DOCSLIB.ORG

Upper Jaw Chronic Osteomyelitis. Report of Four Clinical Cases Osteomielitis Crónica Maxilar

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Upper Jaw Chronic Osteomyelitis. Report of Four Clinical Cases Osteomielitis Crónica Maxilar www.medigraphic.org.mx Revista Odontológica Mexicana Facultad de Odontología Vol. 16, No. 2 April-June 2012 pp 105-111 CASE REPORT Upper jaw chronic osteomyelitis. Report of four clinical cases Osteomielitis crónica maxilar. Informe de 4 casos clínicos Alberto Wintergerst Fish,* Carlos Javier Iturralde Espinosa,§ Vladimir de la Riva Parra,II Santiago Reinoso QuezadaII ABSTRACT RESUMEN Osteomyelitis is an infl ammatory bone disease commonly related La osteomielitis es una enfermedad ósea infl amatoria, comúnmente to an infectious origin caused by germs, mainly pyogenic staphy- relacionada a un origen infeccioso por gérmenes piógenos funda- lococcus, and occasionally, streptococci, pneumococci and en- mentalmente estafi lococos y en algunas ocasiones por estreptoco- terobacteriae. Several treatments and classifi cations for osteomy- cos, neumococos y enterobacterias. Se han establecido diversas elitis have been established. These are based on clinical course, clasifi caciones y tratamientos para la osteomielitis, basadas en el pathologic-anatomical or radiologic features, etiology and patho- comportamiento clínico, características anatomo-patológicas, ra- genesis. Chronic osteomyelitis is a complication of non-treated or diográfi cas, etiología y patogenia. La osteomielitis crónica es una inadequately treated acute osteomyleitis. It can also be caused by a complicación de la osteomielitis aguda no tratada, manejada inade- low grade prolonged infl ammatory reaction. This study presents four cuadamente o como una reacción infl amatoria prolongada de bajo cases of maxillary osteomyelitis treated between 2007 and 2009. grado. Se presentan 4 casos de osteomielitis crónica en el maxilar Cases were treated with antimicrobial therapy. Preoperatively, pa- tratadas entre 2007 y 2009 mediante terapia antimicrobiana preo- tients were prescribed Clindamycin, 300 mg every eight hours, Ce- peratoriamente con clindamicina 300 mg, IV cada 8 h y ceftriaxona friaxone, 1 g IV every 12 hours. Cases were surgically treated with 1 g IV cada 12 h quirúrgicamente con hemimaxilectomía subtotal, subtotal hemi-maxillectomy. Postoperatively, cases were treated postoperatoriamente se trata con penicilina G procaínica 800,000 UI with Penicillin G 800,000 units IM per day, for 30 days. All cases IM cada 24 hrs. resolviendo satisfactoriamente y sin recidiva actual evolved satisfactorily without relapse. en todos los casos. Key words: Maxillary chronic osteomyelitis, subtotal hemi-maxillectomy. Palabras clave: Osteomielitis crónica maxilar, hemimaxilectomía subtotal. INTRODUCTION such as diabetes mellitus, auto-immune diseases, agranulocytosis, leukemia, anemia, nutritional defi cien- Osteomyelitis is an infl ammatory bone disease af- cies, syphilis, cancer, chemotherapy and radiotherapy, fecting bone marrow. It frequently compromises corti- as well as habits of alcohol or tobacco consumption.7 cal bone and periosteum.1-8 Before the advent of anti- In the maxillofacial region, the lower jaw is more fre- biotics, it was a life-threatening disease; in our days, if quently affected than the upper one. This is due to the adequately treated, it can resolve satisfactorily. One of fact that, in the upper jaw, there is cancellous bone the fi rst reports on osteomyelitis was written in 1832 by tissue with greater vascular supply, which hinders bac- British physician Sir Benjamin Brodie, who for the fi rst terial colonization, since cellular response is enhanced time described a type of abscess, which in our days is known as the Brodie abscess,www.medigraphic.org.mx and which represents one of the chronic features of osteomyelitis.9 Infl ammation has its origin in the bone marrow, and * Oral Surgery Professor, Graduate Department of the National extends to cancellous bone spaces. It then spreads School of Dentistry, National University of Mexico (UNAM), Max- through blood vessels, fi bro-elastic tissues, and even- illofacial Surgeon, the Maxillofacial Surgery Service, Hospital 20 de Noviembre, National Medical Center, ISSSTE, Mexico City. tually to the periosteum. When the vascularity of bone § Teacher, School of Dentistry, Universidad Latinoamericana, tissue is compromised, it induces bone necrosis and Mexico City. sequestration.2,3,6-8 II Maxillofacial Surgeon, private practice. th th Osteomyelitis typically appears during the 5 and 6 This article can be read in its full version in the following page: decades of life. It is associated to systemic diseases http://www.medigraphic.com/facultadodontologiaunam 106 Wintergerst FA et al. Upper jaw chronic osteomyelitis and has greater blood flow which thus counteracts sion extension, empiric administration of antimicrobial bone invasion.10,11 drugs to combat predominant microorganisms, remov- Notwithstanding, in the upper jaw anterior region, vas- al of septic foci such as teeth and bone sequestrations, cular supply is juxta-terminal thus favoring bone seques- drug prescription based on cultures and antibiogram, tration, this is due to blood being compromised and elic- sequestration, debridement, decortication or resection iting as a consequence oral-nasal communication.12,13 according to the case.3,6-8,15 Upper jaw osteomyelitis shows predilection for in- Several authors have described, with satisfactory fants and children in their fi rst decade of life. This is results, adjuvant treatments for chronic osteomyelitis due to the fact that the upper jaw includes dental buds such as use of non-steroid anti-infl ammatory drugs, and therefore there is a more intense vascular irriga- corticosteroids, biphosphonates and hyperbaric oxy- tion, which can become the origin of hematogenous gen therapy.1,7,10,12-14,16,17 osteomyelitis or by a neighboring skin process due to a staphylococci infection in the infant.2 CLINICAL CASES Lower jaw vascular supply is very singular: when there is an intense osteomyelitic infection, there is CASE 1 greater probability to develop bone sequestrations. This is due to a terminal type irrigation which cannot 60 year old male patient attending the Maxillofacial compensate peripheral vascular supply of gums and Surgery Service at the National Medical Center «20 de periodontium. Due to vascular thromboses and en- Noviembre» I.S.S.S.T.E., Mexico City. The patient de- doarteritis or sympathetic and parasympathetic veg- scribes the onset of his affl iction as dental pain, previ- etative refl exes, a vasoconstriction of these vessels is ously treated with upper left second molar extraction. produced. As a result of odontogenic infection, osteo- The patient received non-specific pharmacological myelitis can be generated in upper or lower jaws.8 therapy as well as unknown surgical treatment. Clini- Lew and Waldvoger14 classify osteomyelitis into cally, the patient presented the following: a 2 x 1 mm suppurative and non-suppurative, depending on its in- fi stula in upper left premolar region, severe halitosis, fectious character or hematogenous origin (Table I).7 asthenia, adynamia, left cranial headache, chronic Habitually, clinical background reveals history of periodontal disease, as well as several missing teeth. odontogenic infection of periodontal or dental pulp tis- Computed tomography showed lytic areas with sclerot- sue origin; it might also reveal history of facial trauma, ic borders, periosteal reaction and bone sequestration especially poorly consolidated fractures.7 (Figure 1). CBC revealed the following: haemoglobin: In chronic osteomyelitis cases, the background is 14 g/dL, leukocytes 7.44 cpm, glucose: 109 g/dL. Phar- normally related to previous acute osteomyelitis, with macological treatment was undertaken with Clinda- presence of old fi stulae, or active fi stulae with puru- mycin 600 mg IV every 8 hours, and Ceftriaxone, 1 g lent secretion, with a segment of poorly vascularized, IV every 12 hours. It was decided to perform subtotal pigmented, atrophic skin, found adhered to the bone hemi-maxillectomy under balanced inhalation general and which ulcerates easily. Pain to palpation and soft anesthesia. A 6 cm circular-vestibular approach was tissue induration are also present.1,7 carried out, dissecting tissues until exposing the le- Osteomyelitis treatments require antibiotics and sion. Bone necrosis areas were observed (Figure 2). A surgery. Treatment principles consist of the following: 3 x 3 cm surgical specimen was obtained, fi nding foul stabilizing systemic conditions of the immune-compro- smelling, black necrotic areas. Macroscopically, lesion mised patient, culture of associated microorganisms, free borders were verifi ed, and tissues were sutured sensitivity tests, image assessment to determine le- with triple cero polyglycolic acid sutures. www.medigraphic.org.mx Table I. Jaw osteomyelitis classifi cation. Suppurative osteomyelitis Non suppurative osteomyelitis Suppurative acute osteomyelitis Chronic osteomyelitis Primary suppurative chronic Diffuse sclerosing osteomyelitis Osteomyelitis secondary preceding phase Focal sclerosing osteomyelitis Infant osteomyelitis Proliferative periostitis (Garre’s sclerosing osteomyelitis) Osteorradionecrosis Revista Odontológica Mexicana 2012;16 (2): 105-111 107 Figure 3. Two year control intraoral clinical picture showing absence of bone exposition or relapse. caine G Penicillin, 800,000 U, IM, every 24 hours during 30 days. At a later stage, the patient was sent to the maxillofacial prostheses service for rehabilitation. Pres- ently, the patient remains asymptomatic after a 21 year control period. No relapse was observed (Figure 3). Figure 1. Computerized tomography.
Load more

Recommended publications
  • Osteomalacia and Osteoporosis D
    Postgrad. med.J. (August 1968) 44, 621-625. Postgrad Med J: first published as 10.1136/pgmj.44.514.621 on 1 August 1968. Downloaded from Osteomalacia and osteoporosis D. B. MORGAN Department of Clinical Investigation, University ofLeeds OSTEOMALACIA and osteoporosis are still some- in osteomalacia is an increase in the alkaline times confused because both diseases lead to a phosphatase activity in the blood (SAP); there deficiency of calcium which can be detected on may also be a low serum phosphorus or a low radiographs of the skeleton. serum calcium. This lack of calcium is the only feature Our experience with the biopsy of bone is that common to the two diseases which are in all a large excess of uncalcified bone tissue (osteoid), other ways easily distinguishable. which is the classic histological feature of osteo- malacia, is only found in patients with the other Osteomalacia typical features of the disease, in particular the Osteomalacia will be discussed first, because it clinical ones (Morgan et al., 1967a). Whether or is a clearly defined disease which can be cured. not more subtle histological techniques will detect Osteomalacia is the result of an imbalance be- earlier stages of the disease remains to be seen. tween the supply of and the demand for vitamin Bone pains, muscle weakness, Looser's zones, D. The the following description of disease is raised SAP and low serum phosphate are the Protected by copyright. based on our experience of twenty-two patients most reliable aids to the diagnosis of osteomalacia, with osteomalacia after gastrectomy; there is no and approximately in that order.
    [Show full text]
  • Osteopetrosis J
    Arch Dis Child: first published as 10.1136/adc.46.247.257 on 1 June 1971. Downloaded from Archives of Disease in Childhood, 1971, 46, 257. Osteopetrosis J. S. YU,* R. K. OATES, K. HELEN WALSH, and SUSAN J. STUCKEY From the Department of Child Health, University of Sydney, and Department of Dietetics, Royal Alexandra Hospital for Children, Camperdown, N.S.W., Australia Yu, J. S., Oates, R. K., Walsh, K. H., and Stuckey, S. J. (1971). Archives of Disease in Childhood, 46, 257. Osteopetrosis. The clinical histories of nine children with osteopetrosis are reported. Two of them had the malignant infantile variety of the disease: one died within 3 months of birth and the other has survived 20 months on a regimen of a low calcium intake, cellulose phosphate, and steroids. The beneficial effect of a low calcium intake, in early infancy, is supported by the clinical course in the infant with the malignant variety and in another child with the more benign form of the disease. No calcium balance studies were performed. This study suggests that the active measures outlined may favourably influence the haematological and osteosclerotic course of the disease, pending further know- ledge of its aetiological basis, and more specific therapy. Osteopetrosis or marble bone disease is a rare positive calcium balance with a diet low in calcium metabolic bone disease characterized by dense and with steroids (Morrow et al., 1967). This bones (Albers-Schonberg, 1904; Karshner, 1926). approach to management has been recently criti- copyright. Two varieties have been clearly defined-an cized by Cohen (Children's Hospital Medical infantile progressive disease and a milder benign Center, Boston, 1965).
    [Show full text]
  • Hematological Diseases and Osteoporosis
    International Journal of Molecular Sciences Review Hematological Diseases and Osteoporosis , Agostino Gaudio * y , Anastasia Xourafa, Rosario Rapisarda, Luca Zanoli , Salvatore Santo Signorelli and Pietro Castellino Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; [email protected] (A.X.); [email protected] (R.R.); [email protected] (L.Z.); [email protected] (S.S.S.); [email protected] (P.C.) * Correspondence: [email protected]; Tel.: +39-095-3781842; Fax: +39-095-378-2376 Current address: UO di Medicina Interna, Policlinico “G. Rodolico”, Via S. Sofia 78, 95123 Catania, Italy. y Received: 29 April 2020; Accepted: 14 May 2020; Published: 16 May 2020 Abstract: Secondary osteoporosis is a common clinical problem faced by bone specialists, with a higher frequency in men than in women. One of several causes of secondary osteoporosis is hematological disease. There are numerous hematological diseases that can have a deleterious impact on bone health. In the literature, there is an abundance of evidence of bone involvement in patients affected by multiple myeloma, systemic mastocytosis, thalassemia, and hemophilia; some skeletal disorders are also reported in sickle cell disease. Recently, monoclonal gammopathy of undetermined significance appears to increase fracture risk, predominantly in male subjects. The pathogenetic mechanisms responsible for these bone loss effects have not yet been completely clarified. Many soluble factors, in particular cytokines that regulate bone metabolism, appear to play an important role. An integrated approach to these hematological diseases, with the help of a bone specialist, could reduce the bone fracture rate and improve the quality of life of these patients.
    [Show full text]
  • Spontaneous Healing of Osteitis Fibrosa Cystica in Primary Hyperparathyroidism
    754 Gibbs, Millar, Smith Postgrad Med J: first published as 10.1136/pgmj.72.854.754 on 1 December 1996. Downloaded from Spontaneous healing of osteitis fibrosa cystica in primary hyperparathyroidism CJ Gibbs, JGB Millar, J Smith Summar biochemistry showed hypercalcaemia, hypo- A 24-year-old man with primary hyper- phosphataemia, elevated parathyroid hormone, parathyroidism and osteitis fibrosa cystica but normal alkaline phosphatase (table). developed acute hypocalcaemia. Sponta- Radiographs showed improvement in the neous healing of his bone disease was mandibular translucency and resolution of the confirmed radiographically and by correc- phalangeal tuft resorption and subperiosteal tion of the serum alkaline phosphatase. erosion (figures 1B, 2B). Thallium scan of the Hypercalcaemia associated with a raised neck showed no evidence of parathyroid serum parathyroid hormone recurred 90 activity and neck exploration failed to reveal weeks after the initial presentation. Dur- any parathyroid tissue. Venous sampling ing the fourth neck exploration a para- showed no step-up in parathyroid hormone thyroid adenoma was removed, resulting concentration in the neck or chest. Selective in resolution of his condition. Haemor- angiography suggested a parathyroid adenoma rhagic infarction of an adenoma was the behind the right clavicle but two further most likely cause of the acute hypocalcae- explorations revealed only one normal para- mic episode. thyroid gland. Computed tomography (CT) of the neck showed a low attenuation, non- Keywords: primary hyperparathyroidism, osteitis enhancing mass in the right lower pole of the fibrosa cystica, hypercalcaemia thyroid gland. Ultrasonography confirmed a hypo-echoic mass 1.5 x 0.5 cm in the right lobe of the thyroid.
    [Show full text]
  • Introduction to the Orthopedics
    [ Color index : Important | Notes | Extra ] Editing file link ​ ​ ​ ​ ​ ​ ​ ​ Introduction to the Orthopedics Objectives: ★ To explain what Orthopedic is and what conditions will be discussed during this course ★ Explain what we mean by Red Flags ★ List the different causes of orthopedic disease. ★ Describe some of clinical examination tests ★ Introduce titles of Clinical Skills which will be taught during this course. Done by: Rana Albarrak & Lamya Alsaghan ​ Edited By: Bedoor Julaidan ​ Revised by: Dalal Alhuzaimi ​ References: slides + Toronto notes + 433 team + 435 team group A ​ Introduction Orthopedic specialty: ★ Branch of surgery concerned with conditions involving the musculoskeletal system. ​ ​ Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. ★ It includes: bones, muscles, tendons, ligaments, joints, peripheral nerves (peripheral neuropathy ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ of hand and foot), , vertebral column, spinal cord and its nerves. NOT only bones. ​ ​ ​ ​ ​ ​ ​ ★ Subspecialties: General, pediatric, sport and reconstructive (commonly ACL “anterior cruciate ​ ​ ligament” injury), trauma, arthroplasty, spinal surgery, foot and ankle surgery, oncology, hand ​ surgery (usually it is a mixed speciality depending on the center. Orthopedics = up to the wrist joint. ​ Orthopedics OR plastic surgery = from carpal bones and beyond, upper limb (new) elbow & shoulder. ​ ​ ​ ​ ​ will be discussed in details in a separate lectures ​Red Flags: ★ Red Flags =​ warning symptoms or signs = necessity for urgent or different action/intervention. ​ ​ ​ ​ ​ ​ ​ ​ ★ Should always be looked for and remembered. you have to rule out red flags with all emergency ​ ​ ​ cases! Fever is NOT a red flag! Do not confuse medicine with ortho. Post-op day 1 fever is considered normal! ​ ★ There are 5 main red flags: ​ ​ ​ ​ 1.
    [Show full text]
  • Bone Homeostasis and Pathology
    Bone Homeostasis and Pathology Instructor: Roman Eliseev Outline: § Bone anatomy and composi<on § Bone remodeling § Factors regulang bone homeostasis § Disorders of bone homeostasis: -Bone loss -Abnormal bone acquisi<on § Methods and Mouse Models Adult Skeleton Axial Skeleton Appendicular Skeleton 206 bones Image from www.pngall.com Adult Bone Architecture Cor<cal bone Marrow cavity Diaphysis Metaphysis Epiphysis Trabecular bone Bone Histology Subchondral bone Trabecular bone Marrow fat Bone marrow Cor<cal bone Bone Composion Bone is a mineralized organic matrix composed of: • Type I collagen and non-collagenous proteins (osteoid) • Hydroxyapate crystals (Ca5(PO4)3(OH)) Osteoblasts Bone Bone-forming cells are osteoblasts (OB) that produce collagen I and deposit HA Bone is Formed by Osteoblasts OBs originate from Bone Marrow Stromal (a.k.a. Mesenchymal Stem) Cells (BMSC) and terminally differen<ate into osteocytes (OT). Wagner et al., PPAR Res., 2010 Bone is Resorbed by Osteoclasts Image from SciencePhotoLibrary Osteoclasts (OC) are bone resorbing mul<nucleated cells that originate from hematopoie<c cells (monocyte/macrophage) Homeostasis = equilibrium (Greek: ὁμοίως + στάσις) Bone Formaon vs Resorp<on = Dynamic Equilibrium (~10% of adult human skeleton is replaced annually) Bone Bone rosorp<on formaon Intact Bone BMSC – bone marrow stromal Blood vessel (a.k.a. mesenchymal stem) cell BMSC OB – osteoblast OT – osteocyte Apoptosis OB (~70%) Lining cells BONE OT TGFb, IGF1, OCN Collagen I Remodeling: Ini<al Phase BMSC – bone marrow stromal (a.k.a. mesenchymal stem) cell Blood vessel HSC OB – osteoblast BMSC OT – osteocyte HSC – hematopoie<c stem cell RANKL, OCP – osteoclast precursor ? m-CSF OCP OB Lining cells BONE OT Remodeling: Resorp<on Pit BMSC – bone marrow stromal (a.k.a.
    [Show full text]
  • Osteoporosis/Bone Health in Adults As a National Public Health Priority
    Position Statement Osteoporosis/Bone Health in Adults as a National Public Health Priority This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions. Osteoporosis is a widespread metabolic bone disease characterized by decreased bone mass and poor bone quality. It leads to an increased frequency of fractures of the hip, spine, and wrist. Osteoporosis is a global public health problem currently affecting more than 200 million people worldwide. In the United States alone, 10 million people have osteoporosis, and 18 million more are at risk of developing the disease. Another 34 million Americans are at risk of osteopenia, or low bone mass, which can lead to fractures and other complications. Low bone mass is a growing global health burden, and likely reflects only a small part of the true burden of osteoporosis, given that bone mineral density (BMD) does not indicate other important components of bone strength. Fragility fractures have a morbidity and mortality related to them that may be avoided more effectively if information is provided in clinical and public health prevention and management programs.14 Eighty percent of people who suffer osteoporosis are females.1 Although more commonly seen in females, osteoporosis in males remains underdiagnosed and underreported.8 The lifetime risk for fracture may be rising in certain populations, specifically Hispanic females. According to the 2004 Surgeon General's Report on Bone Health and Osteoporosis, the prevalence of osteoporosis in Hispanic females is similar to that found in Caucasian females.
    [Show full text]
  • Osteomyelitis & Arthritis
    Osteomyelitis & Arthritis Colors of text: Definitions: Blue. Examples: Green. Important: Red. Extra explanation: Gray. It is only there to help you understand. If you feel that it didn’t add anything to you just skip it. Diseases names: Underline. 1 CONTENTS: (numbers are pages in Robbins book) ● Osteomyelitis 773 ● Pyogenic Osteomyelitis 773 ● Tuberculous Osteomyelitis 774 ● JOINTS 782 ● Infectious Arthritis 789 ● Arthritis 782 ● Osteoarthritis 782 ● Rheumatoid Arthritis 784 ● Gout 786 ● Pseudogout 789 Note: this lecture has lots of information related to microbiology, immunology, biochemistry, and pharmacology. Take it easy and try to understand the diseases to be able to link the information between the subjects. Focus on the big picture and don’t waste your precious time on small details. 2 Osteomyelitis (Robbins page 773) Osteomyelitis , Osteomyelitis (Acute and Chronic) Osteomyelitis: inflammation of the bone and bone marrow spaces, it’s common and it can start as a primary disease or secondary to systemic infections. Remember: Epiphysis is at the Ends of the bone. Primary osteomyelitis: Most cases of acute osteomyelitis are caused by bacteria. It can be seen usually in children, and the bacteria is usually transmitted by the bloodstream. Osteomyelitis is common in vertebral bones. It begins in long bone in Metaphysis then it can spread to Diaphysis especially in children. - Osteomyelitis classically manifests as an acute systemic illness, with malaise, fever, leukocytosis, and throbbing pain over the affected region. Secondary osteomyelitis: Mixed bacterial infections (aerobes and anaerobes) are responsible for osteomyelitis secondary to bone trauma. The organisms usually reach the bone through the bloodstream. Mostly, osteomyelitis is secondary to : ● Compound fractures.
    [Show full text]
  • Osteopetrosis Associated with Familial Paraplegia: Report of a Family
    Paraplegia (1975), 13, 143-152 OSTEOPETROSIS ASSOCIATED WITH FAMILIAL PARAPLEGIA: REPORT OF A FAMILY By SKIP JACQUES*, M.D., JOHN T. GARNER, M. D., DAVID JOHNSON, M.D. and C. HUNTER SHELDEN, M. D. Departments of Neurosurgery and Radiology, Huntington Memorial Hospital, Pasadena, Ca., and the Huntington Institute of Applied Medical Research, Pasadena, Ca., U.S.A. Abstract. A clinical analysis of three members of a family with documented osteopetrosis and familial paraplegia is presented. All patients had a long history of increased bone density and slowly progressing paraparesis of both legs. A thorough review of the literature has revealed no other cases which presented with paraplegia without spinal cord com­ pression. Although the etiologic factor or factors remain unknown, our review supports the contention that this is a distinct clinical entity. IN 1904, a German radiologist, Heinrich Albers-Schonberg, described a 26-year­ old man with multiple fractures and generalised sclerosis of the skeleton. The disease has henceforth commonly been known as Albers-Schonberg disease or marble osteopetrosis, a term first introduced by Karshner in 1922. Other eponyms are bone disease, osteosclerosis fragilis generalisata, and osteopetrosis generalisata. Approximately 300 cases had been reported in the literature by 1968. It has been generally accepted that the disease presents in two distinct forms, an infantile progressive disease and a milder form in childhood and adolescence. The two forms differ clinically and genetically. A dominant pattern of inheritance is usually seen in the benign type whereas the severe infantile form is usually inherited as a Mendelian recessive. This important distinction has not been well emphasised.
    [Show full text]
  • Who Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level
    WHO SCIENTIFIC GROUP ON THE ASSESSMENT OF OSTEOPOROSIS AT PRIMARY HEALTH CARE LEVEL Summary Meeting Report Brussels, Belgium, 5-7 May 2004 1 © World Health Organization 2007 All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected] ). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e- mail: [email protected] ). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader.
    [Show full text]
  • Clinical and Laboratory Considerations in Metabolic Bone Disease
    ANNALS OF CLINICAL AND LABORATORY SCIENCE, Vol. 5, No. 4 Copyright ® 1975, Institute for Clinical Science Clinical and Laboratory Considerations in Metabolic Bone Disease LYNWOOD H. SMITH, M.D. AND B. LAWRENCE RIGGS, M.D. Mayo Clinic and Mfiyo Foundation Rochester, MN 55901 ABSTRACT An overview of the common types of metabolic bone disease is described. When the disease is present in pure form, diagnosis is not difficult. When mixed disease is present, as may be the case, the pathophysiology involved must be clearly under­ stood for accurate diagnosis and treatment. Introduction opausal or senile osteoporosis, a disorder of unknown etiology, is the commonest form of There are many metabolic disorders that bone disease in the Western hemisphere. affect human bones; but, fortunately, the This disorder may simply represent an exag­ ways in which bones can respond are limited geration of the normal loss of bone that oc­ so that certain generalizations are valid for a curs with aging. It is estimated that the total group of diseases causing a characteristic bone loss between youth and old age is metabolic abnormality in the bone. The about 35 percent in women and somewhat common pathologic responses to metabolic less in men. The loss of bone that has oc­ bone disease include osteoporosis, os­ curred in some patients with osteoporosis is teomalacia, Paget’s disease, osteitis fibrosa not significantly different from that in age- cystica and renal osteodystrophy. These are matched normals without osteoporosis. not mutually exclusive, and it is not uncom­ In osteoporosis there is a greater propor­ mon to find more than one abnormality in tional loss of trabecular than of cortical the same patient.
    [Show full text]
  • Anatomy, Shoulder and Upper Limb, Humerus - Statpearls - NCBI Bookshelf
    12/17/2018 Anatomy, Shoulder and Upper Limb, Humerus - StatPearls - NCBI Bookshelf NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Anatomy, Shoulder and Upper Limb, Humerus Authors Evan Mostafa1; Matthew Varacallo2. Affilations 1 Albert Einstein College of Medicine 2 Department of Orthopaedic Surgery, University of Kentucky School of Medicine Last Update: December 3, 2018. Introduction The humerus is the largest bone of the upper extremity and defines the human brachium (arm). It articulates proximally with the glenoid via the glenohumeral (GH) joint, and distally with the radius and ulna at the elbow joint. The most proximal portion of the humerus is the head of the humerus, which forms a ball and socket joint with the glenoid cavity on the scapula.[1] Just inferior to the head of the humerus is the anatomical neck of the humerus, which divides the head of the humerus from the greater and lesser tubercles. The anatomical neck of the humerus is the residual epiphyseal plate. An intertubercular groove is located proximally, which demarcates the two tubercles vertically. Following the tubercles is the surgical neck of the humerus, a site commonly susceptible to fractures. Continuing distally is the cylindrical­shaped shaft of the humerus, which contains a deltoid tubercle on its lateral aspect and a radial groove on its posterior aspect (also referred to as the spiral groove).[2] At the distal portion of the humerus, there exists a widening of the bone that forms the medial and lateral epicondyles. The distal portion of the humerus ends with an area referred to as the condyle which is composed of the trochlea, capitulum, olecranon, coronoid and radial fossae.[3] On the anterior lateral surface of the condyle is the lateral capitulum which articulates with the head of the radius bone, and on the anterior medial surface of the condyle is the trochlea which articulates the trochlear notch of the ulna bone.
    [Show full text]