PURPOSE OF THE STUDY: Intertrochanteric hip fractures in elderly patients are a significant cause of morbidity and mortality, with increasing incidence due to the aging population. Despite advancements in intramedullary nailing (IMN) technology, fixation failure remains a concern. This study aims to evaluate pre-and postoperative radiographic risk factors for varus collapse in geriatric intertrochanteric fractures treated with twin interlocking derotation and compression screw cephalomedullary nail (InterTAN, Smith & Nephew). MATERIAL AND METHODS: This retrospective study included patients over 60 years with AO 31A1 and 31A2 intertrochanteric femur fractures treated with InterTAN at a tertiary referral center from August 2012 to August 2017. Patients with high-energy fractures, AO 31A3 fractures, or those requiring open reduction were excluded. Data on demographics, fracture classification, implant sizes, imaging studies, and follow-up were collected. Radiographic assessments included Chang's medial cortical support concept, tip-apex distance (TAD), calcar-referenced TAD (CalTAD), neck-shaft angles (NSA), and screw placement according to Cleveland zones. Varus collapse was defined as a >5° change in NSA within three months postoperatively. Multivariate logistic regression analysis was used to identify risk factors for varus collapse. RESULTS: The study included 136 patients with a mean age of 79.8 years, of whom 38.2% were male. The early postoperative tipapex distance (TAD) averaged 21.9mm, with 30.1% of patients experiencing varus collapse greater than 5°. Positive medial cortical support (PMCS) or neutral position (NP) type reduction was highly protective against varus collapse (p < 0.001), as well as TAD less than 25mm (p < 0.001). Additionally, the placement of screws in the central-central or central-inferior zones provided a protective effect against varus collapse (p = 0.031). Conversely, having an OTA/AO type A2.2 or A2.3 fracture significantly increased the risk of varus collapse (p = 0.030). Other factors, such as CalTAD and the nail width to medullary canal ratio, did not significantly predict varus collapse (p = 0.831 and p = 0.952, respectively). DISCUSSION: Our findings align with previous studies highlighting TAD and screw placement as critical factors in preventing fixation failure. The protective effect of PMCS or NP reduction and the increased risk associated with OTA/AO type A2.2 and A2.3 fractures are noteworthy. Unlike previous studies, CalTAD was not significantly associated with varus collapse in our cohort. The study underscores the importance of surgical technique and radiographic parameters in optimizing outcomes for elderly patients with intertrochanteric fractures. CONCLUSIONS: In elderly patients treated with InterTAN nails, varus collapse is influenced by fracture type, TAD, reduction quality, and screw placement. Ensuring a TAD <25mm, achieving PMCS or NP reduction, and placing screws in central-central or central-inferior zones are crucial for minimizing varus collapse. These findings highlight the importance of meticulous surgical technique and radiographic assessment in managing intertrochanteric fractures in the elderly. KEY WORDS: hip fractures, intertrochanteric fractures, internal Fixation, geriatrics, cephalomedullary nail.

