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Background Orbital decompression surgery is frequently the last therapeutic measure in the surgical treatment of endocrine orbitopathy (EO). Additional rehabilitative and corrective surgical treatments are often used to improve the resulting eyelid stigmata, such as an increased lid aperture and scleral show. The aim of the study was to evaluate the effect of adjunctive surgical procedures after orbital decompression surgery in patients with EO. Methods A total of 120 orbitae from 65 patients with EO from 2010 to 2020 at a tertiary care center in Germany were retrospectively evaluated. Ocular surface area (OSA) and vertical palpebral fissures were three-dimensionally analyzed at the following stages: presurgical decompression, postsurgical decompression, and post-adjunctive surgical procedures. For the analysis of vertical palpebral fissures, predefined vertical line distances were measured on the upper and lower lids in the central, medial, and lateral pupillary regions. Results The initial OSA was 2,98 ± 0.85 cm2, and it decreased significantly after decompression surgery to 2.52 ± 0.62 cm2. After adjunct surgical procedures, OSA further decreased to 2,31 ± 0,55 cm2. Furthermore, a statistically significant reduction in all pupillary parameters was noted after each treatment step. More lid-lengthening procedures were performed on the lower lid than on the upper lid. Canthoplasty (n = 13) was the most frequently performed procedure during rehabilitation. Conclusion Surgical decompression surgery improves OSA and leads to a significant reduction in lid aperture. Adjunctive surgical procedures, addressing the upper and lower lid, have a significant influence on the ongoing clinical course and contribute to a reduction in OSA.

Background Minimally invasive temporomandibular joint surgery (MITMJS) is an option for patients suffering from severe internal derangement or adhesions. To improve TMJ access, a workflow to create surgical templates is introduced. Methods A workflow to generate a dividable patient specific template based on CBCT and optical scanning to access the joint is introduced. In a first clinical trial 3 patients (6 joints) were treated by way of template-guided endoscopically-assisted TMJ therapy (3 arthrocenteses and 3 arthroscopies). Results Generation and clinical use of the templates was as planned. All templates showed perfect fit and permitted instant access to the TMJ. All surgeries were performed without complications. Conclusions Template-guidance could improve the feasibility of endoscopically-assisted TMJ therapy. An important issue is the capability to dis- and remount the template during surgery. Using in-house production, costs are affordable. Trial registration This study was registered at the Ethic Committee of the Berlin Medical Chamber (Eth-30/17, 12/06/2017).

In May 2017, a hospitalized index case of tick-borne encephalitis (TBE) was confirmed by Serology. The case was linked to alimentary infection by raw milk from a goat farm in the region of Tübingen, Baden-Württemberg, Germany, where no previous TBE cases in the area had been reported before. The TBE focus was confirmed by isolation of the TBE virus from ticks and Serological confirmation of past infection in one of the five flock goats. Additional investigations by the local public health office identified 27 consumers of goat milk at the putative period of exposure. For 20/27 exposed persons, anamnestic information was gained by the local public health office. Twelve/fourteen exposed and non-vaccinated people developed clinical illness and were confirmed as TBE cases by Serology. Five/six vaccinated and exposed people did not develop the disease. The one exposed and vaccinated person had their last TBE vaccination booster more than 15 years ago, and therefore a booster was more than 10 years overdue. None of the regularly vaccinated and exposed persons developed clinical overt TBE infection. We report the first known TBE outbreak, during which, protection by TBE vaccination against alimentary TBE infection was demonstrated.

Background: Digitally designed surgical templates for minimally invasive temporomandibular joint (TMJ) surgery (MITMJS) are a promising tool for improving the safety in these procedures. Given the anatomy of the TMJ, the fitting of the template and intraoperative overview are the most important issues to conduct the surgery safely. This article describes an endaural surgical template based on the Moses approach as a possible solution.Material and Methods: Three patients with internal derangement were treated with guidance of a MITMJS- template based on cone beam computed tomography (CBCT) and a surface imprint of the periauraural region. None of the patients needed an additional open surgical procedure. Fitting of the templates was judged in terms of position and rotational stability. Surgical side effects and complications were recorded for each patient.Results: The template design and clinical use performed the MITMJS satisfactory. The templates showed satisfying fit and good visibility. In the study cohort, no bleeding, facial nerve injury, or other complications occurred after the procedure, and no visible scars were noted postoperatively.Conclusion: Our feasibility report on template-guided MITMJS shows a promising new application of templates. It points an improved access in arthroscopy or arthrocentesis of TMJ- surgery via an endaural access with increased level of safety during surgery.

