scholarly journals Experience in the successful application of extracorporeal methods in treatment of tumor lysis syndrome

2021 ◽  
Vol 20 (2) ◽  
pp. 106-110
Author(s):  
D. G. Voroshin ◽  
V. V. Beloborodov ◽  
А. V. Vazhenin ◽  
М. А. Ermakov
Keyword(s):  
Intensive Care Unit ◽  
Nuclear Medicine ◽  
Intensive Care ◽  
Clinical Case ◽  
Tumor Lysis Syndrome ◽  
Healthcare Institution ◽  
Special Treatment ◽  
Antitumor Therapy ◽  
Tumor Lysis ◽  
Clinical Center

Introduction. This article, using a clinical case as an example, reflects the problem of the development of tumor lysis syndrome (TLS). The most common cause of SLO development is antitumor treatment: radiation therapy, radiofrequency ablation, vascular embolization, the use of monoclonal antibodies, high-dose chemotherapy with transplantation of stasis from peripheral blood. This disorder leads to the development of metabolic, hemodynamic, respiratory and renal disorders. The TLS distinguished by high mortality rates, from 17% to 70%.Materials and methods. Presented a clinical case of patient, 30 years old - observation of successful treatment of TLS of the III degree of clinical course according to Cairo-Bishop, in the conditions of the State Budgetary Healthcare Institution «Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine», in the conditions of the intensive care unit and intensive care with the use of renal replacement therapy on the Prismaflex device.Results and discussion. When the patient applied to the State Budgetary Healthcare Institution «Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine», the diagnosis made — Non-Hodgkin lymphoma with a diffuse type of growth of a high degree of malignancy. Revealed the defeat of the lymph nodes, parietal pleura, right hemithorax, atelectasis of the middle lobe of the right lung with air bronchography, hydrothorax on both sides, hydropericardium, free fluid in the pelvic cavity, phlebolitis of the parametric tissue, degenerative-dystrophic changes in the spine. On the first day of hospitalization, antibacterial and pain relief therapy started, and nutritional disturbances were corrected. After the pre-phase chemotherapy (cyclophosphamide, vincristine), the patient's condition worsened, she was transferred to the intensive care unit. Where was the treatment carried out: convulsive syndrome, respiratory failure, acute renal failure, bilateral pneumonia, PE. Against the background of this therapy, special treatment continued - 2 cycles of chemotherapy. After the patient transferred to spontaneous breathing and the indices of blood slags and potassium were normalized, she was transferred to the antitumor therapy department to continue special treatment. Conclusion. Our algorithm for the treatment of SLO led to positive dynamics and the possibility of carrying out special antitumor therapy for this patient. 

scholarly journals Hyperleucocytosis in children with acute mieloid leukemia

2020 ◽  
Vol 19 (1) ◽  
pp. 116-121
Author(s):  
N. V. Zacharov ◽  
I. I. Kalinina ◽  
D. A. Venev ◽  
T. Y. Salimova ◽  
D. A. Evseev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tumor Lysis Syndrome ◽  
Blood Transfusions ◽  
Review Of The Literature ◽  
Specific Therapy ◽  
Important Place ◽  
Tumor Lysis ◽  
Life Threatening

This article presents analysis of recent publications on hyperleukocytosis in children with AML. The mechanisms of the development of life-threatening complications accompanying hyperleukocytosis are analyzed in detail. In this review of the literature, the authors focus on the adequacy and timing of therapy for such life-threatening complications of hyperleukocytosis as leukostasis, DIC, and acute tumor lysis syndrome. The authors emphasize that in the treatment of hyperleukocytosis an important place, in addition to specific therapy, is taken by the accompanying therapy in the intensive care unit. The place of replacement blood transfusions and leukopheresis as part of the accompanying therapy is discussed.

Oncologic Emergencies

2011 ◽  
Vol 22 (4) ◽  
pp. 337-348 ◽  
Author(s):  
Regan Demshar ◽  
Rachel Vanek ◽  
Polly Mazanec
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Superior Vena ◽  
Tumor Lysis Syndrome ◽  
Vena Cava ◽  
Hemodynamic Instability ◽  
Cord Compression ◽  
Current Evidence ◽  
Oncologic Emergencies ◽  
Life Threatening

The picture of oncologic emergencies in the intensive care unit has changed over the past decade. The classic emergencies, that is, superior vena cava syndrome, spinal cord compression, tumor lysis syndrome and life-threatening hypercalcemia, are now routinely managed on the general oncology unit or in an outpatient setting. Vigilant monitoring for early signs of complications, proactive interventions to prevent complications, and aggressive management account for this change. Currently, emergent conditions that necessitate intensive care unit admission or transfer in the patient with cancer include respiratory failure, cardiac emergencies, hemorrhagic events and coagulopathies, sepsis, and hemodynamic instability. This article will present the current evidence-based management of these conditions, a brief summary of classic oncologic emergencies, and the role of the critical care nurse in meeting the multidimensional needs of the patient and family during the life-threatening episode, based on Ferrell’s quality of life model.

Assembling (non) treatable cases: The communicative constitution of medical object in doctor–doctor interaction

2017 ◽  
Vol 19 (1) ◽  
pp. 30-48 ◽  
Author(s):  
Letizia Caronia ◽  
Arturo Chieregato ◽  
Marzia Saglietti
Keyword(s):  
Infectious Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Case ◽  
Disease Diagnosis ◽  
Ethnographic Study ◽  
Discursive Construction ◽  
Medical Object ◽  
Communicative Constitution ◽  
The One

Research on medical interactions shows how the discursive construction of the clinical case impacts diagnostic reasoning and treatment recommendations. Drawing on an ethnographic study in an intensive care unit, we illustrate how this process is at play in a ward that adopts an extreme, guideline-divergent policy as to the use of antibiotics. The article focuses on how physicians assemble the case as ‘treatable’ or ‘not yet treatable’, and how in doing so they ‘talk into being’ two contrastive policies on antibiotics and position themselves toward the one adopted in the ward. The analysis identifies the discursive resources displayed by physicians to both project an infectious disease diagnosis and resist this treatment-implicative trajectory. We argue that the physicians’ contentious discursive construction of the case has crucial consequences in the way the ward’s extreme policy is jointly accomplished as a highly reflexive process sensitive to the contingencies of any particular case.

scholarly journals The impact of prehospital management of trauma patients on outcome of ICU treatment at Emergency center CC "Vojvodina" - one - year experience

2016 ◽  
Vol 63 (2) ◽  
pp. 19-26
Author(s):  
Vesna Pajtic ◽  
Dunja Mihajlovic ◽  
Vladimir Vrsajkov ◽  
Aleksandar Gluhovic ◽  
Slavko Lovrencic
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Trauma Center ◽  
Venous Access ◽  
Emergency Center ◽  
Prehospital Treatment ◽  
Clinical Center ◽  
One Year ◽  
Injured Patients ◽  
The Impact

Impact of prehospital treatment of traumatized patients on treatment outcome in intensive care unit at Emergency center Clinical center of Vojvodina-one year experience Introduction: Trauma is the leading cause of death in 1-44 years old population. Recommendations of prehospital treatment of injured patients rely on the speed of response and transport to referent trauma center, where the patient will be adequately treated. Aim: The aim of our study was to investigate the impact of prehospital treatment and characteristics of patients before admission of patients to Emergency center-Clinical center of Vojvodina on survival of these patients in intensive care unit of Emergency center in order to improve the treatment and outcome of these patients. Material and methods: 209 patients who were treated in intensive care unit after the initial resuscitation in Emergency center-Clinical center of Vojvodina were included in our study. Data were analyzed using SPSS 20.0 software. Differences between groups of patients were assessed by Mann-Whitney U test. Categorical variables were compared using chi-square test. Statistical significance (p) was set at a value of 0.05. Results; Patients with worse outcome were significantly older than patients who had good outcome (49.4?18.5 vs. 63?14.7, p<0.05). Patients with manifestations of hypovolemic shock, respiratory distress and with GCS=8 on admission to Emergency center also had significantly worse outcome. Patients who had been intubated before admission to Emergency center had significantly better outcome in comparison to patients who did not have secured airway (p<0.05). However the placement of venous accessin prehospital setting did not impact survival significantly. Patients who were initially treated in regional hospitals had venous access and airway placement significantly in higher percent than patients treated by emergency medical service. Conclusion: While there is no strong evidence to support the benefits of airway and venous access management in injured patients in prehospital setting, our results suggest that these interventions can be beneficial if the transport to referent trauma center is long and if they are completed by educated medical staff.

scholarly journals Recurrent squamous cell carcinoma of head and neck: results of treatment in the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in 2012–2016

2020 ◽  
Vol 10 (1) ◽  
pp. 20-28
Author(s):  
R. Yu. Karabut ◽  
A. V. Vazhenin ◽  
E. Y. Mozerova ◽  
T. M. Sharabura ◽  
M. M. Sarycheva ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Nuclear Medicine ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Combined Treatment ◽  
Special Treatment ◽  
Results Of Treatment ◽  
Clinical Center ◽  
Recurrent Squamous Cell Carcinoma

Introduction. There is no treatment for recurrence of head and neck squamous cell carcinoma, which significantly increases the overall survival (OS) of patients.The study objective is to analyze the results of treatment of patients with recurrences of squamous cell carcinoma of the head and neck and to assess the impact of risk factors for relapse, as well as different treatment options for relapse on OS. Materials and methods. In the period from 2012 to 2016, 182 patients with relapses of squamous cell carcinoma of the larynx, oral cavity and tongue received treatment in the Chelyabinsk regional clinical center of Oncology and nuclear medicine. The group 1 included 66 patients with resectable relapse who were operated. The group 2 consisted of 25 patients who received a course of radiation therapy. The group 3 consisted of 46 patients who underwent chemotherapeutic treatment of relapse. The group 4 was represented by combined treatment (surgery + radiation therapy), this group included 9 people. The group 5 consisted of those of patients who were not specifically treated for relapse because of the low Karnofsky index in patients (<70 %). Results. OS among patients who received special treatment was significantly higher compared with the group of symptomatic therapy. The median OS in the special treatment group was 40 months, and without it – 18 months. Comparing all types for treating relapse, the highest rates of OS were in the surgical treatment group. OS rates in combined therapy group and radiotherapy group were comparable rate in the radiotherapy. The lowest OS rate was after chemotherapy (only 21 months).Conclusion. Surgery is the optimal method for treating recurrent squamous cell carcinoma of head and neck, if it is resectable. If surgical treatment is not possible, no other method significantly increases the OS. If the overall status of the patient is normal, re-radiation or polychemotherapy may be performed. A limited category of patients can be subjected to combined treatment for relapse. 

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