Infekční endokarditida představuje velmi závažné onemocnění s možnými kardiálními i extrakardiálními vzdálenými komplikacemi. Výpočetní tomografie i magnetická rezonance hrají v současnosti zásadní roli v diagnostice i sledování komplikací či efektu terapie a jsou součástí doporučení Evropské i Americké kardiologické společnosti pro tuto problematiku. Článek obsahuje základní teoretické informace o infekční endokarditidě od rizikových faktorů, patogenů, přes klinický obraz až po diagnostiku. Dále je uvedeno šest kazuistik s typickou anamnézou a ilustrativním nálezem na vyšetřeních na výpočetní tomografii a jeden z případů představuje extrakardiální intrakraniální komplikace na magnetické rezonanci.
Infective endocarditis is a very serious disease with possible cardiac and extracardiac distant complications. Computed tomography and magnetic resonance imaging currently play an essential role in diagnosis and monitoring of complications or the effect of therapy, and are part of the recommendations of the European and American Society of Cardiology for this issue. The article contains basic theoretical information about infective endocarditis, from risk factors, pathogens, through the clinical picture to diagnostics. Furthermore, six case reports with a typical history and illustrative findings on computed tomography examinations are presented, and one of the cases presents extracardiac intracranial complications on magnetic resonance imaging.
BACKGROUND: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure. METHODS: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group. RESULTS: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years. CONCLUSION: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.
- MeSH
- dávka záření MeSH
- dospělí MeSH
- fluoroskopie metody MeSH
- ganglion trigeminale chirurgie diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- neuralgie trigeminu * chirurgie diagnostické zobrazování radioterapie MeSH
- počítačová rentgenová tomografie * metody MeSH
- radiační expozice * prevence a kontrola MeSH
- retrospektivní studie MeSH
- rizotomie * metody MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND/AIM: Patients with unresectable liver colorectal cancer metastases are treated with neoadjuvant chemotherapy often accompanied by biological therapy aimed at reducing the mass of metastases and thus increasing the chances of resectability. Bevacizumab comprises an anti-VEGF (vascular endothelial growth factor) humanized IgG monoclonal antibody that is used for biological therapy purposes. It acts to inhibit angiogenesis, thereby slowing down the growth of metastases. Due to its being administered systematically, bevacizumab also exerts an effect on the surrounding healthy liver parenchyma and potentially limits the process of neovascularization and thus regeneration of the liver. Since the remnant liver volume forms an important factor in postoperative morbidity and mortality following a major hepatectomy, we decided to study the effect of bevacizumab on vascular and biliary microarchitecture in healthy liver parenchyma and its ability to regenerate following major hepatectomy. MATERIALS AND METHODS: We performed an experiment employing a large animal model where a total of 16 piglets were divided into two groups (8 piglets in the control group and 8 piglets in the experimental group with bevacizumab). All the animals were subjected to major hepatectomy and the experimental group was given bevacizumab prior to hepatectomy. All the animals were sacrificed after 4 weeks. We performed biochemical analyses at regular time intervals during the follow-up period. Histological examination of the liver tissue was performed following sacrifice of the animals. RESULTS: No statistical difference was shown between groups in terms of the biochemical and immunohistochemical parameters. The histological examination of the regenerating liver tissue revealed the higher length density of sinusoids in the experimental group. CONCLUSION: Bevacizumab does not act to impair liver regeneration following hepatectomy.
