[Kahler's disease. Multiple myeloma]

Item does not contain fulltextKahler's disease, multiple myeloma, is a malignant condition of unbridled multiplication of plasma cells in bone marrow. Clinical features are anaemia, pain in the affected bones, spontaneous bone fractures and increased infection susceptibility. In the final stage of the disease severe renal failure can occur. With the present chemotherapy a good response is seen in 50-70% of patients, but complete response occurs only in a minority of patients. Radiotherapy is often used in addition to chemotherapy. Bisphosphonates are used to inhibit osteolysis and to prevent complications associated with osteolysis. Recently, an association was found between use of bisphosphonates and jaw osteonecrosis. In order to minimize the risk of complications, it is advocated to be in touch with the patients haematologist before starting an invasive oral treatment

Does hyperbaric oxygen therapy play a role in the management of osteoradionecrosis? A survey of Dutch oral and maxillofacial surgeons

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A computed tomographic evaluation of change in bone volume after secondary bone grafting over the first postoperative year

The result of secondary alveolar bone grafting has been evaluated in many ways. 1–3 When there is only the need to see a bony bridging of the cleft several months after operation the evaluation method can be simple. 1 In these cases, conventional dental radiography will be sufficient to visualize the cleft area. Bergland et al. 2 and Enemark et al. 3 used conventional dental radiographs to make a quantitative analysis of the remaining bone graft in the cleft to measure the rate of success which was determined by the coverage of the root of both teeth adjacent to the cleft. The use of computed tomographic scans increased the amount of information about the cleft area and so became more widely used for this purpose. 4–8 Several methods of quantitative measurement have been described. Besides the evaluation of the transplanted bone, computed tomographic scans can be used for imaging the position of the cuspid, the position of other teeth in the cleft area, to visualize asymmetries of the face resulting from clefts, and for planning implants if necessary. The aim of this study was to evaluate whether there was resorption of the bone graft and to determine what would happen to the bone volume of the cleft area after the secondary bone grafting

Cone-beam CT in the assessment of mandibular invasion by oral squamous cell carcinoma: results of the preliminary study.

Contains fulltext : 89390.pdf (publisher's version ) (Closed access)This preliminary retrospective study evaluates the diagnostic value of cone-beam computed tomography (CBCT), as a potential standard preoperative procedure, in assessing mandibular invasion by oral squamous cell carcinoma (OSCC) compared with conventional preoperative panoramic radiography (PR), magnetic resonance imaging (MRI) and histological examination of the resection specimen (the golden standard). Between September 2006 and September 2009, 23 patients with histology proven primary OSCC, adjacent to or fixed to the mandible were included. The tumours were classified into four groups, ranging from no bone invasion to evident bone invasion. Sensitivity and specificity for PR were 55% (95% CI [0.350;0.619]) and 92% (95% CI 0.737;0.984]), respectively, both were significantly lower than the 91% (95% CI [0.740;0.909]) and 100% (95% CI [0.845;1]), respectively, for CBCT. MRI showed 82% sensitivity (95% CI [0.608;0.941]) and 67% specificity (95% CI [0.474;0.779]). CBCT has the potential to become a new diagnostic tool in the OSCC screening procedure to predict mandibular invasion or erosion, but its value may be limited by its relatively low sensitivity. A prospective study will start on 64 patients (alpha=0.05; power 0.8; effect size 0.5) to improve these results statistically.1 mei 201

Prevention of thrombosis after microvascular tissue transfer in the head and neck. A review of the literature and the state of affairs in Dutch Head and Neck Cancer Centers.

Item does not contain fulltextFree vascularized graft or free-flap reconstruction is frequently used in the reconstruction of defects in head and neck oncology patients. A common complication in free-flap surgery is thrombosis. Thrombosis occurs in 8-14% of cases and often leads to flap failure. A review of the literature on this subject was carried out and Dutch head and neck cancer centres were asked to share their guidelines concerning the prevention of thrombosis after free vascularized graft surgery. No consensus in the literature was found on how thrombosis could best be prevented. The Dutch Head and Neck Cancer Centers use routine deep venous thrombosis prophylaxis to prevent thrombosis in the anastomosis. It was also concluded that non-pharmacologic measures for preventing thrombosis, such as meticulous microvascular surgery and smoking cessation prior to the operation, are thought to play an important role in the prevention of thrombosis in microvascular free-flap reconstructions. It has not been determined which pre- and postoperative pharmacologic measure can prevent thrombosis most effectively. A pharmacologic regimen to prevent thrombosis that is customized to the patient is suggested. This should be based on an individual risk profile for the development of thrombosis.1 februari 201

Evaluatie van de effectiviteit van toevoeging van hyperbare zuurstoftherapie aande behandeling van late bestralingsschade van de mandibula (osteoradionecrose)

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Hyaluronan accumulation and arrested oligodendrocyte progenitor maturation in vanishing white matter disease

Vanishing white matter disease is a genetic leukoencephalopathy caused by mutations in eukaryotic translation initiation factor 2B. Patients experience a slowly progressive neurological deterioration with episodes of rapid clinical worsening triggered by stress. The disease may occur at any age and leads to early death. Characteristic neuropathological findings include cystic degeneration of the white matter with feeble, if any, reactive gliosis, dysmorphic astrocytes and paucity of myelin despite an increase in oligodendrocytic density. These features have been linked to a maturation defect of astrocytes and oligodendrocytes. However, the nature of the link between glial immaturity and the observed neuropathological features is unclear. We hypothesized that the defects in maturation and function of astrocytes and oligodendrocytes are related. Brain tissue of seven patients with genetically proven vanishing white matter disease was investigated using immunohistochemistry, western blotting, quantitative polymerase chain reaction and size exclusion chromatography. The results were compared with those obtained from normal brain tissue of age-matched controls, from chronic demyelinated multiple sclerosis lesions and from other genetic and acquired white matter disorders. We found that the white matter of patients with vanishing white matter disease is enriched in CD44-expressing astrocyte precursor cells and accumulates the glycosaminoglycan hyaluronan. Hyaluronan is a major component of the extracellular matrix, and CD44 is a hyaluronan receptor. We found that a high molecular weight form of hyaluronan is overabundant, especially in the most severely affected areas. Comparison between the more severely affected frontal white matter and the relatively spared cerebellum confirms that high molecular weight hyaluronan accumulation is more pronounced in the frontal white matter than in the cerebellum. High molecular weight hyaluronan is known to inhibit astrocyte and oligodendrocyte precursor maturation and can explain the arrested glial progenitor maturation observed in vanishing white matter disease. In conclusion, high molecular weight species of hyaluronan accumulate in the white matter of patients with vanishing white matter disease, and by inhibiting glial maturation and proper function, they may be a major determinant of the white matter pathology and lack of repair. © (2012) The Author

Quality of porcine blastocysts produced in vitro in the presence of absence of GH

GH receptor (GHR) mRNA is expressed in bovine in vitro produced embryos up to the blastocyst stage and GH improves the quality of bovine embryos by increasing blastocyst cell numbers and reducing the incidence of apoptosis as evaluated by DNA strand-break labelling. Porcine in vitro produced blastocysts have lower cell numbers than in vivo blastocysts and exhibit higher incidences of apoptosis. Therefore we investigated the effects of 100 ng GH/ml NCSU23 medium during in vitro culture of presumptive in vitro fertilized sow zygotes on embryo development and blastocyst quality (defined by diameter, cell number, apoptosis and survival after non-surgical transfer). In vivo produced blastocysts were analysed concurrently as a reference value. GHR was expressed in embryos from the 2-cell to blastocyst stages. GH had no effect on blastocyst development or cell numbers, but increased the mean blastocyst diameter. The incidence of apoptosis, detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL), was decreased by GH, but when non-TUNEL-labelled apoptotic fragmented nuclei were included, no difference was seen. GH appeared to slow down the progression of apoptosis though. In vivo produced blastocysts presented no apoptotic nuclei, and contained higher cell numbers and larger diameters. Pregnancy rates on day 11 were similar for all groups, but survival was poorer for in vitro than in vivo produced blastocysts. In this study GH appeared to be beneficial only from the blastocyst stage, but the presence of GHR from early cleavage stages nevertheless indicates a role for GH throughout porcine embryo development and deserves further investigation