U pacientů s kompletní míšní lézí nedochází v poúrazovém vývoji k zásadnímu neurologickému zlepšení. Proto je možné u nich podle výšky léze dobře odhadnout potenciál funkčních schopností. Očekávané funkční výsledky pro jednotlivé úrovně míšních lézí byly vypracovány v roce 1999 a publikovány formou tabulek prezentujících úroveň soběstačnosti během různých aktivit. Zdrojem byly publikované studie, konsenzus odborníků a hodnocení FIM (Functional Independence Measure). Cílem této práce je revize očekávaných funkčních výsledků, včetně úprav aktivit a potřebných pomůcek a záměna použitých dat FIM za data SCIM (Spinal Cord Independence Measure).

There is no significant neurological improvement in patients after complete spinal cord lesion. Therefore, based on the lesion level, we can determine a clients functional ability potential quite accurately. In 1999, expected functional outcomes for individual levels of spinal lesion were described and published in forms of tables presenting the level of self-sufficiency and coping with activities of daily living. These tables were based on previously published studies, professional consensus and FIM (Functional Independence measure) results. This paper presents revised functional outcome tables evaluating additional activities and the ability to use specific equipment. Finally, we propose to use SCIM (Spinal Cord Independence Measure) instead of FIM data.

• Klíčová slova
• míšní léze, funkční testy, asistence,
• MeSH
• lidé MeSH
• pomůcky pro sebeobsluhu MeSH
• poranění míchy * MeSH
• posouzení stavu pacienta MeSH
• samostatný způsob života MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• lidé MeSH

INTRODUCTION: Assessment of outcomes after face transplantation (FT) is necessary to provide sound evidence on the benefits of this life-giving surgery. Current methods for outcomes assessment, however, are imprecise or prone to subjectivity. Software-based video analysis may allow fast, objective and retrospective assessment of restoration of facial movements and functions after FT. PATIENTS AND METHODS: We recorded videos of 7 subjects before as well as every 3-6 months after facial transplantation. Patients performed the same sequence of facial movements in every video: smile, open mouth, purse lips, wrinkle nose, frown, close eyes, and lift eyebrows. The videos were retrospectively analyzed using EMOTIENT software, which is capable of automatic tracking and detailed measurements of facial movements and expressions. These measurements were subsequently compared to the same patient at different time points, as well as to the normal population. RESULTS: Open mouth, wrinkle nose and smile functions significantly improved in all patients when compared to pre-transplant functions; this improvement was significant at 3, 6, and 12 months after transplant, respectively. Lip purse, eye closure and frown functions improved by 6, 9, and 18 months after transplantation, respectively; however, improvement in these particular functions was not significantly with respect to pre-transplant. Face transplantation did not improve any of the patients' ability to lift their eyebrows. Most remarkably, mouth opening and smiling functions both reached values comparable to the normal population at 3 and 12 months after transplantation, respectively. CONCLUSION: Software-based video analysis provides a valuable assessment tool capable of objective, precise and reproducible analysis of facial movements and functions after FT.

• MeSH
• audiovizuální záznam * MeSH
• dospělí MeSH
• hodnocení výsledků zdravotní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• obnova funkce MeSH
• pohybová aktivita fyziologie   MeSH
• poranění obličeje patofyziologie   chirurgie   MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• software * MeSH
• transplantace obličeje * MeSH
• výraz obličeje * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Childhood thalamopeduncular gliomas arise at the interface of the thalamus and cerebral peduncle. The optimal treatment is total resection but not at the cost of neurological function. We present long-term clinical and oncological outcomes of maximal safe resection. METHODS: Retrospective review of prospectively collected data: demography, symptomatology, imaging, extent of resection, surgical complications, histology, functional and oncological outcome. RESULTS: During 16-year period (2005-2020), 21 patients were treated at our institution. These were 13 girls and 8 boys (mean age 7.6 years). Presentation included progressive hemiparesis in 9 patients, raised intracranial pressure in 9 patients and cerebellar symptomatology in 3 patients. The tumour was confined to the thalamus in 6 cases. Extent of resection was judged on postoperative imaging as total (6), near-total (6) and less extensive (9). Surgical complications included progression of baseline neurological status in 6 patients, and 5 of these gradually improved to preoperative status. All tumours were classified as low-grade gliomas. Disease progression was observed in 9 patients (median progression-free survival 7.3 years). At last follow-up (median 6.1 years), all patients were alive, median Lansky score of 90. Seven patients were without evidence of disease, 6 had stable disease, 7 stable following progression and 1 had progressive disease managed expectantly. CONCLUSION: Paediatric patients with low-grade thalamopeduncular gliomas have excellent long-term functional and oncological outcomes when gross total resection is not achievable. Surgery should aim at total resection; however, neurological function should not be endangered due to excellent chance for long-term survival.

• MeSH
• dítě MeSH
• gliom * komplikace   diagnostické zobrazování   chirurgie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• nádory mozku * komplikace   diagnostické zobrazování   chirurgie   MeSH
• neurochirurgické výkony metody   MeSH
• retrospektivní studie MeSH
• thalamus diagnostické zobrazování   patologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Narušenie funkčnosti patrí k základným charakteristikám klinického obrazu pri poruchách schizofrenického spektra a spravidla pretrváva aj po odznení akútnej fázy ochorenia. Vzhľadom na viacdimenzionálny charakter funkčnosti existuje široké množstvo metód, ktoré slúžia na hodnotenie rôznych aspektov funkčnosti. Niektoré metódy sa zameriavajú na meranie pracovnej či školskej oblasti, iné na voľnočasové aktivity, prípadne medziľudské a partnerské vzťahy, dôležitými oblasťami funkčnosti sú aj starostlivosť o domácnosť a starostlivosť o seba. Okrem hodnotenia prítomnosti a rozsahu narušenia funkčnosti je dôležité sledovanie zmien v sociálnom fungovaní u pacientov, napríklad ako ukazovateľa úspešnosti farmakoterapie alebo účinnosti psychosociálnej rehabilitácie. Cieľom práce je popísať funkčnosť pri schizofrénii so zameraním na súčasné metódy jej hodnotenia. Postupne priblížime rôzne spôsoby hodnotenia funkčnosti od sebaposudzovacích dotazníkov po objektívne škály. Zároveň priblížime aj nové prístupy, ako hodnotenie funkčnej kapacity a Experience sampling method. V závere ilustrujeme potreby implementácie rutinného hodnotenia funkčnosti do klinickej praxe s dôrazom na sledovanie efektívnosti liečby, potreby valídneho hodnotenia invalidity či vhodnosti pre zapojenie do psychosociálnych intervencií pre pacientov s poruchami schizofrenického spektra.

Deficits in functioning is one of the core characteristics of the clinical picture in schizophrenia spectrum disorders, which in most patients occurs even before the full expression of the disorder and generally persists even after the acute phase of disorder. Due to the multidimensional nature of functioning, a variety of methods exists to evaluate various aspects of functioning. Some methods focus on measuring employment or education, others on free-time activities, or interpersonal and partnership relationships, other important areas of functioning are home making and self-care. In addition to assessing the presence and extent of functional impairment, it is important to monitor changes in the patients? social functioning, for example, as an indicator of the effect of pharmacotherapy or the effectiveness of psychosocial rehabilitation. The aim of the article is to describe the functioning in schizophrenia with a focus on current methods of assessment. Gradually, different ways of evaluating functioning will be elucidated, both self-assessment questionnaires and objective scales. At the same time, we will introduce new approaches such as assessment of functional capacity and Experience sampling method. Lastly, we will illustrate the needs of implementing routine assessment of functioning into clinical practice, with an emphasis on monitoring the effectiveness of treatment, the need for a valid assessment of disability and suitability for involvement in psychosocial interventions in patients with schizophrenia spectrum disorders.

PURPOSE OF THE STUDY The aim of this prospective study was to present injury characteristics and to evaluate therapeutic procedures and midterm functional and radiographic results of the surgical management of talus fractures. MATERIAL AND METHODS In the period from January 1, 2004, to December 31, 2009, a total of 53 patients with 56 talar bone fractures or peritalar dislocations were treated surgically. The prospective study included 39 patients with 42 fractures of the talar neck and body; of these, 31 men had 34 fractures (79.5%) and eight women had eight fractures (20.5%). There were recorded demographic data, medical history, associated injuries, polytrauma criteria, time to surgery and its type, failure of osteosynthesis, complications associated with soft tissue healing, length of hospital stay, duration of follow-up, radiographic evidence of bone healing and the presence of avascular necrosis or arthritis. Fractures were classified according to the systems of Hawkins (modified by Canale), Sneppen and Marti. Outcomes were assessed on the basis of functional and radiographic scores (West Point Ankle Score). The injuries included 21 (50%) talar neck fractures, 12 (28.5%) isolated fractures of the talar body and nine (21.5%) combined fractures of the talar neck and body. There were four (9.5%) open fractures. Twenty-five (64.1%) patients had associated skeletal injuries; eight (20.5%) patients suffered polytrauma. Staged treatment was used in five patients (12.8%). The average time to final surgery was 4.2 days. The technique of minimally invasive osteosynthesis under fluoroscopic or arthroscopic control was used in 18 (42.9%) fractures, and open reduction and internal fixation was carried out in 24 (57.1%) fractures. The average follow-up was 30.9 months. RESULTS Signs of avascular necrosis partly or completely affecting the talar body were found in six fractures (14.3 %), three of which required secondary arthrodesis. Arthritis developed in 10 cases (23.8%) Functional and radiographic results assessed with the West Point Ankle Score, regardless of fracture type, were excellent in 17 (43.5%), good in 11 (28.2%), satisfactory in five (12.8%) and poor in six (15.5%) patients. DISCUSSION High incidence of polytrauma and complex injuries of the hindfoot makes the timing of surgical management difficult and also affects its outcome. Timing used in our study is in agreement with general trends of staged talus fracture treatment. In accordance with the international practice, the majority of non-displaced talar neck fractures (Hawkins 1) were treated by means of osteosynthesis. We preferred minimally invasive fracture reduction under arthroscopic control in less complicated fracture types of the talar neck and body. The incidence of avascular necrosis, as reported in the literature, has had a decreasing tendency. Incidence of avascular necrosis without talar dome collapse does not necessarily lead to functional impairment. The results of functional and radiographic scoring were in agreement with the literature data and confirmed that functional outcome is related to the severity of fracture. CONCLUSIONS Our results confirmed that the management of talar fractures by means of osteosynthesis is indicated even in non-displaced Hawkins type 1 fractures, staged treatment is effective in dislocated and open fractures, delayed surgery is a safe procedure for less dislocated fractures and injuries requiring complex care should be referred to foot surgery centres.

• MeSH
• dospělí MeSH
• fraktury kostí klasifikace   radiografie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• talus zranění   radiografie   chirurgie   MeSH
• vnitřní fixace fraktury metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• MeSH
• laryngektomie MeSH
• nádory hrtanu chirurgie   MeSH
• řeč alaryngální MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• otorinolaryngologie
• onkologie

The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.

• MeSH
• hodnocení výsledků zdravotní péče * MeSH
• konverzní poruchy * MeSH
• lidé MeSH
• nemoci nervového systému * MeSH
• psychosomatické poruchy * MeSH
• Check Tag
• lidé MeSH

EAU Guidelines z roku 2011 klasifikují roboticky asistovanou cystektomii (RARC) jako experimentální operaci. Operatéři v řadě center se nacházeli teprve ve fázi nácviku této techniky, což znemožňovalo vyvodit jednoznačné závěry o její bezpečnosti a účinnosti. V roce 2012 byla RARC klasifikována jako možnost volby, ovšem bez prokázaných výsledků. V roce 2013 již ovšem bylo možné RARC zařadit na seznam ověřených a bezpečných operačních zákroků. Vzhledem k tomu, že se jedná o velmi složitou operaci sestávající z mnoha kroků, je nutné, aby RARC prováděl pouze dobře školený tým operatérů, sester a anesteziologů, kteří mají s touto technikou zkušenosti a ovládají všechny její fáze. Publikované údaje nasvědčují tomu, že RARC je spojena s menší krevní ztrátou, kratší délkou hospitalizace a menším výskytem časných i pozdních komplikací. Dále poskytuje benefit v podobě intrakorporální techniky derivace moči (ve srovnání s extrakorporální). Nejnovější dlouhodobé onkologické výsledky RARC jsou navíc srovnatelné s otevřenou cystektomií. Ovšem dokud nebudeme mít k dispozici kvalitní, randomizované kontrolované studie s dostatečně dlouhým intervalem sledování, zůstává otevřená radikální cystektomie nadále zlatým standardem. Tento přehledový článek detailně popisuje naši techniku (krok za krokem) včetně užitečných tipů a triků a prezentuje aktuální přehled různých výsledných parametrů této operační techniky.

In 2011, the EAU Guidelines were describing robot–assisted radical cystectomy (RARC) as an experimental procedure. Many centers were still in their learning curve and safe conclusions about the safety and efficacy of the procedure could not be drawn. In 2012, RARC was an option, but not proven. But, in 2013, RARC is a feasible and safe operation. It is advocated that RARC, being a highly complex surgery, consisting of multiple steps, should be performed by a devoted team of robotic surgeons, nurses and anesthetists, which are all experienced and have mastered the above steps. Literature data show that RARC trends to be superior in blood loss, hospitalization, and early and late complication rates. Additionally, there seems to be an advantage of the totally intracorporeal technique of urinary diversion compared to the extracorporeal technique. Moreover, recent long‑term oncological results show similar outcomes for RARC to open cystectomy. Until, high‑powered, randomized controlled trials with sufficient follow‑up will be published, open radical cystectomy remains the gold standard. In this review paper, we will describe our technique step by step, providing useful tips and tricks and present an update on multiple outcomes of the operation.

• Klíčová slova
• derivace moči,
• MeSH
• cystektomie * metody   MeSH
• diverze moči * metody   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• nádory močového měchýře * chirurgie   MeSH
• pooperační komplikace MeSH
• robotika * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• finanční podpora výzkumu jako téma MeSH
• fyzikální stimulace metody   MeSH
• interpretace obrazu počítačem metody   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• roztroušená skleróza diagnóza   účinky záření   MeSH
• výsledek terapie analýza   MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY The aim of the study was to assess the functional outcomes of rehabilitation in patients with surgically treated distal radius fractures in the early postoperative period. We compared the functional outcomes of patients undergoing standard rehabilitation with the group of patients whose postoperative rehabilitation was extended with shoulder girdle exercises of the affected upper limb while the wrist was immobilized. Several indices and variables were used for the assessment of the functional therapeutic outcomes of the affected wrist. MATERIAL AND METHODS Forty patients (32 females and 8 males, the mean age 60.5 years) with distal radius fractures treated by internal fixation using volar surgical approach were involved in the study between 2013-2016. The tested subjects were randomized and split into two groups according to the selected method of rehabilitation. The tested subjects with standard rehabilitation extended with shoulder girdle muscles activation were labelled as group I. It included patients (n = 20) of the mean age 59.8 (age range 42-73 years) with immobilized wrist (i.e. for 3-4 weeks) performing shoulder girdle muscles exercises at the same time. Furthermore, standard kinesiotherapy continued after their fixation was removed. The other tested group, labelled as group II (n = 20), the mean age 61.3 (variation 40-74 years of age) involved patients with distal radius fractures. Only standard rehabilitation was performed in this group as late as their forearm fixation was removed. The following indices and parameters were assessed in the early postoperative period (i.e. by 8 weeks after the fixation removal): wrist and fingers range of motion (ROM), hand grip strength (dynamometry), local swelling, pain, scores of a nine hole peg test (NHPT), and a DASH score. RESULTS After the fixation had been removed, the group I reported statistically significantly higher values of movement compared to the values of the contralateral limb in the following directions: dorsal flexion, palmar flexion, MP joints flexion, flexion of PIP joints (proximal interphalangeal), and flexion of DIP joints (distal interphalangeal). After eight weeks, the group I manifested significantly higher values in dorsal flexion, palmar flexion and ulnar deviation in the wrist. There were no significant differences in other movement directions. The hand grip strength mean value examined with a dynamometer was significantly higher in the group I in the sixth and eighth week of testing (group I - 58.9% strength of a healthy limb after six weeks, or 66.5% after eight weeks). The results in the group II were 49.9% strength of a healthy limb after six weeks, or 56.6% after eight weeks. The group I showed statistically significantly lower values of wrist swelling and higher finger dexterity in the NHPT in all measured weeks. Lower pain intensity in the group I during the measurements was observed. At the same time, this group showed significantly better results in the DASH score. DISCUSSION The results of this study are useful for clinical practice. They confirm a functional relation between the activity of hand muscles and the shoulder muscle activity. The differences in the functional ability of the hand and the functional state of the injured wrist were detected as early as in the early postoperative period. It could be stated that the tested subjects in the group I showed a greater and faster improvement in the physical function of the injured hand. This was also accompanied by a positive psychological effect. We had not found a study of a similar type in the available literature that we could have compared our submitted results to. CONCLUSIONS Shoulder girdle muscles exercises after a distal radius fracture, while wrist is immobilized, can evidently enhance functional capability and accelerate the hand-function restitution. Early functional outcomes of the injured wrist after the rehabilitation with shoulder girdle muscles exercises support the efficiency of this broadened rehabilitation protocol. Key words: distal radius frac,ture, hand, shoulder, functional treatment, rehabilitation.

• MeSH
• dospělí MeSH
• fraktury vřetenní kosti rehabilitace   chirurgie   MeSH
• imobilizace škodlivé účinky   metody   MeSH
• kosterní svaly * patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rameno * patofyziologie   MeSH
• rozsah kloubních pohybů MeSH
• senioři MeSH
• síla ruky MeSH
• terapie cvičením metody   MeSH
• vnitřní fixace fraktury škodlivé účinky   metody   rehabilitace   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH