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International Journal of Surgery Case... Oct 2023Complications using bioresorbable anchors in arthroscopic rotator cuff surgery include osteolysis, aseptic synovitis, and foreign body reaction. However, the precise...
INTRODUCTION AND IMPORTANCE
Complications using bioresorbable anchors in arthroscopic rotator cuff surgery include osteolysis, aseptic synovitis, and foreign body reaction. However, the precise triggering factors are unknown.
CASE PRESENTATION
A healthy, 63-year-old male patient underwent rotator cuff repair using 7PLGA/b-TCP anchors. Nine months after surgery he returned to the senior author because of right shoulder pain and stiffness, pain in the right hand, foot and leg, and presence of erythematous patches at the aforementioned joints following SARS-Cov-2 infection, as well as increasing in blood inflammatory markers. Magnetic Resonance Arthrography (Arthro-MRI) showed no rotator cuff tendons re-tear but intra-articular synovitis, subacromial bursitis and humeral osteitis. A diagnostic arthroscopy, intra-articular fluid collection, biopsy and joint lavage was performed to rule out a septic arthritis. Co-amoxicillin 2.2 g intravenous treatment was administered following samples. Histological analysis of synovial tissue showed fibrin-exudative synovitis, while humeral bone biopsy showed an anchor resorption reaction. All microbiological analysis showed sterile samples. Three months post-lavage follow-up physical examination showed painless, recovered mobility, while Arthro-MRI showed a significant post-refixation remodeling of the rotator cuff tendons and reduction in humeral head osteitis and synovitis.
CLINICAL DISCUSSION
The abrupt onset of symptomatology and the close chronological link with SARS-Cov-2 infection suggests a causal relationship between clinical and radiological manifestations and the infection itself, with clinical and radiological manifestation being a viral host response reaction to SARS-Cov-2 infection.
CONCLUSION
Shoulder pain, stiffness and humeral osteitis could be manifestations of a viral host response to SARS-Cov-2 infection.
PubMed: 37742353
DOI: 10.1016/j.ijscr.2023.108847 -
Frontiers in Endocrinology 2023Disordered and hypomineralized woven bone formation by dysfunctional mesenchymal stromal cells (MSCs) characterize delayed fracture healing and endocrine -metabolic bone...
BACKGROUND
Disordered and hypomineralized woven bone formation by dysfunctional mesenchymal stromal cells (MSCs) characterize delayed fracture healing and endocrine -metabolic bone disorders like fibrous dysplasia and Paget disease of bone. To shed light on molecular players in osteoblast differentiation, woven bone formation, and mineralization by MSCs we looked at the intermediate filament desmin (DES) during the skeletogenic commitment of rat bone marrow MSCs (rBMSCs), where its bone-related action remains elusive.
RESULTS
Monolayer cultures of immunophenotypically- and morphologically - characterized, adult male rBMSCs showed co-localization of desmin (DES) with vimentin, F-actin, and runx2 in all cell morphotypes, each contributing to sparse and dense colonies. Proteomic analysis of these cells revealed a topologically-relevant interactome, focused on cytoskeletal and related enzymes//chaperone/signalling molecules linking DES to runx2 and alkaline phosphatase (ALP). Osteogenic differentiation led to mineralized woven bone nodules confined to dense colonies, significantly smaller and more circular with respect to controls. It significantly increased also colony-forming efficiency and the number of DES-immunoreactive dense colonies, and immunostaining of co-localized DES/runx-2 and DES/ALP. These data confirmed pre-osteoblastic and osteoblastic differentiation, woven bone formation, and mineralization, supporting DES as a player in the molecular pathway leading to the osteogenic fate of rBMSCs.
CONCLUSION
Immunocytochemical and morphometric studies coupled with proteomic and bioinformatic analysis support the concept that DES may act as an upstream signal for the skeletogenic commitment of rBMSCs. Thus, we suggest that altered metabolism of osteoblasts, woven bone, and mineralization by dysfunctional BMSCs might early be revealed by changes in DES expression//levels. Non-union fractures and endocrine - metabolic bone disorders like fibrous dysplasia and Paget disease of bone might take advantage of this molecular evidence for their early diagnosis and follow-up.
Topics: Male; Animals; Rats; Osteogenesis; Intermediate Filaments; Osteitis Deformans; Core Binding Factor Alpha 1 Subunit; Desmin; Proteomics; Calcinosis; Mesenchymal Stem Cells; Adenocarcinoma; Alkaline Phosphatase; Bone Diseases, Metabolic
PubMed: 37732119
DOI: 10.3389/fendo.2023.1234569 -
Bone Nov 2023Paget's disease of bone (PDB) is a focal bone disorder characterized by an increased bone remodeling and an anarchic bone structure. A decline of prevalence and...
BACKGROUND
Paget's disease of bone (PDB) is a focal bone disorder characterized by an increased bone remodeling and an anarchic bone structure. A decline of prevalence and incidence of PDB has been observed in some countries. No epidemiological data are available on PDB in Canada.
AIMS
We aimed at examining the evolution of the prevalence and incidence of PDB in Quebec (Canada) by analyzing health administrative databases.
METHODS
PDB case definition relied on one or more hospitalizations, or one or more physician-billing claims with a diagnosis code of PDB. To identify incident cases, a 'run-in' period of four years (1996-1999) was used to exclude prevalent cases. For each fiscal year from 2000 to 2001 to 2019-2020 (population size 2,914,480), crude age and sex-specific prevalence and incidence rates of PDB among individuals aged ≥55 years were determined, and sex-specific rates were also standardized to the 2011 age structure of the Quebec population. Generalized linear regressions were used to test for linear changes in standardized prevalence and incidence rates.
RESULTS
Over the study period, standardized prevalence of PDB has remained stable in Quebec, from 0.44 % in 2000/2001 to 0.43 % in 2019/2020 (mean change -0.002, p-value = 0.0935). For the 2019-2020 fiscal year, 13,165 men and women had been diagnosed with PDB and prevalence of PDB increased with age. Standardized incidence of PDB has decreased over time from 0.77/1000 in 2000/2001 to 0.28/1000 in 2019-2020 (mean change -0.228/year, p-value<0.0001), the incidence decreasing from 0.82/1000 to 0.37/1000 in men and from 0.76/1000 to 0.22/1000 in women, respectively. This decrease was observed in all age categories.
CONCLUSION
With the exception of a slight increase in PDB prevalence up to 0.55 % in years 2005 to 2007, the prevalence of PDB has remained stable in Quebec over the past 20 years, 13,160 men and women being currently diagnosed with PDB. The incidence has decreased over time. Our results support the epidemiological changes of PDB reported in other countries.
Topics: Male; Female; Humans; Quebec; Incidence; Osteitis Deformans; Prevalence; Canada
PubMed: 37683713
DOI: 10.1016/j.bone.2023.116895 -
Restorative Dentistry & Endodontics Aug 2023The formation of new bone by periosteum due to an insult is called periosteal bone reaction (PBR). This study assessed the cone beam computed tomography (CBCT) patterns...
OBJECTIVES
The formation of new bone by periosteum due to an insult is called periosteal bone reaction (PBR). This study assessed the cone beam computed tomography (CBCT) patterns of periosteal bone reactions associated with periapical inflammatory lesion (apical periodontitis/periapical rarefying osteitis).
MATERIALS AND METHODS
Twenty-two small field of view CBCT images of patients with PBR were selected from a database of a private practice limited to endodontics. The volume of the periapical inflammatory lesion, the presence of cortical fenestration, the distance of the root apices to the affected cortex, and the location, pattern, and longest diameter of the periosteal reaction were recorded. Statistical analysis was performed using Wilcoxon Ranksum, Fischer's exact, Spearman Correlation Coefficient, and paired -test.
RESULTS
In all cases, periosteal bone reaction manifested as either parallel (90.9%) or irregular (9.1%). No correlation was found between periapical inflammatory lesion volume and the periosteal reaction's longest diameter ( > 0.05). Cortical fenestration was noted in 72.7% of the cases. In addition, the findings showed that periosteal reactions were located mostly on the buccal and were present 53.8% and 100% of the time in the mandible and maxilla, respectively.
CONCLUSIONS
The periosteal reactions of endodontic origin had a nonaggressive form (., parallel or irregular), and none of the lesions resulted in a periosteal reaction with an ominous Codman's triangle or spicule pattern.
