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1.
Semin Vasc Surg ; 32(1-2): 68-72, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540659

RESUMO

The management of infection involving the abdominal aorta requires clinical decisions based on patient factors and the nature of the infectious process. Any infection occurring after endovascular aortic aneurysm repair or open aortic replacement grafting should be treated promptly with appropriate systemic antibiotic therapy. Once a vascular prosthesis becomes infected, surgical treatment is necessary. There should be a low threshold for graft excision and extra-anatomic bypass in the presence of fistula or abscess cavity, when feasible entire graft should be excised. In selected patients, graft excision with in situ aorta reconstruction is an appropriate option using an autogenous femoral vein, cryopreserved allograft, or a prosthetic graft impregnated with antibiotic. The replaced in situ aortic graft should be covered with an omental pedicle. For primary aortic graft infections, endovascular treatment may act as a bridge to more definitive treatment; or, in the absence of gross retroperitoneal infections, endovascular grafting alone with prolonged systemic antibiotic therapy is a viable option, particularly in patients not fit for open surgical procedures.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/uso terapêutico , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo/métodos , Procedimentos Endovasculares , Infecções Relacionadas à Prótese/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Implante de Prótese Vascular/instrumentação , Medicina Baseada em Evidências , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Fatores de Risco , Resultado do Tratamento
2.
Semin Vasc Surg ; 32(1-2): 73-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540660

RESUMO

The use of autologous femoral veins for in situ reconstruction of the aortoiliac segment is an effective technique to treat native aorta or prosthetic graft infections. The indications, technical details, and outcomes of this procedure are detailed. Graft infection involving the aortic segment, while rare, remains one of the most challenging vascular surgery conditions to treat. The original technique of "neo-aortoiliac surgery" with in situ autologous vein grafts has evolved over the past 25 years and remains a worthwhile alternative for the treatment of aortic graft infections, with lower mortality rates compared with other extra-anatomic or in situ surgical options. Acceptance of this surgical option is due to low graft re-infection rates, rare graft disruption, and low long-term aneurysmal degeneration. Excision of the femoral veins is associated with acceptable rates of lower limb edema. The use of an autologous femoral vein graft can be considered the standard of care in selected patients for the management of aortic graft infections. Optimal management of patients with aortic graft infections requires consideration of all potential therapeutic options because no single modality can be used, and individualizing treatment according to the clinical condition will yield the best patient outcomes.


Assuntos
Aneurisma Infectado/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Veia Femoral/transplante , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta/diagnóstico por imagem , Aorta/microbiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Remoção de Dispositivo , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Fatores de Risco , Resultado do Tratamento
3.
Semin Vasc Surg ; 32(1-2): 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540661

RESUMO

Aortic graft infection remains one of the most complex clinical challenges faced by vascular specialists, and is often associated with significant patient morbidity and mortality regardless of the approach used for management. The cryopreserved aortic allograft is now a commonly used in situ aortic replacement in the management of graft infection, and is preferred over rifampin-soaked prosthetic grafts. In the review, we summarize the indications for cryopreserved aortic allograft usage, as well as operative technique, clinical results, and alternative treatments. We propose the use of a novel term tertiary aortic fistula, to distinguish aortic fistulae in the setting of aortic endograft infection, a clinical entity whose natural history and best management are currently being characterized.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Vasos Sanguíneos/transplante , Criopreservação , Infecções Relacionadas à Prótese/cirurgia , Aloenxertos , Aorta/diagnóstico por imagem , Aorta/microbiologia , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Fatores de Risco , Resultado do Tratamento
4.
Isr Med Assoc J ; 21(8): 532-537, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474015

RESUMO

BACKGROUND: Implant-related spinal infections are a surgical complication associated with high morbidity. Due to infection, hardware removal may be necessary, which could lead to pseudarthrosis and the loss of stability and alignment. OBJECTIVES: To evaluate the accuracy and diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the workup of patients with suspected implant-related infections of the spine and to assess the clinical impact of PET/CT results on the management of these infections. METHODS: The study included nine consecutive patients with a history of spinal surgery who underwent PET/CT for evaluation of suspected spinal implant related infection. All imaging studies were performed between January 2011 and December 2013. All 18F-FDG PET/CT scans were performed on an 8 slice PET/CT following an 18F-FDG injection. Images were scored both visually and semi-quantitatively by a radiology expert. Results were compared to additional imaging studies when available, which were correlated to clinical and bacteriological findings allowing calculation of sensitivity, specificity and accuracy. RESULTS: Among the patients, five experienced hardware-related spinal infection. 18F-FDG PET/CT sensitivity was 80%, specificity 100%, and accuracy 88.9%. One scan produced a false negative; however, a second PET/CT scan revealed an infection. CONCLUSIONS: PET/CT was found to be valuable for the diagnosis of postoperative hardware-related spinal infection, especially when other imaging modalities were uninformative or inconclusive. As such, PET/CT could be useful for management of infection treatment.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Infecções Relacionadas à Prótese/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Coluna Vertebral/patologia
5.
Bone Joint J ; 101-B(8): 910-914, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31362552

