Metastatic bone disease is a major sequela of several malignancies, such as the prostate, breast, lung, kidney and thyroid. Bone pain is a common symptom in advancing malignancy and often determines the quality of life in the later stages of disease. Management of bone pain from metastasis remains palliative at present. With the improved cancer survival resulting from advances in cancer management, the population of patients seeking relief of bone pain has increased. Radiopharmaceutical therapy offers potential pain relief with minimal adverse effects. This is a case report on the clinical utility of strontium-89 chloride for the palliation of bone pain in metastatic prostate cancer. A 67-year-old male presented with bone pain due to disseminated bone metastases form prostate cancer, most intense in the lower back (Visual Analogue Scale pain score of 8). Strontium-89 chloride was administered intravenously at a dose of 148 MBq (4mCi). There was a transient, moderate, tolerable pain flare (Visual Analogue Scale pain score of 4) within the first week of treatment, which was relieved by oral opioid analgesics. He was pain-free thereafter (Visual Analogue Scale pain score of 0). Reversible bone marrow suppression was also observed a few weeks after the treatment.

Human ; Male ; Aged ; .analgesics, Opioid ; Radiopharmaceuticals ; Strontium Chloride ; Strontium ; Thyroid Gland ; Bone Marrow ; Quality Of Life ; Visual Analog Scale ; Prostatic Neoplasms ; Bone Neoplasms ; Pain Management

Diabetes mellitus is a major risk factor for cardiovascular disease. Diabetics often have asymptomatic coronary artery disease that is less amenable to favorable interventional treatment compared with the non-diabetic population. Myocardial perfusion scintigraphy [MPS] is used widely to evaluate patients with suspected or known coronary artery disease. Prognosis and management can be assessed after the evaluation of coronary arteries and overall left ventricular systolic function. This study aimed to evaluate the role of MPS in the prediction of cardiac events in patients with diabetes mellitus. A prospective study was done on diabetic patients who underwent MPS in 2007. Patients were followed for at least 18 months after MPS. The occurrence of major and minor cardiac events was determined. A total of 149 patients were included in the study. Of the 114 patients with normal MPS findings only one patient had a minor cardiac event while the rest [99.1 %] had no events. On the other hand, of the 35 patients with abnormal findings, two [5.7%] patients had major cardiac events while 25 [71.4%] had minor cardiac events. The risk of developing a major cardiac event in patients with abnormal MPS is 4.4 times higher compared to those with normal MPS. The risk of developing a minor cardiac event in patients with abnormal MPS is 9.3 times higher compared to those with normal MPS. Myocardial perfusion imaging has a very high negative predictive value for any cardiac [99.1 %], minor cardiac [99.1 %], and major cardiac events [100%]. Diabetics with normal MPS findings have a very good prognosis.
Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; MYOCARDIAL PERFUSION IMAGING ; CARDIAC IMAGING TECHNIQUES ; DIABETES MELLITUS ; GLUCOSE METABOLISM DISORDERS

Metastatic bone disease is a major sequela of several malignancies, such as the prostate, breast, lung, kidney and thyroid. Bone pain is a common symptom in advancing malignancy and often determines the quality of life in the later stages of disease. Management of bone pain from metastasis remains palliative at present. With the improved cancer survival resulting from advances in cancer management, the population of patients seeking relief of bone pain has increased. Radiopharmaceutical therapy offers potential pain relief with minimal adverse effects. This is a case report on the clinical utility of strontium-89 chloride for the palliation of bone pain in metastatic prostate cancer. A 67-year-old male presented with bone pain due to disseminated bone metastases form prostate cancer, most intense in the lower back (Visual Analogue Scale pain score of 8). Strontium-89 chloride was administered intravenously at a dose of 148 MBq (4mCi). There was a transient, moderate, tolerable pain flare (Visual Analogue Scale pain score of 4) within the first week of treatment, which was relieved by oral opioid analgesics. He was pain-free thereafter (Visual Analogue Scale pain score of 0). Reversible bone marrow suppression was also observed a few weeks after the treatment.

Human ; Male ; Aged ; .analgesics, Opioid ; Radiopharmaceuticals ; Strontium Chloride ; Strontium ; Thyroid Gland ; Bone Marrow ; Quality Of Life ; Visual Analog Scale ; Prostatic Neoplasms ; Bone Neoplasms ; Pain Management

PURPOSE: We evaluated hemodynamic significance of stenosis on magnetic resonance angiography (MRA) using acetazolamide perfusion single photon emission computed tomography (SPECT). MATERIALS AND METHODS: Of 171 patients, stenosis in internal carotid artery (ICA) and middle cerebral artery (MCA) (ICA-MCA) on MRA and cerebrovascular reserve (CVR) of MCA territory on SPECT was measured using quantification and a 3-grade system. Stenosis and CVR grades were compared with each other, and their prognostic value for subsequent stroke was evaluated. RESULTS: Of 342 ICA-MCA, 151 (44%) presented stenosis on MRA; grade 1 in 69 (20%) and grade 2 in 82 (24%) cases. Decreased CVR was observed in 9% of grade 0 stenosis, 25% of grade 1, and 35% of grade 2. The average CVR of grade 0 was significantly different from grade 1 (p<0.001) and grade 2 stenosis (p=0.007). In quantitative analysis, average CVR index was -0.56+/-7.91 in grade 0, -1.81+/-6.66 in grade 1 and -1.18+/-5.88 in grade 2 stenosis. Agreement between stenosis and CVR grades was fair in patients with lateralizing and non-lateralizing symptoms (kappa=0.230 and 0.346). Of the factors tested, both MRA and CVR were not significant prognostic factors (p=0.104 and 0.988, respectively), whereas hypertension and renal disease were significant factors (p<0.05, respectively). CONCLUSION: A considerable proportion of ICA-MCA stenosis detected on MRA does not cause CVR impairment despite a fair correlation between them. Thus, hemodynamic state needs to be assessed for evaluating significance of stenosis, particularly in asymptomatic patients.
*Acetazolamide ; Adult ; Aged ; Aged, 80 and over ; Brain/blood supply/radionuclide imaging ; Carotid Artery, Internal/physiopathology/radionuclide imaging ; Carotid Stenosis/physiopathology/*radionuclide imaging ; *Cerebrovascular Circulation ; Constriction, Pathologic ; Diuretics ; Female ; *Hemodynamics ; Humans ; Hypertension/physiopathology ; Iodine Radioisotopes ; *Magnetic Resonance Angiography ; Male ; Middle Aged ; *Radiopharmaceuticals ; Tomography, Emission-Computed, Single-Photon/*methods