Purpose Surgery in endocrine orbitopathy should address exophthalmos and adjunct stigmata such as increased lid aperture and scleral show. Secondary to decompression, rehabilitative surgical treatment such as blepharoplasty is routinely used to achieve this goal. Until now, however, there has been no investigation to measure the effect of decompression surgery on scleral show and lid aperture 3-dimensionally. Materials and methods Ocular surface area (OSA) and lid aperture of 34 patients (67 orbits) were measured pre and post decompression surgery in a retrospective investigation using 3-dimensional (3D) stereophotogrammetry. The mean follow-up after decompression was 6 ± 4 months. Results Mean OSA ranged between 3.1 ± 1.5 cm2 (pre orbital decompression) and 2.5 ± 0.6 cm2 (post orbital decompression). Orbital decompression caused a statistically significant reduction of the surface area of about 19.4% (p Conclusion Our results show that surgical decompression, besides correcting exophthalmos, leads to a significant reduction of scleral show and lid aperture. However, it is not possible to estimate its effect on an individual basis.

The aim of the study was to analyze the eligibility of resorbable collagen membrane in the treatment of midfacial fractures to prevent gap formation and subsequent cheek tissue retraction. We included nine patients (six males, three females; mean age 51; range 20–73 years; mean bone gap size 8.03 × 13.12 mm) in a retrospective study design. The defect size was assessed by ultrasound. After a healing period of 4 to 55 weeks, treatment resulted in a significant reduction of gap size (residual mean bone gap size 6.14 × 7.32 mm). Native resorbable collagen membrane is a promising tool to reduce the size of bony gap in midfacial defects.

Lipodystrophy (LD) patients suffer from loss or maldistribution of subcutaneous adipose tissue accompanied by dysregulation of several adipocyte-secreted factors, e.g., leptin. The effect of recombinant leptin (metreleptin) therapy on facial soft tissue volume in patients with non-human immunodeficiency virus LD has not been quantified to date. Eight LD patients (six female, two male; six familial partial LD [FPLD], two generalized LD) were treated with metreleptin over 1 year. Anthropometric parameters and 3D stereophotogrammetric imaging of the patients´ faces were assessed at baseline and after 1 year of metreleptin treatment. Median fat mass was significantly reduced during metreleptin treatment from 22.3 kg at baseline to 20.0 kg at 1 year (p = 0.031); however, body weight, body mass index, and waist-to-hip ratio were not significantly affected. Five of the six patients with FPLD lost between 4 and 114 cm3 of facial soft tissue volume in the pre-auricular, buccal, and submandibular area during metreleptin treatment whereas a slight volume gain was seen in one FPLD patient. The two patients with generalized LD developed a volume loss of 20 and 8 cm3 in the buccal region between baseline and 1 year of metreleptin therapy, respectively. Metreleptin replacement leads to loss of facial soft tissue volume in FPLD and generalized LD. However, volume changes in most patients are not visible by the naked eye.

