BACKGROUND: Prolonged mechanical ventilation caused by ventilator-induced diaphragm dysfunction (VIDD) is a serious problem in critically ill patients. Identification of patients who will have difficulty weaning from ventilation along with attempts to reduce total time on mechanical ventilation is some of the aims of intensive care medicine. OBSERVATIONS: This article briefly summarizes current options for temporary phrenic nerve stimulation therapy in an effort to keep the diaphragm active as direct prevention and treatment of ventilator-associated diaphragmatic dysfunction in patients on mechanical ventilation. The results of feasibility studies using different approaches are promising but so far, the clinical relevance is low. One important question is which tool would reliably identify early signs of diaphragmatic dysfunction and also be useful in guiding therapy. The authors present a brief overview of the current options considering the advantages and disadvantages of the available examination modalities. Despite the fact that current data point out some limitations of ultrasound examination, we believe that it still has a unique position in the bedside examination of critically ill patients on mechanical ventilation. CONCLUSION: Temporary phrenic nerve stimulation, regardless of the specific approach used, has the potential to directly treat or reverse VIDD, and ultrasound examination plays an important role in the comprehensive care of critically ill patients.

• MeSH
• dýchání MeSH
• kritický stav * terapie   MeSH
• lidé MeSH
• mechanické ventilátory MeSH
• nervus phrenicus * MeSH
• umělé dýchání MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Fyzioterapeuti se ve své praxi často setkávají s dětmi, které trpí bolestmi v oblasti krční páteře (dále jen Cp) nebo hlavy. Důvodů vzniku těchto bolestí je mnoho. Z literatury vyplývá, že predisponujícím faktorem bolestí hlavy a Cp může být vadné držení těla, zejména předsunuté držení hlavy. V rámci diferenciální diagnostiky těchto obtíží je třeba vyloučit strukturální vady a další onemocnění. Následně v kineziologickém rozboru vyšetřit postavení těla, obzvláště hlavy, Cp, ramen a hrudníku. Kromě fyzioterapeutických metod je vhodné do prevence bolestí hlavy a Cp zařadit regulaci využívání moderních technologií. Důležité je také zařazení adekvátní pohybové zátěže, která má ve vývoji dítěte nezastupitelnou úlohu.

Physiotherapists are increasingly encountering children with neck or head pain in their practice. There are many reasons for these pains. The literature named as predisposing factor for headaches and neck pain poor head posture. Structural defects and other diseases must be excluded as part of the differential diagnosis of these problems. Kinesiological analysis should consist of exami­nation of posture, especially the head, neck, shoulders and chest. In addition to physiotherapeutic methods, it is appropriate to reduce the use of modern technologies as prevention. It is also important to include adequate physical activity, because regular physical activity has an irreplaceable benefit in the child's development.

• MeSH
• bolesti hlavy * etiologie   rehabilitace   MeSH
• dítě MeSH
• lidé MeSH
• nemoci páteře rehabilitace   MeSH
• plexus cervicalis patologie   MeSH
• postura těla MeSH
• techniky fyzikální terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

KEY POINTS: Spinal treatment can restore diaphragm function in all animals 1 month following C2 hemisection induced paralysis. Greater recovery occurs the longer after injury the treatment is applied. Through advanced assessment of muscle mechanics, innovative histology and oxygen tension modelling, we have comprehensively characterized in vivo diaphragm function and phenotype. Muscle work loops reveal a significant deficit in diaphragm functional properties following chronic injury and paralysis, which are normalized following restored muscle activity caused by plasticity-induced spinal reconnection. Injury causes global and local alterations in diaphragm muscle vascular supply, limiting oxygen diffusion and disturbing function. Restoration of muscle activity reverses these alterations, restoring oxygen supply to the tissue and enabling recovery of muscle functional properties. There remain metabolic deficits following restoration of diaphragm activity, probably explaining only partial functional recovery. We hypothesize that these deficits need to be resolved to restore complete respiratory motor function. ABSTRACT: Months after spinal cord injury (SCI), respiratory deficits remain the primary cause of morbidity and mortality for patients. It is possible to induce partial respiratory motor functional recovery in chronic SCI following 2 weeks of spinal neuroplasticity. However, the peripheral mechanisms underpinning this recovery are largely unknown, limiting development of new clinical treatments with potential for complete functional restoration. Utilizing a rat hemisection model, diaphragm function and paralysis was assessed and recovered at chronic time points following trauma through chondroitinase ABC induced neuroplasticity. We simulated the diaphragm's in vivo cyclical length change and activity patterns using the work loop technique at the same time as assessing global and local measures of the muscles histology to quantify changes in muscle phenotype, microvascular composition, and oxidative capacity following injury and recovery. These data were fed into a physiologically informed model of tissue oxygen transport. We demonstrate that hemidiaphragm paralysis causes muscle fibre hypertrophy, maintaining global oxygen supply, although it alters isolated muscle kinetics, limiting respiratory function. Treatment induced recovery of respiratory activity normalized these effects, increasing oxygen supply, restoring optimal diaphragm functional properties. However, metabolic demands of the diaphragm were significantly reduced following both injury and recovery, potentially limiting restoration of normal muscle performance. The mechanism of rapid respiratory muscle recovery following spinal trauma occurs through oxygen transport, metabolic demand and functional dynamics of striated muscle. Overall, these data support a systems-wide approach to the treatment of SCI, and identify new targets to mediate complete respiratory recovery.

• MeSH
• bránice * MeSH
• kinetika MeSH
• krysa rodu rattus MeSH
• kyslík MeSH
• lidé MeSH
• mícha MeSH
• nervus phrenicus MeSH
• obnova funkce MeSH
• poranění míchy * MeSH
• potkani Sprague-Dawley MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Diaphragm atrophy and dysfunction is a major problem among critically ill patients on mechanical ventilation. Ventilator-induced diaphragmatic dysfunction is thought to play a major role, resulting in a failure of weaning. Stimulation of the phrenic nerves and resulting diaphragm contraction could potentially prevent or treat this atrophy. The subject of this study is to determine the effectiveness of diaphragm stimulation in preventing atrophy by measuring changes in its thickness. METHODS: A total of 12 patients in the intervention group and 10 patients in the control group were enrolled. Diaphragm thickness was measured by ultrasound in both groups at the beginning of study enrollment (hour 0), after 24 hours, and at study completion (hour 48). The obtained data were then statistically analyzed and both groups were compared. RESULTS: The results showed that the baseline diaphragm thickness in the interventional group was (1.98 ± 0.52) mm and after 48 hours of phrenic nerve stimulation increased to (2.20 ± 0.45) mm (p=0.001). The baseline diaphragm thickness of (2.00 ± 0.33) mm decreased in the control group after 48 hours of mechanical ventilation to (1.72 ± 0.20) mm (p<0.001). CONCLUSIONS: Our study demonstrates that induced contraction of the diaphragm by pacing the phrenic nerve not only reduces the rate of its atrophy during mechanical ventilation but also leads to an increase in its thickness - the main determinant of the muscle strength required for spontaneous ventilation and successful ventilator weaning. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (18/06/2018, NCT03559933, https://clinicaltrials.gov/ct2/show/NCT03559933 ).

• MeSH
• bránice diagnostické zobrazování   patofyziologie   MeSH
• elektrostimulační terapie přístrojové vybavení   metody   MeSH
• kritický stav MeSH
• lidé středního věku MeSH
• lidé MeSH
• nervus phrenicus fyziologie   MeSH
• prospektivní studie MeSH
• respirační insuficience terapie   MeSH
• senioři MeSH
• svalová atrofie etiologie   patofyziologie   MeSH
• ultrasonografie MeSH
• umělé dýchání škodlivé účinky   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

Cervikokraniální syndrom zahrnuje bolest hlavy způsobenou poruchou v oblasti krční páteře. Terapie cervikokraniálního syndromu vyžaduje komplexní multioborový přístup s využitím farmakologické léčby i nefarmakologických postupů vč. rehabilitační a myoskeletální medicíny. Mobilizace a manipulace byly vyhodnoceny jako postupy přínosné při léčbě poruch krční páteře. Cílem práce bylo zhodnotit účinky manipulace krční páteře podle principů myoskeletální medicíny. Do studie bylo zařazeno 103 probandů s diagnostikovaným cervikokraniálním syndromem, kteří byli náhodně rozděleni do kontrolní a experimentální skupiny. V kontrolní skupině probandi absolvovali standardní rehabilitační myoskeletální léčbu. V experimentální skupině byla ke standardní myoskeletální rehabilitační léčbě přidána vstupně jednorázová nárazová manipulace krční páteře. Naše studie prokázala, že manipulace krční páteře vede bezprostředně po zákroku k signifikantnímu zlepšení hybnosti. Po 6týdenní komplexní terapii pozorujeme zlepšení hybnosti a zmírnění bolesti krční páteře v obou sledovaných skupinách. Lepší efekty pozorujeme v experimentální skupině, avšak tyto rozdíly jsou u našeho souboru pacientů nesignifikantní.

The symptoms of cervicocranial syndrome include headache caused by cervical spine disorder. The treatment of cervicocranial syndrome requires a comprehensive multidisciplinary approach using pharmacological treatment and non-drug procedures, including physiotherapy and myoskeletal therapy. There is a consensus that the physiotherapy procedures of mobilization and manipulation are beneficial in the treatment of cervical spine disorders. The aim of the study was to evaluate the effects of manipulation therapy of the cervical spine according to the principles of myoskeletal medicine. The study included 103 patients with cervicocranial syndrome, who were randomly divided into a control and an experimental group. The control group underwent standard physiotherapy myoskeletal treatment. In addition to the standard physiotherapy myoskeletal treatment, the experimental group received one initial thrust manipulation of the cervical spine at the very beginning of the treatment. The results of our study showed that the manipulation of the cervical spine led to a significant increase in immediate mobility after the therapy. An improvement of cervical spine mobility and pain reduction were observed in both groups after six weeks of comprehensive physiotherapy myoskeletal treatment. The differences between the experimental group and controls were shown to be non-significant.

• Klíčová slova
• cervikokraniální syndrom, manipulace páteře,
• MeSH
• bolesti hlavy * rehabilitace   MeSH
• klinická studie jako téma MeSH
• krční obratle patologie   MeSH
• lidé MeSH
• management bolesti metody   MeSH
• muskuloskeletální manipulace * metody   MeSH
• plexus cervicalis patologie   MeSH
• rotace MeSH
• techniky fyzikální terapie MeSH
• Check Tag
• lidé MeSH

In the current study, we display a rare association of an aberrant innervation of the sternocleidomastoid muscle by the ansa cervicalis (AC) with a tortuous common carotid artery (TCCA). In specific, in a male cadaver we observed on the right side of the cervical region, a nerval branch of remarkable size originating from the most distal part of the AC's superior root and after piercing the superior belly of the omohyoid muscle innervated the distal portion of the sternocleidomastoid muscle. Furthermore, we noticed a tortuous course of the initial part of the right common carotid artery. We discuss the surgical significance of the awareness of AC's variations during neurotisation of the recurrent laryngeal nerve in cases of its damage, as well as the importance of aberrant innervation of the sternocleidomastoid muscle by AC for the preservation of muscle's functionality after accessory nerve's damage. Furthermore, we highlight the fact, that the knowledge of the relatively uncommon variant, such as TCCA is crucial for the physician in order to proceed more effectively in differential diagnosis of a palpable mass of the anterior cervical region or deal with symptoms such as dyspnea, dysphagia or symptoms of cerebrovascular insufficiency.

