Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Allogeneic hematopoietic progenitor cell (HPC) transplantation is an established therapy for many hematologic disorders. HPCs may be collected from bone marrow, peripheral blood, or umbilical cord blood. In order to minimize the risk for healthy HPC donors, thorough investigation is required before donation. ⋯ Recently, a report of AML developing in a 62-year-old female donor 14 months after G-CSF-primed PBPC donation has been published. Whether G-CSF therapy contributed to the development of this cancer is unknown, but future studies should carefully follow the donors and report any similar event. According to currently available evidence, the risk of major late toxicities secondary to administration of G-CSF is minimal.
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Allogeneic hematopoietic stem cell transplantation is a standard therapeutic option in the treatment of patients with malignant hematologic diseases and some acquired or inherited nonmalignant hematologic disorders. It is the most efficacious method for eradication of acute leukemia, its efficacy being described by DFS (Disease Free Survival) and OS (Overall Survival), however, still associated with a high Transplant Related Mortality (TRM) rate. ⋯ Since that time, 281 patients with acute leukemia have undergone allotransplantation at our Department. Results are presented of 72 patients with acute myeloid leukemia transplanted at our Department during the 1993-2007 period.
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Acute coronary syndrome (ACS) represents a significant global socioeconomic problem. In the United States, 6-7 million patients present to emergency service annually for chest pain or symptoms of ACS, the diagnosis of ACS being confirmed in 20-25% of these patients. There are two groups of ACS patients, with chest pain as the main and common the presentation that basically has the same pathophysiologic substrate. ⋯ It should be noted that history data, ECG findings and testing for cardiac markers are of particular importance in setting the diagnosis of ACS. Other useful methods of risk assessment include TIMI degree of risk, which is in general use because of its simplicity, but is less predictive, and the Pursuit and Frisco degree of risk. Regardless of the method used, it is recommended to determine the degree of risk for every patient on admission and at discharge.
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By establishing the Croatian network of primary PCI more patients can now be treated by this method every year. Nevertheless, therapeutic success depends on appropriate, i.e. complete antithrombotic therapy. On the other hand, about half of inhabitants of Croatia have not yet been covered with primary PCI network. ⋯ Heparin is an essential part of therapy for almost all acute coronary syndrome scenarios, but the role of low-molecular heparins is yet to be clarified. Fibrinolytic therapy still "saves lifes". By improving new fibrinolytics, they have become easier to use, entail less side effects and are more efficient.
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The goal of palliative care is to provide the best possible quality of life for patients and their families in the process of dying as well as before, during the course of illness. Emphasis is on the role of team approach in every aspect of patient care. The moral principles of sacredness of life and the right of personal autonomy may occasionally come in conflict. ⋯ The role of the "directive for the future" and proxy-decision-makers becomes problematic for the following reasons. By the time when the directives should be implemented many forms of medical treatment have been further developed, so that the illness may have become curable or treatment easier. Older and weak people that need care and feel they pose a burden could feel forced to sign directives for the future if they are legally obligatory.