Utjecaj fizioterapije na vitalni kapacitet prije velikih abdominalnih operacija kod bolesnika s karcinomom, sustavni pregled literature

Introduction: Cancer is one of the leading causes of death worldwide. However, if diagnosed in an operable stage, it is treated as a chronic disease. As such, long-term results and quality of life requirements imposed a comprehensive approach. Prehabilitation programs encompassing nutritional, physical, and psychological components improved the recovery and minimized the complication rate after surgery. We will focus on physiotherapy as part of prehabilitation in this review. Methods: For systematic search, we used the MEDLINE/PubMed (National Library of medicine), Cochrane Central Register of Controlled Trials (Wiley), Embase (Elsevier, Web of Science, and Cochrane database of systematic reviews. The last search update was on 15th December 2020. The search included randomized clinical trials or quasi-randomized clinical trials evaluating exercise or other non-pharmacological preoperative interventions in gastrointestinal cancers. Results: The ten trials included 1058 patients, 535 (50,6%) patients were in the experimental group, and 523 (49,4%) patients were in the control group. Bicycle exercise training was the best-ranked intervention with the standard mean difference (SMD) of 1,4077 (95% C.I. is 0,7018 – 2,1135) to improve vital functional capacity (s, VO˙ 2 at uˆ L). Short-term exercise affected inspiratory muscle strength, and SMD was 1,1819 (95% C.I.,2953 – 2,0684). Short- term intensity training program SMD was 0,8356 (95% C.I. 0,2042 - 1,4669), and short- term intensity program for muscle endurance 0,8156 (95% C.I. 0,2042 – 1,4669). improves respiratory muscle endurance. Small effect was shown on quality of life in high-intensity cycling interval training SMD 0,7439( 95%C.. 0,0856 – 1,4023), WHO performance status in bicycle exercise training SMD 0,7068( 95% C.I. 0,0547 – 1,3589), mean number of complication in high-intensity endurance training SMD 0,3606 (95% C.I. 0,0072 – 0,7141). Conclusion: Although exercise therapy has been shown to improve vital capacity and respiratory muscle strength, there was a lack of comparison between different exercises. Evidence from these indirect-comparisons studies indicated that physical activity should be encouraged during the preoperative period before oncologic surgery.Uvod: Karcinom je jedan od vodećih uzroka smrti u svijetu. Međutim, ako se dijagnosticira u operabilnoj fazi, liječi se poput kroničnih bolesti. Kao takvi, dugoročni rezultati i zahtjevi za kvalitetom života nametnuli su sveobuhvatan pristup. Programi prehabilitacije koji uključuju nutritivne, fizičke i psihološke komponente, poboljšali su oporavak i minimizirali stopu komplikacija nakon operacije. U ovom ćemo se preglednom radu usredotočiti na fizioterapiju kao dio prehabilitacije. Metode: Za sustavno pretraživanje koristili smo MEDLINE / PubMed (Nacionalna medicinska knjižnica), Cochraneov Centralni registar kontroliranih ispitivanja (Wiley), Embase (Elsevier, Web of Science i Cochrane baza podataka sustavnih pregleda). Posljednje ažuriranje pretraživanja bilo je 15. prosinca 2020. Pretraga je uključivala randomizirana klinička ispitivanja ili kvazi-randomizirana klinička ispitivanja koja ocjenjuju vježbanje ili druge nefarmakološke preoperativne intervencije kod karcinoma probavnog sustava. Rezultati: Deset pokusa obuhvaćalo je 1058 bolesnika, 535 (50,6%) bolesnika bilo je u eksperimentalnoj skupini, a 523 (49,4%) bolesnika u kontrolnoj skupini. Trening s vježbama na biciklu bio je najbolje rangirana intervencija sa standardnom srednjom razlikom (SMD) od 1.4077 (95% C.I. je 0,7018 - 2,1135) za poboljšanje vitalne funkcionalne sposobnosti (s, VO˙ 2 pri uˆ L). Kratkotrajno vježbanje utjecalo je na snagu inspiratornih mišića, a SMD je iznosio 1,1819 (95% C.I, 2953 - 2,6684). Program kratkotrajnog intenzivnog treninga SMD iznosio je 0,8356 (95% C.I. 0,2042 - 1,4669), a program kratkotrajnog intenzivnog treninga za izdržljivost mišića 0,8156 (95% C.I. 0,2042 - 1,4669). Pokazan je mali učinak na kvalitetu života u visokointenzivnom intervalnom treningu na biciklom SMD 0,7439 (95% C.l. 0,0856 - 1,4023), status izvedbe prema WHO-u u treningu na biciklu SMD 0,7068 (95% C.I. 0,0547 - 1,3589), srednji broj komplikacija u visokointenzivnom treningu izdržljivosti SMD 0,3606 (95% C.I. 0,0072 - 0,7141). Zaključak: Iako se pokazalo da fizioterapija vježbanjem poboljšava vitalni kapacitet i snagu respiratornih mišića, nije bilo usporedbe između različitih vrsta vježbanja. Dokazi iz ovih studija neizravne usporedbe ukazuju na to da tjelesnu aktivnost treba poticati tijekom preoperativnog razdoblja prije velikih abdominalnih kirurških zahvata kod onkoloških pacijenata

Internal Hernias in Acute Abdomen: Review of Literature and Report of four Cases

Internal hernias are very rare in clinical practice and surgeons often disregard internal hernias in spectrum of differential diagnosis in acute abomen. Reaching the diagnosis before internal hernia causes an acute abdomen, is difficult despite modern diagnostic tools, mostly because of wide range of symptoms and variable time of their occurrence. Furthermore, the lag in diagnosis may prove dangerous as they can cause acute bowel or intestinal obstruction. In such cases high mortality has been recorded. In fact, emergency exploratory surgery seems to be of high importance because timing directly influences the outcome. Herein we present four cases with developed acute abdomen due to internal hernia, treatments provided and their outcome along with review of literature

Dermatomyositis as paraneoplastic syndrome of peritoneal and ovarian relapse after long-term complete remission in patient with metastatic bilateral breast cancer [Dermatomiozitis kao paraneoplastički sindrom peritonealnog i ovarijalnog relapsa nakon dugog perioda potpune remisije u bolesnice s metastatskim bilateralnim rakom dojke]

Dermatomyositis is a rare disease characterised by inflammatory muscle affection and characteristic cutaneous changes. When occuring in a patient with cancer, dermatomyositis may indicate recurrence or progression and poor outcome. Herein, the treatment of metastatic breast cancer, metastatic pattern, characteristics of long-term survivors, and link between dermatomyositis and breast cancer are discussed and the literature reviewed. We report a 57-year old female patient with metastatic bilateral breast cancer whose ovarian and peritoneal relapse after long-term remission was disclosed by occurence of paraneoplastic dermatomyositis. The patient previously had a 15-year long disease free-period after primary treatment for breast cancer before onset of pulmonary dissemination. Following antracycline-based chemotherapy, the complete remission lasting another 15 years was accomplished. Dermatomyositis had been resolved upon induction of second-line taxane-based chemotherapy. After completion of six cycles of gemcitabine and paclitaxel chemotherapy, check-up revealed further progression. The patient subsequently underwent six cycles of third-line CAP chemotherapy (cyclofosfamide, doxorubicine, cisplatin) but disease progressed and oral capecitabine chemotherapy was initiated. The patient received four cycles of capecitabine followed by further vast progression and finally expired following massive pulmonary embolism. Our case stresses the need of thorough staging and check-up when dermatomyositis arises in patients with breast cancer, regardless of previous stable long-term complete remission. Furthermore, we believe that treatment with curative intent in young patients with metastatic breast cancer, who have good performance statuses and no comorbidities is required, because it is more likely to produce long-term complete remission. However, following disease relapse a poor outcome can be expected

