BACKGROUND: This dual-center, randomized controlled trial aimed to compare 2 types of intra-abdominal drains after pancreatic resection and their effect on the development of pancreatic fistulae and postoperative complications. METHODS: Patients undergoing pancreatic resection were randomized to receive either a closed-suction drain or a closed, passive gravity drain. The primary endpoint was the rate of postoperative pancreatic fistula. A secondary endpoint was postoperative morbidity during follow-up of 3 months. The planned sample size was 223 patients. RESULTS: A total of 294 patients were assessed for eligibility, 223 of whom were randomly allocated. One patient was lost during follow-up, and 111 patients in each group were analyzed. The rate of postoperative pancreatic fistula (closed-suction 43.2%, passive 36.9%, P = .47) and overall morbidity (closed-suction 51.4%, passive 40.5%, P = .43) were not different between the groups. We did not find any differences between the groups in reoperation rate (P = .45), readmission rate (P = .27), hospital stay (P = .68), or postoperative hemorrhage (P = .11). We found a significantly lesser amount of drain fluid in the passive gravity drains between the second and fifth postoperative days and also on the day of drain removal compared with closed-suction drains. CONCLUSION: The type of drain (passive versus closed suction) had no influence on the rate of postoperative pancreatic fistulae. The closed-suction drains did not increase the rate of postoperative complications. We found that the passive gravity drains are more at risk for obstruction, whereas the closed-suction drains kept their patency for greater duration.

• MeSH
• časové faktory MeSH
• délka pobytu statistika a číselné údaje   MeSH
• drenáž metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory slinivky břišní chirurgie   MeSH
• následné studie MeSH
• odsávání metody   MeSH
• pankreas chirurgie   MeSH
• pankreatektomie škodlivé účinky   MeSH
• pankreatická píštěl epidemiologie   etiologie   prevence a kontrola   MeSH
• pooperační komplikace epidemiologie   etiologie   prevence a kontrola   MeSH
• reoperace statistika a číselné údaje   MeSH
• senioři MeSH
• výsledek terapie MeSH
• znovupřijetí pacienta statistika a číselné údaje   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

PURPOSE OF THE STUDY Our study compared early outcomes of total knee arthroplasty performed in conventional and enhanced perioperative care regimes, i.e. without the use of Redon drain, with intensified perioperative analgesia and more frequent and intensive rehabilitation regime in the latter. MATERIAL AND METHODS The prospective study included 194 patients (76 men and 118 women) implanted with primary knee endoprosthesis. The mean age was 68.8 (44.7 - 88.0 years). The patients were divided into two groups - the "enhanced" and "conventional" procedures. In the first group, Redon suction drain was not inserted at the end of the surgery, and the patients commenced passive knee mobility exercise of the operated knee immediately after being brought back from the operating theatre. The general anaesthesia was supplemented by a combined femoral nerve block and wound infiltration with local anaesthetics. The second group comprised the patients who underwent conventional surgery, i.e. with the use of drain, without femoral nerve block, with no wound infiltration with local anaesthetics, and without immediate post-operative mobilization of the joint. The evaluation was carried out using regular clinical tools (subjective evaluation, objective examination, questionnaire and Knee Society Score (KSS)). Standard statistical methods were applied to data processing. RESULTS The patients under the "conventional regime" showed a significantly sharper drop in haemoglobin and haematocrit levels, higher consumption of blood transfusion and analgesics during the first three days after the surgery. The patients under the "enhanced regime" showed a better range of joint motion at hospital discharge, flexion in particular (p = 0.001). During the hospital stay no frequent swelling, secretion or wound reddening was reported in any of the monitored groups. In the "conventional" group, however, haematomas were more frequently present. The postoperative checks did not reveal any differences in satisfaction of the patients with the surgery. At the first follow-up examination at the outpatient department the "conventional" group patients more often reported knee pain and a feeling of a swollen knee. Nonetheless, their statements did not correspond with the VAS score. In the period between the 6th and 12th months following the surgery, the differences in the range of motion disappeared. The KSS showed a noticeable improvement in both the groups as against the preoperative values. In the "enhanced" group patients, the score increased dramatically at the beginning, whereas in the "conventional" group, the score was growing slowly and gradually until the last follow-up check after the surgery. The "conventional" group patients more frequently reported infectious complications (surface and deep wound infections: 4 vs. 2 patients) requiring a revision surgery (p = 0.024). DISCUSSION Recently, attention has been drawn to the rapid recovery approach, which eliminated postoperative immobilization and enabled the patient to start exercising already on the day of the surgery, with some patients even walking independently. The individual enhanced recovery regimes differ in details but mostly result in achieving the aim much sooner when compared to the conventional approaches. The patients under the enhanced recovery regimes can accomplish better functional outcomes in the first few months after the surgery than the patients undergoing the surgery under the conventional regime. The routine use of Redon drains in TKA is obviously unnecessary; it tends to be associated with a higher blood loss and a higher risk of prosthetic joint infection. CONCLUSIONS The TKA implant without suction drains combined with intensified perioperative analgesia and intensive postoperative rehabilitation is a safe way to earlier recovery of the function of the operated knee, or, by extension, the lower limb. The described approach is not associated with a higher risk of perioperative complications (bleeding, healing disorders or early infections). Patients also benefit from lower blood losses. Based on the results of our study, we recommend performing the TKA surgeries routinely without drains, with perioperative analgesia and immediate postoperative joint mobilization. Key words: total knee arthroplasty; perioperative care; rapid recovery; drainage; active movement; postoperative outcomes; pain; infection.

