in mucosal immunotherapy of atopic diseases. Nevertheless little is known about the phenotypical differences of oral and nasal mucosal DC (nmDC). Recently, we could show that oral mucosal myeloid CD1a(+) DC (omDC) differ from their skin counterparts especially by the expression of high affinity receptor for immunoglobulin E (IgE; FcepsilonRI). However, expression pattern of FcepsilonRI and phenotypical characteristics of CD1a(+) nmDC have not been elucidated in detailed yet. METHODS: We performed detailed phenotypical comparison of nmDC and omDC of atopic and nonatopic individuals. RESULTS: As reported for omDC, FcepsilonRI on nmDC of atopic donors was elevated and mostly occupied by IgE while FcepsilonRI was present only in low amounts on nmDC of nonatopic donors. Nevertheless, the highest FcepsilonRI expression has been observed on omDC. Furthermore, significant amounts of costimulatory molecules CD40, CD80 and CD86 could be detected on nmDC that expressed more CD80 compared with omDC. Moreover, nmDC displayed less major histocompatability complex (MHC) class I and II molecules than omDC. In addition, nmDC expressed more C-type lectins CD205, CD206 as well as myeloid marker CD11b while omDC displayed increased expression of CD207 and lipopolysaccharide (LPS) receptor CD14. CONCLUSION: Together these data imply that nmDC phenotypical differ from omDC which might result in diverse functional properties and might be of relevance for selecting routes for immunotherapy of atopic diseases. Moreover these data provide a basis for further studies investigating immunological mechanisms underlying mucosal immunotherapy.

Zur Minimierung des perioperativen Risikos transfusionsassoziierter Komplikationen wird im Rahmen von Dysgnathieeingriffen in der Regel eine praoperative Eigenblutspende durchgefuhrt. Mit der vorliegenden Studie wurde die Notwendigkeit dieser Masnahme kritisch hinsichtlich gesundheitlicher, okonomischer und juristischer Fragestellung untersucht. Im Zeitraum von 1994 bis 2002 wurden in der Klinik fur Mund-, Kiefer- u. Gesichtschirurgie in Bonn 178 Dysgnathieoperationen durchgefuhrt. Alle Patienten (101 weibliche, 77 mannliche) wurden uber die Moglichkeit einer Eigenblutspende (EBS) aufgeklart. 83% nahmen das Angebot wahr, wobei fur einen monognathen Eingriff zwei und fur eine bignathe Operation in der Regel drei bis vier Erythrozytenkonzentrate vorgesehen waren. 99 Patienten wurden monognath im Unterkiefer, 27 Patienten im Oberkiefer operiert. In 52 Fallen erfolgte ein bignathes Vorgehen. Der mittlere Blutverlust bei einer monognathen Operation im Unterkiefer betrug 756 ml, im Oberkiefer 858 ml und bei einer bignathen Operation 1391 ml. Bei 13 Patienten wurde ein absoluter Hamoglobinwert von 7,5 g/dl unterschritten und in 12 Fallen Eigenblut retransfundiert. Insgesamt wurden 57,7% der gespendeten Erythrozytenkonzentrate verworfen. Die Kenntnis des Vorhandenseins von Eigenblut verleitete zur fruheren Gabe von Erythrozytenkonzentraten im Vergleich zur Fremdblutgabe und muss kritisch hinterfragt werden. Eine Eigenblutspende sollte aus medizinischer Sicht weiterhin bei bignathen Eingriffen durchgefuhrt, jedoch bei monomaxillaren Eingriffen auf Einzelfalle mit besonderem Risiko beschrankt werden.

