Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 20.576
Filtrar
1.
Skeletal Radiol ; 52(1): 39-46, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35882659

RESUMO

Bone biopsy remains the gold standard for diagnosis of osteomyelitis while MRI results in a radiologic diagnosis that generally precedes biopsy. This study's purpose is to examine the diagnostic yield and effect of biopsy results on clinical management in children with suspected osteomyelitis and positive MRI findings. A retrospective review was performed at a tertiary care children's hospital. Search of the EMR and radiology PACS identified patients below 18 years who underwent bone biopsy with interventional radiology for osteomyelitis and had positive MRI findings for osteomyelitis prior to biopsy. Data was collected on patient demographics, MRI findings, biopsy procedural details, tissue culture, histopathology results, and clinical management before and after biopsy. Changes in management were categorized as antibiotic type/quantity, duration, or diagnosis. A total of 82 biopsies in 79 patients with suspicion for osteomyelitis and positive MRIs prior to biopsy were performed over 5 years from 2014 to 2019. All biopsies were successful and sent for tissue culture. 22/82 biopsies (27%) yielded positive cultures. Of those with tissue cultures, 16/22 (72%) resulted in change in clinical management. Of all biopsies, 18/82 (22%) resulted in a change in management (15 antibiotic, 1 duration, 2 diagnosis). The 2 changes in diagnosis included one biopsy done which was positive for cancer and a second which was found to not demonstrate osteomyelitis on histology. In the pediatric population, bone biopsy is a reasonably low morbidity procedure. However, there is a relatively low rate of positive tissue cultures even with MRI findings suspicious for osteomyelitis. Approximately 1 in 5 biopsies resulted in a change in clinical management, mostly in antibiotic selection. Bone biopsy may have a higher clinical impact in pre-specified circumstances.


Assuntos
Osteomielite , Humanos , Criança , Osteomielite/tratamento farmacológico , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética , Osso e Ossos/patologia , Biópsia , Antibacterianos/uso terapêutico , Estudos Retrospectivos
2.
BMC Musculoskelet Disord ; 23(1): 1036, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36451238

RESUMO

BACKGROUND: Gustilo type III tibial fractures commonly involve extensive soft tissue and bony defects, requiring complex reconstructive operations. Although several methods have been proposed, no research has elucidated the efficacies and differences between vascular bone graft (VBG) and the Masquelet technique (MT) to date. We aimed to evaluate and compare the clinical effectiveness of VBG and the MT for the reconstruction of Gustilo type III tibial fractures. METHODS: This retrospective cohort study enrolled patients who underwent reconstruction for Gustilo type III tibial fractures using VBG or the MT in a single center from January 2000 to December 2020. The patients' demographics, injury characteristics, and surgical interventions were documented for analysis. The clinical outcomes including union status, time to union, postoperative infections, and the causes of union failure were compared between the two groups. RESULTS: We enrolled 44 patients: 27 patients underwent VBG, and 17 underwent MT. The average union time was 20.5 ± 15.4 and 15.1 ± 9.0 months in the VBG and MT groups, respectively (p = 0.232). The postoperative deep infection rates were 70.4% and 47.1% in the VBG and MT groups (p = 0.122), respectively. Though not statistically significant, the VBG group had a shorter union time than did the MT group when the bone defect length was > 60 mm (21.0 ± 17.0 versus 23.8 ± 9.4 months, p = 0.729), while the MT group had a shorter union time than did the VBG group when the bone defect was length < 60 mm (17.2 ± 5.6 versus 10.7 ± 4.7 months, p = 0.067). CONCLUSIONS: VBG and MT are both promising reconstruction methods for Gustilo type III tibial fractures. VBG appears to have more potential in reconstructing larger bone defects, while MT may play an important role in smaller bone defects, severe surgical site infections, and osteomyelitis. Therefore, flexible treatment strategies are required for good outcomes in Gustilo type III open tibial fractures.


