Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiac metastases are often clinically inapparent but have important prognostic significance. A total of 1046 consecutive autopsies performed between 1981 and 1983 were reviewed, and 210 patients with both premortem and autopsy diagnoses of cancer were found, in whom a recent (less than 3 months before death) ECG was available. Of these patients, 47 had cardiac metastases (group I) and 163 did not (group II). In group I, 19 patients had new ECG changes suggestive of myocardial ischemia or injury, including either diffuse T wave inversion (10%), segmental (ECG pattern suggestive of a specific coronary distribution) T wave inversion (80%), or ST elevation (10%). None of these patients had symptoms suggestive of myocardial ischemia. In group II, six patients had ECG changes suggestive of myocardial ischemia or injury: four patients with preterminal sepsis, one with myocardial infarction, and one with aspergillus nodules within the myocardium. New atrial arrhythmias (seven patients) and low voltage (10 patients) were found with greater frequency in group I patients (p less than 0.0005 and p less than 0.00001, respectively, vs group II). Patients with normal ECGs were unlikely to have cardiac metastases; however, the finding of nonspecific ST-T wave changes was not helpful in differentiating the two groups. In clinically stable patients with cancer and no cardiac symptoms suggestive of ischemia, any new ECG change should raise the suspicion of cardiac metastases. The ECG finding of myocardial ischemia or injury has high specificity (96%, p less than 0.000001) for cardiac metastases.
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PMID:Electrocardiographic markers of cardiac metastasis. 378 78

Seventeen high-risk critically ill patients with suspected cholecystitis underwent percutaneous transhepatic cholecystostomy between 1981 and 1986 using Hawkins' needle guide system for gallbladder intubation. Acute cholecystitis was documented in 15 patients, including 1 with common bile duct obstruction. Two other patients had common bile duct obstruction secondary to metastatic cancer (one patient) and chronic pancreatic fibrosis (one patient). There was rapid resolution of the signs and symptoms of cholecystitis, sepsis, or both in 16 of the 17 patients. One critically ill patient with positive findings on blood culture and an organism resistant to triple antibiotic therapy died soon after percutaneous cholecystostomy. In the entire group of 17 patients, there was no evidence of bile leaks or other catheter complications. Six patients subsequently underwent successful cholecystectomy and two underwent common bile duct exploration without complications. One patient underwent cholecystojejunostomy, and in three patients, the catheter was removed with no sequelae of cholecystitis. Two remaining patients had the catheter in place and were awaiting operation at last follow-up. Three of four patients who died within 30 days of percutaneous transhepatic cholangiographic cholecystostomy died either from the terminal malignant condition (two patients) or from arrhythmia (one patient with cirrhosis). This review suggests that percutaneous cholecystostomy is a safe and effective procedure for resolving acute cholecystitis in high-risk patients. In addition, the technique of percutaneous transhepatic cholangiographic cholecystostomy appears well suited for percutaneous dissolution of stones, sclerosis of the gallbladder, or both in selected high-risk critically ill patients.
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PMID:Percutaneous cholecystostomy for acute cholecystitis in high-risk patients. 379 87

Between 1980 and 1983, 373 patients with clinically resectable rectal adenocarcinoma entered a prospective randomized study aimed to evaluate the effect of short-term preoperative radiotherapy. Protocol violations were identified in 21 instances. Of the remaining 352 patients, 182 were randomized to surgical treatment only (S-group). Immediately, before surgery, 170 patients were irradiated to the pelvic region with 25 Gy (2500 rad) during a 5-day period (RT-group). Of these patients, 59% underwent abdominoperineal excision, 38% anterior resection, and 3% laparotomy only. At surgery distant metastases were discovered in 32 patients (9%). There were no significant differences between the groups in the distribution of age, sex, operative methods, and tumor stage according to the original Dukes' classification. During the follow-up time, ranging between 6 months and 3 years, tumor recurrence occurred in 35 patients, 19 in the S-group and 16 in the RT-group. Fifteen patients in the S-group had pelvic recurrence compared to 10 patients in the RT-group. Distant metastases occurred in six and eight patients, respectively. Two patients in each group had both pelvic and distant recurrence. There was no correlation between tumor recurrence and type of operation. Median time interval from diagnosis to pelvic recurrence was 10 months in the S-group and 16 months in the RT-group. Postoperative complications in the form of wound sepsis were slightly more common in the RT-group. In summary, the applied treatment regimen, is well-tolerated and apparently does not affect the Dukes' stage of the tumor. Although there is no statistically significant difference, there is a trend of less pelvic recurrence in patients receiving preoperative radiotherapy.
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PMID:Preoperative short-term radiotherapy in rectal carcinoma. A preliminary report of a prospective randomized study. 388 16

Forty-four patients with non-small cell carcinoma of the lung were treated every 3 weeks with vinblastine (4 mg/m2/day iv X 2) and cisplatin (20 mg/m2/day iv X 3). Of the 28 patients with metastatic disease, eight (29%; 90% confidence interval of true response, 17%-47%) achieved objective response, for a median duration of 27 weeks. Median survival in this group was 47 and 28 weeks for responders and nonresponders, respectively. Of the 16 patients with advanced regional disease, 11 (69%; 90% confidence interval of true response, 49%-86%) achieved objective response. Thirteen of these patients received consolidation radiotherapy (4500 cGy/25 fractions/5 weeks), with a boost of 1000 cGy/5 fractions/1 week in those patients who achieved response. In the three patients who did not receive radiotherapy, two died during the induction phase, one from grade 4 leukopenia and sepsis and the second from unrelated factors. The third patient had systemic progression of disease during induction chemotherapy. Six patients experienced overall improvement in their chemotherapy response from the radiotherapy. Two patients who did not respond to the chemotherapy achieved partial response with irradiation. Four patients who had partial response to the chemotherapy achieved complete response with irradiation, and seven patients had no further change in their degree of response to irradiation. The overall median survival of this group was 81 weeks. Maintenance chemotherapy was not given. After radiotherapy, the site of first failure was outside the radiation field in nine of 13 patients (69%). Hematologic toxicity was dose-limiting. Other toxic effects that were not dose-limiting included nephrotoxicity, neurotoxicity, and acute nausea and vomiting. In the patients with advanced regional disease, there was no increase in the radiation toxicity attributable to the chemotherapy. We conclude that: (a) this dose schedule of vinblastine and cisplatin has reproducible activity in non-small cell carcinoma of the lung; (b) the response and median survival of patients with advanced regional disease are superior to those of patients with metastatic disease; and (c) in patients with advanced regional disease, treatment with chemotherapy followed by radiotherapy yielded an overall response rate of 81% (90% confidence interval of true response, 60%-93%) and improved survival compared to a similar group of patients studied by others receiving radiotherapy alone. We recommend further testing of this concept.
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PMID:Cisplatin and vinblastine chemotherapy for metastatic non-small cell carcinoma followed by irradiation in patients with regional disease. 395 44

We evaluated the efficacy and the complications of 65 silicone elastomer catheters inserted percutaneously for long-term venous access for administration of chemotherapy, antibiotics, and blood products in patients with metastatic cancer. Treatments were administered either in the hospital or in the outpatient clinic, using a portable infusion pump. The median indwelling time of catheters was 238 days (range, two to 521). The projected duration of catheter function, when the electively removed catheters were censured, was 310 days. Twenty-three catheters were removed because of malfunction, while the remaining either were discontinued electively (20) or were functioning at the conclusion of the study (22). The problems necessitating removal of 23 catheters were inadvertent dislodgement from loose sutures (eight), mechanical damage to the catheters (four), sepsis (four), phlebitis (four), intraluminal blockage with a clot (two), and cellulitis (one). We conclude that silicone elastomer catheters are safe and reliable for extended venous access for cancer chemotherapy. They are easy to insert and remove and can be replaced with a guide wire without requiring surgical intervention.
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PMID:Evaluation of silicone elastomer catheters for long-term intravenous chemotherapy. 401 68

Twenty-seven chondrosarcomata of the pelvis were treated by local resection with preservation of the limb. Twenty-two were grade I or II, and 5 were grade III or IV. Attention is drawn to the importance of tomodensitometry in assessing the extent of the tumor before operation. An en bloc resection was well wide of the tumour in 16 cases, close to the tumour in 10 cases and involved the tumour in one case. Post-operative complications were varied. There were 6 nerve paralyses after iliac resection, 3 cases of sepsis after resection of the anterior part of the pelvic ring, and 3 cases of sepsis and 2 vascular complications after peri-acetabular resections. The average follow-up was 5 years. Three had metastases and three had local recurrences, one of whom died later from pulmonary metastases. No local recuRrence was seen in cases with wide resection. The functional results were satisfactory in 6 out of 7 partial resections of the ilium and in 4 out of 5 resections of the anterior part of the pelvic ring. They were only fair after peri-acetabular resections and complete resections of the ilium. After peri-acetabular resections, the results were about the same after ilio-femoral arthrodesis or Girdlestone operations. It is not appropriate to reconstruct the pelvic ring after resection limited to the anterior part of the pelvis but it is indicated after resections of the whole of the ilium, particularly in children to avoid shortening of the limb with pelvic shift.
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PMID:[Resection with preservation of the lower limb in chondrosarcoma of the pelvis]. 408 64

Forty-two patients with advanced testis carcinoma without previous chemotherapy were treated with VAB-4, and 41 were evaluable. The program consisted of three in-hospital inductions 16 weeks apart, and outpatient treatments every three weeks. Of the patients, 80% achieved complete remissions (CR). Chemotherapy alone induced CR in 61%, partial remissions (PR), in 24% and minor response (MR), in 15%. An additional 20% of patients (six PRs and 2 MRs) achieved CR following resection of residual tumor deposits. With a median follow-up of 27 months, the median duration of CR has not been reached. Of those achieving CR to chemotherapy alone, 12% had relapses. Bulk and extent of metastatic disease, histology of primary tumor, and tumor markers at the beginning of therapy influenced the frequency of CR. Of those with minimal disease, 90% achieved CR. The CR rate was 67% for those with advanced thoracic disease and 29% for those with advanced abdominal disease. Patients who had embryonal carcinoma and those who had no elevation of alpha-fetoprotein had a higher frequency of CRs. Myelosuppression with a leukocyte count drop less than 1000/mm3 occurred in three patients, and no patient had chronic renal failure or pulmonary fibrosis. One patient died from sepsis while in complete remission.
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PMID:VAB-4 combination chemotherapy in the treatment of metastatic testis tumors. 616 66

Sixty-five patients with metastatic melanoma were treated with vinblastine, bleomycin, and cis-diammine dichloroplatinum (VBD). Sixty-four patients were evaluable for response and toxicity. Twelve (19%) of 64 responded. Three patients (5%) achieved a complete response and nine patients (14%) achieved a partial response. Eleven (22%) of 50 previously untreated patients responded. Nine (30%) of 30 women responded while only three (9%) of 34 men responded. All three complete responses were in previously untreated women. Ten (19%) of 52 patients with visceral metastases responded and two (17%) of 12 patients with soft tissue metastases responded. The duration of complete responses was 23, 25, and 32 weeks. The median duration of the partial responses was 20 weeks (range, 12-28 weeks). Major toxicity was encountered. Leukocyte counts less than 1.0 X 10(9)/L were seen in 27% of the patients. There was one sepsis-related death. Platelet counts less than 50 X 10(9)/L were seen in 22% of patients. Mucositis was common. VBD can cause regression of advanced visceral metastatic disease but the low response rate, short duration of response, and major toxicity abrogates most of its utility as initial treatment for metastatic melanoma.
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PMID:Vinblastine, bleomycin, and cis-platinum for the treatment of metastatic malignant melanoma. National Cancer Institute of Canada Melanoma Group. 619 80

Liver metastases are a common cause of death in colon carcinoma. The dual blood supply of the liver permits regional perfusion while hepatic catabolism fo 5-fluorouracil (FU), floxuridine (FUdR) permit higher drug exposures than systemic (IV) administration. We have studied the effect of continuous intra-arterial chemotherapy (FU: 5-10 mg/kg/day and FUdR: 0.2 mg/kg/day) and whole liver irradiation (1000 rad every 4 weeks, total dose of 3000 rad) for metastatic colon carcinoma to liver. Eighteen patients with metastases to liver only are reported using this combination therapy. Seven patients had percutaneous placement of a catheter via the brachial artery, two had operative placement of a catheter via the gastroduodenal artery, all of which were connected to the Cormed infusor system, nine had operative placement of the Infusaid implantable pump with catheter placement into the hepatic artery via the gastroduodenal artery. The median survival for the entire group was 241 days. In those patients whose liver function tests (bilirubin and alkaline phosphatase) were less than two times normal, the median survival was 770 days. The median survival of the patients with greater than two times normal LFT's was 178 days. Two patients died of complications of the treatment. One who developed irreversible radiation hepatitis but at autopsy had only two areas of microscopic tumor foci in the liver and another who had received only 15 days of infusion and 1000 rad to liver. This patient developed irreversible chemical enteritis secondary to chemotherapy infusion into the superior mesenteric artery. Three patients have undergone abdominal reexploration and one at autopsy, who were found to have no gross evidence of tumor in the liver despite previous pathologic confirmation. It appears that some patients with minimal tumor burdens can have sterilization of their tumors. There were three cases of reversible liver function abnormalities. Complications associated with conventional intra-arterial chemotherapy (artery thrombosis, catheter sepsis and dislodgement, pump infusion variation and pump failure) were not seen with the Infusaid delivery system. The pump is refilled every 2-3 weeks via percutaneous puncture. All therapy was given on an outpatient basis. Pump acceptance and tolerance was 100%. Intra-arterial chemotherapy can now be accomplished without the morbidity associated with it in the past. The combination of chemotherapy and liver irradiation may offer improved survival in selected patients.
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PMID:Intra-arterial chemotherapy using an implantable infusion pump and liver irradiation for the treatment of hepatic metastases. 621 14

Five observations of hepatoblastoma in boys of 10 months to 4 years of age are presented. Tumor mass in the right part of the abdominal cavity was detected 1--9 months before death. Three patients died of pulmonary cardiac insufficiency, 2 of cateterization sepsis and hepatic insufficiency. The liver weight varied from 840 to 3500 g. Two children had intrahepatic metastases, one of them also had extrahepatic metastases into the portal lymph nodes and lungs. In 2 observations hepatoblastoma was of an epithelial structure, in 3 cases of a mixed type. It is suggested that hepatoblastoma, as well as liver carcinoma in adults, occurs more frequently in males.
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PMID:[Hepatoblastoma in children]. 625 73


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