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

A group of 165 geriatric patients is compared with a control group of 114 younger patients concerning different frequency of laparoscopic diagnoses. As it was suspected from the clinical view aged patients predominently suffered from posthepatic cirrhosis and from cirrhosis of unknown origin, from recurrent cholecystitis, obstructive jaundice, metastases and carcinosis of peritoneal cavity. Younger patients much more frequently showed toxic liver damage starting from fatty liver and ending up with fatty liver cirrhosis. Persistent acute hepatitis non associated with HBSAg was scarcely seen with the aged group. It was a frequent diagnosis with the younger control group. There are explanations given for the differing endoscopic results concerning aged persons and younger control persons.
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PMID:[Laparoscopic findings in aged patients (author's transl)]. 2 56

CT can clearly demonstrate dilation of intra- and extra-hepatic bile ducts due to mechanical obstruction. Note is made that the intrahepatic bile must not necessarily participate in dilation in obstructive jaundice. The cause in 27 cases observed in our institutions was as follows: 16 pancreatic tumors; 1 stone; 2 extrahepatic bile duct obstructions; 4 liver lesions (tumor and cirrhosis) and 4 with cause unknown. Furthermore, CT is helpful in the evaluation of hepatogenic non-obstructive jaundice such as due to primary liver cell carcinoma (hepatoma), metastases to the liver and advanced cirrhosis of the liver. The value of CT in the evaluation of different types of cholestasis is demonstrated by several exemplary cases; and the problems of differential diagnosis are pointed out.
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PMID:[Computerized tomography in the evaluation (author's transl)]. 22 56

Three patients who developed obstructive jaundice after mastectomy for carcinoma of the breast are presented. Prognosis is invariably poor as widespread metastases are usually present at the time of presentation. The pathogenesis, investigations and clinical significance are discussed.
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PMID:Metastatic breast carcinoma presenting as obstructive jaundice. A report of 3 cases. 43 36

Twenty-four patients with clinical evidence of obstructive jaundice were examined by percutaneous transhepatic cholangiography (PTC) and needle biopsy (NB) of liver. The presence of extrahepatic bile duct obstruction was confirmed by surgery in 21 cases. PTC and the combination of both methods were superior to NB alone in the differential diagnosis between extra- and intrahepatic biliary obstruction. Sampling bias added to the difficulties of NB in distinguishing beween these two types of obstruction. The combination of both precedures proved most useful in three cases with intrahepatic obstruction, in which the patients were spared unnecessary surgery. In five cases the NB provided additional information about the nature of the tumor metastases and gave suport to the clinicians in their therapeutic approach.
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PMID:Percutaneous transhepatic cholangiography and needle biopsy in the differential diagnosis of obstruction of bile flow. 61 15

116 patients with clinically suspected obstructive jaundice were subjected to primary sonographic examination by means of the "real-time" method to differentiate between intrahepatic (internal) and extrahepatic (surgical) cholestasis. Diagnosis was finally confirmed by observing the clinical course, by further examinations, and in 63 cases by surgery or PM. Sonographic examination revealed the direct cause of the extrahepatic obstruction in 82 of 87 patients (94.3%) with extrahepatic cholestasis; in case of dilatation of the bile duct, the approximate site of the obstruction could be determined. In about 75% of the cases, the cause of biliary obstruction was correctly identified. Intrahepatic tumours or metastases were present in 10 of 27 patients with intrahepatic cholestasis; sonographic identification was effected in all cases and histologically or cytologically confirmed with aspiration material from fine-needle biopsies. The high accuracy and uncomplicated technique avoiding discomfort or harm to the patient, make sonography a useful method in differential diagnosis of cholestasis.
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PMID:[Ultrasound in differential diagnosis of intrahepatic and extrahepatic cholestasis (author's transl)]. 69 86

This study was performed to comparatively assess the diagnostic accuracy of computerized tomography (CT) and nuclear liver-scanning in detecting and defining circumscript and diffuse liver diseases in 83 patients. Presence or absence of liver diseases was assessed based on the results of invasive diagnostic procedures such as biopsy, laparoscopy, laparotomy, and/or autopsy. The percentage of true negative diagnoses was 94% for CT and 91% for static gamma-imaging (n = 33). With a rate of 94% true positive diagnoses, CT proved to be superior to gamma imaging with radiocolloids (81% true positives) in diagnosing circumscript liver diseases (n = 31). In addition. CT was superior to nuclear imaging regarding discrimination of number and size of space-occupying lesions within the liver. In contrast to nuclear screening, CT scans were pathognomonic to some circumscript liver diseases such as cysts, metastases, and perhaps echinococciasis. This was also true for obstructive jaundice. Nuclear imaging, because it reflects a sort of liver function, was superior with cirrhosis, whereas CT showed only alterations in the size and shape of the liver and spleen.
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PMID:Computerized tomography and nuclear imaging of the liver: a comparative study in 83 cases. 75 Feb 3

Three types of expandable metallic stents were used to relieve obstructive jaundice in 59 patients. They consisted of 3 cases with benign stricture, and 56 with malignant obstruction including 28 of cholangiocarcinoma, 17 of pancreatic carcinoma, 9 of lymph node metastases, and 2 of gall bladder carcinoma. The median age of patients was 68.9 years. Of 56 cases with malignant obstruction, 51 cases were able to remove external drainage catheter. In these 51 cases, 35 patients died, and 16 are still alive. No significant difference was noted in the incidence of stent destruction or migration in three types of stents. The average survival period was 189.9 days in 35 patients who died after withdrawal of external drainage. Twenty-three of 35 patients had no recurrence of obstructive jaundice. Sixteen patients with malignant obstruction are still alive and have been observed for 22 to 764 days. The 30 day mortality rate was 6.8%. Three cases of acute cholecystitis were noted after procedure. It is warranted to say that endoprostheses using expandable metallic stents will be the major treatment of choice for biliary obstruction because of long term patency and low complication rate.
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PMID:[Efficacy of biliary endoprostheses using expandable metallic stents in obstructive jaundice--long-term results of three different types of stent]. 133 40

Self-expanding metal endoprostheses have ben used in the treatment of malignant obstructive jaundice for a few years. We report on a patient with obstructive jaundice due to a metastasis of a squamous cell lung cancer into the pancreatic head who received an expandable metal endoprosthesis and suffered recurrent jaundice and cholangitis after 38 days. On repeat ERCP, a very narrow stenosis was seen in the stent lumen caused by tumor ingrowth through the mesh. Intraluminal biopsies showed squamous cell carcinoma. A 10 Fr plastic endoprosthesis was inserted through the self-expanding stent with good drainage. On the basis of this experience, we feel that when faced with a patient with obstructive jaundice due to metastatic disease from a rapidly progressive carcinoma, the use of the currently available self-expanding metal endoprosthesis should be discouraged until the results of prospective studies with large numbers of patients have proven its superiority over the plastic endoprostheses. Meanwhile, modifications to prevent tumor ingrowth through the mesh of the stent are under investigation.
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PMID:Early recurrence of obstructive jaundice after placement of a self-expanding metal endoprosthesis. 150 92

Alcohol can induce a wide spectrum of histological changes in the liver. Three morphologic patterns of alcoholic liver injury are now generally accepted, i.e. fatty change, alcoholic hepatitis and alcoholic cirrhosis, but a broad array of lesions has been added to this list in recent years. These damage patterns differ considerably in their significance as to indication and diagnostic power of liver biopsies. Liver biopsy is recommended in patients with clinically suspected alcoholic liver disease for diagnostic and prognostic reasons. Moreover, clinicians want to exclude nonalcoholic liver diseases that might otherwise be missed. Alcoholic hepatitis, which is associated with increased morbidity and mortality, has the highest degree of diagnostic specificity in biopsies, because its features are well-defined and are mimicked by a rather small group of other causes. When associated with perivenular and pericellular fibrosis, it may provide prognostic parameters. In contrast, fatty liver, which may be induced by alcohol as well as other etiologies, usually does not need liver biopsy, with some exceptions. It may lead to cholestasis severe enough to mimic obstructive jaundice, or may result in abnormal imaging studies suggesting metastases. Verification of histological findings may be important when these circumstances arise. Cirrhosis is easily verified in biopsies of appropriate quality; however, advanced cirrhosis is a morphologically nonspecific alteration, because cirrhotic tissue patterns converge irrespective of their cause. Liver biopsy may help to identify nonalcoholic liver disease in patients suspected of harboring alcoholic liver disease. In fact, up to 20% of biopsies may show other, potentially treatable disorders, thus extending the indication for liver biopsy in situations of complex clinical and laboratory patterns.
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PMID:[Liver biopsy in suspected alcoholic liver damage]. 162 Dec 36

Endoscopic retrograde cholangio-pancreatography (ERCP) confirms the diagnosis of obstructive jaundice and sometimes provides the histological proof that the stenosis is due to cancer. Palliative treatment of biliary and pancreatic cancers is indicated when the extension of the tumour is such that it precludes any oncologically satisfactory excision, in patients at high operative risk, when jaundice recurs after surgery and in cases of biliary metastases from distant cancers. Cancers located below the hilum are usually easily treated by endoscopic insertion of a biliary stent, whereas hilar cancers extending to the bifurcation often require combined endoscopic and percutaneous techniques to drain all liver segments. The most frequent of early complications of biliary stents is cholangitis, notably in hilar cancers. Late complications, notably obstruction of the stent, can be reduced by using expandable metal stents.
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PMID:[Endoscopic retrograde cholangiopancreatography and biliary prosthesis]. 200 79


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