Das Ameloblastom ist der haufigste epitheliale odontogene Tumor im Bereich des Kieferknochens. Es wachst lokal infiltrierend und neigt zu Rezidiven. Falle einer malignen Transformation und das Auftreten von Fernmetastasen sind beschrieben. Immunhistochemische Untersuchungen zeigen eine erhohte Expression von P53-Protein in Ameloblastomen. Mutationen des tp53-Tumorsuppressorgens wurden in einer Vielzahl menschlicher Tumoren nachgewiesen. In der vorliegenden Studie wurden histologische Gewebeschnitte auf die Expression von P53-Protein untersucht und das tp53-Gen betroffener Patienten einer Mutationsanalyse unterzogen. Die Tumor-DNS von 29 Ameloblastompatienten wurde auf Mutationen in den Exons 5 bis 8 des tp53-Tumorsuppressorgens mittels PCR, SSCP- und Sequenzanalyse untersucht. Schnittpraparate dieser Tumoren wurden immunhistochemisch auf eine Uberexpression von P53-Protein uberpruft. Erstmalig konnten zwei tp53-Mutationen (6,9%) in Ameloblastomen nachgewiesen werden. 58,6% der Tumoren zeigten eine Immunreaktivitat fur P53-Protein. Es bestand eine statistisch signifikante positive Korrelation (Fisher’s Exact-Test p

We did a morphometric analysis of 130 histological sections of basal cell carcinoma (BCC) of the face to find out whether morphometric variables in the structure of the nuclei of BCC cells could serve as predictors of the biological behaviour. We considered the following variables: maximum and minimum diameters, perimeter, nuclear area and five form factors that characterise and quantify the shape of a structure (axis ratio, shape factor, nuclear contour index, nuclear roundness and circumference ratio). We did a statistical analysis of primary and recurring tumours and four histology-based groups (multifocal superficial BCCs, nodular BCCs, sclerosing BCCs and miscellaneous forms) using a two-sided t test for independent samples. Multifocal superficial BCCs showed significantly smaller values for the directly measured variables (maximum and minimum diameters, perimeter and nuclear area). Morphometry could not distinguish between primary and recurring tumours.

Aim A geminated maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report describes the coordination of coronal division, root extraction, bone grafting, endodontic treatment and orthodontics in achieving treatment goals. It is the intention of this report to show how a difficult case could be managed by properly coordinated multidisciplinary care. Summary Pulp testing of the geminated central right maxillary incisor gave a normal response. Radiographic investigation indicated a connection of the pulp chambers. Both the mesial and distal root were filled with gutta-percha. The connection between the two root canals was sealed with a flowable dentine-bonded resin. After dividing the crown with a diamond bur, the mesial part of the tooth was removed and the extraction socket was filled with beta-tricalcium phosphate ceramic (Cerasorb™). Radiographs taken immediately after surgery and after 6 months showed no periodontal or periapical lesions. No signs of external resorption were identified. The diastema between the central incisors was closed by orthodontic treatment. Key learning points • Geminated teeth may present aesthetic and functional problems which require multidisciplinary care. • Careful clinical and radiographic examination is essential to decide on the fate of the coronal and root halves involved. • A proper coordination between endodontic and surgical treatment may result in maintaining one tooth half, even if a midroot connection between the pulp chambers becomes evident. • Orthograde endodontic treatment, hemisection and orthodontics may solve the aesthetic problem of a geminated tooth.

Objective The aim of this study was to determine the relationship between facial clefts, associated malformations and chromosomal abnormalities. Study design Sonograms of 70 fetuses with cleft lip with or without cleft palate were prospectively and retrospectively evaluated in our tertiary referral center for the nature of the cleft lip or palate and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of the 70 patients (90%). Results The frequency of additional anomalies and the mortality rate in this selected population varied with the type of cleft. None of the fetuses presenting an isolated cleft lip had additional anomalies and all survived. All fetuses presenting a median facial cleft had concurrent anomalies (particularly of the central nervous system (90%)) and a fatal outcome. Associated defects were more frequent in fetuses with bilateral clefts (72%) than in those with unilateral clefts (48%). Fetuses with a unilateral cleft lip with or without cleft palate had a better survival rate (52%) than those with a bilateral cleft lip with or without cleft palate (35%). The frequency and type of chromosomal abnormalities varied with the type of cleft. The highest rate of chromosomal abnormalities was found in fetuses with median clefts (82%). Conclusions Although no conclusions regarding the prevalence of chromosomal or other anomalies in patients with a cleft lip with or without cleft palate in the general population could be drawn, the study revealed a strong relationship between the type of facial cleft, associated malformations, chromosomal abnormalities and fetal outcome. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology

Complications Arthroscopy of the temporomandibular joint is an invasive procedure that can entail potential complications. Based on many years of personal experience and taking data from the literature into account, this article discusses functional, surgical, and anesthesiological complications of arthroscopy of the temporomandibular joint. The majority of these complications can be avoided by heeding specific knowledge of topography, careful manipulation, and corresponding surgical experience. Informing the patient The information given to the patient prior to the intervention should cover not only hemorrhaging, swelling, and wound infection, but also damage to (branches of) the facial nerve, the risk of perforation of the auditory canal as well as the possibility of temporary occlusal disturbances.

The temporomandibular joint is rarely affected by crystal deposition disease (gout and pseudogout). Only the temporomandibular joint was affected in a 69-year-old patient with calcium pyrophosphate dihydrate deposition disease (pseudogout). This case is described here. Clinically presenting as painless swelling, computed tomography and magnetic resonance imaging showed signs of a chronic destructive arthritis. The evidence for calcium pyrophosphate dihydrate crystals was provided by histological examination. Diagnostic criteria, differential diagnosis and possibilities for treatment are discussed on the basis of our own experience and the literature.

Problem: There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer – some of it is even contradictory. The results of this study should lead to the establishment of more clear criteria. Patients: 165 patients suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations. Results: The CT and MRI staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of 22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate of 69%. Conclusion: The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary examination at a second stage.

Improving the precision in estimating the nitrogen (N) requirement for citrus trees on sandy soils is important for increasing N efficiency by the trees and minimizing potential losses of N in commercial citrus production areas. In this study, representative Florida soils were sampled from major citrus production areas and the electro-ultrafiltration (EUF) technique was used to measure the concentrations of total EUF-extractable nitrogen (EUF-Nt), ammonium-N (EUF-NH4 +–N) and nitrate-N (EUF-NO3 ––N). Available organic N (Norg) was calculated as: EUF-Nt–(NH4 +–N+NO3 ––N). The N concentrations in the EUF extraction were greater than those by the KCl or CaCl2 method. The Norg fraction, estimated by the EUF method, varied from 4.4 to 40.8 mg kg–1 soil, equivalent to 10 to 91 kg N ha–1 (for the top 15 cm depth soil) and was positively correlated with the total soil N determined by the Kjeldahl method. The presence of appreciable amounts of Norg in these soils indicates that these soils contain high proportions of the total soil N in easily mineralizable Norg forms. This study demonstrates that the EUF-extractable organic bound N must be considered in developing N fertilizer recommendations for citrus.

Two mini-pigs and 6 micropigs were fitted with a dentally fixed device for osteodistraction of the mandible. Following bilateral osteotomy and after a latency period of 7 days, the apparatus was activated 1 mm per day. A 9 mm lengthening of the mandible was achieved. After a retention period of 6 weeks, the device was removed followed by a consolidation period of 6 weeks. During the experiment, the callus and bone formation and potential dental and periodontal reactions were radiologically examined. Polychrome sequential labelling was performed by injecting calcein green and xylenol orange for histological assessment of bone. The animals were killed at the 14th postoperative week and the area of distraction and the roots of the adjacent teeth were histologically studied. After 12 weeks, the osteogenesis in the distraction gap was complete, showing lamellar bone. No detrimental effects at the roots or in the periodontium of the adjacent teeth were seen. Thus, lengthening or widening of the mandible using a tooth-borne distraction device seems feasible in selected cases.

