INTRODUCTION: Cannulation v. subclavia is connected with many complications. Haemothorax is occurs approximately in 2% of cases. Surgical revision is indicated immediately if a major blood loss or a circulation insufficiency occur. Surgical treatment of bleeding in cupola of pleural cavity is due to its bad accesability difficult and conventional surgical methods aren't sufficient. In these cases one can use local haemostyptic. CASE REPORT: The authors present a case review of a 36-years old patient with a developed massive haemothorax on the left side post a catheterization of v. subclavia. During surgical revision it was found out that a source of bleeding in superior thoracic aperture is present. It wasn't able to be stopped by classical surgical procedure. TachoSil and Arista preparations were used in this case with a good effect.
- MeSH
- dospělí MeSH
- hemotorax etiologie chirurgie MeSH
- katetrizace centrálních vén škodlivé účinky MeSH
- lidé MeSH
- vena subclavia * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
INTRODUCTION: The authors assess and compare results of percutaneous and open repair of closed Achilles tendon rupture METHOD AND CLINICAL MATERIAL: The authors retrospectively examined 115 patients with subcutaneous Achilles tendon rupture who were treated in the Regional Hospital of Pardubice during the years 2000-2005. They used the 100 point Hannover Achilles Tendon Score. 42 patients were operated on exclusively with percutaneous technique and 73 patients with open repair of Achilles tendon. Duration of the rehabilitation, post-operative complications and using of alternative fixation system in a post-operative treatment of Achilles tendon rupture were also assessed. RESULTS: 62 % of evaluated patients achieved good or excellent results. There was no significant difference between the open and percutaneous repair. In a case of percutaneous repair there was achieved a shortening of post-fixation rehabilitation time in compare with open repair about two weeks. Eighteen postoperative complications were identified after open Achilles tendon repair, resulting in institutional complication rate of 24.7 %. The complications included 6 (8.2%) superficial wound infections. 7 (9.6%) deep crural flebothromboses, 4 (5.5%) re-ruptures and 1 (1.4%) sural nerve injury. Seven postoperative complications were identified after percuaneous Achilles tendon repair, resulting in institutional complication rate of 11.8%. The complications included 3 (7.1%) sural nerve injury and 2 (4.7%) deep crural flebothromboses. The vacuum brace system VacoAchill was used in 23 patients and involved in shortening of duration of rehabilitation about 20%. CONCLUSION: Percutaneous suture of Achilles tendon rupture is a simple and safety method, that brings comparable functional results to open repair with the same time of post-operative fixation and with a significantly lower rate of complications. The vacuum brace system VacoAchill is an alternative method of post-operative fixation allowing earlier mobilization and shortening patient's disability.
- MeSH
- Achillova šlacha zranění chirurgie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ruptura MeSH
- senioři MeSH
- šicí techniky * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- srovnávací studie MeSH
INTRODUCTION: Serious blunt injuries are accompanied with the worsening of the mechanics of ventilation due to the chest and lung injuries alone as well as with a systemic inflammatory response (SIRS) that always affects the lungs. The development of an injury-induced respiratory failure is multifactorial and timely pharmacological intervention is likely to contribute to the treatment algorithm, thus improving prognosis in some patients with a serious chest trauma. THE OBJECTIVE OF THE STUDY: The objective of this study is to verify the efficacy of the pharmacological blockade of the systemic inflammatory response of the body (SIRS) in serious blunt chest injuries. The study also intends to identify whether the administration of indomethacin could reduce SIRS score and prevent multiorgan dysfunction and multiorgan failure. METHODS: 126 patients with blunt chest injuries were evaluated during 33 months. The patients were divided into four groups, depending on the extent of trauma severity assessed by means of ISS (Injury Severity Score). Randomly selected patients in each group were administered--in addition to standard therapy--indomethacin in usual doses. All tests were carried out at a significance level alpha of 0.05. RESULTS: The onset of SIRS in the subgroup with indomethacin was statistically significantly postponed in groups I. and II. Groups ISS I to III showed a statistically markedly shorter time of SIRS duration in the subgroup with indomethacin. The first increase in inflammatory markers (acute phase proteins) was statistically significantly postponed in the group ISS I without the administration of indomethacin. Groups ISS II through IV did not show a statistically significant differences in the first onsets of inflammatory markers. The evaluation of all four groups did not detect any statistically significant differences in the duration of the inflammatory markers increase in the subgroup with indomethacin and in a control group. There was no statistical significance in the average time of ventilation support. An average hospitalization time was shorter in the subgroup ISS II with indomethacin. There was found statistically significant difference. Of the patients included in our file seven died during the monitored period. Lethality is thus 5.6%. A multiorgan failure was the cause of death in two patients in the non-indomethacin subgroup and in one patient in the indomethacin subgroup. CONCLUSION: We proved that the factors that can be affected by the blockade of cyclooxygenase display statistically significant changes in subgroups with the administration of indomethacin. No changes were recorded with regard to acute phase proteins whose synthesis is not mediated by prostaglandins. The administration of indomethacin positively affects the development of SIRS, reduces and diminishes its effects as well as impact on the impaired body.
- MeSH
- dospělí MeSH
- indomethacin terapeutické užití MeSH
- inhibitory cyklooxygenasy terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění hrudníku komplikace terapie MeSH
- skóre závažnosti úrazu MeSH
- syndrom systémové zánětlivé reakce etiologie prevence a kontrola MeSH
- tupá poranění komplikace terapie MeSH
- umělé dýchání MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- indomethacin MeSH
- inhibitory cyklooxygenasy MeSH
INTRODUCTION: Each injury is accompanied with the oxidation stress with an increase in the level of free oxygen radicals accompanied with a simultaneous decrease in the body's antioxidation capacity. The objective of the study: The objective of this study is to verify connection between the severity of an injury and the intensity of oxidation stress. METHODS: 126 patients with blunt chest injuries were evaluated during 33 months. The patients were divided into four groups, depending on the extent of trauma severity assessed by means of ISS (Injury Severity Score). Randomly selected patients in each group were administered--in addition to standard therapy--indomethacin in usual doses. Level of free oxygen radicals and the body's antioxidation capacity were observed. All tests were carried out at a significance level alpha of 0.05. RESULTS: Practically all patients, regardless of their respective subgroups, experienced an increase in the level of free oxygen radicals accompanied with a simultaneous decrease in the body's antioxidation capacity. CONCLUSION: The identified results display a connection between the severity of an injury and the intensity of oxidation stress.
- MeSH
- antioxidancia metabolismus MeSH
- indomethacin terapeutické užití MeSH
- inhibitory cyklooxygenasy terapeutické užití MeSH
- lidé MeSH
- oxidační stres * MeSH
- poranění hrudníku metabolismus MeSH
- reaktivní formy kyslíku metabolismus MeSH
- skóre závažnosti úrazu MeSH
- tupá poranění metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
- Názvy látek
- antioxidancia MeSH
- indomethacin MeSH
- inhibitory cyklooxygenasy MeSH
- reaktivní formy kyslíku MeSH
INTRODUCTION: Frequency and severity of the blunt chest injuries are increasing. Rather high letality is caused by the injury and following systemic inflammatory response. OBJECTIVE: The aim of the study is to verify the efficacy of pharmacological blockade of the systemic inflammatory response syndrome (SIRS) in serious blunt chest injuries. The aim is also to find out if the administration of indomethacin as a cyclooxygenase inhibitor could prevent multiorgan dysfunction (MODS) and multiorgan failure (MOF). MATERIAL AND METHODS: Patients were divided into 4 groups according to trauma severity (Injury Severity Score). The group I. contains patients with ISS up to 17. There is no premise of the SIRS development. In the group II. there were patients with ISS 18-30, which means polytrauma group due to new definition. In the group III. there were patients with ISS 31-40 (severe trauma). Group IV. contains critically injured patients (ISS 41 and higher). Some patients involved in our study were given indomethacin (as cyclooxygenase inhibitor in arachidonic acid cycle) together with standard therapy. RESULTS: 65 patients were included into study in last 14 months, 22 patients were given indomethacin. The group with indomethacin administration has later increase of inflammatory markers in groups III. and IV. This increase also takes less time in groups II. and III. Shorter time of mechanical ventilation support in group III. in patients with indomethacin was significant. SIRS is present in time of admission approximately in 44%. All patients have low antioxidants level. 5 patients died in our group, letality was 7.7%. All the died patients came from the subgroup without indomethacin, however only one death caused by MOF. CONCLUSION: From the results of the first 14 months of the study we can conclude that certain number of patients with serious blunt thoracic trauma could benefit from indomethacin administration.
- MeSH
- indomethacin terapeutické užití MeSH
- inhibitory cyklooxygenasy terapeutické užití MeSH
- lidé MeSH
- multiorgánové selhání etiologie prevence a kontrola MeSH
- poranění hrudníku komplikace MeSH
- premedikace MeSH
- syndrom systémové zánětlivé reakce prevence a kontrola MeSH
- tupá poranění komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- klinické zkoušky kontrolované MeSH
- klinické zkoušky MeSH
- práce podpořená grantem MeSH
- Názvy látek
- indomethacin MeSH
- inhibitory cyklooxygenasy MeSH
