7.1.08 – Hoảng loạn
Ngày hôm nay rất tệ.
Tớ đã xin chụp được KQXNghiệm nhưng lại khá bậnở văn fòng, chưa kịp đến gặp Giáo sư Liễu để hỏi.
Nhưng Mẹ tớ thì càng ngày càng suy sụp, hôm nay Mẹ tớ đã fải chuyển sang fòng cấp cứu và thở bằng bình oxy. Vẫn hầu như không ăn uống được gì, và bụng vẫn rất trướng dù tối qua đã rút ra đc 1.5l dịch.
Tớ thực sự chiều nay thấy hơi hoảng loạn, vì Mẹ tớ mệt quá, kiệt sức quá rồi mà ko biết làm thế nào nữa, Bsỹ ở viện cũng chẳng có ý kiến gì tốt hơn giúp được. Gọi cho GS Liễu mà bật khóc, nhưng ông cũng tạm thời không thể đưa ra lời khuyên nào cụ thể, chỉ hẹn chiều mai đến gặp vì sáng ông đã bận ko thể bỏ được.
Tớ đã up các kết quả xét nghiệm của tớ lên đây. Để nếu ai có thể hỏi được bất kỳ bác sỹ hay chuyên gia nào, để có thể giảm được các triệu chứng cụ thể hiện nay, thì giúp Mẹ con tớ với:
http://download.yousendit.com/BD14BF2B6AF3B3AC
(File rar nặng 48Mb)
Gấm Hương's 
Mong moi chuyen se tot dep den voi me con ay
Co len Gam oi!
Chị ơi, cố lên chị nhé. Em chẳng biết giúp chị thế nào.
Hay vung tin nhe’ ! To cung dang cho thu cua ben Sing, to se bao ay ngay neu nhan duoc thong tin gi…
Hy vong moi dieu roi se qua di , va gia dinh em lai vui ve va hanh phuc .
Cha biet co giup duoc nhieu ko , nhung de anh thu hoi moi so nguoi ve ket qua xet nghiem kia xem sao
To’ da dung IDM de download ket qua xet nghiem, sau khi download ve cac ban phai copy mot them mot ban cua file transfer.php, doi ten file mo’i na`y thanh file lab.rar, sau do du`ng winrar mo doc binh thuong. Ai co can hoi gi thi lien lac voi to’ (0986290057)
http://gps-team.googlegroups.com/web/lab.zip?gda=oSO4ajgAAAD899ksTZUXfmcgiv6uAL_gu6b3FFUUPi1RuS296jntimG1qiJ7UbTIup-M2XPURDQ1slD4Wg_j3RercSRVGKib
To da nen lai con 5MB, cac ban co the download tai day.
Tạm thời mình giúp Gấm lưu tạm kết quả xét nghiệm của bác Hồng ở đây: ftp://youth.homelinux.net/public/cancer
Bạn nào muốn lấy tất cả một lần thì tải xuống tệp .zip. Còn nếu đường mạng chậm thì tải xuống từng tệp ảnh một (mỗi ảnh là một tờ xét nghiệm).
Download 2 lần KQXNghiệm, nhưng không mở ra xem đựơc.
Em có thể chia files lớn ay, thành những file nhỏ, va send bằng email đến đia chỉ này có đựơc không? n.thien77@yahoo.com
neu Me cua em bi indolent lymphoma thi co the chua tri bang loai thuoc duoc xem la rat pho bien o USA khi chua tri benh nay. Treatment sau day duoc
Treatment of Some Specific Disease Entities
Body_ID: HC006262
INDOLENT LYMPHOMAS
Body_ID: HC006263
The common indolent lymphomas are small lymphocytic lymphoma and grade 1 follicular lymphoma, representing more than one third of NHLs. The great majority (85% to 90%) present with stage III or IV disease; in fact 90% to 100% of small lymphocytic lymphomas and 40% to 90% of follicular lymphomas have bone marrow involvement, marking them stage IV. Patients with apparent localized presentations are candidates for radiotherapy with curative intent (recognizing that two thirds will eventually relapse). Adjuvant chemotherapy is under study for such patients.
