Cases reported "Bone Neoplasms"

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1/26. role of radionuclide imaging in osteoid osteoma.

    Radiophosphate bone scans readily disclosed osteoid osteomas in 20 symptomatic patients, including nine patients whose radiographic findings had been negative. In five of the nine patients adjuvant radiogallium imaging was performed, and four showed a disproportionately low uptake relative to radiophosphate. When this occurs, osteoid osteoma can be distinguished from subacute osteomyelitis, which is particularly helpful if the radiograph is equivocal. Radiophosphate bone imaging's generally accepted excellent sensitivity in disclosing obscure symptom-producing focal bone disorders makes it the screening procedure of choice, especially if osteoid osteoma is considered in the differential diagnosis. Only abnormal areas need to be radiographed to add specificity and more precise delineation.
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2/26. The usefulness of 99mTc-HMPAO-labeled leukocyte scintigraphy in the diagnosis of skeletal metastases of cancers.

    The usefulness of bone marrow scintigraphy with 99mTc-HMPAO-labeled leukocytes (leukocyte bone marrow scintigraphy) in the diagnosis of skeletal metastases of cancers was investigated in 70 lesions in 27 patients with various types of cancer. The final diagnosis of skeletal metastases was based on one or more criteria consisting of histological confirmation, typical findings of metastases by bone radiograph, CT and MRI, or progressive swellings of the lesions with severe pain due to nerve compression. Of the 70 lesions, 55 were finally diagnosed as metastases, and 15 as benign lesions. Leukocyte bone marrow scintigraphy showed photopenic defects in 52 of the 55 metastatic lesions (sensitivity 95%), and the remaining 3 negative lesions were found positive for metastases by MRI. In contrast, MRI could evaluate only 39 of the 55 lesions because 16 lesions in the ribs, scapula and sternum were not visualized. Of these 39 lesions, MRI showed positive findings for metastases in 33 (sensitivity 85%), and negative findings in 6 with photopenic defects found by leukocyte bone marrow scintigraphy. Of the 15 benign lesions, 3 were false positive for metastases on leukocyte bone marrow scintigraphy (specificity 80%). We conclude that 99mTc-HMPAO-labeled leukocyte bone marrow scintigraphy may be useful in the diagnosis of skeletal metastases of cancers, particularly when MRI fails to evaluate the lesions.
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3/26. Tc-99m PMT whole-body scintigraphy for evaluated of therapeutic effect and for monitoring bone metastasis in a patient with hepatocellular carcinoma.

    Detection of metastatic lesions by bone scintigraphy is highly sensitive but has a low rate of specificity. Often bone metastases from hepatocellular carcinoma are not detected by bone scintigraphy because of low uptake or a photopenic area in the tumor. In contrast, Tc-99m Sn-N-pyridoxy-5-methyltryptophan (Tc-99m PMT) whole-body scintigraphy reflects tumor viability, and the specificity of detection is so high that tumor structure can be shown well. Tc-99m PMT whole-body scintigraphy was helpful for evaluating the response to therapy and monitoring the course of the patient described here with bone metastasis from hepatocellular carcinoma.
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keywords = specificity
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4/26. Mini-Mental State Questionnaire: problems with its use in palliative care.

    The Mini-Mental State Questionnaire (MMSQ) has been established as a reliable research instrument and is recommended for the early detection of impaired mental status (Fainsinger et al, 1993). Using reflection on a clinical incident, the problems associated with the clinical application of the MMSQ that may outweigh its usefulness are identified. The patient's experience of MMSQ as routine cognitive monitoring can be distressing as the person experiences loss of cognitive ability in a visible way. This experience has a negative influence on the person's quality of life, which is contrary to the essential aim of palliative care. research evidence suggests that the MMSQ lacks specificity (the ability to detect impaired mental status) because it is affected by pre-morbid ability and intelligence, and therefore cannot be used to assess competence in decision making. Further research on the meaning of losing cognitive ability in terminal illness and other cognitive assessment strategies is required.
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keywords = specificity
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5/26. magnetic resonance imaging evaluation of monostotic fibrous dysplasia of the tibia.

    The authors present a case report documenting the evaluation of monostotic fibrous dysplasia by magnetic resonance imaging. This type of evaluation demonstrates specificity for this disease process when combined with other imaging studies, laboratory findings, and clinical presentation. This technique is extremely useful in the identification of a no-touch lesion, allowing avoidance of an unnecessary bone biopsy.
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6/26. Reduced hemithoracic uptake on 99mTc-MDP bone scintigraphy: an underrecognized sign of massive pleural effusion--a case report.

    The uptake of (99m)Tc-methylene diphosphonate (MDP) in malignant pleural effusions and, rarely, in nonmalignant pleural effusions has been well documented in the literature. Although the exact mechanism of uptake in these conditions remains unclear, there have been attempts to use the bone scintigraphic features of pleural effusion to predict sensitivity and specificity for malignancy based on pleural fluid cytology. It has been suggested that activity in the chest increases with an increase in effusion volume. We report here, however, a case of malignant pleural effusion, that showed reduced hemithoracic activity in contrast to the expected increased activity. Our experience highlights the need for an open and inquisitive mind to avoid diagnostic pitfalls when confronted with a bone scintigram showing reduced uptake unilaterally or bilaterally in the chest.
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7/26. Tumor-specific immunity in sarcoma patients.

    Stimulatory responses of 40 patients with bone [33] and soft tissue [7] sarcomas to autologous tumor cells were correlated with clinical data and prognosis. Although conclusive judgments for individual patients cannot be made, some genral features emerge: patients with stimulation indices greater than 1.5 have a 50 percent relapse-free interval after surgery of 22 months, patients with indices, below 1.5 have a 50 percent relapse-free interval of 5 months. 7 out of 10 responder patients are tumor-free 1 year after surgery as compared to 5 out of 19 (26 percent of non-responder pateints (p less than 0.05). Removal of the tumor is followed by an increase in the stimulatory response and by the dissappearance of blocking serum factors in patients with favourable prognosis. Responses return to baseline levels in tumor free patients 9-12 months after surgery. The results suggest that tumor-associated immune responses play a role in the development of human sarcomas. In addition, 47 lymphocyte samples of 25 patients were tested for stimulation by autologous tumor cells and for cell-mediated cytotoxicity against allogeneic sarcoma cell lines. Similar results were obtained in both test systems when pre-therapy lymphocytes were used. Discordant results were frequently seen at times after surgery. Both test systems may complement each other and may help clarify the tumor-specificity of certain lymphocytotoxic activities.
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keywords = specificity
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8/26. FDG-PET uptake in occult acute pelvic fracture.

    The role of FDG-PET in the diagnosis of bone metastases remains unsettled, although it is hoped that PET scans will add specificity to or replace bone scintigraphy. We report a case in which an acute traumatic fracture presented with a level of uptake generally considered indicative of neoplasm. It is important to recognize that increased FDG-PET activity in bone should not be accepted as definitive evidence of metastatic disease.
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9/26. Gamma probe assisted biopsy of suspected metastatic rib lesions.

    Retrieving diagnostic tissue from a rib lesion can be challenging. Using a hand-held intraoperative gamma probe to target and biopsy the areas of increased radioisotope uptake has been limited largely to use by thoracic surgeons and interventional radiologists. Such techniques also have been used by orthopaedic oncologists in localizing osteoid osteomas. We pursued a similar technique in localizing the rib lesion. During the 10 months, two patients with a history of cancer and recent bone scans indicative of possible rib metastasis required biopsies for definitive tissue diagnosis. Both patients had gamma-probe localization of their rib lesions intraoperatively using minimally invasive techniques. The operation of the probe was simple with a short learning curve. Both patients had biopsies that yielded diagnoses verifying the abnormality on the staging bone scan. Localization was sensitive and accurate with histologic confirmation in both patients. The length and extent of surgery were markedly reduced with no complications. These results match those reported in the literature by thoracic surgeons and radiologists. The hand-held gamma probe assisted biopsy of suspicious rib abnormalities can be an effective surgical technique that the orthopaedic surgeon should consider. Additional experience with the technique will allow an assessment of the sensitivity and specificity.
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ranking = 1
keywords = specificity
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10/26. FDG-PET in a case of multiple bone metastases of gastric cancer.

    F-18 2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) is useful for surveys to detect bone metastasis because of its greater specificity than bone scintigraphy. However, FDG-PET is also known to yield false-positive results in acute fractures and inflammatory lesions, and distinguishing between benign and malignant lesions is difficult, even when semiquantitative methods are used. We report a case of multiple bone metastases of gastric cancer. One of the bone lesions that was positive for FDG uptake was benign, suggesting that FDG-PET can yield false-positive results.
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ranking = 1
keywords = specificity
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