Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Routine follow-up of patients after carotid endarterectomy with duplex scanning is commonly practiced, yet the clinical significance of identifying those with asymptomatic restenosis is unclear. To address this issue we reviewed 120 consecutive patients who underwent 143 carotid endarterectomies from August 1983 to December 1988. One hundred one patients (118 operations) were available for clinical follow-up, and the overall incidence of recurrent symptoms was 6% (6/101). Sixty-three of these patients (78 carotid endarterectomies) had postoperative duplex examination. Two had evidence of residual disease from the time of surgery and were not included in further analysis. Significant recurrent stenosis (greater than 50% diameter reduction) developed in 14 of the remaining 76 arteries (18.2%). Twelve of 14 stenoses remained asymptomatic during follow-up from 18 to 72 months (mean 47.0 months) and did not undergo reoperation. Recurrent ipsilateral hemispheric symptoms developed in two patients with restenosis (14.3%). Four of the 62 arteries without significant recurrent stenosis developed ipsilateral symptoms (6.5%), but none required reoperation during follow-up from 1 to 71 months (mean 31.6 months). Life-table analysis showed no increased risk of transient ischemic attack, stroke, or death in patients with restenosis. This study supports regular clinical follow-up after carotid endarterectomy with emphasis on patient education in the recognition of symptoms. Although duplex scanning may be useful to follow known contralateral asymptomatic disease or evaluate those with recurrent symptoms, its routine use to identify patients with asymptomatic restenosis after carotid endarterectomy may be unnecessary.
 ...
PMID:Is routine duplex examination after carotid endarterectomy justified? 220 37

During the past 25 years, 77 giant pituitary adenomas have been treated surgically, including suprasellar extensions of type C in 66 cases and of type D in 11 cases. Non-secreting adenomas were present in 53 and secreting adenomas in 24 cases. All patients except 3 presented with significant visual field defects; including bitemporal hemianopia, superior quadranopia or unilateral temporal hemianopia, contralateral blindness in 73% of the cases, and one case with sudden bilateral blindness due to acute pituitary apoplexy. A single transsphenoidal procedure was carried out in 74% of the patients while 11 patients (7%) required re-operations for recurrent or residual tumor. Only 3 patients required a subsequent transcranial procedure. Complications included 1 CSF-leak, 1 empty-sella syndrome and 4 fatal post-operative hematomas. We prefer the transsphenoidal route even in very large or giant pituitary adenomas, since it allows rapid and adequate decompression of the optic nerves and chiasm, avoids major pituitary insufficiency in 60% of the cases and is associated with low morbidity-mortality rates.
 ...
PMID:Surgical management of giant pituitary adenomas. 231 Oct 19

Thirteen patients who presented with signs and symptoms of pituitary disease gave a history of classical pituitary apoplexy. Six presented with acute symptoms and in 7 the history antedated the admission by a mean of 887 days (range 365-2,190 days). All patients had an enlarged eroded sella. CT scans revealed a bleed in the tumor in 11 (histologically confirmed in all 8 patients operated), evidence of residual tumor in 1 and an empty sella (ES) in 1 patient. Hypopituitarism was present in 9, 4 were endocrinologically normal, 8 had visual problems requiring decompressive surgery and radiotherapy (RT) was given to 7 patients. They were subsequently followed for a median period of 730 days (range 365-3,385 days). During this time an empty sella developed in 5, 2 of whom had no surgery or RT; 4 remained endocrinologically normal, and a second hemorrhage occurred in 2 patients. Histological evidence of previous bleeds was noted in 6 of the 8 patients treated surgically. We conclude that apoplexy (1) may produce complete or partial tumor destruction with or without preservation of endocrine function; (2) recurrent, often silent, bleeding into a pituitary tumor appears to be a common event; (3) RT should be withheld unless recurrent tumor is documented (since at least 2 patients in this study have experienced spontaneous resolution of the tumor); and (4) the presence of an enlarged eroded fossa with an ES is reasonable presumptive evidence of an infarction of a pre-existing pituitary tumor.
 ...
PMID:Classical pituitary apoplexy presentation and a follow-up of 13 patients. 274 25

Since January 1984, 74 patients (61 men, 13 women; age range: 43-76 years) with carcinoma of the esophagus were evaluated. Fifty-two patients had squamous cell carcinoma and 22 patients had adenocarcinoma. Sixty-three patients had preoperative chemotherapy and radiation that consisted of cis-platinum and VP-16 for squamous cell carcinoma and cis-platinum 5-FU for adenocarcinoma combined with 4500-6000 rads. Thirty-four patients were staged inoperable at the completion of the 4-month treatment regimen. Eleven patients had surgery alone because they refused or were not candidates for the preoperative regimen. Twenty-nine patients completed the combined modality regimen and have had esophagogastrostomy. All patients receiving chemotherapy and radiation demonstrated improved swallowing and a dramatic reduction of tumor mass early in the course of therapy and have been able to maintain oral nutrition without other support in the posttreatment period. Of the 34 patients who had chemotherapy and radiation therapy as palliation, 18 are currently living. One patient died secondary to complications of chemotherapy, another patient died at 9 months of myocardial infarction. The remaining patients died secondary to their disease. Of the 29 patients who had radiation therapy and chemotherapy plus esophagogastrostomy, 25 are alive. There were no operative deaths. One patient died at 9 months of stroke. Three other patients had recurrence and died 1 year after surgery. Of the 11 patients who had surgery alone, two have died of the disease. Of the 29 patients who completed the integrated therapy, 10 had no evidence of residual tumor in the specimen, and in an additional five patients only microscopic foci were evident. These early results are an encouragement to continue the multidiscipline approach to carcinoma of the esophagus in the hope that the quality of life and disease-free interval, as well as ultimate survival, will be enhanced.
 ...
PMID:Early results with combined modality therapy for carcinoma of the esophagus. 357 3

A case of cardiac myxoma presenting as metastatic brain tumor are reported. The patient was a 44-year-old man. One year prior to this admission, he had suffered stroke, which was characterized by right hemiparesis and dysarthria. The computed tomographic (= CT) scan of the head at that time showed a low density on the left basal ganglia and the echocardiogram suggested a left atrial myxoma. At surgery, a polypoid myxoma attached to the atrial septum was totally removed. Right hemiparesis was improved and the patient was discharged. A few months later, the patient was evaluated for multiple cutaneous masses and diagnosed by biopsy as metastatic myxoma. The patient's condition remained unchanged until this admission. In March 1985, the patient had a tonic-clonic convulsion marching from right hand and developed right hemiplegia with drowsy. An echocardiogram failed to reveal recurrence of the cardiac myxoma. A CT scan revealed a 5-cm, relatively circumscribed, low density mass in the left fronto-parietal lobe, ring mottled enhancement after contrast administration and more enhancement in the delayed scanning of 45 min. Craniotomy showed a tender, friable tumor with a yellowish cyst fluid, but apparently not invading the brain parenchyma. After complete excision of the mass, there was rapid lessing in the hemiplegia and improvement in the level of consciousness. A contrast-enhancement CT scan performed 2 weeks after craniotomy revealed no evidence of residual tumor. Pathohistological examination showed spindle-shaped and stellate cells which formed clusters and contained large amounts of acid polysaccharides as demonstrated by the alcian blue method.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Cardiac myxoma metastatic to the brain]. 379 Mar 67

Complete resection with conservation of cranial nerves is the primary goal of contemporary surgery for glomus jugulare tumors. This publication reports the value of combined surgical approaches in achieving this goal in 12 patients with extensive tumors. Eleven of these tumors were classified as Fisch Class C and/or D, while eight were categorized as Jackson-Glasscock Grade III or IV. Intracranial (intradural) extension was present in 10 patients; four patients had tumor extension into the clivus and two into the cavernous sinus. The petrous internal carotid artery (ICA) was involved in eight and the vertebral artery (VA) in one. Subtemporal-infratemporal, retrosigmoid, and/or extreme lateral transcondylar approaches were added to the usual transtemporal-infratemporal approach. This improved the exposure, provided early control of the petrous ICA, and facilitated tumor removal from the clivus, cavernous sinus, posterior fossa, and foramen magnum, allowing a single-stage resection in eight patients. Ten patients had a complete microscopic resection with no mortality. The facial nerve was preserved in nine cases, with tumor involvement requiring nerve resection followed by grafting in the remaining three. Mobilization of the facial nerve was avoided in five cases; of these, three had intact function and two had House-Brackmann Grade III function on follow-up review. Only one patient had a mild persistent swallowing difficulty. The ICA was preserved in 10 patients and resected in two, while the VA required reconstruction in one case. There were no instances of stroke, and blood transfusions were required in five patients who had tumors with nonembolizable ICA or VA feeders. While complete resection provides the best possibility for cure, the important role of adjuvant radiation therapy in cases with residual tumor is discussed. The importance of degrees of brain-stem compression and vascular encasement is emphasized in classifying the more extensive tumors.
 ...
PMID:Combined approaches for resection of extensive glomus jugulare tumors. A review of 12 cases. 818 58

Between 1970 and 1989, 31 patients with a diagnosis of giant pituitary adenoma were referred to the London Regional Cancer Center. Giant pituitary adenoma was defined in terms of extension in excess of 40 mm from the midpoint of the jugum sphenoidale. The diagnosis was made surgically in 30 patients and clinically in one. Tumor extent and dimensions were obtained from operative reports and/or radiological scans computed tomography or magnetic resonance imaging. Mean follow-up was 8 years. Initial treatment consisted of surgery alone (4 patients), radiotherapy alone (2 patients) and combined surgery-radiotherapy (25 patients). One patient underwent a needle biopsy for histological confirmation and was grouped with the radiotherapy alone subset. Four of the six patients who received single modality treatment failed initial treatment (three surgery and one radiation). In contrast only 3 of the 25 patients treated with combined surgery-post-operative radiotherapy progressed despite the fact that all patients had gross residual disease post-operatively and that 43% of these patients received radiotherapy based on the post-operative rather than the pre-operative tumor extent. With subsequent salvage, overall tumor control amongst the 31 patients was 93.5%. Complications in general were minimal although one acromegalic patient sustained a unilateral internal capsular cerebrovascular accident year post treatment. In summary, combined modality treatment with initial surgical debulking followed by radiotherapy in the dose range of 4500-5000 cGy over 25 fractions yields tumor control rates in giant pituitary adenomas similar to those of smaller pituitary adenomas without undue morbidity.
 ...
PMID:Giant pituitary adenomas: role of radiotherapy. 845 86

Pseudomyxoma peritonei is a mucinous cancer of low biologic aggressiveness that disseminates widely throughout the abdominopelvic cavity prior to diagnosis. Complete control of the disease process on peritoneal surfaces should translate into long-term disease-free survival. In a series of 120 patients with pseudomyxoma peritonei, 46 were defined as treatment failures after cytoreductive surgery and regional chemotherapy. Clinical features that correlated significantly with treatment failure were tumor site (colon vs. appendix), histopathology grade (grade II vs. grade I), preoperative cancer volume, and completeness of cancer removal by cytoreductive surgery. For grade I histopathology, treatment failure was 10 times more common after incomplete versus complete cytoreduction. For grade II histopathology treatment failure was three times more common with incomplete cytoreduction. Death from other causes was more common over the age of 65, and stroke was the most common diagnosis. The major causes of morbidity and mortality were related to progressive disease in the abdomen causing intestinal obstruction and biliary obstruction. When treatment failures were categorized as surgical (failure to cytoreduce) versus medical (failure of chemotherapy to sustain a response), there were 27 surgical and 10 medical treatment failures. Improvements in the cytoreductive approach await the development of surgical technologies to increase the total clearance of cancer from the abdominal cavity and chemotherapy treatments that are complete enough to sustain control of small-volume residual disease on all peritoneal surfaces.
 ...
PMID:Clinical determinants of treatment failure in patients with pseudomyxoma peritonei. 883 80

Because of their critical location, invasive nature, and aggressive recurrence, skull base chordomas are challenging and, at times, frustrating tumors to treat. Both radical surgical removal and high-dose radiation therapy, particularly proton beam therapy, reportedly are effective in tumor control and improve survival rates. The authors posit that these tumors are best treated with radical surgery and proton-photon beam therapy. During the last 5 years, they treated 25 patients (15 females and 10 males) who harbored pathologically diagnosed skull base chordomas. The mean age of the patients was 38.4 years (range 8-61 years). Previous surgery or radiation therapy was performed at other institutions in seven and two patients, respectively. The authors performed 33 surgical procedures on 23 patients. Radical removal (defined as absence of residual tumor on operative inspection and postoperative imaging) was achieved in 10 patients; subtotal resection (defined as resection of > 90% of the tumor) was achieved in 11 patients; and partial resection (defined as resection of < 90% of the tumor) was achieved in two patients. Radical surgical removal included not only the excision of soft-tumor tissue, but also extensive drilling of the adjacent bone. Adjuvant therapy consisted of postoperative combined proton-photon beam therapy (given to 17 patients and planned for one patient) and conventional radiation therapy (two patients); three patients received no adjunct therapy. To date, four patients have died. One patient who had undergone previous surgery and sacrifice of the internal carotid artery died postoperatively from a massive stroke; one patient died from adenocarcinoma of the pancreas without evidence of recurrence; and two patients died at 25 and 39 months of recurrent tumor. Permanent neurological complications included third cranial nerve palsy (one patient) and hemianopsia (one patient); radiation necrosis occurred in three patients. Of the 21 patients followed for more than 3 months after surgery, 16 have had no evidence of recurrence and five (including the two mortalities noted above) have had recurrent tumors (four diagnosed clinically and one radiologically). The mean disease-free interval was 14.4 months. A longer follow-up period will, hopefully, support the early indication that radical surgical removal and postoperative proton-photon beam therapy is an efficacious treatment. The use of skull base approaches based on the tumor classification introduced in this paper is associated with low mortality and morbidity rates.
 ...
PMID:Skull base chordomas: a management challenge. 901 Apr 16

This study reviews 500 consecutive carotid endarterectomies performed in 429 patients in one practice over a 12-year period, emphasis being placed on the technique of vein patch closure and its durability. The records of all such patients were reviewed. Data collected included indication, age, sex, angiogram and duplex scan results, technique of carotid closure, complications within 30 days, and follow-up postoperative duplex scans. The technique emphasized generous exposure, distal arteriotomy, routine shunting, and narrow vein patch angioplasty. The mean patient age was 68 years; 245 (57.1%) were men, and 184 (42.9%) were women. Indications for surgery were transient ischemic attack 256 (51.2%); symptom-free stenosis 144 (28.8%); recovered stroke 60 (12%); and non-hemispheric symptoms 40 (8%). The arteriotomy was closed primarily in 71 (14.2%) instances and with a patch in 429 (85.8%). Complications included five (1%) deaths, one (0.2%) stroke, nine (1.8%) transient ischemic attacks, and four (0.8%) wound hematomas. One (0.2%) vein patch rupture occurred. Serial postoperative duplex scans were reviewed in 455 (91%) patients. No significant residual disease was found in any of these patients; three (0.7%) patients were identified with recurrent symptom-free stenoses of >80%; one (0.2%) silent carotid occlusion occurred; and no aneurysms were identified. Classic descriptions of carotid endarterectomy limited the carotid arteriotomy to the bulb area, while contemporary carotid surgery emphasizes wide internal carotid exposure and distal arteriotomy. The authors' experience with vein patch closure confirms the validity of this technique and its low short- and long-term morbidity.
 ...
PMID:Five hundred consecutive carotid endarterectomies: emphasis on vein patch closure. 921 98


1 2 3 Next >>