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Keywords: adenokarcinom želodca, priporočila, prebavni trakt, multidisciplinarno zdravljenje
Published in DiRROS: 16.12.2021; Views: 1112; Downloads: 498
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Abstract: V Sloveniji vsako leto zboli zaradi raka želodca okrog 450 bolnikov, od tega ima tri četrtine bolnikov ob postavitvi diagnoze razširjeno ali razsejano bolezen. Zato je pomembno, da imamo razvito sodobno multidisciplinarno zdravljenje. Onkološki inštitut je na poti pridobitve evropske onkološke akreditacije, ki jo podeljuje priznana Evropska organizacija onkoloških inštitutov (OECI), katere član je tudi Onkološki inštitut Ljubljana. Namen tega projekta je razvoj kliničnih poti, ki bodo omogočile celostno obravnavo bolnikov z rakom. Slovenskih priporočil za zdravljenje adenokarcinoma želodca trenutno nimamo, zato smo bili primorani sprejeti te, ki jim bomo sledili na Onkološkem inštitutu. V teh priporočilih, zaradi drugačne narave bolezni, ni zajeto zdravljenje raka ezofagogastričnega stika.
Keywords: rak želodca, adenokarcinom, onkološko zdravljenje, priporočila
Published in DiRROS: 14.09.2021; Views: 1380; Downloads: 367
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Abstract: Background. Mortality rates for patients with ARDS remain high. We assessed temporal changes in the epidemiology and management of ARDS patients requiring invasive mechanical ventilation in European ICUs. We also investigated the association between ventilatory settings and outcome in these patients. Methods. This was a post hoc analysis of two cohorts of adult ICU patients admitted between May 1–15, 2002 (SOAP study, n = 3147), and May 8–18, 2012 (ICON audit, n = 4601 admitted to ICUs in the same 24 countries as the SOAP study). ARDS was defined retrospectively using the Berlin definitions. Values of tidal volume, PEEP, plateau pressure, and FiO2 corresponding to the most abnormal value of arterial PO2 were recorded prospectively every 24 h. In both studies, patients were followed for outcome until death, hospital discharge or for 60 days. Results. The frequency of ARDS requiring mechanical ventilation during the ICU stay was similar in SOAP and ICON (327[10.4%] vs. 494[10.7%], p = 0.793). The diagnosis of ARDS was established at a median of 3 (IQ: 1–7) days after admission in SOAP and 2 (1–6) days in ICON. Within 24 h of diagnosis, ARDS was mild in 244 (29.7%), moderate in 388 (47.3%), and severe in 189 (23.0%) patients. In patients with ARDS, tidal volumes were lower in the later (ICON) than in the earlier (SOAP) cohort. Plateau and driving pressures were also lower in ICON than in SOAP. ICU (134[41.1%] vs 179[36.9%]) and hospital (151[46.2%] vs 212[44.4%]) mortality rates in patients with ARDS were similar in SOAP and ICON. High plateau pressure (> 29 cmH2O) and driving pressure (> 14 cmH2O) on the first day of mechanical ventilation but not tidal volume (> 8 ml/kg predicted body weight [PBW]) were independently associated with a higher risk of in-hospital death. Conclusion. The frequency of and outcome from ARDS remained relatively stable between 2002 and 2012. Plateau pressure > 29 cmH2O and driving pressure > 14 cmH2O on the first day of mechanical ventilation but not tidal volume > 8 ml/kg PBW were independently associated with a higher risk of death. These data highlight the continued burden of ARDS and provide hypothesis-generating data for the design of future studies.
Keywords: respiratory insufficiency, artificial respiration, tidal volume, airway pressures, driving pressure
Published in DiRROS: 16.06.2021; Views: 1161; Downloads: 543
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Abstract: Izhodišče: Zdravilo olaparib uporabljamo za vzdrževalno peroralno zdravljenje recidivnega epitelijskega raka jajčnikov z mutacijami v genih BRCA 1 in BRCA 2 pri bolnicah, ki se odzovejo na kemoterapijo s preparati platine. Namen: Prikazati varnost in učinkovitost zdravljenja s poli-ADP riboza polimeraznim (PARP) inhibitorjem olaparibom v redni klinični praksi v sklopu vzdrževalnega zdravljenja recidivnega epitelijskega raka jajčnikov z mutacijami v genih BRCA 1 in BRCA 2. Metode: V retrospektivno analizo smo vključili bolnice z recidivnim epitelijskim rakom jajčnikov z mutacijami v genih BRCA 1 in BRCA 2, ki so se začele zdraviti z olaparibom na Onkološkem inštitutu Ljubljana v obdobju od 1. novembra 2015 do 31. decembra 2020. Cilja raziskave sta bila oceniti varnost in učinkovitost zdravila olaparib (preživetje brez ponovitve bolezni, celokupno preživetje). Raziskavo je odobrila etična komisija na Onkološkem inštitutu Ljubljana. Rezultati: V opazovanem obdobju je bilo z olaparibom zdravljenih 88 bolnic z recidivnim epitelijskim rakom jajčnikov z mutacijami v genih BRCA 1 in BRCA 2. Mediana starost bolnic je bila 60 let. Večina (61 %) je imela prvi recidiv bolezni, prav tako večina (74 %) je imela tudi zarodno mutacijo v genu BRCA 1. Večina bolnic (85 %) je nadalje imela vsaj en neželeni učinek zdravljenja z olaparibom. Najpogostejši (vse stopnje) so bili: slabost (59 %), utrujenost (59 %), anemija (25 %), dispepsija (14 %), tekoče blato (11 %), spremembe okusa (10 %), nevtropenija (6 %) in aritmija (1 %). Resne neželene učinke (stopnje 3/4) je imelo 10 % bolnic: pojavljali sta se anemija (9 %) in slabost (1 %). Mediani čas sledenja je bil 40 mesecev. Mediano preživetje brez ponovitve bolezni je bil 14,3 meseca, mediano celokupno preživetje pa 20,4 meseca. Preživetje brez napredovanja bolezni je bilo odvisno od vrste mutacije v genih BRCA: pri somatski mutaciji v genih BRCA 1/2 je bilo 80 % bolnic brez progresa bolezni, pri zarodni mutaciji BRCA 2 je bilo teh 55 % bolnic, pri zarodni mutaciji BRCA 1 pa 32 % (p = 0,021). Vrsta mutacije v genih BRCA 1/2 ni imela vpliva na celokupno preživetje bolnic.
Keywords: epitelijski rak jajčnikov, olaparib, BRCA 1/2, genska mutacija
Published in DiRROS: 10.06.2021; Views: 1115; Downloads: 320
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Keywords: zunanje spolovilo, rak (medicina), diagnostika, zdravljenje
Published in DiRROS: 07.04.2021; Views: 1279; Downloads: 473
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