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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary adrenal lymphoma is an extremely rare entity. Only 70 cases have been reported in the English literature. Most of the patients are elderly men with bilateral adrenal masses without extraadrenal involvement. The most common presenting symptoms are fever, weight loss, lumbar pain, and/or symptoms of adrenal insufficiency. Of the cases reported, CT, ultrasound, and MRI were the imaging modalities used to describe the lesions. FDG PET has been used successfully to differentiate benign and malignant adrenal masses. The authors report a 67-year-old man diagnosed as having primary bilateral adrenal lymphoma and having no evidence of extraadrenal spread who was evaluated from the time of diagnosis to complete remission with FDG PET scanning. The literature of this unusual neoplasm is reviewed in detail.
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PMID:FDG-PET imaging in primary bilateral adrenal lymphoma: a case report and review of the literature. 1576 75

A 69-year-old man with a history of lung cancer was referred for FDG whole body positron emission tomography (PET) with computed tomography (CT) fusion. Three days before the study, the patient was involved in a motor vehicle accident (MVA). In addition to hypermetabolic lesions representing metastatic lung cancer, PET scan showed marked anterior and lateral abdominal muscle uptake. Multiple focal abnormalities were seen on the PET scan that corresponded to multiple rib fractures on the CT scan that were secondary to the MVA. When the patient was interviewed, he stated that he had thoracic wall pain that prevented him from breathing properly. This case illustrates an unusual pattern of increased anterior and lateral abdominal muscle uptake as a result of pain while breathing.
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PMID:Abdominal muscle uptake on FDG PET secondary to multiple rib fractures and use of accessory muscles of respiration. 1582 5

A 35-year-old man presented with insidious onset of severe sacral pain. Plain radiography, computed tomography, and magnetic resonance imaging revealed a large, locally invasive mass within the sacrum. Skeletal scintigraphy showed marked hyperemia and minimal peripheral osteoblastic activity of the sacral mass. An F-18 FDG PET study was performed for further assessment and clinical staging. The mass demonstrated high glucose avidity consistent with a high-grade tumor. Histologic examination confirmed the lesion to be a plasmacytoma. Solitary plasmacytoma of bone occurs predominantly in older patients involving the axial skeleton. This case is interesting in view of the large dimension, sacral involvement, the young age of the patient, and the appearance of this lesion across multiple imaging modalities.
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PMID:Solitary plasmacytoma of bone: an unusual cause of severe sacral pain in a young man. 1610 Apr 81

The way in which medication overuse transforms episodic migraine into chronic daily headache is unknown. To search for candidate brain areas involved in this process, we measured glucose metabolism with 18-FDG PET in 16 chronic migraineurs with analgesic overuse before and 3 weeks after medication withdrawal and compared the data with those of a control population (n = 68). Before withdrawal, the bilateral thalamus, orbitofrontal cortex (OFC), anterior cingulate gyrus, insula/ventral striatum and right inferior parietal lobule were hypometabolic, while the cerebellar vermis was hypermetabolic. All dysmetabolic areas recovered to almost normal glucose uptake after withdrawal of analgesics, except the OFC where a further metabolic decrease was found. A subanalysis showed that most of the orbitofrontal hypometabolism was due to eight patients overusing combination analgesics and/or an ergotamine-caffeine preparation. Medication overuse headache is thus associated with reversible metabolic changes in pain processing structures like other chronic pain disorders, but also with persistent orbitofrontal hypofunction. The latter is known to occur in drug dependence and could predispose subgroups of migraineurs to recurrent analgesic overuse.
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PMID:Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. 1680 37

Brodie abscess is a rare, localized type of subacute or chronic pyogenic osteomyelitis, usually of staphylococcal origin. Imaging with standard radiographs, bone scintigraphy, and MRI has been described in the literature. We present the case of a 28-year-old patient with pain in the right knee. Whole-body FDG-PET/CT scan showed a solitary FDG-active (SUV max 5.2) intracortical lesion in the meta-/epiphysis of the proximal tibia. CT demonstrated a sclerotic rim around the lesion. A Brodie abscess was considered a possible diagnosis. Multifocality could be excluded. CT-guided transosseous biopsy and curettage was performed and the diagnosis of a Brodie abscess was confirmed.
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PMID:PET/CT of a brodie abscess. 1655 16

We present the FDG PET-CT findings in a patient with persistent pain 7 weeks after a nephrectomy and lymph node dissection for a sarcomatoid renal cell carcinoma. Although conventional imaging was unable to detect evidence of metastatic spread outside the para-aortic nodes, a PET-CT scan showed unexpected extensive dissemination. Currently, there are no reports in the literature of the PET-CT findings in sarcomatoid renal cell carcinomas.
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PMID:Sarcomatoid renal cell carcinoma: rapid dissemination detected on FDG PET-CT. 1710 35

