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Informing 1

What Is Chemotherapy?
Chemotherapy is the treatment of with drugs that can destroy cancer cells.
These drugs often are called anticancer drugs.

How Does Chemotherapy Work?
Normalcells grow and die in a controlled way. When cancer occurs,cells in thebody that are not normal keep dividing and forming morecells withoutcontrol. Anticancer drugs destroy cancer cells bystopping them fromgrowing or multiplying. Healthy cells can also beharmed, especiallythose that divide quickly. Harm to healthy cells iswhat causes sideeffect. These cells usually repair themselves afterchemotherapy.Because some drugs work better together than alone, oftentwo or moredrugs are given at the same time. This is called combination chemotherapy.

Othertypes of drugs may be used to treat your cancer. These may includecertain drugs that can block the effect of your body's hormones. Ordoctors may use biological therapy,whichis treatment with substances that boosts the bodys own immunesystemagainst cancer. Your body usually makes these substances insmallamounts to fight cancer and other diseases. These substances canbe madein the laboratory and given to patients to destroy cancer cellsorchange the way the body reacts to a tumor. They may also help thebodyrepair or make new cells destroyed by chemotherapy.

What Can Chemotherapy Do?
Depending on the type of cancer and how advanced it is, chemotherapy can be used for different goals:
  • To cure the cancer. Cancer is considered cured when the patient remains free of evidence of cancer cells.
  • To control the cancer.Thisis done by keeping the cancer from spreading; slowing thecancersgrowth; and killing cancer cells that may have spread to otherparts ofthe body from the original tumor.
  • To relieve symptoms that the cancer may cause. Relieving symptoms such as pain can help patients live more comfortably.
Is Chemotherapy Used With Other Treatments?
Sometimeschemotherapy is the only treatment a patient receives. Moreoften,however, chemotherapy is used in addition to surgery, radiation therapy, and/or biological therapy to:
  • Shring a tumor before surgery or radiation therapy. This is called neo-adjuvant therapy.
  • Help destroy any cancer cells that may remain after surgery and/or radiation therapy. This is called adjuvant chemotherapy.
  • Make radiation therapy and biological therapy work better.
  • Help destroy cancer if it recurs or has spread to other parts of the body from the original tumor.
Which Drugs Are Given?
Somechemotherapy drugs are used for many different types of cancer,whileothers might be for just one or two types of cancer. Yourdoctorrecommends a treatment plan based on:
  • What kind of cancer you have.
  • What part of the body the cancer in found.
  • The effect of cancer on your normal body functions.
  • Your general health.
Getting the Support You Need:
Chemotherapy,like cancer, can bring major changes to a persons life.While it canhelp cure your cancer, it can sometimes effect overallhealth, causestress, disrupt day-to-day schedules, and strain personalrelationships.It is no wonder, then, that some people feel tearful,anxious, angry, ordepressed at some point during their chemotherapy.
These emotionscan be perfectly normal, but they can also bedisturbing. Fortunately,there are ways to deal with these emotionalside effects, just as thereare ways to cope with the physical sideeffects of chemotherapy.

How Can I Get Support?
You can draw on many sources of support. Here are some of the most important:
Doctors,nurses and other health professionals. If you have questionsor worriesabout your cancer treatment, talk with members of yourhealth care team.Tell them if you are feeling anxious or depressed, orif you areexperiencing other emotional or physical changes.

Counseling professionals:
Thereare many kinds of counselors who canhelp you express, understand, andcope with your feelings. If you aredepressed, you should considerseeking Professional help. Feelinghopeless, worthless, guilty, or thatlife is not worth living are signsof depression. Depending on yourpreferences and needs, you may want totalk with a psychiatrist,psychologist, social worker, sex therapist,or member of the clergy.There are also medicines that can be used totreat depression. Manycancer centers have psycho-oncology programswith psychiatrists,psychologists, and social workers trained to workwith cancer patients.Your doctor, nurse, or social worker may be ableto suggest who tocontact.

