Současná náplň pneumologie

Vítězslav Kolek

Vnitr Lek 2017, 63(11):743-745  

A targeted search for patients with chronic obstructive pulmonary disease: brief summary

Vladimír Koblížek, Karel Hejduk

Vnitr Lek 2017, 63(11):750-756 | DOI: 10.36290/vnl.2017.146  

Chronic obstructive pulmonary disease (COPD) is a leading cause mortality and morbidity globally, with permanently growing prevalence. Expressive underdiagnosis and undertreatment is a general features across all European countries. Individuals with undiagnosed, symptomatic COPD had significantly increased risk of exacerbations, pneumonia, and death. Early smoking cessation is able to reduce the mortality and morbidity burden of newly diagnosed COPD individuals. These findings suggest that better initiatives for early diagnosis and early treatment of COPD are needed. A clear diagnosis of COPD requires post-bronchodilator spirometry in symptomatic mid-elderly...

Asthma bronchiale in the context of internal medicine

Milan Teřl

Vnitr Lek 2017, 63(11):757-769 | DOI: 10.36290/vnl.2017.147  

The article is supposed to give a modern perspective on etiopatogenesis of asthma and its management. There are accentuated new diagnostics and treatment opportunities as well as coincident areas with others internal fields and pragmatic recommendation for daily clinical practice.

Diagnostics and treatment of community-acquired pneumonia - simplicity is the key to success

Vítězslav Kolek, Petr Jakubec, Stanislav Losse

Vnitr Lek 2017, 63(11):770-775 | DOI: 10.36290/vnl.2017.148  

Pneumonia is the most wide-spread infectious disease and requires unrelenting attention. It is defined as an acute inflammatory disease affecting pulmonary alveoli, respiratory bronchioles and the pulmonary interstitium. In recent years we have seen the endeavour to rationalize the approach to pneumonias and utilize the current methods of administering effective antibiotics to reduce occurrence of complications, limit the number of hospitalizations and shorten the length of treatment. With the awareness of all the potential agents it is empiric therapy which predominates, being supported by the knowledge of a regional epidemiological situation, good...

Hospital-acquired pneumonias

Petr Jakubec, Aneta Křenková, Vítězslav Kolek

Vnitr Lek 2017, 63(11):776-785 | DOI: 10.36290/vnl.2017.149  

Nosocomial infections are a common complication of hospital care. Hospital-acquired (HAP) pneumonia is one of the most common nosocomial infections and it is the most dangerous in terms of mortality. The problem is mainly selected hospital bacterial strains with rising antibiotic resistance. Diagnosis of the cause of pneumonia is difficult and often does not lead to a positive result. Management is complex and is based on timely and appropriate empirical antibiotic treatment. Local and extrapulmonary complications are relatively common and they increase morbidity and mortality. Prognosis of the HAP is often unfavorable, especially in the elderly and...

Pneumonia in immunocompromised persons

Jana Skřičková

Vnitr Lek 2017, 63(11):786-795 | DOI: 10.36290/vnl.2017.150  

In the broadest sense, the term immunocompromised individual means a person with any impairment of infection resistance, whether it is deficiency or impairment of innate resistance (by another name impairment of non-specific resistance), or impairment of acquired resistance (impairment of specific immunity). Pneumonia in immunocompromised patients is characterized by a different microbiological spectrum. Apart from common pathogens there are also opportunistic agents involved in this group of patients. Management of pneumonia in immunocompromised patients is often decisive for their future fate. Very rare are innate immune deficiencies. Acquired immune...

Idiopathic pulmonary fibrosis. Can we always diagnose and treat it right?

Martina Vašáková

Vnitr Lek 2017, 63(11):796-801 | DOI: 10.36290/vnl.2017.151  

Idiopathic pulmonary fibrosis (IPF) is a severe pulmonary disease characterized by fibrotisation of lung tissue based on pathological healing of alveolar lesions. The disease is initiated in individuals of middle and older age who have a genetical disposition to fibroproliferation. Clinical presentation is not uniform. The patients can have a rapidly progressive disease, eventually severe acute exacerbations, however some of them can have relatively benign course of the disease. Problems in diagnosis are usually caused by atypical radiologic findings and no or nondiagnostic lung biopsy. Causal treatment of this life-threatening disease is available...

Extrinsic allergic alveolitis: minimum for clinical practice

Martina Šterclová

Vnitr Lek 2017, 63(11):802-806 | DOI: 10.36290/vnl.2017.152  

Extrinsic allergic alveolitis (EAA) represent a group of diseases, that develop in susceptible individuals after repeated exposure to usually organic inhalation antigen. Patient may be in contact with these agents both in occupational and in home environment, as well as during free time activities and hobbies. The course of the disease is highly variable - EAA may have dramatic symptoms with fever, cough and severe dyspnoea as well as may be presented with slowly increasing dyspnoea and chronic cough. The more inconspicious are the symptoms of chronic EAA, the more problematic its treatment may be. Treatment options must be sought individually and...

Sarcoidosis - enigmatic disease still unresolved

Vítězslav Kolek, Monika Žurková, Vladimíra Lošťáková

Vnitr Lek 2017, 63(11):807-814 | DOI: 10.36290/vnl.2017.153  

Sarcoidosis is a systemic disease of unknown etiology, characterized by the presence of granulomatous inflammation in affected tissues. In about 90 % it affects the lungs, but it may basically affect any organ, the most frequently the skin, lymph nodes and eyes. In the case of classic lung manifestation this disease is not difficult to diagnose. When dealing with extrapulmonary manifestations, interdisciplinary cooperation is necessary. The treatment of sarcoidosis is needed in about half of the cases, in some 30 % of patients it may change into a chronic stage and possibly lead to serious health problems or premature death. Treatment is commenced...

Current approach to diagnostics, treatment and prevention of tuberculosis

Martina Vašáková

Vnitr Lek 2017, 63(11):815-820 | DOI: 10.36290/vnl.2017.154  

Tuberculosis is world-wide spread infectious disease with persistant high incidence, mainly in the densely populated countries with low income. Czech Republic belongs to the countries with highly efficient control of tuberculosis and continuously decreasing incidence of the disease. High-risk population for tuberculosis in the Czech Republic are the homeless people, who together with migrants from the countries with high incidence of tuberculosis represent reservoir of infection for our population. Treatment of tuberculosis is long-term, combined and controlled. Minimal efficious duration of the treatment is 6 moths. The most severe form of tuberculosis...

Non-CF bronchiectasis of adults: short review for clinical practice. Position paper of Board of disease with bronchial obstruction Czech Pulmonological and Phthiseological Society Czech Medical Association of J. E. Purkyne

Zuzana Antušová, Libor Fila, Vladimír Herout, Eva Kočová, Kateřina Neumannová, Jaromír Zatloukal, Vladimír Koblížek

Vnitr Lek 2017, 63(11):821-833 | DOI: 10.36290/vnl.2017.155  

Bronchiectasis is a clinically important, but poorly understood, pulmonary condition characterized by dilated and thick-walled bronchi. Bronchiectasis remains a significant cause of morbidity and mortality around the world. Targeted effort to early high-resolution computed tomography diagnosis and detailed confirmation of causation are in the spotlight of respiratory physicians in the developed countries. The risk population consists of subjects with persistent and/or productive cough, where another clear diagnosis has not been performed. Specific treatment tailored on underlying diseases and non-specific airway clearance techniques are able to improve...

Cystic fibrosis in adults

Libor Fila

Vnitr Lek 2017, 63(11):834-842 | DOI: 10.36290/vnl.2017.156  

Cystic fibrosis (CF) is an inherited disease caused by mutations in the transmembrane conductance regulator (CFTR) gene. The disease leads to dysfunction of the exocrine glands with high concentration of chloride in the sweat and formation of abnormally viscous mucus in the respiratory, digestive and reproductive tract. Chronic sinopulmonary disease, exocrine pancreatic insufficiency, liver disease, intestinal obstruction, impaired nutritional status, salt loss syndrome and male infertility dominates in the clinical presentation. The examination of sweat chloride concentration and mutations in the CFTR gene is used in CF diagnostics for detection...

Cardiovascular risk of sleep apnoea and case report

Jana Vyskočilová

Vnitr Lek 2017, 63(11):843-847 | DOI: 10.36290/vnl.2017.157  

The most frequently occurring sleep breathing disorders include sleep apnoea which in particular negatively affects quality of sleep, thereby affecting all organs in the body. Among the severe complications of untreated sleep apnoea are cardiovascular diseases including the most serious complication - sudden death in sleep due to a severe heart rhythm disorder.

The complications after lung transplantation

Petr Jakubec, Monika Žurková, Lenka Hajdová, Aneta Křenková, Vítězslav Kolek

Vnitr Lek 2017, 63(11):848-859 | DOI: 10.36290/vnl.2017.158  

Lung transplantation (LuTx) is an important treatment for a selected group of patients in the terminal stage of a number of lung diseases, which can bring them a significant improvement in quality of life and long-term survival. Nowadays a perioperative period is not significant limitation for patient survival due to the development of transplant surgery, but the period of months to years after LuTx is crucial for survival. The post-transplant period is very complicated for LuTx patients due to a special treatment regimen, special medication, especially immunosuppressive drugs and the possibility of many complications, whether early or late or acute...

Non-small cell lung cancer

Jana Skřičková, Bohdan Kadlec, Ondřej Venclíček

Vnitr Lek 2017, 63(11):861-874 | DOI: 10.36290/vnl.2017.159  

Non-small cell lung cancer (NSCLC) represents 80 % of diseases considering all patients with lung cancer. NSCLC comprises all histological types except for the small cell cancer. The treatment is chosen based on a clinical stage, morphological diagnosis and performance status of patients. In the low clinical stages a surgical solution is indicated. An alternative is radiotherapy. In some cases adjuvant treatment is indicated. In the locally advanced and metastatic stages chemotherapy and biological therapies are available and in recent time also immunotherapy is used. With regard to locally advanced diseases radiotherapy should also be considered.

Small-cell lung cancer: epidemiology, diagnostics and therapy

Miloš Pešek, Jan Mužík

Vnitr Lek 2017, 63(11):876-883 | DOI: 10.36290/vnl.2017.160  

Authors present actual overview of information on diagnostic and therapeutic procedures in small-cell lung cancer (SCLC). This highly aggressive type of lung cancer is diagnosed in 14.8 % of Czech lung cancer patients. Vast majority of those patients (87 %) suffer from advanced and metastatic disease in the time of diagnosis. In this issue are presented prognostic factors, staging diagnostic procedures and therapeutic recommendations. The backbone of actual SCLC treatment is combined chemotherapy and radiotherapy and less frequently, carefully in selected cases, surgical procedures. SCLC should be have as chemosensitive, chemoresistent or chemorefractory...

Malign pleural mesothelioma - so far an undefeated tumor

Vítězslav Kolek

Vnitr Lek 2017, 63(11):884-888 | DOI: 10.36290/vnl.2017.161  

Malign pleural mesothelioma is the most frequent primary tumor of the pleura of high aggressiveness. Its most frequent cause is contact with asbestos and, although working with asbestos is already prohibited in developed countries, its incidence is on the increase so far. Diagnostics primarily considers anamnesis, clinical symptoms and immunohistochemical examination of a tumor sample. The basic therapy used over the past 10 years is chemotherapy with cisplatin - pemetrexed combinations. Numerous studies are going on with a different biologically targeted therapy, immunotherapy and other drugs which may improve patients' prognosis. The surgical approach...

Spirometry - basic examination of the lung function

Jana Kociánová

Vnitr Lek 2017, 63(11):889-894 | DOI: 10.36290/vnl.2017.162  

Spirometry is one of the basic internal examination methods, similarly as e.g. blood pressure measurement or ECG recording. It is used to detect or assess the extent of ventilatory disorders. Indications include respiratory symptoms or laboratory anomalies, smoking, inhalation risks and more. Its performance and evaluation should be among the basic skills of pulmonologists, internists, alergologists, pediatricians and sports physicians. The results essentially influence the correct diagnosing and treatment method. Therefore spirometry must be performed under standardized conditions and accurately and clearly assessed to enable answering clinical questions.

The role of bronchology in pneumological diagnostics

František Salajka

Vnitr Lek 2017, 63(11):895-899 | DOI: 10.36290/vnl.2017.163  

Bronchoscopic examination has a key role in diagnosing or further specifying of a broad spectrum of respiratory diseases. Although classic bronchoscopy with its rigid instrumentation still upholds its position, the vast majority of procedures are performed with flexible bronchoscopes. Diagnostic possibilities are broadened by new technical findings and procedures, such as endobronchial ultrasonography, examination through autofluorescence, navigated bronchoscopy and others. The material for cytological, microbiological or other examinations can be sampled through a whole number of procedures using specialized instruments. In the hands of an experienced...

Ultrasound examination of the chest in the hands of the clinical physician

Vratislav Sedlák, Vladimír Koblížek, Rastislav Šimek

Vnitr Lek 2017, 63(11):900-907 | DOI: 10.36290/vnl.2017.164  

Implementation of ultrasound into clinical medicine is current trend in many subspecialties of internal medicine. Remarkable development and use of this technology is currently present in intensive care and respiratory medicine. This review summarizes current knowledge and nomenclature of artefacts and findings in clinical chest ultrasound. It describes ultrasound-based approach in a differential diagnostic algorithm of acute severe dyspnoea. Chest ultrasound should be a standard knowledge of chest physician.

Non-invasive ventilation

David Havel, Jan Zeman

Vnitr Lek 2017, 63(11):908-915 | DOI: 10.36290/vnl.2017.165  

The paper describes the history and the present of non-invasive ventilation, the therapeutic method which plays an essential role in the therapy of acute as well as chronic respiratory illnesses. It focuses on indications and contraindications, adverse effects as well as some pitfalls of this therapy.