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)

Five distinct clinical syndromes of pulmonary angiitis and granulomatosis are currently recognized: Wegener granulomatosis, lymphomatoid granulomatosis, necrotizing sarcoid granulomatosis, bronchocentric granulomatosis, and allergic angiitis and granulomatosis (Churg-Strauss syndrome). Patients typically present in middle age with fever, cough, hemoptysis, dyspnea, or chest discomfort. Upper airway involvement such as sinusitis suggests Wegener granulomatosis. Medical renal disease is associated with Wegener granulomatosis and Churg-Strauss syndrome. Asthma may be present in bronchocentric granulomatosis and Churg-Strauss syndrome. Pathologic examination of these entities demonstrates vasculitis, granulomatous inflammation, and parenchymal necrosis. The radiologic manifestations of pulmonary disease are varied, but the most typical appearance is that of multiple nodules or masses that may demonstrate cavitation. Diffuse multifocal air-space opacities with or without cavitation may also be seen. Pulmonary hemorrhage is a well-known presenting manifestation of Wegener granulomatosis and, less commonly, of Churg-Strauss syndrome. Because of the multifocal lung involvement in these diseases, pulmonary metastases and infectious causes are often considered in the differential diagnosis. Affected patients are treated with cytotoxic agents and corticosteroids. The prognosis is variable, depending on the specific syndrome, but may be favorable in the absence of significant complications.
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PMID:Pulmonary angiitis and granulomatosis: radiologic-pathologic correlation. 959 92

Primary non-Hodgkin's lymphoma of the liver is an extremely rare lymphoma subset that often presents with diagnostic difficulties to both clinicians and pathologists. Using MEDLINE search, 90 cases of primary hepatic lymphomas reported in the literature were reviewed. The epidemiology and etiology, clinical presentation, pathologic features, management, and outcome of these patients have been summarized and described. Results of this review show that middle-aged males are most often affected. Abdominal pain or discomfort, weight loss and fever are the most frequent presenting symptoms. Most cases have a solitary or multiple mass lesions in the liver, and are frequently misdiagnosed as having a primary liver tumor or metastatic cancer. Diffuse large cell lymphoma is the most commonly encountered histologic subtype. Surgery, chemotherapy and radiotherapy have been used alone or in combination as treatment but the outcome is generally poor. Although primary hepatic lymphoma is an aggressive disease, it is resectable, and responsive to chemotherapy and radiotherapy. Because of the profound therapeutic implications, it should be considered in the differential diagnosis for patients presenting with mass lesions in the liver or hepatic disease.
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PMID:Primary non-Hodgkin's lymphoma of the liver. 968 27

In metastatic breast cancer the goal to reach must be the best possible palliation with minimum discomfort for the patient. We reviewed our experience with radiotherapy (20 or 30 Gy), systemic therapy and brace. Among 2200 breast cancer patients, we extracted 28 potential candidates for resection. All of them developed new metastases outside the treated field within one year. Local control was achieved in 68%, and 80% of them had stable or better performance status at 3 months. From our analysis, even patients with a so called "solitary lesion" do not seem to have a better prognosis than others. We conclude that radiotherapy (with systemic therapy and a brace) is still first-choice treatment for vertebral metastases; CT-guided percutaneous biopsy can avoid worthless major operations. The role of surgery should be limited to neurological compression, severe mechanical instability and to salvage the failures of conservative treatment.
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PMID:Radiotherapy and spinal brace: still first-choice treatment for vertebral metastases from breast cancer. 971 26

Regional chemotherapy has achieved high response rates in hepatic metastases from colorectal cancer and has been shown to improve survival significantly. The present paper reports the use of pre-operative regional therapy to establish marker response as a means of selection of patients for surgery. Fourteen patients underwent radiologically placed hepatic artery catheter (HAC) for chemotherapy. In the 11 patients with carcino-embryonic antigen (CEA) fall the patient proceeded to open surgical placement of HAC. The predictive effect of CEA fall following radiological HAC was good. Non-responding patients are clearly spared the discomfort and inconvenience and costs of an unnecessary operation.
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PMID:Radiologically placed hepatic artery catheter allows selection of patients with high-volume liver metastases for regional chemotherapy. 972 42

In a prospective evaluation of 58 consecutive patients referred for operation of a suspected pancreatic or peri-ampullary cancer, the accuracy of ultrafast magnetic resonance imaging (UMRI) in predicting the resectability of pancreatic tumors compared with alternative staging interventions was assessed. The staging methods included: 1) transcutaneous ultrasound (US) with color Doppler, 2) UMRI, including echoplanar sequences and breath-hold gadolinium-enhanced dual-phase three-dimensional magnetic resonance angiography (MRA), 3) rapid bolus dual-phase helical computed tomography (CT), 4) angiography of celiac and mesenteric arterial systems, including portal venous phase, and 5) endoscopic cholangiopancreatography (performed in jaundiced patients). Patients were evaluated for extrapancreatic tumor spread, presence of hepatic metastases, lymph node involvement, and vascular involvement--each a sign of unresectability. After an investigator blinded to the results of the other imaging studies assessed resectability, patients were then divided into three categories: 1) probably resectable, 2) probably unresectable, and 3) certainly inoperable. Final diagnosis was obtained by laparotomy (47 of 58 pts), or by histopathological examination of fine needle aspiration specimens in patients deemed inoperable. The 58 suspected tumors were localized to the pancreatic head in 35 (60%), body in 11 (19%), and tail in one (2%). Nine (16%) ampullary tumors and two (3%) distal common bile duct tumors made up the remainder. For those 52 patients for whom histology was obtained, 44 were malignant and eight benign. Accuracy for assessing extrapancreatic tumor extension was highest with UMRI (95.7%) followed by US (85.1%), and CT (74.4%). UMRI provided the best means for detecting liver metastases with an accuracy of 93.5% compared with 87.2% for each of US and CT. UMRI, US, and CT had a reduced capacity for detecting lymph node involvement (80.4%, 76.6%, and 69.2%, respectively). In assessing vascular invasion, UMRI had an accuracy of 89.1%, US 83.0%, CT 79.5%, and angiography 68.8%. The findings suggest that UMRI is equal to or superior to other staging methods with regards to sensitivity, specificity, and overall accuracy. Since UMRI has the potential to reduce patient time, money, and discomfort, this study concludes that this staging technique should replace alternative methods as it provides an "all-in-one" diagnostic modality.
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PMID:Identification of patients with resectable pancreatic cancer: at what stage are we? 977 77

The aim of the study was to evaluate single-injection gamma probe-guided sentinel lymph node (SLN) detection, applied in 40 melanomatous selective sentinel lymphadenectomies (SSLNDs). Thirty-four patients underwent preoperative lymphoscintigraphy, intraoperative SLN identification by a gamma-detecting probe and blue dye, and SLN sampling. The first 11 patients underwent formal lymphadenectomy. The following 23 patients underwent formal lymphadenectomy only when the SLN was involved with tumor. Evaluation included hematoxylin-eosin-stained slide microscopy, monoclonal antibodies to S-100 protein, and the melanoma-associated antigen HMB45. In all patients, single or multiple SLNs were identified by the gamma-detecting probe. However, only 82.5% of these specimens included blue-stained nodes. None of the non-SLN specimens were the exclusive site of metastases. Four patients had metastases in their SLN specimen without non-SLN involvement. We conclude that SSLND can be performed easily and precisely with the exclusive use of the gamma-detecting probe. A single injection is feasible, and decreases operating room contamination and patient discomfort.
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PMID:Single-injection gamma probe-guided sentinel lymph node detection in 40 melanomatous lymphadenectomies. 978 20

A 70-year-old man is referred to a urologist for recommendations on the management of metastatic prostate cancer. His cancer was diagnosed 5 years ago, and he underwent radical prostatectomy at that time. The tumour was confined to the prostate gland (Gleason score 7), and during surgery the lymph nodes were assessed as being clear of cancer. Before the surgery, the patient's prostate-specific antigen (PSA) level had been 8 ng/mL. After the prostatectomy, PSA was at first undetectable, but recently the PSA level rose to 2 ng/mL and then, at the most recent test, to 16 ng/mL. A bone scan was ordered to investigate back discomfort, which has been persistent but easily controlled with acetaminophen. Unfortunately, the bone scan shows several sites of metastatic disease. The man's medical history includes type 2 diabetes, which has developed during the past 3 years and which is controlled by diet, as well as asymptomatic hypertension, which is managed by means of a thiazide diuretic. The patient asks what treatments are available, what impact they are likely to have on his disease and what risks are associated with the therapies.
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PMID:Prostate cancer: 9. Treatment of advanced disease. 995 46

Malignant tumors of the hepatobiliopancreatic system are not curable in > 60%. For this reason, palliation plays an important therapeutic role. Indications are mainly obstructive jaundice, duodenal obstruction and pain. Assessment of the tumor's morphology and resectability is often possible only by surgical exploration. If necessary and feasible, non-curable malignancies are treated synchronously during this operation. In preoperatively proven distant metastases or local non-resectability, interventional procedures are preferred. They are efficient, at least primarily, and mostly correlated with little patient discomfort. A surgical biliary bypass obviously leads to improved long-term palliation. Especially in Klatskin tumors, palliative resection may be useful. Generally the patients benefit from palliation depends on minor therapeutic discomfort and long-lasting control of symptoms.
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PMID:[Palliative measures in the hepatobiliary-pancreatic system]. 1063 94

The objective of this work was to perform a feasibility study on the use of scalp cooling during palliative whole brain radiotherapy. Seven patients (1 male, 6 female) with good performance status underwent scalp cooling prior to and during radiotherapy for cerebral metastases. Five patients were prescribed 12 Gy in two fractions and two patients were prescribed 20 Gy in five fractions. Phantom thermoluminescent dosemeter (TLD) studies to assess the build-up effect from the scalp cap were performed. Seven out of eight patients that were offered scalp cooling completed treatment uneventfully. One patient reported discomfort on application of the scalp cap and continued treatment without scalp cooling. No patients reported other adverse effects from use of the cap during treatment or at follow-up. TLD studies demonstrated a 55-80% increase in dose to the scalp after application of the scalp cap. All patients experienced hair loss. Scalp cooling caps are well tolerated through a course of palliative whole brain radiotherapy. The scalp dose is significantly increased owing to a bolus effect from the scalp cap.
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PMID:A pilot study to assess the feasibility of prior scalp cooling with palliative whole brain radiotherapy. 1088 48

23 patients (age 11-66 years) underwent video-assisted thoracoscopic biopsy for diffuse disease or peripheral nodular lesions of the lung. 12 had been previously treated for extrapulmonary malignancy and lung biopsy was done for suspicious metastases. In all cases except 1, lesions were identified and biopsied by thoracoscopy. The postoperative course was easier and shorter as compared to thoracotomy and the mean hospital stay was only 2.5 days. Thoracoscopic lung biopsy is a safe, effective and accurate diagnostic modality for diffuse lung disease and peripheral lesions. It is associated with minimal postoperative pain and discomfort, short hospital stay, early return to normal activity, and gives good cosmetic results.
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PMID:[Video-assisted thoracoscopic surgery for diagnosis of pulmonary lesions]. 1091 93


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