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)

Forty-two mobile tumours on digital rectal examination were excised by posterior rectotomy: via a transsphincteric approach in 16 cases and via a pararectal suprasphincteric approach in 26 cases; 3 primary protective colostomies were performed. Nineteen tubulovillous adenomas and 23 carcinomas were excised. The excision included the entire thickness of the rectal wall in the form of resection-anastomosis (n = 10) or a disk resection (n = 32). This series consisted of 27 males and 15 females between the ages of 42 and 92 years (mean = 70 years). The definitive histology revealed 12 T1 tumours, 7 T2 tumours and 3 T3 tumours. There were two postoperative deaths. The remaining patients have a mean postoperative follow-up of 45 months. 2/16 (12.5%) local recurrences occurred in the group of tubulovillous adenomas and 2 local recurrences with distant metastases were observed in the carcinoma group, while 3 patients only developed distant metastases. The cancer-related mortality was 5/21 (23.89%). Disturbances of continence persisted in 6/29 surviving patients, 4 patients complained of urgent defecation, 1 of uncontrolled passage of gas and a single patient had persistent incontinence of liquid stools. Posterior rectotomy allows excision of extensive tubulovillous adenomas and local recurrences are less frequent than after transanal excision and are similar to the results obtained with transabdominal rectal resections. The operative mortality was lower than that of laparotomy. Posterior rectotomy allows adequate resection of localised carcinomas (T1) with no lymph node involvement. The statistical frequency of lymph node metastases in stage T2 and T3 tumours only justifies the use of this technique when the patient refuse colostomy, has an excessively high risk to undergo laparotomy or when the operation is purely designed to be palliative. The disturbances of continence observed were minor and only slightly disabling.
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PMID:[Limited indications for posterior rectotomy. Results of a series of 42 cases]. 161 87

A female patient with the IV grade cervical carcinoma without distant metastases is presented. The patient underwent a radical surgical intervention. An anterior pelvic exenteration with ileocystoplasties was successfully performed. The patient is alive 14 months after the initial treatment. No greater complications were observed during the operation and after it, but in spite of a satisfactory general status, the patient has had nocturnal incontinence all the time. It is believed that this complication is the sequel of the newly formed urinary bladder, as the convolution of the ileum is only 30 cm long which has proved insufficient.
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PMID:[Anterior pelvic exenteration with ileocystoplasty in advanced cancer of the uterine cervix]. 174 85

From 1973 to 1986, 160 patients with adenocarcinoma localized to the prostate were treated with radical prostatectomy and pelvic lymphadenectomy. In 78 (49%) patients more advanced stage of disease was found at surgery and they received local pelvic irradiation (RT). This consisted of 45 Gy for microscopic and 55 Gy for macroscopic residual disease. RT was given at 1.8 Gy a day, using the four-field "box" technique with the 23 MV X ray beam. Pelvic lymph node metastases were found in 28 (36%) patients who, in addition to RT, received systemic therapy: 20 with cyclophosphamide alone, 4 combined with 5-Fluorouracil, and 4 patients received DES. The 5- and 10-year overall actuarial survival was 95 and 77%, respectively, and the 5- and 10-year disease-free survival was 58 and 43%, respectively. Recurrent tumor was found in 34 (44%) patients. Of these 34 patients, 32 (94%) had distant metastatic tumor and 2 (6%) had local recurrence in the pelvis. The presence of metastatic disease in pelvic lymph nodes had clinical significance since it influenced disease-free survival and the incidence of tumor recurrence. The 10-year disease-free survival for the 50 patients with no lymph node metastases was 51%, as compared to 28% for the 28 patients with such metastases, p = 0.001. Similarly, recurrent tumor was found in 28% of the former and 68% of the latter patients, p = 0.002. Other important parameters predicting recurrence were: clinical stage, p = 0.018, histological grade, p = 0.013, and Gleason's grade, p = 0.002. This treatment program was very well tolerated and of low toxicity. There was no surgical mortality. Surgical complications were seen in 10 (13%) patients including: minor in 5 and major in 5. At 1 year, 77% of the patients remained continent, while 10% had mild stress incontinence. Of the remaining 13% only 3 (4%) patients had severe incontinence (greater than 5 pads daily). RT toxicity was mild with 38% experiencing diarrhea. Severe toxicity was seen in 2 (3%) patients who, early in the study, developed scrotal and lower extremity edema. Severe chemotherapy complications were seen in 1 (4%) patient who had severe neutropenic sepsis. Postoperative radiotherapy is a well tolerated, safe and effective treatment in patients who have microscopic or macroscopic residual tumor following radical prostatectomy.
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PMID:Radiotherapy following radical prostatectomy in patients with adenocarcinoma of the prostate. 191 24

