pyrophosphate and Chronic-Disease

Topics: Calcium Pyrophosphate; Chondrocalcinosis; Chronic Disease; Diagnosis, Differential; Diphosphates; Humans; Joint Diseases; Radiography

Technetium-99 (99Tc) pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. Although bone biopsy seems useful in diagnosing osteomyelitis underlying decubitus ulcers, its role in diabetic patients with foot infections is not established. I do not recommend biopsy of foot bones in diabetic patients, since culture of bone biopsy specimens often give unreliable results in these situations because of contamination with ulcer organisms.

Topics: Acute Disease; Bone and Bones; Chronic Disease; Costs and Cost Analysis; Diabetes Complications; Diagnostic Errors; Diphosphates; Foot Diseases; Humans; Osteomyelitis; Radiography; Radionuclide Imaging; Skin Ulcer; Staphylococcal Infections; Technetium; Technetium Tc 99m Pyrophosphate; Wound Infection

Fifteen patients with bilateral, symmetrical, chronic pyrophosphate arthropathy of the knee were given intra-articular injections of yttrium-90 (5 mCi) plus steroid (triamcinolone hexacetonide, 20 mg) into one knee, and saline plus steroid into the other (control) knee. Allocation of the 90Y injection was random and double blind. After 6 months there was significantly less pain, inactivity stiffness, joint-line tenderness, and effusion in the 90Y-injected knees than in the controls (p less than 0.01). There were also significant differences between 90Y-injected and control knees in the changes in range of movement (p less than 0.01) and joint circumference (p less than 0.05) caused partly by progression of disease in the control knees. No significant differences in joint deformity, instability, X-ray appearance, or synovial-fluid analysis were seen. In all cases patient and observer assessment favoured the treated side (p less than 0.01). These findings indicate that intra-articular 90Y may be of benefit in chronic pyrophosphate arthropathy, a disease for which there is no treatment. The predilection of this condition to affect the knees of the elderly makes such treatment highly suitable because the joint lends itself readily to injection and the procedure carries very few actual or potential risks in this age group.

Topics: Aged; Arthritis; Chronic Disease; Clinical Trials as Topic; Diphosphates; Double-Blind Method; Female; Humans; Injections, Intra-Articular; Knee; Male; Middle Aged; Random Allocation; Triamcinolone Acetonide; Yttrium Radioisotopes

Soft tissue calcification occurs in several common acquired pathologies, such as diabetes and hypercholesterolemia, or can result from genetic disorders. ABCC6, a transmembrane transporter primarily expressed in liver and kidneys, initiates a molecular pathway inhibiting ectopic calcification. ABCC6 facilitates the cellular efflux of ATP, which is rapidly converted into pyrophosphate (PPi), a major calcification inhibitor. Heritable mutations in ABCC6 underlie the incurable calcification disorder pseudoxanthoma elasticum and some cases of generalized arterial calcification of infancy. Herein, we determined that the administration of PPi and the bisphosphonate etidronate to Abcc6

Topics: Acute Disease; Animals; ATP-Binding Cassette Transporters; Calcinosis; Chronic Disease; Diphosphates; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Evaluation, Preclinical; Etidronic Acid; Female; Liver; Male; Mice, Inbred C57BL; Mice, Knockout; Multidrug Resistance-Associated Proteins; Phenotype; Pseudoxanthoma Elasticum; Transgenes

Pyrophosphate (PPi) is a potent inhibitor of vascular calcification and may be deficient in renal failure. We sought to determine whether plasma PPi is affected by dialysis or the mode of dialysis and whether it correlates with vascular calcification.. PPi was measured in plasma samples stored from a recent study of vascular calcification in 54 HD patients, 23 peritoneal dialysis (PD) patients and 38 patients with stage 4 chronic kidney disease (CKD). Calcification was quantified in a standardized section of the superficial femoral artery using computed tomography, and PPi was measured by enzyme assay, at both baseline and 1 year.. Baseline plasma PPi was weakly correlated with age and serum phosphate, but not with alkaline phosphatase activity or other biochemical parameters, and did not differ between HD, PD and CKD patients. Both baseline calcification score and change in the calcification score at 1 year decreased with increasing quartiles of plasma PPi. In a multivariate analysis, plasma PPi was independently correlated with baseline calcification (P = 0.039) and the change in calcification (P = 0.029).. Plasma PPi is negatively associated with vascular calcification in end-stage renal disease (ESRD) and CKD but is not affected by dialysis, the mode of dialysis or nutritional or inflammatory status. Although these data are consistent with an inhibitory effect of PPi on vascular calcification, further studies are needed to establish a causal role.

Topics: Aged; Calcinosis; Chronic Disease; Diphosphates; Female; Femoral Artery; Humans; Kidney Diseases; Kidney Failure, Chronic; Male; Middle Aged; Multivariate Analysis; Peritoneal Dialysis; Renal Dialysis; Tomography, X-Ray Computed

Topics: Alkaline Phosphatase; Calcinosis; Carrier Proteins; Chronic Disease; Diphosphates; Diphosphonates; Disease Progression; Femoral Artery; Humans; Kidney Diseases; Phosphoric Diester Hydrolases; Pyrophosphatases

Topics: Chronic Disease; Diphosphates; Exercise Test; Heart; Heart Failure; Hemodynamics; Humans; Pulmonary Circulation; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

The time course of myocardial 99mTc-pyrophosphate accumulation 1 hour after a bicycle ergometric test versus the resting scintigraphic findings was correlated with the severity of chronic coronary heart disease (CHD) and long-term prognosis. A group of the patients who had higher radiotracer accumulation following the exercise showed the most severe disease and unfavorable prognosis (in this group 19.4% deaths were observed during a three-year follow-up). A single administration of 99mTc-pyrophosphate followed by scintigraphy 2 hours after bicycle ergometry and repeated scintigraphy 1 hour later allows one to assess the time course of myocardial radiotracer accumulation and to judge how the myocardium is supplied by blood.

Topics: Adult; Chronic Disease; Coronary Disease; Diphosphates; Exercise Test; Heart; Humans; Male; Middle Aged; Prognosis; Radionuclide Imaging; Severity of Illness Index; Technetium; Technetium Tc 99m Pyrophosphate

The possibility of myocardial necrosis occurrence in coronary failure proceeding as atypical myocardial infarction was examined in 176 patients with chronic types of coronary heart disease and in experiments with 16 dogs with reversible coronary failure simulated in chronic tests. 99mTe-labeled pyrophosphate myocardial scintigraphy was used in the clinical studies. Myocardial pyrophosphate accumulation was recorded in 37% of patients with angina pectoris without a history of myocardial infarction and 73% myocardial infarction survivals. Histological evidence for small myocardial necroses at various stages of their development was found in 12 dogs. Recurrent transient myocardial ischemias were shown to be able to lead to myocardial necroses that are not always followed by a typical course of acute myocardial infarction.

Topics: Angina Pectoris; Animals; Chronic Disease; Coronary Disease; Diphosphates; Dogs; Heart; Myocardium; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The authors presented the results of clinical, x-ray and osteoscintigraphic investigations of 133 psoriatic arthritis patients and 72 patients with common psoriasis. Osteoscintigraphy was performed using a routine method with 99mTc-pyrophos (USSR) and 99mTc-phosphone (Hungary) on gamma-camera LFOV (Nuclear-Chicago, USA). X-ray signs of the involvement of the osteoarticular system were noted in 69 (51%) patients with psoriatic arthritis and in 16 (22%) patients with common psoriasis. The method permitted the detection of the foci of RP hyperfixation in 129 (97%) patients with psoriatic arthritis and in 51 (70.8%) patients with common psoriasis. They were observed mostly in large and small limb joints, less frequently--in the vertebral column, cranial bones, thorax, and ribs. Thus, osteoscintigraphy is a highly sensitive method for the detection of active inflammatory foci of the osteoarticular system in psoriasis at all stages of arthritis development. It makes it possible to detect the spreading of arthritis and its preclinical forms.

Topics: Arthritis; Bone and Bones; Chronic Disease; Diphosphates; Evaluation Studies as Topic; Humans; Psoriasis; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Application of a complex of clinical, thermography and radionuclide methods in 79 patients with rheumatoid arthritis has demonstrated high sensitivity of scintigraphy with the use of osteotropic radiopharmaceuticals (99mTc-pyrophosphate, 99mTc-phosphone) as well as a possibility of diagnosing preclinical injuries to the joints. The thermography and scintigraphic parameters depended on the degree of inflammation, permitting an objective evaluation of the treatment effect.

Topics: Adult; Arthritis, Rheumatoid; Chronic Disease; Combined Modality Therapy; Diphosphates; Female; Follow-Up Studies; Humans; Joints; Male; Middle Aged; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thermography

A comparison of synovial fluid lactate levels has been made in cases of chronic pyrophosphate arthropathy (PA) with and without joint destruction, acute PA and osteoarthritis. No statistically significant difference could be observed between results of chronic PA and osteoarthritis. By contrast, synovial fluid lactate levels were significantly higher in acute PA in comparison with the two other groups. These data suggest that hypoxia is unlikely to play a role in destructive arthropathy commonly found in chronic PA.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Chondrocalcinosis; Chronic Disease; Diphosphates; Humans; Knee Joint; Lactates; Middle Aged; Osteoarthritis; Synovial Fluid

Topics: Adolescent; Adult; Aged; Chronic Disease; Diagnosis, Differential; Diphosphates; Female; Humans; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed

Topics: Adult; Angina Pectoris; Chronic Disease; Coronary Disease; Diphosphates; Evaluation Studies as Topic; Heart; Humans; Male; Middle Aged; Physical Exertion; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

The general and regional contractility of the left ventricle was studied in 69 patients with chronic coronary heart disease (CHD) and in 10 practically healthy persons using the method of radionuclide ventriculography (RNVG). The contractility indicators in dynamic and static RNVG were correlated. A high degree of correlation was obtained between them as well as with the findings of radiopaque ventriculography. It was established that data processing with the help of a cardiosynchronizer is of high informative value, significant and can be used in RNVG variants thus making it possible to use the same program of processing. The frequency of the methods and mean dispersion of the results were assessed. Numerical values of the general and regional contractility in healthy persons and in patients with varying severity of chronic CHD were determined.