Assuntos
Osteomielite , Fraturas da Tíbia , Humanos , Fraturas da Tíbia/cirurgia , Estudos Retrospectivos , Transplante Ósseo/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia
3.
Sci Rep ; 12(1): 18387, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36319854

RESUMO

Currently, implants are utilized clinically for bone transplant procedures. However, if infectious osteomyelitis occurs at implant sites, removal of bacteria can be challenging. Moreover, altered blood flow at peri-implant infectious sites can create an anaerobic environment, making it more difficult to treat infection with antibiotics. Thus, it would be beneficial if implants could be modified to exhibit antibacterial activity, even in anaerobic conditions. Here, we show antibacterial activity of silver ions coated on titanium rods, even against the anaerobic bacteria Porphyromonas gingivalis (P. gingivalis), both in vitro and in vivo. Specifically, we implanted silver-coated or control uncoated titanium rods along with P. gingivalis in mouse femoral bone BM cavities and observed significantly inhibited P. gingivalis infection with silver-coated compared with non-coated rods, based on in vivo bio-imaging. Osteonecrosis by infectious osteomyelitis and elevation of the inflammatory factors C-reactive protein and IL-6 promoted by P. gingivalis s were also significantly reduced in the presence of silver-coated rods. Overall, our study indicates that silver ion coating of an implant represents a therapeutic option to prevent associated infection, even in anaerobic conditions or against anaerobic bacteria.


Assuntos
Antibacterianos , Bactérias Anaeróbias , Materiais Revestidos Biocompatíveis , Implantes Experimentais , Osteomielite , Prata , Animais , Camundongos , Antibacterianos/farmacologia , Bactérias Anaeróbias/efeitos dos fármacos , Materiais Revestidos Biocompatíveis/farmacologia , Íons/farmacologia , Osteomielite/microbiologia , Osteomielite/prevenção & controle , Prata/farmacologia , Titânio/química , Porphyromonas gingivalis/efeitos dos fármacos , Implantes Experimentais/efeitos adversos , Implantes Experimentais/microbiologia , Fêmur , Proteína C-Reativa
4.
Medicina (Kaunas) ; 58(11)2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36422180

RESUMO

Background and Objectives: Treating segmental tibial and ankle bone loss after radical surgery for chronic osteomyelitis is one of the most challenging problems encountered by orthopaedic surgeons. Open tibia and ankle fractures occur with an incidence of 3.4 per 100,000 and 1.6 per 100,000, respectively, and there is a high propensity of developing fracture-related infection with associated chronic osteomyelitis in patients. Segmental tibial and ankle bone loss have recently received new and improved treatments. Materials and Methods: Above all, 3D printing allows for the customization of implants based on the anatomy of each patient, using a personalized process through the layer-by-layer deposition of materials. Results: This article presents different cases from the authors' experience. Specifically, four patients suffered tibia and ankle fractures and after radical surgery for chronic osteomyelitis combined with high-performance antibiotic therapy underwent ankle reconstruction/arthrodesis with custom-made tibial spacers. Conclusions: Thanks to 3D-printed patient-specific devices, it is possible to perform surgical procedures that, for anatomical reasons, would have been impossible otherwise. Moreover, an improvement in overall functionality and an important reduction in pain were shown in the last follow-up in all patients.


Assuntos
Fraturas do Tornozelo , Osteomielite , Fraturas da Tíbia , Humanos , Tíbia/cirurgia , Tornozelo , Estudos Retrospectivos , Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/cirurgia , Fraturas da Tíbia/complicações , Fraturas da Tíbia/cirurgia , Artrodese/métodos , Osteomielite/complicações , Osteomielite/cirurgia , Progressão da Doença
5.
Medicina (Kaunas) ; 58(11)2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36422232

