bluuebunny/crossref_metadata_2025 huggingface dataset:
Arterial and ductus venosus Doppler in fetuses with absent or reverse end‐diastolic flow in the umbilical artery: correlation with short‐term perinatal outcome
Authors: Müller Thomas , Nanan Ralph , Rehn Monika , Kristen Peter , Dietl Johannes
Published: March 2003

Background.  High perinatal morbidity and mortality rates have been reported in association with absent or reverse end‐diastolic flow velocities in the umbilical artery. Doppler of fetal venous blood flow might be a helpful instrument for predicting fetal outcome. However, clinical data addressing this issue are rare. Thus, the aim of this study was to evaluate arterial and ductus venosus blood flow velocities as a predictor of short‐term outcome in fetuses with umbilical absent or reverse end‐diastolic flow velocities .

Methods.  Thirty‐five high‐risk single pregnancies complicated by umbilical absent or reverse end‐diastolic flow velocities were monitored by serial measurement of the pulsatility index of the umbilical artery, middle cerebral artery, and ductus venosus waveforms over a period of 1–75 days.

Results.  The mean observation period between first detection of an umbilical absent or reverse end‐diastolic flow velocity and delivery was 8.9 days. A significant correlation was found between parameters of short‐term perinatal outcome (art. pH, art. base excess, development of intraventricular hemorrhage, mortality) and end‐diastolic flow velocity waveform or pulsatility index of the ductus venosus waveform, but not with arterial Doppler parameters. Gestational age proved to be the best predictor for duration of assisted ventilation and development of respiratory distress syndrome.

Conclusions.  Our results indicate that in high‐risk pregnancies with umbilical absent or reverse end‐diastolic flow velocities, determination of blood flow velocities in the ductus venosus is a useful additional parameter for prediction of fetal outcome and for timing delivery.
Doppler velocimetry for predicting outcome of pregnancies with decreased fetal movements
Authors: Korszun Przemyslaw , Dubiel Mariusz , Kudla Marek , Gudmundsson Saemundur
Published: March 2003

Aim.  The aim of this study was to evaluate umbilical artery (UA) and uterine artery (Ut.A) Doppler velocimetry in a low‐risk pregnancy group with decreased fetal movements.

Material and methods  Eight hundred and eighty‐eight women were examined because of decreased fetal movements. All fetuses were alive on maternal admission. In all cases, UA and Ut.A Doppler velocimetries were performed, as well as a nonstress test (NST). The managing clinician was informed only of the UA Doppler.

Results.  In the group of 135 women who gave birth within 2 days, UA velocimetry was abnormal in seven fetuses. In 11 cases, Ut.A vascular resistance was abnormal and in 18 cases ‘notch’ was stated. There were 19 emergency sections in this group. Signs of increased placental vascular resistance were correlated with need for operational delivery because of fetal distress. Among the remaining 753 women who delivered after more than 2 days after examination, UA velocimetry showed abnormality in five fetuses. In 42 cases the Ut.A pulsatility index was abnormal and in 118 cases an early end diastolic ‘notch’ was present. There was one perinatal death in this group.

Conclusions.  Decreased fetal movement perception by mothers should be taken seriously. Abnormal placental Doppler was an infrequent finding in these low‐risk pregnancies. However, adding UA and Ut.A Doppler velocimetries to conventional NST surveillance might be reassuring for managing clinicians.
Cesarean section and reoperative mitral valve replacement for thrombosis of a mechanical valve in a 32‐week parturient
Authors: Sharma J. B. , Nigam M. , Tempe A. , Tempe D. K. , Gupta S.
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 89–90. © Acta Obstet Gynecol Scand 2003
Dissection and cotransplantation of large pieces of RPE and neural retina; effect of protease K on the development
Authors: Sharma Rajesh Kumar
Published: March 2003

Purpose: This study attempts to cotransplant large pieces of the RPE and neural retina in the subretinal space of rabbits by using protease K for dissection of the donor tissue, and to investigate the effect of dissection technique on the development of the grafts.

Methods: Eyes from 15‐day‐old pigmented rabbit embryos were partly digested by protease K to assist dissection of sclera and the choroid from RPE and neural retina. Large pieces of RPE and the neural retina thus obtained were cotransplanted into the eyes of adult albino rabbits who were allowed to survive for up to 63 days. The transplants were examined under light microscope.

Results: It was possible to transplant large sheets of RPE and neural retina together. Both the RPE and the neural retina survived after cotransplantation. Retinal pigment epithelium survived in layers, but at places formed clusters. In cotransplants neural retina formed rosettes, developed gliosis, and photoreceptors failed to develop outer segments, possibly due to the action of protease K.

Conclusion: Proteases seem to be injurious for the development of the neural retina.
Helical and conventional CT in the imaging of metallic foreign bodies in the orbit
Authors: Lakits Adalbert , Prokesch Rupert , Scholda Christoph , Nowotny Robert , Kaider Alexandra , Bankier Alexander
Published: March 2003

Purpose: To compare helical CT to conventional CT imaging in the assessment of orbital metallic foreign bodies with regard to image quality, scanning time, and radiation exposure.

Methods: Twenty‐four standardized metallic foreign bodies, placed into the orbit (anterior, epibulbar, posterior) of cadaver heads were studied. Helical CT scanning in the axial plane with multiplanar reconstruction of coronal and sagittal images was performed as well as conventional CT imaging with direct scanning in the axial and the coronal planes (Tomoscan SR 7000, Philips, The Netherlands). Two masked observers consensually graded the studies using 5 predetermined criteria. Radiation dose delivered to the lens and scanning time were measured for the helical and the conventional CT imaging workup.

Results: Helical CT imaging scored statistically significantly better with regard to overall accuracy of foreign body localization and presence of beam‐hardening streak artifacts from dental fillings. Conventional CT scored significantly better with regard to stair‐step artifacts. The radiation dose delivered to the lens was 35.4 mGy for helical CT imaging and 73.9 mGy for conventional CT workup (axial and coronal scanning). Total scanning time was 18 seconds for helical CT axial scanning and 104 seconds for conventional CT axial and coronal scanning.

Conclusion: Helical CT is superior to conventional CT imaging, because it can provide adequate information about orbital metallic foreign bodies with a single acquisition, thus reducing both the number of examinations and the radiation exposure for the patient.
Paediatric laser DCR
Authors: Doyle A , Russell J. , O'Keefe M.
Published: March 2003

Purpose: Endoscopic laser dacrocystorhinostomy is an alternative procedure to external approach DCR in children. We report our results with 5 patients (6 eyes) with congenital nasolacrimal duct obstruction.

Methods: Six endonasal DCR's were carried out using the KTP laser in patients with congenital nasolacrimal duct obstruction resistant to probing and intubation.

Results: The follow‐up ranged from 3–8 months. All patients experienced a recurrence of their symptoms postoperatively.

Conclusion: Endoscopic laser assisted DCR is not a successful procedure in children.
Optic nerve coloboma with retinal degeneration associated with cystic microphthalmia of the other eye
Authors: Theodossiadis Panos , Moschos Michael , Theodossiadis George
Published: March 2003

ABSTRACT. In a seventy‐five‐year old man an optic nerve coloboma with generalised retinal degeneration associated with a cystic microphthalmia of the other eye is described. The MR imaging revealed the existence of a left microphthalmic eye with a lower lid cyst. From the other eye an optic nerve coloboma with a cystic ectasia of the coloboma area freely open to the vitreous cavity was apparent. The ERG recorded from this eye was extinguished.
Visually impaired Swedish children. Longitudinal comparisons 1980–1999
Authors: Blohmé Jonas , Bengtsson‐Stigmar Elisabeth , Tornqvist Kristina
Published: March 2003

Purpose: To produce the background to a pilot‐study of the visual and social outcome of visually impaired children. A study, originally including 219 individuals, done in 1980 in the county of Malmρhus in southern Sweden, was revisited.

Methods: A revision according to current WHO classification led to a cohort of 128 individuals. This was compared to the corresponding group, comprising 2048 individuals, of the total Swedish registration of visually impaired children of today.

Results and conclusion: The two groups were mostly similar as regards male/female distribution, additional impairments, etiological factors and diagnoses. The prevalence of visual impairment due to peri‐/neonatal influence had increased (p=0.038; odds ratio (OR): 1.61, 95% confidence interval (CI): 1.04–2.61), while visual impairment due to prenatal infections had decreased (p=0.0001; OR: 0.26, 95%CI: 0.15–0.49). Regarding diagnoses we saw a significant decrease in chorioretinitis, as well as in microphthalmus and Stargardt's disease, while hypoplasia of the optic nerve increased. In all these, except chorioretinitis, the changes are probably due to altered diagnostic classification.
Chronic bilateral keratitis in autoimmune polyendocrinopathy‐candidiadis‐ectodermal dystrophy (APECED)
Authors: Merenmies Lauri , Tarkkanen Ahti
Published: March 2003

Purpose: To report the outcome of chronic bilateral keratitis and other ocular manifestations in autoimmune polyendocrinopathy‐candidiasis‐ectodermal dystrophy (APECED).

Material and Methods: The material consists of 69 patients with APECED, who were examined by the senior author as referrals from the pediatricians. The patients were seen at the Helsinki University Eye Hospital a total of 370 times and the follow‐up periods range from 2 to 25 years.

Results: 25% of the patients had chronic bilateral keratitis with symptoms of intense photophobia, blepharospasm and lacrimation. On 13 patients the first symptoms appeared before the age of 4 years. Keratitis was the first presenting sign before any evidence of systemic disease in three patients, and in all patients keratitis was among the first three manifestations of the syndrome. The clinical picture from the acute to the chronic cicatricial stage is described. The best corrected visual acuity at the end of the follow‐up was 0.6 or better in six patients only. Of the total material 12 patients had lenticular opacities as the manifestation of hypoparathyroidism.

Conclusions: Chronic bilateral keratitis is an ocular manifestation of APECED and in its etiology both hypoparathyroidism and candidiasis may be ruled out as single causes. When an ophthalmologist is confronted with a young child with bilateral chronic keratitis with symptoms of intense photophobia, blepharospasm, lacrimation and either with mucocutaneous candidiasis or hypoparathyroidism, the patient should be referred to a pediatric endocrinological consultation for the possibility of underlying APECED.
Refractive results of radial keratotomy: a ten‐year retrospective study
Authors: Salamon Suheil Andreas , Hjortdal Jesper Ø. , Ehlers Niels
Published: March 2003

Purpose: To investigate the long‐term effects and stability of refraction after radial keratotomy procedure.