• MeSH
• Hip Fractures * surgery   MeSH
• Fracture Fixation, Intramedullary * methods   instrumentation   adverse effects   MeSH
• Bone Nails * MeSH
• Bone Screws * adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Postoperative Complications etiology   epidemiology   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Prosthesis Failure MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Úvod: Sakrální neuromodulace/stimulace sakrálního nervu (SNM/SNS) se stala v posledních 10 letech nejúspěšnější metodou léčby fekální inkontinence (FI). Vysoká efektivita SNM spočívá v elektrické stimulaci zevního análního svěrače a mechanismus účinku je vysvětlován i modulací somatoviscerálních reflexů a percepce aferentních informací. Účinek je proto komplexní na rozdíl od ostatních metod. V České republice byla SNM poprvé provedena 2010 za podpory grantu IGA MZ ČR. Od 2018 byla v ČR ustanovena dvě specializovaná centra pro léčbu FI metodou SNM. Metoda: V letech 2010–2020 bylo k SNM indikováno 35 pacientů, z toho 34 žen a jediný muž. Průměrný věk byl 62 let (v rozmezí 46–75). Převažovali pacienti v pokročilejším věku s maximem v 6. a 7. deceniu. U všech pacientů byly provedeny obě diagnostické fáze, tj. perkutánní vyšetření sakrálních nervů S2−S4 s implantací stimulační elektrody Medtronic 3889-28 cm a jejím napojením na zevní stimulátor a následná subchronická stimulace po dobu 14–28 dní. Kritériem pro indikaci k implantaci permanentního neurostimulátoru bylo minimálně 50% snížení epizod FI týdně nebo 50% snížení skóre inkontinence. Pacientům byl poté implantován permanentní neurostimulátor Medtronic InterStim II 3058. Výsledky: Permanentní neurostimulátor byl implantován u 33 z 35 pacientů (94 %). Letalita byla nulová. Morbidita byla 11,4 %. U 2 pacientů šlo o pooperační lokální infekci, jednou o malpozici stimulátoru po pádu a jednou o zalomení elektrody po pádu s malfunkcí stimulátoru. Všechny komplikace byly úspěšně vyřešeny reoperací. Dlouhodobý efekt SNM byl hodnocen u skupiny prvních 15 pacientů z let 2010–2011. Z nich bylo k dispozici 9 pacientů, u nichž byla 2018–2020 z důvodu vybití baterie provedena reimplantace nového neurostimulátoru. Průměrná délka sledování byla 112 měsíců (99–124). Průměrný počet epizod FI za týden činil 1,9 (0−13) ve srovnání s počtem epizod FI 13,6 (3–25) před stimulací a Cleveland Clinic Incontinence Score (CCIS) bylo 8,3 (3−16) ve srovnání s CCIS 18,8 (15−20) před stimulací. Hodnoty počtu epizod FI i CCIS byly signifikantně nižší než před stimulací (p<0,05). Podle PP (per protocol) analýzy u všech 9 pacientů (64,3 %) přetrvává i po 8–10 letech minimálně 50% zlepšení kontinence, resp. snížení epizod FI ve srovnání se stavem před primoimplantací a plné kontinence bylo dosaženo u 4 pacientů (28,6 %). Závěr: Sakrální neuromodulace je efektivní a bezpečná minimálně invazivní metoda léčby těžké fekální inkontinence. U více než poloviny pacientů je pozorován i příznivý dlouhodobý efekt. Úspěšnost SNM spočívá v pečlivém výběru pacientů, technickém provedení i zkušenostech specializovaného pracoviště.

Introduction: Sacral neuromodulation/sacral nerve stimulation (SNM/SNS) has become the most successful method for treatment of faecal incontinence (FI) in the last 10 years. The high efficiency of SNM is based on the electrical stimulation of the external anal sphincter and moreover the mechanism of action of SNS can be explained by the modulation of somatovisceral reflexes and perceptions of afferent information. Therefore the mechanism of action is more complex in contrast to other methods of treatment. In the Czech Republic, the SNM was implemented for the first time in 2010 with the financial support of the IGA grant of the Ministry of Health of the Czech Republic. Since 2018, two specialized centres for the treatment of FI using the SNM method have been established in the Czech Republic. Methods: In the years 2010−2020, 35 patients were indicated for SNM. The ratio of women to men was 34:1. The mean age at implantation was 62 years (range 46−75). Most patients were in the 6th and 7th decade. Two diagnostic procedures were performed in all patients, percutaneous evaluation of the S2−S4 sacral nerves, implantation of the Medtronic 3889 28cm stimulation tined lead electrode and its connection to an external stimulator and subsequent subchronic stimulation for 2−4 weeks. The criteria for permanent neurostimulator implantation were a minimum 50% reduction in the number of FI episodes per week or a 50% reduction in incontinence score. Patients were then implanted with a Medtronic InterStim II 3058 permanent neurostimulator. Results: A permanent neurostimulator was implanted in 33 of 35 patients (94%). No patient died. The complication rate was 11.4%. In 2 patients it was an infectious complication. In one patient malposition of the stimulator occurred after falling down and in one patient we observed lead breakage with subsequent malfunction of the stimulator after falling down. All complications were successfully resolved by reoperation. The longterm effect of SNM was evaluated in the group of the first 15 implanted patients from 2010−2011. Of these, 9 patients were available, in whom a new neurostimulator was reimplanted due to loss of battery power in 2018−2020. The mean length of follow-up was 112 months (99−124). The mean number of FI episodes per week was 1.9 (0−13) after neurostimulator implantation compared to 13.6 (3−25) before implantation. The Cleveland Clinic Incontinence Score (CCIS) was 8.3 (3−16) after neurostimulator implantation compared to CCIS 18.8 (15−20) before implantation. Both FI episode counts and CCIS scores were significantly lower (p<0.05). According to PP (per protocol) analysis, in 64.3% of patients at least 50% improvement of continence or reduction of FI episodes persists after 8−10 years in comparison with the condition before primary implantation; full continence was achieved in 4 patients (28.6%). Conclusion: Sacral neuromodulation is an effective and safe minimally invasive method for the treatment of severe faecal incontinence. A beneficial long-term effect is observed in more than half of the patients. Successful outcomes of SNM depend on careful selection of patients, precise electrode placement technique and experience of the specialized centre.

