Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021843 (bowel obstruction)
 9,927 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-three patients with advanced gynecologic malignancy were treated with definitive irradiation and synchronous sensitizing chemotherapy (CT) consisting of cisplatin (CDDP), 50 mg/m2 i.v. rapid infusion, and a 5-day continuous infusion of 5-fluorouracil (5-FU), 750 mg/m2/day. A total of three cycles were administered every 3-4 weeks. Fifteen patients had primary cervical epidermoid carcinoma (three bulky stage IIB, one stage IIIA, ten stage IIIB, one stage IV), four had pelvic recurrences of carcinoma of the cervix, two had endometrial adenocarcinomas (stage IV), and two had vulvar epidermoid carcinoma (one stage III and one stage IV). Radiotherapy (RT) for implantable tumors consisted of 2,000 cGy whole pelvis, 3,000-4,000 cGy split field, and two intracavitary or interstitial insertions, resulting in a total dose of 7,500-8,000 cGy to point A. Three courses of CT were delivered simultaneously with irradiation of the central bulk of tumor: during the first week of whole pelvis RT and with each of the two brachytherapy procedures. Nonimplantable tumors were treated with protracted external beam RT (5,500 cGy tumor dose) and three courses of CT during weeks 1, 4, and 7 of RT. Twenty-one of 23 patients completed RT and 18 of 23 patients completed CT as planned, but half had delays in either RT or CT. Grade 2 or 3 late sequelae consisted of leg edema (one patient), proctosigmoiditis (one patient), bowel obstruction (one patient), vesicovaginal fistula (one patient), and pulmonary embolus (two--one fatal). The incidence of grade 2 and 3 sequelae were 18 and 22%, respectively. With 1-3 years of follow-up evaluation, 12 of 23 (52%) patients are free of disease, and 9 of 22 evaluable patients (41%) have had failure within the pelvis. We conclude that high-dose definitive RT can be delivered with synchronous CDDP and 5-FU at the doses given, with acceptable toxicity. Further study is required to evaluate the impact of radiosensitization on tumor control and late morbidity of therapy. Optimization of irradiation and drug doses as well as the best schedules that may enhance the interaction of these two modalities should be further investigated.
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PMID:Phase I/II study of definitive radiotherapy and chemotherapy (cisplatin and 5-fluorouracil) for advanced or recurrent gynecologic malignancies. Preliminary report. 268 92

Three women had endometriosis that involved the rectosigmoid colon; their clinical presentation suggested primary colonic malignant neoplasm. Intestinal obstruction, weight loss, and, in two patients, rectal bleeding with radiologic evidence of a mass lesion that involved the rectosigmoid were present at initial evaluation. All patients eventually underwent colonic resection as definitive therapy. Endometriosis of the pelvic colon may mimic primary intestinal disease, mistakenly suggesting malignant neoplasm. Such symptoms in a young woman should prompt a search for endometriosis, which is a more likely diagnosis. Adequate therapy frequently requires surgical intervention.
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PMID:Pelvic endometriosis simulating colonic malignant neoplasm. 270 45

Intestinal surgery is frequently required in the management of patients with gynecologic malignancies. During a recent 3-year period 10.4% of all laparotomies performed on the Gynecology Service at Memorial Sloan-Kettering Cancer Center included major intestinal surgery. A total of 215 separate intestinal procedures were performed during 171 operations on 158 patients. The majority of operations were performed in patients with ovarian (42.7%), cervical (24%), and endometrial (12.3%) malignancies. Seventy-nine of 171 (46.2%) of operations were performed on previously irradiated patients. The most frequent indications for intestinal surgery were intestinal obstruction (43.2%) and intestinal fistula (21%). Procedures performed included 87 intestinal resections, 26 intestinal bypasses, 82 colostomies, and 20 intestinal conduit urinary diversions. Hand suturing was used in 71% of anastomoses; automatic stapling instruments were used in 29%. There was a single surgical mortality. Complications including infections, obstruction, and fistula formation were infrequent. These difficult intestinal procedures can be performed safely in the context of a fellowship training program. Since a significant proportion of all laparotomies done in gynecologic cancer patients will include major intestinal surgery, physicians managing patients with these diseases should have both the technical skills necessary to perform these procedures, as well as a thorough understanding of the diseases themselves.
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PMID:Intestinal surgery in gynecologic oncology. 273 22

Data obtained in examination of 195 patients are analysed. The most marked changes in the homeostasis system in patients with intestinal obstruction due to cancer of the colon are related to hydro-ion and protein metabolism, acid-base equilibrium, and blood toxic properties. This requires purposeful preoperative management which allows the results of operative treatment to be improved. Characteristic changes of the absorptive property of the small intestine are of principal importance in the genesis of intoxication in these patients. The authors emphasize the important role of decompression of the intestine and intestinal lavage in the complex of therapeutic measures.
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PMID:[Treatment of disorders of the homeostatic system in patients with colonic obstruction of tumor etiology]. 273 35

The effect of subacute large-bowel obstruction on the mesenteric circulation was studied in a chronic dog model. Colonic obstruction was produced 40 cm distal to the ileocolic sphincter. Five days later, gut blood flow was measured with 15 microns microspheres, together with hemodynamic and metabolic values. Two other groups provided comparative data: unoperated animals to measure baseline values and sham-operative controls. With adequate hydration, hemodynamic and metabolic values remained stable in the experimental group. There was a two-fold increase (P less than 0.05) in blood flow in the dilated colon proximal to the obstruction site, whereas blood flow to the other organs remained unchanged. These results have relevance for the hemodynamic management and use of primary anastomosis in patients with large-bowel obstruction. Furthermore, these data might implicate increased local bowel blood flow as a contributory factor to the poorer long-term prognosis found in patients with large-bowel cancer presenting with intestinal obstruction.
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PMID:Effect of large-bowel obstruction on colonic blood flow. An experimental study. 275 53

An increased incidence of small bowel lymphoma in patients with long-standing celiac sprue is well documented in the literature. Less common is the association of adenocarcinoma of the small intestine. We report a patient with celiac sprue who initially responded to a gluten-free diet. Eighteen months later, diarrhea, abdominal cramps, and bloating was found to have its origin in partial small bowel obstruction. At laparotomy, two distinct adenocarcinomas of the jejunum were resected. Celiac patients who initially respond to gluten withdrawal and subsequently suffer exacerbation while adhering to strict dietary therapy should be carefully evaluated for evidence of a small bowel malignancy.
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PMID:Adenocarcinoma of the jejunum in association with celiac sprue. 275 19

Sixteen cases of Meckel's diverticulum are reported, 14 of them detected during emergency operative intervention for acute surgical abdomen and 2 during planned operation. The complicated forms of Meckel's diverticulum were 10: acute diverticulitis 4 (25 per cent), intestinal obstruction 4 (25 per cent), neoplastic process 1 (6.25 per cent), intestinal hemorrhage 1 (6.25 per cent). Symptom-free were 43.75 per cent of the diverticuli. The clinical symptoms of acute diverticulitis resembled much those of acute appendicitis. The method of choice for its surgical management is cuneiform resection of the intestinal wall at the site of the diverticulum and transverse reconstruction of the intestinal lumen. Cancer of the diverticulum requires extended intestinal resection.
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PMID:[The pathology of Meckel's diverticulum]. 279 8

Between January 1 1974 and October 31 1987, 98 patients with biopsy proven unresectable adenocarcinoma of the pancreas were treated with I-125 implants during laparotomy. Presenting symptoms were pain (57 patients), jaundice (45 patients), and weight loss (34 patients). All patients underwent laparotomy and surgical staging. Thirty patients had T1NoMo disease, 47 patients had T2-3NoMo disease, and 21 patients had significant regional lymph node involvement (T1-3N1Mo). The surgical procedure performed was biopsy only (16 patients), gastric bypass (36 patients), biliary bypass (49 patients), and partial or total pancreatectomy with incomplete resection (5 patients). The total activity and the number of seeds used were determined from the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram. Stereoshift localization X ray films were taken 3-6 days after operation. The mean activity, minimal peripheral dose (MPD), and volume of the implants were 35 mCi, 13,660 cGy, and 53 cm3, respectively. In addition, 27 patients received postoperative external irradiation and 27 patients received chemotherapy. Postoperative complications were observed in 19 patients. These included post-operative death (1 patient), biliary fistula (4), intraabdominal abscess (4), GI bleeding (3), gastric or small bowel obstruction (6), sepsis (5), and deep vein thrombophlebitis (4). Pain relief was obtained in 37/57 patients (65%) presenting with pain. A multivariate analysis showed that four factors significantly affected survival: T stage, N stage, administration of chemotherapy, and more than 30% reduction in the size of the implant on follow-up films. The median survival for the entire group was 7 months. A subgroup of patients with T1No stage disease who received chemotherapy survived 18.5 months. The indications for I-125 seed implantation in unresectable carcinoma of the pancreas are discussed.
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PMID:Treatment of primary unresectable carcinoma of the pancreas with I-125 implantation. 280 54

Pseudomyxoma peritonei is an unusual malignancy arising from the goblet cells of the large bowel or appendix. Its characteristic clinical features are low histologic grade of malignancy and widespread dissemination throughout the abdominal cavity. In a clinical study of 14 patients, the most common initial symptoms were abdominal distention or right lower quadrant pain suggestive of appendicitis. All patients underwent radical procedures in an attempt to surgically remove all gross disease from the abdomen. Six patients had small-bowel obstruction and five of these had bowel function restored. All of eight patients had relief from bulky intra-abdominal tumors. Six cycles of intraperitoneal 5-FU and three doses of mitomycin C were used following cytoreductive surgery in seven patients. Five of these seven patients are disease free following staging by celiotomy with two- to four-year follow-up. This new treatment strategy, designed to cure some patients with pseudomyxoma peritonei, has given favorable results in a disease that previously had a uniformly lethal outcome.
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PMID:Malignant pseudomyxoma peritonei of colonic origin. Natural history and presentation of a curative approach to treatment. 282 Jun 71

Eighty-five patients aged 40 or less who presented with colorectal carcinoma over a 32-year period were reviewed. The incidence was 2.5 per cent of all patients with large bowel cancer (n = 3426). Predisposing causes included familial polyposis (eight patients), panprotocolitis (ulcerative, one, Crohn's, one) and irradiation (one), four patients were pregnant, one-third of the patients presented as emergencies, and 43 per cent of these had intestinal obstruction. Five-year survival rates were 41 per cent overall and 59 per cent after "curative" resection. Survival was equivalent both for elective and emergency admission and for mucinous carcinomas (n = 16) and those non-mucinous carcinomas of moderate histological differentiation. Five-year survival rates were poorer when the history was less than three months in duration (20 per cent vs 45 per cent: P = 0.02) and for rectal and rectosigmoid tumours than colonic tumours (31 per cent vs 50 per cent: P = 0.05). Radical resection is indicated when feasible: four of five patients with involvement of adjacent viscera and four of six patients with resectable recurrence survived beyond 10 years. The outcome is similar to that at all ages, any unfavourable pathological features being balanced by improved survival following emergency operations.
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PMID:Large bowel cancer in the young. 282 93


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