11/620. Electroconvulsive treatment of a bipolar adolescent postcraniotomy for brain stem astrocytoma.This is the first reported use of electroconvulsive treatment (ECT) in an adolescent with bipolar mania who had been treated with craniectomy for an intracranial neoplasm. The reported case is of a 16-year-old girl with a history of brain stem glioma (pontomesencephalic astrocytoma) diagnosed at 13 years of age. She presented in a psychiatric emergency room with suicidal ideation, depressed mood, irritability, olfactory hallucinations, early insomnia, grandiosity, and guilt. Her symptoms failed to respond to a trial of an antidepressant, mood stabilizer alone, and mood stabilizer in conjunction with a neuroleptic. The decision to use ECT was based on suicidal ideation, extreme disinhibition, and danger to self and others. Significant improvement in mood and remission in psychosis were noted after the eighth treatment. Comparison of 2-week pre-ECT and 3-month post-ECT cognitive testing revealed no change in IQ. This report highlights rapid response and the ability to tolerate ECT in an adolescent diagnosed with bipolar disorder, who had also been treated with radiation and craniotomy.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
12/620. Glutaraldehyde-fixed heterologous pericardium for vena cava grafting following hepatectomy.BACKGROUND/AIMS: Glutaraldehyde-fixed heterologous pericardium has been widely used for grafts in cardiac surgery. We applied it for inferior vena cava (IVC) patch grafting following combined resection of the liver and the IVC. METHODOLOGY: IVC grafting using a glutaraldehyde-fixed horse pericardium following combined resection of the liver and the IVC was performed in 2 patients--one with hepatocellular carcinoma and the other with hepatic metastasis following rectal cancer. The retrohepatic vena cava defect was closed with a 10 x 5 cm patch in one patient and a 7 x 4 cm patch in the other. RESULTS: Hepatic vascular exclusion was avoided in both patients. The IVC exclusion period was 40 min for the first patient and 25 min for the second. One patient required a veno-venous bypass with an active centrifugal pump of 153 min. There was no complication and no graft infection. The microscopic extension to the IVC was evident in one patient, and fibrous adhesive was evident in the IVC wall of the other. One patient died of hepatic failure 3 years and 6 months after surgery, and the other died of hepatic recurrence 7 months after surgery. Both grafts were patent, without calcification and stricture, until the patients' death. CONCLUSIONS: Glutaraldehyde-fixed heterologous pericardium is an option for IVC grafting.- - - - - - - - - - ranking = 5.1807195366451keywords = cancer (Clic here for more details about this article) |
13/620. Ten-year survival after pancreatoduodenectomy for advanced gastric cancer--report of two cases.We performed pancreatoduodenectomy for 5 patients with gastric cancer, and here we present 2 who have survived for more than 10 years. Patient one had a large antral tumor tightly adherent to the head of the pancreas. Pancreatoduodenectomy with lymph node dissection was performed. Pathologic examination of the resected specimen revealed that the tumor was a well differentiated adenocarcinoma invading the duodenum, but not the pancreas. Patient two had an infrapyloric lymph node metastasis invading not only the pancreatic head, but also the duodenocolic ligament and the transverse mesocolon. Pancreatoduodenectomy and right hemicolectomy with lymph node dissection were performed. Pathological examination of the resected specimen revealed grade III lymph node metastasis, and invasion of the pancreas by the metastatic infrapyloric lymph node. These results indicate that complete resection of tumor by pancreatoduodenectomy may result in a long survival not only for the patients in whom pancreatic invasion and/or lymph node metastasis is limited, but also for some patients with tumor invading the pancreatic parenchyma and/or of grade III lymph node metastasis.- - - - - - - - - - ranking = 25.903597683226keywords = cancer (Clic here for more details about this article) |
14/620. Early occurrence of an adenocarcinoma after allogeneic bone marrow transplantation in a patient with AML.Several reports have showed an increased risk of secondary malignancies after bone marrow transplantation (BMT), especially after total body irradiation (TBI). We report on a 39-year-old female who underwent BMT with a matched unrelated donor because of acute myeloid leukemia in second complete remission. Previously, the patient received chemotherapy for induction, consolidation, maintenance and reinduction after diagnosis of relapse. Conditioning regimen consisted of cyclophosphamide and TBI. MTX and CSA was administered for GvHD prophylaxis. Engraftment was confirmed on day 28. Within 6 months following BMT, no complication occurred. Continuous complete remission was demonstrated by repeated bone marrow smears. On day 300 the patient complained of chest pain and dyspnea. X-ray and CT-scan showed thickening of the pleura and pleural effusion. A pleuracarcinosis was diagnosed by cytologic examination of a pleural aspirate. By an open thoracotomy a disseminated inoperable disease became apparent. diagnosis of an adenocarcinoma was confirmed by histologic examination. The patient died 2 months later due to disseminated tumour in complete remission of AML. Solid tumours are rare as secondary malignancies after BMT. Usually the neoplasmas are late events occurring more than 10 years after BMT. In this case predisposing factors such as genetic disposition, long-term smoking, intensive pretransplant chemotherapy, TBI and immunosuppression may have lead to the early secondary malignancy.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
15/620. anxiety symptoms and panic attacks preceding pancreatic cancer diagnosis.Cancer of the pancreas is a highly malignant disease with a very poor prognosis. depression and anxiety occur more frequently in cancer of the pancreas than they do in other forms of intra-abdominal malignancies and other cancers in general. Yet, the etiology of psychiatric symptoms in patients with cancer of the pancreas may not be traced solely to poor prognosis, pain, or existential issues related to death and dying. In as many as half of patients that go on to be diagnosed with the disease, symptoms of depression and anxiety precede knowledge of the diagnosis. This observation has raised speculation that mood and anxiety syndromes are related to disruption in one of the physiologic functions of the pancreas. In this paper, we present a patient who had no prior psychiatric history and developed panic attacks just prior to diagnosis of her cancer. To our knowledge, this is the first report in the literature where panic attacks, not simply anxiety, presented prior to a pancreatic cancer diagnosis. Her symptoms resolved following resection of the tumor. Implications of such phenomena for the diagnosis and treatment of anxiety and depression in pancreas cancer are discussed.- - - - - - - - - - ranking = 51.807195366451keywords = cancer (Clic here for more details about this article) |
16/620. aortic valve replacement after retrosternal gastric tube reconstruction for esophageal cancer.A 59-year-old man with a history of the thoraco-abdominal esophagus resection with retrosternal gastric tube reconstruction for esophageal cancer complicated by anastomosis leakage and purulent pericarditis was admitted for aortic regurgitation due to infective endocarditis. Floppy vegetation and worsening cardiac failure indicated aortic valve replacement. In a median sternotomy approach, the thickest adhesion between the cervical esophagus and posterior surface of the manubrium sternae was freed using an ultrasonic osteotome. Severe adhesions in the pericardium due to purulent pericarditis were found. Median sternotomy enabled minimal exposure of the aortic root, upper right atrium, and right superior pulmonary vein for instituting extracorporeal circulation and replacing the aortic valve. The patient's postoperative course was uneventful. For cardiac surgery in patients with a retrosternal gastric tube, left anterior or right thoracotomy may be considered to avoid gastric tube injury. Median sternotomy, however, is an alternative enabling safe heart exposure, and the ultrasonic osteotome was very useful in incising the sternum without injuring the cervical esophagus, which had no serosa.- - - - - - - - - - ranking = 25.903597683226keywords = cancer (Clic here for more details about this article) |
17/620. Occipitocervicothoracic fixation for spinal instability in patients with neoplastic processes.OBJECT: Occipitocervicothoracic (OCT) fixation and fusion is an infrequently performed procedure to treat patients with severe spinal instability. Only three cases have been reported in the literature. The authors have retrospectively reviewed their experience with performing OCT fixation in patients with neoplastic processes, paying particular attention to method, pain relief, and neurological status. methods: From July 1994 through July 1998, 13 of 552 patients who underwent a total of 722 spinal operations at the M. D. Anderson Cancer Center have required OCT fixation for spinal instability caused by neoplastic processes (12 of 13 patients) or rheumatoid arthritis (one of 13 patients). Fixation was achieved by attaching two intraoperatively contoured titanium rods to the occiput via burr holes and Luque wires or cables; to the cervical spinous processes with wisconsin wires; and to the thoracic spine with a combination of transverse process and pedicle hooks. Crosslinks were used to attain additional stability. In all patients but one arthrodesis was performed using allograft. At a follow-up duration of 1 to 45 months (mean 14 months), six of the 12 patients with neoplasms remained alive, whereas the other six patients had died of malignant primary disease. There were no deaths related to the surgical procedure. Postoperatively, one patient experienced respiratory insufficiency, and two patients required revision of rotational or free myocutaneous flaps. All patients who presented with spine-based pain experienced a reduction in pain, as measured by a visual analog scale for pain. All patients who were neurologically intact preoperatively remained so; seven of seven patients with neurological impairment improved; and six of seven patients improved one Frankel grade. There were no occurrences of instrumentation failure or hardware-related complications. In one patient a revision of the instrumentation was required 13.5 months following the initial surgery for progression of malignant fibrous histiosarcoma. CONCLUSIONS: In selected patients, OCT fixation is an effective means of attaining stabilization that can provide pain relief and neurological preservation or improvement.- - - - - - - - - - ranking = 1keywords = neoplasm (Clic here for more details about this article) |
18/620. Primary squamous cell carcinoma in a patient with vaginal agenesis.BACKGROUND: The development of a carcinoma in a neovagina constructed in patients with congenital vaginal agenesis is rare. CASE: To our knowledge, this is the first report of a squamous cell carcinoma developing in a neovagina that had been constructed by a simple cleavage technique without tissue transplantation. The latency period between reconstruction and tumor diagnosis was 20 years, during which the patient regularly used a prosthesis. The most important observation during this time was the repeated formation of granulation tissue and chronic inflammatory pseudopolyps in the neovagina, which were removed by cauterization. Despite pre- and intraoperative irradiation and radical surgery followed by chemotherapy, the prognosis is poor. CONCLUSION: patients with neovaginas, whatever the construction technique, need to be followed up regularly, as mechanical irritation from a prosthesis can add to other cancer risk factors, such as viral infection. Furthermore, the absence of transplanted tissue does not seem to protect from the risk.- - - - - - - - - - ranking = 5.1807195366451keywords = cancer (Clic here for more details about this article) |
19/620. A case of carcinoma associated with the remained intrapancreatic biliary tract 17 years after the primary excision of a choledochal cyst.Although the incidence of biliary carcinoma associated with choledochal cyst is high, there are extremely rare reports about cancer development in the remaining intrapancreatic biliary tract in patients who underwent primary excision of the choledochal cyst. The authors present a case of carcinoma associated with the remnant intrapancreatic biliary tract in a 39 year-old woman, 17 years after the initial excision of a choledochal cyst with Roux-en-Y hepaticojejunostomy. Long-term follow-up may be recommended even in patients who have undergone excisional surgery for choledochal cyst, because it is possible that cancer associated with the intrapancreatic biliary tract may develop.- - - - - - - - - - ranking = 10.36143907329keywords = cancer (Clic here for more details about this article) |
20/620. Kaposi's sarcoma in renal transplant recipients: pathogenetic relation between the reduced density of langerhans cells and cyclosporin-A therapy.patients treated with immunosuppressive drugs can develop cancers. The authors present two cases of Kaposi's sarcoma in kidney transplant patients who had been treated with azathioprine, steroids and cyclosporin-A; during this treatment the langerhans cells decreased and Kaposi's sarcoma appeared. Discontinuation or reduction of the dosage of cyclosporin-A led to complete regression of the illness, and the langerhans cells reappeared. We suggest that cyclosporin-A damages the immunological function of the epidermal langerhans cells, and that this is the primary factor in the development of Kaposi's sarcoma.- - - - - - - - - - ranking = 5.1807195366451keywords = cancer (Clic here for more details about this article) |
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