Topics: Adult; Chronic Disease; Coronary Disease; Diphosphates; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Pentetic Acid; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Adult; Chronic Disease; Diphosphates; Humans; Middle Aged; Osteomyelitis; Pentetic Acid; Radionuclide Imaging; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Pyrophosphate; Tibia

In 66 patients suffering on chronic stable angina pectoris myocardial scintigrams with 99mTc-pyrophosphate were evaluated. Patients who had former infarcts or infarct signs in ECG were excluded. 16 normal subjects were used as controls. In all normal subjects and in 35 patients with chronic A.P. a normal myocardial scintigram could be obtained. In the remaining 31 patients a localized myocardial tracer accumulation could be seen. There was a correlation between the tracer accumulation and the limitted left ventricular function. No correlation was found between the severity and the number of involved coronary arteries and a positive scintiphoto. The mechanism of the tracer accumulation is discussed. The results of this investigation show that a positive myocardial scintigram does not prove a myocardial infarction. It is a sign for a insufficiency of the contractility of the left ventricle, probably due to under perfusion.

Topics: Angina Pectoris; Chronic Disease; Diphosphates; Electrocardiography; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Scintigraphy of the myocardium with pyrophosphate-99mTc was used in the examination of 45 patients with chronic ischemic heart disease and 3 patients with vegetovascular dystonia. A direct dependence of the character of the scintigram on the anginous attack was revealed. Accumulation of pyrophosphate-99mTc in the myocardium was observed in all patients with the agent injected just before the attack, during the attack or in the first 8 hours after it. Pyrophosphate-99mTc accumulation in the myocardium demonstrated on the scintigrams of the myocardium was less intense but more diffuse and extensive in chronic ischemic heart disease than in the focus of acute myocardial infarction.

Topics: Adult; Chronic Disease; Coronary Angiography; Coronary Disease; Diphosphates; Heart; Humans; Middle Aged; Radionuclide Imaging; Technetium

Pyrophosphate arthropathy has a wide spectrum of clinical symptoms and is a common cause of synovitis in the elderly. The acute "pseudogout" attack is the most commonly recognized, but chronic synovitis might be just as prevalent. Familial pyrophosphate arthropathy with a dominant autosomal heredity is a rare form, with an earlier debut and a more severe prognosis. Another rare expression of pyrophosphate arthropathy is severe joint destruction. The cause of pyrophosphate arthropathy is still unknown. Both individual reactivity and crystal properties determine the intensity of the inflammatory response to crystals.

Topics: Acute Disease; Adult; Aged; Anti-Inflammatory Agents; Calcium Pyrophosphate; Cartilage, Articular; Chondrocalcinosis; Chronic Disease; Diphosphates; Female; Humans; Intervertebral Disc; Knee Joint; Male; Middle Aged; Radiography; Synovial Fluid; Synovitis

Topics: Acute Disease; Age Factors; Aged; Calcium Pyrophosphate; Cartilage, Articular; Chronic Disease; Diphosphates; Humans; Middle Aged; Synovial Membrane; Synovitis

Topics: Adult; Aged; Calcium; Calcium Pyrophosphate; Chondrocalcinosis; Chronic Disease; Crystallization; Diphosphates; Humans; Hydroxyapatites; Joint Diseases; Middle Aged

Pseudogout, or calcium pyrophosphate arthropathy, is a crystalline synovitis, characterised either by acute attacks of joint pain, which usually occur in the large joints, or by a more chronic, progressive form of joint disease. The essential features of the disease are chondrocalcinosis and the presence of pyrophosphate crystals in the synovial fluid. The exact pathogenesis is unknown. Case reports of 2 patients with confiemed pseudogout, and of 1 who is suspected to be suffering from the disease, as well as a summary of the outstanding aspects of the condition, are presented.

Topics: Acute Disease; Aged; Chondrocalcinosis; Chronic Disease; Diagnosis, Differential; Diphosphates; Female; Humans; Knee; Male; Middle Aged; Radiography; Wrist

Topics: Acromegaly; Acute Disease; Aged; Arthritis, Rheumatoid; Bursitis; Calcium Phosphates; Chondrocalcinosis; Chronic Disease; Colitis, Ulcerative; Crystallization; Diphosphates; Female; Gout; Humans; Knee Joint; Male; Middle Aged; Osteoarthritis; Pyrophosphatases; Radioisotope Dilution Technique; Synovial Fluid

Topics: Adult; Arthritis; Arthroplasty; Calcium Phosphates; Chondrocalcinosis; Chronic Disease; Diphosphates; Female; Humans; Knee; Middle Aged; Radiography; Syndrome; Synovial Fluid