V článku autoři popisují způsob zavedení postmortem CT angiografie do praxe na Ústavu soudního lékařství Fakultní nemocnice Ostrava v případech bodnořezných poranění končetin. Detailně je popsána nezbytná příprava cévního řečiště před provedením samotné angiografie, způsob aplikace kontrastní látky do cévního řečiště i praktické tipy usnadňující následné provedení konvenční pitvy. Stručně je uveden rovněž souhrn publikovaných prací zabývající se problematikou postmortem CT angiografie, popisující nejen její nesporné výhody, ale také limity a úskalí, která s sebou tato metoda přináší. Adresa pro korespondenci: MUDr. Bc. Jana Mertová Ústav soudního lékařství FN Ostrava 17. listopadu 1790/5, 708 52 Ostrava-Poruba Tel.: +420 597 371 713 Fax: +420 597 371 706 E-mail: jana.mertova@fno.cz Delivered: June 24, 2024 Accepted: July 24, 2024
This article describes a method of introducing postmortem CT angiography into daily forensic medicine practice involving cases of limb stab wounds investigated at the Department of Forensic Medicine, University Hospital Ostrava. The essential preparation of the vessels as well as practical tips facilitating the subsequent performance of a classic autopsy are described in detail. Article also includes brief review of published papers dealing with PMCT angiography related issues, advantages which brings CT angiography into forensic routine work, but also its limits and pitfalls.
- MeSH
- Agar MeSH
- Biomedical Research methods MeSH
- Computed Tomography Angiography methods instrumentation MeSH
- Forensic Imaging methods instrumentation MeSH
- Extremities diagnostic imaging injuries MeSH
- Contrast Media MeSH
- Humans MeSH
- Wounds, Penetrating * diagnostic imaging MeSH
- Autopsy MeSH
- Postmortem Imaging * methods instrumentation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Keywords
- laloková plastika,
- MeSH
- Achilles Tendon surgery pathology MeSH
- Leg surgery diagnostic imaging pathology MeSH
- Surgical Flaps * surgery adverse effects MeSH
- Lower Extremity anatomy & histology surgery diagnostic imaging blood supply pathology injuries MeSH
- Femur surgery diagnostic imaging pathology injuries MeSH
- Fractures, Bone surgery diagnostic imaging pathology MeSH
- Upper Extremity anatomy & histology surgery diagnostic imaging blood supply pathology injuries MeSH
- Humerus anatomy & histology surgery diagnostic imaging blood supply MeSH
- Clavicle surgery MeSH
- Extremities anatomy & histology surgery diagnostic imaging blood supply pathology injuries MeSH
- Muscle, Skeletal surgery MeSH
- Foot Bones anatomy & histology surgery diagnostic imaging blood supply injuries MeSH
- Humans MeSH
- Metacarpal Bones surgery diagnostic imaging MeSH
- Metacarpus surgery diagnostic imaging MeSH
- Metatarsophalangeal Joint surgery MeSH
- Foot anatomy & histology surgery diagnostic imaging blood supply pathology MeSH
- Orthopedic Procedures methods adverse effects MeSH
- Osteomyelitis surgery MeSH
- Calcaneus anatomy & histology surgery diagnostic imaging blood supply pathology injuries MeSH
- Surgery, Plastic methods adverse effects MeSH
- Lunate Bone surgery diagnostic imaging MeSH
- Leg Injuries surgery diagnostic imaging pathology MeSH
- Foot Injuries surgery diagnostic imaging pathology MeSH
- Forearm Injuries surgery diagnostic imaging MeSH
- Finger Injuries surgery diagnostic imaging pathology MeSH
- Hand Injuries surgery diagnostic imaging pathology MeSH
- Fingers surgery diagnostic imaging blood supply pathology transplantation MeSH
- Pseudarthrosis surgery diagnostic imaging MeSH
- Hand surgery diagnostic imaging pathology MeSH
- Thigh surgery diagnostic imaging pathology injuries MeSH
- Talus anatomy & histology surgery diagnostic imaging injuries MeSH
- Tarsal Bones surgery diagnostic imaging pathology MeSH
- Plastic Surgery Procedures methods adverse effects MeSH
- Wrist anatomy & histology diagnostic imaging innervation MeSH
- Check Tag
- Humans MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
