The observational study of delayed wound healing after tooth extraction in patients receiving oral bisphosphonate therapy

IntroductionIn this study, we investigated whether such a discontinuation of oral bisphosphonate (BP) for 3 months might influence the incidence of BP-related osteonecrosis of the jaw (BRONJ) and wound healing after tooth extraction in patients receiving oral BP therapy.Material and methodsThere were a total of 434 teeth in 201 patients (18 males and 183 females). The patients were divided into two groups depending on whether or not they underwent a 3-month discontinuation of BP therapy (BP? and BP+) before tooth extraction. In this observational study investigated delayed wound healing after tooth extraction in patients receiving oral BP therapy.ResultsIn all cases of the BP? group, there were no BRONJ although there was delayed wound healing in two cases. However, in one case of the BP+ group, oral BP was continued because it was deemed high risk to discontinue treatment by the patient's physician. In this case, an intraoral fistula was still present with bone exposure at 120 weeks after extraction (BRONJ stage 1).ConclusionThis study supports the idea of a drug holiday and encourages further clinical research on this topic of tooth extraction in patients receiving oral BP therapy.     

Multiple calcifications within the parotid gland of patients with Sjögren's syndrome

PurposeThe purpose of this study was to investigate computed tomography (CT) and clinical features relating to calcifications within the parotid gland of patients with Sjögren's syndrome (SS).MethodsData from 30 patients with SS who had been examined by CT were extracted from our radiological information database accumulated from 2001 to 2011, and their CT images were reread carefully. Of these patients, 14 (all female; age range 20–95 years; mean age 61.4 years) with calcifications within the parotid gland were retrospectively investigated with CT findings. The relationship between calcification occurrence and clinical symptoms including parotid swelling and/or saliva colic was investigated. The degree of destruction of the parotid gland on CT images was also evaluated.ResultsAll calcifications of 14 patients were located within the parotid gland, not in the parotid duct. CT images of all calcifications showed small and regular round shapes. Multiple occurrences of calcifications were recognized in 10 patients, and a solitary occurrence was seen in 4 patients. Seven patients had bilateral calcifications. There was little relationship between the occurrence of calcifications and clinical symptoms, and the severity of destruction of the parotid gland.ConclusionThe presented CT and clinical features would be peculiar to SS because too many patients lacked the typical features of sialoliths within the parotid gland.     

Assessment of the differences in the short-term clinical outcomes of superotemporal and inferonasal Baerveldt glaucoma implantation surgeries performed via the pars plana route

AIM: To investigate and discover whether different insertion areas for Baerveldt glaucoma implant (BGI) surgery produce different outcomes in terms of the reduction of intraocular pressure (IOP). METHODS: This retrospective study involved the review of cases of patients admitted at Toho University Sakura Medical Center, who underwent BGI surgery via the pars plana route for the treatment of neovascular glaucoma. The patients were divided into two groups: the superotemporal insertion group [18 eyes in 16 subjects (13 males, 3 females; mean age 62.9±14.4y)] and the inferonasal insertion group [17 eyes in 15 subjects (11 males, 4 females; mean age 56.9±10.7y)]. The patients were followed up and re-evaluated at 12mo. The IOP reduction rate 12mo after surgery relative to preoperative IOP was compared between the two groups. RESULTS: The mean preoperative IOP was 31.1±10.0 mm Hg and postoperative IOP was 14.4±4.5 mm Hg in the superotemporal group, whereas for the inferonasal group, the mean preoperative IOP was 34.9±9.7 mm Hg and postoperative IOP was 15.9±3.7 mm Hg. The IOP reduction rate of the superotemporal group was 50.0%±19.0% and that of the inferonasal group was 51.2%±16.3%. There was no significant correlation between the two groups (Student’s t-test, P=0.590). CONCLUSION: There was no difference in the short-term clinical outcomes between superotemporal and inferonasal BGI performed via the pars plana route.     

Three-dimensional evaluation of volume change in ossification of the posterior longitudinal ligament of the cervical spine using computed tomography

Background

Two-dimensional imaging is not adequate for evaluating ossification of the posterior longitudinal ligament (OPLL). This study was designed to evaluate the accuracy of a novel computed tomography (CT)-based three-dimensional (3D) analysis method that we had devised to measure volume changes in OPLL.

Subjects and methods

Twenty OPLL patients (12 male and 8 female; mean age 63.6 years) who were being followed conservatively were examined twice with an interval of at least 1 year between the two scans. The mean interval was 22 (range 12–45) months. A 3D model was created with DICOM data from CT images, using the MIMICS^® software to calculate the volume. The mean ossification volume was determined from two measurements. Since ossification size varies widely, evaluation of change in volume is generally affected by the original size. Therefore, the change in ossification volume between the first and second CT examinations was calculated as the annual rate of progression.

Results

The type of OPLL was classified as continuous in 3 patients, segmented in 3, and mixed in 14. The mean ossification volume was 1,831.68 mm³ at the first examination and 1,928.31 mm³ at the second, showing a significant mean increase in ossification volume. The mean annual rate of lesion increase was 3.33 % (range 0.08–7.79 %).

Conclusion

The 3D method used allowed detailed OPLL classification and quantification of change in the ossified volume. Thus, this method appears to be very useful for quantitative evaluation of OPLL with only minimal measurement error.     

Pulmonary lobar root clamping and stapling technique: return of the “en masse lobectomy”

Purpose

Most thoracic surgeons have experienced difficulty dissecting the pulmonary hilus because of scarring. In such potentially dangerous situations, we advocate a method of clamping and severing the pulmonary lobar root structure en masse. The aim of this study was to evaluate en masse lobectomy, particularly considering the constellation of pulmonary vessels and the bronchus.

Methods

Twelve patients (median age 70 years) underwent en masse lobectomy. We retrospectively evaluated the surgical procedures and clinical outcomes. Care was taken to consider the remaining vessels and bronchus, which regulate the direction of device placement.

Results

Seven patients had inflammatory lung disease, four had primary pulmonary carcinoma, and one had suffered blunt chest trauma. Ten operations were elective and two were emergent. Lobectomy included the right upper lobe in two cases, the right middle lobe in three, the right lower lobe in two, the right middle-lower lobe in two, and the left lower lobe in three. A stapler was used in ten patients, and sutures were applied in three (both were used in one case). Morbidities included a pyothorax and a persistent air leak; both made a recovery. Mortality included one emergency case of acute respiratory distress syndrome. No bronchopleural or bronchovascular fistulas occurred.

Conclusions

We believe that the en masse lobectomy is an alternative and necessary technique in critical or unexpected situations, possibly as a last resort. Trauma and severe inflammation may be good indications for en masse lobectomy.