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Adalja D, Tagliaferri A, Rezkalla A, Taha B. Diffuse B-Cell Lymphoma of the Mandible Disguised as Acute Osteomyelitis. Eur J Case Rep Intern Med 2024; 11:004243. [PMID: 38352811 PMCID: PMC10860914 DOI: 10.12890/2024_004243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
Background Primary bone lymphoma (PBL) is a rare form of extra nodal non-Hodgkin's lymphoma (NHL). Case description We describe a 39-year-old-male with no medical history who presented with unilateral facial swelling following a tooth extraction. Initial diagnoses after various presentations over the course of three weeks, based on inflammatory and infectious aetiologies. However, the patient was ultimately diagnosed with diffuse large B-cell lymphoma. Discussion Symptoms of PBL are very similar to inflammatory and infectious diseases of the bone, such as osteomyelitis or osteonecrosis. Clinical features of PBL involving the head and neck include persistent jaw pain, tooth mobility secondary to extensive destruction of bone, and in advanced cases, lip numbness and swelling. On examination it may present as an exposed necrotic bone with surrounding soft tissue oedema. Misdiagnosis of these lesions as an infectious or inflammatory aetiology may lead to an unnecessary delay in lymphoma treatment, and subsequently worsen the prognosis if caught at a later stage. Therefore, any concerning lesion, especially in the oral cavity, must be subjected to early histopathological evaluation to differentiate PBL from osteomyelitis and/or osteonecrosis. Conclusion This case report highlights the importance of an early histopathological evaluation to prevent delay in the diagnosis of primary bone lymphomas. LEARNING POINTS Resemblance in symptoms: Primary bone lymphoma (PBL) symptoms overlap with bone infections, necessitating careful consideration and differential diagnosis to prevent misjudgment.Head and neck manifestations: recognising PBL's signs in the head and neck region, such as jaw pain and bone destruction, aids in timely identification and treatment.Timely biopsy significance: swift histopathological assessment for suspicious lesions is critical to avoid delays in diagnosing primary bone lymphomas.
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Affiliation(s)
- Devina Adalja
- Department of Internal Medicine, St Joseph’s University Medical Center, Paterson, USA
| | - Ariana Tagliaferri
- Department of Gastroenterology and Transplant Hepatology, Creighton University, Phoenix, USA
| | - Abraam Rezkalla
- Department of Internal Medicine, St Joseph’s University Medical Center, Paterson, USA
| | - Basil Taha
- Department of Infectious Diseases, St Joseph’s University Medical Center, Paterson, USA
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2
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Asfour MAR, Aljoujou AA, Saifo MS, Jabban HAL. The use of advanced-platelet rich fibrin (A-PRF) in the management of medication-related osteonecrosis of the jaw (MRONJ): A case report. Clin Case Rep 2023; 11:e8259. [PMID: 38028038 PMCID: PMC10675097 DOI: 10.1002/ccr3.8259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) is a serious debilitating disease resulting from long-term treatment with Antiresorptive drugs such as Bisphosphonates or Denosumab, which significantly affects patients' quality of life. A 43-year-old female patient with stage 4 breast cancer and treated with Zoledronic Acid for bone metastases was referred to the Department of Oral Medicine at the Faculty of Dentistry, Damascus University. The main complaint was pain in the right maxilla. Intraoral examination showed an exposure of necrotic bone in the right maxillary region with presence of purulent exudate. The treatment plan was discussed with the patient. Treatment included resection of all necrotic bone and application of Advanced platelet-rich fibrin (A-PRF) clots and membranes. Follow-up and outcome were conducted by clinical measures to assess healing and recurrence (6-month follow-up). Topical treatment with A-PRF demonstrated a reduction in pain and resulted in complete wound healing within 30 days. A-PRF stimulates the release of growth factors and chemotaxis involved in tissue repair mechanisms. This method seemed to be effective in the treatment of MRONJ.
