The aim of the present study was to assess systemic circulatory and tissue activities of both the classical arm and of the alternative arm of the renin-angiotensin system (RAS) in a new transgenic rat line (TG7371) that expresses angiotensin-(1-7) (ANG 1-7)-producing fusion protein; the results were compared with the activities measured in control transgene-negative Hannover Sprague-Dawley (HanSD) rats. Plasma and tissue concentrations of angiotensin II (ANG II) and ANG 1-7, and kidney mRNA expressions of receptors responsible for biological actions of ANG II and ANG 1-7 [i.e. ANG II type 1 and type 2 (AT1 and AT2) and Mas receptors] were assessed in TG7371 transgene-positive and in HanSD rats. We found that male TG7371 transgene-positive rats exhibited significantly elevated plasma, kidney, heart and lung ANG 1-7 concentrations as compared with control male HanSD rats; by contrast, there was no significant difference in ANG II concentrations and no significant differences in mRNA expression of AT1, AT2 and Mas receptors. In addition, we found that in male TG7371 transgene-positive rats blood pressure was lower than in male HanSD rats. These data indicate that the balance between the classical arm and the alternative arm of the RAS was in male TGR7371 transgene-positive rats markedly shifted in favor of the latter. In conclusion, TG7371 transgene-positive rats represent a new powerful tool to study the long-term role of the alternative arm of the RAS in the pathophysiology and potentially in the treatment of cardio-renal diseases.

• MeSH
• angiotensin I * metabolismus   MeSH
• angiotensin II * MeSH
• kardiovaskulární nemoci metabolismus   genetika   MeSH
• krevní tlak fyziologie   MeSH
• krysa rodu rattus MeSH
• ledviny metabolismus   MeSH
• nemoci ledvin metabolismus   genetika   MeSH
• peptidové fragmenty * metabolismus   MeSH
• potkani Sprague-Dawley * MeSH
• potkani transgenní * MeSH
• protoonkogen Mas MeSH
• receptor angiotensinu typ 1 genetika   metabolismus   MeSH
• receptory spřažené s G-proteiny genetika   metabolismus   MeSH
• rekombinantní fúzní proteiny metabolismus   MeSH
• renin-angiotensin systém * fyziologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

Among carotenoids, ꞵ-carotene has the highest biological activity and is found as an all-trans isomer in many biological systems. Blakeslea trispora is a microorganism that is of interest to industries for the commercial production of ꞵ-carotene. This study investigated the effect of different bacteria on carotenogenesis in B. trispora. The B. trispora bisexual mold was cultured in a production medium, and different bacterial cells were added to it after 24 h. Then, the culture conditions and the culture medium were optimized in the presence of the selected bacteria using the experimental design. The percentage of carotenoids obtained from the mixed culture was determined using high-performance liquid chromatography (HPLC). Results showed that Kocuria rhizophila had the greatest effect on increasing the production of carotenoids in B. trispora. The highest content of carotenoids obtained during optimization was 770 ± 7.5 mg/L, a 6.8-fold increase compared to the control. HPLC analysis of carotenoids indicated the presence of two main peaks, ꞵ-carotene and γ-carotene, in which the primary carotenoid was ꞵ-carotene followed by γ-carotene with a lower content. Therefore, due to the importance of ꞵ-carotene in industry, the use of biostimulants is one of the appropriate strategies to increase the production of this pigment in industry.

• MeSH
• Bacteria * metabolismus   růst a vývoj   MeSH
• karotenoidy * metabolismus   analýza   MeSH
• kokultivační techniky MeSH
• kultivační média chemie   MeSH
• Mucorales * metabolismus   růst a vývoj   MeSH
• vysokoúčinná kapalinová chromatografie MeSH
• Publikační typ
• časopisecké články MeSH

