RESUMEN
Medication-related osteonecrosis of the jaw (MRONJ) is a major disease under study for over the last twenty years. Different classifications have been proposed and many therapies for the different stages have been applied. The evolution of treatments lead to an increasingly conservative approach. Numerous adjuvant treatments have been proposed in the last decade. All these complementary treatments have been proposed mainly to resolve or reduce the painful stress, predominantly caused by bacterial infection, simplifying the wound healing process and improving patients' compliance. Nowadays "secondary" treatments, such as autologous platelet concentrates (APCs, more specifically PRP, PRGF or PRF), hyperbaric oxygen (HBO), Auto/tetracycline fluorescence-guided bone surgery (AF-GBS/TF-GBS), medical drugs like teriparatide or the combination between pentoxifylline and tocopherol, fluorodeoxyglucose positron emission tomography (FDG-PET), laser and/or low-laser therapy and ozone therapy are more or less well documented and known considering their clinical effectiveness. The aim of the present review is the evaluation of the quantity and quality of scientific studies concerning this specific topic.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Antibacterianos/uso terapéutico , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Humanos , Terapia por Láser , Tocoferoles/uso terapéutico , Resultado del TratamientoRESUMEN
One hundred thirteen children referred for chronic constipation were examined by means of diagnostic work-up including anal inspection, rectal exploration, weekly bowel frequency evaluation, measurement of total and segmental intestinal transit times (TITT, SITT), contrast enema, anorectal manometry (ARM), suction rectal biopsy for histochemistry. Final diagnosis were: chronic functional "simple" constipation in 53 children; chronic functional constipation and soiling in 32; Hirschsprung's disease in 18. In 10 children, initially referred for constipation, TITT was in the normal range so they underwent no further examination. Conclusions are that bowel frequency identifies a real gastrointestinal problem, but definite diagnosis of constipation is relied on TITT. In the assessment of chronic constipation nature, ARM is more sensitive than radiology. Suction rectal biopsy is reliable in detection of aganglionosis: its accuracy can be improved by histochemical or biochemical determination of Acetylcholinoesterase.