Oncologic%20Emergencies

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(No Transcript)
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Oncologic Emergencies
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Cardiothoracic E.
1- ?????? ????? ????? ???? ?????? ???
????????????? ??? ? ???? ?????? ????? ????
??????? ????????????? ?? ???? 2- ?? ???????
????? Superior vena cava syndrom) SVCS )
(Superrior mediastinal syndrom) SMS
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SVCS- SMS

• 1- ?? ????? ????- ?????? ?? ??????? ?? ????????
  ?????? SVCS
• 2- ???? ?? ????? SMS
• 3- ??( Mediastinal mass (M-M ???? ?? ?? ????
  ?????.

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????????

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

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?????????????

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

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?????

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

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?????

• 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

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Treatment

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

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Spinal cord compression

• 1- ?? 5-3 ??????? ?? ?????
• 2- ?????? ?? ???????? ??? ??????? ?? SC
• ???? ??? ??????????? - .Germ cell T - ????? -
  ????? CNS

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????? ?????? ???????

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

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?????

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

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Hyperleukocytosis

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

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????? ?????? ???? ?????- ????? ??? ???????-
?????- ???? ??????-????- ????- ??????- ????? ????

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

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Tumor lysis syndrome

• 1- ?? ??? ??? ??????
• 2- ????? ??????????- ???????????- ?????????(
  ??????????)
• 3- ???? ??? ?? ???? ?????? ?? 72 ???? ?? ???? ??

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???????? ? ?????????????

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

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????? ? ????? ???????

• 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
  
  

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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

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