[Analysis of symptoms and case history data in the set of 353 patients with lung cancer]. / Analýza anamnestických dat a výsledku vysetrení v souboru 353 nemocných s plicním karcinomem z let 2004-2007.

BACKGROUND: Lung cancer (LC) incidence in men in the Czech Republic has been declining since 1995, in women it grows up continually. To analyse the characteristics of recent set of patients (pts) and contribution of their symptoms for diagnostic, treatment and prognosis we carried on the retrospective study on patients from 1st Pulmonary department from 2004-2007. METHODS AND RESULTS: Men:women ratio in the set of 353 pts was 2:1. The frequency of symptoms at the time of diagnosis were: cough 69%, dyspnoe 54%, loss of weight 49%, expectoration 39%, pain on the chest 37%, haemoptysis 17.7%, fever 16%, vena cava superior syndrome 3.7%. Smokers fell in to the disease in significantly younger age than nonsmokers, 63 vs. 73 years. 40% of pts with LC suffer from COPD, more frequently have had squamous type of cancer. 78% of the set was morphologically verified, most frequent types of cancer were squamous type (22.1%) followed by adenocarcinoma, 21.2%. Surgical therapy underwent 18.1% of the whole set. We look consequently for correlation between symptoms and other data of the pts. The pts with abuse of alcohol beverage fell in to the disease in a younger age. The pts with central tumor suffer from stronger cough more frequently, at bronchoscopy had more often direct tumor changes. The pts with IV. TNM stage of LC more frequently suffer from fever and pain. Significantly fewer pts with dyspnoe, loss of weight and lower FEV1 underwent surgical resection, FEV1 was lower in pts with central than with peripheral type of tumor. In pts with direct bronchoscopical tumor changes were found more frequently haemoptysis, broader spectrum of symptoms, lower FVC and FEV1. Dyspnoe correlated with PaO2 but not with PaCO2. CRP was lower in pts with peripheral type of LC, higher in pts with small cell LC (SCLC). Occurrence of haemoptysis did not correlate with number of smoked cigarettes. Conclusions. In conclusion we proofed that proper taking of history case may accelerate and improve the diagnostic process.

[Tuberculosis in Czech Republic in the year 2007]. / Tuberkulóza v Ceské republice v roce 2007.

BACKGROUND: The number of notified tuberculosis cases in the Czech Republic decreased in the year 2007. 871 new tuberculosis cases and relapses were reported in the year 2007 (8.4/100 000 inhabitants). METHODS AND RESULTS: 744 cases were pulmonary tuberculosis (7.2/100 000) and from them 506 were definite pulmonary cases (4.9/100 000). In 2007 266 smear-positive cases of pulmonary tuberculosis were diagnosed. The decreasing trend in tuberculosis incidence reported since 1998 has continued. Only 14.7% of new cases of pulmonary tuberculosis were discovered by active case-finding. CONCLUSIONS: Next targets of tuberculosis control in the Czech Republic must be an active case-finding in high-risk groups and monitoring of latent tuberculosis infection.

[Tuberculosis among foreigners in the Czech Republic 2003-2006]. / Tuberkulóza u cizincu v Ceské republice v letech 2003-2006.

Authors compared the situation in tuberculosis among foreigners in the Czech Republic during the years 2003-2006. Foreigners participated in 13.0-14.2% of total notified tuberculosis cases during this period. Proportion of smear positive cases among foreigners in this period grew up from 32.8% to 40.8%. The proportion of active case finding of tuberculosis cases among foreigners declined from 36.0% to 15.4%. At the same time foreigners formed an important part in drug resistance of TB-strains in the Czech Republic. 50% of MDR-TB cases were detected in foreigners. In 20 MDR-TB cases notified in the years 2003-2006 10 were detected in foreigners. If the number of immigrants from countries with high prevalence of tuberculosis to the Czech Republic increases the control of TB in the Czech Republic could be negatively influenced.

[Tuberculosis in the Czech Republic during 2006]. / Tuberkulóza v Ceské republice v roce 2006.

BACKGROUND: In the Czech Republic the number of all notified tuberculosis cases decreased in the year 2006. 973 (9.5/100,000) all tuberculosis cases of new diseases and relapses were reported. 799 cases (7.8/100,000) were pulmonary tuberculosis and from them 556 cases (5.5/100,000) were definite pulmonary tuberculosis. In 2006 267 cases of smear positive pulmonary tuberculosis were detected. The decrease in tuberculosis notification rate reported in the Czech Republic since 1998 has continued. METHODS AND RESULTS: The resistance for antituberculotic drugs was 7.4% and MDR-TB cases were detected in 1.4% of all bacteriologically confirmed cases. The low level of resistance, good treatment constitutes presumption of further decline in tuberculosis in the Czech Republic. CONCLUSIONS: The majority of tuberculosis cases were diagnosed because of symptoms (74.7%)-passive case-finding. By active case-finding only 11.7% of new pulmonary tuberculosis were detected. In Prague only 6.7% of all pulmonary tuberculosis cases were diagnosed by active case-finding. Next target of tuberculosis control in the Czech Republic will be to increase the percentage of active case-finding in high-risk groups and to monitor latent tuberculosis infection in our population.

[Incidence, diagnostics and therapy of the lung cancer in the Czech Republic in 2003]. / Výskyt, diagnostika a léca plicího karcinomu v Ceské republice v roce 2003.

Lung cancer epidemic has not ended. According to the data on the incidence and mortality in the Czech Republic it is obvious that both parameters decline in males; the rise in women probably ends. According to the present epidemiological parameters the number of new cases is still very high. Number of adenocarcinomas is slightly rising. No improvement has been achieved in the early diagnostics of TNM stage I and II, which are diagnosed in less than 21 %. It brings low number of indications for resection therapy, which in 2003 achieved 10.8 % for men and 10.1 % for women. Positive appears the higher number of verified tumours (72 % in men and 69 % in women) and the higher percentage of those who survived over 5 years (6.3 % in men and 9.4 % in women) in comparison with the situation 10 years earlier. The presented paper describes regional differences in the incidence of lung carcinoma (apparent gradient between the western and eastern part of the country) and the promptness of the diagnostics and the treatment indications.

[Tuberculosis in the Czech Republic]. / Tuberkulóza v Ceské republice a ve svete.

Tuberculosis is a general infectious inflammatory disease caused by the bacillus (mycobacterium) tuberculosis. The disease originated when the bacillus was transmitted from affected cattle herds to humans. Genetic methods proved the existence of tuberculosis in mummies of the ancient Egypt. In the 19th and 20th century socio-economic conditions enabled pandemics of tuberculosis. The essential element for spreading of tuberculosis is the tuberculous patient. The disease develops in 10% of those who were infected. Tuberculosis manifests by long-lasting coughing, night sweating, tiredness, growing slim, febriles and loss of appetite. Diagnosis can be established on the basis of thoracic sciagram, confirmed by microscopic and cultivation examination of sputum. In the Czech Republic, an effective surveillance of tuberculosis was established with resulting good epidemiological situation.

[Treatment of lung carcinoma patients at the First Department of Tuberculosis and Respiratory Diseases]. / Péce o nemocné s plicním karcinomem na I. klinice tuberkulózy a respiracních nemocí.

Lung carcinoma (BCA) represents the most frequent malignancy in men and the fourth most frequent one in women. In 2004, 5568 persons died from that disease. Study of the lung carcinoma has been the main research program of the First Department of Tuberculosis and Respiratory Diseases of the First Faculty of Medicine, Charles University and General Teaching Hospital since 1960. The presented article summarises results from present and older studies which can show that numbers of diagnosed BCA patients increased since 1960 till 1977, when they reached 96 cases. Since that time the situation has been stabile and the present number of newly diagnosed cases is about 90 cases. Ratio of men and women has changed--since the cohort in 1960 to 1961 with ratio 8:1, to the present ratio 2:1. Number of cases diagnosed at the first and second stadium decreased from 56% at the beginning of our study in 1960 to 1961 to 19.9% in the cohort from 2004 to 2006. Occurrence of individual structural types of carcinomas has also changed; the second position after the epidermoid types has now adenocarcinoma. Number of microscopically verified BCA cases increased from 32% at the beginning to 79% at present. Proportion of treatment methods has also changed. Surgical treatment increased from 10.1% in 1960-1961 to 16.7% in 1985-1987 and remained stabile since that. Radiotherapy was used in 10% of cases in 1960 to 1961 and in 39.5% in 2004 to 2006. Number of patients with chemotherapy increased from 41% to 58% during the same period. In 2004 to 2006 bronchoscopy verified 95% of cases with direct tumor changes, 54% of indirect changes and in 20% bronchoscopy revealed normal picture. Our results show that the treatment approaches for patients with BCA has developed with the constant necessity to improve the assessment, diagnostics and therapy of new cases.

[Diagnostics and indications of surgical treatment of patients with lung carcinoma at the first clinic of TRN of the first faculty of medicine and the VFN Prague in years 2004 to 2005]. / Diagnostika a indikace operacni lécby nemocných s plicním karcinomem na I. klinice TRN 1. LF UK a VFN praha v letech 2004-2005.

BACKGROUND: Results of the diagnostics and indications of surgical treatment of patients with lung carcinoma (BCA) at the First clinic in years 2004 to 2005 were evaluated in a retrospective study. METHODS AND RESULTS: The cohort of 209 patients with the male to female ratio of 2 to 1 included 63 % of current smokers, 22 % of former smokers and 15 % of non-smokers. BCA was diagnosed in significantly earlier age in smokers in comparison to former smokers or non-smokers. Men had smoked in average 107 000 of cigarettes more than women. In the family history we found one or more malignancies in 49 % of patients. In the personal history COPD was found in 42 % of patients. Patients with COPD had more frequently epidermoid type of cancer. In patients diagnosed at earlier stages of BCA (I to IIIA) COPD was present more frequently as an intercurrent disease in comparison with patients in higher stages. 34 % of patients had a history of alcohol abuse, the median age of alcoholic patients was 65 years, the median age of other patients was 70 years. In histologically verified tumours, the highest occurrence had the epidermoid type (29% of patients) and adenocarcinoma (27 %). 39 patients (18.6 % from the cohort) were surgically treated; from 128 patients with NSCLC 33 were surgically treated (25 % of NSCLC cohort). Among the causes of surgical treatment impossibility, the most frequent ones were COPD in the third to four stage, age over 80 years, polymorbidity and ill-being. CONCLUSIONS: Results of our study indicate that BCA is frequently diagnosed in already developed stage, numbers of surgically treated patients represent less than 20% of the total patients' number.

[Tuberculosis in the Czech Republic in 2005]. / Tuberkulóza v Ceské republice v roce 2005.

BACKGROUND: The number of notified TB cases decreased in the year 2005, when 1007 new TB cases and relapses were reported (9.9/100,000 inhabitants). METHODS AND RESULTS: 838 cases were pulmonary TB (8.2/100,000) and from them 586 were definite pulmonary cases (5.7/100,000). The decreasing trend in TB incidence reported since 1998 has continued. The treatment of definite pulmonary cases notified in 2004 and evaluated in 2005 was effective. Treatment success was in 80.7 % of cases, but failures and interrupted treatment were only 2.5 % of cases. Only 14.7 % new cases of pulmonary TB were found by active case-finding. CONCLUSIONS: Next targets of TB control must be an active case-finding in high-risk groups and monitoring latent TB infection.

[Extent of tuberculin skin testing spot in bacteriologically verified tuberculosis]. / Velikost kozní reakce tuberkulinového testu u bakteriologicky overené tuberkulózy.

BACKGROUND: Tuberculin skin test was evaluated in patients with bacteriologically verified tuberculosis notified in the Czech Republic during 2003 and 2004. METHODS AND RESULTS: Out of 1172 patients with bacteriologically verified tuberculosis altogether 28.8% were tuberculin-negative. The average value of tuberculin reaction in this cohort was 11.6 mm. Among 30-year-old patients with bacteriologically verified tuberculosis the number of tuberculin-negative individuals was statistically lower (14 %) in comparison with 70-year-old and older patients, where the prevalence of tuberculin-negative individuals was 42 %. Higher rate of tuberculin-negative individuals with bacteriologically verified tuberculosis was found among patients who were diagnosed with liver disease (42 % of tuberculin-negative) or malignant tumor (47 % of tuberculin-negative). Presented results show that in circumstances of the Czech Republic the tuberculin skin test can be used to follow up the spreading of tuberculosis infection in younger age groups without accompanying serious disease only. CONCLUSIONS: The improvement of the diagnostics of latent tuberculosis infection can bring the routine introduction of new tests, e.g. Quantiferon-TB Gold or other methods.

