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PubMedDate not supplied

[The status of the teeth and periodontal tissues of children living in an area polluted by the wastes from an aluminum plant].

The author compares dental, periodontal, and bone system status of children living in two regions characterized by different degrees and patterns of environmental pollution. Children living in regions polluted by aluminum plant waste (sulfur dioxide, nitrogen dioxide, carbon monoxide, dust, hydrogen fluoride) developed specific abnormalities because of body poisoning with fluorides, namely, dental fluorosis, osteoporosis and osteosclerosis of the bones; periodontal diseases in these children were more incident than in controls. These findings prompted the development of a complex of sanitary, technologic, health, therapeutic and prophylactic measures aimed at reduction of fluorine levels in the environment to the normal level and of dental diseases incidence among children living near the Tajik aluminum plant.

Adolescent↗
PubMed1993

Use of skeletal surveys in the radiological assessment of renal osteodystrophy--a study in the Singapore General Hospital.

The aims of this review on the use of skeletal surveys in the radiological assessment of renal osteodystrophy were threefold: to describe the radiological pattern of renal osteodystrophy in a local cohort of patients with chronic renal failure, to assess whether serial radiographs of the hands may effectively replace full radiological skeletal surveys in the long-term follow-up assessment of renal bone disease, and to formulate a grading system for bone resorption due to hyperparathyroidism. A radiological study of 61 patients with chronic renal failure revealed 20 (32.8%) patients with unequivocal radiological signs of renal osteodystrophy. The main abnormal radiological features observed in descending order of frequency were: osteopenia with associated cortical thinning and coarsened bone trabecular pattern (75%), subperiosteal resorption (60%), osteosclerosis (50%), extraosseous calcification (30%) and periosteal new bone formation (15%). A five-grade method of assessing the severity and extent of bone resorption was formulated. The study showed that 40% of the patients with a radiological diagnosis of renal osteodystrophy did not show changes in the hand radiographs. This finding precluded a recommendation of hand radiographs being used alone in the long-term radiological follow-up of patients with renal bone disease. An alternative was proposed and this was a limited radiological skeletal survey of three projections: radiographs of both hands, chest including the clavicles and the pelvis. This limited study would result in a cost saving of 62% as compared to a full study.

Adult↗
PubMed1993

Fluor in the treatment of osteoporosis. An overview of thirty years clinical research.

It has long been known that fluoride "hardens" mineralized tissues. Fluoride ingestion through drinking water in areas naturally rich in fluoride leads to osteosclerosis, known as endemic fluorosis. The first suggestion that fluoride be used in the treatment of osteoporosis was made in 1964. However, despite 30 years of research, the treatment remains controversial. Fluoride has a dual effect on osteoblasts. On the one hand, it increases the birthrate of osteoblasts at tissue level by a mitogenic effect on precursors of osteoblasts, while on the other hand it has a toxic effect on the individual cell with mineralization impairment and reduced apposition rate resembling osteomalacia. Fluoride has a positive effect on axial bone density, but the axial bone gain is not matched by similar changes in cortical bone. Furthermore, approximately one third of patients are non-responders. The effect of the addition of fluoride to the drinking water on fracture rate is not clear. It probably only has a small relative impact on total hip fracture rates. In two controlled fluoride therapy studies the incidence of vertebral fractures decreased, while in two other studies it increased. Experience teaches that denser bones are not necessarily better bones. The major side effects of fluor therapy are skeletal fluorosis, gastrointestinal intolerance, and painful lower extremity syndrome. Fluoride is the single most effective agent for increasing axial bone volume in the osteoporotic skeleton; however, its therapeutic window is narrow. The best candidates for fluoride therapy are patients with axial osteoporosis but with good peripheral bone density. They should have a good renal function and vitamin D status.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Density↗
PubMed1993

[Topography of tumoral and pseudotumoral lesions of the proximal femur].

This study of the topographic distribution of tumoral and pseudotumoral lesions of the proximal femur shows that certain lesions have a preferential site, for example osteoid osteoma affects the internal cortex of the neck and diaphysis or the intertrochanteric zone; chondroblastoma occurs in zones of epiphyseal ossification of the head; fibrous dysplasia affects the femoral neck, while sparing the epiphyseal femoral head and trochanters. The island of osteosclerosis is situated, at least partially, in the support fan; so-called physiological cysts are situated on or above the midline of the neck and below the basicapital line. Osteolytic or mixed metastases preferentially involve Ward's triangle in the femoral neck and the intertrochanteric region. The sites of these lesions therefore appears to depend on the bony architecture which, in turn, is dependent on mechanical stresses. However, this purely morphological study fails to demonstrate whether mechanical stresses influence the development of these lesions.

Bone Cysts↗
PubMed1993

[Osteoid osteoma of the spine. Radiological study of 21 cases].

Spinal osteoid osteomas are rare. We report 21 cases, that have been studied and treated since 1985. The tumor affects young people, who are less than 25 years old. The pain is the most common sign. Diagnosis is difficult, but can be made by radiology. X ray sometimes enables to suspect the diagnosis. Scintigraphy shows a focus hyperfixation more suggestive. Computed tomography enables the diagnosis by showing a bony lacuna surrounded by osteosclerosis. Moreover, computed tomography localizes very well the nidus of the osteoid osteoma, and guides the surgical treatment. Since computed tomography, other techniques like angiography and tomography are less used for diagnosis.

Adolescent↗
PubMed1977

[Osteopetrosis ( Albers-Schönberg disease ). II. Personal contribution].

Five cases of marble bones in two families living near Brescia are presented. Case 1 (42-yr-old female) was a typical malignant form with deep and extensive eburnation, many pathological fractures, concomitant osteitis and the formation of many fistulae, massive spleen enlargement and infarct, and marked anaemia with clear signs of extra-medullary haemopoiesis. The patient died 5 yr after her first admission. Two of her brothers had had an identical, fatal form. Case 4 (28-yr-old male) was much the same: virtually general osteosclerosis despite the difference in age, marked spleen enlargement, a history of fractures, serious anaemia and extramedullary haemopoiesis. Benign pictures were seen in cases 2 and 3 (73- and 68-yr-old females). In case 5 (25-yr-old male), typical bone condensation was the only significant pathological sign. It is suggested that this, too, may be seen as a "benign" form.

Adult↗
PubMed1995

Bone fractures in children undergoing orthotopic liver transplantation.

This retrospective study documents the incidence and distribution of fractures in 117 children with end-stage liver disease who underwent orthotopic liver transplantation (OLT) over a 6-year period (1987-1993). Both the pre- and post-OLT phases were included. Nineteen children (16.2 %) sustained a total of 69 fractures. Age at time of fracture ranged from 3 months to 9 years 8 months (median 13.5 months). There was no documented trauma in 14/19 cases. Metabolic bone disease, assessed qualitatively on plain radiographs, was present in 17/19 children at the time of fracture. This took the form of rickets (n = 3), osteopenia (n = 12) and osteosclerosis (n = 2). Potential risk factors including pre-existing metabolic bone disease, drugs and immobilization were assessed. The findings emphasise the need for clinical and radiological awareness of the fracture risk, particularly during the peri-transplant period when this risk may be greatest.

Bone Diseases, Metabolic↗
PubMed1996

[Renal disease and trace elements].

Correlation between renal disease and trace elements includes following two types; 1) Renal failure due to excess of trace element intake into the body, such as itai-itai disease or heavy metal intoxication. 2) Disturbances of trace elements in patients with chronic renal failure, such as aluminum dementia and aluminum-related bone disease. Itai-itai disease occurred by water pollution with cadmium. Cadmium causes Fanconi syndrome in the kidney and osteomalasia in person, especially in old women, who were living near the riverside. Recently, we have shown that an itai-itai disease model can be made using rats by long-term intravenous injection of cadmium chloride. In patients with chronic renal failure, aluminum dementia and aluminum related bone disease were reported. However, aluminum dementia has disappeared by using reverse osmosis system for making dialysate. Fluoride should be one of ions which must be paid attention, because excess of fluoride cause mottled tooth and osteosclerosis. It may be dangerous to add fluoride into tap water system for the purpose of preventing decayed tooth, because fluoride retention in the serum may occur in patients with chronic renal failure.

Animals↗
PubMedDate not supplied

The role of DEXA bone densitometry in evaluating renal osteodystrophy in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: The aims of this study were to assess the clinical utility of total and regional bone densitometry in a large continuous ambulatory peritoneal dialysis (CAPD) population and to determine the clinical, biochemical, and radiographic variables that best identified osteopenic CAPD patients. DESIGN AND PATIENTS: A cross-sectional study was performed on 45 CAPD patients (19 males, 26 females), comprising the total CAPD population at the Princess Alexandra Hospital. MAIN OUTCOME MEASURES: Total body (TB), anteroposterior lumbar spine (APL), femoral neck (FN), Ward's triangle (WT), and skull bone mineral densities (BMDs) were measured using dual-energy x-ray absorptiometry (DEXA) and then correlated with clinical, biochemical, and radiographic indices of uremic osteodystrophy. RESULTS: BMDs were not significantly different from age- and sex-matched reference population data. Considerable regional variation of BMD Z scores were noted between FN (-0.11 +/- 0.23), WT (-0.11 +/- 0.22), and APL (1.22 +/- 0.04) (p = 0.003). APLZ scores were significantly reduced in patients with a previous history of fracture (-1.36 +/- 1.07 vs 0.89 +/- 0.31), bone pain (-0.72 +/- 1.08 vs 1.01 +/- 0.31), or steroid treatment (-0.62 +/- 0.39 vs 1.16 +/- 0.35). Increased BMD Z scores for APL (1.82 +/- 0.57 vs 0.38 +/- 0.29, p < 0.05), FN (0.32 +/- 0.36 vs -0.38 +/- 0.29, p = 0.014), and WT (0.45 +/- 0.38 vs -0.45 +/- 0.26, p < 0.05) were found in patients with radiographic hyperparathyroid bone disease. Both APL BMD Z scores and skull BMDs were weakly correlated with PTH (r = -0.33, p < 0.05 and r = -0.33, p < 0.05, respectively) and with CAPD duration (r = 0.30, p < 0.05 and r = -0.30, p < 0.05). Generally, however, total body and regional BMDs were poorly related to age, renal disease type, dialysis duration, renal failure duration, serum aluminum, calcium, phosphate, alkaline phosphatase, osteocalcin, and parathyroid hormone. CONCLUSIONS: We conclude that the prevalence of osteopenia is not increased in CAPD patients. Clinical and biochemical parameters do not reliably predict BMD measurements, but prior steroids and bone symptoms are major risk factors for important bone loss. Although DEXA can reliably detect osteopenia in different skeletal regions, its usefulness in detecting osteodystrophy is limited by the confounding effects of superimposed hyperparathyroid osteosclerosis, which increases BMD.

Absorptiometry, Photon↗
PubMed1996

In vivo adenovirus vector-mediated transfer of the human thrombopoietin cDNA maintains platelet levels during radiation-and chemotherapy-induced bone marrow suppression.

Thrombopoietin (TPO, c-mpl ligand) has emerged as a major hematopoietic cytokine stimulating megakaryocyte proliferation, endomitosis, and platelet production. This study shows that a single administration of an adenovirus (Ad) vector encoding TPO (AdCMV.TPO) abrogates thrombocytopenia induced in mice by carboplatin and irradiation. Normal Balb/c mice receiving the vector had increased platelet counts peaking at 7 days and returning to baseline by day 15. Mice rendered pancytopenic with 500 rads and 1.2 mg of carboplatin had a nadir platelet count of five percent of the baseline. Mice receiving AdCMV.TPO 3 days before receiving irradiation and chemotherapy achieved a platelet nadir fourfold higher, and had significant reduction in duration of thrombocytopenia, than mice receiving the control Ad vector. Introduction of AdCMV.TPO the same day of chemotherapy and irradiation was equally effective in acceleration of platelet recovery, but administration of AdCMV.TPO 3 days after chemotherapy-radiation had little effect on platelet recovery. At 30 days after therapy bone marrow and spleen of mice treated with AdCMV.TPO were populated with a large number of polyploid megakaryocytes, but there was no evidence of circulating megakaryocytes in the liver or lungs and no pathologic bone abnormalities such as osteosclerosis or myelofibrosis. These observations suggest that an Ad vector may be an excellent delivery system to provide adequate TPO production to maintain platelet levels in circumstances associated with life-threatening thrombocytopenia.

Adenoviruses, Human↗
PubMed1996

[Transplantation of pedicled pisiform bone to replace lunate bone with aseptic necrosis].

OBJECTIVE: To find out a new and effective method for the treatment of aseptic necrosis of lunate bone. METHODS: Blood supply and morphology of pisiform bone were investigated in 25 upper limbs and 57 sets of carpal bone from adult cadavers on the basis of anatomical study. The lunate bone was replaced with pisiform bone of pedicled blood vessel and tendon of musculus flexor earpiulnaris in 17 patients with aseptic necrosis of lunate bone (stage III). RESULTS: The patients were followed up for 18-46 months (average of 28 months). Complete relief of pain was obtained in all of the patients, and the range of motion of their wrists was improved. Grip strength was increased by 48.2%. Radiograph showed normal location of transferred pisiform bone without osteosclerosis and atrophy in 16 patients. Atrophy of pisiform bone was found 2 years after operation in one patient. In the 17 patients, 15 resumed their original jobs and 2 changed their jobs for other reasons. CONCLUSION: We consider that the carpal bone chain can be completely preserved by transplantation of pedicled pisiform bone, which it is an effective method to treat aseptic necrosis stage III of lunate bone.

Adult↗
PubMed1995

[Radiological signs of type I primary hyperoxaluria].

The authors report the radiological signs observed in 14 patients between the ages of 3 months and 16 years, suffering from type I primary hyperoxaluria. Four of these patients were being treated conservatively for renal failure and ten had reached end-stage renal failure. Stones were demonstrated in 9 patients. Nephrocalcinosis was present on the plain abdominal x-ray in 6 patients before dialysis, and in all patients dialysed for more than 3 months. Bone signs characteristic of type I primary hyperoxaluria were only observed in children with end-stage renal failure. Metaphyseal dense bands were revealed in 5 patients. Metaphyseal clear bands, observed in 4 patients, occurred later and appeared to replace dense bands which moved towards the diaphysis. The other signs detected were osteosclerosis of the vertebrae and ilium (4 patients) and epiphyseal subchondral clear bands (one patient).

Adolescent↗
PubMed1996

[Destructive arthrosis of the hip. Natural history, pathogenesis, and radiographic features].

Degenerative hip arthritis is caused by the joint failing to bear the normal walk load, because of changes in the anatomical components and of some factors leading to static or dynamic unbalance of the joint surfaces. Degenerative arthritis usually evolves slowly, but its evolution is rapid under certain circumstances and in elderly patients. In such cases destruction is severe and irregular erosions are observed in the femoral heads, which become small and move to the superior lateral edge of the acetabulum. Osteophytes and reactive osteosclerosis are uncommon. Severe pain, functional inability and lower limb shortening are quite constant findings. The patient is often immobilized in bed and risks his/her life. Since the pathogenesis of destructive arthritis is still debated and its clinical features are severe, the knowledge of the natural history and of the underlying factors appears to be very important. The only therapy is arthroprosthesis and prevention becomes, therefore, necessary. On the basis of radiographic findings, we selected three groups of elderly patients hospitalized from 1992 to 1995; of them, 178 had destructive arthritis. The control group consisted of 102 patients with degenerative arthritis and 188 with normal hip joints. The radiographic patterns were related to some clinical and laboratory findings, which are the suspected pathogenetic factors. Two main factors emerged, with high statistical development risk (p < 0.01): hypoxia from femoral head ischemia, due to atherosclerotic vasculopathy and associated anemia, and the articular biodynamic changes which, through minor repeated trauma, cause the lesions, with the appearance of stress fractures.

Aged↗
PubMed1996

[Radiographic manifestations in teeth and jaws in chronic kidney insufficiency].

Forty-five patients affected with chronic renal failure (29 men and 16 women; mean age: 47.8 years), treated with hemodialysis for 4 to 245 months (mean: 66.9 months) were examined with panoramic and skeletal radiographs-the latter of the skull, hands, shoulders and clavicles, pelvis and spine. The control group (45 subjects with no renal diseases) was examined only with panoramic radiography. Dental and skeletal radio-graphs were given an 0-6 score and then compared to assess a possible relationship between skeletal and dental changes at radiography. Twenty-six dialysis patients (57.7%) had radiographic abnormalities in the maxillary bones-i.e., osteoporosis (100% of patients), focal osteosclerosis adjacent to the roots (11.5%), lamina dura reduction or loss (26.9%), calcifications of soft tissues or salivary glands (15.3%) and brown tumors (7.6%). In the teeth of dialysis patients, the dental pulp chamber was narrowed in 11.1% and hypercementosis of the roots was observed in 4.5%. Radiographic abnormalities in the hand, shoulder and pelvis were depicted in 51.1% of dialysis patients-in 86.9% of them with maxillary lesions. In the control group, 15.5% had mandibular bone lesions-i.e., osteopenia, cortex reduction at the mandibular angles and cyst-like lesions -but the evidence of caries and periodontal disease did not differ from that in the dialysis group. The diagnosis and follow-up of dialysis patients are currently made with serum biochemistry, radiography and histology. The purpose of skeletal radiology is to monitor the progression or regression of musculoskeletal abnormalities. Panoramic radiography might be useful in monitoring renal osteodystrophy, especially to assess the response to therapy-i.e., parathyroidectomy, calcium or vitamin-D therapy and renal transplant.

Adult↗
PubMed1996

Mastocytosis presenting as a skeletal disorder.

Mastocytosis is a rare disease of mast-cell proliferation with involvement of the reticuloendothelial systems including skin, bone, gastrointestinal tract, liver, lungs, spleen, and lymph nodes. Systemic mastocytosis is characterized by a combination of symptoms that relate to the mast cells' release of vasoactive substances, such as histamine. These symptoms include urticaria pigmentosa, flushing, syncope with hypotension, headaches, nausea, vomiting, diarrhea, and occasional bronchospasm. The diagnosis of mastocytosis is typically based on the presence of the characteristic extraosseus manifestations. A well recognized roentgenographic feature seen in 70-75% of patients with mastocytosis is diffuse osteolysis and osteosclerosis, affecting primarily the axial skeleton and the ends of the long bones. Rarely, the bony involvement consists of generalized osteoporosis, which may lead to pathologic fracture, or solitary lesions (mastocytomas) which may cause symptoms of localized pain. Four patients with previously diagnosed systemic mastocytosis had unusual skeletal lesions. Clinical and laboratory evaluation of these patients eventually led to the correct diagnosis of systemic mastocytosis. We report these four cases to emphasize the need for thorough evaluation of unusual musculoskeletal findings in association with extraosseus symptoms that are characteristic of mastocytosis. Knowledge of a wide differential diagnosis of unusual skeletal lesions should include systemic mastosytosis.

Adult↗
PubMed1997

[Involvement of the temporomandibular joints in Bechterew's disease].

Temporomandibular joints are involved in Bechterew's diseases in 59.6% of cases, more often in the peripheral form of the disease. Involvement at the debut of the disease was observed in 33.3%, including monoarthritis in 28.6%. The incidence of these lesions correlated with involvement of the hip, knee, and ankle joints. Unstable symmetrical arthritides with early rigidity predominate in the clinical picture. Extraarticular symptoms, such as defiguration, tenosynovitis, are typical. X-ray examination reveals pseudodilatation of the joint fissure, periarticular osteosclerosis, ossification of the ligaments, early ankylosis without predestruction. Erosive changes of the temporomandibular joint are not typical. Scintigraphy with pertechnephore is an informative method for ruling out other diseases of the temporomandibular joint.

Cephalometry↗
PubMed1997

[Thrombopoietin is a multifunctional factor].

Thrombopoietin (TPO) is the critical regulator of proliferation and differentiation of megakaryocytic lineage. TPO has potent stimulatory effects on platelet production in patients with chemotherapy-induced thrombocytopenia. In addition to sustaining megakaryocytopoiesis, TPO may play an important role in regulating neutrophil activation and erythropoiesis. Furthermore, TPO induces proliferation of acute myeloblastic leukemia cells in vitro in some cases. These results suggest that TPO may be multifunctional factor. Recently osteosclerosis is observed in TPO transgenic mice. To determine whether TPO can modulate the osteoclastic differentiation from hematopoietic stem cells, we investigated the effect of TPO on in vitro osteogenesis. TPO inhibited the formation of osteoclastic cells and decreased the areas of bone resorption pits in a dose-dependent manner. We examined whether transforming growth factor-beta (TGF-beta) and platelet derived growth factor (PDGF), major cytokines produced by megakaryocytes, mediate the inhibitory effect of TPO. The addition of either anti-TGF-beta or anti-PDGF antibody to bone marrow cell cultures completely antagonized the effect of TPO on osteoclastogenesis. These data suggest that TPO inhibits osteoclastogenesis by stimulating thrombopoiesis and that TGF-beta and PDGF mediate the effect of TPO by impacting macrophage-lineage cells as osteoclast precursors.

Animals↗
PubMed1997

High thrombopoietin production by hematopoietic cells induces a fatal myeloproliferative syndrome in mice.

To evaluate the effects of long-term, high-dose exposure to thrombopoietin (TPO), lethally irradiated mice were grafted with bone marrow cells infected with a retrovirus carrying the murine TPO cDNA. Mice were studied for 10 months after transplantation. In plasma, TPO levels were highly elevated (10(4) U/mL) throughout the course of the study. All mice developed a lethal myeloproliferative disorder evolving in two successive phases. During the first phase (7-9 weeks posttransplant), platelet and white blood cell (WBC) counts rose four- and ten-fold, respectively, whereas hematocrits decreased slightly to 29% +/- 3%. The WBC were mainly mature granulocytes, but myeloid precursor cells were invariably observed as well as giant platelets with an irregular granule distribution. The striking features were a massive hyperplasia of megakaryocytes and granulocytes in the spleen and bone marrow and a hypoplasia of erythroblasts in bone marrow. Total numbers of megakaryocyte colony-forming cell, burst-forming unit-erythroid, and granulocyte macrophage colony-forming cells were increased but colony-forming unit-erythroid numbers decreased. From 10 weeks posttransplant and thereafter, WBC, platelets, and red blood cell numbers declined dramatically. The absolute numbers of progenitor cells were very low in the spleen and bone marrow, but sharply increased in the blood and peritoneal cavity. Extramedullary hematopoiesis was observed in several organs. Histologic sections of the spleen and bones revealed severe fibrosis and osteosclerosis. The mean survival time was 7 months posttransplant and mice died with severe pancytopenia. Notably, two mice died between 3 and 4 months posttransplant with a leukemic transformation. This disorder was transplantable into secondary recipients who developed an attenuated form of the disease similar to the one previously described (Yan et al, Blood 86:4025, 1995). Taken together, our data show that high and persistent TPO production by transduced hematopoietic cells in mice results in a fatal myeloproliferative disorder that has a number of features in common with human idiopathic myelofibrosis.

Animals↗