Radionuclide Bone Scan Research Articles

Bisphosphonate-induced periprosthetic fracture: a cause of painful total hip arthroplasty.

Background. Cases have been reported in the literature of periprosthetic fractures associated with the use of bisphosphonates occurring in the long term following a Total Hip Replacement (THR). We report an interesting case of periprosthetic fracture secondary to bisphosphonate use only a few months after a THR. Case Report. A 72-year-old lady (on bisphosphonates for 10 years) underwent a THR for osteoarthritis. She was pain-free in the first four months postoperatively. Thereafter, she developed spontaneous onset of pain in the lateral aspect of her thigh and groin and found it difficult to weight-bear. X-rays and blood tests were unremarkable. An ultrasound and MRI scan showed no evidence of effusion/collection or periprosthetic fracture. A radionuclide bone scan showed an abnormal appearance of the right femoral shaft. A subsequent CT scan showed an oblique vertical split on the anterior surface of the upper right femoral shaft. This stress fracture was managed nonoperatively with protected weight bearing. She has progressed well with good clinical and radiological signs of fracture healing. Conclusion. This case is an important addition to our knowledge that bisphosphonate-induced periprosthetic stress fractures can be a cause of hip pain only a few months following a THR.

Abstract P3-06-02: The use of imaging and tumor markers in the staging of patients age <65 years with early-stage breast cancer

Abstract Purpose Guidelines from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recommend against the use of positron emission tomography (PET), computed tomography (CT), radionuclide bone scans (RBS) and tumor markers (TM) in the staging of early-stage breast cancer with a low risk for distant metastasis. No previous studies have described the use of these tests or identified factors associated with this practice in patients age <65 years. Methods We used the national employer-based claims database MarketScan to identify patients with a first diagnosis of breast cancer, age 20 to 64 years, who had undergone a mastectomy or a lumpectomy, and a sentinel lymph node biopsy between the years of 2005 and 2010. We excluded patients who had undergone an axillary lymph node dissection, as this may indicate advanced nodal disease for which staging tests may be recommended. We ascertained claims for PET, CT, RBS and TM during the period of 3 months before and 1 month after the date of surgery. We used a multivariable logistic regression model to identify factors associated with the use of these tests. The variables included in the model were: age at diagnosis, geographic region, year of diagnosis, type of surgery (lumpectomy vs. mastectomy), endocrine therapy (yes vs. no), radiation therapy (yes vs. no), and chemotherapy (trastuzumab-based, non-trastuzumab-based, vs. no). Results We identified 42,606 patients (median age 53 years) of whom 12% had at least one claim for a PET, 6.5% for a CT, and 2.5% for TM. In combination, 17% of the patients had at least one claim for a test. Among patients diagnosed in 2005, 14% had claims for tests, whereas between 2006 and 2010, this proportion ranged between 16% and 18% (test for trend p-value: 0.08). Among patients who had chemotherapy, 22% of those who received trastuzumab-based regimens and 21% of those who received non-trastuzumab-based regimens had claims for tests, compared to 14% of patients who did not receive chemotherapy. In the regression analysis, we observed geographic differences, where patients from the Northeast had increased odds of testing, compared to patients from the North Central region (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.34 - 1.59). Patients who underwent a lumpectomy had decreased odds of testing, compared to those who had a mastectomy (OR 0.62, 95% CI 0.57 - 0.66). Patients who received radiation therapy (OR 1.30; 95% CI 1.20 - 1.40) and chemotherapy (non-trastuzumab-based: OR 1.67, 95% CI 1.58 - 1.77; trastuzumab-based: OR 1.69, 95% CI 1.55 - 1.84) had increased odds of testing. Conclusion Despite current ASCO and NCCN guidelines, the use of imaging tests and TM in the staging of early-stage breast cancer remains common, and there is no clear trend of a change of this non-recommended practice over time. Subsets of patients with early-stage breast cancer had an increased probability of undergoing tests not recommended for staging purposes. The use of imaging tests and TM may be increased in those patients who are perceived to be at a higher risk for metastasis during diagnosis, as there was a significant association of this practice with mastectomy (over lumpectomy), radiation therapy and chemotherapy. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-02.