[Lung cancer operability--history and presence]. / Operabilita bronchogenního karcinomu--historie a soucasnost.

Review of contemporary publication on the operability of lung cancer in the Czech Republic and in other countries is presented. Since 1912, when 374 cases of lung cancer were described, the incidence has risen and culminated towards the end of the 20th century. From the available treatment modalities, surgery gives the best results. An overview of papers describing the beginning of thoracic surgery in the Monde and in the Czech Republic is given. In the Czech Republic during 2002, 11.3% of all lung cancers were resected. From the TRN clinics in the Czech Republic about 20 to 27% of patients are recommended. In the leading world centres the operability is higher--about 25 to 35% of patients. The improvement of operability of lung cancer is possible namely by the increase of timely diagnosed tumors and by more frequent use of neoadjuvant medication in the treatment algorithms.

[Tuberculosis in the Czech Republic in the year 2004]. / Tuberkulóza v Ceské republice v roce 2004.

The number of notified TB cases in the Czech Republic continued to decrease in the year 2004. 1057 new TB cases and relapses of TB were reported in the year 2004 (10.3 / 100,000). 861 were pulmonary TB (8.4 / 100,000) and from those 584 were unequivocal pulmonary TB cases (5.7 / 100,000). The decreasing trend in TB incidence reported since 1998 has continued. Treatment success was present in 76.7% of cases; failures and interrupted treatment were observed in only 2.0%. Results of the treatment were affected by great numbers of deaths for other causes then TB, because they were observed in the oldest part of population. The resistance for AT drugs was confirmed in less than 6% of cases and MDR-cases were under 2%. The low level of resistance and good treatment outcomes are very important for further decline of new TB cases. The next target of TB control should be the active case finding in high-risk groups and monitoring latent TB infection.

[Tuberculosis in the Czech Republic in 2003]. / Tuberkulóza v Ceské republice v roce 2003.

BACKGROUND: 1162 new cases of tuberculosis were diagnosed in the Czech Republic in 2003; pulmonary tuberculosis represented 942 cases and in 660 cases the diagnosis of tuberculosis was bacteriologically confirmed. METHODS AND RESULTS: 355 cases were smear positive tuberculosis. The increase of certain TB cases (70%) in 2003 compared to 2002 is not statistically significant (p = 0.031). The notification rate (incidence) in 2003 was 11,4/100 000 all cases of tuberculosis, 9,2/100 000 pulmonary tuberculosis and 6,5/100 000 certain cases of tuberculosis. CONCLUSIONS: Compared to 2002 a decline of all forms of tuberculosis was observed, this decline however was not statistically significant. The increase in bacteriologically confirmed tuberculosis and smear positive tuberculosis was also not statistically significant.

[Resistance of Mycobacterium tuberculosis to antituberculotic drugs in Czech Republic in 2003]. / Rezistence kmenu Mycobacterium tuberculosis na antituberkulotika v Ceské republice v roce 2003.

BACKGROUND: The results of Mycobacterium tuberculosis susceptibility testing in 2003 were analysed in 568 (84%) pulmonary TB definite cases in the Czech Republic. METHODS AND RESULTS: The resistance on antituberculotic drugs was detected in 4.9% of TB bacilli. Most frequently, resistance on one drug--isoniazid (1.8% of pulmonary TB definite cases) has been observed. Multidrug resistant TB was found in two cases in 2003. CONCLUSIONS: The resistance of Mycobacteria was found significantly more often in foreign-born persons with pulmonary TB (25% of strains of TB bacilli were resistant on one or more AT drugs). Resistance on AT drugs was more frequent also in previously treated TB cases, especially if the relapse occurred after 3,5 years after finishing previous treatment.

[Tuberculosis in the Czech Republic in 2002]. / Hodnocení situace tuberkulózy v Ceské republice v roce 2002.

BACKGROUND: The number of all notified TB cases decreased in the year 2002. 1200 (11.8/100,000) cases of new TB diseases and relapses were reported in the year 2002. 972(9.6/100,000) were pulmonary TB and from them 658 (6.4/100,000) were confirmed pulmonary cases. METHODS AND RESULTS: The decreasing trend in TB incidence, reported since 1999, has continued. The treatment of confirmed pulmonary cases notified in 2001 and evaluated in 2002 was effective. Treatment success was in 71% of cases, but failures and interrupted were only 3.3%. Results of treatment were affected by many patients who died for other reason then TB, because they were from the oldest group of population. We have no influence on these deaths. The resistance for AT drugs was less then 7% and MDR cases were less the 2%. CONCLUSION: The low level of resistance and the effectiveness of treatment allow presuming a further decrease of TB cases. Next target of TB control should be active case finding in high-risk groups and monitoring latent infection.

[Tuberculosis in the Czech Republic in the year 2000]. / Tuberkulóza v Ceské republice v roce 2000.

BACKGROUND: Incidence of tuberculosis (TB) in the Czech Republic (CR) during the year 2000 was evaluated on the basis of newly detected cases as well the restriction of known TB sources by antituberculosis treatment. Data from compulsory reported TB cases in the TB register for the year 2000 were used as well as data from the analysis of treatment in cohorts of patients reported quarterly in 1999 and evaluated 12 months later. METHODS AND RESULTS: 1442 cases of new diseases and TB relapses were reported in 2000 (14.1/100,00). 1244 cases (12.1/100,000) were TB of the respiratory system, 198 cases (2.0/100,000) belonged to the extra-respiratory TB. 61.9% of cases were bacteriologically verified TB of the respiratory system. In comparison with the year 1999, the number of TB cases was lower by 11.7%, respectively by 9.3% in TB of the respiratory system. The positive trend in TB incidence recorded in CR since 1998 has continued. From 1442 cases of the TB, 916 were males (63.5%) and 526 females (36.5%). Majority of patients was older than 65 years. 143 (9.9%) of TB cases were patients born extra CR ("foreigners"), namely coming from Ukraine (41), Vietnam (16), and Romania (14). 74 patients died of tuberculosis, mostly those older than 65 years. The youngest was the 24-year-old Ukrainian and a 38 year old homeless person, the citizen of CR. The highest incidence of TB was in West Bohemia, in Prague and in North Moravia; the lowest incidence was in South Moravia and in South Bohemia. TB was identified because of patient's troubles (68.0%), in the risk groups (13.3%), and by examination of contact persons (4.7%). Other mycobacteriosis than TB was identified in 92 patients. The treatment was evaluated in 606 persons with the pulmonary TB, which was bacteriologically verified; analysis was done in cohorts of patients reported quarterly in 1999. 70.1 to 77.5% of patients in individual cohorts were successfully treated, in 3 patients the treatment failed and 9 patients interrupted the treatment. Remaining 25% of patients either died before or during the treatment. The high mortality rate resulted from the high age and other diseases in some of the patients. CONCLUSIONS: WHO includes CR between countries with low TB incidence. Within the stabile population of CR the continuous decrease of TB incidence should continue, unless some unfavourable effects occur.

[Multiresistant tuberculosis in the Czech Republic in 1998 and causes of its occurrence]. / Multirezistentní tuberkulóza v Ceské republice v roce 1998 a príciny jejího vzniku.

Multidrug resistant tuberculosis (MDR-TB) belongs to the most serious forms of TB. The number of MDR-TB patients represents an indicator of the effectiveness of TB regimentation. The aim of the study was to determine the number of registered MDR-TB patients in CR in 1998 and to identify causes of the resistance. Analysis of clinical documentation of 27 patients with MDR-TB positive sputum was done in 1998. According to the documentation, this form of tuberculosis was not confirmed in 5 persons. Out of 22 patients with confirmed MDR-TB, 21 were males and one female. In 3 of them we could not reveal whether they had been cured with antituberculotics before MDR-TB developed. Such resistance was then classified as an initial form. In 19 patients we found that resistance developed during treatment. Those cases were classified as secondary forms. In 16 patients the secondary resistance was related to the interruption of treatment, which was done wantonly by the patients in 14 cases. The consistent treatment of the sensitive TB is therefore the best prevention for MDR-TB development. Incidence of MDR-TB cases has not been influenced by immigration from countries with high rate of occurrence of MDR-TB.

Is quarterly cohort analysis useful for assessing treatment outcomes in a low incidence country?

SETTING: In the Czech Republic, a country regarded as having a low incidence of tuberculosis (TB), short-course chemotherapy (SCC) of TB has been implemented in routine practice country-wide. OBJECTIVE: To assess the outcome of SCC by quarterly cohort analysis of patients using the methodology recommended by the World Health Organization (WHO). DESIGN: Patients with newly detected bacteriologically confirmed pulmonary TB notified in 1998 were treated according to local recommendations (SCC) or with the WHO-recommended DOTS strategy. The type of chemotherapy and its outcome were evaluated 12 months later by quarterly cohort analysis. RESULTS: A total of 731 patients with bacteriologically confirmed pulmonary TB, 403 of them smear-positive, were assessed. The proportion of those treated under the DOTS strategy increased from 56.2% to 75.1%. Favourable treatment outcomes (cure or treatment completed) were achieved in 69.0% of patients in the first quarter and 74.0% in the fourth quarter. Only four treatment failures and 21 defaulters were recorded. A total of 129 patients (15-21% in different cohorts) died before or during treatment, mostly from causes not connected with TB. If this proportion were not taken into account, treatment efficacy would have attained 85%. CONCLUSIONS: Analysis of SCC based on quarterly cohorts proved feasible in routine conditions in a country with a low incidence of TB and ongoing TB control, and provided more information than once yearly analysis.

Screening of TB contacts by tuberculin skin tests in a low-incidence community by BCG vaccination.

A 36-year-old man, an unemployed waiter, a regular patron of two bars living in a Czech city suffered for about a year from disorders caused probably by tuberculosis (TB). When hospitalised, diabetes mellitus and extensive lung TB were diagnosed. TB was found also at the post mortem examination when the patient died one week later. Screening of his contacts by tuberculin skin tests (2TU RT23 W. Tw.80) provided data for analyzing the usefulness of tuberculin tests for monitoring of propagation of TB infection among BCG vaccinated population with high TB prevalence in the A statistically significant difference was found in tuberculin reactivity between 543 contacts and 232 individuals who had not reported contact with, the patient. A skin reaction of 12 mm and more was found in 55.6% contacts while only in 2.6% of those included in the second group. The high tuberculin reactivity was proved in the individuals exposed to massive TB infection. Neither BCG vaccination, nor possible previous contact with TB in the past seemed to influence the actual tuberculin reactivity in the group of non-contacts. Furthermore, it is indicative of the fact that unknown TB sources are rare among the Czech population. The high tuberculin reactivity is suggestive of a fresh infection and justifies the tuberculin testing and the application of chemoprophylaxis.

[Tuberculosis in the Czech Republic in 1998]. / Situace tuberkulózy v Ceské Republice v roce 1998.

In Czech Republic (CR) the epidemiological situation in tuberculosis (TB) was evaluated in 1998 using the notification TB into the TB register. 1805 new TB cases and relapses were notified (17.5/100,000 citizens). Majority TB cases, 1535 (14.9/100,000 citizens) were of the respiratory system and 270 TB cases were in other localized Two thirds (988 cases = 9.6/100,000 citizens) of the respiratory system TB, were bacteriologically verified thereout 564 direct smear positive. Patients with lung TB only were 10% less frequent than those with respiratory system TB. 69 TB cases were identified in foreigners. Relapse of TB was found in 66 patients. Among the notified TB cases were 62.9% of males and 37.1% females. In both sexes patients over 70 predominated. In the medium age category males also prevailed. Due to subjective troubles of patients TB was passively identified in 72.2%, actively by the physician 12.9% were identified. Late TB diagnosis during section occurred at 5.4% of patients. During the last 9 years annual number of notified patients has not changed. Only the number of bacteriologically verified cases of the respiratory system TB decreased and number of not verified cases increased. Decease due to TB was notified in 73 (0.7/100,000 citizens) usually old patients. In 67 patients TB was diagnosed premortally or at section. Differences in TB prevalence were found in different regions. Higher numbers of the TB patients than in average for the whole state were found in Prague, northern and western Bohemia and in northern Moravia. 112 new cases and relapses of MOTT were reported in 1998. Notification of TB in CR was on a good level. State of TB morbidity was stabilised and under control. However, the decrease of numbers of bacteriologically verified cases and increase of not verified ones, causes of occurrence of microscopically positive diseases will be necessary to analyse and groups which will require higher dispensary care have to be recognised.