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

Explorative laparoscopy is an endoscopic examination of the abdominal cavity which, with the modern endoscopy tables, permits a considerably improved survey than formerly. Within one year, 105 patients were examined and a suspected tumor was confirmed 20 times in 57 patients. Metastases were sought 23 times in patients known to have a primary tumor, and demonstrated 11 times. The differential diagnosis of cholestasis was made 18 times, 6 times a negative cholecystogram required further clarification. Two of these showed an inoperable, infiltrating, growing carcinoma of the gall bladder. For the purpose of classification of lymphogranulomata, laparoscopy shows the advantage over laparotomy of careful magnifying observation of the surface of the liver which can be repeated as often as desired.
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PMID:[Explorative laparoscopy or laparotomy? (author's transl)]. 13 93

Explorative laparoscopy is an endoscopic examination of the abdominal cavity which, with the modern endoscopy tables, permits a considerably improved survey than formerly. Within one year, 105 patients were examined and a suspected tumor was confirmed 20 times in 57 patients. Metastasis were sought 23 times in patients known to have a primary tumor, and demonstrated 11 times. The differential diagnosis of cholestasis was made 18 times, 6 times a negative cholecystogram required further clarification. Two of these showed an inoperable, infiltrating, growing carcinoma of the gall bladder. For the purpose of classification of lymphogranulomata, laparoscopy shows the advantage over laparotomy of careful magnifying observation of the surface of the liver which can be repeated as often as desired.
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PMID:[Explorative Laparoscopy or Laparotomy (author's transl)]. 13 94

A study was carried out on 27 patients (22 women and 5 men) suffering from gallbladder carcinoma confirmed through surgery or autopsy. The examinations were performed with a real-time scanner and 3.5 MHz transducer. Lately, higher resolution transducers (5 MHz and 7.5 MHz) have been employed which have proven more effective due to their improved resolution. The importance is stressed of scanning patients in different positions in order to allow stones and echogenic material to redistribute inside the gallbladder. A correct diagnosis was obtained in 20/27 cases. Bile duct metastases were correctly evaluated by US in 13/13 cases; liver metastases in 25/27 patients. US proved unreliable in those cases where lymph nodes were involved (0/4). Six patients underwent scanning few months, or even years, before the onset of the symptoms. Three patients presented with fundic tumors, whose wall thickening and shadowing of the external wall had been incorrectly evaluated. In the other 3 cases the gallbladder was filled with stones and had thick and constricted walls. There was only a case of invisible carcinoma. Gallbladder carcinoma has often an unfavorable prognosis due to its being diagnosed in an advanced stage. The prognosis of such patients can be improved through an earlier US diagnosis only. The first step in this direction seems to be the identification of the precursor lesions.
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PMID:[Potentials of echography in the diagnosis of gallbladder carcinoma]. 306 Sep

The data of 34 patients with a sonographically established dilated common bile duct were analysed as to the clinical significance of these findings. Whereas it was possible to diagnose dilated proximal common bile ducts in all of the cases under examination, presentation of the distal section succeeded in only 56% of the patients involved. Thus distal concretions escaped diagnosis in seven out of 24 cases. There is no established relation between the extent of dilatation of the common bile duct and hyperbilirubinemia; quite to the contrary, in three cases without any signs of arrest of bile excretion under chemical analysis, it was not until ultrasonography was performed that some initial indications of an impeded bile outflow due to concretions were discovered. It was possible to obtain a confirmed diagnosis in the case of two pancreas carcinomas, three bile duct carcinomas, a local recurrent carcinoma of the gall bladder and lymph node metastases of a gastric carcinoma in the hepaticoduodenal ligament. In another gall bladder carcinoma nothing but dilated bile ducts presented itself. What was thought to be a hepatoma, turned out to be a carcinoma of the bile duct during autopsy. A cirrhotic carcinoma of the common bile duct was considered to be a case of calculi in the common bile duct without shadow when examined with ultrasound. During their stay in the hospital, four patients passed gallstones, thus relieving distention of the duct. Additional tests were carried out in 16 patients (47%) in order to confirm the diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical significance of the dilated common bile duct in the sonogram]. 664 81

The US and CT images of 40 surgical patients with histologically proved gallbladder carcinoma were retrospectively reviewed. The radiologic diagnosis was correct in 22 patients (55%). Gallbladder carcinoma patterns were: an intraluminal mass (type I) (7 patients, 17.5%), focal or diffuse wall thickening (type II) (5 patients, 12.5%) a mass replacing the gallbladder (type III) (10 patients, 25%). In 5 patients with type I or II gallbladder carcinoma, US and CT diagnosis was made easier by the presence of associated findings--i.e., liver infiltration and/or metastases, lymphadenopathy, dilated intrahepatic ducts, ascites. In 7 patients a gallbladder carcinoma was suspected in the presence of a small intraluminal mass (6 cases) or of focal wall thickening (1 case), with no stones and with dilated intrahepatic biliary ducts. In the extant 18 patients (45%) the radiologic diagnosis was: polyps (6 cases), stones with cholecystitis (11 cases) and empyema (1 case). US is the examination of choice in the diagnosis of gallbladder and biliary ducts conditions, but several diagnostic problems may arise in the differentiation from polyps and acute inflammatory disease. CT better demonstrates gastrointestinal tract invasion and lymphadenopathy, which can be a valuable finding for treatment planning.
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PMID:[Ultrasonography and computerized tomography in the diagnosis of gallbladder carcinoma]. 800 96

Gallbladder carcinoma is the most common malignancy of the biliary tract. There are still many controversies regarding the type of curative surgical treatment for each stage of the disease. The staging system used is the TNM classification of the International Union Against Cancer. Different patterns of spread characterize gallbladder cancer but the two main types are direct invasion and lymph node metastases; since only the depth of invasion can be easily recognized by imaging techniques, it becomes the main variable in choosing the appropriate surgical treatment. Most Tis and T1 tumours are incidentally discovered after cholecystectomy for cholelithiasis and no further therapy is requested; for pT1b tumours, relaparotomy with hepatic resection and N1 dissection is associated with a better survival. For T2 tumours, cholecystectomy with hepatic resection and dissection of N1-2 lymph nodes is the standard treatment, with a 5-year survival of 60-80%. The only chance of long-term survival for patients with a T3-T4 tumour is an extended operation combining an hepatic resection with an N1-2 dissection with or without excision of the common bile duct. A subset of patients with peripancreatic positive nodes or invasion of adjacent organs seems to benefit from a synchronous pancreaticoduodenectomy.
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PMID:Radical surgery for gallbladder cancer: current options. 1101 62

Gallbladder carcinoma shows an unusual geographic and demographic distribution. It is relatively uncommon in Europe, but more frequent in Israel, Chile, Bolivia and in Southwestern Native Americans in the United States. Chronic cholecystitis, choledochal cysts, high body mass index, female gender, age, nicotine and industrial exposure to carcinogens are associated risk factors. The frequency of gallbladder cancer in all operations of the biliary tract is about 1-3%, reflecting the commonest biliary tract malignancy. Preoperative imaging, including ultrasound and computed tomography (CT), may reveal signs indicative of the presence of malignancy. However, most patients are not diagnosed prior to surgical intervention. Survival depends on the ability to achieve a curative resection, including hepatectomy and lymph node dissection in patients with local extended tumour according to the stage of the disease. Overall, the curative resection rates for gallbladder carcinoma range from 10% to 30%. Regional and para-aortic lymphadenectomy provides no survival benefit for patients with para-aortic disease, which has a negative influence on prognosis equivalent to that of distant metastases. A survival benefit is seen only in selected patients with metastases limited to the regional nodes. Taking a sample biopsy of the para-aortic nodes before starting surgery is recommended because these nodes are involved more frequently than expected. For those patients with unresectable cancer, palliative surgical, endoscopic or radiological bypass procedures can improve quality of life. Other approaches to the management of advanced tumours include systemic chemotherapy or combined chemo-radiotherapy and need further evaluation. Early-stage tumours are often discovered as an incidental finding during (laparoscopic) cholecystectomy or on histological examination of the gallbladder, mostly necessitating relaparotomy and extensive resection. In the following, management of patients with gallbladder cancer at different stages and situations is discussed.
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PMID:Gallbladder carcinoma and surgical treatment. 1120 Oct 5

Gallbladder cancer is an extremely difficult disease to cure once metastases occur. In this paper, we explored the potential of G207, an oncolytic, replication-competent herpes simplex virus type 1 mutant, as a new therapeutic means for gallbladder cancer. Gallbladder carcinoma cell lines (four human and one hamster) showed nearly total cell killing within 72 h of G207 infection at a m.o.i. of 0.25 to 2.5 in vitro. The susceptibility to G207 cytopathic activity correlated with the infection efficiency demonstrated by lacZ expression. Intraneoplastic inoculation of G207 (1 x 10(7) pfu) in immunocompetent hamsters bearing established subcutaneous KIGB-5 tumors caused a significant inhibition of tumor growth and prolongation of survival. Repeated inoculations (three times with 4-day intervals) were significantly more efficacious than a single inoculation. In hamsters with bilateral subcutaneous KIGB-5 tumors, inoculation of one tumor alone with G207 caused regression or growth reduction of uninoculated tumors as well as inoculated tumors. In athymic mice, however, the anti-tumor effect was largely reduced in inoculated tumors and completely abolished in remote tumors, suggesting large contribution of T-cell-mediated immune responses to both local and systemic anti-tumor effect of G207. These results indicate that G207 may be useful as a new strategy for gallbladder cancer treatment.
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PMID:Therapeutic efficacy of G207, a conditionally replicating herpes simplex virus type 1 mutant, for gallbladder carcinoma in immunocompetent hamsters. 1131 3

Gallbladder carcinoma is a fatal disease with highly metastatic potential, and the chemotherapeutic regimen has not been established yet. We reported here a case of gallbladder carcinoma with lung and liver meatstases responding to a single agent, UFT. A 70-year-old female with advanced carcinoma of the gallbladder and bilateral pulmonary metastases were treated with UFT 600 mg/day weekday for half a year. Pulmonary metastases disappeared completely, and the primary lesion shrank markedly 6 months after. Unfortunately, the patient died 1.5 years after the start of treatment due to relapse of liver and lung lesions.
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PMID:[A case with advanced carcinoma of the gallbladder responding to UFT monotherapy]. 1585 22

Carcinoma gallbladder is associated with an overall 5-year survival rate reported less than 5% due to late diagnosis. Advent of ultrasound scanning may help in detecting gallbladder polyps and an early gallbladder cancer. Excellent 5-year survival (up to 100%) has been reported for Stage Ia disease and the survival has significantly improved for Stage Ib, II, and III if appropriate re-operation is carried out soon after the incidental detection of gallbladder cancer. Laparoscopic cholecystectomy (LC) is contraindicated in the presence of gallbladder cancer. It is recommended to excise all laparoscopic port sites, at the time of re-operation. Re-operation for Stage II gallbladder cancer is associated with a 90-100% 3-year survival rate. Patients with Stage III and IV tumors also benefit from an extended cholecystectomy. Patients with bulky primary tumors without lymph node metastases (T4N0) seem to have a better prognosis than those with distant lymph node metastases, and should be treated aggressively. It is advantageous to perform the appropriate extent of surgery for gallbladder cancer at the initial operation. Heightened awareness of the presence of cancer and the knowledge of appropriate management are important. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated for all disease except Stage Ia. Radiotherapy and chemotherapy have not been found effective as an adjuvant or palliative therapy in gallbladder cancer.
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PMID:Management of cancer gallbladder found as a surprise on a resected gallbladder specimen. 1672 57


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