The assessment of surgical and non-surgical treatment of stage II medication-related osteonecrosis of the jaw.

BACKGROUND: Non-surgical treatment has generally been recommended for stage II medication-related osteonecrosis of the jaw (MRONJ) in preference to surgery. However, non-surgical treatment is not empirically effective. The aim of this study was to evaluate whether surgical or non-surgical treatment leads to better outcomes for stage II MRONJ. MATERIAL AND METHODS: In this retrospective study, surgery was performed in a total of 28 patients while 24 patients underwent non-surgical treatment. The outcomes of both treatment approaches after 6 months were evaluated and statistically compared. In addition, risk factors for surgical and non-surgical treatments were assessed for each. RESULTS: Surgical treatment in 25 patients (89.3%) resulted in success, with failure in 3 patients (10.7%). Non-surgical treatment was successful for 8 patients (33.3%) and failed in 16 patients (66.7%). There was therefore a significant difference between surgical and non-surgical treatment outcomes (P<0.01). Regarding risk factors, in non-surgical treatment primary diseases, medications, and drug holiday had a significant effect on outcomes (P<0.01). Risk factors for surgical treatment could not be clarified. CONCLUSIONS: Surgical treatment is more effective than non-surgical treatment for stage II MRONJ, and drug holiday, primary disease, and medication constitute risk factors in non-surgical treatment.

Treatment of postoperative pain with thoracic epidural morphine in oral malignant tumor patients.

CASE REPORT: Thoracic epidural morphine was administered to five patients who underwent radical resection and reconstructive surgery for oral malignant tumors. METHODS AND RESULTS: In case 1, an epidural catheter was inserted at the T3-T4 interspace, and 4 mg morphine was administered through the catheter approximately 5 h before the end of surgery. Forty-five minutes after the end of surgery, a total of 10 mg morphine was continuously infused over a 2-day period using a balloon infusion system. The patient did not complain of pain, and no other analgesics were necessary. There were no serious side effects throughout the treatment of postoperative pain. Good control of pain was obtained by this method in four similar cases. CONCLUSION: Thoracic epidural morphine was effective in the relief of postoperative pain following oral surgery in five cases.

Papillary adenoma of the lung. Histological and ultrastructural findings in two cases.

Two cases of papillary adenoma of the lung are presented along with results of histological and ultrastructural examinations. The tumors were encountered in two asymptomatic patients in a mass-survey chest X-ray examination. The chest X-ray films showed the tumors as well demarcated small lesions. Histologically, both tumors arose in the bronchioles and consisted of cuboidal cells resembling type II pneumocytes showing papillary growth with accompanying edematous connective tissue. Several tumor cells each possessed a large eosinophilic intranuclear inclusion. In case 1, ciliated cells and Clara-like cells were also present in the tumor. Ultrastructurally, most of the tumor cells had various numbers of lamellar bodies in their cytoplasm, indicative of type II pneumocytes, and some of case 1 showed features of Clara cells and ciliated cells. The intranuclear inclusions appeared as aggregates of tubular structures or had lamellar body-like features. These findings are identical to those of papillary adenoma arising from the bronchiole.