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Sample records for bone pain secondary

  1. Recurrent Upper Quadrant Pain: A Fish Bone Secondary to Gastric Perforation and Liver Abscess

    Directory of Open Access Journals (Sweden)

    Hui Liang

    2011-12-01

    Full Text Available A 60-year-old male patient was admitted to our hospital for recurrent upper quadrant pain for 1 month. He had a past history of coronary artery disease. After admission, he repeatedly suffered from high-grade fever, chills and upper quadrant pain. Computed tomography (CT showed a round hypodense mass in the left lobe of the liver, approximately 2.7 × 2.2 cm in size, and a fish bone was confirmed by surgery in the left lobe of liver. The patient was cured completely after surgical removal of the fish bone and liver abscess. CT scan 1 month after discharge showed that the liver abscess had disappeared completely.

  2. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma.

    Science.gov (United States)

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-06-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma. PMID:27504302

  3. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma.

    Science.gov (United States)

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-06-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma.

  4. Vitamin D -prevalence, mortality and bone pain

    DEFF Research Database (Denmark)

    Durup, Darshana Tiffany

    2013-01-01

    Bone pain is a common and debilitating symptom of many metabolic bone diseases. However, almost nothing is known about the molecular and cellular mechanisms leading to bone pain and the pain states are poorly characterized. It is well-established that osteomalacia due to severe vitamin D deficiency...... of this thesis was to determine the prevalence of vitamin D insufficiency and deficiency and its impact on mortality. Furthermore, a multidisciplinary and translational study was carried out to investigate the effects of disturbed calcified tissue on the nervous system. Thus, quantification and characterization...... of the pain syndrome in patients with vitamin D deficiency and bone pain. Furtherme, development of a non-cancer animal model of bone pain, was carried out, to enable investigations of bone pain threshold, bone microenvironment and endocrinology parameters involved in this debilitating disease. A unique...

  5. Acidic microenvironment and bone pain in cancer-colonized bone

    OpenAIRE

    Yoneda, Toshiyuki; Hiasa, Masahiro; Nagata, Yuki; Okui, Tatsuo; White, Fletcher A.

    2015-01-01

    Solid cancers and hematologic cancers frequently colonize bone and induce skeletal-related complications. Bone pain is one of the most common complications associated with cancer colonization in bone and a major cause of increased morbidity and diminished quality of life, leading to poor survival in cancer patients. Although the mechanisms responsible for cancer-associated bone pain (CABP) are poorly understood, it is likely that complex interactions among cancer cells, bone cells and periphe...

  6. Pain and Paget's Disease of Bone

    Science.gov (United States)

    ... Home Paget’s Disease of Bone Paget’s Disease Management Pain and Paget’s Disease of Bone Publication available in: ... focus(); */ } //--> Print-Friendly Page May 2015 Types of Pain Paget’s disease can cause several different kinds of ...

  7. Acupuncture for cancer-induced bone pain?

    OpenAIRE

    Mark I Johnson; Bennett, Michael I; Paley, Carole A.

    2011-01-01

    Bone pain is the most common type of pain in cancer. Bony metastases are common in advanced cancers, particularly in multiple myeloma, breast, prostate or lung cancer. Current pain-relieving strategies include the use of opioid-based analgesia, bisphosphonates and radiotherapy. Although patients experience some pain relief, these interventions may produce unacceptable side-effects which inevitably affect the quality of life. Acupuncture may represent a potentially valuable adjunct to existing...

  8. Multiple spontaneous bone infarcts secondary to alcohol abuse

    International Nuclear Information System (INIS)

    Alcohol induced spontaneous osteonecrosis is part of the differential diagnosis in patients with history of alcohol abuse and diffuse bone pain. Usually patients have a longer than 10 year history of alcohol abuse prior to the development of osteonecrosis. The femoral head is the commonest site involved, however, involvement of the long bones is also seen. Facial involvement is rarely seen. Fat embolism secondary to coexisting hyperlipidemia has been postulated as a possible cause of osteonecrosis in alcoholics. A case of multifocal spontaneous bone infarction with facial bone involvement in a 34 year old female alcoholic is described. Copyright (1999) The Australian and New Zealand Society of Nuclear Medicine Inc

  9. Radiotherapy for pain management of bone metastases

    International Nuclear Information System (INIS)

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  10. Radiotherapy for pain management of bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Rezende Junior, Ismar de; Mattos, Marcos Duarte de; Nakamura, Ricardo; Lemes Junior, Joaquim; Vanzelli, Talita Lozano, E-mail: rezende.med@terra.com.br [Radioterapia do Hospital de Cancer de Barretos, SP (Brazil)

    2011-07-01

    Purpose: This is the first Brazilian study intended to evaluate the response of pain relief with radiotherapy in three different fractionation and the clinical differences in managing pain in patients with painful bone metastases. Methods: Prospective study of patients with painful bone metastases referred to the Radiotherapy Sector of the Hospital de Cancer de Barretos for pain-relieving radiotherapy between March and December 2010. It is known that radiotherapy seems to alter the activation of osteoclast-mediated bone resorption, relieving pain in cases of painful bone metastases. Patients were assessed in relation to the status of pain intensity before and after the initiation of radiotherapy. Either a single fraction of 8Gy, five fractions of 4Gy or ten fractions of 3Gy were given. A visual analog scale (VAS) was applied by doctors, nurses and nursing technicians to assess pain intensity at each session of radiotherapy, and follow-up at 8, 30 and 90 days from the end of treatment. Results: We evaluated 92 consecutive patients, 48 male and 44 female, with a median age of 58 years. We found that 14% of patients referred from the Palliative Care or Clinical Oncology sectors need better pharmacological analgesia due to severe pain, compared with 40.5% of patients from the other sectors (p = 0.004). We also found that the onset of pain relief to patients receiving 10 fractions of 300cGy analgesia without changing the pre-radiotherapy analgesia occurred with significance after the fifth fraction. Improvement in pain experienced within 90 days of follow-up was found in eighty percent of patients, independent of fractionated radiotherapy, site of metastases and the clinical condition of the patient. Discussion/Conclusion: The Palliative Care and Clinical Oncology sectors expressed greater concern in regards to analgesia for the patient with painful bone metastases. Radiotherapy is an effective pain-relieving treatment in different fractionation studied, even though the

  11. Acupuncture for Cancer-Induced Bone Pain?

    Directory of Open Access Journals (Sweden)

    Carole A. Paley

    2011-01-01

    Full Text Available Bone pain is the most common type of pain in cancer. Bony metastases are common in advanced cancers, particularly in multiple myeloma, breast, prostate or lung cancer. Current pain-relieving strategies include the use of opioid-based analgesia, bisphosphonates and radiotherapy. Although patients experience some pain relief, these interventions may produce unacceptable side-effects which inevitably affect the quality of life. Acupuncture may represent a potentially valuable adjunct to existing strategies for pain relief and it is known to be relatively free of harmful side-effects. Although acupuncture is used in palliative care settings for all types of cancer pain the evidence-base is sparse and inconclusive and there is very little evidence to show its effectiveness in relieving cancer-induced bone pain (CIBP. The aim of this critical review is to consider the known physiological effects of acupuncture and discuss these in the context of the pathophysiology of malignant bone pain. The aim of future research should be to produce an effective protocol for treating CIBP with acupuncture based on a sound, evidence-based rationale. The physiological mechanisms presented in this review suggest that this is a realistic objective.

  12. Chondroblastoma with secondary aneurysmal bone cyst of the capitate.

    Science.gov (United States)

    Sato, Eiichi; Ichikawa, Jiro; Ando, Takashi; Sato, Nobutaka; Kawasaki, Tomonori; Haro, Hirotaka

    2014-05-01

    Chondroblastoma is a benign tumor that typically arises in the epiphysis of a long bone. There have been only 2 reported cases of chondroblastoma involving the capitate. This is the first report of chondroblastoma with secondary aneurysmal bone cyst involving the capitate. A 33-year-old man presented with a 3-year history of pain and swelling of the right wrist. Radiography as well as computed tomography showed a radiolucent area and no matrix calcification within the capitate. Magnetic resonance imaging revealed a homogeneous signal that was low on T1-weighted images and high on T2-weighted images and showed only slight enhancement. On the basis of imaging findings, the authors chose excisional biopsy. The bone tumor in the capitate was explored through a dorsal approach by dividing the extensor tendons. After repeated curettages, bone graft substitute using allograft bone was packed into the capitate. Histologically, the authors diagnosed this tumor as a chondroblastoma with a secondary aneurysmal bone cyst. At the final 2-year follow-up, there was evidence of bone union, full range of motion, and recovery and no evidence of recurrence. Although the recurrence of chondroblastoma is occasionally reported, the principal treatment is intralesional curettage and bone graft. High-speed burring, phenol, bone cement, and cryosurgery have been reported to reduce local recurrence. Complete excision of the carpal bone seems to be overtreatment.

  13. Chondroblastoma with secondary aneurysmal bone cyst of the capitate.

    Science.gov (United States)

    Sato, Eiichi; Ichikawa, Jiro; Ando, Takashi; Sato, Nobutaka; Kawasaki, Tomonori; Haro, Hirotaka

    2014-05-01

    Chondroblastoma is a benign tumor that typically arises in the epiphysis of a long bone. There have been only 2 reported cases of chondroblastoma involving the capitate. This is the first report of chondroblastoma with secondary aneurysmal bone cyst involving the capitate. A 33-year-old man presented with a 3-year history of pain and swelling of the right wrist. Radiography as well as computed tomography showed a radiolucent area and no matrix calcification within the capitate. Magnetic resonance imaging revealed a homogeneous signal that was low on T1-weighted images and high on T2-weighted images and showed only slight enhancement. On the basis of imaging findings, the authors chose excisional biopsy. The bone tumor in the capitate was explored through a dorsal approach by dividing the extensor tendons. After repeated curettages, bone graft substitute using allograft bone was packed into the capitate. Histologically, the authors diagnosed this tumor as a chondroblastoma with a secondary aneurysmal bone cyst. At the final 2-year follow-up, there was evidence of bone union, full range of motion, and recovery and no evidence of recurrence. Although the recurrence of chondroblastoma is occasionally reported, the principal treatment is intralesional curettage and bone graft. High-speed burring, phenol, bone cement, and cryosurgery have been reported to reduce local recurrence. Complete excision of the carpal bone seems to be overtreatment. PMID:24810829

  14. Unexplained Bone Pain Is an Independent Risk Factor for Bone Metastases in Newly Diagnosed Prostate Cancer

    DEFF Research Database (Denmark)

    Zacho, Helle D; Mørch, Carsten D; Barsi, Tamás;

    2016-01-01

    OBJECTIVE: To determine the relationship between bone pain and bone metastases in newly diagnosed prostate cancer. PATIENTS AND METHODS: This prospective study of bone scintigraphy enrolled 567 consecutive patients with newly diagnosed prostate cancer. The presence of all-cause bone pain, known b...

  15. Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma

    OpenAIRE

    Barman, Sandip; Diwaker, Preeti; Bansal, Divya; Wadhwa, Neelam; Singh, Gurvinder

    2016-01-01

    Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date.

  16. The child with bone pain: malignancies and mimickers

    OpenAIRE

    McCarville, M. Beth

    2009-01-01

    Abstract Bone pain in children is common. The cause may be as benign as growing pains or as life-threatening as a malignancy. When a cause cannot be established by laboratory tests, physical examination or patient history, imaging of the affected body part is often obtained. Distinguishing benign from malignant processes involving the bones of children, based on imaging findings, can be challenging. The most common benign conditions that mimic pediatric bone tumors on imaging are Langerhan's ...

  17. Bone pain induced by metastatic cancer: pathophysiology and treatment

    International Nuclear Information System (INIS)

    Cancer patients who develop bone metastases are an estimated 60 to 84% . Of these 79% experienced pain syndromes are difficult to manage, of which 50% die without adequate pain relief and with a poor quality of life. Therefore, it is necessary to have accessible and effective medications for the management of this condition. The pathophysiology of pain in bone is reviewed and the drugs used most frequently in the management of this type of cancer pain are described. Furthermore an algorithm of 6 steps is presented and can guide the physician when making a therapeutic decision. (author)

  18. Radionuclide therapy of patients with metastastic bone pain

    International Nuclear Information System (INIS)

    Bone metastases are often the first sign of distant spread in breast, prostate, and lung cancers. The pathophysiology of bone metastasis is poorly understood and related complications is complex. Bone pain consequent to metastatic cancer continues to be a major therapeutic challenge for clinicians and its alleviation is crucial to improving the patient's quality of life. Targeted radionuclide therapy is an effective and cost efficient treatment for multi-site metastatic bone pain, its advantages may also include therapy for subclinical micro-or oligometastatic disease before clinical manifestation. But radionuclides remain underutilized in such treatments. (authors)

  19. The efficacy analysis of yunke for the treatment of bone pain in secondary osteoporosis due to rheumatoid arthritis%99锝-亚甲基二膦酸盐治疗类风湿关节炎继发骨质疏松骨痛的疗效分析

    Institute of Scientific and Technical Information of China (English)

    库尔班江; 木亚赛尔; 武丽君

    2011-01-01

    目的 观察99锝-亚甲基二磷酸盐注射液(商品名称:云克)治疗类风湿关节炎( Rheumatoid arthritis,RA)继发骨质疏松骨痛的临床疗效 方法 52例RA继发骨质疏松骨痛的患者给予云克治疗,所有病例用药前及用药15天后根据WHO疼痛分级标准和评定方法进行评定 结果 52例接受云克治疗的患者中骨痛完全缓解15例,部分缓解23例,轻度缓解9例,无效5例,疼痛有效率为90.3%.疼痛VAS评分用药前6.89、用药后5.1 结论 经正规治疗,病情相对稳定的类风湿关节炎患者,补足钙剂及维生素D3后,仍有全身酸痛不适,骨密度提示骨质疏松患者加用云克效果更为理想.%Objective To observe the clinical efficacy of yunke ( methylene diphosphonate, MDP) for the treatment of bone pain in secondary osteoporosis due to rheumatoid arthritis. Methods All 52 secondary osteoporotic patients with bone pain were treated with MDP. Pain before and 15 days after the medicine use in all cases was evaluated according to the WHO standard pain classification. Results The complete remission of bone pain happened in 15 cases among the 52 patients treated with MDP. Partial remission happened in 23 cases, slight remission in 9 cases, and no remission in 5 cases. The effective rate of relieving pain was 90. 3%. The VAS scores were 6. 89 before medicine use and 5. 1 after medicine use. Conclusion The relative stable rheumatoid arthritis patients can still feel pain in whole body after regular treatment and enough supplement of calcium and vitamin D. Bone mineral density measurement indicates that MDP is a more ideal treatment for osteoporotic patients.

  20. Validation of symptom clusters in patients with metastatic bone pain

    OpenAIRE

    Hadi, S.; Zhang, L.; Hird, A.; Sa, E.; Chow, E.

    2008-01-01

    Purpose Symptom clusters (scs) are a dynamic construct. They consist of at least 2 or 3 interrelated symptoms that may be a significant predictor of patient morbidity. In a previous study, we identified 2 scs in patients with bone metastases: An activity-related interference cluster A psychology-related interference cluster These scs may be clinically important in the pain and symptom management of patients with metastatic bone pain. It is therefore important to validate the reported scs to d...

  1. Pain During Bone Marrow Aspiration: Prevalence and Prevention

    NARCIS (Netherlands)

    Vanhelleputte, P.; Nijs, K.A.N.D.; Delforge, M.; Evers, G.; Vanderschueren, S.

    2003-01-01

    The Prevalence, intensity, determinants and prevention of pain during bone marrow aspiration (BMA) in adults are not well defined. In the first part of this prospective study (observational phase), 132 adult hematological patients undergoing BMA after local anesthesia scored the procedural pain by m

  2. Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome

    OpenAIRE

    Naslund, J; Odenbring, S; Naslund, U; Lundeberg, T.

    2005-01-01

    Objectives: Painful disorders of the patellofemoral joint are one of the most frequent complaints in orthopaedic and sports medicine. The aims of this study were to determine whether bone scintigrams of patients suffering from patellofemoral pain syndrome (PFPS) show diffuse uptake and in what bony compartment of the knee uptake, if any, was localised.

  3. The role of radioisotopes for the palliation of bone pain from bone metastases

    Institute of Scientific and Technical Information of China (English)

    YANG Ji-gang; LI Chun-lin

    2006-01-01

    Bone metastasis occurs as a result of a complex pathophysiologic process between host and tumor cells leading to cellular invasion, migration adhesion, and stimulation of osteoclastic and osteoblastic activity. Several sequences occur as a result of osseous metastases and resulting bone pain can lead to significant debilitation. Pain associated with osseous metastasis is thought to be distinct from neuropathic or inflammatory pain. Several mechanisms, such as invasion of tumor cells, spinal cord astrogliosis,and sensitization of nervous system, have been postulated to cause pain. Pharmaceutical therapy of bone pain includes nonsteroidal analgesics and opiates. These drags are associated with side effects, and tolerance to these agents necessitates treatment with other modalities. Bisphosphonates act by inhibiting osteoclast-mediated resorption and have been increasingly used in treatment of painful bone metastasis. While external beam radiation therapy remains the mainstay of pain palliation of solitary lesions, bone-seeking radiopharmaceuticals have entered the therapeutic armamentarium for the treatment of multiple painful osseous lesions. 32p has been used for over 3 decades in the treatment of multiple osseous metastases. The myelosuppression caused by this agent has led to the development of other bone-seeking radiopharmaceuticals, including 89SrCl, and 153Sm-ethylenediaminetetramethylene phosphonic acid (153Sm-EDTMP). 89Sr is a bone-seeking radionuclide, whereas 153Sm-EDTMP is a bone-seeking tetraphosphonate; both have been approved by the Food and Drug Administration for the treatment of painful osseous metastases. While both agents have been shown to have efficacy in the treatment of painful osseous metastases from prostate cancer, they may also have utility in the treatment of painful osseous metastases from breast cancer and perhaps from non-small cell lung cancer. This article illustrates the salient features of these radiopharmaceuticals, including the

  4. Secondary aneurysmal bone cyst following chondroblastoma of the patella

    Directory of Open Access Journals (Sweden)

    Tomoyuki Kato

    2013-09-01

    Full Text Available Aneurysmal bone cyst (ABC is a rare benign cystic lesion of the bone that composes 1-2% of the entire bone tumors. Some are idiopathic, and some occur secondary to other tumors such as giant cell tumor and chondroblastoma. In this article, we report the clinical, radiographic, and histological findings of a secondary ABC following chondroblastoma of the patella with a review of the literature.

  5. Secondary aneurysmal bone cyst following chondroblastoma of the patella

    OpenAIRE

    Tomoyuki Kato; Michiro Susa; Robert Nakayama; Itsuo Watanabe; Keisuke Horiuchi; Yoshiaki Toyama; Hideo Morioka

    2013-01-01

    Aneurysmal bone cyst (ABC) is a rare benign cystic lesion of the bone that composes 1-2% of the entire bone tumors. Some are idiopathic, and some occur secondary to other tumors such as giant cell tumor and chondroblastoma. In this article, we report the clinical, radiographic, and histological findings of a secondary ABC following chondroblastoma of the patella with a review of the literature.

  6. Secondary aneurysmal bone cyst following chondroblastoma of the patella.

    Science.gov (United States)

    Tomoyuki, Kato; Susa, Michiro; Nakayama, Robert; Watanabe, Itsuo; Horiuchi, Keisuke; Toyama, Yoshiaki; Morioka, Hideo

    2013-01-01

    Aneurysmal bone cyst (ABC) is a rare benign cystic lesion of the bone that composes 1-2% of the entire bone tumors. Some are idiopathic, and some occur secondary to other tumors such as giant cell tumor and chondroblastoma. In this article, we report the clinical, radiographic, and histological findings of a secondary ABC following chondroblastoma of the patella with a review of the literature.

  7. New Mechanism of Bone Cancer Pain: Tumor Tissue-Derived Endogenous Formaldehyde Induced Bone Cancer Pain via TRPV1 Activation.

    Science.gov (United States)

    Wan, You

    2016-01-01

    In recent years, our serial investigations focused on the role of cancer cells-derived endogenous formaldehyde in bone cancer pain. We found that cancer cells produced formaldehyde through demethylation process by serine hydroxymethyltransferase (SHMT1 and SHMT2) and lysine-specific histone demethylase 1 (LSD1). When the cancer cells metastasized into bone marrow, the elevated endogenous formaldehyde induced bone cancer pain through activation on the transient receptor potential vanilloid subfamily member 1 (TRPV1) in the peripheral nerve fibers. More interestingly, TRPV1 expressions in the peripheral fibers were upregulated by the local insulin-like growth factor I (IGF-I) produced by the activated osteoblasts. In conclusion, tumor tissue-derived endogenous formaldehyde induced bone cancer pain via TRPV1 activation. PMID:26900062

  8. Secondary infertility caused by the retention of fetal bones after an abortion: a case report

    Directory of Open Access Journals (Sweden)

    Kramer Hannah MC

    2008-06-01

    Full Text Available Abstract Introduction Unwanted contraception through prolonged retention of fetal bone is a rare cause of secondary infertility. It is usually associated with a history of abortion, either spontaneous or induced. Case presentation We describe a case of intrauterine retention of fetal bone diagnosed 8 years after the termination of a pregnancy. The patient had no complaints of pain, irregular vaginal bleeding or discharge. A hysteroscopy was performed and irregular structures were removed. These fragments were fetal bones, which probably functioned as an intrauterine contraceptive device. After removal of the fetal bone fragments the patient conceived spontaneously within 6 months. Conclusion This case report stresses the importance of taking a thorough history and evaluation of the endometrium by transvaginal ultrasound or hysteroscopy in women with secondary infertility.

  9. The Physiology of Bone Pain. How Much Do We Really Know?

    Science.gov (United States)

    Nencini, Sara; Ivanusic, Jason J

    2016-01-01

    Pain is associated with most bony pathologies. Clinical and experimental observations suggest that bone pain can be derived from noxious stimulation of the periosteum or bone marrow. Sensory neurons are known to innervate the periosteum and marrow cavity, and most of these have a morphology and molecular phenotype consistent with a role in nociception. However, little is known about the physiology of these neurons, and therefore information about mechanisms that generate and maintain bone pain is lacking. The periosteum has received greater attention relative to the bone marrow, reflecting the easier access of the periosteum for experimental assessment. With the electrophysiological preparations used, investigators have been able to record from single periosteal units in isolation, and there is a lot of information available about how they respond to different stimuli, including those that are noxious. In contrast, preparations used to study sensory neurons that innervate the bone marrow have been limited to recording multi-unit activity in whole nerves, and whilst they clearly report responses to noxious stimulation, it is not possible to define responses for single sensory neurons that innervate the bone marrow. There is only limited evidence that peripheral sensory neurons that innervate bone can be sensitized or that they can be activated by multiple stimulus types, and at present this only exists in part for periosteal units. In the central nervous system, it is clear that spinal dorsal horn neurons can be activated by noxious stimuli applied to bone. Some can be sensitized under pathological conditions and may contribute in part to secondary or referred pain associated with bony pathology. Activity related to stimulation of sensory nerves that innervate bone has also been reported in neurons of the spinoparabrachial pathway and the somatosensory cortices, both known for roles in coding information about pain. Whilst these provide some clues as to the way

  10. The physiology of bone pain. How much do we really know?

    Directory of Open Access Journals (Sweden)

    Sara eNencini

    2016-04-01

    Full Text Available Pain is associated with most bony pathologies. Clinical and experimental observations suggest that bone pain can be derived from noxious stimulation of the periosteum or bone marrow. Sensory neurons are known to innervate the periosteum and marrow cavity, and most of these have a morphology and molecular phenotype consistent with a role in nociception. However, little is known about the physiology of these neurons, and therefore information about mechanisms that generate and maintain bone pain is lacking. The periosteum has received greater attention relative to the bone marrow, reflecting the easier access of the periosteum for experimental assessment. With the electrophysiological preparations used, investigators have been able to record from single periosteal units in isolation, and there is a lot of information available about how they respond to different stimuli, including those that are noxious. In contrast, preparations used to study sensory neurons that innervate the bone marrow have been limited to recording multi-unit activity in whole nerves, and whilst they clearly report responses to noxious stimulation, it is not possible to define responses for single sensory neurons that innervate the bone marrow. There is only limited evidence that peripheral sensory neurons that innervate bone can be sensitized or that they can be activated by multiple stimulus types, and at present this only exists in part for periosteal units. In the central nervous system, it is clear that spinal dorsal horn neurons can be activated by noxious stimuli applied to bone. Some can be sensitized under pathological conditions and may contribute in part to secondary or refered pain associated with bony pathology. Activity related to stimulation of sensory nerves that innervate bone has also been reported in neurons of the spinoparabrachial pathway and the somatosensory cortices, both known for roles in coding information about pain. Whilst these provide some clues

  11. Efficacy of Radiotherapy for Painful Bone Metastases During the Last 12 Weeks of Life

    NARCIS (Netherlands)

    Meeuse, Jan J.; van der Linden, Yvette M.; van Tienhoven, Geertjan; Gans, Rijk O. B.; Leer, Jan Willem H.; Reyners, An K. L.

    2010-01-01

    BACKGROUND: Radiotherapy is an effective treatment for painful bone metastases. Whether this applies also in patients with limited survival remains to be investigated. This study analyzed the effect of radiotherapy for painful bone metastases in patients with a survival

  12. Re-evaluation of bone pain in patients with type 1 Gaucher disease suggests that bone crises occur in small bones as well as long bones.

    Science.gov (United States)

    Baris, Hagit N; Weisz Hubshman, Monika; Bar-Sever, Zvi; Kornreich, Liora; Shkalim Zemer, Vered; Cohen, Ian J

    2016-09-01

    Bone crises in type 1 Gaucher disease are reported in long bones and occasionally in weight bearing bones and other bones, but rarely in small bones of the hands and feet. We retrospectively examined the incidence of bone pain in patients followed at the Rabin Medical Center, Israel, before and following the initiation of enzyme replacement therapy (ERT) and evaluated them for bone crises. Of 100 type I Gaucher disease patients, 30 (30%) experienced one or more bone crises. Small bone crises represented 31.5% of all bone crises and were always preceded by crises in other bones. While the incidence of long bone crises reduced after the initiation of ERT, small bone crises increased. Almost 60% of patients with bone crises were of the N370S/84GG genotype suggesting a greater susceptibility of N370S/84GG patients to severe bone complications. These patients also underwent the greatest number of splenectomies (70.6% of splenectomised patients). Splenectomised patients showed a trend towards increased long and small bone crises after surgery. Active investigation of acute pain in the hands and feet in patients in our cohort has revealed a high incidence of small bone crises. Physicians should consider imaging studies to investigate unexplained pain in these areas. PMID:26051481

  13. Calcaneal chondroblastoma with secondary aneurysmal bone cyst: a case report.

    Science.gov (United States)

    Guedes, Alex; Barreto, Bruno; Soares Barreto, Lara Grimaldi; Athanazio, Daniel A; Athanazio, Paulo R F

    2010-01-01

    We present a case of destructive chondroblastoma associated with secondary aneurysmal bone cyst involving the left calcaneus. Because of the extensive destruction of the calcaneus, total calcanectomy was the treatment of choice. PMID:20350821

  14. Calcaneal chondroblastoma with secondary aneurysmal bone cyst: a case report.

    Science.gov (United States)

    Guedes, Alex; Barreto, Bruno; Soares Barreto, Lara Grimaldi; Athanazio, Daniel A; Athanazio, Paulo R F

    2010-01-01

    We present a case of destructive chondroblastoma associated with secondary aneurysmal bone cyst involving the left calcaneus. Because of the extensive destruction of the calcaneus, total calcanectomy was the treatment of choice.

  15. Incidence of pain flare following palliative radiotherapy for symptomatic bone metastases: multicenter prospective observational study

    OpenAIRE

    Gomez-Iturriaga, Alfonso; Cacicedo, Jon; Navarro, Arturo; Morillo, Virginia; Willisch, Patricia; Carvajal, Claudia; Hortelano, Eduardo; Lopez-Guerra, Jose Luis; Illescas, Ana; Casquero, Francisco; del Hoyo, Olga; Ciervide, Raquel; Irasarri, Ana; Pijoan, Jose Ignacio; Bilbao, Pedro

    2015-01-01

    Background Palliative radiotherapy (RT) is an effective treatment for symptomatic bone metastases. Pain flare, a transient worsening of the bone pain after RT, has been described in previous reports with different incidence rates. The aim of the study was to prospectively evaluate the incidence of pain flare following RT for painful bone metastases and evaluate its effects on pain control and functionality of the patients. Methods Between June 2010 and June 2014, 204 patients were enrolled in...

  16. Cementoplasty for managing painful bone metastases outside the spine

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Gang; Jin, Peng; Liu, Xun-wei; Li, Min; Li, Li [Jinan Military General Hospital, Department of Medical Imaging, Jinan, Shandong Province (China)

    2014-03-15

    To illustrate the effect of treatment with cementoplasty in patients with painful bone metastases in the extraspinal region. A retrospective study was conducted to review 51 consecutive patients who underwent cementoplasty under CT or fluoroscopic guidance, a total of 65 lesions involving the ilium, ischium, pubis, acetabulum, humeral, femur and tibia. In 5 patients with a high risk of impending fracture in long bones based on Mirels' scoring system, an innovative technique using a cement-filled catheter was applied. The clinical effects were evaluated using the visual analogue scale (VAS) preoperatively and postoperatively. All patients were treated successfully with a satisfying resolution of painful symptoms at 3 months' follow-up. Cement leakage was found in 8 lesions without any symptoms. VAS scores decreased from 8.19 ± 1.1 preoperatively to 4.94 ± 1.6 at 3 days, 3.41 ± 2.1 at 1 month and 3.02 ± 1.9 at 3 months postoperatively. There was a significant difference between the mean preoperative baseline score and the mean score at all of the postoperative follow-up points (P < 0.01). Cementoplasty is an effective technique for treating painful bone metastases in extraspinal regions, which is a valuable, minimally invasive, method that allows reduction of pain and improvement of patients' quality of life. (orig.)

  17. Dexamethasone for the prevention of a pain flare after palliative radiotherapy for painful bone metastases: a multicenter double-blind placebo-controlled randomized trial

    International Nuclear Information System (INIS)

    Radiotherapy has a good effect in palliation of painful bone metastases, with a pain response rate of more than 60%. However, shortly after treatment, in approximately 40% of patients a temporary pain flare occurs, which is defined as a two-point increase of the worst pain score on an 11-point rating scale compared to baseline, without a decrease in analgesic intake, or a 25% increase in analgesic intake without a decrease in worst pain score, compared to baseline. A pain flare has a negative impact on daily functioning and mood of patients. It is thought to be caused by periostial edema after radiotherapy. Dexamethasone might diminish this edema and thereby reduce the incidence of pain flare. Two non-randomized studies suggest that dexamethasone reduces the incidence of a pain flare by 50%. The aim of this trial is to study the effectiveness of dexamethasone to prevent a pain flare after palliative radiotherapy for painful bone metastases and to determine the optimal dose schedule. This study is a three-armed, double-blind, placebo-controlled multicenter trial. We aim to include 411 patients with uncomplicated painful bone metastases from any type of primary solid tumor who receive short schedule radiotherapy (all conventional treatment schedules from one to six fractions). Arm 1 consists of daily placebo for four days, arm 2 starts with 8 mg dexamethasone before the (first) radiotherapy and three days placebo thereafter. Arm 3 consists of four days 8 mg dexamethasone. The primary endpoint is the occurrence of a pain flare. Secondary endpoints are pain, quality of life and side-effects of dexamethasone versus placebo. Patients complete a questionnaire (Brief Pain Inventory with two added questions about side-effects of medication, the EORTC QLQ-C15-PAL and QLQ-BM22 for quality of life) at baseline, daily for two weeks and lastly at four weeks. This study will show whether dexamethasone is effective in preventing a pain flare after palliative radiotherapy for

  18. Recurrent acute low back pain secondary to lumbar epidural calcification

    International Nuclear Information System (INIS)

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  19. Recurrent acute low back pain secondary to lumbar epidural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  20. Spinal cord compression secondary to bone metastases from hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Dinesh Chandra Doval; Komal Bhatia; Ashok Kumar Vaid; Keechelat Pavithran; Jai Bhagwan Sharma; Digant Hazarika; Amarnath Jena

    2006-01-01

    Bone metastases are rare in primary hepatocellular carcinoma (HCC). Spinal cord compression (SCC) due to bone metastases occur commonly in patients with lung and breast carcinomas, and metastatic HCC is an unusual cause of SCC. Spinal cord compression is an oncologic emergency and treatment delays can lead to irreversible consequences. Thus, the awareness that SCC could be a potential complication of bone metastases due to HCC is of significance in initiation of early treatment that can improve the quality of life and survival of the patients, if diagnosed earlier. This paper describes four cases of primary HCC with varied manifestations of SCC due to bone metastases. The first patient presented primarily with the symptoms of bone pains corresponding to the bone metastases sites rather than symptoms of associated hepatic pathology and eventually developed SCC. The second patient, diagnosed as having HCC, developed extradural SCC leading to paraplegia during the course of illness, for which he underwent emergency laminectomy with posterior fixation. The third patient developed SCC soon after the primary diagnosis and had to undergo emergency laminectomy. Post laminectomy he had good neurological recovery. The Fourth patient presented primarily with radicular pains rather than frank paraplegia as the first manifestation of SCC.

  1. Intrauterine Retained Fetal Bones as a Cause of Secondary Infertility

    OpenAIRE

    Srofenyoh, EK; Addison, M.; Dortey, B; Kuffour, PA

    2006-01-01

    Three cases of retained fetal bones, the first two after mid-trimester termination of pregnancy and the third after dilatation and evacuation (D&E) of the uterus for a missed abortion, are presented. All the cases were complicated by secondary infertility. In all the cases the diagnosis was confirmed by a high resolution pelvic ultrasound scan. The pieces of bones were removed at dilatation and evacuation under general anaesthesia. In two of the cases pregnancy occurred within 6 months of rem...

  2. Secondary aneurysmal bone cystic change of the chondroblastoma, mistaken for a primary aneurysmal bone cyst in the patella.

    Science.gov (United States)

    Chung, Jin Wha; Lee, Hwa Sung

    2014-03-01

    A 29-year-old woman complained of a 3-month history of left knee pain without trauma history. X-ray showed a well-defined osteolytic lesion with a sclerotic margin in the patella and magnetic resonance imaging showed T1-low and T2-high signal intensity with different fluid level. Our impression was an aneurysmal bone cyst. At surgery, the lesion was a blood-filled cystic cavity, surrounded by a gray or brownish tissue. Hemorrhagic soft tissues with recognizable bone fragments were observed. Curettage and autogenous bone graft was done. Microscopically, sheets of tumor cells were intermingled with some areas of eosinophilic chondroid matrix. The tumor cells showed oval-shaped nuclei with moderate eosinophilic cytoplasm. Several multinucleated giant cells and blood filled cystic cavities were observed. The final diagnosis was a chondroblastoma with a secondary aneurysmal bone cyst. At the post-operative 1.5-year follow-up, grafted bones were well incorporated radiographically and there were no recurrent evidence or any other abnormal symptoms. PMID:24639947

  3. Secondary aneurysmal bone cystic change of the chondroblastoma, mistaken for a primary aneurysmal bone cyst in the patella.

    Science.gov (United States)

    Chung, Jin Wha; Lee, Hwa Sung

    2014-03-01

    A 29-year-old woman complained of a 3-month history of left knee pain without trauma history. X-ray showed a well-defined osteolytic lesion with a sclerotic margin in the patella and magnetic resonance imaging showed T1-low and T2-high signal intensity with different fluid level. Our impression was an aneurysmal bone cyst. At surgery, the lesion was a blood-filled cystic cavity, surrounded by a gray or brownish tissue. Hemorrhagic soft tissues with recognizable bone fragments were observed. Curettage and autogenous bone graft was done. Microscopically, sheets of tumor cells were intermingled with some areas of eosinophilic chondroid matrix. The tumor cells showed oval-shaped nuclei with moderate eosinophilic cytoplasm. Several multinucleated giant cells and blood filled cystic cavities were observed. The final diagnosis was a chondroblastoma with a secondary aneurysmal bone cyst. At the post-operative 1.5-year follow-up, grafted bones were well incorporated radiographically and there were no recurrent evidence or any other abnormal symptoms.

  4. Treatment with bone-seeking radionuclides for painful bone metastases in patients with lung cancer

    DEFF Research Database (Denmark)

    Zacho, Helle D; Karthigaseu, Nita Nishanthiny; Fuglsang, Randi;

    2016-01-01

    Treatment with bone-seeking radionuclides may provide palliation from pain originating from bone metastases. However, most studies have been conducted in patients with prostate cancer and patients with breast cancer. We aimed to perform a systematic review of the use of radionuclide treatment...... in lung cancer in accordance with the PRISMA guidelines. In the eligible trials, pain relief was reported in 75% of the patients included in the studies. The onset of pain relief was seen within 1-5 weeks after treatment, lasting up to 6 months. However, the methodology in the included trials was poor...... of prior/concomitant analgaesics. Large randomised controlled trials are needed to clarify the efficacy of radionuclide treatment in lung cancer....

  5. Magnification bone scan of knees for knee pain evaluation

    International Nuclear Information System (INIS)

    Knee pain is one of the common complaints of patients seen in our orthopedic clinic. Routine anterior and posterior views of whole body bone scan (WBBS) is often not sufficient in the evaluation of these patients. An ideal bone scan using pinhole collimator or single photon emission tomography (SPECT), however, is impractical and time consuming in busy nuclear medicine department with limited resources. Therefore, the aim of the study is to assess limited bone scan of knees with magnification (LNSKM) for knee pain evaluation. Technical aspect of LBSKM and diagnostic efficacy are discussed on this poster. Adult patients with knee pain were reffered for LBSKM from an orthopedic surgen specializing knees. Four hundred fifteen LBSKMs were performed since 1999. patients were given 740 MBq (20mCi) Tc-99m MDP intravenously and 3 hours later LBSKM was performed using a low energy high resolution parallel hole collimator and Siemens Orbitor camera. (Simens medical systems. Inc., Hoffman Estates, III., USA). Anterior view of the knees was taken for 5 min, without magnification and both lateral views of symptomatic knees were obtained with electronic magnification (1.25, upto 2.0) for 8 min each. Disease processes such as DJD, traumatic arthritis, P-F tendonitis, SONK, meniscus tear are detected and illustrated along with normal knee scan finding. We believe LBSKM may not be as good as SPECT or pinhole imaging of the knees in the evaluation of knee pain but superior to routine WBBS in the nuclear medicine department with limited resources of instrumentation and manpower

  6. Post-operative breast cancer patients diagnosed with skeletal metastasis without bone pain had fewer skeletal-related events and deaths than those with bone pain

    Directory of Open Access Journals (Sweden)

    Koizumi Mitsuru

    2010-08-01

    Full Text Available Abstract Background Skeletal metastases are often accompanied by bone pain. To investigate the clinical meaning of bone pain associated with skeletal metastasis in breast cancer patients after surgery, we explored whether the presence of bone pain was due to skeletal-related events (SREs or survival (cause specific death, CSD, retrospectively. Methods Consecutive breast cancer patients undergoing surgery between 1988 and 1998 were examined for signs of skeletal metastasis until December 2006. Patients who were diagnosed as having skeletal metastasis were the subjects of this study. Bone scans were performed annually for 5, 7 or 10 years; they were also conducted if skeletal metastasis was suspected. Data concerning bone pain and tumor markers at the time of skeletal metastasis diagnosis, and data relating to various factors including tumors, lymph nodes and hormone receptors at the time of surgery, were investigated. The relationships between factors such as bone pain, SRE and CSD were analyzed using the Kaplan-Meier method and Cox's analysis. Results Skeletal metastasis occurred in 668 patients but the pain status of two patients was unknown, therefore 666 patients were included in the study. At the time of skeletal metastasis diagnosis 270 patients complained of pain; however, 396 patients did not. Analysis of data using Cox's and Kaplan-Meier methods demonstrated that patients without pain had fewer SREs and better survival rates than those with pain. Hazard ratios regarding SRE (base = patients without pain were 2.331 in univariate analysis and 2.243 in multivariate analysis. Hazard ratios regarding CSD (base = patients without pain were 1.441 in univariate analysis and 1.535 in multivariate analysis. Similar results were obtained when analyses were carried out using the date of surgery as the starting point. Conclusion Bone pain at diagnosis of skeletal metastasis was an indicator of increased SRE and CSD. However, these data did not

  7. Do laying hens with keel bone fractures experience pain?

    Directory of Open Access Journals (Sweden)

    Mohammed A F Nasr

    Full Text Available The European ban on battery cages has forced a change towards the use of non-cage or furnished cage systems, but unexpectedly this has been associated with an increased prevalence of keel bone fractures in laying hens. Bone fractures are acutely painful in mammals, but the effect of fractures on bird welfare is unclear. We recently reported that keel bone fractures have an effect on bird mobility. One possible explanation for this is that flying becomes mechanically impaired. However it is also possible that if birds have a capacity to feel pain, then ongoing pain resulting from the fracture could contribute to decreased mobility. The aim was to provide proof of concept that administration of appropriate analgesic drugs improves mobility in birds with keel fracture; thereby contributing to the debate about the capacity of birds to experience pain and whether fractures are associated with pain in laying hens. In hens with keel fractures, butorphanol decreased the latency to land from perches compared with latencies recorded for these hens following saline (mean (SEM landing time (seconds birds with keel fractures treated with butorphanol and saline from the 50, 100 and 150 cm perch heights respectively 1.7 (0.3, 2.2 (0.3, p = 0.05, 50 cm; 12.5 (6.6, 16.9 (6.7, p = 0.03, 100 cm; 20.6 (7.4, 26.3 (7.6, p = 0.02 150 cm. Mobility indices were largely unchanged in birds without keel fractures following butorphanol. Critically, butorphanol can be considered analgesic in our study because it improved the ability of birds to perform a complex behaviour that requires both motivation and higher cognitive processing. This is the first study to provide a solid evidential base that birds with keel fractures experience pain, a finding that has significant implications for the welfare of laying hens that are housed in non-cage or furnished caged systems.

  8. Celiac Disease Presenting with Bone Pain: Two Case Reports

    OpenAIRE

    Nural Albayrak Aydın; Kamil Yazıcıoğlu

    2011-01-01

    Celiac disease or gluten sensitive enteropathy is an autoimmune disease characterized by inflammation of the small-bowel mucosa. As can be asymptomatic, involvement of the hematologic, gastrointestinal system, musculosceletal system, nervous system or endocrine system may occur as well. The presence of osteoporosis in celiac disease, may be the only sign of patients who have not been diagnosed yet. The direct effect of celiac disease on bones happens secondary to decreased absorbsion of calci...

  9. Influence of sex differences on the progression of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria; Appel, Camilla;

    2013-01-01

    on the progression of cancer-induced bone pain. Materials and Methods: 4T1-luc2 mammary cancer cells were introduced into the femoral cavity of female and male BALB/cJ mice. Bioluminescence tumor signal, pain-related behavior and bone degradation were monitored for 14 days. Results: Female mice demonstrated...... a significantly greater bioluminescence signal on day 2 compared to male mice and, in addition, a significant earlier onset of pain-related behavior was observed in the females. No sex difference was observed for bone degradation. Finally, a strong correlation between pain-related behavior and bone degradation...

  10. Current Studies of Acupuncture in Cancer-Induced Bone Pain Animal Models

    OpenAIRE

    Hee Kyoung Ryu; Yong-Hyeon Baek; Yeon-Cheol Park; Byung-Kwan Seo

    2014-01-01

    Acupuncture is generally accepted as a safe and harmless treatment option for alleviating pain. To explore the pain mechanism, numerous animal models have been developed to simulate specific human pain conditions, including cancer-induced bone pain (CIBP). In this study, we analyzed the current research methodology of acupuncture for the treatment of CIBP. We electronically searched the PubMed database for animal studies published from 2000 onward using these search terms: (bone cancer OR can...

  11. Pheochromocytoma presenting as musculoskeletal pain from bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Lynn, M.D.; Braunstein, E.M.; Shapiro, B.

    1987-10-01

    Six patients presented with musculoskeletal pain resulting from destructive bone lesions. These patients were ultimately shown to have metastatic pheochromocytoma. None of the cases exhibited typical symptoms of metastatic pheochromocytoma, nor was it suspected at the time of presentation. In three patients, hypertension caused pheochromocytoma to be considered as a diagnosis. The three remaining patients, all of whom had documented hypertension in the past, underwent bone biopsy. Two of these patients became markedly hypertensive in the postoperative period. Malignant pheochromocytoma may present with metastatic skeletal disease in some patients in whom the presence of hypertension as well as a carefully elicited history may suggest the diagnosis. In such patients, the possibility of pheochromocytoma should be taken into account, as biopsy may trigger a hypertensive crisis in patients not under adrenergic blockade.

  12. Secondary Alveolar Bone Grafting (CLEFTSiS) 2007-2010.

    Science.gov (United States)

    Paterson, Michael; Rae, Jennifer; Paterson, Paul; Gilgrass, Toby; Devlin, Mark; McIntyre, Grant

    2016-03-01

    Objective To determine whether alveolar bone graft outcomes for unilateral and bilateral cleft lip and palate patients have continued to improve since the reorganization of cleft services in Scotland in 2000. Design Retrospective analysis of postoperative anterior occlusal radiographs. Patients and Participants Eighty-one of 106 patients who were eligible for alveolar bone grafting between 2007 and 2010 had suitable postoperative radiographs available. Interventions Twenty-seven percent of the patients (n = 22) had presurgical orthodontic intervention. All patients underwent alveolar bone grafting with bone harvested from the iliac crest. Main Outcome Measures The Kindelan bone-fill index was used to evaluate success. Weighted kappa statistics were used to assess intra- and interobserver reproducibility. A comparison was made with results from 2000 to 2004 to assess any improvement. Chi-square tests (or Fisher exact test) were used to determine whether outcomes differed depending on the laterality of the cleft, use of presurgical expansion, or age at bone grafting. Results Interobserver scoring agreement was good (weighted kappa = .383). Intraobserver reproducibility was greater (weighted kappas of .835 and .620). Success was achieved in 99% of bone grafts, compared with 76% in the period from 2000 to 2004 (P < .001). There was no statistically significant relationship between the laterality of the cleft (P = 1.000), use of presurgical expansion (P = 1.000), or age at time of bone grafting and outcome (P = .259). Conclusion Scottish secondary alveolar bone graft outcomes improved during 2007 to 2010 in comparison to the 2000 to 2004 results. PMID:26914161

  13. Radiofrequency thermal ablation for pain control in patients with single painful bone metastasis from hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Carrafiello, Gianpaolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: gcarraf@tin.it; Lagana, Domenico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: donlaga@gmail.com; Ianniello, Andrea [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: ianand@libero.it; Nicotera, Paolo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: paolonicotera@virgilio.it; Fontana, Federico [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: fede.fontana@libero.it; Dizonno, Massimiliano [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: massimilianodizonno@libero.it; Cuffari, Salvatore [Service of Anaesthesiology and Palliative Care, University of Insubria, 21100 Varese (Italy)], E-mail: salvatore.cuffari@libero.it; Fugazzola, Carlo [Department of Radiology, Vascular and Interventional Radiology, University of Insubria, 21100 Varese (Italy)], E-mail: carlo.fugazzola@ospedale.varese.it

    2009-08-15

    Objective: The aim of this study was to assess the safety and the efficacy of radiofrequency thermal ablation (RFA) for pain relief and analgesics use reduction in two patients with painful bone metastases from hepatocellular carcinoma (HCC). Materials and methods: Two patients with lytic metastases from HCC located at the left superior ileo-pubic branch and at the middle arch of VII rib, performed RFA displacing a LeVeen Needle (3.5 and 4.0 cm diameter) under US (ultrasonography) and fluoroscopic guidance. Two methods were used to determine the response of both patients: the first method was to measure patient's worst pain with a Brief Pain Inventory (BPI) 1 day after the procedure, every week for 1 month, and thereafter at week 8 and 12 (total follow-up 3 months); Second method was to evaluate patient's analgesics use recorded at week 1, 4, 8 and 12. Analgesic medication use was translated into a morphine-equivalent dose. Results: The RFA were well tolerated by the patients who did not develop any complication. Both patients obtained substantial reduction of pain, which decreased from a mean score of 8 to approximately 2 in 4 weeks. In both patients we observed a reduction in the use of morphine dose-equivalent after a peak at week 1. CT (computed tomography) imaging, performed at 1 month after RFA, demonstrated that both procedures were technically successful and safe because consistent necrosis and no evidence for complications were observed. Conclusion: RFA provides a potential alternative method for palliation of painful osteolytic metastases from HCC; the procedure is safe, and the pain relief is substantial.

  14. 186Re-HEDP for metastatic bone pain in breast cancer patients

    International Nuclear Information System (INIS)

    Two-thirds of patients with metastatic cancer suffer from pain. Pain originating from skeletal metastases is the most common form of cancer-related pain. Bone pain, often exacerbated by pressure or movement, limits the patient's autonomy and social life. Pain palliation with bone-seeking radiopharmaceuticals has proven to be an effective treatment modality in patients with metastatic bone pain. These bone-seeking radiopharmaceuticals are extremely powerful in treating scattered painful bone metastases, for which external beam radiotherapy is impossible because of the large field of irradiation. 186Re-hydroxyethylidene diphosphonate (HEDP) is a potentially useful radiopharmaceutical for this purpose, having numerous advantageous characteristics. Bone marrow toxicity is limited and reversible, which makes repetitive treatment safe. Studies have shown encouraging clinical results of palliative therapy using 186Re-HEDP, with an overall response rate of ca. 70% in painful bone metastases. It is effective for fast palliation of painful bone metastases from various tumours and the effect tends to last longer if patients are treated early in the course of their disease. 186Re-HEDP is at least as effective in breast cancer patients with painful bone metastases as in patients with metastatic prostate cancer. It is to be preferred to radiopharmaceuticals with a long physical half-life in this group of patients, who tend to have more extensive haematological toxicity since they have frequently been pretreated with bone marrow suppressive chemotherapy. This systemic form of radionuclide therapy is simple to administer and complements other treatment options. It has been associated with marked pain reduction, improved mobility in many patients, reduced dependence on analgesics, and improved performance status and quality of life. (orig.)

  15. 125I brachytherapy in the palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments

    Science.gov (United States)

    Gilani, Saba; Zhong, Zhihui; Zhang, Tao; Zhang, Fujun; Gao, Fei

    2016-01-01

    Purpose This study sought to assess the safety and effect of 125I seed implantation for palliation of painful bone metastases from lung cancer after failure or rejection of conventional treatments. Materials and Methods 89 patients with painful bone metastases secondary to lung cancer were consented and enrolled in this study from June 2013 to May 2015. All patients had failed or refused conventional treatments underwent percutaneous CT-guided 125I seed implantation. The Brief Pain Inventory (BPI) was used to measure pain intensity prior to treatment (T0), 2, 4, 6, 8 and 12 weeks (T2, T4, T6, T8 and T12) after treatment in a 24-hour period. Analgesic, quality of life (QOL) scores and complications were also recorded. Four patients were excluded as they were lost to follow-up or had incomplete data. Results 85 patients with 126 bone metastases from lung cancer were treated. There were significantly lower scores after treatment in the visual analog scale (VAS) and analgesic. The VAS scores for worst pain was 6.3±1.8 at T0. At T2, T4, T6, T8 and T12, the score in a 24-hour period decreased to 4.9±1.2 (Pmetastases from lung cancer after failure or rejection of conventional treatments. PMID:26919235

  16. Improving radionuclide therapy in prostate cancer patients with metastatic bone pain

    NARCIS (Netherlands)

    Lam, M.G.E.H.

    2009-01-01

    Bone seeking radiopharmaceuticals are indicated in cancer patients with multiple painful skeletal metastases. The majority of these patients are hormone-refractory prostate cancer patients in an advanced stage of their disease. Bone seeking radiopharmaceuticals relieve pain and improve the patients

  17. Treatment of 56 Cases of Pain of Supra-orbital Bone by Puncturing Siguan Acupoints

    Institute of Scientific and Technical Information of China (English)

    李玲

    2008-01-01

    @@ Pain of supra-orbital bone is very common in clinic.The author achieved significant effect in treating 56 cases of pain of supra-orbital bone by puncturing Siguan(four gates)points.The report is as follows.

  18. The Walker 256 Breast Cancer Cell- Induced Bone Pain Model in Rats

    Directory of Open Access Journals (Sweden)

    Priyank Ashok Shenoy

    2016-08-01

    Full Text Available The majority of patients with terminal breast cancer show signs of bone metastasis, the most common cause of pain in cancer. Clinically available drug treatment options for the relief of cancer-associated bone pain are limited due to either inadequate pain relief and/or dose-limiting side-effects. One of the major hurdles in understanding the mechanism by which breast cancer causes pain after metastasis to the bones is the lack of suitable preclinical models. Until the late twentieth century, all animal models of cancer induced bone pain involved systemic injection of cancer cells into animals, which caused severe deterioration of animal health due to widespread metastasis. In this mini-review we have discussed details of a recently developed and highly efficient preclinical model of breast cancer induced bone pain: Walker 256 cancer cell- induced bone pain in rats. The model involves direct localized injection of cancer cells into a single tibia in rats, which avoids widespread metastasis of cancer cells and hence animals maintain good health throughout the experimental period. This model closely mimics the human pathophysiology of breast cancer induced bone pain and has great potential to aid in the process of drug discovery for treating this intractable pain condition.

  19. Pain in castration-resistant prostate cancer with bone metastases: a qualitative study

    Directory of Open Access Journals (Sweden)

    Gater Adam

    2011-10-01

    Full Text Available Abstract Background Bone metastases are a common painful and debilitating consequence of castration-resistant prostate cancer (CPRC. Bone pain may predict patients' prognosis and there is a need to further explore CRPC patients' experiences of bone pain in the overall context of disease pathology. Due to the subjective nature of pain, assessments of pain severity, onset and progression are reliant on patient assessment. Patient reported outcome (PRO measures, therefore, are commonly used as key endpoints for evaluating the efficacy of CRPC treatments. Evidence of the content validity of leading PRO measures of pain severity used in CRPC clinical trials is, however, limited. Methods To document patients' experience of CRPC symptoms including pain, and their impact on health-related quality of life (HRQL, semi-structured in-depth qualitative interviews were conducted with 17 patients with CRPC and bone metastases. The content validity of the Present Pain Intensity (PPI scale from the McGill Pain Questionnaire (MPQ, and the 'Average Pain' and 'Worst Pain' items of the Brief Pain Inventory Short-Form (BPI-SF was also assessed. Results Patients with CRPC and bone metastases present with a constellation of symptoms that can have a profound effect on HRQL. For patients in this study, bone pain was the most prominent and debilitating symptom associated with their condition. Bone pain was chronic and, despite being generally well-managed by analgesic medication, instances of breakthrough cancer pain (BTcP were common. Cognitive debriefing of the selected PRO measures of pain severity highlighted difficulties among patients in understanding the verbal response scale (VRS of the MPQ PPI scale. There were also some inconsistencies in the way in which the BPI-SF 'Average Pain' item was interpreted by patients. In contrast, the BPI-SF 'Worst Pain' item was well understood and interpreted consistently among patients. Conclusions Study findings support the

  20. Randall Selitto pressure algometry for assessment of bone-related pain in rats

    DEFF Research Database (Denmark)

    Falk, S.; Ipsen, D. H.; Appel, C. K.;

    2015-01-01

    Background: Deep pain is neglected compared with cutaneous sources. Pressure algometry has been validated in the clinic for assessment of bone-related pain in humans. In animal models of bone-related pain, we have validated the Randall Selitto behavioural test for assessment of acute...... and pathological bone pain and compared the outcome with more traditional pain-related behaviour measures. Methods: Randall Selitto pressure algometry was performed over the anteromedial part of the tibia in naïve rats, sham-operated rats, and rats inoculated with MRMT-1 carcinoma cells in the left tibia......, and the effect of morphine was investigated. Randall Selitto measures of cancer-induced bone pain were supplemented by von Frey testing, weight-bearing and limb use test. Contribution of cutaneous nociception to Randall Selitto measures were examined by local anaesthesia. Results: Randall Selitto pressure...

  1. Efficacy and time course of palliative radiotherapy for pain relief in 70 patients with bone metastases

    Institute of Scientific and Technical Information of China (English)

    Peng Zhang; Chen Gong; Huihua Xiong

    2016-01-01

    Objective The aim of this study was to evaluate the ef icacy and time course of radiotherapy for pain relief in patients with bone metastases. Methods A total of 70 patients with painful bone metastases were investigated between January 2013 and August 2015. The patients were divided into 3 groups and each group was treated with radiotherapy using 30 Gy in 10 fractions, 20 Gy in 5 fractions, or a single dose of 8 Gy. The pain over the irradiated site was assessed using a numerical rating scale (NRS) ranging from 0 to 10. Pain relief was assessed every 5 days based on a pain questionnaire. Results Complete pain relief was achieved in 14.3% (10/70) patients; partial pain relief in 74.3% (52/70); and no response in 11.4% (8/70). The overal response rate was 88.6%. No significant dif erence was observed between single fraction radiotherapy and multifraction radiotherapy. There was no relationship between the pain relief and treated sites. The pain score gradual y decreased and most patients reached a moderate pain score (NRS Conclusion Local radiotherapy is a very rapid and ef ective pal iative treatment for painful bone metas-tases; however, the optimal dose and fractionation regimen remain debatable. Individualized therapy for painful bone metastases should be considered according to the patient’s condition and life expectancy.

  2. Effect of sex in the MRMT-1 model of cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Al-Dihaissy, Tamara; Mezzanotte, Laura;

    2015-01-01

    An overwhelming amount of evidence demonstrates sex-induced variation in pain processing, and has thus increased the focus on sex as an essential parameter for optimization of in vivo models in pain research. Mammary cancer cells are often used to model metastatic bone pain in vivo...

  3. The use of dynamic bone scanning in the evaluation of wrist and hand pain

    International Nuclear Information System (INIS)

    Twenty-seven patients with complaints of wrist and/or hand pain were evaluated using a quantitative technique of dynamic (blood flow analysis) and static bone scan. The patients were divided in two groups according to their clinical history. Group A included 13 patients with a history of trauma. Seven patients had scaphoid fracture and 6 of them were scanned to determine non-union and/or avascular necrosis of the joint. One patient was scanned to determine the viability of a graft for non-union fracture. In all cases the scan gave a correct diagnosis as confirmed by later x-ray changes. Six patients in this group had negative x-rays. The scan demonstrated 4 cases of occult fractures, 4 had early Kienbock's Disease (KD) and 1 a soft tissue tumor. Group B included 14 patients with no known history of trauma. Nine had positive x-rays including 3 with KD that were scanned to determine their viability for surgical replacement of the lunate. The scan could distinguish between isolated involvement of the lunate and secondary degenerative changes of the surrounding carpal bones and radiocarpal joint. Two patients with tumor were correctly diagnosed by the scan, one as benign and one malignant. Four other patients with nonspecific changes on x-ray showed early arthritis (3 cases) and a cyst of the triquetrum ( 1 case) on the bone scan. Four patients in Group B had negative x-rays and the scan showed degenerative changes (3 cases) and an occult fracture of the hamate (1 case). The use of dynamic and static bone scanning appears to be a very valuable technique in the evaluation of patients with wrist and hand pain

  4. Mechanisms of PDGF siRNA-mediated inhibition of bone cancer pain in the spinal cord

    Science.gov (United States)

    Xu, Yang; Liu, Jia; He, Mu; Liu, Ran; Belegu, Visar; Dai, Ping; Liu, Wei; Wang, Wei; Xia, Qing-Jie; Shang, Fei-Fei; Luo, Chao-Zhi; Zhou, Xue; Liu, Su; McDonald, JohnW.; Liu, Jin; Zuo, Yun-Xia; Liu, Fei; Wang, Ting-Hua

    2016-01-01

    Patients with tumors that metastasize to bone frequently suffer from debilitating pain, and effective therapies for treating bone cancer are lacking. This study employed a novel strategy in which herpes simplex virus (HSV) carrying a small interfering RNA (siRNA) targeting platelet-derived growth factor (PDGF) was used to alleviate bone cancer pain. HSV carrying PDGF siRNA was established and intrathecally injected into the cavum subarachnoidale of animals suffering from bone cancer pain and animals in the negative group. Sensory function was assessed by measuring thermal and mechanical hyperalgesia. The mechanism by which PDGF regulates pain was also investigated by comparing the differential expression of pPDGFRα/β and phosphorylated ERK and AKT. Thermal and mechanical hyperalgesia developed in the rats with bone cancer pain, and these effects were accompanied by bone destruction in the tibia. Intrathecal injection of PDGF siRNA and morphine reversed thermal and mechanical hyperalgesia in rats with bone cancer pain. In addition, we observed attenuated astrocyte hypertrophy, down-regulated pPDGFRα/β levels, reduced levels of the neurochemical SP, a reduction in CGRP fibers and changes in pERK/ERK and pAKT/AKT ratios. These results demonstrate that PDGF siRNA can effectively treat pain induced by bone cancer by blocking the AKT-ERK signaling pathway. PMID:27282805

  5. Palliative treatment of bone metastases with samarium-153 EDTMP at onset of pain.

    Science.gov (United States)

    Gallicchio, Rosj; Giacomobono, Sabrina; Nardelli, Anna; Pellegrino, Teresa; Simeon, Vittorio; Gattozzi, Domenico; Maddalena, Francesca; Mainenti, Pierpaolo; Storto, Giovanni

    2014-07-01

    We evaluated the pain response and daily discomfort in patients suffering from a borderline degree of bone pain due to breast or lung cancer bone metastases, who had undergone early palliative radionuclide treatment. The results were compared with those from patients who had received standard analgesic therapy. Twenty-one patients (65.7 ± 3 years; 17 women) with metastatic bone cancer underwent samarium-153 (Sm-153) ethylene diamine tetramethylene phosphonate (EDTMP) administration (group A) and 18 patients (64.3 ± 8 years; 16 women)continued to receive standard analgesics (group B; control group). The patients kept a daily pain diary assessing both their discomfort and the pain at specific sites by means of a visual analog scale, rating from 0 (no discomfort–no pain)to 10 (worst discomfort–pain). These diaries were reviewed weekly for 2 months and three physicians rated the pain response on a scale from -2 (considerable deterioration) to +2 (considerable improvement). Baseline characteristics were similar in both groups. The reduction of total discomfort and of bone pain in group A was significantly greater compared to group B (p < 0.0001). A significant improvement of clinical conditions was observed in group A, where the physician rate changed from -1 to 1, compared to group B in which the rate changed from -1 to 0. Sm-153 EDTMP therapy can be considered for patients with bone pain from breast and lung cancer in advance, i.e.,before the establishment of severe pain syndrome.

  6. P2X7 receptor-deficient mice are susceptible to bone cancer pain

    DEFF Research Database (Denmark)

    Hansen, Rikke Rie; Nielsen, Christian K.; Nasser, Arafat;

    2011-01-01

    The purinergic P2X7 receptor is implicated in both neuropathic and inflammatory pain, and has been suggested as a possible target in pain treatment. However, the specific role of the P2X7 receptor in bone cancer pain is unknown. We demonstrated that BALB/cJ P2X7 receptor knockout (P2X7R KO) mice...... were susceptible to bone cancer pain and moreover had an earlier onset of pain-related behaviours compared with cancer-bearing, wild-type mice. Furthermore, acute treatment with the selective P2X7 receptor antagonist, A-438079, failed to alleviate pain-related behaviours in models of bone cancer pain...... with and without astrocyte activation (BALB/cJ or C3H mice inoculated with 4T1 mammary cancer cells or NCTC 2472 osteosarcoma cells, respectively), suggesting that astrocytic P2X7 receptors play a negligible role in bone cancer pain. The results support the hypothesis that bone cancer pain is a separate pain state...

  7. P2X7 receptor-deficient mice are susceptible to bone cancer pain

    DEFF Research Database (Denmark)

    Hansen, RR; Nielsen, CK; Nasser, A;

    2011-01-01

    The purinergic P2X7 receptor is implicated in both neuropathic and inflammatory pain, and has been suggested as a possible target in pain treatment. However, the specific role of the P2X7 receptor in bone cancer pain is unknown. We demonstrated that BALB/cJ P2X7 receptor knockout (P2X7R KO) mice...... were susceptible to bone cancer pain and moreover had an earlier onset of pain-related behaviours compared with cancer-bearing, wild-type mice. Furthermore, acute treatment with the selective P2X7 receptor antagonist, A-438079, failed to alleviate pain-related behaviours in models of bone cancer pain...... of the P2X7R KO mouse. Further experiments are needed to elucidate the exact role of the P2X7 receptors in bone cancer pain. Pain-related behaviours had an earlier onset in bone cancer-bearing, P2X7 receptor-deficient mice, and treatment with A-438079 failed to alleviate pain-related behaviours....

  8. Hemi body irradiation: An economical way of palliation of pain in bone metastasis in advanced cancer

    Directory of Open Access Journals (Sweden)

    Santanu Pal

    2014-01-01

    Full Text Available Background: The primary aim of this prospective non-randomized study was to evaluate the effect of hemi-body irradiation (HBI on pain and quality of life in cancer patients with extensive bone metastases. The secondary aim was to evaluate side-effects and cost-effectiveness of the treatment. Materials and Methods: Between March 2008 and December 2010, a total of 23 (male = 14, female = 9, median age = 60 years diagnosed cases of metastatic cancer patients (prostate = 11, breast = 6, and lung = 6 received HBI, which was delivered as lower (n = 7 (dose = 8 Gy, upper (n = 8 (dose = 6 Gy, or sequential HBI (n = 8 with a Telecobalt unit (Theratron 780C. Among them, one lung cancer patient died at 2 months and one prostate cancer patient defaulted after the second follow-up. Thus, 21 patients (male = 13, female = 8, median age = 65 years (prostatic cancer = 10, breast cancer = 6, and lung cancer = 5 were followed up for a minimum of 6 months. Evaluations were performed before and at 2, 4, 8, 16, and 24 weeks after treatment. Pain evaluation was done by Visual Analogue Scale (VAS, Verbal Rating Scale (VRS, Percentage of Pain Relief (PRR, and Global Pain Score (GPS. Toxicity was assessed by CTC v-3 toxicity scores in the medical record. Assessment of oral morphine consumption was done before and after radiation using paired t-test, and correlation analysis was also done with decrease of morphine consumption and reduction of pain score using statistical analysis. Results: Response (control of pain was partial (PR in 67% and complete (CR in 22% of patients. For most patients, the pain control lasted throughout the follow-up period (6 months. From 66.66% patients requiring 13 or more Morphine (10 mg tablets per day prior to HBI, none of the patients required to consume 13 or more Morphine (10 mg tablets per day following HBI, which was correlated with significant reduction in various pain scores (P < 0.05. One way ANOVA with Dunnett′s Multiple Comparison

  9. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    International Nuclear Information System (INIS)

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: “time until first increase in pain” (85%), “incidence of spinal cord compression” (50%), and “incidence of pathologic fractures” (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  10. Is heat pain detection threshold associated with the area of secondary hyperalgesia following brief thermal sensitization?

    DEFF Research Database (Denmark)

    Hansen, Morten Sejer; Wetterslev, Jørn; Pipper, Christian Bressen;

    2016-01-01

    BACKGROUND: Several factors are believed to influence the development and experience of pain. Human clinical pain models are central tools, in the investigation of basic physiologic pain responses, and can be applied in patients as well as in healthy volunteers. Each clinical pain model investiga......BACKGROUND: Several factors are believed to influence the development and experience of pain. Human clinical pain models are central tools, in the investigation of basic physiologic pain responses, and can be applied in patients as well as in healthy volunteers. Each clinical pain model...... investigates different aspects of the human pain response. Brief thermal sensitization induces a mild burn injury, resulting in development of primary hyperalgesia at the site of stimulation, and secondary hyperalgesia surrounding the site of stimulation. Central sensitization is believed to play an important...

  11. Treatment of chondroblastoma of the calcaneus with a secondary aneurysmal bone cyst using endoscopic curettage without bone grafting.

    Science.gov (United States)

    Otsuka, Takanobu; Kobayashi, Masaaki; Yonezawa, Masato; Kamiyama, Fumiaki; Matsushita, Yasusi; Matsui, Nobuo

    2002-04-01

    Chondroblastoma is a relatively rare benign bone tumor. Approximately 7% of chondroblastomas occur in the calcaneus, and 17% of chondroblastoma associated with cystic lesions. We report a case of a chondroblastoma in the calcaneus with a secondary aneurysmal bone cyst treated successfully by endoscopic curettage without bone grafting. New bone formation is facilitated by minimal damage to the bone and soft tissue. The cosmetic results of this procedure are good. Two years later, the patient is asymptomatic with no radiographic evidence of recurrence. Endoscopic curettage without bone grafting is a promising new treatment for chondroblastoma.

  12. Pain and bone disease: a patient’s view

    Directory of Open Access Journals (Sweden)

    L. Brunetta

    2011-12-01

    Full Text Available Pain in thalassemia proves to be an emergent issue even if it is not possible to correlate it definitely to bone disease, but we strongly believe that a multidisciplinary approach, may be as decisive in this case as it was in the struggle against thalassemia. In fact, we strongly believe that the involvement of various specialists such as endocrinologists, orthopedist, anesthesiologist, in a close team coordinated by a specialist in thalassemia is absolutely necessary for achieving our aims. First of all, we need to implement clinical trials to identify the mechanisms of disease, to find the optimal management of the problem in order to provide new therapeutic methods for preventing the thalassemia-induced osteoporosis and to reduce the presence of very disabling pain for patients. Patients’ expectations for the future are to continuously improve the quality of life. To do that it is needed to identify pathways to prevent all the complications of thalassemia that cause widespread pain, above all osteoporosis. Although we have seen that osteoporosis is not the sole cause of pain for thalassemia patients, it is true that this seems to have a great incidence in thalassemia patients and it gives a significant contribute to an increased pain. 地中海贫血疼痛亟待解决,即使它可能与和骨病毫不相关,但我们坚信可以找到一种战胜地中海贫血症的多学科结合疗法。 事实上,如果要完成我们的目标,绝对有必要邀请一名地中海贫血专家,在内分泌学家、矫形外科医师和麻醉学家组成的队伍的配合下紧密展开工作。 首先,我们需要开展临床试验,确认发病机制,找出疾病最佳的控制方法,以找到预防地中海贫血诱发骨质疏松症的新疗法和减少疼痛的频率。 病患者对未来的期望是能够不断地提高自己的生活质量。要做到,病患者需要找到预防地中海贫血所有并发症引起的疼痛的方

  13. Dexamethasone for the prevention of a pain flare after palliative radiotherapy for painful bone metastases : a multicenter double-blind placebo-controlled randomized trial

    NARCIS (Netherlands)

    Westhoff, Paulien G.; de Graeff, Alexander; Geerling, Jenske I.; Reyners, Anna K. L.; van der Linden, Yvette M.

    2014-01-01

    Background: Radiotherapy has a good effect in palliation of painful bone metastases, with a pain response rate of more than 60%. However, shortly after treatment, in approximately 40% of patients a temporary pain flare occurs, which is defined as a two-point increase of the worst pain score on an 11

  14. Secondary alveolar bone grafting in cleft of the lip and palate patients

    Directory of Open Access Journals (Sweden)

    Abhilashaa Walia

    2011-01-01

    Full Text Available Aim: The aim was to restore the function and form of both arches with a proper occlusal relationship and eruption of tooth in the cleft area. Materials and Methods: Eleven patients were selected irrespective of sex and socio-economic status and whose age was within the mixed dentition period. Iliac crest is grafted in cleft area and subsequently evaluated for graft success using study models, and periapical and occlusal radiographs. Results: At the time of evaluation teeth were erupted in the area and good alveolar bone levels were present. Premaxilla becomes immobile with a good arch form and arch continuity. There are no major complications in terms of pain, infection, paraesthesia, hematoma formation at donor site without difficulty in walking. There is no complication in terms of pain, infection, exposure of graft, rejection of graft, and wound dehiscence at the recipient site. Discussion: It is evident that secondary alveolar grafting during the mixed dentition period is more beneficial for patients at the donor site as well as the recipient site. Conclusion: Long-term follow-up is required to achieve maximum advantage of secondary alveolar grafting; the age of the patient should be within the mixed dentition period, irrespective of sex, socio-economic status. It may be unilateral or bilateral.

  15. The role of purinergic receptors in cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; Uldall, Maria; Heegaard, Anne-Marie

    2012-01-01

    Cancer-induced bone pain severely compromises the quality of life of many patients suffering from bone metastasis, as current therapies leave some patients with inadequate pain relief. The recent development of specific animal models has increased the understanding of the molecular and cellular...... mechanisms underlying cancer-induced bone pain including the involvement of ATP and the purinergic receptors in the progression of the pain state. In nociception, ATP acts as an extracellular messenger to transmit sensory information both at the peripheral site of tissue damage and in the spinal cord....... Several of the purinergic receptors have been shown to be important for the development and maintenance of neuropathic and inflammatory pain, and studies have demonstrated the importance of both peripheral and central mechanisms. We here provide an overview of the current literature on the role...

  16. Enhanced excitability of small dorsal root ganglion neurons in rats with bone cancer pain

    OpenAIRE

    Zheng Qin; Fang Dong; Cai Jie; Wan You; Han Ji-Sheng; Xing Guo-Gang

    2012-01-01

    Abstract Background Primary and metastatic cancers that affect bone are frequently associated with severe and intractable pain. The mechanisms underlying the development of bone cancer pain are largely unknown. The aim of this study was to determine whether enhanced excitability of primary sensory neurons contributed to peripheral sensitization and tumor-induced hyperalgesia during cancer condition. In this study, using techniques of whole-cell patch-clamp recording associated with immunofluo...

  17. Spinal cord stimulation for chronic visceral pain secondary to chronic non-alcoholic pancreatitis.

    Science.gov (United States)

    Kapural, Leonardo; Rakic, Mladen

    2008-07-01

    Spinal cord stimulation (SCS) suppresses visceral response to colon distension in an animal model. In humans, it may be an effective therapy for chronic pain of pelvic origin, irritable bowel syndrome, and persistent unspecified abdominal pain. Described here is the case of SCS for 38-year-old woman with visceral pain secondary to chronic pancreatitis. Previous therapies included numerous endoscopic retrograde cholangiopancreatographies, multiple pancreatic duct stenting, chemical and surgical sympathectomies with short-lasting pain relief. After the initial evaluation, the patient underwent retrograde epidural differential block to determine possible source of pain. Delay in pain recurrence after block suggested that the origin of her pain was visceral. After the psychologic evaluation, the patient underwent SCS trial over 14 days. She had 2 trial leads placed epidurally via T9-T10 paramedian entry with the tips of both leads positioned at T6 vertebral body. During the trial, visual analog scale pain score decreased from 8 to 1 cm, Pain Disability Index from 62 to 14, and opioid use from 150 to 0 mg of morphine sulfate equivalent a day. After the completion of successful SCS trial, she was implanted with dual octrode leads and rechargeable pulse generator. Median pain scores decreased from 8 to 1 at 3 months after the implant. Pain Disability Index changed from 62 to 15. Opiate use decreased to none. It seems that SCS may have a significant therapeutic potential for the treatment of visceral pain secondary to chronic pancreatitis. PMID:18496389

  18. Effectiveness of Reirradiation for Painful Bone Metastases: A Systematic Review and Meta-Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Huisman, Merel, E-mail: m.huisman-7@umcutrecht.nl [Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands); Bosch, Maurice A.A.J. van den; Wijlemans, Joost W. [Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Linden, Yvette M. van der [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands); Verkooijen, Helena M. [Department of Radiology, University Medical Center Utrecht, Utrecht (Netherlands)

    2012-09-01

    Purpose: Reirradiation of painful bone metastases in nonresponders or patients with recurrent pain after initial response is performed in up to 42% of patients initially treated with radiotherapy. Literature on the effect of reirradiation for pain control in those patients is scarce. In this systematic review and meta-analysis, we quantify the effectiveness of reirradiation for achieving pain control in patients with painful bone metastases. Methods and Materials: A free text search was performed to identify eligible studies using the MEDLINE, EMBASE, and the Cochrane Collaboration library electronic databases. After study selection and quality assessment, a pooled estimate was calculated for overall pain response for reirradiation of metastatic bone pain. Results: Our literature search identified 707 titles, of which 10 articles were selected for systematic review and seven entered the meta-analysis. Overall study quality was mediocre. Of the 2,694 patients initially treated for metastatic bone pain, 527 (20%) patients underwent reirradiation. Overall, a pain response after reirradiation was achieved in 58% of patients (pooled overall response rate 0.58, 95% confidence interval = 0.49-0.67). There was a substantial between-study heterogeneity (I{sup 2} = 63.3%, p = 0.01) because of clinical and methodological differences between studies. Conclusions: Reirradiation of painful bone metastases is effective in terms of pain relief for a small majority of patients; approximately 40% of patients do not benefit from reirradiation. Although the validity of results is limited, this meta-analysis provides a comprehensive overview and the most quantitative estimate of reirradiation effectiveness to date.

  19. [Chronic bone pain due to raised FGF23 production? The importance of determining phosphate levels

    NARCIS (Netherlands)

    Jongh, R.T. de; Vervloet, M.G.; Bravenboer, N.; Heijboer, A.C.; Heijer, M. den; Lips, P.

    2013-01-01

    Hypophosphatemia is an important finding in the evaluation of patients with chronic bone pain. Fibroblast-growth factor 23 (FGF23) plays a role in the differential diagnosis of hypophosphatemia. A 34-year-old man had progressive pain in both shoulders and hips due to hypophosphatemic osteomalacia. H

  20. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Naoki, E-mail: naokinak@luke.or.jp [Department of Radiation Oncology, St. Luke' s International Hospital, Tokyo (Japan); Shikama, Naoto [Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka (Japan); Wada, Hitoshi [Department of Radiation Oncology, Miyagi Cancer Center, Natori (Japan); Harada, Hideyuki [Division of Radiation Oncology, Shizuoka Cancer Center, Mishima (Japan); Nozaki, Miwako [Department of Radiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya (Japan); Nagakura, Hisayasu [Department of Radiology, KKR Sapporo Medical Center, Sapporo (Japan); Tago, Masao [Department of Radiology, Teikyo University Mizonokuchi Hospital, Kawasaki (Japan); Oguchi, Masahiko [Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo (Japan); Uchida, Nobue [Department of Radiation Oncology, Shimane University Hospital, Izumo (Japan)

    2012-05-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: 'time until first increase in pain' (85%), 'incidence of spinal cord compression' (50%), and 'incidence of pathologic fractures' (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  1. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K;

    2012-01-01

    and the bone bruise volume of the lateral femoral condyle. Patients with bone bruise of the medial tibia and patients with meniscal lesions had more pain. It is suggested that pain and decreased function after acute ACL injury most likely is related to soft tissue and cartilage injury and not to bone bruise....

  2.  Oncogenic osteomalacia and its symptoms: hypophosphatemia, bone pain and pathological fractures

    Directory of Open Access Journals (Sweden)

    Sonia Kaniuka-Jakubowska

    2012-08-01

    Full Text Available  Oncogenic osteomalacia (OOM is a rare paraneoplastic syndrome induced by tumor produced phosphaturic factors, i.e. phosphatonins. The disorder is characterized by renal tubular phosphate loss, secondary to this process hypophosphatemia and defective production of active form of vitamin D. The clinical course of oncogenic osteomalacia is characterized by bone pain, pathological fractures, muscle weakness and general fatigue. Osteomalacia-associated tumors are usually located in the upper and lower limbs, with half of the lesions primarily situated in the bones. Most of them are small, slow-growing tumors. Their insignificant size and various location coupled with rare occurrence of the disease and non-specificity of clinical symptoms lead to difficulties in reaching a diagnosis, which is often time-consuming and requires a number of additional tests. The average time between the appearance of the first symptoms and the establishment of an accurate diagnosis and the beginning of treatment is over 2.5 years. The aim of this study is to discuss the pathophysiology of disease symptoms, pathomorphology of tumors, diagnostic methods and treatment of oncogenic osteomalacia.

  3. Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

    International Nuclear Information System (INIS)

    Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

  4. Isotope bone scans in the assessment of children with hip pain or limp

    International Nuclear Information System (INIS)

    Bone scans from 43 children referred with hip pain of uncertain cause were reviewed. The bone scan was abnormal in 36 patients: normal in 7. In 12 the findings were diagnostic: osteomyelitis, osteoid osteoma, osteomyelitis with septic arthritis, Perthes' Disease and juvenile chronic arthritis. Twenty-four patients had abnormal scans including diffuse periarticular increase and of these 18 had transient synovitis. Immobilisation and trauma accounted for the remainder. Isotope bone scans have been found to be a valuable investigation in children presenting with hip pain or limp, where the X-rays may appear normal or nondiagnostic. (orig.)

  5. Pain relief by palliative radiotherapy in patients with advanced bone metastases

    Institute of Scientific and Technical Information of China (English)

    BU Jun-guo; YUAN Ya-wei

    2001-01-01

    To compare 3 local field radiation therapies for bone metastases to determine the strategy producing the best results. Methods: Among 104 patients with bone metastases, 30 patients were given 8 Gy in single fraction, 31 given 20 Gy in 5 fractions, 43 given 40Gy in 20 fractions. Results and Conclusion: The method of 40 Gy in 20 fractions had a higher pain relief rate and a lower pain relapse rate, suggesting that large-dose fractioned treatment regimen is more appropriate for patients with bone metastasis.

  6. Secondary bone grafting for alveolar cleft in children with cleft lip or cleft lip and palate

    NARCIS (Netherlands)

    J. Guo; C. Li; Q. Zhang; G. Wu; S.A. Deacon; J. Chen; H. Hu; S. Zou; Q. Ye

    2011-01-01

    BACKGROUND: Secondary alveolar bone grafting has been widely used to reconstruct alveolar cleft. However, there is still some controversy. OBJECTIVES: To compare the effectiveness and safety of different secondary bone grafting methods. SEARCH STRATEGY: The final electronic and handsearches were car

  7. Analgesic effects of lappaconitine in leukemia bone pain in a mouse model

    Directory of Open Access Journals (Sweden)

    Xiao-Cui Zhu

    2015-05-01

    Full Text Available Bone pain is a common and severe symptom in cancer patients. The present study employed a mouse model of leukemia bone pain by injection K562 cells into tibia of mouse to evaluate the analgesic effects of lappacontine. Our results showed that the lappaconitine treatment at day 15, 17 and 19 could effectively reduce the spontaneous pain scoring values, restore reduced degree in the inclined-plate test induced by injection of K562 cells, as well as restore paw mechanical withdrawal threshold and paw withdrawal thermal latency induced by injection of K562 cells to the normal levels. Additionally, the molecular mechanisms of lappaconitine’s analgesic effects may be related to affect the expression levels of endogenous opioid system genes (POMC, PENK and MOR, as well as apoptosis-related genes (Xiap, Smac, Bim, NF-κB and p53. Our present results indicated that lappaconitine may become a new analgesic agent for leukemia bone pain management.

  8. Gender differences in pain and secondary hyperalgesia after heat/capsaicin sensitization in healthy volunteers

    DEFF Research Database (Denmark)

    Jensen, Magnus Thorsten; Petersen, Karin Lottrup

    2006-01-01

    , but not total pain, during prolonged noxious thermal stimulation was higher in women. There was no gender difference in pain ratings during capsaicin sensitization or in heat pain detection thresholds. The results provided only limited support to the hypothesis that gender differences in clinical pain syndromes....../capsaicin sensitization, and heat pain detection thresholds. There was a trend toward smaller areas of secondary hyperalgesia in women. After adjusting for estimated gender differences in forearm surface area, areas to brush but not von Frey hair stimulation after capsaicin sensitization were larger in women. Peak pain...... can be explained by enhanced central sensitization in women. PERSPECTIVE: Our findings suggest that gender differences in nociceptive transmission and neuronal sensitization are small and provide only limited support to the hypothesis that gender differences in acute and chronic pain syndromes can...

  9. Bone

    Science.gov (United States)

    Helmberger, Thomas K.; Hoffmann, Ralf-Thorsten

    The typical clinical signs in bone tumours are pain, destruction and destabilization, immobilization, neurologic deficits, and finally functional impairment. Primary malignant bone tumours are a rare entity, accounting for about 0.2% of all malignancies. Also benign primary bone tumours are in total rare and mostly asymptomatic. The most common symptomatic benign bone tumour is osteoid osteoma with an incidence of 1:2000.

  10. [Effect of P2X7 receptor knock-out on bone cancer pain in mice].

    Science.gov (United States)

    Zhao, Xin; Liu, Hui-Zhu; Zhang, Yu-Qiu

    2016-06-25

    Cancer pain is one of the most common symptoms in patients with late stage cancer. Lung, breast and prostate carcinoma are the most common causes of pain from osseous metastasis. P2X7 receptor (P2X7R) is one of the subtypes of ATP-gated purinergic ion channel family, predominately distributed in microglia in the spinal cord. Activation of P2X7Rs in the spinal dorsal horn has been associated with release of proinflammatory cytokines from glial cells, causing increased neuronal excitability and exaggerated nociception. Mounting evidence implies a critical role of P2X7R in inflammatory and neuropathic pain. However, whether P2X7R is involved in cancer pain remains controversial. Here we established a bone cancer pain model by injecting the Lewis lung carcinoma cells into the femur bone marrow cavity of C57BL/6J wild-type mice (C57 WT mice) and P2X7R knockout mice (P2rx7(-/-) mice) to explore the role of P2X7R in bone cancer pain. Following intrafemur carcinoma inoculation, robust mechanical allodynia and thermal hyperalgesia in C57 WT mice were developed on day 7 and 14, respectively, and persisted for at least 28 days in the ipsilateral hindpaw of the affected limb. CatWalk gait analysis showed significant decreases in the print area and stand phase, and a significant increase in swing phase in the ipsilateral hindpaw on day 21 and 28 after carcinoma cells inoculation. Histopathological sections (hematoxylin and eosin stain) showed that the bone marrow of the affected femur was largely replaced by invading tumor cells, and the femur displayed medullary bone loss and bone destruction on day 28 after inoculation. Unexpectedly, no significant changes in bone cancer-induced hypersensitivity of pain behaviors were found in P2rx7(-/-) mice, and the changes of pain-related values in CatWalk gait analysis even occurred earlier in P2rx7(-/-) mice, as compared with C57 WT mice. Together with our previous study in rats that blockade of P2X7R significantly alleviated bone cancer

  11. Bone scintigraphy in chronic knee pain: comparison with magnetic resonance imaging

    Science.gov (United States)

    Boegard, T.; Rudling, O.; Dahlstrom, J.; Dirksen, H.; Petersson, I.; Jonsson, K.

    1999-01-01

    OBJECTIVE—To compare increased bone uptake of 99Tcm-MDP and magnetic resonance (MR) detected subchondral lesions, osteophytes, and cartilage defects in the knee in middle aged people with longstanding knee pain.
METHODS—Fifty eight people (aged 41-58 years, mean 50) with chronic knee pain, with or without radiographic knee osteoarthritis, were examined with bone scintigraphy. The pattern and the grade of increased bone uptake was assessed. On the same day, a MR examination on a 1.0 T imager was performed. The presence and the grade of subchondral lesions, osteophytes, and cartilage defects were registered.
RESULTS—The κ values describing the correlation between increased bone uptake and MR detected subchondral lesions varied between 0.79 and 0.49, and between increased bone uptake and MR detected osteophytes or cartilage defects the values were <0.54. The κ values describing the correlation between the grade of bone uptake and the grade of the different MR findings was <0.57.
CONCLUSIONS—Good agreement was found between increased bone uptake and MR detected subchondral lesion. The agreement between increased bone uptake and osteophytes or cartilage defects was in general poor as well as the agreement between the grade of bone uptake and the grade of the MR findings.

 Keywords: knee; osteoarthritis; magnetic resonance imaging; bone scintigraphy PMID:10343536

  12. The diagnostic value of bone scintigraphy in patients with low back pain

    International Nuclear Information System (INIS)

    Bone scintigraphy has been studied in two groups of patients presenting with low back pain. In one group of 38 patients suffering ''non-specific'' back pain, bone scintigraphy and laboratory findings were negative in 24. There were abnormal laboratory findings in all of the remaining 14 and 7 had positive bone scans indicative of clinically significant disease. Selection of patients for bone scintigraphy in this group should therefore be influenced by abnormal laboratory findings and elevation of the erythrocyte sedimentation rate in particular. By comparison, the bone scans were reviewed from another group of patients suffering previously known malignancy. Out of 138 patients, nearly 40% showed a positive bone scan due to subsequently proven metastasis. Bone scintigraphy was positive in a further 14% as a result of osteoporotic rib fracture and vertebral body collapse. In half of these, it was not possible to exclude malignancy by scintigraphy. The present findings indicate that bone scintigraphy is not a useful procedure in patients with long-standing low back pain who have normal radiographs and normal laboratory findings. (orig.)

  13. Secondary Alveolar Bone Grafting and Iliac Cancellous Bone Harvesting for Patients With Alveolar Cleft.

    Science.gov (United States)

    Pan, Weiyi; Wu, Chenzhou; Yang, Zheng; Duan, Zexi; Su, Zhifei; Wang, Peiqi; Zheng, Qian; Li, Chunjie

    2016-06-01

    To assess the efficacy of present interventions optimizing the result of secondary alveolar bone grafting (SABG) and the interventions alleviating the donor site morbidity after iliac cancellous bone harvesting. Researches were identified by searching the electronic database of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Chinese BioMedical Literature Database, and the China National Knowledge Infrastructure. In addition, relevant journals and references of the included studies were searched manually. The Oxford 2011 Levels of Evidence were applied to assess the methodological quality of selected studies, and the best evidence synthesis system was applied afterward to measure the strength of evidence. As a result, 42 studies were considered eligible and included, among which 4 were of high quality while 38 were of low quality. Thirty lines of evidences were acquired after the synthesis, among which 13 were rated as moderate while 17 were rated as insufficient. As for the interventions optimizing the result of SABG, moderate evidence confirmed the efficacy of preoperative orthodontic treatment, the superiority of performing SABG before the eruption of canine, and the accuracy of cone beam computed tomography in preoperative estimation of the cleft volume. As for the interventions alleviating the morbidity of iliac cancellous bone harvesting, moderate evidence confirmed the treatment benefit of the interventions below: minimally invasive technique, including trephine and Shepard osteotomy; preemptive analgesia, including continuous bupivacaine infusion or transversus abdominis plane block. As for the rest interventions, only insufficient evidence was found. PMID:27244214

  14. Inducible Lentivirus-Mediated siRNA against TLR4 Reduces Nociception in a Rat Model of Bone Cancer Pain

    OpenAIRE

    Ruirui Pan; Huiting Di; Jinming Zhang; Zhangxiang Huang; Yuming Sun; Weifeng Yu; Feixiang Wu

    2015-01-01

    Although bone cancer pain is still not fully understood by scientists and clinicians alike, studies suggest that toll like receptor 4 (TLR4) plays an important role in the initiation and/or maintenance of pathological pain state in bone cancer pain. A promising treatment for bone cancer pain is the downregulation of TLR4 by RNA interference; however, naked siRNA (small interference RNA) is not effective in long-term treatments. In order to concoct a viable prolonged treatment for bone cancer ...

  15. Regional variability in secondary remodeling within long bone cortices of catarrhine primates: the influence of bone growth history.

    Science.gov (United States)

    McFarlin, Shannon C; Terranova, Carl J; Zihlman, Adrienne L; Enlow, Donald H; Bromage, Timothy G

    2008-09-01

    Secondary intracortical remodeling of bone varies considerably among and within vertebrate skeletons. Although prior research has shed important light on its biomechanical significance, factors accounting for this variability remain poorly understood. We examined regional patterning of secondary osteonal bone in an ontogenetic series of wild-collected primates, at the midshaft femur and humerus of Chlorocebus (Cercopithecus) aethiops (n = 32) and Hylobates lar (n = 28), and the midshaft femur of Pan troglodytes (n = 12). Our major objectives were: 1) to determine whether secondary osteonal bone exhibits significant regional patterning across inner, mid-cortical and outer circumferential cortical rings within cross-sections; and if so, 2) to consider the manner in which this regional patterning may reflect the influence of relative tissue age and other circumstances of bone growth. Using same field-of-view images of 100-microm-thick cross-sections acquired in brightfield and circularly polarized light microscopy, we quantified the percent area of secondary osteonal bone (%HAV) for whole cross-sections and across the three circumferential rings within cross-sections. We expected bone areas with inner and middle rings to exhibit higher %HAV than the outer cortical ring within cross-sections, the latter comprising tissues of more recent depositional history. Observations of primary bone microstructural development provided an additional context in which to evaluate regional patterning of intracortical remodeling. Results demonstrated significant regional variability in %HAV within all skeletal sites. As predicted,%HAV was usually lowest in the outer cortical ring within cross-sections. However, regional patterning across inner vs. mid-cortical rings showed a more variable pattern across taxa, age classes, and skeletal sites examined. Observations of primary bone microstructure revealed that the distribution of endosteally deposited bone had an important influence on

  16. Bone scan: A useful test for evaluating patients with low back pain

    International Nuclear Information System (INIS)

    For many years it has been known that the sensitivity of bone scanning to the presence of destructive bony lesions favors its use in screning for bone metastases and osteomyelitis. More recently bone scanning has been routinely employed in evaluating benign skeletal pathology that may be the cause of low back pain. Bone scanning can play an important part identifying the cause of pain, clarifying the significance of radiographic findings, and evaluating the results of spinal surgery. This expansion of the role of nuclear medicine in diagnosing and managing low back pain is based in part upon novel diagnostic applications of 99mTc-methylene diphosphonate, a radiopharmaceutical that has been available for over 15 years. Equally important for this development, however, has been the recent availability of SPECT, a tomographic imaging technique that can be used to display the spine in a series of 6- to 8-mm thick sections. Slightly more than one-half of newly purchased gamma cameras are rotating systems suitable for bone SPECT studies. Thus, many community hospitals can now perform state-of-the-art bone scans for low back pain. (orig.)

  17. Topical Treatment with Xiaozheng Zhitong Paste (XZP Alleviates Bone Destruction and Bone Cancer Pain in a Rat Model of Prostate Cancer-Induced Bone Pain by Modulating the RANKL/RANK/OPG Signaling

    Directory of Open Access Journals (Sweden)

    Yanju Bao

    2015-01-01

    Full Text Available To explore the effects and mechanisms of Xiaozheng Zhitong Paste (XZP on bone cancer pain, Wistar rats were inoculated with vehicle or prostate cancer PC-3 into the tibia bone and treated topically with inert paste, XZP at 15.75, 31.5, or 63 g/kg twice per day for 21 days. Their bone structural damage, nociceptive behaviors, bone osteoclast and osteoblast activity, and the levels of OPG, RANL, RNAK, PTHrP, IGF-1, M-CSF, IL-8, and TNF-α were examined. In comparison with that in the placebo group, significantly reduced numbers of invaded cancer cells, decreased levels of bone damage and mechanical threshold and paw withdrawal latency, lower levels of serum TRACP5b, ICTP, PINP, and BAP, and less levels of bone osteoblast and osteoclast activity were detected in the XZP-treated rats (P<0.05. Moreover, significantly increased levels of bone OPG but significantly decreased levels of RANL, RNAK, PTHrP, IGF-1, M-CSF, IL-8, and TNF-α were detected in the XZP-treated rats (P<0.05 for all. Together, XZP treatment significantly mitigated the cancer-induced bone damage and bone osteoclast and osteoblast activity and alleviated prostate cancer-induced bone pain by modulating the RANKL/RANK/OPG pathway and bone cancer-related inflammation in rats.

  18. A case of thyroid medullary carcinoma with multiple painful bone metastases successfully treated with strontium-89 chloride

    International Nuclear Information System (INIS)

    A 70-year-old man was diagnosed as thyroid medullary carcinoma with multiple bone metastases. He underwent total thyroidectomy and cervical lymph node dissection. After one year, the pain from his bone lesions was becoming severe. To relieve the pain, he was administered opioids and external-beam radiation therapy. However, he continued to have substantial multiple bone pain. We used combination therapy of strontium-89 chloride for the treatment of widespread multiple bone pain and external-beam radiation therapy for localized pain. That combination therapy was effective and improved the quality of life (QOL) of the patient. We used strontium-89 chloride four times within one year, and no serious side effects occurred during therapy. Our thoroughly investigated case suggests that strontium-89 therapy is one of the effective and safe therapies for patients with painful bone metastases of thyroid medullary carcinoma. (author)

  19. Treatment efficacy of 153Sm-EDTMP for painful bone metastasis

    Directory of Open Access Journals (Sweden)

    Narjess Ayati

    2013-04-01

    Full Text Available Introduction: Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases. Methods: 28 patients (14 males and 14 females aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases. 1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed. Results: 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks (mean±SD=15.22±7.8. 64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. (Over all response to therapy was 85.7%. The lowest amount of peripheral blood cells was detected in the fourth week

  20. Treatment efficacy of 153Sm-EDTMP for painful bone metastasis

    Directory of Open Access Journals (Sweden)

    Narjess Ayati

    2013-04-01

    Full Text Available Introduction: Involvement of the skeleton can cause an excruciating pain in two-thirds of terminal patients with a history of malignancy. Due to several limitations of other therapies, such as analgesics, bisphosphonates, chemotherapy, hormonal therapy and external beam radiotherapy; bone-seeking radiopharmaceuticals have an important role in palliation of pain from bone metastases. Although these kinds of therapies have many advantages including the ability to treat multiple sites of tumoral involvement simultaneously, no significant confliction with other treatments, ease of administration and the potential to be used repetitively; in Iran using of this modality is not widely practiced. In this study we evaluated the clinical usefulness of Sm-153 lexidronamfor pain management of bone metastases. Methods: 28 patients (14 males and 14 females aged 38-77 years with a history of painful bone metastases caused by different cancers, not responding to conventional treatments were included in the study. All patients had a recent whole body bone scan indicating multiple bone metastases. 1 mCi/Kg Sm-153 lexidronam was injected intravenously to the patients. Whole body scintigraphy was done 3 or 18 hours post injection. Pain relief and quality of life have been evaluated by analog pain scale and Karnofsky index every week, respectively. Also, all patients were evaluated for hematological toxicity every two weeks. Active follow ups were performed. Results: 43% of patients showed the presence of the flare phenomenon during the first three days after Sm injection with a mean duration of 2.2 days. The pain relief began between 2 and 16 days post injection and the duration of pain palliation was in the range of 4 to 32 weeks (mean±SD=15.22±7.8. 64.3% of patients showed complete relief of pain and 21.4% achieved partial response to therapy. (Over all response to therapy was 85.7%. The lowest amount of peripheral blood cells was detected in the fourth week

  1. Analgesic effects of adenylyl cyclase inhibitor NB001 on bone cancer pain in a mouse model

    Science.gov (United States)

    Kang, Wen-bo; Yang, Qi; Guo, Yan-yan; Wang, Lu; Wang, Dong-sheng; Cheng, Qiang; Li, Xiao-ming; Tang, Jun; Zhao, Jian-ning; Liu, Gang; Zhuo, Min

    2016-01-01

    Background Cancer pain, especially the one caused by metastasis in bones, is a severe type of pain. Pain becomes chronic unless its causes and consequences are resolved. With improvements in cancer detection and survival among patients, pain has been considered as a great challenge because traditional therapies are partially effective in terms of providing relief. Cancer pain mechanisms are more poorly understood than neuropathic and inflammatory pain states. Chronic inflammatory pain and neuropathic pain are influenced by NB001, an adenylyl cyclase 1 (AC1)-specific inhibitor with analgesic effects. In this study, the analgesic effects of NB001 on cancer pain were evaluated. Results Pain was induced by injecting osteolytic murine sarcoma cell NCTC 2472 into the intramedullary cavity of the femur of mice. The mice injected with sarcoma cells for four weeks exhibited significant spontaneous pain behavior and mechanical allodynia. The continuous systemic application of NB001 (30 mg/kg, intraperitoneally, twice daily for three days) markedly decreased the number of spontaneous lifting but increased the mechanical paw withdrawal threshold. NB001 decreased the concentrations of cAMP and the levels of GluN2A, GluN2B, p-GluA1 (831), and p-GluA1 (845) in the anterior cingulate cortex, and inhibited the frequency of presynaptic neurotransmitter release in the anterior cingulate cortex of the mouse models. Conclusions NB001 may serve as a novel analgesic to treat bone cancer pain. Its analgesic effect is at least partially due to the inhibition of AC1 in anterior cingulate cortex. PMID:27612915

  2. Therapy for bone pain palliation in skeletal metastases with Samarium -153 EDTMP (Indonesian experience)

    International Nuclear Information System (INIS)

    Full text: Radiopharmaceutical therapy may be used for the treatment of cases with painful skeletal metastases. We evaluate and want to share an experience with application and efficacy of Sm-153 EDTMP in palliative painful bone metastases therapy. Our aim was to determine the efficacy and toxicity of single-dose Sm- 153 EDTMP as a palliative treatment for painful skeletal metastases. Material and methods: we selected 18 patients (9 male, 9 female). The average age 35-65 years weight 40- 60 kg; with metastatic bone confirmed with bone scan examination. 6 with breast cancer, 5 with nasopharyngeal cancer, 5 with prostatic cancer, 2 with lung cancer were treated with 30 mCi ( 1110 MBq) Sm-153 EDTMP. All showed extensive metastatic bone disease. The patients were given intravenous injections of 30 mCi Sm-153 EDTMP, after reconditioning, hydration . We established intensity of pain, haematological parameters, scintigraphic, Karnofsky scale. Clinical assessment was performed one month later. Responses were classified in completed (good response), partial and absent taking into account symptoms and drugs reduction. The discontinuation or the reduction of analgesic drugs like opiate dosage was also considered as successful palliative results of the treatment. Result: pain relief was obtained in 16/18 patients, Sm-153 was effective in patients with reduced drug assumption. The response to Sm-153 was good in 14/18(77,7%) of the patients and partial in 3/18(16,6%) and no response in 1/18(0,5%). The application of Sm-153 in patients with painful disseminated bone metastases has a satisfactory pain alleviating effects. Sides effects were noted, decrease hemoglobin counts and white blood cell and platelets, which gradually returned to near normal after 6 weeks. Easy application and low cost and produced in own country are important factors. Conclusion: radiopharmaceutical therapy can be recommended because of the favorable palliation effect and the low cost of Sm-153, especially

  3. Labelling of Re-ABP with {sup 188}Re for bone pain palliation

    Energy Technology Data Exchange (ETDEWEB)

    Arteaga de Murphy, Consuelo E-mail: cmurphy@data.net.mx; Ferro-Flores, Guillermina; Pedraza-Lopez, Martha; Melendez-Alafort, Laura; Croft, B.Y.Barbara Y.; Ramirez, Flor de Maria; Padilla, Juan

    2001-03-01

    Etidronate and medronate have been labelled with technetium-99m ({sup 99m}Tc-HEDP, {sup 99m}Tc-MDP) for bone scanning and, with rhenium-188 ({sup 188}Re-HEDP) to palliate the pain resulting from bone metastases. The objective of this study was to label alendronate, ABP, a new bisphosphonate, with SnF{sub 2}-reduced-{sup 188}Re. The reagents for the 5 mg ABP kit were SnF{sub 2}, KReO{sub 4} and gentisic acid at acid pH. The chemical, spectroscopic and microscopic characteristics, quality control, rat bone uptake of [{sup 188}Re]Re-ABP and similarities with {sup 99m}Tc-ABP are presented. We conclude that this is a promising new radiopharmaceutical for bone metastases pain palliation.

  4. Back Pain in Children and Diagnostic Value of 99mTc MDP Bone Scintigraphy

    OpenAIRE

    Alkhawaldeh, Khaled; Ghuweri, Ali AL; Kawar, Jane; Jaafreh, Amany

    2014-01-01

    ABSTRACT Aim: The aim of our study is to assess the diagnostic value of Technituim-99m-Methyle diphosphonate (99mTc-MDP) Bone scintigraphy in the assessment of children with back pain. Methods: Included in this retrospective study were 68 child referred to us complaining of back pain (mean age of 13+ 2). There were 45 boys and 23 girls. All children have been investigated with conventional x-ray which revealed normal or inconclusive result. All underwent bone scintigraphy after the injection ...

  5. Improving radionuclide therapy in prostate cancer patients with metastatic bone pain

    OpenAIRE

    Lam, M. G. E. H.

    2009-01-01

    Bone seeking radiopharmaceuticals are indicated in cancer patients with multiple painful skeletal metastases. The majority of these patients are hormone-refractory prostate cancer patients in an advanced stage of their disease. Bone seeking radiopharmaceuticals relieve pain and improve the patients quality of life. The mostly used radiopharmaceuticals are 89SrCl2 (Metastron), 153Sm-EDTMP (Quadramet) and 186Re-HEDP. Differences between 89SrCl2, 153Sm-EDTMP and 186Re-HEDP were investigated. It ...

  6. Topical Treatment with Xiaozheng Zhitong Paste (XZP) Alleviates Bone Destruction and Bone Cancer Pain in a Rat Model of Prostate Cancer-Induced Bone Pain by Modulating the RANKL/RANK/OPG Signaling

    OpenAIRE

    Yanju Bao; Yebo Gao; Maobo Du; Wei Hou; Liping Yang; Xiangying Kong; Honggang Zheng; Weidong Li; Baojin Hua

    2015-01-01

    To explore the effects and mechanisms of Xiaozheng Zhitong Paste (XZP) on bone cancer pain, Wistar rats were inoculated with vehicle or prostate cancer PC-3 into the tibia bone and treated topically with inert paste, XZP at 15.75, 31.5, or 63 g/kg twice per day for 21 days. Their bone structural damage, nociceptive behaviors, bone osteoclast and osteoblast activity, and the levels of OPG, RANL, RNAK, PTHrP, IGF-1, M-CSF, IL-8, and TNF-α were examined. In comparison with that in the placebo gr...

  7. Value of percutaneous radiofrequency ablation with or without percutaneous vertebroplasty for pain relief and functional recovery in painful bone metastases

    Energy Technology Data Exchange (ETDEWEB)

    Clarencon, Frederic; Jean, Betty; Cormier, Evelyne; Chiras, Jacques [Pitie-Salpetriere Hospital, Department of Neuroradiology, Paris (France); Pham, Hang-Phuong; Bensimon, Gilbert [Pitie-Salpetriere Hospital, Department of Clinical Pharmacology, Paris (France); Rose, Michele [Pitie-Salpetriere Hospital, Department of Critical Care, Paris (France); Maksud, Philippe [Pitie-Salpetriere Hospital, Assistance Publique des, Hopitaux de Paris, Department of Nuclear Medicine, Paris (France)

    2013-01-15

    To evaluate the effectiveness of percutaneous radiofrequency (RF) ablation with or without percutaneous vertebroplasty (PV) on pain relief, functional recovery and local recurrence at 6 months' follow-up (FU), in patients with painful osseous metastases. Thirty RF ablations were performed in 24 patients (mean age: 61 years) with bone metastases. Half of the patients had an additional PV. The primary end point was pain relief evaluated by a visual analogue scale (VAS) before treatment, and at 1 and 6 months' FU. Functional outcome was assessed according to the evolution of their ability to walk at 6 months' FU. Imaging FU was available in 20 out of 24 patients with a mean delay of 4.7 months. Reduction of pain was obtained at 6 months FU in 81% of cases (15 out of 18). Mean pretreatment VAS was 6.4 ({+-}2.7). Mean VAS was 1.9 ({+-}2.4) at 1 month FU, and 2.3 ({+-}2.9) at 6 months' FU. Pain was significantly reduced at 6 months FU (mean VAS reduction = 4.1; P < 0.00001). Functional improvement was obtained in 74% of the cases. Major complications rate was 12.5 % (3 out of 24) with 2 skin burns, and 1 case of myelopathy. Local tumour recurrence or progression was recorded in 5 cases. Radiofrequency ablation is an effective technique in terms of pain relief and functional recovery for the treatment of bone metastases, which provides a relatively low rate of local recurrence. (orig.)

  8. The value of SPECT bone scans in diagnosis of patients with zygapophseal joint pain

    International Nuclear Information System (INIS)

    Objective: Bone scintigraphy with SPECT of the lumbar spine allows identification of lesions not seen with planar imaging, in patients with chronic low back pain. The aim of this study was to investigate the value of SPECT bone scans in diagnosis of patients with zygapophyseal joint pain. Methods: Thirty-five consecutive patients in Ruijin hospital from July 2006 to March 2007 with low back pain were en- rolled. All patients underwent bone scintigraphy with SPECT. According to the results of SPECT, patients with isotope-uptake joints received injections at the levels where abnormalities were identified on the scan. Patients with negative scans received other treatment (conservative treatment or surgery) but not facet joint injection. Clinical records were collected at 1-, 3-, and 6-month in SPECT-positive group after their initial treatment. And the SPECT-negative group were followed up at 6-month after therapy. Statistical analysis was performed with SPSS 10.0. Patients with SPECT-positive and -negative results were performed with the grouped t-test. Visual analog scales (VAS) were with the paired t-test used in patients with positive scans at before and after treatment. Results: Fifteen cases had facetal uptake of isotope on SPECT bone scans. After facet joint injection, 85.7% patients (12/14, 1 patient was excluded for operation) had improvement in pain score at 1-month, 78.6% (11/14) at 3-month, and 50.0% (7/14) at 6-month. Of 20 negative cases, 3 were treated by surgery and 17 by conservative treatment. All 20 cases were followed up for 6 months and 70.0% (14/20) had long time pain relief. Conclusion: SPECT bone scans are helpful to identify patients with low back pain who would benefit from facet joint injections. (authors)

  9. Minimally invasive procedures for the management of vertebral bone pain due to cancer

    DEFF Research Database (Denmark)

    Mercadante, Sebastiano; Klepstad, Pål; Kurita, Geana Paula;

    2016-01-01

    BACKGROUND: Image-guided percutaneous ablation methods have proved effective for treatment of benign bone tumors and for palliation of metastases involving the bone. However, the role of these techniques is controversial and has to be better defined in the setting of palliative care. METHODS......: A systematic review of the existing data regarding minimally invasive techniques for the pain management of vertebral bone metastases was performed by experts of the European Palliative Care Research Network. RESULTS: Only five papers were taken into consideration after performing rigorous screening according...

  10. Effectiveness of the radioactive strontium (89Sr) chloride agent, SMS.2P for pain palliation in patients with metastatic bone tumor in phase III multicenter clinical trial

    International Nuclear Information System (INIS)

    The phase III clinical trial of strontium-89 chloride agent (SMS.2P) was performed in 90 patients with painful bone metastases secondary to prostate (53), breast (18) and other types of cancer (19). Some patients experienced a transient increase in pain or nausea and vomiting. However both symptoms subsided and serious side effects were not observed in any of the patients. As reported, we confirmed some abnormal changes in peripheral blood picture. A decrease in the number of white blood cells and platelets was considered to be partly a result of bone marrow suppression due to 89Sr irradiation. Pain was substantially improved after 89Sr therapy in 58% of the patients and there was some alleviation in 12%. The release from pain was accompanied by an improved quality of life for these patients including sleep patterns and morbidity. Some patients were able to resume their former life styles. Most of the improved patients experienced pain relief from days to one week following 89Sr therapy and in half cases, this remained effective for 2 or 3 months. There were even cases in which the pain relief continued over an observation period of time of clinical study. (author)

  11. Initial experience of single fraction radiotherapy (8 Gy x 1) in the treatment of painful bone metastases

    International Nuclear Information System (INIS)

    Sixteen patients with painful bone metastases received single fraction radiotherapy of 8 Gy. Single fraction radiotherapy was effective in providing pain relief with response rate of 88.8%. There were no severe acute side effects. The therapeutic regimen was also safe and effective in patients with poor performance status and poor prognosis. Therefore single fraction radiotherapy should be considered to treat pain arising from bone metastases. (author)

  12. Inducible Lentivirus-Mediated siRNA against TLR4 Reduces Nociception in a Rat Model of Bone Cancer Pain.

    Science.gov (United States)

    Pan, Ruirui; Di, Huiting; Zhang, Jinming; Huang, Zhangxiang; Sun, Yuming; Yu, Weifeng; Wu, Feixiang

    2015-01-01

    Although bone cancer pain is still not fully understood by scientists and clinicians alike, studies suggest that toll like receptor 4 (TLR4) plays an important role in the initiation and/or maintenance of pathological pain state in bone cancer pain. A promising treatment for bone cancer pain is the downregulation of TLR4 by RNA interference; however, naked siRNA (small interference RNA) is not effective in long-term treatments. In order to concoct a viable prolonged treatment for bone cancer pain, an inducible lentivirus LvOn-siTLR4 (tetracycline inducible lentivirus carrying siRNA targeting TLR4) was prepared and the antinociception effects were observed in bone cancer pain rats induced by Walker 256 cells injection in left leg. Results showed that LvOn-siTLR4 intrathecal injection with doxycycline (Dox) oral administration effectively reduced the nociception induced by Walker 256 cells while inhibiting the mRNA and protein expression of TLR4. Proinflammatory cytokines as TNF-α and IL-1β in spinal cord were also decreased. These findings suggest that TLR4 could be a target for bone cancer pain treatment and tetracycline inducible lentivirus LvOn-siTLR4 represents a new potential option for long-term treatment of bone cancer pain. PMID:26556957

  13. Inducible Lentivirus-Mediated siRNA against TLR4 Reduces Nociception in a Rat Model of Bone Cancer Pain

    Directory of Open Access Journals (Sweden)

    Ruirui Pan

    2015-01-01

    Full Text Available Although bone cancer pain is still not fully understood by scientists and clinicians alike, studies suggest that toll like receptor 4 (TLR4 plays an important role in the initiation and/or maintenance of pathological pain state in bone cancer pain. A promising treatment for bone cancer pain is the downregulation of TLR4 by RNA interference; however, naked siRNA (small interference RNA is not effective in long-term treatments. In order to concoct a viable prolonged treatment for bone cancer pain, an inducible lentivirus LvOn-siTLR4 (tetracycline inducible lentivirus carrying siRNA targeting TLR4 was prepared and the antinociception effects were observed in bone cancer pain rats induced by Walker 256 cells injection in left leg. Results showed that LvOn-siTLR4 intrathecal injection with doxycycline (Dox oral administration effectively reduced the nociception induced by Walker 256 cells while inhibiting the mRNA and protein expression of TLR4. Proinflammatory cytokines as TNF-α and IL-1β in spinal cord were also decreased. These findings suggest that TLR4 could be a target for bone cancer pain treatment and tetracycline inducible lentivirus LvOn-siTLR4 represents a new potential option for long-term treatment of bone cancer pain.

  14. Bone scanning in patients with low back pain following minimal trauma

    International Nuclear Information System (INIS)

    Full text: Low back pain following minimal trauma may be caused by insufficiency fracture of the sacrum, which is often radiographically occult. Bone scintigraphy is a method of reference for the diagnosis; the results have been analyzed retrospectively. Bone scintigraphy was done on 228 patients treated by the departments of orthopedics at the General Hospital Linz. Predominantly after (minor) trauma, they suffered from lower back pain and their conventional radiographic findings were negative. During a 24 month period, a sacral insufficiency fracture was diagnosed in 68 patients (29,8 %). H-shaped hyperfixation of the tracer - described as typical - was present in only 12 % of the gases. Tracer accumulation was found as follows: located uni/bilateral in the sacral wings (39 % / 9 %), horizontal (31 %) and half H-shaped (9 %). In the majority of the gases bone scan detected farther fractures with main localization in the pubic bones, in the spine and the ribs. The insufficiency fracture of the sacrum as cause of lower back pain is not uncommon, especially in postmenopausal women with risk factors. Bone scintigraphy is not only an adequate procedure for the detection of often radiographically occult sacral fractures, but also an easy method to reveal the often concomitand fractures. (author)

  15. Primary and secondary somatosensory cortex responses to anticipation and pain: a magnetoencephalography study.

    Science.gov (United States)

    Worthen, Siân F; Hobson, Anthony R; Hall, Stephen D; Aziz, Qasim; Furlong, Paul L

    2011-03-01

    Several brain regions, including the primary and secondary somatosensory cortices (SI and SII, respectively), are functionally active during the pain experience. Both of these regions are thought to be involved in the sensory-discriminative processing of pain and recent evidence suggests that SI in particular may also be involved in more affective processing. In this study we used MEG to investigate the hypothesis that frequency-specific oscillatory activity may be differentially associated with the sensory and affective components of pain. In eight healthy participants (four male), MEG was recorded during a visceral pain experiment comprising baseline, anticipation, pain and post-pain phases. Pain was delivered via intraluminal oesophageal balloon distension (four stimuli at 1 Hz). Significant bilateral but asymmetrical changes in neural activity occurred in the β-band within SI and SII. In SI, a continuous increase in neural activity occurred during the anticipation phase (20-30 Hz), which continued during the pain phase but at a lower frequency (10-15 Hz). In SII, oscillatory changes only occurred during the pain phase, predominantly in the 20-30 Hz β band, and were coincident with the stimulus. These data provide novel evidence of functional diversity within SI, indicating a role in attentional and sensory aspects of pain processing. In SII, oscillatory changes were predominantly stimulus-related, indicating a role in encoding the characteristics of the stimulus. We therefore provide objective evidence of functional heterogeneity within SI and functional segregation between SI and SII, and suggest that the temporal and frequency dynamics within cortical regions may offer valuable insights into pain processing.

  16. Radiopharmaceuticals for the palliation of painful bone metastases-a systematic review

    International Nuclear Information System (INIS)

    Background and Purpose: The purpose was to develop a systematic review that would address the following question: what is the role of radiopharmaceuticals in the palliation of metastatic bone pain in adults with uncomplicated, multifocal painful bone metastases whose pain is not controlled with conventional analgesic regimens? The outcomes of interest are pain response, analgesic consumption, overall survival, adverse effects and quality of life. Materials and methods: A systematic review of the English published literature was undertaken to provide evidence relevant to the above outcomes. Results: Six randomized phase III trials, two randomized phase II trials and one randomized crossover trial of strontium-89 were reviewed. A randomized phase III trial comparing strontium-89 plus cisplatin with strontium-89 plus placebo reported a significantly higher proportion of patients experiencing pain relief for a significantly longer duration with strontium-89 plus cisplatin. A randomized phase III trial comparing adjuvant strontium-89 with placebo following radiotherapy reported a higher proportion of pain-free patients with strontium-89. Patients who received strontium-89 also experienced fewer new sites of bone pain. A second, but underpowered study failed to confirm these results. In one randomized trial of strontium-89 versus radiotherapy (hemibody or local), patients treated with strontium-89 developed fewer new sites of pain. In a second trial comparing strontium-89 versus local radiotherapy, median overall survival was improved with radiotherapy, while pain response and time-to-progression were similar in the two groups. One randomized phase III trial reported no difference in pain relief between strontium-89 and placebo. Three randomized phase III trials and two randomized phase II trials investigating samarium-153 were reviewed. In a randomized phase III trial of three different doses of samarium-153, the pain responses were similar for all three doses. In a

  17. Biological evaluation of 175Yb-EDTMP as radiopharmaceutical for bone pain palliation

    International Nuclear Information System (INIS)

    Ideal radiopharmaceutical used as bone pain palliatives requires a moderate energy β emitter with a stable carrier molecule. Ytterbium-175 (T1/2 = 4.2 d, Eβ(max) = 0,480 MeV) has radionuclide properties suitable for palliative therapy of bone metastases. Ethylenediamine tetramethylene phosphonic acid (EDTMP) is known to form complexes with high stability. The present study was conducted to evaluate EDTMP complexed with 175Yb as radiopharmaceutical for bone imaging and potential agents for bone palliation which produced by PTNBR-BATAN Bandung. The 175Yb-EDTMP radiopharmaceutical was tested for the biodistribution and blood clearance. The bone uptake of 175Yb-EDTMP complexes are 12.68; 11.83; 10.00; and 8.20 (%ID) at 1, 3, 5 and 24 h post-injection. The radioactivity level in the stomach was 0.06 (%ID/g) up to 24 h post-injection, indicating that 175Yb-Emptied remained stable in vivo. The blood clearance study exhibited that 175Yb-Emptied had fast clearence profile from blood.This study showed that 175Yb-EDTMP is potential as radiopharmaceutical for bone pain palliation agents. (author)

  18. The role of alpha 6 integrin in prostate cancer migration and bone pain in a novel xenograft model.

    Directory of Open Access Journals (Sweden)

    Tamara E King

    Full Text Available Of the estimated 565,650 people in the U.S. who will die of cancer in 2008, almost all will have metastasis. Breast, prostate, kidney, thyroid and lung cancers metastasize to the bone. Tumor cells reside within the bone using integrin type cell adhesion receptors and elicit incapacitating bone pain and fractures. In particular, metastatic human prostate tumors express and cleave the integrin A6, a receptor for extracellular matrix components of the bone, i.e., laminin 332 and laminin 511. More than 50% of all prostate cancer patients develop severe bone pain during their remaining lifetime. One major goal is to prevent or delay cancer induced bone pain. We used a novel xenograft mouse model to directly determine if bone pain could be prevented by blocking the known cleavage of the A6 integrin adhesion receptor. Human tumor cells expressing either the wildtype or mutated A6 integrin were placed within the living bone matrix and 21 days later, integrin expression was confirmed by RT-PCR, radiographs were collected and behavioral measurements of spontaneous and evoked pain performed. All animals independent of integrin status had indistinguishable tumor burden and developed bone loss 21 days after surgery. A comparison of animals containing the wild type or mutated integrin revealed that tumor cells expressing the mutated integrin resulted in a dramatic decrease in bone loss, unicortical or bicortical fractures and a decrease in the ability of tumor cells to reach the epiphyseal plate of the bone. Further, tumor cells within the bone expressing the integrin mutation prevented cancer induced spontaneous flinching, tactile allodynia, and movement evoked pain. Preventing A6 integrin cleavage on the prostate tumor cell surface decreased the migration of tumor cells within the bone and the onset and degree of bone pain and fractures. These results suggest that strategies for blocking the cleavage of the adhesion receptors on the tumor cell surface can

  19. Short- term curative effects of Boning on relieving pain of bone metastasis of lung cancer%博宁缓解肺癌骨转移疼痛的近期疗效

    Institute of Scientific and Technical Information of China (English)

    岳莉; 吴红卫; 薛海鸥; 王新华

    2002-01-01

    @@ Background:23.8% patients with late stage lung cancer accompany bone metastasis, which bring about severe pain and make great influence on patients' living quality.Boning is the representation of domestic second generation Diphosphonate, which take good curative effects on bone pain caused by bone metastasis of malignant tumor.

  20. Studies on {sup 177}Lu-labeled methylene diphosphonate as potential bone-seeking radiopharmaceutical for bone pain palliation

    Energy Technology Data Exchange (ETDEWEB)

    Abbasi, Imtiaz Ahmed, E-mail: imtiaz_abbasi@yahoo.co

    2011-04-15

    Objective: {sup 99m}Tc-MDP (technetium-99{sup m}-labeled methylene diphosphonate) has been widely used as a radiopharmaceutical for bone scintigraphy in cases of metastatic bone disease. {sup 177}Lu is presently considered as an excellent radionuclide for developing bone pain palliation agents. No study on preparing a complex of {sup 177}Lu with MDP has been reported yet. Based on these facts, it was hypothesized that a bone-seeking {sup 177}Lu-MDP (lutetium-177-labeled MDP) radiopharmaceutical could be developed as an agent for palliative radiotherapy of bone pain due to skeletal metastases. Biodistribution studies after intravenous injection of {sup 177}Lu-MDP complex in rats may yield important information to assess its potential for clinical use as a bone pain palliation agent for the treatment of bone metastases. Methods: {sup 177}Lu was produced by irradiating natural Lu{sub 2}O{sub 3} (10 mg) target at a thermal flux {approx}8.0x10{sup 13} n/cm{sup 2} per second for 12 h in the swimming pool-type reactor.{sup 177}Lu was labeled with MDP by adding nearly 37 MBq (1.0 mCi) of {sup 177}LuCl{sub 3} to a vial containing 10 mg MDP. The radiochemical purity and labeling efficiencies were determined by thin layer chromatography. Labeling of {sup 177}Lu with MDP was optimized, and one sample was subjected to high-performance liquid chromatography (HPLC) analysis. Twelve Sprague-Dawley rats were injected with 18.5 MBq (0.5 mCi). {sup 177}Lu-MDP in a volume of 0.1 ml was injected intravenously and then sacrificed at 2 min, 1 h, 2 h and 22 h (three rats at each time point) after injection. Samples of various organs were separated, weighed and measured for radioactivity and expressed as percent uptake of injected dose per gram. Bioevaluation studies with rats under gamma-camera were also performed to verify the results. Results: The quality control using thin layer chromatography has shown >99% radiochemical purity of {sup 177}Lu-MDP complex. Chromatography with Whatman 3

  1. Lutetium-177-EDTMP for pain palliation in bone metastases

    International Nuclear Information System (INIS)

    Experiences with the new palliative agent Lu-177 EDTMP are summarized. The production of primary 177Lu by the 176Lu(n,γ) 177Lu reaction and the synthesis of the radioactive complex are described as well as the procedures used for the control of the radionuclidic and the radiochemical purity. The stability of the compound has been also studied. The in vivo essays with rats and the use of the radiopharmaceutical, after a careful dose evaluation, in a patient with bone metastases from a breast cancer, show that the behaviour of Lu-177 EDTMP is similar to that of the analogue Sm-153 EDTMP. (author)

  2. Pathobiology and management of prostate cancer-induced bone pain: recent insights and future treatments.

    Science.gov (United States)

    Muralidharan, Arjun; Smith, Maree T

    2013-10-01

    Prostate cancer (PCa) has a high propensity for metastasis to bone. Despite the availability of multiple treatment options for relief of PCa-induced bone pain (PCIBP), satisfactory relief of intractable pain in patients with advanced bony metastases is challenging for the clinicians because currently available analgesic drugs are often limited by poor efficacy and/or dose-limiting side effects. Rodent models developed in the past decade show that the pathobiology of PCIBP comprises elements of inflammatory, neuropathic and ischemic pain arising from ectopic sprouting and sensitization of sensory nerve fibres within PCa-invaded bones. In addition, at the cellular level, PCIBP is underpinned by dynamic cross talk between metastatic PCa cells, cellular components of the bone matrix, factors associated with the bone microenvironment as well as peripheral components of the somatosensory system. These insights are aligned with the clinical management of PCIBP involving use of a multimodal treatment approach comprising analgesic agents (opioids, NSAIDs), radiotherapy, radioisotopes, cancer chemotherapy agents and bisphosphonates. However, a major drawback of most rodent models of PCIBP is their short-term applicability due to ethical concerns. Thus, it has been difficult to gain insight into the mal(adaptive) neuroplastic changes occurring at multiple levels of the somatosensory system that likely contribute to intractable pain at the advanced stages of metastatic disease. Specifically, the functional responsiveness of noxious circuitry as well as the neurochemical signature of a broad array of pro-hyperalgesic mediators in the dorsal root ganglia and spinal cord of rodent models of PCIBP is relatively poorly characterized. Hence, recent work from our laboratory to develop a protocol for an optimized rat model of PCIBP will enable these knowledge gaps to be addressed as well as identification of novel targets for drug discovery programs aimed at producing new analgesics

  3. Calpain Inhibitor Reduces Cancer-induced Bone Pain Possibly Through Inhibition of Osteoclastogenesis in Rat Cancer-induced Bone Pain Model

    Institute of Scientific and Technical Information of China (English)

    Jia-Ying Xu; Yu Jiang; Wei Liu; Yu-Guang Huang

    2015-01-01

    Background:Calpain,a calcium-dependent cysteine protease,has been demonstrated to regulate osteoclastogenesis,which is considered one of the major reasons for cancer-induced bone pain (CIBP).In the present study,calpain inhibitor was applied in a rat CIBP model to determine whether it could reduce CIBP through regulation of osteoclastogenesis activity.Methods:A rat CIBP model was established with intratibial injection of Walker 256 cells.Then,the efficacy of intraperitoneal administered calpain inhibitor Ⅲ (MDL28170,1 mg/kg) on mechanical withdrawal threshold (MWT) of bilateral hind paws was examined on postoperative days (PODs) 2,5,8,11,and 14.On POD 14,the calpain inhibitor's effect on tumor bone tartrate-resistant acid phosphatase (TRAP) stain and radiology was also carefully investigated.Results:Pain behavioral tests in rats showed that the calpain inhibitor effectively attenuated MWTs of both the surgical side and contralateral side hind paws on POD 5,8,and 11 (P < 0.05).TRAP-positive cell count of the surgical side bone was significantly decreased in the calpain inhibitor group compared with the vehicle group (P < 0.05).However,bone resorption and destruction measured by radiographs showed no difference between the two groups.Conclusions:Calpain inhibitor can effectively reduce CIBP of both the surgical side and nonsurgical side after tumor injection in a rat CIBP model.It may be due to the inhibition of receptor activator of nuclear factor-kappa B ligand-induced osteoclastogenesis.Whether a calpain inhibitor could be a novel therapeutic target to treat CIBP needs further investigation.

  4. P2X7 receptor-mediated analgesia in cancer-induced bone pain

    DEFF Research Database (Denmark)

    Falk, Sarah; D. Schwab, Samantha; Frøsig-Jørgensen, Majbrit;

    2015-01-01

    to low intensity or electrical stimulation. In contrast, A839977 had no effect on the tested parameters in naïve or sham animals. In awake animals, 40mg/kg A839977 (i.p) significantly reduced both early and late stage pain behavior. In contrast, no effect was observed in sham or vehicle-treated animals....... The results suggest that the P2X7R is involved in the mechanisms of cancer-induced bone pain, and that P2X7R antagonism might be a useful analgesic target. No effect was observed in sham or naïve animals, indicating that the P2X7R-mediated effect is state-dependent, and might therefore be an advantageous......Pain is a common and debilitating complication for cancer patients significantly compromising their quality of life. Cancer-induced bone pain involves a complex interplay of molecular events, including mechanisms observed in inflammatory and neuropathic pain states, but also changes unique...

  5. Methods of reducing pain during bone marrow biopsy: a narrative review.

    Science.gov (United States)

    Zahid, Mohammad Faizan

    2015-10-01

    Bone marrow examination plays a crucial role in the diagnosis and management of various hematological and systemic diseases. Even though the procedure has been carried out for decades, it remains an extremely painful and uncomfortable experience for a majority of patients. This paper reviews the different strategies used to provide analgesia and summarizes the advantages and drawbacks of one strategy over the other. A literature review was carried out addressing the different approaches to providing pain relief during bone marrow aspiration and biopsy. Several different methods, procedure modifications and protocols are employed at various centers but pain control and analgesia remain incomplete. Local infiltration with lidocaine or similar local analgesics is the standard at most centers. Although there is limited data, there are several studies in literature demonstrating the pain relieving effects of different methods and drugs when used with local anesthetics. Sedation, usually using benzodiazepines, reduces anticipatory anxiety, provides analgesia and also short term amnesia. Combinations of different agents not only yield potent effects but also reduce the required dose of each individual drug, minimizing adverse effects. Non-pharmacological factors also play key roles. Providing patients with complete and comprehensible information is vital to ensure the least amount of discomfort during the biopsy. Distraction techniques, such as cognitive behavioral therapy, hypnosis and music therapy, may also play a role in minimizing pain. PMID:26541397

  6. Differential effects of repeated low dose treatment with the cannabinoid agonist WIN 55,212-2 in experimental models of bone cancer pain and neuropathic pain

    DEFF Research Database (Denmark)

    Hald, Andreas; Ding, Ming; Egerod, Kristoffer Lihme;

    2008-01-01

    Pain due to bone malignancies is one of the most difficult types of cancer pain to fully control and may further decrease the patients' quality of life. Animal models of chronic pain conditions resulting from peripheral inflammatory reactions or nerve injuries are responsive to treatment....... Furthermore, this treatment strategy was not found to induce measurable CNS related side effects or tolerance. Cancer cell viability assays and bone volume fraction assessed by micro computed tomography (microCT) demonstrated that these effects were not due to changes in cancer progression. The difference...... with cannabinoid agonists. However, the use of cannabinoid agonists in humans may be hampered by CNS related side effects and development of tolerance. In the present study, we investigated the effect of repeated low dose administration of the synthetic cannabinoid agonist WIN 55,212-2 on bone cancer pain...

  7. [Clinical experience with rhenium-188 HEDP therapy for metastatic bone pain].

    Science.gov (United States)

    Róka, R; Séra, T; Pajor, L; Thurzó, L; Láng, J; Csernay, L; Pávics, L

    2000-05-01

    Rhenium-188 hydroxyethylidene diphosphonate (Re-188 HEDP) is a new radiopharmaceutical for treatment of metastatic bone pain. Re-188 is a generator-produced radionuclide emitting high energy beta and gamma rays and having a relative short physical half-life makes it of especially interesting for therapeutic purpose. Seven patients (pts) with multiple painful bone metastases were treated with Re-188 HEDP. Five pts with prostate cancer and 2 pts with breast cancer received a fixed activity of 3000 MBq of Re-188 HEDP intravenously in two steps. Complete blood counts were determined, blood chemistry examinations and urine-analysis were performed before and 1, 2, 3, 4, 6, 8, 12 weeks following the treatment. A visual analogue score, a verbal rating scale, the Spitzer index and the Karnofsky score were used to assess pain and performance status. Three hours after Re-188 HEDP administration at 1 m from the anterior mid-trunk of the pts gamma and at the patient body surface beta-radiation dose measurements were made, together with urine radioactivity measurements. Three pts become pain-free, 2 pts exhibited partial pain improvement and 1 patient gave no response to the Re-188 HEDP therapy. In 1 patient due to central nervous system metastasis the modification of the pain intensity could not be evaluated. Three pts displayed a flare reaction within 1 week after the treatment. Transient decreases in platelet and white blood cell counts were observed. There were no significant changes in the liver and renal functions. Radiation dose rate values of 6.3 +/- 1.0 microSv/h for gamma, and of 183 +/- 40 s-1 for beta-radiation were found. 25-32% of the administered dose was eliminated via the urinary tract in the first three hours. The preliminary data suggests that Re-188 HEDP is an effective radiopharmaceutical in treatment for metastatic bone pain. An administered activity of 3000 MBq can bring about a pain reduction without causing any clinically significant bone marrow toxicity

  8. Prospective Analysis of Secondary Alveolar Bone Grafting in Cleft Lip and Palate Patients

    Science.gov (United States)

    Reddy, M Gokul Chandra; Babu, V Ramesh; Rao, V Eswar; Chaitanya, J Jaya; Allareddy, S; Reddy, C Charan Kumar

    2015-01-01

    Background: To assess the success of the uptake of bone graft in cleft alveolus of the cleft lip and palate patients, quantitatively through computed tomography (CT) scan 6 months postoperative. To assess the successful eruption of permanent lateral incisor or canine in the bone grafted area. Materials and Methods: The children age group of 9-21 years with unilateral cleft lip and palate came to the hospital, needing secondary alveolar bone grafting. A detailed history and clinical examination of the patient was taken. A 3D CT scan was taken and the volume of the cleft was measured pre-operatively. After ambulatory period, 3D CT scan of the alveolar cleft region was taken and volume of the bone grafted was measured and patient was discharged from the hospital. After 6 months, patient was recalled and again 3D CT scan was taken and the volume of remaining bone was measured. Results: The mean volume of the defect pre-operatively is 0.80 cm3 with a standard deviation of 0.36 cm3 with minimum volume of the defect 0.44 cm3 and maximum volume of the defect 1.60 cm3. The mean volume of the bone post-operative immediately after grafting is 1.01 cm3 with a standard deviation of 0.52 cm3 with minimum of bone volume is 0.48 cm3 and maximum of 2.06 cm3. The mean volume of the bone after 6 months after bone grafting is 0.54 cm3 with a standard deviation of 0.33 cm3, minimum bone volume of 0.22 cm3 and maximum bone volume of 1.42 cm3. Conclusion: The CT scan is a valuable radiographic imaging modality to assess and follow the clinical outcome of secondary alveolar bone grafting. PMID:25954076

  9. Sports nuclear medicine. Bone imaging for lower extremity pain in athletes

    International Nuclear Information System (INIS)

    Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes

  10. Studying on process for labeling of EDTMP with 90Y using for bone pain palliation

    International Nuclear Information System (INIS)

    This Study describes the method for preparation of labelling compound Ethylene diamine tetramethylene phosphonic acid (EDTMP) with 90Y. Malignant cancer is one of the most important resulting in human death. Bone metastases in nearly 25% of all cancer patients; so it is useful to develop radiopharmaceuticals for the treatment of bone cancer. Yttrium-90 is high energy (2.3 MeV) beta emitter required with a physical haft life of 2.7 days which has limited bone-seeking properties. Its physical properties make it ideal for therapeutic application, the most energetic beta emission being able to penetrate to 1 cm from the site of deposition in soft tissue with an average range of approximately 4 mm. Theoretically, therefore, it can penetrate all marrow spaces in normal trabecular bone and conceivably even to the centre of large tumours where bone destruction may be extensive. Specific deposition of 90Y into the skeleton demands its delivery in a chemical form with affinity for bone mineral alone. Compounds with these properties are the phosphonate analogues of polyaminocarboxylic acids, and one in particular EDTMP (ethylen diamine tetra methylene phosphonate) has already been used to target 153Sm to bone mineral with success. Because of chemical similarities between 90Y and the rare earths, EDTMP should form stable complexes with 90Y and carry it specifically to the bone with comparable efficiency. Skeletal uptake of -emitting radionuclides may be used for bone pain palliation or myeloablation. The physical characteristics of the β- particles required for the two conditions are, however, different, that is, higher energies are favorable for destruction of bone marrow. (author)

  11. Cost of palliative radiation to the bone for patients with bone metastases secondary to breast or prostate cancer

    Directory of Open Access Journals (Sweden)

    Hess Gregory

    2012-10-01

    Full Text Available Abstract Background To estimate the costs (paid amounts of palliative radiation episodes of care (REOCs to the bone for patients with bone metastases secondary to breast or prostate cancer. Methods Claims-linked medical records from patients at 98 cancer treatment centers in 16 US states were analyzed. Inclusion criteria included a primary neoplasm of breast or prostate cancer with a secondary neoplasm of bone metastases; ≥2 visits to ≥1 radiation center during the study period (1 July 2008 through 31 December 2009 on or after the metastatic cancer diagnosis date; radiation therapy to ≥1 bone site; and ≥1 complete REOC as evidenced by a >30-day gap pre- and post-radiation therapy. Results The total number of REOCs was 220 for 207 breast cancer patients and 233 for 213 prostate cancer patients. In the main analysis (which excluded records with unpopulated costs the median number of fractions per a REOC for treatment of metastases was 10. Mean total radiation costs (i.e., radiation direct cost + cost of radiation-related procedures and visits per REOC were $7457 for patients with breast cancer and $7553 for patients with prostate cancer. Results were consistent in sensitivity analyses excluding patients with unpopulated costs. Conclusions In the US, current use of radiation therapy for bone metastases is relatively costly and the use of multi-fraction schedules remains prevalent.

  12. Cost of palliative radiation to the bone for patients with bone metastases secondary to breast or prostate cancer

    International Nuclear Information System (INIS)

    To estimate the costs (paid amounts) of palliative radiation episodes of care (REOCs) to the bone for patients with bone metastases secondary to breast or prostate cancer. Claims-linked medical records from patients at 98 cancer treatment centers in 16 US states were analyzed. Inclusion criteria included a primary neoplasm of breast or prostate cancer with a secondary neoplasm of bone metastases; ≥2 visits to ≥1 radiation center during the study period (1 July 2008 through 31 December 2009) on or after the metastatic cancer diagnosis date; radiation therapy to ≥1 bone site; and ≥1 complete REOC as evidenced by a >30-day gap pre- and post-radiation therapy. The total number of REOCs was 220 for 207 breast cancer patients and 233 for 213 prostate cancer patients. In the main analysis (which excluded records with unpopulated costs) the median number of fractions per a REOC for treatment of metastases was 10. Mean total radiation costs (i.e., radiation direct cost + cost of radiation-related procedures and visits) per REOC were $7457 for patients with breast cancer and $7553 for patients with prostate cancer. Results were consistent in sensitivity analyses excluding patients with unpopulated costs. In the US, current use of radiation therapy for bone metastases is relatively costly and the use of multi-fraction schedules remains prevalent

  13. Administration of a tropomyosin receptor kinase inhibitor attenuates sarcoma-induced nerve sprouting, neuroma formation and bone cancer pain

    Directory of Open Access Journals (Sweden)

    Bloom Aaron P

    2010-12-01

    Full Text Available Abstract Pain often accompanies cancer and most current therapies for treating cancer pain have significant unwanted side effects. Targeting nerve growth factor (NGF or its cognate receptor tropomyosin receptor kinase A (TrkA has become an attractive target for attenuating chronic pain. In the present report, we use a mouse model of bone cancer pain and examine whether oral administration of a selective small molecule Trk inhibitor (ARRY-470, which blocks TrkA, TrkB and TrkC kinase activity at low nm concentrations has a significant effect on cancer-induced pain behaviors, tumor-induced remodeling of sensory nerve fibers, tumor growth and tumor-induced bone remodeling. Early/sustained (initiated day 6 post cancer cell injection, but not late/acute (initiated day 18 post cancer cell injection administration of ARRY-470 markedly attenuated bone cancer pain and significantly blocked the ectopic sprouting of sensory nerve fibers and the formation of neuroma-like structures in the tumor bearing bone, but did not have a significant effect on tumor growth or bone remodeling. These data suggest that, like therapies that target the cancer itself, the earlier that the blockade of TrkA occurs, the more effective the control of cancer pain and the tumor-induced remodeling of sensory nerve fibers. Developing targeted therapies that relieve cancer pain without the side effects of current analgesics has the potential to significantly improve the quality of life and functional status of cancer patients.

  14. Continuous neuropathic pain secondary to endoscopic procedures: report of two cases and review of the literature.

    Science.gov (United States)

    Kalladka, Mythili; Nasri-Heir, Cibele; Eliav, Eli; Ananthan, Sowmya; Viswanath, Archana; Heir, Gary

    2016-08-01

    Neuropathic pain encompasses a spectrum of conditions that can arise from a lesion or dysfunction of the central or the peripheral nervous system, and it may develop at variable intervals after nerve injury or inflammation. Nerve injuries arising from surgical procedures commonly occur secondary to the surgical trauma, and in rare instances they are a complication of intubation during general anesthesia or endoscopic procedures. A series of 2 cases of bilateral glossopharyngeal neuropathic pain subsequent to endoscopic procedures is presented with a review of the literature concerning the mechanisms of development of neuropathic pain after these procedures. The purpose of these case reports is to make dentists aware of the occurrence, the mechanisms of nerve injuries, and the treatment of neuropathic pain after endoscopic procedures. In the first case, the patient had relief of pain with a combination therapy of clonazepam 1.0 mg in divided doses twice daily and gabapentin 300 mg in divided doses 3 times daily. In the second case, the patient had significant relief of pain with a monotherapy of gabapentin 1200 mg in divided doses 3 times daily. PMID:27422430

  15. Lysine-Specific Demethylase 1 in Breast Cancer Cells Contributes to the Production of Endogenous Formaldehyde in the Metastatic Bone Cancer Pain Model of Rats

    OpenAIRE

    Jia Liu; Feng-Yu Liu; Zhi-Qian Tong; Zhi-Hua Li; Wen Chen; Wen-Hong Luo; Hui Li; Hong-Jun Luo; Yan Tang; Jun-Min Tang; Jie Cai; Fei-Fei Liao; You Wan

    2013-01-01

    BACKGROUND: Bone cancer pain seriously affects the quality of life of cancer patients. Our previous study found that endogenous formaldehyde was produced by cancer cells metastasized into bone marrows and played an important role in bone cancer pain. However, the mechanism of production of this endogenous formaldehyde by metastatic cancer cells was unknown in bone cancer pain rats. Lysine-specific demethylase 1 (LSD1) is one of the major enzymes catalyzing the production of formaldehyde. The ...

  16. Effect of age on response to palliative radiotherapy and quality of life in patients with painful bone metastases

    International Nuclear Information System (INIS)

    Background: Multimorbidity and declining performance in elderly cancer patients may result in less treatment benefit. We investigated whether age is a predictor for pain response and quality of life (QoL) after radiotherapy in patients with painful bone metastases. Methods: The database of the Dutch Bone Metastasis Study was used (1996–1999). 1157 patients, irradiated for painful bone metastases, rated their pain, QoL-domains and overall health at baseline and during follow-up. Response was calculated taking into account changes in pain score and medication. Patients were grouped into three age cohorts: A: <65 (n = 520), B: 65–74 (n = 410) and C: ⩾75 years (n = 227). Results: No significant difference existed in pain response between cohorts: 78% in cohort A, 74% in B and 67% in C. When assessing baseline QoL, a significant difference in activity level was noticed, with more impairment in elderly compared to younger patients (C versus B (p = 0.01), C versus A (p < 0.001)). Other QoL-domains were similar at baseline and during follow-up among cohorts. A pain response was significantly associated with improvement of health-related QoL (OR 3.74, 95% CI 2.66–5.25). Conclusion: The majority of elderly patients with painful bone metastases responded to radiotherapy and showed comparable overall QoL compared to their younger counterparts. Age is not a predictor for pain response or QoL

  17. Development of [90Y]DOTA-conjugated bisphosphonate for treatment of painful bone metastases

    International Nuclear Information System (INIS)

    Introduction: Based on the concept of bifunctional radiopharmaceuticals, we have previously developed 186Re-complex-conjugated bisphosphonate analogs for palliation of painful bone metastases and have demonstrated the utility of these compounds. By applying a similar concept, we hypothesized that a bone-specific directed 90Y-labeled radiopharmaceutical could be developed. Methods: In this study, 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA) was chosen as the chelating site, and DOTA was conjugated with 4-amino-1-hydroxybutylidene-1,1-bisphosphonate. [90Y]DOTA-complex-conjugated bisphosphonate ([90Y]DOTA-HBP) was prepared by coordination with 90Y, and its biodistribution was studied in comparison to [90Y]citrate. Results: In biodistribution experiments, [90Y]DOTA-HBP and [90Y]citrate rapidly accumulated and resided in the bone. Although [90Y]citrate showed a higher level of accumulation in the bone than [90Y]DOTA-HBP, the clearances of [90Y]DOTA-HBP from the blood and from almost all soft tissues were much faster than those of [90Y]citrate. As a result, the estimated absorbed dose ratios of soft tissues to osteogenic cells (target organ) of [90Y]DOTA-HBP were lower than those of [90Y]citrate. Conclusions: [90Y]DOTA-HBP showed superior biodistribution characteristics as a bone-seeking agent and led to a decrease in the level of unnecessary radiation compared to [90Y]citrate. Since the DOTA ligand forms a stable complex not only with 90Y but also with lutetium (177Lu), indium (111In), gallium (67/68Ga), gadolinium (Gd) and so on, complexes of DOTA-conjugated bisphosphonate with various metals could be useful as agents for palliation of metastatic bone pain, bone scintigraphy and magnetic resonance imaging

  18. A randomized controlled trial to compare the efficacy of bisphosphonates in the management of painful bone metastasis

    Directory of Open Access Journals (Sweden)

    Krishnangshu Bhanja Choudhury

    2011-01-01

    Conclusion: The use of bisphosphonates for 6 months or more results in a statistical significant improvement in bone pain, more so with zoledronic acid. Hypercalcemia, an SRE, was significantly less in the zoledronic acid arm.

  19. Treatment of Extraspinal Painful Bone Metastases with Percutaneous Cementoplasty: A Prospective Study of 50 Patients

    International Nuclear Information System (INIS)

    The aim of this study was to assess the efficacy of percutaneous cementoplasty (PC) with polymethylmethacrylate (PMMA) in painful extravertebral lytic bone metastases not responding to conventional therapy. Fifty patients (25 females), mean age 64.7 ± 11.2 years, underwent PC after giving informed consent. Procedures were performed under fluoroscopy (1/50) or combined fluoroscopy-CT (49/50) guidance in local anesthesia or under deep sedation in 7 patients with large metastases who underwent radiofrequency thermoablation (RFA) in the same session. Seventy lesions were treated (1-6 per patient; average, 1.4 ± 0.9), arranging in size from 1 to 10 cm (average, 3.6 ± 2.1 cm). Mean volume of PMMA per lesion was 5.9 ± 3.2 ml (range, 1.5-15.0 ml). Pain was prospectively evaluated on an 11-point visual analog scale (VAS) before and after the procedure (follow-up, 15 to 36 months). Mean VAS score dropped from 9.1 ± 1.2 (range: 6-10) to 2.1 ± 2.5 (range: 0-9). Mean VAS difference was 7.0 ± 2.3 (range, 1-10; p < 0.0001, Wilcoxon signed rank test). Forty-seven of the 50 patients (94%) suspended narcotic drugs, in 22 (44%) pain was controlled with a nonsteroidal anti-inflammatory drug, in 25 (50%) analgesic therapy was suspended, and 13 of 50 (26%) had complete pain regression. In 3 of the 50 patients (6%) pain was not improved. No statistical difference between osteoplasty and osteoplasty plus RFA was found (p = 0.8338, Mann-Whitney test). No complications arose during the procedure. Two patients with metastases in the femoral diaphysis reported a fracture 1 month after treatment. PC is effective to obtain pain regression in painful bone metastases not responding to conventional analgesic therapy; bone consolidation cannot be obtained in the diaphysis of long weight-bearing bones.

  20. The characteristics of physical activity and gait in patients receiving radiotherapy in cancer induced bone pain

    International Nuclear Information System (INIS)

    Background and purpose: An objective measure of pain relief may add important information to patients’ self assessment, particularly after a treatment. The study aims were to determine whether measures of physical activity and/or gait can be used in characterizing cancer-induced bone pain (CIBP) and whether these biomarkers are sensitive to treatment response, in patients receiving radiotherapy (XRT) for CIBP. Materials and methods: Patients were assessed before (baseline) and 6–8 weeks after XRT (follow up). The following assessments were done: Brief Pain Inventory (BPI), activPAL™ activity meter, and GAITRite® electronic walkway (measure of gait). Wilcoxon, Mann–Whitney and Pearson statistical analyses were done. Results: Sixty patients were assessed at baseline; median worst pain was 7 and walking interference was 5. At follow up 42 patients were assessed. BPI worst pain, average pain, walking interference and total functional interference all improved (p < 0.001). An improvement in functional interference correlated with aspects of physical activity (daily hours standing r = 0.469, p = 0.002) and gait (cadence r = 0.341, p = 0.03). The activPAL and GAITRite parameters did not change following XRT (p > 0.05). In responder analyses there were no differences in activPAL and GAITRite parameters (p > 0.05). Conclusion: Assessment of physical activity and gait allow a characterization of the functional aspects of CIBP, but not in the evaluation of XRT

  1. Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com; Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy); Ballicu, Nicola, E-mail: nicolaballicu77@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy)

    2016-01-15

    PurposeTo retrospectively evaluate the effectiveness of computed tomography-guided percutaneous microwave ablation (MWA) and cementoplasty in patients with painful bone metastases at high risk of fracture.Materials and MethodsThirty-five patients with 37 metastatic bone lesions underwent computed tomography-guided MWA combined with cementoplasty (polymethylmethacrylate injection). Vertebrae, femur, and acetabulum were the intervention sites and the primary end point was pain relief. Pain severity was estimated by visual analog scale (VAS) before treatment; 1 week post-treatment; and 1, 6, and 12 months post-treatment. Functional outcome was assessed by improved patient walking ability. Radiological evaluation was performed at baseline and 3 and 12 months post-procedure.ResultsIn all patients, pain reduction occurred from the first week after treatment. The mean reduction in the VAS score was 84, 90, 90 % at week 1, month 1, and month 6, respectively. Improved walking ability occurred in 100 and 98 % of cases at the 1- and 6-month functional outcome evaluations, respectively. At the 1-year evaluation, 25 patients were alive, and 10 patients (28 %) had died because of widespread disease. The mean reduction in the VAS score and improvement in surviving patients’ walking ability were 90 and 100 %, respectively. No patients showed evidence of local tumor recurrence or progression and pathological fracture in the treated sites.ConclusionOur results suggest that MWA combined with osteoplasty is safe and effective when treating painful bone metastases at high risk of fracture. The number of surviving patients at the 1-year evaluation confirms the need for an effective and long-lasting treatment.

  2. {sup 188}Rhenium-HEDP in the Treatment of Pain in Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Gaudiano, J.; Savio, E.; Robles, A.; Muniz, S.; Leon, A.; Verdera, S.; Martinez, G.; Hermida, J.C.; Knapp, F.F., Jr.

    1999-01-18

    Systemic use of radiopharmaceuticals is a recognized alternative method for the treatment of pain in patients with multiple bone metastasis. A new option, {sup 188}Re-HEDP is proposed, using generator-obtained {sup 188}Rhenium ({beta} energy = 2.1 MeV, {gamma} energy = 155 keV, half-life = 16.9 hours). After establishing parameters of biodistribution, dosimetry and image acquisition in mice, rats and rabbits, Phase I and II studies were conducted on 12 patients with multiple metastasis from carcinomas, with pain surpassing other analgesic options. More than 50% pain relief was found in 91% of the patients, with total relief during a variable period in 41% of them allowing opiate and other analgesic drugs to be decreased or withdrawn, and showing a lower bone marrow contribution to total absorbed dose than that reported for other similar radiopharmaceuticals. Further study of this option is recommended in order to determine higher dose protocols without toxic bone marrow reaction possibilities.

  3. Differences in electrophysiological properties of functionally identified nociceptive sensory neurons in an animal model of cancer-induced bone pain

    Science.gov (United States)

    Zhu, Yong Fang; Ungard, Robert; Seidlitz, Eric; Zacal, Natalie; Huizinga, Jan; Henry, James L

    2016-01-01

    Background Bone cancer pain is often severe, yet little is known about mechanisms generating this type of chronic pain. While previous studies have identified functional alterations in peripheral sensory neurons that correlate with bone tumours, none has provided direct evidence correlating behavioural nociceptive responses with properties of sensory neurons in an intact bone cancer model. Results In a rat model of prostate cancer-induced bone pain, we confirmed tactile hypersensitivity using the von Frey test. Subsequently, we recorded intracellularly from dorsal root ganglion neurons in vivo in anesthetized animals. Neurons remained connected to their peripheral receptive terminals and were classified on the basis of action potential properties, responses to dorsal root stimulation, and to mechanical stimulation of the respective peripheral receptive fields. Neurons included C-, Aδ-, and Aβ-fibre nociceptors, identified by their expression of substance P. We suggest that bone tumour may induce phenotypic changes in peripheral nociceptors and that these could contribute to bone cancer pain. Conclusions This work represents a significant technical and conceptual advance in the study of peripheral nociceptor functions in the development of cancer-induced bone pain. This is the first study to report that changes in sensitivity and excitability of dorsal root ganglion primary afferents directly correspond to mechanical allodynia and hyperalgesia behaviours following prostate cancer cell injection into the femur of rats. Furthermore, our unique combination of techniques has allowed us to follow, in a single neuron, mechanical pain-related behaviours, electrophysiological changes in action potential properties, and dorsal root substance P expression. These data provide a more complete understanding of this unique pain state at the cellular level that may allow for future development of mechanism-based treatments for cancer-induced bone pain. PMID:27030711

  4. Transcranial magnetic stimulation over human secondary somatosensory cortex disrupts perception of pain intensity

    OpenAIRE

    Lockwood P.L.; Iannetti G.D.; Haggard P.

    2013-01-01

    Pain is a complex sensory experience resulting from the activity of a network of brain regions. However, the functional contribution of individual regions in this network remains poorly understood. We delivered single-pulse transcranial magnetic stimulation (TMS) to the contralateral primary somatosensory cortex (S1), secondary somatosensory cortex (S2) and vertex (control site) 120 msec after selective stimulation of nociceptive afferents using neodymium:yttrium-aluminium-perovskite (Nd:YAP)...

  5. Chondroblastoma with secondary aneurysmal bone cyst of the hamate: case report.

    Science.gov (United States)

    Rhee, Peter C; Novais, Eduardo N; Shives, Thomas C; Shin, Alexander Y

    2012-03-01

    Chondroblastoma of the carpals is rare, can mimic other benign bone tumors, and presents a diagnostic challenge. There have been few cases of benign tumors involving the hamate, with only one reported case of chondroblastoma, which was treated with complete hamate excision. We present a case of chondroblastoma with secondary aneurysmal bone cyst of the hamate treated with curettage, high-speed burring, phenol, and autogenous iliac crest bone grafting. At the time of the most recent radiographic follow-up, there was full graft incorporation, preserved hamate morphology, and no evidence of recurrence.

  6. The Role of the Three Phase Bone Scintigraphy in the Management of the Patients with Costochondral Pain

    Directory of Open Access Journals (Sweden)

    Zehra Pınar Koç

    2013-12-01

    Full Text Available Aim: The bone scintigraphy is indicated in patients with costochondral pain in order to identify the organic etiology. We aimed to investigate the local and projecting pain, or incidental findings in the three phase bone scintigraphy of the patients referred for costochondral pain. Methods: We included 50 patients (36F, 24M; mean: 41±18 years-old referred to our department for three phase bone scintigraphy for costochondral pain between January 2009-July 2012. Results: Among the 50 patients 22 had normal scintigraphy. An increased activity accumulation in the sternoclavicular joint was observed in 12 patients (right in 4, left in 4 and bilateral in 4 only in late phase and in 9 patients (right in 2, left in 1 and bilateral in 6 with increased vascularity. Among projecting pain causes, activity was present on sternum in 4 patients, on humerus in 2 patients and on the first costae in 2 patients. For the characterization of inflammatory pathology, the three phase bone scintigraphy showed sensitivity, specificity, accuracy, positive and negative predictive values of 43%, 94%, 78%, 77% and 78% respectively. Conclusion: Bone scintigraphy is an effective diagnostic method for the identification of local or projecting pain, and additionally unexpected incidental pathologies associated with costochondral pain. However regarding the characterization of inflammatory process false negatives should be considered.

  7. 博宁联合化疗治疗恶性肿瘤骨转称疼痛%Combined chemotherapy with Boning in the treatment of pain due to bone metastases from malignant tumors

    Institute of Scientific and Technical Information of China (English)

    安晓华; 焦立新; 王正艳

    2002-01-01

    Objective To investigate the effect of Boning on pain due to bone metastases from malignant tumors. Method From December,1998 to December,2000,86 patients with pathologically proved bone metastases from malignant tumors were randomly divided into two groups, study group(combined chemotherapy with boning),control group(simple chemotherapy).Boning (60 mg) dissolved in saline solution(500 ml) were given IV for consecutive 3 days. Then 60 mg Boning was given every half month .Patients in control group accepted simple chemotherapy. Results Efficacy in study group was 88.37% which was significantly superior to that in control group (66.47% ).Boning could repair injured bone. Adverse reaction associated with Boning was weak. Boning quickly relieved symptoms for a long time. Conclusion Effect of large dose Boning for relieving pain due to bone metastases from malignant tumors is satisfying. At the same time, Boning play important role in repair of destructed bone.

  8. A Traditional Chinese Medicine Xiao-Ai-Tong Suppresses Pain through Modulation of Cytokines and Prevents Adverse Reactions of Morphine Treatment in Bone Cancer Pain Patients

    Directory of Open Access Journals (Sweden)

    Yan Cong

    2015-01-01

    Full Text Available Treating cancer pain continues to possess a major challenge. Here, we report that a traditional Chinese medicine Xiao-Ai-Tong (XAT can effectively suppress pain and adverse reactions following morphine treatment in patients with bone cancer pain. Visual Analogue Scale (VAS and Quality of Life Questionnaire (EORTC QLQ-C30 were used for patient’s self-evaluation of pain intensity and evaluating changes of adverse reactions including constipation, nausea, fatigue, and anorexia, respectively, before and after treatment prescriptions. The clinical trials showed that repetitive oral administration of XAT (200 mL, bid, for 7 consecutive days alone greatly reduced cancer pain. Repetitive treatment with a combination of XAT and morphine (20 mg and 30 mg, resp. produced significant synergistic analgesic effects. Meanwhile, XAT greatly reduced the adverse reactions associated with cancer and/or morphine treatment. In addition, XAT treatment significantly reduced the proinflammatory cytokines interleukin-1β and tumor necrosis factor-α and increased the endogenous anti-inflammatory cytokine interleukin-10 in blood. These findings demonstrate that XAT can effectively reduce bone cancer pain probably mediated by the cytokine mechanisms, facilitate analgesic effect of morphine, and prevent or reduce the associated adverse reactions, supporting a use of XAT, alone or with morphine, in treating bone cancer pain in clinic.

  9. An Easy Tool to Predict Survival in Patients Receiving Radiation Therapy for Painful Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Westhoff, Paulien G., E-mail: p.g.westhoff@umcutrecht.nl [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Graeff, Alexander de [Department of Medical Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Bollen, Laurens; Dijkstra, Sander P. [Department of Orthopedic Surgery, Leiden University Medical Center (Netherlands); Steen-Banasik, Elzbieta M. van der [ARTI Institute for Radiation Oncology Arnhem, Arnhem (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Leer, Jan Willem H. [Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen (Netherlands); Marijnen, Corrie A.; Linden, Yvette M. van der [Department of Clinical Oncology, Leiden University Medical Center, Leiden (Netherlands)

    2014-11-15

    Purpose: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and patient-reported scores of pain and quality of life, to predict survival in patients with painful bone metastases. Methods and Materials: In the Dutch Bone Metastasis Study, 1157 patients were treated with radiation therapy for painful bone metastases. At randomization, physicians determined the KPS; patients rated general health on a visual analogue scale (VAS-gh), valuation of life on a verbal rating scale (VRS-vl) and pain intensity. To assess the predictive value of the variables, we used multivariate Cox proportional hazard analyses and C-statistics for discriminative value. Of the final model, calibration was assessed. External validation was performed on a dataset of 934 patients who were treated with radiation therapy for vertebral metastases. Results: Patients had mainly breast (39%), prostate (23%), or lung cancer (25%). After a maximum of 142 weeks' follow-up, 74% of patients had died. The best predictive model included sex, primary tumor, visceral metastases, KPS, VAS-gh, and VRS-vl (C-statistic = 0.72, 95% CI = 0.70-0.74). A reduced model, with only KPS and primary tumor, showed comparable discriminative capacity (C-statistic = 0.71, 95% CI = 0.69-0.72). External validation showed a C-statistic of 0.72 (95% CI = 0.70-0.73). Calibration of the derivation and the validation dataset showed underestimation of survival. Conclusion: In predicting survival in patients with painful bone metastases, KPS combined with primary tumor was comparable to a more complex model. Considering the amount of variables in complex models and the additional burden on patients, the simple model is preferred for daily use. In addition, a risk table for survival is

  10. Efficacy of Sm-153 radionuclide therapy for bone pain palliation in metastatic prostate cancer

    International Nuclear Information System (INIS)

    Full text of publication follows. Aim: the aim of this study is to evaluate the usefulness and efficacy of radionuclide therapy with Sm-153 in patients with prostate cancer presenting painful osteoblastic osseous metastases. Materials and methods: in our study, 10 patients aged between 59-80 years (mean age=69±6.26 years) with osteoblastic osseous metastases of prostate cancer, treated in our unit between November 2011 and December 2012, were included. All patients had undergone Tc99m hydroxy methylenediphosphonate (HDP) bone scintigraphy documenting increased multiple osteoblastic activity in the painful sites. Images were obtained from anterior-posterior projection with double headed gamma camera (Infinia, GE, Tirat Hacermel, Israel) equipped with LEHR collimators. Patients were excluded from the study, when their hemoglobin<10 g/dl, WBC<4.5x109 /l, platelet count <100x109 /l, treated with systemic chemotherapy or RT in six weeks, spinal cord compression, pathologic fractures, life expectancy less than 3 months. All patients were treated with Sm153-EDTMP at a standard intravenous dose of 37 MBq/kg and were observed for toxicity and decrease in pain score using visual analog scale (VAS) once in a week up to 6 weeks. A bone scan with Sm153-EDTMP was performed 4 hours post treatment. Results: there was a significant decrease in VAS score from the time of administration up to 6 weeks. Mean pain score was decreased from 79% to 15%. Median duration of response to therapy was found to be 8-12 weeks. No serious acute adverse events were observed post-treatment period. When we evaluated hemato-toxicity of Sm153-EDTMP; 2 patients showed a reduced toxicity (grade 1 anemia and grade 0-1 WBC) and other 8 patients did not show hematological toxicity. There was no relationship between the number and/or severity of bone lesions at the beginning of therapy and at the 6. week. Finally, 6 of 10 patients died from terminal cancer within the mean 31 weeks (8-56 weeks) observation

  11. Bone involvement in secondary syphilis: a case report and systematic review of the literature.

    Science.gov (United States)

    Park, Ki-Ho; Lee, Mi Suk; Hong, Il Ki; Sung, Ji-Youn; Choi, Sang-Ho; Park, Sang Ok; Shin, Myung Jin; Chung, Hye Won; Lee, Sang Hoon

    2014-09-01

    Bone involvement is an unusual manifestation of secondary syphilis, but little information is available in the English-language literature. We carried out a systematic review of the English-language literature from 1964 to 2013, describing cases of secondary syphilis with bone involvement. We also describe a case of secondary syphilis with multiple osteolytic lesions, mimicking metastatic cancer or myeloma, which was included in an analysis of 37 eligible cases of secondary syphilis with bone involvement. Of these 37 patients, 28 (76%) patients were male, and the median age was 32 years (range, 12-64 years). Eleven (30%) patients had human immunodeficiency virus (HIV) infection with a median CD4 lymphocyte count of 343 cells/mm (range, 130-689 cells/mm). The diagnosis of early syphilis was suspected based on mucocutaneous findings in 28 (76%) cases. In the remaining 9 (24%) cases, high titers of nontreponemal serologic tests were the only evidence of early syphilis. The median venereal disease research laboratory (VDRL) titer was 1:64 (range, 1:8-1:320), and median rapid plasma reagin (RPR) titer was 1:64 (range, 1:16-1:512). The bones most often affected were long bones of the limbs (n = 22) and skull (n = 21). The bone lesions were multifocal in 27 (73%) cases and osteolytic in 19 (51%) cases. The treatment of syphilitic bone lesions was medical only in most patients, and prognosis was favorable with high-dose penicillin therapy. Clinical features and outcome between HIV-uninfected and HIV-infected patients were not different. Knowledge of this rare entity may lead to early diagnosis and appropriate management. PMID:25118965

  12. SPECT/CT bone scintigraphy to evaluate low back pain in young athletes: common and uncommon etiologies.

    Science.gov (United States)

    Matesan, M; Behnia, F; Bermo, M; Vesselle, H

    2016-01-01

    Low back pain of various etiologies is a common clinical presentation in young athletes. In this article, we discuss the utility of SPECT/CT bone scintigraphy for the evaluation of low back pain in young athletes. The spectrum of lower spine lesions caused by sports injuries and identifiable on bone scan is presented along with strategies to avoid unnecessary irradiation of young patients. Also covered are pitfalls in diagnosis due to referred-pain phenomenon and normal skeletal variants specific to this age group. PMID:27387155

  13. Prevention and Control of Secondary Disease following Allogenic Bone-Marrow Transplantation

    International Nuclear Information System (INIS)

    A review is presented of the various methods found to be effective in preventing or ameliorating acute secondary disease in rodents and primates. Selective physical elimination of lymphoid cells by centrifugation over a discontinuous albumin gradient, post-transplantation administration of cyclophosphamide, amethopterin or ALS and the selection of histocompatible bone-marrow donors are considered to be the most promising methods in primares. It is not known to what extent delayed secondary disease will occur in monkeys and man in cases where acute secondary disease has been successfully avoided. (author)

  14. A randomized trial of hypnosis for relief of pain and anxiety in adult cancer patients undergoing bone marrow procedures.

    Science.gov (United States)

    Snow, Alison; Dorfman, David; Warbet, Rachel; Cammarata, Meredith; Eisenman, Stephanie; Zilberfein, Felice; Isola, Luis; Navada, Shyamala

    2012-01-01

    Pain and anxiety are closely associated with bone marrow aspirates and biopsies. To determine whether hypnosis administered concurrently with the procedure can ameliorate these morbidities, the authors randomly assigned 80 cancer patients undergoing bone marrow aspirates and biopsies to either hypnosis or standard of care. The hypnosis intervention reduced the anxiety associated with procedure, but the difference in pain scores between the two groups was not statistically significant. The authors conclude that brief hypnosis concurrently administered reduces patient anxiety during bone marrow aspirates and biopsies but may not adequately control pain. The authors explain this latter finding as indicating that the sensory component of a patient's pain experience may be of lesser importance than the affective component. The authors describe future studies to clarify their results and address the limitations of this study. PMID:22571244

  15. Differential diagnosis of metastatic bone disease and benign bone disease on spine SPECT in patients with low back pain

    International Nuclear Information System (INIS)

    One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients, as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. We reviewed spine SPECT studies obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2 Posterior element; posterior to body (pedicle), posterior to intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Sixty-nine bone lesions were detected on SPECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis: linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients

  16. Differential diagnosis of metastatic bone disease and benign bone disease on spine SPECT in patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Hun; Choi, Yun Young; Cho, Suk Shin [College of Medicine, Hanyang Univ., Seoul (Korea, Republic of)

    2001-12-01

    One or more abnormal vertebrae detected on bone scintigraphy is a common finding in clinical practice, and it could pose a diagnostic dilemma especially in cancer patients, as either metastasis or benign disease may cause scintigraphic abnormality. The purpose of this study was to determine whether additional spine SPECT has a role in differentiating malignant from benign lesions in patients with back pain. We reviewed spine SPECT studies obtained over a three-year period in 108 patients. Among them, forty-five patients with abnormal SPECT and clinically followed records were evaluated (20 cancer patients were included). Uptake patterns were classified as follows: 1. Body: diffusely increased uptake, linear increased uptake of end plate, segmental increased uptake, and cold defect, 2 Posterior element; posterior to body (pedicle), posterior to intervertebral disc space (facet joint), and spinous process. Lesions were correlated with radiological findings and with final diagnosis. Sixty-nine bone lesions were detected on SPECT images, including 18 metastases, 28 degenerative diseases and 21 compression fractures. Cold defect (6) and segmental increased uptake (5) were dominant findings in metastasis: linear increased uptake (12), and facet joint uptake (15) were in degenerative change; and diffuse increased uptake (9), and linear increased uptake (9) were in compression fracture. Cold defect and segmental increased uptake of body were characteristic findings of metastasis, but care should be taken because compression fracture also shows segmental increased uptake in some cases. Degenerative disease was easily diagnosed because of the typical finding of linear increased uptake of end plate and facet joint. Therefore, additional bone SPECT after planar bone scan would be helpful for differentiating metastasis from benign condition in cancer patients.

  17. Enhanced excitability of small dorsal root ganglion neurons in rats with bone cancer pain

    Directory of Open Access Journals (Sweden)

    Zheng Qin

    2012-04-01

    Full Text Available Abstract Background Primary and metastatic cancers that affect bone are frequently associated with severe and intractable pain. The mechanisms underlying the development of bone cancer pain are largely unknown. The aim of this study was to determine whether enhanced excitability of primary sensory neurons contributed to peripheral sensitization and tumor-induced hyperalgesia during cancer condition. In this study, using techniques of whole-cell patch-clamp recording associated with immunofluorescent staining, single-cell reverse-transcriptase PCR and behavioral test, we investigated whether the intrinsic membrane properties and the excitability of small-sized dorsal root ganglion (DRG neurons altered in a rat model of bone cancer pain, and whether suppression of DRG neurons activity inhibited the bone cancer-induced pain. Results Our present study showed that implantation of MRMT-1 tumor cells into the tibial canal in rats produced significant mechanical and thermal hyperalgesia in the ipsilateral hind paw. Moreover, implantation of tumor cells provoked spontaneous discharges and tonic excitatory discharges evoked by a depolarizing current pulse in small-sized DRG neurons. In line with these findings, alterations in intrinsic membrane properties that reflect the enhanced neuronal excitability were observed in small DRG neurons in bone cancer rats, of which including: 1 depolarized resting membrane potential (RMP; 2 decreased input resistance (Rin; 3 a marked reduction in current threshold (CT and voltage threshold (TP of action potential (AP; 4 a dramatic decrease in amplitude, overshot, and duration of evoked action potentials as well as in amplitude and duration of afterhyperpolarization (AHP; and 5 a significant increase in the firing frequency of evoked action potentials. Here, the decreased AP threshold and increased firing frequency of evoked action potentials implicate the occurrence of hyperexcitability in small-sized DRG neurons in bone

  18. Osteoporosis in patients with low back pain - a study with DEXA bone densitometer

    International Nuclear Information System (INIS)

    Osteoporosis has frequently been called the 'silent epidemic' because most patients do not present until they fracture or alternatively in some cases of spinal disease develop back pain, significant loss of height, or a kyphosis. In a longitudinal study of one year period a total of 96 patients were evaluated for bone densitometric measurements. Among them 48 patients (40 F, 8 M) complained of persistent low back pain. The age group was 35-80 years (Mean 59 years). They were referred for their first Dual Energy X-ray Absorptiometry (DEXA) studies. None of the patients received estrogen, biphosphonates or steroid therapy. Bone density of the hip and lumbar spine were measured. The T- score, which measures the difference between patient's BMD and young normal was computed and Z-score, were calculated. X-ray correlation was also done in most of the cases. Out of 48 patients, 18 (39.6%) showed osteoporosis, 16 (33.3%) showed osteopenia and 12 (25%) were normal. In the osteoporosis group, 14 were female and 4 were male. All were above 50 years of age except a 35 -year old man with Cushing's disease. This study demonstrates the importance of DEXA studies in diagnosing osteoporosis in patients suffering from low back pain. (author) 19 refs

  19. Clinical correlates and treatment of bone/joint pain and difficulty with sexual arousal in patients on maintenance hemodialysis.

    Science.gov (United States)

    Carreon, Myra; Fried, Linda F; Palevsky, Paul M; Kimmel, Paul L; Arnold, Robert M; Weisbord, Steven D

    2008-04-01

    Bone/joint pain and difficulty with sexual arousal are prevalent, frequently severe, and potentially treatable in patients on maintenance hemodialysis. However, the mediators and adequacy of treatment for these symptoms have been less well studied. We sought to assess the clinical correlates and treatment of these symptoms in patients receiving chronic hemodialysis. Using the Dialysis Symptom Index, we assessed the presence and severity of bone/joint pain and difficulty with sexual arousal in 75 patients on chronic hemodialysis. Associations of demographic and clinical variables with these 2 symptoms were assessed. We also recorded the use of analgesics for bone/joint pain and, among men, phosphodiesterase-5 inhibitors for difficulty with sexual arousal. Twenty-eight patients (37%) reported bone/joint pain, of whom 20 (71%) described it as moderate to severe. Nineteen of 50 male patients (38%) reported difficulty with sexual arousal, which was described as moderate to severe by 15 (79%). Patients' demographic and clinical characteristics were not correlated with bone/joint pain. Among men, there were no correlations between patients' demographic and clinical characteristics and difficulty with sexual arousal. Only 48% of patients with bone/joint pain were receiving analgesics, while 21% of men who described difficulty with sexual arousal were receiving phosphodiesterase-5 inhibitors. Demographic, clinical, and dialysis-related variables are poorly correlated with bone/joint pain and difficulty with sexual arousal. However, these symptoms are prevalent and under-treated, which should spur efforts to assess the impact of improving provider assessment and treatment of these symptoms on patient outcomes, including health-related quality of life.

  20. Bone tumor

    Science.gov (United States)

    Tumor - bone; Bone cancer; Primary bone tumor; Secondary bone tumor ... The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include: Genetic defects ...

  1. Pneumolabyrinth secondary to temporal bone fracture: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Bacciu A

    2014-09-01

    Full Text Available Andrea Bacciu,1 Vincenzo Vincenti,1 Sampath Chandra Prasad,1 Daniela Tonni,1 Elisa Ventura,2 Salvatore Bacciu,1 Enrico Pasanisi1 1Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, 2Department of Neuroradiology, University Hospital of Parma, Parma, Italy Abstract: Pneumolabyrinth following temporal bone fracture is an extremely rare condition. It results from air entering the inner ear when a communication between the air-filled middle ear spaces and inner ear is established. The imaging modality of choice for pneumolabyrinth is high-resolution computed tomography of the temporal bone. Treatment options include conservative management (bed rest, antibiotics, corticosteroids or surgery (exploratory tympanotomy. We present the case of a 31-year-old female who had pneumolabyrinth secondary to a temporal bone fracture. The patient was treated surgically and made a full clinical recovery. Keywords: pneumolabyrinth, temporal bone fractures, head trauma

  2. Tibolone inhibits bone resorption without secondary positive effects on cartilage degradation

    Directory of Open Access Journals (Sweden)

    Byrjalsen I

    2008-11-01

    Full Text Available Abstract Background Osteoarthritis is associated with increased bone resorption and increased cartilage degradation in the subchondral bone and joint. The objective of the present study was to determine whether Tibolone, a synthetic steroid with estrogenic, androgenic, and progestogenic properties, would have similar dual actions on both bone and cartilage turnover, as reported previously with some SERMS and HRT. Methods This study was a secondary analysis of ninety-one healthy postmenopausal women aged 52–75 yrs entered a 2-yr double blind, randomized, placebo-controlled study of treatment with either 1.25 mg/day (n = 36, or 2.5 mg/day Tibolone (n = 35, or placebo (n = 20, (J Clin Endocrinol Metab. 1996 Jul;81(7:2419–22 Second void morning urine samples were collected at baseline, and at 3, 6, 12, and 24 months. Urine CrossLaps® ELISA (CTX-I and Urine CartiLaps® ELISA (CTX-II was investigated as markers of bone resorption and cartilage degradation, respectively. Results Tibolone significantly (P Conclusion These data suggest uncoupling of the bone and cartilage effects of the synthetic steroid, Tibolone. Bone resorption was significantly decreased, whereas cartilage degradation was unchanged. These effects are in contrast to those observed some SERMs with effects on both bone and cartilage degradation. These effects may in part be described by the complicated pharmacology of Tibolone on testosterone, estrogen and progesterone receptors.

  3. Impact of educational strategies in positioning Samarium-153 EDTMP as a treatment for metastatic bone pain

    International Nuclear Information System (INIS)

    To educate is a difficult task but its results make efforts worthwhile. Many patients in Peru suffer from intractable bone pain due to metastases. Since 1993 radionuclides were used to palliate bone pain due to metastases in Peru. First, with the help of the IAEA, Peru participated in a clinical trial using Phosphorus 32 and Strontium 89. Then, efforts were performed to produce Samarium 153 EDMTP locally, which was achieved in 1995. Nevertheless, years passed and Samarium use did not increase proportionally to the needs of people with cancer and bone pain, mainly the poor. Educational strategies have been proven useful for delivering solutions to many health problems in other diseases and also in cancer. Health education makes patients and their relatives assume responsible care of their problems. The purpose of this work was to increase Samarium EDTMP use as palliative treatment in patients with bone pain due to metastases, using educational strategies as means to change attitudes towards this health problem. In September 2003, a task group conducted studies in order to apply several methods to achieve the goal of increasing Samarium EDTMP use. Educational strategies employed were performed to provide verbal and written information to patients, physicians, medical students, residents, pain specialists, oncologists and neurologists, as well as general public. Verbal information included radio interviews, television spots and a phone number (in charge of two secretaries, prepared for answering and if not possible, a physician was in charge of attending patient consultation), e-mail and a web page for consultation. Written material was delivered to several newspapers, including clinical use of Samarium, possibilities of being elected for treatment, benefits and risks and a photography of the product. Politics of the institution producing Samarium changed, in order to achieve minimum cost of the product and it was delivered to all publics at the lowest cost for a year

  4. Samarium-153 ethylenediamine tetramethylene phosphonate therapy for bone pain palliation in skeletal metastases

    Directory of Open Access Journals (Sweden)

    Tripathi Madhavi

    2006-01-01

    Full Text Available BACKGROUND: Systemic therapy with radionuclides may be used for the treatment of patients with painful skeletal metastases owing to its efficacy, low cost and low toxicity. Imported radionuclides for pain palliation, like Strontium-89 are expensive; particularly for developing countries. In the Indian scenario, Samarium-153 (Sm-153 is produced in our own reactors and as a result, it is readily available and economical. AIM: We undertook this study to determine the efficacy and toxicity of single-dose Sm-153 ethylenediamine tetramethylene phosphonate as a palliative treatment for painful skeletal metastases. MATERIALS AND METHODS: Eightysix patients with painful skeletal metastases from various primaries, were treated with Sm-153 EDTMP at a dose of 37 MBq/kg. The effects were evaluated according to change in visual analogue pain score, analgesic consumption, Karnofsky performance score, mobility score and blood count tests, conducted regularly for 16 weeks. STATISTICS: Repeated measures analysis. RESULTS: The overall response rates were 73%, while complete response was seen in 12.4%. Reduction in analgesic consumption with improvement in Karnofsky performance score and mobility score, was seen in all responders. Response rates were 80.3 and 80.5% in breast and prostate cancer, respectively. One case, each of Wilms tumor, ovarian cancer, germ cell tumor testis, multiple myeloma, primitive neuroectodermal tumor and oesophageal cancer, did not respond to therapy. No serious side-effects were noted, except for fall in white blood cell, platelet and haemoglobin counts, which gradually returned to normal levels by six-eight weeks. CONCLUSION: Sm-153 EDTMP provided effective palliation in 73% patients with painful bone metastases: the major toxicity was temporary myelosuppression.

  5. Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost

    Directory of Open Access Journals (Sweden)

    Meizer Roland

    2009-01-01

    Full Text Available Background: Bone marrow edema (BME is a common cause of hip pain. The aim of the study was to assess the efficacy of the vasoactive drug iloprost in the treatment of BME of femoral head. Materials and Methods: We reviewed 27 patients (19 male, 8 female with BME of the femoral head. Their mean age was 53.7 ± 10.8 years. All patients were treated with iloprost, a vasoactive drug that dilates arterioles and venules, reduces capillary permeability and suppresses platelet aggregation. The therapy comprised a series of five infusions with 20 to 50 μg iloprost over 6 h on 5 consecutive days each. Weight bearing was reduced for up to 3 weeks, depending on the severity of symptoms. Pain at rest as well as under stress was assessed with a semi quantitative scale from before and 4 months after therapy. MRI investigations were done before and repeated 4 months after therapy. Results: At the clinical follow up of four months after therapy, the pain level at rest had diminished by a mean of 58.3% ( P < 0.0001. Pain under stress decreased by a mean of 41.9% ( P < 0.0001. On MRI, 20 patients had a significant reduction of BME size or complete normalization and 4 showed no change. Worsening of the MRI pattern was found in 3 patients. Conclusion: The authors conclude that the use of parenteral iloprost might be a viable method in the treatment of BME of femoral head.

  6. Characterization of a rat model of metastatic prostate cancer bone pain

    Directory of Open Access Journals (Sweden)

    Paolo Donato De Ciantis

    2010-11-01

    Full Text Available Paolo Donato De Ciantis1, Kiran Yashpal2, James Henry3, Gurmit Singh11Department of Pathology and Molecular Pathology, 2Pain Research Laboratories, 3Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, CanadaPurpose: The objectives of this study were to establish and characterize a novel animal model of metastatic prostate cancer-induced bone pain.Methods: Copenhagen rats were injected with 106 MATLyLu (MLL prostate cancer cells or phosphate-buffered saline by per cutaneous intra femoral injections into the right hind leg distal epiphysis. Over 13 days, rats progressively developed a tumor within the distal femoral epiphysis. On days 3, 7, 10, and 13 post injection, rats were subjected to the incapacitance and Randall–Selitto behavioral tests as they are believed to be indirect reflections of tumor induced pain. Ipsilateral hind limbs were subjected to X-ray and computed tomography (CT scans and histological sections were stained with hematoxylin and eosin (H&E.Results: Intra femoral injections of MLL cells resulted in the progressive development of a tumor leading to bone destruction and nociceptive behaviors. Tumor development resulted in the redistribution of weight to the contralateral hind leg and significantly reduced the paw withdrawal threshold of the ipsilateral hind paw as observed via the incapacitance and Randall–Selitto tests, respectively. X-ray and computed tomography scans along with H&E stains indicated tumor-associated structural damage to the distal femur. This model was challenged with administration of meloxicam. Compared with vehicle-injected controls, the meloxicam-treated rats displayed smaller nociceptive responses as observed with the incapacitance and Randall–Selitto tests, suggesting that meloxicam was effective in reducing the pain-related symptoms displayed by model animals and that the model behaved in a predictable way to cyclooxygenase-2 treatment.Conclusions: This

  7. 99m technetium-MDP bone scintigraphy in evaluation of painful joint prosthesis

    International Nuclear Information System (INIS)

    In addition of clinical evaluation and x-ray radiography, the diagnosis of a loose joint prosthesis is often made by nuclear medicine imaging techniques. Differentiation between loosening and infected prosthesis is important for better treatment of those patients. Aim: The aim of this study was to reevaluate the scintigraphic patterns in patients with painful hip of knee arthroplasty. Material and Method: From 1996. to 2003. forty patients aged 49-78 years were referred for evaluation of possible loosening/infection joint prosthesis: 36 pts with 39 total/ partial hip prosthesis, 1 pt with knee prosthesis and 3 pts with history of previously extracted hip prosthesis due to infection. Whole body acquisition had been performed with a single head gamma camera three hours after the injection of 740 MBq 99mTc-MDP. Scans were classified as: positive for loosening if abnormal uptake was shown at the tip of the prosthesis; positive for infection if diffuse abnormal uptake was shown around the implant; negative and indeterminate scans. Scintigraphic findings were compared to clinical follow up, histology or cultures. Results: Positive findings were found in 17 bone scans strongly suggesting loosening in 10 cases, infection of prosthesis in 4 cases and both loosening/infection in 3 cases. Bone scintigraphy was normal in 11pts. Scans of three pts with previously extracted hip prosthesis and scheduled for reimplatation, showed inhomogeneously and mildly increased uptake in femur. Most of scans classified as indeterminate (n=12) showed slightly increased tracer uptake in region of acetabular roof, greater or lesser tho chanter, suggesting bone remodeling due to the presence of implant, rather than loosening. Conclusion: 99mTc-MDP bone scintigraphy had a significant role in assessing the painful joint prosthesis. Complementary diagnostic procedures should be considered in indeterminate scintiscans. (authors)

  8. 177Lu-EDTMP for palliation of pain from bone metastases in patients with prostate and breast cancer: a phase II study

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the efficacy and safety of 177Lu-EDTMP for pain palliation in patients with bone metastases from castration-resistant prostate and breast cancer. The secondary objective was to compare low-dose and high-dose 177Lu-EDTMP in bone pain palliation. Included in the study were 44 patients with documented breast carcinoma (12 patients; age 47 ± 13 years) or castration-resistant prostate carcinoma (32 patients; age 66 ± 9 years) and skeletal metastases. Patients were randomized into two equal groups treated with 177Lu-EDTMP intravenously at a dose of 1,295 MBq (group A) or 2,590 MBq (group B). Pain palliation was evaluated using a visual analogue score (VAS), analgesic score (AS) and Karnofsky performance score (KPS) up to 16 weeks. Toxicity was assessed in terms of haematological and renal parameters. The overall response rate (in all 44 patients) was 86 %. Complete, partial and minimal responses were seen in 6 patients (13 %), 21 patients (48 %) and 11 patients (25 %), respectively. A favourable response was seen in 27 patients (84 %) with prostate cancer and in 11 patients (92 %) with breast cancer. There was a progressive decrease in the VAS from baseline up to 4 weeks (p 177Lu-EDTMP was found to be a safe and effective radiopharmaceutical for bone pain palliation in patients with metastatic prostate and breast carcinoma. There were no differences in efficacy or toxicity between patients receiving low-dose and high-dose 177Lu-EDTMP. (orig.)

  9. Percutaneous Bone Tumor Management

    OpenAIRE

    Gangi, Afshin; Buy, Xavier

    2010-01-01

    Interventional radiology plays a major role in the management of bone tumors. Many different percutaneous techniques are available. Some aim to treat pain and consolidate a pathological bone (cementoplasty); others aim to ablate tumor or reduce its volume (sclerotherapy, thermal ablation). In this article, image-guided techniques of primary and secondary bone tumors with vertebroplasty, ethanol injection, radiofrequency ablation, laser photocoagulation, cryoablation, and radiofrequency ioniza...

  10. Acute Kidney Injury Secondary to NSAID Diagnosed on 99mTc MDP Bone Scan

    Directory of Open Access Journals (Sweden)

    Özhan Özdoğan

    2013-08-01

    Full Text Available A bone scan with 99mTc MDP was obtained to rule out the presence of micro fractures in a patient with the diagnosis of idiopathic osteoporosis. There was not any sign of micro fractures, but interestingly, both kidneys were diffusely very active. A differential diagnosis of acute kidney injury secondary to the use of nonsteroidal anti-inflammatory drug was made and reported after elimination of other clinical situations. The renal functions obtained following bone scan were impaired. The anti-inflammatory drug was discontinued. The renal functions were recovered starting with the following day.

  11. Inhibition of spinal UCHL1 attenuates pain facilitation in a cancer-induced bone pain model by inhibiting ubiquitin and glial activation

    Science.gov (United States)

    Cheng, Wei; Chen, Yuan-Li; Wu, Liang; Miao, Bei; Yin, Qin; Wang, Jin-Feng; Fu, Zhi-Jian

    2016-01-01

    The present study examined alterations of spinal ubiquitin C-terminal hydrolase L1 (UCHL1), ubiquitin expression and glial activation in the cancer-induced bone pain rats. Furthermore, whether inhibition of spinal UCHL1 could alleviate cancer-induced bone pain was observed. The CIBP model was established by intrathecal Walker 256 mammary gland carcinoma cells in SD rats. The rats of CIBP developed significant pain facilitation in the Von Frey test. Double immunofluorescence analyses revealed that in the spines of CIBP rats, ubiquitin co-localized with NeuN, Iba-1 or GFAP; UCHL1 and NeuN were co-expressed and UCHL1 also co-localized with ubiquitin. The CIBP model induced up-regulation of ubiquitin and UCHL1 in the spines, as well as glial activation. Inhibition of spinal UCHL1 attenuated pain facilitation by down-regulation of ubiquitin expression and glial activation. in the CIBP rats. Our data suggests that UCHL1/ubiquitin distributed and increased in the spines of CIBP rats, that glial activation also increased in the CIBP model and that inhibition of spinal UCHL1 may be an effective method to alleviate cancer-induced bone pain. PMID:27508024

  12. The effect of a single dose of bupivacaine on donor site pain after anterior iliac crest bone harvesting.

    Science.gov (United States)

    Barkhuysen, R; Meijer, G J; Soehardi, A; Merkx, M A W; Borstlap, W A; Bergé, S J; Bronkhorst, E M; Hoppenreijs, T J M

    2010-03-01

    Transplants from the anterior iliac crest are used for most reconstructive procedures in cranio-maxillofacial surgery. The advantages are easy accessibility, the ability to work in two teams and the amount of corticocancellous bone available; disadvantages are postoperative pain and gait disturbances. To reduce donor-site pain, the effect of a single dose of bupivacaine (10 cc of 2.5mg/cc with 1:80.000 epinephrine) was studied. 200 consecutive patients, who underwent anterior iliac crest bone harvesting for reconstructive procedures, were randomly divided into those receiving bupivacaine and those not. They completed a standardized questionnaire. Patients scored the intensity of the pain and difficulties walking at different times with a visual analogue scale. They recorded analgesics used. 98 questionnaires were eligible for analysis. No differences between the bupivacaine and the control group were detected for postoperative pain and gait disturbance. There is no support for administration of a single dose of bupivacaine to reduce pain in the first postoperative days. The surface area of the removed bone had a significant influence on pain and walking; pain is related to the local osseous damage or periosteal stripping rather than to the length of incision or the operation time.

  13. Cancer-induced bone loss and associated pain-related behavior is reduced by risedronate but not its phosphonocarboxylate analog NE-10790

    DEFF Research Database (Denmark)

    Hald, Andreas; Hansen, Rikke Rie; Thomsen, Mette W;

    2009-01-01

    that a direct toxic effect on tumor cells may also be present in vivo and be related to the efficacy of bisphosphonate compounds. In conclusion, these results suggest that risedronate treatment may lead to an increased life quality, in patient suffering from bone cancer, in terms of decreased osteolysis......Prostate, breast and lung cancers readily develop bone metastases which lead to fractures, hypercalcemia and pain. Malignant growth in the bones depends on osteoclast-mediated bone resorption and in this regard bisphosphonate compounds, which have high-bone affinity and inhibit osteoclast activity......, have been found to alleviate bone cancer symptoms. In this study, the bisphosphonate risedronate and its phosphonocarboxylate derivative NE-10790 was tested in a murine bone cancer pain model. Risedronate decreased bone cancer-related bone destruction and pain-related behavior and decreased the spinal...

  14. Role of technetium-99m planar bone scanning in the evaluation of low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Valdez, D.C. [Texas Univ., San Antonio, TX (United States). Health Science Center]|[St. Luke`s Lutheran Hospital, San Antonio, TX (United States); Johnson, R.G. [Texas Univ., San Antonio, TX (United States). Health Science Center]|[St. Luke`s Lutheran Hospital, San Antonio, TX (United States)

    1994-02-01

    The records of 1018 patients with low back pain in a tertiary spine referral practice were reviewed. One hundred thirty-nine out of 1018 (13.6%) underwent technetium-99m planar bone scannings as part of their investigation. Seventy-three out of 139 scans (52%) showed increased uptake in some area, but only 27 out of 139 (19.4%) showed increased uptake specifically in the low back. Scans consistently yielded no findings with reference to the back when the prescan diagnosis was spinal stenosis, lumbar pain syndrome, herniated nucleus pulposus, or postlaminectomy syndrome. Some scans gave positive findings in patients with a diagnosis of degenerative disc disease, pseudoarthrosis, spondylolisthesis, fracture, infection, metabolic disorder, or tumor. Positive scans were generally obtained early after presentation (within 3 months) and negative scans obtained later (after 6 months), suggesting that clinical suspicion is still the main indication for early scanning. Planar bone scanning was helpful in both diagnosis and therapeutic decision-making in many conditions. (orig.)

  15. Role of technetium-99m planar bone scanning in the evaluation of low back pain

    International Nuclear Information System (INIS)

    The records of 1018 patients with low back pain in a tertiary spine referral practice were reviewed. One hundred thirty-nine out of 1018 (13.6%) underwent technetium-99m planar bone scannings as part of their investigation. Seventy-three out of 139 scans (52%) showed increased uptake in some area, but only 27 out of 139 (19.4%) showed increased uptake specifically in the low back. Scans consistently yielded no findings with reference to the back when the prescan diagnosis was spinal stenosis, lumbar pain syndrome, herniated nucleus pulposus, or postlaminectomy syndrome. Some scans gave positive findings in patients with a diagnosis of degenerative disc disease, pseudoarthrosis, spondylolisthesis, fracture, infection, metabolic disorder, or tumor. Positive scans were generally obtained early after presentation (within 3 months) and negative scans obtained later (after 6 months), suggesting that clinical suspicion is still the main indication for early scanning. Planar bone scanning was helpful in both diagnosis and therapeutic decision-making in many conditions. (orig.)

  16. Lysine-specific demethylase 1 in breast cancer cells contributes to the production of endogenous formaldehyde in the metastatic bone cancer pain model of rats.

    Directory of Open Access Journals (Sweden)

    Jia Liu

    Full Text Available BACKGROUND: Bone cancer pain seriously affects the quality of life of cancer patients. Our previous study found that endogenous formaldehyde was produced by cancer cells metastasized into bone marrows and played an important role in bone cancer pain. However, the mechanism of production of this endogenous formaldehyde by metastatic cancer cells was unknown in bone cancer pain rats. Lysine-specific demethylase 1 (LSD1 is one of the major enzymes catalyzing the production of formaldehyde. The expression of LSD1 and the concentration of formaldehyde were up-regulated in many high-risk tumors. OBJECTIVE: This study aimed to investigate whether LSD1 in metastasized MRMT-1 breast cancer cells in bone marrows participated in the production of endogenous formaldehyde in bone cancer pain rats. METHODOLOGY/PRINCIPAL FINDINGS: Concentration of the endogenous formaldehyde was measured by high performance liquid chromatography (HPLC. Endogenous formaldehyde dramatically increased in cultured MRMT-1 breast cancer cells in vitro, in bone marrows and sera of bone cancer pain rats, in tumor tissues and sera of MRMT-1 subcutaneous vaccination model rats in vivo. Formaldehyde at a concentration as low as the above measured (3 mM induced pain behaviors in normal rats. The expression of LSD1 which mainly located in nuclei of cancer cells significantly increased in bone marrows of bone cancer pain rats from 14 d to 21 d after inoculation. Furthermore, inhibition of LSD1 decreased the production of formaldehyde in MRMT-1 cells in vitro. Intraperitoneal injection of LSD1 inhibitor pargyline from 3 d to 14 d after inoculation of MRMT-1 cancer cells reduced bone cancer pain behaviors. CONCLUSION: Our data in the present study, combing our previous report, suggested that in the endogenous formaldehyde-induced pain in bone cancer pain rats, LSD1 in metastasized cancer cells contributed to the production of the endogenous formaldehyde.

  17. Radionuclide Treatment with 153Sm-EDTMP is Effective for the Palliation of Bone Pain in the Context of Extensive Bone Marrow Metastases: A Case Report

    Directory of Open Access Journals (Sweden)

    Kalevi Kairemo

    2014-10-01

    Full Text Available Radionuclide therapy is widely used as an effective modality in the management of bone pain. The main indication for this treatment is symptomatic bone metastases, confirmed by bone scintigraphy. We present a case of small cell lung cancer (SCLC stage T4N2M1b, with a good metabolic response to systemic therapy and radiotherapy of the primary tumor and locoregional disease, which became metabolically less active and remarkably smaller in size (reduction to 1/6 of the original volume. In spite of the good overall response, the patient developed a syndrome with severe bone pain and had progression in the bone marrow metastases, confirmed by 18F-FDG PET/CT. The patient received 153Sm-EDTMP treatment with a good clinical response. However, in the whole body bone scan with the therapeutic dose, there was no visual evidence of bone metastasis. Retrospectively, by drawing the region of interest, it was possible to identify one metastatic site. The possible mechanisms of the efficacy of this treatment modality, in this specific setting, are also discussed.

  18. Radionuclide Treatment with 153Sm-EDTMP is Effective for the Palliation of Bone Pain in the Context of Extensive Bone Marrow Metastases: A Case Report

    Science.gov (United States)

    Kairemo, Kalevi; Rasulova, Nigora; Suslaviciute, Justina; Alanko, Tuomo

    2014-01-01

    Radionuclide therapy is widely used as an effective modality in the management of bone pain. The main indication for this treatment is symptomatic bone metastases, confirmed by bone scintigraphy. We present a case of small cell lung cancer (SCLC) stage T4N2M1b, with a good metabolic response to systemic therapy and radiotherapy of the primary tumor and locoregional disease, which became metabolically less active and remarkably smaller in size (reduction to 1/6 of the original volume). In spite of the good overall response, the patient developed a syndrome with severe bone pain and had progression in the bone marrow metastases, confirmed by 18F-FDG PET/CT. The patient received 153Sm-EDTMP treatment with a good clinical response. However, in the whole body bone scan with the therapeutic dose, there was no visual evidence of bone metastasis. Retrospectively, by drawing the region of interest, it was possible to identify one metastatic site. The possible mechanisms of the efficacy of this treatment modality, in this specific setting, are also discussed. PMID:27408870

  19. Chondroblastoma with secondary aneurysmal bone cyst in the anterior skull base

    OpenAIRE

    Ming Jie Wang, MD, PhD; Bing Zhou, MD

    2016-01-01

    Chondroblastoma with secondary aneurysmal bone cyst (ABC), especially in the anterior skull base, is an extremely rare condition. A 5-year-old boy presented with a large space-occupying lesion in the anterior skull base along with a left sided-epistaxis, proptosis and decreased vision. Radical excision of the lesion was performed by an endoscopic transnasal and transethmoidal approach. The patient recovered without any recurrence during a follow-up period of up to 28 months. Here, we review t...

  20. Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients

    DEFF Research Database (Denmark)

    Meyer, Steffen; Pedersen, Kirsten Mølsted

    2013-01-01

    The objective was to assess the long-term outcome of secondary alveolar bone grafting (SABG) in cleft lip and palate patients and to examine relationships between preoperative and postoperative factors and overall long-term bone graft success. The records of 97 patients with cleft lip and palate......, who had secondary alveolar bone grafting of 123 alveolar clefts, were examined. Interalveolar bone height was assessed radiographically a minimum of 10 years after grafting using a 4-point scale (I-IV), where types I and II were considered a success. After an average follow-up of 16 years after SABG...... (range = 10.2-22.7 years), 101 of the 123 grafts (82%) were categorised as successes. Mean age in the success group was 12.1 years and 13.6 years in the failure group (p = 0.03). It was found that the success rate was significantly lower (p = 0.02) if SABG was performed after eruption of the tooth distal...

  1. Aneurysmal bone cyst secondary to a giant cell tumor of the patella: A case report

    Science.gov (United States)

    YU, XIAOLONG; GUO, RUNSHENG; FAN, CONGLIANG; LIU, HUCHENG; ZHANG, BIN; NIE, TAO; TU, YI; DAI, MIN

    2016-01-01

    The patella is an unusual location for primary and metastatic bone tumors to develop. The most frequently encountered primary osteolytic lesions at the patella include giant cell tumors of the bone (GCT), chondroblastoma and aneurysmal bone cysts (ABC). However, the presentation of an ABC originating secondary to a GCT at the patella is rare. The present study describes such a case in a 46-year-old female. The differential diagnosis of the condition was extensive. The patient underwent curettage and the addition of bone cement to fill the defect. Pathological analysis of the resected tissue demonstrated that the lesion was consistent with an ABC forming secondary to a GCT. A 3-month follow-up was completed subsequent to the surgery, with a computed tomography scan demonstrating no evidence of recurrence. However, frequent and continuous observations of the patient following diagnosis are planned in order to evaluate the long-term efficacy of the surgical treatment. To the best of our knowledge, the present study describes the third reported case in the literature of this rare, double synchronous, benign tumor located at the patella. PMID:26893764

  2. Pain and quality of life following palliative radiotherapy of bone metastases; Der Einfluss palliativer Strahlentherapie auf Schmerz und Lebensqualitaet bei Patienten mit Knochenmetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Sauer, N.; Wild, B.; Henningsen, P.; Jakobsen, T. [Klinik fuer Psychosomatische und Allgemeine Klinische Medizin, Univ. Heidelberg (Germany); Leising, D. [Inst. fuer Psychologie, Univ. Wuerzburg (Germany); Treiber, M. [Radiologische Universitaetsklinik, Heidelberg (Germany)

    2006-09-15

    Pain and quality of life following palliative radiotherapy of bone metastases Background and purpose: palliative irradiation is used to provide pain relief and to increase quality of life. Most studies exclude patients with advanced cancer disease and, therefore, a positive selection results. This prospective clinical study investigates the effect of palliative radiotherapy on pain and quality of life of patients with painful bone metastases. Patients and methods: 263 patients with bone metastases due to advanced cancer were observed with respect to pain and quality of life during a 2-month course of radiotherapy. Missing data were substituted by the LOCF method (last observation carried forward) to prevent a biased reduction of data. Results: radiotherapy resulted in pain relief. In the complete group, pain medication was not increased. Quality of life was not affected positively. Side effects of radiotherapy increased remarkably. Conclusion: Radiotherapy leads to pain relief. However, risks and benefits must be considered critically due to side effects. (orig.)

  3. Suddenly occurring pain in the shin due to solitary metastasis to bone from a non-recognised primary tumour

    DEFF Research Database (Denmark)

    Chatterjee, Shefali Anup; Isaksen, Christin R Graff

    2014-01-01

    A woman who had formerly had adequately treated breast cancer presented with symptoms of pain in the right shin. An X-ray of the punctum maximum for the pain showed a bone lesion. Biopsy revealed that it came from an adenocarcinoma of the lung, contrary to the first diagnosis of breast cancer meta......-stasis. The lung lesion had been seen on a subsequent com-puted tomography. There were no presenting symptoms relating to lung cancer. This case is interesting as adenocar-cinoma metastasis to bone rarely occurs in the tibia and below the knee....

  4. Eligibility audits for the randomized neuropathic bone pain trial (TROG 96.05)

    International Nuclear Information System (INIS)

    In February 1996 the Trans-Tasman Radiation Oncology Group (TROG) initiated a two-arm, multicentre, prospective randomized trial on radiotherapy for neuropathic pain due to bone metastases (TROG 96.05). This trial compares the response to a single 8-Gy fraction with 20 Gy in five fractions. The accrual target is 270 patients. In order to evaluate compliance with eligibility criteria after approximately 1 year of accrual, an independent audit of the first 42 randomized patients was commissioned. This found that only one of these patients did not have genuine neuropathic pain, but that this patient and seven others (19%) had infringements of other eligibility/exclusion criteria for the trial. Accordingly it was decided to continue the full audit up to 90 patients. This detected no further patients without genuine neuropathic pain, and found only one other eligibility infringement (1/48; 2%). It is concluded that this quality assurance (QA) measure undertaken early in the trial led to significantly improved clinician awareness of, and compliance with, eligibility/exclusion criteria. It also enabled an accurate comparison of outcome data for all randomized versus all eligible patients at the time of the preplanned first interim analysis at 90 patients. In view of the excellent compliance demonstrated in the second audit, a one-in-five sampling is proposed for future audits from centres that have already accrued at least five consecutive eligible patients. This is consistent with TROG QA guidelines now operational. Copyright (2000) Blackwell Science Pty Ltd

  5. Analysis of effects of radiotherapy on pain caused by metastic tumor of bone%骨转移癌放疗止痛疗效分析

    Institute of Scientific and Technical Information of China (English)

    张洪祥; 陈法爱; 张友平

    2001-01-01

    @@ Background:Metastic tumor of bone is a kind of complications common in clinic,which severely injured patients'quality of life and health.Local therapy was emphasized for pain caused by metastic tumor of bone.Radiotherapy quickly alleviated pain and the effects was lonstanding.

  6. Functional Interference Clusters in Cancer Patients With Bone Metastases: A Secondary Analysis of RTOG 9714

    International Nuclear Information System (INIS)

    Purpose: To explore the relationships (clusters) among the functional interference items in the Brief Pain Inventory (BPI) in patients with bone metastases. Methods: Patients enrolled in the Radiation Therapy Oncology Group (RTOG) 9714 bone metastases study were eligible. Patients were assessed at baseline and 4, 8, and 12 weeks after randomization for the palliative radiotherapy with the BPI, which consists of seven functional items: general activity, mood, walking ability, normal work, relations with others, sleep, and enjoyment of life. Principal component analysis with varimax rotation was used to determine the clusters between the functional items at baseline and the follow-up. Cronbach's alpha was used to determine the consistency and reliability of each cluster at baseline and follow-up. Results: There were 448 male and 461 female patients, with a median age of 67 years. There were two functional interference clusters at baseline, which accounted for 71% of the total variance. The first cluster (physical interference) included normal work and walking ability, which accounted for 58% of the total variance. The second cluster (psychosocial interference) included relations with others and sleep, which accounted for 13% of the total variance. The Cronbach's alpha statistics were 0.83 and 0.80, respectively. The functional clusters changed at week 12 in responders but persisted through week 12 in nonresponders. Conclusion: Palliative radiotherapy is effective in reducing bone pain. Functional interference component clusters exist in patients treated for bone metastases. These clusters changed over time in this study, possibly attributable to treatment. Further research is needed to examine these effects.

  7. Bone SPECT in low back pain: Results of an IAEA co-ordinated research project

    International Nuclear Information System (INIS)

    The aim of this study was to determine if it would be possible to use spinal bone single photon emission computed tomography (SPECT) in patients with unexplained back pain in varied clinical backgrounds and to determine if a positive or negative study had any prognostic value. The study was co-ordinated by the International Atomic Energy Agency (IAEA) and involved 8 centres in 7 countries. A total of 174 patients (mean age 42 years, range 15-80 years) were screened and found to have no obvious cause for their back pain at the time of the SPECT scan. All patients had a CT, and planar radiology. There was clinical follow-up data for 6 months without active treatment (such as surgery) in 147 patients. A panel of 9 specialists in nuclear medicine, radiology and orthopaedics reviewed all images and histories. Final assessment determined that 141 patients had skeletal causes for their back pain. SPECT was abnormal in 64% of these patients as compared to 58% with CT and 18% with planar radiology. CT was most likely to be diagnostic in disc degeneration (sensitivity 92%). SPECT was most diagnostic in facet joint disease (sensitivity 96%). In the 43 patients without any skeletal disease the specificity of SPECT was 79%, compared to 65% for CT. Follow-up of patients at 6 months showed that on average 71% had improvement of symptoms, suggesting a benign course for their back pain, with the exception of patients with pure facet joint disease, identified on SPECT but with no treatment. Spinal skeletal SPECT can be applied in a wide range of social and clinical settings. Results compare well with CT, providing additional information in 30% of patients, especially in facet joint disease where a positive SPECT study, suggests a worse clinical outcome at 6 months. (author)

  8. Effect of sex in the MRMT-1 model of cancer-induced bone pain [version 3; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Sarah Falk

    2015-11-01

    Full Text Available An overwhelming amount of evidence demonstrates sex-induced variation in pain processing, and has thus increased the focus on sex as an essential parameter for optimization of in vivo models in pain research. Mammary cancer cells are often used to model metastatic bone pain in vivo, and are commonly used in both males and females. Here we demonstrate that compared to male rats, female rats have an increased capacity for recovery following inoculation of MRMT-1 mammary cells, thus potentially causing a sex-dependent bias in interpretation of the data.

  9. A new rat model of bone cancer pain produced by rat breast cancer cells implantation of the shaft of femur at the third trochanter level

    OpenAIRE

    GUI, QI; Chengcheng XU; Liang ZHUANG; Xia, Shu; Chen, Yu; Peng, Ping; Shiying YU

    2013-01-01

    Bone cancer pain remains one of the most challenging cancer pains to fully control. In order to clarify bone cancer pain mechanisms and examine treatments, animal models mimicking the human condition are required. In our model of Walker 256 tumor cells implantation of the shaft of femur at the third trochanter level, the anatomical structure is relatively simple and the drilled hole is vertical and in the cortical bone only 1–2 mm in depth without injury of the distal femur. Pain behaviors an...

  10. Pain-reduction strategies in hypnotic context and hypnosis: ERPs and SCRs during a secondary auditory task.

    Science.gov (United States)

    De Pascalis, Vilfredo; Bellusci, Anna; Gallo, Carlo; Magurano, Maria Rosaria; Chen, Andrew C N

    2004-10-01

    Pain-rating scores were obtained from 10 high, 10 medium, and 10 low hypnotizable subjects who were holding a painful cold bottle in their left hands and were exposed to pain reduction treatments while they were performing a secondary oddball task. All subjects received suggestions of dissociative imagery and focused analgesia as cognitive strategies for pain reduction. The following measures were obtained for tone targets of the auditory oddball task: (a) reaction time; (b) P300 peak amplitude of the event-related potentials; (c) skin conductance levels and skin conductance responses. Focused analgesia produced the most pain reduction in high, but not medium or low, hypnotizable subjects who showed shorter reaction times, higher central and parietal P300 peaks, and higher skin conductance responses. These findings were discussed vis-a-vis the dissociated-control model assuming that capacity demands of hypnotic suggestion are low. PMID:15590503

  11. Image-guided ablation of painful metastatic bone tumors: a new and effective approach to a difficult problem

    Energy Technology Data Exchange (ETDEWEB)

    Callstrom, Matthew R.; Charboneau, J. William; Atwell, Thomas D.; Farrell, Michael A.; Welch, Timothy J.; Maus, Timothy P. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Goetz, Matthew P.; Rubin, Joseph [Mayo Clinic, Department of Oncology, Rochester, MN (United States)

    2006-01-01

    Painful skeletal metastases are a common problem in cancer patients. Although external beam radiation therapy is the current standard of care for cancer patients who present with localized bone pain, 20-30% of patients treated with this modality do not experience pain relief, and few further options exist for these patients. For many patients with painful metastatic skeletal disease, analgesics remain the only alternative treatment option. Recently, image-guided percutaneous methods of tumor destruction have proven effective for treatment of this difficult problem. This review describes the application, limitations, and effectiveness of percutaneous ablative methods including ethanol, methyl methacrylate, laser-induced interstitial thermotherapy (LITT), cryoablation, and percutaneous radiofrequency ablation (RFA) for palliation of painful skeletal metastases. (orig.)

  12. Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Kevin E. Kip

    2014-05-01

    Full Text Available Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA system may have posttraumatic stress disorder (PTSD, and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART, a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD. Methods: A randomized controlled trial of ART versus an attention control (AC regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART. Results: Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93% reported pain. The majority (78% used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ was −16.9±16.6 in the ART group versus −0.7±14.2 in the AC group (p=0.0006. Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006, pain-related impairment in mobility (effect size = 0.69, p=0.01, and negative affect (effect size = 1.01, p=0.001. Conclusions: Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain.

  13. Pharmacological evaluation of opioid and non-opioid analgesics in a murine bone cancer model of pain.

    NARCIS (Netherlands)

    ElMouedden, M.; Meert, T.F.

    2007-01-01

    The intramedulary injection of osteosarcoma cells in the mouse femur has served as a laboratory model to study bone cancer pain. However, the efficacy of different classes of analgesics has not fully been analyzed in this model. Therefore, the acute antinociceptive properties of different classes of

  14. The effect of a single dose of bupivacaine on donor site pain after anterior iliac crest bone harvesting.

    NARCIS (Netherlands)

    Barkhuysen, R.; Meijer, G.J.; Soehardi, A.; Merkx, M.A.W.; Borstlap, W.A.; Berge, S.J.; Bronkhorst, E.M.; Hoppenreijs, T.J.M.

    2010-01-01

    Transplants from the anterior iliac crest are used for most reconstructive procedures in cranio-maxillofacial surgery. The advantages are easy accessibility, the ability to work in two teams and the amount of corticocancellous bone available; disadvantages are postoperative pain and gait disturbance

  15. Structural studies of human alkaline phosphatase in complex with strontium: Implication for its secondary effect in bones

    OpenAIRE

    Llinas, Paola; Masella, Michel; Stigbrand, Torgny; Ménez, André; Stura, Enrico A.; Le Du, Marie Hélène

    2006-01-01

    Strontium is used in the treatment of osteoporosis as a ranelate compound, and in the treatment of painful scattered bone metastases as isotope. At very high doses and in certain conditions, it can lead to osteomalacia characterized by impairment of bone mineralization. The osteomalacia symptoms resemble those of hypophosphatasia, a rare inherited disorder associated with mutations in the gene encoding for tissue-nonspecific alkaline phosphatase (TNAP). Human alkaline phosphatases have four m...

  16. Spinal high-mobility group box 1 contributes to mechanical allodynia in a rat model of bone cancer pain

    International Nuclear Information System (INIS)

    Mechanisms underlying bone cancer-induced pain are largely unknown. Previous studies indicate that neuroinflammation in the spinal dorsal horn is especially involved. Being first reported as a nonhistone chromosomal protein, high-mobility group box 1 (HMGB1) is now implicated as a mediator of inflammation. We hypothesized that HMGB1 could trigger the release of cytokines in the spinal dorsal horn and contribute to bone cancer pain. To test this hypothesis, we first built a bone cancer pain model induced by intratibal injection of Walker 256 mammary gland carcinoma cells. The structural damage to the tibia was monitored by radiological analysis. The mechanical allodynia was measured and the expression of spinal HMGB1 and IL-1β was evaluated. We observed that inoculation of cancer cells, but not heat-killed cells, induced progressive bone destruction from 9 d to 21 d post inoculation. Behavioral tests demonstrated that the significant nociceptive response in the cancer cells-injected rats emerged on day 9 and this kind of mechanical allodynia lasted at least 21 d following inoculation. Tumor cells inoculation significantly increased HMGB1 expression in the spinal dorsal horn, while intrathecal injecting a neutralizing antibody against HMGB1 showed an effective and reliable anti-allodynia effect with a dose-dependent manner. IL-1β was significantly increased in caner pain rats while intrathecally administration of anti-HMGB1 could decrease IL-1β. Together with previous reports, we predict that bone cancer induces HMGB1 production, enhancing spinal IL-1β expression and thus modulating spinal excitatory synaptic transmission and pain response.

  17. Spinal high-mobility group box 1 contributes to mechanical allodynia in a rat model of bone cancer pain

    Energy Technology Data Exchange (ETDEWEB)

    Tong, Wei [Department of Out-Patient, Xijing Hospital, Fourth Military Medical University, Xi' an 710032 (China); Wang, Wei; Huang, Jing [Department of Anatomy and K. K. Leung Brain Research Centre, Fourth Military Medical University, Xi' an 710032 (China); Ren, Ning [Comprehensive Diagnostic and Therapeutic Center, Xijing Hospital, Fourth Military Medical University, Xi' an 710032 (China); Wu, Sheng-Xi, E-mail: shengxi@fmmu.edu.cn [Department of Anatomy and K. K. Leung Brain Research Centre, Fourth Military Medical University, Xi' an 710032 (China); Li, Yong-Qi, E-mail: devneuro@fmmu.edu.cn [Comprehensive Diagnostic and Therapeutic Center, Xijing Hospital, Fourth Military Medical University, Xi' an 710032 (China)

    2010-05-14

    Mechanisms underlying bone cancer-induced pain are largely unknown. Previous studies indicate that neuroinflammation in the spinal dorsal horn is especially involved. Being first reported as a nonhistone chromosomal protein, high-mobility group box 1 (HMGB1) is now implicated as a mediator of inflammation. We hypothesized that HMGB1 could trigger the release of cytokines in the spinal dorsal horn and contribute to bone cancer pain. To test this hypothesis, we first built a bone cancer pain model induced by intratibal injection of Walker 256 mammary gland carcinoma cells. The structural damage to the tibia was monitored by radiological analysis. The mechanical allodynia was measured and the expression of spinal HMGB1 and IL-1{beta} was evaluated. We observed that inoculation of cancer cells, but not heat-killed cells, induced progressive bone destruction from 9 d to 21 d post inoculation. Behavioral tests demonstrated that the significant nociceptive response in the cancer cells-injected rats emerged on day 9 and this kind of mechanical allodynia lasted at least 21 d following inoculation. Tumor cells inoculation significantly increased HMGB1 expression in the spinal dorsal horn, while intrathecal injecting a neutralizing antibody against HMGB1 showed an effective and reliable anti-allodynia effect with a dose-dependent manner. IL-1{beta} was significantly increased in caner pain rats while intrathecally administration of anti-HMGB1 could decrease IL-1{beta}. Together with previous reports, we predict that bone cancer induces HMGB1 production, enhancing spinal IL-1{beta} expression and thus modulating spinal excitatory synaptic transmission and pain response.

  18. An integrative approach for comparing microcirculation between normal and alveolar cleft gingiva in children scheduled for secondary bone grafting procedures

    NARCIS (Netherlands)

    D.M.J. Milstein; Y.W. Cheung; L. Ziukaite; C. Ince; H.P. van den Akker; J.A.H. Lindeboom

    2013-01-01

    Objective The aim of this study was to compare microcirculatory parameters in normal versus alveolar cleft gingiva in children selected for secondary bone grafting procedures. Study Design This study included 11 consecutive patients with complete unilateral alveolar clefts who required secondary bon

  19. Effects of Electroacupuncture Treatment on Bone Cancer Pain Model with Morphine Tolerance

    Directory of Open Access Journals (Sweden)

    Lei Sima

    2016-01-01

    Full Text Available Objective. To explore the efficacy of electroacupuncture treatment in cancer induced bone pain (CIBP rat model with morphine tolerance and explore changes of calcitonin-gene related peptide (CGRP expression in dorsal root ganglion (DRG. Methods. Forty SD rats were divided into five groups: sham, CIBP (B, CIBP + morphine (BM, CIBP + electroacupuncture (BE, and CIBP + morphine + electroacupuncture (BME. B, BM, BE, and BME groups were prepared CIBP model. The latter three groups then accepted morphine, electroacupuncture, and morphine combined electroacupuncture, separately, nine days consecutively (M1 to M9. Mechanical withdraw threshold (MWT was evaluated. Results. BE group only had differences in M1, M2, and M3 compared to B group (P<0.01. From M5, BM group showed significantly decreased MWT. Electroacupuncture could obtain analgesic effects only at early stage (M1 to M5. From M5 to M9, BME had the differences with BM group (P<0.01. IOD value of CGRP in BM and BME was substantially less than in B group. CGRP in BME was significantly lower than that in BM group (P<0.01. Conclusion. When used in combination with electroacupuncture, morphine could result in improving analgesic effects and reducing tolerance. CGRP may be associated with pain behaviors.

  20. Phase II study of concurrent capecitabine and external beam radiotherapy for pain control of bone metastases of breast cancer origin.

    Directory of Open Access Journals (Sweden)

    Yulia Kundel

    Full Text Available Pain from bone metastases of breast cancer origin is treated with localized radiation. Modulating doses and schedules has shown little efficacy in improving results. Given the synergistic therapeutic effect reported for combined systemic chemotherapy with local radiation in anal, rectal, and head and neck malignancies, we sought to evaluate the tolerability and efficacy of combined capecitabine and radiation for palliation of pain due to bone metastases from breast cancer.Twenty-nine women with painful bone metastases from breast cancer were treated with external beam radiation in 10 fractions of 3 Gy, 5 fractions a week for 2 consecutive weeks. Oral capecitabine 700 mg/m(2 twice daily was administered throughout radiation therapy. Rates of complete response, defined as a score of 0 on a 10-point pain scale and no increase in analgesic consumption, were 14% at 1 week, 38% at 2 weeks, 52% at 4 weeks, 52% at 8 weeks, and 48% at 12 weeks. Corresponding rates of partial response, defined as a reduction of at least 2 points in pain score without an increase in analgesics consumption, were 31%, 38%, 28%, 34% and 38%. The overall response rate (complete and partial at 12 weeks was 86%. Side effects were of mild intensity (grade I or II and included nausea (38% of patients, weakness (24%, diarrhea (24%, mucositis (10%, and hand and foot syndrome (7%.External beam radiation with concurrent capecitabine is safe and tolerable for the treatment of pain from bone metastases of breast cancer origin. The overall and complete response rates in our study are unusually high compared to those reported for radiation alone. Further evaluation of this approach, in a randomized study, is warranted.ClinicalTrials.gov NCT01784393NCT01784393.

  1. Up-regulation of brain-derived neurotrophic factor in the dorsal root ganglion of the rat bone cancer pain model

    Directory of Open Access Journals (Sweden)

    Tomotsuka N

    2014-07-01

    Full Text Available Naoto Tomotsuka,1 Ryuji Kaku,1 Norihiko Obata,1 Yoshikazu Matsuoka,1 Hirotaka Kanzaki,2 Arata Taniguchi,1 Noriko Muto,1 Hiroki Omiya,1 Yoshitaro Itano,1 Tadasu Sato,3 Hiroyuki Ichikawa,3 Satoshi Mizobuchi,1 Hiroshi Morimatsu1 1Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; 2Department of Pharmacy, Okayama University Hospital, Okayama, Japan; 3Department of Oral and Craniofacial Anatomy, Tohoku University Graduate School of Dentistry, Sendai, Japan Abstract: Metastatic bone cancer causes severe pain, but current treatments often provide insufficient pain relief. One of the reasons is that mechanisms underlying bone cancer pain are not solved completely. Our previous studies have shown that brain-derived neurotrophic factor (BDNF, known as a member of the neurotrophic family, is an important molecule in the pathological pain state in some pain models. We hypothesized that expression changes of BDNF may be one of the factors related to bone cancer pain; in this study, we investigated changes of BDNF expression in dorsal root ganglia in a rat bone cancer pain model. As we expected, BDNF mRNA (messenger ribonucleic acid and protein were significantly increased in L3 dorsal root ganglia after intra-tibial inoculation of MRMT-1 rat breast cancer cells. Among the eleven splice-variants of BDNF mRNA, exon 1–9 variant increased predominantly. Interestingly, the up-regulation of BDNF is localized in small neurons (mostly nociceptive neurons but not in medium or large neurons (non-nociceptive neurons. Further, expression of nerve growth factor (NGF, which is known as a specific promoter of BDNF exon 1–9 variant, was significantly increased in tibial bone marrow. Our findings suggest that BDNF is a key molecule in bone cancer pain, and NGF-BDNF cascade possibly develops bone cancer pain. Keywords: BDNF, bone cancer pain, chronic pain, nerve growth

  2. Fat Embolism Syndrome Secondary to Bone Marrow Necrosis in Patients with Hemoglobinopathies.

    Science.gov (United States)

    Gangaraju, Radhika; Reddy, Vishnu V B; Marques, Marisa B

    2016-09-01

    Bone marrow necrosis with subsequent embolization of the fat and necrotic tissues into the systemic circulation causing fat embolism syndrome and multiorgan failure is a rare complication of patients with hemoglobinopathies. The exact etiology of this condition is not known. Because it occurs more often in patients with compound heterozygous conditions than in sickle cell disease, some patients are unaware of their predisposition. The initial symptoms are nonspecific, such as back and/or abdominal pain, fever, and fatigue, which may rapidly progress to respiratory failure and severe neurologic compromise. Common laboratory tests reveal anemia without reticulocytosis, thrombocytopenia, leukoerythroblastic picture with immature white cells and nucleated red blood cells, increased lactate dehydrogenase, high ferritin, and, sometimes increased creatinine. The diagnosis can be delayed because of an apparent lack of awareness about bone marrow necrosis with fat embolism syndrome, its rarity, and its similarities with other conditions such as thrombotic thrombocytopenic purpura. Although a bone marrow biopsy is diagnostic, waiting for it delays definitive treatment, which appears to be essential for the recovery of end-organ damage, such as neurologic and pulmonary damage. In our experience, either multiple units of red blood cell transfusion or, preferably, red cell exchange initiated promptly, is lifesaving. PMID:27598359

  3. New bisphosphonate labeled with Iodine-131 for the palliative therapy for bone metastases pain

    International Nuclear Information System (INIS)

    The aim of this work was to obtain new bisphosphonate marked with 131I suitable for palliative treatment of bone metastases pain characteristics. Materials and Methods: It started with aromatic amino acids and the synthesis consisted of three stages: 1) Protection of amino groups by acetylation; 2) phosphonation protected amino acids with a mixture of phosphorous acid and phosphorus pentachloride; 3) Lack of protection of the amino groups by basic hydrolysis. The compounds obtained were characterized by IR, 1H NMR, RMN13-C mass. Los spectrometry bisphosphonic acids obtained were labeled with 131I using chloramine T and iodogen as oxidants. Stability of labeled compounds in aqueous solution was studied serum. 3 mg of 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1-bisphosphonic acid labeled of 131I were administered to male wistar rats (170-190 g) through a lateral tail vein. The scintigraphic study was conducted at 2, 6 and 12 hours. Results: The yield of the reactions of the amino group protection four compounds ranged from 75 to 80%, while the phosphonation was between 50 and 60%. The radiochemical purity of 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1- bisphosphonic acid labeled with 131I was (91.5 ± 1.4)% and its stability was satisfactory for 72h. Scintigraphic images suggest excretion by the kidneys of the compound and from 12 h post-administration begin to visualize bone structures of the animal, suggesting that the compound exhibits affinity for these tissues. Conclusions: A novel synthesis method with modifications that yielded the sodium salts of bisphosphonic acids starting from the respective aromatic amino acids was developed. 2-amino-3- (4-hydroxyphenyl) -1-hydroxypropyl-1,1-bisphosphonic acid 131I labeled was stable up to 72h and showed affinity for bone tissue. (author)

  4. Combine strontium-89 and 99Tc-MDP: desirable therapeutic for painful bone metastases of prostate cancer

    International Nuclear Information System (INIS)

    Objective: To evaluate the efficacy of strontium-89 (89Sr) and 99Tc-MDP in treatment of painful bone metastases of prostate cancer. Methods: A total of 138 patients with painful bone metastases of prostate cancer received emasculate, The average age of the patients is 69.3±8.2 (from 58 to 93, Randomly Divided them into two groups randomly: 1 Antitheses treatment group have 73 of the patients. 89Sr treat only. followed by intravenous injection of 89Sr at the dose of 1.48-2.22 MBq (40-60 μCi)/kg. 2 Combine 89Sr and 99Tc-MDP treatment group have 65 of the patients. 89Sr and 99Tc-MDP: The scheme is same as Combine treatment group. 99Tc-MDP 200 mg, intravenous transfusion per day, total 5 times(the period of treatment). Clinical efficacies were evaluated by follow-up analysis once a month, Two groups were analysed contrast. Results: 1 Two groups painful alleviated rate in 73.97% and 90.77% in respectively, The efficacy is quite different. 2 Flare ache occurred rate in 30.14% and 27.6% of the patients, The efficacy is not quite different. 3 After treatment the applied dose of anodyne reduced in 72.60% and 83.08%, distinct efficacy. 4 Pain relief lasted average (4.41±1.57) months and (4.64±2.52) months in respectively, distinct efficacy. 5 After treatment Two groups advance function ability 64.38% and 81.54%, distinct efficacy. Conclusion: 89Sr and 99Tc-MDP can be used as a desirable therapeutic for painful bone metastases of prostate cancer, can reduce medicine of ease pain, can prolong pain relief lasted. can improve function ability of the patients. (authors)

  5. Chondroblastoma with secondary aneurysmal bone cyst in the anterior skull base

    Directory of Open Access Journals (Sweden)

    Ming Jie Wang, MD, PhD

    2016-06-01

    Full Text Available Chondroblastoma with secondary aneurysmal bone cyst (ABC, especially in the anterior skull base, is an extremely rare condition. A 5-year-old boy presented with a large space-occupying lesion in the anterior skull base along with a left sided-epistaxis, proptosis and decreased vision. Radical excision of the lesion was performed by an endoscopic transnasal and transethmoidal approach. The patient recovered without any recurrence during a follow-up period of up to 28 months. Here, we review this rare case and discuss the clinical presentation and surgical treatment.

  6. Registration of CT to pre-treatment MRI for planning of MR-HIFU ablation treatment of painful bone metastases

    International Nuclear Information System (INIS)

    MR-HIFU is a new non-invasive treatment modality that can be used for palliation in patients with painful bone metastases. Since treatment strategies are mainly focused on the ablation of periosteal nerves, information on the presence and geometry of cortical bone influences the treatment strategy, both in determining the acoustic power and in avoiding safety issues related to far-field heating. Although MRI is available for imaging during treatment, CT is best used for examining the cortical bone. We present a registration method for registering CT and MR images of patients with bone metastases prior to therapy. CT and MRI data were obtained from nine patients with metastatic bone lesions at varying locations. A two-step registration approach was used, performing simultaneous rigid registration of all available MR images in the first step and an affine and deformable registration with an additional bone metric in the second step. The performance was evaluated using landmark annotation by clinical observers. An average registration error of 4.5 mm was obtained, which was comparable to the slice thickness of the data. The performance of the registration algorithm was satisfactory, even with differences in MRI acquisition parameters and for various anatomical sites. The obtained CT overlay is useful for treatment planning, as it allows an assessment of the integrity of the cortical bone. CT-MR registration is therefore recommended for HIFU treatment planning of patients with bone metastases. (paper)

  7. Registration of CT to pre-treatment MRI for planning of MR-HIFU ablation treatment of painful bone metastases

    Science.gov (United States)

    Noorda, Yolanda H.; Bartels, Lambertus W.; Huisman, Merel; Nijenhuis, Robbert J.; AAJ van den Bosch, Maurice; Pluim, Josien PW

    2014-08-01

    MR-HIFU is a new non-invasive treatment modality that can be used for palliation in patients with painful bone metastases. Since treatment strategies are mainly focused on the ablation of periosteal nerves, information on the presence and geometry of cortical bone influences the treatment strategy, both in determining the acoustic power and in avoiding safety issues related to far-field heating. Although MRI is available for imaging during treatment, CT is best used for examining the cortical bone. We present a registration method for registering CT and MR images of patients with bone metastases prior to therapy. CT and MRI data were obtained from nine patients with metastatic bone lesions at varying locations. A two-step registration approach was used, performing simultaneous rigid registration of all available MR images in the first step and an affine and deformable registration with an additional bone metric in the second step. The performance was evaluated using landmark annotation by clinical observers. An average registration error of 4.5 mm was obtained, which was comparable to the slice thickness of the data. The performance of the registration algorithm was satisfactory, even with differences in MRI acquisition parameters and for various anatomical sites. The obtained CT overlay is useful for treatment planning, as it allows an assessment of the integrity of the cortical bone. CT-MR registration is therefore recommended for HIFU treatment planning of patients with bone metastases.

  8. Use of 5% lidocaine medicated plaster to treat localized neuropathic pain secondary to traumatic injury of peripheral nerves

    Directory of Open Access Journals (Sweden)

    Correa-Illanes G

    2012-07-01

    Full Text Available Gerardo Correa-Illanes,1 Ricardo Roa,2 José Luis Piñeros,2 Wilfredo Calderón31Rehabilitation Department, 2Burns and Plastic Surgery Department, Hospital del Trabajador, 3Plastic Surgery Department, Hospital del Salvador, Santiago, ChileObjective: The efficacy of 5% lidocaine medicated plaster (LMP has previously been demonstrated in post-traumatic localized neuropathic pain. This study evaluated the use of LMP in localized neuropathic pain secondary to traumatic peripheral nerve injury.Patients and methods: This prospective observational study enrolled patients with traumatic injuries to peripheral nerves that were accompanied by localized neuropathic pain of more than 3 months duration. Demographic variables, pain intensity (measured using the numeric rating scale; NRS, answers to the Douleur Neuropathique 4 (DN4 questionnaire, and the size of the painful area were recorded.Results: Nineteen patients were included, aged (mean ± standard deviation 41.4 ± 15.7 years. Nerve injuries affected the upper (eight patients or lower (11 patients limbs. The mean duration of pain before starting treatment with LMP was 22.6 ± 43.5 months (median 8 months. Mean baseline values included: NRS 6.7 ± 1.6, painful area 17.8 ± 10.4 cm2 (median 18 cm2, and DN4 score 6.7 ± 1.4. The mean duration of treatment with LMP was 19.5 ± 10.0 weeks (median 17.4 weeks. Mean values after treatment were: NRS 2.8 ± 1.5 (≥3 point reduction in 79% of patients, ≥50% reduction in 57.9% of patients and painful area 2.1 ± 2.3 cm2 (median 1 cm2, ≥50% reduction in 94.7% of patients. Functional improvement after treatment was observed in 14/19 patients (73.7%.Conclusion: LMP effectively treated traumatic injuries of peripheral nerves which presented with chronic localized neuropathic pain, reducing both pain intensity and the size of the painful area.Keywords: chronic post-surgical pain, chronic post-traumatic pain, 5% lidocaine medicated plaster, neuropathic pain

  9. Calculation of the Dose of Samarium-153-Ethylene Diamine Tetramethylene Phosphonate (153Sm-EDTMP as a Radiopharmaceutical for Pain Relief of bone Metastasis

    Directory of Open Access Journals (Sweden)

    Fatemeh Razghandi

    2016-04-01

    Full Text Available Introduction One of the important applications of nuclear physics in medicine is the use of radioactive elements as radiopharmaceuticals. Metastatic bone disease is the most common form of malignant bone tumors. Samarium-153-ethylene diamine tetramethylene phosphonate (153Sm-EDTMP as a radiopharmaceutical is used for pain palliation. This radiopharmaceutical usually emits beta particles, which have a high uptake in bone tissues. The purpose of this study was to calculate the radiation dose distribution of 153Sm-EDTMP in bone and other tissues, using MCNPX Monte Carlo code in the particle transport model. Materials and Methods Dose delivery to the bone was simulated by seeking radiopharmaceuticals on the bone surface. The phantom model had a simple cylindrical geometry and included bone, bone marrow, and soft tissue. Results The simulation results showed that a significant amount of radiation dose was delivered to the bone by the use of this radiopharmaceutical. Conclusion Thebone acted as a fine protective shield against rays for the bone marrow. Therefore, the trivial absorbed dose by the bone marrow caused less damage to bone-making cells. Also, the high absorbed dose of the bone could destroy cancer cells and relieve the pain in the bone.

  10. {sup 177}Lu-DOTMP: a viable agent for palliative radiotherapy of painful bone metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Das, T.; Chakraborty, S.; Banerjee, S. [Radiopharmaceuticals Div., Bhabha Atomic Research Centre, Mumbai (India); Sarma, H.D. [Radiation Biology and Health Sciences Div., Bhabha Atomic Research Centre, Mumbai (India)

    2008-07-01

    The suitable nuclear decay characteristics [T{sub 1/2} = 6.73 d, E{sub {beta}}{sub (max)} = 497 keV, E{sub {gamma}} = 113 keV (6.4%), 208 keV (11%)] as well as the feasibility of large-scale production with adequate specific activity and radionuclidic purity using a moderate flux reactor are important attributes towards {sup 177}Lu to be considered as a promising radionuclide for palliative care in painful bone metastasis. The present study describes the preparation of {sup 177}Lu complex of 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetramethylene phosphonic acid (DOTMP) and its preliminary biological evaluation in animal models with an aim to proposing it as a viable radiopharmaceutical for bone pain palliation. The choice DOTMP as the polyaminophosphonic acid carrier ligand is based on the enhanced thermodynamic stability and kinetic inertness of the metal-ligand complexes with macrocyclic chelators. {sup 177}Lu was produced with a specific activity of {proportional_to} 12 GBq/mg ({proportional_to} 324 mCi/mg) and radionuclidic purity of 99.98% by irradiation of natural Lu{sub 2}O{sub 3} target at a thermal neutron flux of {proportional_to} 6 x 10{sup 13} n/cm{sup 2} s for 21 d. {sup 177}Lu-DOTMP complex was prepared in high yield and excellent radiochemical purity (> 99%) using DOTMP synthesized and characterized in-house. The complex exhibited excellent in-vitro stability at room temperature. Biodistribution studies in Wistar rats showed rapid skeletal accumulation of the injected activity [(1.60{+-}0.19)% per gram in femur at 3 h post-injection] with fast clearance from blood and minimal uptake in any of the major organs. Scintigraphic studies carried out in normal Wistar rats and New Zealand white rabbits also demonstrated significant accumulation of the agent in skeleton and almost no retention in any other vital organs. (orig.)

  11. {sup 177}Lu-EDTMP for palliation of pain from bone metastases in patients with prostate and breast cancer: a phase II study

    Energy Technology Data Exchange (ETDEWEB)

    Agarwal, Krishan Kant; Singla, Suhas; Arora, Geetanjali; Bal, Chandrasekhar [All India Institute of Medical Sciences, Department of Nuclear Medicine, Ansari Nagar, New Delhi (India)

    2015-01-15

    The purpose of this study was to evaluate the efficacy and safety of {sup 177}Lu-EDTMP for pain palliation in patients with bone metastases from castration-resistant prostate and breast cancer. The secondary objective was to compare low-dose and high-dose {sup 177}Lu-EDTMP in bone pain palliation. Included in the study were 44 patients with documented breast carcinoma (12 patients; age 47 ± 13 years) or castration-resistant prostate carcinoma (32 patients; age 66 ± 9 years) and skeletal metastases. Patients were randomized into two equal groups treated with {sup 177}Lu-EDTMP intravenously at a dose of 1,295 MBq (group A) or 2,590 MBq (group B). Pain palliation was evaluated using a visual analogue score (VAS), analgesic score (AS) and Karnofsky performance score (KPS) up to 16 weeks. Toxicity was assessed in terms of haematological and renal parameters. The overall response rate (in all 44 patients) was 86 %. Complete, partial and minimal responses were seen in 6 patients (13 %), 21 patients (48 %) and 11 patients (25 %), respectively. A favourable response was seen in 27 patients (84 %) with prostate cancer and in 11 patients (92 %) with breast cancer. There was a progressive decrease in the VAS from baseline up to 4 weeks (p < 0.05). Also, AS decreased significantly from 1.8 ± 0.7 to 1.2 ± 0.9 (p < 0.0001). There was an improvement in quality of life of the patients as reflected by an increase in mean KPS from 56 ± 5 to 75 ± 7 (p < 0.0001). The overall response rate in group A was 77 % compared to 95 % in group B (p = 0.188). There was a significant decrease in VAS and AS accompanied by an increase in KPS in both groups. Nonserious haematological toxicity (grade I/II) was observed in 15 patients (34 %) and serious toxicity (grade III/IV) occurred in 10 patients (23 %). There was no statistically significant difference in haematological toxicity between the groups. {sup 177}Lu-EDTMP was found to be a safe and effective radiopharmaceutical for bone pain

  12. Radionuclide therapy for painful bone metastases. An italian multicentre observational study

    International Nuclear Information System (INIS)

    It has been affirmed that observational studies give analogous results to randomised controlled ones. A multicentre observational trial was conducted between 1996-1998 in order to evaluate the efficacy of palliative radionuclide therapy for bone metastases in a large number of patients. An evaluation was made on 510 patients with prostate cancer and painful bone metastases, treated with a single i.v. dose of 89Sr-chloride (527 treatments) or 186Re-HEDP (83 treatments), in 29 Italian Nuclear Medicine Departments. Eighty-one patients received up to five injections, totalling 100 retreatments. Patients were followed up for a period of 3 months-2 years. Results were expressed at four levels of response: excellent, good, mild, and nil. Responses were excellent in 26.4%, good in 33.3%, mild in 21.3% and nil in 19% of all treatments, while good and excellent responses were obtained in 48% of retreatments. No statistically significant correlations were found between response and age of patients, skeletal extension of tumor, pretherapeutic PSA levels, evidence of non-bony metastases, previous chemotherapy and/or external-beam radiotherapy; osteolytic lesions responded worse than osteoblastic or mixed ones. Hematological toxicity (mild to moderate), mainly affecting platelets, was observed in 25.5% of all treatments and in 38.9% if retreatments. No clear differences were found between the two radiopharmaceuticals employed. In conclusion, bearing in mind that observational studies can provide just as accurate results as randomised controlled trials, this study confirms the main findings of various limited monocentre trials

  13. Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Latus J

    2013-07-01

    Full Text Available Joerg Latus,1 Meike Roesel,1 Peter Fritz,2 Niko Braun,1 Christoph Ulmer,3 Wolfgang Steurer,3 Dagmar Biegger,4 M Dominik Alscher,1 Martin Kimmel1 1Department of Internal Medicine, Division of Nephrology, Robert Bosch Hospital, Stuttgart, Germany; 2Department of Diagnostic Medicine, Robert Bosch Hospital, Stuttgart, Germany; 3Department of Surgery, Robert Bosch Hospital, Stuttgart, Germany; 4Margarete Fischer-Bosch Institute of Clinical Pharmacology, University of Tuebingen, Stuttgart, Germany Introduction: Secondary hyperparathyroidism develops in nearly all patients with end-stage renal disease. Parathyroidectomy is often performed when medical therapy fails. The most common postoperative complication, hungry bone syndrome (HBS, requires early recognition and treatment. Materials and methods: A total of 84 patients who underwent parathyroidectomy because of secondary hyperparathyroidism were investigated. Detailed analysis of laboratory parameters (calcium, phosphate, parathyroid hormone, hemoglobin, and urea levels and baseline characteristics (age at time of surgery, duration of renal replacement therapy, and medication was performed to detect preoperative predictors for the development of HBS. Results: Average overall follow-up of the cohort was 4.7 years. Within this time frame, 13 of 84 patients had to undergo a second surgery because of recurrent disease, and HBS occurred in 51.2%. Only decreased preoperative calcium levels and younger age at time of surgery were significant predictors of HBS. Minimal levels of calcium were detected 3 weeks after surgery. Preoperative vitamin D therapy could not prevent HBS and could not shorten the duration of intravenous calcium supplementation. Conclusion: HBS is a very common complication after parathyroidectomy. Younger patients and patients with low preoperative calcium levels were at higher risk for the development of HBS. Remarkably, preoperative vitamin D therapy could not prevent HBS and had no

  14. Ultrastructural Analyses of Alveolar Bone in a Patient With Osteomyelitis Secondary to Osteopetrosis: A Review of the Literature.

    Science.gov (United States)

    Mikami, Toshinari; Miake, Yasuo; Bologna-Molina, Ronell; Takeda, Yasunori

    2016-08-01

    Osteopetrosis is a generic term for generalized sclerotic conditions caused by rare genetic disorders. Decreased osteoclastic activities disturb bone remodeling, resulting in greater mineral density and greater compressive strength; therefore, bone fracture is a major physical symptom of osteopetrosis. Osteomyelitis of the maxilla or mandible is a common and well-documented complication of osteopetrosis. Local infection, such as odontogenic infection, is more likely to lead to osteomyelitis, and treatment strategies can be challenging. However, detailed ultrastructural analyses of bone from patients with osteopetrosis and odontogenic infection are limited. This report describes a case of osteomyelitis of the maxilla and mandible secondary to osteopetrosis in an adult patient and presents ultrastructural data of alveolar bone tissue analyzed by contact microradiography, electron probe microanalysis, and x-ray diffraction. Cases of osteomyelitis of the jaw secondary to osteopetrosis also are reviewed. PMID:27000409

  15. Pain, PSA flare, and bone scan response in a patient with metastatic castration-resistant prostate cancer treated with radium-223, a case report

    International Nuclear Information System (INIS)

    Radium-223 has been shown to improve overall survival in men with metastatic castration-resistant prostate cancer with symptomatic bone metastases. The bone scan response to radium-223 has only been described in one single center trial of 14 patients, none of whom achieved the outstanding bone scan response presented in the current case. In this case report, we describe a 75 year-old white man with extensively pre-treated metastatic castration-resistant prostate cancer and symptomatic bone metastases who experienced a flare in pain and prostate-specific antigen, followed by dramatic clinical (pain), biochemical (prostate-specific antigen), and imaging (bone scan) response. The flare phenomena and bone scan response we observed have not previously been described with radium-223. This case suggests that the degree and duration of bone scan response may be predictive of overall survival benefit

  16. Bone scan findings of chest wall pain syndrome after stereotactic body radiation therapy: implications for the pathophysiology of the syndrome

    OpenAIRE

    Lloyd, Shane; Decker, Roy H.; Evans, Suzanne B.

    2013-01-01

    We present a case of a 72-year-old woman treated with stereotactic body radiation therapy (SBRT) for peripherally located stage I non-small cell lung cancer (NSCLC). After treatment she developed ipsilateral grade II chest wall pain. A bone scan showed nonspecific and heterogeneous increased radiotracer uptake in the volume of ribs receiving 30% of the prescription dose of radiation (V30). We present a color wash image demonstrating excellent concordance between the V30 and the area of scinti...

  17. Bone mineral density, rib pain and other features of the female athlete triad in elite lightweight rowers

    OpenAIRE

    Dimitriou, Lygeri; Weiler, Richard; Lloyd-Smith, Rebecca; Turner, Anthony N.; Heath, Luke; James, Nic; Reid, Anna

    2014-01-01

    Objective: To determine bone mineral density (BMD) and the associations among BMD, menstrual history, disordered eating (DE), training history, intentional weight loss (IWL) and rib pain for the first time in female lightweight rowers. Setting: 9 lightweight rowing clubs, UK. Participants: 29 Caucasian female lightweight rowers volunteered. 21 (12 active, 9 retired) completed the study. Inclusion criteria: female lightweight rowers aged over 18 years. Exclusion crit...

  18. A clinical trial of 153Sm EDTMP in promotion of bone metastatic cancer pains%153钐改善骨转移癌痛疗效观察

    Institute of Scientific and Technical Information of China (English)

    王新

    2002-01-01

    Objective To evaluate the effect of 153Sm EDTMP in the bone metastatic cancer pains.Methods In treatment group(32 patients with bone metastatic diseases) 153Sm EDTMP were given by infusion for one time.In control group,32 patients received radiotherapy. The radio dose was DT30Gy,5 times per week for 2 weeks.Pain relief was used as criteria of response at the time treatment finished and 6 months later.Results At the time treatment finished,there were statistically differences in pain relief between two groups.Pains relief rate was superior to control group after 6 months (P< 0.05).Conclusion Treatment with 153Sm EDTMP one time can reduce apparently pains caused by bone metastases,which is conveniently used and well tolerated.

  19. Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus.

    Directory of Open Access Journals (Sweden)

    Hiroki eNakata

    2014-12-01

    Full Text Available Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging (fMRI, and neurophysiological methods, such as magnetoencephalography (MEG and electroencephalography (EEG, have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural responses to pain stimulation during meditation in the anterior cingulate cortex (ACC and insula, whereas others showed a decrease in these regions. There have been inconsistent findings to date. Moreover, in general, since the activities of the ACC and insula are correlated with pain perception, the increase in neural activities during meditation would be related to the enhancement of pain perception rather than its reduction. These contradictions might directly contribute to the ‘mystery of meditation’. In this review, we presented previous findings for brain regions during meditation and the anatomical changes that occurred in the brain with long-term meditation training. We then discussed the findings of previous studies that examined pain-related neural activity during meditation. We also described the brain mechanisms responsible for pain relief during meditation, and possible reasons for paradoxical evidence among previous studies. By thoroughly overviewing previous findings, we hypothesized that meditation reduces pain-related neural activity in the ACC, insula, secondary somatosensory cortex, and thalamus. We suggest that the characteristics of the modulation of this activity may depend on the kind of meditation and/or number of years of experience of meditation, which were associated with paradoxical findings among previous studies that investigated pain-related neural activities during meditation.

  20. Temporal bone chondroblastoma with secondary aneurysmal bone cyst presenting as an intracranial mass with clinical seizure activity.

    Science.gov (United States)

    Stapleton, Christopher J; Walcott, Brian P; Linskey, Katy R; Kahle, Kristopher T; Nahed, Brian V; Asaad, Wael F

    2011-06-01

    Chondroblastomas are rare tumors that characteristically arise from the epiphyseal cartilage of long bones of the immature skeleton. Intracranial involvement is uncommon, though the squamous portion of the temporal bone is preferentially affected due to its cartilaginous origin. Patients with temporal bone chondroblastomas classically present with otologic symptoms, while primary neurological complaints are rare. In this report, we describe a 33 year-old man with a chondroblastoma of the temporal bone and an associated aneurysmal bone cyst constituting a large intracranial mass lesion who presented with new-onset seizure activity. We review issues relevant to the pathology and treatment of these lesions.

  1. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    OpenAIRE

    Laxmaiah Manchikanti, Kimberly A. Cash, Vidyasagar Pampati, Bradley W. Wargo, Yogesh Malla

    2013-01-01

    Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted deli...

  2. Overall response rates to radiation therapy for patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment

    International Nuclear Information System (INIS)

    Introduction: Radiation therapy has been shown to successfully palliate bone metastases. A number of systematic reviews and large clinical trials have reported response rates for initial treatment and retreatment. Objective: To determine overall response rates of patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment. Methods: Intent-to-treat and evaluable patient statistics from a systematic review of palliative radiotherapy trials for initial treatment of bone metastases and a randomized clinical trial of retreatment were pooled and analyzed to determine the overall response rates for patients receiving initial treatment and retreatment. Results: In the intent-to-treat calculation, 71–73% of patients had an overall response to radiation treatment and in the evaluable patient population; 85–87% of patients did so. Response rates varied slightly whether patients underwent single or multiple fractions in initial treatment or retreatment. Conclusions: Single and multiple fraction radiation treatment yielded very similar overall response rates. Patients treated with a single fraction for both initial and repeat radiation experience almost identical overall response to those patients treated with multiple fraction treatment. It is therefore recommended that patients with uncomplicated painful bone metastases be treated with a single 8 Gy fraction of radiation at both the initial treatment and retreatment

  3. Strategies for the chemical analysis of highly porous bone scaffolds using secondary ion mass spectrometry

    International Nuclear Information System (INIS)

    Understanding the distribution of critical elements (e.g. silicon and calcium) within silica-based bone scaffolds synthesized by different methods is central to the optimization of these materials. Time-of-flight secondary ion mass spectrometry (ToF-SIMS) has been used to determine this information due to its very high surface sensitivity and its ability to map all the elements and compounds in the periodic table with high spatial resolution. The SIMS image data can also be combined with depth profiles to construct three-dimensional chemical maps. However, the scaffolds have interconnected pore networks, which are very challenging structures for the SIMS technique. To overcome this problem two experimental methodologies have been developed. The first method involved the use of the focused ion beam technique to obtain clear images of the regions of interest and subsequently mark them by introducing fiducial marks; the samples were then analysed using the ToF-SIMS technique to yield the chemical analyses of the regions of interest. The second method involved impregnating the pores using a suitable reagent so that a flat surface could be achieved, and this was followed by secondary ion mapping and 3D chemical imaging with ToF-SIMS. The samples used in this work were sol–gel 70S30C foam and electrospun fibres and calcium-containing silica/gelatin hybrid scaffolds. The results demonstrate the feasibility of both these experimental methodologies and indicate that these methods can provide an opportunity to compare various artificial bone scaffolds, which will be of help in improving scaffold synthesis and processing routes. The techniques are also transferable to many other types of porous material. (paper)

  4. Are Selective Serotonin Reuptake Inhibitors a Secondary Cause of Low Bone Density?

    Directory of Open Access Journals (Sweden)

    Kim Chau

    2012-01-01

    Full Text Available Background. Osteoporosis is a chronic disease that can significantly impact numerous aspects of health and wellness. The individual consequences of osteoporosis can be devastating, often resulting in substantial loss of independence and sometimes death. One of the few illnesses with greater disease burden than low bone mineral density (BMD is major depressive disorder (MDD. Both depression and antidepressant use have been identified as secondary causes of osteoporosis. The objective of this paper is to review and summarize the current findings on the relationship between antidepressant use and BMD. Methods. Relevant sources were identified from the Pubmed and MEDLINE databases, citing articles from the first relevant publication to September 1st, 2010. Results. 2001 articles initially met the search criteria, and 35 studies were thoroughly reviewed for evidence of an association between SSRI use and BMD, and 8 clinical studies were detailed and summarized in this paper. Conclusions. Current findings suggest a link between mental illness and osteoporosis that is of clinical relevance. Additional longitudinal studies and further research on possible mechanisms surrounding the association between SSRI use on bone metabolism need to be conducted. Treatment algorithms need to recognize this association to ensure that vulnerable populations are screened.

  5. Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease

    Directory of Open Access Journals (Sweden)

    Coluzzi F

    2015-05-01

    Full Text Available Flaminia Coluzzi,1,2 Robert B Raffa,3 Joseph Pergolizzi,4 Alessandra Rocco,1 Pamela Locarini,1 Natalia Cenfra,5 Giuseppe Cimino,5 Consalvo Mattia1,2 1Department of Medical and Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Unit of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Polo Pontino, Sapienza University of Rome, Latina, Italy; 2SIAARTI Study Group on Acute and Chronic Pain, Rome, Italy; 3Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA; 4Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 5Department of Cellular Biotechnology and Hematology, Sapienza University of Rome, Rome, Italy Context: Myeloma bone disease (MBD is a devastating complication of multiple myeloma that leads to severe pain. Objectives: The aim of this study was to evaluate the efficacy and tolerability of tapentadol prolonged release (PR in the management of patients with MBD suffering from moderate-to-severe cancer pain. Methods: A 12-week prospective study was carried out in 25 opioid-naïve MBD patients. Patients initially received twice-daily doses of tapentadol PR 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity. The following parameters were recorded at weekly intervals for 4 weeks, and then at weeks 8 and 12: pain, opioid-related adverse effects, use of other analgesics, DN4 (Douleur Neuropathique 4 score. Quality of life (SF-36 [36-item short-form health survey] was measured at baseline and at final evaluation. Results: Of 25 patients, 22 completed the study. Pain intensity significantly decreased from baseline to all the week intervals (P<0.01. Quality of life significantly improved with respect to all SF-36 subscale parameters (P<0.01, and so did both the physical and mental status (P<0.01. Tapentadol PR significantly reduced DN4 mean value (P<0.01 and the number of patients with neuropathic component

  6. Radiofrequency-Induced Intradiscal Nucleoplasty Chronic Low Back Pain Secondary To Lumbar Disc Herniation

    OpenAIRE

    Lee, DW; Loh, ESY; Kueh, CC; Poi, JH; Francis, T.; Koh, KC; Wazir, NN; Singh, H

    2013-01-01

    Abstract We set out to assess the efficacy of radiofrequency-induced intradiscal nucleoplasty in reducing pain in symptomatic patients with MRI-defined lumbar disc herniation and their satisfaction with the procedure. We compared the patients’ pain intensity and severity of disability scores before and after undergoing the procedure in a retrospective questionnaire. These patients reported statistically significant reduction of pain intensity and disability level after the procedure. We concl...

  7. CREB-regulated transcription coactivator 1 enhances CREB-dependent gene expression in spinal cord to maintain the bone cancer pain in mice

    Science.gov (United States)

    Liang, Ying; Liu, Yue; Hou, Bailing; Zhang, Wei; Liu, Ming; Sun, Yu-E; Gu, Xiaoping

    2016-01-01

    Background cAMP response element binding protein (CREB)-dependent gene expression plays an important role in central sensitization. CREB-regulated transcription coactivator 1 (CRTC1) dramatically increases CREB-mediated transcriptional activity. Brain-derived neurotrophic factor, N-methyl-d-aspartate receptor subunit 2B, and miRNA-212/132, which are highly CREB responsive, function downstream from CREB/CRTC1 to mediate activity-dependent synaptic plasticity and in turn loops back to amplify CREB/CRTC1 signaling. This study aimed to investigate the role of spinal CRTC1 in the maintenance of bone cancer pain using an RNA interference method. Results Osteosarcoma cells were implanted into the intramedullary space of the right femurs of C3H/HeNCrlVr mice to induce bone cancer pain. Western blotting was applied to examine the expression of spinal phospho-Ser133 CREB and CRTC1. We further investigated effects of repeated intrathecal administration with Adenoviruses expressing CRTC1-small interfering RNA (siRNA) on nociceptive behaviors and on the upregulation of CREB/CRTC1-target genes associated with bone cancer pain. Inoculation of osteosarcoma cells induced progressive mechanical allodynia and spontaneous pain, and resulted in upregulation of spinal p-CREB and CRTC1. Repeated intrathecal administration with Adenoviruses expressing CRTC1-siRNA attenuated bone cancer–evoked pain behaviors, and reduced CREB/CRTC1-target genes expression in spinal cord, including BDNF, NR2B, and miR-212/132. Conclusions Upregulation of CRTC1 enhancing CREB-dependent gene transcription in spinal cord may play an important role in bone cancer pain. Inhibition of spinal CRTC1 expression reduced bone cancer pain. Interruption to the positive feedback circuit between CREB/CRTC1 and its targets may contribute to the analgesic effects. These findings may provide further insight into the mechanisms and treatment of bone cancer pain. PMID:27060162

  8. Augmented Pain Processing in Primary and Secondary Somatosensory Cortex in Fibromyalgia: A Magnetoencephalography Study Using Intra-Epidermal Electrical Stimulation.

    Science.gov (United States)

    Lim, Manyoel; Roosink, Meyke; Kim, June Sic; Kim, Hye Won; Lee, Eun Bong; Son, Kyeong Min; Kim, Hyun Ah; Chung, Chun Kee

    2016-01-01

    The aim of this study was to investigate augmented pain processing in the cortical somatosensory system in patients with fibromyalgia (FM). Cortical evoked responses were recorded in FM (n = 19) and healthy subjects (n = 21) using magnetoencephalography after noxious intra-epidermal electrical stimulation (IES) of the hand dorsum (pain rating 6 on a numeric rating scale, perceptually-equivalent). In addition, healthy subjects were stimulated using the amplitude corresponding to the average stimulus intensity rated 6 in patients with FM (intensity-equivalent). Quantitative sensory testing was performed on the hand dorsum or thenar muscle (neutral site) and over the trapezius muscle (tender point), using IES (thresholds, ratings, temporal summation of pain, stimulus-response curve) and mechanical stimuli (threshold, ratings). Increased amplitude of cortical responses was found in patients with FM as compared to healthy subjects. These included the contralateral primary (S1) and bilateral secondary somatosensory cortices (S2) in response to intensity-equivalent stimuli and the contralateral S1 and S2 in response to perceptually-equivalent stimuli. The amplitude of the contralateral S2 response in patients with FM was positively correlated with average pain intensity over the last week. Quantitative sensory testing results showed that patients with FM were more sensitive to painful IES as well as to mechanical stimulation, regardless of whether the stimulation site was the hand or the trapezius muscle. Interestingly, the slope of the stimulus-response relationship as well as temporal summation of pain in response to IES was not different between groups. Together, these results suggest that the observed pain augmentation in response to IES in patients with FM could be due to sensitization or disinhibition of the cortical somatosensory system. Since the S2 has been shown to play a role in higher-order functions, further studies are needed to clarify the role of augmented

  9. A health information system in radiotherapy to support health personnel in evaluation of standard pain in patients with bone metastases

    International Nuclear Information System (INIS)

    Radiation therapy is a medical specialty that uses ionizing radiation sources, and can be applied to relieve the pain. The Numerical Dosimetry Group (GDN) of Recife-PE, Brazil presented in June 2012 the SISRAD (Health information system in radiotherapy), developed to organize information about data of patients with bone metastasis, aiming to evaluate patterns of pain after radiation treatment. They have since been carried out interviews with this type of patient and the answers have been added to a data file of the software. Were developed some graphical visualization tools as well as data sheets. The current version of SISRAD reads the data file and displays graphics and numerical results, with options to save them or print them. In this paper is presented a roadmap for the health care professional use with efficiency the SISRAD to form quantitative profiles of intensity of pain that their patients, on their responsibility, feel after the radiation treatment. A hypothesis used in SISRAD consists of organizing the responses of the patients supposing them free from other effects other than those arising from the permanence of the pain he felt before treatment or modification by the treatment. So the way the information is handled in the SISRAD enable the trader can discern patterns of pain and, consequently, improve the quality of treatment. In this sense the computational tool here presented can be classified as educational software for health professionals

  10. Comparable effects of exercise and analgesics for pain secondary to knee osteoarthritis

    DEFF Research Database (Denmark)

    Henriksen, Marius; Hansen, Julie B; Klokker, Louise;

    2016-01-01

    administered analgesics for pain in patients with knee osteoarthritis. METHODS: The Cochrane Database of systematic reviews was searched for meta-analyses of randomized controlled studies comparing exercise or analgesics with a control group (placebo or usual care) and with pain as an outcome. Individual study...

  11. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

    Energy Technology Data Exchange (ETDEWEB)

    Zeng Liang [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Chow, Edward, E-mail: edward.chow@sunnybrook.ca [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Bedard, Gillian; Zhang, Liying [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Fairchild, Alysa [Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta (Canada); Vassiliou, Vassilios [Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia (Cyprus); Alm El-Din, Mohamed A. [Department of Clinical Oncology, Tanta University Hospital, Tanta Faculty of Medicine, Tanta (Egypt); Jesus-Garcia, Reynaldo [Department of Orthopedic Oncology, Federal University of Sao Paulo, Sao Paulo (Brazil); Kumar, Aswin [Division of Gynaecology and Genitourinary Oncology, Department of Radiation Oncology, Regional Cancer Center, Trivandrum (India); Forges, Fabien [Inserm CIE3, Saint Etienne University Hospital, Saint-Etienne (France); Unit of Clinical Research, Innovation, and Pharmacology, Saint Etienne University Hospital, Saint-Etienne (France); Tseng, Ling-Ming [Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (China); Hou, Ming-Feng [Department of Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (China); Chie, Wei-Chu [Department of Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan (China); Bottomley, Andrew [European Organisation for Research and Treatment of Cancer, EORTC Headquarters, Brussels (Belgium)

    2012-11-01

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  12. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

    International Nuclear Information System (INIS)

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  13. Transient Receptor Potential Channel and Interleukin-17A Involvement in LTTL Gel Inhibition of Bone Cancer Pain in a Rat Model.

    Science.gov (United States)

    Wang, Juyong; Zhang, Ruixin; Dong, Changsheng; Jiao, Lijing; Xu, Ling; Liu, Jiyong; Wang, Zhengtao; Lao, Lixing

    2015-07-01

    Cancer pain management is a challenge for which Chinese herbal medicine might be useful. To study the spinal mechanisms of the Chinese medicated gel Long-Teng-Tong-Luo (LTTL), a 7-herb compound, on bone cancer pain, a bone cancer pain model was made by inoculating the tibias of female rats with Walker 256 cells. LTTL gel or inert gel, 0.5 g/cm(2)/d, was applied to the skin of tumor-bearing tibias for 21 days beginning a day after the inoculation. Mechanical threshold and paw withdrawal latency to thermal stimulation was measured. Transient receptor potential (TRP) cation channels in lumbar dorsal root ganglia (DRG) were immunostained and counted, and lumbar spinal cord interleukin-17A (IL-17A) was measured with real-time polymerase chain reaction and enzyme-linked immunosorbent assay. TRP antagonists and interleukin (IL)-17A antibodies were intrathecally administered to determine their effects on bone cancer pain. The gel significantly (P cancer-induced mechanical allodynia and thermal hyperalgesia and inhibited cancer-enhanced expression of IL-17A in spinal astrocytes and the TRP subfamily members V1, A1, and V4 in lumbar DRG. Intrathecal TRP antagonists at 10 µg significantly (P cancer pain. IL-17A antibodies inhibited cancer pain, suggesting that IL-17A promotes such pain. The data show that LTTL gel inhibits cancer pain, and this might be accounted for by the decrease in expression of DRG TRP channels and spinal astrocyte IL-17A. PMID:26100378

  14. Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease

    Science.gov (United States)

    Coluzzi, Flaminia; Raffa, Robert B; Pergolizzi, Joseph; Rocco, Alessandra; Locarini, Pamela; Cenfra, Natalia; Cimino, Giuseppe; Mattia, Consalvo

    2015-01-01

    Context Myeloma bone disease (MBD) is a devastating complication of multiple myeloma that leads to severe pain. Objectives The aim of this study was to evaluate the efficacy and tolerability of tapentadol prolonged release (PR) in the management of patients with MBD suffering from moderate-to-severe cancer pain. Methods A 12-week prospective study was carried out in 25 opioid-naïve MBD patients. Patients initially received twice-daily doses of tapentadol PR 50 mg. Doses were then managed to maintain adequate relief or dose-limiting toxicity. The following parameters were recorded at weekly intervals for 4 weeks, and then at weeks 8 and 12: pain, opioid-related adverse effects, use of other analgesics, DN4 (Douleur Neuropathique 4) score. Quality of life (SF-36 [36-item short-form health survey]) was measured at baseline and at final evaluation. Results Of 25 patients, 22 completed the study. Pain intensity significantly decreased from baseline to all the week intervals (P<0.01). Quality of life significantly improved with respect to all SF-36 subscale parameters (P<0.01), and so did both the physical and mental status (P<0.01). Tapentadol PR significantly reduced DN4 mean value (P<0.01) and the number of patients with neuropathic component (DN4 ≥4) (P<0.01). After 8 weeks of treatment, all patients were negative for the DN4 score. Tapentadol PR was well tolerated, and the use of other analgesics was reduced during the study period. Conclusion Tapentadol PR started in doses of 100 mg/day was effective and well tolerated in opioid-naïve MBD patients with moderate-to-severe pain. Tapentadol PR can be considered a first-choice opioid in cancer patients suffering from mixed pain with a neuropathic component. PMID:26064064

  15. Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: usefulness of 99mTc-pyrophosphate bone scintigraphy.

    Science.gov (United States)

    Kinnaert, P; Van Hooff, I; Schoutens, A; Bergmann, P; Fuss, M; Dratwa, M; Vienne, A; Pasteels, J L; van Geertruyden, J; Vanherweghem, J L

    1989-01-01

    Forty-one patients in chronic end-stage renal failure and 4 patients with a functioning kidney transplant presented with spontaneous hypercalcemia or intolerance to vitamin D3 sterols and/or oral calcium supplements. Bone iliac crest biopsy with aluminum staining and Tc-pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum-induced osteomalacia (AL O). Thirty-eight biopsies showed renal osteodystrophy (secondary hyperparathyroidism or various combinations of osteitis fibrosa and osteomalacia): 19 with positive staining for aluminum (RO + AL) and 19 without aluminum deposits (RO). The series also comprised 2 cases of pure osteomalacia (OM), 2 cases of osteoporosis (OP), and 1 case of osteoporosis with aluminum accumulation (OP + AL). Mean Fogelman score in RO patients (9.1 +/- 0.3) was significantly higher than in all other categories (5.9 +/- 0.5 for RO + AL, and scores ranging from 0 to 8 in the last 7 patients, p less than 0.01). Patients with massive aluminum accumulation in bone (greater than 75% of the total trabecular surface) showed no or very low uptake of the isotope by the skeleton. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism. 99mTc-pyrophosphate bone scintigraphy is helpful to distinguish aluminum intoxication from secondary hyperparathyroidism in uremic patients. PMID:2543146

  16. Counselling low-back-pain patients in secondary healthcare: a randomised trial addressing experienced workplace barriers and physical activity

    DEFF Research Database (Denmark)

    Jensen, Lone Donbæk; Maribo, Thomas; Schiøttz-Christensen, Berit;

    2012-01-01

    OBJECTIVE: To assess if counselling by an occupational physician (OP) addressing experienced workplace barriers and physical activity integrated as a part of low-back pain (LBP) outpatient treatment influences pain, function and sick leave. METHODS: Randomised controlled trial in the secondary...... healthcare sector with 3 months' follow-up. The participants were LBP patients who, independently of sick-leave status, expressed concerns about the ability to maintain their current job. Patients referred for surgery were excluded. The intervention consisted of two counselling sessions conducted by an OP...... physical activity and maximum oxygen uptake, supported compliance and adherence to the part of the intervention focusing on enhanced physical activity. CONCLUSION: Two short counselling sessions by an OP combining advice on meeting workplace barriers and enhancing physical activity had a substantial effect...

  17. 放疗对乳腺癌骨转移后癌痛的疗效分析%Analysis of radiotherapy curative effects on pains of bone metastases of breast cancer

    Institute of Scientific and Technical Information of China (English)

    邹浩元; 郑广进; 张汉雄; 黎荣光

    2001-01-01

    Objective To investigate the radiotherapy curative effects on pains of bone metastases of breast cancer. Methods To analysis 32 patients retrospectively, in which 22 patients received radiotherapy(17 moderate pain, 5 severe pain, 6 dysfunction). Result 16 patients obtained complete remission with 6 cases partial response to radiation. Karnorfsky's score was improved and malfunction disappeared. Conclusion Radiotherapy is a simple and effective treatment on bone metastases of breast cancer with quick and persistent pain relieves.

  18. Does increased local bone resorption secondary to breast and prostate cancer result in increased cartilage degradation?

    DEFF Research Database (Denmark)

    Leeming, Diana J; Byrjalsen, Inger; Qvist, Per;

    2008-01-01

    BACKGROUND: Breast and prostate cancer patients often develop lesions of locally high bone turnover, when the primary tumor metastasizes to the bone causing an abnormal high bone resorption at this site. The objective of the present study was to determine whether local increased bone turnover...... in breast and prostate cancer patients is associated with an increase in cartilage degradation and to test in vitro whether osteoclasts or cathepsin K alone generate CTXII from human bone. METHODS: The study included 132 breast and prostate cancer patient, where presence of bone metastases was graded...... according to the Soloway score. Total bone resorption (CTXItotal) and cartilage degradation (CTXII) were determined. RESULTS: Breast and prostate cancer patients with bone metastases revealed significant increased levels of CTXItotal at Soloway scores 1 and higher compared to patients without bone...

  19. Radionuclide bone imaging as a means of differentiating loosening and infection in patients with a painful total hip prosthesis

    International Nuclear Information System (INIS)

    Twenty patients with 23 painful total hip prostheses were examined by radionuclide imaging (20 cases), arthrography (11 cases), needle aspriation (9 cases), and surgery (19 cases) for the purpose of assessing loosening and/or infection. Bone imaging was most accurate, showing three main distributions of activity: (a) ectopic calcification, (b) focal increased activity at the upper and lower ends of the femoral prosthesis, and (c) diffuse activity. These findings suggest that infection and loosening can be differentiated in many instances. None of the patients with focal activity had infection, compared to 2 of the 3 patients with diffuse uptake

  20. Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases – an evidence-based practice guideline

    Directory of Open Access Journals (Sweden)

    Bezjak Andrea

    2004-10-01

    Full Text Available Abstract Background This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases. Methods A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee. Results Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%. Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report. Conclusion For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: • Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and

  1. Acute Renal Infarction Presenting with Acute Abdominal Pain Secondary to Newly Discovered Atrial Fibrillation: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Sherif Ali Eltawansy

    2014-01-01

    Full Text Available We report an 85-year-old female with known history of recurrent diverticulitis presented with abdominal pain. It was believed that the patient again needed to be treated for another diverticulitis and was started on the routine treatment. The initial CT scan of abdomen showed renal infarcts bilaterally that were confirmed by a CT with and without intravenous contrast secondary to unknown cause. An ECG found accidentally that the patient was in atrial fibrillation, which was the attributed factor to the renal infarctions. Subsequently, the patient was started on the appropriate anticoagulation and discharged.

  2. {sup 99m}Tc-MDP bone uptake in secondary hyperparathyroidism: comparison among mandible, cranium, radius and femur

    Energy Technology Data Exchange (ETDEWEB)

    Boasquevisque, Edson; Silva, Jorge Wagner Esteves da; Bernardo, Vanessa V. de Albuquerque; Macedo, Sara Mello Santana de; Boasquevisque, Camila S.

    2008-07-01

    Full text: Objective: Evaluating bone involvement in secondary hyperparathyroidism (SHPT) by {sup 99m}Tc-MDP uptake in the mandible, cranium, radius and femur and with data correlation with PTHi serum (Intact Parathyroid Hormone). Materials and Methods: In a prospective study of 54 patients with SHPT due to chronic renal disease and 15 normal individuals (control group), all patients had elevated serum PTHi, concentration and positive {sup 99m}Tc-MDP bone scintigraphy. Bone uptake measurements were carried out drawing regions-of-interest (ROI) on the mandible, posterior cranium, distal radius and proximal femur. Additionally, soft tissue uptake was measured with one region-of-interest on the internal tight soft tissue (BG). The ROI-BG ratio used as the index of normalized bone uptake. Results: The uptake differences from SHPT and control groups mainly for mandible (p = 0,001) and cranium (p = 0,002) were statistically significant, even when the SHPT groups were separated according to serum PTHi levels. There was increased bone uptake with the increased levels of PTHi serum. All of the mandibles of the SHPT patients were abnormal with 33% having focal lesions. Conclusions: The bone uptake in SHPT group was abnormal in all areas evaluated, with high uptake of {sup 99m}Tc-MDP correlated to the increase of PTHi serum concentration. (author)

  3. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    Energy Technology Data Exchange (ETDEWEB)

    Pan, Hubert Y.; Allen, Pamela K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin S. [Department of Symptom Research, University of Texas MD Anderson Cancer, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Department of Radiation Oncology, USC Norris Cancer Center, Los Angeles, California (United States); Rhines, Laurence D.; Tatsui, Claudio E. [Department of Neurosurgery, University of Texas MD Anderson Cancer, Houston, Texas (United States); Amini, Behrang [Department of Diagnostic Radiology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin A. [Department of Radiation Physics, University of Texas MD Anderson Cancer, Houston, Texas (United States); Tannir, Nizar M. [Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Brown, Paul D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Ghia, Amol J., E-mail: AJGhia@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States)

    2014-11-15

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred.

  4. Complex Regional Pain Syndrome Type II Secondary to Endovascular Aneurysm Repair

    Directory of Open Access Journals (Sweden)

    Hamilton Chen

    2015-01-01

    Full Text Available Complex regional pain syndrome (CRPS is a chronic pain disorder characterized by severe pain and vasomotor and pseudomotor changes. Endovascular aneurysm repair (EVAR of abdominal aortic aneurysms is a recent advance in vascular surgery that has allowed repair of AAA while offering reduced intensive care unit and hospital lengths of stay, reduced blood loss, fewer major complications, and more rapid recovery. Pseudoaneurysms are a rare complication of an EVAR procedure that may result in a wide range of complications. The present report examines CRPS type II as a novel consequence of pseudoaneurysm formation from brachial artery access in the EVAR procedure. To our knowledge, this is the first reported case of CRPS type II presentation as sequelae of an EVAR procedure.

