Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery?

Bisphosphonates (BSPs) are used for the treatment of multiple myeloma, metastatic breast and lung cancer, Paget's disease, osteoporosis, hypercalcemia due to malignancy, and many other skeletal diseases. BSPs reduce osteoclastic functions, which result in bone resorption. Bisphosphonates-related osteonecrosis of jaws (BRONJ) is a newly developed term that is used to describe the significant complication in patients receiving bisphosphonates. BSPs are known to exhibit an anti-angiogenetic effect that initiates tissue necrosis of the hard tissue. There is currently no consensus on the correct approach to this issue. The aim of this retrospective study is to compare the effects of laser surgery with biostimulation to conventional surgery in the treatment of BSP-induced avascular bone necrosis on 20 patients who have been treated in our clinic. BRONJ was evaluated in patients with lung, prostate, and breast cancer under intravenous BSP treatment. Twenty patients in this study developed mandibular or maxillary avascular necrosis after a minor tooth extraction surgery or spontaneously. Bone turnover rates were evaluated by serum terminal C-telopeptide levels (CTX) using the electrochemiluminescence immunoassay technique and patients were treated with laser or conventional surgical treatments and medical therapy. Ten patients were treated with laser surgery and biostimulation. An Er:YAG laser (Fotona Fidelis Plus II® Combine laser equipment, Slovenia) very long pulse (VLP) mode (200 mJ, 20 Hz) using a fiber tip 1.3 mm in diameter and 12 mm in length was used to remove the necrotic and granulation tissues from the area of avascular necrosis. Biostimulation was applied postoperatively using an Nd:YAG laser. Low-level laser therapy (LLLT) was applied to the tissues for 1 min from 4 cm distance using an Nd:YAG laser (Fotona-Slovenia) with a R24 950-µm fiber handpiece long-pulse (LP) mode, 0.25-W, 10 Hz power/cm² from the mentioned distance the spot size was 0.4 cm², and power output was 2.5 J. Energy density from the mentioned distance was calculated to be 6.25 J/cm². The other ten patients were treated with conventional surgery. Treatment outcomes were noted as either complete healing or incomplete healing. There were no statistically significant differences between laser surgery and conventional surgery (p?>?0.05). CTX values also did not affect the prognosis of the patients. Treatment outcomes were significantly better in patients with stage II osteonecrosis than in patients with stage I osteonecrosis. Our findings suggest that dental evaluation of the patients prior to medication is an important factor in the prevention of BRONJ. Laser surgery is a beneficial alternative in the treatment of patients with this situation. Further randomized studies with larger patient numbers may also improve our understanding of treatment protocols for this situation.     

Behaviours of students who have repeated urinary tract infections

To determine the behaviours of students and the variables that have an effect on repeated urinary tract infections (UTIs). A cross‐sectional study was implemented on elementary and high school students in Izmir, Turkey. The sample consisted of 318 volunteers from the 6–17 years of age students. Written consent was obtained from parents and institutions. The data were collected through sociodemographic characteristics and a behavioural assessment semi‐structured design questionnaire. The data for closed‐ended questions were evaluated for frequencies, variance, Chi‐square and logistic regression. Content analysis was used for examining the open‐ended questions. Students' mean age was 10·28 ± 2·27 (6–15 years of age), 68·2% were females and 70·4% were in elementary school. Of the students, 26·1% avoided using school toilets, 70·4% held urine too long and 30·2% cleaned the perineum from back‐to‐front. In the prediction of the factors that affect students' behaviours with ages, it was determined that ‘washed the genital area after defecation/urination’, ‘method of cleaning the perineum’, ‘urination status at school’, ‘enuresis’, ‘frequency of changing underwear’ and ‘washing hands before going to the toilet’ increased linearly with age (p < 0·05). Most of the students may have negative perceptions about toilet habits. Students' behaviours are important for improving social well‐being. Health professionals and teachers serve a key role in the psychosocial development of students. They can develop individualized health care plans and help parents and students to understand strategies that can prevent UTIs.     

Mutations in the CYLD gene in Brooke-Spiegler syndrome, familial cylindromatosis, and multiple familial trichoepithelioma: lack of genotype-phenotype correlation

Brooke-Spiegler syndrome (BSS), familial cylindromatosis (FC), and multiple familial trichoepithelioma (MFT), originally described as distinct entities, share overlapping clinical findings. Patients with BSS are predisposed to multiple skin appendage tumors such as cylindroma, trichoepithelioma, and spiradenoma. FC, however, is characterized by cylindromas and MFT by trichoepitheliomas as the only tumor type. These disorders have recently been associated with mutations in the CYLD gene. In this report, we describe three families with BSS, one with FC, and two with MFT phenotypes associated with novel and recurrent mutations in CYLD. We provide evidence that these disorders represent phenotypic variation of a single entity and lack genotype-phenotype correlation.     

Comparison of the Orpington Prognostic Scale (OPS) and the National Institutes of Health Stroke Scale (NIHSS) for the prediction of the functional status of patients with stroke

PURPOSE: The aim of our study is to compare the Orpington Prognostic Scale (OPS) and the National Institutes of Health Stroke Scale (NIHSS) and to evaluate whether they help us estimate the future functional status of patients with stroke. METHOD: Twenty-five patients with stroke were administered the OPS and NIHSS on the 7th day of stroke in order to define the severity of the disease, and the Barthel Index was performed in order to evaluate the functional status and the activities of daily living (ADL) at the 1st, 3rd, and 6th months. RESULTS: Both scales were statistically correlated (P = 0.0001). When the predictability of these scales in terms of the ADL and functional status was evaluated, the regression coefficient at the 1st month was -14.746, R(2) = 0.58, P < 0.0001 and -4.885, R(2) = 0.50, P < 0.0001 for OPS and NIHSS, respectively, the same coefficient at the 3rd month was -12.482, R(2) = 0.41, P = 0.001 for OPS and -3.280, R(2) = 0.23, P = 0.016 for NIHSS, and at the 6th month it was -11.662, R(2) = 0.38, P = 0.001 for OPS and -2.997, R(2) = 0.20, P = 0.02 for NIHSS. CONCLUSION: In patients with stroke, OPS and NIHSS had significant contribution to the estimation of the functional status and OPS was more effective than NIHSS.     

The protective role of Visudyne eyeglass® against VEGF synthesis after photodynamic therapy with verteporfin

Purpose: We aimed to determine the extent of protection provided by Visudyne eyeglass^® against vascular endothelial growth factor (VEGF) synthesis following photodynamic therapy (PDT). Methods: Three groups with 14 rabbits in each were established. These consisted of a control (dextrose infusion) group, an infusion (verteporfin infusion) group and an irradiation (verteporfin infusion + irradiation) group. One eye in each animal was closed with Visudyne eyeglass^® and the other by eyelid sutures. The rabbits were exposed to daylight for 30 mins at 2 and 48 hours after the infusion was administered. Half the animals in each group were killed on day 5. The remaining animals were killed on day 10. Levels of VEGF in homogenized retina and choroids were analysed with an ELISA (enzyme‐linked immunosorbent assay). Results: Mean VEGF levels, in pg/mg protein, on days 5 and 10 in the control + glass, control + suture, infusion + glass, infusion + suture, irradiation + glass and irradiation + suture subgroups were, respectively: 1.69 ± 0.67, 1.91 ± 0.44; 1.75 ± 0.69, 1.93 ± 0.53; 2.30 ± 0.77, 3.47 ± 2.02; 1.90 ± 1.00, 2.93 ± 0.16; 4.39 ± 2.74, 13.63 ± 5.25; 3.38 ± 1.05, 7.37 ± 2.12. On day 10, VEGF levels were significantly higher in the infusion and irradiation groups compared with the control group (p < 0.05). There were no statistically significant differences between glass and suture samples on days 5 and 10 in the infusion group, or on day 5 in the irradiation group. However, on day 10, the mean VEGF level in eyes closed with Visudyne eyeglass^® in the irradiation group was significantly higher than in sutured eyes (p = 0.011). Conclusions: Visudyne eyeglass^® offers full protection against VEGF increases caused by verteporfin infusion but is only partially protective in eyes exposed to sensitizing light.