RESUMEN
BACKGROUND: Bisphosphonates (BP) are used in the treatment of severe osteoporosis and metastasis of malignant diseases. A possible relationship between the occurrence of osteonecrosis of the jaw and BP therapy was first described in 2003. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is difficult to treat. In some cases the condition of the patients is so compromised that only minimally invasive surgery is possible. Histopathologically, osteonecrosis shows the features of chronic sequestered osteomyelitis, which can be found in different areas of the upper and lower jaw. Sometimes extensive resections of the jaw are necessary. Thus, BRONJ can cause mutilation, impairment of function and esthetics in the orofacial system and, thereby, compromise the life quality of the patients. Triggering factors are often tooth extraction without surgical plastic wound closure of the alveoli, but can also be associated with bruises from denture or other minor wounds. OBJECTIVES: The purpose of this article is to present results from our own patient collective, including therapy regime, success rate, and therapy recommendations. METHODS: The patient populations at three German hospitals were analyzed using a standard questionnaire. The patients in the study group, entered into a follow-up system for early detection of possible BRONJ, were evaluated for treatement outcome. RESULTS: The success rate for prophylactic surgery in asymptomatic patients was very high at 96 %. In the group with symptomatic BRONJ, the outcome was significantly lower (76.4 %). CONCLUSIONS: Because of the complex symptoms, close cooperation between oncologists, dentists, and maxillofacial surgeons is required in the treatment of BRONJ. Before starting therapy with bisphosphonates and during the therapy, dental treatment and monitoring of the patient' oral health is necessary.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/diagnóstico , Osteonecrosis de los Maxilares Asociada a Difosfonatos/terapia , Difosfonatos/uso terapéutico , Imidazoles/uso terapéutico , Anciano , Terapia Combinada , Difosfonatos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Imidazoles/efectos adversos , Comunicación Interdisciplinaria , Colaboración Intersectorial , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Osteoporosis/tratamiento farmacológico , Plasmacitoma/tratamiento farmacológico , Factores de Riesgo , Extracción Dental , Resultado del Tratamiento , Ácido ZoledrónicoRESUMEN
BACKGROUND: Fifty tumor specimens from primarily untreated patients were analyzed to elucidate the involvement of the tumor suppressor gene PTEN/MMAC1 in the development of oral squamous cell cancer. METHODS: Eight microsatellite markers, spanning 10 cM of genomic DNA located centromeric, telomeric or intragenic of PTEN/MMAC1 were used for loss of heterozygosity (LOH) and breakpoint analysis. The microsatellite panel within or in close proximity (1 cM) to the 10q23.3 locus showed a LOH rate of 12%. Complete sequence analysis of the genes coding region was performed in all 10 cases that exhibited LOH in one of the eight microsatellite markers within or around the PTEN/MMAC1 gene. Comparative multiplex PCR reactions served to screen for homozygous deletions. RESULTS: There was no association between allelic loss of the gene, overall patient survival and recurrence-free survival. Sequencing did not reveal any mutation in the coding region of PTEN/MMAC1. Differential PCR analysis failed to detect any homozygous deletion. CONCLUSIONS: We conclude that PTEN/MMAC1 gene alterations do not play a key role in tumorigenesis of oral squamous cell cancers.
Asunto(s)
Carcinoma de Células Escamosas/genética , Genes Supresores de Tumor/fisiología , Mutación de Línea Germinal/genética , Neoplasias de la Boca/genética , Monoéster Fosfórico Hidrolasas/genética , Proteínas Supresoras de Tumor/genética , Adulto , Anciano , Anciano de 80 o más Años , Alelos , Centrómero/genética , Cromosomas Humanos Par 10/genética , Supervivencia sin Enfermedad , Femenino , Eliminación de Gen , Marcadores Genéticos/genética , Homocigoto , Humanos , Modelos Lineales , Pérdida de Heterocigocidad/genética , Masculino , Repeticiones de Microsatélite/genética , Persona de Mediana Edad , Recurrencia Local de Neoplasia/genética , Fosfohidrolasa PTEN , Reacción en Cadena de la Polimerasa , Análisis de Secuencia de ADN , Estadística como Asunto , Estadísticas no Paramétricas , Tasa de Supervivencia , Telómero/genéticaRESUMEN
The effect of T4 administration on epidermal growth factor (EGF) expression in kidney and submandibular glands (SMG) was studied in newborn mice. EGF messenger RNA (mRNA) abundance and EGF immunoreactivity were assessed by in situ hybridization and immunohistochemical techniques, respectively. T4 treatment on days 0-6 augmented both the in situ hybridization and immunocytochemical signals in kidney but not in SMG on day 7. By contrast, T4 injections on days 7-14 did not alter the in situ hybridization or immunocytochemical signals in kidney but increased both signals in SMG on day 15. Thus, neonatal T4 treatment augments the levels of EGF mRNA as well as EGF immunoreactivity in both kidney and SMG. The T4 effect is manifested during the first week in kidney whereas the SMG responds to T4 treatment only during the second week of life.