Ictal central apnoea is a feature of focal temporal seizures. It is implicated as a risk factor for sudden unexpected death in epilepsy (SUDEP). Here we study seizure-related apnoeas in two different models of experimental seizures, one chronic and one acute, in adult genetically-unmodified rats, to determine mechanisms of seizure-related apnoeas. Under general anaesthesia rats receive sensors for nasal temperature, hippocampal and/or neocortical potentials, and ECG or EMG for subsequent tethered video-telemetry. Tetanus neurotoxin (TeNT), injected into hippocampus during surgery, induces a chronic epileptic focus. Other implanted rats receive intraperitoneal pentylenetetrazol (PTZ) to evoke acute seizures. In chronically epileptic rats, convulsive seizures cause apnoeas (9.9 ± 5.3 s; 331 of 730 convulsive seizures in 15 rats), associated with bradyarrhythmias. Absence of EEG and ECG biomarkers exclude obstructive apnoeas. All eight TeNT-rats with diaphragm EMG have apnoeas with no evidence of obstruction, and have apnoea EMGs significantly closer to expiratory relaxation than inspiratory contraction during pre-apnoeic respiration, which we term "atonic diaphragm". Consistent with atonic diaphragm is that the pre-apnoeic nasal airflow is expiration, as it is in human ictal central apnoea. Two cases of rat sudden death occur. One, with telemetry to the end, reveals a lethal apnoea, the other only has video during the final days, which reveals cessation of breathing shortly after the last clonic epileptic movement. Telemetry following acute systemic PTZ reveals repeated seizures and seizure-related apnoeas, culminating in lethal apnoeas; ictal apnoeas are central - in 8 of 35 cases diaphragms initially contract tonically for 8.5 ± 15.0 s before relaxing, in the 27 remaining cases diaphragms are atonic throughout apnoeas. All terminal apnoeas are atonic. Differences in types of apnoea due to systemic PTZ in rats (mainly atonic) and mice (tonic) are likely species-specific. Certain genetic mouse models have apnoeas caused by tonic contraction, potentially due to expression of epileptogenic mutations throughout the brain, including in respiratory centres, in contrast with acquired focal epilepsies. We conclude that ictal apnoeas in the rat TeNT model result from atonic diaphragms. Relaxed diaphragms could be particularly helpful for therapeutic stimulation of the diaphragm to help restore respiration.

• MeSH
• apnoe patofyziologie   MeSH
• bránice * patofyziologie   MeSH
• chronická nemoc MeSH
• elektroencefalografie MeSH
• krysa rodu rattus MeSH
• modely nemocí na zvířatech * MeSH
• pentylentetrazol toxicita   MeSH
• potkani Sprague-Dawley MeSH
• relaxace svalu fyziologie   MeSH
• tetanový toxin toxicita   MeSH
• záchvaty * patofyziologie   MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: The Dynamic Neuromuscular Stabilization (DNS) diaphragm test and intra-abdominal pressure regulation test (IAPRT) are qualitative clinical tests that assess postural stability provided by the diaphragm. OBJECTIVE: Evaluate the inter-rater reliability of the diaphragm test and IAPRT between an experienced and novice DNS clinician among individuals with non-specific low back pain (LBP) and neck pain. METHODS: Forty-five participants with non-specific LBP and/or neck pain were assessed by an experienced and novice DNS physiotherapist in the diaphragm test and IAPRT, and scored on a visual analog scale (VAS) according to five different criteria. RESULTS: Moderate reliability was noted when assessing LBP and neck pain patients in the diaphragm test and IAPRT (p < 0.001). Moderate reliability also existed when assessing only LBP (p < 0.001) or neck pain (p = 0.002, p = 0.009) independently. Patients with lower pain (NPRS score of 5 or < ) demonstrated lower intra-class correlation coefficients, yet still moderate reliability in the diaphragm test (p = 0.004) and IAPRT (p = 0.001). Patients with higher pain (NPRS score of 6 or > ) demonstrated greater intra-class correlation coefficients, with the diaphragm test resulting in good reliability (p < 0.001). CONCLUSIONS: The diaphragm test and IAPRT demonstrate moderate reliability between an experienced and novice DNS clinician when evaluating LBP and neck pain patients, with a greater degree of reliability noted in patients suffering from higher reported pain.

