• Klíčová slova
• popáleniny - patofyziologie - endokrinologie - terapie - monografie, opařeniny - patofyziologie - endokrinologie - terapie - monografie,

• Konspekt
• Lékařské vědy. Lékařství
• NLK Obory
• chirurgie
• endokrinologie

AIM OF THE STUDY: Epidemiologic evaluation of pelvic ring injuries in children. METHODS: Retrospective analysis over a period of 13 years, excluding pathological fractures. AO/OTA type, epidemiological data, type of treatment, and complications were recorded. Data were assessed using Fisher's exact test and Wilcoxon test. RESULTS: 243 boys, 115 girls, mean age (SD) 14.1 ± 3.0 years, AO/OTA types: 281 A, 52 B, 25 C. Multiple trauma: 62, combined trauma: 59, mono-trauma: 237. 281 patients were treated non-operatively, 97 surgically. ETIOLOGY: traffic accidents 88, falls from a great height 37, crushing injuries four, and sports injuries 192, simple falls 30, others seven. High-energy mechanisms prevailed in types B and C. Low-energy mechanism in type A (p < 0.0001). Similar differences were found between type A (p = 0.0009) and in case type C requiring surgery and cases treated non-operatively (p < 0.0001). Twenty-six patients (7.3%) had complications (pelvic asymmetry 5, neurological deficits 5, non-union 1, ectopic calcification 4, others 7). Higher complication rates were associated with types B and C (p = 0.0015), with surgically treated cases (p < 0.0001) and multiple trauma (p = 0.0305). DISCUSSION: Results of this trial were comparable with other studies. CONCLUSION: Sports injuries accounted for most type A injuries, while types B and C tended to be associated with high-energy trauma. Complications were associated with the severity of pelvic trauma, more common in surgically treated group of patients; this is primarily linked to the surgical cases being more serious as well as the associated injuries.

• MeSH
• dítě MeSH
• fraktury kostí * epidemiologie   chirurgie   MeSH
• lidé MeSH
• mladiství MeSH
• pánevní kosti * zranění   chirurgie   MeSH
• polytrauma * MeSH
• retrospektivní studie MeSH
• traumatologická centra MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY Trauma represents the third cause of death after cardio vascular disease and tumors. Also in Iran, road accidents are one of the leading causes of death. Rapid evaluation of trauma severity and prediction of prognosis and mortality rate and probability of survival and rapid treatment of patients is necessary. One of the useful instruments for this is ISS and RTS scoring systems. This study evaluated 70 multi trauma patients in Fatemi trauma center affiliated to Ardabil University of medical science. MATERIALS AND METHODS This study was prospective study populations were 70 trauma patients admitted in Fatemi trauma center. During the II month, and patients data was collected by clinical evaluating of patients and follow up them and arranged as a questionnaire then related findings were evaluated by SPSS software. RESULTS The average age of patients was 37.6?23.5 years and minimum and maximum age was 1 and 85 years. The most common involved group was 10-19 years (13 men and 1 woman). 81.4% of patients (57 cases were male) and 18.6% were female (13 cases). The most common causes of trauma was car accident with 64.2% frequency (43 cases) and then motorcycle accident with 16.4% frequency (11 cases) and all injured patient due to motorcycle accident compose the age group less than 40 years old. Also car accident had the highest frequency in both gender. Other causes of trauma were fall down with 13.5% frequency (9 cases) and under debris 5.9% (4 cases). Also from 70 studied patients, 67 cases (95.7%) had blunt trauma and 3 cases (4.3%) had penetrating trauma. The most penetrating trauma occurs in ages less than 50 years and was in the range of 30-50 years. The average RTS and ISS was 10.67?1.45 and 18.11 ?8.64, high and low scores of ISS existed in all age groups but a low score of RTS was highest in the children age group. The average length of ICU stay was 12.14?11.11 days. Overall mortality was 15.7 (11 cases). In this study, by the ISS increasing, the mortality rate also increased. But there is no relation between the mortality rate and RTS ratio. CONCLUSION The ISS scoring system performed better than the RTS in predicting of mortality and probability of survival and the length of ICU stay and had high accuracy and can predict patients' outcome better by ISS measuring.