- MeSH
- bevacizumab farmakologie terapeutické užití MeSH
- hepatektomie MeSH
- humanizované monoklonální protilátky farmakologie terapeutické užití MeSH
- kolorektální nádory * farmakoterapie patologie chirurgie MeSH
- lidé MeSH
- modely nemocí na zvířatech MeSH
- nádory jater * farmakoterapie sekundární chirurgie MeSH
- patologická angiogeneze farmakoterapie MeSH
- prasata MeSH
- regenerace jater MeSH
- vaskulární endoteliální růstový faktor A MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Mixed neuroendocrine-non-neuroendocrine tumors (MINEN) of the gallbladder are extremely rare; indeed, the English expert literature reports a mere handful of case reports and case series on this topic. According to the WHO classification of 2010, MINEN are considered to be tumors consisting of two major components, neuroendocrine and non-neuroendocrine, each of which hosts at least 30% of the total cellular population. To date, the etiology and pathogenesis of MINEN have not been precisely determined and the non-specific symptoms generally result in late diagnosis (mainly in the terminal stages of the condition) and contribute to the generally poor prognosis. As far as the management of the disease is concerned, radical surgery plays a crucial role; however, the significance of surgical debulking and biological therapy applying somatostatin analogues has not yet been determined. CASE PRESENTATION: A 56-year-old female was referred to our department for a rapidly progressing tumor in the subhepatic area along with the infiltration of S5 and S6 liver segments. With regard to preoperative findings, the tumor appeared as operable, although, during the surgery, an extensive involvement of the hepatoduodenal ligament by the tumor through the lymph nodes was revealed. Due to acute perioperative bleeding from the necrotic tumor, we decided to perform modified resection. Histologically, the tumor was confirmed as MINEN of gallbladder, where the neuroendocrine component was dominant over the non-neuroendocrine component. Six weeks after the discharge, the patient underwent a follow-up CT revealing large recurrence of the disease. Thereafter, the patient was started on systemic therapy with etoposide and carboplatin in combination with somatostatin analogues. Thirteen months after the surgery, the patient is in good clinical condition, and while a recently performed PET/MRI scan revealed a hepatic lesion and hilar lymphadenopathy in full regression, there was a spread of small peritoneal and pleural metastases. The patient remains in the follow-up care. CONCLUSIONS: The occurrence of mixed neuroendocrine-non-neuroendocrine neoplasms is extremely rare. Radical surgery remains the only potentially effective approach to the cure of this disease. The role of biological therapy and debulking in the management of the disease has not yet been precisely defined. In our experience, both of these methods have the potential to positively influence overall survival rates and the postoperational quality of life of patients.
- MeSH
- cholecystektomie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru diagnostické zobrazování terapie MeSH
- maligní smíšený nádor diagnóza patologie terapie MeSH
- nádory žlučníku diagnóza patologie terapie MeSH
- neuroendokrinní karcinom diagnóza patologie terapie MeSH
- počítačová rentgenová tomografie MeSH
- protokoly protinádorové kombinované chemoterapie terapeutické užití MeSH
- výsledek terapie MeSH
- žlučník diagnostické zobrazování patologie chirurgie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Výsledek léčby zlomeniny proximálního femuru vedle standardně provedeného operačního výkonu závisí na dalších faktorech. Po předoperačním vyšetření má na vývoj stavu pacienta vliv časnost operačního zákroku. Standardní součástí léčby zlomeniny proximálního femuru je prevence infekce a trombózy. Z hlediska pooperačního vývoje je vhodá svodná anestezie.. Zlomeniny krčku femuru jsou podle dislokace, věku a celkového stavu pacienta řešeny chirurgicky osteosyntézou, implantací totální endoprotézy nebo cervikokapitální endoprotézy. Zlomeniny pertrochanterické, intertorchanterické a subtrochanterické jsou řešeny osteosyntézou dynamickým skluzným šroubem nebo nitrodřeňovým implantátem. Součástí péče o pacienty se zlomeninou proximálního femuru je rehabilitační léčba a řešení sociální otázky. Zhodnocení rizika vzniku další zlomeniny a doporučení sekundární prevence zlomeniny u pacientů po zlomenině horního konce stehenní kosti by mělo být též nedílnou součástí léčby.
In addition to standard surgical procedure, the success of treatment of proximal femoral fracture is influenced by further factors. The sooner surgery is carried out following a preoperative medical examination, the greater the rate of patient improvement. Prevention of infection and thrombosis is a standard part of treatment of proximal femoral fractures. As a factor in improving a patient's postoperative development, local anesthesia is preferable. Femoral neck fractures are treated surgically by osteosynthesis, total hip arthroplasty or hemiarthroplasty, depending on the degree of fracture dislocation, as well the patient's age and condition. Intertrochanteric and subtrochanteric fractures are treated by osteosynthesis by dynamic hip screw or intramedullary implant. In the treatment of patients with proximal femoral fractures, it is also important to look at rehabilitation treatment and the patient's social situation. Evaluating the risk of future fractures, recommending secondary fracture prevention in patients with proximal femoral fracture should be an integral part of treatment.
