Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: 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)

From 1981 through 1991, 40 patients 80 years of age or older underwent thoracotomy for curative resection of bronchogenic carcinoma. There were 22 males and 18 females with a mean age of 82.7 years (range 80-88). In three patients, the operation was aborted due to unexpected metastatic disease discovered at the time of thoracotomy. The remaining 37 patients underwent 5 pneumonectomies, 26 lobectomies and 6 segmentectomies or wedge resections. Three of these patients (1 pneumonectomy, 1 lobectomy, and 1 wedge resection) underwent concomitant en bloc chest wall resection. The overall operative mortality rate (in hospital or within 30 days) was 15% (6/40) while there was a 16% mortality rate (6/37) for resected patients. Complications occurred in 18 of 40 patients (45%) but were major in only 12 (30%). Major complications included respiratory insufficiency (6), pneumonia (4), prolonged air leak (2), stroke (1), urinary retention prostatectomy (1), and one unexplained sudden death 2 weeks following discharge. Postoperative stay in the 34 operative survivors averaged 14 +/- 8.8 days (range 3-47). Univariate analysis revealed that neither gender, extent of lung resection, preoperative NYHA class, history of heart disease nor chronic obstructive pulmonary disease (COPD) were predictive of operative mortality in the 37 patients undergoing lung resection. Age was the only predictor of mortality (survivors 82.2 +/- 2.2, non-survivors 84.3 +/- 2.6; P < 0.05). The need for chest wall resection approached but did not quite achieve significance (P < 0.08). Actuarial survival for all 40 patients at 1 and 3 years is 55% and 40%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Lung cancer surgery in the octogenarian. 781 76

Alternating chemoradiotherapy has recently been reported to produce encouraging results in patients with advanced head and neck cancer. We have treated 17 patients with squamous cell carcinoma of the upper esophagus by alternating chemoradiotherapy and by following the patients for 2 to 5 years, or until their death. Chemotherapy (cisplatin and 5-fluorouracil) was delivered during weeks 1, 4, and 7, and radiotherapy (180 to 200 cGy twice each day to 2,000 cGy) during weeks 2, 5, and 8 (total 6,000 cGy). Three patients (18%) died of toxicity (nadir sepsis). All 14 patients who survived the treatment achieved a complete response as shown by endoscopy and biopsy specimens, with restoration of swallowing, and none experienced a local relapse. Three patients died of distant metastases (actuarial incidence 32% at 3 years). The 5-year survival rate was only 16%, however, because 8 other patients with no evidence of the cancer died of a variety of other causes: radiation pneumonitis (1), chronic neutropenia (1), esophageal actinomycosis (1), pneumonia (2), stroke (1), myocardial infarction (1), and small-cell lung cancer (1). Conceivably, some further improvement in the results might occur from cytokines, stem cells, and brachytherapy (by decreasing deaths due to toxicity), but with so many causes of comorbidity it seems unlikely, for the foreseeable future, that the 5-year survival rate could be much improved by better treatment of esophageal cancer.
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PMID:Patterns of failure in carcinoma of the upper esophagus after alternating chemoradiotherapy. 797 65

The preoperative evaluation and technique of combined thyroplasty and inferior constrictor myotomy are described and illustrated. The results in cases in which thyroplasty type I and inferior constrictor myotomy were done as separate procedures are compared to those in cases in which thyroplasty and inferior constrictor myotomy were combined in the same operation. The end results obtained with these two approaches did not differ significantly; however, with the exception of brain stem disease, patients undergoing the combined procedure at an early date are more likely to be spared gastrostomy and aspiration pneumonia. Diseases of the brain stem (ie, stroke and metastatic disease such as breast cancer) respond poorly to an inferior constrictor myotomy. In such cases the patient can best be rehabilitated with a thyroplasty type I along with a gastrostomy or laryngeal closure procedure.
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PMID:Combined thyroplasty type I and inferior constrictor myotomy. 797 99

Renal carcinoma (RCA) presenting in association with abdominal aortic aneurysm (AAA) is extremely rare, with only sporadic case reports previously described. The management of six cases of AAA and concomitant RCA presenting to a single institution from March, 1991 through December, 1993 was reviewed and management options considered. AAAs ranged in size from 4.5-7.0 cm (mean, 5.6 cm). Three left renal carcinomas were resected via a retroperitoneal approach simultaneous to repair of the AAA. One right renal carcinoma was resected in combination with repair of an AAA through a transperitoneal approach. The fifth case was managed by left nephrectomy, followed by interval aneurysmectomy, and the sixth case was managed by nonsurgical methods because of the presence of widely metastatic disease. Renal malignancies included five renal cell carcinomas and one transitional cell carcinoma. Three patients remain free of disease 8-11 months postoperatively, and one patient had metastatic disease detected 19 months postoperatively. Two deaths have occurred; one due to a massive CVA 1 month following a combined aneurysmectomy and left nephrectomy, and a second due to unknown etiology in the patient managed non-surgically. No peripheral vascular or aortic graft related complications have occurred. The treatment of AAA and RCA should be governed by the size of the AAA, the location of the cancer, and the extent of malignant disease. Simultaneous resection is safe and effective in patients with coexistent AAA and renal cancer. Left sided tumors should be resected via a retroperitoneal approach that also provides excellent exposure for simultaneous AAA resection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Coexistent abdominal aortic aneurysm and renal carcinoma: management options. 799 75

The authors performed a retrospective review of their 10-year experience of carotid artery resection without revascularization for advanced squamous cell carcinoma of the neck. From 1982 to 1991, seven patients underwent elective carotid artery resection without reconstruction at the University of Colorado Health Sciences Center in Denver. A vascular clamp with gradual carotid occlusion was placed preoperatively on four patients and awake temporary balloon occlusion of the carotid was used on three patients. The primary lesions were three laryngeal carcinomas, two oral cavity carcinomas, and two hypopharyngeal carcinomas. All seven resected specimens showed invasion of the carotid fascia on pathological exam, while five specimens exhibited actual destruction of the arterial wall. Cerebrovascular accidents occurred in two patients (one immediate and one delayed), and the perioperative mortality was 29% (one cerebrovascular accident and one gastrointestinal bleed). The five remaining patients died of locoregional recurrence or metastatic disease within 1 year after their carotid artery resection. Resection of the common or internal carotid artery without reconstruction has a significant morbidity and mortality. This operation did not improve the long-term survival in our limited series of patients who presented with histologically proven invasion of the carotid artery.
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PMID:Elective carotid artery resection for advanced squamous cell carcinoma of the neck. 812 79

The clinical features and long-term outcome of seven patients with delayed cerebral radiation necrosis (DCRN) are described. Radiotherapy had been given for pituitary tumour (1), astrocytoma (2), pinealoma (2), craniopharyngioma (1) and parotid carcinoma (1). The mean latency to onset of the first neurological symptoms was 22 months (range 6-40 months), and mean duration of follow-up was 86 months (range 60-126). Three patients died at a mean of 84 months after radiotherapy (range 62-98). A fourth patient probably died from metastatic disease. Three patients remain alive, albeit severely disabled, after 5-10 years. The illness typically ran a stepwise course, with fits and stroke-like episodes occurring against a background of progressive dementia and somnolence. CT and MRI scans showed progressive ventricular dilatation associated with cerebral atrophy and diffuse or focal changes in the white matter. Four patients had had two or more neurosurgical procedures after the radiotherapy. In only one of the seven patients was the diagnosis made at presentation. DCRN produces a distinctive clinical picture, yet remains a poorly recognized complication of cranial irradiation.
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PMID:Delayed cerebral radiation necrosis. 815 88

An 85-year-old woman had a right-sided renal cell carcinoma removed 20 years ago. At haemoglobin concentration. Two years ago she had a syncope, at which time the haemoglobin concentration was 16.9 g/dl. Ultrasound and computed tomography (CT) revealed an extensive retroperitoneal space-occupying lesion, which however was not investigated further, and no therapeutic consequences were drawn. An erythrocytosis (7.5 x 10(6)/microliters) and elevated haemoglobin concentration (> 20 g/dl) were found when she was examined after a fall in which she had sustained only minimal injury. The retroperitoneal mass had slightly increased in size. Histological examination of a CT-guided fine-needle biopsy revealed metastases of the hypernephroid carcinoma. The serum erythropoietin concentration was increased (42.4 U/l) and failed to increase even after repeated venesections, indicating erythropoietin production by the late metastases of the renal cell carcinoma. There was no evidence for any systemic haematological disease. Six months after the diagnosis of metastases the patient died at home, presumably of a cerebrovascular accident.
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PMID:[Polycythemia in the late metastasis of an erythropoietin-producing renal-cell carcinoma]. 818 21

Assessment of the pelvic lymph node status is a major concern in prostatic cancer staging. In spite of a normal abdominopelvic CT scan examination in patients with organ-confined disease, 7-30% will have lymph node metastases at pathological examination and will not benefit from radical prostatectomy. Laparoscopy enables pelvic lymph node dissection via a minimally invasive approach. Twenty-nine patients underwent laparoscopic pelvic lymph node dissection (LPLND) for prostatic cancer staging. The average duration of the bilateral dissection was 90 +/- 40 min (range 35-180 min). One patient died of a stroke on postoperative day 1, without local complication. The peroperative complications were 1 injury of the external iliac vein, 1 ileal injury, 1 ureteral injury, all 3 (11%) requiring immediate or delayed laparotomy. One patient had a self-resolving bilateral obturator nerve paresis. A previously irradiated patient had perineal lymphedema for 4 weeks. The average number of lymph nodes removed was 8.4 +/- 3.4 (range 4-17) for bilateral LPLND. Five patients had lymph node metastases. The median length of stay for patients undergoing LPLND as a single procedure was 2 days (range 2-11 days). After an operational period, during which the complication rate was relatively high, we now consider LPLND as a safe and effective procedure for the staging of patients with organ-confined prostatic cancer, but considering the increased risk of complications during the application period, we do not encourage the generalization of this technique which should remain restricted to some particular strategies, as in combination with perineal radical prostatectomy.
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PMID:Laparoscopic pelvic lymph node dissection for staging of prostatic cancer. 820 Apr

Chemosensitivity testing in vitro of breast cancer has been difficult because of small tumour volume, an even smaller yield of viable cells after disaggregation, and the low evaluability rate and sensitivity of current assays. We have employed an alternative approach that quantitates intracellular adenosine triphosphate (ATP) as a measure of cell viability. This ATP-cell viability assay (ATP-CVA) determines in vitro tumor cell viability after exposure to chemotherapeutic agents in comparison to untreated controls following 6 days of incubation. Sixty-one fresh breast cancer specimens upon testing yielded an evaluability rate of 95%. Forty-seven of the tumors were untreated primary breast cancers, the remaining 14 were from patients with metastatic disease. Correlations of in vitro drug sensitivity with in vivo response were obtained for 17 treatment regimens in 14 patients with metastatic breast cancer. The level of sensitivity was 90% and the specificity 86%. These preliminary data demonstrated the ATP-CVA to be a practical in vitro approach to breast cancer testing. It will require a larger clinical study for confirmation.
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PMID:Application of the adenosine triphosphate-cell viability assay in human breast cancer chemosensitivity testing: a report on the first results. 841 58

It was found a solid tumour of 24 x 28 x 31 mm size above the right kidney with ultrasound screening in a three days old newborn. After three days appeared cystic areas inside the tumour, so it was thought to adrenal haemorrhage. The tumour didn't decrease during two months and metastases developed in the liver. The urinary VMA level was normal, the HVA elevated. The MIBG scintigraphy was first negative, after a month pathognostic. The primer tumour and metastases disappeared after cyclophosphamid and Adriablastin treatment. The adrenal neuroblastoma can imitate the adrenal apoplexy, so it's important to control all neonatal adrenal haemorrhage until their disappearance.
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PMID:[Neonatal neuroblastoma detected by ultrasonic screening]. 823 51


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