RESUMO

Background and Objectives: This study investigated the usefulness of deep neural network (DNN) models based on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and blood inflammatory markers to assess the therapeutic response in pyogenic vertebral osteomyelitis (PVO). Materials and Methods: This was a retrospective study with prospectively collected data. Seventy-four patients diagnosed with PVO underwent clinical assessment for therapeutic responses based on clinical features during antibiotic therapy. The decisions of the clinical assessment were confirmed as 'Cured' or 'Non-cured'. FDG-PETs were conducted concomitantly regardless of the decision at each clinical assessment. We developed DNN models depending on the use of attributes, including C-reactive protein (CRP), erythrocyte sedimentation ratio (ESR), and maximum standardized FDG uptake values of PVO lesions (SUVmax), and we compared their performances to predict PVO remission. Results: The 126 decisions (80 'Cured' and 46 'Non-cured' patients) were randomly assigned with training and test sets (7:3). We trained DNN models using a training set and evaluated their performances for a test set. DNN model 1 had an accuracy of 76.3% and an area under the receiver operating characteristic curve (AUC) of 0.768 [95% confidence interval, 0.625-0.910] using CRP and ESR, and these values were 79% and 0.804 [0.674-0.933] for DNN model 2 using ESR and SUVmax, 86.8% and 0.851 [0.726-0.976] for DNN model 3 using CRP and SUVmax, and 89.5% and 0.902 [0.804-0.999] for DNN model 4 using ESR, CRP, and SUVmax, respectively. Conclusions: The DNN models using SUVmax showed better performances when predicting the remission of PVO compared to CRP and ESR. The best performance was obtained in the DNN model using all attributes, including CRP, ESR, and SUVmax, which may be helpful for predicting the accurate remission of PVO.


Assuntos
Fluordesoxiglucose F18 , Osteomielite , Humanos , Estudos Retrospectivos , Tomografia por Emissão de Pósitrons/métodos , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Redes Neurais de Computação , Proteína C-Reativa
6.
BMJ Case Rep ; 15(11)2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36414342

RESUMO

Aspergillus osteomyelitis (AO) is a rare and often lethal opportunistic infection in predominantly immunocompromised patients. Treatment has shifted from amphotericin therapy to voriconazole monotherapy due to increased effectiveness and less toxicity. We report a case of an immunocompetent woman with vertebral osteomyelitis due to Aspergillus flavus who was successfully treated with surgery (requiring hardware implantation) and monotherapy posaconazole (following intolerance and hepatitis due to voriconazole). She remained well at follow-up post cessation of 12 months of antifungal therapy. We provide an updated literature review examining the role of azole monotherapy as the gold standard of treatment for AO.


Assuntos
Hepatite A , Osteomielite , Feminino , Humanos , Aspergillus flavus , Voriconazol/uso terapêutico , Osteomielite/tratamento farmacológico , Azóis
7.
Sultan Qaboos Univ Med J ; 22(4): 570-573, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36407710

RESUMO

Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disease characterised by sterile bone lesions. We report a case of a seven-year-old female patient who presented at a university hospital in 2010 and 2018 with CRMO. While the most promising results have been observed in patients under treatment with bisphosphonates (BPs), the initial decision to treat the current patient with a dose of zoledronic acid every six months was recalled as the patient developed tonic-clonic seizures immediately following the second dose BP administration. Following recall, the patient maintained a prompt response at follow-up and her disease remained controlled with non-steroidal anti-inflammatory drugs. The current case report speculates a possible relationship between BP use and a possible seizure threshold reduction, thereby emphasising the need for closer monitoring when BPs are used.


Assuntos
Osteomielite , Feminino , Humanos , Criança , Ácido Zoledrônico/efeitos adversos , Osteomielite/tratamento farmacológico , Difosfonatos/efeitos adversos , Convulsões/tratamento farmacológico
8.
Pediatr Int ; 64(1): e15351, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36410717

