Colocación de implantes en paciente con antecedentes de toma de bifosfonatos / Placement of implants in a patient with a history of bisphosphonates taken

El uso de bifosfonatos es un excelente tratamiento para pacientes con artritis reumatoide y enfermedades óseas, por ejemplo, osteoporosis. Se realiza un reporte de caso de paciente femenino, quien estuvo bajo consumo de este fármaco por prescripción de su médico para la prevención de artritis reumatoide postmenopausia. La paciente acude a consulta para la colocación de implantes en zona desdentada y comenta haber terminado el tratamiento de bifosfonatos hace un año. Se tomaron pruebas de diagnóstico y se realizó la colocación de implantes sin ninguna complicación. Sus citas de control fueron más frecuentes en cuatro meses, sobre todo por el detalle de consumo de bifosfonatos, pero en ninguna cita hubo algún detalle alarmante, la cicatrización iba en forma. Se dio de alta a la paciente después de sus citas periódicas y de asegurar su buena cicatrización a un implante bien situado (AU))

The use of bisphosphonates is an excellent treatment for patients with rheumatoid arthritis and bone diseases such as osteoporosis. Here is a case report of a female patient, who was under consumption of this drug by prescription of her doctor for the prevention of post-menopausal rheumatoid arthritis. The patient went to the consultation for the placement of implants in the edentulous area and comments having finished the bisphosphonate treatment one year ago. The diagnostic tests were taken, and the implant placement was performed well without any complications. The control appointments were more frequent in four months, especially due to the detail of bisphosphonate consumption, but in no appointment, there were any alarming details, the healing was in good shape. The patient discharged after her regular appointments and to ensure that she was healing well and that implant was well placed (AU)

Aggressive Diffuse Intraosseous Hemangioma: Case Report / Hemangioma intraósseo difuso agressivo: Relato de caso

Abstract Vertebral hemangioma is a benign vascular tumor that is usually asymptomatic and is discovered incidentally on imaging. When symptomatic, the most frequent presentation occursinthe formofvague back painofinsidiousonset and,inrare cases, maybeassociated with root or spinal compression, causing sensory and motor deficits. The authors report the case of a 33-year-old man, previously healthy, with a diagnosis of thoracic spine hemangio-ma at multiple levels, in the sternum, in the scapula and in the costal arches; all lesions were symptomatic,and surgicalinterventionwas required; oneof thelesionsatthe thoracicspine level evolved with spinal compression and acute neurological deficit, requiring urgent surgical intervention. Intraosseoushemangiomas represent<1%ofall bonetumors, having few reports of multifocal presentation in the axial and appendicular skeleton. In the literature review, no other case of aggressive multifocal intraosseous hemangioma with this presentation was found, including associated neurological symptoms in the same case.

Resumo O hemangioma vertebral, um tumor vascular benigno, geralmente é assintomático e descoberto incidentalmente em exames de imagem. Quando sintomático, a apresentação mais frequente ocorre sob a forma de dorsalgia vaga de início insidioso e, em raros casos, pode estar associadoa compressão radicularoumedular, causando déficit sensitivo emotor. Osautores relatamocasodeumhomemde33anos, previamentehígido, com diagnósticos de hemangioma na coluna torácica em múltiplos níveis, no esterno, na escápula e nos arcos costais; todas as lesões eram sintomáticas e houve necessidade de intervenção cirúrgica, sendo que uma das lesões ao nível da coluna torácica evoluiu com compressão medular e déficit neurológico agudo, com necessidade de intervenção cirúrgica de urgência. Os hemangiomas intraósseos representam<1% detodosostumores ósseos,eaapresentação multifocal no esqueleto axial e apendicular apresenta poucos relatos. Na revisão bibliográfica, não foi encontrado outro caso dehemangioma intraósseo multifocal agressivo com tal apresentação, inclusive com sintomas neurológicos associados em um mesmo caso.

Cannabis. Usos y aplicaciones en la práctica odontológica diaria: revisión de la literatura / Cannabis. Uses and applications in daily dental practice: a review of the literature

La evidencia científica presente en la literatura indica que el cannabis puede ser utilizado con fines terapéuticos para tratar distintas afecciones odontológicas. Dado el acceso sencillo a la cavidad bucal, las distintas formulaciones de cannabis pueden aplicarse de forma tópica. La aplicación local de dosis bajas de cannabis ha demostrado alta efectividad para tratar distintas afecciones bucales, constituyendo un tratamiento seguro con baja probabilidad de generar repercusiones sistémicas indeseadas. En la actualidad, está siendo incorporado a materiales convencionales de uso e higiene odontológica con la finalidad de aprovechar sus efectos terapéuticos. El cannabis tiene múltiples usos en odontología: como componen-te de enjuagues bucales y soluciones para la desinfección de conductos radiculares, en tratamientos de trastornos de ansiedad bucal, como complemento en terapias oncológicas, como analgésico para atenuar el dolor inflamatorio y el neuropático, como miorrelajante y condroprotector para tratar trastornos de articulación témporomandibular (ATM) y bruxismo, como osteomodulador para el tratamiento de patologías que comprometen la integridad ósea, como la enfermedad periodontal y la osteoporosis, y para la cicatrización ósea asociada a fracturas, extracciones dentarias e implantes, y como inmunomodulador con potencial terapéutico para tratar patologías autoinmunes como las enfermedades reumáticas. El trata-miento local con cannabis es efectivo, bien tolerado por el paciente y con pocos efectos adversos. Por lo tanto, se puede concluir que el cannabis aporta un enorme abanico de posibilidades terapéuticas para tratar distintas afecciones odontológicas, aunque aún se requiere mayor cantidad de estudios científicos que avalen su utilización en cada situación fisiopatológica particular (AU)

The scientific evidence present in the literature indicates that cannabis can be used for therapeutic purposes to treat different dental conditions. Given the easy access to the oral cavity, the different cannabis formulations can be applied topically. The local application of low doses of cannabis has shown high effectiveness in treating different oral conditions, constituting a safe treatment with a low probability of generating unwanted systemic repercussions. It is currently being incorporated into conventional materials for dental use and hygiene in order to take advantage of its therapeutic effects. Cannabis has multiple uses in dentistry: as a component of mouthwashes and solutions for disinfecting root canals, in the treatment of oral anxiety disorders, as a complement in oncological therapies, as an analgesic to reduce inflammatory and neuropathic pain, as a muscle relaxant and chondroprotective to treat temporomandibular joint disorders and bruxism, as an osteomodulator for the treatment of pathologies that compromise bone integrity, such as periodontal disease and osteoporosis, and or bone healing associated with fractures, dental extractions and implants, and as immunomodulator with therapeutic potential to treat autoimmune pathologies such as rheumatic diseases. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Therefore, it can be concluded that cannabis provides an enormous range of therapeutic possibilities to treat different dental conditions, although more scientific studies are still required to support its use in each particular pathophysiological situation (AU)

Daptomycin to bone and joint infections and prosthesis joint infections: a systematic review

ABSTRACT Backgroud: Daptomycin has been used in bone and joint infections (BJI) and prosthesis joint infections (PJI) considering spectrum of activity and biofilm penetration. However, the current experience is based on case reports, case series, cohorts, and international surveys. The aim of this systematic review was to evaluate studies about daptomycin treatment efficacy in BJI/PJI compared to other antibiotic regimens. Methods: PubMed, LILACS, Scielo and Web of Science databases were searched for articles about daptomycin and treatment of BJI and PJI from inception to March 2018. Inclusion criteria were any published researches that included patients with BJI treated with daptomycin. Diagnosis of BJI was based on clinical, laboratory and radiological findings according to IDSA guidelines. Results: From 5107 articles, 12 articles were included. Only three studies described the outcomes of patients with BJI treated with daptomycin with comparator regimen (vancomycin, teicoplanin and oxacillin). Studies presented large heterogeneity regarding device related infections, surgical procedures, and daptomycin regimens (varied from 4 mg/kg to 10 mg/kg). A total of 299 patients have been included in all studies (184 infections associated with orthopedic disposal and 115 osteomyelitis/septic arthritis). Two hundred and thirty-three patients were treated with daptomycin. The clinical cure rates on device related and non-device related infections (i.e. osteomyelitis) were 70% and 78%, respectively. Compared to all regimens evaluated, daptomycin group outcomes were non-inferior. Conclusion: Although a randomized clinical trial is needed, this systematic review tends to support daptomycin usage for bone and joint infections.

Reduced Frequency of Bone Pain Crises in Patients with Sickle Cell Disease Given an Angiotensin-converting Enzyme Inhibitor / Reducción de la frecuencia de la crisis de dolor óseo en pacientes con la enfermedad de células falciformes mediante los inhibidores de la enzima convertidora de angiotensina

ABSTRACT Objective: To determine if sickle cell disease (SCD) bone pain crisis is mitigated by use of an angiotensin-converting enzyme inhibitor (ACEI), following a case report of ACEIs preventing bone pain crisis. Methods: Patients with SCD who attended the Haematology Clinic at Jos University Teaching Hospital, Nigeria, were assessed with a questionnaire, given 2.5 mg of ramipril and followed up monthly for three months. Frequencies of bone pain crises in the month preceding enrolment and three months following treatment as well as the cardiovascular status were evaluated. Results: Thirty-five patients with complete data were reported. Blood pressure remained stable, and cumulative frequency of bone pain crises fell. The relative risk reduction for bone pain was 56.2% at one month, 63.0% at two months and 13.0% at three months. Conclusion: Vaso-occlussion-induced hypoxia, triggering bone pain crises, produces angiotensin II from angiotensin and worsens vasoconstriction. Angiotensin-converting enzyme inhibitors block this process, reducing severity or preventing bone pain crises. With these observations and a stable blood pressure profile, we recommend wider use of ACEIs in patients with SCD to cut down on the need of opioid use with attendant addiction risk, as a way of improving their quality of life.

RESUMEN Objetivo: Determinar si la crisis de dolor por la enfermedad de células falciformes (ECF) es mitigada con el uso de los inhibidores de la enzima convertidora de angiotensina (IECA), luego de un informe que reporta que IECA previene la crisis del dolor óseo. Métodos: A pacientes con ECF que asistían a la Cínica de Hematología del Hospital Docente de la Universidad de Jos, Nigeria, se les evaluó con un cuestionario, se les suministró 2.5 mg de ramipril, y se les hizo un seguimiento mensual por tres meses. Se evaluaron las frecuencias de las crisis de dolor óseo en el mes anterior al alistamiento y tres meses después del tratamiento, así como el estado cardiovascular. Resultados: Se reportaron treinta y cinco pacientes con datos completos. La presión sanguínea se mantuvo estable, en tanto que se produjo un descenso de la frecuencia cumulativa de las crisis de dolor óseo. La reducción del riesgo relativo del dolor óseo fue de 56.2% en un mes, 63.0% en dos meses, y 13.0% en tres meses. Conclusión: La hipoxia inducida por vaso-oclusión, que desencadena la crisis de dolor óseo, produce angiotensina II a partir de la angiotensina y empeora la vasoconstricción. Los inhibidores de la enzima convertidora de angiotensina bloquean este proceso, reduciendo la severidad o previniendo las crisis del dolor óseo. Con estas observaciones y un perfil de presión arterial estable, recomendamos hacer un amplio uso de IECA en pacientes con ECF para reducir la necesidad del consumo de opioides y el consiguiente riesgo de adicción, como una manera de mejorar su calidad de vida.

Baja masa ósea, osteoporosis primaria y secundaria en mujeres premenopáusicas / Low bone mass, primary and secondary osteoporosis in premenopausal women / Baixa massa óssea e osteoporose primária e secundária em mulheres na premenopáusicas

