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Biomedical subjects

Alexander Schramm

Publications and source records attributed to Alexander Schramm.

35 records · Page 2Linked to original sources

Structure and function of a regulated archaeal triosephosphate isomerase adapted to high temperature.

Triosephophate isomerase (TIM) is a dimeric enzyme in eucarya, bacteria and mesophilic archaea. In hyperthermophilic archaea, however, TIM exists as a tetramer composed of monomers that are about 10% shorter than other eucaryal and bacterial TIM monomers. We report here the crystal structure of TIM from Thermoproteus tenax, a hyperthermophilic archaeon that has an optimum growth temperature of 86 degrees C. The structure was determined from both a hexagonal and an orthorhombic crystal form to resolutions of 2.5A and 2.3A, and refined to R-factors of 19.7% and 21.5%, respectively. In both crystal forms, T.tenax TIM exists as a tetramer of the familiar (betaalpha)(8)-barrel. In solution, however, and unlike other hyperthermophilic TIMs, the T.tenax enzyme exhibits an equilibrium between inactive dimers and active tetramers, which is shifted to the tetramer state through a specific interaction with glycerol-1-phosphate dehydrogenase of T.tenax. This observation is interpreted in physiological terms as a need to reduce the build-up of thermolabile metabolic intermediates that would be susceptible to destruction by heat. A detailed structural comparison with TIMs from organisms with growth optima ranging from 15 degrees C to 100 degrees C emphasizes the importance in hyperthermophilic proteins of the specific location of ionic interactions for thermal stability rather than their numbers, and shows a clear correlation between the reduction of heat-labile, surface-exposed Asn and Gln residues with thermoadaptation. The comparison confirms the increase in charged surface-exposed residues at the expense of polar residues.

Adaptation, Physiological↗

Navigation-aided reconstruction of medial orbital wall and floor contour in cranio-maxillofacial reconstruction.

The reconstruction of the anterio-posterior inclination of the medial aspect of the orbital floor, despite a wide 360 degrees exposure, including coronal and conjunctival incisions, is a challenging task in severe injuries of the orbit with massive comminution and complete displacement of the medial orbital wall and orbital floor. Out of a total of 20 patients with orbital fractures, five underwent a surgical intervention of repositioning the medial aspect of the orbital floor and especially the transition area between the orbital floor and medial orbital wall, using navigation-aided procedures. Using the mirroring tool of the Stryker-Leibinger STN-system, post-operative CTs indicated an average difference of the globe position of -4.9% between the operated side and the unaffected side, depending on the position of the medial aspect of the orbital floor. Navigation-aided procedures proved to be an essential precondition for achieving precise and predictable results in orbital reconstruction. In such cases, unlike those with an intact medial orbital wall remnant as a surgical target, bone grafts for reconstruction of the orbital floor cannot be implanted as onlay grafts.

Adult↗

Neuronavigation-assisted cranial reconstruction.

OBJECTIVE: Cranial defects resulting from congenital deformities, ablative resection of osseous tumors, traumatic injury, and destructive infectious lesions are often severe enough to warrant surgical reconstruction. In particular cases, satisfactory cosmetic results may be difficult to achieve because of the extent and location of the lesion. METHODS: We evaluated the role of neuronavigation for reconstruction of large cranial defects with prefabricated titanium and intraoperatively constructed neuronavigation-assisted polymethylmethacrylate implants. RESULTS: Neuronavigation-assisted cranial reconstruction was performed in 14 patients. Surgical procedure, illustrative cases, postoperative results, and apparent benefits of the technique are presented and discussed. In all patients, excellent cosmetic results were achieved. CONCLUSION: In cranial reconstruction, neuronavigation is of value not only for intraoperative determination of resection margins but also for preoperative assessment and planning. The combination of navigation techniques with prefabricated or intraoperatively constructed implants enables achievement of excellent cosmetic results.

Adult↗

Color duplex sonography for the monitoring of vascularized free bone flaps.

OBJECTIVE: When vascular complications are suspected after the microsurgical transfer of free buried fibular bone flaps without a skin island, revision surgery often proves to be unnecessary. We sought to determine the efficacy of color duplex sonography in the close observation of bone graft patency postoperatively. Study design Twelve free fibular bone flaps without a skin island were postoperatively monitored through color duplex sonography with a 7.5-MHz scanner. RESULTS: With color duplex sonography, the rate of perfusion in the vascular pedicle could be visualized in all 12 fibular flaps. In 3 patients, vascular complications and flap failure were suspected. However, because adequate perfusion of the vascular pedicle was observed immediately after surgery and in the daily follow-up examinations, revision surgery was not necessary. CONCLUSIONS: Color duplex sonography is not time-consuming; in fact, it is a reliable, noninvasive, and inexpensive method for the postoperative monitoring of free bone flaps.

Bone Transplantation↗

Maxillary sinus floor augmention with autogenous bone grafts to enable placement of SLA-surfaced implants: preliminary results after 15-40 months.

This study presents preliminary results of placing SLA(R) surfaced ITI(R) implants in conjunction with maxillary sinus floor augmentations using autogenous bone. One hundred and eighty three ITI implants (SLA(R) surface) were inserted after 66 sinus floor elevation procedures in 41 consecutive patients. Forty-eight implants were placed simultaneously and 135 implants in a staged procedure with an average healing time of 4.9 months (148 days) after sinus grafting. Loading of the implants was allowed following an average time of 4.1 months (122 days). The follow-up time was 15-40 months after implant placement. Clinical follow-up consisted of single tooth and panoramic X-rays, and determination of Bleeding On Probing (BOP) and Plaque Index. One implant failed. One hundred and eleven of the inserted implants were used for fixed dentures, 20 for bar constructions, 41 for single crowns, and 11 were loaded provisionally until today. The total 2-year implant survival rate was 99.5%. Keeping the short follow-up period in mind, the encouraging results compared with previous studies, further support the findings of a positive influence of rough surfaces in grafted bone.

Adult↗

Follow-up of condylar fractures of the mandible in 8 patients at 18 months after transoral endoscopic-assisted open treatment.

PURPOSE: The results of endoscopic-assisted transoral approach for open reduction and miniplate fixation of condylar mandible fractures were evaluated 18 months after surgery. PATIENTS AND METHODS: The transoral endoscopic-assisted treatment of condylar fractures was performed in 8 consecutive patients from April 1998 to December 1999 at the University Hospital Freiburg. Four of 8 condylar fractures were dislocated, and 6 of the 8 patients had additional mandibular fractures. RESULTS: Anatomic reduction was achieved in all patients without facial nerve damage. There were no signs of bony resorption and good temporomandibular joint function 18 months after surgery. In 4 patients, the transoral management of condylar fractures was facilitated by angulated drills and screw drivers. Transbuccal stab incisions were not needed in these 4 patients. In all 8 patients, visible scars were avoided. CONCLUSIONS: The endoscopic-assisted transoral approach proved to be a reliable surgical method for condylar fractures when dislocation with lateral override was present.

Adult↗

Characteristics of oral cancer in a central European population: defining the dentist's role.

BACKGROUND: The authors conducted a study to evaluate the effectiveness of dentists in the early detection, treatment and postoperative care of oral squamous cell carcinoma, or SCC, in a central European population. METHODS: This multicenter retrospective study was conducted under the auspices of DOSAK (a German, Austrian and Swiss cooperative group on tumors of the maxillofacial region). A questionnaire was used to evaluate the diagnostic, treatment and postoperative processes involved in managing the care of patients with oral SCC. A total of 3,894 questionnaires was sent to patients who had been diagnosed with and operated on for oral SCC at least six months previously; 1,761 questionnaires were returned. Another 1,652 additional questionnaires were sent to their oral surgeons; 1,543 were returned. RESULTS: The pT staging was pT2 (40.41 percent), pT1 (31.30 percent), pT4 (16.35 percent) and pT3 (11.90 percent). In 61.3 percent of the patients, there was no evidence of metastases. In 40 percent of the patients, the dentist treated the first symptoms, whereas the physician did so in 27 percent of the patients. A total of 72.5 percent of the dentists and 40.11 percent of the physicians identified oral SCC correctly. CONCLUSIONS: Dentists should participate actively in oral cancer patients' rehabilitation processes through regular clinical follow-up examinations and restoration of intraoral function. Clinical Implications. Dentists should conduct an oral cancer screening at each patient visit. Patients who are at risk should undergo more intense surveillance. Dentists should advise their patients to stop high-risk habits such as smoking and help them make choices for healthier lifestyles.

Aged↗

Distraction osteogenesis and tissue engineering--new options for enhancing the implant site.

In severe atrophy of the mandible, implant placement in original bone may not be possible. In this field, augmentation procedures have already been described and controversially discussed. By the use of distraction osteogenesis, bone augmentation without donor morbidity is obtained, while the implant-bone interface remains in original bone. Despite soft tissue expansion during the distraction process, a lack of attached gingiva may cause difficulties at the implant site. In certain cases, an additional soft tissue augmentation procedure has to be performed for a good long-term functional and esthetic rehabilitation. The connective tissue graft and the free gingival graft are recommended to be standard procedures to create a stable periimplant mucosa, but the morbidity and the size limitation of the donor site have to be taken into consideration in selected patients. Transplantation of in vitro-cultured keratinocytes could be an alternative. Distraction osteogenesis and tissue engineering of keratinocytes, as well as bone-cultivating techniques, may increasingly be valuable adjuncts to current augmentation procedures.

Adult↗

Follow-up in patients with oral cancer.

PURPOSE: To provide standardized follow-up of patients who underwent oral cancer treatment, the German-Austrian-Swiss Cooperative Group on Tumors of the Maxillofacial Region (DOSAK) established a schedule of check-up examinations for a 5-year period. MATERIALS AND METHODS: On the basis of a questionnaire, we investigated oncologic follow-up in respect to early detection of recurrences, cost and outcome efficiencies, and physician and patient judgment in the development of impairments. RESULTS: Only 11% of all operated patients participated regularly in the follow-up program within the first 3 years. Ultrasound was the most effective imaging for the detection of recurrences. Swallowing, speaking, tongue mobility, and facial appearance were the most common problems. Troubles with swallowing were mainly induced by poorly fitted dentures, discontinuity of the mandible, osteomyelitis, and xerostomia. Outer appearance was mostly impaired by scars, missing facial muscle function, and edema. The problem of chronic pain remained unsolved. CONCLUSION: Due to the sequelae of treatment, this study shows the need for close medical and psychological follow-up.

Austria↗

Pain, function, and psychologic outcome before, during, and after intraoral tumor resection.

PURPOSE: The aim of the present study was to determine the quality of life of patients with respect to pain before, during, and after ablative intraoral tumor surgery. PATIENTS AND METHODS: The Bochum Questionnaire on Rehabilitation was used to determine 147 items including the morphologic, functional, and psychosocial aspects of rehabilitation. One thousand six hundred fifty-two of 3,500 patients (47.2%) (413 women and 1,239 men) completed the questionnaire. The statistical investigation was carried out using 2-sample (independent) and paired (dependent) t tests. RESULTS: Pain and the functional impairment of chewing and swallowing are the most important parameters before treatment. Immediately after surgical treatment, other variables, such as speech intelligibility and mobility disorders in the head, neck, and shoulder regions, became more apparent. Pain was reported in the shoulder region in 38.5% and in the neck in 34.9% of patients after surgery. The temporomandibular joint was painful in 20.1%, the oral cavity in 18.7%, and the face in 8.2%. Pain was described by 7.4% of patients in other regions of the head. Seventy-five percent of 1527 patients were not taking pain medications during the investigation. The rate of physiotherapy consequently applied after surgery was less than 10%. CONCLUSIONS: Quality of life after ablative intraoral surgery is not greatly affected by pain. Because functional disorders play the dominant role in the impairment of postoperative quality of life, functional reconstruction, using microvascular techniques, and early rehabilitation, including physiotherapy, should be intensified.