Ewing Sarcoma of the Distal Part of the Thumb: Allograft Reconstruction to Preserve Function: A Case Report.

Ewing sarcoma (ES) is the second most common primary malignant bone tumor in childhood and adolescence after osteosarcoma1. It mainly affects the long bones and the pelvis2. Occasionally, the metacarpals are involved, and more rarely, the phalanges are affected3,4. Treatment for ES may include surgery, chemotherapy, radiation therapy, or a combination of these therapies. Amputation with adjuvant chemotherapy is the treatment of choice for the short tubular bones of the hand. Radiation therapy is not indicated when the digits are involved because of a high rate of complications5,6. We present the clinical course of a case of ES in the distal phalanx of the thumb, along with the radiographic and histopathological findings. We also describe a novel surgical treatment to address functional and cosmetic issues. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-eight-year-old man presented with pain in the distal phalanx of the left thumb. Symptoms initially manifested as itching and intermittent swelling that had begun three months previously. Over time, this had changed to increasing pain. Physical examination findings included tenderness in the distal phalanx and painful range of motion in the interphalangeal joint. The skin of the affected area was slightly erythematous with induration. There was no history of trauma and there were no constitutional symptoms. Radiographs revealed a lytic lesion with a honeycomb appearance in the distal phalanx, without remarkable cortical expansion or periosteal reaction (Fig. 1). A radionuclide whole-body bone scan showed increased uptake in the distal phalanx but was otherwise normal (Fig. 2). There was high signal intensity of the distal phalanx on the T2-weighted magnetic resonance imaging (MRI) and hypointense signal abnormality on the T1-weighted MRI without soft-tissue involvement (Figs. …

Designing effective eLearning for healthcare professionals

OvervieweLearning has been identified as a versatile, economic method of delivering education, adopted by many education providers. Yet, little research has been undertaken into its impact as a sole method of delivery and effectiveness for imparting new knowledge or skills. This may have particular implications for busy healthcare practitioners wishing to access an educational programme to maintain, or extend their knowledge base in response to service needs. Aims and methodologyFollowing an action research approach and using an instructional design methodology, a discrete eLearning resource was devised and constructed to prepare non-medical healthcare practitioners to report radionuclide bone scans. Volunteers were recruited from across the UK to assess and establish the feasibility and efficacy of the module. ResultsIn terms of versatility, access, design and content, the module achieved resonance, with knowledge gains and transferability demonstrated, particularly amongst less experienced volunteers, suggesting a positive influence of the eLearning approach. ConclusionsOwing to the small-scale nature of the study, the capability of eLearning, as a sole educational medium to establish emergent skills, can only be cautiously expressed. However, as a tool for blended learning, continuing professional development, or audit purposes, it demonstrated its potential, confirming the place for this type of resource within the professional learning arena.

A case report of disabling bone pain after long-term kidney transplantation

A 77-year-old man, who received a renal transplant 13 years before for IgA glomerulonephritis, was referred after he developed bilateral mid-tibial aching pain that did not improve with simple analgesia. He had recently been changed from low-dose cyclosporine to tacrolimus, but the pain did not improve when this was reversed. He had a history of focal prostatic adenocarcinoma, cryptococcal lung infection, osteoporosis treated with alendronate for 2 years and multiple squamous cell carcinomas, including one requiring left neck dissection and radiotherapy. Upon physical examination, he had gouty tophi and marked bilateral tibial tenderness but had no other clinical findings. Laboratory investigations included an elevated intact parathyroid hormone value of 7.9 pmol/L (1.6 to 6.9), bone specific alkaline phosphatase of 22 µg/L (3.7 to 20.9), urinary deoxypyridinoline/creatinine ratio of 7.2 nmol/mmol (2.5 to 5.4) and C-reactive protein. Chest X-ray and tibial X-rays were normal, but there was marrow oedema and a prominent periosteal reaction on magnetic resonance imaging. A radionuclide bone scan showed increased symmetrical, linear uptake in both tibiae and the left femur, and uptake was also noted in both clinically asymptomatic humeri. Tibial bone biopsy disclosed small deposits of poorly differentiated metastatic cancer and a follow-up chest CT revealed a lung lesion. It was concluded that the bone pain and periostitis was caused by primary lung cancer with metastatic disease to bone, and an associated hypertrophic osteoarthropathy.

