Normal bone turnover markers in a patient with active Paget’s disease of bone: response to treatment with zoledronic acid

Celem leczenia choroby kości Pageta (PDB) jest zahamowanie zwiększonego obrotu kostnego. Obecnie lekami z wyboru są bisfosfoniany. Do wskazań do stosowania leków antyresorpcyjnych u pacjentów z objawowa postacią PDB należą: bóle kostne i stawowe, powikłania neurologiczne, planowany zabieg chirurgiczny w rejonie aktywnych zmian chorobowych i hiperkalcemia spowodowana unieruchomieniem. Celem terapii antyresorpcyjnej jest uzyskanie poprawy stanu klinicznego i remisji biochemicznej, ocenianej na podstawie normalizacji stężeń biomarkerów obrotu kostnego. Przed podjęciem decyzji o wdrożeniu terapii u chorych w późnej, sklerotycznej fazie choroby (burned out) należy wziąć pod uwagę pogorszenie stanu klinicznego, a zwłaszcza występowanie bólów kostnych. U tych chorych duże znaczenie ma badanie scyntygraficzne kości, ponieważ może ono uwidocznić zwiększoną aktywność osteoblastyczną, której mogą nie wykazać markery obrotu kostnego. W niniejszej pracy przedstawiono przypadek chorego w późnym, sklerotycznym stadium PDB, u którego występowały nasilone objawy kliniczne, lecz stężenia markerów obrotu kostnego były prawidłowe. Po leczeniu kwasem zoledronowym nastąpiła istotna poprawa kliniczna.The treatment of Paget’s disease of bone (PDB) aims at the suppression of abnormal bone turnover; bisphosphonates are currently the treatment of choice. Indications for antiresorptive treatment in symptomatic patients with PDB include bone or joint pain, neurological complications, surgery planned at an active pagetic site and hypercalcaemia from immobilisation. The goals of antiresorptive treatment are clinical improvement and biochemical remission, as assessed by the normalisation of bone turnover markers. Clinical deterioration, especially bone pain, should be considered before deciding to treat patients with late sclerotic (burned-out) PDB. Bone scintigraphy may be of importance in these patients, because it depicts increased osteoblastic activity, when bone markers may not. We present a case of late sclerotic PDB with clinical deterioration but normal bone turnover markers, who experienced significant clinical improvement after treatment with zoledronic acid

Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection:Results of a Large Retrospective Multicenter Study

Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI

EXPERIMENTALLY INDUCED MUSCULAR ATROPHY IN RATS AND STUDY OF THE MORPHOLOGICAL, ELECTROPHYSIOLOGICAL AND HISTOCHEMICAL CHANGES IN THE DEVELOPING AND ADULT ANIMALS