Internal Hernias in Acute Abdomen: Review of Literature and Report of four Cases

Internal hernias are very rare in clinical practice and surgeons often disregard internal hernias in spectrum of differential diagnosis in acute abomen. Reaching the diagnosis before internal hernia causes an acute abdomen, is difficult despite modern diagnostic tools, mostly because of wide range of symptoms and variable time of their occurrence. Furthermore, the lag in diagnosis may prove dangerous as they can cause acute bowel or intestinal obstruction. In such cases high mortality has been recorded. In fact, emergency exploratory surgery seems to be of high importance because timing directly influences the outcome. Herein we present four cases with developed acute abdomen due to internal hernia, treatments provided and their outcome along with review of literature

Karakteristike raka dojke ovisno o statusu mutacija u genima BRCA1 i BRCA2 u Hrvatskoj

Breast cancer (BC) represents 25% of all malignancies in Croatian women, and in 18.8% of cases, it is diagnosed before the age of 50. Croatia launched BRCA testing of people at increased family risk. Hereditary BC is mainly caused by a pathogenic mutation in the BRCA1 or BRCA2 gene and is a significant risk factor for developing breast and ovarian cancer. The present study included 127 women diagnosed with BC, with a strong family history of BC and the known status of the germline mutations in the BRCA1/BRCA2 genes. The majority of women were BRCA1/2 mutation non-carriers, while 15.7% were BRCA1/2 mutation carriers, and 4% had a variant of unknown significance (VUS). BRCA1/2 mutation carriers were younger than non-carriers (median 38.5 years vs. 44 years) (P=.01) and had tumors of higher histological grade (P<.001). The intrinsic subtype of BC differs significantly depending on the type of mutation (P<.001). Triple-negative BC prevailed (87.5%) in BRCA1 mutation carriers, and 12.5% had a luminal B/HER2-negative BC. Four patients were BRCA2 mutation carriers, and two of them had luminal B/HER2-positive BC. Most BRCA1/2 non-carriers (69.2%) and all VUS-carriers have luminal B/HER2-negative BC. Our results show that BRCA1/2 mutation testing is essential for women with a family history burden. It is a piece of valuable information in breast cancer risk assessment and contributes to early diagnosis.Rak dojke predstavlja 25% svih zloćudnih bolesti u žena u Hrvatskoj, a u 18,8% slučajeva dijagnosticira se prije 50. godine života. Nasljedni rak dojke uglavnom je uzrokovan patogenom mutacijom u genima BRCA1 ili BRCA2 te predstavlja glavni čimbenik rizika za razvoj raka dojke i jajnika. Stoga je Hrvatska pokrenula testiranje mutacija u genima BRCA1 i BRCA2 kod osoba koje, prema smjernicama za genetičko testiranje, imaju povećani obiteljski rizik. Ovo retrospektivno istraživanje obuhvatilo je 127 žena s pozitivnom obiteljskom anamnezom i utvrđenim statusom mutacija u genima BRCA1 i BRCA2, kojima je dijagnosticiran rak dojke. Većina žena nisu bile nositeljice mutacija u genima BRCA1 ili BRCA2 (BRCA1/2), dok je 15,7% bilo nositeljica mutacije BRCA1/2, a 4% je imalo varijantu nepoznatog značaja (VUS). Nositeljice mutacije BRCA1/2 bile su mlađe od ne-nositeljica (medijan 38,5 godina u odnosu na 44 godine) (P=.01) te su imale tumore višeg histološkog gradusa (P<.001). Intrinzični podtip raka dojke značajno se razlikuje ovisno o tipu mutacije (P<.001). Trostruko negativni podtip raka dojke prevladao je u nositeljica mutacija u BRCA1 (87,5%), a 12,5% imalo je luminalni B/HER2-negativni podtip. Četiri bolesnice bile su nositeljice mutacija u BRCA2 genu, od kojih dvije s luminalnim B/HER2-pozitivim rakom dojke. Većina bolesnica (69,2%) koje nisu nositeljice patoloških mutacija BRCA1/2 i sve one s VUS imale su luminalni B/HER2-negativni podtip raka dojke. Naši rezultati pokazuju da je testiranje mutacija u genima BRCA neophodno za žene s opterećenom obiteljskom anamnezom jer može igrati vitalnu ulogu u procjeni rizika od raka dojke i doprinjeti ranoj dijagnozi

Rodna ravnopravnost u vodećim onkološkim centarima

Background: Gender equality policy has been instituted in institutions across the European Union and the United States. Based on landscapes drawn over a decade ago about gender inequalities in health management. Oncology is projected to be a significant burden for healthcare systems very soon. Aim: to record leadership gender status in most prominent oncology institutions in 2022. Materials and methods: We searched the Organisation of European Cancer Institute website and the National Cancer Center Network Member Institutions website. We recorded the gender of the legal representative of the center (CEO/director). Results: The Organisation of the European Cancer Institute has a membership of 123 cancer centers, seven outside the European Union. Those situated in the EU have 17 leaders of the female sex (out of 116; 14,66%). While in the US, there are seven leaders of the female gender (out of 32; 21,88%). Conclusion: The introduction of gender equality policy in recent years slowly impacts the predominance of the male gender in leading positions of oncology centers.Uvod: Politika rodne ravnopravnosti uspostavljena je u institucijama diljem Europske unije i Sjedinjenih Država, na temelju pregleda stanja rađenih prije više od deset godina o rodnim nejednakostima u upravljanju zdravstvom. Predviđa se da će onkologija vrlo brzo biti značajan teret za zdravstvene sustave i jedno od područja koje će ekspandirati starenjempopulacije. Cilj: Istražiti rodni status upravljačke pozicije u vodećim onkološkim centrima u 2022. Materijali i metode: Pretražili smo web stranicu Organizacije Europskog instituta za rak i web stranicu institucija članica mreže Nacionalnih centara za rak. Zabilježili smo spol zakonskog zastupnika centra (CEO/direktor). Rezultati: Organizacija Europskog instituta za rak ima članstvo od 123 centra za rak, sedam izvan Europske unije. Oni koji se nalaze u EU imaju 17 voditeljica ženskog spola (od 116; 14,66%). Dok je u SAD-u sedam lidera ženskog spola (od 32; 21,88%). Zaključak: Uvođenje politike ravnopravnosti spolova posljednjih godina polako utječe na prevlast muškog spola na vodećim pozicijama onkoloških centara

Onkološko savjetovanje bolesnika i obitelji oboljelih od nasljednog karcinoma debelog crijeva

Colorectal cancer (CRC) is the third most common malignancy in the world. Thirty percent of all CRC cases are hereditary or familial forms of the disease. Approximately 5% of them represent well defined hereditary syndromes. Colon cancer syndromes are inherited autosomal dominant diseases, with exception of MUTYH associated polyposis, which is inherited in autosomal recessive manner. Most of CRC syndromes also carry significant risk of developing cancers of extra colonic localization.The clinician who deals with hereditary CRC patients should have a wide knowledge ofpresentation, genetics and cancer risks in hereditary CRC syndromes.In Croatia we donot have the center that systematically deals with CRC genetics, pharmacogenetics and hereditary CRC syndromes. Therefore, with this article, we systematically review the characteristics CRC syndromes.Kolorektalni karcinom je treći najčešći maligni tumor u svijetu. 30% slučajeva su nasljedni i familijarni oblici bolesti. Približno 5% nasljednih oblika čine dobro definirani nasljedni sindromi kolorektalnog karcinoma.To su nasljedne autosomno dominantne bolesti, s izuzetkom tzv. MUTYH polipoze koja se naslje|uje autosomno recesivno. Većina nasljednih sindroma kolorektalnog raka nosi rizik razvoja karcinoma drugih lokalizacija. Kliničar koji sudjeluje u liječenju oboljelih od kolorektalnog karcinoma trebao bi imati široko znanje o kliničkoj slici, genetici i rizicima za pojedine tumore u nasljednim sindromima kolorektalnog raka.U Hrvatskoj još uvijek nemamo centar koji bi se sustavno bavio genetikom kolorektalnog karcinoma, farmakogenetikom i nasljednim sindromima kolorektalnog raka. U ovom članku donosimo pregled i karakteristike nasljednih sindroma kolorektalnog raka

Prikaz slučaja rijetkog retroperitonealnog Schwannoma

Schwannoma is a tumor arising from peripheral nerve sheath, found very rarely in the retroperitoneal part of the pelvis. It can reach large proportions before causing symptoms due to mass effect and is mostly diagnosed incidentaly. We describe a pelvic retroperitoneal Schwannoma in a 67-year-old man presented with progressive pain in lower left abdominal quadrant with digestive discomforts, which lasted for three months. Patohistological examination after complete surgical excision revealed a Schwannoma.Schwannom je tumor koji potječe iz ovojnice perifernog živca. Retroperitonealni Schwanom smješten u zdjelici je izuzetno rijedak. Doseže velike dimenzije prije uzrokovanja simptoma zbog čega se obično slučajno dijagnosticira. Opisan je prikaz slučaja retroperitonealnog Schwannoma zdjelice u 67-godišnjeg muškarca s progresivnim bolovima u donjem lijevom kvadrantu abdomena i probavnim smetnjama, u trajanju od tri mjeseca. Kirurški je tumor potpuno odstranjen i patohistološka dijagnoza je Schwannom

Transanal ekscizija za rektalni karcinom - multidisciplinarni pristup?

Incidence of rectal cancer in Croatia was 1174 cases in 2012. Most cases were diagnosed at an advanced stage, however there are a few diagnosed in cT1-2N0M0 stage which opens a window for transanal resection. These patients have to be staged meticulously not to disregard possible local spread of disease and nodal involvement. Endorectal ultrasound is not always easily available, therefore MRI is usually the method of choice for preoperative staging. Nevertheless, since the implementation of this mode of treatment advances in neoadjuvant and adjuvant therapy and multidisciplinary approach to treatment have blurred these clear cut indications. In this paper we discuss specificities in selection, treatment and follow up of these patients.Incidencija karcinoma rektuma u Hrvatskoj je oko 1174 slučajeva u 2012 godini. Većina slučajeva je dijagnosticirana u poodmaklim stadijima bolesti, ipak odre|en broj se dijagnosticira u cT1-T2N0M0 stadiju što otvara mogućnost za transanalnu eksciziju. Pacijenti kod kojih se predvi|a trananalna ekscizija moraju biti u potpunosti slikovno obrađena kako se preoperativno ne bi previdjela proširenja bolest. Endorektalni ultrazvuk nije široko dostupan, tako da se najčešće koristi MR pri odluci o vrsti zahvata. Unatoč dosta jasno definiranim indikacijama za ovaj zahvat, napredak u neoadjuvantom i adjuvantnom pristupu te multidisciplinarnosti liječenja je iste relativizirao. U ovom preglednom radu raspravit ćemo izbor, vrstu liječenja i praćenja ovih pacijenat

Prikaz slučaja rijetkog retroperitonealnog Schwannoma

Schwannoma is a tumor arising from peripheral nerve sheath, found very rarely in the retroperitoneal part of the pelvis. It can reach large proportions before causing symptoms due to mass effect and is mostly diagnosed incidentaly. We describe a pelvic retroperitoneal Schwannoma in a 67-year-old man presented with progressive pain in lower left abdominal quadrant with digestive discomforts, which lasted for three months. Patohistological examination after complete surgical excision revealed a Schwannoma.Schwannom je tumor koji potječe iz ovojnice perifernog živca. Retroperitonealni Schwanom smješten u zdjelici je izuzetno rijedak. Doseže velike dimenzije prije uzrokovanja simptoma zbog čega se obično slučajno dijagnosticira. Opisan je prikaz slučaja retroperitonealnog Schwannoma zdjelice u 67-godišnjeg muškarca s progresivnim bolovima u donjem lijevom kvadrantu abdomena i probavnim smetnjama, u trajanju od tri mjeseca. Kirurški je tumor potpuno odstranjen i patohistološka dijagnoza je Schwannom