What difficulties can we encounter in the diagnosis of plasma cell myeloma?

Plasma cell myeloma is a cancer originating from plasmocytes. This disease is characterized by a bone marrow infiltration by plasmocytes, which produce monoclonal immunoglobulin or light chains of immunoglobulins (so-called M-protein) and release cytokines stimulating bone destruction. It represents 1% of all neoplasms and 10-15% of haematological neoplasms. The median age of the disease is 70 years. In imaging, PCM lesions are described as osteolytic, osteoporotic or mixed. This radiological appearance can occur in many diseases' categories. A CASE REPORT: A 60-year-old patient was admitted to the Department of Maxillofacial Surgery in Lublin in 2018 in order to diagnose and treat a pathological lesion of the right maxilla. Patient has been treated due to generalised PCM since 2016. CT examination of the bones indicated the presence of osteolytic lesion of the right maxilla, radiologically corresponded to the odontogenic cyst. However, because of the coexisting disease, it was impossible to make a final diagnosis at this stage of diagnostics. After additional examinations, the patient was qualified for enucleation of the lesion. The result of histopathological examination confirmed the presence of a follicular cyst. CONCLUSIONS: In the described case, particular attention has been paid to the differentiation of cysts with bone osteolytic defects occurring in PCM. The final diagnosis is the result of histopathological examination of the tissue material obtained during an enucleation procedure of the pathological lesion of the maxilla.

Therapy-related peripheral neuropathy in multiple myeloma patients.

This review discusses the most common issues concerning multiple myeloma (MM)-related peripheral neuropathy (PN). This is an important MM complication, observed in up to 54% of newly diagnosed patients, caused by the disease itself or its treatment. Although its aetiology is largely unknown, a number of mechanisms are suspected. It is important to know the neurological status of a patient, as many new antimyeloma medicines can trigger or exacerbate any pre-existing neuropathy. Examples include thalidomide-induced and bortezomib-induced PN (TiPN and BiTN, respectively), which are key MM treatment options. TiPN is usually sensory and sensorimotor, whereas BiPN is typically sensory. The mechanisms of chemotherapy-induced neurotoxicity in MM are well known; thalidomide seems to induce PN through its antiangiogenic properties, whereas bortezomib neurotoxicity is connected with disrupted calcium homeostasis. TiPN incidence ranges from 25% to 75%, and its prevalence and severity appears to be dose-dependent. BiPN incidence is almost 40% and is dose-related as well. Poor (25%) reversibility of TiPN prompted the recommendations for dose and exposure reduction, whereas BiPN cases are mostly reversible (64%). Peripheral sensory neuropathy is very rare in patients receiving bendamustine monotherapy. Because of this favourable toxicity profile, bendamustine may be considered a promising option for combination therapies in pre-existing PN in myeloma patients. Considering the lack of curative therapy for treatment-emergent PN, prevention is a key management strategy in MM patients. All patients should be evaluated for PN before the administration of a neurotoxic drug, and those under treatment should be closely monitored by a neurologist.

[Mandibular fractures--retrospective study]. / Zlamania zuchwy na podstawie dokumentacji medycznej Kliniki Chirurgii Stomatologicznej i Szczekowo-Twarzowej AM w Lublinie w latach 1988-1997.

Between the years 1988 and 1997 1222 patients with mandible fractures were treated in the Department of Dental and Maxillofacial Surgery at Medical University in Lublin. Majority of them were male patients aged 19-40. In most cases fractures were caused by assault (55%) and traffic accidents (29.9%) frequently related to earlier consumption of alcohol. Among 702 from 1222 treated patients mandible fractures were accompanied by other injuries and that is both of bones structure and also of soft tissues.

[Treatment of mandibular fractures in patients at the Department of Oral and Maxillofacial Surgery, University Hospital in Lublin in the years 1988-1997]. / Metody zaopatrzenia zlaman zuchwy u pacjentów leczonych w Klinice Chirurgii Stomatologicznej i Szczekowo-Twarzowej Akademii Medycznej w Lublinie w latach 1988-1997.

Between 1988-1997 in the Department of Dental and Maxillo-facial Surgery of Medical University in Lublin there were applied three types of fixation of mandible bone fracture. Depending on the kind of fracture and teeth condition with 692 (i.e. 60%) patients there was applied preservative treatment and 530 undergone surgery (i.e. 18.1%) and undergone surgical and orthopedic treatment (i.e. 21.9%). Upon analysis of treated population it was concluded, that during period of assessment there occurred significant change of implications for the application of fixation of mandible bone fracture and the leading method became mandible osteosynthesis with intraoral approach.

[Symptoms of temporomandibular joint dysfunction in patients treated for the condylar fractures]. / Objawy dysfunkcji stawu skroniowo-zuchwowego u chorych leczonych z powodu zlaman wyrostka stawowego zuchwy.

124 patients at the age of 7 to 70 years with condylar fractures were treated in the Department of Dental and Maxillo-Facial Surgery in the years 1992-96. The authors carried out control clinical examinations and the radiographic investigations in 42 patients treated conservatively. Late results of treatment were assessed after 5 since post fracture. In the assessment the range of mandible abduction, function of temporomandibular joints, mandibular malposition following movements, occlusal disturbance, dislocation of the central line, and the acoustic symptoms in TMJ.