RESUMO
BACKGROUND: Patients with complex tumour prostheses often require radiotherapy or radiochemotherapy. OBJECTIVES: Possible tumour diagnoses, indications, planning and therapy procedures, and prognosis of radiotherapy in the context of an interdisciplinary treatment for bone sarcomas are reviewed, including interactions of metal prostheses with radiation and possible subsequent complications. METHODS: Literature search, summary of personal experience. RESULTS: Complex prosthetic procedures are usually applied to patients suffering from Ewing sarcoma or osteosarcoma. In patients with Ewing sarcoma, radiotherapy is an integral part of multimodal treatment, while in patients with osteosarcoma radiotherapy is indicated in special situations. Planning and implementation of radiotherapy treatment can be impaired by metal implants within the target volume (artefacts in the planning computerized tomography, interaction of metal with the therapeutic beam). However, it is-to our knowledge-a point of debate whether radiotherapy after implantation of a prosthesis could impair healing or prosthesis fixation to bone. The data available in the literature suggest that prostheses implanted after radiotherapy entail a higher rate of complications. Multidisciplinary treatment improves the prognosis for these patients markedly. CONCLUSIONS: Patients with sarcomas of the bone undergoing interdisciplinary treatment consisting of surgery, radiotherapy and chemotherapy have a favourable prognosis and an acceptable functionality of the limb can be expected.
Assuntos
Neoplasias Ósseas , Osteossarcoma , Sarcoma de Ewing , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Ósseas/terapia , Humanos , Osteossarcoma/terapia , Sarcoma/terapiaRESUMO
We present a mass map reconstructed from weak gravitational lensing shear measurements over 139 deg2 from the Dark Energy Survey science verification data. The mass map probes both luminous and dark matter, thus providing a tool for studying cosmology. We find good agreement between the mass map and the distribution of massive galaxy clusters identified using a red-sequence cluster finder. Potential candidates for superclusters and voids are identified using these maps. We measure the cross-correlation between the mass map and a magnitude-limited foreground galaxy sample and find a detection at the 6.8σ level with 20 arc min smoothing. These measurements are consistent with simulated galaxy catalogs based on N-body simulations from a cold dark matter model with a cosmological constant. This suggests low systematics uncertainties in the map. We summarize our key findings in this Letter; the detailed methodology and tests for systematics are presented in a companion paper.
RESUMO
The detection of oxacillin resistance is evaluated by the disk diffusion method in a collection of 374 Staphylococcus sp strains. The disk diffusion assay is performed with 5-microgram oxacillin disk and a 10(8) CFU/mL inoculum on Mueller-Hinton agar plates supplemented with 2 or 5% NaCl and incubated at 37 degrees C for 24 h. Strains are considered resistant in accordance to the French recommendations (any growth around the disk is observed). The detection of mecA gene is performed by PCR almost for resistant and discordant strains. Results are concordant for 246 of 256 Staphylococcus aureus strains (182 susceptible and 64 resistant strains) and for 105 of 118 S. epidermidis isolates tested (37 susceptible and 68 resistant strains). Six mecA-negative strains (3 S. aureus and 3 S. epidermidis) give false resistant results on agar with 2 and 5% NaCl. Seventeen isolates are discordant on 5% NaCl: 7 mecA-negative S. aureus strains are susceptible on 2% NaCl agar but resistant at 5% (3% false-positive results), 10 mecA-positive S. epidermidis strains are resistant on 2% NaCl agar but susceptible at 5% NaCl (5% false-negative results). The detection of meticillin resistance is improved on agar supplemented with 2% NaCl.
Assuntos
Hexosiltransferases , Resistência a Meticilina , Testes de Sensibilidade Microbiana/métodos , Peptidil Transferases , Cloreto de Sódio/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus epidermidis/efeitos dos fármacos , Ágar , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Proteínas de Transporte/genética , Proteínas de Transporte/metabolismo , DNA Bacteriano/genética , Difusão , Relação Dose-Resposta a Droga , Géis , Muramilpentapeptídeo Carboxipeptidase/genética , Muramilpentapeptídeo Carboxipeptidase/metabolismo , Oxacilina/farmacologia , Proteínas de Ligação às Penicilinas , Reação em Cadeia da Polimerase , Sensibilidade e Especificidade , Cloreto de Sódio/administração & dosagem , Staphylococcus aureus/genética , Staphylococcus aureus/metabolismo , Staphylococcus epidermidis/genética , Staphylococcus epidermidis/metabolismoRESUMO
The in vitro activity of rifapentine for 44 clinical isolates of Mycobacterium tuberculosis complex was compared with that of rifampicin using the Bactec radiometric method and the absolute concentration method for susceptibility testing. Twenty-nine M. tuberculosis, 11 Mycobacterium bovis and four Mycobacterium africanum strains were studied. Control tests showed that rifapentine was stable for 14 days in 7H9 broth and for 3 weeks in 7H10 agar medium. The 44 M. tuberculosis complex strains were more susceptible to rifapentine than to rifampicin, irrespective of the testing method. In the radiometric system, the MIC50 and MIC90 of rifapentine for M. tuberculosis complex strains were one or two two-fold dilutions lower than those of rifampicin (0.06-0.125 mg/L versus 0.25 mg/L, respectively). By the absolute concentration method, the MIC50 and MIC90 of rifapentine for M. tuberculosis complex strains were two two-fold dilutions lower than those of rifampicin (0.125-0.25 mg/L versus 0.5-1 mg/L, respectively). The MIC90 of rifapentine for the 44 M. tuberculosis complex strains was always 0.25 mg/L, irrespective of the method used, but the radiometric method was more reliable and more reproducible than the agar 7H10 method.
Assuntos
Antibióticos Antituberculose/farmacologia , Mycobacterium bovis/efeitos dos fármacos , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/análogos & derivados , Rifampina/farmacologia , Ágar , Animais , Bovinos , Meios de Cultura , Testes de Sensibilidade Microbiana/métodos , Radiometria/métodos , Reprodutibilidade dos TestesRESUMO
One hundred and seven clinical isolates of Streptococcus pyogenes, 80 susceptible to macrolides and 27 resistant to erythromycin A (MIC >0.5 microgram/ml), were examined. The erythromycin A-lincomycin double-disk test assigned 7 resistant strains to the M-phenotype, 8 to the inducible macrolide, lincosamide, and streptogramin B resistance (iMLS(B)) phenotype, and 12 to the constitutive MLS(B) resistance (cMLS(B)) phenotype. MICs of erythromycin A, clarithromycin, azithromycin, roxithromycin, and clindamycin were determined by a broth microdilution method. MICs of telithromycin were determined by three different methods (broth microdilution, agar dilution, and E-test methods) in an ambient air atmosphere and in a 5 to 6% CO(2) atmosphere. Erythromycin A resistance genes were investigated by PCR in the 27 erythromycin A-resistant isolates. MICs of erythromycin A and clindamycin showed six groups of resistant strains, groups A to F. iMLS(B) strains (A, B, and D groups) are characterized by two distinct patterns of resistance correlated with genotypic results. A- and B-group strains were moderately resistant to 14- and 15-membered ring macrolides and highly susceptible to telithromycin. All A- and B-group isolates harbored erm TR gene, D-group strains, highly resistant to macrolides and intermediately resistant to telithromycin (MICs, 1 to 16 microgram/ml), were all characterized by having the ermB gene. All M-phenotype isolates (C group), resistant to 14- and 15-membered ring macrolides and susceptible to clindamycin and telithromycin, harbored the mefA gene. All cMLS(B) strains (E and F groups) with high level of resistance to macrolides, lincosamide, and telithromycin had the ermB gene. The effect of 5 to 6% CO(2) was remarkable on resistant strains, by increasing MICs of telithromycin from 1 to 6 twofold dilutions against D-E- and F-group isolates.
Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias , Eritromicina/farmacologia , Cetolídeos , Macrolídeos , Testes de Sensibilidade Microbiana/métodos , Streptococcus pyogenes/efeitos dos fármacos , Dióxido de Carbono/metabolismo , Meios de Cultura , Resistência Microbiana a Medicamentos/genética , Humanos , Proteínas de Membrana/genética , Metiltransferases/genética , Reação em Cadeia da Polimerase , Streptococcus pyogenes/genética , Streptococcus pyogenes/metabolismoRESUMO
An HIV-negative woman with chronic lymphopenia related to past sarcoidosis situated in the bone marrow presented with an inflammatory lesion in the iliac region due to a localized Mycobacterium genavense soft tissue infection. The lesion resolved after 12 months of antibiotic therapy with clarithromycin, ethambutol and ciprofloxacin. The patient had no recurrence of the subcutaneous abscess during a follow-up period of 14 months after the end of the treatment.
Assuntos
Hospedeiro Imunocomprometido , Linfopenia/complicações , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Infecções dos Tecidos Moles/diagnóstico , Adulto , Feminino , Soronegatividade para HIV , Humanos , Ílio , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/patologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/patologiaRESUMO
DNA fingerprinting analysis of Mycobacterium tuberculosis is used for epidemiological studies and the control of laboratory cross-contamination. Because standardized procedures are not entirely safe for mycobacteriology laboratory staff, the paper proposes a new technique for the processing of specimens. The technique ensures the inactivation of M. tuberculosis before DNA extraction without the loss of DNA integrity. The control of inactivated cultures should be rigorous and should involve the use of two different culture media incubated for at least 4 months.
Assuntos
Mycobacterium tuberculosis/classificação , Tuberculose/diagnóstico , Técnicas de Tipagem Bacteriana , Impressões Digitais de DNA/métodos , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Temperatura Alta , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Polimorfismo de Fragmento de Restrição , SegurançaRESUMO
The Roche Amplicor Mycobacterium tuberculosis PCR test was compared with mycobacterial culture for direct detection of M. tuberculosis in extrapulmonary specimens. From January 1995 to October 1996, 124 clinical specimens from 112 patients were assessed, including 47 body fluids, 61 tissue specimens and 16 abscesses. The sensitivity and specificity of Amplicor PCR compared to culture were 63.6% and 93.1% respectively. Analysis of 7 PCR-positive, culture-negative specimens confirmed that all were from patients with recently diagnosed tuberculosis under treatment. Eight specimens were PCR negative-culture positive, including a pleural fluid containing inhibitory substances. On acid-fast bacilli (AFB) smear-negative specimens, sensitivity and specificity were 53 and 100% respectively. The best results for Amplicor PCR were obtained with abscesses and biopsies. It is concluded that this test, highly specific for the diagnosis of tuberculosis, is at least as sensitive on extrapulmonary specimens as on smear-negative respiratory specimens.
Assuntos
Reação em Cadeia da Polimerase , Kit de Reagentes para Diagnóstico , Tuberculose/diagnóstico , Abscesso/microbiologia , Biópsia , Líquidos Corporais/microbiologia , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Sensibilidade e EspecificidadeRESUMO
Among 231 clinical strains of Escherichia coli tested during may 1992, 89 isolates (38.5%) were resistant to beta-lactams. The resistant strains were principally recovered from urinary and genital specimen from medicine and surgical departments. MICs of beta-lactams were determined alone or combined with clavulanic acid, and beta-lactamases were identified by isoelectric point characterization and by enzymatic inhibition tests. Among the resistant strains, 92.1% were secreting a penicillinase and 6.7% a cephalosporinase. No extended-spectrum beta-lactamase was observed. 85.5% of penicillinases were TEM-1 enzymes, 4.9% SHV-1 beta-lactamase, 1.1% OXA-1 beta-lactamase and 8.5%, 7 strains, were IRT beta-lactamases (formerly called TRI). For 24 clinical E. coli strains, the MICs values were > or = 32 mg/l for amoxicillin plus clavulanic acid. The 7 IRT beta-lactamases showed the highest MICs, 256 to 4096 mg/l. Four of them exhibited a beta-lactamase of pI 5.4 and 3 a beta-lactamase of pI 5.2. The IRT beta-lactamases represent 3% of all the Escherichia coli strains. This frequency is comparable or lower than the values reported by other studies conducted between 1992 and 1994.