Koriokarcinom maternice – prikaz slučaja

Choriocarcinoma is one of the histological types of entities called gestational trophoblastic neoplasia (GTN) that refers to a rare group of malignancies that are formed by abnormal proliferation of trophoblastic tissue. Choriocarcinoma is the most aggressive GTN histological type and is characterized by early vascular invasion and disseminated disease. The clinical presentation depends on the spread of the disease and the location of the seedlings. In this paper we present the case of a 32-year-old patient sent to our Department for a specific oncological treatment of uterine choriocarcinoma diagnosed in an external institution. The disease is according to FIGO and WHO scale classified as III stage, low risk and chemotherapy with methotrexate and folic acid is indicated. The chemotherapy achieved negativity of the initially elevated tumor marker human chorionic gonadotropin (hCG) and full regression of lesions described in computerized tomography (CT).Koriokarcinom jedan je od histoloških tipova gestacijske trofoblastične neoplazije (GTN), rijetke skupine malignoma nastale abnormalnom proliferacijom tkiva trofoblasta i predstavlja najagresivniji histološki tip GTN. Odlikuje se ranim krvožilnim bujanjem i udaljenim presadnicama. Klinička slika ovisi o proširenosti bolesti i smještaju presadnica. U ovom radu prikazan je slučaj 32 godišnje bolesnice upućene u našu ustanovu radi specifičnog liječenja koriokarcinoma maternice dijagnosticiranog u drugoj ustanovi. Bolest je prema FIGO i WHO ljestvici klasificirana u III stadij niskog rizika. Liječenje metotreksatom i folnom kiselinom dovelo je do negativizacije početno izrazito povišenog tumorskog biljega humanog korionskog gonadotropina (hCG) i potpunog povlačenja promjena opisanih CT-om

Higijenizacija svinjskog tekućeg gnoja s ekološki prihvatljivim dezinficijensom, kompleksom vodikova peroksida i iona srebra.

Liquid fraction of pig slurry sampled at the site of drainage into an aerobic lagoon was treated with a hydrogen peroxide-based disinfectant with silver ions for catalytic action in order to define a hygienically acceptable substrate according to its organoleptic, physicochemical and especially microbiologic properties, intended for environmental disposal. In the in vitro experiment using substrate mixture with the disinfectant at a final concentration of 2%, time of action of 1 hour, and efficacy control at 24 hours, the following results were observed: the dark, turbid, green-brown, malodorous slurry samples turned light and the intensity of malodour declined substantially. The concentration of ammonium ions and nitrite decreased significantly (P99% reduction in their number. The results obtained in the study pointed to efficient hygienization with hydrogen peroxide and silver ions, rendering pig slurry a more acceptable substrate to be disposed of into the environment.Uzorci tekuće frakcije svinjskog tekućeg gnoja uzeti na mjestu utoka u aerobnu lagunu bili su obrađeni dezinfekcijskim pripravkom na osnovi vodikova peroksida uz katalitičko djelovanje srebrnih iona. To je učinjeno radi dobivanja higijenski prihvatljivijeg supstrata za spuštanje u okoliš glede organoleptičkih, fizikalno-kemijskih te osobito mikrobioloških svojstava. U pokusu in vitro mješanjem supstrata s dezinficijensom u koncentraciji 2% i djelovanju od jednog sata te provjerom učinkovitosti nakon 24 sata dobiveni su sljedeći rezultati: tamni, mutni, zelenosmeđi uzorci tekućeg gnoja neugodnog mirisa postali su svjetliji, a jačina neugodna mirisa bitno se smanjila. Koncentracija amonijevih iona značajno se snizila (P<0,01), također i koncentracija nitrita (P<0,05), a može se pretpostaviti da se zbog oksidacije povećala koncentracija nitrata (P<0,05). Oksidacijskim procesima u gnoju značajno (P<0,01) je smanjena biokemijska potrošnja kisika (BPK5), ali vrijednost 1992,50 ± 244,59 mg O2/L još je uvijek ekološki neprihvatljiva za utok u vodotoke. Smanjio se postotak suhe tvari i sedimentacije (P<0,05), a pH se neznatno povećao, dok su sadržaj organske tvari i elektroprovodljivost ostali u istim granicama. Značajno je smanjen (P<0,01) broj mezofilnih i ukupnih koliformnih bakterija. Uspješnost dezinfekcije iskazana kao log10 faktor redukcije (RF) iznosila je za mezofile 3,23, a za ukupne koliforme 3,12 što predstavlja redukciju njihova broja veću od 99%. Dobiveni rezultati upućuju na učinkovitu higijenizaciju vodikovim peroksidom i srebrnim ionima nakon koje tekući gnoj postaje prihvatljiviji supstrat za ispuštanje u okoliš

THERAPY OF OVARIAN CANCER WITH PACLITAXEL Our Results

Cilj istraživanja. Standardna kemoterapija u bolesnica s lokalno uznapredovalim rakom jajnika stadija II do IVa je kombinacija paklitaksela s cisplatinom/karboplatinom. Više od 75% bolesnica javlja se upravo u tim stadijima bolesti. Početkom 90-tih godina prošlog stoljeća ova kombinacija lijekova koristila se u recidivima nakon incijalne kemo-terapije s cisplatinom/karboplatinom, u kombinaciji s ciklofosfamidom i/ili adriamicinom, da bi se nakon zadovoljavajućih rezultata nakon 1995. godine počela koristiti i u »prvoj« liniji liječenja. Metode. U Zavodu za ginekološku onkologiju Klinike za ženske bolesti i porode KBC-a Zagreb započeli smo primjenom paklitaksela 1994. godine. Od 1994.–1996. godine davali smo ga isključivo u slučaju recidiva da bismo 1996. godine prvi puta započeli liječenje spomenutom kombi-nacijom kao prvom linijom. Od 1994. do 2002. godine ukupno je liječeno 65 bolesnica; paklitaksel je ušao na listu lijekova Hrvatskog Zavoda za zdravstveno osiguranje (HZZO) za recidiv bolesti 1997. godine, a tek 1998. godine za prvu liniju uz posebne zamolbe HZZO-u. Svaka je bolesnica primila između 4–10 ciklusa kemoterapije te je ukupno primijenjeno preko 650 ciklusa kemoterapije. Rezultati. Tijekom primjene ni u jedne bolesnice nismo imali smrtni ishod, a samo kod dvije (3%) ozbiljnije alergijske reakcije koje su uspješno zbrinute, pa je nastavljeno s kemoterapijom. Zaključak. Na temelju našega iskustva možemo reći da je paklitaksel u kombinaciji s cisplatinom/karboplatinom vrlo učinkovit citostatik te da se naši rezultati liječenja ne razlikuju od rezultata objavljenih u svjetskoj literaturi.The aim of investigation. Standard chemotherapy in patients with locally advanced ovarian cancer stage II to stage IV is the combination of paclitaxel with cisplatin/carboplatin. More than 75% of patients are diagnosed at these stage of disease. At the begining of the 90’s of last century this combination of agents was used in recurrencies after initial chemotherapy with cisplatin/carboplatin with cyclophosphamide and/or adriamycin and has, proving to have satisfactory results, since 1995 been used in the first-line therapy. Methods. At Gynecologic Cancer Center, University Hospital Zagreb the use of paclitaxel started in 1994; from 1994 to 1996 paclitaxel was exclusively used for patients with recurrent disease. The use of paclitaxel plus cisplatin/carboplatin combination began as the first-line therapy in 1996. From 1994 to 2002 a total of 65 patients were treated with this combination. In 1997 paclitaxel was listed by the Croatian Health Insurance Agency (HZZO) as therapy for recurrent disease; in 1998 was the special request to HZZO for the first-line therapy and in 2002 separate funds were allocated for the treatment of patients with ovarian cancer stage II to IV with paclitaxel. From 1994 to 2001 paclitaxel was used in 23 patients, of which 5 in the first-line therapy and 18 after recurrencies as second-line therapy. In 2002, 42 patients were treated with paclitaxel – 32 in the first-line and 10 in the second-line therapy. Considering the fact that each patient was treated with between 4 to 10 cycles of chemoterapy, it has amounted to a total of more than 650 cycles of chemotherapy. Results. No treatment had a death outcome, only two patients (3%) experienced a serious allergic reaction but were successfully managed and chemotherapy was continued. Conclusion. Our experience confirms that paclitaxel in combination with cisplatin/carboplatin is a very effective drug and our results of chemotherapy do not differ from the results published in the world literature

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH OVARIAN CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak jajnika i jajovoda po učestalosti je peta zloćudna bolest žena u Hrvatskoj. Histološki je rak jajnika najčešće epitelnog podrijetla, i to seroznog podtipa. Rjeđi su različiti neepitelni malignomi jajnika, a posebnu skupinu čine epitelni karcinomi niskoga zloćudnog potencijala karakterizirani neinvazivnošću, klinički indolentnim tijekom i dobrom prognozom te primarni rak potrbušnice i rak jajovoda. Klinički su ovi zloćudni tumori u ranim stadijima razvoja uglavnom asimptomatski, zbog čega se najčešće dijagnosticiraju u kasnijim stadijima bolesti. Dijagnoza se potvrđuje patohistološkim nalazom, a iznimno citološkim nalazom nakon provedene dijagnostičke obrade. O liječenju odlučuje multidisciplinarni tim uzimajući u obzir dob, opće stanje i komorbiditete bolesnice, kao i obilježja samog tumora uključujući stadij bolesti, histološki tip i gradus tumora. Principi liječenja primarnog raka potrbušnice i jajovoda temelje se na principima liječenja epitelnog raka jajnika koji obuhvaćaju primjenu kirurških zahvata, kemoterapije, imunoterapije i hormonske terapije, kao i suportivno-simptomatskih mjera tijekom cijelog liječenja. Razlikuje se terapijski pristup rjeđim, neepitelnim histološkim tipovima tumora koji se češće dijagnosticiraju u ranim stadijima bolesti, imaju indolentniji tijek pa se kod ovih bolesnica češće primjenjuju poštedni kirurški zahvati s ciljem očuvanja plodnosti. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnica s rakom jajnika, jajovoda i potrbušnice u Republici Hrvatskoj.Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY

Rak trupa maternice javlja se u većini slučajeva u poslijemenopauzalnih žena, a najčešće se očituje ginekološkim krvarenjem. Nakon raka jajnika i vrata maternice treći je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistološkim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrđuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeličnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia

Prognostic factors for recurrence and metastases in persons with high-risk cutaneous melanoma and the impact of the disease on the quality of life

obolelelih. Kvalitet ţivota osoba kod kojih je dijagnostikovan visokorizični melanom koţe (IIC i III stadijum) moţe se vremenom menjati, u zavisnosti od toka bolesti. Osobe sa melanomom koţe, nakon primarnog hirurškog lečenja, imaju povećan rizik za loko-regionalni recidiv bolesti i/ili udaljene metastaze i za smrtni ishod usled progresije bolesti. Najvaţniji prognostički faktori koji imaju ulogu u predviĎanju toka bolesti nakon primarnog hirurškog lečenja su histomorfološke karakteristike melanoma, karakteristike pacijenata i serološki parametri. CILJ: Ciljevi istraţivanja bili su: ispitati validnost i pouzdanost upitnika za merenje kvaliteta ţivota, prethodno lingvistički i kulturološki adaptiranog na srpski jezik; proceniti kvalitet ţivota osoba sa melanomom koţe nakon završenog primarnog hirurškog lečenja i u periodu 6–12 meseci od postavljanja dijagnoze (u slučaju pojave recidiva i ranije); ispitati prediktore promene kvaliteta ţivota osoba sa melanomom tokom godinu dana praćenja iispitati prediktore pojave recidiva i metastaza melanoma. METOD: Istraţivanje je sprovedeno od juna 2017. do decembra 2018. godine u Institutu za onkologiju i radiologiju Srbije. U cilju validacije Upitnika za funkcionalnu procenu terapije raka – melanoma (FACT-M) sprovedena je studija preseka. Za longitudinalno ispitivanje kvaliteta ţivota, kao i za procenu ishoda bolesti (recidivi i metastaze) primenjena je prospektivna kohortna studija. Ustudiju su uključeni ispitanici sa histopatološki dokazanim melanom koţe u kliničkom stadijumu IIC, IIIA, IIIB i IIIC, kod kojih klinički i radiografski nisu potvrĎeni znaci bolesti nakon primarnog hirurškog lečenja. Sociodemografski i klinički podaci prikupljeni su iz medicinske dokumentacije i uz pomoć opšteg upitnika. Za inicijalno i kontrolno merenje kvaliteta ţivota korišćeni su Opšti upitnik za merenje kvaliteta ţivota povezanog sa zdravljem (SF-36) i upitnik FACT-M. Kvalitet ţivota je procenjivan tokom dva merenja: nakon završenog primarnog hirurškog lečenja i potvrde dijagnoze visokorizičnog melanoma koţe i nakon 6 do 12 meseci, a u slučaju pojave recidiva i metastaza i ranije. Za procenu stepena depresivosti primenjena je Bekova skala depresivnosti (BDI). TakoĎe, praćene su vrednosti laktatdehidrogenaze (LDH), C-reaktivnog proteina (CRP) i vitamina D u krvi. REZULTATI: Srpska verzija upitnika FACT-M pokazala je dobru unutrašnja konzistentnost merenu Kronbahovim alfa koeficijentom (0,912) i MekDonaldovim omega koeficijentom (0,904). UtvrĎeno je da je Skala funkcionalne procene opšte terapije raka (FACT-G) u našoj populaciji imala sedam, umesto četiri domena.Melanomska skala (MS) i melanomska hirurška skala (MSS) nisu odgovarale originalnoj jednodimenzionalnoj strukturi. Inicijalni kvalitet ţivota povezan sa zdravljem je bio bolji, ako su ispitanici imali niţi BDI skor, tj. manje depresivnih simptoma, niţi Funkcionalni performans status pacijenata(ECOG PS) i viši nivo vitamina D u serumu. Kvalitet ţivota povezan sa zdravljem na kontroli bio je bolji, ako su ispitanici i dalje bili zaposleni tokom praćenja, ako su imali niţi BDI skor, tj. manje depresivnih simptoma, niţi Breslow skor, odsustvo metastaza i niţi nivo CRP u serumu na kontrolnom merenju. Osobe koje su imale veće pogoršanje kvaliteta ţivota povezanog sa zdravljem razvile su više depresivnih simptoma tokom praćenja (B = -2,50, 95% interval poverenja [IP] -3,05--1,94, p=0,001), imale su povećanje TNM-T stadijuma melanoma (B = -4,46, 95% IP -8,76--0,16, p=0,042) i prisustvo metastaza (B = -24,36, 95% IP -36,55--12,16, p=0,001)...BACKGROUND: Melanoma is a malignant tumor thathas an impact on the quality of life of a patient due to the severity and potential complications. The quality of life of persons diagnosed with high-risk cutaneous melanoma (stages IIC and III) may change over time, depending on the course of the disease. People with high-risk cutaneous melanoma, have an increased risk of loco-regional relapse and/or developing distant metastases as well as a higher risk of dying due to the disease progressionafter primary surgical treatment. The most important prognostic factors that mayhave a role in disease prognosis after the primary (surgical) treatment are the histomorphological characteristics of melanoma, patient’s characteristics, but also some serological indicators. OBJECTIVES:The objectives of the study were: to examine the validity and reliability of the quality of life questionnaire, which was previously linguistically and culturally adapted in Serbian language; to assess the quality of life of persons with cutaneous melanoma after the primary surgical treatment and after 6-12 months of follow-up (in case of recurrence even earlier); to examine the predictors of change in the quality of life of people with melanoma over 1 year of follow-up; to examine the predictors of melanoma recurrence and metastases. METHODS: The study was conducted from June 2017 to December 2018 at the Institute of Oncology and Radiology of Serbia. To validate the Functional Assessment of Cancer Therapy – Melanoma (FACT-M), a cross-sectional study was conducted. A prospective cohort study was used for longitudinal examination of the quality of life as well as for the assessment of melanoma outcomes (recurrence and metastases). This study included subjects with histopathologically verified cutaneous melanoma in clinical stages IIC, IIIA, IIIB and IIIC, among whom no signs of disease were clinically and radiographically present after the primary surgical treatment. The sociodemographic and clinical data were collected from the medical records and using a general questionnaire. Short Form 36 Health Survey(SF-36) and FACT-M were used to quantify quality of life. The quality of life was assessed: after the primary surgical treatment and confirmation of the diagnosis of high-risk melanoma and after 6-12 months(in case of recurrence and/or metastases even earlier). The Beck Depression Inventory (BDI) was used to assess the degree of depressive symptoms. Also, lactate dehydrogenase (LDH), C-reactive protein (CRP) and vitamin D values were monitored. RESULTS: The Serbian version of the FACT-M questionnaire showed good internal consistency as measured by the Cronbach's alpha coefficient (0.912) and the McDonald's omega coefficient (0.904).It was found that the Functional Assessment of Cancer Therapy – General (FACT-G) in our populationhad 7 instead of 4 domains. The Melanoma scale (MS) and Melanoma surgery scale (MSS) did not fit the original one-dimensional structure.The baseline health-related quality of life was higher, i.e. better, if the participants had a lower BDI score, i.e. fewer depressive symptoms, lower ECOG Performance Status (ECOG PS), and higher serum vitamin D levels. The control health-related quality of life was higher, i.e. better, if the participants were still employed during follow-up, had a lower BDI score, i.e. fewer depressive symptoms, lower Breslow score, absence of metastases, and lower serum CRP levels on control measurement. Individuals who had a greater decline in the health-related quality of lifedeveloped more depressive symptoms over follow-up (B = -2.50, 95% confidence interval [CI] - 3.05--1.94, p = 0.001), had a progression of melanoma according to TNM-T classification (B = -4.46, 95% CI -8.76--0.16, p = 0.042) and the metastases (B = -24.36, 95% CI -36.55--12.16, p = 0.001)..