• MeSH
• analýza přežití * MeSH
• kvalita zdravotní péče MeSH
• lidé MeSH
• polytrauma * epidemiologie   klasifikace   mortalita   MeSH
• prospektivní studie MeSH
• rozložení podle pohlaví * MeSH
• skóre závažnosti úrazu * MeSH
• ukazatel závažnosti úrazu * MeSH
• urgentní zdravotnické služby metody   MeSH
• věkové rozložení * MeSH
• Check Tag
• lidé MeSH

Chemické trauma tvoří pouze malou část etiologie popálenin jak v dětské, tak dospělé populaci. Léčbě těchto úrazů by měla vždy být věnována zvláštní pozornost, kvůli jejich jedinečnému a nevyzpytatelnému chování. Při chemických poraněních kůže je nutné vždy maximálně zkrátit dobu expozice noxy a včas rozpoznat systémovou toxicitu, a tím snížit závažnost poranění spolu s celkovou morbiditou. Bohužel nízký výskyt tohoto typu poranění nekoreluje s mírou poškození tkání, a proto nezřídka vyžaduje chirurgickou terapii.

Chemical trauma is only a small part of the etiology of burns in both children and adults. Special attention should always be paid to the treatment of these injuries, due to their unique and unpredictable behavior. In the case of chemical skin injuries, it is always necessary to shorten the exposure time as much as possible and to recognize systemic toxicity in time, thus reducing the severity of the injury along with the overall morbidity. Unfortunately, the low incidence of this type of injury does not correlate with the degree of tissue damage and therefore often needed surgical therapy.

• Klíčová slova
• Matriderm, dermální náhrada Matriderm,
• MeSH
• hojení ran MeSH
• kojenec MeSH
• lidé MeSH
• orgány z umělého a biologického materiálu MeSH
• popálení MeSH
• transplantace kůže * MeSH
• umělá kůže MeSH
• výsledek terapie MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY To evaluate, in a retrospective study, injuries to the urogenital tract in patients with pelvic ring fractures. MATERIAL In the years 1998-2007, a total of 308 patients with pelvic ring fractures were treated. The study did not comprise patients with low-energy fractures, such as apophyseolysis in children, osteoporotic bone fractures or pathologic fractures. It also did not include patients with multiple injuries who died within 6 hours of admission to the hospital. The group consisted of 186 men and 122 women with an average age of 34 (range, 6 to 76) years. RESULTS The fractures sustained were classified as type A in 5 %, type B in 57 % and type C in 38 % of the patients. The average follow-up was 71 (range, 13 to 121) months. A primary injury to the urogenital tract was recorded in 50 (16 %) patients. Injury to the urethra was found in 23 (7.5%) and urinary bladder trauma in 18 (6%) patients, vaginal injury was in four women (1%), and penis injury in three (1%) and lacerated testicles in two men (1%). Injury to the urogenital tract was associated with a pelvic ring fracture type A in 5 %, type B in 34 % and type C in 61 % of the patients. Out of the 23 patients with urethral trauma, only six (26 %) were free from functional and subjective complaints; eight (35 %) continued to receive therapy for urethral stenosis seven (30 %) reported urinary incontinence, and seven men (30 %) had erection problems. In six patients (26%) the lasting sequelae were combined. The 18 patients with injury to the bladder reported no subjective complaints at a one-year follow-up. Two patients with penis root injury had erectile dysfunction. Two patients with the loss of both testicles were in the care of a psychiatrist. The patient´s satisfaction was evaluated on a 0-to10-point scale. The average value for the whole group was 4.1 points. In the patients with erectile dysfunction, the value was 0.8, and in those with isolated injury to the urinary bladder it was 9.4 points. DISCUSSION The increasing number of injuries to the urogenital tract associated with permanent sequelae is caused by a growing number of pelvic ring fractures as well as, and this is more important, by decreasing mortality in patients with severe trauma to the pelvic ring The extent of urogenital injury is related to the degree of dislocation of the pelvic skeleton. Injury to the male urethra is the most frequent urogenital trauma because of the male anatomy. It occurs most often in unstable C type fractures when the pelvic ring is disrupted with bone displacement due to shear force at the site of urethra attachment. The consequences are related to the quality of treatment of urogenital tract injury as well as to how the skeletal injury is managed. The lasting effects of the primary injury to nerve structures are beyond repair by therapy. CONCLUSIONS Injury to the urethra results in erectile dysfunction in 50 % of the injured patients it is often associated with urinary incontinence that has a strong effect on the patient´s life quality. Isolated trauma to the urinary bladder has a good prognosis. The incidence of post-traumatic incontinence is not high, but reduces the patient´s personal and social comfort. A prerequisite for a successful therapeutic outcome is a good cooperation of the orthopaedic surgeon and urologist.

