Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Extramedullary plasmacytoma arising in the kidney is uncommon. So far only 11 cases have been reported. Recently, we noted the 12th case, the third case seen at the Kyoto University Hospital. The literature is reviewed. A 43-year-old man was hospitalized because of paraplegia due to spinal cord compression by the solitary plasmacytoma arising in the cervical spine, producing an IgG-lambda paraprotein. The tumor excision was followed by radiotherapy and standard chemotherapy. Two years later, new lesions on the thoracic spine, the left clavicle, and the occipital bone successively developed with Bence Jones proteinuria (lambda), but without IgG-lambda paraproteinemia. Ga-67 scanning was performed to detect extramedullary tumors. The marked accumulation of the radionuclide revealed intraabdominal tumors. A CT scan of the abdomen revealed a large soft-tissue mass (73 x 50 mm) emanating from the right kidney and several enlarged lymph nodes. Ultrasound of the right kidney revealed a solid mass with hydronephrotic change. RI-renogram showed delayed excretion from the right kidney. Clusters of myeloma cells were repeatedly observed in the urinary sediment. Thus, a diagnosis of plasmacytoma of the kidney was made. Treatment with radiotherapy alone was sufficient.
 ...
PMID:[Renal plasmacytoma]. 825 10

In this study we have tried to develop a method to predict the survival and the functional outcome following neoplastic spinal cord injury (SCI), which can be helpful when selecting patients for an intensive inpatient rehabilitation programme. We reviewed the clinical records of all patients with neoplastic epidural spinal cord compression, admitted to any Dutch spinal cord unit (SCU) between 1-1-1985 and 1-1-1990 (n = 74). According to the outcome on 1-1-1991 the average stay at the SCU was 111 days, whereas the average survival after discharge was 423 days. Seven patients died during their stay. Of all of the factors analysed, six showed a positive relationship with prolonged survival (> one year after discharge) and improved functional level: tumour biology (lymphoma, myeloma, breast and kidney tumours); SCI as the presenting symptom of the malignancy; slow (> 1 week) progression rate of neurological symptoms; tumours treated with a combination of surgery and radiotherapy; (partial) bowel control at admission; and (partial) independence regarding transfer activities at admission. A sum score (range 0-6) of these indicators is introduced. A patient with a sum score of 0-1 has zero probability of living longer than one year after discharge and 0.19 of functional improvement during stay at the SCU. A score of 5-6 yields probabilities of 0.77 and 0.92 respectively. We conclude that the sum score can be helpful when selecting patients for an intensive inpatient rehabilitation programme or modifying such a programme. Validation for application in a general hospital is needed.
 ...
PMID:Factors related to the outcome of inpatient rehabilitation in patients with neoplastic epidural spinal cord compression. 833 99

Frequent complications of bone metastases include pain, pathologic fracture, hypercalcemia and spinal cord compression. Lytic bone metastases result from excessive activation of osteoclasts by tumor-produced cytokines. Aredia (pamidronate) is a potent bisphosphonate that inhibits osteoclast activation. In two dose-seeking phase I trials in patients with breast cancer and prostate cancer, repeated intravenous infusion of Aredia was shown to be safe and effective in reducing bone resorption and pain. In a randomized phase III trial of 377 patients with multiple myeloma, Aredia was administered in a dosage of 90 mg i.v. every 4 weeks. Compared with placebo, treatment with Aredia was associated with a significant decrease in bone pain and in the incidence and time to development of all skeleton-related events. Data from two phase III breast cancer trials each involving 300 patients are now being analyzed. The newer bisphosphonates can safely be used together with standard anticancer therapy to provide effective palliation of symptoms caused by lytic bone metastases.
 ...
PMID:The role of bisphosphonates in the treatment of bone metastases--the U.S. experience. 873 55

