[On the importance of standardization in the assessment of population-based cancer patient survival in the Czech Republic -  methodology and results from the Czech National Cancer Registry]. / Význam standardizace v hodnocení populacního prezití onkologických pacientu v CR -  metodický koncept a výsledky analýzy dat Národního onkologického registru.

BACKGROUND: Calculating 5-year overall and relative survival is the standard method for population-based analyses in oncology. Survival rates based on population data do not, however, guarantee standardized benchmarks for comparison of different patient populations, which is especially true when compared populations differ considerably in age structure and representation of clinical stages. In this paper, we present and compare statistical methods for standardization of cancer survival rates. PATIENTS AND METHODS: Using data of the Czech National Cancer Registry, we estimated 5-year overall and relative survival estimates for periods 2001- 2005 and 2006- 2010. To demonstrate the effect of standardization, we calculated crude and age -standardized survival rates as well as survival rates standardized for both age and clinical stage. RESULTS: Our results show that the particular standardization method influences resulting 5-year overall and relative survival rates regarding both within and between time periods comparisons. In addition, our results document a recent improvement in 5-year relative survival between periods 2001- 2005 and 2006- 2010 for 19 of 20 evaluated diagnoses. All most prevalent cancers including prostate, lung, colorectal, breast, kidney, and uterine cancer and melanoma were observed among the diagnoses with statistically significantly improved patient survival. CONCLUSION: Unless the use of standardization to the age and stage of tumor is limited due to a small number of patients in individual age-  and stage- specific subgroups, this method can be considered as a proper statistical methodology for the population assessment of Czech cancer patient survival rates.

[The strategy of the Czech Society for Oncology of the Czech Medical Association of J. E. Purkyne for the organisation of oncological care in the Czech Republic]. / Strategie Ceské onkologické spolecnosti Ceské lékarské spolecnosti J. E. Purkyne pri organizaci onkologické péce v CR.

The Czech Society for Oncology of the Czech Medical Association of J. E. Purkyne (COS CLS JEP) builds on intensive collaboration at all levels of medical care during the organisation of oncological care. Over 77,000 malignant neoplasms are diagnosed in the Czech Republic annually. Every year, over 27,000 patients with a malignant tumour die in the Czech Republic. A total of over 450,000 patients with malignant tumours or patients with a history of an oncological disease are living in the Czech Republic. The specialised society analyses available data about the treatment history and offers them to the individual regions; it also plans population based treatment costs which are then discussed with the healthcare payers. The Czech National Cancer Control Programme (NOP) presents a strategic outline for the management and development of the treatment, and facilitates the communication with all stakeholders and the public. The COS CLS JEP Society includes a specialised section responsible for data analysis, which provides a complex agenda of population based data, estimated numbers of treated patients, standards for reference of survival analysis and a system of collecting required clinical data. Even with a growing incidence, the Czech Republic shows a stabilised mortality in all cancer diagnoses. Screening programmes for breast, colorectal and cervical carcinoma are ongoing. We have a consolidated and cooperating network of oncology centres. We are able to actively plan diagnostic and treatment needs and we have a system of data collection that is able to respond to the needs of evaluation of cost efficiency. We are currently introducing a hospital care quality assessment.

Chronic antioxidant therapy lowers blood pressure in adult but not in young Dahl salt hypertensive rats: the role of sympathetic nervous system.

AIM: It is well-known that salt hypertension is associated with increased oxidative stress. Since the development of salt hypertension is age-dependent, we were interested whether young and adult salt hypertensive Dahl rats differ in oxidative stress level and/or in the effects of chronic antioxidant therapy on blood pressure (BP) level and on the participation of particular vasoconstrictor/vasodilator systems in BP maintenance. METHODS: Young (5-week-old) and adult (12-week-old) salt-sensitive (Dahl-S) male rats were fed high-salt diet (5% NaCl) and drank tempol solution (2 mm) for 5 weeks. BP was monitored with radiotelemetry and vasoconstrictor/vasodilator balance was evaluated at the end of experiment. Moreover, NO synthase activity, superoxide production and lipoperoxidation were determined in heart, kidney and aorta in separate subgroups of Dahl rats. RESULTS: Tempol treatment had quite opposite BP effects in young and adult Dahl-S rats. While it tended to increase BP in young salt hypertensive Dahl-S rats, it significantly lowered BP in the adult ones due to reduced sympathetic vasoconstriction. Importantly, high salt intake substantially reduced NO synthase activity in heart and kidney, and markedly increased superoxide production in kidneys and aorta of adult Dahl-S rats in which BP correlated positively with superoxide production in thoracic aorta and lipoperoxidation in kidneys. CONCLUSION: Chronic antioxidant therapy lowered BP only in adult salt hypertensive Dahl-S rats in which superoxide levels were increased in both kidneys and aorta. Blood pressure reduction induced by chronic tempol treatment is related to attenuated sympathetic vasoconstriction rather than to augmented NO-dependent vasodilatation.

[External factors catalyzing the development of tumours or providing protection against them]. / Zevní vlivy podminující vznik nádoru nebo ochranující pred jejich vznikem.

The number of malignant diseases increases and the question is why. Why is there an increasing incidence of certain cancers and why an increasing number of people dies from them? We do not have a clear answer to these questions. We just know that a development of cancer depends on certain internal predispositions as well as external conditions. We are unable to change our genetic predisposition but we are able, to some extent, influence the intensity of external factors. This paper summarizes information on the effects of external environment on the development of malignant diseases.

[A network of comprehensive cancer care centres in the Czech Republic]. / Sít' komplexních onkologických center Ceské republiky.

The exponential growth in medical knowledge is closely followed by expanding range of therapeutic options as well as increasing expenses associated with the use of new diagnostic techniques and treatments. This development requires organizational steps that would ensure that the expenditure is associated with the maximum benefit. The following text discusses foundation and development of a network of cancer care centres in the Czech Republic.

[Kidney failure in a patient with chronic B-lymphocytic leukaemia (B-CLL) with underlying cast nephropathy. The value of free immunoglobulin light chain identification for early diagnosis of this complication]. / Selhání ledvin u pacientky s chronickou B-lymfocytární leukemií (B-CLL) vzniklé na podklade tvorby odlitkových válcu v tubulech ledvin z monoklonálnich volných lehkých retezcu (cast nephropathy). Prínos stanovení volných lehkých retezcu imunoglobulinu pro casnou diagnostiku této komplikace.

We describe a case of an untreated female patient monitored over 8 years for chronic B-lymphocytic leukaemia (B-CLL). Over the 8 years, the patient has gradually developed severe kidney failure, even though the criteria for B-CLL treatment had not been fulfilled. Kidney biopsy revealed renal damage due to lamda free light chains cast nephropathy as well as an infiltration of renal parenchyma with B-CLL cells. It was not before this biopsy that the presence of monoclonal immunoglobulins has been investigated. Immunofixation identified free monoclonal lamda light chains in the serum and urine. Their serum concentration, quantified by densitometry, was 2.6 g/l and urine concentration was 0.5 g/l. A specific evaluation of free light chains in the serum revealed an extremely high concentration of free X light chains, over 4500 mg/l, and normal concentration of K free light chains, 10 mg/l. The aim of this report is to emphasise that monoclonal immunoglobulin may be present in B-CLL as well as other lymphoprolipherative diseases and that it may cause damage to organs, similar to multiple myeloma or monoclonal gammopathy of undetermined significance. The described case confirms poor prognostic value of monoclonal immunoglobulin free light chains in patients with B-CLL and usefulness of an evaluation of their presence in patients with B-CLL, particularly if the patients have increased creatinine level. The described case also highlights the need for evaluation of the presence of free light chains in the serum of all patients with unclear cause of renal failure.

[Sepsis and the septic shock in oncological or other immunocompromised patients--diagnosis, therapy]. / Sepse a septický sok u onkologicktch a imunokompromitovaných patientu--diagnostika, terapie.

Sepsis and the septic shock and the up to date knowledge about them represent a marked drifting for diagnostics and the treatment of this complications. Their application in patients with the oncological disease or the other immunocompromised patients represents further extension in the specific group of patients with several unique properties. In despite of the improving results in the oncological treatment there are only few reports in literature about this group of patients and this one is steadily growing due to the progressive improving of the supportive care in oncology. This group of patients with the febrile neutropenia and the sepsis (the most frequent complication) request the special focus of general practitioners and the internists because these ones are with these patients in contact as a first. They have to master the basal image about the specialties of this patient group. In our article we analyze this group of patients with focus on antibiotics in febrilie neutropenia and sepsis and on the other supportive care in the immunocopromised patients.

[Different courses of recurrent or multisystem Langerhans cells histiocytosis in adults--description of 22 cases from one centre]. / Odlisné prubehy recidivující anebo multisystémové formy histiocytózy z Langerhansoých bunek u dosplýtch osob--popis 22 prípadu z jednoho pracoviste.

Since its establishment in 1990, a total of 22 patients with confirmed Langerhans cell histiocytosis (LCH) have been monitored and treated at the Clinic of Internal Medicine Haemato-Oncology in Brno. In 5 patients, the disease was diagnosed in childhood and 2 of these 5 patients had late neurodegenerative changes in the CNS with a typical picture on MR and a typical PET-CT imaging fluorodeoxyglucose hypometabolism in the cerebellar area. In 5 patients from the cohort of 22, the disease had unifocal form, dominant in the area of skeleton with no recurrence after the treatment. However, in 12 patients, the disease affected a number of organs simultaneously (multifocal form of LCH). The aim of the description below is to characterise the monitored cohort of 22 patients and describe the very different courses of multifocal forms of LCH in 12 patients.

[A psychological perspective on the problems faced by the oncology patients and their care teams]. / Psychologický náhled na problémy onkologických pacientu a osetrujícího týmu.

Survey of the history and study of the psychical expressions of the oncology patients, the rules of communication ofoncologist and his patient. Personality of oncology patient and a Model of Kübler-Ross, then a decalogue of speaking about the oncology diagnosis. Clinical psychologict as an integral part of the medical team, which brings a supportive care for the oncology patients, then the psychopatological behaviour appears iside a medical team. In the end there are the authentic patients stories with the psychologist commentary.