Magnetnoresonančno slikanje srca pri bolnikih s presajenim srcem

Omejujoči dejavnik kratkoročnega preživetja pri bolnikih po presaditvi srca je zavrnitev presadka, dolgoročno preživetje pa omejuje predvsem vaskulopatija presadka. Za bolnike po presaditvi srca je ključnega pomena, da morebitno zavrnitveno reakcijo ali pa vaskulopatijo presadka odkrijemo v zgodnji fazi bolezni, ko so terapevtski ukrepi še učinkoviti in presadek še ni nepovratno poškodovan. Danes je prva izbira pri diagnosticiranju vaskulopatije koronarografija, zlati standard pri diagnosticiranju zavrnitvene reakcije pa je endomiokardna biopsija. Zaradi invazivnosti, potrebe po hospitalni obravnavi in suboptimalni občutljivosti obeh preiskav se vse več raziskav usmerja v neinvazivne diagnostične pristope, med katerimi se je kot obetajoča preiskava izkazalo zlasti magnetnoresonančno slikanje srca. V preglednem članku bomo predstavili uporabnost magnetnoresonančnega slikanja srca pri bolnikih s presajenim srcem, njegove prednosti in izhodišča za razvoj pri zgodnjem diagnosticiranju zavrnitvenih reakcij in vaskulopatije presadka v prihodnosti

Intracardiac echocardiography-guided cardiac tumor biopsy: report of the first Slovenian case

Background: Intracardiac echocardiography (ICE) is an established imaging modality for guiding electrophysiology procedures, with a rapidly expanding role also in other percutaneous structural interventions. Endomyocardial biopsy (EMB) is another potential application where ICE can be used to guide diagnosis of cardiac tumors.1-3 Here we present our first case of a cardiac tumor in which EMB was guided by ICE. Case report: 62-year-old man with a history of non-Hodgkin lymphoma treated with radiation and chemotherapy 10 years ago was admitted due to acute coronary syndrome. Coronary angiogram showed a subtotal occlusion of already collateralized RCA. Due to induced ischemia on myocardial perfusion imaging postponed percutaneous coronary intervention of RCA was performed. During diagnostic work-up at admission when pulmonary embolism was at first suspected, CTA was performed. It showed a heterogeneous formation in the right ventricle (RV) with a thickness of up to 16 mm, that extended from the base towards the apex and into the interventricular septum at the level of the tricuspid ring (Figure 1). According to the CT appearance the mass was suspected to be a liposarcoma. Transthoracic echocardiography showed a hypoechogenic form in the RV, clearly defined after application of contrast for left ventricular opacification. Due to previous history of malignancy PET CT was done that revealed hypometabolic RV mass without any sign of distant metastasis. Percutaneous biopsy of the cardiac mass for histopathological diagnosis was performed guided by ICE and fluoroscopy. ICE allowed continuous imaging of intracardiac structures and clear visualization of the cardiac mass in the RV outflow tract under the pulmonary valve (Figure 2). On angiography there was no evidence of flow restriction. A cardiac biopsy catheter was percutaneously inserted into the RV and with the guidance of ICE accurate positioning of the bioptome was achieved. Three tumor specimens were taken for analysis. The histology revealed lipoma, with no evidence of malignancy. In the absence of any cardiac functional disturbances surgical therapy could be avoided and follow-up was proposed. Conclusion: Cardiac masses are rare and often incidental findings. Histology provides definite diagnosis and ICE could be a valuable tool for guiding biopsy procedure. Our first experience confirmed the benefits of ICE that are real-time visualization of cardiac structures, facilitating proper positioning of biopsy catheter, good patient tolerability and the lack of need for general anesthesia. Therefore, with ICE guided percutaneous biopsy the more invasive diagnostic open heart procedures could be avoided

Priporočila za obravnavo bolnikov s pljučnim rakom

No abstract.Ni abstrakta

Priporočila za obravnavo bolnikov s pljučnim rakom

In 2019, the Recommendations for the management of patients with lung cancer were published bringing much-needed standardisation of diagnosis and treatment to improve survival of patients with lung cancer. Three years after the original Recommendations were published, the update of the Recommendations brings the most innovations in the chapter on systemic treatment of patients with lung cancer. This reflects the remarkable progress made in the field of understanding the oncogenesis and biology of lung cancer and thus the development of new drugs. The burden of lung cancer remains high, as lung cancer is still the most common cause of cancer related death in our country and worldwide. Lung cancer is responsible for one of five cancer-related deaths. Almost one third of patients with lung cancer do not receive any oncological treatment, either because of poor performance status, comorbidities or the extent of the disease. Half of the patients have metastatic disease at diagnosis, resulting in only small improvements in survival despite advances in the treatment of lung cancer patients. These data remind us that if we are to make major shifts in the management of lung cancer patients, we will need to take different approaches. The most promising seems to be the detection of early stages of lung cancer which offers the best treatment results. The Recommendations written here are guidelines for the management of patients with lung cancer. Only with comprehensive multidisciplinary treatment approach, the best outcome from the prognostically unfavourable disease can be offered.Leta 2019 so bila objavljena Priporočila za obravnavo bolnikov s pljučnim rakom, ki so v slovenski prostor vnesla prepotrebno poenotenje diagnostike in zdravljenja z namenom izboljšanja preživetja bolnikov s pljučnim rakom. Posodobitev Priporočil tri leta po izidu izvirnika prinaša največ novosti v poglavju o sistemskem zdravljenju bolnikov s pljučnim rakom. To kaže na izjemen napredek na področju razumevanja onkogeneze in biologije pljučnega raka ter s tem razvoja novih zdravil. Breme pljučnega raka ostaja veliko, saj je pljučni rak pri nas in v svetu še vedno najpogostejši vzrok smrti zaradi raka. Za vsako peto smrt zaradi raka je odgovoren pljučni rak. Skoraj tretjina bolnikov s pljučnim rakom ne prejme specifičnega onkološkega zdravljenja, bodisi zaradi slabega stanja zmogljivosti, spremljajočih bolezni ali obsega bolezni. Polovica bolnikov ima ob diagnozi razsejano bolezen, zaradi česar izboljšanje preživetja z malimi koraki sledi napredku v zdravljenju bolnikov s pljučnim rakom. Ti podatki nas opominjajo, da se bomo morali za velike premike v obravnavi bolnikov s pljučnim rakom lotiti drugačnih pristopov. Kot najbolj obetavno se ponuja zgodnje odkrivanje bolezni, ko so možnosti ozdravitve pljučnega raka najboljše. Zapisana Priporočila so usmeritev za obravnavo bolnikov s pljučnim rakom. Le s sodobnim multidisciplinarnim pristopom obravnave lahko bolniku ponudimo zdravljenje, ki mu omogoča najboljši izhod prognostično neugodne bolezni

Recommendations for diagnosis and treatment of patients with lung cancer

In 2019, the Recommendations for the management of patients with lung cancer were published bringing much-needed standardisation of diagnosis and treatment to improve survival of patients with lung cancer. Three years after the original Recommendations were published, the update of the Recommendations brings the most innovations in the chapter on systemic treatment of patients with lung cancer. This reflects the remarkable progress made in the field of understanding the oncogenesis and biology of lung cancer and thus the development of new drugs. The burden of lung cancer remains high, as lung cancer is still the most common cause of cancer related death in our country and worldwide. Lung cancer is responsible for one of five cancer-related deaths. Almost one third of patients with lung cancer do not receive any oncological treatment, either because of poor performance status, comorbidities or the extent of the disease. Half of the patients have metastatic disease at diagnosis, resulting in only small improvements in survival despite advances in the treatment of lung cancer patients. These data remind us that if we are to make major shifts in the management of lung cancer patients, we will need to take different approaches. The most promising seems to be the detection of early stages of lung cancer which offers the best treatment results. The Recommendations written here are guidelines for the management of patients with lung cancer. Only with comprehensive multidisciplinary treatment approach, the best outcome from the prognostically unfavourable disease can be offered