Case Study Multiple Myeloma

Metastases to the spine represent a challenging problem in an oncology practice. Treatment decisions require multidisciplinary review. Radiation therapy remains the primary treatment for metastatic spinal tumor, but advances in radiation therapy, chemotherapy, and surgery have changed the roles of each and lead to improved patient outcomes. Regardless of the treatment, diagnosis and treatment before the development of significant neurologic and functional deficits improve outcomes. Physician awareness and appropriate imaging greatly assist in the early detection of tumor.

Multiple myeloma (MM) is characterized by neoplastic proliferation of immunoglobulin-producing plasma cells. Many malignancies can mimic MM, however the concomitant existence of another primary malignancy alongside MM is exceedingly rare. We report the first case wherein MM and esophageal adenocarcinoma manifest concomitantly.

Metastatic Spinal cord compression (MSCC) complicates cancer patient’s movement capabilities with pain included. When patient’s deal with this diagnosis they are terminal in the illness. The last stage has unsafe complications from deep vein thrombosis to delicate walking to bed sores. Some devices avoid further damage to the spinal column but are sometimes unsuccessful in providing the desired effects expected. When health care providers manage these situations they face controversies from the suggested recommendations.

Approximately 10% of patients with tumors derived from cells that produce immunoglobulins (plasma cell disorders, B-cell lymphoma) are affected by a paraneoplastic peripheral neuropathy. Over half of the patients with the rare osteosclerotic form of myeloma develop a severe predominantly motor paraneoplastic peripheral neuropathy. In other hematological malignancies, the incidence of PNS is very low with the exception of Hodgkin's disease. However, the incidence of PNS is even in Hodgkin's disease well below 1%.

Myelomeningocele: the most severe form, herniation of spinal cord and nerves along with the meninges and CSF.

Malignant bone tumors have a propensity to spread via the bloodstream to various areas of the body, especially to the lungs and other bones. Annually, approximately 2800 new bone sarcomas are diagnosed in the United States. Unlike soft tissue tumors, malignant bone tumors present most commonly with pain. Therefore, these tumors require serious therapy plans that typically involve some combination of surgery, chemotherapy, and bone reconstruction. Specifically, the treatment of a malignant tumor calls for resection of the main tumor as well as the normal tissue surrounding the cancerous area. Bone sarcomas can come in three types: Osteosarcoma, Ewing sarcoma, and Chondrosarcoma.

Setting up the Pattern: The Waxwing and the Windowpane Nabokov introduces John Shade and Charles Kinbote as character foils to each other by beginning both poem and commentary with their differing interpretations of the same image of glass. The objective basis of the image of a waxwing’s death caused by slamming against a window due to its lack of realization of the presence of the glass barrier remains the same. However, the subtleties in the presentation surrounding the role of glass in this image, casts these two authors and their thematic preoccupations in a largely different light. As this initial image can be seen as a representation of both their existential struggles, Shade and Kinbote are paradoxically paralleled to each other and separated due to their distinct roles in the novel. From the very first lines of the poem, “I was the shadow of the waxwing slain /

“These tumors can cause pain, limit joint movement, and exert pressure on nerves, blood vessels, and surround tissues” (2). Multiple tumors can also “disrupt bone growth and can cause disturbances of the arms, hands, and legs, leading to

Osteosarcoma patients don’t really feel sick, but they do limp more than usual because there knee/arm is heavier and hurts a lot. The bones also start to swell and get bigger which also causes the limping to happen. Most people think that this is just “growing pains” but as they get older they get worse and the pains hurt more. With Osteosarcoma, there is also limitation to movement because of the tumor. There is a lot of bad thing that come with Osteosarcoma, but there is some ways to discover and help get rid of the tumor. Osteosarcoma is usually found out by x-ray machines. They use the x-ray to scan the tumor and to make sure that it is Osteosarcoma, or if it is another type of bone cancer. Usually once they find out about the tumor they will do a biopsy. There are two different kinds of biopsies, a needle aspiration and a surgical biopsy. Whichever they choose may change the outcome of the surgery. Now knowing that there are many bad and good things that can happen there is still one more thing to learn about. Daily

It is rare that patients with OPLL in the cervical spine progress to quadriplegia within a short duration without any trauma. Westwick et al have reviewed the cases of rapidly progressive myelopathy caused by cervical disc herniation, included 4 cases with OPLL in the cervical spine. Two of these cases received a cervical massage or manipulation, and other 2 cases had a neck pain during several months, prior to the onset of paralysis[15-18]. These reports have suggested that the pathology of disc herniation is relevant to the presence of OPLL [15, 18-20]. Several cases of acute myelopathy or paralysis caused by cervical disc herniation, which is also rare, have been reported. On their assessment, the pathology of the spinal cord damage is not

Some people are born with natural god given skills and ability while others who are not that lucky and have to work twice as hard just to get the same result. And then there are those rare individual who even though they are born with the talent, they still work just as hard and sometimes even harder to keep improving. It is called determination and that is a trait that all the great athletes share and it is what separates the great ones from the just good ones. This is perfect way to describe Peyton Williams Manning, who is considered to be one of the most prolific passers in NFL history.

Roberts detailed a retrospective series of 24 patients with CSM which were diagnosed by examination and myelography with average age of 54.2 years. This study specified the 2-year period before to any treatment with mean follow-up period of 3.1 years, and patients were treated with bed rest and immobilization. The author concluded that long duration & severe symptoms predict poor outcome from nonoperative therapy. The population in this study was heterogeneous, and objective outcome measures were lacking.

In Sellner et al.’s (2009) retrospective 9-year survey on the diagnostic work-up of TM, it was found out that spinal cord magnetic resonance imaging (MRI) has become a valuable tool in the diagnosis of patients with TM. Tillema and Pirko (2013) asserted that MRI is the modality of choice as it offers high- resolution images in a noninvasive and safe method without exposing patients to large doses of radiation. Jacob and Weinshenker (2008) emphasized that getting rid of an acute compressive cause is of paramount priority when dealing with patients with acute myelopathy. Hence, an MRI scan is vital in this respect to

Conservative treatment are helpful in the early stage of the disease. Patients who are unfit or unwilling to undergo operative treatment, patient who are in plateau period without recent exacerbation, patients who present with new onset of subtle myelopathic findings and radiographic evidence of a soft disc herniation should undergo for preoperative evaluation, and these type of patient should undergo, physical therapy for gait training, occupational therapy for improvement of upper extremity dexterity, and neck immobilization with a hard cervical collar. Patient counseling about the possibility of symptomatic worsening and hazards of minor cervical trauma should be done. Follow up of patient every 6 to 12 months is done to look for neurologic function deterioration.

The limited space within the vertebrae actually plays an important roll in spinal cord injury. Once the initial injury occurs the body, as with every other part of the body, tries to protect the injured area with swelling. But the swelling occurs within the small confines of the spinal column and causes further damage to the surrounding tissue. It has only recently been discovered how much of an impact this secondary damage has. One of the areas of crucial ongoing research is on what kind of window of opportunity medicine has in treating these types of injuries and still attaining the best recovery.