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Affiliation(s)
| | | | - Maher Sadik Saifo
- Oncology Department‐ Medical Oncology, Faculty of MedicineDamascus UniversityDamascusSyria
| | - Haya A. L. Jabban
- Oral and Maxillofacial Surgery Department, Faculty of DentistryDamascus universityDamascusSyria
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3
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Inneh A, Martinez K, Elizee J, Ganguli M, Turan A. COVID-19-Related Bilateral Avascular Necrosis of the Femoral Head. Cureus 2023; 15:e44034. [PMID: 37746447 PMCID: PMC10517632 DOI: 10.7759/cureus.44034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Osteonecrosis is a pathologic process that involves focal bone infarction and death of bone tissue caused by trauma, infections, autoimmune conditions, and chronic steroid use; however, most cases go undiagnosed. The link between bilateral osteonecrosis and coronavirus disease 2019 (COVID-19) infections has not been fully investigated. This is the case of a 42-year-old Caucasian woman who presented to the emergency department for bilateral hip pain, which started three months prior. Initially, the pain was mild; however, her symptoms worsened, causing her to have difficulty ambulating. Co-incidentally she tested positive for COVID-19 10 days after the onset of pain. She denied any lower-extremity numbness, weakness, and loss of bowel or bladder function. X-ray of the hips showed significant sclerosis of bilateral femoral heads and acetabula, indicating avascular necrosis. She was given ketorolac injection intramuscularly for analgesia and remained in stable condition. Upon discharge, she was given a referral to orthopedic surgery for bilateral total hip arthroplasty. Atraumatic osteonecrosis of the femoral head can be caused by multiple etiologies, including exposure to medications, post-transplantation procedures, trauma, and hypercoagulable states. This condition is likely due to poor angiogenesis after an infarct, causing a domino effect of bone demineralization, trabecular thinning, and cortical collapse. A literature search demonstrated prior cases of unilateral femoral head necrosis associated with COVID-19 infection and steroid use. There have been no cases of bilateral osteonecrosis of the femoral head reported without long-term steroid use. Considering the disease severity in both hips and limited steroid use (only five days of prednisone), other common etiologies were sought and were ruled out. In our patient, the only event that was related to her initial onset of hip pain was a COVID-19 infection. We suggest a relationship between COVID-19 infection and avascular necrosis given the rapid progression of the disease. We acknowledge that this presentation of bilateral osteonecrosis is rare and warrants further investigation. More research should be performed to establish a tenable relationship between COVID-19 infection and osteonecrosis, with and without the use of steroids.
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Affiliation(s)
- Adesuwa Inneh
- Urology, Ross University School of Medicine, Pontiac, USA
| | - Kayla Martinez
- Surgery, Ross University School of Medicine, Pontiac, USA
| | - Juleen Elizee
- Pediatrics/Internal Medicine, Ross University School of Medicine, Pontiac, USA
| | - Malika Ganguli
- Internal Medicine, Ross University School of Medicine, Pontiac, USA
| | - Aydin Turan
- Internal Medicine, Trinity Health Oakland Hospital, Pontiac, USA
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4
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El Mobadder M, Grzech-Lesniak Z, El Mobadder W, Rifai M, Ghandour M, Nammour S. Management of Medication-Related Osteonecrosis of the Jaw with Photobiomodulation and Minimal Surgical Intervention. Dent J (Basel) 2023; 11:dj11050127. [PMID: 37232778 DOI: 10.3390/dj11050127] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/21/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a relatively common pathology occurring in around 5% of patients taking bisphosphate and other antiresorptive or anti-angiogenic medications. Despite the efforts, as of today there is still no consensus on its management. In this case report, the successful management of stage II MRONJ was performed for an eighty-three-year-old female patient suffering from pain and alteration in her normal oral functions (swallowing and phonation). The treatment consisted of three sessions of photobiomodulation therapy (PBM), followed by minimal surgical intervention and three other sessions of PBM. PBM was applied on the sites of osteonecrosis with the follow parameters: 4 J/cm2; a power of 50 mW; 8 mm applicator diameter; a continuous contact mode. Irradiation was performed on three points, including the vestibular, occlusal and lingual parts of each of the bone exposure areas. Each point was irradiated for 40 s, and, in total, nine points were made per session, and nine sessions were conducted. To assess the pain, a visual analogue scale was used in which zero represented no pain at all and ten represented the greatest pain. At the first session and before any intervention, the patient stated that her pain was 8 out of 10. At the end of the treatment, a significant reduction in VAS was noted (2/10) and, clinically, a healing of the soft tissue in the previously exposed bone was observed. This case report suggests that the combination of PBM with surgical intervention is promising in the management of MRONJ.