Comparison of radionuclide bone scan and MRI for vertebral metastasis detection from lung cancer tumor

Objective To compare radionuclide bone scan and MRI for vertebral metastasis detection fromlung cancer tumor.Methods 45 cases with lung cancer were collected for radionuclide bone scan and MRI scan,the scanning time within 15 days.Three deputy directors read the piece,the detection rate of two kinds of examination methods was compared.Results 35 cases were detected by radionuclide bone scan and MRI (x2 =0.135,P ＞0.05).It was detected 84 positive bone metastases vertebral,detected in 45 of radionuclide bone scan,MRI detected73,the difference was significant (x2 =15.300,P ＜ 0.05).Conclusion MRI can effectively detect lung cancer spine bone vertebral metastasis loci without false positive lesions,which contribute to the diagnosis and treatment of disease,worthy of clinical promotion. Key words: Radionuclide bone scan; Magnetic resonance imaging; Neoplasm metastasis

When to perform positron emission tomography/computed tomography or radionuclide bone scan in patients with recently diagnosed prostate cancer

Skeletal metastases are very common in prostate cancer and represent the main metastatic site in about 80% of prostate cancer patients, with a significant impact in patients’ prognosis. Early detection of bone metastases is critical in the management of patients with recently diagnosed high-risk prostate cancer: radical treatment is recommended in case of localized disease; systemic therapy should be preferred in patients with distant secondary disease. Bone scintigraphy using radiolabeled bisphosphonates is of great importance in the management of these patients; however, its main drawback is its low overall accuracy, due to the nonspecific uptake in sites of increased bone turnover. Positron-emitting radiopharmaceuticals, such as fluorine-18-fluorodeoxyglucose, choline-derived drugs (fluorine-18-fluorocholine and carbon-11-choline) and sodium fluorine-18-fluoride, are increasingly used in clinical practice to detect metastatic spread, and particularly bone involvement, in patients with prostate cancer, to reinforce or substitute information provided by bone scan. Each radiopharmaceutical has a specific mechanism of uptake; therefore, diagnostic performances may differ from one radiopharmaceutical to another on the same lesions, as demonstrated in the literature, with variable sensitivity, specificity, and overall accuracy values in the same patients. Whether bone scintigraphy can be substituted by these new methods is a matter of debate. However, greater radiobiological burden, higher costs, and the necessity of an in-site cyclotron limit the use of these positron emission tomography methods as first-line investigations in patients with prostate cancer: bone scintigraphy remains the mainstay for the detection of bone metastases in current clinical practice.

Imaging of Osteoporosis

There are many imaging methods for evaluating osteoporosis. Only a limited assessment of bone density and trabecular architecture can be done by plain radiography. Radiography is most useful in finding atraumatic fractures that are associated with osteoporosis. Radionuclide bone scanning and MRI also are useful in finding these fractures. Evaluation of bone density is most frequently assessed by dual-energy x-ray absorptiometry but can be done by other methods.

2024 CONTEMPORARY TRENDS OF IMAGING AFTER PRIMARY TREATMENT FOR PROSTATE CANCER

You have accessJournal of UrologyImaging/Radiology: Uroradiology (I)1 Apr 20132024 CONTEMPORARY TRENDS OF IMAGING AFTER PRIMARY TREATMENT FOR PROSTATE CANCER Sanoj Punnen, Sam Washington, Tranh Trang, Matthew Trusedale, Janet Cowan, Peter Carroll, and Matthew Cooperberg Sanoj PunnenSanoj Punnen San Francisco, CA More articles by this author , Sam WashingtonSam Washington San Francisco, CA More articles by this author , Tranh TrangTranh Trang San Francisco, CA More articles by this author , Matthew TrusedaleMatthew Trusedale San Francisco, CA More articles by this author , Janet CowanJanet Cowan San Francisco, CA More articles by this author , Peter CarrollPeter Carroll San Francisco, CA More articles by this author , and Matthew CooperbergMatthew Cooperberg San Francisco, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2443AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies have suggested an over-utilization of imaging in the diagnosis and assessment of newly diagnosed prostate cancer. However, data on utilization of imaging after the primary treatment for the disease are limited. We aimed to characterize trends in the use of imaging after prostate cancer treatment stratified by primary treatment type and time, and to identify patient characteristics associated with increased likelihood of receiving post treatment imaging. METHODS Patients in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database with complete data on primary treatment and more then one year of follow up were selected for analysis. Imaging modalities assessed included radionuclide bone scan (BS), computed tomography (CT) and magnetic resonance imaging (MRI) completed within 5 years of primary treatment or before any secondary treatments. Rates of postoperative imaging were compared by primary treatment modality and year of diagnosis. Multivariable logistic regression was used to identify characteristics significantly associated with receiving postoperative imaging. RESULTS 9,176 patients comprised the analytic cohort. Less then 10% of patients received imaging after primary prostate cancer treatment and this rate was consistent across years of diagnosis. The use of BS decreased over time while the rates of CT scans increased (p<0.01). Patients managed with active surveillance/watchful waiting (AS/WW) or primary androgen deprivation therapy (ADT) had a higher utilization of post treatment imaging, primarily with BS compared to patients treated by other modalities. Being managed with primary ADT (OR 4.66, 95% CI: 3.8-6.4; p-value <0.01) was associated with an increased likelihood of posttreatment imaging compared to surgery, while management with external beam radiotherapy (OR 0.37, 95% CI: 0.2-0.7; p-value <0.01) and brachytherapy (0.57, 95% CI: 0.4-0.9, p-value <0.01) was associated with a decreased likelihood of posttreatment imaging. In addition, receipt of pretreatment imaging was associated with a decreased likelihood of posttreatment imaging (OR 0.56, 95% CI: 0.4-0.7, p-value <0.01). CONCLUSIONS Although the overall rates of imaging have remained stable over time, there has been a trend toward decreased BS and increased CT scans. Patients managed with primary ADT were more likely to receive imaging compared to patients managed with more definitive local therapy. These results do not address adequacy or appropriateness of imaging; optimal strategies for post-treatment imaging have yet to be defined. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e831 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanoj Punnen San Francisco, CA More articles by this author Sam Washington San Francisco, CA More articles by this author Tranh Trang San Francisco, CA More articles by this author Matthew Trusedale San Francisco, CA More articles by this author Janet Cowan San Francisco, CA More articles by this author Peter Carroll San Francisco, CA More articles by this author Matthew Cooperberg San Francisco, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment of cervical vertebral (C1) metastasis of lung cancer with radiotherapy: A case report

The present study discusses a patient with C1 vertebral metastasis from adenocarcinoma of the left lung. The patient was a 31-year-old female suffering from neck pain who was referred by her physician. Magnetic resonance imaging revealed osteolytic destruction of the C1 vertebra. Chest and computed tomographic scans revealed lung carcinoma changes involving the left lung. A biopsy confirmed adenocarcinoma of the left lung. Abnormal activity was present in the cervical spine (C1) region in a radionuclide bone scan. The patient was then referred to an oncologist. The spine was stabilized with a rigid collar and a course of radiation therapy and pain medication was initiated immediately. At the 9-month follow-up examination, there was no evidence of progression on the MRI scans and the main neck symptoms had disappeared. At present, the overall survival (OS) time is 11 months. Patients complaining of new onset back or neck pain should be assumed to have vertebral metastasis until proven otherwise. Trivial trauma should be taken seriously in these cases and investigated with appropriate clinical, laboratory and imaging examinations.

