RESUMO
Thirty-five patients with suspected chronic osteomyelitis related to an orthopaedic device had 50 99Tcm-HMPAO-labelled leucocyte scans (LS). The scan appearances were compared with the bacteriological or clinical results and gave a sensitivity and specificity of HMPAO-LS of 83 and 100%, respectively. Bacteriological examination is often inaccurate in the diagnosis of osteomyelitis and therefore we assessed the clinical utility of HMPAO-LS. When the clinical, biological and radiological data were clearly suggestive of osteomyelitis (16/50) LS was unhelpful or even misleading when falsely negative (3/16). When the clinical, biological and radiological data were poorly suggestive of osteomyelitis (20/50) or conflicting (14/50) LS was misleading in only one patient (false negative). It is concluded that HMPAO-LS should only be performed to assist in the diagnosis of chronic osteomyelitis when there is no preexisting strong suspicion based on clinical, biological and radiological signs.
Assuntos
Leucócitos , Compostos de Organotecnécio , Equipamentos Ortopédicos/efeitos adversos , Osteomielite/diagnóstico por imagem , Oximas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Doença Crônica , Feminino , França/epidemiologia , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Dispositivos de Fixação Ortopédica/efeitos adversos , Osteomielite/epidemiologia , Osteomielite/etiologia , Cintilografia , Estudos Retrospectivos , Sensibilidade e Especificidade , Tecnécio Tc 99m ExametazimaRESUMO
Teicoplanin-impregnated plaster of Paris beads were made and in vitro release properties were studied. Teicoplanin was released in an initial massive dose, with a rapid decline during the first three days, followed by a slowly declining prolonged release up to 30 days. The release tested by diffusion in gelose and high-performance liquid chromatography was found to be 21.4% and 28.2%, respectively, of the amount theoretically present in the beads. Plaster of Paris is a resorbable, nontoxic biomaterial that has already been used to fill dead spaces in bone and deliver antibiotics in the treatment of chronic osteomyelitis. The addition of teicoplanin, a new antistaphylococcal agent with low known bacterial resistance, is a promising alternative. Follow-up tests in vivo, simulating local conditions of the osteomyelitic bone, are necessary to prove efficacy.