Radiotherapy remains the primary treatment of malignant epidural spinal cord compression. Therapeutic success depends on diagnosis before the development of neurological compromise and the prompt initiation of radiotherapy. Radiotherapy alone is effective in over 85% of cases of spinal cord compression that occur in highly radioresponsive tumors (multiple myeloma, germ cell or lymphoproliferative tumors). In the more common tumors, like breast, prostate, and lung cancer, response to radiotherapy is based on presenting neurologic deficits, extent of disease, duration of symptoms, and overall clinical status, including other sites of metastatic involvement. Surgery is recommended in addition to radiotherapy in selected cases, and further study is needed to better define the prognostic and neurological parameters for the surgical management of spinal cord compression. Improvements in outcome in the treatment of spinal cord compression will require approaches like combined modality therapy because of the limitations primarily imposed by the radiation tolerance of the spinal cord.
 ...
PMID:Radiotherapeutic management of spinal metastases. 881 50

Multiple myeloma (MM) is characterized by a proliferation of plasma cells responsible for osteolytic lesions. Imaging studies are performed in MM to establish diagnosis and prognosis, and may also be used to judge the efficacy of treatment and to detect complications. TO ESTABLISH THE DIAGNOSIS: Conventional radiography demonstrates, at the time of diagnosis, characteristic features in 80% of cases. These lytic lesions involve more often the sites of red marrow. More rarely the only abnormal finding is diffuse osteopenia. Tomodensitometry and, above all, magnetic resonance imaging (MRI), which is a reference method for bone marrow disorders, can be useful for diagnosis in some difficult cases. But the lesions observed, hyposignals on spin echo T1 sequences and hyposignals on T2-weighted gradient echo, are not specific and usually do not allow to distinguish MM from osteolytic metastasis or other bone marrow disorders. TO DETERMINE EXTENT OF DISEASE AND TO EVALUATE PROGNOSIS: According to Durie and Salmon, the extension of home lesions at diagnosis is strongly correlated with the myelomatous measured cellular mass and with survival of patients. But this relation is denied by some authors who have noted that the shortest survival was seen in patients with normal X-rays. TO JUDGE THE EFFICACY OF TREATMENT: Improvement of the radiological abnormalities is observed in nearly 30% of patients responding to a conventional chemotherapy and appears to be an adverse pronostic sign. A good correlation between MRI and the biological response to treatment has also been reported. TO RECOGNIZE COMPLICATIONS OF DISEASE: Conventional radiography is also very important in diagnosis of complications like fractures or vertebral compression. Lastly, MRI is the investigation of first choice in the evaluation of patients with suspected spinal cord compression.
 ...
PMID:[Imaging of multiple myeloma]. 913 84

The major clinical manifestations of multiple myeloma are related to enhanced bone destruction resulting in osteolytic lesions, osteoporosis, and pathologic fractures in most patients as well as hypercalcemia and spinal cord compression in many individuals. These patients frequently require radiation therapy or surgery. In an attempt to reduce these complications, bisphosphonates have been evaluated in several large randomized trials in patients also receiving chemotherapy. Oral etidronate given daily showed no clinical benefit, whereas the use of oral clodronate daily did reduce the development of new osteolytic lesions but did not significantly affect bone pain or rates of pathologic fractures. A large, randomized, double-blind study was conducted in which Stage III multiple myeloma patients received either pamidronate (90 mg) or placebo as a 4-hour infusion every 4 weeks for 21 cycles in addition to antimyeloma chemotherapy. The proportion of patients with at least one skeletal complication was significantly reduced in the pamidronate group compared with the placebo group. Although survival was not different between the pamidronate and placebo groups overall, patients in whom first-line chemotherapy had failed when they entered the trial lived longer with pamidronate treatment than those receiving placebo. Patients who received pamidronate had significant decreases in bone pain, had less analgesic drug use, and had better Eastern Cooperative Oncology Group performance status than patients receiving placebo. Pamidronate was safe and well tolerated during the trial.
 ...
PMID:Bisphosphonates in multiple myeloma. 936 33

For some patients with spinal metastasis and spinal cord compression, newer surgical techniques are better than laminectomy or radiotherapy alone in relieving pain and restoring function. While radiotherapy remains the standard for spinal metastases due to myeloma, lymphoma, and many types of adenocarcinoma, proper surgical treatment can significantly improve function and outcome in selected patients.
 ...
PMID:Newer management options in patients with spinal metastasis. 967 91

