[Surgical treatment of bronchogenic carcinoma 1970-2001]. / Operacní lécba bronchogenního karcinomu v letech 1970-2001.

BACKGROUND: Lung cancer (LC) is a permanent medical and social problem. 5709 patients died in the year 2000 of this disease in Czech Republic. Its incidence in men is 100/100,000 and it shows only small trend to decrease. In women the incidence has reached 22/100,000 and is still rising. The ratio males/females in the whole country is 4:1, in pulmonary department of University hospital Motol is close to 2:1. The optimal way of treatment is a surgery. METHODS AND RESULTS: From the data about diagnostics and operability in Pneumological Clinic of the 1st Medical Faculty of the Charles University (former 2nd Clinic of Tuberculosis and Respiratory Diseases) and from adequate data obtained from the Pulmonary department of University hospital Motol we can see that the number of operated patients increased from 20% in 1970 to 28% in 2001. When compared two set of patients operated in the period 1985-1990 and 1998-2001 we learned the change of the ratio males/females (from 17:1 to 2:1), lower number of pneumonectomies (from 34% to 31%), lower number of exploratory thoracotomies (from 13% to 5%), decrease of perioperative mortality from 10% do 2%. The percentage of correct clinical when compared to pathological TNM staging was similar in both periods (55% in the period 1985-1990 and 53% in the period 1998-2001). In the article we describe also results of diagnostics, induction and adjuvant treatment and possibilities of the increase of operability of the patients with lung cancer. CONCLUSIONS: The authors think that despite some improvements in several parameters, the 5-year survival of patients with lung cancer is in our country and the whole world still unsatisfactory. We recommend the revision of current attitude to the screening of lung cancer and we recommend joining the running European-American trials of screening of such patients with the help of low-dose spiral CT.

Metabolic characterisation of solitary pulmonary nodules by positron emission tomography with FDG--preliminary report.

BACKGROUND: In the past some authors evaluated FDG-PET as a powerful tool for non-invasive assessment of malignancy of solitary pulmonary nodules (SPN). The aim of this paper is to verify the performance of positron emission tomography with fludeoxyglucose (FDG-PET) in SPN in the conditions of the Czech Republic during the first 16 months of the operation of the PET Centre Prague. MATERIAL AND METHODS: The group of 22 patients with 23 SPN was investigated by dedicated PET scanner due to inconclusive CT scan. Micromorphological confirmation was available in 61%; follow-up (median = 12 months) concerned the other 39% SPN. RESULTS: PET was clearly positive in 11 nodules, all were malignant according to micromorphological assessment. PET was completely negative in 10 nodules, 3 of them were micromorphologically evaluated as benign, the other 7 nodules were followed up without any signs of malignancy. In two cases, PET revealed enhanced glucose consumption, but the pattern was not typical for malignancy. These cases were considered as bronchopneumonia, but till now, they have not been definitely resolved. CONCLUSIONS: Excluding two unresolved cases, sensitivity and specificity of FDG-PET was 100% for malignancy in our series. PET was helpful in medical decision-making in all patients.

[Fulminant diphtheria myocarditis in an unvaccinated preschool child]. / Maligne diphtherische Myokarditis bei einem ungeimpften Kleinkind.

We describe a case of a three year old unvaccinated child who developed a fulminant diphtheric myocarditis and nephritis four days after the onset of a tonsillar diphtheria. Despite of the administration of antitoxin on day three and four the child died within 48 hours from the beginning of rhythm disturbances. The cardiac involvement rapidly progressed from bradyarrhythmias with the necessity of a temporary pacemaker to ventricular rhythm disturbances with cardiac failure and final ventricular fibrillation.

[Heart transplantation in infancy: experiences at the Giessen Pediatric Heart Center]. / Herztransplantation im Säuglingsalter: Erfahrungen am Kinderherzzentrum Giessen.

From June 1988 to December 1996 heart transplantations were performed in 36 newborns and infants below one year of age. Diagnosis were hypoplastic left heart syndrome (n = 26), endocardial fibroelastosis (n = 4), cardiomyopathy (n = 3), and other complex congenital heart defects (n = 3). Mean waiting time for transplantation was 52 days, the mean donor-recipient bodyweight ratio was 1.8. Seven patients (19%) died after transplantation mainly within the first month after transplantation. The cumulative probability of survival is 79% in all patients. The influence of increasing experience is indicated when patients transplanted from 1988-1993 (n = 15) are compared with transplants from 1994-1996 (n = 21). The overall survival in the first group was 50%, whereas patients transplanted from 1994 showed a probability of survival of 92%. The 1-year survival rate in the later group was 100%. In 20 patients a total of 31 rejection episodes were observed. 2 infants died due to rejection. 71% of all rejections occurred during the first month after transplantation. Renal function was slightly impaired one year after transplantation in all patients without tendency for deterioration in the sequel. The somatic development is normal in nearly all infants and the quality of life is excellent. All infants live at home without any restrictions. Two patients, however, suffer from a neurologic deficit. Until now there is no evidence of coronary vascular disease or malignancy. Heart transplantation is in our opinion a reconsiderable alternative in the treatment of complex cardiac disease and cardiomyopathy in infants.

Acute pulmonary oedema due to transient myocardial dysfunction: an uncommon cause of respiratory distress in the term neonate.

UNLABELLED: Acute postnatal pulmonary oedema due to transient myocardial dysfunction is an uncommon cause of respiratory distress in neonates. Among 11,732 liveborns we observed 3 term neonates with this condition requiring mechanical ventilation. After a delivery mildly to moderately suggestive of subpartum hypoxia, good adaptation and a short symptom free interval all three infants presented with tachydyspnoea, cyanosis, haemorrhagic pulmonary secretions at intubation and pleural effusions, pulmonary venous congestion and patchy alveolar opacities in the first chest radiograph. No evidence of hypoxic-ischaemic encephalopathy was present. The initial need for high ventilatory support and high FiO2 was followed by rapid recovery after only a couple of hours. In two cases an underlying transient myocardial dysfunction could be demonstrated by echocardiography. CONCLUSION: Pulmonary oedema due to transient myocardial dysfunction can be a rare cause in the differential diagnosis of respiratory distress of the newborn. Myocardial impairment after probable hypoxia can be present without concomitant encephalopathy.

[Trends in epidemiologic indicators of lung cancer in the Czech Republic 1970-1990]. / Vývoj epidemiologických ukazatelu plicní rakoviny v Ceské republice v letech 1970-1990.

BACKGROUND: Lung cancer is the malignant tumour with the highest mortality in the Czech Republic as well as in highly developed countries of the world. The objective of the present study in an account on the incidence, diagnosis, treatment and mortality in the Czech Republic, at the Pneumological Clinic and the population in the district. METHODS AND RESULTS: The incidence and mortality rate from lung cancer increased during the past twenty years in men by 12% and declined by 2% resp. In women both indicators are steadily rising by 100 and 76% resp. The highest values of incidence and mortality in men were recorded at the end of the seventies and beginning of the eighties. During the investigation period a reduction of the age of those who died from lung cancer-men and women -was found, the increase in the group of 35-49-year-olds is 51% in men and 159% in women. As to histological types, spinocellular carcinoma is still the most frequent type, gradually the small cell type and adenocarcinoma are increasing in numbers. The authors investigated also differences in the epidemiological situation as regards lung cancer in the southern and northern Czech regions and compared the position in this country with that in other European countries. CONCLUSIONS: Despite some positive signals (decline of the lung cancer incidence in men), lung cancer still remains a serious medical and social problem. An alarming feature is in particular the linear rise of lung cancer incidence in women and the shift of deaths from this disease to younger age groups.

Diagnosis of pleural effusions. Experience with clinical studies, 1986 to 1990.

OBJECTIVES: To identify in patients with pleural effusion which procedures are most useful in separating malignant from nonmalignant pleural effusions and to identify which procedures most commonly lead to a definitive diagnosis. DESIGN: Prospective consecutive case series. SETTING: Pulmonary referral hospital in Prague, Czech Republic. PATIENTS: One hundred seventy-one adults between ages 18 and 70 years with a pleural effusion and a Karnofsky score of 70 or above. INTERVENTIONS: All patients underwent history, physical, pleural fluid cytologic study, laboratory evaluation of serum and pleural fluid, pleural biopsy, bronchoscopy, and lung scan and/or pulmonary arteriogram. RESULTS: In this series in which 45% of the patients had malignant effusions, 19% had paramalignant effusions, and 36% had benign diseases, the pleural fluid cytologic study was the best for establishing a diagnosis. The pleural fluid carcinoembryonic antigen (CEA) levels above 10 had a high specificity (90%) for malignancy but had low sensitivity (37%). The pleural fluid CEA level was increased only in 19% of patients with paramalignant effusions. Although there were statistically significant differences in the mean results on several biochemical tests of pleural fluid, none were very accurate in separating malignant from benign disease. CONCLUSION: From this study, we conclude that patients with an undiagnosed pleural effusion should be evaluated in an individualized stepwise manner. If malignancy is strongly considered, the initial three steps should be relatively noninvasive and include clinical evaluation and cytologic study.

The results of surgical treatment of non-small cell lung cancer at the Pneumological Clinic in Prague, Czech Republic 1985-1990.

In the Czech Republic, lung cancer is the most frequent malignant tumor in men. In 1990 the incidence was 99.6/100,000 for men and 15.8/100,000 for women. Neither diagnostic nor therapeutic approaches have changed significantly in the last 10 years. Patients undergoing lung resection have a chance of long-term survival. In this retrospective study, the authors analysed the data of 252 patients undergoing the operation for non-small cell lung cancer (NASCL) in the period 1985-1990. Of all patients who in that period had lung cancer diagnosed in our clinic, only 22% were operated on. Lobectomy was the most frequent type of operation (45%), and exploratory thoracotomy was carried out in 13%. The epidermoid type of cancer was the most frequent one (62%). Comparing cTNM with pTNM, concordant results were found in 55% of the series, 39% were clinically underestimated and 6% overestimated. By the time of the evaluation (31 December 1992), 78% of all patients who had undergone surgery during the study period had died. The most frequent cause of death was lung cancer metastasis. In the subseries of patients who died within 1 month after surgery (10% of all patients), the most frequent cause of death was pneumonia. The survival curve shows the best prognosis for patients in the Ist TNM stage, with 40% surviving 5 years. The authors consider the results of this study to favour aggressive surgical treatment of NSCLC patients.

[Initial experience with the treatment of endobronchial lesions using the Nd:YAG laser]. / První zkusenosti s lécbou endobronchiálních lézí Nd:YAG laserem.

Endobronchial treatment by means of a laser acquired during the past ten years a firm place in bronchology. In the submitted paper the authors present their initial experience with this treatment in patients of the Pneumological Clinic in Prague-Veleslavín. In the course of 12 months since when there is a Nd:YAG laser, Sharplan Co. at the clinic, 52 patients were treated by this method. Forty of them suffered from lung cancer. Three had other types of tumours. Eight patients suffered from benign cicatricial stenoses and one female patient aspirated a foreign body. A total of 124 bronchoscopies, using a laser, were performed, on average 2.4 per patient. In 75% of patients with lung cancer recanalization was achieved, the trachea was dilated in all patients with cicatricial stenoses, however, only in one quarter of them complete restitution of the lumen was achieved. Hitherto assembled experience confirms the value of laser treatment for improving the life and its prolongation in patients with lung cancer and its importance for treatment of other endotracheobronchial processes. Three serious haemorrhages during operation were recorded, one female patient died. The use of the laser is simple, its operation smooth.

[Differential diagnosis of pleural effusions. Experience from a clinical study 1986-1990]. / Differenciální diagnostika pleurálních výpotku. Zkusenosti z klinické studie 1986-1990.

In a group of 171 patients with pleural effusions included in a perspective study at the Second Clinic for Tuberculosis and Respiratory Diseases in Prague in 1986-1990, the authors evaluated the asset of examination methods for the diagnosis of different types of effusions. They compared differences between the group of patients with effusions associated with neoplastic diseases (group 1-108 subjects) with a group of patients with other types of effusions (group 2-63 subjects). They compared data in the case-history, physical examination, examination of the effusions and other auxiliary examinations. For significantly different parameters of blood examination (CEA, TPA, IgM, LDH) and the effusions (CEA, IgM, ALP) liminal values, specificity and sensitivity were assessed for differentiation of tumourous and other types of exudates. The authors compared also the required time and method of diagnosis in the two groups of patients. In group 1 cytology of the exudate, biopsy of the pleura and bronchoscopy were most valuable. In patients of group 2 in addition to the cytology of the exudate, biochemistry and bacteriology and auxiliary examinations were most important. The number of necessary diagnostic "steps" for assessment of the aetiology of exudates differed. Fewer steps were necessary for assessment of tumourous exudates. The groups differed as to treatment and survival of the patients.

[Results of bronchoscopy studies in patients with pleural effusion]. / Výsledky bronchoskopického vysetrení nemocných s pleurálním výpotkem.

The authors investigated in a group of 141 patients included in a study of pleural exudates at the Second Clinic for TB and Respiratory Diseases, Medical Faculty, Charles University Prague, endoscopic findings in correlation with the basic diagnosis and type of exudate. The group comprised 45 women and 96 men, mean age 52 and 54 years resp. 60.3% of the group suffered from neoplastic disease, most frequently bronchogenic carcinoma which was recorded in 56 of the patients. 114 patients were subjected to bronchoscopy, a tumour was detected by this examination in 33%, inflammatory changes in 19%, stenosis of the segments in 9% and merely dilated carinae in 3% of the subjects with pleural exudates who were subjected to bronchoscopy. The authors verified during bronchoscopy by cytological or histological examination 79% bronchogenic carcinomas, 35% other tumours. Bronchoscopy was the decisive examination; due to it the type of exudate was determined in 17 patients, i. c. 12%. In patients with other than neoplastic disease the endoscopic finding supported the basic diagnosis in 30% of the examined subjects, but did not assess the type of exudate in any of the patients. Bronchoscopy revealed pathological changes in 16 patients (11% of the group) where the skiagram of the chest indicated only changes suggesting a pleural exudate. Fifteen of them suffered from neoplastic disease, one from TB of the intrathoracic nodes. The authors conclude that the importance of bronchoscopic examination in patients with pleural exudates is increasing due to the changed spectrum of basic diagnoses and that it should be made in all patients with an obscure pleural exudate.

[Comparison of the results of transbronchial puncture of the lymph nodes with surgical findings in patients with lung cancer]. / Srovnáni výsledku perbronchiálních punkcí mízních uzlin s operacními nálezy u nemocných s plicní rakovinou.

Referring to a group of 144 patients with lung cancer planned for lung surgery, the authors compared the results of the needle biopsy of hilar, bifurcation and paratracheal nodes with the pathologist's finding in the resected portions of the lungs. In the hilar region, there were 89.5% findings in agreement with postoperative, 10.5% different findings. These were six patients where falsely negative results were found in 2 patients, falsely positive results in 4 patients. In the bifurcation and paratracheal regions, the cytologist's and pathologist's findings were entirely in agreement. At the same time the authors considered peribronchial needle biopsy for the ability to detect the lymph node. In the group of patients, in whom the nodes had not been reached by the needle, the pathologist described enlarged nodes in 14.7% patients in the hilar region, a 2.9% rate in the region of the bifurcation, and a 12.2% rate in the paratracheal region. In the authors' opinion, the method of peribronchial needle biopsy is sufficiently accurate and very useful for the intrathoracic staging of bronchogenic carcinoma. They see it as an inseparable part of bronchoscopy in patients with lung cancer.

[The significance of digital subtraction angiography in diseases of the lungs and mediastinum]. / Význam digitální subtrakcní angiografie (DSA) u onemocnení plic a mediastina.

The authors present their first experience with lung DSA in a group of 75 patients. The examination was most frequently performed by instilling a contrast medium into central, less frequently into peripheral veins. The most frequent indications included tumorous lung diseases and mediastinal tumours before an operation treatment, a suspected pulmonary embolism, lung and vascular malformation. Intravenous DSA proved to be also useful in the evaluation of pathological changes of thoracic aorta.

[Results of surgical treatment of pulmonary carcinoma in patients over 60 years of age]. / Výsledky chirurgické lécby plicního karcinomu u nemocných starsích 65 let.

The authors submit an analysis of patients operated in 1972-1982 at the First Surgical Clinic, Faculty of General Medicine, Charles University Prague. The group of patients was divided into those under 65 years and those above this age. The effect of the patients' age on the postoperative course was investigated, the survival of the two groups was compared, the causes of early postoperative deaths, the extent of the disease and histological type of tumour were evaluated. In was revealed that the risk of early postoperative death within one month is greater in patients above 65 years where it is 19.6%, as compared with 11.3% in the younger group. The risk increases in particular in patients above 70 years where it is as high as 26%. There is no fundamental difference in the causes of death between the two groups. The highest percentage of operated patients dies from embolism (40% and 42% in the patients above 65 years), the second place is held by inflammatory pulmonary complications which are somewhat more frequent in patients of the younger age group (24% as compared with 15% in the older patients). The survival curves of patients who had a radical operation in stage I and II of the neoplastic disease are almost identical and there is no significant difference in the survival of the two groups. In the group under 65 years 30% survive five years, in the older group 25%. The ratio of differentiated types of lung cancer, i.e. adenocarcinoma and epidermoid carcinoma is equal in both groups, contrary to small-cell carcinoma which was recorded in 6% in the older patients, as compared with 15% in the younger ones.