Komplementarna potporna terapija za dijete tijekom rehabilitacije i palijativne skrbi

The study included 23 patients (17 male, 6 female) with malignant diseases (brain tumor, Wilms tumor, Ewing’s sarcoma, Hodgkin’s disease) aged 4 to 17 years, admitted at the Children’s Hospital Hematology/Oncology Department, Zagreb. The patients were included in individual complementary supportive therapy programs developed on the concepts of Ex-Gen creative therapy according to diagnosis, clinical picture and needs of each child. For the purpose of this study, the Multicultural Apperception Test TEMAS (“Tell-Me-A-Story”) was used which is both an evaluation instrument and a form of therapy known as guided imagery. The study results show that induced spontaneity and creativity had a prophylactic and therapeutic function. This was observable in children’s newly developed coping mechanisms and an improved quality of life during their complex treatment and rehabilitation.Ispitivanje je provedeno na 23 bolesnika (17 muškaraca, 6 žena) s malignom bolešću (Tumor cerebri, Tumor Wilms, Sarcoma Ewing, Morbus Hodgkin…) u dobi od 4 do 17 godina, hospitaliziranih na Odjelu za onkologiju i hematologiju u Klinici za dječje bolesti u Zagrebu. Pacijenti su bili uključeni u individualne komplementarne suportivno terapijske programe u konceptu Ex-Gen kreativne terapije, koji su bili koncipirani ovisno o dijagnozi, kliničkoj slici i potrebama djeteta. U tu svrhu korišten je multikulturalni test tematske apercijacije TEMAS (Tell-Me-A-Story/Pričaj mi priču) koji je istovremeno i instrument za evaluaciju i oblik terapije u obliku vo|ene imaginacije. Rezultati istraživanja pokazuju da je potaknuta spontanost i kreativnost imala profilaktičku i terapijsku funkciju. To se očitovalo u novim mehanizmima djetetovog suočavanja s bolešću i boljoj kvaliteti života tijekom kompleksnog liječenja i rehabilitacije

Kreativna i art/ekspresivna terapija kao komplementarni pristup na Odjelu za hematologiju i onkologiju Klinike za dječje bolesti: izvodi iz studija slučaja

In terms of modern approaches to psychosocial oncology and sophrology, the paper shows some experiences with creative and art/expressive therapies used as complementary approaches to complex treatment and rehabilitation of a 12-year-old girl with the clinical picture of a pilocytic astrocytoma with neurofibromatosis, and a 14-year-old boy with an osteosarcoma of the right maxilla. The study was conducted at the Hematology/Oncology Department, Children’s Hospital, Zagreb. The assessment was performed using the six-variable model of BASIC Ph, self-report measures of stress reaction including the Aqua test, and visual art expression (drawings and mandala colorigrams) to analyze the child’s latent (introspective) psychoemotional experiences during therapy. Original data for controlled variables were processed using the INDIFF analysis of changes. The study results demonstrate the value of including complementary supportive therapies to develop coping mechanisms and improve the quality of life of the child. The excerpts from case studies were prepared as part of a scientific research project on “Complementary Supportive Therapies and Development of Life Potentials”, supported by the Ministry of Science, Education and Sports of the Republic of Croatia.U okviru suvremenih pristupa u psihosocijalnoj onkologiji i sofrologiji prikazana su neka iskustva o primjeni kreativne terapije i art/ekspresivne terapije kao komplementarnih pristupa u kompleksnom liječenju i rehabilitaciji djevojčice u dobi od 12 godina s kliničkom slikom pilocitičkog astrocitoma, neurofibromatoze; te dječaka u dobi od 14 godina s kliničkom slikom Osteosarcoma maxillae l. dex. Studija je provedena na Odjelu za hematologiju i onkologiju Klinike za dječje bolesti u Zagrebu. U svrhu evaluacije korišteni su model BASIC Ph sa šest kontroliranih varijabli, ljestvice za samoprocjenu reakcije na stres uz primjenu Aqua testa, te likovno izražavanje (crtež i kolorigram mandale) u svrhu analize latentnih (introspektivnih) psihoemocionalnih iskustava u djeteta tijekom terapije. Izvorni podaci za kontrolirane varijable obrađeni su programom analize promjena primjenom algoritma INDIFF. Rezultati istraživanja upu}uju na vrijednost primijenjenog komplementarnog suportivno-terapijskog pristupa u razvijanju mehanizama suočavanja i u podržavanju djetetove kvalitete života. Ovi izvodi iz studija slučaja pripremljeni su u okviru znanstvenog projekta «Komplementarne terapije i razvoj životnih potencijala», pod potporom Ministarstva znanosti i tehnologije Republike Hrvatske

Relationship Between Tumor Vascularity and Vascular Endothelial Growth Factor as Prognostic Factors for Patients with Neuroblastoma

Although the role of angiogenesis in tumor progression and response to treatment is generally well-characterized, for neuroblastomas clinical data regarding the contribution of angiogenesis and its predictive capacity remain unclear. The aim of this study was to evaluate whether tumor vascularity in the combination with expression of vascular endothelial growth factor (VEGF) represent prognostic factors for patients with neuroblastoma. Immunohistochemistry using anti- -CD34 and anti-VEGF antibodies was used to analyze paraffin-embedded primary tumor tissues from 56 patients diagnosed with neuroblastoma. Tumor vascularity was estimated by calculating the tumor vascular volume fraction (TVVF), and VEGF expression was determined using semi-quantitative scoring. Statistical analyses including multivariate analysis were performed and compared with these two factors. Tumor vascularity had impact on survival of high VEGF expression neuroblastoma patients. Combination of high VEGF expression and TVVF value 5% was independent predictor of overall survival (p-value =0.0041, odds ratio (OR) (95%CI)=8.67 (1.99–37.69) by the Cox proportional hazards model). This study revealed for the first time a group of extremely high-risk neuroblastoma with both high VEGF expression and poor vascularity. For these patients reduced rates of survival were observed (37% vs. 92.5%) (p<0.0001). These patients did not experience a significant improvement following hematopoietic stem cell transplantation, and could be candidates for receiving novel therapies. These results indicate the importance of the mutual relationship between tumor vascularity and VEGF, because it gives better insight into the prognosis of patients with neuroblastoma

Considering Parents of Malignant ill Children in COVID-19 Health Crisis

Aim: Parents of children suffering from malignant diseases indubitably represent a very dainty population, underrepresented in psychosocial research. It is common for these parents to move to the hospital wards in order to support their children, which causes an unnatural cut in their lifeline, in addition to coping with terrifying diagnosis. Coping with a child’s malignant disease includes a continuous feeling of fear and concern, and change in the overall family dynamics, but also the cessation of daily life activities, even outside the context of a global pandemic, some pre-COVID research had shown. COVID-19 brought some additional challenges. In order to protect children’s fragile physical state, parents were obliged to adapt to new rules and distance from the others even more. At the same time, their fears and worries grew only bigger and coping mechanisms were seriously limited. Subjects and Methods: In this paper we investigate parental experiences and needs during COVID-19 crisis. Semi-structured in-depth interviews were conducted with ten mothers with experience of children’s in-patient treatment before and during pandemics. Results: According to main findings, theoretical model of parental adjustment and wellbeing in health crisis is proposed. Conclusion: Results imply the necessity to consider parental psychological wellbeing in order to support them and their children, especially when additional stressful and/or traumatic experiences emerge, and treat them as especially vulnerable group in research and practice

Psychosocial oncology and some aspects of complex rehabilitation in adults and children with malignant diseases

Osjećaji i misli koji se pojavljuju u oboljelih od malignih bolesti tijekom dijagnostike, liječenja i rehabilitacije predstavljaju kompleksno problemsko područje za oboljele, društvenu okolinu, kao i za stručnjake iz raznih disciplina u području biomedicinskih, humanističkih, društvenih i drugih znanosti. Način na koji odrasla osoba ili dijete doživljava prijetnju za vlastitu egzistenciju važan je i u njenom suočavanju s bolesti tijekom liječenja i rehabilitacije. Interdisciplinarno područje psihosocijalne onkologije prikazano je i u okviru nekih studijskih programa na raznim sveučilišnim i kliničkim institucijama u svijetu kao i okviru kolegija „Psihosocijalna onkologija“ na Edukacijsko-rehabilitacijskom fakultetu Sveučilišta u Zagrebu. Posebice su prikazana neka istraživanja koja su provođena tijekom liječenja i rehabilitacije osoba oboljelih od raka dojke, kao i u djece sa solidnim malignim tumorima. Istaknuta je potreba adekvatne sveučilišne edukacije stručnjaka u području rehabilitacijskih znanosti kako bi stečenim kompetencijama tijekom studija i/ili nakon raznih programa specijalizacije, bili u mogućnosti pružiti komplementarne oblike psihoemocionalne i psihosocijalne podrške oboljelima.The emotions and thoughts that appear in people with malignant diseases during diagnostics, treatment and rehabilitation, represent a complex problem area for the patient, social enviroment, as well as professionals from biomedical, humanities, social and other sciences. The way that an adult or child experiences the threat to it´s own existence is very important when coping with their disease during treatment and rehabilitation. Psychosocial oncology as an interdisciplinary field of study is presented within some study programs at various universities and clinical institutions worldwide and within the course „Psychosocial oncology“ at the Faculty of Education and Rehabilitation Sciences at the University of Zagreb. Some clinical and scientific researches that were conducted during the treatment and rehabilitation of patients with breast cancer, as well as in children with solid malignant tumors are shown. The need for adequate university education of professionals in the field of rehabilitation sciences is emphasized, so they may be abled with their acquired competencies during their studies and/or after various specializations, to provide complementary forms of psychoemotional and psychosocial support to patients

Bol i palijativna medicina – tempus projekt u Hrvatskoj

Pain and Palliative Medicine Project (PPMP), funded by the TEMPUS programme of the European Union, has been established with a goal of sharing knowledge and experience from countries in which palliative care is already substantially developed to partner countries whose palliative care encountered more problems. Croatia as partner country, has tried to improve national palliative care systems through education of medical and non-medical personnel. Protocols of collaboration and training courses in pain management and palliative medicine at the Universities of Florence and Lyon, including options of collaboration with some university and clinical institutions in Croatia have been presented. After their two-year project, the Croatian team has noted significant progress in the fields of education, infrastructure and legislative support for development of palliative care. These results show the need for improving Croatian palliative care system as well as possible solutions for overcoming obstacles derived from nation’s traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenošenja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljšati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja. Prikazani su protokoli suradnje i tečajeva o boli i palijativnoj medicine na Sveučilištima u Firenci i Lyonu, kao i na nekim sveučilišnim i kliničkim institucijama u Hrvatskoj. Nakon dvogodišnjeg projekta hrvatski tim zabilježio je značajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljšavanjem hrvatske palijativne skrbi kao i moguća rješenja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda društva na skrb terminalno bolesnih

Bol i palijativna medicina – tempus projekt u Hrvatskoj

Pain and Palliative Medicine Project (PPMP), funded by the TEMPUS programme of the European Union, has been established with a goal of sharing knowledge and experience from countries in which palliative care is already substantially developed to partner countries whose palliative care encountered more problems. Croatia as partner country, has tried to improve national palliative care systems through education of medical and non-medical personnel. Protocols of collaboration and training courses in pain management and palliative medicine at the Universities of Florence and Lyon, including options of collaboration with some university and clinical institutions in Croatia have been presented. After their two-year project, the Croatian team has noted significant progress in the fields of education, infrastructure and legislative support for development of palliative care. These results show the need for improving Croatian palliative care system as well as possible solutions for overcoming obstacles derived from nation’s traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenošenja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljšati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja. Prikazani su protokoli suradnje i tečajeva o boli i palijativnoj medicine na Sveučilištima u Firenci i Lyonu, kao i na nekim sveučilišnim i kliničkim institucijama u Hrvatskoj. Nakon dvogodišnjeg projekta hrvatski tim zabilježio je značajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljšavanjem hrvatske palijativne skrbi kao i moguća rješenja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda društva na skrb terminalno bolesnih

Invazivne gljivične infekcije u djece liječene zbog hematoloških malignih bolesti - petogodišnje iskustvo

Invasive fungal infections (IFI) are life-threatening complications of intensive chemotherapy treatment, with the incidence in pediatric patients ranging from 2% to 21%. In this article, we describe our 5-year experience of IFI in pediatric oncology patients and its clinical manifestations with radiological findings, treatment and outcome. A retrospective and descriptive survey of IFI in children with hematologic neoplasms was conducted at the Department of Oncology and Hematology, Zagreb Children’s Hospital. Medical charts of children 0-17 years of age, of both sexes, treated for leukemias and lymphomas from January 2016 to December 2020 were reviewed. In a 5-year period, 60 patients were treated for hematologic malignancy, acute lymphoblastic leukemia (ALL) being the most prevalent diagnosis. IFI was verified in 9 (15%) children, predominantly in patients with ALL (75%). The specific causative agent was detected in one child, whereas other infections were classified as probable pulmonary aspergillosis. All the patients received standard prophylaxis with fluconazole and treatment with liposomal amphotericin B and voriconazole. The majority of our patients achieved recovery. IFI prevention, diagnosis and treatment remain a challenge. Uniform prophylaxis and therapy protocols, as well as environmental control are of vital importance for the development of better strategies in the prevention, early detection and treatment of IFI in pediatric hematology patients.Invazivne gljivične infekcije (IFI) životno su ugrožavajuće komplikacije liječenja hematoonkoloških bolesnika, učestalost kojih je od 2% do 21%. Ovaj članak prikazuje naše petogodišnje iskustvo s IFI u pedijatrijskih onkoloških bolesnika, njihove kliničke prezentacije te ishoda liječenja. U Zavodu za onkologiju i hematologiju Klinike za dječje bolesti Zagreb provedeno je retrospektivno i deskriptivno istraživanje učestalosti IFI u djece u dobi od 0-17 godina oboljele od hematoloških malignih bolesti. Pretraženi su medicinski podaci djece oba spola koja su liječena u Zavodu zbog leukemije i limfoma u razdoblju od siječnja 2016. do prosinca 2020. godine. U petogodišnjem razdoblju hematološka bolest dijagnosticirana je u 60 bolesnika, a prevladavala je dijagnoza akutne limfoblastične leukemije (ALL). IFI je dijagnosticirana kod 9 bolesnika, pretežito kod onih oboljelih od ALL. Specifični uzročnik dokazan je u samo jednog bolesnika. Svi bolesnici primili su standardnu profilaksu flukonazolom te terapiju liposomnim amfotericinom B i vorikonazolom. U većine bolesnika postignut je oporavak. Poboljšanje prevencije i liječenja IFI moglo bi se postići postojanjem ujednačenih protokola za profilaksu i liječenje kao i bolje kontrole koncentracije gljivičnih spora u bolesničkim sobama

Metastaze u nosnoj šupljini, paranazalnim sinusima i nazofarinksu - prikazi sluučajeva

Uvod: Metastaze u nosnu šupljinu, paranazalne sinuse i nazofarinks su rijetke, ali ako su prisutne tada je najčešće sijelo maksilarni sinus. Prateći simptomi metastaze u navedenim sijelima mogu imitirati druga benigna i češća stanja, a prava etiologija se može predvidjeti i propustiti tijekom duljeg razdoblja. Prikaz slučaja: Prikazujemo dva slučaja s prisutnim tumorskim tvorbama u nosnoj šupljini, paranazalnim sinusima i nazofarinksu s različitom kliničkom slikom i konačnim ishodom. Prvi je slučaj šesnaestogodišnjeg bolesnika sa suspektnom metastazom ekstraosealnog Ewingovog sarkoma lijeve potkoljenice u nazofarinks i desni maksilarni sinus. Sumnja je postavljena nakon snimanja PET/CT-a, a bolesnik nije imao tegobe od strane nosa i paranazalnih šupljina. Patohistološka analiza bioptata ukazala je na upalne promjene bez tumorskih stanica. Drugi je slučaj pedesetsedmogodišnje bolesnice koja se žalila na otežano disanje i učestale epistakse iz lijeve nosnice. Kliničkim pregledom i radiološkom obradom bila je vidljiva tumorska tvorba u lijevom nosnom kavumu, a patohistološka analiza bioptata ukazala je na metastazu karcinoma bubrega. Zaključak: Metastaze u nosnu šupljinu, paranazalne sinuse i nazofarinks vrlo su rijetke. Mogući je širok spektar pratećih simptoma, a njihova odsutnost ne isključuje mogućnost prisutnosti metastaze. Svaki patološki nalaz utvrđen kliničkim pregledom ili radiološkom obradom, te prisutnost tegoba od strane nosa i paranazalnih sinusa kod bolesnika s malignom bolešću zahtjeva pregled i obradu otorinolaringologa