Onkologija
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Karcinom nosnega žrela: pregled uspešnosti zdravljenja na Onkološkem inštitutu
Get PDFNasopharyngeal carcinoma is a very rare type of malignant tumor which appears sporadically in the district of Slovenia and most parts of the Western world. Factors important for its development are infection with Epstein-Barr virus, genetic susceptibility and some environmental factors. The main modality of treatment is radiotherapy. Chemotherapy has an important role in the treatment of advanced stages of the disease, including distant metastases. In the article, etiology, pathology, symptoms, diagnostics and treatment of nasopharyngeal carcinoma as well as retrospective analysis of treatment results and value of prognostic factors in the patients with nasopharyngeal carcinoma treated at the Institute of Oncology Ljubljana between 1990-2003 are described.Karcinom nosnega žrela je v Sloveniji in večjem delu zahodnega sveta zelo redka vrsta malignega tumorja. Med pomembne dejavnike za njegov nastanek štejemo okužbo z virusom Epstein-Barr, genetsko nagnjenost in nekatere dejavnike okolja. Temeljno zdravljenje je obsevanje. Kemoterapija ima pomembno vlogo pri zdravljenju napredovalih stadijev bolezni, tudi oddaljenih zasevkov. V prispevku so opisani etiologija, patologija, simptomatika, diagnostika in zdravljenje karcinoma nosnega žrela. Predstavljeni so rezultati retrospektivne analize uspešnosti zdravljenja in pomena napovednih dejavnikov pri bolnikih s to vrsto raka v Sloveniji v obdobju od 1990 do 2003. Rezultati zdravljenja z obsevanjem z dodano kemoterapijo ali brez nje pri slovenskih bolnikih v preiskovanem obdobju so primerljivi z rezultati retrospektivnih raziskav s konvencionalnim obsevanjem v drugih delih sveta
Novosti v zdravljenju tumorjev prebavil in melanoma: 46. kongres ASCO 2010
Get PDFNo abstract.Ni abstrakta
Primer pozne smrti po zdravljenju meduloblastoma
Get PDFA 27-year-old male was treated for medulloblastoma with complete removal of tumor, postoperative RT to CNA with 36 Gy and boost to the posterior fossa 16 Gy. Nine years later, a suprasellar recurrence was treated with Carboplatin and Vepezid and 33 Gy to the tumor bed. Three years later he complained about headaches, periodic loss of conciousness and progressively showed bizarre behavior. He was referred to psychiatrist. No recurrence was found. He did not appear on the day of follow-up appointment. He died at home, at the age of 43 years, 16 years after the first treatment. The cause of death determined by forensic autopsy : anemic subacute infarction in the left cerebellum.Ni abstrakta
Anemija pri bolnikih z rakom
Get PDFAnemia is defined as a significant reduction of the red cell mass and a corresponding decrease of the oxigen-carrying capacity of the blood. The etiology of anemia can be due to decreased red blood cell (RBC) production, increased RBC destruction and blood loss. Anemia is prevalent in 30-90 % of cancer patients with a number of factors that may contribute to its developement, most often overexpression of inflammatory cytokines accompanying malignant disease and mielosuppressive cancer treatment. Anemia in cancer patients should be identified by standard diagnostic procedures. Decision about treatment of cancer related anemia depends on the patient's symptoms, degree of anemia and the rate at which it has evolved, patient's comorbidities and the goal of cancer treatment in a certain patient. Management of anemia in cancer patients includes the transfusion of packed red blood cells and / or the administration of recombinant erythropoetin.Anemija ali slabokrvnost je bolezensko stanje, pri katerem je zmanjšana celotna masa eritrocitov v krvnem obtoku, zaradi česar se zmanjša tudi sposobnost krvi za prenos kisika. Glavni vzroki anemije so zmanjšana tvorba eritrocitov, povečana razgradnja eritrocitov in krvavitev. Anemija, ki se pojavlja pri 30 do 90 % bolnikov z rakom je navadno posledica kombinacije več vzrokov, najpogosteje vpliva citokinov, ki se sproščajo ob maligni bolezni in mielosupresivnega učinka specifičnega onkološkega zdravljenja. Anemijo tudi pri bolnikih z rakom opredelimo po standardnih diagnostičnih postopkih, zdravljenje pa je odvisno od bolnikovih simptomov, stopnje anemije, hitrosti njenega nastanka, spremljajočih bolezni in ciljev zdravljenja bolnika z rakom. Najpogosteje uporabljamo transfuzijo koncentriranih eritrocitov in rekombinantne eritropoetine (EPA)
Intraabdominalni tlak in utesnitveni sindrom trebuha
Get PDFIntraabdominal compartment syndrome increases significantly the morbidity and mortality of ICU patients. In the present article, this complication is explained through definitions, pathophysiology, etiology and treatment doctrine. The increased intraabdominal pressure and intraabdominal compartment syndrome can be related to the pathological changes in the abdominal cavity as well as to the extraabdominal causes. The excessive fluid resuscitation, in particular with crystalloids in acute critical illness is an important risk factor as well. One of the most serious pathophysiological consequences of the increased intraabdominal pressure is the decrease of perfusion pressure and thereby also of blood perfusion of the abdominal organs. The measures to reduce the intraabdominal pressure include: measures to improve the abdominal wall compliance, measures to reduce the content of the abdominal cavity, reduction of the intravascular fluid therapy and the treatment of the primary disease. In worst cases, the surgical abdominal decompression should be performed without delay.Utesnitveni sindrom trebuha (abdominalni kompartment sindrom) zelo poveča obolevnost in umrljivost bolnikov v intenzivnih enotah. V prispevku je predstavljen z vidika definicij, patofiziologije, vzrokov in načinov zdravljenja. Vzroki za zvišan intraabdominalni tlak in utesnitveni sindrom trebuha so bolezenska dogajanja v trebuhu in zunaj njega, pomemben dejavnik pa je tudi zdravljenje teh bolezni s čezmernimi količinami tekočin, zlasti kristaloidov. Ena ključnih patofizioloških posledic zvišanega intraabdominalnega tlaka je znižanje perfuzijskega tlaka in s tem prekrvitve organov v trebuhu. Intraabdominalni tlak znižamo z ukrepi za večjo popustljivost trebušne stene, z zmanjšanjem vsebine v trebušni votlini, z manjšo obremenitvijo s tekočinami ter z zdravljenjem osnovnega obolenja. Skrajni ukrep, ki pa mora biti pravočasen, je kirurško odprtje trebuha
Pomen tumorskih označevalcev pri bolnikih s solidnimi tumorji in limfomi
Get PDFTumor markers may be produced by tumor cells or by the body as a response to the tumor. A diagnosis of cancer cannot be based only on the presence of higher level of tumor markers in the blood or body fluids because tumor markers can be elevated in the patients who don't have cancer or can be normal in the patients with cancer, and because no tumor marker is entirely specific to a particular type of cancer. One of the most important uses of tumor marker testing is to evaluate the efficacy of cancer treatment in the patients on treatment, especially in cases of advanced cancer. Tumor marker testing is also used in the follow-up of patients after the completed treatment of some cancers in order to detect early relapse.Tumorski označevalci so snovi, ki jih izloča tumor ali pa nastanejo kot odgovor na tumor v telesu. Samo na podlagi določitve koncentracije tumorskega označevalca ne moremo postaviti diagnoze raka, ker je koncentracija lahko povečana tudi pri bolnikih, ki nimajo raka, in normalna pri bolnikih z rakom, poleg tega pa označevalci večinoma niso specifični za določeno vrsto raka. Koristni so predvsem pri vrednotenju uspešnosti zdravljenja, v manjši meri pa tudi pri spremljanju bolnikov po končanem zdravljenju nekaterih vrst raka, da bi zgodaj odkrili ponovitev bolezni
Telesna aktivnost pri bolnikih z rakom
Get PDFCachexia-induced metabolic changes stimulate an enhanced loss of functional tissue in human body, particularly muscles. Inadequate physical activity and undernourishment further increase the loss of tissue. In cancer patients as well as in chronic patients, physical activity inhibits straightforwardly the negative effect of the disease on the body organs. Regular aerobic exercise enhances functional capacity of blood circulation, heart, muscles and metabolic processes, which help to sustain better physical condition. The strength training exercises help to maintain the muscles in good condition, thereby inhibiting their weakening. Physical exercises should be regularly performed, at least 3 to 5 times per week. A patient with derailed metabolism or severely impaired immune system is not advised to perform exercises.Presnovne spremembe pri kaheksiji povzročajo pospešeno izgubo funkcionalnih tkiv v telesu, predvsem so prizadete mišice. Nezadostna telesna aktivnost in podhranjenost telesno propadanje še pospešujeta. Učinki vadbe pri bolnikih z rakom tako kot pri drugih kroničnih bolnikih neposredno zmanjšujejo negativen vpliv bolezni na telo. Z redno telesno vadbo v aerobnem območju se povečujejo funkcionalne sposobnosti obtočil, srca, mišic in presnovnih procesov, ki vodijo do večje vzdržljivosti telesa. Z vajami za moč pa se vzdržuje zmogljivost mišic in zavira njihovo propadanje.Telesna vadba naj bo redna, 3- do 5-krat na teden. Če je bolnik močno presnovno iztirjen in ima hudo prizadet imunski sistem, telesne vadbe ne priporočamo
