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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report a rare case of metastatic carcinoma of the large bowel, secondary to a primary bronchogenic adenocarcinoma. Abdominal pain developed in a 44-year old man 5 months after lobectomy for lung adenocarcinoma. The diagnosis of a large caecal extraluminal mass was established by means of sonography, scanner and laparoscopy. Palliative resection (brain metastases) was performed. Postoperative histological examination revealed the resected tumor to be identical to the lung adenocarcinoma. The patient eventually died 4 months after resection (complication of intracranial hypertension). Diagnosis and therapeutic features of metastatic extra-thoracic lung carcinoma are discussed.
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PMID:[An unusual secondary localization of bronchial adenocarcinoma]. 831 14

5-fluorouracil (5-FU) is still one of the most prescribed cytostatic drugs, but gastrointestinal toxicity limits its use. Capecitabine, an orally administered prodrug of 5-FU, is activated by a cascade of three enzymes, resulting in the preferential release of 5-FU at the tumor site; it was developed in an attempt to avoid the problem of gastrointestinal toxicity of fluoropyrimidines. The aim of the present study was to investigate the safety profile of capecitabine at the daily oral dose of 502 mg/m2, given in two divided doses 12 hr apart for at least 10 days of treatment. In conformity with Italian law, 11 patients (8 females and 3 males) with advanced or metastatic pretreated solid tumors (4 colon-rectum, 3 breast, 2 stomach, 1 ovary, 1 lung) were enrolled. Treatment duration ranged from 1.5 to 14 days. Ten of the 11 patients received the planned 10 days of treatment. One patient was discontinued on the second treatment day when he presented with symptoms of intracranial hypertension with multiple brain metastases documented by CT scan. Toxicity consisted of 1 case of mild edema; no adverse events characteristic of fluoropyrimidines were recorded. No abnormalities in hematologic, renal, hepatic or electrolyte values were seen. In conclusion, capecitabine, given at this dose and for a relatively short period, proved to be well tolerated. Further investigation is recommended to define the promising antitumor efficacy documented in many human xenograft models in mice.
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PMID:A pilot safety study of capecitabine, a new oral fluoropyrimidine, in patients with advanced neoplastic disease. 906 21

We report the case of a patient in whom brain MR imaging was requested for initial symptoms of intracranial hypertension. The presence of multiple intracranial hemorrhagic lesions suggested brain metastases. Body screening showed periosteal osteosarcoma of the left fibula with no lung metastases, but with a patent foramen ovale which probably allowed neoplastic cells to reach the brain without being filtered through the lungs. The conclusion of this study was that a left-right cardiac communication is to be considered in cases of isolated brain metastases from osteosarcoma.
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PMID:Isolated brain metastases of osteosarcoma in a patient presenting with a patent foramen ovale. 908 59

Non-small cell lung cancer is the most frequently encountered malignant neoplasm. Brain metastases occur in about 30% of patients with NSCLC The recent data from Poland indicate that there were about 6000 patients with NSCLC and brain metastasis in the year 1993. The first symptoms in those patients are usually of neurological nature, because brain metastases have high dynamics of growth and accompanying brain oedema accelerates increase of intracranial hypertension. Although the surgical treatment of NSCLC with brain metastases has been known for 50 years there is still controversy over indications for such treatment and possibility of improvement in results by combining surgery with other methods of treatment. There is good evidence in literature on the surgical treatment of lung cancer and synchronous brain metastasis. In some papers the results of treatment of many hundreds of patients are presented. They show, that thoracic and neurological surgery operations coordinated in time provide a chance to extend the survival time of the majority of patients, and enable even 5-year survival in up to 20% of patients. Polish experience on this subject resulted in only a few publications. Majority of those papers come from neurosurgical centres related to the results of treatment of brain metastases. Patients with single brain metastasis and a resectable primary lung tumour have the best prognosis for radical treatment. Presented study suggests that it is still worth undertaking the combined neurosurgical and thoraco-surgical treatment in patients with NSCLC and brain metastasis.
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PMID:[Current views on surgical treatment of non-small cell lung neoplasms with metastasis to the central nervous system]. 950 88

The overall incidence of renal cell carcinoma is rising, for reasons not fully explained by increased abdominal imaging. Risk factors associated with renal cell carcinoma include hypertension, smoking, increased body mass index, and diet. There is an inverse association of renal cell carcinoma risk with consumption of a variety of carotenes. In addition, increased red meat intake has been associated with increased risk. Partial nephrectomy may be as effective as radical nephrectomy as treatment for localized disease, and radiosurgery may be as effective as surgical resection in the management of brain metastases. Immunotherapy remains the mainstay for systemic treatment, with response rates between 5% and 20%. Survival in renal cell carcinoma is related to pathologic stage, nuclear grade, microscopic vascular invasion, DNA content, nuclear morphometry, and histologic pattern. In addition, patients with deletion (8p)/-8, +12, and +20 appear to have a worse prognosis.
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PMID:Renal cell carcinoma. 1084 Nov 99

Brain metastases represent the most frequent intracranial neoplasms in adults: between 15 and 25% of patients with systemic tumors will face brain metastases along the clinical course of disease. Lung cancers, breast cancers and melanomas are the commonest causes of brain metastases (about 75%), while the primary site remains unknown inasmuch as 15% of cases. Headache, focal neurological deficits, epilepsy and intracranial hypertension are the most frequent initial symptoms and signs. Computerized Tomography and Magnetic Resonance represent the methods of choice for diagnosis. Supportive care is based on corticosteroids and antiepileptic drugs. Anticancer therapy planning must be based on prognostic factors: performance status, tumor activity and age. Surgical removal followed by external adjuvant radiotherapy is considered the best treatment in patients with single brain metastases and systemic disease under control or absent. Stereotactic radiosurgery is preferable in cases of unoperable metastatic lesions of the brain or progressive systemic disease. The usefulness of whole brain radiotherapy following surgery or radiosurgery is debated. In patients with multiple brain metastases, apart from radiotherapy, surgical excision of the symptomatic lesions, when feasible, seems advantageous. Chemotherapy is a valid option only in cases of metastases from chemosensitive neoplasms (small-cell lung tumors or breast tumors).
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PMID:[Cerebral metastatis. Diagnostic and therapeutic features]. 1151 93

Brain metastases occur in 20-40% of patients with cancer and their frequency has increased over time. Lung, breast and skin (melanoma) are the commonest sources of brain metastases, and in up to 15% of patients the primary site remains unknown. After the introduction of MRI, multiple lesions have outnumbered single lesions. Contrast-enhanced MRI is the gold standard for the diagnosis. There are no pathognomonic features on CT or MRI that distinguish brain metastases from primary malignant brain tumors or nonneoplastic conditions: therefore a tissue diagnosis by biopsy should be always obtained in patients with unknown primary tumor before undergoing radiotherapy and/or chemotherapy. Some factors are prognostically important: a high Performance Status, a solitary brain metastasis, an absence of systemic metastases, a controlled primary tumor and a younger age. Based on these factors, subgroups of patients with different prognosis have been identified (RPA class I, II, III). Symptomatic therapy includes corticosteroids to reduce vasogenic cerebral edema and anticonvulsants to control seizures. In patients with newly diagnosed brain metastases prophylactic anticonvulsants should not be used routinely. The combination of surgery and whole-brain radiotherapy (WBRT) is superior to WBRT alone for the treatment of single brain metastasis in patients with limited or absent systemic disease and good neurological condition. Complete surgical resection allows a relief of intracranial hypertension, seizures and focal neurological deficits. Radiosurgery, alone or in conjunction with WBRT, yields results which are comparable to those reported after surgery followed by WBRT, provided that lesion's diameter does not exceed 3-3.5 cm. Radiosurgery offers the potential of treating patients with surgically inaccessible metastases. Still controversial is the need for WBRT after surgery or radiosurgery: local control seems better with the combined approach, but overall survival does not improve. Late neurotoxicity in long surviving patients after WBRT is not negligible; to avoid this complication patients with favorable prognostic factors must be treated with conventional schedules of RT, and monitoring of cognitive functions is important. WBRT alone is the treatment of choice in patients with single brain metastasis not amenable to surgery or radiosurgery, and with an active systemic disease, and in patients with multiple brain metastases. A small subgroup of these latter may benefit from surgery. The response rate of brain metastases to chemotherapy is similar to the response rate of the primary tumor and extracranial metastases, some tumor types being more chemosensitive (small cell lung carcinoma, breast carcinoma, germ cell tumors). New radiosensitizers and cytotoxic or cytostatic agents, and innovative technique of drug delivery are being investigated.
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PMID:Management of brain metastases. 1238 50

With the widespread diffusion of stereotactic radiosurgical procedures, GKR treatments have gained considerable momentum as a major therapeutic option for patients harboring primary or metastatic brain tumors. Present results in high grade gliomas indicate a potential palliative role of this technique. The overall low radiosensitivity of these oncotypes and their infiltrative nature-with the resulting problems in properly defining the tumor target-are still a major obstacle to further development of the approach. In this regard, useful contributions are expected from advances in molecular neurobiology and functional neuroimaging as shown by preliminary investigations with MR spectroscopy. Surgery maintains a dominant role in the therapeutic armamentarium for low grade gliomas. However, in unfavorable cases (unresectable tumors, recurrences), GKR seems to be an effective alternative to conventional radiochemotherapy. In grade 2 astrocytomas and specifically in grade 1 pilocytic forms, short-to-mid-term reported studies have documented encouraging 70 to 93% local tumor control rates, with minimal cerebral toxicity. Finally, during the last decade, GKR has become a primary treatment choice for patients harboring small-to-medium-size brain metastases, with reasonable life expectancy and no impending intracranial hypertension. Focal tumor responses are consistently elevated, even in the most radioresistant oncotypes (melanoma, renal carcinoma); median and actuarial survival rates are far better than with conventional radiation treatments and are comparable to those observed in accurately selected surgical-radiation series.
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PMID:The role of gamma knife radiosurgery in the treatment of primary and metastatic brain tumors. 1277 10

Papillary thyroid carcinoma (PTC) is the most common type of well-differentiated thyroid carcinoma and typically has an excellent prognosis. The incidence of distant metastasis from PTC is low. However, once metastasis has developed in a distant site, prognosis is markedly diminished. Brain metastases from PTC are extremely rare. No consensus regarding management has yet been reached. We report on the case of a patient who presented with signs of intracranial hypertension. Cranial magnetic resonance imaging (MRI) identified a lesion of the right temporofrontoparietal lobe. The patient underwent a craniotomy with a total removal of the tumor. Histologic examination of the lesion showed a metastasis of papillary adenocarcinoma. We observed a cold nodule in the right lobe of the thyroid on physical examination and imaging techniques (e.g., CT and scintigraphy). Fine-needle-aspiration cytology of the nodule was reported as PTC. A total thyroidectomy was performed and histopathological examination showed intrathyroidal variant of PTC. Postoperatively adjuvant whole brain radiation therapy with 44 Gy to multiple brain metastases of PTC was applied. One month later, the patient then underwent 131I radioiodine therapy with 150 mCi of 131I given orally. In conclusion, the present case underwent an aggressive multimodal approach to therapy. This report indicates that the early detection and control of brain metastases may contribute to a better quality of life for patients affected by brain metastases.
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PMID:Intrathyroideal papillary thyroid carcinoma presenting with a solitary brain metastasis. 1571 Oct 33

Cardiac myxoma is a source of emboli to the vascular tree, especially to the central nervous system. Although it is rare, its early recognition is particularly important because of its unique clinical features of subsequently leading to intracerebral or subarachnoid hemorrhage, even brain metastases, and its potential for surgical cure. Missing the diagnosis may lead to devastating results, including stroke, even sudden death. A 40-year-old male with no other conventional vascular risk factors such as hypertension, diabetes or hyperlipidemia presented with right hemiplegia, global aphasia, vomiting, and fever. Infarction over the left middle cerebral artery was disclosed on magnetic resonance imaging study, and echocardiogram showed a huge mass, about 5cm in size, on the mitral valve which was histopathologically proved to be a cardiac myxoma. He also presented with multiple emboli to the kidneys and the left eye. There is uncertainty about the role of anticoagulation. The treatment of choice remains surgical excision of the cardiac myxoma which may lead to normalization of serum interleukin-6 levels and resolution of constitutional symptoms, and the intracranial aneurysms may regress and resolve.
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PMID:Young stroke, cardiac myxoma, and multiple emboli: a case report and literature review. 1699 1


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