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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The renal involvement in patients with multiple myeloma has been described as a sign of poor prognosis. The influence of renal insufficiency in the clinical patterns and in the prognosis of patients with multiple myeloma was studied retrospectively in 45 patients. Patients with renal insufficiency, at first visit, more often presented weight loss, proteinuria, hypercalcemia. The means of uricemia, ESR, were higher and the hematocritic mean was lower in patients with renal insufficiency. There was no difference in edema, arterial hypertension, fractures and bone pain. The reversibility of renal insufficiency occurred in 47% of the cases, which happened more often in the first months of the follow up. The creatinine mean was lower in patients with reversible renal insufficiency. The median survival was: patients with renal insufficiency: 11 months; patients with normal renal function: 50 months. Among patients with renal insufficiency those with recuperation of renal function showed a higher median survival (24 months) than those with irreversible renal insufficiency (1 month). The renal involvement then is frequent and often reversible. Patients with impaired renal function showed a worse prognosis; normalization of the renal function was associated with a better outcome.
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PMID:[Clinical characteristics and prognostic implications of renal involvement in multiple myeloma]. 822 May 5

A 77-year-old woman with hypertension was admitted to our hospital because of exertional dyspnea end peripheral edema. Chest X-ray showed cardiomegaly, pulmonary congestion and right pleural effusion. Hypertensive heart failure was diagnosed and treated, and right pleural effusion disappeared in 2 weeks. Abnormalities on laboratory data, i.e. anemia and increased ESR et al. continued after the improvement of heart failure. Serum IgG was elevated (2570 mg/dl), while IgA and IgM were decreased. Immunoelectrophoresis indicated the presence of monoclonal IgG-lambda in the serum. Bone marrow puncture revealed an increase in atypical plasma cells (38.4%). Multiple myeloma was diagnosed from these findings and treated with melphalan and prednisolone. But increases in atypical plasma cells (43.2%) and serum IgG (2573 mg/dl) continued. During treatment, right pleural effusion increased again. Thoracocentesis showed bloody effusion with numerous atypical plasma cells, and the presence of monoclonal IgG-lambda was indicated by immunoelectrophoresis. The patient died of renal and heart failure 2 months after the onset of malignant pleural effusion. Cytological examination and immunoelectrophoresis are necessary for pleural effusion in multiple myeloma.
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PMID:[A case of multiple myeloma associated with abnormal plasma cells and M-protein in pleural effusion]. 864 97

Bone involvement can represent the inaugural symptom of Gaucher's disease (GD). Here, we report the case of a 68-year old man diagnosed as having GD since 1963. In June 1994 the patient was referred to our Rheumatology Unit because of a long-lasting coxalgia on the left hip and progressive walking impairment following traumatic fracture of the left femur. Multicystic osseous changes at standard X-ray and hyper-gamma-globulinemia with an elevated ESR (122 mm, 1st hour) suggested the diagnosis of either osteonecrosis of the femoral head or multiple myeloma. On bone marrow biopsy examination, Gaucher's cell infiltrates were detected and an increased uptake in the distal left femur and proximal tibia were demonstrated by lipophilic tracer scan (99mTc-Sestamibi). Subsequently, the patient suffered another femoral fracture at a site of Gaucher's infiltrates previously documented by bone scan. We conclude that in patients with GD, 99mTc-Sestamibi bone scan can selectively evaluate the presence of bone lipid deposits, and could indirectly differentiate this bone condition from other serious skeletal complications of the disease.
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PMID:Bone involvement in Gaucher's disease: 'bone crisis' or disease complication? 873 28

Multiple myeloma is characterized by the production of a monoclonal immunoglobulin, free monoclonal light chains, or both. Although bone pain is the classic presentation, multiple myeloma should be a consideration in differential diagnosis in elderly patients with arthritic complaints if other typical symptoms or laboratory abnormalities, such as anemia, hypercalcemia, and elevated ESR, are present. A combination of radiation therapy and chemotherapy is the usual treatment.
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PMID:Multiple myeloma. Diagnostic clues in a patient presenting with incapacitating arthralgias. 933 6

Patients with monoclonal gammopathies comprise a heterogenous group. The few studies on incidence and follow-up are single-centre-based and may reflect referral bias. To avoid this, all patients (n=1275) in midwestern Netherlands with a newly discovered paraproteinaemia in 1991, 1992 and 1993 were included in a population-based registry and divided into four major diagnostic groups: multiple myeloma and plasmacytoma (n=230, 18%), other haematological diseases (n=141, 11%), paraprotein-related internal diseases (n=191, 15%) and monoclonal gammopathy of undetermined significance (MGUS, n=713, 56%). To avoid a possibly erroneous diagnosis, patients who were classified as having MGUS but who did not undergo confirmatory bone marrow examination were included in a separate group 'provisional MGUS' (n=524, 41%), whereas patients who did were classified as having 'definite MGUS' (n=189, 15%). The 'provisional MGUS' patients were relatively older and had more often a poor performance status, but differences between this and the 'definite MGUS' group were otherwise small. Patients complaining of general malaise more often had a full work-up of their paraproteinaemia. Bone pain, hypercalcaemia, high total protein, and high ESR occurred predominantly in the myeloma group, whereas fever or infection was less often seen in these patients. This registry of patients with paraproteinaemias provided valuable data related to all different diseases associated with paraproteinaemia.
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PMID:A population-based registry on paraproteinaemia in The Netherlands. Comprehensive Cancer Centre West, Leiden, The Netherlands. 960 40

A 49-year-old man presented a clinical picture suggesting seronegative rheumatoid arthritis. He developed severe joint contractions, pasty synovial swelling, macroglossia and proteinurie. Subsequent investigations disclosed light-chain multiple myeloma and A1-amyloid deposits in synovial tissue and skin. A1-amyloidosis should be considered in the differential diagnosis of patients with seronegative polyarthritis. Clues to the diagnosis of amyloid arthropathy are a carpal tunnel syndrome, early occurrence of joint contractures in combination with a relatively mild synovitis and a low ESR as well as the presence of other possible organ involvement with amyloidosis.
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PMID:Amyloidosis mimicking rheumatoid arthritis. 980 91

Technetium 99m-2-methoxyisobutil-isonitrile (Tc-99m-MIBI), also called sestaMIBI, has been used successfully to detect malignant tumours at diagnosis. Recently, it has been proposed as a safe and effective tracer in patients with multiple myeloma (MM). The purpose of this study was to demonstrate the value of the Tc-99m-MIBI uptake in disease detection and to assess the correlation between the uptake of this scintigraphy agent and prognostic factors in newly diagnosed MM patients. Thirty-five untreated patients were enrolled in the study. Tc-99m-MIBI scanning was performed in 33 patients after intravenous injection of 7.4 MBq/kg. Whole-body anterior and posterior scans were obtained after 30 min, 60 min, 2 and 4 h. The correlation between known prognostic factors of MM and the intensity of Tc-99m-MIBI uptake was assessed. Our results showed seven patients with an intensity score of I0, 12 patients with I1, eight patients with I2 and six patients with a score of I3. There was a positive correlation between Tc-99m-MIBI intensity and C-reactive protein (CRP; r=0.506, P < 0.01), erythrocyte sedimentation rate (ESR; r=0.368, P < 0.05), beta2- microglobulin (beta2M; r=0.749, P < 0.001), interleukin-6 (IL-6; r=0.823, P < 0.001), soluble Interleukin-6 receptor (sIL-6r; r=0.806, P < 0.001), serum calcium (r=0.578, P < 0.001) and bone alkaline phosphatase (BAP; r=0.472, P < 0.01). An inverse correlation was found between Tc-99m-MIBI intensity and osteocalcin (OC) and type I procollagen carboxyterminal propeptide (PICP). In conclusion, the results of this study suggest that more extensive disease activity, as determined by high levels of CRP, beta2M, IL-6 and sIL-6r correlated with a higher uptake of the radiotracer.
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PMID:Correlation between the uptake of Tc-99m-sestaMIBI and prognostic factors in patients with multiple myeloma. 1206 79

