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Biomedical subjects

V Kolek

Publications and source records attributed to V Kolek.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Neurosarcoidosis. Role of new examination methods for early diagnosis and therapy].

BACKGROUND: Affection of the nervous system is one of the most serious forms of sarcoidosis. The objective of the present work was to evaluate the prevalence and manifestations of this disease, contemporary opportunities of its diagnosis and the importance of early adequate therapy. METHODS AND RESULTS: Neurosarcoidosis was diagnosed in seven patients (4 men and 3 women) from a total number of 211 patients with sarcoidosis in 1977 to 1993. The mean age of the patients with neurosarcoidosis was 47 years. In six patients affection of the nervous system was the first clinical manifestation of the disease. In four patients it was paresis of the facial nerve, in two instances diabetes insipidus, in two instances affection of the spinal cord with subsequent spastic triparesis or paraparesis of the lower extremities, in one instance the disease was manifested by neuralgia of the trigeminal nerve. The serious character of the disease is apparent from the fact that only in two instances complete regression of symptoms occurred. In three patients regression was partial, in one instance the affection persisted without changes and in one instance it progressed to metabolic breakdown with a fatal outcome. In the differential diagnosis examination of the nervous system by computed tomography, magnetic resonance and possibly perimyelography proved to be helpful. In all instances there was a typical finding in cerebrospinal fluid. Lymphomonocytic pleocytosis was present, a raised protein content, elevated gammaglobulin levels. The diagnosis was assisted by radiograms of the chest and biopsy. The latter was made from intrathoracic or subcutaneous nodes, in one instance from muscle. As auxiliary methods the following were used: tuberculin test, bronchoalveolar lavage, pulmonary gallium scintigraphy, serum level of angiotensin converting enzyme and immunological examination. CONCLUSIONS: The authors emphasize the necessity of early diagnosis and intensive initial treatment with corticoids or antimalaria drugs, which may prevent the development of irreversible changes. Magnetic resonance appears to be the most promising examination method in neurosarcoidosis.

Adult↗
PubMed1996

[Treatment of inoperable non-small cell bronchogenic carcinoma with a combination of cisplatin and vinorelbine--preliminary evaluation].

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.

Antineoplastic Agents↗
PubMed1995

"The sarcoidosis map": a joint survey of clinical and immunogenetic findings in two European countries.

We pooled immunogenetic data obtained in independent studies in two European populations (Italian and Czech) of patients affected by sarcoidosis. Correspondence analysis was used to investigate the associations between clinical and immunogenetic data. Two hundred and thirty-three patients were enrolled in the study, of which 126 were from the Czech Republic and 107 from Italy. Using a common protocol, we examined each patient for sex, age of disease onset, roentgenologic stage, extrapulmonary spread, and clinical course. One thousand and ten healthy individuals, HLA typed for class I and II serologic polymorphisms, served as controls. Findings that were essentially in agreement in both populations were: (1) a positive association of sarcoidosis with HLA-A1, B8, and DR3 markers, and a negative association with HLA-B12 and DR4; (2) a prevalence of HLA-DR3 and DR4 among females and of DR5 among males; (3) a relationship of B13 and B35 with early onset and of A30, B8, DR3, and DR4 with late onset of disease; (4) an association of B27 with sarcoidosis restricted to the lungs; (5) a relationship of A1, B8, B27, and DR3 to roentgenologic stage I and of B12 and DR4 to stage III; and (6) an association of HLA-DR3 with a good outcome. Population-restricted findings essentially concerned the alleles HLA-B13 and B22, the former being associated with the disease, male sex, early onset, extrapulmonary localization and relapse only in Czechs, and the latter to disease spread only in Italians. Our results seem to support the concept that immunogenetic background may at least partly account for the clinical heterogeneity of sarcoidosis.

Adult↗
PubMed1995

Vinorelbine and cisplatin in the treatment of advanced non-small cell lung cancer: results of a multicenter Czech study.

There is continuous discussion about the optimal treatment for patients with inoperable non small cell lung cancer. This is because chemotherapy can only improve the quality of life in a fraction of treated patients while prolonging survival by a couple of weeks at best. The new cytostatic drug "vinorelbine" has been tested in this indication during the last years. The drug has reached the response rate of 16 to 30% when used as monotherapy. The phase II studies proved the combination of vinorelbine with cisplatin to be the most efficient one and this combination was picked up for phase III clinical trials. The clinical trial with the aims to verify published data on treatment efficacy, to assess adverse effects of treatment and to evaluate appropriateness for routine application has been made in the Czech Republic. The treatment schedule was as follows: cisplatin (Platidiam Lachema) in a dose of 80 mg/m2 on day 1, vinorelbine (Navelbine Pierre Fabre) in a dose of 30 mg/m2 on days 1 and 8. The whole cycle was repeated on day 22. The treatment was applied for 12 weeks. After that the efficacy of treatment was evaluated and only the patients with regression or stabilization of the disease continued the treatment. 44 (35%) partial remissions and 3 (2.3%) complete remissions were achieved in a group of 126 evaluable patients. The effect of treatment was evaluated as stable disease in 35 (27%) patients while the progression of disease occurred in 38 (30%) patients. The tolerance of treatment using effective antiemetic support (ondansetron or granisetron) was fairly good.

Adult↗
PubMed1994

Epidemiology of cryptogenic fibrosing alveolitis in Moravia and Silesia.

Cryptogenic fibrosing alveolitis in Moravia and Silesia (4 million inhabitants) was evaluated using standard epidemiological and clinical parameters. During 1981-1990 the incidence of cryptogenic fibrosing alveolitis ranged from 0.74 to 1.28/100,000. The trend of incidence was increasing slightly. The prevalence rose from 6.5 to 12.1/100,000. The male/female ratio was 1:1.2; 54% of patients were less than 40 years old. Biopsy (mostly open lung biopsy) supported the diagnosis in 38% of cases. During 1981-1990 years 379 new cases were detected, 488 cases altogether were registered up to 1990. The death rate calculated by incidence and prevalence was 13% and 10% resp. The mean regional incidences varied from 0.34 to 2.69/100,000, regional prevalences varied from 4.1 to 27.6/100,000. No correlation with the regional incidences of sarcoidosis and tuberculosis was found. No significant differences in coal mining areas with a high occurrence of pneumoconiosis or in areas with developed agriculture were detected. Significantly higher values were found in the regions of the four major diagnostic centres: a mean incidence of 1.58/100,000 and a mean prevalence of 20.8/100,000 (p < 0.05). The results suggest that the level of diagnostic possibilities and efforts dominates over ecological and environmental factors in the detecting of cryptogenic fibrosing alveolitis.

Adult↗
PubMed1994

Epidemiological study on sarcoidosis in Moravia and Silesia.

Standard epidemiological and clinical features of sarcoidosis were evaluated in 24 regional centres from Moravia and Silesia (4 million inhabitants). During 1981-1990 the incidence ranged from 3.3 to 4.4/100,000 with slight decrease after 1985, when unselected chest X-ray screening was restricted. The prevalence (however disputable in sarcoidosis) increased from 41.3 to 63.1/100,000. Sex ratio male/female was 1: 2.35; only 39% of patients were younger than 40 years. Biopsy supported the diagnosis in 60% of cases. Tuberculin negativity was found in 64%. X-ray types were presented as follows: 0-2%, I-71%, II-22%, III-5%. Regional incidences varied from 0.9 to 11.7/100,000. Lower values were found in mining areas and high pneumoconiosis incidence. The course of the disease was benign with only sporadic extrapulmonary complications or pulmonary fibrosis. The results indicate that improved knowledge of sarcoidosis has brought epidemiological equilibrium to the evaluated area.

Adult↗
PubMed1993

[T-lymphocyte subpopulations in bronchoalveolar lavage in pulmonary sarcoidosis and other interstitial pulmonary diseases].

In the bronchoalveolar lavage of 17 patients with pulmonary sarcoidosis and in the lavage of 18 patients with other diseases of the pulmonary interstitium the authors assessed by means of monoclonal antibodies, T-lymphocyte subpopulations. In the lavage from sarcoidosis helper-inducer lymphocytes (CD4+) dominated markedly, while in other interstitial pulmonary diseases a predominance of suppressor-cytotoxic lymphocytes (CD8+) was found. The different ratio of CD4+ and CD8+ lymphocytes was manifested particularly markedly when for evaluation the CD4/CD8 ratio was used: in sarcoidosis it was 7.2 +/- 3.5, while in other interstitial lung diseases only 0.9 +/- 0.6. The presented results indicate possible practical use of assessment of lymphocyte subpopulations in bronchoalveolar lavage for the differential diagnosis of interstitial lung diseases.

Bronchoalveolar Lavage Fluid↗
PubMed1993

Intrabronchial brachytherapy using 226-radium source.

Present work reports on results of manual brachytherapy in lung cancer using intrabronchial catheter and 226-radium source. Expected dosage was 18 Gy at 1 cm from the source. This therapy was combined with external radiotherapy by 60-cobalt till the dosage about 65 Gy. 19 men were treated, the mean survival was 14.3 months. Advantages and disadvantages of the method are discussed.

Adult↗
PubMed1993

Diffuse interstitial lung disease--evaluation with high-resolution computed tomography.

We evaluated patterns of normal and abnormal lung parenchyma on standard 8-mm computed tomography (CT) scans, and 1-mm or 2-mm high-resolution CT (HRCT) scans in 22 subjects. There were five control subjects with no lung symptoms, and 17 patients with proved diagnosis of diffuse interstitial diseases consisting of sarcoidosis (n = 7), bronchioloalveolar carcinoma (n = 3), extrinsic allergic alveolitis (n = 2), asbestosis (n = 2), scleroderma (n = 2), and drug toxicity (n = 1). CT and HRCT scans were evaluated for specific parenchymal features particularly the distribution in secondary pulmonary lobule; conditions of pleura, mediastinum, and thoracic wall were appreciated. CT and HRCT findings were described in individual disease. We believe that CT and HRCT are useful investigations in patients with suspected or known diffuse interstitial lung diseases. At present time CT, and particularly HRCT seem to be the best available method to image the lung parenchyma.

Adult↗
PubMed1992

Absolute quantitation of gallium-67 citrate accumulation in the lungs and its importance for the evaluation of disease activity in pulmonary sarcoidosis.

Our modification of a method for the absolute quantification of gallium-67 uptake in lungs with a scintillation camera and computer is described. The uptake of 67Ga in lungs, expressed in percentage of administered radioactivity, was determined by the transmission-emission method. We proved theoretically and experimentally that a 67Ga planar source could be replaced with a 57Co planar source. The performance of lung perfusion scans allows a more accurate delineation of the regions of interest on gallium scans. The method was applied to control subjects (n = 27) and to patients (n = 114) suffering from biopsy-proven pulmonary sarcoidosis (28 with inactive and 86 with active disease). The obtained results were compared with chest X-ray findings, the percentage of lymphocytes in the bronchoalveolar fluid (BAF-ly%), and serum angiotensin-converting enzyme (SACE) values. The method seems suitable for the assessment of disease activity in sarcoidosis. It is more accurate in detecting parenchymal involvement in lung sarcoidosis than the commonly used X-ray criteria. No correlation was found between 67Ga uptake and the BAF-ly% and SACE values.

Bronchoalveolar Lavage Fluid↗
PubMed1991

Determination of T-lymphocyte subsets in bronchoalveolar lavage of patients with pulmonary sarcoidosis.

Bronchoalveolar T-lymphocyte subsets were evaluated in seven patients with pulmonary sarcoidosis and eight patients with other interstitial lung disorders. Both disease groups considerably differed in the distribution of bronchoalveolar CD4+ and CD8+ cells. The lymphocytic alveolitis in sarcoidosis was characterized by excess CD4+ (helper-inducer) cells; mean CD4/CD8 ratio was 6.8 +/- 3.8. Inversely, in the lungs of patients with other interstitial pulmonary disorders a less pronounced but clear predominance of CD8+ (suppressor-cytotoxic) lymphocytes was observed with CD4/CD8 ratio 0.7 +/- 0.4. The results of the study suggest that the determination of the major immunoregulatory subsets of bronchoalveolar lymphocytes contributes to the reliable differentiation of sarcoidosis from other interstitial lung disorders. The recent advances improving our understanding of the pathogenesis of sarcoidosis are briefly reviewed in the discussion.

Adult↗
PubMed1991

The features of hypertrophic osteoarthropathy.

Features of 10 patients with hypertrophic osteoarthropathy are described. Seven patients suffered from lung disease. Joint symptoms preceded the symptoms of primary disease in four cases. Symmetrical periosteal new bone formation was present in all patients. The theories of hypertrophic osteoarthropathy pathogenesis are discussed.

Adolescent↗
PubMed1991

Comparative study of midazolam and diazepam in premedication of bronchoscopy.

Two types of benzodiazepines were used in premedication of flexible bronchoscopy. The agents were introduced in randomized, double-blind trial. Midazolam (Dormicum Hoffmann-La Roche AG) was given to 21 patients (0.07 mg/kg i.v.), diazepam (Seduxen Richter) to 22 patients (0.14 mg/kg i.v.) and placebo (saline) to 20 patients (0.07 ml/kg i.v.). Vigility, motor functions and anxiety were estimated from the application to 3 hours after endoscopy. Breathing, pulse rate, blood pressure and local reactions were followed as well. The course of bronchoscopy, anterograde amnesia and acceptability of further intervention were evaluated. Midazolam offered short term action, stronger sedative and anxiolytic effect than diazepam (48% to 27%). The anterograde amnesia was more frequent (90.5% to 55% in diazepam), acceptability of further bronchoscopy after midazolam was present in 95% of patients, after diazepam in 86% of patients. These favourable properties can be utilized especially in cases with enhanced anxiety and necessity of further endoscopies.

Adult↗
PubMed1990

Actual contribution of bronchology to the management of lung diseases.

The paper reports on bronchoscopic examinations carried out at the Department of Bronchoscopy, Clinic of Tuberculosis and Respiratory Diseases, in the period of 1977 to 1987. The applicability of individual bronchoscopic methods is evaluated. Advantages and limitations of the rigid bronchoscope and the fibrescope, techniques of removal of material for cytologic and other examinations are discussed. It is stressed that the most frequent indication for bronchoscopy is suspected bronchial carcinoma with increasing incidence.

Bronchoscopy↗
PubMed1990

[Diagnosis of lung injury due to amiodarone--contribution of bronchoalveolar lavage].

Based on the authors' own observation of a patient with pulmonary affection during amiodarone treatment, they demonstrate contemporary possibilities of early diagnosis of this potentially serious condition. They emphasize the importance of bronchoalveolar lavage, a non-invasive diagnostic method which provides information on the conditions in the peripheral portions of the lungs. The authors give an account of data in the literature on the pathogenesis of side effects of amiodarone in the lungs and draw attention to the need of systematic pneumological check-up examinations during treatment. If the drug is discontinued in time, all side-effects may recede spontaneously.

Amiodarone↗