Efficacy of synovectomy in haemophilic patients with 153Sm-hydroxyapatite

Introduction - We preconized the use of 153Sm-Hydroxyapatite (HYP) in the synoviorthesis of haemophilic patients (pts) by physical, chemical and biological characteristics. The real efficacy is beeing confirmed by the actual experience over the previous results. These are the first results with 153Sm-HYP in our literature review. Material and Methods - Fiftheen pts. were treated, all males, with ages between 15 and 31 years (average = 22,8 years old), with an intraarticular injection of 185MBq (5mCi) of 153Sm-HYP, totalizing 29 joints: 12 knees, 11 elbows, 4 ankles and 2 shoulders. The 153Sm, produced by IPEN/CNEN - São Paulo, targeted hydroxyapatite particles with a diameter between 1-10µm, radiochemical purity superior to 95 percent and stability of 96,6 percent 1440min after the labeling process. The intraarticular punction was made after local antiseptic, aspirating synovial fluid, injecting 0,5 ml of radioactive solution and flushing the tract with a saline with a total volume no greater than 1,5 ml. The images were obtained 2 and 24h after injection in all pts in a large field of view gamma-camera. The clinical evaluation was made before and one year after it, using objective (range of motion, joint tenderness, degree of joint effusion) and subjective criteria (joint pain by visual scale and joint aspect). The response were graded: 1 - Excellent (E); 2 - Good (G); 3 - Mild (M); 4 - Bad (B); 5 - Worse (W). The reduction in clotting factor use and heamarthroses were others aspects evaluated. Results - The scintigrafies showed homogeneous distribution of the material in joints (2h) and no articular scape (24h). The was a reduction of 34 percent in the clotting factor use and of 51,4 percent in haemarthroses including the poor responses in knees. The results by patients were: 53,3 percent E, 20 percent G, 13,3 percent M, 13,3 percent B, 0 percent W and by joints were 47,75 with excellent and good responses and 84,75 percent when included the mild group. The...

Utilidade do 67 Ga na febre reumática: dados preliminares / Usefullness of 67 Ga in rheumatic fever: preliminary data

Foram estudados retrospectivamente 18 pacientes com febrereumática (FR), sendo 9 do sexo masculino, com idade média de 14,1 anos, tendo 16 cardite, 1 coréia e 1 FR sem cardite, sob regime de internamento hospitalar, com avaliaçäo clínica, laboratorial, radiológica, eletrocardiográfica e cintilográfica (67-Ga) extensiva. Dos 16 casos de cardite, 5 correspondiam ao 1§ surto da FR, 7 à recorrência e 4 à doença inativa. Os pacientes foram divididos em dois grupos: a) tratados clincamente, b) tratados cirurgicamente. No primeiro grupo de 13 pacientes (11 com cardite) efetuou-se correlaçäo clínica, eletro, eco e cintilográfica que resultou concordante, tendo 6 casos provas reumáticas negativas. No 2§ grupo (5 pacientes) a correlaçäo clínico-cintilográfico-histológica foi concordante em 4 e discordante em 1 (cuja intervençäo ocorreu 2,5 meses após estudo com 67-Ga). Houve acompanhamento terapêutico em 6 pacientes coincidindo a evoluçäo clínica com imagens de 67-Ga em todos, embora as provas reumáticas fossem negativas em 3. Estes resultados sugerem que os estudo com 67-Ga sejam úteis para caracterizar atividade de cardite reumática, como elemento de acompanhamento terapêutico e definir sua inatividade nos casos cirúrgicos