In this systematic review, we report on the effects of diuretic deprescribing compared to continued diuretic use. We included clinical studies reporting on outcomes such as mortality, heart failure recurrence, tolerability and feasibility. We assessed risk of bias and certainty of the evidence using the GRADE framework. We included 25 publications from 22 primary studies (15 randomized controlled trials; 7 nonrandomized studies). The mean number of participants in the deprescribing groups was 35, and median/mean age 64 years. In patients with heart failure, there was no clear evidence that diuretic deprescribing was associated with increased mortality compared to diuretic continuation (low certainty evidence). The risk of cardiovascular composite outcomes associated with diuretic deprescribing was inconsistent (studies showing lower risk for diuretic deprescribing, or comparable risk with diuretic continuation; very low certainty evidence). The effect on heart failure recurrence after diuretic deprescribing in patients with diuretics for heart failure, and of hypertension in patients with diuretics for hypertension was inconsistent across the included studies (low certainty evidence). In patients with diuretics for hypertension, diuretic deprescribing was well tolerated (moderate certainty evidence), while in patients with diuretics for heart failure, deprescribing diuretics can result in complaints of peripheral oedema (very low certainty evidence). The overall risk of bias was generally high. In summary, this systematic review suggests that diuretic discontinuation could be a safe and feasible treatment option for carefully selected patients. However, there isa lack of high-quality evidence on its feasibility, safety and tolerability of diuretic deprescribing, warranting further research.

• MeSH
• depreskripce * MeSH
• diuretika * škodlivé účinky   aplikace a dávkování   terapeutické užití   MeSH
• dospělí MeSH
• hypertenze farmakoterapie   MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• randomizované kontrolované studie jako téma MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• srdeční selhání * farmakoterapie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

Cíl: Zhodnocení výsledků bezpečnosti a účinnosti implantace PRESERFLOTM MicroShunt u pacientů s primárním glaukomem otevřeného úhlu. Soubor a metodika: Retrospektivní analýza dat 19 očí 12 pacientů, z toho 5 žen a 7 mužů. Pacienti byli operováni od srpna 2020 do února 2022. Sledovací období bylo stanoveno na 24 měsíců od operace. Ve sledovacím období byla zjišťována hodnota nitroočního tlaku (NOT), nutnost podávání lokální antiglaukomové farmakoterapie a její spektrum, stav zorného pole, nález na terči zrakového nervu a komplikace v pooperačním období. Indikací k implantaci PRESERFLOTM MicroShunt byl primární glaukom otevřeného úhlu (PGOÚ) špatně kontrolovatelný s maximální možnou tolerovanou medikací. Výsledky: Průměrný NOT byl snížen z 19,05 ±5,58 mmHg před operací, na 11,47 ±2,48 mmHg 3 měsíce po operaci, 12,26 ±2,48 mmHg 6 měsíců po operaci, 14,0 mmHg ±2,43 12 měsíců po operaci, 11,78 ±2,37 mmHg 18 měsíců po operaci a 12,73 ±2,51 mmHg 24 měsíců po operaci (p < 0,001). Bez nutnosti antiglaukomové medikace bylo 3 měsíce po operaci 19 očí, 6 měsíců po operaci 19 očí, 12 měsíců po operaci 19 očí, 18 měsíců po operaci 16 očí a 24 měsíců po operaci 15 očí. Nutnost nasazení monoterapie byla na 1 oku (5,26 %) 18 měsíců po operaci a na 2 očích (10,52 %) 24 měsíců po operaci. Nutnost nasazení dvojkombinace byla 18 měsíců po operaci na 2 očích (10,52 %) a 24 měsíců po operaci na 2 očích (10,52 %). V časném pooperačním období jsme zaznamenali uvolněný spojivkový steh na 3 očích s následnou resuturou na 1 oku. V pozdním pooperačním období jsme u jednoho oka zjistili obstrukci implantátu sklivcovým vláknem, což si vyžádalo jeho výměnu. Závěr: Z našich prvotních výsledků vyplývá, že glaukomový implantát PRESERFLOTM MicroShunt je účinnou chirurgickou metodou s minimálními pooperačními komplikacemi, vedoucí ke statisticky významnému snížení průměrného NOT a k vysazení či snížení lokální antiglaukomové medikace po dobu dvou let od operace

