Five cases of patients with systemic connective tissue diseases (CTD) who developed connective tissue disease-associated interstitial lung disease (CTD-ILD) with progressive pulmonary fibrosis (PPF) are reported here. Unspecified ILD was diagnosed using high-resolution computed tomography (HRCT). Histologically, all cases were usual interstitial pneumonia (UIP) with findings of advanced (3/5) to diffuse (2/5) fibrosis, with a partially (4/5) to completely (1/5) formed image of a honeycomb lung. The fibrosis itself spread subpleurally and periseptally to more central parts (2/5) of the lung, around the alveolar ducts (2/5), or even without predisposition (1/5). Simultaneously, there was architectural reconstruction based on the mutual fusion of fibrosis without compression of the surrounding lung parenchyma (1/5), or with its compression (4/5). The whole process was accompanied by multifocal (1/5), dispersed (2/5), or organized inflammation in aggregates and lymphoid follicles (2/5). As a result of continuous fibroproduction and maturation of the connective tissue, the alveolar septa thickened, delimiting groups of alveoli that merged into air bullae. Few indistinctly visible (2/5), few clearly visible (1/5), multiple indistinctly visible (1/5), and multiple clearly visible (1/5) fibroblastic foci were present. Among the concomitant changes, areas of emphysema, bronchioloectasia, and bronchiectasis, as well as bronchial and vessel wall hypertrophy, and mucostasis in the alveoli and edema were observed. The differences in the histological appearance of usual interstitial pneumonia associated with systemic connective tissue diseases (CTD-UIP) versus the pattern associated with idiopathic pulmonary fibrosis (IPF-UIP) are discussed here. The main differences lie in spreading lung fibrosis, architectural lung remodeling, fibroblastic foci, and inflammatory infiltrates.

• MeSH
• dospělí MeSH
• idiopatická plicní fibróza patologie   komplikace   MeSH
• intersticiální plicní nemoci * patologie   komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci pojiva * patologie   komplikace   MeSH
• plíce patologie   diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Pulmonary alveolar proteinosis (PAP) is a rare disease characterised by excessive accumulation of surfactant components in alveolar macrophages, alveoli, and peripheral airways. The accumulation of surfactant is associated with only a minimal inflammatory response but can lead to the development of pulmonary fibrosis. Three clinical forms of PAP are distinguished - primary, secondary and congenital. In recent years, significant findings have helped to clarify the ethiology and pathogenesis of the disease. Apart from impaired surfactant protein function, a key role in the development of PAP is played by signal pathway of granulocyte and macrophage colonies stimulating growth factor (GM-CSF) which is necessary for the functioning of alveolar macrophages and for surfactant homeostasis. Surfactant is partially degraded by alveolar macrophages that are stimulated by GM-CSF. The role of GM-CSF has been shown especially in primary PAP, which is currently considered an autoimmune disease involving the development of GM-CSF neutralising autoantibodies. Clinically, the disease may be silent or manifest with dyspnoeic symptoms triggered by exertion and cough. However, there is a 10 to 15% rate of patients who develop respiratory failure. Total pulmonary lavage is regarded as the standard method of treatment. In addition, recombinant human GM-CSF has been studied as a prospective therapy for the treatment of PAP.

• MeSH
• alveolární makrofágy * imunologie   patologie   MeSH
• faktor stimulující granulocyto-makrofágové kolonie * metabolismus   MeSH
• lidé MeSH
• plicní alveolární proteinóza * patologie   MeSH
• vzácné nemoci * patologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

V našom článku, na podklade dvoch prípadov z praxe, popisujeme priebeh, diagnostiku a liečbu pľúcnej alveolárnej proteinózy (PAP). V prvom prípade ide o 52-ročnú ženu, v druhom o 34-ročného muža. Obaja pacienti boli vyšetrovaní spádovým pneumológom pre intersticiálne pľúcne ochorenie, v prvom prípade aj s prechodom do pľúcnej fibrózy. V rámci diferenciálnej diagnostiky boli hospitalizovaní v NÚTPCHaHCH vo Vyšných Hágoch. RTG hrudníka ukázalo nález difúznych obojstranných infiltrátov pľúc, ktoré u prvého pacienta vykazovali miestami splývavý charakter. CT hrudníka zobrazilo parenchýmové postihnutie pľúc s obojstrannými areálmi charakteru mliečneho skla („ground-glass opacity“/GGO) so zhrubnutými interlobulárnymi septami (crazy paving). U oboch pacientov bolo urobené bronchoskopické vyšetrenie s bronchoalveolárnou lavážou, ktorá mala charakteristický mliečne skalený vzhľad. Pacientom bola dodatočne indikovaná videotorakoskopická biopsia pľúc a histopatologicky potvrdená pľúcna alveolárna proteinóza. Terapeuticky pacienti podstúpili veľkoobjemovú laváž pľúc, po ktorej došlo k zlepšeniu ich klinického stavu a tiež zlepšeniu rádiologického nálezu. Poukazujeme na základné piliere diagnostiky pľúcnej alveolárnej proteinózy, ktorými sú vzor pľúcneho postihnutia v RTG a CT (resp. HRCT) obraze, charakteristický vzhľad bronchoalveolárnej lavážovej tekutiny a dodatočne dokumentujeme aj histopatologický obraz pľúcneho postihnutia pri tomto ochorení. Akcentujeme potrebu centralizácie manažmentu pacientov s pľúcnymi ochoreniami, ktorá je obzvlášť naliehavou v prípadoch raritných ochorení, kedy umožňuje rýchlu dostupnosť všetkých relevantných diagnostických a terapeutických možností, vrátane veľkoobjemovej laváže pľúc.

In this article, we describe the course and diagnosis of pulmonary alveolar proteinosis (PAP) based on two cases from our practice. The first case is a 52-yearold woman, the second a 34-year-old man. Both referred patients were examined by a pulmonologist for interstitial lung disease, in the first case also with transition to pulmonary fibrosis. As part of the differential diagnosis, these patients were hospitalized at the NÚTPCHaHCH in Vyšné Hágy. Chest X-ray showed diffuse bilateral lung infiltrates, in the first patient locally confluent. Chest CT showed parenchymal involvement of the lungs with bilateral ground-glass opacities with thickened interlobular septa (crazy paving). Bronchoscopic examination was performed in both patients with bronchoalveolar lavage, which had a characteristic milky-glazed appearance. Videothoracoscopic lung biopsy was additionally indicated and histopathologically there were pulmonary alveolar proteinosis confirmed. Therapeutically, the patients underwent large volume lung lavage, with clinical condition improvement, including radiological findings improvement. We point out the basic pillars of the diagnosis of pulmonary alveolar proteinosis, which are the pattern of pulmonary involvement in the radiographic and CT (or HRCT) images, the characteristic appearance of the bronchoalveolar lavage fluid, and additionally also the histopathologic pattern of pulmonary involvement in this disease. We emphasize the need for centralized management of patients with lung diseases, which is particularly urgent in cases of rare diseases, where it provides rapid availability of all relevant diagnostic and therapeutic options, including large-volume lung lavage.

• MeSH
• bronchoalveolární laváž metody   MeSH
• bronchoskopie metody   MeSH
• diagnostické zobrazování metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní alveolární proteinóza * diagnóza   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Úvod: Staphylococcus aures (S. aureus) je grampozitívny fakultatívne anaeróbny kok, ktorý je schopný vyvolať infekčné ochorenie zvierat aj ľudí. Zvlášť nebezpečné sú multirezistentné formy s nižšou, alebo aj žiadnou odpoveďou na dostupnú liečbu. Ciele: Cieľom práce je overiť vplyv enzybiotík v hojení S. aureus infikovaných kožných rán na exprimentálnom modeli prasiat. Metodika: Do pokusu boli zaradené dve prasatá, ktorým boli na chrbtovej oblasti vyrezané rany (10x/1prasa) o veľkosti 5x5 cm s 2 cm odstupmi. Rany boli infikované methicilin (Oxacilin) a amoxicilin resistentným kmeňom S. aureus baktérie (MRSA). Experimentálne skupiny pozostávali z jednotlivých rán, ktoré boli infikované jedným sekvenčným typom baktérie S. aureus v koncentrácii 2x10 9 CFU/ml. Dve rany ostali neliečené (N), štyri rany boli liečené hydrogélom doplneným lyzostatínom (L) a štyri boli liečené hydrogélom doplneným lyzostatínom a endolyzínom (LE). Následne boli na štvrtý, siedmy, jedenásty a štrnásty deň odoberané vzorky z jednotlivých rán. Materiál bol spracovaný štandardnou histologickou technikou formou parafinových bločkov a rezy boli farbené hematoxylínom-eozínom. Výsledky: Z výsledkov vyplýva, že ide o defekty s celým spektrom reparačných zmien s reepitelizáciou so striedaním úsekov nekróz a novovytvoreného granulačného tkaniva s doprevádzajúcim guľatobunečným zápalovým infiltrátom na podklade edematózneho tkaniva a povrchovými chrastami. Na povrchu rán a tiež v menších skupinkách v novovytvorenom granulačnom tkanive sú viditeľné kokovitné útvary charakteru S. aureus. V hydrogélových krytoch, ktoré obsahujú lyzostafín, alebo kombináciu lyzostafínu s endolyzínom sa porovnaním s neliečenými ranami zachytávajú väčšie množstvá kolónie S. aureus kokov, ktoré tu vo veľkej miere následne odumierajú. Záver: Enzybiotiká môžu mať potenciál v topickej terapii MRSA infikovaných kožných rán.

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• MeSH
• enzymoterapie * metody   MeSH
• hojení ran * účinky léků   MeSH
• infekční nemoci kůže * farmakoterapie   MeSH
• lidé MeSH
• methicilin rezistentní Staphylococcus aureus patogenita   účinky léků   MeSH
• prasata mikrobiologie   zranění   MeSH
• Staphylococcus aureus * patogenita   účinky léků   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

The objective of this article is to describe and classify usual interstitial pneumonia (UIP) changes according to their relevance in the pathology of the idiopathic pulmonary fibrosis (IPF) process. In a cohort of 50 patients (25♀, 25♂) with UIP findings, the percentage ratio between fibrotic and preserved parts of the lungs was quantified. Three quantitative stages of fibrotic involvement of the lung parenchyma and concomitant changes were defined. These are initial (≤20%), advanced (21-40%), and diffuse (≥41%) fibrosis of the lungs. Histologically, temporal heterogeneity is predominant with thickened alveolar septa, interstitial fibrosis, and the presence of fibroblastic foci up to mature diffuse fibrosis with honeycomb changes. The finding is accompanied by variably mature lymphocytic inflammation, presence of macrophages, emphysema, bronchioloectasia of the alveoli, bronchiectasis, bronchial muscle wall hypertrophy, hypertrophy of the vessel walls, alveolar mucosa, focal haemorrhage, and hyalinization of the lungs. Pneumocyte hyperplasia, occasionally atypical in appearance with hobnail changes, as well as squamous metaplasia are observed. In the methodically quantified stages of fibrous involvement, 14 subjects were classified (6♀, 8♂) into the stage of initial fibrosis, 21 subjects (11♀; 10♂) into the stage of advanced fibrosis, and 15 subjects (8♀; 7♂) into the stage of diffuse fibrosis.

• MeSH
• biopsie MeSH
• fibróza MeSH
• hypertrofie patologie   MeSH
• idiopatická plicní fibróza * patologie   MeSH
• lidé MeSH
• plíce patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Suicides are one of the topics discussed around the world. This problem receives large space in scientific and professional literature, in order to eliminate its occurrence. Mechanisms of suicides are determined by whole spectrum of reasons determined by/depending on physical and psychological health. The objective of this work is to document the differences in mechanisms and realization of suicides by mentally sick people. Ten cases of suicides are reported in the article: three of which in people with a history of depression of the victim noted by family members, one with treated depression, three with anxiety-depressive disorder and three schizophrenic patients cases. There are five men and five women. Four of these women overdosed themselves by medicaments and one jumped out of a window. Two men shot themselves, two hanged themselves and one jumped out of a window. Persons without anamnestically proven psychiatric diseases end their lives mostly because of inconclusive situation or as a result of balancing their whole life (usually with good plan and preparation of the act). Persons with treatment of depression or anxiety-depressive disorder kill themselves mostly after several “unsuccessful” attempts. In case of victims with schizophrenia suicides follow a hardly predictable sequence of actions which sometimes do not seem to have any logic. Differences have been found between victims with and without mental disorders in ways of realization of suicides. Psychological predispositions in mood changes, long-term sadness and threatening suicide should be recognized by family members. Prevention of suicides in cases of people with a history of mental disorders is based on medical treatment and cooperation between the client and family members and a psychiatrist (Ref. 30).