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J Homolka

Publications and source records attributed to J Homolka.

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

[3 years of long-term home oxygen therapy in the Czech Republic].

BACKGROUND: Long-term domiciliary oxygen therapy was introduced in the Czech Republic as a standard therapeutic method in patients with chronic respiratory failure in October 1992. As a source of oxygen almost exclusively oxygen concentrators are used which are allocated to the patients according to criteria elaborated by the European Respiratory Society. METHODS AND RESULTS: From October 1, 1992 to October 1, 1995 the mean number of installed concentrators is 10,24/100000 population. From a total of 1064 patients by October 1, 1995 3.8% were treated for three years, 20.7% for two years and 34.4% for more than one year. In the course of three years a total of 490 patients died. The mean survival period of patients treated for prolonged periods by domiciliary oxygen therapy was 8.88 months. The high mortality rate is due to the fact that patients in a very serious state are treated. On account of chronic pulmonary disease oxygen therapy was indicated in 93.4%, on account of interstitial pulmonary processes (KFA and other fibroses) in 3.9, on account of kyphoscoliosis in 2.4% and on account of cystic fibrosis in 0.3% of the group. The mean costs of treatment were 114.40 Kĕ/day which is a third of the costs when the patient is hospitalized. CONCLUSIONS: Domiciliary oxygen therapy proved effective and economical in patients with chronic respiratory failure.

Czech Republic↗
PubMed1996

[High-resolution computer tomography in the diagnosis of cryptogenic fibrosing alveolitis. Correlation with pulmonary function and bronchoalveolar lavage].

BACKGROUND: High resolution computed tomography (HRCT) revealed new findings as regards changes associated with cryptogenic fibrotizing alveolitis. So far views on changes suggesting activity of the disease are not uniform and they were not yet confronted with examinations of fluid obtained by bronchoalveolar lavage (BALT). The objective of the present work is to evaluate the contribution of HRCT to the assessment of the activity of the disease and compare the findings with the examination of BALT. METHODS AND RESULTS: The authors evaluated the HRCT examination made in 52 patients with histologically confirmed cryptogenic fibrotizing alveolitis and in 39 of them the finding was confronted with the BALT examination. Signs of active inflammatory disease according to HRCT comprised a ground-glass increase of the density in 80.8%, centrilobular micronodules in 17.3% and a prominence of centrilobular structures in 32.7%. The suggested extent of affection of the pulmonary parenchyma assessed according to HRCT correlated well with the degree of dyspnoea, restrictive and obstructive ventilation disorder, pulmonary diffusion and with hypoxaemia. The authors confirmed also an inverse correlation between the grade assessed by HRCT and the percentage of lymphocytes in BALT. CONCLUSIONS: The investigation confirmed the contribution of HRCT in the diagnosis of patients with cryptogenic fibrotizing alveolitis, it confirmed the complementary importance of HRCT and BALT examination when assessing the activity of the disease and its asset when monitoring patients during treatment.

Adolescent↗
PubMed1996

Anti-inflammatory cytokine release by alveolar macrophages in pulmonary sarcoidosis.

Sarcoidosis is a systemic, granulomatous disorder with a high rate of spontaneous remission indicating the presence of antiinflammatory mechanisms. Antiinflammatory mediators such as interleukin-10 (IL-10) and transforming growth factor-beta (TGF-beta) should be able to induce spontaneous remission of sarcoidosis. By measuring the release of both mediators in culture supernatants of bronchoalveolar lavage (BAL) cells, we investigated their relevance in the spontaneous remission of sarcoidosis. No spontaneous IL-10 release was observed by BAL cells of sarcoid patients. In supernatants of BAL cells of seven patients found retrospectively to be free of any interstitial lung disease, we found 612 +/- 261.2 pg/ml (mean +/- SEM) TGF-beta. TGF-beta release was recorded in 20 of 39 patients with active disease. Patients with active disease without TGF-beta release in BAL cell culture either required therapy (n = 21; 677 +/- 159 pg/ml) or showed evidence of persisting disease (n = 6; 762 +/- 419 pg/ml). Patients with active disease without indications for therapy and with significantly increased TGF-beta release (n = 12; 1,422 +/- 215 pg/ml; p < 0.004 in all comparisons) had a spontaneous remission within 6 mo. Increased TGF-beta release (1,560 +/- 353 pg/ml) was observed in five of five patients receiving therapy. We conclude that TGF-beta is a regulator of the inflammatory process in sarcoidosis.

Adrenal Cortex Hormones↗
PubMed1994

[Transparietal puncture aspiration biopsy of the lung and mediastinum].

BACKGROUND: The contribution of fine needle transparietal aspiration biopsy for the diagnosis of diseases of thoracic organs is generally accepted. The objective of the present study is to evaluate the contribution of this method to the diagnosis of processes in the lung and mediastinum. METHODS AND RESULTS: Transparietal fine needle aspiration biopsy was performed in 115 patients, 75 men and 40 women, mean age 59 +/- 10.7 years in men and 58.4 +/- 10.3 years in women. The site of insertion and position of the needle were checked by skiascopy. The assembled material was evaluated cytologically under a light microscope. Malignant tumours were classified according to WHO recommendations. The greatest diagnostic yield of the method was in a group of 73 patients with clinical suspicion of a malignant process; this suspicion was confirmed by cytological examination in 50 patients, i.e. in 68.5% of the patients. In 7 of 15 patients with suspected tuberculosis cytological evidence of epithelioid and Langerhans cells supported the diagnosis of pulmonary tuberculosis; from four punctures of mediastinal formations confirmed a malignant tumour in half of them. In a relatively large group of patients with inflammatory processes the cytological finding did not prove useful for establishment of the diagnosis. Complications of this examination in the whole group were recorded in 18 patients (15.6%). The most frequent complication was the development of pneumothorax (18 patients, 15.6%) which however, only in 2 patients required exsufflation. In three patients after the procedure minimal haemoptysis developed. CONCLUSIONS: Complications, although fairly frequent (15.6%), are not serious.

Biopsy, Needle↗
PubMed1994

[Extrapulmonary tuberculosis with involvement of the reticuloendothelial system and secondary lupus vulgaris].

The authors describe a case of extrapulmonary tuberculosis with affection of the reticuloendothelial system in a 59-year-old female patient. After successful treatment the findings in the spleen, bone marrow and the laboratory results had normal levels. The authors draw attention to the diagnostic difficulties. They were able to confirm the diagnosis only by histological examination of biopsy from the pelvic bone. An interesting finding was eruption of lupus vulgaris on the legs in the course of treatment. The authors discuss some aspects of the disease and its differential diagnosis.

Bone Marrow Diseases↗
PubMed1993

Increased interleukin 6 production by bronchoalveolar lavage cells in patients with active sarcoidosis.

Alveolitis of sarcoidosis is characterized by activated alveolar macrophages (AMs) and T cells. The mediators interleukin-1 (IL-1) and interleukin 6 (IL-6) released by AMs represent essential factors for the progression of the T cells in the cell cycle. The role of IL-1 in pulmonary sarcoidosis has previously been studied; however, the relevance of other mediators (i.e. IL-6) has not yet been evaluated. We measured the spontaneous and lipopolysaccharide (LPS)-induced release of IL-6 and tumor necrosis factor alpha (TNF alpha) by bronchoalveolar lavage cells (BAL) and peripheral blood mononuclear cells (PBMNC) in 6 control subjects (group A) and in 15 patients with sarcoidosis, 10 with active (group B), 5 with inactive disease (group C). IL-6 as well as TNF alpha were spontaneously released by BAL cells of the active group in significantly greater amounts compared to both other groups; IL-6: A, 165.5 pg/ml/24 hr/10(6) cells (range, 0-604), B, 946 (0-2467), C, 16.6 (0-83); TNF alpha: A, 162 pg/ml/24 hr/10(6) cells (0-523), B, 803 (100-17352), C, 100 (0-379). In all groups autologous PBMNC proved to be quiescent, releasing only baseline levels of the cytokines tested. After stimulation with LPS all these cells released great quantities of IL-6 and TNF alpha. In active disease a positive correlation between IL-6 and TNF alpha release was observed (r = 0.77, p < 0.02). The present study documents that in active sarcoidosis the spontaneous release of IL-6 by BAL cells parallels the spontaneous release of TNF alpha. IL-6 is capable of initiating the proliferation and activation of T cells in the lung.

Adult↗
PubMed1992

Evaluation of soluble CD 14 and neopterin as serum parameters of the inflammatory activity of pulmonary sarcoidosis.

CD14 represents the most specific marker for monocytes/macrophages. It has been demonstrated in vitro that monocytes/macrophages lose this antigen upon activation. Results of studies investigating the expression of membrane-bound CD14 on the surface of monocytes/macrophages in sarcoidosis patients are controversial. To investigate whether the soluble form of CD14 reflects monocyte/macrophage activation in sarcoidosis, serum levels of soluble CD14 were determined concurrently with other serum markers of monocyte/macrophage activation (neopterin, angiotensin-converting enzyme) in 50 consecutive patients with bioptically confirmed sarcoidosis. The patients were allocated to three groups according to disease activity and therapy. The soluble interleukin-2 receptor in serum and the CD4/CD8 ratio in lavage fluid were used to monitor T-lymphocyte activation. No significant differences in serum or bronchoalveolar lavage levels of soluble CD14 were observed in patients with active or inactive sarcoidosis. Despite the presence of normal soluble CD14 serum concentrations a correlation with serum neopterin and angiotensin-converting enzyme was found in active sarcoidosis (soluble CD14 versus neopterin, rs = 0.61 and 0.65, P < 0.05 and 0.01, respectively; soluble CD14 versus angiotensin-converting enzyme, rs = 0.6 and 0.72, P < 0.02 and 0.003, respectively). A correlation between soluble CD14 and parameters of T-cell activity was not demonstrated. We therefore conclude that soluble CD14 in serum is not a useful clinical parameter in establishing disease activity in sarcoidosis. Neopterin and angiotensin-converting enzyme serum concentrations are parameters with higher sensitivity, although specificity remains very low. The exact role of CD14 antigen in sarcoidosis requires further investigation.

