-
Revista Da Associacao Medica Brasileira... Jul 2019To evaluate the epidemiological data and available treatments for fractures secondary to radiotherapy treatment.
OBJECTIVE
To evaluate the epidemiological data and available treatments for fractures secondary to radiotherapy treatment.
METHODS
Identification of publications on pathological skeletal fractures previously exposed to ionizing radiation.
RESULTS
The incidence of fractures after irradiation varies from 1.2% to 25% with a consolidation rate of 33% to 75%, being more frequent in the ribs, pelvis, and femur. The time elapsed between irradiation and fracture occurs years after radiotherapy. Risk factors include age above 50 years, female gender, extensive periosteal detachment, circumferential irradiation, tumor size, and anterior thigh location. The etiology is still uncertain, but cellular disappearance, reduction of bone turnover and activity were observed hematopoietic as possible causes of failure of consolidation.
CONCLUSION
There is no consensus in the literature on the factors related to the development of fractures, with radiation dose, previous tumor size and periosteal detachment being suggested as potential factors.
Topics: Fractures, Bone; Humans; Radiation Injuries; Radiotherapy; Risk Factors
PubMed: 31340323
DOI: 10.1590/1806-9282.65.6.902 -
Experimental and Therapeutic Medicine Apr 2022Paget's disease of bone (PDB) is characterized by abnormal osteoclastic bone resorption with disorganized bone neo-formation, primarily affecting elderly (>55 years)...
Paget's disease of bone (PDB) is characterized by abnormal osteoclastic bone resorption with disorganized bone neo-formation, primarily affecting elderly (>55 years) patients. Although the majority of patients are asymptomatic, some patients may experience bone pain due to local periosteal involvement or osteoarthritic lesions in the spine; in addition, limb deformities may lead to secondary gait problems or degenerative joint changes. Anemia has an overall prevalence of 12-17% in elderly adults (>65 years old), with macrocytic anemia being the less common type. Megaloblastic anemia is a macrocytic anemia characterized by the presence of large, immature, nucleated cells (megaloblasts) in the blood, with the most common cause being a deficiency of folate and/or vitamin B12. We herein report the rare case of a 72-year-old male patient exhibiting both these conditions, with the aim of discussing the possible association between the two and, most importantly, the clinical management of the patient in a real-life setting over a period of 10 years. The patient was diagnosed based on clinical symptoms (bone pain), radiological imaging and specific laboratory tests, and received discontinuous courses of bisphosphonates and cyanocobalamin supplementation therapy, based mainly on aggravated symptomatology. A systematic literature review was also performed and revealed not only the scarcity of reports on similar cases, but also the mechanisms that may underlie the possible association of PDB with macrocytic anemia due to vitamin B12 deficiency in elderly patients.
PubMed: 35251335
DOI: 10.3892/etm.2022.11195 -
Acta Bio-medica : Atenei Parmensis Jan 2022Philadelphia negative myeloproliferative neoplasms (MPNs) are classically characterized by excess production of terminal myeloid cells in the peripheral blood. They...
Philadelphia negative myeloproliferative neoplasms (MPNs) are classically characterized by excess production of terminal myeloid cells in the peripheral blood. They include polycythemia vera, essential thrombocythemia, and primary myelofibrosis. Among this group, primary myelofibrosis is the least common and usually carries the worst prognosis. Bone involvement in primary myelofibrosis has many forms; it affects bone marrow leading to bone marrow fibrosis, it can cause periostitis, in addition to bone and joint pain. A common radiologic finding in primary myelofibrosis is the presence of osteosclerotic lesions. However, the presence of osteolytic lesions in bone imaging was described in few reports. In this review, we searched English literature using the PRISMA guidelines looking for patients with Primary myelofibrosis who had osteolytic bone lesions to assess the impact of such findings on the disease and its effect on prognosis. We found the vast majority of lesions were painful affecting most commonly the vertebral column, pelvis, and ribs, and were detected in patients above 50 years of age with no gender preference, unfortunately they represented advanced disease stages, resulting in inadequate treatment response and poor outcome.
Topics: Bone Marrow; Humans; Myeloproliferative Disorders; Polycythemia Vera; Primary Myelofibrosis; Thrombocythemia, Essential
PubMed: 35075062
DOI: 10.23750/abm.v92i6.12350 -
International Journal of Medical... 2024Periodontal regeneration refers to procedures aimed at restitution of lost supporting tissue around the periodontally compromised tooth. Regenerative procedures very... (Meta-Analysis)
Meta-Analysis Review
Appraising and comparing the role of autogenous periosteal graft as a barrier membrane in the treatment of intrabony defects in chronic periodontitis cases: A systematic review and meta-analysis.
Periodontal regeneration refers to procedures aimed at restitution of lost supporting tissue around the periodontally compromised tooth. Regenerative procedures very often include the use of barrier materials to encourage the growth of key surrounding tissues. The current study aimed to evaluate the effectiveness of autogenous periosteal graft as a barrier membrane for the treatment of intrabony defects in chronic periodontitis patients. A total of four data bases MEDLINE (by PubMed), Cochrane database, EBSCO, and Google Scholar were explored to identify the studies in English up to December 2022. An additional hand search of relevant journals was also done. A team of three independent reviewers screened the retrieved articles using the inclusion criteria. Randomized control trials (RCTs) evaluating the effectiveness of autogenous periosteal grafts in the treatment of intrabony defects in chronic periodontitis cases were included in the study. A total of six relevant articles were recognized for data procurement. A total of 117 patients with 68 sites with an age range between 18 years and 55 years were selected. Outcome variables examined were pocket depth (PD), clinical attachment level (CAL), radiographic bone defect fill (BDF), gingival recession (GR), plaque index (PI), gingival index (GI) and bleeding on probing (BOP). Data were analyzed using Revman 5.3 software. The mean differences and 95% confidence interval were used to illustrate the estimate of effect size. There is an equal effect in both groups for the PI, GI, and BOP reduction. For PD reduction, the result was in the favor of periosteal graft with open flap debridement (OFD) group. For CAL gain, radiographic BDF and GR, results also favored the periosteal graft, but no statistically significant difference was found amongst the groups. Within the limitation of the study, it seems that the autogenous periosteal graft can be used successfully along with OFD to treat intrabony defects in chronic periodontitis patients.
Topics: Adolescent; Humans; Alveolar Bone Loss; Chronic Periodontitis; Gingival Recession; Treatment Outcome; Young Adult; Adult; Middle Aged
PubMed: 38169567
DOI: 10.7150/ijms.86720 -
Frontiers in Bioengineering and... 2023The unavailability of adequate human primary cells presents multiple challenges in terms of bone and cartilage regeneration and disease modeling experiments ....
The unavailability of adequate human primary cells presents multiple challenges in terms of bone and cartilage regeneration and disease modeling experiments . Periosteal cells (PCs), which represent promising skeletal stem cell sources, could be a promising strategy in tissue engineering. The present study aimed to summarize the characteristics of PCs to investigate the efficacy of these cells in bone and cartilage regeneration in different models, paying special attention to the comparison of bone marrow stromal cells (BMSCs). A comprehensive literature search was conducted in Embase, PubMed/MEDLINE, Web of Science, and Scopus for articles published in English until April 2023. Only original researches in which PCs were employed for bone or cartilage regeneration experiments were included. A total of 9140 references were retrieved. After screening the results, 36 publications were considered to be eligible for inclusion in the present literature review. Overall, PCs demonstrated beneficial bone and cartilage regenerative efficacy compared to the bare scaffold since almost all included studies reported positive results. The 9 studies assessing the differences in bone formation capacity between PCs and BMSCs indicated that PCs exhibited stronger osteogenic differentiation capabilities compared to BMSCs, while the other study demonstrated stronger chondrogenic potential of BMSCs. PCs demonstrated beneficial to bone regenerative efficacy compared to the bare scaffold with a low risk of most studies included. However, the cartilage formation capacity of BMSCs still needs to be investigated due to the limited research available and the certain risk of bias. PCs exhibited higher osteogenic capabilities compared to BMSCs in combination with various scaffolds with good evidence. Further researches are needed to elucidate the comparative benefits of cartilage regeneration. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023411522, CRD42023411522.
PubMed: 38026851
DOI: 10.3389/fbioe.2023.1292483 -
Otology & Neurotology : Official... Dec 2021To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To identify perioperative surgical factors associated with wound complications following cochlear implantation (CI).
DATA SOURCES
PubMed, Web of Science, and Cochrane databases.
STUDY SELECTION
Eligible studies included peer-reviewed research in English evaluating wound complications (wound infection, skin flap breakdown/dehiscence, seroma/hematoma) following CI. Studies with paired samples were included in the meta-analysis.
DATA EXTRACTION
Surgical factors (techniques and perioperative management) in CI and reported wound complications were examined. Level of evidence was assessed using the Oxford Centre for Evidence-based Medicine guidelines and bias was assessed using the NIH Quality Assessment Tool.
DATA SYNTHESIS
Twenty-six studies representing 10,214 cochlear implantations were included. The overall wound complications rate was 3.1% (range 0.03-13.9%). Eleven studies contained paired data and were used for meta-analysis regarding three different surgical factors: incision length, implant placement method, and antibiotic usage. Longer incision lengths (≥7 cm) demonstrated a higher risk of wound complications (risk ratio 2.27, p = 0.02, CI 1.16-4.43). Different implant placement techniques (suture fixation versus periosteal pocket) (p = 0.08, CI 0.92-3.69) and postoperative antibiotic regimens (postoperative use versus none) (p = 0.68, CI = 0.28-7.18) were not associated with differences in wound complication rates following CI.
CONCLUSIONS
Overall rate of wound complications following CI is low. Shorter incision length is associated with lower risk of wound complications. Differences in perioperative techniques and practices regarding implant placement and antibiotic use were not associated with differences in wound complication rates. Considering the low number and quality of studies, there is a need for research in CI outcomes using paired sample prospective designs and standardized reporting.
Topics: Cochlear Implantation; Humans; Prospective Studies; Seroma; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 34607994
DOI: 10.1097/MAO.0000000000003325 -
Journal of Pharmacy & Bioallied Sciences Nov 2021With increase in exposure to titanium in daily life and its use in medical procedures, there is a greater chance for developing titanium hypersensitivity. Our aim and...
BACKGROUND
With increase in exposure to titanium in daily life and its use in medical procedures, there is a greater chance for developing titanium hypersensitivity. Our aim and objective is to examine whether patient patients with titanium implants had a greater incidence of titanium hypersensitivity or not. Titanium is widely considered to have good biocompatibility. A passivating surface layer of TiO is formed when exposed to air which gives it good corrosion resistance. These properties along with its high strength, lightweight, and improvements in smelting technologies have led to its widespread use as an intraosseous and periosteal implant in dentistry and orthopedics.
MATERIALS AND METHODS
Only case-control studies were used for the meta-analysis. Studies with a sample size of <5 were excluded. Cutaneous and epicutaneous tests were used in the study.
RESULTS
Three studies met the inclusion criteria. Titanium hypersensitivity is more prevalent in patients with titanium implants.
CONCLUSIONS
It is also used in a variety of medical devices such as pacemakers and insulin pumps. Moreover, our external exposure to titanium is increasing. It is used in aerospace, chemical, and automobile industries. It is also used in jewelry, home furnishings, and in making sports and marine equipment. Titanium implants increase the possibility of developing titanium hypersensitivity, and thus, it should be considered as a major factor in unexplained implant failure where other causes have been excluded.
PubMed: 35017986
DOI: 10.4103/jpbs.jpbs_159_21 -
Orthopedic Reviews 2023Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesions can lead to chronic shoulder instability and repetitive dislocations in active populations.
INTRODUCTION
Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesions can lead to chronic shoulder instability and repetitive dislocations in active populations.
OBJECTIVE
The purpose of this systematic review was to evaluate associated injuries and postoperative outcomes following ALPSA lesion repairs.
METHODS
Medline, Embase, Cochrane, and Web of Science were searched through May 2022 for studies that investigated management and surgical outcomes of ALPSA lesion repair. Data was extracted on the following topics: surgical management, surgical complications, associated injuries, follow-up duration, and outcome parameters, including recurrence rates, functional outcome scores, range-of-motion (ROM), and return to activity.
