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1.
Cient. dent. (Ed. impr.) ; 16(3): 181-190, sept.-dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185992

RESUMO

Introducción: La osteonecrosis de los maxilares inducida por medicamentos (MRONJ) es una reacción adversa severa causada por determinados fármacos empleados para el tratamiento del cáncer y la osteoporosis que cursa con una destrucción progresiva del hueso de los maxilares. Actualmente, no se ha establecido un protocolo de tratamiento ideal para el manejo de la enfermedad. En los últimos años, el desarrollo de los concentrados plaquetarios autólogos (CPA) y su empleo en la mejora de la cicatrización ósea en el área oral ha ido en aumento. El objetivo de este trabajo es determinar la efectividad de la aplicación de CPA en el lecho quirúrgico en pacientes con riesgo de desarrollar MRONJ o con MRONJ ya establecida. Material y métodos: Se realizó una búsqueda bibliográfica en las plataformas MEDLINE/PubMed, Science Direct y Cochrane Central Registred of Controlled Trials (CENTRAL) desde el año 2003 al 2018.Resultados: Fueron incluidos 28 artículos originales en los cuáles se trataron 299 casos con MRONJ con CPA logrando la curación en 274 (92%). Y se emplearon los CPA en la prevención de la enferme-dad en 1.970 situaciones quirúrgicas en pacientes con riesgo de MRONJ sometidos a cirugías orales y no se desarrolló la enfermedad en ninguno de los casos. Conclusiones: Debido al bajo nivel de evidencia de los estudios revisados, a la heterogeneidad entre los mismos y al tamaño muestral reducido, los resultados obtenidos no aportan evidencia científica suficiente que demuestre una ventaja objetiva en el empleo de CPA en el tratamiento y prevención de la MRONJ


Purpose: Medication related osteonecrosis of the jaws (MRONJ) is an adverse drug reaction consisting on progressive bone destruction in the maxilofacial region of patients with cancer or osteoporosis under treatment with certain drugs. The management of patients with MRONJ remains controversial as an ideal treatment protocol has not been yet established. Autologous platelet concentrates (APC) have demonstrated to improve bone healing. The aim of the present systematic review is to evaluate the effectiveness of APC’s application for treatment and prevention of MRONJ. Methods: a bibliographic research was performed on the following databases: MEDLINE/PubMed, ScienceDirect and Cochrane Central Registred of Controlled Trials (CENTRAL). Results: 28 studies were included, reporting on 299 patients affected by MRONJ were treated in combination with APC, satisfactory healing was observed in 92%. Additionaly, APC for MRONJ prevention were used in 1.970 risky patients undergoing oral surgery procedures, and none of them developed osteonecrosis.Conclusion: Although the results obtained using APC for MRONJ prevention are satisfactory, due to the low level of evidence, the heterogenety and small simple size of the studies, cannot be demonstrated that the use of APC is beneficial for the treatment and prevention of MRONJ


Assuntos
Humanos , Osteonecrose/induzido quimicamente , Osteonecrose/prevenção & controle , Fibrina Rica em Plaquetas , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Osteonecrose/terapia , Mandíbula/efeitos dos fármacos , Mandíbula/fisiopatologia , Plaquetas/metabolismo , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/terapia
4.
Cient. dent. (Ed. impr.) ; 16(2): 129-136, mayo-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183724

RESUMO

El objetivo, establecer si existe una evidencia científica que avale una relación entre la administración de anticuerpos monoclonales y la aparición de osteonecrosis de los maxilares (ONM). En la literatura que revisamos nos muestra determinados casos en los que la ONM está relacionada con los anticuerpos monoclonales (denosumab, sunitib, etc.) siempre y cuando el paciente sea sometido a un tratamiento dental. También se evalúan aquellos artículos en los que se administra anticuerpos monoclonales y bifosfonatos de manera simultánea y se observa que la frecuencia de ONM es más elevada. Como conclusión se establece que no hay evidencia científica suficiente para asegurar una relación entre ONM y anticuerpos monoclonales, aunque sí la hay para demostrar relación entre ONM y anticuerpos monoclonales si se administra junto a los bifosfonatos


The aim is establish if there is a scientific evidence to support a relationship between the administration of monoclonal antibodies and the appearance of osteonecrosis of the jaws (ONJ). In the literature we review shows certain cases in which ONJ is related to monoclonal antibodies (denosumab, sunitib, etc.) as long as the patient undergoes dental treatment. Those articles in which monoclonal antibodies and bisphosphonates are administered simultaneously are also evaluated and it is observed that the frequency of ONJ is higher. As conclusión it is established that there is not enough scientific evidence to ensure a relationship between ONJ and monoclonal antibodies, but there is evidence to show that the relationship between ONJ and monoclonal antibodies if administered with bisphosphonates


Assuntos
Humanos , Medicina Baseada em Evidências/métodos , Osteonecrose/induzido quimicamente , Osteonecrose/complicações , Anticorpos Monoclonais/efeitos adversos , Difosfonatos/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Antissépticos Bucais
5.
Med. oral patol. oral cir. bucal (Internet) ; 24(4): e529-e536, jul. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-185667

RESUMO

Background: Bisphosphonate-related osteonecrosis of the jaw is a pathological condition without effective established treatment and preventive strategies. The aim of this study was to analyse the effect of adipose-derived stem cells (ASC) in an experimental murine model of osteonecrosis. Material and Methods: 38 Wistar rats were injected intraperitoneally with zoledronic acid. After treatment, upper jaw molars were extracted. The animals were randomly assigned to one of two groups. In the control group, saline solution was applied over the alveolar sockets after the tooth extractions. In the treatment group, ASCs were applied instead of saline solution. The control and treatment groups were subdivided based on the time of euthanasia. A clinical and histological analysis was performed. Results: The presence of osteonecrosis in alveolar bone was observed in a similar distribution in both groups. In the ASC-treated group, new bone formation was greater than in controls. Conclusions: In this study, application of ASCs showed greater new bone formation in an osteonecrosis-like murine model. Previous inhibited post-extraction bone remodelling could be reactivated, and these findings appeared to be secondary to implantation of ASCs


No disponible


Assuntos
Animais , Camundongos , Ratos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Osteonecrose , Difosfonatos , Modelos Animais de Doenças , Imidazóis , Células-Tronco , Extração Dentária , Ratos Wistar
7.
Rev. osteoporos. metab. miner. (Internet) ; 11(2): 55-63, abr.-jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188337

RESUMO

Objetivo: La osteonecrosis de maxilares (ONM) es una enfermedad recientemente descrita cuya etiopatogenia es des‐conocida, aunque se ha atribuido, entre otras causas, al tratamiento prolongado con bifosfonatos. Sin embargo, mientras que la ONM es una patología localizada, la acción de los bifosfonatos es generalizada, es decir, afecta a todos los huesos. No hay estudios que muestren el estado óseo general de los pacientes con ONM. Con este trabajo hemos querido estudiaren pacientes afectos de ONM dicho estado general mediante medidas cuantitativas y estimaciones cualitativas del hueso por medio de la densidad mineral ósea (DMO) y el trabecular bone score(TBS) y los parámetros ultrasonográficos en el calcáneo (QUS), además de la presencia de otras enfermedades y la toma de fármacos (especialmente los bifosfonatos)en los pacientes con ONM que pudieran participar en su etiopatogenia. Material y método: Estudio observacional y transversal de casos y controles, realizado en 304 pacientes de ambos sexos, en los que el grupo de casos (grupo I) estaba formado por 24 pacientes que habían sufrido una ONM, mientras que el grupo control (grupo II) estaba formado por 280 pacientes que no presentaban ONM y que recibían bifosfonatos desde un mínimo de 5 años por causas diversas. A todos ellos se les realizó una densitometría ósea (DXA, Hologic 4500 Discovery(R)) en la columna lumbar y en la extremidad proximal del fémur. Además, se les realizó mediciones del TBS en la columna lumbar, así como de los parámetros ultrasonográficos en el calcáneo (Hologic, Sahara(R)...


Objetive: Osteonecrosis of the jaw (ONJ) is a recently reported disease whose origin and development are unknown, although prolonged bisphosphonate treatment has been attributed, among other causes. While ONJ is a localized condition, the action of bisphosphonates is widespread and affects all bones. No studies show the general bone status of patients with ONJ. Our study examines the general condition in patients with ONJ using quantitative measurements and qualitative estimates of bone by means of bone mineral density (BMD) and trabecular bone score (TBS) and ultrasound parameters in the calcaneus (QUS), along with other diseases and the taking of drugs (especially bisphosphonates) in patients with ONJ who may be involved in the pathogenesis. Material and method: Observational and cross‐sectional study of cases and controls, conducted in 304 patients of both sexes, in which the case group (group I) was formed by 24 patients who had suffered ONJ. The control group (group II)contained 280 patients who did not present ONJ and who received bisphosphonates over at least 5 years for various reasons. All of them underwent bone densitometry (DXA, Hologic 4500 Discovery®) in the lumbar spine and proximal femur. In addition, TBS measurements were made in the lumbar spine, as well as ultrasound parameters in the calcaneus (Hologic, Sa‐hara®) in the dominant foot (QUS). Results: Patients suffering ONJ presented greater comorbidity than controls, with a higher prevalence of diabetes mellitus, cancer, rheumatoid arthritis, hyperthyroidism, heart disease, arrhythmias, heart failure and hypercholesterolemia. There‐fore, the consumption of corticosteroids, (oral and inhaled), anticoagulants, hypnotics, bisphosphonates i.v. (zoledronate)...


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteonecrose/tratamento farmacológico , Doenças Maxilares/tratamento farmacológico , Difosfonatos/uso terapêutico , Estudos de Casos e Controles , Osteonecrose/diagnóstico por imagem , Doenças Maxilares/diagnóstico por imagem , Estudos Transversais , Densitometria , Absorciometria de Fóton
8.
Med. oral patol. oral cir. bucal (Internet) ; 24(3): e326-e338, mayo 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-185641

RESUMO

Background: Tyrosine kinase receptor family is involved in tumor growth, pathological angiogenesis and the progression (metastasis) of cancer. Sunitinib (Sutent(R)) inhibits members of the tyrosine kinase receptor family affecting the induction of angiogenesis and tumor progression. It is not clear if sunitinib increases the risk of osteonecrosis of the jaws (ONJ). The aim of this study was to carry out a systematic review about ONJ related to sunitinib, describing existing cases and possible associated risk factors. Material and Methods: The PubMed/MEDLINE and Cochrane Library databases were searched without date restriction up to September 2018. We included prospective and retrospective observational studies, cross-sectional studies, clinical cases and series of cases, involving only human subjects. The methodological quality of the studies was assessed using The Joanna Briggs Institute (JBI) and Newcastle-Ottawa tools. Results: A total of 13 studies fulfilled our inclusion criteria of which 7 were clinical cases, 5 case series and a retrospective study. All the articles were published between 2009 and 2018. Of the 102 patients treated with sunitinib analyzed in this study, 58 developed ONJ, being or having been treated with sunitinib and bisphosphonates or exclusively with sunitinib. Conclusions: In this systematic review, we found an increase of ONJ in patients who are medicated with other drugs different than bisphosphonates and denosumab. It is necessary that dentists, oral and maxillofacial surgeons as well as oncologists know the risk of ONJ that these antiresorptive drugs could have. There is a need to continue researching in this field with the aim of an increasing knowledge in this area and creating an adequate protocol of action for this population


No disponible


Assuntos
Humanos , Conservadores da Densidade Óssea , Osteonecrose , Estudos Transversais , Difosfonatos , Estudos Prospectivos , Estudos Retrospectivos , Sunitinibe
9.
Med. oral patol. oral cir. bucal (Internet) ; 24(3): e339-e345, mayo 2019. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-185642

RESUMO

Background: The exact pathogenesis of medication-related osteonecrosis of the jaw (MRONJ) is still unknown. The aim of this paper was to investigate the effects of zoledronic acid and dexamethasone on the early phases of socket healing in rats subjected to tooth extractions. Material and Methods: Thirty male Sprague-Dawley rats were divided into 2 groups: pharmacologically treated group (T, n = 20) and non-pharmacologically treated group (C, n=10). T group rats received 0.1 mg/Kg of zoledronic acid (ZOL) and 1 mg/Kg of dexamethasone (DEX) three times a week for 10 consecutive weeks. C group rats were infused with vehicle. After 9 weeks from the first infusion, first maxillary molars were extracted in each of the rats. Quantitative macroscopic and microscopic analysis was performed to evaluate socket healing 8 days after extraction. Results: Pharmacologically treated rats showed significant inhibition of bone remodeling. Connective tissue/al-eolar bone ratio, osteoclast number and woven bone deposition were significantly reduced in group T compared to group C. Conversely, the proportion of necrotic bone was higher in group T compared to group C (0.8% and 0.3%, respectively. P = 0.031). ZOL plus DEX do not cause gross effects on socket healing at a macroscopic level. Conclusions: Our findings confirmed that exposure to ZOL plus DEX impairs alveolar wound repair. Inhibition of osteoclastic resorption of socket walls after tooth extraction and the inability to dispose of the necrotic bone may be considered the initial steps of MRONJ onset


No disponible


Assuntos
Humanos , Animais , Masculino , Ratos , Conservadores da Densidade Óssea , Osteonecrose , Dexametasona , Difosfonatos , Extração Dentária , Alvéolo Dental , Ácido Zoledrônico , Ratos Sprague-Dawley
10.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 63(1): 29-34, ene.-feb. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-182061

RESUMO

Objetivo: El objetivo de este trabajo es reportar los resultados a corto plazo y las complicaciones de la artroplastia de superficie del húmero proximal (HemiCup(R)) en pacientes tratados por necrosis ósea avascular. Material y métodos: Entre 2010 y 2014 fueron evaluados 9 pacientes a los que se les realizó una artroplastia de superficie del húmero proximal. Todos los pacientes fueron tratados por necrosis ósea avascular. El seguimiento promedio fue de 44 meses (mínimo 24 meses). La edad promedio fue de 47 años (rango 32-57 años). Los pacientes fueron evaluados cínica y radiológicamente. Se reportaron las complicaciones. Resultados: Los pacientes presentaron una mejoría significativa en los scores funcionales y la movilidad entre el preoperatorio y el último control en el seguimiento. El score de Constant mejoró de 35 a 79 puntos (p<0,001), el score de ASES mejoró de 31 a 76 puntos (p<0,001), la flexión anterior y la rotación externa mejoraron de 101 a 150° (p<0,001) y de 24 a 45° (p<0,001), respectivamente. Un paciente presentó desgaste sintomático en la glena durante el seguimiento, requiriendo una cirugía de revisión. Conclusión: En nuestra serie, la artroplastia parcial de superficie del húmero proximal (HemiCup(R)) demostró una mejoría significativa en los scores funcionales y la movilidad en pacientes tratados por necrosis ósea avascular, con un seguimiento promedio de 44 meses


Objective: The aim of this study was to report the short-term results and complications of partial humeral head resurfacing (HemiCup(R)) in patients treated by avascular necrosis. Material and methods: Between 2010 and 2014, 9 patients who underwent partial resurfacing of humeral head were evaluated. All the patients were treated by avascular necrosis. The mean follow-up was 44 months (minimum 24 months). The average age was 47 years (range 32-57 years). The patients were evaluated clinically and radiologically. Complications were reported. Results: The patients had a significant improvement in functional scores and mobility between the pre-operative and last follow-up control. The Constant score improved from 35 to 79 points (P<.001), ASES score improved from 31 to 76 points (P<.001), forward flexion and external rotation improved from 101 to 150° (P<.001), and from 24 to 45° (P<.001), respectively. One patient presented symptomatic glenoid wear during follow-up, requiring revision surgery. Conclusion: In our patients treated by avascular necrosis, the partial resurfacing of humeral head (HemiCup(R)) demonstrated a significant improvement in functional scores and mobility with an average follow-up of 44 months


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Artroplastia/métodos , Osteonecrose/cirurgia , Úmero/cirurgia , Resultado do Tratamento , Recuperação de Função Fisiológica/fisiologia , Complicações Pós-Operatórias/epidemiologia , Seguimentos
11.
Clin. transl. oncol. (Print) ; 20(5): 584-590, mayo 2018. ilus
Artigo em Inglês | IBECS | ID: ibc-173534

RESUMO

Purpose. Corticoid-induced osteonecrosis (ON) of femoral head can lead to severe hip joint impairment and hip replacement, with negative impact in young survivors of acute lymphoblastic leukaemia (ALL) with long life expectancy. We aim to improve quality of life in these patients with a novel approach. Methods/patients. Based on the regenerative capacities of mesenchymal stem cells (MSCs), we performed locally implanted autologous cell therapy in two adolescents suffering of bilateral femoral ON. This required a simple, minimally invasive surgical procedure. Results. Both patients experienced significant pain relief and restoration of gait kinematic values. Radiographic evaluation showed cessation of hip collapse. No toxicities/complications were observed after a 4-year follow-up. Conclusions. Our preliminary results suggest that autologous MSCs can be considered as a novel treatment for children and young adults with ON after overcoming ALL. It may avoid hip replacement and improve quality of life of leukaemia survivors


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adulto Jovem , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/terapia , Glucocorticoides/efeitos adversos , Transplante de Células-Tronco Mesenquimais/métodos , Antineoplásicos Hormonais/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Sobreviventes , Resultado do Tratamento , Osteonecrose
12.
Med. oral patol. oral cir. bucal (Internet) ; 23(3): e282-e289, mayo 2018. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-175878

RESUMO

Background: The aim of this retrospective study was to compare the morphological features of neurovascular canals and foramina of patients with medication-related osteonecrosis of the jaws (MRONJ) and healthy individuals by using cone beam computed tomography (CBCT). Material and Methods: The CBCT images of 58 patients under bisphosphonate therapy diagnosed with MRONJ and age gender- matched controls were retrospectively evaluated. The diameter of mandibular and nasopalatine canal and mandibular, mental and lingual foramina were measured on several sections of CBCT. The value of mental index (MI) and panoramic mandibular index (PMI) were also assessed. Results: The mean value of diametric measurements for all neurovascular canals and foramina in MRONJ patients were narrower than controls. Left mandibular foramen was the most affected area (p<0.001). There were significantly difference in all measurements of mental foramen, lingual foramen and mandibular incisive canal between two groups (p<0.05). PMI of MRONJ subjects were also significantly differences in both sides (p<0.05). Conclusions: In MRONJ patient, neurovascular canals and foramina are affected due to the alterations in bone remodeling. Therefore, the diametric measurement of neurovascular canals and assessment of MI and PMI on CBCT, is a potentially useful method for detection of early changes associated with bisphosphonate therapy and for predict areas where new necrosis may occur


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/patologia , Mandíbula/irrigação sanguínea , Mandíbula/inervação , Maxila/irrigação sanguínea , Maxila/inervação , Osteonecrose/induzido quimicamente , Osteonecrose/patologia , Tomografia Computadorizada de Feixe Cônico , Mandíbula/diagnóstico por imagem , Mandíbula/patologia , Maxila/diagnóstico por imagem , Maxila/patologia , Tamanho do Órgão , Estudos Retrospectivos
14.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 61(6): 367-374, nov.-dic. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-168631

RESUMO

Introducción. Las luxaciones o fracturas-luxaciones de la cadera pueden suponer severas complicaciones como la artrosis o la necrosis. El objetivo de este estudio fue identificar las variables y los factores pronósticos asociados con resultados clínicos y radiológicos a largo plazo tras una luxación traumática de cadera. Material y métodos. Se realizó un estudio retrospectivo de todas las luxaciones y fracturas-luxaciones tratadas desde enero de 1999 a diciembre de 2012. Una tomografía axial computerizada fue realizada tras la reducción en todos los casos. Para la evaluación de los resultados clínicos se utilizó el Harris Hip Score y la escala Merlé-d'Aubigné-Postel, mientras que los resultados radiológicos se evaluaron con la clasificación de Thompson-Epstein. Resultados. Se identificaron 30 casos en 29 pacientes, con un seguimiento medio de 11 años (rango 4-17). Existió una mayor frecuencia de luxaciones simples (21; 70%) respecto a luxaciones complejas (9; 30%). Se realizó una reducción cerrada en menos de 6h en todos los casos excepto en uno (29; 96,7%). Todos los pacientes con luxaciones simples tuvieron excelente resultado sin signos radiológicos de artrosis al final del seguimiento (p<0,01). Del total de la muestra, 4 pacientes desarrollaron signos artrósicos (13,3%) y 3 pacientes presentaron necrosis avascular (10%). Cinco pacientes con fragmentos intraarticulares fueron tratados de forma conservadora, y 3 de ellos desarrollaron artrosis (p<0,05). Conclusión. Nuestro estudio muestra que las luxaciones complejas tienen peores resultados funcionales y radiológicos que las luxaciones simples. Hemos encontrado una fuerte asociación entre cuerpos libres intraarticulares y artrosis, por lo que la extracción de esos fragmentos podría ser considerada (AU)


Introduction. Traumatic hip dislocations can have devastating complications such as osteoarthritis or osteonecrosis. The aim of this study was to identify the variables and prognostic factors associated with clinical and radiological outcome after a traumatic hip dislocation at long-term follow-up. Material and methods. A review was performed of all dislocations and fracture-dislocations of the hip from January 1999 to December 2012. A computed tomography scan was performed after reduction in all cases. The Harris Hip Score and modified Merle-d'Aubigné-Postel method were used for clinical evaluation and radiological assessment was performed according to the Thompson and Epstein classification. Results. There were 30 cases in 29 patients with a mean follow-up of 11 years (range, 4-17). The great majority were simple dislocations (21; 70%) vs. complex dislocations (9; 30%). Closed reduction was performed in less than 6h in all except one case (29; 96.7%). All of the patients with simple dislocations had an excellent outcome without radiological signs of osteoarthritis at the end of the follow-up (P<.01). Overall, arthritic signs had developed in 4 patients (13.3%) and avascular necrosis was noted in 3 patients (10%). Five patients with intraarticular fragments were treated non-operatively, and 3 of them developed arthritic changes (P<.05). Conclusion. Our study suggests that complex dislocations are associated with poorer functional and radiological outcomes than simple dislocations. We also found a strong association between intraarticular fragments and osteoarthritis, so surgical fragment removal could be considered in these cases (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Luxação do Quadril/complicações , Osteonecrose/epidemiologia , Osteoartrite do Quadril/epidemiologia , Estudos Retrospectivos , Prognóstico , Fraturas do Colo Femoral/complicações
16.
Rev. Soc. Andal. Traumatol. Ortop. (Ed. impr.) ; 34(3): 45-50, jul.-sept. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-169135

RESUMO

Objetivo: Presentar un caso de una patología poco común como la enfermedad de Kummell, y revisar la situación actual respecto a diagnóstico y tratamiento. Caso clínico: Mujer de 59 años con AP de osteoporosis que consulta por dolor de meses de evolución a nivel dorsal sin traumatismo previo, mal controlado con analgesia. En estudios de imagen se comprueba colapso de vértebras T8 y T10 e imagen de vacío intravertebral, tanto en radiografías como en resonancia magnética. Ante la falta de respuesta a tratamiento conservador, se decide intervenir, realizándose fijación vertebral posterior desde T7 a T12, con aumentación mediante cementación de T8 y T10. Tras meses de la cirugía, la paciente se encuentra prácticamente sin dolor y buena funcionalidad de su espalda. Conclusiones: La enfermedad de Kummell es un proceso en el que tras un traumatismo banal y un periodo asintomático, con estudios negativos, se presenta un colapso vertebral y necrosis avascular, con sintomatología cada vez más invalidante. El tratamiento de elección es la cifoplastia o la vertebroplastia. En nuestro caso, optamos por otro tratamiento por la situación de la paciente


Objective: To present a case of an unusual pathology such as Kummell's disease, and to review the current situation regarding diagnosis and treatment. Clinical case: A 59-year-old female with osteoporosis who consults for pain of months of evolution at the dorsal level without prior trauma, poorly controlled with analgesia. In imaging studies, collapse of T8 and T10 vertebrae and intravertebral vacuum cleft imaging were verified, both in X-rays and in MRI. Given the lack of response to conservative treatment, it was decided to intervene, with posterior vertebral fixation from T7 to T12, with augmentation by T8 and T10 cementation. After months of surgery, the patient is virtually pain free and good functionality of her back. Conclusions: Kummell's disease is a process in which after a normal trauma and an asymptomatic period, with negative studies, there is a vertebral collapse and avascular necrosis, with symptomatology becoming more and more invalidating. The treatment of choice is kyphoplasty or vertebroplasty. In our case, we opted for another treatment because of the situation of the patient


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Traumatismos da Coluna Vertebral/diagnóstico , Osteonecrose/diagnóstico , Degeneração do Disco Intervertebral/diagnóstico , Osteoporose/complicações , Osteoartrite da Coluna Vertebral/complicações , Difosfonatos/efeitos adversos
17.
Rev. Esp. Cir. Ortop. Traumatol. (Ed. Impr.) ; 61(3): 154-161, mayo-jun. 2017. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-162852

RESUMO

Introducción y objetivo. La presencia de lesión cartilaginosa condiciona en gran medida el resultado funcional de cualquier articulación tras el tratamiento quirúrgico. Nuestro objetivo fue determinar la prevalencia, localización, grado y factores preoperatorios asociados a la lesión cartilaginosa del reborde acetabular en pacientes intervenidos mediante cirugía artroscópica de cadera. Material y métodos. Estudio prospectivo de los hallazgos intraoperatorios en 152 caderas de 122 pacientes consecutivos intervenidos mediante cirugía artroscópica de cadera por choque femoroacetabular entre enero de 2011 y mayo de 2016. Se determinó la prevalencia, localización, grado, y factores preoperatorios asociados a la lesión cartilaginosa del reborde acetabular. Resultados. La edad media de los pacientes fue de 36,8 años. El grado de degeneración articular era Tönnis 0 en 103 caderas y Tönnis 1 en 52 caderas. En 109 caderas (70,3%) se detectó lesión cartilaginosa del reborde acetabular. La localización de las lesiones fue superior y anterior. El análisis estadístico estableció como factores preoperatorios independientes para la presencia de lesión cartilaginosa del reborde acetabular un ángulo alfa igual o mayor de 55°, un tiempo de evolución de los síntomas hasta la artroscopia igual o mayor de 20 meses, y un nivel de actividad física en la escala de Tegner igual o mayor de 6. Discusión. A pesar de que los pacientes se clasificaron como Tönnis 0 y 1, y que la resonancia nuclear magnética de 3tesla informó de la presencia de lesión cartilaginosa en el 1,3% de los casos, existía una alta frecuencia de lesiones cartilaginosas del reborde acetabular. El conocimiento de los factores predictores preoperatorios asociados a la lesión cartilaginosa del reborde acetabular puede ayudar al cirujano ortopédico sobre la indicación de la cirugía artroscópica de cadera (AU)


Introduction and purpose. Articular cartilage lesions have a direct effect on the success of surgical treatment. The aim of this study was to determine the prevalence rate, location, grade, and factors associated with acetabular rim articular cartilage lesions in patients undergoing hip arthroscopy. Material and methods. A prospective study was conducted by analysing the intraoperative data of 152 hips in 122 patients treated with hip arthroscopy for femoroacetabular impingement from January 2011 to May 2016. The prevalence rate, location, and grade were calculated, as well as the pre-operative factors associated with acetabular rim articular cartilage lesions. Results. The mean age of the patients was 38.6 years. The Tönnis grade was 0 in 103 hips, and 1 in 52 hips. Acetabular rim articular cartilage lesions were present in 109 (70.3%) hips. The location of the lesions was superior-anterior. Independent risk factors for the presence of acetabular rim articular cartilage lesions were an alpha-angle equal or greater than 55°, duration of symptoms equal or greater than 20 months, and Tegner activity scale level equal or greater than 6. Discussion. Although patients were classified as Tönnis grade 0 and 1, and 3tesla MRI reported acetabular lesions in 1.3% of cases, there was a high frequency of acetabular rim cartilage lesions. Knowledge of the independent risk factors associated with acetabular rim articular cartilage lesions may assist the orthopaedic surgeon with the decision to perform hip arthroscopy (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Artroscopia/métodos , Cartilagem Articular/lesões , Cartilagem Articular , Fraturas do Quadril , Período Pré-Operatório , Estudos Prospectivos , Osteonecrose/complicações , Doença de Legg-Calve-Perthes/complicações , Inquéritos e Questionários , Análise Multivariada , Estatísticas não Paramétricas
18.
Cir. plást. ibero-latinoam ; 43(1): 53-58, ene.-mar. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-161909

RESUMO

La osteonecrosis postraumática del polo distal del escafoides es una complicación rara, ya que hasta donde hemos podido conocer solo se encuentran recogidos 3 casos en la literatura mundial. Presentamos un paciente con fractura de polo distal de escafoides que evoluciono a osteonecrosis y el tratamiento quirúrgico realizado con artrodesis escafo-trapecio-trapezoide con placa en flor. A los 6 meses de postoperatorio el paciente presenta mejoría del dolor y rango adecuado de movilidad de muñeca y pulgar, realizando pinza sin dificultad y con buen agarre. Obtuvimos por tanto un buen resultado en la mejoría del dolor y en la funcionalidad de la mano. Entre los casos reportados en la literatura no hemos encontrados tratamientos similares al que presentamos (AU)


Posttraumatic osteonecrosis of the distal pole of the scaphoid bone is a rare complication; up to this point we could only find 3 reported cases in world literature. We present a rare case of scaphoid distal pole osteonecrosis that after a year presented avascular necrosis of the involved segment, and the performed treatment with scaphoid-trapezium-trapezoid arthrodesis with flower plate. After 6 months evolution there is a clear improvement of pain and movement, with complete recovery of range mobility of wrist and thumb. We got very good results regarding pain resolution and improvement in hand function. We could not find any other case reported that has used the same approach (AU)


Assuntos
Humanos , Masculino , Adulto , Artrodese/métodos , Osso Escafoide/cirurgia , Pseudoartrose/cirurgia , Fraturas Ósseas/cirurgia , Osteonecrose/cirurgia , Parafusos Ósseos , Resultado do Tratamento , Fraturas Ósseas/complicações , Osteonecrose/etiologia , Traumatismos da Mão/cirurgia , Recuperação de Função Fisiológica , Manejo da Dor/métodos
20.
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 51(6): 329-334, nov.-dic. 2016. graf
Artigo em Espanhol | IBECS | ID: ibc-157820

RESUMO

Antecedentes. El ácido zoledrónico se utiliza en el tratamiento de diversas enfermedades, tumorales o no, aunque su uso se asocia con necrosis avascular ósea. Objetivo. Determinar un posible efecto protector de diferentes sustancias antioxidantes frente a la inhibición del crecimiento de células epiteliales de próstata humana (PNT2) y en células tumorales de adenocarcinoma transgénico de próstata murina (TRAMP-C1), en tratamientos combinados de ácido zoledrónico junto con radiación ionizante (IR). Material y métodos. Mediante un ensayo de viabilidad celular (MTT) se estudia la supervivencia celular de 2 líneas celulares en tratamientos aislados y combinados con ácido zoledrónico y con IR, así como, el efecto de la adición de diferentes sustancias antioxidantes. Resultados. El ácido zoledrónico muestra un efecto citotóxico significativo sobre las células PNT2 y TRAMP-C1 (p<0,001). La administración de diferentes sustancias antioxidantes en el tratamiento con ácido zoledrónico presenta un efecto protector sobre las células PNT2 (p<0,001), pero no sobre las células tumorales. Sin embargo, la administración de ácido rosmarínico y apigenina en el tratamiento combinado con ácido zoledrónico junto con IR presenta un efecto protector no solo sobre las células PNT2 (p<0,001), sino también sobre las células TRAMP-C1 (p<0,001). Conclusión. El uso de sustancias antioxidantes produce una disminución del efecto citotóxico del ácido zoledrónico sobre las células no tumorales, por lo que podrían ser utilizadas en enfermedades benignas no tumorales. Sin embargo, en un tratamiento combinado con IR, también pueden proporcionar protección a las células tumorales, y reducir de este modo el efecto terapéutico deseado (AU)


Background. Zoledronic acid is used in the treatment of cancer-related diseases, although its use has been associated with avascular osteonecrosis. Aims. To determine the possible protective effect of a range of antioxidant substances against the inhibition of human prostate epithelial cell growth (PNT2) and transgenic adenocarcinoma mouse prostate tumour cells (TRAMP-C1), in treatments combining zoledronic acid and ionising radiation (IR). Material and method. Cell survival is studied via cell viability assays (MTT) for 2 cell lines in isolated and combined treatments with zoledronic acid and/or IR, as well as the effect of adding 3 antioxidant substances. Results. Zoledronic acid displays a significant cytotoxic effect over PNT2 and TRAMP-C1 cells (P<.001). The administration of antioxidants together with the zoledronic acid shows a protective effect for normal prostate cells, yet not so for prostate tumour cells. However, the administration of rosmarinic acid and apigenin in treatments combined with zoledronic acid provides a protective effect from the harmful effects of applying ionizing radiation, not only for normal PNT2 cells, but also for tumour cells. Conclusion. The use of antioxidant substances decreases the cytotoxic effect of zoledronic acid over non-tumour cells, and as such could be used in benign diseases. Furthermore, in the combined treatment using ionising radiation, these antioxidants also produced a protective effect in tumour cells, thus reducing the therapeutic effect sought by combining the treatment with radiation (AU)


Assuntos
Humanos , Masculino , Feminino , Toxicidade/métodos , Antioxidantes/uso terapêutico , Osteonecrose/tratamento farmacológico , Difosfonatos/uso terapêutico , Células Epiteliais , Radiação Ionizante , Adenocarcinoma/tratamento farmacológico , Análise de Variância , Análise Estatística , Neoplasias Ósseas/tratamento farmacológico
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