PubMed: 37675448
DOI: 10.5395/rde.2023.48.e23 -
Cureus Jul 2023Mandibular third-molar extraction is a frequently executed minor oral surgical procedure, with a subsequent recovery period lasting several days. Typically, preemptive... (Review)
Review
Mandibular third-molar extraction is a frequently executed minor oral surgical procedure, with a subsequent recovery period lasting several days. Typically, preemptive administration of non-steroid anti-inflammatory drugs (NSAIDs) and steroids has been employed, resulting in a notable decrease in postoperative complications like pain, facial swelling, trismus, and alveolar osteitis. This systematic review's primary goal was to investigate the efficacy of preemptive analgesia with dexamethasone and diclofenac in minimizing the post-surgical complications following the surgical extraction of the mandibular third molars. The systematic search was carried out to identify relevant literature in digital databases including PubMed®, Cochrane Library, Web of Science, and Scopus, from January 1990 to January 2022. The search used specific keywords. The randomized clinical trials assessing the efficacy of dexamethasone and diclofenac or dexamethasone alone compared to diclofenac or placebo as preemptive analgesics were considered inclusion criteria for this systematic review. Case reports, literature reviews, letters to the editor, and non-English publications were not included. Two authors screened the titles and abstracts, and articles fulfilling the study criteria were included. After reading the full text and data collection, analysis was performed. The included article's bias was evaluated by the Risk of Bias 2 (RoB 2) tool. A digital database search yielded a total of 207 articles. After excluding duplicates and articles written in languages other than English, 90 were removed. Based on the title and abstract, out of 177, 95 studies were excluded. After full-text reading of 22 articles, 17 were eliminated because they did not meet the inclusion and exclusion criteria. The remaining five studies were found eligible and included in the systematic review. Four studies were of low risk, while one study had some concerns. Two studies evaluated the combination of dexamethasone with diclofenac, while three evaluated dexamethasone alone. Total samples included samples of 436 third-molar surgeries in 420 patients. There was a substantial decrease in the mean pain score and swelling measurement when diclofenac alone was compared with coadministration of diclofenac and dexamethasone. Preemptive administration of dexamethasone and diclofenac has been shown to effectively reduce pain and facial swelling, with the exception of trismus, in third-molar surgeries when compared to diclofenac alone. As a result, it is recommended to administer these drugs prior to the commencement of third-molar extraction. However, further research is mandatory, specifically good quality randomized controlled trials involving large cohorts, in order to assess any significant variations and validate these findings.
PubMed: 37654946
DOI: 10.7759/cureus.42709 -
CMAJ : Canadian Medical Association... Aug 2023
Topics: Humans; Osteitis Deformans; Adenocarcinoma; Bone and Bones
PubMed: 37640400
DOI: 10.1503/cmaj.230164-f -
Cancers Aug 2023Osteitis fibrosa cystica (OFC) and Brown Tumours are two related but distinct types of bone lesions that result from the overactivity of osteoclasts and are most often... (Review)
Review
Osteitis fibrosa cystica (OFC) and Brown Tumours are two related but distinct types of bone lesions that result from the overactivity of osteoclasts and are most often associated with chronic kidney disease (CKD). Despite their potential consequences, these conditions are poorly understood because of their rare prevalence and variability in their clinical manifestation. Canonically, OFC and Brown Tumours are caused by secondary hyperparathyroidism in CKD. Recent literature showed that multiple factors, such as hyperactivation of the renin-angiotensin-aldosterone system and chronic inflammation, may also contribute to the occurrence of these diseases through osteoclast activation. Moreover, hotspot KRAS mutations were identified in these lesions, placing them in the spectrum of RAS-MAPK-driven neoplasms, which were until recently thought to be reactive lesions. Some risk factors contributed to the occurrence of OFC and Brown Tumours, such as age, gender, comorbidities, and certain medications. The diagnosis of OFC and Brown Tumours includes clinical symptoms involving chronic bone pain and laboratory findings of hyperparathyroidism. In radiological imaging, the X-ray and Computed tomography (CT) scan could show lytic or multi-lobular cystic alterations. Histologically, both lesions are characterized by clustered osteoclasts in a fibrotic hemorrhagic background. Based on the latest understanding of the mechanism of OFC, this review elaborates on the manifestation, diagnosis, and available therapies that can be leveraged to prevent the occurrence of OFC and Brown Tumours.
PubMed: 37627135
DOI: 10.3390/cancers15164107 -
Laryngoscope Investigative... Aug 2023Although several mucosal flap techniques have been reported to improve the outcomes in Draf IIb and Draf III procedures, there is scant knowledge on frontal ostium...
OBJECTIVE
Although several mucosal flap techniques have been reported to improve the outcomes in Draf IIb and Draf III procedures, there is scant knowledge on frontal ostium neo-osteogenesis after reconstruction with mucosa flap. This study evaluates the potential benefits of mucosa flaps on frontal ostium neo-osteogenesis after frontal sinus drill-out procedures.
METHODS
Forty-three patients who underwent extended Draf IIb and Draf III were enrolled. Among them, 20 patients had frontal neo-ostium (FNO) reconstructed by mucosal flap (group A), and 23 patients did not have neo-ostium reconstruction (group B). The cross-sectional area of FNO, frontonasal bone, and the amount of frontal neo-osteogenesis (FNOG) were measured with OsiriX®. In addition, the Global Osteitis Scoring Scale (GOSS), Lund-Mackay score (LMS), and Lund-Kennedy score (LKS) were also evaluated.
RESULTS
At one year postoperatively, the remaining neo-ostium area was significantly larger in group A ( = .001), and group A had significantly less FNOG ( < .05). The month 12 postoperative GOSS score was significantly decreased in group A. In contrast, it slightly increased in group B. Both the average LKS and LMS were significantly reduced in groups A and B at month 12 postoperatively. Still, the average LKS of group A significantly decreased than that of group B at month 12 postoperatively.
CONCLUSION
Coverage of the bare frontal bone with the mucosal flap could prevent excessive neo-osteogenesis and keep the neo-ostium open widely.
LEVEL OF EVIDENCE
2b.
PubMed: 37621273
DOI: 10.1002/lio2.1104 -
Pediatric Rheumatology Online Journal Aug 2023Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by chronic vasculitis involving small to medium sized arteries, granulomatous inflammation...
BACKGROUND
Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by chronic vasculitis involving small to medium sized arteries, granulomatous inflammation of the upper and lower respiratory tracts, pauci-immune necrotizing glomerulonephritis, as well as vasculitis of other organs. Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory syndrome characterized by sterile bone inflammation.
CASE PRESENTATION
We report a case of CRMO that was doing well on non-steroidal anti-inflammatory drugs (NSAID for 6 years and then developed ANCA positive limited GPA presenting with pyoderma gangrenosum, persistent bilateral otalgia with serous otitis, otorrhea, then sensorineural hearing loss.
CONCLUSION
This is the first report of limited GPA initially presenting as pyoderma gangrenosum in a patient with underlying CRMO. It is unclear how the pathology of an autoimmune and an autoinflammatory condition can overlap.
Topics: Child; Humans; Pyoderma Gangrenosum; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Osteomyelitis; Osteitis; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 37620906
DOI: 10.1186/s12969-023-00876-x -
Journal of Clinical and Translational... Aug 2023Paget's disease of the bone refers to a chronic cumulative disorder characterized by enhanced osteoclastic function followed by a secondary surge in osteoblastic...
BACKGROUND AND AIM
Paget's disease of the bone refers to a chronic cumulative disorder characterized by enhanced osteoclastic function followed by a secondary surge in osteoblastic activity. The condition can manifest as a polyostotic or monostotic bone disease with most patients having an asymptomatic presentation, although some may complain of pain localized to the affected bone while others express symptoms of nerve compression. A pagetic bone is predisposed to develop pathological fractures, bony deformities, and a rare yet detrimental transformation into osteosarcoma. Detection is often accidental when performing radiographic tests for other indications or when elevated blood levels of alkaline phosphatase (ALP) are detected. Treatment with third-generation bisphosphonates is helpful in preventing further bone resorption and, additionally, reduces bony pains that are believed to be caused by excessive metabolic activity. Here, we present a case of a middle-aged asymptomatic female with elevated serum ALP levels up to 1537 IU/L (reference range 40-150 U/L) during her pre-operative evaluation for elective cholecystectomy. Tc-methylene diphosphonate bone scintigraphy revealed diffuse uptake in the skull and, hence, was diagnosed as a case of isolated Paget's disease of the skull.
RELEVANCE FOR PATIENTS
The rarity of this disease in Southeast-Asians, its uncontrived detection, and the isolated skull involvement, imparts high clinical relevance on this case. Early detection and management of this disease can help prevent the development of life-threatening complications in affected patients, hence decreasing the morbidity.
PubMed: 37593243
DOI: No ID Found