Adolescent↗

Navigation-guided resection of temporomandibular joint ankylosis promotes safety in skull base surgery.

PURPOSE: Computer-assisted surgery (CAS) has not been a routine part of craniomaxillofacial surgery to date. This report investigates the use of CAS to promote the safe removal of ankylosed temporomandibular joint bone in the skull base. PATIENTS AND METHODS: Out of a total pool of experience with 102 navigation-guided CAS procedures between January 1998 and December 2000, we report on 2 cases of navigation-aided resection of severe ankylosis of the mandibular condyle with a predetermined safety margin of the resection toward the middle cranial fossa, and identification of the foramen ovale. RESULT: The use of CAS with navigation resulted in the promotion of safe surgical excision of the ankylosed skull base tissue. CONCLUSIONS: We regard navigation-aided resection of an ankylosis fo the mandibular condyle as a valuable additional technique in this potentially complicated procedure.

Adult↗

Quantification of the neurodegenerative impact on the visual system following sudden retrobulbar expanding lesions - an experimental model.

INTRODUCTION: Afferent disorders of the visual system are a potential consequence following orbital trauma. The aim of this study was to investigate the tolerance of neurons in the retinal ganglion cell layer to acute expanding retrobulbar lesions. MATERIAL AND METHODS: In 42 male albino rats, intraorbital haemorrhage was simulated by transconjunctival insertion of a retrobulbar micro-balloon (filling volume 0.2-0.5 ml, duration of lesion 60 or 90 min). Neurodegeneration in the retinal ganglion cell layer was investigated by measuring the mean total neuron number and the mean neuron size. RESULTS: Increased retrobulbar volumes of 0.3 ml for 60 min led to a decrease in a number of neurons by 14.5% and in size of the neurons by 1.7%. Prolongation of the trauma to 90 min resulted in a decrease in number of neurons by 48.3% and in reduction of size of neurons by 22.1%. In contrast, a retrobulbar filling volume of 0.5 ml for 60 min resulted in a decrease in number of neurons by 11.4% and in size of neurons by 6.7%. CONCLUSION: The duration of a retrobulbar lesion leading to subsequent retinal ischaemia seems to be more important for neuron survival than the exerted pressure (once it is greater than a critical point for producing retinal ischaemia). The results strengthen the need for emergency treatment in cases of retrobulbar haemorrhage.

Animals↗

Computer-assisted secondary reconstruction of unilateral posttraumatic orbital deformity.

Until now, computer-assisted surgery has not been practiced as part of the surgical routine of posttraumatic orbital reconstruction. The purpose of this study was to investigate the use of a navigation system for computer-assisted preoperative planning with virtual reconstruction to obtain symmetry of the orbits and intraoperative control of virtual contours in comparison with the clinically achieved surgical results. A further objective of the computer-assisted orbital analysis was to use an ideal measurement for the two-dimensional and three-dimensional changes following orbital reconstruction and to check the equality of the postoperative values for the affected orbits in comparison with those of the unaffected sides. Patients with unilateral posttraumatic orbital defects (n = 18) underwent computer-assisted surgery and preoperative planning using a spiral computed tomography database. Surgical procedures were preplanned with virtual correction by mirroring an individually defined three-dimensional segment from the unaffected side onto the deformed side, creating an ideal unilateral reconstruction. These computer-models were intraoperatively used as virtual templates to navigate the preplanned contours and the globe projection using the Stryker-Leibinger navigation system. Individual noninvasive registration with an overall inaccuracy of approximately 1 mm was achieved by using a maxillary occlusal splint with four markers. The mirroring of the unaffected side allowed an ideal virtual reconstruction. A mean decrease in enlarged orbital volume of 4.0 (SD +/- 1.9) cm was achieved, as was a mean increase in the sagittal globe projection of 5.88 (SD +/- 2.98) mm. With a paired Student test, the decrease between the preoperative and postoperative differences of the affected and unaffected sides was proved significant for orbital volume, globe projection, and computed tomography-based Hertel scale changes (p < 0.01). In 15 of 18 cases, simultaneous malar bone advancement resulted primarily in an additional increase in orbital volume before intraorbital augmentation with calvarial split-bone grafts could be performed. Intraorbital bony augmentation included one (n = 1), two (n = 7), three (n = 8), and all four (n = 2) orbital walls. Computer-assisted preoperative planning enables the surgeon to predict reconstructive surgical steps before the operation. Highly vulnerable structures such as the optic nerve can be detected and avoided intraoperatively, and virtually preplanned bone graft positions and/or orbital frame contours can be checked. Computer-assisted preoperative planning and surgery thus advance the difficult surgical field of orbital reconstruction, particularly through a greater exploitation of radiologic information without additional radiation to the patient.

Adolescent↗

Expression analysis of pediatric solid tumor cell lines using oligonucleotide microarrays.

We identified patterns of differentially-expressed genes in cell lines derived from several pediatric solid tumors. Affymetrix Human Cancer G110 Arrays, carrying 1,700 cancer-associated genes, were applied to a panel of 11 cell lines originating from Ewing tumors (ETs), neuroblastomas, and malignant melanoma of soft parts. Hierarchical clustering clearly differentiated these 3 entities and revealed groups of 75, 102, and 36 gene probe-sets exhibiting tumor-type specific up-regulation in these cell lines, respectively. Whereas ET lines demonstrated increased expression of microtubule-associated protein tau (MAPT), protein phosphatase 1 regulatory subunit 1A (PPP1R1A), NIMA (never in mitosis gene a)-related kinase 2 (NEK2), and cyclin D1 (CCND1), neuroblastoma samples exhibited high expression of wingless-type mouse mammary tumor virus integration site family member 11 (WNT11), Drosophila frizzled homolog 2 (FZD2), and adenomatous polyposis coli (APC) which are involved in regulating free beta-catenin levels. These genes likely maintain tumor-specific characteristics and participate in key downstream regulatory mechanisms. We also correlated the expression levels of up-regulated genes in ETs with their chromosomal localization and compared these data to the comparative genomic hybridization profiles of the cell lines. We demonstrate that gains of genetic material contribute essentially to differential gene expression.

Child↗

Computer-aided procedures in implantology, distraction and cranio-maxillofacial surgery.

Smaller implants and less invasive techniques for osteotomies using an endoscope assisted approach may facilitate the surgical procedures in cranio-maxillofacial distraction osteogenesis. Although sophisticated distraction devices are routinely used, there are still certain problems which need to be addressed. The preoperative planning, even of complex cases can be facilitated by using modern imaging techniques such as computer assisted surgery (CAS). The placement of the devices and the outline of complex osteotomies can be controlled intra-operatively. CAS allows for postoperative monitoring and for the long term follow up. The vector of distraction can be monitored and, depending on the device, a change of the vector of distraction may be possible during the activation period.

Cephalometry↗

Distraction osteogenesis in an anterior mandibular bone defect utilizing lingual periosteal release: a case report.

This clinical report presents a modified distraction technique to achieve height in the vector of distraction. The success of distraction osteogenesis depends on both biologic and biomechanical factors. The focus in this case is on correcting the direction of distraction; incorrect distraction direction is a frequent complication associated with distraction osteogenesis in the mandible. A 21-year-old man presented with a 10-mm vertical bone defect in the anterior mandible caused by facial trauma. The treatment chosen was distraction osteogenesis. After osteotomizing a bone segment and slitting the lingual periosteum, the bone segment was advanced anteriorly 4 mm and an extra-alveolar distraction device was applied. This approach allows the distraction device to be placed vertically, thus preventing lingual shift. The newly created alveolar ridge fully met prosthodontic requirements for a predictable outcome.

Adult↗