Léčiva používaná v denní praxi urologa mají vysoký potenciál farmakodynamických i farmakokinetických lékových interakcí. U pacientů léčených pro hypertenzi je třeba v rámci jednotlivých indikací pečlivě zvažovat výběr molekuly, aby se minimalizovaly nežádoucí účinky ve smyslu navození hypertenze či posturální hypotenze. Obdobně u nemocných, kteří jsou již léčeni pro symptomy dolních močových cest, se doporučuje volit antihypertenziva, která primárně nepovedou ke zhoršení jejich příznaků. Článek shrnuje klinicky významné lékové interakce mezi antihypertenzivy a léčivy užívanými pro terapii hyperaktivního močového měchýře, benigní hyperplazie prostaty a interakce antiandrogenů.
Drugs commonly used in urological daily practice have a high potential for pharmacodynamic and pharmacokinetic drug interactions. In patients treated for hypertension, the choice of molecule must be carefully considered within the individual indications in order to minimize adverse effects (hypertension or postural hypotension). Similarly, in patients treated for lower urinary tract symptoms, choose antihypertensives that will not primarily lead to worsening of their symptoms. The article summarizes clinically significant drug interactions between antihypertensives and drugs used to treat overactive bladder, benign prostatic hyperplasia, and antiandrogen interactions.
- MeSH
- alfa-1-adrenergní receptory - antagonisté farmakologie klasifikace škodlivé účinky terapeutické užití MeSH
- antagonisté androgenů farmakologie klasifikace škodlivé účinky terapeutické užití MeSH
- antagonisté muskarinových receptorů farmakologie klasifikace škodlivé účinky terapeutické užití MeSH
- antihypertenziva * farmakologie klasifikace terapeutické užití MeSH
- hypertenze diagnóza farmakoterapie MeSH
- lékové interakce * MeSH
- lidé MeSH
- močové ústrojí * účinky léků MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE: The incidence of surgical site infections is considered a relevant indicator of perioperative and postoperative care quality. The aim of this study is to analyze and evaluate SSIs after elective cervical spine surgery under the guidance of our preventive multimodal wound protocol. METHODS: A monocentric observational cohort study analyzed 797 patients who underwent cervical spine surgery from 2005 to 2010 (mean age 51.58 ± 11.74 year, male 56.09%, mean BMI 26.87 ± 4.41, ASA score 1-2 in 81.68% of patients), fulfilling the entry criteria: (1) cervical spine surgery performed by neurosurgeons (degenerative disease 85.19%, trauma 11.04%, tumor 3.76%), (2) elective surgery, (3) postoperative care in our neurointensive care unit. Our preventive wound control protocol management focused mainly on antibiotic prophylaxis, wound hygiene regime, and drainage equipment. All wound complications and surgical site infections were monitored up for 1 year after surgery. RESULTS: We had only 2 (0.25%) patients with SSI after cervical spine surgery-one organ/space infection (osteomyelitis, primary due to liquorrhea) after anterior surgical approach, and one deep surgical site infection (due to dehiscence) after posterior approach. We had 17 (2.13%) patients with some wound complications (secretion 7, dehiscence 4, hematoma 1, edema 3, and liquorrhea 2) that were not classified as SSI according to the CDC guidelines. CONCLUSION: Concerning our study population of patients undergoing elective cervical surgery, with ASA scores 1-2 in 81.68% of our patients, the incidence of SSI was 0.14% after anterior surgical approach, 1.4% after posterior surgical approach, and 0.25% altogether in the referred cohort.
