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In a 52-year-old man with general malaise, muscle stiffness and weakness, POEMS-syndrome was diagnosed based on polyneuropathy, splenomegaly, lymphadenopathy, subclinical hypothyroidism and the presence of a monoclonal paraprotein with osteosclerotic lesions and an indurated skin (POEMS is an acronym for Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, Skin changes). This is a rare systemic disease from the clinical spectrum of plasma cell dyscrasias with polyneuropathy. The clinical picture is broader and more pleomorphic than the acronym suggests. The possibility of a POEMS syndrome should be considered in the differential diagnosis of polyneuropathy in association with monoclonal gammopathy. Quite often it is associated with osteosclerotic myeloma or mixed osteoscleroticlytic lesions. The patient described was treated with high dose corticosteroids which were gradually decreased over the next three months, upon which a marked improvement could be seen. The general malaise subsided, as did the splenomegaly, and the skin became supple again.

In clinical decision analysis a quantitative value is attached to a longevity or a life quality by means of utility assessment. The actual value of the utility can determine the result of the decision analysis. In this article utility theory is briefly discussed. Four kinds of utility tests (direct scaling methods, the basic reference gamble, the time trade-off test and additive conjoint measurement) are introduced on the basis of an example and their pros and cons are discussed. It is concluded that additive conjoint measurement has the best formal infrastructure, but that the test method is not always easily applicable.