Breast cancer is the most common malignant tumor of females, the incidence increases with age. Bone is the most common site to which breast cancer metastasizes. Between 30% to 85% of patients with metastatic breast cancer develop bone metastases during the course of the disease. Bone scan is the most commonly used means of detecting bone metastasis; it visualizes increases in osteoblastic activity and skeletal vascularity. Many radio-pharmaceuticals (radionuclides) have been used in bone scan including technetium-99m bound to methylene diphosphonate (MDP). Published sensitivity and specificity rates of bone scan for diagnosis varies, with sensitivity ranging from 62% to 100% and specificity from 78% to 100%. However, bone scan is generally considered sensitive for detecting bone metastases on whole-body images.The aim of this study was to evaluate the pattern of distribution of skeletal metastases in patients with breast carcinoma by using Tc-99m MDP bone scan. A retrospective study was conducted on 245 consecutive female breast carcinoma patients irrespective of clinical staging, menopausal status and pre-operative / post- mastectomy status, referred for bone scan to Institute of Nuclear Medicine and Allied Sciences, Rajshahi from July 2015 to June 2017.  The mean age of the patients was 43.4 ± 13.8 years (mean ± SD) with range from 29 to 66 years. Bone scan was performed by an intravenous bolus injection of 20 mCi Tc99m-MDP. Bone phase images were taken at three hours after injection of the radiotracer. Out of 245 studied patients, 163 patients (66.53%) were negative for skeletal metastasis and 82 patients (33.47%) were positive for skeletal metastasis. Out of 82 patients with positive skeletal metastasis, 68 (82.93%) patients had multiple sites (two or more) and 14 (17.07%) patients had solitary site of bony involvement. Out of 68 patients with multiple sites of skeletal metastasis, highest number was noted in thoraco-lumbar spine (80.89%), followed by ribs including sternum and clavicle (57.35%), pelvic bones (47.06%), upper extremities including scapula (41.18%), lower extremities (33.82%), cervical spine (23.53%) and skull bone (8.82%). Among 14 patients with solitary skeletal metastasis, maximum number was noted in thoraco-lumbar spine (64.29%), followed by cervical spine (14.29%), pelvic bone (07.14%), ribs (07.14%) and sternum (07.14%). Skeletal metastases were  much more common in multiple sites than solitary lesion in breast cancer patients. Thoraco-lumbar spine was the most common site of involvement in both solitary and multiple lesions in our study. Axial skeleton was more commonly involved than the appendicular skeleton. Bone scan may pick up bone metastases up to 18 months earlier than conventional radiology, with an average lead of four months. 99m Tc- MDP bone scan is very cost effective in comparison to other imaging modalities (CT, MRI, and PET) and play a major role in early detection of skeletal metastasis in breast cancer patients. Bangladesh J. Nuclear Med. 21(1): 21-25, January 2018

<p><strong><em>Background: </em></strong>Lung cancer is the leading cause of cancer deaths worldwide. Lung cancer is often insidious, producing no symptoms until the disease is well advanced. In approximately 7-10% of cases, lung cancer is diagnosed in asymptomatic patients. Some patients are asymptomatic for skeletal metastasis and a recent prospective study showed that in staging of non-small cell lung cancer (NSCLC), failure to perform a bone scan could miss asymptomatic bone metastasis in 14–22% of patients. Radionuclide bone scintigraphy with ^99m Tc MDP (Technetium-99mmethylene diphosphonate) is very useful nuclear imaging tool to detect skeletal metastasis with a sensitivity of 98.2% and a specificity of 95.2%. The aim of this study was to detect the asymptomatic skeletal metastasis of non-small cell lung cancer patients by ^99mTc MDP bone scan.</p><p><strong><em>Patients and methods:</em></strong> It is a retrospective study, carried out from January 2015 to December 2016 in Institute of Nuclear Medicine and Allied Sciences, Rajshahi. Bone scan was performed by an intravenous bolus injection of 20 m Ci ^99mTc MDP. Bone phase images were taken at three hours after injection of the radiotracer.</p><p><strong><em>Results:</em></strong> A total of 52 patients were enrolled in the study. The mean age of the patients was 57.6 ± 14.5 years (mean ± SD) with range from 36 to 75 years and 42 (80.77%) were male and 10 (19.23%) were female. Out of 52 patients, only 06 (11.54%) patients were diagnosed as positive and 46 (88.46%) were negative for bone metastasis. Out of 06 patients with positive skeletal metastasis 04 (66.67%) patients had multiple sites (two or more) and 02 (33.33%) patients had solitary site of bone involvement. Common sites of metastasis were in thoracic (83.33%) and lumbar spine (83.33%), ribs (50%), pelvic bones (33.33%), long bones (16.66%), skull (16.66%) and other bony sites including clavicle, sternum, scapula, sacrum (16.66%). Regarding staging prior to bone scan, out of 06 bone scan positive patients 03 (50%) patients were in stage III, 02 (33.33%) patients were in stage IV and 01(16.67%) patient was in stage II. On the basis of histopathology, out of 06 skeletal metastatic patients 04 (66.67%) patients had adenocarcinoma, 01 (16.67%) patient had squamous cell carcinoma and 01 (16.67%) had large cell carcinoma. The exclusion of bone metastasis is important in the initial staging of non-small cell lung cancer.</p><p><strong><em>Conclusion:</em></strong> There is debate about whether bone scans should be performed routinely or restricted to patients who present with clinical or laboratory indicators suggesting skeletal metastasis. The present study indicates that if bone scans were done only in patients reporting skeletal symptoms an important number of patients (11.54%) would have been miss-staged due to asymptomatic bone metastasis. As bone scan is very cost effective in comparison to other imaging modalities (MRI / PET-CT), it can play a vital role in detecting asymptomatic skeletal metastasis in NSCLC patients.</p><p>Bangladesh J. Nuclear Med. 20(2): 110-114, July 2017</p>

Abstract

Background: Foreign material used in ocular surface surgery may lead to local complications such as discomfort, scarring, or infection. Plasma-derived products such as fibrin glue may produce hypersensivity reactions whereas the risk of viral transmission remains. We describe a simple method of achieving conjunctival autograft adherence during pterygium surgery avoiding potential complications associated with the use of fibrin glue or sutures. Materials & Methods: This study was conducted at Jahurul Islam Medical college Hospital, Bajitpur, Kishoregonj from August 2016 to April 2018. Fifty cases with unilateral primary pterygium were selected for the study. The operation was done under local anaesthesia. After pterygium excision and fashioning of the autologus conjunctival graft, the recipient bed is allowed to achieve natural haemostasis and relative dessication before graft placement. Excessive haemorrhage in the graft bed is temponaded. Graft adherence and positioning is examined after surgery. Results: A total of 50 eyes of 50 patients mean age at the time of surgery was 40.5±10.3 years ranged from 17 to 70 years, with a female to male ratio was 1:1.94, underwent sutureless glue-free autologus conjuntival graft after pterygium excision. Mean graft area was 24(1.5) mm2. The patients were followed up for 4 months. Cosmesis was excellent in all cases and there were no intra- or post-operative complications requiring further treatment. Conclusion: This simple technique for pterygium surgery may prevent potential adverse reactions encountered with the use of foreign materials and this small series provided safe and comparable results to current methods. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 28-31