RESULTS
A total of 6 studies covering 202 patients met the inclusion criteria. In the included studies, 79% of patient were male with a mean age of 25.1 years. A total of 192 associated injuries were reported amongst 176 patients with the most common being Hill Sachs lesions (84, 43.8%), synovitis (35, 18.2%), SLAP tears (32, 16.7%) and glenoid erosions or lesions (30, 15.6%). All 202 patients were treated arthroscopically with no reported complications. 26 patients (12.9%) experienced operative failure as evidenced by recurrence of shoulder instability over a mean follow-up of 4.3 years. Various clinical outcome scores showed postoperative functional improvement and one study reported a 100% return to activity rate in 26 patients.
CONCLUSION
Our findings suggest a high 12.9 % risk of recurrence following ALPSA repair but satisfactory functional outcomes, both of which should be weighed by physicians when considering arthroscopic repair. Physicians should also be cognizant of co-pathologies when examining patients with suspected ALPSA lesions.
PubMed: 37091317
DOI: 10.52965/001c.74255 -
European Journal of Medical Research Jun 2024Conventional radiography is regularly used to evaluate complications after total hip arthroplasty. In various recent consensus meetings, however, plain radiographs of a... (Review)
Review
Conventional radiography is regularly used to evaluate complications after total hip arthroplasty. In various recent consensus meetings, however, plain radiographs of a potentially infected hip joint have been judged as being only relevant to exclude diagnoses other than infection. Solid data on radiographic presentations of periprosthetic joint infection (PJI) are scarce. As a result, the prognostic value of radiological features in low-grade PJI remains uncertain. The present review article aims to present an overview of the available literature and to develop ideas on future perspectives to define the diagnostic possibilities of radiography in PJIs of the hip. The primary outcome of interest of this systematic review was the radiologic presentation of periprosthetic joint infections of the hip. As secondary outcome of interest served the sensitivity and specificity of the radiologic presentation of periprosthetic joint infections. Of the included articles, 26 were reviews, essays, or case reports and only 18 were clinical studies. Typical radiologic abnormalities of PJI were a periosteal reaction, a wide band of radiolucency at the cement-bone or metal-bone interface, patchy osteolysis, implant loosening, bone resorption around the implant, and transcortical sinus tracts. The frequency of their occurrence is still inadequately defined. A deeper understanding of the underlying causes and the relation between microorganisms to radiologic abnormalities can probably help clinicians in the future to diagnose a PJI. This is why further research shall focus on the radiographic features of PJI.
Topics: Humans; Prosthesis-Related Infections; Prognosis; Arthroplasty, Replacement, Hip; Radiography; Hip Joint; Hip Prosthesis
PubMed: 38849967
DOI: 10.1186/s40001-024-01891-8 -
BMC Public Health Nov 2019Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels....
BACKGROUND
Pain is common in older adults. To maintain their quality of life and promote healthy ageing in the community, it is important to lower their pain levels. Pharmacological pain management has been shown to be effective in older adults. However, as drugs can have various side effects, non-pharmacological pain management is preferred for community-dwelling older adults. This systematic review evaluates the effectiveness, suitability, and sustainability of non-pharmacological pain management interventions for community-dwelling older adults.
METHODS
Five databases, namely, CINHAL, Journals@Ovid, Medline, PsycInfo, and PubMed, were searched for articles. The criteria for inclusion were: full-text articles published in English from 2005 to February 2019 on randomized controlled trials, with chronic non-cancer pain as the primary outcome, in which pain was rated by intensity, using non-pharmacological interventions, and with participants over 65 years old, community-dwelling, and mentally competent. A quality appraisal using the Jadad Scale was conducted on the included articles.
RESULTS
Ten articles were included. The mean age of the older adults was from 66.75 to 76. The interventions covered were acupressure, acupuncture, guided imagery, qigong, periosteal stimulation, and Tai Chi. The pain intensities of the participants decreased after the implementation of the intervention. The net changes in pain intensity ranged from - 3.13 to - 0.65 on a zero to ten numeric rating scale, in which zero indicates no pain and ten represents the worst pain.
CONCLUSIONS
Non-pharmacological methods of managing pain were effective in lowering pain levels in community-dwelling older adults, and can be promoted widely in the community.
Topics: Aged; Analgesics, Opioid; Chronic Pain; Complementary Therapies; Female; Humans; Independent Living; Male; Pain Management; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31703654
DOI: 10.1186/s12889-019-7831-9