Suportivno liječenje bolesnika s karcinomom

Malnutrition is a common problem among cancer patients. Cachexia causes death in >20% of patients with malignancy. Cachexia is most pronounced in patients with carcinoma of the stomach and pancreas. The aim of the study was to see whether appetite can be increased and weight loss decelerated using the pharmacological approach to appetite stimulation. The study is retrospective and relates to 20 patients with cancer of different localization treated over a two-month period. The patients received individual dietary recommendations, nutrition support and megestrol acetate 400mg/day. All patients were assessed by using the PG – SGA score (Patient Generated Subjective Global Assessment) and ECOG status. Throughout the two-month period, appetite changes using a visual analogue scale and body wieght changes were measured every two weeks. With nutritional advice and pharmacological support, the appetite significantly increased to reach the appetite score – good (p20% oboljelih od malignih bolesti. Kaheksija je najizraženija u bolesnika s karcinomom želuca i gušterače. Cilj rada bio je utvrditi je li moguće povećati apetit i usporiti gubitak tjelesne težine farmakološkim liječenjem stimulatorom apetita. Retrospektivno smo obradili dvomjesečno razdoblje u kojem smo liječili 20 bolesnika oboljelih od karcinoma različite lokalizacije. Bolesnici su pojedinačno dobili prehrambene savjete, nutritivnu potporu i megestrol-acetat 400mg/dan. Bolesnicima smo odredili PG – SGA skor (Patient Generated Subjective Global Assessment) i ECOG status. Tijekom dvomjesečnog razdoblja pratili smo svaka dva tjedna promjene apetita bolesnika koristeći se vizualno analognom skalom i promjenama u tjelesnoj težini. Nutritivnim savjetima i framakološkom potporom apetit se znatno poboljšao u 75% bolesnika do kategorije dobrog apetita (p<0,01), te je došlo do povećanja tjelesne težine za 3,6 kg u prosjeku

Hemodinamičko praćenje perikardnog izljeva s tamponadom srca kod bolesnika s kolorektalnim karcinomom

Metastatic cardiac malignancies mainly come from the breast, lung, esophagus and lymphoreticular system. Metastasis from colorectal cancer to the heart or pericardium is seldom reported and only sporadic antemortem cases have been reported. We report an unusual case of malignant pericardial effusion with cardiac tamponade caused by metastatic adenocarcinoma of colon in a 58-year-old patient and hemodynamic monitoring with lithium dilution cardiac output (LiDCO) method of measuring cardiac output to prepare patient for surgery of the subileus.Najčešći uzroci malignog perikardijalnog izljeva su karcinom dojke, pluća, jednjaka i limforetikularnog sustava. Maligni perikardijalni izljev je vrlo rijetka komplikacija u bolesnika s karcinomom debelog crijeva. Ovo je prikaz slučaja liječenja 58 godišnjeg bolesnika s malignim perikardijalnim izljevom i srčanom tamponadom pomoću mjerenja minutnog srčanog volumena LIDCO metodom u svrhu pripreme bolesnika za hitnu operaciju subileusa

Hemodinamičko praćenje perikardnog izljeva s tamponadom srca kod bolesnika s kolorektalnim karcinomom

Metastatic cardiac malignancies mainly come from the breast, lung, esophagus and lymphoreticular system. Metastasis from colorectal cancer to the heart or pericardium is seldom reported and only sporadic antemortem cases have been reported. We report an unusual case of malignant pericardial effusion with cardiac tamponade caused by metastatic adenocarcinoma of colon in a 58-year-old patient and hemodynamic monitoring with lithium dilution cardiac output (LiDCO) method of measuring cardiac output to prepare patient for surgery of the subileus.Najčešći uzroci malignog perikardijalnog izljeva su karcinom dojke, pluća, jednjaka i limforetikularnog sustava. Maligni perikardijalni izljev je vrlo rijetka komplikacija u bolesnika s karcinomom debelog crijeva. Ovo je prikaz slučaja liječenja 58 godišnjeg bolesnika s malignim perikardijalnim izljevom i srčanom tamponadom pomoću mjerenja minutnog srčanog volumena LIDCO metodom u svrhu pripreme bolesnika za hitnu operaciju subileusa

Continuous wound infusion of levobupivacaine after total abdominal hysterectomy with bilateral salpingo-oophorectomy

Background and Purpose: Blockade of nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a postoperative multimodal pain management after total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO). The role of continuous wound infusion of levobupivacaine for pain relief and postoperative recovery was evaluated. Materials and Methods: Fifty female patients (ASA I-III) scheduled for TAH and BSO were divided in two equal groups during prospective, double-blinded, placebo-controlled trial. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above the superficial abdominal fascia. Patients were randomly assigned to receive through the catheter 0.25% levobupivacaine (Group L) with 6ml bolus followed by an infusion of 7 ml/h during 48 h, or the same protocol with 0.9% NaCl (Group S). Simultaneously, patient-controlled analgesia provided intravenous morphine. All patients also received diclofenac 75 mg every 12 h for 48 h. Results and Conclusions: Median Visual Analogue Scale (VAS) was satisfactory. Compared with suprafascial saline, levobupivacaine infusion reduced morphine consumption during the first 48 h. The morphine consumption was significantly less (P<0.001) in Group L (6.91 +/– 3.17 mg) in comparison to Group S (50.61 +/– 14.02 mg). Nausea was less in Group L. Time to recover the bowel function was significantly reduced in Group L. No side effects were observed. Postoperative pain control with continuous wound infusion of 0.25% levobupivacaine after TAH with BSO provides effective analgesia, decreases opioid requirements and reduces time to recover the bowel function

Rectal Metastasis from Lobular Carcinoma of the Breast: A Case Report

Rectal metastases from breast carcinomas are very rare. They often occur in lobular invasive breast carcinoma (ILC), usually after a long disease-free period. It is important to be aware of these unusual metastatic patterns of ILC of the breast because of the possibility of systemic therapy. We present a case of 83-year old woman with rectal metastesis from ILC seven years after surgery of primary tumor

Distrofična bulozna epidermoliza s kožnim karcinomom – utjecaj na anesteziju – prikaz slučaja

We report a patient with recessive dystrophic epidermolysis bullosa who developed multiple skin cancer on the upper arm. She was scheduled for arm amputation. Skin and mucosa lesions render more difficulty in anesthetic management, especially monitoring, positioning and airway instrumentation. General anesthesia based on ketamine enables us to avoid some of the problems.Opisujemo bolesnicu s distrofičnim oblikom buloznog dermatitisa u koje su se razvili multipli kožni karcinomi nadlaktice. Bolesnica je predviđena za amputaciju ruke. Kožne promjene i promjene sluznice otežavaju vođenje anestezije, a osobito promatranje, namještanje i pristup dišnom putu. Opća anestezija ketaminom omogućila nam je da izbjegnemoneke od navedenih problema

Kirurško liječenje lokalno proširenog raka dojke

Surgical treatment for breast cancer has remained the primary modality for locoregional treatment, except in the case of locally advanced breast cancer. The surgical treatment is aimed at removing the tumor, achieving local control of the disease and obtaining enough tissue for pathohistological diagnosis and evaluation of breast cancer hormone receptor status. The assessment of local spread of the disease is of the utmost importance for surgical decision making.Kirurško liječenje raka dojke bilo je i ostalo osnovna metoda lokoregionalnog liječenje, osim u slučaju lokalno proširenog raka dojke. Cilj kirurškog liječenja je uklanjanje tumora i postizanje lokalne kontrole bolesti, te osiguravanje dovoljno tkiva za postavljanje patohistološke dijagnoze i određvanje hormonskog statusa tumora. Procjena lokalne proširenosti bolesti od najveće je važnosti u odabiru kirurškog postupka

Distrofična bulozna epidermoliza s kožnim karcinomom – utjecaj na anesteziju – prikaz slučaja

