Background: Mycobacterium tuberculosis infection is known to cause inflammation and lung tissue damage in high-risk populations. Nevertheless, direct associations between mycobacterial loads, systemic inflammation and pulmonary lesions upon treatment initiation have not been fully characterized. In the present exploratory study, we prospectively depict the immune profile, microbial clearance and evolution of radiographic lesions in a pulmonary tuberculosis (PTB) patient cohort before and 60 days after anti-tuberculous treatment (ATT) initiation. Methods: Circulating levels of cytokines (IL-2, IL-4, IL-6, IL-10, IFN-γ, TNF-α) and C-reactive protein (CRP), as well as values of erythrocyte sedimentation rate (ESR) were measured in cryopreserved serum samples obtained from 73 PTB patients at pre-ATT and day 60 of treatment. Changes of the immune profile over time were compared with mycobacterial loads in sputum and culture conversion at day 60 of ATT. Additional analyses tested associations between improvement of chest radiographic lesions at day 60 and pre-treatment status of inflammation and mycobacterial loads.
-Objective:To demonstrate imaging findings during the follow-up of patients with aneurysmal bone cyst (ABC) of C2 treated with intralesional injection of calcitonin and methylprednisolone. Method: Three patients with ABC of C2 were treated percutaneously with intralesional injection of calcitonin and methylprednisolone. All the patients were females, with ages varying from 6 to 13 years. All of them presented with cervical masses, but without neurological symptoms. Results: Imaging follow-up with CT and plain films showed progressive ossification and reduction of the blood-filled cavities with volume reduction of all lesions. No recurrence was noted during the follow-up. Conclusion: Intralesional injection of calcitonin and methylprednisolone is a safe treatment option for cervical ABC. The CT scan is especially valuable as a guide of injection site and for the follow-up of ossification of the treated ABCs.KEY WORDS: aneurysmal bone cyst, calcitonin, methylprednisolone. cisto ósseo aneurismático em c2: avaliação por imagem após injeção intralesional de calcitonina e metilprednisolonaResumo -Objetivo: Demonstrar os aspectos de imagem no acompanhamento de pacientes submetidos ao tratamento de cisto ósseo aneurismático com injeção intralesional de calcitonina e metilprednisolona. Método: Três pacientes com cisto ósseo aneurismático em C2 foram tratados com injeção intralesional percutânea de calcitonina e metilprednisolona. Os três pacientes eram do sexo feminino com idades variando de 6 a 13 anos. Os três pacientes apresentavam massa cervical sem sintomas neurológicos. Resultados: O acompanhamento por imagem com tomografia computadorizada e radiografia simples demonstrou ossificação progressiva e redução das cavidades preenchidas por sangue, com redução do volume das lesões. Não foi percebida recidiva durante o acompanhamento. Conclusão: A injeção intralesional de calcitonina e metilprednisolona é uma opção de tratamento segura para o cisto ósseo aneurismático cervical. A tomografia computadorizada é especialmente útil para orientar o sítio da punção e para o acompanhamento da ossificação dos cistos ósseos aneurismáticos tratados. Aneurysmal bone cysts (ABC) are relatively rare lesions that occur more commonly among patients in the first and second decades, especially in females. Characteristically, the ABC has many cavities full of blood. Most of the lesions occur at long bones, vertebrae and flat bones. The cervical vertebrae involvement is uncommon 1,2 . When seen in this location, the lesion involves initially the posterior arch and pedicles, with bone destruction and cortical expansion. Occasionally, the ABCs compress the spinal cord and nerve roots. PALAVRAS-CHAVEUnlike many surgical treatments performed to deal with vertebral ABC percutaneous intralesional injection of calcitonin and methylprednisolone is a less aggressive but effective approach [3][4][5][6] . This technique stimulates the cyst ossification, with new cancellous bone formation and reducing angiogenesis 7 .
Sporotrichosis is the most common subcutaneous mycosis in South America and its association with zoonotic transmission remains a relevant public health problem in Rio de Janeiro, Brazil. The disease most commonly presents as subacute or chronic cutaneous lesions, although dissemination to various organs and systems occurs in rare cases, mainly in immunosuppressed individuals. This report describes a case of sporotrichosis with severe bone and subcutaneous damage in an immunocompetent patient who did not exhibit the characteristic skin lesions of sporotrichosis, including ulcers, nodules, and lymphangitis.
Summary It has been suggested that technetium‐99m (99mTc)‐anti‐tumour necrosis factor alpha (TNF‐α) scintigraphy (SCI) may be a useful diagnostic tool in Graves' ophthalmopathy (GO). This study evaluated whether orbit total radioactivity uptake on SCI could be used to predict corticosteroid therapy (CorT) responses in active‐GO patients. A longitudinal study of patients with active GO defined by Clinical Active Score (CAS) >3/7 was done. Clinical, laboratory and SCI evaluations were performed at baseline and 3 months after concluding intravenous CorT. SCI (planar and tomographic) was assessed after intravenous injection of 10 mCi of 99mTc‐anti‐TNF‐α. Orbits and cerebral hemispheres were defined as regions of interest (ROIs) to enable orbit/hemisphere ROI‐ratios of total radioactive uptake. ROI‐ratios were considered positive at >2·5. Average total radiation uptake (TRU) was also determined for each orbit (AVGROI). Clinical, laboratory and SCI data were compared between responders (CAS became inactive) and non‐responders to CorT (18 patients). At baseline, AVGROI were higher in active OG orbits (67·3 cps) than in inactive ones (33·6 cps; P<0·05). AVGROI (absolute values) reduced (−29·9 cps) in CorT responders and tended (P = 0·067) to differ from variations occurred in non‐responders (+6·9 cps in patients with maintained CAS positivity post‐treatment). Higher baseline ROI‐ratios (4·9 versus 3·3; P = 0·056) and its pronounced reductions following CorT (−37% versus +56% in non‐responders; P = 0·036) tended to be associated with good CorT responses in the subgroup of GO history ≥1 year. SCI showed a good association with active eye disease and may be an additional tool to identify CorT responders.
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