Jolanta Wojciechowicz

Therapy-related peripheral neuropathy in multiple myeloma patients

This review discusses the most common issues concerning multiple myeloma (MM)‐related peripheral neuropathy (PN). This is an important MM complication, observed in up to 54% of newly diagnosed patients, caused by the disease itself or its treatment. Although its aetiology is largely unknown, a number of mechanisms are suspected. It is important to know the neurological status of a patient, as many new antimyeloma medicines can trigger or exacerbate any pre‐existing neuropathy. Examples include thalidomide‐induced and bortezomib‐induced PN (TiPN and BiTN, respectively), which are key MM treatment options. TiPN is usually sensory and sensorimotor, whereas BiPN is typically sensory. The mechanisms of chemotherapy‐induced neurotoxicity in MM are well known; thalidomide seems to induce PN through its antiangiogenic properties, whereas bortezomib neurotoxicity is connected with disrupted calcium homeostasis. TiPN incidence ranges from 25% to 75%, and its prevalence and severity appears to be dose‐dependent. BiPN incidence is almost 40% and is dose‐related as well. Poor (25%) reversibility of TiPN prompted the recommendations for dose and exposure reduction, whereas BiPN cases are mostly reversible (64%). Peripheral sensory neuropathy is very rare in patients receiving bendamustine monotherapy. Because of this favourable toxicity profile, bendamustine may be considered a promising option for combination therapies in pre‐existing PN in myeloma patients. Considering the lack of curative therapy for treatment‐emergent PN, prevention is a key management strategy in MM patients. All patients should be evaluated for PN before the administration of a neurotoxic drug, and those under treatment should be closely monitored by a neurologist. Copyright

Mandibular odontogenic cysts associated withbasal cell carcinoma in a patient withGorlin-Goltz syndrome – Case Report

Gorlin-Goltz syndrome (GGS) is a genetic disease of autosomal dominant inheritance. It is characterized by the presence of multiple basal-cell carcinoma foci, odontogenic keratocysts and anomalies of the skin, eyes, bones, nervous and endocrine system. Patients are predisposed to various neoplasms, such as medulloblastoma and fibrosarcoma. Rare incidence of the syndrome and multi-organ manifestations require providing patients with multi-specialist care, in particular, with dermatologists, dentists and surgeons. This is a case report of a 63-year-old patient with Gorlin-Goltz syndrome treated for odontogenic keratocysts of the mandible and basal-cell carcinoma. The report includes an extensive review of the GGS with regard to its etiology, features, clinical examination, diagnostic criteria and treatment modalities.

Necrosis BRONJ of the mandible, complicated by Actinomyces infection – Case Report

Biphosphonate-related osteonecrosis of the jaw (BRONJ) is a common complication of the therapy of malignant cancers. Drugs improve bone density and reduce hypercalcaemia in patients with primary tumours, as well as their metastases to the bones. A characteristic feature are emerging foci of osteonecrosis of the jaws, with secondary infection which is often actinomycotic. Actinomyces are Gramm-positive bacteria which colonize the mucous membrane and in favourable conditions are the cause of inflammation. BRONJ appears spontaneously or may be a consequence of surgical treatment in the area of the jaws. The case is presented of an 82-year-old woman after hysterectomy due to a cancerous lesion who had taken ibandronic acid for a long time. Because of the severe pain in the mandible and the advanced disease, surgical sequestration of the necrosis and antibiotic treatment of the actinomycosis were necessary.

Severe herpes simplex oral mucositis in a patient with non-Hodgkin’s lymphoma after autologous stem cells transplantation – Case Report

The study presents the case of a 25-year-old patient with the diagnosis of diffuse large B cell lymphoma treated autologously with haematopoietic stem cells transplantation. During the period of aplasia after chemotherapy severe sore lips, mouth and esophagus herpes simplex mucositis developed and is successfully treated with foscarnet. The clinical course, localized causal and symptomatic treatment, along with the therapy imaging, are presented.

Epidemiological analysis of 22 patients with congenital bleeding diathesis hospitalized in the Department of Maxillofacial Surgery in Lublin, Poland, 2008–2013

Introduction. Haemophilia A and B are congenital bleeding disorders caused by coagulation factor VIII or IX deficiency. Haemophilia A and B occur in men, like all qualities dependent on genes linked to gender, whereas women are asymptomatic carriers of the gene. The most dangerous manifestations of severe haemophilia include spontaneous haemorrhages into the joints, muscles and body cavities, haematuria and potentially very dangerous intracranial haemorrhages are also quite frequent. The most common manifestations in the region of the maxillofacial skeleton and oral cavity are recurring bleedings from the nose and the gums after dental extractions, as well as extensive haemorrhages from wounds after surgical procedures. Objective. The aim of the study was the analysis of epidemiologic case records of 22 patients affected by various types of haemophilia, admitted to Maxillofacial Surgery Department at Medical University in Lublin, Poland, during 2008–2013. Results. The most numerous group constituted patients diagnosed with Haemophilia A, followed by patients with von Willebrand disease and Haemophilia B, aged 21–40 years. The main cause of hospital admission was the need to perform complex oral cavity sanation. The patients were treated with factor VIII or Factor IX, FEIBA or Heamate P, depending on the type and severity of bleeding diathesis.

Cervicofacial actinomycosis following jaw pathology – Case Reports

Cervicofacial actinomycosis is a specific, primarily chronic inflammatory process caused by Gram-positive anaerobic, microaerophilic Actinomyces bacteria. The infection usually results from the skin or mucosal lesions. The following paper reports two cases of Cervicofacial actinomycosis in patients admitted in 2014 to Maxillofacial Surgery Department in Lublin, Poland. Diagnosis of culture-positive actinomycosis was based on histopathology findings and the presence of actinomyces colonies. Cervicofacial actinomycosis requires surgical treatment, oral cavity sanation, and in the case of presenting actinomycosis abscesses formation, combined surgical incision and drainage. Long-term penicillin antibiotic therapy is necessary.

The cooperation between orthodontists and surgeons in treating facial skeletal deformities

Abstract Face skeletal deformities have been confusing both doctors and patients for ages. The harmony of the face exerts huge influence not only on one’s psyche but also the behavior and the individual’s social and professional status. In this study we present a procedure of treating skeletal malocclusion. It was performed using various orthodontic methods, like the alteration of the growth of jaws and camouflage applied in appropriate age groups. We paid special attention to the close cooperation between the orthodontist and the surgeon, which hugely facilitates curing the most complex, multi-dimensional deformities. In this study, we present our own materials concerning the effects of cooperation between two departments of Medical University of Lublin, namely the Chair and Clinic of Maxillofacial Surgery and Department of Jaw Orthopedics.