Onkologija
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Samomori med osebami, zbolelimi za levkemijo v otroštvu, v Sloveniji
Get PDFPersons with childhood leukaemia often suffer from physical and psychosocial consequences of the disease and its treatment. Several studies have shown that depression and suicidal behaviour are expressed strongly in persons with a childhood cancer experience. In our study, we researched the occurrence of suicides among persons with childhood leukaemia compared to the general population in Slovenia in the period 1978–2010. The expected number of suicides was calculated based on the control group of individuals from the general population with the same gender, age at the beginning of observation, starting year and duration of observation as the research group, thus group of persons with childhood cancer. The study showed that none of the persons with childhood cancer committed suicide in the period 1978-2010, which is not statistically different from the expected number of suicides (0.448) in comparison with the general population in Slovenia. The findings of this study indicate that, despite the significantly increased expression of suicidal behaviour among survivors of childhood leukaemia in Slovenia compared to the general population, suicides do not occur more often among people with childhood leukaemia than among the general population.Pri osebah, ki so v otroštvu zbolele za rakom, so pogosto prisotne telesne in psihosocialne posledice bolezni ter njenega zdravljenja. Mnoge raziskave so pokazale, da je pri osebah z izkušnjo raka v otroštvu depresivnost in samomorilno vedenje močneje izraženo. V naši raziskavi smo proučili pojavljanje samomorov pri osebah, ki so v otroštvu zbolele za levkemijo, v primerjavi s splošno populacijo v Sloveniji, v obdobju 1978–2010. Pričakovano število samomorov smo izračunali na osnovi kontrolne skupine posameznikov iz splošne populacije, ki je bila s skupino preiskovancev, tj. oseb, ki so v otroštvu zbolele za levkemijo, izenačena po spolu, starosti ob začetku opazovanja, letu začetka opazovanja in dolžini opazovanja. Raziskava je pokazala, da med tistimi, ki so v otroštvu zboleli za levkemijo, v letih 1978–2010 nobena oseba ni storila samomora, kar se statistično značilno ne razlikuje od pričakovanega števila samomorov (0,448) v primerljivi splošni populaciji v Sloveniji. Ugotovitve raziskave nakazujejo, da kljub znano bolj izraženem samomorilnem vedenju med preživelimi raka v otroštvu v Sloveniji v primerjavi s splošno populacijo pojavljanje samomorov pri osebah, zbolelih za levkemijo v otroštvu, ni pogostejše kot v splošni populaciji
Sodelovanje splošnega družinskega zdravnika s specialisti: mednivojsko sodelovanje
Get PDFOn the basic level of health care in Slovenia, the role of a physician is a role of a doorman and coordinator: besides the low-threshold access to health care, regulation of the health system has also entrusted him with the role of a doorman - coordinator.
Some studies conducted in our regions have shown that a family physician solves nearly 80% of the patients' problems in his practice. An analysis of 12,296 consultations in the family physician's practice revealed that, in Slovenia, 20.2% of the examined patients are referred to see a specialist. The frequency of referrals is affected by patient characteristics, the physician and the environment in which the physician practices.
A specialist in general/family medicine often communicates with specialists at the secondary and tertiary levels of health care. Family medicine specialists learn to collaborate with specialists at the secondary and tertiary levels through a module comprising 16 pedagogical hours. Our health system provides for formal channels of communication, and the development of information technology offers unused solutions. Good practice examples for inter-level communication enable physicians to establish a direct contact with the clinical specialist and the patients to transit the health system in a faster and more effective manner. Good treatment outcomes depend on a well-coordinated multidisciplinary management.
Interpersonal communication between members of the multidisciplinary team treating individual patients is necessary and inevitable. Besides classic and formal communication, there are also numerous informal channels available, which have a positive effect on the relationship between members of the multidisciplinary team, and thus also between different levels of patient management. Some examples of good practice at this level have already been established, facilitating the work of the participating physicians and, most of all, affecting the treatment outcomes.Ni abstrakta
Paragangliom kot zasevek: primer bolnika s paragangliomom in rakom na modih
Get PDFIntroduction: Carotid paragangliomas are usually slowly enlarging and painless lateral neck masses. These mostly benign lesions are often recognised due to their typical location, vessel displacement and intratumoral blood flow, features that are usually observed in different imaging modalities. In differential diagnosis, lymphadenopathies, branchial cleft cysts, salivary gland tumours, schwannomas and aneurysms of the carotid artery should be considered.
Case presentation: A 36-year-old male was presented with a lump on the right side of the neck eleven months after being treated for testicular cancer. He was referred for fine-needle aspiration biopsy. The sample was diagnosed as a lymph node metastasis of a teratoma component of the germinal tumour or of another primary tumour. Performed neck US and fluorine [F-18]-fluoro-deoxy-Dglucose (FDG) PET-CT showed no signs of hypervascularity or vessel displacement. A functional neck dissection of levels II through V was planned. During the procedure, a suspicion of carotid paraganglioma was raised, and the tumour was carefully dissected from the walls of both carotid arteries with minimal blood loss. The histology report revealed carotid paraganglioma with no metastasis in the rest of the lymph nodes.
Conclusion: This is a case of carotid paraganglioma over-treatment by neck dissection performed in a patient previously diagnosed with testicular germ cell tumour.Ni abstrakta
VMAT - volumetrična modulirana ločna terapija
Get PDFVolumetric Modulated Arc Therapy (VMAT) Volumetric Modulated Arc Therapy (VMAT) is one of the most advanced radiation therapy techniques, which has been used by the Division of Radiation Oncology at the Institute of Oncology in Ljubljana since March 2011. The fundamental characteristic of VMAT is that the linear accelerator delivers the photon beam for the entire duration of the treatment head’s rotation around the patient’s body. While doing so, it simultaneously changes 3 parameters: the shape of the radiation field, the treatment head’s rotation speed and the dose speed of the delivered photon beam. On the contrary, the Intensity Modulated Radiotherapy (IMRT) utilises static radiation fields and delivers the dose at a constant speed. Compared to IMRT, the most important strengths of VMAT are shorter irradiation time, which makes it less likely that the patient (or target - the tumour) will move on the table of the irradiation device, and a lower dose burden to healthy tissues around the target so that the conformity of the dose distribution in the target region and the level of protection of the healthy organs and tissues surrounding it are comparable to those provided by IMRT or, in some cases (irradiation of the pelvic region), even more improved. The article presents VMAT: its features, course of treatment, indications for the selection and the hazards associated with such an accurate radiation therapy.Volumetrična modulirana ločna terapija (angl. Volumetric Modulated Arc Therapy, VMAT) je ena izmed najsodobnejših obsevalnih tehnik, ki jo od marca 2011 uporabljamo tudi v Sektorju radioterapije na Onkološkem inštitutu v Ljubljani. Temeljna značilnost VMAT je, da linearni pospeševalnik seva fotonski snop ves čas kroženja glave obsevalnika okoli bolnikovega telesa. Pri tem sočasno prihaja do spreminjanja 3 parametrov: oblike obsevalnega polja, hitrosti vrtenja roke oz. glave obsevalnika ter hitrosti doze izsevanega fotonskega snopa. Nasprotno pa pri intenzitetno moduliranem obsevanju (angl. Intensity Modulated RadioTherapy, IMRT) uporabljamo statična obsevalna polja in je hitrost doze ves čas nespremenjena. Najpomembnejši prednosti VMAT pred IMRT sta krajše obsevanje in s tem manjša verjetnost, da se bo bolnik (ali tarča, tj. tumor v njem) na mizi obsevalnika premaknil, ter manjša dozna obremenitev zdravih tkiv v okolici tarče, pri čemer sta konformnost porazdelitve doze v območju tarče in stopnja zaščite zdravih organov in tkiv v okolici najmanj primerljiva s tisto, ki jo dosežemo z IMRT, v nekaterih primerih (obsevanje območja medenice) pa celo izboljšani. V prispevku predstavljamo VMAT: njene značilnosti, potek, indikacije za izbiro in nevarnosti, s katerimi se srečamo pri tako natančnem obsevanju
Progresivna multifokalna levkoencefalopatija po rituksimabu pri bolniku z recidivnim limfomom plaščnih celic v popolni remisiji
Get PDFProgressive multifocal leukoencephalopathy (PML) is a rare and usually fatal demyelinating disease of the brain that is developed almost exclusively in patients with immunodeficiency and is a result of a latent infection with the JC polyomavirus. In recent years, several cases of PML have been reported following rituximab therapy. We present our first confirmed case of PML in a 55-year-old HIV-negative patient with a relapsed mantle cell lymphoma who was treated successfully with chemotherapy, rituximab and autologous transplantation of peripheral haematopoietic stem cells (PHSC). By reporting this case we wish to draw attention to the importance of PML in differential diagnosis of patients with a progressing neurological symptoms and immunodeficiency following lymphoma treatment with rituximab and stress the importance of early detection of this disease with evidence of JC virus infection in the cerebrospinal fluid or stereotactic brain biopsy sample.Progresivna multifokalna levkoencefalopatija (PML) je redko in običajno smrtno demielinizacijsko obolenje možganov, ki se razvije skoraj izključno pri bolnikih z imunsko pomanjkljivostjo in je posledica reaktivacije latentne okužbe s polioma virusom JC. V zadnjih letih so opisani tudi primeri PML po zdravljenju z rituksimabom. Predstavljamo naš prvi potrjeni primer PML pri 55-letnem HIV-negativnem bolniku z recidivnim limfomom plaščnih celic, pri katerem smo raka uspešno zdravili s kemoterapijo in rituksimabom ter z avtologno presaditvijo perifernih krvotvornih matičnih celic (PKMC). S primerom želimo opozoriti na pomembnost PML v diferencialni diagnozi pri bolnikih z napredujočo nevrološko simptomatiko in imunsko pomanjkljivostjo po zdravljenju limfoma z rituksimabom ter pomembnost zgodnjega prepoznavanja te bolezni z dokazom JC-virusne okužbe v likvorju ali v vzorcu stereotaktične biopsije možganov
Novosti v zdravljenju raka dojk in raka jajčnikov ASCO, Annual Meeting, Chicago, 1.-5. 6. 2012
Get PDFNo abstract.Ni abstrakta
Kortikosteroidi pri možganskih tumorjih
Get PDFCorticosteroids (CS) have been used for decades to reduce peritumoral edema in patients with brain tumours, both primary and metastatic. Despite their long use, the mechanisms of their actions are still not completely known in terms of biological and clinical effectiveness. Dexamethasone is the most frequently used CS in neuro-oncology due to its beneficial pharmacokinetic, pharmacodynamic and other properties. As CS have many undesirable effects that can impair the quality of the patient's life, we use the lowest effective doses for the shortest period possible. Several new target medicines for cancer treatment obstruct the paths in the process of angiogenesis, and they are also effective in decreasing the peritumoral edema in patients with brain tumours.Kortikosteroidi (KS) se že desetletja uspešno uporabljajo za zmanjševanje obtumorskega edema pri bolnikih z možganskimi tumorji, tako primarnimi kot metastatskimi. Kljub dolgi uporabi niso povsem znani mehanizmi njihovega delovanja v smislu na biološko in klinično učinkovitost. Deksametazon je najbolj uporabljen KS v nevroonkologiji zaradi njegovih ugodnih farmakokinetičnih, farmakodinamičnih in drugih lastnosti. Zaradi številnih možnih neželenih učinkov KS, ki lahko močno okrnijo kakovost bolnikovega življenja, uporabljamo čim nižje še učinkovite odmerke čim krajši možni čas. Številna nova tarčna zdravila za zdravljenje raka, ki zavirajo poti v procesu angiogeneze, izkazujejo učinkovitost tudi v zmanjšanju obtumorskega edema pri bolnikih z možganskimi tumorji