ABSTRACT Introduction: Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018. Materials and Method: Baseline bone health was assessed using Tc-99 MDP Bone scan/ DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were receiving ADT. Baseline and follow-up (at 12-months) BMD using DEXA scan at various sites (spine, femur total, femur neck and radius) and subjective improvement in bony pain using Numeric Pain Rating Score after administration of ZA were compared. Results: A total of 96-patients of locally advanced and metastatic prostate cancer receiving ADT with or without BDT were included in the study cohort. Mean age of presentation was 68.4±15.61 years. Median serum PSA was 32.2±13.1ng/mL. There was significant improvement in mean BMD (T-score) in 64-patients post ZA therapy at 12-months (at femoral total, femoral neck and spine; 0.95, 0.79 and 0.68, respectively) (p <0.05) while there was significant deterioration in mean BMD at 12-months (at spine, femoral neck and femoral total; −0.77, −0.55 and −0.66, respectively) in 32 patients who did not receive ZA and were on ADT (p <0.05). Pain scores significantly decreased in patients after 12-months of ZA use (−2.92±2.16, p <0.01). Conclusion: Bone-directed therapy (Zoledronic acid) leads to both subjective and objective improvement in bone health of prostate cancer patients on ADT.

Resumo O presente relato descreve um caso de acidente vascular cerebral perioperatório que resultou em diplopia e dificuldade de marcha no segundo dia após orquidopexia de rotina sob raquianestesia em um jovem, em outros aspectos, saudável. Ressonância magnética cerebral revelou infarto agudo em hemisférios cerebelares bilaterais, metade esquerda do bulbo e tálamo esquerdo. Um diagnóstico de acidente vascular cerebral agudo (infarto) foi feito e o paciente começou a receber tratamento com aspirina oral (75 mg.dia-1), após o qual sua visão começou a melhorar após duas semanas. Possíveis mecanismos de desenvolvimento de acidente vascular cerebral no período perioperatório são discutidos, mas, mesmo após extensas investigações, a etiologia do infarto pode ser difícil de determinar. O infarto agudo após cirurgia eletiva não cardíaca e não neurológica é raro; talvez não seja possível identificar a etiologia em todos os casos. Os médicos devem ter um elevado grau de suspeita para diagnosticar essas complicações inesperadas, mesmo após procedimentos cirúrgicos de rotina, para diminuir a morbidade e as sequelas em longo prazo.

Abstract The report describes a case of peri-operative stroke that presented as diplopia and gait difficulty on 2nd post-operative day after routine orchidopexy under spinal anesthesia in an otherwise healthy young boy. Magnetic resonance imaging of the brain revealed acute infarct in bilateral cerebellar hemispheres, left half of medulla and left thalamus. A diagnosis of acute stroke (infarct) was made and patient was started on oral aspirin 75 mg.day-1, following which his vision started improving after 2 weeks. Possible mechanisms of development of stroke in the peri-operative period are discussed, but, even after extensive investigations, the etiology of infarct may be difficult to determine. Acute infarct after elective non-cardiac, non-neurological surgery is rare; it may not be possible to identify the etiology in all cases. Clinicians must have a high index of suspicion to diagnose such unexpected complications even after routine surgical procedures in order to decrease the morbidity and long term sequelae.