Metastatic castration resistant prostate cancer – chemotherapy, novel hormonal agents and supportive care

Metastatski, na kastracijo odporen rak prostate predstavlja pri bolnikih z rakom prostate zadnjo stopnjo razvoja bolezni. Na prognozo teh bolnikov najbolj vpliva mesto zasevkovnajugodnejšo prognozo imajo bolniki z zasevki le v bezgavkah, najslabšo pa bolniki z zasevki v visceralnih organih. Dva citostatika – docetaksel in kabazitaksel – ter dve novejši hormonski zdravili – enzalutamid in abirateron acetat – podaljšujeta preživetje teh bolnikov. Pomembno je, da jim nudimo tudi dobro podporno zdravljenje, saj se z napredovanjem bolezni breme simptomov stopnjuje, kar poslabšuje kakovost življenja bolnikov

Kronična mieloična levkemija

Chronic myelogenous leukemia (CML) is a rare myeloproliferative disease with an incidence of approximately 1-2/100,000 population per year. It is a clonal disease of a pluripotent stem cell committed to granulopoiesis. Most patients are diagnosed in the chronic phase when the blood count typically shows leukocytosis with predominance of mature neutrophil granulocytes and there are evident signs of increased metabolism, such as fatigue, weight loss and perspiration, and splenomegaly. Through the accelerated phase, the chronic phase progresses to a blast crisis resembling acute leukemia. The diagnosis is based on the discovery of the Philadelphia chromosome arising as a consequence of chromosomal translocation t(9;22), BCRABL gene or its product, BCR-ABL tyrosine kinase, in the peripheral blood or bone marrow cells. Significant progress in the treatment of CML was accomplished by the discovery of the BCR-ABL tyrosine kinase inhibitors, which provide long-term disease control, namely with imatinib as the first choice of treatment in the chronic phase of CML. The other two possible treatments are the allogeneic transplantation of haematopoietic stem cells and palliative treatment with chemotherapeutics.Kronična mieloična levkemija (KML) je redka mieloproliferativna bolezen z incidenco okrog 1–2/100.000 prebivalcev na leto. Je klonska bolezen pluripotentne matične celice, usmerjene v granulopoezo. Večino bolnikov odkrijemo v kroničnem obdobju, za katero je značilna levkocitoza v krvni sliki, s prevladovanjem zrelih nevtrofilnih granulocitov, znaki pospešene presnove, kot so utrujenost, hujšanje in potenje, ter splenomegalija. Kronično obdobje prek pospešenega obdobja preide v blastno krizo s sliko akutne levkemije. Za postavitev diagnoze je nujna najdba kromosoma Philadelphia, ki nastane kot posledica kromosomske translokacije t(9;22), gena BCR-ABL ali njegovega produkta tirozinske kinaze BCR- -ABL v celicah periferne krvi ali kostnega mozga. Velik napredek pri zdravljenju KML je bilo odkritje zaviralcev tirozinske kinaze BCR-ABL, s katerimi dosežemo dolgotrajen nadzor bolezni, in sicer z imatinibom kot prvo izbiro zdravljenja kroničnega obdobja KML. Drugi možni izbiri zdravljenja sta alogenična presaditev krvotvornih matičnih celic in paliativno zdravljenje s kemoterapevtiki

Chronic myelogenous leukemia

Kronična mieloična levkemija (KML) je redka mieloproliferativna bolezen z incidenco okrog 1–2/100.000 prebivalcev na leto. Je klonska bolezen pluripotentne matične celice, usmerjene v granulopoezo. Večino bolnikov odkrijemo v kroničnem obdobju, za katero je značilna levkocitoza v krvni sliki, s prevladovanjem zrelih nevtrofilnih granulocitov, znaki pospešene presnove, kot so utrujenost, hujšanje in potenje, ter splenomegalija. Kronično obdobje prek pospešenega obdobja preide v blastno krizo s sliko akutne levkemije. Za postavitev diagnoze je nujna najdba kromosoma Philadelphia, ki nastane kot posledica kromosomske translokacije t(922), gena BCR-ABL ali njegovega produkta tirozinske kinaze BCR- -ABL v celicah periferne krvi ali kostnega mozga. Velik napredek pri zdravljenju KML je bilo odkritje zaviralcev tirozinske kinaze BCR-ABL, s katerimi dosežemo dolgotrajen nadzor bolezni, in sicer z imatinibom kot prvo izbiro zdravljenja kroničnega obdobja KML. Drugi možni izbiri zdravljenja sta alogenična presaditev krvotvornih matičnih celic in paliativno zdravljenje s kemoterapevtiki.Chronic myelogenous leukemia (CML) is a rare myeloproliferative disease with an incidence of approximately 1-2/100,000 population per year. It is a clonal disease of a pluripotent stem cell committed to granulopoiesis. Most patients are diagnosed in the chronic phase when the blood count typically shows leukocytosis with predominance of mature neutrophil granulocytes and there are evident signs of increased metabolism, such as fatigue, weight loss and perspiration, and splenomegaly. Through the accelerated phase, the chronic phase progresses to a blast crisis resembling acute leukemia. The diagnosis is based on the discovery of the Philadelphia chromosome arising as a consequence of chromosomal translocation t(922), BCRABL gene or its product, BCR-ABL tyrosine kinase, in the peripheral blood or bone marrow cells. Significant progress in the treatment of CML was accomplished by the discovery of the BCR-ABL tyrosine kinase inhibitors, which provide long-term disease control, namely with imatinib as the first choice of treatment in the chronic phase of CML. The other two possible treatments are the allogeneic transplantation of haematopoietic stem cells and palliative treatment with chemotherapeutics

Efficiency of antimalarial chemoprophylaxis – an analysis of malaria morbidity among members of section for tropical medicine, medical faculty of Ljubljana, on electives in third world countries 1990–2005

Background: The aim of this study was to assess the incidence of malaria among the homogenous population of medical students and young doctors, specifically educated in tropical medicine, travelling to the third world countries for electives of two to four months’ duration with professional and humanitarian purposes. We focused on the efficiency of currently widely reccomended antimalarial chemoprophylaxis, especially mefloquine.Methods: The data were collected by a questionnaire, analysis of medical documentation and medical examinations of elective participants after their return. Malaria was diagnosed either microscopically or on basis of typical clinical features, followed by marked improvement after antimalarial therapy.Results: From 106 expedition members that were adherent to regular exposure prophylactic measures as well as recommended chemoprophylaxis, 28 (26 %) reported malaria. 23 (82 %) among them visited Africa and 23 (82 %) were taking mefloquine for chemoprophylaxis. None suffered from complicated form of disease. No statistically significant differences in malaria morbidity with reference to travel destination, gender or weather season were found.Conclusions: High incidence of malaria in our population could be partially explained by a relatively long period of travel in malaria hyperendemic regions. We carefully examined the possibility of erroneous diagnosis of malaria as well as probable increase in mefloquine resistance in hyperendemic rural regions of Africa. Absence of complicated malaria proves the benefits of complete adherence to antimalarial exposure and chemoprophylaxis.</p