Background: Femoroacetabular impingement syndrome (FAI) is a complex, often post-traumatically developing impairment of the hip joint. It is characterized by ambiguous symptomatology, which makes early diagnosis difficult. Aim: The study was conducted to evaluate the applicability of a triaxial gyroscopic sensor in routine practice as an additional indication criterion for operative versus conservative treatment procedures. Methods: Ninety-two patients were included in the experimental retrospective study and 62 completed the examination. All patients signed informed consent. A gyroscopic sensor was placed on the right side of the pelvis above the hip joint and patients walked approximately 15 steps. Data were also evaluated while the patients climbed stairs. A complete clinical examination of the dynamics and physiological movements in the joint was performed. The data measured by the gyroscopic sensor were processed using differential geometry methods and subsequently evaluated using spectral analysis and neural networks. Results: FAI diagnosis using gyroscopic measurement is fast and easy to implement. Our approach to processing the gyroscopic signals used to detect the stage of osteoarthritis and post-traumatic FAI could lead to more accurate detection and capture early in FAI development. Conclusions: The obtained data are easily evaluated, interpretable, and beneficial in the diagnosis of the early stages of FAI. The results of the study show that this approach can lead to more accurate and early detection of osteoarthritis and post-traumatic FAI.
- MeSH
- analýza chůze metody MeSH
- biomechanika * MeSH
- femoroacetabulární impingement * chirurgie diagnóza patofyziologie MeSH
- kyčelní kloub patofyziologie MeSH
- lidé MeSH
- nositelná elektronika * MeSH
- osteoartróza diagnóza patofyziologie MeSH
- retrospektivní studie MeSH
- telemedicína metody MeSH
- umělá inteligence MeSH
- Check Tag
- lidé MeSH
ERAS (enhanced recovery after surgery) představuje komplexní strategii zaměřenou na urychlení rekonvalescence, redukci komplikací a optimalizaci pooperační péče. Protokol ERAS se skládá z doporučení pro předoperační, perioperační a pooperační fázi péče o pacienty. Implementace ERAS protokolu přináší řadu benefitů, a to jak pro pacienty, tak pro zdravotnický systém. Zkracuje dobu hospitalizace, snižuje počet a závažnost pooperačních komplikací a zlepšuje kvalitu života pacientů. Tyto faktory vedou k úspoře nákladů na zdravotní péči a zefektivnění obratu pacientů na lůžkách (tzv. obložnost). Důsledné dodržování protokolu ERAS je klíčové pro dosažení optimálních výsledků. Komplexní strategie ERAS tak představuje historický zlom v perioperační péči a stává se nezbytným standardem v chirurgii jater a slinivky břišní.
ERAS (enhanced recovery after surgery) represents a comprehensive strategy aimed at expediting patient recovery, reducing complications, and optimizing postoperative care. The ERAS protocol encompasses recommendations for the preoperative, perioperative, and postoperative phases of patient care. Implementation of the ERAS protocol yields a multitude of benefits for both patients and the healthcare system. It shortens hospital stays, diminishes the number and severity of postoperative complications, and enhances patient’s quality of life. These factors contribute to healthcare cost savings and improved bed turnover efficiency. Rigorous adherence to the ERAS protocol is paramount to achieving optimal outcomes. The comprehensive ERAS strategy thus marks a paradigm shift in perioperative care and emerges as an indispensable standard in liver and pancreatic surgery.
