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Trotz moderner digitaler Schnittbildverfahren ist die Orthopantomographie unverandert die breit verfugbare, haufig angewandte Basisuntersuchungsmodalitat zur Beurteilung des Zahnstatus vor umfangreichen Therapien wie auch entzundlicher und tumoroser odontogen-ossarer Pathologien. Das klassische Rontgentomographieprinzip wurde fur die Darstellung der unterschiedlich breiten, formvarianten Zahn-Kiefer-Bogen weiterentwickelt. Die Untersuchungseinheit aus starr miteinander verbundener Rontgenrohre und Detektor lauft auf einer ellipsenahnlichen Bahn um den Gesichtsschadel. Dabei werden verschiedene Drehzentren angesteuert. Durch die unterschiedlichen Abstande der Kieferabschnitte zu Rontgenrohre und Bildempfanger resultieren differierende Geschwindigkeiten und damit Verwischungseffekte als Grundlage der Schichtdarstellung. Schlitzblenden fuhren zu einer schmalen, kontinuierlich ablaufenden zeilenartigen Darstellung der unterschiedlich breiten Zahnbogenanteile.

Medikamenteninduzierte Osteonekrosen der Kiefer stellen ein relativ neues, multifaktoriell ausgelostes Krankheitsbild dar. Erkrankungen mit erhohter Knochenresorption werden heute breit mit Antiresorptiva therapiert. Aufgrund des aktiven Knochenstoffwechsels, insbesondere im Unterkiefer, kann es bei gestorter Barrierefunktion in der Mundhohle sowie kompliziert durch systemische Begleiterkrankungen in Abhangigkeit von Dauer, Intensitat und Applikation der antiresorptiven Therapie zu Osteonekrosen kommen. Wegen des besonderen Einflusses dieser Veranderungen auf die Lebensqualitat und wegen des komplexen Therapiemanagements kommt der Fruherkennung bzw. der Ausdehnungsbestimmung durch die Bildgebung eine besondere Bedeutung zu. Die Orthopantomographie der Kiefer stellt eine gute Basisuntersuchung, vor allem auch fur die Detektion dentogener Ursachen als mogliche Differenzialdiagnose, dar. Die dreidimensionalen bildgebenden Verfahren wie die Computertomographie (CT) und insbesondere die Magnetresonanztomographie (MRT) konnen aber ossare Veranderungen wesentlich sensitiver detektieren und die in hoheren Erkrankungsstadien manifesten komplexen Pathologien erfassen.

Despite the increasing use of modern digital cross-sectional imaging techniques (especially digital volume tomography) in dental X‑ray examinations, orthopantomography remains the widely available, commonly used basic imaging modality for evaluating dental status prior to extensive treatment. It is also used for inflammatory and tumorous odontogenic osseous pathologies which are demonstrated with typical imaging findings. The classical X‑ray tomography principle has been further developed for the presentation of the differently wide, shape variants of dental arches. The examination unit, consisting of a rigidly connected X‑ray tube and detector, runs on an elliptical path around the facial skull. Thereby different rotation centers are controlled. Due to the different distances of the jaw sections to the X‑ray tube and the image receiver, differencing velocities result and thus blurring effects as the basis of the layer or slice representation. Slit collimators lead to a narrow and continuous line-like representation of the different widths of the dental arch.

Drug-induced osteonecrosis of the jaw represents a relatively new, multifactor-induced disease. Diseases with increased bone resorption are widely treated with antiresorptive drugs. Due to the active bone metabolism, especially in the lower jaw, it can lead to osteonecrosis if the barrier function in the oral cavity is impaired and it may be complicated by systemic comorbidities depending on duration, intensity, and application of antiresorptive therapy. Due to the special influence of these changes on the quality of life and because of the complex therapy management, the early detection and determination of the extent of the lesion(s) by imaging is of particular importance. The orthopantomography (panoramic radiography) of the jaw provides a good basic examination, especially for the detection of dental causes as a possible differential diagnosis. Three-dimensional imaging techniques such as computed tomography and in particular magnetic resonance imaging can detect bone changes much more sensitively and detect the manifestation of complex pathologies in higher stages of disease.