The diagnostic value of single photon-emission computed tomography bone scans combined with CT (SPECT-CT) in diseases of the foot and ankle

A radionuclide bone scan with single photon-emission computed tomography and CT (SPECT-CT) is a new imaging modality which combines highly detailed CT with the functional information from a triple phase radionuclide bone scan. Little has been published about its diagnostic accuracy and usefulness in foot and ankle pathology. The aim of this study is to evaluate whether bone scans with SPECT-CT provide a useful contribution to the management of patients with foot and ankle pain, and whether it results in changes to clinical management. A retrospective study involving 50 patients was conducted between March 2010 and April 2011. SPECT-CT was requested in cases where definitive clinical diagnosis could not be achieved after clinical examination and plain radiography. Pathology as highlighted on SPECT-CT was taken as the definitive diagnosis in these patients and was treated accordingly. Patients were subsequently seen in the follow up clinic to evaluate the outcome of their treatment. In 11 patients (22%), the provisional clinical diagnosis matched with the findings of the SPECT-CT and no change in treatment was necessary. In 39 patients (78%) the findings of the SPECT-CT did not correlate exactly with the initial clinical diagnosis and led to a modified treatment plan. The accuracy, sensitivity, specificity, positive predictive and negative predictive value of SPECT-CT in this series was 94%, 95.45%, 83.3%, 97.6% and 71.43% respectively. SPECT-CT is a useful investigation tool in foot and ankle pathologies. The present study shows a high diagnostic accuracy and we recommend its use in cases with diagnostic uncertainty.

Use of diagnostic testing for patients with early-stage breast cancer in a multi-hospital quality collaborative in Michigan.

242 Background: In 2012, ASCO identified five opportunities to improve the quality of cancer care and reduce costs. Two of these recommendations focused on limiting use of advanced diagnostic imaging with computed tomography (CT), Positron Emission Tomography (PET), and radionuclide bone scans (BS) at diagnosis and during surveillance for women with early stage breast cancer with a low risk of metastasis. We describe the use of diagnostic imaging among patients with early stage breast cancer treated at hospitals in Michigan. Methods: The Michigan Breast Oncology Quality Initiative is a collaboration between Michigan hospitals, the University of Michigan Comprehensive Cancer Center, and the National Comprehensive Cancer Network (NCCN). This collaborative collects longitudinal demographic, staging, treatment, and follow up data using the NCCN Breast Outcomes Database platform. We analyzed use of advanced diagnostic testing with CT, PET, BS and contrast it with use of traditional imaging (mammography/ultrasound) at diagnosis and during follow up in patients with stage 0, I, II breast cancer between 1998 to 2009. Patients who died or recurred were excluded. Results: The cohort included 7,632 patients (19.6% stage 0, 48.1% stage I, 32.3% stage II) treated at 17 hospitals. Use of traditional imaging was documented in nearly 100% of patients at diagnosis and throughout the follow up period. With respect to advanced diagnostic imaging, 20.3 % underwent CT, 4.7% underwent PET, and 11.6% underwent BS at diagnosis. Advanced testing use decreased over time (Table). Conclusions: Despite published guidelines, which recommend against their routine use, advanced diagnostic imaging use was prevalent among patients treated for early breast cancer at MiBOQI hospitals. Education efforts should target physicians and patients on the lack of proven benefit and potential risks of using advanced diagnostic imaging in this population. [Table: see text]

A Solitary Bone Lesion in a Patient With Previous Breast Cancer and the Importance of Bone Biopsy: A Case Report and a Review of Guidelines

Introduction Increased radionuclide bone scan uptake in a solitary bony site in patients with known malignancy are common and can be a diagostic problem, given the nonspecificity of bone scintigraphy. Bone s the most common site of metastatic breast cancer recurrence, and approximately 80% of patients with metastatic disease have bone metastases. Bony lesions are usually, but by no means always, ultiple, and, in one study, 98% of solitary bone lesions suspected of eing metastatic subsequently proved to be so. Other investigations, including, in particular, magnetic resonance imaging (MRI) can add to the diagnostic accuracy of isotopic bone scanning, but the definitive diagnosis would be with histologic material obtained at bone biopsy. However, bone biopsy is by no means a routine procedure. Imaging-guided bone biopsy is generally a low-risk procedure, but possible adverse effects range from minor (pain and minor damage to surrounding tissue) to major (localized infection, osteomyelitis, par-

