There is an obvious need in most areas for effective centralization. Unrestrained, purely "market driven" approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.
Background: The Czech Republic ranks among the countries with the highest cancer burden in Europe as well as worldwide. The purpose of this study is to summarize long-term trends in the cancer burden and to provide up-to-date estimates of incidence and mortality rates after 2011. Data and Methods: The Czech National Cancer Registry (CNCR) was instituted in 1977 and contains information collected over a 34-year period of standardized registration covering 100% of cancer dia gnoses within the entire Czech population. The CNCR analysis is supported by demographic data and by the Death Records Database. An overview of the epidemiology of malignant tumors in the Czech population is available on-line at www.svod.cz. Results: All neoplasms, including non-melanoma skin cancer, reached a crude incidence rate of almost 802 cases per 100,000 men and 681 cases per 100,000 women in 2011. The annual mortality rate exceeded 258 deaths per 100,000 individuals; in other words, more than 27,000 individuals die of cancer each year. The overall incidence of malignancies has increased with a growth index of +27.6% during the last decade (2001-2011), while the mortality rate has been stabilized over the time span (growth index in 2001-2011:-5.0%). Consequently, the prevalence has signifi cantly increased in the observed period and exceeded 475,000 cases in 2011. In addition to demographic aging of the Czech population, the cancer burden has also increased due to the growing incidence of multiple primary tumors (recently more than 15% of the total incidence). The most frequent dia gnoses include colorectal cancer, lung cancer, breast cancer, and prostate cancer. Although some neoplasms are increasingly dia gnosed at an early stage (e. g. the proportion of stage I or II was 75.3% for female breast cancer and 84.2% for skin melanoma), the numbers of early dia gnosed cases are generally insuffi cient, even in the case of highly prevalent cancers such as colorectal carcinoma (only 46.1% of incident cases are dia gnosed at stage I or II, according to recent data). Conclusion: Population-based data on malignant tumors are available in the Czech Republic. The data survey can help us defi ne national cancer management priorities. The current priority is to achieve a sustained reduction of cases dia gnosed at an advanced stage and reduction of the signifi cant regional diff erences in dia gnostic effi ciency.
Individuals after orthotopic liver transplantation (OLT) often show renal dysfunction, which may substantially affect the post-OLT course. Renal function after OLT is commonly assessed by means of serum creatinine (S,,) concentration or renal creatinine clearance (C,,). A glomerular filtration rate (GFR) estimate based on S,, level is not accurate enough because even a more marked decrease in GFR need not be associated with an increase in S,, level, especially in jaundiced patients. The study intends to try to estimate GFR in individuals after OLT by means of determining serum cystatin C (Sv,) concentrations. In 58 individuals (mean age, 49 k 7 years; 31 men, 27 women) at various intervals from OLT (mean, 14 f 10 months), GFR was estimated by using simultaneous determinations of !Scyst, S,, C,,, and renal inulin clearance (Cin). In most subjects (91.3%), Cin was decreased to less than the lower limit of normal (80 mL/min/1.73 m'). A significant correlation (r = 0.70; P < .001) was found between l/Sqst and Cin. Receiver operating characteristic analysis was performed on S and S,, using a Cin cutoff value of 80 mWmid1.73 m . The area under the curve for S, , was 0.912 A 0.044, and that for S,, 0.899 f 0.049. There was no statistically significant difference between these values. The sensitivity for a S, , level of 1.20 mg/L (upper limit of normal value) to detect a decrease in GFR (measured as Cin) below the lower limit of normal (80 mWmid1.73 m') was 96.1%. The sensitivity of S, , level was significantly greater (P < .01) than the sensitivity of S,, level for men and at borderline significance for women (P = .05).Findings support the assumption that a S, , level less than 1.2 mg/L indicates with a high degree of probability (P C .001) that GFR is not decreased to less than the normal limit. S, , assessment in individuals after OLT could be proposed as a confirmatory test of a decrease in GFR in individuals with normal S,, levels. (Liver Transpl2002;8: T'574-577.)
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