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)

Transcatheter intra-arterial therapy for the cancer patient encompasses infusion of chemotherapy and embolization. Intra-arterial infusion of chemotherapeutic agents has been resurrected because of the availability of new drugs, combinations of drugs, and the capability of percutaneous selective catheter placement. Intra-arterial infusion has been effective in patients with carcinomas of the liver, bladder, prostate, uterus, ovary, and lung and in bone and soft tissue sarcomas, melanomas, and tumors of the brain. Embolization of the arterial supply, creating ischemia of the neoplasm, has been employed in the therapeutic management of patients with primary and secondary neoplasms of the liver, kidney, and bone. The median survival of 100 patients with neoplasms of the liver from the time of hepatic artery embolization was 11.5 months. In 100 patients with pulmonary metastases from carcinoma of the kidney, 28 experienced a response to renal artery embolization, a therapeutic delay of 4 to 7 days, nephrectomy, and Depo-Provera (medroxyprogesterone). Seven of 12 patients with giant cell tumor of the pelvis and lumbar spine responded to arterial embolization after all other therapy failed. Chemoembolization, the combination of arterial infusion of chemotherapy and embolization, can be accomplished by the use of microencapsulated agents, liposomes, and particulate emboli with drugs. This approach integrates the advantages of infusion and occlusion, and has considerable potential. Intra-arterial immunotherapy has been initiated with bacillus Calmette-Guerin (BCG) administration into renal neoplasms in patients with metastatic disease.
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PMID:Infusion-embolization. 609 84

Fourteen patients with diffuse tumors of the liver were treated with temporary occlusion of the hepatic artery (HA) by an external tourniquet followed by infusion and systemic chemotherapy. Three patients had primary neoplasms (one hepatocarcinoma and two cholangiocarcinomas) and eleven had metastatic disease (nine from carcinoma of the colon and rectum, one from retroperitoneal liposarcoma, and one from pulmonary small cell cancer). Infusion chemotherapy in all patients was based on 5-FU, Mitomycin and Vincristine. Systemic chemotherapy was FIVB in metastatic carcinoma and Adriamycin in primary liver tumors. All patients showed improvement of the performance status according to the Karnofsky Index. Objective response (OR) was present in 54% of cases. At present, median survival time in 12.5 months. Aggressive treatment combining hepatic ischemia with infusion and systemic polychemotherapy seems to provide an effective method of palliation in diffuse tumors of the liver. Delayed occlusion by an external tourniquet appears safer than intraoperative ligation of the HA.
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PMID:Temporary occlusion of the hepatic artery plus infusion and systemic chemotherapy for inoperable cancer of the liver. 616 63

Peptic ulceration is a known complication of hepatic arterial chemotherapy for metastatic disease. We report a case of peptic ulceration associated with marked epithelial atypia initially interpreted as carcinoma, probably metastatic in nature. Subsequent partial gastric resection proved the lesion benign. Examination of other gastric biopsies from ulcerated and nonulcerated mucosa from similarly treated patients has revealed similar marked atypical changes. The etiology of the epithelial atypia and ulceration remains unanswered, but is probably related to locally enhanced chemotherapeutic cytotoxicity or ischemia. Care should be taken not to interpret the marked epithelial atypia as carcinoma in this clinical setting.
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PMID:Peptic ulceration with marked epithelial atypia following hepatic arterial infusion chemotherapy. A lesion initially misinterpreted as carcinoma. 622 Jun 16

52 patients with hepatic resection due to liver tumor, metastases, Echinococcus or liver trauma are reported. Hepatic resection represents a relatively harmless procedure in case of benign liver tumor; however, in case of a malignant disease, the prognosis after hepatic resection is impaired by the difficulty to predict the regeneration capability of the liver. The indication for the different operative procedures is being discussed. It is suggested to perform hepatic resection in the border lines of the liver lobes without extensive preparation of the liver hilus and to clamp the liver hilus during resection. If the liver hilus was occluded after steroid pretreatment, 40 min of hepatic ischemia were well tolerated without any consequences and intraoperative bloodloss could be reduced significantly.
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PMID:[Hepatic resection for tumors, trauma and Echinococcus]. 687 97

Although blood spread of pulmonary malignancy presumably occurs through microembolization, frank embolization of tumor fragments is uncommon. The first reported case of bronchogenic carcinoma appearing as a peripheral arterial embolus is described. The patient, a 64-year-old female, had acute ischemia of the left leg secondary to tumor embolism to the left profunda femoris and popliteal arteries. Shortly after embolectomy, she suffered atelectasis of the whole left lung from an epitheloid carcinoma in the left main bronchus. Twenty-eight cases of frank tumor embolism to the arterial tree occurring during the course of a noncardiac malignancy have been reported. None, however, occurred as an initial event. Pulmonary metastasis in patients with advanced malignancy was the source of the arterial emboli in 45% (13/29) of reported cases, but bronchogenic carcinoma was the original cell type in 38% (11/29) of cases. In general, arterial tumor embolism is a complication of advanced malignancy usually originating from one of multiple pulmonary metastases. This first case report of tumor embolism to a lower extremity occurring as the initial event in the clinical course of a bronchogenic carcinoma serves to emphasize the protein manifestations of malignant disease.
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PMID:Unusual presentation of bronchogenic carcinoma: case report and review of the literature. 700 96

