Impossibility of the treatment of inoperable liver multicystic echinococcosis due to adverse reactions to antihelminitics

Introduction. In some cases of multicystic forms of liver echinococcal disease, the advanced method for treatment of cystic echinococcosis faces great problems relating to the final outcome of the treatment. Case report. In May 2005, a computerized tomography of the abdomen obtained in a 27-year -old famale patient with abdominal pain revealed more than 20 echinococcal cysts measuring up to 6.7 cm in both lobes of the liver. Laboratory analyses found the value of eosinophils 6.8%, gamma globulins 29.9%, immunoglobulin E 29 600 IU/mL and the indirect hemagglutination for echinococcosis 1 : 8 196. The treatment started in December that year with the continuous administration of a daily dose of 800 mg (14.5 mg/kg body weight) of albendazole, but it was terminated two months later due to high serum transaminases values. By the end of 2006, the largest cyst detected in the left lobe of the liver had a diameter of 5.7 cm and the one in the right lobe of the liver measured 4.1 cm. There were lesions of germinative membrane found on both cysts. Six months later, praziquantel at daily dose of 2 500 mg (45.3 mg/kg body waight) was introduced into the therapy, but the treatment was terminated after eight days because of the development of exanthema. The computerized tomography of the abdomen obtained in February 2008 revealed the presence of a large number of echinococcal cysts in the liver. The largest among those cysts measured 3.5 cm while calcifications of the cyst walls were observed on some of them. None of the remaining therapeutic options for further treatmetnt of echinococcal disease could be applied. Conclusion. The presented case confirms medical therapy as the only option for the treatment of some forms of cystic echinococcosis. Benzimidazole carbamates (albendazole, mebendazole) and praziquantel are only efficacious antihelminitics currently available, and when they have to be withdrawn due to serious adverse offects, futher treatment of a patient with liver multicystic echinococcosis is impossible. Because of that there is a need to search for new and more efficient drugs for the treatment of ehinococcal disease

Procena stanja starih osoba u gerijatriji

Elderly people are characterized by certain peculiarities evolving as a consequence of the process of ageing and relate to the all components of health. Geriatric assessment includes an objective view of the health condition in elderly people, taking into consideration their peculiarities, and it provides a suitable approach to their treatment and their health care. The treatment and health care of elderly patients are based on the comprehensive geriatric estimation which should be done within a team. Due to a number of reasons the geriatric estimation is very significant for the old people, their family, medical staff, health prevention system, narrow and wide social community; the reasons include greater diagnostic accuracy, improvement of the functional status of elderly people, improvement of the health condition of patients, decrease in the morbidity and mortality rate in elderly people, decrease in the need for permanent accommodation of the elderly people, more frequent use of home care and social service, more rational medication prescription, decrease in neglect within health protection, improvement of life quality of old people, lower expenses used for taking care of elderly people, etc. The assessment of the old people condition requires the knowledge from several areas, each of which is multidimensional: functional status (everyday activities and instrumental everyday activities); mental health; physical health; social sources; economic sources; environment conditions; problems of people providing health care.Stare ljude prate određene specifičnosti koje se javljaju kao posledica procesa starenja i odnose se na sve komponente zdravlja. Gerijatrijska procena podrazumeva objektivno sagledavanje stanja zdravlja starih ljudi uz uvažavanje njihovih specifičnosti i omogućava odgovarajući pristup njihovom lečenju i njihovoj zdravstvenoj nezi. Lečenje i zdravstvena nega starih osoba se zasnivaju na sveobuhvatnoj gerijatrijskoj proceni koja treba da se obavlja timski. Gerijatrijska procena je značajna za staru osobu, njenu porodicu, za zdravstvene radnike, sistem zdravstvene zaštite, užu i širu društvenu zajednicu iz velikog broja razloga, i to: veća dijagnostička tačnost, poboljšanje funkcionalnog statusa starih osoba, poboljšanje zdravstvenog stanja bolesnika, pad stope mortaliteta i morbiditeta starih osoba, smanjenje potreba za trajnim smeštajem starih osoba, smanjenje potreba za smeštajem u bolnicu starih osoba, češće korišćenje kućnog lečenja i socijalnih servisa, racionalnije propisivanje lekova, smanjenje propusta u pružanju zdravstvene zaštite starim osobama, poboljšanje kvaliteta života starih osoba, smanjenje godišnjih troškova zbrinjavanja starih osoba i dr. Za procenu stanja starih osoba potrebna su saznanja iz nekoliko oblasti od kojih je svaka multidimenzionalna: funkcionalni status (aktivnosti svakodnevnog života i instrumentalne aktivnosti svakodnevnog života); mentalno zdravlje; fizičko zdravlje; socijalni izvori; ekonomski izvori; uslovi okoline; teškoće osoba koje pružaju negu