Friends and family members:
Talkingwith friends or family members canhelp you feel a lot better. Often,they can comfort and reassure you inway that no one else can. However,you may need to help them help you.At a time when you  might expectthat other will rush to your aid, youmay have to make the first move.Before starting chemotherapy, chancesare you will still find pleasurein physical intimacy during yourtreatment. You may discover, however,that intimacy changes duringtreatment. Hugging, touching, holding, andcuddling may become moreimportant, while sexual intercourse may becomeless important. Rememberthat what was true before you startedchemotherapy remains true now: There is no one right way to expressyour sexuality. You and partnershould decide together what gives bothof you pleasure.

Eating Well During Chemotherapy:
Itis very important to eat well while you are getting chemotherapy.Eatingwell during chemotherapy means choosing a balanced diet thatcontainsall the nutrients the body needs.  Eating well also meanshaving a diethigh enough in calories to keep your weight up and highenough inprotein to rebuild tissues that cancer treatment may harm.People whoeat well can cope with side effects and fight infectionbetter. Also,their bodies can rebuild healthy tissues faster..

Can I Drink Alcoholic Beverages?
Smallamounts of alcohol can help you relax and increase your appetite.On theother hand, alcohol may interfere with how some drugs workand/or worsentheir side effects. For this reason, some people mustdrink less alcoholor avoid alcohol completely during chemotherapy. Askyour doctor if andhow much beer, wine, or other alcoholik beveragesyou can drink duringtreatment.

Can I take Extra Vitamins and Minerals?
Youcan usually get all the vitamins and minerals you need by eatingahealthy diet. Talk to your doctor, nurse, registered dietician, orapharmacist before taking any vitamin or mineral supplements. Toomuchof some vitamins and minerals can be just as dangerous as toolittle.Find out what is recommended for you. You are not feeling sick.This isbecause some anti-sickness drugs are much better at preventingsicknessthan stopping it once it has started.

How often treatment is given:
Yourdoctor may use the word regimen (eg the AC regimen), whentalkingabout your chemotherapy. This means the whole plan or scheduleof theparticular treatment that you are receiving.
You will be givendoxorubicin and cyclophosphamide (as described) onthe first day of yourtreatment. After this you will have a rest periodwith no chemotherapyfor the next three weeks. This completes what iscalled a cycle of yourtreatment.
After the rest period the same drugs will be given again,which beginsthe next cycle of your treatment. Four to six cycles oftreatment areusually given over a period of three to months. This makesup a courseof treatment.

Possible side effects:
Eachpersons reaction to chemotherapy is different. Some people haveveryfew side effects, while others may experience more. The sideeffectsdescribed in this information will not affect everyone who ishaving ACchemotherapy. We have outlined the most common side effects,so that youcan be aware of them if they occur. However, we have notincluded thosethat are rare and therefore unlikely to affect you. Ifyou notice anyeffects that you think may be due to the drug, but whichare not listedbelow, please let your nurse or doctor know.

Lowered resistanceto infection AC can reduce the production of whiteblood cells by thebone marrow, making you more prone to infection.This effect can beginseven days after treatment has been given, withyour resistance toinfection usually reaching its lowest point 10-14days afterchemotherapy. Your blood cells will then increase steadilyand willusually have returned to normal levels before your next cycleofchemotherapy is due.

Contact your doctor or the hospital straightaway if:
  • Your temperature goes above 38˚C (100.5F)
  • You suddenly feel unwell (even with a normal temperature).
Youwill have a blood test before having more chemotherapy to make surethatyour cells have recovered. Occasionally, it may be necessary todelayyour treatment if the number of blood cells (the blood count) isstilllow.

Brusing or bleeding AC can reduce the production ofplatelets (whichhelp the blood to clot). Let your doctor know if youhave anyunexplained bruising or bleeding.

Anemia (low number ofred blood cells): While having treatment with ACyou may become anemic.This may make you feel tired and breathless. Letyour doctor or nurseknow if this is a problem.
Feeling sick (nausea) and vomiting: Yourdoctor can now prescribe veryeffective anti-sickness (anti-emetic)drugs to prevent or reduce nauseaand vomiting. If the sickness is notcontrolled, or if it continues,tell your doctor. They can prescribeother anti-sickess drugs which maybe more effective. Some anti-sicknessdrugs may cause constipacion. Letyour doctor or nurse know if this is aproblem.

Tiredness: Many people feel extremely tired (fatigued)duringchemotherapy, particularly towards the end of treatment. This isverycommon side effect and it is important to try and get as much restasyou need.
Hair loss This usually stars 3-4 weeks after the firstcycle oftreatment. Hair is usually lost completely. You may also havethinningand loss of eyelashes, eyebrows and other body hair. Hair lossistemporary and will start to grow again once the treatment hasfinished.
Scalp cooling is a method of reducing hair loss that maybe helpful forsome people. You can ask your doctor or nurse if it isavailable atyour hospital.
Sore mouth and taste change Your mouthmay become sore or dry. Or youmay notice small ulcers during thistreatment. Drinking plenty offluids and cleaning your teeth regularlywith a soft toothbrush canhelp to reduce the risk of this happening.Tell your nurse or doctor ifyou do have any of these problems, as theycan give you  specialmouthwashes and medicine to prevent or clear anymouth infection.
You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes

Irritation of the bladder:
Cyclophosphamidemay irritate your bladder.It is important to as much fluid as you can(up to two liters) duringthe 24 hours after chemotherapy to helpprevent this. Doxorubicin iscoloured red and due to this your urine maybecome a pink-red colour.This may last up to 24 hours after yourtreatment and is quite normal.
Diarrhoea: If you have diarrhea itcan usually be controlled easilywith medicine. Let your doctor know ifit is severe or if it continues.Try to drink as many as 2-3 liters offluid a day to replace the fluidyou are losing.

Skin changes:Your skin may become itchy and dry. Your doctor canprescribe treatmentto help to reduce this. Rarely, your skin maydarken. If it does itusually goes back to normal a few months afterthe treatment hasfinished.
During treatment, and for several months afterwards, youwill be moresensitive to the sun and your skin may burn more easily.You can stillgo out in the sun, but always wear a high protectionfactor sun-creamand cover up with clothes.

Sometimes areas ofskin which have been treated with radiotherapy maybecome red and sore.Let your doctor know if this happens. The skinover the vein used forthe injection may become discolored.
Changes in nails: Your nailsmay become darker and white lines mayappear on them. These changesusually grow out over a few months onceyour treatment has finished

How treatment is given:
Treatmentcan usually be given to you as a day patient. Before youstart you startyour treatment, you will need to have a blood test onte same day, or afew days beforehand. You will also be seen by adoctor, specialist nurseor pharmacist. If the results of your bloodtest are normal, thepharmacy will prepare your chemotherapy drugs. Allof this may take acouple of hours.

When you begin your treatment, the nurse willput a thin, flexible tube(cannula) into a vein in your hand or arm. Youmay find thisuncomfortable or a little painful, but it should not takelong. Somepeople have their chemotherapy given through a thin plastictube thatis inserted under the skin into a vein near the collarbone(centralline), or passed through a vein in their arm (PICC line). Yourdoctoror nurse will explain more about this to you.

You will begiven some anti-sickness (anti-emetic) drugs. These areusually given byinjection through the cannula, central line or PICCline, which isconnected to a drip (infusion), but some anti-sicknessdrugs can also begiven as tablets.

OSTEOPOROSIS
The osteoporosis is the skeleton endocrine decease characterized by a low bone resistance, which carries a high fracture risk.

The epidemiology
Osteoporosisis a decease, which frequency and clinical manifestation isproportionate with the increase of the hope to live, adding to theother concerns of the age.
Impacting factors: - an essential and determinant factor: age, race, low weight, moment of identifying the hormone deficiency 
Aiding factors: lack of calcium and vitamin D, lack of ostrogens (despite the cause), sedentary life, smoking, coffee, etc.
Withthe passing of years women lose on average 30-40% of the bone mass,whereas men lose 20-30%. This loss happens in two lines:
- the firstone is the light and constant age-related loss which happens in men andwomen alike, and is on average 0.5-1% per annum.
- the second relates to the estrogen lack happening in menopause; this is an accelerated loss and is more than some % per annum.
Other reasons are:
Incapacity of development of an optimal bone mass during the adolescence and later:
- genetic causes
- insufficient diet with calcium
Other deceases, (this case is recognized as a secondary Osteoporosis):
- hypercorticism; 
- thyrotoxicosis; 
- hypogonadism;
- immobilization, etc.

When should you see the doctor?
Osteoporosis does not show any sign, and this is why it is referred to as the silent epidemics.
For this reason, the doctor should be seen:
- by all the women above the age of 65;
- the ones that have a fragile fracture (after a minor traumatization);
- women in pre or post menopausal period which have other risk factors;
- patients suffering from deceases causing osteoporosis;
- people having such concerns as: height loss, bone aches, deformations.

What is an osteoporotic fracture?
Patients with osteoporosis brake their bones with more ease than other persons; the most frequent fractures are:
the radius fracture (one of the pre-arm bones) when falling or when weighting oneself on the laid arm.
Thevertebral fractures are an important part of the osteoporotic syndromebeing frequently included in the osteoporosis definition. They appearspontaneously or after the minor traumas, such as the effort to cough,immediate movements, or weight lifting. They are more frequent in themiddle of the dorsal column (T 7-8) and of the thoracal-lumbar zone.Problems of this fracture are acute pains and the long-termconsequences.
The pain is deep and distributed along the column,becomes more serious with the movement and improves with resting. Thepatient has problems while staying seated and on foot, and sometimesthe pain is so strong that the patient is confined to bed. Theradicular pressing (of nerves) is almost a rule in the vertebralfractures and can cause a one or two sided pain disseminated before andalong the ribs. Often the pain is lessened after two weeks ofconfinement in bed, but it can also continue with a lower intensity.Use of non steroidal anti-inflammatory drugs improves the situation ofthe patient a lot.
Long-term consequences are: bending of thecolumn, chronic pain and loss of height. The chronic pain in the backis mostly stressed in the seated position or the excessive staying onfoot and gets improved from the laying position.
Fraction of thefemur is the gravest. It is caused due to the falling from an on-footposition, but it can also happen spontaneously. This is a painfulfracture and the patient needs a long-term hospitalization as it isaccompanied by a high mortality rate. Over 30% of patients remain witha high final functional impotence.

DIAGNOSIS
TheWorld Health Organization has set a definition based on thedetermination of the density of the bone mass, expressed in a T value,which represents the number of standard deviations (DS) below theaverage of values of a normal young person:
normal: +/- 1 DS
osteopenia: -1 up to -2.5 DS
osteoporosis: below -2.5 DS
serious osteoporosis: below -2.5 DS plus fracture
The loss of the bone mass becomes evident in radiographies only in the case of a loss of over 30% .
The DXA (dual-energy x-ray absorptiometry) examination, which is highly sensitive, is currently used.

Treatment:
I. Preventive treatment
normal sexualization process
This period corresponds with the phase of the bone mass growth, a growth which is proportionate with normal sexualization.
Maintenance of a life-long stability
Pubertyand post-puberty period of the bone mass growth, which ends in thesecond decade of life, is accompanied by a decade of consolidation ofthe maximal bone mass. Every problem that affects the normal hormonalmass in this period has consequences in the bone mass.
Confrontation with factors causing osteoporosis

Care should be given to the glococorticoid therapy, maintaining the minimal effective dosage.
Careshould be taken for replacing therapies with thyroid hormone, knowingthat the sub-clinical thyrotoxicosis yields bone modifications.

Stop smoking and alcohol!

Physical Activity
Calcium and vitamin D or its metabolites 
Additionof calcium and vitamin D in the diet reduces bone losses in menopause;1000-1500 gr of calcium per day and 400-800 UI of vitamin D per day isrecommended.
Metabolites of vitamin D, calcitriol and aphacalcidol give better effects for the elderly.

II. Curing prescription:
Biphosponates;
Estrogens and estro-progestative therapy;
Selective modulars of the estrogen receptors;
Calcitonin;
Parathormone, etc.

What is the Computerised Tomography (CT)?
Tomografia e KompjuterizuarComputerized tomography is a non-invasive examination helping in diagnosing, and consequently, curing various deceases.
Thisexamination is made thanks to the X rays, helping in attaining accessimages of the body, which are processed by the computer. The images canbe analyzed and studied in the computer monitor and can also be printed.
TheCT of internal organs, bones, soft tissues and of the blood circulatorysystem (CT Angiography) gives more qualitative images of a higherresolution than examinations of X rays that are used so far(radiography).
The radiologists, using these imaginary appliances,can more easily diagnose such deceases as cancer, cardio-vasculardeceases, infective deceases, traumas and deceases of themusculoskeletal system.  
Computerized tomography gives a more detailed information on traumas, tumors and other body deceases than radiography.  

Fields of application of computerized tomography

Computerized tomography is:
one of the best methods for studying and diagnosing deceases of thehuman head, chest and abdomen because gained images are detailed, andall the tissue structures can be properly differentiated.
is amethod often preferred for diagnosing various maligned lung, liver andpancreas, as it does not only confirm presence of the tumor and itsaccurate dimensions, but also identifies its localization and extensionwithin or outside the affected organ.
valuable examination fordiagnosing and treating deceases of the vertebral column and traumas inthe upper and lower sides up to the less voluminous bones, of softtissues around muscles and of the blood circulation system.
is an examination which plays a huge role in diagnosing vascular deceases causing cerebral ischemia, renal insufficiency, etc.

CTAngiography is an examination that can be carried out with modern CTequipments with many detectors and used for diagnosing decease of bloodvessels in different parts of the body, such as:
brain
kidneys
Pelvis
Lower extremities
Lungs
Heart
Neck

This examination is used for:
Diagnosing the aorta and of other big vessel aneurysm 
Arteriosclerosis of the neck (carotid arteries), which lower the influxof blood in the brain and can cause ischemia/cerebral infarct.
Identification of small aneurisms or arteriovenous (MAV) malformations of blood vessels.
Identification of the atherosclerotic deceases narrowing the blood vessels of inferior extremities.
Narrowing of renal arteries and their supply with blood.
Guides surgeons in treating blood vessel deceases and the stent assessment.
Identifies damages of arteries in traumatized patients.
Assesses the artery supplying tumor with blood prior to the operation.
Diagnosis of the aortic dissection and its main branches.
Shows extension and level of arteriosclerosis in the coronary arteries.
Helps planning a surgical interventions, such as the coronary by-pass.
Early diagnosis of the arterial system deceases, in particular in patients with a family history in vascular deceases.
Assessment of patients donating their kidney or liver.
Examination of pulmonary arteries of pulmonary thromboembolism.
Discovery of thrombosis in the venous system.

CT urography is an examination serving diagnosing of urinary system pathologies when pyelography remains insufficient. 

Endoscopyis also an examination realized by a modern scanner with manydetectors, used as an alternative of broncoscopy and invasivecolonoscopy.

Preparation before the examination:
Inform the doctor about your deceases, even if you have no heart, asthma, diabetes, kidney or thyroid deceases.
Pregnant women are barred from having this examination. 

How does the machinery look like?
CTScanner is an appliance with a tunnel in the center. You will belying in a bed that flows in and out of the tunnel. The tube of X raysand of the detectors spin around your body. The computer commanding theequipment and processing images is located in another room.
Imagesare received as your body moves through the tunnel, they are processedby the computer through special programmes and are reformatted in 2 and3D pictures. 
Our scanner is among the most modern scanners ofcontemporary technology; it contains 64 detectors and can detect imagesof up to 0.5 mm of thickness with a speed of 37 miliseconds. 
Youwill go through a very speedy examination, which shall scan your entirebody in just a few seconds. Speed is satisfactory for all patients, butit becomes more of a must in particular for children, the elderly andthe ones in a serious situation. 
No contrast substances can be used in some kinds of scanning examinations for better defining the diagnosis of your decease. 

How is scanning done?
The technician accompanies you and instructs you in the scanner bed/table.
The contrast substance, if necessary, can be taken by mouth, or in the vein, depending on the type of the examination.
You might be required to hold your breath during the examination.
Scanning is a brief procedure, lasting only for some minutes.

What would you feel during the examination and afterwards?  
You will feel no pain during the examination. The laying time has been substantially reduced with the multi-detector scanner.
Youcan feel uncomfortable as you are lying down and not moving for someminutes. If you find it hard to stay rigid, if you are claustrophobic(you have phobia from closed environments), or have chronicle pains,this examination shall cause no discomfort to you. If this is the case,the technician or the doctor can inject a tranquilizing medication onyou.
If venous contrast is realized, you can feel some heat in theinjection place. During the injection you can feel heat or a metallictaste in the mouth, which lasts for some minutes. If difficulties inbreath-taking occur, please tell the technical or the nurseimmediately, as it can be a sign of an allergic reaction.
Ifcontrast is used by mouth, you can find the taste irritating, anyhow,this is a taste most of the patients can tolerate with no difficulty. 
Youwill be alone in the examination room, although you will be under thetechnician auspices, and it will be possible for you to communicate tohim.
For the children patients, a family member can be allowed inthe room, but he/she should put on the protection cloth against Xradiation.
You can keep on carrying a normal activity after theexamination. If a contrast substance is used, special advice will begiven to you.

Which are the advantages and risks?
Advantages:
CT is able to study the bone system and the soft tissues and the blood vessels all at the same time.
Different from radiography, CT can be used to get detailed images ofthe tissue structures and of the bodies, such as lungs, bones and ofthe blood vessels.
Examinations by CT are quick and simple; incases of emergencies, we are immediately informed of the internal organdamages, hemorrhage, which can be fatal to life.
Examinations by CT diagnose several clinical problems at a short time and low cost.
CT is applied in cases when Magnetic Resonance cannot be used.
CT gives images in a real time, valuable for procedures ofinterventions as the biopsy and aspiration by needle in the variousparts of the body, particularly in the lungs, abdomen, pelvis and bones.
accurate diagnosis with CT can identify the need for explorative surgery and surgery biopsy.
CT Angiography is able to discover in due time narrowing and blockages of the blood vessels.
Compared to the catheter angiography, which consists in injecting thecatheter and contrast substance in a big artery or vessel, CTAngiography is less invasive. This examination is useful for monitoringdeceases of the arterial system because it is safer and less expensivethan the angiography with catheter.
No radiation is remained in your body after the CT examination.
X rays used in CT do in general have no by-side effect.

Risks (By-side effects):
the effective dosage from this examination is about 10mSv, which equalsaveragely the amount of radiation a person receives in three years fromsolar radiation.
Women should inform the doctor or the technician if they are pregnant or suspect of being pregnant.
CT is not recommended for pregnant women due to the high risk it has for the fetus.
Breast-feeding mothers should not nurse their child up to 24 hours after injection of the contrast.
risk of allergic reaction from the contrast substances containingiodine is smaller, and our radiology department is supplied with allthe necessary medicaments to treat such a case of emergency.
Children should undergo a CT examination only if this is indispensablefor their diagnosis and should repeat this examination only in casethere is an absolute indication to do so.

Limitations of CT examinations
thin tissue structures like the knee, shoulder or the backbone are better studied by the Magnetic Resonance. 
CT Angiography should not be used in the patients suffering of kidneydeceases or diabetes, because the contrast substance can further damagethe renal function.
Brain structures and covers around the brain are less visible by CT, compared to the Magnetic Resonance. 
In some cases, in the deceases of kidney, over-kidney glands, pancreasand urino-genital organs, examination by Magnetic Resonance is moresensible than CT.
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