• MeSH
• arteria carotis communis abnormality   MeSH
• krční svaly inervace   MeSH
• lidé MeSH
• mrtvola MeSH
• plexus cervicalis abnormality   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Cíl: Studie byla zaměřena na vyhodnocení etiologických faktorů zlomenin dolní čelisti a jejich četnost, vztah k ročnímu období a souvislost s poraněním skeletu hlavy a krku. Metodika: Byla provedena retrospektivní studie úrazů dolní čelisti na Klinice ústní čelistní a obličejové chirurgie ve Fakultní nemocnici Olomouc v období od 1. 1. 2013 do 31. 12. 2017. Bylo zaznamenáno 432 pacientů, u kterých byla radiograficky verifikována fraktura dolní čelisti. Klasifikace zlomenin se řídila klasifikačním systémem společnosti AOCMF. Bylo sledováno roční období, ve kterém k úrazu došlo, mechanismus poranění a zda byly poraněny i jiné struktury skeletu obličeje a krku. Výsledky: Z celkového počtu 432 pacientů bylo diagnostikováno 250 jednoduchých fraktur. Ve 182 případech se jednalo o násobnou zlomeninu a v 77 případech došlo k poranění jiných struktur skeletu hlavy a krku. Nejčastější příčinou bylo napadení (143krát, 33,10 %), následovaly pády, úrazy cyklistů a dopravní nehody. Maximum zlomenin dolní čelisti bylo zaznamenáno v měsíci červenci (50 pacientů). Závěr: Fraktura dolní čelisti je relativně častá diagnóza, nejčastěji je způsobena brachiálním násilím. Rizikovou skupinou jsou muži ve třetím deceniu. U žen je mechanismus vzniku jiný, příčinou jsou pády bez výraznější specifikace výskytu a určité věkové skupiny.

Aim: The study was focused on the evaluation of etiological factors of mandibular fractures, their frequency, relationship to the season and the relationship with head and neck skeletal injuries. Methodology: A retrospective study of lower jaw injuries was performed at the Department of Oral and Maxillofacial Surgery at the Olomouc University Hospital in the period from 01. 01. 2013 to 31. 12. 2017. 432 patients with radiographically verified mandibular fracture were reported. The classification of fractures was governed by the AOCMF classification system. The season in which the injury occurred, the mechanism of the injury, and whether other structures of the skeleton of the face and neck were injured were monitored. Results: Out of a total of 432 patients, 250 simple fractures were diagnosed. In 182 cases it was a multiple fracture and in 77 cases other structures of the skeleton of the head and neck were injured. The most common cause was evaluated 143 attacks (33.10%), followed by falls, cyclist injuries and traffic accidents. The maximum of mandibular fractures was recorded in July (50 patients).

• MeSH
• fraktury mandibuly * etiologie   MeSH
• lidé MeSH
• plexus cervicalis zranění   MeSH
• poranění obličeje MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH

OBJECTIVES: Maintaining diaphragm work using electrical stimulation during mechanical ventilation has been proposed to attenuate ventilator-induced diaphragm dysfunction. This study assessed the safety and feasibility of temporary percutaneous electrical phrenic nerve stimulation on user-specified inspiratory breaths while on mechanical ventilation. DESIGN: Two-center, nonblinded, nonrandomized study. SETTING: Hospital ICU. PATIENTS: Twelve patients mechanically ventilated from 48 hours to an expected 7 days. INTERVENTIONS: Leads were inserted to lie close to the phrenic nerve in the neck region using ultrasound guidance. Two initial patients had left-sided placement only with remaining patients undergoing bilateral lead placement. Percutaneous electrical phrenic nerve stimulation was used for six 2-hour sessions at 8-hour intervals over 48 hours. MEASUREMENTS AND MAIN RESULTS: Data collected included lead deployment success, nerve conduction, ventilation variables, work of breathing, electrical stimulation variables, stimulation breath synchrony, and diaphragm thickness measured by ultrasound at baseline, 24, and 48 hours. Primary endpoints included ability to capture the left and/or right phrenic nerves and maintenance of work of breathing within defined limits for 80% of stimulated breaths. Lead insertion was successful in 21 of 22 attempts (95.5%). Analysis of 36,059 stimulated breaths from 10 patients with attempted bilateral lead placement demonstrated a mean inspiratory lag for phrenic nerve stimulation of 23.7 ms (p < 0.001 vs null hypothesis of <88ms). Work of breathing was maintained between 0.2 and 2.0 joules/L 96.8% of the time, exceeding the 80% target. Mean diaphragm thickness increased from baseline by 7.8% at 24 hours (p = 0.022) and 15.0% at 48 hours (p = 0.0001) for patients receiving bilateral stimulation after excluding one patient with pleural effusion. No serious device/procedure-related adverse events were reported. CONCLUSIONS: The present study demonstrated the ability to safely and successfully place percutaneous electrical phrenic nerve stimulation leads in patients on mechanical ventilation and the feasibility of using this approach to synchronize electrical stimulation with inspiration while maintaining work of breathing within defined limits.

