Lung cancer incidence in the Czech Republic: a time-trend study.

BACKGROUND: Analysis of cancer incidence trends is one of the prerequisites for cancer prevention. It is possible to set up priorities and assess current development of morbidity. METHODS: All lung cancer incidences in the Moravia region of the Czech Republic (4,000,000 inhabitants) in the years 1984-1998 have been assessed concerning incidence, anatomical subsites, stage, and morphology. Age and sex distribution have been taken into consideration. RESULTS: There has been a continuous increase in the incidence of lung cancer in females and a mild decrease in males. In both sexes the most affected anatomical subsites were upper and lower lobe of the lung. Stage III and IV predominated. Main morphological type was squamous cell carcinoma in males (39.3%) and in females (22.2%), the second most frequent type in males was small cell carcinoma (13.6%) and in females adenocarcinoma (21.8%). The highest incidence was observed in the age group of 55-75 in males and 60-80 in females. CONCLUSION: Lung cancer epidemiology and prevention is one of the top-priority health problems in the Czech Republic. The incidence is one of the highest in the world especially for males; in females it is continuously increasing. Primary prevention is available but difficult to implement, particularly non-smoking. Secondary prevention is not available due to lack of suitable screening tests and a short lead time.

Radiotherapy of early stages Hodgkin's disease. 10 years experience of the Masaryk Memorial Cancer Institute.

Radiotherapy and chemotherapy, alone or in combination, are curative treatment methods in early stages of Hodgkin's disease (HD). The choice of treatment depends on the stage of the disease, histological type and localization of the tumor, as well as on other prognostic factors. A retrospective study was conducted including 145 patients with clinical Stages I and II of HD according to Ann Arbor classification, all treated in the Masaryk Memorial Cancer Institute in Brno during the years 1985 through 1994. 80 patients were males (55%) and 65 patients females (45%). The age of the patients ranged from 11 to 77 years, with an average of 34.8 years. 41 patients were diagnosed with Stage IA tumor, 1 patient with Stage IB, 75 patients with Stage IIA and 28 with Stage IIB disease. The histological types of the disease were lymphocyte predominant in 23 patients, nodular sclerosis in 49 patients, mixed cellularity in 65 cases and lymphocyte depletion in 8 cases. 91 patients were treated with radiotherapy alone. In this group 14 patients relapsed within the radiation field (15%) and 25 outside the radiation field (28%). 39 patients were treated with combination of radiotherapy and chemotherapy. In this group relapse occurred within the radiation field in 3 patients (8%) and outside the radiation field in 7 patients (18%). 15 patients were given chemotherapy alone, 7 patients from this group experienced a relapse. The five-year survival was 81% in patients with Stages IA and IIA disease, 65% in Stages IB and IIB disease. The five-year survival in the patients who relapsed was 56%. Radiotherapy remains the curative method of choice in highly selected group of patients with early stages of Hodgkin's disease. The results of radiotherapy alone are unsatisfactory in unselected clinical Stage I--II patients because of the presence of patients with adverse prognostic factors, particularly B symptomatology, mixed cellularity/lymphocyte depletion histology, higher age. These patients are candidates for combined treatment. Modern equipment and meticulous treatment are conditions crucial for the outcome of curative radiotherapy in patients with Hodgkin's disease. Combination chemotherapy is very effective in the treatment of relapse following the primary radiotherapy.

p53 status in breast carcinomas revealed by FASAY correlates well with p53 protein accumulation determined by immunohistochemistry.

The prognostic and predictive value of p53 mutation in breast cancer is still conflicting. The choice of the p53 status detection method may account for some discrepancies. In this pilot study we compared two differently-based methods for detection of p53 alteration in 32 breast carcinoma samples: the immunohistochemical method using Bp53, DO1 and DO11 monoclonal antibodies for analysis of the p53 protein accumulation in cell nuclei and the functional method FASAY. FASAY - functional analysis of the separated alleles in yeast - tests the capability of the human p53 to transactivate a reporter with a p53 binding site RGC driving the ADE2 gene in yeast. In our group the percentage of breast cancers with accumulated p53 protein was 50%, as well as percentage of mutant p53 scored by FASAY was 50%. Although the agreement of both methods, when comparing the results of individual patients was high (94%), our results show that immunohistochemistry does not reflect the p53 status quite exactly.

Detection of Bronchial Neoplasia in Uranium Miners by Autofluorescence Endoscopy (SAFE-1000).

The increase in the detection rate for premalignant changes of bronchial epithelium was studied in 56 symptom-free volunteers from the risk group of Czech uranium miners (mean age 50.69 years, mean WLM 21.06 (1 Working Level Month is equal to the absorption of latent energy of 2.08 x 10(-5) J/m(3) in one month, i.e. 170 working hours)) by the additional employment of the System of Autofluorescence Endoscopy (SAFE-1000 Pentax) to conventional white-light bronchoscopy, comparing results with those of bronchial biopsy histopathology examination. Histopathology using hematoxylin and eosin staining confirmed intraepithelial neoplasias in 15 areas in 10 persons. White-light bronchoscopy sensitivity was 21.05%, and specificity 93.7% which an autofluorescence bronchoscopy sensitivity was 78.95% and specificity 81.89%.

[The ergometry stress test in patients with stenosis of the left main coronary artery]. / Ergometrický zátezový test u nemocných se stenózou kmene levé vencité tepny.

In 168 patients with ischaemic heart disease an ergometric loading test on a bicycle ergometer was made before coronarography. A total of 19 patients had on coronarography a finding of significant stenosis of the lumen of the trunk of the left coronary artery--group A. These patients were compared with a control group of 20 patients with confirmed coronary heart disease (narrowing of the diameter of the lumen by 50 or more percent) without affection of the trunk of the left coronary artery-group B. As to the investigated parameters of the ergometric test the two groups differed significantly in the total time of the load (group A: 6.21 minutes, group B: 7.94 minutes, p < 0.05), while in all other parameters--total amount of performed work, sum of depressions of the ST segments during a maximum load, time of onset of stenocardias, time since development of 1 mm depressions of the ST segment, maximal depression of the ST segment in lead V5 and number of leads with ST depressions above 1 mm--no significant difference was found. From the work ensues that from the ergometric loading test the finding of stenosis of the left coronary artery on coronarography cannot be predicted.

Variability of changes in Doppler transmitral filling pattern during stress echocardiography in patients with stable angina pectoris.

Stress electrocardiography and echocardiography using atrial pacing together with the right-sided heart catheterization were performed in 21 patients with stable angina pectoris. Peak velocity of transmitral flow in early diastole (E) and in atrial contraction (A), deceleration time of early filling, and pulmonary artery wedge pressure were measured simultaneously at rest and immediately after each pacing frequency. Patients were divided according to their stress pulmonary artery wedge pressure changes into Group A (14 patients with an increase in pulmonary artery wedge pressure > or = 3 mmHg during stress) and into Group B (6 patients with a change in pulmonary artery wedge pressure < or = 2 mmHg during stress). One patient, T.L., with an increase in pulmonary artery wedge pressure > or = 5 mmHg after each pacing frequency was evaluated separately. In Group A patients, the non-linear course of the E/A ratio changes (from 0.78 +/- 0.06 to 0.66 +/- 0.05, P < 0.01; to 0.72 +/- 0.05, P = NS; and to 0.93 +/- 0.06, P < 0.01) and deceleration time changes (from 188.9 +/- 7.2 ms to 195.3 +/- 8.9 ms, P = NS; to 188.8 +/- 9.9 ms, P = NS; and to 154.2 +/- 6.7 ms, P < 0.01) was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Transmitral flow velocities and times during stress transthoracic echocardiography in patients with myocardial ischaemia.

Twenty-nine men with chronic stable angina pectoris were investigated using stress electrocardiography (ECG) and stress transthoracic echocardiography by means of transoesophageal stimulation of the left atrium. At rest and after each stimulated frequency, ECG and 2-dimensional echocardiography combined with Doppler were performed simultaneously. Fourteen patients without ischaemia at stress ECG and two patients who were subjected only to two different frequencies of stimulation were excluded from our study. Thirteen patients with ischaemic electrocardiographic response at stress, who were subjected to at least three stimulated frequencies, were evaluated. Their deceleration time of early transmitral filling was prolonged from 171 +/- 15.4 ms to 178.1 +/- 14.4 ms (P = ns) after the first stimulated frequency, to 172.8 +/- 15.1 ms after the second stimulated frequency (P = ns) and was shortened to 143.6 +/- 7.9 ms (P < 0.05) after the fastest stimulated frequency. The ratio of peak transmitral flow velocity in early diastole (E) to that during atrial contraction (A) decreased from 0.93 +/- 0.07 at rest to 0.85 +/- 0.07 (P < 0.05) after the first stimulated frequency, to 0.87 +/- 0.07 (P = ns) after the second stimulated frequency and increased to 1.13 +/- 0.08 (P < 0.05) after the fastest stimulated frequency. In patients with angina pectoris and myocardial ischaemia, the changes in the E/A ratio and deceleration time during stress are not linear and their direction depends on the moment of their evaluation. Their use for the quantitative evaluation of the diastolic function of the left ventricle is problematic.

[Comparison of the effects of nifedipine and diltiazem in patients with stable angina pectoris of various severity and pathomorphology of the coronary arteries]. / Srovnání úcinku nifedipinu a diltiazemu u nemocných se stabilní anginou pectoris a ruznou tízí a patomorfologií postizení koronárních tepen.

In a double blind 7-week randomized study the authors compared in 29 patients with stable angina the action of placebo, nifedipine and diltiazem. Nifedipine was administered in amounts of 60 mg/day for three weeks, diltiazem 270 mg/day also for three weeks. Nifedipine and diltiazem exerted a significant antianginous action in patients with occluded but collateralized coronary arteries (group A), as well as in patients without collaterals (group B). In both these groups diltiazem improved the load tolerance significantly more than nifedipine. Nifedipine and diltiazem were useful also in patients with mild (group E), medium (group D) and severe (group C) affections of the coronary arteries. Groups C and E differed significantly as to the different effect of nifedipine and diltiazem on load S-T depressions (in group C diltiazem was significantly more effective, in group E nifedipine was insignificantly better), and it was not possible to explain these differences by a different effect on Robinson's index. The authors conclude that neither nifedipine nor diltiazem led in the amounts used to the "steal phenomenon" with clinical impact. In patients with mild affections of the coronary arteries their antiischaemic and antianginous action was similar, in patients with severe affection of the coronary arteries diltiazem was more effective.

[The effect of air pollution factors on the frequency of acute laryngotracheitis in children]. / Vliv nekterých faktoru znecistení ovzdusí na frekvenci akutní laryngotracheitidy u detí.

The authors investigated 325 children with acute laryngotracheitis. The frequency of the disease in 1986 was correlated with the three most frequent factors of atmospheric contamination, dust, sulphur dioxide and nitrogen oxides. The author found a significant increase of the morbidity from laryngotracheitis in conjunction with a greater contamination of the atmosphere.

[Effectiveness of nifedipine, diltiazem and their combination in the treatment of chronic stable angina pectoris]. / Ucinnost nifedipinu, diltiazemu a jejich kombinace v lécbe chronické stabilní anginy pectoris.

In a double blind crossed ten-week study with a randomized beginning the authors compared in 25 patients with chronic stable angina pectoris (II-III according to NYHA classification) and with normal blood pressure the effect of placebo, nifedipine, diltiazem and in 16 of the patients (who completed treatment with the combined drugs) also a combination of nifedipine and diltiazem. Nifedipine, 60 mg per day, and diltiazem, 270 mg per day, improved significantly the total amount of performed work as compared with placebo, they delayed significantly the onset of stenocardias and reduced the ST depression in lead V5 during ergometry, they reduced significantly the rate of stenocardias per day as well as the nitroglycerin consumption. Diltiazem, as compared with nifedipine, increased significantly the total volume of performed work and delayed the development of stenocardias during ergometry, the symptomatic improvement of the patients being similar. A combination of 30 mg nifedipine per day with 180 mg diltiazem per day did not lead to improvement, as compared with a higher dose of diltiazem alone, as compared with a higher dose of diltiazem alone. A combination of 60 mg nifedipine per day with 270 mg diltiazem per day did not improve the exercise tolerance, as compared with diltiazem alone, however, it reduced significantly the rate of stenocardias. However, the combination of the latter amounts was tolerated without side-effects only by 13% of the patients (2 of 15 patients), 53% (8 of 15 patients) terminated treatment prematurely because of several side-effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Residues of polychlorinated biphenyls in breast milk of women non-occupationally exposed to PCBs.

Samples of breast milk were collected from 27 women and examined for residues of polychlorinated biphenyls (PCBs) using gas-liquid chromatography. A questionnaire was used to obtain information on environmental factors relevant to the women's exposure to PCBs. The levels of breast milk PCB residues were considered in relation to the women's medical history before and during pregnancy and to the health status of the infants. Despite the fact that the production and use of PCBs were banned in Czechoslovakia in 1982, all breast milk samples tested had detectable levels of PCBs, with the average value of 2,411 ng.g-1 milk fat (i.e., 22.8 ng.g-1 whole milk). In 25% of the women the PCB levels were higher than 2,500 ng.g-1 milk fat, which is considered a limit concentration for PCB in breast milk.