• MeSH
• dítě MeSH
• dospělí MeSH
• erektilní dysfunkce etiologie   MeSH
• fraktury kostí komplikace   MeSH
• infertilita etiologie   MeSH
• inkontinence moči etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pánevní kosti zranění   MeSH
• senioři MeSH
• urogenitální systém zranění   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

PURPOSE OF THE STUDY The purpose of this study was to assess the available information on patients with a whole-body CT and to ascertain whether the number of examinations could be reduced. MATERIAL AND METHODS This retrospective study included all patients who underwent a whole-body CT in the University Hospital Olomouc during a period of one year. Epidemiologic data of patients and information about the trauma and injuries suffered were collected. The injuries were assessed using the Abbreviated Injury Scale and the Injury Severity Score and classified as high- and low-energy injuries. These two groups were subsequently compared. RESULTS A total of 338 patients were examined, of whom 75% were male and the median age of all patients was 48 years. The most frequent causes of trauma were road accidents in 53% and falls from height in 25%. Ninety-one percent of examined patients were admitted to hospital, 42% underwent a surgery and 3% died. The average ISS was 10.7 and the severity of injury increased with age (p = 0.01). The patients after an attempted suicide and those after motorbike and bike accidents had the highest ISS observed. A higher ISS was detected more often in high-energy traumas than in low-energy traumas (p = 0.002). A completely negative polytrauma CT scan finding was observed in 5 patients with low-energy trauma and in 9 patients with high-energy trauma. CONCLUSIONS High-energy injuries were shown to be associated with higher severity as well as more negative CT scans than lowenergy ones. Bearing in mind that a whole-body CT scan is an extensive examination in which relatively high doses of radiation are used, it should always be considered whether a selective CT of fewer body parts would not be sufficient for the diagnosis. Key words: abbreviated injury scale, injury severity score, multiple trauma.

• MeSH
• lidé středního věku MeSH
• lidé MeSH
• lidské tělo * MeSH
• počítačová rentgenová tomografie MeSH
• polytrauma * diagnostické zobrazování   epidemiologie   MeSH
• retrospektivní studie MeSH
• skóre závažnosti úrazu MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Background: Although trauma exposure is universally prevalent, the ways in which individuals respond to potentially traumatic events vary. Between-country differences have been identified as affecting the development and manifestation of transdiagnostic psychological symptoms, but it remains unclear how stress and trauma-related transdiagnostic symptoms and risk patterns differ based on geographic region.Objective: To explore whether there are distinct classes of stress and trauma-related transdiagnostic symptoms and to determine predictors of class membership in a global sample.Method: Participants (N = 8675) from 115 different countries were recruited online between 2020-2022 and completed the Global Psychotrauma Screen, which assesses stress and trauma exposure, related symptoms, and risk factors. A latent class analysis (LCA) was used to identify classes of stress and trauma-related symptoms per world region (African States, Asia-Pacific States, Eastern European States, Latin American and Caribbean States, Western European and Other States, and North America) and the total sample. Likelihood of class membership was assessed based on demographics, characteristics of the potentially traumatic event, and potential risk factors across the world regions.Results: Similar class compositions were observed across regions. A joint latent class analysis identified three classes that differed by symptom severity (i.e. high, moderate, low). Multinomial logistic regression analyses revealed several factors that conferred greater risk for experiencing higher levels of symptoms, including geographic region, gender, and lack of social support, among others.Conclusions: Stress and trauma-related symptoms seem to be similarly transdiagnostic across the world, supporting the value of a transdiagnostic assessment.