We report the case of a 50-year-old Japanese woman with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteomyelitis) syndrome. Radiographs showed osteosclerosis of the cervical and lumbar vertebrae, as well as osteosclerosis and osteolysis of the right femoral neck, resembling multiple metastatic bony lesions. Arriving at a diagnosis required hematological and imaging tests. Whole-body bone scintigraphy identified diffuse uptake from the lower cervical vertebrae to the lumbar vertebrae and marked uptake in the right femoral neck. However, with [(18)F]fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET) scanning, abnormal [(18)F]FDG uptake was not detected in cervical and lumbar spine, or in the femoral neck. Bone biopsy showed signs of chronic nonspecific inflammation, rather than tumor or infection. Based on these findings, the patient was diagnosed with SAPHO syndrome unaccompanied by skin lesions, and administration of non-steroidal anti-inflammatory drugs provided pain relief.
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PMID:A case of SAPHO (synovitis-acne-pustulosis-hyperostosis-osteomyelitis) syndrome in which [18F]fluorodeoxyglucose positron emission tomography was useful for differentiating from multiple metastatic bone tumors. 1727 26

Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression. Because a prominent clinical feature of depression is anhedonia--the inability to experience pleasure from previously pleasurable activities--and because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive symptomatology in otherwise treatment-resistant depression. Three patients suffering from extremely resistant forms of depression, who did not respond to pharmacotherapy, psychotherapy, and electroconvulsive therapy, were implanted with bilateral DBS electrodes in the nucleus accumbens. Stimulation parameters were modified in a double-blind manner, and clinical ratings were assessed at each modification. Additionally, brain metabolism was assessed 1 week before and 1 week after stimulation onset. Clinical ratings improved in all three patients when the stimulator was on, and worsened in all three patients when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Using FDG-PET, significant changes in brain metabolism as a function of the stimulation in fronto-striatal networks were observed. No unwanted effects of DBS other than those directly related to the surgical procedure (eg pain at sites of implantation) were observed. Dysfunctions of the reward system--in which the nucleus accumbens is a key structure--are implicated in the neurobiology of major depression and might be responsible for impaired reward processing, as evidenced by the symptom of anhedonia. These preliminary findings suggest that DBS to the nucleus accumbens might be a hypothesis-guided approach for refractory major depression.
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PMID:Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. 2654 64

Gastrointestinal stromal tumours (GISTs) are defined as a group of C-KIT positive mesenchymal tumours of the gastrointestinal tract. Although they may arise throughout the gut, the commonest sites are stomach and small intestine. Over 80% of metastases are to the liver and omentum. Targeted therapy (imatinib) can inhibit C-KIT and thereby aberrant tumoural proliferation. Imatinib may induce shrinkage of lesions and cystic change. Such physical changes often correspond with reduced metabolic activity demonstrated by (18-FDG)PET scans. These changes may enable metastatectomy reducing tumour pain and the risk of haemorrhage and rupture in the short term. In the long term, resection may lessen the risk of recurrence by removing potentially resistant clones. The precise role of palliative resection for GIST metastases on imatinib remains unclear. Imatinib has changed the natural history of metastatic GISTs, with increased survival times. Surgery remains an important management strategy in the metastatic setting because complete pathological responses are rare with imatinib. Surgery is likely to provide the best palliation, greatest reduction in tumour burden and eliminate resistant clones. A multidisciplinary team approach with expertise concentrated in a few centres specialising in the management of these rare tumours is vital to the successful outcome. Future issues regarding the management of differential response of the metastases to imatinib are highlighted. With the emergence of techniques enabling identification of the precise mutational status of the C-KIT oncogene, the imatinib/surgery sequence could be tailored to the type of C-KIT mutation.
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PMID:A review of the surgical management of metastatic gastrointestinal stromal tumours (GISTs) on imatinib mesylate (Glivec). 1746 85

Neuroimaging studies have explored cerebral activation patterns in patients with cluster headache (CH) during attacks and have revealed activation of multiple brain areas known to belong to the general pain-processing network. However, it is still unclear which changes in brain metabolism are inherent to the shift from the 'in bout' to the 'out of bout' period. We measured cerebral glucose metabolism in 11 episodic CH patients during the cluster and again during the remission period with (18)F-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) and compared these data with 11 healthy controls. 'In bout' compared with 'out of bout' scans were associated with increases of metabolism in the perigenual anterior cingulate cortex (ACC), posterior cingulate cortex, prefrontal cortex, insula, thalamus and temporal cortex. Decreases in metabolism were observed in the cerebellopontine area. Compared with healthy volunteers, hypometabolism in the patient group ('in bout' and 'out of bout') was found in the perigenual ACC, prefrontal and orbitofrontal cortex. Thus, FDG-PET in CH patients revealed 'in bout' activation of brain structures which are involved in descending pain control. Compared with controls, the regional brain metabolism was constitutively decreased in most of these structures, irrespective of the bout. This finding indicates a deficient top-down modulation of antinociceptive circuits in CH patients. We suggest that trigger mechanisms of CH are insufficiently controlled and thus promote the initiation of the bout period and acute attack.
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PMID:Altered metabolism in frontal brain circuits in cluster headache. 1766 83


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