Gravidita po augmentační enterocystoplastice se stává stále častějším jevem u žen s kongenitálními anomáliemi nebo s neurogenním močovým měchýřem. Možné komplikace v graviditě a v období kolem porodu a jejich řešení uvádějí autoři na základě vlastní kazuistiky u 221eté primipary po ileocekální augmentaci a shrnují zatím jen omezené zahraniční údaje.
Pregnancy after augmentation enterocystoplasty is an increasingly frequent phenomenon in women with congenital anomalies or a neurogenic urinary bladder. Possible complications during pregnancy and the period near delivery and their treatment is described by the authors, based on the case-history of a 22-year-old primipara after ileocoecal augmentation. The authors summarise the so far scarce data reported in the literature.
- MeSH
- Adult MeSH
- Pregnancy Complications MeSH
- Humans MeSH
- Urinary Bladder abnormalities surgery MeSH
- Urinary Bladder, Neurogenic surgery MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Osteoporotic vertebral fractures can be treated by minimally invasive percutaneous vertebral augmentation with bone cement using vertebroplasty or balloon kyphoplasty. Transcutaneous reduction and vertebral body stenting has been the most recent principle. In contrast to balloon placement in kyphoplasty, the stent remains in the vertebral body and supports both the vertebral body and cement filling. In this retrospective study we present the essential information on the method and our first results. MATERIAL AND METHODS: The method of vertebral body stent placement was used in 22 patients treated at 29 levels. Of these, 19 patients with 26 segments followed up for 3 months were evaluated. The group included 12 women and seven men with an average age of 68.3 years (12 to 83). The patients assessed their subjective complaints on the visual analogue scale (VAS) before surgery, and then at 1, 6 and 12 weeks post-operatively. The value of vertebral body reduction was obtained by measurement of anterior, middle and posterior vertebral body heights (AVBH, MVBH and PVBH, respectively) and a change in the vertebral body kyphotic angle (VBKA). RESULTS: Twenty-four vertebrae were treated for osteoporotic fracture and two as preventive stenting in metastatic breast cancer. In 24 fractures, the stents extended fully in 20 vertebrae, i.e., 40 stents. These fractures evidently were not older than 3 months. In four segments, a total of eight stents did not extend at all or did only slightly. The 20 stabilised vertebral bodies had an average AVBH value of 19.41 mm pre-operatively and that of 22.775 mm post-operatively, which is an average increase by 3.365 mm in absolute numbers and by 17.34 %. The average pre- and post-operative MVBH values were 16.625 mm and 23.065 mm, which was improvement by 6.41 mm or by 38.56 %. The average PVBH values pre- and post-operatively were 26.835 mm and 28.31 mm, which meant improvement by 1.475 mm or by 5.5 %. The average correction of the kyphotic angle was 4.58°, i.e., 35.2 %, from a VBKA of 11.71° pre-operatively to 7.13° post-operatively. There were five cases (22.7 %) of cement leakage, i.e., two of ventral leakage, one of lateral leakage, one of dorsal leakage through a canal left in the pedicle by cannula insertion, and a dorsal leakage in metastatic disease. No neurological findings were recorded. The average VAS scores were as follows: 81.4 before surgery, 30.6 at 1 week, 16.3 at 6 weeks and 15.4 at 12 weeks after surgery. DISCUSSION: Two experimental and one clinical study on vertebral body stenting only have been available in the recent relevant literature. In comparison with their results as well as with those of previous reports on vertebroplasty and kyphoplasty, our results showed high quality fracture reduction in all vertebrae. The rapid decrease in pain intensity in our group is comparable with all available groups treated by any method of vertebral body augmentation by cement injection; and cement leakage was recorded in even fewer cases. CONCLUSIONS: The novel method of vertebral body stenting with cement augmentation provides a rapid pain relief, gives stability to fracture reduction and has a low rate of cement leakage. However, care must be taken not to indicate cases with a damaged posterior corticalis of the vertebral body.
- MeSH
- Cementation methods utilization MeSH
- Adult MeSH
- Spinal Fractures surgery MeSH
- Data Interpretation, Statistical MeSH
- Bone Cements therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Neoplasm Metastasis MeSH
- Breast Neoplasms surgery complications MeSH
- Osteoporosis surgery complications MeSH
- Spine surgery pathology MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Statistics as Topic MeSH
- Stents utilization MeSH
- Treatment Outcome MeSH
- Outcome and Process Assessment, Health Care MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
Cílem práce bylo ověřit, zda augmentace antipsychotik vysokofrekvenční stimulací levého prefrontálníko kortexu o celkovém počtu 15 stimulačních sekcí bude účinná ve snížení závažnosti negativních příznaků schizofrenie v podmínkách otevřené studie. Do studie bylo zařazeno 12 pacientů se schizofrenií s výraznou negativní symptomatologií, kteří byli dlouhodobě stabilizováni na antipsychotické medikaci. Stimulační léčba rTMS byla prováděna každý pracovní den, tedy 5krát týdně, do celkového počtu 15 procedur. Vlastní výkon rTMS byl definován lokalizací aplikace (levý dorzolaterální prefrontální kortex), intenzitou magnetické stimulace v % MP (110 % MP), frekvencí stimulace (10Hz), trváním série pulzů (10 sec), intervaly mezi sekvencemi (30 sec.) a celkovým počtem aplikovaných stimulů (1500). Během stimulační léčby rTMS došlo ke snížení závažnosti negativních schizofrenních příznaků, což je vyjádřeno statisticky významným poklesem mediánových skórů negativní subškály PANSS (o 32 %) a SANS (o 59 %). Kombinace vysoké frekvence (min. 10 Hz), maximální intenzity stimulace (tj. 110 % motorického prahu) a dostatečný počet stimulačních sezení (15 min.) jsou faktory, které určují účinnost rTMS v této indikaci. Augmentace antipsychotik vysokofrekvenční stimulací levého prefrontálního kortexu o celkovém počtu 15 stimulačních sekcí byla účinná ve snížení závažnosti negativních příznaků u pacientů se schizofrenií.
The objective of the study was to verify whether augmentation of antipsychotics by high-frequency stimulation of the left prefrontal cortex involving the total of 15 stimulation sessions would prove efficient in reducing the seriousness of negative symptoms of schizophrenia in an open-trial design. The study included 12 patients with schizophrenia characterized by marked negative symptomatology who had been stabilized on antipsychotic medication for a long time. rTMS stimulation was applied every working day, i.e. 5 times a week, up to the total of 15 treatment sessions. rTMS application was defined by application site (left dorsolateral prefrontal cortex), intensity of magnetic stimulation in % of MT (110% of MT), stimulation frequency (10 Hz), pulse series duration (10 sec), intervals between sequences (30 sec) and the total of stimuli applied (1500). The rTMS stimulation therapy succeeded in reducing the seriousness of negative symptoms of schizophrenia, which was reflected in a significant reduction of the median scores of the subscales for negative symptoms of PANSS (by 32%) and SANS (by 59%). The combination of a high frequency (10 Hz), maximum stimulation intensity (i.e. 110% of MT) and a sufficient number of stimulation sessions (at least 15) is what makes rTMS efficient in this indication. Augmentation of antipsychotics by high-frequency stimulation of the left prefrontal cortex consisting in 15 stimulation sessions reduced the seriousness of negative symptoms in schizophrenic patients.
- MeSH
- Antipsychotic Agents therapeutic use MeSH
- Electromagnetic Fields MeSH
- Research Support as Topic MeSH
- Deep Brain Stimulation MeSH
- Data Interpretation, Statistical MeSH
- Middle Aged MeSH
- Humans MeSH
- Neural Conduction radiation effects MeSH
- Prefrontal Cortex radiation effects MeSH
- Signs and Symptoms MeSH
- Schizophrenia therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
Jasné světlo může být účinné v léčbě sezónní afektivní poruchy, cirkadiánní poruchy spánku, jet legu, zlepšuje vzorce bdění a spánku a zlepšuje poruchy chování u hospitalizovaných pacientů s Alzheimerovou chorobou. Několik studií ukazuje na antidepresivní účinek fototerapie také u depresivních epizod bez sezónního vzorce. Léčba komorbidní depresivní poruchy a hraniční poruchy osobnosti bývá popisována jako méně úspěšná než léčba pacientů bez poruchy osobnosti. Studie, které by popisovaly použití jasného světla u depresivnich pacientů s komorbidní hraniční poruchou osobnosti zatím nebyly publikovány. Cílem naší otevřené studie bylo hodnotit účinnost 6týdenní kombinované léčby s přídatnou aplikací jasného světla (10000 luxů od 6:30 do 7:30 ráno po dobu 6 týdnů) k SSRI u farmakoresistentních depresivních pacientů s komorbidní hraniční poruchou osobnosti, kteří nereagovali zlepšením na 6týdenní podávání antidepresiv. Studie se účastnilo 13 pacientek, které splňovaly MKN-10 výzkumná diagnostická kritéria a DSM-IV-TR diagnostická kritéria pro velkou depresi. Pacientky byly pravidelně hodnoceny pomocí CGI, HAMD, MADRS a sebeposuzovacích dotazníků BDI a BAl. Podle všech hodnotících nástrojů došlo během aplikace jasného bílého světla k významnému zlepšení léčených nemocných. Výsledky je však potřebné interpretovat opatrně, protože studie probíhala za otevřených podmínek.