Methods: Radial keratotomy was performed on 123 persons to reduce myopia (range: −1 to −13 diopters) in 1986 to 1989. A mean of 11.5 years later (range 10 to 13), 61 of these patients with 102 eyes underwent a standardised refractive examination where subjective spherical equivalent refraction was measured and compared to the preoperative and the one month postoperative refractive measurement collected from the patients records.

Results: There was a reduction in spherical equivalent from an average of −5.46 diopters (SD 2.38) preoperatively to −2.32 diopters (SD 1.96) 11.5 years postoperatively. The mean change in direction of myopia between 1 month and 11.5 years postoperatively was 0.17 diopters (SD 1.18). This change was not statistically significant. From 1 month to 11.5 years, 10 of the eyes had developed more than 1 diopter hyperopia, and 20 % more than 1 diopter myopia. When asked directly, all patients were satisfied with the result of their operation in general; 2 patients still complained of glare.

Conclusion: No significant changes in refraction were found between 1 month and 11.5 years after radial keratotomy. Previously reported long‐term studies on this field have found a trend toward progressive hyperopia. No evidence of such change can be supported by this study.
Ocular changes in a case of Kyrle's disease. 20‐year follow‐up
Authors: Alyahya Ghassan Ayish , Heegaard Steffen , Prause Jan Ulrik
Published: March 2003

Purpose: To re‐evaluate a case of Kyrle's disease with conjunctival and corneal changes in a 52‐year‐old patient with onset at the age of 5 years.

Methods: Repeated biopsies from the skin, conjunctiva and oral mucosa along with a corneal button obtained from a right eye keratoplasty were examined histopathologically.

Results: The skin, oral, conjunctival and corneal histopathology showed parakeratosis, dyskeratotic cells and single cell keratinization. The clinical picture and the histopathological findings are consistent with the diagnosis of Kyrle's disease.

Conclusions: This is the first reported case of Kyrle's disease with conjunctival changes. We suggest that Kyrle's disease, although predominantly affecting young adults, may also be seen in childhood. The disease may be a genodermatosis. It is not confined only to the skin, but can be seen in mucous membranes like the conjunctiva and buccal mucosa, and in tissues having the same embryological origin as the skin, i.e. the cornea.
Fibrinogen and detached retina with or without proliferation
Authors: Theoharis I. P. , Mangouritsas G. , Feretis E.
Published: March 2003

Purpose: Fibrinogen is a multifunctional molecule, participating in processes such as wound healing, inflammation and cell proliferation. Therefore a comparative study of plasma fibrinogen levels was performed on patients with rhegmatogenous retinal detachment (RRD) and proliferative vitreoretinopathy after RRD (PVR).

Method: Plasma fibrinogen levels were measured preoperatively in three groups of patients; twenty‐two (n=22) patients from the ORL department of our hospital, serving as a control group; twenty‐eight (n=28) patients with RRD; and twenty (n=20) patients with PVR after RRD. Patients' ages were matched for all three groups; diabetics and patients with cardiovascular disease were excluded. T‐Student's test was performed for the comparison of the plasma fibrinogen mean values of the aforementioned groups.

Results: Statistically significant (p value: 0.013) elevation of fibrinogen plasma levels was observed in patients with RRD compared to those of the control group. In addition, patients with PVR had significantly higher plasma fibrinogen levels (p value: 0.03) than RRD patients.

Conclusion: The results suggest a correlation between fibrinogen plasma levels and the development of RRD and PVR.
Adverse ocular effects of flecainide
Authors: Ikäheimo Kirsi , Kettunen Raimo , Mäntyjärvi Maija
Published: March 2003

ABSTRACT. Purpose: To study if flecainide has ocular adverse effects.

Methods: Both eyes of 38 flecainide medicated patients were thoroughly examined including colour vision, contrast sensitivity and visual fields.

Results: 10.5% of the patients had blurred vision on lateral gaze lasting for a couple of seconds. Small corneal deposits were found in 14.5% of the patients. All visual function tests were normal.

Conclusion: Flecainide seems to be a safe drug with minimal ocular adverse effects.
Cone photoreceptors in laminated retinal transplants
Authors: Gjörloff K. , Bruun A. , Ghosh F.
Published: March 2003

ABSTRACT. Purpose: To investigate the contents of green‐ and blue‐sensitive cone photoreceptors in laminated rabbit retinal transplants.

Methods: Eleven rabbits each received a sheet of embryonic neuroretina into the subretinal space in one eye. Vitrectomy was used in the procedure and properly polarized flat transplants were placed on the host pigment epithelium. After 17–309 days the transplants were examined immunohistochemically with specific antibodies against COS‐1 (green‐sensitive cones) and OS‐2 (blue‐sensitive cones).

Results: All grafts displayed normal lamination with well developed photoreceptor outer segments apposed to the host retinal pigment epithelium. Occasionally, rosettes were found at the transplant edges. Both COS‐1 positive and OS‐2 positive cones were detected. In the laminated part of the grafts, COS‐1 positive cones were more numerous than OS‐2 positive ones. In the rosetted parts of the transplants the relationship between the cones was reversed.

Conclusion: Full‐thickness embryonic rabbit retinal transplants develop into laminated retinas with well‐developed photoreceptor outer segment. Both green‐ and blue‐sensitive cone photoreceptors are present and the ratio between the two cone types is the same as in the normal adult rabbit retina.
Small incision trabeculectomy: experiences with this new procedure for glaucoma surgery in Indian eyes
Authors: Das J. C. , Sharma Pankaj , Chaudhuri Zia , Bhomaj Sharad
Published: March 2003

ABSTRACT. Purpose: The purpose of this study was to evaluate the potential advantages and disadvantages, success rate and complications of this new procedure for glaucoma surgery, which includes the formation of a filtration fistula without any dissection of the Tenon’s capsule; as an alternative to trabeculectomy with or without pharmacological wound modulation.

Methods: Small Incision Trabeculectomy avoiding Tenon’s capsule was performed in 40 glaucomatous eyes through a 2.5 mm limbal incision and intraocular pressure was monitored serially over a period of 12 months.

Results: The mean postoperative intraocular pressure (16.60±5.93 mmHg) at 12 months follow‐up was significantly lower than the mean preoperative IOP (30.20±10.70 mmHg). Thirty‐six eyes (90%) had IOP less than 22 mmHg without antiglaucoma medications at the end of the 12‐month follow‐up. Blebs were pale and diffusely elevated. No serious complications were encountered.

Conclusion: This new technique is a low‐cost and safe alternative to conventional trabeculectomy that effectively reduces intraocular pressure. The use of a small 2.5 mm incision which obviates the dissection of the Tenon’s capsule and subsequent subconjunctival fibrosis, the absence of requirement of any sophisticated instruments, and the absence of any major complications which are encountered with the use of anti‐metabolites entails that this procedure be performed more often in glaucomatous eyes needing filtration surgery.
Uveal melanomas with optic nerve extension: Report of two cases diagnosed by transvitreal biopsy, one of them with a multicentric tumour
Authors: Eide Nils , Syrdalen Per , Scheie David , Chen Ying , Elgjo Kjell , Kerty Emilia , Brabrand Knut
Published: March 2003

ABSTRACT. Purpose: To report two cases of invasive uveal melanomas, one of which showed multifocality.

Methods: Clinical examination, ultrasonography, colour Doppler analysis, cytological and histopathological evaluations.

Results: Transvitreal biopsy (case 1) or fine needle aspiration biopsy (FNAB) (case 2) revealed malignant melanomas in both patients. Light microscopy and immunohistochemical examinations substantiated the diagnosis of mixed cell type melanomas. In addition, one patient had a multifocal melanoma with papilloedema and colour Doppler findings suggestive of optic disc involvement.

Conclusion: Transvitreal biopsy for histology or cytology is a reliable procedure to obtain an accurate diagnosis without delay of a lesion adjacent to the optic nerve head. In our two cases the biopsy findings led to enucleation.
Data reliability and structure in the Swedish National Cataract Register
Authors: Håkansson Ingemar , Lundström Mats , Stenevi Ulf , Ehinger Berndt
Published: March 2003

Purpose: A Swedish National Cataract Register was instituted in 1992, monitoring nearly all cataract operations in Sweden, and since its inception comprising about 95% of all operations. Data from a total of approximately 290 000 operations have been collected during 1992–1998. Data quality is an important factor, and we have therefore assessed the various types and frequencies of data entry errors in the material.

Methods: The medical records for all operations in five selected participating clinics were retrieved for a set month. Each data transfer step from the record to the final data base was monitored for a total of 574 operations. A total of 10 variables were recorded for each operation.

Results: Significant sources of error were absent in most variables. However, possibly important errors appeared in three: “date entering waiting list”, “preoperative best corrected visual acuity in the operated eye”, or “visual acuity in the fellow eye”. There were also noteworthy variations between the five clinics, different for different parameters. Errors were predominantly prone to appear at the very first step of registration. In most cases this was due to deviations from the data collection instructions.

Conclusions: The reliability is good for most values entered into the register, but it is important to ensure that data definitions are exact and adhered to. Repeated information to the involved persons on how to fill in the forms appears to be a requisite for maintaining good input quality.
Visual acuity, residual amblyopia and ocular pathology in a screened population of 12–13‐year‐old children in Sweden
Authors: Ohlsson Josefin , Villarreal Gerardo , Sjöström Anders , Abrahamsson Maths , Sjöstrand Johan
Published: March 2003

Purpose: To establish the distribution of visual acuity and the prevalence of residual amblyopia and other ocular disorders in a vision‐screened population group of 12–13‐year‐old children.

Methods: In total 1046 children were examined in a field study in Sweden. The examination included visual acuity, stereopsis, cover testing, red reflex, refractive retinoscopy and examination of the posterior pole. In selected cases VEP was also performed.

Results: Visual acuity ≥1.0 in at least one eye was present in 98% of cases. Residual amblyopia (≤0.5) was found in 1.1% of the population. Manifest strabismus was found in 2.7%. There were only a small number of ocular opacities and posterior pole abnormalities. Ocular albinism was found in 7 cases. In 15 children the cause of subnormal VA was unexplained.

Conclusion: Results for visual acuity, residual amblyopia and other ocular disorders are very similar to previous Nordic, vision‐screened populations.
Repeated UVR exposures cause keratocyte resistance to apoptosis and hyaluronan accumulation in the rabbit cornea
Authors: Podskochy Alexander , Fagerholm Per
Published: March 2003

Purpose: To evaluate hyaluronan (HA) production and level of apoptosis of corneal cells after repeated UVR exposures.

