scholarly journals An unusual case of bone regeneration of a necrotic mandible with pathologic fracture in an elderly hemodialysis patient with medication-related osteonecrosis of the jaw: a case report and review of the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Kunio Yoshizawa ◽  
Akinori Moroi ◽  
Ran Iguchi ◽  
Akihiro Takayama ◽  
Junko Goto ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Unusual Case ◽  
Pathologic Fracture ◽  
Osteonecrosis Of The Jaw ◽  
Intraoperative Bleeding ◽  
Case Presentation ◽  
Old Japanese ◽  
Systemic Condition ◽  
Intravenous Bisphosphonate ◽  
Rare Report

Abstract Background Bisphosphonates are frequently used for osteoporosis. Medication-related osteonecrosis of the jaw, a complication of bone-modifying agents, including bisphosphonates or angiogenic inhibitors, can be challenging to treat in elderly patients with numerous preexisting conditions. Achieving good treatment outcomes is especially difficult in patients with pathological fractures accompanied with extraoral fistulae. Case presentation We report an unusual case of prominent bone regeneration following palliative surgical treatment in a 72-year-old Japanese female patient undergoing hemodialysis. She previously had severe osteoporosis due to renal osteodystrophy and was receiving antiresorptive intravenous bisphosphonate. Computed tomography revealed a discontinuous left lower mandibular margin with a pathologic fracture and extensive, morphologically irregular sequestrum formation (80 × 35 × 20 mm). The patient was diagnosed with stage III medication-related osteonecrosis of the jaw and pathologic mandibular fracture. Immediately before the surgery, the anticoagulant used for dialysis was changed from heparin to nafamostat mesylate to reduce the risk of intraoperative bleeding. Sequestrectomy was performed under general anesthesia. Postoperative infection was not observed, the intraoral and submandibular fistula disappeared, and, surprisingly, prominent spontaneous bone regeneration was observed postoperatively at 6 months. Despite the severe systemic condition of the patient, the conservative surgical approach with sequestrectomy has yielded desirable results for more than 6 years since the surgery. Conclusions This rare report of spontaneous bone regeneration in a patient of advanced age and poor general condition is the oldest case of mandibular regeneration ever reported.

scholarly journals Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takehiro Hashimoto ◽  
Ryuichi Takenaka ◽  
Haruka Fukuda ◽  
Kazuhiko Hashinaga ◽  
Shin-ichi Nureki ◽  
...  
Keyword(s):  
Septic Shock ◽  
Therapeutic Strategy ◽  
Yersinia Pseudotuberculosis ◽  
Immunocompromised Host ◽  
Immunocompetent Patient ◽  
Case Presentation ◽  
Gram Negative ◽  
Old Japanese ◽  
The Right ◽  
Immunocompetent Patients

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

scholarly journals Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Seung-Hun Lee ◽  
So-Young Choi ◽  
Min-Su Bae ◽  
Tae-Geon Kwon
Keyword(s):  
Retrospective Study ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Osteonecrosis Of The Jaw ◽  
Group Differences ◽  
Bisphosphonate Treatment ◽  
Administration Route ◽  
Lesion Number ◽  
Different Characteristics ◽  
Intravenous Bisphosphonate

Abstract Purpose This retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP). Materials and methods This retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared. Results Total 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group. Conclusion IV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.

scholarly journals Falsely diagnosed thyrotoxicosis caused by anti-streptavidin antibodies and pre-wash procedures

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Takuya Ishikawa ◽  
Hiroyuki Sakai ◽  
Tokutaro Itaya ◽  
Suwanai Hirotsugu ◽  
Jumpei Shikuma ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Magnetic Particle ◽  
Thyroid Function Tests ◽  
Case Presentation ◽  
Analytical Interference ◽  
Function Tests ◽  
Inappropriate Treatment ◽  
Published Report ◽  
Old Japanese ◽  
Polyethylene Glycol Precipitation

Abstract Background Anti-streptavidin antibodies are causal determinants of analytical interference during Thyroid function tests, and numerous reports have detailed such interference, with anti-streptavidin antibodies attracting attention. Case presentation We conducted a straightforward investigation of interference due to anti-streptavidin antibodies, with a case of a 60-year-old Japanese man who consulted our department for inconsistencies between his clinical course and Thyroid function tests. Experiments were conducted using Cobas8000 e602, which employs assay procedures with pre-wash to evaluate FT4 and FT3 levels. Conclusions To our knowledge, this is the first published report to clearly investigate such interferences using a combination of polyethylene glycol precipitation, heterophilic blocking tube precipitation, streptavidin-coated magnetic particle precipitation, and different instruments with or without pre-wash. Clinicians should consider that interferences caused by anti-streptavidin antibodies could lead to a misdiagnosis of thyrotoxicosis. Moreover, discussions between laboratory specialists, clinicians, and manufacturers are required to identify interferences and avoid unnecessary examinations and inappropriate treatment.

563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Gungadin ◽  
A Taib ◽  
M Ahmed ◽  
A Sultana
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Unusual Case ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Case Presentation ◽  
Peritoneal Encapsulation ◽  
History Of ◽  
Gall Stone Ileus

Abstract Introduction Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band. Case Presentation A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band. Discussion Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula. Conclusions The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.

Bone Regeneration Without Bone Grafting After Resection of a Segment of the Mandible to Treat Bisphosphonate-Related Osteonecrosis of the Jaw

2011 ◽  
Vol 69 (10) ◽  
pp. 2657-2662 ◽  
Author(s):  
Frank Wilde ◽  
Jörg Hendricks ◽  
Christoph Riese ◽  
Niels Christian Pausch ◽  
Alexander Schramm ◽  
...  
Keyword(s):  
Bone Regeneration ◽  
Bone Grafting ◽  
Osteonecrosis Of The Jaw

scholarly journals Ascending aorta graft pseudoaneurysm and aortobronchial fistula caused by a fractured sternal wire: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Ali Amirghofran ◽  
Elahe Nirooei ◽  
Mohammad Ali Ostovan
Keyword(s):  
Unusual Case ◽  
Preventive Measures ◽  
Prosthetic Graft ◽  
Ascending Aorta ◽  
Dacron Graft ◽  
Thoracoabdominal Aorta ◽  
Case Presentation ◽  
Pseudoaneurysm Formation ◽  
Aortobronchial Fistula ◽  
History Of

Abstract Background Pseudoaneurysm of ascending aorta is a rare but serious complication of cardiovascular surgeries and it infrequently occurs in the normal prosthetic graft materials. We share our experience with an unusual case of ascending aorta Dacron graft pseudoaneurysm caused by a fractured sternal wire. Case presentation A 34-year-old man, known case of Marfan syndrome, with history of two prior aortic surgeries for aneurysm of ascending aorta, arch and thoracoabdominal aorta, presented with hemoptysis. The hemoptysis originated from an aortobronchial fistula secondary to a huge ascending aorta Dacron graft pseudoaneurysm. The graft erosion and subsequent pseudoaneurysm was caused by a fractured sternal wire. Surgical repair of the pseudoaneurysm was performed successfully and a Gore-tex patch was placed behind the sternum over the graft to prevent further direct contact of the wire and the graft. Conclusion Sternal wires can damage the adjacent vascular grafts and lead to fatal complications such as pseudoaneurysm formation. Thus, preventive measures such as using sternal bands and placing a covering layer between the sternal wires and aortic grafts are recommended in patients with dilated or replaced ascending aorta.

scholarly journals Bilateral Pulmonary Nodules after Surgery for Ameloblastoma: A Case of Misdiagnosis for 32 Years

2020 ◽  
Author(s):  
Jie Liu ◽  
Shudong Yang ◽  
zhen yu ◽  
Tao Bian
Keyword(s):  
Rare Case ◽  
Inflammatory Cell ◽  
Pulmonary Nodules ◽  
Radical Resection ◽  
Case Presentation ◽  
Bronchoscopic Biopsy ◽  
Medical Histories ◽  
Bilateral Lung ◽  
The Right ◽  
Systemic Condition

Abstract Background: We describe a rare case of metastatic ameloblastoma in a 68-year-old Chinese woman diagnosed with ameloblastoma of the right mandible in 1974. Case presentation: Despite radical resection, she experienced repeated local recurrences, including asymptomatic bilateral pulmonary nodules, cough, and hemoptysis diagnosed as non-malignant inflammatory cell infiltration. The patient developed an aggravated cough, palpitations, and dyspnea and was admitted to our respiratory department in September 2018. Chest computed tomography revealed multiple bilateral lung nodules, masses, and soft tissue opacities. She was diagnosed with advanced metastatic ameloblastoma in bilateral lungs via bronchoscopic biopsy, with a misdiagnosis time of 32 years. Because her systemic condition was poor, systemic chemotherapy and radiotherapy were not recommended. Dyspnea significantly improved after interventional bronchoscopic therapy and tumor electroexcision; she died of respiratory failure 1 year after diagnosis. Conclusions: Clinicians should carefully explore the medical histories of patients with surgical histories of ameloblastoma and subsequent unexplained pulmonary metastatic tumors to avoid misdiagnosis.

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