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1.
J Oral Implantol ; 46(3): 249-252, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32582921

RESUMO

Chronic endodontic infections are associated with osseous changes in the peri-apical regions. Dental implants are often placed after the extraction of hopeless teeth with periapical infections. This clinical report describes a patient with a radiopaque mass attached to the root apex of the mandibular right second premolar tooth (No. 45). The differential diagnoses of the radiopaque mass were bone- and tissue-borne diseases. Based on the clinical and radiologic findings (bone density and trabeculation of the bone), the definitive diagnosis of the osseous mass was condensing osteitis. The osseous tumor associated with tooth 45 was atraumatically extracted under local anesthesia. Guided bone regeneration was performed immediately after extraction of tooth 45, and a dental implant was placed in the site after 6 months of healing.


Assuntos
Implantes Dentários , Osteíte , Dente Pré-Molar , Regeneração Óssea , Implantação Dentária Endo-Óssea , Humanos , Extração Dentária
2.
Br Dent J ; 228(4): 228-229, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32111993
3.
J Craniofac Surg ; 31(2): 510-512, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977710

RESUMO

SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome is a chronic inflammatory disease involving multiple organs such as skin and bones. At present, its etiology and pathogenesis are still unclear. Due to the variety of clinical manifestations and the small number of SAPHO syndrome involving the mandible, accurate diagnosis is difficult for oral and maxillofacial surgeons. Here, the authors report that a male patient with SAPHO syndrome involving the maxillofacial skin and mandible, followed for 3 years. We used Tc-MDP (technetium-99 conjugated with methylene disphosphonate) (commercially known as Yunke) to treat this disease and achieved significant clinical treatment. This suggests that Tc-MDP can be used as a bisphosphonate to treat SAPHO syndrome.


Assuntos
Síndrome de Hiperostose Adquirida/tratamento farmacológico , Doenças Mandibulares/tratamento farmacológico , Medronato de Tecnécio Tc 99m/uso terapêutico , Acne Vulgar/tratamento farmacológico , Adulto , Doença Crônica , Humanos , Hiperostose/tratamento farmacológico , Masculino , Osteíte/tratamento farmacológico , Sinovite/tratamento farmacológico
4.
J Pediatr Orthop ; 40(2): 93-96, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923169

RESUMO

BACKGROUND: Sever disease is a common condition in active, growing children. This condition presents as pain in the heel and is thought to be an overuse condition of the calcaneal apophysis. There are currently no defined radiographic diagnostic criteria for evaluation of Sever disease, with radiographs generally showing normal appearance of the calcaneal apophysis. A better understanding of the relationship of Sever disease and skeletal maturity may allow for improved interpretation of radiographs when trying to diagnose this condition. METHODS: ICD-9 code 732.5 was used to search for patients diagnosed with Sever disease from 2007 to 2015 at a single hospital. For every patient with Sever disease with available calcaneal imaging within 40 days of diagnosis, heel x-rays were staged for calcaneal maturity score using a previously described calcaneal skeletal maturity assessment system. Controls matched by age, race, and sex were evaluated for calcaneal stage to compare with the Sever patients. RESULTS: The chart review yielded 78 patients diagnosed with Sever disease by the orthopaedic attending, 39 of which have x-rays around the time of diagnosis. Calcaneal scores averaged 2.2±0.8 for all patients, 2.1±0.9 for male individuals, and 2.3±0.8 for female individuals. The average age for male individuals was 10.4±1.9 years and for female individuals, 9.2±2.2 years. The ages of diagnosis were similar for patients with and without x-rays. Twenty-two of 39 patients with Sever disease were calcaneal stage 2, and 37 of 39 were stages 1, 2, or 3. We calculated the absolute difference from stage 2 for the Sever and control groups. Mean difference from stage 2 was 0.51±0.68 for the Sever patients and 0.95±0.79 for control patients (P=0.01). CONCLUSION: Sever disease occurs in a very narrow range of skeletal maturity, as measured by the calcaneal skeletal maturity assessment system and our observations with chronological age. When compared with age-matched and race-matched controls, stage 2 was seen more frequently in the Sever patients. If a child is not within calcaneal stages 1, 2, or 3, then a different diagnosis should be considered. LEVEL OF EVIDENCE: Level III-retrospective case-control study.


Assuntos
Calcâneo/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Osteíte/diagnóstico por imagem , Determinação da Idade pelo Esqueleto , Calcâneo/crescimento & desenvolvimento , Estudos de Casos e Controles , Criança , Feminino , Doenças do Pé/complicações , Humanos , Masculino , Dor Musculoesquelética/etiologia , Osteíte/complicações , Radiografia , Estudos Retrospectivos
5.
BMC Cancer ; 20(1): 14, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906956

RESUMO

BACKGROUND: Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib. CASE PRESENTATION: A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset. CONCLUSIONS: This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression.


Assuntos
Quinase do Linfoma Anaplásico/antagonistas & inibidores , Antineoplásicos/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Crizotinibe/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Osteíte/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Adulto , Quinase do Linfoma Anaplásico/genética , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Crizotinibe/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Osteíte/diagnóstico por imagem , Osteíte/patologia , Inibidores de Proteínas Quinases/farmacologia , Pirimidinas/farmacologia , Sulfonas/farmacologia , Tomografia Computadorizada por Raios X
6.
J Orthop Surg Res ; 14(1): 329, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640735

RESUMO

BACKGROUND: Osteitis pubis (OP) is a common source of groin and extra-articular hip pain and is associated with intra-articular hip pathology. In this study, we aimed to determine the prevalence of osteitis pubis on magnetic resonance imaging (MRI) in non-athletic patients with cam-type femoroacetabular impingement (FAI). METHODS: This retrospective cross-sectional study included 178 subjects: 90 patients with cam-type FAI diagnosed by MRI and 88 subjects used as a control group. Additionally, their MRI data were analyzed for the characteristics of osteitis pubis, with severity graded from minimal to severe on a four-point scale. RESULTS: A total of 98 patients and 88 controls were studied. Seventy-two males (80%) and 18 females (20%) were the patient group, whereas 71 males (80.68%) and 17 females (19.32%) were the control group. The mean alpha angle of the patients with FAI was 65.8 ± 3.3° in the right side and 66.2 ± 3.2° in the left side, whereas in the control group, it was 47 ± 5.6° in the right side and 47.8 ± 5.2° in the left side. Alpha angle measurements were significantly higher in the patient group than the control group (p < 0.001). A statistically significant increase in the prevalence of osteitis pubis was found in patients with cam-type FAI (45.56%) compared to control subjects (5.68%) (p < 0.001). CONCLUSIONS: This study demonstrated that the frequency of osteitis pubis was increased in non-athletic patients with FAI syndrome. Further studies are required to determine whether these findings reflect the clinical symptoms in patients with hip pain.


Assuntos
Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/epidemiologia , Imagem por Ressonância Magnética/métodos , Osteíte/diagnóstico por imagem , Osteíte/epidemiologia , Osso Púbico/diagnóstico por imagem , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Estudos Retrospectivos , Adulto Jovem
7.
Semin Immunopathol ; 41(5): 607-618, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31520179

RESUMO

The inflammasomes are intracellular protein complexes that are assembled in response to a variety of perturbations including infections and injuries. Failure of the inflammasomes to rapidly clear the insults or restore tissue homeostasis can result in chronic inflammation. Recurring inflammation is also provoked by mutations that cause the constitutive assembly of the components of these protein platforms. Evidence suggests that chronic inflammation is a shared mechanism in bone loss associated with aging, dysregulated metabolism, autoinflammatory, and autoimmune diseases. Mechanistically, inflammatory mediators promote bone resorption while suppressing bone formation, an imbalance which over time leads to bone loss and increased fracture risk. Thus, while acute inflammation is important for the maintenance of bone integrity, its chronic state damages this tissue. In this review, we discuss the role of the inflammasomes in inflammation-induced osteolysis.


Assuntos
Suscetibilidade a Doenças , Inflamassomos/metabolismo , Osteíte/etiologia , Osteíte/metabolismo , Animais , Biomarcadores , Reabsorção Óssea , Citocinas/metabolismo , Gerenciamento Clínico , Regulação da Expressão Gênica , Humanos , Proteína 3 que Contém Domínio de Pirina da Família NLR/genética , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Osteíte/diagnóstico , Osteíte/terapia , Transdução de Sinais
8.
Semin Immunopathol ; 41(5): 619-626, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31552472

RESUMO

Bone homeostasis depends on a balance between osteoclastic bone resorption and osteoblastic bone formation. Bone cells are regulated by a variety of biochemical factors, such as hormones and cytokines, as well as various types of physical stress. The immune system affects bone, since such factors are dysregulated under pathologic conditions, including infection. The bone marrow, one of the primary lymphoid organs, provides a special microenvironment that supports the function and differentiation of immune cells and hematopoietic stem cells (HSCs). Thus, bone cells contribute to immune regulation by modulating immune cell differentiation and/or function through the maintenance of the bone marrow microenvironment. Although osteoblasts were first reported as the population that supports HSCs, the role of osteoblast-lineage cells in hematopoiesis has been shown to be more limited than previously expected. Osteoblasts are specifically involved in the differentiation of lymphoid cells under physiological and pathological conditions. It is of critical importance how bone cells are modified during inflammation and/or infection and how such modification affects the immune system.


Assuntos
Osso e Ossos/citologia , Osso e Ossos/metabolismo , Imunomodulação , Osteíte/etiologia , Osteíte/metabolismo , Osteoblastos/metabolismo , Osteoclastos/metabolismo , Animais , Diferenciação Celular , Suscetibilidade a Doenças , Hematopoese , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/metabolismo , Humanos , Sistema Imunitário/imunologia , Sistema Imunitário/metabolismo , Osteíte/diagnóstico , Osteoblastos/imunologia , Osteoclastos/imunologia
10.
Pediatr Int ; 61(10): 982-987, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31465608

RESUMO

BACKGROUND: Interferon-γ (IFN-γ) and interleukin-12 (IL-12) play a crucial role in the defense against mycobacteria, and in the response to bacillus Calmette-Guérin (BCG) vaccination. We have previously reported clinical and outcome data of 222 BCG osteitis cases diagnosed in 1960-1988 in Finland. The immunological and genetic reports have been based on 132 blood samples obtained in 2007-2008. METHODS: We compared IFNγ rs2430561 and rs35314021, IL12A rs568408 and rs2243115, and IL12B rs3212227 single-nucleotide polymorphisms (SNP) between 132 BCG osteitis patients and 99 population-based controls. In addition, stimulated production of IFN-γ and IL-12 in cell culture was evaluated in relation to the presence of IFNγ and IL12 wild versus variant genotypes, respectively. RESULTS: The distributions of IFNγ rs2430561, IFNγ rs35314021, IL12A rs568408, IL12A rs2243115 and IL12B rs3212227 SNP did not differ between BCG osteitis patients and Finnish population-based controls. For IFNγ rs2430561, IFNγ rs35314021 and IL12A rs2243115, the negative result was confirmed by comparing the minor allele frequencies (MAF) in BCG osteitis cases with those in the publicly available genome aggregation database, including data for 3,472 Finnish persons. Instead, for IL12A rs568408 and IL12B rs3212227, the comparison of MAF in BCG osteitis cases with those in population-based and in aggregation-based controls gave conflicting results. The presence of the wild versus variant genotype had no significant association with IL-12 or IFN-γ production in BCG-stimulated cell cultures. CONCLUSION: IFNγ gene polymorphisms did not show any association with BCG osteitis after newborn vaccination.


Assuntos
Interferon gama/genética , Subunidade p35 da Interleucina-12/genética , Subunidade p40 da Interleucina-12/genética , Infecções por Mycobacterium/genética , Mycobacterium bovis , Osteíte/genética , Polimorfismo de Nucleotídeo Único , Adulto , Vacina BCG/efeitos adversos , Estudos de Casos e Controles , Feminino , Seguimentos , Marcadores Genéticos , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Osteíte/microbiologia
11.
Rheumatol Int ; 39(9): 1559-1565, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31292710

RESUMO

The aim of the study was to compare the diagnostic efficacy of the visual assessment of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences compared to the STIR sequence in the diagnostics of active sacroiliitis in the course of axial spondyloarthritis (axSpA). The study group consisted of 49 patients who had undergone multiparametric magnetic resonance imaging of the sacroiliac joints (SIJs) due to clinical suspicion of axSpA. Two independent observers retrospectively assessed four quadrants of the SIJs for the presence of subchondral bone marrow oedema/osteitis with the use of modified SPARCC score in sequences: STIR, DWI (with ADC map) and DCE. Diagnostic efficiency parameters were calculated for DWI and DCE sequence separately, using STIR sequence as a reference. Inter-observer agreement was evaluated with the use of κ coefficient. Patients' clinical symptoms were analysed to identify the group fulfilling the imaging arm of the ASAS criteria for axSpA. Overall, 46.9% (n = 23) of patients fulfilled the imaging arm of ASAS criteria for axial spondyloarthritis. DWI with ADC map: accuracy 95.6%, sensitivity 99.4%, specificity 54.0%. DCE sequence: accuracy 96.8%, sensitivity 98.4%, specificity 79.5%. The highest level of inter-observer agreement was achieved for STIR sequence (κ = 0.888), slightly lower for DCE sequence (κ = 0.773) and the lowest for DWI with ADC (κ = 0.674). Visual assessment of the DWI and DCE sequences has high accuracy and sensitivity of bone marrow oedema/osteitis detection, but the specificity and inter-observer agreement are poor, especially for the DWI sequence with ADC maps.


Assuntos
Imagem de Difusão por Ressonância Magnética , Edema/diagnóstico por imagem , Osteíte/diagnóstico por imagem , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Adolescente , Adulto , Meios de Contraste/administração & dosagem , Diagnóstico Precoce , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Compostos Organometálicos/administração & dosagem , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
12.
Neuroradiology ; 61(9): 959-970, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31321462

RESUMO

PURPOSE: Understanding the underlying pathophysiology and the patterns of disease spread is crucial in accurate image interpretation. In this pictorial review, the common and important inflammatory processes of the temporal bone in children will be discussed, and key computed tomography (CT) and magnetic resonance imaging (MRI) features described. METHODS: Inflammatory processes are categorized by anatomical location: the petrous apex and the inner, middle and outer ear. A complete review of the literature is provided. RESULTS: Cholesteatoma, cholesterol granuloma and mucoceles are inflammatory processes that occur across the anatomical subsites of the temporal bone, whilst site-specific inflammatory processes include labyrinthitis ossificans in the inner ear and keratosis obturans in the external ear. Infection is a key cause of inflammation in the temporal bone, and specific infections include petrous apicitis, otitis media and necrotizing otitis externa. Finally, important mimics and do-not-touch lesions are considered. CT and MRI are complementary in assessing these disorders, as two of the most important diagnostic clues are the presence of bone erosion, best appreciated on CT, and true diffusion restriction as seen on MRI. Flow charts to assist in the diagnosis of paediatric temporal bone inflammatory disease are also provided. CONCLUSION: Paediatric temporal bone inflammatory processes are common and can have severe clinical sequelae. Timely intervention, facilitated by correct radiological diagnosis, can often prevent progression of disease, loss of hearing and systemic illness.


Assuntos
Imagem por Ressonância Magnética , Osteíte/diagnóstico por imagem , Osso Temporal , Tomografia Computadorizada por Raios X , Criança , Humanos
14.
Pediatr Rheumatol Online J ; 17(1): 35, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272461

RESUMO

BACKGROUND: To study the response to pamidronate using whole body magnetic resonance imaging (WB-MRI) in children with chronic non-bacterial osteitis (CNO) in a tertiary health centre. METHODS: The medical records of children under the age of sixteen with a diagnosis of chronic non-bacterial osteitis between 2005 and 2018 were reviewed. All those who were treated with pamidronate were included and relevant data was collected. Response to therapy was determined based on the status of lesions on WB- MRI. RESULTS: Forty six patients were included in the study. Pre- and post-treatment WB-MRI was available in forty patients. Cumulative lesions pre-treatment were 150 and reduced to 45 (30%) post-treatment. Seventeen patients (42.5%) had a good response with complete resolution of all lesions and nine patients (22.5%) worsened during or following treatment with pamidronate. Vertebral disease had a good response and 82.3% of the lesions resolved completely. CONCLUSION: Our study describes the experience with pamidronate in a tertiary health centre using WB-MRI as a marker of disease activity. Pamidronate was well tolerated in our cohort and treatment response was fairly good. SIGNIFICANCE AND INNOVATION: 1. Bisphosphonates can be used in the treatment of CNO when response to NSAIDs is suboptimal. 2. In the presence of spinal or mandibular lesions bisphosphonates were used as first line. 3. Treatment was escalated to a TNF blocker when response to bisphosphonates was suboptimal.


Assuntos
Osteíte/tratamento farmacológico , Pamidronato/uso terapêutico , Adolescente , Conservadores da Densidade Óssea/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Imagem Corporal Total/métodos
15.
Acta Reumatol Port ; 44(1): 42-56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249275

RESUMO

In the second part of this review article we will describe the imaging features of non- spondyloarthritis (SpA) pathologies that may mimic sacroiliitis on Magnetic Resonance Imaging (MRI), and that readers should be aware (part 2). Based on the established literature, there is currently an "overcall" of sacroiliitis on MRIs. In this setting, differential diagnoses and their imaging features come into play. In fact, non-SpA related sacroiliac joints (SIJs) pathologies are more commonly found than true sacroiliitis on MRI of the SIJs, even in patients with inflammatory type back pain. An imaging literature review, highlighting "easy-to-use" learning points regarding MRI interpretations in patients with suspected sacroiliitis and/or nonspecific lumbar back pain is presented. This two-part article aims to be a snapshot of the most common inflammatory versus non-inflammatory entities found on SIJs imaging studies in routine practice, while trying to keep this review article simple, educational and above all, practical.


Assuntos
Imagem por Ressonância Magnética , Articulação Sacroilíaca/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Síndrome de Hiperostose Adquirida/diagnóstico por imagem , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Fraturas de Estresse/diagnóstico por imagem , Gota/diagnóstico por imagem , Humanos , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Hipertireoidismo/complicações , Infecções/diagnóstico por imagem , Dor Lombar/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteíte/diagnóstico por imagem , Osteíte Deformante/diagnóstico por imagem , Osteoartrite/diagnóstico por imagem , Articulação Sacroilíaca/anatomia & histologia , Sarcoidose/diagnóstico por imagem
16.
BMJ Case Rep ; 12(4)2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30967452

RESUMO

A 33-year-old man presented to the emergency department with a right-sided facial paralysis and maxillary division (V2, trigeminal nerve) paraesthesia. He had been suffering with upper respiratory tract symptoms in the preceding 2 months, including rhinorrhoea, fever and headache. The patient was otherwise fit and immunocompetent. Urgent radiological investigation revealed extensive fungal sinusitis with sphenoid sinus dehiscence and skull base osteitis. The patient underwent emergency endoscopic sinus surgery revealing concretions and debris in the ethmoid and sphenoid sinuses. He was commenced on systemic antifungal therapy and made a full recovery with resolution of his cranial neuropathies. The fungus Schizophyllum commune was isolated and is a rare cause of fungal sinusitis, but with the potential for invasive disease in immunosuppressed individuals.


Assuntos
Doenças Ósseas Infecciosas/etiologia , Doenças dos Nervos Cranianos/etiologia , Micoses/complicações , Osteíte/etiologia , Sinusite/complicações , Adulto , Antifúngicos/uso terapêutico , Doenças Ósseas Infecciosas/complicações , Doenças Ósseas Infecciosas/microbiologia , Fluconazol/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Micoses/diagnóstico , Micoses/microbiologia , Micoses/terapia , Osteíte/microbiologia , Schizophyllum/isolamento & purificação , Sinusite/diagnóstico , Sinusite/microbiologia , Sinusite/terapia , Base do Crânio/diagnóstico por imagem , Base do Crânio/microbiologia , Base do Crânio/patologia , Tomografia Computadorizada por Raios X
17.
Curr Allergy Asthma Rep ; 19(5): 24, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-30874957

RESUMO

PURPOSE OF REVIEW: Osteitis is recognized as a common factor in recalcitrant chronic rhinosinusitis (CRS). There is evidence for the association of osteitis with revision surgeries and CRS severity, in terms of higher Lund-Mackay scores. This is a narrative review on the osteitis in CRS patients. RECENT FINDINGS: Evidence to date is inconclusive with regard to the etiology and pathogenesis of this bony thickening. Histopathology of osteitis in primary CRS is likely a process of neo-osteogenesis and bone remodeling. For better understanding, various associating factors have been studied including an inflammatory pattern of rhinosinusitis. Recent studies have associated osteitis with nasal polyps and tissue eosinophilia with the increase in periostin expression and P-glycoprotein mucosal expression. There is no association of osteitis to symptoms or quality of life. Osteitis is an outcome of neo-osteogenesis rather than inflammatory processes in CRS patients without a prior history of surgery. While CT has become a staple in osteitis assessment, the standards for grading osteitic severity remain in an experimental stage. There is no association between the presence or severity of osteitis at the time of surgery and clinical outcomes at 1 year after surgery. This review provides a comprehensive overview of the pathogenesis, epidemiology, and correlation with clinical and biological factors of osteitis in CRS patients.


Assuntos
Osteíte/etiologia , Rinite/complicações , Sinusite/complicações , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteíte/patologia
18.
PLoS One ; 14(3): e0213590, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30870491

RESUMO

Cerament (Bonesupport Holding, Lund, Sweden) is a bioresorbable synthetic bone substitute consisting of calcium sulfate and hydroxyapatite which is successfully used as a bone graft in bone defects or in delayed and non-unions after fractures. Besides, calcium sulfate/ hydroxyapatite (CAS/HA) could have, attributed to its composition and osteoinductive properties, have great importance in the treatment of bone infections with critical size defects (CSD). Aim of the study was to evaluate the effects of antibiotic infused CAS/HA on inflammation and bone healing in an implant-associated osteitis mice model. In a standardized murine model, the left femur of 72 BALB/c mice were osteotomized, generating a CSD (2,5 mm) with stabilization through a 6-hole titanium locking plate. Osteitis has been induced through inoculation of Staphylococcus aureus (SA) into the fracture gap. To analyze the effect of CAS/HA, following groups were generated with either CAS/HA, CAS/HA with gentamycin (CAS/ HA-G) or CAS/HA with vancomycin (CAS/HA-V) insets placed into the osteotomy. Debridément and lavages were progressed on day 7 and 42 to determine the local bacterial growth and the immune reaction. Fracture healing was quantified on day 7 and 42 by x-ray and bone healing markers from blood samples. Progression of infection was assessed by estimation of colony-forming units (CFU) and immune response was analyzed by determination of Interleukin (IL)- 6 and polymorphonuclear neutrophils (PMN) in lavage samples. Osteitis induced higher IL-6 and PMN-levels in the lavage samples on day 7. Both parameters showed a reduction in all groups on day 42. CAS/HA-V revealed a significant reduction of CFU and PMNs in lavage samples on day 42. A positive effect on bone healing could only be shown in non-infected mice. Whereas, application of mere CAS/HA in infected mice did show tendencies of bone destruction and lysis, independent of impregnation with antibiotics or not. Thus, application of CAS/HA in acute implant-associated infections is not recommended. In non-infectious environments or after infect-convalescence CAS/HA could albeit serve as a suggestive tool in trauma and orthopedic surgery.


Assuntos
Antibacterianos/farmacologia , Placas Ósseas , Sulfato de Cálcio/farmacologia , Durapatita/farmacologia , Fraturas do Fêmur/terapia , Osteíte/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Animais , Antibacterianos/química , Sulfato de Cálcio/química , Modelos Animais de Doenças , Durapatita/química , Feminino , Fraturas do Fêmur/metabolismo , Fraturas do Fêmur/microbiologia , Fraturas do Fêmur/patologia , Consolidação da Fratura/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos BALB C , Osteíte/etiologia , Osteíte/metabolismo , Osteíte/patologia , Infecções Estafilocócicas/metabolismo , Infecções Estafilocócicas/patologia
19.
JAMA ; 321(5): 461-472, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30721294

RESUMO

Importance: Whether using magnetic resonance imaging (MRI) to guide treatment in patients with rheumatoid arthritis (RA) improves disease activity and slows joint damage progression is unknown. Objective: To determine whether an MRI-guided treat-to-target strategy vs a conventional clinical treat-to-target strategy improves outcomes in patients with RA in clinical remission. Design, Setting, and Participants: Two-year, randomized, multicenter trial conducted at 9 hospitals in Denmark. Two hundred patients with RA in clinical remission (disease activity score in 28 joints-C-reactive protein [DAS28-CRP] <3.2 and no swollen joints) were enrolled between April 2012 and June 2015. The final follow-up visit was April 2017. Interventions: Patients were randomly allocated (1:1) to an MRI-guided vs a conventional treat-to-target strategy. In the MRI-guided group, the treatment goal was absence of MRI bone marrow edema combined with clinical remission, defined as DAS28-CRP of 3.2 or less and no swollen joints. In the conventional group, the treatment goal was clinical remission. Main Outcomes and Measures: Co-primary outcomes were proportions of patients achieving DAS28-CRP remission (DAS28-CRP <2.6) and with no radiographic progression (no increase in total van der Heijde-modified Sharp score) at 24 months. Significance testing for the primary outcome was based on 1-sided testing. Secondary outcomes were clinical and MRI measures of disease activity, physical function, and quality of life. Results: Of 200 patients randomized (133 women [67%]; mean [SD] age, 61.6 [10.5] years; median baseline DAS28-CRP, 1.9 [interquartile range, 1.7-2.2]; van der Heijde-modified Sharp score, 18.0 [interquartile range, 7.0-42.5]), 76 patients (76%) in the MRI-guided group and 95 (95%) in the conventional group completed the study. Of these, 64 (85%) vs 83 (88%), respectively, reached the primary clinical end point (risk difference, -4.8% [1-sided 95% CI, -13.6% to + ∞; 1-sided P = .19]) and 49 (66%) vs 58 (62%), respectively, reached the primary radiographic end point (risk difference, 4.7% [1-sided 95% CI, -7.0% to + ∞; 1-sided P = .25). Of 10 key secondary end points, 8 were null and 2 showed statistically significant benefit for the MRI treat-to-target group. Seventeen patients (17%) in the MRI-guided treat-to-target group and 6 patients (6%) in the conventional treat-to-target group experienced serious adverse events. Conclusions and Relevance: Among patients with RA in clinical remission, an MRI-guided treat-to-target strategy compared with a conventional treat-to-target strategy did not result in improved disease activity remission rates or reduce radiographic progression. These findings do not support the use of an MRI-guided strategy for treating patients with RA. Trial Registration: ClinicalTrials.gov Identifier: NCT01656278.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Medula Óssea/diagnóstico por imagem , Articulações/diagnóstico por imagem , Imagem por Ressonância Magnética , Idoso , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Medula Óssea/patologia , Progressão da Doença , Edema/diagnóstico por imagem , Feminino , Humanos , Articulações/efeitos dos fármacos , Articulações/patologia , Masculino , Pessoa de Meia-Idade , Osteíte/diagnóstico por imagem , Avaliação de Processos e Resultados em Cuidados de Saúde , Radiografia , Indução de Remissão
20.
BMC Med Imaging ; 19(1): 13, 2019 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717680

RESUMO

BACKGROUND: Even though progressive rhinosinusitis with osteitis is a major clinical problem in granulomatosis with polyangiitis (GPA), there are no studies on how GPA-related osteitis develops over time, and no quantitative methods for longitudinal assessment. Here, we aimed to identify simple and robust CT-based methods for capture and quantification of time-dependent changes in GPA-related paranasal sinus osteitis and compare performance of the methods under study in a largely unselected GPA cohort. METHODS: GPA patients (n = 121) with ≥3 paranasal CT scans obtained ≥12 months apart and control patients not having GPA or rhinosinusitis (n = 15) were analysed by: (i) Global osteitis scoring scale (GOSS), originally developed for chronic rhinosinusitis; (ii) Paranasal sinus volume by manual segmentation; (iii) Mean maxillary and sphenoid diameter normalised to landmark distances (i.e. diameter ratio measurement, DRM). RESULTS: Time-dependent changes in GPA-related osteitis were equally well measured by the simple DRM and the labour-intensive volume method while GOSS missed ongoing changes in cases with extensive osteitis. GOSS at last CT combined with DRM identified three distinct patient groups: (i) The no osteitis group, who had no osteitis and no change in DRM from baseline CT to last CT (45/121 GPA patients and 15/15 disease controls); (ii) Stable osteitis group, with presence of osteitis, but no change in DRM across time (31 GPA); (iii) Progressive osteitis, defined by declining DRM (45 GPA). CONCLUSIONS: We suggest DRM and GOSS as complementary methods for capturing, classifying and quantifying time-dependent changes in GPA-related osteitis.


Assuntos
Granulomatose com Poliangiite/complicações , Osteíte/diagnóstico por imagem , Seios Paranasais/diagnóstico por imagem , Sinusite/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Granulomatose com Poliangiite/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteíte/etiologia , Sensibilidade e Especificidade , Fatores de Tempo , Adulto Jovem
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