• MeSH
• analýza latentních tříd MeSH
• lidé MeSH
• posttraumatická stresová porucha * diagnóza   epidemiologie   psychologie   MeSH
• rizikové faktory MeSH
• sociální opora MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Asie MeSH

OBJECTIVES: To estimate the efficacy and metabolic effects of growth hormone substitution as intravenous pulses together with alanyl-glutamine supplementation and tight blood glucose control in prolonged critical illness. DESIGN: Prospective double-blind, randomized trial with open-label control arm. SETTING: Intensive care unit of tertiary level hospital. PATIENTS: Thirty multiple trauma patients (median Injury Severity Score 34). INTERVENTIONS: Patients were randomized, at day 4 after trauma, to receive intravenous alanyl-glutamine supplementation (0.3 g/kg x day(-1) from day 4 until day 17) and intravenous growth hormone (administered days 7-17, full dose 50 microg/kg x day(-1) from day 10 onward) (group 1, n = 10) or alanyl-glutamine and placebo (group 2, n = 10). Group 3 (n = 10) received isocaloric isonitrogenous nutrition (proteins 1.5 g/kg x day(-1)) without alanyl-glutamine. MEASUREMENTS AND MAIN RESULTS: Cumulative nitrogen balance for the whole study period was -97 +/- 38 g of nitrogen for group 1, -193 +/- 50 g of nitrogen for group 2, and -198 +/- 77 g of nitrogen for group 3 (p < .001). This represents a daily saving of 300 g of lean body mass in group 1. Insulin-mediated glucose disposal, during euglycemic clamp, as a measure of insulin sensitivity, significantly worsened between days 4 and 17 in group 1 but improved in groups 2 and 3. Group 1 required significantly more insulin to control blood glucose, resulting in higher insulinemia (approximately 70 mIU in group 1 vs. approximately 25 mIU in groups 2 and 3). Despite this, growth hormone treatment caused an increase in plasma nonesterified fatty acid (approximately 0.5-0.6 mM in group 1 in comparison with approximately 0.2-0.3 mM in groups 2 and 3) but did not influence lipid oxidation. There were no differences in morbidity, mortality, or 6-month outcome among the groups. CONCLUSIONS: Treatment with frequent intravenous pulses of low-dose growth hormone together with alanyl-glutamine supplementation improves nitrogen economy in patients with prolonged critical illness after multiple trauma but worsens insulin sensitivity. Tight blood glucose control is possible but requires higher doses of insulin.

• MeSH
• amoniak moč   MeSH
• APACHE MeSH
• délka pobytu MeSH
• dipeptidy aplikace a dávkování   MeSH
• dospělí MeSH
• dusík moč   MeSH
• dvojitá slepá metoda MeSH
• energetický metabolismus účinky léků   MeSH
• financování organizované MeSH
• index tělesné hmotnosti MeSH
• intravenózní infuze MeSH
• inzulinová rezistence fyziologie   MeSH
• kombinovaná farmakoterapie MeSH
• kreatinin moč   MeSH
• krevní glukóza metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lidský růstový hormon aplikace a dávkování   MeSH
• míra přežití MeSH
• nepřímá kalorimetrie MeSH
• péče o pacienty v kritickém stavu metody   MeSH
• pilotní projekty MeSH
• polytrauma farmakoterapie   mortalita   patofyziologie   MeSH
• prospektivní studie MeSH
• pulzní dávkování léků MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

