ABSTRACT
La enfermedad de Albers-Schõmberg u osteopetrosis es un raro padecimiento óseo. La osteomielitis mandibular es una infrecuente complicación de esta enfermedad. Por ello y por lo interesante de la presentación clínica de ambas entidades, nos propusimos como objetivo presentar este caso. Este paciente masculino de 32 años con antecedentes de enfermedad de Albers- Schõmberg de tipo adulta benigna que dos años atrás acudió a consulta y refirió haberse realizado una exodoncia once meses antes, a partir de lo cual presentó aumento de volumen facial y dolor de intensidad variable con períodos de agudización. Luego del estudio clínico e imagenológico se llegó al diagnóstico de una osteomielitis mandibular como complicación de su enfermedad de base. Se aplicó terapia antimicrobiana, exéresis del hueso necrótico y oxígeno hiperbárico. A los dos años acudió a consulta con una reagudización del proceso, se le produjo la expulsión espontánea de un secuestro óseo y se decidió la realización de una mandibulectomía parcial más reconstrucción con placa mandibular. En estos momentos el paciente no presenta signos de reagudización del proceso y se mantiene bajo vigilancia estricta a los tres meses de realizada la intervención quirúrgica(AU)
Albers-Schomberg disease or osteopetrosis is a rare bone condition. Mandibular osteomyelitis is an infrequent complication of this disease. It was for this reason, alongside the peculiar clinical presentation of both entities, that we decided to present this case. A male 32-year-old patient with a history of benign adult Albers-Schomberg disease attended consultation two years ago and stated to have undergone exodontia eleven months before, after which he had had facial swelling and pain of variable intensity with acute episodes. Clinical and imaging studies led to the diagnosis of mandibular osteomyelitis as a complication of his underlying condition. Treatment consisted of antimicrobial therapy, exeresis of the necrotic bone and hyperbaric oxygen. Two years later the patient came back to consultation with a relapse of the acute pain process. Spontaneous expulsion of an osseous sequestrum was performed, followed by partial mandibulectomy and reconstruction with a mandibular plate. At this moment the patient does not present any signs of relapse of the acute pain process. Three months after surgery, he remains under strict surveillance(AU)
Subject(s)
Humans , Male , Adult , Osteomyelitis/complications , Osteomyelitis/diagnostic imaging , Osteopetrosis/etiology , Mandibular Osteotomy/methodsABSTRACT
To detect the nature and frequency of short and long term side effects of Methylprednisolone pulse therapy in patients with multiple sclerosis. sixty three patients with multiple sclerosis treated in multiple sclerosis clinic in Baghdad teaching hospital from April 2001 till December 2002 with one gram methylprednisolone [MPN] succinate pulse therapy were studied for short term side effects; forty six patients who received more than six doses were studied for short and long term side effects including serum lipid profile, ophthalmological complications, vascular necrosis of head of femur and osteoporosis by Achilles express device. body weight studied cross sectional at the start and after six months showed no significant changes; short term symptoms that occurred during and after pulse therapy were transient and occurred infrequently apart from taste changes in form of bitter sensation in 420 [60.87%] out of 690 pulses. There was no anaphylactic reactions, no cardiac dysrrhythmias and no deep venous thrombosis nor serious infections or septicemic complications during follow up. Blood pressure changes were not significant. Hematological investigation including hemoglobin, white blood cell count, platelets count changed within normal values after one week of pulse therapy. None of the patients developed diabetes mellitus at the end of the study. Among the 46 patients studied for long term side effects, one developed post subcapsular cataract non developed glaucoma, two showed increment in serum triglyceride, and one developed a vascular necrosis of the neck or the femur. Eighteen women receiving more than six pulses were evaluated for osteoporosis by Achellis express at the end of the study. Of them, 7 [38.88%] showed osteoporosis, 7 [38.88%] osteopenia, and 4 [22.22%] normal readings. methylprednisolone, when used on our therapeutic protocol, was a safe drug; there was a risk of developing osteoporosis for patients receiving more than 6 pulses