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

Bilateral radical mastectomy and concomitant mammoplasty is a new operative procedure for the treatment of carcinoma of the breast in the stages T0 and the small T1, N0, M0. The advantage of the procedure is the increased extent of the operation, the improved cosmetic result and the single stage of the procedure. Consequently the cure rate is improved and the psychic trauma to the patient is decreased. The operation is more radical since the so-called healthy breast is operated first, including axillary lymphadenectomy and subsequent mammoplasty followed by the same procedure on the so-called diseased breast. If the pectoral muscles are involved, a conventional radical mastectomy has to be done. The diagnosis is made by excisional biopsy and frozen section microscopy. The cosmetic result is improved because both breasts are subjected to the same operation, and lateral differences in shape, volume and consistency of the breasts are eliminated. Cylastic prostheses are inserted as new breasts usually sub-pectorally and rarely subcutaneously. The nipples are surgically reconstructed and pigmented by tattooing. The advantage of this single stage procedure is a single general anaesthesia and less psychic trauma since the patient goes to sleep with the knowledge of waking up with two breasts even though endoprothetic breasts. Post-operative radiotherapy can be applied with the prostheses in place. The principle of cure before cosmetics is preserved. Radical operation of the so-called healthy side is justified because of the above mentioned cosmetic advantages and the 25% incidence of primary or metastatic cancer of the so-called healthy side. The post-operative care of women with a bilateral operation is not a problem since no more breast tissue is left behind. Orthopedic complaints which can occur because of macromastia of the remaining breast are also eliminated.
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PMID:[Bilateral radical mastectomy for carcinoma of the breast of the stages T0 and T1 (N0, M0) and mammoplasty of both breasts, areola and nipples in a single operation (author's transl)]. 124 24

The indications for and the results of hypophysectomy for advanced cancer of the breast or prostate gland are reviewed. The technic of open microsurgical transsphenoidal hypophysectomy is described. Since the metabolism of some breast cancers is influenced by estrogenic hormones, the major effect of hypophysectomy seems to be the complete suppression of estrogen production by the gonads and adrenal glands by removal of gonadotropin and ACTH, respectively. Other specific substances, such as growth hormone or prolactin, may also be factors. In cases of prostate cancer which relapse after castration, the adrenals seem to elaborate a significant amount of extradgonadal androgen. Hypophysectomy removes the source of ATCH and thus stops androgen production by the adrenal glands. Other hormones may also be important. In premenopausal patients with advancing cancer of the breast, oophorectomy should be the initial procedure. Most patients after a previous favorable response to oophorectomy get a subsequent objective improvement from hypophysectomy. In postmenopausal patients the effects of hormone therapy should 1st be tried. Many patients responding favorably to hormone therapy will also be benefited later by hypophysectomy. Remission rates are higher in older women. However, hypophysectomy should be carried out relatively early to obtain a useful remission. About 25% of those not responding to other methods will obtain a remission following hypophysectomy. Along interval after the mastectomy before metastases occurs is a favorable prognostic sign. While bony metastases respond best, other sites of metastases do not contraindicate the operation. Most patients with prostatic metastases obtain relief after hypophysectomy, even some of those who have not been benefited by other methods. Advanced age alone is not a contraindication. A preoperative evaluation should be done including a series of endocrine studies. Open microsurgical transsphenoidal hypophysectomy is considered the operation of choice. Complete removal of the gland is accomplished with less disturbance to the patient than an intracranial operation. General anesthesia is used. After the operation tests for pituitary reserve are repeated and a maintenance regimen of hydrocortisone prescribed. Thyroid replacement therapy is often needed. Subjective remissions are more common than objective ones, particularly relief of pain. This operation was done on 20 men with metastatic cancer of the prostate and 23 women and 1 man with metastatic cancer of the breast. Of the prostate cases, 3 patients died during the early postoperative period. Of the other 17, there have been 7 deaths from the cancers after 1-7 months. Of the 23 breast cases, severe body pain was the indication for the operation. Relief occurred in 19 (83%). There have been 7 deaths from the cancers. Hypophysectomy does not predispose to or lead to alterations in emotional state or mental function. Others with larger series of cases have reported that those responding favorably have lived an average of 25.8 months while average survival of those not so responding has been only 5.6 months.
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PMID:Hypophysectomy in the treatment of disseminated carcinoma of the breast and prostate gland. 127 14

Ultrasound can induce tissue lesions by a combination of thermal and mechanical effects related to the tissue absorption of the energy emitted at the focal point of the transducer. The effects of focused ultrasound were studied in vivo in Fisher/Copenhagen hybrid rats bearing Dunning R3327 experimental prostatic carcinoma. The experimental tumour was transplanted by subcutaneous injection into the abdomen of 20 mg of tumour tissue derived from the Mat-Ly-Lu strain. Treatment was performed under general anaesthesia. The animal, maintained in a sarcophage exposing the tumour, was immersed in degassed water ensuring the interface between the tumour and the 1 MHz transducer. The displacements of the transducer were guided by computerised ultrasound screening, allowing irradiation of the entire tumour. The energy was supplied by a 7.5 kW amplifier in the form of series of impulses of variable duration. 77 rats were treated and the tumour growth was compared to that of non-irradiated control rats. Comparative series demonstrated the following results: 1. Immediate tumour destruction was obtained with a very high acoustic intensity (9,000 Watts/cm2) and a brief exposure time. 2. A transient slowing of the tumour growth rate was observed for an acoustic intensity of between 3,500 and 5,500 Watts/cm2. 3. Partial or total necrosis of the tumour was obtained with intensities of between 300 and 2,750 Watts/cm2 and a long exposure time. Total tumour destruction was obtained in 30 of the 49 rats treated under these conditions. 14 animals developed a local recurrence, 9 animals did not develop a local recurrence but developed metastases and 7 animals obtained long-term survival without local recurrence or metastasis. Under certain experimental conditions, focused ultrasound, without any adjuvant treatment, was able to destroy the Dunning R3327 Mat-Ly-Lu strain experimental tumour and, in certain cases, induced complete cure of this experimental cancer.
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PMID:[Tumor ablation with focalized ultrasound. In vivo experiment with prostatic adenocarcinoma R3327 Mat-Ly-Lu]. 130 56

The focus of Guttmann's treatment concept had been to set up a comprehensive rehabilitation system, aimed not only at saving the life of a person with paraplegia or tetraplegia but at giving it meaning as well. Progress made in the fields of rescue services, anaesthesia, intensive medicine, in spinal surgery, neurourology and diagnostics (CT, MRI) as well as in pharmacology, have decisively enhanced the possibilities of clinical rehabilitation, and have in some respects entailed deviations from Guttmann's classical treatment principles. Moreover, the patient population has changed in profile in the course of time, due to better chances of survival also in high-level tetraplegia, greater numbers of higher-age SCI patients and of patients with non-traumatic SCI (tumours, metastases, infections). A higher life expectancy achieved by better possibilities as regards prevention and treatment of SCI-related complications, new challenges for the future emanate from age-related diseases occurring in addition to the spinal lesion.
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PMID:[Clinical rehabilitation of the spinal cord injury patient--is the Guttmann concept still valid?]. 141 Jul 74

A case of paraplegia occurring after a spinal anaesthetic is reported. The 79-year-old man was admitted for a fractured neck of femur. Twenty years previously, he had had pharyngeal surgery and a tracheostomy. He had also undergone a prostatectomy for prostate cancer, and had been on oestrogen therapy for two years. He complained of dyspnoea at rest and his chest film showed diffuse pulmonary opacities. In order to avoid possible intubation and respiratory complications, spinal anaesthesia was performed without any problems in the L4 space. After the surgery, the patient recovered all his motor and sensory functions in the lower limbs. On the second postoperative day, he suffered from a motor paralysis of the right leg, which spread to the left leg on the fourth day. NMR imaging showed several vertebral metastases, together with anterior and lateral epidural invasion responsible for cord compression. Treatment with tetracosactide was begun, but the patient died six weeks later in his home, not having recovered any neurological function at all in his lower limbs. In fact, it was only after the procedure that the anaesthetist was informed that, at the time the prostate cancer had been diagnosed, vertebral body metastases, of which the patient had not been informed, were already present. The part played by the spinal anaesthetic in the occurrence of the paraplegia is not clear. It is reminded that such a technique should be used with extreme care in patients having a neoplasm with a very often high incidence of vertebral metastases.
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PMID:[Paraplegia after spinal anesthesia]. 150 98

Recent advances in video technology and endoscopic instrumentation have expanded the use of thoracoscopy from diagnosis to treatment of pulmonary parenchymal disease. We recently performed 14 pulmonary wedge excisions using videothoracoscopic techniques in 10 patients (7 women and 3 men). Median age was 60 years (range, 21 to 82 years). Indications were small peripheral solitary pulmonary nodules in 4 patients, diffuse pulmonary infiltrates in 4, and recurrent pneumothoraces in 2. Thoracoscopic wedge excisions were accomplished using double-lumen endotracheal anesthesia and a percutaneous stapling device. Tissue diagnosis was obtained in all patients; 6 had benign disease, 3 had metastatic cancer, and 1 had diffuse bronchoalveolar cell carcinoma. Median operating time was 90 minutes (range, 40 to 140 minutes). There were no operative deaths. The single complication was a prolonged air leak. Median hospitalization was 5 days (range, 3 to 16 days). All patients returned to full activity within 10 days of discharge. Median follow-up was 6 months (range, 5 to 8 months). We conclude that videothoracoscopic wedge excision is a safe and effective procedure for selected small peripheral indeterminate pulmonary nodules, diffuse interstitial lung diseases, and recurrent spontaneous pneumothoraces. Further evaluation and prospective studies are indicated.
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PMID:Videothoracoscopic wedge excision of the lung. 151 May 6

