RESUMO
Bone marrow lesions of the knee in patients with osteoarthritis (OA-BML) are an important clinical entity that may explain progressive pain, decreased quality of life, and impaired function. MRI of OA-BMLs demonstrates a region of subchondral bone with hyperintense marrow signal on T2-weighted images. Histopathology retrieval studies have demonstrated that these lesions correlate with microdamage of the trabecular bone, and subsequently, this leads to a vicious cycle of subchondral bone attrition, attempts at repair, pain, and progressive deformity. These lesions have also been linked to accelerated loss of adjacent articular cartilage and increases in the severity of knee pain, prompting patients to seek musculoskeletal care and treatment. Multiple studies have also correlated the presence of an OA-BML with an increased probability of seeking knee arthroplasty. Knowledge of these lesions is important in the context that knee OA is both a cartilage-based and bone-based disease. Further study of OA-BMLs may provide opportunities for early intervention and OA disease-modifying treatments.
Assuntos
Doenças da Medula Óssea/patologia , Doenças das Cartilagens/patologia , Osteoartrite do Joelho/patologia , Doenças da Medula Óssea/diagnóstico por imagem , Doenças da Medula Óssea/cirurgia , Doenças das Cartilagens/diagnóstico por imagem , Doenças das Cartilagens/cirurgia , Humanos , Imageamento por Ressonância Magnética , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Qualidade de Vida , Procedimentos de Cirurgia PlásticaRESUMO
Plantar fasciitis is one of the most common chief complaints seen in the foot and ankle clinic. With a relatively benign course, most cases are self-limiting or amendable to conservative therapy; ~90% of all plantar fasciitis cases will respond to these methods. When conservative treatment and time fail, surgical intervention can be necessary to improve outcomes. We present a novel method using Subchondroplasty® (SCP®; Zimmer Holdings, Inc.; Warsaw, IN) and revision fasciotomy in a case in which initial fasciotomy had failed. After the patient had failed to improve, a worsening underlying bone marrow lesion was identified at the origin of the plantar fascia; thus, SCP® was used with repeat fasciotomy. SCP® involves injecting calcium phosphate into bone marrow lesions to stimulate long-term bone repair. At 10 months after SCP®, the patient remained pain free and had returned to running at the final follow-up examination. This surgical treatment should be considered as an adjunctive procedure for those patients with plantar fasciitis, identifiable bone marrow lesions on magnetic resonance imaging, and continued pain when other treatment modalities have failed.
Assuntos
Doenças da Medula Óssea/cirurgia , Fosfatos de Cálcio/uso terapêutico , Fasciíte Plantar/cirurgia , Fasciotomia , Doenças da Medula Óssea/complicações , Doenças da Medula Óssea/diagnóstico por imagem , Fasciíte Plantar/complicações , Fasciíte Plantar/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.
Assuntos
Assistência Odontológica para Doentes Crônicos/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Avaliação das Necessidades/estatística & dados numéricos , Tratamento do Canal Radicular/estatística & dados numéricos , Adolescente , Adulto , Idoso , Contagem de Células Sanguíneas , Doenças da Medula Óssea/imunologia , Doenças da Medula Óssea/cirurgia , Criança , Feminino , Humanos , Terapia de Imunossupressão/efeitos adversos , Leucemia/imunologia , Leucemia/cirurgia , Linfoma/imunologia , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/imunologia , Mieloma Múltiplo/cirurgia , Fatores de Risco , Estatísticas não Paramétricas , Transplante Homólogo/efeitos adversos , Transplante Homólogo/estatística & dados numéricos , Adulto JovemRESUMO
Abstract The aim of this study is to investigate the relationship between the epidemiological and clinical profiles of patients before and after hematopoietic stem cell transplantation (HSCT) and the need for endodontic treatment. The subjects included 188 individuals enrolled in the dental care program for transplanted patients of the School of Dentistry, Federal University of Minas Gerais (Faculdade de Odontologia da Universidade Federal de Minas Gerais, FO-UFMG) from March 2011 through March 2016. The patients were subjected to an HSCT conditioning dental regimen based on a thorough clinical and radiographic evaluation. Intraoral periapical and bite-wing X-rays were obtained, and after evaluation, specific dental treatment was planned and performed. The following demographic and clinical data were collected from the patients' medical records: age, gender, transplantation stage, primary disease, transplant type, medication used, complete blood count at the time of visit, and need for endodontic treatment. The Kolmogorov-Smirnov and the chi-square tests were used. Leukemia (31.3%) and multiple myeloma (17.9%) were the most prevalent primary diseases. Most patients were subjected to allogeneic-related transplantation (83.6%). Most patients exhibited platelet counts and hemoglobin concentrations below the reference values in the pre-transplantation stage, while the neutrophil and platelet counts and the hemoglobin levels were within the reference ranges in the post-transplantation stage. The proportions of individuals requiring endodontic treatment were similar between the pre- and post-transplantation groups: 24.3% and 24.7%, respectively. The systemic conditions of the patients referred for dental treatment were compromised.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Tratamento do Canal Radicular/estatística & dados numéricos , Assistência Odontológica para Doentes Crônicos/estatística & dados numéricos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Avaliação das Necessidades/estatística & dados numéricos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/estatística & dados numéricos , Contagem de Células Sanguíneas , Doenças da Medula Óssea/cirurgia , Doenças da Medula Óssea/imunologia , Leucemia/cirurgia , Leucemia/imunologia , Fatores de Risco , Terapia de Imunossupressão/efeitos adversos , Estatísticas não Paramétricas , Linfoma/cirurgia , Linfoma/imunologia , Pessoa de Meia-Idade , Mieloma Múltiplo/cirurgia , Mieloma Múltiplo/imunologiaRESUMO
El transplante de médula ósea en el humano, tiene como objetivo el proporcionar al receptor un sistema hematopoyético nuevo que funcione permanentemente después de la administración de dosis supraletales de agentes quimiorradioterapéuticos utilizados como condicionamiento o preparación para el trasplante del mismo. El procedimiento debe efectuarse en un receptor que padezca una de las entidades (neoplasias hematológicas o de otro tipo, enfermedades congénitas o adquiridas de la médula ósea) en las cuales ésta plenamente demostrada su utilidad y que disponga de un donante histocompatible. La evidencia de funcionamiento de la nueva médula ósea se obtiene entre 14 y 28 días después de su infusión y en el período de aplasia se debe administrar soporte hematológico, nutricional y antibioticoterapia para mentener al receptor. Dentro de las complicaciones se debe mencionar la "enfermedad del injerto contra el huesped", el rechazo del injerto, la recurrencia de la enfermedad y las infecciones.
Assuntos
Humanos , Transplante de Medula Óssea , Neoplasias da Medula Óssea/cirurgia , Doenças da Medula Óssea/cirurgia , Doenças Hematológicas/cirurgia , Rejeição de Enxerto/etiologia , Medula Óssea/cirurgia , Medula Óssea/fisiopatologiaRESUMO
La Utilización de injertos óseos busca lograr una mayor consolidación ósea en situaciones clínicas particulares, tales como defectos por trauma, retardos de consolidación, artrodesis y tumores. Existe evidencia de la capacidad osteogénica de la médula ósea a partir de injertos autólogos de cresta ilíaca y de banco de hueso, ofrece aún una disponibilidad muy limitada. Este trabajo presenta los resultados de un estudio experimental en defectos óseos de conejos, tratados con injertos de médula ósea(MO) e injertos corticoesponjosos (CE) convencionales, efectuando un seguimiento comparativo radiológico, anatomopatológico y biomecánico al final de la consolidación. Los resultados obtenidos teniendo en cuenta los parámetros establecidos, mostraron consolidación ósea avanzada, tanto en los defectos con MO, como en los de CE. Se confirmó la actividad osteogénica propia de la médula ósea y la posibilidad de su aplicación clínica, debe ser tenida en cuenta en casos seleccionados