Výpočet dávky cytostatik je nejčastěji odvozen od tělesného povrchu (Body Surface Area, BSA) či tělesné hmotnosti, pacienti po amputaci končetin však vykazují odchylky od běžných schémat pro výpočet BSA. Kazuistika prezentuje pacienta po amputaci horní a dolní končetiny, léčeného chemoradioterapií pro nádor tonzily. Podávána byla cisplatina v týdenních intervalech celkem 6 sérií, v kombinaci s radioterapií. V daném případě bylo s ohledem na nekompletní tělesnou schránku nutno upravit dávku cytostatika, resp. modifikovat výpočet BSA. Teoretický BSA byl korigován pomocí „pravidla devíti“, tedy dle obecně akceptovaného odhadu, že přední a zadní strana dolní končetiny a každá horní končetina představují vždy cca 9 % tělesného povrchu. Dále byly při úpravě dávky zavzaty do úvahy omezeně vypovídající ukazatele renálních funkcí (kreatinin i cystatin C mají vlivem absence končetin modifikovánu bazální produkci) a kinetika cisplatiny. V diskuzi je nadnesena myšlenka, zda takováto korekce dávky pomocí úpravy výpočtu BSA je univerzálně použitelná u všech cytostatik, či zda je nutno vzít v úvahu další faktory, jako míru vazby na plazmatické bílkoviny, metabolizaci léčiva či distribuci do specifických tkání. Odpovědi na tyto otázky zůstávají nejasné.
The dose of cytotoxic drugs is often calculated by the body surface area (BSA) or body weight. However, patiens after limb amputation cannot be estimated by standard calculation of BSA. This case shows patient after amputation of the arm and leg, treated for tonsil cancer by chemoradiotherapy. Cisplatin was administred weekly, 6 series with concomitant radiotherapy. The dose was adjusted to incomplet body constitution, according to modified BSA calculation. BSA was modified by the „rule of nines“, known from burn medicine, where every side of leg and every arm takes 9 % of the BSA. There was also involved modified renal function parameters (creatinine and cystatine C have a smaller production), and cisplatin kinetics respectively. This correction and its use in other cytotoxic drugs, pharmacokinetics and other factors (protein binding, metabolism, specific distribution, etc.) is discussed. Many of these questions are without clear answer.
- MeSH
- Amputation, Surgical MeSH
- Chemoradiotherapy * methods MeSH
- Cisplatin administration & dosage MeSH
- Adult MeSH
- Extremities pathology injuries MeSH
- Humans MeSH
- Body Surface Area MeSH
- Tonsillar Neoplasms drug therapy MeSH
- Drug Dosage Calculations * MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
OBJECTIVES: The aim of this study was to assess fractures of extremities, spine and pelvis in patients with respect to mechanism, time of the incident and demography of patients in order to propose preventive measures. METHODS: A mono-centric (Level I Trauma Centre, predominantly urban population) prospective study was carried-out during the one-year period from 1 January to 31 December 2012. Patients with bone fractures of extremities, spine and pelvis were studied. Demography, mechanism and time of the injury were analysed. RESULTS: The study group consisted of 3,148 patients, 53% being women and treated for 3,909 fractures. The mean age of patients was 53 years. The most traumatised patients were of the 3rd and 4th decade, a further increase in the incidence of fractures was seen in the 7th and 9th decade. Multiple fractures were significantly higher in men (p = 0.002). A car crash or fall from a height was more common cause of spinal fracture or pelvic fracture than fracture to the upper or lower limbs (p < 0.001). Most of the fractures occurred during the day between 9 a.m. and 6 p.m., on Saturdays and during the winter season. The bones most often broken were the radius (739 patients, 18.5%) and femur (436 patients, 11.1%). CONCLUSIONS: Our study highlights the need for injury prevention focused on sex, age and types of activities performed. Among younger individuals, such programmes should primarily be targeted toward men who, as observed in our sample, have a higher fracture frequency compared to women. Conversely, injury prevention programmes for individuals ≥ 60 years should primarily be targeted toward women, who have the highest fracture prevalence in this population.
- MeSH
- Adult MeSH
- Fractures, Bone epidemiology prevention & control therapy MeSH
- Spinal Fractures epidemiology prevention & control therapy MeSH
- Incidence MeSH
- Extremities injuries MeSH
- Middle Aged MeSH
- Humans MeSH
- Pelvic Bones injuries MeSH
- Prospective Studies MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Keywords
- radionekróza,
- MeSH
- Central Nervous System pathology MeSH
- Decompression Sickness diagnosis etiology classification physiopathology prevention & control therapy MeSH
- Diabetic Foot therapy MeSH
- Child MeSH
- Adult MeSH
- Fasciitis, Necrotizing etiology classification pathology MeSH
- Wound Healing MeSH
- Hyperbaric Oxygenation * standards MeSH
- Soft Tissue Infections etiology classification complications microbiology pathology MeSH
- Ischemia therapy MeSH
- Clinical Studies as Topic MeSH
- Clostridium Infections pathology MeSH
- Extremities injuries MeSH
- Humans MeSH
- Urinary Bladder radiation effects MeSH
- Brain pathology MeSH
- Myocardium pathology MeSH
- Tumor Hypoxia MeSH
- Necrosis etiology therapy MeSH
- Neuroblastoma therapy MeSH
- Osteoradionecrosis MeSH
- Carbon Monoxide Poisoning history diagnosis epidemiology etiology complications mortality physiopathology pathology prevention & control therapy MeSH
- Oxygen Inhalation Therapy classification instrumentation MeSH
- Postoperative Complications etiology therapy MeSH
- Auditory Perceptual Disorders etiology therapy MeSH
- Hearing Disorders classification therapy MeSH
- Diving adverse effects MeSH
- Surveys and Questionnaires MeSH
- Radiation Injuries physiopathology pathology MeSH
- Wounds and Injuries classification physiopathology pathology therapy MeSH
- Rectum radiation effects MeSH
- Practice Guidelines as Topic MeSH
- Tinnitus therapy MeSH
- Radiation Tolerance MeSH
- Blood Gas Monitoring, Transcutaneous MeSH
- Accidents MeSH
- Ulcer classification physiopathology therapy MeSH
- Treatment Outcome MeSH
- Embolism, Air diagnosis etiology classification physiopathology therapy MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
- MeSH
- Splints utilization MeSH
- Drug Therapy methods utilization MeSH
- Fracture Fixation methods utilization MeSH
- Fractures, Bone * diagnosis etiology therapy MeSH
- Spinal Fractures diagnosis therapy MeSH
- Spinal Fusion methods utilization MeSH
- Fracture Fixation, Intramedullary methods trends utilization MeSH
- Extremities injuries MeSH
- Bone Cements MeSH
- Bone Screws utilization MeSH
- Humans MeSH
- Orthopedic Procedures * methods utilization MeSH
- Osteoporosis * diagnosis complications prevention & control MeSH
- Check Tag
- Humans MeSH
- MeSH
- Surgical Procedures, Operative MeSH
- Ischemia MeSH
- Extremities * injuries MeSH
- Humans MeSH
- Postoperative Complications MeSH
- Policy MeSH
- Replantation * history classification contraindications methods utilization MeSH
- Sutures MeSH
- Amputation, Traumatic * surgery MeSH
- Accidents MeSH
- Fracture Fixation, Internal MeSH
- Treatment Outcome MeSH
- Plastic Surgery Procedures MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
x
x
- Keywords
- podtlaková terapie ran (NPWT),
- MeSH
- Amputation, Surgical statistics & numerical data MeSH
- Anesthesia, General MeSH
- Wound Healing MeSH
- Wound Infection * etiology prevention & control MeSH
- Extremities surgery injuries MeSH
- Middle Aged MeSH
- Humans MeSH
- Bandages, Hydrocolloid statistics & numerical data MeSH
- Fractures, Open * surgery complications MeSH
- Postoperative Complications MeSH
- Soft Tissue Injuries * therapy MeSH
- Retrospective Studies MeSH
- Negative-Pressure Wound Therapy * methods statistics & numerical data MeSH
- Trauma Severity Indices MeSH
- Accidents MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Comparative Study MeSH
