Paget's disease, also known as osteitis deformans, is characterized by rapid bone remodeling and the formation of bone that is structurally abnormal. Men are affected twice as often as women. The disease is uncommon in persons of African and Asian descent. The majority of patients with Paget's disease are usually asymptomatic, although the most frequent symptom is pain. This paper aims to present a rare case of Paget's disease in a local setting and to present the scintigraphic features of Paget's disease in correlation with other diagnostic modalities. This is a case of a 69-year-old female with a history of low back pain and difficulty in walking of one month duration. CT scan showed sclerotic changes in the right pelvic bone probably degenerative or infectious in nature, however, neoplastic process is not totally ruled out. Bone scan showed an osteoblastic lesion in the right hemipelvis. Considerations include Paget's disease and metastasis (in the presence of a primary neoplastic lesion). The alkaline phosphatase was elevated. An open bone biopsy of the right pelvis was done. Histopathologic report showed prominent cement lines with numerous large osteoclasts. This was signed-out as Paget's disease of the bone. Paget's disease is rare in the Philippines. Our case illustrated a common clinical feature of the disease seen in an elderly patient presenting with bone pain, elevated alkaline phosphatase value, and associated with cortical thickening and sclerosis of the right pelvis on radiolograph and osteoblastic lesion on bone scan.

Human ; Male ; Female ; Aged ; Alkaline Phosphatase ; Biopsy ; Bone Remodeling ; Low Back Pain ; Osteitis Deformans ; Osteoclasts ; Pelvic Bones ; Pelvis ; Philippines ; Sclerosis ; Tomography, X-ray Computed ; Walking

Bone metastases in differentiated thyroid carcinoma occur in 3-5%of patients. When present, overall 10-year survival rate drops to 13-21%. Although rarely curative, radioactive iodine therapy for bone metastases has been found to improve survival especially in patients younger than 45 years of age. This study aims to investigate the diagnostic circumstances and influence of age on the outcome of patients with bone metastases from differentiated thyroid carcinoma recently managed in one institution. Between November 2001 and October 2007, 21 patients were managed for bone metastases from differentiated thyroid carcinoma. A review of medical records was performed. Of 21 patients, 7 patients were less than or equal to 45 years of age (35.29 plus minus 8.16 years), and were classified as group 1 (stage II "low risk", WHO classification). The rest, 14 patients, were greater than or equal to 45 years old (63.14 plus minus 7.73 years and formed group 2 (stage IV, "high risk", WHO classification). Complete and partial remission was more frequently noted with group I (5 of 7 or 71.4% of patients) than with group II (6 of 14 or 42.9% of patients). Although remission can be observed in both age groups, patients younger than 45 years old at the diagnosis of bone metastases show a better response to therapy.
Human ; Male ; Female ; THYROID NEOPLASMS

This is a case report of a 65-year-old female with lumbar vertebral lesions secondary to an unknown primary malignancy. 99mTc-methylene diphosphonate bone scintigraphy showed multiple bone metastases as well as focal extraosseous uptake in the area above the right supraclavicular area. Further imaging with SPECT/CT localized the calcified extraosseous uptake to the right thyroid bed. These findings narrowed down the primary malignancy to a thyroidal origin, which was eventually proven as such through immunohistologic studies of the lumbar lesions. Different pathophysiologic mechanisms of extraosseous uptake in bone scintigraphy and how SPECT/CT can increase the diagnostic value of a standard nuclear medicine procedure are highlighted in this paper.

Human ; Female ; Aged ; Thyroid Neoplasms ; Thyroid cancer, papillary ; Tomography, Emission-Computed, Single-Photon ; Low Back Pain

This is a case report of a 51-year-old female diagnosed with papillary microcarcinoma of the thyroid gland after undergoing total thyroidectomy. A 99mTc pertechnetate thyroid scan was done before radioiodine ablation therapy. It showed cervical neck lymph nodes taking up the radiotracer. Another scan after ablation therapy showed the same nodes taking up the therapeutic iodine131. The paper discusses using 99mTc pertechnetate to detect thyroid cancer metastases.
Human ; Female ; Middle Aged ; THYROID NEOPLASMS ; NEOPLASMS ; NEOPLASMS BY SITE ; ENDOCRINE GLAND NEOPLASMS

This is a case of a 66-year-old, Filipina, who presented with persistent proteinuria diagnosed with renal amyloidosis. In the presented case, the equivocal cardiac and incidental extracardiac findings in the Tc-99m pyrophosphate (Tc-99m PYP) scan aided in the diagnosis of primary systemic light chain amyloidosis (AL amyloidosis). Tc-99m PYP scan with single photon emission computed tomography (SPECT) is currently used as a non-invasive imaging modality to diagnose Transthyretin amyloidosis (ATTR amyloidosis) however its role in diagnosing AL amyloidosis is not well documented. The case highlights its role in detecting extracardiac amyloid burden and suggests possible biopsy sites. The researchers recommend an additional whole-body planar scan with possible SPECT/CT on the 3rd hour delay to survey other areas with possible amyloid protein deposit.
Philippines

The use of high- or low-dose radio-iodine therapy (RAIT) for initial thyroid remnant ablation in post-thyroidectomised patients diagnosed with differentiated thyroid cancer (DTC) with no distant metastases has long been a subject of much debate. Meta-analyses and systematic reviews have been previously made using both randomised control trials (RCTs) and observational studies without due regard to differences in study design. Hence, amore focused meta-analysis of available RCTs alone was conducted to determine the presence of a compelling difference between the initial remnant ablation success rates of high- and low-dose RAIT in post-thyroidectomised DTC patient without distant demtastases. An extensive search of PubMed and Cochrane Central register of RCTs (up to August 2013) was performed by two reviewers, which was completed by hand search of referencesfrom releveangt articles and review papers published from 1996 to 2012. The two reviewers independtly selected eligible studies, with disagreement resolved by consensus. The inclusion criteria were as follows: (a) randomised controlled trials, (b) post-thyroidectomised adult subjects diagnosed with well differentiated thyroid cancer and no evidence of distant metastases, and (c) subject randomisation into 30-50 mCi or 100 mCi 131I treatment groups. Studies were exluded if (a) the full text of the study is not available, (b) the study is in another language other than English, and (c) if the data on relative risk was not available or could not be derived from the study. Of eight published RCTs on radio-iodine therapy as of August 2013, only 5 were eligible for this meta-analysis; namely those by JOhansen et al. (1991), Bal et al. (1996), Zaman et al. (2006), Maenpaa et al. (2008) and Caglar et al. (2012). The same two reviewers independenty extracted data from the full text of the selected five studies. Two-by-two tables comparing frequencies of successful and failed remnant ablation using low-dose (30-60 mCi) and high-dise (100 mCi) RAIT were derived from the published results of the included studies, and the weighted and pooled relative risks for successful remnant ablation were computed via the Mantel-Haenszel method using a fixed effects model (cx = 5%). Subgroup analyses were performed based on different definitions of a successful remnant ablation. The pooled relative risk (-0.03) was statistically insignificant (p=0.54) and had poor precision (95% confidence interval of {-0.12,0.06}) even when adjustments to the varied definitions of a successful ablation were performed. Thus, using available RCTs that compare high- and low-dose RAIT for remnant ablation of DTC, there is an apparent trend favoring higher success rates using high-dose RAIT. However, the lack of well designed RCTs precludes recommending high-dose initial RAI ablation, and encourages the present practice of individualized.
Meta-Analysis ; Thyroid Neoplasms ; Iodine Radioisotopes

Background: Parathyroid carcinoma is an uncommon, aggressive, endocrine malignant neoplasm and subsequent parathyroidectomy of such cases may lead to the life-threatening hypocalcemic condition called Hungry Bone Syndrome. We present a very rare case of parathyroid carcinoma with concomitant thyroid microcarcinoma with Hungry Bone Syndrome as its sequalae. Case Presentation: A 54/F initially presenting with hypogastric pain was showed to have nephrolithiasis. Subsequent Endocrinology referral revealed hypercalcemia and osteoporosis – and with a working impression of hypercalcemia secondary to a parathyroid adenoma. Sestamibi parathyroid scan showed persistently avid uptake in the left thyroid lobe highly suspicious for a parathyroid adenoma, but a concomitant thyroid nodule was not ruled out. Bone scan showed intense and diffuse tracer uptake in the skull and irregular tracer activity in the ribs, suggestive of metabolic bone disease, with no evidence of metastatic-looking bone lesions. She underwent left thyroid lobectomy with isthmusectomy and Sestamibi-guided left parathyroidectomy. Histopathology report showed a parathyroid gland carcinoma with papillary thyroid microcarcinoma. Two weeks post-surgery, hypocalcemic signs developed and ionized calcium was low. Hungry Bone Syndrome was considered and was treated with calcium gluconate and Zoledronic acid. Conclusion Nuclear imaging techniques and radioguided surgery are helpful in the diagnosis and management of both parathyroid and thyroid lesions – especially in difficult cases.
Parathyroid Neoplasms

Introduction: COVID-19 emerged as a new disease during the early period of 2020. Given that our institution is a cardiac specialty center and our patients have numerous co-morbidities compared to the general population, we wanted to determine the clinical profiles and in-hospital short-term outcomes of suspect, probable and confirmed adult COVID-19 patients seen at our institution. Methodology: We prospectively enrolled 323 adult (115 health care workers) suspect, probable and confirmed COVID- 19 patients admitted from March to June 2020. We described and analyzed their clinical presentation, and in-hospital outcomes. Results: There were 117 (36.22%) RT-PCR positive patients with 36.53% confirmed, 13.00% probable and 50.46% suspect patients. For probable and confirmed patients, 25%, 21.25%, 23.13% 16.25% had no, mild, moderate, and severe symptoms, respectively with 14.28% critical cases. Over-all mortality rate for probable and confirmed cases was 25.54% with 91.3% mortality rate for critical cases. Co-morbidities with statistically significant association with severity of disease were as follows: hypertension, heart disease, cerebrovascular disease, diabetes mellitus and COPD. Conclusion During the early period of the COVID-19 pandemic, only 36.53% of cases admitted at our institution were COVID-19 confirmed by RT-PCR. One-third of the cases were severe and critical, with more clinical instability, increased inflammatory markers, and higher in-hospital morbidity and mortality.
COVID-19 ; Pandemics ; Philippines

Introduction: Among older populations, osteoarthritis (OA) is one of the most common chronic joint disorders and is a leading cause of disability, while osteoporosis is the most common metabolic bone disease, conferring fragility and significant risk of fracture. The relationship between OA and osteoporosis remains controversial. Although earlier studies reported an inverse association between the two diseases, more recent literature found a complex relationship mediated by various factors. Objective: The investigators sought to determine the association of osteoporosis with radiologic grading of the hip among older Filipino patients with suspected hip osteoarthritis. Methodology: A cross-sectional analytical study was conducted involving 256 patients with suspected hip OA who underwent radiography of the hips and central dual energy x-ray absorptiometry (DXA). Radiographs of the hips were evaluated by a radiologist using the Kellgren-Lawrence (KL) grading scale, while central DXA images were processed and evaluated by a nuclear medicine physician using the World Health Organization criteria for the diagnosis of osteoporosis and the 2019 International Society for Clinical Densitometry guidelines. The primary outcome measures were the prevalence of osteoporosis in patients with suspected hip OA, and the association of osteoporosis with radiologic KL grading of the hips. The secondary outcome measure was the association of osteoporosis with sex and BMI. Results: The study found that osteoporosis was present in 136 (53.1%) of the 256 patients who all presented with radiologic evidence of hip OA. There was a positive association between the presence of osteoporosis and the radiologic grade of hip OA (p-value: 0.006 on the right hip and 0.036 on the left). Osteoporosis was more prevalent in women compared to men (p-value: 0.031). Likewise, osteoporosis had a direct relationship with BMI (p-value: <0.001). Conclusion Osteoporosis was prevalent in a significant proportion of older Filipino patients with clinical and radiologic evidence of hip OA, particularly among women, and was positively associated with increasing severity of OA. The study suggests that obesity may not necessarily protect against osteoporosis in this population, possibly relating to increased adiposity and decreased lean muscle mass.
Osteoporosis ; Osteoarthritis ; Osteoarthritis, Hip ; Absorptiometry, Photon

INTRODUCTION AND OBJECTIVES: Differences in ethnicity and geographical factors may have an effect in the characteristics of the prostate in men. To date, there is no demographical data regarding the average prostate volume among Filipino males stratified per age. METHODS: Retrospectively collected data from 3568 consecutive patients who had an ultrasound of the prostate from January 1, 2015 to December 31, 2016. Age and prostate volume by ultrasound were collected. Patients who had previous prostate surgery were excluded, and for uniformity of results, only patients who underwent transabdominal prostate ultrasound were included. RESULTS: Patients were stratified into the following age groups: 29 and below, 30 to 39, 40 to 49, 50 to 59, 60 to 69, 70 to 79, and 80 and above, and present results showed that the mean values of prostate volume were 15.8 ± SD 5.4, 19.6 ± SD 5.7, 22.1 ± SD 7.3, 28.0 ± SD 11.0, 34.0 ± SD 17.9, 39.6 ± SD 28.13, 39.2 ± SD 23.3, respectively. CONCLUSION The mean prostate volume among Filipino males increases with age and the threshold for an enlarged prostate might need an adjustment in dealing with Filipino patients.