Background Surgical treatment of endocrine orbitopathy can be performed by way of resecting orbital walls, which effectively releases superfluous tissue from the surgically enlarged orbital space allowing the eyeballs to move back. Existing approaches aim to select an optimal surgical strategy based on statistical correlations between the extent of the surgical procedure and the resulting bulbus displacement but do not provide an individual surgery plan or predict surgery outcome. Methods In this retrospective study, we performed a quantitative analysis of pre- and post-surgery 3D tomographic data of six patients and applied explorative biomechanical modeling of orbital mechanics to dissect factors influencing patient-specific outcome. Findings Our experimental results showed a large variability of the backward eyeball displacement in dependency on the amount of orbital volume flow, which could partially be described by computational simulation. Our detailed analysis revealed that patients with regular fat tissue show a good correlation between bulbus displacement and relative volume of decompressed tissue, which, in turn, correlates with decrease in hydrostatic pressure. In contrast, patients with fibrotic tissue exhibit significantly reduced and computationally less predictable eyeball translation in response to surgical tissue decompression. Interpretation Based on the results of this study we see a great potential for quantitative planning of surgical exophthalmos treatment using 3D biomechanical modeling. Conventional approaches to planning of soft tissue interventions consider, however, only the patient's 3D anatomy and widely disregard individual tissue properties. Further investigations are required to establish reliable procedures for assessment of individual tissue properties and incorporating them into patient-specific models of orbital mechanics.

Purpose The aim of this investigation was to generate a statistical shape model (SSM) of the midface and evaluate symmetry, gender aspects, and bone thickness. Methods About 102 computed tomography scans were analyzed to create the SSM. This included segmentation, landmark attribution, and Procrustes and principal component analysis. Afterward, symmetry and gender differences were visualized by registration and color coding. Bone thickness was calculated by measuring the distance between outer and inner surfaces. Results Symmetry was high in all models. The male model showed a more prominent forehead, nasal bones, and larger bizygomatic width. Bone thickness resembled the concept of vertical and horizontal maxillary pillars and buttresses. Conclusions SSM can be used to analyze midface morphology and help in virtual surgery planning. Calculation of bone thickness could also be a useful tool in surgical planning and biomechanics.

Since the middle of the 1990s distraction osteogenesis has been introduced into maxillofacial surgery. Its advantage in comparison to single-step movements of mandible or maxilla lies in the simultaneous augmentation not only of bone but also of soft tissues. Thus it can be applied to cases where long distances (n > 10 mm) have to be overcome and/or unfavourable conditions of the soft tissue envelope (marked retrusion, scars of previous operations) exist.

Background Clinical studies report on vision impairment after blunt frontal head trauma. A possible cause is damage to the optic nerve bundle within the optic canal due to microfractures of the anterior skull base leading to indirect traumatic optic neuropathy. Methods A finite element study simulating impact forces on the paramedian forehead in different grades was initiated. The set-up consisted of a high-resolution skull model with about 740 000 elements, a blunt impactor and was solved in a transient time-dependent simulation. Individual bone material parameters were calculated for each volume element to increase realism. Results Results showed stress propagation from the frontal impact towards the optic foramen and the chiasm even at low-force fist-like impacts. Higher impacts produced stress patterns corresponding to typical fracture patterns of the anterior skull base including the optic canal. Transient simulation discerned two stress peaks equalling oscillation. Conclusions It can be concluded that even comparatively low stresses and oscillation in the optic foramen may cause micro damage undiscerned by CT or MRI explaining consecutive vision loss. Higher impacts lead to typical comminuted fractures, which may affect the integrity of the optic canal. Finite element simulation can be effectively used in studying head trauma and its clinical consequences.

The purpose of this work was to define and illustrate the skeletal morphology of open-bite patients against the background of sagittal jaw relationships on the basis of lateral cephalograms. Lateral cephalograms of 197 untreated adults were analyzed in dental imaging software (Onyx Ceph 3™; Image Instruments, Chemnitz, Germany). Four groups were formed based on vertical (Index scores) and sagittal (individualized ANB values) parameters. Ninety-nine patients were defined as the control group due to their neutral sagittal and vertical relationships. The remaining patients were found by their vertical relationships to represent open-bite cases and were divided by their sagittal relationships into three study groups: neutral (Class I, n = 34), distal (Class II, n = 26), and mesial (Class III, n = 38). A geometric morphometric approach was used to analyze the x,y-coordinates of 28 skeletal landmarks on each cephalogram. Relative size was captured based on centroid size (CS). The shape-determining factors in the groups were compared by permutation testing after Procrustes transformation, and intergroup differences were visualized in the form of thin-plate splines. While size (CS) was significantly increased in the Class III group, the other two groups were not different from the control group. After Procrustes transformation, characteristic and invariably significant (p