Bright light has been found to be effective in treating seasonal affective disorder, delayed sleep phase type disorder, jet lag , improved sleep-wake patterns and reduces sundowing behavior in hospitalized patients with Alzheimer's disease. Some studies reported an antide- pressant effect of bright light also in non-seasonal depression (non-SAD). The efficacy of any treatment of comorbid depressive disorder and borderline personality disorder was been reported as less successful than the therapy of patients without personality disor der. There were no studies, which describe using the bright light therapy in patients with comorbid depression and borderline personality disorder. The aim of our open label study is to asses the efficacy of the 6 week combined therapeutic program with adjunctive administrat ion of the bright light therapy (10000 lux from 6:30 to 7:30 in the morning for 6 weeks) to previous stabile 6 week administration of high dosages of SSRI in a pharmaco-resistant depressive patients suffering with the comorbidity with the borderline personality diso rder. Thirteen patients with major depression and borderline personality disorder according the ICD-10 research diagnostic criteria a nd DSM-IV-TR were participated in this study. They were regularly assessed on the CGI, HAMD, MADRS and in self-assessments BDI and BAI. During the bright light therapy administration the patients improved in all assessment instruments. The results must be se en with caution because the trial was open.
- MeSH
- Affective Disorders, Psychotic drug therapy therapy MeSH
- Antidepressive Agents administration & dosage adverse effects therapeutic use MeSH
- Depressive Disorder drug therapy therapy MeSH
- Research Support as Topic MeSH
- Financing, Organized MeSH
- Phototherapy methods instrumentation utilization MeSH
- Borderline Personality Disorder MeSH
- Data Interpretation, Statistical MeSH
- Comorbidity MeSH
- Personality Disorders drug therapy therapy MeSH
- Psychiatric Status Rating Scales MeSH
- Check Tag
- Female MeSH
- Publication type
- Evaluation Study MeSH
xiv, 247 s. : il.
BACKGROUND: Peripheral wave reflection augments central blood pressure and contributes to cardiac load. This pressure augmentation is not quantifiable from brachial cuff pressure but can be determined from carotid pulsations using the augmentation index (AI). However, carotid tonometry is technically challenging and difficult to standardize in practice. We tested whether automated radial pressure analysis provides a viable alternative. METHODS AND RESULTS: Carotid and radial AI (cAI, rAI) were measured in 46 volunteers with a broad range of arterial properties. Data were assessed at rest, during a cold-pressor test, and following 0.4 mg of sublingual nitroglycerin. cAI correlated with rAI independent of age, mean blood pressure (BP), gender or body mass (cAI = 0.79 x rAI - 0.467, r = 0.81, P < 0.00001), with zero mean bias. There was individual variability in the prediction (difference of -4 +/- 23%), though 65% of the estimates fell within 15% of each other. Change in rAI and cAI with provocative maneuvers also correlated (r = 0.77, P < 0.001). Both cAI and rAI were nonlinearly related to late-systolic pressure-time integral (PTI), an index of cardiac load. At cAI < 0.1 or rAI < 0.69, PTI was unaltered, while greater values correlated with increased PTI. rAI accurately predicted this cut-off in 88% of cases, with a 5.5% false negative rate. CONCLUSIONS: Automated rAI analysis is an easily applied method to assess basal and dynamic central pressure augmentation. While individual predictive accuracy of cAI was variable, overall population results were consistent, supporting use of rAI in clinical trials. Its prediction of when AI is associated with greater LV loading (i.e. cardiac risk) is good and may help stratify individual risk along with brachial cuff pressure.
- MeSH
- Radial Artery physiology MeSH
- Carotid Arteries physiology MeSH
- Adult MeSH
- Financing, Organized MeSH
- Hypertension diagnosis physiopathology MeSH
- Myocardial Contraction physiology MeSH
- Blood Pressure physiology MeSH
- Middle Aged MeSH
- Humans MeSH
- Manometry methods instrumentation MeSH
- Blood Pressure Determination methods instrumentation MeSH
- Adolescent MeSH
- Elasticity MeSH
- Pulsatile Flow physiology MeSH
- Blood Flow Velocity physiology MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
Úvod: Cílem této prospektivní studie bylo zjistit objektivně rotační stabilitu kolenního kloubu po augmentaci předního zkříženého vazu (PZV) kolenního kloubu za pomoci štěpu z m. gracilis 2 roky po operaci. Metodika: Do studie bylo zařazeno 20 mladých sportovně aktivních pacientů po augmentaci PZV štěpem z m. gracilis při poranění posterolaterálního (PL) svazku. Tibiální i femorální kostní kanál byl cílen do anatomického úponu PL svazku. Doba vyšetření byla v průměru 28 měsíců po operaci (min. 24 měsíců). Všechna měření byla realizována za pomoci počítačového systému navigace a byla prováděna pro zdravé i operované koleno. Po určení potřebných dat pro navigaci zůstal pacient stát v pozici s oběma nohama plantou pevně na podložce s intermaleolární distancí 20 cm. Poté provedl pacient 30st. flexi v kolenních kloubech a provedl nejprve rotaci vnitřní v kloubu torzí trupu, poté rotaci vnější. Hodnocena byla i subjektivní spokojenost s operovaným kolenem za pomoci ortopedických dotazníků. Výsledky: Vnitřní rotace v kolenním kloubu byla u poraněného kolena v průměru po operaci 7,7st, u zdravého kolena 9,5st. Zevní rotace dosahovala hodnoty u operovaného kolena po operaci 8,3st. a 9,2st. u zdravého kolena. Subjektivní hodnocení obou kolenních kloubů 2 roky po operaci neprokazuje statisticky významný rozdíl. Závěr: Naměřené hodnoty poukazují na fakt, že augmentace PZV za pomoci štěpu m. gracilis poskytuje dobrou rotační stabilitu v porovnání s kontralaterálním zdravým kolenním kloubem. Subjektivně vykazuje operovaný kolenní kloub stejnou funkci jako kolenní kloub neoperovaný.
Purpose: The objective of this study was to evaluate knee rotational stability at least 2 years after augmentation of the anterior cruciate ligament (ACL) with using of musculus gracilis graft. Methods: There were 20 patients after the tear of posterolateral (PL) bundle of the ACL reconstructed by m.gracilis grafting. The mean follow-up was 28 months. For all measurements, the navigation system OrthoPilot was used, the operated and the healthy knee joins were analysed. Measurement started with the patient in the standing position in neutral rotation. Then, the patient achieved in 30° knee flexion under weight-bearing maximal external trunk rotation and returned to the neutral position. The same measurement was done for the internal trunk rotation. All measurements were repeated 3 times for each knee joint. The orthopaedics scoring systems were analysed too. Results: After the augmentation of the ACL, IR was 7,7° and ER was 8,3°. In the contralateral healthy knee joint, IR was 9,5° and ER was 9,2°. The analyse of the orthopaedic scores were in the same extend for both knee joints. Conclusions: The augmentation of the PL bundle of the ACL restores the rotational stability of the knee joint without any significant difference in comparison to the contralateral healthy knee (p < 0.05). The function of the knee joint is similar with the contralateral healthy knee too.
- Keywords
- rotační stabilita, augmentace předního zkříženého vazu,
- MeSH
- Biomechanical Phenomena MeSH
- Adult MeSH
- Humans MeSH
- Anterior Cruciate Ligament * surgery physiopathology MeSH
- Adolescent MeSH
- Orthopedic Procedures * methods MeSH
- Postoperative Complications MeSH
- Postoperative Period MeSH
- Prospective Studies MeSH
- Athletes MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Female MeSH
Úvod: sLORETA (standardizovaná elektromagnetická tomografie) je nyní široce užívanou výzkumnou metodou, která umožňuje vytvořeni třídimenzionálního modelu mozkové elektrické aktivity. Metodika: V naší studii jsme sledovali pomocí sLOTERA 13 pacientů s diagnózou panické poruchy s nebo bez agorafobie rezistentních na léčbu psychofarmaky před léčbou a po léčbě přídatnou kognitivně-behaviorální terapií (KBT). Výsledky: Během přídatné KBT došlo k významné redukci psychopatologie v posuzovacích stupnicích BAI, BDI a CGI. V sLORETA jsme znamenali trend ke snižování alfa-2 aktivity (10,5-12 Hz) v oblasti předního cingula, beta-1 aktivity (12,5-18 Hz) v oblasti precuneu a zvyšování beta-3 aktivity (21,5-30 Hz) v oblasti superiorního frontálního laloku. Závér: Po přidání KBT k psychofarmakologické léčbě došlo ke zvýšení beta-3 aktivity v oblasti superiorního frontálního laloku, což může souviset se zvýšením kognitivní kontroly a poklesu alfa-2 aktivity v oblasti předního cingula, což lze dát do souvislosti s regulací kontroly emocí nad tělesnými příznaky. Zvyšování beta-1 aktivity v oblasti precuneu lze hypoteticky interpretovat jako změnu ve vyhledávání v epizodické paměti.
Introduction: sLORETA (standardized low resolution brain electromagnetic tomography) is now widely used research method that allows to determine three-dimensional intracerebral distribution of electrical brain activity. Method: We measured 13 patients resistant to pharmacological treatment with Panic disorder with or without Agoraphobia. Patients were treated both by psychotropics and CBT (cognitive behavioral therapy) for six week. Results: There was a significant symptom reduction measured by BAI, BDI and CGI after accessory CBT. We found a downward trend in alfa-2 (10.5–12 Hz) activity in anterior cingulum, beta-1 activity (12.5–18 Hz) in precuneus and an upward trend in beta-3 ( 21.5–30 Hz) activity in superior frontal gyrus. Conclusions: We found upward trend in beta-3 activity in superior frontal gyrus, that may be interpreted as a gain conscious control of emotions, decrease of alpha-2 activity in anterior cingulate can be interpreted as change in primarily executive functions r elated to the emotional control of somatic symptoms. Increase of beta-1 activity in precuneus may be hypothetically interpreted as change in episodic memory retrieval.
- Keywords
- farmakorezistence, přední cingulum, frontální lalok, precuneus,
- MeSH
- Gyrus Cinguli MeSH
- Adult MeSH
- Financing, Organized MeSH
- Cognitive Behavioral Therapy statistics & numerical data MeSH
- Combined Modality Therapy utilization MeSH
- Drug Resistance MeSH
- Middle Aged MeSH
- Humans MeSH
- Brain Mapping methods statistics & numerical data MeSH
- Cerebral Cortex MeSH
- Men MeSH
- Neuroimaging utilization MeSH
- Panic Disorder diagnosis therapy MeSH
- Psychotropic Drugs therapeutic use MeSH
- Tomography utilization MeSH
- Treatment Outcome MeSH
- Women MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Comparative Study MeSH
A global obesity pandemic is one of the most significant health threats worldwide owing to its close association with numerous comorbidities such as type 2 diabetes mellitus, arterial hypertension, dyslipidemia, heart failure, cancer and many others. Obesity and its comorbidities lead to a higher rate of cardiovascular complications, heart failure and increased cardiovascular and overall mortality. Bariatric surgery is at present the most potent therapy for obesity, inducing a significant weight loss in the majority of patients. In the long-term, a substantial proportion of patients after bariatric surgery experience a gradual weight regain that may, in some, reach up to a presurgical body weight. As a result, anti-obesity pharmacotherapy may be needed in some patients after bariatric surgery to prevent the weight regain or to further potentiate weight loss. This article provides an overview of the use of anti-obesity medications as an augmentation to bariatric surgery for obesity. Despite relatively limited published data, it can be concluded that anti-obesity medication can serve as an effective adjunct therapy to bariatric surgery to help boost post-bariatric weight loss or prevent weight regain.
Objective: In the current posthoc analyses, we evaluated the impact of markers of aberrant data variability on drug placebo separation and placebo and drug response in an acute schizophrenia clinical trial. Methods: Positive and negative syndrome scale data were obtained from a phase 2, randomized, double-blind, placebo controlled trial in hospitalized adults with schizophrenia experiencing an acute exacerbation. We assessed the impact of a total of six markers of aberrant data variability: erratic ratings, unusually large postbaseline improvement, high and low mean square successive difference (MSSD), identical and nearly identical ratings and compared the drug placebo difference, drug and treatment response at last visit in affected subjects vs those not affected. All analyses were conducted using generalized linear models. Results: In this posthoc analysis, drug placebo separation decreased with the presence of most markers of aberrant data variability. The only exception was high MSSD was associated with significant increase in the signal. In the affected subjects, the presence of indicators of increased data variability augmented the response to placebo, in the case of large postbaseline change and high MSSD, significantly. The presence of indicators of decreased variability numerically but not statistically decreased the response to placebo. Similar findings were observed in the drug treatment group with the exception of erratic ratings that numerically but not statistically decreased the response to the drug. Discussion: The presence of most indicators of aberrant data variability had a detrimental effect on drug-placebo separation and showed different effects on placebo and treatment response.
- Publication type
- Journal Article MeSH