A laboratory soil incubation and a pot experiment with ryegrass were carried out in order to examine the extractability of microbial biomass N by using either 10-mM CaCl2 extraction or the electro-ultrafiltration (EUF) method. The aim of the experiment was to test the hypothesis whether the organic N (Norg) extracted by EUF or CaCl2 from dried soil samples represents a part of the microbial biomass. For the laboratory incubation a 15N-labelled Escherichia coli suspension was mixed with the soil. For the pot experiment a suspension of 15N-labelled bacteria was applied which had previously been isolated from the soil used. Soil samples of both treatments, with and without applied bacterial suspension, were extracted by EUF and CaCl2. The extractability of applied microbial biomass was estimated from the difference in extractable Norg between the two treatments. In addition, the N isotopic composition in the upper plant matter, in the soil, and in organic and inorganic N fractions of EUF and CaCl2 extracts was analysed. Both experiments showed that the applied microbial biomass was highly accessible to mineralization and thus represented potentially mineralizable N. However, this mineralizable N was not extractable by CaCl2 or by the EUF method. It was, therefore, concluded that the organic N released on soil drying and which was thus extractable was derived from the non-biomass soil organic matter. The result suggests that both extraction methods may provide a suitable index for mineralizable N only in cases where the decomposable organic substrates are derived mainly from sources other than the living soil biota.

Field trials were carried out to examine to what extent nitrogen fertilizer and various soil nitrogen fractions contribute to the nitrogen uptake of cereals. The study focused on soil N tests which are easy to handle, in order to improve their acceptance by farmers. The soil nitrogen fractions estimated were NH 4 + , NO 3 − , and organic nitrogen extracted by electro-ultrafiltration (EUF) or CaCl 2 solution, respectively, sampled at various times in early winter and spring. The investigation comprised 36 different sites; all sandy soils derived from mottled sandstone or alluvium. Nitrogen fertilizer rates were 0, 40, 80, and 120 kg N ha -1 applied in the form of calcium ammonium nitrate. The relationship between nitrogen fertilizer rates and nitrogen uptake was weak ( r 2 = 0.36). The coefficient of determination ( r 2 ) for the nitrogen uptake by the crop was improved to 73% if, in addition to the N fertilizer rate, the inorganic N (NH 3 − + NH 4 + ) present in the soil profile (0–90 cm) in spring was included in a multiple regression. Soil sampling to a depth of 90 cm in early spring is laborious work and therefore empirical models of « available N » were evaluated based on soil samples taken from the top, soil layer (0–30 cm) in early winter. Satisfactory coefficients of determination for the relationship between nitrogen uptake of crops v.s. soil test were found for soil tests in which the samples were taken from the top layer (0–30 cm) in December and in which, besides inorganic nitrogen, organic nitrogen was included in the regression. The coefficients of determination thus obtained were 0.65, 0.68 and 0.73 for the EUF-N org , the CaCl 2 -N org , and total soil nitrogen, respectively. We believe that such a soil test method based on soil sampfing from the upper soil layer in early winter will be more readily accepted by farmers than the N min method.

Sandy soils have low reserves of mineral N in spring. Therefore organic-bound N is the most important pool available for crops. The objective of the present investigation was to study the importance of the organic-bound N extracted by electro-ultrafiltration and by a CaCl2 solution for the supply of N to rape and for N mineralization. Mitscherlich-pot experiments carried out with 12 different sandy soils (Germany) showed a highly significant correlation between the organic N extracted (two fractions) and the N uptake by the rape (electroultrafiltration extract: r=0.76***; CaCl2 extract: r=0.76***). Organic N extracted by both methods before the application of N fertilizer was also significantly correlated with N mineralization (electro-ultrafiltration extract: r=0.75***; CaCl2 extract: r=0.79***). N uptake by the rape and the mineralization of organic N increased with soil pH and decreased with an increasing C:N ratio and an increasing proportion of sand in the soils. Ninety-eight percent of the variation in N uptake by the rape was determined by the differences in net mineralization of organic N. This show that in sandy soils with low mineral N reserves (NO inf3 sup- -N, NH 4 + -N) the organic soil N extracted by electro-ultrafiltration or CaCl2 solutions indicates the variance in plant-available N. Total soil N was not related to the N uptake by plants nor to N mineralization.