RESUMO

BACKGROUND: Chronic non-bacterial osteomyelitis is a chronic sterile inflammatory bone condition. We aimed to describe patients' clinical and radiographic findings and to evaluate their response to therapy and their quality of life. METHODS: This cross-sectional study included 18 patients from a single center in Turkey whose clinical, radiological features, and outcomes were reviewed retrospectively. The quality of the patients' lives after treatment was compared with healthy controls using the Pediatric Quality of Life Inventory 4.0. RESULTS: The median age of disease onset was 12 years (IQR 10-14 years) and 11 (61.1%) patients were male. The median follow-up duration was 15 months (IQR 12-22 months). The persistent form of chronic non-bacterial osteomyelitis was the most common pattern in 15 (83.3%) patients and a recurrent pattern was defined in three (16.7%) patients. The lesions were multifocal in all patients and 15 (83.3%) patients had symmetric distribution in whole-body magnetic resonance imaging. The most common sites of arthritis were the knee and sacroiliac joints. Methotrexate was used in 16 (88.9%) patients as first-line therapy. However, some patients were unresponsive to the first-line therapy and needed tumor necrosis factor-α inhibitors (55.6%) and bisphosphonates (16.7%). We observed remission in only four (22.2%) patients, and three (16.7%) patients were unresponsive. The patients had a significantly poorer quality of life than controls (P = 0.005). CONCLUSIONS: Chronic non-bacterial osteomyelitis is an insidious disease that requires detailed analysis for diagnosis and whole-body magnetic resonance imaging is an effective tool for its diagnosis. Despite the advanced treatment, patients with chronic non-bacterial osteomyelitis have a poor quality of life.


Assuntos
Doença Enxerto-Hospedeiro , Osteomielite , Criança , Humanos , Masculino , Adolescente , Feminino , Qualidade de Vida , Imagem Corporal Total , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Estudos Transversais , Doença Crônica
9.
Nat Commun ; 13(1): 6648, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333322

RESUMO

The impact of bone cell activation on bacterially-induced osteolysis remains elusive. Here, we show that matrix-embedded osteocytes stimulated with bacterial pathogen-associated molecular patterns (PAMPs) directly drive bone resorption through an MYD88-regulated signaling pathway. Mice lacking MYD88, primarily in osteocytes, protect against osteolysis caused by calvarial injections of bacterial PAMPs and resist alveolar bone resorption induced by oral Porphyromonas gingivalis (Pg) infection. In contrast, mice with targeted MYD88 restoration in osteocytes exhibit osteolysis with inflammatory cell infiltration. In vitro, bacterial PAMPs induce significantly higher expression of the cytokine RANKL in osteocytes than osteoblasts. Mechanistically, activation of the osteocyte MYD88 pathway up-regulates RANKL by increasing binding of the transcription factors CREB and STAT3 to Rankl enhancers and by suppressing K48-ubiquitination of CREB/CREB binding protein and STAT3. Systemic administration of an MYD88 inhibitor prevents jawbone loss in Pg-driven periodontitis. These findings reveal that osteocytes directly regulate inflammatory osteolysis in bone infection, suggesting that MYD88 and downstream RANKL regulators in osteocytes are therapeutic targets for osteolysis in periodontitis and osteomyelitis.


Assuntos
Perda do Osso Alveolar , Osteólise , Osteomielite , Periodontite , Camundongos , Animais , Osteócitos/metabolismo , Osteólise/induzido quimicamente , Osteólise/complicações , Osteólise/metabolismo , Fator 88 de Diferenciação Mieloide/genética , Fator 88 de Diferenciação Mieloide/metabolismo , Padrões Moleculares Associados a Patógenos/metabolismo , Ligante RANK/metabolismo , Porphyromonas gingivalis/metabolismo , Periodontite/metabolismo , Transdução de Sinais , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Osteoclastos/metabolismo
10.
Otol Neurotol ; 43(10): 1095-1107, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36351221

RESUMO

INTRODUCTION: Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis. MATERIALS AND METHODS: A scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes. RESULTS: Sixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy. DISCUSSION: Many of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.


Assuntos
Osteomielite , Humanos , Comorbidade , Osteomielite/epidemiologia , Osteomielite/terapia , Paralisia/complicações , Prognóstico , Osso Temporal
13.
Neurol India ; 70(5): 1911-1919, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36352587

