1/277. Revision hip arthroplasty in patients with a history of previous malignancy.BACKGROUND AND OBJECTIVES: The potential association between implants and malignancy has been discussed in the literature, but never as a cause of loosening of joint arthroplasty. methods: The records of all patients who underwent revision arthroplasty at our institution between 1992 and 1995 were reviewed. RESULTS: Among 93 patients who underwent revision hip arthroplasties, 11 (11.8%) had a history of previous malignancy. At surgery, in 2 of these patients, metastasis was found to be the cause of loosening in the affected hip. CONCLUSIONS: When revision hip arthroplasty is considered, patients with a history of malignancy require attenuated pre-, intra-, and postoperative workup. Management algorithm in such cases is proposed.- - - - - - - - - - ranking = 1keywords = malignancy (Clic here for more details about this article) |
2/277. antibodies against factor viii in patients with solid tumors: successful treatment of cancer may suppress inhibitor formation.Between 1995 and 1998, we treated 5 patients with anti-factor viii antibodies and spontaneous bleeding. All patients had underlying malignant conditions. Initial control of the bleeding episodes and reduction in inhibitor titer was achieved in all patients. Disappearance of factor viii inhibitor occurred in 3 patients after either resection of the tumor or chemotherapy. immunosuppression therapy failed to eradicate the antibody in 2 patients with metastatic disease. antibodies against factor viii appearing in certain patients may be directly associated with the underlying malignancy, rather than a coincidental finding. Attempts to reduce the titer or eradicate the inhibitor may fail if recognition of the underlying condition is not sought, or an appropriate treatment of cancer is not offered.- - - - - - - - - - ranking = 0.14285714285714keywords = malignancy (Clic here for more details about this article) |
3/277. A plea for incidental appendectomy in pediatric patients with malignancy.The evaluation of right lower quadrant (RLQ) abdominal pain in pediatric patients with malignancy can be difficult. However, since the mortality rate from peritoneal infections in these patients is very high, the differential diagnosis of RLQ peritoneal irritation, mainly of acute appendicitis (AA) versus neutropenic enterocolitis (NE), is crucial. Three cases of pediatric patients with malignancy demonstrating these difficulties are represented to enlighten this problem. The first patient died of multiorgan failure after operation for perforated appendicitis without generalized peritonitis. The second had a severe life-threatening postoperative complication because of delayed diagnosis of acute appendicitis. The third patient with malignant pelvic spread, underwent an unnecessary abdominal exploration for suspected AA. In all these cases and probably in many others, the clinical outcome could have been different if a previous incidental appendectomy had been performed during the primary abdominal operation. Incidental appendectomy in oncologic patients is recommended to facilitate the differential diagnosis of RLQ pain and to exclude the diagnosis of AA.- - - - - - - - - - ranking = 0.85714285714286keywords = malignancy (Clic here for more details about this article) |
4/277. Preliminary experience of the use of a gonadotrophin-releasing hormone antagonist in ovulation induction/in-vitro fertilization prior to cancer treatment.Therapeutic regimens for the treatment of malignant disease may compromise future fertility. One approach to circumvent this is the cryopreservation of embryos created before treatment for the malignancy. Conventional regimens using gonadotrophin-releasing hormone (GnRH) agonists are time consuming, requiring pituitary down-regulation before gonadotrophin administration, thus the duration of treatment is approximately 20-30 days. GnRH antagonists, however, do not cause an initial stimulation of gonadotrophin secretion and can thus be administered during the later stages of follicular maturation to prevent premature luteinization and ovulation. The duration of ovulation induction/in-vitro fertilization (IVF) treatment is thus reduced. In this study, case histories are reported of six women with newly diagnosed malignancies who requested ovulation induction/IVF prior to chemotherapy or surgery in which we have used the GnRH antagonist Cetrorelix. Gonadotrophin administration was started in the early follicular phase, and Cetrorelix (0.25 mg s.c. daily) was added from day 6 of treatment. Subsequent to human chorionic gonadotrophin (HCG) administration oocytes were recovered and successful fertilization and embryo cryopreservation was achieved in all cases. The median duration of treatment was 12 days (range 8-13, including induction of luteolysis in two patients). These results illustrate the potential use and advantages of a GnRH antagonist in ovulation induction/IVF when the need for immediate initiation of treatment and its duration are critical factors.- - - - - - - - - - ranking = 0.14285714285714keywords = malignancy (Clic here for more details about this article) |
5/277. High incidence of cancer in a family segregating a mutation of the ATM gene: possible role of ATM heterozygosity in cancer.ATM mutations predispose cells to malignancy by promoting chromosomal instability. We have identified a family with multiple cancers that segregates a mutant allele of ATM, IVS61 2insTA, which causes skipping of exon 61 in the mRNA, as well as a previously undescribed polymorphism, IVS61 104C(54):T(46). The mutation was inherited by two sisters, one who developed breast cancer at age 39 and the second at age 44, from their mother, who developed kidney cancer at age 67. Molecular studies were undertaken to determine the role of the ATM gene in the development of cancer in this family. Studies of irradiated lymphocytes from both sisters revealed elevated numbers of chromatid breaks, typical of A-T heterozygotes. Studies on lymphoblastoid cell lines established from these individuals revealed abnormal p53 induction and apoptosis after dna damage. Loss of heterozygosity (LOH) in the ATM region of chromosome 11q23.1 showed that the normal ATM allele was lost in the breast tumor of the older sister. LOH was not seen at the BRCA1 or BRCA2 loci. BRCA2 is not likely to be a cancer-predisposing gene in this family because each sister inherited different chromosomes 13 from each parent. The sisters share their maternal BRCA1 allele, although no mutation in this gene was detected in the family. Our findings suggest that haploinsufficiency at ATM may promote tumorigenesis, even though LOH at the locus supports a more classic two-hit tumor suppressor gene model.- - - - - - - - - - ranking = 0.14285714285714keywords = malignancy (Clic here for more details about this article) |
6/277. dermatomyositis associated with malignancy. 12 case reports.dermatomyositis (DM) is an idiopathic inflammatory disease of unknown etiology which manifests itself with symmetrical proximal muscle weakness and typical heliotrope skin rash. Internal malignancy is a specific trigger for some cases of DM. The aim of this study is to find predictive signs of cancer in dermatomyositis patients. Twelve (2 males and 10 females) (24%) out of 50 adult patients with DM (10 males and 40 females between 21 and 81 years old) had associated with malignancy (paraneopastic dermatomyositis, PDM). The male: female ratio in patients with idiopathic dermatomyositis (IDM) was 1:3.75 and for PDM it was 1:5. The frequency of dermatomyositis increases with age. PDM is most frequent between 40 and 69 years of life. Associated malignancies were respiratory tract carcinomas in males, genital and breast carcinomas in females. DM preceded the carcinoma in 5 cases (41.7%); 7 patients (58.3%) had already been treated for malignancy. In conclusion PDM in our country is more frequent in females and in the age after 40 years. association of dermatomyositis with malignancy is relatively high.- - - - - - - - - - ranking = 1.1428571428571keywords = malignancy (Clic here for more details about this article) |
7/277. hypokalemia associated with antibiotic treatment. Evidence in children with malignant neoplasms.A patient with acute lymphocytic leukemia developed hypokalemia during two separate courses of antibiotic therapy. In a review of 33 children from our institution with various malignant neoplasms, 24 of 48 antibiotic courses were associated with hypokalemia that could not be explained by gastrointestinal fluid losses. carbenicillin disodium, gentamicin sulfate, and methicillin sodium or nafcillin sodium combination therapy was associated with hypokalemia in 23 of 35 courses in which serum electrolytes were monitored. No correlation between hypokalemia and the stage of the basic disease or the use of antineoplastic agents was found with this antibiotic combination. Our data and a review of the literature suggest that carbenicillin produces hypokalemia through an impermeant anion effect on the renal tubule. Children receiving carbenicillin should be monitored with frequent serum potassium determinations.- - - - - - - - - - ranking = 4.4939105922154keywords = neoplasm (Clic here for more details about this article) |
8/277. The role of clostridium septicum in paraneoplastic sepsis.CONTEXT: clostridium septicum infections are rare but often associated with serious if not fatal outcomes. clostridium septicum infection does not appear to be associated with a single specific defect in cellular or humoral immunity. It has been associated with multiple medical problems, including but not limited to leukemia, malignancy of the bowel, other solid tumors, cyclic neutropenia with enterocolitis, diabetes mellitus, and severe arteriosclerosis. Most cases of C septicum are associated with malignancy, and mortality approaches 100% if care is not rendered within 12 to 24 hours. OBJECTIVES: To evaluate outcomes of patients with C septicum bacteremia, whether treated medically or surgically or both, and to note associated conditions. DESIGN: Retrospective evaluation of patients found to have C septicum bacteremia in the past 6 years. SETTING: Two teaching hospitals, Brooke Army Medical Center (250 beds) and Wilford Hall Medical Center (292 beds), were the source of our patients. patients: All patients found to have C septicum bacteremia during hospitalization or postmortem examination were included in the study. There were no exclusion criteria. MAIN OUTCOME MEASURE: mortality associated with C septicum infection. RESULTS: In our case series, mortality was 33%, which is slightly lower than reported in prior studies (43%-70%). CONCLUSION: Presumptive identification based on Gram stain, awareness of C septicum infection as a paraneoplastic syndrome, and prompt, clear communication between laboratory personnel and clinicians are necessary for early diagnosis of C septicum infection. Early institution of antibiotic therapy improves prognosis.- - - - - - - - - - ranking = 0.28571428571429keywords = malignancy (Clic here for more details about this article) |
9/277. nijmegen breakage syndrome. The International nijmegen breakage syndrome Study Group.BACKGROUND: nijmegen breakage syndrome (NBS) is a rare autosomal recessive disorder. NBS-1, the gene defective in NBS, is located on chromosome 8q21 and has recently been cloned. The gene product, nibrin, is a novel protein, which is member of the hMre11/hRad50 protein complex, suggesting that the gene is involved in DNA double strand break repair. AIMS: To study the clinical and laboratory features of NBS as well as the genotype-phenotype relation. methods: Fifty five patients with NBS, included in the NBS registry in Nijmegen were evaluated. The majority of the patients were of eastern European ancestry. Most of them had shown a truncating 5 bp deletion 657-661 delACAAA. Four further truncating mutations have been identified in patients with other distinct haplotypes. RESULTS AND CONCLUSIONS: Essential features found in NBS were microcephaly, usually without severe retardation, typical facial appearance, immunodeficiency, chromosomal instability, x ray hypersensitivity, and predisposition to malignancy. In 40% of the patients cancer was noted before the age of 21 years. Important additional features were skin abnormalities, particularly cafe au lait spots and vitiligo, and congenital malformations, particularly clinodactyly and syndactyly. Congenital malformations, immunodeficiency, radiation hypersensitivity, and cancer predisposition were comprehensible in case of dysfunctioning of dna repair mechanisms. No specific genotype-phenotype relation could be found. patients with the same genotype may show different phenotypes and patients with different genotypes may express the same phenotype. Specific mutations did not lead to specific clinical features.- - - - - - - - - - ranking = 0.14285714285714keywords = malignancy (Clic here for more details about this article) |
10/277. Trousseau's syndrome and acute arterial thrombosis.This report describes three patients treated for acute arterial thrombosis due to malignancy-related hypercoagulability (Trousseau's syndrome). The average age was 59yr. There were two women and one man. The cancers were breast, lung, and pancreas. atherosclerosis or nonneoplastic hypercoagulable states did not appear to be a factor in any patient. One patient who presented with irreversible arm ischemia and Stage IV breast cancer underwent primary amputation. The other two patients underwent immediate surgical thrombectomy and thrombolytic therapy, and malignancy was discovered during postoperative workup for hypercoagulable states. Both ultimately required amputation. All three patients died due to cancer less than one year after presentation. When a hypercoagulable state is suspected as the cause of acute arterial thrombosis, an evaluation for occult malignancy is indicated. Although aggressive revascularization attempts may be appropriate, the prognosis for limb salvage and long-term survival is poor.- - - - - - - - - - ranking = 0.42857142857143keywords = malignancy (Clic here for more details about this article) |
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