Mesothelioma

is a form of cancer that is almost always caused by previous exposure to asbestos In this disease, malignant cells develop in the mesothelium, a protective lining that covers most of the body's internal organs. Its most common site is the pleura (outer lining of the lungs and chest cavity), but it may also occur in the peritoneum (the lining of the abdominal cavity) or the pericardium (a sac that surrounds the heart). Most people who develop mesothelioma have worked on jobs where they inhaled asbestos particles, or have been exposed to asbestos dust and fibre in other ways, such as by washing the clothes of a family member who worked with asbestos, or by home renovation using asbestos cement products. There is no association between mesothelioma and smoking. Legal issues The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos manufacturers and employers, for neglecting to implement safety measures after the link between asbestos, asbestosis and mesothelioma became known (some reports seem to place this as early as 1898). The liability resulting from the sheer number of lawsuits and people affected has reached billions of dollars. The amounts and method of allocating compensation have been the source of many court cases, and government attempts at resolution of existing and future cases. The first lawsuit against asbestos manufacturers was brought in 1929. The parties settled that lawsuit, and as part of the agreement, the attorneys agreed not to pursue further cases. It was not until 1960 that an article published by Wagner et al in 1960 first officially established mesothelioma as a disease arising from exposure to crocidolite asbestos[8]. The article referred to over 30 case studies of people who had suffered from mesothelioma in South Africa. Some exposures were transient and some were mine workers. In 1962 Dr McNulty reported the first diagnosed case of malignant mesothelioma in an Australian asbestos worker[9]. The worker had worked in the mill at the asbestos mine in Wittenoom from 1948 to 1950. In the town of Wittenoom, asbestos-containing mine waste was used to cover schoolyards and playgrounds. In 1965 an article in the British Journal of Industrial Medicine established that people who lived in the neighbourhoods of asbestos factories and mines, but did not work in them, had contracted mesothelioma. Despite proof that the dust associated with asbestos mining and milling causes asbestos related disease, mining began at Wittenoom in 1943 and continued until 1966. It is difficult to understand why the mine and mill was allowed to initially open and operate without adequate risk control measures; and why nothing was done to force the owner (CSR) to clean them up, adopt safer work practices or close down their operations. In 1974 the first public warnings of the dangers of blue asbestos were published in a cover story called "Is this Killer in Your Home?" in Australia's Bulletin magazine. In 1978 the Western Australian Government decided to phase out the town of Wittenoom, following the publication of a Health Dept. booklet, "The Health Hazard at Wittenoom", containing the results of air sampling and an appraisal of worldwide medical information. By 1979 the first writs for negligence related to Wittenoom were issued against CSR and its subsidiary ABA, and the Asbestos Diseases Society was formed to represent the Wittenoom victims Pathophysiology The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibres in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fibre can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibres from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibres may be deposited in the gut after ingestion of sputum contaminated with asbestos fibres. Pleural contamination with asbestos or other mineral fibres has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers)[4]. However, there is now evidence that smaller particles may be more dangerous than the larger fibers.[1][2] They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.[3] Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibres. It has been suggested that in humans, transport of fibres to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localised lesions of accumulated asbestos fibres in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumour. Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibres remain unclear despite the demonstration of its oncogenic capabilities. However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibres has not yet been achieved. In general, asbestos fibres are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages. Analysis of the interactions between asbestos fibres and DNA has shown that phagocytosed fibres are able to make contact with chromosomes, often adhering to the chromatin fibres or becoming entangled within the chromosome. This contact between the asbestos fibre and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms. Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes: Neurofibromatosis type 2 at 22q12 P16INK4A P14ARF Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms: Inactivation of tumor suppressor genes Activation of oncogenes Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region Activation of DNA repair enzymes, which may be prone to error Activation of telomerase Prevention of apoptosis Asbestos fibres have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences. Asbestos may also possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer (LAK) cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres. Signs and symptoms Symptoms of mesothelioma may not appear until 20 to 50 years after exposure to asbestos. Shortness of breath, cough, and pain in the chest due to an accumulation of fluid in the pleural space are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face. These symptoms may be caused by mesothelioma or by other, less serious conditions. Mesothelioma that affects the pleura can cause these signs and symptoms: chest wall pain pleural effusion, or fluid surrounding the lung shortness of breath wheezing, hoarseness, or cough In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body. Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include: abdominal pain ascites, or an abnormal buildup of fluid in the abdomen a mass in the abdomen problems with bowel function weight loss In severe cases of the disease, the following signs and symptoms may be present: blood clots in the veins, which may cause thrombophlebitis disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs jaundice, or yellowing of the eyes and skin low blood sugar level pleural effusion pulmonary emboli, or blood clots in the arteries of the lungs severe ascites A mesothelioma does not usually spread to the bone, brain, or adrenal glands. Pleural tumors are usually found only on one side of the lungs. Malignant Mesothelioma Symptoms Symptoms of malignant mesothelioma in the lung and chest cavity are as follows: Shortness of breath Cough Weight Loss Chest Pain Symptoms of malignant mesothelioma in the abdomen are as follows: Abdominal swelling and pain Weight Loss Wondering How You Could Have Gotten Mesothelioma Cancer? Several diseases are associated with exposure to asbestos. They include: malignant mesothelioma, asbestosis, pleural effusion, pleural plaques and thickening, and lung cancer. Prior to 1975 asbestos fibers were commonly used. You could have been exposed to asbestos while working at any number of different industries. Chief among the possibilities would be jobs at asbestos mining and milling plants, shipyards, fireproofing and heating, construction, automotive repair, insulation, pipefitting and boilermaking. If you did not work in one of these industries or another that used asbestos, it is also possible that you could have been exposed if someone in your household worked with asbestos and carried asbestos fibers home on his or her clothing, hair or body. You may also have been exposed indirectly by living near asbestos mines. Although it is true that most patients with malignant mesothelioma, lung cancer or other asbestos-related diseases likely had prolonged exposure to asbestos over a long period of time, it is also possible for one to develop one of these diseases from a brief exposure to asbestos. The odds of developing lung cancer from smoking also increases significantly from exposure to asbestos. Although most people with lung cancer are told that their lung cancer was caused from smoking, if you or someone you know has lung cancer and also worked in an environment that gave you exposure to asbestos, it is highly recommended that you contact an attorney that specializes in handling mesothelioma and lung cancer cases caused by exposure to asbestos. The justice system has been very generous in its rewards to people who suffer diseases caused by asbestos exposure Diagnosis Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytology if this fluid is aspirated with a syringe. For pleural fluid this is done by a pleural tap or chest drain, in ascites with an paracentesis or ascitic drain and in a pericardial effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). If cytology is positive or a plaque is regarded as suspicious, a biopsy is needed to confirm a diagnosis of mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a histopathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary. Mesothelioma Diagnosis Aided by Imaging and Sampling Because mesothelioma is a rare disease, it may be misdiagnosed by the everyday physician. Often, it is necessary to find a specialist who has treated numerous mesothelioma patients. A history of asbestos exposure will be an important factor in the physician’s diagnostic plan, which generally includes imaging tests, such as x–rays, CT, MRI, or PET scans and tissue and fluid sampling. X–Rays as Preliminary Step in Mesothelioma Diagnosis A chest x–ray may indicate irregular thickening of the pleura or the thin covering that protects and cushions the lungs. It may also show pleural calcifications (mineral deposits), lowering of the lung fissures (spaces between the lobes of the lungs) and accumulation of fluid in the lungs (pleural effusion) or in the abdomen (ascites). These may be ominous signs leading to a mesothelioma diagnosis. CT, MRI, and PET Scans for Mesothelioma Diagnosis and Tumor Detection A computed tomography or CT scan is useful in determining the location, size and extent of cancer such as mesothelioma. It is a special radiographic technique that uses a computer to combine multiple x–ray images into a two dimensional cross–sectional x–ray image. A machine rotates 180 degrees around the patient’s body, sending out a thin x–ray beam at numerous points. Crystals at the opposite points of the beam pick up and record the absorption rates of the varying thickness’ of tissue and bone. The computer turns the information into a detailed picture. The CT scan allows a radiologist to see distinct aspects of the lungs and pleura to better advantage than the x–ray. Magnetic resonance imaging (MRI) scans use magnetic fields, radio waves, and a computer to create images of selected areas of the body. MRI images tend to be quite clear and are superior to routine x–ray images. Positron emission tomography (PET) scans use cameras and tracers to form images that indicate biological changes and detect extremely small cancerous tumors. PET scans often provide even more information than CT or MRI scans. Mesothelioma Tissue and Fluid Samples A needle may be inserted into the chest cavity to remove fluid for sampling purposes. The same method is used to extract fluid samples from the abdomen or pericardium. Microscopic and chemical examination of the fluid can be essential to determine whether cancer cells are present. Tissue samples may be obtained through surgical techniques. In “thoracoscopy”, a thin telescopic instrument (thoracoscope) fitted with a lighting system is inserted through a puncture in the chest wall. The physician can see the tumor and sample it using a forceps–like tool. Special stains or electron microscopy can aid tissues analysis. The most common stains include acid–Schiff diastase, hyaluronic acid, mucicarmine, CEA, and Leu M1. These “immunohistochemical” procedures are useful to ensure an accurate mesothelioma diagnosis