To minimize the perioperative risk of transfusion-associated complications, preoperative autologous blood donation is routinely performed in orthognathic surgery. This study critically analyzed the necessity of this procedure with respect to clinical, economic, and juridical issues.In the Department of Oral and Maxillofacial Surgery, Bonn Medical School, 178 orthognathic surgical procedures were performed from 1994 to 2002. All patients (women, n=101; men, n=77) were informed about the possibility of autologous blood donation. This procedure was carried out in 83%, for single jaw surgery two and for bimaxillary osteotomies three to four units of packed red blood cells were predeposited. Of the patients, 99 underwent monognathic surgery in the lower jaw, 27 patients in the upper jaw, and bimaxillary osteotomy was performed in 52 patients.The average blood loss for the monognathic procedure in the lower jaw was 756 ml, in the upper jaw 858 ml, and in double jaw surgery 1391 ml. In 13 patients the hemoglobin concentration fell below 7.5 g/dl and 12 patients received their predeposited autologous blood units. A total of 57.7% of all donated autologous blood units were discarded.Autologous blood donation should be performed from the medical point of view for double jaw surgery and considered in single cases with special risks in monomaxillary osteotomies.

Advanced glycation end (AGE)-products are a complex group of compounds that have been implicated in diabetes related long-term complications. Up to the present only few data exist about serum levels of the AGE-proteins N-epsilon-Carboxymethyllysine (CML) and pentosidine in patients with diabetes mellitus.In the present 10-year, population-based trial of a selection-free cohort of patients with insulin-treated diabetes mellitus, serum CML and pentosidine levels were examined in correlation to the patients' quality of diabetes control and the prevalence of diabetes related long-term complications.Following the reunification of Germany in 1989 the health care system was decentralised. Up to 1994/95 the relative HbA1c (HbA1c/mean normal) of patients with type 1 diabetes increased (1.65 +/- 0.35 versus 1.52 +/- 0.31, p = 0.002). For patients with type 2 diabetes it remained constant (1.75 +/- 0.4 versus 1.78 +/- 0.31, p = 0.669). During the following period (from 1994/95 to 1999/2000) specialised diabetes care, structured treatment and teaching programmes (TTP), intensified insulin therapy and blood glucose self-monitoring for all patients were broadly implemented. This was accompanied by a substantial improvement in the relative HbA1c of both, patients with type 1 (1.48 +/- 0.3, p0.0001), and insulin-treated type 2 diabetes mellitus (1.47 +/- 0.25, p0.0001). During the same period the mean concentration of the AGE-product CML in the sera of patients with type 1 and insulin-treated type 2 diabetes decreased (type 1: 1994/95: 1158.1 +/- 410.0 ng/ml versus 1999/2000: 938.5 +/- 422.4 ng/ml, p0.0001, type 2: 1994/94: 1244.7 +/- 1231.3 ng/ml versus 1999/2000: 970.9 +/- 458.6 ng/ml, p = 0.007). For pentosidine the same tendency was found for patients with type 1 diabetes (1994/95: 253.6 +/- 280.7 pmol/ml versus 1999/2000: 148.2 +/- 91.4 pmol/ml, p0.0001). For patients with type 1 diabetes there was a positive correlation between the relative HbA1c-value calculated over the total follow-up period of 10 years and the CML-concentration in 1999/2000 (r = 0.405, p = 0.017). In 1999/2000 a reduced creatinine clearance (/=80 ml/min) was found in 7.8% of patients with type 1 and 14.9% of patients with insulin-treated type 2 diabetes. In comparison to patients with a normal creatinine clearance, patients with a reduced creatinine clearance had not only higher creatinine-concentrations in the sera and higher values of albuminuria but also significantly higher pentosidine levels.Comparing the data of 1999/2000 with those from 1994/95, there was not only a substantial improvement in patients' quality of diabetes control but also a decrease in the concentration of AGE-products. In patients with diabetes mellitus the AGE-products seem to be mainly influenced by the quality of diabetes control. The decline in renal function leads to increased serum pentosidine levels in patients with insulin-treated diabetes mellitus. Thus it seems that in patients with reduced renal function, higher levels may either play a causal role in the development and progression of nephropathy or they are an epi-phenomenon caused by the decrease in urinary excretion.

