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      Osteomielitis: Criterios actuales e importancia para el Estomatólogo

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          Abstract

          Entre las múltiples afecciones que se presentan en el complejo bucofacial se encuentra la osteomielitis, una enfermedad ósea poco frecuente, que con el advenimiento de los antibióticos ha dejado de ser un problema de salud para muchos países del mundo. Dada la importancia que tiene su conocimiento para el estomatólogo, se recopilan criterios actuales sobre esta entidad en lo referente a la etiopatogenia, manifestaciones clínicas, diagnóstico y tratamiento, especialmente cuando afecta al maxilar o a la mandíbula. Tomando como base algunas consideraciones generales, y abarcando varios elementos, se exponen las características macroscópicas y microscópicas de las lesiones causadas por esta enfermedad.

          Translated abstract

          Among the various affections of the orofacial complex is osteomyelitis, a rare bone disease that, with the introduction of antibiotics, has cesed to be a health problem in many countries. Given the importante of the detection of this disease by the dentist, present criteria on this entity as to etiopathogenecity, clinical manifestations, diagnosis and treatment are collected, specially when the maxilla or the jaw is affected. Taking some general considerations and a number of elements as a basis, some macroscopic and microscopic characteristics of the lesions caused by this disease were set forth in this paper.

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          Most cited references22

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          Mechanisms of Staphylococcus aureus invasion of cultured osteoblasts.

          Staphylococcus aureus is a bacterial pathogen causing approximately 80% of all cases of human osteomyelitis. This bacterium can adhere to and become internalized by osteoblasts and previous studies indicate that osteoblasts are active in the internalization process. In the current study, we examined the roles of microfilaments, microtubules and clathrin-dependent receptor-mediated endocytosis in the internalization of S. aureus by MC3T3-E1 mouse osteoblast cells. Microfilament and microtubule polymerization was inhibited with cytochalasin D and colchicine. Clathrin-coated pit formation was examined by using the transaminase inhibitor, monodanslycadaverine. The results of this study indicate that mouse osteoblasts utilize actin microfilaments, microtubules and clathrin-coated pits in the internalization of S. aureus; however, microfilaments seem to play the most significant role in the invasion process. Copyright 1999 Academic Press.
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            Antimicrobial treatment of chronic osteomyelitis.

            Chronic osteomyelitis has been a difficult problem for patients and the treating physicians. Appropriate antibiotic therapy is necessary to arrest osteomyelitis along with adequate surgical therapy. Factors involved in choosing the appropriate antibiotic(s) include infection type, infecting organism, sensitivity results, host factors, and antibiotic characteristics. Initially, antibiotics are chosen on the basis of the organisms that are suspected to be causing the infection. Once the infecting organism(s) is isolated and sensitivities are established, the initial antibiotic(s) may be modified. In selecting specific antibiotics for the treatment of osteomyelitis, the type of infection, current hospital sensitivity resistance patterns, and the risk of adverse reactions must be strongly appraised. Antibiotic classes used in the treatment of osteomyelitis include penicillins, beta-lactamase inhibitors, cephalosporins, other beta-lactams (aztreonam and imipenem), vancomycin, clindamycin, rifampin, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, metronidazole, and new investigational agents including teicoplanin, quinupristin/dalfopristin, and oxazolidinones. Traditional treatments have used operative procedures followed by 4 to 6 weeks of parenteral antibiotics. Adjunctive therapy for treating chronic osteomyelitis may be achieved by using beads, spacers, or coated implants to deliver local antibiotic therapy and/or by using hyperbaric oxygen therapy (once per day for 90-120 minutes at two to three atmospheres at 100% oxygen).
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              Pathophysiology of posttraumatic osteomyelitis.

              Understanding the pathophysiology of posttraumatic osteomyelitis is crucial as researchers attempt to meet the challenge of developing more effective strategies for the management and prevention of this infection. Some aspects of pathogenesis have been well described, including the important roles of the extent of soft tissue injury, bacterial attachment to necrotic bone and fixation devices, and bacterial contamination at the time of injury. More recently, the importance of early wound coverage in preventing osteomyelitis has been emphasized. Now some of the cellular interactions that promote infection and tissue damage are beginning to be understood. Trauma can have deleterious effects on host response to infection through its activation of certain cytokines. These cytokines, mainly produced by cells of the immune system, regulate the action of polymorphonuclear leukocytes, macrophages, and lymphocytes. Bacteria have been shown to use diverse tactics to initiate and maintain infection that lead to host defense impairment, decreased efficacy of antibiotics, and direct tissue damage. New insights into the pathophysiology of osteomyelitis may lead to the innovative therapeutic approaches needed to improve the standard of care for this infection.
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                Author and article information

                Journal
                est
                Revista Cubana de Estomatología
                Rev Cubana Estomatol
                Editorial Ciencias Médicas (Ciudad de La Habana, , Cuba )
                0034-7507
                1561-297X
                April 2001
                : 38
                : 1
                : 52-66
                Affiliations
                [01] Ciudad de La Habana orgnameFacultad de Estomatología Cuba
                [02] orgnameHospital Freyre de Andrade
                Article
                S0034-75072001000100006 S0034-7507(01)03800106
                70f42890-a3f5-4d57-b60e-4c042d7bbc79

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 15 March 2001
                : 18 April 2001
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 15
                Product

                SciELO Cuba

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                ARTICULOS DE REVISION

                JAW DISEASES,OSTEOMYELITIS,ANTIBIOTICOS,ENFERMEDADES DE LA BOCA,ENFERMEDADES MAXILO MANDIBULARES,ANTIBIOTICS,MOUTH DISEASES,OSTEOMIELITIS

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