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In 114 patients with systemic malignant gammopathies followed during a 10-year period in the hematology clinic of the Rambam Medical Center, 23 episodes of CNS involvement were recorded. 19 cases with spinal cord compression and 4 cases of intracranial plasmacytomas. Early diagnosis followed by prompt laminectomy and subsequent radiotherapy resulted in complete recovery in 50% and partial improvement in 30% of the patients with spinal cord involvement. In good responders. overall survival was not affected by the neurological complication. In the 4 patients with intracranial involvement, external plasmacytomas of the skull preceded the neurological symptoms. 3 of them were diagnosed late, which led to delay and failure of accurate treatment. Only 1 patient was immediately operated and continued to be well for the past 2 years.

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SUMMARY Patterns of pertechnetate uptake were correlated with ultrastructural properties of the endothelial wall in 14 human brain tumours. In tumours with reduced uptake of the radionuclide, intercellular tight junctions were observed whereas absence of intercellular tight junctions was characteristic of all tumours with an increased uptake of pertechnetate. In some tumours with increased uptake, fenestrated endothelial wall was seen while in others nonfenestrated wall was evident. We concluded that intercellular junctions and not fenestrations affect the permeability of brain tumours to pertechnetate. (Penning and Front, 1975). Two main factors govern the passage of Tc-pertechnetate from the blood into the tissue of the tumours-the vascularity of the tumour, and the permeability of the blood-brain barrier.In a previous study, uptake of pertechnetate was found to be independent of vascularity (Front, 1978). It was suggested that changes in the bloodbrain barrier, which is localised in the capillary wall, might be involved with the different rates of 99mTc-pertechnetate uptake. In the present study we extended our investigations to include the ultrastructural properties of the capillary wall. Thus, both scintigraphic assessments and electron microscopic studies were carried out on the same tumour, in order to correlate given ultrastructural features with scintigraphic patterns of pertechnetate uptake. Subjects and methodsFourteen patients whose clinical condition enabled detailed scintigraphic assessments and whose removed tumours were adequately processed for