Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Generalized tendomyopathy (GTM), or fibromyalgia (FM), is a disease characterized by wide-spread pain in the musculoskeletal system which usually begins at a single site, e.g., as low-back pain or cervical syndrome, and develops into generalized pain over months or years. The disorder affects primarily women, beginning around the age of 35 and reaching its peak during or after the menopause. Its etiology is still unknown. Secondary forms are observed particularly in rheumatoid arthritis. In order to get more information on FM we determined the local metabolic rate of glucose in vivo in the skeletal muscle (lumbar region) with dynamic 18F-FDG positron emission tomography (PET). 2 healthy volunteers and 6 female patients with FM reaching in age from 31 to 53 years were scanned. As 18F-FDG PET scanning is a metabolic tool, it is crucial to observe standardized conditions of metabolic steady-state. We used, therefore, the hyperinsulinemic euglycemic insulin clamp technique to stimulate the myogenic glucose uptake under stable plasma-glucose levels. The local metabolic rates of glucose utilization were estimated with a non-linear least squares fit on the 3 compartment 18F-FDG-model. A lumped constant of 0.67 was assumed. Under glucose clamp conditions patients with FM showed a significantly (p < 0.001) lower metabolic rate of glucose (4.3 +/- 1.1) mumol/100 g tissue/min compared with normal volunteers (8.5 +/- 2.3 mumol/100 g/min). Due to a significantly (p < 0.005) increased glucose backflow from tissue into the vascular space (k2 in the kinetic model) the rate of phosphorylation was markedly reduced in patients with FM.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Determination of regional rate of glucose metabolism in lumbar muscles in patients with generalized tendomyopathy using dynamic 18F-FDG PET]. 147 8

21 patients were followed by positron-emission-tomography (PET) FDG (18Flourdeoxyglucose) uptake, physical examination, CT and CEA levels after combined photon-neutron irradiation for inoperable recurrent rectal carcinoma. In order to evaluate the response to radiotherapy symptomatic relief, CEA levels, decrease of tumor volume measured by CT analysis were correlated with the FDG-uptake. The objective of this study was also to investigate if the level of FDG-uptake prior to radiotherapy or the early decrease after therapy can be used as a prognostic factor. Prior to radiotherapy sacral pain was the predominant symptom. All malignancies showed measurable tumor masses, evaluation of CEA levels and enhanced tracer accumulation of FDG in the PET cross section. The mean FDG-uptake before radiotherapy was 2.3 +/- 1.1 (range 1.1 to 5.0) in 21 patients in contrast to 1.9 +/- 0.7 (range 0.8 bis 4.0) three months after radiotherapy. In six patients FDG concentration values decreased to the range of normal soft tissue, moreover, two of them relapsed after six and 22 months. Elevated FDG-uptake of the sacral bone was noted in PET cross sections in two patients, while there was no evidence of osseous alterations in CT. Normal levels of CEA were achieved in 14 patients and complete or partial pain relief in 20 of 21 patients. A decrease of tumor volume of more than 50% was detected in the follow-up CT scans of three patients but no complete remission was found. The result suggests that enhanced glucose uptake is associated with recurrent rectal cancer. However, enhanced glycolytic activity is related not only to malignant cells but also to all proliferating cells. To distinguish between proliferation, repair, inflammation, and residual viable tumor cells is not possible and may be responsible for an unchanged or elevated FDG-uptake after radiotherapy.
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PMID:Therapy monitoring of presacral recurrences after high-dose irradiation: value of PET, CT, CEA and pain score. 157 69

Experience of scintigraphic detection of bone lesion and active bone marrow involvement of multiple myeloma, especially with sestamibi and FDG-PET scans is in evolution. We report a case of intense sestamibi uptake in bone marrow correlating with the extent of the disease, while FDG-PET scans showed activity only in areas of active disease progression associated with pain. Technetium-99m-sestamibi appears to indicate the extent of the disease, while [18F]FDG-PET scans show sites of active tumor proliferation and may be useful in directing local therapy such as radiation.
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PMID:Technetium-99m-MIBI versus fluorine-18-FDG in diffuse multiple myeloma. 925 51

The value of whole body PET-FDG in the evaluation of metastases has been demonstrated in a wide variety of tumors. In this report, we present the case of a patient with antecedent of papillary thyroid carcinoma, who was operated twelve years ago, and submitted to an ablative dose of residual thyroid tissue through 131I, being the levels of thyroglobulin normals. After twelve years of evolution, the patient refers bag pain and respiratory trouble, appearing in the CT image suspicious of metastases in right pulmonary base. The levels of thyroglobulin were shown increased, being the 131I scan negative. A whole body PET-FDG study was performed in order to exclude metastases of his malignant process, showed multiple high FDG uptake focus in brain, cerebellum, neck, chest, lymphatic nodes and bone, suggestive of dedifferentiated disease These findings were confirmed subsequently in the clinic evolution. Therefore, whole-body PET-FDG is a complementary diagnostic technique for study patients with CDT (Thyroid Differentiated Carcinoma) with 131I scan negative and rising thyroglobulin levels.
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PMID:[PET-FDG in thyroid cancer with high thyroglobulin levels and negative 131-I scan. A case report]. 1007 19

Despite highly efficacious chemotherapy, patients with osteosarcomas still have a poor prognosis if adequate surgical control cannot be obtained. We applied high-activity Sm-153-EDTMP therapy within a multimodal therapy concept to improve local control of an unresectable osteosarcoma with poor response to initial polychemotherapy. A 21-year-old woman with an extended, unresectable pelvic osteosarcoma and multiple pulmonary metastases was treated with high-activity of Sm-153- EDTMP (150 MBq/kg BW, total 8.1 GBq). Afterwards external radiotherapy of the primary tumor site was performed and polychemotherapy was continued, followed by autologous peripheral blood stem cell reinfusion. Within 48 h after Sm-153-EDTMP application the patient had complete pain relief. After three weeks the response was documented by 3-phase Tc-99m-MDP bone scintigraphy (primary tumor and metastases: decreased tracer uptake), whole-body F-18-FDG-PET (primary tumor and metastases: diminution of glucose metabolism) and thoracic CT (metastases: reduction of size). The present case warrants further evaluation of feasibility and efficacy of this multimodal therapy combination of high-activity Sm-153-EDTMP therapy, external radiation, polychemotherapy and stem cell support for unresectable osteosarcomas.
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PMID:High-activity samarium-153-EDTMP therapy in unresectable osteosarcoma. 1061 69

The aim of this study was to evaluate changes of flow, metabolism and left ventricular function in patients revealing a "reversed mismatch" pattern (reduced glucose uptake relative to perfusion) on positron emission tomography (PET) early after myocardial infarction. In 19 out of 68 patients (28%), prospectively included in the GUSTO-I or STAR studies, a PET reversed mismatch pattern in the infarct-related region was found. All patients received thrombolytic therapy within 3 h after onset of pain and coronary angiography 90 min later. 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG)/nitrogen-13-labelled ammonia (13NH3) PET was performed after 5 days and 3 months. In 12 of the 19 patients, functional recovery was investigated with two-dimensional echocardiography at the same time points. In the infarct-related region, normalized 13NH3 uptake was 76% +/- 11% at 5 days and 85% +/- 10% at 3 months (P < 0.00001). Absolute blood flow in this region was 75 +/- 25 ml/min per 100 g at 5 days and 80 +/- 19 ml/min per 100 g at 3 months. At 5 days, normalized 18F-FDG uptake in the infarct-related region was decreased (51% +/- 12%). At 3 months, 18F-FDG uptake in this region had significantly recovered (75% +/- 11%, P < 0.00001). In the infarct-related region, absolute FDG metabolism was 17 +/- 6 mumol/min per 100 g at 5 days and 26 +/- 9 mumol/min per 100 g at 3 months (P < 0.0001). At 5 days, normalized 18F-FDG uptake was more severely decreased as compared to the normalized 13NH3 uptake (P < 0.00001) in the infarct-related region, resulting in a reversed mismatch pattern (25% +/- 13% of the left ventricle). At 3 months, 18F-FDG metabolism had partially recovered, giving rise to a change into a PET match pattern. Reversed mismatch regions were present in only 7% +/- 7% of the left ventricle at that time. The ratio of 18F-FDG uptake to 13NH3 uptake in the infarct-related region increased from 0.67 +/- 0.8 at 5 days to 0.88 +/- 0.09 at 3 months (P < 0.00001). No functional recovery was observed in the infarct-related region (the 5-day and 3-month wall motion scores were both 2.5 +/- 0.5). In patients with a myocardial infarction showing a PET reversed mismatch pattern 5 days after thrombolytic therapy, recovery of 18F-FDG uptake was found but no functional recovery was observed at 3-month follow-up.
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PMID:PET "reversed mismatch pattern" early after acute myocardial infarction: follow-up of flow, metabolism and function. 1135 96

