• MeSH
• antikoagulancia terapeutické užití   MeSH
• heparin aplikace a dávkování   terapeutické užití   MeSH
• incidence MeSH
• krvácení epidemiologie   prevence a kontrola   MeSH
• lidé MeSH
• náhrada kyčelního kloubu * škodlivé účinky   MeSH
• perioperační období MeSH
• pooperační komplikace * epidemiologie   prevence a kontrola   MeSH
• rizikové faktory MeSH
• totální endoprotéza kolene * škodlivé účinky   MeSH
• tromboembolie epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

Úvod: Cílem práce je určit přesné údaje o počtu poranění velkých cév v rámci traumatu pánve u souboru pacientů léčených v období 12 let. Metody: Sledovaný soubor tvořilo 715 pacientů léčených pro zlomeninu pánve v letech 2001–2012. Z databáze pacientů byly vybrané údaje o peroperačních nebo pitevních nálezech poranění velkých cév (aorta, dolní dutá žíla, a. et v. iliaca communis). Statistická významnost dosažených výsledků byla testována pomocí kontingenčních tabulek (chí-kvadrát test nezávislosti, Fischerův faktoriálový test). Hladina významnosti pro počítané testy byla zvolena 5%. Výsledky: V prvních hodinách po úrazu zemřelo 66 (9 %) pacientů sledovaného souboru, z toho 43 (6 %) před provedením operační revize. Časně bylo revidováno 70 (10 %) pacientů, 47 (7 %) z nich přežilo a 23 (3 %) se nepodařilo zachránit. Život ohrožující cévní poranění v oblasti pánve bylo zaznamenáno u 13 (2 %) pacientů. U přeživších revidovaných pacientů bylo nalezeno pouze jednou závažné poranění pánevních venózních plexů jako jediný zdroj krvácení (2 %), zatímco u nepřeživších revidovaných a u pitvaných pacientů bylo závažné poranění cév zaznamenáno u 5 resp. 7 z nich (22 % resp. 41 %) a tento rozdíl byl v obou případech proti přeživším signifikantně vyšší (p=0,0002 resp. p=0,0109). Závěr: Výskyt poranění velkých cév s život ohrožujícím krvácením jako součásti pánevního traumatu nebyl vysoký, avšak riziko úmrtí pacienta s tímto poraněním bylo signifikantně vyšší. Skutečnost, že poranění velké tepny či žíly v kombinaci s masivním krvácením ze žilních pletení při dislokované zlomenině pánve vede u většiny zraněných k úmrtí ještě před příjezdem záchranné služby, je obtížné prokázat. Domníváme se však, že údaje týkající se našeho souboru pacientů umožňují alespoň formulovat tuto hypotézu.

Introduction: The aim of the study was to provide accurate data regarding the incidence of large vessel injury as part of pelvic trauma in patients treated during a 12–year period. Methods: In total, 715 patients admitted and treated for pelvic fractures from 2001-2012 were analyzed. Data on large vessel injuries (aorta, inferior vena cava, common iliac artery and vein) reported in perioperative or autopsy findings were obtained from the patient database. The statistical significance of achieved results was tested using contingency tables (chi-square test of independence or Fisher factorial test). The significance level for the calculated tests was chosen to be 5%. Results: Sixty six (9%) patients died in the first hours after admission, 43 (6%) of them prior to surgery. Seventy (10%) underwent urgent surgeries, 47 (7%) of whom survived and 23 (3%) died. A large vessel injury in the pelvic region was detected in 13 (2%) patients. In the surviving surgical patients, a serious injury of pelvic venous plexus, as the only source of bleeding, was found only once (2%), while in patients who deceased post-surgically and pre-surgically, serious vascular injury in the pelvic region was diagnosed in 5 and 7 patients in both subgroups (22% and 41%, resp.). This difference was significantly higher in comparison with surviving patients (p=0.0002 and p=0.0109, resp.). Conclusion: The incidence of large vessel injury with severe bleeding associated with pelvic trauma was low in our study; however, the risk of death in patients with this injury was significantly higher. The results of our study support the hypothesis that in most patients a large artery or vein injury in combination with massive bleeding from the venous plexus due to a dislocated pelvic fracture results in death even before arrival of emergency services. This hypothesis could be verified in a study including also autopsy findings in persons who died even before hospital admission.