Methods: Fifteen albino rabbit corneas were exposed to 310 nm UVR at a dose that causes biomicroscopically significant keratitis (0.47 J/cm2). Nine rabbits received a single dose of UVR. Six rabbits were irradiated 3 times at 7‐day intervals. Rabbits exposed to the single dose of UVR, were sacrificed 24 hours, 7 and 14 days after irradiation. Rabbits exposed to the repeated doses of UVR, were sacrificed 24 hours and 14 days after the last irradiation. The corneal tissue specimens were processed for histological analysis using specific staining for HA, and the TdT‐dUTP terminal nick‐end labeling (TUNEL) assay.

Results: Corneas exposed to a single UVR dose showed extensive positive TUNEL staining 24 hours after exposure. Almost all basal epithelial cells, keratocytes throughout the entire thickness of the stroma, and endothelial cells were TUNEL‐positive. No HA was found 24 hours after exposure. Extracellular HA staining of high intensity was found at day 7 throughout the entire central stroma, except the anterior one‐fourth. At day 14 only a faint HA staining was detected in the posterior stroma, close to Descemet’s membrane. Corneas exposed to repeated UVR doses showed at 24 hours positive TUNEL staining only in epithelial cells and in very few stromal cells. The majority of stromal cells and endothelial cells were unaffected. At the same time HA staining of very high intensity was found both at 24 hours and day 14, and it was evenly distributed throughout the entire thickness of the stroma.

Conclusion: Repeated UVR exposures lead to increased production and accumulation of HA in the corneal stroma. The repopulated keratocytes are much more resistant to apoptosis than the native ones. HA accumulation may be a sign of long‐term changes in the cornea.
Survey of laboratory findings in suspected cases of bovine spongiform encephalopathy in Denmark from 1990 to 2000
Authors: Agerholm J. S. , Tegtmeier C. L. , Nielsen T. K.
Published: March 2003

A survey of the laboratory findings in suspected cases of bovine spongiform encephalopathy (BSE) in Denmark from 1 June 1990 to 31 December 2000 is presented. During this period BSE was a notifiable disease, and the heads of suspected cases were submitted according to the legislation on BSE. A total of 176 submissions were made, mostly from bovines with neurological disorders and mainly during the last 3 years of this period. Lesions or other laboratory findings consistent with severe neurological disorders were found in 115 cases. The most frequent diagnosis was encephalic listeriosis (35.8% of submissions) followed by other forms of inflammatory lesions. A wide range of lesions were diagnosed less prevalent. BSE was diagnosed twice. The first case occurred in an imported cow in 1992, while the second confirmed case was diagnosed in a native cow in February 2000. A marked increase in the number of submissions occurred following the detection of BSE in February 2000.
Phenotypic and genotypic characterisation of blood isolates of coagulase‐negative staphylococci in the newborn
Authors: Björkqvist Maria , Söderquist Bo , Törnqvist Eva , Sjöberg Lennart , Fredlund Hans , Kühn Inger , Colque‐Navarro Patricia , Schollin Jens
Published: March 2003

Coagulase‐negative staphylococci (CNS) are the leading cause of late‐onset sepsis in newborns (>72 h of age). Our aim was to determine whether phenotypic and/or genotypic differences existed between blood isolates of CNS regarded as inducers of sepsis or as contaminants. Ninety‐seven bloodisolates of CNS recovered from newborns at the neonatal intensive care unit, Örebro, Sweden in 1983–1997 were analysed. Twenty‐nine of them (30%) were classified as sepsis isolates and 68 (70%) as contaminants. The most prevalent species was Staphylococcus epidermidis (n=59). Staphylococcus haemolyticus (n=16) was most often isolated from newborns with the lowest gestational age and birth weight. Biochemical typing using the Phene Plate system (PhP) and genotyping using pulsed‐field gel electrophoresis (PFGE) showed that the S. epidermidis isolates regarded as inducers of sepsis (n=16) were more homogeneous than isolates considered contaminants (n=37). One main genotypic group, representing seven (44%) isolates, was identified among the sepsis isolates. Phenotypically the S. epidermidis sepsis isolates comprised three major clusters. In contrast, among the S. epidermidis contaminants, eight genotypic groups and two phenotypic clusters were identified. The dominating genotypic group among the sepsis isolates of S. epidermidis may represent strains with higher invasive capacity.
Postnatal development of β‐cells in rats
Authors: Svenstrup Kirsten , Skau Maren , Pakkenberg Bente , Buschard Karsten , Bock Troels
Published: March 2003

The previously shown wave of β‐cell apoptosis and the apparent plateau in the β‐cell mass in the third week of life in rats are still unexplained events. Using a novel design‐based stereological method we investigated the postnatal development of the β‐cell population in Sprague‐Dawley rats. The total β‐cell mass increased from postnatal day 4 until day 16, to be followed by a plateau until day 24, after which it increased further. This plateau was caused by β‐cell hypotrophia as well as decreased net β‐cell formation. The β‐cell mass per unit body weight (the relative β‐cell mass) was five times higher at birth compared with the adult constant level that was reached at approximately 24 days of age. We propose an explanatory model for the postnatal development of the β‐cell population in rats. According to this model, β‐cells in the early postnatal period are immature, i.e. are not susceptible to the mechanism that in later life maintains a constant relative β‐cell mass. Within the following weeks the number of mature β‐cells increases, and from approximately day 24 and onwards the β‐cell population is dominated by mature β‐cells that adjust to match the body weight, keeping a constant relative β‐cell mass. Findings of an apoptotic wave, a plateau phase in the total β‐cell mass development, a period with β‐cell hypotrophia, and the disappearance of insulin‐like growth factor II positive β‐cells at postnatal day 21 all fit well in the model.
Primary colorectal carcinomas and their intrapulmonary metastases: Clinical, glyco‐, immuno‐ and lectin histochemical, nuclear and syntactic structure analysis with emphasis on correlation with period of occurrence of metastases and survival
Authors: Kayser Klaus , Zink Stefan , André Sabine , Schüring Max‐Peter , Hecker Erich , Klar Ernst , Bovin Nicolai V. , Kaltner Herbert , Gabius Hans‐J.
Published: March 2003

Background.
The aim of the study was to correlate clinical factors (disease‐free interval/survival) with growth pattern in terms of structural entropy of patients with primary colorectal carcinomas and secondary lung lesions.
Methods.
Proliferation and apoptosis markers as well as determinants involved in information transfer by protein‐carbohydrate interactions were monitored. The clinical history, surgical and histopathological reports, tumor load, survival of the patients with a maximum follow‐up of 14 years, and sections of paraffin blocks of 60 colorectal carcinoma specimens and their pulmonary metastases were examined. Measurements of the staining intensities after processing sections of primary and secondary carcinomas with the marker panel and calculations of syntactic structure and stereological parameters were performed.
Results.
The majority of primary tumors (80%, 49/60) were surgically treated at advanced tumor stages (pT3/pT4), with detectable lymph node involvement (34/60). Lung metastases were resected after a median disease‐free interval of 30.5 months, an average of 3.0 metastases adding up to a mean intrapulmonary tumor load of 9.98 ccm. The median survival was calculated to be 82 months after resection of the colon/rectal carcinomas and 40 months after that of intrapulmonary metastases. It was correlated with certain structural and vascular features such as vascular circumference. The proliferation index and several textural features were strongly associated with vascularization in primary and secondary tumors.
Conclusions. Despite intra‐ and interindividual variations, vascularization properties and features such as bcl‐2 positivity and CEA‐ and galectin‐3‐associated structural entropy in primary tumors or metastases are described as independent prognostic features. Absence of lymph node involvement or limited tumor stages of colon/rectal carcinomas should not exclude patients from thorough postsurgical scrutiny to detect lung metastases.
Posterior jaw bone resorption in osseointegrated implant‐supported overdentures
Authors: Jacobs R. , Schotte A. , Van Steenberghe D. , Quirynen M. , Naert I.
Published: March 2003

For several years, osseointegrated implant‐supported overdentures have been used in the rehabilitation of full edentulism with excellent results, at least in the lower jaw. This study involved 3 groups of patients with different prosthetic reconstructions:(1) mandibular overdentures supported by 2 implants connected by a bar (30 patients), (2) mandibular fixed prostheses supported by 4–6 implants (25 patients) and (3) mandibular complete dentures without implant support as controls (85 patients). The primary aim of this study was to examine on orthopantomograms (by means of the area index to minimize distortion and magnification errors), posterior mandibular ridge resorption in the 3 treatment groups. The present data demonstrated a minimal posterior mandibular ridge resorption in patients with fixed implant‐supported prostheses. A more considerableposterior ridge resorption was observed in the complete denture group and especially in the overdenture wearers. For the latter, the annual posterior jaw bone resorption after the post‐extraction remodeling period of 6 months, was 2‐ to 3‐fold that of full denture wearers. When patients were edentulous for more than 10 years, the difference between the 2 latter groups disappeared. It is suggested that although the overdenture design on 2 implants offers advantages from a financial and failure rate point of view, its indications in younger patients should cautiously be evaluated in a long‐term perspective concerning posterior mandibular bone resorption.
Plaque‐induced marginal tissue reactions of osseointegrated oral implants: a review of the literature
Authors: Hämmerle C. H. F. , Schou S. , Holmstrup P. , Hjorting‐hansen E. , Lang N. P.
Published: March 2003

An intimate contact between bone and titanium implants was first demonstrated in 1969. and since then the bone‐implant interface of osseointegrated implants has been investigated extensively. However. investigations of the marginal tissues and the microflora associated with osseointegrated implants have almost exclusively been carried out over the last decade. This review covers the clinical, radiographic, histologic, and microbiologic studies of marginal tissues of osseointegrated oral implants. In general, successfully osseointegrated implants exhibit low amounts of plaque con‐comitant with the absence of marginal inflammation. However, plaque accumulation may cause inflammatory reactions around the implants, sometimes giving rise to mucosal hyperplasia. Apparently, keratinized mucosa is not a requisite for the maintenance of peri‐implant health if oral hygiene is adequate, but the presence of peri‐implant keratinized mucosa is generally advocated. Alveolar bone loss around successful implants is minimal, but significant focal loss may occur due to plaque‐induced inflammation or perhaps repeatedly extensive implant load. The progression of plaque‐induced alveolar bone loss of osseointegrated implants may be different from that of teeth. It is unknown whether simultaneous marginal inflammation and excessive implant load further increase the loss of alveolar bone height. Both the light microscopic and ultrastructural characteristics of marginal tissues of implants and teeth are similar except for a lack of root cementum with inserting gingival collagen fibers of implants. Clinical inflammatory reactions are histologically characterized by an increased number of inflammatory cells infiltrating the connective tissue. The scattered subgingival microbiota associated with osseointegrated implants surrounded by healthy or slightly inflamed marginal tissues is similar to that of teeth with healthy gingiva. The microbiota associated with implants affected by marginal inflammation and bone loss is complex and consists predominantly of gram‐negative anaerobic rods: this. again, is a similarity to periodontal disease.
Immediate implant placement using a biodegradable barrier, polyhydroxybutyrate‐hydroxyvalerate reinforced with polyglactin 910. An experimental study in dogs.
Authors: Gotfredsen K. , Nimb L. , Hjørting‐hansen E.
Published: March 2003

