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)

Nonoperative decompression procedures for the relief of obstructive jaundice have been used in both malignant and benign processes. These techniques have proven to be as effective as surgical procedures in the palliative management of malignant biliary stenosis. However, nonoperative decompression procedures have certain advantages, in that they reduce morbidity and mortality associated with palliative surgical procedures, resulting in a decrease in the length of hospital stay and convalescence. Endoscopic transduodenal and percutaneous methods continue to evolve with improved techniques. Herein, we describe a new technique of transduodenal endoscopic decompression of a malignant obstruction of the common bile duct using a large caliber (15 French) endoprosthesis. This is the first report of successful endoscopic placement of such a large caliber endoprosthesis reported in the United States. Subsequently, three other prostheses have been placed in a similar manner. The procedure uses a combined endoscopic-fluoroscopic method and is performed in the same setting as endoscopic retrograde cholangiopancreatography in patients with cancer of the pancreas, cholangiocarcinomas, metastatic disease, and benign strictures.
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PMID:Endoscopic and fluoroscopic transpapillary placement of a large caliber biliary endoprosthesis. 620 1

The pathologic findings of 232 consecutive cases of hepatocellular carcinoma (HCC) autopsied during the past ten years at Kurume, Japan, were analyzed from the point of view of global epidemiology, in relation to clinical feature, and in regard to incidence, age, sex, etiologic factors, size of liver, changes in noncancer parenchyma, gross type of tumor, extrahepatic metastases, intravascular and intraductal growths, cancer cell histology, hepatitis B surface antigen (HBsAg) in hepatocytes and cancer cells, liver cell dysplasia, and frequency and clinicopathologic characteristics of minute HCC. Furthermore, postmortem hepatic arteriography and portography were done in 152 livers for comparison with gross anatomy and celiac angiograms. It was found that: (1) epidemiologically, HCC in Japan is distinct from that in the West that it is frequently encapsulated, livers are generally small because of frequent and advanced cirrhosis and small cancer, minute HCC, is not uncommon at autopsy, cirrhosis most commonly associated is the one with thin stroma and medium size nodules, and micronodular cirrhosis is very rare despite frequent alcohol abuse; (2) HCC is increasing in incidence; (3) HBsAg is frequently found in parenchyma; (4) liver cell dysplasia is indirectly related to HBsAg with no evidence for premalignancy; (5) the lung is the most frequent site of metastasis but peritoneal dissemination is unusual; (6) intraportal tumor growth is very common and the hepatic vein is less frequently affected; (7) growth in the major bile duct is frequently associated with intraportal growth and clinically presents as obstructive jaundice; and (8) tumor is supplied solely by arteries and celiac arteriograms are closely correlated with gross pathologic findings.
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PMID:Pathology of hepatocellular carcinoma in Japan. 232 Consecutive cases autopsied in ten years. 629 17

This is a follow-up study of 171 patients concerning the patients' care and complications following biliary drainage. Complications caused by puncture and drainage are considered separately. External biliary drainage resulted in 39%, internal in 26% with complications. The influence of advantages and side effects upon the indications of biliary drainage is discussed. Prognosis concerning the survival rate depends on the underlying pathology: In obstructive jaundice caused by metastases the patients only survived two months while the mean survival rate in carcinoma of the biliary ducts is 18 months.
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PMID:[After-care problems and complications of percutaneous biliary drainage]. 643 11

We encountered a relatively rare case of primary double cancer arising simultaneously from both the stomach and choledochus in a 72-year-old woman with obstructive jaundice. The patient was admitted to Saiseikai Shigaken Hospital, and was diagnosed as having both early gastric cancer at the lesser curvature of the antrum and cancer of the choledochus. She underwent curative pancreato-duodenectomy with extended gastrectomy. One of the resected tumors was histopathologically diagnosed as a well differentiated, tubular adenocarcinoma of the stomach with invasion reaching as deep as the submucosa. The other tumor was a moderately differentiated, tubular adenocarcinoma of the choledochus with lymph node metastases (hepatic, retroligamentic, paracholedochal, and posterior and superior pancreaticoduodenal lymph nodes). Our review of the literature suggests that the incidence of primary double malignancies is on the increase.
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PMID:[A case report of primary double cancer of the stomach and choledochus]. 670 Jan 18

Metastatic obstructive jaundice usually results from an occlusion of the common hepatic or bile duct. More rarely, the underlying cause is a disseminated intrahepatic infiltration that has led to the occlusion of the bile canaliculi. The endoscopic-radiological examination techniques usually permit a reliable differentiation between neoplasms originating primarily in the biliary tract, and ductal occlusions caused by metastatic disease. In addition to this, both ERC and PTC permit the placement of an internal or external biliary drain during one and the same procedure. ERC represents a highly suitable method for the follow-up monitoring or documentation of the therapeutic effect of biliary drainage, radiotherapy and/or polychemotherapy. With the aid of regular follow-up examinations, recurrent disease can be detected early on, and appropriately treated.
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PMID:Endoscopic-radiological findings in metastatic obstructive jaundice. 682 22

Metastasis of melanoma to gastrointestinal organs are common and have been well documented. Metastasis to the common bile duct with a clinical presentation of obstructive jaundice and hemobilia, as encountered in our patient, is a heretofore unreported clinical problem. This diagnosis was not suspected before operation but was established after a successful pancreaticoduodenectomy. The patient had an uneventful recovery and has shown no signs of recurrence. The causes of obstructive jaundice and hemobilia have been presented and discussed.
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PMID:Metastatic melanoma presenting as obstructive jaundice with hemobilia. 685 23

Percutaneous insertion of an internal endoprosthesis was attempted in 22 patients with obstructive jaundice due to metastatic lesions in the porta hepatis. The primary tumors were located outside the pancreas and the biliary tract. Insertion was successful in 16 patients. The endoprosthesis normalized the plasma bilirubin in 10 patients and improved the general condition in 12. The median survival was short when hepatic metastases were present. Insertion of an endoprosthesis is an attractive alternative to other palliative procedures.
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PMID:Relief of metastatic obstruction in porta hepatis by endoprosthesis. 716 55

The development of percutaneous transhepatic techniques of access to biliary tree with the fine needle made possible the wide diffusion of percutaneous biliary drainage. Results of 19 attempts of biliary drainage are presented; success rate in positioning external or external-internal drainage was 79% (92.3% in the last year). The technique employed is described and discussed comparing it with the methods proposed by other authors. Early therapeutic effects and long-term benefits on bilirubin levels and survival were good. Only 2 major complications were observed (hepatic abscess and biliary subcapsular cyst) but they did not require surgery. Cholangiocarcinomas and ilar hepatic metastases appeared to be elective indications to definitive palliative drainage, but pre-surgical or palliative drainage is also recommended in all cases of obstructive jaundice. Careful follow-up and check of patients with the biliary drainage improves the drainage function and reduces the complications.
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PMID:[Percutaneous transhepatic biliary drainage in obstructive jaundice. Report of 19 cases (author's transl)]. 731 71

Twenty-seven patients underwent percutaneous antegrade biliary drainage for obstructive jaundice. The serum bilirubin levels was elevated in all patients. Generalized pruritus was a major complaint. Twenty of the patients had had a laparotomy for malignant disease. Of the 24 patients in whom this method of drainage was successful, the obstructing lesion was found at the porta hepatis in 12 and in the extrahepatic bile ducts in 12. Metastatic disease was the commonest cause of obstruction. Following drainage the serum bilirubin level fell from a mean of 21.4 mg/dl (366 mumol/l) to a mean of 4.1 mg/dl (70.1 mumol/l) within a week. Pruritus was relieved. The major complications were transient cholangitis in five patients and inadvertent dislodgement of the catheter in four. In three of these patients another catheter was reinserted with ease. There was no peritonitis or uncontrolled bleeding. Twenty-one patients were able to leave hospital. Their mean survival time was 7.3 months. A multiperforated catheter manipulated through the obstruction has the advantage of permitting bile flow into the duodenum (antegrade) in contrast to external drainage (retrograde) by T- or U-tubes. Although the mean survival time with this method is similar to that with insertion of drainage tubes at the time of laparotomy, morbidity and mortality are reduced; this is important in view of the poor prognosis of bile duct obstruction due to malignant disease.
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PMID:Percutaneous antegrade biliary drainage: a nonoperative approach to biliary obstruction. 732 20

We report the clinical and pathologic features of five children wih a botyroid rhabdomyosarcoma of the biliary tract. There were three boys and two girls ranging in age from 11/2 to 51/2 years at diagnosis. Obstructive jaundice was the usual presenting sign, often with fever and hepatomegaly. Of four tumors involving the common bile ducts, two extended into porta hepatis and adjacent liver parenchyma; the fifth tumor arose in the wall of the cystic duct. Each had a typical botryoid (grape-like) configuration with a cambium layer of tumor cells beneath biliary epithelium. Rhabdomyoblasts were identified in all cases and confirmed by ultrastructure in one. Our data, along with review of other cases reported in the English literature, indicate a rather guarded prognosis. Although metastases have developed in 40% of cases, death was usually due to the effects of local invasion by tumor. Aggressive adjuvant therapy currently in use for childhood rhabdomyosarcomas may lessen the high mortality associated with this tumor.
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PMID:Botryoid rhabdomyosarcoma of the biliary tract. 733 57


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