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

During the years 1975 through 1989, 189 patients have been operated because of metastases within bones of the lower extremity. Thereof, 34 patients received an endoprosthesis of the KMFTR (Kotz Modular Femur-Tibia reconstruction system) type. In detail, the following reconstruction elements had been used: proximal femur (n = 20), distal femur (n = 7), complete femur (n = 2), proximal tibia (n = 5). At the time of follow-up examination 30 patients had died. Mean survival time after resection of metastases was 18.6 months (range 8-44 months). According to histologic judgement, in 23 cases wide or marginal resections had been performed whereas 11 patients had been operated intralesionally. In no case local recurrence as relevant to therapy was observed. At the same time-point, survival periods after detection of secondary manifestations of the malignant diseases within the remaining 4 patients were 29, 61, 73 and 125 months, respectively. The following complications were observed: luxation of the prosthesis (n = 6), transient paresis of the peroneus (n = 3), deep vein thrombosis (n = 2), pulmonary infarction (n = 1), wound healing disturbances (n = 2) and hematoma (n = 3).
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PMID:[Therapy of bone metastases of the lower extremity with the KMFTR modular tumor endoprosthesis system]. 128 Oct 65

From 1985 to 1987 148 patients underwent mastectomy for breast cancer, of whom 91 underwent modified radical mastectomy. Of these patients (median age 60 years (range 31-86 years)), 89 have been assessed for early (< 30 days) and late (> 30 days) non-tumour morbidity and mortality. A total of 41 patients had nodal metastases. Adjunctive therapy used was tamoxifen in 70 patients and radiotherapy in 20. Overall, 47 patients (53%) developed a total of 75 complications, and there was one 30-day mortality. Of the patients, 26 developed one complication, 14 had two complications and 7 three complications. Early complications were lymphocoele/seroma (n = 22), wound infection (n = 9) and cardiopulmonary problems (five deep vein thrombosis, two pulmonary embolus (1 death), one myocardial infarct). Late complications were lymphoedema (n = 10), pectoralis major wasting (n = 6), frozen shoulder (n = 7), intercostobrachial neuralgia (n = 4), and a small number of self-limiting wound problems (n = 9). There were two late deaths (myocardial infarcts). Early complications were not related to nodal status, and late complications were related to neither nodal status nor radiotherapy. Significant morbidity is attached to radical surgery for breast cancer. Most complications are minor and self-limiting, but there are a small number of late complications which may affect quality of life.
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PMID:Non-tumour morbidity and mortality after modified radical mastectomy. 141 1

Fine-needle aspiration (FNA) of the liver is a procedure considered virtually risk-free. We report here a patient with carcinoma of the pancreas, who suffered a fatal hemoperitoneum (HP) subsequent to FNA of the liver under the guidance of ultrasound. The patient had presented with migratory deep vein thrombosis (DVT), and recurrent cerebral embolism. The prothrombin time (PT) and partial thromboplastin time (PTT) had been normal, and FNA demonstrated adenocarcinoma cells. Autopsy findings demonstrated carcinoma in the tail of the pancreas with liver and adrenal metastases, massive HP, and findings of chronic disseminated intravascular clotting (DIC). Since chronic DIC with enhanced fibrinolysis might have participated in the fatal bleeding, we recommend that FNA should be contraindicated in patients suspected of having malignancy with migratory DVT and recurrent arterial embolism, despite normal PT and PTT tests, unless the appropriate laboratory tests succeed in excluding DIC.
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PMID:Fatal hemoperitoneum after fine-needle aspiration of a liver metastasis. 153 72

In 1985, as a result of the high complication rate associated with anticoagulants in patients who have cancer and deep venous thrombosis (DVT) and/or pulmonary embolism (PE), we established a policy of placing Greenfield filters (GFs) as primary therapy instead of anticoagulation. Since 1985 we have been asked to consult in the treatment of 18 patients with cancer and with DVT and/or PE, and we have placed a GF in each of these patients. This represented 34% (18/53) of the filters placed during that same period. Over the same 4-year period, 11 patients with cancer and DVT and/or PE underwent anticoagulation therapy. The purpose of this study was to compare the results of anticoagulation versus GF insertion in these two groups of patients. A significantly higher number of major complications (n = 4) occurred in the anticoagulation group (p less than 0.05, Fisher's exact test) than in the GF group (n = 0). The four complications that occurred in the anticoagulation group included three bleeding episodes (tumor bleeding, gastrointestinal bleeding, and hip hematoma) and one PE, despite adequate anticoagulation. Two patients died as a direct result of these complications (PE and gastrointestinal bleeding). The three patients with bleeding complications each required a transfusion of more than 3 units of blood. All four of the patients with complications had metastatic disease (pancreatic carcinoma, chronic lymphocytic leukemia, prostate carcinoma, and uterine carcinoma). Although this is a small, nonrandomized, nonprospective study, the data seem to indicate that GF placement is safer than anticoagulation for DVT or PE in patients with cancer and particularly in patients with metastatic disease. We conclude that GF insertions may be a better primary treatment than anticoagulation.
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PMID:Greenfield filter as primary therapy for deep venous thrombosis and/or pulmonary embolism in patients with cancer. 198 34

We treated 41 patients with transitional cell carcinoma with methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy. Median patient age was 56 years. Of the patients 33 had either distant metastases or locoregional disease that could not be cured by an operation or radiation. Of these patients 30 had measurable disease and 12 responded (4 complete and 8 partial responses, response rate 40 per cent, 95 per cent confidence limits 23 to 59 per cent). Only 2 of these patients remain with an unmaintained complete response at 34 and 52 months. Of 5 patients 3 responded who were treated with neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin for locally advanced bladder cancer before radiation or cystectomy, and only 1 of these patients is free of disease. The remaining 3 patients were treated postoperatively because they were at high risk for recurrence and all are well. Toxicity of the regimen was severe: 41 per cent of the patients experienced neutropenic sepsis and 54 per cent required hospitalization for management of toxic complications. Three patients experienced pulmonary embolism and 1 had deep vein thrombosis. There was 1 drug-related death of sepsis. Although a patient occasionally may have long-term benefit from this chemotherapy our results suggest caution in the widespread application of this protocol.
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PMID:M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) chemotherapy for transitional cell carcinoma: the Princess Margaret Hospital experience. 274 45

Ninety-three patients with stage I primary cutaneous malignant melanoma of the lower limb were treated by wide local excision and hyperthermic isolated regional perfusion with melphalan (L-phenylalanine dihydrochloride) in a prospective non-randomized study between 1976 and 1982. Eighteen patients (19.4%) developed recurrent melanoma. Nine had recurrent regional disease, one with in transit metastases and eight with positive regional nodes. Nine patients developed distant metastases. No patient had locally recurrent disease. This series confirmed the close correlation between tumour microstaging, melanoma recurrence and survival. Seventy-nine per cent of patients were disease-free at 5 years. Males had deeper lesions (mean 4.56 mm) and increased recurrence (33%) than females (mean 3.36 mm and 13%). Superficial spreading melanoma had the most favourable prognosis of the three histological types. Overall survival was 83% (female 86%; males 64%) at 5 years. Significant morbidity occurred in two patients with deep vein thrombosis. Adjuvant therapy using hyperthermic regional perfusion provides improved local and intransit control of limb melanoma.
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PMID:Prophylactic hyperthermic limb perfusion in stage I melanoma. 304 34

After a 20-year latent period an angiosarcoma developed in the edematous leg of a 74-year-old woman with primary lymphedema. A deep venous thrombosis of the leg which further aggravated tissue swelling preceded the appearance of angiosarcoma. Histogenetic classification of the tumor as hemangiosarcoma rather than lymphangiosarcoma was favored by positive immunohistochemical staining for Factor VIII. Despite high amputation and isolated perfusion with hyperthermal cytostatic infusion, she developed local recurrence and distant metastases and died 16 months after operation. Patients with chronic primary or secondary lymphedema are susceptible to angiosarcoma although the overall risk is small.
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PMID:Angiosarcoma in primary lymphedema of the lower extremity--Stewart-Treves syndrome. 654 Aug 32

We have treated 14-patients with metastatic tumors located in eloquent cortical areas by a stereotactic-guided keyhole craniotomy and total microsurgical excision utilizing the Pelorus stereotactic device. Patients ranged in ages from 26 to 82 years with a median age of 59 years. There were 9 women and 5 men. Ten patients presented with hemiparesis and 4 with aphasia. Primary tumor location was lung in 7, colon in 2, melanoma in 2, and breast, renal, and bone in 1 case each. Gross total resection was accomplished in all cases, with postoperative imaging confirmation of complete removal. Single metastatic tumors were removed in 12 cases, and multiple lesions in 2 cases. Twelve patients had postoperative whole brain irradiation (30 Gy/10 fractions); 2 patients had previously received whole brain irradiation, yet demonstrated tumor growth. Complete resolution of neurologic deficits was accomplished in 8 patients, 3 had improved and 2 were unchanged. One patient had resolution of preoperative deficit but developed hemiparesis secondary to a hemorrhagic infarction contralateral to the operative site. Nonneurologic morbidity includes deep venous thrombosis in 3 patients, and pneumonia in 1. Thirty-day perioperative mortality is zero, and to date no patient had died of intracranial disease. We believe that with the assistance of stereotactic localization, metastases in vital regions of the cortex can be removed with very low neurologic morbidity, and with a high proportion of patients having improvement in their level of neurologic function. The morbidity in this series compares favorably with that of stereotactic radiation series reported in the literature with local disease control and resolution of neurologic deficits that equals or exceeds stereotactic radiation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Stereotactic resection of brain metastases in eloquent brain. 762 49

Despite the infrequent use in the United States, venous thrombectomy seems to have a beneficial effect in carefully selected patients with acute iliofemoral thrombosis. The final decision to proceed with venous thrombectomy should be based on a balanced analysis of two factors--the characteristics of the thrombus and the characteristics of the patient. First, the diagnosis of acute deep vein thrombosis must be unequivocally established preoperatively. Accurate anatomic localization is usually achieved with venography, but duplex Doppler examination may be sufficient in selected instances. Second, the distribution of thromboses should be determined. Venous thrombectomy should be considered only in instances of deep vein thrombosis involving the iliofemoral venous segment. Thrombectomy for venous thrombosis below the inguinal ligament has not been consistently beneficial. Third, the age of the thrombus should be estimated. This can usually be accomplished though a careful analysis of the clinical history, but may be corroborated by duplex Doppler or venographic features of the thrombus. Venous thrombectomy should rarely be attempted if the age of the thrombus is thought to be greater than 72 hours. Unfortunately, in many instances the clinical history substantially underestimates the actual age of the underlying thrombus. Fourth, patient characteristics must be assessed preoperatively. While venous thrombectomy can usually be accomplished using local anesthesia, substantial shifts in fluid and acid base balance may be poorly tolerated by elderly, frail patients. In the setting of widespread metastatic disease, rethrombosis rates may be too high to justify thrombectomy in some patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of venous thrombectomy in the treatment of deep vein thrombosis. 826 78

Metastatic disease from nonvulvar gynecologic malignancies involving the groin lymph nodes is uncommon. The purpose of this study is to analyze the morbidity, recurrence-free interval, and survival in this group of surgically managed patients. Twenty patients underwent surgical resection of metastatic disease involving the groin lymph nodes between January 1, 1984 and December 31, 1991. Individual factors which have an impact on morbidity, recurrence, and survival were analyzed. Two patients developed wound infection and 2 had wound breakdown. Both of the patients with postoperative wound infection had clinically fixed nodes. None of the patients developed deep venous thrombosis. Long-term complications included lymphocytes in 2 patients and lymphedema in 4 patients. The median local disease progression-free interval was 10 months, with 5 of 20 patients developing local recurrence. The overall median survival was 11 months, with an adjusted 5-year survival rate of 11.5%. Patients with clinically fixed lymph nodes had a shorter median survival (3.6 months) than those with clinically mobile (median, 22.6 months) nodes (P = 0.0032). Metastatic disease from carcinoma of the ovary, fallopian tube, uterus, and cervix involving the groin lymph nodes can be managed safely and effectively with surgical resection. The acute and long-term morbidity is acceptable. Local control can be achieved in the majority of patients.
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PMID:Surgical management of groin node metastases from nonvulvar gynecologic malignancies. 827 99


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