AIM OF THE STUDY: The aim of the study was to evaluate prevalence, seriousness and risk factors of intra-thoracic injuries (ITI) injuries associated with CPR in non-survivors after out-of-hospital cardiac arrest. METHODS: This was a prospective forensic autopsy cohort study conducted in a single institution. Pathologists recorded autopsy data using standardized protocol which contained data from external and internal examination of the body focused on ITI. RESULTS: In total, 80 persons were included in this study. CPR-associated injuries were found in 93.7% of cases; majority of injuries were skeletal chest fractures (rib fractures in 73.7%, sternal fractures in 66.3%). ITI were identified in 41.2% of cases. Contusion of at least one lung lobe was found in 31.2%, lung laceration in 2.5%, and hemothorax in 5.0% of cases. Transmural heart contusion was identified in 17.5% of cases; hemopericard on the grounds of right atrium rupture of aortic rupture was revealed in 8.7% of cases. Risk factor analysis did not show any statistically significant correlation between ITI and any of general data (age, gender, BMI, cause of death, season of the year or location where the body was found) or CPR specifications (type and duration of CPR, manner of chest compressions). A strong correlation between ITI and skeletal chest fractures was proven. CONCLUSION: ITI present frequent and serious complications of unsuccessful CPR. ITI could contribute to the death only provided the fact that ROSC had been achieved. Correct performance of chest compressions according to guidelines is the best way to avoid ITI.

• MeSH
• kardiopulmonální resuscitace škodlivé účinky   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pitva statistika a číselné údaje   MeSH
• poranění hrudníku epidemiologie   MeSH
• příčina smrti MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• zástava srdce mimo nemocnici mortalita   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Almost 70 scapular fractures in children and adolescents, up to the age of 17 years, have been described in detail in the literature since 1839. The diagnosis of these injuries was based on autopsy, radiographs, CT and MRI examinations. The most frequent findings were fractures/epiphyseolyses of the coracoid, followed by fractures of the infraspinous part of the body and avulsion of the inferior angle of the scapular body. Less common were fractures of the acromion. Intra-articular fractures of the glenoid, or separation of an intact glenoid along the line of the anatomical or surgical necks, were reported only sporadically. Scapulothoracic dissociation was also recorded in several cases. The majority of fractures were treated non-operatively; operative treatment was used in glenoid fractures, certain fractures of the coracoid and fractures of the scapular body with intrathoracic penetration. Except for scapulothoracic dissociation, outcomes of treatment of these injuries were very good.

• MeSH
• akromion MeSH
• dítě MeSH
• fraktury kostí * diagnostické zobrazování   chirurgie   MeSH
• fraktury proximálního humeru * diagnostické zobrazování   MeSH
• intraartikulární fraktury * MeSH
• lidé MeSH
• lopatka chirurgie   MeSH
• mladiství MeSH
• poranění hrudníku * MeSH
• radiografie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• bolest farmakoterapie   MeSH
• fixní kombinace léků MeSH
• injekce intraartikulární MeSH
• injekce subkutánní MeSH
• kolagen aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• léčivé přípravky MeSH
• lidé středního věku MeSH
• lidé MeSH
• meziobratlová ploténka MeSH
• muskuloskeletální nemoci farmakoterapie   MeSH
• nemoci kloubů farmakoterapie   MeSH
• osteochondróza MeSH
• páteř patologie   MeSH
• revmatické nemoci farmakoterapie   MeSH
• rostlinné extrakty aplikace a dávkování   farmakologie   terapeutické užití   MeSH
• spondylartritida MeSH
• spondylóza MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• cévy anatomie a histologie   účinky léků   MeSH
• diagnostické techniky dýchacího ústrojí metody   MeSH
• elektrofyziologické techniky kardiologické metody   MeSH
• lidé MeSH
• plicní hypertenze diagnóza   patologie   terapie   MeSH
• plicní oběh fyziologie   MeSH
• rentgendiagnostika hrudníku metody   MeSH
• srdeční katetrizace MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• bolesti na hrudi etiologie   radiografie   MeSH
• cévní přístupy škodlivé účinky   MeSH
• cizí tělesa komplikace   radiografie   chirurgie   MeSH
• dospělí MeSH
• hrudní chirurgie video-asistovaná MeSH
• katetrizace centrálních vén škodlivé účinky   přístrojové vybavení   MeSH
• lidé MeSH
• odstranění implantátu metody   MeSH
• počítačová rentgenová tomografie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY: Multidetector computed tomography (MDCT) is more sensitive for the detection of injury to the thoracic wall and intra-thoracic organs than a plain chest radiograph. The chest wall deformity and instability following multiple rib fracture involves fractures of four or more adjacent ribs at two levels, sometimes including a sternal fracture. It may also be associated with lung trauma (pneumothorax, haemothorax, rupture, laceration or pulmonary contussion). An isolated multiple-rib fracture can successfully be treated conservatively. Early intubation and mechanical ventilation are indicated in patients with progressive respiratory insufficiency. Indications for surgical stabilisation of this fracture are based on the signs of respiratory failure and the results of imagining methods (MDCT at the present time). MATERIAL AND METHODS: Examination by MDCT was carried out in patients with severe thoracic trauma. In five patients with multiple rib fractures, the CT findings were included in indication criteria for open rib osteosynthesis and thoracotomy. A clinical indication criterion was respiratory insufficiency after the patient's weaning from a ventilator, manifested by paradoxical chest motion. A radiographic indication included an extensive chest deformity with rib displacement into the pleural cavity in 3D reconstruction from MDCT images. Surgery was performed within one hour to five days of admission. Access was gained through an oblique skin incision and by cutting though the chest wall muscles to release fractured ribs. To explore the thoracic cavity, a defect in the intercostal muscles was extended by an incision at the site of rib fracture. Suction of a haemothorax was done and lung ruptures were sutured in three patients. After chest drain insertion, the fractured ribs were stabilized by plate osteosynthesis (fy Medin). RESULTS: In the post-operative period, mechanical ventilation was continued for 3 to 6 days in four patients. There were no complications. In the patients with flail chest, the 3D reconstruction from MDCT images allowed us to make more exact pre- operative decisions concerning the extent of rib osteosynthesis and the method of exposure. If lung injury was also shown, this was an indication for thoracic cavity exploration. DISCUSSION: The pathophysiological effects of flail chest involve several factors including the size of a flail segment, change in intra-thoracic pressure during spontaneous breathing and multiple injuries to the intra-thoracic organs. Therapy is related to the seriousness of respiratory disorder associated with flail chest, the degree of chest wall deformity and other complications of conservative treatment (dependence on mechanical ventilation with no possibility of weaning). Surgical stabilization of the chest wall is the most reliable method of treatment which allows us to avoid or interrupt the adverse effect of rib displacement and chest instability. A contribution of MDCT examination to the indication for surgical stabilization lies in that MDCT provides imagining of the details decisive for the classification of fracture types including their tendency to displacement. MDCT permits a better visualisation of chest injury and a better understanding of the respiratory disorder. CONCLUSIONS: Based on 3D reconstruction from MDCT images, it is possible to make the pre-operative considerations for rib osteo- synthesis more specific and to choose the best approach. At the same time MDCT enables us to diagnose associated intra-thoracic injuries and provides indications for their treatment. In addition, it gives us a possibility to evaluate the role of a flail segment in breathing dysfunction and to establish indications for surgical stabilization in multiple rib fractures. Rib osteosynthesis allowed for early stabilization of the chest wall and improved the mechanics of breathing, thus requiring a shorter period of mechanical ventilation. The evaluation of statistical significance of these facts will be made when a larger group of patients examined by MDCT is available.

• MeSH
• dospělí MeSH
• fraktury žeber chirurgie   komplikace   radiografie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• multidetektorová počítačová tomografie MeSH
• paradoxní dýchání etiologie   chirurgie   radiografie   MeSH
• poranění hrudníku radiografie   MeSH
• tupá poranění chirurgie   radiografie   MeSH
• vnitřní fixace fraktury MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH

Radiotherapy has been used to treat loco-regional recurrences located at various intra-thoracic sites, but longterm survival of these patients has been rarely observed. We report herein a lung adenocarcinoma patient with locoregional recurrence, who was successfully treated with high-dose radiotherapy. The patient could survive with no evidence of recurrence 5 years after thoracic irradiation. It is probably safe to administrate high-dose radiotherapy for some loco-regional recurrent patients with favorable prognostic factors such as good PS, no body weight loss. Further studies will be required to define a favorable subset of patients most likely to benefit from an aggressive approach.

• MeSH
• adenokarcinom radioterapie   sekundární   MeSH
• celková dávka radioterapie MeSH
• lidé MeSH
• lokální recidiva nádoru radioterapie   MeSH
• lymfatické metastázy MeSH
• mediastinum MeSH
• nádory plic patologie   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH

We report an unusual source of intra-operative bleeding in a patient undergoing cardiosurgical reoperation. After sternotomy, hematocrit dropped significantly. Only intra-thoracic bleeding from adhesions was considered to be responsible for the anemia. During reperfusion, abdominal wall was distended with a bluish bulge in the right hemidiaphragm. Immediate laparotomy revealed bleeding from a tear in the right hepatic lobe without any diaphragm injury. The tear was likely caused by blunt trauma from an oscillating saw. We emphasize cautious use of an oscillating saw in patients with hepatic congestion undergoing a repeat sternotomy. We propose that lifting the sternum in redo procedures might prevent the hepatic tear.

• MeSH
• aortální chlopeň chirurgie   MeSH
• hematokrit MeSH
• hemoperitoneum etiologie   krev   terapie   MeSH
• hemostatika terapeutické užití   MeSH
• játra zranění   MeSH
• kardiochirurgické výkony škodlivé účinky   MeSH
• kardiopulmonální bypass MeSH
• krevní transfuze MeSH
• laparotomie MeSH
• lidé středního věku MeSH
• lidé MeSH
• reoperace MeSH
• sternum chirurgie   MeSH
• trikuspidální chlopeň chirurgie   MeSH
• tupá poranění krev   etiologie   chirurgie   komplikace   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Střelná poranění ledvin řadíme mezi poranění otevřená, která bývají často sdružena s poraněním orgánů dutiny hrudní nebo orgánů dutiny břišní (v 80 %) [1,5]. V klinickém obraze pak dominují buď příznaky poranění hrudníku, nebo břicha [6]. Rozsah poranění ledvin je pestrý, počínaje malými poraněními až po poranění tzv. velká. Celkové následky poranění závisí na mnoha faktorech, zvláště pak na razanci střely, charakteru, průraznosti a ranivosti projektilu. V dnešní mírové době prezentujeme vzácné střelné poranění ledviny.

The kidney shot injuries are counted among open injuries that are often connected with thoracic cavity organs injuries or intra-abdominal organs injuries (in 80 %). In clinical picture then dominate either abdominal or thoracic injuries symptoms. The extent of the kidney injuries is varied, from minor renal injuries to so-called major renal injuries. Overall injury repercussions depend on many factors, especially on force of penetration, nature, penetration and injureability of projectile. At this peaceful period let us present rather peculiar kidney shot injury.

• MeSH
• dospělí MeSH
• ledviny zranění   MeSH
• lidé MeSH
• penetrující rány terapie   MeSH
• polytrauma terapie   MeSH
• reoperace MeSH
• střelné rány chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

PURPOSE OF THE STUDY The aim of this retrospective randomised study is a comparison of two surgical approaches (anterior versus posterior) for the treatment of idiopathic thoracic scoliosis by corrective spondylodesis with segmental instrumentation in adolescents aged 13 to 20 years. MATERIAL AND METHODS The study included patients with right-sided idiopathic thoracic scoliosis (Cobb's angle, 40°-70°; Lenke type I). The group of patients treated from the posterior approach by fusion and segmental instrumentation, involving the use of a hybrid, two-rod system or screws only, comprised 31 girls with an average age of 14.5 years (group 1). In this group three instrumentation systems were used. The patients treated from the anterior approach, which included thoracotomy for disc excision, fusion and segmental instrumentation with a one- or two-rod system, consisted of 25 girls and six boys with an average age of 15.3 years (group 2). In this group four instrumentation systems were employed. In all patients radiographs were evaluated before surgery, immediately after the procedure and then every 12 months. The evaluation also included the operative time, blood loss, length of hospital stay, hospital costs and complications. The random selection was based on casting lots. Some patients indicated for the anterior approach withdrew after receiving detailed information on this procedure and therefore patients operated on from the anterior approach before the study had begun were enrolled. The statistical comparison of the results of anterior and posterior procedures was made using the two-sample t-test or Wilcoxon's test. The Shapiro-Wilk test was used for normality testing and Fisher's F-test for the equality of variances. The paired t-test or non-parametric paired Wilcoxon's test was employed for testing two variables within each group. The level of significance was set at 0.05. RESULTS In group 1, anteroposterior radiographs showed, on the average, 54.3° before surgery, 18.7° immediately after it and 19.1° at one year after surgery. The sagittal profile before surgery was T5 +30.0° T12 -57.7° S1; the surgery resulted in reducing thoracic kyphosis by 9.5° and lumbar lordosis by 14.2°. The average operative time was 245.8 min, intra-operative blood loss was 1095.2 ml and drained blood loss was 636.9 ml. The average hospital stay lasted 10.2 days. In group 2, anteroposterior radiographs had the average values of 53.7° pre-operatively, 23.6° post-operatively and 25.9° at one year after surgery. The pre-operative sagittal profile was T5 +21.5° T12 -54.2° S1 and, post-operatively, thoracic kyphosis increased by 7.0° and lumbar lordosis decreased by 2.2°. The average operative time was 226.8 min, intra-operative and drained blood losses were 1095.2 ml and 636.9 ml, respectively, and length of hospital stay was 15.5 days. In group 2, the operative time and intra-operative blood loss were lower and post-operative drained blood loss (due to longer duration of chest drainage) was higher than in group 1. All findings were statistically significant. Significant differences between the groups were also found in the costs of implants and hospital stay because, for the posterior approach, they were higher by a total of 68 466 CZK and 52 250 CZK, respectively. DISCUSSION In the frontal plane, thoracic kyphosis corrections through either surgical approach are comparable; in the sagittal plane, surgery from the posterior approach results in reducing thoracic kyphosis and that from the anterior approach produces a mild increase in it. CONCLUSIONS In terms of surgical treatment selection, the anterior approach is more economical and requires spinal fixation and instrumentation to a lesser extent. However, prolonged chest wound drainage results in a longer hospital stay. The majority of idiopathic scoliosis cases are indicated for a posterior approach. In scoliosis with marked hypo-kyphosis or lordosis, an anterior approach can be considered because it produces an increase in thoracic kyphosis.

• MeSH
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• ortopedické výkony * klasifikace   metody   MeSH
• retrospektivní studie MeSH
• skolióza chirurgie   MeSH
• výsledek terapie MeSH
• zakřivení páteře * chirurgie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH
• srovnávací studie MeSH