• MeSH
• anestetika lokální aplikace a dávkování   MeSH
• celková anestezie metody   MeSH
• dospělí MeSH
• kolenní kloub patofyziologie   MeSH
• krevní transfuze MeSH
• lidé středního věku MeSH
• lidé MeSH
• management bolesti metody   MeSH
• nervová blokáda metody   MeSH
• nervus femoralis MeSH
• odsávání škodlivé účinky   metody   MeSH
• pooperační péče metody   MeSH
• prospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• strečink metody   MeSH
• totální endoprotéza kolene metody   rehabilitace   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH
• Názvy látek
• anestetika lokální MeSH

• MeSH
• capsulorhexis MeSH
• fakoemulzifikace * MeSH
• grampozitivní bakteriální infekce diagnóza   mikrobiologie   terapie   MeSH
• implantace nitrooční čočky MeSH
• léčebná irigace metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci oční čočky diagnóza   mikrobiologie   terapie   MeSH
• oční infekce bakteriální diagnóza   mikrobiologie   terapie   MeSH
• odsávání metody   MeSH
• polymethylmethakrylát MeSH
• pooperační komplikace * MeSH
• Propionibacterium acnes izolace a purifikace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• kazuistiky MeSH
• Názvy látek
• polymethylmethakrylát MeSH

• MeSH
• hrudní chirurgické výkony * MeSH
• lidé MeSH
• odsávání přístrojové vybavení   metody   MeSH
• perikard MeSH
• pleurální dutina MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Large recurrent pericardial effusion can be managed by repeat pericardiocentesis or by surgery. A relatively new, catheter-based method uses a balloon catheter (percutaneous balloon pericardiotomy) for drainage from the pericardial sac to the pleural space. As an alternative, we present a newly developed device: Cutting pericardiotome.

• MeSH
• design vybavení MeSH
• dospělí MeSH
• echokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• miniaturní prasata MeSH
• odsávání metody   MeSH
• perikardektomie přístrojové vybavení   MeSH
• perikardiální efuze diagnostické zobrazování   chirurgie   MeSH
• pleura chirurgie   MeSH
• radiografie MeSH
• recidiva MeSH
• reoperace MeSH
• senioři MeSH
• zvířata MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

The authors evaluate a group of 92 patients with the diagnosis of chronic subdural haematoma confirmed by CT. All patients were operated from two trepanation bores with insertion of drainage into the subdural space and its connection with the closed drainage system. They used three types of drainage systems. The best clinical results were obtained with the negative pressure suction system of Braun Co in 92%. This system was switched on intermittently only till the patient developed signs of headache. Attention is focused on possible types of complications in different systems. In the remaining 13 patients who did not improve reinsertion of the drain was used, or craniotomy with membranectomy with a 60% improvement. The mentioned negative pressure drainage system in treatment in chSDH seems most suitable and is associated with the least number of complications.

• MeSH
• chronická nemoc MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• odsávání přístrojové vybavení   metody   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• subdurální hematom diagnóza   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Bimanual irrigation/aspiration is a safe method for the removal of lenticular mass from the eye and can be used in some complicated cases. As it is a perfectly closed system, oscillation of the posterior capsule does not occur and this prevents prolapse of the vitreous body. If the pupil is narrow, the margin of the pupil can be shifted by means of the irrigation cannula and thus suction of the lenticular mass up to the equator is made possible. In subluxed lenses by gently pushing back the lenticular capsule its adherence to the aspiration cannula is prevented. It is relatively easy to clean the anterior lenticular capsule from epithelial cells by bimanual I/A.

• MeSH
• extrakce katarakty přístrojové vybavení   metody   MeSH
• léčebná irigace přístrojové vybavení   metody   MeSH
• lidé MeSH
• odsávání přístrojové vybavení   metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

• MeSH
• kojenec MeSH
• lidé MeSH
• nosní sliznice metabolismus   MeSH
• novorozenec MeSH
• odsávání přístrojové vybavení   metody   MeSH
• předškolní dítě MeSH
• Check Tag
• kojenec MeSH
• lidé MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• Publikační typ
• časopisecké články MeSH

A case of an infertile married couple by whom the cause of infertility was oligoasthenospermia of man is described. The couple was treated by intrauterine insemination by capacitated spermatozoa in a cycle stimulated by clomiphene. The ultrasonography revealed a pregnancy of triplets. The patient refused a multiple pregnancy and asked for its interruption. As an alternative we proposed the selective abortion by means of an ultrasound-guided aspiration of two gestational sacs. Description of this method and the result are the theme of our paper.

• MeSH
• druhý trimestr těhotenství MeSH
• homologní inseminace * MeSH
• lidé MeSH
• odsávání metody   MeSH
• odumření plodu MeSH
• potrat léčebný metody   MeSH
• těhotenství mnohočetné fyziologie   MeSH
• těhotenství MeSH
• ultrasonografie prenatální metody   MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Fifty eight ultrasound-guided transurethral aspirations for in vitro fertilization were performed from October 1987 to June 1988. At that time twenty two laparoscopic oocyte retrievals were done, mostly in patients in our gamete intrafallopian transfer (GIFT) program. All procedures were performed by the same ovarian stimulation protocol under general anesthesia. In the transurethral ultrasound-guided group 143 oocytes were recovered from 207 follicles aspirated (69.1%). The fertilization rate was 52.4% and one clinical pregnancy occurred. In the laparoscopy group 43 oocytes were recovered from 70 follicles aspirated (61.4%). The fertilization rate (because of GIFT procedures) could not be assessed. There were no statistically differences between the two groups. No major complications were noted. Transurethral transvesical ultrasound-guided follicular aspiration should be considered as an alternative route for oocyte retrieval.

• MeSH
• fertilizace in vitro metody   MeSH
• lidé MeSH
• odsávání metody   MeSH
• oocyty * MeSH
• přenos embrya metody   MeSH
• přenos gamet do vejcovodu metody   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH