Necrosis, bone

Treatment of osteomyelitis is dependent on the extent of bone necrosis. For acute osteomyelitis with minimal bone destruction, an extended course of antimicrobial therapy should effectively treat the infection however, in chronic osteomyelitis surgical intervention is also typically required. 

O Osteomyelitis is an infection of the bone that is associated with high morbidity and increased health care costs. The inflammatory response associated with acute osteomyelitis can lead to bone necrosis and subsequently chronic infections. Bacterial pathogens, particularly Staphylococcus aureus, are the most common microorganisms implicated in these infections. Diagnosis and treatment are often difficult due to the heterogeneous... 

The presenting complaints of overexposed workers may be toothache and excessive salivation. There may be a dull red appearance of the oral mucosa. One or more teeth may loosen, followed by pain and swelling of the jaw healing may be delayed after dental procedures such as extractions with necrosis of bone, a sequestrum may develop with sinus tract formation. In a series of 10 cases, the shortest period of exposure to phosphorus fume (concentrations not measured) that led to bone necrosis was 10 months (2 cases), and the longest period of exposure was 18 years. ... 

Bone diseases with osteoblast activity (Paget s disease, rachitis, osteomalacia, bone tumours, aseptic bone necrosis, fracture healing)... 

The use of arsenical paste in dental medicine can lead to severe toxicity. Severe alveolar bone necrosis has been reported as a result of leakage of an arsenical devitalization paste into the periodontium (24). 

Ozmeric N. Localized alveolar bone necrosis following the use of an arsenical paste a case report. Int Endod J 2002 35(3) 295-9. 

Chronic ingestion and/or inhalation of phosphorus may result in osteomyelitis and bone necrosis. Signs and symptoms of this condition include bone inflammation, spontaneous bone fractures, anemia, and weight loss. A typical example of this condition is phossy jaw . This condition is caused by the absorption of phosphorus fumes through teeth cavities. Once absorbed, phosphorus attacks and destroys the bones of the mandible and maxilla. The extent of facial bone loss can be so severe that the bone necrosis may extend from the maxilla to the eye orbits. Phossy jaw is an irreversible and usually fatal condition. 

One aspect of improper decompression that has been reported is aseptic bone necrosis. Bone is poorly vascularized and poorly innervated thus, gas bubbles trapped between the periosteum and the bone may lead to necrosis. Being poorly innervated there is no warning until too late. It is insidious. Bone necrosis has been associated with high pressures, hard work, prolonged exposure, and most important inadequate decompression Thus far bone necrosis has been seen only in caisson work. Aseptic bone necrosis at a later date could provide a basis for compensation claims. 

TOXICITY AND MONITORING Most side effects are dose-dependent. Long-term use is associated with a number of complications, including psychiatric problems, cataracts, myopathy, osteoporosis, avascular bone necrosis, glucose intolerance or overt diabetes melhtus, and hypertension. In addition, psoriatic patients treated with parenteral or topical glucocorticoids may have a pustular flare, particularly if the steroid is tapered rapidly. 

Phosphorus (yellow phosphorus, white phosphorus, P [CAS 7723-14-0]) Severe, penetrating burns may result upon direct contact. Material may ignite upon contact with skin. Fumes irritating to eyes and respiratory tract pulmonary edema may occur. Potent hepatotoxin. Systemic symptoms include abdominal pain, jaundice, and garlic odor on the breath. Historically, chronic poisoning caused jaw bone necrosis (phossy jaw). See also p 307. 

A family cat turned up with a suppurating jaw the Hill s Army veterinarian recognized the bone necrosis as a sign of radiation poisoning from Tech Area contamination and kept the animal alive to observe its unusual symptomatology, about which not much was yet known. Its tongue swelled and its hair fell out in patches its heartsick owner eventually asked that the animal be destroyed. 

Evans, E.M., Freeman, M.A.R., Miller, A.J. et al. (1974) Metal Sensitivity as a Cause of Bone Necrosis and Loosening of the Prosthesis in Total Joint Replacement, J. Bone and Joint Surg., 56B (4), 626-642 One of the original articles pointing to a possible problem. Skin test used. 

The health hazards of work in compressed air and diving are decompression sickness ( the bends ) and aseptic bone necrosis ( bone rot ). Both these illnesses can have long-term effects varying from slight impairment of mobility to severe disablement. The protective measures, including decompression procedures, are laid down in the Work in Compressed Air Special Regulations and these should be observed in conjunction with the medical code of practice for work in compressed air. 

Sometimes this exposure of bone to high temperatures leads to incidences of bone necrosis and tissue damage that could, finally, result in failure of the prosthetic fixation [74]. It has been shown that three factors can affect bony tissue as a consequence of implant fixation using PMMA bone cement [75,76] ... 

Paragraph 8 of the Paper seems to imply that bone necrosis is far more amenable to treatment, cure and prevention than bends. 

If the hazard of bone necrosis is to be elim-ated would the Author agree that work in compressed air should be eliminated at least until further research and investigation on this condition can give a positive lead to effective precautions that can be taken and an effective curative treatment has been found and is available ... 

In answer to Mr Brueton I did not intend to give the impression that bone necrosis is less important than the bends. Research on bone necrosis is still going on. The Paper draws attention to the possibility of alternative means of tunnelling. 

Prevention of GVHD has been limited to either the depletion of donor T cells before transplantation or the use of broadly immunosuppressive drugs that cause profound immunodeficiency and toxicides such as hypertension, diabetes, renal failure, and aseptic bone necrosis [197,198]. Alternatively, ECP appears to be an effective strategy for both acute and chronic GVHD, even in patients who are refractory to conventional immunosuppressive therapy [197,199]. 

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