OBJECTIVES: Although sarcopenia is recognized as one of the risk factors for increased morbidity after resection for colorectal cancer, the question of the most appropriate way to identify and quantify it is still unresolved. MATERIAL AND METHODS: This is a retrospective unicentric study following patients undergoing elective resection of the rectum for carcinoma with available staging computed tomography (CT) of the trunk. Psoas muscle density (PMD) and its area relative to patient height psoas muscle index (PMI) at the level of inferior vertebral end plate of third lumbar vertebra (L3) were assessed using an initial staging CT scan of the trunk. Post-operative complications, evaluated according to the Clavien-Dindo classification, and blood samples on post-operative days (POD) 3 and 5 were also recorded in the study population. Patients were divided into groups with complicated and uncomplicated post-operative course, and observed parameters were then statistically compared. RESULTS: The correlation of PMI values with the development of post-operative complications was not confirmed in a data set of 206 patients. PMD values were found to be borderline statistically significant in patients with complicated post-operative course, while in the group of patients with severe complications (Clavien-Dindo III-IV), there was no statistically significant difference in PMI or PMD values. The same results were obtained when comparing patients with anastomotic leak (AL). It was confirmed that operations on the lower rectum are riskier for the development of post-operative complications. The secondary objective of our study regarding serum C-reactive protein (CRP) levels of 3rd and 5th POD gave us the answer in the form of cutoff values of 115.7 mg/L (3rd POD) and 76 mg/L (5th POD). CONCLUSION: PMD appears to be a promising tool for predicting post-operative morbidity in patients after rectal resection, but a clear consensus on the method of measurement, interpretation of results and cutoff values is needed. Lower rectal resections are burdened with a higher risk of post-operative complications, especially AL. Monitoring of CRP levels remains an important marker in the prediction of AL due to its negative predictive value.
- Publikační typ
- časopisecké články MeSH
Platelet-rich plasma (PRP) is presently employed across various medical disciplines, including surgical specialties. It is primarily used in the healing of chronic wounds, burn medicine, tissue regeneration support, and scar correction as well as in other surgical and orthopedic indications. Wounds, in general, possess a pro-inflammatory biochemical environment characterized by high protease activity that diminishes the effective concentration of growth factors. In contrast, PRP serves as a source of growth factors and exhibits mitogenic, angiogenic, and chemotactic properties. PRP is a biological product defined as a portion of the autologous blood's plasma fraction with a higher than physiological platelet concentration. PRP is obtained through the centrifugation of blood samples collected from patients. The insights into the biology, mechanism of action, and classification of PRP presented in this review can assist medical professionals in orienting themselves and comprehending the possibilities of the clinical application of this therapy, which remains a subject of investigation and validation. This review summarizes up-to-date information regarding the use of PRP, primarily in burn and reconstructive surgery, plastic surgery, traumatology, and general surgery.
- MeSH
- hojení ran * fyziologie MeSH
- lidé MeSH
- plazma bohatá na destičky * MeSH
- popálení chirurgie krev MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: In this experimental study, we aimed to determine whether platelet-rich plasma (PRP) is a suitable preservative for dermo-epidermal grafts. An additional objective was to investigate how long grafts can be stored without biological degradation. METHODS: We compared pig skin graft preservation using PRP versus saline solution and crystalloid Custodiol®, which is used for hypothermic preservation of organs for transplantation. Grafts (10 × 10 mm) were placed on gauze impregnated with one of the tested solutions, and stored for 3, 7, 11, and 15 days at a constant temperature of 4°C. We evaluated a total of 240 pig skin samples: 120 by histopathology and 120 by fluorescence optical microscopy. RESULTS: Overall, Custodiol® solution appeared to be the best medium for preservation of dermo-epidermal grafts, with beneficial properties manifested on days 7 and 11. Although we expected PRP to be a better preservative than saline, this was not confirmed by our results, as we found no significant difference between these two media. In fact, by day 3, the histopathological results were better with standard saline solution than with PRP. On day 15, with each tested solution, some samples showed histological changes that are incompatible with graft viability. CONCLUSION: Overall, Custodiol® appears to be the best medium for dermo-epidermal graft preservation. Moreover, the present findings suggest a maximum graft storage time of 11 days in all of the tested solutions. We do not recommend using grafts stored for 15 days, due to isolated signs of graft biodegradation with all solutions.