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

Although percutaneous transhepatic biliary drainage (PTBD) restores hepatic and renal function in patients with obstructive jaundice, it is not certain whether it reduces the rate of complications and death after biliopancreatic surgery. We studied the possibility that the operative risks of jaundiced patients are related to malnutrition and the usefulness of hyperalimentation with PTBD to reduce the incidence of complications. Sixty-four patients with obstructive jaundice and serum bilirubin greater than 200 mumol/l were randomized into two treatment groups (n = 32) with PTBD or PTBD + hyperalimentation. Four patients were withdrawn from the latter group, two for metastatic cancer and two for complications of PTBD. Before starting hyperalimentation, the incidence of malnutrition was assessed by biochemical, immunological and anthropometric tests: malnutrition was found in 70 per cent of the patients. All the patients had good recovery of hepatic function but patients treated with PTBD alone still had high mortality (12.5 per cent) and morbidity (46.8 per cent) after biliopancreatic surgery. When hyperalimentation was provided to patients on PTBD for a period of 20 days before the operation, the incidence of complications fell to 17.8 per cent and mortality to 3.5 per cent. These results suggest that the combined use of PTBD and hyperalimentation, improving both hepatic function tests and the nutritional status of jaundiced patients, can reduce the rate of complications after biliary and pancreatic surgery.
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PMID:Hyperalimentation of jaundiced patients on percutaneous transhepatic biliary drainage. 309 94

Protein-energy malnutrition (PEM) is common in cancer patients and may develop into the syndrome known as 'cancer cachexia'. This is characterised by complex disturbances in carbohydrate, lipid, protein, and electrolyte metabolism. The aetiology is equally complex, with host and therapeutic factors contributing to the reduced food intake and effects on host tissues. Anorexia is of prime importance, differing in its cause from one patient to another and often presenting a barrier to successful nutritional support. Further research is necessary to elucidate the interaction of central and peripheral factors that may be involved in the aetiology of anorexia. Because of the interplay of biochemical, physiological, and psychological consequences of cancer, the nutritional support of the patient presents a considerable challenge to the caring professions.
Cancer Metastasis Rev 1987
PMID:Malignant disease: nutritional implications of disease and treatment. 312 Dec 1

Children with cancer are at high risk for major nutrition problems both from the tumor itself and from the treatment administered. Overt malnutrition is seen in as many as 17% of children with newly diagnosed localized tumors and 37% of those with metastatic disease. Weight loss in children with cancer is directly correlated with a poor nutritional status at the time of diagnosis and with a low serum albumin. Massive surgical resections are a common source of nutritional problems and are usually not indicated as primary therapy in children with cancer. Both radiotherapy and chemotherapy are associated with recognized acute and long-term complications which may have an impact upon the nutritional status of the child. The majority of childhood cancers are best managed by a multidisciplinary approach including limited surgery, irradiation, and chemotherapy. This combined modality approach requires careful management including monitoring for known sequelae such that optimistic cure rates can be achieved without compromising the nutritional status of a child with cancer.
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PMID:Effects of therapy on nutritional status of the pediatric cancer patient. 679 91

Although protein-energy malnutrition is common in the cancer patient, the efficacy of aggressive nutritional therapy is unclear. This study evaluates the effects of protein deficiency on tumor growth, response, and chemotherapy complications in primary and metastatic rat hepatoma. Seventy-two ACI rats (200-250 g) with implanted Morris hepatoma were divided into four groups (N = 18 for each group): 1, regular diet; 2, regular diet plus cyclophosphamide (CPM) (100 mg/kg/ip); 3, protein-free diet; and 4, protein-free diet + CPM. Forty additional rats in similar groups (5-8, ten in each group) underwent intravenous injection of 6 X 10(3) tumor cells to produce pulmonary metastases. Animals were assessed for survival, tumor size, serum albumin, number of pulmonary metastases, and hemorrhagic cystitis at 2 weeks. Survival was 50% in groups 4 and 8, and 100% in the others. Serum albumin was significantly lower in rats on protein free diets (2.59 +/- 0.37 vs 3.35 +/- 0.40 g%, P less than 0.01). Tumor volume was significantly reduced by CPM (26.0 +/- 4.2 cm3 vs 1.2 +/- 0.4 cm3, P less than 0.01). Protein-free diets resulted in lower total body weight, and reduced tumor volume without, but not with CPM (14 +/- 1.6 cm3 P less than 0.05, 1.1 +/- 0.3 cm3, P less than 0.05 vs above controls). CPM reduced the number of pulmonary metastases in regular diet groups (307.2 +/- 108.3 vs 36 +/- 11, P less than 0.01), while protein free diets did not significantly affect metastases, without or with CPM (251.7 +/- 71.4 and 22.3 +/- 12.4, P greater than 0.05 vs controls). Hemorrhagic cystitis was much more common in protein free groups compared to rats on regular diets (55 vs 11%, P less than 0.01). These data indicate that protein deficiency did not affect response to chemotherapy in a primary or metastatic rat hepatoma model. However, protein deficiency results in a significantly increased rate of mortality, weight loss, and hemorrhagic cystitis which may lead to delay or cessation of cancer therapy.
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PMID:The effect of protein deficiency on growth and response of primary and metastatic hepatoma. 684 9

The initial clinical manifestations of lung cancer are diverse and may occur with or without symptoms. Manifestations of pulmonary malignant lesions are produced by local growth or invasion, metastatic disease, or paraneoplastic processes. Patterns of local invasion such as Pancoast's syndrome or the superior vena cava syndrome are relatively uncommon but well recognized. Metastatic lung cancer can involve almost any anatomic area by hematogenous, lymphatic, or, occasionally, interalveolar dissemination. Complications related to malnutrition, infection, electrolyte disturbances, and coexisting diseases influence the initial manifestations. Although individual tumor cell types are associated with characteristic features, no constellation of findings is pathognomonic for a specific histologic variant. Because successful treatment of pulmonary carcinoma depends on early detection, awareness of the typical clinical manifestations is important.
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PMID:Clinical manifestations of lung cancer. 847 71

We report a case of multiple hepatic abscesses due to Yersinia enterocolitica in a 58 yr old male. This case is typical of the other 39 cases reported in the literature in that the patient had alcoholism, malnutrition, iron overload and a subsequently diagnosed malignancy. Ultrasound showed multiple hypoechoic areas in the liver which were confirmed by CT scan. The patient also had a rectal lesion initially thought to be malignant, leading to a presumptive diagnosis of metastatic disease. A CT-guided fine needle aspiration biopsy of a liver lesion unexpectedly revealed pus which subsequently grew Yersinia enterocolitica. The organism was also isolated from the patient's blood and feces. This case illustrates the need for histological microbiological investigation of radiologically diagnosed presumptive malignancy.
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PMID:Multiple hepatic abscesses due to Yersinia enterocolitica. 877 Nov 60

Characteristics of 10-year survival after esophagectomy for carcinoma were studied retrospectively in 161 patients who underwent curative operation between 1973 and 1984. Of the 161 patients, 44 (27.3%) survived for 10 years after operation (right transthoracic approach with cervical anastomosis in 36 patients and left thoracoabdominal approach with jejunoesophagostomy in 8 patients). Females survived significantly longer than males; 10-year survival was observed in 10 (50%) of 20 females and 34 (24.1%) of 141 males. TNM factors were significantly linked to the 10-year survival for 25 patients (56.8%) whose tumors invaded the adventitia and 20 patients (45.5%) who had lymph node metastases, where the total number of involved nodes was less than eight. A questionnaire mailed 10 years after operation revealed that about one-fifth of the 10-year survivors could not go up one flight of stairs without taking a rest, and that the daily activity significantly deteriorated if the patient's age at the time of surgery was more than 66 years. One-third of the 10-year survivors were not satisfied with the daily quantity of food intake, resulting in no gain of body weight after discharge from the hospital. This complaint was significantly correlated with either weekly reflux or heartburn, resulting in the increasing number of nonmalignancy deaths. Of 13 ten-year survivors who were alive at 10 years but died after that, 11 (84.6%) died of pneumonia or malnutrition. Duodenogastroesophageal reflux may eventually cause nonmalignancy death 10 years after esophagectomy for carcinoma.
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PMID:Appraisal of ten-year survival following esophagectomy for carcinoma of the esophagus with emphasis on quality of life. 901 71

Two patients, women of 85 and 76 years, presented with horizontal ocular paresis. The first patient had a palliative ileocecal resection for adenocarcinoma with metastases and developed the ocular paresis only after intravenous glucose infusion. The second had chronic haemolytic anaemia and weight loss due to malnutrition. The two women were also confused. In both patients acute Wernicke's encephalopathy was diagnosed, caused by thiamine deficiency. The disorder could easily have been missed because of confounding clinical problems. Early treatment of Wernicke's encephalopathy (thiamine 100 mg/day intramuscularly for 3 days) is of major importance in preventing permanent neurological damage or even death.
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PMID:[Eye paralysis and confusion]. 955 50

Familiar Amyloid Polyneuropathy (FAP), an autosomal dominant inherited multisystemic disorder was first observed by Corino de Andrade, a Portuguese neurologist, in 1939. This disease of Portuguese origin was probably spread by fishermen, mainly to Sweden and Japan. It is characterized by a progressive peripheral polyneuropathy and autonomic neuropathy (erectile sexual disfunction, gastrointestinal disfunction, bladder dysfunction and cardio vascular disease) and malnutrition. There are neural and systemic amiloid deposits. Type I FAP, of Portuguese origin, is the most common variety. The amyloid protein is the variant transthyretin (TTR) in which methionine (MET) is a substitute for valine in position 30 (TTR MET 30). It is mainly produced by the liver (90%) and, in small amounts, by the choroidal plexus. Symptoms usually start in the 3rd and 4th decade of life and the patients usually die within 10-15 years. From the therapeutic options--plasmapheresis, immunoadsorption and liver transplantation; the latter seems to be the only one, which stops the production of TTR MET 30 in a permanent way, by means of the liver. The lack of any other effective therapy and the success of the first liver transplantation performed in Sweden arouse great hope. So far, around 300 patients have been transplanted all over the world. A hundred and thirty of them were transplanted in Portugal. A Kaplan Meier survival curve of the Portuguese patients shows a survival rate of 78% at 5 years. However, in spite of the progression of the disease being halted, the irreversibility of some neurological lesions seems to persist. This fact raises the problem of the timing of the transplantation. It seems that the patients should be transplanted as soon as the symptoms start, since mortality and severe morbidity seems to mainly involve those in whom symptomatic disease has lasted longer than six years. As the explanted liver is a morphologic normal liver, a sequential (domino) transplant has been carried out in 16 cases so far done--by one of the authors (ALF) on patients with either hepatocellular carcinoma or liver metastatic disease.
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PMID:Liver transplantation for familial amyloid polyneuropathy. 984 68

Enterocutaneous fistulae that develop in patients with cancer represent a difficult management situation, which is often complicated by prior treatment including surgery, radiation therapy, and chemotherapy. A fistula may in turn delay potentially beneficial treatment of the underlying malignancy. To provide a better understanding of this problem, we reviewed the National Institutes of Health experience with enterocutaneous fistulae in adult patients with cancer. The medical records of patients with cancer who developed a fistula from the gastrointestinal tract during the period 1980 through 1994 were reviewed. Etiology, management, outcome, and impact on further treatment were assessed. Twenty-five patients with gastrointestinal fistulae were identified. The most common primary tumor site was the colon/rectum in males and the ovary in women. The majority of patients had metastatic disease at diagnosis and a history of prior therapy and presented with anorexia and weight loss. The fistula was usually single, most commonly developed from the jejunum/ileum (13 patients) or colon/rectum (6 patients), and occurred postoperatively after procedures on the small bowel (10 patients) or colon (8 patients). Malnutrition and sepsis developed in 60 per cent of patients. Thirty-day mortality was 16 per cent and correlated with prior radiation therapy, location and output from the fistula, and hypoalbuminemia. An enterocutaneous fistula negatively impacted on the provision of further therapy for the majority of patients (63%). Enterocutaneous fistula in the patient with cancer occurs most frequently in the setting of extensive prior therapy and is associated with prolonged morbidity. Identification of high-risk patients and early management of fistulas once they develop may prevent delays in subsequent cancer therapy and decrease morbidity.
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PMID:Enterocutaneous fistula in cancer patients: etiology, management, outcome, and impact on further treatment. 984 47


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