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This position paper has been drafted by experts from the Czech national board of diseases with bronchial obstruction, of the Czech Pneumological and Phthisiological Society. The statements and recommendations are based on both the results of randomized controlled trials and data from cross-sectional and prospective real-life studies to ensure they are as close as possible to the context of daily clinical practice and the current health care system of the Czech Republic. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable heterogeneous syndrome with a number of pulmonary and extrapulmonary clinical features and concomitant chronic diseases. The disease is associated with significant mortality, morbidity and reduced quality of life. The main characteristics include persistent respiratory symptoms and only partially reversible airflow obstruction developing due to an abnormal inflammatory response of the lungs to noxious particles and gases. Oxidative stress, protease-antiprotease imbalance and increased numbers of pro-inflammatory cells (mainly neutrophils) are the main drivers of primarily non-infectious inflammation in COPD. Besides smoking, household air pollution, occupational exposure, low birth weight, frequent respiratory infections during childhood and also genetic factors are important risk factors of COPD development. Progressive airflow limitation and airway remodelling leads to air trapping, static and dynamic hyperinflation, gas exchange abnormalities and decreased exercise capacity. Various features of the disease are expressed unequally in individual patients, resulting in various types of disease presentation, emerging as the "clinical phenotypes" (for specific clinical characteristics) and "treatable traits" (for treatable characteristics) concept. The estimated prevalence of COPD in Czechia is around 6.7% with 3,200-3,500 deaths reported annually. The elementary requirements for diagnosis of COPD are spirometric confirmation of post-bronchodilator airflow obstruction (post-BD FEV1/VCmax <70%) and respiratory symptoms assessement (dyspnoea, exercise limitation, cough and/or sputum production. In order to establish definite COPD diagnosis, a five-step evaluation should be performed, including: 1/ inhalation risk assessment, 2/ symptoms evaluation, 3/ lung function tests, 4/ laboratory tests and 5/ imaging. At the same time, all alternative diagnoses should be excluded. For disease classification, this position paper uses both GOLD stages (1 to 4), GOLD groups (A to D) and evaluation of clinical phenotype(s). Prognosis assessment should be done in each patient. For this purpose, we recommend the use of the BODE or the CADOT index. Six elementary clinical phenotypes are recognized, including chronic bronchitis, frequent exacerbator, emphysematous, asthma/COPD overlap (ACO), bronchiectases with COPD overlap (BCO) and pulmonary cachexia. In our concept, all of these clinical phenotypes are also considered independent treatable traits. For each treatable trait, specific pharmacological and non-pharmacological therapies are defined in this document. The coincidence of two or more clinical phenotypes (i.e., treatable traits) may occur in a single individual, giving the opportunity of fully individualized, phenotype-specific treatment. Treatment of COPD should reflect the complexity and heterogeneity of the disease and be tailored to individual patients. Major goals of COPD treatment are symptom reduction and decreased exacerbation risk. Treatment strategy is divided into five strata: risk elimination, basic treatment, phenotype-specific treatment, treatment of respiratory failure and palliative care, and treatment of comorbidities. Risk elimination includes interventions against tobacco smoking and environmental/occupational exposures. Basic treatment is based on bronchodilator therapy, pulmonary rehabilitation, vaccination, care for appropriate nutrition, inhalation training, education and psychosocial support. Adequate phenotype-specific treatment varies phenotype by phenotype, including more than ten different pharmacological and non-pharmacological strategies. If more than one clinical phenotype is present, treatment strategy should follow the expression of each phenotypic label separately. In such patients, multicomponental therapeutic regimens are needed, resulting in fully individualized care. In the future, stronger measures against smoking, improvements in occupational and environmental health, early diagnosis strategies, as well as biomarker identification for patients responsive to specific treatments are warranted. New classes of treatment (inhaled PDE3/4 inhibitors, single molecule dual bronchodilators, anti-inflammatory drugs, gene editing molecules or new bronchoscopic procedures) are expected to enter the clinical practice in a very few years. [ABSTRACT FROM AUTHOR]

Aim. To retrospectively evaluate the technical features, feasibility, efficacy, accuracy and appropriate complications of CT-guided biopsies of mediastinal masses and correlate them with anatomical relationships in the mediastinum. Methods. Over the course of ten years, 81 percutaneous biopsy procedures in 78 patients for tumors sizes 27 - 189 mm in diameter (median length 57.5 mm) were performed using only local anesthesia. These interventions were done under the guidance of computed tomography. The patients were men in 30 cases and women in 48 cases, aged 19 to 90 years. Results. In 78 cases (96.3%) results were either true positive or true negative; in only 3 cases (3.7%, 3 biopsies of 2 tumors in 2 patients) were histological findings false negative. In 2.3% of the patients, complications were revealed in the anterior part of the mediastinum, 43.7% occurred in the middle region, and 14.3% in the posterior region of the mediastinum. Statistical data analysis verified there was a 3.74 times chance of an increase in complications in the middle mediastinal section in correlation with other anatomical localizations. In only one case was therapeutic intervention for complication necessary. For all other cases, a conservative approach was suitable. Conclusion. Percutaneous CT guided biopsies of the mediastinal tumors has a high accuracy rate in establishing the correct diagnosis. Masses in the middle mediastinum are associated with statistically higher incidences of postprocedural complications, which are not serious. [ABSTRACT FROM AUTHOR]

Objectives. The aim of the study was to evaluate the CT features of adrenal tumors in an effort to identify features specific to pheochromocytomas and second, to define a feasible probability calculation model. Methods. This multicentric retrospective study included patients from the period 2003 to 2017 with an appropriate CT examination and a histological diagnosis of an adrenal adenoma, pheochromocytoma, adrenocortical carcinoma, or metastasis. In total, 346 patients were suitable for the CT image analysis, which included evaluation of the largest diameter, the shape of the lesion, the presence of central necrosis and its margins, and the presence of an enhancing peripheral rim ("ring sign"). Results. Pheochromocytomas have a significantly more spherical shape (P<0.001), whereas an elliptical shape significantly reduces the probability of a pheochromocytoma (odds ratio = 0.015), as does another shape (odds ratio = 0.006). A "ring sign" is also more frequent in pheochromocytomas compared to other adrenal tumors (P=0.001, odds ratio = 6.49). A sharp necrosis also increases the probability of a pheochromocytoma more than unsharp necrosis (odds ratio 231.6 vs. 20.2). The probability calculation model created on the basis of the results confirms a high sensitivity and specificity (80% and 95%). Conclusion. This study confirms the value of anatomical features in the assessment of adrenal masses with the ability to significantly improve the identification of pheochromocytomas. Advanced assessment of the tumor shape was defined and a original comprehensive calculating tool of the pheochromocytoma probability was created on the basis of the results presented here and could be used in clinical routine. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a serious, yet preventable and treatable, disease. The success of its treatment relies largely on the proper implementation of recommendations, such as the recently released Global Strategy for Diagnosis, Management, and Prevention of COPD (GOLD 2011, of late December 2011). The primary objective of this study was to examine the extent to which GOLD 2011 is being used correctly among Czech respiratory specialists, in particular with regard to the correct classification of patients. The secondary objective was to explore what effect an erroneous classification has on inadequate use of inhaled corticosteroids (ICS). In order to achieve these goals, a multi-center, cross-sectional study was conducted, consisting of a general questionnaire and patient-specific forms. A subjective classification into the GOLD 2011 categories was examined, and then compared with the objectively computed one. Based on 1,355 patient forms, a discrepancy between the subjective and objective classifications was found in 32.8% of cases. The most common reason for incorrect classification was an error in the assessment of symptoms, which resulted in underestimation in 23.9% of cases, and overestimation in 8.9% of the patients' records examined. The specialists seeing more than 120 patients per month were most likely to misclassify their condition, and were found to have done so in 36.7% of all patients seen. While examining the subjectively driven ICS prescription, it was found that 19.5% of patients received ICS not according to guideline recommendations, while in 12.2% of cases the ICS were omitted, contrary to guideline recommendations. Furthermore, with consideration to the objectively-computed classification, it was discovered that 15.4% of patients received ICS unnecessarily, whereas in 15.8% of cases, ICS were erroneously omitted. It was therefore concluded that Czech specialists tend either to under-prescribe or overuse inhaled corticosteroids. [ABSTRACT FROM AUTHOR]

Background Idiopathic pulmonary fibrosis (IPF) is a clinical form of usual interstitial pneumonia (UIP). Computed chest tomography (CT) has a fundamental role in the multidisciplinary diagnostics. However, it has not been verified if and how a subjective opinion of a radiologists or pneumologists can influence the assessment and overall diagnostic summary. Purpose To verify the reliability of the scoring system. Material and Methods Assessment of conformity of the radiological score of high-resolution CT (HRCT) of lungs in patients with IPF was performed by a group of radiologists and pneumologists. Personal data were blinded and the assessment was performed independently using the Dutka/Vasakova scoring system (modification of the Gay system). The final score of the single assessors was then evaluated by means of the paired Spearman’s correlation and analysis of the principal components. Results Two principal components explaining cumulatively a 62% or 73% variability of the assessment of the single assessors were extracted during the analysis. The groups did not differ both in terms of specialty and experience with the assessment of the HRCT findings. Conclusion According to our study, scoring of a radiological image using the Dutka/Vasakova system is a reliable method in the hands of experienced radiologists. Significant differences occur during the assessment performed by pneumologists especially during the evaluation of the alveolar changes. [ABSTRACT FROM AUTHOR]

Objective: Blunt thoracic aortic injury is life-threatening injury. High suspicion on this clinical condition can be made by initial chest X-ray on emergency department. The aim of study was to detect which other signs, except widened mediastinum, are specific for rupture of the thoracic aorta., Methods: To the study were included all Triage positive patients primary headed from the scene of injury to the Trauma center Level I from January to December 2014 and which have performed chest X-ray on emergency department followed by CT of chest, abdomen and pelvis. On chest X-ray were evaluated diameter of superior mediastinum, deviation of trachea, deviation of left and right main bronchus, aortic arch, fracture of first or second rib on the left side and obliteration of aortopulmonary space., Results: Totally n=208 patients were enrolled to the study. Seven patients had blunt thoracic aortic injury on CT angiography. All these patients had widened superior mediastinum more than 80 mm (p=0.021). Six patients with blunt thoracic aortic injury had obliteration of aortic arch (p=0.0001) and obliteration of aortopulmonary space (p=0.0001)., Conclusion: All patients after high energy trauma with widened mediastinum together with obliteration of aortic arch and obliteration of aortopulmonary space on initial chest X-ray without initial CT, must be indicated to the CT after initial stop the bleeding procedures for the exclusion of traumatic rupture of thoracic aorta.