Existe escasa información sobre baja masa ósea y osteoporosis en mujeres premenopáusicas. Solo el 2% de las mujeres jóvenes consulta para evaluar la presencia de osteoporosis. En el 50% de las mujeres premenopáusicas que presentan una disminución de su masa ósea se diagnostican enfermedades o medicaciones que la provocan. Las causas deben ser cuidadosamente investigadas para no emitir un diagnóstico apresurado de osteoporosis premenopáusica. Al diagnóstico de baja masa ósea se arriba luego de descartar las causas que ocasionan osteoporosis secundaria y su etiología se relaciona genéticamente con un bajo pico de masa ósea. El cuadro de osteoporosis primaria presenta una densidad mineral ósea (DMO) muy disminuida y fracturas óseas por fragilidad. La etiología no es clara aún, la genética marca el 50-80% de lo que sucede con la masa ósea. Se ha encontrado en diferentes poblaciones, una disminución de la función osteoblástica, resistencia a IGF1, disminución de la hormona de crecimiento, bajos niveles de estradiol, alteración de la expresión del receptor a-estrogénico de los osteoblastos, alteración de la dinámica de secreción de la PTH y aumento de la excresión de interleuquina 1. El diagnóstico se realiza por densitometría, marcadores bioquímicos óseos y radiografías de columna dorsal y lumbar que permiten visualizar fracturas vertebrales asintomáticas. La International Society for Clinical Densitometry (ISCD) y las guías argentinas para osteoporosis sugieren definir la DMO premenopáusica por Z-score y se considera normal hasta -2.0. El tratamiento se basa fundamentalmente en generar hábitos saludables para el hueso: ingesta de calcio y vitamina D o suplementos de calcio y vitamina D, actividad física, evitar sustancias perjudiciales como alcohol y tabaco en exceso. Cuando la DMO es muy baja o existe una pérdida acelerada de DMO o fracturas por fragilidad, el tratamiento con teriparatide ha demostrado ser efectivo. Los bifosfonatos solo deben indicarse en situaciones especiales de osteoporosis. Cuando se diagnostica una osteoporosis secundaria, el tratamiento es el de la enfermedad que la provoca. Cada paciente debe ser analizada con mucha prudencia para arribar al diagnóstico correcto y al mejor tratamiento.

There is little information about low bone mass and osteoporosis in premenopausal women. Only 2% of young women consult to evaluate the presence of osteoporosis. A total of 50% of premenopausal women have a disease or take a medication that lessens their bone mass. The causes must be carefully investigated to arrive at a correct diagnosis. Diagnosing low bone mass up after ruling out secondary osteoporosis and its etiology is genetically related to low peak bone mass. Primary osteoporosis presents a very reduced bone mineral density (BMD) with bone fragility fractures. The etiology is not clear yet: genetics marks 50-80% of what happens with bone mass. Decreased osteoblast function, IGF1 resistance, decreased growth hormone, low estradiol levels, altered expression receptor a-estrogenic of osteoblasts, altered dynamics of PTH secretion, and increased excretion of interleukin-1 have been found in different populations. The diagnosis is not only performed by densitometry but also through bone biochemical markers and radiographs of thoracic and lumbar spine radiographs that can diagnose asymptomatic vertebral fractures. The International Society for Clinical Densitometry (ISCD) and Argentine guidelines suggest definition premenopausal osteoporosis by BMD Z -score, in which a value up to -2.0 is considered normal. The treatment is based primarily on healthy habits for the bone: intake of calcium and vitamin D or calcium and vitamin D supplements, physical activity, and avoiding damaging substances to the bone, like alcohol and tobacco in excess. When BMD is very low or there is a rapid loss of BMD or fragility fractures, teriparatide treatment has proven effective. The bisphosphonates should be indicated only in special patients with osteoporosis. When a secondary osteoporosis is diagnosed, the treatment given is for the disease that has caused it. Each patient must be analyzed with great care to arrive at the correct diagnosis and the best treatment.

Há pouca informação sobre baixa massa óssea e osteoporose em mulheres na pré-menopausa. Apenas 2% das mulheres jovens consulta para avaliar a presença de osteoporose. 50% das mulheres premenopáusicas que apresentam diminuição da massa óssea são diagnosticadas como causas doenças ou medicamentos. As causas devem ser cuidadosamente investigadas para emitir um diagnóstico rápido de osteoporose premenopáusica. Chega-se ao diagnóstico de baixa massa óssea após descartar as causas que provocam osteoporose secundária e sua etiologia é geneticamente relacionada com baixo pico de massa óssea. O quadro de osteoporose primária apresenta densidade mineral óssea (DMO) muito diminuída e fraturas ósseas por fragilidade. A etiologia ainda não está clara, a genética marca 50-80% do que acontece com a massa óssea. Foi encontrada em diferentes populações diminuição da função osteoblástica, resistência a IGF1, diminuição do hormônio de crescimento, baixos níveis de estradiol, alteração da expressão do receptor a-estrogênico dos osteoblastos, alteração da dinâmica de secreção de PTH, aumento da excreção de interleucina 1. O diagnóstco é realizado por densitometria, marcadores bioquímicos ósseos e radiografias de coluna dorsal e lombar que permitem visualizar fraturas vertebrais assintomáticas. A International Society for Clinical Densitometry (ISCD) e os Guias argentinos para osteoporose sugerem definir a DMO por Z-score e se considera normal até -2,0. O tratamento baseia-se principalmente em gerar hábitos saudáveis para o osso: ingestão de cálcio e vitamina D ou suplementos de cálcio e vitamina D, atividade física, evitar substâncias prejudiciais como álcool e tabaco em excesso. Quando a DMO é muito baixa ou há uma rápida perda de DMO ou fraturas por fragilidade, o tratamento com teriparatide demonstrou ser eficaz. Os bifosfonatos só devem ser indicados em situações especiais osteoporose. Quando uma osteoporose secundária é diagnosticada, o tratamento é o da doença que a provoca. Cada paciente deve ser analisado com muito cuidado para chegar ao diagnóstico correto e o melhor tratamento.

Ingesta de bifosfonatos y cirugía oral: ¿es viable? / Biphosphonates intake and oral surgery: is it feasible?

Es sabida la acción terapéutica favorable que los bifosfonatos ocasionan en el tejido óseo en aquellos pacientes que presentan como causa etiológica la osteoporosis. El presente artículo pretende relacionar tratamientocrónico con bifosfonatos nitrogenados y la cirugía oral, para lo cual la AAOMS define el concepto de Osteonecrosis Maxilar (ONM) asociada a tratamientocrónico con bifosfonatos como: Área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza ycuello

It is known the correct therapeutic actions that Bisphosphonates involved in bone tissue when patientsare affected with a pathologic cause: Osteoporosis.This article is supposed to communicate the interaction between nitrogen bisphosphonates and oral surgery, for that reason AAOMS describes Osteonecrosisof the Jaw (ONJ) as: “Exposed, necrotic bone in the maxillofacial region that has persisted for more than eight weeks with current or pervious treatment with bisphosphonates and had no history of radiation to thejaw”.

Pharmacological management of osteogenesis

Osteogenesis and bone remodeling are complex biological processes that are essential for the formation of new bone tissue and its correct functioning. When the balance between bone resorption and formation is disrupted, bone diseases and disorders such as Paget's disease, fibrous dysplasia, osteoporosis and fragility fractures may result. Recent advances in bone cell biology have revealed new specific targets for the treatment of bone loss that are based on the inhibition of bone resorption by osteoclasts or the stimulation of bone formation by osteoblasts. Bisphosphonates, antiresorptive agents that reduce bone resorption, are usually recommended as first-line therapy in women with postmenopausal osteoporosis. Numerous studies have shown that bisphosphonates are able to significantly reduce the risk of femoral and vertebral fractures. Other antiresorptive agents indicated for the treatment of osteoporosis include selective estrogen receptor modulators, such as raloxifene. Denosumab, a human monoclonal antibody, is another antiresorptive agent that has been approved in Europe and the USA. This agent blocks the RANK/RANKL/OPG system, which is responsible for osteoclastic activation, thus reducing bone resorption. Other approved agents include bone anabolic agents, such as teriparatide, a recombinant parathyroid hormone that improves bone microarchitecture and strength, and strontium ranelate, considered to be a dual-action drug that acts by both osteoclastic inhibition and osteoblastic stimulation. Currently, anti-catabolic drugs that act through the Wnt-β catenin signaling pathway, serving as Dickkopf-related protein 1 inhibitors and sclerostin antagonists, are also in development. This concise review provides an overview of the drugs most commonly used for the control of osteogenesis in bone diseases.

Histiocitosis dendrocítica (histiocitosis de células de langerhans), manifestaciones orales y craneofaciales: reporte de tres casos / Dendrocitic histiocytosis (langerhans cell histiocytosis), oral and craniofacial manifestations: report of three cases

La Histiocitosis de células de Langerhans (HCL) corresponde a una proliferación anormal de células dendríticas, de tipo clonal, cuyo espectro clínico general incluye compromiso de la piel y las mucosas, las uñas, el hueso, la médula ósea, el hígado, el bazo, linfonodos, el pulmón, el tracto gastrointestinal inferior, el sistema endocrino y el sistema nervioso central. En este trabajo presentamos tres casos de la enfermedad, con manifestaciones orales y craneofaciales, analizadas desde el punto de vista clínico (examen extra e intra oral), imagenológico (tomografías computadas) e histopatológico (expresión de marcador específico CD1a). Dos casos fueron clasificados como HCL de presentación aguda diseminada y uno como presentación crónica. Los pacientes fueron tratados oportunamente con quimioterapia según el protocolo del Programa Infantil Nacional de Drogas Antineoplásicas.

The Langerhans cell histiocytosis (LCH) corresponds to an abnormal proliferation of dendritic cells, clonal type, which usually involves compromise of skin and mucous membranes, nails, bone, bone marrow, liver, spleen, lymph nodes, lung, lower gastrointestinal tract, endocrine system and the central nervous system. We present three cases of the disease, with oral and craniofacial manifestations, analyzed from the clinical perspective (intra and extra oral exam), imaging (CT scans) and histopathological (specific marker CD1a expression). Two cases were classified as acute disseminated LCH presentation and one as a chronic disease. Patients were treated with chemotherapy timely according to the protocol of the National Child Program of Antineoplastic Drugs.

Management of Eosinophilic Granuloma Occurring in the Appendicular Skeleton in Children

BACKGROUND: We compared indomethacin therapy with the more aggressive approaches of anti-cancer chemotherapy and surgery in the treatment of isolated Langerhans cell histiocytosis (LCH) of bone in children. METHODS: Comparisons were made with respect to healing of the lesion without recurrence, time to radiological healing of the lesion, time to functional recovery, and complications related to treatment. RESULTS: Complete radiologic healing of the lesion (mean, 15.3 months) and functional recovery (mean, 5.6 months) were observed in all patients treated with either approach. No significant differences were noted in the time to complete radiologic healing or the time to functional recovery between the two groups. There were no recurrences with either approach until the last follow-up (mean, 56 months). Complications were common with anti-cancer chemotherapy, but indomethacin was well-tolerated. CONCLUSIONS: Indomethacin seems to be effective for treating isolated LCH of bone in children. Hence, morbidities associated with aggressive treatment approaches such as anti-cancer chemotherapy or surgery can be avoided.

Compromiso óseo en tres escolares por enfermedad por arañazo de gato / Tree schoolboys with bone compromise caused by cat scratch disease

La enfermedad por arañazo de gato (EAG)es una enfermedad infecciosa, producida por Bartonella henselae, de curso benigno, que se presenta frecuentemente como adenopatía crónica en niños. En un 5 a 25 por ciento se puede manifestar de forma atípica, con compromiso óseo, abdominal, neurológico y oftalmológico. Presentamos 3 casos de EAG de curso atípico, con compromiso óseo confirmado con cintigrafía ósea y serología positiva para Bartonella henselae. Después de tratamiento antibiótico se obtuvo completa mejoría clínica.

Cranial neuropathy and bone involvement in primary systemic amyloidosis.

Bone involvement in primary systemic amyloidosis is rare. Intracranial involvement in primary amyloidosis has not been reported so far. We report two cases of bone involvement in primary amyloidosis. The first patient also had combined deficiencies of factor IX and XII, while the second patient had associated intracranial involvement and XIIth cranial nerve palsy. Both these cases are unique in that, destructive bone lesions with intracranial involvement and combined factor deficiencies have not been reported in primary amyloidosis previously.

Influence of simvastatin on bone regeneration of tibial defects and blood cholesterol level in rats

The purpose of this study was to evaluate the effects of simvastatin, by oral or subcutaneous administration, on tibial defects regeneration and blood cholesterol level in rats. A surgical defect was made on the right tibia of 40 male animals assigned to 4 groups (n=10), based on two routes of administration and on the use or not of simvastatin: subcutaneous injection of simvastatin (7 mg/kg) (group AT) or only the vehicle of drug suspension (group AC), above the defect area, for 5 days; and 20 mg/kg of simvastatin macerated on water (group BT) or only water (group BC), orally, daily, during the whole observation period. The animals were sacrificed after 15 or 30 days, when blood samples were analyzed to check plasma cholesterol levels. Tibiae were removed and, after decalcification and routine laboratorial processing, histological and histomorphometrical analyses were carried out. ANOVA was used for statistical analysis at 5 percent signficance level. The histological and histomorphometrical analyses showed significant differences only between the experimental periods (p<0.05). Animals sacrificed after 30 days showed better bone repair (p<0.05). There was no statistically significant difference (p>0.05) for blood cholesterol levels between the groups. In conclusion, simvastatin administration either orally or subcutaneously did not improve bone repair of experimental tibial defects and did not alter blood cholesterol levels in rats.

Este estudo avaliou a influência da sinvastatina, administrada por via oral ou subcutânea, na reparação de defeitos ósseos em tíbia e nos níveis de colesterol sangüíneo, em ratos. Foram realizados defeitos cirúrgicos nas tíbias direitas de 40 ratos machos, distribuídos em 4 grupos (n=10), tomando-se como base duas vias de administração e o uso ou não de sinvastatina: injeção subcutânea de sinvastatina (7 mg/kg) (grupo AT) ou apenas do veículo de suspensão da droga (grupo AC), sobre a região do defeito, durante 5 dias; 20 mg/kg de sinvastatina (grupo BT) ou água filtrada (grupo BC) via oral, diariamente, durante todo o período de observação. Os animais foram sacrificados após 15 ou 30 dias, quando amostras sangüíneas foram colhidas para análise do nível de colesterol. As tíbias foram removidas e, após descalcificação e procedimentos laboratoriais de rotina, procedeu-se à análise histológica e histomorfométrica. Para avaliação estatística utilizou-se ANOVA com nível de significância de 5 por cento. As análises histomorfométrica e histológica mostraram diferença entre os grupos apenas com relação ao período experimental (p<0,05), apresentando os melhores resultados os animais sacrificados em 30 dias (p<0,05). Quanto ao nível de colesterol sangüíneo, não houve diferença estatisticamente significante entre os grupos analisados (p>0,05). Concluiu-se que, nas condições utilizadas, a sinvastatina, administrada via oral ou subcutânea, não exerceu efeito estimulador sobre o reparo ósseo de defeitos experimentais em tíbias de ratos e não alterou os níveis de colesterol sangüíneo.

Efficacy of Oral Etidronate for Skeletal Diseases in Japan

Etidronate is an oral bisphosphonate compound that is known to reduce bone resorption through the inhibition of osteoclastic activity. The efficacy of etidronate for involutional (postmenopausal and senile) and glucocorticoid-induced osteoporosis, as well as that for other skeletal diseases, was reviewed in Japanese patients. Cyclical etidronate treatment (200 mg or 400mg/day for 2 weeks about every 3 months) increases the lumbar bone mineral density (BMD) in patients with involutional osteoporosis and prevents incident vertebral fractures in patients with glucocorticoid-induced osteoporosis. The losses of the lumbar BMD in patients with liver cirrhosis and the metacarpal BMD in hemiplegic patients after stroke are prevented, and the lumbar BMD is possibly increased, preventing fragile fractures in adult patients with osteogenesis imperfecta type I. Furthermore, proximal bone resorption around the femoral stem is reduced and some complications may be prevented in patients who undergo cementless total hip arthroplasty. Oral etidronate treatment may also help to transiently relieve metastatic cancer bone pain followed by a decrease in abnormally raised bone resorption in patients with painful bone metastases from primary cancer sites, such as the lung, breast and prostate. Thus, oral etidronate treatment is suggested to be efficacious for osteoporosis, as well as other skeletal diseases associated with increased bone resorption, in Japanese patients. Randomized controlled trials needed to be conducted on a large number of patients to confirm these effects.

