Presence Of Disseminated Disease Research Articles

Deaths in tuberculosis patients in British Columbia, 1980–1984

Records of all 1884 newly notified tuberculosis cases, over the 5-year period 1980–1984 in British Columbia, Canada, were reviewed and 201 deaths were identified, including 48 diagnosed only after death, and 153 who died while on treatment; 56 of unrelated causes, 67 in whom tuberculosis was a contributing cause, and 30 in whom it was the principal cause. Significant predictors of death while on treatment (specific to tuberculosis) were the extent of disease, history of previous disease and sputum smear-positive for acid-fast organisms. Significant predictors of failure of diagnosis, in patients who died, were the presence of disseminated disease and the absence of a history of previous disease. The presenting features were not different in those dying, in whom the diagnosis was made before, as compared with after, death. The most frequent mode of death due to tuberculosis was respiratory failure, followed by multiple organ system failure and haemoptysis. The case fatality rate was low (1.6%) and did not change over 10 years. One-half of patients whose death was due to tuberculosis were diagnosed only after death and this had not changed over 10 years. We conclude that death due to tuberculosis is uncommon in patients while on treatment and that the main reason for death due to tuberculosis is that some patients are not diagnosed, and therefore not treated, before they die of the disease.

METASTATIC MELANOMA OF THE ORBIT. A CASE REPORT

We report a metastatic cutaneous melanoma of the medial rectus muscle of the right orbit which presented with diplopia, exophthalmos and retrobulbar pain. Radioimmunoscintigraphy using melanoma-specific monoclonal antibody was used to confirm the diagnosis and to show the presence of disseminated disease in other areas. Effective palliation was achieved with external beam irradiation.

Hindquarter amputation for tumours of the musculoskeletal system

We reviewed 34 hindquarter amputations performed for malignant tumours around the hip from 1971 to 1988, classifying them as palliative or curative according to the resection margins or the presence of disseminated disease at the time of surgery. There were three peri-operative deaths, 12 palliative and 19 curative procedures. Ten patients died of disseminated disease within a year of surgery, eight of whom had had a palliative operation. Three patients died between one and five years after palliative surgery. One died of unrelated disease at nine years. Seventeen patients are disease free an average of 31 months from surgery, 16 after curative procedures. The median survival after palliative amputations was six months and the 5-year survival rate for curative cases was 83%.

Metastatic melanoma of the gallbladder: A case report and review of the literature

A single case of symptomatic metastatic melanoma to the gallbladder, with roentgenographic findings of gallbladder disease, is presented. Review of the 12 previously reported cases of symptomatic metastatic biliary melanoma and of those reports of "primary" melanoma of the gallbladder reveals marked similarity between the two groups, with regard to relative size, pathologic description, number, and location of lesions. This, together with the finding of "junctional activity" in our case, leads us to believe that most if not all melanomas present in the gallbladder are metastatic deposits from a known, undetected, or regressed primary locus elsewhere. Surgical removal, even in the presence of disseminated disease, is a worthwhile palliative procedure.

Carcinoma of the prostate with soft tissue or non-regional lymphatic metastases at the time of diagnosis: a review of 47 cases.

The clinical course of 47 patients with carcinoma of the prostate who at the time of initial presentation had metastases to soft tissue or non-regional lymph nodes was retrospectively reviewed. The response rate to primary hormonal treatment (orchiectomy or oestrogens) and the duration of response were similar to those of 47 other patients presenting with skeletal metastases only. The survival of the patients in the study group was not statistically different from that of patients with skeletal metastases only. The results suggest that patients presenting initially with metastases to non-regional lymph nodes or soft tissue should be treated by the same therapeutic methods as for disseminated prostatic cancer in general (oestrogens or orchiectomy). Slight or no urinary symptoms at the time of initial presentation in spite of a locally advanced tumour was a common finding; 20% of the patients had normal serum prostatic acid phosphatase despite the presence of disseminated disease. Lymph node enlargement in the left supraclavicular fossa was the most common site of non-regional lymphatic spread. Elderly males with metastatic carcinoma in this region should be investigated for the possibility of prostatic cancer.

Sequential nonsurgical and surgical staging of non-Hodgkin's lymphoma.

The yield of specific diagnostic procedures in the staging of non-Hodgkin's lymphoma was assessed in 170 consecutive patients who were evaluated with a sequence of diagnostic procedures. Stage III or Stage IV disease was established in 141 of 170 patients (80%) by nonsurgical procedures, including lymphangiography (positive in 78%), bone-marrow biopsy (positive in 39%), percutaneous liver biopsy (positive in 21%), and peritoneoscopy-directed liver biopsy (positive in 29% of those tested). Staging laparotomy showed disease outside conventional nodal irradiation fields in 21 of 26 patients with a positive lymphangiogram, but in only three of 17 patients with a negative lymphangiogram. The yield of staging procedures was highest in patients with nodular lymphomas, only 6% of whom were Stage I or Stage II after staging, but was lowest in patients with histiocytic lymphoma, 30% of whom had localized disease. This study shows that the presence of disseminated disease can be detected in the majority of patients with non-Hodgkin's lymphoma without the use of staging laparotomy.

Analysis of a bioassay for circulating tumor cells in two murine malignancies: Correlations with tumor age and extent of metastatic disease

Analysis was performed in two murine tumor systems of a bioassay for determining the relative concentrations of circulating tumor cells in tumor-bearing animals. Blood obtained from donor mice bearing a methylcholanthrene-induced fibrosarcoma or S-91 melanoma was intravenously injected into paired syngeneic recipient animals. For both tumors, the relative concentrations of circulating tumor cells in the donors were measured by the frequency of embolic pulmonary tumor growths in the recipient mice. The concentrations of circulating malignant cells correlated significantly better with the extent of metastatic disease in the donors than with the size of the primary tumors. It was concluded that the concentration of circulating malignant cells is not dependent upon the extent of primary tumors. It was further concluded that, for the tumors studied, the presence of disseminated disease is correlated with a relatively high concentration of circulating tumor cells.