ABSTRACT
For decades, conventional skeletal survey (CSS) has been the standard imaging technique for multiple myeloma (MM). However, recently whole-body computed tomography (WBCT) has been implemented into the diagnostic criteria of MM. This analysis compares sensitivity and prognostic significance of WBCT and CSS in patients with smoldering MM (SMM) and MM. Fifty-four of 212 patients (25.5%) had a negative CSS and a positive WBCT for osteolytic lesions (P<0.0001). Of 66 patients with SMM based on CSS, 12 (22.2%) had osteolytic lesions on WBCT. In comparison, WBCT failed to detect some bone destructions in the appendicular skeleton possibly due to limitations of the field of view. Presence of lytic bone lesions in WBCT was of borderline prognostic significance (P=0.051) for SMM patients, with a median time to progression of 38 versus 82 months for those without bone destructions. In conclusion, WBCT identifies significantly more sites of bone destruction than CSS. More than 20% of patients with SMM according to CSS have in fact active MM detectable with WBCT. On the basis of this and other studies, WBCT (either computed tomography (CT) alone or as part of a positron emission tomography-CT protocol) should be considered the current standard for the detection of osteolytic lesions in MM.
Subject(s)
Multiple Myeloma/diagnostic imaging , Multiple Myeloma/mortality , Osteolysis/diagnostic imaging , Osteolysis/mortality , Positron-Emission Tomography , Tomography, X-Ray Computed , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Female , Humans , Male , Middle Aged , Retrospective Studies , Survival RateABSTRACT
Most cancer patients receiving life-prolonging or palliative treatment are offered non-specialist palliative services. There is a lack of knowledge about their problem profile. The aim of this article is to describe the incidence of patient-reported physical and emotional problems on admission and discharge from general hospital wards and health staff's reported intervention. A prospective study was undertaken over 12 months, where advanced cancer patients completed a patient questionnaire, EORTC QLQ C15-PAL, on admission (n= 97) and discharge (n= 46). The incidences of the problems were dichotomised in intensity categories. The average number of 'clinically relevant problems' on admission was 5 (SD 2) and on discharge 4 (SD 2). A Wilcoxon signed rank test showed significant change in mean score for six out of nine problem areas, but the majority of the patients did not move to the lower intensity category. The highest concurrence was between patient-reported problems and reported intervention for physical function, pain, constipation and loss of appetite. Palliative cancer patients' self-reported problem profile on admission and discharge from hospital has not previously been described and the results indicate a need to focus on improvements to palliative services and for a special service for pain and constipation that could prevent some admissions.
Subject(s)
Hospitals, General/statistics & numerical data , Neoplasms/complications , Palliative Care/standards , Aged , Aged, 80 and over , Denmark , Diarrhea/etiology , Diarrhea/therapy , Female , Hospitalization/statistics & numerical data , Hospitals, General/standards , Humans , Male , Middle Aged , Neoplasms/psychology , Neoplasms/therapy , Pain/etiology , Pain Management/standards , Patient Discharge/statistics & numerical data , Prospective Studies , Stress, Psychological/etiology , Stress, Psychological/therapy , Surveys and Questionnaires , Terminally IllABSTRACT
Papillomatous tissue samples from 12 adult patients with laryngeal papillomatosis were examined by light microscopy before and after interferon-alpha (IFN) treatment. Increased atypia, a change in intra-epithelial differentiation, sclerosis of the underlying stroma and infiltration of especially plasma cells were found in tumour tissue removed after 3 weeks of IFN treatment. These morphological findings do not explain the effects exerted by IFN on the growth pattern of adult laryngeal papillomatosis, but provide a basis for further studies.
