Chlamydia

ChlamydiaCHLAMYDIA - a tumor of the lymph nodes with the presence of cells Berezovsky - Sternberg. The etiology is unknown. The clinical picture varied. In some cases, the disease begins with the appearance of intoxication (fever, weakness, sweating, swollen lymph nodes, increased erythrocyte sedimentation rate (ESR). Sometimes the onset of the disease is characterized only by the increase in any one group (or one) of the lymph nodes. Nodes plotnovato, elastic, often not soldered together. Sometimes they arise necrosis appear fistula (inoculation of them often sterile). A frequent symptom of intoxication - skin itch. When the primary tumor is localized in the lymph nodes of the abdominal cavity may be a severe intoxication with hyperthermia, drenching sweat, leukopenia with stab shift and increase in ESR. Occasionally observed primary localization of infection in the stomach, lung, spleen. Blood picture in typical cases characterized by severe lymphopenia, neutrophilia with a moderate band shift, increased ESR. With severe intoxication possible eosinophilia. In the absence of intoxication blood for a long time not to change, in some cases there is a slight lymphocytosis. Diagnosis is based on histological examination byobserving lymph node (or of the authority under extranodal tumor localization); detect the violation of the node structure, rubbed his figure and the presence of cells Berezovsky - Sternberg (mandatory diagnostic feature). Clinical or only cytological on punctata diagnosis of Hodgkin's disease should not take place. In the beginning of the process, especially if the affected lymph node involved in banal inflammatory process (it may be painful, increases rapidly at the height of infection and decreases on a background of antibacterial therapy lymphadenitis tumor lymph node), histological interpretation of the biopsy may not be possible (so at the height of infection biopsy of lymph node junk). In these cases we have to resort to a re-biopsy of the enlarged dense lymph nodes (NIV no case should biopiracy soft unaugmented lymph nodes based on the "systematic" process: this tumor is not perichromosomal, and spreads, as well as other tumors of the lymph nodes). The treatment is carried out according to certain schemes that, in the absence of organ lesions allows to achieve recovery in most patients. The main program of treatment consist in the appointment of 2-4 courses of chemotherapy, then the gradual exposure of all major groups of lymph nodes (both affected and unmodified) on both sides of the diaphragm, the irradiation of the spleen or her bed (if there are no signs of tumor spread beyond the lymph nodes, the spleen is usually removed) and subsequent chemotherapy. Total before and after irradiation are usually b courses of chemotherapy. For exposure use sources of high energy to achieve the absorbed dose at the center of about 4000 happy without severe damage to the skin. The scope of the initial lesion, it is desirable to irradiate at a higher dose. Polychemotherapy in efficiency is almost as radiation treatment. Prescribe cyclophosphamide, vincristine, procarbazine (natulan) and prednisolone for 2 weeks with a subsequent 2-week break. Drugs administered in the following order: cyclophosphamide -600 mg/m2/or mustargen -6 mg/m2 (all doses for adults) 1-th and 8-th day of the cycle, vincristine 2 mg/m2/1-th and 8-th day of the cycle, procarbazine (natulan) - 100 MT/m2 per day orally daily from the 1st to the 14th day of the cycle, prednisolone 40 mg/m2 per day, inside the 1st to the 14th day of the cycle with the abolition of it in one day. Prednisolone is prescribed only in the 1st, 4th, 8th and 12th cycles. In the remaining cycles of treatment without prednisolone. It is desirable to alternate courses of chemotherapy, in which mustargen is replaced by cyclophosphamide, or conduct courses adriablastin, bleomycin, CCNV. Under appropriate conditions the chemotherapy and radiation can be conducted mainly on an outpatient basis. Sometimes (in severe nausea and vomiting) have to hospitalize patients for intravenous introduction of cytostatics. When polyneuritis caused by the introduction of vincristine (more often in the elderly or in severe liver disease), the drug is replaced by vinblastine. There are other schemes of chemotherapy. The use of monochemotherapy for starting treatment is contraindicated. The forecast for labour and prognosis in General are not a formal dissemination of process and outcomes. Now recover up to 60-80% of patients with software treatment. Prevention of the disease have not been developed. Relapse prevention - implementation of treatment and adherence to the required mode. The occurrence of relapses contribute insolation, pregnancy, childbirth. Pregnancy permitted no earlier than 2 years from the beginning of remission..



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