Comparison of the prognosis of bisphosphonate-related osteonecrosis of the jaw caused by oral and intravenous bisphosphonates.

Bisphosphonates (BPs) have been used in medical practice for the treatment of osteoporosis, bone metastasis, and multiple myeloma. Although many studies have been published, the treatment and prognosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ) remain unclear. This study included 59 patients with BRONJ: 29 had taken oral BPs and 30 had taken intravenous (IV) BPs. All received conservative treatments. When separated sequestra were seen, a sequestrectomy was performed. Segmental mandibular resection was performed when pathological fractures were diagnosed. The outcomes of treatments were compared between groups. For patients treated with oral rinses or mandibular resection, the number in whom clinical healing was observed did not differ between the oral BP and IV BP groups. With regard to sequestrectomy, 94% of patients in the oral BP group showed improvement with this treatment compared to 50% in the IV BP group. The number of patients in whom clinical healing of BRONJ was achieved was statistically better in the oral BP group than in the IV BP group after 6 months of treatment (P<0.001). The results showed that >90% of patients treated with oral BPs could be cured. However, 50% of patients treated with IV BPs did not show an improvement. Additional research is needed to further increase the therapeutic efficacy for the resolution of BRONJ.

Silent mixed ganglioneuroma/pheochromocytoma which produces a vasoactive intestinal polypeptide.

An unusual pheochromocytoma was incidentally discovered in a 48-year-old woman. The patient had a 3-year history of myasthenia gravis. At the time of examination in our hospital, the right adrenal tumor was incidentally discovered by ultrasonography of the abdomen. She had no history of headache, perspiration, palpitation or hypertension. Although blood catecholamine levels were within the normal limits, urinary secretion of catecholamine was elevated. Histologically, the tumor was diagnosed to be mixed ganglioneuroma/pheochromocytoma and histochemically confirmed to produce vasoactive intestinal polypeptide. Such a tumor is quite rare.

[The Japanese family of congenital high red cell membrane phosphatidylcholine hemolytic anemia].

A Japanese family of congenital high red cell membrane phosphatidylcholine hemolytic anemia (HPCHA) is reported. The propositus was a 48-year-old woman, who had been followed up as hemolytic anemia of unknown origin and undergone splenectomy. She showed no improvement after splenectomy. She also had primary biliary cirrhosis, of which a diagnosis was made based on laboratory data and liver biopsy. Red cell morphology demonstrated stomatocytosis with erythroid hyperplasia in the bone marrow. Abnormal hemoglobins and the red cell enzyme activities were not demonstrated. A marked abnormality was noted in red cell membrane lipids, specifically the elevation of phosphatidylcholine (PC) and free cholesterol (FC), despite of normal plasma lipids and lecithin cholesterol acyltransferase activity. Sodium transport, both influx and efflux, was increased. Therefore, the diagnosis of HPCHA was confirmed. The three additional cases were found in her pedigree. The data on the red cells of her mother and elder sister were similar to hers with respect to the red cell lipids and sodium transport. The propositus and her mother showed no improvement of anemia or icterus after splenectomy. There are only three reports of the family with HPCHA in the world.

[Significance of the bioclean room during the treatment of lung cancer].

The effectiveness of a vertical air flow room using HEPA filter (class 5000) was studied in relation to the prevention of infection during induction chemotherapy for primary lung cancer and metastatic pulmonary tumors. From November 1982 to July 1983, 12 patients (11 primary lung cancer: 9 small cell carcinoma, 2 non-small cell carcinoma and 1 metastatic pulmonary tumor) were treated in the bioclean room, while 14 patients (1 small cell carcinoma, 13 non-small cell carcinoma) were treated in conventional room during this period as control. Partial response was observed in 6 patients with small cell carcinoma treated in the bioclean room and 4 patients with non-small cell carcinoma treated in the conventional room. In patients treated in the bioclean room, the median day of stay in the room was 21 ranged 9 to 43. The leukocyte counts in the peripheral blood less than 1500/mm3 and 1000/mm3 were observed in 6 and 4 cases, respectively. Decrease in granulocyte counts less than 500/mm3 was observed in 6 cases. Only one patient with leukocyte count of 800 (granulocyte count 104) experienced fever higher than 38 C lasting 8 days. On the other hand, in 14 patients treated in the conventional room, leukocytopenia less than 1500/mm3 and 1000/mm3 was observed in 7 and 0 cases, respectively. Granulocytopenia less than 500/mm3 was observed in 8 cases, and 7 patients experienced fever higher than 38 C. Number of non-viable particles in the bioclean room ranged from 2.9 to 6.8 X 10(2)/ft3. Organisms isolated from the bioclean room and from the skin of patients were normal flora, and the numbers of colonies detected from the skin of patients decreased 1-2 weeks after the beginning of treatment in the bioclean room. The usefulness of a vertical air flow room during chemotherapy of lung cancer, especially of small cell carcinoma, was suggested.