Introduction Polydioxanone (PDS) sheets are commonly used in the treatment of orbital wall fractures. A potential drawback of PDS is that it may be difficult to adapt to the anatomy of the orbital walls. Therefore a study was conceived to test the feasibility of preforming PDS sheets. Material and methods PDS sheet material was water-heated and preformed using a template based on a statistical anatomical model. Then the deformed sheet was cooled, stored and compared to the original model to investigate post-deformation changes. Results PDS sheet material could easily be deformed using a mould. No significant post-cooling shape changes were noticed. Conclusions PDS sheet material can be preformed into complex geometric shapes. This could be a benefit in the treatment of orbital wall fractures.

Naso-orbitoethmoid fractures account for 5% of all facial fractures. We used data derived from a white 34-year-old man to make a transient dynamic finite element model, which consisted of about 740 000 elements, to simulate fist-like impacts to this anatomically complex area. Finite element analysis showed a pattern of von Mises stresses beyond the yield criterion of bone that corresponded with fractures commonly seen clinically. Finite element models can be used to simulate injuries to the human skull, and provide information about the pathogenesis of different types of fracture.

As the biomechanical mechanisms of orbital wall fractures are still under research, three different fracture mechanisms were tested in a finite element based investigation. In contrast to earlier studies, a finer skeletal model and a transient dynamic simulation were used to test pure hydraulic, pure buckling and a mixed force transmission. Results showed that each set-up led to different orbital fracture patterns, which correlate well with clinical findings. Therefore the conclusion is that different mechanisms may act together explaining the variety of clinical fracture situations. Biomechanical testing has proven to be appropriate in answering questions regarding fracture mechanisms.

Purpose In navigated craniomaxillofacial surgery, bone segments often have to be repositioned. To keep them reliably in the desired place during referencing and osteosynthesis, a miniature external distractor can be used. Materials and methods The use of a miniature external mandibular distractor is shown in a case of bilateral lateral orbital rim advancement during endocrine orbitopathy decompression surgery. Results The advantages of using a distractor are the possibility of changing the fragment position incrementally in all directions during intraoperative control with the navigated pointer and the small size of the appliance. Conclusions Bone segments can be manipulated intraoperatively with a miniature distractor in navigated surgery.

Purpose Aim of this study was to investigate whether a mold generated from a statistical shape model of the orbit could be generated to provide a cost-efficient means for the treatment of orbital fractures. Materials and Methods A statistical shape model was created from 131 computed tomographic (CT) scans of unaffected adult middle European human orbits. To generate the model, CT scans were segmented in Brainlab software, preregistered using anatomic landmarks, trimmed to an identical size, and definitely registered. Then, the model was created using the global master algorithm. Based on this model, a mold consisting of a male part and a female part was constructed and printed using a rapid prototyping technique. Results A statistical shape model of the human orbit was generated from 125 CT scans. Six scans (4.5%) presented major anatomic deviations and were discarded. A solid mold based on this model was printed. Using this mold, flat titanium mesh could be successfully deformed to serve as an orbital implant. Conclusion A mold based on the statistical orbital shape could serve as a cost-effective means for the treatment of orbital fractures. It allows the anatomic preformation of titanium or resorbable implant material for orbital reconstruction. Because these materials could be cut from larger sheets, the use of a mold would be a cost-effective treatment alternative.

Purpose Orbital wall decompression is routinely used to treat proptosis in endocrine orbitopathy. Until now, however, there has been no investigation to measure the area/extent of the removed walls. Materials and methods The inner areas of 154 orbital walls (lateral, inferior, medial) which had been resected in 38 patients were measured using pre- and postsurgical computed tomographic data in Brainlab iPlan software. Furthermore the effect of concomitant centrolateral orbital rim advancement was calculated in 48 cases. Surgery was performed after preoperative planning using intraoperative navigation. Results The mean area of resected inferior and medial orbital walls lay at 6.7 cm 2 and 6.2 cm 2 , while the area of the lateral orbital wall was 6.9 cm 2 . Rotation-advancement of the lateral rim added an area of 1.8 cm 2 (∼25% of the lateral orbital wall). Comparison of the pre- and postsurgical computed tomographic data showed excellent conformity of the presurgical planning and postsurgical results. Conclusions This investigation is a first step in analyzing the potential surgical effect of bony decompression surgery by stating the metric amount of orbital wall removal. Using these data, further studies will be performed in the future.

