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LAM KID

DECEMBER 20, 2013

[Femoral neck fractures treated with DHLS screws - early results]

KOCSIS András, KÁDAS István, KÁDAS Dániel, HANGODY László

[In Hungary, the treatment approach for medial femoral neck fractures depends on the type of fracture and the overall condition of the patient. An obvious goal is to minimise the most common complications of the applied method, namely avascular necrosis of the head and redisplacement, while maintaining a low-risk and minimally invasive technique. Following the surgical method most commonly used in our country, we combined the double cannullated screws technique with the compressing HeadLess Screw System. This way we succeeded to achieve intraoperative compression, which provides intensified stability while retaining the principles of minimally invasive techniques.]

LAM KID

DECEMBER 23, 2011

[Osteonecrosis of the jaws: real and unreal scares]

VASZILKÓ Mihály

[Osteonecrosis caused by bisphosphonates has been known for a long time, but it is still not widely known. Some people overestimate the danger caused by this disease, whereas others underrate it. In this paper, we summerise data from the international literature and our experiences concerning 93 patients treated at our clinic. We discuss the already known details of the pathomechanism of this disease, its risk factors, the diagnostic methods, the specific stages of the disease and the treatment approaches. Considering the difficulties of treatment, we can't emphasise enough the importance of prevention, since the development of this complication can be minimised even in patients at risk with dental sanation before the bisphosphonate therapy and/or with further intervention performed with antibiotic preventive therapy. We must also point out the importance of early diagnosis and of directing these patients to the appropriate specialist units.]

Hungarian Radiology

APRIL 10, 2005

[Early detection of adult femoral head necrosis]

GION Katalin, PALKÓ András

[Adult avascular femoral head necrosis is common in young adulthood, and in 80% of cases affects male patients. The disease is bilateral in 40-80 %, and it may take several years to develop on the contralateral side. Late diagnosis and lack of early therapy can cause progressive disease and finally movement restraint. The diagnosis in early stage is crucial for choosing the most effective strategy in therapy. It is important to be aware of pathogenesis, clinical course and the differential diagnostic options of the disease, and these should be associated to the diagnostic findings at different imaging modalities. Based on this concept, we conclude that MR examinaton is the method of choice for the early (reversible) stage assessment. MRI of the hip is also able to evaluate and follow up the healthy contralateral side without further strain.]

Ca&Bone

MAY 20, 2004

[The role of alfacalcidol in the prevention of osteopenia following renal transplantation]

BERCZI Csaba, ASZTALOS László, KINCSES Zsolt, BALOGH Ádám, LŐCSEY Lajos, BALÁZS György, LUKÁCS Géza

[AIM - The aim of this prospective study was the long-term evaluation of the effect of calcium and alfacalcidol treatment on calcium metabolism in patients with renal transplantation. METHODS - Patients were divided in two groups. Patients in Group 1 (n=159) received calcium substitution, while patients in Group 2 (n=81) were treated with alfacalcidol. Serum Ca, P, Mg, alkaline phosphatase (AP) and PTH levels were determined before and after transplantation regularly for three years. Femur neck and lumbar vertebral bone mineral densities (BMD) were measured at the same time after transplantation. RESULTS - After transplantation the mean serum calcium level significantly increased, while the mean serum phosphate level significantly decreased in both groups. After the operation the PTH levels decreased in both groups and it was found to be more pronounced in the alfacalcidol group.The majority of patients had osteopenia in the follow-up period. Between the third month and the third year after transplantation, BMD increased by 9.4% in Group1, and decreased by 4% in Group 2 at the lumbar spine. At 3 years the mean BMD value at the femoral neck was increased by 6.5% in Group 1, and by 6.7% in Group 2, compared to the 3-month values.The change in BMD was only significant at the lumbar spine, in Group 1 (p=0.019). During the follow-up period osteonecrosis was diagnosed in 6 patients in Group 1 and in 9 cases in Group 2. CONCLUSION - Alfacalcidol treatment decreased secondary hyperparathyroidism more rapidly and effectively, which was also indicated by the more pronounced decrease of serum PTH levels. During the 3 years follow-up period, BMD increased in both groups except for the lumbar spine in Group 2, however, the majority of the patients still had osteopenia.The study could not demonstrate a superiority of alfacalcidol over calcium supplementation in the prevention of posttransplantational osteopenia.]

Lege Artis Medicinae

JANUARY 27, 2009

[Medicine-induced osteonecrosis of the jaw]

VASZILKÓ Mihály, CSÉPLŐ Krisztina, NÉMETH Zsolt, BARABÁS József, UJPÁL Márta

[INTRODUCTION - Bisphosphonates are often used in the treatment of osteoporosis and of certain tumors with bone defects. Thus their rare side effect, necrosis of the jaw becomes more and more frequent. CASE REPORT - Between September 2005 and March 2008 we have treated 40 patients with bisphosphonate induced osteonecrosis in the maxillofacial region at our hospital. From this group, we selected two cases where typical complications emerged. CONCLUSION - Based upon data from the international literature and on our own experiences, we would like to draw attention to the importance of prevention. If symptoms are emerging, referral to a specialized department prepared to the treatment of this condition is recommended.]

Lege Artis Medicinae

JANUARY 20, 2011

[Osteonercosis of the femoral head during pregnancy]

KISS-POLAUF Marianna, TAKÁCS János, TASI Róbert, RÁKÓCZI István

[Osteonecrosis of the femoral head associated with pregnancy is a rare condition. Approximately 40-50 cases have been reported, the first one by Pfeifer in 1957. Avascular osteonecrosis is usually caused by factors that impair the bone’s blood supply (intraosseous arterious or venous occlusion, venous stasis, hypertension in the bone marrow). Owing to the cautious use of radiological imaging techniques during pregnancy and the limited experience with this condition, the correct diagnosis is usually made only retrospectively. Thus, total hip replacement is required in most cases. In the third trimester, MRI examination is safe to perform, and in some cases a simple X-ray should be also considered, as timely avoidance of weight-bearing and other therapeutic interventions might help to prevent the arthroplasty. Here, we would like to present a case observed and treated by us, and to overview the options that could facilitate making the correct diagnosis and finding the appropriate therapeutic program.]

Ca&Bone

SEPTEMBER 11, 2007

[Femoral head osteonecrosis in a child with acute lypmhoblastic leukemia]

GÁCS ZSÓFIA, KOVÁCS GÁBOR, HOSSZÚ ÉVA

[INTRODUCTION - The treatment of pediatric leukemia has become increasingly successful, with a survival rate over 80%. Thus interest has been increasingly focused on the long-term side-effects of the treatment. The questions of reduced fertility rate, occurance of second malignancies, cardiomyopathy, impaired renal and pulmonal function have been extensively studied. Changes of bone metabolism in connection with the disease itself and the treatment have been analysed in the past decade. CASE REPORT - We present the case of a 15-year-old boy with acute lymphoblastic leukemia, who had bone pain soon after the diagnosis. During the course of chemotherapy his complaints were fluctuating, and he developed severe osteoporosis. The level of a bone resorption marker, β-CrossLaps, was elevated. In the second year of therapy an acute pain of the left hip occured with fever and restriction of joint movement, which was diagnosed and treated as osteomyelitis. A few months later avascular necrosis of the left femoral head was revealed. Both pharmaceutic (calcium, vitamin D, calcitonin, bisphophonate) and orthopedic treatment were used, as a result bone mineral density and movement restriction improved; his leukemia is now in remission. CONCLUSIONS - The factors influencing bone metabolism in leukemic children are reviewed. Firstly the effects of malignant cells on bone mineral content are analyzed, then the chemotherapeutic drugs’ mechanisms of action are examined extensively. The direct and indirect effects of secondary factors (hospitalization, immobility, lack of sun exposure, malabsorption, immunsuppression, peripheral neuropahty) are also analyzed. The advantages and disadvantages of drugs used in preventing and treating childhood osteopenia are reviewed.]

Lege Artis Medicinae

MARCH 19, 2007

[BISPHOSPHONATES IN THE TREATMENT OF BONE METASTASES]

NAGYKÁLNAI Tamás

[Bisphosphonates are used in the treatment of malignant diseases with bone metastases and of osteoporosis. The currently available bisphosphonates have a wide range of effectiveness, tolerability and dosing profiles. In metastatic disease, bisphosphonate therapy is aimed at the correction of hypercalcaemia and the reduction of skeletal-related events due to malignancy metastatic to bone. Large clinical trials have shown that long-term administration of bisphosphonates can reduce skeletal-related events by 30 to 40% and significant analgesic effect is reached in at least 50% of the patients. The superiority of zoledronate to the old standard pamidronate has been proved in large randomized trials. Despite the fact that bisphosphonates are generally well tolerated, certain toxicities such as renal toxicity and osteonecrosis of the jaw should be considered with prolonged use.]