Combined anterior and posterior shoulder dislocation as a manifestation of a brain tumour

Seizures are sometimes the first manifestation of a brain tumour. They may give rise to shoulder fractures or fracture-dislocations. When bilateral, these lesions tend to be symmetrical. The patient reported here suffered from a previously undiagnosed brain tumour, the first manifestation of which were seizures, which provoked a bilateral shoulder dislocation in opposite directions. The posterior dislocation was recognized with a delay of 16 days. After an episode of seizures, shoulder dislocation can occur in either direction, and bilateral shoulder dislocations may not be symmetrical

Effect of pamidronate administration on markers of bone turnover and disease activity in multiple myeloma

Aim: Bisphosphonates are potent inhibitors of osteoclastic activity and are used in the treatment of multiple myeloma (MM) in combination with chemotherapy. The effect of pamidronate on markers of bone resorption [cross-linked N-telopeptides of type I collagen (NTx)] markers of bone formation [serum alkaline phosphatase (BAP) and osteocalcin (OSC)], interleukin-6 (IL-6), beta (2)-microglobulin, CRP, paraprotein and disease-related pain and skeletal events has been evaluated in 62 newly diagnosed patients with MM. Patients and methods: The patients were randomly assigned to two groups: the first included 32 patients under chemotherapy and pamidronate (group I) and the second 30 patients on chemotherapy only (group II). Pamidronate was administered at a monthly dose of 90 mg iv, and the above parameters were evaluated at the beginning of this study and after 1, 3, 6, 9, 12 and 14 months of treatment. Results: The addition of pamidronate to chemotherapy resulted in a significant reduction of NTx, IL-6 and paraprotein from the 3rd month and of beta (2)-microglobulin, CRP and pain from the 6th month of treatment. No changes of NTx, IL-6, beta2-microglobulin, CRP or skeletal events were observed in patients of group II, while paraprotein was significantly reduced after 6 months of treatment. The differences in NTx, IL-6, paraprotein and beta (2)-microglobulin were statistically significant between the two groups. Multivariate analysis revealed a significant correlation between changes of NTx, changes of IL-6 in both groups and reduction of pain and paraprotein in group I. Conclusions: These results suggest that pamidronate may have a synergistic action with chemotherapy in decreasing osteoclastic activity, in reducing markers of myeloma activity and myeloma related pain and in improving the quality of life in patients with MM

Abnormal bone remodelling and increased levels of macrophage inflammatory protein-1 alpha (MIP-1 alpha) in Waldenstrom macroglobulinaemia

Serum levels of macrophage inflammatory protein-1 alpha (MIP-1 alpha) and bone remodelling markers were evaluated in 38 patients with Waldenstrom macroglobulinaemia (WM) and correlated with clinical and laboratory variables. MIP-1 alpha was elevated in WM; untreated patients had higher MIP-1 alpha levels than patients in remission or with active disease after treatment. MIP-1 alpha correlated with increased bone resorption, beta(2)-microglobulin and splenomegaly. Receptor activator of nuclear factor-kappa B ligand serum levels were elevated in WM patients; the subsequent increased bone resorption was balanced by a comparable elevation of osteoprotegerin production and bone formation. These findings may explain the absence of lytic lesions in WM patients and suggest a potential role of MIP-1 alpha in WM