Acute side effects of radiation therapy in the head, neck and thoracic region

Stranski učinki so kljub napredku radioterapije v zadnjih desetletjih še vedno pomemben in neizogiben sopojav tovrstnega zdravljenja, ki pomembno vpliva na kvaliteto življenja bolnikov z rakom. Akutni stranski učinki se razvijejo znotraj 90 dni od pričetka obsevanja. Pri zdravljenju raka v področju glave in vratu ter prsnega koša se najpogosteje srečujemo z radiodermatitisom in radiomukozitisom, ki se pojavljata pri več kot 90% obsevanih bolnikov, pogosto pa se jima pridružujejo tudi pomanjkanje sline (kserostomija), motnje okusa (disgevzija) in težave pri požiranju (disfagija). V pričujočem članku so omenjeni stranski učinki na kratko predstavljeni, navedeni pa so tudi ukrepi za preprečevanje in zdravljenje le-teh.In spite of the advances in radiation therapy in the last decades, radiation side effects still remain an important and unavoidable issue, with a great impact on cancer patients\u27 quality of life. Acute side effects develop up to 90 days from the beginning of therapy. In patients receiving treatment in the head, neck and thoracic region, radiodermatitis and radiomucositis are the most common acute side effects, followed by lack of saliva (xerostomia), altered taste (dysgeusia) and difficulties in swallowing (dysphagia). This article offers a short description of aforementioned side effects and presents the preventive and therapeutic measures

Etiološki vzroki za nastanek raka glave in vratu ter možnosti za preventivno ukrepanje

Najpomembnejša etiološka vzroka za nastanek raka glave in vratu sta tobak in alkohol, ki sta skupaj udeležena pri nastanku več kot 70 % rakov glave in vratu, v ospredju pa je v zadnjih letih tudi okužba s humanim papilomavirusom (HPV). Kot najbolj učinkovit ukrep za zmanjševanje uživanja škodljivih substanc se je izkazala primarna preventiva, za preprečevanje rakov, povzročenih s HPV, pa cepljenje

The role of radiotherapy in treatment of ocular melanoma

Očesni melanom je redek rak z incidenco 5/ milijon prebivalcev in vrhom pojavnosti okrog 60. leta starosti. Uvealni melanom predstavlja več kot 90% primerov. Enukleacija je bila primarna metoda zdravljenja več kot stoletje, vendar je privedla do izgube funkcionalnega očesa. Danes je radioterapija, primarno brahiterapija, metoda izbora za zdravljenja uvealnega melanoma. Za izvedbo brahiterapije je potrebna kirurška vstavitev radioaktivne ploščice v bližino tumorja, primerna pa je za tumorje debeline 8- 10 mm in premera do 16 mm. Pri večjih tumorjih se uporablja zunanje obsevanje, pri čemer tako obsevanje s protonskim snopom (PBT) kot tudi stereotaktična radioterapija (SRT) kažeta dobre in primerljive rezultate. Radioterapija lahko povzroči neželene učinke, kot so katarakta, radiacijska retinopatija in neovaskularni glavkom, vendar koristi ohranjanja vida pogosto pretehtajo tveganja. Radioterapija je učinkovita možnost zdravljenja uvealnega melanoma, ki dosega primerljive izide z enukleacijo in omogoča ohranitev vida v večini primerov

Akutni stranski učinki obsevanja glave in vratu ter prsnega koša

In spite of the advances in radiation therapy in the last decades, radiation side effects still remain an important and unavoidable issue, with a great impact on cancer patients' quality of life. Acute side effects develop up to 90 days from the beginning of therapy. In patients receiving treatment in the head, neck and thoracic region, radiodermatitis and radiomucositis are the most common acute side effects, followed by lack of saliva (xerostomia), altered taste (dysgeusia) and difficulties in swallowing (dysphagia). This article offers a short description of aforementioned side effects and presents the preventive and therapeutic measures.Stranski učinki so kljub napredku radioterapije v zadnjih desetletjih še vedno pomemben in neizogiben sopojav tovrstnega zdravljenja, ki pomembno vpliva na kvaliteto življenja bolnikov z rakom. Akutni stranski učinki se razvijejo znotraj 90 dni od pričetka obsevanja. Pri zdravljenju raka v področju glave in vratu ter prsnega koša se najpogosteje srečujemo z radiodermatitisom in radiomukozitisom, ki se pojavljata pri več kot 90% obsevanih bolnikov, pogosto pa se jima pridružujejo tudi pomanjkanje sline (kserostomija), motnje okusa (disgevzija) in težave pri požiranju (disfagija). V pričujočem članku so omenjeni stranski učinki na kratko predstavljeni, navedeni pa so tudi ukrepi za preprečevanje in zdravljenje le-teh

Abdominal compartment syndrome in dogs

Sindrom abdominalnog odjeljka predstavlja karakteristično stanje s povišenim vrijednostima intraabdominalnog tlaka višim od 12 mmHg, dilatacijom abdomena popraćeno zatajenjem unutarnjih organa: bubrega, pluća i krvožilnog sustava. Budući da se uz njega često javljaju i brojne komplikacije kao i zatajenje brojnih organskih sustava, razvoj sindroma abdominalnog odjeljka predstavlja vrlo opasno i hitno stanje s visokom stopom mortaliteta. U humanoj medicini, ovaj sindrom je prepoznat već godinama, a do sada je dobro istražena i opisana njegova klasifikacija, etiologija, patofiziologija, klinička slika, dijagnostički postupci kao i smjernice za uspješno liječenje. U veterinarskoj medicini pojava ovoga sindroma u kliničkoj praksi vrlo često prolazi nedijagnosticirano. Zbog širokog spektra nespecifičnih simptoma koji se kod ovog oboljenja javljaju u pasa, kao i zbog prilično rijetkog prakticiranja mjerenja vrijednosti intraabdominalnog tlaka, razvoj sindroma abdominalnog odjeljka često se na vrijeme ne prepoznaje i/ili se kao takav pripisuje drugim patološkim stanjima različitih organskih sustava. Iz istog je razloga u veterinarskoj medicini do sada provedeno premalo kliničkih ispitivanja i znanstvenih radova u pasa, koji bi pružali odgovor i detaljnije objasnili etiologiju, mehanizam nastanka, progresiju, adekvatne dijagnostičke postupke te smjernice u liječenju ovoga sindroma. S obzirom da u pasa još uvijek nisu jasno definirane granične vrijednosti intraabdominalnog tlaka, teško je govoriti u kojem se trenutku javlja abdominalna hipertenzija i ako se javi hoće li rezultirati pojavom navedenog sindroma. Postavljanje egzaktne dijagnoze sindroma abdominalnog odjeljka u pasa je otežano s obzirom da do razvoja sindroma može doći zbog različitih traumatskih stanja, ozljeda, opekotina i različitih organskim ili sistemskih bolesti. Smjernice za liječenje za sada u veterinarskoj medicini nisu specifične, nije opisan jasan protokol liječenja u pasa, već se on odvija prema smjernicama preuzetim iz humane medicine. Sigurno je da je potrebno provesti dodatna znanstvena i klinička istraživanja koja će pridonijeti boljem shvaćanju ovoga sindroma. Usvojena nova znanja pridonijet će njegovu lakšem prepoznavanju, dijagnosticiranju i adekvatnom liječenju na dobrobit svih budućih pacijenata.Abdominal compartment syndrome is a characteristic condition with an intraabdominal pressure higher than 12 mmHg, dilatation of the abdomen accompanied by multiorgan failure, especially the kidney, lungs and cardiovascular system. The development of abdominal compartment syndrome is a very urgent and life-threatening condition with high mortality since it is often accompanied by numerous complications and multiple organ failure. This syndrome has been recognized in human medicine for years and its classification, aetiology, pathophysiology, clinical signs, diagnostic procedures and treatment guidelines have been described. On the other hand, this syndrome often goes unrecognized and undiagnosed in veterinary practice. Due to the broad range of non-specific clinical signs that occur in dogs and due to the rare practice of measuring intra-abdominal pressure, the development of compartment syndrome is often not recognized by veterinarians or it is attributed to other diseases. For the same reason, very few clinical trials or scientific studies in dogs have been conducted to explain the aetiology, pathophysiology, progression, adequate diagnostic procedures and treatment guidelines for this syndrome in veterinary medicine. Since the limits of intraabdominal pressure are not clearly defined in dogs, it is difficult to say when abdominal hypertension actually occurs, and once it occurs whether it will progress into a life-threatening condition. Making the final diagnosis of abdominal compartment syndrome in dogs is very difficult as it can develop due to different traumatic conditions, injuries, burns or organic and systemic diseases. The guidelines for treatment in veterinary patients are not specific, with no individual treatment protocol for dogs described to date, and so treatment is performed according to guidelines taken from human medicine. Indeed, scientific and clinical studies will be needed to gain a better understanding of compartment syndrome, which will enable its easier recognition, better diagnosis and more successful treatment for the benefit of all future patients

A machine learning-based risk stratification model for ventricular tachycardia and heart failure in hypertrophic cardiomyopathy

Background: Machine learning (ML) and artificial intelligence are emerging as important components of precision medicine that enhance diagnosis and risk stratification. Risk stratification tools for hypertrophic cardiomyopathy (HCM) exist, but they are based on traditional statistical methods. The aim was to develop a novel machine learning risk stratification tool for the prediction of 5-year risk in HCM. The goal was to determine if its predictive accuracy is higher than the accuracy of the state-of-the-art tools. Method: Data from a total of 2302 patients were used. The data were comprised of demographic characteristics, genetic data, clinical investigations, medications, and disease-related events. Four classification models were applied to model the risk level, and their decisions were explained using the SHAP (SHapley Additive exPlanations) method. Unwanted cardiac events were defined as sustained ventricular tachycardia occurrence (VT), heart failure (HF), ICD activation, sudden cardiac death (SCD), cardiac death, and all-cause death. Results: The proposed machine learning approach outperformed the similar existing risk-stratification models for SCD, cardiac death, and all-cause death risk-stratification: it achieved higher AUC by 17%, 9%, and 1%, respectively. The boosted trees achieved the best performing AUC of 0.82. The resulting model most accurately predicts VT, HF, and ICD with AUCs of 0.90, 0.88, and 0.87, respectively. Conclusions: The proposed risk-stratification model demonstrates high accuracy in predicting events in patients with hypertrophic cardiomyopathy. The use of a machine-learning risk stratification model may improve patient management, clinical practice, and outcomes in general

Oligometastatic cancer

Oligometastatska bolezen (OMB) predstavlja vmesno stanje med lokalno napredovalo boleznijo in obsežnejšo metastatsko boleznijo. Zaenkrat ne poznamo specifičnih biomarkerjev, ki bi nam pomagali opredeliti bolnike z majhnim bremenom bolezni, zato diagnoza OMB temelji na slikovni diagnostiki. V zadnjih letih narašča zanimanje za optimizacijo zdravljenja OMB predvsem zaradi obetavnih rezultatov dodatka lokalnega k obstoječemu sistemskemu zdravljenju. S takšnim načinom zdravljenja se je prvič pokazala možnost doseganja dolgotrajnih zazdravitev ali redko celo ozdravitev teh bolnikov. Razlikovanje posameznih vrst OMB in njihovo enotno poimenovanje je pomembno zlasti v kliničnih raziskavah, saj nam omogoča medsebojno primerjavo rezultatov različnih raziskav.Oligometastatic disease (OMD) is a stage between locally advanced disease and polymetastatic disease, a group of diseases that are used interchangeably based on treatment history, ongoing treatment status, and imaging findings. The diagnosis of OMD is based on imaging because, as of yet, we are not aware of any specific biomarkers that would enable us to recognize patients with a low disease burden. In recent years, there has been an increasing interest in optimizing the treatment of OMD, owing mostly to the promising outcomes of combining local and systemic treatment. For the first time, the prospect of achieving long-term cures or possibly curing these individuals was established using this form of treatment. The standard name of OMD subgroups allows for the comparison of diverse circumstances in everyday clinical work, as well as the classification for clinical study comparability

Posodobljena priporočila diagnostike in zdravljenja diferenciranega raka ščitnice

no abstractni abstrakt