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)

An analysis of indications, techniques, results of stabilization and decompression of 100 consecutive spinal tumour cases was carried out. Localized metastatic disease is best operated anteriorly. Primary malignancies are best treated with en bloc resection. Pain relief in metastatic disease is achieved by rigid stabilization. The unstable spine secondary to benign or malignant disease often requires stabilization for alleviation of pain; 132 stabilization procedures were performed in 100 patients. There were nine benign and 91 malignant tumors including 71 metastatic. Indications for stabilization were pathological fracture or following decompression. Anterior approaches including implant stabilization were used in those with metastatic disease limited to one to two levels or where significant kyphosis existed. Posterolateral decompression with Luque rod stabilization was indicated where disease was more widespread. In metastatic disease acrylic cement was used both anteriorly and posteriorly together with implant stabilization. Eighty-one percent had good to excellent relief of pain; 68 patients had neurological deficits. Significant neurological return was achieved in 40% of posterior decompressions and 71% of anterior decompressions in metastatic disease. All patients with benign tumors have solid fusions. In malignant disease the use of cement provided stability without loss of fixation in 87 of 91 procedures. Complications were 4% infection and failure of two Harrington rods without wiring, one Luque rod and two anterior constructs. The average longevity of patients treated for metastatic disease was 11.3 months.
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PMID:Spinal stabilization of vertebral column tumors. 245 50

Pain is the earliest and most prominent feature of symptomatic spinal metastases. In some cases, pain may have been present for months and dismissed as arthritis or back strain. Local back or neck pain occurring in a cancer patient is due to spinal metastasis until proved otherwise. Once weakness occurs, the disease progresses to paraplegia unless treatment is undertaken. Pedicle erosion is the most common abnormality on spinal films. Irradiation is often effective, but surgery is indicated for radiation failure, unknown diagnosis, pathologic fracture-dislocation and rapid disease progression.
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PMID:Symptomatic spinal metastases. 252 57

Eleven patients with metastases in the cervical spine had operations for severe pain due to a pathological fracture which, in eight of the cases, was unstable. Conservative treatment had either failed or was unsuitable. In the first five patients internal fixation with tension band wires and bone grafts was supported by a halo-brace. The method has evolved to the use of posterior instrumentation with laminar wires from two levels above the lesion to two levels below. Stability is increased by the use of bone cement with or without bone autografts applied to one side of the spine. This technique enables the patient to get up within a few days of operation--a great advantage when life expectancy is limited. The operations were successful in all except one case.
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PMID:Pathological fractures of the cervical spine. Palliative surgical treatment. 258 72

The search into the way in which skeletal metastases develops has not only shown that there are several mechanisms for the progressive bone destruction and bone formation that occur simultaneously in the majority of skeletal metastases, but also that an understanding of these basic mechanisms has significant therapeutic implications. Our results have shown that there are two main mechanisms for the bone formation: stromal bone formation and reactive bone formation. The former occurs in tumours which tend to be acellular, with a large fibrous stroma, whereas the latter occurs in virtually all metastases. There is no difference in the basic pathological process of sclerotic or lytic metastases, the radiographic appearance purely indicating the net balance between the different types of bone formation and the simultaneous progressive bone destruction. An understanding of the pathophysiological response to skeletal metastases explains why skeletal scintigraphy can be used to diagnose these lesions and the different mechanisms underlying the 'three-phase scintigram'. The first phase indicates the vascularity of the lesion; the second phase or 'blood-pool' image indicates the concentration in the extracellular fluid and the third phase or 'skeletal or delayed image' indicates the uptake in the reactive new bone. The secretion of an osteoblast inhibiting factor by myeloma indicates why there is no reactive bone produced by the majority of lesions in the absence of a fracture, and why scintigraphy is less reliable than plain radiographs for the detection of the lesions. There are two main mechanisms for the bone destruction, the most important being mediated via osteoclasts. An understanding of the humoral mechanisms stimulating the osteoclast proliferation may lead to more effective treatment of malignant hypercalcaemia and lytic metastases. Early results of use of APD are encouraging, and our results also suggest that clinical trials should be established to evaluate the effect of combination therapy with APD or prostaglandin inhibitor combined with the agents normally used in the management of patients with disseminated mammary carcinoma. The development of treatments to inhibit tumour-induced osteolysis will minimise the complications of pathological fracture, spinal instability, etc., and even if these treatments do not affect the primary tumour, its ability to metastasize, or the patient's survival, such treatment will be a major advance in the management of patients with carcinoma, because of the significant morbidity currently associated with the development of skeletal metastases and their complications.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The development of skeletal metastases. 279 40

A total of 595 patients treated over a 20-year period in 16 Austrian hospitals for pathologic fractures, most caused by metastases of malignant disease, were analysed retrospectively. It appeared that women were affected by pathologic fractures 2.5 times as often as men. Most of the fractures had occurred when the patients were between 60 and 80 years of age. It was found that there were three types of carcinoma for which an association with pathologic fracture was particularly frequent (breast, bronchi, kidney). In a high percentage of these cases widespread metastatic disease was already present when the pathologic fracture occurred. Well over 80% of the fractures were surgically treated, and the complication rate associated with surgery was 19.8%. A questionnaire was also prepared, with questions relating to statistical parameters and to different forms of therapy and the results obtained with them.
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PMID:[Treatment and results of pathologic fractures. A collaborative study from 1965 to 1985 of 16 Austrian hospitals]. 281 20

Metastasis of the cervical spine or pathological fracture respectively presents a demanding therapeutical task. Pain and threatening, neurological deficit require an active action, even if curative treatment is unlikely. The remaining survival time after appearance of osseous metastasis is on the average nine to twelve months and justifies an operation, especially in view of psychosocial consequences for the patient. We are describing the unique case of cervical spinal manifestation after liver transplantation because of primary hepatic cancer.
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PMID:[Occipitocervical fusion in metastasis to the dens]. 285 Dec 3

Malignant fibrous histiocytoma is a rare primary bone tumor, and there have been conflicting reports on its grades of malignancy. We are describing the cases of eight patients who were seen between 1977 and 1982. Four had pulmonary metastases and five, involvement of the lymph nodes. Five patients had a high level of serum alkaline phosphatase. None of the patients had a pathological fracture, an associated bone infarct, or Paget's disease. Seven of the eight patients died within one year after diagnosis.
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PMID:Malignant fibrous histiocytoma of bone. 298 79

Sixteen cases of primary leiomyosarcoma of bone are described. The patients, 11 males and 5 females, ranged in age from 9 to 74 years. The annual incidence of this tumor in Sweden was calculated to be 0.09 cases per million. This figure was obtained by reviewing a Swedish series of spindle cell sarcomas of bone of which one quarter (11/44) were diagnosed by us as primary leiomyosarcoma. The diagnosis was based on light- and electron-microscopic examinations using the same criteria as for leiomyosarcoma of soft tissues. Thirteen tumors were located in a long bone of an extremity (nine close to the knee joint) and three in the central skeleton. Radiographically, all the tumors presented as a purely osteolytic lesion, and three patients had sustained a pathologic fracture. In four of six cases angiography suggested malignancy by revealing hypervascularity, irregular tortuous vessels, and diffuse contrast opacification. Contrast-enhanced computed tomography, performed in two cases, showed hypervascular areas within the tumors. Scintigraphy showed a marked increase in radionuclide uptake in all five cases studied. The clinical behavior indicates that primary leiomyosarcoma of bone is highly malignant. Eight patients had died of the tumor and, of the eight patients who were alive at follow-up, two had metastases, and one had been operated on three times for a cutaneous metastasis, which had recurred locally twice. The remaining five patients had been continuously free of disease for 6.5 to 12.3 years.
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PMID:Primary leiomyosarcoma of bone. A clinical, radiographic, pathologic-anatomic, and prognostic study of 16 cases. 330 38

During the 8-year period beginning 1979, 116 cases of musculoskeletal sarcoma were treated by limb salvage operation. Of these, the local recurrence rate was 9% and the postoperative metastatic rate was 28%. The limb salvage rate was about 80%. Limb salvage procedures were generally performed using curative surgical procedures without preoperative adjunctive therapy. However, reduction of the surgical margin to achieve local cure was made possible by combined therapy with preoperative adjunctive chemotherapy or radiotherapy. The wide procedures combined with preoperative adjunctive therapy achieved a local curability rate equal to curative procedures. Marginal procedures following preoperative radiotherapy were also undertaken in those cases in which the tumor was located in an area for which curative or wide procedures were not feasible. Also, similar procedures were performed for patients of advanced age, patients with lung metastasis, patients who refused ablative surgery, and for extirpation of lymph node metastases. Accordingly, we were able to determine which procedures best ensure local curability. Also, the most significant prognostic factor was found to be local recurrence caused by inadequate surgical margin. This was especially true in the treatment of high malignant sarcoma. Moreover, from analysis of recurrent cases, the suggested factors contributing to local recurrence were: the invasive character of the tumor, lymph node metastasis, skip metastasis, tumor dissemination due to pathological fracture, previously performed inadequate surgery, venous invasion, and multicentrical occurrence of certain tumors.
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PMID:[Procedures and results of limb salvage surgery of musculoskeletal sarcoma]. 338 92

In a retrospective study of 172 patients with disseminated carcinoma in the skeleton, 54% were shown by radiography and scintigraphy to have vertebral metastases. Breast carcinoma was the most common primary tumour, occurring in 30% of the patients, followed by lung (17%), prostate (10%) and kidney (9%). The lumbar spine was most often involved and some primary carcinomas showed a predilection for particular spinal segments. Cord compression occurred in 30% of the patients with vertebral spread and was a poor prognostic sign for long-term survival. Hypernephroma was the most common tumour to cause spinal cord involvement. The thoracic segment was the most frequent site of cord compression (43%), and pathological fracture-dislocation was the most common cause (50%).
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PMID:Metastatic carcinoma of the spine. A study of 92 cases. 344 Jun 53


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