delayed treatment
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Acta neurochirurgica, ISSN 0065-1419 suppl. 45, 1988
55 s. : il., tab., grafy ; 28 cm
Atrézia dlhého segmentu pažeráka u detí a jej chirurgické riešenie býva často veľmi zložité a je sprevádzané ^sokým výskytom komplikácií. Autori prezentujú pacienta s dlhým segmentom atrézie pažeráka typu Vogt IIIB. Vzdialenosť medzi orálnym a aborálnym pahýľom bola 4 cm. V prvom sedení autori vykonali thorakotómiu, odpojili aborálny pahýl od trachei a uzavreli otvor v trachei ako aj distálny pahýf. Potom obidva pahýle priblížili k sebe bez pokusu o anastomózu a prifixovali stehmi ku chrbtici. Uzavreli hrudník a vykonali gastrostomiu. Po ôsmich týždňoch vykonali opäť thorakotómiu a vykonali oesophago-oesophago end-to-end anastomózu. Pacient podstúpil po operácii 3x balónovú dilatáciu pre striktúru v mieste anastomózy. Pacient je teraz jeden a pol roka po operácii a je bez ťažkosti nemá striktúru.
Atresia of the long segment of the oesophagus in children and its surgical treatment is frequently very complicated and is associated with a high rate of complications. The authors present a patient with a long segment of oesophageal atresia type Vogt IIIB. The distance between the oral and aboral stump was 4 cm. During the first session the authors made a thoracotomy, separated the aboral stump from the trachea and closed the opening in the trachea as well as the distal stump. Then they approximated both stumps without attempting an anastomosis and fixed them by stitches to the spine. They closed the chest and performed a gastrostomy. After eight weeks they repeated the thoracotomy and made an oesophago-oesophago end-to-end anastomosis. The patient was subjected after operation three times to balloon dilatation on account of a stricture at the site of anastomosis. He is now 18 months after operation and has no complaints and no stricture.
- MeSH
- anastomóza chirurgická MeSH
- atrézie jícnu chirurgie MeSH
- dítě MeSH
- gastrostomie MeSH
- lidé MeSH
- nemoci novorozenců vrozené MeSH
- novorozenec MeSH
- stenóza jícnu prevence a kontrola MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: To study the effects of abatacept on disease activity and on muscle biopsy features of adult patients with dermatomyositis (DM) or polymyositis (PM). METHODS: Twenty patients with DM (n=9) or PM (n=11) with refractory disease were enrolled in a randomised treatment delayed-start trial to receive either immediate active treatment with intravenous abatacept or a 3 month delayed-start. The primary endpoint was number of responders, defined by the International Myositis Assessment and Clinical Studies Group definition of improvement (DOI), after 6 months of treatment. Secondary endpoints included number of responders in the early treatment arm compared with the delayed treatment arm at 3 months. Repeated muscle biopsies were investigated for cellular markers and cytokines. RESULTS: 8/19 patients included in the analyses achieved the DOI at 6 months. At 3 months of study, five (50%) patients were responders after active treatment but only one (11%) patient in the delayed treatment arm. Eight adverse events (AEs) were regarded as related to the drug, four mild and four moderate, and three serious AEs, none related to the drug. There was a significant increase in regulatory T cells (Tregs), whereas other markers were unchanged in repeated muscle biopsies. CONCLUSIONS: In this pilot study, treatment of patients with DM and PM with abatacept resulted in lower disease activity in nearly half of the patients. In patients with repeat muscle biopsies, an increased frequency of Foxp3+ Tregs suggests a positive effect of treatment in muscle tissue.
- MeSH
- abatacept aplikace a dávkování MeSH
- dermatomyozitida farmakoterapie MeSH
- dospělí MeSH
- imunosupresiva aplikace a dávkování MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- polymyozitida farmakoterapie MeSH
- rozvrh dávkování léků MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze II MeSH
- randomizované kontrolované studie MeSH
Pozitivní vliv zpožděné zpětné sluchové vazby na řeč koktavých je znám od roku 1951 (tzv. Lee-efekt podle jména objevitele, či DAF z anglického Delayed Auditory Feedback). Předpokládá se nesoulad mezi zpětnou proprioceptivní a sluchovou vazbou, který se právě vlivem zpožděné akustické aferentace vyrovnává. Jako optimální délka zpoždění se udává délka 55 ms, v naší studii jsme použili i zpoždění kratší (dříve totiž nebylo možné z technických důvodů tato zpoždění vyšetřovat). Náš soubor obsahoval 41 pacientů. Zjistili jsme, že u 16 pacientů (39 %) došlo ke zlepšení plynulosti řeči při délce zpoždění 55 ms, což je ve shodě s předchozími studiemi. U osmi pacientů (19 %) však došlo k výraznému zlepšení plynulosti řeči i pod vlivem délky zpoždění 40 ms, zejména pak ve skupině balbutiků do 15 let. Plynulost řeči tedy lze zlepšit i při užití zpoždění kratších než 55 ms. U 13 pacientů (32 %) byl zaznamenán pozitivní vliv až do délky zpoždění 110 ms a u čtyř pacientů jsme nezaznamenali zlepšení plynulosti řeči pod vlivem DAF. Zajímavé je, že ne vždy dochází ke shodě mezi subjektivním hodnocením samotného pacienta a hodnocením objektivním. Lee-efekt se využívá nejen k diagnostickým, ale i terapeutickým účelům.