Authors report on a case of [18F]-fluorodeoxyglucose ([18F]-FDG) uptake in the soft tissue of a patient referred for [18F]-FDG coincidence detection emission tomography (CDET) in a search for recurrence of colorectal cancer. A herpes zoster eruption occurred in the same site within two days, but was spontaneously resolved. To the best of our knowledge this is the first description of a false positive [18F]-FDG result in relation to a viral infection of soft tissue. It shows that interpretation of subcutaneous foci has to be cautious in patients with or without a past history of herpes zoster even in pain-free areas and prior to skin eruption.
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PMID:[18F]-FDG uptake in soft tissue dermatome prior to herpes zoster eruption: an unusual pitfall. 1175 54

Pain is a common unspecific symptom in orthopaedic prosthetics. The accurate differentiation between synovitis, loosening or infection is often difficult with conventional X-rays, arthrography or bone scintigraphy. Because of the high glucose uptake of inflammatory cells, [18F]fluorodeoxyglucose (18F-FDG) is an appropriate tracer for the evaluation of suspected inflammation or infection. In this preliminary study we describe 18F-FDG PET findings in patients referred for evaluation of painful hip or knee prostheses. We studied 23 patients with 28 prostheses, 14 hip and 14 knee prostheses, who had a complete operative or clinical follow-up. 18F-FDG PET scans were obtained with an ECAT EXACT HR+ PET scanner. High glucose uptake in the bone prostheses interface was considered as positive for infection, an intermediate uptake as suspect for loosening, and uptake only in the synovia was considered as synovitis. The imaging results were compared with operative findings or clinical outcome. PET correctly identified three hip and one knee prostheses as infected, two hip and two knee prostheses as loosening, four hip and nine knee prostheses as synovitis, and two hip and one knee prostheses as unsuspected for loosening or infection. In three patients covered with an expander after explantation of an infected prosthesis PET revealed no further evidence of infection in concordance with the clinical follow-up. PET was false negative for loosening in one case. Our preliminary results suggest that FDG PET could be a useful tool for differentiating between infected and loose orthopaedic prostheses as well as for detecting only inflammatory tissue such as synovitis.
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PMID:The use of [18 F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses. 1208 87

We report a patient with a relapsed in bone marrow of extremities after allogeneic peripheral blood stem cell transplantation for acute lymphoblastic leukemia (ALL). The patient complained of pain in the right upper arm and left leg 15 months after transplantation. Magnetic resonance imaging (MRI) and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) showed abnormal findings in bone marrow of upper and lower extremities. There were no findings of relapse in aspirates from the sternum and iliac bone marrow. Biopsy specimen from the iliac bone marrow showed normocellular marrow without leukemic cells. Biopsy specimen from the right humerus revealed marked leukemic cell infiltration in the bone marrow. This is apparently the first case of localized relapse of ALL in bone marrow of extremities. Physicians should be aware of unusual relapse sites of leukemia after allogeneic stem cell transplantation. MRI and FDG-PET may be of value in detecting this type of relapse.
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PMID:Localized relapse in bone marrow of extremities after allogeneic stem cell transplantation for acute lymphoblastic leukemia. 1522 67

A 58-year-old woman presented with non-radicular pain in the upper thorax. Due to the prolonged duration of symptoms, a bone scintigraphy was made, which showed pathological enhancement in the upper thoracic spine. An MRI demonstrated lesions of the third and fourth thoracic vertebrae. A biopsy showed a metastasis of poorly differentiated carcinoma. A whole-body 18-F-FDG PET scan failed to identify a primary tumour. The patient was given radiotherapy, chemotherapy and analgesic treatment. She died within 3 years. In the late stage, the tumour marker CA 19-9 was positive; however, an MRI of the abdomen failed to identify a pancreatic tumour. Metastasis from an unknown primary site can present as cervical spinal disease very similar to degenerative disease.
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PMID:Spinal pain due to metastasis of unknown origin. 1568 89


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