Palliation of pain associated with metastatic bone cancer using samarium-153 lexidronam: a double-blind placebo-controlled clinical trial.

PURPOSE: To evaluate the effectiveness and safety of samarium-153 (153Sm) lexidronam (EDTMP) in a double-blind, placebo-controlled study. PATIENTS AND METHODS: Patients with painful bone metastases secondary to a variety of primary malignancies were randomized to receive 153Sm-EDTMP 0.5 or 1.0 mCi/kg, or placebo. Treatment was unblinded for patients who did not respond by week 4, with those who had received placebo eligible to receive 1.0 mCi/kg of active drug in an open-label manner. Patient and physician evaluations were used to assess pain relief, as was concurrent change in opioid analgesia. RESULTS: One hundred eighteen patients were enrolled onto the study. Patients who received 1.0 mCi/kg of active drug had significant reductions in pain during each of the first 4 weeks in both patient-rated and physician-rated evaluations. Pain relief was observed in 62% to 72% of those who received the 1.O-mCi/kg dose during the first 4 weeks, with marked or complete relief noted in 31% by week 4. Persistence of pain relief was seen through week 16 in 43% of patients who received 1.0 mCi/kg, of active drug. A significant correlation (P = .01) was observed between reductions in opioid analgesic use and pain scores only for those patients who received 1.0 mCi/kg 153Sm-EDTMP. Bone marrow suppression was mild, reversible, and not associated with grade 4 toxicity. CONCLUSION: A single dose of 1.0 mCi/kg of 153Sm-EDTMP provided relief from pain associated with bone metastases. Pain relief was observed within 1 week of administration and persisted until at least week 16 in the majority of patients who responded.

Plasma D-dimer: a useful tool for evaluating suspected pulmonary embolus.

Although ventilation-perfusion lung scanning is widely used in evaluating patients with suspected pulmonary embolus, additional rapid screening tests are needed to supplement scintigraphy in patients in whom the scan is indeterminate or the scan results are discordant with clinical suspicion. D-dimer is a fibrin degradation product which should be elevated in the presence of intravascular coagulation. We prospectively studied patients referred for lung scanning by obtaining a plasma D-dimer latex agglutination assay at the time of the scan. Of 64 patients who had pulmonary angiography to confirm the diagnosis, 16 were positive for pulmonary embolus and only one had a normal D-dimer. The D-dimer was normal in 27 of 48 patients without embolus and elevated in 21. Although an elevated D-dimer level is a nonspecific finding, we conclude that a normal D-dimer is a good negative predictor for pulmonary embolus, with a negative predictive value of 0.97.

Pulmonary embolism: chest radiographic abnormalities.

The value of chest radiography in the diagnosis of pulmonary embolism has been investigated extensively. Although the chest radiograph seldom permits one to say whether embolism is or is not present, it is still an essential component in the evaluation of the patient with suspected pulmonary embolism. This article stresses the radiographic abnormalities that occur with pulmonary embolism and defines the role of the chest radiograph for evaluation of this disorder.

Computed tomography and magnetic resonance imaging in the diagnosis of pulmonary thromboembolic disease.

In selected cases CT and MRI may be useful for the evaluation of patients suspected of having central pulmonary emboli. In stable patients MRI appears to be superior to CT because no iodinated contrast medium is required. In evaluating critically ill patients CT is better because of its superior resolution, ability to assess changes in the lung parenchyma, and ease of patient monitoring.

Crossed renal ectopia. Correlative imaging.

Anatomic variants of the kidneys are often noted during renal scintigraphy and other imaging studies. These conditions have a variable effect on overall renal function and can cause confusion, both clinically and on initial imaging. The authors describe a case of unfused, crossed renal ectopia in an elderly woman that appeared to be an abdominal mass and was subsequently evaluated by computed tomography, ultrasound, and scintigraphy.

A rapid method for standardization of the gated radionuclide left ventricular ejection fraction.

Radionuclide ventriculography has become the standard method for serially evaluating left ventricular ejection fraction (EF). The "gold standard" for evaluating EF is the contrast ventriculogram, which uses mathematical models to arrive at the volumes used to calculate EF. These models are subject to possible error. This paper reports the standardization of volume measurements of a digital angiographic camera system using a series of cardiac phantoms and the correlation of measurement of the EF of a series of patients whose EF was determined by digital angiography and radionuclide ventriculography.

Indium-111 leukocyte localization in infected prosthetic graft.

Infective endocarditis can be difficult to prove, even in the face of strong clinical suspicion. A case in which standard methods of diagnosis failed to demonstrate endocarditis in a patient with recurrent Staphylococcus aureus bacteremia and porcine aortic valve is reported. An In-111 labelled leukocyte SPECT study demonstrated uptake in the aortic root and leaflets, and autopsy demonstrated vegetations on the leaflets. In-111 may prove useful in demonstrating endocarditis in patients with prosthetic valve infection.

Complications from extravasated retroperitoneal barium: case report and review of the literature.

Extravasation of barium into the retroperitoneum is an uncommon complication of radiologic examinations of the gastrointestinal tract. It may occur during evaluation of either the upper or lower tract. A case is presented in which the result was abscess formation, a potential delayed complication of duodenal perforation and retroperitoneal extravasation of barium. In this case, medical treatment was successful.