Avascular necrosis of the jaw in multiple myeloma (MM) patients (pts) treated with bisphosphonates (BP)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18538-18538
Author(s):  
L. Curreli ◽  
A. D. Palmas ◽  
G. Latte ◽  
A. Murgia ◽  
A. Gabbas
Keyword(s):  
Oral Cavity ◽  
Progressive Disease ◽  
Alveolar Bone ◽  
High Dose ◽  
Allogenic Bone ◽  
History Of Disease ◽  
Aggressive Surgical Approach ◽  
History Of ◽  
The Right

18538 Background: Oral cavity avascular bone necrosis (ABN) has been recently reported as an emerging serious complication in pts receiving BP for the treatment of hypercalcemia related to MM or metastatic solid tumors. Methods: We report the cases of 6 pts with MM treated initially with pamidronate and later with zoledronic acid (ZA). Results: Pts characteristics : M/F 3/3; mean age 58.4 (46–78); 4 IgG κ,1 γ and 1 κ MM; 5 St IIIA and 1 IIIB; mean history of disease 61.3 mo. (23–103); 5 pts had a relapsing MM refractory to several lines of therapy but 1 pt had received only high dose dexametazone (D); 2 pts had received autologous stem cell transplantation and 1 pt allogenic bone marrow transplantation; mean n.° of BP doses was 41.3 (17–81). At the time of ABN onset all pts were receiving ZA along with, respectively: D (2 pts); cyclophosphamide plus D (1 pt), bortezomib plus D (2 pts) and oral melphalan (1 pt). ABN was localized in 2 pts at alveolar bone of the right maxilla and presented as an inflammation of the gum, followed by a painful bone exposure. In the other 4 pts ABN was localized at mandible and presented as dental abscesses followed in 2/4 pts by cutaneous fistulization. Treatment has included in all pts discontinuation of ZA, antibiotics, chlorhexidine mouthwashes, pain control, minor regional débridement, and bone trimming. In 1 pt a more aggressive surgical approach was attempted at an other Institution and postoperative course was complicated by massive haemorrhage and complete loss of chewing. Four pts dead with progressive disease with a mean overall survival after ABN presentation of 6 mo.; 2 pts are alive after 3 and 4 mo. after ABN presentation; however in all pts ABN significantly worsened quality of life. Conclusions: Oral cavity ABN is a severe complication in refractory MM pts receiving BP. Mechanisms of action of BP that determine a reduction in osteoclastic activity and an accumulation of nonvital osteocytes with microfractures of old mineral matrix appear to play an important role. However other causes may be involved as a long history of disease; an uncontrolled progressive disease; type and doses of previous and present therapies, primarily steroids; status of oral cavity and teeth of pts and possibly the n.° of doses of BP. No significant financial relationships to disclose.

scholarly journals Management of HAM/TSP

2020 ◽  
pp. 10.1212/CPJ.0000000000000832 ◽  
Author(s):  
Abelardo Araujo ◽  
Charles R.M. Bangham ◽  
Jorge Casseb ◽  
Eduardo Gotuzzo ◽  
Steve Jacobson ◽  
...  
Keyword(s):  
Progressive Disease ◽  
Spastic Paraparesis ◽  
Oral Prednisolone ◽  
Interferon Α ◽  
High Dose ◽  
First Line Therapy ◽  
Methyl Prednisolone ◽  
Disease Modifying Therapy ◽  
History Of

Purpose of reviewTo provide an evidence-based approach to the use of therapies that are prescribed to improve the natural history of HTLV-1–associated myelopathy/tropical spastic paraparesis (HAM/TSP)—a rare disease.Recent findingsAll 41 articles on the clinical outcome of disease-modifying therapy for HAM/TSP were included in a systematic review by members of the International Retrovirology Association; we report here the consensus assessment and recommendations. The quality of available evidence is low, based for the most part on observational studies, with only 1 double-masked placebo-controlled randomized trial.SummaryThere is evidence to support the use of both high-dose pulsed methyl prednisolone for induction and low-dose (5 mg) oral prednisolone as maintenance therapy for progressive disease. There is no evidence to support the use of antiretroviral therapy. There is insufficient evidence to support the use of interferon-α as a first-line therapy.

