The Preventive Effect of Preoperative and Postoperative Selenium on the Medication-Related Osteonecrosis of the Jaw: An Animal Study in Rats.

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a condition that can occur primarily in patients undergoing or have previously undergone therapy with bisphosphonates, particularly in the presence of risk factors, such as tooth extraction (TE). PURPOSE: This study aimed to evaluate the effect of selenium (SEL) administration on the prevention of osteonecrosis of the jaw in an MRONJ animal model. STUDY DESIGN, SETTING, AND SAMPLE: This study was a longitudinal in vivo animal study using a TE model in a sample of 48 Wistar rats. PREDICTOR VARIABLE: The predictor variables were SEL exposure, timing of SEL exposure, and zoledronic acid (ZOL) exposure. The animals were randomly assigned to 4 treatment groups (n = 12 per group): 1) saline (negative control), 2) ZOL (positive control), 3) SELpreop + ZOL, and 4) ZOL + SELpostop. The animals were administered saline (negative control) or ZOL (0.06 mg/kg, intraperitoneally) once a week for 5 weeks. All rats underwent TE at the end of the fifth week. SEL (0.3 mg/kg, intraperitoneally) was administered once daily for 15 days to the SELpreop + ZOL group before TE and to the ZOL + SELpostop group after TE. All animals were sacrificed at the end of the ninth week. MAIN OUTCOME VARIABLES: The primary outcome variables were new bone area, necrotic bone area, fibrosis, new connective tissue formation, and inflammatory cell infiltration in the histopathological analysis, as well as angiogenesis and percentage of osteoblasts in the immunohistochemical analysis. COVARIATES: There was none. ANALYSES: Statistical analysis was conducted using the Kruskal-Wallis test, followed by post hoc Bonferroni-corrected Mann-Whitney U tests, with a significance level of P ≤ .05. RESULTS: The new bone area was higher in the ZOL + SELpostop group (3.00 score) than in the saline group (0.58 ± 1.08 score, P < .001) and the ZOL group (0.82 ± 1.40 score, P = .001), while the necrotic bone area was lower in the ZOL + SELpostop group (0.08 ± 0.29 score) than in the ZOL group (2.82 ± 0.40 score, P < .001) and the SELpreop + ZOL group (1.67 ± 0.89 score, P = .007). The percentage of osteoblasts was higher in the ZOL + SELpostop group (18.73%) than in the saline group (8.63%, P < .001) and the ZOL group (0.07%, P < .001), and it was also higher in the SELpreop + ZOL group (18.49%) than in the ZOL group (0.07%, P < .001). CONCLUSION AND RELEVANCE: In conclusion SEL prevents MRONJ, with postoperative SEL demonstrating greater prevention effects. Given these findings, we hypothesize that SEL exposure may decrease the risk of MRONJ.

The role of laparoscopy in suspicious abdomen pain in children.

OBJECTIVE: Abdominal pain is a frequently encountered problem in children. Suspicious right lower quadrant pains are sometimes a problem for pediatric surgeons. In this study, we wanted to evaluate the effectiveness of laparoscopy in diagnosis and treatment of children with suspicion of abdominal pain. METHODS: The files of 84 patients treated with a diagnosis of suspicious right lower quadrant peritonitis between 2005 and 2011 were investigated. Laparoscopic exploration was performed for all cases with right lower quadrant pain where the appendix was not seen on USG/CT and the cause of acute abdomen could not be determined. RESULTS: In this process, 84 patients consisting of 60 (71%) females and 24 (29%) males were included in the study. The mean age was 10.5 years (7-16 years). Appendicitis was determined during diagnostic laparoscopy in 35 (41.6%) patients. The appendix was normal in the remaining 49 (58.3%) patients. In 36 of these patients, gynecological diseases were encountered on pathology as the most frequent cause of the acute abdomen. The appendix was preserved in patients where the cause of the abdominal pain was explained. CONCLUSION: Laparoscopy can be used in the diagnosis and treatment of patients with suspected acute abdomen that imitates acute appendicitis and cannot be differentiated with physical examination and laboratory methods. Delays in diagnosis and unnecessary appendectomy will be prevented in this way.