• MeSH
• bolest krku * patofyziologie   diagnóza   MeSH
• bránice * patofyziologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• lumbalgie * patofyziologie   diagnóza   MeSH
• měření bolesti metody   MeSH
• odchylka pozorovatele MeSH
• posturální rovnováha fyziologie   MeSH
• reprodukovatelnost výsledků MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

INTRODUCTION: The inferior phrenic artery is a paired artery with a variable origin and course, primarily supplying the diaphragm, but also the suprarenal glands, inferior vena cava, stomach, and oesophagus. The aim of this study is to investigate the origin and course of the inferior phrenic arteries on multidetector computed tomography and angiography. MATERIALS AND METHODS: The anatomy of the inferior phrenic artery was analysed on 2449 multidetector computed tomography scans. Three-dimensional reconstructions were made of the main variations. Additionally, the course and branching pattern of the inferior phrenic artery were descriptively analysed in a cohort of 28 angiograms. RESULTS: In 565 (23.1%) cases the inferior phrenic arteries arose as a common trunk and in 1884 (76.9%) cases as individual vessels. The most common origins of a common trunk were the coeliac trunk (n=303; 53.6%) and abdominal aorta (n=255; 45.1%). The most common origins of the right inferior phrenic artery were the coeliac trunk (n=965; 51.2%), abdominal aorta (n=562; 29.8%) and renal arteries (n=214; 11.4%). The most common origins of the left inferior phrenic artery were the coeliac trunk (n=1293; 68.6%) and abdominal aorta (n=403; 21.4%). CONCLUSION: The inferior phrenic artery has a very variable anatomy. The most common origins of the inferior phrenic artery are the coeliac trunk and its branches, the abdominal aorta, and the renal arteries.

• MeSH
• angiografie metody   MeSH
• aorta abdominalis anatomie a histologie   diagnostické zobrazování   MeSH
• arteria coeliaca * anatomie a histologie   diagnostické zobrazování   MeSH
• arterie anatomie a histologie   diagnostické zobrazování   MeSH
• bránice krevní zásobení   diagnostické zobrazování   anatomie a histologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• multidetektorová počítačová tomografie * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Patients with impaired diaphragm function are dependent on long-term mechanical ventilation. It is associated with numerous health complications as well as significant economic burden. Intramuscular diaphragm stimulation through laparoscopic implantation of pacing electrodes is a safe method which enables restoring breathing using diaphragm in a considerable number of patients. The first implantation of diaphragm pacing system in the Czech Republic was performed in a thirty-four-year-old patient suffering from a high-level cervical spinal cord lesion. After eight years of mechanical ventilation support, just five months from initiation of stimulation, the patient is able to breathe spontaneously for ten hours per day on average, with expected total weaning. Once the insurance companies decide to reimburse the pacing system, a widespread use of the method even in patients with other diagnoses, including children, is expected. Key words: electrical stimulation, diaphragm, spinal cord injury, laparoscopic surgery.

