Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spinal epidural metastases were detected in 75 of 140 cancer patients with back pain who were evaluated prospectively by clinical criteria, spine roentgenography, and bone scan. Fifty-five of the 75 patients with epidural metastases had no evidence of myelopathy when diagnosed. Of the patients diagnosed and treated while still ambulatory, more than 90% remained so. Myelograms were performed in 127 patients to diagnose the 75 with epidural disease. To try to reduce the number of myelograms needed, we attempted to design radiotherapy ports based on clinical symptoms and the plain spine films alone. A port could not be designed for 64 of the 127 patients, either because of diffuse vertebral metastases or a normal plain roentgenogram. A port could be designed for 63 patients, and all epidural disease would have been encompassed in 50 of the 54 patients who had spinal epidural metastases (93%). Most patients with cancer and back pain require myelography for accurate treatment planning. There are, however, situations in which treatment can be determined based on symptoms and plain films alone, with a low risk of missing epidural cancer.
 ...
PMID:Early detection and treatment of spinal epidural metastases: the role of myelography. 294 91

Seventy-two cases of acute non-traumatic myelopathy in which walking became impossible within one week after the onset of paralysis were investigated. Fifty-one cases (71%) consisted of mass lesions requiring surgery, such as metastatic spine tumors, hemangioma of spinal cord and hematoma within the spinal canal. Others were 6 cases of anterior spinal artery syndrome and 15 cases of undetermined diagnosis. Pain preceding paralysis or paralysis itself was the initial symptom in 64% of the spinal metastases. Severe pain followed by rapidly progressive paralysis was associated with the vascular lesions. Myelography was generally the most useful diagnostic tool of mass lesions and angiography was also useful in vascular lesions. Walking ability was recovered in 23 of 47 cases after spinal decompression. Postoperative recovery was especially marked when operation was done in the stage of incomplete paralysis. Locating the mass lesion and timely decompression were the most important approaches for handling these conditions.
 ...
PMID:[A clinical study on acute non-traumatic myelopathies]. 324 1

We have previously reported an algorithm that invokes several imaging modalities in the early detection of metastatic and benign disease of the spine in patients with cancer (J Clin Oncol 4:576, 1986). The development of new lesions (shown by Tc99m bone scans) in cancer patients with normal neurological examinations is further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M). Of 60 patients in the original study, 28% were diagnosed as having only benign disease and the remainder had spinal metastases. Thecal sac impingement was seen in 47% of patients with metastatic disease and disruption of the posterior vertebral cortex was noted in all patients with epidural compression. We now report the 2-year follow-up of 55 of these patients. Without treatment, the 17 patients diagnosed with benign disease have shown no evidence of local failure in the spine and median survival is greater than 27 months. Thirty-eight patients diagnosed with spinal metastases had a median survival time of 16.9 months. Radiation therapy directed by CT-M findings provided pain relief in 78% of patients with back pain and metastatic disease. No patient, including 19 with thecal sac impingement, developed clinical myelopathy. These results demonstrate the usefulness of an imaging algorithm for the early identification and distinction of spinal metastatic disease and benign disease in patients with cancer.
 ...
PMID:Clinical usefulness of an algorithm for the early diagnosis of spinal metastatic disease. 333 87

The diagnosis of intramedullary spinal cord metastasis (ISM) is difficult, and treatment is usually ineffective. We review our own experience with ISM as well as the pertinent medical literature, and suggest a practical diagnostic and therapeutic approach. The problem of the diagnosis of ISM is essentially that of the differential diagnosis of a noncompressive myelopathy in a patient with systemic cancer. Most such patients prove to have ISM, meningeal carcinomatosis, radiation myelopathy, or paraneoplastic necrotizing myelopathy. Neurologic features of value in this differential diagnosis are pain, the tempo and mode of progression of symptoms, and tumor cells in the spinal fluid. Oncologic features of value are the location of the primary tumor, the past exposure to therapeutic radiation, cerebral metastases, and the extent of systemic metastatic disease. The myelogram in ISM is either normal or nonspecifically abnormal; therefore, the diagnosis must be made on clinical grounds. Although no single finding is diagnostic of ISM, a careful clinical analysis will lead to the correct diagnosis in most cases. Radiation therapy is effective treatment for ISM, but only if it is administered early, before paraplegia supervenes. Thus, the diagnosis should be made and treatment begun as soon as possible. Intramedullary spinal cord metastasis is often multifocal rather than solitary; therefore, whole-cord rather than local spinal radiation should be given, if possible. If local radiotherapy is chosen, the construction of the portal can be based on the myelogram or, in the event of a normal study, on the clinical localization of the tumor.
 ...
PMID:Intramedullary spinal cord metastasis. Diagnostic and therapeutic considerations. 357 64

Spinal involvement by systemic malignancy is common, and often leads to extradural compression of the spinal cord and/or nerve roots by metastases. Rapid, anatomically accurate diagnosis is essential to the successful management of these patients. We compared spinal magnetic resonance imaging (MRI) with conventional myelography in a series of 31 cancer patients being evaluated for myelopathy (N = 10), or back/radicular pain (N = 21). All patients were evaluated between April 1985 and July 1986, and underwent both studies within ten days of each other (median, two days). MRI was performed on a 0.5 Tesla Technicare unit with a body surface coil, and results compared with standard contrast myelography. All studies were reviewed separately and in a "blinded" fashion. MRI and myelography were comparable in detecting large lesions that produced complete subarachnoid block (five of ten patients with myelopathy, three of twenty-one patients with back/radicular pain). In 19 of 31 patients, smaller but clinically significant extradural lesions were found. In nine of 19 cases, these lesions were demonstrated equally well by both modalities; in nine of 19 cases, these lesions were demonstrated by myelography alone; in one of 19, a lesion was demonstrated by MRI alone. Given our current technology, myelography appeared superior to MRI as a single imaging modality. However, MRI may be an alternative in patients where total myelography is technically impossible or unusually hazardous.
 ...
PMID:Comparison of spinal magnetic resonance imaging and myelography in cancer patients. 365 63

The clinical and pathological findings in nine cases of intramedullary spinal cord metastases are reported and are compared with those of previous studies. Intramedullary metastases are more common than is generally believed and the incidence is probably increasing with the more prolonged survival of cancer patients. A wide spectrum of symptoms and signs may be produced, frequently with attendant diagnostic difficulties. Most patients present with myelopathy as the first manifestation of cancer or of its recurrence. Symptoms may be present for several months, with few clinical signs, despite distortion and destruction of much of the spinal cord by tumour. The extent of metastatic disease remains limited in a significant proportion of patients. No neurological symptoms or signs differentiate intramedullary metastases clearly from the more common extradural deposits. However, the diagnosis should be considered when myelopathy evolves more slowly, where plain radiographic evidence of adjacent vertebral disease is absent, and particularly when myelography is normal. Early diagnosis and aggressive medical treatment may provide for a more favourable outcome.
 ...
PMID:Intramedullary spinal cord metastases: a clinical and pathological study of nine cases. 365 45

Rheumatoid arthritis and metastatic cancer occur commonly in the elderly, and may cause neck pain. Rheumatoid arthritis may produce cervical radiculopathy and myelopathy resulting from vertebral body subluxation, although radiological manifestations of subluxation are much more common than neurological dysfunction. Cervical spinal cord compression is a neurological emergency and may produce cervical radiculopathy as well as myelopathy. Careful neurological and radiological assessments are required to minimize pain and preserve neurological function in elderly patients suffering from neck pain complicating rheumatoid arthritis or cervical spinal metastasis.
 ...
PMID:Neck pain in the elderly: a management review. Part II. 380 32

A variety of spinal pathological processes demonstrated by intraoperative ultrasound is presented. Use of spinal ultrasound proved helpful in viewing alignment, assessing spinal cord pathology, and viewing anterior to the cord in cases of spinal trauma. As an operative adjunct, ultrasound was especially helpful for viewing extradural spinal metastases and cavitary lesions of the spinal cord, such as syrinxes, cystic tumors, and hematomas. In cases of spondylotic myelopathy, intraoperative ultrasound allowed assessment of the adequacy of the decompression, the space ventral to the cord, and the size and configuration of the spinal cord.
 ...
PMID:Intraoperative ultrasound for spinal lesions. 388 1

Between 1975 and 1978, 343 evaluable male patients with a diagnosis of locally advanced lung cancer of all cell types were entered in Protocol 15. The patients had unresectable or inoperable tumor limited to one hemithorax and no evidence of distant metastases. The cell-type distribution was as follows: squamous cell carcinoma (Sq CC) 137 (40%); positive cytology 66 (19%); large cell carcinoma 57 (17%); small cell carcinoma (SCC) 46 (13%) and adenocarcinoma 37 (11%). An intermediate course of irradiation (ICI) of 5000 rads in 25 fractions, 200 rads each, in 5 weeks was compared with a short course of irradiation (SCI) of 4200 rads in 15 fractions, 280 rads each, in 3 weeks (equal Nominal Standard Dose). The effectiveness of low dose irradiation to control subclinical brain metastases was studied and was reported separately. The median survival for all 343 patients was 38 weeks. There was no significant difference in survival, response and control rate between the 191 ICI and the 152 SCI patients. The following factors had a significant individual influence on survival: initial performance status, ambulatory vs. nonambulatory, P = 0.006; histology, Sq CC vs. other cell types (OCT), P = 0.0007; prior surgery, less than 6 weeks vs. greater than 6 weeks, p = 0.04; tumor size, diameter less than 6 cm vs. greater than 6 cm, P = 0.05 and weight loss less than 5% vs. greater than 5% in the previous 6 months, P = 0.01. The overall response rate (CR or PR) was 38%. The median duration of response was shorter for the ICI group when compared with the SCI group, 18.4 vs. 34.4 weeks, P = 0.02. The presence of partial or complete response enhanced the median survival 50 vs. 31 weeks. Cell type, Sq CC vs. OCT was an important factor for the duration of response, 49 vs. 21 weeks, P = 0.0006. The complication rate was similar for the 191 ICI patients when compared with the 152 SCI patients. There were however, two patients with radiation myelopathy among the SCI patients and none among the ICI patients.
 ...
PMID:Radiotherapy in the management of locally advanced lung cancer of all cell types: final report of randomized trial. 626 83

Early signs of spinal cord injury on neurologic examination have been the primary indication to proceed with myelography in patients with possible spinal epidural metastases. With this approach, loss of ambulation occurs in more than one half of the patients. In an attempt to diagnose epidural metastases before the onset of myelopathy, we designed a prospective study based on the development of back pain, a precursor of spinal cord injury in nearly all cancer patients. Eighty-seven patients were studied. A high incidence of epidural metastases was found in patients with myelopathy (78 percent). In addition, patients with radiculopathy alone frequently had epidural tumor (61 percent). In 36 percent of the patients who presented with back pain but who had normal neurologic findings, there was evidence of epidural metastases on myelography; all of those patients had vertebral metastases on plain roentgenogram. Over-all, the plain roentgenogram of the spine correctly predicted the presence or absence of epidural tumor in 83 percent of the patients. Whereas 93 percent of the patients with myelopathy had more than 75 percent myelographic block, this occurred in 53 percent of those with radiculopathy and in only 33 percent of those with back pain and normal neurologic findings. In most cancer patients, spinal epidural metastases are both detectable and significantly less extensive before the onset of spinal cord injury.
 ...
PMID:Early diagnosis of spinal epidural metastases. 645 30


<< Previous 1 2 3 4 5 6 7 8 9 Next >>