Poems syndrome presenting as plasmacytoma and polyneuropathy

We report a 52 year old woman presented with a solitary plasmacytoma in the left 4

h rib and chronic demyelinating polyneuropathy. Patient had associated lymphadenopathy, hepatosplenomegaly and hyper pigmentation of the skin. Serum electrophoresis and lmmuno fixation revealed M band [lgG, Lambda light chain]. With the above constellation of clinical findings patient was diagnosed to have POEMS syndrome [polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes]. Radiation to the plasmacytoma resulted in significant improvement. Hence we suggest that all patients with cryptogenic polyneuropathy be investigated properly for this potentially treatable condition

Prognostic factors in immediate outcome of patients with spontaneous intracranial hemorrhage

In a patient with severe intracranial hemorrhage [ICH], the most important question is whether he servives the episode. In this study, 100 patients with ICH were enrolled to see the factors influencing the immediate outcome in these patients. Using 14 day mortality as the dependent variable, univariate analysis was first performed to correlate the patients outcome. On univariate, analysis initial level of sensorium [p<0.0001], degree of limb weakness [p<0.0002], hemorrhage volume [p<0.0000], midline shift [p<0.0133], intraventricular spread of hemorrhage [p<0.0001], aspiration pneumonia [p<0.0000] to be inversely correlated with 2 weeks survival. Also abnormal respiratory pattern [p<0.0004], pupillary abnormality [p<0.0000], abnormal metabolic parameter [p<0.0199] were highly significant predictors. According to the results of univariate analysis eight potential prognostic factors [level of sensorium, degree of limb weakness, pupillary abnormality, hemorrhage volume, abnormal metabolic parameters] were further defined with a multivariate analysis using stepwise logistic regression methods. The results revealed that the combination of three variables, volume of intraparenchymal hematoma, level of sensorium and chest infection were significantly associated with the outcome of patients