- MeSH
- dospělí MeSH
- incidence MeSH
- infekce chirurgické rány * epidemiologie etiologie prevence a kontrola MeSH
- kohortové studie MeSH
- krční obratle * chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- pozorovací studie MeSH
- Publikační typ
- abstrakt z konference MeSH
BACKGROUND: Transoral spine surgery is specific due to both its surgical approach and the spectrum of diseases it targets. Patients with high age and elevated clinical frailty scores are often involved, and there are reports of increased risks of surgical site infection (SSI) due to extended exposures requiring maxilotomy or mandibulotomy. Our case series describes surgical wound complications under the meticulous application of individualized perioperative multimodal management. METHODS: Our primary outcome was the occurrence of SSI and the secondary outcome was the occurrence of other noninfectious wound complications evaluated in 22 adult patients who consecutively underwent the transoral spine surgery from 2001 to 2018 (trauma - C2, cervical nonunion: 6 patients, 27%; tumor: 4 patients, 18%; osteomyelitis: 6 patients, 27%; other non-traumatic cases: 6 patients, 27%). Structuralized data comprising parameters related to nosocomial infections after spine surgery were continuously processed and put into specialized database of preventive multimodal nosocomial infection control protocol that was used as a main source of analyzed parameters. The mean age of studied cohort was 54.9 [Formula: see text] 15.5 years, with 68% males, mean body mass index (BMI) 24.9 [Formula: see text] 5.22, and the mean clinical frailty score was 2.59 [Formula: see text] 1.07. There were 7 patients (32%) who only had the transoral approach and 15 patients (68%) having this approach followed by additional posterior approach. We observed SSI from all wound complications for up to one year after surgery. RESULTS: There were 4 (18%) superficial wound complications from transoral approach, but none of them were infected. We had 2 patients (13%) with deep wound infections after subsequent posterior approach, but only one (4.5%) was classified as SSI. CONCLUSIONS: We describe the wound complications and the incidence of SSI in a series of 22 patients after the transoral surgery. Considering the average values of the clinical frailty score reaching 2.59, American Society of Anesthesiologists score of 2.73, and the BMI of 26.87, the transoral spine surgery did not seem to be a considerable risk for SSI in the analyzed cohort, provided preventive perioperative multimodal management is properly individualized and followed.
- MeSH
- chirurgická rána * MeSH
- dospělí MeSH
- infekce chirurgické rány epidemiologie etiologie MeSH
- kohortové studie MeSH
- křehkost * MeSH
- lidé MeSH
- mladiství MeSH
- retrospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Článek má za cíl diskutovat vliv vitaminu D na primární a sekundární prevenci zlomenin a jeho vliv na stavy po vybraných ortopedických výkonech. Zlomeniny můžeme podle příčiny vzniku rozdělit na úrazové (traumatické), únavové a patologické. Jednou z komplikací zlomenin je tvorba pakloubu (nesrůst kosti). Kromě řešení zlomenin je velmi častým výkonem v ortopedii i totální náhradu kloubu. Jelikož i nedostatečná svalová síla může vést k riziku pádu, a dojít tak ke zlomenině, budou v článku tato témata také zmíněna. Vzhledem k dopadu nedostatku vitaminu D na různé poruchy pohybového aparátu by si ortopedičtí chirurgové měli u pacienta stále více všímat stavu vitaminu D a obeznámit se s různými strategiemi prevence hypovitaminózy D, ačkoliv jasná doporučení medicíny založená na důkazech v této oblasti jsou stále insuficientní.
The article discusses the effect of vitamin D on primary and secondary prevention of fractures and its effect on conditions after selected orthopaedic procedures. Fractures can be divided into traumatic, fatigue and pathological according to the cause. One of the complications of fracture is the formation of a nonunion. In addition to dealing with fractures, a total joint replacement is another common procedure in orthopaedic surgery. Because insufficient muscle strength can increase the risk of falls and thus result in a fracture, these topics are also mentioned in this article. Due to the impact of vitamin D deficiency on various musculoskeletal disorders, orthopaedic surgeons should pay more attention to the patient’s vitamin D status and be familiar with different strategies for preventing hypovitaminosis D, although clear evidence-based medical recommendations are still insufficient.
- MeSH
- artroplastiky kloubů MeSH
- fraktury kostí prevence a kontrola terapie MeSH
- lidé MeSH
- nedostatek vitaminu D MeSH
- osteoporóza etiologie MeSH
- pooperační péče MeSH
- vitamin D * terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Surgical site infection (SSI) is a risk in every operation. Infections negatively impact patient morbidity and mortality and increase financial demands. The aim of this study was to analyse SSI and its risk factors in patients after thoracic or lumbar spine surgery. METHODS: A six-year single-centre prospective observational cohort study monitored the incidence of SSI in 274 patients who received planned thoracic or lumbar spinal surgery for degenerative disease, trauma, or tumour. They were monitored for up to 30 days postoperatively and again after 1 year. All patients received short antibiotic prophylaxis and stayed in the eight-bed neurointensive care unit (NICU) during the immediate postoperative period. Risk factors for SSI were sought using multivariate logistic regression analysis. RESULTS: We recorded 22 incidences of SSI (8.03%; superficial 5.84%, deep 1.82%, and organ 0.36%). Comparing patients with and without SSI, there were no differences in age (p=0.374), gender (p=0.545), body mass index (p=0.878), spine diagnosis (p=0.745), number of vertebrae (p=0.786), spine localization (p=0.808), implant use (p=0.428), American Society of Anesthesiologists (ASA) Score (p=0.752), urine catheterization (p=0.423), drainage (p=0.498), corticosteroid use (p=0.409), transfusion (p=0.262), ulcer prophylaxis (p=0.409) and diabetes mellitus (p=0.811). The SSI group had longer NICU stays (p=0.043) and more non-infectious hospital wound complications (p<0.001). SSI risk factors according to our multivariate logistic regression analysis were hospital wound complications (OR 20.40, 95% CI 7.32-56.85, p<0.001) and warm season (OR 2.92, 95% CI 1.03-8.27, p=0.044). CONCLUSIONS: Contrary to the prevailing literature, our study did not identify corticosteroids, diabetes mellitus, or transfusions as risk factors for the development of SSI. Only wound complications and warm seasons were significantly associated with SSI development according to our multivariate regression analysis.
- MeSH
- bederní obratle chirurgie MeSH
- časové faktory MeSH
- délka pobytu MeSH
- hrudní obratle chirurgie MeSH
- incidence MeSH
- infekce chirurgické rány epidemiologie etiologie prevence a kontrola MeSH
- kontrola infekce MeSH
- lidé MeSH
- logistické modely MeSH
- multivariační analýza MeSH
- ortopedické výkony škodlivé účinky metody MeSH
- pooperační komplikace epidemiologie etiologie prevence a kontrola MeSH
- prospektivní studie MeSH
- rizikové faktory MeSH
- roční období * MeSH
- vysoká teplota MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Most cardiac surgery patients undergo median sternotomy during open heart surgery. Sternotomy healing is an arduous, very complex, and multifactorial process dependent on many independent factors affecting the sternum and the surrounding soft tissues. Complication rates for median sternotomy range from 0.5 to 5%; however, mortality rates from complications are very variable at 7-80%. Low calcidiol concentration below 80 nmol/L results in calcium absorptive impairment and carries a risk of bone loss, which is considered as a risk factor in the sternotomy healing process. The primary objective of this clinical trial is to compare the incidence of all postoperative sternotomy healing complications in two parallel patient groups administered cholecalciferol or placebo. The secondary objectives are focused on general patient recovery process: sternal bone healing grade at the end of the trial, length of hospitalization, number of days spent in the ICU, number of days spent on mechanical lung ventilation, and number of hospital readmissions for sternotomy complications. METHODS: This clinical trial is conducted as monocentric, randomized, double-blind, placebo-controlled, with planned enrollment of 600 patients over 4 years, approximately 300 in the placebo arm and 300 in the treatment arm. Males and females from 18 to 95 years of age who fulfill the indication criteria for undergoing cardiac surgery with median sternotomy can be included in this clinical trial, if they meet the eligibility criteria. DISCUSSION: REINFORCE-D is the first monocentric trial dividing patients into groups based on serum calcidiol levels, and with dosing based on serum calcidiol levels. This trial may help to open up a wider range of postoperative healing issues. TRIAL REGISTRATION: EU Clinical Trials Register, EUDRA CT No: 2016-002606-39 . Registered on September 8, 2016.
- MeSH
- hojení ran MeSH
- kardiochirurgické výkony * škodlivé účinky MeSH
- lidé MeSH
- pooperační komplikace etiologie prevence a kontrola MeSH
- sternotomie * škodlivé účinky MeSH
- vitamin D škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
