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

A case of chiasmal compression and panhypopituitarism from carcinoma of the breast metastatic to the pituitary gland is presented. A review of the subject of metastatic disease of the pituitary emphasizes the paucity of clinical involvement in most cases. Posterior pituitary insufficiency is the most common manifestation, with anterior pituitary involvement being much rarer, and chiasmal compression the least common.
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PMID:Chiasmal compression from metastatic cancer to the pituitary gland. 45 45

Forty-two mobile tumours on digital rectal examination were excised by posterior rectotomy: via a transsphincteric approach in 16 cases and via a pararectal suprasphincteric approach in 26 cases; 3 primary protective colostomies were performed. Nineteen tubulovillous adenomas and 23 carcinomas were excised. The excision included the entire thickness of the rectal wall in the form of resection-anastomosis (n = 10) or a disk resection (n = 32). This series consisted of 27 males and 15 females between the ages of 42 and 92 years (mean = 70 years). The definitive histology revealed 12 T1 tumours, 7 T2 tumours and 3 T3 tumours. There were two postoperative deaths. The remaining patients have a mean postoperative follow-up of 45 months. 2/16 (12.5%) local recurrences occurred in the group of tubulovillous adenomas and 2 local recurrences with distant metastases were observed in the carcinoma group, while 3 patients only developed distant metastases. The cancer-related mortality was 5/21 (23.89%). Disturbances of continence persisted in 6/29 surviving patients, 4 patients complained of urgent defecation, 1 of uncontrolled passage of gas and a single patient had persistent incontinence of liquid stools. Posterior rectotomy allows excision of extensive tubulovillous adenomas and local recurrences are less frequent than after transanal excision and are similar to the results obtained with transabdominal rectal resections. The operative mortality was lower than that of laparotomy. Posterior rectotomy allows adequate resection of localised carcinomas (T1) with no lymph node involvement. The statistical frequency of lymph node metastases in stage T2 and T3 tumours only justifies the use of this technique when the patient refuse colostomy, has an excessively high risk to undergo laparotomy or when the operation is purely designed to be palliative. The disturbances of continence observed were minor and only slightly disabling.
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PMID:[Limited indications for posterior rectotomy. Results of a series of 42 cases]. 161 87

We describe a 78-year-old woman with eccrine porocarcinoma presenting a zosteriform appearance on the lateral upper part of the buttock. Erosion and bleeding were observed in the center of a 50 X 80 mm, erythematous indurated plaque with an elevated border. Posterior to the plaque, there was another erosive plaque, 50 X 20 mm in diameter, with peripheral induration overlaid by two reddish papules. Based on the previous reports of 21 patients with eccrine porocarcinoma in Japan, we discuss the relationship between the clinical pattern and lymph node metastasis. The pedunculated eccrine porocarcinoma has less tendency to metastasize to the regional lymph nodes than the nonpedunculated form.
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PMID:Eccrine porocarcinoma. 165 54

The authors reviewed 89 patients treated for cerebellar medulloblastoma between 1970 and 1989 to determine the impact of changing treatment (high-dose posterior fossa radiation therapy and chemotherapy) on the pattern of failure in medulloblastoma. Between 1970 and 1983, 50 patients (median follow-up, 110 months) were treated with surgery and postoperative craniospinal irradiation (CSI). Nineteen of the 50 (38%) recurred in the central nervous system (CNS). Isolated systemic (bone) metastases occurred in six. The median time to the development of bone metastases was 12 months. Since 1984, 39 patients (median follow-up, 27 months) were treated with preradiation chemotherapy consisting of cisplatin and vincristine for 9 weeks before initiation of CSI. Nine of the 39 (23%) patients recurred in the CNS. There were no systemic failures in this cohort. The actuarial 5-year disease-free survival was 55 +/- 7% for the earlier cohort and 72 +/- 8% for the later cohort (P equals 0.3). Posterior fossa recurrence was associated with radiation therapy to this area. The cumulative incidence of posterior fossa relapse was 50 +/- 13% in patients who received less than 5300 cGy and 18 +/- 7% in those who received 5300 cGy or more (P equals 0.005). All six bone relapses were in patients treated with CSI alone and 5300 cGy or more to the posterior fossa for a 5-year cumulative incidence of bone metastases of 18 +/- 7% compared with 0% for patients treated with 5300 cGy or more and chemotherapy (P equals 0.03). The authors concluded that high-dose radiation therapy has altered the pattern of relapse with an increase in systemic recurrence after radiation therapy alone that is now equivalent to the risk of recurrence in the posterior fossa. Chemotherapy may be indicated in an attempt to decrease this high risk of systemic metastases.
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PMID:The change in patterns of relapse in medulloblastoma. 189 59

We divided lymph nodes into three groups, those that are normal, those with lymphadenitis, and those that are metastatic. We analyzed these groups based on their ultrasonographic images by measuring maximum cross-section, L/T ratio, coutour, internal echo images, and posterior echo images, and examined the results statistically. In this study, especially for images relevant to internal echoes, the sound wave reflected from the interior of the lymph nodes was taken as aggregate of bright spots, which were analyzed in terms of the following aspects: texture or size, distribution pattern, and brightness. The results are as follows. (1) The size of the lymph nodes is 7.1 +/- 1.7 mm (mean +/- S.D.) for normal, 10.6 +/- 3.8 mm for lymphadenitis, and 13.1 +/- 7.3 mm for metastatic. (2) The L/T ratio is 0.55 +/- 0.16 for normal, 0.64 +/- 0.21 for lymphadenitis, and 0.83 +/- 0.15 for metastatic. (3) The increment of the lymph node size and the variation in L/T ratio are plotted in the disperation diagram. It was concluded that differential diagnosis would be difficult only based on the size and L/T ratio of the lymph nodes under study. (4) The contour appears indistinct in normal lymph nodes, especially in their lateral aspect, while it is distinct around the whole circumference in lymph nodes with inflammation or metastatic cancer. (5) From the analysis based on texture, distribution, and brightness of the echo images of the interior of lymph nodes, it was concluded that in metastatic lymph nodes, aggregated echoes are distributed unevenly, and their brightness is similar to that of adjacent tissues. 6. Posterior echo images were unique findings that showed acute lymphadenitis. Those analytical results based on the three types of findings were rated and submitted to T-tests, which showed that there is a significant difference at a level of 5% among normal lymph nodes, those with inflammatory changes, and those with metastases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Differential diagnosis of lymph nodes in oral-maxillary regions by ultrasonography]. 213 3

Data from dynamic radiocolloid liver scintigraphy (DLS) have been analysed to calculate three indices of relative arterial to total hepatic perfusion. Ninety subjects have been studied, comprising 21 normals, 62 patients with metastatic liver disease and 7 patients with cirrhosis. Correlation coefficients above 0.81 were found in all patient groups between an index based on rates of liver uptake (the hepatic perfusion index, HPI) and a method based on quantitative liver uptake (the mesenteric fraction, MF). A further method employing the spleen to model arterial inflow (hepatic arterial ratio, HAR) had less agreement with both HPI and MF, with correlation coefficients below 0.76. Posterior images have previously been used to calculate HAR, and greater errors are expected in HAR from the anterior images acquired in this study. Receiver operating characteristic analysis showed that the diagnostic performance of HPI and MF indices in metastatic disease were not significantly different. For anterior image data analysis both HPI and MF were superior to HAR.
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PMID:A comparison of three indices of relative hepatic perfusion derived from dynamic liver scintigraphy. 232 73

We are reporting our experience in 23 patients with tumors of the thoracic or lumbar vertebrae treated via surgical anterior decompression and stabilization. Seventeen patients had metastatic disease and were treated with vertebral body resection followed by stabilization with anterior polymethylmethacrylate and threaded Harrington rods with sacral distraction hooks. Six patients had primary tumors and, following tumor resection and partial vertebral body resection, had autogenous bone graft struts placed anteriorly as well as posterior instrumentation. Posterior instrumentation was transpedicular one level above and below in the lumbar spine, and segmental hooks and rods three levels above and below in the thoracic spine. Nineteen patients presented with severe unremitting pain, and 16 had neurologic deficits, including 7 who were unable to ambulate. Radiation therapy was used as an additional treatment and routinely begun 2 weeks postoperatively. All patients survived the surgery, and none had neurologic deterioration immediately postoperatively. Eight patients had died at the time of review. The mean survival was 14 months and ranged from 6 to 38 months. Of the surviving patients, follow-up ranged from 24 to 40 months with an average follow-up of 30 months. Pain relief was excellent in all but two patients (93%). Motor recovery occurred to some extent in all patients, and only one remained nonambulatory. Complications were minor in three patients (13%) and major in one (4%). Tumor recurrence with neurologic deterioration occurred in two patients. We are very encouraged by these results, and we recommend that patients with tumors of the vertebral body with neurologic deficit or severe unremitting pain be studied with MRI and/or myelography and CT. The patients with gross vertebral destruction and greater than 50% collapse of the vertebral body, those in need of a tissue diagnosis, or those with major neurologic deficit can be effectively treated by anterior decompression and stabilization.
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PMID:Tumors of the thoracic and lumbar spine: surgical treatment via the anterior approach. 252 70

The authors' ideas on the management of acute and chronic cervical spine injuries are presented. Unstable fractures and dislocations of the lower cervical spine should be reduced as soon as possible. Most frequently, the authors use the anterior approach and the Smith-Robinson technique with the addition of a H-shaped plate. Posterior fusion is mainly indicated for the release of irreducibly locked facets. Unstable odontoid fractures, especially those in group II according to Anderson and d'Alonzo, are stabilized by internal fixation with a screw. Between 1971 and 1987, 263 patients with lesions of the cervical spine were treated operatively: of these, 169 had acute and 32 chronic injuries; 47 patients had primary tumors or metastases; 15 suffered from arthritis, spondylodiscitis or congenital deformity. The findings in 92 patients (group I) with acute and 24 (group II) with chronic injuries at follow-up are reported. Among the 53 patients in group I with neurologic failure, an improvement was noted in 45 (85%); in 30 cases there was complete restoration of function and 72% of the injured patients became symptom-free. In 71% of those with acute and 58% of those with chronic injuries normal mobility was observed. Regardless of neurologic failure, 89% of patients in group I were able to work after 5 months. The rate of pseudarthrosis was 2%. The risks involved in anterior interbody fusion in the cervical spine are small when a careful and standardized operation technique is used. This allows early functional treatment and shortens the rehabilitation time.
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PMID:[The surgical treatment of injuries of the cervical spine]. 279 93

Conventional chest radiographs and CT scans were studied retrospectively in 283 patients with untreated non-seminomatous testicular tumor. Intrathoracic metastases were found in 47 patients, and CT was the only positive examination in 20 of them. Lung metastases were seen in 39 patients and mediastinal lymph nodes were involved in 13. The additional yield of CT in detecting only at CT in 9 out of 13 cases as compared with 14 out of 39 for the lung parenchyma). Posterior mediastinal and retrocrural lymph nodes were most often enlarged, and involvement of these was most difficult to detect at conventional radiography.
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PMID:Computed tomography and conventional radiography in intrathoracic metastases from non-seminomatous testicular tumor. 316 74

Fifty-four patients were given intraoperative radiation therapy (IORT) for adenocarcinoma of the pancreas between April, 1980 and August, 1987 at Aichi Cancer Center Hospital. Thirty-five of these patients with well-advanced cancer underwent palliative IORT of their main primary lesions which could not be resected. Twenty (or 57%) of them had liver and/or peritoneal metastases. Electron irradiation at doses of 12 Gy (1 patient), 15 Gy, 20 Gy, 22 Gy, 22.5 Gy, 25 Gy and 30 Gy was given to these patients in single doses. Gastric and/or biliary bypasses were performed in 27 (77%) of them following IORT. Twenty (80%) of the 25 patients in this group who had intractable back pain before this treatment achieved relief of pain within one week postoperatively. The median survival for this group of 35 unresectable cases was 5.3months (range 0.5-28.6 months). The remaining 19 patients underwent pancreatectomy and received adjuvant IORT to the bed of the pancreas. Two of the patients in this group had liver metastases and one patient had peritoneal seeding. All of the visible metastatic lesions were removed by local excision in these three patients. Posterior surgical margins were cancer-positive in 8 patients, suspicious in 6 and negative in 5. IORT doses were 20 Gy (7 patients), 25 Gy and 30 Gy. Median survival for this group of 19 resectable cases was 9.4 months, including 10 patients who remain alive at the time of this report (August 15, 1987). The longest survival has been 6 years 10 months in one patient after absolute non-curative distal pancreatectomy followed by 20 Gy of IORT for cancer of the body of the pancreas with a microscopically proven cancer-positive posterior surgical margin. The other nine are alive at 5 years 10 months, 2 years 4 months, 1 year 5 months, 1 year, and within one year (5 patients), respectively. Survival rates were compared between one group of 41 patients operated on in the 5 years before we began IORT and another group of 70 patients operated on after IORT introduction. The latter group included 16 patients who did not receive IORT for various reasons. The background factors were rather worse in the latter group, but both the survival rates and the staying-home survival rates were significantly better (p less than 0.05). One-year survival rates were 7% in the before-IORT period and 26% in the after-IORT period. One-year staying-home survival rates were 2% and 18%, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Intraoperative radiation therapy (IORT) of adenocarcinoma of the pancreas]. 338 27


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