[Diagnostics and treatment of community-acquired pneumonia - simplicity is the key to success]. / Diagnostika a lécba komunitní pneumonie - v jednoduchosti je klíc k úspechu.

Pneumonia is the most wide-spread infectious disease and requires unrelenting attention. It is defined as an acute inflammatory disease affecting pulmonary alveoli, respiratory bronchioles and the pulmonary interstitium. In recent years we have seen the endeavour to rationalize the approach to pneumonias and utilize the current methods of administering effective antibiotics to reduce occurrence of complications, limit the number of hospitalizations and shorten the length of treatment. With the awareness of all the potential agents it is empiric therapy which predominates, being supported by the knowledge of a regional epidemiological situation, good diagnosing and experience of rational antibiotic treatment. Very important is categorization of patients based on possible risks of complications and mortality. Considering that an appropriate form of treatment is chosen: outpatient care or hospitalization.Key words: community-acquired pneumonia - treatment criteria - prognosis - occurrence.

[Closed pleural biopsy in the diagnostics of malignant pleural involvement]. / Necílená biopsie pleury v diagnostice maligního pleurálního výpotku - nase zkusenosti za posledních 15 let.

INTRODUCTION: Pleural effusion is a frequent reason for a pulmonologist´s investigation. The cornerstone is to distinguish transudative pleural effusion from exudative pleural effusion. In the case of the exudative pleural effusion the next step is detection of malignant etiology of pleural effusion. We have a variety of any non-invasive or invasive examinations. The pleural biopsy is one of the most important methods for diagnostics of malignant pleural effusion. MATERIAL AND METHODS: Two hundred and twenty-two closed pleural biopsies (CPB) were performed in 208 patients with pleural effusion, where the cytologic examination of pleural fluid was negative. The authors evaluated the value of CPB for the diagnosis of malignant pleural involvement. RESULTS AND CONCLUSION: Total sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 63.1%, 100%, 73.9%, 100% and 52.8%, but in the group of mesotheliomas these results were 59.1%, 100%, 79.4%, 100% and 70.7%. The incidence of complications and representative sampling of the pleura was mentioned. The authors compared the diagnostic value and the incidence of complications of various diagnostic methods in malignant pleural involvement by data in the literature.

Bacillus Calmette-Guérin pneumonitis after intravesical instillation: Report of two cases and a review of the literature.

OBJECTIVE: Intravesical administration of bacillus Calmette-Guérin is standard adjuvant treatment of non-muscle invasive bladder cancer. In spite of the fact that this immunotherapy is locoregional, there are still risk of some complications. METHODS: We describe two cases of systemic BCG infection after intravesical administration of BCG vaccine in patients with early stage of bladder cancer. RESULTS: Both patients suffered from systemic BCG infection manifesting as BCG pneumonitis. After standard therapy with antituberculotic agents, both of them fully recovered. CONCLUSION: BCG infection can occur as a rare but potentially serious complication of this treatment procedure. Gravity of this side effect and its specific therapy require prompt and right diagnosis.

The Effect of Tobacco Smoking and Smoking Cessation on Urinal miRNAs in a Pilot Study.

The diseases associated with tobacco smoking affect miRNAs and small single-stranded non-coding RNAs. However, there are no data on urinal miRNAs in healthy smokers. We searched for the possible effect of smoking and smoking cessation on miRNA urine expression. For screening, Affymetrix miRNA 4.0 arrays were used in 33 urine samples obtained from six never smokers and from current smokers in three time-points before smoking cessation (n = 10), after short time abstinence (3-8 weeks), and after long-term abstinence (1 year). For validation, a quantitative (q) polymerase chain reaction (PCR) method was used in 93 urine samples obtained from 18 never smokers and 25 current smokers in three time-points before smoking cessation, after short time abstinence (3-8 weeks), and after long-term abstinence (1 year). In screening analysis, 5 miRNAs (hsa-miR-3620-5p, hsa-miR-3613-5p, hsa-miR-3921, hsa-miR-5094, and hsa-miR-337-3p) were dysregulated in current vs. never smokers after multiple testing corrections. Smoking cessation was accompanied by miRNA dysregulation that did not reach a significant level after a multiple testing correction. In validation analysis, three miRNAs correlated with cotinine, but they were affected neither after smoking cessation nor between current and never smokers. Our whole-genome screening of 2.578 miRNAs and validation suggest that tobacco smoking has no or only a small effect on urinal miRNAs.

Real life adjuvant chemotherapy uptake and survival in patients with non-small cell lung cancer after complete resection.

OBJECTIVES: Adjuvant chemotherapy (AC) in non-small cell lung cancer (NSCLC) has become a standard of care in patients with stages IIA, IIB, and IIIA after complete tumor resection. Utilization and outcome of AC in routine practice is described in a few studies, with non-conclusive results. MATERIALS AND METHODS: This retrospective study included consecutive patients with NSCLC who underwent curative-intent surgery. Data of AC uptake in stages IB (tumor of ≥4 cm in diameter), II, and IIIA, and reasons of AC omission were evaluated according to medical records. Mortality risk among patients treated with surgery (only) and different types of AC in routine practice was compared. RESULTS: AC was applied to 79% of patients with stages IB (tumor of ≥4 cm in diameter), II, and IIIA, and was associated with an improved median of overall survival (HR = 0.69; 95% CI = 0.44-1.06). Significantly longer survival was achieved in the sub-group treated with platinum and oral vinorelbine (HR = 0.575, 95% CI = 0.339-0.974), and the longest survival was among patients treated with oral vinorelbine and cisplatin (HR = 0.371, 95% CI = 0.168-0.820). CONCLUSIONS: AC utilization should be based on co-operation between surgeons, pneumo-oncologists, and patients. Rational use of AC offers better survival in routine practice.