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)

After cystoprostatectomy for cancer of the bladder 43 men were provided with a detubularized, low pressure ileal reservoir (Kock pouch) connected to the urethra. Reflux was prevented by an intussusception valve. There was no operative mortality and few early complications. At followup the mean postoperative observation time was 13 months, with a range of 5 to 20 months. Late complications included manifestations of local tumor recurrence or distant metastases in 9 patients within 6 months postoperatively, which made adequate functional evaluation impossible. In 18 patients reflux to the upper urinary tract due to eversion or sliding of the antireflux valve occurred at various postoperative intervals. In 16 of these patients incontinence developed as a consequence of the reflux. Surgical correction of the failing antireflux valve restored reflux prevention and continence. Within 3 to 6 months the capacity of the reservoirs had reached an ultimate volume of approximately 600 ml. Pressure waves exceeding 40 cm. water seldom occurred in the mature reservoirs and then only at high filling volumes. The mean urethral resting resistance to flow was 64 cm. water. The configuration and function of the upper urinary tract improved or stabilized postoperatively. Of 34 evaluable patients 30 were continent during the day with a voiding frequency of 3 to 5 times and dry at night with a frequency of 0 to 2.
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PMID:Replacement of the bladder by the urethral Kock pouch: functional results, urodynamics and radiological features. 270 96

A case is presented of melanoma located at the distal urethra in a 74-year-old patient who underwent local surgery. At present the survival rate is 5 years and local relapse and metastases of one inguinal ganglion has been observed. The different clinical, diagnostic and therapeutic aspects of this neoplasia are discussed.
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PMID:[Melanoma of female distal urethra: apropos of a case]. 271 10

Primary carcinoma of the urethra is a rare lesion, and there are no standard therapeutical modalities suggested in the literature. We report the case of a 65-year-old woman with transitional cell carcinoma of the distal urethra and metastasis to the inguinal lymph nodes (T2 N1 MO G2). Locally, the lesion was treated by Nd:YAG laser coagulation in four sessions. Ileoinguinal and pelvic lymph-node dissection was performed as a diagnostic and therapeutic procedure. Twenty-eight months after the initial treatment, no evidence of tumor recurrence has been found, although extensive biopsy specimens have been taken. Clinical staging showed no evidence of metastases.
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PMID:[Treatment of distal urethral cancer by laser coagulation]. 281 40

Twenty-two cases of adenocarcinoma of the urethra in women were studied. Nine were classified histologically as clear cell adenocarcinoma and 13 were classified as columnar/mucinous adenocarcinoma. Thirteen patients (59%) were black. The average patient age was 61 years (range, 27 to 76 years). Follow-up ranged from 6 to 194 months, (average, 40 months). At presentation, most patients (82%) had extension of tumor into adjacent structures or metastases to regional lymph nodes. Eighty-six percent received radiation therapy and 41% underwent an anterior exenteration or cystectomy. Eight of 22 patients (36%) had no evidence of disease 21 to 194 months after diagnosis (average, 83 months). Fourteen (64%) were dead of disease 6 to 23 months after diagnosis (average, 15 months). In general, the extent of tumor correlated best with survival time. Forty-four percent of patients with clear cell adenocarcinoma were dead of disease within 24 months of diagnosis, in contrast to 77% of those with columnar/mucinous adenocarcinoma, suggesting that patients with clear cell adenocarcinoma may have a better prognosis than those with columnar/mucinous adenocarcinoma. However, the difference in survival probability between the two groups was not found to be statistically significant. Recognition of the two histologic types of urethral adenocarcinoma is important to prevent misdiagnosis of such tumors as metastases (or direct extension) of nonurethral neoplasms having a similar histologic appearance. A possible predilection of the disease for black women has not been previously described.
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PMID:Adenocarcinoma of the urethra in women. A clinicopathologic study. 303 94

Progress has been made at both ends of the spectrum of bladder cancer. The introduction and increasing use of effective intravesical agents for both treatment and prophylaxis of tumors limited to the mucosa or lamina propria has reduced the incidence and frequency of subsequent tumors. At the other end of the spectrum--patients with locally extensive bladder cancer--neoadjuvant or initial chemotherapy is producing complete and partial responses. Hopefully this will translate into an improvement in the cure rate. In arriving at a decision regarding treatment for a patient with bladder cancer the urologist integrates information derived from a thorough endoscopic examination of the lower urinary tract (bladder and urethra), complete grading and staging of resected tumor including results of mucosal biopsies from suspicious and normal appearing urothelium, and cytology obtained by bladder irrigation. Treatment also may be influenced by such factors as prior history and treatment of bladder cancer and the patient's age and medical status. Assuming no prior bladder tumor history, endoscopic resection/fulguration followed by intravesical therapy will be used for tumors confined to the mucosa (Ta or Tcis) or lamina propria (TI). Optimally the urologist should resect all evident tumor and incorporate the intravesical agent as prophylaxis. Cytology and endoscopy will monitor the success of this approach. If the patient develops another superficial tumor while receiving prophylaxis another intravesical agent can be delivered, possibly using an intensive treatment schedule. Several agents have demonstrated effectiveness both for treatment and prophylaxis. They include mitomycin C, thiotepa, Adriamycin (doxorubicin), and bacillus Calmette-Guerin. The indications for radical cystectomy are invasion into the bladder muscle, tumor extension into the prostatic ducts or prostatic substance, or persistent tumor after an adequate trial of one or more intravesical agents used in conjunction with endoscopic resection. The escalating complete and partial response rates associated with combination chemotherapy of metastatic bladder cancer has led to the use of these regimens before considering cystectomy for patients with locally extensive bladder cancer, e.g., T3, T4, and N1-2. Downstaging with chemotherapy in this group of poor-risk patients may be preferable to the traditional approach of proceeding with exenterative surgery or full-dose radiation and considering chemotherapy later when metastases are evident.
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PMID:Selecting initial therapy for bladder cancer. 310 25

Flow cytometry analysis was performed on 30 primary male urethral squamous cell carcinoma specimens. Nuclei were extracted from paraffin-embedded archival material and isolated nuclei were stained with propidium iodide. Bulbomembranous urethral tumors had a higher incidence of abnormal deoxyribonucleic acid ploidy patterns than penile urethral tumors (69 and 29 per cent, respectively). Of the tumors exhibiting a deoxyribonucleic acid diploid pattern and an abnormal (deoxyribonucleic acid tetraploid or aneuploid) histogram 18 and 93 per cent, respectively, showed tumor progression (p less than 0.001). None (0 per cent) of the low grade (grade 1 or 2) tumors with a deoxyribonucleic acid diploid pattern developed local recurrence or distant metastases, whereas 90 per cent of the low grade tumors with an abnormal deoxyribonucleic acid pattern progressed (p less than 0.002). Patients with tumors exhibiting deoxyribonucleic acid diploid ploidy had 5 and 10-year rates free of disease of 85 per cent. In contrast, patients with tumors with abnormal deoxyribonucleic acid ploidy patterns had 5 and 10-year rates of 20 and 0 per cent, respectively (p less than 0.001). Determination of deoxyribonucleic acid ploidy pattern by flow cytometry provides important prognostic information for male patients with primary squamous cell carcinoma of the urethra.
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PMID:Primary squamous cell carcinoma of the male urethra: nuclear deoxyribonucleic acid ploidy studied by flow cytometry. 333 28

A retrospective study of the incidence and clinical course of transitional cell carcinoma of the urethra is reported. Of 110 consecutive male patients who underwent cystectomy during a 9-year period, 9 had or developed a urethral tumour. Five patients undergoing radical cystectomy had known or suspected urethral involvement which was confirmed at urethrectomy. All 5 had deeply invasive (T3 or T4) transitional cell carcinomas of the bladder and subsequently died of metastatic disease. Four patients underwent urethrectomy because of signs or symptoms of urethral recurrence at an average interval of 2.5 years after cystectomy. There were two deaths in this group, neither of which appeared to be due to urethral recurrence. Six additional patients had undergone prophylactic urethrectomy because of prostatic urethral involvement or diffuse carcinoma in situ in the cystectomy specimen, and none had identifiable tumour in the anterior urethra. The residual urethra is a potential focus for recurrent tumour and this necessitates careful follow-up with serial cytology, but the low incidence of urethral recurrence (3.5% in this series) does not appear to warrant routine urethrectomy at the time of cystectomy.
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PMID:Transitional cell carcinoma of the urethra in men after radical cystectomy for bladder cancer. Is prophylactic urethrectomy indicated? 340 61

The results of treatments for localized carcinoma of the urethra were assessed in 21 consecutive women treated at our institutions over a twenty year period. Only one of the tumors was confined to the distal urethra. Eighty-six percent invaded the periurethral tissues and 24% were known to be associated with regional lymph node metastases. Fifty-seven percent were adenocarcinomas. Five patients refused active therapeutic intervention and expired within one to 30 months following diagnosis. Sixteen patients were treated with extirpative surgery, radiation therapy, or combinations of the two. Four are free of disease at one, four, eleven, and 15 years after treatment. Nine developed pelvic recurrences, two developed pelvic recurrences and distant metastases and one developed distant metastases only from six to 72 months (mean, 19 months) after initial treatment. Eight of these 12 patients died at two to 13 months (mean, 8 months) after secondary treatment, two are alive with residual pelvic tumor, and two are clinically free of disease at 7 and 48 months. Only six patients were known to have distant metastases at the time of death and five of these six had adenocarcinomas. Advanced localized urethral cancer in women is difficult to eradicate and usually fatal.
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PMID:Localized urethral cancer in women. 362 Nov 27

This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.
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PMID:Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer. 367 73

A 9-year review of our experience with head and neck metastases from 845 urogenital tract tumors of the kidney, prostate, bladder, testicle, spermatic cord, penis, urethra, and ureter was performed. Thirty-one (3.7%) of these tumors developed metastases to the cervical and supraclavicular lymph nodes, scalp, thyroid gland, thyroid cartilage, parotid gland, retroorbit, mandible, nasal cavity, and paranasal sinuses. Unusual cases and a review of the literature are presented. The frequency of such metastases to the head and neck from various primaries, diagnostic application of current immunohistochemical methodology, and therapeutic alternatives are emphasized.
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PMID:Urogenital tract carcinoma metastatic to the head and neck. 378 39


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