[118th Internal Medicine Seminar and the 27th Vanýsek Seminar organized by the Czech and Slovak Internal Medicine Society, the Association of Czech Physicians in Brno and the Czech Oncological Society on the anniversary of the birth of Dr. Rudolf Vanýsek, founder of the Brno School of Internal Medicine. Friday, 2 March 2001 in Brno. Oncology of Solid Tumors in Internal Medicine].

Vnitr Lek 2001, 47(8):509-590

[Perspectives of medical therapy of solid tumours].

I Koza

Vnitr Lek 2001, 47(8):510-515

In the course of 55 years of its existence clinical chemotherapy succeeded in curing some types of leukaemia, aggressive lymphomas and some patients with some solid tumours. Other patients with solid tumours, due to treatment with cytostatics, hormones and immunomodulators, survive longer and have a better quality of life. Further improvement of results of medical treatment of solid tumours may be foreseen from new classical cytostatics, hormones and immunomodulators and better use of known cytostatics. Liposomal forms of cytostatics are at least equally effective and less toxic than original classical cytostatics. Pegylated forms of cytostatics are...

[Trends in cancer incidence in the Czech Republic].

J Zaloudík, E Geryk, R Vyzula, L Dusek

Vnitr Lek 2001, 47(8):516-518

In general, the cancer incidence becomes stabilized in the Czech Republic during last years. However, the incidence of colorectal and renal cancers remains increasing and dominates also in European comparisons. A program of cancer prevention and early detection needs to be established at least for six so called preventable cancers as breast, lung, colorectal, cervical and prostatic carcinomas and malignant melanoma, which represent together 40 % of all oncological cases. The aim is reduction of cancer mortality as well as improved effectivity of cancer treatment and cost reduction. More efficient utilisation of the National Cancer Registry data for...

[Suggestion for a concept of clinical oncology].

P Klener

Vnitr Lek 2001, 47(8):519-520

[Applied molecular pathology in oncology].

Z Kolár

Vnitr Lek 2001, 47(8):521-526

In the past decades in molecular biotechnology marked advances were made which led to the development of a special branch of pathology and according to some concepts an independent discipline, molecular pathology. This discipline deals with investigations of processes associated with the genesis and development of diseases at the nucleic acid level, proteins coded by these nucleic acids and their signal pathways. To this end molecular-biological techniques are used and the results are put into context with diagnostic and therapeutic procedures of other medical disciplines. It provides extremely valuable information for clinical therapy, in particular...

[Advances in the diagnosis of tumours by imaging methods (possibilities of three-dimensional imaging and application to volumetric resections of brain tumours with evaluation in virtual reality and subsequent stereotactically navigated demarcation].

P Krupa, Z Novák

Vnitr Lek 2001, 47(8):527-531

Oncological problems are so varied that it is very difficult to record all advances in different diagnostic branches in a comprehensive manner. In the first part the authors focus attention on an example of the possible use of imaging examination methods in conjunction with different types of three-dimensional imaging used in their hospital. The second part is devoted to volumetric resections of brain tumours with navigated demarcation. In 17 patients the authors used the PC working station equipped with navigation software STEREOPLAN PLUS for planning volumetric resection of different brain tumours in virtual reality. The demarcation proper of the...

[Intervention radiology in the diagnosis and treatment of hepatic tumours].

V A Válek

Vnitr Lek 2001, 47(8):532-537

Although intervention radiology has affected all spheres of oncology, in particular in diagnostics and therapy of malignant liver processes, its importance is fundamental. The authors summarize their long-term experience with invasive diagnosis of focal processes in the liver and with a minimally invasive therapy in more than 250 patients with malignant focal processes in the liver. Intervention radiology extends common diagnostic methods by the possibility of aimed administration of contrast substance before examination (CT after administration of Lipiodol) or during examination (CT angiography). Biopsy from a focus only 10 mm in size or less under...

[Bronchoscopic diagnosis of lung tumours].

F Salajka

Vnitr Lek 2001, 47(8):538-540

The role of diagnostic bronchoscopy in patients with lung tumours is to evaluate the presence, extent and character of endobronchial tumourous changes. Videobronchoscopes and ultrathin bronchoscopes introduced recently into clinical practice make more accurate evaluation of larger areas of the bronchial tree possible. The clinical impact of methods based on the principle of (auto)fluorescence is searched for. From sites affected with the tumour samples are taken for histological or cytological examination which in addition to evidence of a tumourous etiology specify the type of tumour. An integral part of the examination is staging when the extent...

[Endoscopy in the diagnosis of tumours of the digestive tract].

P Dítě

Vnitr Lek 2001, 47(8):541-543

Methods of digestive endoscopy belong to the diagnostic standard of tumours of the digestive tract. The classical method is endoscopic examination of the upper and lower part of the tract which makes it possible to identify under visual control lesions which alter the character of the mucosal structure of hollow organs or lead to changes e.g. of the coloration of portions of the mucosa. From these sites samples can be taken to evaluate the character of the lesion and facilitate the differential diagnosis. Similarly examination of the pancreatobiliary system (ERCP) evaluates gross changes in the morphology of efferent systems. The objective is to find...

[Informing the patient of the oncological diagnosis].

J Vorlícek, O Sláma, L Kalvodová

Vnitr Lek 2001, 47(8):544-547

Communication with the patient on various aspects of his disease is one of the most important skills of every doctor. Despite this for some doctors informing on the diagnosis in diseases which potentially endanger the patient's life is a great problem. In everyday practice open and sensitively presented information on the diagnosis and prognosis leads to better acceptance of the disease by the patient and his family. At the same time it arouses in the patient realistic expectations and plans, promotes his feeling of autonomy and also confidence in the doctor. It creates also a framework for effective collaboration and communication between the patient,...

