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At least 631 records · Page 35Linked to original sources
PubMed2000

Multiple primary neoplasms at a single institution: differences between synchronous and metachronous neoplasms.

During the 10-year period (1987-1996) of our study, 26,255 patients with cancer were admitted to our clinic and, of these, 271 (1%) patients had multiple primary malignant tumors. Ninety-two (34%) patients had synchronous tumors (synchronous group), and 179 (66%) patients had metachronous tumors (metachronous group). The mean age at first diagnosis was higher in the former group. The ratio of men to women was 1.36 in the synchronous group and 0.74 in the metachronous group (p = 0.018). Smokers and drinkers were more common in the synchronous group. Breast cancer and lung cancer were most prevalent, and associations between head/neck and lung cancer and between breast and breast cancer were the most frequent associations in both the synchronous and the metachronous group. The frequency of aerodigestive tumors was higher and that of mesenchymal tumors was lower in the synchronous group than in the metachronous group. Localization in the medial region and in the head/neck was more frequent in the synchronous group than in the case of metachronous secondary tumors.

Age Factors↗
PubMed2006

Experience of endoscopic ultrasound in an Australian tertiary hospital.

BACKGROUND: There is minimal prospective data on endoscopic ultrasound (EUS) experience in Australia. This study aimed to review the recent EUS experience of a single Australian tertiary hospital. METHODS: Data of all EUS carried out at St Vincent's Hospital, Melbourne, Australia were prospectively collected from August 2002 to September 2005. Patient demographics, indications, anatomical sites of EUS and fine-needle aspiration (FNA) were extracted from the database. A subset of 231 patients were involved in a prospective study to assess the clinical effect of EUS: with accuracy and outcomes data derived from surgical histology and pre-EUS and post-EUS questionnaires. RESULTS: Five hundred and sixty-one procedures were carried out for 526 patients. Men comprised 57% (n = 300). Mean age was 60 years (range, 19-92 years). The indications were (i) oesophageal 30.7% (n = 172); (ii) pancreaticobiliary 29.6% (n = 166); (iii) mediastinal and lung 20.7% (n = 116); (iv) gastric 15.9% (n = 89); and (v) duodenal 3.2% (n = 18). Endoscopic ultrasound-guided FNA was carried out in 30.3% procedures (170/561). Overall EUS accuracy was 84% (55/67 patients) and EUS-guided FNA accuracy was 88% (28/32 patients). There were no major complications. CONCLUSIONS: This is the largest reported Australian experience of EUS to date. Overall EUS was accurate, safe with no major complications or mortality and had useful outcomes. The role, expertise and accessibility of EUS in the Australian clinical setting are anticipated to continue to increase.

Adult↗
PubMedDate not supplied

Factors affecting post-operative mortality in malignant biliary tract obstruction.

BACKGROUND/AIMS: Although malignant obstruction, itself, is a significant risk factor associated with post-operative mortality, factors affecting mortality in the surgery of malignant obstruction have not been thoroughly studied in the literature. METHODOLOGY: In order to identify independent risk factors which might be associated with an increase in post-operative mortality in patients with malignant biliary obstruction, 24 clinical and laboratory parameters in 52 patients undergoing biliary tract surgery were analyzed retrospectively. RESULTS: Simple regression revealed 24 factors with prognostic significance, but multivariate analysis detected only 3 factors with independent significance in predicting mortality (cholangitis, weight loss of 10 kg or more and operative or post-operative blood transfusion). The presence of 2 of these risk factors identified a group of patients with an 37% mortality rate. CONCLUSIONS: The results of this study show that the presence of pre-operative cholangitis, marked weight loss, and operative and post-operative blood transfusion are associated with high post-operative mortality. The major challenge is the prevention of cholangitis in high-risk patients, improvement of the nutritional status of the patients, and avoidance of unnecessary blood transfusions.

Adult↗
PubMed2001

[The scintigraphy of somatostatin receptors in the carcinoid tumor].

UNLABELLED: This study aimed to evaluate the diagnostic utility of 111In-DTPA-D-Phe1-octreotide scintigraphy in the different situations that can be present when an examination is requested during the clinical course of the carcinoid tumor (CT). MATERIALS AND METHODS: We have performed 41 scintigraphies with 111In-octreotide (145-185 MBq) in 35 patients (19 females and 16 males) with clinically suspected or confirmed CT. The patients were classified into five groups: Group A: Indolent symptoms of CT (n=9); B: CT staging located in lung (n=4), stomach (n=2), cecum (n=1), thymus (n=1) and pancreas (n=1); C: Carcinoid syndrome (n=1); D: CT staging after surgery located in pancreas (n=1), ovary (n=1), cecum (n=1), stomach (n=1), appendix (n=1) and ileum (n=1); and E: Post-treatment follow-up (n=13), with CT located in bronchial tree (n=5), small intestine (n=3), appendix (n=2), thymus (n=1), ovary (n=1) and unknown primary tumor (n=1). Three patients of this group had one scintigraphic study before the treatment. Head and neck, thorax and abdomen images were obtained at 4 and 24 h in all of the patients and SPECT images of the abdomen (n=14), thorax (n=10), and brain (n=1) were obtained at 24 h in 25 patients. RESULTS: Group A: In the 3 patients with a positive scintigraphy, the definitive diagnosis was meningioma, Hurtle cell's carcinoma and lung adenocarcinoma. The clinical follow-up in the six other patients, at least during one year, did not show any evidence of CT. Group B: Six of the 9 CT were detected with the scintigraphy. In 2 cases of bronchial CT, the scan showed sarcoidotic regional lymph node involvement and CT hepatic and bone metastases, respectively. Group C: The scintigraphy detected hepatic metastases from an unknown primary tumor. Group D: The scintigraphy was positive in 3 cases (hepatic or/and abdominal metastases) and was normal in the other 3. The scintigraphy was negative in one patient with peritoneal metastases. Group E: The scintigraphy was normal in 7 patients in concordance with the clinical follow-up. In 3 patients with a scintigraphy performed prior to treatment, the scintigraphy detected recurrence (thymic CT), progression of the metastatic disease (ovarian CT) and partial regression of the hepatic metastases (carcinoid syndrome). In the three other patients, the scintigraphy showed metastases located in liver in one patient and hepatic and extra-hepatic metastases in the two other patients. The sensitivity and specificity of 111In-Octreotide in the detection of the primary tumor and metastases were 72% and 84% respectively. CONCLUSIONS: The 111In-Octreotide scintigraphy has a low diagnostic utility in patients with indolent symptoms of CT. However, it is the first line of diagnosis for the staging of the CT and to evaluate the follow up after therapy.

Adult↗
PubMedDate not supplied

Clinical application of low dose-rate brachytherapy combined with simultaneous mild temperature hyperthermia.

BACKGROUND: Recent biological research has shown that mild temperature hyperthermia (MTH) around 41 degrees C simultaneously combined with low dose-rate irradiation (LDRI) is an effective treatment modality for cancer. The aim of the study was to assess the clinical usefulness of a combination of MTH and simultaneous low dose-rate brachytherapy. MATERIALS AND METHODS: Seven superficial and 8 deep-seated tumors were included in this protocol. Two tumors had no previous treatment and the remainder were recurrent tumors which had arisen from previously treated sites. The average major diameters of superficial and deep tumors were 8.6 and 7.0 cm, respectively. The average values for Tmin in superficial and deep tumors were 41.5 and 40.7 degrees C, respectively. Brachytherapy was delivered by 137Cs and/or 192Ir LDRI sources. RESULTS: For superficial tumors, six of the seven tumors responded to the treatment (4 achieved CR, 2 PR, 1 NC) and four tumors did not recur within the follow-up period of 5-15 months. All of the deep tumors responded and 5 achieved CR, 3 PR. Four tumors recurred 4-17 months after the treatment and the remainder showed no local recurrence within the follow-up period of 4-31 months. CONCLUSION: MTH simultaneously combined with LDRI was an effective method for treating progressive and bulky tumors with a previous treatment history.

Adult↗
PubMedDate not supplied

Laparoscopic surgery for cancer: are we ready?

Following feasibility studies more and more large prospective reports even randomised trials document the treatment of digestive cancer using a laparoscopic approach. While the spectre of port-site recurrences, once so alarming has faded, it has become a challenge for laparoscopic surgeons to provide long-term follow-up. There is good class II and III evidence that staging laparoscopy (SL) has a value for oesophageal, gastric, pancreatic and hepatobiliary cancer as well as for intra-abdominal lymphomas since it adds to primary staging and often alters the clinical stage of the disease and hence the management of the individual patient. For minimally invasive oesophagectomy and gastric cancer surgery several series have demonstrated shorter perioperative morbidity and hospital stay however at present most studies report smaller numbers of selected patients and long term follow up is rare. The laparoscopic resection of pancreatic malignancies is not reported to be feasible, safe or potentially beneficial for the patient while the curative resection of suspected early gallbladder cancer is a poor indication. Nevertheless laparoscopy is documented to be safe and applicable for small malignant liver lesions and the Lacy trial was significantly in favour of laparoscopy-assisted colectomy, predominantly for stage III disease. Bearing in mind that in many fields of digestive cancer surgery, laparoscopy should still be conducted as part of a trial, it is safe to say that "we are ready" for this revolution to arise.

Abdominal Neoplasms↗
PubMed2005

[CA19-9].

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Biomarkers, Tumor↗