• MeSH
• analgetika aplikace a dávkování   MeSH
• cévní onemocnění míchy * chirurgie   diagnóza   klasifikace   patologie   MeSH
• hyperestezie etiologie   patologie   MeSH
• lidé MeSH
• mícha krevní zásobení   patologie   MeSH
• mladý dospělý MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• dekomprese metody   MeSH
• elektrická stimulace metody   MeSH
• kmenové buňky MeSH
• lidé MeSH
• mícha krevní zásobení   patologie   MeSH
• nervová tkáň účinky léků   ultrastruktura   zranění   MeSH
• Nogo proteiny terapeutické užití   MeSH
• poranění míchy * farmakoterapie   klasifikace   komplikace   rehabilitace   terapie   MeSH
• výzkum MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

PURPOSE: The artery of Adamkiewicz (AKA) provides the major blood supply to the anterior thoracolumbar spinal cord and iatrogenic injury or inadequate reconstruction of this vessel during vascular and endovascular surgery can result in postoperative neurological deficit due to spinal cord ischemia. The aim of this study was to provide comprehensive data on the prevalence and anatomical characteristics of the AKA. METHODS: An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included study type, prevalence of the AKA, gender, number of AKA per patient, laterality, origin based on vertebral level, side of origin, morphometric data, and ethnicity subgroups. RESULTS: A total of 60 studies (n = 5437 subjects) were included in the meta-analysis. Our main findings revealed that the AKA was present in 84.6% of the population, and patients most frequently had a single AKA (87.4%) on the left side (76.6%) originating between T8 and L1 (89%). CONCLUSION: As an AKA is present in the majority of the population, caution should be taken during vascular and endovascular surgical procedures to avoid injury or ensure proper reconstruction. All surgeons operating in the thoracolumbar spinal cord should have a thorough understanding of the anatomical characteristics and surgical implications of an AKA.

• MeSH
• arterie anatomie a histologie   MeSH
• bederní obratle MeSH
• hrudní obratle MeSH
• lidé MeSH
• mícha krevní zásobení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

INTRODUCTION: Ventral sulcus spinal cord arteriovenous shunts (SCAVS) are rare vascular lesions that are located outside the spinal cord, are exclusively vascularized by the anterior spinal axis, and drain exclusively through the anterior spinal vein. We report the anatomical, clinical, and neuro-radiological features of SCAVS managed by our team. METHODS: We conducted a retrospective study of patients with SCAVSs evaluated by the senior author of this report (GR) between 1981 and 2014. Data were collected by reviewing clinical notes and by a systematic analysis of spinal angiograms and MRI. RESULTS: Among 358 patients, we identified 8 patients (3 women) with ventral sulcus spinal cord arteriovenous shunts. Mean age was 30.5 years. Six patients presented with progressive neurological symptoms, and two with acute neurological symptoms related to hematomyelia. Three shunts were located in the cervical cord, four in the thoracic cord, and one at the conus medullaris; there were two nidus type A-V shunts (AVMs) and six fistula type A-V shunts (AVFs). Seven patients were treated by endovascular therapy with glue embolization. Embolization led to anatomical cure in 5 cases, and a significant reduction of shunt volume and flow of more than 75% in 2 cases. In none of the cases we observed permanent morbidity. CONCLUSIONS: AVS of the ventral sulcus of the spinal cord are rare. Recognition of these lesions and precise localization of the anatomical space in which they are located, may allow a better understanding of their pathophysiology and clinical manifestations and guide proper therapeutic decisions.

• MeSH
• arteriovenózní malformace diagnostické zobrazování   terapie   MeSH
• dospělí MeSH
• kontrastní látky MeSH
• lidé MeSH
• magnetická rezonanční angiografie MeSH
• magnetická rezonanční tomografie metody   MeSH
• mícha krevní zásobení   MeSH
• retrospektivní studie MeSH
• terapeutická embolizace metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Arteriovenózní malformace (AVM) conus medullaris jsou velmi vzácné léze. V literatuře jsou popsány jen ojedinělé kazuistiky. První soubor 16 pacientů popsal v dubnu 2012 Spetzler. Jedná se o komplexní vysokoprůtokové léze v elokventní lokalizaci. Nejčastějšími příznaky jsou parézy dolních končetin, sfinkterové potíže a bolest. U třetiny případů se léze projeví krvácením. Autoři popisují případ 30leté pacientky s půlroční anamnézou progredujících obtíží. Její AVM conus medullaris byla odstraněna mikrochirurgicky s dobrým výsledkem. Jedná se o první případ úspěšně řešené AVM conus medullaris publikovaný v ČR. Z rozboru literatury i z vlastní zkušenosti vyplývá, že léčebný postup je individuální. Nejčastěji použitou léčebnou modalitou je kombinace endovaskulární obliterace s následnou excizní AVM nebo pouze otevřená operace. Dobré léčebné výsledky jsou možné u velké části pacientů.