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Affiliation(s)
- Marwan El Mobadder
- Dental Surgery Department, Wroclaw Medical University, 50-425 Wroclaw, Poland
- Department of Dental Sciences, Faculty of Medicine, University of Liege, 4000 Liege, Belgium
| | | | - Wassim El Mobadder
- Department of Endodontics, Dental Specialist' DS Polyclinics, Saida 1600, Lebanon
| | - Mohamad Rifai
- Department of Periodontology, Faculty of Dental Medicine, Lebanese University, Beirut 6573/14, Lebanon
| | - Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Samir Nammour
- Department of Dental Sciences, Faculty of Medicine, University of Liege, 4000 Liege, Belgium
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5
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Singh H, Patel P, Parikh S, Zreik H, Caliman N, Kak V. Pancreatitis, panniculitis and polyarthralgia syndrome: A rare complication of pancreatic pathology. Radiol Case Rep 2023; 18:2001-2004. [PMID: 37020599 PMCID: PMC10068013 DOI: 10.1016/j.radcr.2023.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
Pancreatitis, panniculitis, and polyarthralgia (PPP) syndrome is a rare complication of chronic pancreatitis and occurs due to leakage of pancreatic enzymes in the systemic vasculature. This enzyme leakage leads to multiple manifestations such as polyarthralgia, panniculitis, and bone necrosis due to tissue autodigestion.The inciting pancreatic pathology may be masked, and the presentation may be due to one of the systemic consequences of enzyme leakage, which can present as a diagnostic challenge for clinicians. Here we present a patient who presented with nodular lesions and bone necrosis, and was found to have PPP syndrome. Therefore, a proper understanding of pathophysiology and radiology findings can help with prompt diagnosis and early exploration of management options.
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Affiliation(s)
- Harjinder Singh
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
- Corresponding author.
| | - Parth Patel
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Shamik Parikh
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Hassan Zreik
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Neil Caliman
- Henry Ford Health, Department of Pathology, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
| | - Vivek Kak
- Henry Ford Health, Department of Internal Medicine, Henry Ford Jackson Hospital, 205 N East Ave, Jackson, MI, 49201, USA
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Konarski W, Poboży T, Kotela A, Śliwczyński A, Kotela I, Hordowicz M, Krakowiak J. Does Diabetes Mellitus Increase the Risk of Avascular Osteonecrosis? A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19:15219. [PMID: 36429946 PMCID: PMC9690760 DOI: 10.3390/ijerph192215219] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
Avascular osteonecrosis (AVN) is caused by the disrupted blood supply to the bone. Most AVN cases occur in the femoral head, but other sites might be affected as well, including the jaw or distal bones of the extremities. Previous studies suggested that diabetes could increase the risk of AVN of the jaw, but the relationship between diabetes and AVN in other bone sites is unclear. This systematic review and meta-analysis aimed to summarize the evidence from studies that had reported on the occurrence of AVN in sites other than the jaw, depending on the diagnosis of diabetes. Overall, we included 6 observational studies carried out in different populations: primary or secondary AVN of the femoral head, Takayasu arteritis, general population, kidney transplant recipients, systemic lupus erythematosus, and primary brain tumors. A random-effects meta-analysis showed that the risk of AVN in sites other than the jaw was non-significantly increased in patients with diabetes (odds ratio: 1.90, 95% confidence interval: 0.93-3.91). The pooled estimate increased and was significant after the exclusion of one study (2.46, 1.14-5.32). There was a significant heterogeneity (I2 = 65%, tau2 = 0.48, p = 0.01; prediction interval, 0.21-16.84). There was no significant publication bias (p = 0.432). In conclusion, diabetes could increase the risk of AVN in sites other than the jaw, but the available evidence is limited. There is a need for large, well-designed, population-based studies.
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Affiliation(s)
- Wojciech Konarski
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | - Tomasz Poboży
- Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
| | - Andrzej Kotela
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland
| | - Andrzej Śliwczyński
- Social Medicine Institute, (Department of Social and Preventive Medicine), Medical University of Lodz, 90-419 Lodz, Poland
| | - Ireneusz Kotela
- Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland
| | - Martyna Hordowicz
- General Psychiatry Unit III, Dr. Barbara Borzym’s Independent Public Regional Psychiatric Health Care Center, 26-600 Radom, Poland
| | - Jan Krakowiak
- Social Medicine Institute, (Department of Social and Preventive Medicine), Medical University of Lodz, 90-419 Lodz, Poland
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7
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Tanaka Y, Aung KT, Ono M, Mikai A, Dang AT, Hara ES, Tosa I, Ishibashi K, Ono-Kimura A, Nawachi K, Kuboki T, Oohashi T. Suppression of Bone Necrosis around Tooth Extraction Socket in a MRONJ-like Mouse Model by E-rhBMP-2 Containing Artificial Bone Graft Administration. Int J Mol Sci 2021; 22:ijms222312823. [PMID: 34884630 PMCID: PMC8657653 DOI: 10.3390/ijms222312823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is related to impaired bone healing conditions in the maxillomandibular bone region as a complication of bisphosphonate intake. Although there are several hypotheses for the onset of MRONJ symptoms, one of the possible causes is the inhibition of bone turnover and blood supply leading to bone necrosis. The optimal treatment strategy for MRONJ has not been established either. BMP-2, a member of the TGF-β superfamily, is well known for regulating bone remodeling and homeostasis prenatally and postnatally. Therefore, the objectives of this study were to evaluate whether cyclophosphamide/zoledronate (CY/ZA) induces necrosis of the bone surrounding the tooth extraction socket, and to examine the therapeutic potential of BMP-2 in combination with the hard osteoinductive biomaterial, β-tricalcium phosphate (β-TCP), in the prevention and treatment of alveolar bone loss around the tooth extraction socket in MRONJ-like mice models. First, CY/ZA was intraperitoneally administered for three weeks, and alveolar bone necrosis was evaluated before and after tooth extraction. Next, the effect of BMP-2/β-TCP was investigated in both MRONJ-like prevention and treatment models. In the prevention model, CY/ZA was continuously administered for four weeks after BMP-2/β-TCP transplantation. In the treatment model, CY/ZA administration was suspended after transplantation of BMP-2/β-TCP. The results showed that CY/ZA induced a significant decrease in the number of empty lacunae, a sign of bone necrosis, in the alveolar bone around the tooth extraction socket after tooth extraction. Histological analysis showed a significant decrease in the necrotic alveolar bone around tooth extraction sockets in the BMP-2/β-TCP transplantation group compared to the non-transplanted control group in both MRONJ-like prevention and treatment models. However, bone mineral density, determined by micro-CT analysis, was significantly higher in the BMP-2/β-TCP transplanted group than in the control group in the prevention model only. These results clarified that alveolar bone necrosis around tooth extraction sockets can be induced after surgical intervention under CY/ZA administration. In addition, transplantation of BMP-2/β-TCP reduced the necrotic alveolar bone around the tooth extraction socket. Therefore, a combination of BMP-2/β-TCP could be an alternative approach for both prevention and treatment of MRONJ-like symptoms.