The purpose of this study was to evaluate the use of a biodegradable membrane of polyhydroxybutyrate‐hydroxyvalerate copolymer reinforced with polyglactin 910 fibers, as an occlusive barrier over implants placed into fresh extraction sockets. Ten dogs had the 3rd and 4th mandibular premolars extracted bilaterally. Each dog had 4 Astra Dental Implants® placed directly into the fresh extraction sockets. The top of the fixtures was placed at the same level as the top of the buccal cortical bone. The two implants in the right side were covered with the hydrolyzable polyester material (polyhydroxybutyrate‐hydroxyvalerate reinforced with polyglactin 910 fibers; PHB‐HVIPG). and the 2 implants in the left side were controls without occlusive membranes. Soft tissue dehiscences were registered for half of the implants in the test side but were not noted in the control side. The histomorphological measurements after 12 weeks showed that the mean distance from the top of the fixtures to the first bone‐to‐implant contact was significantly greater than for the control side. The membrane‐covered implants without dehiscences showed also significantly less bone fill compared with the control side. Inflammatory cell infiltrates were seen adjacent to all PHB‐HVIPG membranes, and frequently the membrane material was surrounded by a fibrous tissue capsule. The polyester membranes used in this study interfered with the marginal bone healing adjacent to the immediately placed implants. An increased inflammatory reaction and significantly less marginal bone healing was registered in the membrane side compared with the control side.
Microbial penetration along the implant components of the Brånemark system®. An in vitro study.
Authors: Quirynen M. , Bollen C. M. L. , Eyssen H. , Van Steenberghe D.
Published: March 2003

This study examined in vitro the existence of microbial leakage along the components of the Brånemark® implant system. Thirty‐two implant/abutment assemblies were installed in a liquid blood medium previously inoculated with oral micro‐organisms. To examine the leakage at the implant abutment interface, 16 assemblies were partially immersed. The remaining 16 were completely immersed to observe the leakage at both the implant abutment and abutment‐prosthesis interface. After 7 days of an‐aerobic incubation, the micro‐organisms in the internal part of the implants were collected and incubated on blood agar plates in anaerobic conditions. Micro‐organisms were found in the completely immersed assemblies and at lower numbers in the partially immersed implants, indicating that bacterial leakage at both levels seems to exist. Several penetrating bacteria have been associated with peri‐implantitis. The clinical importance of this bacterial leakage is not yet well understood. Although the longevity of the Brånemark® implants is well documented, this bacterial leakage might play a role in peri‐implantitis. both in the etiology as well as in the treatment.
Acute‐phase proteins and immunoglobulin G against Porphyromonas gingivalis in peri‐implant crevicular fluid: a comparison with gingival crevicular fluid
Authors: Adonogianaki E. , Mooney J. , Wennström J. L. , Lekholm U. , Kinane D. F.
Published: March 2003

This investigation had 2 aims: 1) to determine the levels of acute‐phase proteins and immunoglobulin G (IgG) against Porphyromonas gingivalis in peri‐implant crevicular fluid (PICF) and their association with the clinical condition of the peri‐implant mucosa; and 2) to compare the inflammatory and immunological responses at implants and teeth as reflected by the gingival crevicular fluid (GCF) and PICF levels of acute‐phase proteins and immunoglobulins. Thirty‐one partially edentulous subjects were recruited for this study. PICF was sampled from 1 healthy and 1 inflamed site from each patient; GCF was sampled from an additional 21 healthy and 27 inflamed tooth sites of the same patients. GCF and PICF were collected with paper strips (for 30 s) and analysed using enzyme‐linked immunosorbent assays for α2‐macroglobulin, α1‐antitrypsin, transferrin, lactoferrin and IgG against P. gingivalis. This investigation demonstrated that the absolute amounts of the acute‐phase proteins and IgG against P. gingivalis are higher in GCF and PICF from inflamed than healthy sites. No significant differences were observed between PICF and GCF components at either healthy or inflamed sites, suggesting that inflammatory and immune events are similar in the peri‐implant mucosa and gingiva in humans and that PICF and GCF production is governed by similar mechanisms.
Comparison of healed tissues adjacent to submerged and non‐submerged unloaded titanium dental implants. A histometric study in beagle dogs.
Authors: Weber H. P. , Buser D. , Donath K. , Fiorellini J. P. , Doppalapudi V. , Paquette D. W. , Williams R. C.
Published: March 2003

