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

A phase I clinical study was done with quelamycin, a recently synthesized triferric derivative of adriamycin. Twenty-one good-risk patients were studied: 19 patients with non-small cell carcinoma of the lung and two patients with metastatic sarcoma. Acute toxicity occurred in all patients and consisted of high fever, flushing, hypertension, generalized body aches, tremors, and confusion, which lasted 3-6 hours. Potentially dangerous cardiotoxicity occurred in eight patients who had previous minor rhythm disturbances, and was characterized by tachycardia, atrial extrasystoles, atrial fibrillation, and branch block which lasted 6-14 hours. The dose-limiting hematologic toxicity was found to occur at 125 mg/m2 iv single-dose. Objective responses were observed in three of 19 patients with lung cancer and in one patient with metastatic osteogenic sarcoma resistant to adriamycin therapy. In conclusion, quelamycin is a new derivative of adriamycin with potential interest. However, the acute generalized toxicity and the immediate cardiotoxicity found in the presently used schedule are excessive. Further studies directed to suppress these side effects are in progress.
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PMID:Phase I clinical study of quelamycin. 36 Dec 26

The incidence of postoperative cardiac disturbances and the value of prophylactic digitalization were studied retrospectively in 143 patients undergoing pneumonectomy for carcinoma of the lung. Cardiac arrhythmias occurred in 29% and tachycardia episodes in 30% of the patients. The incidence of myocardial infarction was 2%. Operative mortality was 4%. The cardiac disturbances developed more often after left than after right pneumonectomy. The age of the patients, a history of angina pectoris or hypertension did not markedly increase the incidence of cardiac disturbances, neither did operative factors, such as pericardiotomy, left atrial resection, major bleeding nor postoperative empyema. Prophylactic digitalization significantly reduced postoperative cardiac disorders, their frequency being 33% in the group of patients who received prophylactic digitalis compared with 65% in the group that did not.
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PMID:Cardiac disturbances after pneumonectomy--the value of prophylactic digitalization. 67 77

Although it is true that pulmonary perfusion scanning is generally accepted primarily in the differential diagnosis of pulmonary embolism, the introduction of regional ventilation studies with radioactive 133Xe, the use of the computer to provide quantitative data, and the advances being made in cardiovascular nuclear medicine indicate that nuclear medicine procedures will be used more and more in the evaluation of patients with a variety of lung and heart diseases. They have already proved of value in the following circumstances: (1) differential diagnosis of pulmonary embolism; (2) assessment of regional involvement in pulmonary parenchymal disease, including degenerative, neoplastic, and infectious diseases; (3) detection of bullous disease and the determination of the possible effectiveness of surgery; (4) assessment of the response to radiation therapy in patients with carcinoma of the lung; (5) detection of pulmonary venous hypertension in patients with mitral valve or left ventricular disease; (6) detection of cor pulmonale; (7) differential diagnosis of cyanosis in newborn infants.
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PMID:The use of radioisotope techniques for the evaluation of patients with pulmonary disease. 124 35

The most common ectopic production of a pituitary hormone is the one of ACTH leading to Cushing's syndrome. Ectopic ACTH-hypersecretion is the cause of Cushing's syndrome in 10-15% of all cases. The ACTH-secreting tumours are often oat-cell carcinomas of the lung, less frequently pancreatic cancers, hypernephromas, or C-cell carcinomas of the thyroid. Some of these tumours may be benign or semi-benign as the rare carcinoid tumours and cause great problems in the differential diagnosis of ACTH-dependent hypercortisolism. Out of 173 of our patients with Cushing's syndrome observed in the last 12 years 21 were caused by ectopic ACTH-production. Of these 21 patients 13 have a small cell carcinoma of the lung. The ectopic ACTH-syndrome often has typical clinical features caused by the levels of ACTH and cortisol leading to hypocalcemic alkalosis with muscle weakness and wasting, carbohydrate intolerance, and hypertension with oedema. The survival time in many of these patients is not long enough to allow them to develop typical signs of Cushing's syndrome though they are often highly pigmented. These patients are easily diagnosed. However, patients with small tumours which do not cause very elevated ACTH-levels and who have the more typical clinical signs of full-blown Cushing's syndrome are difficult to recognize. For the differential diagnosis of ACTH-dependent Cushing's syndrome the corticotropin-releasing hormone (CRH) stimulation test and dexamethasone suppression test with high doses are helpful. In special cases the venous sampling procedure for ACTH-measurements is necessary, also CT or NMR is helpful. Ectopic CRH-production is a rare cause of ACTH-dependent Cushing's syndrome. Patients with ectopic CRH-production and consecutive ACTH-hypersecretion from the pituitary have not been studied extensively. There are especially no well documented results of the use of the CRH-stimulation test in vivo in this group of patients with Cushing's syndrome. On the other hand, in the documented cases, not only CRH-, but also ACTH-production was found in the tumours. So far, this rare cause of ACTH-dependent Cushing's syndrome has to be excluded or confirmed by the measurement of endogenous CRH-levels. But until now we have not been able to detect one single case of ectopic CRH-production using a sensitive homologous CRH-radioimmunoassay over a period of more than 8 years in which we have seen nearly 120 newly diagnosed patients with ACTH-dependent Cushing's syndrome. Only in the plasma and tumour tissue of two patients of other groups have we found high CRH-levels.
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PMID:Ectopic production of ACTH and corticotropin-releasing hormone (CRH). 132 73

In this retrospective study, 81 patients operated by craniotomy for a brain metastasis are reviewed. Mean age is 56.3 years and most of the patients are male (71.6%). Clinically, 79% of the patients present a focal semiology, most frequently with neuropsychologic disturbances (43%); epilepsy is found in 31% of the cases. Symptoms related to intracranial hypertension (vomiting and headache) are present in 43% of the patients. On C.T.-scan, there is a solitary metastasis in 89% and the most common intracranial location is the frontal lobe (33.3%). The most frequent primary neoplasms are: bronchial adenocarcinoma in 19%, squamous carcinoma of the lung in 11%, melanoma in 12% and unknown origin in 18%. The surgical removal (as judged by the surgeon) is total in 70%, subtotal in 19% and partial in 11%. Standard operative mortality (30 days after craniotomy) is 7.4%. The postoperative course (till the patients leave our department) is excellent in 58% (complete neurologic recovery), steady in 20% (stability of symptoms and neurologic examination) and bad in 22%, with worsening of the neurological deficits. Most of the patients (84% of the patients who survive more than 30 days after the craniotomy) had postoperative whole brain radiotherapy with a hypofractionned schedule (total doses of 15 to 40 Gy with fractions of 200 to 650 cGy). Ten patients had surgery alone. Mean survival is 10.2 months with a follow-up of 12 months to 10 years. Ten patients survived over 18 months and one is still alive almost 4 years after his craniotomy. In this study, the survival is not modified by the primary lesion's histology.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cerebral metastases. A study of a surgical series of 81 cases]. 160 35

Most of the symptoms from a malignant tumor are caused by local invasion by the tumor, or obstruction, either at the site of the primary disease or by metastases. However, tumors can produce symptoms at a remote site. Patients with gastrointestinal malignancy may present with symptoms which include dysphagia, nausea, vomiting, abdominal pain, diarrhea, bleeding and ascites. Palliation gastrectomy delays or prevents these symptoms. About 30% of gastric carcinomas are inoperable at the time of presentation. Chemotherapy is rarely effective in the palliation of gastric carcinoma. Laser irradiation can be delivered to assay site accessible to fibreoptic endoscopy, which is an advantage over endocavity irradiation or diathermy fulguration. Ascites is a common and disabling implication in patients with advanced malignant disease. Spironolactone will increase urinary sodium excretion significantly and control their ascites. If spironolactone fails to control, useful control can be achieved by draining the ascites. Patients with carcinoma of the lung may present with symptoms that include cough, bloody sputum and dyspnoea. Pain in the chest wall is usually secondary to invasion of the parietal pleura, ribs or intercostal nerves. Lesions in the medial portion of the right upper lobe, or mediastinal metastases, may invade or compress the superior vena cava, causing venous hypertension with oedema of the head and arms. The patients may complain of dyspnoea, dysphagia, stridor and headaches. Radiotherapy can be expected to improve the quality of life for these patients. Successful palliation of symptoms is almost related to tumor regression. The problems of obstruction and bleeding from malignant tumor is common. Recently, laser techniques have been applied to aid in palliation of these problems. Malignant effusion may occur early and be the first signs of metastases. The aim of therapy is to evacuate the fluid and induce pleural adhesion. One of the sad situations that we have to face is the patient with recurrent cancer which complains of various symptoms. The relief of symptoms is the most important palliative therapy to them.
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PMID:[Palliative therapy in cancer. 3. Palliation of the symptoms from a malignant tumor (1)]. 169 82

The Preventive Health Examination (PHE) program was designed to screen for cancer of the lung, colon, skin, and prostate (or breast) and to detect the risk factors for coronary artery disease, i.e., arterial hypertension, hypercholesterolemia, cigarette smoking, and obesity. To investigate the cost-effectiveness of PHE performed by nurse practitioners, the first 176 subjects enrolled in the PHE program at a northeastern, suburban VA Medical Center were evaluated prospectively. The subjects were recruited through random mailing. The direct cost of PHEs was $80 per patient. PHEs were performed on 171 men and 5 women, mean age 57.2 years, divided into groups according to the date of evaluation. Nine percent of patients had findings highly suspicious of cancer (lung nodules in 7, skin lesions in 9). As a consequence, one patient underwent lobectomy for squamous carcinoma of the lung and another underwent prostatectomy for adenocarcinoma of the prostate. Fifty-five percent of patients had high cholesterol levels, 53% were obese, 30% were heavy cigarette smokers, and 19% were hypertensive. Nineteen percent of the patients had three or more coronary artery disease risk factors. We conclude that low cost PHEs performed by nurse practitioners have a high yield in detecting risk factors for coronary artery disease, and for detecting potentially treatable malignancies.
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PMID:Screening for cancer and coronary risk factors through a nurse practitioner-staffed preventive health clinic. 251 28

We use the unexpected results of five kidney biopsies to discuss how early biopsy in renal disease can change the therapy and correct the diagnosis of the disease. The first patient was a 73 year-old male diabetic who had osteomyelitis and developed rapidly progressive glomerulonephritis. The next patient was a 72 year-old man who was treated for cardiac failure and increasing serum creatinine. The kidney biopsy revealed rapidly progressive glomerulonephritis. The third patient developed acute renal failure after an episode with vomiting. Here the histological diagnosis was acute renal failure and parenchymatous renal disease could be ruled out. The next patient was a 13 year-old girl. She had proteinuria (5-6 g/d) and hypertension (200/140 mm Hg). After four months, serum creatinine was 200 mumol/l. She was then biopsied, and we found membranoproliferative glomerulonephritis type 1. After the diagnosis was established she was treated with immunosuppression and her condition improved. The last patient was a 55 year-old male diabetic. He developed nephrotic syndrome and the histological diagnosis of the kidney biopsy was membranous glomerulonephritis stage 1. Six months after the kidney biopsy we found carcinoma of the lung. This underlines the importance of the fact that 10% of membranous glomerulonephritides are tumour associated.
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PMID:[Clinical significance of early kidney biopsy]. 281 89

We describe a woman with metastatic small cell carcinoma of the lung who presented with pituitary apoplexy and hyperprolactinemia. Within seventeen months she developed florid Cushing's syndrome with anasarca, hyperpigmentation, hypertension with marked hypercortisolemia (not suppressible with 8 mg dexamethasone), elevated serum ACTH, hypokalemic metabolic alkalosis, and multiple hepatic metastases. This picture suggested the presence of ectopic ACTH syndrome. She died 26 months after the episode of pituitary apoplexy. Primary small cell carcinoma of the lung was diagnosed post-mortem. Metastases were present in the left lung, regional lymph nodes, heart, liver, bone marrow, sphenoid bone, anterior pituitary and pituitary capsule. Posterior pituitary was normal. There was no evidence of pituitary hyperplasia, of adenoma or of primary pituitary carcinoma. The results suggest the presence of a primary ACTH-producing small cell carcinoma of the lung that metastasized to the parasellar sphenoid bone and then extended to the anterior pituitary and dura to mimic a primary intrasellar cause of pituitary apoplexy and Cushing's syndrome. The case demonstrates how difficult it may be to diagnose the etiology of Cushing's syndrome and it emphasizes a unique variation in the presentation of small cell carcinoma of the lung.
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PMID:Metastatic small cell carcinoma of the lung presenting as pituitary apoplexy and Cushing's syndrome. 608 26

This report describes a 63-yr-old man with lung cancer accompanying hypertension, hyperpigmentation, muscle weakness, psychosis, hypokalemia, hyperglycemia, hyponatremia, massive natriuresis and lower serum osmolality than urine osmolality. Elevated levels of plasma and urine corticosteroids and of plasma immunoreactive adrenocorticotropic hormone (ACTH) were not altered by the administration of large amounts of dexamethasone. Elevated plasma antidiuretic hormone (ADH) values were also demonstrated. Postmortem examinations revealed small cell lung carcinoma with extensive metastasis, bilateral adrenocortical hyperplasia and Crooke's degeneration of the pituitary gland. Immunoradiological and immunohistochemical studies demonstrated the presence of immunoreactive ACTH, ADH and gastrin-releasing peptide in the tumor tissue. Beta-melanocyte-stimulating hormone, calcitonin and carcinoembryonic antigen were also detected by one of the methods. Hence, this is a rare case of lung cancer with multiple hormone production and clinical and laboratory evidence of both the ectopic ACTH and ADH syndromes.
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PMID:Small cell lung carcinoma with ectopic adrenocorticotropic hormone and antidiuretic hormone syndromes: a case report. 632 89


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