- MeSH
- algoritmy MeSH
- anestezie metody využití MeSH
- financování organizované MeSH
- fraktury femuru chirurgie terapie MeSH
- fraktury kyčle chirurgie terapie MeSH
- lidé MeSH
- medicína založená na důkazech trendy MeSH
- náhrada kyčelního kloubu metody MeSH
- ortopedické výkony metody využití MeSH
- pooperační péče metody rehabilitace MeSH
- předoperační péče metody využití MeSH
- sekundární prevence metody MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY The treatment of femoral neck fractures shows a relatively high number of poor outcomes, usually due to late complications, such as avascular necrosis of the femoral head or pseudoarthrosis. The latter may develop when the osteosynthesis of osteoporotic bone fails. The aim of this retrospective study was to evaluate a group of patients treated by osteosynthesis for intra-capsular femoral neck fractures at our department, and to verify indication criteria and identify the therapeutic procedures that are best suited to our conditions. MATERIAL In the 1997-2001 period, a total of 81 patients with intra-capsular femoral neck fractures were operated on. Of these, 64 treated by dynamic hip screw (DHS) fixation were followed up for at least 5 years. There were 33 women and 31 men; the average age was 21.5 years (range, 21 to 74 years). METHODS The Garden classification was used to evaluate the displacement of femoral neck fractures. Preferably, osteosynthesis was carried out by closed reduction; only exceptionally was an extension device for the operating table used. A 135-degree sliding hip screw, with a short thread, directed to the head centre and a two-hole side plate were used most often. The average follow-up was 6.9 years. Evaluated were: the occurrence of late complications in relation to the length of time between injury and surgery, quality of fracture reduction, use of an anti-rotation screw and necessity of repeat surgery. RESULTS Garden I or II fractures were diagnosed in 13 patients, 51 had Garden III or Garden IV fractures. Bone union without complications was achieved in 73.4 % of the patients within 12 months of surgery. Late complications were found in 26.6 %; of these, only one had Garden I fracture and the rest were Garden III and IV fractures. An anti-rotation screw was used in 39 patients (60.9 %) and its use had no effect on the development of late complications. Of the seven patients who developed pseudoarthrosis, the screw was used in four (57.1%); out of the nine patients with avascular necrosis, it was used in six (66.7 %). In the whole group, an unsatisfactory outcome of post-operative reduction was recorded in 29.7 %. In the patients with late complications this was found in 52.9 %, which was a statistically significant difference. Of the 17 patients with poor outcomes, 14 underwent total hip arthroplasty; in the patients with necrosis, arthroplasty was carried out at an average of 26 months post-operatively, in those with pseudoarthrosis it was at 7 months post-operatively. DISCUSSION For the treatment of intra-capsular fractures of the femoral neck, surgery is the most frequent approach, but there are controversial views on various relevant issues. An important factor affecting the treatment outcome is the patient?s bone quality. CONCLUSIONS Our results show a direct relationship between the extent of fracture displacement and late complications, i.e., avascular necrosis and non-union. The quality of fracture reduction had a greater effect on fracture non-union than on the development of femoral head necrosis. The length of time between injury and surgery played a lesser role than it is believed. The use of an anti-rotation screw was not significantly related to the occurrence of late complications. The DHS method is economical and available, and provided sufficient results whose comparisons with the literature data show that this therapeutic approach is correct.
- MeSH
- dospělí MeSH
- femur radiografie MeSH
- fraktury krčku femuru chirurgie patologie radiografie MeSH
- kostní šrouby MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
Traumatic obturator dislocation of the hip without fracture associated with antero-lateral knee dislocation is considered to be an extreme injury. Such a case, which has never been treated in our department, is reported here. The patient was a 40-year-old man who suffered his injury in a motorcycle accident. He had ipsilateral traumatic obturator hip dislocation and anterior knee dislocation. Within two hours of injury dislocation reduction was carried out under general anaesthesia, the anterior cruciate ligament was reconstructed using BTB allograft and a CT scan was obtained. In this type of trauma CT-angiography is always indicated to detect any possible threat to limb vitality. The functional results were excellent and were directly dependent on the correct use of arthroscopy. At 3 years post-operatively, his hip and knee joints were examined. The Harris hip score was 98 points and the International Knee Documentation Score (IKDC) was also excellent. There was no neurological deficit, although this type of trauma is usually associated with neurological complications. At the time of examination the patient was symptom free.
- MeSH
- dopravní nehody MeSH
- dospělí MeSH
- lidé MeSH
- luxace kolena chirurgie komplikace radiografie MeSH
- luxace kyčle chirurgie komplikace radiografie MeSH
- motocykly MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