Local destruction of malignant growths was achieved rapidly by creating around their cells a strongly hypertonic environment. Various hexoses, injected in and around tumors at 37 degrees, were utilized to produce the osmotic disturbance. Homeostatic correction of the osmotic disturbance was prevented by local ischemia, induced by vasoconstriction, and maintained soon afterwards by thrombosis. Of the few vasoactive agents tested for this purpose, serotonin was the safest and most effective. It worked better when mixed with the hexose than when injected separately s.c. at a distance. The best response to treatment was obtained from tumors which were unattached to deep structures, poorly vascularized, and resistant to an increase of internal pressure, whereas special precautions had to be taken with friable neoplasms to avoid dissemination of metastases. Under certain conditions, by causing acute tumor necrosis, a single treatment achieved a high ratio of cure; in which a favorable immune response to dramatic reduction of tumor burden and to resorbed lysed material perhaps played a part.
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PMID:Influence of various hexoses and vasoactive agents on osmotically induced oncolysis. 730 7

Fatty change of the liver is a well-recognized entity associated with many clinical situations. It is a diffuse lesion although it may show centrolobular or periportal accentuation. Focal fatty change, on the other hand, is a rarely recognized and poorly characterized entity. We are presenting 10 cases of this condition. The lesions were discovered incidentally at post mortem examination in patients ranging in ages from 26 mo to 79 yr. The nodules measured up to 4.0 cm in diameter, were predominantly subcapsular in location, and the majority occurred in livers with minimal diffuse steatosis. At autopsy some had been confused with abscesses and metastases. The underlying disease processes and therapy were examined to determine etiology. Focal ischemia superimposed upon conditions producing fatty change is postulated as a pathogenic mechanism for this entity. Focal fatty change may have importance in the differential diagnosis of space-occupying lesions of the liver.
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PMID:Focal fatty change of the liver, a hitherto poorly recognized entity. 735 47

Dearterialization of the liver causes necrosis of primary liver tumors or metastases, because their blood supply is largely arterial. The normal liver tissue remains vital after a period of ischemia if the portal vein is intact. A patient with a carcinoid syndrome due to liver metastases is described. It was found that it is difficult to achieve complete dearterialization of the liver. Rather, preoperative and particularly peroperative angiograms are required to ensure the best possible degree of dearterialization.
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PMID:Improvement of hepatic dearterialization: a case report. 737 54

Surgery is the only potentially curative treatment for patients with carcinoid tumors. Patients with localized disease even with lymph node metastases can be resected for potential cure. Patients with distant metastatic disease have been reported to be cured by resection of all tumor. However, long-term follow-up of these individuals suggests that these patients probably will recur. Debulking surgery, that is removal of part but not all disease, has been advocated by some to decrease symptoms secondary to hormone secretion, relieve intestinal obstruction and ischemia, and prolong survival. Certainly, the first and second indications have been demonstrated by retrospective analysis of patient records. The final indication is less substantiated. It is my opinion that surgery to prolong survival will be beneficial if all gross tumor can be removed. Debulking procedures may improve quality but not quantity of life. Because of the potential benefits of surgery in the management of all patients with carcinoid tumors, a surgeon should be part of the team of physicians who manage these complex patients.
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PMID:Surgical management of carcinoid tumors: role of debulking and surgery for patients with advanced disease. 753 70

An intrahepatic posterior approach to the portal triad has been used over a 2-year period to perform right hepatectomies and right segmental resections in 29 patients (20 men, 9 women; median age 63 years, range 22-82 years). Two resections were palliative for cholangiocarcinomas; the remainder included 9 hepatocellular carcinomas, 12 colorectal metastases, 2 adenomas, 3 cancers of the gallbladder, and one case of chronic hepatic fibrosis. The median operative time was 3 hours 40 minutes (3:40; range 2:20-7:00) with a median period of hepatic ischemia of 87 minutes (range 27-152 minutes). Median blood transfused was 0 unit (range 0-12 units) with only three patients requiring intensive care admission. There was one hospital death. All but one patient was followed up after surgery (median period 24 months; range 1-36 months) at which time there had been three deaths from metastatic disease; the remaining patients were free of clinical recurrence. This operative approach allows minimally resective surgery to be performed safely with excellent short- and medium-term results.
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PMID:Clinical experience with the intrahepatic posterior approach to the portal triad for right hepatectomy and right segmental resection. 757 78


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