Cíl: Analyzovat důvody, které vedou porodníky a porodní asistentky k provedení epiziotomie. Následně identifikovat sporné indikace jejího provedení na základě výsledků výzkumu pro snížení frekvence této operace při zachování kvality porodnické péče. Metodika: Byly zaznamenány důvody provedení epiziotomie u porodů vedených porodníky a porodními asistentkami na GPK FN Plzeň v období únor 2006 až červen 2007. Byl hodnocen hlavní důvod i vedlejší důvody provedení epiziotomie. Výsledky: Z celkového počtu 2707 odvedených vaginálních porodů byla u 1150 (42 %) porodů provedena mediolaterální epiziotomie a důvod provedení byl zaznamenán v 1069 případech (93 %). Při hodnocení hlavního důvodu provedení epiziotomie byla nejčastěji zastoupena obava o zachování funkce pánevního dna (624, 58 %), a to nejčastěji z důvodu tuhé, neelastické hráze (401, 37 %). Dále známky intrauterinní tísně plodu (181, 17%) a poruchy vypuzovacích sil či suboptimální spolupráce s rodičkou ve finální fázi porodu (109, 10 %). Při hodnocení všech (včetně vedlejších) důvodů nejčastějším důvodem zůstala obava o zachování funkce pánevního dna (871, 50 %). Porucha vypuzovacích sil či obtížná spolupráce s rodičkou (354, 20 %) převýšila známky intrauterinní tísně plodu (253, 15 %). Při rozdělení epiziotomií podle osob, které epiziotomie prováděli (lékař/porodní asistentka) byla u porodních asistentek výrazně významněji provedena epiziotomie primárně z obavy před následnou poruchou pánevního dna (81 % vs. 39 %). Známky intrauterinní tísně plodu naopak patří výrazně častěji k hlavním důvodům provedení epiziotomie u lékařů (28 % vs. 4 %). Závěr: Vzhledem k tomu, že na našem pracovišti vedou porodní asistentky pouze fyziologické porody, je u nich spektrum důvodů provedení epiziotomie užší a dominuje obava o zachování funkce pánevního dna. V současnosti není obava o zachování funkce pánevního dna považována za oprávněnou indikaci k provedení epiziotomie. Fakt, že 624 (58 %) epiziotomií bylo provedeno primárně z důvodu obavy o zachování funkce pánevního dna, představuje významný prostor pro snížení počtu epiziotomií. Redukce by měla být možná zejména ve skupině porodních asistentek (81 % všech hlavních důvodů provedení epiziotomie ve skupině porodních asistentek, tj. 37 % všech provedených epiziotomií). Analýza důvodů epiziotomie je důležitým krokem, který má umožnit snížení frekvence této operace při současném zachování, či zvýšení standardu poskytované péče.

Aim: To analyze reasons for episiotomy use in vaginal delivery among obstetricians and midwives. Consecutively, to indentify disputable indications for its use based on published research in order to facilitate the decrease in frequency of this operation, while preserving high quality of obstetrical care. Methods: Reasons for mediolateral episiotomy use were recorded by obstetricians and midwives after each vaginal delivery with episiotomy at the Ob&Gyn Department of the Charles University Hospital in Pilsen in the period of February 2006 – June 2007. The main reason and all reasons for episiotomy use were evaluated separately. Results: The reason for episiotomy use was recorded in 1069 cases (93%) out of a total of 1150 vaginal deliveries, in which mediolateral episiotomy was performed (42% of all vaginal deliveries). The most common group of main reasons for episiotomy use was a concern about postpartum pelvic floor functional impairment (624, 58% of episiotomies), especially a rigid, non-elastic perineum (401, 37%). Fetal distress (181, 17%) and abnormalities of the expulsive forces/uncooperative parturient (109, 10%) followed. When evaluating all (including secondary) reasons, the most common groups of reasons for episiotomy use were the effort of pelvic floor functionality preservation (871, 50%), abnormalities of the expulsive forces/uncooperative parturient (354, 20%) and fetal distress (253, 15%). When evaluating episiotomies performed by obstetricians and midwives separately, the concern about postpartum pelvic floor functionality prevailed in midwives (81% vs. 39% of episiotomies performed primarily for this reason). Conversely, the obstetricians performed episiotomy more frequently for fetal distress (28% vs. 4 %). Conclusion: In view of the fact that midwives attend only physiological deliveries in our department, the spectrum of reasons for episiotomy use among midwives is narrower and the concern about postpartum pelvic floor functionality dominates. Currently, the concern about postpartum pelvic floor functionality should not be considered a legitimate indication for episiotomy use. The fact that 624 (58%) episiotomies were performed for this reason represents a significant reserve for a decrease in the frequency of episiotomy use. The reduction should be possible primarily among midwives (81% of all main reasons for episiotomy use in the midwive group, i.e. 37% of all episiotomies performed). The analysis of reasons for episiotomy use is an important step in reduction of episiotomy rates while preserving or improving the standard of treatment provided.

• Keywords
• mediolaterální epiziotomie, indikace, poranění dna pánevního,
• MeSH
• Episiotomy utilization   MeSH
• Data Interpretation, Statistical MeSH
• Clinical Trials as Topic MeSH
• Obstetric Labor Complications surgery   MeSH
• Humans MeSH
• Pelvic Floor injuries   MeSH
• Perineum surgery   MeSH
• Surveys and Questionnaires MeSH
• Statistics as Topic MeSH
• Pregnancy MeSH
• Check Tag
• Humans MeSH
• Pregnancy MeSH
• Female MeSH

OBJECTIVE: The perineal body connects muscles from the pelvic floor and is critical for support of the lower part of the vagina and proper function of the anal canal. We determined mechanical parameters and volume fractions of main components of the human female postmenopausal perineal body. METHODS: The specimens were taken from 15 fresh female cadavers (age 74 ± 10, mean ± standard deviation). Seventy-five specimens from five regions of the perineal body were processed histologically to assess volume fractions of tissue components using stereological point testing grid. Fifteen specimens taken from the midline region were loaded uniaxially with 6 mm/min velocity until tissue rupture to determine Young's modulus of elasticity, ultimate stresses, and strains. RESULTS: The perineal body was composed of collagen (29%), adipose cells (27%), elastin (7%), smooth muscle (11%), and skeletal muscle (3%). The residual tissue (19%) constituted mostly peripheral nerves, lumina of blood vessels, fibroblasts, and fibrocytes. Young's modulus of elasticity at midline region was 18 kPa (median) at small and 232 kPa at large deformations, respectively. The ultimate stress was 172 kPa and the ultimate strain was 1.4. CONCLUSIONS: We determined the structural and mechanical parameters of the perineal body. The resultant data could be used as input for models simulating pelvic floor prolapse or dysfunction.

• MeSH
• Anal Canal MeSH
• Biomechanical Phenomena physiology   MeSH
• Elastin analysis   MeSH
• Muscle, Smooth anatomy & histology   MeSH
• Collagen analysis   MeSH
• Muscle, Skeletal anatomy & histology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Cadaver MeSH
• Pelvic Floor anatomy & histology   physiology   surgery   MeSH
• Perineum anatomy & histology   physiology   surgery   MeSH
• Postmenopause physiology   MeSH
• Pelvic Organ Prolapse physiopathology   MeSH
• Elasticity physiology   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Adipose Tissue anatomy & histology   MeSH
• Vagina MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

INTRODUCTION AND HYPOTHESIS: Quantitative characterization of the birth canal and critical structures before delivery may provide risk assessment for maternal birth injury. The objective of this study was to explore imaging capability of an antepartum tactile imaging (ATI) probe. METHODS: Twenty randomly selected women older than 21 years with completed 35th week of pregnancy and a premise of vaginal delivery were enrolled in the feasibility study. The biomechanical data were acquired using the ATI probe with a double-curved surface, shaped according to the fetal skull and equipped with 168 tactile sensors and an electromagnetic motion tracking sensor. Software package COMSOL Multiphysics was used for finite element modeling. Subjects were asked for assessment of pain and comfort levels experienced during the ATI examination. RESULTS: All 20 nulliparous women were successfully examined with the ATI. Mean age was 27.8 ± 4.1 years, BMI 30.7 ± 5.8, and week of pregnancy 38.8 ± 1.4. Biomechanical mapping with the ATI allowed real-time observation of the probe location, applied load to the vaginal walls, and a 3D tactile image composition. The nonlinear finite element model describing the stress-strain relationship of the pelvic tissue was developed and used for calculation of Young's modulus (E). Average perineal elastic modulus was 11.1 ± 4.3 kPa, levator ani 4.8 ± 2.4 kPa, and symphysis-perineum distance was 30.1 ± 6.9 mm. The pain assessment level for the ATI examination was 2.1 ± 0.8 (scale 1-4); the comfort level was 2.05 ± 0.69 (scale 1-3). CONCLUSIONS: The antepartum examination with the ATI probe allowed measurement of the tissue elasticity and anatomical distances. The pain level was low and the comfort level was comparable with manual palpation.

• MeSH
• Adult MeSH
• Elasticity Imaging Techniques * MeSH
• Humans MeSH
• Young Adult MeSH
• Pelvic Floor * diagnostic imaging   MeSH
• Perineum diagnostic imaging   MeSH
• Parturition MeSH
• Feasibility Studies MeSH
• Pregnancy MeSH
• Imaging, Three-Dimensional MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: The mechanical properties and microstructure of the perineal body are important for the improvement of numerical models of pelvic organs. We determined the mechanical parameters and volume fractions of the ewe perineal body as an animal model. METHODS: The 39 specimens of 13 pregnant swifter ewes delivering by cesarean section (aged 2 years, weight 61.2 ± 6.2 kg (mean ± standard deviation) and 24 specimens of 8 postmenopausal swifter ewes 150 days after surgical ovariectomy (aged 7 years, 58.6 ± 4.6 kg)) were loaded uniaxially to determine Young's moduli of elasticity in the small (E0) and large (E1) deformation regions, and ultimate stresses and strains. The 63 adjacent tissue samples were processed histologically to assess volume fractions of smooth and skeletal muscle, adipose cells, elastin, and type I collagen using a stereological point testing grid. We compared the structural and mechanical differences along the ewe perineal body, and between pregnant and postmenopausal groups. RESULTS: The pregnant/postmenopausal perineal body was composed of smooth muscle (12/14%; median), skeletal muscle (12/16%), collagen (10/23%), elastin (8/7%), and adipose cells (6/6%). The E0 was 37/11 kPa (median), E1 was 0.97/1.04 MPa, ultimate stress was 0.55/0.59 MPa, and ultimate strain was 0.90/0.87 for pregnant/postmenopausal perineal body. The perineal body showed a structural and mechanical stability across the sites. The pregnant ewes had a higher amount of skeletal muscle, higher E0, and a less amount of collagen when compared with postmenopausal ewes. CONCLUSIONS: The data can be used as input for models simulating vaginal delivery, pelvic floor prolapsed, or dysfunction.

• MeSH
• Biomechanical Phenomena MeSH
• Elastin analysis   MeSH
• Muscle, Smooth anatomy & histology   physiology   MeSH
• Collagen analysis   MeSH
• Muscle, Skeletal anatomy & histology   physiology   MeSH
• Models, Animal MeSH
• Sheep MeSH
• Perineum anatomy & histology   physiology   MeSH
• Postmenopause MeSH
• Pregnancy MeSH
• Adipocytes MeSH
• Animals MeSH
• Check Tag
• Pregnancy MeSH
• Female MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH

Cíl: Cílem sdělení je poskytnout principiální popis a vysvětlení techniky kinezio tapingu u vybraných diagnóz. Seznámit odborníky s anatomickými aspekty účinné techniky a možnostmi její aplikace v klinické praxi. Metody: Technika kinezio tapingu byla vyvinuta v Japonsku v 70. letech. S využitím hypoalergenních elastických náplastí se používá jako pomůcka pro zlepšení terapeutických i výkonnostních výsledků a jsou posílena, fixována nebo podpořena problematická místa. V tomto článku jsou popsány anatomické principy a schématické provedení kinezio tape s ukázkou techniky kinezio tapu u interkostální neuralgie a vertebrogenních obtíží. Závěr: Technika kinezio tapu pomocí novodobých elastických pásek prokazatelně pomáhá např. při regulaci svalového napětí, aktivaci systému pro snížení bolesti, zlepšení funkce svalů nebo korekce svalových dysbalancí. Funkčnost tapů spočívá především ve zvýšené cirkulaci krve a lymfy přímo pod tapem a následné zvýšení látkové výměny, a proto je zcela zásadní správné a anatomicky přesné umístění kineziotapu.

Objective: The objective of the paper is to provide a clear description and explanation of Kinesio Taping in selected diagnoses, and also introduce anatomical aspects of this very effective technique, and the possibilities of its application in the field of neurology to health care professionals. Methods: Kinesio Taping technique was developed in Japan in the 1970's. Using hypoallergenic elastic tapes provides strengthening, fixation or support for problematic areas. This article describes anatomical principles and schematic performance of Kinesio Tape in intercostal and vertebral neuralgia. Conclusion: Kinesio Tape technique using modern elastic tapes is proven to help in e. g. regulation of myotonus, activating a system for pain reduction, improving the function of muscles or correcting muscular dysbalance. Functionality of tapes consists primarily in increased circulation directly below the tape and subsequent increase in metabolism, so correct and anatomically precise placement of Kinesio Tape is therefore absolutely essential.

• MeSH
• Back Pain therapy   MeSH
• Humans MeSH
• Neuralgia MeSH
• Proprioception MeSH
• Muscle Contraction * physiology   MeSH
• Muscles anatomy & histology   MeSH
• Athletic Tape classification   utilization   MeSH
• Exercise Therapy MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Prevalencia a incidencia chronických i akútnych vénových cievnych chorôb je globálne veľmi vysoká v priemyslovo rozvinutých i rozvojových krajinách. Vénové choroby dolných končatín sú aktuálne integrálnou súčasťou smrtiacej angiopandémie tretieho milénia. Najzávažnejšie prípady s pokročilým štádiom vénového zlyhávania sú v populácii asi v dvojnásobnom počte (2,1 %) voči donedávno známym údajom. Syndróm panvovej kongescie/varikokéla je súbor chronických symptómov (panvové bolesti, perineálne ťažkosti, urgentné močenie, postkoitálne bolesti), spôsobené ováriovým/testikulárnym a/alebo panvovým vénovým refluxom a/alebo vénovou obštrukciou a môže sa prejaviť objektívnymi znakmi, ako sú vulvové, perineálne a/alebo končatinové varixové vény/ varikokéla. Mikronizovaná purifikovaná flavonoidná frakcia diosmín hesperidínu zostáva medzi venofarmakmi preparátom s najvyšším stupňom odporúčaní a indikovaná je aj k farmakoterapeutickej podpore hojenia vredov predkolenia, spolu so sulodexidom a pentoxifylínom. Kompresívna skleroterapia roztokom alebo penou je účinná a bezpečná invazívna metóda liečby telangiektázií, retikulárnych vén a varixov. Nové priame orálne antikoagulanciá predstavujú jednu z možností terapie a prevencie hĺbkovej vénovej trombózy a vénovej tromboembólie s limitáciou u pacientov s malígnymi chorobami a v gravidite. Najefektívnejšia je trojaká simultánna farmako‑kinezio‑mechano‑flebotromboemboloprofylaxia. Povrchové vénové trombózy dlhšie než 5 cm sú tiež indikované na antikoagulačnú liečbu. Kľúčové slová: angiológia/vaskulárna medicína – flebológia/vénová medicína – véna – vénové cievne choroby – manažment – súčasnosť – budúcnosť

The global prevalence and incidence of chronic and acute venous vascular disease has been shown to be very high, in both industrialised and developing countries. Venous diseases of lower extremities are an integral part of the third millennium's deadly angiopandemy. The rate of the most severe cases with advanced stage of venous failure is approximately twice as high in the population (2.1%) as has been assumed so far. Pelvic congestion syndrome/varicocele is a combination of chronic symp­toms, which may include pelvic pain, perineal heaviness, urgency of micturition, and post‑coital pain, caused by ovarian/testicular and/or pelvic vein reflux and/or obstruction, and which may be associated with vulvar, perineal, and/or lower extremity varices/varicocele. Among venoactive drugs, micronised purified flavonoid fraction of diosmin hesperidin remains the agent with the highest degree of recommendation and it is also indicated as pharmaceutical support of leg ulcer healing, along with sulodexide and pentoxifylline. Compression sclerotherapy with liquid or foam is a safe and effective invasive method to treat telangiectasias, reticular varicose veins and subcutaneous varicose veins. Direct oral anticoagulants represent one of the therapeutic and preventive options for deep venous thrombosis and venous thromboembolism with a limitation in patients with malignant conditions and in pregnancy. The most effective method is triple simultaneous pharmaco‑kinezio‑mechano‑phlebothromboemboloprophylaxis. Superficial vein thromboses longer than 5 cm are also indicated to anticoagulant therapy. Keywords: angiology/vascular medicine – phlebology/venous medicine – vein – venous vascular disease – management – present – future

• Keywords
• syndrom pánevní kongesce, NOAC,
• MeSH
• Anticoagulants administration & dosage   therapeutic use   MeSH
• Administration, Oral MeSH
• Lower Extremity blood supply   MeSH
• Heparin administration & dosage   therapeutic use   MeSH
• Hesperidin therapeutic use   MeSH
• Hyperemia etiology   physiopathology   MeSH
• Platelet Aggregation Inhibitors administration & dosage   therapeutic use   MeSH
• Combined Modality Therapy MeSH
• Stockings, Compression MeSH
• Humans MeSH
• Vascular Diseases physiopathology   MeSH
• Pelvis blood supply   MeSH
• Pelvic Pain etiology   MeSH
• Syndrome MeSH
• Telangiectasis etiology   therapy   MeSH
• Varicose Veins etiology   therapy   MeSH
• Warfarin administration & dosage   therapeutic use   MeSH
• Venous Insufficiency * etiology   classification   physiopathology   therapy   MeSH
• Venous Thromboembolism etiology   therapy   MeSH
• Check Tag
• Humans MeSH