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

Nine cases of untreatable tumour in which radical surgery was employed palliatively are presented. Three hemipelvectomies for recurrent rhabdomyosarcoma were performed. In one case, death occurred postoperatively, probably as a result of pulmonary embolism. One patient survived for 8 months, while the other is still alive after three years. Of two cases in which interscapulothoracic disarticulation was performed, survivals of 9 and 5 months were observed in subjects with fibrosarcoma in a mastectomy site and recurrent sarcoma of the humerus with ling metastases. Survival to 7 months was obtained in a case of sarcoma of the maxilla, while three patients with squama cell cancer of the mouth floor, chondrosarcoma of the mandible and botryoid sarcoma of the tonsillar fossa are still living after periods of 10 months to 2 yr. Though devoid of schematic indications, palliative demolition surgery can be considered in borderline cases where the operative risk is not high. Irrespective of "quantity", the "quality" of life remaining to the patients can be made compatible with the psychophysiological limits of the human personality.
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PMID:[Palliative demolitive surgery]. 4 19

1351 patients with lung resection were analyzed. Lethality during hospital treatment was 6.2%. 11 patients, who died during the 6 first weeks after the resection, had occult metastases. The causes of death among these 6.2% were pulmonary embolism (40.5%), insufficiency of the bronchial stump and following complications (17.9%), pneumonia (10.7%), cardiorespiratory failure (9.5%) and intraabdominal complications (8.3%). Improving these figures should begin with reducing the cases with pulmonary embolism.
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PMID:[Mortality rate after lung resection for bronchial carcinoma (author's transl)]. 19 45

A patient is described, with a history of pain in the neck, followed by a slowly progressive loss of muscle strength in both arms, followed by tetraplegia. Medical history included laryngectomy with partial hypopharyngectomy preceded by radiotherapy, because of carcinoma. X-ray of the cervical spine was suggestive for metastases. The patient died as a consequence of massive pulmonary embolism and at autopsy the cause of the neurological deficit turned out to be vertebral osteomyelitis and epidural abscess due to mucormycosis.
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PMID:Vertebral osteomyelitis and epidural abcess due to mucormycosis, a case report. 22 96

Documented rarity, diagnostic difficulty and poor results stimulated this study of 79 malignant and 37 benign small bowel tumors in order to emphasize these lesions, determine their symptomatology and improve diagnosis and results, particularly in the malignant group. Chief symptoms were recurrent abdominal pain and tenderness, signs of obstruction and gastrointestinal bleeding. Fourteen cases were asymptomatic. The mean symptom-diagnosis interval was 6.6 months. Roentgenographic contrast studies were helpful in diagnosing 33 of 43 patients, with false negatives in 10. Laboratory studies were usually not helpful. Metastases were present at the time of surgery in approximately 58%. In the malignant group curative procedures were performed in 36 and palliative in 43, with an operative mortality of 10%. Five and 10 year survival rates were respectively 21/51 (41.2%) and 8/38 (21.2%) for malignancies. Individual 5 and 10 year survival rates were respectively as follows: carcinoid 11/15, 4/8; undifferentiated carcinoma 3/5, 1/3; lymphoma 3/11, 1/9; leiomyosarcoma 2/7, 1/6 and adenocarcinoma 2/13, 1/12. In the benign group results were excellent, except for one death from pulmonary embolism. The study suggests that if results with malignant small bowel tumors are to be improved, prompt diagnostic study and early consideration of laparotomy in patients with suggestive symptoms is mandatory.
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PMID:The small bowel tumor problem: an assessment based on a 20 year experience with 116 cases. 45 45

Analysis of the clinical and autopsy reports of 200 deaths following surgery for colorectal cancer from 1956 to 1974, at the Dept. of Surgery, University of Heidelberg, revealed that pneumonia (24.5%) was the most common cause of death followed by peritonitis (22%), pulmonary embolism (15.5%), advanced tumor disease (14%), cardiac failure (9.5%), ileus (5.5%), and others (9%). The explanation for the postoperative mortality rate of 12% (cancer of colon) and 13.2% (cancer of rectum) lies in the fact that 82.5% of those who died postoperatively were beyond the age of 60, and 40.5% beyond 70 years at the time of surgery. Moreover, in 50.5% advanced tumors with regional and/or distant metastases were found. In 55.5% severe preoperative complications (ileus: 38%, peritonitis: 11%, abscess formation or hemorrhage: 6.5%) required an emergency operation. Only 38.5% of the procedures were considered for cure. Besides the need for early recognition of the cancer, intensification of pre- and postoper treatment appears to be the predominant task in the effort to decrease postoperative mortality.
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PMID:[Analysis of postoperative deaths in colon and rectal cancer (author's transl)]. 84 78

Causes of death of 260 tumorous patients autopsied in 1974 were analyzed. Most common causes were inflammation and tumorous and non-tumorous organ insufficiencies; the others, in order of decreasing incidence, massive tumorous dissemination, infarct and haemorrhage. Pneumonia was predominating over the inflammatory causes although peritonitis and sepsis were also not rarely encountered. Death due to inflammation occurred most frequently in cases of myeloid-lymphoid, urogenital and gastro-intestinal tumours and in postoperative states. The incidence of insufficiencies due to tumorous or non-tumorous origin differed but slightly. Of the various organ insufficiencies, massive hepatic metastases, occlusion of the biliary duct and cardiac failure were the most common. In cases of tumors of the small pelvis, compression of the ureters led most often to death. Massive dissemination was observed most of all in breast and ovarian carcinomas. Myeloid-lymphoid tumors led to death through extensive organ infiltration in about one thirds of the cases. After hearth infarction, venous thrombosis was often followed by pulmonary embolism, however, coronary occlusion was also not rare. Death due to haemorrhage originated from acute or chronic ulcers of the gastrointestinal tract or from vascular invasion of tumors in the head and neck regions or from thrombocytopaenia induced by cytostatics.
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PMID:[Causes of death in cancer patients]. 92 45

Fifty-five patients of mean age 69 (range 41-96) years with rectal cancer (Dukes' A:B:C, 11:24:20) underwent anterior resection using a double stapling technique under the care of one consultant surgeon between 1983 and 1988. The mean distance of the anastomosis from the anal margin was 7.2 (range 4-13) cm. The clinical leak rate was 9 per cent (five patients). There were three postoperative deaths from pulmonary embolism, lower limb ischaemia and renal failure. On prospective follow-up, 35 patients had no evidence of local or systemic cancer a median of 32 (range 24-84) months after operation; seven have died from unrelated diseases and ten from metastatic cancer. Pelvic recurrence, in four patients at 9, 11, 12 and 50 months, has occurred only in association with widespread metastasis. These results suggest that the theoretical risks of an increase in the local recurrence rate of rectal cancer after resection using a double stapling technique are not substantiated.
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PMID:Local recurrence after anterior resection for rectal cancer using a double stapling technique. 139 88

The case history is reported of a patient with an invasion of the inferior vena cava by metastases of a non-seminomatous testicular tumour. He was treated with combination chemotherapy, followed by laparotomy and resection of residual tumour tissue. Fourteen months after this operation he is in good health. For every retroperitoneal lymph node dissection it is necessary to be on the look-out for invasion of the vena cava, because of the risk of a sudden pulmonary embolism.
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PMID:Haematogenous tumour growth in the inferior vena cava in a patient with a nonseminomatous testicular tumour. 194 92

In 1985, as a result of the high complication rate associated with anticoagulants in patients who have cancer and deep venous thrombosis (DVT) and/or pulmonary embolism (PE), we established a policy of placing Greenfield filters (GFs) as primary therapy instead of anticoagulation. Since 1985 we have been asked to consult in the treatment of 18 patients with cancer and with DVT and/or PE, and we have placed a GF in each of these patients. This represented 34% (18/53) of the filters placed during that same period. Over the same 4-year period, 11 patients with cancer and DVT and/or PE underwent anticoagulation therapy. The purpose of this study was to compare the results of anticoagulation versus GF insertion in these two groups of patients. A significantly higher number of major complications (n = 4) occurred in the anticoagulation group (p less than 0.05, Fisher's exact test) than in the GF group (n = 0). The four complications that occurred in the anticoagulation group included three bleeding episodes (tumor bleeding, gastrointestinal bleeding, and hip hematoma) and one PE, despite adequate anticoagulation. Two patients died as a direct result of these complications (PE and gastrointestinal bleeding). The three patients with bleeding complications each required a transfusion of more than 3 units of blood. All four of the patients with complications had metastatic disease (pancreatic carcinoma, chronic lymphocytic leukemia, prostate carcinoma, and uterine carcinoma). Although this is a small, nonrandomized, nonprospective study, the data seem to indicate that GF placement is safer than anticoagulation for DVT or PE in patients with cancer and particularly in patients with metastatic disease. We conclude that GF insertions may be a better primary treatment than anticoagulation.
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PMID:Greenfield filter as primary therapy for deep venous thrombosis and/or pulmonary embolism in patients with cancer. 198 34

In contrast to pulmonary parenchyma metastases or lymphangitic carcinomatosis, neoplastic emboli of small pulmonary arteries and capillaries frequently go unrecognized and are only discovered at autopsy. Five patients (48 +/- 12 years old) were admitted to 3 intensive care units for severe acute respiratory failure and died between the first and the tenth day following hospitalization. Each patient had a history of rapidly progressive dyspnea, and physical examination showed clinical evidence of right ventricular failure. The lungs were clear on chest X-rays and the ECG revealed sinus tachycardia with a right QRS axis. The mean partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were, respectively, 50.8 +/- 9.1 mm Hg and 22.2 +/- 2.4 mm Hg. A swan-Ganz catheter, inserted into 4 patients, revealed pulmonary arterial hypertension (55, 43, 37, 28) with capillary wedge pressure within the normal limits and cardiac output normal or low (3.0, 3.8, 4.4, 5.0 l/min). Pulmonary angiograms from each patient showed decreased distal lung perfusion without any proximal defects suggestive of pulmonary embolism. The inferior vena cava always appeared clear. Malignant cells were found upon autopsy (4 cases) in the lumina of the pulmonary arterioles and the primary site of the cancer was determined in 3 patients (2 hepatomas and 1 pancreatic carcinoma). The last patient had a known breast cancer with bone marrow metastases and clinical, hemodynamic and angiographic evidence of neoplastic emboli. The clinical course of neoplastic emboli can suggest acute pulmonary embolism, but the diagnosis can only be advanced after pulmonary angiography, especially if the patient is to have a cancer.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute respiratory distress caused by distal neoplastic pulmonary emboli]. 209 8


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