The study involves a series of 10 primary neoplasms of the anterior cervical column (body and transverse processes) surgically treated by intralesional excision and followed-up after 2-10 years. The series included 6 benign and 4 malignant neoplasms. Among the benign tumors 4 cases were classified Enneking stage II (2 osteoid osteomas, 1 fibrous dysplasia, 1 osteoma): after simple excision none of the cases revealed symptoms or signs of recurrence at long-term follow-up. The other 2 benign forms were stage III (giant cell tumor and aneurysmal cyst): both of the cases were treated by extracapsular intralesional excision after selective arterial embolization and reconstruction with anterior fusion; the giant cell tumor was irradiated after surgery: at long-term follow-up the patients were asymptomatic and there were no signs of recurrence. The 4 malignant neoplasms (stage IIB) were 1 osteosarcoma and 3 solitary plasmacytomas with spinal cord compression. The osteosarcoma was treated by intralesional excision in 3 stages and radiation therapy, and there were no signs of disease 6 years after diagnosis. The cases of plasmocytoma were treated by intralesional excision and spinal cord decompression, anterior fusion with iliac graft and plate, radiation therapy, and chemotherapy, and they died after 2, 3 and 4 years with findings of multiple myeloma with no signs of disease at the level of the cervical vertebra treated.
 ...
PMID:Intralesional surgery of primary tumors of the anterior cervical column. 971 14

Despite its lack of specificity, magnetic resonance imaging (MRI) of the bone marrow has the potential to play a role in the management of patients with primary neoplastic disorders of the hematopoietic system, including lymphomas, leukemias and multiple myeloma. In addition to its use in the assessment of suspected spinal cord compression, bone marrow MRI could be used as a prognostic method or as a technique to assess the response to treatment. The current review addresses the common patterns of bone marrow involvement observed in primary neoplasms of the bone marrow, basic technical principles of bone marrow MRI, and several applications of MRI in selected clinical situations.
 ...
PMID:Magnetic resonance imaging of the bone marrow in hematological malignancies. 985 10

Metastatic bone disease is a frequent cause of morbidity in advanced cancer patients with a subsequent high incidence of skeletal complications (fractures, hypercalcemia, spinal cord compression) and severe pain. The osteolytic process is mainly characterized by an osteoclastic activity of bone resorption and inflammatory activity provoked by various cytokines and prostaglandins. Bisphosphonates represent a new class of drugs with inhibitory activity on bone resorption and on inflammatory processes which revealed themselves to be efficacious in a series of clinical conditions such as tumour-induced hypercalcemia, Paget's disease, osteoporosis and metastatic bone disease. The aim of this review of the literature is to show the analgesic efficacy of the different bisphosphonates in phase III studies carried out on patients with metastatic bone disease. Medline and Cancerlit database from January 1984 to February 1998 have been considered. From the analysis of the published studies it appears that bisphosphonates and, in particular, intravenous Disodium Pamidronate, are not only able to slow down the progression of the disease and to reduce the onset of skeletal complications but also have an analgesic effect and the possibility of improving the quality of life, above all in patients with osteolytic metastases due to breast cancer and multiple myeloma. Bisphosphonates represent a further valid therapy to add to an already consolidated list of therapies such as radio, chemo and endocrine therapy, analgesic drugs, orthopaedic and physiatric in the pain management of patients with bone metastases. These drugs meet with the patients' compliance, are well-tolerated as well as having a good cost/efficacy profile. It still remains to be seen if the newer and more potent bisphosphonates such as Ibandronate and Zoledronate can be administered differently from the intravenous route such as by mouth or by patch which are readily accepted by the patient and, moreover, if these more potent drugs are able to prevent or delay the onset and/or the progression of bone metastases.
 ...
PMID:The role of bisphosphonates in the treatment of painful metastatic bone disease: a review of phase III trials. 987 May 69


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>