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Chen Z, Akanbi F, Lucas DR, Walton DM, Benavides E, Soki FN, Siegel GW, McCauley LK, Clines GA. A skeleton in a huff: insights in etiologies of osteosclerosis. J Bone Miner Res 2024; 39:79-84. [PMID: 38477819 DOI: 10.1093/jbmr/zjad021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 03/14/2024]
Abstract
A 30-yr-old man developed right lower leg pain and a palpable solid mass. Radiographic imaging revealed a periosteal reaction with an exostotic mass arising from the right distal fibula. Generalized skeletal osteosclerosis with periosteal reaction was discovered on a radiographic skeletal survey. A biopsy of the right fibular mass revealed reactive woven bone. The patient was referred to a metabolic bone disease clinic, where laboratory values were consistent with secondary hyperparathyroidism and increased bone turnover. A DXA bone density scan revealed high bone density, with an L1-4 spine Z-score of +9.3, a left femoral neck Z-score of +8.5, and a total hip Z-score of +6.5. A dental exam revealed generalized gingival inflammation, teeth mobility, generalized horizontal alveolar bone loss and widening of the periodontal ligament space, increased bone density around the teeth, and thickening of the radicular lamina dura. An extensive evaluation was performed, with the result of a single test revealing the diagnosis. The differential diagnoses of osteosclerosis affecting the skeleton, teeth, and oral cavity are discussed.
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Affiliation(s)
- Zhaozhao Chen
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Folake Akanbi
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - David R Lucas
- Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - David M Walton
- Department of Orthopaedic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Erika Benavides
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Fabiana N Soki
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Geoffrey W Siegel
- Department of Orthopaedic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Laurie K McCauley
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, United States
- Department of Pathology, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Gregory A Clines
- Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
- Veterans Affairs Medical Center, Ann Arbor, MI, United States
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2
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Verscaj CP, Smith C, Homeyer M, Matalon DR. Raine syndrome: Prenatally identified severe craniofacial phenotype with multisuture synostosis and brain abnormalities associated with variants in FAM20C. Prenat Diagn 2024; 44:369-372. [PMID: 38163266 DOI: 10.1002/pd.6506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/20/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
Raine syndrome (MIM 259775) is a rare autosomal recessive disorder, first described by Raine et al. in 1989, with an estimated prevalence of <1/1,000,000. This is due to pathogenic variants in FAM20C characterized by osteosclerosis, typical craniofacial features, and brain calcifications. Here, we report a novel variant in FAM20C, describe a uniquely severe craniofacial and CNS phenotype of Raine syndrome, and correlate it with prenatal findings. Fetal phenotyping was based on ultrasound and MRI. Solo exome sequencing was performed from DNA extracted from postmortem skin biopsy. Targeted parental variant testing was subsequently performed. A homozygous missense variant NM_020223.4 (c.1445 G > A (p.Gly482Glu)) was identified in FAM20C associated with Raine syndrome. The infant had the characteristic dysmorphic features seen in Raine syndrome. He had particularly significant CNS manifestations consisting of multisuture craniosynostosis with protrusion of the brain parenchyma through fontanelles and cranial lacunae. Histological sections of the brain showed marked periventricular gliosis with regions of infarction, hemorrhage, and cavitation with global periventricular leukomalacia. Numerous dystrophic calcifications were diffusely present. Here, we demonstrate the identification of a novel variant in FAM20C in an infant with the characteristic features seen in Raine syndrome. The patient expands the characteristic phenotype of Raine syndrome to include a uniquely severe CNS phenotype, first identified on prenatal imaging.
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Affiliation(s)
- Courtney P Verscaj
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carly Smith
- Perinatal Diagnostic Center, Stanford Children's Health, Stanford, California, USA
| | - Margaret Homeyer
- Perinatal Diagnostic Center, Stanford Children's Health, Stanford, California, USA
| | - Dena R Matalon
- Perinatal Diagnostic Center, Stanford Children's Health, Stanford, California, USA
- Department of Pediatrics, Division of Medical Genetics, Stanford University, Stanford, California, USA
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3
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Tassoker M, Öziç MÜ, Yuce F. Performance evaluation of a deep learning model for automatic detection and localization of idiopathic osteosclerosis on dental panoramic radiographs. Sci Rep 2024; 14:4437. [PMID: 38396289 PMCID: PMC10891049 DOI: 10.1038/s41598-024-55109-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/20/2024] [Indexed: 02/25/2024] Open
Abstract
Idiopathic osteosclerosis (IO) are focal radiopacities of unknown etiology observed in the jaws. These radiopacities are incidentally detected on dental panoramic radiographs taken for other reasons. In this study, we investigated the performance of a deep learning model in detecting IO using a small dataset of dental panoramic radiographs with varying contrasts and features. Two radiologists collected 175 IO-diagnosed dental panoramic radiographs from the dental school database. The dataset size is limited due to the rarity of IO, with its incidence in the Turkish population reported as 2.7% in studies. To overcome this limitation, data augmentation was performed by horizontally flipping the images, resulting in an augmented dataset of 350 panoramic radiographs. The images were annotated by two radiologists and divided into approximately 70% for training (245 radiographs), 15% for validation (53 radiographs), and 15% for testing (52 radiographs). The study employing the YOLOv5 deep learning model evaluated the results using precision, recall, F1-score, mAP (mean Average Precision), and average inference time score metrics. The training and testing processes were conducted on the Google Colab Pro virtual machine. The test process's performance criteria were obtained with a precision value of 0.981, a recall value of 0.929, an F1-score value of 0.954, and an average inference time of 25.4 ms. Although radiographs diagnosed with IO have a small dataset and exhibit different contrasts and features, it has been observed that the deep learning model provides high detection speed, accuracy, and localization results. The automatic identification of IO lesions using artificial intelligence algorithms, with high success rates, can contribute to the clinical workflow of dentists by preventing unnecessary biopsy procedure.
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Affiliation(s)
- Melek Tassoker
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Necmettin Erbakan University, Bağlarbaşı Street, 42090, Meram, Konya, Turkey.
| | - Muhammet Üsame Öziç
- Faculty of Technology, Department of Biomedical Engineering, Pamukkale University, Denizli, Turkey
| | - Fatma Yuce
- Faculty of Dentistry, Department of Oral and Maxillofacial Radiology, Istanbul Okan University, Istanbul, Turkey
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4
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Moreno Rabie C, García-Larraín S, Contreras Diez de Medina D, Cabello-Salazar I, Fontenele RC, Van den Wyngaert T, Jacobs R. How does the clinical and tomographic appearance of MRONJ influences its treatment prognosis? Dentomaxillofac Radiol 2023; 52:20230304. [PMID: 37870051 DOI: 10.1259/dmfr.20230304] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVES To identify clinical and tomographic prognostic factors for conservative and surgical treatment of medication-related osteonecrosis of the jaws (MRONJ). METHODS A retrospective search identified patients treated with antiresorptive drugs (ARDs), diagnosed with Stage 1, 2 or 3 MRONJ, and having CBCT scans previous to conservative or surgical treatment. Following data collection, imaging assessment of the following parameters on each MRONJ site was performed: involvement of teeth and/or implants, presence of osteosclerosis, osteolysis, sequestrum formation, periosteal reaction, and pathological fractures. For statistical analysis, patients and lesions were divided into conservative and surgical treatment. Comparisons were made between successful and unsuccessful outcomes. Significance was set at p ≤ 0.05. RESULTS 115 ARD-treated patients who developed 143 osteonecrosis lesions were selected. 40 patients and 58 lesions received conservative treatment, of which 14 patients (35%) and 25 lesions (43%) healed. Additionally, 75 patients and 85 lesions underwent surgery, with 48 patients (64%) and 55 lesions (65%) that healed. Clinical and tomographic risk factors for conservative treatment were MRONJ staging, tooth involvement, extensive osteosclerosis, and deep sequestrum formation (p < 0.05). Complementarily, poor prognostic indicators for surgical therapy were a short bisphosphonate (BP) holiday, MRONJ staging, absence of sequestrum formation, and presence of periosteal reaction (p < 0.05). CONCLUSIONS Lesions at Stage 3 MRONJ, with tooth involvement, or sequestrum formation showed poor outcomes when conservative treatment is chosen. Alternatively, surgical treatment is most effective when BPs are discontinued, in Stage 1 lesions, in the presence of sequestrum formation, and absence of periosteal reaction.
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Affiliation(s)
- Catalina Moreno Rabie
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Santiago García-Larraín
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Radiology, Facultad de Odontología, Universidad de los Andes, Santiago, Chile
| | - David Contreras Diez de Medina
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Radiology, Facultad de Odontología, Universidad de los Andes, Santiago, Chile
| | - Isadora Cabello-Salazar
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Radiology, Facultad de Odontología, Universidad de los Andes, Santiago, Chile
| | - Rocharles Cavalcante Fontenele
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, Leuven, Belgium
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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5
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Orhan K, Sanders A, Ünsal G, Ezhov M, Mısırlı M, Gusarev M, İçen M, Shamshiev M, Keser G, Namdar Pekiner F, Golitsyna M, Önder M, Manulis D, Atakan C. Assessing the reliability of CBCT-based AI-generated STL files in diagnosing osseous changes of the mandibular condyle: a comparative study with ground truth diagnosis. Dentomaxillofac Radiol 2023; 52:20230141. [PMID: 37641960 PMCID: PMC10552125 DOI: 10.1259/dmfr.20230141] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES This study aims to evaluate the reliability of AI-generated STL files in diagnosing osseous changes of the mandibular condyle and compare them to a ground truth (GT) diagnosis made by six radiologists. METHODS A total of 432 retrospective CBCT images from four universities were evaluated by six dentomaxillofacial radiologists who identified osseous changes such as flattening, erosion, osteophyte formation, bifid condyle formation, and osteosclerosis. All images were evaluated by each radiologist blindly and recorded on a spreadsheet. All evaluations were compared and for the disagreements, a consensus meeting was held online to create a uniform GT diagnosis spreadsheet. A web-based dental AI software was used to generate STL files of the CBCT images, which were then evaluated by two dentomaxillofacial radiologists. The new observer, GT, was compared to this new STL file evaluation, and the interclass correlation (ICC) value was calculated for each pathology. RESULTS Out of the 864 condyles assessed, the ground truth diagnosis identified 372 cases of flattening, 185 cases of erosion, 70 cases of osteophyte formation, 117 cases of osteosclerosis, and 15 cases of bifid condyle formation. The ICC values for flattening, erosion, osteophyte formation, osteosclerosis, and bifid condyle formation were 1.000, 0.782, 1.000, 0.000, and 1.000, respectively, when comparing diagnoses made using STL files with the ground truth. CONCLUSIONS AI-generated STL files are reliable in diagnosing bifid condyle formation, osteophyte formation, and flattening of the condyle. However, the diagnosis of osteosclerosis using AI-generated STL files is not reliable, and the accuracy of diagnosis is affected by the erosion grade.
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Affiliation(s)
- Kaan Orhan
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
| | - Alex Sanders
- Diagnocat Inc, West Sacramento, California, United States
| | - Gürkan Ünsal
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Near East University, Nicosia, Cyprus
| | - Matvey Ezhov
- Diagnocat Inc, West Sacramento, California, United States
| | - Melis Mısırlı
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, International Final University, Nicosia, Cyprus
| | - Maxim Gusarev
- Diagnocat Inc, West Sacramento, California, United States
| | - Murat İçen
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Nevşehir Hacı Bektaş Veli University, Nevsehir, Turkey
| | | | - Gaye Keser
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Marmara University, Istanbul, Turkey
| | - Filiz Namdar Pekiner
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Marmara University, Istanbul, Turkey
| | | | - Merve Önder
- Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Ankara University, Ankara, Turkey
| | - David Manulis
- Diagnocat Inc, West Sacramento, California, United States
| | - Cemal Atakan
- Faculty of Science and Letters, Department of Statistics, Ankara University, Ankara, Turkey
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Bono F, Rapisarda L, Bombardieri C, Gagliardi M, Procopio R, Demonte G, Tosto F, Bruno PA, Gambardella A, Annesi G. Neurological manifestations in patients and disease carriers in an Italian family with osteosclerosis. Neurol Sci 2023; 44:1393-1399. [PMID: 36481973 DOI: 10.1007/s10072-022-06541-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hereditary cranial hyperostosis is a rare disease never described in Italy, so the neurological manifestations in patients and carriers of the disease have been little studied. METHODS We describe the neurological and neuroimaging features of patients and carriers of the gene from a large Italian family with sclerosteosis. RESULTS In this family, genetic testing detected the homozygous p.Gln24X (c.70C > T) mutation of the SOST gene in the proband and a heterozygous mutation in 9 siblings. In homozygous adults, severe craniofacial hyperostosis was manifested by cranial neuropathy in childhood, chronic headache secondary to intracranial hypertension, and an obstructive sleep apnea syndrome in adults. In one of the adult patients, there was a compressible subcutaneous swelling in the occipital region caused by transosseous intracranial-extracranial occipital venous drainage, a compensation mechanism of obstructed venous drainage secondary to cranial hyperostosis. Mild cranial hyperostosis causing frequent headache and snoring was evident in the nine heterozygous subjects. CONCLUSIONS Multiple cranial neuropathies and headache in children, while severe chronic headache and sleep disturbances in adults, are the neurological manifestations of the first Italian family with osteosclerosis. It is reasonable to extend neurological and neuroimaging evaluation to gene carriers as well.
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Affiliation(s)
- Francesco Bono
- Headache Center, Neurology Unit A.O.U. Mater Domini, University Campus, Viale Europa, 88100, Catanzaro, Italy.
| | - Laura Rapisarda
- Headache Center, Neurology Unit A.O.U. Mater Domini, University Campus, Viale Europa, 88100, Catanzaro, Italy
| | | | - Monica Gagliardi
- Institute of Molecular Bioimaging and Physiology, N. R. C., Catanzaro, Italy
| | - Radha Procopio
- Institute of Molecular Bioimaging and Physiology, N. R. C., Catanzaro, Italy
| | - Giulio Demonte
- Headache Center, Neurology Unit A.O.U. Mater Domini, University Campus, Viale Europa, 88100, Catanzaro, Italy
| | - Federico Tosto
- Headache Center, Neurology Unit A.O.U. Mater Domini, University Campus, Viale Europa, 88100, Catanzaro, Italy
| | - Pietro A Bruno
- Headache Center, Neurology Unit A.O.U. Mater Domini, University Campus, Viale Europa, 88100, Catanzaro, Italy
| | - Antonio Gambardella
- Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Grazia Annesi
- Institute of Molecular Bioimaging and Physiology, N. R. C., Catanzaro, Italy
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7
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Turan S. Osteopetrosis: Gene-based nosology and significance Dysosteosclerosis. Bone 2023; 167:116615. [PMID: 36402365 DOI: 10.1016/j.bone.2022.116615] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
Dysosteosclerosis (DSS) refers to skeletal dysplasias that radiographically feature focal appendicular osteosclerosis with variable platyspondyly. Genetic heterogeneity is increasingly reported for the DSS phenotype and now involves mutations of SLC29A3, TNFRSF11A, TCIRG1, LRRK1, and CSF1R. Typical radiological findings are widened radiolucent long bones with thin cortices yet dense irregular metaphyses, flattened vertebral bodies, dense ribs, and multiple fractures. However, the radiographic features of DSS evolve, and the metaphyseal and/or appendicular osteosclerosis variably fades with increasing patient age, likely due to some residual osteoclast function. Fractures are the principal presentation of DSS, and may even occur in infancy with SLC29A3-associated DSS. Cranial base sclerosis can lead to cranial nerve palsies such as optic atrophy, and may be the initial presentation, though not observed with SLC29A3-associated DSS. Gene-specific extra-skeletal features can be the main complication in some forms of DSS such as CSF1R- associated DSS. Further genetic heterogeneity is likely, especially for X-linked recessive DSS and cases currently with an unknown genetic defect. Distinguishing DSS can be challenging due to variable clinical and radiological features and an evolving phenotype. However, defining the DSS phenotype is important for predicting complications, prognosis, and instituting appropriate health surveillance and treatment.
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Affiliation(s)
- Serap Turan
- Pediatric Endocrinology and Diabetes, Marmara University School of Medicine, Istanbul, Turkey.
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8
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Hayek E, Maalouf E, Nassar J, AbiLamaa F, Aoun G. Idiopathic Osteosclerosis and Condensing Osteitis in a Sample of the Lebanese Population: A Digital Panoramic Based Study. Med Arch 2023; 77:396-399. [PMID: 38299083 PMCID: PMC10825735 DOI: 10.5455/medarh.2023.77.396-399] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
Background Idiopathic osteosclerosis (IO) is an area of enlarged bone production in the jaw that usually appears radiopaque and round, elliptical, or irregular in shape. Condensing osteitis (CO) is a focalized osseous reaction leading to periapical sclerotic bone growth. Objective The aim of this study was to investigate the prevalence, localization, shape, and dental relationship of IO and CO in a group of Lebanese patients and to correlate these findings to age and gender. Methods 520 digital panoramic radiographs of patients (215 men and 305 women) ranging in age from 18 to 77 (mean age 40.89 years) who visited the Faculty of Dental Medicine, Lebanese University, for dental treatment were included in this study and assessed for IO and CO. The prevalence of the two lesions according to gender and age, as well as their localization, and dental relationship, were recorded and saved in an Excel sheet. Results Among the 520 radiographs, 47 (9%) showed IO, and 30 (5.8%) showed CO. Both lesions are more frequent among females in their third decade and are essentially found in the mandible, mainly in relation to the root apices. Conclusion Within the limits of this study, we concluded that in our sample of the Lebanese population, the prevalence of IO and CO is low and supports the theory that IO can be defined as developmental variations of normal bony architecture unrelated to a local stimulant, and CO could be considered reactive bone formations related to pulpitis, deep restoration, or caries.
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Affiliation(s)
- Elie Hayek
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University
| | - Elie Maalouf
- Department of Periodontology, Faculty of Dental Medicine, Lebanese University
| | - Jean Nassar
- Department of Periodontology, Faculty of Dental Medicine, Lebanese University
| | - Fadi AbiLamaa
- Department of Periodontology, Faculty of Dental Medicine, Lebanese University
| | - Georges Aoun
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University
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9
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Yamagishi H, Monden Y, Michigami T, Tachikawa K, Osaka H, Nozaki Y, Tajima T. A case of osteopathia striata with cranial sclerosis with facial nerve palsies. Pediatr Int 2023; 65:e15648. [PMID: 37804062 DOI: 10.1111/ped.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 10/08/2023]
Affiliation(s)
| | - Yukifumi Monden
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Toshimi Michigami
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka Prefectural Hospital Organization, Izumi, Japan
| | - Kanako Tachikawa
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka Prefectural Hospital Organization, Izumi, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
| | - Yasuyuki Nozaki
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
- Department of Pediatrics, Shin-Oyama City Hospital, Oyama, Japan
| | - Toshihiro Tajima
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan
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10
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Zhu S, Liu J, Zhao J, Zhou B, Zhang Y, Wang H. HIF-1α-mediated autophagy and canonical Wnt/β-catenin signalling activation are involved in fluoride-induced osteosclerosis in rats. Environ Pollut 2022; 315:120396. [PMID: 36220573 DOI: 10.1016/j.envpol.2022.120396] [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] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Fluoride (F) exposure can cause osteosclerosis, which is characterised by a high bone mass, but its mechanism is not fully illustrated. Here, we aimed to evaluate the effects of excessive F exposure on the bone lesion by treating female Sprague-Dawley rats with different concentrations of sodium fluoride (NaF) (0, 55, 110 and 221 mg/L) for 90 days and the corresponding concentrations of fluorine ion (0, 25, 50 and 100 mg/L, respectively). Histopathological results showed that excessive F exposure caused the enlargement of trabeculae and their integration into one large piece, growth plate thickening, articular cartilage impairment and bone collagen abnormality. Meanwhile, F promoted calcium deposition and bone mineralisation, and induced abnormal osteogenesis increased. The results of micro-computed tomography also confirmed that excessive F destroyed the bone microstructure and induced a high-bone-mass phenotype, consistent with the results of pathomorphology. Mechanistically, excessive amounts of F led to angiogenesis inhibition and HIF-1α signalling enhancement. Subsequently, F induced autophagy and canonical Wnt/β-catenin signalling pathway activation. Collectively, these results manifested that F enhanced the hypoxia inducible factor-1α signalling, which in turn triggered autophagy and canonical Wnt/β-catenin signalling activation, ultimately leading to osteosclerosis in the rats.
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Affiliation(s)
- Shiquan Zhu
- Henan Key Laboratory of Environmental and Animal Product Safety, Henan University of Science and Technology, Luoyang, 471000, Henan, People's Republic of China.
| | - Jing Liu
- Henan Key Laboratory of Environmental and Animal Product Safety, Henan University of Science and Technology, Luoyang, 471000, Henan, People's Republic of China.
| | - Jing Zhao
- Henan Key Laboratory of Environmental and Animal Product Safety, Henan University of Science and Technology, Luoyang, 471000, Henan, People's Republic of China.
| | - Bianhua Zhou
- Henan Key Laboratory of Environmental and Animal Product Safety, Henan University of Science and Technology, Luoyang, 471000, Henan, People's Republic of China.
| | - Yuling Zhang
- Henan Key Laboratory of Environmental and Animal Product Safety, Henan University of Science and Technology, Luoyang, 471000, Henan, People's Republic of China.
| | - Hongwei Wang
- Henan Key Laboratory of Environmental and Animal Product Safety, Henan University of Science and Technology, Luoyang, 471000, Henan, People's Republic of China.
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11
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Salles Rosa Neto N, Englert D, McAlister WH, Mumm S, Mills D, Veis DJ, Burshell A, Boyde A, Whyte MP. Periarticular calcifications containing giant pseudo-crystals of francolite in skeletal fluorosis from 1,1-difluoroethane "huffing". Bone 2022; 160:116421. [PMID: 35429657 DOI: 10.1016/j.bone.2022.116421] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 01/28/2023]
Abstract
Inhalant use disorder is a psychiatric condition characterized by repeated deliberate inhalation from among a broad range of household and industrial chemical products with the intention of producing psychoactive effects. In addition to acute intoxication, prolonged inhalation of fluorinated compounds can cause skeletal fluorosis (SF). We report a young woman referred for hypophosphatasemia and carrying a heterozygous ALPL gene variant (c.457T>C, p.Trp153Arg) associated with hypophosphatasia, the heritable metabolic bone disease featuring impaired skeletal mineralization, who instead suffered from SF. Manifestations of her SF included recurrent articular pain, axial osteosclerosis, elevated bone mineral density, maxillary exostoses, and multifocal periarticular calcifications. SF was suspected when a long history was discovered of 'huffing' a computer cleaner containing 1,1-difluoroethane. Investigation revealed markedly elevated serum and urine levels of F-. Histopathology and imaging techniques including backscattered electron mode scanning electron microscopy, X-ray microtomography, energy dispersive and wavelength dispersive X-ray emission microanalysis, and polarized light microscopy revealed that her periarticular calcifications were dystrophic deposition of giant pseudo-crystals of francolite, a carbonate-rich fluorapatite. Identifying unusual circumstances of F- exposure is key for diagnosing non-endemic SF. Increased awareness of the disorder can be lifesaving.
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Affiliation(s)
- Nilton Salles Rosa Neto
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Daniel Englert
- Endocrinology Department, Ochsner Medical Center, New Orleans, LA 70121, USA.
| | - William H McAlister
- Pediatric Radiology Section, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Steven Mumm
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - David Mills
- Dental Physical Sciences, Dental Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK.
| | - Deborah J Veis
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Alan Burshell
- Endocrinology Department, Ochsner Medical Center, New Orleans, LA 70121, USA.
| | - Alan Boyde
- Dental Physical Sciences, Dental Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK.
| | - Michael P Whyte
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
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12
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Liu SZ, Zhou X, Wang YP, Liu Y. Osteosclerosis in Castleman's disease. QJM 2022; 115:171-172. [PMID: 35088859 DOI: 10.1093/qjmed/hcac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S-Z Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| | - X Zhou
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| | - Y-P Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
| | - Y Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuaifu Yuan, Beijing 100730, China
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Yesiltepe S, Bayrakdar IS, Orhan K, Çelik Ö, Bilgir E, Aslan AF, Odabaş A, Costa ALF, Jagtap R. A Deep Learning Model for Idiopathic Osteosclerosis Detection on Panoramic Radiographs. Med Princ Pract 2022; 31:555-561. [PMID: 36167054 PMCID: PMC9841764 DOI: 10.1159/000527145] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/14/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE The purpose of the study was to create an artificial intelligence (AI) system for detecting idiopathic osteosclerosis (IO) on panoramic radiographs for automatic, routine, and simple evaluations. SUBJECT AND METHODS In this study, a deep learning method was carried out with panoramic radiographs obtained from healthy patients. A total of 493 anonymized panoramic radiographs were used to develop the AI system (CranioCatch, Eskisehir, Turkey) for the detection of IOs. The panoramic radiographs were acquired from the radiology archives of the Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University. GoogLeNet Inception v2 model implemented with TensorFlow library was used for the detection of IOs. Confusion matrix was used to predict model achievements. RESULTS Fifty IOs were detected accurately by the AI model from the 52 test images which had 57 IOs. The sensitivity, precision, and F-measure values were 0.88, 0.83, and 0.86, respectively. CONCLUSION Deep learning-based AI algorithm has the potential to detect IOs accurately on panoramic radiographs. AI systems may reduce the workload of dentists in terms of diagnostic efforts.
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Affiliation(s)
- Selin Yesiltepe
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Aydın Adnan Menderes University, Aydın, Turkey
- *Selin Yesiltepe,
| | - Ibrahim Sevki Bayrakdar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
- Eskisehir Osmangazi University Center of Research and Application for Computer Aided Diagnosis and Treatment in Health, Eskisehir, Turkey
| | - Kaan Orhan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
- Ankara University Medical Design Application and Research Center (MEDITAM), Ankara, Turkey
| | - Özer Çelik
- Eskisehir Osmangazi University Center of Research and Application for Computer Aided Diagnosis and Treatment in Health, Eskisehir, Turkey
- Department of Mathematics and Computer Science, Faculty of Science, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Elif Bilgir
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ahmet Faruk Aslan
- Department of Mathematics and Computer Science, Faculty of Science, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Alper Odabaş
- Department of Mathematics and Computer Science, Faculty of Science, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | - Rohan Jagtap
- Division of Oral and Maxillofacial Radiology, Department of Care Planning and Restorative Sciences, University of Mississippi Medical Center School of Dentistry, Jackson, Mississippi, USA
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Affiliation(s)
- Lakshman Meena
- All India Institute of Medical Sciences, New Delhi, India
| | - Ranjan Gupta
- All India Institute of Medical Sciences, New Delhi, India
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15
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Magalhães BM, Catarino L, Carreiro I, Gomes RAMP, Gaspar RR, Matos VMJ, Santos AL. Differential diagnosis of a diffuse sclerosis in an identified male skull (early 20th century Coimbra, Portugal): A multimethodological approach for the identification of osteosclerotic dysplasias in skeletonized individuals. Int J Paleopathol 2021; 34:134-141. [PMID: 34243133 DOI: 10.1016/j.ijpp.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This work aims to discuss the difficulties in diagnosing osteosclerotic changes in skeletonized individuals and to raise awareness of osteosclerotic dysplasias as a group of rare ancient diseases. MATERIALS The skull of a 62-year-old male individual from the International Exchange Skull Collection, curated by the University of Coimbra, who died in 1928 presenting albuminous nephritis (Bright disease)/uraemia as the registered cause of death. METHODS The skull was macroscopically and radiologically examined and bone elemental analysis was investigated. The genealogy and medical records of the individual were also searched. RESULTS The lesions are in accordance with an osteosclerotic process possibly pointing to osteosclerosis, osteosclerotic metaphyseal dysplasia, or dysosteosclerosis, but osteoclasia with hyperphosphatasia, endosteal hyperostosis, sclerosteosis, or osteopathia striata with cranial sclerosis cannot be ruled out. CONCLUSIONS Representativeness of the skeleton is a crucial feature in diagnosing rare diseases and, to avoid a misdiagnosis, the final diagnosis should include a group of diseases rather than a definite disease. SIGNIFICANCE Difficulties in diagnosing rare diseases are discussed and best approaches in the study osteosclerotic dysplasias in skeletonized individuals are offered in the light of current clinical knowledge. LIMITATIONS The absence of the postcranial skeleton and of pathognomonic lesions associated with osteosclerotic dysplasias limits diagnosis. Although rare diseases often have a genetic basis, specific genetic testing for the diagnosis of rare diseases in paleopathological cases are not yet available. SUGGESTIONS FOR FURTHER RESEARCH Future genetic studies might help narrow down the diagnosis.
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Affiliation(s)
- Bruno M Magalhães
- University of Coimbra, Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, Coimbra, 3000-456, Portugal.
| | - Lidia Catarino
- University of Coimbra, Geosciences Centre, Department of Earth Sciences, Portugal
| | - Inês Carreiro
- Medical Imaging Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Ricardo A M P Gomes
- University of Coimbra, Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, Coimbra, 3000-456, Portugal
| | - Rosa Ramos Gaspar
- University of Coimbra, Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, Coimbra, 3000-456, Portugal; Medical Imaging Department, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Vitor M J Matos
- University of Coimbra, Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, Coimbra, 3000-456, Portugal
| | - Ana Luisa Santos
- University of Coimbra, Research Centre for Anthropology and Health, Department of Life Sciences, Calçada Martim de Freitas, Coimbra, 3000-456, Portugal
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Gamba TO, Maciel NAP, Rados PV, da Silveira HLD, Arús NA, Flores IL. The imaging role for diagnosis of idiopathic osteosclerosis: a retrospective approach based on records of 33,550 cases. Clin Oral Investig 2020; 25:1755-1765. [PMID: 32737665 DOI: 10.1007/s00784-020-03477-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study aimed to describe the diagnostic imaging features of idiopathic osteosclerosis (IO) to aid in differential diagnosis of similar dentomaxillomandibular conditions. MATERIALS AND METHODS An archive of 550 dentomaxillofacial radiographic (panoramic radiography (PR) and cone beam computed tomography (CBCT)) images and 33,000 histopathological records were reviewed to identify IO cases. Chi-square, Student's t test, and ANOVA tests, with a significance of p < 0.05, were applied for comparative analysis. In addition, we analyzed various studies to present a short review. RESULTS After meticulous observation, 36 images of 34 patients revealed 60 IO lesions in 31 PR and 5 CBCT. Sex, age group, anatomical site, shape, regularity, and root relationship showed statistical significance: sex and age group (p = 0.046), sex and IO regularity (p = 0.007), age group and IO regularity (p = 0.014), anatomical site and IO shape (p = 0.010), anatomical site and IO regularity (p = 0.003), and IO shape and IO regularity (p = 0.002). We presented a short review from 26 articles, including retrospective, cross-sectional, and longitudinal studies, documenting 2307 patients with 2435 IO lesions from 51,160 imagiological examinations. CONCLUSIONS A radiographic diagnostic profile of IO may guide the clinical practitioners in differentiating an incidental radiopacity. PR is a preliminary examination, with CBCT facilitating the IO diagnosis. CLINICAL RELEVANCE Knowledge of imaging characteristics variability of idiopathic osteosclerosis is crucial for accurate diagnosis process when incidental radiopacities are found in the panoramic radiographs, thus avoiding unnecessary biopsies. CBCT scans facilitate the interpretation of idiopathic osteosclerosis overlapping the mandibular canal.
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Affiliation(s)
- Thiago Oliveira Gamba
- UCS, School of Dentistry, Caxias do Sul University, Rua Francisco Getúlio Vargas, Caxias do Sul, RS, 1130, Brazil
| | - Nathália Alves Paz Maciel
- UCS, School of Dentistry, Caxias do Sul University, Rua Francisco Getúlio Vargas, Caxias do Sul, RS, 1130, Brazil
| | - Pantelis Varvaki Rados
- School of Dentistry, Federal University of Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos 2492 Sala 503, 90035-004, RS, Porto Alegre, Brazil
| | - Heraldo Luís Dias da Silveira
- School of Dentistry, Federal University of Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos 2492 Sala 503, 90035-004, RS, Porto Alegre, Brazil
| | - Nádia Assein Arús
- School of Dentistry, Federal University of Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos 2492 Sala 503, 90035-004, RS, Porto Alegre, Brazil
| | - Isadora Luana Flores
- School of Dentistry, Federal University of Rio Grande do Sul, UFRGS, Rua Ramiro Barcelos 2492 Sala 503, 90035-004, RS, Porto Alegre, Brazil.
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17
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Zarnecki KG, Kristianto J, Charlson J, Wilson B, Blank RD, Shaker JL. Diffuse osteosclerosis as a presentation of recurrent breast cancer: role of endothelin 1. Osteoporos Int 2019; 30:1699-1703. [PMID: 31079185 DOI: 10.1007/s00198-019-04998-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED We report a 46-yr-old woman with a history of breast cancer who presented with diffuse myalgias, bone pain, and osteosclerosis. She was found to have recurrent breast cancer producing endothelin-1. INTRODUCTION Acquired osteosclerosis can be caused by various disorders. Endothelin -1 is believed to contribute to osteosclerosis caused by breast cancer. METHODS Although the bone marrow biopsy did not reveal breast cancer, she developed skin lesions consistent with metastatic breast cancer. She ultimately died from progressive disease. At autopsy immunohistochemistry for endothelin-1 was performed on a section from the L5 vertebral body. RESULTS The section from the L5 vertebral body showed small foci of cells consistent with metastatic carcinoma and a prominent sclerotic response. Immunohistochemistry for endothelin-1 was strongly positive. CONCLUSIONS Recurrent breast cancer may present with diffuse osteosclerosis. Endothelin-1 may be a paracrine factor responsible for increased bone formation and osteosclerosis.
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Affiliation(s)
- K G Zarnecki
- Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Kristianto
- Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine (Endocrinology), University of Wisconsin School of Medicine, Madison, WI, USA
- GRECC Service and William S. Middleton Veterans Hospital, Madison, WI, USA
- Endocrine and Reproductive Physiology Program, University of Wisconsin, Madison, WI, USA
- Unity Biotechnology, Brisbane, CA, USA
| | - J Charlson
- Department of Medicine (Hematology and Oncology), Medical College of Wisconsin, Milwaukee, WI, USA
| | - B Wilson
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - R D Blank
- Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA
- GRECC Service and William S. Middleton Veterans Hospital, Madison, WI, USA
- Medical Service, Clement J. Zablocki VAMC, Milwaukee, WI, USA
| | - J L Shaker
- Department of Medicine (Endocrinology), Medical College of Wisconsin, Milwaukee, WI, USA.
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18
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Rolvien T, Kornak U, Schinke T, Amling M, Oheim R. A novel FAM20C mutation causing hypophosphatemic osteomalacia with osteosclerosis (mild Raine syndrome) in an elderly man with spontaneous osteonecrosis of the knee. Osteoporos Int 2019; 30:685-689. [PMID: 30151622 DOI: 10.1007/s00198-018-4667-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/12/2018] [Indexed: 12/11/2022]
Abstract
Raine syndrome is characterized by FGF23-mediated hypophosphatemic osteomalacia with osteosclerosis caused by mutations in the FAM20C gene. We report a case of a 72-year-old man who presented with rapid progressive spontaneous osteonecrosis of the knee (SONK). A full osteologic assessment including dual energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and serum analyses revealed a high bone mass in the lumbar spine and hip (DXA T-score + 7.5 and + 4.7/+4.2) with increased bone microstructural parameters in the distal radius and tibia (BV/TV 127%, 140% of the age-matched mean, respectively), as well as a low bone turnover state. Phosphate levels were low due to renal phosphate wasting and high FGF23 levels (126.5 pg/ml, reference range 23.2-95.4 pg/ml). Using gene panel sequencing, we identified a novel FAM20C heterozygous missense mutation in combination with a homozygous duplication that potentially alters splicing. Taken together, this is the first case of mild Raine syndrome with spontaneous osteonecrosis of the knee, phosphate wasting, and a pronounced trabecular high bone mass phenotype.
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Affiliation(s)
- T Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - U Kornak
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg School for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
- FG Development and Disease, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - T Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany.
- National Bone Board, Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Howaldt A, Nampoothiri S, Quell LM, Ozden A, Fischer-Zirnsak B, Collet C, de Vernejoul MC, Doneray H, Kayserili H, Kornak U. Sclerosing bone dysplasias with hallmarks of dysosteosclerosis in four patients carrying mutations in SLC29A3 and TCIRG1. Bone 2019; 120:495-503. [PMID: 30537558 DOI: 10.1016/j.bone.2018.12.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/01/2018] [Accepted: 12/06/2018] [Indexed: 11/23/2022]
Abstract
The osteopetroses and related sclerosing bone dysplasias can have a broad range of manifestations. Especially in the milder forms, sandwich vertebrae are an easily recognizable and reliable radiological hallmark. We report on four patients from three families presenting with sandwich vertebrae and platyspondyly. The long bone phenotypes were discordant with one patient showing modeling defects and patchy osteosclerosis, while the second displayed only metaphyseal sclerotic bands, and the third and fourth had extreme metaphyseal flaring with uniform osteosclerosis. Two of the four patients had experienced pathological fractures, two had developmental delay, but none showed cranial nerve damage, hepatosplenomegaly, or bone marrow failure. According to these clinical features the diagnoses ranged between intermediate autosomal recessive osteopetrosis and dysosteosclerosis. After exclusion of mutations in CLCN7 we performed gene panel and exome sequencing. Two novel mutations in SLC29A3 were found in the first two patients. In the third family a TCIRG1 C-terminal frameshift mutation in combination with a mutation at position +4 in intron 2 were detected. Our study adds two cases to the small group of individuals with SLC29A3 mutations diagnosed with dysosteosclerosis, and expands the phenotypic variability. The finding that intermediate autosomal recessive osteopetrosis due to TCIRG1 splice site mutations can also present with platyspondyly further increases the molecular heterogeneity of dysosteosclerosis-like sclerosing bone dysplasias.
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Affiliation(s)
- Antonia Howaldt
- Institut für Medizinische Genetik und Humangenetik, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Lisa-Marie Quell
- Institut für Medizinische Genetik und Humangenetik, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ayse Ozden
- Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Björn Fischer-Zirnsak
- Institut für Medizinische Genetik und Humangenetik, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Corinne Collet
- Service de Biochimie et Biologie Moléculaire, CHU Paris-GH St-Louis Lariboisière F. Widal - Hôpital Lariboisière, Paris, France
| | - Marie-Christine de Vernejoul
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Rhumatologie, GH Saint-Louis Lariboisière Fernand Widal, Paris, France
| | - Hakan Doneray
- Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Hülya Kayserili
- Medical Genetics Department, Koç University School of Medicine (KUSOM), Istanbul, Turkey
| | - Uwe Kornak
- Institut für Medizinische Genetik und Humangenetik, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Max Planck Institute for Molecular Genetics, Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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20
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Debevc D, Hitij T, Kansky A. Painful neuropathy caused by compression of the inferior alveolar nerve by focal osteosclerotic lesion of the mandible: A case report. Quintessence Int 2018; 48:725-732. [PMID: 28920110 DOI: 10.3290/j.qi.a38905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Osteosclerotic lesions are a common finding on dental radiographs. They are considered developmental variants of a normal bone architecture and they usually do not need any treatment. The purpose of this article is to present a rare case of osteosclerotic lesion of the mandible causing trigeminal neuropathy by compression of the alveolar nerve. The pain started with dental hypersensitivity of the mandibular right first molar. Later on, signs of irreversible molar tooth pulpitis developed. Endodontic therapy and apicoectomy did not resolve the pain, which later intensified, and painful neuropathy localized to inferior alveolar nerve developed; therefore, surgical decompression was indicated. Treating a dental patient with neuralgic pain is always a challenge, especially if there is no obvious source or reason for this type of pain. A clear evaluation and treatment protocol are important to minimize the patient's morbidity and avoid unnecessary overtreatment.
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21
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Campbell GM, Tower RJ, Damm T, Kneissl P, Rambow AC, Schem C, Tiwari S, Glüer CC. Tracking the Progression of Osteolytic and Osteosclerotic Lesions in Mice Using Serial In Vivo μCT: Applications to the Assessment of Bisphosphonate Treatment Efficacy. J Bone Miner Res 2018; 33:410-418. [PMID: 29044710 DOI: 10.1002/jbmr.3317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 11/11/2022]
Abstract
The metastasis of tumor cells to bone can lead to osteolytic and osteosclerotic lesions, which cause severe, highly-localized bone destruction and abnormal bone apposition, respectively. Accurate quantification of lesion progression is critical to understand underlying mechanisms and assess treatment efficacy; however, standard structural parameters may be insensitive to local changes. We developed methods to quantify osteolytic and osteosclerotic lesions using micro-computed tomography (μCT) within in vivo mouse datasets. Two Balb/c nude datasets were used: (i) bone-homing MDA-MB-231 (osteolytic) cells injected into the left ventricle, treatment with alendronate or vehicle, and weekly μCT (proximal tibia) for 4 weeks, and (ii) MCF7 (osteosclerotic) cells injected into the right tibia and weekly μCT over 12 weeks. After registering images to baseline, osteolytic lesion volume was determined by summing all baseline bone voxels at distances greater than a threshold (150 μm) from the nearest follow-up. Osteosclerotic lesions were determined by measuring the distance from each follow-up surface voxel to the nearest baseline surface and calculating the standard deviation of distance values (SDDT) of the surrounding voxels. Bone mineral density (BMD), bone volume density (BV/TV), and separation (Sp) were determined for comparison. Osteolytic lesions were observed 1 week after tumor cell injection; however, no corresponding BV/TV losses or Sp increases were observed, indicating that standard parameters were unable to detect early metastatic changes. Lesion volume was smaller in the alendronate versus control group (15.0%, p = 0.004 and 18.6%, p = 0.002 of control lesion volume at weeks 3 and 4, respectively). In the osteosclerotic dataset, increased SDDT was observed following injection, providing a potential new measure of osteosclerotic bone apposition. These data show that quantification of local structural change with serial μCT may overcome the limitations of standard mineral and microstructural parameters, and successfully separates metastatic and normal bone turnover. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Graeme M Campbell
- Section Biomedical Imaging, Department of Radiology and Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Institute of Biomechanics, Hamburg University of Technology (TUHH), Hamburg, Germany
| | - Robert J Tower
- Section Biomedical Imaging, Department of Radiology and Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Timo Damm
- Section Biomedical Imaging, Department of Radiology and Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Philipp Kneissl
- Department of Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anna C Rambow
- Department of Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Christian Schem
- Department of Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sanjay Tiwari
- Section Biomedical Imaging, Department of Radiology and Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Claus C Glüer
- Section Biomedical Imaging, Department of Radiology and Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
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Abstract
Skeletal fluorosis (SF) is an osteosclerotic metabolic bone disorder caused by excessive ingestion or inhalation of fluoride. SF is extremely rare in developed countries. We report a case of SF due to inhalational abuse from a fluoride-containing air dust cleaner. A 33-year-old man with no past medical history presented with progressively worsening low back pain for 2 years. Physical examination was notable for loss of lumbar lordosis and tenderness over the lumbar spine. Radiographs were notable for uniform generalized osteosclerosis in the long bones, entire spine, rib cage, and pelvic bones, and loss of the normal lumbar curvature. DXA scan showed Z-scores of +10.7 at the lumbar spine, +6.5 at the total hip, and +1.0 at the 1/3 radius. Laboratory studies were notable for elevated serum alkaline phosphatase (334 U/L, ref: 40-129 U/L) compared to a normal value 3 years prior, suggesting acquired osteosclerosis. Serum fluoride concentration returned elevated (2.8 mg/L, ref: 0.0-0.2 mg/L). Initially, the source of fluoride excess could not be identified. At a follow-up visit, he was found inhaling from a can of an air duster hidden in an inner pocket. He admitted "huffing" 2-7 cans weekly from a fluorocarbon-containing air dust cleaner for the past 3 years to achieve a euphoric feeling, explaining the source of his SF. Fluoride inhalation can be a potential source for SF, and should be suspected in patients with acquired osteosclerosis, as inhalant abuse is increasingly practiced in many countries.
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Affiliation(s)
- Katherine Peicher
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Naim M Maalouf
- Division of Mineral Metabolism, Department of Internal of Medicine, and The Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8885, USA.
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Syed AZ, Yannam SD, Pavani G. Research: Prevalence of Dense Bone Island. Compend Contin Educ Dent 2017; 38:e13-e16. [PMID: 28972383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the prevalence of dense bone island (DBI) and its relationship to age and sex; its predominant location, amount, and shape; and its correlation with resorption of roots. STUDY DESIGN A retrospective chart review was done with panoramic images of 4581 patients above the age of 14 years at Case Western Reserve University School of Dental Medicine in northeast Ohio from January 2014 to May 2015. RESULTS Of 4581 patients seen, 147 (3.2%) reported with DBI. Females were mostly affected compared with males, and this was statistically significant. The age group primarily involved was from 15 to 24 years. The mandibular right premolar apical region was mostly involved,and the shape of lesions was mostly round. CONCLUSION Based on the findings, DBI appears as radiopaque islands without any radiolucent rim on radiographic images. These islands can occur at any age and at any location, with a predilection for females.The lesions are mostly seen in the mandibular premolar apical area. Resorption was seen in few cases of DBI, and follow-up showed no deleterious effects.
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Affiliation(s)
- Ali Zakir Syed
- Director of Radiology, Assistant Professor, Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio
| | - Savitha Deepthi Yannam
- Fellow, Advanced Education in General Dentistry, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio
| | - Gedela Pavani
- Former Fellow, Advanced Education in General Dentistry, Case Western Reserve University, School of Dental Medicine, Cleveland, Ohio
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Abstract
RATIONALE We report a case of successful diagnosis of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome based on monoclonality that was confirmed by an osteosclerotic lesion biopsy in a patient without pathognomonic symptoms or monoclonal gammopathy, probably because of comorbidities, which included systemic lupus erythematosus, rheumatoid arthritis, and Sjögren syndrome. PATIENT CONCERNS A 57-year-old woman presented with an approximately 2-year history of numbness in the toes that had gradually spread, along with muscle weakness in both arms and legs. She had been receiving immunosuppressant and corticosteroid therapy since being diagnosed with systemic lupus erythematosus and Sjögren syndrome at the age of 31 years and rheumatoid arthritis at the age of 44 years. Neurological examination revealed predominantly distal hypoesthesia and weakness in a typical stocking-and-glove pattern. Immunoelectrophoresis revealed elevated polyclonal immunoglobulin, which was attributed to her known underlying disease. DIAGNOSES Biopsy of an osteosclerotic lesion confirmed proliferation of monoclonal plasma cells, leading to a diagnosis of POEMS syndrome. INTERVENTIONS AND OUTCOMES Lenalidomide therapy was started after the diagnosis and the patient had a favorable outcome. LESSONS Osteosclerotic lesion biopsy can be useful for diagnosis of POEMS syndrome in difficult cases.
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Affiliation(s)
- Daisuke Hara
- Department of Internal Medicine, Division of Neurology
| | | | - Saki Nukui
- Department of Internal Medicine, Division of Neurology
| | | | - Masahiro Hoshikawa
- Department of Diagnostic Pathology, Division of Diagnostic Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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25
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Miettinen HE, Sane T, Lamminen A, Välimäki MJ. [Osteosclerosis associated with hepatitis C]. Duodecim 2017; 133:881-885. [PMID: 29240322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We describe the first Finnish case of hepatitis C associated osteosclerosis. In which the patient's bone symptoms and bone density were resolved with hepatitis C treatment. Suspecting the possibility of osteosclerosis underlying bone pains in a hepatitis C patient is well-founded, although osteoporotic fractures are a more common problem.
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Ciray I, Aström G, Andréasson I, Edekling T, Hansen J, Bergh J, Ahlström H. Evaluation of new sclerotic bone metastases in breast cancer patients during treatment. Acta Radiol 2016; 41:178-82. [PMID: 10741794 DOI: 10.1080/028418500127345019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: According to the World Health Organization (WHO) criteria for response of bone metastases to therapy, new lesions indicate progressive disease. We intended to prove that a new sclerotic lesion on conventional radiography may also be a sign of a positive therapeutic response in a previously undetectable lytic metastasis. Material and Methods: In a previous placebo-controlled clinical trial of clodronate (Ostac) therapy, 139 breast cancer patients with bone metastases underwent both conventional radiography and bone scan every 6 months for 2 years with 99mTc before and during clodronate treatment. WHO criteria were applied for therapy response evaluation. Results: In 24 patients, 52 new sclerotic lesions observed during therapy were selected for re-evaluation of conventional radiographs and bone scans. In 8 of the 24 patients, 17 of 52 new sclerotic lesions (33%) had showed positive uptake on previous bone scans. These lesions were possibly misinterpreted as new when applying WHO criteria. Conclusion: For better assessment of new sclerotic lesions during treatment, more sensitive techniques, e.g. bone scan, are needed as a complement to conventional radiography.
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Affiliation(s)
- I Ciray
- Department of Diagnostic Radiology, University Hospital, Uppsala, Sweden
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Tang K, Cai Z, Chen Z, Cui W, You X, Liu Q. Juvenile hyaline fibromatosis: report of a rare case at an advanced stage with osteosclerosis and scoliosis. Int J Dermatol 2016; 55:903-5. [PMID: 27061595 DOI: 10.1111/ijd.13249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/06/2015] [Accepted: 11/10/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Kuangyun Tang
- Department of Plastic and Reconstructive Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Zhen Cai
- Department of Plastic and Reconstructive Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Zaihong Chen
- Department of Plastic and Reconstructive Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Wei Cui
- Department of Plastic and Reconstructive Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Xiaobo You
- Department of Plastic and Reconstructive Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Quan Liu
- Department of Plastic and Reconstructive Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
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Li ZJ, Lai RF, Feng ZQ. Case History Report: Cone Beam Computed Tomography for Implant Insertion Guidance in the Presence of a Dense Bone Island. INT J PROSTHODONT 2016; 29:186-7. [PMID: 26929962 DOI: 10.11607/ijp.4160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article describes the use of cone beam computed tomography (CBCT) to diagnose a dense bone island (DBI) to facilitate implant insertion guidance in a patient followed up for 4 years. Suitable image-directed preplanning and periodic review by CBCT scanning is recommended when a jaw DBI is encountered in treatment planning for implant placement.
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29
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Affiliation(s)
- A Sandford
- Department of Rheumatology, The Royal London Hospital, Bancroft Road, London E1 4DG, UK.
| | - A S Jawad
- Department of Rheumatology, The Royal London Hospital, Bancroft Road, London E1 4DG, UK
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30
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Adam Z, Petrášová H, Řehák Z, Koukalová R, Krejčí M, Pour L, Vetešníková E, Čermák A, Ševčíková S, Szturz P, Král Z, Mayer J. [Evaluation of five years of treatment of Erdheim-Chester disease with anakinra: case report and overview of literature]. Vnitr Lek 2016; 62:820-832. [PMID: 27900869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Erdheim-Chester disease is a histiocytic neoplasm of diseases from the group of non-Langerhans-cell histiocytoses, formed by infiltrates of foamy histiocytes. These pathological histiocytes produce pro-inflammatory cytokines. Therefore Erdheim-Chester disease is called inflammatory histiocytary neoplasm. The disease is accompanied by clinical symptoms of systemic inflammatory response, i.e. B symptoms. Imaging examinations detect typical osteosclerotic changes affecting diaphyses and metaphyses of the lower long bones and fibrotic changes which affect the aorta wall and the vessels leading from it. Also characteristic are perirenal fibrotic changes spreading in the retroperitoneum. They can cause serious complications - hydronephrosis with all its consequences. The therapy for this disease was not satisfactory in the previous years. Conventional chemotherapy or glucocorticoids do not bring any substantial and long-term improvement. Considering cytostatic drugs, only 2-chlorodeoxyadenosine (cladribine) is effective, though not in all patients. We have only reached complete remission through 2-chlorodeoxyadenosine in one of our two patients, which now lasts more than 5 years, while cladribine in the same patient did effect the reduction of infiltrates into the CNS, but it did not achieve abatement of the disease activity in other locations as shown by PET/CT with the application of the radio-pharmaceutical fluorodeoxyglucose (FDG). Another effective medicine for patients with Erdheim-Chester disease is interferon α. However its long-term administration is associated with multiple adverse effects and so we did not test it in the described patient. The introduction of anakinra, the interleukin-1 receptor blocker, to therapy brought a new hope for these patients. We are describing the patient who has been treated with anakinra for more than 5 years. The patient applies 1 ampoule of 100 mg subcutaneously per day. This treatment completely removed systemic B symptoms, relieved bone pains and attained normalization of all findings that signalled systemic inflammatory response. The treatment effect is regularly checked by CT imaging of the abdomen and by FDG-PET/CT examinations. The retroperitoneal fibrotic changes gradually regressed during the 5 years of anakinra treatment, as documented by the pictures in the text. Low-dose CT imaging which was part of the PET/CT examination, identified many osteosclerotic lesions in the skeleton, mainly in the legs, with an increased accumulation of 18F-fluorodeoxyglucose (FDG). Osteosclerotic lesions remain well visible at repeated examinations. Still during the course of the 5-year period the FDG accumulation in them decreased, as shown by the pictures in the text. Anakinra treatment has a character of maintenance therapy. The BRAFV600E mutation was not proven in the described patient, therefore we did not test vemurafenib treatment. CONCLUSION anakinra effected regression of fibrotic changes in the retroperitoneum and disappearance of B symptoms as well as decrease in FDG accumulation at FDG-PET/CT examination.Key words: anakinra - Erdheim-Chester disease - cladribine - retroperitoneal fibrosis - vemurafenib.
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31
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Edwards R, Alsufyani N, Heo G, Flores-Mir C. Agreement among orthodontists experienced with cone-beam computed tomography on the need for follow-up and the clinical impact of craniofacial findings from multiplanar and 3-dimensional reconstructed views. Am J Orthod Dentofacial Orthop 2015; 148:264-73. [PMID: 26232835 DOI: 10.1016/j.ajodo.2015.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION In this study, we aimed to assess interrater and intrarater agreement among orthodontic clinicians in their assessments of reported incidental findings in regard to both the need for additional follow-up and the impact on future orthodontic treatment in large-field maxillofacial cone-beam computed tomography (CBCT) imaging. METHODS The study sample consisted of 18 nonrandomly selected large-field maxillofacial CBCT volumes containing a reported total of 88 radiographic findings. All scans were associated with formal radiologic reports. However, the suggestions of further follow-up were removed from the radiologic reports so as to not bias the 3 evaluating orthodontists in their subsequent decision making. The evaluators had on average 7.6 years of CBCT usage and self-interpretation experience. Reliability was determined by quantifying the level of agreement between the evaluators' assessments for both research questions for all 88 findings using a binary response (yes/no) as the outcome measure. The Cohen kappa statistic was calculated to quantify intrarater and interrater agreement globally for both statements. RESULTS Although interrater agreement was considerable, potential decisions with clinical impact were not consistent. This needs to be considered when interpreting maxillofacial incidental findings. Evaluators demonstrated higher levels of agreement for dentoalveolar findings compared with all other extragnathic regions when assessing clinical significance. CONCLUSIONS Among the evaluators who were considered experienced in CBCT, "fair-to-good" interrater agreement and "excellent" intrarater agreement were demonstrated in terms of the need for further follow-up and their potential impact on future orthodontic treatment.
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Affiliation(s)
| | - Noura Alsufyani
- Assistant professor, Division of Oral Medicine, Pathology and Radiology, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Giseon Heo
- Associate professor, Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos Flores-Mir
- Professor and head, Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Hodovana OI. [INVESTIGATION OF THE LEVEL OF MINERAL DENSITY OF SKELETAL OSSEOUS TISSUE IN PATIENTS WITH PERIODONTAL TISSUE DISEASES]. Lik Sprava 2015:123-128. [PMID: 27491164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Results of investigation of mineral density condition of skeletal osseous tissue in patients with inflammatory and dystrophic-inflammatory diseases of periodontal tissues with ultrasound densitometry method have been presented. Various changes of osseous tissue of skeletal bones have been detected: osteopenia, osteoporosis and osteosclerosis, which correlated with the severity of pathological process in periodontium. Analysis of the obtained results has been carried out depending on patients' sex as well as form and severity degree of the course of periodontal diseases. It has been established that the peak of detected impairments of mineral density in the skeleton is due to osteopenia, the degree of severity of which deteriorates with the severity of pathological process in periodontal tissues, especially in women.
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Delgado Flores G, Robles Cartagena A, Robles Cartagena I, Muñiz A, Cabanillas F, Vicens R. POEMS Syndrome: A Rare Disease With A Challenging Diagnosis. Bol Asoc Med P R 2015; 107:85-88. [PMID: 26742203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A complex conglomerate of symptoms, signs, and abnormalities are present with POEMS syndrome, making the diagnosis, management and follow-up a challenge. Recognizing the disease early on may be difficult. Many patients are initially misdiagnosed as having others disorders, for example: multiple myeloma. There is no standard treatment for patients diagnosed with POEMS syndrome.
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Affiliation(s)
- Eisuke Kobayashi
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
| | - Nokitaka Setsu
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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35
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Serraino C, Melchio R, Silvestri A, Borretta V, Pomero F, Fenoglio L. Hepatitis C-associated osteosclerosis: a new case with long-term follow-up and a review of the literature. Intern Med 2015; 54:777-83. [PMID: 25832941 DOI: 10.2169/internalmedicine.54.3448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hepatitis C-associated osteosclerosis (HCAO) is an uncommon condition characterized by increased bone density, skeletal pain and elevated bone formation markers. Since 1992, only 17 cases have been reported. We herein describe the case of a 61-year-old woman affected by severe pain involving the lower limbs. The laboratory data showed an elevated serum alkaline phosphatase level, and the patient was found to be seropositive for hepatitis C virus infection. In addition, an X-ray skeleton survey showed marked cortical thickening of both femurs and tibias, and a whole-body bone scan revealed an increased cortical radionuclide uptake in the involved bones. These findings were consistent with a diagnosis of HCAO. In this report, we discuss the patient's clinical course over 16 years and, for the first time, show a normalized radioisotope uptake on bone scanning 10 years after the diagnosis.
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Affiliation(s)
- Cristina Serraino
- Department of Internal Medicine, S. Croce e Carle General Hospital, Cuneo, Italy
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36
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Whyte MP, Madson KL, Mumm S, McAlister WH, Novack DV, Blair JC, Helliwell TR, Stolina M, Abernethy LJ, Shaw NJ. Rapid skeletal turnover in a radiographic mimic of osteopetrosis. J Bone Miner Res 2014; 29:2601-9. [PMID: 24919763 PMCID: PMC4391634 DOI: 10.1002/jbmr.2289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 12/13/2022]
Abstract
Among the high bone mass disorders, the osteopetroses reflect osteoclast failure that prevents skeletal resorption and turnover, leading to reduced bone growth and modeling and characteristic histopathological and radiographic findings. We report an 11-year-old boy with a new syndrome that radiographically mimics osteopetrosis (OPT), but features rapid skeletal turnover. He presented at age 21 months with a parasellar, osteoclast-rich giant cell granuloma. Radiographs showed a dense skull, generalized osteosclerosis and cortical thickening, medullary cavity narrowing, and diminished modeling of tubular bones. His serum alkaline phosphatase was >5000 IU/L (normal <850 IU/L). After partial resection, the granuloma re-grew but then regressed and stabilized during 3 years of uncomplicated pamidronate treatment. His hyperphosphatasemia transiently diminished, but all bone turnover markers, especially those of apposition, remained elevated. Two years after pamidronate therapy stopped, bone mineral density (BMD) Z-scores reached +9.1 and +5.8 in the lumbar spine and hip, respectively, and iliac crest histopathology confirmed rapid bone remodeling. Serum multiplex biomarker profiling was striking for low sclerostin. Mutation analysis was negative for activation of lipoprotein receptor-related protein 4 (LRP4), LRP5, or TGFβ1, and for defective sclerostin (SOST), osteoprotegerin (OPG), RANKL, RANK, SQSTM1, or sFRP1. Microarray showed no notable copy number variation. Studies of his nonconsanguineous parents were unremarkable. The etiology and pathogenesis of this unique syndrome are unknown.
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Affiliation(s)
- Michael P. Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - Katherine L. Madson
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - William H. McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children’s Hospital, Washington University School of Medicine; St. Louis, MO, USA, 63110
| | - Deborah V. Novack
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
- Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - Jo C. Blair
- Department of Endocrinology, Alder Hey Children’s National Health Service Foundation Trust; Liverpool, UK, L12 2AP
| | - Timothy R. Helliwell
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool; Liverpool, UK, L69 3GA
| | | | - Laurence J. Abernethy
- Department of Radiology, Alder Hey Children’s National Health Service Foundation Trust; Liverpool, UK, L12 2AP
| | - Nicholas J. Shaw
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital; Birmingham, UK, B4 6NH
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Nguyen T, Bistreanu R, Daens S. [Diagnosis of Erdheim-Chester disease following a traumatic fracture]. Rev Med Brux 2014; 35:431-435. [PMID: 25672012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We describe the case of a woman with the diagnosis of Erdheim-Chester disease following an upper limb traumatic fracture. A 65-year-old woman presents to the emergency department for left shoulder and right ankle pain, she admits recent multiple falls. Imaging shows a left trochiter fracture and osteosclerotic lesions in the upper and lower limbs. Bone biopsy confirms the suspicion of Erdheim-Chester disease. Erdheim-Chester disease is a rare systemic non- Langerhans cell histiocytosis of the middle-aged adult. The most common characteristic is bilateral and symmetric osteosclerotic lesions in long bones. Pathological examination provides the definitive diagnosis. Imaging and clinical biology assess the extent of the disease. Treatment must be decided on a case-to-case basis taking into account patient's symptoms.
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Waterval JJ, Borra VM, Van Hul W, Stokroos RJ, Manni JJ. Sclerosing bone dysplasias with involvement of the craniofacial skeleton. Bone 2014; 60:48-67. [PMID: 24325978 DOI: 10.1016/j.bone.2013.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 01/13/2023]
Abstract
In this review we provide a complete overview of the existing sclerosing bone dysplasias with craniofacial involvement. Clinical presentation, disease course, the craniofacial symptoms, genetic transmission pattern and pathophysiology are discussed. There is an emphasis on radiologic features with a large collection of CT and MRI images. In previous reviews the craniofacial area of the sclerosing bone dysplasias was underexposed. However, craniofacial symptoms are often the first symptoms to address a physician. The embryology of the skull and skull base is explained and illustrated for a better understanding of the affected areas.
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Affiliation(s)
- J J Waterval
- Department of Otorhinolaryngology-Head & Neck Surgery, Maastricht University Medical Center, P.O. 5800, 6202AZ Maastricht, The Netherlands.
| | - V M Borra
- Department of Medical Genetics, University of Antwerp, Prins Boudewijnlaan 43, B-2650 Edegem, Belgium.
| | - W Van Hul
- Department of Medical Genetics, University of Antwerp, Prins Boudewijnlaan 43, B-2650 Edegem, Belgium.
| | - R J Stokroos
- Department of Otorhinolaryngology-Head & Neck Surgery, Maastricht University Medical Center, P.O. 5800, 6202AZ Maastricht, The Netherlands.
| | - J J Manni
- Department of Otorhinolaryngology-Head & Neck Surgery, Maastricht University Medical Center, P.O. 5800, 6202AZ Maastricht, The Netherlands.
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Ustün N, Ustün I, Ozgür T, Atci N, Aydoğan F, Sümbül AT, Turhanoğlu AD. Diffuse osteosclerosis in a patient with prostate cancer. Osteoporos Int 2014; 25:1181-5. [PMID: 24136106 DOI: 10.1007/s00198-013-2545-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/01/2013] [Indexed: 01/15/2023]
Abstract
A 61-year-old man was referred to our outpatient clinic because of severe bilateral upper leg pain for 1 year. On admission, the patient had anemia and a high serum alkaline phosphatase level. Lumbar and femoral neck T-scores were +10.5 and +9.6, respectively. His radius 33 % T-score was -2.8. Plain radiographs of the patient's pelvis, spine, and long bones revealed osteosclerosis. The patient had previously undergone a prostate biopsy, which showed prostate adenocarcinoma (Gleason score 3 + 4). The patient's total and free prostate-specific antigen were very high. According to previous records, the patient did not have anemia, and his serum alkaline phosphatase (ALP) level was normal. An abdominal radiograph taken 2 years earlier revealed a normal spine and pelvic bone. Bone scintigraphy yielded nontypical findings for prostate cancer metastasis. Computed tomography of the patient's thorax and abdomen showed heterogeneous sclerotic areas in all bones consistent with prostate cancer metastasis. A bone marrow biopsy disclosed disseminated carcinomatosis of bone marrow in association with prostate cancer. Clinicians should be aware of the possibility of prostate malignancy as a cause of high bone mineral density (BMD), even in the absence of typical localized findings on plain radiographs.
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Affiliation(s)
- N Ustün
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey,
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Zaman MU, Nakamoto T, Tanimoto K. A retrospective study of digital subtraction technique to detect sclerotic changes in alveolar bone on intraoral radiographs of bisphosphonate-treated patients. Dentomaxillofac Radiol 2013; 42:20130242. [PMID: 24404602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES Several reports have suggested that sclerotic changes in cancellous bone of the jaw and thickening of the lamina dura are characteristic radiographic changes of an early silent stage of bisphosphonate (BP)-related osteonecrosis of the jaw. No quantitative evaluation has been reported to support this hypothesis. Emago® software (Oral Diagnostic Systems, Amsterdam, Netherlands) can perform digital subtraction on intraoral radiographs even if they were obtained by non-standardized radiography, provided the dimensional error is within a certain limit. The purpose of this study was to evaluate whether sclerotic changes of alveolar bone or thickening of lamina dura in patients using BP can be detected using the subtraction function of Emago. METHODS The authors selected 46 pairs of intraoral radiographs of the mandibular molar area in dental patients. All radiographs were obtained at intervals of 6 months or more. Among the 46 pairs, 7 pairs were from patients who were being treated with BP (study subjects), and 39 pairs were from patients who had not been using BP (controls). All pairs of radiographs underwent digital subtraction by Emago. The number of pixels of the sclerotic areas was counted and compared between subjects and controls. RESULTS The sclerotic changes were significantly distinguishable in two of the seven subjects (28.6%) using BP. CONCLUSIONS Digital subtraction function of Emago was able to detect sclerotic changes in alveolar bone. Therefore, it is suggested that the subtraction function of Emago is a useful tool for quantitatively detecting sclerotic changes that are observed at an early, silent stage of BP-related osteonecrosis of the jaw.
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Wang C, Zhang BH, Zhang H, He JW, Hu YQ, Li M, Yue H, Hu WW, Gu JM, Liu YJ, Fu WZ, Zhang ZL. The A242T mutation in the low-density lipoprotein receptor-related protein 5 gene in one Chinese family with osteosclerosis. Intern Med 2013; 52:187-92. [PMID: 23318847 DOI: 10.2169/internalmedicine.52.8164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Osteosclerosis (OMIM: 144750) is a type of autosomal dominant bone disease caused by a mutation in the low-density lipoprotein receptor-related protein 5 (LRP5) gene. The case of a Chinese family with two affected individuals is reported in the present study in order to investigate the clinical characteristics and virulence genes of this sclerosing bone disorder. METHODS Biochemical and radiographic examinations and bone mineral density (BMD) and genetic analyses were performed in two patients and eight other family members. RESULTS The 40-year-old proband (II-1) and her 64-year-old mother (I-2) both had chronic lumbodorsal pain, an elongated mandible and torus palatinus in the center of the hard palate. No fractures were observed in any of the family members. Skull, mandibular and pelvic X-rays in each of the two patients revealed thickened cranial plates, an enlarged sella turcica, an elongated mandible and cortical thickening of the long bones. The BMD values of the two patients was significantly higher than the standard age- and sex-matched adult mean reference values. Both patients had higher serum sclerostin levels, while their renal function markers and serum calcium, phosphonium, parathyroid hormone (PTH) and 25(OH)D levels were within the normal ranges. The heterozygous missense mutation p.Ala242Thr in exon 4 of the LRP5 gene was detected in the two patients, while the other family members and 200 healthy donors had normal wild-type genotypes. CONCLUSION The A242T mutation in the LRP5 gene resulted in a high bone mass phenotype with an elongated mandible and torus palatinus in this osteosclerotic family.
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Affiliation(s)
- Chun Wang
- Metabolic Bone Disease and Genetics Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Sixth People's Hospital affiliated with Shanghai Jiao Tong University, China
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Desai B, Gross ME, Jadvar H. Multimodality imaging in biochemical recurrence of prostate cancer: utility of (18)F-NaF PET/CT in early detection of metastasis. Rev Esp Med Nucl Imagen Mol 2012; 31:231-2. [PMID: 22980132 DOI: 10.1016/j.remn.2012.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 03/19/2012] [Accepted: 03/20/2012] [Indexed: 11/18/2022]
Affiliation(s)
- B Desai
- Department of Radiology, PET Imaging Science Center, Keck School of Medicine, University of Southern California, Los Angeles, USA
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Minenkov GO, Shalabaev BD. [Computed tomographic criteria for the diagnosis of variable manifestations of Paget's disease in the cerebral cranium and facial bones]. Vestn Rentgenol Radiol 2012:56-58. [PMID: 23214031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE to optimize the diagnosis of different stages of Paget's disease, by determining the extent of bone structural lesions in the cerebral and visceral cranium on the basis of computed tomography data. MATERIAL AND METHODS Computed tomographic data were assessed by keeping in mind the structure, density, outlines, shadow shapes of the described tumor-like disease and the state of involved bone structures. Twelve patients with histologically verified Paget's disease were examined. RESULTS The findings allowed the high informative value of computed tomography in diagnosing different stages of Paget's disease to be estimated in bone structural lesions in the cerebral and visceral cranium and skull base. Also, the obtained computed tomography data permitted the tracing of the extent of the lesion in the area under study.
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Ledesma-Montes C, Salcido-García JF, Hernández-Flores F, Garcés-Ortíz M. Pathological findings in a sample of Mexican pediatric patients. Clinical and radiographic survey. Minerva Stomatol 2012; 61:205-212. [PMID: 22576445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM The findings of a clinical-radiological review of 467 children attending the Oral Diagnosis Clinic of the Facultad de Odontología, UNAM, Mexico, are presented. METHODS All patients were clinically reviewed, clinical history was taken, and an orthopantomogram obtained by last year dentistry students. Patients and radiographs were then reviewed by the panel and all alterations in teeth, soft tissues and bone were recorded. RESULTS Clinical and/or radiographic alterations were found in 132 (28.26%) children. The main alterations were developmental (75%) and inflammatory/infectious and traumatic (6.06% each). The most common entities were: supernumeraries (30.77%); hypodontia (29.7%); osteosclerotic lesions and microdontia (4.4% each). CONCLUSION The data on the frequency of alterations in the pediatric population attending at our institution reinforce the importance of this kind of study in efforts to improve the quality of stomatologic services in the pediatric population.
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Affiliation(s)
- C Ledesma-Montes
- Laboratorio de Patología Clínica, División de Estudios de Posgrado e Investigación, Facultad de Odontología, UNAM, Mexico.
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Krisjane Z, Urtane I, Krumina G, Neimane L, Ragovska I. The prevalence of TMJ osteoarthritis in asymptomatic patients with dentofacial deformities: a cone-beam CT study. Int J Oral Maxillofac Surg 2012; 41:690-5. [PMID: 22464854 DOI: 10.1016/j.ijom.2012.03.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 01/04/2012] [Accepted: 03/02/2012] [Indexed: 12/18/2022]
Abstract
Osteoarthritis of the temporomandibular joint (TMJ) can be described as non-inflammatory arthritic condition that results in degenerative changes of the joint structures. The aim of this study was to evaluate the skeletal morphology of the TMJ in patients with osteoarthritis with severe skeletal malocclusions (Class II and Class III) and patients with Class I occlusion as controls. Cone beam computed tomography images of 45 Class I, 28 Class II and 44 Class III joints of Caucasian patients were assessed for the presence of any degenerative changes in the condyle and fossa/eminence complex as described in the research diagnostic criteria for temporomandibular disorders (RDC/TMD). In all groups, the most commonly observed features were articular surface flattening and subcortical sclerosis. A combination of features that corresponds to a diagnosis of osteoarthritis was observed in 3% Class I, 43% Class II and 20% Class III patient joints. In conclusion, degenerative TMJ changes were more common in patients with skeletal jaw discrepancies, but wide inter-individual variations can be observed even in patients with clinically similar malocclusions.
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Affiliation(s)
- Z Krisjane
- Department of Orthodontics, Riga Stradins University, Riga, Latvia.
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Abstract
BACKGROUND High fluoride ion (F(-)) levels are found in many surface and well waters. Drinking F(-)-contaminated water typically explains endemic skeletal fluorosis (SF). In some regions of Asia, however, poor quality "brick tea" also causes this disorder. The plant source of brick, black, green, orange pekoe, and oolong tea, Camellia sinensis, can contain substantial amounts of F(-). Exposure to 20 mg F(-) per day for 20 yr of adult life is expected to cause symptomatic SF. High F(-) levels stimulate osteoblasts and enhance bone apposition but substitute for OH(-) groups in hydroxyapatite crystals and thereby result in skeletal fragility and perhaps lead to secondary hyperparathyroidism. Beginning in 2005, we showed that daily consumption of 1-2 gallons of instant tea made from this plant can lead to SF. AIM We describe a 48-yr-old American woman who developed SF from brewed tea. PATIENT AND METHODS Our patient had elevated bone mineral density revealed by dual-energy x-ray absorptiometry (spine Z-score, +9.9), severe chronic bone and joint pain, and kyphosis after consuming 1-2 gallons of brewed orange pekoe tea daily for more than three decades. F(-) levels were high in her serum, urine, and clippings of fingernails and toenails, as well as in our reproduction of her beverage. Renal function was normal. She had vitamin D deficiency. Elevated serum PTH levels were unresponsive to adequate vitamin D supplementation. Pain resolved over several months when she stopped drinking tea and continued ergocalciferol. CONCLUSION Our patient shows that SF can result from chronic consumption of large volumes of brewed tea.
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Affiliation(s)
- Kenneth Izuora
- Division of Endocrinology, Department of Medicine,Emory University, School of Medicine, Atlanta, Georgia 3032, USA
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Awad EA, Al-Dharrab A. Panoramic radiographic examination: a survey of 271 edentulous patients. INT J PROSTHODONT 2011; 24:55-57. [PMID: 21210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of this study was to quantify the frequency of positive radiographic findings in edentulous arches. Panoramic radiographs from 271 patients who were edentulous in one or both arches were evaluated for the presence of retained root fragments, impacted teeth, foreign bodies, radiolucencies, radiopacities, mental foramina at or near the crest of the residual alveolar ridge, and maxillary sinus proximity to the crest of the residual alveolar ridge. One or more of these radiographic observations were found in 51.7% of the examined films. The most frequent finding (30.6%) was close approximation of the maxillary sinus to the crest of the ridge. These results underscore the importance of panoramic examination of edentulous patients in detecting potential problems before complete denture treatment. However, prescribing such an examination in patients seeking replacement dentures requires a thorough patient history and clinical examination.
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Affiliation(s)
- Emad Ahmed Awad
- Oral and Maxillofacial Rehabilitation Department, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
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Khurana NA, Khurana G, Uppal N. Socket sclerosis: a rare complication obstructing orthodontic tooth movement. Orthodontics (Chic.) 2011; 12:e1-e5. [PMID: 21935502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Socket sclerosis is usually asymptomatic and does not require any treatment. The only potential complication arises during orthodontic treatment, wherein a sclerosed socket of the premolars may be an obstacle in closing spaces by movement of teeth through the extraction space. This article demonstrates the problems encountered during the orthodontic treatment of a 20-year-old woman with socket sclerosis and the treatment strategy employed to overcome the same.
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Affiliation(s)
- Navneet Arora Khurana
- Department of Orthdontics, Manipal College of Dental Sciences, Manipal, Karnataka, India.
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Oral Pathology Quiz #70. Case number 3. Idiopathic osteosclerosis. J N J Dent Assoc 2011; 82:15, 18. [PMID: 21488271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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[Osteoporosis and osteosclerosis as parity components of occupational fluorosis]. Med Tr Prom Ekol 2011;:39-43. [PMID: 22413429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Assessment of bone tissue density in aluminium plant workers revealed obligatory osteoporosis in them. When primary endocrine disorders ruled out, conclusion can be made of osteoporosis along with osteosclerosis as parity components in occupational fluorosis, so contemporary methods of osteologic studies are necessary for assessment of bone tissue.
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