Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ninety-nine carcinoid tumors of the duodenum were studied. Seventy-seven patients were followed up for a mean period of 65 months, 20 tumors were autopsy findings, and two patients were unavailable for follow-up. Sixteen tumors (21%) produced metastases, all discovered initially; 3 patients (4%) died from metastatic disease (mean survival, 37 months postoperatively). Features associated with metastatic risk were involvement of muscularis propria, size greater than 2 cm, and the presence of mitotic figures. For 51 tumors, there was no correlation between immunohistochemical somatostatin and history of diarrhea, cholelithiasis, or diabetes mellitus (somatostatin syndrome). Five tumors were associated with Zollinger-Ellison syndrome and had immunohistochemical gastrin, but in the others there was no correlation between ulcer disease and gastrin positivity. Duodenal carcinoids are indolent, especially when small and localized to the submucosa. Immunohistochemical identification of somatostatin and gastrin has little clinical relevance.
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PMID:Carcinoid tumors of the duodenum. A clinicopathologic study of 99 cases. 169 55

Gallbladder cancer afflicts predominantly women, the elderly, and persons with gallstones. Despite its producing symptoms of abdominal pain, nausea and vomiting, weight loss, jaundice, and anorexia, this disease remains difficult to detect. Even with contemporary imaging techniques, most gallbladder cancers escape diagnosis until the time of laparotomy. The aggressive character of this malignancy permits an overall 5-year survival rate of 3-5%. Although cures occur, the majority of operations performed for gallbladder cancer are for palliation. The objects of palliation include relief of pain, relief of jaundice, relief of intestinal obstruction, and the restoration of normal food intake. Resection of the tumor should be performed whenever possible; however, extensive operations including large liver resections and pancreaticoduodenectomy should be avoided in the presence of distant metastases. In the presence of large unresectable hilar masses, internal biliary bypass may relieve jaundice. Biliary-enteric anastomosis using the segment III duct exposed via the umbilical fissure may offer satisfactory relief of jaundice in selected cases.
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PMID:Palliative operative procedures for carcinoma of the gallbladder. 137 59

Ultrasonography has now become an integral part of the gastroenterological diagnostic work-up and treatment. In some clinical problems it may be employed as the sole procedure, for example in the diagnostic evaluation of gallstones, for measuring the size of the liver and spleen, or in the detection of free fluid within the peritoneal cavity. Among the diffuse lesions of the liver, macronodular cirrhosis and typical forms of fatty liver can be diagnosed ultrasonographically, while the majority of such diffuse changes are not amendable to ultrasonographic evaluation. Cystic lesions of the liver are often diagnosable with ultrasonography, while many circumscribed solid lesions, such as metastases or focal-nodular hyperplasia, pose a differential diagnostic problem.
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PMID:[Diagnosis of gastroenterologic diseases with sonography. Part 1: Principles--ultrasound diagnosis of diffuse and local liver damage]. 176 Dec 62

A clinicopathologic study of 40 cases of carcinoma of the gallbladder is presented. Twenty-six cases resected were assessed retrospectively with respect to the operative procedures employed and the results based on the pathologic findings from the resected specimens. The relationship between clinical features, macroscopic forms of tumor, histological types, liver invasion, and lymph node metastasis were investigated. Papillary, papillary infiltrative and nodular forms were classified as either papillary adenocarcinoma or well-differentiated tubular adenocarcinoma and invasion of the liver and lymph node metastasis were rare. Frequent lymph node metastasis was encountered in the nodular infiltrative form and invasion of the liver was frequently present in the infiltrative form. Invasion of the liver, lymph node metastasis, and the presence of gallstones were less frequent in papillary adenocarcinoma. In contrast, moderately-differentiated tubular adenocarcinoma frequently had lymph node metastasis. Invasion of the liver and lymph node metastasis were, however, present regardless of the histologic types and were more related to the extent of subserosal involvement present. A female preponderance was noted in poorly-differentiated adenocarcinoma. The main reasons for surgery being limited to exploratory laparotomy only or palliative procedures included carcinoma infiltration into the hepatoduodenal ligament, carcinoma extension to the neighboring structures, multiple liver metastases, peritoneal dissemination, large liver invasion, and multiple metastases to the paraaortic lymph nodes.
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PMID:Pathology of carcinoma of the gallbladder. 185 9

The standard operation for gastric cancer is carried out for advanced gastric cancer with serosal invasion accompanying patent disseminative metastasis to the peritoneum of the omental bursa and lymph node metastases. It consists of subtotal or total gastrectomy, omentobursectomy and extended lymph node dissection. An early stage cancer, which in Japan accounts for almost a half of the resectable cases of gastric cancer, shows no serosal invasion, and lymph node metastases are rare if the cancer remains intramucosal. Such cases represent about a half the cases of the early stage cancer. The diagnosis of the early stage cancer, especially if it remains intramucosal, is made by means of preoperative radiological and endoscopic examinations and intraoperative examination. Since 1977 we have been performing a modified operation as well for cases of the early stage cancer. The surgical procedure is as follows: reduction in the size of gastric resection by 2/3, pylorus-preserving gastrectomy and proximal gastric resection; preservation of the distal portion of the greater omentum and transverse incision of the upper abdomen instead of upper midline incision to prevent ileus due to intestinal adhesion to abdominal wound around umbilicus; sparing bursectomy; narrowing the area of lymph node dissection; sparing thoracotomy for cancer in the esophagogastric junction; sparing splenopancreatectomy; preservation of the hepatic branch of the vagal nerve and postoperative temporary oral administration of cholagogue to prevent postgastrectomy cholelithiasis. In addition, the primary lesion is isolated from the blood circulation by means of ligation of the drainage veins to diminish metastasis through the blood vessels (hepatic metastasis, etc.), which is the main cause recurrence after surgery for the early stage cancer. The results of this new surgery are satisfactory; the five-year postoperative survival rate is 100.0% and it reduced the time needed for surgery, anesthesia and blood transfusion.
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PMID:[Modified operation for an early stage gastric cancer]. 202 97

Thirty duodenal and three upper-jejunal endocrine tumors are reported. Clinical manifestations included: a) the Zollinger-Ellison syndrome (10 cases); b) peptic ulcer disease in which hypergastrinemia was not documented (3 cases); c) cholestasis or cholelithiasis (4 cases); d) abdominal pain (4 cases); e) gastro-intestinal bleeding (1 case); f) celiac sprue (1 case). Ten further tumors were discovered incidentally, at autopsy or in pathological specimens after gastrectomy or duodenopan-createctomy. Histological pattern was trabecular in 19 cases, insular in 2 and mixed in ten cases. Two cases were typical ganglioneuromatous paragangliomas. All tumors were examined immunohistochemically. Twelve tumors contained gastrin, four somatostatin, six both of these peptides, one serotonin, two both gastrin and serotonin, and two tumors contained gastrin, serotonin and somatostatin. Ganglioneuromatous paragangliomas combined somatostatin and/or pancreatic polypeptide containing endocrine cells with protein-S100-positive Schwann cells. In four tumors no peptide or amine was demonstrated. Gastrin cell tumors (63.6% of our cases), both functionally active (gastrinomas) and clinically silent, predominated in the proximal duodenum, while somatostatin cell tumors (15.1%) and paragangliomas were mostly found in the periampullary region. Two tumors were classified as malignant on the basis of lymph node metastases, and both were jejunal gastrinomas associated with Zollinger-Ellison syndrome. Two somatostatin cell tumors had manifestations of von Recklinghausen's disease.
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PMID:Endocrine tumors of the duodenum and upper jejunum. A study of 33 cases with clinico-pathological characteristics and hormone content. 216 Apr 22