REACH TO RECOVERY

What [is] so-called with Reach To Recovery ?

Reach To Recovery [is] program of[is non medical, what for the first time started by American of Cancer Society, what aim to to help patient of bosom cancer in experiencing everyday life, and by UICC urged in order to program this carried out by Institution - cancer institution [of] exist in each;every state.

In the year 1997, Institution of Indonesia Cancer adopt this program from Reach To Recovery International - UICC become one of support program which under Bidang Pelayanan And Rehabilitasi.

Reach To Recovery [is] service type for patient of bosom cancer given by a group of volunteer ( volunteer) what most have suffered the cancer type and the other [is] volunteer of[is non patient. All this volunteer lift a hand in the form of morale support, information, and the miscellaneous which be of benefit to patient in overcoming [his/its] problem.

Personal experience [of] this ripe ex patient continually be added with knowledge and ketrampilan [of] other;dissimilar which good for facing patient to or [is] experiencing pangobatan, goodness in the form of surgery ( mastectomy), irradiating ( radiotherapy) or gift of cancer drugs ( kemoterapi).

Program Reach To Recovery with all volunteer which have been selected [by] and get good training, have been confessed by all professional [in] area kedokteran and promoted by cancer institute in all the world. In this time program Reach To Recovery have been executed around 30 state.

What [is] [done/conducted] by all volunteer ?

A lot of woman feel calmer talk with other;dissimilar woman have experienced medication of bosom cancer and understand problem faced [by] goodness from facet of emotion and also in reality. All this volunteer earn to divide their experience [is] moment they face situation that [of] of equal.

This volunteer earn to give information and suggestion to face medication effect. All volunteer earn to visit patient [of] before or hereafter the surgery, ill goodness at home or at home. If/When (it) is true be needed, volunteer earn to give information [of] about everything hit protesa bosom ( brand bosom) and the related/relevant miscellaneous.

Criterion of Volunteer of Reach To Recovery.

At least 2 year post operate for for the especial bosom cancer and get recommendation from doctor taking care of that pertinent earn to work.
Education minimize SMU/SLTA
In the physical make healthy and ready to provide time.
Able to accomodate clearly the effective strategy to overcome cancer.
In psychology [of] accustomed to medication.
desire and Ability to experience training and observation continually and continual.
Willingness to work as part of a team.
Able to communicate with goodness.
For volunteer of[is non patient, have had congeniality in general about medication step and psychological [of] patient.

Who assisted by Reach To Recovery.

Patient of Bosom cancer
Patient to and [is] experiencing medication action [of] such as surgery ( mastectomy), irradiating ( radiotherapy), kemoterapi and others

How forming service of Reach To Recovery?

Service given by Tim Reach To Recovery [in] hospital, clinic, and or the patient house
Earn given in alone or team, goodness [of] through looking in the face or by telephone
Service Given in the form of support bounce, spiritual and psikososial
This Pelayanan given free

How to get service of Reach To Recovery YKI ?

Contacting Secretariat of Reach To Recovery Yayasan Kanker Indonesia
Patient ask for [by] xself or for doctor fomentation taking care of
Filling registration form



Handling of Stadium Cancer Continue.

Strategy " fight" best melawan cancer [is] with prevention [of] such as also [at] other;dissimilar diseases. But if this matter have been done, but still also be come down with [by] a cancer, hence properly that disease as soon as be known [by] by executing efforts detect early. Since if/when that disease [is] diketemukan in stadium early, hence the medication will give better result. Equally, prosentase kesembuhan will be higher.

Cancercous medication earn with surgery , with giving drugs antikanker ( so-called kemoterapi ), and or with irradiating of[is so-called radiotherapy . Often also be given [by] combination from third the way of that medication.

But if that cancercous have in stadium continue, or have disseminated wide to various body shares, difficult hence - even earn told not possible (to)- to be healed, even if with sophisticated technology kedokteran.

Are There So Many Cancer Patients?

Ironically, as have been reported by Departemen Kesehatan Republik Indonesia, more than 50% cancer patient come first time for have the drug have in stadium continue. While number of occurence or cancercous insidens in Indonesia [is] 0,1% from resident amount.

Why most cancer patient come lost time for have drug? A lot of [his/its] cause factor, for example:

Pada Stadium early often [is] not realized by patient that he [is] suffering cancercous. Since symptom [of] [at] stadium early often [do] not typically and is not be fearful.
If cancercous have started to disseminate to gland of lymph causing incidence [of] benjolan, still also less get attention, or seldom have a notion that that matter " made" ( black magic) by one who in bad faith to patient.
Bila Patient understand that disease is non ordinary disease, oftentimes the patient fear memeriksakan x'self for fear of be operated for.
What also often be happened, conscious patient that disease is non ordinary disease, and not afraid though there [is] the possibility of operated for, but expense for have the drug often become constraint. Fortunately now have there [is] program " maskin" what very assist less fortunate patient ( unable to).

That effect [of] all, hence the new patient come for have drug after felt [by] [his/its] grief bother or fearful, for example pain in bone, haemorrahage, out of breath, etc.

Grief of Patient of Stadium Cancer Continue.

More and more continue [his/its] stadium will give grief which more and more weight. Seldom that grief [is] not forbore by patient. Since grief wt. suffered [his/its], he determined try suicide. That grief not even be felt by patient [by] xself, but also by [his/its] family.

Why we [do] not improve effort with non-stoped to utilize various means to earn to heal? If/When healing [his/its] disease of course [his/its] grief also will disappear.

If that cancer have disseminated to various body shares or to various our body organ, as told mentioned no longer possible be healed. If we non-stoped [by] mengupayakan with various means of medication on the chance of earning to heal, what we get [is] increase [it] grief. Since effort we will cause grief come from two source:

First source from [his/its] own disease [is] which (it) is true not possible (to) be healed [by] and will remain to give grief.
Second source [of] effect [of] our effort. Cancer medication by anything always give side effects causing patient is not be balmy. surgery and Pasca operate on of course will cause pain in bone . side effects of kemoterapi and Radiotherapy also will make patient is not be balmy, for example queasy, vomit , etcetera.

Since the things, hence the patient will add to suffer and finally die in heavy grief

Whether/What Our Strategy If/When Cancer Have In Stadium Continue?

just If [of] our family member there [is] suffering that way, or if You have seen how [his/its] grief weight, just if [is] You have heard rintihannya or even [his/its] scream, I trust You will not until the liver let [it].

But insufficient perhaps only feel pity without doing something. Let us do something to help our relative suffering that. Let us give bold to our relative which have fall into darkness of[is full (of) distress. Let us do something to bring back belief our relative which have been unsettled [by] or even disappear effect [of] heavy grief

But what [is] we to perbuat? Under the circumstances only workable treatment paliatif in manusiawi, realistik, and rational.

Whether/What Treatment of Paliatif Itu?

If treatment paliatif you Not yet recognize, even You have never heard [it], is understandable. Since (it) is true treatment paliatif represent to form health service which relative newly in Indonesia. policy of This treatment paliatif newly governmental dicanangkan, in this case Departemen Kesehatan Republik Indonesia, by publishing of SK Menkes RI Number 604/MENKES/SK/IX/1989. While service of treatment paliatif for the new society started [at] date of 19 Februari 1992.

Body of World Health ( World Health Organization; WHO) giving definition of the following treatment paliatif ( 2005):

Paliative Care is an integrated system of care that: improves the quality of life, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement.

While in book of Pedoman Penanggulangan Kanker Terpadu Paripurna Published by Departemen Kesehatan Republik Indonesia ( 1997) got [by] philosophy constitutoing execution of treatment paliatif, the following:

Becoming rights [of] all patient to get best treatment to the death. Cancer patient which in stadium continue or [do] not gradually heal need get health service so that [his/its] grief [is] deductible. Given service have to earn to improve optimal life quality, so that the patient earn to die quietly in belief.

In definition and philosophy constitutoing treatment paliatif, mentioned over and over besides physical problem - for example pain in bone- also the psychological problem, social, and spiritual. This Hal based on: human being in fact [do] not only be consisted of [by] just a just physical element, but psychological also, social, cultural, and spiritual. This Berbagai element interact and each other memperngaruhi. Karenanya [of] if/when one of this element experience of trouble, hence the other element will follow annoyed. In fact this matter [is] llama have taught previous to us.

" In that human being body there are flesh clod. If nicely ( that flesh clod), hence nicely also entirely ( soul, mind, [his/its] behavior). But if ugly ( that flesh clod), [is] ugly hence also entirely ( soul, mind, [his/its] behavior). Know, that he ( that flesh clod) [is] HATI."
- Hadist
( Sumber: Rizal Ibrahim. Keajaiban Hati. DIVA Press. Cetakan III. Jan 2007)

Total Grief Concept.

As have been told [by] above, that human being [do] not only be consisted of [by] just a just physical element [is] we which can see, but still a lot of again elements forming human being as intact as. Since [do] not look clear such as physical element, that elements often [is] not paid attention to even be disregarded.

elements Forming that human being such as have been touched [by] above, namely: physical, psychological , social, cultural and spiritual. This Unsur-unsur interact and each other influence. Example [Of]: psychological problems, social, cultural, and spiritual earn to cause pain in bone of physical or memperberat of pain in bone physical. In this case [there] no satupun medicinize anti pain in bone which can memperingan [of] and surely omitting felt [by] pain in bone [of] patient, except if/when at the (time) of same [is] we handle also problems from various element tesebut. Demikian also on the contrary.

Follow the example of above representing a[n fact highlighting how important is/are to evaluate various that problem and handle [it] in simultan. Untuk earn to execute this required [by] a[n team from individuals by various membership which each other support, so-called team interdisiplin.

Into this team have to be [entered/included] [by] patient and [his/its] family. Exactly in fact the patient [is] prima facie team member. Since patient which [is] entitled to first time know [his/its] pandemic and what medication to be passed to [his/its]. He also which [is] entitled to determine medication [which/such] to be accepted [by] and which [is] which refused, after getting clear information.

Without team capable to execute total treatment ( totalize care) or treatment holistik ( holistic care) such as this, representing conditions in execution of treatment paliatif, we not possible (to) will improve quality live patient and [his/its] family.

Love [of] In Treatment Paliatif.

Love, will do not want to we have to confess as a(n) important aspect in treatment paliatif, even [is] more important the than pain in bone handling representing one of absolute matter have to be executed. Love materialization will look in treatment paliatif [of] [at] things [of] such as: love in merespon of somebody requirements. Love will look also in execution of pendampingan and momen-momen of[is other;dissimilar existence we with [done/conducted] patient attentively.

the No other representing to form statement of affection representing nucleus;core from altruistic love, affection majoring importance of others ( altrui = others). But that way, affection like that needn't negate kepedulian to ownself.

Let us see a moment the love meaning and various forming [his/its] materialization, what consciously or [do] not, we have experience of.
Love [of] [among/between] mankind couple.
Love to our parent.
Love to child.
Still a lot of again the love which we have experience of in meaning and [his/its] materialization [is] which different each other. Then what is the meaning of love in execution of treatment paliatif? Love Constitutoing execution of treatment paliatif have meaning care.


love Meaning kepedulian can be in the form of:
· Care [of] [at] ownself
Causing us able to recognize and love own self. We will know strength and feebleness which we own. Given the strength and feebleness of own self, individual hence that earn always present x'self which can be accepted by whoever [in] environment where about he reside in.
· Care to society
Since Careness to society, individual often mentioned in [his/its] effort do a[n kindliness to socialize [his/its] get gibing and jeer.