Stuttering is a serious health and social problem, which is reflected in socialising processes and job opportunities. It is a generalised discoordinative disorder of muscle groups, that take part in motor realisation of speech. The prevalence in population differs according to various authors from 1 % to 3%, of which men prevail. The opinions on etiology and therapy differ a lot, causes can be either somatic, functional or psychogenic. A positive effect of delayed auditory feedback (DAF) on speech in stutterers has been known since 1951 (so called Lee effect, named after its discoverer). There is supposed to be a disharmony between proprioceptive and auditory feedback, which is corrected by delayed auditory feedback. The optimal interval of DAF should be 55 ms. Considering that the former technologies were not able to study shorter intervals, we focused our study on intervals shorter than 55 ms and we tried to find an optimal interval of DAF. Most of previous research studied the influence of DAF on reading. Considering that severity of fluency disorder is usually smaller when reading than in spontaneous speech, we decided to study the influence of DAF using description of standard pictures. Our group of patients consisted of 41 stutterers (35 women and 6 men), aged from 8 to 35, the mean age was 15 years. We found out that 16 patients (39%) improved in speech fluency under the influence of DAF with delay speed 55 ms, which is in good accord with previous studies. However, in 8 patients (19%) speech fluency was improved using delay speed 40 ms especially in patients aged up to 15 years.We proved then that speech fluency in stutterers can be improved by using intervals shorter than 55 ms. In 13 patients (32%) we observed positive effect from delay 110 ms, mostly in patients with severe form of stuttering. Four patients (10%) did not improve at all. Normal fluency under the influence of DAF was reached by 10 patients (24%) who had mild or medium stuttering. We also observed self evaluation of patients which is not always in accordance with objective evaluation. From the group of 23 patients the accordance was reached in 7 patients, another delay interval was subjectively more pleasant in 10 patients, for 5 patients DAF was not pleasant at all and one patient was not able to assess subjectively improving or worsening. We can use the positive effect of DAF in treatment. At present there exist not only large- sized devices using DAF but also miniature devices that look like behind the ear hearing aids.We usually use table devices as an aid during speech therapy.
- MeSH
- akustická stimulace MeSH
- koktavost klasifikace terapie MeSH
- lidé MeSH
- prospektivní studie MeSH
- zpětná vazba MeSH
- Check Tag
- lidé MeSH
Growth is a very reliable index of health assessment, both in children and teenagers. Growth is often affected (slowed or arrested) in children who suffer from chronic diseases, including the gastrointestinal disorders. Since the use of the serologic markers and small intestinal biopsy as diagnostic tools, it has become evident that the clinical presentation is highly variable in patients with celiac disease. Some patients present the classic symptoms of the celiac disease (diarrhea, malnutrition and growth failure), while others, unveil their disorder at puberty when growth failure and delayed puberty seem to be the only symptoms of the disease. We present the clinical case of a 16 years old girl, referred to our endocrine unit for short stature, failure to thrive and lack of menarche
- MeSH
- celiakie * MeSH
- histologické techniky MeSH
- lidé MeSH
- mladiství MeSH
- opožděná puberta MeSH
- poruchy růstu MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Kazuistika pojednává o klinicko-patologickém syndromu transfusion-related acute lung injury (TRALI) u mladé ženy léčené na JIP, která byla primárně přijata pro rozvíjející se hemoragický šok při krvácení z peptického vředu bulbu duodena. K rychlému zhoršení plicních funkcí došlo mimo časový limit pro diagnostiku klasické TRALI (více než 6 hodin od podání transfúze). I přesto, že detekce aloprotilátek nebyla úspěšná, následný klinický vývoj a rychlá funkční restituce oxygenačních a ventilačních parametrů vedly k podezření na TRALI.
This case report provides description of clinical course of a young female patient treated in ICU. The patient was primarily admitted due to hemorrhagic shock during duodenal peptic ulcer bleeding. Worsening of pulmonary functions occurred after the limit for classic TRALI (more than 6 hours from transfusion). Despite the negative antibodies testing, following clinical course and fast functional restitution of oxygenation and ventilatory parameters then led to the suspicion for TRALI.
- MeSH
- akutní poškození plic diagnóza etiologie farmakoterapie terapie MeSH
- autologní krevní transfuze škodlivé účinky MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- lidé MeSH
- péče o pacienty v kritickém stavu metody MeSH
- respirační insuficience diagnóza etiologie farmakoterapie terapie MeSH
- rizikové faktory MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