PURPOSE: Trauma is a leading cause of mortality, with major bleeding and trauma-induced coagulopathy (TIC) contributing to negative patient outcomes. Treatments for TIC include tranexamic acid (TXA), fresh frozen plasma (FFP), and coagulation factor concentrates (CFCs, e.g. prothrombin complex concentrates [PCCs] and fibrinogen concentrate [FCH]). Guidelines for TIC management vary across Europe and a clear definition of TIC is still lacking. METHODS: An advisory board involving European trauma experts was held on 02 February 2019, to discuss clinical experience in the management of trauma-related bleeding and recommendations from European guidelines, focusing on CFC use (mainly FCH). This review summarises the discussions, including TIC definitions, gaps in the guidelines that affect their implementation, and barriers to use of CFCs, with suggested solutions. RESULTS: A definition of TIC, which incorporates clinical (e.g. severe bleeding) and laboratory parameters (e.g. low fibrinogen) is suggested. TIC should be treated immediately with TXA and FCH/red blood cells; subsequently, if fibrinogen ≤ 1.5 g/L (or equivalent by viscoelastic testing), treatment with FCH, then PCC (if bleeding continues) is suggested. Fibrinogen concentrate, and not FFP, should be administered as first-line therapy for TIC. Several initiatives may improve TIC management, with improved medical education of major importance; generation of new and stronger data, simplified clinical practice guidance, and improved access to viscoelastic testing are also critical factors. CONCLUSIONS: Management of TIC is challenging. A standard definition of TIC, together with initiatives to facilitate effective CFC administration, may contribute to improved patient care and outcomes.

• MeSH
• fibrinogen terapeutické užití   MeSH
• hemostatika * terapeutické užití   MeSH
• koagulační faktory farmakologie   terapeutické užití   MeSH
• koagulopatie * terapie   MeSH
• krvácení farmakoterapie   etiologie   MeSH
• kyselina tranexamová * terapeutické užití   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Aktuálně diskutovanou otázkou v České republice je zařazení onemocnění bederní páteře do Seznamu nemocí z povolání. Proces uznávání nemocí z povolání má u nás svá specifika, kdy po splnění klinických kritérií následuje část zaměřená na objektivní posouzení konkrétních podmínek šetřené práce. Cílem předkládaného sdělení je praktické přiblížení postupu ověřování podmínek vzniku onemocnění pro účely posouzení nemoci z povolání v konkrétních pracovních podmínkách, tedy posouzení souvislosti vzniklých zdravotních obtíží s vykonávanou prací u pacienta s chronickým lumbagem, který pracoval nejméně tři roky v podmínkách, které mohou vést podle obecných pracovnělékařských předpokladů k přetěžování bederní páteře. Základním parametrem pro posouzení zatížení bederní páteře je odhad komprese na meziobratlovou ploténku v oblasti L4/5 vyhodnocený pomocí speciálně vytvořeného výpočtového modulu.

A classification of lumbar spine diseases into the List of Occupational Diseases is a presently discussed question. The proves of acknowledging an occupational disease in this country has specific features, when the fulfillment of clinical criteria is followed objective evaluation of specific conditions of the work under investigation. The objective of this communication is an applicative approach in the procedure verifying conditions of the disease origin for the sake of evaluating an occupational disease in specific working conditions, therefore the evaluation of associations of the developed health complaints with the work performed by the patient with chronic lumbago, who has worked for at least three years in conditions, which could cause, according to general occupational-medical presumptions to overload of lumbar spine. The principal parameter for evaluating lumbar spine load is the estimation of compression exerted on intervertebral disk in the L4/5 region evaluated by means of specially created calculation module.

• Klíčová slova
• potenciálně rizikové pracovní úkony, přetěžování bederní páteře,
• MeSH
• lidé MeSH
• lumbalgie * etiologie   MeSH
• nemoci z povolání * MeSH
• poranění z opakovaného přetěžování * MeSH
• posouzení stavu pacienta MeSH
• posudkové řízení ve zdravotní péči MeSH
• pracovní zátěž * MeSH
• výzkum MeSH
• Check Tag
• lidé MeSH