• MeSH
• bránice MeSH
• dítě MeSH
• dospělí MeSH
• elektrostimulační terapie * metody   MeSH
• implantované elektrody MeSH
• lidé MeSH
• poranění míchy * komplikace   terapie   MeSH
• umělé dýchání MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or breathing with simultaneous voluntary contraction of the abdominal muscles (VCAM). This study analyzed diaphragm motion in healthy individuals during various postural-respiratory situations. METHODS: 31 healthy participants underwent examination of the diaphragm using M-mode ultrasonography, spirometry, and abdominal wall tension (AWT) measurements. All recordings were performed simultaneously during three consecutive scenarios, i.e., 1. Lifting a load without breathing; 2. Lifting a load and breathing naturally; 3. Lifting a load and breathing with simultaneous VCAM. RESULTS: Using paired-samples t-tests, lifting a load without breathing displaced the diaphragm's expiratory position more caudally (P < .001), with no change noted in the inspiratory position (P = .373). During lifting a load breathing naturally, caudal displacement of the diaphragm's inspiratory position was presented (P < .001), with no change noted in the expiratory position (P = 0.20) compared to tidal breathing. Total diaphragm excursion was greater when loaded (P = .002). Lifting a load and breathing with VCAM demonstrated no significant changes in diaphragm position for inspiration, expiration, or total excursion compared to natural loaded breathing. For all scenarios, AWT measures were greater when lifting a load (P < .001). CONCLUSION: In healthy individuals, caudal displacement and greater excursions of the diaphragm occurred when lifting a load. The postural function of the diaphragm is independent of its respiratory activity and is not reduced by the increase in AWT.

• MeSH
• bránice * diagnostické zobrazování   fyziologie   MeSH
• dýchání * MeSH
• lidé MeSH
• svalová kontrakce MeSH
• ultrasonografie MeSH
• vydechnutí MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Úvod: Ruptura bránice je vzácný, ale život ohrožující stav doprovázející 0,8–5 % torakoabdomiálních traumat podstoupivších operaci. Většinu doprovází přidružená poranění, která jsou zodpovědná za špatnou prognózu. Projevy brániční ruptury bývají překryty vážnějšími projevy přidruženého traumatu. Ruptura bývá viditelná na RTG snímku hrudníku či na CT vyšetření. Menší defekt však může diagnostice uniknout, zvláště pokud není pacient indikován k akutní operaci. Metody: Autoři uvádějí 2 kazuistiky pacientů, kteří byli léčeni pro chronickou brániční rupturu na Chirurgické klinice LF UK a FN Plzeň mezi 1. 1. 2009 a 31. 12. 2021. Cílem byla analýza klinických dat a jejich porovnání s literárními údaji. Výsledky: Oba pacienti s chronickou brániční rupturou byli muži v produktivním věku, kteří primární trauma utrpěli při dopravní nehodě. V jednom případě byla ruptura diagnostikována po 6 letech, v druhém po 14 letech. V jednom případě šlo o rupturu levé poloviny bránice, v druhém případě pak její pravé poloviny. Oba pacienti podstoupili plastiku bráničního defektu cestou torakotomie. Závěr: Nerozpoznaná ruptura bránice je závažný stav, který může vyústit v život ohrožující komplikaci inkarcerací břišních orgánů vyhřezlých do hrudníku. Na tuto diagnózu je nutné myslet u pacientů s gastrointestinálními či dechovými potížemi po vysokoenergetickém tupém traumatu břicha a hrudníku i s odstupem několika let od traumatu.

Introduction: Diaphragmatic rupture is a rare but life-threatening condition that occurs in 0.85% of surgically managed thoracoabdominal injuries. In most cases, the condition is accompanied by associated traumas responsible for poor prognosis. Signs of diaphragmatic rupture are often masked by more serious manifestations of the associated trauma. The rupture is usually revealed by an X-ray of the chest or CT scan. However, a minor defect may be missed, especially if the patient is not indicated for urgent surgery. Methods: The authors present 2 case reports of patients treated for chronic diaphragmatic rupture at the Department of Surgery of the Faculty of Medicine, Charles University and University Hospital in Pilsen between 01 January 2009 and 31 December 2021. The aim was to analyze the clinical data and to compare this data with literature. Results: Both patients with the chronic diaphragmatic rupture were men in their productive age. The mechanism of their primary trauma was a traffic accident. In the first case, the rupture was diagnosed 6 years after the trauma. The second case was diagnosed 14 years after the primary trauma. The diaphragmatic rupture was present on the left side in the first case and on the right in the other. Both patients underwent suture of the diaphragmatic defect via thoracotomy. Conclusion: Unrecognized diaphragmatic rupture is a severe condition that can result in a life-threatening complication, namely incarceration of abdominal organs dislocated to the chest. It is necessary to keep this diagnosis in mind in patients with gastrointestinal or respiratory problems after a previous high-energy, blunt-force abdominal and thoracic injury, even many years after the trauma.