The authors studied postoperatively fourteen men who underwent urinary diversion with a Camey ileal bladder for bladder cancer in association with radical cystoprostatectomy, from March 1986 to June 1988. Mean follow-up was 19.5 +/- 9 months. Three patients died (21.4%), two other patients are alive with metastases. Ureteral reflux and upper tract dilatation occurred in 14.3 and 28.6% of the renal units, respectively. Daytime continence was achieved in 92.9% of the patients (13 patients), frequently 6 months after the operation. Nocturnal incontinence was almost universal (1 patient circumvented this problem by getting up to void every three hours during the night). Thirteen patients had urodynamic testing after the operation. Mean capacity of the ileal bladder was 344 ml with mean intraluminal pressure of 24 cm water. Mean urethral closing pressure was 49 cm water. Voiding was accomplished by abdominal straining concomitant with external sphincter relaxation. Post-void residual was less than 50 ml, except in one patient. The authors discuss these results and compare them to those of other studies.
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PMID:[Functional outcome of a U-shaped ileocystoplasty (the Camey I procedure) in cancer of the bladder. Apropos of 14 cases]. 202 Dec 71

Since 1981 a curative radiation treatment was performed in 84 patients with prostatic carcinoma. Previously, in 37 cases a transurethral resection of bladder outlet obstruction was done and in 18 patients a pelvic lymph node dissection was performed, whereas 29 patients were without operative therapy. Mild side effects of radiation could observed in all 3 groups in nearly the same portion (59/56/65%). However, in the group with transurethral resection after follow-up of 4,4 years severe late complications were found (cystitis, incontinence, urethral fistula). Therefore, radiation treatment of prostatic carcinoma after transurethral resection was abandoned. The cumulative 5-year-survival rate was 63% and in the TUR group only 41%. 9 out of 10 patients with histological verified lymph node metastases and radiation treatment are alive after mean follow-up time of 3.1 years without evidence of recurrent disease.
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PMID:[Experiences with intensive radiotherapy of prostatic cancer in conjunction with surgery (transurethral resection, pelvic lymph node excision)]. 262 19

After cystoprostatectomy for cancer of the bladder 43 men were provided with a detubularized, low pressure ileal reservoir (Kock pouch) connected to the urethra. Reflux was prevented by an intussusception valve. There was no operative mortality and few early complications. At followup the mean postoperative observation time was 13 months, with a range of 5 to 20 months. Late complications included manifestations of local tumor recurrence or distant metastases in 9 patients within 6 months postoperatively, which made adequate functional evaluation impossible. In 18 patients reflux to the upper urinary tract due to eversion or sliding of the antireflux valve occurred at various postoperative intervals. In 16 of these patients incontinence developed as a consequence of the reflux. Surgical correction of the failing antireflux valve restored reflux prevention and continence. Within 3 to 6 months the capacity of the reservoirs had reached an ultimate volume of approximately 600 ml. Pressure waves exceeding 40 cm. water seldom occurred in the mature reservoirs and then only at high filling volumes. The mean urethral resting resistance to flow was 64 cm. water. The configuration and function of the upper urinary tract improved or stabilized postoperatively. Of 34 evaluable patients 30 were continent during the day with a voiding frequency of 3 to 5 times and dry at night with a frequency of 0 to 2.
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PMID:Replacement of the bladder by the urethral Kock pouch: functional results, urodynamics and radiological features. 270 96

