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)

Periosteal reaction with spicule formation is very rare in metastatic bone disease, as only 75 cases are reported in the literature. Although prostatic cancer often metastasizes to the spine, spiculation here has not been reported. We present the first two cases of vertebral metastases from prostatic carcinoma with spicule formation giving rise to osseous spinal stenosis and neurological deficits, best demonstrated by CT.
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PMID:Spiculated vertebral metastases from prostatic carcinoma. Report of first two cases. 223 98

During a 6 month period, 50 patients with signs and symptoms referable to the cervical spine were studied with a 0.6 T superconducting magnetic resonance (MR) imaging unit. The last 23 of these 50 patients were studied with combined multislice and multiecho techniques. In 38 of the 50 patients, abnormalities were demonstrated on MR images. Intramedullary lesions included syringomyelia (three cases), primary tumors (two), metastatic neoplasm (one), cord atrophy secondary to trauma (one), and multiple sclerosis (one). Intradural, extramedullary lesions included two neurofibromas and two Chiari malformations. The rest of the lesions were extradural: degenerative changes (10), spinal stenosis with cord compression (five), disk degeneration and/or herniation (five), postoperative changes (four), metastases to bone/epidural disease (three), and neurofibromatosis (one). Two patients had more than one abnormality. The MR findings were compared with available routine radiographs, computed tomographic (CT) scans with and without metrizamide, and myelograms. MR imaging was consistently better than routine CT scanning in the detection of lesions of the spinal cord and in directly imaging the effects on the spinal cord of extrinsic abnormalities such as spinal stenosis. Metrizamide-enhanced CT scanning detected all cases of syringomyelia, but it involved an invasive procedure. Myelography alone was slightly less sensitive and considerably less specific than MR in detecting intramedullary lesions and in distinguishing cord neoplasms from syringomyelia. Multislice, multiecho techniques with up to 240 msec echo times (TEs) were particularly helpful in the detection and characterization of extradural processes.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:0.6 T MR imaging of the cervical spine: multislice and multiecho techniques. 392 Aug 81

One hundred and seventy-four patients with orthopedic and musculoskeletal problems received computed tomography (CT) scans between January 1979 and July 1980. There were 34 trauma patients, 35 patients with known or suspected primary tumors, 20 patients with metastases, 18 patients with suspected spinal stenosis, 25 patients with disc problems, five patients with infections, 13 children with congenital anomalies, and 24 patients with miscellaneous problems. The CT scans proved useful in all the pediatric cases, 97% of the trauma patients, and in the majority of patients with tumors. It appears that absolute indications for CT scanning in orthopedic patients include acute trauma to the spine, pelvis, hip, and shoulder girdles as well as in children with congenital spinal anomalies. Relative indications include determining the extent of the tumor and also aiding in the correct approach for biopsying a lesion.
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PMID:Efficacy of CT scanning in a group of 174 patients with orthopedic and musculoskeletal problems. 733 Jun 69

Low back pain is a common complaint in primary care practice, particularly among older patients. The office-based workup starts with a careful history aimed at determining the onset, location, and severity of pain. A physical examination includes attention to gait, palpation, and some simple neurologic tests. Most patients require plain x-rays. Bone scans are useful for identifying suspected tumors and infections; CT and MRI are indicated in specific cases. Although the origin of most low back pain is indeterminate, the workup may uncover some important causes in older adults, including lumbar spinal stenosis, osteoporotic vertebral fractures, and metastatic disease to the spine.
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PMID:Low back pain: how to make the diagnosis in the older patient. 808 59

Two hundred one consecutive patients with cancer pain who received intrathecal pain treatment between 1985 and 1993 were included in this retrospective study undertaken to test the hypothesis that epidural metastasis is a common cause of "refractory" cancer pain and that its presence may affect the efficacy and the complication rates of intraspinal pain treatment. Fifty-seven (approximately 28%) patients were investigated by metrizamide myelography, computerized tomography (CT), magnetic resonance imaging (MRI), laminectomy, or neurohistopathology. Epidural metastases were found in 40 (70%) and spinal stenosis in 33 (approximately 58%); 7 patients with total and 26 with partial occlusion of the spinal canal. Presence of epidural metastasis affected catheter insertion complications, daily dosages, and complications of the intrathecal pain treatment only when it was associated with spinal canal stenosis (partial or total). During the period of the intrathecal treatment, the patients with confirmed epidural metastasis and total spinal canal stenosis needed significantly (P < 0.05) higher daily doses of opioid (means = 77 +/- 103 versus 22 +/- 29 mg) and intrathecal bupivacaine (means = 65 +/- 44 versus 33 +/- 20 mg) and had significantly (P < 0.05) higher rates (14% versus 0%) of radicular pain at injection and poor distribution of analgesia than those without epidural metastasis and spinal canal stenosis. In contrast, the rate of occurrence of post-dural puncture headache was significantly (P < 0.05) lower in patients with partial (4%) and total (14%) spinal stenosis than in those without (29%). Unexpected paraplegia occurred in four patients and was due to accidental injury during attempted dural puncture (N = 1) and collapse (due to cerebrospinal fluid leakage leading to "medullary coning" of an unknown epidural metastasis (N = 3).
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PMID:Spinal epidural metastasis: implications for spinal analgesia to treat "refractory" cancer pain. 902 59

To evaluate safety and efficacy of the Olerud Cervical Fixation System a one-year follow up study was done by an independent observer. There were 30 patients (14 women) with a mean age of 68 (37-85) years. Indications were rheumatoid arthritis in 10, spinal stenosis in 6, trauma in 6, metastases in 4, revisions in 3, and painful spondylotic deformity in one patient. Short fusions were performed in 8 patients and long fusions in 22. Four patients were fused to occiput. C1-C2 fusion was performed in 3 patients. Nineteen of the 20 still alive were evaluated at follow up. One patient was deliberately fused in hyperlordosis, in the rest the alignment was acceptable. Primary stabilization was achieved in all but one. 107 pedicle screws were used; one screw in Th2 was placed lateral to the pedicle. 42 subaxial transarticular screws were used. There were no complications related to these screws. One patient experienced a non-instrument related neurological deterioration. Two infections and one hematoma drainage healed on conservative treatment. Loss of fixation and non-union developed in 2 patients. Patients with metastasis or myelopathy due to rheumatoid arthritis carried a high mortality risk. The Olerud Cervical Spine Fixation System is versatile in posterior fixation of the cervical spine and has proven to be both safe and efficient.
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PMID:The Olerud Cervical Fixation System; a study of safety and efficacy. 1042 16

Postoperative infection remains a troublesome but not uncommon complication after spinal surgery. Most previous reports, however, are small or involve cases with more than one surgeon often at different institutions. This study represents a single surgeon's 9-year experience with postoperative infection at one institution. The authors describe the features of wound infection after spinal surgery with reference to diagnosis, microbiology, and treatment and they describe a protocol for effective management of postoperative spinal wound infection. The records of the senior author (F.P.C.) during a 9-year period for cases of postoperative wound infection were reviewed. Of 2,391 operative procedures, 46 cases of wound infection were identified, yielding an overall infection rate of 1.9%. Patients' preoperative risk factors, original diagnosis prompting the surgery, onset of infection, presentation, treatment, and outcome were analyzed. The mean age of the 23 men and 23 women was 57.2 years. The preoperative diagnoses included lumbar degenerative scoliosis or spinal stenosis in 28 cases, disk prolapse in 8 cases, metastatic disease in 4 cases, degenerative disk disease in 1 case, and a group of 5 miscellaneous cases. Seventeen (37%) of the patients underwent at least one previous spinal surgery at the same site. Twenty-three patients had a fusion, of whom 22 also had instrumentation. Forty-three (93%) of the patients had significant wound drainage after an average of 15 days (range, 5-80 days). The other three patients were examined approximately 2 years after the surgery. Fourteen of the patients also had pyrexia (temperature >37.5 degrees C) at presentation. Staphylococcus aureus alone was cultured in 29 patients, whereas another six patients had a different single organism. In nine patients, more than one organism was cultured during their hospital stay. Surgical treatment included primary closure in only seven patients, with most undergoing wound drainage and debridement followed by delayed closure. Instruments were removed in the three patients with late presentation who had solid fusion at operation. Viable bone graft and instrumentation were left in situ in all patients who were seen before fusion. All wounds healed without sequelae, except for three that required flap closure. Pseudarthrosis was noted in three patients after more than 1 year of follow-up in this series. Postoperative spinal wound infection is a potentially devastating problem. In this series, infection was more common in patients undergoing fusion with instrumentation and in patients with cancer metastatic to the spine. An aggressive surgical approach, including repeated debridement followed by delayed closure, is justified. Instrumentation may be safely left in situ to provide stability for fusion.
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PMID:Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. 1105 52

Pamidronate, along with other bisphosphonates, has been used for treatment of bone pain secondary to malignant involvement or metastatic disease for years. Some data, however, have also accumulated on the utility of pamidronate in a variety of benign conditions frequently handled by rheumatologists. This study aims to review the available published data regarding the potential use of pamidronate in rheumatology practice. Methods include the review of relevant articles retrieved by a PUBMED search utilizing the index term "pamidronate". All available randomized control trials, open trials, and case series, as well as properly reported case studies evaluating usage of pamidronate in rheumatic disorders, have been included in the literature review. The efficacy of pamidronate in patients with spondyloarthropathies; synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome; hypertrophic osteoarthropathy; osteoporotic vertebral fractures; chronic back pain due to disk disease or spinal stenosis; Charcot arthropathy; transient osteoporosis; and complex regional pain syndrome-I, has been demonstrated in more than 40 reports, the majority of which, however, were not controlled studies. In some of reviewed conditions, aside from providing analgesic relief, pamidronate may also have disease-modifying properties. While used in different doses in a variety of rheumatic disorders, pamidronate was generally reported to be well tolerated with an overall good safety profile. Pamidronate may represent an effective and safe choice for a spectrum of rheumatic patients, suffering from intractable musculoskeletal pain, unresponsive to traditionally recommended therapies. Large randomized, controlled studies examining the efficacy of pamidronate in the rheumatic conditions are urgently needed.
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PMID:Pamidronate treatment in rheumatology practice: a comprehensive review. 1969 Sep 38

A 73-year-old man with a history of prostate and bladder carcinoma and persistent back pain was diagnosed by MRI with multiple vertebral metastases including a compression fracture of T7. He received radiotherapy for pain relief and for vertebral instability with incipient spinal stenosis, but additional targeted systemic therapy was intended. Therefore, multiple attempts at minimally invasive and open biopsies for histological characterisation of the bone metastases were performed, but failed to provide a conclusive specimen, although CT, MRI and bone scintigraphy were used for biopsy planning. Only histopathological analysis of an (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT-guided additional biopsy at a site with high metabolic activity yielded the final diagnosis of bone metastases of a neuroendocrine small cell cancer of unknown origin; hence, the patient had a third malignancy requiring a different therapy regimen and diagnostic work-up.
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PMID:FDG-PET/CT-guided biopsy of bone metastases sets a new course in patient management after extensive imaging and multiple futile biopsies. 2132 61

Malignant pheochromocytoma is a neuroendocrine tumor that originates from chromaffin tissue. Although osseous metastases are common, metastatic dissemination to the spine rarely occurs.Five years after primary diagnosis of extra-adrenal, abdominal pheochromocytoma and laparoscopic extirpation, a 53-year old patient presented with recurrence of pheochromocytoma involving the spine, the pelvis, both proximal femora and the right humerus. Magnetic resonance imaging and computed tomography revealed osteolytic lesions of numerous vertebrae (T1, T5, T10, and T12). In the case of T10, total destruction of the vertebral body with involvement of the rear edge resulted in the risk of vertebral collapse and subsequent spinal stenosis. Thus, dorsal instrumentation (T8-T12) and cement augmentation of T12 was performed after perioperative alpha- and beta-adrenergic blockade with phenoxybenzamine and bisoprolol.After thorough preoperative evaluation to assess the risk for surgery and anesthesia, and appropriate perioperative management including pharmacological antihypertensive treatment, dorsal instrumentation of T8-T12 and cement augmentation of T12 prior to placing the corresponding pedicle screws did not result in hypertensive crisis or hemodynamic instability due to the release of catecholamines from metastatic lesions.To the authors' knowledge, this is the first report describing cement-augmentation in combination with dorsal instrumentation to prevent osteolytic vertebral collapse in a patient with metastatic pheochromocytoma. With appropriate preoperative measures, cement-augmented dorsal instrumentation represents a safe approach to stabilize vertebral bodies with metastatic malignant pheochromocytoma. Nevertheless, direct manipulation of metastatic lesions should be avoided as far as possible in order to minimize the risk of hemodynamic complications.
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PMID:Cement-augmented dorsal instrumentation of the spine as a safe adjunct to the multimodal management of metastatic pheochromocytoma: a case report. 2222 47


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