Contemporary Aspects of Orthognatic Surgery

Ortognatska kirurgija se tijekom prošlih 50 godina razvila jednom od standardnih zahvata čeljusne kirurgije. Na osnovama rada Obwegesera, koji je uveo sagitalnu osteotomiju ramusa mandibule početkom 50-tih godina, danas se ova metoda smatra “Gold standardom” mandibularnih ortognatskih zahvata u cijelome svijetu. Luhrov uvod sprava osiguranja centrične pozicije kondilusa tijekom čitavog zahvata ranih 80-ih godina daje dodatnu podršku modernom pristupu sveobuhvatne funkcionalne rehabilitacije pacijenata s disgnatijama. Iako je Wassmund već 20-ih godina uveo LeFort-I-osteotomiju, trajalo je daljnjih 50-ak godina dok je ta tehnika bila prihvaćena u čeljusnoj kirurgiji. Najvažniji razlog tome je ležao u strahu od teških krvarenja do kojih može doći tijekom zahvata. Uvođenjem kompletnog sustava za osiguranje kondilarne pozicije tijekom maksilarne i mandibularne osteotomije pri bimaksilarnim zahvatima, kao i ciljanom korištenju distraktora u određenim indikacijama, u današnje vrijeme kirurgija je u stanju rješiti i najteže slučajeve disgnatia. S iskustvom dužim od 20 godina, te nakon više od 2000 ortognatskih zahvata u našoj klinici, pokušavamo dati široki pregled o razvitku kirurških tehnika te kliničkih rezultata na tom području. Ovaj napredak ne bi bio moguć bez primarne i kontinuirane terapije specifično obrazovanog specijalista ortodoncije tijekom primarne terapije, uključujući interdisciplinarne indikacije za zahvat, ortognatske pripreme pacijenata te postoperativne terapije. Radi toga naglašavamo ortognatsku terapiju te tehničke preduvjete za kirurški zahvat.Orthognatic Surgery within the past half decade has become a standard procedure in cranio-maxillo-facial surgery. Based upon the elementary works by Obwegeser introducing the sagittal split ramus osteotomy in the early 50ies, today this procedure has became the gold standard in mandibular orthognathic procedures worldwide. The introduction of devices to ensure the centric condyle position throughout the entire surgery by Luhr in the early 80ies gives another impact to the modern understanding on a complete functional rehabilitation after dysgnathia. Even though the LeFort-I Osteotomy already was introduced by Wassmund in the 20ies it took almost another 50 years until this procedure became accepted in surgery, mainly based on the fear of severe bleeding that may occur during surgery. By introducing compund condyle positioning device to ensure the exact condyle position troughout both procedures of maxillary and mandibular osteotomy respectively, during combined bimaxillary osteotomies as well as the targeted use of distraction devices, today we are able to solve even severest dysgnathia problems. At the Department of Crani-Maxillo-Facial Surgery of the University of Würzburg during the past two decades and far more than 2000 orthognatic surgery cases we are trying to present a broad overview over the development of the latest surgical techniques and clinical results This progress is not possible without the primary and consistent treatment by a specifically skilled orthodontist during primary treatment including the interdisciplinary indication for surgery, the orthognathic preparation of the patient as well as the postoperative treatment. Therefore special emphasis will be put onto the orthognathic treatment, as well as on the technical prerequisites fo rthe surgical procedure

Factores de éxito en campañas de alimentación saludable : un estudio de casos

Introduction: Public campaigns and interventions are rarely fully evaluated regarding their effectiveness. The analysis of past, successful activities can contribute to the future development of public campaigns and interventions for healthier eating. Objectives: The study of public campaigns and interventions for healthier eating aimed at identifying the underlying success factors and describing their relation. Methods: Interviews were conducted with representatives of 11 cases that had been identified as especially successful in an earlier research step. The interviews were analysed with regard to possible success factors and the latter used to develop a model of success factor interrelation. Results: It was found that success of the cases was first, attributed to characteristics of the macro environment or to public private partnerships in the initiation of campaigns, second, to the engagement of social communities, elements of empowerment of the target group and the implementation of social marketing measures, and thirdly, in citizens adoption of the campaign and in accompanying structural changes. Conclusions: The model and identified success factors underline that success can stem from three crucial phases: the set up of a campaign, the conduction and finally, the interrelation with the citizen. The model can serve as a guide in the future development of campaigns

Results of the Patient-Related Outcomes of Mechanical lead Extraction Techniques (PROMET) study: a multicentre retrospective study on advanced mechanical lead extraction techniques.

AIMS: Several large studies have documented the outcome of transvenous lead extraction (TLE), focusing on laser and mechanical methods. To date there has been no large series addressing the results obtained with rotational lead extraction tools. This retrospective multicentre study was designed to investigate the outcomes of mechanical and rotational techniques. METHODS AND RESULTS: Data were collected on a total of 2205 patients (age 66.0 ± 15.7 years) with 3849 leads targeted for extraction in six European lead extraction centres. The commonest indication was infection (46%). The targeted leads included 2879 pacemaker leads (74.8%), 949 implantable cardioverter-defibrillator leads (24.6%), and 21 leads for which details were unknown; 46.6% of leads were passive fixation leads. The median lead dwell time was 74 months [interquartile range (IQR) 41-112]. Clinical success was obtained in 97.0% of procedures, and complete extraction was achieved for 96.5% of leads. Major complications occurred in 22/2205 procedures (1%), with a peri-operative or procedure-related mortality rate of 4/2205 (0.18%). Minor complications occurred in 3.1% of procedures. A total of 1552 leads (in 992 patients) with a median dwell time of 106 months (IQR 66-145) were extracted using the Evolution rotational TLE tool. In this subgroup, complete success was obtained for 95.2% of leads with a procedural mortality rate of 0.4%. CONCLUSION: Patient outcomes in the PROMET study compare favourably with other large TLE trials, underlining the capability of rotational TLE tools and techniques to match laser methods in efficacy and surpass them in safety

Long-term results of radiotherapy for periarthritis of the shoulder: a retrospective evaluation

<p>Abstract</p> <p>Background</p> <p>To evaluate retrospectively the results of radiotherapy for periarthritis of the shoulder</p> <p>Methods</p> <p>In 1983–2004, 141 patients were treated, all had attended at least one follow-up examination. 19% had had pain for several weeks, 66% for months and 14% for years. Shoulder motility was impaired in 137/140 patients. Nearly all patients had taken oral analgesics, 81% had undergone physiotherapy, five patients had been operated on, and six had been irradiated. Radiotherapy was applied using regular anterior-posterior opposing portals and Co-60 gamma rays or 4 MV photons. 89% of the patients received a total dose of 6 Gy (dose/fraction of 1 Gy twice weekly, the others had total doses ranging from 4 to 8 Gy. The patients and the referring doctors were given written questionnaires in order to obtain long-term results. The mean duration of follow-up was 6.9 years [0–20 years].</p> <p>Results</p> <p>During the first follow-up examination at the end of radiotherapy 56% of the patients reported pain relief and improvement of motility. After in median 4.5 months the values were 69 and 89%, after 3.9 years 73% and 73%, respectively. There were virtually no side effects. In the questionnaires, 69% of the patients reported pain relief directly after radiotherapy, 31% up to 12 weeks after radiotherapy. 56% of the patients stated that pain relief had lasted for "years", in further 12% at least for "months".</p> <p>Conclusion</p> <p>Low-dose radiotherapy for periarthropathy of the shoulder was highly effective and yielded long-lasting improvement of pain and motility without side effects.</p