The diagnosis of monoclonal gammopathy of undetermined significance (MGUS), requires both the detection of monoclonal gammopathy by immunofixation on the one hand, and the exclusion of signs of multiple myeloma (MM) on the other. The risk of an MGUS evolving into an MM is about 1% per year. The possibility of an MM should be considered in particular in elderly patients with an elevated ESR, anemia, recurrent infections and hypercalcemia. The diagnosis of MM is established on the basis of a constellation of major and minor criteria that includes characteristic results of serum and urine electrophoresis and immunofixation, routine lab and bone marrow (plasma cell infiltration) studies as well as complications (anemia, renal failure, hypercalcemia, osteolysis). Standard chemotherapy comprises melphalan-prednisone or chemotherapy VAD. Improved results have been achieved with high-dose chemotherapy plus various forms of stem cell transplantation. To treat recurrences, thalidomide and bortezomib are now available.
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PMID:[Monoclonal gammopathy--multiple myeloma]. 1600 31

Technetium-99m methoxy-isobutyl-isonitrile (99mTc-MIBI) has been proposed as an in-vivo marker of various active malignant diseases. The goal of this study was to evaluate the 99mTc-MIBI whole body scintiscan for the early detection of multiple myeloma (MM), active or in remission. We have studied 43 patients with MM, 32 men and 11 women aged 52+/-10 years. Group A patients had active MM disease (29 cases) and Group B patients had MM disease in remission (14 patients). Plasma proteins, serum immuno-electrophoresis, bone marrow biopsy, whole body 99mTc-MIBI scan and serum bio-chemical tests (ESR, and serum alkaline phosphatase) were carried out in each patient for the diagnosis of active or relapsed disease, or remission. Clinical and laboratory evaluation was made by two oncologists. Scintigraphic images were interpreted by three nuclear physicians who were blinded to the patients' clinical condition. The extension scale of the lesions on scintigraphy (E-score) was categorized into E0-E3. The intensity of radiotracer uptake throughout the skeleton (I-score) was also classified from I0-I3 as compared to the intensity of myocardial uptake. All patients were followed for at least one year and reassessed by the end of the year for confirming active-relapsed disease or remission. One-way analysis of variances and Spearman correlation coefficient were used for statistical data analysis. The sensitivity, specificity, positive and negative predictive values and accuracy of the 99mTc-MIBI scan for determining active or relapsed cases were: 69%, 100%, 100%, 61% and 79%, respectively. There were significant differences in scan pattern, intensity, and extension of the lesions in patients with active-relapsed disease versus those in remission (P<0.001). It is concluded that the pattern of extension and intensity of 99mTc-MIBI uptake in MM patients is associated with disease activity. Hence, in addition to the hematological and pathological findings, the 99mTc-MIBI scan may be considered as a relatively accurate non-invasive technique for the differential diagnosis of active-relapsed from in remission MM.
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PMID:The value of 99mTc-MIBI whole body scintigraphy in active and in remission multiple myeloma. 1639 23

Total 14 cases of myeloma in young age group (<40 years) have been reported out of 178 cases of myeloma in a time period of 7 years (1993-1999). Males predominated overfe males. Like adult myeloma, patients presented mostly with the backache, pain in pelvis, lower spine and weakness in about 60% of cases followed by swelling of bone in 40% of cases. One case presented with bleeding gum, malena and hepatosplenomegaly and was diagnosed as plasma cell leukemia. Radiological examination revealed lytic lesion in almost all the cases with fracture femur and rib in 28.57% of cases. Anaemia and raised ESR was noted in all the cases. Myeloma typing revealed IgG myeloma in 10 cases, light chain myeloma in 3 cases and IgA myeloma in one case. None of the patient was traceable after 2 years. Thus our study concludes that myeloma in the young age in India occurs in increased frequency and clinically presents just like adult and elderly myeloma, but serologically are predominantly of IgG type. There is also an increased frequency of solitary plasmacytoma as compared to adult myeloma.
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PMID:Myeloma in young age. 1676 40


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