Risk of tuberculosis in patients treated with biological medicines.

OBJECTIVE: The number of medicines used for biological therapy is constantly increasing. Biologic medicines selectively block the immunological processes leading to autoimmune manifestations with tissue damage or block the progression of haemato-oncological or other malignancies. Biological medicines are usually monoclonal antibodies or inhibitors of certain cytokines, cell receptors and enzymes. Their administration results in immunosuppression associated with increased risk of infectious complications, including tuberculosis. Assessment of the risk of tuberculosis associated with biological medicines is an important part of the medical decision done by pneumologist. We describe the risks of different biologicals and suggest the possible necessary steps in evaluating the risk of tuberculosis in individual patient (Ref. 18).

[Analysis of symptoms and case history data in the set of 353 patients with lung cancer]. / Analýza anamnestických dat a výsledku vysetrení v souboru 353 nemocných s plicním karcinomem z let 2004-2007.

BACKGROUND: Lung cancer (LC) incidence in men in the Czech Republic has been declining since 1995, in women it grows up continually. To analyse the characteristics of recent set of patients (pts) and contribution of their symptoms for diagnostic, treatment and prognosis we carried on the retrospective study on patients from 1st Pulmonary department from 2004-2007. METHODS AND RESULTS: Men:women ratio in the set of 353 pts was 2:1. The frequency of symptoms at the time of diagnosis were: cough 69%, dyspnoe 54%, loss of weight 49%, expectoration 39%, pain on the chest 37%, haemoptysis 17.7%, fever 16%, vena cava superior syndrome 3.7%. Smokers fell in to the disease in significantly younger age than nonsmokers, 63 vs. 73 years. 40% of pts with LC suffer from COPD, more frequently have had squamous type of cancer. 78% of the set was morphologically verified, most frequent types of cancer were squamous type (22.1%) followed by adenocarcinoma, 21.2%. Surgical therapy underwent 18.1% of the whole set. We look consequently for correlation between symptoms and other data of the pts. The pts with abuse of alcohol beverage fell in to the disease in a younger age. The pts with central tumor suffer from stronger cough more frequently, at bronchoscopy had more often direct tumor changes. The pts with IV. TNM stage of LC more frequently suffer from fever and pain. Significantly fewer pts with dyspnoe, loss of weight and lower FEV1 underwent surgical resection, FEV1 was lower in pts with central than with peripheral type of tumor. In pts with direct bronchoscopical tumor changes were found more frequently haemoptysis, broader spectrum of symptoms, lower FVC and FEV1. Dyspnoe correlated with PaO2 but not with PaCO2. CRP was lower in pts with peripheral type of LC, higher in pts with small cell LC (SCLC). Occurrence of haemoptysis did not correlate with number of smoked cigarettes. Conclusions. In conclusion we proofed that proper taking of history case may accelerate and improve the diagnostic process.

[Tuberculosis in Czech Republic in the year 2007]. / Tuberkulóza v Ceské republice v roce 2007.

BACKGROUND: The number of notified tuberculosis cases in the Czech Republic decreased in the year 2007. 871 new tuberculosis cases and relapses were reported in the year 2007 (8.4/100 000 inhabitants). METHODS AND RESULTS: 744 cases were pulmonary tuberculosis (7.2/100 000) and from them 506 were definite pulmonary cases (4.9/100 000). In 2007 266 smear-positive cases of pulmonary tuberculosis were diagnosed. The decreasing trend in tuberculosis incidence reported since 1998 has continued. Only 14.7% of new cases of pulmonary tuberculosis were discovered by active case-finding. CONCLUSIONS: Next targets of tuberculosis control in the Czech Republic must be an active case-finding in high-risk groups and monitoring of latent tuberculosis infection.

[Tuberculosis among foreigners in the Czech Republic 2003-2006]. / Tuberkulóza u cizincu v Ceské republice v letech 2003-2006.

Authors compared the situation in tuberculosis among foreigners in the Czech Republic during the years 2003-2006. Foreigners participated in 13.0-14.2% of total notified tuberculosis cases during this period. Proportion of smear positive cases among foreigners in this period grew up from 32.8% to 40.8%. The proportion of active case finding of tuberculosis cases among foreigners declined from 36.0% to 15.4%. At the same time foreigners formed an important part in drug resistance of TB-strains in the Czech Republic. 50% of MDR-TB cases were detected in foreigners. In 20 MDR-TB cases notified in the years 2003-2006 10 were detected in foreigners. If the number of immigrants from countries with high prevalence of tuberculosis to the Czech Republic increases the control of TB in the Czech Republic could be negatively influenced.

[Tuberculosis in the Czech Republic during 2006]. / Tuberkulóza v Ceské republice v roce 2006.

BACKGROUND: In the Czech Republic the number of all notified tuberculosis cases decreased in the year 2006. 973 (9.5/100,000) all tuberculosis cases of new diseases and relapses were reported. 799 cases (7.8/100,000) were pulmonary tuberculosis and from them 556 cases (5.5/100,000) were definite pulmonary tuberculosis. In 2006 267 cases of smear positive pulmonary tuberculosis were detected. The decrease in tuberculosis notification rate reported in the Czech Republic since 1998 has continued. METHODS AND RESULTS: The resistance for antituberculotic drugs was 7.4% and MDR-TB cases were detected in 1.4% of all bacteriologically confirmed cases. The low level of resistance, good treatment constitutes presumption of further decline in tuberculosis in the Czech Republic. CONCLUSIONS: The majority of tuberculosis cases were diagnosed because of symptoms (74.7%)-passive case-finding. By active case-finding only 11.7% of new pulmonary tuberculosis were detected. In Prague only 6.7% of all pulmonary tuberculosis cases were diagnosed by active case-finding. Next target of tuberculosis control in the Czech Republic will be to increase the percentage of active case-finding in high-risk groups and to monitor latent tuberculosis infection in our population.

[Incidence, diagnostics and therapy of the lung cancer in the Czech Republic in 2003]. / Výskyt, diagnostika a léca plicího karcinomu v Ceské republice v roce 2003.

Lung cancer epidemic has not ended. According to the data on the incidence and mortality in the Czech Republic it is obvious that both parameters decline in males; the rise in women probably ends. According to the present epidemiological parameters the number of new cases is still very high. Number of adenocarcinomas is slightly rising. No improvement has been achieved in the early diagnostics of TNM stage I and II, which are diagnosed in less than 21 %. It brings low number of indications for resection therapy, which in 2003 achieved 10.8 % for men and 10.1 % for women. Positive appears the higher number of verified tumours (72 % in men and 69 % in women) and the higher percentage of those who survived over 5 years (6.3 % in men and 9.4 % in women) in comparison with the situation 10 years earlier. The presented paper describes regional differences in the incidence of lung carcinoma (apparent gradient between the western and eastern part of the country) and the promptness of the diagnostics and the treatment indications.

Dielectron production in 12C+12C collisions at 2A GeV with the HADES spectrometer.

The invariant-mass spectrum of e+e- pairs produced in 12C+12C collisions at an incident energy of 2 GeV per nucleon has been measured for the first time. The measured pair production probabilities span over 5 orders of magnitude from the pi(0)-Dalitz to the rho/omega invariant-mass region. Dalitz decays of pi(0) and eta account for all the yield up to 0.15 GeV/c(2), but for only about 50% above this mass. A comparison with model calculations shows that the excess pair yield is likely due to baryon-resonance and vector-meson decays. Transport calculations based on vacuum spectral functions fail, however, to describe the entire mass region.

[Tuberculosis in the Czech Republic]. / Tuberkulóza v Ceské republice a ve svete.

Tuberculosis is a general infectious inflammatory disease caused by the bacillus (mycobacterium) tuberculosis. The disease originated when the bacillus was transmitted from affected cattle herds to humans. Genetic methods proved the existence of tuberculosis in mummies of the ancient Egypt. In the 19th and 20th century socio-economic conditions enabled pandemics of tuberculosis. The essential element for spreading of tuberculosis is the tuberculous patient. The disease develops in 10% of those who were infected. Tuberculosis manifests by long-lasting coughing, night sweating, tiredness, growing slim, febriles and loss of appetite. Diagnosis can be established on the basis of thoracic sciagram, confirmed by microscopic and cultivation examination of sputum. In the Czech Republic, an effective surveillance of tuberculosis was established with resulting good epidemiological situation.

[Treatment options in sarcoidosis]. / Soucasné moznosti lécby sarkoidózy.

When to start the treatment of sarcoidosis and what are the optimal treatment methods? The curative of the first choice are glucocorticoids used in indicated cases in general administration, as inhalation therapy or locally in the skin manifestations. Frequently used are also immunosuppressives, cytostatics and antimalarics. The newest trend in the treatment of this multi-organ granulomatose disease of unknown origin is the use of TNF inhibitors--pentoxifyllin, infliximab, adalimumab, leflunomid, thalidomid.

[Cryptogenic fibrotizing alveolitis]. / Kryptogenní fibrotizující alveolitida.

Presented article deals with the pathogenesis of cryptogenic fibrotizing alveolitis (CFA), gives distinct histological types according ATS and ERS, considers clinical CFA picture and recommends examination program for this disease. The anti-inflammatory and immunosuppressive treatment is discussed together with other therapeutic approaches (long-lasting oxygenotherapy at home, transplantation and treatment of pulmonary hypertension). Final part deals with less frequent clinical manifestations.

[Treatment of lung carcinoma patients at the First Department of Tuberculosis and Respiratory Diseases]. / Péce o nemocné s plicním karcinomem na I. klinice tuberkulózy a respiracních nemocí.

Lung carcinoma (BCA) represents the most frequent malignancy in men and the fourth most frequent one in women. In 2004, 5568 persons died from that disease. Study of the lung carcinoma has been the main research program of the First Department of Tuberculosis and Respiratory Diseases of the First Faculty of Medicine, Charles University and General Teaching Hospital since 1960. The presented article summarises results from present and older studies which can show that numbers of diagnosed BCA patients increased since 1960 till 1977, when they reached 96 cases. Since that time the situation has been stabile and the present number of newly diagnosed cases is about 90 cases. Ratio of men and women has changed--since the cohort in 1960 to 1961 with ratio 8:1, to the present ratio 2:1. Number of cases diagnosed at the first and second stadium decreased from 56% at the beginning of our study in 1960 to 1961 to 19.9% in the cohort from 2004 to 2006. Occurrence of individual structural types of carcinomas has also changed; the second position after the epidermoid types has now adenocarcinoma. Number of microscopically verified BCA cases increased from 32% at the beginning to 79% at present. Proportion of treatment methods has also changed. Surgical treatment increased from 10.1% in 1960-1961 to 16.7% in 1985-1987 and remained stabile since that. Radiotherapy was used in 10% of cases in 1960 to 1961 and in 39.5% in 2004 to 2006. Number of patients with chemotherapy increased from 41% to 58% during the same period. In 2004 to 2006 bronchoscopy verified 95% of cases with direct tumor changes, 54% of indirect changes and in 20% bronchoscopy revealed normal picture. Our results show that the treatment approaches for patients with BCA has developed with the constant necessity to improve the assessment, diagnostics and therapy of new cases.

[Diagnostics and indications of surgical treatment of patients with lung carcinoma at the first clinic of TRN of the first faculty of medicine and the VFN Prague in years 2004 to 2005]. / Diagnostika a indikace operacni lécby nemocných s plicním karcinomem na I. klinice TRN 1. LF UK a VFN praha v letech 2004-2005.

BACKGROUND: Results of the diagnostics and indications of surgical treatment of patients with lung carcinoma (BCA) at the First clinic in years 2004 to 2005 were evaluated in a retrospective study. METHODS AND RESULTS: The cohort of 209 patients with the male to female ratio of 2 to 1 included 63 % of current smokers, 22 % of former smokers and 15 % of non-smokers. BCA was diagnosed in significantly earlier age in smokers in comparison to former smokers or non-smokers. Men had smoked in average 107 000 of cigarettes more than women. In the family history we found one or more malignancies in 49 % of patients. In the personal history COPD was found in 42 % of patients. Patients with COPD had more frequently epidermoid type of cancer. In patients diagnosed at earlier stages of BCA (I to IIIA) COPD was present more frequently as an intercurrent disease in comparison with patients in higher stages. 34 % of patients had a history of alcohol abuse, the median age of alcoholic patients was 65 years, the median age of other patients was 70 years. In histologically verified tumours, the highest occurrence had the epidermoid type (29% of patients) and adenocarcinoma (27 %). 39 patients (18.6 % from the cohort) were surgically treated; from 128 patients with NSCLC 33 were surgically treated (25 % of NSCLC cohort). Among the causes of surgical treatment impossibility, the most frequent ones were COPD in the third to four stage, age over 80 years, polymorbidity and ill-being. CONCLUSIONS: Results of our study indicate that BCA is frequently diagnosed in already developed stage, numbers of surgically treated patients represent less than 20% of the total patients' number.

[Tuberculosis in the Czech Republic in 2005]. / Tuberkulóza v Ceské republice v roce 2005.

BACKGROUND: The number of notified TB cases decreased in the year 2005, when 1007 new TB cases and relapses were reported (9.9/100,000 inhabitants). METHODS AND RESULTS: 838 cases were pulmonary TB (8.2/100,000) and from them 586 were definite pulmonary cases (5.7/100,000). The decreasing trend in TB incidence reported since 1998 has continued. The treatment of definite pulmonary cases notified in 2004 and evaluated in 2005 was effective. Treatment success was in 80.7 % of cases, but failures and interrupted treatment were only 2.5 % of cases. Only 14.7 % new cases of pulmonary TB were found by active case-finding. CONCLUSIONS: Next targets of TB control must be an active case-finding in high-risk groups and monitoring latent TB infection.

[Extent of tuberculin skin testing spot in bacteriologically verified tuberculosis]. / Velikost kozní reakce tuberkulinového testu u bakteriologicky overené tuberkulózy.

BACKGROUND: Tuberculin skin test was evaluated in patients with bacteriologically verified tuberculosis notified in the Czech Republic during 2003 and 2004. METHODS AND RESULTS: Out of 1172 patients with bacteriologically verified tuberculosis altogether 28.8% were tuberculin-negative. The average value of tuberculin reaction in this cohort was 11.6 mm. Among 30-year-old patients with bacteriologically verified tuberculosis the number of tuberculin-negative individuals was statistically lower (14 %) in comparison with 70-year-old and older patients, where the prevalence of tuberculin-negative individuals was 42 %. Higher rate of tuberculin-negative individuals with bacteriologically verified tuberculosis was found among patients who were diagnosed with liver disease (42 % of tuberculin-negative) or malignant tumor (47 % of tuberculin-negative). Presented results show that in circumstances of the Czech Republic the tuberculin skin test can be used to follow up the spreading of tuberculosis infection in younger age groups without accompanying serious disease only. CONCLUSIONS: The improvement of the diagnostics of latent tuberculosis infection can bring the routine introduction of new tests, e.g. Quantiferon-TB Gold or other methods.

[Lung cancer operability--history and presence]. / Operabilita bronchogenního karcinomu--historie a soucasnost.

Review of contemporary publication on the operability of lung cancer in the Czech Republic and in other countries is presented. Since 1912, when 374 cases of lung cancer were described, the incidence has risen and culminated towards the end of the 20th century. From the available treatment modalities, surgery gives the best results. An overview of papers describing the beginning of thoracic surgery in the Monde and in the Czech Republic is given. In the Czech Republic during 2002, 11.3% of all lung cancers were resected. From the TRN clinics in the Czech Republic about 20 to 27% of patients are recommended. In the leading world centres the operability is higher--about 25 to 35% of patients. The improvement of operability of lung cancer is possible namely by the increase of timely diagnosed tumors and by more frequent use of neoadjuvant medication in the treatment algorithms.

[Tuberculosis in the Czech Republic in the year 2004]. / Tuberkulóza v Ceské republice v roce 2004.

The number of notified TB cases in the Czech Republic continued to decrease in the year 2004. 1057 new TB cases and relapses of TB were reported in the year 2004 (10.3 / 100,000). 861 were pulmonary TB (8.4 / 100,000) and from those 584 were unequivocal pulmonary TB cases (5.7 / 100,000). The decreasing trend in TB incidence reported since 1998 has continued. Treatment success was present in 76.7% of cases; failures and interrupted treatment were observed in only 2.0%. Results of the treatment were affected by great numbers of deaths for other causes then TB, because they were observed in the oldest part of population. The resistance for AT drugs was confirmed in less than 6% of cases and MDR-cases were under 2%. The low level of resistance and good treatment outcomes are very important for further decline of new TB cases. The next target of TB control should be the active case finding in high-risk groups and monitoring latent TB infection.

[Tuberculosis in the Czech Republic in 2003]. / Tuberkulóza v Ceské republice v roce 2003.

BACKGROUND: 1162 new cases of tuberculosis were diagnosed in the Czech Republic in 2003; pulmonary tuberculosis represented 942 cases and in 660 cases the diagnosis of tuberculosis was bacteriologically confirmed. METHODS AND RESULTS: 355 cases were smear positive tuberculosis. The increase of certain TB cases (70%) in 2003 compared to 2002 is not statistically significant (p = 0.031). The notification rate (incidence) in 2003 was 11,4/100 000 all cases of tuberculosis, 9,2/100 000 pulmonary tuberculosis and 6,5/100 000 certain cases of tuberculosis. CONCLUSIONS: Compared to 2002 a decline of all forms of tuberculosis was observed, this decline however was not statistically significant. The increase in bacteriologically confirmed tuberculosis and smear positive tuberculosis was also not statistically significant.

[Resistance of Mycobacterium tuberculosis to antituberculotic drugs in Czech Republic in 2003]. / Rezistence kmenu Mycobacterium tuberculosis na antituberkulotika v Ceské republice v roce 2003.

BACKGROUND: The results of Mycobacterium tuberculosis susceptibility testing in 2003 were analysed in 568 (84%) pulmonary TB definite cases in the Czech Republic. METHODS AND RESULTS: The resistance on antituberculotic drugs was detected in 4.9% of TB bacilli. Most frequently, resistance on one drug--isoniazid (1.8% of pulmonary TB definite cases) has been observed. Multidrug resistant TB was found in two cases in 2003. CONCLUSIONS: The resistance of Mycobacteria was found significantly more often in foreign-born persons with pulmonary TB (25% of strains of TB bacilli were resistant on one or more AT drugs). Resistance on AT drugs was more frequent also in previously treated TB cases, especially if the relapse occurred after 3,5 years after finishing previous treatment.

[Endobronchial neurofibroma]. / Endobronchiální neurofibrom.

Neurofibroma belongs to the benign tumors and it is categorised as neuroectodermal tumor. Neurofibromas are most frequently found in the posterior mediastinum, their endobronchial localisation is rather rare. Our paper presents two cases of endobronchial neurofibromas with diverse clinical and X-ray symptomatology. Both patients underwent surgery and the etiology of tumours was assessed by histological examination of the preoperative biopsy.

[Lymphangioleiomyomatosis in a menopausal woman]. / Lymfangioleiomyomatóza u zeny v menopauze.

Lymphagioleiomyomatosis is a rare pulmonary disease which affects mainly women of childbearing age. An observation of lymphangiomyomatosis in a menopausal woman or in men is considered very unusual. We report a case of lymphagioleiomyomatosis in a 60-year-old woman.