Care [is] description of affection of somebody which emerge effect [of] existence feel ketidaktegaan see circumstance or somebody grief. Later;Then arise motivation in our x'self to assist others which [is] suffering.

The real Careness represent expression of integrity or selfless sacrifice. somebody Trying to raise a hand moment see a mobile of others walk out [in] transportation;journey is not be interpreted [by] as interesting effort [of] people sympathy. But solely purification of expression of affection [of] [at] humanity.

Even so the effect [of] the aid, one who assisted to feel sympathy, that [is] something else. the Given to aid represent liver call which have disturbed mind and feeling of adversity somebody of others. Kepedulian as existing the affection (it) is true have to be based on by integrity. Otherwise, he only a illusion expression which [do] not have a meaning (of). If we assist others without integrity, there [is] which [is] passing by quickly in mind wish to get reward or praise from others. If this matter [is] not happened, arise disappointment.

Integrity [is] word of[is differ from candidness. [Is] strength capable to inseminate sindroma of soul calmness. Candidness make us as grateful clever human being for what have been given [by] God to us, so that there [is] bliss blanketing motion and step us. There [is] mind satisfaction [of] when what [is] we own to give benefit [of] [at] others

Thrown after it is not usefully

In fact by expanding [it] the health service [of] up at which more and more goodness, hence we now have [done/conducted] medical intervention to human being in the early [his/its] life, namely during that human being still in [his/its] mother content, with service of ante noel which aim to ( Reference of Service of Maternal And Neonatal, 2002):

Watching pregnancy progress to ascertain mother health and grow baby flower.
· Improve and defend physical health, mental, social of mother and baby.
· Mengenali early existence of ketidaknormalan or komplikasi which possible be happened [by] during pregnancy, inclusive of disease history in general, midwifery, and surgery.
· Mempersiapkan Copy enough the month;moon, bearing good safely Ms. and also [his/its] baby, with trauma as minimum as possible.
· Mempersiapkan Mother in order to the child bed walk normal and earn to give Exclusive ASI.
· Mempersembahkan of role of mother and Family in accepting baby birth in order to earn to grow flower normally.

From above mentioned targets, hence we understand all that [done/conducted] [by] for example to draw up early life which with quality. Or equally we draw up that human being to start life [in] this world better

Later;Then that baby grow as healthy child, and hereinafter become healthy adult. This human being for certain have done kindliness or service, [at] least for [his/its] family, or even to socialize, nation, and [his/its] state. Why this human being moment [is] powered becoming not since [his/its] disease, [do] not become our attention?

[is] Very inequitable, if us [do] not prepare this human being to start [his/its] life [in] eternity, such as those which we [do/conduct] when this human being will start with life [in] world.

Don'T be sweet used up sepah thrown!

Let us draw up and we send those who have over a barrel that to enter door of eternity life better, by [doing/conducting] treatment paliatif.

Handing out submitted/sent [at] Simposium Awam And Citra Pesona Paliatif, Hyatt Regency Hotel Surabaya, 17 Februari 2007.

THERAPY HIPERTEMIA

Latterly we often see advertisement [in] newspaper offering " recent medication" for the cancer, one of them is use therapy hipertermia. What Sebetulnya [is] sih of that therapy hipertermia? Why the doctor at our hospital never mean it?

Therapy Hipertermia ( referred [as] also termoterapi, hereinafter we mention just just hipertermia) [is] cancer medication by heating body network reach 44o even 45oC. Researching into to prove that high temperature earn to break and kill cancer cell, with damage minimize [at] normal network. With destroying protein and also cell structure, hipertermia earn to kill cancer cell and minimize size measure tumor.

Generally hipertermia used [by] bersamaan with other;dissimilar therapy, for example adiotherapy, kemoterapi , or imunoterapi , since hipertermia earn to make more sensitive cancer cell, even earn direct break cancer cells which cannot be broken by radiasi.

There [is] a lot of used method for hipertermia. Wide Berdasar [of] area which the therapy, divisible for local hipertermia, hipertermia regional, and hipertermia totalize ( entire/all body).

Local Hipertemia

[At] local hipertermia [of] warm-up [done/conducted] [at] finite area, in this case the cancer network. heat source Used [by] for example microwave ( microwave), radiowave ( radio frequency), and sound wave of high frequency ( ultrasound).

For the cancer which located in body surface or close to husk, hot producer appliance placed [by] at elbow tumor, later;then the wave radiation pointed at [by] a area which will be heated. If cancer [of] located in in or [in] around body holes ( for example throat or anus), hot source [entered/included] [by] into [his/its] use special appliance in order to the warm-up hit home target. This technique named [by] intraluminal or endocavitary hyperthermia.

Medium [of] if tumor location far in body, for example [at] brain cancer, used [by] technique [is] interstitial. Penderita anaesthetized, then the special needle or the heater inseminated to middle [of] cancer network with guidance of appliance of ultrasonografi or CT ( computed tomography). Transmitted radiowave will heat and kill cancer cells around.

Regional Hipertemia

Hipertermia Regional aim to to heat broader body area such as entire/all arm, tungkai, body organs, and the body channels. There are some used technique. First technique for the cancer which the near by hole or as long as body channel [of] such as gracious cancer mulut/leher, obstetrical cancer, cancer contain urine, dsb. Heater placed [by] at elbow hole or in channel, later;then the hot radiation from microwave or radiowave pointed at [by] a cancer network becoming target.

Second technique that is regional perfusion, to cure cancer [in] arm and foot/feet, or in body organs [of] such as liver and lung. Its Way, partial;some patient blood [released] to be, heated, then be re-pumped into arm, foot/feet, or the the organ. This technique generally be [done/conducted] [by] bersamaan with kemoterapi.

Third technique [is] CHPP ( continuous hyperthermic peritoneal perfusion), used to cure cancer in stomach cavity [of] such as peritoneal mesothelioma. Selama Surgery, medicinize kemoterapi heated later;then be conducted [by] into stomach cavity, so that [his/its] temperature reach 41,1-42,2oC.

Total Hipertemia

For the cancer [of] bermetastase ( disseminating) to entire/all body, [done/conducted] [by] total hipertermia ( whole body hyperthermia). Penderita blanketed with electric blanket or hot water, or [entered/included] [by] into hot space ( a kind of incubator) to make [his/its] body temperature mount until 41,7-43,8oC.

therapy Hipertermia proven to [by] earn to improve effectiveness of radiotherapy and also kemoterapi. Banyak Location which can be reached, for example cancer [in] head and neck, bosom cancer, lung, liver, stomach cavity, gracious neck, intestine, obstetrical, prostate, husk, bone. type of Therapy cancer which can even also kinds of, from adenocarcinoma, melanoma, carcinoma, thymoma, mesothelioma, lymphoma, sarcoma, squamous cell, basa cell.

effectiveness of medication Hipertermia [of] depend on how far the improved success body temperature, how long succeed defended, besides also depend on characteristic of cell and network which therapy. During [his/its] temperature therapy non-stoped [by] a watcher use mini thermometer, in order to temperature of the desired earn reached [by] but [is] not skipped over. This brand heat defended [by] during one clock.

Side Effects of Hipertermia

therapy Hipertermia [of] generally [do] not cause damage of network normal/sehat [of] if [his/its] temperature [do] not exceed 43,8oC. But difference of network character earn to generate difference of temperature or side effects [of] [at] body network which different each other. What often be happened [by] [is] feeling heat ( such as burnted), swelling to contain dilution ( mlenthung - Jw), is not be balmy, ill even.

technique Perfusi earn to cause pembengkakan network, blood cloting, perdarahan, or the other;dissimilar trouble [in] area which therapy. But this side effects [is] tentative. medium of whole body Hyperthermia earn to generate more serious side effects - but seldom be happened- such as heart disparity and venous. Sometime the side effects which emerge oppositely;also the diarrhoea, queasy, or vomit.