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

From 1973 to 1987, 33 patients aged from 46 to 86 years (25 female, 8 male) were treated for a tumour of the anal canal with radiotherapy and curietherapy. Tumour distribution was 7 T1, 19 T2, 7 T3, and 4 patients were N+. After treatment it was possible to assess 31 patients; 29 were in complete remission, remission was obtained in 2 others following surgery. Tolerance was comparable to other series but 4 patients developed necrosis of the anal canal; 2 patients died under general anesthesia and 1 patient had a radiation injury of the small intestine. The sphincter was conserved in 65 p. cent of cases. Relapse occurred in 8 patients within 6-92 months, and 6 patients developed metastases. Overall survival was 78 p. cent at 3 years and 74 p. cent at 5 and 10 years. Disease-free survival was 65 p. cent at 3 and 5 years and 52 p. cent at 10 years. Our results confirm those of other series using a similar treatment plan. This treatment is difficult to put into practice. Patients must be carefully selected preferably by a team including proctologist, surgeon and radiotherapist.
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PMID:[Conservative treatment of epidermoid cancer of the anal canal combining radiotherapy and curietherapy. Experience at the Antoine-Lacassagne Center]. 218 53

Breast cancer is the most frequently seen cancer in pregnancy and lactation, but the incidence is low, the disease being seen in approximately 0.03% of pregnancies. Only 1% to 2% of breast cancer overall is diagnosed during pregnancy or lactation. There is no evidence to implicate pregnancy or lactation in either the etiology or the progression of breast cancer. Careful breast examination early in the pregnancy is very important to find solid masses that require biopsy before breast engorgement hides them. Therapeutic options vary, depending on the stage of disease and the stage of the pregnancy. Operable disease in the first 6 to 7 months of the pregnancy should be treated by mastectomy, as irradiation is contraindicated. Late in the pregnancy, a lumpectomy and axillary dissection can be done, with irradiation being delayed until after delivery. General anesthesia is safe if the usual precautions are taken to compensate for the physiologic changes induced by pregnancy. Unfortunately, delay in diagnosis is common, and 70% to 89% of patients with operable primary lesions have positive axillary lymph nodes. Late stage appears to be the only reason for the generally worse prognosis in these patients, as stage for stage, they have a course similar to that of nonpregnant patients. Adjuvant chemotherapy can be considered late in the pregnancy but should usually be delayed until after delivery. In patients with locally advanced or metastatic cancer diagnosed early in the pregnancy, for whom both chemotherapy and radiation therapy would normally be recommended, consideration must be given to termination of the pregnancy. There is no evidence that termination of pregnancy improves the outlook for the patients, but it does permit standard aggressive therapy in advanced disease.
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PMID:Breast cancer during pregnancy and lactation. 221 25

The mean age of 100 patients who underwent orchiectomy for carcinoma of the prostate was 76.4 years. 50% of the patients had distant metastases. Almost all had a locally advanced tumour. 49 patients were operated by orchiectomy only. On 51 occasions, a transurethral resection of the prostate was carried out under the same anesthesia. In 22 patients, operation of the prostate was done without previous planning, "because the patient was already on the operating table". Mean stay in hospital varied from 11.2 to 15.6 days, depending on the extent of the operative treatment. Social factors were the most important reason for prolonged hospitalization. Patients who are offered castration in the treatment of prostatic cancer have a great latent need for medical service and social care.
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PMID:[Medical or surgical castration in prostatic cancer? Experience of 100 orchiectomies]. 230 93

Metastatic lesions to the mandible are rare, comprising less than 1% of all malignancies. Twenty-two cases of metastatic disease to the mandible were seen from 1938 to 1985. The records of 17 cases were available for detailed review. The age range was from 27 to 80 years with a female to male ratio of 12 to 5. A mandibular or paramandibular mass or swelling was the most common presenting sign. Three patients presented with mandibular metastasis prior to the discovery of the primary tumor. In the other 14 patients, the mandibular lesion appeared from 2 months to 20 years following discovery of the primary tumor. The mandibular lesion was the initial sign of distant metastatic disease in 11 of the 17 patients. Breast, lung, and colon cancer were the most common primary tumors. When presented with an isolated mandibular mass, a high index of suspicion is necessary to make the diagnosis of metastatic disease. Since plain x-rays may initially be normal, technetium or CT scan may be necessary to demonstrate osseous destruction. Inferior alveolar nerve anesthesia should be considered an indication of tumor until proven otherwise. Treatment is often of a palliative nature because of the presence of widespread metastatic disease; however, surgical resection may be considered in the rare patient with a well-documented, solitary mandibular metastasis.
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PMID:Metastatic disease to the mandible. 244 92

Patients with midgut carcinoids undergoing surgical resection or ischemic treatment of hepatic metastases by embolization are at risk for development of carcinoid crises due to release of hormonally active tumor products. Eight such patients were treated on nine separate occasions with increasing subcutaneous doses of a synthetic somatostatin analogue (SMS 201-995) 4 days prior to surgery or hepatic arterial embolization. The patients were tested by pentagastrin provocation and simultaneous measurement of serotonin (5-HT) levels in peripheral blood before and after prophylactic treatment, to evaluate the efficacy of SMS 201-995. The provoked release of 5-HT was markedly diminished, and the basal levels of 5-HT were markedly reduced in patients with high initial levels. During surgery or embolization both SMS 201-995, as well as ketanserin, a 5-HT2 receptor blocker, were given. With this combined treatment all patients were hemodynamically stable during surgery or embolization. During embolization the arterial levels of 5-HT increased only moderately, while urinary excretion of 5-hydroxyindoleacetic acid remained unchanged despite a proven adequate embolization. Two patients were operated on without previous treatment with SMS 201-995; both developed severe crises at induction of anesthesia, but IV SMS 201-995 rapidly reversed the bronchoconstriction and facial flush and gradually restored arterial blood pressure, even though cardiac output remained depressed for a prolonged period. The crisis reaction correlated well with high circulating levels of 5-HT, but after treatment with SMS 201-995 these levels were still high.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:SMS 201-995 and provocation tests in preparation of patients with carcinoids for surgery or hepatic arterial embolization. 246 65

We have evaluated the sensitivity, specificity and accuracy of laparoscopy under general anaesthesia, ultrasound and computed tomography (CT) in detecting intra-abdominal metastases in 90 consecutive patients with carcinoma of the oesophagus or cardia. Metastases were histologically confirmed as hepatic in 25 patients, nodal in 35 and peritoneal in nine. All investigations had high specificity (86-100 per cent) for each type of metastasis. Laparoscopy was found to be significantly more sensitive (P less than 0.01; P less than 0.02) and more accurate (P less than 0.01; P less than 0.01) than either ultrasound or CT, respectively, with regard to hepatic status. Although laparoscopy performed best with regard to nodal metastases, this reached statistical significance only when sensitivity of ultrasound was compared (P less than 0.01). Neither ultrasound nor CT detected any peritoneal metastases, although laparoscopy detected eight out of nine, giving a sensitivity of 89 per cent and an accuracy of 98 per cent. There was no morbidity or mortality associated with laparoscopy, which offers a safe, reliable method of determining intra-abdominal status and may obviate the need for surgery in some patients with malignant dysphagia.
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PMID:Laparoscopy, ultrasound and computed tomography in cancer of the oesophagus and gastric cardia: a prospective comparison for detecting intra-abdominal metastases. 253 50

The perioperative management of a 39-year-old patient with a rare, catecholamine producing, non-chromaffin paraganglioma of the bladder is presented. Although the management of this patient was comparable with a patient with a phaeochromocytoma, this case was complicated by marked release of catecholamines, high requirements for vasodilator therapy preoperatively, the presence of a malignant tumour with metastases and an atypical presentation. Preoperatively the diagnosis was a non-metastatic bladder phaeochromocytoma and the blood pressure was controlled with prazosin, nifedipine and propranolol. Anaesthesia was induced with fentanyl, lidocaine, thiopentone and vecuronium and was maintained with nitrous oxide, isoflurane, fentanyl and vecuronium. The patient was haemodynamically stable throughout the operative and postoperative period.
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PMID:Perioperative management for resection of a malignant non-chromaffin paraganglioma of the bladder. 253 11

26 patients suffering from nonresectable adeno-carcinoma of the rectum have been treated since Sept. 1980. The mean age was 72 years. The temperature of the probe tip was -160 degrees C. A closed system with liquid nitrogen was used. In 12 patients there was an indication of systemic inoperability, 13 had an irremovable tumour or metastases. 1 patient refused curative operation. Cryosurgery was aimed at reducing the mass of rectal tumours and preventing colostomy. Colostomy could also be avoided in 12 of 14 patients suffering from stenosing tumours. The advantages of cryotherapy are outpatient treatment, no anaesthesia and minimal complications. Generally, this method will yield good results in palliative treatment of inoperable rectal carcinomata.
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PMID:[Cryosurgery in inoperable rectal cancer]. 258 Apr 1

Second look operation in surgical oncology practice has been performed because of three reasons: 1. revision of operative wound due to hematoma and dehiscence of wound, 2. doubt on local recidive and 3. because of doubt on spreading process on second breast. During the period from 1977 to 1986 at surgical oncology we had revision due to hematoma and dehiscence-27, local recidives-147, metastasis in lymphoglads axilla neck, parasternal and subclavicular-38. Metastasis in second breast were 11. Up to local recidive and expansion on a second breast we have got a period of relatively good health. At reoperation because of dehiscence and hematoma interval between two operation is very short so we have got present not only hypovolemia but also summation effect of used anesthetic and plasma expander. In our material, except anesthesia a great influence on blood hemism has got irradiation and cytostatic therapy so out of 147 women patients-45 have been previously radiated, 4 under cytostatic therapy, while combined therapy had 31 patients. And that was the reason why we had to examine the influence of anesthesia polyhemio and irradiation therapy on a change in hepatogramms, blood picture and coagulation. Found deviation are statistically significant in proportion, so we emphasize it a fact, that at revision we can't find very often the source of bleeding, connected with disorders of coagulation which we have found in our examination. Because of that, without regard on a spreading hematoma, we suggest parallel hemism, and before closing the wound local use of Beriplast or Surgicel.
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PMID:[Second-look operations in malignancies of the breast]. 261 26

Thirty-seven patients with widely metastatic malignant melanoma were treated with one of three chemotherapy regimens, incorporating high-dose dacarbazine (DTIC). The chemotherapy was followed by autologous bone marrow rescue which was harvested under local anesthesia in 25 of the patients. The three regimens comprised a 24-hour infusion of DTIC (Regimen A for patients less than 45 years of age, 4.3 to 10.5 g/m2; B, if greater than 45 years of age 2.7 to 4.0 g/m2; and later C, if greater than 45 years of age 7.0 to 8.0 g/m2). The second alkylating agent was given at +8 and +16 hours from the start of DTIC. The total doses of the melphalan ranged from 60 to 130 mg/m2 for Regimen A and 30 to 40 mg/m2 for Regimen B. Ifosfamide 5.0 to 8.0 g/m2 was given instead of melphalan in Regimen C. The response rates for the regimens were 81% (25% CR) for A, 27% (11% CR) for B, and 20% (with no complete responders) for Regimen C. There was no statistically significant difference between the three regimens for survival with a median value of 6 months. One of the 16 patients treated with the very high dose Regimen A died of septicemia and three of ten patients in Regimen C died within the first 2 weeks of treatment. There was statistically significant greater myelosuppression, stomatitis, and diarrhea in the very high dosage DTIC and melphalan (Regimen A) compared with the other two regimens. No significant difference in response rate or toxicity was observed for the different dosages escalated within each of the three regimens. Although hematologic and gastrointestinal toxicity were very severe, no unusual side effects were noted except for one episode of severe acute renal failure in the high-dose DTIC and melphalan, Regimen A. Responses occurred mainly in nonvisceral, nodal, and cutaneous sites and occasionally in pulmonary metastases. The Karnofsky performance improved 4 to 6 months after treatment notably with the high-dose DTIC and melphalan therapy. No survival benefit for the combination chemotherapy despite the high dosages was detected and such an approach currently cannot be recommended.
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PMID:High-dose, double alkylating agent chemotherapy with DTIC, melphalan, or ifosfamide and marrow rescue for metastatic malignant melanoma. 264 5


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