RESUMO

Background: Central or atypical skull base osteomyelitis (CSBO) often presents with severe unrelenting headache and progressive mono or polyneuritis cranialis. MRI and CT are used as initial imaging techniques but have a poor specificity and sensitivity. Objective: To analyze our cohort of CSBO. Materials and Methods: Over a 5-year period [2015-2020], we retrospectively analyzed the records of all patients with CSBO who had undergone a 3T MRI Brain, MR angiography, regional FDG PET-CT, and skeletal scintigraphy with 99mTc MDP/SPECT-CT. Surgical biopsy specimens were sent for bacterial and fungal cultures. Results: In total, 17 patients with CSBO were identified. Typically, 88% of patients presented with severe unilateral headache. All patients had at least a cranial mono or polyneuritis. The majority of patients were diabetic [64%]. MRI was normal in 42% of patients, whereas PET-CT and with 99mTc MDP scan and SPECT-CT were abnormal in all patients. Conclusion: Our series of CSBO showed a 40% mortality rate with significant morbidity and relentless progression. Patients required repeated PET CT and bone scans to detect regression of disease activity. The average duration of IV therapy ranged from 3 weeks to 9 months and oral therapy for around 2-3 months. Cure was defined after taking into account the original diagnosis, symptom resolution, and concordant reduction of tissue uptake on PET CT and 99mTc bone scan. The combination of MRI, FDG PET CT, and 99mTc bone scan with concurrent SPECT CT was able to detect disease and disease progression in all patients.


Assuntos
Neurite (Inflamação) , Osteomielite , Humanos , Medronato de Tecnécio Tc 99m , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Osteomielite/diagnóstico por imagem , Osteomielite/patologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Neurite (Inflamação)/patologia
14.
J Infect Dev Ctries ; 16(10): 1655-1659, 2022 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-36332222

RESUMO

Tuberculosis is a communicable disease that is a major cause of ill health. It is one of the top ten causes of death worldwide and the leading cause of death from a single infectious agent. Its most common clinical presentation is pulmonary involvement. However, approximately 23-30% of tuberculosis patients have extrapulmonary symptoms. A rare (1%) clinical presentation of tuberculosis is foot and ankle infection. This is complicated by the fact that the diagnosis of osteoarticular tuberculosis is difficult. Our case was a 66-year-old multi-pathological pensioner, who, while working in the countryside, had an ankle sprain on the left foot, with a lacerated wound of about 2 cm diameter. The non-endemic area and the negative chest X-ray made the diagnosis extremely complex. However, a multidisciplinary approach with the radiologists and the infectious disease department led to clinical stabilization of the patient. Therefore, awareness and high index of suspicion of the disease is essential and referral to experts should be made if diagnosis is indeterminate despite extensive investigations. The knowledge allows early identification of the disease and prompt therapy in order to avoid long-standing untreated infections which typically cause bone destruction and loss of function. The knowledge is also mandatory for western physicians due to increasing international travel, immigration from less developed countries and increased use of immunosuppressive medications. We believe that this article can bring awareness around osteoarticular tuberculosis and help with improving outcome and eradication of the infection. Level of clinical evidence: 4.


Assuntos
Osteomielite , Tuberculose Osteoarticular , Humanos , Idoso , Tuberculose Osteoarticular/diagnóstico , Tuberculose Osteoarticular/tratamento farmacológico , Osteomielite/diagnóstico , Radiografia
16.
Nucl Med Commun ; 43(12): 1188-1194, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36345763

RESUMO

OBJECTIVES: To investigate the comparison of maximum and mean standardized uptake values (SUVs) of jaw pathologies with bone Single-photon emission computed tomography/computed tomography (SPECT/CT), and a special focus on medication-related osteonecrosis of the jaw (MRONJ). METHODS: Eighty-nine patients with jaw pathologies (63 MRONJ, 13 chronic osteomyelitis, 11 osteoradionecrosis and 2 primary intraosseous carcinoma) underwent bone SPECT/CT scans acquisition at 4 h after intravenous injection of Tc-99m hydroxymethylene diphosphonate in this prospective study. The evaluation of mean and maximum SUVs of jaw pathologies were performed using Q. Metrix and Xeleris workstation and defined the data automatically. Statistical analyses were performed by Pearson's correlation coefficient for comparison of maximum and mean SUVs and Mann-Whitney U-test for SUVs of MRONJ. A P value lower than 0.05 was considered to indicate statistical significance. RESULTS: Maximum SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 17.6 ± 8.4, 21.7 ± 7.1, 11.9 ± 4.8 and 26.6 ± 7.0, respectively. Mean SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 10.1 ± 4.9, 11.9 ± 3.3, 7.0 ± 2.8 and 10.1 ± 4.5, respectively. The maximum SUV of jaw pathologies was significantly correlated with the mean SUV (Y = 0.494X + 1.228; R2 = 0.786; P < 0.001). Furthermore, maximum and mean SUVs of MRONJ had significant differences in underlying diseases, medication and staging. CONCLUSION: The maximum and mean SUVs with bone SPECT/CT can be an effective tool for the quantitative evaluation of jaw pathologies, especially MRONJ.


Assuntos
Carcinoma , Osteomielite , Osteonecrose , Osteorradionecrose , Humanos , Osteorradionecrose/diagnóstico por imagem , Osteorradionecrose/patologia , Estudos Prospectivos , Osteonecrose/diagnóstico por imagem , Osteonecrose/patologia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Osteomielite/diagnóstico por imagem
17.
J Am Coll Radiol ; 19(11S): S473-S487, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36436971

RESUMO

Musculoskeletal infections involve bones, joints, and soft tissues. These infections are a common clinical scenario in both outpatient and emergent settings. Although radiography provides baseline findings, a multimodality approach is often implemented to provide more detailed information on the extent of infection involvement and complications. MRI with intravenous contrast is excellent for the evaluation of musculoskeletal infections and is the most sensitive for diagnosing osteomyelitis. MRI, CT, and ultrasound can be useful for joint and soft tissue infections. When MRI or CT is contraindicated, bone scans and the appropriate utilization of other nuclear medicine scans can be implemented for aiding in the diagnostic imaging of infection, especially with metal hardware and arthroplasty artifacts on MRI and CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.


Assuntos
Artrite Infecciosa , Diabetes Mellitus , Pé Diabético , Osteomielite , Infecções dos Tecidos Moles , Humanos , Pé Diabético/diagnóstico por imagem , Infecções dos Tecidos Moles/diagnóstico por imagem , Sociedades Médicas , Medicina Baseada em Evidências , Osteomielite/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem
18.
Zhonghua Er Ke Za Zhi ; 60(12): 1271-1275, 2022 Dec 02.
Artigo em Chinês | MEDLINE | ID: mdl-36444429

RESUMO

Objective: To investigate the clinical features of children with chronic nonbacterial osteomyelitis (CNO), and raise awareness among clinicians. Methods: In this retrospective study, 18 patients with CNO who were diagnosed in Children's Hospital of Fudan University from January 2015 to December 2021 were included. Results: Eighteen children with CNO (12 males, 6 females) were identified. Their age at onset was 9 (5, 11) years, the delay in diagnosis was 2 (1, 6) months, and follow-up-was 17 (8, 34) months. The most common symptoms were fever in 14 children, as well as bone pain and (or) arthralgia in 14 children. In terms of laboratory results, normal white blood cell counts were observed at onset in 17 patients; increased erythrocyte sedimentation rate (ESR) in all patients; increased C reactive protein (CRP) over the normal value in 14 patients. Of the 18 patients, 2 had positive antinuclear antibodies, while none had positive human leukocyte antigen-B27 or rheumatoid factor. Imaging examination revealed that all the patients had symmetrical and multifocal skeletal lesions. The number of structural lesions detected by imaging investigation was 8 (6, 11). The most frequently affected bones were tibia in 18 patients and femur in 17 patients. Bone biopsy was conducted in 14 patients and acute or chronic osteomyelitis manifested with inflammatory cells infiltration were detected. Magnetic resonance imaging (MRI) found bone lesions in all the patients and bone scintigraphy were positive in 13 patients. All the patients were treated with nonsteroidal anti-inflammatory drugs, among whom 10 cases also treated with oral glucocorticoids, 9 cases with traditional disease modifying anti-rheumatic drugs, 8 cases with bisphosphonates and 6 cases with tumor necrosis factor inhibitors. The pediatric chronic nonbacterial osteomyelitis disease activity score, increased by 70% or more in 13 patients within the initial 6-month follow-up. Conclusions: The clinical manifestations of CNO are lack of specificity. The first symptom of CNO is fever, with or without bone pain and (or) arthralgia, with normal peripheral blood leukocytes, elevated CRP and (or) ESR. Whole body bone scanning combined with MRI can early detect osteomyelitis at subclinical sites, and improve the diagnostic rate of CNO.


Assuntos
Doença Enxerto-Hospedeiro , Osteomielite , Feminino , Masculino , Humanos , Criança , Estudos Retrospectivos , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Artralgia , Difosfonatos , Febre
19.
J Med Case Rep ; 16(1): 434, 2022 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-36404336

RESUMO

BACKGROUND: In recent years, the number of patients with ischemic skin ulcers due to diabetes mellitus and arteriosclerosis obliterans are increasing. Accordingly, endovascular therapy, drugs, and various wound dressings have been developed and applied to diabetic foot ulcers, and negative-pressure wound therapy, which often requires expensive and burdensome procedures for medical personnel, has also become popular. So simple and minimal invasive home treatment by the patient or their caregiver is required. CASE PRESENTATION: The present patient (77 years old, male, Asian) had developed left sole ulcers with draining pus that were resistant to conventional treatment, and he suffered from gait disturbance. We report a case of metatarsal osteomyelitis in a patient with diabetes mellitus and arteriosclerosis obliterans, in whom artificial carbon dioxide foot bathing and povidone-iodine sugar ointment were used continuously to promote bone and joint regeneration, and skin ulcer healing. CONCLUSIONS: A simple therapeutic intervention with artificial carbon dioxide foot bathing and povidone-iodine sugar ointment can improve not only ischemic skin ulcers, but also the bone and joint regeneration of ischemic limbs. This therapy can lead to a reduction in healthcare costs for a huge number of diabetic patients.


Assuntos
Arteriosclerose Obliterante , Ossos do Metatarso , Osteomielite , Úlcera Cutânea , Humanos , Masculino , Idoso , Povidona-Iodo/uso terapêutico , Dióxido de Carbono , Açúcares , Pomadas , Arteriosclerose Obliterante/tratamento farmacológico , Osteomielite/tratamento farmacológico , Úlcera Cutânea/tratamento farmacológico
20.
Medicine (Baltimore) ; 101(45): e31364, 2022 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-36397437

RESUMO

BACKGROUND: Calcium sulfate (CS) is used extensively as an antibiotic carrier in the treatment of chronic osteomyelitis, largely due to its biodegradable nature. The aim of this systematic review and meta-analysis is to analyze the comprehensive performance of CS in the literature when compared to other biomaterials or treatments for osteomyelitis. We assess the ability of CS to eradicate infection and achieve other key clinical outcomes. METHODS: All studies comparing the use of CS to any other surgical technique for the surgical management of osteomyelitis were eligible for analysis. The indication for surgery in each case was chronic osteomyelitis. The minimum dataset required included details regarding infection eradication rates, union rates (in cases of nonunion), all-cause revision surgery and wound leakage. The primary outcome variables of concern were infection eradication and all-cause revision surgery. Secondary outcome variables included union and wound leakage. A random effects meta-analysis was performed. RESULTS: Five studies were deemed eligible for inclusion. The CS group had a significantly higher rate of infection eradication (P = .013) and a significantly lower rate of revision for all causes (P < .001) when compared to the comparative group. In total, the CS group had 30 cases of wound leakage compared to 8 in the comparative group (P = .064). CONCLUSION: CS demonstrates superior rates of infection eradication and all-cause revision when compared with alternative treatment methods for chronic osteomyelitis. While the current study reports on differing but nonsignificant rates of wound leakage between CS and other treatments, future studies are required to accurately investigate this clinically important complication.


Assuntos
Sulfato de Cálcio , Osteomielite , Humanos , Sulfato de Cálcio/uso terapêutico , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Osteomielite/etiologia , Antibacterianos/uso terapêutico , Materiais Biocompatíveis/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...