• MeSH
• bránice * chirurgie   diagnostické zobrazování   zranění   MeSH
• dopravní nehody MeSH
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• opožděná diagnóza škodlivé účinky   MeSH
• poranění hrudníku chirurgie   diagnostické zobrazování   komplikace   MeSH
• ruptura * chirurgie   komplikace   MeSH
• tupá poranění chirurgie   diagnostické zobrazování   komplikace   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

• MeSH
• barotrauma diagnostické zobrazování   patologie   MeSH
• bránice zranění   MeSH
• fraktury žeber diagnostické zobrazování   komplikace   patologie   terapie   MeSH
• lidé MeSH
• poranění hrudníku * diagnostické zobrazování   klasifikace   patologie   terapie   MeSH
• poškození plic diagnostické zobrazování   klasifikace   patologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• bránice * abnormality   patologie   MeSH
• lidé MeSH
• vnitřní kýla * diagnostické zobrazování   etiologie   patologie   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• bolesti na hrudi * etiologie   patologie   rehabilitace   MeSH
• bránice patologie   MeSH
• diferenciální diagnóza MeSH
• hrudník patologie   MeSH
• lidé MeSH
• nemoci kloubů diagnóza   etiologie   patologie   rehabilitace   MeSH
• nemoci páteře diagnóza   etiologie   patologie   rehabilitace   MeSH
• nociceptivní bolest etiologie   patologie   rehabilitace   MeSH
• Scheuermannova nemoc diagnóza   komplikace   patologie   rehabilitace   MeSH
• spoušťové body MeSH
• syndromy myofasciální bolesti diagnóza   etiologie   patologie   rehabilitace   MeSH
• techniky fyzikální terapie * MeSH
• Tietzeův syndrom diagnóza   etiologie   rehabilitace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Parvovirus B19 infection in pregnancy may have a poor outcome for the fetus. Ocular anomalies, brain damage with hydrocephalus and central nervous system (CNS) scarring, cleft lip and hypospadias, as well myocarditis and congenital heart disease have been reported. We present a case of a preterm female neonate born with ascites, hydrothorax and congenital diaphragmatic eventration (CDE), with a prenatal diagnosis of congenital diaphragmatic hernia (CDH). The neonate was born prematurely at 32 weeks gestation with caesarean section due to a previous caesarean delivery. She was immediately intubated in the delivery room, transferred in the Neonatal Intensive Care Unit (NICU) and supported with high frequency oscillatory ventilation (HFOV). The diagnosis of CDH was sonographically estimated from the 20th week of gestation and surgical correction was decided. During surgery CDE was diagnosed instead of CDH and despite postoperatively care the neonate developed disseminated intravascular coagulation and finally died in the 40th hour of life. Along with the identification of parvovirus B19 in the pleural fluid by PCR, the biopsy of the diaphragm revealed connective tissue, full of vasculature and absence muscle tissue. Although only cytomegalovirus, rubella, and toxoplasmosis were considered to be associated with CDE, parvovirus B19 might also be related to this congenital diaphragmatic malformation. In CDE, the function of the lungs can be compromised as a consequence of the compression applied by the abdominal organs. The neonatologists should include this condition in their differential diagnosis for a more direct and effective management.

• MeSH
• bránice abnormality   MeSH
• císařský řez MeSH
• erythema infectiosum * MeSH
• eventrace bránice * diagnóza   MeSH
• lidé MeSH
• lidský parvovirus B19 * MeSH
• novorozenec MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH