Úvod: Burzy jsou tíhové váčky vystlané synoviální vrstvou buněk a obsahují tekutinu podobnou kloubní synovii. Jejich účelem je snižovat mechanické namáhaní (tření) v místech kontaktu šlach s kostí, kloubním pouzdrem anebo vazem. Vlivem různých příčin se může burza zanítit a způsobovat pacientovi obtíže. Burzitidu je možné diagnostikovat zavedením metodiky časného SPECT/CT při vyšetření skeletu. Kazuistiky: Uvádím zde tři pacienty, dva přišli s bolestí kolenních kloubů trvající několik měsíců a jeden s bolestí v oblasti bederní páteře, u kterých byla diagnostikovaná burzitis na třífázové scintigrafii skeletu. Závěr: Dle BOSS klasifikace patří všechny burzitidy do tvz. skupiny C (neboli extraoseální). Tyto patologie na scintigrafii skeletu odhalí pouze provedení SPECT/CT ve fázi blood poolu.

Introduction: Bursae are weight-bearing sacs lined with a synovial layer of cells and contain a fluid similar to joint synovium. Their purpose is to reduce mechanical stress (friction) in the points of contact of tendons with bone, joint capsule or ligament. Due to various reasons, the bursa can become inflamed and cause difficulties for the patient. It is possible to diagnose bursitis by introducing early SPECT/CT methodology during the examination of the skeleton. Case reports: Three patients are presented here, two with pain in the knee joints lasting several months and one with pain in the area of the lumbar spine, who were diagnosed with bursitis on three-phase skeletal scintigraphy. Conclusion: According to the BOSS classification, all bursitis belongs to what is known as group C (or extraosseous). These pathologies on bone scintigraphy can only be detected by performing SPECT/CT in the blood pool phase.

• Keywords
• SPECT/CT krevního poolu,
• MeSH
• Back Pain diagnostic imaging   pathology   MeSH
• Bursitis * diagnostic imaging   MeSH
• Knee Joint diagnostic imaging   pathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Radionuclide Imaging MeSH
• Single Photon Emission Computed Tomography Computed Tomography * MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

• MeSH
• Bursitis * diagnostic imaging   etiology   classification   therapy   MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Arthroscopy methods   MeSH
• Shoulder Pain diagnosis   etiology   MeSH
• Bursitis surgery   diagnosis   drug therapy   MeSH
• Diagnosis, Differential MeSH
• Shoulder Dislocation surgery   diagnosis   etiology   MeSH
• Postoperative Care methods   rehabilitation   MeSH
• Shoulder Injuries surgery   etiology   MeSH
• Rotator Cuff Injuries surgery   diagnosis   MeSH
• Shoulder Joint * surgery   physiopathology   MeSH
• Shoulder Impingement Syndrome surgery   diagnosis   drug therapy   MeSH
• Physical Therapy Modalities * MeSH
• Age Factors MeSH
• Publication type
• Review MeSH

• MeSH
• Analgesics therapeutic use   MeSH
• Shoulder Pain MeSH
• Bursitis * diagnosis   prevention & control   rehabilitation   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Musculoskeletal Manipulations methods   MeSH
• Recovery of Function MeSH
• Shoulder Joint physiopathology   MeSH
• Range of Motion, Articular physiology   MeSH
• Physical Therapy Modalities MeSH
• Athletic Tape trends   MeSH
• Exercise Therapy MeSH
• Check Tag
• Humans MeSH

Gluteálna tendinopatia je častou diagnózou. Postihnuté bývajú najčastejšie šľachy m. gluteus medius a m. gluteus minimus. V rámci klinického vyšetrenia je možné využiť stoj na jednej nohe, FADER test, rezistovanú abdukciu a palpačné vyšetrenie v oblasti veľkého trochanteru. Pri vstupnom vyšetrení je možné využiť aj VISA-G dotazník zameraný na funkčný stav pacienta. Pacienti s gluteálnou tendinopatiou často pociťujú bolesť pri sedení. Častá je aj bolesť v sede s prekríženými nohami. Vznik gluteálnej tendinopatie je spojený s viacerými rizikovými faktormi. Vznik gluteálnej tendinopatie môžu podmieňovať nesprávne biomechanické parametre. U pacientov s gluteálnou tendinopatiou je možné nájsť oslabenie abduktorov bedrového kĺbu a zhoršenú stabilitu stoja. Gluteálna tendinopatia taktiež vedie k zmenám kinematiky chôdze. Medzi základnú terapiu pri gluteálnej tendinopatii patrí konzervatívna liečba, ktorá zahŕňa terapie rehabilitácie.

