Лечение Эссенциальной Гипертензии – Essential hypertension treatment

You will be anesthetized; this can happen several ways. Most likely, you’ll have either spinal or epidural anesthesia; with both forms, you remain conscious and aware of the procedure, even though you can’t feel it. In spinal anesthesia, you’ll have a shot of local anesthetic injected into the small of your back through the dura, the membrane lining the spinal cord, and into the spinal fluid. Within minutes, you’ll feel numb, relaxed and heavy from your waist to your toes. After surgery, you’ll be asked to lie flat in bed until the numbness goes away and you can move your legs again. This is important; sitting up too soon can cause a severe headache.

Epidural anesthesia is like having an IV tube hooked up to your back, instead of to a vein in your arm. A local anesthetic enters the body through a tiny plastic tube, inserted between the vertebrae of your spine near the small of your back. The epidural anesthetic (often used to provide pain relief in pregnant women during labor) bathes the area outside the membrane lining the spinal cord, temporarily numbing the nerves in your lower body. Unlike spinal anesthesia, which comes in one dose, epidural anesthesia can be given continuously. The area of numbness can be adjusted; so can the degree of pain relief. After surgery, this tube can also be used to administer pain relief for the first few days. One point about epidural anesthesia: It reduces the likelihood of blood clots in the legs, perhaps by boosting blood circulation in the legs during surgery.

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The diagnosis is official. You have prostate cancer. What do you do now? The stage of your cancer and your age and overall health all have a huge bearing on this important decision.

Prostate cancer grows relatively slowly. It can stay localized, or confined to the prostate, indefinitely—so a man can die with prostate cancer, and not of it. But once it escapes the prostate, cancer’s growth is relentless. It can no longer be cured. And once it has spread to bone, a man’s average life expectancy is about three years.

In studies of watchful waiting in men with small, moderately well-differentiated cancers (Gleason scores from 5 to 7) that appear to be localized to the prostate, this is what happens over time: In ten years, 40 percent of these men will have cancer that has spread to the bone; by fifteen years, 70 percent of these men will have cancer spread to bone.

What does this mean to you? Once again, we go back to your age, general health, and stage of cancer.

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In the long term, it’s unclear whether watchful waiting will actually result in a decrease in health care dollars, as some studies have claimed. A 65-year-old man has a 50-percent likelihood of living fifteen years. The Swedish study mentioned above suggests that even under the best circumstances, about half of men with untreated localized disease will live to see their cancer spread beyond the prostate, requiring further treatment for advanced disease. If these men decide to have hormonal treatment, the cost of this over two years, at hundreds of dollars a month, may be more than the expense of a radical prostatectomy (which is about $12 thousand). Also, the symptoms from advanced cancer and the side effects of hormonal treatment and chemotherapy can be much worse than the side effects that can accompany treatment for early disease.

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So even in the men who haven’t died of prostate cancer (yet) this statistic,( 13 percent of these men had died from the cancer) almost becomes a technicality. Certainly their lives aren’t the same as those of men without prostate cancer. It’s hard to enjoy old age when prostate cancer’s symptoms begin to affect your quality of life. Incredibly, one of these men who «demonstrated no evidence of disease progression before death» turned out, an autopsy revealed, to have died of prostate cancer. How could this be? Men with end-stage prostate cancer don’t usually drop dead without warning. They suffer, as do their loved ones who watch this happen. They become increasingly frail as the cancer eats away their bones. Life ebbs away over a period of time that seems at once fleeting and yet agonizingly slow. How, then, could someone die of this cancer and be classified as being without symptoms? This astounding statistic suggests that men in the Swedish health care system were not carefully watched and that the progression rates are probably higher than the 50 percent these investigators quoted. (It also sheds unsavory light on another statistic: Some of the most strenuous objections to aggressive treatment for prostate cancer have come from doctors in Sweden, where definitive treatment for this disease is not widespread. And—this comes as news to many—Sweden has the highest death rate from prostate cancer in the world!

In Sweden, half of the men who are diagnosed as having localized prostate cancer die from it, and 69 percent of men who live longer than 10 years also die of the disease.)

These statistics are particularly distressing to think about when you consider this: Today, when localized prostate cancer is diagnosed in men who have a lifespan longer than ten years, the decision not to offer these men potentially curable therapy may be a death sentence. Because in most patients, the disease is going to progress.

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Despite its «kinder, gentler» technique, some doctors question the value of laparoscopic pelvic lymphadenectomy. For one thing, minimally invasive or not, it’s still invasive, and it’s not without side effects. These don’t occur often, but they can be significant and may include injury to the bladder or bowel, internal bleeding, damage to blood vessels, gas embolism (when air, pumped into the abdomen, escapes into the bloodstream), or even, rarely, heart failure and death.

Is the procedure ultimately necessary? It has no therapeutic benefit—a doctor can’t cure a man’s prostate cancer by removing cancerous lymph nodes; once the cancer spreads to the lymph nodes, it always spreads to other sites, like bone, as well. Perhaps the most useful benefit of this procedure is that it can rule out surgery for a man who doesn’t need it—but so can careful staging.

Also, finding that the lymph nodes are cancer-free still does not mean a man’s cancer is curable. Say, for example, a man has a large, palpable cancer that invades the muscles in the pelvic side wall (stage T3 or C), a Gleason score of 8, and a PSA level of 30. Sadly, there is no reason for this man to go ahead with a lymph node dissection; his disease is already extensive, and treatment for him should be aimed at relieving symptoms and pain. To put this man through the rigors of a procedure that ultimately won’t help him is neither helpful nor kind.

And finally, when surgical candidates are carefully evaluated, only about 5 percent wind up having positive lymph nodes—so a separate procedure just to determine the state of the lymph nodes is probably unnecessary in most men. Even this number may decrease as doctors begin computing the results of the digital rectal exam, PSA and the Gleason score. Methods for determining the scope of prostate cancer are constantly being refined.

However, the laparoscopic pelvic lymph node dissection can be useful in some instances—in a man who’s scheduled to undergo a radical perineal prostatectomy, for example, instead of a retropubic operation. (With the perineal approach, the lymph nodes aren’t dissected.) Also, sometimes this procedure provides more information than the frozen sections obtained during prostatectomy, and this may be helpful in determining the state of cancer in a man with a high Gleason score (8, 9 or 10).

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