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)

Mediastinal exploration by sternotomy was carried out 36 times in 35 patients with evidence of hyperparathyroidism amongst a group of 1,461 operations for hyperparathyroidism between 1962 and 1987. The exploration was indicated 30 times as re-operation for hyperparathyroidism persistent after one or more negative cervicotomy procedures or recurrent, and 6 times from the outset, (5 in a context of acute hypercalcemia). Exploration was positive 20 times (16 adenomas, 2 hyperplasias, 2 metastases of a parathyroid carcinoma), but negative 16 times (3 diagnostic errors, 6 cervical lesions discovered subsequently, 7 explorations totally negative). The site of mediastinal parathyroid lesions is usually intrathymic (13 cases) but may sometimes (3 cases) be in the middle mediastinum. Pre-operative investigation to identify the site of a possible mediastinal lesion, in re-operation surgery, remains unreliable, the best investigation in this series being thoracic CT scan with 63% true positives. Thallium-Technetium subtraction isotope scan, carried out once with a good result, should now have a place amongst investigations. The principal post-operative complication is hypoparathyroidism which can be prevented by cryopreservation of a fragment of the lesion for possible subsequent reimplantation. Mediastinal exploration is rarely indicated in hyperparathyroid surgery and should be undertaken only after meticulous cervical exploration.
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PMID:[Mediastinal exploration by sternotomy in surgery of hyperparathyroidism. 36 cases]. 306 94

Hypercalcemia is associated with a few primary malignant neoplasms and with a variety of tumors that have spread by metastases. Hyperparathyroidism is a diagnosis that is usually not considered in these patients. At our institution, 18 patients with malignant tumors presented over a 6-year period with hypercalcemia caused by hyperparathyroidism. There were five men and 13 women with a mean age of 48 years (range 24-87 years). Primary tumors in these patients included colon carcinoma (four cases), breast carcinoma (four cases), lymphoma (four cases), thyroid carcinoma (four cases), Paget's disease (one case), and lung carcinoma (one case). Metastases of the primary tumor occurred in seven patients, and in 11 patients the tumor was not metastatic or recurrent. Serum levels of calcium, phosphate, and chloride averaged 11.8 mg/dl, and 100 mEq/liter, respectively. C-terminal parathyroid hormone (PTH) levels ranged from 300 to 1,900 pg/ml with an average of 1,150 pg/ml (normal 50-340 pg/ml). At operation, a single parathyroid adenoma was discovered in 15 patients, and four-gland hyperplasia was noted in three patients. In all cases, serum levels of calcium returned to normal after operation. We conclude that patients with malignant tumors and concomitant hypercalcemia should be evaluated for the possibility of hyperparathyroidism. In cases of primary hyperparathyroidism, elevated C-terminal PTH level should be diagnostic. If hyperparathyroidism is determined to be the cause of hypercalcemia, neck exploration and parathyroidectomy are indicated.
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PMID:Malignancy and concomitant primary hyperparathyroidism. 333 14

This study was carried out to evaluate the metabolic consequences of osteosclerotic skeletal metastases of prostatic origin in a homogeneous group of patients. We found significantly increased mean values of serum alkaline phosphatase activity and significantly reduced mean values of serum phosphate, 24-h urinary calcium, fasting calcium excretion and TmP/GFR in cancer patients with respect to age-matched controls. Mean serum immunoreactive parathyroid hormone (iPTH) levels were raised, with two patients showing increased values of the hormone above our normal limits. Our findings indicate that mild secondary hyperparathyroidism is a feature of these patients. However, it cannot be excluded that both the reduced serum phosphate and TmP/GFR values may be related, at least in some cases, to the effects of the tumour itself on tubular reabsorption of phosphate.
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PMID:Biochemical picture accompanying sclerotic bone metastases of prostatic origin. 342 18

Two cases of parathyroid carcinoma with hyperparathyroidism, a relatively rare endocrine tumor are reported. It accounts for approximately 1-4% of all cases of primary hyperparathyroidism. Parathyroid crisis occurred for three times in one case. It is difficult to make an early diagnosis, frequently leading to misdiagnosis and wrong treatment. During operation iatrogenic implant or incomplete resection may occur, resulting in recurrence and repeated operations. It is important to differentiate from hypercalcemia caused by parathyroid adenoma. Neck mass, hypercalcemia usually above 14 mg%, severe decalcification and pathological fractures are characteristic. Fibrosis and inflammatory reaction of the tumor and metastases in the neck lymph nodes are commonly seen at operation. Histologically active tumor cell mitosis, capsular and vascular invasions usually exist. Local recurrences often occur after surgical treatment. If the surgeon can recognized the malignant change and give a curative resection in the initial operation, more gratifying results can be obtained.
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PMID:[Hyperfunctioning parathyroid carcinoma]. 359 30

The causes of complaints in the acromioclavicular joint include arthrosis after dislocation of the joint, metastases, polyarthritis, tuberculosis, or hyperparathyroidism. Some causes have not yet been identified. If conservative therapy is unsuccessful the condition may be treated by resection of the acromial end of the clavicular, as first described by Gurd and Mumford. The present paper reports the results obtained in 22 patients who were followed up. Complete freedom from pain was achieved in 59% of the cases and improvement in 23.7%, while in 13.6% the results had to be classified as unchanged or poor. An analysis of these results admits the conclusion that with restricted indication and in particular in post-traumatic conditions, it is certainly possible to achieve results which make this technically simple procedure the treatment of choice in arthrosis of the acromioclavicular joint; this is borne out by the literature. In much rarer cases, changes in the sternoclavicular joint have to be surgically treated. Here also, the majority of cases are post-traumatic changes, and here again most of them are conditions following anterior luxation. Analogously to resection at the acromial end of the clavicula, a resection at its sternal end may also produce successful results. With reference to three of the authors' own cases, the clinical picture is considered and the results are presented and discussed; however, since the various surgical techniques cannot be compared, a final evaluation is only possible to a limited extent.
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PMID:[Resection of the acromial and sternal end of the clavicle]. 367 90

In an evaluation of 213 patients from 15 kindreds with familial medullary thyroid carcinoma (MTC), we detected 41 subjects from two kindreds (L and O) who had MTC but no extra-thyroidal manifestations (hyperparathyroidism, phaeochromocytomas or mucosal neuromas) of multiple endocrine neoplasia (MEN) type IIa or IIb. In screening 178 members of the L and O kindreds, we found no evidence that any of them had died from MTC. To assess whether the malignancy was relatively indolent in these families, 20 selected subjects from the two kindreds were compared with 33 MEN IIa subjects. Both groups had clinically occult disease which was diagnosed biochemically by documenting elevated plasma calcitonin (CT) levels following stimulation with intravenous calcium and pentagastrin. There were no differences in the peak stimulated plasma CT levels at the time of diagnosis (1055 +/- 236 pg/ml versus 1096 +/- 191 pg/ml) or the incidence of regional lymph node metastases (0/20 versus 1/33) in the two groups. The mean age at diagnosis, however, was significantly higher in patients of the L and O kindreds than in patients with MEN IIa (43.1 +/- 3.4 years versus 21.1 +/- 2.2 years; P less than 0.001) indicating that in the two kindreds the MTC either developed at a later age or grew more slowly. This study demonstrates that MTC may occur in a familial pattern distinct from its presentation as MEN IIa or MEN IIb. In this setting it appears to be the least aggressive form of MTC yet described.
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PMID:Familial medullary thyroid carcinoma without associated endocrinopathies: a distinct clinical entity. 369 57

Eight cases of the Zollinger-Ellison syndrome were diagnosed at St Vincent's Hospital in the period 1966-84. Although a rare tumour, its true incidence is almost certainly greater than the number of cases represented in this series. The Zollinger-Ellison syndrome should be suspected in all cases of recurrent peptic ulceration, in cases of peptic oesophagitis not responding to medical treatment, in some cases of diarrhoea and in those cases of peptic ulceration associated with hypercalcaemia. Rarely the gastrinoma may first present as a mass in the head of the pancreas causing obstructive jaundice. Diagnosis has been made easier by estimation of fasting serum gastrins and the use of the secretin test. Localization is difficult. The treatment of the condition remains contentious. In those cases shown to be harbouring a so-called solitary gastrinoma, laparotomy should be performed with a view to resection. If the gastrinoma cannot be localized then it is reasonable to use H2 blocking agents to control hypersecretion. The presence of hypercalcaemia due to hyperparathyroidism must be controlled by parathyroidectomy. Total gastrectomy is reserved for those few cases who for one reason or another are not controlled by adequate H2 blocking therapy. In the presence of malignant gastrinoma with metastatic disease, hypersecretion is controlled by the use of H2 blocking agents. In this group cytotoxic chemotherapy may be used in an attempt to control the mass effects of the tumour.
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PMID:The Zollinger-Ellison syndrome: a review of the St Vincent's Hospital, Melbourne experience. 386 9

Parathyroid adenomas are subdivided into chief cell and oxyphil cell variants. However, the parathyroid carcinomas described thus far have been only of the chief cell type. Two cases of oxyphil cell carcinoma of the parathyroid gland are reported, with light and electron microscopic study. The patients presented apparent clinical hyperparathyroidism with x-ray finding of generalized fibrous osteitis and palpable parathyroid tumors. Initially, a pathologic diagnosis of parathyroid adenoma was made in both of them. However, in due course, pulmonary metastases developed in one patient and a local recurrence occurred in the other, 5 and 8 years after the primary operation, respectively. Review of the microscopic slides showed that both primary tumors met the criteria of parathyroid carcinoma. A matter of interest in both cases is that the neoplasms were composed principally of oxyphil cells. Electron microscopic study confirmed the existence of typical oxyphil cells packed with numerous mitochondria.
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PMID:Parathyroid carcinoma of the oxyphil cell type. A report of two cases, light and electron microscopic study. 397 40

A 60-year-old woman presented with diffuse bone pain 12 months after simple mastectomy. During investigation for metastatic disease it was realized that her pain had preceded the mastectomy by 2 years and that the biochemical and radiological findings were inconsistent with metastatic disease. The findings of phosphaturia, hypophosphataemia, normocalcaemia and normal renal function without hyperparathyroidism are discussed in the light of the rarity of such findings in a 60-year-old adult and, in particular, in a patient with cancer of the breast.
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PMID:Hypophosphataemic osteomalacia misdiagnosed as metastatic carcinoma. A case report. 400 77

Parathyroid carcinoma, although rare, represents 0.5-4.0 per cent of the cases of hyperparathyroidism. The authors have encountered five cases of parathyroid carcinoma in their experience treating 445 patients with primary hyperparathyroidism (1.1%) since 1965. All five patients were women, ranging in age fro 29 to 60 years, and had marked hypercalcemia at the time of presentation, with values up to 26 mg/dl in one case. All the tumors were locally adherent to surrounding structures at the time of parathyroidectomy. Pathologically they were characteristic with a dense sclerotic reaction and fibrous bands criss-crossing islands of parathyroid cells. Three patients with local as well as distant metastases have died as a result of recurrent parathyroid carcinoma (follow-up: 2, 3, and 6 years). The remaining two patients became normocalcemic following resection, and have been asymptomatic for 1 and 7 years, respectively. The overall survival and clinical course, in our limited experience with five parathyroid carcinoma cases demonstrates that the morbidity and mortality in these patients is mainly due to local recurrence with the resultant metabolic disturbances, as has been previously noted in the literature.
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PMID:Parathyroid carcinoma. A report of five cases. 401 80


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