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)

Tumor staging in patients with a malignant obstruction of the proximal bile duct is focused on selecting patients who could benefit from a resection. Diagnostic laparoscopy, which has proved its value in several gastrointestinal malignancies, has been used routinely at our hospital since 1993 in patients with a malignant obstruction of the proximal bile duct, although data in the literature with regard to its additional value are conflicting. Therefore the diagnostic accuracy of diagnostic laparoscopy in patients with malignant proximal bile duct obstruction was evaluated. From January 1993 to May 2000, diagnostic laparoscopy was performed in 110 patients (61 males and 49 females), with a mean age of 60 years (range 30 to 80 years), who had a suspected malignant proximal bile duct tumor and in whom "potential resectability" was demonstrated by means of conventional radiologic staging methods (i.e., ultrasound combined with Doppler imaging, CT, endoscopic retrograde cholangiopancreatography, and percutaneous transhepatic cholangiography). Laparoscopy revealed histologically proved incurable disease in 44 (41%) of the 110 patients (31 with metastases and 13 with extensive tumor ingrowth). Laparoscopic ultrasound imaging, however, revealed histologically proved incurable disease in one patient (1%), thereby preventing exploratory laparotomy in 46 because these patients had already been treated by palliative endoscopic stent placement. The remaining 65 patients were staged as having a resectable tumor and underwent surgical exploration. Thirty patients had an unresectable tumor (distant metastases in five; tumor ingrowth in surrounding tissues in 24) or benign disease (one patient). Sensitivity and negative predictive value of diagnostic laparoscopy for detecting unresectable disease were 60% and 52%, respectively. Diagnostic laparoscopy avoided unnecessary laparotomy in 41% of patients with a malignant proximal bile duct obstruction considered resectable according to conventional imaging studies. The additional value of laparoscopic ultrasound was limited. Therefore diagnostic laparoscopy should be performed routinely in the workup of patients with a potentially resectable proximal bile duct tumor.
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PMID:Diagnostic laparoscopy and laparoscopic ultrasound for staging of patients with malignant proximal bile duct obstruction. 1202 96

Hepatic and peritoneal metastases are the most frequent metastatic lesions in patients with gastrointestinal stromal tumors (GIST), and may result in intra- or extrahepatic cholestasis and altered drug metabolism. While the tyrosine kinase inhibitor imatinib, which has been recently shown to represent the treatment of choice for GIST, is primarily metabolized by the liver, data on the pharmacokinetics and the tolerability of imatinib in patients with increased cholestasis parameters are not yet available. We here report on two patients who received imatinib in the presence of increased bilirubin and/or cholestasis parameters. With a follow-up duration of 3-4 months, we observed no toxicities outside of well-known side effects including some degree of myelosuppression and fluid retention. This report may aid in the decision of imatinib being given under close surveillance to this kind of patients.
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PMID:Imatinib mesylate therapy in patients with gastrointestinal stromal tumors and impaired liver function. 1239 70

Drug-induced hepatotoxicity accounts for more than a third of the cases of acute liver failure in the United States. In complex medical conditions, the diagnosis of drug-induced liver injury may be confounding and, specifically, the potential hepatotoxicity of chemotherapeutic agents may be easily overlooked. Two fatal cases of cholestatic hepatotoxicity have been previously reported, clearly implicating gemcitabine therapy. We report a third fatal case of cholestatic liver failure that we think is strongly linked to the use of gemcitabine. This chemotherapeutic agent is a fluorine analog with broad-spectrum antitumor activity commonly used in the treatment of breast, lung, prostate, and cervical cancer. The case we report is of a 45-year-old woman with a history of metastatic breast cancer to her spine. The patient was in remission for two years before she presented with a compensated mixed hepatitis of mild to moderate severity. Inpatient work-up found metastases to the right humerus and inferior pubic ramus, but none in the liver. Gemcitabine and carboplatin therapy was initiated for relapse of breast cancer. The patient's liver enzyme elevation diminished, but did not normalize before the start of chemotherapy. She received four courses of gemcitabine/carboplatin and subsequently presented with decompensated, severe cholestatic hepatitis. Transjugular liver biopsy displayed marked cholestasis and hepatocellular injury consistent with drug-induced hepatoxicity. Gemcitabine has been extensively studied in the oncology literature and at this time is thought to be a low-risk hepatotoxin causing hepatic adaptation and transient, reversible liver enzyme elevation, rarely leading to termination of gemcitabine therapy for solid tumors. We believe that gemcitabine therapy, particularly in the setting of preexisting liver injury or metastases to the liver, increases the relative risk of severe and potentially fatal hepatic injury possibly by idiosyncratic and dose-dependent mechanisms. We recommend careful monitoring and dose adjustment of gemcitabine in patients with abnormal liver function tests or evidence of hepatic metastases until further study clarifies this issue.
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PMID:Fatal cholestatic liver failure associated with gemcitabine therapy. 1456 Oct 5

Malignancies may cause cholestatic jaundice through well-recognized mechanisms (e.g., bile duct obstruction or widespread hepatic infiltration). Paraneoplastic syndromes associated with malignancy, particularly with renal cell carcinoma (Stauffer's syndrome) and malignant lymphoproliferative diseases, can induce a reversible form of cholestasis through an unclear pathogenetic mechanism. Prostate cancer presenting initially with cholestatic jaundice without any obvious cause (i.e., obstruction or infiltration) has been reported in 2 cases in the medical literature. We report a patient who presented with pruritus and cholestatic jaundice. During the diagnostic work-up, prostate cancer was diagnosed. Conjugated bilirubin and alkaline phosphatase levels were increased markedly with modest increases of gamma-glutamyltranspeptidase and transaminase levels. The results of appropriate investigations performed during the patient's hospitalizations indicated no evidence of hepatic metastases or extrahepatic biliary obstruction. After treatment with flutamide and leuprolide, the patient's symptoms and the laboratory abnormalities reversed rapidly. We regard the cholestatic jaundice of this patient as part of a paraneoplastic syndrome; the cause of cholestasis remains an enigma. Patients with unexplained cholestasis should be investigated for malignancies, including prostate cancer.
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PMID:Cholestatic jaundice as a paraneoplastic manifestation of prostate adenocarcinoma. 1501 48

Gemcitabine (GEM) is currently considered a standard drug for advanced pancreatic cancer and widely used for patients with this carcinoma. We report on 2 patients with unresectable pancreatic cancer who were able to survive for more than 2 years after GEM treatments. Case 1 was a 82-year-old woman with invasion to celiac artery and who was inoperable. During GEM administration, she had no symptoms and the tumor did not progress. However, because of the toxicities of heart failure, GEM administration was stopped after she took a total of 16,800 mg. After GEM administration was stopped, symptoms appeared and the tumor progressed. Case 2 was a 39-year-old man with obstructive jaundice with liver and lymph node metastases. He was treated with metallic stent in order to reduce cholestasis. During GEM administration, he had no symptoms and the tumor did not progress. As an adverse event, rash occurred after he took a total of 51,800 mg. GEM administration was then stopped. This patient sometimes developed cholestasis due to tumor ingrowths and sludge and was treated successful by endoscopy. GEM has shown to improve survival and show a clinically beneficial response in patients with advanced pancreatic cancer. However, toxic events can be expected to occur with long term GEM administration. We consider that management of complications such as obstructive jaundice is very important in the treatment of pancreatic cancer.
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PMID:[Two cases of advanced pancreatic cancer responding to gemcitabine with long survival of 2 years]. 1522 20

Focal, segmental, and diffuse liver pathologies have been described in the literature. This article describes a pattern in which liver pathology is confined to a lobe. This lobar pattern has not been described previously to our knowledge. Herein, we illustrate computed tomography (CT) and magnetic resonance imaging (MRI) findings of diffuse lobar involvement patterns in various liver conditions. Diffuse lobar involvement can be observed in benign (steatosis, hepatic iron overload, cholestasis, perfusion alterations, infarction, alveolar hydatid cysts, trauma, and hemangiomas) and primary malignant (hepatocellular carcinoma) pathologies. Diffuse lobar involvement in metastatic disease appears to be rare. Due in part to their potentially unusual appearances, the diagnosis of lobar pathologies using imaging can be challenging, and entities with lobar patterns can cause diagnostic confusion. Liver MRI can be used as a problem-solving tool for diffuse lobar pathologies detected on ultrasonography and CT. Inand out-of-phase MRI can help in the assessment of lobar fat accumulation.
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PMID:CT and MRI of diffuse lobar involvement pattern in liver pathology. 2105 76

We report the first case of fatal bile duct necrosis following transcatheter arterial chemoembolization (TACE) in a 58-year-old woman. The patient underwent two TACEs to treat hepatic metastases from an ileal endocrine tumor. Persistent cholestasis occurred after the second procedure, leading to the diagnosis of bile duct necrosis confirmed by liver biopsy. The patient died of liver failure with encephalopathy six months after the second TACE. Even though this complication is very rare, physicians should consider this diagnosis in patients who develop chronic, marked cholestasis following a TACE procedure.
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PMID:Fatal bile duct necrosis: a rare complication of transcatheter arterial chemoembolization in a patient with endocrine hepatic metastasis. 2149 Aug 69

Liver function is a broad term, as the organ participates in a multitude of different physiological and biochemical processes, including metabolic, synthetic, and detoxifying functions. However, it is the function of the hepatocyte that is central to sustaining normal life and dealing with disease states. When the liver begins to fail in severely ill patients, it forecasts a terminal outcome. However, unlike the glomerular filtration rate which clearly quantifies the key renal function, at most practice sites, there is no clinically available quantitative test for liver function. Although it is commonplace to assess indirect evidence of that function (by measuring blood levels of its end products and by-products) and to detect an acute injury (by following rising transaminases), a widely available test that would directly measure hepatocellular function is lacking. This article reviews current knowledge on liver function studies and focuses on those nuclear medicine tests available to study the whole liver and regional liver function. The clinical application driving these tests, prediction of remnant liver function after partial hepatectomy for primary liver malignancy or metastatic disease, is addressed here in detail. The test was recently validated for this specific application and was shown to be better than the current standard of practice (computed tomography volumetry), particularly in patients with hepatic comorbidities like cirrhosis, steatosis, or cholestasis. Furthermore, early assessment of regional liver function increase after preoperative portal vein embolization becomes possible with this technology. The limiting factor to a wider acceptance of this test is based on the lack of clinical software that would allow calculation of liver function parameters. This article provides information that enables a clinical nuclear medicine facility to provide this test using readily available equipment. Furthermore, it addresses emerging clinical applications that are under investigation.
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PMID:Liver function testing with nuclear medicine techniques is coming of age. 2229 67

Metastasis is an infrequent cause of tumor involvement of the major duodenal papilla and of cholestasis. We report a case of obstructive jaundice due to a metastatic breast carcinoma to the major duodenal papilla, and assess curative and palliative treatment that interventional endoscopy can offer.
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PMID:Metastasis of breast cancer to major duodenal papilla. 2502 7

Autoimmune hepatitis is a rarely seen autoimmune paraneoplastic syndrome of thymic carcinoma. Chemotherapy may be an effective choice in the treatment of primary tumor and paraneoplastic disorder. In this case, we report a 32-year-old man presented with increased liver enzymes and cholestasis with a history of thymoma surgically removed four years ago. Liver biopsy showed chronic active autoimmune hepatitis. Computed tomography scan showed pulmonary metastases and pleural mass as a recurrence of thymic carcinoma, proven by biopsy. After four cycles of cisplatin plus adriamycin plus cyclophosphamide plus vincristine and six cycles of paclitaxel plus gemcitabine, maintenance metronomic cyclophosphamide plus etoposide regimen was offered to the patient. Complete biological signs of hepatitis without need for steroids or immune suppressors and complete radiologic response in primary tumor were achieved. Maintenance metronomic chemotherapy regimens may be an alternative to the current treatment options in patients with thymic carcinomas.
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PMID:Metronomic maintenance chemotherapy in patients presenting with paraneoplastic autoimmune hepatitis with recurrent thymic carcinoma. 2523 62


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