Multifocal Skeletal Tuberculosis = سل متعدد البؤر

A 6-year-old Indian boy presented with a month-long insidious onset of pain in his back and left shoulder. He had had a low-grade fever, decreased appetite and weight loss for 2 months. There was no history of trauma, chronic cough, or bowel or bladder complaints. His father was on anti-tuberculous therapy for pulmonary tuberculosis (TB) (sputum positive). On examination, the boy had a gibbus deformity of the thoracic spine [Figure 1]. Tenderness was present over the upper thoracic spine and the left shoulder joint. Paraspinal spasm and swelling was present. A systemic examination was normal. Investigations revealed haemoglobin of 9.4 gm%; a total leucocyte count of 12,400/cumm (neutrophils 55%, lymphocyte 45%); a platelet count of 2.1 lac/cumm, and an erythrocyte sedimentation rate of 88 mm at 1 hour. A human immunodeficiency virus (HIV) enzyme linked immunosorbent assay (ELISA) test was negative. A Mantoux test was positive (28 mm). A chest X-ray and an ultrasound of the abdomen were normal. Magnetic resonance imaging (MRI) of the spine revealed multifocal skeletal TB involving the thoracic spine, the lateral end of the left clavicle, and the left acromion process. There was also evidence of prevertebral, paravertebral, and anterior epidural abscesses [Figures 2–4]. Surgical debridement was done and 150 ml of pus was drained. Acid-fast bacilli were demonstrated in the pus by a Ziehl-Neelsen stain. Our patient was diagnosed with multifocal TB and was started on an antituberculous therapy of isoniazid, rifampicin, pyrazinamide, and ethambutol for two months, followed by isoniazid and rifampicin for four months. He was followed up monthly after discharge and at the end of six months showed marked improvement in symptomatology. His appetite and weight had increased, the fever had subsided, and his paraspinal abscess had decreased. Figure 1: Clinical photograph of the patient showing gibbus deformity in the upper thoracic spine and paraspinal abscess. Figure 2: Coronal T2 weighted image shows complete destruction, with a collapse of the T3 and T4 vertebrae. Marrow oedema is noted from T1 to T5 vertebral levels and also in the left lateral end of clavicle and acromion process. Figure 4: Sagittal T2 weighted image showing complete destruction with collapse of T3 and T4 vertebrae with decreased T3 and T4 disc height and the resultant severe gibbus deformity. There is an associated prevertebral and anterior epidural abscess, causing complete ... In recent years, widespread immigration, HIV infection, illicit drug use, and the emergence of multi-drug resistant mycobacteria have resulted in a worldwide resurgence of TB.1 Skeletal TB accounts for less than 10% of all cases of TB. Multifocal TB is rare, occurring in less than 5% of cases even in endemic countries.2 Multifocal skeletal TB is defined as osteoarticular lesions that occur simultaneously in two or more locations, with or without pulmonary involvement. It may affect a single bone with multifocal lytic cortical lesions or multiple sites at different bones.3 Multifocal skeletal TB most often involves the axial skeleton (spine) followed by the major weight bearing joints. It is commonly seen in immunosuppressed patients, and usually associated with pulmonary TB.2,4 Our patient was immunocompetent and had normal pulmonary findings. Other atypical features were the involvement of the lateral end of the clavicle and the acromion process of scapula. TB of the lateral end of the clavicle and shoulder is extremely rare, occurring in less than 1% of cases.5,6 To the best of our knowledge, only two cases of TB of the acromion process and less than ten cases of TB of the lateral end of the clavicle have been reported to date.5,6 Multifocal skeletal TB must be considered in the differential diagnosis of multiple destructive skeletal lesions. Conventional X-rays often fail to detect early skeletal disease, resulting in a delayed diagnosis. In addition, the radiological picture is variable and the lytic bony lesions may easily be confused with osseous, or inflammatory or neoplastic diseases, either primary or metastatic.2,4 Computed tomography (CT) and MRI scans can usefully determine the extent of bone lesion and soft tissue involvement and differentiate between abscess and the granulation of tissue. A radionuclide bone scan is non-specific, may be negative in the early stages of the disease, and does not differentiate between lytic tuberculous lesions or malignancy. The diagnosis is confirmed by biopsy. Uncomplicated tuberculous lesions of the clavicle and scapula usually resolve with anti-tubercular therapy. Similarly, spinal TB is managed with bracing and anti-TB drugs. Surgery is needed only if there is a neurologic deficit or spinal instability.2,4

Variation in Occult Injury Screening for Children With Suspected Abuse in Selected US Children’s Hospitals

To describe variation across selected US children's hospitals in screening for occult fractures in children <2 years old diagnosed with physical abuse and in infants <1 year old who have injuries associated with a high likelihood of physical abuse. We performed a retrospective study of children <2 years old with a diagnosis of physical abuse and infants <1 year old with non-motor vehicle crash-associated traumatic brain injuries or femur fractures admitted to 40 hospitals within the Pediatric Hospital Information System database from January 1, 1999, to December 31, 2009. We examined variation among the hospitals in the performance of screening for occult fractures as defined by receipt of skeletal survey or radionuclide bone scan. Marginal standardization implemented with logistic regression analysis was used to examine hospital variation after adjusting for patient demographic characteristics, injury severity, and year of admission. Screening for occult fractures was performed in 83% of the 10,170 children <2 years old with a diagnosis of physical abuse, 68% of the 9942 infants who had a traumatic brain injury, and 77% of the 2975 infants who had femur fractures. After adjustment for patient characteristics, injury severity, and year of admission, hospitals varied significantly in use of screening for occult fractures in all 3 groups of children. The observed variation in screening for occult fractures in young victims of physical abuse and infants who have injuries associated with a high likelihood of abuse underscores opportunities to improve the quality of care provided to this vulnerable population.

Modified transperitoneal laparoscopic radical prostatectomy : clinical study of 285 cases

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 285 patients received the operation with mean age of 67 years (50-76 years) from January 2008 to April 2012.Mean level of PSA was 15.7 μg/L (1.8 -50.0 μg/L),and mean prostatic volume was 44 ml (26 -74 ml). No lymph node or seminal vesicle involvement was found by CT or MR and radionuclide bone scan revealed no metastasis.271 cases were confirmed diagnosis by prostatic biopsy and 14 were detected through pathological studies of TURP specimens.Gleason score ranged from 6 to 8.14 cases were in clinical stage T1b,29 cases in T1c,214 cases in T2 and 28 cases in T3a.Transperitoneal approach and modified technique involving bladder neck dissection,nervesparing technique and vesicoureteral anastomosis were applied on patients. Results Mean operative time was 105 min (55 -150 min).Mean intraoperative estimated blood loss was 240 ml (50-800 ml).Rectal injures occurred in 2 cases and were repaired under laparoscopy.Drainage tube and urinary catheter were removed 48 -72 h and 5 -8 d postoperatively.Postoperative hospital stay was 7 d (5 - 11 d).Positive surgical margin was present in 58 patients.Mean follow-up time was 29 months (3 -50 months).Complete continence were found in 208 patients immediately after catheter removal.68 patient recovered continence within 3 months and 9 patients remained incontinence 3 months after surgery. Normal erection presented in 42 of the 57 cases with nerve-sparing. Conclusions Transperitoneal laparoscopic radical prostatectomy is safe and efficient.Higher efficiency and lower complication rate have been achieved through modified laparoscopic technique involving bladder neck dissection,nerve-sparing technique and vesicoureteral anastomosis. Key words: Prostatic neoplasms; Laparoscopy; Transperitoneal approach; Radical prostatectomy

Response in bone turnover markers during therapy predicts overall survival in patients with metastatic prostate cancer: analysis of three clinical trials.

