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)

Systemic hyperthermia is an adjuvant method of treatment used in the management of advanced cancer; the hyperthermic state is induced by either the thermal blanket or the external blood shunt method. Strict monitoring of the cardiopulmonary status, the temperature, and the fluid balance is necessary. Chest radiographs were reviewed of 61 patients undergoing hyperthermia; pre-, intra-, and posthyperthermia radiographs were compared and significant radiographic findings tabulated. Intra- and postprocedural pulmonary edema, cardiomegaly, and pleural effusions were found in a significant number of patients. The radiologist should be familiar with systemic hyperthermia as a treatment modality for metastatic cancer and with the chest radiographic alterations resulting from it.
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PMID:Thoracic radiographic changes after systemic hyperthermia for advanced cancer. 315 80

A study of 30 cases of pheochromocytoma encountered at our department between 1959 and 1986 is presented. Fourteen patients were males and 16 were females. Their ages ranged from 18 to 72 years with a peak incidence in the fifties. Hypertension was present in 87% of the patients. The incidence of extra-adrenal tumors was 30% and that of malignancy 7%. The 24-hr urinary level of catecholamine was to a certain degree in accord with the location of the tumor and type of hypertension. Computed tomography and venous sampling were very useful for the diagnosis which had an accuracy rate of 100% in this series. Preoperative management using an alpha-blocker was effective in controlling blood pressure and circulating blood volume in most cases. Postoperative blood pressure was normalized within a week after operation in 85% of the patients who had been suffering from hypertension, although elevated levels of norepinephrine in urine were still noted in 56% of the patients one week after operation. Of the 27 follow-up cases, 21 cases (78%) were in good health and 2 cases were alive with hypertension with a mean follow-up period of 8.1 years. Four patients died, one during angiography, one of pulmonary edema one day after operation and the other 2 of metastases of malignant pheochromocytoma.
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PMID:[A clinical review of 30 pheochromocytoma patients]. 340 May 41

The surgical challenge of resection of renal cell carcinoma with vena caval invasion may require close cooperation between the urologist and cardiovascular surgeon. From 1977 to 1986, 13 patients with renal cell carcinoma and tumor thrombus invading the inferior vena cava (IVC) underwent radical surgical resection. In three of 13 patients the thrombus extended into the heart (right atrium two patients and right ventricle one patient). The tumor originated in the right kidney in 10 patients and in the left kidney in three patients. There were 10 men and three women with a mean age of 64 years (range, 46 to 75 years). Surgical management included midline incision, seven, with median sternotomy, four, and thoracoabdominal, two. After exposure of the renal vessels and IVC, all patients underwent radical nephrectomy. Two patients had caval sleeve resection, one had a partial caval resection, and seven had a 1 cm caval cuff. Planned cardiopulmonary bypass was used in three patients. The tumor thrombus was extracted by simultaneous atrial and caval approaches. One patient underwent unplanned emergency cardiopulmonary bypass after intraoperative cardiac arrest caused by a large tumor embolus of the pulmonary artery. No operative deaths occurred. Postoperative morbidity was significant in five of 13 patients, caval thrombosis in one, lower limb swelling in two, renal failure in one, and pulmonary edema in one patient. Two patients required long-term anticoagulation therapy for confirmed pulmonary emboli within 1 month of surgery. These complications resolved. The follow-up period ranged from 7 to 64 months with a mean of 36 months. Two patients died of metastatic disease at 24 and 48 months after surgery. Three patients are alive with metastatic disease at 6 to 64 months while one patient had a solitary metastatic lesion removed from the frontal lobe 4 years after nephrectomy and has been disease free a subsequent 18 months. Eight of 11 patients are disease free at 7 to 64 months (four patients greater than 52 months). Our 83% survival rate at a mean follow-up of 36 months suggests that this group of patients should not be denied aggressive resection. Documentation of tumor source and caval extension are essential to plan operative procedures, including use of cardiopulmonary bypass.
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PMID:Caval tumor thrombus complicating renal cell carcinoma: a surgical challenge. 366 Feb 38

Three uremic patients had chest x-ray changes due to pulmonary edema, but mimicking lobar pneumonia and fungal or metastatic disease. It is important to be aware of these deceptive radiographic patterns. Otherwise, a potentially disastrous delay in fluid removal, the mainstay of therapy, may result.
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PMID:Deceptive patterns of uremic pulmonary edema. 371 51

Forty-three peritoneovenous shunts have been inserted to palliate malignant ascites in 33 patients. Ascites was controlled for a time in every patient, but 18 shunts eventually blocked. Further shunt revision successfully controlled ascites until death in five of these patients and for prolonged periods in another five. The authors observed a marked difference between the performances of the two available shunts, but emphasize that the two groups of patients were not selected at random and therefore may not be comparable. Twelve postmortem examinations have been performed in the 33 patients to ascertain causes of shunt malfunction and to identify possible evidence of abnormal or accelerated tumor spread. The postmortem findings highlight great variability in the capacity of iatrogenically introduced showers of tumor cells to seed. There was a spectrum of tumor growth in the lung from a complete absence of tumor cells through dormant tumor clumps to developing metastases. The authors found no evidence either clinically or at autopsy, that the procedure had adversely affected the prognosis, except in one patient who died from pulmonary edema immediately after the operation.
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PMID:Surgical and pathologic complications associated with peritoneovenous shunts in management of malignant ascites. 397 77

The case of a 25-year-old man who had periosteal osteogenic sarcoma with intravascular metastases in unusual locations is reported. The patient presented with acute renal failure, unilateral pulmonary edema, functional mitral stenosis, and low cardiac output. After successful surgical removal of a left atrial metastasis with subsequent improvement in cardiac output, renal function improved only transiently and urinary output varied markedly. At autopsy, metastatic osteogenic sarcoma was discovered within the lumen of the abdominal aorta obstructing both renal arteries. The case is the first report of a neoplasm metastatic to the aorta causing intermittent bilateral renal arterial obstruction; it illustrates the diagnostic difficulties presented by intravascular metastatic disease.
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PMID:Metastatic periosteal osteosarcoma causing cardiac and renal failure. 657

Interleukin 12 (IL-12) enhances lysis mediated by NK- and lymphokine activated killer (LAK) cells. It also causes proliferation of IL-2 stimulated T and NK cells in vitro. For these IL-2 complementing properties murine pulmonary metastases of a coloncarcinoma line were treated with IL-12 and IL-2 or with the individual agents. Results were compared to sham treated controls. IL-2 alone mediated significant tumor reduction but provoked pulmonary edema and concomittand toxicity, graded in three steps. IL-12 combined with an IL-2 dose reduced by 81% still resulted in significant antitumoral activity. Toxicity, however, was not discernable from sham treated controls. IL-12 thus appears as an attractive cytokine for combination with IL-2 in antitumor therapy. Particularly treatment of tumors, like gastrointestinal tract cancers, so far mainly resistant to cell mediated antitumor therapy, might profit from this approach.
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PMID:Addition of interleukin 12 to low dose interleukin 2 treatment improves antitumor efficacy in vivo. 852 51

Chest radiographs are frequently requested on admission of patients with a clinical diagnosis of acute stroke. This study assesses their value in subsequent management of these patients. A retrospective analysis of 435 patients with a clinical diagnosis of acute stroke was made. All admission chest radiographs were reviewed to document both radiographic quality and any radiological abnormality. In those patients with an abnormal radiograph, clinical records were reviewed to assess their impact on clinical management. Eighty-six percent of patients had a chest radiograph performed on admission. 77.5% of these films were deemed to be technically unsatisfactory, the commonest problems being positioning and suboptimal inspiration. Radiological abnormality was demonstrated in 61 patients (16.4% of radiographs obtained). Clinical management was altered in 14 of the 61 patients (3.8% of the total number of patients radiographed). Radiological abnormality was missed by the admitting clinicians in four radiographs (1 hilar mass, 2 cases of consolidation, one of pulmonary oedema). One abnormality not clinically suspected was recorded (multiple metastases). We conclude that admission chest radiographs in patients with an acute stroke are not indicated in the absence of appropriate clinical indications.
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PMID:Is admission chest radiography of any clinical value in acute stroke patients? 868 26

One hundred patients operated for left atrial myxoma in the same surgical department underwent clinical and anatomical assessment at long-term from 1959 to July 1995 (66 women and 34 men, average age 52.2 years). The clinical presentation was related to mitral valve obstruction in half the cases (dyspnoea, cough, pulmonary oedema), the presentation in the other half of cases being very variable. The widespread use of echocardiography has relegated other investigations to a subsidiary role: auscultation, radiology, ECG (9 cases diagnosed by echocardiography performed for another indication). Serious complications of left atrial myxoma include systemic embolism : 37 cases out of the 100 in this series, including 10 plurifocal but mainly cerebral (19 cases including 11 isolated cerebral emboli). Surgical treatment is well established, should not be deferred and gives excellent results (2 early postoperative deaths out of 100 cases in the early years of the study). There were 6 cases of recurrences including 3 cases of Carney's syndrome. Clinico-pathological correlations showed that mitral stenotic effects occurred when the tumour diameter exceeded 5 cm and embolism was associated with tumours having multiple villositi. Histopathological analysis distinguished between active and inactive tumours, differentiated or not, and enabled the elaboration of hypotheses on the rate of growth of the tumour and on the absence of true metastases. Histopathological techniques also show the presence of lymphoplasmocytic infiltration, the sign of secretion of interleukin 6 by the myxoma, a cytokine involved in the general inflammatory process and which explains the unusual clinical presentation sometimes observed.
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PMID:[Myxoma of the left atrium, Clinical outcome of 100 operated patients]. 895 35

We evaluated the effects of the addition of escalating doses of tumor necrosis factor (TNF) to two fixed doses and schedules of a combination of interleukin-2 (IL-2) and interferon-alpha (IFN-alpha) to determine the maximum tolerated dose of this three-cytokine combination and its feasibility as an outpatient regimen. Eighteen patients with metastatic cancer were enrolled. Each course consisted of 3 consecutive weeks of treatment with IFN-alpha 9 x 10(6) IU/m2/day intramuscularly (i.m.) or subcutaneously (s.c.) days 1, 3, and 5 each week for 3 weeks plus IL-2 continuous infusion 1 x 10(6) IU/m2/day (group A) or 3 x 10(6) IU/m2/day (group B) days 1-5 each week for 3 weeks. TNF was administered only during the first week of each course intravenously (i.v.) for 2 h on days 1-5. The dose of TNF was escalated (40, 80, 120 micrograms/m2) in cohorts of 3 patients. The most common side effects were fever, chills, and fatigue in all patients. Grade 3-4 toxicity included anemia (3 patients), thrombocytopenia (1 patients), arrhythmia (2 patients), pulmonary edema (3 patients),- and weight loss (1 patient). Five patients withdrew from study due to toxicity. The combination of the three cytokines is feasible as an outpatient regimen in one of the following combinations: (a) TNF 80 micrograms/m2/day as 2-h infusion on days 1-5 + IL-2 1 x 10(6) IU/m2/day continuous infusion on days 1-5 for 3 weeks + IFN-alpha 9 x 10(6) IU/m2/day s.c. or i.m. on days 1, 3, and 5 for 3 weeks, or (b) TNF 40 micrograms/m2/day as a 2-h infusion on days 1-5 + IL-2 3 x 10(6) IU/m2/day continuous infusion on days 1-5 for 3 weeks + IFN-alpha 9 x 10(6) IU/m2/day s.c. or i.m. on days 1, 3, and 5 for 3 weeks.
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PMID:Phase I study combining tumor necrosis factor with interferon-alpha and interleukin-2. 934 39


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