Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carcinoids are rare endocrine tumors that can develop in several organs in the body. Clinically, patients can have a wide spectrum of signs and symptoms that range from incidental findings of a polyp during endoscopy to the carcinoid syndrome characterized by severe flushing, diarrhea, abdominal cramping, and life-threatening right-sided heart failure. Most carcinoid tumors are indolent but can metastasize to regional lymph nodes and to other organs, including the liver, bone, and the central nervous system. Treatment is determined by tumor location and by the presence of distant metastasis. Surgical resection of the tumor is advocated in patients with localized disease and can often be curative. Long-acting somatostatin analogs, including octreotide, octreotide long-acting repeatable, and lanreotide prolonged release, are effective in providing symptom relief in patients with the carcinoid syndrome. Patients with metastatic disease to the liver that is refractory to somatostatin treatment should be considered for hepatic artery occlusion. Overall, 5- and 10-year survival rates in patients with metastatic disease are favorable, although tumors can be resistant to most forms of medical or surgical therapy.
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PMID:Carcinoid tumors. 1207 68

Flushing is a known symptom in intestinal carcinoid tumors which usually occurs only in the presence of liver metastases. A 62-year-old women presented with abdominal pain, nausea and flush symptoms. US, CT, octreotide scintigraphy and biopsy revealed a primary mesenteric carcinoid with retroperitoneal lymph node metastases and a solitary leftsided supraclavicular lymph node metastasis proving lymphatic spread over the thoracic duct, but liver metastases were excluded. This is a report on a mesenteric carcinoid which lead to flush symptoms despite absence of liver metastases, since retroperitoneal lymph node metastases enabled a direct hormone release into the systemic circulation.
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PMID:Flush symptoms caused by a mesenteric carcinoid without liver metastases. 1246 2

The therapeutic efficacy of weekly paclitaxel infusion for relapsed breast cancer patients is not known. We assessed safety, feasibility, and therapeutic efficacy in a pilot study of weekly 1-h low-dose paclitaxel infusion for relapsed breast cancer in an outpatient clinic. Eighteen patients with relapsed breast cancer who had received prior chemotherapy regimens, including anthracyclines, mitomycin, and 5-fluorouracil beyond a second line of treatment were enrolled into the study. The dose of paclitaxel was between 40 mg/m(2) and 80 mg/m(2) per week in a 1-h infusion, and a treatment cycle was 4 weeks until there was no evidence of progressive disease. When a dose of 80 mg/m(2) was administered, the treatment cycle was weekly infusion three times with a 1-week interval per 4-week cycle. The mean treatment period was 5.5 months and the maximal length of administration was 8 months. The overall response rate was 44.4%, including 2 cases of complete response and 6 cases of partial response. Tumor response was observed in 3 of 7 cases of lung metastases (42.8%), 6 of 12 cases of soft tissue metastases (50.0%), and 1 of 3 cases of liver metastases (33.3%), whereas 8 cases with bone metastases did not respond. The mean time to response was 1.8 months and the mean response duration was 4.3 months. The dose between 31.5 mg/m(2)/wk and 79.7 mg/m(2)/wk was not associated with tumor response. Toxicities associated with weekly 1-h low-dose paclitaxel infusion were tolerable, and most were less than grade 2, including alopecia (100%), neutropenia (88.8%), flushing (66.6%), face edema (61.1%), numbness (55.5%), and myalgia (38.8%). There was 1 case of grade 3 neutropenia. Weekly 1-h low-dose paclitaxel might be a therapeutically effective, safe infusion and feasible as a salvage chemotherapy for relapsed breast cancer patients following failure of prior chemotherapy.
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PMID:Feasibility and therapeutic efficacy of weekly 1-h low-dose paclitaxel infusion for relapsed breast cancer. 1246 61

Who ever is writing about standards should put himself the question: What is a standard? How is it produced? Who is defining it? How compulsory is it? A standard should only be understood as guiding principles or as following guidelines and never as a dogma, while otherwise every operative technical or therapeutical progress is prohibited. On the basis of the onco-surgical guidelines for the colo-rectal carcinoma is shown how standards can begin to sway. The Turnbull "no-touch isolation technique" does not stand up to the criteria of the evidence based medicine. The usefulness of the high ligation of the veins and the intestinal occlusion has not been proven by any studies. The central ligature of the Arteria mesenterica inferior in left resection is wrong according more recent anatomical knowledge. Ligation near to the aorta leads obligatory to lesions of the plexus hypogastricus. Animal experiments are controversial concerning the dissemination of tumour cells during crushing of the cancer. And a prospective controlled study does not show any advantage of respecting the Turnbull criteria. Independent prognostic factors are the surgeon, the frequency of performing the procedure in the hospital concerned, the pT and N stage, the R-0 resection and according to American pathologists the pre-operative CEA titre. Also are mentioned the infiltration of veins and lymph vessels, micro metastases in lymph nodes and the grading. The resection should if possible be performed in anatomical layers, specially considering the meso-rectum. What should be done in the distal 8 cm till the pelvic floor has not yet been clarified. On the contrary, the laparoscopic surgery has definitively also found its acceptance in oncological surgery. The discussions about port-metastases and tumour-cell-dissemination by the pneumoperitoneum-gas have silenced. Already, partially better long-term results are mentioned. In the beginning of 2003, the pillars of the standard technique of oncological colo-rectal surgery are besides the orthograde intestinal flushing, the pre-operative low molecular Heparin and the antibiotic prophylaxis, the open or laparoscopic R-0 en bloc resection, the minimal safety distance in the low rectum of 1 cm, the ligature of the Arteria mesenterica inferior 2-3 cm distally to its origin from the aorta in case of left resection, respectively the Arteria ilio-colica at its origin from the Arteria mesenterica superior in case of right resection, the cytotoxic intestinal flushing in case of left resection and the flushing of the abdominal cavity as well as the port-site with Taurolin 0.5%. In case of rectum-carcinoma uT3 or uN+, a neo-adjuvant radio-chemotherapy is administered and adjuvant chemotherapy is given by positive nodal colon-carcinoma.
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PMID:[Standard technique of oncologic colorectal surgery]. 1281 36