Ameloblastoma is the most frequent epithelial tumor of the jaws. The spread is locally invasive and it tends to recur. Malignant transformation and occurrence of metastases has been described. Immunohistochemical analysis shows an enhanced expression of P53 protein in ameloblastomas. Mutation of the tp53 tumor suppressor gene was verified in several human tumors. In this study histological sections were analyzed for the expression of P53 protein and the tp53 gene was examined for mutations.Tumor DNA from 29 patients with an ameloblastoma was examined for mutations in exons 5 to 8 of the tp53 tumor suppressor gene using PCR, SSCP,- and sequential analysis. Histological sections of the tumors were analyzed immunohistochemically for an overexpression of P53 protein.Two tp53 mutations (6.9%) in ameloblastomas were verified for the first time. In all 58.6% of the tumors showed an immunoreactivity for P53 protein. There was a statistically significant positive correlation (Fisher's exact test p0.0148) between an increased number of P53-positive tumor cells and the appearance of recurrence.In the face of the uncertain postoperative behavior of ameloblastomas, the immunohistochemical verification of more than 10% P53-positive tumor cells may give a prognostic indication for a tendency to recurrence.

We present three cases of cervical teratoma, two of which were detected prenatally by ultrasound. The two cases diagnosed prenatally showed rapid early growth, which indicated the aggressive nature of the tumour and assisted the parents' decision to terminate the pregnancy. The third case was undiagnosed prenatally and the child was born after a normal pregnancy and uncomplicated vaginal delivery. She recovered well after excision of the teratoma.

A geminated maxillary incisor required complex multidisciplinary treatment to preserve health and restore aesthetics. This report describes the coordination of coronal division, root extraction, bone grafting, endodontic treatment and orthodontics in achieving treatment goals. It is the intention of this report to show how a difficult case could be managed by properly coordinated multidisciplinary care.Pulp testing of the geminated central right maxillary incisor gave a normal response. Radiographic investigation indicated a connection of the pulp chambers. Both the mesial and distal root were filled with gutta-percha. The connection between the two root canals was sealed with a flowable dentine-bonded resin. After dividing the crown with a diamond bur, the mesial part of the tooth was removed and the extraction socket was filled with beta-tricalcium phosphate ceramic (Cerasorb). Radiographs taken immediately after surgery and after 6 months showed no periodontal or periapical lesions. No signs of external resorption were identified. The diastema between the central incisors was closed by orthodontic treatment.Geminated teeth may present aesthetic and functional problems which require multidisciplinary care. Careful clinical and radiographic examination is essential to decide on the fate of the coronal and root halves involved. A proper coordination between endodontic and surgical treatment may result in maintaining one tooth half, even if a midroot connection between the pulp chambers becomes evident. Orthograde endodontic treatment, hemisection and orthodontics may solve the aesthetic problem of a geminated tooth.

A 0.30 /spl mu/m gate CMOS technology for high speed microprocessors with five levels of interconnect is described. A primary challenge in developing a manufacturable 0.30 /spl mu/m gate CMOS process is gate length control. A detailed investigation of the sources of gate length variation using a specially designed testchip is presented. Linewidth control of /spl plusmn/10% is achieved using I-line lithography by applying optical proximity correction to the gate reticle. A high speed cache memory for the target 250 MHz microprocessor product has an access time of 2.02 ns from clock to data out.

TiN or organic Bottom AntiReflection Coatings (BARC), polysilicon hammerheads, phase shift masks, quadrupole off-axis illumination I-line lithography at N.A.=0.60, shallow source/drain extenders, LOCOS isolation, and 6 nm gate oxide are used to obtain high performance 0.30 /spl mu/m 2.5 V CMOS with effective channel lengths

Objective. The primary diagnosis of synovial chondromatosis of the temporomandibular joint is extremely rare. Often many months, or even years pass before the diagnosis is confirmed. Study Design. Eight patients with synovial chondromatosis were treated by arthrotomy. In addition to the definitive diagnosis, histologic classification according to the stages proposed by Milgram was undertaken and confirmed with the literature. Results. The predominant symptoms of synovial chondromatosis, including pain, swelling, restricted movement of the mandible, and crepitation, were evaluated. Nevertheless, more than 80% of the patients were previously primarily treated on the basis of other tentative diagnoses. Conclusion. Synovial chondromatosis of the temporomandibular joint should be included in the differential diagnosis of chronic swelling and pain in the preauricular region, and the patient should be sent for appropriate diagnostics and therapy at an early stage. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:31-8)

The aim of this study was to determine the relationship between facial clefts, associated malformations and chromosomal abnormalities.Sonograms of 70 fetuses with cleft lip with or without cleft palate were prospectively and retrospectively evaluated in our tertiary referral center for the nature of the cleft lip or palate and for the nature of the associated anomalies. Additionally, karyotyping was performed in 63 of the 70 patients (90%).The frequency of additional anomalies and the mortality rate in this selected population varied with the type of cleft. None of the fetuses presenting an isolated cleft lip had additional anomalies and all survived. All fetuses presenting a median facial cleft had concurrent anomalies (particularly of the central nervous system (90%)) and a fatal outcome. Associated defects were more frequent in fetuses with bilateral clefts (72%) than in those with unilateral clefts (48%). Fetuses with a unilateral cleft lip with or without cleft palate had a better survival rate (52%) than those with a bilateral cleft lip with or without cleft palate (35%). The frequency and type of chromosomal abnormalities varied with the type of cleft. The highest rate of chromosomal abnormalities was found in fetuses with median clefts (82%).Although no conclusions regarding the prevalence of chromosomal or other anomalies in patients with a cleft lip with or without cleft palate in the general population could be drawn, the study revealed a strong relationship between the type of facial cleft, associated malformations, chromosomal abnormalities and fetal outcome.

Arthroscopy of the temporomandibular joint is an invasive procedure that can entail potential complications. Based on many years of personal experience and taking data from the literature into account, this article discusses functional, surgical, and anesthesiological complications of arthroscopy of the temporomandibular joint. The majority of these complications can be avoided by heeding specific knowledge of topography, careful manipulation, and corresponding surgical experience.The information given to the patient prior to the intervention should cover not only hemorrhaging, swelling, and wound infection, but also damage to (branches of) the facial nerve, the risk of perforation of the auditory canal as well as the possibility of temporary occlusal disturbances.

The temporomandibular joint is rarely affected by crystal deposition disease (gout and pseudogout). Only the temporomandibular joint was affected in a 69-year-old patient with calcium pyrophosphate dihydrate deposition disease (pseudogout). This case is described here. Clinically presenting as painless swelling, computed tomography and magnetic resonance imaging showed signs of a chronic destructive arthritis. The evidence for calcium pyrophosphate dihydrate crystals was provided by histological examination. Diagnostic criteria, differential diagnosis and possibilities for treatment are discussed on the basis of our own experience and the literature.

The case is presented of a 47-year-old woman with an 8-week history of persistent right ear discomfort and a 2-week history of unilateral parotid swelling, as well as peripheral paresis of the facial nerve. The case points to the difficulties encountered when Wegener's granulomatosis presents in an unusual and varied way which mimics a malignant tumour of the parotid gland. To our knowledge, the association of parotid gland involvement and facial palsy in Wegener's granulomatosis has not previously been described in the literature.

