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.

• MeSH
• lidé MeSH
• nemoci jater * chirurgie   MeSH
• nemoci slinivky břišní * chirurgie   MeSH
• perioperační péče MeSH
• pooperační péče MeSH
• předoperační péče MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• urychlená pooperační rehabilitace * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Úvod: Incidence akutní pankreatitidy za posledních dvacet let stále stoupá a kauzální léčba není k dispozici. Přestože těžké pankreatitidy tvoří jen asi pětinu všech akutních pankreatitid, jejich komplikovaný průběh a vysoká letalita nutí k optimalizaci a ke sjednocení léčebných postupů. Metody: V pětiletém období jsme operovali 27 pacientů s těžkou formou akutní pankreatitidy. Porovnávali jsme vybrané parametry jako pohlaví, věk, BMI, etiologii, přítomnost cukrovky 2. typu, BISAP skóre a jeho korelaci s úmrtími pacientů, předcházející miniinvazivní terapii a přítomnost nitrobřišní hypertenze. Výsledky: V naší skupině byl průměrný věk mužů i žen podobný. Většina pacientů měla nadváhu nebo byla obézní. U mužů byla nejčastěji etiologie alkoholická, u žen biliární. Mortalita v našem souboru čítala 26 %. Syndrom nitrobřišního kompartmentu s následnou urgentní dekompresní operací byl přítomen u čtvrtiny pacientů. Miniinvazivní přístup byl užit přibližně u poloviny pacientů a k chirurgickému řešení se přistupovalo v případě jeho neúčinnosti či selhání. Závěr: Po každé chirurgické revizi dojde během prvních dvou až tří dnů ke klinickému zhoršení stavu pacienta v reakci na operační stres. Proto je současný trend v léčbě akutní pankreatitidy postupovat co nejvíce konzervativně, případně miniinvazivně a chirurgickou léčbu rezervovat pro stavy nezvládnutelné jinak. Pokud je k chirurgické revizi přikročeno, je výhodné provést cholecystektomii, ať je etiologie pankreatitidy jakákoliv.

Introduction: The incidence of acute pancreatitis has been increasing over the past twenty years and there is still no causal treatment available. Although cases of severe acute pancreatitis account for only about a fifth of all cases of acute pancreatitis, high morbidity and lethality call for an optimization and unification of treatment procedures. Methods: We operated on 27 patients suffering from severe acute pancreatitis in the past five years. We compared selected parameters such as gender, age, body mass index, aetiology, presence of type 2 diabetes, BISAP score, previous minimally invasive treatment and presence of the intraabdominal compartment syndrome. Results: The average age of men and women was similar in our group. Most patients were overweight or obese. Alcoholic aetiology was more common in men while biliary aetiology prevailed in women. The mortality rate was 26% in our group. The intra-abdominal compartment syndrome followed by emergency decompression surgery was present in one fourth of the patients. A minimally invasive approach was used in approximately in one half of the patients, and surgical treatment was used only in cases where the minimally invasive approach failed. Conclusion: After each surgical revision, clinical deterioration of the patient´s condition occurs during the first two to three days in response to operative stress. Therefore, the current trend in the treatment of acute pancreatitis is to proceed as conservatively as possible, or using the minimally invasive approach, and surgical treatment should be reserved only for conditions that cannot be managed otherwise. If surgical treatment is used, it is advisable to perform cholecystectomy, whatever the aetiology of the pancreatitis.

• MeSH
• akutní nekrotizující pankreatitida * chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH

• Publikační typ
• abstrakt z konference MeSH

• MeSH
• demence MeSH
• komunikace * MeSH
• lidé MeSH
• senioři MeSH
• sociální práce * MeSH
• vztahy mezi zdravotnickým pracovníkem a pacientem MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

• MeSH
• demence psychologie   MeSH
• lidé MeSH
• osobní vzpomínky jako téma MeSH
• psychoterapie * metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• kazuistiky MeSH
• přehledy MeSH

OBJECTIVES: Here we tested the hypothesis that multiple toxic and infectious stressors combine in their adverse effects to produce higher tissue responses of metallothioneins (MTs) in birds. METHODS: We used Japanese quails as a model avian species. The study is based on data obtained from single and combined exposures of Japanese quails to cyanobacterial biomass containing microcystins, lead and a live Newcastle disease vaccination virus. Eight groups of 5 birds were exposed to single, double and triple combinations of these stressors and compared with controls. Birds were euthanized after the 30-day exposure to collect brain, liver, kidney, and pectoral muscle for MTs measurement. RESULTS: Baseline levels of MTs differed in avian tissues. The gradient of MTs in control quails was pectoral muscle < liver < brain < kidney. Double and triple exposures induced higher levels of MTs. While increases of MTs were driven mainly by dietary exposure to cyanobacterial biomass and/or lead, Newcastle disease vaccination induced the least response. Induction of brain MTs was dominated by exposure to lead. Patterns of MTs responses were similar in the liver and pectoral muscle as well as in the kidney and brain. CONCLUSIONS: Understanding better responses of birds to oxidative stress induced by toxic and infectious stressors may have implications for avian conservation issues and disease risk assessment.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: While commercial poultry and captive birds are exposed to antimicrobials through direct medication, environmental pollution may result in contamination of wild birds. Fluoroquinolones are commonly used medications to treat severe avian bacterial infections; however, their adverse effects on birds remain understudied. Here, we examine toxicity of enrofloxacin and marbofloxacin during the egg incubation period using the chicken (Gallus Gallus domesticus) as a model avian species. Laboratory tests were based on eggs injected with 1, 10 and 100 μg of fluoroquinolones per 1 g of egg weight prior to the start of incubation and monitoring of chick blood biochemistry, reproductive parameters and heart rate during incubation. RESULTS: Eggs treated with fluoroquinolones displayed reduced hatchability due to embryonic mortality, particularly on day 13 of incubation. Total hatching success showed a similar pattern, with a significantly reduced hatchability in low and high exposure groups treated with both enrofloxacin and marbofloxacin. From 15 to 67% of chicks hatching in these groups exhibited joint deformities. Hatching one-day pre-term occurred with a prevalence of 31 to 70% in all groups treated with fluoroquinolones. Embryonic heart rate, measured on days 13 and 19 of incubation, increased in all enrofloxacin-treated groups and medium and high dose groups of marbofloxacin-treated eggs. Blood biochemistry of chicks sampled at hatch from medium dose groups showed hypoproteinaemia, decreased uric acid and increased triglycerides. Chicks from the enrofloxacin-treated group displayed mild hyperglycaemia and a two-fold rise in the blood urea nitrogen to uric acid ratio. Principal components analysis based on blood biochemistry clearly separated the control bird cluster from both enrofloxacin- and marbofloxacin-treated birds. CONCLUSIONS: Fluoroquinolones induce complex adverse effects on avian embryonic development, considerably reducing the performance of incubated eggs and hatching chicks. Cardiotoxicity, which quickens embryonic heart rate, meant that the total number of heart beats required for embryogenesis was achieved earlier than in the standard incubation period, resulting in pre-term hatching. Our data suggest that enrofloxacin has a higher potential for adverse effects than marbofloxacin. To conclude, care should be taken to prevent exposure of reproducing birds and their eggs to fluoroquinolones.

• MeSH
• antiinfekční látky toxicita   MeSH
• enrofloxacin toxicita   MeSH
• fluorochinolony toxicita   MeSH
• hypoproteinemie chemicky indukované   veterinární   MeSH
• kur domácí * krev   MeSH
• kuřecí embryo účinky léků   MeSH
• nemoci drůbeže chemicky indukované   MeSH
• rozmnožování účinky léků   MeSH
• srdeční frekvence účinky léků   MeSH
• zvířata MeSH
• Check Tag
• kuřecí embryo účinky léků   MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

V době, kdy se prodlužuje střední délka života a lékaři úspěšně zasahují i u pacientů, kteří by dříve své chorobě či prodělanému úrazu podlehli, se stále častěji setkáváme i se seniory, jimž lékařská věda zachránila život, ale nadchází zde otázka kvality tohoto života a návratu k soběstačnosti. Na třech kazuistikách z praxe demonstruji nezastupitelnou roli rehabilitační péče u geriatrického pacienta.

