Poranění míchy s sebou přináší řadu trvalých zdravotních následků, které se díky špatnému životnímu stylu a stárnutí zhoršují. Jedním z nich jsou i gastrointestinální komplikace, které se výrazně promítají do problematiky zdraví a kvality života pacientů. Hlavním cílem článku je zhodnotit účinnost viscerální masáže na redukci gastrointestinálních obtíží u chronických pacientů se spinální lézí. K objektivizaci výsledků studie byly využity české verze standardizovaných dotazníků Neurogenic Bowel Dysfunction score (NBD score) a Irritable Bowel Syndrome – Quality of Life survey (IBS-QOL) a nestandardizované české verze dotazníku Burwood Bowel Dysfunction. Hodnocení bylo doplněno i informacemi z anamnestických rozhovorů. Kazuistika prokázala pozitivní vliv viscerální masáže na snížení hodnoty NBD score a subjektivního vnímání bolesti a diskomfortu břicha, ovlivnění frekvence vyprazdňování, množství a konzistence stolice i fekální inkontinence. Fyzioterapeuti by neměli v klinické praxi opomíjet vyšetřovat a ošetřovat gastrointestinální obtíže u subpopulace chronických spinálních pacientů. Nicméně, jejich stav je přednostně ovlivněn dodržováním dietních opatření, optimálního managementu vyprazdňování a zásad zdravého životního stylu.

People with spinal cord injury have a number of permanent health problems that get worse during the bad lifestyle and aging. Among them there are gastrointestinal complications, which have a significant negative impact on health, quality of life and well-being of patients. The purpose of this case study was to determine the efficacy of visceral massage in reducing the severity of bowel dysfunction symptoms of chronic patients with spinal cord injury. The standardized questionnaire Neurogenic Bowel Dysfunction score (NBD score), the standardized questionnaire Irritable Bowel Syndrome – Quality of Life survey (IBS-QOL) and non-standardized Czech version questionnaire Burwood Questionnaire were used to objectify the study results. The assessment was added with information from the anamnestic interviews. This case study demonstrated the positive impact of visceral massage on the reduction of NBD score, abdominal pain and discomfort. Defecation characteristics were positively changed, too (frequency, amount, consistency, faecal incontinence). Physiotherapists should not neglect the need for diagnosis and therapy of gastrointestinal problems in persons with spinal cord injury in clinical practice. However, this issue also depends on the patient‘s compliance with dietary measures, optimal bowel management and healthy lifestyle.

• MeSH
• Adult MeSH
• Gastrointestinal Diseases * etiology   pathology   therapy   MeSH
• Quality of Life MeSH
• Middle Aged MeSH
• Humans MeSH
• Massage * classification   methods   MeSH
• Neurogenic Bowel pathology   MeSH
• Spinal Cord Injuries complications   MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH

• MeSH
• Genital Diseases, Female MeSH
• Gynecology MeSH
• Pregnancy Complications MeSH
• Obstetric Surgical Procedures MeSH
• Obstetrics MeSH
• Publication type
• Atlas MeSH

• Conspectus
• Gynekologie. Porodnictví
• NML Fields
• gynekologie a porodnictví

Meralgia paresthetica je kompresivní neuropatie n. cutaneus femoris lateralis. I přes svou vzácnost je nejčastějším úžinovým syndromem dolních končetin. Vzhledem ke svým symptomům, které imitují častou radikulopatii L4 či L5, bývá často diagnostikována s dlouhou (až mnohaletou) latencí anebo vůbec. Myslet je na ni potřeba zejména u pacientů s obezitou a diabetem, kteří mají chronické iritace ventrolaterální plochy stehna nereagující na klasickou vertebrogenně orientovanou konzervativní terapii a negativní nález na MR bederní páteře. Představujeme zkušenosti s operační dekompresí nervu u tří pacientů s bolestmi, paresteziemi a poruchou citlivosti v inervační zóně nervu. Všichni trpěli výraznou trunkální obezitou. Veškerá konzervativní léčba včetně pokusů o redukci hmotnosti byla neúspěšná. Uvolnění nervu vedlo ve dvou případech k okamžitému úplnému ústupu obtíží, u jednoho pacienta způsobilo přechodné zesílení iritací, které se postupně zmírnily během jednoho měsíce. I přes kontroverzi týkající se operační léčby meralgie (neurolýza či protětí nervu) lze konstatovat, že dekomprese nervu má dobrý efekt. Protětí nervu lze dle našeho názoru považovat za volbu rezervní při selhání primární operační terapie.

Meralgia paresthetica is a compression neuropathy of the lateral femoral cutaneous nerve. Despite its rarity, it is the most common nerve entrapment of the lower limbs. It produces similar symptoms as those associated with the more common L4 or L5 radiculopathy. Therefore, it is often diagnosed late (sometimes only after several years of latency) or not at all. This diagnosis should be considered especially in patients with obesity and diabetes who have chronic irritation of the ventrolateral areas of the thigh not responding to conservative therapy and a negative finding on lumbar MRI. We present our experience with surgical nerve decompression in three patients with pain, paresthesias, and sensory loss within the distribution of the lateral cutaneous nerve of the thigh. They all suffered from severe abdominal obesity. All conservative treatments, including weight reduction attempts, were unsuccessful. Nerve release caused an immediate effect in two cases. One patient experienced a temporary worsening of pain, which gradually improved within one month. In spite of the controversy surrounding the surgical treatment of meralgia (neurolysis or nerve resection), it can be concluded that nerve decompression has a good effect. Nerve resection is, in our view, considered to be a reserve option when primary surgery fails.

• Keywords
• neurolýza, meralgia paresthetica,
• MeSH
• Adult MeSH
• Electrodiagnosis methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Neurosurgical Procedures methods   MeSH
• Femoral Neuropathy * diagnosis   therapy   MeSH
• Tendon Entrapment diagnosis   therapy   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Publication type
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

Between seizures, irritative network generates frequent brief synchronous activity, which manifests on the EEG as interictal epileptiform discharges (IEDs). Recent insights into the mechanism of IEDs at the microscopic level have demonstrated a high variance in the recruitment of neuronal populations generating IEDs and a high variability in the trajectories through which IEDs propagate across the brain. These phenomena represent one of the major constraints for precise characterization of network organization and for the utilization of IEDs during presurgical evaluations. We have developed a new approach to dissect human neocortical irritative networks and quantify their properties. We have demonstrated that irritative network has modular nature and it is composed of multiple independent sub-regions, each with specific IED propagation trajectories and differing in the extent of IED activity generated. The global activity of the irritative network is determined by long-term and circadian fluctuations in sub-region spatiotemporal properties. Also, the most active sub-region co-localizes with the seizure onset zone in 12/14 cases. This study demonstrates that principles of recruitment variability and propagation are conserved at the macroscopic level and that they determine irritative network properties in humans. Functional stratification of the irritative network increases the diagnostic yield of intracranial investigations with the potential to improve the outcomes of surgical treatment of neocortical epilepsy.

• Publication type
• Journal Article MeSH

OBJECTIVE: The purpose of the presented study is to determine whether there are frequency-independent high-frequency oscillation (HFO) parameters which may differ in epileptic and non-epileptic regions. METHODS: We studied 31 consecutive patients with medically intractable focal (temporal and extratemporal) epilepsies who were examined by either intracerebral or subdural electrodes. Automated detection was used to detect HFO. The characteristics (rate, amplitude, and duration) of HFO were statistically compared within three groups: the seizure onset zone (SOZ), the irritative zone (IZ), and areas outside the IZ and SOZ (nonSOZ/nonIZ). RESULTS: In all patients, fast ripples (FR) and ripples (R) were significantly more frequent and shorter in the SOZ than in the nonSOZ/nonIZ region. In the group of patients with favorable surgical outcomes, the relative amplitude of FR was higher in the SOZ than in the IZ and nonIZ/nonSOZ regions; in patients with poor outcomes, the results were reversed. The relative amplitude of R was significantly higher in the SOZ, with no difference between patients with poor and favorable surgical outcomes. CONCLUSIONS: FR are more frequent, shorter, and have higher relative amplitudes in the SOZ area than in other regions. The study suggests a worse prognosis in patients with higher amplitudes of FR outside the SOZ. SIGNIFICANCE: Various HFO parameters, especially of FR, differ in epileptic and non-epileptic regions. The amplitude and duration may be as important as the frequency band and rate of HFO in marking the seizure onset region or the epileptogenic area and may provide additional information on epileptogenicity.

• MeSH
• Adult MeSH
• Electroencephalography methods   MeSH
• Epilepsy diagnosis   physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Brain Mapping methods   MeSH
• Adolescent MeSH
• Young Adult MeSH
• Brain physiopathology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Comparative Study MeSH

PURPOSE: To evaluate the success of a mini-invasive technique for operation of idiopathic macular hole (IMH). METHODS: We retrospectively examined 29 patients (30 eyes) in whom 25-G pars plana vitrectomy (PPV), peeling of the inner limiting membrane (ILM), and application of air tamponade were performed. The group of the patients included 7 males and 22 females (76%), age range 57-79 years (median 70). The follow-up period was 3-47 months (median 17). RESULTS: Pars plana vitrectomy was indicated only in the stages of full-thickness macular hole. Prior to operation, 13 eyes (43%) were in stage 2, 15 eyes (50%) in stage 3, and 2 eyes (7%) in stage 4. The IMH healed in 28 eyes after operation. Persistence of IMH occurred in 2 eyes (7%). After subsequent reoperation with extension of the peeling zone of the ILM and gas tamponade (with 10% C3F8), these macular holes also healed (100%). Prior to carrying out PPV, best-corrected visual acuity (BCVA) ranged between 20/40 and 20/500 (median 20/125). At the end of the follow-up period, BCVA was improved to 20/40 (median). The change in the final BCVA compared to the initial visual acuity was statistically significant (p = 0.008; Wilcoxon). CONCLUSIONS: The 25-G PPV with peeling of the ILM and air tamponade is an effective technique and presents no increased risks in comparison with routine procedures. The main benefit of the intervention is its good tolerance by the patient, particularly with respect to painfulness and postoperative irritation.

