Josias Alves Machado

Clinical evaluation after 1 year of 153‐samarium hydroxyapatite synovectomy in patients with haemophilic arthropathy

Summary.  The aim is to evaluate the efficiency of the treatment with 153‐samarium hydroxyapatite (153‐Sm‐HA) in haemophilic arthropathy. Thirty‐one patients (30 males) with ages ranging from 8 to 34 years (average age = 20.6 years) were treated with fixed intra‐articular dose of 185 MBq (5 mCi) and divided into two groups: infantile‐juvenile (13 patients with up to 18 years of age, an average age of 12.7 years and arthropathy evolution of 7.8 years), and adult (18 patients older than 18 years, an average age of 24 years and arthropathy evolution of 18.7 years). The clinical evaluation before and after 1 year of synovectomy used the following criteria: subjective (pain through visual scale, articulation inspection), objective (articular movement through flexion level, sensitivity to palpation and leakage through joint circumference), reduction on the use of the coagulation factor, number of haemarthrosis, and the occurrence of adverse effects. The results were classified as: 1, good (remission from 70% to 100% of manifestations); 2, moderate (remission from 40% to 69%); and 3, poor (remission from 0% to 39%). Seventy‐eight joints were tested: 15 knees, 36 elbows, 24 ankles, 1 shoulder and 2 hips. Early scintigraphic (1–2 h) and late scintigraphic (24–72 h) studies were performed after synoviorthesis. The cost of the procedure per joint was also estimated. No significant difference in the synoviorthesis result between groups was observed. The results were good for 75% of elbows, 87.5% of ankles and 40% of knees; the reduction in haemarthrosis and use of the coagulation factor was respectively 78% and 80% for elbows, 82% and 85% for ankles and 30% and 35% for knees. Four cases of reactional synovitis were observed in the 31 patients. The scintigraphic control showed homogeneous distribution of the material with no articular escape. The use of 153 Sm‐HA in the treatment of the haemophilic arthropathy is effective for intermediate‐size joints (elbows and ankles), but less effective for knees. Moreover, this treatment presents an excellent safety profile and accessible cost.

The use of 185 MBq and 740 MBq of 153-samarium hydroxyapatite for knee synovectomy in haemophilia

The penetration of beta energy of 153‐samarium (153Sm) (0.8 MeV) is not only appropriate for synovectomy of median articulations but is possible to improve the radiobiological effect using increased activities. The aim of this study was to assess the effectiveness of 185 MBq and 740 MBq of 153‐samarium hydroxyapatite (153Sm‐HA) in knees of haemophilic patients. Thirty‐one patients – 36 knees, 30 males, were divided into two groups without coinjection of corticosteroid: A – 14 patients (17 knees) treated with intra‐articular dose of 185 MBq of 153Sm‐HA, average age 23 years; B – 17 patients (19 knees) with 740 MBq of 153Sm‐HA, average age 21.3 years. The evaluation before and after 1 year of synovectomy used the following criteria: reduction in the number of haemarthroses and use of the coagulation factor and improvement in articular motility. Adverse‐effects occurrence was considered too. Early and late scintigraphic studies were performed after synoviorthesis and no joint immobilization was recommended. The reduction in haemarthrosis and use of coagulation factor were: group 1 – 31.3% and 25%; group 2 – 81.5% and 79% with P < 0.001 respectively; no significant improvement in knees motility was noted for both groups. Four cases of mild reactional synovitis were observed in each group. The scintigraphic control showed homogenous distribution of the radiopharmaceuticals with no articular escape; the material was considered safe by its permanence in the articulation. We have significant improvement in the synovectomy of haemophilic knees with 740 MBq of 153Sm‐HA; the less penetration of its beta radiation was compensated by the increased biological effect with the higher used activity.

Investigação molecular de Ehrlichia spp. e Anaplasma platys em felinos domésticos: alterações clínicas, hematológicas e bioquímicas

Ehrlichia sp. and Anaplasma platys are Gram-negative micro-organisms, obligate intracellular parasites, residing in cytoplasmic vacuoles of leukocytes and platelets, found in peripheral blood or tissue. Few reports have been made about ehrlichiosis and anaplasmosis in cats in Brazil, which are based on the presence of morulae in leukocytes and platelets, or by detecting antibodies. The objective of this study was to investigate the natural infection with Ehrlichia sp. and A. platys in cats in Campos dos Goytacazes-RJ, by hematoscopia and DNA detection of these agents. Samples of whole blood and serum from 91 cats, regardless of race, gender and age. Blood count, serum biochemistry and PCR using primers for Ehrlichia sp. and A. platys were perfomed. Data from hematoscopia showed 9.89% of morulae only in platelets. The DNA of A. platys was detected in 13.18% of the 91 samples and 44.44% of the positive at hematoscopia. The DNA of Ehrlichia sp. was not detected in any sample. All animals studied did not show clinical signs neither positive laboratory results. The data suggest that domestic cats can serve as potential reservoirs for A. platys as asymptomatic form of related diseases

Oxigenação extracorpórea por membrana em cães sem auxílio circulatório

In humans, arteriovenous extracorporeal membrane oxygenation (AV-ECMO) is a life support technique capable to assume in part or totally lungs functions, when these are not able to promote appropriated hematosis. To know the viability of this method in dogs (Canis familiaris), the present study applied AV-ECMO in ten adult mixed-breed dogs, with expected three hours of duration to each experiment. In Group 1 (n=4), mechanical ventilation and dopamine continuous infusion were associated with the extracorporeal support. In Group 2 (n=6), any other measure of intensive care was used concomitantly AV-ECMO. Blood gas analysis and lactate levels were evaluated every 10 minutes and one hour, respectively, from arterial blood samples. Inotropic support improved the blood flow through the circuit promoting a better tissue perfusion with oxygenated blood, suggested by the lactate and mean arterial pressure levels measured. Mechanical ventilation used simultaneously with AV-ECMO was able to further improve levels of blood gases. Therefore, if applied along intensive care support, AV-ECMO is a viable technique for use in dogs with respiratory failure refractory to conventional treatments.