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Affiliation(s)
- Yukie Tanaka
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Kyaw Thu Aung
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Mitsuaki Ono
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
- Correspondence: ; Tel.: +81-86-235-7129; Fax: +81-86-222-7768
| | - Akihiro Mikai
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
| | - Anh Tuan Dang
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Emilio Satoshi Hara
- Department of Biomaterials, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Ikue Tosa
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Kei Ishibashi
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
| | - Aya Ono-Kimura
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama 700-8558, Japan
| | - Kumiko Nawachi
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
| | - Takuo Kuboki
- Department of Oral Rehabilitation and Regenerative Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.A.); (I.T.); (T.K.)
- Department of Oral Rehabilitation and Implantology, Okayama University Hospital, Okayama 700-8558, Japan; (A.M.); (A.O.-K.); (K.N.)
| | - Toshitaka Oohashi
- Department of Molecular Biology and Biochemistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (Y.T.); (A.T.D.); (K.I.); (T.O.)
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8
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Thermos G, Kalogirou EM, Tosios KI, Sklavounou A. Oral ulceration with bone sequestration: Retrospective study of eight cases and literature review. Oral Dis 2018; 25:515-522. [PMID: 30383915 DOI: 10.1111/odi.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/07/2018] [Accepted: 10/23/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Oral ulceration with bone sequestration (OUBS) describes a site-specific intraoral ulcer that covers exposed, non-vital bone in patients lacking any etiological factor known to induce osteonecrosis. We aimed to conduct a retrospective study of eight new cases of OUBS and review the literature. SUBJECTS AND METHODS This is a retrospective study of OUBS cases, diagnosed and managed during 2007-2017. Inclusion criteria were the presence of oral ulcer with exposed non-vital bone at sites of bone prominence and the absence of any factor known to cause osteonecrosis. The English literature was reviewed on original OUBS cases. RESULTS Eight patients (5 males and 3 females, aged 27-75 years) were diagnosed with OUBS during years 2007-2017. Four cases involved the mandibular mylohyoid ridge, one a mandibular anterior exostosis and three the maxillary buccal/palatal exostoses. Exposed bone was removed under local anesthesia, resulting in complete healing in all cases. The literature review yielded 32 OUBS cases in the mandible. CONCLUSION Oral ulceration with bone sequestration is a distinct, probably under-reported rather than rare clinical entity that should be regarded the provisional diagnosis in case of an oral ulcer covering exposed, non-vital bone at sites of bone prominence in patients lacking any etiological factor known to induce osteonecrosis.
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Affiliation(s)
- Grigorios Thermos
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni-Marina Kalogirou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Vácz G, Major B, Gaál D, Petrik L, Horváthy DB, Han W, Holczer T, Simon M, Muir JM, Hornyák I, Lacza Z. Hyperacute serum has markedly better regenerative efficacy than platelet-rich plasma in a human bone oxygen-glucose deprivation model. Regen Med 2018; 13:531-543. [PMID: 30132395 DOI: 10.2217/rme-2017-0141] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM Platelet-rich plasma (PRP) and hyperacute serum (HAS) were compared in a novel human model of ex vivo bone damage induced by oxygen-glucose deprivation (OGD). MATERIALS & METHODS Osteoarthritic subchondral bone pieces were harvested from discarded femoral heads during hip replacement surgery and subjected to transient OGD. RESULTS Proteome profiling revealed that PRP is more angiopoietic, whereas HAS is more antiangiopoietic in composition. However, treatment of OGD-exposed bone with multiple PRP preparations had no effect on cell counts, whereas HAS restored cell proliferation capacity and rescued viable cell number following OGD. CONCLUSION A similar pro-proliferation effect was observed with recombinant growth factors, indicating that HAS may be an alternative agent for enhancing the regeneration of damaged bone cells.
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Affiliation(s)
- Gabriella Vácz
- Institute of Clinical Experimental Research, Semmelweis University, Tűzoltó u. 37-47, Budapest, Hungary, 1094
| | - Bálint Major
- Polyclinic of the Hospitaller Brothers of St. John of God in Budapest, Orthopaedic Department, Frankel Leo u. 54., Budapest, Hungary, 1023
| | - Dorottya Gaál
- Institute of Clinical Experimental Research, Semmelweis University, Tűzoltó u. 37-47, Budapest, Hungary, 1094
| | - Laura Petrik
- Institute of Clinical Experimental Research, Semmelweis University, Tűzoltó u. 37-47, Budapest, Hungary, 1094
| | - Dénes Balázs Horváthy
- Institute of Clinical Experimental Research, Semmelweis University, Tűzoltó u. 37-47, Budapest, Hungary, 1094
| | - Weiping Han
- Bioimaging Consortium, A-STAR, Singapore, Helios, Biopolis Way 11
| | - Tünde Holczer
- Department of Laboratory Medicine, Semmelweis University, Nagyvárad t. 4, Budapest, Hungary, 1089
| | - Melinda Simon
- Institute of Clinical Experimental Research, Semmelweis University, Tűzoltó u. 37-47, Budapest, Hungary, 1094
| | - Jeffrey M Muir
- Motion Research, 3-35 Stone Church Rd, Suite 215, Ancaster, Ontario, L9K 3S9 Canada
| | - István Hornyák
- OrthoSera GmbH, Dr. Karl-Dorrek-Straße 23-29, 3500 Krems an der Donau, Austria
| | - Zsombor Lacza
- OrthoSera GmbH, Dr. Karl-Dorrek-Straße 23-29, 3500 Krems an der Donau, Austria.,University of Physical Education, Alkotás u. 44, Budapest, Hungary 1123
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10
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Livada R, Hosn K, Shiloah J, Anderson KM. Management of heat-induced bone necrosis following thermal removal of gutta-percha. Quintessence Int 2018; 49:535-542. [PMID: 29662971 DOI: 10.3290/j.qi.a40246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many endodontically treated teeth require a post to improve the retention of the coronal restoration, which necessitates removal of the coronal part of the gutta-percha from the canal by thermal method, among other techniques. However, this technique carries the risk of heat conduction to the attachment unit of the periodontium and infliction of permanent damage especially in cases where the remaining root's dentin walls are thin. The overall objective of this article is to report on the clinical manifestations, histologic description, and periodontal management of three cases of heat-induced damage following thermal removal of gutta-percha.
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Surmik D, Rothschild BM, Dulski M, Janiszewska K. Two types of bone necrosis in the Middle Triassic Pistosaurus longaevus bones: the results of integrated studies. R Soc Open Sci 2017; 4:170204. [PMID: 28791147 PMCID: PMC5541542 DOI: 10.1098/rsos.170204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/28/2017] [Indexed: 05/03/2023]
Abstract
Avascular necrosis, diagnosed on the basis of either a specific pathological modification of the articular surfaces of bone or its radiologic appearance in vertebral centra, has been recognized in many Mesozoic marine reptiles as well as in present-day marine mammals. Its presence in the zoological and paleontologic record is usually associated with decompression syndrome, a disease that affects secondarily aquatic vertebrates that could dive. Bone necrosis can also be caused by infectious processes, but it differs in appearance from decompression syndrome-associated aseptic necrosis. Herein, we report evidence of septic necrosis in the proximal articular surface of the femur of a marine reptile, Pistosaurus longaevus, from the Middle Triassic of Poland and Germany. This is the oldest recognition of septic necrosis associated with septic arthritis in the fossil record so far, and the mineralogical composition of pathologically altered bone is described herein in detail. The occurrence of septic necrosis is contrasted with decompression syndrome-associated avascular necrosis, also described in Pistosaurus longaevus bone from Middle Triassic of Germany.