Between 1982 and 1988, 111 elderly women with breast cancer but without clinical involvement of the axillary lymph nodes underwent wide lumpectomy in a Day Hospital regimen at the National Cancer Institute of Milan. The patients ranged in age from 70 to 92 years (median, 79). An adjuvant treatment was carried out in all but 9 cases: tamoxifen only in 84 cases, tamoxifen plus radiotherapy in 6 cases, radiotherapy alone in 12 cases. The median duration of follow-up was 44 months (range, 30-109 months). Four patients (3.6%) were lost to follow-up. In the remaining 107 patients, 10 local-regional relapses (9.1%) and 7 distant metastases (6.5%) occurred. Six patients died from the disease, 14 from unrelated conditions. This retrospective study showed that selected elderly patients with breast cancers can be treated successfully under local anesthesia on an outpatient basis. The treatment guarantees local control of the disease, meets the favor of elderly women and consequently improves their quality of life.
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PMID:Treatment of breast cancer in elderly women: retrospective analysis of 111 wide lumpectomies performed in a day hospital regimen between 1982 and 1988. 152 1

Fifty-three patients with suspected gallbladder carcinoma underwent ultrasonography and laparoscopy. Laparoscopy correctly excluded malignancy in five patients when ultrasonography had suggested gallbladder neoplasia. Of 48 patients with gallbladder carcinoma, laparoscopy identified 46 (95.8%) as compared with 30 (62.5%) by ultrasonography (p less than 0.001). Distant metastases in the liver, parietal peritoneum, or omentum were present in 41 patients (85.4%) and were detected by laparoscopy in 39 (sensitivity 95%) and by ultrasonography in 21 (sensitivity 51.2%) (p less than 0.001). Combination of ultrasonography and laparoscopy improved the overall diagnostic accuracy to 100%. Laparoscopy provided histological diagnosis of the disease in 36 patients (75%) and circumvented unnecessary laparotomy in 40 (83.3%) patients by revealing advanced or associated disease. When laparoscopy suggested that the disease was localized, the diagnosis was correct in 83.3% (5 of 6) patients. Laparoscopy under local anesthesia is useful in the diagnosis and staging of gallbladder carcinoma, and therefore helpful in planning management.
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PMID:Laparoscopy in primary carcinoma of the gallbladder. 153 59

Over the past decade, the principal advances in the imaging of genitourinary cancer have come in the fields of ultrasound, CT, and MR imaging. As applied to carcinomas of the urethra and penis, these techniques show promise. The local staging of the lesion may be done with either ultrasound or MR imaging. Ultrasound has correctly staged two penile cancers and predicted the presence or absence of lymph node metastasis. Sonourethrography has been successful in the evaluation of urethral stricture disease and should now be studied for imaging carcinomas of the urethra. Magnetic resonance imaging allows direct tumor visualization. This and its large field of view make it more accurate than clinical staging by palpation. In addition, MR imaging can identify destruction of both the tunica albuginea and the septum between the corpora by metastases to the penis or contiguous involvement by other neoplasms. It also offers the advantage of imaging in three orthogonal planes, giving more anatomic detail of the primary tumor. Tissue contrast is superb, and the study can simultaneously evaluate the pelvic nodes. After careful palpation of the primary tumor and examination of the regional and distant lymph nodes, we perform physical examination under anesthesia and obtain histologic confirmation of the cancer. We then base our decision to obtain further imaging studies on the grade and invasiveness of the tumor along with the findings on physical examination. In patients with tumors that appear to be superficial and are of low grade who have no evidence of regional or distant nodal disease on physical examination, further imaging is not carried out.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Recent advances in imaging studies for staging of penile and urethral carcinoma. 157 16

Intraperitoneal hyperthermic perfusion is a method of regional chemotherapy shown to be effective in the prevention and treatment of peritoneal metastases. General anaesthesia for a patient who required this procedure is described. Guidelines for management are suggested, with particular emphasis on temperature control, fluid and electrolyte balance and postoperative care.
Anaesthesia 1992 Jun
PMID:Anaesthesia for intraperitoneal hyperthermic perfusion. 161 83


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