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)

In contrast to pulmonary parenchyma metastases or lymphangitic carcinomatosis, neoplastic emboli of small pulmonary arteries and capillaries frequently go unrecognized and are only discovered at autopsy. Five patients (48 +/- 12 years old) were admitted to 3 intensive care units for severe acute respiratory failure and died between the first and the tenth day following hospitalization. Each patient had a history of rapidly progressive dyspnea, and physical examination showed clinical evidence of right ventricular failure. The lungs were clear on chest X-rays and the ECG revealed sinus tachycardia with a right QRS axis. The mean partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were, respectively, 50.8 +/- 9.1 mm Hg and 22.2 +/- 2.4 mm Hg. A swan-Ganz catheter, inserted into 4 patients, revealed pulmonary arterial hypertension (55, 43, 37, 28) with capillary wedge pressure within the normal limits and cardiac output normal or low (3.0, 3.8, 4.4, 5.0 l/min). Pulmonary angiograms from each patient showed decreased distal lung perfusion without any proximal defects suggestive of pulmonary embolism. The inferior vena cava always appeared clear. Malignant cells were found upon autopsy (4 cases) in the lumina of the pulmonary arterioles and the primary site of the cancer was determined in 3 patients (2 hepatomas and 1 pancreatic carcinoma). The last patient had a known breast cancer with bone marrow metastases and clinical, hemodynamic and angiographic evidence of neoplastic emboli. The clinical course of neoplastic emboli can suggest acute pulmonary embolism, but the diagnosis can only be advanced after pulmonary angiography, especially if the patient is to have a cancer.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Acute respiratory distress caused by distal neoplastic pulmonary emboli]. 209 8

Gastrointestinal malignancy may spread to peritoneal surfaces in the absence of lymphatic or hematogenous metastases. To treat peritoneal carcinomatosis, a uniformly lethal disease process, extensive cytoreductive surgery and i.p. chemotherapy were combined. Early postoperative i.p. chemotherapy was instilled in the first few days after the surgical procedure in an attempt to treat anatomic sites that would be sealed off by postoperative adhesions. Mitomycin C was given on the first postoperative day at two doses, 10 and 12 mg/m2. 5-Fluorouracil was given on postoperative days 2-5 at 15 and 20 mg/kg, respectively. Median area under the curve ratio i.p./i.v. was 117 for 5-fluorouracil and 21.6 for mitomycin C. Elevated intraportal levels of drug were observed for i.p. 5-fluorouracil but not for mitomycin C. The marked pharmacokinetic advantage of postoperative i.p. suggests that this treatment strategy should be considered in a clinical trial in patients at risk for progression of peritoneal carcinomatosis.
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PMID:Early postoperative intraperitoneal chemotherapy as an adjuvant therapy to surgery for peritoneal carcinomatosis from gastrointestinal cancer: pharmacological studies. 211 20

Sixteen instances of adenocarcinoma of the appendix treated at Roswell Park Memorial Institute between 1964 and 1986 were reviewed. Thirteen of 15 were mucinous and ten were well differentiated. Synchronous metastases were present in 11 patients, with carcinomatosis being the most common pattern of metastases (nine patients). Seven of eight women had ovarian metastases. Nine of the 11 patients with metastatic disease presented with complaints referrable to the metastatic site. The five year survival rate was 50 per cent in the eight patients who underwent right hemicolectomy and 25 per cent in the four patients who underwent appendectomy. The data from this review support right hemicolectomy as the treatment of choice for adenocarcinoma of the appendix. The prolonged survival time of patients with metastatic disease and the symptomatic nature of that disease support the application of palliative oophorectomy in patients with ovarian metastases.
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PMID:Adenocarcinoma of the appendix. 245 89

The diagnosis of lymphangitic spread of carcinoma in the lungs is sometimes difficult. We studied the cytologic characteristics of blood drawn through a wedged pulmonary-artery catheter from eight patients in whom lymphangitic carcinomatosis was confirmed by subsequent autopsy, lung biopsy, or clinical evaluation. The sites of the primary tumors were the prostate, breast, esophagus, and lung. Malignant cells were found in seven of the eight patients. Cytologic findings were normal in 16 of 17 patients with cancer but without pulmonary metastases and in 22 of 23 patients with nonmalignant pulmonary disorders. In a patient with cancer with tumor embolism to the lungs, the findings were positive, probably because of extensive intravascular tumor in large hepatic veins. One false positive finding occurred in a patient with extensive pulmonary infarction. Megakaryocytes, which are present in large numbers in the pulmonary capillary bed, are the hallmark of a satisfactory pulmonary vascular blood sample for pulmonary microvascular cytologic study. Familiarity with the cytologic characteristics of these cells in Papanicolaou preparations is essential to avoid mistakenly identifying them as malignant. Although transbronchial lung biopsy remains the diagnostic procedure of choice in this disorder, our findings suggest that the presence of malignant cells in pulmonary microvascular-cytology preparations in patients with cancer and unexplained dyspnea constitutes presumptive evidence of lymphangitic carcinomatosis. Pulmonary microvascular cytology may be particularly valuable when lung biopsy is refused or is thought to be too hazardous.
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PMID:Pulmonary microvascular cytology in the diagnosis of lymphangitic carcinomatosis. 229 20

Palliative therapy for obstructing esophageal carcinoma is more often necessary than curative surgery. The neodymium:yttrium-aluminum-garnet laser was used for vaporization of obstructing esophageal carcinoma in 18 patients requiring 24 treatments. Three women and 15 men (age range 42 to 87 years) had esophageal carcinoma (seven squamous cell and nine adenocarcinoma). Twelve tumors were at the esophagogastric junction, four at the midesophagus, and two in the cervical esophagus. Lengths varied from 3 to 7 cm. Inoperability was due to diffuse metastases in eight patients, local invasion in five, poor operative risk in one patient, and patient refusal for operative treatment in four patients. Energy use was 1000 to 22,600 J per session (mean 6120 J). Good results were achieved in 16 patients (88.9%): Seven returned to full diet, five to soft diet, and four to full fluids without dysphagia. Four patients required retreatment 1 to 3 months later because of recurrent dysphagia. One patient was not benefited by the treatment and died of carcinomatosis 1 week later. No intraoperative complications occurred. Postoperatively, one patient had laryngeal edema and another had a bronchoesophageal fistula 3 weeks later. The mean survival time is 3 1/2 months. Neodymium:yttrium-aluminum-garnet laser vaporization for obstructing esophageal carcinoma is effective palliation regardless of histologic tumor type. It can be performed under direct vision with a low frequency of postoperative complications.
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PMID:Neodymium:yttrium-aluminum-garnet laser vaporization for palliation of obstructing esophageal carcinoma. 247 31

MR imaging was used to investigate normal and abnormal meningeal enhancement, with an emphasis on meningeal carcinomatosis. Three groups of patients were studied on a 1.5-T system. In group 1, the normal meninges were examined in 20 patients and were found to show fine linear enhancement in short segments, especially in a parasagittal distribution. In group 2, all gadolinium-enhanced head scans were reviewed retrospectively. Abnormal meningeal enhancement was detected in 52 patients. In some of these, the enhancement was associated with pathologic conditions of the meninges, including leptomeningeal tumor and meningeal infections and other inflammatory conditions; in others the enhancement was adjacent to subdural hematomas, subacute infarcts, and skull lesions, such as metastases or postoperative defects. In group 3, 30 cases of meningeal carcinomatosis were studied prospectively. Enhancement was seen in approximately two-thirds of cases and usually was quite diffuse and applied to the inner table of the skull. Frank nodules were seen less often. Contrast-enhanced CT was equal to MR in the detection of nodules but was nearly always unable to show diffuse meningeal enhancement against the inner table of the skull. Contrast-enhanced MR was more sensitive than contrast-enhanced CT in the examination of normal and abnormal meninges. Abnormal findings, such as meningeal carcinomatosis, were demonstrated more often by MR than by CT.
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PMID:MR imaging of the cranial meninges with emphasis on contrast enhancement and meningeal carcinomatosis. 250 42

A new form of dosage (MMC-CH) was composed of activated carbon particles adsorbing mitomycin C. Intraperitoneal administration of MMC-CH was tested clinically for prophylactic and therapeutic effects on peritoneal carcinomatosis of gastric cancer. The criteria of MMC-CH's administration were equal or less than 70 years old, more than 40 kg in body weight, no disfunction of liver and kidney, no particular findings in electrocardiography, S2 or S3 in the grade of serosal invasion, P0, P1, P2 or P3 in the grade of peritoneal dissemination, according to the General Rules for the Gastric Cancer Study in Surgery and Pathology by the Japanese Research Society for Gastric Cancer. MMC-CH was given to 44 patients undergoing gastrectomy for gastric cancer in our department from 1985 to 1988. The 44 patients were composed of 12 patients with P0 findings (P0 patients), 8 patients with P1 findings (P1 patients), 12 patients with P2 findings (P2 patients), and 12 patients with P3 findings (P3 patients). MMC-CH at 50 mg/person in terms of mitomycin C was administered intraperitoneally before the operation wound was closed. Fifty-seven patients in our department from 1983 to 1987 for whom the same criteria were applicable and did not receive MMC-CH therapy, served as the control group. The 57 patients were composed of 23 P0 patients, 21 P1 patients, 10 P2 patients, and 3 P3 patients. There was statistically with chi 2 test no significant difference of age, sex, depth of infiltration macroscopically and microscopically defined progression of lymph-nodal metastases between the MMC-CH group and the control group. Survival rate was calculated with Kaplan-Meier's method in the overall patients in each of the MMC-CH group or the control group. The overall survival rate in the MMC-CH group was statistically significantly (p less than 0.01-0.05) higher from day 460 to day 552 and from day 736 to day 800 than that in the control group. Next, the patients were classified into two subgroups, namely the subgroup composed of P0 patients and the subgroup composed of P1, P2, and P3 patients, in order to examine each of the MMC-CH's prophylactic effects on subsequent dissemination or its therapeutic effects on established dissemination. Survival rate was calculated with Kaplan-Meier's method in the two subgroups through the same procedures used for the overall survival rate.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Intraoperative chemotherapy with intraperitoneal activated carbon particles adsorbing mitomycin C against peritoneal dissemination of gastric cancer]. 250 20

Gastrointestinal malignancies frequently recur with metastatic disease limited to the abdominal cavity. Due to full thickness penetration of tumor through bowel wall and spillage of tumor from lymphatic channels by surgical trauma, tumor cells are disseminated throughout the peritoneal surfaces either prior to at the time of surgical removal of the primary tumor. Diagnosis of recurrent cancer is difficult because no sensitive diagnostic test is available by which to image a small tumor volume present on peritoneal surfaces. Computerized tomography can not demonstrate small to moderate nodules. Intraperitoneal instillation of 131-1 labeled monoclonal antibody has allowed visualization of mucinous tumor on peritoneal surfaces not seen by any other radiologic test. Intraperitoneal chemotherapy has been shown to provide palliation in patients with small volume disease confined to peritoneal surfaces. Because of limited penetration of chemotherapy into large tumor nodules this treatment strategy has not been effective for bulky intraabdominal recurrent cancer. Cytoreductive surgery can make patients relatively disease free. New surgical technologies combined with postoperative intraperitoneal chemotherapy have been shown to be curative for selected patients with recurrent cystadenocarcinoma. The wider application of immediate postoperative intraperitoneal chemotherapy treatments for gastrointestinal patients in an adjuvant setting may be of value in preventing the occurrence of peritoneal carcinomatosis and in improving survival.
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PMID:Management of peritoneal carcinomatosis. 251 51

In this case report the clinical course of a female patient with metastatic breast cancer receiving a mild cytostatic regimen with chlorambucil, methotrexate and prednisone is described. She developed an unusual clinico-pathological syndrome with pancytopenia, fever and bone pain resulting from a bone marrow necrosis. The clinical course illustrates the great diagnostic difficulties and the potential benefit from rapid identification of this prognostically very poor event. Leading symptoms such as fever, bone pain, pancytopenia, an increase in the sedimentation rate, in lactate dehydrogenase and alkaline phosphatase in serum are often misinterpretated as tumor progression with bone or hepatic metastases and bone marrow carcinomatosis. An iliac crest aspirate and biopsy detects the diagnosis of a marrow necrosis. These symptoms should be kept in mind in order to avoid a diagnostic pitfall resulting from a misinterpretation of the morphological picture as necrotic metastasis in bone marrow or as an artefact. It is assumed that, in addition to the underlying malignant disease, cytostatic therapy with chlorambucil, methotrexate and prednisone triggers this event.
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PMID:[Bone marrow necrosis in a patient with metastatic breast cancer in chemotherapy with chlorambucil, methotrexate and prednisone]. 254 86

We reviewed the computerized tomographic features of pathologically proven metastases to the ovary in 12 patients. Serial CT scans were available in nine of the 12 patients--before removal of the ovaries in five cases (showing typical growth characteristics of these metastases) and afterward in six (showing common patterns of tumor progression). Primary neoplasms metastasizing to the ovary included adenocarcinoma of the colon (seven), stomach (two), appendix (one), and endometrium (one), and carcinoid tumor (one). On CT, metastases to the ovary were large lobulated or oval masses with cystic and solid components. Nine were bilateral and three were unilateral. Three patterns of ovarian enlargement were seen: macrocystic (six), microcystic (three), and predominantly solid enlargement with necrosis (three). Other associated CT findings included carcinomatosis, hydronephrosis, ascites, liver metastases, and lymphadenopathy. The primary tumor in patients without a prior history of malignancy was identifiable retrospectively on CT in four of the five cases.
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PMID:Krukenberg tumors: CT features and growth characteristics. 215 42


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