Symptom Control And Palliative Care Used In Patients Affected By Kaposi Sarcoma In Vryheid Hospital

摘要

Thirty nine patients were diagnosed histological as sarcomas in Vryheid District Hospital since October 2004 until March 2008, in Kwazulu Natal Province Republic of South Africa. From these 39 patients 27 had been suffered from Kaposi's sarcoma disease. The clinical features found in these patients as well as the pain, symptom control and palliative care done in those at district rural hospital level are exposed. The prognosis of patients was better proportionally with the proper adherence of the relevant protocols, as well as the level of family and community support to them. Introduction Kaposi's sarcoma (KS) is a tumor caused by Human herpes virus 8 (HHV8), also known as Kaposi's sarcoma-associated herpes virus (KSHV). It was originally described by Moritz Kaposi, a Hungarian dermatologist practicing at the University of Vienna in 1872.[1] It became more widely known as one of the AIDS defining illnesses in the 1980s.KS lesions are nodules or blotches that may be red, purple, brown, or black, and are usually papular (i.e. palpable or raised).They are typically found on the skin, but spread elsewhere is common, especially the mouth, gastrointestinal tract and respiratory tract. Growth can range from very slow to explosively fast, and is associated with significant mortality and morbidity.[2]Despite its name, it is generally not considered a true sarcoma, which is a tumor arising from mesenchymal tissue. KS actually arises as a cancer of lymphatic endothelium and forms vascular channels that fill with blood cells, giving the tumor its characteristic bruise-like appearance.KS lesions contain tumor cells with a characteristic abnormal elongated shape, called spindle cells. The tumor is highly vascular, containing abnormally dense and irregular blood vessels, which leak red blood cells into the surrounding tissue and give the tumor its dark color. Inflammation around the tumor may produce swelling and pain.Although KS may be suspected from the appearance of lesions and the patient's risk factors, a definite diagnosis can only be made by biopsy and microscopic examination, which will show the presence of spindle cells. Detection of the viral protein LANA in tumor cells confirms the diagnosis.Vryheid District Hospital is located into the rural area in Abaqulusi Municipality, Zululand – Ulundi DC-26 Kwazulu Natal Province Republic of South Africa. It is known the high incidence and prevalence of HIV – AIDS in this area, that why as a logical consequence an increasing number of HIV – AIDS relatives' diseases are found. Vryheid Hospital has an organized CDC and Anti Retroviral Treatment Program instituted; it works in close coordination with Surgical, Natural & Bioenergetics and Pathologic Services. Kaposi's sarcoma is not curable, in the usual sense of the word, but it can often be effectively palliated for many years and this is the aim of treatment... In KS associated with immunodeficiency or immunosuppressant, treating the cause of the immune system dysfunction can slow or stop the progression of KS. In 40% or more of patients with AIDS-associated Kaposi's sarcoma, the Kaposi lesions will shrink upon first starting highly active antiretroviral therapy (HAART). However, in a certain percentage of such patients, Kaposi's sarcoma may again grow after a number of years on HAART, especially if HIV is not completely suppressed. Before the AIDS epidemic, Kaposi's sarcoma was seen primarily in elderly Italian and Jewish men, and rarely, in elderly women. Among this group, the tumors developed slowly. In AIDS patients, the cancer can develop very fast, and may also involve the skin, lungs, gastrointestinal tract, and other organs. The visceral lesions are generally asymptomatic and are most often discovered only at autopsy, though clinically, gastrointestinal bleeding can occur. As many as 33% of the patients with classic KS develop a second primary malignancy, which is most often non-Hodgkin lymphoma. [3,4,5]Pain, one of the most common