Carcinoid tumors were first described more than a century ago, but the treatment of patients with advanced disease remains a challenge to physicians. The etiology of carcinoid tumors, the biologic determinants of the growth of these malignancies, as well as the high frequency of multiple carcinoid and/or non-carcinoid tumors in patients with this disease also remain to be elucidated. A 5-decade analysis of 13,715 carcinoid tumors in the USA showed that distant metastases were demonstrated at the time of diagnosis in 12.9% of patients with this neoplasia. The overall 5-year survival rate for all patients with carcinoids regardless of the site, was reported to be 67.2%. The prognosis of patients with early stage disease is good and surgical resection is the standard form of treatment. The resection of local or regional metastases can result in cure for some cases. However, patients with metastatic dissemination have poor outcomes since chemotherapy is generally ineffective. Surgical resection of isolated hepatic metastases, surgical hepatic artery ligation or embolization produce responses in selected patients. Radiation therapy may ease the pain of bone metastases. The administration of long acting analogs of somatostatin can control the symptoms of diarrhea and flushing in patients with the malignant carcinoid syndrome. However, a complete regression of metastatic carcinoid tumors following the administration of somatostatin analog octreotide has been reported so far in only 3 cases. Other modalities of treatment, including liver transplantation and the administration of radiolabeled somatostatin analogs have likewise been applied in patients with advanced disease. It is expected that advances in proteomics research will contribute to our understanding of the mechanisms of diseases and aid in designing new drugs.
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PMID:A clinical overview of carcinoid tumors: perspectives for improvement in treatment using peptide analogs (review). 1564 13

Endocrine tumors (ET) of the digestive tract (formerly called neuroendocrine tumors) are rare. They are classified into two principal types: gastrointestinal ET's (formerly called carcinoid tumors) which are the most common, and pancreaticoduodenal ET's. Functioning ET's secrete polypeptide hormones which cause characteristic hormonal syndromes. The management of ET is multidisciplinary. Poorly-differentiated ET's have a poor prognosis and are treated by chemotherapy. Surgical excision is the only curative treatment of well-differentiated ET's. The surgical goals are to: 1. prolong survival by resecting the primary tumor and any nodal or hepatic metastases, 2. control the symptoms related to hormonal secretion, 3. prevent or treat local complications. The most common sites of gastrointestinal ET's ( carcinoids) are the appendix and the rectum; these are often small (<1 cm), benign, and discovered fortuitously at the time of appendectomy or colonoscopic removal. Ileal ET's, even if small, are malignant, frequently multiple, and complicated in 30-50% of cases by bowel obstruction, mesenteric invasion, or bleeding. The carcinoid syndrome (consisting of abdominal pain, flushing, diarrhea, hypertension, bronchospasm, and right sided cardiac vegetations) is caused by the hypersecretion of serotonin into the systemic circulation; it occurs in 10% of cases and is usually associated with hepatic metastases. More than half of the cases of pancreatic ET are non-functional. They are usually malignant and of advanced stage at diagnosis presenting as a palpable or obstructing mass or as liver metastases. Insulinoma and gastrinoma (cause of the Zollinger-Ellison syndrome) are the most common functional ET's. 80% are sporadic; in these cases, tumor size, location, and malignant potential determine the type of resection which may vary from a simple enucleation to a formal pancreatectomy. In 10-20% of cases, pancreaticoduodenal ET presents in the setting of multiple endocrine neoplasia (NEM type I), an autosomal-dominant genetic disease with multifocal endocrine involvement of the pituitary, parathyroid, pancreas, and adrenal glands. For insulinoma with NEM-I, enucleation of lesions in the pancreatic head plus a caudal pancreatectomy is the most appropriate procedure. For gastrinoma with NEM-I, the benefit of surgical resection for tumors less than 2-3 cm in size is not clear. The lesions are frequently small, multiple, and widespread and recurrence is frequent after excision. The long-term prognosis is nevertheless fairly good. But the eventual development of liver metastases which are the most common cause of mortality still argues for an aggressive surgical approach in the early stages of the disease.
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PMID:[Surgical treatment of gastric, enteric, and pancreatic endocrine tumors Part 1. Treatment of primary endocrine tumors]. 1614 76

Carcinoid tumors are rare, often insidious neoplasms arising from neuroendocrine cells. The majority arise in the gastrointestinal system, and are often incidentally found during investigation, although some may present as an emergency bleed or perforation. The prosaic symptoms of flushing, diarrhea, and sweating are often overlooked; thus, the diagnosis is usually much delayed and the tumor is advanced at presentation. This diagnostic delay renders effective management difficult and adversely affects outcome. This overview provides a current assessment of the evolution of the diagnostic techniques available to establish an accurate biochemical (5-hydroxyindole-3-acetic acid and chromogranin A) and topographic diagnosis (octreoscan, radio-labeled metaidobenzylguanidine, computerized tomography, magnetic resonance imaging, positron emission tomography, enteroclysis, endoscopic ultrasound, enteroscopy, capsule endoscopy, and angiography) of carcinoid tumors. The utility and shortcomings of the respective modalities available are evaluated. Although considerable advances have been made in establishing the diagnosis of carcinoid tumors and in defining the topography of metastatic disease, the major limitation is the inability to establish an early and timely diagnosis before the advent of metastatic disease.
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PMID:Gastrointestinal carcinoids: the evolution of diagnostic strategies. 1691 96

The pathological reports, minimum datasets and topographical plots of the neck dissections from 439 cases of oral and oropharyngeal cancer reported by a single pathologist following a standard protocol were analysed. Metastasis was evident in 47% of patients including bilateral metastases in 6%, extracapsular spread in 29% and matting in 7%. The extent of metastasis (both volume and distribution) was greatest in tumours of the oropharynx followed by lateral tongue, ventral tongue and floor of mouth. The typical 'inverted-cone pattern' was seen in 67% of patients with metastasis. A single micrometastasis was seen in 14%, skip lesions in 10% and involvement of 'other' nodal groups in 4%. Contralateral neck metastases (0.4%), peppering (2%), flushing of lymph node sinuses (1%) and all nodes positive (0.4%) accounted for the remaining 'aberrant' patterns. Skip lesions were seen in tumours at all sites other than retromolar.
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PMID:The topography of cervical lymph node metastases revisited: the histological findings in 526 sides of neck dissection from 439 previously untreated patients. 1723 62

Patients with carcinoid tumours frequently present with metastatic disease. There are only a few therapeutic options for these patients, and the main goal of palliative treatment is to reduce symptoms and thus to improve quality of life. Current therapy includes surgical resection, hepatic artery embolisation, chemotherapy and somatostatin analogue treatment; however, all these options have limitations. It seems probable that therapeutic modalities based on radiopharmaceuticals may provide better therapy, not only in relation to symptom reduction but may also improve patient survival. In this case report we present a 46-year-old woman with a symptomatic carcinoid, who at the time of diagnosis had liver and abdominal lymph node metastases, the primary tumour being located in the terminal ileum. (111)In-pentetreotide scanning was negative, whereas (123)I-MIBG scanning showed high avidity in the tumour tissue. After right hemicolectomy, two courses of (131)I-MIBG treatment were given (12.95 GBq and 12 GBq, respectively). After the second dose of (131)I-MIBG temporary pancytopenia was present. Octreotide therapy was given empirically only for a short time and was stopped because of drug intolerance. The patient underwent tricuspid and pulmonary valve replacement because of her carcinoid heart disease, followed by two courses of embolisation of liver metastases. While (131)I-MIBG therapy reduced the patient's symptoms of flushing and diarrhoea, there has not yet been any effect on tumour response or 5-HIAA production. This case illustrates the multimodality and multidisciplinary approach to such patients.
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PMID:Multimodality palliative treatment of (111)In-pentetreotide negative/(123)I-MIBG positive metastatic carcinoid - a case report. 1877 5

We present a case of a 44 year old man with flushing, diarrhea and markedly elevated 24 hour urinary 5-HIAA level, who was referred for an indium-111 pentetreotide study, after the excision of a carcinoid tumor in the terminal ileum. Scan findings revealed focal uptake in the myocardium and liver, suspicious for metastases. Subsequent transthoracic echocardiogram failed to demonstrate a cardiac lesion. Previously, our group has unequivocally demonstrated the usefulness of software fusion of SPECT and CT imaging in the evaluation of a carcinoid metastasizing to the myocardium. This case illustrates that hardware SPECT/CT fusion imaging utilizing indium-111 pentetreotide to evaluate metastatic carcinoid tumors can be useful. In addition, the echocardiogram can yield false negative results, because of a smaller lesion size and the influence of an operator-dependent factor.
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PMID:Focal myocardial uptake in a patient with carcinoid tumor by indium-111-pentetreotide on SPECT/CT. 1881 65


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