Efectos de bifosfonatos sobre el hueso y su repercusión sobre el movimiento ortodóncico: revisión de la literatura / The effects of biphosphonates on bones and their repercussion on orthodontic tooth movement: review of the literature

En esta revisión de la literatura se obtuvo información acerca de los efectos de los bifosfonatos sobre el hueso y las aplicaciones clínicas qaue tienen durante el movimiento de los dientes en ortodoncia. Los bisfosfonatos son una familia de drogas usadas actualmente en medicina para combatir afecciones óseas como: osteoporosis, metástasis óseas, osteolisis en mielomas, enfermedad de Paget, etc. En odontología, el efecto más notable entre otros es el de anclaje a nivel local durante el movimiento ortodóncico de los dientes pero existen otras especialidades de la odontología que se pueden beneficiar de los efectos de los bisfosfonatos, entre estas áreas tenemos la patología bucal, la odontopediatría, la cirugía y la periodoncia, ya que éstas, en casos especiales, hay requerimientos locales específicos para salvar un diente o incluso tratar peacientes con afecciones óseas sistémicas controladas por estas drogas o para remitirlos a un médico para que sean tratados con estas si hay alguna afección sistémica detectada por el odontólogo

Opioides tópicos. Una nueva herramienta terapéutica / Topical opioids. A new therapeutic tool

En este artículo se describe la utilización eficaz de morfina en forma típica en un paciente oncológico que no responde a tratamientos instaurados convencionales por la vía oral. Esto constituye una nueva herramienta terapéutica basada en estudios recientes que plantean la existencia de analgesia mu mediada periféricamente por presencia anatómica de receptores opioides en la periferia y por migración desde neuronas aferentes primarias, siendo la inflamación un requisito previo para su activación. Se demuestra su utilidad para el tratamiento del dolor de tipo oncológico y no oncológico: piel y mucosas, articulaciones, huesos, molares, córneas.

Tratamento das infecçöes ósseas pelo método de Ilizarov usando o transporte ósseo e/ou a osteossíntese monofocal / Treatment of osseous infections with the Ilizarov method using bone transport and/or monofocal osteosynthesis

Os autores estudaram 44 casos referentes a 43 pacientes portadores de infecçöes ósseas com várias etiologias, tratadas pelo método de Ilizarov, no período de maio de 1988 a fevereiro de 1995, no Hospital Universitário de Taubaté. A limpeza ampla da área infectada seguida de transporte ósseo foi praticada em 19(43,1 por cento) pacientes. A osteossíntese monofocal (compressäo ou compressäo seguida de traçäo de afastamento - distraction) sem limpeza do foco infeccioso foi utilizada em 25(56,8 por cento) pacientes. Em 9(36 por cento) pacientes que apresentavam imagens cavitárias ao RX simples fez-se a osteotomia oblíqua sobre o foco infeccioso, com posterior drenagem por compressäo. A antibioticoterapia foi utilizada em todos os pacientes submetidos ao transporte ósseo, após identificaçäo do agente microbiano pela cultura do material colhido no ato operatório. O seguimento dos 43 pacientes foi no mínimo de 1 ano e 8 meses e no máximo de 6 anos e 9 meses, com acompanhamento médio de 4 anos, 2 meses e 15 dias. Nos 19(43,1 por cento) pacientes em que o transporte ósseo foi usado ocorreram 11(57,9 por cento) consolidaçöes sem recidiva da infecçäo. A infecçäo permaneceu inativa em 13(68,4 por cento) pacientes. A consolidaçäo aconteceu em 14(73,7 por cento) pacientes; 8(42,1porcento) pacientes apresentaram resultados insatisfatórios. Nos 25(56,8 por cento) pacientes em que se utilizou a osteossíntese monofocal, 23(92 por cento) obtiveram consolidaçäo sem recidiva da infecçäo. A consolidaçäo ocorreu em 24(96 por cento), dos quais 1 (4 por cento) manteve a infecçäo ativa. Outro dos pacientes desse grupo de estudo (4porcento) permaneceu em pseudoartrose infectada. Na avaliaçäo do total de 43 pacientes estudados, 37(77,3 por cento) obtiveram a consolidaçäo com foco infeccioso inativo até o presente momento, tendo sido considerado como bom resultado

Pseudotumor inflamatório de mastóide: localizaçäo atípica / Inflammatory mastoid pseudotumor: atypical site

Os autores relatam e discutem o primeiro caso de pseudotumor inflamatório (PTI) de mastóide descrito na literatura médica. PTI é um termo descrito para caracterizar histologicamente um infiltrado de origem obscura sem atipias composto de linfócitos, células plasmáticas e neutrófilos. O diagnóstico de PTI é de exclusäo, sendo importante diferenciá-lo de patologias malignas. Nesta apresentaçäo discorreremos sobre as características da lesäo, a conduta diagnóstica e porpostas de tratamento.