Ulnar neuropathy at the elbow (UNE) is commonly encountered in clinical practice. It results from either static or dynamic compression of the ulnar nerve. While the retroepicondylar groove and its surrounding structures are quite superficial, the use of ultrasound (US) imaging is associated with the following advantages: (1) an excellent spatial resolution allows a detailed morphological assessment of the ulnar nerve and adjacent structures, (2) dynamic imaging represents the gold standard for assessing the ulnar nerve stability in the retroepicondylar groove during flexion/extension, and (3) US guidance bears the capability of increasing the accuracy and safety of injections. This review aims to illustrate the ulnar nerve's detailed anatomy at the elbow using cadaveric images to understand better both static and dynamic imaging of the ulnar nerve around the elbow. Pathologies covering ulnar nerve instability, idiopathic cubital tunnel syndrome, space-occupying lesions (e.g., ganglion, heterotopic ossification, aberrant veins, and anconeus epitrochlearis muscle) are presented. Additionally, the authors also exemplify the scientific evidence from the literature supporting the proposition that US guidance is beneficial in injection therapy of UNE. The non-surgical management description covers activity modifications, splinting, neuromobilization/gliding exercise, and physical agents. In the operative treatment description, an emphasis is put on two commonly used approaches-in situ decompression and anterior transpositions.

• Klíčová slova
• US-guidance, cubital tunnel syndrome, elbow, entrapment neuropathy, musculoskeletal, peripheral nerve, ulnar nerve (MeSH), ultrasound,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE OF THE STUDY: The variability in width, height, and orientation of spinal pedicles makes pedicle screw insertion a delicate operation. Fluoroscopic guidance often exposes the patient and especially surgeons to relatively high doses of ionising radiation. The use of pulsed fluoroscopy is safer, as compared to continuous fluoroscopy, because of reduced radiation exposure. There are increasing numbers of literature reports regarding the high doses of radiation to which orthopaedic and spine surgeons are exposed during surgical procedures. Spine surgery can be associated with significant radiation exposure to the surgical staff. The purpose of this prospective study was to compare a computer-assisted navigation with a conventional procedure in order to assess if it is possible to reduce radiation exposure while preserving the accuracy of screw placement. MATERIAL AND METHODS: The first "conventional" group consisted of 30 patients, with an average of 1.9 segments of the lumbar spine stabilised. Screws were inserted transpedicularly under image intensifier guidance. In the second "navigated" group of 30 patients, stabilisation of 1,8 segments was performed on average. A CT-free fluoroscopic 2D spinal navigation system (VectorVision, Brain LAB, Germany) was used intra-operatively. It combines image-guided surgery with C-arm fluoroscopy. For each surgery (navigated or not), the duration of irradiation was recorded. The irradiation duration was collected from the X-ray image intensifier. In both groups the screw positioning accuracy was controlled intra-operatively according to Learch's, Acikbas's, and Whitecloud's methods from AP and lateral images and by meticulous pedicle palpation. RESULTS: The irradiation duration calculated to one vertebra (two screws) was significantly shorter in the second (navigated) group (3.4 s) than in the first (conventional) group (14.4 s). The mean duration of data registration was 6.0 minutes (range, 3 to 11 minutes). The mean ratio according to Acikbas's calculation method was 43.2 % (range, 32 % to 74 %) in the first (conventional) group and 44.1 % (range, 35 % to 76 %) in the second (navigated) group. DISCUSSION: During a conventional surgical procedure many X-ray images are made to control the accuracy of screw insertion. If the trajectory is not satisfying, it must be corrected or the pedicle is drilled again, always with a new fluoroscopic control. The process is repeated until satisfactory orientation is achieved. This is the explanation for a much longer duration of irradiation in conventional procedures. Navigation facilitates the surgical act, enabling us to acquire the right position of all screws, with only an AP image and a lateral image at the beginning of instrumentation for data registration; prolongation of the operative time is irrelevant. CONCLUSIONS: Navigation allows us to keep the same accuracy of pedicle screw placement while reducing radiation exposure of the surgeons and operating room staff by about one quarter. In multiple-level vertebral instrumentations this reduction is more pronounced. In centres where many procedures involving spine instrumentation are done every day, the "saved" exposure time can amount to hours.

• MeSH
• bederní obratle chirurgie   MeSH
• chirurgie s pomocí počítače * MeSH
• dávka záření * MeSH
• dospělí MeSH
• fluoroskopie * metody   MeSH
• hrudní obratle chirurgie   MeSH
• intervenční radiografie * MeSH
• kostní šrouby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři 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

Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.

• Klíčová slova
• CVD, Cardiovascular, Diabetes, Diabetogenicity, Statins, T2D,
• MeSH
• anticholesteremika aplikace a dávkování   škodlivé účinky   farmakologie   terapeutické užití   MeSH
• diabetes mellitus 2. typu epidemiologie   etiologie   prevence a kontrola   MeSH
• dospělí MeSH
• glykovaný hemoglobin analýza   MeSH
• hodnocení rizik MeSH
• kardiovaskulární nemoci epidemiologie   prevence a kontrola   MeSH
• kohortové studie MeSH
• komorbidita MeSH
• LDL-cholesterol krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metaanalýza jako téma MeSH
• multicentrické studie jako téma statistika a číselné údaje   MeSH
• náchylnost k nemoci MeSH
• omezení příjmu potravy krev   MeSH
• pozorovací studie jako téma MeSH
• prediabetes epidemiologie   MeSH
• předpověď MeSH
• rizikové faktory MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• statiny aplikace a dávkování   škodlivé účinky   farmakologie   terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• anticholesteremika MeSH
• glykovaný hemoglobin MeSH
• LDL-cholesterol MeSH
• statiny MeSH

To evaluate the accuracy, efficiency, complication rate, technical features, and relations among followed parameters of CT-guided percutaneous biopsies of the pelvic lesions. 140 biopsies in 136 patients for tumors, sizes 17-160 mm in largest diameter, were carried out in patients with probable tumorous pelvic process within ten years period. The patients were women in 77 cases and men in 59 cases, aged 21 to 87 years. The lesions´ size varied from 17 mm to 160 mm in largest diameter. In 135 biopsies (96.4%) results were true positive or true negative; only 5 procedures (3.6%) were histologically false negative and had to be verified surgically. Metastatic affection was the most common diagnosis (26.4%). Lymphomas were diagnosed in 25%; serous adenocarcinoma of ovary or uterine tube was verified in 15.7% of cases. Totally 7 complications (5%) were confirmed, all were minor hemorrhages. A statistically significant relation between the complication rate and hypervascular character (p = 0.00004), and between needle gauge and histological accuracy (p = 0.00429) was revealed. Core needle biopsy using percutaneous approach and CT guidance had a high overall accuracy in determining the final histological diagnosis including subtyping. Concurrently, the complication incidence was low.

• Klíčová slova
• CT guidance, Pelvic tumor, complication rate, core needle biopsy, diagnostic accuracy, percutaneous approach,
• MeSH
• biopsie dutou jehlou metody   MeSH
• lidé MeSH
• pánev * diagnostické zobrazování   MeSH
• počítačová rentgenová tomografie metody   MeSH
• retrospektivní studie MeSH
• ultrazvukem navigovaná biopsie * metody   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

• MeSH
• hormony kůry nadledvin aplikace a dávkování   MeSH
• injekce metody   MeSH
• lidé MeSH
• lupavý prst diagnostické zobrazování   farmakoterapie   MeSH
• ultrasonografie metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• Názvy látek
• hormony kůry nadledvin MeSH

BACKGROUND AND OBJECTIVE: The Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-ADOLOPMENT methodology has been widely used to adopt, adapt, or de novo develop recommendations from existing or new guideline and evidence synthesis efforts. The objective of this guidance is to refine the operationalization for applying GRADE-ADOLOPMENT. METHODS: Through iterative discussions, online meetings, and email communications, the GRADE-ADOLOPMENT project group drafted the updated guidance. We then conducted a review of handbooks of guideline-producing organizations, and a scoping review of published and planned adolopment guideline projects. The lead authors refined the existing approach based on the scoping review findings and feedback from members of the GRADE working group. We presented the revised approach to the group in November 2022 (approximately 115 people), in May 2023 (approximately 100 people), and twice in September 2023 (approximately 60 and 90 people) for approval. RESULTS: This GRADE guidance shows how to effectively and efficiently contextualize recommendations using the GRADE-ADOLOPMENT approach by doing the following: (1) showcasing alternative pathways for starting an adolopment effort; (2) elaborating on the different essential steps of this approach, such as building on existing evidence-to-decision (EtDs), when available or developing new EtDs, if necessary; and (3) providing examples from adolopment case studies to facilitate the application of the approach. We demonstrate how to use contextual evidence to make judgments about EtD criteria, and highlight the importance of making the resulting EtDs available to facilitate adolopment efforts by others. CONCLUSION: This updated GRADE guidance further operationalizes the application of GRADE-ADOLOPMENT based on over 6 years of experience. It serves to support uptake and application by end users interested in contextualizing recommendations to a local setting or specific reality in a short period of time or with limited resources.

• Klíčová slova
• Adaptation, Adolopment, Adoption, Contextualization, GRADE, Global health, Guidelines, Research waste, Systematic reviews,
• MeSH
• lidé MeSH
• medicína založená na důkazech normy   MeSH
• směrnice pro lékařskou praxi jako téma * normy   MeSH
• systém GRADE normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

To quantitatively evaluate the extent to which fiducial-based image-guidance improves dose coverage of the target volume and sparing of critical organs for prostate cancer patients treated with intensity modulated radiotherapy (IMRT) and determination of planning margins by original approach of detailed daily dose volume histogram (DVH) and patient's position correction analysis. Sixty-two patients divided in two groups (clinical target volume (CTV) → planning target volume (PTV) margin 10 and 7 mm) were treated with IMRT using implanted fiducial markers. Each patient's treatment fraction was recalculated as it would have been treated without fiducial-guided positioning. For both plans (IGRT and non-IGRT), equivalent uniform doses (EUD), maximal and minimal doses for target volumes, normal tissue complication probability (NTCP), maximum and mean doses for organs at risk and the whole DVH differences were assessed. In the group with 10 mm margins, the only significant difference was worse rectal NTCP by 4.5%, but the CTV dose coverage remained at the same level. Recalculated plans with 7 mm margin could not achieve the prescribed target volume coverage, and the EUD decreased by 3.7 and 0.6 Gy for PTV and CTV, respectively. Desired CTV → PTV margin for non-IGRT plans should be no lower than 12 mm to guarantee 95% instances when delivered dose to CTV maintain as planned, for IGRT plans decrease this requirement to 2 mm. Prostate IMRT strategies involving margin reduction below 7 mm require image-guidance to maintain the planned dose coverage. Using fiducial-based image-guidance and large margins seems to be superfluous.

• MeSH
• celková dávka radioterapie MeSH
• lidé MeSH
• nádory prostaty patologie   radioterapie   MeSH
• plánování radioterapie pomocí počítače * MeSH
• počítačová rentgenová tomografie MeSH
• radioterapie s modulovanou intenzitou metody   MeSH
• zaměřovací značky pro radioterapii MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVE: The objective of this study was to evaluate the craniofacial morphology of children with unilateral cleft lip and palate (UCLP) resulting from differing management protocols practiced in Prague from 1945 to 1976. DESIGN: The craniofacial morphologies of four groups of patients were compared. Two groups were assessed retrospectively (individuals born from 1945 to 1963), and two groups were followed on a longitudinal basis (individuals born from 1966 to 1976). SETTING: The study was conducted at the Cleft Lip and Palate Center at the Department of Plastic Surgery, Prague, which has a catchment area population of 6 million. PATIENTS: The subjects were a consecutive series of adult males (n = 84) who had complete UCLP without associated malformations. INTERVENTIONS: Patients born from 1945 to 1955 did not receive centralized orthodontic therapy. From 1945 to 1965, the alveolar process in the area of the cleft was not surgically repaired. Primary bone grafting was used for the group born from 1965 to 1972, and primary periosteoplasty was used in the subsequent period. Throughout the period covered by the study, the palate was operated on by pushback and pharyngeal flap surgery. From 1945 to 1965, the lip was repaired initially according to Veau, and later according to Tennison and Randall, and during this time, fixed appliances were used for orthodontic treatment. RESULTS: The results for the period from 1945 to 1955 are characterized by mandibular overclosure with anterior crossbite. Centralized orthodontic treatment in the later period improved sagittal jaw relations due to the posterior displacement of the mandible and an edge-to-edge bite was attained, but maxillary retrusion was unchanged. Primary bone grafting increased retrusion of the maxilla, which was compensated by further posterior displacement of the mandible. An edge-to-edge bite was also obtained. Primary periosteoplasty reduced maxillary retrusion, and the marked proclination of the upper dentoalveolar component with fixed appliances resulted in a positive overjet. It was no longer necessary to push the mandible back to the extent required in bone grafting. CONCLUSION: Effective orthodontic treatment made the greatest contribution to improved facial development. It allowed compensation of maxillary retrusion by changes in the position of the mandible or by proclination of the upper dentoalveolar component with fixed appliances. The applied surgical methods using primary bone grafting caused deterioration of the anterior growth of the maxilla.

• MeSH
• alveolární plastika MeSH
• chirurgické laloky MeSH
• dospělí MeSH
• farynx chirurgie   MeSH
• hodnotící studie jako téma MeSH
• lidé MeSH
• longitudinální studie MeSH
• malokluze etiologie   patologie   MeSH
• mandibula patologie   MeSH
• maxila patologie   MeSH
• maxilofaciální vývoj * MeSH
• okostice chirurgie   MeSH
• ortodoncie korekční MeSH
• ortodontické aparáty MeSH
• patro chirurgie   MeSH
• ret chirurgie   MeSH
• retrospektivní studie MeSH
• rozštěp patra patofyziologie   chirurgie   MeSH
• rozštěp rtu patofyziologie   chirurgie   MeSH
• transplantace kostí MeSH
• zubní okluze MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

The authors deal with the problem of application of a therapeutic fine needle aspiration puncture in abscesses and other purulent foci in organs of abdominal cavity and retroperitoneum. The treatment using this method under continuing antibiotic therapy has been used in 60 patients (40 men, 20 women), 25 of them suffering from liver abscesses, 28 other from purulent foci of pancreas and seven patients from purulent foci of the kidney. In most patients there were solitary foci (43 persons). The total volume of the evacuated pus was higher than 20 ml in most patients (52), being even more than 100 ml in 2 patients. No relation ship was found among the number of foci, their volume and efficiency of the treatment. The average number of punctures until the abscesses and other purulent foci were healed up was 2.76 in the liver, 2.5 in pancreas and 1.1 in the kidney. The efficiency of therapy was higher in liver abscesses (96%), in purulent foci of pancreas (82%) and lower in the kidney abscesses (57%). The higher efficiency in the purulent foci of pancreas was probably influenced by predominant representation by infected pseudocysts in this group. The lower average number of punctures until the abscesses were healed up and the lower success in the kidney were influenced by a more radical approach of urologists who, having made the first evacuation puncture, performed a radical operation intervention. The complications were encountered in 9.5% of all punctures, being always insignificant. The results obtained demonstrated the contribution of aimed therapeutic aspiration puncture in the therapy of purulent foci of parenchymal organs of abdominal cavity and retroperitoneum as compared with surgical treatment. The advantage of the applied method in the therapy of purulent foci of the liver and pancreas may be seen in the higher success rate, low invasiveness and a low risk of complications together with a low financial cost and wide availability.

• MeSH
• absces jater terapie   MeSH
• absces diagnostické zobrazování   terapie   MeSH
• intervenční ultrasonografie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci ledvin terapie   MeSH
• nemoci slinivky břišní terapie   MeSH
• odsávání MeSH
• punkce MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Shoulder pain is a common musculoskeletal disorder of variable etiology, ranging from rotator cuff pathology to peripheral nerve entrapment. Advances in ultrasound (US) technology have allowed static and dynamic evaluation of shoulder problems and most importantly, offer real-time, radiation-free guidance for interventions. The present review aims to describe shoulder anatomy in detail using information from cadaveric models and to illustrate US-guided techniques using clearly labeled figures and videos. The review will also present evidence of specific US-guided therapies for shoulder pain by summarizing landmark studies, systematic reviews, and meta-analyses. The following shoulder structures will be covered: 1) the biceps long head tendon, 2) the acromioclavicular joint, 3) the subacromial-subdeltoid bursa, 4) the glenohumeral joint, 5) the suprascapular nerve, and 6) the axillary nerve.

• Klíčová slova
• injection, joint, pain, rehabilitation, sonography, tendon,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH