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Bones and fractures
Published in Henry J. Woodford, Essential Geriatrics, 2022
Plain X-rays of the thoracic and lumbar spine can be used to detect vertebral fractures in people reporting height loss or with clinical evidence of kyphosis. Quantitative computerised tomography (CT) measurements allow accurate bone density assessment but its use is associated with increased costs and radiation exposure. Quantitative ultrasound measurements are taken at peripheral sites, such as the calcaneum. It is a simple, quick and radiation-free technique but its accuracy has not been fully proven. A bone biopsy may be considered when there is diagnostic uncertainty. This can exclude certain conditions, including malignancy, but is rarely performed. Biochemical markers of bone turnover have been detected in serum and urine samples. They may have the advantage of reflecting responses to treatment before BMD changes are detectable on DEXA scans. They include bone-specific ALP, various breakdown products of collagen and the non-collagenous bone protein called osteocalcin. They are often utilised in the setting of clinical trials but are not recommended for use in routine clinical practice.21
Bone metastases
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Rupert Berkeley, Muaaze Ahmad, Rikin Hargunani
Bone biopsy is classically performed using trephine systems with cannulated cutting trocars to breach the cortex. Drilling may occasionally be required, notably for sclerotic lesions. Bone biopsy can be a painful procedure and attempts should be made to minimize discomfort with use of sufficient local anaesthetic agent—particularly focussed on the periosteum—and, where appropriate, sedation. General anaesthetic may be required, particularly in children.
The Non-Hodgkin’s Lymphomas and Plasma Cell Dyscrasias
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Lynne V. Abruzzo, L. Jeffrey Medeiros
Screening procedures: CBC with differential: All values within normal limits.x-Ray of the left distal femur: Mixed lytic and blastic lesion with periosteal reaction in the left distal femur.Bone scan: Increased uptake in the left distal femur.A bone biopsy was performed.
Drug treatment strategies for paget’s disease: relieving pain and preventing progression
Published in Expert Opinion on Pharmacotherapy, 2023
Daniela Merlotti, Domenico Rendina, Guido Cavati, Veronica Abate, Alberto Falchetti, Christian Mingiano, Ranuccio Nuti, Luigi Gennari
The radiographic images of painful and/or deformed bones are usually diagnostic for PDB, unraveling the typical mixed appearance of osteolytic areas due to increased osteoclast activity and osteosclerosis due to an excessive osteoblastic bone formation [11]. Common radiological features of PDB include osteolytic areas, with advancing wedge of resorption, thickening of the cortical bone, accentuation and coarsening of trabecular pattern (mainly along stress lines) and enlargement of bone contours. Then, in the presence of radiological signs suggestive of PDB, a whole-skeleton bone scan (with technetium-99 m-methylene diphosphonate) is also recommended in order to define the skeletal extent of metabolically active PDB [12,13]. Other imaging approaches, such as CT and MRI, are, in general, not needed for PDB diagnosis, but might be of help to improve differential diagnosis (e.g. with fibrous dysplasia or metastatic disease) in some skeletal districts such as skull, facial bones and spine, as well to better evaluate neurologic symptoms or other complications in the context of PDB. Bone biopsy of the affected skeletal sites may be recommended if equivocal clinical features remain.
Non traumatic vertebral lesions: incremental utility of PET-CT over MRI and FNAC in a suggested diagnostic algorithm
Published in British Journal of Neurosurgery, 2019
Rajesh Meena, Ashish Aggarwal, Anish Bhattacharya, Vivek Gupta, Sivashanmugam Dhandapani, Rajesh Chhabra
However, these non-invasive imaging investigations still have an important role in diagnosis, especially when FNAC is inconclusive (up to one third of the cases in this series). An attempt at tissue diagnosis can be made from other sites in the body, guided by PET-CT. This proved helpful in eight cases in the present series, thus implying an incremental utility of 38.9% of PET-CT. In cases, where even an alternate site for FNAC is not identifiable, further management may be guided by the combined reports of MRI and FDG PET-CT. If these are in concordance, empirical therapy (though less than ideal) can be initiated. However, the sub group where FNAC is inconclusive and MRI and PET-CT are in discordance, continues to burden us with dilemma .Perhaps there is a role of wide bore bone biopsy. Another important role of PET-CT is to monitor the progress of disease and response to therapy, especially in cases where empirical ATT was started.
Ertapenem-associated neurotoxicity in the spinal cord injury (SCI) population: A case series
Published in The Journal of Spinal Cord Medicine, 2018
Ursula C. Patel, Mallory A. Fowler
A 72 year-old male (180 cm, 103 kg) with a history of T4 paraplegia (ASIA C), diabetes mellitus, cellulitis, cocaine dependence, chronic obstructive pulmonary disorder, obstructive sleep apnea, multiple flap surgeries for pressure ulcers, elevated PSA and history of bladder stones was admitted for treatment of a left ischial ulcer. CT imaging revealed osteomyelitis and the patient was initially treated with wound care. Though recommended, a bone biopsy was not performed and the patient was treated with oral antibiotics. A month later they were discontinued due to pathology demonstrating chronic osteomyelitis. The patient eventually underwent debridement of the ischial ulcer, osteotomy and bi-planar flap reconstruction surgery six weeks later. Preliminary bone culture results showed Gram-positive cocci, so empiric IV vancomycin was started. Final culture results grew Enterobacter cloacae and Staphylococcus epidermidis. Ertapenem 1000 mg IV daily was started two days after the vancomycin was initiated. The patient’s SCr at the time of ertapenem initiation was elevated from his baseline of <1.0 mg/dL to 1.26 mg/dL.