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Affiliation(s)
- Dawid Surmik
- Park of Science & Human Evolution, 1 Maja 10, 46-040 Krasiejów, Poland
- Faculty of Earth Science, University of Silesia, Będzińska 60, 41-200 Sosnowiec, Poland
- Author for correspondence: Dawid Surmik e-mail:
| | - Bruce M. Rothschild
- Carnegie Museum, 4400 Forbes Ave, Pittsburgh, PA 15213, USA
- West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Mateusz Dulski
- Silesian Centre for Education and Interdisciplinary Research, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
- Institute of Material Science, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
| | - Katarzyna Janiszewska
- Institute of Paleobiology, Polish Academy of Sciences, Twarda 51/55, 00-818 Warsaw, Poland
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Forner L, Lee A, Jansen EC. Survey of referral patterns and attitudes toward hyperbaric oxygen treatment among Danish oncologists, ear, nose and throat surgeons and oral and maxillofacial surgeons. Diving Hyperb Med 2014; 44:163-166. [PMID: 25311325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 07/14/2014] [Indexed: 06/04/2023]
Abstract
In head and neck cancer patients with late radiation injury, hyperbaric oxygen (HBO) is used for therapeutic or prophylactic reasons against soft-tissue and osteoradionecrosis (ORN). Twenty-nine departments of oncology, ENT, oral and maxillofacial (OMF) surgery were surveyed using the Enalyzer tool (www.enalyzer.com), of whom 21 responded. Data were incomplete in four returns. Within the previous year, 14 departments had referred at least one patient for hyperbaric oxygen therapy (HBOT). There appears to be a generally positive attitude in Danish OMF, ENT and oncology departments towards referral of patients with ORN for HBOT. However, there is an increasing desire for better evidence for its role in head and neck cancer in the prevention and treatment of soft-tissue injury and osteonecrosis following radiotherapy.
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Affiliation(s)
- Lone Forner
- Department of Anaesthesia, Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital Blegdamsvej 9, DK-2100 Copenhagen, Denmark, Phone: +45-(0)2-639-6440, E-mail:
| | - Anne Lee
- Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Odense, Denmark
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Abstract
BACKGROUND Metal-on-metal bearing with cemented femoral component and cementless acetabular fixation is the current standard in surface replacement arthroplasty (RSA) of the hip. Because of concerns about the long-term survivorship of cemented stems in conventional hip arthroplasty, it seems logical to achieve cementless fixation on the femoral side with RSA. QUESTIONS/PURPOSES The goals of this review were to evaluate clinical and radiological data reported from previously published cementless RSA series. In addition, we intend to review author's preliminary experience with Conserve Plus cementless devices specifically assessing the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels measured in follow-up. METHODS A references search was done with PubMed using the key words "cementless hip resurfacing", "cementless hip resurfacing prosthesis", and "femoral cementless hip resurfacing". Additionally, the clinical outcomes, the complications rate, the survivorship, and the metallic ions levels were measured in 94 cementless Conserve Plus(©) devices in 90 patients (68 males and 22 females) with a mean age of 41.1 years (18-59). Mean follow-up was 13.1 months (8-16). RESULTS No revision was performed during the observed follow-up. Neither radiological signs of loosening nor neck narrowing >10% were evident. Chromium and cobalt levels in whole blood samples rose respectively from 0.53 μg/l (0.1-1.7) to 1.7 μg/l (0.6-2.9) and from 0.54 μg/l (0.1-1.4) to 1.98 μg/l (0.1-2.8). CONCLUSIONS Cementless "fit and fill" femoral-side fixation, which seems to be potentially evolved and design-related, should be considered for future hip-resurfacing device generations.
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Affiliation(s)
- Julien Girard
- Department of Orthopaedic Surgery, Roger Salengro Hospital, University of Lille, 2 avenue Oscar Lambret, Lille, France
- Department of Sports Medicine, University of Lille 2, Lille cedex, 59037 France
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