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Query: UMLS:C0027651 (tumor)
 685,946 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present revision has been carried out in order to final out to what extent corticosteroids have improved the vital and functional prognosis of dermatomyositis. Over the sixties and in the early seventies, statistical tables have not shown any substantial differences compared with those of the pre-steroid era. It has been observed since 1973 that early treatment with high doses (1-2 mg of prednisone per kg per day) clearly improves the vital prognosis of infantile dermatomyositis, but not the functional one. In adults, there is less experience and the problem always exists of a possible underlying neoplasm. In cases with resistance to corticosteroids, the association of immunosuppressors, particulary methotrexate, has begun to be tested. There is no proved effective treatment of calcinosis which results in functional recovery.
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PMID:[Prognosis and current treatment of dermatomyositis]. 36 60

Malignant disorders may produce neuromuscular syndromes in a variety of ways, for some of which it is still difficult to determine the exact pathophysiology. In the myopathic and neuropathic disorders, one possible explanation is that they are due to a virus such as is found in the rare "progressive multifocal leukoencephalopathy". This is seen in association with the malignant lymphomas and with other conditions such as sarcoidosis where immune responses may be altered by either the disease or the treatment. No viral material has been found in the nonmetastatic neurological disorders apart from progressive multifocal leukoencephalopathy. An alternative theory is that there may be an autoimmune process, the nervous system sharing some antigenic determinant with the neoplasm (Urich, 1967). The prognosis in the paraneoplastic neurological disorders is usually poor. As well as the direct threat to life posed by the malignant disease, when the neurological disorder is due to destruction of neurones (for instance cerebellar degeneration or sensory neuronopathy) recovery of function is impossible. Spontaneous remissions have been recorded in cases of proximal muscle weakness and sensorimotor neuropathy, but it is difficult to know whether the remissions have been truly spontaneous or related to treatment (excision of the neoplasm or administration of steroids). Further immunological and virological studies will probably reveal the answers to some of the outstanding problems. In the meantime the clinician must continue to investigate patients with muscular weakness for evidence of an occult neoplasm, and to repeat investigations if no other cause for the neurological disorder is found. Also, in patients with known malignant disease, apart from trying to differentiate forms of neuromyopathy from the effects of metastases the various metabolic disorders must be considered because the therapeutic possibilities are a little more promising in the paraneoplastic endocrine disorders. Ross (1975) wisely said that "cancer has replaced syphilis as the great imitator".
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PMID:Neuromuscular syndromes associated with malignant disease. 85 66

Ninety-four patients with lymphoma involving the extradural space with spinal cord compression proven at the time of laminectomy were reviewed. There were about three times as many patients with non-Hodgkin's lymphoma than with Hodgkin's disease. The majority of those with Hodgkin's disease had a proven histologic diagnosis before the onset of the spinal cord compression syndrome, whereas only 15% of those with non-Hodgkin's lymphoma had previously been so diagnosed. Plain roentgenograms of the spine were suggestive of tumor involvement in less than one-third of the patients, whereas myelograms were invariably abnormal. As noted by others, the outlook for functional recovery and extended life expectancy is relatively good for patients with this type of cancer, in contrast to reports in the literature regarding prognosis for patients who have metastatic carcinoma with extradural spinal cord compression.
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PMID:Lymphoma of the spinal extradural space. 99 Nov

Hypoglossal-facial nerve anastomosis is one of the procedures frequently performed to restore function after facial palsy secondary to surgery for removal of cerebellopontine angle tumors. The published results of hypoglossal-facial nerve anastomosis have been variable, and there are still questions about the indications, timing, and surgical techniques for this procedure. The goals of the present retrospective analysis of 22 cases of hypoglossal-facial nerve anastomosis were to assess the extent of the functional recovery and to analyze the factors affecting this recovery. The 22 cases of complete facial palsy were gleaned from a series of 245 cases of cerebellopontine angle tumors treated surgically by one of the authors. Twenty patients had an acoustic neuroma (average size 3.5 cm), one patient had a petrous meningioma, and one patient had a facial neuroma. The average age of the patients was 47.3 years (range 19 to 69 years). The average interval from tumor surgery to hypoglossal-facial nerve anastomosis was 6.4 months (range 12 days to 17 months), and the average follow-up period after the procedure was 65 months. The results were graded as good, fair, poor, or failure according to a new method of classifying facial nerve function after hypoglossal-facial nerve anastomosis. The results were good in 14 cases (63.6%), fair in three (13.6%), and poor in four (18.2%); one (4.5%) was a failure. Good and fair results occurred with higher frequency in younger patients who were operated on within shorter intervals, although these relationships were not statistically significant. There were no surgical complications. Good or fair results were achieved in 17 (77.3%) of the 22 cases, and thus hypoglossal-facial nerve anastomosis is considered an effective procedure for most patients with facial palsy after surgery for cerebellopontine angle tumors.
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PMID:Hypoglossal-facial nerve anastomosis for facial nerve palsy following surgery for cerebellopontine angle tumors. 140 14

Median and posterior tibial somatosensory evoked potentials (SEPs) were studied on 25 patients with pathologically proven intraspinal neoplasms, and the results were compared and correlated with the details of clinical examination and the information derived from magnetic resonance imaging (MR). MR was abnormal in all cases and in 23 of 25 (92%) demonstrated an intraspinal expansile lesion. SEP was abnormal in 19 of 25 patients (76%). Abnormal SEPs were found in 18 of 19 patients (94%) with cervical or thoracic neoplasms but only in 1 of 6 patients (16%) with the tumor in the thoracolumbar or lumbar region. SEP-MR correlation was significant (P less than 0.05) for thoracic intraspinal neoplasms where all 9 had an abnormal SEP showing a similar pattern of normal median and abnormal posterior tibial study. Clinically, all 7 patients with posterior column sensory deficits had abnormal SEP (100%). Abnormal SEPs were seen in 7 of 11 (63%) patients with spinothalamic deficits and in 4 of 8 (50%) of those with normal sensory examinations. Four of 9 patients (44%) with a normal neurological examination or an examination disclosing ambiguous results indistinguishable from a peripheral pathology had an abnormal SEP strongly suggesting a central sensory disorder. Comparison of preoperative and postoperative SEPs did not disclose useful prognostic information pertaining to the functional recovery.
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PMID:Somatosensory evoked potentials and magnetic resonance imaging in intraspinal neoplasms. 169 Jan 9

The results of lateral cranial base surgery for glomus jugulare tumors are gratifying when normal anatomy and function can be preserved. The goal of conservation surgery is to preserve normal ear anatomy and cranial nerve function. In general, conservation surgery is tumor-size dependent. Thus, excellent states of functional recovery depend upon accurate early diagnosis. This paper reviews the technical aspects of transtemporal conservation skull base tumor surgery while also reviewing our experience with nearly 100 glomus jugulare patients. Adjuvants to early diagnosis will be highlighted from a review of presenting symptoms, clinical signs, and related diagnosis. Our objective is to provoke a high index of suspicion in physicians charged with the responsibility of diagnosing these tumors. Diagnostic guidelines are proposed.
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PMID:Conservation surgery for glomus jugulare tumors: the value of early diagnosis. 221 31

Pathology affecting the spinal cord structures and/or vertebral segments at the TLJ is not uncommon. Trauma is the most frequent cause of dysfunction-compression at these levels and may result in permanent neurological disability and vertebral column instability. Patients with TLJ pathology must be evaluated carefully and thoroughly with serial neurological examinations and diagnostic radiographic studies as outlined. The treatment of patients who are documented to harbor TLJ pathology must be individualized and is determined by the type, extent, and level of the lesion, the presence of dislocation and/or instability, and the degree of neurological compromise. Surgical decompression is the treatment of choice for patients with tumor or herniated disk. Many of the TLJ trauma patients may be managed nonoperatively, but surgical decompression and stabilization will be required in selected patients to maximize their long-term functional recovery. There are several viable surgical options and approaches available for the treatment of TLJ lesions, depending on individual patient pathology and the experience and expertise of the surgical team. In general, ventral compressive lesions, depending on individual patient pathology and the experience and expertise of the surgical team. In general, ventral compressive lesions must be approached via a ventral or ventrolateral exposure allowing decompression without injury to neural structures. In our experience, the "modified" costotransversectomy approach is an efficacious approach for treatment of TLJ pathology and incorporates both a decompression procedure and a stabilization-fusion procedure (when required) into the same operative setting.
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PMID:Surgical approaches to the thoracolumbar spine. 240 80

In 76 of 575 children operated on for intracranial tumors during a 15 year period, symptoms had started during the first 2 years of life. Excision of the tumor was complete in 44, subtotal in 13, partial in 13, and in 6 only a biopsy was taken. Surgical mortality was 13% (10/76). 31 died later as their tumors progressed. The overall survival rate was 46% and 27 of the survivors are leading useful lives, with no signs of recurrence, 8 months to 14 years after operation. All of these had total or subtotal removal of the tumor. Only 3 required oncologic treatment. Despite radical surgery, the late neuropsychological results were good. However, 8 children who had had brain irradiation are severely handicapped. We conclude that in infancy functional recovery from a focal surgical lesion, even if extensive, is more complete than after diffuse damage to the immature central nervous system caused by irradiation. In this age group brain irradiation leads to severe handicapping in the great majority of cases. Radiotherapy should therefore be used only for highly malignant tumors, especially when surgical excision is incomplete. Radical surgery gives the best results in terms of survival and satisfactory neuropsychological state.
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PMID:[Brain tumors in infants]. 271 91

Ten adult patients developed sixth-nerve palsy after trauma or a cerebral tumor. No clinical evidence of recovery of function was noted by at least 8 months after onset. All patients underwent total transposition of the superior and inferior rectus muscle insertions to the area of the lateral rectus insertion, accompanied by botulinum toxin (Oculinum) injection of the ipsilateral medial rectus. These patients developed a mean diplopia-free field of 51 degrees, with a diplopia-free field in the abducted field of 20 degrees. This procedure involved surgery on only two rectus muscles, but the results compared favorably with surgical strategies involving three rectus muscles. Thus, the risk of developing anterior segment ischemia was greatly reduced.
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PMID:Vertical rectus muscle transposition and botulinum toxin (Oculinum) to medial rectus for abducens palsy. 192 13

Over a recent 16-month period, 35 cerebellopontine angle tumors were removed at our institution by a surgical team consisting of one neurosurgeon and one otologist. Nineteen tumors were less than 2 cm in diameter and six were greater than 4 cm. There were 26 acoustic neuromas, six meningiomas, two epidermoid tumors, and a glossopharyngeal schwannoma. A suboccipital transmeatal approach was used in the majority of patients. There were no deaths. Thirty-two patients had an excellent outcome. Twenty-four patients had complete tumor removal (92% of the acoustic neuromas). The facial nerve was preserved anatomically in all but one patient, who had nerve grafting intraoperatively and has partial recovery of function. Thirteen of the 24 patients who had auditory function retained some of it postoperatively. With current diagnostic techniques, combined with the neurosurgical and otologic team approach, the majority of patients with acoustic tumors of all sizes may expect a complete resection of the tumor with a good outcome. Certainly, early diagnosis and resection of smaller tumors will increase the likelihood that hearing will be preserved, thus providing impetus for aggressive diagnostic and surgical treatment of patients with these lesions.
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PMID:Cooperative neuro-otologic management of acoustic neuromas and other cerebellopontine angle tumors. 325 36


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