PURPOSE OF THE STUDY The aim of the study was to ascertain what proportion of patients undergoing total knee arthroplasty (TKA) complain of restricted knee joint motion, and to investigate options for improvement of this situation. MATERIAL Our evaluation included a group of 796 patients treated with TKA at our department in the period from January 1, 1990, to December 31, 2004. In all cases, a condylar implant with preservation of the posterior cruciate ligaments was used. METHODS In addition to medical history, the range of motion, knee joint malalignment and radiological findings were assessed before surgery. After THA, the type of implant and complications, if any, were recorded, and improvement in joint motion was followed up. Based on the results of Kim et al., flexion contracture equal to or higher than 15 degrees and/or flexion less than 75 degrees were made the criteria of stiffness after THA. Patients with restricted THA motion who had aseptic or septic implant loosening were not included. RESULTS Of the 796 evaluated patients, 32 (4.14 %) showed restricted motion after total knee arthroplasty, as assessed by the established criteria. In 16 patients, stiffness defined by these criteria had existed before surgery, and three patients showed an excessive production of adhesions and heterotopic ossifications. In three patients, the implantation procedure resulted in an elevated level of the original joint line and subsequent development of patella infera and increased tension of the posterior cruciate ligament. Four patients declined physical therapy and, in six, the main cause of stiffness could not be found. Seventeen patients did not require surgical therapy for restricted motion; TKA provided significant pain relief and they considered the range of motion achieved to be sufficient. One patient underwent redress 3 months after surgery, but with no success. Repeated releases of adhesions, replacement of a polyethylene liner and revision surgery of the extensor knee structures were performed in 15 patients. In these, the average value of knee flexion increased by 17°only and, in the patients suffering from excessive adhesion production, this value remained almost unchanged. Revision TKA was carried out in four patients, in whom knee joint flexion increased on average by degrees to achieve an average flexion of degrees. DISCUSSION Restricted motion after TKA has been reported to range from 1.3 % to 12.0 %, but consistent criteria have not been set up. In our study it was 4.14 %. In agreement with the literature data, one of the reasons was pre-operative restricted motion, which was recorded in 16 of 32 patients. Similarly, also in our patients, biological predisposition to excessive production of fibrocartilage associated with adhesions in all knee joint compartments was the major therapeutic problem. Intra-operative fractures, ligament tears requiring post-operative fixation and unremoved dorsal osteophytes lead to the restriction of knee joint motion. By inadequate resection of articular surface, the original joint line may be at a higher level; this results in an increased tension of the posterior cruciate ligament and patella infera development, both influencing knee flexion. In our study, three patients were affected. Knee joint stiffness can also develop in patients declining physical therapy or in whom this is not correctly performed, often for insufficient analgesia. In contrast to the data reported in the literature, 17 of 32 patients in this study had no need for surgical treatment of restricted knee joint motion. Redress under general anesthesia was not effective. For markedly restricted motion of the knee joint, reimplantation can be recommended or, in less severe cases, an intervention on adjacent soft tissues. CONCLUSIONS Restricted motion of the knee joint after TKA is difficult to treat and, therefore, prevention is recommended. This should include thorough conservative treatment of gonarthrosis, early indication for surgery, prevention of elevation in the joint line and consistent rehabilitation with appropriate analgesia. For severe stiffness of the knee joint, as evaluated by the criteria of Kim et al., revision arthroplasty can be recommended.

• MeSH
• artróza kolenních kloubů prevence a kontrola   terapie   MeSH
• interpretace statistických dat MeSH
• omezení pohyblivosti MeSH
• pooperační komplikace prevence a kontrola   MeSH
• pooperační péče metody   rehabilitace   MeSH
• reoperace metody   využití   MeSH
• rozsah kloubních pohybů fyziologie   MeSH
• totální endoprotéza kolene metody   škodlivé účinky   využití   MeSH

Zmena vo vykonávaní činností vo vzťahu ku selfmanažmentu diabetes mellitus v závislosti od metodiky a priebehu edukačných intervencií predstavuje významný, ale v praxi nehodnotený, ukazovateľ terapeutickej hodnoty edukácie. Cieľom práce bolo zistiť rozdiely v činnostiach vo vzťahu ku selfmanažmentu diabetu medzi pacientmi na intenzifikovanom inzulínovom režime v závislosti od absolvovania štrukturovaného edukačného programu v Národnom endokrinologickom a diabetologickom ústave v Ľubochni. Ďalším cieľom práce bolo zistiť, ako realizácia uvedených činností ovplyvňuje ich celkovú spokojnosť s liečbou. Spokojnosť pacientov bola hodnotená dotazníkom Diabetes Treatment Satisfaction Questionnaire. Činnosti v selfmanažmente diabetu boli posudzované prostredníctvom štrukturovaného rozhovoru. Vzorku respondentov tvorilo 104 pacientov s diagnostikovaným DM 1. typu alebo DM 2. typu hospitalizovaných v Národnom endokrinologickom a diabetologickom ústave v Ľubochni v období od novembra 2006 do marca 2007. Signifikantné rozdiely v činnostiach významných v selfmanažmente diabetu v závislosti od absolvovania štrukturovaného edukačného programu boli zistené len v oblasti využívania sacharidových jednotiek (p < 0,05). Štatisticky nevýznamné rozdiely boli zistené vo vykonávaní pravidelného selfmonitoringu glykémie, úpravách dávok inzulínu v špecifických situáciách ako aj vedení záznamu hypoglykémií. Najnižšia spokojnosť s liečbou bola zistená v oblasti flexibility liečby. Celková spokojnosť s liečbou bola signifikantne vyššia u pacientov, ktorí vykonávali pravidelný selfmonitoring glykémie. Využívanie sacharidových jednotiek, prispôsobovanie dávok inzulínu v špecifických situáciách nemali vplyv na celkovú spokojnosť s liečbou.

The change in performing activities concerning the self-management of diabetes mellitus depending on the method and course of educational interventions represents an important parameter of the therapeutic value of education which is, however, not evaluated in practice. The purpose of the present work was to specify differences in activities with respect to diabetes self-management among patients on intensified insulin regimens depending on completing a structured educational programme in the National Endocrinological and Diabetological Institute in L’ubochňa. A further purpose of the work was to establish the effect of the implementation of the activities mentioned on their general satisfaction with the treatment. The satisfaction of the patients was evaluated with the help of the questionnaire “Diabetes Treatment Satisfaction Questionnaire”. The activities in the diabetes self-management were considered based on a structured dialogue. The sample of respondents included 104 patients with detected first type DM or second type DM hospitalized in the National Endocrinological and Diabetological Institute in L’ubochňa in a period of November 2006 to March 2007. Significant differences in activities important in the diabetes self-management depending on completing the structured educational programme were observed only in the field of using saccharide units (p < 0.05). Statistically non-significant differences were found in performing the regular self-monitoring of glycaemia, adjustments of insulin doses in specific situations as well as in keeping hypoglycaemia records. The lowest satisfaction with the treatment was found in the field of the treatment flexibility. The general satisfaction with the treatment was significantly higher in patients, who implemented a regular glycaemia self-monitoring. The use of saccharide units and adjustments of insulin doses in specific situations had no effect on the general satisfaction with the treatment.

• MeSH
• diabetes mellitus 1. typu prevence a kontrola   terapie   MeSH
• diabetes mellitus 2. typu prevence a kontrola   terapie   MeSH
• dospělí MeSH
• interpretace statistických dat MeSH
• lidé MeSH
• rozhovory jako téma metody   MeSH
• selfmonitoring glykemie metody   využití   MeSH
• vzdělávání pacientů jako téma metody   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• hodnotící studie MeSH
• srovnávací studie MeSH
• Geografické názvy
• Slovenská republika MeSH

PURPOSE OF THE STUDY The aim of this prospective randomised study was to compare and statistically analyse two methods of condylar twist angle (CTA) measurement in total knee arthroplasty in order to assess their applicability in routine practice. MATERIAL AND METHODS The study included 238 patients with 256 sites undergoing total knee arthroplasty (TKA) in the period from January 2009 to May 2011. There were 93 men (nine with bilateral TKA) and 145 women (nine with bilateral TKA) with an average age of 69.3 years and a range of 47 to 88 years. The implants NexGen (Zimmer) and ADVANCE? Medial-Pivot Knee (Wright) were used. In each patient, CTA was measured before surgery by the radiologist on a multidetector CT SOMATOM 64 (Siemens) using the Yoshioki method. The other CTA measurement was made intra-operatively by the surgeon using our modification of the Hofmann method which involved the identification of a reference line for optimal rotational alignment of the femoral component. A STATISTICA 9.0 software package was used for statistical analysis. In addition to basic statistical data, selected data were presented in graphical forms as Box and Whisker's plots and histograms. Changes in CTA and differences between the groups were evaluated using the Wilcoxon signed-rank test. Relationships among the variables were studied using Spearman's correlation coefficient. RESULTS The statistical analysis showed that the pre-operative CTA value obtained from CT scans was, on the average, higher by 0.5 degrees than the value from intra-operative measurement, as assessed at the level of significance p = 0.001 (signed-rank test). The intra-individual variability was lower than the inter-individual one (14.4% and 30.8%, respectively). This means that both methods are suitable for CTA measurement in the knee joint replacement procedures. Spearman's correlation coefficient was 0.6, which is the value of medium strong correlation. The post-operative CTA assessed on CT scans was in the range of 0 to 2 degrees in 87.5% of the patients. Both the pre-operative and intra-operative CTA values were significantly higher in women than in men (Wilcoxon two-sample test). There was no statistical difference between the left and the right side. DISCUSSION Malrotation of the femoral component is one of the causes leading to patellar subluxation and pain in the front part of the knee. The post-operative CTA value should be zero. Optimal rotational alignment of the femoral component varies with each patient; in our study it was found in the range of 0 to 7 degrees on the basis of CTA values. We do not recommend 7 degrees of external rotation to be exceeded because of the risk associated with balancing the flexion gaps; nor do we recommend to set internal rotation of the femoral component for the risk of patellar complications. The difference of 0.5 degree found in the CTA value between the two measuring methods can be explained by individual differences in the anatomy of the medial epicondylar region, and by the use of only selected whole numbers (0, 3, 5, 7) in intra-operative measurements. This difference does not play any role in routine surgical procedures. CONCLUSIONS The statistical evaluation of the results of CTA measurement with the two methods showed that both were equally suitable for routine total knee arthroplasty. The results of intra-operative CTA measurements are comparable with those obtained on CT scans; in addition, the intra-operative method is less expensive and eliminates exposure of the patient to radiation. CT-based CTA measurements are useful in the patients with chronic problems afterTKA in whom femoral component malrotation needs to be either confirmed or ruled out.

• Klíčová slova
• CTA, condylar twist angle, Advance Medial - Pivot Knee, NexGen,
• MeSH
• chirurgie operační metody   využití   MeSH
• financování organizované MeSH
• interpretace statistických dat MeSH
• kolenní kloub chirurgie   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• peroperační péče statistika a číselné údaje   využití   MeSH
• počítačová rentgenová tomografie statistika a číselné údaje   MeSH
• prospektivní studie MeSH
• protézy a implantáty využití   MeSH
• protézy kolene statistika a číselné údaje   využití   MeSH
• reprodukovatelnost výsledků MeSH
• rotace škodlivé účinky   MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) statistika a číselné údaje   MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

In contrast to the single-channel dimensional complexity, the global dimensional complexity is calculated from a multichannel EEG. The intention with the method is to measure the spatial distribution of information processing in the brain. The method seems to be of interest in psychopharmacological research, but the interpretation of the results in physiological terms is rather difficult. To get a more detailed information on the physiological significance of the EEG complexity measures, the influence of well-known physiological factors was studied in a group of 14 healthy subjects aged from 1.5 to 61 years. It was found that the correlation dimension was somewhat higher in older individuals, but the correlation with age was not statistically significant. However, the global correlation dimension was significantly lower during full alertness than during drowsiness. These results might reflect the changes in spatial structure of information processing, a high complexity suggesting a 'disorganisation' during drowsiness. As regards the age-dependent changes of the correlation dimension, the spatial 'flexibility' of information processing was also studied, using the differences between the 'alert' and 'drowsy' parts of the same EEG as indicator. It was found that the differences 'drowsy minus alert' were significantly related to age. A plausible interpretation seems to be that the spatial distribution of information processing is more changeable, or more flexible, in adults than in children.

• MeSH
• dítě MeSH
• dospělí MeSH
• elektroencefalografie * statistika a číselné údaje   MeSH
• interpretace statistických dat MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mozek * fyziologie   MeSH
• pozornost * fyziologie   MeSH
• předškolní dítě MeSH
• psychiatrie MeSH
• psychofarmakologie MeSH
• stadia spánku fyziologie   MeSH
• věkové faktory MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• kojenec MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH

In 2004 the European Commission and Member States initiated activities towards a harmonized approach for Human Biomonitoring surveys throughout Europe. The main objective was to sustain environmental health policy by building a coherent and sustainable framework and by increasing the comparability of data across countries. A pilot study to test common guidelines for setting up surveys was considered a key step in this process. Through a bottom-up approach that included all stakeholders, a joint study protocol was elaborated. From September 2011 till February 2012, 17 European countries collected data from 1844 mother-child pairs in the frame of DEMOnstration of a study to COordinate and Perform Human Biomonitoring on a European Scale (DEMOCOPHES).(1) Mercury in hair and urinary cadmium and cotinine were selected as biomarkers of exposure covered by sufficient analytical experience. Phthalate metabolites and Bisphenol A in urine were added to take into account increasing public and political awareness for emerging types of contaminants and to test less advanced markers/markers covered by less analytical experience. Extensive efforts towards chemo-analytical comparability were included. The pilot study showed that common approaches can be found in a context of considerable differences with respect to experience and expertize, socio-cultural background, economic situation and national priorities. It also evidenced that comparable Human Biomonitoring results can be obtained in such context. A European network was built, exchanging information, expertize and experiences, and providing training on all aspects of a survey. A key challenge was finding the right balance between a rigid structure allowing maximal comparability and a flexible approach increasing feasibility and capacity building. Next steps in European harmonization in Human Biomonitoring surveys include the establishment of a joint process for prioritization of substances to cover and biomarkers to develop, linking biomonitoring surveys with health examination surveys and with research, and coping with the diverse implementations of EU regulations and international guidelines with respect to ethics and privacy.

• MeSH
• biologické markery analýza   MeSH
• environmentální zdraví metody   MeSH
• interpretace statistických dat MeSH
• lidé MeSH
• mezinárodní spolupráce * MeSH
• monitorování životního prostředí metody   MeSH
• pilotní projekty MeSH
• rozvoj plánování * MeSH
• studie proveditelnosti MeSH
• vystavení vlivu životního prostředí analýza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH