BackgroundMany reconstruction materials for orbital floor fractures have been described in the past including autologous bone transplants, resorbable polymers and titan meshes. So far evidence is missing which material is used successfully regarding indication and particular size of defect. Therefore the aim of this study was to evaluate which reconstruction technique produces best clinical outcome and least complications associated with indication.MethodsRetrospectively, surgical and ophthalmological data plus CT scans from a collective of 775 patients between 2005 and 2012 were analyzed. Furthermore included patients were sounded on satisfaction and potential problems postoperatively.ResultsOverall 593 patients offered full pre- and postoperative short-time data appropriate to inclusion criteria – of these 507 (85,5 %) underwent primary surgical treatment. Smallest average defect size was found in cases with no indication for surgical treatment (81 mm2), largest in cases indicating titanium mesh reconstruction (601.5 mm2). In 15 cases exact fragment reposition was possible without insertion of alloplastic material. Best clinical results obtained reconstruction using polydioxanone foil (PDS). 0.15 mm PDS-foil: 444 patients, reduced diplopia pre to postoperative 16 to 6 % (p < 0.01), ex- and enophthalmus < 2 % after surgery. 0.25 mm PDS-foil: 26 patients, reduced diplopia from pre- to postoperative 34,6 to 3,8 % (p < 0.01), postoperative exophthalmus rate was higher than preoperative (3,8 to 7,7 %). In comparison to reconstruction with PDS-foil a higher percentage of patients reconstructed with titanium meshes (n = 22) revealed no significant reduction of diplopia (45,5 to 31,8 %; p = 0.07). Furthermore 63 of all included patients agreed to complete a questionnaire on intermediate-term postoperative symptoms and surgical contentedness. Remarkably 50 % of the patients reconstructed with titanium meshes indicated foreign body sensations and cold feeling in the long-term.ConclusionsShort- and intermediate-term results of clinical outcome in our patients with surgical treated orbital floor fractures (i.e. diplopia, en- or exophthalmus) reveal that thin resorbable foils, particularly 0.15 mm diameter PDS-foil seem to generate best results referring to orbital floor defects with a size of 250 to 300 mm2.Trial registrationStudy number 4222, year 2013, ethics committee of the medical faculty of the Heinrich Heine university of Duesseldorf.

The authors hypothesize that histopathological characteristics of basal cell carcinomas of the head and neck (BCCHN) have changed over time and the correlation of BCCHN localization and histological tumour type can help improving the number and quality of necessary therapeutic interventions. Information of 222 patients with 344 BCCHN was gained. Descriptive measures were compared to prior studies to prove whether or not characteristics of basal cell carcinomas or patients have changed over time. Afterwards descriptive measures were correlated with number of conducted operations to evaluate if tumour localization, histological tumour type and number of operations depend on one another. Aggravating factors which lead to a higher number of operations were older age, greater size of BCCHN, adjacent elastosis, the localizations eye, ear and nose and histological tumour types morpheaform and nodularulcerated. In comparison to earlier studies characteristics of BCCHN and patients showed positive developments because of grown awareness of BCCHN. Furthermore, our correlations demonstrate that therapeutic results of BCCHN treatment are continuously improving. Nevertheless, treatment of aggressive morpheaform BCCHN in combination with distinctive patient characteristics still needs improvement.

The functional and morphologic integrity of the peritoneal membrane is of major importance for the successful treatment of patients with chronic peritoneal dialysis. This study aimed at the establishment and functional characterization of human peritoneal fibroblasts (HPFB) in cell culture. HPFB were isolated from human omentum by enzymatic digestion and cultured. Confluent HPFB could be identified as spindle-shaped cells, growing in parallel arrays and whorls which stained positive for vimentin and negative for factor VIII, cytokeratin 18, and desmin. Maximum cell growth was observed after 24 h in medium supplemented with 10% fetal calf serum. HPFB could be growth arrested and maintained in fetal calf serum-depleted medium (0.1%) for > 48 h without loss of cell viability as evaluated by intracellular ATP determination. Stimulation of resting HPFB for 0.5 to 48 h with increasing doses of interleukin (IL)-1 beta and/or tumor necrosis factor-alpha (1 to 10,000 pg/mL) resulted in a dose- and time-dependent induction of IL-6 messenger RNA and an increase in immunoreactive IL-6 protein secreted into HPFB supernatants, which was significant with IL-1 beta or tumor necrosis factor-alpha doses as low as 1 pg/mL. HPFB IL-6 production could be inhibited by both actinomycin D or cycloheximide, which suggests that the induction of IL-6 occurs both on a transcriptional and a post-transcriptional level. In summary, this cell culture model is expected to facilitate further investigation of the potential role of the HPFB in the peritoneal cytokine network of patients treated with chronic peritoneal dialysis.

BackgroundLittle is known regarding the impact of host response in acute pancreatitis. Here, we induce murine necrotizing pancreatitis in 9 different mouse strains.Materials and methodsWe examined 9 different mouse strains: Balb/CB4J, C3H/HEJ, NOD/SHILT, A/J, AKR/J, C57BI/6J, DBA/2J, FVB/NJ, 129S1/SvlmJ. 10 animals per strain were randomly allotted to two groups. Sterile necrotizing pancreatitis was induced by injection of taurocholate into the common bile duct. Control animals were injected with saline. Every 6 h, clinical parameters were examined and scored. After 24 h, animals were sacrificed to examine and compare serum enzymes, histology, bronchoalveolar lavage fluid, and serum IL-6.ResultsHistologically, taurocholate treated animals scored significantly higher than control animals. Concordantly, serum lipase and amylase were significantly elevated in pancreatitis animals in all strains. NOD/SHILT and AKR/J mice had the highest enzyme activity. 24 h after induction, there were no signs of increased pulmonary vascular leak in taurocholate animals. Remarkably, interleukin 6 was not increased at all in C57BL/6J, C3H/HeJ, and 129S1/SvlmJ mice compared to all other strains.ConclusionThe genetic strain has an impact on pancreatitis severity and systemic inflammatory response in a murine taurocholate induction model. Analogous differences in humans may partially account for the disparity in post-ERCP pancreatitis.