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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An overview of the current status of various aspects of spinal metastasis, including pathology, diagnosis, and management is presented. The cell type of the tumor, particularly with reference to its radiosensitivity, seems to be positively correlated with treatment outcome, regardless of the treatment modality. Because pretreatment neurological status also seems to influence prognosis, early identification of spinal involvement in patients at risk is important; therefore, a high index of suspicion in patients known to have cancer is necessary. The most useful warning of impending spinal cord or nerve root compression is spinal or radicular pain, which usually precedes neurological deficit by days to years. An aggressive diagnostic evaluation of pain symptoms is therefore warranted; this should include plain spine films and, in questionable cases, radioisotope bone scan. Myelography should also be considered in any cancer patient with persistent spinal or radicular pain, even in the absence of neurological deficit and certainly if there is any neurological impairment. Therapeutically, radiation and surgery continue as the mainstays of management, whereas steroids and chemotherapy serve as adjuvants. The guidelines for management recommended in this paper are to be viewed as tentative because the ideal treatment for spinal metastasis has not been established. The proposed guidelines are based on an analysis of retrospective studies that suggest that radiotherapy should be the primary mode of treatment and that surgery should be reserved for situations in which radiotherapy fails or where there is bony compression or spinal instability. Cases are presented to illustrate the application of these guidelines. (Neurosurgery, 5: 726--746, 1979).
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PMID:Spinal metastasis: current status and recommended guidelines for management. 39 32

The immunological implications of anaesthetic practice relate to the possibility that exposure to anaesthesia and surgery, by depressing a variety of both non-specific resistance mechanisms and specific immune responses, renders patients more liable to infections and the spread of malignancy in the period after operation. A review of the literature suggests that, although various anaesthetic agents themselves depress immune responses, the effects are shortlived and of minor importance when compared with the effects of the hormonal aspects of the stress response. A more aggressive approach to relief of pain and anxiety may be beneficial from the immunological point of view.
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PMID:Effects of anaesthesia and surgery on immune status. 39 89

Because of alarming delays in the diagnosis and treatment of vertebral osteomyelitis we have reviewed our experience over the past 15 years. Of the 36 cases, 25 were pyogenic and 11 tuberculous. Because of late referral there was a delay from onset of symptoms to diagnosis of at least three months in 13 patients. The reason for this was the failure of the initial physician to consider osteomyelitis in the differential diagnosis of a febrile illness associated with back pain. The majority of our patients from the onset did not have intense localized pain, tenderness and a high fever which is the classical clinical picture in this condition. Seven patients with a long history required surgical exploration and debridement of the lesion in order to eradicate the infection. The remainder did well on 6 to 12 weeks of antibiotic therapy. None required spinal fusion. Ten of 11 patients with spinal tuberculosis had curettage of the lesion and spinal fusion. Patients with diabetes, malignancy, alcoholism, corticosteroid therapy and recent lower urinary tract surgery were found to be at particular risk of developing spinal osteomyelitis. Very often it was difficult to identify differences in the presentation of pyogenic and tuberculous infections.
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PMID:Atypical manifestations of spinal infections. 40 8

Five patients, previously treated with pelvic irradiation for cancer of the cervix uteri, ovaries or bladder are presented. They developed occlusions of the distal aorta and/or the iliac arteries 2 to 6 years after irradiation. The presenting symptoms caused by the vascular obstructions were claudication or rest pain. All patients were operated upon with revascularization procedures and thereby relieved from their symptoms. One vascular graft occluded but reoperation was successful. The mechanism by which radiation causes atherosclerosis is discussed. All patients were heavy cigarette smokers. The patients with signs of atherosclerosis outside the irradiated area were the ones with the shortest time interval between radiation and symptoms of ischaemia. It is proposed that irradiation acts synergistically to other atherogenetic factors and this should be kept in mind when radiation therapy is planned in patients with high risk of developing atherosclerosis.
Cancer 1978 Jun
PMID:Localized arterial occlusions in patients treated with pelvic field radiation for cancer. 41 68

The authors summarize clinical studies on 5-FU treatment for advanced disseminated colonic, rectal and pancreas cancers. The advantage of pushing intravenous (I.V.) injections slowly to avoid pain and using peristalt pumps for I.V. infusion are pointed out. Since the renal toxicity of 5-FU is minimal, higher doses may be envisaged which could give better results. Studies are in progress to try to determine a model for 5-FU kinetics.
Bull Cancer 1979
PMID:Clinical pharmacological studies on 5-FU treatment for advanced gastro-intestinal carcinomas. 42 Sep 54

Thirty-four patients with cancer of the breast and 12 with cancer of the prostate were treated with testosterone and 32P-sodium phosphate for relief of pain from bony metastases. Thirty were treated with chemotherapy as well, and 34 were treated with external radiation to single ports for localized pain. Of the 46 patients treated, good results were achieved in 34, fair results in six, and no improvement in six. Subsequent marrow depression necessitated transfusion in 10 patients; no other side effect was observed.
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PMID:32P-sodium phosphate treatment of metastatic malignant disease. 42 5

The cases of 70 consecutive patients having a transsphenoidal hypophysectomy for metastatic carcinoma of the breast or prostate are reviewed. In half of the patients with cancer of the breast an objective remission was obtained. In 30 percent of the patients with cancer of the prostate there were objective signs of tumor regression and in 75 percent there was relief of pain. The operative mortality was 1.4 percent and the morbidity of the procedure was gratifyingly small. There is some indication that hypophysectomy may be preferred to adrenalectomy in patients with hormone-responsive metastatic mammary cancer.
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PMID:Transsphenoidal hypophysectomy in the treatment of metastatic breast and prostate carcinoma. 42

We have recently used grey-scale ultrasonography and endoscopic pancreatography to investigate 11 patients with symptoms attributed to pancreatic trauma weeks, months or even years earlier. The pancreas was normal in one patient, and another, who presented with pain and jaundice after a car accident, was shown to have cancer of the pancreatic head. The remaining patients all had local lesions due to trauma; ultrasound showed a mass or cyst close to the point of duct obstruction or stenosis shown on pancreatography. Ultrasonography and pancreatography can together provide a precise map with which to plan effective management in patients having suffered pancreatic trauma.
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PMID:Grey-scale ultrasonography and endoscopic pancreatography after pancreatic trauma. 42 82

A study of 36 patients with adenocarcinoma of the rectum recurrent in the perineum after Miles abdominoperineal resection defined a subgroup of 21 patients in whom curative re-excision of the perineum, with or without associated resection of viscera as warranted by operative findings, was performed. Recurrence without palpable disease was disclosed microscopically in seven patients (33%). None of the 21 patients had clinical or laboratory evidence of dissemination at the time of re-excision. Mortality and morbidity were low and yield in terms of pain control was excellent. Results achieved in patients treated with pre- and/or postoperative radiotherapy did not differ quantitatively or qualitatively from those treated by operation alone. Survival free of disease proved to be disappointing and underlines at present the palliative nature of this approach when the primary operation has been an adequate standard abdominoperineal operation. This report provides further evidence as to the value of the better definition of high risk primary rectal cancers and the need for continuing refinement of the follow-up and retreatment process.
Cancer 1979 Mar
PMID:The results of treatment of perineal recurrence of cancer of the rectum. 42 35

Thirty-four patients with cancer of the breast and 12 with cancer of the prostate were treated with testosterone and 32P-sodium phosphate for relief of pain from bony metastases. Thirty received chemotherapy as well, and 34 received external radiation to single ports for localized pain. Of the 46 patients, 34 had good results, 6 fair, and 6 were failures. Ten patients needed transfusion for marrow depression; no other side effect was observed.
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PMID:32P-sodium phosphate treatment of metastatic malignant disease. 42 68


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