Bisphosphonate-associated osteonecrosis of the jaws: Case reports and analysis of 184 cases

18595 Background: In this study, we described four new cases of bisphosphonates-related jaw osteonecrosis and reviewed the English Medical Literature for similar case reports. Methods: A MEDLINE literature search was performed from September 2003 to November 2005 for all case reports of bisphosphonates-associated jaw osteonecrosis. Results: Our patients were three female and one male with a median age of 50.5 years (range, 35–57 years). Two patients had breast cancer and two another had multiple myeloma. Two patients received pamidronate initially and were switched later to zoledronate. The two other patients were treated with zoledronate. The median duration from the first administration of bisphosphonates to the diagnosis of osteonecrosis was 48 (range, 18–75) months. Review of the literature of all published cases revealed 184 patients. Age of these patients ranged from 37 to 89 years (median, 64 years). Seventy-eight patients (43.4%) were treated with bisphosphonates for metastatic breast carcinoma, 65 (36.3%) for multiple myeloma, and 14 (7.8%) for metastatic prostate cancer. Thirteen patients (7.2%) without cancer diagnosis were treated for osteoporosis (10 patients) or Paget’s disease (3 patients). Primary disease was not specified in five patients. Eighty-two patients (46.8%) were treated with pamidronate, 47 (26.8%) treated with zoledronate, 35 (20%) treated with pamidronate initially and later were changed to zoledronate, 9 (5.1%) treated with oral bisphosphonates and 2 (1.1%) treated with oral bisphosphonates initially and subsequently switched to zoledronate. Type of bisphosphonate was not specified in ten patients. The duration of bisphosphonates treatment was available for 45 patients (24.4%) and ranged from 1 to 93 (median, 28) months. Conclusion: Oncologists and dental professionals should be aware of this potential serious complication of long-term bisphosphonates treatment and special caution should be taken before dental intervention in such patients. No significant financial relationships to disclose. </jats:p

G-CSF-mobilized haploidentical peripheral blood stem cell transplantation in children with poor prognostic nonmalignant disorders

PubMedID: 17722073Haploidentical hematopoietic stem cell transplantation (HSCT) is currently one of the alternative curative treatment options for some nonmalignant but also for malignant diseases. However, concerns regarding its safety cause delays in time and a successful outcome. Between 2000 and 2005, twenty-one children with poor prognostic nonmalignant disorders, 13 boys and 8 girls, with a median age of 12 months, underwent 28 haploidentical peripheral HSCT. Immunomagnetic bead depletion device (CliniMACS) was used for indirect T-cell depletion. Indications for transplant were severe combined immunodeficiency (n = 16), osteopetrosis (n = 2), MDS (n = 1), amegakaryocytic thrombocytopenia (n = 1), and aplastic anemia (n = 1). Five patients (24%) had lung infection at the time of transplantation. The patients received a median of 25.67 × 106 G-CSF-mobilized peripheral CD34+ progenitor cells and a median of 4.19 × 104 T-lymphocytes per kilogram of body weight with a T-cell depletion rate of median 4.59 logs. The rate of total engraftment was 66.6%. Median times for leukocyte and platelet engraftment were 14 and 16 days, respectively. The 6-year projected survival was 32% for all patients and 29.76% for patients with severe combined immunodeficiency (SCID). The rates of transplant-related mortality, graft failure, and severe GvHD were 14.2, 33.4%, and 8.3%, respectively. Infection was the main cause of death. The poor outcome may be explained with the poor prognostic factors of our patients such as the type of SCID in most cases (T-B- SCID), the median age over 6 months and the presence of lung infection in some children at the time of transplantation. © 2007 Wiley-Liss, Inc

The value of postoperative radiotherapy in renal cell carcinoma: A single-institution experience

Aim: To evaluate the efficacy of postoperative irradiation in renal cell carcinoma

CA-125; a new marker for diagnosis and follow-up of patients with tuberculous peritonitis

Background. Most malignancies with peritoneal infiltration, especially ovarian cancers and chronic liver diseases associated with ascites give rise to high serum CA-125 levels. Tuberculous peritonitis is another cause for high serum CA-125 levels

Phase II study of loading-dose ibandronate treatment in patients with breast cancer and bone metastases suffering from moderate to severe pain

PubMed ID: 22868504Background: The aim of this study was to determine the efficacy and safety of loading-dose intravenous (i.v.) ibandronate in women with breast cancer and bone metastases. Patients and Methods: In this prospective, phase II, open-label study, 13 women with breast cancer, bone metastases, and moderate/severe bone pain received ibandronate 6 mg/day (i.v. loading-dose 15 min infusion over 3 consecutive days) with follow-up until day 14. Endpoints included pain response (primary), duration until pain response, analgesic use, Karnofsky index, safety (including hematologic, biochemical, and urine examinations), and adverse events. Results: Pain intensity decreased on days 7 and 14 versus day 1 (mean visual analogue scale score: 3.2 ± 2.2 and 3.0 ± 2.1 versus 6.1 ± 0.9, respectively; p < 0.01 for both). Mean time to pain response was 8.2 ± 3.3 days. Mean rate of analgesic use decreased (69.2%, 16.7% and 15.4% on days 1, 7 and 14, respectively). Mean Karnofsky index score increased (80.8 ± 13.1 and 80.8 ± 13.2, on days 7 and 14 versus 77.7 ± 11.7 on day 1; p < 0.05 on both days). Conclusion: Bone pain and analgesic use decreased in women with breast cancer and bone metastases following loadingdose i.v. ibandronate which was well-tolerated with no renal safety concerns. Copyright © 2012 S. Karger AG, Basel

A case of advanced scalp angiosarcoma successfully treated with combination chemotherapy of adriamycin, cisplatin and ifosfamide

Scalp angiosarcoma is a rare and highly malignant tumour originating from endothelial cells of vessels and occurring predominantly in elderly men. Its prognosis is poor and the 5-year survival rate of patients is reported to be 12–33% [1]. Complete surgical excision with wide margins remains the cornerstone of therapy for localised tumours. Additional radiotherapy may provide improved local control. Given the rarity of this tumour, an optimum chemotherapy regimen has not yet been defined for metastatic cases. Here we report a case of scalp angiosarcoma with local recurrence and distant metastases which was successfully treated with a combination chemotherapy consisting of adriamycin, cisplatin, ifosfamide and mesna (APIM). A 24-year-old man presented to a plastic surgeon in January 2005 with a painless nodule on the scalp measuring 3 cm in diameter. Surgical total excision of the nodule was carried out, providing a negative surgical margin (2 cm). The diagnosis of angiosarcoma was confirmed pathologically. An X-ray of the scull, magnetic resonance imaging of the brain and computed tomography of the neck, thorax and abdomen revealed no evidence of local or distant metastases at the time of diagnosis. The patient was not given any adjuvant therapy. Five months after the surgery, the patient developed two new angiosarcoma lesions (1.5 and 2 cm in diameter) on different sites of the scalp. In addition, computed tomography of the neck and chest revealed conglomerate lymph nodes on the left side of the neck and five small metastatic nodules, up to 1.5 cm greatest dimension in bilateral lung fields