This study involved histometry of the healed tissues around submerged and nonsubmerged dental implants in beagle dogs. In a split‐mouth design, 19 submerged and 19 nonsubmerged commercially pure titanium implants, titanium plasma‐sprayed in the bone anchoring part and smooth in the transmucosal portion were placed in the mandibles of 6 dogs. Oral hygiene was performed 3 times weekly. After 3 months of healing, transmucosal abutments were inserted in the submerged implants. Six weeks after second stage surgery, the dogs were sacrificed and specimens obtained and processed for histology and histometry. Using a light microscope and a digitizing pad, the distance from implant top to mucosa border (DIM), the extent of epithelial downgrowth (ED), the attachment level (AL). the length of connective tissue contact (CTC) and the distance of the first coronal alveolar bone contact from the implant top (DIB) were measured at the mesial and distal aspects. Means+standard deviations for submerged and nonsubmerged implants were calculated, with the dog being the unit of measure. No statistically significant differences between submerged and nonsubmerged implants here found for DIM, CTC and DIB. However, significant differences were observed for ED and AL. This study in beagle dogs indicates that the apical extension of the peri‐implant epithelium is significantly greater and the attachment level significantly lower adjacent to submerged implants with second‐stage transmucosal abutments than in nonsubmerged, one‐stage implants.
Microbiology of ligature‐induced marginal inflammation around osseointegrated implants and ankylosed teeth in cynomolgus monkeys Macaca fascicularis)
Authors: Schou S. , Holmstrup P. , Keiding N. , Fiehn N.‐E.
Published: March 2003

The microbiota associated with ligature‐induced marginal inflammation around osseointegrated dental implants, ankylosed teeth, and normal control teeth was investigated in 8 cynomolgus monkeys (Macaca fascicularis). Submucosa;/subgingival plaque was sampled with paper points on the day of ligature placement and after 7 weeks. The samples were evaluated by phase‐contrast microscopy and by cultivation on enriched non‐selective and various selective solid media. The submucosal/subgingival flora was changed 7 weeks after ligation. The total number of cultivable bacteria and the proportions of motile rods, anaerobic Gram‐negative rods, black‐pigmented rods, Porphyromonas gingivalis, and Prevotella intermedia increased significantly around implants, ankylosed teeth, and normal control teeth. Except for a significantly higher proportion of anaerobic Gram‐positive cocci around implants compared to ankylosed teeth and normal control teeth at the end of the study, no significant microbiological differences were observed between implants, ankylosed teeth, and normal control teeth neither at baseline nor at the end of the study. Consequently, the microbiota associated with marginal inflammation around implants, ankylosed teeth, and normal control teeth appears to he rather similar in cynomolgus monkeys.
Immunological responses to maxillary on‐lay allogeneic bone grafts
Authors: Köndell P. Å. , Mattsson T. , Åstrand P.
Published: March 2003

4 patients with severely resorbed maxillae underwent rehabilitation with on‐lays of allogeneic femoral head bone grafts, titanium implants (Brånemark System®) and fixed prostheses. Donors and recipients were matched according to blood groups (ABO/Rh). Potential immunological responses were monitored by determining autoantibodies in peripheral blood, and inflammatory reactions in the recipient site. Biopsies from the bone graft 6 months after grafting showed vital bone. After a mean observation period of 19.5 months, 22 of 23 implants were osseointegrated. None of the investigated autoantibodies were detected in peripheral blood, and there was no local inflammatory response. Allogeneic bone grafts in combination with titanium implants can be used in reconstruction of edentulous severely resorbed maxillae without immunological reactions directed against the graft.
Influence of different parameters on bone heating and drilling time in implantology
Authors: Reingewirtz Y. , Szmukler‐moncler S. , Senger B.
Published: March 2003

The influence of various parameters on bone heating during drilling and drilling time was studied in vitro in a bovine cortical femur model. Drilling using a standard, a surgical or a laboratory motor unit did not affect bone temperature elevation. For a given speed, low l/40 reduction contra‐angle was more effective in moderating temperature elevation when compared to l/10 reduction; but drilling time in this case (l/40) had to be doubled. Enhancing the drilling load from 0.8kg to 2kg had little effect on temperature elevation at 400 μm and 800 μm (<3°C). Drilling time drastically decreased and was inversely proportional to the square of the load. Predrilling did not affect temperature elevation, but decreased drilling time. From 400 rpm to 10,000 μm, temperature elevation was positively correlated with drilling speed. It further decreased up to 24,000 μm and then was constant up to 40,000 μm. Drilling time was proportionally reduced with increased rotation speed. Strikingly, heat was largely dissipated within 10 s at high rotation speed. The use of a cryogenic spray at 24.000 μm allowed the reduction of temperature elevation. Finally. protection from temperature elevation according to above parameters is suggested.
A 5‐year randomized clinical trial on the influence of splinted and unsplinted oral implants in the mandibular overdenture therapy. Part I: peri‐implant outcome.
Authors: Naert Ignace , Gizani Stella , Vuylsteke Magda , Van Steenberghe Daniel
Published: March 2003

Thirty‐six completely edentulous patients were enrolled for a 5‐year prospective study testing the treatment outcome between splinted and unsplinted implants retaining a mandibular hinging overdenture. The patients were randomized into 3 groups of equal size depending on the attachment system used such as: magnets, ball attachments or bars (reference group). Only 1 implant out of the 72 had failed at the abutment stage. Not a single implant failed during the 5‐year loading period. The accumulation of plaque was significantly higher for the Magnet than for the Ball group. Bleeding on probing, as well as marginal bone level, attachment level and Periotestg values did not statistically differ among the groups, neither at year 1 nor at year 5. However, the Periotestm values were significantly lower at year 5 compared to year 1 for all groups, which indicates a higher rigidity at the bone‐implant interface. No correlation was found between bleeding on probing and marginal bone loss. We conclude that the connection state of 2 implants retaining a hinging overdenture did not influence the peri‐implant outcome.