36 research outputs found
KLINIÄKO LABORATORIJSKE KORELACIJE I KOMUNIKACIJSKO DIJAGNOSTIÄKI PROCES
Clinical-laboratory correlations are the most important part of everyday practice in the era of modern clinical medicine. It is based on the successful functioning of the patient-physician (clinician)-laboratory triangle. Laboratory or other diagnostic tests do not define specific clinical entity or disease; however, they are very useful to make decision related to complicated diagnostic procedures and therapies. Each clinical diagnostic process begins with medical history and physical examination where the doctor uses professional and communication skills. This is followed by setting of the working diagnosis and differential diagnosis. Finally, laboratory tests should help in successful diagnosis and treatment. Daily communication between clinicians and laboratory professionals is very important, and teamwork guidelines are based on modern technological achievements, which is the main postulate for effective diagnostic procedures and treatment. Translational medicine has been developed rapidly in the past ten years, representing a two-way communication between basic science and clinical practice. Discovery of biomarkers and different new molecular pathways in the pathogenesis of disease has enabled early detection of disease when it could not be detected by other standard diagnostic methods. This should lead to more successful diagnosis and treatment.U modernoj medicini kliniÄko laboratorijske korelacije dio su svakodnevne prakse i temelje se na uspjeÅ”nom funkcioniranju trokuta bolesnikālijeÄnikā laboratorij. Laboratorijsko-dijagnostiÄke pretrage ne definiraju pojedini kliniÄki entitet, ali pomažu kliniÄaru u donoÅ”enju daljnjih složenijih dijagnostiÄkih procedura i terapijskih odluka. Svaki kliniÄko-dijagnostiÄki proces zapoÄinje anamnezom i fizikalnim pregledom gdje se lijeÄnik koristi struÄnim i komunikacijskim vjeÅ”tinama. Nakon stvaranja radne dijagnoze i diferencijalnih dijagnoza odabiru se laboratorijske pretrage koje trebaju pomoÄi u Å”to bržem i uspjeÅ”nijem dijagnosticiranju bolesnikovog problema ā bolesti. Svakodnevna komunikacija kliniÄara i laboratorijskih struÄnjaka, donoÅ”enje smjernica timskim radom utemeljenih na suvremenim tehnoloÅ”kim dostignuÄima preduvjet su uspjeÅ”nog dijagnostiÄkog procesa i lijeÄenja. Translacijska medicina se razvija zadnjih desetak godina i predstavlja dvosmjernu komunikaciju izmeÄu baziÄnih znanosti i kliniÄkih struka. OtkriÄe biomarkera i molekularnih puteva u nastanku bolesti omoguÄava ranije otkrivanje bolesti kada se ne može otkriti standardnim metodama. To bi trebalo pripomoÄi u uspjeÅ”nijem dijagnosticiranju bolesti i lijeÄenju oboljelih
Monoklonska protutijela u lijeÄenju ne-Hodgkinovih limfoma
Monoclonal antibodies are an exciting advance in the treatment of lymphoma. They are safe and well-tolerated, and exhibit little cross-resistance with conventional chemotherapeutic agents. In indolent lymphomas, antibody has shown useful response rates both as first line therapy and in relapsed disease. Follicular lymphomas appear to be particularly sensitive to rituximab, and chronic lymphocytic leukaemia to alemtuzumab. In aggressive lymphomas, the addition of rituximab to CHOP chemotherapy significantly prolongs disease-free and overall survival compared to CHOP alone as first-line therapy. Novel agents, including radiolabelled antibodies are showing promise in phase I and II trials in a variety of clinical settings.Monoklonska protutijela su velik korak naprijed u lijeÄenju limfoma. Sigurna su i dobro se podnose, a s konvencionalnim kemoterapijskim lijekovima izazivaju vrlo malu unakrsnu rezistenciju. Kod indolentnih limfoma protutijela su pokazala korisnu stopu odgovora kad su primjenjivani kao terapija prvoga reda i kao terapija kod relapsa bolesti. Folikularni limfomi su osobito osjetljivi na rituksimab, a kroniÄna limfocitna leukemija na alemtuzumab. Dodavanjem rituksimaba kemoterapiji po shemi CHOP u lijeÄenju agresivnih limfoma znatno se produljuje razdoblje bez bolesti i sveukupno preživljenje usporedimo li rezultate primjene samo kemoterapije CHOP kao terapije prvoga reda. Novi lijekovi meÄu kojima su radioaktivno obilježena protutijela u kliniÄkim ispitivanjima I. i II. faze pokazuju obeÄavajuÄe rezultate u razliÄitim kliniÄkim situacijama
Monoklonska protutijela u lijeÄenju ne-Hodgkinovih limfoma
Monoclonal antibodies are an exciting advance in the treatment of lymphoma. They are safe and well-tolerated, and exhibit little cross-resistance with conventional chemotherapeutic agents. In indolent lymphomas, antibody has shown useful response rates both as first line therapy and in relapsed disease. Follicular lymphomas appear to be particularly sensitive to rituximab, and chronic lymphocytic leukaemia to alemtuzumab. In aggressive lymphomas, the addition of rituximab to CHOP chemotherapy significantly prolongs disease-free and overall survival compared to CHOP alone as first-line therapy. Novel agents, including radiolabelled antibodies are showing promise in phase I and II trials in a variety of clinical settings.Monoklonska protutijela su velik korak naprijed u lijeÄenju limfoma. Sigurna su i dobro se podnose, a s konvencionalnim kemoterapijskim lijekovima izazivaju vrlo malu unakrsnu rezistenciju. Kod indolentnih limfoma protutijela su pokazala korisnu stopu odgovora kad su primjenjivani kao terapija prvoga reda i kao terapija kod relapsa bolesti. Folikularni limfomi su osobito osjetljivi na rituksimab, a kroniÄna limfocitna leukemija na alemtuzumab. Dodavanjem rituksimaba kemoterapiji po shemi CHOP u lijeÄenju agresivnih limfoma znatno se produljuje razdoblje bez bolesti i sveukupno preživljenje usporedimo li rezultate primjene samo kemoterapije CHOP kao terapije prvoga reda. Novi lijekovi meÄu kojima su radioaktivno obilježena protutijela u kliniÄkim ispitivanjima I. i II. faze pokazuju obeÄavajuÄe rezultate u razliÄitim kliniÄkim situacijama
Primarni limfomi srediÅ”njeg živÄanog sustava
Primary central nervous system lymphoma (PCNSL) is a distinct form of aggressive non-Hodgkinās lymphoma (NHL) confined to the central nervous system. PCNSL typically affects older population. Individuals with HIV infection are especially at risk of PCNSL development and their outcome is extremely poor. Due to the presence of the blood brain barrier, PCNSL is treated differently from other extranodal NHLs. The mainstay of treatment is the high-dose methotrexate (MTX). Despite the treatment, local relapses are frequent and almost inevitably fatal. Intensification of treatment is possible in patients younger than 60 years. Radiotherapy is effective but complicated with significant delayed neurotoxicity, especially in the elderly. There are no curative treatment options in older patients who represent the majority of patients. Novel less toxic agents have modest activity. Prospective multicentric trials are needed to establish the optimal treatment for PCNSL.Primarni limfom srediÅ”njeg živÄanog sustava (PLSZÅ ) je poseban oblik agresivnog ne-Hodgkinovog limfoma (NHL) lokaliziran u srediÅ”njem živÄanom sustavu. PLSZÅ tipiÄno zahvaÄa stariju populaciju. Za razvoj PLSZÅ -a posebno su riziÄne osobe s HIV infekcijom Äija je prognoza ekstremno loÅ”a. Zbog krvno-moždane barijere, PLSZÅ se lijeÄi drugaÄije od ostalih ekstranodalnih NHL. Temelj lijeÄenja su visoke doze metotreksata. UnatoÄ lijeÄenju, lokalni relapsi su Äesti i gotovo uvijek fatalni. Radioterapija je uÄinkovita, ali komplicirana znaÄajnom kasnom neurotoksiÄnosti, posebno u starijih. U starijih bolesnika, koji Äine veÄinu, nema terapijskih opcija koje bi dovele do izljeÄenja. Noviji, manje toksiÄni lijekovi, skromnog su djelovanja. Potrebne su prospektivne multicentriÄne studije kako bi se definiralo optimalno lijeÄenje PLSZÅ -a
Hematological abnormalities in rheumatic diseases
HematoloÅ”ke promjene se javljaju u 25-70% bolesnika s upalnim reumatskim bolestima. NajÄeÅ”Äi hematoloÅ”ki poremeÄaj je anemija kroniÄne bolesti uzrokovana upalnim citokinima koji izazivaju promjene u metabolizmu željeza, proizvodnji eritropoetina, proliferaciji prethodnih stanica crvene loze i dužini života eritrocita. Glavni regulator prometa željeza u organizmu je hepcidin koji koÄi apsorpciju željeza kroz crijevni epitel i oslobaÄanje željeza iz stanica monocitno - makrofagnog sustava. LijeÄenje anemije kroniÄne bolesti uspjeÅ”no se provodi rekombinantnim eritropoetinom i željezom. Znatno su rjeÄi poremeÄaji drugih krvnih loza na razini koÅ”tane srži ili periferne krvi koji se oÄituju smanjenjem ili poveÄanjem broja leukocita i trombocita. Ostali hematoloÅ”ki poremeÄaji mogu se smatrati dijelom osnovnog autoimunog zbivanja. Trajna antigena stimulacija može biti poticaj na limfomagenezu te je uÄestalost limfoma u bolesnika s upalnim reumatskim bolestima 5-6 puta veÄa nego u obiÄnoj populaciji.Haematological abnormalities are present in 25-50% patients with rheumatic diseases. The most common finding is anaemia of chronic disease which is driven by inflammatory cytokines. Hepcidin plays key role in iron homeostasis. It reduces iron absorption from duodenum and iron release from reticuloendothelial cells. Anaemia of chronic disease could be successfully treated by recombinant erythropoietin in combination with iron supplementation. Various abnormalities can be observed in the leukocyte and platelets counts. Other haematological disturbances are considered as part of autoimmune disease. Prolonged antigen stimulation can induce lymphomagenesis and lymphoma incidence in patients with rheumatic diseases is 5 to 6-fold increased compared to normal population
FNA based diagnosis of head and neck nodal lymphoma [CitomorfoloÅ”ka dijagnoza limfoma u podruÄju glave i vrata]
Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics
Erdheim-Chester Disease and Concomitant Tuberculosis Successfully Treated with Chemotherapy and Long-Term Steroids
Erdheim-Chester disease (ECD) is a rare histiocytosis usually affecting the skeletal system, but visceral organs and
central nervous system involvement are common as well. Probability exists that immunomodulatory therapies and disorders
can play a role in clinical course of the disease. Because of rarity of the disorder, it is hard to classify it and standardize
the treatment options, but, according to published material and our experience, cytotoxic chemotherapy and
long-term steroids have therapeutic benefit. Although this approach can probably be accepted as standard of care management,
novel therapeutic modalities should be explored, and pathogenesis and disorder classification should be cleared
out as well. The case of ECD affecting skeletal system and lungs and concomitant laryngeal tuberculosis successfully
treated with chemotherapy and long-term steroid therapy is presented
Treatment of patients with advanced Hodgkinās lymphoma with escalated BEACOPP
Cilj: Svrha rada je pokazati rezultate, kao i nuspojave, u bolesnika s Hodgkinovim limfomom stadija III ili IV, koji su lijeÄeni s 4 ciklusa eBEACOPP-a i 4 ciklusa sBEACOPP-a. Metode: U razdoblju od listopada 2003. do ožujka 2011. godine lijeÄeno je 15 bolesnika. Medijan dobi bio je 28 godina (19 ā 47), s medijanom praÄenja od 14 mjeseci (1 ā 90). Svi su bolesnici lijeÄeni s 4 ciklusa eBEACOPP-a, 11 bolesnika lijeÄenje je nastavilo s 4 ciklusa sBEACOPP-a, kod 3 bolesnika, zbog znaÄajnih nuspojava, primijenjen je program ABVD, dok je jedan bolesnik (pluÄna toksiÄnost) lijeÄen programom COPP. Rezultati: U 10 bolesnika lijeÄenjem je postignuta kompletna remisija bolesti, a u 5 bolesnika parcijalna remisija bolesti; ukupan odgovor na terapiju bio je 100 %. U 5 bolesnika koji su postigli parcijalnu remisiju bolesti provedena je radioterapija. Nakon praÄenja od 14 mjeseci, preživljenje bez znakova bolesti, kao i ukupno preživljenje, iznosi 100 %. Kod veÄine bolesnika primijeÄena je ozbiljna hematotoksiÄnost, a 5 bolesnika (33 %) je zbog febrilne neutropenije lijeÄeno bolniÄki. Rasprava i zakljuÄak: Ova preliminarna studija potvrÄuje da je program lijeÄenja eBEACOPP-om izrazito uÄinkovit, a rezultati su u skladu s rezultatima dosad provedenih studija. Radi se o malom uzorku bolesnika s kratkim razdobljem praÄenja. Treba naglasiti da za sada nisu zamijeÄeni rani relapsi bolesti. ToksiÄnost je znaÄajna, naroÄito hematotoksiÄnost uz neutropenijske vruÄice.Aim: We present the outcome and toxicity of intensive chemotherapy protocol escalated BEACOPP (eBEACOPP 4 cycles) followed by standard BEACOPP (sBEACOPP 4 cycles). Methods: From October 2003 untill March 2011, 15 patients were treated with eBEACOPP. The median age was 28 years with a range of 19 to 47 years; median follow-up was 14 months (range 1 to 90 months). All patients received 4 cycles of eBEACOPP; 11 patients continued their therapy with 4 cycles of sBEACOPP; in 3 patients ABVD was given because of severe toxicity, while in one patient with lung toxicity COPP was the therapy of choice after eBEACOPP. Results: Complete remission and partial remission has been achieved in 10 and 5 patients, respectively. The response to treatment was 100 %. In 5 patients with PR, radiotherapy was given after chemotherapy. After the median of 14 months follow-up the probability of progression-free survival and overall survival is 100 %. The majority of patients experienced serious hematological toxicity and 5 patients (33 %) had to be admitted to hospital because of febrile neutropenia. Discussion and conclusion: This study confirms the efficacy of eBEACOPP protocol, and the results are similar with the reported data. However, the number of patients and relatively short follow-up is the weakness of this study. It has to be stressed out that relapse of Hodgkin lymphoma was not reported. Toxicity is a serious problem, especially hematological toxicity with febrile neutropenia
FNA Based Diagnosis of Head and Neck Nodal Lymphoma
Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics
FNA Based Diagnosis of Head and Neck Nodal Lymphoma
Fine-needle aspiration (FNA) biopsy has become a well established technique in the diagnosis, staging, and follow-up of patients with head and neck lesions. As in lymphoma diagnostics, FNA serves as a screening method in evaluating potentially affected lymph node for open or core biopsy. According to the World Health Organization classification of lymphoid neoplasms, today it is important to recognize cell morphology and reveal its phenotype, then combine it with different genotypic information and clinical data to provide appropriate therapy. The aim of this study was to assess the efficacy of FNA and immunocytochemistry based lymphoma diagnostic in head and neck region. We conducted a retrospective study during a period of three years where cases with either FNA diagnosis or clinical suspicion of newly recognized or relapsing lymphoma were reviewed. In the study were included patients that were referred to our laboratory from hematology department, in whom head and neck lymphadenopathia was found and lymph node FNA preceded other procedures. Two hundred eighty-five aspirations from 248 patients fulfilled study criteria. Adequate specimens were diagnosed as lymphoma in 100 cases (36%), in 65 male and 35 female patients, 76 in patients with newly discovered disease and 24 in patients with prior lymphoma diagnosis. Overall sensitivity of FNA specimens in the diagnosis of head and neck lymphomas was 90%, specificity 88%, predictive value of a positive result 97%, and predictive value of negative result 61%. Based on our results FNA corroborated with immunophenotyping by immunocytochemistry can be method of choice in primary lymphoma diagnosis as a method complementary to histopathology in lymphoma diagnostics