RESUMO

AIMS: Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. PATIENTS AND METHODS: A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. RESULTS: The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. CONCLUSION: FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910-914.


Assuntos
Fluordesoxiglucose F18 , Prótese de Quadril/efeitos adversos , Tomografia por Emissão de Pósitrons/métodos , Cuidados Pré-Operatórios/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Idoso , Reações Falso-Positivas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/cirurgia , Sensibilidade e Especificidade
6.
Orv Hetil ; 160(26): 1015-1024, 2019 Jun.
Artigo em Húngaro | MEDLINE | ID: mdl-31230470

RESUMO

Over the past decades, 18F-FDG-PET/CT imaging has been recognized as an indispensable tool in the diagnosis, staging and treatment monitoring of cancer. This modern imaging technique combining functional and morphologic information has approved indications not only in oncology but in clinical cardiology as well. In the current review we discuss the specific requirements of patient preparation and image acquisition protocol for cardiac 18F-FDG-PET/CT. We review the literature in some cases highlighted by our own examinations of well-known "gold standard" viability and onco-cardiology examinations while placing special emphasis on inflammatory disorders involving the heart. This relatively newer class of indications includes prosthetic valve endocarditis, cardiac implantable device infection, myocardial inflammation of varying origin such as sarcoidosis where 18F-FDG-PET/CT appears to be particularly useful in the differential diagnosis of cases where standard investigation is non-diagnostic or equivocal. Orv Hetil. 2019; 160(26): 1015-1024.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/microbiologia , Miocardite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Cardiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Miocardite/microbiologia , Infecções Relacionadas à Prótese/etiologia , Compostos Radiofarmacêuticos
7.
Eur J Vasc Endovasc Surg ; 57(6): 876-884, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31130421

RESUMO

OBJECTIVES: Prosthetic vascular graft infections (PVGIs) are associated with high mortality rates. To improve treatment outcome, an early and definite diagnosis is critical, and current diagnostic criteria are often insufficient. The accuracy of 2-deoxy-2-[fluorine-18]-fluoro-d-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) and white blood cell (WBC) scan for the diagnosis of PVGI were compared. METHODS: A retrospective single centre study was conducted on patients undergoing WBC scan and 18F-FDG PET/CT for a suspected PVGI between April 2013 and June 2016 at the Bordeaux University Hospital, France. The diagnostic value of both imaging tests was assessed for all grafts, using receiver operating characteristic (ROC) curve analysis. Images were independently interpreted by two nuclear medicine physicians blinded to the patients' clinical and other imaging data. RESULTS: Thirty-nine patients were included, of whom 15 had PVGI. Antibiotic treatment was started before nuclear imaging for 16 patients, including nine patients with a PVGI. The 96 grafts of these patients were analysed, and 19 were infected. The diagnostic value of the WBC scan was significantly higher than 18F-FDG PET/CT (ROC AUC = 0.902, 95% CI 0.824-0.980, and 0.759, CI 95% (0.659-0.858), respectively, p = .0071). Interobserver agreement was good for 18F-FDG PET/CT and excellent for WBC scan (kappa value of 0.76, 95% CI 0.62-0.9, and 0.97, 95% CI 0.92-1, respectively). Only one patient had a false negative 18F-FDG PET/CT result under antibiotic therapy. CONCLUSION: The WBC scan has a better diagnostic value than 18F-FDG PET/CT for PVGI diagnosis.