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Blood loss during major abdominal surgery is an essential parameter in the evaluation of strategies aimed at reducing perioperative bleeding. However, blood loss quantification remains unreliable and inaccurate. The aim of this study was to compare several methods of blood loss quantification-visual estimation by surgeon and anesthesiologist, the gravimetric method, the calculation method with spectrophotometric measurement. The spectrophotometric measurement is considered as the most accurate method. METHODS: The study was designed as a prospective observational cohort single-center study. We analyzed 61 patients who underwent elective liver or pancreatic resection. The anesthesiologists' and surgeons' estimate of blood loss was based on a visual assessment. The gravimetric method was based on weighing the suction canister and surgical drapes before and after use. The basis of calculation method was anthropometric and hematological parameters, we used López-Picado's formula. The spectrophotometric method was based on the spectrophotometric determination of hemoglobin mass in the lost blood. We compared the methods using paired t-test, non-parametric Wilcoxon test and Bland-Altman analysis. RESULTS: Visual estimation by surgeons and anesthesiologists, gravimetric measurement, and calculation method were significantly different from spectrophotometric measurement at the significance level α = 0.05. All methods overestimated blood loss which was measured by spectrophotometric method. The estimate by surgeons was the closest to the spectrophotometric measurement, difference 68.7 ml (95% confidence interval [CI]: -129.3--8.2). CONCLUSIONS: We conclude that the estimate of blood loss by surgeons and anesthesiologists, as well as gravimetric method and calculation method are all significantly inaccurate in real surgical setting. We did not confirm the commonly accepted assumption that surgeons underestimate the blood loss. TRIAL REGISTRATION: The study was registered under the title " Blood Loss Quantification During Major Abdominal Surgery" at ClinicalTrials.gov with the registration number NCT05316649. Date of the first registration was 20/3/2022.
- MeSH
- břicho chirurgie MeSH
- chirurgové * MeSH
- krvácení při operaci MeSH
- lidé MeSH
- poporodní krvácení * MeSH
- prospektivní studie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
PURPOSE OF THE STUDY Femoroacetabular impingement syndrome is a complex, often post-traumatically developing impairment of the hip joint, characterized by ambiguous symptomatology, which makes early diagnosis diffi cult, especially in the early stages. Experimental retrospective study was carried out to evaluate the usability of a triaxial gyroscopic sensor in routine practice as an additional indication criterion for operative versus conservative treatment procedures. MATERIAL AND METHODS 92 patients were included in the retrospective study, and 62 completed the investigation. All patients signed informed consent. A gyroscopic sensor was placed on the right side of the pelvis above the hip joint, and the patients walked approximately 15 steps. Furthermore, an evaluation of the data during stair climbing and a complete clinical examination of the dynamics and physiological movements in the joint was carried out. Data measured with a gyroscopic sensor were processed using differential geometry methods and then evaluated using spectral analysis and neural networks. The proposed technique of diagnosing FAI using gyroscope measurement is a fast, easy-to-perform method. RESULTS Our approach in processing gyroscopic signals used to detect the stage of arthrosis and post-traumatically developing FAI could lead to more accurate early detection and capture in the early stages. CONCLUSIONS The obtained data are easily evaluated, interpretable and benefi cial in diagnosing the early stages of FAI. The results of the conducted research showed this approach to more accurate early detection of arthrosis and post-traumatically developing FAI. Key words: wearable sensors; osteoarthritis; mathematical biophysics; telemedicine.
PURPOSE OF THE STUDY This study aims to analyse a subpopulation of patients with severe haemorrhagic shock and a concurrent unstable pelvic ring fracture. MATERIAL AND METHODS This manuscript is a retrospective study of prospectively collected data on trauma patients over a period of 10 years, namely between 2010 and 2019. These patients, primarily (after injury) referred to the trauma centre of the University Hospital Hradec Králové, were diagnosed with an unstable pelvic ring fracture as a part of multiple injuries. RESULTS The total number of patients with a pelvic ring fracture and concurrent acute phase of decompensated haemorrhagic shock in the period from 2010 to 2019 was 112. After excluding 25 patients with AIS 4 and 5 (Abbreviated Injury Scale) severe head trauma and another two patients who died of late-stage SIRS (systemic infl ammatory response syndrome) complications, the group consisted of 85 patients. Subsequently, the subpopulation of patients "in extremis" evaluated by the study included a total of 22 patients with the baseline systolic pressure below 70 mm Hg and/or baseline haemoglobin level below 80 g/l. CONCLUSIONS Prior to the evaluation of this study population, our department had no single algorithm developed to treat such patients. Slow blood circulation stabilisation or death were usually associated with inadequate haemostatic algorithm. The patients leaving the operating room and being handed over to the ICU presented the signs of a decompensated shock. Oftentimes, the pelvis was merely stabilised, with no further intervention to stop the bleeding. The extraperitoneal pelvic packing was performed in very few cases only. The extravasation of contrast media during the initial CT scan does not necessarily have to be detected due to vasospasm or hypotension with reduced blood fl ow. In such cases, only the size of haematoma is a sign of arterial bleeding. It is also risky to rely solely on vasography when stopping the bleeding which will certainly fail to stop venous bleeding. However, venous bleeding always accompanies arterial bleeding. Stabilisation of both segments of the pelvis is essential to stop bleeding in haemodynamically unstable patients with a pelvic ring injury. It is followed by extraperitoneal pelvic packing and in the case of continuing haemodynamic instability also vasography, namely even if there is a negative fi nding of the initial CT scan or if no initial CT scan was performed. This procedure has become the core of our single haemostatic algorithm. Key words: pelvic ring injury, patients in extremis, haemostatic algorithm.
INTRODUCTION: Adhesions are the most common cause of long-term morbidity after abdominal surgery and most often cause various forms of intestinal passage disorders ranging from partial obstruction to complete, life-threatening intestinal obstruction. The aim of the present study was to evaluate the protective effect of intraperitoneally administered lipid emulsions on the formation of adhesions in larger animal model, as the lubricating effect of phospholipids and the mechanical barrier of the lipid component are combined with the anti-inflammatory effect of fish oil. METHODS: Thirty-one female domestic pigs were randomly divided into three groups. At the end of the surgical procedure, a lipid emulsion or saline solution was applied intraperitoneally. After 14 days, an independent macroscopic, histological and immunohistochemical evaluation of the adhesions were performed. RESULTS: Intraperitoneal administration of lipid emulsions significantly reduced the incidence of intra-abdominal adhesions. Microscopic examination demonstrated a significant reduction in the number of inflammatory elements and the amount of collagen in the adhesions, especially after administration of the fish oil-based emulsion. A simultaneous decrease in neovascularization was observed in the adhesions. Evaluation of the intestinal anastomosis did not reveal significant differences in healing between the groups. CONCLUSION: Intraperitoneal administration of lipid emulsions can reduce the development of postoperative intra-abdominal adhesions by the combined action of phospholipids as important lubricants and lipids as a mechanical barrier. Their effect is caused by a reduction in proinflammatory and profibrotic mediators. At the same time, intraperitoneal administration of lipid emulsions does not impair healing of the anastomosis in larger animal model.
- MeSH
- adheze tkání etiologie prevence a kontrola patologie MeSH
- anastomóza chirurgická metody MeSH
- emulze MeSH
- pooperační komplikace * prevence a kontrola patologie MeSH
- rybí oleje * terapeutické užití MeSH
- zvířata MeSH
- Check Tag
- ženské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie veterinární MeSH
Úvod: I když během posledních desetiletí společně s vývojem šetrné operační techniky, instrumentári a a perioperačního managementu došlo k významnému zlepšení pooperačních výsledků, infekční komplikace společně s rozvojem pooperačního krvácení jsou stále vedoucími příčinami pooperační morbidity a letality v HPB chirurgii. Metody: Provedli jsme retrospektivní studii za tříleté období u 256 pacientů, kteří podstoupili operaci slinivky, jater, žlučníku či žlučových cest. Sledovali jsme vliv velikosti krevních ztrát a počtu podaných transfuzních přípravků na druh a závažnost pooperačních komplikací, počet reoperací a rehospitalizací. Výsledky: Průměrná velikost krevní ztráty byla 457 ml. Transfuze jsme podali 39 pacientům (17 %). Potvrdili jsme hypotézu, že přítomnost krevní ztráty statisticky významně zvyšuje rozvoj hlubokých nitrobřišních infekcí (p=0,0188). S narůstající krevní ztrátou se zvyšuje morbidita (p =0,0168). Potvrdili jsme statisticky významný rozdíl ve velikosti krevních ztrát mezi skupinou s komplikacemi a bez nich (p=0,001). Pooperační 30denní letalita byla menší než 1 % (n=2). Reoperovaných pacientů bylo 15 (6 %), z toho 7 pro akutní krvácení a 8 pro infekční komplikace. Doba hospitalizace se statisticky významně prodloužila u pacientů, kterým byly podány transfuze – erytrocyty (p=0,023), plazma (p=0,011). Rehospitalizovali jsme 12 pacientů, během rehospitalizace zemřeli tři pacienti (90denní letalita byla 2 %, n=5). Celkem 59 % pacientů v našem souboru bylo klasifikováno jako ASA III. Závěr: Se zvyšující se krevní ztrátou statisticky významně stoupá morbidita, a to především rozvoj intraabdominálních infekcí, ale i přesto zůstává celková pooperační letalita nízká. Příčinou poloviny akutních reoperací je rozvoj časného pooperačního krvácení. Doba hospitalizace se statisticky významně prodlužuje s počtem podaných transfuzních přípravků.
Introduction: During the last decades, simultaneously with the development of surgical technique, modern equipment and perioperative management, there has been a significant improvement in postoperative outcome. Despite this, infectious complications and perioperative bleeding remain the leading causes of postoperative morbidity and mortality in HPB surgery. Methods: We conducted a retrospective study over a three-year period in 256 patients who underwent surgery of the pancreas, liver, gallbladder, or bile ducts. We monitored perioperative blood loss, the number of administered transfusions, the type and severity of postoperative complications, the number of reoperations and the number of readmissions. Results: The average blood loss was 457 ml. We administered transfusions to 39 patients (17%). We confirmed the hypothesis that the presence of blood loss statistically significantly increases the development of deep intra-abdominal infections (p=0.0188). Morbidity increases with increasing blood loss (p=0.0168). We confirmed a statistically significant difference in the blood loss between the groups with and without complications (p=0.001). Postoperative 30-day mortality was less than 1% (n=2). There were 15 (6%) reoperated patients, seven for acute bleeding and eight for infectious complications. The length of hospital stay was statistically significantly longer in patients who received transfusions – erythrocytes (p=0.023), and plasma (p=0.011). We readmitted 12 patients, three patients died during rehospitalization (the 90-day mortality rate was 2%, n=5). A total of 59% patients in our group were classified as ASA III. Conclusion: With increasing blood loss, morbidity (development of intra-abdominal infections) increases significantly, but despite this, overall post- operative mortality remains low. Early postoperative bleeding is the cause of more than half of reoperations. The length of hospitalization increases significantly with the number of transfusions administered.
- MeSH
- dospělí MeSH
- hepatektomie MeSH
- krvácení při operaci * MeSH
- lidé středního věku MeSH
- lidé MeSH
- pankreatektomie MeSH
- pooperační komplikace MeSH
- retrospektivní studie 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
- práce podpořená grantem MeSH