At a time of prolonging life expectancy as a result of successful medical treatment that saves lives of patients who would have passed away due to grave illness or injury in the past, we ask questions about the quality of life and the self-sufficiency of those who survived. I would like to demonstrate the irreplaceable role of rehabilitation care for the elderly geriatric patients on three case studies.

• MeSH
• kardiovaskulární rehabilitace metody   MeSH
• lidé MeSH
• pomůcky pro sebeobsluhu MeSH
• rehabilitace po cévní mozkové příhodě metody   MeSH
• rehabilitace * metody   MeSH
• samostatný způsob života * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• činnosti denního života MeSH
• následná péče MeSH
• pomůcky pro sebeobsluhu MeSH
• rehabilitace MeSH
• samostatný způsob života MeSH
• senioři MeSH
• Check Tag
• senioři MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Lead, a serious threat for raptors, can hamper the success of their conservation. This study reports on experience with accidental lead intoxication and responses to chelation therapy in captive Cinereous (Aegypius monachus) and Egyptian (Neophron percnopterus) Vultures. RESULTS: Soil contamination by lead-based paint sanded off the steel aviary resulted in poisoning of eight Cinereous and two Egyptian Vultures. A male Egyptian Vulture developed signs of apathy, polydipsia, polyuria, regurgitation, and stupor, and died on the next day. Liver, kidney and blood lead concentrations were 12.2, 8.16 and 2.66 μg/g, respectively. Laboratory analyses confirmed severe liver and kidney damage and anaemia. Blood Pb levels of Pb-exposed Cinereous Vultures were 1.571 ± 0.510 μg/g shortly after intoxication, decreased to 0.530 ± 0.165 μg/g without any therapy in a month and to 0.254 ± 0.097 μg/g one month after CaNa(2)EDTA administration. Eight months later, blood lead levels decreased to close to the background of the control group. Blood parameters of healthy Pb-non-exposed Cinereous Vultures were compared with those of the exposed group prior to and after chelation therapy. Iron levels in the lead-exposed pre-treatment birds significantly decreased after chelation. Haematocrit levels in Pb-exposed birds were significantly lower than those of the controls and improved one month after chelation. Creatine kinase was higher in pre-treatment birds than in the controls but normalised after therapy. Alkaline phosphatase increased after chelation. A marked increase in the level of lipid peroxidation measured as thiobarbituric acid reactive species was demonstrated in birds both prior to and after chelation. The ferric reducing antioxidant power was significantly lower in pre-treatment vultures and returned to normal following chelation therapy. Blood metallothionein levels in lead-exposed birds were higher than in controls. Reduced glutathione dropped after CaNa(2)EDTA therapy, while oxidised glutathione was significantly lower in both pre- and post-treatment birds. A chick in an egg produced by a Cinereous Vulture female two months after lead toxicosis died on day 40 of artificial incubation. Lead concentrations in foetal tissues were consistent with levels causing avian mortality. CONCLUSIONS: The reported blood parameters and reproduction impairment in captive birds may have implications for professionals dealing with lead exposure in wild birds.

• MeSH
• chelátová terapie metody   veterinární   MeSH
• EDTA terapeutické užití   MeSH
• Falconiformes * krev   MeSH
• nemoci ptáků chemicky indukované   farmakoterapie   MeSH
• olovo krev   MeSH
• otrava olovem farmakoterapie   veterinární   MeSH
• zvířata v ZOO MeSH
• zvířata MeSH
• Check Tag
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH