Attempts to Target Staphylococcus aureus Induced Osteomyelitis Bone Lesions in a Juvenile Pig Model by Using Radiotracers.

Background [18F]FDG Positron Emission Tomography cannot differentiate between sterile inflammation and infection. Therefore, we, aimed to develop more specific radiotracers fitted for differentiation between sterile and septic infection to improve the diagnostic accuracy. Consequently, the clinicians can refine the treatment of, for example, prosthesis-related infection. METHODS: We examined different target points; Staphylococcus aureus biofilm (68Ga-labeled DOTA-K-A9 and DOTA-GSGK-A11), bone remodeling ([18F]NaF), bacterial cell membranes ([68Ga]Ga-Ubiquicidin), and leukocyte trafficking ([68Ga]Ga-DOTA-Siglec-9). We compared them to the well-known glucose metabolism marker [18F]FDG, in a well-established juvenile S. aureus induced osteomyelitis (OM) pig model. RESULTS: [18F]FDG accumulated in the OM lesions seven days after bacterial inoculation, but disappointingly we were not able to identify any tracer accumulation in OM with any of the supposedly more specific tracers. CONCLUSION: These negative results are, however, relevant to report as they may save other research groups from conducting the same animal experiments and provide a platform for developing and evaluating other new potential tracers or protocol instead.

Successful treatment of chronic recurrent multifocal osteomyelitis using low-dose radiotherapy : A case report.

BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare autoinflammatory disease, which lacks an infectious genesis and predominantly involves the metaphysis of long bones. Common treatments range from nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids at first onset of disease, to immunosuppressive drugs and bisphosphonates in cases of insufficient remission. The therapeutic use of low-dose radiotherapy for CRMO constitutes a novelty. CASE REPORT: A 67-year-old female patient presented with radiologically proven CRMO affecting the right tibia/talus and no response to immunosuppressive therapy. Two treatment series of radiation therapy were applied with an interval of 6 weeks. Each series contained six fractions (three fractions per week) with single doses of 0.5 Gy, thus the total applied dose was 6 Gy. Ten months later, pain and symptoms of osteomyelitis had completely vanished. CONCLUSION: Radiotherapy seems to be an efficient and feasible complementary treatment option for conventional treatment refractory CRMO in adulthood. The application of low doses per fraction is justified by the inflammatory pathomechanism of disease.

[The application of laser therapy for the medical rehabilitation of the children presenting with chronic osteomyelitis].

The objective of the present study was to develop a scientifically sound rationale for the application of infrared laser radiation (IRLR) either separately or in the combination with fluctuation magnetic therapy in the medical rehabilitation of the children presenting with chronic hematogenous osteomyelitis. Another objective was to evaluate the clinical effectiveness of this therapeutic modality. Two achieve these goals, the clinical observations and special research studies were conducted in two directions with the participation of 95 patients at the age varying from 1 to 15 years. The study has demonstrated the effectiveness of the inclusion of IRLR in the medical rehabilitation program for the children with chronic hematogenous osteomyelitis in different periods of the disease. It was shown that the transcutaneous infrared irradiation of the affected area during the exacerbation of chronic osteomyelitis had a well apparent immunostimulatory effect and reduced the activity of the inflammatory process. The application of IRLR in combination with fluctuation magnetic therapy during the period of partial remission, had a more pronounced influence on the microcirculation and stimulated the regenerative and trophic processes.

The use of 808-nm light therapy to treat experimental chronic osteomyelitis induced in rats by methicillin-resistant Staphylococcus aureus.