211 patients (88 female, 123 male, mean age 63 years) presented with 279 basal cell carcinomas (191 primary tumours, 88 recurrent tumours) in the head and neck area that were excised. The resected margins were examined microscopically and the defect repaired at a second operation. The excision margin was 1-2 mm. The recurrence rate was 3%, which is lower than is achieved by other methods, and unaffected structures are optimally conserved.

There is a lack of clear criteria for the use of MR and CT in the diagnosis of head and neck cancer--some of it is even contradictory. The results of this study should lead to the establishment of more clear criteria.165 patients suffering from head and neck tumors were subjected to a total of 463 CT and 197 MRI examinations.The CT and MRI staging corresponded in 67% and 60% of the oropharynx tumors, respectively, with the clinical findings. In the case of oral cavity tumors, the clinical TNM stages were identical with CT and MRI results in 50% and 43% of cases, respectively. In the case of lymphatic node staging, the frequency of error was slightly higher using MRI, at 27%, compared with the CT rate of 22%. In the evaluation of cervical lymphatic nodes, CT proved to be more sensitive attaining 78% compared to the MRI rate of 69%.The results provide clear indications as to the MRI and CT examinations. Primary preoperative screening and post-therapeutic aftercare should be assessed using CT, as should lymphatic node diagnosis in the neck area. In the case of special problems such as, for example, the relevant bone and periostium infiltration, MR should be considered as a supplementary examination at a second stage.

Based on reported animal studies, the case report presented demonstrates the use of tooth-borne distraction osteogenesis for mandibular widening of 1 cm in order to avoid extraoral distraction devices. Detrimental side effects on healthy anchoring teeth are not likely.

With the aim of eliminating pathological growth during the active period of condylar hyperplasia, 17 patients were treated with a high condylectomy with a retroauricular incision. Postoperatively none of the patients showed signs of continuing growth activity neither clinically nor roentgenologically. Thus, the high condylectomy can be recommended as a reliable technique to stop pathological and untimely growth with a low risk of complications, before occlusion and skeletal asymmetry are corrected by orthodontic surgery.

During a period of 8 years (1986-1994) we treated 183 patients with mandibular fractures. Within this period we changed our treatment protocol from the rigid internal fixation (AO/ASIF method) to monocortical noncompression miniplates. The complications of 127 AO/ASIF cases versus 41 miniplate cases were studied. Complications mostly consisted in dehiscences. Comparing the two methods we found more complications (19.5%) when the AO plate is applicated via an intraoral approach. After extraoral AO treatment and after monocortical miniplates there was no significant difference concerning our complications (8.1% versus 7.3%).

Although widely used, the radial forearm flap has been criticized for the poor quality of its donor site. Attempts to avoid donor-site problems have concentrated on the elaboration of the split-thickness and full-thickness skin graft methods of reconstruction. Skin grafts frequently fail over the flexor carpi radialis tendon, leading to chronic skin breakdown or, at best, tendon adhesion. Tissue expansion appears to be a good alternative that allows the use of local tissues to ultimately improve the forearm donor-site appearance. To avoid the disadvantages of traditional silicone balloon expanders (such as pressure peaks, infection, the valve at a distance from the expander, postoperative fillings), an osmotically active system was used. In an 18-month prospective study, 10 osmotically active hydrogel tissue expanders were placed on the forearms of 10 patients. The radial forearm flap was performed for intraoral reconstruction after surgical resection of oral cavity malignancies. The study showed that, in nine out of 10 patients, the expanded skin achieved was sufficient to cover the donor site after raising the forearm flap. Additionally, the expansion-related swelling pressure was well tolerated by the patients, the cosmetic results were very satisfactory, and the incidence of complications was very low. By using osmotically active hydrogel tissue expanders, there is no postoperative filling and no risk of complications arising from defective balloon expanders, filling valves, or missing ports.