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

This study reviews a total of 26 renal cell carcinoma (RCC) who underwent enucleation of the tumour with functionally and anatomically normal controlateral kidney and no evidence of systemic renal disease. At follow-up, after a mean of 62 months the disease specific survival rate for this series was 88.5%. Survival rates according to the pathologic stage, grading, tumour diameter and ploidy are reported. Local recurrences were documented in 4 of the 26 RCC. All 4 RCC were more than 5 cm in diameter and recurred in the remaining parenchyma. After local recurrence, three tumours with aneuploid DNA content underwent radical nephrectomy, whereas 1 with diploid DNA content was submitted to a new enucleation of the recurrence. To date the diploid case is still alive 3 years after the original resection of the primary tumour whereas the other 3 patients died for metastatic disease. In our experience the ideal candidate for renal sparing surgery in the presence of a normal opposite kidney is an asymptomatic patient that incidentally is brought to our attention with a small size (less than 5 cm in diameter), low stage (T1-T2) tumour, well surrounded by a pseudocapsule. DNA content is a valuable prognostic factor in patients submitted to conservative surgery. Diploid tumours have been seen to have a better prognosis and in case of local recurrence they may be reconsidered for a new enucleation of the recurrence.
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PMID:Surgical enucleation for renal cell carcinoma (RCC). Prognostic significance of tumour stage, grade and DNA ploidy. 916 73

In the preceding sections we have emphasized the current status of our knowledge concerning the involvement of apoptosis in normal and abnormal renal developmental processes, in control of the adult kidney size and capacity, in the development of renal disease states and in renal oncogenesis. At several points, we noted that studies of apoptosis in the kidney and in renal cells lag behind those in other organ systems. Even with the rudimentary knowledge now available, however, it is apparent that apoptosis is an extremely important process in the kidney. Recent observations lend credence to the view that continued study of this unique cell death process might enable the generation of novel and more effective therapies to treat renal diseases and renal malignancies. We wish to highlight several areas that require particular attention. First, the relationship between blood supply and apoptosis in the kidney requires further investigation. Benign human renal diseases are common in our population; and we now know that most of these diseases are associated with abnormal rates of apoptosis. Although the initiating agents for the various renal diseases vary, there is good reason to believe that much of the apoptosis that occurs in these adult diseases is the end result of reduced renal blood flow initiated by the causative agent. Cytokines or other extrinsic agents that can reduce the apoptotic loss of renal cells under these conditions hold theoretical promise in treating these diseases. Second, there is an urgent need to define the endocrine, paracrine, or autocrine roles of cytokines in normal renal physiology and in the pathogenesis of various renal syndromes. As indicated above, elaboration of fibrous extracellular material by fibroblasts in the tubulointerstitial regions of the kidney appears to be part of the final common pathway leading to end-stage renal disease. It is important to understand how the function of these fibroblasts is controlled. Conversely, apoptosis of glomerular or renal tubular cells also appears to play a role in the development of many of these syndromes. There is already experimental and clinical evidence showing that IGF-1 and hepatocyte growth factor therapies can be useful in renal diseases [57, 58]. It remains to be determined how much of the usefulness of these cytokines is related to their ability to suppress apoptosis as opposed to their ability to promote true growth. Finally, the analysis of apoptotic regulation during renal oncogenesis is critical. Maligant renal cell cancers are difficult to detect in adults before their metastases cause symptoms; and by this late stage renal tumors are almost invariably fatal. The ability of these tumors to regress spontaneously indicates that most apoptotic pathways are retained in these cells, yet their disappointing response to chemotherapy indicates that we have much to learn about how to trigger these pathways. Hopefully a better understanding of the control of these pathways will lead to improved therapy for this devastating group of neoplasms.
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PMID:Apoptosis in the mammalian kidney: incidence, effectors, and molecular control in normal development and disease states. 920 52

Five distinct clinical syndromes of pulmonary angiitis and granulomatosis are currently recognized: Wegener granulomatosis, lymphomatoid granulomatosis, necrotizing sarcoid granulomatosis, bronchocentric granulomatosis, and allergic angiitis and granulomatosis (Churg-Strauss syndrome). Patients typically present in middle age with fever, cough, hemoptysis, dyspnea, or chest discomfort. Upper airway involvement such as sinusitis suggests Wegener granulomatosis. Medical renal disease is associated with Wegener granulomatosis and Churg-Strauss syndrome. Asthma may be present in bronchocentric granulomatosis and Churg-Strauss syndrome. Pathologic examination of these entities demonstrates vasculitis, granulomatous inflammation, and parenchymal necrosis. The radiologic manifestations of pulmonary disease are varied, but the most typical appearance is that of multiple nodules or masses that may demonstrate cavitation. Diffuse multifocal air-space opacities with or without cavitation may also be seen. Pulmonary hemorrhage is a well-known presenting manifestation of Wegener granulomatosis and, less commonly, of Churg-Strauss syndrome. Because of the multifocal lung involvement in these diseases, pulmonary metastases and infectious causes are often considered in the differential diagnosis. Affected patients are treated with cytotoxic agents and corticosteroids. The prognosis is variable, depending on the specific syndrome, but may be favorable in the absence of significant complications.
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PMID:Pulmonary angiitis and granulomatosis: radiologic-pathologic correlation. 959 92

The patient, aged 49 years, on chronic dialysis for 5 years, was admitted to Clinic of Nephrology of Military Medical Academy to establish the cause of the anemic syndrome. During the investigation, ultrasonographically, and by computed tomography of kidneys and Color-Doppler sonography it was discovered, and by renovasography confirmed, the carcinoma of the left kidney, together with the acquired polycystic renal disease. Left nefrectomy was performed. The tumor of 2 cm without regional invasion and with no evident distant metastases was histopathologically described as a well differentiated clear cell renal carcinoma. The increased frequency of renal carcinoma in uremic patients with acquired cystic renal disease compared to the common population, the absence of classic clinical picture, small tumor dimensions and asymptomatic course in the majority of patients necessitates the detailed search for suspected changes and routine screening once a year in all the patients on chronic dialysis program.
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PMID:[Acquired renal cystic disease and renal carcinoma in patients on chronic hemodialysis]. 972 Apr 51

The paper presents 2 cases of metastases of clear cell carcinoma of kidney into thyroid gland in patients on renal replacement therapy. In one patient after bilateral nephrectomy due to renal clear cell carcinoma (in 15 years time interval) and in second patient after left-side nephrectomy performed 16 years earlier and terminal right kidney insufficiency due to nephropathy with nephrotic syndrome for a year. In diagnosis essentials were: physical signs--palpable single node within the thyroid gland, earlier neoplastic anamnesis, cold node in scintigraphy, hypoechogenic node in ultrasonography of the thyroid gland, particularly with a rich vascular net within the node in power-doppler examination and, at last cytology of material from ultrasound-guided fine needle biopsy of the node. The diagnosis had been confirmed in intraoperative histopathological examination before the total thyroidectomy was performed.
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PMID:[Metastasis of kidney clear cell carcinoma to the thyroid cell in patients on renal replacement therapy]. 1021 80

The widespread availability of abdominal ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) scanning has increased the diagnosis of incidental renal tumors, which now comprise the vast majority of the new cases diagnosed each year. With the detection of renal tumors at an earlier stage, partial nephrectomy and nephron-sparing surgery have evolved as effective alternatives to radical nephrectomy. The poor prognostic findings of involved regional lymph nodes or ipsilateral adrenal metastases has led to more selective operations on those sites in the face of incidental tumor detection. Technological advances have allowed for the development by committed surgical investigators of techniques of laparoscopic and laparoscopically assisted nephrectomy. Although not widely employed, further improvements in technology may widen the appeal of these approaches to selected renal tumors. Advances in cardiovascular surgical techniques have made resection of renal cell carcinoma (RCC) with tumor thrombi involving the inferior vena cava (IVC) possible, although this approach is still associated with significant perioperative mortality depending on the degree of caval involvement. In highly selected cases, resection of limited metastatic disease is recommended, particularly if the disease-free interval is greater than 12 months and there is a only a single site of metastatic disease. Whether metastectomy is therapeutic or fits within the realm of the often long and unpredictable natural history of RCC is not known. Strategies for follow-up are based primarily on the pathologic stage of the operated tumor. Small incidental tumors have an excellent prognosis and require little in the way of postoperative imaging. As the pathologic stage increases, the likelihood of developing metastatic disease increases, necessitating biannual chest x-ray in addition to history and physical examination. Symptom-directed bone scans and CT scans are effective in identifying most recurrences in patients with large, poorly differentiated tumors. Patients requiring specialized follow-up programs include those treated by partial nephrectomy, and those with end-stage renal disease, acquired cystic disease of the kidney, or von Hippel-Lindau (VHL) disease.
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PMID:Renal cell carcinoma: presentation, staging, and surgical treatment. 1076 95

DOTA-D-Phe1-Tyr3-octreotide (DOTATOC), a newly developed somatostatin analogue which can be stably labelled with the beta-emitter yttrium-90, can be used for receptor-mediated internal radiotherapy. A 78-year-old woman suffering from a carcinoid of the small intestine with multiple metastases in the liver as well as mesenteric and supraclavicular lymph node metastases was treated with this therapy after the disease had progressed under other chemotherapy options employed years previously. The patient received four single doses of 90Y-DOTATOC at 6-week intervals, yielding a cumulative dose of 9,620 MBq (5,659 MBq/m2). Restaging revealed stable metastatic disease. Serum creatinine and urea nitrogen levels were within the normal range prior to starting and during DOTATOC therapy. However, 15 months after cessation of DOTATOC therapy, a progressive deterioration of renal function occurred, leading to end-stage renal disease. Urinalysis revealed a slight proteinuria of 700 mg/day without haematuria, leucocyturia or casts. There was no obvious risk factor for chronic renal insufficiency except DOTATOC therapy. However, it was not feasible to use kidney biopsy to prove the presence of radiation-induced nephritis. Intermittent haemodialysis was started as the creatinine clearance declined to below 10 ml/min. Diuresis was not affected. The presented case shows delayed renal insufficiency after a relatively low cumulative dose of 90Y-DOTATOC (5,659 MBq/m2). This serious adverse event indicates that further studies are needed to evaluate which dose of 90Y-DOTATOC, under which renal protection regimen, will provide optimal management, balancing risks and benefits.
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PMID:End-stage renal disease after treatment with 90Y-DOTATOC. 1200 21

Until recently, the therapeutic protocol widely accepted for ablation of the thyroid remnant and for metastases of thyroid papillary carcinoma was the administration of 131I after surgery. However, at present, some data question the usefulness of such treatment in patients considered low risk. The treatment with radioiodine in patients suffering from end-stage renal disease (ESRD) undergoing hemodialysis requires controlled dosages and individualized administration guidelines. The need to include these patients on the waiting list for a renal transplantation, once they have overcome the disease, and the higher prevalence of thyroid carcinoma in ESRD patients makes this an increasingly significant problem. The cases reported in the literature are few and the therapeutic models followed are very difficult. In this paper we propose a therapeutic model that provides the highest thyroid ablative dosage, minimizing radiation exposure to the rest of the organs. The main difference between our protocol and that already described is the performance of daily hemodialysis during the first 5 days of treatment, as well as the administration of a dose of 131I equivalent to that administered to patients who show normal renal function.
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PMID:Iodine-131 treatment of thyroid papillary carcinoma in patients undergoing dialysis for chronic renal failure: a dosimetric method. 1176 12

Transfusion is associated with multiple risks and morbidities. Little is known, however, about preoperative predictors of transfusion in gastrointestinal surgery patients. To identify factors that influence transfusion practices, we analyzed hospital discharge data from colorectal cancer surgery patients in Maryland between 1994 and 2000 (n = 14,052). The primary outcome variable was whether or not patients received a blood product ("Any Transfusion"). Characteristics independently associated with an increased risk of receiving Any Transfusion included: advanced age (>80 yr: OR 2.3; 95% CI 1.9-2.9; 70-79 yr: OR 1.6; 95% CI 1.4-2.0 vs. <60 yr), moderate to severe liver disease (OR 2.5; 95% CI 1.5-4.2), mild liver disease (OR 2.1; 95% CI 1.5-2.9), diabetes with complications (OR 2.1; 95% CI 1.6-2.6), chronic renal disease (OR 2.1; 95% CI 1.4-3.0), female gender (OR 1.3; 95% CI 1.2-1.5), chronic pulmonary disease (COPD) (OR 1.3; 95% CI 1.1-1.4), and metastatic disease (OR 1.2; 95% CI 1.1-1.4). Patients at hospitals with an annual case volume in the highest quartile were at an increased risk for receiving Any Transfusion (OR 2.1; 95% CI 1.3-3.4) and those with surgeons in the highest volume quartile (>12 cases/yr) were at a decreased risk (OR 0.8; 95% CI 0.6-0.99). The association between greater surgeon case volume and low transfusion rates was seen in all but the very high volume hospitals (>74 cases/yr). Blood product transfusion was associated with a 2.5-fold (95% CI 2.1-3.1) increased mortality, 3.7 day (95% CI 2.1-3.1) increase in hospital length of stay, and a 7120 dollars (95% CI 6472 dollars-7769 dollars) increase in total charges compared to patients that did not receive Any Transfusion. This data can be used by providers in discussions with patients regarding the risks for transfusion and in identifying patients in whom strategies to reduce transfusions should be evaluated.
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PMID:Preoperative predictors of blood transfusion in colorectal cancer surgery. 1239 66

Lung cancer is associated with smoking and age, both of which are associated with comorbidity. We evaluated the impact of comorbidity on lung cancer survival. Data on 56 comorbidities were abstracted from the records of a cohort of 1,155 patients. Survival effects were evaluated with Cox regression (outcome crude death). The adjusted R(2) statistic was used to compare the survival variation explained by predictive variables. No comorbidity was observed in 11.7% of patients, while 54.3% had 3 or more (mean 2.97) comorbidities. In multivariate analysis, 19 comorbidities were associated with survival: HIV/AIDS, tuberculosis, previous metastatic cancer, thyroid/glandular diseases, electrolyte imbalance, anemia, other blood diseases, dementia, neurologic disease, congestive heart failure, COPD, asthma, pulmonary fibrosis, liver disease, gastrointestinal bleeding, renal disease, connective tissue disease, osteoporosis and peripheral vascular disease. Only the latter was protective. Some of the hazards of comorbidities were explained by more directly acting comorbidities and/or receipt of treatment. Stage explained 25.4% of the survival variation. In addition to stage, the 19 comorbidities explained 6.1%, treatments 9.2%, age 3.7% and histology 1.3%. Thirteen uncommon comorbidities (prevalence <6%) affected 21.2% of patients and explained 3.5% of the survival variation. Comorbidity count and the Charlson index were significant predictors but explained only 2.5% and 2.0% of the survival variation, respectively. Comorbidity has a major impact on survival in early- and late-stage disease, and even infrequent deleterious comorbidities are important collectively. Comorbidity count and the Charlson index failed to capture much information. Clinical practice and trials need to consider the effect of comorbidity in lung cancer patients.
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PMID:Impact of comorbidity on lung cancer survival. 1251 1


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