Between April 1986 and April 1989, each of 108 patients received an ileum neobladder, 94 patients for total bladder substitution after radical cysto-prostatectomy and 14 for augmentation of a fibrotic and contracted bladder following tuberculosis, interstitial cystitis or radiotherapy of the pelvis. The operative technique is standardized, relatively simple and safe, and it prevents upper urinary tract deterioration and reflux. Continence is preserved in more than 80% of all patients by the function of the external urethral sphincter and by the high capacity and the low internal pressure of the intestinal reservoir. Follow-up of more than 3 months postoperatively was possible in 96 patients, the evaluation including micturition behavior at home and a urodynamic investigation. Stress incontinence requiring correction by an artificial sphincter was found in 3 and nocturnal incontinence necessitating some external device in 6 patients. There was no perioperative mortality. Local tumor recurrence and/or metastases occurred in 14 patients; 7 patients died postoperatively, 5 owing to tumor progression, 1 of pneumonia and serve metabolic acidosis, and 1 owing to septicemia of unknown cause. Re-operation was necessary in 13 patients, in 6 because of mechanical ileus or intra-abdominal abscess, in 3 because of stenosis of the uretero-ileal anastomosis, in 1 because of tumor progression, in 1 because of vesico-vaginal fistula, in 1 patient because of incisional hernia, and in 1 because of wound dehiscence. Urethrotomy or dilatation of urethral strictures was necessary in 8 patients. All other early and late complications were rare and could be managed by conservative means.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[3 years' experience with the ileum neobladder--the first 108 patients]. 276 96

A series of 32 patients operated on for rectal carcinoma is reported. A new technique by using the gracilis muscles to reconstruct a functional anal sphincter after abdominoperineal resection was performed. No operative mortality was recorded. Functionality of the new sphincter was guaranteed by electromyostimulation. Electrostimulation has been useful in both increasing the muscular trophic level and in improving the postoperative bio-feedback. Perineal infection was recorded in 9 patients being the most common complication although it did not compromise the functionality of the new sphincter. In one case acute colonic ischaemia was treated by resection and definitive left colostomy. 17 out of the 27 patients in which a functional follow-up was obtained, scored a "very good" continence to stool and flatus while in 6 patients occasional episodes of incontinence to liquid stool are referred. Local or distant metastases presented in 6 patients. The obtained results encourage in continuing the research with this technique in the attempt to reduce the number of patients that must pay the high price of a definitive abdominal colostomy for cure.
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PMID:Construction of a continent perineal colostomy by using electrostimulated gracilis muscles after abdominoperineal resection: personal technique and experience with 32 cases. 344 42

Optimal management of men with diffuse incidental prostatic cancer (Stage A2) is an unresolved issue. Current forms of therapy include radical prostatectomy, external beam radiation therapy, and no treatment. Long-term results with curative therapy have been unreported because of the relatively recent substaging of Stage A into incidental and diffuse disease. The results of radical prostatectomy in 25 patients with Stage A2 prostatic cancer were reviewed. Incontinence was the most serious complication and occurred in four patients (16%). Pathologically, 24 patients (96%) had residual carcinoma present in the radical prostatectomy specimen. In 22 men (88%) the tumor was entirely confined to the prostate. Two patients (8%) demonstrated seminal vesicle invasion, and one (4%) had capsular penetration. In follow-up metastatic disease has developed in one patient, and another died without evidence of cancer. The remaining patients are alive without evidence of disease. Since 88% of men with Stage A2 disease have their tumor entirely confined to the prostate, radical prostatectomy offers an excellent chance of long-term cure, as in Stage B prostatic cancer.
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PMID:Efficacy of radical prostatectomy for stage A2 carcinoma of the prostate. 405 63

Twenty-eight patients received postoperative radiotherapy with curative intent following either radical prostatectomy (18 patients) or enucleative prostatectomy (10 patients). In patients undergoing radical prostatectomy, the indications for postoperative radiotherapy included positive margins in 13, "close" margins in 2, and seminal vesicle involvement in 3 patients. The majority of patients (82%) received total dose to the prostatic bed in excess of 6500 rad. In over 80% of the patients, the pelvic lymphatics are also treated (to a total dose of 4000-5000 rad). Minimum follow-up is one year, maximum is 10 years, average 54 months, median 41 months. Local recurrence was observed in only 1 patient, who was treated post-enucleation. All of the patients irradiated after radical prostatectomy clinically remained disease-free locally. Approximately one-half of the patients in both the enucleation and radial prostatectomy groups developed evidence of distant metastases. The complications of treatment have been comparable to those in patients treated with radiotherapy only. The continence status has not been affected significantly. All patients (5 in the radical prostatectomy group and 2 in the enucleation group) with incontinence following completion of radiotherapy had documented impairment of continence prior to radiotherapy. Postoperative radiotherapy administered following either radical or enucleative prostatectomy was tolerated well and resulted in excellent local control.
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PMID:Postoperative irradiation in carcinoma of the prostate. 643 99


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