33 research outputs found
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, Ewingās sarcoma, Hodgkinās disease) aged 4 to 17 years, admitted at the Childrenās 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 (āTell-Me-A-Storyā) 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 childrenās newly developed coping mechanisms and an improved quality of life during their complex treatment and rehabilitation.Ispitivanje je provedeno na 23 bolesnika (17 muÅ”karaca, 6 žena) s malignom boleÅ”Äu (Tumor cerebri, Tumor Wilms, Sarcoma Ewing, Morbus Hodgkinā¦) u dobi od 4 do 17 godina, hospitaliziranih na Odjelu za onkologiju i hematologiju u Klinici za djeÄje bolesti u Zagrebu. Pacijenti su bili ukljuÄeni u individualne komplementarne suportivno terapijske programe u konceptu Ex-Gen kreativne terapije, koji su bili koncipirani ovisno o dijagnozi, kliniÄkoj slici i potrebama djeteta. U tu svrhu koriÅ”ten je multikulturalni test tematske apercijacije TEMAS (Tell-Me-A-Story/PriÄaj mi priÄu) 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 profilaktiÄku i terapijsku funkciju. To se oÄitovalo u novim mehanizmima djetetovog suoÄavanja s boleÅ”Äu i boljoj kvaliteti života tijekom kompleksnog lijeÄenja i rehabilitacije
Kreativna i art/ekspresivna terapija kao komplementarni pristup na Odjelu za hematologiju i onkologiju Klinike za djeÄje bolesti: izvodi iz studija sluÄaja
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, Childrenās 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 childās 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 āComplementary Supportive Therapies and Development of Life Potentialsā, 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 lijeÄenju i rehabilitaciji djevojÄice u dobi od 12 godina s kliniÄkom slikom pilocitiÄkog astrocitoma, neurofibromatoze; te djeÄaka u dobi od 14 godina s kliniÄkom slikom Osteosarcoma maxillae l. dex. Studija je provedena na Odjelu za hematologiju i onkologiju Klinike za djeÄje bolesti u Zagrebu. U svrhu evaluacije koriÅ”teni su model BASIC Ph sa Å”est 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 obraÄeni su programom analize promjena primjenom algoritma INDIFF. Rezultati istraživanja upu}uju na vrijednost primijenjenog komplementarnog suportivno-terapijskog pristupa u razvijanju mehanizama suoÄavanja i u podržavanju djetetove kvalitete života.
Ovi izvodi iz studija sluÄaja pripremljeni su u okviru znanstvenog projekta Ā«Komplementarne terapije i razvoj životnih potencijalaĀ», 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 (1.99ā37.69) 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 childās 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 childrenās 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 childrenās 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
OsjeÄaji i misli koji se pojavljuju u oboljelih od malignih bolesti tijekom dijagnostike, lijeÄenja i rehabilitacije predstavljaju kompleksno problemsko podruÄje za oboljele, druÅ”tvenu okolinu, kao i za struÄnjake iz raznih disciplina u podruÄju biomedicinskih, humanistiÄkih, druÅ”tvenih i drugih znanosti. NaÄin na koji odrasla osoba ili dijete doživljava prijetnju za vlastitu egzistenciju važan je i u njenom suoÄavanju s bolesti tijekom lijeÄenja i rehabilitacije. Interdisciplinarno podruÄje psihosocijalne onkologije prikazano je i u okviru nekih studijskih programa na raznim sveuÄiliÅ”nim i kliniÄkim institucijama u svijetu kao i okviru kolegija āPsihosocijalna onkologijaā na Edukacijsko-rehabilitacijskom fakultetu SveuÄiliÅ”ta u Zagrebu. Posebice su prikazana neka istraživanja koja su provoÄena tijekom lijeÄenja i rehabilitacije osoba oboljelih od raka dojke, kao i u djece sa solidnim malignim tumorima. Istaknuta je potreba adekvatne sveuÄiliÅ”ne edukacije struÄnjaka u podruÄju rehabilitacijskih znanosti kako bi steÄenim kompetencijama tijekom studija i/ili nakon raznih programa specijalizacije, bili u moguÄnosti pružiti komplementarne oblike psihoemocionalne i psihosocijalne podrÅ”ke 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 itĀ“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 āPsychosocial oncologyā 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 ā 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 nationās traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenoÅ”enja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljÅ”ati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja.
Prikazani su protokoli suradnje i teÄajeva o boli i palijativnoj medicine na SveuÄiliÅ”tima u Firenci i Lyonu, kao i na nekim sveuÄiliÅ”nim i kliniÄkim institucijama u Hrvatskoj.
Nakon dvogodiÅ”njeg projekta hrvatski tim zabilježio je znaÄajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljÅ”avanjem hrvatske palijativne skrbi kao i moguÄa rjeÅ”enja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda druÅ”tva na skrb terminalno bolesnih
Bol i palijativna medicina ā 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 nationās traditional views on the treatment of the terminally ill.Bol i palijativna medicina (PPMP) je projekt u okviru TEMPUS programa Europske Unije s ciljem prenoÅ”enja znanja i iskustava zemalja, u kojima je palijativna skrb dobro razvijena, zemljama u kojima je palijativna skrb manje aktivna. Hrvatska, kao zemlja partner, nastoji poboljÅ”ati nacionalni program palijativne skrbi kroz edukaciju medicinskog i ne-medicinskog osoblja.
Prikazani su protokoli suradnje i teÄajeva o boli i palijativnoj medicine na SveuÄiliÅ”tima u Firenci i Lyonu, kao i na nekim sveuÄiliÅ”nim i kliniÄkim institucijama u Hrvatskoj.
Nakon dvogodiÅ”njeg projekta hrvatski tim zabilježio je znaÄajni napredak u poljima edukacije, infrastrukture i zakonske potpore razvoju palijativne skrbi. Ovi rezultati su pokazali potrebu za daljnjim poboljÅ”avanjem hrvatske palijativne skrbi kao i moguÄa rjeÅ”enja za prevladavanje prepreka koje proizlaze iz tradicionalnih pogleda druÅ”tva na skrb terminalno bolesnih
Invazivne gljiviÄne infekcije u djece lijeÄene zbog hematoloÅ”kih malignih bolesti - petogodiÅ”nje 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 Childrenās 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 gljiviÄne infekcije (IFI) životno su ugrožavajuÄe komplikacije lijeÄenja hematoonkoloÅ”kih bolesnika, uÄestalost
kojih je od 2% do 21%. Ovaj Älanak prikazuje naÅ”e petogodiÅ”nje iskustvo s IFI u pedijatrijskih onkoloÅ”kih bolesnika, njihove
kliniÄke prezentacije te ishoda lijeÄenja. U Zavodu za onkologiju i hematologiju Klinike za djeÄje bolesti Zagreb provedeno
je retrospektivno i deskriptivno istraživanje uÄestalosti IFI u djece u dobi od 0-17 godina oboljele od hematoloÅ”kih malignih
bolesti. Pretraženi su medicinski podaci djece oba spola koja su lijeÄena u Zavodu zbog leukemije i limfoma u razdoblju od
sijeÄnja 2016. do prosinca 2020. godine. U petogodiÅ”njem razdoblju hematoloÅ”ka bolest dijagnosticirana je u 60 bolesnika, a
prevladavala je dijagnoza akutne limfoblastiÄne leukemije (ALL). IFI je dijagnosticirana kod 9 bolesnika, pretežito kod onih
oboljelih od ALL. SpecifiÄni uzroÄnik dokazan je u samo jednog bolesnika. Svi bolesnici primili su standardnu profilaksu flukonazolom
te terapiju liposomnim amfotericinom B i vorikonazolom. U veÄine bolesnika postignut je oporavak. PoboljÅ”anje
prevencije i lijeÄenja IFI moglo bi se postiÄi postojanjem ujednaÄenih protokola za profilaksu i lijeÄenje kao i bolje kontrole
koncentracije gljiviÄnih spora u bolesniÄkim sobama
Metastaze u nosnoj Å”upljini, paranazalnim sinusima i nazofarinksu - prikazi sluuÄajeva
Uvod: Metastaze u nosnu Ŕupljinu, paranazalne sinuse i nazofarinks su rijetke, ali ako su prisutne tada
je najÄeÅ”Äe sijelo maksilarni sinus. PrateÄi simptomi metastaze u navedenim sijelima mogu imitirati druga
benigna i ÄeÅ”Äa stanja, a prava etiologija se može predvidjeti i propustiti tijekom duljeg razdoblja.
Prikaz sluÄaja: Prikazujemo dva sluÄaja s prisutnim tumorskim tvorbama u nosnoj Å”upljini,
paranazalnim sinusima i nazofarinksu s razliÄitom kliniÄkom slikom i konaÄnim ishodom. Prvi je sluÄaj
ŔesnaestogodiŔnjeg 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 Ŕupljina. PatohistoloŔka analiza bioptata ukazala je
na upalne promjene bez tumorskih stanica. Drugi je sluÄaj pedesetsedmogodiÅ”nje bolesnice koja se žalila
na otežano disanje i uÄestale epistakse iz lijeve nosnice. KliniÄkim pregledom i radioloÅ”kom obradom bila
je vidljiva tumorska tvorba u lijevom nosnom kavumu, a patohistoloŔka analiza bioptata ukazala je na
metastazu karcinoma bubrega.
ZakljuÄak: Metastaze u nosnu Å”upljinu, paranazalne sinuse i nazofarinks vrlo su rijetke. MoguÄi je Å”irok
spektar prateÄih simptoma, a njihova odsutnost ne iskljuÄuje moguÄnost prisutnosti metastaze. Svaki
patoloÅ”ki nalaz utvrÄen kliniÄkim pregledom ili radioloÅ”kom obradom, te prisutnost tegoba od strane nosa
i paranazalnih sinusa kod bolesnika s malignom boleÅ”Äu zahtjeva pregled i obradu otorinolaringologa