Chronic recurrent multifocal osteomyelitis, a rare disease. case report

ABSTRACT Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disease usually observed in children and adolescents. It is caused by an imbalance between proinflammatory and anti-inflammatory factors. To establish its diagnosis, it is necessary to integrate clinical and laboratory elements that are typically aimed at ruling out other conditions, constituting a diagnosis of exclusion. Treatment is based on non-steroidal anti-inflammatory drugs and other drugs in specific cases. Case presentation: A 16-year-old female patient with a 1-year history of joint pain, especially in the knees, accompanied by signs of local inflammation was admitted to the emergency department of a quaternary care hospital due to a fever >38.5°, odynophagia, asthenia, and adynamia over the last two days. The patient underwent multiple extension studies, including laboratory, imaging and histopathological tests, which ruled out various etiologic causes. She received empirical antibiotic treatment without remission of symptoms, so a diagnosis of CRMO was finally established and outpatient treatment with non-steroidal anti-inflammatory drugs and corticosteroids was indicated, obtaining a favorable response. Conclusions: CRMO should be considered in children and adolescents with bone pain and a poorly defined clinical history with non-specific laboratory, imaging and histopathological findings. To date, little is known about CRMO, so it is necessary to carry out research and expand the knowledge related to this disease.

RESUMEN Introducción. La osteomielitis multifocal recurrente crónica (CRMO) es una enfermedad inflamatoria ósea poco frecuente que se presenta principalmente en niños y adolescentes a causa de un desequilibrio entre factores proinflamatorios y antiinflamatorios. Para establecer su diagnóstico se deben integrar elementos clínicos y paraclínicos con el fin de descartar otras entidades, pues su diagnóstico es de exclusión. El tratamiento se basa en antiinflamatorios no esteroideos y otros medicamentos en casos específicos. Presentación del caso. Adolescente femenina de 16 años con cuadro clínico de un año de evolución consistente en episodios de dolor articular, especialmente en rodillas, acompañado de signos de inflamación local, quien ingresó al servicio de urgencias de un hospital de cuarto nivel por presentar fiebre >38.5°, odinofagia, astenia y adinamia durante los dos últimos días. A la paciente se le realizaron múltiples estudios de extensión, incluyendo exámenes de laboratorio, imagenológicos e histopatológicos, con los que se descartaron diversas causas etiológicas. Asimismo, la joven recibió tratamiento antibiótico empírico sin remisión de sus síntomas, por lo que finalmente se estableció el diagnóstico de CRMO y se indicó manejo ambulatorio con antiinflamatorios no esteroideos y corticoesteroides, con el cual se obtuvo respuesta favorable. Conclusiones. La CRMO debe ser considerada en niños y adolescentes con dolor óseo y un cuadro clínico poco definido con hallazgos de laboratorio, imagenológicos e histopatológicos inespecíficos. En la actualidad es poco lo que se conoce sobre la CRMO, por lo que es necesario realizar investigaciones y ampliar los conocimientos relacionados con esta enfermedad.

Osteítis de calota por sífilis secundaria. Presentación de caso / Calvarial osteitis due to secondary syphilis. Case presentation

RESUMEN Introducción: La sífilis es una infección de transmisión sexual causante de grandes estragos durante toda la historia de la humanidad, en la actualidad su prevalencia es preocupante. El compromiso óseo en la sífilis secundaria puede preceder o seguir a las lesiones mucocutáneas y en algunos casos ocurrir como única manifestación. Objetivo: Describir el caso clínico de un paciente con osteítis de calota en el curso de una sífilis secundaria, que permita a los profesionales de la salud asociar estas lesiones con las infecciones de transmisión sexual. Presentación de caso: Paciente masculino de 33 años de edad, estado civil soltero, con antecedentes patológicos personales de ser portador del Virus del herpes simple oral desde los 24 años, quien asiste a la consulta por presentar cefalea frontal izquierda, opresiva, pulsátil, de inicio leve que se intensifica e irradia al oído homolateral. El examen físico, que incluyó el sistema nervioso, fue negativo. Se indicaron estudios imagenológicos y de laboratorio, los que evidenciaron la presencia de imágenes osteolíticas en región parietal izquierda próxima a la sutura sagital y pruebas serológicas positivas que confirman el diagnóstico de manifestaciones óseas de osteítis de calota por sífilis secundaria. Conclusiones: Durante la sífilis secundaria el hueso del cráneo es el más afectado, al sufrir osteítis proliferativa. Es responsabilidad del personal de salud el diagnóstico oportuno y precoz de la enfermedad, a fin de evitar su progresión, morbilidad y posibles complicaciones.

ABSTRACT Introduction: Syphilis is a sexually transmitted infection that has caused great havoc throughout the history of mankind; currently, its prevalence is of great concern. Bone involvement in secondary syphilis may precede or follow mucocutaneous lesions and, in some cases, occur as the only manifestation of the disease. Objective: To describe the clinical case of a patient with calvarial osteitis in the course of secondary syphilis to allow health professionals to associate these lesions with sexually transmitted infections. Case presentation: Thirty-three-year-old male patient, single, with personal pathological antecedents of being carrier of the oral herpes simplex virus since he was 24 years old who attends the consultation due to left frontal, oppressive, throbbing headache of mild onset that intensifies and radiates to the ipsilateral ear. Physical examination, which included the nervous system, was negative. Imaging and laboratory studies were ordered; the imaging studies showed the presence of osteolytic images in the left parietal region near the sagittal suture, and the positive serological tests confirmed the diagnosis of bone manifestations of calvarial osteitis due to secondary syphilis. Conclusions: In secondary syphilis, the skull bone is most often affected by proliferative osteitis. Risky sexual practices and self-medication have a negative influence on the expression of the disease. The health personnel is responsible for conducting a timely and early diagnosis of the disease in order to avoid its progression, morbidity, and possible complications.

Enfermedad ósea de Paget: reporte de caso / Paget's disease of bone: case report

La enfermedad ósea de Paget es una alteración metabólica generada por un disbalance entre la actividad osteoclástica y osteoblástica, llevando a un proceso de remodelación inadecuado que genera cambios en la estructura ósea. Aunque en muchos casos puede ser asintomática, se asocia a complicaciones severas como posibles fracturas, deformidades esqueléticas, neoplasias óseas y síntomas por compresión de estructuras nerviosas a nivel de cráneo y columna vertebral. Esta patología se presenta más frecuentemente pacientes de sexo masculino y en el Reino Unido, así como en países de población inmigrante británica, sin embargo es muy infrecuente en países latinoamericanos. Se presenta el caso de una paciente de 72 años, diagnosticada con enfermedad de Paget de acuerdo con hallazgos de imágenes y laboratorio, tratada con ácido zoledrónico para manejo sintomático.

Paget's disease of bone is a metabolic alteration generated by an imbalance between osteoclastic and osteoblastic activity, leading to an inadequate remodeling process that generates changes in the bone structure. Although in many cases it can be asymptomatic, it is associated with severe complications such as possible fractures, skeletal deformities, bone neoplasms and symptoms due to compression of nervous structures at the level of the skull and spine. This pathology occurs more frequently in male patients and in the United Kingdom, as well as in countries with a British immigrant population, however it is very rare in Latin American countries. The case of a 72-year-old patient is presented, diagnosed with Paget's disease according to imaging and laboratory findings, treated with zoledronic acid for symptomatic management.

Septic Arthritis of the Pubic Symphysis in Adult: A Case Report / Artrite séptica da sínfise pubiana em adultos: Relato de caso

Abstract Septic arthritis of the pubic symphysis is a rare condition. Risk factors include trauma, low-grade infection, urological or gynecological procedures, malignant tumors of the pelvis, sports, and intravenous drug abuse. This report describes a case of septic arthritis of the pubic symphysis in a 23-year-old male patient with no history of pelvic surgery, previous infections, or intense physical activity. Arthritis was diagnosed by blood culture positive for Enterococcus spp. and yeasts, and the patient was treated with antibiotics. This case emphasizes the importance of complementary exams to aid the treatment of septic arthritis of the pubic symphysis and shows that an invasive procedure, such as pubic symphysis puncture biopsy, may not be required.