[Possibilities of curative chemotherapy of solid tumours].

J Abrahámová

Vnitr Lek 2001, 47(8):548-552

The author analyzes the terms "cure", "curability" in relation to solid tumours at different sites. The attitude to so-called cure changed with time as the therapeutic possibilities changed. At the same time various markers, prognostic and predictive factors (epidemiological, anatomical and cellular and molecular genetic), were sought and found. On an international scale the extent of the disease was defined more accurately and codified and this was reflected in the TNM system. The attitude to such biological phenomena as spontaneous remission or late metastases changed also. A quite new clinical meaning was acquired by the phenomenon described histopathologically...

[Intensified chemotherapy of solid tumours].

R Vyzula

Vnitr Lek 2001, 47(8):553-554

Treatment of solid malignant diseases is despite significant scientific advances during the last decade still a problem. The results of treatment do not satisfy oncologists. New substances are sought which influence the proliferation of malignant cells and some of them are promising. At present however rather new therapeutic approaches are sought which use already known cytostatic substances. With the help of hithero known laws of chronobiology therapeutic regimes are elaborated which are less toxic than classical standard administration. The advances of high-dose chemotherapy in haematooncology led oncologists to create intensified cytostatic therapeutic...

[Diagnosis and treatment of tumor metastases].

L Petruzelka

Vnitr Lek 2001, 47(8):555-560

More than half the patients with malignat tumours have at the time of diagnosis already remote metastases or they develop remote dissemination after different intervals following termination of local treatment. Organ complications in case of metastatic dissemination are for the majority of patients the most life threatening condition. In therapeutic decisions the approach to some solid tumours is the same as in systemic diseases. The possibility to achieve a long-term therapeutic effect during conventional systemic therapy are limited in metastatizing solid tumours of adult age. Assessment of the extent of the disease incl. detection of metastatic...

[Some aspects of advances in the chemotherapy of bronchogenic carcinoma].

J Skricková, I Pálková, S Spelda, L Babicková, J Kaplanová, O Kubová

Vnitr Lek 2001, 47(8):561-567

Bronchogenic carcinoma is in the Czech Republic the most frequent malignant tumour in males. For practice the classification into non-small cell bronchogenic carcinoma (NSCLC) and small cell bronchogenic carcinoma (SCLC) is most useful. Views on chemotherapy of NSCLC were before 1980 rather pessimistic. In untreated patients with advanced NSCLC the median survival is 6 months and one-year survival in 10 %. In the nineties, due to the introduction of cytostatics of the IIIrd generation into treatment of NSCLC, the median survival was prolonged to 10 - 12 months and one-year survival is reported in 40 - 50 % patients. The importance of chemotherapy in...

[New aspects in chemotherapy of tumors of the digestive tract].

J Fínek

Vnitr Lek 2001, 47(8):568-571

Concomitant radiochemotherapy is the most effective approach in the treatment of esophageal, gastric and pancreatic cancer. Standard treatment of advanced or metastatic colorectal carcinoma was 5-fluorouracil and leukovorin combination (Mayo combination). In comparison with this schedule present the new drugs raltitrexed and capecitabin less toxicity and equivalent efficacy. Combination oxaliplatin 5-FU/FA is superior in response rate to the standard 5-FU/FA combination.

[Complications of radiotherapy--a medical problem?].

M Kohoutek

Vnitr Lek 2001, 47(8):572-575

The ever increasing number of solid tumours and revival of radiotherapy as the method of choice of locoregional treatment in particular in combination with surgery in curative treatment of not advanced diseases leads to the fact that the specialist in internal medicine is faced with early as well late postirradiation changes which may play a part in the differential diagnosis in internal medicine The radiation effects on the living organism can be divided into those conditioned by cellular losses (deterministic) and structural DNA changes in surviving cells (stochastic). Both types of changes must be taken into account in relation to the administered...

[Psychology and ethics of care of oncology patients].

M Munzarová

Vnitr Lek 2001, 47(8):576-578

The author discusses the necessity of perception of the uniqueness of oncological patients and the necessity to treat all their dimensions (physical, social, mental and spiritual). She analyzes the concept of total pain according to Cecilia Saunders who discusses the mentioned dimensions of man. Total pain is made up of mutually linked components which are difficult to separate: physical pain, social pain, emotional pain, and spiritual pain. Contemporary alarming statistics provide evidence that in many patients suffering is not alleviated correctly. One of the important reasons of failure is also failure of health workers as regards knowledge of the...

[Treatment of oncological pain--its main principles].

Z Bystrický

Vnitr Lek 2001, 47(8):579-587

The paper reviews the main principles of treatment of oncological pain. It deals with evaluation of its causes, description of non-biological factors, which influence perception of this pain. The author describes the main medicamentous and other procedures in the treatment of pain in oncological patients. Attention is drawn to the main mistakes encountered in this treatment and outlines the basic objectives of comprehensive treatment of oncological pain with emphasis on the quality of the patient's life.

[Incurable oncological patient?].

O Sláma, J Vorlícek

Vnitr Lek 2001, 47(8):588-590

Despite the significant advances in oncology achieved during the last two decades more than half the patients die as a result of the tumour or associated complications. When we are unable to cure the patient, he is described as incurable. The word is however frequently conceived in a distorted way, i.e. unfit to be treated. If the objective of our treatment is only the tumour. Then active treatment really ends with the possibilities of anti-tumour treatment. If however the objective of our therapeutic efforts is man - the oncological patient, we must conceive active treatment and care as a certain continuous process where from the very beginning anti-tumourous...