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

Current research on the efficacy of CPR in specific patient groups may lead to the withholding of CPR in groups that statistically show minimal success. Prognosticative factors that indicate minimal-at-best success with CPR include age greater than 70, dysrhythmias such as asystole and electromechanical dissociation, sepsis, metastatic cancer, GI hemorrhage, and acute stroke. Although physicians are under no legal or ethical obligation to provide futile treatments, how one defines a treatment as "futile" is unclear. As a patient advocate, the nurse acts to ensure the autonomous patient is fully informed, freely consenting, and actively directing his/her own health care. End-of-life decisions regarding health care must be based on the patient's goals, which will be revealed through the moral discourse among health care professionals, patients, and their loved ones.
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PMID:Limiting care: is CPR for everyone? 235 36

Physician practice patterns and attitudes about the use of nasogastric (NG) feeding tubes in a group of elderly patients with severe chronic illness were explored in a community-based teaching hospital in Rochester, NY, using a physician questionnaire and a chart review. The physician questionnaire showed considerable divergence in beliefs about whether this treatment is extraordinary (42%), ordinary (21%), or comfort oriented (37%). Physicians who believed it was extraordinary treatment said they would recommend it less often than those who believed it to be ordinary or comfort oriented in the abstract scenario of a chronically ill, elderly patient who was not maintaining adequate nutrition. Most physician-respondents believed that the patient's wishes should guide the decision. Independently, medical records were retrospectively reviewed for all patients admitted to the hospital in the previous year who had an NG feeding tube placed, who were over the age of 70 years, and who had primary diagnoses of cerebrovascular accident, organic brain syndrome, or metastatic cancer. Contrary to the questionnaire responses, oral or written consent was documented in only 2 of 51 insertions of NG tubes. Of the 7 charts where a surrogate gave consent, only one expressed consideration of the patient's actual wishes. The clinical reasoning leading to the decision documented in the chart emphasized biomedical concerns much more than the patient's quality of life (8:1 ratio). Sixty-four percent (35/55) of patients in the study group died in the hospital, including 90% (19/21) of those who were to be treated with a comfort orientation. In only 2 of 55 patients was medical improvement cited as the reason for discontinuing use of the NG feeding tube. Restraints were used in 53% of the patients to keep the tube in. Recommendations are made that emphasize the need for active patient and family participation in the decision to use an NG feeding tube, requiring a balanced presentation of potential benefits, burdens, and limitations in patients with severe irreversible illnesses.
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PMID:Utilization of nasogastric feeding tubes in a group of chronically ill, elderly patients in a community hospital. 212 Nov 15

The authors reviewed the records of 2261 patients with histologically proven cervical cancer. Among the 1042 patients with carcinoma in situ, four neurologic complications occurred (0.4%), including three strokes and one seizure. None of the neurologic complications were related to cervical cancer. Among the 1219 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage I or greater disease, 99 neurologic complications occurred (8%). Metastatic neurologic complications were twice as common as nonmetastatic neurologic complications and included lumbosacral plexopathy (50 patients), peripheral nerve compressions (eight patients), spinal cord compressions (two patients), and brain metastases (six patients). Nonmetastatic neurologic complications were less frequent and included stroke (11 patients), encephalopathies (three patients), infectious complications (two patients), effects of therapy (six patients), and seizures (11 patients). In conclusion, neurologic complications are rare in cervical cancer and virtually nonexistent in Stage 0 disease. Metastatic neurologic complications were more common than nonmetastatic complications and lumbosacral plexopathy caused by retroperitoneal lymph node metastases was the most common neurologic complication.
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PMID:Neurologic complications of cervical cancer. A review of 2261 cases. 266 51

At the University of Alberta Hospital between 1950 and 1988, 17 patients who had a diagnosis of carotid body tumour were seen; 15 of them were followed up for an average of 8 years (range from 1 to 38 years). In 14 patients the tumour was removed surgically. There were no operative deaths and no strokes occurred. The most frequent complication was cranial nerve deficit. Of the 15 patients followed up, 10 (67%) manifested a deficit of the facial, vagus or hypoglossal nerve. The primary tumour was diagnosed histologically as a benign neoplasm in all 14 patients operated on, but in 3 distant metastases developed or there was invasive local recurrence. Patients with malignant tumour were significantly (p less than or equal to 0.01) younger than those with a benign tumour. Carotid body tumours can be managed safely with respect to stroke complications, but cranial nerve injuries continue to be a problem. Malignant tumours are difficult to distinguish from benign tumours except that they tend to occur in younger patients. Prompt surgery and close follow-up is particularly important in patients with carotid body tumour.
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PMID:Carotid body tumours: the University of Alberta Hospital experience. 271 69

We compared exercise responses in two groups of hypertensive patients treated with an angiotensin converting enzyme (ACE) inhibitor (lisinopril, 20-80 mg/day, n = 17) or a cardioselective beta-blocker (atenolol, 50-200 mg/day, n = 9). Measurements were made at rest and during exercise at 25 W (2.7 mets) and at 50 W (3.8 mets) on a bicycle ergometer (where mets is exercising oxygen consumption/resting oxygen consumption) after 4 weeks of placebo, and again after 12 weeks of drug administration. Both drugs reduced (P less than 0.05) mean arterial pressure. Atenolol caused significant decreases in the heart rate (approximately 25%) and cardiac output (approximately 26%; Defares CO2 rebreathing), and significant increases in total peripheral resistance (approximately 30%) and arteriovenous O2 content (approximately 20%). Lisinopril decreased (P less than 0.05) stroke volume. At the same exercise intensity systolic blood pressure, arteriovenous O2 and total peripheral resistance were lower (P less than 0.05) and the heart rate was higher (P less than 0.05) after lisinopril than after atenolol. After the treatment of hypertension with the ACE inhibitor the responses to exercise were less restrictive than those after treatment with the cardioselective beta-blocker.
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PMID:Effects of angiotensin converting enzyme inhibition and beta-blockade on exercise responses in hypertensive patients. 285 65

A previously unreported complication of low anterior resection of the rectum, seminal vesicle-rectal fistula, was encountered one month after surgery in an elderly patient with adenocarcinoma of the midrectum. Antibiotic-induced colitis in the immediate postoperative period led to anastomotic leakage with abscess formation and ensuing fistulization to the surgically denuded right seminal vesicle. Pneumaturia, bacteriuria, and right testicular pain were treated by cutaneous vasostomy and antimicrobial therapy. Despite recurrent low-grade urinary sepsis controlled by alternating courses of various antimicrobials, and radiation therapy for local tumor recurrence, the patient remained reasonably healthy until his death two years later due to stroke associated with cerebral metastases.
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PMID:Seminal vesicle-rectal fistula. Report of a case. 291 Jun 63

From March 1958 to October 1984, 10 patients with cylindroma (cystic adenoid epithelioma) arising in the nasopharynx were treated in our hospital. The presenting symptoms of these patients ranged in duration for 2 weeks to 8 years, with an average of 25 months. Eighty percent of the patients had destruction of the base of skull and 60% had cranial nerve involvement. Of these 10 patients, two had Stage II disease, two had Stage III, and six had Stage IV. Response was seen in this tumor at tissue doses between 5000-8000 rad. Of the seven patients at risk for 5 years, 86% survived, yet 36% of the patients died of tumor between the fifth to tenth year. Fifty percent of the patients lived beyond 10 years. Based on this experience, a dose of more than 8000 rad is advised for the primary lesion. For the neck region, radiation is indicated only when there are lymph node metastases; prophylactic radiation of the neck is not necessary. Local recurrence or single distant metastasis is amenable to radiation therapy. Among the six patients who failed in the course of follow-up, three had local recurrences, two had pulmonary metastases, and one died of cerebral vascular accident.
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PMID:Cylindroma of the nasopharynx: a chronic disease. 300 14

One hundred and thirteen patients with early gastric cancer operated on during the period from 1967 to 1982 were followed up until 1985; 24 of them died. The 5- and 10-year cumulative survival rates of 99 patients, excluding 14 (12.4%) who died of diseases unrelated to gastric cancer, were 97.8% and 89.1%, respectively. Of the 24 deaths, seven were due to recurrence of gastric cancer, one to pulmonary metastasis found preoperatively and 16 to diseases unrelated to gastric cancer. Recurrence took the form hepatic metastasis in four cases, bone metastasis in two and recurrence in the gastric remnant in one. The metastases were distant in the majority of cases of recurrence, and recurrence characteristically occurred late, with six patients dying more than 5 years and one dying 10 years after surgery. The recurrences were mostly found in patients with poorly differentiated adenocarcinoma. On the other hand, the causes of death in 16 patients were diseases unrelated to gastric cancer, i.e., primary cancer of other organs in six, operative complications, heart diseases, senility, and pneumonia in two each, and a traffic accident and apoplexy in one each. Thus, Many of the deaths were due to primary cancer of other organs. Four patients underwent non-curative resection. One had lung metastasis found preoperatively and the remaining three had positive margins. The latter three did not undergo a second operation, but the causes of their deaths were not recurrence of gastric cancer. It is necessary to follow up patients from the standpoint not only of recurrence of gastric cancer, but also of diseases other than gastric cancer and multiple gastric cancer in elderly patients.
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PMID:Factors influencing the postoperative course 113 patients with early gastric cancer. 302 77

The effect of hypothyroidism on left ventricular function at rest and during exercise was studied in nine patients without demonstrable cardiovascular disease who had had total thyroidectomy and ablative radioiodine treatment for thyroid cancer. Radionuclide ventriculography and simultaneous right heart catheterisation were performed while the patients were hypothyroid two weeks after stopping triiodothyronine treatment (to permit routine screening for metastases) and while they were euthyroid on thyroxine replacement treatment. When the patients were hypothyroid, cardiac output, stroke volume, and end diastolic volume at rest were all lower and peripheral resistance was higher than when they were euthyroid. Pulmonary capillary wedge pressure, right atrial pressure, heart rate, left ventricular ejection fraction, and the systolic pressure:volume relation of the left ventricle, which was used as an estimate of the contractile state, were not significantly different when the patients were hypothyroid or euthyroid. During exercise, heart rate, cardiac output, end diastolic volume, and stroke volume were higher when the patients were euthyroid than when they were hypothyroid. Again, pulmonary capillary wedge pressure, ejection fraction, and the systolic pressure:volume relation were similar in both thyroid states. The data suggest that the alterations in cardiac performance seen in short term hypothyroidism are primarily related to changes in loading conditions and exercise heart rate; they do not suggest that acute thyroid hormone deficiency has a major effect on the contractile properties of the myocardium.
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PMID:Left ventricular function at rest and during exercise in acute hypothyroidism. 317 36

Bone imaging of the body is often requested to rule out metastatic disease. A patient with suspected breast carcinoma underwent bone imaging which revealed a focal area of uptake that appeared to be localized in the right posterior calvarium. The initial interpretation was possible solitary metastatic breast carcinoma to the skull. Skull radiographs and head computed tomography (CT) were suggested for follow-up evaluation. The skull series was performed immediately after bone imaging and was negative. Further clinical information revealed that the patient recently had undergone total right internal carotid artery ligation for treatment of a large, surgically inaccessible right cavernous aneurysm. SPECT imaging of the head localized the region of abnormal uptake adjacent to the calvarium, which suggested the uptake was due to a recent brain infarction or metastatic disease to the brain. A CT scan performed 4 days later demonstrated generalized cerebral atrophy, but was otherwise normal, ruling out metastatic breast carcinoma. This case emphasizes the importance of SPECT imaging when a solitary skull lesion is found on bone imaging. SPECT can localize the lesion to be within the brain and/or skull and can aid in further investigative management. A lesion located at the periphery of the brain may be due to an occult stroke. This finding is of particular consideration in the elderly in whom there is a relatively high incidence of coexisting cancer and silent brain infarction.
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PMID:Silent infarction of the brain. Incidental finding demonstrated by SPECT. 326 77


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