Head and neck cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
The aim of surgery is to remove the primary tumour with a margin adequate to encompass all microscopic spread with the reconstruction of any major tissue deficits. Surgery may also include excision of the regional lymph nodes. This may be the sole primary treatment, combined with radiotherapy or as salvage for local recurrence following radical radiotherapy. Surgery is sometimes the treatment of choice for locally advanced tumours, i.e. T3 and T4 tumours, as these are bulky tumours that may invade adjacent bone when they are particularly difficult to eradicate by radiotherapy alone. There is also an increased risk of osteonecrosis after radiotherapy when the bone is invaded and this is a particularly difficult management problem. However, radical surgery can involve a major resection of tissue, leading to severe functional morbidity. For example, resection of part of the tongue will result in some degree of dysarthria and possible difficulty in mastication of food and swallowing. Such symptoms can severely compromise the patient's quality of life. Therefore, T1, T2 and small bulk T3 tumours are usually best treated by radiotherapy with surgery reserved for local recurrence.
Microsurgery and Orthopedic Animal Models
Yuehuei H. An, Richard J. Friedman in Animal Models in Orthopaedic Research, 2020
Another approach for treatment of osteonecrosis is a vascularized bone graft. Femoral head osteonecrosis has been treated using vascularized fibula graft73,74 and vascularized iliac crest graft.75 The clinical application was started seven years prior to the first experimental study in a canine femoral head model using vascularized ribs transfer.76 Recently, a vascularized periosteal bone graft has been reported to treat osteonecrosis of talus.64 Although most cases of femoral head necrosis have been treated with femoral head replacement or total hip arthroplasty, vascularized bone graft still remains as an alternative treatment, especially when the collapse is not severe.77,78
Normal Tissue Tolerance
Loredana G. Marcu, Iuliana Toma-Dasu, Alexandru Dasu, Claes Mercke in Radiotherapy and Clinical Radiobiology of Head and Neck Cancer, 2018
Late effects from radiation originate either from chronic changes induced in the early reacting tissues or from pathophysiological changes induced by radiation in the vasculature and connective tissues. Thus, radiation induces vasodilatation and increases permeability of the blood vessels, which allow the deposition of fibrin and collagen that eventually leads to the formation of fibrosis in the vessel walls and the perivascular spaces. These, in turn, narrow the vascular lumen and decrease the vascular perfusion in a process consistent with arteroschlerotic changes due to aging, which ultimately result in an impairment of the function of the tissue that they support. The connective tissue pathogenesis has been related to increased collagen biosynthesis and enhanced proliferation of the irradiated fibroblasts, which subsequently invade the connective tissue leading to fibrosis (Cooper et al. 1995). Given the multitude of tissues involved in head and neck radiotherapy, late effects have a larger variability in terms of manifestation. Thus, damage of the mucosa or the skin could lead to chronic ulceration, atrophy and telangiectasia. Damage to the connective tissues could lead to oedema, fibrosis, trismus, and even necrosis. Damage to the salivary glands could lead to abnormal salivary flow, which, in turn, leads to dental decay. Damage to the nervous tissue could lead to neuropathies and necrosis. Damage to the bone or cartilages could lead to osteonecrosis or chondronecrosis.
Antiphospholipid antibodies and osteonecrosis in systemic lupus erythematosus: a meta-analysis
Published in Expert Review of Clinical Immunology, 2021
Wei Qijiao, Zhou Meng, Liu Jianwen, Zhang Shengli, Gao Fei, Lin He, Chen Zhihan
Osteonecrosis (ON) is the destruction of the normal blood supply to bone tissue, which is attributable to various reasons, leading to collapse of the bone structure, thereby causing joint pain and loss of function. The femoral head and knee joint bone are most commonly affected [1]. ON is the primary cause of disability in systemic lupus erythematosus (SLE), which seriously hampers the quality of life of patients [2]. Several risk factors for ON in SLE have been identified [3,4]. Antiphospholipid antibodies (aPLs) include lupus anticoagulant (LA), anticardiolipin (ACL), and antiβ2GP1 antibodies. They closely modulate thrombus formation [5]. However, aPLs have also been considered a classification criterion for SLE post-1997 (SLICC, ACR-EULAR, etc.). The association between aPLs and ON in SLE remains a matter of contention, and no concrete conclusion has been arrived at yet. In the present study, a meta-analysis of the literature related to SLE, aseptic ON, and aPLs was conducted, and their association was explored.
Complications and adverse effects related to surgical and medical treatment in patients with inflammatory bowel disease in a prospectively recruited population-based cohort
Published in Scandinavian Journal of Gastroenterology, 2021
Anders Rönnblom, Östen Ljunggren, Urban Karlbom
In this material, there are only occasionally bone mineral density (BMD) measurements so osteoporosis development, measured as a decrease in BMD, cannot be assessed. Data on fractures were, however, collected and in this material only one fracture, a femoral fracture, which might be related to GC treatment was identified. This fracture occurred in a young patient after a prolonged steroid treatment. The patient also suffered from severe comorbidity in the form of cerebral palsy and tetraplegia. The BMD measurement from this patient revealed low bone mass for the age but to what extent this was due to GC treatment is not possible to decide. Overall there are no indications of an overrepresentation of typical osteoporosis-related fractures in this material. As for osteonecrosis three patients were identified with this diagnose in the charts. One suffered severely and had joint replacement in both hips and in a shoulder. Regarding the other two there are no information of joint replacements. One of the cases was unclear since the MRI was not conclusive, and the patient did not attend further appointments. The third patient was lost to follow up. In total giving the fact that in this material 358 patients were treated with systemic GC this gives an incidence of 0.8% which is in the lower range of previous reports [35–37].
Human umbilical cord mesenchymal stem cells prevent glucocorticoid-induced osteonecrosis of the femoral head by promoting angiogenesis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Gang Tian, Chuanjie Liu, Haitao Wang, Zhiping Yu, Jian Huang, Qi Gong, Daoqiang Zhang, Haibo Cong
Osteonecrosis of the femoral head (ONFH) is a destructive orthopedic disease that is a series of pathological changes and clinical symptoms including obstruction of the blood circulation in the femoral head of the necrotic site and the death of local bone cells, resulting in trabecular necrosis, and subsequent changes in the normal structure of the femoral head until local collapse occurs [1]. It is estimated that the total prevalence of non-traumatic osteonecrosis in China is 0.725%, and it tends to be younger [1,2]. Clinically, it is characterized by severe hip pain, claudication, and limited flexion and extension activities [1]. Especially, many previously difficult diseases have been alleviated or even cured due to the improvement of medical standards and the continuous improvement of diagnostic techniques; however, the toxic effect of some drugs involved in this longer course can eventually develop into osteonecrosis.
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