• MeSH
• analýza přežití MeSH
• cévy * zranění   MeSH
• fraktury kostí * chirurgie   krev   MeSH
• krvácení mortalita   MeSH
• lidé MeSH
• pánev * chirurgie   krevní zásobení   zranění   MeSH
• pitva MeSH
• příčina smrti MeSH
• Check Tag
• lidé MeSH

INTRODUCTION: The study objective was to ascertain the incidence of bleeding and ischemic complications related to acute and planned orthopedic surgery in patients with known cardiovascular diseases. MATERIALS AND METHODS: The study conducted between 2010 and 2013 enrolled 477 patients (289 women, 188 men) with a diagnosed cardiovascular disease or a history of thromboembolic event. Aside from gender, age, height and weight, the study observed other anamnestic data and perioperative laboratory test results that may impact on a bleeding or ischemic event. RESULTS: Two hundred seventy-two (57 %) patients had acute surgery, and 205 (43 %) patients had elective surgery. Complications arose in 55 (11.6 %) patients, 32 (6.9 %) had bleeding complications, 19 (4.0 %) ischemic complications, and both complications were experienced by 4 (0.8 %) patients. Bleeding developed in 14 (5.1 %) patients who had acute surgery, and in 22 (10.7 %) who had elective surgery. Twenty-two (8.1 %) patients having acute surgery and one (0.1 %) undergoing elective surgery suffered from ischemic complications. The incidence of bleeding complications was significantly higher in elective surgery (p = 0.026, OR 2.22), and when adjusted (general anaesthesia, gender, and use of warfarin), the difference was even higher (p = 0.015, OR 2.44), whereas the occurrence of ischemic complications was significantly higher in acute surgery (p = 0.005, OR 18.0), and when adjusted (age), the difference remained significant (p = 0.044, OR 8.3). CONCLUSIONS: The study noted a significantly higher incidence of bleeding complications in elective orthopedic surgery when compared with acute surgery. Conversely, the incidence of ischemic complications was significantly higher in patients having acute orthopedic surgery when compared with those operated on electively.

• MeSH
• dospělí MeSH
• elektivní chirurgické výkony škodlivé účinky   MeSH
• incidence MeSH
• ischemie epidemiologie   etiologie   MeSH
• kardiovaskulární nemoci komplikace   chirurgie   MeSH
• krvácení epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ortopedické výkony škodlivé účinky   MeSH
• pooperační komplikace epidemiologie   MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

PURPOSE OF THE STUDY The aim of the study was to compare the duration of corrective surgery for scoliosis in relation to the intra-operative use of either fluoroscopic or CT navigation. MATERIAL AND METHODS The indication for surgery was adolescent idiopathic scoliosis in younger patients and degenerative scoliosis in middleage or elderly patients. In a retrospective study, treatment outcomes in 43 consecutive patients operated on between April 2011 and April 2014 were compared. Only patients undergoing surgical correction of five or more spinal segments (fixation of six and more vertebrae) were included. RESULTS Transpedicular screw fixation of six to 13 vertebrae was performed under C-arm fluoroscopy guidance in 22 patients, and transpedicular screws were inserted in six to 14 vertebrae using the O-arm imaging system in 21 patients. A total of 246 screws were placed using the C-arm system and 340 screws were inserted using the O-arm system (p < 0.001). The procedures with use of the O-arm system were more complicated and required an average operative time longer by 48% (measured from the first skin incision to the completion of skin suture). However, the mean time needed for one screw placement (the sum of all surgical procedures with the use of a navigation technique divided by the number of screws placed using this technique) was the same in both techniques (19 min). DISCUSSION With good teamwork (surgeons, anaesthesiologists and a radiologist attending to the O-arm system), the time required to obtain one intra-operative CT scan is 3 to 5 minutes. The study showed that the mean time for placement of one screw was identical in both techniques although the average operative time was longer in surgery with O-arm navigation. The 19- minute interval was not the real placement time per screw. It was the sum of all operative times of surgical procedures (from first incision to suture completion including the whole approach within the range of planned stabilization) which used the same navigation technique divided by the number of all screws inserted during the procedures. The longer average operative time in procedures using O-arm navigation was not related to taking intra-operative O-arm scans. The authors consider surgery with an O-arm imaging system to be a safer procedure and use it currently in surgical correction of scoliosis. CONCLUSIONS The study focused on the length of surgery to correct scoliosis performed using either conventional fluoroscopy (C-arm) or intra-operative CT scanning (O-arm) showed that the mean placement time for one screw was identical in both imaging techniques when six or more vertebrae were stabilised. The use of intra-operative CT navigation did not make the surgery longer, and the higher number of inserted screws provides evidence that this technique is safer and allows us to achieve good stability of the correction procedure. Key words: virtual CT guidance, O-arm, scoliosis, transpedicular screw.

• MeSH
• chirurgie s pomocí počítače přístrojové vybavení   metody   MeSH
• délka operace MeSH
• fluoroskopie přístrojové vybavení   metody   MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• ortopedické fixační pomůcky * MeSH
• peroperační péče MeSH
• počítačová rentgenová tomografie přístrojové vybavení   metody   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• skolióza diagnostické zobrazování   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Prospective registry of all consecutive cardiac patients undergoing non-cardiac surgery. Patients have to meet all three inclusion criteria: (1) Any kind of non-cardiac surgery (acute or elective) performed under general or neuroaxial anaesthesia in three surgical departments - General surgery, Orthopedics-Trauma and Neurosurgery. (2) History of cardiac disease with risk of arterial, intracardiac or vein thrombosis or embolism. (3) Signed Informed consent. All operated patients who meet the inclusion criteria will be enrolled, i.e. all consecutive cardiacs, who signed Informed consent. Inclusion of cca 2000 - 3000 patients is expected. Baseline clinical indicators, chronic and perioperative medication, ECG, echocardiography, laboratory tests and all complications (especially ischemic and bleeding) will be registered. The second phase (randomized study) will include cca 1000 patients. Inclusion/exclusion criteria will be defined on the basis of results of the first phase.

Prospektivní registr všech konsekutivních kardiaků, postupujících nekardiální chirurgický výkon: pacienti musí splnit všechna tři vstupní kriteria: (1) Jakákoli operace (elektivní nebo akutní) v celkové nebo v neuroaxiální anestezii, prováděná na Chirurgické, Ortopedické nebo Neurochirurgické klinice. (2) Anamneza kardiovaskulárního onemocnění s rizikem arteriální, intrakardiální či žilní trombozy nebo embolie. (3) Podepsaný informovaný souhlas. Zařazeni budou všichni nemocní, splňující vstupní kriteria, tj. všichni operovaní kardiaci, kteří podepsali informovaný souhlas. Předpokládáme zařazení 2000 až 3000 nemocných. Budou sledovány základní klinické ukazatele, chronická i perioperační medikace, EKG, echokardiografie, laboratoř a samozřejmě veškeré komplikace (zejména ischemické a krvácivé). Ve 2. fázi (randomizovaná studie) předpokládáme zařazení cca 1000 nemocných. Vstupní / vylučovací kriteria pro tuto fázi budou definována na základě výsledků 1. fáze.

• MeSH
• inhibitory agregace trombocytů MeSH
• kardiovaskulární nemoci MeSH
• koronární trombóza MeSH
• krvácení při operaci MeSH
• multivariační analýza MeSH
• nemoci koronárních tepen MeSH
• onemocnění periferních arterií komplikace   MeSH
• peroperační komplikace MeSH
• rizikové faktory MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• chirurgie
• kardiologie
• farmacie a farmakologie
• NLK Publikační typ
• závěrečné zprávy o řešení grantu IGA MZ ČR

• Publikační typ
• abstrakt z konference MeSH

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• acetabulum * MeSH
• fraktury kostí MeSH
• pánev * zranění   MeSH
• statistika jako téma MeSH
• Check Tag
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• abstrakt z konference MeSH

PURPOSE OF THE STUDY The patients with pelvic ring injury involve two groups: 1) young and middle-age persons, mostly men, with serious injury to the pelvic ring due to high-energy trauma; and 2) older patients, mostly women, with osteoporotic fractures due to a simple fall. The aim of this study was to show significant differences in the selected epidemiological characteristics between these two groups. MATERIAL AND METHODS The group comprised 225 patients older than 15 years with pelvic fractures who were treated between January 1, 2007, and December 31, 2009. In this retrospective descriptive study, the patients' data on age, gender, mechanism of injury and a type of fracture according to the AO classification were retrieved and analysed. Categorical data at a level of significance of 5% were compared using the Chi-square test. RESULTS In the group reviewed there were 113 women and 112 men, with an average age of 51 years (women, 53 years; men, 49 years) in the range of 15 to 95 years. More men than women were in the age range of 15 to 60 years (with the difference being significant only in the sixth decade of life; p=0.043). In the age category of over sixty, women outnumbered men, and this was significant in the eight and ninth decades (p=0.023 and p=0.04, respectively). Significantly more men were involved in motorbike accidents (p=0.047) or had falls from heights (p=0.004) and particularly those at a worksite (p<0.001). Fractures due to a simple fall were significantly more frequent in women than men (p<0.001) and, generally, were most often found in the old-age category, in which women were eight years senior to men. Type A fractures were found in 58, type B fractures in 140 and type C fractures in 27 patients. The most frequent fractures (A2.2, p=0.054; B2.1, p=0.038) occurred more often in women and at a much higher age than in men (the age difference was 15 years in type A2.2 fractures and "only" 7 years in type B2.1 fractures). The patients who sustained either of these fractures in a simple fall were about 35 years older than those in whom these fractures were caused by high-energy trauma. DISCUSSION The fact that pelvic injuries most often occur in men at young or middle age has been confirmed by several epidemiological studies with a conclusion that age-related risky male behaviours play a significant role. The findings of this study showed that pelvic fractures due to simple falls were mostly found in old-age patients, with women eight years older than men. This provides evidence for the existence of two distinct groups of patients with pelvic fractures. The existence of two epidemiologically different groups of patients with pelvic fractures, in the authors' opinion, is demonstrated by a correlation of AO fracture type, patient gender and age in each group. A mere comparison of the age of patients indicates that older patients had mostly type A and B fractures. Unilateral fractures of the pubic ramus after a simple fall, which are regarded as related to osteoporosis, were recorded in a significantly higher number of women of the oldest age. The authors suggest that epidemiological studies of pelvic injuries should use the age of 70+ as an exclusion criterion in the patients with type A2.2 and B2.1 fractures. This will remove the bias of epidemiological data on patients with severe pelvic injuries, resulting from involvement of patients with osteoporotic fractures. CONCLUSION The evaluation of epidemiological data in this study allows us to conclude that younger men are those most frequently sustaining pelvic injuries due to high-energy trauma and that old age (80+) is characteristic for patients of both sexes, with female sex predominance, who have fractures due to simple falls. These findings give support to the concept that, in a group of patients with pelvic injuries, a subgroup with fractures different in terms of epidemiology and aetiology (osteoporotic fracture) can be identified.

• MeSH
• dospělí MeSH
• epidemiologické metody MeSH
• financování organizované MeSH
• fraktury kostí epidemiologie   etiologie   klasifikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pánevní kosti zranění   MeSH
• rozložení podle pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sportovní úrazy epidemiologie   etiologie   MeSH
• úrazy pádem MeSH
• věkové rozložení MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• časové faktory MeSH
• lidé MeSH
• popálení komplikace   MeSH
• sepse MeSH
• septický šok etiologie   MeSH
• Check Tag
• lidé MeSH