In several overseas centres endoscopic biliary drainage is now a standard procedure in the initial or definitive management of biliary tract obstruction. We report the first nine patients in whom this procedure was carried out in our unit. Four patients presented with acute cholangitis due to cholelithiasis. Urgent endoscopic biliary drainage improved the general condition in three patients prior to subsequent elective surgery. In one other patient with huge common bile duct calculi a biliary stent prevented recurrent episodes of cholangitis. Endoscopic endoprostheses were used in three patients with malignant biliary tract obstruction. Two had terminal metastatic disease and endoscopic drainage provided adequate palliation of jaundice and pruritus in one. Endoprosthesis blockage necessitated percutaneous drainage in the other patient. The third patient with carcinoma of the head of the pancreas was improved by endoscopic drainage prior to an open surgical bypass procedure. Another patient with obstructive jaundice due to terminal gall bladder carcinoma experienced relief of jaundice and pruritus following endoscopic insertion of a nasobiliary drain. We anticipate that endoscopic biliary drainage will become increasingly used in Singapore.
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PMID:Experience with endoscopic biliary drainage in Singapore. 239 99

A retrospective study was made of cancer of the gallbladder over a 10-year period, during which 874 operations of the biliary tract were performed, 26 for gallbladder neoplasm (2.97%). Of the 26 patients studied, 22 (84.6%) were women, mean age at appearance of the tumor being 63.9 years. In 77% of the patients the time of evolution of the symptoms was less than a year, a men of 3.6 months. The principal symptom was abdominal pain, encountered in 96% of patients, followed by nausea and vomiting (65.4%). Fifty-eight percent of patients had gallstones and 46% had metastases at the time of operation. In 23% of the patients only laparotomy and biopsy could be performed, 42% underwent cholecystectomy and 34% cholecystectomy and drainage of the biliary tract. Of the 26 patients in our study, 24 (92%) had adenocarcinoma.
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PMID:[Cancer of the gallbladder]. 271 Sep 89

Cholecystosonography in approximately 40,000 patients over five years in two university hospitals revealed 30 (75%) of the 40 macroscopic primary carcinomas. In 3 cases the carcinoma was obscured by gallstones with shadowing, in 3 cases the origin of a tumour mass was misinterpreted, and in 4 cases the neoplastic growth mimicked gallbladder inflammatory changes or sludge. Malignancy was incorrectly diagnosed or suggested in 25 patients. The most frequent cause of a false positive report was acute or chronic inflammation, found at surgery in 16 gallbladders. Four carcinomas of the pancreatic head were believed to be gallbladder tumours. Cirrhosis with marked gallbladder wall thickening, gastric carcinomas with metastases, a common duct carcinoma, and two cases of sludge (with normal control studies) caused a false suggestion of gallbladder carcinoma. The most frequent ultrasonographic finding in gallbladder carcinomas was a mass filling the gallbladder (15 diagnosed cases), followed by wall thickening (9 cases), and polypoid or fungating tumour (6 cases). Real-time ultrasonography is a useful method for the preoperative diagnosis of gallbladder carcinoma, but considerable diagnostic problems in the differentiation from inflammatory diseases may be encountered.
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PMID:Ultrasonography in carcinoma of the gallbladder. 296 4

Somatostatinomas are rare endocrine tumors that were first described in 1977. In addition to the present case report, there have been 31 cases reported in the literature. We have reviewed the literature to integrate the symptoms, physical findings, diagnostic tests, treatment, and length of survival of these patients. Although the symptoms that occurred in the majority of cases were those that are seen in most patients with intra-abdominal neoplasms, symptoms relating to the presence of excess circulating somatostatin--diabetes, maldigestion, and cholelithiasis--were frequently seen. Physical findings and the results of diagnostic tests were usually nonspecific. The majority of the patients underwent radical surgical procedures (Whipple procedure or pancreatic resection). The pancreas was the most frequent site of involvement (21/31 cases), but primaries in the duodenum, ampulla of Vater, cystic duct, and jejunum have been described as well. Metastases were most frequently seen in the liver and lymph nodes. Chemotherapeutic agents were administered to 10 patients, usually as adjuvant therapy, and appear to be useful in treating recurrent and metastatic disease. The one-year survival of these patients is 48%, which is better than that for patients with carcinoma of the pancreas or biliary tree. Therefore, it is important that the diagnosis of somatostinoma be made so that the patient may be treated accordingly and followed by serial somatostatin levels for evidence of metastasis or recurrent disease.
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PMID:Somatostatinoma: a case report and review of the literature. 304 Nov 16


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