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1.
Int J Mol Sci ; 20(17)2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31480433

RESUMO

Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases. In addition, osteoporosis is critical in patients receiving a liver transplant. Nevertheless, few studies have evaluated bone diseases in patients with more frequently observed chronic liver disease, such as chronic viral hepatitis, nonalcoholic fatty liver disease and alcoholic liver disease. Osteoporosis is a disease caused by an imbalance in the activities of osteoblasts and osteoclasts. Over the last few decades, many advances have improved our knowledge of the pathogenesis of osteoporosis. Importantly, activated immune cells affect the progression of osteoporosis, and chronic inflammation may exert an additional effect on the existing pathophysiology of osteoporosis. The microbiota of the intestinal tract may also affect the progression of bone loss in patients with chronic liver disease. Recently, studies regarding the effects of chronic inflammation on dysbiosis in bone diseases have been conducted. However, mechanisms underlying osteoporosis in patients with chronic liver disease are complex and precise mechanisms remain unknown. The following special considerations in patients with chronic liver disease are reviewed: bone diseases in patients who underwent a liver transplant, the association between chronic hepatitis B virus infection treatment and bone diseases, the association between sarcopenia and bone diseases in patients with chronic liver disease, and the association between chronic liver disease and avascular necrosis of the hip. Few guidelines are currently available for the management of low bone mineral density or bone diseases in patients with chronic liver disease. Due to increased life expectancy and therapeutic advances in chronic liver disease, the importance of managing osteoporosis and other bone diseases in patients with chronic liver disease is expected to increase. Consequently, specific guidelines need to be established in the near future.


Assuntos
Doenças Ósseas/complicações , Hepatopatias/complicações , Animais , Doenças Ósseas/patologia , Doenças Ósseas/terapia , Doença Crônica , Gerenciamento Clínico , Humanos , Hepatopatias/patologia , Hepatopatias/terapia , Transplante de Fígado
2.
World Neurosurg ; 128: 14-17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054339

RESUMO

BACKGROUND: An epidermoid cyst arising from diploic space in the skull can cause an intracranial mass effect with compression of the underlying venous sinuses. CASE DESCRIPTION: A 66-year-old woman came to us with a persistent headache and unsteadiness. Computed tomography demonstrated an occipital bone cystic lesion with an intracranial mass effect overlying the torcular herophili, with high-intensity findings in diffusion-weighted magnetic resonance imaging. Cerebral angiogram demonstrated obstruction of the torcular herophili with development of diploic venous drainage. The patient underwent removal of the lesion and a cranioplasty procedure. The diagnosis was torcular epidermoid cyst. The postoperative course was uneventful, and the symptoms were resolved. CONCLUSIONS: Development of diploic venous drainage contributed to avoidance of critical intracranial hypertension during slow growth of a torcular epidermoid cyst.


Assuntos
Doenças Ósseas/complicações , Transtornos Cerebrovasculares/etiologia , Cavidades Cranianas , Cisto Epidérmico/complicações , Idoso , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Doenças Ósseas/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cavidades Cranianas/patologia , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Osso Occipital
3.
Clin Imaging ; 54: 15-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30500454

RESUMO

Differentiation of bone infarct from osteomyelitis is one of the most challenging issues in the evaluation of acute bone pain in sickle cell patients. The imaging modalities that are currently being used for assessment of bone marrow in this population have several limitations. We present a case of an 18-year-old male with a history of sickle cell disease, who was transferred to our emergency department with progressively severe headache and jaw pain for one-week. Initial evaluation was concerning for osteomyelitis and epidural abscess formation. Due to the lack of response to the current antibiotic treatment, he was transferred to our institution. On further review of the images, atypical DWI findings that were identified in the early phase of presentation helped to differentiate bone infarct from osteomyelitis. Radiologists should be aware of this phenomenon, as it can help in the differentiation between these two pathologies and can affect the patient's management overall.


Assuntos
Anemia Falciforme/complicações , Doenças Ósseas/diagnóstico , Osso e Ossos/patologia , Adolescente , Antibacterianos , Doenças Ósseas/complicações , Doenças Ósseas/patologia , Medula Óssea , Humanos , Masculino , Osteomielite/diagnóstico , Osteomielite/patologia
4.
World Neurosurg ; 123: 165-167, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30476663

RESUMO

BACKGROUND: Cranial pneumatization in humans is normally confined to the paranasal sinuses and the petrous and mastoid parts of the temporal bones. CASE DESCRIPTION: We present a case of left-sided fractures of the occipital condyle and lateral mass of the atlas in the setting of extensive craniocervical pneumatization but in the absence of trauma, with a resulting unilateral hypoglossal nerve palsy. CONCLUSIONS: We discussed the possible etiology of this rare disease, its management, and prognosis.


Assuntos
Doenças Ósseas/complicações , Atlas Cervical/lesões , Fraturas Espontâneas/complicações , Doenças Ósseas/diagnóstico por imagem , Atlas Cervical/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Doenças do Nervo Hipoglosso/diagnóstico por imagem , Doenças do Nervo Hipoglosso/etiologia , Masculino , Pessoa de Meia-Idade , Osso Occipital
6.
BMJ Case Rep ; 20182018 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-30232074

RESUMO

Reported is the case of a 79-year-old woman initially diagnosed with periorbital abscess on the background of a recent upper respiratory tract infection. Unexpectedly, intraoperative findings were that of a haematoma rather than an abscess. Subperiosteal orbital haematoma (SOH) is an extremely rare complication of rhinosinusitis. In contrast to the more common periorbital abscess, it is seldom listed as a complication of sinusitis. A review of reported cases suggests an older patient demographic are affected by SOH in contrast to periorbital abscess which typically affects paediatric patients. Given current demographic trends toward an older patient population with multiple comorbidities, failure to consider SOH as a differential will have important implications on preoperative workup, perioperative care and final outcome for patients. We present this case as a reminder of a rare but important complication of a common disease.


Assuntos
Sinusite Frontal/complicações , Hematoma/diagnóstico por imagem , Órbita/patologia , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Doenças Ósseas/complicações , Doenças Ósseas/microbiologia , Doenças Ósseas/patologia , Drenagem/métodos , Feminino , Hematoma/tratamento farmacológico , Hematoma/microbiologia , Hematoma/cirurgia , Humanos , Órbita/irrigação sanguínea , Doenças Orbitárias/etiologia , Doenças Orbitárias/patologia , Propionibacterium acnes/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Atherosclerosis ; 278: 49-59, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30253289

RESUMO

Mineral bone disease (MBD) is a common complication of chronic kidney disease (CKD) characterized by disruption of normal mineral homeostasis within the body. One or more of the following may occur: hypocalcemia, hyperphosphatemia, secondary hyperparathyroidism (SHPT), decreased vitamin D and vascular calcification (VC). The greater the decrease in renal function, the worse the progression of CKD-MBD. These abnormalities may lead to bone loss, osteoporosis and fractures. CKD-MBD is a major contributor to the high morbidity and mortality among patients with CKD. Another well-known complication of CKD is cardiovascular disease (CVD) caused by increased atherosclerosis and VC. CVD is the leading cause of morbidity and mortality in CKD patients. VC is linked to reduced arterial compliance that may lead to widened pulse pressure and impaired cardiovascular function. VC is a strong predicator of cardiovascular mortality among patients with CKD. Elevated phosphorus levels and increased calcium-phosphorus product promote VC. Controlling mineral disturbances such as hyperphosphatemia and SHPT is still considered among the current strategies for treatment of VC in CKD through restriction of calcium based phosphate binders in hyperphosphatemic patients across all severities of CKD along with dietary phosphate restriction and use of calciminetics. Additionally, Vitamin D insufficiency is common in CKD and dialysis patients. The causes are multifactorial and a serious consequence is SHPT. Vitamin D compounds remain the first-line therapy for prevention and treatment of SHPT in CKD. Vitamin D may also have atheroprotective effects on the arterial wall, but clinical studies do not show clear evidence of reduced cardiovascular mortality with vitamin D administration. This review discusses the issues surrounding CKD-MBD, cardiovascular disease and approaches to treatment.


Assuntos
Aterosclerose/complicações , Densidade Óssea , Doenças Ósseas/complicações , Cálcio/metabolismo , Insuficiência Renal Crônica/complicações , Calcificação Vascular/complicações , Animais , Aterosclerose/patologia , Doenças Ósseas/patologia , Osso e Ossos/patologia , Cardiotônicos/farmacologia , Ensaios Clínicos como Assunto , Homeostase , Humanos , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário/patologia , Hiperfosfatemia/complicações , Hiperfosfatemia/patologia , Rim/fisiopatologia , Fosfatos/metabolismo , Diálise Renal , Insuficiência Renal Crônica/patologia , Sevelamer/farmacologia , Calcificação Vascular/patologia , Vitamina D/farmacologia
9.
Otol Neurotol ; 39(6): 797-802, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29697584

RESUMO

OBJECTIVE: To discuss the clinical implications of the association between temporal bone tegmen dehiscence (TD) necessitating surgical correction and the adjacent dehiscent superior semicircular canal (SSCD). STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: Sixteen patients with idiopathic TD, with or without SSCD, requiring surgical correction. INTERVENTIONS: Corrective surgery for TD. High-resolution temporal bone-targeted computed tomography. MAIN OUTCOME MEASURES: The impact of the minimal distance between TD and SSCD or the arcuate eminence on the choice of surgical approach to TD. RESULTS: The patients' median age was 58 years and 5 were males. The median body mass index was 31.8 kg/m. The average distance from the TD and the SSC was 4.9 mm (range 2.1-14.2 mm). Three of the 14 patients who were operated via a temporal craniotomy to fix a cerebrospinal fluid-leaking TD required plugging of an asymptomatic SSCD due to its close proximity (3-5 mm) to the defect, and two of them had relatively protracted vestibular recuperation. Two patients were operated via a transmastoid approach for sealing a cerebrospinal fluid-leaking TD coexisting with a bilateral asymptomatic SSCD. No patient had a hearing loss. CONCLUSION: The close proximity of a TD and an SSCD might not allow selective exposure. As a result, asymptomatic SSCD may become symptomatic during TD correction via the temporal craniotomy approach. The need to plug an asymptomatic SSCD that is proximal to a TD should be factored in planning for surgery and rehabilitation. The choice of surgical approach (middle fossa vs. transmastoid) could be influenced by this relationship, especially in cases of bilateral lesions.


Assuntos
Canais Semicirculares/patologia , Osso Temporal/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas/complicações , Feminino , Humanos , Doenças do Labirinto/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Osso Temporal/cirurgia
10.
Future Oncol ; 14(28): 2945-2955, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29693420

RESUMO

Interventional radiology has experienced an exponential growth in the last years. Nowadays it is possible to treat painful benign lesions or metastases with optimal results in terms of pain management and disease control. Among the benign lesions, osteoid osteoma is the most frequently treated with minimal invasive techniques and the results are excellent. Another lesion, traditionally treated with surgery (osteoblastoma) represent today another field of application. In the oncological field, metastases are, numerically, the most diffuse indications for treatment. Research carried out during the last decades has provided the interventional radiologist with a great variety of techniques of ablation and devices for monitoring the sensitive structures close to the target lesion. New ablation techniques and monitoring devices contribute to the achievement of significantly increasing rates of effectiveness and safety of interventional radiology procedures.


Assuntos
Doenças Ósseas/complicações , Dor/etiologia , Dor/radioterapia , Radiologia Intervencionista , Doenças Ósseas/diagnóstico , Doenças Ósseas/etiologia , Diagnóstico por Imagem/métodos , Gerenciamento Clínico , Humanos , Manejo da Dor/métodos , Radiologia Intervencionista/métodos
11.
J Ultrasound Med ; 37(10): 2297-2307, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29655254

RESUMO

Bone stress injuries are common in military personnel and athletes. The delayed diagnosis of a bone stress injury can lead to a more severe injury that requires a longer period of treatment. The early detection of bone stress injuries is a central part of management. Currently, the reference standard for detecting bone stress injuries is magnetic resonance imaging. However, the expanding use of point-of-care ultrasonography (US) may enable the early detection of bone stress injuries in the clinical setting. In this article, we review the US detection of bone stress injuries, as well as discuss the rationale for the use of US in the diagnosis of these injuries.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Transtornos Traumáticos Cumulativos/diagnóstico por imagem , Fraturas de Estresse/diagnóstico por imagem , Ultrassonografia/métodos , Doenças Ósseas/complicações , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/lesões , Transtornos Traumáticos Cumulativos/complicações , Fraturas de Estresse/complicações , Humanos
12.
Biochem Biophys Res Commun ; 498(3): 654-659, 2018 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-29545182

RESUMO

The study of parathyroid hyperplasia with bone disease as a critical manifestation of chronic kidney disease-mineral and bone disorders (CKD-MBDs) is challenging due to the lack of a suitable research model. Here, we established a rat model with secondary hyperparathyroidism (SHPT) and bone disease induced by adenine and a high phosphorous diet and analyzed the skeletal characteristics. We performed blood analysis, emission computed tomography (ECT), dual energy X-ray absorptiometry (DEXA), micro-computed tomography (micro-CT), bone histomorphometry, and bone mechanical tests. The CKD rats with SHPT induced by adenine and a high phosphorus diet showed severe abnormalities in calcium and phosphorus metabolism and exhibited parathyroid hyperplasia. The bone mineral density (BMD) of femurs and lumbar vertebrae was significantly lower in the CKD rats than in the control (CTL) rats. The cortical and trabecular bone parameters of femurs showed significant bone loss. In addition, we found decreases in ultimate force, work to failure, stiffness, and elastic modulus in the CKD rats. In conclusion, our findings demonstrated that the CKD rats with SHPT induced by adenine and a high phosphorus diet may serve as a useful model for skeletal analysis in CKD with SHPT.


Assuntos
Doenças Ósseas Metabólicas/patologia , Doenças Ósseas/patologia , Osso e Ossos/patologia , Dieta/efeitos adversos , Hiperparatireoidismo Secundário/patologia , Falência Renal Crônica/patologia , Adenina/efeitos adversos , Animais , Densidade Óssea , Doenças Ósseas/complicações , Doenças Ósseas/etiologia , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/etiologia , Modelos Animais de Doenças , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário/etiologia , Rim/patologia , Falência Renal Crônica/complicações , Falência Renal Crônica/etiologia , Masculino , Fósforo/efeitos adversos , Ratos , Ratos Sprague-Dawley , Microtomografia por Raio-X
13.
J Cell Mol Med ; 22(5): 2706-2716, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29473714

RESUMO

Recent research showed that invariant natural killer T (iNKT) cells take part in the regulation of osteoclastogenesis. While the role of iNKT cells in myeloma bone disease (MBD) remains unclear. In our study, the quantity of iNKT cells and the levels of cytokines produced by them were measured by flow cytometry. iNKT cells and osteoclasts were induced from peripheral blood mononuclear cells after activation by α-GalCer or RANKL in vitro. Then, gene expressions and the levels of cytokines were determined by RT-PCR and ELISA, respectively. The results showed that the quantity of iNKT and production of IFN-γ by iNKT cells were significantly decreased in newly diagnosed MM (NDMM), and both negatively related with severity of bone disease. Then, the osteoclasts from healthy controls were cultured in vitro and were found to be down-regulated after α-GalCer-stimulated, while there was no significant change with or without α-GalCer in NDMM patients, indicating that the regulation of osteoclastogenesis by iNKT cells was impaired. Furthermore, the inhibition of osteoclastogenesis by iNKT cells was regulated by IFN-γ production, which down-regulated osteoclast-associated genes. In conclusion, the role of α-GalCer-stimulated iNKT cells in regulation of osteoclastogenesis was impaired in MBD, as a result of iNKT cell dysfunction.


Assuntos
Doenças Ósseas/imunologia , Mieloma Múltiplo/imunologia , Células T Matadoras Naturais/imunologia , Osteoclastos/patologia , Osteogênese , Idoso , Doenças Ósseas/complicações , Estudos de Casos e Controles , Proliferação de Células , Feminino , Galactosilceramidas/metabolismo , Humanos , Interferon gama/biossíntese , Subpopulações de Linfócitos/imunologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico , Indução de Remissão
14.
Medicine (Baltimore) ; 97(8): e9883, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29465576

RESUMO

RATIONALE: The typical intraoperative presentation of vertebral artery injury (VAI) usually involves profuse bleeding and requires immediate treatment. However, an occult VAI may occur intraoperatively and result in delayed life-threatening epidural pseudoaneurysm several days postoperatively. PATIENT CONCERNS: A 21-year-old man with compressive cervical myelopathy resulting from canal stenosis of skeletal fluorosis underwent decompression of C1 to C7 and instrumentation from C2 to C7. No impressive bleeding event occurred during the operation. On postoperative day 40, progressive quadriplegia developed. DIAGNOSES: Pseudoaneurysm of the VA was established by angiography. INTERVENTIONS: After occlusion of the right VA, the patient underwent hematoma clearing. OUTCOMES: Fortunately, the patient experienced significant recovery of neurologic function after the second surgery. LESSONS: From this case, we realize even in the absence of obvious signs of VAI during a cervical operation, postoperative evaluation should be mandatory for suspected bleeding events occurring at VAI-prone sites during surgery. Moreover, the bone morphological abnormality of skeletal fluorosis was determined to be the most important risk contributing to VAI in this case. The safety limits of bone removal should be determined preoperatively to avoid the effects of bone morphological abnormalities.


Assuntos
Falso Aneurisma/etiologia , Doenças Ósseas/complicações , Vértebras Cervicais/cirurgia , Intoxicação por Flúor/complicações , Laminectomia/efeitos adversos , Compressão da Medula Espinal/cirurgia , Estenose Espinal/cirurgia , Artéria Vertebral/lesões , Constrição Patológica , Humanos , Complicações Intraoperatórias , Masculino , Complicações Pós-Operatórias , Compressão da Medula Espinal/etiologia , Estenose Espinal/etiologia , Adulto Jovem
15.
Calcif Tissue Int ; 103(2): 131-143, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29441423

RESUMO

The aim of this study is to describe the association of bone marrow lesions (BMLs) present on two different MRI sequences with clinical outcomes, cartilage defect progression, cartilage volume loss over 2.7 years, and total knee replacement (TKR) over 13.3 years. 394 participants (50-80 years) were assessed at baseline and 2.7 years. BML presence at baseline was scored on T1-weighted fat-suppressed 3D gradient-recalled acquisition (T1) and T2-weighted fat-suppressed 2D fast spin-echo (T2) sequences. Knee pain, function, and stiffness were assessed using WOMAC. Cartilage volume and defects were assessed using validated methods. Incident TKR was determined by data linkage. BMLs were mostly present on both MRI sequences (86%). BMLs present on T2, T1, and both sequences were associated with greater knee pain and functional limitation (odds ratio = 1.49 to 1.70; all p < 0.05). Longitudinally, BMLs present on T2, T1, and both sequences were associated with worsening knee pain (ß = 1.12 to 1.37, respectively; p < 0.05) and worsening stiffness (ß = 0.45 to 0.52, respectively; all p < 0.05) but not worsening functional limitation or total WOMAC. BMLs present on T2, T1, and both sequences predicted site-specific cartilage defect progression (relative risk = 1.22 to 4.63; all p < 0.05) except at the medial tibial and inferior patellar sites. Lateral tibial and superior patellar BMLs present on T2, T1, and both sequences predicted site-specific cartilage volume loss (ß = - 174.77 to - 140.67; p < 0.05). BMLs present on T2, T1, and both sequences were strongly associated with incident TKR. BMLs can be assessed on either T2- or T1-weighted sequences with no clinical predictive advantage of either sequence.


Assuntos
Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Doenças das Cartilagens/diagnóstico por imagem , Imagem por Ressonância Magnética , Idoso , Idoso de 80 Anos ou mais , Antropometria , Artroplastia do Joelho/estatística & dados numéricos , Doenças Ósseas/complicações , Doenças Ósseas/diagnóstico por imagem , Cartilagem/diagnóstico por imagem , Cartilagem/patologia , Doenças das Cartilagens/complicações , Progressão da Doença , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Razão de Chances , Osteoartrite do Joelho/diagnóstico por imagem , Dor , Patela/diagnóstico por imagem , Patela/fisiopatologia , Risco , Índice de Gravidade de Doença , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia
16.
Foot Ankle Surg ; 24(6): 542-548, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29409267

RESUMO

BACKGROUND: Tibiotalocalcaneal (TTC) fusion using a retrograde intramedullary (IM) nail is an effective salvage option for terminal-stage hindfoot problems. However, as many patients who receive TTC fusion bear unfavorable medical comorbidities, the risk of nonunion, infection and other complications increases. This study was performed to identify the factors influencing outcomes after TTC fusion using a retrograde IM nail. METHODS: Between September 2008 and February 2012, 34 consecutive patients received TTC fusion using a retrograde IM nail for limb salvage. All patients had a minimum follow-up of two years. Throughout follow-up, standard ankle radiography was performed along with clinical outcome assessment using a visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society Ankle-Hind Foot Scale (AOFAS A/H scale) and the Foot and Ankle Outcome Score (FAOS). For the retrospective analysis, demographic factors, preoperative medical status, laboratory markers, and etiology were comprehensively reviewed using medical records. The success of the index operation was determined using clinical and radiological outcomes. Finally, the effect of each factor on failure after the operation was analyzed using univariate logistic regression. RESULTS: In a mean of seven months, 82% (28/34) achieved union, as evaluated by standard radiography. All clinical outcome parameters improved significantly after the operation, including VAS, AOFAS A/H scale, and FAOS (P<0.001). At the last follow-up, five cases of nonunion with less than AOFAS A/H scale of 80 and two cases of below knee amputation due to uncontrolled infection were determined to be failures. None of the factors (etiology, demographics, laboratory markers and medical status) significantly influenced failures. However, uncontrolled DM significantly increased the failure rate with an odds ratio of 10 (P=0.029). CONCLUSIONS: TTC fusion with a retrograde intramedullary nail is a successful treatment for complicated hindfoot problems such as traumatic osteoarthritis, Charcot arthropathy and failed TAA. However, it should be used judiciously in patients with uncontrolled DM, as the risk of failure increases. DESIGN: Retrospective cohort study.


Assuntos
Articulação do Tornozelo/cirurgia , Artrite/cirurgia , Artrodese/efeitos adversos , Doenças Ósseas/cirurgia , Complicações do Diabetes/complicações , Idoso , Artrite/complicações , Artrodese/instrumentação , Doenças Ósseas/complicações , Pinos Ortopédicos , Calcâneo/cirurgia , Feminino , Doenças do Pé/complicações , Doenças do Pé/cirurgia , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Tálus/cirurgia , Tíbia/cirurgia , Falha de Tratamento
18.
Oral Dis ; 24(1-2): 253-260, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29480621

RESUMO

In healthy subjects, dental implants have evolved to be a common therapy to solve problems related to stability and retention of dentures as well as to replace failing teeth. Although dental implants are applied in medically compromised patients, it is often not well known whether this therapy is also feasible in these patients, whether the risk of implant failure and developing peri-implantitis is increased, and what specific preventive measures, if any, have to be taken when applying dental implants in these patients. Generally speaking, as was the conclusion by the leading review of Diz, Scully, and Sanz on placement of dental implants in medically compromised patients (J Dent, 41, 2013, 195), in a few disorders implant survival may be lower, and the risk of a compromised peri-implant health and its related complications be greater, but the degree of systemic disease control outweighs the nature of the disorder rather than the risk accompanying dental implant treatment. So, as dental implant treatment is accompanied by significant functional benefits and improved oral health-related quality of life, dental implant therapy is a feasible treatment in almost any medically compromised patient when the required preventive measures are taken and follow-up care is at a high level.


Assuntos
Implantes Dentários , Neoplasias de Cabeça e Pescoço/complicações , Nível de Saúde , Odontopatias/cirurgia , Doenças Ósseas/complicações , Contraindicações de Procedimentos , Complicações do Diabetes/complicações , Humanos , Hospedeiro Imunocomprometido , Odontopatias/complicações
19.
J Adolesc Young Adult Oncol ; 7(3): 400-403, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29446693

RESUMO

Multiple osteolytic lesions are usually associated with metastatic involvement of the bone; however, metabolic bone diseases should also be included in the differential diagnosis. In this study, we describe a case of primary hyperparathyroidism (PHPT) with multiple osteolytic lesions that was diagnosed initially as having metastatic bone involvement. The laboratory results showed hypercalcemia and raised alkaline phosphatase along with fibrosis in the bone marrow biopsy with no increase in tumor markers and normal serum protein electrophoresis. The parathyroid hormone levels were high, which pointed toward a diagnosis of PHPT. Sestamibi scan revealed uptake at the level of the left inferior pole of the thyroid gland, which was suggestive of parathyroid adenoma. The possibility of hyperparathyroidism should be kept in mind when a patient presents with multiple osteolytic lesions and hypercalcemia.


Assuntos
Doenças Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Hiperparatireoidismo Primário/diagnóstico , Adulto , Doenças Ósseas/complicações , Doenças Ósseas/cirurgia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/cirurgia , Masculino , Prognóstico , Adulto Jovem
20.
Rheumatology (Oxford) ; 57(5): 850-855, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29452423

RESUMO

Objectives: RA is an articular chronic inflammatory disease that in a subgroup of patients can also present with extra-articular manifestations (EAMs). Despite intense investigation on this topic, reliable biomarkers for EAMs are lacking. In recent years several ACPAs, including those targeting anti-citrullinated alpha enolase peptide-1 (anti-CEP-1), have been identified in patients with RA. Data about the ability of anti-CEP-1 to predict the development of erosive disease are confliciting and no evidence concerning their possible association with EAMs in RA is currently available. The aim of this study was to investigate the prevalence and significance of anti-CEP-1 with regard to the association with erosive disease and EAMs in a large cohort of patients with RA. Methods: Anti-CCP and anti-CEP-1 antibodies have been assessed on serum samples of RA patients, healthy donors and patients with SpA using commercially available ELISA kits. Results: Anti-CEP-1 antibodies are detectable in over 40% of RA patients and are associated with erosive RA and with RA-associated interstitial lung disease (ILD). Conclusion: Anti-CEP-1 antibodies may represent a useful biomarker for RA-associated ILD and erosive disease to be employed in clinical practice.


Assuntos
Artrite Reumatoide/imunologia , Autoanticorpos/sangue , Doenças Ósseas/imunologia , Doenças Pulmonares Intersticiais/imunologia , Fosfopiruvato Hidratase/imunologia , Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Biomarcadores/sangue , Doenças Ósseas/sangue , Doenças Ósseas/complicações , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/complicações , Masculino , Pessoa de Meia-Idade , Fosfopiruvato Hidratase/sangue
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