BACKGROUND DATA: In vivo and in vitro studies have reported that laser energy in differing wavelengths and irradiation regimes has a potential bactericidal effect on Staphylococcus aureus. OBJECTIVE: The purpose of this study was to investigate whether a light wavelength of 808 nm in varying doses has an effect on chronic osteomyelitis induced experimentally in the rat tibia. METHODS: Intramedullary cavities were surgically created in the left tibias of 39 adult Wistar albino rats. Five randomly selected subjects were injected with a sterile saline solution, and methicillin-resistant S. aureus (MRSA) was used to induce osteomyelitis in the remaining rats. After 3 weeks, rats with evidence of osteomyelitis were treated with debridement alone (n = 7), with debridement plus laser irradiation to induce photoeradication (n = 21), or were not treated at all [negative control, (n = 6)]. Active irradiation was performed using an 808 nm, 100 mW continuous-wave diode laser with a beam spot size of 0.7854 cm(2) (irradiance = 127.3 mW/cm(2)). Laser treatment commenced immediately after debridement surgery and was applied daily for 5 consecutive days. Irradiation lasted 60 secs (6 J at 7.64 J/cm(2): n = 7), 120 secs (12 J at 15.29 J/cm(2): n = 7), or 180 secs (18 J at 22.93 J/cm(2): n = 7). Rats in the sham and negative control groups were killed 21 days post-induction surgery, and those in the treatment groups were killed after 42 days. Following killing, tibias were removed and analyzed histopathologically, radiographically, and microbiologically. RESULTS: Histopathological analysis showed that infection levels had decreased by 37%, 67%, 81%, and 93% in the groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93 J/cm(2) light therapy, respectively, compared to the negative control group. Osteomyelitis-induced rats had the highest bacteria count (5 × 10(5)). Bacterial counts fell to 1.6 × 10(4), 4.3 × 10(2), 5.5 × 10(1), and 3.3 × 10(0) in groups treated by debridement or by debridement plus 7.64, 15.29, and 22.93 J/cm(2) light therapy, respectively, compared to the negative control group. CONCLUSIONS: Within the limitations of this study, laser phototherapy with the appropriate irradiation parameters appears to be a promising adjunct and/or alternative technique to pharmacological agents in the treatment of osteomyelitis. The 808 nm 100 mW (127.3 mW/cm(2)) laser device used in this study achieved a maximum effect with an irradiation time of 180 secs, delivering 18 J at an energy density of 22.93 J/cm(2).

Surgical strategies for vertebral osteomyelitis and epidural abscess.

Pyogenic vertebral discitis and osteomyelitis (PVDO) has become an increasing problem for the spine surgeon. Despite recent advances in medical care and improved diagnostic neuroimaging, PVDO remains a major cause of illness and death in the elderly population. Infection of the spinal column often presents insidiously; however, if not treated appropriately and in a timely manner it can lead to severe neurological impairment, systemic septicemia, and progressive spinal deformity. In this paper the authors review the epidemiological and pathophysiological features and the clinical presentation of PVDO. Conventional medical therapy is described, with a particular focus on the methods of diagnosis. Surgical strategies for PVDO are then presented based on the literature and according to the practice of the senior author (S.L.O.), with an emphasis placed on structural considerations, implant selection, and techniques for augmenting vascular tissue to the site of infection.

[Omentoplasty in surgical treatment of osteomyelitis of the ribs and sternum]. / Omentoplastika v khirurgicheskom lechenii osteomielita reber i grudiny.

Seven-year experience in the treatment of 21 patients with chronic osteomyelitis of the ribs and sternum is summarized. Great omentum was used as plastic and disinfecting material in combination with laser radiation. Indications, techniques, short- and long-term results are presented. There were no recurrences of purulent process in the bones. Omentoplasty is the method of choice in surgical treatment of purulent lesions of costal cartilage and sternum.

[Use of radiotherapy in the complex treatment of patients with complicated forms of diabetic angiopathy]. / Primenenie rentgenoterapii v komplekse lecheniia bol'nykh s oslozhnennymi formami diabeticheskoi angiopatii.

In 140 patients with purulent-necrotic complications of diabetic microangiopathy the results of different methods of treatment were analyzed. High efficacy of antiinflammatory X-ray therapy was confirmed. Application of X-ray therapy in combination with long lasting intraarterial infusions promoted lowering the frequency of high amputation of the extremity conduction.

Meningiomas múltiples inducidos por radiaciones: a propósito de un caso / Multiple meningiomas induced by radiation: case report

La etiología de los meningiomas no está dilucidada. Las radiaciones son uno de los pocos factores etiológicos estudiados que pueden inducir el desarrollo de estos tumores, al provocar alteraciones en el brazo largo del cromosoma 22. Se presenta el caso de una paciente que a raíz de una osteomielitis crónica de la calota, fue irradiada en el cráneo, desarrollando 20 años más tarde múltiples meningiomas de la convexidad, que fueron resecados. Se comentan las características de los meningiomas inducidos por radiaciones, como son la multiplicidad, frecuente localización en la convexidad, tendencia a la malignización y recurrencia precoz, características que se deben tener en cuenta en el tratamiento

[An initial assessment of therapeutic value of strontium 85 isotope in treatment of chronic osteomyelitis in adults]. / Wstepna ocena wartosci terapeutycznej izotopu strontu-85 w leczeniu przewleklego zapalenia kosci u doroslych.

An initial assessment of treatment of chronic osteomyelitis in 16 adults with Strontium 85 is presented. A dose 3.5-5 times greater than standard scintigraphic one was administered. In 3 cases the dose has been repeated because of the persistence of infection. The radionuclide was well tolerated. In 14 cases ceasing of osteomyelitis have been achieved. Laboratory tests showed no abnormalities.

Chronic nonhematogenous osteomyelitis treated with adjuvant CO 2 laser sterilization: a preliminary report.

A CO 2 laser was used to sterilize wounds resulting from trauma injuries to bone on 12 sites in 11 patients. This treatment relieved chronic osteomyelitis and enabled most of the patients to function normally within 3 months of surgery.

[Effects of intravascular laser irradiation of blood on the state of the immune system of patients with chronic osteomyelitis]. / Vliianie vnutrisosudistogo lazernogo oblucheniia krovi na sostoianie immunnoi sistemy bol'nykh khronicheskim osteomielitom.

The authors discuss the results of study of the immune status in 55 patients with chronic osteomyelitis, it was found that the condition of the patients' immune system reflects the duration and severity of the disease and the individual reactivity of the organism. The inclusion of laser treatment in the complex of therapeutic measures should be based on appraisal of the condition of the immune system and conducted under dynamic immunological control. In deficiency of the thymus-dependent immunity the sessions of blood intravascular laser irradiation activate the organism's defence forces and facilitate correction of the imbalance in the system of the regulating cells. Laser irradiation of blood in mild changes of the immunological status is expedient because it may lead to negative dynamics of the immune system. Attainment of an optimal immunological condition in the preoperative period is conductive to a favourable course of the postoperative period and a favourable outcome of the disease.

[Problems and perspectives of radiotherapy of non-tumor diseases]. / Problemy i perspektivy luchevoi terapii neopukholevykh zabolevanii.

The experience of the world leading hospitals confirms the high efficacy and appropriateness of radiation therapy of nontumorous diseases. The authors consider the general principles of the organization of radiotherapeutic service, discuss reasons that have led to a decrease in the use of this method for therapy of nontumorous diseases in this country. They also emphasize the fact that radiation therapy must have its place among therapeutic modalities used for nontumorous diseases.

[The effect of low-intensity radiation from a helium-neon laser on the alkaline phosphatase activity in an uncomplicated mandibular fracture and in traumatic osteomyelitis]. / Vliianie nizkointensivnogo izlucheniia gelii-neonovogo lazera na aktivnost' shchelochnoi fosfatazy pri neoslozhnennom perelome nizhnei cheliusti i travmaticheskom osteomielite.

The osteal alkaline phosphatase (AP) activity was examined in 167 Wistar rats with uncomplicated regeneration and traumatic osteomyelitis of the mandible, exposed to low-intensity He-Ne laser. Laser exposure stimulated the bone AP activity in the animals with traumatic osteomyelitis and uncomplicated regeneration, confirming the efficacy of therapy with He-Ne laser.

Multiple eccrine poromas arising in chronic radiation dermatitis.

A 70-year-old white man developed 7 eccrine poromas in an area of chronic radiation dermatitis of his right lower extremity over a period of 37 years. To our knowledge, multiple eccrine poromas unequivocally linked to chronic X-ray damage are hitherto unreported.

[Helium-neon lasers in the treatment of suppurative-inflammatory diseases in children]. / Gelii-neonovyi lazer v lechenii gnoino-vospalitel'nykh zabolevanii u detei.

The use of radiation of the helium-neon laser makes time of the treatment of patients with purulent processes 4-6 days shorter, prevents the formation of rough scars and deformities at the place of the former purulent wound. The laser irradiation is especially effective when combined with proteolytic enzymes.

[Radiotherapy in the prevention of postoperative and traumatic complications]. / Luchevaia terapiia v preduprezhdenii posleoperatsionnykh i ranevykh oslozhenii.

An analysis of the results of radiation therapy of 587 patients with postoperative and traumatic complications has shown that special gamma-therapy used at early time following trauma or surgical intervention, with the first clinical signs of an incipient inflammatory process (the so-called "anticipating" irradiation), makes it possible to avoid the development of serious postoperative, post-traumatic complications: wound suppuration, fistulas, secondary parotitis, postamputation pain syndrome, "needle" osteomyelitis, keloid cicatrix, skin graft rejection, etc. In the authors' opinion, this promising trend in radiotherapy of nontumorous diseases is worth a wider using in clinical practice.