Conus medullaris AVM is a very rare lesion. Only a few case reports have been described in the literature. The first cohort of 16 patients was described by Spetzler in April 2012. These AVMs are very complex, high‑flow lesions in eloquent area. The most frequent symptoms are paraparesis, sphincter disorders and pain. The lesion presents with bleeding in one third of patients. The authors describe a case of 30‑years old female with a half year history of slowly progressing symptoms. Her conus medullaris AVM was excised by microsurgery with a good result. This is the first case of a successfully treated conus medullaris AVM published in the Czech Republic. A literature review and our own experience suggest that the choice of treatment has to be individual. A combination of endovascular obli­teration followed by microsurgical excision or microsurgical excision only is the most commonly used treatment modality. Good treatment results are possible in a large proportion of patients.

• Klíčová slova
• endovaskulární léčba,
• MeSH
• angiografie MeSH
• arteriovenózní malformace * diagnóza   chirurgie   MeSH
• dospělí MeSH
• endovaskulární výkony * metody   MeSH
• lidé MeSH
• mícha * chirurgie   krevní zásobení   MeSH
• mikrochirurgie metody   MeSH
• paréza etiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Currently, there is no effective strategy for the treatment of spinal cord injury (SCI). A suitable combination of modern hydrogel materials, modified to effectively bridge the lesion cavity, combined with appropriate stem cell therapy seems to be a promising approach to repair spinal cord damage. We demonstrate the synergic effect of porosity and surface modification of hydrogels on mesenchymal stem cell (MSC) adhesiveness in vitro and their in vivo survival in an experimental model of SCI. MSCs were seeded on four different hydrogels: hydroxypropylmethacrylate-RGD prepared by heterophase separation (HPMA-HS-RGD) and three other hydrogels polymerized in the presence of a solid porogen: HPMA-SP, HPMA-SP-RGD, and hydroxy ethyl methacrylate [2-(methacryloyloxy)ethyl] trimethylammonium chloride (HEMA-MOETACl). Their adhesion capability and cell survival were evaluated at 1, 7, and 14 days after the seeding of MSCs on the hydrogel scaffolds. The cell-polymer scaffolds were then implanted into hemisected rat spinal cord, and MSC survival in vivo and the ingrowth of endogenous tissue elements were evaluated 1 month after implantation. In vitro data demonstrated that HEMA-MOETACl and HPMA-SP-RGD hydrogels were superior in the number of cells attached. In vivo, the highest cell survival was found in the HEMA-MOETACl hydrogels; however, only a small ingrowth of blood vessels and axons was observed. Both HPMA-SP and HPMA-SP-RGD hydrogels showed better survival of MSCs compared with the HPMA-HS-RGD hydrogel. The RGD sequence attached to both types of HPMA hydrogels significantly influenced the number of blood vessels inside the implanted hydrogels. Further, the porous structure of HPMA-SP hydrogels promoted a statistically significant greater ingrowth of axons and less connective tissue elements into the implant. Our results demonstrate that the physical and chemical properties of the HPMA-SP-RGD hydrogel show the best combination for bridging a spinal cord lesion, while the HEMA-MOETACl hydrogel serves as the best carrier of MSCs.