  5. Balloon sacroplasty as a palliative pain treatment in patients with metastasis-induced bone destruction and pathological fractures

    Energy Technology Data Exchange (ETDEWEB)

    Andresen, R.; Luedtke, C.W.; Kamusella, P.; Wissgott, C. [Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Luebeck and Hamburg, Heide (Germany). Inst. of Diagnostic and Interventional Radiology/Neuroradiology; Radmer, S. [Center of Orthopedics, Berlin (Germany). Orthopedic Surgery and Traumatology; Schober, H.C. [Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock (Germany). Dept. of Internal Medicine

    2014-09-15

    Purpose: In the case of metastatic involvement of the sacrum with destruction and consecutive pathological fracture, intense disabling pain is one of the defining factors. The feasibility, safety and pain development with cement augmentation were to be investigated. Materials and Methods: CT-guided balloon sacroplasty was conducted in 10 patients with metastasis-induced bone destruction of the sacrum. After establishment of the entry point, a K-wire was first introduced as far as the central tumor lesion via the short, or transiliac axis. A cannula was then positioned over the wire. Under CT guidance, a balloon catheter was introduced through the cannula and inflated and deflated several times. The PMMA cement was then injected into the preformed cavity. The procedure was completed by a spiral CT control using the thin-slice technique. Pain intensity was determined using a visual analog scale (VAS) before the procedure, on the 2nd postoperative day and 6 months after the intervention. Finally, the patients were asked to state how satisfied they were. Results: Balloon sacroplasty was technically feasible in all patients. The control CT scan showed central distribution of the cement in the tumor lesion. On average 6+/-1.78 (4-10) ml of PMMA cement were introduced per treated lesion. A significant (p < 0.001) reduction in pain according to the VAS occurred in all patients from 9.3+/-0.67 (8-10) pre-operatively to 2.7+/-1.28 (1-5) on the 2nd postoperative day and 2.9+/-0.81 (2-5) 6 months after the intervention. All of the patients were re-mobilized after the procedure and underwent the further therapeutic measures as planned. Conclusion: Balloon sacroplasty is a helpful therapeutic option in the overall palliative treatment of patients with tumor-induced destruction. It is a safe and practicable procedure that markedly reduces disabling pain. (orig.)

  6. Does increased local bone resorption secondary to breast and prostate cancer result in increased cartilage degradation?

    International Nuclear Information System (INIS)

    Breast and prostate cancer patients often develop lesions of locally high bone turnover, when the primary tumor metastasizes to the bone causing an abnormal high bone resorption at this site. The objective of the present study was to determine whether local increased bone turnover in breast and prostate cancer patients is associated with an increase in cartilage degradation and to test in vitro whether osteoclasts or cathepsin K alone generate CTXII from human bone. The study included 132 breast and prostate cancer patient, where presence of bone metastases was graded according to the Soloway score. Total bone resorption (CTXItotal) and cartilage degradation (CTXII) were determined. Breast and prostate cancer patients with bone metastases revealed significant increased levels of CTXItotal at Soloway scores 1 and higher compared to patients without bone metastases (p < 0.001). CTXII was statistically elevated at score 3 and 4 (p < 0.01). CTXII/CTXItotal significantly decreased at score 3 and 4 (p < 0.001). Levels of CTXItotal, CTXII and CTXII/CTXItotal changed +900%, +130%, and -90%, respectively at Soloway score 4 compared to score 0. The in vitro experiments revealed that osteoclasts released CTXI fragments but not CTXII from bone specimens. The same was observed for cathepsin K. Data suggest that an uncoupling between bone resorption and cartilage degradation occurs in breast and lung cancer patient

  7. Magnetic Acupressure in Reducing Pain in Cancer Patients Undergoing Bone Marrow Aspiration and Biopsy

    Science.gov (United States)

    2010-04-09

    Brain and Central Nervous System Tumors; Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Pain; Precancerous Condition; Unspecified Adult Solid Tumor, Protocol Specific

  8. The Effects of Bone Mineral Density and Level of Serum Vitamin-D on Pain and Quality of Life in Fibromialgia Patients - Original Investigation

    OpenAIRE

    Ayşegül Küçükali Türkyılmaz; Ebru Yılmaz Yalçınkaya; Kadriye Öneş

    2010-01-01

    Aim: The purpose of this study is to determine bone mineral density (BMD) and the levels of serum 25-OH-vitamin D3 in premenopausal Fibromyalgia Syndrome (FMS) patients, and to examine the effect of them to the pain and quality of life in premenopausal FMS patients. Material and Methods: Premenouposal 30 patients with fibromyalgia and 30 healthy controls included the study. The demographic characteristic, serum values, vitamin D levels, bone mineral density measurements, Visual Analog ...

  9. Preparation, Biological Evaluation and Dosimetry Studies of 175Yb-Bis-Phosphonates for Palliative Treatment of Bone Pain

    Directory of Open Access Journals (Sweden)

    Ashraf Fakhari

    2015-10-01

    Full Text Available Objective: Optimized production and quality control of ytterbium-175 (Yb-175 labeled pamidronate and alendronate complexes as efficient agents for bone pain palliation has been presented. Methods: Yb-175 labeled pamidronate and alendronate (175Yb-PMD and 175Yb-ALN complexes were prepared successfully at optimized conditions with acceptable radiochemical purity, stability and significant hydroxyapatite absorption. The biodistribution of complexes were evaluated up to 48 h, which demonstrated significant bone uptake ratios for 175Yb-PAM at all-time intervals. It was also detected that 175Yb-PAM mostly washed out and excreted through the kidneys. Results: The performance of 175Yb-PAM in an animal model was better or comparable to other 175Yb-bone seeking complexes previously reported. Conclusion: Based on calculations, the total body dose for 175Yb-ALN is 40% higher as compared to 175Yb-PAM (especially kidneys indicating that 175Yb-PAM is probably a safer agent than 175Yb-ALN.

  10. Assessment of Effectiveness of Percutaneous Adhesiolysis in Managing Chronic Low Back Pain Secondary to Lumbar Central Spinal Canal Stenosis

    Directory of Open Access Journals (Sweden)

    Laxmaiah Manchikanti, Kimberly A. Cash, Carla D. McManus, Vidyasagar Pampati

    2013-01-01

    Full Text Available Background: Chronic persistent low back and lower extremity pain secondary to central spinal stenosis is common and disabling. Lumbar surgical interventions with decompression or fusion are most commonly performed to manage severe spinal stenosis. However, epidural injections are also frequently performed in managing central spinal stenosis. After failure of epidural steroid injections, the next sequential step is percutaneous adhesiolysis and hypertonic saline neurolysis with a targeted delivery. The literature on the effectiveness of percutaneous adhesiolysis in managing central spinal stenosis after failure of epidural injections has not been widely studied.Study Design: A prospective evaluation.Setting: An interventional pain management practice, a specialty referral center, a private practice setting in the United States.Objective: To evaluate the effectiveness of percutaneous epidural adhesiolysis in patients with chronic low back and lower extremity pain with lumbar central spinal stenosis.Methods: Seventy patients were recruited. The initial phase of the study was randomized, double-blind with a comparison of percutaneous adhesiolysis with caudal epidural injections. The 25 patients from the adhesiolysis group continued with follow-up, along with 45 additional patients, leading to a total of 70 patients. All patients received percutaneous adhesiolysis and appropriate placement of the Racz catheter, followed by an injection of 5 mL of 2% preservative-free lidocaine with subsequent monitoring in the recovery room. In the recovery room, each patient also received 6 mL of 10% hypertonic sodium chloride solution, and 6 mg of non-particulate betamethasone, followed by an injection of 1 mL of sodium chloride solution and removal of the catheter.Outcomes Assessment: Multiple outcome measures were utilized including the Numeric Rating Scale (NRS, the Oswestry Disability Index 2.0 (ODI, employment status, and opioid intake with assessment at 3, 6

  11. Vitamin D levels appear to be normal in Danish patients attending secondary care for low back pain and a weak positive correlation between serum level Vitamin D and Modic changes was demonstrated

    DEFF Research Database (Denmark)

    Johansen, Jannick Vaaben; Manniche, Claus; Kjær, Per

    2013-01-01

    Hypovitaminosis D has previously been reported in both the general population, in people with chronic musculoskeletal pain, and in people with low back pain (LBP). Myopathy-related symptoms such as diffuse bone and muscle pain, weakness and paresthesia in the legs, have also been observed in people...

  12. Time of flight secondary ion mass spectrometry of bone-Impact of sample preparation and measurement conditions.

    Science.gov (United States)

    Henss, Anja; Hild, Anne; Rohnke, Marcus; Wenisch, Sabine; Janek, Juergen

    2015-06-07

    Time of flight secondary ion mass spectrometry (ToF-SIMS) enables the simultaneous detection of organic and inorganic ions and fragments with high mass and spatial resolution. Due to recent technical developments, ToF-SIMS has been increasingly applied in the life sciences where sample preparation plays an eminent role for the quality of the analytical results. This paper focusses on sample preparation of bone tissue and its impact on ToF-SIMS analysis. The analysis of bone is important for the understanding of bone diseases and the development of replacement materials and new drugs for the cure of diseased bone. The main purpose of this paper is to find out which preparation process is best suited for ToF-SIMS analysis of bone tissue in order to obtain reliable and reproducible analytical results. The influence of the embedding process on the different components of bone is evaluated using principal component analysis. It is shown that epoxy resin as well as methacrylate based plastics (Epon and Technovit) as embedding materials do not infiltrate the mineralized tissue and that cut sections are better suited for the ToF-SIMS analysis than ground sections. In case of ground samples, a resin layer is smeared over the sample surface due to the polishing step and overlap of peaks is found. Beside some signals of fatty acids in the negative ion mode, the analysis of native, not embedded samples does not provide any advantage. The influence of bismuth bombardment and O2 flooding on the signal intensity of organic and inorganic fragments due to the variation of the ionization probability is additionally discussed. As C60 sputtering has to be applied to remove the smeared resin layer, its effect especially on the organic fragments of the bone is analyzed and described herein.

  13. ¹⁷⁷Lu-Labeled Agents for Neuroendocrine Tumor Therapy and Bone Pain Palliation in Uruguay.

    Science.gov (United States)

    Balter, Henia; Victoria, Trindade; Mariella, Terán; Javier, Gaudiano; Rodolfo, Ferrando; Andrea, Paolino; Graciela, Rodriguez; Juan, Hermida; Eugenia, De Marco; Patricia, Oliver

    2016-01-01

    Lutetium-177 is an emerging radionuclide due its convenient chemical and nuclear properties. In this paper we describe the development and evaluation in Uruguay of the targeted 177Lu labelled radiopharmaceuticals EDTMP (for bone pain palliation) and DOTA-TATE (neuroendocrine tumors). We optimized the preparation of these 177Lu radiopharmaceuticals including radiolabelling, quality control methods, in vitro and in vivo stability and their therapeutic application in patients. Radiation dosimetry aspects of 177Lu are also included. Nine male patients with prostate cancer and four female patients with breast carcinoma with multiple bone metastatic lesions were treated with 177Lu-EDTMP. Four patients with gastroentheropancreatic neuroendocrine tumors (GEP-NET) and one patient with bronchial NET were treated with 1- 3 cycles with a cumulative dose of 4.44-22.2 GBq of 177Lu-DOTA-TATE. Scintigraphic images of the patients treated with 177Lu-EDTMP evidenced high and rapid uptake in bone metastasis, remaining after 7 days post administration. Images allow skeletal visualization with high definition and demonstrate increased uptake in bone metastases. For 177Lu-DOTA-TATE, partial remissions were obtained in 4 patients and the remaining patient did not show significant progression 3 months after the second cycle. No serious adverse effects were registered, even in two patients with confirmed renal disease and high risk for renal disease Dosimetry assessments confirm the predictive value of the personalized therapy with radiolabelled peptides. We found it is possible to accumulate high therapeutic doses in tumours in sequential administrations of 177Lu-DOTA-TATE, increasing the probability of biological response without significant impairment of the renal function in patients with risk factors. These results demonstrate the attractive therapeutic properties of these two 177Lu labelled agents and the feasibility of this metabolic therapy in regions far away from 177Lu producing

  14. ¹⁷⁷Lu-Labeled Agents for Neuroendocrine Tumor Therapy and Bone Pain Palliation in Uruguay.

    Science.gov (United States)

    Balter, Henia; Victoria, Trindade; Mariella, Terán; Javier, Gaudiano; Rodolfo, Ferrando; Andrea, Paolino; Graciela, Rodriguez; Juan, Hermida; Eugenia, De Marco; Patricia, Oliver

    2016-01-01

    Lutetium-177 is an emerging radionuclide due its convenient chemical and nuclear properties. In this paper we describe the development and evaluation in Uruguay of the targeted 177Lu labelled radiopharmaceuticals EDTMP (for bone pain palliation) and DOTA-TATE (neuroendocrine tumors). We optimized the preparation of these 177Lu radiopharmaceuticals including radiolabelling, quality control methods, in vitro and in vivo stability and their therapeutic application in patients. Radiation dosimetry aspects of 177Lu are also included. Nine male patients with prostate cancer and four female patients with breast carcinoma with multiple bone metastatic lesions were treated with 177Lu-EDTMP. Four patients with gastroentheropancreatic neuroendocrine tumors (GEP-NET) and one patient with bronchial NET were treated with 1- 3 cycles with a cumulative dose of 4.44-22.2 GBq of 177Lu-DOTA-TATE. Scintigraphic images of the patients treated with 177Lu-EDTMP evidenced high and rapid uptake in bone metastasis, remaining after 7 days post administration. Images allow skeletal visualization with high definition and demonstrate increased uptake in bone metastases. For 177Lu-DOTA-TATE, partial remissions were obtained in 4 patients and the remaining patient did not show significant progression 3 months after the second cycle. No serious adverse effects were registered, even in two patients with confirmed renal disease and high risk for renal disease Dosimetry assessments confirm the predictive value of the personalized therapy with radiolabelled peptides. We found it is possible to accumulate high therapeutic doses in tumours in sequential administrations of 177Lu-DOTA-TATE, increasing the probability of biological response without significant impairment of the renal function in patients with risk factors. These results demonstrate the attractive therapeutic properties of these two 177Lu labelled agents and the feasibility of this metabolic therapy in regions far away from 177Lu producing

  15. Unusual facial pain secondary to inferior alveolar nerve compression caused by impacted mandibular second molar

    Directory of Open Access Journals (Sweden)

    Urvashi Sharma

    2014-01-01

    Full Text Available Symptoms of inferior alveolar nerve (IAN compression are reported during endodontic procedures, placement of implants, third molar surgeries, inferior alveolar nerve block injections, trauma, orthognathic injuries, ablative surgeries or use of medicaments. Presented is a rare case of a 15-year-old girl who reported severe pain in relation to an impacted permanent mandibular left second molar, the roots of which had entrapped the mandibular canal causing compression of IAN. Timely surgical intervention and sectional removal of the impacted molar is indicated to relieve the symptoms and avoid permanent damage to the nerve.

  16. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Directory of Open Access Journals (Sweden)

    Vincent Ochieng

    2016-01-01

    Conclusion: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.

  17. Single- versus multiple-fraction radiotherapy in patients with painful bone metastases: cost-utility analysis based on a randomized trial.

    NARCIS (Netherlands)

    Hout, W.B. van den; Linden, Y.J.M. van der; Steenland, E.; Wiggenraad, R.G.; Kievit, J.; Haes, J.C.J.M. de; Leer, J.W.H.

    2003-01-01

    BACKGROUND: Radiotherapy is an effective palliative treatment for cancer patients with painful bone metastases. Although single- and multiple-fraction radiotherapy are thought to provide equal palliation, which treatment schedule provides better value for the money is unknown. We compared quality-ad

  18. The inhibition of subchondral bone lesions significantly reversed the weight-bearing deficit and the overexpression of CGRP in DRG neurons, GFAP and Iba-1 in the spinal dorsal horn in the monosodium iodoacetate induced model of osteoarthritis pain.

    Directory of Open Access Journals (Sweden)

    Degang Yu

    Full Text Available BACKGROUND: Chronic pain is the most prominent and disabling symptom of osteoarthritis (OA. Clinical data suggest that subchondral bone lesions contribute to the occurrence of joint pain. The present study investigated the effect of the inhibition of subchondral bone lesions on joint pain. METHODS: Osteoarthritic pain was induced by an injection of monosodium iodoacetate (MIA into the rat knee joint. Zoledronic acid (ZOL, a third generation of bisphosphonate, was used to inhibit subchondral bone lesions. Joint histomorphology was evaluated using X-ray micro computed tomography scanning and hematoxylin-eosin staining. The activity of osteoclast in subchondral bone was evaluated using tartrate-resistant acid phosphatase staining. Joint pain was evaluated using weight-bearing asymmetry, the expression of calcitonin gene-related peptide (CGRP in the dorsal root ganglion (DRG, and spinal glial activation status using glial fibrillary acidic protein (GFAP and ionized calcium binding adaptor molecule-1 (Iba-1 immunofluorescence. Afferent neurons in the DRGs that innervated the joints were identified using retrograde fluorogold labeling. RESULTS: MIA injections induced significant histomorphological alterations and joint pain. The inhibition of subchondral bone lesions by ZOL significantly reduced the MIA-induced weight-bearing deficit and overexpression of CGRP in DRG neurons, GFAP and Iba-1 in the spinal dorsal horn at 3 and 6 weeks after MIA injection; however, joint swelling and synovial reaction were unaffected. CONCLUSIONS: The inhibition of subchondral bone lesions alleviated joint pain. Subchondral bone lesions should be a key target in the management of osteoarthritic joint pain.

  19. A comparative study of the effects of daily minodronate and weekly alendronate on upper gastrointestinal symptoms, bone resorption, and back pain in postmenopausal osteoporosis patients.

    Science.gov (United States)

    Yoshioka, Toru; Okimoto, Nobukazu; Okamoto, Ken; Sakai, Akinori

    2013-03-01

    The purpose of the present study was to precisely compare both the efficacy and abdominal symptom-related quality of life after treatment with daily minodronate and weekly alendronate in patients with primary postmenopausal osteoporosis. The efficacy of the two drugs was assessed based on improvements in a bone turnover marker, back pain, and gastrointestinal symptoms that impair quality of life, which was assessed using the Izumo scale questionnaire. In the minodronate group, there were no significant changes during the treatment period in the specific scores for heartburn, epigastralgia and epigastric fullness, whereas all of the scores were significantly elevated at some time point after drug administration in the alendronate group. Urinary N-telopeptide of type I collagen (uNTX), a bone resorption marker, and bone-specific alkaline phosphatase, a bone formation marker, significantly decreased in both groups, but decreases in uNTX in the minodronate group was observed significantly earlier compared with those in the alendronate group. The back pain scores, which were obtained using a visual analog scale, were significantly reduced in both groups. However, analgesic effects were detected earlier in the minodronate group. In conclusion, compared with weekly alendronate, daily minodronate improved bone turnover and back pain more promptly without causing upper gastrointestinal symptoms.

  20. An easy tool to predict survival in patients receiving radiation therapy for painful bone metastases

    NARCIS (Netherlands)

    Westhoff, P.G.; Graeff, A. de; Monninkhof, E.M.; Bollen, L.; Dijkstra, S.P.; Steen-Banasik, E.M. van der; Vulpen, M. van; Leer, J.W.H.; Marijnen, C.A.; Linden, Y.M. van der; Study, G.

    2014-01-01

    PURPOSE: Patients with bone metastases have a widely varying survival. A reliable estimation of survival is needed for appropriate treatment strategies. Our goal was to assess the value of simple prognostic factors, namely, patient and tumor characteristics, Karnofsky performance status (KPS), and p

  1. Single fraction versus multiple fraction radiotherapy for palliation of painful vertebral bone metastases: A prospective study

    Directory of Open Access Journals (Sweden)

    Dipanjan Majumder

    2012-01-01

    Conclusions: Different fractionation of radiation has same response and toxicity in treatment of vertebral bone metastasis. Single fraction RT may be safely used to treat these cases as this is more cost effective and less time consuming. Studies may be conducted to find out particular subgroup of patients to be benefitted more by either fractionation schedule; however, our study cannot comment on that issue.

  2. Efficacy of SPECT over planar bone scan in the diagnosis of solitary vertebral lesions in patients with low back pain

    International Nuclear Information System (INIS)

    The purpose of our study has been to evaluate the efficacy of single photon emission computed tomography (SPECT) over planar bone scan in identifying solitary vertebral lesions in patients with low backache and its ability to differentiate various pathologies according to the uptake pattern. Materials and Methods: The study included twenty patients out of whom six patients presented with known carcinoma and fourteen patients with low back pain. SPECT was done in all following planar skeletal survey. Benign and malignant lesions were identified according to the uptake pattern in vertebral elements, based on Gary F. Gates observations. Final diagnosis was obtained by means of biopsy or correlation with radiograph or computed tomography (CT) or magnetic resonance imaging (MRI), and/or follow up. Results: SPECT detected additional 30% of solitary vertebral lesions that were obscured on planar scan. Seven out of twenty were localized in anterior vertebral body and were diagnosed as benign ostophytes in six and osteoma in one substantiating the previous observations. Out of six cases of known carcinoma, three were having solitary metastases and showed posterior vertebral body uptake with pedicle involvement. SPECT could localize specific lesions as source of pain in eleven patients with low back pain (78%) and identified various etiologies including benign tumors (osteoid osteoma and osteoma), facet arthritis, discitis, transverse process fractures and spondylolysis. Conclusion: Our study highlighted the higher diagnostic value of SPECT over planar skeletal scintigraphy in localizing solitary vertebral lesions in low backache patients. Based on SPECT pattern, malignant and benign lesions could be differentiated in the given clinical context. (author)

  3. Bone

    International Nuclear Information System (INIS)

    Bone scanning provides information on the extent of primary bone tumors, on possible metastatic disease, on the presence of osteomyelitis prior to observation of roentgenographic changes so that earlier therapy is possible, on the presence of collagen diseases, on the presence of fractures not disclosed by x-ray films, and on the evaluation of aseptic necrosis. However, the total effect and contribution of bone scanning to the diagnosis, treatment, and ultimate prognosis of pediatric skeletal diseases is, as yet, unknown. (auth)

  4. Bilateral downregulation of Nav1.8 in dorsal root ganglia of rats with bone cancer pain induced by inoculation with Walker 256 breast tumor cells

    International Nuclear Information System (INIS)

    Rapid and effective treatment of cancer-induced bone pain remains a clinical challenge and patients with bone metastasis are more likely to experience severe pain. The voltage-gated sodium channel Nav1.8 plays a critical role in many aspects of nociceptor function. Therefore, we characterized a rat model of cancer pain and investigated the potential role of Nav1.8. Adult female Wistar rats were used for the study. Cancer pain was induced by inoculation of Walker 256 breast carcinosarcoma cells into the tibia. After surgery, mechanical and thermal hyperalgesia and ambulation scores were evaluated to identify pain-related behavior. We used real-time RT-PCR to determine Nav1.8 mRNA expression in bilateral L4/L5 dorsal root ganglia (DRG) at 16-19 days after surgery. Western blotting and immunofluorescence were used to compare the expression and distribution of Nav1.8 in L4/L5 DRG between tumor-bearing and sham rats. Antisense oligodeoxynucleotides (ODNs) against Nav1.8 were administered intrathecally at 14-16 days after surgery to knock down Nav1.8 protein expression and changes in pain-related behavior were observed. Tumor-bearing rats exhibited mechanical hyperalgesia and ambulatory-evoked pain from day 7 after inoculation of Walker 256 cells. In the advanced stage of cancer pain (days 16-19 after surgery), normalized Nav1.8 mRNA levels assessed by real-time RT-PCR were significantly lower in ipsilateral L4/L5 DRG of tumor-bearing rats compared with the sham group. Western-blot showed that the total expression of Nav1.8 protein significantly decreased bilaterally in DRG of tumor-bearing rats. Furthermore, as revealed by immunofluorescence, only the expression of Nav1.8 protein in small neurons down regulated significantly in bilateral DRG of cancer pain rats. After administration of antisense ODNs against Nav1.8, Nav1.8 protein expression decreased significantly and tumor-bearing rats showed alleviated mechanical hyperalgesia and ambulatory-evoked pain. These

  5. Association between salivary α-amylase activity and pain relief scale scores in cancer patients with bone metastases treated with radiotherapy

    Institute of Scientific and Technical Information of China (English)

    LIU Hong; DONG Wen-yan; WANG Jian-bo; WANG Tao; HU Peng; WEI Shu-fang; YE Lin

    2013-01-01

    Background Subjective assessment tools such as visual analog scales (VAS) or pain scores are commonly used to evaluate the intensity of chronic cancer-induced pain.However,their value is limited in some cases.We measured changes in VAS pain scores and salivary a-amylase (sAA) concentrations in cancer patients receiving radiotherapy for bone metastases to ascertain the correlation between these measures.Methods We enrolled 30 patients with bone metastases attending a single institution from June 2010 to March 2011.All patients with cancer-induced bone pain received radiation therapy (RT) at the same dose (30 Gy) and fractionation (3 Gy/ fraction,5 days/week) for palliative pain relief.We assessed heart rate (HR),systolic and diastolic blood pressures (DBP/SBP) and VAS pain scores before (d0) and after five (d5) and ten fractions (d10) of irradiation,sAA and salivary cortisol (SC)concentrations were measured using a portable analyzer and automated chemiluminescence analyzer,respectively.Results Radiotherapy markedly decreased VAS scores from (82.93±9.29) to (31.43±t16.73) mm (P <0.001) and sAA concentrations from (109.40±26.38) to (36.03±19.40) U/ml (P <0.001).Moreover,there was a significant correlation between these two indices (P <0.01,r=0.541).HR decreased by 6.5% after radiotherapy,but did not correlate with VAS scores (P >0.05).SC concentrations and BP did not change significantly during the study (P >0.05).Conclusions The significant correlation between sAA concentrations and VAS pain scores identified in these preliminary results suggests that this biomarker may be a valuable,noninvasive and sensitive index for the objective assessment of pain intensity in patients with cancer-induced bone pain.

  6. Can patients identify what triggers their back pain? Secondary analysis of a case-crossover study.

    Science.gov (United States)

    Parreira, Patricia do Carmo Silva; Maher, Chris G; Latimer, Jane; Steffens, Daniel; Blyth, Fiona; Li, Qiang; Ferreira, Manuela L

    2015-10-01

    The aim of this case-crossover study was to investigate the extent to which patients can accurately nominate what triggered their new episode of sudden-onset acute low back pain (LBP). We interviewed 999 primary care patients to record exposure to 12 standard triggers and also asked the patients to nominate what they believed triggered their LBP. Exposure to the patient-nominated trigger during the case window was compared with exposure in the control window. Conditional logistic regression models were constructed to quantify the risk of LBP onset associated with the patient-nominated trigger. Sensitivity analyses were conducted varying the duration and timing of case/control windows. We compared the extent to which patient-nominated triggers matched standard triggers. The odds ratios for exposure to patient-nominated triggers ranged from 8.60 to 30.00, suggesting that exposure increases the risk of LBP. Patients' understanding of triggers however seems incomplete, as we found evidence that while some of the standard triggers were well recognised (such as lifting heavy loads), others (such as being distracted during manual tasks) were under-recognised as possible triggers of an episode of LBP. This study provides some evidence that patients can accurately nominate the activity that triggered their new episode of sudden-onset acute LBP. PMID:26039901

  7. Gelatinous bone marrow transformation secondary to unusual eating habits and drastic weight loss.

    Science.gov (United States)

    Rafiullah; Islam, Rezwan; Mahmood, Ruth; Sitwala, Kajal V

    2013-01-01

    Gelatinous bone marrow transformation (GMT), also known as starvation bone marrow, has been reported in a number of chronic illnesses, eating disorders (anorexia nervosa) and malignancies. We report the case of a 37-year-old man with a history of bipolar disorder and obesity (weighing >300 pounds) who presented due to recently developing a deep yellow colour to his skin. Over the past 2 years, through diet and exercise, he lost over 150 pounds. He reported running 6-8 miles per day and eating 'lots of squash'. We made the diagnosis of starvation hepatitis and bone marrow degeneration, and referred the patient to a dietician and haematologist/oncologist, where improvements were observed at 4 weeks follow-up. PMID:23861277

  8. Benign osteoblastoma of the odontoid process of the axis with secondary aneurysmal bone cyst component: a case report.

    Science.gov (United States)

    Tarantino, Roberto; Piccirilli, Manolo; Anichini, Giulio; Delfini, Roberto

    2008-01-01

    The authors report their experience on one patient with osteoblatoma of the odontoid process of the axis with secondary aneurysmal bone cyst. According to their knowledge, this is the first case, reported in the literature, of this kind of lesion in that particular anatomical region. Because of the rarity of this lesion, it was difficult to have a certain preoperative diagnosis. Therefore, the patient underwent a biopsy via a transoral route. The biopsy was performed over the noncalcified component of the lesion. The intraoperative histological examination showed the benign nature of the lesion. Thereafter, the lesion was totally removed, succeeding in preserving the remaining part of the odontoid process and the anterior arch of C1. In the follow-up, there was no evidence of cranio-vertebral instability. The histological examination revealed an osteoblastoma of the odontoid process of the axis with a secondary aneurysmal bone cyst. To the best of our knowledge, this is the first case reported in the literature.

  9. Zygomatico-coronoid ankylosis secondary to heterotopic bone formation: Combined treatment by surgery and radiation therapy

    International Nuclear Information System (INIS)

    Zygomatico-coronoid ankylosis is a rare, extra-articular form of ankylosis of the jaws. An unusual case is presented in which true bony zygomatico-coronoid ankylosis was produced by a mass of heterotopic bone. Surgical treatment consisted of an oblique ostectomy across the mandibular ascending ramus, with interposition of Silastic sheeting to form a pseudarthrosis. Since surgery is often the stimulus for this condition, 2000 rads were delivered to the surgical site postoperatively in order to inhibit recurrent heterotopic bone formation. The rationale and indications for this form of treatment are discussed. (orig.)

  10. Formaldehyde up-regulates TRPV1 through MAPK and PI3K signaling pathways in a rat model of bone cancer pain

    Institute of Scientific and Technical Information of China (English)

    Ying Han; Yah Li; Xing Xiao; Jia Liu; Xiang-Ling Meng; Feng-YuLiu; Guo-Gang Xing; You Wan

    2012-01-01

    Objective Our previous study showed that tumor tissue-derived formaldehyde at low concentrations plays an impoaant role in bone cancer pain through activating transient receptor potential vanilloid subfamily member 1 (TRPV1).The present study further explored whether this tumor tissue-derived endogenous formaldehyde regulates TRPV1 expression in a rat model of bone cancer pain,and if so,what the possible signal pathways are during the development of this type of pain.Methods A rat model of bone cancer pain was established by injecting living MRMT-1 tumor cells into the tibia.The formaldehyde levels were determined by high performance liquid chromatography,and the expression of TRPV1 was examined with Western blot and RT-PCR.In primary cultured dorsal root ganglion (DRG) neurons,the expression of TRPV1 was assessed after treatment with 100 μmol/L formaldehyde with or without pre-addition of PD98059 [an inhibitor for extracellular signal-regulated kinase],SB203580 (a p38 inhibitor),SP600125 [an inhibitor for c-Jun Nterminal kinase],BIM [a protein kinase C (PKC) inhibitor] or LY294002 [a phosphatidylinositol 3-kinase (PI3K) inhibitor].Results In the rat model of bone cancer pain,formaldehyde concentration increased in blood plasma,bone marrow and the spinal cord.TRPV1 protein expression was also increased in the DRG.In primary cultured DRG neurons,100μmol/L formaldehyde significantly increased the TRPV1 expression level.Pre-incubation with PD98059,SB203580,SP600125 or LY294002,but not BIM,inhibited the formaldehyde-induced increase of TRPV1 expression.Conclusion Formaldehyde at a very low concentration up-regulates TRPV1 expression through mitogen-activated protein kinase and PI3K,but not PKC,signaling pathways.These results further support our previous finding that TRPV1 in peripheral afferents plays a role in bone cancer pain.

  11. Cancer Pain Physiology

    DEFF Research Database (Denmark)

    Falk, Sarah; Bannister, Kirsty; Dickenson, Anthony

    2014-01-01

    reorganization within segments of the dorsal horn of the spinal cord receiving nociceptive input from the bone are discussed. Changes in certain neurotransmitters implicated in brain modulation of spinal function are also altered with implications for the affective components of cancer pain. Treatments......Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells....... This precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined...

  12. Pain and Nociception

    DEFF Research Database (Denmark)

    Falk, Sarah; Dickenson, Anthony H

    2014-01-01

    therapies are often only partially effective. Until recently, knowledge of cancer pain mechanisms was poor compared with understanding of neuropathic and inflammatory pain states. We now view cancer-induced bone pain as a complex pain state involving components of both inflammatory and neuropathic pain......Cancer pain, especially pain caused by metastasis to bone, is a severe type of pain, and unless the cause and consequences can be resolved, the pain will become chronic. As detection and survival among patients with cancer have improved, pain has become an increasing challenge, because traditional...... but also exhibiting elements that seem unique to cancer pain. In addition, the pain state is often unpredictable, and the intensity of the pain is highly variable, making it difficult to manage. The establishment of translational animal models has started to reveal some of the molecular components involved...

  13. The Effects of Bone Mineral Density and Level of Serum Vitamin-D on Pain and Quality of Life in Fibromialgia Patients - Original Investigation

    Directory of Open Access Journals (Sweden)

    Ayşegül Küçükali Türkyılmaz

    2010-12-01

    Full Text Available Aim: The purpose of this study is to determine bone mineral density (BMD and the levels of serum 25-OH-vitamin D3 in premenopausal Fibromyalgia Syndrome (FMS patients, and to examine the effect of them to the pain and quality of life in premenopausal FMS patients. Material and Methods: Premenouposal 30 patients with fibromyalgia and 30 healthy controls included the study. The demographic characteristic, serum values, vitamin D levels, bone mineral density measurements, Visual Analog Scala (VAS, Beck Depression Inventory (BDI, Short Form- 36 (SF-36 and Fibromyalgia Impact Questionery Form (FIQ were determined. Patient and control group were compared in terms of these parameters. Results: There was no significant difference of Vitamin D levels and bone mineral density between case and controls. There was no significant difference between the groups with low and high vitamin D levels in terms of VAS, FIQ, BDI in SF-36 in FMS patients. There was no significant change with regard to VAS, FIQ, BDI, and SF36 between FMS patients with high or low BMD. Conclusion: There is no difference of vitamin D levels and bone mineral density between FMS patients and control group, vitamin D levels and bone mineral density have no effect on pain and quality of life in premenopausal patients with FMS. (From the World of Osteoporosis 2010;16:53-7

  14. The PRESLO study: evaluation of a global secondary low back pain prevention program for health care personnel in a hospital setting. Multicenter, randomized intervention trial

    Directory of Open Access Journals (Sweden)

    Denis Angélique

    2012-11-01

    Full Text Available Abstract Background Common low back pain represents a major public health problem in terms of its direct cost to health care and its socio-economic repercussions. Ten percent of individuals who suffer from low back pain evolve toward a chronic case and as such are responsible for 75 to 80% of the direct cost of low back pain. It is therefore imperative to highlight the predictive factors of low back pain chronification in order to lighten the economic burden of low back pain-related invalidity. Despite being particularly affected by low back pain, Hospices Civils de Lyon (HCL personnel have never been offered a specific, tailor-made treatment plan. The PRESLO study (with PRESLO referring to Secondary Low Back Pain Prevention, or in French, PREvention Secondaire de la LOmbalgie, proposed by HCL occupational health services and the Centre Médico-Chirurgical et de Réadaptation des Massues – Croix Rouge Française, is a randomized trial that aims to evaluate the feasibility and efficiency of a global secondary low back pain prevention program for the low back pain sufferers among HCL hospital personnel, a population at risk for recurrence and chronification. This program, which is based on the concept of physical retraining, employs a multidisciplinary approach uniting physical activity, cognitive education about low back pain and lumbopelvic morphotype analysis. No study targeting populations at risk for low back pain chronification has as yet evaluated the efficiency of lighter secondary prevention programs. Methods/Design This study is a two-arm parallel randomized controlled trial proposed to all low back pain sufferers among HCL workers, included between October 2008 and July 2011 and followed over two years. The personnel following their usual treatment (control group and those following the global prevention program in addition to their usual treatment (intervention group are compared in terms of low back pain recurrence and the

  15. Quality assurance experience with the randomized neuropathic bone pain trial (Trans-Tasman Radiation Oncology Group, 96.05)

    International Nuclear Information System (INIS)

    Background and purpose: Trans-Tasman Radiation Oncology Group 96.05 is a prospective randomized controlled trial comparing a single 8 Gy with 20 Gy in five fractions of radiotherapy (RT) for neuropathic pain due to bone metastases. This paper summarizes the quality assurance (QA) activities for the first 234 patients (accrual target 270). Materials and methods: Independent audits to assess compliance with eligibility/exclusion criteria and appropriateness of treatment of the index site were conducted after each cohort of approximately 45 consecutive patients. Reported serious adverse events (SAEs) in the form of cord/cauda equina compression or pathological fracture developing at the index site were investigated and presented in batches to the Independent Data Monitoring Committee. Finally, source data verification of the RT prescription page and treatment records was undertaken for each of the first 234 patients to assess compliance with the protocol. Results: Only one patient was found conclusively not to have genuine neuropathic pain, and there were no detected 'geographical misses' with RT fields. The overall rate of detected infringements for other eligibility criteria over five audits (225 patients) was 8% with a dramatic improvement after the first audit. There has at no stage been a statistically significant difference in SAEs by randomization arm. There was a 22% rate of RT protocol variations involving ten of the 14 contributing centres, although the rate of major dose violations (more than ±10% from protocol dose) was only 6% with no statistically significant difference by randomization arm (P=0.44). Conclusions: QA auditing is an essential but time-consuming component of RT trials, including those assessing palliative endpoints. Our experience confirms that all aspects should commence soon after study activation

  16. Development of 111In DOTMP for dosimetry of bone pain palliation agents

    International Nuclear Information System (INIS)

    Particle emitter 1,4,7,10-tetraazacyclododecane-1,4,7,10 tetraethylene phosphonic acid complexes (DOTMP) are used for delivering high doses to bone marrow as well as palliative therapy. In this research production, quality control and biodistribution studies of [111In]-DOTMP with respect to its radiochemical and in vivo biological characteristics have been presented for imaging as well as dosimetry studies of therapeutic analogs. [111In]-DOTMP complex was obtained in high radiochemical purity (>99 %, ITLC) under at optimized conditions. This complex exhibited excellent in vitro stability at room temperature and human serum. Biodistribution studies in rats showed favorable selective skeletal uptake with rapid clearance from blood along with insignificant accumulation of activity in other non-target organs using tissue dissection and single-photon emission computed tomography (SPECT). This tracer can be used in the long term skeletal studies in SPECT procedures as well as presenting a dosimetry probe for therapeutic DOTMP analogs. (author)

  17. Utility of the dimercapto succinic acid pentavalent (99m Tc- DMSA V) in the diagnostic of secondary bone leisure at metastasis of diverse primary tumours. Preliminary study

    International Nuclear Information System (INIS)

    The more used method in the diagnosis of secondary bone lesions to become cancerous it is by means of having derived of phosphates like it is the 99mTc- MDP. The reason of acquiring searching with the radiopharmaceutical 99mTc- DMSA V is with the purpose to find other bone lesions that are not visualized with the gammagraphy with diphosphonate and therefore to increase the specificity of the study. (Author)

  18. The analysis curative efficiency of the painful metastatic bone cancer treated using 89SrCl2 combined with 99Tc-MDP

    International Nuclear Information System (INIS)

    A single item cures of 89SrCl2 and 89SrCI2 combined with 99Tc-MDP ade used to treat painful metastatic bone cancer, respectively. The results show that the curative efficiency of the two methods are all good, but the total curative efficiency of 89SrCl2 combined with 99Tc-MDP group (89.4%) are better than that of 89SrCl2 group (72.1%), Pgland cancer>scale cancer. So the patients with bone painful caused by breast cancer (particularly mammary glands gradually sexual cancer) are chosen to be treated using 89SrCl2 combined with 99Tc-MDP at first. In addition, the toxin and poison side effect treated using 89SrCl2 combined with 99Tc-MDP is less than that of 89SrCl2, and the living quantity and physical strength conditions are more improved. (author)

  19. Chondroblastoma of the patella with aneurysmal bone cyst.

    Science.gov (United States)

    Tan, Honglue; Yan, Mengning; Yue, Bing; Zeng, Yiming; Wang, You

    2014-01-01

    Chondroblastoma of the patella is rare. Aneurysmal bone cysts, which develop from a prior lesion such as a chondroblastoma, are seldom seen in the patella. The authors report a case of a 36-year-old man who presented with 2 years of right knee pain without calor, erythema, pain on palpation, or abnormal range of motion. Radiological studies suggested aneurysmal bone cyst. The lesion was excised with curettage and the residual cavity filled with autogenous bone graft. Histopathology revealed chondroblastoma associated with a secondary aneurysmal bone cyst. In the follow-up period, the patient demonstrated normal joint activities with no pain. Normal configuration of the patella and bone union were shown on plain radiographs. The authors present a review of the literature of all cases of patellar chondroblastoma with aneurysmal bone cyst. This case is the 14th report of aneurysmal bone cyst arising in a chondroblastoma of the patella. According to the literature, computed tomography and magnetic resonance imaging are useful in the study of these lesions. The pathologic diagnosis is based on the presence of chondroblastoma and aneurysmal bone cyst. Treatment of this lesion includes patellectomy, curettage alone, and curettage with bone grafting. Despite the risk of recurrence of this lesion in the patella, the authors first recommend curettage followed by filling the cavity with bone graft. To protect the anterior tension of the patella intraoperatively, the bone window should be made at the medial edge of the patella to perform the curettage and bone grafting.

  20. Chondroblastoma of the patella with aneurysmal bone cyst.

    Science.gov (United States)

    Tan, Honglue; Yan, Mengning; Yue, Bing; Zeng, Yiming; Wang, You

    2014-01-01

    Chondroblastoma of the patella is rare. Aneurysmal bone cysts, which develop from a prior lesion such as a chondroblastoma, are seldom seen in the patella. The authors report a case of a 36-year-old man who presented with 2 years of right knee pain without calor, erythema, pain on palpation, or abnormal range of motion. Radiological studies suggested aneurysmal bone cyst. The lesion was excised with curettage and the residual cavity filled with autogenous bone graft. Histopathology revealed chondroblastoma associated with a secondary aneurysmal bone cyst. In the follow-up period, the patient demonstrated normal joint activities with no pain. Normal configuration of the patella and bone union were shown on plain radiographs. The authors present a review of the literature of all cases of patellar chondroblastoma with aneurysmal bone cyst. This case is the 14th report of aneurysmal bone cyst arising in a chondroblastoma of the patella. According to the literature, computed tomography and magnetic resonance imaging are useful in the study of these lesions. The pathologic diagnosis is based on the presence of chondroblastoma and aneurysmal bone cyst. Treatment of this lesion includes patellectomy, curettage alone, and curettage with bone grafting. Despite the risk of recurrence of this lesion in the patella, the authors first recommend curettage followed by filling the cavity with bone graft. To protect the anterior tension of the patella intraoperatively, the bone window should be made at the medial edge of the patella to perform the curettage and bone grafting. PMID:24683664

  1. Imaging differentiation of pathologic fractures caused by primary and secondary bone tumors

    International Nuclear Information System (INIS)

    Objective: To describe pre-treatment imaging features of pathologic fractures caused by primary bone tumors (PBTs) and metastatic bone tumors (MBTs) and determine if radiographic or cross-sectional features can differentiate the underlying pathologies associated with the fractures. Methods: Sixty-nine patients with a diagnosis of a pathologic fracture were enrolled. Biopsy established PBT as the cause of the pathologic fracture in 16 (23%) cases and MBT in 53 (77%) cases. The radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans of the subjects were retrospectively reviewed for the presence of multiple imaging features. Results: Compared to pathologic fractures caused by MBTs, the fractures caused by PBTs demonstrated a higher incidence of lytic bone cortex, mineralization and a soft-tissue mass on radiographs, mineralization and a soft-tissue mass on CT scans, and periosteal abnormality on MRI scans (P < 0.01). These features also exhibited a high negative predictive value in supporting the diagnosis of an underlying PBT over MBT. Conclusion: Pathologic fractures caused by PBT and MBT may be differentiated by a few specific radiographic and CT imaging features, though MRI was poor for characterization of the underlying lesion. Such knowledge may assist radiologists in raising the possibility of a PBT as the cause of a pathologic fracture

  2. Imaging differentiation of pathologic fractures caused by primary and secondary bone tumors

    Energy Technology Data Exchange (ETDEWEB)

    Soldatos, Theodoros, E-mail: tsoldat1@jhmi.edu [Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287 (United States); Chalian, Majid, E-mail: mchalia1@jhmi.edu [Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287 (United States); Attar, Samer, E-mail: sattar1@jhmi.edu [Department of Orthopaedic Surgery, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287 (United States); McCarthy, Edward F., E-mail: emccart2@jhmi.edu [Department of Pathology, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287 (United States); Carrino, John A., E-mail: jcarrin2@jhmi.edu [Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287 (United States); Fayad, Laura M., E-mail: lfayad1@jhmi.edu [Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287 (United States)

    2013-01-15

    Objective: To describe pre-treatment imaging features of pathologic fractures caused by primary bone tumors (PBTs) and metastatic bone tumors (MBTs) and determine if radiographic or cross-sectional features can differentiate the underlying pathologies associated with the fractures. Methods: Sixty-nine patients with a diagnosis of a pathologic fracture were enrolled. Biopsy established PBT as the cause of the pathologic fracture in 16 (23%) cases and MBT in 53 (77%) cases. The radiographs, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans of the subjects were retrospectively reviewed for the presence of multiple imaging features. Results: Compared to pathologic fractures caused by MBTs, the fractures caused by PBTs demonstrated a higher incidence of lytic bone cortex, mineralization and a soft-tissue mass on radiographs, mineralization and a soft-tissue mass on CT scans, and periosteal abnormality on MRI scans (P < 0.01). These features also exhibited a high negative predictive value in supporting the diagnosis of an underlying PBT over MBT. Conclusion: Pathologic fractures caused by PBT and MBT may be differentiated by a few specific radiographic and CT imaging features, though MRI was poor for characterization of the underlying lesion. Such knowledge may assist radiologists in raising the possibility of a PBT as the cause of a pathologic fracture.

  3. High-dose OxyContin to treat pain associated with bone metastasis in patients with small-cell lung cancer: a case study report

    Directory of Open Access Journals (Sweden)

    Zhou T

    2016-01-01

    patient quality of life, relieve pain, and help prolong patient survival. This article reports the treatment procedure and adverse reactions in a patient who was treated with high-dose OxyContin, with the aim of providing a reference for other clinical practitioners. Keywords: pain, OxyContin, bone metastasis, palliative care

  4. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wei, Zhigang; Ye, Xin; Yang, Xia; Zheng, Aimin; Huang, Guanghui; Wang, Jiao [Shandong Provincial Hospital Affiliated to Shandong University, Department of Oncology, Jinan, Shandong Province (China); Zhang, Kaixian [Teng Zhou Central People' s Hospital Affiliated to Jining Medical College, Department of Oncology, Tengzhou, Shandong Province (China)

    2015-10-15

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  5. Computed tomography-guided percutaneous microwave ablation combined with osteoplasty for palliative treatment of painful extraspinal bone metastases from lung cancer

    International Nuclear Information System (INIS)

    To retrospectively evaluate the efficacy and safety of microwave ablation (MWA) combined with osteoplasty in lung cancer patients with painful extraspinal bone metastases. From January 2011 to July 2014, 26 lung cancer patients with 33 painful extraspinal bone metastases underwent percutaneous MWA combined with osteoplasty. Effectiveness was evaluated by visual analog scale (VAS) and daily morphine dose with a follow-up of 6-months. Complications were also recorded. Mean VAS score and morphine dose pre-procedure were 7.4 ± 1.6 (range, 5-10) and 47.7 ± 30.1 mg (range, 20-120 mg), respectively. Technical success and pain relief were achieved in all patients. Mean VAS scores and daily morphine doses post-procedure were as follows: 48 h, 1.7 ± 1.2 (p < 0.001) and 29.6 ± 16.1 mg (p = 0.003); 7 days, 1.9 ± 1.7 (p < 0.001) and 16.1 ± 12.0 mg (p < 0.001); 1 month, 1.5 ± 0.9 (p < 0.001) and 10.8 ± 10.9 (p < 0.001); 3 months, 0.9 ± 0.7 (p < 0.001) and 8.4 ± 9.2 mg (p < 0.001); and 6 months, 1.2 ± 0.8 (p < 0.001) and 9.2 ± 12.3 mg (p < 0.001). Complications were observed in eight patients (28 %); among these, major complications were reported in two (7.7 %) patients, one with local infection and the other with a bone fracture. The minor complication rate was 23.1 % (6/26). MWA combination with osteoplasty appeared to be an effective and safe treatment for lung cancer patients with painful extraspinal bone metastases. (orig.)

  6. Preparation, Characterization and Stability Test of 177Lu-CTMP as Palliative Agent For Bone Pain Metastases

    International Nuclear Information System (INIS)

    177Lu-CTMP is an ideal radiopharmaceutical for palliative agent on bone pain metastases. This radiopharmaceutical was synthesized from cyclic polyaminophosphonic ligand, known as 1,4,8,11-tetraazacycIotetradecane-l, 4,8,11 tetramethylene phosphonic acid (CTMP) and labeled with 177Lu radio nuclide, a beta emitter which has long enough half life (t1/2=6.71 days, E β-max= 497 KeV). The labeling method was modified from Tapas Das Method by changing buffer type. Ammonium carbonate buffer was changed by phosphate buffer. In this research some variables were used. such as mol comparison (Lu:CTMP), pH variation, and reaction temperature. The result, indicated that an optimum condition of 177Lu-ClMP preparation was at mol comparison Lu:CTMP= 1:20, pH=7, and at room temperature. Optimum labeling of 177Lu-CTMP has been tested using paper chromatography, giving 99.4 % of radiochemical purity. From the stability test, it was found that the radiopharmaceutical was stable until 10 days (when it stored in room temperature and 4°C). After 10 days, decreasing of radiochemical purity, was found if stored in room temperature ( below of the required radiochemical purity «95%)). However, when it was stored at 4°C, it was stable until 21 days with a good condition (radiochemical purity >95%). (author)

  7. Preliminary clinical studies with 89SrCl2 in palliative therapy of the painful bone metastases from breast and prostate carcinoma

    International Nuclear Information System (INIS)

    The results of palliative therapy with 89SrCl2 in 34 cases of multiple malignant metastases to the skeleton, mainly from breast or prostate cancer are presented and discussed. In 32% of the patients administration of 89SrC2 a very good analgesic effect was obtained (complete regression of pain or marked improvement). In 41% moderate pain alleviation was achieved, and in 23% the effect was weak or absent. Following radiotherapy a transient fall of platelet cound was noted, by 25-35% of the initial value in 26% of the cases. The study shows that the radiopharmaceutical 89SrCl2 produced in OBRI Swierk is an effective preparation of low toxicity for palliative treatment of pains caused by cancer metastases to bone from breast and prostate. The observed therapeutic and toxic effects were qualitatively and quantitatively similar to those after Metastron produced in Amersham. (author)

  8. Contribution of the bone scintigraphy in unexplained pains of the thigh; Apport de la scintigraphie osseuse dans le cadre de douleurs inexpliquees de la cuisse

    Energy Technology Data Exchange (ETDEWEB)

    Oufroukhi, Y.; Ech Charraq, I.; Ben Rais, N. [Centre Hospitalier Universitaire Ibn Sina Rabat (Morocco)

    2006-05-15

    Mr. R.N. 32 year's old, high level sportsman, without particular pathological antecedents, consults for pains of the area above the knee of the left thigh, of mechanical pace being exacerbated with the effort. The clinical examination notes pains induced by the deep of the left thigh. The biological assessment, in particular blood cell formula and CRP were normal. The standard radiography of the femurs did not find an anomaly of the osseous structure. Because of the persistence of the pains, an osseous scintiscan was carried out and orientated towards pathology of soft tissues. The doppler and the TDM made it possible to pose the diagnosis of intra-tissues muscular hemangioma. The early times of the bone scintigraphy appears important in the approach diagnosis of many osseous disease of the sportsman. (author)

  9. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Mansfield Richard J

    2005-02-01

    Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

  10. The insufficiency fracture of the sacrum. An often unrecognized cause for low back pain: results of bone scanning in a major hospital

    International Nuclear Information System (INIS)

    Aim: The insufficiency fracture of the sacrum is often radiographically occult. Bone scintigraphy is a method of reference for the diagnosis; the results have been analysed retrospectively. Methods: Bone scintigraphy was done on patients who, predominantly after minor trauma, suffered from lower back pain and whose radiographic findings were negative. Results: During a 24 month period, a sacral insufficiency fracture was diagnosed in 102 patients. H-shaped hyperfixation of the tracer - described as typical - was present in only 19.6% of the cases. Tracer accumulation was found as follows: located uni/bilateral in the sacral wings (32.4%/6.9%), horizontal (27.4%) and half H-shaped (13.7%). In 85% of the cases there were further fractures with main localisations in the pubic bone, in the spine and the ribs. Conclusion: The insufficiency fracture of the sacrum as cause of lower back pain is not uncommon, especially in postmenopausal women with risk factors. Bone scintigraphy is not only an adequate procedure for the detection of often radiographically occult sacral fractures, but also an easy method to reveal the often concomitand fractures. (orig.)

  11. Radionuclide therapy of patients with metastastic bone pain%放射性核素治疗癌转移性骨痛

    Institute of Scientific and Technical Information of China (English)

    程爱萍; 陈绍亮

    2008-01-01

    癌性骨转移原发病灶常见于前列腺癌、乳腺癌、肺癌等,转移发生的病理生理机制、疼痛机制目前不十分明确.止痛治疗尤其是对广泛骨转移性疼痛的治疗是临床医师面对的主要挑战,放射性核素及其标记药物治疗是一种有效、价廉、不良反应较小的治疗方法,对广泛转移的止痛治疗及微转移患者的治疗独具优势,目前有待充分利用.%Bone metastases are often the first sign of distant spread in breast, prostate, and lung cancers. The pathophysiology of bone metastasis is poorly understood and related complications is complex.Bone pain consequent to metastatic cancer continues to be a major therapeutic challenge for clinicians and its alleviation is crucial to improving the patient's quality of life. Targeted radionuclide therapy is an effective and cost efficient treatment for multi-site metastatic bone pain, its advantages may also include therapy for subclinical micro-or oligometastatic disease before clinical manifestation. But radionuclides remain underutilized in such treatments.

  12. Using a Powered Bone Marrow Biopsy System Results in Shorter Procedures, Causes Less Residual Pain to Adult Patients, and Yields Larger Specimens

    Directory of Open Access Journals (Sweden)

    Croopnick Jonathan

    2011-03-01

    Full Text Available Abstract Background In recent years, a battery-powered bone marrow biopsy system was developed and cleared by the U.S. Food and Drug Administration to allow health care providers to access the bone marrow space quickly and efficiently. A multicenter randomized clinical trial was designed for adult patients to determine if the powered device had advantages over traditional manually-inserted needles in regard to length of procedure, patient pain, complications, user satisfaction, and pathological analysis of the specimens. Methods Adult patients requiring marrow sampling procedures were randomized for a Manual or Powered device. Visual Analog Scale (VAS pain scores were captured immediately following the procedure and 1 and 7 days later. Procedure time was measured and core specimens were submitted to pathology for grading. Results Ten sites enrolled 102 patients into the study (Powered, n = 52; Manual, n = 50. Mean VAS scores for overall procedural pain were not significantly different between the arms (3.8 ± 2.8 for Powered, 3.5 ± 2.3 for Manual [p = 0.623]. A day later, more patients who underwent the Powered procedure were pain-free (67% than those patients in the Manual group (33%; p = 0.003. One week later, there was no difference (83% for Powered patients; 76% for Manual patients. Mean procedure time was 102.1 ± 86.4 seconds for the Powered group and 203.1 ± 149.5 seconds for the Manual group (p 3; Manual: 20.4 ± 9.0 mm3; p = 0.039. Two non-serious complications were experienced during Powered procedures (4%; but none during Manual procedures (p = 0.495. Conclusions The results of this first trial provide evidence that the Powered device delivers larger-volume bone marrow specimens for pathology evaluation. In addition, bone marrow specimens were secured more rapidly and subjects experienced less intermediate term pain when the Powered device was employed. Further study is needed to determine if clinicians more experienced with the

  13. Structural studies of human alkaline phosphatase in complex with strontium: Implication for its secondary effect in bones

    Science.gov (United States)

    Llinas, Paola; Masella, Michel; Stigbrand, Torgny; Ménez, André; Stura, Enrico A.; Le Du, Marie Hélène

    2006-01-01

    Strontium is used in the treatment of osteoporosis as a ranelate compound, and in the treatment of painful scattered bone metastases as isotope. At very high doses and in certain conditions, it can lead to osteomalacia characterized by impairment of bone mineralization. The osteomalacia symptoms resemble those of hypophosphatasia, a rare inherited disorder associated with mutations in the gene encoding for tissue-nonspecific alkaline phosphatase (TNAP). Human alkaline phosphatases have four metal binding sites—two for zinc, one for magnesium, and one for calcium ion—that can be substituted by strontium. Here we present the crystal structure of strontium-substituted human placental alkaline phosphatase (PLAP), a related isozyme of TNAP, in which such replacement can have important physiological implications. The structure shows that strontium substitutes the calcium ion with concomitant modification of the metal coordination. The use of the flexible and polarizable force-field TCPEp (topological and classical polarization effects for proteins) predicts that calcium or strontium has similar interaction energies at the calcium-binding site of PLAP. Since calcium helps stabilize a large area that includes loops 210–228 and 250–297, its substitution by strontium could affect the stability of this region. Energy calculations suggest that only at high doses of strontium, comparable to those found for calcium, can strontium substitute for calcium. Since osteomalacia is observed after ingestion of high doses of strontium, alkaline phosphatase is likely to be one of the targets of strontium, and thus this enzyme might be involved in this disease. PMID:16815919

  14. D-D dimer levels in patients with sickle cell disease during bone pain crises and in the steady state

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    Fakunle EE

    2012-05-01

    Full Text Available Eyitayo Emmanuel Fakunle,1 Kapoona Iwara Ibiang Eteng,2 Wuraola Adebola Shokunbi21Department of Pathology, King Edward VII Memorial Hospital, Bermuda; 2Department of Hematology, University College Hospital, Ibadan, NigeriaObjective: To determine the presence of ongoing thrombosis by measuring the D-D dimer levels in bone pain crises (BPCs and in the steady state of patients with sickle cell disease, comparing these levels with those in individuals with normal hemoglobin (HbAA in southwest Nigeria.Study design, patients, and methods: The study design involved 38 patients with homozygous sickle cell anemia (HbSS and 78 adults with the HbAA phenotype, seen at the Hematology Day Care and Accident and Emergency units of the University College Hospital, Ibadan, Nigeria. The TintElize kit was used to quantitatively determine human D-D dimer levels in the plasma with enzyme immunoassay.Results: The mean D-D dimer level measured of the 78 individuals with HbAA was 73.59 ng/mL. The mean D-D dimer level of the patients with HbSS during BPCs was 4002.40 ng/mL, while the mean level in the same patients in the steady state measured 6 weeks after their BPCs, with no other painful crisis episode before the sample was collected, was 1320.00 ng/mL.Conclusion: This study demonstrated a significant increase in the D-D dimer levels of patients with HbSS in the steady state, when compared with those of individuals with HbAA of the same age and sex distribution. There was also an approximate threefold increase in the D-D dimer levels in the same patients with HbSS during BPCs. This confirms the activation of coagulation and fibrinolytic systems in patients with HbSS in the steady state, which is further escalated during BPCs. A multicenter study on the use of anticoagulants in BPCs in patients with sickle cell disease is required.Keywords: anticoagulant, dimer, sickle cell disease, BPC, Nigeria, chronic hemolytic anemia

  15. Lipoxins and aspirin-triggered lipoxin alleviate bone cancer pain in association with suppressing expression of spinal proinflammatory cytokines

    Directory of Open Access Journals (Sweden)

    Hu Shan

    2012-12-01

    Full Text Available Abstract Background The neuroinflammatory responses in the spinal cord following bone cancer development have been shown to play an important role in cancer-induced bone pain (CIBP. Lipoxins (LXs, endogenous lipoxygenase-derived eicosanoids, represent a unique class of lipid mediators that possess a wide spectrum of anti-inflammatory and pro-resolving actions. In this study, we investigated the effects of intrathecal injection with lipoxin and related analogues on CIBP in rats. Methods The CIBP model was induced by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells. Mechanical thresholds were determined by measuring the paw withdrawal threshold to probing with a series of calibrated von Frey filaments. Lipoxins and analogues were administered by intrathecal (i.t. or intravenous (i.v. injection. The protein level of LXA4 receptor (ALX was tested by western blot. The localization of lipoxin receptor in spinal cord was assessed by fluorescent immunohistochemistry. Real-time PCR was carried out for detecting the expression of pro-inflammatory cytokines. Results Our results demonstrated that: 1 i.t. injection with the same dose (0.3 nmol of lipoxin A4 (LXA4, lipoxin B4 (LXB4 or aspirin-triggered-15-epi-lipoxin A4 (ATL could alleviate the mechanical allodynia in CIBP on day 7 after surgery. ATL showed a longer effect than the others and the effect lasted for 6 hours. ATL administered through i.v. injection could also attenuate the allodynia in cancer rats. 2 The results from western blot indicate that there is no difference in the expression of ALX among the naive, sham or cancer groups. 3 Immunohistochemistry showed that the lipoxin receptor (ALX-like immunoreactive substance was distributed in the spinal cord, mainly co-localized with astrocytes, rarely co-localized with neurons, and never co-localized with microglia. 4 Real-time PCR analysis revealed that, compared with vehicle, i.t. injection with ATL could significantly

  16. Effect of PRO-SELF Pain Control Program on Pain Score from Bone Metastasis%PRO-SELF疼痛管理项目对肿瘤骨转移患者疼痛评分的影响

    Institute of Scientific and Technical Information of China (English)

    王静; 熊永祥; 黄启静; 郑艳娟; 卢妍容

    2014-01-01

    目的:进一步了解 Pro-self 疼痛管理项目对患者疼痛评分的影响。方法已证实有肿瘤骨转移的门诊病人随机分为 Pro-self 组(n=29)和标准护理组(n=30)。针对 Pro-self 组患者,疼痛专科护士分别在第1,4周电话访问,指导如何应对癌症疼痛及止痛药使用,以及与医师沟通,从而改进疼痛控制策略。标准护理组按常规护理。4周后患者对疼痛情况进行评分。结果 Pro-self 组在疼痛评分上降低,且与标准护理组有统计学差异(P<0.05)。两组在疼痛持续时间上没有统计学差异。结论 Pro-self 疼痛管理项目能有效提高患者自我护理能力,增强了癌症疼痛的管理。%Objective to better understand the effect of the Pro-self Pain control Program on pain scores. Methods:oncology outpatients with pain from bone metastasis were randomly assigned to the Pro-self intervention group (n=29) or standard care group (n=30). Pro-self group patients were taught how to cope with cancer pain and use an analgesic drug, and were given instructions on how to communicate with their doctors about unrelieved pain, at week 1 and 4 respectively. Patients in standard care group received routine nursing. Patients scored the pain intensity after 4weeks. Results Pain intensity scores in the PRO-SELF group decreased compared with pre-intervention, significantly lower than that in the standard care group (p<0.05). no differences were observed on hours per day in cancer pain between these two groups. Conclusions the use of Pro-self Pain control Program can improve self care ability and help to manage the cancer pain.

  17. The impact of the opioids fentanyl and morphine on nociception and bone destruction in a murine model of bone cancer pain.

    NARCIS (Netherlands)

    ElMouedden, M.; Meert, T.F.

    2007-01-01

    Chronic pain resulting from metastasis into skeleton of certain neoplastic diseases remains poorly understood and relatively resistant to analgesic treatment. Opioids are the principal axis in drug therapy for this type of pain, especially at the end stage of cancer. Our aim was to examine whether,

  18. Pediatric aneurysmal bone cyst in the ischial region

    Science.gov (United States)

    Hetaimish, Bandar M.; Alshaya, Osama S.

    2016-01-01

    Aneurysmal bone cyst (ABC) is an expanding osteolytic lesion. ABC represents 1% of all primary benign bone tumors, whereby 4-12% occur in the pelvis. The etiology of this disease remains vague. Aneurysmal bone cyst can exist either as primary bone lesion (70%) or as secondary lesion arising from another bone disorder (30%). Moreover, pelvic ABCs are characterized by their large size and high vascularity. We present a rare pediatric case with ABC involving the ischial region. A 5-year-old girl presented with left pelvic pain and limping for the past 6 months. Initial imaging showed an expansile lesion in the left ischium, and computed tomography guided biopsy showed giant cells in histopathology study with no evidence of metastasis. The patient underwent intraoperative frozen section followed by extensive intra-lesional bone excision. Bone curettage was pursued along with bone grafting. The case was successfully managed without postoperative complications after the 6-month follow-up period. PMID:27381543

  19. Imaging non-specific wrist pain: interobserver agreement and diagnostic accuracy of SPECT/CT, MRI, CT, bone scan and plain radiographs.

    Directory of Open Access Journals (Sweden)

    Martin W Huellner

    Full Text Available PURPOSE: Chronic hand and wrist pain is a common clinical issue for orthopaedic surgeons and rheumatologists. The purpose of this study was 1. To analyze the interobserver agreement of SPECT/CT, MRI, CT, bone scan and plain radiographs in patients with non-specific pain of the hand and wrist, and 2. to assess the diagnostic accuracy of these imaging methods in this selected patient population. MATERIALS AND METHODS: Thirty-two consecutive patients with non-specific pain of the hand or wrist were evaluated retrospectively. All patients had been imaged by plain radiographs, planar early-phase imaging (bone scan, late-phase imaging (SPECT/CT including bone scan and CT, and MRI. Two experienced and two inexperienced readers analyzed the images with a standardized read-out protocol. Reading criteria were lesion detection and localisation, type and etiology of the underlying pathology. Diagnostic accuracy and interobserver agreement were determined for all readers and imaging modalities. RESULTS: The most accurate modality for experienced readers was SPECT/CT (accuracy 77%, followed by MRI (56%. The best performing, though little accurate modality for inexperienced readers was also SPECT/CT (44%, followed by MRI and bone scan (38% each. The interobserver agreement of experienced readers was generally high in SPECT/CT concerning lesion detection (kappa 0.93, MRI 0.72, localisation (kappa 0.91, MRI 0.75 and etiology (kappa 0.85, MRI 0.74, while MRI yielded better results on typification of lesions (kappa 0.75, SPECT/CT 0.69. There was poor agreement between experienced and inexperienced readers in SPECT/CT and MRI. CONCLUSIONS: SPECT/CT proved to be the most helpful imaging modality in patients with non-specific wrist pain. The method was found reliable, providing high interobserver agreement, being outperformed by MRI only concerning the typification of lesions. We believe it is beneficial to integrate SPECT/CT into the diagnostic imaging algorithm of

  20. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Science.gov (United States)

    Ochieng, Vincent; Hendrickx, Leo; Valk, Jody

    2016-01-01

    Background The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP. PMID:27107305

  1. Alleviation of bone pain in prostate cancer. Effectiveness of treatment with rhenium-186 HEDP; Linderung von Knochenschmerzen bei metastasiertem Prostatakarzinom. Nutzen der Radionuklidtherapie mit Rhenium-186-HEDP

    Energy Technology Data Exchange (ETDEWEB)

    Klutmann, S.; Bohuslavizki, K.H. [Universitaetskrankenhaus Eppendorf, Hamburg (Germany). Abt. fuer Nuklearmedizin

    1999-11-04

    Pain caused by bone metastases from carcinoma of the prostate are treated in particular by non-steroidal anti-inflammatory drugs and opioid-containing analgesics. In case of painful multilocular metastases, the use of osteotropic radionuclides which selectively irradiate the bone metastases while sparing healthy surrounding tissue offers an alternative. Owing to their favorable physical properties, rhenium-189 and samarium-153 are preferentially used. The rate of side effects - for the most part transient thrombocytopenia - is low, and the response rate is roughly 70 to 80% of the patients treated. Pain relief may last for between 1 and 6 months, with the option of multiple treatments. The prognosis of the disease is, however, not affected. (orig.) [German] Das Skelettsystem ist nach der lymphatischen Metastasierung der zweithaeufigste Sitz von Metastasen beim Prostatakarzinom. Um die Lebensqualitaet dieser Patienten zu verbessern, steht die effektive Schmerzbekaempfung im Mittelpunkt der Therapie. Neben der Gabe von Analgetika ist hier die Applikation des osteotropen Radionuklids Rhenium-186 gut geeignet. (orig.)

  2. Differential diagnosis between secondary hyperparathyroidism and aluminum intoxication in uremic patients: Usefulness of /sup 99m/Tc-pyrophosphate bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Kinnaert, P.; Van Hooff, I.; Schoutens, A.; Bergmann, P.; Fuss, M.; Dratwa, M.; Vienne, A.; Pasteels, J.L.; van Geertruyden, J.; Vanherweghem, J.L.

    1989-03-01

    Forty-one patients in chronic end-stage renal failure and 4 patients with a functioning kidney transplant presented with spontaneous hypercalcemia or intolerance to vitamin D3 sterols and/or oral calcium supplements. Bone iliac crest biopsy with aluminum staining and Tc-pyrophosphate bone scintigraphy with determination of Fogelman score were performed in all cases. Two patients had aluminum-induced osteomalacia (AL O). Thirty-eight biopsies showed renal osteodystrophy (secondary hyperparathyroidism or various combinations of osteitis fibrosa and osteomalacia): 19 with positive staining for aluminum (RO + AL) and 19 without aluminum deposits (RO). The series also comprised 2 cases of pure osteomalacia (OM), 2 cases of osteoporosis (OP), and 1 case of osteoporosis with aluminum accumulation (OP + AL). Mean Fogelman score in RO patients (9.1 +/- 0.3) was significantly higher than in all other categories (5.9 +/- 0.5 for RO + AL, and scores ranging from 0 to 8 in the last 7 patients, p less than 0.01). Patients with massive aluminum accumulation in bone (greater than 75% of the total trabecular surface) showed no or very low uptake of the isotope by the skeleton. Fogelman scores of 9 or higher were always associated with histological secondary hyperparathyroidism. /sup 99m/Tc-pyrophosphate bone scintigraphy is helpful to distinguish aluminum intoxication from secondary hyperparathyroidism in uremic patients.

  3. Chronic abdominal pain secondary to mesentericpanniculitis treated successfully with endoscopicultrasonography-guided celiac plexus block: A case report

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Mesenteric panniculitis is a chronic illness that ischaracterized by fibrosing inflammation of the mesenteriesthat can lead to intractable abdominal pain. Paincontrol is a crucial component of the management plan.Most patients will improve with oral corticosteroidstreatment, however, some patients will require a trialof other immunosuppressive agents, and a minorityof patients will continue to have refractory disease.Endoscopic ultrasound guided celiac plexus block is usedfrequently to control abdominal pain in patients withpancreatic pathology. To our knowledge there are nocase reports describing its use in mesenteric panniculitispatients with refractory abdominal pain.

  4. Chronic administration of the selective P2X3, P2X2/3 receptor antagonist, A-317491, transiently attenuates cancer-induced bone pain in mice

    DEFF Research Database (Denmark)

    Hansen, RR; Nasser, A; Falk, S;

    2012-01-01

    The purinergic P2X3 and P2X2/3 receptors are in the peripheral nervous system almost exclusively confined to afferent sensory neurons, where they are found both at peripheral and central synapses. The P2X3 receptor is implicated in both neuropathic and inflammatory pain. However, the role of the ......X3 receptor in chronic cancer-induced bone pain is less known. Here we investigated the effect of systemic acute and chronic administration of the selective P2X3, P2X2/3 receptor antagonist (5-[[[(3-Phenoxyphenyl)methyl][(1S)-1,2,3,4-tetrahydro-1-naphthalenyl]amino]carbonyl]-1...

  5. Preparation and biological assessment of 177Lu-BPAMD as a high potential agent for bone pain palliation therapy. Comparison with 177Lu-EDTMP

    International Nuclear Information System (INIS)

    In this study, 177Lu-(4-{[(bis(phosphonomethyl))- carbamoyl]methyl}-7,10-bis(carboxymethyl)-1,4,7,10-tetraazacyclododec-1-yl) acetic acid (177Lu-BPAMD) was successfully prepared. The quality control, partition coefficient, hydroxyapatite binding assay and stability of the complex were determined. For better comparison, biodistribution patterns of 177Lu-BPAMD and 177Lu-EDTMP complexes were compared in same animal model. 177Lu-BPAMD was prepared with high radiochemical purity ([93 %) and specific activity of 534 GBq/mmol at the optimal conditions. Comparative study between 177Lu-BPAMD and 177Lu-EDTMP indicated higher bone uptake and lesser accumulation in the other organs for 177Lu-BPAMD. 177Lu-BPAMD can be considered as a promising agent for bone pain palliation in the near future. (author)

  6. Painful os acromiale presenting as septic shoulder.

    Science.gov (United States)

    Kapadia, Nirav S; Demetracopoulos, Constantine A; Fayad, Laura M; McFarland, Edward G; Millin, Michael G

    2011-10-01

    The unfused acromial apophysis of an os acromiale typically is an undetected orthopedic anomaly with minimal symptoms. In some instances, however, pain and disability can result from motion between the unfused bone fragments. Trauma to the acromion can similarly displace the unfused os acromiale or can result in chronic symptoms of pain and swelling. In this article, we report the case of a young man who had a fractured os acromiale secondary to trauma and presented with the signs and symptoms of a septic glenohumeral joint.

  7. Avascular necrosis of the lunate bone (Kienböck’s disease) secondary to scapholunate ligament tear as a consequence of trauma – a case study

    International Nuclear Information System (INIS)

    Avascular necrosis of the lunate bone (Kienböck’s disease), is a condition in which lunate bone, loses its blood supply, leading to necrosis of the bone. There is probably no single cause of Kienbock’s disease. Its origin may involve multiple factors, such as the blood supply (arteries), blood drainage (veins), and skeletal variations. Trauma, either isolated or repeated, may possibly be a factor in some cases. This case presented with multifactorial etiology. In the presented case, a patient with negative ulnar variant had injured her right wrist and presented at an orthopedic clinic due to nonspecific pain 6 months later. An arthro-MRI examination revealed necrosis of the lunate bone, scapholunate ligament tear and coexisting TFCC (triangular fibrocartilage complex) tear. Early diagnosis and treatment can prevent progression of necrotic lesions and bone collapse. MRI examination seems to be the key diagnostic method in the early stage of the Kienböck’s disease with negative x-ray and CT images. Arthro-MRI examination also allows us to identify the underlying ligamentous injury. In cases of traumatic etiology, an additional CT test enables stating the final diagnosis

  8. EORTC QLQ-BM22 and QLQ-C30 quality of life scores in patients with painful bone metastases of prostate cancer treated with strontium-89 radionuclide therapy

    International Nuclear Information System (INIS)

    Approximately 80% of patients with prostate cancer will develop bone metastases, which often lead to bone pain and skeletal-related events. Sr-89 is an established alternative for the palliation of bone pain in prostate cancer. We aimed to assess the effect of Sr-89 radionuclide therapy on quality of life (QOL) in prostate cancer patients with painful bone metastases. Thirteen patients received a single intravenous injection of Sr-89 at a dose of 2.0 MBq/kg. All patients underwent QOL evaluation prior to Sr-89 treatment and 1, 2, and 3 months afterward using the Japanese version of the European Organisation for Research and Treatment of Cancer developed a Quality of Life questionnaire for Patients with Bone Metastases 22(EORTC QLQ-BM22), EORTC Quality of Life Group core questionnaire (EORTC QLQ-C30), a visual analog scale (VAS), and face scale. We also evaluated prostate-specific antigen (PSA) and serum alkaline phosphatase (ALP) response and toxicity of the Sr-89 therapy. The pain characteristics subscale of the EORTC QLQ-BM22 was significantly reduced from 1 month onward compared with the baseline. The functional interference and psychosocial aspects subscales were significantly higher than baseline from 2 months onward. At 2 months, VAS indicated a significant reduction in pain as compared to the baseline. Sr-89 therapy caused a nonsignificant reduction in PSA and ALP levels. No patients had leukocyte toxicity, and one patient had grade 3 platelet toxicity. Sr-89 radionuclide therapy can provide not only reduced pain characteristics but also better psychosocial aspects and functional interference in patients with painful bone metastases of prostate cancer. (author)

  9. Pain Assessment

    Science.gov (United States)

    Introduction Types of Pain Pain Assessment Pain Treatments Integrative Pain Therapy Pain Management Recommendations References September 04, 2016 Pain Assessment Effective pain management begins with a comprehensive ...

  10. Knee pain

    Science.gov (United States)

    ... time, overuse, or injury. Dislocation of the kneecap Fracture of the kneecap or other bones Iliotibial band syndrome . Injury to the thick band that runs from your hip to the outside of your knee. Pain in the front of your knee around ...

  11. Biological 18[F]-FDG-PET image-guided dose painting by numbers for painful uncomplicated bone metastases: A 3-arm randomized phase II trial

    International Nuclear Information System (INIS)

    Background: Antalgic radiotherapy for bone metastases might be improved by implementing biological information in the radiotherapy planning using 18F-FDG-PET-CT based dose painting by numbers (DPBN). Materials and methods: Patients with uncomplicated painful bone metastases were randomized (1:1:1) and blinded to receive either 8 Gy in a single fraction with conventionally planned radiotherapy (arm A) or 8 Gy in a single fraction with DPBN (dose range between 610 Gy and 10 Gy) (arm B) or 16 Gy in a single fraction with DPBN (dose range between 1410 Gy and 18 Gy) (arm C). The primary endpoint was overall pain response at 1 month. The phase II trial was designed to select the experimental arm with sufficient promise of efficacy to continue to a phase III trial. Results: Forty-five patients were randomized. Eight (53%), 12 (80%) and 9 patients (60%) had an overall response to treatment in arm A, B and C, respectively. The estimated odds ratio of overall response for arm B vs. A is 3.5 (95% CI: 0.44–17.71, p = 0.12). The estimated odds ratio of arm C vs. A is 1.31 (95% CI: 0.31–5.58, p = 0.71). Conclusion: A single fraction of 8 Gy with DPBN will be further evaluated in a phase III-trial

  12. Music in Reducing Anxiety and Pain in Adult Patients Undergoing Bone Marrow Biopsy for Hematologic Cancers or Other Diseases

    Science.gov (United States)

    2012-07-12

    Chronic Myeloproliferative Disorders; Leukemia; Lymphoma; Lymphoproliferative Disorder; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic Syndromes; Myelodysplastic/Myeloproliferative Neoplasms; Pain; Precancerous Condition; Psychosocial Effects of Cancer and Its Treatment

  13. Analysis of therapeutic efficacy of Aredia in treating pain caused by advanced malignant metastatic bone tumors%阿可达治疗晚期恶性肿瘤骨转移疼痛的疗效分析

    Institute of Scientific and Technical Information of China (English)

    劳逸; 王伟; 陈绍锋; 胡建新; 吕德政

    2001-01-01

    Objective To study therapeutic efficacy of Aredia in treating malignant metastatic bone tumors. Method 60~ 90 mg Aredia was administrated iv in 31 cases with malignant metastatic tumors,once each week. Results Pain in 12 cases was significantly relieved.14 cases acquired relif.Total effective rate was 83.9% .Activity ability was improved by 80.6% .No apparent toxicological and adverse effects as well as fever and cold symptoms were observed.Conclusion Aredia is a kind of ideal drugs for treatment of pain caused by malignant metastatic bone tumors.It is convenient in use and could be endured by patients.

  14. Tapentadol prolonged release for patients with multiple myeloma suffering from moderate-to-severe cancer pain due to bone disease

    OpenAIRE

    Coluzzi F; Raffa RB; Pergolizzi J; Rocco A; Locarini P; Cenfra N; Cimino G; Mattia C

    2015-01-01

    Flaminia Coluzzi,1,2 Robert B Raffa,3 Joseph Pergolizzi,4 Alessandra Rocco,1 Pamela Locarini,1 Natalia Cenfra,5 Giuseppe Cimino,5 Consalvo Mattia1,2 1Department of Medical and Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Unit of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Polo Pontino, Sapienza University of Rome, Latina, Italy; 2SIAARTI Study Group on Acute and Chronic Pain, Rome, Italy; 3Department of Pharmaceutical Sciences, Temple University Scho...

  15. The Nijmegen decision tool for chronic low back pain. Development of a clinical decision tool for secondary or tertiary spine care specialists.

    Directory of Open Access Journals (Sweden)

    Miranda L van Hooff

    Full Text Available BACKGROUND: In Western Europe, low back pain has the greatest burden of all diseases. When back pain persists, different medical specialists are involved and a lack of consensus exists among these specialists for medical decision-making in Chronic Low Back Pain (CLBP. OBJECTIVE: To develop a decision tool for secondary or tertiary spine care specialists to decide which patients with CLBP should be seen by a spine surgeon or by other non-surgical medical specialists. METHODS: A Delphi study was performed to identify indicators predicting the outcome of interventions. In the preparatory stage evidence from international guidelines and literature were summarized. Eligible studies were reviews and longitudinal studies. Inclusion criteria: surgical or non-surgical interventions and persistence of complaints, CLBP-patients aged 18-65 years, reported baseline measures of predictive indicators, and one or more reported outcomes had to assess functional status, quality of life, pain intensity, employment status or a composite score. Subsequently, a three-round Delphi procedure, to reach consensus on candidate indicators, was performed among a multidisciplinary panel of 29 CLBP-professionals (>five years CLBP-experience. The pre-set threshold for general agreement was ≥70%. The final indicator set was used to develop a clinical decision tool. RESULTS: A draft list with 53 candidate indicators (38 with conclusive evidence and 15 with inconclusive evidence was included for the Delphi study. Consensus was reached to include 47 indicators. A first version of the decision tool was developed, consisting of a web-based screening questionnaire and a provisional decision algorithm. CONCLUSIONS: This is the first clinical decision tool based on current scientific evidence and formal multidisciplinary consensus that helps referring the patient for consultation to a spine surgeon or a non-surgical spine care specialist. We expect that this tool considerably helps

  16. Epidural injections with or without steroids in managing chronic low back pain secondary to lumbar spinal stenosis: a meta-analysis of 13 randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Meng H

    2015-08-01

    steroids or with local anesthetic alone provide significant pain relief and functional improvement in managing chronic low back pain secondary to lumbar spinal stenosis, and the inclusion of steroids confers no advantage compared to local anesthetic alone. Keywords: chronic low back pain, spinal stenosis, epidural injections, steroids, local anesthetics 

  17. Zoledronic acid improves bone mineral density, reduces bone turnover and improves skeletal architecture over 2 years of treatment in children with secondary osteoporosis

    DEFF Research Database (Denmark)

    Simm, Peter J; Johannesen, Jesper; Briody, Julie;

    2011-01-01

    There are limited data on the use of bisphosphonate therapy for secondary osteoporoses in childhood, and no previous reports of the use of zoledronic acid in this group. We report 20 children with a variety of underlying primary diagnoses with associated secondary osteoporosis, who were treated...

  18. Meditation reduces pain-related neural activity in the anterior cingulate cortex, insula, secondary somatosensory cortex, and thalamus.

    OpenAIRE

    Hiroki eNakata; Kiwako eSakamoto; Ryusuke eKakigi

    2014-01-01

    Recent studies have shown that meditation inhibits or relieves pain perception. To clarify the underlying mechanisms for this phenomenon, neuroimaging methods, such as functional magnetic resonance imaging (fMRI), and neurophysiological methods, such as magnetoencephalography (MEG) and electroencephalography (EEG), have been used. However, it has been difficult to interpret the results, because there is some paradoxical evidence. For example, some studies reported increased neural response...

  19. Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D., E-mail: dfilippiadis@yahoo.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Anselmetti, G., E-mail: gc.anselmetti@fastwebnet.it [GVM Care and Research Maria Pia Hospital (Italy); Brountzos, E., E-mail: ebrountz@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Mavrogenis, A., E-mail: afm@otenet.gr; Papagelopoulos, P., E-mail: pjp@hol.gr [University General Hospital “ATTIKON”, A Orthopedic Clinic (Greece); Kelekis, N., E-mail: kelnik@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece); Martin, J.-B., E-mail: jbmartin@cird.ch [Centre Imaginerie Rive Droite & Gauche (Switzerland)

    2016-01-15

    PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing.

  20. Percutaneous Augmented Peripheral Osteoplasty in Long Bones of Oncologic Patients for Pain Reduction and Prevention of Impeding Pathologic Fracture: The Rebar Concept

    International Nuclear Information System (INIS)

    PurposeTo evaluate clinical efficacy/safety of augmented peripheral osteoplasty in oncologic patients with long-term follow-up.Materials and MethodsPercutaneous augmented peripheral osteoplasty was performed in 12 patients suffering from symptomatic lesions of long bones. Under extensive local sterility measures, anesthesiology care, and fluoroscopic guidance, direct access to lesion was obtained and coaxially a metallic mesh consisting of 25–50 medical grade stainless steel micro-needles (22 G, 2–6 cm length) was inserted. PMMA for vertebroplasty was finally injected under fluoroscopic control. CT assessed implant position 24-h post-treatment.ResultsClinical evaluation included immediate and delayed follow-up studies of patient’s general condition, NVS pain score, and neurological status. Imaging assessed implant’s long-term stability. Mean follow-up was 16.17 ± 10.93 months (range 2–36 months). Comparing patients’ scores prior (8.33 ± 1.67 NVS units) and post (1.42 ± 1.62 NVS units) augmented peripheral osteoplasty, there was a mean decrease of 6.92 ± 1.51 NVS units. Overall mobility improved in 12/12 patients. No complication was observed.ConclusionPercutaneous augmented peripheral osteoplasty (rebar concept) for symptomatic malignant lesions in long bones seems to be a possible new technique for bone stabilization. This combination seems to provide necessary stability against shearing forces applied in long bones during weight bearing

  1. Hospital visits among women with skeletal-related events secondary to breast cancer and bone metastases: a nationwide population-based cohort study in Denmark

    Directory of Open Access Journals (Sweden)

    Svendsen ML

    2013-03-01

    Full Text Available Marie Louise Svendsen,1 Henrik Gammelager,1 Claus Sværke,1 Mellissa Yong,2 Victoria M Chia,2 Christian F Christiansen,1 Jon P Fryzek1 1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 2Center for Observational Research, Amgen, Thousand Oaks, CA, USA Objective: Skeletal-related events (SREs among women with breast cancer may be associated with considerable use of health-care resources. We characterized inpatient and outpatient hospital visits in a national population-based cohort of Danish women with SREs secondary to breast cancer and bone metastases. Methods: We identified first-time breast cancer patients with bone metastases from 2003 through 2009 who had a subsequent SRE (defined as pathologic fracture, spinal cord compression, radiation therapy, or surgery to bone. Hospital visits included the number of inpatient hospitalizations, length of stay, number of hospital outpatient clinic visits, and emergency room visits. The number of hospital visits was assessed for a pre-SRE period (90 days prior to the diagnostic period, a diagnostic period (14 days prior to the SRE, and a post-SRE period (90 days after the SRE. Patients who experienced more than one SRE during the 90-day post-SRE period were defined as having multiple SREs and were followed until 90 days after the last SRE. Results: We identified 569 women with SREs secondary to breast cancer with bone metastases. The majority of women had multiple SREs (73.1%. A total of 20.9% and 33.4% of women with single and multiple SREs died in the post-SRE period, respectively. SREs were associated with a large number of hospital visits in the diagnostic period, irrespective of the number and type of SREs. Women with multiple SREs generally had a higher number of visits compared to those with a single SRE in the post-SRE period, eg, median length of hospitalization was 5 days (interquartile range 0–15 for women with a single SRE and 13 days (interquartile range 4

  2. Unexpected skeletal histology of an ichthyosaur from the Middle Jurassic of Patagonia: implications for evolution of bone microstructure among secondary aquatic tetrapods

    Science.gov (United States)

    Talevi, Marianella; Fernández, Marta S.

    2012-03-01

    During the Mesozoic, one of the most significant evolutionary processes was the secondary adaptation of tetrapods to life in water. Several non-related lineages invaded from the terrestrial realms and from the oceans of the entire world. Among these lineages, ichthyosaurs were particularly successful. Advance parvipelvian ichthyosaurs were the first tetrapods to evolve a fish-shaped body profile. The deep skeletal modifications of their bodies, as well as their biology, depict advance ichthyosaurs as the paradigm of secondary adaptation of reptiles to marine life. Functional inferences point to them as off-shore cruising forms, similar to a living tuna, and some of them were capable of deep diving. Bone histology of some genera such as Temnodontosaurus, Stenopterygius, Ichthyosaurus, and Caypullisaurus, characterized by overall cancellous bone, is consistent with the idea of a fish-shaped ichthyosaurs as fast and far cruisers. Here, we provide histological examination of the ribs of the Middle Jurassic parvipelvian Mollesaurus. Contrasting with the bone histology of other parvipelvian, Mollesaurus ribs are characterized by a compact and thick cortex. Our data indicate that the rib cage was heavy and suggest that not all advanced ichthyosaurs were fast cruisers. The compact and dense ribs in these parvipelvian show that advance ichthyosaurs were ecologically more diverse than previously thought and that the lightening of the skeleton reversed, as also occurred in the evolution of cetacean, at least once along the evolutionary history of ichthyosaurs.

  3. Trans arterial embolization of primary and secondary tumors of the skeletal system

    International Nuclear Information System (INIS)

    Percutaneous transcatheter al embolization s of primary and secondary bone tumors are important minimal invasive angiographic interventions of the skeletal system. In most of the cases embolization is performed for preoperative devascularization or as a palliative measure to treat tumor-associated pain or other tumor bulk symptoms. The transarterial embolization of primary and secondary tumors of the skeletal system has been developed to a safe and very effective method. Indications, techniques, results and complications of this minimal invasive interventional therapy for treatment of primary and secondary bone tumors are described and discussed and compared with the newer literature and our own results

  4. Irradiation parameters play a crucial role in the (n, γ) production of 170Tm suitable for clinical use in bone pain palliation

    International Nuclear Information System (INIS)

    While neutron activation of natural Tm2O3 is the convenient strategy for producing 170Tm for use in palliative care of painful bone metastases, the coproduction of 171Tm (t1/2 = 1.92 years) is as an impediment towards its clinical utility. The production strategy has been optimized to obtain 170Tm with adequate specific activity and radionuclidic purity. Preliminary clinical studies carried out using the 170Tm-labeled ethylenediaminetetramethylene phosphonic acid (170Tm-EDTMP) showed site specific localization of the radiopharmaceutical in skeleton with preferential accumulation in metastatic lesions along with almost no accumulation in non-target organs, a distribution pattern comparable to that of 99mTc-labeled methylene diphosphonate (99mTc-MDP). (author)

  5. 腹腔注射沙利度胺对骨癌痛小鼠痛行为的影响%Effect of intraperitoneal injection of thalidomide on pain behaviors in a mouse model of bone cancer pain

    Institute of Scientific and Technical Information of China (English)

    郑亚国; 马正良; 梅凤美; 张睿; 任炳旭; 张娟; 顾小萍

    2010-01-01

    Objective To investigate the effect of intraperitoneal injection of thalidomide on pain behaviors in a mouse model of bone cancer pain. Methods 36 male C3H/HeJ mice were divided randomly into tumor group (n= 18) and sham group (n= 18) ,six mice from each group were chosen to examine the time course of changes in behavior after tumor cells inoculated to the bone. 2 × 105 osteosarcoma NCTC 2472 cells were implanted into the intramedullary space of the right femurs of mice to induce ongoing bone cancer related pain behaviors. The sham group was inoculated by α-MEM without any cells. On the day before inoculation,the tumor mice were divided randomly into tumor + thalidomide group and tumor + vehicle group. The sham group mice were further divided randomly into sham + thalidomide group and sham + vehicle group. Pain ethology indexes such as paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were observed on 1 d before inoculation and on 3 d ,5 d ,7 d, 10 d, 14 d after inoculation. Results ( 1 ) At day 7 after the operation, compared with sham mice ( 1. 70 ± 0. 33 ) g, PWMT of tumor mice decreased to ( 1.07 ± 0. 30) g (P < 0. 05 ). At day 10, PWTL shortened to ( 12.60 ± 1.69 ) s (P < 0. 05 ) compared with sham mice ( 17.70 ± 1.54 ) s. And the pain behaviors of tumor mice were aggravated along with the development of cancer pain. (2) At day 7 after the operation, compared with tumor + vehicle group ( 1. 07 ± 0.39 ) g, PWMT of tumor + thalidomide group increased to ( 1. 53 ± 0. 39 ) g (P <0.05). At day 10, PWTL extended to ( 16.48 ± 1.13 ) s compared with sham mice ( 12.64 ± 1. 56) s (P <0. 05 ). Conclusion Intraperitoneal injection of thalidomide can efficiently relieve mechanical hyperalgia and thermal hyperalgia in a mouse model of bone cancer pain.%目的 观察腹腔注射沙利度胺对骨癌痛小鼠痛行为的影响.方法 36只C3H/HeJ小鼠随机分为肿瘤组(n=18)和假手术组(n=18),每组抽取6只小鼠

  6. Optimization of the production, quality control of samarium-153, 153 Sm-EDTMP and biodistribution of 153 Sm-EDTMP in animals for metastatic bone cancer pain palliation

    International Nuclear Information System (INIS)

    Samarium-153 has suitable physical properties for metastatic bone cancer pain palliation with 46.7 hr half-life. Not only decays it with multi-energetic B-radiation but also emits a gamma-ray at 103 keV which is suitable for imaging during therapy. The optimization of 153 Sm production, by irradiation 152 Sm2 O3 as a solid and liquid target, is conducted in TRIGA Mark III research reactor. The feasibility to label it with EDTMP, a bone seeking agent, is also studied. The specific activity obtained from liquid target is about 2 times higher than solid target. At least 500 mCi/week can be produced with specific activity about 50 to 70 mCi/mg Sm. EDTMP as Na-EDTMP and Ca-EDTMP is labelled with 153 Sm at various conditions. The radiochemical purity achieved, is greater than 99% (85 mCi of 153 Sm labelled with Na-EDTMP or Ca-EDTMP, molar ratio of Sm:EDTMP 1:10 and 1:100 respectively, pH 7.5-8). The biodistribution in animals of 153 Sm-Na-EDTMP showed similar results as obtained from 153 Sm-Ca-EDTMP but slightly higher uptake in various organs and showed high skeletal uptake up to 32% at 24 hr post injection. The labeled compound obviously undergoes rapid removal, completely clearance into urine within 24 hr. This labeled compound is under clinical trials

  7. Treatment of painful bone metastases by Quadramet: retrospective study in 77 patients 2-year experience; Traitement des metastases osseuses douloureuses par Quadramet: experience retrospective ches 77 patients sur 2 ans

    Energy Technology Data Exchange (ETDEWEB)

    Klingelschmitt, S.; Boulahdour, H.; Blagosklonov, O.; Rudenko, B.; Aubry, R.; Bidet, A.C.; Bosset, J.F.; Cardot, J.C. [Centre Hospitalier Universitaire, 25 - Besancon (France)

    2002-09-01

    Metabolic radiotherapy offers an alternative therapeutic tactic in patients with painful bone metastases. The efficacy and toxicity of Quadramet were evaluated in 77 patients. All patients received a 37 MBq/kg dose of Quadramet, and 13 patients received the dose twice. Then, the efficacy of treatment was evaluated according to WHO/OMS score, to pain relief and modification of opioid treatment. The WHO/OMS score was not changed or increased in 87.5 % (63172) of patients. The pain relief was observed in 77.8 % (56/72) of patients. The antalgic treatment decreased in 76.4 % (55/72) of patients. In patients with prostatic cancer, pain relief (79.2 % of patients) was more noticeable than in patients with breast cancer (76.9 % of patients). An opposite response was observed in 8.3 % (6/72) of patients. The rate of PSA decreased in 42.8 % (12/28) of patients with prostatic cancer. The only toxicity observed was myelo-toxicity. This toxicity was moderate and recovered by 8 weeks. After the second administration of Quadramet as well as after the first, we observed the pain relief in 76.9 % of patients. The results of our study confirm the efficacy and the safety of Quadramet in early painful bone metastases treatment. This treatment can be repeated without decrease of the efficacy. (authors)

  8. Progression of cartilage degradation, bone resorption and pain in rat temporomandibular joint osteoarthritis induced by injection of iodoacetate.

    Directory of Open Access Journals (Sweden)

    Xue-Dong Wang

    Full Text Available BACKGROUND: Osteoarthritis (OA is an important subtype of temporomandibular disorders. A simple and reproducible animal model that mimics the histopathologic changes, both in the cartilage and subchondral bone, and clinical symptoms of temporomandibular joint osteoarthritis (TMJOA would help in our understanding of its process and underlying mechanism. OBJECTIVE: To explore whether injection of monosodium iodoacetate (MIA into the upper compartment of rat TMJ could induce OA-like lesions. METHODS: Female rats were injected with varied doses of MIA into the upper compartment and observed for up to 12 weeks. Histologic, radiographic, behavioral, and molecular changes in the TMJ were evaluated by light and electron microscopy, MicroCT scanning, head withdrawal threshold test, real-time PCR, immunohistochemistry, and TUNEL assay. RESULTS: The intermediate zone of the disc loosened by 1 day post-MIA injection and thinned thereafter. Injection of an MIA dose of 0.5 mg or higher induced typical OA-like lesions in the TMJ within 4 weeks. Condylar destruction presented in a time-dependent manner, including chondrocyte apoptosis in the early stages, subsequent cartilage matrix disorganization and subchondral bone erosion, fibrosis, subchondral bone sclerosis, and osteophyte formation in the late stages. Nociceptive responses increased in the early stages, corresponding to severe synovitis. Furthermore, chondrocyte apoptosis and an imbalance between anabolism and catabolism of cartilage and subchondral bone might account for the condylar destruction. CONCLUSIONS: Multi-level data demonstrated a reliable and convenient rat model of TMJOA could be induced by MIA injection into the upper compartment. The model might facilitate TMJOA related researches.

  9. Current options for the treatment of Paget’s disease of the bone

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    Daniela Merlotti

    2009-07-01

    Full Text Available Daniela Merlotti, Luigi Gennari, Giuseppe Martini, Ranuccio NutiDepartment of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Siena, ItalyAbstract: Paget’s disease of bone (PDB is a chronic bone remodeling disorder characterized by increased osteoclast-mediated bone resorption, with subsequent compensatory increases in new bone formation, resulting in a disorganized mosaic of woven and lamellar bone at affected skeletal sites. This disease is most often asymptomatic but can be associated with bone pain or deformity, fractures, secondary arthritis, neurological complications, deafness, contributing to substantial morbidity and reduced quality of life. Neoplastic degeneration of pagetic bone is a relatively rare event, occurring with an incidence of less than 1%, but has a grave prognosis. Specific therapy for PDB is aimed at decreasing the abnormal bone turnover and bisphosphonates are currently considered the treatment of choice. These treatments are associated with a reduction in plasma alkaline phosphatase (ALP activity and an improvement in radiological and scintigraphic appearance and with a reduction in bone pain and bone deformity, Recently, the availability of newer, more potent nitrogen-containing bisphosphonates has improved treatment outcomes, allowing a more effective and convenient management of this debilitating disorder.Keywords: Paget’s disease of bone, bisphosphonates, aminobisphosphonates, bone remodeling

  10. Record-Breaking Pain: The Largest Number and Variety of Forelimb Bone Maladies in a Theropod Dinosaur.

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    Phil Senter

    Full Text Available Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.

  11. Record-Breaking Pain: The Largest Number and Variety of Forelimb Bone Maladies in a Theropod Dinosaur.

    Science.gov (United States)

    Senter, Phil; Juengst, Sara L

    2016-01-01

    Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.

  12. Anorexia Nervosa and Bone

    OpenAIRE

    Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN) is a condition of severe low weight that is associated with low bone mass, impaired bone structure and reduced bone strength, all of which contribute to increased fracture risk., Adolescents with AN have decreased rates of bone accrual compared with normal-weight controls, raising addition concerns of suboptimal peak bone mass and future bone health in this age group. Changes in lean mass and compartmental fat depots, hormonal alterations secondary to nutritional factors...

  13. The analgesic effect of rolipram is associated with the inhibition of the activation of the spinal astrocytic JNK/CCL2 pathway in bone cancer pain

    Science.gov (United States)

    Guo, Chi-Hua; Bai, Lu; Wu, Huang-Hui; Yang, Jing; Cai, Guo-Hong; Wang, Xin; Wu, Sheng-Xi; Ma, Wei

    2016-01-01

    Bone cancer pain (BCP) is one of the most difficult and intractable tasks for pain management, which is associated with spinal 'neuron-astrocytic' activation. The activation of the c-Jun N-terminal kinase (JNK)/chemokine (C-C motif) ligand (CCL2) signaling pathway has been reported to be critical for neuropathic pain. Rolipram (ROL), a selective phosphodiesterase 4 inhibitor, possesses potent anti-inflammatory and anti-nociceptive activities. The present study aimed to investigate whether the intrathecal administration of ROL has an analgesic effect on BCP in rats, and to assess whether the inhibition of spinal JNK/CCL2 pathway and astrocytic activation are involved in the analgesic effects of ROL. The analgesic effects of ROL were evaluated using the Von Frey and Hargreaves tests. Immunofluorescence staining was used to determine the number of c-Fos immunoreactive neurons, and the expression of spinal astrocytes and microglial activation on day 14 after tumor cell inoculation. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of pro-inflammatory cytokines [interleukin (IL)-1β, IL-6 and tumor necrosis factor (TNF)-α] and chemokines (CCL2), and western blot analysis was then used to examine the spinal phosphodiesterase 4 (PDE4), ionized calcium binding adapter molecule-1 (IBA-1) and JNK levels on day 14 after tumor cell inoculation. The results revealed that ROL exerted a short-term analgesic effect in a dose-dependent manner, and consecutive daily injections of ROL exerted continuous analgesic effects. In addition, spinal 'neuron-astrocytic' activation was suppressed and was associated with the downregulation of spinal IL-1β, IL-6 and TNF-α expression, and the inhibition of PDE4B and JNK levels in the spine was also observed. In addition, the level of CCL2 was decreased in the rats with BCP. The JNK inhibitor, SP600125, decreased CCL2 expression and attenuated pain behavior. Following co-treatment with ROL and SP600125, no significant

  14. 宣痹合剂治疗腰椎退行性骨关节病疼痛的临床研究%Clinical Study on Xuanbi Mixture in the Treatment of Lumbar Degenerative Bone Joint Disease Pain

    Institute of Scientific and Technical Information of China (English)

    崔长锋

    2016-01-01

    Objective To investigate the effect Xuanbi mixture in the treatment of lumbar degenerative bone joint disease pain symptoms. Methods The control group received routine clinical. The research group used Xuanbi mixture on the basis of the Western medicine. The improvement of lumbar degenerative bone joint disease pain before and after treatment was recorded, and the resulting data were implemented statistical test. Results The two groups had no significant difference in pain intensity ( P >0. 05 ) . After corresponding treatment, the improvement of lumbar degenerative bone joint disease pain of the two groups was significantly improved, the research group was better than the control group, and the difference was statistically significant (P0.05);治疗后两组疼痛程度均较之前显著改善,且研究组改善效果优于对照组,对比结果具有统计学意义(P<0.05)。结论对腰椎退行性骨关节病患者给予常规治疗联合宣痹合剂可获得更为理想的临床疗效,有利于保障患者生活质量及身心健康。

  15. Collaborative multimedia project for teaching the nervous system and pain to students of the Third year of Obligatory Secondary Education

    Directory of Open Access Journals (Sweden)

    David GONZÁLEZ JARA

    2013-01-01

    Full Text Available Society is deeply immersed in a new paradigm where Information and Communication Technologies (ICT are modifying and conditioning the way which we interact with our surroundings and with our peers. All the facets of the world in which today’s citizen operates are gradually adapting to this new paradigm and yet, in many aspects, teaching remains firmly attached to the past and we teach twenty-first century students with the methodology used in the nineteenth century. The classic teaching methodology, with the teacher set up as the only and vital source of information, has been a complete failure for the teaching of certain topics whose contents are highly abstract and complex, as is the case with the topics being worked on by students of the third year of ESO (the period of compulsory secondary education in Spain on the subject of the nervous system. This research article applied an innovative collaborative methodology for learning in the classroom, backed up by ICTs; the objective is to improve the acquisition of knowledge and skills in students of the third year of secondary education, at a point where the students are facing one of the most complex topics amongst those explored in the subject of biology and geology. A multimedia CD has been prepared to this end, which, in combination with text, images, videos and interactive activities, together with the indispensable guidance of the teacher in the classroom, will allow students to work cooperatively, so as to understand and assimilate each part of the contents explored in the topic of the nervous system. Analysis of the results obtained after the application of this collaborative methodology showed a significant improvement in the academic performance of the students, showing better results than those obtained when the methodology used in the classroom was more classic in style.

  16. 地塞米松对大鼠 Walker 256乳腺癌骨转移癌痛的作用%Effect of dexamethasone on rat bone metastasis pain induced by Walker 256 mammary gland carcinoma cells

    Institute of Scientific and Technical Information of China (English)

    张凡; 李毅; 丁杰; 张海林

    2015-01-01

    Objective To establish a rat model of bone metastasis pain induced by Walker 256 mammary gland carcinoma cells and observe the effect of dexamethasone on bone cancer pain. Methods Ascitic tumour cells were made from Walker 256 mammary gland carcinoma cells injected to tibia of rats.Then,the withdrawal threshold to mechanical stimulus and withdrawal time in response to radiant thermal stimulus were tested before and after operation.Results The withdrawal threshold to mechanical stimulus and withdrawal time in response to radiant thermal stimulus were significantly reduced in the tibia bone inoculated with Walker 256 cells.The pathology results showed the evidence of tibia bone structure was destructed by tumor.It is suggested that the model of bone metastasis pain induced by Walker 256 mammary gland carcinoma cell was successfully established.Dexamethasone (5 mg/kg ) elevated withdrawal threshold to mechanical stimulus in rat model of bone metastasis pain induced by Walker 256 mammary gland carcinoma cell.Conclusion Dexamethasone could alleviate bone cancer pain.%目的:建立大鼠 Walker 256乳腺癌骨转移癌痛模型,观察地塞米松对骨转移癌疼痛痛阈的影响。方法制备 Walker 256乳腺癌细胞的大鼠腹腔积液瘤细胞,将其注射入大鼠胫骨,测量术前及术后机械刺痛阈和辐射热痛阈。结果接种 Walker 256乳腺癌大鼠术侧机械刺激痛觉和辐射热痛觉阈值显著降低,且病理学结果显示骨质受到肿瘤破坏,提示 Walker 256大鼠乳腺癌骨转移癌疼痛模型成功建立。地塞米松(5 mg/kg)能够显著提高骨转移癌疼痛模型刺痛痛阈。结论地塞米松能够缓解大鼠骨转移癌疼痛。

  17. What's a Funny Bone?

    Science.gov (United States)

    ... Help White House Lunch Recipes What's a Funny Bone? KidsHealth > For Kids > What's a Funny Bone? Print A A A Text Size Have you ... prickly kind of dull pain? That's your funny bone! It doesn't really hurt as much as ...

  18. Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO

    Directory of Open Access Journals (Sweden)

    Reslan Walid

    2009-01-01

    Full Text Available Abstract Background Chronic recurrent multifocal osteomyelitis (CRMO is an inflammatory, non-infectious osteopathy that affects predominantly patients ≤ 18 years of age. There is no uniformly effective treatment. Our objective is to describe clinical, magnetic resonance imaging (MRI, and bone resorption response to intravenous pamidronate in pediatric CRMO. Methods We report our prospectively documented experience with all CRMO patients treated with pamidronate between 2003 and 2008 at a tertiary pediatric centre. Pamidronate was administered as intravenous cycles. The dose of pamidronate varied among subjects but was given as monthly to every 3 monthly cycles depending on the distance the patient lived from the infusion center. Maximum cumulative dose was ≤ 11.5 mg/kg/year. Pamidronate treatment was continued until resolution of MRI documented bone inflammation. Visual analog scale for pain (VAS and bone resorption marker urine N-telopeptide/urine creatinine (uNTX/uCr were measured at baseline, preceding each subsequent pamidronate treatment, at final follow-up, and/or at time of MRI confirmed CRMO flare. MRI of the affected site(s was obtained at baseline, preceding every 2nd treatment, and with suspected CRMO recurrence. Results Nine patients (5 F: 4 M were treated, with a median (range age at treatment of 12.9 (4.5–16.3 years, and median (range duration of symptoms of 18 (6–36 months. VAS decreased from 10/10 to 0–3/10 by the end of first 3–day treatment for all patients. The mean (range time to complete MRI resolution of bone inflammation was 6.0 (2–12 months. The mean (confidence interval (CI baseline uNTX/uCr was 738.83 (CI 464.25, 1013.42nmol/mmol/creatinine and the mean (CI decrease from baseline to pamidronate discontinuation was 522.17 (CI 299.77, 744.56nmol/mmol/creatinine. Median (range of follow-up was 31.4 (24–54 months. Four patients had MRI confirmed CRMO recurrence, which responded to one pamidronate re

  19. Inhibition of calcitonin gene-related peptide and insulin-like growth factor: a potential new therapeutic strategy to reduce bone pain in bone metastases of breast cancer%抑制降钙基因相关肽和胰岛素样生长因子:一种减轻乳腺癌骨转移患者骨痛的新策略

    Institute of Scientific and Technical Information of China (English)

    梁燕

    2010-01-01

    @@ 2009年圣·安东尼奥会议上,Teruhisa Sakurai等作了题名为"Inhibition of calcitonin gene-related peptide and insulin-like growth factor:a potential new therapeutic strategy to reduce bone pain in bone metastases of breastcancer"的报告.

  20. A case of Primary Bone Anaplastic Large Cell Lymphoma

    Science.gov (United States)

    Kim, Kyung Hyun; Jung, Yun Hwa; Han, Chi Wha; Woo, In Sook; Son, Jong ho

    2016-01-01

    Patient: Female, 52 Final Diagnosis: Primary bone anaplastic large cell lymphoma Symptoms: Bone pain Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: Anaplastic large cell lymphoma (ALCL) is a relatively rare subtype of non-Hodgkin’s lymphoma (NHL). Like other types of NHL, ALCL primarily involves the nodal area, and sometimes it can involve several extra-nodal sites such as skin, soft tissue, and lungs. However, extensive bone involvement in cases of ALCL is very rare whether it is primary or secondary. Without nodular involvement, ALCL can be misdiagnosed as bone tumor or metastatic carcinoma such as lung, breast, or prostate cancer, which frequently spread to bone. Case Report: A 52-year-old woman with generalized pain and 2 months of fever of unknown origin presented to our institution. After extensive evaluation, only multiple osteolytic bone lesions with periosteal soft tissue reaction were identified. Repeated core needle biopsy revealed only inflammatory cells with histiocytic reactions. After pathologic and chromosomal analysis of sufficient tissue, which was acquired from incisional biopsy, primary bone ALCL was confirmed. Conclusions: Clinicians should keep in mind that ALCL can present with extensive bone involvement without nodal involvement. PMID:27729639

  1. The Evaluation of Efficacy of Calcitriol on Bone Mineral Density, Pain and Quality of Life in Postmenopausal Osteoporotic Patients With or Without Depression

    Directory of Open Access Journals (Sweden)

    Halil Koyuncu

    2003-12-01

    Full Text Available The aim of this study was to determine whether depression was affect on bone loss in postmenopausal osteoporotic (PMO women and response to calcitriol treatment in this patients. Seventy two females (mean age 65 ± 6.9 were included in this study. Out of these patients, 27 (37.5% had depression, 45 (62.5% were normal. All cases were evaluated by DXA, Hamilton depression scale, Short Form-36 (SF-36 scale and visual analog scale. In the patients with depression, L1-L4 t-score (-3.29 ± 1.07, femur total t-score (-2.60 ± 1.00 and z-score (-0.97 ± 0.82 were significantly lower than PMO patients without depression (respectively; -2.71 ± 0.83, -1.86 ± 1.16 and –0.50 ± 0.91. Improvement of t- and z- scores in both groups were statistically significant after calcitriol treatment. Improvement of L1-L4 t- and z-scores and femur neck t-score were higher in patients with depression. SF-36 scores (75.9 ± 19.8 were lower in patients with depression than patients without depression (86.5 ± 14.4 (p=0.041. Negative correlations between Hamilton score and L1-L4 z-score (R=-0.432, p=0.024, femur neck t-score (R=-0.528, p=0.005 were found before treatment. Improvement of pain in both groups were similar. In conclusion, postmenopausal bone loss was higher and the response to calcitriol treatment was better in patients with depression.

  2. Cost-appropriateness of whole body vs limited bone imaging for suspected focal sports injuries

    International Nuclear Information System (INIS)

    Bone imaging has been recognized as a useful diagnostic tool in detecting the presence of focal musculoskeletal injury when radiographs are normal. A retrospective review of bone images in a small number of amateur athletes indicates that secondary injuries were commonly detected at sites different from the site of musculoskeletal pain being evaluated for injury. While a larger study will be necessary to confirm the data, this review suggests that it is medically justified and cost-appropriate to perform imaging of the entire skeleton as opposed to imaging limited to the anatomic site of pain and suspected injury

  3. Understanding and optimizing bone health in breast cancer.

    Science.gov (United States)

    Guise, Theresa A; Brufsky, Adam; Coleman, Robert E

    2010-12-01

    Bone is the preferred site of metastasis for breast cancer, and presence of skeletal lesions is associated with significant morbidity and poor prognosis. Skeletal-related effects such as pain, pathologic fractures, spinal compression, and hypercalcemia are frequent consequences of skeletal lesions of breast cancer that have debilitating effects on the patients' quality of life. In addition to direct cancer effects on the skeleton, therapies commonly used to treat patients with breast cancer such as chemotherapy and aromatase inhibitors (AI) result in cancer therapy-induced bone loss (CTIBL) which is associated with increased risk of skeletal complications such as fractures. Bisphosphonates are a class of antiresorptive drugs that are now firmly established as the cornerstone of the management of skeletal-related events due to breast cancer. Other novel bone-targeting agents such as the anti-receptor activator of NF-κB ligand (RANKL) monoclonal antibody denosumab are also showing promising activity in the treatment of bone metastasis secondary to breast cancer. Moreover, recent provocative evidence suggests that bisphosphonates might also exhibit antitumor activity via direct and indirect mechanisms. The goal of this review is to summarize the pathophysiology of osteolytic bone lesions secondary to breast cancer, provide clinical evidence of currently available bone-targeted drugs in the treatment of bone metastasis and CTIBL, and explore the antitumor activity of current bone-targeted agents in patients with breast cancer.

  4. 1,25-Dihydroxyvitamin D3 prevents bone loss of the secondary spongiosa in arthritic rats by an increase of bone formation and mineralization and inhibition of bone resorption

    OpenAIRE

    Oelzner, Peter; Petrow, Peter K; Wolf, Gunter; Bräuer, Rolf

    2014-01-01

    Background Active vitamin D metabolites have been shown to have protective effects in experimental arthritis especially when used as preventive treatment. However, because the direct effects of 1,25-dihydroxyvitamin D3 (1,25(OH) 2D3) on bone formation and resorption are very complex, the net effect of 1,25(OH)2D3 on histomorphometric parameters of bone turnover and mineralisation should be investigated. Therefore, we examined the influence of 1,25(OH)2D3 therapy on arthritis-induced alteratio...

  5. Resection and Resolution of Bone Marrow Lesions Associated with an Improvement of Pain after Total Knee Replacement: A Novel Case Study Using a 3-Tesla Metal Artefact Reduction MRI Sequence.

    Science.gov (United States)

    Kurien, Thomas; Kerslake, Robert; Haywood, Brett; Pearson, Richard G; Scammell, Brigitte E

    2016-01-01

    We present our case report using a novel metal artefact reduction magnetic resonance imaging (MRI) sequence to observe resolution of subchondral bone marrow lesions (BMLs), which are strongly associated with pain, in a patient after total knee replacement surgery. Large BMLs were seen preoperatively on the 3-Tesla MRI scans in a patient with severe end stage OA awaiting total knee replacement surgery. Twelve months after surgery, using a novel metal artefact reduction MRI sequence, we were able to visualize the bone-prosthesis interface and found complete resection and resolution of these BMLs. This is the first reported study in the UK to use this metal artefact reduction MRI sequence at 3-Tesla showing that resection and resolution of BMLs in this patient were associated with an improvement of pain and function after total knee replacement surgery. In this case it was associated with a clinically significant improvement of pain and function after surgery. Failure to eradicate these lesions may be a cause of persistent postoperative pain that is seen in up to 20% of patients following TKR surgery.

  6. Celecoxib enhances radiation response of secondary bone tumors of a human non-small cell lung cancer via antiangiogenesis in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Klenke, Frank Michael [Bern Univ. (Switzerland). Dept. of Orthopedic Surgery; Abdollahi, Amir [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Dept. of Radiation Oncology; Tufts Univ. School of Medicine, Boston, MA (United States). Center of Cancer Systems Biology; Bischof, Marc; Huber, Peter E. [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Dept. of Radiation Oncology; Gebhard, Martha-Maria [Heidelberg Univ. (Germany). Dept. of Experimental Surgery; Ewerbeck, Volker [Heidelberg Univ. (Germany). Dept. of Orthopedic Surgery; Sckell, Axel [Charite Univ. Medical Center, Berlin (Germany). Dept. of Orthopedic, Trauma and Reconstructive Surgery

    2011-01-15

    Purpose: Cyclooxygenase-2 (COX-2) inhibitors mediate a systemic antitumor activity via antiangiogenesis and seem to enhance the response of primary tumors to radiation. Radiosensitizing effects of COX-2 inhibition have not been reported for bone metastases. Therefore, the aim of this study was the investigation of the radiosensitizing effects of the selective COX-2 inhibitor celecoxib in secondary bone tumors of a non-small cell lung carcinoma in vivo. Materials and Methods: Human A549 lung carcinomas were implanted into a cranial window preparation in male SCID mice (n = 24). Animals were treated with either celecoxib or radiation (7 Gy single photon dose) alone or a combination of celecoxib and radiation, respectively. Untreated animals served as controls. The impact of radiation and COX-2 inhibition on angiogenesis, microcirculation, and tumor growth was analyzed over 28 days by means of intravital microscopy and histological methods. Results: Monotherapies with radiation as well as celecoxib had significant antitumor effects compared to untreated controls. Both therapies reduced tumor growth and vascularization to a similar extent. The simultaneous administration of celecoxib and radiation further enhanced the antitumor and antiangiogenic effects of single-beam radiation. With the combined treatment approach, tumor vascularization and tumor size were decreased by 57% and 51%, respectively, as compared to monotherapy with radiation. Conclusion: The combined application of radiation therapy and COX-2 inhibition showed synergistic effects concerning the inhibition of tumor growth and tumor angiogenesis. Therefore, the combination of radiation with COX-2 inhibitor therapy represents a promising approach to improve the therapeutic efficacy of radiotherapy of bone metastases. (orig.)

  7. Fusion of bone marrow-derived cells with cancer cells:metastasis as a secondary disease in cancer

    Institute of Scientific and Technical Information of China (English)

    John M. Pawelek

    2014-01-01

    This perspective article highlights the leukocyte-cancer cellhybrid theory as a mechanism for cancer metastasis. Beginning from the first proposal of the theory more than a century ago and continuing today with the first proof for this theory in a human cancer, the hybrid theory offers a unifying explanation for metastasis. In this scenario, leukocyte fusion with a cancer cellis a secondary disease superimposed upon the early tumor, giving birth to a new, malignant cellwith a leukocyte-cancer cellhybrid epigenome.

  8. Evaluation of Bone Marrow in 143 Lymphomas: The Relative Frequency and Pattern of Involvement, Secondary Myelopathies, Pitfalls and Diagnostic Validity

    International Nuclear Information System (INIS)

    The aim of the present study is to assess the frequency of bone marrow (BM) involvement by both bone marrow aspirate and biopsy (BMA and BMB, respectively) procedures in established cases of lymphomas at initial presentation, and to study the relative frequency of marrow disease in relation to lymphoma types, patterns of infiltration and the 2ry associated changes, as well as the diagnostic challenges. Moreover, the diagnostic validity of BMA is tested taking the results of the BMB as the true test results, in order to determine the role of each procedure in the diagnostic approach of marrow infiltration. Patients and Method: This is a retrospective study carried out on 143 non consecutive Egyptian patients with lymphomas obtained from a private series during the years 2005 to 2008. Criteria of inclusion included the availability of full medical records and material (medical and pathological), patient consent, nodal disease with no therapy prior to BM sampling, except in 7 patients who had another 2nd BMB following therapy. BMA and BMB were performed as part of the routine workup for diagnosis and staging of lymphoma. The patients had a male to female sex ratio of 2.6:1 and a wide age range from 4 to 74 years. Results: In the present series, 64 cases out of the 143 lymphoma patients studied (44.8%) had a BM disease. Involvement was mostly bilateral (80%). Patients older than 40 years showed higher incidence of bone marrow involvement. There was complete concordance (100%) between both diagnostic procedures in the detection of 76 marrow disease-free lymphoma patients. BMA showed no false positive results and a low rate of deference that makes of it an ideal screening test. Three deferred smears of CLL for BMB diagnosis were all positive for involvement. However, in a total number of 64 BMB positive patients, aspirates could only identify lymphoma involvement in 42 lymphoma patients and missed 22 patients with a BM disease, with an overall sensitivity rate of 65

  9. Interesting bone scans - unusual findings

    Energy Technology Data Exchange (ETDEWEB)

    Dobson, M.; Wadhwa, S.S.; Mansberg, R.; Fernandes, V.B. [Wollongong Hospital, Wollongong, NSW (Australia)

    1997-12-01

    A 59-year-old female with carcinoma of the colon and known liver metastatic disease was referred for bone scan to evaluate for bone metastases. Although no bone metastases were found, there was abnormal uptake noted in the liver corresponding to a metastatic calcified lesion. The only other findings were of degenerative disease in the cervical spine, right shoulder and small joints of the hands. A 69-year-old male with carcinoma of the prostate and right side low back pain was referred for bone scan. No focal abnormalities to suggest metastatic disease were identified; findings within the cervical spine, lumber spine and knees were presumed secondary to degenerative disease. Intermittent pain persisted and the patient was referred for a repeat bone scan six months later. Previous scan findings of degenerative disease and no metastatic disease were confirmed; however, closer inspection revealed an enlarged right kidney with significant retention of tracer in the pelvicalyceal system suggesting possible obstruction. A Retrograde pyelogram was performed, and no obvious obstruction demonstrated. As bone scan findings were very suggestive of obstruction, a DTPA scan with lasix was performed showing a dilated right collecting system with no functional obstruction. Given the degree of dilation, it is possible that the patient experiences intermittent PUJ obstruction causing his symptoms. A 33-year-old male with insulin dependent diabetes mellitus and viral arthritis was referred for a bone scan. A three phase revealed increased uptake in the region of the knee and leR proximal tibia. Delayed whole body images revealed multiple focal areas of osteoblastic activity in the leR tibia. Abnormal uptake was also seen in the upper third of the leR femur. The remainder of the skeletal survey was normal. X-ray correlation of the leR tibia and femoral findings was undertaken. Combinating unilateral changes on bone scan and X-ray although very suggestive of sclerotic polyostotic

  10. Expression of CDKN1C in the bone marrow of patients with myelodysplastic syndrome and secondary acute myeloid leukemia is associated with poor survival after conventional chemotherapy.

    Science.gov (United States)

    Radujkovic, Aleksandar; Dietrich, Sascha; Andrulis, Mindaugas; Benner, Axel; Longerich, Thomas; Pellagatti, Andrea; Nanda, Kriti; Giese, Thomas; Germing, Ulrich; Baldus, Stefan; Boultwood, Jacqueline; Ho, Anthony D; Dreger, Peter; Luft, Thomas

    2016-09-15

    We tested the hypothesis that proliferative activity of hematopoietic stem cells has impact on survival in newly diagnosed patients with myelodysplastic syndrome (MDS) and secondary acute myeloid leukemia (AML). RNA expression profiles of CD34(+) cells were analyzed in 125 MDS patients and compared to healthy controls. Prognostic impact on overall survival (OS) of mRNA proliferation signatures established for solid tumor cells was analyzed retrospectively. For validation on the protein level, immunofluorescence and immunohistochemistry analyses in bone marrow (BM) biopsies were performed, and an independent cohort of 223 MDS and secondary AML patients was investigated. Lower proliferative activity correlated with the expression of cyclin-dependent kinase inhibitor 1C (CDKN1C) and with shorter OS (p < 0.001). In multivariable analysis, higher CDKN1C expression was associated with worse OS (p = 0.02). On the BM level, a total of 84 (38%) patients showed CDKN1C protein expression before start of treatment. Patient, disease and treatment characteristics did not differ between CDKN1C-positive and -negative patients. Positive CDKN1C BM status was associated with shorter OS in multivariable analysis (HR 1.54, p = 0.04). There was an interaction between CDKN1C BM status and subsequent treatment with negative impact on OS being most pronounced in patients receiving conventional cytotoxic chemotherapy (n = 83, 2-year OS 30% versus 58%, p = 0.002). In conclusion, low-proliferative phenotype and CDKN1C expression were associated with shorter OS. CDKN1C protein expression in the BM of newly diagnosed, treatment-naïve MDS and secondary AML patients was identified as a prognostic factor for poor survival in patients treated with antiproliferative chemotherapy. PMID:27170453

  11. BROWN TUMOR OF THE FACIAL BONES

    Directory of Open Access Journals (Sweden)

    Violeta Trandafir

    2010-11-01

    Full Text Available Brown tumor arises as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. The lesion localizes in areas of intense bone resorbtion, and the bone defect becomes filled with fibroblastic tissue that can deform the bone and simulate a neoplastic process. Brown tumors can affect the mandible, maxilla, clavicle, ribs and pelvic bones. Most patients with hyperparathyroidism are asymptomatic. Skeletal changes may represent the first manifestations of the disease. Radiologically, brown tumor in the jaws presents as a well-defined radiolucent osteolytic lesion, making it hard to differentiate it from other maxillary expansive lesions that can present with a similar imaging. Brown tumors exhibit no pathognomonic histologic changes. Differentiating between a brown tumor and other giant-cell tumors may be very difficult, even with histology. A final diagnosis can be defined only by evaluating the radiological findings with histopathological, laboratory and clinical data. At present, brown tumor is considered as a reparative cellular process rather than a real neoplasia. This phenomenon is considered as pathognomonic of hyperparathyroidism secondary to renal failure, especially in patients on long-term hemodialysis. The initial treatment of brown tumor involves control of hyperparathyroidism, regardless of whether it is primary or secondary. The clinical management of brown tumor aims primarily to reduce the elevated parathyroid hormone levels by pharmacological treatment. Surgical treatment is reserved to nonresponders or to patients with painful symptomatology or alteration of normal function. Brown tumor can recur if hyperparathyroidism persists or recurs.

  12. Incremental value of metabolic radiotherapy of bone metastases with 153Sm-EDTMP in prostate cancer. About 67 cases

    International Nuclear Information System (INIS)

    Full text of publication follows. Introduction: painful bone metastases are common in advanced prostate cancer. Samarium-153-ethylenediaminetetra-methylenephosphonic acid (153Sm-EDTMP; Quadramet) is a beta-particles emitter that concentrates in the areas of enhanced osteoblastic activity and used for palliate pain from bone metastases. Our purpose is to evaluate the incremental value of the 153Sm-EDTMP, in patients affected of cancer of the prostate with painful bony metastasis. Methods: 67 patients with metastatic prostate cancer received a single bolus infusion of 153Sm (37 MBq/kg). All patients had painful bone metastases to more than one anatomical region. Bone specific pain, analgesic score, and blood count were evaluated before and after treatment with a receding of 38 months. Results: we observed a positive answer in 85% of the cases; this answer was complete in 35% of the cases. The results gotten after multiple administrations show that the cures could be repeated with results comparable to those of the first cure. The therapeutic efficiency is at least equivalent to those of the other therapeutic means, with nearly non-existent secondary effects. The only toxicity is of hematological order; it is the most often moderate and reversible with a complete recuperation at the end of 8 weeks. Besides, the effect on the pain came with an improvement of the quality of life of the patients treaties. Conclusion: due to its half-life of 46 hours and its beta emissions, a high dose rate of 153Sm can be delivered to regions adjacent to enhanced osteoblastic activity over a short period of time with little residual long term activity being left in the bone marrow. Its administration to patients with prostate cancer suffering from painful bone metastases that enhance on bone scans, offered clinical relevant pain relief with tolerable hematological toxicity and then enjoy a better quality of life. (authors)

  13. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy

    DEFF Research Database (Denmark)

    Albert, H. B.; Sørensen, Joan S.; Berit Schiott, Christensen;

    2013-01-01

    outcome leg pain, number of hours with pain last 4 weeks, global perceived health, EQ-5D thermometer, days with sick leave, bothersomeness, constant pain, magnetic resonance image (MRI). RESULTS: 144 of the 162 original patients were evaluated at 1-year follow-up. The two groups were similar at baseline...

  14. Bayesian meta-analysis of test accuracy in the absence of a perfect reference test applied to bone scintigraphy for the diagnosis of complex regional pain syndrome.

    Science.gov (United States)

    Held, Ulrike; Brunner, Florian; Steurer, Johann; Wertli, Maria M

    2015-11-01

    There is conflicting evidence about the accuracy of bone scintigraphy (BS) for the diagnosis of complex regional pain syndrome 1 (CRPS 1). In a meta-analysis of diagnostic studies, the evaluation of test accuracy is impeded by the use of different imperfect reference tests. The aim of our study is to summarize sensitivity and specificity of BS for CRPS 1 and to identify factors to explain heterogeneity. We use a hierarchical Bayesian approach to model test accuracy and threshold, and we present different models accounting for the imperfect nature of the reference tests, and assuming conditional dependence between BS and the reference test results. Further, we include disease duration as explanatory variable in the model. The models are compared using summary ROC curves and the deviance information criterion (DIC). Our results show that those models which account for different imperfect reference tests with conditional dependence and inclusion of the covariate are the ones with the smallest DIC. The sensitivity of BS was 0.87 (95% credible interval 0.73-0.97) and the overall specificity was 0.87 (0.73-0.95) in the model with the smallest DIC, in which missing values of the covariate are imputed within the Bayesian framework. The estimated effect of duration of symptoms on the threshold parameter was 0.17 (-0.25 to 0.57). We demonstrate that the Bayesian models presented in this paper are useful to address typical problems occurring in meta-analysis of diagnostic studies, including conditional dependence between index test and reference test, as well as missing values in the study-specific covariates. PMID:26479506

  15. In a secondary care setting, differences between neck pain subgroups classified using the Quebec task force classification system were typically small

    DEFF Research Database (Denmark)

    Rasmussen, Hanne; Kent, Peter; Kjaer, Per;

    2015-01-01

    BACKGROUND: The component of the Quebec Task Force Classification System that subgroups patients based on the extent of their radiating pain and neurological signs has been demonstrated to have prognostic implications for patients with low back pain but has not been tested on patients with neck...... and patients with NP + NRI had experienced the largest improvements in pain intensity. Similar results were obtained for activity limitation. CONCLUSIONS: This study found baseline and outcome differences between neck pain subgroups classified using the Quebec Task Force Classification System. However...

  16. Proximal Tibial Bone Graft

    Science.gov (United States)

    ... Complications Potential problems after a PTBG include infection, fracture of the proximal tibia and pain related to the procedure. Frequently Asked Questions If proximal tibial bone graft is taken from my knee, will this prevent me from being able to ...

  17. A randomised sham controlled trial of vertebroplasty for painful acute osteoporotic vertebral fractures (VERTOS IV

    Directory of Open Access Journals (Sweden)

    Juttmann Job R

    2011-04-01

    Full Text Available Abstract Background The standard care in patients with a painful osteoporotic vertebral compression fracture (VCF is conservative therapy. Percutaneous vertebroplasty (PV, a minimally invasive technique, is a new treatment option. Recent randomized controlled trials (RCT provide conflicting results: two sham-controlled studies showed no benefit of PV while an unmasked but controlled RCT (VERTOS II found effective pain relief at acceptable costs. The objective of this study is to compare pain relief after PV with a sham intervention in selected patients with an acute osteoporotic VCF using the same strict inclusion criteria as in VERTOS II. Secondary outcome measures are back pain related disability and quality of life. Methods The VERTOS IV study is a prospective, multicenter RCT with pain relief as primary endpoint. Patients with a painful osteoporotic VCF with bone edema on MR imaging, local back pain for 6 weeks or less, osteopenia and aged 50 years or older, after obtaining informed consent, are included and randomized for PV or a sham intervention. In total 180 patients will be enrolled. Follow-up is at regular intervals during a 1-year period with a standard Visual Analogue Scale (VAS score for pain and pain medication. Necessary additional therapies and complications are recorded. Discussion The VERTOS IV study is a methodologically sound RCT designed to assess pain relief after PV compared to a sham intervention in patients with an acute osteoporotic VCF selected on strict inclusion criteria. Trial registration This study is registered at ClinicalTrials.gov., NCT01200277.

  18. Effect and nursing in the treatment of bone pain related to metastasis with Strontium-89%89锶治疗恶性肿瘤骨转移性疼痛的效果和护理方法

    Institute of Scientific and Technical Information of China (English)

    冀小平; 许新华; 代文莉; 覃斌芳; 鲁明骞

    2013-01-01

    Objective To explore the effect and nursing in treatment of bone pain related to metastasis with Strontium-89. Methods The clinical data of 42 patients of malignant cancer with skeletal complications were retrospectively analyzed. Bone metastases were found by radionuclide bone imaging and proved by X-ray, CT or MRI. Strontium (Sr-89)chloride was injected and the effect and adverse effect was observed. Nursing methods were conducted by clinical nurse. Results The severity of bone pain before treatment and 12 weeks after treatment were compared, 76.2% of the 42 patients were observed pain parliament, especially those patients with mammary cancer with efficient rate of 91.7%. The general adverse reactions and hematologic toxicity after treatment were observed. The side effects were mild, 33 cases occured 1 grade reversible myelosuppression with no treatment and 1 case got 2 grade myelosuppression who was cured by treatment. Several special nursing methods were conducted by clinical nurses. Conclusion Strontium-89 are effective and safe for the management of malignant cancer related bone pain, and special nursing should be paid great attention.%目的 探讨89锶治疗骨转移癌患者疼痛的效果与护理方法.方法 42例均经病理学检查确诊的恶性肿瘤患者,经ECT及X线平片、CT、MR证实骨转移,给予氯化锶注射治疗,观察疼痛缓解效果及不良反应,并做好护理.结果 42例患者经评价疗效,患者疼痛缓解率为76.2%,其中乳腺癌效果最为明显,有效率为91.7%,不良反应主要为骨髓抑制,33例患者出现白细胞、血小板及血色素下降,占78.6%,其中1例患者出现白细胞Ⅱ度下降,其余患者均为Ⅰ度下降,无需特殊处理.结论 89锶可减轻恶性肿瘤骨转移,改善生活质量,方法简便、不良反应较少,值得临床推广应用,要注意治疗前、治疗中及治疗后的护理.

  19. The epidemiological investigation and analysis of bone-derived low back pain in armored infantry%装甲步兵骨关节源性下腰痛调查与分析

    Institute of Scientific and Technical Information of China (English)

    王宪卫; 黄昌林

    2015-01-01

    目的 抽样调查某部装甲步兵职业性骨关节源性下腰痛的发生原因及分布情况,探讨其流行特征及预防措施.方法 以问卷结合体格检查的方式,依照《军事训练伤诊断标准及防治原则》(WSB38-2001)中所规定军事训练所致下腰痛的诊断标准,对某部参训装甲步兵进行骨关节源性下腰痛流行病学调查,采集数据资料,并进行相关分析. 结果 被筛选调查的402名参训装甲步兵罹患下腰痛113例,发生率28.11%. 其中骨关节源性下腰痛24例,发生率为5.97%,占下腰痛人员比例21.24%.≥2年军龄骨关节源型下腰痛发病率为10.93%,明显高于≤1年军龄组的5.19%和1~2年军龄组的4.76%(P<0.05).在骨关节源性下腰痛24名战士中,乘员17名,所占比例高达70.83%,载员7名,占29.17%.装甲乘员比例明显高于装甲载员(P<0.05).24例装甲步兵组骨关节源性下腰痛伤员中,Ⅰ度疼痛患者发生率较高(3.98%),明显高于Ⅱ度疼痛伤员(1.49%)(P<0.05),Ⅲ度以上的患者发生率极低,仅为0.50%,三组发病率比较有统计学意义(P<0.05).此外,腰背肌相对肌力素质锻炼的方法进行干预治疗,结果没有新增骨关节源性下腰痛伤员,且有7名骨关节源性下腰痛伤员症状减轻. 结论 通过调查发现,装甲步兵下腰痛发病率较高,骨关节源性下腰痛所占比例不可忽视,主要集中在≥2年军龄,其中装甲乘员明显高于装甲载员,腰背肌相对肌力素质锻炼对于骨关节源性下腰痛的预防和治疗均具有明显的效果. 因此,在平常的军事训练及作业中,应该加强腰背肌锻炼及健康宣教工作,减少骨关节源性下腰痛的发生.%Objective To investigate the cause and the distribution of bone-derived low back pain of armored infantry and to discuss the epidemiological features and preventions. Methods Combined with the questionnaire and physical examination,authors conducted the epidemiological investigation and the

  20. P2X7受体敲除对小鼠骨癌痛的影响%Effect of P2X7 receptor knock-out on bone cancer pain in mice

    Institute of Scientific and Technical Information of China (English)

    赵欣; 刘慧珠; 张玉秋

    2016-01-01

    associated with release of proinflammatory cytokines from glial cells,causing increased neuronal excitability and exaggerated nociception.Mounting evidence implies a critical role of P2X7R in inflammatory and neuropathic pain.However,whether P2X7R is involved in cancer pain remains controversial.Here we established a bone cancer pain model by injecting the Lewis lung carcinoma cells into the femur bone marrow cavity of C57BL/6J wild-type mice (C57 WT mice) and P2X7R knockout mice (P2rx7-/-mice) to explore the role of P2X7R in bone cancer pain.Following intrafemur carcinoma inoculation,robust mechanical allodynia and thermal hyperalgesia in C57 WT mice were developed on day 7 and 14,respectively,and persisted for at least 28 days in the ipsilateral hindpaw of the affected limb.CatWalk gait analysis showed significant decreases in the print area and stand phase,and a significant increase in swing phase in the ipsilateral hindpaw on day 21 and 28 after carcinoma cells inoculation.Histopathological sections (hematoxylin and eosin stain) showed that the bone marrow of the affected femur was largely replaced by invading tumor cells,and the femur displayed medullary bone loss and bone destruction on day 28 after inoculation.Unexpectedly,no significant changes in bone cancer-induced hypersensitivity of pain behaviors were found in P2rx7/-mice,and the changes of pain-related values in CatWalk gait analysis even occurred earlier in P2rx7-/-mice,as compared with C57 WT mice.Together with our previous study in rats that blockade of P2X7R significantly alleviated bone cancer pain,it is implied that P2X7R may play different roles in bone cancer pain in different species (e.g.rat vs mouse).These results implicated a huge difference between the pathophysiology discovered in the experimental animal models and that of human disease.

  1. Victimization and pain

    Directory of Open Access Journals (Sweden)

    Małgorzata K. Szerla

    2013-12-01

    Full Text Available Pain has several causes. It can be caused not only by operative trauma or cancer. Some patients suffer from pain as a result of being victims of violence. The aim of the study was to introduce diagnosis and treatment of pain problems in patients who are victims of violence, from a physician’s and a psychologist’s common perspective. Physical pain-related primary effects experienced by the victims of domestic violence go far beyond the results which are noticeable directly and confirmed visually in a forensic examination. In the present paper we introduce an ‘invisible’ group of secondary effects of violence. They appear in time, often after several years, in the form of a variety of psychosomatic disorders. The body is devastated insidiously and the secondary effects are visible as vegetative symptoms, a variety of psychosomatic disorders and pain, difficult to diagnose and treat.

  2. High-dose OxyContin to treat pain associated with bone metastasis in patients with small-cell lung cancer: a case study report.

    Science.gov (United States)

    Zhou, Tao; Zhang, Xia; Dong, Yan; Zhuang, Feifei; Jiang, Fengquan; Yu, Jinming; Zhang, Bin

    2016-01-01

    Pain management is an important topic that has received extensive attention from clinical practitioners. Nearly all patients with malignant tumors suffer pain at the advanced stage of their disease. Oxycodone is a first-line choice for treating moderate-to-severe cancer-related pain, and OxyContin, a controlled-release oxycodone hydrochloride tablet, is internationally recognized as a safe and effective opioid analgesic. OxyContin has the characteristics of both immediate release and sustained release, with a time to onset and peak similar to those of immediate-release morphine. It acts on both μ and κ receptors and has been shown to be effective in treating different types of pain, especially neuropathic pain, theoretically without a dose cap. However, the dose is limited in clinical applications due to various factors that are likely to affect its analgesic effect and reduce patient quality of life. Cooperation with a patient's family members is required during the treatment of cancer pain. Chronic cancer pain has a long disease course, which could easily cause complex psychological symptoms due to their important role in the pain experience. Pain is controllable, and patients have a right to not experience pain. An optimal living state can be achieved through collaboration between physicians and patients. Rational personalized treatment of cancer pain can improve patient quality of life, relieve pain, and help prolong patient survival. This article reports the treatment procedure and adverse reactions in a patient who was treated with high-dose OxyContin, with the aim of providing a reference for other clinical practitioners. PMID:26855563

  3. Effects of repeated injection of flurbiprofen axetil on bone cancer pain%重复注射氟比洛芬酯对骨癌痛的影响

    Institute of Scientific and Technical Information of China (English)

    吴刘萍; 孙晓凤; 胡正权; 周瑜; 倪坤; 崔昕龙; 马正良; 顾小萍

    2012-01-01

    the effects of repeated injection of flurbiprofen axetil on pain behaviors and side effects in a rat model of bone cancer pain.Methods 24 female SD rats were randomly divided into 3 groups(n=8) as follows.Sham group (S group): intra-tibial injection of 10 μl Hank's solution.Tumor group (T group): intra-tibial injection of 10 μl 4×105 Walker 256 mammary gland carcinoma cells.Flurbiprofen axetil group (Fa group): intraperitoneal injection of flurbiprofen axetil on day 15 to 21 after tumor model.Paw withdrawal mechanical threshold (PWMT) was tested on day 1 before surgery and days 1,3,5,7,10,14,15,17,19,21,24 after surgery.The blood,liver,kidney and ipsilateral tibial bone of all rats were obtained on day 24 to examine the pathological changes.Results ① Compared to S group,the PWMT in T group decreased significantly at day 5 after tumor surgery [(10.92±1.04) g vs (9.01±1.49) g,P<0.05],and peaked at day 14 after surgery.Compared to T group,the PWMT in Fa group increased obviously at day 17[(6.64±1.70) g vs (4.06±1.69) g,P<0.05].At day 21,the PWMT in Fa group was lower than that in S group [(8.04±0.81) g vs (10.31±1.35) g,P<0.05].② The results of bleeding and clotting tests [prothrombin time(PT),activated partial prothrombin time (APTT),thrombin time (TT),fibrinogen (FIB),platelet (PLT)],hepatic and renal functional tests [glutamic-pyruvic transaminase (ALT),aspartate amino-transaminase (AST),total protein (TP),urea (UREA),creatinine (CREA)]had no significant difference among S group,T group and Fa group.③ HE staining revealed that there were no significant pathological changes in liver and renal tissue after repeated intraperitoneal injection of flurbiprofen axetil.Live tumor cells were found in tibia marrow cavities in both T and Fa groups.Conclusions Repeated intraperitoneal injection of flurbiprofen axetil could significantly attenuate bone cancer pain in rats while having no influence on hepatic and renal functions as well as hemostatic function.

  4. Half body irradiation of patients with multiple bone metastases: A phase II trial

    DEFF Research Database (Denmark)

    Berg, Randi; Yilmaz, Mette; Høyer, Morten;

    2009-01-01

    AIM OF STUDY: The primary aim of this study was to evaluate the effect of half-body irradiation (HBI) on pain and quality of life in cancer patients with multiple bone metastases. The secondary aim was to evaluate side effects of the treatment. PATIENTS AND METHODS: A total of 44 patients received...... lower (n = 37), upper (n = 5), or sequential HBI (n = 2). The dose for lower HBI was 8 Gy in one fraction and for upper HBI 7 Gy in one fraction, with reduction of the lung dose to 6 Gy in one fraction by partial shielding. The majority of patients (n = 41) were males with prostate cancers (93...... after treatment. RESULTS: Relief of pain was observed in 76% of the patients receiving HBI with 8.8% of the patients experiencing complete pain relief with no residual pain in the treated field. For most patients, the pain relief was lasting throughout the follow-up period. About one third...

  5. The role of electron-emitting radiopharmaceuticals in the palliative treatment of metastatic bone pain and for radiosynovectomy: applications of conversion electron emitter Tin-117m

    Directory of Open Access Journals (Sweden)

    Suresh C. Srivastava

    2007-09-01

    Full Text Available A variety of radionuclides continue to be investigated and/or clinically used for different therapeutic applications in nuclear medicine. The choice of a particular radionuclide with regard to appropriate emissions, linear energy transfer (LET, and physical half-life, etc., is dictated to a large extent by the character of the disease (e.g., solid tumor or metastatic disease, and by the carrier to selectively transport the radionuclide to the desired site. An impressive body of information has appeared in the recent literature that addresses many of these considerations. This article summarizes and discusses the role of high-LET electron emitters and their advantage in the treatment of cancer or for other disorders in specific situations. Areas such as bone pain palliation, bone malignancy therapy, and radiation synovectomy are covered in greater detail. Projections are made as to the future directions and progress in these areas. A discussion of the various issues related to the selection criteria that are useful for choosing the appropriate radionuclide for a particular application is included. Use of high-LET electron emitters is discussed in greater detail, with particular emphasis on the use of conversion electron emitter tin-117m for various therapeutic applications.Uma variedade de radionuclídeos continua a ser investigada e/ou clinicamente utilizada para diferentes aplicações terapêuticas em medicina nuclear. A escolha de um radionuclídeo, considerando-se sua emissão apropriada, transferência linear de energia (LET e meia-vida física é determinada na maior parte pelo caráter da doença (p.ex., tumor sólido ou doença metastática, e pelo carreador que transporta o radionuclídeo seletivamente para o sítio desejado. Um notável conjunto de informações voltadas para essas considerações tem aparecido na literatura recente. Esse trabalho resume e discute o papel de emissores de elétrons de alta-LET e sua vantagem no

  6. Pain in burn patients.

    Science.gov (United States)

    Latarjet, J; Choinère, M

    1995-08-01

    While severe pain is a constant component of the burn injury, inadequate pain management has been shown to be detrimental to burn patients. Pain-generating mechanisms in burns include nociception, primary and secondary hyperalgesia and neuropathy. The clinical studies of burn pain characteristics reveal very clear-cut differences between continuous pain and pain due to therapeutic procedures which have to be treated separately. Some of the main features of burn pain are: (1) its long-lasting course, often exceeding healing time, (2) the repetition of highly nociceptive procedures which can lead to severe psychological disturbances if pain control is inappropriate. Pharmaco-therapy with opioids is the mainstay for analgesia in burned patients, but non-pharmacological techniques may be useful adjuncts. Routine pain evaluation is mandatory for efficient and safe analgesia. Special attention must be given to pain in burned children which remains too often underestimated and undertreated. More educational efforts from physicians and nursing staff are necessary to improve pain management in burned patients.

  7. Progress in the clinical imaging research of bone diseases on ankle and foot sesamoid bones and accessory ossicles

    OpenAIRE

    Li, Xiaozhong; Shi, Lenian; Liu, Taiyun; Wang, Lin

    2012-01-01

    Sesamoid bones and accessory ossicles are research focuses of foot and ankle surgery. Pains of the foot and ankle are related to sesamoid bones and accessory ossicles. The specific anatomical and functional relationship of sesamoid bones and accessory ossicles can cause such bone diseases as the dislocation of sesamoid bones and accessory bones, infection, inflammation and necrosis of sesamoid bones, cartilage softening, tenosynovitis of sesamoid bones and the sesamoid bone syndrome. However,...

  8. [Treatment of pain in children burns].

    Science.gov (United States)

    Latarjet, J; Pommier, C; Robert, A; Comparin, J P; Foyatier, J L

    1997-03-01

    Burn injury is considered by children as one of the most painful traumas (just after bone factures). Burn pain in children can and must be controlled as well as for adult patients, with almost identical techniques. Continuous pain from injury and intermittent pain caused by therapeutic procedures must be evaluated and treated separately. Due to very high levels of nociception, satisfactory management of procedural pain requires the use of opioid therapy. Non pharmacological methods are meaningless if pharmacological treatment is not optimal.

  9. Lewis肺癌细胞构建小鼠股骨骨癌痛行为模型%A mouse model of bone cancer pain signs constructed by Lewis lung carcinoma cells inoculation of the femur

    Institute of Scientific and Technical Information of China (English)

    黄晓玲; 孔高茵; 黄东

    2009-01-01

    目的 观察骨癌痛行为模型小鼠影像学改变和骨质损害程度.方法 将Lewis肺癌细胞接种于雄性C57BL/6小鼠股骨骨髓腔,构建骨癌痛动物行为模型.术后7 d始隔日观察小鼠自发痛反应、测定行走评分与热缩腿反射潜伏期.术后第7、15、23天,行双侧后肢X线摄片,评估肿瘤诱发的骨组织破坏程度.同时取术侧后肢行苏木精-伊红(HE)染色后观察骨质破坏情况,术后23 d另取腰段脊髓做神经胶质酸性蛋白(GFAP)免疫组化检查.结果 实验组接种后第11d左右出现明显自发痛行为,表现为自发抬足时间延长;第13天左右出现明显行走诱发患肢痛和热痛敏现象,表现为使用评分持续下降与缩腿潜伏期显著降低.术后23 d放射学结果显示,术侧股骨下段骨髓腔消失,骨皮质中断.同时HE染色可见肿瘤细胞充满骨髓腔,且穿破骨皮质向外生长,侵犯周围肌肉组织.免疫组化结果示术侧腰段脊髓星形胶质细胞增生、肥大.结论 采用Lewis肺癌细胞构建小鼠骨癌痛模型是可行的.%Objective To evaluate the behavior and bone destruction of the mouse model of bone cancer pain signs. Method A mouse model of bone cancer pain signs was developed by intra-femur inoculations of Lewis lung carcinoma cells in C57BL/6 mice. Spontane-ous lifting time, ambulatory score and paw withdrawal latencies to radiant heat stimulation were measured in alternative days throughout the experiment. The structural damage of the femur were monitored by radiogram on the 7th, 15th and 23rd day respectively, and the pathohisto-logical changes of the femur bones were observed by hematoxylin-eosin staining (HE) staining on the same days. Meanwhile, the glial fibril-lary acid protein (GFAP) immunohistochemistry changes of the spinal cord in lumbar segments on the 23rd day after inoculation were ob-served. Results Mice received intra-femur inoculation of Lewis lung carcinoma cells gradually developed

  10. BONE TUMOR ENVIRONMENT AS POTENTIAL THERAPEUTIC TARGET IN EWING SARCOMA

    Directory of Open Access Journals (Sweden)

    Françoise eREDINI

    2015-12-01

    Full Text Available Ewing sarcoma is the second most common pediatric bone tumor, with three cases per million worldwide. In clinical terms, ES is an aggressive, rapidly fatal malignancy that mainly develops in osseous sites (85%, but also in extraskeletal soft tissue. It spreads naturally to the lungs, bones and bone marrow with poor prognosis in the two latter cases. Bone lesions from primary or secondary (metastases tumors are characterized by extensive bone remodeling, more often due to osteolysis. Osteoclast activation and subsequent bone resorption is responsible for the clinical features of bone tumors including pain, vertebral collapse and spinal cord compression. Based on the vicious cycle concept of tumor cells and bone resorbing cells, drugs which target osteoclasts may be promising agents as adjuvant setting for treating bone tumors, including Ewing sarcoma. There is also increasing evidence that cellular and molecular protagonists present in the bone microenvironment play a part in establishing a favorable niche for tumor initiation and progression. The purpose of this review is to discuss the potential therapeutic value of drugs targeting the bone tumor microenvironment in Ewing Sarcoma. The first part of the review will focus on targeting the bone resorbing function of osteoclasts by means of bisphosphonates (BPs or drugs blocking the pro-resorbing cytokine Receptor Activator of NF-kappa B Ligand (RANKL. Second, the role of this peculiar hypoxic microenvironment will be discussed in the context of resistance to chemotherapy, escape from the immune system, or neo-angiogenesis. Therapeutic interventions based on these specificities could be then proposed in the context of Ewing sarcoma.

  11. Secondary alveolar bone grafting in combination with autologous iliac crest cortical plate and concellous bone for 19 adult cleft patients%自体髂骨皮质骨块与松质骨联合移植修复成人牙槽突裂19例分析

    Institute of Scientific and Technical Information of China (English)

    李增健; 卢利; 金山; 任媛媛; 刘强; 张斌; 张蕾; 吴楠; 杨鸣良; 王绪凯

    2012-01-01

    Objective To retrospectively study secondary alveolar bone grafting in combination with autologous iliac crest cortical bone and concellous bone for adult cleft patients. Methods Analveolar bone grafting procedure in combination with autologous illiac crest cortical bone and concellous bone has been applied in 19 adult cleft patients since 2008. A water-tight mucocusperiosteum pocket was formed around the alveolar cleft. The iliac concellous bone was put into the alveolar cleft with tender pressing. The carved iliac crest cortical bone was then covered on to the labial surface of alveolar cleft and pyriform aperture with titanium screws. Results Based on Bergland's criterion, the overall survival rate of bone grafting was 84.2% , clinical success rate was 73.7% , clinical failure rate was 26. 3%. Oral-nasal fistular recurred in 2 patients. Conclusion Secondary alveolar bone grafting in combination with autologous iliac crest cortical bone and concellous bone can effectively improve the grafting survival rate and keep a sufficient volume in regions of cleft and the pyriform aperture of adult cleft patients.%目的 观察自体髂骨块和松质骨联合移植修复成人牙槽突裂的效果.方法 对2008年以来在我院就诊的成人牙槽突裂患者19例采用自体髂骨块和松质骨联合移植修复.将髂松质骨填充牙槽突裂间隙内,用骨块恢复梨状孔边缘形态和鼻翼基底部高度后,采用微型钛板和单皮质钛钉固定.术后1年复查进行Bergland 分级评价.结果 植入骨成活率(Ⅰ~Ⅲ级)为84.2%,临床成功率(Ⅰ、Ⅱ级)为73.7%,临床失败率(Ⅲ、Ⅳ级)为26.3%.2例患者再次出现口鼻瘘孔.结论 自体髂骨块和松质骨联合移植修复成人牙槽突裂可以有效恢复牙槽突高度,增加患侧梨状孔周围骨量.

  12. Patellofemoral pain.

    Science.gov (United States)

    Crossley, Kay M; Callaghan, Michael J; van Linschoten, Robbart

    2016-02-01

    Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner's knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.(1 2) While it typically occurs in physically active people aged Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle. PMID:26834209

  13. Prospective analysis of a first MTP total joint replacement. Evaluation by bone mineral densitometry, pedobarography, and visual analogue score for pain

    DEFF Research Database (Denmark)

    Wetke, Eva; Zerahn, Bo; Kofoed, Hakon

    2012-01-01

    We hypothesized that a total replacement of the first metatarsophalangeal joint (MTP-1) would alter the walking pattern with medialisation of the ground reaction force (GRF) of the foot and subsequently cause an increase in bone mineral density (BMD) in the medial metatarsal bones and a decline...

  14. The periodontal pain paradox: Difficulty on pain assesment in dental patients (The periodontal pain paradox hypothesis

    Directory of Open Access Journals (Sweden)

    Haryono Utomo

    2006-12-01

    Full Text Available In daily dental practice, the majority of patients’ main complaints are related to pain. Most patients assume that all pains inside the oral cavity originated from the tooth. One particular case is thermal sensitivity; sometimes patients were being able to point the site of pain, although there is neither visible caries nor secondary caries in dental radiograph. In this case, gingival recession and dentin hypersensitivity are first to be treated to eliminate the pain. If these treatments failed, pain may misdiagnose as pulpal inflammation and lead to unnecessary root canal treatment. Study in pain during periodontal instrumentation of plaque-related periodontitis revealed that the majority of patients feel pain and discomfort during probing and scaling. It seems obvious because an inflammation, either acute or chronic is related to a lowered pain threshold. However, in contrast, in this case report, patient suffered from chronic gingivitis and thermal sensitivity experienced a relative pain-free sensation during probing and scaling. Lowered pain threshold which accompanied by a blunted pain perception upon periodontal instrumentation is proposed to be termed as the periodontal pain paradox. The objective of this study is to reveal the possibility of certain factors in periodontal inflammation which may involved in the periodontal pain paradox hypothesis. Patient with thermal hypersensitivity who was conducted probing and scaling, after the relative pain-free instrumentation, thermal hypersensitivity rapidly disappeared. Based on the successful periodontal treatment, it is concluded that chronic gingivitis may modulate periodontal pain perception which termed as periodontal pain paradox

  15. Unusual presentations and pitfalls of secondary syphilis: osteitis, pneumonia and malignancy.

    Science.gov (United States)

    Crouzy, Frederike; Alvarez, Veronica; Gex, Grégoire; Troillet, Nicolas

    2015-01-01

    Syphilis can show unexpected clinical characteristics rendering its diagnosis difficult. We report on two cases of secondary syphilis presenting with atypical histories of knee or cervical pain and cough. Both had bone involvement and one, pulmonary involvement, documented by MRI, CT scan and PCR. Both responded well to therapy with intravenous aqueous penicillin G followed by intramuscular benzathine penicillin G, but a pulmonary adenocarcinoma was diagnosed during follow-up in one case. PMID:26504092

  16. Pain palliative Radiopharmaceuticals

    International Nuclear Information System (INIS)

    A pain relieving agents based on β emitters mainly and in some cases a complex preparation are being given for bone metastasis in relation with breast,prostate and lung carcinoma with good performance in clinical practice.Several radionuclides and radiopharmaceuticals are mentioned giving strength to those newly proposed, 153Sm and 186Re.Bibliography

  17. The effects of cinacalcet treatment on bone mineral metabolism, anemia parameters, left ventricular mass index and parathyroid gland volume in hemodialysis patients with severe secondary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Dilek Torun

    2016-01-01

    Full Text Available The aim of this study was to investigate the effects of cinacalcet therapy on anemia parameters, bone mineral metabolism, left ventricular mass index (LVMI and parathyroid gland volume in hemodialysis (HD patients with secondary hyperparathyroidism. Twenty-five HD patients (M/F: 11/14, mean age: 45.2 ± 17.9 years, mean HD duration: 96.4 ± 32.7 months were included in this prospective pilot study. The indication to start calcimimetic therapy was persistent serum levels of parathyroid hormone (PTH >1000 pg/mL, refractory to intravenous (i.v. vitamin D and phosphate-binding therapy. The initial and one-year results of adjusted serum calcium (Ca +2 , phosphate (P, Ca × P product, PTH, hemoglobin (Hb and ferritin levels, transferrin saturation index (TSAT, median weekly erythropoietin (EPO dose, LVMI, and parathyroid volume by parathyroid ultrasonography were determined. There were no differences between pre- and post-treatment levels of serum Ca +2 (P = 0.853, P (P = 0.447, Ca × P product (P = 0.587, PTH (P = 0.273, ferritin (P = 0.153 and TSAT (P = 0.104. After 1 year of calcimimetic therapy, the Hb levels were significantly higher than the initial levels (P = 0.048. The weekly dose of EPO decreased with no statistical significance. The dose of cinacalcet was increased from 32.4 ± 12.0 to 60.0 ± 24.4 mg/day (P = 0.01. There were no differences between the pre- and post-treatment results regarding weekly vitamin D dose, parenteral iron dose, LVMI and parathyroid volume. The results of our study suggest that cinacalcet therapy might have an additional benefit in the control anemia in HD patients.

  18. Cancer to bone: a fatal attraction

    OpenAIRE

    Weilbaecher, Katherine N.; Guise, Theresa A.; McCauley, Laurie K

    2011-01-01

    When cancer metastasizes to bone, considerable pain and deregulated bone remodelling occurs, greatly diminishing the possibility of cure. Metastasizing tumour cells mobilize and sculpt the bone microenvironment to enhance tumour growth and to promote bone invasion. Understanding the crucial components of the bone microenvironment that influence tumour localization, along with the tumour-derived factors that modulate cellular and protein matrix components of bone to favour tumour expansion and...

  19. Bone-seeking therapeutic radiopharmaceuticals

    Directory of Open Access Journals (Sweden)

    Srivastava Suresh C.

    2002-01-01

    Full Text Available Bone-seeking therapeutic radiopharmaceuticals are utilized on the basis of the radionuclide?s particulate emissions (primarily low to intermediate beta emission. The requirements therefore are different from those of bone imaging agents that consist mainly of short-lived single photon emitters. Lately, the therapeutic bone seeking radiopharmaceuticals have attained increasing importance due to their potential role in alleviating pain from osseous metastases in cancer patients, for the treatment of joint pain resulting from inflamed synovium (radiosynoviorthesis, or radiosynovectomy, or from various other forms of arthritic disease. There is, however, a paucity of published data on the bio-pharmacokinetics of these agents when used following intravenous administration for bone pain palliation. This paper will briefly review and summarize the presently available chemical and biopharmacokinetic information on the various clinically approved as well as experimental bone-localizing therapeutic radiopharmaceuticals, and make projections on their clinical application for the treatment of primary/metastatic cancer in bone.

  20. Continuous Quality Improvement in the Management of Patients with Bone Trauma Pain Application Value%持续质量改进在骨创伤患者疼痛管理中的应用价值

    Institute of Scientific and Technical Information of China (English)

    孙爱松; 冯铮铮; 李春萌

    2016-01-01

    Objective to further study in patients with bone trauma pain management of clinical effectiveness of continuous quality improvement program. Methods randomly selected from our hospital 01, 2015-01, 2016 37 patients with bone trau-ma were treated, as a team, and implementation of continuous quality improvement programs; At the same time we do con-trast analysis on 37 patients with bone trauma, set as control group, routine nursing and implement, on postoperative pain is 2 set of selected objects, objective evaluation indexes of nursing work satisfaction, at the same time objective compared in two groups. Result: the nursing management procedures have been successfully launched, the team selected object VAS e-valuation score (visual analogue scale) for (4.01±1.00), the control group (5.91±1.28). In addition, the control group included in the object of nursing job satisfaction by 70.27%, and 100.00% analysis group, show that two groups included in the ob-ject of nursing job satisfaction, pain index and evaluation results have difference (P< 0.05). Conclusion in patients with bone trauma, a continuous quality improvement scheme can obtain significant effect, not only can improve the patients' pain symptoms, but also can promote the nursing job satisfaction, is the important guarantee of improving the quality of patients with pain management, it is recommended that promotion.%目的:进一步研究骨创伤患者疼痛管理工作中展开持续质量改进方案的临床有效性。方法随机选取该院2015年1月—2016年1月收治的37例骨创伤患者,设作研究组,并实施持续质量改进方案;同期选取37例骨创伤患者进行对照分析,设作对照组,并实施常规护理方案,对2组入选对象术后疼痛情况、护理工作满意度等指标进行客观评定,同时在2组内进行客观对照。结果研究组入选对象VAS评定分数(视觉模拟评分)为(4.01±1.00)分,对照组(5.91±1.28)分。此外,对照

  1. Women in pain : the course and diagnostics of chronic pelvic pain

    NARCIS (Netherlands)

    Weijenborg, Philomena Theodora Maria

    2009-01-01

    The main subject of this thesis is pelvic pain in women in secondary and/or tertiary medical care. Studies aim to examine: 1. The clinical course of acute abdominal pain and risks of pain persistence. 2. The clinical course of chronic pelvic pain (CPP) and predictors of recovery. 3. The moderat

  2. Dor óssea e sua relação na apresentação inicial da leucemia linfóide aguda Bone pain and its relation to the initial presentation of acute lymphoblastic leukemia

    Directory of Open Access Journals (Sweden)

    Patrícia S. Ikeuti

    2006-03-01

    Full Text Available A leucemia linfóide aguda é uma neoplasia maligna do sistema hematopoiético caracterizada pela alteração do crescimento e da proliferação das células linfóides na medula óssea, com conseqüente acúmulo de células jovens indiferenciadas, denominadas blastos. É a neoplasia maligna mais freqüente (70% entre as crianças menores de 15 anos de idade. As manifestações clínicas mais comuns incluem febre, equimose e palidez, porém a dor óssea pode ser encontrada como sintoma inicial em 25% dos casos. Assim, com o objetivo de determinar a freqüência da dor óssea e sua relação com dados clínico-laboratoriais em crianças portadoras de leucemia linfóide aguda atendidas na unidade de Oncologia Pediátrica do Hospital de Base de São José do Rio Preto-SP, foram avaliadas cinqüenta crianças portadoras de leucemia linfóide aguda com idade até 15 anos, no período de dezembro de 1991 a dezembro de 2001. Entre as crianças estudadas, 18 apresentaram dor óssea como queixa principal e, destas, 14 apresentaram tempo de evolução (período entre primeiro sintoma e o diagnóstico superior a 15 dias (p=0.018. Além disso, 13 crianças com dor óssea e tempo de evolução superior a 15 dias apresentaram níveis de hemoglobina inferiores a 8g/dl (p=0,008.Acute lymphoblastic leukemia is a hematopoietic malignancy characterized by alterations in the growth and proliferation of lymphoblastic cells in bone marrow, with consequent accumulation of immature white blood cells called blasts. It is the most common malignant neoplasm seen in under fifteen-year-olds. Acute lymphoblastic leukemia frequently presents with fever, ecchymosis and paleness, however bone pain is the initial symptom found in 25% of the cases. The objective of this work is to determine the frequency of bone pain and its relation with clinical and laboratory data in children with acute lymphoblastic leukemia admitted in the Pediatric Oncology Unit of Hospital de Base de S

  3. Interventional radiology in pain treatment

    Energy Technology Data Exchange (ETDEWEB)

    Kastler, B. (ed.) [Univ. de Franche-Comte, Besancon (France). Lab. d' Imagerie ed d' Ingenierie pour la Sante

    2007-07-01

    Disease whether it is acute, chronic, or at end stage, is all too regularly accompanied by pain. Pain is often difficult to control, in malignant disease in particular, even by using appropriate medications. Anesthesiologists and pain therapists have developed new invasive therapies including nerve block, sympatholysis, and neurolysis useful for both diagnosis and pain management. To insure the efficiency and safety of these procedures, and furthermore for elaborate techniques such as vertebroplasty, cementoplasty, and radio frequency bone ablation, imaging guidance becomes mandatory. This state-of-the-art book describes the techniques elaborated by interventional radiologists in the treatment and palliation of a variety of benign and malignant painful conditions. Each chapter written by an expert in the field concentrates on a particular aspect of pain management, with emphasis on practical issues. This book will serve as an invaluable source of information for the radiologist willing to learn about new pain therapy techniques aimed at optimizing or replacing more invasive traditional methods. (orig.)

  4. 多塞平对骨癌疼痛模型大鼠的镇痛作用研究%Analgesic Effect of Doxepin on Bone Cancer Pain Model Rats

    Institute of Scientific and Technical Information of China (English)

    姚旌; 王林; 陆魏

    2012-01-01

    OBJECTIVE: To study the analgesia effect of doxepin on the bone cancer pain rats. METHODS: Of total 90 rats, 10 rats were included in normal group and other 80 rats were injected with Walker256 cell to build the bone cancer pain model. Then those model rats were divided into model group, morphine group (1 000 μg·kg-1) and doxepin groups (3, 10, 30, 100, 300, 1 000 μg·kg-1). Those groups were given relevant medicine intrathecally. The pain thresholds of bilateral foot of rats were detected at 0.5, 1, 2, 4 h after medication, and maximum analgesia effect of doxepin was calculated. RESULTS: Doxepin and morphine exerted analgesia effect at 0.5 h, and reached the top at 1 h. Contralateral paw pain thresholds in doxepin groups had no significant change, and the increase of ipsilateral paw pain thresholds was positively related with dose; maximum analgesic efficacy of doxepin (1 000 μg·kg-1) was 67.7%, and median effective dose was 46.6 μg·kg-1. There was no significant difference in the analgesic effect between doxepin 1 000 μg·kg-1 group and morphine 1 000 μg·kg-1 group. CONCLUSION: Doxepin has beneficial effect of analgesia for bone cancer pain rats.%目的:研究多塞平对骨癌疼痛模型大鼠的镇痛作用.方法:取大鼠90只,其中10只为正常组,另80只胫骨注射含人乳腺癌Walker 256细胞株的大鼠细胞液建立骨癌疼痛模型,待模型成功稳定后分为模型组、吗啡组(1 000 μg·kg-1)、多塞平(3、10、30、100、300、1000μg·kg-1)组,鞘内给予相应药物,考察给药后0.5、1、2、4h时各组大鼠的双侧脚痛阈值,并计算多塞平的最大镇痛效应.结果:多塞平与吗啡在给药后0.5h即产生镇痛作用,给药后1h镇痛作用达到高峰;多塞平各剂量组大鼠造模对侧脚痛阈值无明显变化,造模同侧脚痛阈值升高与剂量呈正相关;多塞平1 000 μg·kg-1的最大镇痛效应为67.7%,半数有效量为46.6 μg·kg-1,与吗啡1000μg·kg-1的镇痛效应比较

  5. Pain syndrome with stress fractures in transplanted patients treated with calcineurin inhibitors

    OpenAIRE

    Gurin, Lindsey; Gohh, Reginald; Evangelista, Peter

    2012-01-01

    Bone disease remains a major cause of morbidity after renal transplantation. Post-transplant osseous complications include osteoporosis and osteonecrosis, both historically associated with glucocorticoids, and a newer syndrome of bone pain associated with calcineurin inhibitors. Calcineurin inhibitor-induced pain syndrome (CIPS) is a reversible etiology of lower extremity bone pain and bone marrow edema reported in patients receiving cyclosporine or tacrolimus after solid organ or bone marrow...

  6. Fusion of the accessory and primary navicular bones for painful type II accessory navicular bone:16 cases report%副舟骨舟骨融合术治疗II型副舟骨疼痛16例报告

    Institute of Scientific and Technical Information of China (English)

    黄野; 及松杰; 杜辉; 顾建明; 周一新

    2014-01-01

    目的:评价副舟骨-舟骨融合术治疗II型副舟骨疼痛的有效性和安全性。方法2009年2月至2012年12月,我科共有16例患者(17只足)接受了副舟骨-舟骨融合术。患者平均年龄26.9(17~35)岁。患者主诉局部慢性疼痛和肿胀,体格检查所有患者都有副舟骨压痛,保守治疗无效。结果平均随访22(14~60)个月。通过患者满意度分级系统的评估,17只足中,12只足评价为优,4只足为良,1只足为可。术后随访X线片显示,16只足(94%)在术后1年内愈合,其中13只足(76%)在术后3个月左右即愈合。1只足在术后1年半的末次随访发现仍未愈合。比较X线片上术前和术后的距-舟骨覆盖角、侧位片上距骨-第一跖骨干夹角和跟骨倾斜角,差异均无统计学意义(P>0.05)。结论副舟骨-舟骨融合术是治疗II型副舟骨疼痛的安全有效的术式。对胫后肌功能,以及对平足发展的影响,还有待长期随访研究。%Objective To evaluate the effectiveness and safety of fusion of the accessory and primary navicular bones for painful type II accessory navicular bone.Methods From February 2009 to December 2012, 16 patients ( 17 feet ) whose average age was 26.9 years old ( range: 17-35 years ) underwent fusion of the accessory and primary navicular bones. The patients complained of local and chronic pain and swelling. The physical examination results showed tenderness in all the patients. The conservative treatment was ineffective.Results The patients were followed up for a mean period of 22 months ( range: 14-60 months ). According to the patients’ satisfaction rating system, the evaluation results of 12 feet were excellent, 4 feet good and 1 foot fair. The postoperative X-rays showed bone consolidation was conifrmed in 13 feet ( 76% ) within 3 months and in 16 feet ( 94% ) within 1 year. One foot of non-union was found in the latest follow-up of half a year after the operation. The

  7. Psychology and related factor in bone metastases cancer with pain%多发骨转移癌疼痛患者心理调查及相关因素研究

    Institute of Scientific and Technical Information of China (English)

    杨胜利; 袁彬; 平焕侠; 孙英; 许建林; 施常备

    2014-01-01

    Objective:To explore the psychology and intervention of the bone metastases patients with pain.Meth-ods:All 101 patients with bone metastases cancer were investigated by SAS(Self-Rating Anxiety Scale)and SDS (Self-Rating Depression Scale ).Results:All patients have tension and depression.Pure pain:SAS:81.20%, 89.70%,95.30%,SDS:87.10%,92.30%,97.50%.Spinal cord injury paresthesia to feel abnormal activities:SAS:71.00%,SDS:89.70%.Conclusion:All patients with bone metastases cancer have obvious problems of psycho-analy,particuly those with pain,spinal cord injury paresthesia to feel abnormal activities.%目的:探讨多发骨转移癌疼痛患者的心理状况。方法:采用临床焦虑自评量表(SAS)及抑郁量表(SDS)调查101例多发骨转移癌患者的心理状况。结果:所有多发骨转移患者均不同程度存在焦虑和抑郁。其中单纯疼痛者轻、中、重度分别为SAS:81.20%、89.70%、95.30%,SDS:87.10%、92.30%、97.50%。伴有脊髓损伤感觉异常和行动障碍者SAS:71.00%,SDS:89.70%。结论:多发骨转移癌患者存在明显心理障碍,尤其是存在疼痛、感觉异常和肢体活动障碍者,更应给予心理帮助和指导。

  8. Groin pain

    Science.gov (United States)

    ... groin pain in men. The terms "groin" and "testicle" are sometimes used interchangeably. But what causes pain ... hernia. It may also involve pain in the testicles. Hernia : This problem occurs when there is a ...

  9. Eye pain

    Science.gov (United States)

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  10. Wrist pain

    Science.gov (United States)

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  11. Elbow pain

    Science.gov (United States)

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  12. Heel pain

    Science.gov (United States)

    Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

  13. Differential diagnosis and treatment of iliotibial band pain secondary to a hypomobile cuboid in a 24-year-old female tri-athlete.

    Science.gov (United States)

    Brandon, Kristina; Patla, Catherine

    2013-08-01

    The purpose of this case report is to relate an episode of movement impairment at the cuboid calcaneal articulation leading to symptoms of iliotibial band (ITB) syndrome. An explanation of the etiology and clinical diagnosis in relation to the differential diagnosis, treatment techniques, and patient outcomes are described. The 24-year-old female tri-athlete reported pain at Gerdy's tubercle and lateral femoral condyle areas occurring within 2 miles of a run. VAS score was 6/10 for the running activity and the lower extremity functional scale (LEFS) score was 93% (74/80). Over the previous 2 years, the ITB symptoms had failed to resolve with extensive conservative treatment at the knee. On weight bearing, the patient demonstrated pain free limitation of active midtarsal pronation more than supination, which correlated with a decrease in passive internal rotation of the cuboid. Symptoms resolved after one cuboid whip manipulation and the patient was able to run pain free. Post-manipulation treatment consisted of two more sessions, which included motor retraining for weight bearing active midtarsal pronation and supination. LEFS was 100% (80/80) and VAS 0/10 with running greater than 10 miles. While causality cannot be inferred from a single case, this report may foster further investigation regarding the differential diagnosis and treatment of a hypomobile cuboid.

  14. Depression, Pain, and Pain Behavior.

    Science.gov (United States)

    Keefe, Francis J.; And Others

    1986-01-01

    Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…

  15. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

  16. The insufficiency fracture of the sacrum. An often unrecognized cause for low back pain: results of bone scanning in a major hospital; Die sakrale Insuffizienzfraktur. Eine haeufig unerkannte Ursache fuer Lumbo-Sakralgien: Ergebnisse der Knochenszintigraphie in einem Schwerpunktkrankenhaus

    Energy Technology Data Exchange (ETDEWEB)

    Hatzl-Griesenhofer, M.; Pichler, R.; Huber, H.; Maschek, W. [Inst. fuer Nuklearmedizin und Endokrinologie, Allgemeines Krankenhaus Linz (Austria)

    2001-12-01

    Aim: The insufficiency fracture of the sacrum is often radiographically occult. Bone scintigraphy is a method of reference for the diagnosis; the results have been analysed retrospectively. Methods: Bone scintigraphy was done on patients who, predominantly after minor trauma, suffered from lower back pain and whose radiographic findings were negative. Results: During a 24 month period, a sacral insufficiency fracture was diagnosed in 102 patients. H-shaped hyperfixation of the tracer - described as typical - was present in only 19.6% of the cases. Tracer accumulation was found as follows: located uni/bilateral in the sacral wings (32.4%/6.9%), horizontal (27.4%) and half H-shaped (13.7%). In 85% of the cases there were further fractures with main localisations in the pubic bone, in the spine and the ribs. Conclusion: The insufficiency fracture of the sacrum as cause of lower back pain is not uncommon, especially in postmenopausal women with risk factors. Bone scintigraphy is not only an adequate procedure for the detection of often radiographically occult sacral fractures, but also an easy method to reveal the often concomitand fractures. (orig.) [German] Ziel: Die Insuffizienzfraktur des Sakrum ist radiologisch haeufig okkult. Die Knochenszintigraphie ist eine Referenzmethode zur Diagnose; die Ergebnisse wurden retrospektiv analysiert. Methoden: Bei Patienten mit Lumbosakralgie ueberwiegend nach Minimaltrauma und konventionell-radiologisch negativem Befund wurde eine Knochenszintigraphie durchgefuehrt. Ergebnisse: In einem Zeitraum von 24 Monaten wurden bei 102 Patienten die Diagnose einer Sakruminsuffizienzfraktur gestellt. Die als typisch beschriebene H-foermige Hyperfixation des Tracers kommt nur in 19,6% der Faelle vor. Es werden vertikale ein- oder beidseitig durch die Sakralfluegel verlaufende (32,4% bzw. 6,9%), horizontale (27,4%) und halb-H-foermige (13,7%) Anreicherunsmuster gefunden. In 85% der Faelle bestehen weitere Frakturen mit den

  17. Is the psychosocial profile of people with low back pain seeking care in Danish primary care different from those in secondary care?

    DEFF Research Database (Denmark)

    Morsø, Lars; Kent, Peter; Albert, Hanne B;

    2013-01-01

    not been investigated. The aim of the study was to determine: (1) if movement-related fear, catastrophisation, anxiety and/or depression in LBP patients are different between primary and secondary care settings, and (2) if those differences are retained when stratified by SBT subgroup. This study...... of Kinesiophobia, the Coping Strategies Questionnaire (catastrophisation subscale), and the Hospital Anxiety and Depression Scale. There were significantly higher scores in secondary care for movement-related fear (1.3 points (95%CI .1-2.5) p = .030) and catastrophisation (2.0 (95%CI 1.0-3.0) p ...

  18. Osteomalacia as a Cause of Chronic Pain

    Directory of Open Access Journals (Sweden)

    Robert W Teasell

    1996-01-01

    Full Text Available Osteomalacia is a form of metabolic bone disease that can present as chronic pain. A 36-year-old woman presented with a three-year history of bilateral leg and back pain, and proximal leg weakness. Repeated consultations and investigations failed to discover a cause for her pain, and a diagnosis of chronic benign pain was made. She was admitted to hospital where the bone scan, laboratory investigation and bone biopsy established a diagnosis of renal phosphate-wasting adult-onset rickets (osteomalacia. Radiographs of the hip and magnetic resonance imaging revealed bilateral femoral neck fractures and segmental, avascular necrosis of the femoral heads. The patient was treated with high dose phosphate and vitamin D with marked relief of pain. Osteomalacia should be considered in unusual cases of intractable chronic pain.

  19. 153 SM-EDTMP (Samario como tratamiento del dolor óseo de origen metastático 153 SM-EDTMP (SAMARIO For the treatment of metastatic bone pain

    Directory of Open Access Journals (Sweden)

    A. B. de la Calle

    2006-04-01

    Full Text Available Introducción: 153 Sm-EDTMP es un agente radioactivo que puede ser usado para el diagnóstico así como el tratamiento de algunas enfermedades. El objetivo de este estudio es evaluar la eficacia de 153 Sm-EDTMP en el tratamiento del dolor crónico debido a metástasis óseas en el cáncer de próstata. Material y métodos: Se realiza un estudio prospectivo dónde se incluyen siete pacientes con dolor crónico, en relación con metástasis óseas por cáncer prostático, a los que se les administra de forma intravenosa 153 Sm-EDTMP para controlar el dolor. La eficacia de este agente fue evaluada según los cambios obtenidos en la escala visual-analgésica de (EVA, tiempo en el que se alcanzó la respuesta terapéutica, efectos adversos y cambios en el consumo diario de analgésicos. Resultados: 2 de 7 pacientes (28.5% tuvieron remisión completa del dolor, 4 de 7 (37.2% remisión parcial (EVA ≥1 y ≤3 y 1 de 7 (14.3% no mostraron mejoría. La respuesta terapéutica ocurrió a los 10-30 días después de la administración del fármaco en 83.3% de los pacientes, 16.6% requirieron más tiempo. No se observaron efectos adversos mayores; 20% sintieron nauseas, 5% vómitos y 0% toxicidad hematológica. 5 de 7 pacientes (71.4% redujeron el consumo de analgésicos. Conclusiones: 153 Sm-EDTMP es seguro y eficaz para la paliación rápida del dolor ocasionado por metástasis óseas, aunque aún quedan importantes cuestiones que resolver, fundamentalmente sobre los factores que influyen en la respuesta terapéutica a este radiofármaco.Introduction: 153 Sm-EDTMP is a radioactive agent used for both the diagnosis and treatment of some diseases. The aim of this study is to evaluate the efficacy of 153 Sm-EDTMP for the treatment of chronic pain due to bone metastasis in prostate cancer. Material and methods: Prospective study including seven patients suffering chronic pain due to bone metastasis in prostate cancer to whom intravenous 153 Sm-EDTMP for pain

  20. Spinal cord injury pain: mechanisms and management.

    Science.gov (United States)

    Finnerup, Nanna Brix; Baastrup, Cathrine

    2012-06-01

    Patients with spinal cord injury (SCI) may experience several types of chronic pain, including peripheral and central neuropathic pain, pain secondary to overuse, painful muscle spasms, and visceral pain. An accurate classification of the patient's pain is important for choosing the optimal treatment strategy. In particular, neuropathic pain appears to be persistent despite various treatment attempts. In recent years, we have gained increasing knowledge of SCI pain mechanisms from experimental models and clinical studies. Nevertheless, treatment remains difficult and inadequate. In line with the recommendations for peripheral neuropathic pain, evidence from randomized controlled treatment trials suggests that tricyclic antidepressants and pregabalin are first-line treatments. This review highlights the diagnosis and classification of SCI pain and recent improvements in the understanding of underlying mechanisms, and provides an update on treatment of SCI pain. PMID:22392531

  1. Correiation between Subchondral Bone Marrow Edema and Pain in Knee Osteoarthritis%膝骨性关节炎疼痛与骨髓水肿MRI影像学改变的相关性

    Institute of Scientific and Technical Information of China (English)

    陆川; 刘海霞; 张国秋; 李得春

    2015-01-01

    目的:探讨膝骨性关节炎(KOA)疼痛程度与MRI软骨下骨髓水肿(BME)程度的相关性。方法:KOA 142例按疼痛程度分为无疼痛组31例、疼痛1级组86例、疼痛2级组25例,将其MRI骨髓水肿分为0级(无骨髓水肿)38例、1级(轻度骨髓水肿)69例、2级(较大骨髓水肿)35例,将疼痛程度与KOA骨髓水肿分级进行χ2检验,并将疼痛各组与水肿分级进行多个独立样本比较的秩和检验。结果:无疼痛组29.1%(9/31例)存在BME,疼痛1级组82.6%(71/86例)存在BME,疼痛2级组92%(24/25例)存在BME;无疼痛组与疼痛1级组、疼痛2级组相比差异有统计学意义(χ2=12.613,P<0.001;χ2=14.535,P<0.001),多个独立样本比较的秩和检验显示,3组BME差异有统计学意义(P<0.001),随疼痛的加重,BME分级的平均秩次逐渐加大(0级、1级和2级分别为79.12、102.82和139.26)。结论:KOA疼痛与软骨下骨髓水肿相关,且存在疼痛越重、骨髓水肿越严重的趋势。%Objective To evaluate whether the presence of subchondral bone marrow edema(BME), detect⁃ed by magnetic resonance imaging(MRI), are associated with different levels of pain among patients suffering os⁃teoarthritis of the knee. Methods Based on rating scale of pain, 142 patients with knee osteoarthritis (OA) were divided into three groups: no pain group, 31; mild pain group, 86;moderate or severe pain group, 25. Con⁃tingency table analyses and rank sum tests were used to compare the difference among pain stages of OA and BME score in these groups. While BME was identified from MRI(0 grade,no BME,38;grade 1,small BME, 69;grade 2,large BME,35). Results 29.1%(9/31)of OA patients in no pain group had BME, while in mild pain group the percentage was 82.6%(71/86),in severe pain gmup 92%(24/25). There was statistical signifi⁃cance between no pain group and mild pain group(χ2=12.613,P<0.001);so was it between no pajn group and severe pain group(χ2

  2. The attenuate hyperalgesia effect of intrathecal U0126 in a rat model of bone cancer pain%骨癌痛大鼠鞘内注射U0126的抗痛觉过敏作用

    Institute of Scientific and Technical Information of China (English)

    李彩芳; 杨建平; 王丽娜; 刘磊; 胡计嬅; 刘思兰

    2011-01-01

    目的 研究鞘内注射(it)U0126对骨癌痛大鼠机械痛敏的影响和对脊髓背角磷酸化cAMP反应元件结合蛋白(pCREB)表达的影响,探讨ERK-CREB信号转导通路在骨癌痛中的作用.方法 ① 40只成年♀SD大鼠分为5组,假模型组Ⅰ和骨癌痛模型组Ⅱ、Ⅲ、Ⅳ、Ⅴ.建模后d 10每只大鼠分别it 10 μg U0126、5%二甲亚砜10 μl和U0126 0.1、1、10 μg(U0126溶于10 μl 5%二甲亚砜中),测机械性缩爪阈值(MWT)和双下肢负重差(WBD);② 25只成年♀SD大鼠分为5组,T1、T2和T3组在制作骨癌痛模型后d 10,it U0126 10 μg后1、6、24 h处死大鼠,M组为模型对照组,it 5%二甲亚砜10 μl后6 h处死大鼠,S组为空白对照组.免疫组化方法测定L4-6术侧脊髓背角pCREB免疫反应阳性神经元数量.结果 鞘内注射U0126 1 μg和10 μg明显逆转了骨癌痛引起的机械痛敏;鞘内注射10 μg U0126明显减少脊髓背角pCREB表达,且效果至少可持续6 h.结论 ERK-CREB通路可能参与骨癌痛.%Aim To investigate the effect of intrathecal ( i. t. ) U0126( MAPK kinase inhibitor ) on the mechanical hyperalgesia and the expression of phosphorylated cAMP response element binding protein( pCREB ) in the dorsal horn of spinal cord following bone cancer pain in rats , trying to evaluate the role played by ERKCREB signal transmission pathway in the mechanism of bone cancer pain. Methods ① 40 adult female SD rats were divided into five groups. Sham group Ⅰ and bone cancer pain ( BCP ) group rats Ⅱ . Ⅲ , Ⅳ , Ⅴ received a bolus of 10 μg U0126. 5% DMSO 10 μl,U0126 0. 1, 1, 10 μg i. t. respectively on the 10th day after the model was made. Mechanical withdrawal threshold ( MWT ) and weight bearing difference ( WBD ) were measured;②25 adult female SD rats were divided into five groups. On the lOth day after the model was made, BCP rats of group T1 , T2 and T3 were killed at 1, 6. 24 h after i. t. U0126 10 μg respectively. In group M, rats produced bone

  3. Bone cysts: unicameral and aneurysmal bone cyst.

    Science.gov (United States)

    Mascard, E; Gomez-Brouchet, A; Lambot, K

    2015-02-01

    Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy.

  4. Myeloma bone disease: Pathophysiology and management

    OpenAIRE

    Silbermann, Rebecca; Roodman, G. David

    2013-01-01

    Multiple myeloma bone disease is marked by severe dysfunction of both bone formation and resorption and serves as a model for understanding the regulation of osteoblasts (OBL) and osteoclasts (OCL) in cancer. Myeloma bone lesions are purely osteolytic and are associated with severe and debilitating bone pain, pathologic fractures, hypercalcemia, and spinal cord compression, as well as increased mortality. Interactions within the bone marrow microenvironment in myeloma are responsible for the ...

  5. Cellular Mechanisms of Multiple Myeloma Bone Disease

    OpenAIRE

    Angela Oranger; Claudia Carbone; Maddalena Izzo; Maria Grano

    2013-01-01

    Multiple myeloma (MM) is a hematologic malignancy of differentiated plasma cells that accumulates and proliferates in the bone marrow. MM patients often develop bone disease that results in severe bone pain, osteolytic lesions, and pathologic fractures. These skeletal complications have not only a negative impact on quality of life but also a possible effect in overall survival. MM osteolytic bone lesions arise from the altered bone remodeling due to both increased osteoclast activation and d...

  6. Pelvic Pain

    Science.gov (United States)

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  7. Shoulder pain

    Science.gov (United States)

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  8. Effect of High-Dose Vitamin D3 Intake on Ambulation, Muscular Pain and Bone Mineral Density in a Woman with Multiple Sclerosis: A 10-Year Longitudinal Case Report

    Directory of Open Access Journals (Sweden)

    François Feron

    2012-10-01

    Full Text Available Mounting evidence correlate vitamin D3 (cholecalciferol supplementation or higher serum levels of vitamin D (25(OHD with a lower risk of developing multiple sclerosis (MS, reduced relapse rate, slower progression or fewer new brain lesions. We present here the case of a woman who was diagnosed with MS in 1990. From 1980 to 2000, her ability to walk decreased from ~20 to 1 km per day. Since January 2001, a vitamin D3 supplement was ingested daily. The starting dose was 20 mcg (800 IU/day and escalated to 100 mcg (4000 IU/day in September 2004 and then to 150 mcg (6000 IU/day in December 2005. Vitamin D3 intake reduced muscular pain and improved ambulation from 1 (February 2000 to 14 km/day (February 2008. Vitamin D intake over 10 years caused no adverse effects: no hypercalcaemia, nephrolithiasis or hypercalciuria were observed. Bowel problems in MS may need to be addressed as they can cause malabsorption including calcium, which may increase serum PTH and 1,25(OH2D levels, as well as bone loss. We suggest that periodic assessment of vitamin D3, calcium and magnesium intake, bowel problems and the measurement of serum 25(OHD, PTH, Ca levels, UCa/Cr and bone health become part of the integral management of persons with MS.

  9. Retained fetal bones: an unusual cause of abnormal uterine bleeding

    Directory of Open Access Journals (Sweden)

    Sonia Chawla

    2016-06-01

    Full Text Available Abnormal uterine bleeding (AUB is a common gynaecological problem with most common causes being fibroid, polyp, endometritis, neoplasia and coagulation disorder. Presence of retained intrauterine fetal bones as a cause of AUB, is a rare but well recognized entity. Patient may present with subfertility, secondary infertility, chronic pelvic pain, vaginal discharge, pelvic inflammatory disease, abnormal uterine bleeding. Incidence reported in literature is 0.15% among patients undergoing diagnostic hysteroscopy. Calcification appears as hyperechoeic area on ultrasound. Hysteroscopy guided removal of bony fragments is the gold standard and leads to complete resolution of symptoms. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 2032-2033

  10. Bone Biopsy

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Bone Biopsy Bone biopsy uses a needle and imaging guidance ... limitations of Bone Biopsy? What is a Bone Biopsy? A bone biopsy is an image-guided procedure ...

  11. Bone Diseases

    Science.gov (United States)

    ... avoid smoking and drinking too much alcohol. Bone diseases can make bones easy to break. Different kinds ... break Osteogenesis imperfecta makes your bones brittle Paget's disease of bone makes them weak Bones can also ...

  12. The natural course of low back pain

    DEFF Research Database (Denmark)

    Lemeunier, Nadège; Leboeuf-Yde, Charlotte; Gagey, Olivier

    2012-01-01

    Most patients in the secondary care sector consulting for low back pain (LBP) seem to have a more or less constant course of pain during the ensuing year. Fewer patients with LBP in the primary care sector report continual pain over a one-year period. However, not much is known about the long...

  13. Tratamiento del dolor secundario al síndrome de ATM mediante estimulación nerviosa periférica The management of pain secondary to TMJ syndrome using peripheral nerve stimulation

    Directory of Open Access Journals (Sweden)

    M. J. Rodríguez

    2012-08-01

    common symptoms include: joint pain and clicking, difficulty opening the mouth, and temporomandibular joint discomfort. Basically, its diagnosis is clinical. The TMJ is supplied by the auriculotemporal nerve, a collateral branch of the mandibular nerve, V3 branch of the trigeminal nerve. Material and method: we report on a total of six female patients who were treated between 2008 and 2010, all of them with pain secondary to TMJ syndrome, unilateral in five cases and bilateral in one. All these patients had previously received maxillofacial surgery, as well as various drug therapies and rehabilitation, with no pain or mouth opening improvements. All patients were subjected to auriculotemporal nerve blocks using 2% lidocaine to determine analgesia extent and level prior to stimulation system implantation. In all cases an electrode was surgically implanted in the preauricular area of the involved temporomandibular joint. Both pain severity and general health status were assessed before treatment onset and after two weeks, at which time the trial period ended and a definitive stimulator was implanted. Results: all patients were females with a mean age of 32 years. All of them had continuous pain and great difficulty opening their mouths, and all were on drug therapy without adequate pain relief. All patients had their pain reduced by 84% at four weeks after electrode implantation.

  14. Production, quality control, biological evaluation and biodistribution modeling of Lutetium-177 maltolate as a viable bone pain palliative in skeletal metastasis

    International Nuclear Information System (INIS)

    177Lu-maltolate (177Lu-MAL) was successfully developed which can be widely used in bone palliation therapy. At optimized conditions a radiochemical purity of about >99 % was obtained for 177Lu-MAL shown by ITLC (specific activity, 970-1,000 MBq/mmole). Biodistribution studies of 177Lu chloride and 177Lu-MAL were carried out in wild-type rats comparing the critical organ uptakes. Compartmental analysis was used to determine temporal biodistribution model of 177Lu-MAL in different organs. 177Lu-MAL is a possible therapeutic agent in human malignancies for the bone palliation therapy so the efficacy of the compound should be tested in various animal models. (author)

  15. Dramatic pain relief and resolution of bone inflammation following pamidronate in 9 pediatric patients with persistent chronic recurrent multifocal osteomyelitis (CRMO)

    OpenAIRE

    Reslan Walid; Kaura Deepak; Wei Xingchang; Miettunen Paivi MH; Aguirre Alberto; Kellner James D

    2009-01-01

    Abstract Background Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory, non-infectious osteopathy that affects predominantly patients ≤ 18 years of age. There is no uniformly effective treatment. Our objective is to describe clinical, magnetic resonance imaging (MRI), and bone resorption response to intravenous pamidronate in pediatric CRMO. Methods We report our prospectively documented experience with all CRMO patients treated with pamidronate between 2003 and 2008 at a te...

  16. Retrospective evaluation of bone pain palliation after samarium-153-EDTMP therapy Avaliação retrospectiva do tratamento da dor óssea metastática com Samário-153-EDTMP

    Directory of Open Access Journals (Sweden)

    Marcelo Tatit Sapienza

    2004-01-01

    Full Text Available PURPOSE: The aim of this study was to evaluate the degree of metastatic bone pain palliation and medullar toxicity associated with samarium-153-EDTMP treatment. METHODS: Seventy-three patients with metastatic bone pain having previously undergone therapy with samarium-153-EDTMP (1 mCi/kg were retrospectively evaluated. Routine follow-up included pain evaluation and blood counts for 2 months after treatment. Pain was evaluated using a subjective scale (from 0 to 10 before and for 8 weeks after the treatment. Blood counts were obtained before treatment and once a week for 2 months during follow-up. Dosimetry, based upon the urinary excretion of the isotope, was estimated in 41 individuals, and the resulting radiation absorbed doses were correlated with hematological data. RESULTS: Reduction in pain scores of 75% to 100% was obtained in 36 patients (49%, with a decrease of 50% to 75%, 25% to 50%, and 0% to 25% in, respectively, 20 (27%, 10 (14%, and 7 (10% patients. There was no significant relationship between the pain response and location of the primary tumor (breast or prostate cancer. Mild to moderate myelosuppression was noted in 75.3% of patients, usually with hematological recovery at 8 weeks. The mean bone marrow dose was 347 ± 65 cGy, and only a weak correlation was found between absorbed dose and myelosuppression (Pearson coefficient = .4. CONCLUSIONS: Samarium-153-EDTMP is a valuable method for metastatic bone pain palliation. A mild to moderate and transitory myelosuppression is the main toxicity observed after samarium therapy, showing a weak correlation with dosimetric measures.OBJETIVO: O presente trabalho teve por objetivo avaliar o efeito paliativo da dor e a toxicidade medular associados ao tratamento com Samário-153-EDTMP em pacientes com metástases ósseas. MÉTODOS: O estudo foi realizado de forma retrospectiva, a partir do levantamento de prontuário de 178 pacientes submetidos a tratamento com 1mCi/kg de 153Sm

  17. 低频脉冲电磁场治疗高龄骨关节疼痛效果研究%Effect research of low frequency pulsed electromagnetic fields on pain of bone and joint in elderly patients

    Institute of Scientific and Technical Information of China (English)

    陈江强

    2014-01-01

    目的:探讨低频脉冲电磁场治疗老年骨关节疼痛的临床疗效。方法选取150例老年骨关节疼痛患者进行研究,并根据老年患者骨关节疼痛的病症分为三组:以骨质疏松症为主的50例为A组、以骨性关节炎为主的50例为B组、以股骨头缺血性坏死为主的50例为C组。对三组患者都采用低频脉冲电磁场进行治疗,治疗过程中采用扫描模式,频率每4分钟就需要变化1档。每周5次,每次30 min。持续治疗15次后休息1周,然后继续接受治疗。4周1疗程,所有患者均连续治疗3个疗程。观察三组患者的疼痛强度、疼痛缓解程度与临床实验室检查结果。结果三组治疗第4、12周的疼痛强度均明显低于较治疗前,差异均有统计学意义(t分别=5.58、5.23、5.15、4.79、6.23、5.33,P均<0.05)。治疗结束后的第4周,A、B两组疼痛强度均较治疗前明显下降,差异均有统计学意义(t分别=5.13、5.87, P均<0.05),但C组未出现明显改变,差异无统计学意义(t=1.21,P均>0.05)。三组患者经过12周的治疗后,A组、B组和C组总缓解率分别为90.00%、92.00%和70.00%。 A、B两组总缓解率均明显高于C组,差异均有统计学意义(χ2分别=6.12、5.79,P均<0.05)。三组患者经过治疗后,对其生命体征与实验室检查,各指标与治疗前比较,差异均无统计学意义(t分别=0.27、2.01、1.52、2.03、1.12、1.13、3.15;1.79、2.11、3.10、3.15、0.89、1.09、1.13;0.97、0.96、1.23、1.15、2.03、2.56、2.05,P均>0.05)。结论采用低频脉冲电磁场对不同原因所导致的骨关节疼痛老年患者进行治疗可以获得良好的效果,且安全性高。%Objective To explore the clinical effect of low-frequency pulsed electromagnetic fields on bone and joint pain in the elderly. Methods A total of 150 cases of elderly patients with pain of bone and joint were selected

  18. A 15-year-old boy with abdominal pain, growth retardation, and anemia secondary to Helicobacter pylori-associated peptic ulcer.

    Science.gov (United States)

    Andrianov, Melissa; Rivera, Edgardo; Azzam, Ruba

    2015-03-01

    A 15-year-old boy with abdominal pain, growth retardation, and symptomatic anemia requiring blood transfusion was seen by a gastroenterologist and found to have a large ulcerated, fungating, and actively bleeding mass in his stomach. Initially, the patient was screened for Helicobacter pylori and found to be negative, so there was concern for malignancy after multiple endoscopic procedures. The patient did not respond to initial ulcer treatment and immediately prior to scheduled partial gastrectomy, additional tissue sections from the initial biopsy were stained for H. pylori and rare positive staining organisms were found. The test was positive, and the patient was started empirically on treatment to which he responded and ultimately recovered fully. Gastrectomy was not performed, and following treatment, the ulcer, anemia, and poor growth resolved.

  19. [Bone metastases in breast carcinoma].

    Science.gov (United States)

    Teut, Michael; Warning, Albrecht

    2006-02-01

    The case of a 66-year-old patient with multiple osteolytic bone metastases caused by breast cancer is presented. The patient refused conventional pain therapy although she suffered from severe pain. A complementary therapy with homoeopathic high potencies, devil's-claw extract, enzymes, alendronate and orthomolecular substitution as well as physiotherapy resulted in effective pain relief over a period of 1 year. The case is discussed. PMID:16582551

  20. Curcumin improves bone microarchitecture in glucocorticoid-induced secondary osteoporosis mice through the activation of microRNA-365 via regulating MMP-9.

    Science.gov (United States)

    Li, Guowei; Bu, Juyuan; Zhu, Yingxian; Xiao, Xiaoyu; Liang, Zibin; Zhang, Rongkai

    2015-01-01

    The present study aimed to investigate bone microarchitecture of the proximal tibia in glucocorticoid-induced osteoporosis (GIOP) mice, and the underlying molecular mechanisms of curcumin in DXM-induced osteoporosis were performed. DXM-treated facilitated to induce hypercalciuria in mice, and curcumin-treated showed a decrease in urine calcium. Curcumin reversed DXM-induced bone resorption, including an increase in serum OCN and a decrease in bone resorption markers CTX and TRAP-5b. H&E staining showed the increased disconnections and separation in trabecular bone network as well as the reduction of trabecular thickness throughout the proximal metaphysis of tibia in GIOP group. Importantly, curcumin reversed DXM-induced trabecular deleterious effects and stimulated bone remodeling. The further evidence showed that curcumin supplement significantly decreased the TRAP-positive stained area and inhibited the activity of OPG/RANKL/RANK signaling in the GIOP mice. Moreover, bioinformatics analysis suggested that miR-365 was a regulator of MMP9. The levels of miR-365 were markedly suppressed; however, curcumin treatment could reverse the downregulation of miR-365 in the tibia of GIOP mice. Simultaneously, the results demonstrated that the mRNA and protein expression of MMP-9 were significantly increased in GIOP mice compared with that of the control group. Curcumin treatment could suppress the expression of MMP-9 in the tibia of GIOP mice. The present study demonstrated the protective effects of curcumin against bone deteriorations in the experimentally DIOP mice, and the underlying mechanism was mediated, at least partially, through the activation of microRNA-365 via suppressing MMP9. PMID:26884838

  1. Interrelationships between chronic tension-type headache, musculoskeletal pain, and vitamin D deficiency: Is osteomalacia responsible for both headache and musculoskeletal pain?

    Directory of Open Access Journals (Sweden)

    Sanjay Prakash

    2013-01-01

    Full Text Available Background: Headache, musculoskeletal symptoms, and vitamin D deficiency are common in the general population. However, the interrelations between these three have not been delineated in the literature. Materials and Methods: We retrospectively studied a consecutive series of patients who were diagnosed as having chronic tension-type headache (CTTH and were subjected to the estimation of serum vitamin D levels. The subjects were divided into two groups according to serum 25(OH D levels as normal (>20 ng/ml or vitamin D deficient (<20 ng/ml. Results: We identified 71 such patients. Fifty-two patients (73% had low serum 25(OH D (<20 ng/dl. Eighty-three percent patients reported musculoskeletal pain. Fifty-two percent patients fulfilled the American College of Rheumatology criteria for chronic widespread pain. About 50% patients fulfilled the criteria for biochemical osteomalacia. Low serum 25(OH D level (<20 ng/dl was significantly associated with headache, musculoskeletal pain, and osteomalacia. Discussion: These suggest that both chronic musculoskeletal pain and chronic headache may be related to vitamin D deficiency. Musculoskeletal pain associated with vitamin D deficiency is usually explained by osteomalacia of bones. Therefore, we speculate a possibility of osteomalacia of the skull for the generation of headache (osteomalacic cephalalgia?. It further suggests that both musculoskeletal pain and headaches may be the part of the same disease spectrum in a subset of patients with vitamin D deficiency (or osteomalacia, and vitamin D deficiency may be an important cause of secondary CTTH.

  2. Galectin-3 in bone tumor microenvironment: a beacon for individual skeletal metastasis management.

    Science.gov (United States)

    Nakajima, Kosei; Kho, Dong Hyo; Yanagawa, Takashi; Zimel, Melissa; Heath, Elisabeth; Hogan, Victor; Raz, Avraham

    2016-06-01

    The skeleton is frequently a secondary growth site of disseminated cancers, often leading to painful and devastating clinical outcomes. Metastatic cancer distorts bone marrow homeostasis through tumor-derived factors, which shapes different bone tumor microenvironments depending on the tumor cells' origin. Here, we propose a novel insight on tumor-secreted Galectin-3 (Gal-3) that controls the induction of an inflammatory cascade, differentiation of osteoblasts, osteoclasts, and bone marrow cells, resulting in bone destruction and therapeutic failure. In the approaching era of personalized medicine, the current treatment modalities targeting bone metastatic environments are provided to the patient with limited consideration of the cancer cells' origin. Our new outlook suggests delivering individual tumor microenvironment treatments based on the expression level/activity/functionality of tumor-derived factors, rather than utilizing a commonly shared therapeutic umbrella. The notion of "Gal-3-associated bone remodeling" could be the first step toward a specific personalized therapy for each cancer type generating a different bone niche in patients afflicted with non-curable bone metastasis. PMID:27067726

  3. Galectin-3 in bone tumor microenvironment: a beacon for individual skeletal metastasis management.

    Science.gov (United States)

    Nakajima, Kosei; Kho, Dong Hyo; Yanagawa, Takashi; Zimel, Melissa; Heath, Elisabeth; Hogan, Victor; Raz, Avraham

    2016-06-01

    The skeleton is frequently a secondary growth site of disseminated cancers, often leading to painful and devastating clinical outcomes. Metastatic cancer distorts bone marrow homeostasis through tumor-derived factors, which shapes different bone tumor microenvironments depending on the tumor cells' origin. Here, we propose a novel insight on tumor-secreted Galectin-3 (Gal-3) that controls the induction of an inflammatory cascade, differentiation of osteoblasts, osteoclasts, and bone marrow cells, resulting in bone destruction and therapeutic failure. In the approaching era of personalized medicine, the current treatment modalities targeting bone metastatic environments are provided to the patient with limited consideration of the cancer cells' origin. Our new outlook suggests delivering individual tumor microenvironment treatments based on the expression level/activity/functionality of tumor-derived factors, rather than utilizing a commonly shared therapeutic umbrella. The notion of "Gal-3-associated bone remodeling" could be the first step toward a specific personalized therapy for each cancer type generating a different bone niche in patients afflicted with non-curable bone metastasis.

  4. Arthritic Pain Relief through Partial Knee Replacement

    Medline Plus

    Full Text Available ... bones grinding against each other, leading to pain, stiffness and inflammation. At times in younger patients this ... full knee replacement, what are the risks of stiffness with a partial knee replacement? Yeah, also known ...

  5. Knee Pain and the Weekend Warriors

    Medline Plus

    Full Text Available ... pain? Absolutely. You know, alignment issues, you know, overall joint alignment issues, if you’re talking about ... bone to re-heal itself in a different overall alignment. So kind of like changing the alignment ...

  6. 蛛网膜下腔注射甲氨蝶呤对大鼠胫骨癌痛的影响%Effects of intraathecal methotrexate on mechanical allodynia in rats with tibial bone cancer pain

    Institute of Scientific and Technical Information of China (English)

    岳冬梅; 申文; 陈立平; 柳娇; 胡学铭

    2011-01-01

    Objective To investigate effects of intrathecal methotrexate on mechanical allodynia in rats with tibial bone cancer pain.Methods Forty-eight female SD rats weighing 150-180 g were randomly divided into 6 groups ( n =8 each):group Ⅰ sham operation + artificial cerebrospinal fluid(SA group),group Ⅱ sham operation + methotrexate 200 μg(SM group),group Ⅲ bone cancer pain + artificial cerebrospinal fluid(CA group),group Ⅳ-Ⅵ bone cancer pain + different doses of methotrexate (CM1-3 groups).The model of tibial bone cancer pain was induced by injecting Walker-256 cell into the tibial marrow cavity.CA and CM1-3 groups were intrathecal injected artificial cerebrospinal fluid,methotrexate 50,100 and 200 μg.SA and SM200 groups were intrathecal injected artificial cerebrospinal fluid and methotrexate 200 μg.The mechanical withdrawl threshold (MWT) was measured at day 1 before Walker-256 injection (baseline),7 day after injection (T0 ) and 2,4,8,24 hour and 1,3,5,7 days after intrathecal injection ( T1-8 ).Results Compered with the baseline,MWT was decrease in CA and CM1-s groups.Competed with To,MWT was decreased at T5-8 in CA group,MWT was increased at T3-5 in CM1 group,at T2-6 in CM2 group and at T2-7 in CM3 groups.MWT was decrease in CA and CM1-3 groups as compered with SA group; MWT was increased at T4-7 in CM1 group and at T3-7 in CM2 and CM3 groups.Conclusion Intrathecal injection of methotrexate can reduce tibial bone cancer pain in rats.%目的 评价蛛网膜下腔注射甲氨蝶呤对大鼠胫骨癌痛的影响.方法 雌性未交配SD大鼠48只,体重150~180 g,采用随机数字表法,将其随机分为6组(n=8):假手术+人工脑脊液组(SA组)、假手术+甲氨蝶呤200μg组(SM200组)、骨癌痛+人工脑脊液组(CA组)和骨癌痛+不同剂量甲氨蝶呤组(CM1~3组).CA组和CM1~3组采用胫骨骨髓腔内注射Walker-256乳腺癌细胞制备胫骨癌痛模型,于注射Walker-256乳腺癌细胞后第7天经L5.6蛛网膜下腔分别注

  7. Pain management in cancer cervix

    Directory of Open Access Journals (Sweden)

    Palat Gayatri

    2005-01-01

    Full Text Available Cancer of the cervix uteri is a common cause of pain among women. On the physical realm, the cancer may cause somatic [soft tissue and bone], visceral and neuropathic pain [lumbosacral plexopathy]. Radiotherapy and chemotherapy may cause neuropathy too. Psychological, social and cultural factors modify the pain. Evaluation of the individual type of pain and a patient-centred approach are fundamental requirements for rational management. Disease modifying treatment like radiotherapy and chemotherapy must be considered when applicable. Pain control is usually achieved by the use of WHO three-step ladder, remembering that possible association of renal dysfunction would necessitate caution in the use of NSAIDs and opioids. Side effects must be anticipated, prevented when possible, and aggressively treated; nausea and vomiting may already be present, and constipation can worsen pain when there is a pelvic mass. Pain emergencies can be treated by quick titration with intravenous morphine bolus doses. Neuropathic pain may warrant the use of usual adjuvants, with particular reference to cortico-steroids and the NMDA antagonist, ketamine. In intractable pain, many neurolytic procedures are tried, but a solid evidence base to justify their use is lacking. Continuous epidural analgesia with local anaesthetic and opioid may be needed when drug therapy fails, and desperate situations may warrant interventions such as neurolysis. Such physical measures for pain relief must be combined with psychosocial support and adequate explanations to the patient and the family.

  8. Why Social Pain Can Live on: Different Neural Mechanisms Are Associated with Reliving Social and Physical Pain.

    Directory of Open Access Journals (Sweden)

    Meghan L Meyer

    Full Text Available Although social and physical pain recruit overlapping neural activity in regions associated with the affective component of pain, the two pains can diverge in their phenomenology. Most notably, feelings of social pain can be re-experienced or "relived," even when the painful episode has long passed, whereas feelings of physical pain cannot be easily relived once the painful episode subsides. Here, we observed that reliving social (vs. physical pain led to greater self-reported re-experienced pain and greater activity in affective pain regions (dorsal anterior cingulate cortex and anterior insula. Moreover, the degree of relived pain correlated positively with affective pain system activity. In contrast, reliving physical (vs. social pain led to greater activity in the sensory-discriminative pain system (primary and secondary somatosensory cortex and posterior insula, which did not correlate with relived pain. Preferential engagement of these different pain mechanisms may reflect the use of different top-down neurocognitive pathways to elicit the pain. Social pain reliving recruited dorsomedial prefrontal cortex, often associated with mental state processing, which functionally correlated with affective pain system responses. In contrast, physical pain reliving recruited inferior frontal gyrus, known to be involved in body state processing, which functionally correlated with activation in the sensory pain system. These results update the physical-social pain overlap hypothesis: while overlapping mechanisms support live social and physical pain, distinct mechanisms guide internally-generated pain.

  9. Intrauterine retention of foetal bone: an IUCD effect

    Directory of Open Access Journals (Sweden)

    Balaji P. Nalwad

    2014-06-01

    Full Text Available Intrauterine retention of foetal bone is a rare complication of abortion. These patients may present with irregular bleeding per vaginum, dysmenorrheal, pelvic pain and secondary infertility. A 27 year old female (G2, P1, L1, A1 referred by a general practitioner to our OPD as a case of secondary infertility. Patient was asymptomatic and had a second trimester abortion three years back. USG showed a foreign body in the uterine cavity. There was no history of IUCD insertion. On the advice of general practitioner, CT scan was done, which showed similar finding. Then this case was referred to us for further clinical evaluation. On hysteroscopy, we found foetal bones impacted between two Ostia which were removed with difficulty in the same setting. Dye test for patency of tubes was negative, probably due to edema. After that, patient conceived naturally within four months and delivered a healthy baby. Retained foetal bone in the uterine cavity was causing secondary infertility by its IUCD effect. Hysteroscopy is the gold standard method for diagnosis and treatment of foreign body in the uterine cavity. [Int J Res Med Sci 2014; 2(3.000: 1229-1231

  10. Influences of intrathecal administration of roscovitine on bone cancer pain in mouse models%鞘内注射Roscovitine对小鼠骨癌痛行为学的影响

    Institute of Scientific and Technical Information of China (English)

    张睿; 马正良; 梅凤美; 张娟; 顾晓萍

    2010-01-01

    Objective To investigate the influences of intrathecal administration of roscovitine on bone cancer pain in mouse models. Methods Twenty four C3H/Hej mice were divided randomly into group S(sham + vehicle ), group C(tumor + vehicle) or group R (tumor+ roscovitine) (n = 8 ). Osteosarcoma NCTC 2472 cells were implanted into the intramedullary space of the right femurs of mice to make bone cancer pain models. α-MEM (group Sand group C) or roscovitine (group R) was injected in 14 post-implanted day. Pain behaviors such as paw withdrawal mechanical threshold(PMWT) and paw withdrawal thermal latency (PWTL) were observed at 1,6, 24,48 and 72 post-injective hour, respectively. Results The level of PMWT and PTWL among every group had no difference before operation. At day 7 after inoculation, PMWT of group tumor decreased to (1.08±0.24) g, and at day 10 PTWL shortened to (12.7±1.4) s, and then the pain behaviors of group tumor showed aggravation along with the development of cancer pain. There was significant difference in the pain behavior thresholds between group sham and group tumor (P<0.05). The level of PM WT [ (0.70±0.19 ) g ] and PTWL [ ( 14.16±1.07 ) s] increased compared with group C and base level at 6 h after intrathecal administration of 20 μg Roscovitine, and kept increasing until reaching maximum level after 12 h, then the value decreased gradually, lowering to the level of group C after 72 h. Conclusion Intrathecal administration of roscovitine can relief bone cancer pain in mouse models.%目的 探讨鞘内给予细胞周期依赖性激酶5(cyclin-dependent kinases,Cdk5)特异性拮抗剂Roscovitine对小鼠骨癌痛行为学的影响.方法 24只C3H/Hej 小鼠采用随机数字表法随机分为3组,S组(假手术后14 d+溶媒)、C组(接种后14d+溶媒)、R组(接种后14 d+Roscovitine),每组8只.C组和R组将含2×105个纤维肉瘤NCTC 2472细胞的最小必需培养基(α-MEM)20μl注射到小鼠右侧股骨远端骨髓腔内,制作骨癌

  11. Pain Management

    Science.gov (United States)

    ... opiates such as morphine could relieve pain and chemist Felix Hoffmann developed aspirin from a substance in ... sensory and emotional experience associated with actual or potential tissue damage.” TODAY Pain affects more Americans than ...

  12. [Oral pain].

    Science.gov (United States)

    Benslama, Lotfi

    2002-02-15

    Pain, a major symptom of stomatological disease, usually leads to a specialist consultation. Most commonly it is caused by dental caries and differs in nature and in intensity according to the stage of disease: dentinitis, pulpitis, desmodontitis and dental abscess. Added to this is peridental pain and the pre- and post-operative pains related to these diseases. Almost all oral-maxillary pathology is painful, be it boney such as in osteomyelitis and fractures, mucosal in gingivo-stomatitis and aphthous ulcers, or tumourous. However, besides the "multidisciplinary" facial pains such as facial neuralgia and vascular pain, two pain syndromes are specific to stomatology: pain of the tempero-mandibular joint associated with problems of the bite and glossodynia, a very common somatic expression of psychological problems.

  13. Habituating pain

    DEFF Research Database (Denmark)

    Ajslev, Jeppe Zielinski Nguyen; Lund, Henrik Lambrecht; Møller, Jeppe Lykke;

    2013-01-01

    the industry reproduce physical strain and the habituation of pain as unquestioned conditions in construction work. The understanding of this mutual reinforcement of the necessity of physically straining, painful, high-paced construction work provides fruitful perspectives on the overrepresentation...

  14. Testicle pain

    Science.gov (United States)

    ... pain include: Injury Infection or swelling of the sperm ducts ( epididymitis ) or testicles ( orchitis ) Twisting of the ... Cyst in the epididymis that often contains dead sperm cells ( spermatocele ) Fluid surrounding the testicle ( hydrocele ) Pain ...

  15. Breast pain

    Science.gov (United States)

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  16. Myofascial pain syndrome treatments.

    Science.gov (United States)

    Borg-Stein, Joanne; Iaccarino, Mary Alexis

    2014-05-01

    Myofascial pain syndrome (MPS) is a regional pain disorder caused by taut bands of muscle fibers in skeletal muscles called myofascial trigger points. MPS is a common disorder, often diagnosed and treated by physiatrists. Treatment strategies for MPS include exercises, patient education, and trigger point injection. Pharmacologic interventions are also common, and a variety of analgesics, antiinflammatories, antidepressants, and other medications are used in clinical practice. This review explores the various treatment options for MPS, including those therapies that target myofascial trigger points and common secondary symptoms.

  17. Utility of the dimercapto succinic acid pentavalent ({sup 99m} Tc- DMSA V) in the diagnostic of secondary bone leisure at metastasis of diverse primary tumours. Preliminary study; Utilidad del acido dimercapto succinico pentavalente ({sup 99m} Tc-DMSA V) en el diagnostico de lesiones oseas secundarias a metastasis de diversos tumores primarios. Estudio preliminar

    Energy Technology Data Exchange (ETDEWEB)

    Ortega L, N. [Hospital de Especialidades ' Dr. Antonio Fraga Mouret' Centro Medico Nacional ' La Raza' , IMSS Mexico D.F. (Mexico); Pichardo R, P.A. [Medico Nuclear adscrito al servicio de Medicina Nuclear del Hospital de Oncologia, Centro Medico Nacional Siglo XXI, IMSS, Mexico D.F. (Mexico); Marquez H, A. [Departamento de Medicina Nuclear, IMSS, Mexico D.F. (Mexico)

    2005-07-01

    The more used method in the diagnosis of secondary bone lesions to become cancerous it is by means of having derived of phosphates like it is the {sup 99m}Tc- MDP. The reason of acquiring searching with the radiopharmaceutical {sup 99m}Tc- DMSA V is with the purpose to find other bone lesions that are not visualized with the gammagraphy with diphosphonate and therefore to increase the specificity of the study. (Author)

  18. Urination Pain

    Science.gov (United States)

    ... more often bad-smelling, bloody, or discolored urine (pee) fever or chills decreased appetite or activity irritability nausea or vomiting lower back pain or abdominal (belly) pain wetting accidents (in potty-trained kids) What to Do Call the doctor if your child has pain while urinating or can't ...

  19. Abdominal Pain

    Science.gov (United States)

    ... relaxation. Guided imagery for abdominal pain About self-hypnosis and kids See YourChild : Pain and Your Child or Teen for more detail ... how to help your baby cope with the pain of medical procedures, circumcision, and teething. ... Helping Kids YourChild : A Look at Biofeedback YourChild : ...

  20. X-ray for primary and secondary aneurysmal bone cyst%原发与继发动脉瘤样骨囊肿X线表现对比研究

    Institute of Scientific and Technical Information of China (English)

    盛业友

    2016-01-01

    Objective To investigate the effect of X-ray for primary and secondary aneurysmal bone cyst.Methods 40 cases of primary aneurysmal bone cyst,40 cases of secondary aneurysmal bone cyst were selected.Compared X-ray findings and characteristics of two group according to pathological type.Results X-ray findings showed that decentration type accounted for 82.5% in primary group,significantly higher than 30.0% in secondary group (P<0.05);intramedullary type and cortical type accounted for 12.5% and 5.0% in primary group,significantly lower than 32.5% and 37.5% in secondary group (P<0.05).The rate of blow balloon like,soap bubble like and fluid-fluid level X-ray characteristics in primary group were 82.5%,77.5% and 72.5%,higher than 12.5%,17.5% and 7.5% in secondary group (P<0.05).Conclusion X-ray for young men showed decentration type lesions,with blow balloon like,soap bubble like and fluid-fluid level X-ray characteristics,who were mostly primary aneurysmal bone cyst.%目的 探讨原发与继发动脉瘤样骨囊肿X线特征表现.方法 选择患者80例,原发性和继发性各40例,根据病理分型统计两组X线表现类型及X线特征样改变.结果 原发组X线表现类型中偏心型比例为82.5%,显著多于继发组的30.0% (P<0.05),髓内型比例为12.5%,皮质型比例为5.0%,显著少于继发组的32.5%和37.5% (P<0.05).原发组存在吹气球样、皂泡样及液-液平面的比例分别为82.5%、77.5%和72.5%,均显著高于继发组的12.5%、17.5%和7.5%(P<0.05).结论 对于青年男性,X线表现为偏心型病变,并存在吹气球样、皂泡样或者液-液平面改变者,原发性动脉瘤样骨囊肿可能性较大.

  1. Spinal pain

    International Nuclear Information System (INIS)

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  2. Spinal pain

    Energy Technology Data Exchange (ETDEWEB)

    Izzo, R., E-mail: roberto1766@interfree.it [Neuroradiology Department, A. Cardarelli Hospital, Naples (Italy); Popolizio, T., E-mail: t.popolizio1@gmail.com [Radiology Department, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (Fg) (Italy); D’Aprile, P., E-mail: paoladaprile@yahoo.it [Neuroradiology Department, San Paolo Hospital, Bari (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Department, A. Cardarelli Hospital, Napoli (Italy)

    2015-05-15

    Highlights: • Purpose of this review is to address the current concepts on the pathophysiology of discogenic, radicular, facet and dysfunctional spinal pain, focusing on the role of the imaging in the diagnostic setting, to potentially address a correct approach also to minimally invasive interventional techniques. • Special attention will be given to the discogenic pain, actually considered as the most frequent cause of chronic low back pain. • The correct distinction between referred pain and radicular pain contributes to give a more correct approach to spinal pain. • The pathogenesis of chronic pain renders this pain a true pathology requiring a specific management. - Abstract: The spinal pain, and expecially the low back pain (LBP), represents the second cause for a medical consultation in primary care setting and a leading cause of disability worldwide [1]. LBP is more often idiopathic. It has as most frequent cause the internal disc disruption (IDD) and is referred to as discogenic pain. IDD refers to annular fissures, disc collapse and mechanical failure, with no significant modification of external disc shape, with or without endplates changes. IDD is described as a separate clinical entity in respect to disc herniation, segmental instability and degenerative disc desease (DDD). The radicular pain has as most frequent causes a disc herniation and a canal stenosis. Both discogenic and radicular pain also have either a mechanical and an inflammatory genesis. For to be richly innervated, facet joints can be a direct source of pain, while for their degenerative changes cause compression of nerve roots in lateral recesses and in the neural foramina. Degenerative instability is a common and often misdiagnosed cause of axial and radicular pain, being also a frequent indication for surgery. Acute pain tends to extinguish along with its cause, but the setting of complex processes of peripheral and central sensitization may influence its evolution in chronic

  3. Bone- and bone marrow scintigraphy in Gaucher disease type 1

    Energy Technology Data Exchange (ETDEWEB)

    Mikosch, P. [Dept. of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt (Austria); Dept. of Internal Medicine II, State Hospital Klagenfurt (Austria); Zitter, F. [Dept. of Internal Medicine II, State Hospital Klagenfurt (Austria); Gallowitsch, H.J.; Lind, P. [Dept. of Nuclear Medicine and Endocrinology, State Hospital Klagenfurt (Austria); Wuertz, F. [Dept. of Pathology, State Hospital Klagenfurt (Austria); Mehta, A.B.; Hughes, D.A. [Lysosomal Storage Disorder Unit, Dept. of Academic Haematology, Royal Free and Univ. Coll. Medical School, London (United Kingdom)

    2008-07-01

    Scintigraphy is a method for imaging metabolism and should be viewed as complimentary to morphological imaging. Bone and bone marrow scintigraphy can particularly contribute to the detection of focal disease in Gaucher disease. In bone crises it can discriminate within three days after pain onset between local infection and aseptic necrosis. A further advantage of bone- and bone marrow scintigraphy is the visualization of the whole skeleton within one setting. Whole body imaging for focal lesions might thus be an objective in GD, in particular in patients complaining of several painful sites. Direct imaging of bone marrow deposits in GD by MIBI scintigraphy might be of special interest in children in whom bone marrow undergoes a developmental conversion from red to yellow marrow in the ap-pendicular skeleton. MRI interpretation in young GD patients is thus difficult in order to estimate the exact amount and extent of bone marrow infiltration by Gaucher cells. 99mTc-MIBI scintigraphy with its direct visualization of lipid storage could thus add interesting additional information not shown with other methods including MRI. Although MRI is the most accepted imaging modality in assessing the skeletal status in GD, a selective use of scintigraphy for imaging bone and bone marrow may add information in the evaluation of patients with Gaucher disease.

  4. [Chronic pain in geriatrics].

    Science.gov (United States)

    Kennes, B

    2001-06-01

    Pain is frequent in communicative or no-communicative, ambulatory, institutionalized or hospitalized veterans. It is associated with severe comorbidity so much more than chronic pain could be neglected and expressed of atypical manner or masked by the absence of classical symptoms in particular in case of dementia or of sensory disorders. Pain detection by clinic examination or by pain assessment's methods and adequate approach by pharmacological and non pharmacological therapies are essential for correct pain management. On pharmacological plan, the strategy of the O.M.S. landings is applicable owing to a more particular attention to secondary effects and drugs interactions. AINS must be manipulated with prudence. There are no reasons to exclude opioides from the therapeutic arsenal but with a reduction of the starting doses, a regular adaptation and a very attentive survey. In drugs of landing 2, tramadol reveals itself as efficient and better tolerated as the codeine and dextropropoxyphene has to be to avoid. The obtaining of a satisfactory result depends on a regular assessment of the pain in a context of polydisciplinar approach (physicians, nurses, paramedicals, other care givers).

  5. Strontium-89 for prostate cancer with bone metastases. The potential of cancer control and improvement of overall survival

    International Nuclear Information System (INIS)

    Strontium-89 (Sr-89) has been considered to have a tumoricidal effect with minimal adverse events. However, few reports have investigated these effects in detail. In this study, we examined the tumoricidal and pain-relief effects of Sr-89 on prostate cancer with bone metastasis as well as survival. A retrospective study was performed involving 31 prostate cancer patients with bone metastasis treated with Sr-89. Using prostate specific antigen (PSA) as an evaluation criterion of cancer control, patients were divided into PSA responder and non-responder groups, and the survival rates of these groups were compared. In addition, using the total amount of painkillers administered as an evaluation criterion of pain relief, patients were divided into pain responder and non-responder groups, and the survival rates of these groups were also compared. As secondary investigation items, age, PSA (ng/ml), pain site, extent of the disease, the presence or absence of castration-resistant prostatic cancer (CRPC), the presence or absence of a past medical history of treatment with docetaxel in CRPC cases, Gleason Score, hemoglobin (g/dl), platelet (Plt) (/μl), serum carboxyterminal telopeptide of type I collagen (ng/ml), and bone-alkaline phosphatase (BAP) (U/l) were investigated. Longer survival was expected for the PSA responder group than for the PSA non-responder group, and whether the spine was the pain site and the presence or absence of CRPC were useful as predictors of this. Plt was suggested to be a useful indicator. Furthermore, the survival time was significantly longer in the pain responder group than in the pain non-responder group, and whether the pain site was present in the spine was considered to be a predictor; however, no significant difference was noted in any of the items assumed to be biomarkers. Sr-89 has the potential to control PSA and prolong survival. A large-scale prospective study of the therapeutic effect of Sr-89 is expected. (author)

  6. Neurovascular plexus theory for "escape pain phenomenon" in lower third molar surgery

    Directory of Open Access Journals (Sweden)

    Gururaj Arakeri

    2015-06-01

    Full Text Available Pain during extraction of impacted mandibular third molars which can occur despite adequate local anesthesia is termed as "escape pain phenomenon". Recently, it was described during elevation of a mesioangular impacted mandibular third molar and also while curetting an extracted third molar socket. This phenomenon has been overlooked, as it was previously considered secondary to pressure effect on the inferior alveolar neurovascular bundle (IANB. However, it is unlikely that the pain impulses originate from direct pressure on the IANB, as the nerve is blocked more proximally at its entry into the mandible. The authors speculated that the occasional presence of a neurovascular plexus (NVP independent of the IANB causes the escape of a pain impulse upon stimulation by root pressure or instrumentation. To validate the presence of such a plexus, a meticulous literature search and review were performed. The search revealed evidence of the occasional presence of a NVP consisting of auriculotemporal and/or retromolar neural filaments. The plexus may be present around the inferior alveolar artery or embedded within the IANB, and does not innervate the tooth. This plexus likely propagates pain impulses only upon stimulation by compression or instrumentation in the apical area of the tooth socket. This theory explains the absence of pain during tooth sectioning and bone guttering in the presence of a complete inferior alveolar nerve block.

  7. Bone Grafts

    Science.gov (United States)

    ... repair and rebuild diseased bones in your hips, knees, spine, and sometimes other bones and joints. Grafts can also repair bone loss caused by some types of fractures or cancers. Once your body accepts the bone ...

  8. Temporomandibular pain.

    Science.gov (United States)

    Prasad, S Raghavendra; Kumar, N Ravi; Shruthi, H R; Kalavathi, S D

    2016-01-01

    Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view. PMID:27601822

  9. Radionuclides and the normal bone scan

    International Nuclear Information System (INIS)

    Recently, Eisenhut and co-workers have described development of iodine-131 labeled diphosphonates for palliative treatment of bone metastases. The compound labeled was alpha-amino (4-hydroxybenzylidene) diphosphonate (BDP3). Other beta-emitting radionuclides have been used for treatment of intractable pain secondary to bone metastases. These include strontium-89, which has some difficulties, particularly in terms of disposal of the excretions due to the long physical half-life of the life of the radionuclide. Yttrium-90 has also been used but has a relatively high hepatic uptake. Phosphorus-32 labeled compounds have also been used. Although palliation has been described, bone marrow depression has also occurred. Rhenium-186 also has been suggested, however, high renal uptake is a problem. At present, the iodine-131 labeled BDP3 appears to be the best of the available therapeutic radiopharmaceuticals. One of the major disadvantages in use of this compound is the production of gamma photons. While undesirable from a dosimetry viewpoint, gamma photons do, however, permit imaging if desired

  10. Musculoskeletal pain in overweight and obese children.

    Science.gov (United States)

    Smith, S M; Sumar, B; Dixon, K A

    2014-01-01

    This review seeks to provide a current overview of musculoskeletal pain in overweight and obese children. Databases searched were Academic Search Complete, CINAHL, Medline, Proquest Health and Medical Complete, Scopus, Google Scholar, SPORTDiscuss and Trove for studies published between 1 January 2000 and 30 December 2012. We used a broad definition of children within a 3- to 18-year age range. The search strategy included the following terms: obesity, morbid obesity, overweight, pain, musculoskeletal pain, child, adolescent, chronic pain, back pain, lower back pain, knee pain, hip pain, foot pain and pelvic pain. Two authors independently assessed each record, and any disagreement was resolved by the third author. Data were analysed using a narrative thematic approach owing to the heterogeneity of reported outcome measures. Ninety-seven records were initially identified using a variety of terms associated with children, obesity and musculoskeletal pain. Ten studies were included for thematic analysis when predetermined inclusion criteria were applied. Bone deformity and dysfunction, pain reporting and the impact of children being overweight or obese on physical activity, exercise and quality of life were the three themes identified from the literature. Chronic pain, obesity and a reduction in physical functioning and activity may contribute to a cycle of weight gain that affects a child's quality of life. Future studies are required to examine the sequela of overweight and obese children experiencing chronic musculoskeletal pain. PMID:24077005

  11. Orofacial pain management: current perspectives

    Directory of Open Access Journals (Sweden)

    Romero-Reyes M

    2014-02-01

    Full Text Available Marcela Romero-Reyes, James M Uyanik Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA Abstract: Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures. Orofacial pain (OFP can arise from different regions and etiologies. Temporomandibular disorders (TMD are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities. Keywords: pain, orofacial, neuropathic, TMD, trigeminal, headache

  12. Nursing of Prostate Cancer With Bone Pain in Patients%前列腺癌骨转移疼痛患者的观察及护理体会

    Institute of Scientific and Technical Information of China (English)

    高会华; 韩萍; 李晓红

    2015-01-01

    目的:探讨对前列腺癌骨转移患者实施唑来磷酸注射治疗的护理。方法回顾分析36例唑来磷酸注射治疗前列腺癌骨转移患者临床资料,行静脉滴注,4 mg/次,4周/次,连续治疗4次,并采取基础护理、心理护理、不良反应、预防感染、疼痛护理等全面的护理措施。结果36例患者治疗后14例CR,18例PR,有效率达88.9%;27例患者生活质量得到显著改善,有效率为75.0%。结论加强前列腺癌骨转移患者行唑来磷酸注射治疗的护理,能有效减轻患者痛苦,确保患者顺利完成治疗。%ObjectiveTo investigate the implementation of prostate cancer patients with bone metastases zoledronic acid injection therapy.Methods Retrospective analysis of 36 cases of zoledronic acid injection therapy clinical data in prostate cancer patients with bone metastases, intravenous infusion, 4mg / times, 4 weeks / time, continuous treatment four times, and take basic care, psychological care, adverse reactions, prevention infection, pain care, comprehensive care measures.Results36 cases of patients after 14 cases of CR, 18 cases PR, the effective rate of 88.9%; 27 patients quality of life has been significantly improved, the effective rate was 75.0%. ConclusionStrengthening of prostate cancer patients with bone metastases zoledronic acid injection therapy care, can effectively reduce the suffering of patients, to ensure the successful completion of patient treatment.

  13. Validation of three tools for identifying painful new osteoporotic vertebral fractures in older Chinese men: bone mineral density, Osteoporosis Self-Assessment Tool for Asians, and fracture risk assessment tool

    Directory of Open Access Journals (Sweden)

    Lin JS

    2016-04-01

    Full Text Available JiSheng Lin,* Yong Yang,* Qi Fei, XiaoDong Zhang, Zhao Ma, Qi Wang, JinJun Li, Dong Li, Qian Meng, BingQiang Wang Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China *These authors contributed equally to this work Objective: This cross-sectional study compared three tools for predicting painful new osteoporotic vertebral fractures (PNOVFs in older Chinese men: bone mineral density (BMD, the Osteoporosis Self-Assessment Tool for Asians (OSTA, and the World Health Organization fracture risk assessment tool (FRAX (without BMD. Methods: Men aged ≥50 years were apportioned to a group for men with fractures who had undergone percutaneous vertebroplasty (n=111, or a control group of healthy men (n=385. Fractures were verified on X-ray and magnetic resonance imaging. BMD T-scores were determined by dual energy X-ray absorptiometry. Diagnosis of osteoporosis was determined by a BMD T-score of ≤2.5 standard deviations below the average for a young adult at peak bone density at the femoral neck, total hip, or L1–L4. Demographic and clinical risk factor data were self-reported through a questionnaire. BMD, OSTA, and FRAX scores were assessed for identifying PNOVFs via receiver-operating characteristic (ROC curves. Optimal cutoff points, sensitivity, specificity, and areas under the ROC curves (AUCs were determined. Results: Between the men with fractures and the control group, there were significant differences in BMD T-scores (at femoral neck, total hip, and L1–L4, and OSTA and FRAX scores. In those with fractures, only 53.15% satisfied the criteria for osteoporosis. Compared to BMD or OSTA, the FRAX score had the best predictive value for PNOVFs: the AUC of the FRAX score (cutoff =2.9% was 0.738, and the sensitivity and specificity were 82% and 62%, respectively. Conclusion: FRAX may be a valuable tool for identifying PNOVFs in older Chinese men. Keywords: osteoporosis, male

  14. Bone within a bone

    Energy Technology Data Exchange (ETDEWEB)

    Williams, H.J.; Davies, A.M. E-mail: wendy.turner@roh.nhs.uk; Chapman, S

    2004-02-01

    The 'bone within a bone' appearance is a well-recognized radiological term with a variety of causes. It is important to recognize this appearance and also to be aware of the differential diagnosis. A number of common conditions infrequently cause this appearance. Other causes are rare and some remain primarily of historical interest, as they are no longer encountered in clinical practice. In this review we illustrate some of the conditions that can give the bone within a bone appearance and discuss the physiological and pathological aetiology of each where known.

  15. A new three-dimensional scale in the evaluation of the secondary alveolar bone grafting%牙槽突裂植骨疗效的影像学评价方法探讨

    Institute of Scientific and Technical Information of China (English)

    刘璐玮; 马莲; 林久祥; 贾绮林

    2015-01-01

    Objective To propose a new three-dimensional method or grading scale in the evaluation of the secondary alveolar bone grafting,thus modifying the Bergland grading scale.Methods A total of 40 patients (26 male,14 female) with unilateral cleft lip and palate (UCLP),who underwent secondary alveolar bone grafting at least 3 months ago,were enrolled.Regional cone-beam CT(CBCT) scans were taken to evaluate the height and thickness of the postoperative bone bridges.A new three-dimensional grafting scale was established,including four grades respectively in alveolar height and thickness.Results According to the new three-dimensional scale in this study,15 grafted sites were rated grade T-Ⅰ or T-Ⅱ in the alveolar thickness among 18 sites of grade H-Ⅰ in height,and 10 among 15 of grade H-Ⅱ in height.Therefore,25 grafted sites were considered as clinical success in the alveolar thickness (grade T-Ⅰ or T-Ⅱ) among 33 sites with clinical success in alveolar height (grade H-Ⅰ and H-Ⅱ).There were 24% of 33 sites with clinical success in height,which were considered as clinical failure in the alveolar thickness.Conclusions It is necessary to establish a new three-dimensional method or grading scale for evaluating the secondary alveolar bone grafting.The three-dimensional scale can take comprehensive view of the bone-grafted alveolar clefts and thus modify the Bergland grading scale.%目的 提出评价牙槽突裂植骨疗效的三维分级标准,完善Bergland评价系统.方法 本研究选择于2014年1至4月在北京大学口腔医学院·口腔医院就诊的单侧完全性唇腭裂患者40例,均在二期牙槽突裂植骨术后3个月拍摄植骨区牙槽突局部锥形束CT片,提出牙槽突高度分级(H-Ⅰ~H-Ⅳ级)、厚度分级(T-Ⅰ ~T-Ⅳ级)、牙槽突综合分级(H+T)及临床成功标准(高度和厚度总分级均为Ⅰ或Ⅱ级时,属于临床成功型).结果 33侧植骨区牙槽突高度为临床成功型(18侧H-Ⅰ级和15侧H-Ⅱ

  16. Wnt and Wnt inhibitors in bone metastasis

    OpenAIRE

    Sottnik, Joseph L; Christopher L. Hall; Zhang, Jian; Evan T. Keller

    2012-01-01

    Bone metastasis is a clinically devastating development of progressive cancers including prostate carcinoma, breast carcinoma and multiple myeloma. Bone metastases are typically painful, lead to adverse skeletal-related events, such as fracture, and are highly resistant to therapy. A major contribution to the ability of cancers to successfully establish bone metastases is their ability to exploit mechanisms of normal bone remodeling. Wnts are a large family of morphogenic proteins that are cr...

  17. Knee bone tumors: findings on conventional radiology*

    Science.gov (United States)

    Andrade Neto, Francisco; Teixeira, Manuel Joaquim Diógenes; Araújo, Leonardo Heráclio do Carmo; Ponte, Carlos Eduardo Barbosa

    2016-01-01

    The knee is a common site for bone tumors, whether clinically painful or not. Conventional radiology has been established as the first line of investigation in patients with knee pain and can reveal lesions that often generate questions not only for the generalist physician but also for the radiologist or general orthopedist. History, image examination, and histopathological analysis compose the essential tripod of the diagnosis of bone tumors, and conventional radiology is an essential diagnostic tool in patients with knee pain. This pictorial essay proposes to depict the main conventional radiography findings of the most common bone tumors around the knee, including benign and malignant tumors, as well as pseudo-tumors.

  18. Bone metastasis in patients with para neoplastic myasthenic syndrome - Possible indication for bone scintigraphy

    International Nuclear Information System (INIS)

    Full text: Myasthenia gravis (MG) is a neuromuscular disorder caused by a decrease in the number of acetylcholine receptors at neuromuscular junctions and consequently characterized by weakness and fatigue. Paraneoplastic myasthenic syndrome (PMS) is a neurological disorder often difficult to diagnose in clinical practice, due to the lack, in most cases, of any sign of malignancy at the time when neurological impairment occurs. The connection between MG and pathological alterations of the thymus as well as between the presynaptic membrane alteration (Lambert-Eaton myasthenic syndrome) and the small-cell lung cancer is often demonstrated. Most researchers agree that myasthenic syndrome noticed in aged persons should be investigated as a possible paraneoplastic disorder. The aim of our study was to find if suspected PMS could be an indication to perform a bone scan, in presence of parameters suggesting malignancy (such as elevated serum levels of alkaline phosphatase, elevated tumor markers, unexplained bone pain etc.). Another question is whether bone metastases occur more frequently in malignancies associated with PMS than in the same diseases without neurological involvement, taking into account that neurological disorders are not produced by metastatic or direct invasion of the nervous system by the cancer. Our observations included 28 patients (13 men and 15 women), aged 42-80 years with myasthenic syndrome, who were referred by the neurology department for suspicion of bone metastasis. All patients had elevated serum levels of alkaline phosphatase, 18 patients had therapy-resistant bone and joints pain. Conventional imaging procedures (abdominal ultrasound, chest X-ray and computer tomography) were performed in all patients. Only in 6 patients the primary malignancy was diagnosed prior to bone scan (5 cases with thymoma and 1 case of digestive neoplasm). Bone scan was performed on a Diacam Siemens gamma camera and consisted of whole-body examination after

  19. Polyphosphate bone scanning on non-malignant bone disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Paul, D.J.; Gilday, D.L.

    1975-12-01

    The advent of /sup 99m/technetium phosphate bone scanning radiopharmaceuticals has opened new methods of investigation of pediatric bone diseases. In axial skeleton pain, suspected osteomyelitis, evaluation of vascular integrity and suspected but undetected fractures, the bone scan has proved to be a highly complementary study to the radiologic examination.

  20. Increased technetium-99 m hydroxy diphosphonate soft tissue uptake on bone scintigraphy in chronic kidney disease patients with secondary hyperparathyroidism

    DEFF Research Database (Denmark)

    Enevoldsen, Lotte Hahn; Heaf, James Goya; Højgaard, Liselotte;

    2015-01-01

    In bone scan patients with dialysis-treated chronic kidney disease (CKD) and hyperparathyroidism, soft tissue accumulation of technetium-99 m hydroxy/methylene diphosphonate (Tc-99 m-HDP/MDP) has been reported primarily in case reports and usually explained by hypercalcaemia and...... only differed from patients without in terms of plasma phosphate levels (1·95 ± 0·15 (n = 37) versus 1·27 ± 0·08 (n = 26), P = 0·0012). All patients with myocardial uptake (n = 27) had a coronary arteriography-verified history of coronary artery disease (CAD), whereas CAD was only present in six...

  1. Pain genes.

    Directory of Open Access Journals (Sweden)

    Tom Foulkes

    2008-07-01

    Full Text Available Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors signal the existence of tissue damage to the central nervous system (CNS, where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.

  2. Clinical Observation in the Treatment of Pain in Bone Metastatic Cancer with Yishengukang Formula and Thermal Therapy%益肾骨康方联合热疗治疗骨转移癌疼痛的临床观察

    Institute of Scientific and Technical Information of China (English)

    高音; 冯利; 王芳; 勾涛

    2014-01-01

    Objective ToobservetheclinicalefficacyofYishenggukangFormulaandthermalthera-pyinthepatientsofpainofbonemetastaticcancer.Methods Fortycaseswererandomizedintoatreatment group and a control group.In the control group,20 cases were treated with Acetaminiphen Oxycodone Tablets to suppress pain of bone metastatic cancer.In the treatment group,20 cases were treated with Yishenggukang Formula and local thermal therapy beside the medication as the control group.In 2 weeks of treatment,pain relief,drug dose of Acetaminiphen Oxycodone Tablets and physical condition were observed and analyzed in thetwogroups.Results Aftertreatment,inthetreatmentgroup,theresultofpainreliefwasremarkablysu-perior to the control group(P<0.05).The reducing rate of the drug dose of Acetaminiphen Oxycodone Tab-lets was quite higher than that in the control group(P<0.05).The improvement rate of physical condition in thetreatmentgroupwashigherthanthatinthecontrolgroup(P<0.05).Conclusion TheallianceofYish-enggukang Formula and local thermal therapy remarkably suppresses pain of bone metastatic cancer,reduces the dose of strong opioids and improves physical condition.It plays the significant role in the improvement of survival quality of patients.%目的:观察骨转移癌疼痛患者应用益肾骨康方联合热疗镇痛的临床疗效。方法将40例伴有不同程度骨转移癌疼痛的患者随机分为治疗组和对照组。对照组20例,单纯应用氨酚羟考酮片(泰勒宁)控制骨转移癌疼痛。治疗组20例,在对照组治疗基础上内服益肾骨康方联合骨转移部位局部热疗。治疗2周后对两组患者治疗前后疼痛缓解情况、氨酚羟考酮片(泰勒宁)用药剂量、体力状况进行观察和分析。结果治疗后治疗组疼痛缓解情况明显优于对照组(P<0.05);治疗组氨酚羟考酮片使用量减少率远高于对照组(P<0.05);两组治疗后体力状况评分提高率比较,治疗组高于

  3. Bone cysts: unicameral and aneurysmal bone cyst.

    Science.gov (United States)

    Mascard, E; Gomez-Brouchet, A; Lambot, K

    2015-02-01

    Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy. PMID:25579825

  4. Myofascial Pain Syndrome in Chronic Back Pain Patients

    Science.gov (United States)

    Nizar, Abd Jalil

    2011-01-01

    Background Myofascial pain syndrome (MPS) is a regional musculoskeletal pain disorder that is caused by myofascial trigger points. The objective of this study was to determine the prevalence of MPS among chronic back pain patients, as well as to identify risk factors and the outcome of this disorder. Methods This was a prospective observational study involving 126 patients who attended the Pain Management Unit for chronic back pain between 1st January 2009 and 31st December 2009. Data examined included demographic features of patients, duration of back pain, muscle(s) involved, primary diagnosis, treatment modality and response to treatment. Results The prevalence of MPS among chronic back pain patients was 63.5% (n = 80). Secondary MPS was more common than primary MPS, making up 81.3% of the total MPS. There was an association between female gender and risk of developing MPS (χ2 = 5.38, P = 0.02, O.R. = 2.4). Occupation, body mass index and duration of back pain were not significantly associated with MPS occurrence. Repeated measures analysis showed significant changes (P pain patients was significantly high, with female gender being a significant risk factor. With proper diagnosis and expert management, MPS has a favourable outcome. PMID:21716607

  5. Low back pain - chronic

    Science.gov (United States)

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause ...

  6. The correlation between bone marrow edema,collapse and pain in osteonecrosis of the femoral head%骨髓水肿与股骨头塌陷及疼痛的相关性研究

    Institute of Scientific and Technical Information of China (English)

    赵凤朝; 李子荣; 王佰亮; 张念非; 程立明; 王冉东; 刘丙立

    2008-01-01

    Objective To explore the mechanism of bone marrow edema(BME),the correlation between BME.collapse and pain in osteonecrosis of the femoral head.Methotis From January 2006 to Octobet 2007.165 hips in 91 cases with osteonecrosis of the femoral head were analyzed.Pain was recorded by using the method of Merle d'Aubigne as modified by Chamley.16 cases with BME were followed up by MRI regularly.Results BME were found in 47 hips among total 165 hips.According to ARCO staging,there were no BME occurred in stage Ⅰ(11 hips);13 hips BME occurred in stage Ⅱ(71 hips);34 hips BME occurred in stage Ⅲ(77 hips);no BME occurred in stage Ⅳ(6 hips).There was,significant difference between them(P<0.05).37 hips with BME occurred on both 112WI and STIR.10 hips occurred only on STIR.40 hips with BME occurred in 6 months since the onset of pain,7 cases in 7-15 months.The pain was 2.46±0.66 in stage Ⅱ with BME,5.21±1.12 witbout BME,there Was signfficant difference between them.The pain Was 2.38±0.78 in stage Ⅲ with BME.3.63±0.93 without BME,there was significant difference between them.In 16 hips with BME followed-up with MRI,the pain Was alleviated when BME disappeared.Conclusion BME often 0ccal-8 in stage Ⅱ and Ⅲ osteonecrosis of the femoral head,and in 6 months since the onset of pain.The relation between BME and collapse is significant.The severity of pain with BME is more than that without BME.STIR is more sensitive in discovering BME.%目的 探讨股骨头缺血性坏死骨髓水肿的发生机制及其与疼痛程度和塌陷的关系.方法 对2006年1月至200r7年10月资料齐全的股骨头缺血性坏死患者共91例(165髋)进行回顾性分析,改良Merle d'Aubigne评分统计每髋的疼痛程度.并对16例(16髋)有骨髓水肿的患者行MRI随访.结果 165髋中47髋出现骨髓水肿,发生于ARCO分期Ⅱ期13髋,Ⅲ期34髋,各期出现骨髓水肿差异有统计学意义(P<0.05).T2加权像和STIR像均出现骨髓水肿37

  7. Autoantibody pain.

    Science.gov (United States)

    Goebel, Andreas

    2016-06-01

    As autoantibodies bind to target tissues, Fc-region dependent inflammation can induce pain via mediators exciting nociceptors. But recently another possibility has emerged, where autoantibody binding to nociceptors can directly cause pain, without inflammation. This is thought to occur as a result of Fab-region mediated modification of nerve transduction, transmission, or neuropeptide release. In three conditions, complex regional pain syndrome, anti-voltage gated potassium channel complex autoimmunity, and chronic fatigue syndrome, all associated with no or only little inflammation, initial laboratory-, and clinical trial-results have suggested a potential role for autoantibody-mediated mechanisms. More research assessing the pathogenic roles of autoantibodies in these and other chronic pain conditions is required. The concept of autoantibody-mediated pain offers hope for the development of novel therapies for currently intractable pains. PMID:26883460

  8. Imaging Pain.

    Science.gov (United States)

    Martucci, Katherine T; Mackey, Sean C

    2016-06-01

    The challenges and understanding of acute and chronic pain have been illuminated through the advancement of central neuroimaging. Through neuroimaging research, new technology and findings have allowed us to identify and understand the neural mechanisms contributing to chronic pain. Several regions of the brain are known to be of particular importance for the maintenance and amplification of chronic pain, and this knowledge provides novel targets for future research and treatment. This article reviews neuroimaging for the study of chronic pain, and in particular, the rapidly advancing and popular research tools of structural and functional MRI. PMID:27208709

  9. Primary and Secondary Somatosensory Cortex Activation Induced by Mild and Moderate Pain: A Functional Magnetic Resonance Imaging Study%轻、中度疼痛对第一、第二躯体感觉皮质激活的功能磁共振成像研究

    Institute of Scientific and Technical Information of China (English)

    公维义; 薛蕴菁; 宋施委; 张良成; 苏建生; 范崇玖

    2012-01-01

    Objective To explore the activation of the primary somatosensory cortex (Si) and secondary somatosensory cortex (Sn) under mild and moderate pain. Methods 7 healthy right-handed volunteers accepted electrostimulation of 1 and 2 times pain threshold respectively. The severity of pain was determined with the Visual Analogue Score (VAS), and they received functional magnetic resonance imaging (fMRI) simultaneously. Results 1 and 2 times pain threshold electrical stimulation caused mild and moderate pain respectively. Both mild and moderate pain activated contralateral S I similarly, and bilateral S n with pain intensity. Conclusion S I and S n respond to the mild and moderate pain in different ways.%目的 研究轻、中度疼痛电刺激对第一躯体感觉皮质(SⅠ)和第二躯体感觉皮质(SⅡ)的激活规律.方法 对7名右利手健康志愿者右足测定痛觉阈值后,给予痛觉阈值和2倍痛觉阈值刺激,进行视觉模拟评分(VAS)和疼痛分级,行功能磁共振成像.结果 痛觉阈值和2倍痛觉阈值刺激分别引起志愿者轻度疼痛和中度疼痛;两种刺激均可激活SⅠ和SⅡ,并以左侧为主.其中,轻度疼痛主要激活左侧SⅠ,对两侧SⅡ激活区域小;中度疼痛明显激活左侧SⅠ和双侧SⅡ.结论 SⅠ对轻、中度疼痛电刺激反应一致,但SⅡ对中度疼痛电刺激的反应更为明显.

  10. Phantom pain after eye amputation

    DEFF Research Database (Denmark)

    Rasmussen, Marie L R; Prause, Jan U; Toft, Peter B

    2011-01-01

    Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation......, orbital exenteration or secondary implantation of an orbital implant in the period between 1993 and 2003. A total of 267 patients were identified and invited to participate; of these, 173 agreed to participate. These patients’ medical records were reviewed. A structured interview focusing on pain...... was conducted by a trained interviewer. Results: Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19–88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2–46). Phantom...

  11. Bone-targeted agents: preventing skeletal complications in prostate cancer.

    Science.gov (United States)

    Morgans, Alicia K; Smith, Matthew R

    2012-11-01

    In men, prostate cancer is the most common non-cutaneous malignancy and the second most common cause of cancer death. Skeletal complications occur at various points during the disease course, either due to bone metastases directly, or as an unintended consequence of androgen deprivation therapy (ADT). Bone metastases are associated with pathologic fractures, spinal cord compression, and bone pain and can require narcotics or palliative radiation for pain relief. ADT results in bone loss and fragility fractures. This review describes the biology of bone metastases, skeletal morbidity, and recent advances in bone-targeted therapies to prevent skeletal complications of prostate cancer.

  12. Relationship Between Changes in Serum Urate and Bone Mineral Density During Treatment with Thiazide Diuretics: Secondary Analysis from a Randomized Controlled Trial.

    Science.gov (United States)

    Dalbeth, Nicola; Gamble, Gregory D; Horne, Anne; Reid, Ian R

    2016-05-01

    In observational studies, serum urate concentrations associate with bone mineral density (BMD) and reduced risk of fractures. Thiazide diuretics slow the bone loss in healthy older adults, are associated with reduced incidence of fracture and also increase serum urate. We hypothesized that changes in serum urate are associated with changes in BMD during treatment with thiazide diuretics. We analysed data from a double-blind randomized controlled trial of hydrochlorothiazide (50 mg per day) and placebo in normal post-menopausal women. The relationship between change in serum urate and change in BMD after 2 years of treatment was examined using Spearman correlation and multiple linear regression models. Total body BMD increased in the hydrochlorothiazide group by 0.52 % and reduced in the placebo group by 0.29 % over 2 years (between group difference P = 0.0034). Serum urate increased in the hydrochlorothiazide group by 0.038 mmol/L and reduced in the placebo group by 0.004 mmol/L (between group difference P < 0.0001). At Year 2, there was a positive relationship between the change in serum urate and change in total body BMD for entire study population (r = 0.32, P = 0.0002) and for the hydrochlorothiazide group (r = 0.29, P = 0.023). The association between change in serum urate and change in total body BMD persisted after adjusting for treatment allocation, and change in weight, serum calcium, urinary calcium and serum creatinine (P change in serum urate = 0.043). These data raise the possibility that the effects of hydrochlorothiazide on BMD may be mediated, in part, by changes in serum urate concentrations.

  13. Relationship Between Changes in Serum Urate and Bone Mineral Density During Treatment with Thiazide Diuretics: Secondary Analysis from a Randomized Controlled Trial.

    Science.gov (United States)

    Dalbeth, Nicola; Gamble, Gregory D; Horne, Anne; Reid, Ian R

    2016-05-01

    In observational studies, serum urate concentrations associate with bone mineral density (BMD) and reduced risk of fractures. Thiazide diuretics slow the bone loss in healthy older adults, are associated with reduced incidence of fracture and also increase serum urate. We hypothesized that changes in serum urate are associated with changes in BMD during treatment with thiazide diuretics. We analysed data from a double-blind randomized controlled trial of hydrochlorothiazide (50 mg per day) and placebo in normal post-menopausal women. The relationship between change in serum urate and change in BMD after 2 years of treatment was examined using Spearman correlation and multiple linear regression models. Total body BMD increased in the hydrochlorothiazide group by 0.52 % and reduced in the placebo group by 0.29 % over 2 years (between group difference P = 0.0034). Serum urate increased in the hydrochlorothiazide group by 0.038 mmol/L and reduced in the placebo group by 0.004 mmol/L (between group difference P < 0.0001). At Year 2, there was a positive relationship between the change in serum urate and change in total body BMD for entire study population (r = 0.32, P = 0.0002) and for the hydrochlorothiazide group (r = 0.29, P = 0.023). The association between change in serum urate and change in total body BMD persisted after adjusting for treatment allocation, and change in weight, serum calcium, urinary calcium and serum creatinine (P change in serum urate = 0.043). These data raise the possibility that the effects of hydrochlorothiazide on BMD may be mediated, in part, by changes in serum urate concentrations. PMID:26713333

  14. Pain frequency moderates the relationship between pain catastrophizing and pain

    OpenAIRE

    Heidi eKjøgx; Robert eZachariae; Mogens ePfeiffer-Jensen; Helge eKasch; Peter eSvensson; Troels Staehelin Jensen; Lene eVase

    2014-01-01

    Background Pain frequency has been shown to influence sensitization, psychological distress and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale, Beck Depression Inventory and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency Results In...

  15. Back Pain and Neuraxial Anesthesia.

    Science.gov (United States)

    Benzon, Honorio T; Asher, Yogen G; Hartrick, Craig T

    2016-06-01

    The incidence of back pain after neuraxial anesthesia in the adult population is not different from that after general anesthesia. The pain is usually mild, localized in the low back, rarely radiates to the lower extremities, and has a duration of only a few days. The risk factors for development of back pain include the lithotomy position, multiple attempts at block placement, duration of surgery longer than 2.5 hours, body mass index ≥32 kg/m, and a history of back pain. However, there is no permanent worsening of preexisting back pain after neuraxial anesthesia. The back pain has been attributed to tears in the ligaments, fascia, or bone with localized bleeding; immobility of the spine; relaxation of the paraspinal muscles under anesthesia; flattening of the normal lumbar convexity; and stretching and straining of the lumbosacral ligaments and joint capsules. The addition of an anti-inflammatory drug to the local anesthetic used for skin infiltration may decrease the incidence and severity of back pain. The use of spinal or epidural anesthesia in the adult, non-obstetric and obstetric populations should depend on the advantages offered by the technique and not on the occurrence of back pain after the procedure. Additional studies are needed to confirm the efficacy of epidural dexamethasone, or other steroids, or the addition of an anti-inflammatory drug to the local anesthetic infiltration for the prevention of back pain after neuraxial anesthesia. Future studies should involve a physician with expertise in the evaluation of chronic low back pain to help identify the cause of the back pain and institute appropriate treatment(s). PMID:27195644

  16. Colonoscopy, pain and fears: Is it an indissoluble trinomial?

    OpenAIRE

    Trevisani, Lucio; Zelante, Angelo; Sartori, Sergio

    2014-01-01

    Colonoscopy is the reference method in the secondary prevention, diagnosis and, in some cases, treatment of colorectal cancer. It can often cause pain associated with embarrassment, anxiety, and physical and emotional discomfort. Pain intensity is influenced by a lot of factors, and there is a strict relationship among pain, pain perception, and mind. Several methods can be used to break the trinomial colonoscopy, pain and fear. Sedoanalgesia is recommended by several guidelines. If no sedati...

  17. Face pain

    Science.gov (United States)

    ... begin in other places in the body. Abscessed tooth (ongoing throbbing pain on one side of the lower face that ... chap 18. Digre KB. Headaches and other head pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap ...

  18. Flank pain

    Science.gov (United States)

    ... between the upper belly area (abdomen) and the back. ... or brown color) in the urine Unexplained flank pain that continues ... The doctor or nurse will examine you. You will be asked about your ... there or comes and goes, if it's getting worse What the pain ...

  19. Neuropathic pain

    Directory of Open Access Journals (Sweden)

    Giuseppe Re

    2009-02-01

    Full Text Available Neuropathic pain is the expression of a dysfunction or primary lesion of a nerve in the peripheral or central nervous system, or both, rather than the biological signal transmitted by the nerve following peripheral nociceptor activation. It represents about 20% of all painful syndromes, with an estimated prevalence of 1.5%, however is actual incidence is hard to pinpoint due to the difficulties encountered in distinguishing it from chronic pain, of which it represents a significant percentage, on account of the not infrequent concurrence of conditions. It is crucial to recognise the variety of symptoms with which it can present: these can be negative and positive and, in turn, motor, sensitive and autonomic. In public health terms, it is important to emphasise that the diagnosis of neuropathic pain does not in most cases require sophisticated procedures and does not therefore weigh on health expenditure. In clinical practice, a validated scale (the LANSS is mentioned is useful for identifying patients presenting neuropathic pain symptoms. Therapy is based on three categories of medication: tricyclic antidepressants, anti-epileptics and opioids at high doses: neuropathic pain has a bad reputation for often resisting common therapeutic approaches and responding less well that nociceptor pain to monotherapy. Therapeutic strategies are all the more adequate the more they are based on symptoms and therefore on the pain generation mechanisms, although the recommendations are dictated more by expert opinions that double-blind randomised trials.

  20. Exertional Leg Pain.

    Science.gov (United States)

    Rajasekaran, Sathish; Finnoff, Jonathan T

    2016-02-01

    Exertional leg pain is a common condition seen in runners and the general population. Given the broad differential diagnosis of this complaint, this article focuses on the incidence, anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and management of common causes that include medial tibial stress syndrome, tibial bone stress injury, chronic exertional compartment syndrome, arterial endofibrosis, popliteal artery entrapment syndrome, and entrapment of the common peroneal, superficial peroneal, and saphenous nerves. Successful diagnosis of these conditions hinges on performing a thorough history and physical examination followed by proper diagnostic testing and appropriate management. PMID:26616179

  1. Pain assessment in clinical Rheumatology

    Directory of Open Access Journals (Sweden)

    L. Sinigaglia

    2011-09-01

    Full Text Available The diagnostic approach in clinical practice in Rheumatology is mainly based on the recognition of pain origin. Patient’s experience of pain may be similar in different diseases involving bones, joints, tendons, muscles or peripheral nervous system. The analysis of some characteristics of pain may be helpful in the diagnostic approach. In this perspective pain must be analyzed according to the type, localization, occurrence, elicitation and concomitant clinical signs. In the majority of cases this analysis allows a preliminary differential diagnosis which is essential to drive further assessments. The diagnostic approach to arthropaties is based on a group of indicative criteria which include diffusion of the arthropathy, the involved sites, the course of the joint disease, the joint damage, the history of preceding events and the presence of extra-articular features which accompany joint disease. This kind of clinical approach helps the clinician in saving time and reducing costs of diagnosis by driving any further investigation.

  2. Pain frequency moderates the relationship between pain catastrophizing and pain

    Science.gov (United States)

    Kjøgx, Heidi; Zachariae, Robert; Pfeiffer-Jensen, Mogens; Kasch, Helge; Svensson, Peter; Jensen, Troels S.; Vase, Lene

    2014-01-01

    Background: Pain frequency has been shown to influence sensitization, psychological distress, and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method: A non-clinical (247 students) and a clinical (223 pain patients) sample completed the Danish versions of the Pain Catastrophizing Scale (PCS), Beck Depression Inventory, and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency. Results: In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed. Conclusions: This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations. PMID:25646089

  3. Pain frequency moderates the relationship between pain catastrophizing and pain

    Directory of Open Access Journals (Sweden)

    Heidi eKjøgx

    2014-12-01

    Full Text Available Background Pain frequency has been shown to influence sensitization, psychological distress and pain modulation. The present study examined if pain frequency moderates the relationship between pain catastrophizing and pain. Method A non-clinical (247 students and a clinical (223 pain patients sample completed the Danish versions of the Pain Catastrophizing Scale, Beck Depression Inventory and the State Trait Anxiety Inventory and rated pain intensity, unpleasantness and frequency Results In both samples, high pain frequency was found to moderate the association between pain catastrophizing and pain intensity, whereas low pain frequency did not. The psychometric properties and the factor structure of the Danish version of the PCS were confirmed.Conclusions This is the first study to validate the Danish version of the PCS and to show that pain frequency moderates the relationship between pain catastrophizing and reported pain in both non-clinical and clinical populations.

  4. Bone health in cancer patients

    DEFF Research Database (Denmark)

    Coleman, R; Body, J J; Aapro, M;

    2014-01-01

    cancer for many patients resulting in a major reduction in skeletal complications, reduced bone pain and improved quality of life. Secondly, many of the treatments we use to treat cancer patients have effects on reproductive hormones, which are critical for the maintenance of normal bone remodelling...... in the metastatic processes required for cancer dissemination, and there are emerging data showing that, at least in some clinical situations, the use of bone-targeted treatments can reduce metastasis to bone and has potential impact on patient survival.......There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major...

  5. Hereditary multiple exostosis with secondary malignization: case report

    Energy Technology Data Exchange (ETDEWEB)

    Coutinho, A.M.N.; Pitella, F.A.; Coura Filho, G.B.; Costa, P.L.A.; Ono, C.R.; Watanabe, T.; Sapienza, M.T.; Hironaka, F.; Cerri, G.G.; Buchpiguel, C.A. [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Radiologia. Centro de Medicna Nuclear

    2008-07-01

    Full text: Introduction: Hereditary Multiple Exostosis (HME) or multiple osteochondromatosis is a skeletal development anomaly which is characterized by generalized exostoses in the bones, mainly in long bone metaphyses, appearing during childhood and adolescence. The transmission is autosomal dominant, its prevalence varies from 1/50,000 to 9/1,000,000 in Europe, and around 10% of cases show no family history. Case Report: Description of an HME case with two secondary malignization episodes. The data was taken from the patient's chart and from imaging exams from the hospital files. WASB, a 19-year-old male, hospitalized after being pre-diagnosed with HME and complaints of bone-consistent mass in the right gluteal region and a lump in the posterior region of the right leg, associated to multiple bone lumps all over the body. A magnetic resonance imaging (MRI) was performed along with a bone scintillography with {sup 99m}Tc-MDP which showed multiple osteogenic lesions in the thorax, pelvic bones and long bones with periarticular prevalence in the lower limbs. The suspicion of malignancy in the right iliac area was raised due to the MRI result and to the higher intensity captured in the scintillography, confirming chondrosarcoma grade I of malignancy in the biopsy. The patient suffered interileo abdominalis amputation of the right lower limb with good evolution and control scintillography performed after 1 and 1,5 years. In the second controlling procedure, the patient complained about pain in the left knee, and a MRI suggested a new secondary malignization. The hypothesis of a head of left fibula osteochondroma with signs of aggressiveness was confirmed following surgery. Discussion: In HME, the exostoses grow along with the individual, ceasing with the epiphyseal fusion. The growth of these formations after skeletal maturation suggests activity of exostoses and, in most times, it is a sign of malignant transformation, which turns almost every time into

  6. The management of chronic pain in rheumatic diseases

    Directory of Open Access Journals (Sweden)

    Pasquale De Negri

    2010-12-01

    Full Text Available Rheumatic diseases are a group of pathologies that usually affect the joints or adjacent anatomical structures or functionally related such as bones, muscles, tendons, bursa, fascia, ligaments, and whose main symptom is the pain. Optimal pain control is a prerequisite for successful therapy of many rheumatic diseases. Many patients may present many diffi culties in terms of pain relief and therefore must be addressed at an appropriate pain treatment center.

  7. Back Pain

    Science.gov (United States)

    ... more vertebrae are joined together using bone grafts, screws, and rods to stop slippage of the affected ... used for spinal fusion surgery. Vertebrae. The individual bones that make ... involves injecting a cement-like mixture into a fractured vertebra to relieve ...

  8. Surgical Options for Atypical Facial Pain Syndromes.

    Science.gov (United States)

    Rahimpour, Shervin; Lad, Shivanand P

    2016-07-01

    Atypical neuropathic facial pain is a syndrome of intractable and unremitting facial pain that is secondary to nociceptive signaling in the trigeminal system. These syndromes are often recalcitrant to pharmacotherapy and other common interventions, including microvascular decompression and percutaneous procedures. Herein, the authors present two other viable approaches (nucleus caudalis dorsal root entry zone lesioning and motor cortex stimulation), their indications, and finally a possible treatment algorithm to consider when assessing patients with atypical facial pain. PMID:27325003

  9. 肺癌骨痛的中西医结合治疗临床研究%Clinical Study on Integration of Traditional Chinese and Western Medicine in Treating Bone Pain in Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    王惠琴; 李天浩; 雷琰; 常永莉

    2014-01-01

    目的:探讨肺癌疼痛患者的中西医结合外治方法的临床效果、不良反应。方法:选择我科2010年1月至2012年12月收治的120例肺癌骨痛患者,随机分为中药穴位治疗组( A组)、西药治疗组( B组)、西药+中药穴位治疗组( C组)各40例。7 d后(1个疗程)观察其疗效及不良反应发生率。结果:治疗后,A组与B组疗效比较,P>0.05;C组与B组疗效比较,P<0.05;C组与A组疗效比较,P<0.05。不良反应发生率:A组、C组与B组比较,P<0.05;C组与A组比较,P>0.05。结论:中药穴位治疗肺癌骨痛具有临床疗效显著、不良反应发生率低的特点;中药穴位联合西药治疗癌痛可明显提高疗效,降低药物的成瘾性及不良反应的发生,提高患者的生活质量。%Objective:To explore the clinical therapeutic effect and side effects of external treatment of integrated traditional Chinese and western medicine in treating pain in lung cancer patients .Methods:One hundred and twenty lung cancer patients with bone metastasis admitted to our department from year 2010 January to year 2012 December were randomly divided into Chinese medicine acupuncture treatment group (group A), western medicine group (group B), western medicine combined with traditional Chinese medicine acupunc-ture treatment group (group C) with 40 cases in each.The curative effect and side effect incidence were observed after 7 days of treat-ment (a treatment course).Results: After treatment, there were no significant differences of therapeutic effect between group A and group B (P>0.05);there were significant differences of therapeutic effect between group C and group B (P0.05).Conclusion: Acupoint therapy for lung cancer pain shows significant clinical efficacy with low side effects occurrence .Traditional Chinese medicine combined with western med-icine improves the efficacy of treating cancer pain , reduces drug addiction and side

  10. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain. PMID:27208716

  11. Assessing and Managing Sleep Disturbance in Patients with Chronic Pain.

    Science.gov (United States)

    Cheatle, Martin D; Foster, Simmie; Pinkett, Aaron; Lesneski, Matthew; Qu, David; Dhingra, Lara

    2016-06-01

    Chronic pain is associated with symptoms that may impair a patient's quality of life, including emotional distress, fatigue, and sleep disturbance. There is a high prevalence of concomitant pain and sleep disturbance. Studies support the hypothesis that sleep and pain have a bidirectional and reciprocal relationship. Clinicians who manage patients with chronic pain often focus on interventions that relieve pain, and assessing and treating sleep disturbance are secondary or not addressed. This article reviews the literature on pain and co-occurring sleep disturbance, describes the assessment of sleep disturbance, and outlines nonpharmacologic and pharmacologic treatment strategies to improve sleep in patients with chronic pain.

  12. Cerebral cortex modulation of pain

    Institute of Scientific and Technical Information of China (English)

    Yu-feng XIE; Fu-quan HUO; Jing-shi TANG

    2009-01-01

    Pain is a complex experience encompassing sensory-discriminative, affective-motivational and cognitiv e-emotional com-ponents mediated by different mechanisms. Contrary to the traditional view that the cerebral cortex is not involved in pain perception, an extensive cortical network associated with pain processing has been revealed using multiple methods over the past decades. This network consistently includes, at least, the anterior cingulate cortex, the agranular insular cortex, the primary (SⅠ) and secondary somatosensory (SⅡ) cortices, the ventrolateral orbital cortex and the motor cortex. These corti-cal structures constitute the medial and lateral pain systems, the nucleus submedius-ventrolateral orbital cortex-periaque-ductal gray system and motor cortex system, respectively. Multiple neurotransmitters, including opioid, glutamate, GABA and dopamine, are involved in the modulation of pain by these cortical structures. In addition, glial cells may also be in-volved in cortical modulation of pain and serve as one target for pain management research. This review discusses recent studies of pain modulation by these cerebral cortical structures in animals and human.

  13. Radicular lower extremity pain as the first symptom of primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Mustonen, Antti O.T.; Kiuru, Martti J.; Koskinen, Seppo K. [Toolo Trauma Center, Helsinki University Central Hospital, Topeliuksenkatu 5, 00029, Helsinki (Finland); Stahls, Anders; Bohling, Tom [Department of Pathology, Haartman Institute, University of Helsinki, 00014, Helsinki (Finland); Kivioja, Aarne [Department of Orthopedics and Traumatology, Helsinki University Central Hospital, 00029, Helsinki (Finland)

    2004-08-01

    Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism. (orig.)

  14. 腹腔注射氟比洛芬酯对大鼠骨癌痛的影响%EFFECTS OF INTRAPERITONEAL INJECTION OF FLURBIPROFEN AXETIL ON BONE CANCER PAIN IN RATS

    Institute of Scientific and Technical Information of China (English)

    胡正权; 杨许丽; 马正良; 顾小萍

    2013-01-01

    目的:探讨腹腔注射氟比洛芬酯对大鼠骨癌痛的影响.方法:30只雌性SD大鼠,完全随机分为5组(n=6):肿瘤+生理盐水组(C组)、肿瘤+氟比洛芬酯10 mg·kg-1·d-1组(CK10组)、肿瘤+氟比洛芬酯25 mg·kg-1·d-1组(CK25组)、肿瘤+氟比洛芬酯50 mg·kg-1·d-1组(CK50组)和假手术组+生理盐水(sham组).大鼠胫骨接种肿瘤14d后,腹腔分别注射相应剂量氟比洛芬酯及生理盐水,每天两次,连续7d.于造模前、后3、5、7、10d及14、17、21 d给药前、后半小时测量左后足底机械性缩足阈值(paw mechanical withdrawal threshold,PMWT)和行走痛行为评分.结果:在14、17、21d给药后,与C组(2.67±1.03,2.13±0.96,1.73±0.43)相比,CK25组(5.00±1.10,6.00±1.26,6.33±0.82)、CK50组(6.67±1.03,7.00±1.10,7.67±1.51)大鼠PMWT明显增加(P<0.05)与C组(2.17±0.41,2.50±0.55,3.33±0.52)相比,CK25组(1.50±0.55,1.33±0.52,1.50±0.55)、CK50(1.10±0.63,1.17±0.41,1.00±0.63)大鼠行走痛评分显著减少(P<0.05);CK10组PMWT(3.60±0.89)和行走痛评分(2.50±0.55)与C组比较在d21差异有统计学意义(P<0.05).在17、21d给药前,与C组比较,CK25组(5.33±1.03,6.33±0.82)和CK50组(5.67±0.82,7.00±1.10)PWMT值明显延长(P<0.05),CK50组(1.67±0.52,2.00±0.63)行走痛评分明显降低(P<0.05);CK25组(2.17±0.41)行走痛评分在d21显著减少(P<0.05).结论:在大鼠骨癌痛模型中,腹腔注射氟比洛芬酯可以剂量依存性缓解骨癌痛,镇痛效果持久.%Objective:To investigate the effect of flurbiprofen axetil by intraperitoneal injection on bone cancer pain in rats.Methods:Thirty female Sprague Drawley (SD) rats were randomly divided into 5 groups (n =6 in each):cancer + normal saline group (C),cancer + flurbiprofen axetil 10 mg·kg-1·d-1 group (CK10),cancer + flurbiprofen axetil 25 mg·kg-1·d-1 group (CK25),cancer + flurbiprofen axetil 50 mg·kg-1·d1 group (CK50),sham operation + normal saline group (sham).Flurbiprofen axetil or

  15. Baseline patterns of bone scintigraphy in patients with established post-poliomyelitis paralysis