PURPOSE: The aim of this study was to assess the efficacy of radiotherapy as first line therapy for the treatment of primary localised orbital lymphomas of low malignancy (St IE) based on our cases. METHODS: 7 patients with histologically proven primary localised orbital lymphomas of low malignancy treated with radiotherapy were retrospectively reviewed. The dose was 40 Gy for unilateral and 36 Gy for bilateral lymphoma. The follow-up period was 12 - 60 months after the end of the therapy (mean follow-up period: 36 months). RESULTS: Complete regression was achieved in 6 patients 12 - 24 months after the end of radiotherapy. In one patient an increase of tumour mass was observed 3 months after radiotherapy. Chemotherapy was subsequently performed and the patient was free of disease 2 years later. In 2 cases cataract surgery had to be performed for post-radiotherapy cataract formation. CONCLUSION: The majority of orbital lymphomas are localised St. IE tumours of low malignancy. Radiotherapy is the first-line therapy in these cases. Success rates of > 90 % are reported in the literature.

The incidence of intraosseous hemangiomas is very low. Most of them occur in adult females. The mandible,the zygoma,the maxilla, and the frontal and nasal bones are the areas of most frequent localization in the facial region. The intraosseous hemangioma is a benign, slowly growing,bony hard tumor causing facial deformity. It is diagnosed histologically. We report a case of an 18-year-old male with an intraosseous cavernous hemangioma located in the perpendicular lamina of the ethmoid bone. Intraosseous hemangioma often has characteristic signs on a CT scan, with either coarsened trabeculae lying adjacent to the vascular channels or multifocal lytic areas creating a honeycomb pattern. Because of the age of the patient we considered a midline granuloma and a chondrosarcoma. The therapy of choice is surgical excision; radiation is done in exceptional cases only.

Bei der Zygomatizitis (syn. Zygomastizitis) handelt es sich um eine Ostitis und Osteonekrose, also um eine eitrige Einschmelzung der Knochenzellen des Os zygomaticum [1] sowie der umgebenden Weichteilstrukturen, welche wie die Mastoiditis als Begleitkomplikation der Otitis media auftreten kann [2]. Sie ist von der Kiefergelenkentzundung, welche mit ahnlicher Symptomatik einhergeht, abzugrenzen. In einzelnen Studien [2] wird eine begleitende Zygomatizitis in 1,4% der Falle bei Otitis media mit Mastoiditis angegeben. Eine Voraussetzung fur eine Zygomatizitis ist jedoch eine gute Pneumatisation der Temporalschuppe und des Felsenbeins.

Explosive amusement and deterrent articles such as New Year's Eve cannons and rockets, toy pistols, and blank guns are not at all harmless items. Their potential dangerousness is often extremely underestimated. Two damaging mechanisms are important: during explosions, high pressures and temperatures develop and a considerable sound pressure level can be measured. If the explosion happens near the human body (intentionally or inadvertently), not only superficial lesions can occur, but also (mainly due to contact shots) serious, deep-seated tissue damage, especially in the head and neck region with its endangered sense organs such as eye and ear, the vessels and nerves supplying the brain, the speech- and voice-forming apparatus, and in particular the face, can be the consequence. Their mutilation can lead to serious and extensive interpersonalchanges. Accidents are published in the relevant otological and forensic medical papers, but nevertheless it seems important to us to point out the dangerousness of these readily available items.

For a 13-month period, all respiratory tract secretions submitted for routine bacteriology from a large hospital complex were cultured for legionella, irrespective of clinical diagnosis and laboratory requests. Ten cases of legionellosis were detected in this manner, three of which met a strict epidemiological definition of hospital-acquired. Therefore, the 16 warm-water systems of the hospitals, spread out over two locations, were examined for the presence of legionella. Legionella pneumophila was found in 15 warm water systems, with a distinct pattern of serogroups between the two locations. Legionella of the same serogroups as those isolated from patients were present in each hospital water supply. The isolates were further typed by monoclonal antibodies and by genomic macrorestriction analysis. Similarity between clinical and environmental isolates was found in seven cases. In these cases, acquisition from the hospital water supply appears very likely. The strains of the remaining three patients did not match those in hospital water, suggesting that community-acquired legionellosis was occurring as well. This study suggests that routinely culturing respiratory tract secretions of pneumonia patients for legionella can help diagnose unsuspected cases of legionellosis. Typing legionella strains beyond the serogroup level with tools such as macrorestriction analysis is useful to define sources of infection, which can then be targeted for control measures.