German animal terms have been used to name oral cleft deformity for centuries. However, their contemporary use and influence on cleft patients remain unstudied.The main aim of this study was to evaluate the current use of German animal terms for oral cleft and their influence on the perception of cleft patients.We used a cross-sectional study design and the study sample consisted of German adult cleft and noncleft subjects in Leipzig, Germany. The study was conducted during May and December 2008, using two questionnaires and two cleft photographs (one unilateral and one bilateral). The predictor variables were medical background and presence of oral cleft. The primary outcome variable was the terminology used for the deformity by noncleft subjects. The secondary outcome variables were self-perception of the cleft patients and their idea about the use of the animal terms. Other study variables included age, gender and specialty/future career of the noncleft participants. Appropriate descriptive, uni- and bivariate statistics were computed, and a P-value of0.05 was considered to be statistically significant.The study sample was composed of 261 noncleft (146 females [55.9%]) and 71 cleft subjects (33 females [46.5%]) with a mean age of 24.2 ± 6.4 and 24.9 ± 7.2 years, respectively. Noncleft subjects without medical background who used animal terms to name oral cleft deformity were more than those with medical background (P0.0001). Over half of cleft patients (60.6%) rejected public use of the animal terms, which was still common in their daily life (P0.0001).The study results suggest that animal terms have been used until now, especially by those without medical background. The cleft patients become insulted by these negative descriptions. This strikes the importance of public education to replace these animal terms with inoffensive words.

Tracheostomy is a common procedure in head and neck surgery and emergency medicine to secure a patent airway. Surgeons should always be aware of anatomical variants of the branches of the aortic arch, which could lead to life-threatening complications. Open tracheostomy is the safest emergency procedure.

Latest developments in heat flux thermography show that the reliable detection of all relevant welding defects has now – finally – become a reality. While testing previously required two-sided access, it is now also possible to carry out testing from only one side; the range of weld seam types that can be tested fully automated has been expanded to include complex weld seam geometries. The implementation of various levels of automation and flexible interfaces enables the integration into a wide range of manufacturing and testing environments.

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

For the first time, nanometer-thin perovskite oxide buffers have been used to accommodate the lattice mismatch between CdTe epitaxial layers and Si substrates. The resulting CdTe is single crystal with quality comparable to that grown by the more mature technology using micron-thick ZnTe or CdTe buffers. This shows that the use of nanometer-thin perovskite oxide buffers is a promising approach for the epitaxial growth of II–VI compounds on Si.

For the first time, focused ion beam milling, secondary electron microscopy, and transmission electron microscopy were used to examine in depth morphological defects during epitaxial growth of CdTe and CdSeTe on Si. Contrary to the literature regarding the formation of morphological defects at the epi/substrate interface, the present defects appear to originate from either the CdTe/CdSeTe interface or 3–4 µm above the CdTe/Si interface where the growth was interrupted and the substrate temperature was temporarily raised. This suggests a correlation between defect nucleation and either shutter movement or growth interruption.

We report on the first successful growth of the quaternary alloy Cd1−yZnySexTe1−x(211) on 3-in. Si(211) substrates using molecular beam epitaxy (MBE). The growth of CdZnSeTe was performed using a compound CdTe effusion source, a compound ZnTe source, and an elemental Se effusion source. The alloy compositions (x and y) of the Cd1−yZnySexTe1−x quaternary compound were controlled through the Se/CdTe and ZnTe/CdTe flux ratios, respectively. Our results indicated that the surface morphology of CdZnSeTe improves as the Zn concentration decreases, which fits well with our previous observation that the surface morphology of CdZnTe/Si is poorer than that of CdSeTe/Si. Although the x-ray full-width at half-maximums (FWHMs) of CdZnSeTe/Si with 4% of Zn + Se remain relatively constant regardless of the individual Zn and Se concentrations, etched-pit density (EPD) measurements exhibit a higher dislocation count on CdZnSeTe/Si layers with about 2% Zn and Se incorporated. The enhancement of threading dislocations in these alloys might be due to an alloy disorder effect between ZnSe and CdTe phases. Our results indicate that the CdZnSeTe/Si quaternary material with low Zn or low Se concentration (less than 1.5%) while maintaining 4% total Zn + Se concentration can be used as lattice-matching composite substrates for long-wavelength infrared (LWIR) HgCdTe as an alternative for CdZnTe/Si or CdSeTe/Si.

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

Fragestellung. Fur Patienten mit ausgepragter Mittelgesichtsrucklage und -atrophie stellt die Distraktionsosteogenese eine Therapiealternative dar. Anhand eines groseren Patientenguts und einem bis zu 4-jahrigen Beobachtungszeitraum soll dieses Verfahren evaluiert werden.

Distraction osteogenesis is an established procedure to cope with marked skeletal retrusion or deficiency. A principal theoretical problem with this method is the given length of the distractor unit. Regarding mandibular distraction, some devices allow reactivation of the distractor. For maxillary and midfacial distraction osteogenesis, to date, no report on how to achieve this has been found, creating the rationale for this technical note. Midfacial and maxillary distraction osteogenesis is an accepted therapy for maxillary retrusion and hypoplasia. External, halo-borne devices have been used for more than 15 years as a technical means for that purpose. Under most conditions, a distractor spindle length of over 3 cm will be sufficient for maxillary protraction. Under certain circumstances, however, this length will not be sufficient. A possible reason is subtotal osteotomy, which necessitates higher forces. Therefore forward bending of the extraoral connection rods instead of pure protraction will result, consuming spindle unit length. A further possible reason necessitating resetting is sutural distraction. Within sutural distraction, no osteotomies are perormed and miniplate-based anchoring devices are fixed o the maxilla and inferior zygoma. Because high forces re needed initially, which again lead to an initial bendng of the extraoral rods, the spindle unit length may e exhausted before the desired outcome has been eached.

This study compares plasma endothelin-1 (ET-1) levels in patients with diabetes mellitus or hypertension with healthy controls, and investigates whether ET-1 levels are correlated with glycemic control, metabolic parameters, and vascular complications.The study population consisted of 103 patients with type 1 diabetes, 124 patients with type 2 diabetes, 35 hypertensive patients without diabetes mellitus, and 99 controls.Plasma ET-1 concentrations were significantly higher in patients with type 1 diabetes (0.28 +/- 0.34 fmol/mL, P =.001), type 2 diabetes (0.31 +/- 0.32 fmol/mL, P.0001), and hypertension (0.35 +/- 0.26 fmol/mL, P.0001) compared to controls (0.08 +/- 0.13 fmol/mL). Diabetic patients taking angiotensin converting enzyme (ACE) inhibitors had significantly lower plasma ET-1 levels than patients without (0.22 +/- 0.20 fmol/mL v 0.38 +/- 0.39 fmol/mL, P =.029). There were significant associations between ET-1 levels and age (r = 0.38, P.05) and systolic blood pressure (BP) (r = 0.27, P.05) in healthy controls. In diabetes we found only nonsignificant associations between ET-1 levels and age or vascular complications and a weak association between plasma ET-1 levels and glycemic control.Patients with diabetes or hypertension have elevated ET-1 levels, but do not exhibit positive correlations between ET-1 levels and BP, which was observed in healthy controls. Increased ET-1 levels do not induce hypertension in diabetes, but were lower in diabetic patients taking ACE inhibitors compared to those without ACE inhibitors. There is no significant association between ET-1 levels and vascular complications. These findings suggest that the plasma ET-1 level is not a marker of endothelial dysfunction but changes in plasma ET-1 levels may precede vascular complications associated with hypertension and diabetes.

Background Severe facial trauma is often associated with intracerebral injuries. So it seemed to be of interest to study stress propagation from face to neurocranium after a fistlike impact on the facial skull in a finite element analysis. Methods A finite element model of the human skull without mandible consisting of nearly 740,000 tetrahedrons was built. Fistlike impacts on the infraorbital rim, the nasoorbitoethmoid region, and the supraorbital arch were simulated and stress propagations were depicted in a time-dependent display. Results Finite element simulation revealed von Mises stresses beyond the yield criterion of facial bone at the site of impacts and propagation of stresses in considerable amount towards skull base in the scenario of the fistlike impact on the infraorbital rim and on the nasoorbitoethmoid region. When impact was given on the supraorbital arch stresses seemed to be absorbed. Conclusions As patients presenting with facial fractures have a risk for craniocerebral injuries attention should be paid to this and the indication for a CT-scan should be put widely. Efforts have to be made to generate more precise finite element models for a better comprehension of craniofacial and brain injury. Electronic supplementary material The online version of this article (doi:10.1186/s13049-015-0117-z) contains supplementary material, which is available to authorized users.

Purpose Preformed orbital titanium meshes have been introduced to improve outcomes in the treatment of orbital wall fractures. This study evaluated the geometry of different commercially available orbital meshes and compared them with an average human orbit. Materials and Methods Seven commercially available preformed orbital meshes were scanned using an optical scanner. For comparison, an average orbit was generated from 113 computed tomographic scans of unaffected orbits. Meshes and the average orbit were compared by registration and the calculation of congruence. Results All meshes showed a high similarity within a ±1.5-mm deviation corridor. Major differences were seen in the slope between the orbital floor and the medial wall and in the upturning toward the lateral orbital rim. Conclusion Preformed orbital meshes conform highly to an average orbit, but differ in size and geometry. Using special software, the best fitting mesh could be chosen preoperatively to improve surgical outcome if its geometry were published.

Several staring infrared focal plane arrays differing in size and in detector material are investigated. The temporal noise and the correctability, c, defined as the ratio of the spatial inhomogeneity to the temporal noise, are determined in order to quantify the temporal-noise-equivalent temperature difference and the inhomogeneity-equivalent temperature difference, after various correction procedures, Additionally another figure of merit, the long-term stability time, τ lts , which indicates the transient degradation of the correctability of a focal-plane-array detector is measured. This time quantifies the duration after a nonuniformity correction during which the spatial noise increases to values higher than that of the temporal noise.

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

Fragestellung: Fur Patienten mit hypoplastischem/atrophem Mittelgesicht konnte die Kallusdistraktion eine neue Therapiealternative darstellen. Material und Methoden: Im Zeitraum von Mai 1998–¶Marz 1999 wurden 6 Patienten mit einem extraoralen Distraktor (RED) behandelt. Es handelte sich um 4 Frauen und 2 Manner im Alter von 16–55 Jahren, wobei bei ¶5 Patienten eine Lippen-Kiefer-Gaumen-Spalte vorlag. Im Oberkiefer zahnlos waren 4 Patienten (bzw. es waren maximal 2 Zahne vorhanden). Ergebnisse: Unter schrittweiser Distraktion (1 mm/¶Tag) konnte in allen Fallen eine ausreichende Vorverlagerung des Mittelgesichts erzielt werden (16–¶31 mm). Als Komplikationen traten 1-mal eine Halolockerung sowie temporare „Spannungsschmerzen“ auf. Veranderungen der Sprache (velopharyngeale Insuffizienz) unter oder nach der Distraktion konnten in keinem Fall festgestellt werden. Gemas den bisherigen Resultaten scheint im zahnlosen-atrophen Kiefer eine sagittale Uberkorrektur von etwa 20% angezeigt zu sein. Schlussfolgerungen: Die Kallusdistraktion des Mittelgesichts stellt bei Problemfallen eine Alternative zur konventionellen orthognathen Chirurgie dar. Der Einsatz eines extraoralen Distraktors erlaubt eine ausreichende Kontrolle des Distraktionsvektors, was bei komplexen Bewegungen des Mittelgesichts notwendig ist.