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)

Bone metastases are a major source of morbidity in patients with metastatic cancer. There are effective systemic treatments available for patients with breast and prostate cancers, who are the majority of patients with bone metastases. Unfortunately, < 50% of patients benefit from currently available endocrine or cytotoxic chemotherapy, although problems of response assessment often lead to under reporting of true response rates. A better understanding of the mechanisms underlying the development of osteolytic bone metastases and the crucial role of increased osteoclastic activation provided the rationale for the use of the bisphosphonates. They reduce hypercalcemic episodes, pain, and pathologic fractures, and can induce radiologic healing of skeletal metastases. The development of potent, easily tolerated oral preparations will lead to their increased use by patients with osteolytic bone metastases. Radioisotopes used either alone or with external beam radiotherapy are effective in palliating the pain of skeletal metastases in patients with breast and prostate cancer and result in little associated subjective toxicity. Most studies have lacked placebo-treated controls, and the results of multicenter studies evaluating the benefits of radioisotopes with respect to pain relief and quality of life are awaited. These treatments combined with local treatments such as radiotherapy, surgery, and analgesia can provide effective palliation of symptoms for the majority of patients.
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PMID:The systemic treatment of bone metastases. 754 93

Nine self-expanding silicone-coated modified Gianturco metal stents were inserted in 8 patients (mean age, 58.2 years) for palliation of malignant esophagorespiratory fistulas caused by esophageal (n = 5) or bronchial (n = 3) carcinoma. One patient with a fistula above a 12-cm-long malignant stenosis received two overlapping stents. The implantation procedure was well tolerated by all patients under intravenous sedation and analgesia. After release, the stents expanded to their full diameter, leading to complete occlusion of the fistulas and bridging of the concomitant stenoses. Two patients with lung cancer received an additional tracheobronchial stent before esophageal stent insertion. Failure to maintain complete contact between the proximal stent margin and the esophageal wall led to insufficient sealing of the fistula of 1 patient and recurrent aspiration, manifested 6 days after stent implantation (overall success, 87.5%). The other patients could swallow semi-solid food until death. Seven patients died of advanced metastatic disease after 21 to 121 days (mean, 54 days) and 1 patient of massive hemoptysis 10 days after stent placement, which could be regarded as a complication (procedure-related mortality rate, 12.5%). These preliminary results suggest that peroral insertion of the modified silicone-coated Gianturco stent is a rapid, reasonably safe, and effective procedure for palliation of malignant esophagorespiratory fistulas.
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PMID:Treatment of esophagorespiratory fistulas with silicone-coated self-expanding metal stents. 761 29

The brain contains neuronal circuits, activation of which by electrical stimulation or environmental stress causes analgesia. Both opioid and non-opioid forms of stimulus-induced analgesia exist, and are anatomically differentiated. Several transmitters have been postulated for non-opioid stimulus-induced analgesia, N-methyl-D-aspartic acid being a particularly likely candidate. In mice there are marked gender differences in the underlying neurochemical medication of stress-induced analgesia, the development of which is sensitive to the hormonal environment during early post-natal development and which changes with age in both sexes. Mice can be bred for a high or low analgesic response to stress and there is evidence that this is determined by a single gene. Operative pain, as a stressor, inhibits natural killer (NK) cell activity and influences the propensity to develop metastases when mice are inoculated with an experimental tumour after abdominal surgery. This can be influenced by peri-operative morphine in analgesic doses.
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PMID:The analgesic response to stress: genetic and gender considerations. 764 37

Reports published in the English literature of clinical trials utilizing intravenous strontium 89 (89Sr) in the treatment of patients with prostatic adenocarcinoma metastatic to bone were reviewed. Correlation coefficients were calculated for increasing dose of 89Sr and complete pain relief and complete and partial pain relief. Statistically significant positive correlations were obtained for complete relief of pain. Positive correlations were also found between those patients who had at least partial pain relief (defined as at least a 50% reduction in analgesia requirement), but these did not reach significance. This analysis suggests that a dose response relationship may exist between the dosage of 89Sr administered, and complete relief of pain due to skeletal metastases. The optimal dosage of 89Sr in this clinical situation has not been established, and prospective, carefully executed and analyzed randomized trials will be required to test whether and to what extent dose intensity of 89Sr determines outcome independently of other factors.
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PMID:Strontium 89 therapy and relief of pain in patients with prostatic carcinoma metastatic to bone: a dose response relationship? 768 18

We hypothesized that intrathecal fentanyl infusion would provide excellent analgesia, require lower doses than necessary for the epidural or intravenous route of administration, and reduce the incidence and/or severity of side effects. Accordingly, we studied 12 patients during 48 h after thoracotomy (three pneumonectomies, six lobectomies, and three multiple resections of metastases or pleural surgery). The mean dose of fentanyl infused intrathecally was 0.81 +/- 0.26 microgram.kg-1 x h-1, and plasma fentanyl concentrations ranged between 0.49 +/- 0.19 and 0.72 +/- 0.34 ng/ml. Four patients needed a supplementary bolus of intrathecal fentanyl. Pain scores decreased below 30/100 within 1 h when measured at rest but required 24 h to decrease to the same level during coughing. Pulmonary function tests returned to approximately 50% of preoperative values within 1 h of fentanyl infusion. Mean respiratory rates averaged 19 +/- 4, and no episode of apnea was detected. Pruritus, nausea, and headache occurred, respectively, in four, one, and zero patients. Excessive pressure in the infusion system occurred frequently, limiting fentanyl infusion in two patients. All catheters were removed intact; however, one broke outside of the patient's back. This study demonstrates that intrathecal fentanyl infusion can safely provide rapid and intense analgesia but that current 32-gauge intrathecal catheters are not well suited for prolonged postoperative use.
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PMID:Prolonged intrathecal fentanyl analgesia via 32-gauge catheters after thoracotomy. 821 30

Between June 1991 and July 1992, 118 patients (57 men and 61 women) underwent video-assisted thoracoscopy for indeterminate pulmonary nodules. Median age was 64 years (range 30 to 85 years). Thoracotomy was performed in 33 patients (28.0%) after thoracoscopy only because the nodule could not be located in 17 patients, was too large to safely resect in 5, appeared malignant in 4, and for technical reasons in 7. Eighty-five patients underwent thoracoscopic wedge excision. Twenty-one (24.7%) of these 85 patients also had thoracotomy--15 to perform formal lung resection for bronchogenic carcinoma, 3 for nondiagnostic abnormalities, 2 to locate a second nodule, and 1 for stapler malfunction. The remaining 64 patients (54.2%) had only video-assisted thoracoscopic wedge excision. A single wedge excision was performed in 56 patients, two in 6, and three in 2. Pathologic examination of these 74 nodules revealed a granuloma in 30, metastatic cancer in 25, hamartoma in 7, lymphoma in 1, and other benign lesions in 11. There were no deaths and only 4 (6.3%) complications in these 64 patients. The 64 patients treated by thoracoscopy only were compared with a similar group of 64 patients who had wedge excision via thoracotomy without prior thoracoscopy. Postoperative analgesic requirements were less in the patients treated by thoracoscopy. Median hospitalization in the thoracoscopy group was 3 days compared with 6 days in the thoracotomy group (p < 0.05). Median total charge for the thoracoscopy-only group was $12,898 as compared with $12,502 for patients undergoing wedge excision via thoracotomy. We conclude that thoracoscopic wedge excision is a safe and effective procedure in selected patients with an indeterminate pulmonary nodule. A significant number of patients (45.8%), however, required a thoracotomy to accomplish a safe operation or to ensure adequate staging and resection for malignancy. Although thoracoscopy reduces postoperative analgesia requirements and shortens hospital stay, total hospital charges were similar to charges for a wedge excision via thoracotomy.
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PMID:Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules. 824 37

A prospective comparison of laparoscopically assisted (n = 11) and conventional (n = 14) anterior resection in patients with sigmoid colon or upper rectal cancer was carried out. Patients were not randomized; age and the presence of metastases determined the type of surgery. Laparoscopic assistance was used to mobilize the tumour and minimize the abdominal incision. This was achieved in all patients and six of the 11 required only a muscle-splitting incision. The mean(s.d.) operating time was longer for laparoscopic than conventional surgery (205(31) versus 123(26) min, P = 0.01). The mean(s.d.) time to reintroduction of normal diet (2.5(0.2) versus 3.6(0.3) days, P = 0.01), postoperative analgesia requirement (2.6(0.4) versus 7.4(2.1) doses of pethidine, P = 0.01) and length of hospital stay (12.3(3) versus 14.3(6) days, P = 0.08) were less in the laparoscopic group. Histopathological examination of the resection specimens showed similar results for the two procedures. Major complications were few and occurred in a similar proportion of patients treated laparoscopically or conventionally. Laparoscopically assisted anterior resection is technically feasible, adequate tumour excision can be achieved and recovery after operation is enhanced.
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PMID:Prospective comparison of laparoscopic and conventional anterior resection. 804 75

Radical perineal prostatectomy despite its many advantages over the past decade had decreased in popularity compared with the retropubic approach and was limited to a few specific indications. The primary reason for this trend was in the ability to first evaluate pelvic lymph node metastases by frozen section using only one retropubic incision. Recently our institution has developed an alternative method which combines laparoscopic lymph node dissection (LLND) with radical perineal prostatectomies (RPP). From January 1990 to January 1992, 30 patients with a mean age of 64 were identified as having clinical stage B prostatic carcinoma. From this population a total of 36 procedures were performed by the senior author. 9 patients underwent LLND alone (group 1), 13 patients underwent RPP alone (group 2) and 14 patients underwent combination LLND and RPP (group 3). The mean EBL for groups 1, 2 and 3 were 1.2, 5 and 5.6 days respectively. Number of transfusions for patients requiring blood in groups 2 and 3 were 1.2 units and 1.5 units respectively. There were no significant differences in post-operative stay, post-operative complications, day tolerating diet or days of analgesia despite the difference in operating room and anesthesia time: group 2 (2:25) and group 3 (5:29). All levels of PSA in groups 2 and 3 remain trace at 1, 3, 6 and 12 months post operatively except for one patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Celioscopic lymphatic excision and perineal radical prostatectomy: a strategy for the treatment of prostatic cancer]. 850 2

We report the case of a 4-month-old infant with terminal malignancy who had systemic metastases and a localized metastasis to the dorsal midbrain periaqueductal gray (PAG). Extraordinary doses of opioids (dose equivalent of 2680 mg morphine sulfate/h, i.v.) were required to achieve adequate analgesia. The behavior of the infant, interpreted as being representative of a response to pain, may have been an aversive reaction due to the location of the lesion in the dorsal PAG. We propose that the lesion in the PAG impaired the responsiveness of this infant to the effect of opioids. This report is to alert clinicians to the possible role of the PAG in impaired opioid responsiveness in patients with terminal malignancy, as well as the possibility that pain-like signs (e.g., tachycardia, tachypnea, vocalization, facial grimacing) may indicate an aversive reaction rather than pain in non-verbal patients.
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PMID:Massive opioid resistance in an infant with a localized metastasis to the midbrain periaqueductal gray. 862 94

Pain relief has been one of the oldest and most important duties of the physician. There has been little change with regard to this obligation of all caregivers. One-third of patients with advanced cancer will develop clinically relevant skeletal metastases and chronic pain during the course of their disease. All physicians involved in the treatment of cancer patients should know the basic principles of pain treatment. These are described in the following article with special regard to bone pain of malignant origin. Correct assessment of pain intensity and frequency, as well as of the probable causes of pain, and the administration of adequate analgesic treatment should achieve satisfactory results in the vast majority of patients. Every physician should obtain detailed knowledge of the indications and adequate administration of pain-killing therapy as well as possible adverse effects and their successful treatment. It is important in particular to concentrate on a few nonsteroidal anti-inflammatory drugs (NSAIDs) as well as opiates. Knowledge of adequate doses, maximal recommended daily doses, pharmacological properties, important adverse effects and interactions is essential for success in the daily routine. Only by selecting 2 or 3 drugs from each step in the analgesic ladder (WHO) will the nonspecialised physician obtain sufficient experience for optimal analgesia. Physicians should also not hesitate to contact other specialists (medical oncologists, radiotherapists, neurosurgeons, anaesthesiologists and others) in order to maximise benefit for an individual patient.
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PMID:Causes and treatment of bone pain of malignant origin. 887 34


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