Body_ID: P006686
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Body_ID: P0544
Stage III and IV patients cannot be cured with standard therapies, yet median survival for asymptomatic subgroups exceeds 10 years. So, a watch and wait approach with no initial therapy is appropriate for most patients, given that the disease is often asymptomatic, indolent in behavior, incurable, and associated with prolonged survival. (One cannot deliver palliative therapy to individuals who are asymptomatic.) Initially untreated patients average 4 years or more before disease progression mandates treatment, with no decrement in survival attributable to treatment delay. Twenty percent of patients with follicular lymphoma, and a greater number with small lymphocytic lymphoma may never require treatment even after more than 10 years of follow-up.
Body_ID: P006687
Factors that mandate treatment at presentation or during follow-up are mainly related to emerging cytopenias (e.g., significant anemia) or systemic symptoms. Young age and psychoemotional factors can be reasons for early therapy, but most patients readily accept no initial treatment when the rationale is fully explained. A major problem impacting survival is transformation to more histologically aggressive lymphomas (Richter-like syndrome); this may occur at 5% per year regardless of treatment.
Body_ID: P006688
When treatment is warranted, additions to our armamentarium have increased choices, making decisions less clear-cut. Single oral alkylating agents such as cyclophosphamideView drug information (Cytoxan) and chlorambucilView drug information (Leukeran) were mainstays and remain reasonable choices for many. Response rates are approximately 50%, few complete, but clinical problems may be dramatically reversed for years. These agents are inexpensive, convenient, and most patients experience no side-effects. Potential toxicities are myelosuppression, leukemogenesis emerging after few years (in approximately 1%), and bladder toxicity with cyclophosphamideView drug information. CyclophosphamideView drug information (often intravenous) is the backbone of the traditional CVP regimen, with vincristine (Oncovin) and prednisoneView drug information. Adding doxorubicin (Adriamycin)-the CHOP (cyclophosphamideView drug information, hydroxydaunomycin [doxorubicin], Oncovin [vincristine], and prednisoneView drug information) regimen-adds toxicity without survival benefit in indolent lymphomas. Nucleoside analogues, particularly fludarabine, are active in these disorders. Response rates may exceed those of alkylating agents at the costs of toxicities and inconvenience (several days monthly of intravenous therapy). Beyond myelosuppression, long-lasting immunosuppression creates significant risks for serious opportunistic infection. Newer combinations such as FC (fludarabine, cyclophosphamideView drug information) and FND (fludarabine, mitoxantrone [Novantrone], dexamethasoneView drug information) reduce the fludarabine dose, reducing toxicities.
Tớ đã resize lại các ảnh để cho nó nhẹ bớt đi rồi. Tất cả khoảng hơn 8MB. (lưu trong tệp .zip).
Bạn nào cần ảnh gốc (kích cỡ lớn) thì lấy tệp .rar nhé.
Spectacular remission rates have been observed with these regimens, making them attractive choices both for initial and salvage therapy.
Body_ID: P006689
The promise of monoclonal antibody therapy is realized in these disorders. RituximabView drug information (Rituxan), an anti-CD20 monoclonal antibody, can be administered singly or in combination with any chemotherapy regimen, either initially or for salvage. It has rapidly become the world’s largest selling antineoplastic agent, even though the only cancers for which it is used are B-cell lymphoproliferative disorders. It is remarkably nontoxic, with fever, chills, and manageable hypotension occurring mainly during the first infusion; infectious risks are low. Understandably, regimens such as FC-R and FND-R are becoming popular. Molecular remissions emerge with these regimens, fueling hopes that curative goals may become realistic. Other monoclonal antibodies for indolent lymphomas are more toxic and used for salvage therapy. These include anti-CD52 alemtuzumabView drug information (Campath) for small lymphocytic lymphoma, associated with high opportunistic infection risks, and anti-CD20 antibodies conjugated to radioisotopes. Recurrent or refractory disease is treated with approaches discussed earlier, but rate and duration of response shortens with each subsequent relapse. To re-emphasize, observation without treatment is reasonable for asymptomatic relapse; more harm has resulted from overly aggressive treatment than the reverse. Patients transforming to large-cell lymphoma have a worse prognosis than de novo large-cell lymphoma, but some respond to combination chemotherapy with or without stem cell transplants. Transplants, both autologous and allogeneic, have benefited selected patients, but utility is limited by the age of patients, the anticipation of long survival, and the frequency of bone marrow involvement, which could contaminate autografts. Grade 1 and 2 follicular lymphomas are considered indolent, but grade 3 (follicular large cell) should be treated as diffuse large-cell lymphoma (in the following text), because it progresses more rapidly and because long-lasting remissions can be achieved.
This most common lymphoma subtype comprises another one third of cases. Unlike indolent lymphomas, these are clinically aggressive with survival of few months untreated. Alkylating agents or monoclonal antibodies used alone are ineffective. Contrasting with indolent lymphomas, there is a reasonable possibility of cure with appropriate chemotherapy. Localized presentations (Stage I or II) occur in less than 30% of large-cell cases. Nonbulky localized disease is treated with three cycles of CHOP or CHOP-R (cyclophosphamideView drug information, hydroxydaunomycin [doxorubicin], Oncovin [vincristine], prednisoneView drug information, and rituximabView drug information) followed by involved-field radiotherapy. A good majority of such patients are cured, as demonstrated in a randomized trial showing progression-free survival of 76% with chemoradiation compared to 67% with eight cycles of CHOP. Patients with stage III or IV disease are given six to eight cycles of CHOP or CHOP-R. Complete response to CHOP will occur in two thirds, and one third will be cured. More intensive regimens like MACOP-B (methotrexate, doxorubicin, cyclophosphamideView drug information, Oncovin, prednisoneView drug information, and bleomycin), ProMACE-CytaBOM (prednisoneView drug information, methotrexate [with leucovorin rescue], Adriamycin, cyclophosphamideView drug information, etoposideView drug information, cytarabineView drug information, bleomycin, Oncovin, dexamethasoneView drug information), or m-BACOD (methotrexate, bleomycin, Adriamycin, cyclophosphamideView drug information, Oncovin dexamethasoneView drug information) are more toxic, more difficult to administer, and no more efficacious than CHOP. The addition of rituximabView drug information improves the progression-free survival to 54% compared with 30% in patients receiving CHOP without rituximabView drug information. Hence, CHOP-R is the standard of care in patients with advanced CD20 positive diffuse large B-cell lymphomas. A baseline echocardiogram is performed because of the potential cardiotoxicity of doxorubicin. Restaging procedures are usually done after four treatment courses. Two additional courses are delivered after remission is confirmed. Prophylactic intrathecal chemotherapy should be strongly considered with involvement of the testis, ovary, breast, sinuses, bone marrow, more than one extranodal site, or a high LD. Recurrent or refractory disease carries a poor prognosis. Cure is still reasonably possible in candidates for autologous stem cell transplantation (those relatively young without serious co-morbidities). It is crucial that they have chemotherapy-sensitive relapse; that is, the disease is not progressing during therapy. Common salvage regimens include ICE (ifosfamideView drug information, carboplatinView drug information, etoposideView drug information), ESHAP (etoposideView drug information, Solu-Medrol, high-dose ara-C, Platinol), and DHAP (dexamethasoneView drug information, high-dose ara-C, Platinol), using ifosfamideView drug information, platinums, etoposideView drug information, cytosine arabinoside, and corticosteroids. Two thirds of patients respond, but longer outlook remains bleak unless stem cell transplant ensues (event-free survival improved from 12% to 46% in a randomized study). Patients refractory to salvage therapy may be candidates for investigational agents, allogeneic transplantation or palliative care.
Body_ID: P006691
Peripheral T-cell lymphoma and anaplastic large-cell lymphoma are treated similarly to diffuse large B-cell lymphoma.
LYMPHOBLASTIC AND BURKITT’S LYMPHOMAS
These represent variant presentations of T-cell and B-cell acute lymphoblastic leukemia, respectively, and they are treated with acute lymphoblastic leukemia (ALL) protocols, which employ vincristine, anthracyclines, cyclophosphamideView drug information, cytosine arabinoside, and methotrexate (e.g., Hyper-CVAD [cyclophosphamide, vincristine, Adriamycin, dexamethasoneView drug information, methotrexate, cytarabine]). Prophylactic CNS therapy is mandatory. Care must be taken to avoid the tumor lysis syndrome (especially with Burkitt’s lymphoma) by vigorous hydration, alkalinization of urine, allopurinolView drug information, and close monitoring. Approximately one third of patients with these disorders can be cured by chemotherapy (higher in some patient subsets).
(Reference 1./ Current Medical Diagnosis and Treatment 2007 (edition 2008 cung khong co thay doi gi mo*’i ve cach chua tri Non Hodgkin’s Lymphoma stage 3 and 4), and 2./ Cecil Textbook of Medicine 20 edition)
Me cua em bi stage 4 co nhieu hy vong keo dai cuoc song.
Tao ko mo dc file ket qua xet nghiem. Neu mo dc tao se forward den anh Vinh xem the nao nhe. Cau mong hom nay may gap giao su Lieu se co ket qua tot!
Ban co the dung phan mem unikey : http://www.unikey.org/ Day la phan mem mien phi, sau khi cai dat ban chon kieu go tieng viet, kieu ma Unicode va kieu go Telex.
Nhung blog cua Gam chua duoc chon font Times nen tieng viet khong the hien tren trinh duyet IE ma chi the hien duoc tren FireFox. Day la ly do tai sao to’ du`ng tieng viet tren blog cua to’ ma tren blog cua Gam to’ lai danh tieng viet khong da’u.
Mong se co nhung thong tin tot dep tu em va Me.
Co gi ca`n Gam cu phone cho to’, to’ se copy va upload tai lieu cho Gam. Cam on ban Thien, mong ban tiep tuc danh thoi gian giup Gam, neu co thac mac gi ve van de tieng viet, ban cu lien lac voi minh nhe’. (din_netcom@yahoo.com – 0986290057)
:(( sang’ mai to’ se~ di hoi? giup Gam ngay…
Mong bac Hong` se~ qua dot. nay`, bac’ con` phai cho` chau’ ve` nha` nua ma`…
Tớ có thể làm gì được đây Gấm ơi? :((
Blog bạn hiện được đăng tải trên trang chính vn.yahoo.com trong 24hrs.
Truoc het, xin chan thanh cam on 2 ban @thailq va @mandr da upload files cua GH. Nho co 2 ban, to*’ da doc duoc cac ket qua xet nghiem rat ro rang.
Sau khi xem xet cac ket qua xet nghiem cua bac, to*’ co the noi rang:
1./ Tinh trang hien nay cua ba’c la` phai duoc 1 (do^.i) team cua bac si cham soc. 1 bs chuyen ve tiet nieu khoa, 1 BS chuyen ve ung thu mau (NHL), (1 bac si theo doi ve phoi, 1 BS chuyen ve Tim de support khi can thiet) de vuot qua 3, 4 tuan sap den.
2./ Van de chinh hien nay la chi co cham soc bang cach ho^? tro*. (support) cho benh nhan ma thoi. Su cham soc do nhu sau (da duoc bac si va benh vien lam dung tieu chuan):
*lam sao de cho dich trong co* the^? duoc bai` tiet va dao thoat ra ngoai.
_bang cach hut nuoc trong o bung (bac si da va dang lam)
_Bang cach di tie^?u, di ca^u`, mo^` ho^i
*truyen albumin (la 1 loai chat dam, protein) de co the tiep tuc lam viec.
*truyen dich glucose de giup co the co nhiet luong day du va brain duoc lam viec.
(khong thay Gam Huong noi ve chuyen nay, nhung to doan rang, BS da dung glucose va albumin de truyen vao co the cua bac hang ngay.
Dieu kho khan la khong the truyen nhieu ho*n 2 lit hay 3 lit moi ngay boi vi dich dang bi u*’ tai. o^? bung, gan, va co the la o duoi 2 chan (dang bi phu` le^n, dung khong?) nguyen nhan la do he thong bach huyet bi sung (ung thu) va khong chiu lam viec.
*De phong ngua bac bi pressure ulcer (loet vi nam tren giuong benh), moi ngay, GH dung khan uot, lau sach lu*ng, mo^ng, 2 dau goi, 2 mac ca chan, 2 got ban chan. Va lot ch(an duoi lu*ng de na(`m cho em.
3./ Moi ngay nau chao (vegetable soup) cho bac an. Tra’nh an cac loai thuc an co mo (fat) nhu thit, soup co’ thit. Uong cac loai nuoc nau chung 1 noi cha’o (khong co thit) gom carrot, susu, bap cai,…. ne^m 1 chut muoi va nau chao’ lon~g. Cac loai vegetable nay se cung cap muoi khoang va cac chat dien giai can thiet de co the hoat dong.
Neu bac co the an duoc, thi co the an nhung thuc an de tieu: nhu chao loang, va can tranh bi nhiem trung bang cach nau do an that ky (dun soi). Khong nen uong su*a vi o trong ruot, cac hach bach huyet co nhiem vu giup co the hap thu chat su*a.
Ve sinh rang mieng hang ngay cho that ky cang (floss, cha rang, dung ban chai rang de cha` vao mat luoi)
4./ Nen de cho bac tiep tuc nam trong benh vien de cham soc, lam xet nghiem va theo doi. Neu bac vuot qua duoc giai doan hiem ngheo va nho 1 yeu to nao do cac hach bach huyet teo lai kich thuoc binh thuong va lam viec tro lai (vi dich u va tich tu o o bung, gan, va phoi, la do bo*?i cac hach bach huyet sung phu` len, khong chiu lam viec nua) thi co* may song sot co nhieu hy vong.
Hach bach huyet co nhiem vu giup co the chong lai nhiem trung (cua vi khuan va vi trung) va chong lai ung thu*. He thong cac mach bach huyet (con co them nhiem vu la) van chuyen dich trong cac mo^ o ngoai bien (tay chan, bung, nguc, dau..) tro ve lai ben trong he thong tuan hoan (ma’u)
Cac lymphnode co nhiem vu nhu nhung chot chan, loc, va tieu diet vi khuan, vi trung, cac vi sinh vat va cac te bao bi hu hai cua co the.
Hien nay, cac lymphnodes (hach bach huyet) deu da bi su*ng phu len vi ung thu*, nen cac hach nay khong co kha nang tren va khong co khac nang chong lai cac benh nhiem trung.
Bac bi met do nhieu yeu to gay ra:
_Na(m` tren giuong benh qua lau^. va khong hoat dong duoc (vi qua ye^’u)
_glucose (duong trong mau thap): de on dinh duoc duong trong mau, co the truyen dich co glucose hang ngay, co gang giu no^`ng do^. glucose trong mau’ o trong khoang 80-100 mg/dl.
Hien nay, cac hach bach huyet cua bac khong con kha nang chong lai cac benh nhiem trung (nhu viem phoi, nhiem trung duong tieu…) nen cac bien phap ve sinh phai duoc chu y dac biet de tranh bi nhiem trung va viem. Viem phoi rat nguy hiem, nhiem trung duong tieu, va cuc mau dong gay nghet o phoi va tim cung nguy hiem va deu dua den tu vong cho nhung nguoi nam lau trong benh vien.
Neu chan bi phu` thung, thi dat 1 goi duoi chan de nang cao chan hon tim chung 5 cm, hoac dieu chinh giuong nang cao hon 5 cm o phia duoi cha^n. Hoac xe^’p 1 cai me^`n, chieu day chung 5 cm, va lot o duoi 2 chan.
Mot khi giai quyet duoc van de dich tich tu trong co the (o bung, o phoi,..o cha^n, …), thi cac van de khac nhu dich trong phoi, tim dap nhanh se binh thuong tro lai.
Hy vong bac se binh phuc va song them voi GH nhieu nam nua. Cam on cac ban da danh chut thi gio de doc. Mot lan nua, xin cam on 2 ban @thailq va @mandr da danh nhieu thoi gian qui bau de upload files cho chung toi doc.
Thien
Co gang len em. Dung khoc mot minh. Hay co gang cuoi voi Me cang nhieu cang tot. Va luon tam niem la Me se vuot qua duoc.
Em co muon qua nha chi nho Bo chong chi xem cho 1 que khong? Ong xem chi tay va que rat dung. Neu duoc thi bao chi nhe, chi se nho ong, em qua luc nao cung duoc.
ah quen, bat cu viec gi can chi va anh Lan giup, em goi nhe bat cu luc nao.
Ghi so moi cua chi vao 0948993369
Cảm ơn các bạn, các anh chị.
Về việc đọc tiếng Việt trên blog bằng trình duyệt IE, mọi người có thể vào “Tools -> Internet Options -> Accessibility -> Ignore Font Styles”.
http://yhocthuchanh.health.vn/vie/templates/giao_dien_y_hoc_thuc_hanh/images/Labs_result.rar
Link down nhanh nè Nấm … Em vẫn để nguyên kích thước ảnh phòng trường hợp cần in ấn
Trời ơi, hôm nay mới đọc blog của Gấm, chẳng còn biết nói thế nào nữa, chỉ còn biết động viên Gấm và gia đình cố gắng. Đã có những biến chuyển tốt, hy vọng bác sẽ chóng khỏe, tai qua nạn khỏi.
IE7 xong tiếng Việt ko bị lỗi như IE6 nữa.
Bây giờ tớ mới vào đây đọc và comment cảm ơn mọi người được.
Hôm trước đang vội quá nên để file quá nặng, cảm ơn Din và a.Thái đã nén và up lên giúp em. Còn 1 số thông tin, hình ảnh về những gì Bác sỹ đang làm nữa, nhưng em sẽ update hẳn lên entry tiếp theo.
Đặc biệt cảm ơn anh/chị Thien, dù chưa quen biết nhưng những gì anh/chị comment giúp em đúng là những thông tin rất quý báu. Hầu như những dự đoán của anh/chị là đúng, bệnh mẹ em đã đến giai đoạn 4B hoặc gọi là giai đoạn cuối
Cố gắng lên Gấm, mọi điều tốt lành sẽ đến với mẹ con Gấm mà 🙂
Lam the nao de danh tieng Viet co da^’u? Ban nao biet, xin vui long goi den cho to*’ 1 file software viet tieng Viet (de download vao computer de xu dung viet email and blog de cac ban doc). Xin cam on cac ban rat nhieu.
To*’ luon luon thac mac la lam sao cac ban viet tieng Viet co’ dau tren blog cua cac ban.
To*’ rat la phien nao~ moi khi viet tieng Viet ma khong bo dau. Do cung chinh la ly do trong blog cua to*’ (ha^`u nhu*) khong viet gi nhieu 🙂
To*’ co’ nhieu tin tuc hay, nhung vi khong the viet tieng Viet (co dau) de trao doi voi cac ban. Thanh ra, cac tin tuc ay nam yen trong computer cua to*’. Thinh thoang, to*’ vao blog cua cac ban doc, doc va doc. Hom thu 2, doc profile cua GH, to*’ cam thay ban ay rat yeu me va co 1 tam long nhan ai, to*’ moi post comment (1st time). Neu cac ban hoac gia dinh bi benh, cac ban cu viec post len blog, send den to*’ 1 email, to*’ se tra loi tren blog cua cac ban de chung ta cung nhau tham khao. OK chua?
Khi nao biet cach danh chu Viet co dau, to* se viet bang tieng Viet (I hope so :)) 1 da`n bai`, de khi trinh bay 1 benh tat tren blog (cua cac ban, hoac khi di kham BS o cac benh vien VN), cac ban se biet cach trinh bay van de that ro rang, day du, va chinh xac… BS VN se chan doan benh chinh xac hon. Phat hien benh so*m hon.
va de dieu tri hon.
Trong tuong lai 10 hay 15 nam nua, cac benh tat o VN se gia tang gap 100 lan, vi o nhiem moi truong, vi thuc pham cua chung ta khong duoc bao quan tot va hop ve sinh, va dieu kien noi an chon o cua chung ta qua yeu kem, mang luoi y te qua yeu kem, va cang ngay, chung ta cang an nhieu thuc pham va do gia vi cua Trung Quoc xuat cang vao nuoc ta … Day, cung chinh la ly do to*’ viet blog de trao doi voi cac ban va ho.c hoi? tu*` cac ban.
To biet lam gi cho Gam day. Co len Gam nhe