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Query: UMLS:C0599766 (functional recovery)
 13,441 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Adoptive transfer of autologous lymphokine-activated killer cells in conjunction with recombinant interleukin-2 in patients with advanced cancer has produced significant regression of metastatic disease in selected patients. We analyzed the effects of interleukin-2 regimens on renal function in 99 consecutive patients. Interleukin-2 therapy with or without lymphokine-activated killer cells was associated with varying degrees of hypotension, fluid retention, azotemia, oliguria, and low fractional sodium excretion. After the patients completed the interleukin-2 regimens, their renal function improved promptly. Renal function values returned to baseline levels within 7 days in 62% of patients, within 14 days in 84%, and within 30 days in 95%. Pretherapy serum creatinine values above 1.4 mg/dL predicted the severity of azotemia and prolonged duration of renal functional recovery, interleukin-2 therapeutic regimens induce prerenal azotemia. Careful selection of patients and early detection of adverse physiologic changes may alleviate the side effects of interleukin-2 therapy.
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PMID:Effects of interleukin-2 on renal function in patients receiving immunotherapy for advanced cancer. 349 13

A preliminary report is made on the use of videothoracoscopy to achieve pulmonary lobectomy in 16 patients, including 12 with centrally located pulmonary metastases and 4 with benign lesions (3 bronchiectases and 1 endobronchial hamartoma). Videothoracoscopy was performed on eight right-lower lobes, one middle lobe, two right-upper lobes, four left-lower lobes, and one left-upper lobe with a thoracoscope and conventional thoracic instruments. All patients received standard pulmonary lobe resection with lymph node clearance similar to that achieved with open thoracotomy. The mean operative time was 3 h (range, 2.5 to 4 h). Average blood loss was 100 mL and mean length of hospital stay was 6 days (range, 4 to 8 days). A combination of videothoracoscopy with use of conventional instruments resulted in similar performance but less chest wall interruption than in conventional pulmonary lobectomy. Videothoracoscopy showed safer and faster lung resection, which subsequently minimized the perioperative morbidity. Pain intensity was lessened, functional recovery was quicker, and hospital stays were shorter in the patients we reviewed.
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PMID:Thoracoscopic-assisted lobectomy. Preliminary experience and results. 787 63

In two women, 72 and 65 years old, medullary metastases were found of a mammary adenocarcinoma and a small cell bronchial carcinoma respectively. Radiotherapy and corticosteroids led to stabilisation and functional recovery, but the patients died shortly afterwards. Intramedullary spinal cord metastasis is an infrequent but devastating complication of cancer. The treatment options are limited and the prognosis is poor.
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PMID:[2 patients with paraplegia caused by spinal cord tumor metastases]. 812 26

Re-irradiation of previously treated areas may become necessary for recurrent cancer, new primary tumours (common in head and neck cancer patients), or nodal and metastatic disease. Factors that should be taken into account in the decision to re-treat include: 1) previously treated volume (how much overlap is there with new treatment fields) and dose fractionation schedule; 2) which critical tissues or organs are at risk; 3) how much time has elapsed since first treatment; 4) whether there are any practical alternatives to re-irradiation? Rapidly proliferating tissues generally recover well from the initial radiotherapy and will tolerate re-irradiation to almost full doses. Some slowly proliferating tissues are also capable of partial proliferative and functional recovery, although this takes several months and some residual damage remains. Preclinical data demonstrate that re-irradiation with reduced doses is possible in lung and spinal cord after intervals of 3-6 months. Other slowly proliferating organs, e.g. the kidneys, do not appear to be capable of recovery, even after low, subtolerance doses. The largest clinical experience of re-irradiation is for head and neck cancers. A review of this literature reveals that the most frequent normal tissue complication seen is trismus (lockjaw), which occurs in 16 to 30% of re-treated cases, with lower incidences of soft tissue or bone necrosis and fibrosis. Myelitis is rarely reported, even in the re-treatment situation. In general the highest incidence of local control for the lowest incidence of serious complications is achieved for combinations of external beam and brachytherapy, and for small, well-differentiated, new primary tumours rather than recurrent disease. Re-treatment with total doses < 55 Gy gives very poor local control rates. Re-treatment schedules with curative intent require a high re-treatment dose, which is accompanied by an increased risk of normal tissue damage. To minimize serious complications, re-irradiation schedules require the best possible treatment planning (conformal therapy where possible). Hyperfractionation or a combination of external beam and brachytherapy could also be beneficial.
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PMID:Re-treatment after full-course radiotherapy: is it a viable option? 1060 15

Retrorectal tailgut cysts (TGC) develop from postanal fetal gut remnants. They have specific radiological and histopathological features that distinguish them from dermoid cysts, enteric duplication cysts, and teratomas. We report a patient with a carcinoembryonic antigen-producing adenocarcinoma arising within a TGC who underwent resection through a combined anterior laparotomy/posterior pelvic approach. Despite complete resection and delayed but complete functional recovery, diffusely metastatic disease was encountered 6 months after resection. Diagnostic, therapeutic, histopathological, and oncological implications of this illustrative case are discussed. It seems possible to use carcinoembryonic antigen measurements for treatment planning and for assessing treatment response for this rare disease. The described outcome also suggests that TGC can develop malignant degeneration and should be resected at the time of diagnosis.
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PMID:A carcinoembryonic antigen-secreting adenocarcinoma arising within a retrorectal tailgut cyst: clinicopathological considerations. 1081 51

The colonic J-pouch (pouch group) functions better than the straight coloanal anastomosis (straight group) immediately after ultra-low anterior resection, but there are few studies with long-term follow-up. This randomized controlled study compared functional outcome, anal manometry, and rectal barostat assessment of these two groups over a 2-year period. Forty-two consecutive patients were recruited, of which 19 of the straight group [17 men with a mean age of 62.1 +/- 2.3 (SEM) year] and 16 of the pouch group (11 men with a mean age of 61.3 +/- 3.2 year) completed the study. Four died from metastases and two emigrated; there was no surgical morbidity or local recurrence. At 6 months the Pouch patients had significantly less frequent stools (32.9 +/- 2.8 vs. 49 +/- 1.4/week; p < 0.05) and less soiling at passing flatus (38% vs. 73.7%; p < 0.05). At 2 years both groups had improved with no longer any differences in stool frequency (7.3 +/- 0.4 vs. 8 +/- 0.2/week) and soiling at passing flatus (38% vs. 53%). Defecation problems remained minimal in both groups. Anal squeeze pressures were significantly impaired in both groups up to 2 years (p < 0.05). The rectal maximum tolerable volume and compliance were not different between groups. Rectal sensory testing on the barostat phasic program showed impairment at 6 months and recovery at 2 years, suggesting that postoperative recovery of residual afferent sympathetic nerves may play a role in functional recovery. In conclusion, stool frequency and incontinence were less in the Pouch patients at 6 months; but after adaptation at 2 years the straight group patients yielded similar results. Nonetheless, this functional advantage can be given to patients with minimal added effort or complications by using the colonic J-pouch.
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PMID:Colonic J-pouch function at six months versus straight coloanal anastomosis at two years: randomized controlled trial. 1157 27

We report cases of 2 pure seminoma patients who developed metastatic spinal cord compressions. One patient was diagnosed at age 33 years with stage 1 seminoma and, after undergoing an orchidectomy, chose to be followed on a surveillance protocol. He was lost to follow-up and presented again 22 months later with back pain, leg weakness and sensory loss when his disease recurred as a spinal cord compression. He was treated with urgent surgical decompression and subsequent standard chemotherapy. More than 2 years posttreatment, he is disease-free with normal neurologic function in his lower extremities. The second patient presented at age 44 years with back pain and rapid loss of leg strength and sensation. Investigations revealed a malignant cord compression with lymphatic and vertebral body metastases. On physical examination, the patient was found to have a 6-cm left testicular mass. He was treated with emergency radiotherapy to the region of his cord compression followed by a left inguinal orchidectomy. Pathology confirmed a pure classic seminoma. Postoperatively, he received standard chemotherapy and eventually regained neurologic function in his legs. Although it is rare for malignant spinal cord compression to occur in seminoma patients-either as the initial presentation of disease or as a site of disease recurrence in stage 1 patients on surveillance-it is crucial to consider seminoma as a possible etiology in young men diagnosed with malignant spinal cord compression because timely contemporary treatments for seminoma will cure most of these patients and offer them excellent functional recovery.
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PMID:Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance. 1854 65

We report the observation of a 55-year-old man in subtotal remission of a bronchial T2 N2 M1 adenocarcinoma. He consulted for left ocular redness, attributed to a foreign body. The patient presented a left iridal metastasis of bronchial carcinoma, a left frontal cerebral metastasis, and mediastinal evolutionary recovery. External radiotherapy of 30 Gy in ten fractions was immediately begun, followed by second-line chemotherapy. Local anatomical and functional recovery was fast. The patient then required two external radiotherapy courses on new extraocular lesions. The patient died 10 months after the ocular metastasis diagnosis. In the event of iridal metastasis, it is necessary to carry out a complete examination of both eyes, to question the patient, to search for a primary tumor and other metastases, and to rapidly implement radiotherapy of the entire ocular sphere (30 Gy in ten fractions).
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PMID:[Iris metastasis of bronchial carcinoma: a case report]. 1864 87

Management of metastatic disease is a significant challenge in modern spinal surgery. Previously, radiation therapy alone was the most commonly employed treatment. Recent data, however, suggest that surgical decompression in addition to radiation therapy improves functional recovery compared with radiation therapy alone. Metastatic disease most commonly affects the thoracic spine. Over the past decade surgical treatment has changed significantly for thoracic disease, shifting from transthoracic resection and reconstruction to single-stage posterolateral approaches that allow transpedicular resection and reconstruction. In posterolateral approaches, patients are spared the morbidity associated with transcavitary approaches while receiving the benefit of radical resection and circumferential reconstruction in a single-stage procedure. The authors report 3 cases in which a similar posterior transpedicular technique, adapted for the cervical spine, was used for intralesional resection of metastatic tumors of the axis.
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PMID:Posterior transpedicular corpectomy and reconstruction of the axial vertebra for metastatic tumor. 1927 23


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