[Treatment of inoperable non-small cell bronchogenic carcinoma with a combination of cisplatin and vinorelbine--preliminary evaluation]. / Lécba neoperabilního nemalobunecného bronchogenního karcinomu kombinací cisplatiny a vinorelbinu--prubezné hodnocení.

The optimal therapeutic approach to patients with inoperable non-small-cell carcinoma is still a matter of discussion. The reason is that chemotherapy improves the quality of life only in some patients. It prolongs their life only by several weeks. In recent years in this indication a new cytostatic is tested--vinorelbine which when used in monotherapy achieves a therapeutic response in 16--30%. In clinical trials of phase 2 a combination of vinorelbine and cisplatinum was most effective and therefore it was selected for the third phase of clinical trials. In the Czech Republic a clinical investigation was made with the objective to verify published data on the success of treatment, evaluate undesirable effects and consider whether it is suitable for routine use. Cisplatinum (Platidiam Lachema) was administered--80 mg/m2 on the first day, vinorelbine (Navelbine Pierre Fabre)--30 mg/m2 on the first and eighth day. The cycle was repeated on the 22nd day. All patients were treated for 12 weeks. Then followed the first evaluation and treatment was continued only in patients with regression or stabilization of the disease. In the group of 126 patients in 44 (35%) partial and in 3 (2.3%) complete therapeutic responses were obtained. In 35 (27%) the disease was evaluated during treatment as stabilized, in 38 (30%) of the patients the disease progressed despite treatment. The tolerance of treatment was, when effective antiemetic treatment was used (ondansetrone or granisetrone), relatively satisfactory.

[Variation in manifestations of bronchopulmonary aspergillosis]. / Rozmanitost projevu bronchopulmonální aspergilózy.

Five cases of bronchopulmonary aspergillosis are scrutinized which showed no unambiguous account for any of 6 forms of the disease as described previously. Clinical signs, roentgenograms and bronchoscopy findings testified about the interaction between the aspergillus and the host being in accord with either the aspergilloma or chronical necrotizing pulmonary aspergillosis. Authors preclude the invasive symptomatology represents a developmental and likely initial phase in aspergilloma's onset. Apart from the disease progression, markedly extinctive signs of aspergilloma's activity have in contrast been detected after a period of its duration. In this case, the important signs are associated rather with the occurrence of other microorganisms whose participation was proved in 3 from 5 patients. Authors suggest also the immune status of those affected and the process invasiveness should be taken in mind in providing etiotropic treatment with the impact on the spectrum of microorganisms detected.

Pulmonary and dermal manifestations of myelosarcoma with delayed onset of acute myeloid leukemia.

An unusual case of illness of a 49 year old woman who suffered from inexpressive skin rash for three years is described. Repeated biopsies did not bring an unequivocal result. Then an illness followed with a short term fever, prolonged cough, and progressing dissemination of tiny focal shadows of infiltration character in both lungs. Simultaneous biopsies of the skin and excised pulmonal tissue revealed histiocytolymphocytic infiltrations of an identical character. Atypical cells which were difficult to classify were present. Dermal and pulmonal infiltrations disappeared after chemotherapy. Eruption occurred again after a year and hasty development of acute myeloid leukemia started. It was a case of prodromal myelosarcoma stage with skin and pulmonal infiltration by quite undifferentiated reticulohistiocytic elements of the myeloid line, which ended as acute myeloid leukemia after 4 years.

[Diagnostic bronchoscopy--mycologic and bacteriologic findings]. / Diagnostische Bronchoskopie--Mykologische und bakteriologische Befunde.

The authors studied the findings of mycotic and bacterial agents in the lower air passages of 122 patients with lung disease examined by bronchoscopy. The series represents a current profile of patients investigated at the Department of tuberculosis and respiratory diseases, Pardubice hospital within 17 months of the years 1982-1983. Bronchial swabs were compared with the findings in the swabs of the throat taken immediately before the endoscopic examination. Yeast organisms were isolated from the bronchi of 12 patients, and from the throats of 50 subjects examined. Amongst the agents isolated, Candida albicans showed the highest frequency of occurrence (68.0%). Isolation of Aspergillus fumigatus from the bronchi revealed pulmonary mycetoma in one case. Pathogenic and potentially pathogenic bacterial flora was isolated from the bronchial swabs in 40 subjects examined. A total of 47.5% findings belonged to patients suffering from inflammatory disease of the lower air passages. Isolations of Mycobacterium tuberculosis from the bronchial swabs of three subjects examined, where other cultivation examinations gave negative results, are considered by the authors as a contribution to the differential diagnosis in infiltrative disease of the lung. The value of examination of directed swabs at bronchoscopy by culture, the problems of contamination and the reliability of the results obtained are discussed.

Possibilities and limitations of non-invasive techniques for the study of left ventricular function in chronic pulmonary disease.

The authors examined systolic time intervals, apexcardiograms and left ventricular echocardiograms in 151 patients with chronic disease of the airways. Their study showed that unlike apexcardiograms and echocardiograms, which can be performed in 33.8% and 56.7% of patients respectively, systolic time intervals can be assessed in 90.1% of patients. Pathological values of left ventricular function parameters were a comparatively common finding: 49.2% in systolic time intervals, 35.1% in apexcardiograms and 23.5 % in echocardiograms. There was no relation between the parameters of pulmonary function and those of left ventricular function. The authors hold that non-invasive examination of the left ventricular function in pulmonary disease is most valuable in long-term follow-up studies of the changes of the above parameters.