Fentanyl nasal spray for the treatment of cancer pain

Introduction: Breakthrough pain, a transitory flare of pain in patients with otherwise controlled chronic pain, has been well characterized in cancer patients but despite medical awareness, sometimes remains underdiagnosed and therefore undertreated. Areas covered: Oral transmucosal fentanyl citrate (OTFC) and fentanyl buccal tablets are the first medications developed specifically for the treatment of breakthrough pain in opioid-tolerant patients. Since oral administration of fentanyl is not an option for many cancer patients, the development of intranasal fentanyl spray (INFS) emerged as a more effective method of administration. Intranasal administration of fentanyl has several advantages over the oral/gastrointestinal route and clinical trials have shown that it is superior to OTFC while being well tolerated and more acceptable by the majority of patients. Expert opinion: The aim of this review is to summarize the pharmacological characteristics and data obtained from clinical studies of INFS in the past few years, and present Fentanyl Pectin Nasal Spray (PecFent), which uses an innovative delivery system and is now approved in the EU. Finally, we discuss the impact that it may have in the future management of breakthrough pain in cancer patients, because an accurate diagnosis followed by the best treatment is crucial for effective pain alleviation. © Informa UK, Ltd

MR appearance of pelvic hemangiopericytoma

A case of pelvic hemangiopericytoma in a 59-year-old woman is reported. The MR imaging features are presented. The tumor was unresectable and the patient received postoperative irradiation of 4200 cGy on the pelvis. One year after diagnosis, metastasis to a lumbar vertebra was discovered and additional irradiation of 3900 cGy was applied. One year later CT showed control of the pelvic turner and its metastasis

Retroperitoneal mucinous cystadenoma

A case of retroperitoneal mucinous cystadenoma histologically confirmed in a 21-year-old woman is reported. Although ultrasound, CT and MR detected the tumor, a preoperative diagnosis could not be established by imaging methods. The cystic tumor was removed and microscopic examination revealed a mucinous cystadenoma, Mullerian mesothelial metaplasia of peritoneal invagination into the retroperitoneal space is the most likely explanation for the histogenesis of these tumors. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved

POSTTRAUMATIC HEMOBILIA

Four patients with post-traumatic hemobilia were evaluated with arteriography over a 2 year period. In two patients hemobilia was of iatrogenic origin; in particular, one case appeared after a cholecystectomy, and the other was due to placement of a biliary stent with an endoscope. In the other two patients hemobilia was the result of a gun injury. Arteriography of the hepatic arterial system demonstrated two false aneurysms, extravasation of contrast medium through the biliary system in one patient and arterioportal fistula in another patient. It is concluded that arteriograpy of the hepatic arterial system is the method of choice for the evaluation and the possible treatment of patients with hemobilia

Plain X-ray, computed tomography and magnetic resonance imaging findings of telangiectatic osteosarcoma: A case report

An 18-year-old male patient presented with chronic nonspecific pain of three months located at his left proximal tibia. The patient was admitted to our department for plain X-ray, computed tomography and magnetic resonance imaging examination. Plain X-ray and computed tomography revealed a geographic lytic lesion at the medial aspect of the proximal tibia. Biopsy of the lesion showed telangiectatic osteosarcoma. Image findings of all modalities are presented. © 2009 Skiadas et al.; licensee Cases Network Ltd

ARTERIOVENOUS MALFORMATION OF THE SPINAL-CORD MIMICKING A TUMOR

We report an arteriovenous malformation of the spinal cord mimicking a tumour on plain radiographs of the spine

Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury

Enlargement of the optic nerve sheath has been described in patients with raised intracranial pressure (ICP), thereby serving as one of its indicators. Optic nerve sonography offers rapid bedside assessment of the optic nerve sheath diameter and has recently been introduced for the noninvasive detection of raised ICP, particularly in patients with severe brain injury. This review explains the pathophysiology of optic nerve sheath enlargement as a result of intracranial hypertension, describes the technique and clinical use of optic nerve sonography, and summarises the studies which have tested this modality in the non-invasive evaluation of ICP

Degenerative endplate changes of the lumbosacral spine: Dynamic contrast-enhanced MRI profiles related to age, sex, and spinal level

Purpose To investigate differences in perfusion profiles between degenerative endplate marrow changes and normal vertebral marrow in relation to spinal level, age, and sex with dynamic contrast-enhanced magnetic resonance imaging (DCE MRI). Materials and Methods Ninety-two consecutive patients referred for evaluation of low back pain or sciatica, without history of malignant or chronic disease, underwent conventional and DCE MRI of the lumbosacral spine. Fifty-two of them demonstrated degenerative endplate marrow changes. Regions of interest were placed on sites of normal marrow (group A) and degenerative changes (group B) on subtracted images. Fitted time-intensity curves (fTICs) were generated and evaluated for curve pattern. Both groups were stratified into upper (L1-L2) and lower (L3-I1) levels, males and females younger or older than 50 years. Perfusion parameters were calculated and statistically compared for both groups and subgroups. Receiver operator curve (ROC) analysis was also performed. Results Two fTIC patterns were identified. Perfusion parameters of degenerative changes and normal marrow differed significantly, even when groups were stratified for spinal level, age, and sex (P < 0.05). A time to peak value >108 seconds was characteristic for degenerative changes with sensitivity 69.5% and specificity 84.6%. Conclusion DCE MRI profiles of degenerative endplate marrow changes of the lumbosacral spine differ significantly from normal marrow regardless of spinal level, age, or sex. Copyright © 2011 Wiley-Liss, Inc