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

Radiation therapy is the elective treatment of inoperable non small cell lung cancer, but is potentially curative only for a few of them: failures result from distant metastases and/or from progressive local disease. During the last years, following the progress in chemotherapy, combining radiation and drugs is becoming a more common approach. Nevertheless, one of the main concerns remains the potential interference between both modalities leading to an increased toxicity, which may outweigh all potential benefit. Several organs can be a target for acute or late toxicity: lung (pneumonitis and fibrosis), esophagus (acute esophagitis, stenosis), heart (pericarditis, impaired ventricular functions, heart failure, coronary stenosis), spinal cord (transient myelopathy, radiation myelitis), skin (moist desquamation, fibrosis, telangiectasia). The current published trials combining drug and radiation appear to be a rather safe approach especially when avoiding concomitant treatment. However, several points remain unsolved: the optimal combination scheme, the real risk of late damage observation including the second cancer occurrence risk. This risk is uneasy to evaluate due to the long latency period. The way of describing the late damage is crucial, seeking for a more precise system of evaluating, recording and reporting late effects, taking into account objective damage as well as the patient's symptoms. Therefore, combining drug and radiation should preferentially be performed within prospective studies, with precise evaluation procedures.
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PMID:[Non small-cell bronchial cancers: toxicity of the association radiotherapy-chemotherapy. Review of the literature]. 794 85

Pleural effusion (PE) has been increasingly diagnosed over the last eight years in the Department of Internal Medicine of the Centre Hospitalier of Kigali, Rwanda. To determine the etiology of PE and to examine its possible association with HIV-1 infection and tuberculosis (TB), the authors performed an etiological work-up, including thoracocentesis and pleural punch biopsy, of all new patients with PE of undetermined etiology referred to the Division of Pulmonary Diseases at the hospital between September 14, 1988, and October 16, 1989. 81 men and 46 women of mean age 34 years were enrolled in the study. Pleural TB was diagnosed in 86% and confirmed histologically and/or bacteriologically in 82%. 82 of the 98 pleural TB patients tested for antibody to HIV-1 were HIV-1-seropositive. Metastatic cancer was responsible for PE in six patients, Kaposi's sarcoma in three, lymphoma in one, anaplastic carcinoma in one, and adenocarcinoma in one. Non-TB pneumonia was documented in five patients and was associated with HIV-1 infection in four. Other causes of PE were congestive heart failure, decompensated cirrhosis, constrictive pericarditis, or undetermined; only one of these latter patients was HIV-seropositive. The authors therefore found TB to be the predominant cause of PE and it is strongly associated with HIV-1 infection. In an African area highly endemic for HIV-1 and Mycobacterium tuberculosis co-infection, PE should therefore be considered a good marker of TB as well as HIV-1 infection.
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PMID:Pleural effusion, tuberculosis and HIV-1 infection in Kigali, Rwanda. 844 20

Among patients admitted to the therapeutic department of the general hospital for 5 years, diagnosis of pericarditis was made in 110 patients (0.44%). Among the most common causes of secondary pericarditis were: chronic renal failure (31.8%), diffuse lesion of the connective tissue (17.7%), tumor metastases to the pericardium (15.5%). Primary pericarditis was, as a rule, of tuberculous etiology. Morphologically, it was adhesive or adhesive-exudative, constrictive, exudative in 13, 4.5 and 76% of patients, respectively. Half of the patients with exudative pericarditis had 300 to 800 ml of fluid in the pericardial cavity. Typical clinical manifestations were dyspnea and tachycardia. X-ray was diagnostically valuable in pericardial exudate 300 ml and more. ECG voltage fell in exudate more than 400-500 ml. Echocardiography remains an effective tool in diagnosis of pericarditis. The treatment consisted of antibiotics, antiinflammatory therapy, evacuation of the liquid from the pericardial cavity.
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PMID:[Pericarditis: 5 year records of general hospital]. 964 32

A 29 year old white man presented to the emergency room with new onset pleuritic chest pain and shortness of breath. He was initially diagnosed as having viral pericarditis and was treated with non-steroidal anti-inflammatory drugs. A few weeks later he developed recurrent chest pain with cough and haemoptysis. Chest radiography, cardiac examination, transthoracic and transoesophageal echocardiography pointed to a mass that arose from the posterior wall of the right atrium, not attached to the interatrial septum, which protruded into the lumen of the right atrium causing intermittent obstruction of inflow across the tricuspid valve. Contrast computed tomography of the chest showed a right atrial mass extending to the anterior chest wall. The lung fields were studded with numerous pulmonary nodules suggestive of metastases. A fine needle aspiration of the pulmonary nodule revealed histopathology consistent with spindle cell sarcoma thought to originate in the right atrium. Immunohistochemical stains confirmed that this was an angiosarcoma. There was no evidence of extracardiac origin of the tumour. The patient was treated with chemotherapy and radiation. This case highlights the clinical presentation, rapid and aggressive course of cardiac angiosarcomas, and the diagnostic modalities available for accurate diagnosis.
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PMID:Primary right atrial angiosarcoma mimicking acute pericarditis, pulmonary embolism, and tricuspid stenosis. 1021 78

Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma. Tumor may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. Impairment of cardiac function occurs in approximately 30% of patients and is usually attributable to pericardial effusion. The clinical presentation includes shortness of breath, which may be out of proportion to radiographic findings in patients with pericardial effusion or may be the result of associated pleural effusion. Patients may also present with cough, anterior thoracic pain, pleuritic chest pain, or peripheral edema. The differential diagnosis of pericardial effusion in a patient with known malignancy includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis. Any disease process that causes thickening or nodularity of the pericardium or myocardium or masses within the cardiac chambers can mimic metastatic disease.
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PMID:Metastatic involvement of the heart and pericardium: CT and MR imaging. 1125 6

Case histories of 84 patients with fevers lasting from 2 weeks to 6 months and suspected infective endocarditis (IE) were analyzed. Infective endocarditis was diagnosed in 15 patients. From the viewpoint of IE diagnosis by the DUKE criteria, the major criteria possess the highest diagnostic value. Use of only minor DUKE criteria gave false-positive results in diagnosis of IE in feverish patients with angiitis, hemopoietic diseases, and malignant tumors with remote metastases. The diagnosis of IE should be based on the DUKE criteria, clinical picture, and data of laboratory tests (pericarditis, shift of the leukocytic formula to the left, increased level of circulating immune complexes, high erythrocyte sedimentation rate, etc.).
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PMID:[Differential diagnosis of infective endocarditis and fevers of unrelated genesis]. 1151 Jan 80

The case concerns a 56 year old male with the diagnosis of squamous cell carcinoma, which clinically presented as a rapidly increasing cardiac tamponade. The patient underwent a pericardio-centesis. Due to the expansion of the process within the bronchus, the patient underwent chemotherapy according to the Taxol + Carboplatine scheme. After 8 months of treatment the patient was hospitalized again due to a further increase in fluid in the pericardium, and symptoms of cardiac insufficiency which lead to patient death. Autopsy revealed neoplastic change within the pericardium (fibrinous-hemorrhagic pericarditis and hemopericardium). Cardiac tumors occur rarely, they may be primary or secondary. Squamous cell carcinoma metastases may be the cause of pericardial effusion, which is associated with poor prognosis.
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PMID:[Cardiac tamponade as the first clinical manifestation of squamous cell carcinoma]. 1215 50

Embolized mesothelial-like cells were detected within pericardial lymphatics and mediastinal lymph nodes of three golden retrievers with idiopathic haemorrhagic pericardial effusion. Morphological, cytochemical, and immunohistochemical investigations indicated that the embolized cells most likely originated from the pericardial mesothelium. None of the dogs showed evidence of an underlying neoplastic disorder. Such findings have not been reported previously in animals, but so-called "benign mesothelial cell inclusions" have been reported in mediastinal lymph nodes of human patients with pleuritis and pericarditis but no history of neoplasia. The present findings in dogs indicate the need to distinguish between lymphatic emboli arising from reactive mesothelial cells and metastases arising from a mesothelioma.
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PMID:Embolized mesothelial cells within mediastinal lymph nodes of three dogs with idiopathic haemorrhagic pericardial effusion. 1263 86

In a dog presenting with the clinical signs of exercise intolerance and ascites, cardiac tamponade due to suspected idiopathic pericarditis was diagnosed based on thoracic radiographs, electrocardiogram (EKG) and cardiac ultrasound. Pericardial effusion recurred soon after pericardiocenteses, prescription of colchizine and again after balloon pericardiotomy. After partial pericardectomy by thoracoscopy and after obtaining a histological diagnosis of mesothelioma adjuvant intracavitary chemotherapy using cisplatin was performed. Already one week later the dog developed marked dyspnea due to severe pleural effusion. The dog was maintained at acceptable life quality judged based on playfulness and appetite using repeated pleuro-centeses for an additional two months, when the dog was euthanized due to uncontrollable pleural effusion. Despite extensive treatments life span from initial presentation to euthanasia was only 5 months. Necropsy revealed extensive mesothelioma metastases covering the whole pleura, epicardium and remaining pericardium. Diagnostic and therapeutic aspects of (recurrent) pericardial effusion are discussed based on this case.
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PMID:[Cardiac tamponade due to pericardial mesothelioma in an 11-year-old dog: diagnosis, medical and interventional treatments]. 1264 54

In 50 patients treated from January 1998 through March 2002 for pericardial effusion and tamponade, we retrospectively investigated the efficacy of percutaneous placement of an indwelling pericardial catheter guided by 2-dimensional echocardiography and fluoroscopy. We also investigated causation. In 80% of the patients, we were able to determine specific causes through clinical, serologic, and cytologic investigation: cancer in 15 patients, chronic renal failure in 11, systemic lupus erythematosus in 2 rheumatoid arthritis in 2, Dressler syndrome in 2, tuberculosis in 1, blunt chest trauma in 1, purulent pericarditis in 1, and probably viral pericarditis in 5. No specific cause could be determined in 10 patients (20%). We did not observe any complication due to the procedure. Two patients died during hospitalization. After hospitalization, 9 patients with metastatic cancer died within 3 months. A 2nd percutaneous drainage procedure was required in 2 cancer patients. Recurrence of pericardial effusion and tamponade and the requirement of pericardiectomy occurred in 2 patients with perfusion of unknown cause and in 1 patient with perfusion due to rheumatoid arthritis. Histologic examination of pericardial tissue in patients with idiopathic disease showed fibrinous pericarditis but no causal factor. In the group with idiopathic pericardial effusion, 2 patients with multiple mediastinal lymphadenopathy underwent mediastinal exploration; biopsy revealed nonspecific lymphadenitis and fibrinous pericarditis. In patients with large pericardial effusions and tamponade, the specific cause was in most cases already known or obtained by initial clinical and laboratory investigation. Sufficient cardiac decompression was achieved by percutaneous pigtail catheter drainage.
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PMID:Pericardial tamponade and large pericardial effusions: causal factors and efficacy of percutaneous catheter drainage in 50 patients. 1574 92


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