• MeSH
• Basement Membrane surgery   MeSH
• Epiretinal Membrane surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Microsurgery methods   MeSH
• Retinal Perforations diagnosis   surgery   MeSH
• Reoperation MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Vitrectomy methods   MeSH
• Treatment Outcome MeSH
• Visual Acuity MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

A clear concept of epileptic zones remains of high clinical relevance in presurgical evaluation of refractory epilepsy patients and in resection planning. Recent advances in understanding how each of the epileptic zones is functionally organized strengthened the importance of the network concept. It has been shown that neuronal networks underlying the individual epileptic zone may involve multiple brain structures with complex interactions between them. The network concept has impact not only for better understanding of pathophysiology of partial epilepsy but also for clinical practice, particularly for epilepsy surgery. This review examines recent reports on the use of advanced imaging techniques which enable to map the epileptic zones and their structural and functional organization. Magnetic resonance postprocessing substantially improved the accuracy in detection of the epileptogenic lesions. The seizure-onset zone is primarily determined by electrophysiology but can also be localized using single photon emission computed tomography. The functional deficit zone is commonly assessed by a number of tests including methods of functional neuroimaging (positron emission tomography) which can delineate hypometabolic cortical areas and subcortical structures. Hemodynamic fluctuations associated with interictal epileptiform discharges can be detected by novel functional magnetic resonance technique which is nowadays widely used for the irritative zone localization. These techniques open new prospect for epilepsy surgery in patients who were previously considered as not suitable candidates of surgical treatment.

• MeSH
• Electroencephalography MeSH
• Epilepsy diagnosis   therapy   MeSH
• Humans MeSH
• Brain pathology   physiopathology   MeSH
• Neuroimaging MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

Již druhé vydání oblíbené celostátní učebnice seznamuje čtenáře se základními poznatky v dermatovenerologii a důraz klade na logiku diagnostiky kožních nemocí, na praktičnost, přehlednost, pochopitelnost a srozumitelnost textu. S tím souvisí i zařazení četných schémat, tabulek, obrázků a doplnění stránek margináliemi, které umožňují rychlou orientaci v textu a pro studenty jsou také pomůckou při opakování. Pětisetstránková publikace je doplněna více než čtyřmi sty barevnými obrázky.

• MeSH
• Skin Diseases diagnosis   epidemiology   etiology   classification   physiopathology   therapy   MeSH
• Skin Neoplasms diagnosis   epidemiology   etiology   classification   physiopathology   therapy   MeSH
• Sexually Transmitted Diseases diagnosis   epidemiology   etiology   classification   physiopathology   therapy   MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• dermatovenerologie
• dermatovenerologie
• NML Publication type
• kolektivní monografie

Interictal high-frequency oscillations (HFO) were recently identified in recordings from depth macroelectrodes in epileptic patients. StereoEEG (SEEG) recordings were analyzed in four patients with medically intractable partial seizures due to focal cortical dysplasia type IIA. Characteristics of HFO within seizure onset zone (SOZ), irritative zone, and remote brain areas were investigated. Whilst the rate of occurrence for ripples (80-200 Hz) was significantly higher in recordings from within than outside the SOZ, the rate of fast ripples (200-450 Hz) was less reliable index of SOZ. Interestingly, the mean powers across subjects were significantly higher within than outside the SOZ in both ripple and fast ripple frequency ranges. Our study demonstrates a capacity of interictal HFO to detect the SOZ in focal cortical dysplasias.

• MeSH
• Analysis of Variance MeSH
• Adult MeSH
• Electrodes MeSH
• Electroencephalography methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging methods   MeSH
• Malformations of Cortical Development complications   pathology   MeSH
• Brain Mapping MeSH
• Adolescent MeSH
• Brain physiopathology   MeSH
• Signal Processing, Computer-Assisted MeSH
• Spectrum Analysis MeSH
• Seizures etiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Učebnice seznamuje čtenáře s novými poznatky v dermatovenerologii a důraz klade na logiku diagnostiky kožních nemocí, na praktičnost, přehlednost, pochopitelnost a srozumitelnost textu. S tím souvisí i zařazení četných schémat, tabulek, obrázků a doplnění stránek margináliemi, které umožňují rychlou orientaci v textu a pro studenty jsou také pomůckou při opakování. Pětisetstránková publikace je doplněna více než 400 barevnými obrázky.

• MeSH
• Diagnosis, Differential MeSH
• Skin Diseases diagnosis   classification   therapy   MeSH
• Sexually Transmitted Diseases diagnosis   classification   therapy   MeSH
• Publication type
• Monograph MeSH

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