strontium-radioisotopes and Osteosclerosis

Osteosclerotic myeloma is a rare disorder characterized by paraproteinaemia and osteosclerosis, and may be associated with a progressive peripheral neuropathy. Patients with widespread osteosclerotic lesions can succumb from neurological complications despite systemic chemotherapy. We present a case of disseminated osteosclerotic myeloma associated with POEMS (peripheral neuropathy, organomegaly, endocrinopathy, M band, skin changes) syndrome, which was complicated by a rapidly progressive, life-threatening neuropathy. The patient's symptoms remained unchanged in the face of combination chemotherapy. However, a substantial improvement was seen following outpatient treatment with the commonly available radioisotope strontium 89 in combination with steroids.

Topics: Anti-Inflammatory Agents; Combined Modality Therapy; Disease Progression; Humans; Male; Middle Aged; Multiple Myeloma; Osteosclerosis; POEMS Syndrome; Prednisolone; Radiopharmaceuticals; Strontium Radioisotopes

Forty femoral neck fractures were followed for 5 years in a prospective clinical, roentgenographic and scintimetric investigation. Thirteen cases had uncomplicated healing, 22 necrosis and five non-union. The diagnostic value of radiographic changes was analysed with reference to development of necrosis of the femoral head or non-union. Sclerosis of the femoral head, and compression and displacement of the fracture were compatible with eventual healing and clinical recovery. Subchondral fracture and collapse of the load-bearing surface, diagnostic for necrosis, were observed in only 7 of 22 cases at 1 year and as late as 3-5 years in three cases. By contrast, four out of five non-union cases were established radiographically within 1 year. Patients needing an arthroplasty after fracture of the femoral neck should be identified on clinical grounds after early radionuclide scintimetry. Waiting for radiographic documentation of necrosis in cases with pain will increase the risk for physical and social impairment associated with poor function of the hip.

Topics: Adult; Aged; Femoral Neck Fractures; Femur Head Necrosis; Follow-Up Studies; Fractures, Ununited; Humans; Middle Aged; Osteosclerosis; Prospective Studies; Radiography; Radionuclide Imaging; Strontium Radioisotopes; Wound Healing

Topics: Adolescent; Adult; Edetic Acid; Female; Femur; Humans; Male; Osteomyelitis; Osteosclerosis; Radiography; Radionuclide Imaging; Recurrence; Strontium Radioisotopes

Topics: Animals; Bone and Bones; Cell Division; Clone Cells; Colloids; Estrone; Female; Hematopoiesis; Hematopoietic Stem Cells; Iron; Iron Radioisotopes; Kinetics; Mice; Mononuclear Phagocyte System; Osteosclerosis; Phagocytosis; Spleen; Strontium; Strontium Radioisotopes; Technetium