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2009, vol. 25, br. 59, str. 883-888
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Kako prepoznati akutnu leukemiju u stomatološkoj ordinaciji
How to recognize acute leukemia in dental practice
aKlinički centar Niš, Klinika za hematologiju i kliničku imunologiju bUniverzitet u Nišu, Medicinski fakultet, Stomatološka klinika
e-adresa: tijanicm@yahoo.com
Sažetak
Akutna leukemija je maligna bolest hematopoetskog tkiva koja se karakteriše klonalnom proliferacijom i akumulacijom abnormalnih leukemijskih ćelija u kostnoj srži i insuficijentnom hematopoezom. Klinička slika se karakteriše pojavom simptoma i znakova usled insuficijencije normalne hematopoeze, infiltracije tkiva i organa malignim ćelijama i metaboličkih poremećaja. Zbog insuficijentne hematopoeze prisutna su tri klinička sindroma: anemije, krvarenja i infekcije. Akutne leukemije nastaju iz punog zdravlja i imaju veoma brz tok. Nelečene dovode do letalnog ishoda za par meseci najviše. Lečenje se bazira na modernim polihemioterapijskim protokolima, koji se razlikuju za svaki podtip leukemije. Stomatološkim pregledom se mogu uočiti krvarenja i infiltracije desni, koje su među prvim oralnim manifestacijma akutne leukemije. Takođe se mogu naći i znaci oralnog mukozitisa, koji se može manifestovati samo eritemom, a u težim slučajevima progredirati do ulceracija. Adekvatna nega usne duplje je obavezan i izuzetno važan deo u terapiji akutnih leukemija, i može ga sprovoditi samo vrhunski obučeno osoblje. Oralne manifestacije akutnih leukemija su brojne i raznovrsne, bitno utiču na kvalitet života ovih pacijenata ali i na ukupan terapijski uspeh u lečenju akutnih leukemija.
Abstract
Acute leukemia is a malignant disease of hematopoietic tissue, characterized by clonal proliferation and accumulation of abnormal leukemia cells in the bone marrow and by insufficient hematopoiesis. Clinical picture is characterized by the appearance of symptoms and signs arising from the insufficiency of normal hematopoiesis, the infiltration of tissues and organs by malignant cells and the metabolic disorders. Due to the insufficient hematopoiesis, three clinical syndromes are present: anemias, bleedings and infections. Acute leukemias occur in the conditions of perfect health and they develop very rapidly. If not treated, they have the lethal outcome in a few months at the latest. The treatment is based on modern poly-chemotherapeutic protocols, which are different for each leukemia subtype. Stomatological examination may reveal gum bleedings and infiltrations, which are among the first oral manifestations of acute leukemia. Indications may also be found for oral mucositis, which can be manifested only by erythema, or progress into ulcerations in more severe cases. Adequate oral cavity care procedure represents an obligatory and extremely important part of treating acute leukemias and it can be administered exclusively by the best-trained medical staff. There is a great number of various oral manifestations of acute leukemias, significantly impacting the quality of life of these patients, as well as the total therapeutic success in treating acute leukemias.
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