Context
Cervical artery dissection (CAD) is a common cause of stroke in young
adults. There is controversy over whether anticoagulation is superior to
antiplatelet therapy in preventing stroke in patients with CAD, although
meta-analyses to date have not shown any difference between the two
treatments.
Evidence acquisition
We performed a PubMed search using each of the keywords:
“Cervical artery dissection”,
“Dissection”, “Carotid
dissection”, and “Vertebral
dissection” between January 1st, 1990 and
July 1st 2015. We identified evidence-based peer-reviewed
articles, including randomized trials, case series and reports, and
retrospective reviews that encompass the epidemiology, clinical
manifestations, pathophysiology, treatment, and outcome of cervical artery
dissection.
Results
This paper highlights the mechanisms of cervical artery dissection
and stroke in patients with dissection as well as the natural history and
treatment.
Conclusion
Given the relatively rare incidence of this disease, multicenter
studies with collaborative effort among stroke centers worldwide should be
considered to enroll patients with cervical artery dissection in a
randomized trial comparing the two treatments.
BackgroundBisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) is an adverse effect of bisphosphonate treatment with varying reported incidence rates.MethodsIn two neighboring German cities, prevalence and additional factors of the development of BP-ONJ in multiple myeloma patients with bisphosphonates therapy were recorded using a retrospective (RS) and cross-sectional study (CSS) design. For the RS, all patients treated from Jan. 2000 - Feb. 2006 were contacted by letter. In the CSS, all patients treated from Oct. 2006 - Mar. 2008 had a physical and dental examination. Additionally, a literature review was conducted to evaluate all articles reporting on BP-ONJ prevalence. PubMed search terms were: bisphosphonat, diphosphonate, osteonecrosis, prevalence and incidence.ResultsIn the RS, data from 81 of 161 patients could be obtained; four patients (4.9%) developed BP-ONJ. In the CSS, 16 of 78 patients (20.5%) developed BP-ONJ. All patients with BP-ONJ had received zoledronate; 12 of these had had additional bisphosphonates. All except one had an additional trigger factor (tooth extraction [n = 14], dental surgical procedure [n = 2], sharp mylohyoid ridge [n = 3]).ConclusionThe prevalence of BP-ONJ may have been underestimated to date. The oral examination of all patients in this CSS might explain the higher prevalence, since even early asymptomatic stages of BP-ONJ and previously unnoticed symptomatic BP-ONJ were recorded. Since nearly all patients with BP-ONJ had an additional trigger factor, oral hygiene and dental care might help to reduce BP-ONJ incidence.
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