Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A total of 25 pathologic fractures in patients affected with thoracolumbar vertebral metastases associated with neurologic deficit are reported. None of the pathologic fractures were stable, while 14 were unstable and 11 were very unstable. Decompression with intralesional excision of the neoplastic mass compressing the dural sac was performed in all of the cases. Posterior stabilization was performed in the first cases using systems of sublaminar segmental fixation, and thereafter using systems of pedicle fixation. Removal of the vertebral body followed by anterior fusion after preventive posterior stabilization was performed in 2 cases. Pain symptoms regressed in 85% of the cases and in more than 50% of the patients there was improvement in the neurologic findings and in vertebral deformity consequent to fracture. Mean survival rate was 12 months. Despite the limited number of cases posterior stabilization of pathological fractures is a good choice of treatment in patients with severe neurologic deficit.
 ...
PMID:Posterior surgery for the treatment of thoracolumbar pathologic fractures in metastatic patients. 971 23

The authors present their experience in the operative treatment of unstable lesions at the cervicothoracic junction. Ten patients, six men and four women, underwent operative procedures at the cervicothoracic junction (C7-T1) between 1990 and 1997. Six patients had sustained fracture-dislocations, three patients had metastases and one patient had a primary malignant lesion. All the patients had significant cervical pain and neurologic deficit. The spinal cord and nerves were decompressed in all cases. Posterior stabilization was accomplished using various types of implants including hooks, wires and rods. Anteriorly, the spine was stabilized with plates and screws. Partial or complete vertebrectomy was performed in five cases and a titanium cylinder or an iliac autograft replaced the vertebral body. Five patients were submitted to a posterior operation only, and the other five to bilateral procedures. In four of these a one-stage operation was performed and in the last case a two-stage procedure. The anatomic and biomechanical characteristics of the cervicothoracic junction require a precise pre-operative analysis of the local anatomy and the selection of the proper implants for anterior and posterior stabilization.
 ...
PMID:Operative treatment of unstable injuries of the cervicothoracic junction. 1048 29

Choroidal melanoma primarily metastasizes to the liver. Isolated extrahepatic metastases have rarely been reported and they generally resulted in death within 6 months. We describe a patient who developed an isolated brain metastasis 27 years after his left eye was enucleated for choroidal melanoma. The metastasis was successfully treated with surgery and radiotherapy. The patient is alive and disease free 3 years after treatment of the metastasis. Posterior location and other clinical and morphologic characteristics of primary choroidal melanoma could explain the unusually long latency of this solitary extrahepatic metastatic disease. Lifelong surveillance to detect early signs of metastasis is mandatory for any patient treated for choroidal melanoma.
 ...
PMID:Isolated brain metastasis of malignant choroidal melanoma 27 years after enucleation. 1056 29

Posterior retroperitoneoscopic adrenalectomy is one of the new endoscopic methods in endocrine surgery. In a prospective clinical study 142 posterior retroperitoneoscopic adrenalectomies (72 right, 70 left) were performed in 130 patients (52 males, 78 females, age 49.1 +/- 14.9 years). Indications were primary adrenal tumors (unilateral, n = 118; bilateral, n = 2), adrenal metastases (n = 2), and bilateral ACTH-dependent hyperplasias (n = 10). Tumor size ranged from 0.5 to 7.0 cm (mean 2.7 +/- 1.4 cm). Partial adrenalectomies were performed in 39 patients. Conversion to open posterior adrenalectomy was necessary in five patients and seven procedures (5%). Intraoperative and postoperative complications were minor and occurred in 5% and 13%, respectively. Mortality was zero. Operating time was 101 +/- 39 minutes (range 35-285 minutes) and depended on tumor type (pheochromocytoma versus others; p < 0.01), tumor size (< 3 vs. > or = 3 cm; p < 0.05), gender (p < 0.05), and extent of resection (partial versus complete, p < 0.05. Twenty-three adrenalectomies (17%) were performed within 1 hour or less. Blood loss was 54 +/- 72 ml. Consumption of analgesics was low (mean 6 mg piritramide postoperatively). Median duration of hospitalization was 3 days. Posterior retroperitoneoscopic adrenalectomy is a safe method that has become a standard procedure in endocrine surgery.
 ...
PMID:Posterior retroperitoneoscopic adrenalectomy: lessons learned within five years. 1137 7

Posterior uveal melanoma is the most common intraocular malignancy in adults. Metastasis occurs in approximately 40% of all cases and spread is primarily to the liver. Once secondary hepatic disease has developed the prognosis is poor. Metastasis involves a series of adhesion and de-adhesion events, coupled with regulated tissue degradation to facilitate tumour cell invasion and spread to both local and distant sites. These processes are assisted by the expression of integrins and degradative enzymes by both tumour and host cells. Using a series of 10 uveal melanomas, we investigated the expression of a panel of integrins, degradative enzymes and their inhibitors that have been shown to be associated with metastasis. In addition, we undertook to establish if there might be differential expression in response to growth under artificial conditions. All the tumours expressed matrix metalloproteinases (MMP)-2 and-9, tissue inhibitor of metalloproteases (TIMP)-2, urokinase plasminogen activator (u-PA), plasminogen activator inhibitor (PAI)-1 and PAI-2. Differences in the expression of the integrins alpha1beta1, alpha2beta1 and alpha6beta1 were observed; in particular, these differences appeared to relate to expression as a consequence of growth in culture. In summary, uveal melanoma cells express both degradative enzymes and their respective inhibitors, which are important in metastasis. It would appear that differential expression of integrins is present, probably as a response to in vitro stimulation.
 ...
PMID:Expression of integrins, degradative enzymes and their inhibitors in uveal melanoma: differences between in vitro and in vivo expression. 1146 15

The purpose of this study was to evaluate imaging findings of metastatic disease to the breast. We analyzed 15 cases that had been previously examined by radiographic study (comprising a total of 11 mammograms, 13 ultrasounds and 3 chest CT). Primary malignancies included the following: 6 breast cancers, 5 stomach cancers, 2 melanomas, 1 cervical cancer, and 1 lung cancer. Radiologic findings were analyzed and the 15 cases were divided into two groups: hematogeneous and lymphangitic metastasis. Eleven cases were classified as lymphangitic metastasis (73.3%) and 4 cases were hematogeneous metastasis (26.7%). Multiple masses were shown in 13 cases (86.7%), and 12 cases displayed unilateral lesions (80%). There was no evidence of calcification. In the 11 cases with available mammogram, 7 cases (63.6%) revealed multiple masses with well-defined (2 cases, 28.6%) or ill-defined margin (5 cases, 71.4%) and 6 cases (54.5%) showed diffuse increased density and skin thickening. Among the 11 cases that revealed mass lesions on ultrasound, 2 cases showed a well-defined margin (18.2%) and 9 cases showed an ill-defined margin (81.8%). Posterior shadowing of the mass was seen in only 1 case. Four cases (36.3%) showed a minimal echogenic boundary around the mass. Eight cases showed diffuse skin thickening (53.3%). Three cases with chest CT showed multiple masses and/or diffuse skin and trabecular thickening of the breast. In conclusion, the characteristic imaging findings of metastatic disease to the breast are multiple ill-defined masses with a lack of desmoplastic reaction and no calcification, as compared to primary breast carcinoma. The diffuse lesions without evidence of breast mass on mammogram and US could be distinguishable from inflammatory carcinoma of breast origin.
 ...
PMID:Imaging findings of metastatic disease to the breast. 1167 77

Spinal metastatic disease occurs in up to one-third of all cancer patients. Advanced spread can lead to vertebral burst fracture, which may result in neurologic compromise. Developing a better understanding of factors affecting burst fracture risk has significant clinical importance, as early intervention can prevent vertebral fracture in high-risk patients. The primary objective of this study was to quantify the effects of tumor location and shape on vertebral body stability and burst fracture risk in the metastatic spine using poroelastic parametric finite element modeling. This study also compared two distinct surface modeling techniques in the representation of lytic defects. A total of 16 ellipsoidal tumor scenarios were analyzed. Single tumors were situated in central, anterior, posterior, superior, inferior, and lateral locations, with smooth and serrated tumor surfaces. Two central shapes and two serrated surface multi-tumor scenarios were also analyzed. Outcome parameters of maximum vertebral bulge and axial displacement were assessed as representative of burst fracture risk. Posterior movement of the tumor caused the greatest increase in vertebral bulge. Tumor shape also affected burst fracture risk. The multi-tumor scenarios yielded the greatest reductions in both vertebral bulge and axial displacement. Serrated tumor scenarios abided by similar trends as smooth tumor scenarios, although tumor serration caused a slight increase in fracture risk. Tumor shape and volume are best controlled by smooth surface modeling. Improved understanding of factors contributing to metastatic burst fracture risk will aid in directing future modeling efforts and in the development of accurate risk assessment criteria.
 ...
PMID:Effects of tumor location, shape and surface serration on burst fracture risk in the metastatic spine. 1504 94

We present survival, neurological function, and complications in a consecutive series of 282 patients operated for spinal metastases from January 1990 to December 2001. Our main surgical indication throughout this time period was neurological deficit rather than pain. Metastases from cancer of the prostate accounted for 40%, breast 15%, kidney 8%, and lung 7%. In 78% the level of decompression was thoracic and lumbar in 22%. Thirteen percent had a single metastases only, 64% had multiple skeletal metastases, and 23% had non-skeletal metastases also. Preoperatively 64% were non-walkers (Frankel A-C), 30% could walk with aids (Frankel D) and 8% had normal motor function (Frankel E). Posterior decompression and stabilization was applied in 212 patients, 47 had laminectomy only, and 23 had anterior decompressions and reconstruction. Complications were recorded at a level of 20%, and systemic complications were often associated with early death. The survival rate was 0.63 at 3 months, 0.47 at 6 months, 0.30 at 1 year, and 0.16 at 2 years. Twelve of 255 (5%) patients with motor deficits were worsened postoperatively, whereas 179 (70%) improved at least one Frankel grade. The ability to walk postoperatively was retained during follow-up in more than 80% of the patients. This study shows that important improvement of function can be gained by surgical treatment, but the complication rate was high and many patients died of their disease within the first months of surgery.
 ...
PMID:Survival, complications and outcome in 282 patients operated for neurological deficit due to thoracic or lumbar spinal metastases. 1574 40

Metastatic spinal tumors are the most common type of malignant lesions of the spine. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors affect outcome including the nature of the primary cancer, the number of lesions, the presence of distant nonskeletal metastases, and the presence and/or severity of spinal cord compression. Initial management consists of chemotherapy, external beam radiotherapy, and external orthoses. Surgical intervention must be carefully considered in each case. Patients expected to live longer than 12 weeks should be considered as candidates for surgery. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. Whereas various surgical approaches have been advocated, anterior-approach surgery is the most accepted procedure for spinal cord decompression. Posterior approaches have also been used with success, but they require longer-length fusion. To obtain a stable fixation, the placement of instrumentation, in conjunction with judicious use of polymethylmethacrylate augmentation, is crucial. Preoperative embolization should be considered in patients with extremely vascular tumors such as renal cell carcinoma. Vertebroplasty, a newly described procedure in which the metastatic spinal lesions are treated via a percutaneous approach, may be indicated in selected cases of intractable pain caused by non- or minimally fractured vertebrae.
 ...
PMID:Metastatic spinal tumors. 1646 92

Pulmonary nodules that are surrounded by aerated lung cannot be visualized with sonography. Therefore, percutaneous biopsy must be guided with computed tomography or fluoroscopy. Although this restriction only applies to central lung nodules, it has permeated referral patterns for other thoracic lesions and has retarded the growth of ultrasound-guided interventions. Nevertheless, sonography is an extremely flexible modality that can expeditiously guide many biopsy procedures in the thorax. Peripheral pulmonary nodules can be successfully biopsied with success rates exceeding 90% and complications rates of less than 5%. Orienting the probe parallel to the intercostal space facilitates biopsies of peripheral pulmonary nodules. Anterior mediastinal masses that extend to the parasternal region are often easily approachable provided the internal mammary vessels, costal cartilage, and deep great vessels are identified and avoided. Superior mediastinal masses can be sampled from a suprasternal or supraclavicular approach. Phased array probes or tightly curved arrays may provide improved access for biopsies in this location. Posterior mediastinal masses are more difficult to biopsy with ultrasound guidance because of the overlying paraspinal muscles. However, when posterior mediastinal masses extend into the posterior medial pleural region, they can be biopsied with ultrasound guidance. Because many lung cancers metastasize to the supraclavicular nodes, it is important to evaluate the supraclavicular region when determining the best approach to obtain a tissue diagnosis. When abnormal supraclavicular nodes are present, they often are the easiest and safest lesions to biopsy.
 ...
PMID:Ultrasound-guided chest biopsies. 1714 32


<< Previous 1 2 3 4 5 Next >>