INTRODUCTION: The inferior phrenic artery is a paired artery with a variable origin and course, primarily supplying the diaphragm, but also the suprarenal glands, inferior vena cava, stomach, and oesophagus. The aim of this study is to investigate the origin and course of the inferior phrenic arteries on multidetector computed tomography and angiography. MATERIALS AND METHODS: The anatomy of the inferior phrenic artery was analysed on 2449 multidetector computed tomography scans. Three-dimensional reconstructions were made of the main variations. Additionally, the course and branching pattern of the inferior phrenic artery were descriptively analysed in a cohort of 28 angiograms. RESULTS: In 565 (23.1%) cases the inferior phrenic arteries arose as a common trunk and in 1884 (76.9%) cases as individual vessels. The most common origins of a common trunk were the coeliac trunk (n=303; 53.6%) and abdominal aorta (n=255; 45.1%). The most common origins of the right inferior phrenic artery were the coeliac trunk (n=965; 51.2%), abdominal aorta (n=562; 29.8%) and renal arteries (n=214; 11.4%). The most common origins of the left inferior phrenic artery were the coeliac trunk (n=1293; 68.6%) and abdominal aorta (n=403; 21.4%). CONCLUSION: The inferior phrenic artery has a very variable anatomy. The most common origins of the inferior phrenic artery are the coeliac trunk and its branches, the abdominal aorta, and the renal arteries.

• MeSH
• Angiography methods   MeSH
• Aorta, Abdominal anatomy & histology   diagnostic imaging   MeSH
• Celiac Artery * anatomy & histology   diagnostic imaging   MeSH
• Arteries anatomy & histology   diagnostic imaging   MeSH
• Diaphragm blood supply   diagnostic imaging   anatomy & histology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Multidetector Computed Tomography * MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVES: The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or breathing with simultaneous voluntary contraction of the abdominal muscles (VCAM). This study analyzed diaphragm motion in healthy individuals during various postural-respiratory situations. METHODS: 31 healthy participants underwent examination of the diaphragm using M-mode ultrasonography, spirometry, and abdominal wall tension (AWT) measurements. All recordings were performed simultaneously during three consecutive scenarios, i.e., 1. Lifting a load without breathing; 2. Lifting a load and breathing naturally; 3. Lifting a load and breathing with simultaneous VCAM. RESULTS: Using paired-samples t-tests, lifting a load without breathing displaced the diaphragm's expiratory position more caudally (P < .001), with no change noted in the inspiratory position (P = .373). During lifting a load breathing naturally, caudal displacement of the diaphragm's inspiratory position was presented (P < .001), with no change noted in the expiratory position (P = 0.20) compared to tidal breathing. Total diaphragm excursion was greater when loaded (P = .002). Lifting a load and breathing with VCAM demonstrated no significant changes in diaphragm position for inspiration, expiration, or total excursion compared to natural loaded breathing. For all scenarios, AWT measures were greater when lifting a load (P < .001). CONCLUSION: In healthy individuals, caudal displacement and greater excursions of the diaphragm occurred when lifting a load. The postural function of the diaphragm is independent of its respiratory activity and is not reduced by the increase in AWT.

• MeSH
• Diaphragm * diagnostic imaging   physiology   MeSH
• Respiration * MeSH
• Humans MeSH
• Muscle Contraction MeSH
• Ultrasonography MeSH
• Exhalation MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Úvod: Ruptura bránice je vzácný, ale život ohrožující stav doprovázející 0,8–5 % torakoabdomiálních traumat podstoupivších operaci. Většinu doprovází přidružená poranění, která jsou zodpovědná za špatnou prognózu. Projevy brániční ruptury bývají překryty vážnějšími projevy přidruženého traumatu. Ruptura bývá viditelná na RTG snímku hrudníku či na CT vyšetření. Menší defekt však může diagnostice uniknout, zvláště pokud není pacient indikován k akutní operaci. Metody: Autoři uvádějí 2 kazuistiky pacientů, kteří byli léčeni pro chronickou brániční rupturu na Chirurgické klinice LF UK a FN Plzeň mezi 1. 1. 2009 a 31. 12. 2021. Cílem byla analýza klinických dat a jejich porovnání s literárními údaji. Výsledky: Oba pacienti s chronickou brániční rupturou byli muži v produktivním věku, kteří primární trauma utrpěli při dopravní nehodě. V jednom případě byla ruptura diagnostikována po 6 letech, v druhém po 14 letech. V jednom případě šlo o rupturu levé poloviny bránice, v druhém případě pak její pravé poloviny. Oba pacienti podstoupili plastiku bráničního defektu cestou torakotomie. Závěr: Nerozpoznaná ruptura bránice je závažný stav, který může vyústit v život ohrožující komplikaci inkarcerací břišních orgánů vyhřezlých do hrudníku. Na tuto diagnózu je nutné myslet u pacientů s gastrointestinálními či dechovými potížemi po vysokoenergetickém tupém traumatu břicha a hrudníku i s odstupem několika let od traumatu.

Introduction: Diaphragmatic rupture is a rare but life-threatening condition that occurs in 0.85% of surgically managed thoracoabdominal injuries. In most cases, the condition is accompanied by associated traumas responsible for poor prognosis. Signs of diaphragmatic rupture are often masked by more serious manifestations of the associated trauma. The rupture is usually revealed by an X-ray of the chest or CT scan. However, a minor defect may be missed, especially if the patient is not indicated for urgent surgery. Methods: The authors present 2 case reports of patients treated for chronic diaphragmatic rupture at the Department of Surgery of the Faculty of Medicine, Charles University and University Hospital in Pilsen between 01 January 2009 and 31 December 2021. The aim was to analyze the clinical data and to compare this data with literature. Results: Both patients with the chronic diaphragmatic rupture were men in their productive age. The mechanism of their primary trauma was a traffic accident. In the first case, the rupture was diagnosed 6 years after the trauma. The second case was diagnosed 14 years after the primary trauma. The diaphragmatic rupture was present on the left side in the first case and on the right in the other. Both patients underwent suture of the diaphragmatic defect via thoracotomy. Conclusion: Unrecognized diaphragmatic rupture is a severe condition that can result in a life-threatening complication, namely incarceration of abdominal organs dislocated to the chest. It is necessary to keep this diagnosis in mind in patients with gastrointestinal or respiratory problems after a previous high-energy, blunt-force abdominal and thoracic injury, even many years after the trauma.

• MeSH
• Diaphragm * surgery   diagnostic imaging   injuries   MeSH
• Accidents, Traffic MeSH
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Delayed Diagnosis adverse effects   MeSH
• Thoracic Injuries surgery   diagnostic imaging   complications   MeSH
• Rupture * surgery   complications   MeSH
• Wounds, Nonpenetrating surgery   diagnostic imaging   complications   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Publication type
• Case Reports 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
• Diaphragm diagnostic imaging   physiopathology   MeSH
• Electric Stimulation Therapy instrumentation   methods   MeSH
• Critical Illness MeSH
• Middle Aged MeSH
• Humans MeSH
• Phrenic Nerve physiology   MeSH
• Prospective Studies MeSH
• Respiratory Insufficiency therapy   MeSH
• Aged MeSH
• Muscular Atrophy etiology   physiopathology   MeSH
• Ultrasonography MeSH
• Respiration, Artificial adverse effects   methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

