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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From 1942 to 1984, 301 operations were performed for hyperparathyroidism; nine patients (3%) had carcinoma. The mean serum calcium level of the patients with carcinoma was 14.0 mg/dl, whereas the mean serum calcium level of patients with benign hyperparathyroidism was 12.0 mg/dl. With follow-up ranging from 2 to 16 years, there has been one death 9 years after the initial operation caused by primary lung cancer. At autopsy the patient also had a recurrence of parathyroid carcinoma in the neck. There were no additional recurrences or deaths. Prognosis was not correlated with any laboratory or pathologic findings. The importance of intraoperative recognition at the time of the initial operation is stressed. En bloc resection is recommended, including ipsilateral thyroid lobectomy and dissection of the tracheoesophageal groove. Radical neck dissection is performed only for extensive cervical node metastases or for reoperations where scarring prevents accurate delineation of the extent of the tumor.
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PMID:Parathyroid carcinoma: the Lahey Clinic experience. 407 85

The relative importance of different causes of hypercalcaemia was studied, and diagnostic tests were evaluated as predictors of the cause of hypercalcaemia. In one year, hypercalcaemia was identified in 166 hospital inpatients. Serum-calcium was below 3.00 mmol/l in 63%. Among 153 patients investigated the commonest cause of hypercalcaemia was malignancy (89 cases), especially breast and bronchial tumours. 75% of the 89 patients had obvious metastases at presentation. 51 patients had primary hyperparathyroidism: their symptoms were non-specific and only 20% had renal stones. Other causes of hypercalcaemia were rare (9% of patients seen). Of patients with no diagnosis initially, 64% had hyperparathyroidism and 32% malignancy, but this was demonstrated early in the illness. Serum phosphate and chloride and acid/base status were unsatisfactory as diagnostic tests; multivariate analysis was more discriminating overall, but incorrect classification was still a significant problem.
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PMID:Hypercalcaemia in hospital patients. Clinical and diagnostic aspects. 610 66

Hypercalcemia secondary to malignancies can be divided into two groups according to their calcium elevating mechanism: solid tumors with bony metastases, most frequently originating from the breast or the bronchi, and solid tumors without bony metastases, associated with secretion by the tumor of a substance which increases the calcium level. This substance resembles parathormone in pseudo-hyperparathyroidism, prostaglandins, or other substances not yet identified. The most common tumors involved are bronchial or renal cancers. Diagnostic problems vary depending on whether the cancer has been identified or not, and if bony metastases have or have not been discovered. Primary hyperparathyroidism must also be considered since it is frequently associated with cancer. Hypercalcemia from blood dyscrasias (myeloma and lymphoma) originates from the same mechanisms. It may or may not be associated with bony lesions. The hypercalcemia could be due to a "parathormone like" substance, to prostaglandins, to a substance that stimulates osteoclasts (OAF), or to calcitriol (1,25-dihydroxycholecalciferol). The treatment of hypercalcemia due to malignancies is primarily through the use of antiosteoclastic agents: calcitonin, mithramycin, and more recently diphosphonates. Corticosteroids and the prostaglandin inhibitors can have an additional calcium lowering effect.
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PMID:[Hypercalcemia of cancer and myeloma]. 639 3

The natural history and prognostic factors of medullary carcinoma of the thyroid (MCT) were studied in 161 patients seen at the University of Texas M. D. Anderson Hospital and Tumor Institute at Houston between 1944 and 1983. One hundred twenty-five patients (77.6%) had the sporadic variety of MCT, 31 patients (19.3%) had multiple endocrine neoplasm (MEN) type IIa and 5 patients (3.1%) had MEN-IIb. The disease occurred equally in both sexes (M:F ratio 1:1.05). Thyroid nodules were the most common presenting feature especially in patients with the sporadic disease and MEN-IIb. Fifteen patients with MEN-IIa had occult MCT; the diagnosis was made through screening of family members with calcitonin measurement before and after stimulation with calcium or pentagastrin. Sixteen patients with MEN-II had pheochromocytoma and 7 had hyperparathyroidism. Total thyroidectomy was the most commonly performed operation. The lowest incidence of recurrence occurred in patients who underwent total thyroidectomy and modified neck dissection. Radioactive 131I was used as adjunct to surgery in 19 patients but it did not improve the survival or lower the incidence of recurrence. Patients who received postoperative radiotherapy had significantly lower adjusted survival rates than those treated by surgery alone, but we tended to irradiate patients with more advanced disease. Chemotherapy was administered to 11 patients with disseminated metastases but the response was poor. The 5- and 10-year adjusted survival rates of all the patients with MCT were 78.2% and 61.4%, respectively. Patients with MEN-IIa had much better rates than patients with sporadic disease (p = 0.0005), who were 7.74 times more likely to die of MCT. The stage of the disease at presentation was a major prognostic factor. Patients with stages III or IV disease were 7.31 times more likely to die of MCT than those with stages I or II. There was no significant difference in survival between patients with stages I and II or III and IV. The presence of cervical lymph node metastases did not affect the survival adversely. Direct extension with involvement of tissue was a bad prognostic sign. Patients younger than 40 years old at the time of diagnosis of MCT had a significantly better adjusted survival rate than those who were older. Women had a better prognosis than men, who were 1.89 times more likely to die of MCT. Diarrhea was a bad prognostic sign. However, it occurred more frequently in patients with advanced stages of the disease and larger tumor mass.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients. 650 83

Bone was collected for trabecular bone morphometry from 6 dogs with hypercalcemia of malignancy. Five of the dogs had lymphosarcoma and 1 had an anal sac apocrine gland carcinoma with vertebral metastases. Parathyroid gland weights varied around normal, with those for 1 dog being slightly low and those for another dog being moderately increased. As a group, the dogs had decreased bone volume, with increased resorption surfaces and increased numbers of osteoclasts. In 4 dogs, osteoid seams and osteoblasts were limited in extent and this distinguished them from dogs with hyperparathyroidism. Although most dogs had received corticosteroids, chemotherapy, or radiation treatment, the bone changes in these dogs were similar to 1 dog that had not received treatment. Also, the changes could not be related to uremia or renal mineralization that had developed in 2 of the dogs. Two of the dogs had somewhat greater amounts of osteoid-covered surface and slightly widened osteoid seams, ie, findings more like those of hyperparathyroidism. One of these dogs had anal sac apocrine gland carcinoma and the other had lymphosarcoma in which there was invasion of the bone cortex at the sampling site. It was concluded that bone remodeling changes do occur in hypercalcemia of malignancy and that these changes are varied and often are not those of hyperparathyroidism.
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PMID:Bone changes in hypercalcemia of malignancy in dogs. 668 16

Arthroses of the acromioclavicular joint mainly occur after trauma and may be the cause of pain in the shoulder region which is difficult to treat. Other possible causes are metastases, hyperparathyroidism, tuberculosis and osteolysis whose pathogenetic mechanism is still unknown. If all conservative treatment methods have been tried without success, lateral resection of the clavicula, first described in 1941 by Gurd and Mumford, is the method of choice. Some of the results obtained by the present authors with 15 patients (of whom 11 were followed up) are presented and compared with those obtained by other authors. Since the results are altogether very good, this operation, which is technically simple to perform, is recommended for arthroses of the acromioclavicular joint of any etiology. In cases with Tossy III ruptures of the joint the procedure described by Weaver and Dunn can be performed in addition.
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PMID:[Resection of the acromial end of clavicula in acromioclavicular joint arthrosis]. 672 46

The appearance of hypercalcemic syndrome during the course of lymphoma is not only an unusual event, but it puts a very difficult diagnostic and therapeutic question too. There are three aetiologic moments: the diffuse osseus metastases, the paraneoplastic syndrome and concomitant primitive hyperparathyroidism. The pathogenesis of these questions has lately stimulated a new kind of research, even if there are still a lot of unknown points. The Authors suggest, as their own contribution, the revision of the literature on this subject and they also suggest an acute hypercalcemic syndrome case brought about a primitive hyperparathyroidism in a patient suffering from Hodgkin's lymphoma.
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PMID:[Hypercalcemic syndrome in malignant lymphomas. Review of the literature and clinical contribution]. 683 83

Serum sialyl tranferase activity (STA) and protein bound carbohydrate were measured in hypercalcemic patients with surgically documented hyperparathyroidism (n = 15) or with cancer without skeletal metastases (n = 10). Precipitable protein-bound sialic acid and hexosamine, but not neutral hexoses or fucose were significantly (P less than 0.025) increased 40% and 21% respectively, in the perchlorate treated sera of cancer patients. Measurements of some specific serum glycoproteins by radial immunodiffusion assay were also different (P less than 0.05). Mean seromucoid protein was almost twice as great in the group with cancer (P less than 0.005), but four of these values overlapped those from the patients with hyperparathyroidism. The mean STA was 21.1 (range, 9.0-46.8) activity units in the patients with the cancer and 9.2 (range 1.0-17.8) in the patients with hyperparathyroidism (P less than 0.005). Six of the patients with cancer had values above the upper limit of the group with hyperparathyroidism. A discriminant function generated from these data correctly classified all the patients with hyperparathyroidism and 70% of those with cancer. Measurements of seromucoid and STA deserve further consideration as a way to discriminate some cases of hypercalcemia.
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PMID:Measurement of sialyl transferase activity and serum glycoproteins in malignant and beningn (hyperparathyroid) hypercalcemia. 712 53

A 68 year old man with prostatic carcinoma and extensive painful osteoblastic metastases was discovered to have hypocalcemia (serum calcium 7.1 mg/dl) without evidence of hypoalbuminemia, renal failure or malabsorption. Baseline studies revealed hypocalciuria (24 hour urine calcium less than 5 mg/day), normal serum phosphate (3.4 mg/dl), low tubular reabsorption of phosphate (68 percent), undetectable serum calcitonin, normal serum 25-hydroxyvitamin D, slightly elevated serum parathyroid hormone level and increased urinary cyclic AMP (8.87 mumol/g creatinine). These studies were compatible with secondary hyperparathyroidism. The intravenous administration of parathyroid extract produced no further change in urinary phosphate but a 25-fold increase in nephrogenous cyclic AMP. Three days administration of intramuscular parathyroid extract slowly and temporarily restored serum calcium to normal levels while increasing urinary cyclic AMP and phosphate. Chemotherapy with cyclophosphamide and 5-fluorouracil rendered the patient free of pain while reducing serum acid and alkaline phosphatase levels and restoring serum total and ionized calcium and urinary cyclic AMP excretion to normal.
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PMID:Hypocalcemia with osteoblastic metastases in patient with prostate carcinoma. A cause of secondary hyperparathyroidism. 724 80

A patient with hyperparathyroidism due to a functioning parathyroid carcinoma presented with distinctive clinical and laboratory features, including high serum calcium levels, roentgenographic signs of severe bone disease, a markedly elevated alkaline phosphatase level, a palpable cervical mass, and a high parathyroid hormone level. Treatment of parathyroid carcinoma requires en bloc resection of the ipsilateral thyroid lobe and isthmus for the primary tumor and ispilateral neck dissection for metastatic disease. Because the tumor grows slowly, recurrences should be resected to provide relief of hypercalcemia, the usual cause of death.
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PMID:Hyperparathyroidism and parathyroid carcinoma. 739 22


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