Aim: To evaluate the safety and efficacy outcomes of PRESERFLO™ MicroShunt implantation in patients with primary open-angle glaucoma. Material and Methods: Retrospective data analysis of 19 eyes of 12 patients, comprising 5 females and 7 males. The patients underwent surgery between August 2020 and February 2022. The follow-up period was 24 months after surgery. During the follow-up period, intraocular pressure (IOP), the need to apply topical antiglaucoma medication and its spectrum, visual field status, optic nerve target findings and postoperative complications were recorded. The indication for PRESERFLO™ MicroShunt implantation was primary open angle glaucoma (POAG), poorly controlled with maximum tolerated medical therapy. Results: Average IOP was reduced from 19.05 ±5.58 mmHg preoperatively to 11.47 ±2.48 mmHg at 3 months postoperatively, 12.26 ±2.48 mmHg at 6 months postoperatively, 14.0 ±2.43 mmHg at 12 months postoperatively, 11.78 ±2.37 mmHg at 18 months postoperatively, and 12.73 ±2.51 mmHg at 24 months postoperatively (p < 0.001). No antiglaucoma medication was required in 19 eyes 3 months after surgery, in 19 eyes 6 months after surgery, 19 eyes 12 months after surgery, 16 eyes 18 months after surgery and 15 eyes 24 months after surgery. One eye (5.26%) required monotherapy 18 months after surgery, and 2 eyes (10.52%) 24 months after surgery. Dual combination therapy was required 18 months after surgery in 2 eyes (10.52%) and 24 months after surgery in 2 eyes (10.52%). In the early postoperative period we found a loose conjunctival suture in 3 eyes, which was followed by resuturing in 1 eye. In the late postoperative period we found an obturated implant in 1 eye, which required implant replacement. Conclusion: Our initial results suggest that the PRESERFLO™ MicroShunt glaucoma implant is an effective surgical technique with minimal postoperative complications, resulting in a statistically significant reduction in average IOP and discontinuation or reduction of topical antiglaucoma medication for 2 years after surgery.

• MeSH
• drenážní implantáty glaukomové * MeSH
• glaukom s otevřeným úhlem chirurgie   patofyziologie   MeSH
• lidé MeSH
• nitrooční tlak MeSH
• oftalmologické chirurgické výkony metody   MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH

BACKGROUND: In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes. METHODS: MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg) (comparator) MAP after resuscitation from cardiac arrest reduces 6-month mortality (primary outcome). Trial participants are adults with sustained return of spontaneous circulation who are comatose following resuscitation from out-of-hospital cardiac arrest. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to allocation group. The sample size of 3500 participants provides 90% power with an alpha of 0.05 to detect a 5.6 absolute risk reduction in 6-month mortality, assuming a mortality of 60% in the control group. Secondary outcomes will be poor functional outcome 6 months after randomization, patient-reported overall health 6 months after randomization, and the proportion of participants with predefined severe adverse events. CONCLUSION: The MAP-CARE trial will investigate if targeting a higher MAP compared to a lower MAP during intensive care of adults who are comatose following resuscitation from out-of-hospital cardiac arrest reduces 6-month mortality.

• MeSH
• arteriální tlak * fyziologie   MeSH
• dospělí MeSH
• hodnocení ekvivalence jako téma MeSH
• kardiopulmonální resuscitace * metody   MeSH
• kóma etiologie   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• randomizované kontrolované studie jako téma MeSH
• resuscitace * MeSH
• srdeční zástava * terapie   patofyziologie   mortalita   MeSH
• výsledek terapie MeSH
• zástava srdce mimo nemocnici * terapie   patofyziologie   mortalita   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

BACKGROUND: Fever is associated with brain injury after cardiac arrest. It is unknown whether fever management with a feedback-controlled device impacts patient-centered outcomes in cardiac arrest patients. This trial aims to investigate fever management with or without a temperature control device after out-of-hospital cardiac arrest. METHODS: The TEMP-CARE trial is part of the 2 × 2 × 2 factorial Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial, a randomized, international, multicenter, parallel-group, investigator-initiated, superiority trial that will evaluate sedation strategies, temperature management, and blood pressure targets simultaneously in nontraumatic/nonhemorrhagic out-of-hospital cardiac arrest patients following hospital admission. For the temperature management component of the trial described in this protocol, patients will be randomly allocated to fever management with or without a feedback-controlled temperature control device. For those managed with a device, if temperature ≥37.8°C occurs within 72 h post-randomization the device will be started targeting a temperature of ≤37.5°C. Standard fever treatment, as recommended by local guidelines, including pharmacological agents, will be provided to participants in both groups. The two other components of the STEPCARE trial evaluate sedation and blood pressure strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. A physician blinded to the intervention will determine the neurological prognosis following European Resuscitation Council and European Society of Intensive Care Medicine guidelines. The primary outcome is all-cause mortality at six months post-randomization. To detect a 5.6% absolute risk reduction (90% power, alpha .05), 3500 participants will be enrolled. Secondary outcomes include poor functional outcome at six months, intensive care-related serious adverse events, and overall health status at six months. CONCLUSION: The TEMP-CARE trial will investigate if post-cardiac arrest management of fever with or without a temperature control device affects patient-important outcomes after cardiac arrest.

• MeSH
• horečka * terapie   MeSH
• kardiopulmonální resuscitace * MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• randomizované kontrolované studie jako téma MeSH
• tělesná teplota MeSH
• terapeutická hypotermie * přístrojové vybavení   MeSH
• zástava srdce mimo nemocnici * terapie   komplikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH

Numerous studies have now documented that athletes of different competition levels vary in their motivational styles. Some are internally motivated and train to be better based on intrinsic values, whereas others are controlled by external pressures that drive performance. A third style does not make causal attributions regarding their performance and are amotivated. In the current study, we used latent profile analysis to examine unique typologies of sports motivation in 456 Czech university students comprised of both recreational and more elite athletes participating in various sports and attending a sport education program. Four qualitatively distinct profiles were distinguished varying in the composition of intrinsic, extrinsic, and amotivation. The four profiles differed in their mean levels of social physique anxiety, global self-esteem, and physical self-worth, three markers of how a person feels about themselves in terms of normative standards. Multiple group comparisons based on gender, individual versus team sports, and level of competition reinforced relative consistency in profile composition. Results are discussed in terms of how people can blend different motivational styles, what this portends for self-beliefs, and whether there is relative consistency across meaningful groups.

• MeSH
• lidé MeSH
• mladý dospělý MeSH
• motivace * MeSH
• představa o vlastním těle MeSH
• průřezové studie MeSH
• průzkumy a dotazníky statistika a číselné údaje   MeSH
• sebepojetí MeSH
• sportovci * psychologie   statistika a číselné údaje   MeSH
• sporty * psychologie   statistika a číselné údaje   MeSH
• studenti * psychologie   statistika a číselné údaje   MeSH
• univerzity statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: Basic management for patients who have suffered a cardiac arrest and are admitted to an intensive care unit (ICU) after resuscitation includes setting targets for blood pressure and managing sedation and temperature. However, optimal targets and management are unknown. METHODS: The STEPCARE (Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation) trial is a multicenter, parallel-group, randomized, factorial, superiority trial in which sedation, temperature, and blood pressure strategies will be studied in three separate comparisons (SED-CARE, TEMP-CARE, and MAP-CARE). The trial population will be adults admitted to intensive care who are comatose after resuscitation from out-of-hospital cardiac arrest. The primary outcome will be all-cause mortality, and the secondary outcomes will be poor functional outcome (modified Rankin Scale 4-6), Health-Related Quality of Life using EQ-VAS, and specific serious adverse events in the intensive care unit predefined for each trial. All outcomes will be assessed at 6 months after randomization. The prognosticators, outcome assessors, statisticians, data managers, steering group, and manuscript writers will be blinded to treatment allocation. This statistical analysis plan includes a comprehensive description of the statistical analyses, handling of missing data, and assessments of underlying statistical assumptions. Analyses will be conducted according to the intention-to-treat principle, that is, all randomized participants with available data will be included. The analyses will be performed independently by two statisticians following the present plan. CONCLUSION: This statistical analysis plan describes the statistical analyses for the STEPCARE trial in detail. The aim of this predefined statistical analysis plan is to minimize the risk of analysis bias.

• MeSH
• kardiopulmonální resuscitace * metody   MeSH
• krevní tlak * MeSH
• kvalita života MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma MeSH
• tělesná teplota MeSH
• zástava srdce mimo nemocnici * terapie   mortalita   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• protokol klinické studie MeSH

BACKGROUND: Sedation is often provided to resuscitated out-of-hospital cardiac arrest (OHCA) patients to tolerate post-cardiac arrest care, including temperature management. However, the evidence of benefit or harm from routinely administered deep sedation after cardiac arrest is limited. The aim of this trial is to investigate the effects of continuous deep sedation compared to minimal sedation on patient-important outcomes in resuscitated OHCA patients in a large clinical trial. METHODS: The SED-CARE trial is part of the 2 × 2 × 2 factorial Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) trial, a randomized international, multicentre, parallel-group, investigator-initiated, superiority trial with three simultaneous intervention arms. In the SED-CARE trial, adults with sustained return of spontaneous circulation (ROSC) who are comatose following resuscitation from OHCA will be randomized within 4 hours to continuous deep sedation (Richmond agitation and sedation scale (RASS) -4/-5) (intervention) or minimal sedation (RASS 0 to -2) (comparator), for 36 h after ROSC. The primary outcome will be all-cause mortality at 6 months after randomization. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to the allocation group. To detect an absolute risk reduction of 5.6% with an alpha of 0.05, 90% power, 3500 participants will be enrolled. The secondary outcomes will be the proportion of participants with poor functional outcomes 6 months after randomization, serious adverse events in the intensive care unit, and patient-reported overall health status 6 months after randomization. CONCLUSION: The SED-CARE trial will investigate if continuous deep sedation (RASS -4/-5) for 36 h confers a mortality benefit compared to minimal sedation (RASS 0 to -2) after cardiac arrest.

• MeSH
• analgosedace * metody   MeSH
• dospělí MeSH
• hluboká sedace * metody   MeSH
• kardiopulmonální resuscitace * metody   MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma MeSH
• zástava srdce mimo nemocnici * terapie   mortalita   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• protokol klinické studie MeSH
• srovnávací studie MeSH

Pacientka náhle v domácím prostředí dušnost, kolaps a bezvědomí. Provedena laická telefonicky navigovaná kardiopulmonální resuscitace, po příjezdu lékaře rychlé záchranné služby úspěšná rozšířená kardiopulmonální resuscitace a poté pacientka převezena na oddělení urgentního příjmu Nemocnice České Budějovice. Byla provedena základní stabilizace klinického stavu, zajištění pacientky, intubace a odvoz na CT. Zde byla pomocí CT verifikována masivní bilaterální plicní embolie. Ihned v prostorách urgentního příjmu byla provedena trombolýza, stabilizace oběhu a pacientka byla uložena na ARO. Za hodinu na oddělení ARO znovu těžká oběhová nestabilita – vysoká podpora oběhu noradrenalinem. Provedeno UZ a následně CT břicha s nálezem masivního hemoperitonea. Urgentní chirurgické konzilium a doporučena operace z vitální indikace. Provedena urgentní laparotomie u hemodynamicky těžce nestabilní pacientky s TK 60/30 a pulzy 180/min. Za masivní oběhové podpory a převodů erymasy odsáty 4 l zcela nesrážlivé krve v oblasti jater. Játra byla tržena na několika místech od zlomených žeber a nejvíce dorzálně v levém laloku v oblasti jaterních žil. Chirurgicky při těžké oběhové nestabilitě neověřitelné a bylo rozhodnuto o stabilizaci pomocí perihepatického packingu a pacientka byl uložena na ARO RES. ARO pokračuje v konzervativní terapii a dochází k postupnému zmenšení odpadů do drénu. Provedena second-look operace za 48 hod – revize původní ranou, odstranění roušek. Nalezeny mnohočetné trhliny na pravém laloku od zlámaných žeber a dorzálně silně krvácející jaterní žíla. Provedena kombinace selektivních sutur s elektrokoagulací trhlin, pro přetrvávající oběhovou nestabilitu se znovu rozhodujeme dát pouze perihepatický packing. Pacientku znovu necháváme na ARO k oběhové stabilizaci a domlouváme se znovu na operační revizi po stabilizaci oběhu za 48 hod. Přistupujeme k další operační revizi. Provádíme znovu revize perihepatického prostoru a anatomickou resekci jaterního segmentu II a III a selektivní podvaz jaterní žíly. Následně dochází k hemodynamické stabilizaci oběhu. V rámci pooperačního průběhu nejprve dochází k rozvoji fluidothoraxu, který byl vyřešen hrudní drenáží, a akutní akalkulozní cholecystitidě, která byla vyřešena punkční cholecystostomií. Pacientka je nyní primárně zhojena a angiologiem nasazena trvalá antikoagulační terapie. Příčina plicní embolizace nebyla zjištěna.

The patient suddenly experienced shortness of breath, collapse, and loss of consciousness at home. Layperson-performed, telephone-guided cardiopulmonary resuscitation was initiated, and upon the arrival of the emergency medical team, successful extended CPR was performed, after which the patient was transported to the emergency department at Hospital of České Budějovice. Basic stabilization of the clinical condition was carried out, the patient was secured, intubated, and transported to the CT scanner. A massive bilateral pulmonary embolism was verified byCT. Thrombolysis was immediately performed in the emergency room, circulation was stabilized, and the patient was transferred to the ICU. An hour later, the patient experienced severe circulatory instability in the ICU, requiring high-dose norepinephrine support. Ultrasound was performed, followed by a CT scan of the abdomen, which revealed massive hemoperitoneum. An urgent surgical consultation was performed, and surgery was recommended on a vital indication. An urgent laparotomy was performed on a hemodynamically unstable patient with the blood pressure 60/30 and the pulse 180/min. Despite massive circulatory support and erythrocyte transfusion, 4 liters of noncoagulable blood were drained from the hepatic region. The liver was torn in several places due to fractured ribs, most severely in the left lobe at the hepatic veins. Due to severe circulatory instability, the injury was deemed inoperable, and it was decided to stabilize the condition with perihepatic packing, after which the patient was transferred to the ICU. The ICU continued conservative therapy, and there was a gradual reduction in the drainage output. A second-look operation was performed after 48 hours – revision of the original wound and removal of the drapes. Multiple fissures were found in the right lobe, caused by broken ribs, with heavy bleeding from the dorsal hepatic veins. A combination of selective suturing and electrocoagulation of the fissures was performed. Due to ongoing circulatory instability, the decision was made to use perihepatic packing once again. The patient was left in the ICU for further circulatory stabilization, with a plan to do another surgical revision after stabilization in 48 hours. Another surgical revision was performed, revisiting the perihepatic space and performing an anatomical resection of liver segments II and III, followed by selective ligation of the hepatic vein. Hemodynamic stabilization was achieved. Postoperatively, a fluidothorax developed, which was managed by thoracic drainage, and acute acalculous cholecystitis, which was treated with puncture cholecystostomy. The patient is now primarily healed and has been started on long-term anticoagulation therapy by the angiologist. The cause of the pulmonary embolism was not determined.

• Klíčová slova
• damage control surgery,
• MeSH
• hemoperitoneum * chirurgie   diagnóza   etiologie   MeSH
• játra chirurgie   diagnostické zobrazování   zranění   MeSH
• laparotomie MeSH
• lidé MeSH
• péče o pacienty v kritickém stavu MeSH
• plicní embolie * diagnóza   komplikace   terapie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH