Monthly infusions of pamidronate as a supplement to chemotherapy can protect against skeletal complications in women with stage IV breast cancer who have osteolytic bone metastases.

Monthly infusions of pamidronate provide significant protection against skeletal complications and improve the quality of life of patients with stage III multiple myeloma.

This copy is for personal use only. To order printed copies, contact reprints@rsna.org I n P r e s s Abbreviations: ICU = intensive care unit; ACE2 = angiotensin converting enzyme 2; COVID-19 = Coronavirus disease 2019; RUQ = right upper quadrant; SARS-CoV-2 = Severe acute respiratory syndrome coronavirus 2.Key Results: -33% of inpatients with COVID-19 had abdominal imaging and 17% had cross-sectional imaging. Imaging was associated with age (OR 1.03 per year increase) and intensive care unit (ICU) admission (OR 17.3). -54% of right upper quadrant ultrasounds demonstrated findings of cholestasis. -31% of CTs showed bowel wall abnormalities. Signs of late ischemia were seen on 20% of CTs in ICU patients (2.7% of ICU patients), with pathologic correlation suggesting small vessel thrombosis. Summary Statement: Bowel abnormalities, including ischemia, and cholestasis were common findings on abdominal imaging of inpatients with COVID-19. I n P r e s s Abstract:Background: Angiotensin converting enzyme 2 (ACE2), a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury.Purpose: To report abdominal imaging findings in patients with coronavirus disease 2019 . Materials and Methods:In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from 3/27/2020 to 4/10/2020 who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included. Abdominal imaging studies performed in these patients were reviewed and salient findings recorded.Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results: 412 patients (average age 57 years; range 18->90 years; 241 men, 171 women) were evaluated. 224 abdominal imaging studies were performed (radiographs, n=137; ultrasound, n=44; CT, n=42; MRI, n=1) in 134 patients (33%). Abdominal imaging was associated with age (odds ratio [OR] 1.03 per year increase, p=0.001) and ICU admission (OR 17.3, p<0.001). Bowel wall abnormalities were seen on 31% of CT scans (13 of 42) and were associated with ICU admission (OR 15.5, p=0.01). Bowel findings included pneumatosis or portal venous gas, seen on 20% of CT scans in ICU patients (4 of 20). Surgical correlation (n=4) revealed unusual yellow discoloration of bowel (n=3) and bowel infarction (n=2). Pathology demonstrated ischemic enteritis with patchy necrosis and fibrin thrombi in arterioles (n=2). Of right upper quadrant ultrasounds, 87% (32 of 37) were performed for liver laboratory findings, and 54% (20 of 37) demonstrated a dilated sludge-filled gallbladder suggestive of cholestasis. Patients with a cholecystostomy tube placed (n=4) had negative bacterial cultures. Conclusion: Bowel abnormalities and cholestasis were common findings on abdominal imaging of inpatients with COVID-19. Patients who went to laparotomy often had ischemia, possibly due to sma...

BACKGROUND Pamidronate therapy previously has been shown to reduce skeletal complications effectively for up to 12 months in breast carcinoma patients with bone metastases. The current study data provide further follow‐up results regarding the effects of long term (up to 24 months) pamidronate treatment in women with breast carcinoma and osteolytic metastases. METHODS Follow‐up results from two prospective, multicenter, randomized, double‐blind, placebo‐controlled intervention trials conducted at academic and community oncology centers were combined to provide a large data set with which to evaluate the long term efficacy and safety of pamidronate therapy. Seven hundred fifty‐four women with Stage IV breast carcinoma and osteolytic metastases were randomized to the 2 treatment arms of the trial. Three patients were excluded from the intent‐to‐treat population for the analysis. A total of 751 evaluable patients were randomized to receive either a 90‐mg intravenous pamidronate infusion (367 patients) or a placebo infusion (384 patients) every 3–4 weeks. The primary outcome measures were skeletal morbidity rate (events/year), proportion of patients developing a skeletal complication, and time to first skeletal complication. RESULTS Of the 367 women receiving pamidronate, 115 (31.3%) completed the trial and 81 (22.1%) discontinued the study due to adverse events. Of the 384 women who received placebo, 100 (26.0%) completed the study and 76 (19.8%) discontinued the study due to adverse events. The skeletal morbidity rate was 2.4 in the pamidronate group and 3.7 in the placebo group (P < 0.001). In the pamidronate group, 186 of the 367 patients (51%) had skeletal complications compared with 246 of the 384 patients in the placebo group (64%) (P < 0.001). The median time to first skeletal complication was 12.7 months in the pamidronate group and 7 months in the placebo group (P < 0.001). Six patients treated with pamidronate discontinued treatment due to drug‐related adverse events. Pain and analgesic scores were significantly worse in the placebo group compared with those patients in the pamidronate group. CONCLUSIONS In the current study, monthly infusions of 90 mg of pamidronate as a supplement to antineoplastic therapy were found to be well tolerated and superior to antineoplastic therapy alone in preventing skeletal complications and palliating symptoms for at least 24 months in breast carcinoma patients with osteolytic bone metastases. Cancer 2000;88:1082–90. © 2000 American Cancer Society.