Background:The bone-forming metastases of prostate cancer result from complex stromal–epithelial interactions within the tumour microenvironment. Autocrine–paracrine signalling pathways between prostate cancer epithelial cells, osteoblasts, and osteoclasts stimulate aberrant bone remodelling, and the activity of these three cell populations can be quantitatively measured using prostate-specific antigen (PSA), bone-specific alkaline phosphatase (BAP) and urine N-telopeptide (uNTx), respectively. The purpose of the present study was to test the hypothesis that serial measurements of BAP and uNTx during therapy would facilitate monitoring of disease activity and predict the overall survival (OS) in patients with metastatic prostate cancer receiving therapy.Methods:Radionuclide bone scan, PSA, BAP, and uNTx data were retrospectively analysed from three clinical trials in patients with metastatic prostate cancer conducted at our institution. Qualitative changes in bone scans and quantitative changes in PSA, BAP, and uNTx concentrations during therapy were correlated with OS.Results:Baseline levels of BAP, but not PSA, were prognostic for OS in both androgen-dependent and castrate-resistant disease. A reduction in PSA, BAP, uNTx, or BAP/uNTx on therapy was predictive of improved OS in both patient groups. Conversely, an increase in PSA, or BAP on therapy was predictive of worse OS in both patient groups. Baseline number of lesions and response on bone scan during therapy were neither prognostic nor predictive of OS in either patient group.Conclusion:These observations support the concept that serial measurements of bone turnover metabolites during therapy function as clinically informative predictive biomarkers in patients with advanced prostate cancer and skeletal metastases. PSA measurements and bone scans remain essential to monitor the overall disease activity and determine the anatomic distribution of skeletal metastases.

Influence of whole-body vibration on biodistribution of the radiopharmaceutical [99mTc]methylene diphosphonate in Wistar rats

Purpose: The radionuclide bone scan is the basis of skeletal nuclear medicine imaging. Bone scintigraphy is a highly sensitive method for indicating disease in bone. Mechanical stimulation in the manner of whole-body vibration (WBV) appears beneficial to the maintenance and/or enhancement of skeletal mass in individuals. The aim of this work was to evaluate the effect of WBV on the biodistribution of the radiopharmaceutical [99mTc]methylene diphosphonate (99mTc-MDP ) in Wistar rats.Materials and methods: In the biodistribution analysis, animals were anesthetized with sodium thiopental, the radiopharmaceutical 99mTc-MDP was administered via ocular plexus and after 10 min the animals were submitted to vibration of 20 Hz (1 min) in an oscillatory platform. Following, the animals were sacrificed, the organs were isolated, the radioactivity determined in a well counter, and the percentages of radioactivity per gram (%ATI/g) in the organs were calculated. An unpaired t-test following Welch test (p < 0.05) was done for statistical analysis of the results.Results: The biodistribution was significantly (p < 0.05) decreased in kidney, bone, lung, stomach, prostate and bowel.Conclusion: The analysis of the results indicates that the vibration could produce metabolic alterations with influence in the uptake of the radiopharmaceutical 99mTc-MDP in bone, stomach, bowel, prostate, kidney and bladder.

Steroid Induced Bilateral Femoral Head Avascular Necrosis in a Patient of Minimal Change Glomerulonephritis: Detection by Radionuclide Bone Scan

One of the commonest causes of avascular necrosis of bones in patients with renal transplants are glucocorticoids. Early detection and management of this complication is crucial to the progression and prevention of collapse of femoral heads. In the early diagnosis of avascular necrosis radionuclide bone scintigraphy provides an useful information on the aetiology of the painful hip before changes appear on X ray examination. We present a case of proved glomerulonephritis taking glucocorticoids with difficulty in walking and pain around hip joints. A planar whole body and a SPECT Technetium 99-m (Tc99-m) bone scans were done which revealed avascular necrosis of both femoral heads. JMS 2012;15(1):61-64.

Letters to Editor Isolated metastasis to the foot as an extremely rare presenting feature of primary endometrial cancer. and review of the literature

Letters to Editor Isolated metastasis to the foot as an extremely rare presenting feature of primary endometrial cancer. and review of the literature