Staphylococcus aureus infection and its complications are of great concern in the care of hemodialysis patients. Nasal contamination with S. aureus seems to be the main source of cutaneous contamination. The decontamination and recontamination of the skin of hemodialysis patients after using mupirocin nasal ointment was followed in a placebo control study. After 10 days of therapy with mupirocin nasal ointment, 25 of 33 (73%) patients were free of nasal S. aureus contamination in the nares (control subjects 2 of 21, 10%). At the same time, the prevalence of positive skin cultures for S. aureus decreased from 30 of 33 (90%) to 11 of 33 (33%) patients. However, during the ensuing 130 days, 14 of 25 (58%) patients with negative nasal cultures became recontaminated, while the skin became recontaminated in 11 of 22 (50%) patients. In 10 of 14 S. aureus recontaminated patients the original S. aureus lysotype was documented by specific phage reaction. Four of fourteen patients had a new S. aureus lysotype. Mupirocin nasal ointment eradicated S. aureus transiently in 75% of the patients but continuously in only 11 of 33 (30%) patients.

The adenoid cystic carcinoma of the lacrimal gland is a rare malignant orbital tumour, which has a generally poor prognosis. The therapy for adenoid cystic carcinoma of the lacrimal gland remains controversial. We present two cases of patients with adenoid cystic carcinoma of the lacrimal gland, who were treated with radical surgery in combination with radiotherapy. The therapeutic results are discussed with reference to relevant literature reports.

Forward displacement of the tongue is a verified principle in the therapy of sleep disorders which prevents the tongue from sinking backwards thus avoiding obstruction of the upper respiratory tract during sleep. In this feasibility study a novel oral appliance which connects to a pin implanted within the tongue was investigated.A new tongue positioning system using previously implanted tongue piercings as a pivot was developed. By pulling the tongue forward the oral device prevents airway obstruction. In our study we fitted 10 subjects who already had the tongue pierced with the developed oral device. The subjects underwent two nights of polysomnography with and without using the tongue positioning system. Wearing comfort and side effects were evaluated using a questionnaire. Moderate alcohol consumption was used to provoke snoring or apnea in the subjects. Tongue positioning with and without the device was visualized with oropharyngeal MRI.Subjects did not report any discomfort or side effects wearing the device. Subjects showed only moderate snoring or apnea after alcohol consumption and snoring after alcohol consumption was reduced with the device. The average apnea/hypopnea index (AHI) was 0.8/h without the device. Using the device led to an increase of apnea in the subjects. MRI visualization showed that the device did not keep the upper airway space opened by fixing the tongue.The effectiveness of the tongue positioning system should be improved by a modification which should be investigated in patients with preexisting sleep disorders.

The aim of this study was to assess the efficacy of radiotherapy as first line therapy for the treatment of primary localised orbital lymphomas of low malignancy (St IE) based on our cases.7 patients with histologically proven primary localised orbital lymphomas of low malignancy treated with radiotherapy were retrospectively reviewed. The dose was 40 Gy for unilateral and 36 Gy for bilateral lymphoma. The follow-up period was 12 - 60 months after the end of the therapy (mean follow-up period: 36 months).Complete regression was achieved in 6 patients 12 - 24 months after the end of radiotherapy. In one patient an increase of tumour mass was observed 3 months after radiotherapy. Chemotherapy was subsequently performed and the patient was free of disease 2 years later. In 2 cases cataract surgery had to be performed for post-radiotherapy cataract formation.The majority of orbital lymphomas are localised St. IE tumours of low malignancy. Radiotherapy is the first-line therapy in these cases. Success rates of90 % are reported in the literature.

2,373 mothers and their newborn were studied during two years with respect to B streptococci colonisation or contamination. Bacteriological, vaginal and anal smears were taken from mothers at the beginning of parturition, as well as the amnion and the aspirated stomach contents of the newborn, employing, in each case, conventional culture methods and a latex agglutination test as a rapid testing method. Smears from the ears were also taken from the newborn for bacteriological examination. The vertical transmission and its possible influencing variables were examined in 1,328 mother/child pairs of the first observation year. Surface contamination of the newborn was confirmed in 10% in at least one smear. In the group of mothers with B streptococci colonisation, the amnion showed the highest rate of contamination (43%), followed by the aspirated stomach contents (26%) and the ear smears (taken from each side separately) with 28% and 30% respectively. Vertical transmission was decisively influenced by vaginal maternal colonisation (50% of the cases resulting in contamination of newborn), whereas anal colonisation, if it was the only site of colonisation, resulted in contamination of newborn in only 32% of the cases. The rate of contamination of newborn dropped significantly from 50% to 20% after intrapartal antibiotic prophylaxis, the latter appearing to be meaningful only after at least 6 hours of exposure. In this group, the surface contamination could be reduced from 61% to 8%. A group of newborn suffering from early onset of sepsis (0.4%), was compared with a group of 13 newborn at risk of infection (0.9%) with established surface contamination and clinical or laboratory chemistry confirmation of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

In a prospective multicentre trial, the influence of schedule, compliance, age, sex and weight on the antibody response to hepatitis B vaccination was investigated. Comparison of the vaccination schedules 0, 1, 6 months (group 1; n = 143) and 0, 1, 2, 12 months (group 2; n = 141) was performed in months 3, 7 and 12. In addition, the antibody response was compared one month after the third and one and six months after the last vaccination. Seroprotection rates (anti-HBs greater than 10 IU/l) and antibody titres, given as geometric means (GMTs), were higher in group 1 at month 12 as well as one month after completion of three immunizations. More vaccinees of group 2, however, showed seroprotection at month 3 with higher GMTs. In addition, GMTs in group 2 were higher both one month and six months after the last vaccine dose. Determination of parallel corrected correlation factors demonstrated that age was the most important single factor, followed by body weight and sex. However, no more than 3% of the variation in the GMT can be explained by the influence of age. Due to decreased compliance with the four-dose schedule with a drop-out rate of approximately 10% of the vaccinees, the total percentage of initial vaccinees who in the end developed protective antibody levels was higher in the 0, 1, 6 months schedule. Thus, it can be concluded that subjects likely to comply will benefit from the 0, 1, 2, 12 months schedule as more rapid protection is obtained and the higher antibody levels after the booster vaccination at month 12 provide longer protection. However, vaccinees whose compliance might be questionable over a period of 12 months, should be selected for the vaccination 0, 1, 6 months schedule as compliance is at a higher level over this period and advantage can be taken of the booster effect of the third dose given in month 6.

At the Hospital of the Department of Gynaecology of the University of Heidelberg, a latex agglutination test (Strep B Patho Dx Test) was applied after extraction of antigens from amniotic fluid and gastric aspirate, parallel to the routine screening programme (vaginal and anal swabs) for maternal colonization with B streptococci. The latex agglutination test was applied in 1336 cases. Maternal vaginal colonization was detected in 14%, anal colonization in 17% of the cases. A comparison of the results obtained with the latex agglutination test and with conventional bacteriological procedures (no gradual bacteriology, incubation 48 hours) showed antigen identification in amniotic fluid in 54%, respectively 24%. In gastric aspirates a B streptococcal contamination was detected by bacteriology in 40% of cases, by the rapid latex agglutination test in 22%. If no streptococci were found in the mother, amniotic fluid or gastric aspirates were contaminated in 4% or 6%, respectively (agglutination test or bacteriology, respectively). With a sensitivity of approximately 50% and a specificity of 98%, the latex agglutination test proved superior to routine bacteriology. All clinically contaminated newborn (positive blood specimens) were clearly identified by this test. With this new latex agglutination test, a procedure is now available to detect B streptococcal contamination in newborns within less than half an hour, thus an intra- or postpartal antibiotic therapy can be applied early.

The purpose of this study is to report orbital volume measurement results in patients with congenital clinical anophthalmia before and after therapy and to compare them with normal values.Normal values were obtained from 35 healthy children (22 boys, 13 girls; aged 3 month to 7 years) in whom MRI was done for non-ophthalmological reasons. 18 patients with congenital anophthalmos could be included, 9 with bilateral, 8 with unilateral disease and 1 microphthalmos. 6 of them had MRI follow-up (more than one examination).Orbital volume at birth is 7 ml and it increases with age: Orbital volume = 7.701 x age (month) (0.2484) ml. It is around 14.2 ml at the age 1 year, 17 ml with 2 years and reaches 23 ml with 7 years. In unilateral clinical anophthalmos orbital volume is 35 to 58 % compared with the healthy side and 31 to 65 % compared with the normal values. In bilateral cases the volume is 43 to 70 % of the normal value. During treatment it develops in parallel to the normal values.The normal values measured by our group are in accordance with the only published study by Bentley . MRI orbital volumetry is a reliable method without using radiation. It allows us to quantify the bony asymmetry and is suitable for therapy control when using orbital expanders. The congenital missing eye might be the most important reason why the orbit does not develop in the normal way to a normal size. Self-inflating high, hydrophilic hydrogel expanders do not seem to be able to compensate this, in spite of the fact that they work very well to prepare the socket for a prosthesis.

The aim of the present work was to establish a method for orbital volume calculation based on MR scanning data for the sake of better radiation hygiene.The orbital volumes of 35 ophthalmologically healthy children were calculated on the basis of MRI scans. After data transfer to a separate workstation, volumetric analysis was carried out by two independent radiologists using semi-automated software. The accuracy of the calculated values was compared with orbital volumes measured by anatomic preparations and given in studies by various authors.Volume calculation was possible in all patients using MRI data. There is an acceptable agreement with the presented anatomic facts and the measured values of Bentheley. In the Wilcoxon test there was not a big difference between the courses of the values (p = 0.507).Even though we can obtain a better image of the bizarre structure of the bony orbits with CT, MR-based volumetry of the orbit is a reliable method and is not burdened by radiation exposure. It can thus be an important condition for the planning and the controlling of modern therapeutic concepts in treating anophthalmos and microphthalmos.

Objective: We investigated the changes in the temporomandibular joint (TMJ) after bilateral sagittal split osteotomy of the mandible for orthognathic surgery and the influence of positioning of the condylar process in the centre of the articular fossa before and during the operation for preventing changes in the TMJ postoperatively. Study design: A total of 28 patients with mandibular retrognathism had bilateral sagittal split osteotomies for mandibular advancement. In one group of 14 patients (28 TMJ), the condyles were placed in the centre of the articular fossa before and during the operation, and in the other group they were not. Differences on magnetic resonance imaging (MRI) were calculated and the results were evaluated. Results: The main differences were found at maximal mouth opening. 15/28 TMJs (54%) that had not been positioned changed the position of the disc from physiological to anterior disc derangement with and without reduction postoperatively. In the 28 that had been positioned, changes were found in only 3 TMJs (11%) postoperatively. Conclusions: Fixing the condylar process in the centre of the articular fossa intraoperatively before bilateral sagittal split osteotomy is a factor in preventing postoperative structural changes in the temporomandibular joint.

The incidence of intraosseous hemangiomas is very low. Most of them occur in adult females. The mandible,the zygoma,the maxilla, and the frontal and nasal bones are the areas of most frequent localization in the facial region. The intraosseous hemangioma is a benign, slowly growing,bony hard tumor causing facial deformity. It is diagnosed histologically. We report a case of an 18-year-old male with an intraosseous cavernous hemangioma located in the perpendicular lamina of the ethmoid bone. Intraosseous hemangioma often has characteristic signs on a CT scan, with either coarsened trabeculae lying adjacent to the vascular channels or multifocal lytic areas creating a honeycomb pattern. Because of the age of the patient we considered a midline granuloma and a chondrosarcoma. The therapy of choice is surgical excision; radiation is done in exceptional cases only.

