99m Tc-Octreotide-Avid Brain Mass In A Patient With Poorly Differentiated Papillary Thyroid Carcinoma, Hope In Despair.

Brain metastases of PTC are rare and occur in 0.1-5% of the patients, especially in the poorly differentiated types that usually fail to concentrate iodine. We present a rare case of PTC with probable brain metastasis in a 58-year-old woman with a history of poorly differentiated PTC that showed elevated Tg levels and no metastasis was detected in the whole-body iodine scan, despite the positive 99m Tc-octreotide scintigraphy. This imaging modality could be helpful as a diagnostic guide for radionuclide therapy with labeled somatostatin analogs in cases of thyroid carcinoma with elevated Tg levels and negative whole-body iodine scan.

Efficacy of duloxetine and gabapentin in pain reduction in patients with knee osteoarthritis.

INTRODUCTION: Knee osteoarthritis (OA) is a common form of arthritis in elders which can lead to reduced daily activity and quality of life. It is important to administer a proper treatment with high efficacy and low side effects. In this study, we evaluated the efficacy of duloxetine and gabapentin in patients with moderate to severe knee OA. METHOD: In this randomized clinical trial, 150 patients with moderate to severe knee OA were randomly allocated to receive duloxetine 30 mg (n = 50), gabapentin 300 mg (n = 50), or acetaminophen 1000 mg (n = 50) all twice a day for 12 weeks. Pain severity using visual analogue scale (VAS) and functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured before, 2 weeks, 1 month, and 3 months after intervention. RESULTS: WOMAC total and its subscale score were significantly lower in duloxetine compared to gabapentin in 2 weeks and 1 months after intervention, with no significant difference at the end of the third month. Both gabapentin and duloxetine groups had significantly more reduction in pain VAS and WOMAC and its subscales compared to acetaminophen group, with no significant difference between groups. CONCLUSIONS: Both gabapentin and duloxetine have similar and acceptable effects in pain reduction and improvement of functional status in patients with knee OA at the end of the third month's treatment. Duloxetine effects begin from the first weeks, while gabapentin effects begin gradually with the best at the end of the third month. KEY POINTS: • Medical treatment is used for releiving pain in knee osteoarthritis. • Gabapentin and duloxetine are both effective in reducing pain in knee osteoarthritis.

99mTC-MDP bone scanning in a subungual glomus tumour.

A 37-year-old female patient with four months history of paroxysmal pain in the left index finger was referred to our department for 99mTC-MDP scintigraphy. Radiographic studies of the patient showed a lytic tumour in the distal phalanx of the left second finger compatible with a glomus tumour. The scan showed mild decreased activity in the blood pool phase and minimal increased activity on the delayed images. The patient underwent surgery and a glomus tumour was removed. To the extent of our knowledge, this is the first case of bone scan in a glomus tumour of the finger reported in the literature.