Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Technological advances in liposomal preparation and efficient drug entrapment, along with supportive preclinical studies, have led to a number of recent clinical trials utilizing liposomes as drug carriers in the treatment of human malignancy. Although the results of these trials must be considered preliminary, it is clear that liposomal delivery of chemotherapeutic agents is safe at the doses administered. Aside from minor constitutional symptoms, virtually all toxicity could be attributed to release of the incorporated drug. Myelosuppression tends to be the dose-limiting toxicity with free drug, whereas constitutional symptoms are more likely to occur with encapsulated biologic therapy. Prior to human trials, there was fear that intravenous injection of liposomes could result in pulmonary emboli. No cases of pulmonary embolism secondary to liposome therapy have been recorded. The objective response rate in the patients studied appears to be minimal. This is not surprising, since the overwhelming majority of patients studied had disease that was advanced and previously shown to be refractory to therapy. Subgroups of patients that appear to benefit most include those with breast cancer who were treated with liposomal doxorubicin and those with advanced melanoma treated with liposomal tumor vaccines. Additional phase II and III clinical trials will better define the effectiveness of treatment modalities incorporating liposomes. VI-A. Future directions One of the earliest applications of liposomes may be in the amelioration of drug toxicity. Although not yet proven, the clinical studies reviewed suggest that liposomal delivery of doxorubicin reduces cardiotoxicity without sacrificing antitumor effect. Although similar claims have been made in support of continuous infusion doxorubicin [11], one can avoid unnecessary hospitalization or the bulk and expense of portable infusion devices by a single administration of the liposomal preparation. Liposome encapsulation can markedly alter the biodistribution and pharmacokinetics of well-known chemotherapeutic agents. The effectiveness of liposomal drug delivery in human trials thus far has probably been more closely related to altered pharmacokinetics rather than enhanced drug delivery to tumor or increased tumor responsiveness. As demonstrated by Gabizon [19], increased liposome circulating time in the murine model can be achieved by using small unilamellar vesicles containing a phosphatidylcholine of high phase-transition temperature and a small molar fraction of monosialoganglioside or hydrogenated phosphatidylinositol.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Liposomes in the treatment of malignancy: a clinical perspective. 149 23

A prospective randomized trial testing regional hyperthermic perfusion with melphalan has been conducted. Sixty-nine patients with recurrent malignant melanoma of the extremities were randomly allocated to surgery (36 patients) or surgery plus regional perfusion (33 patients). Prognostic variables concerning primary tumor as well as the recurrent disease were evenly distributed in the groups, excluding any bias in the randomization. Median tumor-free survival after randomization was 17 months in the perfusion group and 10 months in the control group. There were 15 locoregional recurrences in the perfusion group and 24 in the control group. The tumor-free survival curve was significantly (P = .044) better for the perfusion group than for the control group. Median survival time after randomization was 57 months in the perfusion group and 35 months in the control group. This difference was not significant. One patient died within 1 month after perfusion of pulmonary embolism. Regional hyperthermic perfusion after surgery of recurrent malignant melanoma should only be recommended in prospective and controlled trials, until its value has been proven in several randomized studies.
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PMID:Regional hyperthermic perfusion with melphalan after surgery for recurrent malignant melanoma of the extremities. Swedish Melanoma Study Group. 196 May 47

We report the clinical features and outcome of 16 patients with cryoglobulinaemia. Two patients with Type I cryoglobulinaemia both had IgG kappa monoclonal paraproteins. Nine of 10 with Type II disease had monoclonal IgM kappa and polyclonal IgG; one had monoclonal IgG kappa and polyclonal IgG in the cryoglobulin. Underlying disorders identified in 3 of the 4 Type III patients were Sjogren's syndrome, infective endocarditis, and non-A non-B hepatitis and HTLV III infection. The commonest presenting features were rash in 94 p. 100 (ulceration 25 p. 100), arthralgia in 63 p. 100 (erosive arthritis 32 p. 100), renal disease in 63 p. 100, neurological involvement in 56 p. 100, hepatomegaly in 32 p. 100 and splenomegaly in 32 p. 100. Major associated conditions were progressive bronchiectasis in one case, and severe peripheral vascular disease in another; underlying malignancy was found in 2 cases (lymphoma and malignant melanoma). Treatment was with plasma exchange (PE) and immunosuppressive drugs (ID) in 10, PE alone in 3, ID alone in 2 and antibiotics [corrected] in 1. Fourteen of 16 patients showed an initial clinical response and fall in cryoglobulin levels. Four patients have died, one each from gastro-intestinal haemorrhage, sepsis, pulmonary embolism and lymphoma. Of the remaining 12 patients, all are symptomatically controlled and 10 have persisting cryoglobulinaemia (3 on PE and ID, 2 on PE, 2 on ID and 3 on no treatment). Of the two cases in whom cryoglobulinaemia resolved, one (Type II) had received PE and ID and the other (Type III) had been treated with antibiotics and surgery for infective endocarditis.
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PMID:Cryoglobulinaemia: clinical features and response to treatment. 376 96

Case report about death due to veno-occlusive liver disease following Dacarbazine treatment: 9 years after surgical treatment of malignant melanoma of the trunk a 68-years old patient developed lymph node metastases in the right axilla, which were removed immediately by surgical excision. One month before the patient had undergone surgical treatment of empyema of the gallbladder: Cholecystectomy and appendectomy were performed, postoperative recovery was uncomplicated. On account of the second lymph node metastasis within nine months adjuvant treatment with Dacarbazine was agreed and started one month later. After having performed the first course of treatment without any hints to intolerance the patient suddenly exhibited severe shock symptoms on the fourth day of the second course. Clinically residual myocardial infarct or pulmonary embolism were assumed, but could not be verified. The patient delivered increasing hepatomegaly. A massive increase in transaminase values was noted. Hemostasiologic changes with decreased Quick value occurred. The patient died of cerebral hemorrhage five days after beginning the second Dacarbazine cycle. Autopsy findings were severe liver cell necroses as well as liver vein thromboses, no metastases of melanoma could be found. Hepatotoxicity of Dacarbazine and the mechanism of liver vein thrombosis are discussed with special regards to possible hemostasiologic changes and sensibilisation due to Dacarbazine and/or previous liver cell damage.
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PMID:[Veno-occlusive syndrome with acute liver dystrophy following decarbazine therapy of malignant melanoma (author's transl)]. 721 35

The dissection incontinuity is indicated for the treatment of malignant melanomas of the skin with high risk and favourable anatomic positions of the lesions. The performance of the incontinuity operation means to remove the primary site, intervening lymphatics and regional lymph nodes en bloc. Intransit- and micrometastases can be excised in addition to the tumor in stadium I of the disease. Melanomas with high risk are all nodular types as well as all other types of the levels IV and V. In level III the selection was made more appropriate to the addition of thickness measurements (greater than 1.5 mm). There were no operative mortalities in this series of 36 cases with high risk melanomas. The morbidity in the postoperative period with ileus, pulmonary embolism and hemorrhage in three patients could be controlled with appropriate measures. The large operation wounds measuring to 60 cm in length and 12 cm in width were closed by dermanaplasties and skin grafting. In two cases only necrosis of the wound edges impaired the healing somewhat; five patients developed edema. In 12 cases the dissection incontinuity was combined with an elective lymphadenectomy of the axillary and in 26 cases of the inguinal groups. Micrometastases in one node were found in three patients; four patients developed metastases. The after-care period with 19 month is still to short for final evaluations. Since the potential for nodal metastases can be reasonably predicted, the performance of dissection incontinuity with elective regional lymphadenectomy continues outweigh any hypothetical disadvantage.
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PMID:[Continuity dissection in malignant melanoma of the skin]. 722 68

During the 7-year period between June 1985 and May 1992, 34 patients with pineal lesions underwent 66 stereotactic procedures (37 biopsies, 19 third ventriculostomies, 6 cyst aspirations, 3 instillations of 32P into cysts, and 1 insertion of an Ommaya reservoir into a cyst) at the Mayo Clinic. Nine patients subsequently also underwent 10 open resections of lesions of the pineal region. In the 34 study patients, the pathologic entities were 9 gliomas (5 astrocytomas, 2 ependymomas, and 2 oligodendrogliomas), 9 germ cell tumors (7 germinomas, 1 entodermal sinus tumor, and 1 malignant teratoma), 8 pineal parenchymal tumors (3 pinealomas, 3 pinealoblastomas, 1 mixed pinealoma-pinealoblastoma, and 1 intermediate differentiation pineal tumor), 4 other malignant tumors (2 undifferentiated carcinomas, 1 malignant melanoma, and 1 non-Hodgkin's lymphoma), 2 meningiomas, and 2 nonneoplastic lesions (1 glial cyst and 1 inflammatory lesion). No mortality or permanent morbidity was associated with the 66 stereotactic procedures; 2 patients had temporary complications--1 neurologic (transient diplopia) and 1 nonneurologic (pulmonary embolism). Diagnostic tissue was obtained in 33 of the 34 patients. An algorithm for the diagnosis and management of patients with lesions of the pineal region is presented. We conclude that stereotactic biopsy of pineal lesions can be performed safely, has a high diagnostic yield, and facilitates rational planning of treatment.
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PMID:Stereotactic procedures for lesions of the pineal region. 841 62

The association between venous thromboembolism and cancer has been known for many years. The clotting system may be activated because of enhanced platelet aggregation and adhesion or by stimulation from the endothelial cells or the tumour cells themselves. Furthermore, thrombosis may develop as a result of prolonged immobilization, surgery, chemotherapy or hormone therapy. We present a case of a patient who underwent surgery for excision of a Clark level II melanoma on the back who developed pulmonary metastasis four years after the operation. The metastasis manifested with very severe venous thromboembolism which, despite anticoagulant therapy and the placement of a vena caval filter, led to the patient's death from pulmonary embolism. The case is uncommon, in terms of both the rarity with which venous thromboembolism is associated to melanoma, and the severity with which it manifested.
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PMID:Venous thromboembolism and melanoma. 1153 52

We report a 58-year-old woman presenting with dyspnoea and recurrent pulmonary embolism. Echocardiography revealed pericardial effusion and a tumour located in the atrioventricular groove. Surgical exploration showed tumorous infiltration of the ventricle wall and of parts of the atrium. Curative excision was not possible and the operation was discontinued. Histology revealed an amelanotic malignant melanoma. No other tumour location was detected by scanning procedures. This case represents a very rare manifestation of melanoma exclusively located in the atrioventricular groove of the heart leading to recurrent pulmonary embolism. A review of the literature on cardiac involvement of melanoma is provided.
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PMID:Isolated amelanotic malignant melanoma of the heart. 1200 Mar 96

The use of implanted central venous catheters with ports has become almost irreplaceable in clinical treatment of cancer patients with advanced disease. It improves the patient's quality of life and simplifies medical treatment. For safe use during outpatient follow-up treatment, possible complications such as wound infections, thrombosis or even pulmonary embolism have to be considered. The incidence of catheter-associated thrombosis in cancer patients has been estimated as 25-66% in screening evaluations. Clinical symptoms were present in only in 6-28% of all patients with diagnosed thromboses. We report on a patient with metastatic malignant melanoma, who developed a deep arm vein thrombosis two weeks after port implantation. The prognosis of deep arm vein thrombosis is determined by the development of pulmonary embolism (8-36%). In such cases, early diagnosis and treatment are essential for the patient's survival.
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PMID:[Subclavian thrombosis after port system implantation]. 1652 79

An 80-year-old woman was admitted for a diagnosis of severe pulmonary embolism. A large serpentine thrombus stuck in a patent foramen ovale (PFO) completely resolved without the patient experiencing any manifestation. The right renal artery was the final destination. Thromboaspiration was unsuccessful. Three months later, the patient was diagnosed with a malignant melanoma and metastatic dissemination.
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PMID:Momentarily stuck in the foramen ovale. 1654 83


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