Casopís lékar̆ů c̆eských
-
Pelvic ring injuries occur at any age. Most injuries to the pelvis are due to high-energy trauma, these injuries are therefore associated with abdominal, thoracic and head injuries. Unstable disruption of the pelvic ring has been often coupled with massive or life-threatening haemorrhage. ⋯ In the acute period minimally invasive internal fixation with closed reduction should be used (transiliacal internal fixator, iliosacral screws). The open reduction with internal fixation can be performed after stabilization of the general state of health (after about 5 days), pelvic plates and spinopelvic fixation are appropriate for this approach. To recover the patient into normal life, bed rest and rehabilitation follows after surgical treatment.
-
Sepsis is a serious high mortality disease. As regards pathophysiology, it is a systemic inflammatory response to infection. Its timely diagnosis strongly influences mortality. ⋯ The most frequently used sepsis markers in routine clinical diagnostics are C-reactive protein and procalcitonin. The detection of selected cytokines, mediators, and surface markers in immunocompetent cells gives us further chance for improvement of this diagnostics. The methods of calculating gene expression represent a technology with a potential for the discovery of new biomarkers which would improve both diagnostics and therapy in the sense of personalized medicine.
-
Casopís lékar̆ů c̆eských · Jan 2011
Review[Hyperglycemia and its control in the critically ill patient].
In the critically ill patient, hyperglycemia was believed to be a response by the body to a stressful situation. Stress-induced hyperglycemia is the consequence of increased levels of cortisol, cytokines, growth hormones, catecholamines, and glucagon resulting in the stimulation of endogenous glucose production through glycogenolysis and gluconeogenesis as well as other mechanisms including central and peripheral insulin resistance. Among other things, hyperglycemia has an effect on inflammation and function of the myocardium, kidney, central nervous system, and the immune system. ⋯ The large multicenter NICE-SUGAR study in 6,022 patients showed higher 90-day mortality in the group with tight glycemic control. The results of NICE-SUGAR led to revision of the guidelines for glycemic control in the critically, recommending to control glycemia below 10 mmol/l. The aim of this overview is to summarize available data on glycemic control in the critically ill patient.
-
Casopís lékar̆ů c̆eských · Jan 2011
[Deep brain stimulation in movement disorders: a Prague-center experience].
Deep brain stimulation (DBS) in the basal ganglia plays an irreplaceable role in the treatment of Parkinson's disease (PD), essential tremor (ET), and some types of dystonia. Electrodes are typically inserted into the subthalamic nucleus (STN), the internal globus pallidus (GPi) and the ventral intermediate nucleus of the thalamus (VIM). Stimulation of the STN is the main objective in PD, GPi in the treatment of dystonia and PD, and VIM stimulation is effective against tremor. ⋯ Intraoperatively we have succeeded in eliminating rigidity in 95% of cases of PD, and tremor in 93% of cases of ET. The positive effect of stimulation on dystonia appeared in 95% with a latency of weeks. Transitory intraoperative morbidity occurred in 8%, intracranial hemorrhage in 1%, infectious complications in 6%, and problems with hardware in 7%.
-
Casopís lékar̆ů c̆eských · Jan 2011
Case Reports[Problems with placement and using of automated external defibrillators in Czech Republic].
The use of automated external defibrillators improves the survival of adults who suffer from cardiopulmonary arrest. Automated external defibrillators detect ventricular fibrillation with almost perfect sensitivity and specificity. Authors describe the use of automated external defibrillator during cardiopulmonary resuscitation in a patient with sudden cardiac arrest during ice-hockey match. The article reports also the use of automated external defibrillators in children.