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)

A 77-year-old male was admitted for the examination of post renal acute renal failure. Blood examination revealed renal dysfunction and elevation of carcinoembryonic antigen (CEA). Computed tomography and retrograde pyelography showed bilateral hydronephrosis due to ureteral stenosis. He died of renal failure and autopsy was done. Histologic findings showed moderately differentiated adenocarcinoma of the prostate associated with endometrioid and mucinous carcinoma, and metastases of retroperitoneal lymph nodes and multiple bones. Immunohistochemically, endometrioid carcinoma was positive for prostatic acid phosphate (PAP) and prostatic specific antigen (PSA), and negative for CEA. Mucinous carcinoma was negative for PAP and PSA, and positive for CEA. Including our case, 29 cases of endometrioid and 32 of mucinous carcinoma of the prostate reported in the Japanese literature are reviewed.
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PMID:[Prostatic adenocarcinoma showing features of endometrioid and mucinous carcinomas: a case report]. 853 79

This prospective, randomized, controlled trial from the University of Hong Kong evaluated the efficacy of perioperative parenteral nutrition (PN) in patients requiring hepatectomy for primary hepatocellular carcinoma. From September 1990 through June 1993, 150 consecutive patients with resectable hepatocellular carcinoma were randomly assigned to receive either perioperative PN (n = 75), in addition to usual oral diet, or to no additional therapy (oral diet alone without PN; n = 75). Excluding patients with metastatic disease, a total of 64 patients in the perioperative PN group (39 with associated cirrhosis, 18 with chronic active hepatitis, and 7 without associated liver disease) were compared to 60 control patients (33 with cirrhosis, 12 with chronic active hepatitis and 15 with no associated liver disease). PN was started 7 days before hepatic resection and continued for 7 days after operation in the experimental patients. The PN consisted of standard micronutrients, dextrose, lipid emulsion (containing 50 percent of lipid as medium-chain triglycerides, MCT) and amino acids enriched in branched-chain amino acids (BCAA, 35 percent of PN protein intake), and provided = 1.5 g protein/kg/day and 30 kcal/kg/day. PN was administered via a superior vena cava Broviac catheter cycled over 12 hours each evening preoperatively, and as a 24 hour infusion during the postoperative week. Control patients received only 5 percent dextrose in normal saline postoperatively, with volume and sodium content similar to the experimental PN-treated patients. All patients studied (experimental and control) received 25 grams of albumin intravenously for 5 days postoperatively, and all were allowed to consume enteral diet as tolerated throughout the entire study period. Preoperative assessment included standard anthropometric indices, serum chemistries and proteins, indocyanine green clearance (an index of hepatic function), hand grip strength, and immune function tests (serum immunoglobulin concentrations and peripheral lymphocyte stimulation by phytohemagglutinin). Postoperative assessment included the same preoperative indices (chemistries measured from days 1 to 8 post-operatively), and overall postoperative mortality and morbidity during the hospitalization. Morbidity indices included both infectious complications and non-infectious complications (eg, pleural effusion, ascites, renal failure, hepatic coma). The two groups of patients were similar in age, sex, total and percent weight loss, hepatic carcinoma stage, incidence of cirrhosis, and other preoperative indices. However, a higher percentage of patients in the PN group had abnormal preoperative hepatic function by indocyanine green clearance (67 vs 47%, p = 0.03). The proportion undergoing major hepatectomy and other important intraoperative factors were similar between groups. No significant difference in postoperative hospital mortality occurred between groups (PN 8% vs control 15%; p = 0.30), and PN use did not change hand-grip strength, skin-fold thickness or midarm circumference. However, a significant beneficial effect of PN on hospital morbidity was observed Perioperative PN use was associated with a significant reduction in the overall postoperative morbidity rate (PN group 34% vs control group 55%; p = 0.02). This difference was mainly due to a significant reduction in infectious complications (PN 17% vs control 37%; p = 0.01), and in the need for diuretic drugs to control ascites (PN 25% vs control 50%; p = 0.004). There were no differences between groups in serum immunoglobulins or lymphocyte response to mitogens. There was less deterioration of liver function with PN as measured by the change in the rate of indocyanine green clearance (PN group -2.8% loss vs control group -4.8% loss; p = 0.05). The attenuation of hepatic function loss with PN occurred despite a significant rise in serum transaminase values from days 5 to 8 postoperatively. PN therapy was also associated with le
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PMID:Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. 878 71

Between 1980 and 1995, 13 patients with end-stage renal disease due to Wegener's granulomatosis received 14 renal transplants (10 cadaveric, 4 living related). The mean follow-up in the 13 successfully transplanted patients was 50 months (4-107 months). One patient had primary nonfunction and received another graft 4 months later. Three episodes of acute rejection occurred in two patients, and one of these patients lost her graft due to severe vascular rejection 4 months after transplantation. Two patients died with well-functioning grafts (one of metastatic cancer and one of sepsis). One patient presented with perisinusitis and had a mild recurrence of Wegener's disease. None of the patients developed recurrent disease in the transplanted organ. At the last follow-up, the mean creatinine (+/-SD) in the 12 patients with functioning grafts was 1.6 +/- 0.6 mgdl. We conclude that renal transplantation is an excellent treatment for renal failure due to Wegener's granulomatosis. Recurrence of the disease is uncommon in patients under immunosuppression, but careful monitoring is extremely important.
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PMID:Single-center experience with renal transplantation in patients with Wegener's granulomatosis. 909 4

Primary renal angiosarcoma is very rare. To our knowledge, only 15 cases have been reported to date. A 77-year-old Japanese man with a unilateral kidney presented with massive hematuria followed by renal failure. A renal tumor was suspected and a left nephrectomy was performed. The histopathological diagnosis was angiosarcoma of the kidney. A hemorrhagic tumor measuring 10 x 5 cm and clotted blood was found in the medullary area. The atypical tumor cells had a sinusoidal and solid appearance, and showed immunohistochemically positive reactions for some of the endothelial markers. The patient died about 21 months after the nephrectomy and the autopsy revealed massive metastases to the liver and retroperitoneum. One of the differential diagnoses of the case was angiomyolipoma, because the tumor cells were relatively bland in their histological appearance with entrapped fat cells in the pelvic area. Fifteen case reports with titles that included the term 'hemangiosarcoma/angiosarcoma', 'hemangioendothelioma/endothelioma' or 'vascular sarcoma' of the kidney were reviewed and compared to the present case.
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PMID:Primary renal angiosarcoma: a case report and review of the literature. 941 38

A single line source brachytherapy (BT) technique has been developed at Clatterbridge to boost the dose to the primary tumour after whole pelvis external beam radiotherapy (EBRT) for the radical treatment of carcinoma of the cervix. 226 patients with invasive carcinoma of the uterine cervix were treated with radiotherapy alone using this technique (median age 57 years; range 25-87 years). 49 patients had Stage IB disease, 97 had Stage II, 73 had Stage III and seven patients had biopsy confirmed Stage IVA disease. Patients with low bulk disease were given 40-42.5 Gy in 20 fractions while those with bulky disease received 45 Gy in 20 fractions or 50 Gy in 25 fractions. On completion of EBRT, 186 patients (82.3%) proceeded to intracavitary BT using a linear arrangement of sources with the Selectron (Nucletron) remote afterloading unit. Most of the patients (137/226, 60.6%) received a single insertion of 20 Gy to point "A", at a preferred dose rate within the range 0.95-1.05 Gy h-1. In another 30 patients (13.3%), BT was possible at a later date after further tumour regression. Only 10 patients (4.4%) did not receive BT as part of their treatment. The 5 year actuarial cause-specific survival rate was 79% in Stage I disease, 61% in Stage II, 31% in Stage III and 71% in the small number of patients with Stage IVA disease. The 5 year pelvic control rates were 88% for Stage I, 69% for Stage II, 45% for Stage III and 71% for Stage IVA. Significant prognostic variables for survival and local pelvic control on univariate analysis included disease stage, patient age, tumour bulk, nodal status, anaemia, renal failure and overall treatment time. Tumour grade was a significant prognostic variable for survival but not for local tumour control. The extent of parametrial involvement was a significant prognostic variable for survival and local control for Stage IIB but not for Stage IIIB. There was a statistically significant decrease in survival and local tumour control for patients receiving > or = 70 Gy to point "A", or > or = 55 Gy to point "B". On multivariate analysis, the independent prognostic variables for survival and local control were disease stage, overall treatment time and renal failure. Patient age was also an independent prognostic variable for survival while nodal status was an independent prognostic variable for local control. A high proportion of the patients had adverse prognostic features resulting in a very high actuarial risk of distant metastases of 38.1% at 5 years (68.8% for Stage III patients). The overall treatment time was significantly longer in Stage III patients compared with Stage I and Stage II patients. The actuarial rate of Grade 2 late radiation morbidity was 2.7% and 4.3% for the urinary tract and bowel respectively while that of Grade 3 morbidity was only 0.6% and 1.4%, respectively. Good local control can be achieved for patients with nonbulky tumours using relatively low biological doses while minimizing the risk of late treatment related toxicity. Several changes in treatment policy have been made in an attempt to improve local tumour control and possibly survival, particularly for Stage III patients and patients with bulky disease.
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PMID:An audit of the treatment of carcinoma of the uterine cervix using external beam radiotherapy and a single line source brachytherapy technique. 950 45

Immunosuppression in the setting of solid organ transplantation is associated with the development of a variety of malignant tumors, most commonly squamous carcinomas and non-Hodgkin's lymphomas. Sarcomas, apart from Kaposi's sarcoma, are relatively infrequent. We recently encountered a 71-year-old man with chronic renal failure, treated by allograft kidney transplantation, who developed a high-grade epithelioid angiosarcoma at the site of a nonfunctioning arteriovenous fistula, previously constructed for hemodialysis. At diagnosis, the patient had numerous satellite nodules of angiosarcoma involving the distal skin, soft tissues, and bones. After a below-elbow amputation, there was a rapid local recurrence at the amputation stump. Currently, the patient is alive with numerous pulmonary metastases, 6 months after amputation. A literature review identified three recently reported identical cases of epithelioid angiosarcoma arising in nonfunctioning arteriovenous fistulae. All three patients had been treated by kidney transplantation for renal failure, suggesting a possible causal association between these events. We performed polymerase chain reaction for human herpes virus 8, the recently recognized herpes virus proposed as a major etiologic agent of Kaposi's sarcoma, and possibly some conventional angiosarcomas, but we failed to identify any viral DNA within the tumor.
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PMID:Epithelioid angiosarcoma arising in a surgically constructed arteriovenous fistula: a rare complication of chronic immunosuppression in the setting of renal transplantation. 973 50

An improved quality of life secondary to reduced chemotherapy toxicity is an important end point in the treatment of all patients with metastatic cancer. In this review, we have demonstrated that gemcitabine and gemcitabine/cisplatin combinations appear to have a reduced toxicity profile compared with MVAC. Phase II studies with gemcitabine and cisplatin have shown good response rates that are possibly equivalent to MVAC, and a Phase III trial is now completed. Similar data have been reported for the paclitaxel/carboplatin combination and a Phase III trial comparing that combination with MVAC is planned. For patients with TCC who are in mild renal failure or who have significant underlying medical conditions, gemcitabine can also be considered as a reasonable single agent therapy. Complete responses can be seen, even in patients who are older than the age of 70. Moore et al., for example, demonstrated near complete responses to gemcitabine monotherapy in 4 patients older than 80 years of age. In conclusion, chemotherapy options for patients with metastatic bladder cancer have changed significantly with the addition of gemcitabine and other drugs to the armentarium. The integration of gemcitabine into the initial chemotherapy plan for these patients is still being developed. It is clear that this agent should be included in the management discussions of all patients with metastatic bladder cancer.
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PMID:Gemcitabine and other new chemotherapeutic agents for the treatment of metastatic bladder cancer. 993 34

Isolated perfusion of the extremities with high-dose tumour necrosis factor alpha (TNF-alpha) plus melphalan leads to dramatic tumour response in patients with irresectable soft tissue sarcoma or multiple melanoma in transit metastases. We developed in vivo isolated organ perfusion models to determine whether similar tumour responses in solid organ tumours can be obtained with this regimen. Here, we describe the technique of isolated kidney perfusion. We studied the feasibility of a perfusion with TNF-alpha and assessed its anti-tumour effects in tumour models differing in tumour vasculature. The maximal tolerated dose (MTD) proved to be only 1 microg TNF-alpha. Higher doses appeared to induce renal failure and a secondary cytokine release with fatal respiratory and septic shock-like symptoms. In vitro, the combination of TNF-alpha and melphalan did not result in a synergistic growth-inhibiting effect on CC 531 colon adenocarcinoma cells, whereas an additive effect was observed on osteosarcoma ROS-1 cells. In vivo isolated kidney perfusion, with TNF-alpha alone or in combination with melphalan, did not result in a significant anti-tumour response in either tumour model in a subrenal capsule assay. We conclude that, because of the susceptibility of the kidney to perfusion with TNF-alpha, the minimal threshold concentration of TNF-alpha to exert its anti-tumour effects was not reached. The applicability of TNF-alpha in isolated kidney perfusion for human tumours seems, therefore, questionable.
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PMID:In vivo isolated kidney perfusion with tumour necrosis factor alpha (TNF-alpha) in tumour-bearing rats. 1002 9

Renal failure in association with uveitis should raise the possibility of sarcoidosis even with a normal chest radiograph. Diode laser photocoagulation using the indirect ophthalmoscope delivery system is shown to be safe in the therapy of eyes with threshold retinopathy of prematurity and especially in eyes with tunica vasculosa lentis and is safer than argon laser, which is known to cause cataract formation. Eyes with retinopathy of prematurity stage 5 remain with a flat electroretinogram despite surgical reattachment, implying the existence of a severe irreversible dysfunction in these retinas. Choroidal metastases from prostate carcinoma can resolve after total androgen deprivation. Optic nerve metastases respond poorly to the radiation dose usually given for choroidal metastases and therefore require a higher dosage of radiation.
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PMID:Ocular manifestations of various systemic diseases. 1016 61

In adults, the haemolytic-uraemic syndrome (HUS) is associated with probable causative factors in the minority of all cases. Cytotoxic drugs are one of these potential causative agents. Although metastatic cancer by itself is a recognized risk-factor for the development of HUS, therapy with mitomycin-C, with cis-platinum, and with bleomycin carries a significant, albeit extremely small, risk for the development of HUS, compared with all other cytotoxic drugs. Gemcitabine is a novel cytotoxic drug with promising activity against pancreatic adenocarcinoma. We are reporting on one patient with metastatic duodenal papillary carcinoma developing HUS while on weekly gemcitabine therapy. The presenting features in this patient were non-cardiac pulmonary oedema, renal failure, thrombocytopenia and haemolytic anaemia. The diagnosis of HUS was made on the day of admission of the patient to this institution. Upon aggressive therapy, including one single haemodialysis and five plasmaphereses, the patient recovered uneventfully, with modestly elevated creatinine-values as a remnant of the acute illness. Re-exposure to gemcitabine 6 months after the episode of HUS instituted for progressive carcinoma, thus far has not caused another episode of HUS.
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PMID:Elevated reticulocyte count--a clue to the diagnosis of haemolytic-uraemic syndrome (HUS) associated with gemcitabine therapy for metastatic duodenal papillary carcinoma: a case report. 1018


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