BACKGROUND AND AIMS: During laparoscopic surgery, a capnoperitoneum is created to optimize the operating space for surgeons. One effect of this is abdominal pressure which alters the physiological thoraco-abdominal configuration and pushes the diaphragm and lungs cranially. Since the lung image acquired by electrical impedance tomography (EIT) depends on the conditions within the thorax and abdomen, it is crucial to know the diaphragm position to determine the effect of diaphragm shift on EIT thorax image. METHODS: The presence of diaphragm in the region of EIT measurement was determined by ultrasound in 20 patients undergoing laparoscopic surgery. Data were obtained in the supine position during spontaneous breathing in a mechanically ventilated patient under general anesthesia with muscle relaxation and in a mechanically ventilated patient under general anesthesia with muscle relaxation during capnoperitoneum. RESULTS: The diaphragm was shifted cranially during capnoperitoneum. The diaphragm detection rate rose by 10% during capnoperitoneum at the fifth intercostal space, from 55% to 65% and by 10% from 0% at mid-sternal level compared to mechanical ventilation without capnoperitoneum. CONCLUSION: The diaphragm was detected in the area contributing to the creation of the thoracic EIT image. Considering the cranial shift of diaphragm caused by excessive intra-abdominal pressure, the impedance changes in the abdomen and the principle of EIT, we assume there could be a significant impact on EIT image of the thorax acquired during capnoperitoneum. For this reason, for lung monitoring using EIT during capnoperitoneum, the manufacturer's recommendation for electrode belt position is not appropriate. The study was registered in ClinicalTrials.gov with an identifier NCT03038061.

• MeSH
• Diaphragm diagnostic imaging   MeSH
• Electric Impedance * MeSH
• Thorax diagnostic imaging   MeSH
• Laparoscopy * MeSH
• Middle Aged MeSH
• Humans MeSH
• Lung diagnostic imaging   MeSH
• Pneumoperitoneum, Artificial methods   MeSH
• Tomography, X-Ray Computed * MeSH
• Prospective Studies MeSH
• Reproducibility of Results MeSH
• Aged MeSH
• Positive-Pressure Respiration MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Úvod: Ruptury bránice nejsou častými úrazy, mají však vzrůstající incidenci a lze říct, že jejich přítomnost bývá jistým indikátorem závažnosti poranění. Vyskytují se v naprosté většině u tupých poranění břicha a hrudníku a jsou součástí polytraumat či sdružených poranění. Kazuistika: V následujícím textu uvádíme tři kazuistiky námi léčených pacientů. U dvou byla ruptura bránice primárně ošetřena, u třetího pacienta byla diagnostikovaná ruptura bránice po 31 letech od úrazu obrazem ile­ózní náhlé příhody břišní. Diskuze: Ruptury bránice jsou poranění málo frekventní, často špatně diagnostikovatelná a i přehlédnuta, přesto ale svými důsledky mohou být zdrojem časných nebo pozdních komplikací. Nutné je na ruptury bránice myslet při tupých poranění břicha a hrudníku a u pádu z výše a cíleně po nich pátrat. Závěr: Včasná diagnóza ruptury bránice je rozhodující pro další management námi léčených pacientů.

Introduction: Ruptures of the diaphragm are not frequent injuries, but they have an increasing incidence and we can tell, that their presence is a certain indicator of the severity of the injury. Originate mostly from blunt abdomi­nal and chest trauma, they are often part of poly­trauma and multiple injuries. Case report: In the following text we present three case reports of patients treated by us. Two of the ruptures were treated immidiately after injury. The third patient was presented with rupture of the diaphragm 31 years after from the injury. Discussion: Diaphragm injuries are infrequent, often difficult to diagnose and even overlooked yet, but its consequences can be a source of early or late complications. It is necessary to think about the diaphragm injury in abdominal and chest trauma.

• Keywords
• ruptura bránice,
• MeSH
• Diaphragm * diagnostic imaging   surgery   injuries   MeSH
• Early Diagnosis MeSH
• Adult MeSH
• Humans MeSH
• Critical Care MeSH
• Multiple Trauma surgery   therapy   MeSH
• Rupture * diagnosis   surgery   complications   MeSH
• Aged, 80 and over MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Female MeSH
• Publication type
• Case Reports MeSH