Peritoneovenous shunts in the management of malignant ascites

Souter, R G; Tarin, David; Kettlewell, M. G. W.

doi:10.1002/bjs.1800700809

Cited by 46 publications

(10 citation statements)

References 9 publications

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“…In a Correcting BUN by fluid resuscitation before shunt placement may be helpful, although this course of action actually may worsen outcome, as in those series that have reported complications of volume overload following shunt placement. 9,18,23,29,30 The current patient group had a low incidence of heart failure (one case) and mirrored the experience of other studied patients. 11,15,19 This may reflect the institutional referral pattern of patients previously failing diuresis.…”

Section: Discussionsupporting

confidence: 72%

Peritoneovenous shunting for nongynecologic malignant ascites

Bieligk

Calvo

Coit

2001

Cancer

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Section: Discussionsupporting

confidence: 72%

Peritoneovenous shunting for nongynecologic malignant ascites

Bieligk

Calvo

Coit

2001

Cancer

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“…The introduction of peritoneovenous (pv) shunts for palliation of malignant ascites has provided an opportunity to study some of the factors affecting metastatic spread in humans. The studies of Tarin and colleagues (82,91,92) describe the outcome of draining ascitic fluid, with the resulting vascular dissemination of viable tumor cells into the jugular veins of patients with malignant ascites. The primary concern was to show that this treatment was beneficial to the patients and did not produce widespread metastases.…”

Section: The Seed and Soil Hypothesis Of Metastasismentioning

confidence: 99%

Origin and biology of cancer metastasis

Fidler

1989

Cytometry

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Metastasis, the spread of cells from a primary neoplasm to distant sites where they grow, contributes to the death of most cancer patients. The process of metastasis is not random. Rather, the process consists of a series of linked, sequential steps that must be completed by tumor cells if a metastasis is to develop. Thus, metastatic cells must succeed in invasion and embolization, survive in the circulation, arrest in a distant capillary bed, and extravasate into and multiply in organ parenchyma. Although some of the steps in this process contain stochastic elements, as a whole metastasis favors the survival and growth of a few subpopulations of cells that preexist within the parent neoplasm. Moreover, metastases can have a clonal origin, and different metastases can originate from the proliferation of single cells. The outcome of metastasis depends on the interaction of metastatic cells with different organ environments. Organ-specific metastases have been demonstrated in a variety of experimental tumor systems, and even within one organ, site-specific tumor growth can be found.The conclusion that metastasis is a highly selective process that is influenced by both the intrinsic properties of tumor cells and by host factors is optimistic. A selective process is regulated and therefore can be studied and then manipulated.Key terms: Metastasis, selective, stochastic, organ selectivityThe ability of malignant neoplasms to produce secondary growths (metastases) in organs distant from the primary tumors is the lethal event in the clinical course of most neoplastic diseases. While primary cancers can be surgically resected or locally irradiated, it is usually difficult to use these therapeutic modalities against disseminated disease. In the majority of patients, by the time of diagnosis of primary malignant neoplasms (excluding skin cancers), metastasis may well have occurred (13,15,71,94,96,99). Metastases can be located in different organs and in different anatomical locations within the same organ. These aspects can exert a significant influence on the response of tumor cells to therapy (13,151. Moreover, by the time of diagnosis, and certainly in clinically advanced lesions, malignant neoplasms and metastases contain multiple cell populations exhibiting a wide range of biological heterogeneity in such parameters as cell surface properties, antigenicity, immunogenicity, growth rate, karyotype, sensitivity to various cytotoxic drugs, and the ability to invade and metastasize (6,13,15,22,38,39,62,70). This biological heterogeneity presents a major obstacle to effective therapy.Continual empiricism in the treatment of cancer metastasis is unlikely to produce improvements. Understanding the mechanisms responsible for the origin, establishment, and growth of cancer metastases and for the development of biological heterogeneity in metastases should contribute to improvements in the design of more effective therapy and in the way physicians deal with cancer metastasis. This brief review concerns data that provide a few a...

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“…Peritoneovenous shunts now have an established place in the treatment of malignant as cite^.^^^^' Their tendency to block leads to a high failure rate and there is a need for design improvements to circumvent the problem. 6 Previous reports of comparative shunt function in malignant ascites have favored the Denver sy~tern. Our patients had a wide variety of cancers, and in the absence of clearly defined criteria, the choice of shunt design was arbitrary.…”

Section: Discussionmentioning

confidence: 99%