Glukokortikoide zur Reduktion postoperativer Beschwerden in der Oralchirurgie

Background

Oral surgical interventions are associated with post-interventional pain, trismus and swelling of varying degrees; therefore, the occurrence of a postinterventional inflammatory reaction is of major importance.

Methoden

To reduce such symptoms, non-steroidal anti-inflammatory drugs (NSAIDs) are used routinely. Additionally, glucocorticoids can be applied as adjuvants in the management of postoperative complaints due to their anti-inflammatory potency. This use of glucocorticoids is still being controversially discussed. The aim of this paper is to describe the mechanisms and indications for administration of glucocorticoids after oral surgical procedures.     

3-D-Diagnostik (DVT/CT) in der Zahnheilkunde

Background

The number of three-dimensional imaging examinations in oral radiology has been constantly growing in the last few years and three-dimensional diagnostics using cone beam computed tomography (CBCT and CT) can be performed in addition to traditional 2-dimensional dental radiography. The indications for CBCT and CT range from oral surgery and implant surgery to conservative dentistry, endodontology and parodontology up to orthodontology and temporomaxillary joint diagnostics.

Methods

Before every dental radiography examination, especially using three-dimensional techniques, strict indications must be present. Furthermore, the health benefits have to outweigh the radiation risk and the ALARA principle (as low as reasonable achievable) should be observed in favor of radiation protection.     

Prevalence of bisphosphonate-associated osteonecrosis of the jaw after intravenous zoledronate infusions in patients with early breast cancer

Objectives

The definite incidence rate of bisphosphonate-related osteonecrosis of the jaws (BRONJ) is still unknown. The aim of this study was to investigate prevalence of BRONJ in a group of breast cancer patients applying the classification of the Association of Oral and Maxillofacial Surgeons 2009.

Patients and methods

Between 2000 and 2008, 63 premenopausal early breast cancer patients who were free of metastases were treated with 4 mg zoledronic acid every 6 months over 3 years as participants of a multicenter, randomized, controlled, adjuvant breast cancer medication trial. Patients were not informed about the risk of jaw necrosis. None reported tooth or jaw complaints during the breast cancer follow-up examinations. In 2010, 48 patients of this cohort were investigated concerning BRONJ by clinical and radiological examinations.

Results

No advanced stages (AAOMS 2009)were detected. However, five patients (10.4 %) presented purulent (2) and nonpurulent (3) fistulas and radiological signs correlating to BRONJ stage 0.

Conclusion

Although no case of advanced BRONJ was detected, the study revealed a high prevalence of BRONJ stage 0. This supports the need for tight cooperation between dentists and medical specialists prescribing bisphosphonates including dental pre-therapeutic and follow-up examinations. Adaption of the BRONJ classification taking account to bone exposure via fistulas is recommended.

Clinical relevance

BRONJ is said to be a complication linked to high-dosage bisphosphonate therapy. The study demonstrates that even after application of zoledronate in a low-dose protocol, early BRONJ occurred. Radiological signs solely are not sufficient to confirm BRONJ; clinical signs are mandatory.     

Combination echinocandin-polyene treatment of murine mucormycosis

We previously found that caspofungin synergized with amphotericin B lipid complex in treating murine mucormycosis. We now report a similarly enhanced activity of liposomal amphotericin combined with micafungin or anidulafungin in mice with disseminated mucormycosis. The efficacy of combination echinocandin-polyene therapy for mucormycosis is a class effect.     

Activation of caspase-8 and caspase-12 pathways by 7-ketocholesterol in human retinal pigment epithelial cells

PURPOSE: To determine whether caspase or cathepsin pathways are activated in human retinal pigment epithelial cells (ARPE-19) after exposure to 7-ketocholesterol (7kCh). METHODS: ARPE-19 cells were exposed to 7kCh with or without z-VAD-fmk, a pan-caspase inhibitor. Caspase-3, -8, and -9 activities were measured by a fluorochrome inhibitor of caspase (FLICA) assay. Caspase-12 activity was detected by Western blotting. RT-PCR was performed for 18s, mortalin-2, cathepsins B, D, and L/V2. RESULTS: At 24 hours, 7kCh-treated cultures had increased caspase-8 (P < 0.001) and caspase-3 (P < 0.001) activities compared with vehicle-treated cultures. 7kCh-induced caspase-3 activation was blocked by z-VAD-fmk (P < 0.001). Caspase-9 was not activated by 7kCh treatment (P > 0.05). Procaspase-12 was cleaved into its active form after treatment with 7kCh for 24 hours. At 6 hours, the RNA level for mortalin-2, a pro-survival gene, was upregulated. ARPE-19 cells did not express RNA for cathepsins B, D, or L/V2 under any conditions. CONCLUSIONS: In ARPE-19 cells, 7kCh-induced apoptosis uses the receptor-mediated caspase-8 pathway and the endoplasmic reticulum stress-induced caspase-12 pathway but not the mitochondrial caspase-9 pathway. The cathepsin pathways are not involved in 7kCh-induced cell death. These data demonstrate that 7kCh causes a loss of cell viability through caspase-dependent apoptosis and can act as an oxidative stressor leading to retinal pigment epithelial cell atrophy. Elucidating the specific apoptotic pathways involved may have therapeutic potential for AMD and other retinal diseases.