Assuntos
Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Fluordesoxiglucose F18/administração & dosagem , Contagem de Leucócitos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/sangue , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos/administração & dosagem , Idoso , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Prognóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Reprodutibilidade dos Testes , Estudos Retrospectivos
8.
Ann Vasc Surg ; 59: 314.e1-314.e4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009726

RESUMO

Secondary stent graft infection is a life-threatening complication after thoracic endovascular aortic repair (TEVAR). There is no consensus on optimal treatment strategy, but combined antibiotic and surgical treatment is advocated. Two years after his TEVAR procedure, a 70-year-old patient was admitted to the hospital with a secondary periaortic abscess. At first, the abscess was managed with clindamycin and transesophageal drainage. The abscess would not dissipate, and an infected iatrogenic aortoesophageal fistula was formed, which was surgically treated with esophageal resection, gastric tube reconstruction, and omental flap coverage.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/cirurgia , Esofagectomia , Omento/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Stents/efeitos adversos , Retalhos Cirúrgicos , Fístula Vascular/cirurgia , Idoso , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Procedimentos Endovasculares/instrumentação , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/microbiologia , Humanos , Doença Iatrogênica , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/microbiologia
10.
J Cardiovasc Med (Hagerstown) ; 20(6): 372-378, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30950985

RESUMO

BACKGROUND: Finding of intracardiac lead masses in patients with cardiac implantable electronic devices remains controversial, as such masses have been observed in cases of exclusively local infections whereas they have not been recognized in patients with positive cultures of intravascular lead fragments. In this study, we aim to describe the prevalence of intracardiac lead masses in true asymptomatic patients with cardiac implantable electronic devices, to identify their predictive factors and to define their prognostic impact at long-term follow-up. METHODS: Seventy-eight consecutive patients admitted over a 6-month period for elective generator replacement without clinical evidence of infection were evaluated by transthoracic and transesophageal echocardiography and prospectively followed at in-clinic follow-up visits. RESULTS: Lead masses were found in 10 patients (12.8%). These patients had more frequently right ventricular dysfunction at univariate analysis (OR 2.71, P = 0.010) and after baseline variables adjustment (hazard ratio 6.25, P = 0.012). At 5-year follow-up without any specific therapy, none of the patients suffered from any cardiac device infections, or developed clinical signs of infections. CONCLUSION: There is an evidence of clinical lead masses in asymptomatic patients with cardiac implantable electronic devices. The value of these findings is still debated for aetiological interpretation and for therapeutic strategy, but they are not necessarily associated with an infection.


Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Desfibriladores Implantáveis/efeitos adversos , Cardioversão Elétrica/efeitos adversos , Cardioversão Elétrica/instrumentação , Cardiopatias/epidemiologia , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Fatores de Tempo
11.
Am J Otolaryngol ; 40(3): 462-464, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30940403

RESUMO

BACKGROUND: Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula. METHODS: Case report. RESULTS: A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability. The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression. CONCLUSIONS: Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.


Assuntos
Mordeduras e Picadas/complicações , Fístula/etiologia , Doenças da Laringe/etiologia , Laringoplastia/métodos , Complicações Pós-Operatórias/etiologia , Infecções Relacionadas à Prótese/etiologia , Dermatopatias/etiologia , Paralisia das Pregas Vocais/cirurgia , Idoso , Animais , Dimetilpolisiloxanos , Cães , Feminino , Fístula/diagnóstico por imagem , Fístula/terapia , Humanos , Doenças da Laringe/terapia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Próteses e Implantes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia , Dermatopatias/diagnóstico por imagem , Dermatopatias/terapia , Fatores de Tempo
13.
PET Clin ; 14(2): 251-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30826023

RESUMO

The 2015 European Society of Cardiology guidelines for the management of infective endocarditis included 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) in the diagnostic work-up of prosthetic valve endocarditis. This article examines the literature from the last 3 years to highlight the additional role 18F-FDG-PET/CT can contribute to an accurate diagnosis of cardiac infections and associated infectious complications. The challenges and pitfalls associated with 18F-FDG-PET/CT in such clinical settings must be recognized and these are discussed along with the suggested protocols that may be incorporated in an attempt to address these issues.


Assuntos
Endocardite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Antibacterianos/uso terapêutico , Eletrodos Implantados/efeitos adversos , Endocardite/tratamento farmacológico , Reações Falso-Negativas , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Coração Auxiliar/efeitos adversos , Humanos , Interpretação de Imagem Assistida por Computador , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Compostos Radiofarmacêuticos
15.
Nucl Med Commun ; 40(6): 555-564, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30807533

RESUMO

Infections involving cardiovascular implantable electronic devices are becoming increasingly common, and increasingly complex to manage. Advances in technology have made implantable electronic devices smaller, and easier to implant, and patients are now also more likely to be older, with more complex comorbidities. Infections related to these devices are, however, not decreasing, and in some settings, these are rising. There is a clinical need for more accurate tests for confirming or ruling out infected devices. In this article, we review the relevant literature and share our own initial experience.


Assuntos
Sistema Cardiovascular , Equipamentos e Provisões Elétricas/microbiologia , Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Equipamentos e Provisões Elétricas/efeitos adversos , Humanos , Processamento de Imagem Assistida por Computador , Infecções Relacionadas à Prótese/etiologia
16.
Ann Vasc Surg ; 58: 380.e1-380.e4, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30711498

RESUMO

Aortic graft infections are a feared complication of aortic bypass operations and impart significant morbidity and mortality when they occur. The most common etiology is bacterial, with a presentation ranging from subclinical to acutely symptomatic depending on the organism. Fungal infections of prosthetic grafts are rare, especially in immunocompetent patients. Graft infections remain a clinical diagnosis. We report a rare case of an aortobifemoral graft infection with Histoplasma capsulatum that was diagnosed on surgical pathology, as the preoperative infectious evaluation was negative. The neoaortoiliac system operation was successfully used to solve this patient's highly morbid condition.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Artéria Femoral/cirurgia , Histoplasmose/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Idoso , Aorta/diagnóstico por imagem , Endarterectomia , Artéria Femoral/diagnóstico por imagem , Histoplasmose/diagnóstico por imagem , Histoplasmose/microbiologia , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento
17.
J Shoulder Elbow Surg ; 28(6): 1040-1048, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30713059

RESUMO

BACKGROUND: Shoulder periprosthetic joint infections (PJI) caused by low-virulent bacteria pose a diagnostic challenge. Combined labeled leukocyte (WBC) and technetium 99m sulfur colloid bone marrow imaging (WBC/BM) is considered the radionuclide imaging gold standard for diagnosing lower limb PJI. However, it is laborious and expensive to perform, and documentation on shoulder arthroplasties is lacking. This study investigated WBC/BM single-photon emission computed tomography-computed tomography diagnostic performance in shoulder PJI. METHOD: All patients with a failed arthroplasty referred to a highly specialized shoulder department were scheduled for a diagnostic program including a WBC/BM. If an arthroplasty was revised, biopsy specimens were obtained and cultured for 14 days. The diagnostic performance of WBC/BM imaging was determined using biopsy specimens as a reference. RESULTS: Of the 49 patients who underwent a WBC/BM scan, 29 (59%) were revised. Infection was present in 11 patients, in whom 2 WBC/BM scans were true positive. The WBC/BM scan in 9 patients was false negative. The remaining 18 patients all had a true negative WBC/BM scan. WBC/BM showed a sensitivity 0.18 (95% confidence interval [CI], 0.00-0.41) and specificity 1.00 (95% CI, 1.00-1.00) in detecting shoulder PJI. The positive predictive value was 1.00 (95% CI, 1.00-1.00), and negative predictive value was 0.67 (95% CI, 0.49-0.84). No patients infected with Cutibacterium (formerly Propionibacterium) acnes resulted in a positive WBC/BM, nor had they preoperative or perioperative signs of infection. CONCLUSION: A positive WBC/BM was found only in patients with obvious PJI. Hence, the scan added nothing to the preoperative diagnosis. The WBC/BM single-photon emission computed tomography-computed tomography scan cannot be recommended as a screening procedure when evaluating failed shoulder arthroplasties for possible infection.


Assuntos
Artroplastia do Ombro/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Prótese de Ombro/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/sangue , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão , Tomografia Computadorizada por Raios X
18.
J Cardiovasc Med (Hagerstown) ; 20(5): 271-277, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30624298

RESUMO

: Cardiac implantable electronic device (CIED) implantation has greatly increased, with an associated exponential increase in CIED infections (CDIs). Cardiac device related infective endocarditis (CDRIE) has high morbidity and mortality: approximately 10-21%. Therefore, a prompt diagnosis and radical treatment of CDRIE are needed; transvenous lead extraction (TLE) is the mainstay for the complete healing, even if associated with wide logistic problems, high therapeutic costs and high mortality risk for patients. Some criticisms about the value of Duke criteria and their limitations for the diagnosis of CDRIE are known. The significance of classic laboratory data, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), considered in the Duke score, are reviewed and critically discussed in this article, with regard to the specific field of the diagnosis of CDI. The need for new techniques for achieving the diagnostic reliability has been well perceived by physicians, and additional techniques have been introduced in the new European Society of Cardiology (ESC) and British Heart Rhythm Society (BHRS) guidelines on infective endocarditis. These suggested techniques, such as 18-Fluorodeoxyglucose PET/computed tomography (FDG-PET/CT), white blood cell PET (WBC PET) and lung multislice CT (MSCT), are also discussed in the study. This short review is intended as an extensive summary of the diagnostic workflow in cases of CDI and will be useful for readers who want to know more about this issue.


Assuntos
Procedimentos Clínicos , Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/cirurgia , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Fluxo de Trabalho , Antibacterianos/uso terapêutico , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/mortalidade , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Humanos , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Fatores de Risco , Resultado do Tratamento
19.
Eur J Nucl Med Mol Imaging ; 46(1): 194-205, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30196365

RESUMO

PURPOSE: 18F-FDG PET/CT is an emerging technique for diagnosis of cardiac implantable electronic devices infection (CIEDI). Despite the improvements in transvenous lead extraction (TLE), long-term survival in patients with CIEDI is poor. The aim of the present study was to evaluate whether the extension of CIEDI at 18F-FDG PET/CT can improve prediction of survival after TLE. METHODS: Prospective, monocentric observational study enrolling consecutive candidates to TLE for a diagnosis of CIEDI. 18F-FDG PET/CT was performed in all patients prior TLE. RESULTS: There were 105 consecutive patients with confirmed CIEDI enrolled. An increased 18F-FDG uptake was limited to cardiac implantable electrical device (CIED) pocket in 56 patients, 40 patients had a systemic involvement. We had nine negative PET in patients undergoing prolonged antimicrobial therapy (22.5 ± 14.0 days vs. 8.6 ± 13.0 days; p = 0.005). Implementation of 18F-FDG PET/CT in modified Duke Criteria lead to reclassification of 23.8% of the patients. After a mean follow-up of 25.0 ± 9.0 months, 31 patients died (29.5%). Patients with CIED pocket involvement at 18F-FDG PET/CT presented a better survival independently of presence/absence of systemic involvement (HR 0.493, 95%CI 0.240-0.984; p = 0.048). After integration of 18F-FDG PET/CT data, absence of overt/hidden pocket involvement in CIEDI and a (glomerular filtration rate) GFR < 60 ml/min were the only independent predictors of mortality at long term. CONCLUSIONS: Patient with CIEDI and a Cold Closed Pocket (i.e., a CIED pocket without skin erosion/perforation nor increased capitation at 18F-FDG PET/CT) present worse long-term survival. Patient management can benefit by systematic adoption of pre-TLE 18F-FDG PET/CT through improved identification of CIED related endocarditis (CIEDIE) and hidden involvement of CIED pocket.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Endocardite Bacteriana/diagnóstico por imagem , Marca-Passo Artificial/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/normas , Infecções Relacionadas à Prótese/diagnóstico por imagem , Idoso , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/etiologia , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Mortalidade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Infecções Relacionadas à Prótese/epidemiologia , Compostos Radiofarmacêuticos
20.
Echocardiography ; 36(2): 401-405, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30592783

RESUMO

Fungal endocarditis is a relatively rare occurrence with high morbidity and mortality. Patients may have an indolent and non-specific course requiring a high index of suspicion to make a diagnosis. Here, we present the case of a 33-year-old patient who presented with fevers and acute lower limb ischemia requiring a 4-compartment fasciotomy caused by septic emboli from Candida albicans endocarditis. The patient had a large vegetation in the ascending aorta associated with a mycotic aneurysm, which is an exceedingly rare location for a vegetation. We also review the literature and summarize the typical echocardiographic appearance and vegetation locations in fungal endocarditis.


Assuntos
Aneurisma Infectado/complicações , Candidíase/complicações , Endarterite/complicações , Doenças das Valvas Cardíacas/complicações , Infecções Relacionadas à Prótese/complicações , Adulto , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/terapia , Antifúngicos/uso terapêutico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/microbiologia , Valva Aórtica/cirurgia , Candida albicans , Candidíase/diagnóstico por imagem , Candidíase/terapia , Diagnóstico Diferencial , Ecocardiografia , Endarterite/diagnóstico por imagem , Endarterite/terapia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/terapia , Próteses Valvulares Cardíacas/microbiologia , Humanos , Masculino , Micafungina/uso terapêutico , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia
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