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AJNR Am J Neuroradiol ; 42(4): 627-631, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541899


Percutaneous image-guided biopsy currently has a central role in the diagnostic work-up of patients with suspected spondylodiscitis. However, on the basis of recent evidence, the value of routine image-guided biopsy in this disease can be challenged. In this article, we discuss this recent evidence and also share a new diagnostic algorithm for spondylodiscitis that was recently introduced at our institution. Thus, we may move from a rather dogmatic approach in which routine image-guided biopsy is performed in any case to a more individualized use of this procedure.

Discite , Discite/diagnóstico por imagem , Humanos , Biópsia Guiada por Imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
Eur J Nucl Med Mol Imaging ; 48(1): 241-253, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32594196


BACKGROUND: Left ventricular assist devices (LVADs) are increasingly used for the treatment of advanced heart failure. LVADs improve quality of life and decrease mortality, but the driveline carries substantial risk for major infections. These device-related LVAD and driveline infections are difficult to diagnose with conventional imaging. We reviewed and analysed the current literature on the additive value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging for the diagnosis of LVAD-related infections." MATERIALS/METHODS: We performed a systematic literature review using several databases from their inception until the 31st of December, 2019. Studies investigating the diagnostic performance of FDG-PET/CT in patients with suspected LVAD infection were retrieved. After a bias risk assessment using QUADAS-2, a study-aggregate meta-analysis was performed on a per examination-based analysis. RESULTS: A total of 10 studies were included in the systematic review, eight of which were also eligible for study-aggregate meta-analysis. For the meta-analysis, a total of 256 FDG-PET/CT scans, examining pump/pocket and/or driveline infection, were acquired in 230 patients. Pooled sensitivity of FDG-PET/CT was 0.95 (95% confidence interval (CI) 0.89-0.97) and pooled specificity was 0.91 (95% CI 0.54-0.99) for the diagnosis of device-related infection. For pump/pocket infection, sensitivity and specificity of FDG-PET/CT were 0.97 (95%CI 0.69-1.00) and 0.93 (95%CI 0.64-0.99), respectively. For driveline infection, sensitivity and specificity were 0.96 (95%CI 0.88-0.99) and 0.99 (95%CI 0.13-1.00) respectively. Significant heterogeneity existed across studies for specificity, mostly caused by differences in scan procedures. Predefined criteria for suspicion of LVAD and/or driveline infection were lacking in all included studies. CONCLUSIONS: FDG-PET/CT is a valuable tool for assessment of device-related infection in LVAD patients, with high sensitivity and high, albeit variable, specificity. Standardization of FDG-PET/CT procedures and criteria for suspected device-related LVAD infections are needed for consistent reporting of FDG-PET/CT scans.

Coração Auxiliar , Infecções Relacionadas à Prótese , Fluordesoxiglucose F18 , Coração Auxiliar/efeitos adversos , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Qualidade de Vida , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade
Diagn Microbiol Infect Dis ; 99(1): 115178, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33017799


INTRODUCTION: A prolonged incubation time is generally recommended for diagnosing periprosthetic joint infections (PJI). However, in literature, no distinction is made between acute and chronic infections. METHODS: All patients with a PJI that underwent surgical debridement between November 2015 and February 2019 with or without revision of the prosthesis were retrospectively evaluated. Synovial fluid, 5 intraoperative periprosthetic tissue samples, and the sonicated prosthesis were cultured. RESULTS: Fifty-nine patients were analyzed, including 21 acute PJIs (33 isolates) and 38 chronic PJIs (46 isolates). In acute PJIs, all isolates grew within 5 days, while this took 11 days for chronic PJIs. Sonication fluid showed the shortest time to positivity (78% at day 2) for chronic PJIs, but no difference was observed for acute PJIs compared to tissue cultures. CONCLUSION: In contrast to cultures from chronic PJIs, acute PJIs do not need a prolonged incubation time and no clear benefit is observed for sonication.

Artroplastia/efeitos adversos , Bactérias/classificação , Período de Incubação de Doenças Infecciosas , Próteses e Implantes/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Bactérias/isolamento & purificação , Humanos , Infecções Relacionadas à Prótese/microbiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Líquido Sinovial/microbiologia
Bone Joint J ; 99-B(5): 660-665, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28455476


AIMS: Recently, several synovial biomarkers have been introduced into the algorithm for the diagnosis of a prosthetic joint infection (PJI). Alpha defensin is a promising biomarker, with a high sensitivity and specificity, but it is expensive. Calprotectin is a protein that is present in the cytoplasm of neutrophils, is released upon neutrophil activation and exhibits anti-microbial activity. Our aim, in this study, was to determine the diagnostic potential of synovial calprotectin in the diagnosis of a PJI. PATIENTS AND METHODS: In this pilot study, we prospectively collected synovial fluid from the hip, knee, shoulder and elbow of 19 patients with a proven PJI and from a control group of 42 patients who underwent revision surgery without a PJI. PJI was diagnosed according to the current diagnostic criteria of the Musculoskeletal Infection Society. Synovial fluid was centrifuged and the supernatant was used to measure the level of calprotectin after applying a lateral flow immunoassay. RESULTS: The median synovial calprotectin level was 991 mg/L (interquartile range (IQR) 154 to 1787) in those with a PJI and 11 mg/L (IQR 3 to 29) in the control group (p < 0.0001). Using a cut-off value of 50 mg/L, this level showed an excellent diagnostic accuracy, with an area under the curve of 0.94. The overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 89%, 90%, 81% and 95% respectively. The NPV was 97% in the nine patients with a chronic PJI. CONCLUSION: Synovial calprotectin may be a valuable biomarker in the diagnosis of a PJI, especially in the exclusion of an infection. With a lateral flow immunoassay, a relatively rapid quantitative diagnosis can be made. The measurement is cheap and is easy to use. Cite this article: Bone Joint J 2017;99-B:660-5.

Prótese Articular/efeitos adversos , Complexo Antígeno L1 Leucocitário/análise , Infecções Relacionadas à Prótese/diagnóstico , Líquido Sinovial/química , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Estudos de Casos e Controles , Doença Crônica , Prótese de Cotovelo/efeitos adversos , Feminino , Prótese de Quadril/efeitos adversos , Humanos , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/etiologia , Curva ROC , Sensibilidade e Especificidade , Prótese de Ombro/efeitos adversos , Adulto Jovem
Neth J Med ; 74(1): 40-2, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26819361


A 30-year-old man from Eritrea was admitted with a pulmonary bacterial abscess. Unexpectedly, histopathology of the resected lobe also revealed an infection with Schistosoma mansoni with surrounding granulomatous tissue and fibrosis. Patients from endemic areas are often asymptomatic with blood eosinophilia being the only diagnostic clue. Early recognition is important as ongoing fibrosing inflammation may result in organ damage.

Achados Incidentais , Abscesso Pulmonar/parasitologia , Schistosoma mansoni , Esquistossomose mansoni/complicações , Adulto , Animais , Humanos , Pulmão/parasitologia , Pulmão/cirurgia , Abscesso Pulmonar/cirurgia , Masculino , Esquistossomose mansoni/parasitologia
J Cyst Fibros ; 10(3): 150-8, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21459688


Fat malabsorption in pancreatic insufficient cystic fibrosis (CF) patients is classically treated with pancreatic enzyme replacement therapy (PERT). Despite PERT, intestinal fat absorption remains insufficient in most CF patients. Several factors have been suggested to contribute to the persistent fat malabsorption in CF (CFPFM). We reviewed the current insights concerning the proposed causes of CFPFM and the corresponding intervention studies. Most data are obtained from studies in CF patients and CF mice. Based on the reviewed literature, we conclude that alterations in intestinal pH and intestinal mucosal abnormalities are most likely to contribute to CFPFM. The presently available data indicate that acid suppressive drugs and broad spectrum antibiotics could be helpful in individual CF patients for optimizing fat absorption and/or nutritional status.

Fibrose Cística/complicações , Insuficiência Pancreática Exócrina/etiologia , Gorduras/metabolismo , Absorção Intestinal , Síndromes de Malabsorção/etiologia , Animais , Antiácidos/uso terapêutico , Antibacterianos/uso terapêutico , Ácidos e Sais Biliares/metabolismo , Ácidos Graxos Essenciais/deficiência , Trânsito Gastrointestinal , Humanos , Concentração de Íons de Hidrogênio , Mucosa Intestinal/metabolismo , Síndromes de Malabsorção/tratamento farmacológico , Síndromes de Malabsorção/metabolismo , Síndromes de Malabsorção/fisiopatologia , Camundongos , Estado Nutricional