Ultrasound (US) proved highly effective for detection, localization, and delineation of enlarged lymph nodes of the neck. Infiltration of adjacent structures, specifically the common, internal, and external carotid arteries, and the neck muscles was reliably demonstrated. Benign and malignant lymph node enlargement could not be differentiated. US examinations changed the operative course of 56% of patients studied. In 41%, a more radical operative procedure was performed than was previously planned; in 14%, US demonstrated inoperability. Small-parts US is a very useful adjunct to current imaging techniques of cervical lymph node disease.
An intravertebral vacuum phenomenon was observed within 19 vertebrae of 17 patients. It represents a non-healing vertebral fracture. Three possible pathologic mechanisms are discussed: ischemic bone necrosis, trauma with ensuing ischemic necrosis, and intraosseous disc prolapse. The intravertebral vacuum phenomenon was found in two patients with multiple myeloma and thus does not exclude the presence of malignancy in the affected bone. Radiographs obtained during traction or extension may be of diagnostic value.
The aim of this study was to examine the effect of intranasal administration of salmon calcitonin to a group of 24 postmenopausal women with severe, established osteoporosis (t score < -2.5 SD) and more than one vertebral fracture. The patients were treated with 200 IU of nasal salmon calcitonin daily for 2 months with a subsequent pause of 2 months (3 cycles) and 500 mg calcium daily over a total of 12 months in an open randomized study. The patients were compared with an age matched control group of 18 women of a similar clinical status who were treated with calcium and vitamin D only. In the nasal calcitonin treatment group an increase in the trabecular axial bone density of 2.8% was achieved, as well as increase in trabecular appendicular (forearm) bone density of 1.6%, together with a cortical bone density increase of 1.8% axial and 1% appendicular. Initially, elevated values of urinary deoxypyridinoline were found in 12 women in the nasal calcitonin treatment group; these levels returned to normal under salmon calcitonin nasal therapy and documented the inhibition of increased osteoclastic activity. Cyclic intermittent calcitonin nasal therapy led to a general increase in trabecular and cortical axial and appendicular bone density, marked alleviation of the subjective sensation of pain, and a reduction in the daily dose of accompanying nonsteroidal anti-inflammatory drugs by 50%.
The sensitivity of radionuclide imaging for detecting skeletal lesions was compared with that of radiography by evaluating 573 different anatomical sites in 41 patients with multiple myeloma. Radiography revealed a significantly greater number of myeloma-related bone lesions than did radionuclide imaging. Of the 179 myeloma-related bone lesions detected when both techniques were applied, 163 were seen by radiography and 82 by radionuclide imaging. Ninety-seven lesions were detected by radiography alone and 16 lesions seen by scintiscanning only, yielding a sensitivity of 91% for the former and of 46% for the latter technique. Radionuclide imaging proved superior to radiography only occasionally in the rib cage, and rarely in other anatomical sites. These findings suggest that radiography is the method of first choice in obtaining a skeletal survey in patients with multiple myeloma. In cases with continued pain, unexplained by standard radiography, the skeletal survey should be supplemented by tomography and radionuclide imaging.
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