• Keywords
• sakrální neuromodulace, stimulace sakrálního nervu,
• MeSH
• Electric Stimulation * methods   MeSH
• Fecal Incontinence * therapy   MeSH
• Humans MeSH
• Retrospective Studies MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH

Úvod: Fibrilace síní (FS) je zatížena velkým rizikem cévní mozkové příhody (CMP). Zásadní roli v etiopatognezi hraje ouško (LAA) levé síně (LS). Až 95 % trombů u nevalvulární FS je lokalizováno v oušku. Prevence CMP pak spočívá v trvalé antikoagulaci, která ale má své limity a rizika. Alternativní metodou je okluze ouška LS. V našem sdělení bychom rádi prezentovali novou možnost uzávěru pomocí epikardiálního systému AtriClip (AtriCure). Metodika: V období od července roku 2012 do září roku 2015 jsme uzavřeli ouško LS u 101 pacientů. Průměrný věk 65 ? 6 let, 47 žen, CHA2DS2 VASc (?) 2,47 (0–6). Sledování 1 837 (? 18,5) měsíců. Konkomitantní procedura byla provedena u 37 pacientů, endoskopický MAZE plus klip 57 u pacientů a izolovaně byl klip implantován u 7 pacientů. Klip byl naložen z plné sternotomie, minitorakotomie nebo torakoskopicky. Naložení klipu, zbytkový recesus a endoleak byly hodnoceny jícnovým ultrazvukem podle Clevelandských kritérií. Výsledky: Perioperační úspěšnost naložení byla 98%. Klip byl naložen s více než 1cm krčkem u 2 nemocných. Nedošlo k žádné migraci klipu, nebyl detekován žádný endoleak, nebyl detekován žádný trombus v bázi ouška. Periprocedurálně jsme zaznamenali jednu CMP. V následném sledování se u 4 pacientů objevila TIA a nebyla zaznamenána CMP. Závěr: Epikardiální okluze ouška LS systémem AtriClip je bezpečná a reprodukovatelná metoda uzávěru ouška LS a mohla by se stát důležitou alternativou v prevenci cévních mozkových příhod.

Introduction: Atrial fibrillation (AFib) is related to a high risk of stroke. The main role in etiopathogenesis is played by the left atrial appendage (LAA). As many as 95 % of thrombi in nonvalvular atrial fibrillation are located in the appendage. Prevention of stroke then consists in permanent anticoagulation which, however, has its limits and risks. An alternative method is the left atrial appendage occlusion. In our report, we would like to present a new possibility of the closure using the epicardial system AtriClip (AtriCure). Methodology: In the period beginning in July 2012 – September 2015 we performed LAA closure in 101 patients. A mean age of 65 ? 6 years, 47 women, CHA2DS2 VASc (?) 2.47 (0–6). Monitoring 1 837 (? 18.5) months. A concomitant procedure was performed in 37 patients, endoscopic MAZE plus clip in 57 patients, and 7 patients underwent stand-alone implantation of the clip. The clip was implanted from full sternotomy, minitoracotomy or through thoracoscopy. Clip loading, residual recess and endoleak were assessed through endoscopic ultrasound according to the Cleveland criteria. Results: The perioperative success rate of loading reached 98 %. The clip was loaded with a neck greater than 1 cm in 2 patients. No migration of the clip occurred, no endoleak was detected and no thrombus at the appendage base was detected. One case of periprocedural stroke was recorded. Within follow-up monitoring TIA occurred in 4 patients and no stroke was recorded. Conclusion: Epicardial LAA occlusion using the AtriClip system is a safe and reproducible method of LAA occlusion and an important alternative in the prevention of stroke.

• MeSH
• Anticoagulants therapeutic use   MeSH
• Stroke prevention & control   MeSH
• Atrial Fibrillation diagnosis   prevention & control   therapy   MeSH
• Clinical Trials as Topic MeSH
• Humans MeSH
• Atrial Appendage * surgery   MeSH
• Treatment Outcome MeSH
• Warfarin therapeutic use   MeSH
• Check Tag
• Humans MeSH