Resumo A artrite séptica da sínfise púbica é uma condição rara. Os fatores de risco são trauma, infecção de baixo grau, procedimentos urológicos ou ginecológicos, tumores malignos da pelve, prática de esportes e uso de drogas intravenosas. O presente relato descreve um caso de artrite séptica da sínfise púbica em um paciente do sexo masculino, de 23 anos, sem história de cirurgias pélvicas, infecções prévias ou atividade física intensa. A artrite foi diagnosticada pela hemocultura que revelou crescimento de Enterococcus sp + leveduras, e o paciente foi tratado com antibioticoterapia. Este caso enfatiza a importância de exames complementares no auxílio do tratamento da artrite séptica da sínfise púbica, e demonstra que procedimentos invasivos, tais como a punção da sínfise púbica, podem não ser necessários.

Anabolic steroid-induced myositis and osteitis. case report through a radiologic approach

ABSTRACT Introduction: Myositis is a rare complication of extra-articular anabolic steroid injections, while osteitis has not been reported as an adverse effect from this cause. This case report provides information about imaging findings of these two entities. Case presentation: A 37-year-old male, bodybuilder, presented pain and edema in the left gluteal region, associated with functional limitation, 5 days after receiving an intramuscular anabolic steroid injection (stanozolol). The man underwent an ultrasound scan and magnetic resonance imaging of the pelvis with contrast, which allowed making the diagnosis of myositis of the left gluteus maximus and osteitis of the iliac bone. The patient was treated with piperacillin-tazobactam and vancomycin for 10 days, without complications. No surgical management was required. Conclusion: Myositis is a rare complication of anabolic steroid injections and the pathophysiological mechanism of this substance is unknown. Osteitis, on the other hand, is an even rarer complication and, to the best of our knowledge, this is the first known case associated with this cause. Given the findings, the myositis reported herein has an infectious nature; however, further studies are required to demonstrate the actual causal association.

RESUMEN Introducción. La miositis es una complicación muy rara de las inyecciones extraarticulares de esteroides anabólicos y la osteítis no ha sido reportada como efecto adverso por esta causa. El presente reporte de caso aporta información sobre los hallazgos imagenológicos de estos dos tipos de inflamaciones. Presentación del caso. Paciente masculino de 37 años, dedicado al fisicoculturismo, quien cinco días después de recibir una inyección de estano-zolol presentó dolor y edema en la región glútea izquierda asociados a limitación funcional. El sujeto asistió a consulta por este motivo y se le realizó una ecografía y una resonancia magnética contrastada de pelvis, cuyos resultados permitieron diagnosticarle miositis del glúteo mayor izquierdo y osteítis del hueso ilíaco. Se indicó tratamiento con piperacilina-tazobactam y vancomicina por 10 días y no se requirió manejo quirúrgico dado que se obtuvieron buenos resultados. Conclusión. La miositis es una complicación rara de las inyecciones de esteroides anabólicos en donde el mecanismo fisiopatológico de estas sustancias es incierto. Por su parte, la osteítis es una complicación aún más rara de la cual se presenta el primer caso conocido por esta causa. Dados los hallazgos se plantea que la miositis reportada es de tipo infecciosa; sin embargo, se requieren estudios adicionales que demuestren la asociación causal real.

Enfermedad de Paget de hueso esporádica. Serie de casos y revisión de la literatura / Sporadic Paget's disease of the bone. Case series and literature review

RESUMEN La enfermedad de Paget ósea es una enfermedad metabólica del hueso de etiología no esclarecida, que se caracteriza por una fase de resorción aumentada seguida por una fase de osteoformación aberrante. Es frecuente en Europa, Norteamérica, Nueva Zelanda y Australia, pero infrecuente en Asia, Medio Oriente y África. En población colombiana hay reportes de casos. Generalmente cursa asintomática y se diagnostica incidentalmente por hallazgos radiográficos o fosfatasa alcalina elevada. El uso de bifosfonatos favorece el control del recambio óseo y permite prevenir complicaciones como las fracturas. Se presenta una serie de casos en Colombia y una revisión de la literatura.

A B S T R A C T Paget's disease of the bone is a metabolic bone disease of unknown origin, and is characterised by an increased phase of resorption, followed by an aberrant osteoformation phase. It is common in Europe, North America, New Zealand, and Australia, but infrequent in Asia, the Middle East, Africa, and in the Colombian population there are case reports. It is usually asymptomatic and is diagnosed incidentally by radiographic findings or an elevated alkaline phosphatase. The use of bisphosphonates favours the control of bone turnover and prevents complications such as fractures. A series of cases in Colombia is presented, along with a review of the literature.

Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report

In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of −2.5 and −2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.

Prevention of bone infection after open fracture using a chitosan with ciprofloxacin implant in animal model

Abstract Purpose To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. Methods Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. Results Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). Conclusion Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.

Síndrome Sapho: reporte de caso / SAPHO syndrome: report of a case

El síndrome SAPHO es una enfermedad inflamatoria de origen multifactorial que incluye una asociación entre manifestaciones dermatológicas y osteoarticulares. La presencia de osteítis e hiperostosis definen la enfermedad. No existe un tratamiento estándar, pero se usan AINES como primera línea. Se presenta el caso de un varón de 18 años con acné severo en dorso, pecho, barbilla y zona retroauricular, asociado a fiebre alta y placas eritematosas en ambas piernas. La gammagrafía presenta hipercaptación en tibia derecha, con relación a osteítis no infecciosa. Tuvo evolución favorable con antibióticos y corticoide oral.

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is a multifactorial inflammatory condition that includes an association between dermatological and bone and joint manifestations. The presence of osteitis and hyperostosis define this disease. There is no standard therapy for SAPHO syndrome, but NSAIDs are used as first line. We present the case of an 18-year-old male subject with severe acne on his back, chest, chin, and the retroauricular area, being this associated to high fever and erythematous plaques in both legs. The bone scan showed right leg hyper-uptake, related to non-infectious osteitis. The patient did well with antibiotics and oral steroids.

Fine Needle Aspiration Cytology, a Useful Tool for the Diagnosis of Specific Leprous Osteitis

Leprosy is known to affect the nerves, skin, respiratory tract and eyes commonly. Leprosy also afflicts bones, the sites of predilection for bone damage include small bones of hands and feet. Advanced bone changes are rarely encountered. We describe a case of specific leprous osteitis diagnosed by fine needle aspiration cytology (FNAC). An 18 year old male presented with multiple swellings and ulcers over the limbs since two months. A 3x2 cm hard swelling with ulceration was seen over distal left ring finger, X-ray of which showed an osteolytic lesion over the distal interphalangeal joint (DIP). FNAC from the lytic lesion showed foamy macrophages, a few lymphocytes and epithelioid cells with strongly positive staining for acid-fast bacilli (AFB). A diagnosis of specific leprous osteitis was made. FNAC is a simple, cost effective and minimally traumatic procedure and may be used as a mode of investigation for the diagnosis of specific leprous osteitis.

Clinical profile of primary hyperparathyroidism in Northeast India: a single centre experience

Background: A retrospective study of the presentation of primary hyperparathyroidism was done at a tertiary care centre in northeast India and was compared with variable features in other parts in India and worldwide.Methods: The clinical presentation, biochemical parameters, radiological and histopathology findings of 27 subjects of primary hyperparathyroidism who presented to us over a period of 5 years were retrospectively analysed. Chi-square test, student t test and 'one way ANOVA' were used to compare different variables. Statistical significance was set at p<0.05.Results: The age distribution ranged from as young as 13 years to 72 years (39±16.7). The male:female ratio was 1:1.25. The duration of symptoms at presentation ranged from 2 to 72 months (21.7±20.3). The most common presentation was bone pain in 59.2% of cases, followed by proximal myopathy (48.1%), fatigue (44.4%), abdominal pain (44.4%), constipation (11.1%), hypertension (18.5%), palpable neck swelling (22.2%), limb deformity (22.2%) and fracture (14.8%). The mean serum calcium was 12.2±0.87mg/dl. Parathyroid adenoma was localized radiologically in all patients and single adenoma was the most common cause in 96.3%. Left inferior parathyroid adenoma was the most common site of involvement in 51.8%.Conclusions: Hyperparathyroidism at our centre in northeast India has a classic symptomatic presentation with severe bone and renal involvement and younger age at diagnosis, and equal gender distribution.

Diagnosis and management of paget's disease of bone - series of 8 cases / Diagnóstico e manejo da doença de paget óssea - série de 8 casos

ABSTRACT Paget's disease of bone is a chronic condition characterized by focal abnormalities of absorption and formation of bone, and it may lead to anatomical deformities, pain, fractures, and malignant transformation. It is common in the UK, Australia, New Zealand, and North America and has a strong hereditary component, affecting first- to third-degree relatives. The etiology remains unclear and treatment is based on control of the disease with bisphosphonates, with the aim of relieving symptoms and correcting laboratory abnormalities. Surgical treatment may also be necessary to correct deformities or treat pathological fractures. This study evaluated the management and course of 8 patients with Paget's disease of bone, followed in the Orthopedic Clinic of this hospital. Among these patients, 1 had concomitant advanced prostate carcinoma, highlighting the association between Paget's disease and secondary bone diseases that can affect the differential diagnosis. Level of evidence IV, Study type: Case Series.

RESUMO A doença de Paget Óssea é uma afecção crônica, caracterizada por distúrbio focal da absorção e formação ósseas, podendo levar a deformidades anatômicas, dor, fraturas e malignização das lesões. É frequente no Reino Unido, Austrália, Nova Zelândia e América do Norte. Mantém forte relação de incidência com parentes de primeiro a terceiro graus. Sua etiologia ainda permanece incerta e o tratamento se baseia no controle da doença, com uso de bisfosfonados, visando melhora dos sintomas e das alterações laboratoriais. O tratamento cirúrgico também pode ser necessário, para correção de deformidades ou para tratamento de fraturas. Este estudo compilou oito pacientes em acompanhamento pela doença de Paget Óssea, no Ambulatório de Ortopedia deste hospital, acerca do tratamento realizado e como evoluíram. Dentre os pacientes acompanhados, houve um caso de carcinoma de próstata concomitante ao Paget, chamando atenção para outras patologias ósseas que são diagnósticos diferenciais ou coexistem com a doença. Nível de evidência IV, Tipo de Estudo: Série de Casos.

Pustulotic Arthro-osteitis Improved with Anti TNF-α Inhibitor / 대한피부과학회지

Pustulotic arthro-osteitis (PAO) is a rare chronic inflammatory disorder characterized by inflammatory osteitis of the sternoclavicular joint and palmoplantar pustulosis. Here, we report a case of PAO that was successfully treated with a TNF-α inhibitor. A 45-year-old man presented with a 3-month history of pustular eruption on the palms and soles. Physical examination showed multiple erythematous papulopustules on the palms, back, and left shin, accompanied by sternoclavicular joint swelling and tenderness. Skin biopsy showed intraepidermal pustules filled with neutrophils on the palm. Bone scintigraphy revealed increased uptake in the bilateral sternoclavicular and other axial joints. Based on these findings, we made the diagnosis of PAO. Even after 6-month treatment of oral steroids and cyclosporine, skin manifestations insufficiently improved, so etanercept therapy was started. Complete clearance of skin lesions and joint pain were achieved after 3 months of etanercept therapy.

Mycobacterium bovis Osteitis Following Immunization with Bacille Calmette-Guérin (BCG) in Korea

BACKGROUND: Mycobacterium bovis Bacille Calmette-Guérin (BCG) osteitis, a rare complication of BCG vaccination, has not been well investigated in Korea. This study aimed to evaluate the clinical characteristics of BCG osteitis during the recent 10 years in Korea. METHODS: Children diagnosed with BCG osteitis at the Seoul National University Children's Hospital from January 2007 to March 2018 were included. M. bovis BCG was confirmed by multiplex polymerase chain reaction (PCR) in the affected bone. BCG immunization status and clinical information were reviewed retrospectively. RESULTS: Twenty-one patients were diagnosed with BCG osteitis and their median symptom onset from BCG vaccination was 13.8 months (range, 6.0–32.5). Sixteen children (76.2%) received Tokyo-172 vaccine by percutaneous multiple puncture method, while four (19.0%) and one (4.8%) received intradermal Tokyo-172 and Danish strain, respectively. Common presenting symptoms were swelling (76.2%), limited movement of the affected site (63.2%), and pain (61.9%) while fever was only accompanied in 19.0%. Femur (33.3%) and the tarsal bones (23.8%) were the most frequently involved sites; and demarcated osteolytic lesions (63.1%) and cortical breakages (42.1%) were observed on plain radiographs. Surgical drainage was performed in 90.5%, and 33.3% of them required repeated surgical interventions due to persistent symptoms. Antituberculosis medications were administered for a median duration of 12 months (range, 12–31). Most patients recovered without evident sequelae. CONCLUSION: Highly suspecting BCG osteitis based on clinical manifestations is important for prompt management. A comprehensive national surveillance system is needed to understand the exact incidence of serious adverse reactions following BCG vaccination and establish safe vaccination policy in Korea.

Mineral and bone metabolism disorder in an adenine-induced rat model of chronic kidney disease / 中国比较医学杂志

Objective To investigate the characteristic changes of biochemical markers of mineral metabolism, vascular calcification, and renal osteodystrophy in an adenine-induced rat model of chronic kidney disease (CKD). Methods A total of 20 male Sprague Dawley rats (SD rats) were randomly divided into two groups: the normal group fed with a diet without adenine, and the CKD group fed with an adenine-containing diet (7. 5 g/kg) for the first 4 weeks and then a diet without adenine for the following 2 weeks. At the end of the 2nd week, serum biochemical markers were detected. At the end of the 6th week, the SD rats were sacrificed and serum biochemical markers were detected once again. The aortas were collected for pathological examination and detection of vascular calcium and phosphorus contents. Femurs and the fifth lumbar vertebrae were taken for bone mineral density (BMD) measurement and bone histomorphometric analysis. Results At the end of the 2nd and 6th weeks, compared with the normal control group, the levels of serum creatinine, urea nitrogen, phosphorus and parathyroid hormone (PTH) in the CKD group were significantly increased (P＜0. 05 or P＜ 0. 01), and the level of serum calcium was significantly decreased (P＜ 0. 05 or P＜ 0. 01). Medial layer vascular calcification of the aorta occurred in 50％ of the rats in the CKD group, but was not observed in the normal control group. Vascular calcium and phosphorus contents were significantly higher in the CKD group compared with the normal control group (P＜ 0. 05). The BMD of total femur, cortical and trabecular bone tissues of the femur, and the fifth lumbar vertebra was significantly decreased in the CKD group (P＜ 0. 05 or P＜ 0. 01). The histomorphometric analysis showed that both bone resorption and bone formation of the trabecular bone in the CKD group were increased, indicating a high bone turnover status. The volumes of both trabecular and cortical bones of rats in the CKD group were significantly lower than that of the normal control group (P ＜ 0. 05 or P ＜ 0. 01). However, the trabecular bone mineralization was not significantly different between the two groups. Conclusions The adenine-induced rat model of chronic kidney disease (CKD) established in this study shows reduced serum calcium and increased serum phosphorus and PTH, and medial layer vascular calcification of the aorta. With respect to renal osteodystrophy, this model shows a high trabecular bone turnover, normal trabecular bone mineralization, and low bone volume of cortical and trabecular bone, which meets the characteristics of osteitis fibrosa. This model may become a useful tool for future study of chronic kidney disease-mineral and bone disorder (CKD-MBD).

Communicating Hydrocephalus in a case of long-term primary Hyperparathyroidism / Journal of the ASEAN Federation of Endocrine Societies

@#We present the rare case of a 47-year-old woman with protracted primary hyperparathyroidism complicated by communicating hydrocephalus and cerebellar tonsillar herniation secondary to calvarial thickening. The parathyroidglands remained elusive, despite the use of advanced preoperative imaging modalities and three neck explorations.The serum calcium was optimally controlled with cinacalcet and alfacalcidol. Awareness of this rare complication is essential for early diagnosis and prompt intervention to prevent fatal posterior brain herniation