Antigens, CD↗
PubMed1991

[Symptoms of diseases of the respiratory system and their importance in diagnosis. Summary and conclusions of research].

The status in the sphere of diagnosis of respiratory diseases and the revealed shortcomings in this area stimulated workers of the First Clinic for TB and Respiratory Diseases to elaborate two investigations, the aim of which was to reveal in the course of the eighties (1983-1988) the most important problems in the diagnostic process and thus contribute to the improvement of the present state. Another task was to record developmental trends as regards the contents of the discipline of pneumology. A relatively large number of patients (2207 subjects) and the period of investigation made it possible to draw some general conclusions. The results proved persisting shortcomings, in particular a slow diagnostic process which e.g. in bronchogenic carcinoma and some other diseases very much restricts effective treatment and in TB there is the danger of infection of the healthy population. From this ensue necessary provisions at all levels of medical care (in particular comprehensive examinations of patients, interdisciplinary collaboration, improved preventive provisions and attention paid to changes in the frequency and clinical picture of lung diseases as a result of different factors).

Aged↗
PubMed1989

[The significance of oxygen radicals in the pathogenesis of interstitial pulmonary processes].

The author assessed the production of superoxide anion radical (O2-) and hydrogen peroxide (H2O2) by monocytes in blood and by alveolar macrophages in five healthy non-smokers and in four non-smokers with a bioptically confirmed cryptogenic fibrotizing alveolitis under basal conditions and after stimulation of the cells with 25 microM forbol myristate acetate. For assessment of the production of O2- and H2O2 he used the colorimetric method described by Pick and Keisari. Alveolar macrophages of patients with cryptogenic fibrotizing alveolitis produce increased amounts of O2- and H2O2 (33.4 +/- 6.7 and 36.2 +/- 7.6 nmol/10(6) cells/hour resp.), as compared with alveolar macrophages of healthy volunteers (5.8 +/- 2.3 and 6.23 +/- 2.7 nmol/10(6) cells/hour resp.). Blood monocytes of patients with cryptogenic fibrotizing alveolitis do not have an increased production of these radicals, as compared with healthy non-smokers (3.97 +/- 1.4 and 4.26 +/- 1.7 resp., as compared with 3.79 +/- 1.2 and 3.87 +/- 1.1 nmol/10(6) cells/hour resp.). After stimulation with forbol myristate acetate alveolar macrophages in patients with cryptogenic fibrotizing alveolitis increase the output of oxide radicals only slightly.

Adult↗
PubMed1989

[The clinical picture of pulmonary tuberculosis over the past 40 years].

Most patients with pulmonary tuberculosis present to their physician because of the symptoms of this disease. This study was aimed at finding out how the clinical picture of pulmonary tuberculosis diagnosed for the first time changes in the patients hospitalized at our department in the years 1948-1986. Furthermore, the percentage of asymptomatic patients, the frequency of detectable cavern and mycobacteria tuberculosis were established. During the time period studied a change in clinical picture of the disease occurred as seen on the 13 symptoms followed. The previously common haemoptysis is a rarer symptom of tuberculosis at present (17.5% in the 1948-1950 population compared to 5.0% in the 1983-1986 population). There is an increasing number of patients in which tuberculosis manifests itself by breathlessness (2.3% of the 1948-1950 population compared to 10.9% in the years 1979-1981). In the whole period studied patients with symptoms prevail, the difference between the 1948-1950 period (71.1%) and that of 1979-1986 (67.0%) is not statistically significant. The number of patients with cavernous tuberculosis is decreasing (75% of patients in the years 1948-1950, 37% of patients in the years 1983-1986), there is an increase in bacteriologically proven diseases (33.9% of the 1948-1950 population, 73.0% of that of 1983-1986). The change in the clinical picture of tuberculosis is connected with the improvement of social conditions of the whole population, introduction of compulsory BCG vaccination and effective therapy, as well as bovine tuberculosis elimination. The change in the clinical picture of the disease is also influenced by the ever increasing mean age of the patients.

Adult↗
PubMed1989

[The clinical picture of pulmonary tuberculosis during the course of 39 years].

The change of signs and symptoms of pulmonary tuberculosis detected for the first time during the years 1948 through 1986 is analysed. During the entire period, the majority of patients attended the physician because of symptoms. Between 13 different evaluated symptoms cough was permanently most frequent. The other symptoms changed in their prevalence. The mean age of the patients increased from 29.7 to 59.0 years. The proportion of patients with cavities decreased from 75% to 37%. The increase of the proportion of patients in whom M. tuberculosis was detected, from 33.9 to 73.0%, is explained by the growing intensity of bacteriological examinations. To provide early case finding, health education of the population and appropriate qualification of physicians and other health providers are required at present as well as in the past.

Adult↗