Osteonecrosis of the jaws in patients with bone metastasis receiving intravenous bisphosphonates. A rising concern

Osteonecrosis of the jaws (ONJ) is a recognized complication of bisphosphonates (BP) therapy in cancer patients with bone metastasis. We report 2 additional cases of ONJ in women with breast cancer after long-term exposure to BP, discussing some considerations about the presentation and management of this rare and new complication.     

Phytoestrogens alter hypothalamic calbindin-D28k levels during prenatal development.

Calbindin-D28K (CALB) in the medial basal hypothalamic (MBH) and preoptic area (POA) of male and female fetuses from pregnant rats fed different phytoestrogens diets during gestation was examined by Western analysis. In animals fed a phytoestrogen containing diet (Phyto-200), males displayed significantly higher CALB levels compared to females. Whereas, in animals fed a phytoestrogen-free diet (Phyto-free), females exhibited significantly higher CALB levels compared to Phyto-200 female values. The present data have far reaching implications where phytoestrogen content in diets apparently influence MBH-POA CALB levels prenatally. The altered CALB levels may in turn modify sexually dimorphic brain structures during neuronal development by buffering Ca2+ that is associated with programmed cell death.     

Evaluation of the Dutch version of the migraine quality of life instrument (MSQOL) and its application in headache coping

The Dutch version of the MSQOL was evaluated psychometrically and applied in a convenience sample of 90 migraine patients from the Dutch Society of Headache Patients. Internal consistency and test-retest reliability of the Dutch MSQOL were good (> 0.90) and comparable with those of the original English version. The measure also had good validity, with its scores associated as expected with headache intensity, psychological well-being and level of patient functioning. Respondents who employ more passive methods of coping with their headaches, such as 'worrying', 'retreating' and 'resting', had worse quality of life. 'Worrying' was particularly associated with diminished quality of life, suggesting that cognitive interventions might be of benefit to migraineurs who use this method of coping.     

Pulmonary valvuloplasty. Long term results at the Centro Medico la Raza]

The purpose of this study was to evaluate the immediate and long term results of pulmonary valve ballon dilation, and to determine the prognostic factors of failure in 109 patients (60 female and 49 male), aged 7.04 +/- 8.4 years. Seventy two patients (66.1%) had isolated valvular stenosis and 33.9% presented associated lesions. Peak systolic pressure gradient across the pulmonary valve decreased from 89.53 +/- 37.23 to 20.8 +/- 19.41 mmHg (p < 0.0001) after valvuloplasty. Forty three patients developed reactive infundibular stenosis after valvuloplasty with a systolic gradient of 19.65 +/- 35.64 mmHg. At a mean period of 8 years of follow-up the pressure gradient was 20.75 +/- 14.32 (p < 0.001). Valvuloplasty was successful in 86.2% of the cases with a global mortality of 1.9%, minor complications in 15.2%, and a failure rate of 13.8%. At follow-up restenosis developed in 6.7%. The comparative analysis between the groups of success and failure yield as significant risk factors for failure an age younger than 3.5 years and a pulmonary valve with displastic (p < 0.05) or combined morphology (p < 0.05). This group had also more complications and higher systolic gradients and right ventricular pressures post-dilation (p < 0.05). Pulmonary valvuloplasty is a safe and effective procedure for the treatment of pulmonary valve stenosis with a good immediate and long-term results, and is now considered the treatment of choice.     

Percutaneous ultrasound-guided sclerotherapy for complicated fetal intralobar bronchopulmonary sequestration.

Bronchopulmonary sequestration (BPS), which can be intralobar or extralobar, is a rare developmental anomaly of the lung characterized by nonfunctional pulmonary tissue without communication with the tracheobronchial tree and with an aberrant systemic arterial blood supply. The intralobar type is typically within the pleural cavity with an arterial feeding vessel generally arising from the thoracic aorta and with venous drainage into the left atrium. The prognosis is poor in cases diagnosed before 26 weeks' gestation and when there is mediastinal shift, polyhydramnios and fetal hydrops. The ideal prenatal management option remains undefined. We present a series of three complicated cases of intralobar BPS treated prenatally with percutaneous ultrasound-guided fetal sclerotherapy (FST). The feeding vessel was successfully accessed percutaneously under ultrasound guidance in all cases. FST with polidocanol resulted in complete obliteration of the blood flow to the mass. Abnormal Doppler findings, ascites, hydrops and polyhydramnios resolved and all patients were delivered at term. Antenatal treatment of patients with complicated BPS can be successfully achieved with FST, which is a simple and inexpensive technique. Comparison of risks and benefits of this approach with other techniques is warranted.     

检测口腔癌的新技术

视觉增强病变观测仪（VELscope）是对患者进行评价的重要仪器，如果将患者的年龄及其他危险因素，如吸烟、饮酒和免疫状态等考虑在内，此仪器能够提高临床医师对患者口腔改变的判断力．包括癌前病变和细胞的恶性转化；对感染性疾病的检测可能产生假阳性结果，仅依赖此仪器也不能检测发育异常，但应用VELscope能够使医师判断病变的性质。并决定对病变进行活检的范围及最佳活检区域。