Maxillomandibular giant osteosclerotic lesions

Abstract Giant Osteosclerotic Lesions (GOLs) are a group of rarely reported intraosseous lesions. Their precise diagnosis is important since they can be confused with malignant neoplasms. Objective This retrospective study aimed to record and analyze the clinical and radiographic Giant Osteosclerotic Lesions (GOLs) detected in the maxillomandibular area of patients attending to our institution. Materials and Methods: Informed consent from the patients was obtained and those cases of 2.5 cm or larger lesions with radiopaque or mixed (radiolucid-radiopaque) appearance located in the maxillofacial bones were selected. Assessed parameters were: age, gender, radiographic aspect, shape, borders, size, location and relations to roots. Lesions were classified as radicular, apical, interradicular, interradicular-apical, radicular-apical or located in a previous teeth extraction area. Additionally, several osseous and dental developmental alterations (DDAs) were assessed. Results Seventeen radiopacities in 14 patients were found and were located almost exclusively in mandible and were two types: idiopathic osteosclerosis and condensing osteitis. GOLs were more frequent in females, and in the anterior and premolar zones. 94.2% of GOLs were qualified as idiopathic osteosclerosis and one case was condensing osteitis. All studied cases showed different osseous and dental developmental alterations (DDAs). The most common were: Microdontia, hypodontia, pulp stones, macrodontia and variations in the mental foramina. Conclusions GOLs must be differentiated from other radiopaque benign and malignant tumors. Condensing osteitis, was considered an anomalous osseous response induced by a chronic low-grade inflammatory stimulus. For development of idiopathic osteosclerosis, two possible mechanisms could be related. The first is modification of the normal turnover with excessive osseous deposition. The second mechanism will prevent the normal bone resorption, arresting the osseous breakdown process.

Chlorhexidine for prevention of alveolar osteitis: a randomised clinical trial

Abstract Objective To determine the effectiveness of chlorhexidine 0.12% mouthwash (CHX) after tooth extraction for the prevention of alveolar osteitis (AO). Material and methods We conducted a double-blind randomised clinical trial stratified by risk factors. We enrolled a cohort of 822 patients who underwent dental extractions, and were considered to be at risk of developing AO (previous surgical site infection, traumatic extraction, and tobacco smoking). After extraction, patients were randomly allocated for CHX group or placebo group, matched by risk factors. The primary outcome was clinical diagnosis of AO: increasing postoperative pain for 4 d within and around the socket, and total or partial breakdown of the blood clot in the socket with or without bone exposure. Results Follow-up was completed by 744 participants (372 chlorhexidine and 372 placebo). We detected no significant differences between the two groups at baseline. After completed follow-up, risk factors were equally distributed between the two groups. Overall incidence of OA was 4.97%, in which 27 participants treated with placebo (7.26%) and 10 participants treated with CHX (2.69%) developed AO. CHX reduced the incidence of AO by 63% [Absolute Risk Reduction: 4.57 (95% CI 1.5-7.7), Number Needed to Treat: 21.88 (95% CI 13.0-69.3), Fisher's exact test: p=0.006]. No adverse effects were reported. Conclusion The use of chlorhexidine 0.12% mouthwash after tooth extraction is safe and effective in reducing the incidence of AO in high-risk patients.

Subchondral Bone Restoration of Supra-acetabular Brown Tumor Secondary to Parathyroid Carcinoma: A Case Report / 대한고관절학회지

The causes of osteolytic lesions found in radiological examinations are not quite certain. Therefore, to determine the appropriate treatment method, various approaches and analyzes are required to find the real cause. Hyperparathyroidism is one of the diseases which forms osteolytic bone lesions so-called brown tumor. A 55-year-old woman who had painful osteolytic bone lesions in both hip joint areas was diagnosed as parathyroid carcinoma after serial work-up. She underwent parathyroidectomy and follow-up imaging showed a decrease in brown tumor size and bone consolidation in the subchondral bone destruction area. Proper evaluation of osteolytic bone lesions helps to avoid unnecessary operative treatments and the first choice for the treatment of osteolytic bone lesions caused by parathyroid carcinoma is parathyroidectomy.

Dry Socket Etiology, Diagnosis, and Clinical Treatment Techniques

Dry socket, also termed fibrinolytic osteitis or alveolar osteitis, is a complication of tooth exodontia. A dry socket lesion is a post-extraction socket that exhibits exposed bone that is not covered by a blood clot or healing epithelium and exists inside or around the perimeter of the socket or alveolus for days after the extraction procedure. This article describes dry socket lesions; reviews the basic clinical techniques of treating different manifestations of dry socket lesions; and shows how microscope level loupe magnification of 6× to 8× or greater, combined with co-axial illumination or a dental operating microscope, facilitate more precise treatment of dry socket lesions. The author examines the scientific validity of the proposed causes of dry socket lesions (such as bacteria, inflammation, fibrinolysis, or traumatic extractions) and the scientific validity of different terminologies used to describe dry socket lesions. This article also presents an alternative model of what causes dry socket lesions, based on evidence from dental literature. Although the clinical techniques for treating dry socket lesions seem empirically correct, more evidence is required to determine the causes of dry socket lesions.