We report a patient with recessive dystrophic epidermolysis bullosa who developed multiple skin cancer on the upper arm. She was scheduled for arm amputation. Skin and mucosa lesions render more difficulty in anesthetic management, especially monitoring, positioning and airway instrumentation. General anesthesia based on ketamine enables us to avoid some of the problems.Opisujemo bolesnicu s distrofičnim oblikom buloznog dermatitisa u koje su se razvili multipli kožni karcinomi nadlaktice. Bolesnica je predviđena za amputaciju ruke. Kožne promjene i promjene sluznice otežavaju vođenje anestezije, a osobito promatranje, namještanje i pristup dišnom putu. Opća anestezija ketaminom omogućila nam je da izbjegnemoneke od navedenih problema

Kirurško liječenje lokalno proširenog raka dojke

Surgical treatment for breast cancer has remained the primary modality for locoregional treatment, except in the case of locally advanced breast cancer. The surgical treatment is aimed at removing the tumor, achieving local control of the disease and obtaining enough tissue for pathohistological diagnosis and evaluation of breast cancer hormone receptor status. The assessment of local spread of the disease is of the utmost importance for surgical decision making.Kirurško liječenje raka dojke bilo je i ostalo osnovna metoda lokoregionalnog liječenje, osim u slučaju lokalno proširenog raka dojke. Cilj kirurškog liječenja je uklanjanje tumora i postizanje lokalne kontrole bolesti, te osiguravanje dovoljno tkiva za postavljanje patohistološke dijagnoze i određvanje hormonskog statusa tumora. Procjena lokalne proširenosti bolesti od najveće je važnosti u odabiru kirurškog postupka

Liječenje raka dojke u muškaraca – 30 godina iskustva u Klinici za tumore u Zagrebu

The study includes records of male patients treated for breast cancer at the Department of Surgery, University Hospital for Tumors, Zagreb, Croatia between 1969 and 1999. In that period, 71 male patients were treated for primary carcinoma of the breast; one of them had cancer in both breasts. The follow-up included the interval between disease onset and diagnosis, age, stage, localization, histologic finding, hormone receptors, metastases and treatment options. The mean age at cancer onset was 62 years, or about 11 years later than in female patients. Age, axillary lymph node status, tumor grade and tumor size were shown to be significant prognostic factors. Primary treatment choice depended upon clinical status of the tumor, age and patient\u27s general condition. The statistical significance was shown between a stage estimated at presentation and stage according to TNM classification (2 = 43.99; d.f. =6; p < 0.01), survival duration by TNM (2 = 45.27; d.f. = 15; p = 0.00007), and between treatment type and duration of survival (2 = 45.26; d.f. = 30; p = 0.04). The correlation bewteen the patient\u27s age and duration of survival, anamnesis and survival, and hormone receptors and survival was not statistically significant.Analizirani su podatci muškaraca liječenih od karcinoma dojke na Kirurškom odjelu Klinike za tumore u Zagrebu u razdoblju 1969-1999. Tijekom navedenog razdoblja liječen je 71 muškarac s primarnim karcinomom dojke. Jedan od njih imao je karcinom obje dojke. Pra}eno je vrijeme od pojave bolesti do dijagnoze, dob, stadij, lokalizacija, histološki nalaz, hormonski receptori, metastaze i liječenje. Srednja dob pojave karcinoma bila je 62 godine, što je za oko 11 godina kasnije nego u žena. Pokazalo se da su dob, status aksilarnih limfnih čvorova, gradus i veličina tumora važni prognostički čimbenici. Izbor primarnog liječenja ovisi o kliničkom statusu tumora, dobi i o op}em stanju bolesnika. Statistička značajnost na|ena je izme|u procijenjenog stadija prigodom dolaska i stadija prema TNM klasifikaciji (_2 = 43,99; d.f. =6; p < 0,01), u duljini preživljenja s obzirom na TNM (_2 = 45,27; d.f. = 15; p = 0,00007), te vrste liječenja i duljine preživljenja (_2 = 45,26; d.f. = 30; p = 0,04). Povezanost dobi bolesnika i duljine preživljenja, anamneze i preživljenja, te hormonskih receptora i preživljenja nije bila statistički znakovita