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

Survivors of acute myocardial infarction (AMI) should have risk stratification for assessment of their future risk of cardiovascular events. One of the important means of risk stratification is by treadmill test (TMT). Most of the algorithms for assessment were done in the prethrombolytic era. But in the post-thrombolytic era, risk stratification by TMT should be properly evaluated. Fifty males with confirmed AMI with age ranging from 38-62 years (mean 48 years) were tested with a symptom limited (Modified Bruce Protocol) TMT. The patients were followed up for a minimum of 6 months (range 6-10 months). Out of 50 patients, 38 reported for follow up. Among them 22 (Group A) had cardiac events and 16 (Group B) had no events. Among the patients (Group A), 6 had unstable angina, 7 had reinfarction, 2 had sudden death, 4 had coronary artery bypass grafting (CABG) and 3 had angioplasty. Comparison between the two groups, A and B in TMT parameters like ST segment depression > 2.5 mm (12 vs 9), no. of leads where ST depression occurred (66 vs 48) during exercise, mean work capacity (8.1 vs 7.9 mets), mean systolic blood pressure response were all statistically insignificant. Though TMT was believed to be a good prognostic indicator to assess further cardiac events after AMI, its efficacy in risk stratification after thrombolysis is yet to be determined. This study does not show its worth in post MI risk assessment.
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PMID:Risk stratification by treadmill testing in acute myocardial infarction following thrombolytic therapy. 1127 11

Though acute myocardial infarction is one of the most frequent causes of ST segment elevation, there are other, less frequent, reasons for such electrocardiographic changes. In the present case, a cardiac metastasis from a squamous cell lung carcinoma was responsible for these changes. The secondary lesion was located in the apex of the left ventricle and induced an ECG alteration mimicking myocardial ischaemia. The literature includes few reports that describe the relation between electrocardiographic changes and heart metastases, since heart metastases are not usually discovered except at autopsy.
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PMID:Electrocardiographic manifestations of heart metastasis from a primary lung cancer. 1143 Apr 24

A second thoracotomy in patients who have undergone previous chest surgery can be performed soon or immediately after the first operation and is usually aimed at resolving severe or even life-threatening postoperative complications. Late reoperations, on the other hand, are either performed to resolve complications of previous surgery or to remove second primary lung tumors (SPLCs) or metastases. The most exacting reoperation in this context is completion pneumonectomy, which is particularly indicated in the case of failure of the residual lobe to re-expand after primary surgery; it is also used for--rarely occurring--fistulas of the lobar bronchi and for new ipsilateral primary lung tumors. This type of surgery is technically complicated and has been associated, in our experience and that of others, with a certain mortality. Technically less difficult is a second ipsilateral thoracotomy for exploratory purposes or minor parenchymal resection, and the same is true of contralateral lobar or sublobar resections. Lastly, Abruzzini's operation, for fistulas of the primary bronchus, is relatively complicated but often leads to good results; we have performed 15 such operations with only one death occurring due to acute myocardial infarction.
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PMID:[Reoperations in lung surgery]. 1219 82

Prostatic cancer (PC) is a frequent finding in aged men. In fact, 3% of males have the chance to die of PC. Radical prostatectomy by the retropubic approach with pelvic lymphadenectomy was made in 97 males. The treatment was performed in the urological department of the MSMSU urological chair from 1995 to 2001. 69 patients followed up for 3-64 months after the operation were eligible for analysis of the outcomes. The patients had the following PC stages: T1--11 patients, T2--44 patients, T3--14 patients. Prostate-specific antibodies ranged within 2.9-67.8 ng/ml (the mean level 16.7 ng/ml). The results of the treatment were satisfactory in 65 (94.2%) of 69 patients. The operation did not take more than 2.5 hours, mean blood loss was under 870 ml. Adequate urination after the catheter was removed resumed in 41 (59.4%) of 69 patients. Active urinary incontinence was observed within one year after the operation in 25 (36.2%) patients, total incontinence--in 3 (4.3%) patients. 51% patients retained the erectile function after nerve-sparing operation. Most of the patients had an unevenful postoperative period. During the follow-up 3 patients died of acute myocardial infarction (n = 1), intestinal cancer (n = 1) and distant PC metastases (n = 1). A postoperative fall in the PSA level under 0.3 ng/ml occurred in 49 (71%) patients, under 2 ng/ml in 7 patients (10%). In 19% of patients with pT2-3 the PCA rose over 2.0 ng/ml. Radical prostatectomy is indicated for patients with local prostatic cancer (stage T1 or T2) and probable survival from 10 to 15 years and longer. A nerve-sparing, sphincter-sparing and ablastic variant of this operation is widely used world-wide and is a method of choice for therapy of patients with retropubic prostatic cancer.
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PMID:[Radical prostatectomy: surgical techniques and preliminary results]. 1281 17

Involvement of the heart and pericardium by cancer is not uncommon, with metastases being more frequent than primary cardiac neoplasms. We present a case of a metastatic lung cancer for which the primary manifestation was chest pain mimicking an acute myocardial infarction.
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PMID:Lung neoplasm mimicking an acute lateral myocardial infarction. 1460 95

A 71 year old patient presented with a non-ST segment elevation acute myocardial infarction. The echocardiogram showed several masses attached to the interatrial septum. Several days after admission the patient died. A postmortem examination found a large hepatocarcinoma with intravascular and intracardiac metastases and several myocardial infarctions of different ages. The infarctions had been caused by coronary paradoxical embolisms through a patent foramen ovale and contained neoplastic cells from the liver carcinoma, which had not been diagnosed. The cause of death was a massive pulmonary embolism.
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PMID:Acute myocardial infarction caused by paradoxical tumorous embolism as a manifestation of hepatocarcinoma. 1508 77

We discuss the case of a 71-year-old female patient who presented with findings suggestive of an acute myocardial infarction. Subsequent evaluation revealed an extrinsic cardiac mass encasing the left circumflex and right coronary arteries (RCA) which caused compression and spasticity of the RCA. Biopsy findings were consistent with a hematologic malignancy. Reports of extrinsic compression of epicardial coronary arteries are uncommon. Neoplasms, either primary cardiac tumors or metastatic disease, are a rare cause of extrinsic compression of coronary arteries.
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PMID:Cardiac mass presenting as ST-elevation myocardial infarction: case report and review of the literature. 1898 5

Cardiac metastases are more common than primary tumors. Several types of malignant tumors have been reported to metastasize to the heart, mainly lung cancer, but in the setting of esophageal cancer, myocardial metastasis is comparatively rare. We report a case of a cardiac metastasis from esophageal squamous cell carcinoma detected 9 months after surgically curative esophagectomy, which presented mimicking acute myocardial infarction. The use of different imaging modalities was fundamental to a correct diagnosis considering the challenging presentation.
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PMID:Cardiac metastasis from epidermoid esophageal cancer mimicking anterior myocardial infarction. 2222 60

In this article we give a case report on a PTC patient with pancreatic metastasis. In this case, the patient was admitted to our hospital for recurrence of PTC and occupying pancreatic lesions. We considered that the pancreatic neoplasm may be pancreatic metastasis of PTC but there is no previous experience about therapeutic approaches to this type of metastases. After some discussion the distant metastasis within the pancreas was successfully removed by a laparotomy and postoperative histology confirmed the diagnosis. After that surgery, the patient recovered well and then received total thyroidectomy and cervical lymph node dissection for recurrent thyroid cancer. After recovery he was discharged from hospital without further treatment. Eventually, he died of acute myocardial infarction in January 2010. To conclude, it is widely believed that the surgical operation should be chosen more positively in the management of those patients without multiple organ metastases. Thus on one hand it can serve to make a definite diagnosis, and on the other hand it can help the body get rid of the bulk of the tumor burden to prolong survival time of the patients.
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PMID:Pancreatic metastasis of papillary thyroid carcinoma: a case report with review of the literature. 2455 10

OBJECTIVE Comorbidities have an impact on risk stratification for outcomes in analyses of large patient databases. Although the Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) are the most commonly used comorbidity indexes, these have not been validated for patients with unruptured cerebral aneurysms; therefore, the authors created a comorbidity index specific to these patients. METHODS The authors extracted all records involving unruptured cerebral aneurysms treated with clipping, coiling, or both from the Nationwide Inpatient Sample (2002-2010). They assessed the effect of 37 variables on poor outcome and used the results to create a risk score for these patients. The authors used a validation data set and bootstrapping to evaluate the new index and compared it to CCI and ECI in prediction of poor outcome, mortality, length of stay, and hospital charges. RESULTS The index assigns integer values (-2 to 7) to 20 comorbidities: neurological disorder, renal insufficiency, gastrointestinal bleeding, paralysis, acute myocardial infarction, electrolyte disorder, weight loss, metastatic cancer, drug abuse, arrhythmia, coagulopathy, cerebrovascular accident, psychosis, alcoholism, perivascular disease, valvular disease, tobacco use, hypothyroidism, depression, and hypercholesterolemia. Values are summed to determine a patient's risk score. The new index was better at predicting poor outcome than CCI or ECI (area under the receiver operating characteristic curve [AUC] 0.814 [95% CI 0.798-0.830], vs 0.694 and 0.712, respectively, for the other indices), and it was also better at predicting mortality (AUC 0.775 [95% CI 0.754-0.792], vs 0.635 and 0.657, respectively, for CCI and ECI). CONCLUSIONS This new comorbidity index outperforms the CCI and ECI in predicting poor outcome, mortality, length of stay, and total charges for patients with unruptured cerebral aneurysm. Reevaluation of other patient cohorts is warranted to determine the impact of more accurate patient stratification.
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PMID:A new comorbidities index for risk stratification for treatment of unruptured cerebral aneurysms. 2674 86


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