Academia.edu no longer supports Internet Explorer.
To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to upgrade your browser.
2020, Pediatrie pro praxi
…
5 pages
1 file
Oddělení dětské chirurgie a traumatologie, FN Hradec Králové 2 Centrum dětské traumatologie, Neurochirurchická klinika LF UK a FN, Hradec Králové Úrazy zad a páteře jsou heterogenní skupina poranění, se kterou se setkávají lékaři dětských pacientů téměř každý den. Článek je shrnutím přístupu k vyšetření a ošetření nejběžnějších poranění páteře z pohledu chirurgických pracovišť Fakultní nemocnice v Hradci Králové. Současně se snaží navrhnout racionální postup u takto zraněných dětí. Klíčová slova: zlomeniny obratlů, hrudní a bederní páteř, zobrazovací vyšetření. Back injures and spinal fractures Back and spine injuries are aheterogeneous group of injuries encountered by physicians of pediatric patients almost every day. The article summarizes the approach to examination and treatment of the most common spinal injuries from the perspective of surgical departments of the University Hospital in Hradec Kralove. At the same time, it seeks to propose arational approach to such injured children.
Onkologie, 2022
Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
Za Monteggiovu lézi (ML) je v moderním písemnictví považována zlomenina ulny ve kterékoliv lokalizaci se současným poraněním v oblasti radio-humero-ulnárního skloubení. Nejrozšířenější patologicko anatomická klasifikace (Bado, 1967) dělí ML podle směru dislokace zlomeniny ulny a směru luxace proximálního radia do 4 základních typů a několika ekvivalentů (2). I když tato klasifikace je určena především pro poranění zralého skeletu, zahrnuje ve svém ekvivalentu I. typu i rostoucí skelet, kde luxace proximálního radia je alternována separací proximální epifýzy radia. Klasifikace je velmi přehledná a byla později Olneyem a Menelausem (13) upravena čistě pro rostoucí skelet (tab. 1). Její nevýhodou je neschopnost určit stabilitu poranění a tím předurčovat i následný terapeutický postup. Na základě předchozích sdělení Laera (9), Lettse (10), Ringa (17) a Vinze (20), kteří posuzovali stabilitu ML podle typu poranění ulny, jsme v roce 2005 navrhli vlastní (16), podle našeho názoru komplexnější klasifikaci (tab. 2a, b). Jsme přesvědčeni, že výsledná stabilita ML je určena charakterem poranění jak ulny, tak radio-humero-ulnárního skloubení. Z posouzení stability skeletálního poranění pak vychází volba adekvátní metody léčby.
2006
PURPOSE OF THE STUDY The aim was to evaluate the diagnostic value of plain X-ray images in the diagnosis of pelvic ring injury in comparison with CT findings. MATERIAL AND METHODS The group evaluated consisted of 30 patients, 11 women and 19 men, at an average age of 46 years (range, 20-81 years; women, 20-68 years, men, 20-81 years; average age, 49 and 44 years in women and men, respectively) in whom plain radiography and CT scans were done as part of the initial examination. A retrospective assessment of plain X-ray images was carried out by two independent specialists (radiologist and trauma surgeon). The authors together evaluated CT scans and carried out the final assessment of all medical records. Pelvic radiography was taken with a mobile X-ray unit; CT scans were done according to the standard trauma scanning protocol, using a CT scanner with either one row (CT) or 16 rows (multidetector/MDCT) of detectors. RESULTS Based on the evaluation of X-ray and CT findings, a total of 133 fractures or displacements in the sacroiliac joint or pubic symphysis were detected. The radiologist identified 99 (74 %) injured structures and the trauma surgeon 111 (83 %) ones. This difference was not significant on the whole (p = 0.536), nor when individual structures were assessed. False negative findings were made by the radiologist on 10 occasions and by the trauma surgeon on seven occasions; the evaluation of image data sets by both observers was associated with only one false positive finding. The overall sensitivity of plain X-ray images, when compared to CT scans, was 83 %, but it was considerably lower on evaluation by one observer only (radiologist, 67 %; trauma surgeon, 78 %). DISCUSSION The biggest difference between the findings of two independent specialists existed in the assessment of injuries to the posterior ring of the pelvis (SI joint, sacrum) on plain X-ray images. However, trauma in this region was identified without any doubt on CT scans. To diagnose the type of pelvic injury from CT scans without a possibility to evaluate standard anteroposterior (AP) radiographs or good-quality 2D or 3D reconstructions was found difficult in over one third of the patients. A validity comparison of standard AP radiography and high-quality 2D or 3D CT reconstructions showed that both had an equal value for the exact detection of pelvic injury type. For correct evaluation of the type of injury, scans from the MDCT were easier to read than those from the CT scanner. CONCLUSIONS There is no doubt about the role of standard AP X-ray in the identification of pelvic injury type in polytraumatized, hemodynamically unstable patients. The validity of CT examination for identification of injury to the posterior ring of the pelvis in particular is so high that, in the primary diagnostic procedure, inlet and outlet radiography of the pelvis has lost its importance. The information on the stability and type of injury provided by 2D and 3D CT reconstructions is so exact that, at present, CT examination can reliably replace AP radiography, particularly if, for various reasons, good-quality X-ray images cannot be guaranteed.
Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca, 2022
PURPOSE OF THE STUDY The study analyses a cohort of patients with surgically treated ankle fractures who developed complete distal tibiofibular synostoses. It focuses on their occurrence and association with the extent of tibiotalar dislocation of the ankle joint on the trauma X-ray and its relation to the choice of surgery. MATERIAL AND METHODS The cohort of a total of 824 patients with type B and C fractures according to Weber classification was followed up for 9 years. The cohort consisted of 403 (48.9%) men and 421 (51.1%) women. The exclusion criteria included associated talus fractures, calcaneus fractures and fractures of the other bones of the foot. The studied data were obtained retrospectively from medical documentation and by evaluation of trauma X-rays and X-rays obtained during the postoperative checks. The ankle fractures were classified based on the Weber classification and the basic epidemiologic data (age and gender), type of fracture and extent of tibiotalar dislocation of ankle fractures on the trauma X-ray were evaluated. Posttraumatic ankle dislocation was divided into tibiotalar dislocation > 10 mm, tibiotalar dislocation < 10 mm and the group with regular ankle joint. When evaluating the treatment method, the cohort was divided into three groups: Group 1 with one-stage osteosynthesis, Group 2 with temporary K-wire transfixation or external fixation and subsequent secondary conversion to internal osteosynthesis, and Group 3 with definitive transfixation or external fixation of the ankle. The results were statistically evaluated using the Pearson s chi-square test, or the Fisher s exact test for low frequencies. A multivariant logistic regression model was created to identify statistically significant factors contributing to the development of synostosis. The results with the p-value < 0.05 were considered statistically significant. RESULTS In the whole cohort, the synostosis of distal tibiofibular joint was observed in a total of 131 (15.9%) patients. In men it was in 85 (21.1%) cases and in women in 46 (10.9%) cases, which was statistically significant (p < 0.0001). There was a statistically significant difference (p = 0.0020) between the mean age in the group of patients with synostosis (54.4 years) and the mean age in the group of patients without synostosis (49.1 years). Complete distal tibiofibular synostoses were found in 78 (12.7%) fractures classified as type B according to the Weber classification and in 53 (25.5%) type C fractures. When taking into account the gender, synostoses occurred more frequently in men in both types of fractures classified based on the Weber classification, only in type C fractures no statistical significance was established (p = 0.3026). Various size of posttraumatic tibiotalar dislocation was present in both types of fractures. The group with less severe type B ankle fractures showed a statistically significant dominance of synostosis development in cases with large tibiotalar dislocation of more than 10 mm (p<0.0001). In the group with type C fractures different results were obtained. The highest frequency of cases with synostosis was reported in the group with dislocation smaller than 10 mm (p = 0.0698). In the entire cohort, 615 (74.6%) one-stage osteosyntheses were performed and synostoses developed in 77 (12.5%) cases. In 165 (20.0%) patients, transfixation with K-wires or external fixation with subsequent conversion to secondary osteosynthesis were used and synostoses were identified in 50 (30.3%) cases (p < 0.0001). The open fractures showed an insignificantly smaller number of synostoses than the closed fractures (p = 0.5902). DISCUSSION Posttraumatic distal tibiofibular synostoses have varied morphology. A number of studies confirmed that they do not affect much the functional status of the ankle, even despite their extensive finding in the area of syndesmosis is evident on the Xray. Etiologically, a certain role in their development is reported to be played by posttraumatic hematoma in case of damage to deep soft and bony structures of the ankle. CONCLUSIONS A higher occurrence of synostoses was observed in male population, older age patients and also in type C fractures according to the Weber classification. Larger tibiotalar dislocation showed statistical significance in the development of synostoses in type B fractures according to the Weber classification, whereas in type C fractures it was not the main factor contributing to the development of synostosis. In cases where one-staged osteosynthesis was performed, the occurrence of synostoses was statistically significantly lower than in secondary osteosynthesis after temporary stabilisation.
Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca, 2011
PURPOSE OF THE STUDY The aim of this study was to simulate different types of cervical vertebra loading and to find out whether mechanical stress would concentrate in regions known in clinical practice as predilection sites for osteophyte formation. The objective was to develop a theoretical model that would elucidate clinical observations concerning the predilection site of bone remodelling in view of the physiological changes inside the cervical vertebral body. MATERIAL AND METHODS A real 3D-geometry of the fourth cervical vertebra had been made by the commercially available system ATOS II. This is a high-resolution measuring system using principles of optical triangulation. This flexible optical measuring machine projects fringe patterns on the surface of a selected object and the pattern is observed with two cameras. 3D coordinates for each camera pixel were calculated with high precision and a polygon mesh of the object's surface was further generated. In the next step an ANSYS programme was used to calculate strains and stresses in each finite element of the virtual vertebra. The applied forces used in the experiment corresponded in both magnitude and direction to physiological stress. Mechanical loading in neutral position was characterized by a distribution of 80% mechanical stress to the vertebral body and 10% to each of the zygoapophyseal joints. Hyperlordotic loading was simulated by 60% force transfer to the vertebral body end-plate and 20% to each of the small joint while kyphotic loading involved a 90% load on the vertebral body endplate and 5% on each facet. RESULTS Mechanical stress distribution calculated in a neutral position of the model correlated well with bone mineral distribution of a healthy vertebra, and verified the model itself. The virtual mechanical loading of a vertebra in kyphotic position concentrated deformation stress into the uncinate processes and the dorsal apophyseal rim of the vertebral body. The simulation of mechanical loading in hyperlordosis, on the other hand, shifted the region of maximum deformation into the articulation process of the Z-joint. All locations are known as areas of osteophyte formation in degenerated cervical vertebrae. DISCUSSION AND CONCLUSIONS The theoretical model developed during this study corresponded well with human spine behaviour in terms of predilection sites for osteodegenerative changes, as observed in clinical practice. A mathematical simulation of mechanical stress distribution in pre-operative planning may lead to the optimisation of post-operative anatomical relationship between adjacent vertebrae. Such improvement in our surgical practice may further reduce the incidence of degenerative changes in adjacent motion segments of the cervical spine and possibly also lead to better subjective and clinical results after cervical spine reconstruction.
Two groups of epigeic arthropods differ in colonising of piedmont quarries: the necessity of multi-taxa and life-history traits approaches in the monitoring studies. Community Ecology 9, 177-184. Tropek R., Konvička M. (2008): Can quarries supplement rare xeric habitats in a piedmont region? Spiders of the Blansky les Mts, Czech Republic.
Vnitřní lékařství, 2020
Interní kardiologická klinika LF MU a FN Brno, pracoviště Bohunice Takotsubo kardiomyopatie, nazývaná také syndrom zlomeného srdce, představuje vzácný typ onemocnění často imitující akutní infarkt myokardu. Jedná se o náhle vzniklou poruchu kinetiky nejčastěji hrotu levé srdeční komory typicky se zachovalou hybností bazálních segmentů srdce. Ta je však na rozdíl od akutního infarktu myokardu ve většině případů plně reverzibilní. V kazuistice popisujeme případ 78leté ženy vstupně vyšetřené pro typické známky akutního infarktu myokardu. Koronarografické vyšetření odhalilo významnou stenózu jedné z hlavních koronárních tepen, ramus interventricularis anterior, nicméně obraz apikální dysfunkce dle ventrikulografie a následný klinický průběh onemocnění vedl k diagnostice Takotsubo kardiomyopatie. V minulosti představoval neobstruktivní až hladkostěnný nález koronárních tepen na koronární angiografii jeden z hlavních diagnostických znaků Takotsubo kardiomyopatie. V minulém roce byla představena nová diagnostická kritéria, která upravují dnešní pohled na diagnózu Takotsubo a výskyt koronární léze již není vylučujícím kritériem pro tento syndrom. Klíčová slova: akutní infarkt myokardu, InterTAK diagnostická kritétia, Takotsubo kardiomyopatie.
2009
Cil: Cilem clanku je objasnit pojmy impakt faktoru a H-indexu a jejich vazby na publikovani a publikujici autory.
On May 24, 2024 I will participate in oral argument before the Bankruptcy Appellate Panel (BAP) for the Ninth Circuit with regards to Agnes Niczyporuk appeals of two decisions by the Bankruptcy Court for the Eastern District of Washington. Yesterday Bill Paatalo, who has appeared on behalf of numerous property owners around the country, published a paper which mentioned her case. That article indicates that the United States’ government has likely been a part of the fraud perpetrated against homeowners by this Nation’s financial industry. Paatalo’s article is titled “The U.S. Government’s Involvement in ‘Foreclosure Genocide Revealed’“ You can also read Paatalo’s article by accessing the PDF version of that article which is attached to this Academia.edu posting. After having been involved in many cases like Nicyporuks for over a decade I have come to believe that the United States government established a scheme which was deliberately designed to unconstitutionally take properties from their owners in order to personally benefit government officials and their wealthy financial industry allies. And now I find myself in a situation where I must decide how to best present those arguments demonstrating those parties’ wrongdoings to those same wrongdoers, who by virtue of their government offices will be required to judge their own or their predecessors’ alleged misconduct in setting up a scheme allowing the government to take Peoples’ properties to benefit office holders and their wealthy allies. In deciding whether to call out the corruption of government officials to those same government officials who assert their right to judge their own conduct I am guided by scripture and my relationship with the Holy Spirit, who guides me now more than ever before. Clearly Jesus recognized that Christians owe allegiance to legitimate human governments when he instructed “[r]ender unto Caesar the things which are Ceasars, and unto God the things that a God’s.” But Jesus never said anything that suggested or implied that Caesar's laws, i.e. the laws of human governments, trumped those spiritual laws established by God. Indeed, Jesus’ actions in removing the money changers from the Temple demonstrates Jesus was not willing to “turn the other cheek” against those who made his Father’s Temple “a hangout for thieves.” And Jesus also made clear that lawyers, scribes, and Pharisees violated God’s laws by their hypocrisy; by taking from those who could not defend themselves against those pious thieves holding official positions. I have concluded that God’s will for me is to present the truth to those hypocrites holding government officials who must judge my clients. This is for me a duty of citizenship in God’s Kingdom, which I have learned to prize far more than my citizenship in the United States, which at this time appears to be ruled by hypocrites.
Journal of Medicine, Nursing & Public Health
European Journal of Mineralogy, 2008
Migraciones centroamericanas en México. Procesos socioespaciales y dinámicas de exclusión, 2022
Boletín de Antropología
New Left Review, 2024
Commerce, Citizenship, and Identity in Legal History, 2021
Twenty-Third Annual Conference of the Cognitive Science Society, 2001
International Journal of Pediatric Endocrinology, 2013
Basic Urological Management, 2018
مطالعات داستانی, 2013
Notulae Botanicae Horti Agrobotanici Cluj-Napoca, 2020
European Journal of Therapeutics
Revista Árvore, 2005
Applied Mathematics and Computation, 2007