Acta clinica Croatica
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Acta clinica Croatica · Nov 2019
ReviewWHICH PATIENTS SHOULD RECEIVE RADIOTHERAPY IN POSTOPERATIVE DISEASE RECURRENCE?
After radical prostatectomy (RP), up to 60% of patients with high-risk prostate cancer (PC), such as high Gleason score, extracapsular prostatic extension (ECE), positive margins, seminal vesicle involvement (SVI), will develop biochemical relapse and they will require further local treatment. Radiotherapy (RT) to the prostate bed has been used as adjuvant (ART) or salvage (SRT). ⋯ Only a few observational studies have compared RP patients who have received only RT with patients who have received RT with some form of hormonal therapy. A few of them have reported improved progression-free survival with addition of hormonal therapy to SRT, but benefit in overall survival (OS) is not yet known.
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The leading cause of death in patients with prostate cancer are cardiovascular diseases. Androgen deprivation therapy is the mainstay of treatment in prostate cancers. ⋯ It is important to point out that prostate cancer survivors have increased prevalence of coronary artery disease, cerebrovascular stroke, myocardial infarctions and cardiovascular mortality. Due to these reasons particular care on prevention and treatment of cardiovascular diseases should become a standard of care in patients with prostate cancer.
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Acta clinica Croatica · Nov 2019
Case ReportsMANAGEMENT OF LOCALLY ADVANCED, AGGRESSIVE PROSTATE CANCER - CASE REPORT.
Treatment of locally advanced prostate cancer (PC) represents a challenge before multidisciplinary team (MDT), typically includes not only local disease control but also systemic therapy and it should be tailored to each individual patient. We present a case of a 58-year-old man, whose PC presented itself as a locally advanced disease. Bearing in mind the patients' age, absence of comorbidities but also his preferences, MDT decided that the rational first step in almost imminent multimodal treatment should be radical prostatectomy (RP). ⋯ The therapy was well tolerated, although there was one episode of transitory radiation cystitis roughly one year after its completion. After 45 months of follow-up the patient is without signs of biochemical recurrence of PC, with fully restored testosterone level and good quality of life. The main task in advanced PC management, through multidisciplinary approach, is providing good oncological outcome while trying to reduce treatment morbidity and to maintain a good quality of life.
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Acta clinica Croatica · Sep 2019
Case ReportsLEUKOCYTAPHERESIS IN THE MANAGEMENT OF SEVERE STEROID-DEPENDENT ULCERATIVE COLITIS.
Ulcerative colitis (UC) is a multifactorial disease of unknown precise etiology and immunopathogenesis. Peripheral blood granulocytes and monocytes/macrophages are the major sources of cytokines, which regulate inflammation. Leukocytapheresis (LCAP) is a method where blood is processed by apheresis system that removes lymphocytes and plasma before being returned to the body. ⋯ The clinical course was complicated with the development of metastatic colorectal carcinoma, which points to the importance of regular disease monitoring rather than the increased risk of malignant disease after LCAP. Patients with UC are a demanding group of patients that warrant the search for novel treatment strategies other than conventional pharmacological therapies. Although LCAP is still not a common treatment modality in our daily practice, data from recent studies suggest it to be an effective and safe procedure in the management of active UC patients.
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We present an atypical case of retrouterine gangrenous perforated appendicitis with Douglas abscess in a 33-year-old woman, with clinical picture developing over two weeks. Laparotomy and appendectomy with abdominal drainage and antibiosis were performed and resulted in complete recovery.