PubMed Health⌕ Search

PubMed · 10208707

Multiple myeloma: recognition and management.

Abstract

Multiple myeloma is the malignant proliferation of plasma cells involving more than 10 percent of the bone marrow. The multiple myeloma cell produces monoclonal immunoglobulins that may be identified on serum or urine protein electrophoresis. Bone pain related to multiple lytic lesions is the most common clinical presentation. However, up to 30 percent of patients are diagnosed incidentally while being evaluated for unrelated problems, and one third of patients are diagnosed after a pathologic fracture, commonly of the axial skeleton. Multiple myeloma must be differentiated from other causes of monoclonal gammopathy, including monoclonal gammopathy of undetermined significance, heavy chain disease, plasmacytoma and Waldenstrom macroglobulinemia. Chemotherapy with melphalan-prednisone is the standard treatment for multiple myeloma. Other treatment modalities include polychemotherapy and bone marrow transplantation. Only 50 to 60 percent of patients respond to therapy. The aggregate median survival for all stages of multiple myeloma is three years.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

E D George, R Sadovsky. 1999-04-01. Multiple myeloma: recognition and management.. https://pubmed.ncbi.nlm.nih.gov/10208707/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Two-dimensional and three-dimensional transthoracic echocardiography in surgical planning for right atrial metastatic melanoma.

Melanoma is the most common form of cardiac metastases. Surgical excision has been shown to be an effective palliative measure. This requires detailed definition of cardiac anatomy in relation to the tumour. Two-dimensional (2D), three-dimensional (3D) transthoracic (TTE) and transoesophageal echocardiography (TEE), spiral computerised tomography (CT) and magnetic resonance imaging (MRI) have all been described in aiding surgical planning for excision of cardiac tumours. In this case report, 3D-TTE provided excellent anatomical definition for surgical planning of a large right atrial melanoma precluding the need for more invasive and expensive investigations.

Diagnosis, Differential↗

The role of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography in disseminated carcinoma of unknown primary site.

BACKGROUND: The authors conducted a comprehensive review of the efficacy of 2-deoxy-2-[F-18]fluoro-D-glucose positron emission tomography (FDG-PET) in the detection of primary tumors in patients with disseminated carcinoma of unknown primary site. METHODS: Ten studies (involving a total of 221 patients) tat were published between 1998 and 2006 were reviewed. Each study evaluated the role of FDG-PET in the detection of unknown primary tumors after a conventional diagnostic workup. Although 94% of patients had a single site of metastases, the studies otherwise were very heterogeneous in the studied population, study design, and additional diagnostic workup. RESULTS: In 41% of patients, FDG-PET detected primary tumors that were not apparent after conventional workup. In this group of patients, the overall sensitivity, specificity, and accuracy rates of FDG-PET in detecting unknown primary tumors were 91.9%, 81.9%, and 80.5%, respectively. FDG-PET imaging also led to the detection of previously unrecognized metastases in 37% of patients. Lung cancers represented 59% of the detected tumors. FDG-PET had a notably high false-positive rate (58.3%) in tumors of the lower digestive tract. FDG-PET altered the clinical management in 34.7% of patients. Most of those patients (53%) received specific chemotherapy for lung and pancreatic cancers; whereas 12% received specific therapy for breast, ovarian, and prostate cancers; and 14% underwent surgery with curative intent. CONCLUSIONS: FDG-PET was an efficient method for detecting primary tumors that were undetected by other modalities and was sensitive for the detection of previously unrecognized metastases. FDG-PET significantly changed clinical management in approximately one-third of the patients studied.

Diagnosis, Differential↗

Sulcus vocalis: a review.

Sulcus vocalis is described as a groove at the free edge of the vocal fold. Different types have been described: sulcus type I is superficial and may be considered as moreless physiologic. Sulcus type IIa corresponds to a kind of vergeture along the margin of the vocal fold. Its deepness is variable but sulcus vergeture may involve deeper layers of the lamina propria. Sulcus type IIb or pounch may be considered as an open cyst. Sulcus lead to a complex glottic dysfunction with, in the same time, a glottal leakage responsible for the breathy component of the dysphonia and a stiffness of the free edge responsible for the roughness. Diagnosis may be difficult even with the help of stroboscopy and finally is sometimes done only under general anesthesia. Etiology remains controversial and the authors present arguments for each theory, acquired or congenital. Treatment options include phonosurgery and speech therapy but phonosurgery gives results often disappointing and surgical treatment must be indicated prudently and patient must be intensively informed on what he or she can expect from the treatment that is mainly an increase of the loudness of the voice.

Diagnosis, Differential↗