Gluteal tendinopathy is a common diagnosis. Tendons of gluteal medius and the gluteal minimus are affected. Important part in diagnosis is clinical examination. It is possible to use one leg stance test, FADER test, resisted abduction test and palpation examination in the area of the great trochanter. It is also possible to use the VISA-G questionnaire focused on the patient's functional condition during the initial examination. Patients with gluteal tendinopathy often experience pain when sitting. Pain in sitting with crossed legs is also common. The development of gluteal tendinopathy is associated with several risk factors. The development of gluteal tendinopathy may be due to incorrect biomechanical parameters. In patients with gluteal tendinopathy, weakening of the hip abductors and impaired standing stability can be found. Gluteal tendinopathy also leads to changes in gait kinematics. The basic therapy for gluteal tendinopathy includes conservative treatment, which includes rehabilitation therapies.

• MeSH
• Pain MeSH
• Bursitis MeSH
• Exercise MeSH
• Muscle, Skeletal * pathology   MeSH
• Humans MeSH
• Pain Management MeSH
• Rehabilitation methods   MeSH
• Tendinopathy * diagnosis   rehabilitation   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Popis kazuistiky ženy léčené pro protrahovanou bolest levé nohy řešené během stáže organizované International Federation of Medical Students' Associations (IFMSA), na oddělení ortopedie nemocnice v Mostaru, Bosna a Hercegovina.

Description of a case report of a woman treated for protracted left foot pain during an internship organized by the International Federation of Medical Students' Associations (IFMSA), Department of Orthopedics, Mostar, Bosnia and Herzegovina.

• MeSH
• Achilles Tendon * surgery   immunology   MeSH
• Bursitis * diagnosis   surgery   physiopathology   MeSH
• Surgical Procedures, Operative MeSH
• Clinical Clerkship organization & administration   MeSH
• Middle Aged MeSH
• Humans MeSH
• Hospitals, University MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH
• Geographicals
• Bosnia and Herzegovina MeSH

• Keywords
• bolest měkkých tkání,
• MeSH
• Shoulder Pain * diagnosis   therapy   MeSH
• Pain diagnosis   MeSH
• Bursitis * diagnosis   therapy   MeSH
• Diagnostic Techniques and Procedures MeSH
• Fractures, Bone complications   MeSH
• Clinical Laboratory Techniques MeSH
• Knee physiopathology   MeSH
• Complex Regional Pain Syndromes * diagnosis   etiology   drug therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Myofascial Pain Syndromes diagnosis   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Úvod: Názvem syndrom zmrzlého ramene se označuje časté postižení glenohumerálního kloubu vyskytující se v obecné populaci s incidencí 2-5 %, s nejčastějším výskytem u žen mezi 40 a 60 lety. I přes častý výskyt se jedná o relativně málo objasněné onemocnění, které bývá označováno jako enigma ortopedie. V článku srovnáváme výsledky zavřeného redresu ramenní kloubu s následnou artroskopií a artroskopické deliberace u pacientů se syndromem frozen shoulder. Materiál a metoda: Autoři prezentují soubor 60 pacientů operovaných pro diagnózu frozen shoulder. U první skupiny byl po uvedení do celkové anestezie proveden zavřený redres a následně artroskopie ramenního kloubu se subakromiální dekompresí. Skupina čítala 31 osob (23 žen a 8 mužů). Druhou skupinu tvořili pacienti, kteří byli ošetřeni artroskopickou deliberací pouzdra. Takto bylo ošetřeno 29 osob (25 žen a 4 muži). Výsledky: U všech pacientů po provedené operaci došlo ke zlepšení pohybu i výkonnosti ramenního kloubu. Ve srovnání obou skupiny docházelo ve skupině artroskopické deliberace k rychlejší úpravě pohybu při kontrolách ve 2. týdnu a po třech měsících. Při kontrole minimálně dva roky po operaci došlo v obou skupinách ke srovnání rozsahu pohybu postiženého kloubu [flexe 168 (redres)/171 (deliberace), abdukce 163/165]. Stejně tak v hodnocení Constantovo skóre se výsledky prakticky shodovaly [zlepšení o 46 (redres) /45 bodů (deliberace)]. Diskuse a závěr: Diagnóza frozen shoulder je relativně častá diagnóza, u které však chybí přesné určení etiologie, a zejména větší prospektivní studie. Výsledky našeho sledování odpovídají literárním údajům, které vypovídají o dobré odezvě na různé strategie léčby. Artroskopická deliberace se nám pak jeví jako vhodnější metoda pro ošetření ramenního kloubu s diagnózou frozen shoulder. Je to sice pro operatéra výkon lehce náročnější, ale s benefitem pro pacienta v časném pooperačním období, zejména však výrazně redukuje možnost iatrogenní zlomeniny humeru při násilném redresu, která je jednoznačně nejvážnější komplikací této metody.