Pseudo-Parkinson Disease Secondary to Ritonavir–Buspirone Interaction

2003 ◽  
Vol 37 (2) ◽  
pp. 202-205 ◽  
Author(s):  
Patrick G Clay ◽  
Molly M Adams
Keyword(s):  
Drug Interaction ◽  
Inhibitory Effect ◽  
Hiv Positive ◽  
High Dose ◽  
Resting Tremor ◽  
Case Summary ◽  
History Of ◽  
Drug Drug Interaction ◽  
To Receive

OBJECTIVE: To report a case of Parkinson-like symptoms appearing in a patient after introduction of ritonavir to buspirone therapy. CASE SUMMARY: A 54-year-old HIV-positive white man presented to the clinic with a 2-week history of ataxia, shuffling gait, cogwheel rigidity, resting tremor, and sad affect with masked features. This patient had been receiving high-dose buspirone (40 mg every morning and 30 mg every evening) for 2 years prior to the introduction of ritonavir/indinavir combination therapy (400 mg/400 mg twice daily) 6 weeks prior to initiation of the above symptoms. Buspirone was decreased to 15 mg 3 times daily, ritonavir/indinavir was discontinued, and amprenavir 1200 mg twice daily was added. The patient's symptoms began to subside after 1 week, with complete resolution after about 2 weeks. The patient continued to receive buspirone for an additional 12 months without recurrence of symptoms. DISCUSSION: This is the first reported interaction of buspirone and antiretrovirals. Buspirone, extensively metabolized by CYP3A4, was likely at supratherapeutic levels due to the inhibitory effect of ritonavir and, secondarily, indinavir. The Parkinson-like symptoms developed rapidly and severely, impacted this patient's quality of life, and necessitated significant clinic expenditures to identify this drug–drug interaction. CONCLUSIONS: This case demonstrates a severe drug–drug interaction between buspirone and ritonavir and further demonstrates the need for awareness of the metabolic profile for all agents an HIV-infected patient is receiving.

scholarly journals Bebês em creches nas zonas rurais do Brasil

2020 ◽  
Vol 6 (10) ◽  
pp. 264
Author(s):  
Patricia Maria Uchôa SIMÕES ◽  
Mariana Uchôa Simões BARBOSA
Keyword(s):  
Early Childhood ◽  
Early Childhood Education ◽  
Rural Areas ◽  
Rural Populations ◽  
Childhood Education ◽  
Daycare Centers ◽  
History Of ◽  
The Right ◽  
Educational Indicators

RESUMONo Brasil, a história da educação institucionalizada dos bebês inicia-se com instituições voltadas para o atendimento das populações mais pobres das cidades e está relacionada à industrialização e urbanização. Essa origem explica, em parte, a escassa oferta de Educação Infantil para as populações rurais, até hoje. O estudo debate a trajetória das creches das zonas rurais, analisa alguns dos indicadores educacionais e dados da implantação do Proinfância nessas áreas. As conclusões apontam para os avanços na legislação e a melhoria dos indicadores educacionais nas primeiras décadas desse século, também apresenta o Proinfância como uma alternativa para as zonas rurais, com a oferta de apoio aos municípios na construção de políticas de inclusão dos bebês em creche com maior qualidade de atendimento. Faz-se necessário a afirmação desses bebês como sujeitos de direitos, da sua educação como condição de cidadania e da especificidade da creche nas zonas rurais como direito à diferença.Bebês. Creche. Educação Infantil do Campo. Babies in daycare centers in rural BrazilABSTRACT In Brazil, the history of institutionalized baby education begins with institutions aimed at serving the poorest populations in cities and is related to industrialization and urbanization. This origin explains, in part, the scarce offer of Early Childhood Education for rural populations, even today. The study debates the trajectory of daycare centers in rural areas, analyzes some of the educational indicators and data on the implementation of Proinfância in these areas. The conclusions point to advances in legislation and the improvement of educational indicators in the first decades of this century, it also presents Proinfância as an alternative for rural areas, with the offer of support to municipalities in the construction of policies for the inclusion of babies in daycare centers with higher quality of care. It is necessary to affirm these babies as subjects of rights, their education as a condition of citizenship and the specificity of daycare in rural areas as the right to difference.Babies. Nursery. Rural Early Childhood Education. Bebés en guarderías en zonas rurales de BrasilRESUMEN En Brasil, la historia de la educación institucionalizada de bebes comienza con instituciones destinadas a servir a las poblaciones más pobres de las ciudades y está relacionada con la industrialización y la urbanización. Este origen explica, en parte, la escasa oferta de educación de la primera infancia para las poblaciones rurales, incluso hoy en día. El estudio debate la trayectoria de las guarderías en áreas rurales, analiza algunos de los indicadores educacionales y los datos sobre la implementación de “Proinfância” en estas áreas. Las conclusiones apuntan a avances en la legislación y la mejora de los indicadores educacionales en las primeras décadas de este siglo, también presenta a “Proinfância” como una alternativa para las zonas rurales, ofreciendo apoyo a los municipios en la construcción de políticas para la inclusión de bebés en guarderías con mejor calidad de cuidado. Es necesario afirmar que estos bebés son sujetos de derechos, su educación debe ser entendida como condición de ciudadanía y la especificidad de la guardería en las zonas rurales como un derecho a la diferencia.Bebés. Guardería. Educación de la primera infancia rural. Bambini in asili nele aree rurali del BrasileSINTESEIn Brasile, la storia dell'educazione al bambino istituzionalizzata inizia con istituzioni progettate per servire le popolazioni più povere delle città ed è legata all'industrializzazione e all'urbanizzazione. Questa origine spiega, in parte, l'offerta limitata di educazione della prima infanzia per le popolazioni rurali, anche oggi. Lo studio discute la traiettoria degli asili nelle aree rurali, analizza alcuni degli indicatori e dati educativi sull'attuazione di "Proinfância" in queste aree. Le conclusioni indicano i progressi della legislazione e il miglioramento degli indicatori educativi nei primi decenni di questo secolo, inoltre presenta "Proinfância" come alternativa alle aree rurali, offrendo supporto ai comuni nella costruzione di politiche per l'inclusione dei bambini negli asili nido con una migliore qualità delle cure. È necessario affermare che questi bambini sono soggetti di diritti, la loro educazione deve essere intesa come una condizione di cittadinanza e la specificità dell'assistenza all'infanzia nelle aree rurali come un diritto alla differenza.

Advocacy and Coordination of Services

1985 ◽  
Vol 2 (1) ◽  
pp. 8-14
Author(s):  
Wanda Jean Rainbolt
Keyword(s):  
Physical Educators ◽  
History Of ◽  
Adapted Physical Educators ◽  
The 1960S ◽  
The Many ◽  
The Right ◽  
Time And Energy ◽  
Consumer Advocates ◽  
Architectural Barriers

Adapted physical educators are spending much of their time and energy advocating for the right of all children and youth to a high quality of physical education service delivery and the elimination of attitudinal, aspirational, and architectural barriers experienced by handicapped persons. Prior to the 1960s, lawyers or legal advocates were the ones who would plead the cause for others. Since then, however, three types of advocates have evolved: citizen, professional, and consumer advocates. Adapted physical educators are professional advocates, but they must have an understanding of the other types of advocates. The purpose of this article is to acquaint adapted physical educators with the job function of advocacy, the history of advocacy, and the many roles advocates play.

Death and survival in the city: approaches to the history of disease

Urban History ◽  
1980 ◽  
Vol 7 ◽  
pp. 53-62 ◽  
Author(s):  
Bill Luckin
Keyword(s):  
Rural Areas ◽  
Life Experiences ◽  
Standard Of Living ◽  
The Past ◽  
Physical Context ◽  
History Of Disease ◽  
History Of ◽  
The City ◽  
Elusive Concept

Now that the debate about the standard of living during the first half of the nineteenth century appears to have entered a relatively quiescent phase, historians have begun to turn their attention towards the more elusive concept of the quality of life. The incidence of fatal and non-fatal disease is clearly central to research of this type and so, too, is a delineation of the physical context in which infections have flourished and in which those who have been afflicted by them have lived. Although there has been a tendency to underestimate the ferocity of epidemics in rural areas in the period after about 1750, historians working on disease in the modern period are inevitably most usually concerned with processes which are specifically urban in character. And urban historians, especially those interested in such topics as the development of utilities, the growth of administrative bureau-cracies or the spatial segregation and different life experiences of the classes, can undoubtedly benefit from a knowledge of patterns of infection in the past.

scholarly journals The Progress of the General Prevention and Treatment of Pediatric Caries in China

2019 ◽  
Vol 2 (2) ◽  
pp. 34
Author(s):  
Jinping Liu
Keyword(s):  
Quality Of Life ◽  
Oral Cavity ◽  
Human Health ◽  
Growth And Development ◽  
Critical Period ◽  
Alveolar Bone ◽  
Life Safety ◽  
Prevention And Treatment ◽  
Healthy Growth

At present, caries has become one of the diseases that threaten peoples' health. Because caries usually does not affect patients' life safety, it is not paid enough attention to. In fact, the harm of caries to human health is significant. Caries can cause damage, defect or loss of teeth in the oral cavity. And it may seriously affect the quality of life and health of patients. Especially for children, they are in a critical period of growth and development. Caries may cause pain, lead to inflammation of alveolar bone and jawbone. The development of the dental system will be affected, and even lead to deformity. The prevalence of caries is high in children. Therefore, general prevention and treatment of caries is of great significance to the healthy growth of children

scholarly journals Fulminant necrotizing streptococcal myositis with dramatic outcome – a rare case report

2021 ◽  
Author(s):  
Tudor Morar ◽  
Radu Pirlog ◽  
Sonia Vlaicu ◽  
Vasile Bintintan ◽  
Doinita Crisan
Keyword(s):  
Soft Tissue ◽  
Rapid Development ◽  
Multiple Organ ◽  
Penicillin G ◽  
High Dose ◽  
Streptococcal Toxic Shock Syndrome ◽  
Necrotizing Myositis ◽  
Rare Case Report ◽  
History Of ◽  
The Right

Necrotizing myositis represents a rare, aggressive form of bacterial-induced soft tissue necrotizing infection. We present a fulminant case of a 44-year-old patient with a necrotizing soft tissue infection  and a history of rheumatoid arthritis transferred to our service, Cluj-Napoca Emergency County Hospital, from a local hospital where he had been admitted two days before with chills and light-headedness after an accidental minor blunt trauma in the right thigh region. After admission to our hospital and first assessment, broad spectrum antibiotherapy was started with Meropenem, Vancomycin and Metronidazole along with surgical debridement. The evolution was fulminant with rapid development of multiple organ dysfunction syndrome, therefore he was transferred to the intensive care unit, intubated, and started the volemic resuscitation and vasopressor therapy. The blood culture was positive for group A beta-hemolytic streptococcus (GAS) and high dose Penicillin G was added to the therapeutic scheme. Despite all efforts, the patient developed disseminated intravascular coagulation syndrome and died in the next hours. The clinical picture together with the findings from the autopsy were suggestive for a streptococcal toxic shock syndrome developed as a complication of GAS induced necrotizing myositis.

scholarly journals Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report

2021 ◽  
Vol 12 (1) ◽  
pp. e12-e12
Author(s):  
Marcelo Vieira da Costa Almeida ◽  
Antonio C. Moura ◽  
Lúcia Santos ◽  
Luciana Gominho ◽  
Ully Dias Nascimento Távora Cavalcanti ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Case Report ◽  
Osteonecrosis Of The Jaw ◽  
Complete Regression ◽  
Antimicrobial Photodynamic Therapy ◽  
Clinical Protocols ◽  
History Of ◽  
Lesion Regression ◽  
The Right

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) corresponds to an adverse effect of the use of drugs such as bisphosphonates and denosumab. This condition is often associated with pain, infection, purulent secretion, paraesthesia, tooth mobility and halitosis, decreasing the patient’s quality of life. The management of MRONJ tends to be conservative, through the guidance of oral hygiene, antibiotic therapy and mouthwashes. However, the use of antimicrobial photodynamic therapy (aPDT) has shown promise in the treatment of these injuries. The purpose of this article is to report a case of MRONJ treatment associated with aPDT. Case Report: A 75-year-old patient, with a history of breast cancer and use of intravenous Zoledronic Acid, presented with bilateral MRONJ lesions in tuberosity on the right and left sides. Treatment was conservatively instituted with the use of aPDT as an adjuvant. After 12 aPDT sessions, complete regression of the lesion was observed. However, after two weeks, the presence of a new lesion was noted, this time in the anterior region of the maxilla. The same protocol previously established was followed and after two aPDT sessions, the patient returned with complete lesion regression. Conclusion: The use of aPDT may represent an important adjuvant within a set of clinical protocols in the treatment of MRONJ.

scholarly journals Clinical and imaging features of suspected pituitary apoplexy in a domestic rat

2020 ◽  
Vol 8 (2) ◽  
pp. e001062
Author(s):  
Stephen James Everest ◽  
Tobias Schwarz ◽  
David Walker ◽  
Kevin Eatwell ◽  
Katia Marioni-Henry
Keyword(s):  
Pituitary Apoplexy ◽  
Acute Onset ◽  
Postmortem Examination ◽  
Female Rat ◽  
Imaging Features ◽  
Gradient Echo ◽  
History Of ◽  
The Right ◽  
The Brain

A two-year-ten-month-old entire female fancy rat was evaluated for acute-onset neurological signs following a two-month history of lethargy and behavioural changes. Physical examination revealed generalised muscle atrophy. Neurological examination localised the lesion likely to the right thalamus based on suspected left unilateral hemineglect. The patient was euthanased over quality-of-life concerns, and postmortem MRI of the brain was performed, followed by postmortem examination. This showed a lesion in the region of the pituitary which was T1 hyperintense to the brain, T2 isointense to the white matter and hypointense on gradient echo sequences, suggesting subacute haemorrhage. The authors described the clinical presentation and imaging features (MRI) of suspected pituitary apoplexia secondary to a pituitary macroadenoma in an aged female rat. Of particular interest are the findings of unilateral hemineglect and blooming artefact on MRI gradient echo sequences that lead to suspicion of pituitary apoplexia confirmed on postmortem examination.

Acute upper airway obstruction following Teflon injection of a vocal cord; the value of nebulized adrenaline and a helium/oxygen mixture in its management

1990 ◽  
Vol 104 (8) ◽  
pp. 654-655 ◽  
Author(s):  
Neil B. Solomons ◽  
Jonathan R. Livesey
Keyword(s):  
Airway Obstruction ◽  
Vocal Cord ◽  
Upper Airway ◽  
Vocal Cord Palsy ◽  
Upper Airway Obstruction ◽  
Oxygen Mixture ◽  
Post Operative Period ◽  
History Of ◽  
The Right

AbstractA 67-year-old man presented with a 45-year history of a weak voice. This was the result of polio which had left him with a right vocal cord palsy.The patient underwent a Teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice. In the immediate post-operative period, he suffered acute upper airway obstruction. The problem of acute upper airway obstruction following Teflon injection is considered and its management with nebulized adrenaline and a helium/oxygen mixture is discussed.

Sign in / Sign up

Export Citation Format

Share Document