Explosive amusement and deterrent articles such as New Year's Eve cannons and rockets, toy pistols, and blank guns are not at all harmless items. Their potential dangerousness is often extremely underestimated. Two damaging mechanisms are important: during explosions, high pressures and temperatures develop and a considerable sound pressure level can be measured. If the explosion happens near the human body (intentionally or inadvertently), not only superficial lesions can occur, but also (mainly due to contact shots) serious, deep-seated tissue damage, especially in the head and neck region with its endangered sense organs such as eye and ear, the vessels and nerves supplying the brain, the speech- and voice-forming apparatus, and in particular the face, can be the consequence. Their mutilation can lead to serious and extensive interpersonalchanges. Accidents are published in the relevant otological and forensic medical papers, but nevertheless it seems important to us to point out the dangerousness of these readily available items.

In case a sonographically high reflective intraocular tumor is detected, some different processes with calcium embedding could be considered.A 56 year-old female patient was seen in our department for the first time because of secondary glaucoma of the amaurotic right eye. The left eye has had no morphological changes and visual acuity was 5/5.More than 20 years ago the patient had noticed decreased visual acuity of the right eye for the first time. 10 years ago in a first report from another eye hospital, a large white tumor in the area of the optic disc had been described. Sonographic size was 12 x 8 mm, 5.3 mm prominence. Visual acuity was perception of light with incorrect projection. A CT scan showed an inhomgeneous structure of calcification in the area of the right optic disc which continued along the optic nerve to intracranial structures. Enucleation was performed. Histopathological examination showed meningothelial meningeoma (grade I WHO) with its origin in the dural sheath of the optic nerve and intraocular growth. A postoperative MRI confirmed the intracranial spreading of the meningeoma along the dural sheath of the optical nerve. A meningeoma of the olfactorius region was found as a second independent tumor.The intraocular spread of an optical nerve sheath meningeoma is a rare case.

In order to estimate the distribution of bacteria and fungi with an elevated level of resistance to antimicrobial substances, we have analyzed water samples and surveyed institutions presumably concerned with analyses of microbial resistance (university institutes for hygiene, health authorities) by means of questionnaire. A total of 41 water samples was drawn from various aquatic biotopes in the region of Heidelberg. The samples originated from the effluents of a community sewage treatment plant, from the Neckar river, from drinking water supplies and from public swimming pools. The following substance groups were included in a search for bacteria with an elevated resistance to antiseptics and disinfectants: Aldehydes, biguanides, quaternary ammonium compounds (QAC), phenols and halogen. Upon determination of the maximal tolerated concentrations to these antimicrobial agents, samples of treated wastewater effluents showed a considerably higher prevalence of bacteria resistant to formaldehyde, chlorhexidine and QAC. The highest levels of resistance were found in Pseudomonas aeruginosa, Pseudomonas putida, Pseudomonas fluorescens and Enterobacter species. The maximal tolerated level of 0.06 percent formaldehyde by weight was considerably higher than the levels tolerated by the corresponding ATCC reference strains. The highest levels of resistance to a biguanid/QAC preparation were seen in isolates of Alcaligenes species and Providencia species, with a maximal tolerated level of 0.5 volume percent. In addition, several isolates of E. coli and Klebsiella species were observed which showed a considerably higher level of resistance to the biguanide preparation as compared to the corresponding ATCC reference strains. A questionnaire was mailed to a series of institutions and companies presumably concerned with problems of microbial resistance. Responses were in accordance with our own observations, both with regard to the spectrum of bacteria observed and to the antimicrobial substances concerned.