THE AIM OF THIS STUDY IS THE INVESTIGATION OF THE EFFECTS OF THE MUSCULAR DISUSE ON THE MORPHOLOGICAL, HISTOCHEMICAL AND FUNCTIONAL PROPERTIES OF THE SOLEUS AND EXTENSOL DIGITORUM LONGUS MUSCLES OF THE DEVELOPING AND ADULT RAT. MUSCULAR ATROPHY WAS ESTIMATED BY MUSCLE WEIGHING AND MORPHOMETRICAL ANALYSIS. MUSCLE-HISTOCHEMISTRY WAS STUDIED USING ATPASE STAINING. MUSCULAR FUNCTION WAS STUDIED BY MEANS OF ISOTONIC AND ISOMETRIC CONTRACTIONS. THE FINDINGS OF THIS STUDY LEAD TO THE FOLLOWING CONCLUSIONS : A) IMMOBILIZATION PRODUCED DISUSE RESULTS IN MUSCULAR ATROPHY IN THE ADULT MUSCLE AND SLOWING OF THE GROWTH RATE IN THE DEVELOPING MUSCLE. B) MUSCULAR ATROPHY IS MORE PROMINENT IN TYPE I FIBRES AND IN THE SLOW SOLEUS MUSCLE IN BOTH YOUNG AND ADULT ANIMALS. C) FUNCTIONAL AND HISTOCHEMICAL CHANGES IN THE SLOW SOLEUS MUSCLE LEAD IN A "SPEEDING UP". THE FAST EXTENSOR DIGITORUM LONGUS MUSCLE REMAINS FUNCTIONALLY AND HISTOCHEMICALLY CONSTANT BOTH IN YOUNG AND ADULT ANIMALS. D) DISUSE OF THE MUSCLE DURING THE EARLY STAGES OF POSTNATAL DEVELOPMENT CAN NOT INHIBIT ITS MATURATION BUT CONTROLS ITS GROWTH RATE. THIS CONCLUSION INDIRECTLY SUPPORTS THEIDEA THAT THE INTEGRITY OF THE NEUROMUSCULAR AXIS DETERMINES THE MUSCULAR POSTNATAL DIFFERENTIATION.ΜΕΛΕΤΗΘΗΚΕ Η ΕΠΙΔΡΑΣΗ ΤΗΣ ΑΝΕΝΕΡΓΗΣΙΑΣ ΑΠΟ ΑΚΙΝΗΤΟΠΟΙΗΣΗ ΣΤΙΣ ΜΟΡΦΟΛΟΓΙΚΕΣ, ΙΣΤΟΧΗΜΙΚΕΣ ΚΑΙ ΛΕΙΤΟΥΡΓΙΚΕΣ ΙΔΙΟΤΗΤΕΣ ΤΟΥ ΑΝΑΠΤΥΣΣΟΜΕΝΟΥ ΚΑΙ ΤΟΥ ΕΝΗΛΙΚΟΥ ΥΠΟΚΝΗΜΙΔΙΟΥ ΚΑΙ ΜΑΚΡΟΥ ΕΚΤΕΙΝΟΝΤΟΣ ΤΟΥΣ ΔΑΚΤΥΛΟΥΣ ΜΥΩΝ ΤΟΥ ΕΠΙΜΥΟΣ. Η ΑΤΡΟΦΙΑ ΕΚΤΙΜΗΘΗΚΕ ΜΕ ΖΥΓΙΣΗ ΤΩΝ ΜΥΩΝ ΚΑΙ ΜΟΡΦΟΜΕΤΡΙΚΗ ΑΝΑΛΥΣΗ ΙΣΤΟΛΟΓΙΚΩΝ ΤΟΜΩΝ. Η ΙΣΤΟΧΗΜΕΙΑ ΤΩΝ ΣΥΣΤΑΛΤΩΝ ΠΡΩΤΕΙΝΩΝ ΜΕΛΕΤΗΘΗΚΕ ΜΕ ΧΡΩΣΗ ΤΟΜΩΝ ΓΙΑ ΤΟ ΕΝΖΥΜΟ ΜΥΟΣΙΝΗ-ΑΤΡ-ΑΣΗ. Η ΛΕΙΤΟΥΡΓΙΚΟΤΗΤΑ ΤΩΝ ΜΥΩΝ ΜΕΛΕΤΗΘΗΚΕ ΜΕ ΚΑΤΑΓΡΑΦΕΣ ΙΣΟΤΟΝΙΚΗΣ ΚΑΙ ΙΣΟΜΕΤΡΙΚΗΣ ΣΥΣΤΟΛΗΣ. ΑΠΟ ΤΑ ΕΥΡΗΜΑΤΑ ΤΗΣ ΕΡΓΑΣΙΑΣ, ΠΡΟΚΥΠΤΟΥΝ ΤΑ ΕΞΗΣ ΣΥΜΠΕΡΑΣΜΑΤΑ: Α) Η ΑΝΕΝΕΡΓΗΣΙΑ ΑΠΟ ΑΚΙΝΗΤΟΠΟΙΗΣΗ ΠΡΟΚΑΛΕΙ ΑΤΡΟΦΙΑ ΤΩΝ ΜΥΩΝ ΤΩΝ ΕΝΗΛΙΚΩΝ ΠΕΙΡΑΜΑΤΟΖΩΩΝ ΚΑΙ ΕΠΙΒΡΑΔΥΝΣΗ ΤΗΣ ΑΝΑΠΤΥΞΗΣ ΤΩΝ ΑΝΑΠΤΥΣΣΟΜΕΝΩΝ ΜΥΩΝ, Β) Η ΑΤΡΟΦΙΑ ΕΙΝΑΙ ΕΜΦΑΝΕΣΤΕΡΗ ΣΤΙΣ ΙΝΕΣ ΤΥΠΟΥ Ι ΚΑΙ ΣΤΟΝ ΥΠΟΚΝΗΜΙΔΙΟ ΜΥ, ΑΝΕΞΑΡΤΗΤΩΣ ΗΛΙΚΙΑΣ. Γ) ΟΙ ΙΣΤΟΧΗΜΙΚΕΣ ΚΑΙ ΛΕΙΤΟΥΡΓΙΚΕΣ ΜΕΤΑΒΟΛΕΣ ΣΤΟΝ ΥΠΟΚΝΗΜΙΔΙΟ ΜΥ, ΑΣΧΕΤΩΣ ΗΛΙΚΙΑΣ, ΟΔΗΓΟΥΝ ΣΕ "ΕΠΙΤΑΧΥΝΣΗ", ΤΟΥ. Ο ΜΑΚΡΟΣ ΕΚΤΕΙΝΩΝ ΤΟΥΣ ΔΑΚΤΥΛΟΥΣ ΣΕ ΚΑΘΕ ΗΛΙΚΙΑ ΕΜΦΑΝΙΖΕΙ ΛΕΙΤΟΥΡΓΙΚΗ ΚΑΙ ΙΣΤΟΧΗΜΙΚΗ ΣΤΑΘΕΡΟΤΗΤΑ, Δ) Η ΑΝΕΝΕΡΓΗΣΙΑ ΣΕ ΠΡΩΙΜΑ ΣΤΑΔΙΑ ΔΕΝ ΑΝΑΣΤΕΛΛΕΙ ΤΗΝ ΕΞΕΛΙΞΗ ΤΟΥ ΜΥΟΣ ΠΡΟΣ ΤΗΝ ΩΡΙΜΟΤΗΤΑ ΑΛΛΑ ΕΛΕΓΧΕΙ ΤΗΝ ΠΟΣΟΤΙΚΗ ΤΟΥ ΑΝΑΠΤΥΞΗ. ΥΠΟΣΤΗΡΙΖΕΤΑΙ ΕΜΜΕΣΑ Η ΣΗΜΑΣΙΑ ΤΟΥ ΝΕΥΡΟΜΥΙΚΟΥ ΑΞΟΝΑ ΩΣ ΚΑΘΟΡΙΣΤΟΥ ΤΗΣ ΜΕΤΑΓΕΝΝΗΤΙΚΗΣ ΔΙΑΦΟΡΟΠΟΙΗΣΕΩΣ ΤΟΥ ΜΥΟΣ

18F-FDG PET/CT in treatment response evaluation of Burkitt lymphoma: complete remission of a peritoneal super scan.

Peritoneal lymphomatosis, defined as the disseminated intraperitoneal lymphomatous infiltration, is a rare presentation usually of non-Hodgkin lymphoma and is associated with aggressive histological subtypes of the malignancy. Recently, the term "peritoneal super scan" has been introduced in positron emission tomography/computed tomography (PET/CT) in a patient with Burkitt lymphoma to describe hypermetabolic lymphomatous involvement of the entire peritoneum, leading to suppression of tracer uptake in organs with otherwise normally increased fluorine-18-fluorodeoxyglucose (18F-FDG) uptake. Herein, we report on a patient with Burkitt lymphoma, initially presenting with a peritoneal super scan in PET/CT demonstrating complete metabolic response to R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) therapy

Long-Term Outcomes of Lymph Node Transfer in Secondary Lymphedema and Its Correlation with Flap Characteristics

Background: This retrospective study aimed to assess the impact of certain flap characteristics on long-term outcomes following microsurgical treatment in Breast Cancer-Related Lymphedema (BCRL) patients. Methods: Sixty-four out of 65 BCRL patients, guided by the “Selected Lymph Node” (“SeLyN”) technique, underwent Vascularized Lymph Node Transfer (VLNT) between 2012 and 2018. According to their surface size, flaps were divided into small (2, n = 32) and large (>25 cm2, n = 32). Twelve large and six small flaps were combined with free abdominally based breast reconstruction procedures. Lymphedema stage, flap size, vascular pedicle and number of lymph nodes (LNs) were analyzed in correlation with long-term Volume Differential Reduction (VDR). Results: At 36-month follow-up, no major complication was recorded in 64 cases; one flap failure was excluded from the study. Mean flap size was 27.4 cm2, mean LNs/flap 3.3 and mean VDR 55.7%. Small and large flaps had 2.8 vs. 3.8 LNs/flap (p = 0.001), resulting in 49.6% vs. 61.8% VDR (p = 0.032), respectively. Lymphedema stage and vascular pedicle (SIEA or SCIA/SCIP) had no significant impact on VDR. Conclusion: In our series, larger flaps included a higher number of functional LNs, directly associated with better outcomes as quantified by improved VDR

Diagnostic Value of 18F-FDG-PET/CT in Patients with FUO

Conventional diagnostic imaging is often ineffective in revealing the underlying cause in a considerable proportion of patients with fever of unknown origin (FUO). The aim of this study was to assess the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with FUO. We retrospectively reviewed 18F-FDG-PET/CT scans performed on 50 consecutive adult patients referred to our department for further investigation of classic FUO. Final diagnosis was based on histopathological and microbiological findings, clinical criteria, or clinical follow-up. Final diagnosis was established in 39/50 (78%) of the patients. The cause of FUO was infection in 20/50 (40%), noninfectious inflammatory diseases in 11/50 (22%), and malignancy in 8/50 (16%) patients. Fever remained unexplained in 11/50 (22%) patients. 18F-FDG-PET/CT scan substantially contributed to the diagnosis in 70% of the patients, either by identifying the underlying cause of FUO or by directing to the most appropriate site for biopsy. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 18F-FDG-PET/CT for active disease detection in patients with FUO were 94.7%, 50.0%, 84.0%, 85.7%, and 75.0%, respectively. In conclusion, whole-body 18F-FDG-PET/CT is a highly sensitive method for detection of the underlining cause of FUO or for correctly targeting suspicious lesions for further evaluation

Dual-Energy X-Ray Absorptiometry and Quantitative Ultrasound in Patients With Paget's Disease of Bone Before and After Treatment With Zoledronic Acid: Association With Serum Bone Markers and Dickkopf-1

The main aim of this study was to determine the effect of zoledronic acid (ZOL) on parameters of dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) in unaffected bones of patients with Paget’s disease of bone (PDB). The secondary aim was the association of bone markers and Dickkopf (DKK)-1 with parameters of DXA and QUS. Ten consecutive patients with polyostotic PDB (median age: 63 yr) received a single 5-mg ZOL infusion. The patients were subjected to calcaneal QUS and DXA of both lumbar spine (LS) and femoral neck (FN). Blood samples for serum bone markers and DKK-1 were serially obtained for 12 mo. There was a significant increase in LS (p = 0.005) and FN bone mineral density (BMD) (p = 0.021) 12 mo after ZOL infusion. QUS parameters remained unaffected throughout the study. A significant correlation between broadband ultrasound attenuation and DKK-1 (p < 0.001) and between speed of sound and DKK-1 (p = 0.033) at baseline was found, which remained significant after adjustment for gender, age, and body mass index. Our data suggest that a single ZOL infusion significantly increases nonpagetic BMD 12 mo after treatment but has no effect on QUS parameters or DKK-1. Significant correlations were observed between QUS parameters and DICK-1 at baseline