Introduction: The name "frozen shoulder syndrome" refers to the frequent involvement of the glenohumeral joint occurring in the general population with an incidence of 2-5%, it most commonly occurs in women between 40 and 60 years. Despite its frequent occurrence, it is a relatively unexplored illness, which is often referred to as enigma of orthopaedics. In the article, we compare the results of closed shoulder joint redress with subsequent arthroscopy and arthroscopic deliberation in patients with frozen shoulder syndrome. Material and Methods: The authors present a set of 60 patients operated on with the diagnosis of frozen shoulder. In the first group, closed redress and subsequent arthroscopy of the shoulder joint with subacromial decompression were performed under general anaesthesia. The group consisted of 31 people (23 women and 8 men). The second group consisted of patients who were treated by arthroscopic deliberation of the capsule. 29 people (25 women and 4 men) were treated in this way. Results: All patients after the surgery had improved movement and performance of the shoulder joint. Comparing both groups, the arthroscopic deliberation group reported a faster adjustment of the movement during the 2 week and 3 months follow-up. At least two years after the operation, the range of movement of the affected joint [flexion 168 (redres) / 171 (deliberation), abduction 163/165] was compared in both groups. Similarly, in the Constant score, the results practically matched [improvement by 46 (redres) / 45 points (deliberation)]. Discussion and Conclusion: Frozen shoulder is a relatively common diagnosis, but it lacks exact aetiology and especially a larger prospective study. The results of our follow-up are consistent with the literature that suggests a good response to different treatment strategies. Arthroscopic deliberation seems to us to be a more appropriate method for treatment of the shoulder joint with the diagnosis of frozen shoulder. Although it is slightly more demanding for the surgeon, but with benefit to the patient in the early postoperative period, he reduces the possibility of iatrogenic fracture of the humerus in violent redress, which is clearly the most serious complication of this method.

• MeSH
• Arthroscopy * methods   nursing   utilization   MeSH
• Bursitis * diagnosis   surgery   therapy   MeSH
• Humeral Fractures surgery   complications   MeSH
• Joint Capsule surgery   physiopathology   pathology   MeSH
• Humans MeSH
• Meta-Analysis as Topic MeSH
• Orthopedic Procedures * methods   nursing   MeSH
• Intraoperative Complications prevention & control   therapy   MeSH
• Postoperative Complications prevention & control   therapy   MeSH
• Statistics as Topic MeSH
• Case-Control Studies MeSH
• Outcome and Process Assessment, Health Care MeSH
• Check Tag
• Humans MeSH

Streptokokový syndrom toxického šoku (SSTŠ) je akutní život ohrožující onemocnění, které se projevuje velmi rychlým rozvojem šoku a multiorgánovým selháním (MODS). V našem sdělení předkládáme soubor aktuálních poznatků a popisujeme tři vlastní kazuistiky. Ve dvou případech byl syndrom vyvolán bakterií Streptococcus pyogenes, v jednom byl jako etiologické agens určen Streptococcus dysgalactiae. Kazuistiky syndromu toxického šoku způsobeného jinými druhy streptokoků jsou ve světové literatuře popisovány méně často. V řadě článků a učebnic (včetně CDC definice z roku 2010) je dokonce stále uváděno, že tento syndrom může vyvolávat pouze streptokok skupiny A (S. pyogenes) [1]. Prezentovaná kazuistika SSTŠ vyvolaného jiným druhem streptokoka je podle našich zjištění v české literatuře publikována poprvé.

Streptococcal toxic shock syndrome (STSS) is an acute, life-threatening condition which presents as a rapid onset shock and multiorgan failure (multiorgan dysfunction syndrome, MODS). This communication summarizes the existing body of evidence and presents three case reports. In two patients, STSS was caused by the bacterium Streptococcus pyogenes and in one patient, Streptococcus dysgalactiae was identified as the causative agent. STSS cases caused by other streptococcal species have been reported less often in the literature. A number of articles and manuals (including the CDC definition from 2010) even continue to state that STSS can only be caused by group A streptococci (S. pyogenes) [1]. To our knowledge, the case report presented of STSS caused by another streptococcal species is the first report in the Czech literature.

• MeSH
• Amputation, Surgical MeSH
• Anti-Bacterial Agents administration & dosage   therapeutic use   MeSH
• Bursitis diagnosis   therapy   MeSH
• Early Diagnosis MeSH
• Diagnosis, Differential MeSH
• Dobutamine therapeutic use   MeSH
• Lower Extremity physiopathology   MeSH
• Erysipelas diagnosis   drug therapy   physiopathology   MeSH
• Fasciitis, Necrotizing diagnosis   MeSH
• Fatal Outcome MeSH
• Upper Extremity surgery   physiopathology   MeSH
• Cardiotonic Agents MeSH
• Catecholamines therapeutic use   MeSH
• Drug Therapy, Combination MeSH
• Middle Aged MeSH
• Humans MeSH
• Multiple Organ Failure MeSH
• Pyelonephritis diagnosis   MeSH
• Shock, Septic * diagnosis   physiopathology   therapy   MeSH
• Heart Arrest MeSH
• Streptococcaceae * pathogenicity   MeSH
• Streptococcus pyogenes pathogenicity   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

INTRODUCTION The authors evaluate the results of endoscopic treatment and analyse the causes of persisting difficulties in retrocalcaneal bursitis unresponsive to conservative treatment. Stated as one of the causes is the possible chronic irritation of minor/partial tears of anterior parts of the distal portion of the Achilles tendon, which have no chance to heal due to continued overload and impingement syndrome of the superior prominence of the calcaneal tubercle. MATERIAL AND METHODS The authors evaluate the group of 24 patients (10 women and 14 men) diagnosed with retrocalcaneal bursitis, who reported more than 12 months of difficulties and in whom the conservative therapy options have already been exhausted. The decision to perform a revision arthroscopy was made by the authors based on chronic long-lasting difficulties, clinical examination, calcaneus radiograph, ultrasound examination and negative response to the performed conservative treatment. The MRI scan was obtained in 4 patients. In 11 patients during arthroscopy the Achilles tendon was intact, in 13 patients (54.2%) minor tears were detected on the anterior aspect of the distal Achilles tendon, not diagnosed preoperatively (by ultrasound examination). In all the patients, resection of the prominence of the calcaneal tubercle was performed, whereas in patients with affected Achilles tendon also the loose tendon fragments were resected. RESULTS A total of 23 patients reported an improvement of their condition, the pain subsided at 21-43 days. Altogether 21 patients returned to activities carried out before the onset of pain. The AOFAS score values measured preoperatively in patients with an intact tendon were 59.5 ± 15.0, in patients with an injured tendon it was 45.57 ± 9.6, while 6 months after the surgery the values were 95.7 ± 6.2, or 88.71 ± 7.8 respectively. In 1 female patient, with one prior surgery, diagnosed with a partial tear of the Achilles tendon, the effect of the surgery was unsatisfactory. After six months the patient underwent an open revision surgery and the Achilles tendon reinsertion. No intraoperative or postoperative complications were observed. DISCUSSION The endoscopic technique facilitates a more visible bone resection, with better control of resection, which is less invasive than the open technique. The source of irritation can be removed, which is not always only the prominence of the calcaneal tubercle, but another cause of persisting problems can also be a microtrauma affecting the anterior portion of the Achilles tendon, with a reactive hyperaemia in bursal tissue. Compared to literature and also based on the results of the authors of this retrospective study, the endoscopic calcaneoplasty is less invasive than the open surgery. It is always necessary to properly diagnose the causes of difficulties and to timely respond to persisting symptoms in patients, not responding satisfactorily to conservative therapy. CONCLUSIONS The findings presented by the authors provide a new perspective on the causes of chronic problems such as the "posterior heel pain" and tend to give preference to the active endoscopic approach in patients with persisting problems, not responding to conservative treatment, predisposed based on the radiological examination and with a positive finding on ultrasound or MRI scan. Key words:retrocalcaneal bursitis, endoscopic calcaneoplasty, arthroscopy.

• MeSH
• Achilles Tendon injuries   MeSH
• Arthroscopy * adverse effects   methods   MeSH
• Bursitis diagnosis   physiopathology   surgery   MeSH
• Outcome Assessment, Health Care MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Calcaneus diagnostic imaging   pathology   MeSH
• Pain, Postoperative diagnosis   etiology   surgery   MeSH
• Radiography methods   MeSH
• Reoperation methods   statistics & numerical data   MeSH
• Ultrasonography methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH