BACKGROUND: Proximal femoral fractures are severe injuries in geriatric patients. Additionally, geriatric patients are at a high risk of death due to coronavirus disease 2019 (COVID-19). OBJECTIVE: To identify predictors of mortality in geriatric patients with COVID-19 and concurrent proximal femoral fractures. MATERIAL AND METHODS: Patients who underwent surgical treatment for proximal femoral fractures and also tested positive for COVID-19 were included. The age, gender, the American Society of Anesthesiology (ASA) score and the admission from a nursing home were considered as variables. The rate of reoperations, the mortality at 3 months and discharge home were evaluated as outcomes. RESULTS: In this study 46 patients with COVID-19 (female/male 31/15, median age 87.0 years with an interquartile range [IQR] of 9.8 years) met the inclusion criteria. Of these, 32 patients (69.6%) had to be cared for in the intensive care unit and 26 patients (56.5%) had a severe course of COVID-19 with pneumonia. The median length of hospital stay for survivors was 19 (IQR 17.5) days and 4 of the patients (8.7%) required surgical revision. The in-hospital and 3‑month mortality were 40.0% (n = 17) and 43.5% (n = 20), respectively. The factors which influenced the in-hospital and 3‑month mortality rates were admission from a nursing home, the presence of pneumonia (increased the risk of death) and female gender (protective). CONCLUSION: The occurrence of COVID-19 in patients with proximal femoral fractures has a high mortality. Admission from a nursing home and the presence of pneumonia increased the risk of death, whereas women were at lower risk.

ZUSAMMENFASSUNG: HINTERGRUND: Proximale Femurfrakturen (PFF) sind schwere Verletzungen bei geriatrischen Patienten. Darüber hinaus besteht für geriatrische Patienten ein hohes Risiko, an COVID-19 zu sterben. ZIEL DER ARBEIT: Ermittlung von Prädiktoren für die Mortalität bei geriatrischen Patienten mit COVID-19 und gleichzeitiger proximaler Femurfraktur. MATERIAL UND METHODEN: Patienten wurden eingeschlossen, die sich einer chirurgischen Behandlung wegen PFF unterzogen und auch positiv auf COVID-19 getestet wurden. Als Variablen wurden Alter, Geschlecht, der ASA-Score, die Aufnahme aus einem Pflegeheim berücksichtigt. Als Ergebnisse wurden die Rate der Reoperationen, die Mortalität im Krankenhaus nach 3 Monaten und die Entlassungen nach Hause ausgewertet. ERGEBNISSE: In dieser Studie erfüllten 46 Patienten mit COVID-19 (weiblich/männlich 31/15, mittleres Alter 87,0 Jahre mit einem Interquartilsbereich [IQR] von 9,8 Jahren) die Einschlusskriterien. Davon mussten 32 Patienten (69,6 %) auf der Intensivstation betreut werden. 26 Patienten (56,5 %) hatten einen schweren Verlauf von COVID-19 mit Lungenentzündung. Bei den Überlebenden betrug die mittlere Krankenhausaufenthaltsdauer 19 (IQR 17,5) Tage. Vier der Patienten (8,7 %) benötigten eine chirurgische Revision. Die 3‑Monats-Mortalität im Krankenhaus betrug 40,0 % (n = 17) bzw. 43,5 % (n = 20). Die Faktoren, die die 3‑Monats-Sterblichkeitsraten im Krankenhaus beeinflussten, waren die Aufnahme aus einem Pflegeheim, das Vorliegen einer Lungenentzündung (erhöhtes Sterberisiko) und das weibliche Geschlecht (schützend). DISKUSSION: COVID-19, das bei Patienten mit PFF auftritt, weist eine hohe Mortalität auf. Die Aufnahme aus einem Pflegeheim und das Vorliegen einer Lungenentzündung erhöhten das Sterberisiko, wohingegen das weibliche Geschlecht schützend wirkte.

• Klíčová slova
• COVID-19, Frailty, Osteoporotic fractures, Proximal femoral fractures, Traumatology,
• MeSH
• COVID-19 * mortalita   MeSH
• délka pobytu statistika a číselné údaje   MeSH
• fraktury femuru mortalita   chirurgie   MeSH
• fraktury kyčle mortalita   chirurgie   MeSH
• fraktury proximálního femuru MeSH
• lidé MeSH
• mortalita v nemocnicích MeSH
• pečovatelské domovy * statistika a číselné údaje   MeSH
• reoperace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• SARS-CoV-2 MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Německo epidemiologie   MeSH

In an open, prospective use study, 161 patients with 198 decubitus ulcers (pressure ulcers, ITT population) in stages II and III were treated with the topical preparation symphytum herb extract cream. The bandages with the cream were changed every 2-3 days. The primary parameters evaluated were the area of the sore and the depth of the wound (planimetrically in mm). In all, 151 patients with a total of 184 pressure sores (PP population) were included and received treatment over a period of 4 weeks in order to evaluate the treatment results. Complete healing of the pressure sores within 4 weeks was observed in 85.9 % (PP population)/79.8 % (ITT population) of the treated ulcers. Over a treatment duration of 25-30 days, a 89.2 % reduction of the total decubitus area was observed. The same result was found for the depth of the pressure ulcer with a reduction of 88 %. The overall treatment success was from both the perspective of the physician and the patient considered successful in 90.4 % (5-point scale) of cases and 87.9% (100 mm VAS, PP population). Two cases of local irritation were observed after 25/30 days (1.2 % of the patients with exposure), thus showing very good skin compatibility. The efficacy of symphytum herb extract cream is surprisingly good in the treatment of pressure ulcers.

• MeSH
• aplikace lokální MeSH
• dekubity diagnóza   farmakoterapie   MeSH
• hojení ran účinky léků   MeSH
• kostival lékařský chemie   MeSH
• léčivé rostliny chemie   MeSH
• léková dermatitida diagnóza   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• obvazy MeSH
• pleťový krém aplikace a dávkování   škodlivé účinky   MeSH
• rostlinné extrakty aplikace a dávkování   škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• 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
• klinické zkoušky MeSH
• Názvy látek
• rostlinné extrakty MeSH

BACKGROUND: Achalasia is an uncommon illness affecting 1 per 100,000 patients a year. It encompasses a rare, primary motor disorder of the distal esophagus. METHODS: Over the period 1998-2006, 115 patients underwent various treatments for achalasia; the subgroup of seniors consisted of 26 patients. Six patients of these (age 69.7 y) underwent a modified Heller cardiomyotomy due to failure of previous endoscopic interventions. Standard esophageal manometry and 24 hour pH metry were performed pre- and postoperatively. RESULTS: Six senior patients with achalasia underwent a laparoscopic Heller myotomy. Average preoperative tonus of the LES was 55 mmHg, postoperative tonus of the LES decreased to 11 mmHg. We performed Toupet partial fundoplication in all patients; no microperforation of the esophagus was found in the preoperative esophagoscopy. We recorded minimal pathological gastroesophageal reflux in pH metry - the average preoperative DeMeester score was 8, postoperatively 10.5. Prolonged dysphagia was not present in any patient--preoperative GIQLI score was 94, postoperative score was 106. There was no mortality or morbidity in the group of the operated patients. CONCLUSION: Our operational results and postoperative follow-up show that laparoscopic Heller myotomy with Toupet partial fundoplication is a safe and effective treatment and can be recommended as the method of first choice for senior patients with no contraindication for laparoscopic operation.

• MeSH
• achalázie jícnu diagnóza   chirurgie   MeSH
• chirurgie trávicího traktu metody   MeSH
• fundoplikace metody   MeSH
• hladké svalstvo chirurgie   MeSH
• kombinovaná terapie MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky kontrolované MeSH

UNLABELLED: Primary, secondary, benign or malignant tumorous diseases of the small intestine are rare. They are very often diagnosed by accident or as a cause of acute abdomen. Less serious symptoms can be overseen mainly in older patients. This work represents a prospective evaluation of a diagnostic and therapeutic algorithm in the management of the small-intestine tumor below the ligamentum Treitzi in patients over 65 years of age. RESULTS: A population of 96 patients who underwent surgery for a small-intestinal tumor in our hospital from 1996 to 2006 is presented. Thirty-four of these patients were older than 65 years. Ultrasound of the small intestine was sufficient to make the diagnosis in 21 of them. Elective surgery (laparoscopy was highly preferred) could be offered to 31 of these older patients. Perioperative mortality was zero. CONCLUSION: The small-bowel ultrasound can be recommended as the first choice method. All complaints regarding the gastrointestinal tract should be verified. Older patients can be safely offered an elective laparoscopic surgery with acceptable morbidity and mortality.

• MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• střevní nádory diagnostické zobrazování   chirurgie   MeSH
• tenké střevo diagnostické zobrazování   chirurgie   MeSH
• ultrasonografie metody   MeSH
• věkové faktory MeSH
• věkové rozložení MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH