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2.
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
3.
J Hand Surg Asian Pac Vol ; 25(1): 123-128, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000607

RESUMO

Extensor tendon rupture of the finger is a very rare complication of Kienböck's disease. However, advanced Kienböck's disease can cause an attritional rupture of extensor tendons due to displaced lunate fragment. An extensor tendon of the thumb is frequently damaged in the distal radial fracture, and an extensor tendon of the fifth finger is mainly ruptured in arthritis of distal radio-ulnar joint. On the other hand, the extensor tendons of the 2nd, 3rd and 4th fingers are usually ruptured in advanced Kienböck's disease. We report two elderly patients diagnosed with advanced Kienböck's disease after non-traumatic rupture of extensor tendon of the fingers. Since the extensor tendon rupture in Kienböck's disease present as a loss of active extension of metacarpophalangeal joint in the central fingers, these patients should undergo imaging of the wrist joints to ascertain concomitant Kienböck's disease.


Assuntos
Articulação Metacarpofalângica , Osteonecrose/complicações , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Idoso , Feminino , Humanos , Ruptura Espontânea/etiologia , Traumatismos dos Tendões/diagnóstico
5.
Medicine (Baltimore) ; 98(33): e16900, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415435

RESUMO

RATIONALE: Spontaneous closed extensor tendon rupture is a rare complication of Kienböck disease with only 23 cases reported in the English literature. PATIENT CONCERNS: We present a case of painless attritional rupture of the extensor tendons of the right fourth finger in a 69-year-old woman with Kienböck disease and review reported cases of Kienböck disease with subcutaneous closed tendon rupture. DIAGNOSES: Physical examination had shown mild painless swelling of the dorsum of the right hand. Plain radiographs showed a dorsally displaced fragment of collapsed lunate bone fracture (Lichtman grade IIIb). Although surgery was recommended, the patient did not desire surgery because she had no pain and no interference with the activities of daily living. Six months later, however, the patient returned to our hospital with complaints of loss of spontaneous extension of the fourth finger. CT and MRI showed aseptic necrosis and large dorsally displaced fragments of the lunate under the extensor tendons of the fingers, suggesting a subcutaneous fourth extensor tendon rupture. INTERVENTIONS: Surgery was performed to achieve functional recovery of the ring extensor and to prevent further subcutaneous tendon rupture. The extensor digitorum communis (EDC) of the ring finger was found to be ruptured and the EDCs to the third and fifth fingers were frayed due to attrition from the protrusion of the dorsal fragmented lunate bone. Inspection of the floor of the compartment revealed that the dorsally displaced fragment of the lunate bone had perforated the wrist capsule and protruded into the fourth compartment. The dorsal and volar fragments of the lunate bone were excised completely and scaphocapitate arthrodesis followed by the reconstruction of the fourth extensor tendon was performed. OUTCOMES: A year after the surgery, radiography showed complete union of the scaphocapitate arthrodesis. The joint motion reached 45% of normal without any pain and there was full active extension of the fourth finger. LESSONS: Because dorsally displacement of collapsed lunate bone fragments is a risk factor for attritional closed rupture of tendons, radiography, and MRI are essential to diagnose and to treat any closed tendon rupture.


Assuntos
Fraturas Ósseas/etiologia , Osso Semilunar/lesões , Osteonecrose/complicações , Ruptura Espontânea/etiologia , Idoso , Doenças Assintomáticas , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osteonecrose/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Tendões/cirurgia , Tomografia Computadorizada por Raios X
6.
Cient. dent. (Ed. impr.) ; 16(2): 129-136, mayo-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183724

RESUMO

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


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


Assuntos
Humanos , Medicina Baseada em Evidências/métodos , Osteonecrose/induzido quimicamente , Osteonecrose/complicações , Anticorpos Monoclonais/efeitos adversos , Difosfonatos/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/epidemiologia , Antissépticos Bucais
7.
J Foot Ankle Surg ; 58(5): 989-994, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266694

RESUMO

Early avascular necrosis of metatarsal heads and cuboid injuries are uncommon conditions encountered by foot and ankle specialists. Treatment options are limited and typically include long periods of offloading or non-weightbearing. There is limited published information on alternative treatment approaches for such pathologies when conservative therapies fail. Presented are 2 patient cases treated with a percutaneous calcium phosphate injection after failure of standard therapy, persistent pain, and bone marrow edema in the foot.


Assuntos
Fosfatos de Cálcio/uso terapêutico , Fraturas de Estresse/terapia , Ossos do Metatarso , Osteonecrose/terapia , Ossos do Tarso/lesões , Adulto , Feminino , Fraturas de Estresse/complicações , Fraturas de Estresse/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/complicações , Osteonecrose/diagnóstico por imagem
8.
BMC Musculoskelet Disord ; 20(1): 305, 2019 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-31253156

RESUMO

BACKGROUND: Transpedicular intracorporeal cement augmentation (TCA) with short segmental posterior instrumentation (SSPI), which provides an ideal immediate analgesic effect and long-term reconstructive stability, is thought to be a sensible advancement to the operative strategy in treating osteonecrosis of the vertebral body (ONV). However, long-term follow-up studies about the treatment are scarce. METHODS: Forty-six ONV patients (22 males and 24 females, mean age of 62.8 ± 7.11 years) underwent TCA with SSPI were retrospectively analyzed. During follow-up, clinical outcomes, such as the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score, were evaluated, as well as radiologic outcomes, such as the average vertebral height and kyphotic angle. RESULTS: A total of 36 patients completed a follow-up period of at least 5 years (mean follow-up period of 67 ± 4.2 months). Among them, seven patients experienced complications, i.e., pneumonia (2/36, 5.56%), screw loosening (2/36, 5.56%), moderate hematoma in the subcutaneous tissue (1/36, 2.78%), and cement leakage (2/36, 5.56%). Compared to the preoperative score, the mean VAS score was significantly reduced 6 months postoperatively (P < 0.05), and it concluded being virtually identical to the preoperative score (P > 0.05). The mean ODI score exhibited a comparable trend. Regarding the radiologic evaluation, the mean kyphotic angle and average vertebral body height were significantly corrected postoperatively (both P < 0.05). However, these radiological parameters were maximally ameliorated during the direct postoperative period and slowly deteriorated over time. CONCLUSION: The present study shows that TCA with SSPI may be only mildly effective for symptom relief and correction of kyphotic deformity during a relatively long follow-up, thus we do not recommend it for ONV.


Assuntos
Dor nas Costas/cirurgia , Cimentos para Ossos/uso terapêutico , Cifose/cirurgia , Osteonecrose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Feminino , Seguimentos , Humanos , Fixadores Internos , Cifose/diagnóstico por imagem , Cifose/etiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteonecrose/complicações , Osteonecrose/diagnóstico por imagem , Medição da Dor , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/instrumentação
9.
Pain Manag ; 9(4): 355-359, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31215846

RESUMO

Aim: This pilot case series examined feasibility of anterior radiofrequency approach under combined ultrasound and fluoroscopy guidance to control pain from avascular necrosis of the hip. Patients & methods: Data on 11 consecutive patients were collected on longevity of cooled radiofrequency ablation (CRFA), pain relief and opioid use. Results: The average age was 56 (28-66), BMI 29.5 (16.5-34), in four women and three men. Their average opioid use was 92 mg MS04 equivalents (median 35 mg). The pain score decreased to 3.3 after the CRFA. Five patients claimed more than 50% of pain relief. The average time interval of greater than 50% of pain relief from the CRFA was 70-250 days. Conclusion: CRFA may be an effective treatment of chronic pain from avascular necrosis.


Assuntos
Osteonecrose/complicações , Osteonecrose/radioterapia , Manejo da Dor/métodos , Dor/complicações , Adulto , Idoso , Feminino , Fluoroscopia , Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Projetos Piloto , Resultado do Tratamento , Ultrassonografia
10.
BMC Surg ; 19(1): 49, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088435

RESUMO

BACKGROUND: Kummell's Disease has insidious progression. Neurological deficit is usually slow in onset and progression and only few cases of acute neurological deficit have been reported. We came across a case of Kummell's disease which progressed to burst fracture, developed neurological deficit within two weeks. We managed patient with "pivot ligamentotaxis" and Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation. CASE PRESENTATION: Eighty-three years old woman following fall was on conservative management at another hospital. She had no neurological deficit. A week later her back pain aggravated and two weeks later developed bilateral buttock pain, bilateral lower limb weakness and diminished sensation in the sacral area. Radiological investigations (X-rays, Magnetic resonance imaging and Computed tomography) showed L1 vertebral body fracture with vacuum cleft and fracture fragment retropulsed into the spinal canal. A diagnosis of Kummell's disease with burst fracture of L1 vertebra & neurological deficit was made. Patient was managed with Polymethylmethacrylate augmented, posterior compressed, short segment percutaneous pedicle screw fixation. The reduction of the retropulsed fragment was achieved by virtue of "Pivot ligamentotaxis". The patient got relieved of the symptoms (Preoperative VAS 8 and postoperative VAS 3) and was allowed brace assisted ambulation on first postoperative day. CONCLUSION: This study reports acute occurrence of the burst fracture in unstable vertebra inflicted by Kummell's disease and role of spinal stability in recovery. We achieved closed reduction of the fracture fragments and relief of the cord compression by posterior compression with "pivot ligamentotaxis".


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas por Compressão/cirurgia , Hipestesia/etiologia , Debilidade Muscular/etiologia , Osteonecrose/complicações , Fraturas da Coluna Vertebral/cirurgia , Idoso de 80 Anos ou mais , Cimentos para Ossos , Parafusos Ósseos , Feminino , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/etiologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Polimetil Metacrilato , Radiografia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Tomografia Computadorizada por Raios X
12.
Int J Mol Sci ; 20(5)2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30841560

RESUMO

Avascular meniscus tears show poor intrinsic regenerative potential. Thus, lesions within this area predispose the patient to developing knee osteoarthritis. Current research focuses on regenerative approaches using growth factors or mesenchymal stem cells (MSCs) to enhance healing capacity within the avascular meniscus zone. The use of MSCs especially as progenitor cells and a source of growth factors has shown promising results. However, present studies use bone-marrow-derived BMSCs in a two-step procedure, which is limiting the transfer in clinical praxis. So, the aim of this study was to evaluate a one-step procedure using bone marrow aspirate concentrate (BMAC), containing BMSCs, for inducing the regeneration of avascular meniscus lesions. Longitudinal meniscus tears of 4 mm in size of the lateral New Zealand White rabbit meniscus were treated with clotted autologous PRP (platelet-rich plasma) or BMAC and a meniscus suture or a meniscus suture alone. Menisci were harvested at 6 and 12 weeks after initial surgery. Macroscopical and histological evaluation was performed according to an established Meniscus Scoring System. BMAC significantly enhanced regeneration of the meniscus lesions in a time-dependent manner and in comparison to the PRP and control groups, where no healing could be observed. Treatment of avascular meniscus lesions with BMAC and meniscus suturing seems to be a promising approach to promote meniscus regeneration in the avascular zone using a one-step procedure.


Assuntos
Transplante de Medula Óssea/métodos , Lesões do Menisco Tibial/terapia , Animais , Células Cultivadas , Masculino , Osteonecrose/complicações , Coelhos , Regeneração , Lesões do Menisco Tibial/etiologia
13.
In Vivo ; 33(2): 559-562, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804141

RESUMO

The association of the high blood pressure D variant of the angiotensin-converting enzyme (ACE) gene with medication-related jaw osteonecrosis (MRONJ) is described in two Greek patients. The first patient, a 73-year-old man, took zolendronate, 4 mg/100 ml IV once per month for two years for prostate cancer and bone metastases. Three months after drug discontinuation, extraction of the first premolar was performed. After the intervention, he suffered from osteonecrosis of the mandible. He presented with hypertension and genetic testing revealed that he was homozygous for the high blood pressure D variant of the ACE gene. The second patient, a 65 years old woman, took denosumab, 120 mg subcutaneously once per month for 6 months for possible bone metastases from breast cancer. Three months after extraction of the first molar, she suffered from MRONJ. He also presented with hypertension and genetic testing revealed that she had the high blood pressure D variant of the ACE gene in a heterozygous state, which moderately predisposes to hypertension. To our knowledge, this is the first report indicating that genetic predisposition to hypertension may increase risk for MRONJ.


Assuntos
Hipertensão/genética , Doenças Maxilomandibulares/genética , Osteonecrose/genética , Peptidil Dipeptidase A/genética , Idoso , Denosumab/efeitos adversos , Testes Genéticos , Heterozigoto , Humanos , Hipertensão/etiologia , Hipertensão/patologia , Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/complicações , Doenças Maxilomandibulares/patologia , Masculino , Metástase Neoplásica , Osteonecrose/induzido quimicamente , Osteonecrose/complicações , Osteonecrose/patologia , Neoplasias da Próstata/complicações , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Ácido Zoledrônico/efeitos adversos
14.
Foot Ankle Clin ; 24(1): 89-105, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30685016

RESUMO

Müller-Weiss disease (MWD) is a dysplasia of the tarsal navicular. The shifting of the talar head laterally over the calcaneus drives the subtalar joint into varus. Failure to identify patients with paradoxic flatfoot varus may lead to the incorrect diagnosis and management. Conservative treatment with the use of rigid insoles with medial arch support and a lateral heel wedge is effective in most patients. Dwyer calcaneal osteotomy combined with lateral displacement seems to be a satisfactory treatment for patients who had failed to respond to conservative measures and a good alternative to the different types of perinavicular fusions.


Assuntos
Doenças do Pé/diagnóstico , Osteonecrose/diagnóstico , Ossos do Tarso/patologia , Pé Chato/etiologia , Pé Chato/terapia , Doenças do Pé/terapia , Humanos , Procedimentos Ortopédicos/métodos , Osteonecrose/complicações , Osteonecrose/terapia
15.
Artigo em Inglês | MEDLINE | ID: mdl-30449690

RESUMO

OBJECTIVE: Osteonecrosis of the jaw (ONJ) is commonly associated with antiresorptive therapy. There have been numerous reports of ONJ unrelated to antiresorptive therapy (ONJuat), confounding risk assessment. This study aimed to determine if ONJuat is associated with one or more particular comorbidities. STUDY DESIGN: This was a retrospective case-control study of patients with ONJuat and delayed healing (DH). Each case was matched for patient age and gender, as well as location of ONJuat or DH lesion to a control patient who had a history of dentoalveolar surgery with uneventful healing and no history of antiresorptive therapy. Comorbidity data included medical conditions and smoking. RESULTS: Of the 92 patients identified, 67 (73%) met the criteria for ONJuat and 25 (27%) for DH. The most common trigger for ONJ and DH was extraction (50%). The presence of any comorbidity (i.e., at least 1) was more prevalent in ONJuat than among controls (P = .04), and there were more comorbidities in patients with ONJuat and DH than in controls [M(SD) = 1.94 (1.2) and 2.0 (1.3) vs 1.26 (0.89); both P < .001]. CONCLUSIONS: ONJ and DH are not limited to patients with a history of antiresorptive therapy. More comorbidities may signal increased risk for ONJuat and DH.


Assuntos
Doenças Maxilomandibulares , Osteonecrose , Estudos de Casos e Controles , Comorbidade , Humanos , Doenças Maxilomandibulares/induzido quimicamente , Doenças Maxilomandibulares/complicações , Osteonecrose/induzido quimicamente , Osteonecrose/complicações , Estudos Retrospectivos , Fatores de Risco
17.
Knee ; 26(1): 267-272, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30559062

RESUMO

Meniscal bearing dislocation while rolling over in sleep has never been reported in Oxford unicompartmental knee arthroplasty (UKA). This study reports two cases of meniscal bearing dislocation into the intercondylar ridge while rolling over in sleep. In the case of one patient, closed reduction of the bearing was performed, and the use of a knee brace was effective in preventing re-dislocation. In the second patient, closed reduction was possible; however, bearing dislocation was repeated. Therefore, revision surgery was performed by replacing the tibial component and using a thicker bearing. The common features in dislocation during rolling over while sleeping in both cases were dislocation into the intercondylar ridge, the combination of small femur and AA-size tibia components, and osteonecrosis. As determined by intraoperative testing, valgus position of the knee while rolling over in sleep could induce bearing dislocation into the intercondylar ridge. LEVEL OF EVIDENCE: Retrospective case series, Level IV.


Assuntos
Artroplastia do Joelho/efeitos adversos , Luxações Articulares/etiologia , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Osteonecrose/complicações , Idoso , Feminino , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Articulação do Joelho/fisiopatologia , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Osteonecrose/cirurgia , Desenho de Prótese , Falha de Prótese , Radiografia , Reoperação , Estudos Retrospectivos
18.
Rheumatol Int ; 39(1): 153-159, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30560445

RESUMO

Avascular necrosis (AVN), also known as osteonecrosis, is characterized by death of the osteocytes due to inadequate blood supply caused by various mechanisms. The hip is the most common affected joint followed by knee. Incidence of AVN in rheumatic diseases is variable and high corticosteroid (CS) therapy is a known major risk factor for development of AVN. Data on the AVN in Behçet disease (BD) are limited. The purpose of this study is to examine the clinical and treatment characteristics of BD patients with diagnosis of AVN. Retrospective medical records of 337 BD patients were reviewed. Nine BD patients with AVN were detected. The clinical data of these patients with AVN have been reviewed. All patients had MRI of the symptomatic joints compatible with AVN. All of the nine patients who were diagnosed with AVN were male. Median duration of BD was 7 years. Median time between diagnosis of BD and detection of AVN was 3 years (1-16 years). Multiple joints were involved in seven patients. Six patients had bilateral knee AVN. Six patients had vascular BD. The median time interval between initial CS dose and AVN development was 24 months (range = 2-100). The median highest daily CS dose was 64 mg/day (range = 32-80) and median cumulative CS dose prior to AVN was 18 g. All of patients had intravenous pulse steroids. CS treatment, smoking and vascular involvement may predispose to AVN in patients with BD. According to this cohort, AVN in BD frequently tended to be in the knee joint and bilateral.


Assuntos
Corticosteroides/uso terapêutico , Síndrome de Behçet/complicações , Osteonecrose/complicações , Adolescente , Adulto , Síndrome de Behçet/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Oral Dis ; 25(2): 515-522, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30383915

RESUMO

OBJECTIVE: Oral ulceration with bone sequestration (OUBS) describes a site-specific intraoral ulcer that covers exposed, non-vital bone in patients lacking any etiological factor known to induce osteonecrosis. We aimed to conduct a retrospective study of eight new cases of OUBS and review the literature. SUBJECTS AND METHODS: This is a retrospective study of OUBS cases, diagnosed and managed during 2007-2017. Inclusion criteria were the presence of oral ulcer with exposed non-vital bone at sites of bone prominence and the absence of any factor known to cause osteonecrosis. The English literature was reviewed on original OUBS cases. RESULTS: Eight patients (5 males and 3 females, aged 27-75 years) were diagnosed with OUBS during years 2007-2017. Four cases involved the mandibular mylohyoid ridge, one a mandibular anterior exostosis and three the maxillary buccal/palatal exostoses. Exposed bone was removed under local anesthesia, resulting in complete healing in all cases. The literature review yielded 32 OUBS cases in the mandible. CONCLUSION: Oral ulceration with bone sequestration is a distinct, probably under-reported rather than rare clinical entity that should be regarded the provisional diagnosis in case of an oral ulcer covering exposed, non-vital bone at sites of bone prominence in patients lacking any etiological factor known to induce osteonecrosis.


Assuntos
Úlceras Orais/complicações , Osteonecrose/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Doenças Mandibulares/cirurgia , Doenças Maxilares/cirurgia , Pessoa de Meia-Idade , Úlceras Orais/etiologia , Úlceras Orais/cirurgia , Osteonecrose/etiologia , Osteonecrose/cirurgia , Estudos Retrospectivos
20.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 34(11): 1032-1035, 2018 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-30591113

RESUMO

Objective To detect serum levels of interleukin-10 (IL-10) and transforming growth factor-ß1 (TGF-ß1) in patients with systemic lupus erythematosus (SLE) with bone damage, and analyze their clinical significance. Methods The study included 56 patients with SLE. Serum IL-10 and TGF-ß1 levels were detected by ELISA. The clinical data of 56 patients were retrospectively analyzed, mainly recording the cases of osteoporosis and osteonecrosis. According to different bone mass, they were divided into normal bone mass group (14 cases), reduced bone mass group (26 cases) and osteoporosis group (16 cases). According to whether or not there was osteonecrosis, the patients were divided into: no osteonecrosis group (49 cases) and osteonecrosis group (7 cases). SPSS18.0 software was used for statistical analysis. Kolmogorov-smirnov t test whether the data is normally distributed. The measurement data of normal distribution are analyzed by the two-tailed t test. For the measurement data of non-normal distribution, mann-whitney U test was used to analyze. Results Compared to the SLE patients with normal bone mass, SLE patients complicated with osteoporosis lowly expressed TGF-ß1 and highly expressed IL-10. The serum level of IL-10 was higher in SLE patients with osteonecrosis than that in SLE patients without osteonecrosis. No difference was found in the TGF-ß1 between two groups. Conclusion TGF-ß1 level is reduced but IL-10 level is elevated in SLE patients with osteoporosis. Serum IL-10 levels in SLE patients with osteonecrosis are higher than that in those without osteonecrosis.


Assuntos
Interleucina-10/sangue , Lúpus Eritematoso Sistêmico/sangue , Osteonecrose/sangue , Osteoporose/sangue , Fator de Crescimento Transformador beta1/sangue , Estudos de Casos e Controles , Humanos , Lúpus Eritematoso Sistêmico/complicações , Osteonecrose/complicações , Osteoporose/complicações , Estudos Retrospectivos
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