Palliative chemotherapy in patients with head and neck cancer after failing previous treatment is generally accepted clinically although real benefits for patients remain controversial. Proponents may feel morally obliged to offer patients this remaining opportunity for further care. Additionally, palliative therapy may have certain favorable effects for the patient, such as pain relief and facilitating swallowing. Critics note that there is no prolongation of survival time and patients may experience a decreased quality of life because of side effects due to treatment. In these cases antineoplastic drugs cannot be targeted to the tumor region because patients develop a poor tissue vascularity in areas previously radiated or operated upon. Our department has treated 34 patients with advanced cancers, using single drug therapy with carboplatin in 19 patients and methotrexate in 6 patients and combination chemotherapy with cisplatin and methotrexate in 9 patients. The average survival time following palliative chemotherapy was 6.5 months. When patients experienced serious side effects and decreased quality of life, therapy was discontinued. However, two patients with inoperable tumors of the epipharynx undergoing this form of treatment survived for 18 and 24 months respectively, with an improved quality of life, as detailed in this report. The best palliative results were achieved in patients with tumors of the nasopharynx, nose and paranasal sinuses when compared to other head and neck localizations. These results were independent of the T-stage but were especially notable in patients without tumor involvement in neck lymph nodes or N1 tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Die Mundhohle beherbergt eine Vielzahl von Mikroorganismen. Die Standortflora der Mundhohle ist einerseits wesentlich an der Infektionsabwehr des Wirtsorganismus beteiligt, andererseits konnen von hier aus Mikroorganismen endogen in den Organismus gelangen bzw. exogen weiterverbreitet und so Ursache einer nosokomialen Infektion werden. Durch die Einfuhrung hochbzw. hochsttouriger Antriebstechnik, der Ultraschall-Zahnsteinentfernung und die wachsende Bedeutung der Behandlung von Parodontopathien sind die Infektionsrisiken gestiegen. Das betrifft nicht zuletzt die Situation durch die zunehmende HIV-Ausbreitung. In zahnarztlichen Einrichtungen werden durch die potentiell bzw. obligat pathogenen Mundhohlenkeime sowohl die Mitarbeiter (Zahnarzt, Assistenz, Zahntechniker, Reinigungspersonal, Apparate-/Servicetechniker) als auch der Patient selbst, nachfolgende Patienten und letztlich auch Angehorige dieser Personengruppe gefahrdet.

Haut und Schleimhaut sind in Abhangigkeit von der Korperregion durch eine mehr oder weniger charakteristische mikrobielle Flora besiedelt (s. Kap. 10, 11, 13–16, 18–20).

Using three UV-plants of different technical designs for water disinfection, we studied the conformity between experimental germ reduction using standard test organisms and calculated UV-doses under various water flow conditions. Taking into consideration the style of construction of the UV-plants, the irradiation area and the layer thickness were used as constant parameters for dose calculations. This was also employed for the irradiation intensity, since the experiments were performed for a relatively short period compared of the life span of the UV-irradiators. Both exposure time and water transmission were employed as variable parameters in the dose calculations and experimental procedures respectively. The calculated UV-dose and experimentally obtained germ reduction values were comparatively the same for two of the three UV-plants studied. However, no correlation was observed between the reduction of E. coli and the corresponding calculated UV-dose values. Therefore, the calculated UV-dose values for any given UV-plant should be considered to be relative and by no means absolute values. We are of the opinion that within a certain range of water flow rate and transmission, antimicrobial effectiveness of different UV-plants should be demonstrated independent of dose values, technical and other construction characteristics. The applicability of the UV-plants studied is discussed.

Since December 1990, strict limits for pesticide content in drinking water have been in effect in the FRG. These limits have to be enforced and controlled regularly. Because the classical analytical methods, like GC/MS and HPLC are relatively expensive and complicated, concentration and clean up of the samples are necessary. Therefore, the significance of Enzyme Immunosorbent Assays has increased in environmental analysis. The topics of our research are synthesis of suitable Metolachlor conjugates for immunization and as coating antigen, as well as development of an Enzyme Immunosorbent Assay. The chloroacetanilide Metolachlor was coupled with an AMSA-Spacer on Sheep IgG and with AHT-Spacer on BSA. The epitope density was measured photometrically with TNB-derivate. Polyclonal antibodies were produced in white New Zealand rabbits. Metolachlor-AMSA-Sheep IgG conjugate was served as immunogen. The test is indirect and competitive. Microtiter plates are coated with the coating antigen (Metolachlor-AHT-BSA conjugate). In the next step the Metolachlor sample competes with the coating antigen for the antibodies. Detection of bounded antibodies is indirect with a peroxidase-labelled secondary antibody. The chromogenic substrates ABTS, TMB and OPD were tested. TMB showed the best qualities, fast turnover, as well as good and steady colour. Titer of serum and crossreactivity of other chloroacetanilide pesticides and their metabolites were tested. With the exception of Alachlor and Dimethachlor, no pesticide showed a high interaction with serum. Quantitative interpretation was done with the logit/log transformation, which allows comparison of different sera and test series. The antibodies are specific but the affinity is not good enough to detect the limits assigned by the "deutsche Trinkwasserverordnung". Raising the concentration, as is done in classical analytical methods, would solve the problems so that the test can be used as a screening test.

2,373 mothers and their newborn were studied during two years with respect to B streptococci colonisation or contamination. Bacteriological, vaginal and anal smears were taken from mothers at the beginning of parturition, as well as the amnion and the aspirated stomach contents of the newborn, employing, in each case, conventional culture methods and a latex agglutination test as a rapid testing method. Smears from the ears were also taken from the newborn for bacteriological examination. The vertical transmission and its possible influencing variables were examined in 1,328 mother/child pairs of the first observation year. Surface contamination of the newborn was confirmed in 10% in at least one smear. In the group of mothers with B streptococci colonisation, the amnion showed the highest rate of contamination (43%), followed by the aspirated stomach contents (26%) and the ear smears (taken from each side separately) with 28% and 30% respectively. Vertical transmission was decisively influenced by vaginal maternal colonisation (50% of the cases resulting in contamination of newborn), whereas anal colonisation, if it was the only site of colonisation, resulted in contamination of newborn in only 32% of the cases. The rate of contamination of newborn dropped significantly from 50% to 20% after intrapartal antibiotic prophylaxis, the latter appearing to be meaningful only after at least 6 hours of exposure. In this group, the surface contamination could be reduced from 61% to 8%. A group of newborn suffering from early onset of sepsis (0.4%), was compared with a group of 13 newborn at risk of infection (0.9%) with established surface contamination and clinical or laboratory chemistry confirmation of infection.(ABSTRACT TRUNCATED AT 250 WORDS)

The guidelines of the German Society for Hygiene and Microbiology for the evaluation of disinfectants suggest an application time of 5 min for surgical scrub products. In a comparative investigation, which included the more important basic substances and agents, tests were carried out to investigate whether it was possible to reduce the application time to 3 min without losing efficiency in both the immediate as well as the prolonged effect of bacterial reduction. It was found that this could be achieved by certain products, depending on the formula and type of active substance. Thus, a reduced application time of 3 min can be considered for the evaluation of surgical scrub disinfectants for national and international guidelines.

In the years 1987-1989 a bacteriological investigation of the milk was made in 44 clinically healthy postparturient bitches. In 30 animals bacteria most commonly isolated were staphylococci. 30.3% (40 samples) of the samples yielded pure cultures and 6.8% (9 samples) anacultures. Small numbers of bacteria were isolated in most of the samples; 67.4% showed moderate bacterial growth (less than or equal to 10(4)/ml sample). In vitro drug sensitivity tests revealed lincomycin, erythromycin and polymyxin B proved to be most efficient. Moreover neomycin, kanamycin and chloramphenicol showed low resistance rates while colistin sulfate and carbenicillin were less effective. A direct influence of lactiferous gland colonization with bacteria on mortality of puppies was not observed. With respect to clinical aspects, the application of antibiotics for sanitation of the lactiferous gland colonization with bacteria in clinically healthy bitches has to be considered carefully. However, for this the estimation of drug sensitivity tests is not satisfactory and should be completed by accurate bacteriological identification.

Within 35 years 1008 patients were treated that were taken ill in a malignant tumor of face, jaw and mouth. There was found in five patients a distant metastasis of a carcinoma in lower yaw. One case with metastasis in left mandibular condyle is being described. The diagnosis was found by using conventional X-ray examination, Computertomography and aspiration cytology.