A comparison of three models of nursing.
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Aged↗
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Results for “CECAL NEOPLASMS”
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Metastatic adenocarcinoma from the colon to the mandible.
Published reports of metastatic adenocarcinoma from the colon or rectum to the mandible are extremely rare. Only eight cases had been reported from 1884 to the time this article was written. A case is presented where a metastatic lesion was found to be histologically similar to the known primary tumor in the cecum. The patient first noted dental pain, isolated to his mandibular left second bicuspid, 10 months after a primary tumor was diagnosed. Subsequently, the tooth was extracted, and it was only after the extraction site failed to heal that a biopsy was performed which confirmed a metastatic lesion. Retrospective study of the preextraction radiograph confirmed the presence of a suspicious area in the osseous structure of the mandible at the time of extraction. It must be emphasized that in patients with a positive history of malignancy, metastatic disease must be considered in the differential diagnosis of oral and dental symptoms, and that need for biopsy should be considered with all surgical procedures, including simple extractions.
Adenocarcinoma↗
Failure of epidural opioid to control cancer pain in a patient previously treated with massive doses of intravenous opioid.
A patient with disseminated cancer pain failed to obtain pain relief despite the intravenous infusion of hydromorphone at a rate equivalent to over 7 g of morphine/day. Temporary pain relief occurred with an epidural injection of the local anesthetic lidocaine. Subsequently, the patient failed to obtain pain relief with a dose of epidural hydromorphone equivalent to approximately 3 g of morphine epidurally/day. At this time a syndrome of agitation, sweating, tachycardia and severe muscle cramps developed in the lower half of the body. After eliminating the possibility of spinal cord compression by diagnostic CT scanning, the patient was treated by reducing the dose of hydromorphone and adding local anesthetic, which provided pain relief but did not eliminate the severe muscle spasms and other symptoms. The addition of oral clonidine followed by clonidine dermal patch rapidly and completely eliminated the other symptoms, suggesting that the response was due to too rapid withdrawal of opioid. Maintenance of pain relief required the simultaneous administration of epidural bupivacaine and hydromorphone. A low-dose infusion of epidural bupivacaine was continued for more than 3 weeks and during this entire period the patient showed no evidence of motor or sympathetic block.
Adenocarcinoma↗
Prognostic factors in malignant lymphoreticular tumors of the small bowel and ileocecal region: a review of 50 case histories.
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Adolescent↗
Adenocarcinoma of the cecum: natural history and clinical patterns of recurrence following radical surgery.
One hundred and forty-three patients with previously untreated primary adenocarcinomas of the cecum were analyzed. Fifty-three patients manifesting disseminated disease at diagnosis were analyzed to define mechanisms of disease spread. Ninety patients were analyzed following attempted curative resection to determine anatomical distribution of initial clinical recurrences. Twenty-eight patients recurred (31%), of whom 9 underwent a second laparotomy. Nineteen of the 28 patients who recurred (68%) demonstrated an initial pattern of relapse clinically confined to the abdomen, liver, and retroperitoneum. Analysis was performed to determine the influence of stage and grade of the primary tumor on prognosis. Implications for adjuvant therapy are discussed.
Adenocarcinoma↗
Postoperative radiation therapy for adenocarcinoma of the cecum using two fractions per day.
Twenty-one patients with adenocarcinoma of the cecum received post-operative local and regional radiation therapy, using two fractions per day. Six lesions were too extensive for any attempt at removal, and none of these was controlled by the irradiation. However, there have been no local recurrences among the 15 who had all or most of the local tumor excised. This local control rate is significantly better than that reported for definitive surgery alone.
Adenocarcinoma↗
Regional adjuvant irradiation for adenocarcinoma of the cecum.
Forty patients with adenocarcinoma of the cecum who underwent right hemicolectomy received regional irradiation for 40-45 Gy/4-5 weeks and weekly 5-Fluorouracil (5-FU). Thirty-four patients received this adjuvant therapy: 12, 10, 5, 4 with Stage B2, B3, C2, C3, respectively, and 3 with abdominal metastasis. Another six patients were similarly treated for palliation because of tumor bed recurrences. Patients were followed for a median of 4 years, 21/31 patients in the adjuvant group with Stage B and C were free of disease with a median survival of 48 months (63% 5-year actuarial disease-free survival). The total local failure rate among the adjuvant group for Stage B and C was 4/31 (13%) with local failure alone occurring in 1 of 4 patients (3%). In the patients treated at our Hospital, there was significant improvement in the 5-year actuarial survival (p = 0.001) for patients with lymph node metastases who received adjuvant irradiation compared to surgery-alone. Acute radiation enteritis occurred in seven out of 40 patients (17.5%) and was severe in 2 (5%). There were no delayed complications. We conclude that adjuvant therapy markedly lowered regional recurrence and seems to improve survival in patients with lymph node metastasis when compared to a group of patients treated by surgery alone in the same institution.
Adenocarcinoma↗
Intussusception in the adult--a rare disease.
We present two cases of intussusception in the adult. Both cases were secondary to a benign lipoma as the lead point. These cases represent typical cases of adult intussusception, a rare disease characterized by insidious onset, vague abdominal symptoms, and elusive diagnosis. A diagnostic and therapeutic approach to adult intussusception is suggested. The need to consider this rare entity in the differential diagnosis of chronic abdominal complaints in the adult is emphasized.
Adult↗
Palliative care rounds: T12 epidural metastasis mimicks pelvic recurrence of cecal adenocarcinoma.
Following resection of an adenocarcinoma of the cecum, a 59-yr-old patient developed pelvic pain. Imaging of the pelvis was unrevealing, but magnetic resonance imaging of the spine demonstrated a T12 epidural lesion. Pelvic pain may be due to an upper lumbar or lower thoracic radiculopathy. This referral pattern must be recognized when evaluating cancer patients with occult pelvic pain.
Adenocarcinoma↗
Computed tomography of the ileocecal region.
The CT scans in 25 patients without ileocecal pathology and 52 patients with ileocecal abnormalities were retrospectively reviewed. The ileocecal region was identified in 18/25 (72%) of patients without pathology. Thirty of 52 patients with ileocecal pathology had inflammatory disease: Crohn's (13), appendicitis (9), abscess (6), and typhlitis (2). CT was complementary to barium studies, demonstrating wall thickening, pericolonic inflammatory change, masses, fascial thickening, and fistulae. Twenty patients had malignancy: primary carcinoma (9), metastases (7), and lymphoma (4). In all patients with carcinoma a mass was identified. Pericolonic stranding represented tumor extension in 5/6 patients. Metastases were identified as extrinsic ileocecal masses in all 7 patients. Liver, mesenteric and omental metastases were present in 8/20 patients. In patients with lymphoma there was wall thickening and two had additional pericecal lymphadenopathy. In 2 patients with hypoalbuminemia, findings included: wall thickening, mesenteric, and subcutaneous edema.
Abscess↗
Tonsillar metastasis of primary signet-ring cell carcinoma of the cecum.
Metastatic carcinoma of the palatine tonsil is unusual. The most common primary sites of the tonsillar metastasis are the kidney, cutaneous melanoma, lung and breast. Primary manifestation of these tumors as a tonsillar mass is extremely rare in the literature. We present a case with a tonsillar metastasis from unusually localized primary signet ring-cell carcinoma of the cecum.
Adult↗
Primary small cell carcinoma of the cecum.
Cecal extrapulmonary small cell carcinoma (cESC) is extremely rare, with only single previous report of occurrence in a child. We report a 76-year-old man admitted for evaluation of a cecal mass seen in colonoscopy. Histology revealed small cell carcinoma with classic immunohistochemical profile similar to those seen in the colon. Further clinical survey documented absence of any other masses or abnormality. To the best of our knowledge, this is the first case of primary cESC occurring in an adult. Awareness of the pathologist and clinician of the cecum as a potential site of cESC may help to prevent misdiagnosis as poorly differentiated adenocarcinoma. This is crucial because extrapulmonary small cell carcinomas usually have worse prognosis.
Aged↗
Inferior vena cava obstruction due to cecum adenocarcinoma.
In this paper, we report the radiologic findings of cecal adenocarcinoma with caval invasion in a 60-year-old man. Caval invasion was confirmed by ultrasonographically guided fine-needle aspiration biopsy and by surgery. To our knowledge, this is the first case report demonstrating malignant caval thrombus due to colon cancer. In addition, we suggest that fine-needle aspiration biopsy may be helpful for prompt diagnosis and treatment in such a case.
Adenocarcinoma↗
Alcoholic hepatitis with leukemoid reaction after surgery.
Alcoholic hepatitis (AH) is a clinicopathologic syndrome resulting from an excessive intake of alcohol. Leukemoid reactions (LRs) are characterized by a strikingly elevated granulocyte count over 40,000-50,000 cells/mm(3). Although a leukocytosis of 15,000-18,000 cells/mm(3) is frequently seen in AH, LRs are rare in this context. AH-associated LRs are a sign of poor prognosis and have a high mortality. A 64-year-old male with a history of heavy alcohol intake underwent a right hemicolectomy for cecal carcinoma. Preoperative laboratory data were normal with the exception of an albumin of 2.1 g/dL. Liver biopsies that were taken because of a nodular appearance revealed micronodular cirrhosis, steatohepatitis, and Mallory bodies. Postoperatively, the patient developed a leukocytosis that progressively increased to 72.6 cells/mm(3). He also developed signs of impaired hepatic and renal function. Extensive workup failed to reveal a source of infection. A trial of intravenous antibiotics had no impact on the leukocytosis. Methylprednisolone at a dose of 40 mg IV daily was started on postoperative day 9. The patient experienced a progressive decline in white blood count (WBC), which reached 25.2/mm(3) on postoperative day 14. However, he died on postoperative day 16. We conclude that the patient had AH-associated LR in the postoperative period, but died despite successful treatment of the LR with steroids.
Carcinoma↗
Inverted appendiceal orifice masquerading as a cecal polyp on virtual colonoscopy.
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Appendix↗
Number versus distribution in classifying regional lymph node metastases from colon cancer.
BACKGROUND: Metastasis to regional lymph nodes from colon cancer is an important prognostic factor. In the TNM classification, node metastases are classified into three grades based on the number of metastatic nodes. In the Japanese General Rules for Clinical and Pathologic Studies on Cancer of the Colon, Rectum, and Anus (JGR), node metastases are classified into four grades based on the distribution of metastatic nodes. STUDY DESIGN: Based on the findings of node metastases in 164 patients with colon cancer obtained by the clearing method, node classifications by the JGR and TNM classifications were compared. RESULTS: The case distribution by the JGR grading was 41.5% in n (-), 29.3% in n1 (+), 18.3% in n2 (+), and 11.0% in n3 (+) disease. In the TNM classification, the distribution was 23.8% in pN1 and 34.8% in pN2 disease. The 5-year survival rate by the JGR was 98.4% in n (-), 74.3% in n1 (+), 51.2% in n2 (+), and 30.0% in n3 (+) disease; in TNM classification, this rate was 76.0% in pN1 and 45.0% in pN2 disease. CONCLUSIONS: In the classification of regional node metastases from colon cancer, the JGR classification showed a wider range in distribution and 5-year survival rate compared with the TNM system.
Cecal Neoplasms↗
Neonatal gastrointestinal stromal tumor. Report of a case and review of literature.
Gastrointestinal stromal tumor (GIST) is very rare in infancy. Most of the reported cases in the literature are in adults; some are in children but there are a few reported cases in the literature. The present case is a 6-day-old female neonate presenting with lethargy, poor feeding, constipation, abdominal distention, and rectal bleeding. She was operated on with the impression of intestinal obstruction, and right hemicolectomy was performed on her. Surgical specimen showed a well-defined and round 3-cm mass in the cecal area. Diagnosis was made by histologic and immunohistochemical studies which showed a GIST. The tumor showed positive vimentin and c-kit but negative for all other markers (desmin, actin, S100, NSE, and CD-34). So the case was an undifferentiated GIST. After 1 year of follow-up the patient was completely normal.
Biomarkers, Tumor↗
Mucosa-associated lymphoid tissue lymphoma in the appendix, a lead point for intussusception.
Abstract Appendiceal intussusception and mucosa-associated lymphoid tissue lymphoma are both uncommon entities, and this is the first report of the two occurring concomitantly in an 8-year-old boy. This report of a mucosa-associated lymphoid tissue lymphoma localized in the appendix has not been reported previously.
Antineoplastic Combined Chemotherapy Protocols↗