BACKGROUND: Fecal incontinence (FI) is a significant health problem among the elderly, with a devastating effect on their quality of life. The aim of the present study was to describe the prevalence and severity of FI among nursing home residents, and to investigate factors associated with FI. METHODS: This was a cross-sectional study conducted in nursing homes in Ostrava, Czech Republic. Demographics and comorbidities were extracted from medical records of nursing homes. Data regarding incontinence were obtained via face-to-face interviews with residents or extracted from registered nurses' accounts (regarding residents with severe cognitive impairment). RESULTS: In total, 588 nursing home residents were enrolled into the study. FI was noted in 336 (57.1%) participating residents. The majority of FI residents (57.8%) reported FI episodes several times a week; daily FI episodes were found in 22.9% of the FI residents. The mean Cleveland Clinic Incontinence Score in FI residents was 17.2±1.8 (mean±SD). Factors associated with FI (statistically significant) were poor general health status (≥4 comorbidities), urinary incontinence, cognitive-function impairment (dementia), decreased mobility, and length of nursing home residency. There was no association between FI and age, sex, body mass index, or living with/without a partner. CONCLUSIONS: Our data indicate that FI is still a serious health problem-FI currently affects more than half of the nursing home residents in Ostrava, Czech Republic. The study outcomes (revealed high prevalence and seriousness of FI) emphasize the importance of close monitoring and appropriately managing FI in nursing home residents.

• MeSH
• Homes for the Aged statistics & numerical data   MeSH
• Fecal Incontinence epidemiology   MeSH
• Cognition Disorders epidemiology   MeSH
• Comorbidity MeSH
• Quality of Life MeSH
• Humans MeSH
• Nursing Homes statistics & numerical data   MeSH
• Prevalence MeSH
• Cross-Sectional Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Health Status MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic epidemiology   MeSH

BACKGROUND: Complexity of logistic issues related to facial transplantation includes donor tissue recovery, recipient preparation, and operative execution. Limited information is available on the intricate process associated with facial allograft procurement in the United States. METHODS: The face transplant teams at the Cleveland Clinic and Brigham and Women's Hospital have combined their experiences regarding collaboration with organ procurement organizations and institutional review boards, and outlined technical and logistic challenges encountered during the process of facial allograft procurement and compared them with those of solid organ procurement. RESULTS: In a collaborative effort, both programs have created comprehensive guidelines for all aspects involved in donor facial allograft procurement. CONCLUSIONS: The authors suggest that every face transplant team should develop a thorough understanding of the local and regional legislative issues related to organ and tissue donation and ethical concerns surrounding this procedure. The recovery plan has to be communicated extensively among all members of the team. The Cleveland and Boston teams hope their experiences may help other teams in the process of building new face transplant programs. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

• MeSH
• Tissue Donors * MeSH
• Transplantation, Homologous MeSH
• Humans MeSH
• Facial Transplantation standards   MeSH
• Tissue and Organ Procurement standards   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Boston MeSH
• Ohio MeSH

Způsob nutrice cestou PEG (perkutánní endoskopická gastrostomie) je v současné době velice používaný a elegantní způsob, jak indikované nemocné vyživovat. O oblíbenosti svědčí prudký nárůst, který tato metoda v naší republice zaznamenala od doby jejího zavedení do praxe na počátku 90. let 20. století. Perkutánní endoskopickou gastrostomii poprvé v historii realizoval dr. Michael W.L. Gauderer, pediatr, který ji v roce 1979 zavedl v univerzitní nemocnici v Clevelandu 4 měsíčnímu kojenci. V současnosti jsou k zavedení PEG indikovaní ti nemocní, kteří se nacházejí v riziku malnutrice nebo již malnutričtí jsou. Dalším indikujícím kritériem je předpoklad dlouhodobější nutriční terapie, a to delší než 6 týdnů. V práci analyzujeme některé demografické a psychosociální faktory implantace PEG z hradecké nemocnice v 2,5 ročním období.

The nutrition via PEG (Percutaneous Endoscopy Gastrostomy) is presently a very common and gentle way to nourish indicated patients. This method's popularity in the Czech Republic is shown by a massive increase in its application since it was first introduced in the early 1990s. This method was first realized by a paediatrician, Dr. Michael W. L. Gauderer, in 1979 at the University Hospital in Cleveland, where he used it for a 4 month old infant. Today patients in need of the PEG implementation are those who are at risk of malnutrition or those who are malnourished. Assumption of a long term nutritional therapy, especially longer than 6 weeks, is another implementation criterion. In this article we are analysing some of demographic and psychosocial factors of PEG implementation during 2.5 - year period at university hospital Hradec Králové.

• MeSH
• Endoscopy, Digestive System MeSH
• Gastrointestinal Diseases MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• gastroenterologie
• radiologie, nukleární medicína a zobrazovací metody

• MeSH
• Central Nervous System MeSH
• Image Interpretation, Computer-Assisted MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• neurochirurgie

• MeSH
• Pathology MeSH
• Heart-Assist Devices MeSH
• Heart, Artificial MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• kardiologie
• patologie

• MeSH
• General Surgery history   MeSH
• History of Medicine MeSH
• Military Medicine MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Lékařské vědy. Lékařství
• NML Fields
• dějiny lékařství
• vojenské lékařství