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Osteonecrosis in patients with acquired immunodeficiency syndrome (AIDS): report of two cases and review of the literature
Lima, Giovanna A. Balarini;Verdeal, Juan Carlos Rosso;Farias, Maria Lucia F. de;
Arquivos Brasileiros de Endocrinologia & Metabologia , 2005, DOI: 10.1590/S0004-27302005000600022
Abstract: an increase in the incidence of abnormalities on bone and mineral metabolism (osteopenia/osteoporosis) and the development of osteonecrosis has been observed in patients with acquired immunodeficiency syndrome (aids). two cases of osteonecrosis in patients with aids are reported. both patients were receiving highly active antiretroviral therapy (haart) and presented with one or more known risk factors for osteonecrosis. we review the literature and discuss the pathogenesis, diagnosis, prevention and treatment of this entity in patients with aids.
Femoral and humeral head osteonecrosis in a patient with hypofibrinolisis and hyperhomocysteinemia. A case report and a review of the literature
P. Lazzarin,G. Cesaro,S. Puggina,B. Perin
Reumatismo , 2011, DOI: 10.4081/reumatismo.2004.202
Abstract: Osteonecrosis is a disease characterized by the death of marrow and bone tissues. All bones may be affected, most commonly those of the hip, knee, shoulder, ankle as well as the small bones of the hands and feet. When the disease involves a weight-bearing joint there is a significant risk that subarticular fracture may develop leading to disabling arthrosis and requiring, therefore, arthroplasty surgery. Osteonecrosis typically affects patients in their third, fourth and fifth decades of life and is associated with many factors including other diseases and co-morbidities. Multifocal osteonecrosis is defined according to the involvement of at least three separated anatomic sites. We describe the case of a young man with osteonecrosis of the shoulder and hip joints which required total arthroplasty. Among biochemical investigations, an increase in the plasminogen activator inhibitor type 1 (PAI-1) levels associated with mild hyperhomocysteinemia was present. Another finding was the HLA B27, without signs of spondyloarthropathies. In patients with osteonecrosis, especially if multifocal, a careful medical history, a complete physical examination and some biochemical investigations, particularly those related to thrombophilia and hypofibrinolysis, should be performed.
Clinical Management of Suppurative Osteomyelitis, Bisphosphonate-Related Osteonecrosis, and Osteoradionecrosis: Report of Three Cases and Review of the Literature  [PDF]
Eduardo Pereira Guimar?es,Fernanda Rafaelly de Oliveira Pedreira,Bruno Correia Jham,Marina Lara de Carli,Alessandro Ant?nio Costa Pereira,Jo?o Adolfo Costa Hanemann
Case Reports in Dentistry , 2013, DOI: 10.1155/2013/402096
Abstract: In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ). Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures. 1. Introduction The osteomyelitis is an inflammatory condition of the bone, which generally begins as an infection of the marrow cavity, rapidly involves the Haversian canals, and eventually extends to the periosteum [1]. In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement (due to loss of bone and teeth and resulting facial scars). Today, the disease is less common, and it is believed that the decline in prevalence may be attributed to the increased availability of antibiotics and improvement of overall health patterns [2]. Nonetheless, osteomyelitis remains a challenging disease for both clinicians and patients. Currently, more common osteomyelitis variants are seen. ORN is one of the most serious complications in the treatment of head and neck malignancies and is defined as the ischemic necrosis of the irradiated bone, which becomes hypovascular, hypocellular, and hypoxic [3, 4]. BRONJ is one of the more recently reported serious adverse effects of bisphosphonates treatment, which are used to manage oncologic patients and to prevent fractures in osteoporosis [5, 6]. Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different management approaches [7]. Thus, the aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features,
Anabolic steroids, acute myocardial infarction and polycythemia: A case report and review of the literature  [cached]
Kathleen Stergiopoulos,Joseph J Brennan,Robin Mathews,John F Setaro
Vascular Health and Risk Management , 2008,
Abstract: Kathleen Stergiopoulos1, Joseph J Brennan2, Robin Mathews1, John F Setaro2, Smadar Kort11Division of Cardiovascular Medicine, Department of Internal Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA; 2Division of Cardiovascular Medicine, Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT, USAAbstract: The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent “stacked” use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse.Keywords: acute myocardial infarction, anabolic steroid use, polycythemia
Isolated Knee Osteonecrosis Secondary to Corticosteroid Use in Two Patients with Idiopathic Thrombocytopenic Purpura  [cached]
?lker Ya?c?,Mehmet A??rman,Gülseren Akyüz
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2010,
Abstract: Idiopathic thrombocytopenic purpura (ITP) is characterized by low platelet count and mucocutaneous bleeding and steroids are commonly used for the treatment of this disorder. Osteonecrosis is one of the well-known side effects of steroids. However, no case of isolated knee osteonecrosis after steroid use has been reported in the literature to date. In this paper, we presented two cases of knee osteonecrosis who had received steroids for the treatment of ITP. Turk J Phys Med Rehab 2010;56:94-6.
Bisphosphonates and Oral Pathology II.: Osteonecrosis of the jaws: Review of the literature before 2005
Estefanía Fresco,Ruth; Ponte Fernández,Nerea; Aguirre Urizar,José Manuel;
Medicina Oral, Patología Oral y Cirugía Bucal (Internet) , 2006,
Abstract: bisphosphonates are bone-turnover modulating drugs which are used in the management of a number of bone diseases ranging from osteoporosis to neoplasic pathology-associated osteolysis. in the last years a number of cases of osteonecrosis of the jaws associated with these drugs have been reported. in this review we analyze the cases published in the literature indexed from 2003 to december 2005. during this period 246 cases were reported, being more frequently associated with women in the sixth decade of life. more frequently associated bisphosphonates were the nitrogenated bisphosphonates (pamidronate, zolendronic acid) and the most common oral antecedent was a dental extraction. nevertheless more than 25% of the cases were spontaneous. the most frequent site was the mandible and most of the cases presented clinical evidence of bone exposure and pain. different treatments have been proposed with different antibiotic therapies with or without surgery, showing in general terms an uncertain prognosis with low healing rates.
Pigmented Villonodular Synovitis Causing Osteonecrosis of the Femoral Head: A Case Report  [PDF]
Tomohiro Mimura,Taku Kawasaki,Keitaro Yagi,Kanji Mori,Shinji Imai,Yoshitaka Matsusue
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/756954
Abstract: We report a case of a 27-year-old man with pigmented villonodular synovitis of the hip joint with coincident osteonecrosis of the femoral head. According to our review of the English-language literature, no detailed report of osteonecrosis of the femoral head complicated with pigmented villonodular synovitis has been published. Preoperative X-ray images showed joint narrowing and severe multiple bone erosions at the acetabulum and femoral neck. Magnetic resonance imaging revealed a low-intensity band attributable to osteonecrosis of the femoral head and massive diffuse pigmented villonodular synovitis lesions. Comparison of a three-dimensional computed tomographic image of this patient with an angiographic image of a normal individual demonstrated proximity of the pigmented villonodular synovitis-induced bone erosions to the medial and lateral femoral circumflex arteries and retinacular arteries, suggesting likely the compromise of the latter by the former. We propose that the massive pigmented villonodular synovitis may have contributed to the pathogenesis of osteonecrosis of the femoral head in this patient. We performed open synovectomy and total hip arthroplasty. No operative complications occurred, and no recurrence of the pigmented villonodular synovitis was detected for 3 years after the operation. 1. Introduction Pigmented villonodular synovitis (PVNS) was named and described by Jaffe et al. in 1941 [1]. However, the first description of PVNS is commonly attributed to Chassaignac in 1852. Myers and Masi estimated that the overall prevalence of PVNS is 1.8 per million people [2]. They reported that the knee is the most commonly affected joint, accounting for up to 80% of cases, and that the hip is the second most commonly affected joint, accounting for 15%. In contrast, osteonecrosis of the femoral head (ONFH) is a relatively common disease, first described by Heimann and Freiberger in 1960 [3]. We herein report a case of ONFH complicated with PVNS, which, to our knowledge, is the first detailed report of this presentation in the English-language literature. We propose that the massive PVNS may have contributed to the occurrence of ONFH in this patient, creating multiple bone erosions around the femoral neck. 2. Case Presentation The patient was a 27-year-old man (weight: 66?kg; height; 166?cm) with no underlying disease. This patient became aware of coxalgia 1 year earlier. The coxalgia was associated with continuous pain that became more severe, and at the time of presentation he could not walk without an axillary crutch. X-ray images showed
Milan Knezevic,Mario Vicente-Barrero,Sergio Dominguez,Francisco Garcia Jimenez
Acta Facultatis Medicae Naissensis , 2008,
Abstract: The paper presents a case of osteonecrosis of the jaw bones with severe orofacial pain as the main symptom. The mechanism of osteonecrosis development, as well as its evolution before and after the pain is discussed, too. Suggestions for the treatment in the post-neuralgiform period are given in the text. A brief overview of the literature is presented in discussion in this article.
Osteonecrose espontanea do joelho em atleta tratamento com o uso de camara hiperbárica: relato de caso e revis o de literatura Spontaneous osteonecrosis in an athlete's knee treated using a hyperbaric chamber: case report and review of the literature  [cached]
Guilherme Campos Barroso,Thiago Fuchs,Edilson Thiele,M?nica Nunes Lima
Revista Brasileira de Ortopedia , 2012, DOI: 10.1590/s0102-36162012000300020
Abstract: A osteonecrose é uma síndrome clínica caracterizada pela necrose óssea de uma por o de sustenta o de carga do c ndilo femoral, seguida de fratura subcondral, colapso segmentar tardio e artrose. Acomete mais frequentemente mulheres com mais de 55 anos de idade e obesas. O tratamento ainda é assunto controverso na literatura. Os autores relatam o caso de um paciente do sexo masculino, 24 anos, jogador profissional de futebol, que apresentou queixa de dor no joelho um dia após atividade física. Os exames de imagem realizados precocemente já demonstraram o início da les o. Foram utilizados no tratamento, com sucesso: retirada de apoio, fisioterapia, medicamentos (como AINH e bifosfonados) e camara hiperbárica. Apesar de ser uma terapia nova, a camara hiperbárica associada à terapia medicamentosa e retirada do apoio pode trazer bons resultados no tratamento da osteonecrose idiopática mesmo em atletas de alta demanda física. No entanto, existe a necessidade de novos relatos e estudos com maior evidência para demonstrar sua validade. Osteonecrosis is a clinical syndrome characterized by osseous necrosis of a load-bearing portion of the femoral condyle, followed by subchondral fracturing, subsequent segmental collapse and arthrosis. It most frequently affects obese women over the age of 55 years. Its treatment is still a matter of controversy in the literature. The authors report the case of a 24-year-old male patient who was a professional soccer player, who presented with a complaint of knee pain one day after physical activity. Imaging examinations performed early on already demonstrated the start of the lesion. The treatment, which was successful, used the following: withdrawal of support, physiotherapy, medications (such as NSAIDs and bisphosphonates) and a hyperbaric chamber. Although hyperbaric chamber therapy is new, its use in association with drug therapy and withdrawal of support may bring good results in treating idiopathic osteonecrosis, even for athletes with high physical demands. However, there is a need for further reports and studies with greater evidence, in order to demonstrate the validity of this treatment.
Steroids in childhood epilepsy
Ramachandrannair Rajesh
Annals of Indian Academy of Neurology , 2006,
Abstract: Treatment of epileptic encephalopathies can be very challenging as most anticonvulsant drugs fail to achieve good seizure control. Steroids are disease modifying as well as anticonvulsant in these conditions. Though steroids are accepted as the first-line treatment for infantile spasms, there are many unanswered questions with regard to the preparation, dose and duration of treatment. In this review a re-exploration of the literature is attempted. Putative mechanism of action of steroids in infantile spasms is also discussed. As steroids are being increasingly used in other epileptic encephalopathies and Rasmussen′s encephalitis, a brief discussion on the role of steroids in these conditions is attempted. The review ends with the discussion on newer neuroactive steroids in the management of epilepsy.
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