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Algorithm for imaging suspected osteomyelitis or septic arthritis in the pediatric population purchase 20 mg erectafil overnight delivery. Diagnostic performance characteristics of imaging studies for osteomyelitis in children and adults Sensitivity Specificity Plain radiograph 43–75% 75–83% (32 discount 20mg erectafil visa,46,47) Radionuclide scintigraphy 73–100% (53–87% in infants) 73–79% (36,41,49–53) MRI (33,57–64) 82–100% 75–96% Table 14. Chapter 14 Imaging of Acute Hematogenous Osteomyelitis and Septic Arthritis 269 Figure 14. Suggested Imaging Protocols • Plain radiograph: At least two orthogonal views of the body part of interest should be obtained; views of the opposite limb may be useful for comparison to detect subtle changes. Imaging should be performed on all patients suspected of osteomyelitis or septic arthritis to evaluate for destruction, as well as to exclude other pathologies such as tumors or fractures. Radionuclide bone scan shows abnormal uptake in the proximal left tibial metaphysis that was found to be osteomyelitis. The imaging findings are not specific for osteomyelitis, because neoplasms and trauma could have a similar appearance. Axial MRI of the pelvis after administration of gadolinium shows abnormal enhancement of the right ischial tuberosity and surrounding soft tissues consistent with osteomyelitis. There is also enhancement around the left greater trochanter, consistent with trochanteric bursitis. Planar images of extremities and single photon emission computed tomogra- phy (SPECT) images of the axial skeleton during the bone phase should be obtained. This imaging should be used if symptoms are nonlocaliz- ing or if there is a suspicion of polyostotic disease. Imaging should be performed if there are localizing symptoms or if the patient fails to respond to antibiotics within 48 hours. Future Research • Can the use of emerging whole-body imaging techniques in MRI obviate the need for radionuclide scintigraphy in the evaluation of osteomyelitis? Chapter 14 Imaging of Acute Hematogenous Osteomyelitis and Septic Arthritis 271 References 1. What is the role of radiography in patients with an acute knee injury and possible fracture?
If we interpret this story from a developmental point of view buy 20 mg erectafil visa, Randy has taken us from the stage of infantile hopes (waiting for another to meet needs) to that of ado- lescence discount 20mg erectafil, with its models of leadership. As we walk through the story we see Randy’s infantile hopes of care and nurturance only assuaged when Terrell the monster "went to seek the truth. This regres- sion gives way to humility as he speaks to the wise counsel about his anxiety- laden fears. Terrell is then seen climbing the rope (industry) and in receiv- ing guidance is able to help others through care and trustworthiness. With this interpretation the following story was told: Therapist: Once upon a time there was a man named Ug who lived on Paradise Island who had a misunderstanding with Thug a long time ago, but they resolved their differences and they are now friends. They find out that there are problems on a neighboring island, and soon Terrell shows up at Par- adise Island, and he is vexed with all types of problems. Terrell came to Paradise Island to bully and trick Ug and Thug, but the power of friendship was too strong for anyone to harm them and they saw through his anger. So Ug and Thug sent Terrell to the Island of Guidance to get help, and they built a bridge that provided shelter and light for his trip. But once he arrived he noticed the caring and gentle expressions of the 239 The Practice of Art Therapy wise men and he spoke with them. Once there, the blue ball revealed his inner secrets and showed him a true reflection of himself. In the process the rope around him uncoiled [note that at this point Randy began to uncoil the rope]. Therapist: The moral is that no one is a misfit who is willing to look at the truth. In this retelling, the story combines the misfit theme with a thrust toward cooperation, but it also presents Ug and Thug as competent guides who take care of not only one another but others in pain. Compared to Randy’s, this story offers a healthier adaptation, as it involves action by all the characters, protagonists and antagonists.
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