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4.
PLoS One ; 15(4): e0231209, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251440

RESUMO

As survival of acute lymphoblastic leukemia (ALL) exceeds 90%, limiting therapy-related toxicity has become a key challenge. Cardio-metabolic dysfunction is a challenge during and after childhood ALL therapy. In a single center study, we measured triglycerides (TG), total cholesterol (TC), high (HDL) and low density lipoproteins (LDL) levels at diagnosis and assessed the association with BMI, early therapy response, on-therapy hyperlipidemia and the toxicities; thromboembolism, osteonecrosis and pancreatitis. We included 127 children (1.0-17.9 years) all treated according to the NOPHO ALL2008 protocol. Dyslipidemia was identified at ALL-diagnosis in 99% of the patients, dominated by reduced HDL levels (98%) and mild hypertriglyceridemia (61%). Hypertriglyceridemia was not associated with body mass index (P = 0.71). Five percent of patients had mild hypercholesterolemia, 14% had mild hypocholesterolemia, 13% had decreased and 1% elevated LDL-levels. Increased TG and TC levels at ALL-diagnosis were not associated with any on-therapy lipid levels. Lipid levels and BMI were not associated to MRD after induction therapy; However, BMI and hypercholesterolemia were associated with worse risk group stratification (P<0.045 for all). The cumulative incidence of thromboembolism was increased both for patients with hypo- (20.0%) and hypercholesterolemia (16.7%) compared to patients with normal TC levels (2.2%) at diagnosis (P = 0.0074). In conclusion, dyslipidemic changes were present prior to ALL-therapy in children with ALL but did not seem to affect dysmetabolic traits during therapy and were not predictive of on-therapy toxicities apart from an association between dyscholesterolemia at time of ALL-diagnosis and risk of thromboembolism. However, the latter should be interpreted with caution due to low number in the groups.


Assuntos
Dislipidemias/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/sangue , Adolescente , Asparaginase/metabolismo , Índice de Massa Corporal , Criança , Pré-Escolar , Dislipidemias/epidemiologia , Feminino , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/epidemiologia , Hipertrigliceridemia/complicações , Hipertrigliceridemia/epidemiologia , Lactente , Masculino , Osteonecrose/complicações , Pancreatite/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos Retrospectivos , Risco , Esteroides/metabolismo , Tromboembolia/complicações , Resultado do Tratamento
5.
Br Dent J ; 228(6): 397-398, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32221424
6.
Br Dent J ; 228(6): 415-421, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32221440

RESUMO

In the last few decades, the number of targeted chemotherapies approved for cancer treatment and undergoing clinical trials has risen. In comparison to conventional chemotherapy, targeted therapies (TTs) act on specific molecular targets involved in cancer development and progression, with reduced detrimental effects to normal tissues. TTs have now been recognised as key treatments in a number of common cancers, including solid tumours and haematological malignancies. The number of patients undergoing novel cancer treatment will continue to increase, and a significant population will likely present to the dental environment. This paper aims to provide an insight into TTs currently available, including monoclonal antibodies, fusion proteins, tyrosine kinase inhibitors, histone deacetylase inhibitors, mammalian target of rapamycin inhibitors, phosphoinositide 3-kinase inhibitors, proteasome inhibitors and hedgehog pathway inhibitors. The mechanisms of action, indications for use and how to identify the medications will be summarised. Dental implications of these novel therapies include medication-related osteonecrosis of the jaw, delayed healing, immunosuppression and thrombocytopenia. These will be discussed to ensure oral healthcare providers are aware of their impact in a dental setting.


Assuntos
Antineoplásicos , Osteonecrose , Odontologia , Proteínas Hedgehog , Humanos , Fosfatidilinositol 3-Quinases
7.
Ned Tijdschr Tandheelkd ; 127(1): 13-17, 2020 Jan.
Artigo em Holandês | MEDLINE | ID: mdl-32159524

RESUMO

A 52-year-old man with a history of krokodil (desomorphine) use was admitted to the department of oral and maxillofacial surgery with drug intoxication and severe pain in his jaw. During clinical and radiological examination, several sites of exposed necrotic bone with purulent discharge were seen. In krokodil-using patients osteonecrosis of the jaw is a frequently occurring manifestation. Other oral aspects associated with the use of krokodil include mucosal changes, a high risk of caries and periodontitis. Systemic effects can interfere with dental and oral and maxillofacial treatment. Treatment consists of sequestrectomy of the necrotic bone under general anaesthesia. The clinical picture of osteonecrosis in krokodil users is similar to cases of 'phossy jaw' and Medication Related Osteonecrosis of the Jaw (MRONJ).


Assuntos
Saúde Bucal , Osteonecrose , Codeína/análogos & derivados , Humanos , Masculino , Pessoa de Meia-Idade
8.
Ned Tijdschr Tandheelkd ; 127(1): 19-27, 2020 Jan.
Artigo em Holandês | MEDLINE | ID: mdl-32159525

RESUMO

the bone can still be present long after patients have stopped taking the medication. Patients are often able to report accurately what disorder(s) they have and certain disorders should cause dentists to be alert. Patients who can be defined as the Big Five users of bone-modulating medicaments are: 1. patients with osteoporosis, 2. patients who have been long-term users of glucocorticoids, 3. patients with solid tumours, 4. patients with multiple myeloma and 5. patients with congenital or hereditary bone disorders. These patient groups have an indication for bone-modulating medicaments. These are anti-resorptive medications (such as bisphosphonates and denosumab) or anti-angiogenic medications. By recognising the correct patient group, dentists can ask appropriate questions about the use of medicaments in the present or in the past. A dentist can recognise patients with a risk of medication-related osteonecrosis by using this method.


Assuntos
Conservadores da Densidade Óssea , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Osteonecrose , Denosumab , Difosfonatos , Humanos
9.
Asian Pac J Cancer Prev ; 21(3): 715-720, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32212798

RESUMO

BACKGROUND: The immunomodulator mifamurtide plus a chemotherapy regimen has been shown to significantly improve the outcome in non-metastatic osteosarcoma patients. We report the results of the addition of mifamurtide to chemotherapy in newly diagnosed patients with osteosarcoma. METHODS: A total of 36 children with osteosarcoma without detectable metastasis were treated between November 2010 and April 2018 at the Ankara University Department of Pediatric Oncology. Mifamurtide was added to the chemotherapy regimen in 17 patients while the remaining 19 did not receive mifamurtide. The probabilities of metastasis and overall survival were compared between the groups. RESULTS: The 43-month survival rate was 87.5% and 89.9% in the patients who received and did not receive mifamurtide, respectively (p=0.65). Common side effects of mifamurtide were chills and fever. The addition of mifamurtide in the high-risk group with ≤95% necrosis tended to decrease the probability of distant metastasis (36.4% vs. 58.3%) (p=0.39). The time to metastasis in the group with positive surgical margins (4 months in one patient in the non-mifamurtide group, 7 and 20 months in the mifamurtide group) was also longer in the mifamurtide group. During the 43-month follow up period, median time to metastasis was longer in the mifamurtide group (20 vs. 5 months). In addition, mifamurtide plus chemotherapy decreased the risk of metastasis in the cases with primary site relapse. CONCLUSIONS: The addition of mifamurtide to chemotherapy might improve event-free survival by decreasing the probability of distant metastasis in bad histologic responders, and also by increasing the time to distant metastasis in the surgical margin positive group. Additional clinical studies are necessary to determine the long-term effects of mifamurtide on metastatic disease.
.


Assuntos
Acetilmuramil-Alanil-Isoglutamina/análogos & derivados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Osteossarcoma/tratamento farmacológico , Fosfatidiletanolaminas/uso terapêutico , Acetilmuramil-Alanil-Isoglutamina/efeitos adversos , Acetilmuramil-Alanil-Isoglutamina/uso terapêutico , Adolescente , Criança , Humanos , Metástase Neoplásica , Osteonecrose/induzido quimicamente , Fosfatidiletanolaminas/efeitos adversos , Recidiva
12.
Orv Hetil ; 161(6): 214-223, 2020 Feb.
Artigo em Húngaro | MEDLINE | ID: mdl-32008346

RESUMO

Introduction: The presumably multifactorial pathomechanisms of medication-related osteonecrosis of the jaws have not been fully elucidated so far. Management of this rare but serious side effect is a real challenge and requires a multidisciplinary approach. Aim: The aim of the authors was to take stock of our present knowledge about the pathogenesis, risk factors, clinical manifestations and the possibilities of prevention and treatment in the medication-related osteonecrosis of the jaws. In addition, the available international guidelines are compared and the evidence-based, stage-specific conservative and adjuvant therapeutic approaches are also reviewed, having regard to special aspects of medical and dental care. Method: In the last 5 years - due to the increasing number of disorder-oriented database - the number of available systematic reviews, recommendations and meta-analyses has escalated significantly which we reviewed and compared. Results: Since the last Position Paper published by the taskforce of the American Association of Oral and Maxillofacial Surgeons, novel pharmacological groups with the potential to induce osteonecrosis have come in the clinical scope, further elaborating the nomenclature of the disease and further specifying patient groups. The sphere of patients at risk has broadened and novel patient groups (rheumatologic-osteological, immunosuppressed, transplanted or oncological patients treated with monoclonal antibody, known as 'target therapy') are expected to develop this serious side effect. Conclusion: Although a number of issues are still open regarding the treatment of the disorder, evidence-based, individualized, stage-adapted therapeutic approaches have replaced the previous empirical treatment. Orv Hetil. 2020; 161(6): 214-223.


Assuntos
Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/prevenção & controle , Osteonecrose/induzido quimicamente , Osteonecrose/prevenção & controle , Humanos , Guias de Prática Clínica como Assunto , Prevenção Primária , Prevenção Secundária
13.
Phys Ther ; 100(3): 509-522, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32044966

RESUMO

BACKGROUND: Glucocorticoids used to treat childhood leukemia and lymphoma can result in osteonecrosis, leading to physical dysfunction and pain. Improving survival rates warrants research into long-term outcomes among this population. OBJECTIVE: The objective of this study was to compare the physical function and quality of life (QOL) of survivors of childhood cancer who had an osteonecrosis history with that of survivors who had no osteonecrosis history and with that of people who were healthy (controls). DESIGN: This was a cross-sectional study. METHODS: This study included St Jude Lifetime Cohort Study participants who were ≥ 10 years from the diagnosis of childhood leukemia or lymphoma and ≥ 18 years old; 135 had osteonecrosis (52.5% men; mean age = 27.7 [SD = 6.08] years) and 1560 had no osteonecrosis history (52.4% men; mean age = 33.3 [SD = 8.54] years). This study also included 272 people who were from the community and who were healthy (community controls) (47.7% men; mean age = 35.1 [SD = 10.46] years). The participants completed functional assessments and questionnaires about QOL. RESULTS: Survivors with osteonecrosis scored lower than other survivors and controls for dorsiflexion strength (mean score = 16.50 [SD = 7.91] vs 24.17 [SD = 8.61] N·m/kg) and scored lower than controls for flexibility with the sit-and-reach test (20.61 [SD = 9.70] vs 23.96 [SD = 10.73] cm), function on the Physical Performance Test (mean score = 22.73 [SD = 2.05] vs 23.58 [SD = 0.88]), and mobility on the Timed "Up & Go" Test (5.66 [SD = 2.25] vs 5.12 [SD = 1.28] seconds). Survivors with hip osteonecrosis requiring surgery scored lower than survivors without osteonecrosis for dorsiflexion strength (13.75 [SD = 8.82] vs 18.48 [SD = 9.04] N·m/kg), flexibility (15.79 [SD = 8.93] vs 20.37 [SD = 10.14] cm), and endurance on the 6-minute walk test (523.50 [SD = 103.00] vs 572.10 [SD = 102.40] m). LIMITATIONS: Because some eligible survivors declined to participate, possible selection bias was a limitation of this study. CONCLUSIONS: Survivors of childhood leukemia and lymphoma with and without osteonecrosis demonstrated impaired physical performance and reported reduced QOL compared with controls, with those requiring surgery for osteonecrosis most at risk for impairments. It may be beneficial to provide strengthening, flexibility, and endurance interventions for patients who have pediatric cancer and osteonecrosis for long-term function.


Assuntos
Sobreviventes de Câncer , Leucemia/tratamento farmacológico , Linfoma/tratamento farmacológico , Osteonecrose/fisiopatologia , Desempenho Físico Funcional , Qualidade de Vida , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Estudos Transversais , Feminino , Glucocorticoides/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Osteonecrose/induzido quimicamente , Osteonecrose/cirurgia , Amplitude de Movimento Articular , Participação Social , Teste de Caminhada
14.
Oral Maxillofac Surg ; 24(2): 133-144, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32056052

RESUMO

PURPOSE: The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy of laser therapy on medication-related osteonecrosis of the jaw (MRONJ) treatment. METHODS: This study followed PRISMA standards, and an electronic search was performed on the PubMed/MEDLINE, Scopus, and Cochrane databases. Eighty-nine articles were found. After reading the manuscripts, 15 articles remained for the review. Three of them were selected for meta-analysis. RESULTS: Female gender was predominant (72.5%), and mean age was 66.5 years. Follow-up varied between 3 and 80 months, and the most used bisphosphonate was zoledronic acid (71.6%). Stage II of MRONJ was the most prevalent (68.9%), and the mandible was the most affected site (64.5%). Qualitative data showed that treatment with laser surgery (Er:YAG) was most effective regarding complete healing of the lesion (90%) compared with other treatments. Meta-analysis data showed that low-level laser therapy (LLLT) was more effective than medical treatment (P = 0.006), and surgical treatment was more effective than LLLT (P = 0.008). CONCLUSION: Laser surgery was significantly superior to LLLT (p < 0.00001). Therefore, laser surgical therapy seems to be a great management strategy for MRONJ treatment from stage II. LLLT was shown to improve conservative management in earlier MRONJ stages.


Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Terapia a Laser , Osteonecrose , Idoso , Difosfonatos , Feminino , Humanos , Arcada Osseodentária
15.
Medicine (Baltimore) ; 99(3): e18766, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011465

RESUMO

RATIONALE: Shoulder pain is a common complaint among patients, and rotator cuff disorders are the most common diagnoses. Humeral head osteonecrosis is easily masked by other more common diagnoses and concomitant conditions. PATIENT CONCERNS: This challenging diagnostic report consists of 2 cases. Case 1 was that of a 59-year-old man who presented with right shoulder pain that had lasted for >1 year. Case 2 was that of a 52-year-old man who complained of right shoulder pain lasting for 6 months. They both presented with chronic right shoulder pain without relevant trauma history, and the physical examination showed a tenderness point over the right greater tuberosity. DIAGNOSIS: These 2 patients were diagnosed with osteonecrosis involving the right greater tuberosity region via magnetic resonance imaging. INTERVENTIONS: In case 1, the patient underwent cord decompression and artificial bone grafting with C-arm guidance. In case 2, the patient refused surgical intervention and decided to continue receiving physical therapy for symptom control. OUTCOMES: In case 1, the patient responded well to cord decompression and artificial bone grafting. After the surgery, the active range of motion was restored and the pain in the right shoulder diminished further. In case 2, conservative treatment helped alleviate the patient's shoulder pain but did not entirely eliminate it. LESSONS: Physicians should always have a high index of suspicion for osteonecrosis, especially when treating chronic shoulder pain, regardless of whether there are typical symptoms/known risk factors or not.


Assuntos
Cabeça do Úmero/diagnóstico por imagem , Imagem por Ressonância Magnética , Osteonecrose/diagnóstico por imagem , Dor de Ombro/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Cabeça do Úmero/patologia , Masculino , Pessoa de Meia-Idade , Osteonecrose/patologia , Osteonecrose/terapia , Modalidades de Fisioterapia , Lesões do Manguito Rotador/diagnóstico por imagem
16.
Instr Course Lect ; 69: 103-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017722

RESUMO

Osteonecrosis is a pathological condition in which the cellular elements of bone die. It is generally a progressive disease, unless the lesions are very small. Osteonecrosis is frequently located in more than one bone (multifocal). The three most common etiologies are local severe trauma, prolonged use of corticosteroids for serious medical conditions, and alcohol abuse. The diagnosis is one of high suspicion in a predisposed younger patient, usually less than 50, with persistent joint pain. Radiographs of the joint and magnetic resonance images confirm the diagnosis. Joint-saving procedures are first initiated if the joint is still anatomically preserved, and bone collapse has not occurred. In the later stages with collapse of bone and subsequent arthritis, the procedure of choice is joint arthroplasty. Earlier diagnosis and intervention, together with new surgical procedures and devices, may prolong the lifetime of the patient's natural joint.


Assuntos
Osteonecrose , Artralgia , Osso e Ossos , Humanos , Radiografia
17.
Instr Course Lect ; 69: 111-128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017723

RESUMO

Osteonecrosis may afflict over 20 million patients worldwide. Prevention and treatment of osteonecrosis is dependent on a better understanding of the pathogenesis of the disease. Treatments range from observation with behavior modification to total joint replacement. As osteonecrosis patients are often relatively young, treatment options sparing the joint and reducing or delaying the need for joint replacement are essential. The results of joint sparing procedures are generally better if performed at early, precollapse stages. Approaches to treatment of early-stage disease are based upon the clinician's acceptance of one of the many hypotheses regarding the underlying pathophysiologic mechanisms involved. These mechanisms have been categorized as direct effects on cells or tissues, vascular interruption, intravascular occlusion, and intraosseous extravascular compression. While there has been a substantial increase in research regarding osteonecrosis, many questions remain to be answered concerning risk factors, pathophysiology, and nonsurgical and surgical interventions.


Assuntos
Osteonecrose , Humanos , Fatores de Risco
18.
Instr Course Lect ; 69: 129-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017724

RESUMO

Osteonecrosis of the femoral head is characterized by reduced intraosseous blood flow to the subchondral bone. The management of early osteonecrosis usually involves joint preservation procedures to provide pain relief, prevent disease progression, and avoid joint replacement. A thorough clinical evaluation is crucial to identify at-risk patients and allow early intervention with joint preservation. The decision to use one joint preserving method over another is dependent on staging and patient characteristics. Surgeons should have a thorough understanding of the available joint preservation procedures to help determine the optimal treatment modality for their patients.


Assuntos
Necrose da Cabeça do Fêmur , Cabeça do Fêmur , Humanos , Osteonecrose
19.
Medicine (Baltimore) ; 99(5): e18989, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000434

RESUMO

RATIONALE: Although the treatment of femoral head necrosis has already been established with the adoption of daily teriparatide, a clear consensus on the treatment of spontaneous osteonecrosis of the knee (SONK) has yet to be reached. Therefore, we focused on the treatment of SONK with daily teriparatide administration (20 µg, subcutaneous) and confirmed its effects to determine whether it is a valid option. PATIENTS' CONCERNS: Three osteoporotic patients who were diagnosed with SONK complained of knee pain. DIAGNOSIS: SONK was diagnosed on magnetic resonance imaging in all cases. INTERVENTIONS: All patients took daily teriparatide as a treatment for SONK. OUTCOMES: There was a significant and dramatic reduction in the visual analog scale score 1 month after treatment. After 6 months of treatment, the sizes of the affected SONK lesions were smaller than in the initial phase, and plain X-rays showed no further signs of progression. LESSONS: Daily teriparatide might be an effective treatment for SONK.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Articulação do Joelho , Osteonecrose/tratamento farmacológico , Teriparatida/uso terapêutico , Idoso , Biomarcadores/sangue , Densidade Óssea , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Osteonecrose/diagnóstico por imagem , Medição da Dor , Teriparatida/administração & dosagem
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