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Oncologic%20Emergencies

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Oncologic Emergencies ... CNS 1- S.C.C= Back pain 2 ... – PowerPoint PPT presentation

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Title: Oncologic%20Emergencies


1
(No Transcript)
2
Oncologic Emergencies
3
Cardiothoracic E.
1- ?????? ????? ????? ???? ?????? ???
????????????? ??? ? ???? ?????? ????? ????
??????? ????????????? ?? ???? 2- ?? ???????
????? Superior vena cava syndrom) SVCS )
(Superrior mediastinal syndrom) SMS
4
SVCS- SMS
  • 1- ?? ????? ????- ?????? ?? ??????? ?? ????????
    ?????? SVCS
  • 2- ???? ?? ????? SMS
  • 3- ??( Mediastinal mass (M-M ???? ?? ?? ????
    ?????.

5
????????
  • 1- SVCS ????? ?????
  • 2- ?? ????? 3/721 ???? ??? ???? SMS ? SVCS?
  • (NHL( 70?(30) HD ?? M.M ?????? ????? ?????
  • ???? ??? ???????????? ALL,Gemm cell T
  • 3- 75 ?????? ?? M.M ??????? ????? ??????.

6
?????????????
  • 1- SVC ????? ?????? ????? ???? ? ????
    ????????????? ????? ???.

7
?????
  • 1- ????? ????- ???????- ????????- ?????? ???
  • 2- ???? ??? ????? ?? ????? Supine
  • 3- ?? ?????? ???? ??????? ?????? ?? ????? ?????
    ????? ??????? ??????
  • ???????? ?????? ??????????? ?????? ( NHL)
  • 4- ????? ????Ct- Scan- C.X.R

8
?????
  • SVCS C.X.R Mass CBC
    Diagnostic T.
  • SMS Other study
    non-D
  • Biopsy
    Low-Risk
  • T. Biopsy Low-Risk
    Assess RISK

  • T. High-Risk
  • T. High-Risk

9
Treatment
  • 1- Radiation ( ARF????? ??????? ???)
  • 2-Chemotherapy ( ???? ?????????? 1mg/kg
    ?????????? mg/m240 - ????????????)
  • 3-Surgical ( ????????? ?? ?? ????? ???? ????
    ???? ? ???? ?? ????? ????
  • Teratoma-large cell lymphoma- neuroblastoma-germ
    cell tumor-benign tumor

10
Spinal cord compression
  • 1- ?? 5-3 ??????? ?? ?????
  • 2- ?????? ?? ???????? ??? ??????? ?? SC
  • ???? ??? ??????????? - .Germ cell T - ????? -
    ????? CNS

11
????? ?????? ???????
  • 1- ?? ?? ???? ????? ?? ????? ?? S.C.C Back pain
  • 2- ??? ????? ?? ???????? ??? ( 80)
  • 3- ????? ????? ?bone Scan? ????????? ??????? CT
  • ?? ??? ???? T1-T2 Weighted MRI ?? ?? ????
    ??????????

12
?????
  • 1- ?????????? mg/kg 1-2( ?? ????? ????????) mg/kg
    0.25- 0.5 ?? ?? ????
  • 2-?????????? Local ?
  • Surgical decompression,Chemotherapy
  • (laminectomy,Posterior decompression)
  • 3-????? (?? ????? ?? ??? ??????? ? ?? ??????
    ????? ??? ??? ??????????) ?????????? ????
  • 4-???? ?????? ( ?????- ?????- ??????????)

13
Hyperleukocytosis
  • 100/00ltWBC-1
  • 2- ????? ??????? ????? ??? ??
  • AML ?????? ?? 200/000
  • ? ?? ALL ?????? ?? 300/000
  • ? ?? CML ?????? ?? 300/000

14
????? ?????? ???? ?????- ????? ??? ???????-
?????- ???? ??????-????- ????- ??????- ????? ????
  • ?????
  • 10gtHb ? ??? 7gt P.C - Hb ???? ????
  • 20/000gtPLT ????? ???? ???
  • ???????- ????????- ??????????
  • ( 52-65) Exchange T.
  • (48-62) Leukapheresis

15
Tumor lysis syndrome
  • 1- ?? ??? ??? ??????
  • 2- ????? ??????????- ???????????- ?????????(
    ??????????)
  • 3- ???? ??? ?? ???? ?????? ?? 72 ???? ?? ???? ??

16
???????? ? ?????????????
  • 1- ?????? ?? ??? ????- ???????- ????? ?? ???? ??
    ???? ?????? ???.
  • 2- ?????? ??????- ??????????? ??????- ALL (
    ??????? Tcell)
  • ( ???? ?? ??????????- ????????????- ????????
    ????-???????? ???? ???? ???)
  • 3- ?? CML,AML ??? ??? WBC ???? ???? ???.
  • 4- Advanced age ?? ( 5.4 10.4 ???) ?? ??????
    ?????? ARF
  • 5- ???? ??????????? K ???? ? ?? ????????? ??????
    ???? ????????? ???? ?????.
  • ????????? ???? ????? ???? ????? ???? ????? ??? .
  • PCa gt60 ???? ???????? ???
    Ca
  • ???? ??????? ???? ????? ?? ????? ???? ?
    ????????????
  • ???? ????? ????? ?? ????? ???? ? ????????????
    ARF

17
????? ? ????? ???????
  • 1- Fullness or abdominal pain -??? ???- ???????-
    ????? ????????- ???????- ?????- ??????- ?????-
    ????- ????? ?? ??? ??????? Hypocalcemia
  • 2- ?????? ???? ??? - ???? ? ??? ???- ???? ????-
    ?????? ?????? ?? ????
  • 3- ????????
  • CBC_BUN-Cr-Na-K-HCo3-Ca-P-CL-Acid uric
    -U/A
  • 4-ECG ?? K ?????? ?? 6 Wide ??? Peak T- QRS
  • 5-???????????Prolonged Q.T interval


18
Typhlitis
  • 1-Necrotizing colitis localized in the cecum in
    the setting of severe neut.( Leukemia-BMT)
  • with right lower quadrant pain.
  • Obstruction_ Bacterial invasion _
    Perforation_Peritonitis_ Septic shock
  • Clostridium septicum (The most)_ gram negative
    (Pseudomonas aeraginosa)
  • Mortality50-100

19
D Neut.Patientright lower quaderant painmass
pneumatosis intestinalis-thickening bowel wall in
the cecum.CT-Scan diffuse thickening
20
  • TMedical( NPO-NG-tube-Antibiotic)
  • Surgical indication
  • Persistant GI-bleeding- perforation -clinical
    deterioration
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