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

Extrahepatic biliary obstruction occurred in 34 patients after 1,300 gastrectomies performed for carcinoma of the stomach. Metastasis to the portal nodes caused mainly by distal gastric neoplasms is the most common cause of extrahepatic biliary obstruction. The syndrome of severe unrelenting bilirubinemia with abdominal aches and a palpable liver signifies extrahepatic biliary obstruction until proved otherwise and calls for early exploration. Palliative operation can prolong survival if properly performed. Selection of the proper procedure requires operative cholangiograms. Pancreatoduodenectomy is the most successful palliative procedure. Prevention of extrahepatic biliary obstruction requires a meticulous dissection of the portal pedicle during radical gastrectomy.
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PMID:Biliary obstruction after gastrectomy for carcinoma of the stomach. 9 52

Twenty-four patients with clinical evidence of obstructive jaundice were examined by percutaneous transhepatic cholangiography (PTC) and needle biopsy (NB) of liver. The presence of extrahepatic bile duct obstruction was confirmed by surgery in 21 cases. PTC and the combination of both methods were superior to NB alone in the differential diagnosis between extra- and intrahepatic biliary obstruction. Sampling bias added to the difficulties of NB in distinguishing beween these two types of obstruction. The combination of both precedures proved most useful in three cases with intrahepatic obstruction, in which the patients were spared unnecessary surgery. In five cases the NB provided additional information about the nature of the tumor metastases and gave suport to the clinicians in their therapeutic approach.
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PMID:Percutaneous transhepatic cholangiography and needle biopsy in the differential diagnosis of obstruction of bile flow. 61 15

116 patients with clinically suspected obstructive jaundice were subjected to primary sonographic examination by means of the "real-time" method to differentiate between intrahepatic (internal) and extrahepatic (surgical) cholestasis. Diagnosis was finally confirmed by observing the clinical course, by further examinations, and in 63 cases by surgery or PM. Sonographic examination revealed the direct cause of the extrahepatic obstruction in 82 of 87 patients (94.3%) with extrahepatic cholestasis; in case of dilatation of the bile duct, the approximate site of the obstruction could be determined. In about 75% of the cases, the cause of biliary obstruction was correctly identified. Intrahepatic tumours or metastases were present in 10 of 27 patients with intrahepatic cholestasis; sonographic identification was effected in all cases and histologically or cytologically confirmed with aspiration material from fine-needle biopsies. The high accuracy and uncomplicated technique avoiding discomfort or harm to the patient, make sonography a useful method in differential diagnosis of cholestasis.
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PMID:[Ultrasound in differential diagnosis of intrahepatic and extrahepatic cholestasis (author's transl)]. 69 86

One of several liver scans were obtained in 29 patients with carcinoma of the pancreas. Scanning of the liver offers several advantages in cases of suspected carcinoma of the pancreas: (1) It may prove malignancy in jaundiced patients without a detectable primary tumor (frequency carcinoma of the pancreas). (2) It may contribute to the differential diagnosis of jaundice when signs of extrahepatic biliary obstruction or metastases can be seen. (3) It is the least strenuous diagnostic method in seriously ill and old patients who are often in very poor condition; sometimes it can spare the patients a laparotomy.
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PMID:[The importance of liver scanning in pancreatic carcinoma (author's transl)]. 82 39

Hepatomegaly and abnormal liver function can occur in nonmetastatic malignancies. A patient with metastatic prostatic adenocarcinoma that had spared the liver and extrahepatic biliary tree is described. He had puzzling episodes of jaundice for a period of 2 1/2 years. The results of appropriate investigations and an exploratory laparotomy performed dlring the patient's four antemortem hospitalizations were indicative of "recurrent intrahepatic cholestasis," the cause of which remained an enigma even after exploratory laparotomy. At autopsy, no evidence of hepatic metastases or extrahepatic biliary obstruction was found. Alcohol, hepatotoxic drugs, toxins, viral and chronic active hepatitis, hemolysis, and extrahepatic biliary obstruction were eliminated as causes of the jaundice. We believe that the intermittent intrahepatic cholestasis is one of the nonmetastatic manifestations (nonmetastatic hepatopathy of malignancy) of the prostatic adenocarcinoma.
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PMID:Intermittent cholestatic jaundice and nonmetastatic prostatic carcinoma. 92 51

Records of twenty-nine patients with adenocarcinoma of the pancreas, ampulla of Vater, common bile duct, and colon who were treated with pancreatoduodenectomy were reviewed. Operative mortality was 24 per cent. Survival was adversely affected by incomplete excision of the primary lesion, the presence of metastases in lymph nodes, and severe biliary obstruction. Twenty-two patients (76 per cent) died from the operation or were not cured. Pancreatoduodenectomy was of dubious value in the treatment of carcinoma of the head of the pancreas.
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PMID:Experience with pancreatoduodenectomy in a cancer hospital. 111 93

Three types of expandable metallic stents were used to relieve obstructive jaundice in 59 patients. They consisted of 3 cases with benign stricture, and 56 with malignant obstruction including 28 of cholangiocarcinoma, 17 of pancreatic carcinoma, 9 of lymph node metastases, and 2 of gall bladder carcinoma. The median age of patients was 68.9 years. Of 56 cases with malignant obstruction, 51 cases were able to remove external drainage catheter. In these 51 cases, 35 patients died, and 16 are still alive. No significant difference was noted in the incidence of stent destruction or migration in three types of stents. The average survival period was 189.9 days in 35 patients who died after withdrawal of external drainage. Twenty-three of 35 patients had no recurrence of obstructive jaundice. Sixteen patients with malignant obstruction are still alive and have been observed for 22 to 764 days. The 30 day mortality rate was 6.8%. Three cases of acute cholecystitis were noted after procedure. It is warranted to say that endoprostheses using expandable metallic stents will be the major treatment of choice for biliary obstruction because of long term patency and low complication rate.
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PMID:[Efficacy of biliary endoprostheses using expandable metallic stents in obstructive jaundice--long-term results of three different types of stent]. 133 40

Between January 1983 and December 1987, 103 patients who had hilar biliary obstruction (59 men, 44 women, median age 73 years) were referred to our institution. The causes of hilar biliary obstruction were carcinoma of the bile ducts (55), hepatic metastases or hepatocellular carcinoma (30), and carcinoma of the gallbladder (18). When endoscopic retrograde cholangiography was performed, the stricture was classified as type I in 28%, type II in 41%, and type III in 31% of the patients. In 92 patients, we tried to insert endoscopically a 10, 11, or 12 F Amsterdam type prosthesis; it proved possible in 66 (74%), and the prosthesis proved functional without further procedure in 49 cases (53%); no combined percutaneous and endoscopic method was used. At death or discharge, 45 patients (49%) had a successful drainage. Cholangitis was the main procedure-related complication and occurred in 25 patients. The 30-day mortality was 43%. Results varied according to type of stenosis: successful drainage was performed in 15% of the patients with type III stenosis, compared with 86% when the stenosis was of type I. Under a multivariate analysis the independent prognostic factors of 30-day mortality were: (1) development of infectious complications after endoscopic attempt at drainage (P less than 0.0001), and (2) absence of successful drainage (P less than 0.0001). In conclusion, endoscopic endoprosthesis placement allows a sufficient drainage in 53% of the cases. In type III stenosis, the high rate of 30-day mortality leads us the conclusion that endoscopic drainage must be avoided.
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PMID:Management of malignant hilar biliary obstruction by endoscopy. Results and prognostic factors. 137 61

In patients with malignancy, jaundice may result from hepatic infiltration or metastatic lymph nodal compression along the bile duct. We attempted endoscopic stent placement on 31 consecutive patients with biliary obstruction from malignant adenopathy, with and without computerized tomographic (CT) scan evidence of hepatic parenchymal metastases. Endoscopic or combined endoscopic-percutaneous decompression was accomplished in 28 patients. Fifteen patients (53.6%) had CT evidence of concomitant metastatic disease to the liver. Thirteen patients had obstructing adenopathy only. Mean survival for patients with hepatic metastases after relief of extrahepatic obstruction was 117.4 days (range 9-386 days). Mean survival after biliary decompression in patients without hepatic involvement was significantly longer at 364.3 days (range 52-1098 days; p = 0.0087). Bilirubin levels fell in all patients in this group. No patient died from complications of obstruction or stent placement. Our data support the conclusion that patients with extrahepatic metastatic biliary obstruction without hepatic metastases have improved survival, compared with patients with both obstruction and hepatic involvement. In the absence of hepatic parenchymal involvement, endoscopic stent placement can safely and effectively palliate metastatic extrahepatic obstruction. Controlled trials are needed to assess the effect of such stenting on survival.
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PMID:Endoscopic stent placement for obstructive jaundice secondary to metastatic malignancy. 164 23

For four years up to December 1987, 190 patients (median age 73 years) with proximal malignant biliary obstruction were treated by endoscopic endoprosthesis insertion. Altogether 101 had cholangiocarcinoma, 21 gall bladder carcinoma, 20 local spread of pancreatic carcinoma, and 48 metastatic malignancy. Fifty eight patients had type I, 54 type II, and 78 type III proximal biliary strictures (Bismuth classification). All patients were either unfit or unsuitable for an attempt at curative surgical resection. A single endoprosthesis was placed initially, with a further stent being placed only if relief of cholestasis was insufficient or sepsis developed in undrained segments. The combined percutaneous-endoscopic technique was used to place the endoprosthesis when appropriate, after failed endoscopic endoprosthesis insertion or for second endoprosthesis placement. Full follow up was available in 97%. Thirteen patients were still alive at the time of review and all but one had been treated within the past six months. Initial endoprosthesis insertion succeeded technically at the first attempt in 127 patients, at the second in 30, and at a combined procedure in a further 13 (cumulative total success rate 89% - type I: 93%; type II: 94%; and type III: 84%). There was adequate biliary drainage after single endoprosthesis insertion in 152 of the 170 successful placements, giving an overall successful drainage rate of 80%. Three patients had a second stent placed by combined procedure because of insufficient drainage, giving an overall successful drainage rate of 82% (155 of 190). The final overall drainage success rates were type I: 91%; type II: 83%; and type III: 73%. The early complication rates were type I: 7%; type II: 14%; and type III: 31%. The principle early complication was clinical cholangitis, which occurred in 13 patients (7%) and required second stent placement in five. The 30 day mortality was 22% overall (type I: 14%; type II: 15%; and type III: 32%) but the direct procedure related mortality was only 3%. Median survival overall for types I, II, and III strictures were 21, 12, and 10 weeks respectively but survival was significantly shorter for metastatic than primary malignancy (p<0.05). Endoscopic insertion of a single endoprosthesis will provide good palliation of proximal malignant biliary obstruction caused by unresectable malignancy in 80% of patients. Second stents should be placed only if required. Extensive structuring because of metastatic disease carries a poor prognosis and careful patient selection for treatment is requires.
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PMID:Palliation of proximal malignant biliary obstruction by endoscopic endoprosthesis insertion. 171 94


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