• MeSH
• bránice inervace   MeSH
• elektrostimulační terapie metody   MeSH
• jednotky intenzivní péče MeSH
• lidé MeSH
• nervus phrenicus patofyziologie   MeSH
• respirační paralýza etiologie   prevence a kontrola   MeSH
• umělé dýchání škodlivé účinky   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

As stated by Korpáš and Tomori (1979), cough is the most important airway protective reflex which provides airway defensive responses to nociceptive stimuli. They recognized that active expiratory efforts, due to the activation of caudal ventral respiratory group (cVRG) expiratory premotoneurons, are the prominent component of coughs. Here, we discuss data suggesting that neurons located in the cVRG have an essential role in the generation of both the inspiratory and expiratory components of the cough reflex. Some lines of evidence indicate that cVRG expiratory neurons, when strongly activated, may subserve the alternation of inspiratory and expiratory cough bursts, possibly owing to the presence of axon collaterals. Of note, experimental findings such as blockade or impairment of glutamatergic transmission to the cVRG neurons lead to the view that neurons located in the cVRG are crucial for the production of the complete cough motor pattern. The involvement of bulbospinal expiratory neurons seems unlikely since their activation affects differentially expiratory and inspiratory muscles, while their blockade does not affect baseline inspiratory activity. Thus, other types of cVRG neurons with their medullary projections should have a role and possibly contribute to the fine tuning of the intensity of inspiratory and expiratory efforts.

• MeSH
• 6-kyano-7-nitrochinoxalin-2,3-dion aplikace a dávkování   MeSH
• antagonisté excitačních aminokyselin aplikace a dávkování   MeSH
• kašel patofyziologie   prevence a kontrola   MeSH
• lidé MeSH
• mechanika dýchání účinky léků   fyziologie   MeSH
• medulla oblongata účinky léků   fyziologie   MeSH
• mikroinjekce metody   MeSH
• nadechnutí účinky léků   fyziologie   MeSH
• nervus phrenicus účinky léků   fyziologie   MeSH
• neurony účinky léků   fyziologie   MeSH
• reflex účinky léků   fyziologie   MeSH
• vydechnutí účinky léků   fyziologie   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Léze v oblasti cervikálního plexu jsou relativně vzácné a mohou uniknout pozornosti klinického neurologa. V posledních letech bylo publikováno několik nových syndromů z této lokalizace. Podáváme aktuální přehled možných postižení krční pleteně, jejich diagnostiky a léčby. Jedná se o okcipitální neuralgii, která je relativně nejčastější a většinou bývá považována za idiopatickou. Dále o neuralgie v oblasti ucha, jako jsou léze n. auricularis magnus a syndrom červeného ucha. Popisujeme i postižení Jacobsonova a Arnoldova nervu, které jsou klinicky velmi podobné, i když se jedná o léze n. glossopharyngeus, resp. n. vagus. Zabýváme se i postižením n. phrenicus, které bývá většinou jednostranné a asymptomatické, při bilaterální paréze jím inervované bránice však může vyústit až do respiračního selhání s nutností umělé plicní ventilace.

Cervical plexus lesions are relatively rare and may be overlooked by clinical neurologists. Several new clinical syndromes centered upon this region have been published in recent years. Herein we present an overview of possible etiologies of cervical plexus lesions, their diagnosis and treatment. Relatively the most common condition is occipital neuralgia, which is largely considered idiopathic. We report considerable auricular neuralgia and red ear syndrome, and neuralgias of Jacobson’s and Arnold’s nerves (branches of the glossopharyngeal and vagus nerves). We deal also with phrenic nerve lesion, which is usually unilateral and asymptomatic. Nevertheless, bilateral diaphragmatic palsy may result in disabling dyspnea requiring mechanical ventilation.

• Klíčová slova
• okcipitální neuralgie, neuralgie n. occipitalis magnus, syndrom červeného ucha,
• MeSH
• lidé MeSH
• nervus phrenicus patologie   MeSH
• neuralgie patofyziologie   terapie   MeSH
• plexus cervicalis * anatomie a histologie   patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH