MUMPS
the hormone calcitonin, is usually can-
cerous,
but most
tumours in
other
endocrine glands are not.
Tumours
are
usually removed
by
surgery, and the person w ill be m oni-
tored afterwards so that any further
endocrine abnormalities can be detect-
ed.
The
person’s
relatives
may
be
offered
screening
for
the abnormal
gene or the effects of the disorder (see
f a m i l i a l s c r e e n i n g ) .
m u ltip le -g a te d a c q u is itio n s c a n
See
M U G A s c a n .
m u ltip le m y e lo m a
A rare, cancerous disorder, also called
myelomatosis, in w hich plasma cells in
the
b o n e m a r r o w
proliferate uncontrol-
lably and function incorrectly. It is more
common in elderly people.
CAUSE
Plasma cells are a type of
B - l y m p h o c y t e
that produce
i m m u n o g l o b u l i n s ,
w hich
help protect against infection. In m ulti-
ple myeloma, the proliferating plasma
cells produce excessive amounts of one
type of im m unoglobulin while the pro-
duction of other types is impaired. This
makes infection more likely.
SYMPTOMS
Proliferation
of
the
abnormal
cells
in the bone marrow causes pain and
destroys the bone tissue. Affected
v e r t e -
b r a e
may collapse and compress the
s p i n a l
c o r d
or
s p i n a l
n e r v e s ,
causing
numbness or
p a r a l y s i s .
As bone is des-
troyed, levels of calcium in the blood
increase, as may the levels of one or
more immunoglobulins. These changes
in the blood may lead to damage of the
kidneys, resulting in
k i d n e y f a i l u r e . T h e r e
may also be
a n a e m i a
and a tendency for
abnormal bleeding.
DIAGNOSIS AND TREATMENT
The disease is diagnosed by a
b o n e m a r -
r o w b i o p s y , b l o o d t e s t s
or
u r i n a l y s i s ,
and
X - r a y s .
Treatment includes
r a d i o t h e r a p y
for localized bone deposits, to relieve
pain and reduce the risk of fractures;
a n t i c a n c e r d r u g s
to slow the course of
the
disease;
correction
of associated
problems, such as kidney failure; and
supportive measures, including
b l o o d
t r a n s f u s i o n s ,
a n t i b i o t i c d r u g s ,
and
a n a l -
g e s i c d r u g s
(painkillers). No treatment
provides a cure, however.
The outlook for m ultiple myeloma
varies depending on the severity of the
illness. Some people remain well for
months or years, and then the progres-
sion of the disease accelerates.
m u ltip le o rg a n fa ilu re
Loss of function in several organs at
once. This
life-threatening
condition
affects the lungs (see
r e s p i r a t o r y d i s t r e s s
s y n d r o m e ) ,
kidneys and other organs,
and the circulation. It is most often trig-
gered by overwhelming infection, but
may also be due to
s h o c k
following
severe injury.
m u ltip le p e rs o n a lity d is o rd e r
A rare disorder in w hich a person has
two or more distinct personalities, each
of w hich dominates at different times.
Each personality may be unaware that
the others exist. The transition from one
personality to another is often sudden,
and may be triggered by stress.The con-
dition is thought to result from severe
emotional trauma, such as violent
s e x u a l
a b u s e ,
during childhood.
m u ltip le p re g n a n c y
See
p r e g n a n c y , m u l t i p l e .
m u ltip le s c le r o s is
A progressive disease of the central
n e r -
v o u s s y s t e m ,
in w hich patches of
m y e l i n
(the protective covering of nerve fibres)
in the brain and the spinal cord are dis-
rupted. The damaged patches are called
plaques. The
nerves
cannot
conduct
electrical impulses, so functions such as
movement and sensation may be lost.
Any part of the central nervous system
may be affected.
CAUSES AND INCIDENCE
There may be a genetic predisposition,
because MS sometimes runs in families.
There may also be an environmental
cause. It is more common in temperate
zones than in the tropics.
SYMPTOMS
MS usually develops between the ages of
20
and
4 5
, and is more common in
women. Symptoms depend on the area
of the brain or spinal cord that is
involved in an attack. Spinal cord dam-
age
may
cause
tingling,
numbness,
weakness in the extremities,
s p a s t i c i t y
,
p a r a l y s i s ,
and
i n c o n t i n e n c e .
Damage to
white matter (myelinated nerves) in the
brain may cause fatigue,
v e r t i g o ,
clumsi-
ness, muscle weakness, slurred speech,
blurred
vision,
facial
numbness,
or
facial pain. For further information see
F e a t u r e s o f m u l t i p l e s c l e r o s i s
box, overleaf.
An attack may last for several weeks
or months. It is followed by a variable
period of remission, in w hich dramatic
improvements may be made. After a
remission period, a further attack or a
relapse occurs. Most people have m ild
relapses and long periods of remission
(relapsing-remitting MS), with few per-
manent
effects.
Others
have a form
called chronic-progressive MS, becom-
ing gradually more disabled from the
first attack. A few have a form called ful-
minant MS, w hich progresses rapidly in
the first year of illness.
DIAGNOSIS
There is no single diagnostic test, but
M R I
may show damage to white matter in the
brain, and a
l u m b a r p u n c t u r e
may show
abnormal proteins in the fluid around
the spinal cord.
E v o k e d r e s p o n s e
tests on
the eyes may reveal disruption of the
nerve pathways from the optic nerves.
TREATMENT
There is no specific treatment. A short
course of
c o r t i c o s t e r o i d d r u g s
may reduce
the severity of relapses, while beta
i n t e r -
f e r o n
can lengthen the time between
attacks; however, these drugs do not
improve the outlook. The use of
r e h a b i l i -
t a t i o n ,
p h y s i o t h e r a p y ,
and
o c c u p a t i o n a l
t h e r a p y
is essential so that people can
carry out daily activities more easily.
Some people try remedies such as
taking sunflower seed oil, following a
gluten-free diet,
h y p e r b a r i c o x y g e n t h e r -
a p y ,
or having various vaccines. To date,
however, there is no evidence that any
of these measures are beneficial.
m u ltiv ita m in s
Over-the-counter preparations, contain-
ing a combination of vitamins, that are
used as a dietary supplement. (See
v i t a -
m i n s u p p l e m e n t s
.)
m u m p s
An acute viral illness usually occurring
in childhood. The main symptom is in-
flammation and swelling of one or both
Appearance of mumps
The swelling may be present on either or both
sides and can give the affected child’s face a
bloated appearance.
M
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