• MeSH
• axony účinky léků   fyziologie   MeSH
• buněčná adheze MeSH
• cholin analogy a deriváty   chemie   farmakologie   MeSH
• fyziologická neovaskularizace MeSH
• hydrogely chemie   farmakologie   MeSH
• kmenové buňky cytologie   účinky léků   fyziologie   MeSH
• krysa rodu rattus MeSH
• methakryláty chemie   farmakologie   MeSH
• mícha krevní zásobení   účinky léků   růst a vývoj   patologie   MeSH
• oligopeptidy chemie   farmakologie   MeSH
• poranění míchy terapie   MeSH
• poréznost MeSH
• potkani Wistar MeSH
• regenerace nervu účinky léků   MeSH
• tkáňové podpůrné struktury MeSH
• transplantace kmenových buněk MeSH
• viabilita buněk MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

• MeSH
• bibliometrie MeSH
• centrální nervový systém anatomie a histologie   MeSH
• eponyma MeSH
• MEDLINE MeSH
• mícha krevní zásobení   MeSH
• patologie MeSH
• Publikační typ
• biografie MeSH

• O autorovi
• Adamkiewicz, Albert, 1850-1921 Autorita

• MeSH
• chronická nemoc MeSH
• lidé MeSH
• mícha krevní zásobení   MeSH
• prediktivní hodnota testů MeSH
• regionální krevní průtok MeSH
• roztroušená skleróza etiologie   patofyziologie   terapie   MeSH
• stenóza etiologie   terapie   ultrasonografie   MeSH
• venae jugulares patofyziologie   ultrasonografie   MeSH
• žilní insuficience patofyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• klinické zkoušky MeSH
• novinové články MeSH
• rozhovory MeSH

OBJECT: Hydrogels are nontoxic, chemically inert synthetic polymers with a high water content and large surface area that provide mechanical support for cells and axons when implanted into spinal cord tissue. METHODS: Macroporous hydrogels based on 2-hydroxyethyl methacrylate (HEMA) were prepared by radical copolymerization of monomers in the presence of fractionated NaCl particles. Male Wistar rats underwent complete spinal cord transection at the T-9 level. To bridge the lesion, positively charged HEMA hydrogels were implanted either immediately or 1 week after spinal cord transection; control animals were left untreated. Histological evaluation was performed 3 months after spinal cord transection to measure the volume of the pseudocyst cavities and the ingrowth of tissue elements into the hydrogels. RESULTS: The hydrogel implants adhered well to the spinal cord tissue. Histological evaluation showed ingrowth of connective tissue elements, blood vessels, neurofilaments, and Schwann cells into the hydrogels. Morphometric analysis of lesions showed a statistically significant reduction in pseudocyst volume in the treated animals compared with controls and in the delayed treatment group compared with the immediate treatment group (p < 0.001 and p < 0.05, respectively). CONCLUSIONS: Positively charged HEMA hydrogels can bridge a posttraumatic spinal cord cavity and provide a scaffold for the ingrowth of regenerating axons. The results indicate that delayed implantation can be more effective than immediate reconstructive surgery.

• MeSH
• axony fyziologie   patologie   MeSH
• biokompatibilní materiály chemie   terapeutické užití   MeSH
• časové faktory MeSH
• cysty patologie   MeSH
• financování organizované MeSH
• hojení ran fyziologie   MeSH
• hydrogely chemie   terapeutické užití   MeSH
• krysa rodu rattus MeSH
• methakryláty chemie   terapeutické užití   MeSH
• mícha krevní zásobení   patologie   MeSH
• modely nemocí na zvířatech MeSH
• neurofibrily ultrastruktura   MeSH
• paraplegie patofyziologie   MeSH
• pojivová tkáň patologie   MeSH
• poranění míchy chirurgie   MeSH
• potkani Wistar MeSH
• regenerace nervu fyziologie   MeSH
• řízená tkáňová regenerace MeSH
• Schwannovy buňky patologie   MeSH
• tkáňové podpůrné struktury MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• srovnávací studie MeSH

Authors present the case of a patient who suffered the blunt thoracic trauma. In the clinical picture there dominated the paraplegia of both the lower extremities. Due to the weakened breathing on the right side the urgent thoracic drainage was performed. For circulation instability and amount of blood passing out of the drain an urgent thoracotomy was indicated even prior to the CT or MRI. During the operation bleeding from the Adamkiewicz's artery was spotted and sanated. After the postoperative stabilization the CT and MRI investigations proved the spinal cord ischemia as a cause of the local damage.

• MeSH
• dospělí MeSH
• ischemie etiologie   MeSH
• lidé MeSH
• mícha krevní zásobení   MeSH
• motocykly MeSH
• poranění hrudníku komplikace   MeSH
• sportovní úrazy patologie   MeSH
• tupá poranění komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH