scholarly journals Effects of Preoperative Drug Holiday On Sequester Separation and Treatment Outcome in Cancer Patients With Medication-Related Osteonecrosis of The Jaw

2021 ◽  
Author(s):  
Mitsunobu Otsuru ◽  
Sakiko Soutome ◽  
Kota Morishita ◽  
Saki Hayashida ◽  
Maho Murata ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Serum Albumin ◽  
Clinical Symptoms ◽  
Univariate Analysis ◽  
Osteonecrosis Of The Jaw ◽  
University Hospital ◽  
Drug Holiday ◽  
Solid Cancer ◽  
Primary Disease ◽  
Antiresorptive Agents

Abstract We aimed to investigate whether antiresorptive agent drug holidays contributed to the formation of sequester separation and treatment outcome in medication-related osteonecrosis of the jaw (MRONJ) patients whose primary disease was malignancy. A total of 105 MRONJ patients with malignant tumors as the primary disease who underwent surgery at Nagasaki University Hospital and Kansai Medical University Hospital from January 2009 to December 2020 were included. We recorded patient age, sex, primary disease (solid cancer, non-solid cancer), MRONJ stage, type and administration period of antiresorptive agents, presence of diabetes, corticosteroid use, drug holiday period, white blood cell count, serum, albumin, serum creatinine, outcomes, and computed tomography findings. We examined the relationship between a drug holiday and sequester separation and outcome. Drug holiday of more than 90 days (P=0.629) was not a significant factor for sequester separation in the univariate analysis. In the multivariate analysis, steroid use (P=0.009) and serum albumin (P=0.003) were extracted as factors affecting prognosis; withdrawal for more than 90 days (P=0.98) was not a significant factor. MRONJ patients with cancer as the primary disease should be operated early without drug holidays if their general condition is relatively good, clinical symptoms are strong, and quality of life is improved.

scholarly journals Impact of Antiresorptive Agents on Maxillary Bones: a Narrative Literature Review

2021 ◽  
Vol 23 (4) ◽  
pp. 268-276
Author(s):  
Maria Luiza da Silva Matos ◽  
Pedro Henrique Bastos de OIiveira ◽  
Ana Carla Barletta Sanches ◽  
Tila Fortuna Costa Freire ◽  
Juliana Borges de Lima Dantas ◽  
...  
Keyword(s):  
Literature Review ◽  
Adverse Effects ◽  
Osteonecrosis Of The Jaw ◽  
Drug Holiday ◽  
Osteonecrosis Of The Jaws ◽  
Antiresorptive Agents ◽  
Antiresorptive Drugs ◽  
Bibliographic Search ◽  
Narrative Literature ◽  
Narrative Literature Review

AbstractAntiresorptive drugs operate in the bone metabolism modulation and are widely used in the treatment of bone metastases and bone losses related to hormonal deficiency. Although this therapy shows satisfactory results, there are adverse effects associated with its use, such as osteonecrosis of the jaws. Medication-related osteonecrosis of the jaws (MRONJ) is, therefore, a serious and challenging condition with important implications in dentistry. The aim was to conduct a narrative literature review on anti-resorptive drugs and their latest repercussions on the maxillary bones. The review was carried out through a bibliographic search using Decs/Mesh descriptors of interest, in Portuguese and English, in the PubMed, Virtual Health Library (VHL) and Scielo databases. After applying the inclusion and exclusion criteria, a total of 33 studies were selected for analysis. It can be noticed that therapy with anti-resorptive agents is complex, especially in dental practice, since MRONJ is a complication that is difficult to manage. Regarding the therapeutic options, these are divided into conservative, surgical or adjuvant therapy, however, there are no protocols in the literature, and there is no consistency regarding the indication of the suspension of the drug administration - "Drug Holiday". Thus, it is important that the multidisciplinary team seeks strategies that minimize complications and promote control over the use of these drugs. In addition, there is a need for investigations that contribute with guidelines for the management and control of adverse effects resulting from therapy with antiresorptive drugs. Keywords: Bone Density Conservation Agents. Diphosphonates. Denosumab. Bisphosphonate-Associated Osteonecrosis of the Jaw. ResumoAs drogas antirreabsortivas atuam na modulação do metabolismo ósseo e são indicadas para o tratamento de metástases ósseas e perdas ósseas relacionadas à deficiência hormonal. Ainda que esta terapia apresente resultados satisfatórios, observam-se efeitos adversos associados ao seu uso, como a osteonecrose dos maxilares. A osteonecrose dos maxilares associada ao uso de medicamentos (OMAM) é, portanto, uma condição séria e desafiadora com implicações importantes na Odontologia. O objetivo foi realizar uma revisão narrativa de literatura sobre as drogas antirreabsortivas e suas respectivas repercussões nos ossos maxilares. A revisão foi realizada através de busca bibliográfica utilizando descritores Decs/Mesh de interesse, em português e inglês, nas bases de dados PubMed, Biblioteca Virtual de Saúde (BVS) e Scielo. Após aplicação dos critérios de inclusão e exclusão, um total de 33 trabalhos foram selecionados para análise. Pode-se constatar que a terapia com agentes antirreabsortivos é complexa, sobretudo na prática odontológica, visto que a OMAM é uma complicação de difícil manejo. Em relação às condutas terapêuticas para esta condição, divide-se em terapia conservadora, cirúrgica ou adjuvante, todavia, não existem protocolos validados na literatura, bem como não há consistência quanto à indicação do intervalo de suspensão da administração da droga - “Drug Holiday”. Desse modo, é importante que a equipe multidisciplinar busque estratégias que minimizem as complicações e promovam o controle no uso dessas drogas. Além disso, nota-se a necessidade de realizar investigações que contribuam com diretrizes para o manejo e controle dos efeitos adversos decorrentes da terapia com medicamentos antirreabsortivos. Palavras-chave: Conservadores da Densidade Óssea. Bisfosfonatos. Denosumabe. Osteonecrose Associada a Bisfosfonatos.  

scholarly journals A Clinical Study Of Segmental Mandibulectomy For Medication-Related Osteonecrosis Of The Jaw

2021 ◽  
Author(s):  
Mitsunobu Otsuru ◽  
Sakiko Soutome ◽  
Saki Hayashida ◽  
Satoshi Rokutanda ◽  
Souichi Yanamoto ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Clinical Symptoms ◽  
Osteonecrosis Of The Jaw ◽  
Metal Plate ◽  
University Hospital ◽  
Purulent Discharge ◽  
Free Fibula Flap ◽  
Osteolytic Lesions ◽  
Segmental Mandibulectomy

Abstract Purpose Few studies have focused on segmental mandibulectomy for the surgical treatment of patients with medication-related osteonecrosis of the jaw (MRONJ). The purpose of this retrospective study was to investigate the extent of mandibular resection required and the treatment outcomes. Methods One hundred thirty-seven patients with MRONJ who underwent surgical treatment at the Nagasaki University Hospital between 2011 and 2019 were included in the study. A total of 168 surgeries (155 marginal mandibulectomies; 13 segmental mandibulectomies) were performed. The relationship between various clinical and imaging factors and the treatment outcomes were investigated in the 13 cases of segmental mandibulectomy. Results Preoperative computed tomography revealed osteolytic lesions (13/13), periosteal reaction (PR; 12/13), and osteosclerosis (12/13) in patients who underwent segmental mandibulectomies. Postoperative CT revealed no residual osteolytic lesions and PR, although osteosclerosis persisted in nine patients. The cure rate of segmental mandibulectomy was 92.3% (12/13), whereas that of marginal mandibulectomy was 67.1% (104/155). One patient relapsed after segmental mandibulectomy was cured by additional resection. Two and four patients received reconstruction with free fibula flap and reconstruction metal plate, respectively; seven patients did not undergo reconstructive surgery in consideration of their poor general condition or will. Finally, in all the 13 patients, clinical symptoms such as pain and purulent discharge disappeared and oral intake was possible. Conclusion Considering the end-of-life care, segmental mandibulectomy is a treatment option for refractory MRONJ, because it can eliminate clinical symptoms early. When segmental mandibulectomy is performed, the area involving osteolytic lesions and PR must be included.

CLINICAL SYMPTOMS, ULTRASOUND AND HISTOPATHOLOGY OF TUMORLIKE LESIONS OF THE BLADDER.

2017 ◽  
pp. 41-46
Author(s):  
Van Mao Nguyen ◽  
Thi Bich Chi Nguyen
Keyword(s):  
Bladder Cancer ◽  
Bladder Tumor ◽  
Clinical Symptoms ◽  
Bladder Wall ◽  
Lower Abdominal Pain ◽  
University Hospital ◽  
Wall Thickening ◽  
Health Examination ◽  
Ultrasound Images ◽  
Key Words Bladder Cancer

Background: Bladder cancer is one of the most frequent type of urinary cancer which has been ever increasing. For the better treatment, the early discovery and definite diagnosis of this disease played an important role. Objective: To describe some clinical symptoms and ultrasound features of tumorlike lesions of the bladder. To diagnose and classify the histopathology of tumorlike lesions of the bladder. Materials, method: cross - sectional study on 64 cases in Hue University Hospital and Hue central hospital from April, 2016 to February, 2017. Results: Hematuria was the most common reason that patients went to hospital (79.7%). Lower abdominal pain and irritation during urination accounting for 9.4% and 6.2% respectively. Only 3 patients with bladder cancer were accidentally discovered through periodic health examination (4.7%). The characteristics of hematuria in bladder tumor was flesh red urine (62.5%) and total hematuria (60.7%). With ultrasonography, the results of 64 patients were divided in 3 groups as follow: bladder tumor, which was the highest rate 87.5%, bladder polyp was 3.1% and focal bladder wall thickening was 9.4%. Of which, the vast majority of these ultrasound images was tumor - like lesions protruding in the lumen of the bladder (75%), the rest was wall thickening lesions (25%). Tumors were different in size, the biggest tumor was 7cm in diameter and the smallest was 0.6cm. Those with the diameter 3cm or bigger accounting for 42.2%, the smaller was 57.8%. Most cases have only one lesion (62.5%) and at lateral wall (46.6%). Histopathologically, cancer was 59/64 case (92.2%): urothelial carcinoma was 98.3 %, squamous cell carcinomawas 1.7% and 5 cases (7.8%) were benign. Most cancerous cases were poorly differentiated, grade II (50.9%) and grade III (32.2%). The stage T1NxMx was 20.3% and worse than T2MxNx was 79.7%. Conclusion: hematuria was the most popular symptom, suggesting bladder cancer. Clinical diagnosing bladder cancer was not high sensitive (61.01%). Ultrasound could detect bladder tumor with high sensitive (89.8%). These patients also needed histopathology classification to diagnose and finally choose the best method for the appropriate treatment. Key words: bladder cancer, histopathology, ultrasound, uroepithelial carcinoma, hematuria

scholarly journals Variable clinical characteristics and laboratory results in five patients with Chinese Good's syndrome (thymoma and hypogammaglobulinemia): an 8-year retrospective analysis in a university hospital in China

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jinyao Ni ◽  
Junwu Zhang ◽  
Yanxia Chen ◽  
Weizhong Wang ◽  
Jinlin Liu
Keyword(s):  
Information System ◽  
Lichen Planus ◽  
Hospital Information System ◽  
Clinical Characteristics ◽  
Opportunistic Infections ◽  
Clinical Symptoms ◽  
University Hospital ◽  
Ivig Treatment ◽  
Good’S Syndrome ◽  
Laboratory Results

Abstract Background Good's syndrome (GS) is a rare secondary immunodeficiency disease presenting as thymoma and hypogammaglobulinemia. Due to its rarity, the diagnosis of GS is often missed. Methods We used the hospital information system to retrospectively screen thymoma and hypogammaglobulinemia patients at the First Affiliated Hospital of Wenzhou Medical University from Apr 2012 to Apr 2020. The clinical, laboratory, treatment, and outcome data for these patients were collected and analyzed. Results Among the 181 screened thymoma patients, 5 thymoma patients with hypogammaglobulinemia were identified; 3 patients had confirmed diagnoses of GS, and the other 2 did not have a diagnosis of GS recorded in the hospital information system. A retrospective review of the clinical characteristics, laboratory results, and follow-up data for these 2 undiagnosed patients confirmed the diagnosis of GS. All 5 GS patients presented with pneumonia, 2 patients presented with recurrent skin abscesses, 2 patients presented with recurrent cough and expectoration, 1 patient presented with recurrent oral lichen planus and diarrhea, and 1 patient presented with tuberculosis and granulomatous epididymitis. In the years after the diagnosis of hypogammaglobulinemia with mild symptoms, all 5 patients had received irregular intravenous immunoglobulin (IVIG) treatment. As the course of the disease progressed, the clinical symptoms of all patients worsened, but the symptoms were partly resolved with IVIG in these patients. However, 4 patients died due to comorbidities. Conclusion GS should be investigated as a possible diagnosis in thymoma patients who present with hypogammaglobulinemia, especially those with recurrent opportunistic infections, recurrent skin abscesses, chronic diarrhea, or recurrent lichen planus.

scholarly journals Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients: A Narrative Review of the Evidence and Considerations for Decision-Making

2021 ◽  
Vol 10 (5) ◽  
pp. 1140
Author(s):  
Kaleen N. Hayes ◽  
Elizabeth M. Winter ◽  
Suzanne M. Cadarette ◽  
Andrea M. Burden
Keyword(s):  
Surrogate Marker ◽  
Femoral Fractures ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
Narrative Review ◽  
Drug Holiday ◽  
Future Research ◽  
Mineral Density ◽  
First Line Therapy

Bisphosphonates are first-line therapy for osteoporosis, with alendronate, risedronate, and zoledronate as the main treatments used globally. After one year of therapy, bisphosphonates are retained in bone for extended periods with extended anti-fracture effects after discontinuation. Due to this continued fracture protection and the potential for rare adverse events associated with long-term use (atypical femoral fractures and osteonecrosis of the jaw), a drug holiday of two to three years is recommended for most patients after long-term bisphosphonate therapy. The recommendation for a drug holiday up to three years is derived primarily from extensions of pivotal trials with alendronate and zoledronate and select surrogate marker studies. However, certain factors may modify the duration of bisphosphonate effects on a drug holiday and warrant consideration when determining an appropriate time off-therapy. In this narrative review, we recall what is currently known about drug holidays and discuss what we believe to be the primary considerations and areas for future research regarding drug holiday duration: total bisphosphonate exposure, type of bisphosphonate used, bone mineral density and falls risk, and patient sex and body weight.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

The Effect of the Change in Lymph Flow Following Gastrectomy for Initial Disease on the Prognosis of Remnant Gastric Cancer

2021 ◽  
Author(s):  
Yoshihiko Kakiuchi ◽  
Satoru Kikuchi ◽  
Shinji Kuroda ◽  
Masahiko Nishizaki ◽  
Shunsuke Kagawa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Poor Prognosis ◽  
Malignant Disease ◽  
Univariate Analysis ◽  
Lymph Flow ◽  
University Hospital ◽  
Gastric Disease ◽  
Remnant Gastric Cancer ◽  
Initial Surgery

Abstract Background: Remnant gastric cancer (RGC) has been increasing for various reasons such as longer life span, medical progress, and others. It generally has a poor prognosis, and its mechanism of occurrence is unknown. The purpose of this study was to evaluate the clinicopathological features of and clarify the prognostic factors of RGC.Methods: Between January 2002 and January 2017, 39 patients with RGC following distal gastrectomy underwent curative surgical resection at the Okayama University Hospital; their medical records and immunohistochemically stained extracted specimens were used for retrospective analysis. Results: On univariate analysis, initial gastric disease, pathological lymph node metastasis, and pathological stage were the significant factors associated with a poor overall survival (OS) (p=0.0139, 0.0061, and 0.0158, respectively). Multivariate analysis of these 3 factors showed that only initial gastric disease caused by malignant disease was an independent factor associated with a poor prognosis (p=0.0141, odds ratio [OR]:4.151, 95% confidence interval [CI]:1.333-12.93). In addition, the presence of a left gastric artery (LGA), and tumor-infiltrating CD8+ T cell expression were higher in the benign disease group than in the malignant group (p<0.0001 and p=0.0485, respectively).Conclusion: The lymph flow change caused by lymph node dissection for malignant disease in initial surgery might have an effect on the suppression of tumor immunity and the poor prognosis of RGC.

Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy

2021 ◽  
Author(s):  
Johannes Laimer ◽  
Martin Hechenberger ◽  
Daniela Müller ◽  
Benjamin Walch ◽  
Andreas Kolk ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Oral Surgery ◽  
Osteonecrosis Of The Jaw ◽  
University Hospital ◽  
Antiresorptive Therapy ◽  
Jaw Cysts ◽  
Dental Focus ◽  
Antiresorptive Drugs ◽  
The University ◽  
Tooth Extractions

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a ‘real-world’ setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

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