Preoperative staging of ovarian cancer: comparison between ultrasound, CT and whole-body diffusion-weighted MRI (ISAAC study).

OBJECTIVES: To compare the performance of transvaginal and transabdominal ultrasound with that of the first-line staging method (contrast-enhanced computed tomography (CT)) and a novel technique, whole-body magnetic resonance imaging with diffusion-weighted sequence (WB-DWI/MRI), in the assessment of peritoneal involvement (carcinomatosis), lymph-node staging and prediction of non-resectability in patients with suspected ovarian cancer. METHODS: Between March 2016 and October 2017, all consecutive patients with suspicion of ovarian cancer and surgery planned at a gynecological oncology center underwent preoperative staging and prediction of non-resectability with ultrasound, CT and WB-DWI/MRI. The evaluation followed a single, predefined protocol, assessing peritoneal spread at 19 sites and lymph-node metastasis at eight sites. The prediction of non-resectability was based on abdominal markers. Findings were compared to the reference standard (surgical findings and outcome and histopathological evaluation). RESULTS: Sixty-seven patients with confirmed ovarian cancer were analyzed. Among them, 51 (76%) had advanced-stage and 16 (24%) had early-stage ovarian cancer. Diagnostic laparoscopy only was performed in 16% (11/67) of the cases and laparotomy in 84% (56/67), with no residual disease at the end of surgery in 68% (38/56), residual disease ≤ 1 cm in 16% (9/56) and residual disease > 1 cm in 16% (9/56). Ultrasound and WB-DWI/MRI performed better than did CT in the assessment of overall peritoneal carcinomatosis (area under the receiver-operating-characteristics curve (AUC), 0.87, 0.86 and 0.77, respectively). Ultrasound was not inferior to CT (P = 0.002). For assessment of retroperitoneal lymph-node staging (AUC, 0.72-0.76) and prediction of non-resectability in the abdomen (AUC, 0.74-0.80), all three methods performed similarly. In general, ultrasound had higher or identical specificity to WB-DWI/MRI and CT at each of the 19 peritoneal sites evaluated, but lower or equal sensitivity in the abdomen. Compared with WB-DWI/MRI and CT, transvaginal ultrasound had higher accuracy (94% vs 91% and 85%, respectively) and sensitivity (94% vs 91% and 89%, respectively) in the detection of carcinomatosis in the pelvis. Better accuracy and sensitivity of ultrasound (93% and 100%) than WB-DWI/MRI (83% and 75%) and CT (84% and 88%) in the evaluation of deep rectosigmoid wall infiltration, in particular, supports the potential role of ultrasound in planning rectosigmoid resection. In contrast, for the bowel serosal and mesenterial assessment, abdominal ultrasound had the lowest accuracy (70%, 78% and 79%, respectively) and sensitivity (42%, 65% and 65%, respectively). CONCLUSIONS: This is the first prospective study to document that, in experienced hands, ultrasound may be an alternative to WB-DWI/MRI and CT in ovarian cancer staging, including peritoneal and lymph-node evaluation and prediction of non-resectability based on abdominal markers of non-resectability. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

A case report of acute apendicitis in puerperium.

OBJECTIVE: This article stresses an impact of appropriate management work up in the diagnosis of acute apendicitis in puerperium. Atypical clinical symptoms may cause doubts in diagnosis and may delay necessary surgical intervention. DESIGN: Case report. SETTINGS: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, and Hospital Na Bulovce, Prague. METHODS: We present a case report describing an atypical presentation of acute apendicitis in early puerperium. Due to atypical course of the disease and atypical imaging locality and morphology, there were doubts about the diagnosis of acute apendicitis, patient was treated conservativelly and the disease later resulted in extensive surgical intervention. CONCLUSION: Acute appendicitis is the most common cause of non-urogenital morbidity in puerperium. Management of work up and timing of surgical intervention have key impact on maternal mortality and morbidity.

Utility of cardiac CT for evaluating delayed contrast enhancement in dilated cardiomyopathy.

BACKGROUND: The presence of myocardial fibrosis is associated with adverse outcome in dilated cardiomyopathy (DCM). Delayed contrast-enhanced cardiac magnetic resonance (DE-CMR) currently represents the gold standard in noninvasive evaluation of myocardial scarring. However, a significant number of patients are unable to undergo DE-CMR study for various reasons. We sought to determine the diagnostic accuracy of cardiac CT (CCT) compared with CMR in the investigation of the presence of delayed contrast enhancement (DCE) in subjects with DCM. METHODS: We prospectively enrolled 17 consecutive patients with DCM, who were initially referred to our institution because of recently manifested heart failure due to unexplained left ventricular systolic dysfunction. In all subjects, CCT and DE-CMR were performed within 1 week. RESULTS: CCT and DE-CMR showed satisfactory agreement in detecting DCE (agreement in 82% cases, κ = 0.56) with 50% sensitivity, 100% specificity, and a positive predictive value of 100%. CONCLUSION: CCT may be a valuable method for detecting DCE in patients with DCM. CCT thus might be considered as an alternative method to DE-CMR in the assessment of the presence and extent of myocardial fibrosis in subjects who are not suitable for DE-CMR examination.

[History of thoracic stabilization]. / Historie stabilizace hrudního kose.

The authors found 220 reports focused on the treatment of chest trauma in available literature. From external fixations, the development of methods continued to internal fixations with sophisticated plates and screws. At the same time, the so-called pneumatic internal fixation (artificial lung ventilation) was abandoned for the benefit of osteosynthetic methods (ORIF). An active surgical approach to thoracic stabilization dates back to the beginning of the 20th century. After WWII the so-called period of the first renaissance began with the introduction of internal osteosynthesis. The period of the last ten years is called the second renaissance. Today, an active early complex surgical solution is preferred, which uses implants based on the principle of stable osteosynthesis.Key words: stabilisation of the thorax external fixation ORIF pneumatic internal fixation timing.

Exosome-associated AAV vector as a robust and convenient neuroscience tool.

Adeno-associated virus (AAV) vectors are showing promise in gene therapy trials and have proven to be extremely efficient biological tools in basic neuroscience research. One major limitation to their widespread use in the neuroscience laboratory is the cost, labor, skill and time-intense purification process of AAV. We have recently shown that AAV can associate with exosomes (exo-AAV) when the vector is isolated from conditioned media of producer cells, and the exo-AAV is more resistant to neutralizing anti-AAV antibodies compared with standard AAV. Here, we demonstrate that simple pelleting of exo-AAV from media via ultracentrifugation results in high-titer vector preparations capable of efficient transduction of central nervous system (CNS) cells after systemic injection in mice. We observed that exo-AAV is more efficient at gene delivery to the brain at low vector doses relative to conventional AAV, even when derived from a serotype that does not normally efficiently cross the blood-brain barrier. Similar cell types were transduced by exo-AAV and conventionally purified vector. Importantly, no cellular toxicity was noted in exo-AAV-transduced cells. We demonstrated the utility and robustness of exo-AAV-mediated gene delivery by detecting direct GFP fluorescence after systemic injection, allowing three-dimensional reconstruction of transduced Purkinje cells in the cerebellum using ex vivo serial two-photon tomography. The ease of isolation combined with the high efficiency of transgene expression in the CNS, may enable the widespread use of exo-AAV as a neuroscience research tool. Furthermore, the ability of exo-AAV to evade neutralizing antibodies while still transducing CNS after peripheral delivery is clinically relevant.

[Effect of Negative Pressure Wound Therapy on Infectious Complications in Grade III Open Fractures]. / Primární aplikace podtlakové terapie u otevrených zlomenin III. stupne a její vliv na vznik infekcních komplikací.

UNLABELLED: PURPOSE OF THE STUDY Grade III open fractures are associated with infectious complications in 25-66% of injuries. Negative pressure wound therapy (NPWT) applied to an injured soft tissue coverage provides an impermeable barrier between the injured structures and the external environment, in addition to early secretion draining and a positive effect on the site of application. All this also prevents secondary bacterial contamination. The objective of the study was to compare the results of treatment methods in view of infectious complications in patients with soft tissue injury in grade-III open fractures managed either by NPWT and primary closure or by covering with combined dressing fabric (COM) in combination with continual wound lavage. MATERIAL AND METHODS This retrospective study comprised 77 patients with 80 grade III open fractures treated in the years 2008-2012; of these, 39 patients with 41 fractures met the inclusion criteria and were finally evaluated. The patients were divided into two groups. The control group included 19 patients with 20 fractures treated by the standard surgical procedure using stabilisation with an external fixator or intramedullary nail, thorough soft tissue debridement, continual wound lavage and suture of skin lesions or using a primary coverage of the defect with COM. The trial group consisted of 20 patients with 21 fractures treated according to the same principle, but NPWT was applied to injured soft tissue coverage first and skin suture or any other type of skin defect coverage was carried out when the healing process was good and bacteriological findings were negative. The results of both methods were evaluated based on the following criteria: development of superficial or deep infection in the wound, interval to negative bacteriological findings and osteomyelitis rate. The results were analysed by Fisher's exact test and the Man Whitney U test. RESULTS Infectious complications were recorded in a total of 15 (37%) fractures: 11 (55%) in the control group and four (19.1%) in the trial group (p = 0.025). Recurrent infection was observed in five control group fractures (25%) and in none of the trial group fractures (p = 0.021). Osteomyelitis was found only in two control group fractures. The average interval before negative bacteriological results were obtained was 22 days in the control group and 12 days in the trial group (p = 0.001). DISCUSSION The NPWT use as a temporary coverage of soft tissue defects in open fractures results in a significant reduction of infectious complications, as shown by many relevant studies including this study. In comparison with Gopal's "fix and flap" concept, the NPWT in our patient group had slightly higher incidence of infectious complications (15.4% versus 19.1%). However, these results can be achieved only if a specialist in reconstructive surgery and appropriate technical facilities are readily available. If this is not possible, then the NPWT, in comparison with conventional methods, provides the best possible way of temporary protection for an injured soft tissue coverage. CONCLUSIONS Application of NPWT within the primary treatment of injured soft tissue coverage in grade III open fractures results in a statistically significant reduction of bacterial contamination at the site of injury, as well as a reduction of the subsequent incidence of infectious complications. Primary application of NPWT also significantly reduced the risk of recurrent infection. KEY WORDS: open fracture, negative pressure wound therapy, continual wound lavage, infection.

[Does an Independent Predictor of In-Hospital Mortality Exist for Patients with Isolated Proximal Femoral Fracture? A Retrospective Two-Year Observational Study]. / Existuje nezávislý prediktor nemocnicní smrtnosti pacientu s izolovanou frakturou proximálního konce femuru? Retrospektivní dvouletá observacní studie.

PURPOSE OF THE STUDY: The primary objective of the study was to find out in-hospital mortality in patients undergoing surgery for proximal femoral fracture. The secondary objective was to identify independent predictors of in-hospital mortality. MATERIAL AND METHODS: A retrospective single-centre observational study PROXIMORT of patients operated on for isolated proximal femoral fracture at the University Hospital (FN) Brno in the years 2011 and 2012. The 30-day and overall one-year mortality in the study group and the impact of observed parameters on mortality were also assessed. The observed parameters were: patient age and sex, ASA score, time from injury to surgery (hr), daily (7-20 hr) or night (20-7 hr) time of surgery, type of anaesthesia (general vs spinal), initial haemoglobin and haematocrit levels, intra-operative administration of blood products and vasopressors, and erudition of the anaesthesiologist and surgeon. To evaluate the relationship of in-hospital mortality to the observed characteristics, we used univariate logistic regression modelling and odds ratio, using SPSS 22 software (IBM, USA). RESULTS: Data were obtained from 414 patients and 369 patients were included (male, n = 91; female, n = 278). Due to exclusion criteria, 45 patients were excluded (not an isolated injury). In-hospital mortality was 6.5% (n = 24), 30-day mortality was 8.4% (n = 31) and total mortality of the study group was 35.8% (n = 132). Statistically significant effects on in-hospital mortality included: older age of the patient (p = 0.013), ASA score of 3 or more (p = 0.002) and general anaesthesia administration (p = 0.043). For 30-day mortality, this was older age (p = 0.012), ASA score of 3 and more (p < 0.001), general anaesthesia administration (p < 0.001), lower weight (p = 0.028), lower BMI (p = 0.006) and intra-operative administration of vasopressors (p = 0.023). The influence of other observed parameters on post-operative mortality was not statistically significant. DISCUSSION: In-hospital mortality in the PROXIMORT study was 6.5% (95% confidence interval (CI) 4.2 to 9.5%), which was significantly higher than in-hospital mortality in unselected surgically treated patients in the Czech Republic, as reported in the EuSOS study (2.3% with 95% CI 0.9 to 3.7%). Administration of general anaesthesia was determined as an independent predictor of in-hospital and 30-day mortality, which was concordant with the results of meta-analysis published by Rodgers et al. and Barbosa et al in 2013. Postponing surgery for perioperative optimisation had no effect on mortality according to the PROXIMORT study. Patorn et al. have supported this conclusion by the results of a selected group of patients with surgery delayed for more than 24 hours; the patients mortality, regardless of anaesthesia, was up to 2.5%. CONCLUSIONS: The PROXIMORT study identified the higher patient age, ASA score of 3 and more and general anaesthesia administration as independent predictors of in-hospital mortality.

[Treatment for volume upgrading of the low-grade supratentorial glioma after the subtotal neurosurgical resection]. / Lécba nízkostupnového gliomu supratentoriální oblasti mozku po neurochirurgické subtotální resekci s projevy objemového up-gradingu.

BACKGROUND: Low-grade gliomas WHO II (LGG) are mostly detected in patients with neurological symptomatology between 20 and 45 years of age very often as secondary epilepsy. We present two cases in which low-grade gliomas attacked neurological zones. Neurosurgical resection was subtotal because of the risk of the damage in neurocognitive functions in both these patients. After the operation, both patients were followed at neurosurgery department in regular intervals using different imaging methods (MRI, MRS and PET). After resections, the MRI detected the enlargement of the volumes of the tumor residua in both patients. PATIENTS AND METHODS: Owing to the risk of up-grading to high-grades glial tumors (overexpression of EGFR and VEGF), both patients were indicated for curative treatment by external beam radiotherapy combined with chemotherapy (Temodal®) and adjuvant chemotherapy. RESULTS: After the end of this treatment, the MRI proved considerable partial regressions in both patients. Moreover, three months later, the MRI did not prove any residual disease. CONCLUSION: Radiotherapy combined with the administration of Temodal should prolong the OS and TTP in patients with a high risk of up-grading of low-grade gliomas of the brain. Both the patients are in a follow-up program, also because of the risk of duplicite brain tumor.

[The NanoKnife and two successful cases of intracavitary irreversible electroporation of main bronchus tumours]. / NanoKnife a dva úspesné prípady intrakavitální ireverzibilní elektroporatizace nádoru hlavního bronchu.

We have used the method of irreversible electroporation (IRE) twice to treat central non-small cell lung tumours. Both tumours obstructed the right main stem bronchus. Due to a high risk of right-sided pneumonectomy we chose to apply the tissue sparing device called NanoKnife and an alternative IRE method. The first surgery was performed in August 2011 and the second one in June 2012. The first case was an epidermoid carcinoma, 3 cm in size, which completely obstructed the right main stem bronchus on the boundary line with the upper lobar bronchus and caused lung atelectasis. The second case was a carcinoid, 2 cm in size, which grew from the main stem bronchus to the carina. Pneumonectomy was contraindicated due to lung function in the first case, and the other patient preferred the IRE method to radical but risky resection with bronchoplasty. IRE was performed through open thoracotomy. No complications were detected after the surgery in both cases. The first patient was discharged on the 12th postoperative day and the second one on the 5th postoperative day. 98% regression of the tumour was detected by CT scan in the first patient, and complete regression occurred in the case of the second one. 100% apoptosis and "disparition" of the carcinoma in the first case was verified by bronchoscopy and cytology after 6 months. Both patients remain in follow-up after surgery using the IRE method and are without subjective or objective complaints and without any signs of tumour recurrence. NanoKnife and IRE without lung resection resulted in the destruction of lung tumours while preserving the lung parenchyma and pulmonary functions.

[Early suture versus ligamentoplasty of scapholunate ligament injury: comparison of clinical results]. / Casná sutura versus ligamentoplastika léze skafolunátního vazu - srovnání klinických výsledku

PURPOSE OF THE STUDY: The aim was to evaluate subjective and objective criteria of wrist, hand and arm function in a group of patients with acute static scapholunate dissociation treated by acute suture or ligament reinsertion, and in a group of patients with chronic static scapholunate dissociation treated by ligament reconstruction using ligamentoplasty. MATERIAL AND METHODS: Of a total number of 70 patients treated surgically for scapholunate instability at the Department of Trauma Surgery, University Hospital in Olomouc and the Department of Trauma Surgery, University Hospital in Brno, from 2002 till the end of 2008, 37 patients with acute or chronic static scapholunate dissociation treated by suture, ligament reinsertion or ligamentoplasty were selected. Of them, 17 patients with chronic scapholunate dissociation and 10 patients with acute scapholunate dissociation appeared at the final follow-up. The assessment of subjective criteria was based on the Disabilities of the Arm, Shoulder and Hand Score, the Wrightington Wrist Function Score and the Visual Analogue Scale. The objective criteria included range of motion and grip strength, and radiographic parameters, such as scapholunate gap and scapholunate and scaphocapitate angles. Satisfaction of the patients and their return to work were also evaluated. The results were statistically analysed using the Chi-square, Mann-Whitney-U and Wilcoxon tests, with the level of significance a=0.05. RESULTS: In the group with acute static scapholunate dissociation, the objective criteria showed an improved range of flexion- extension. The range of radial and ulnar bending and grip strength were almost identical with those of the healthy wrist. In both evaluated groups the self-rated criteria had almost the same values in all three rating systems used. No statistically significant difference in any of the values compared was recorded. DISCUSSION: The results of subjective and objective assessments were comparable in the two groups. Paradoxically, some items of the subjective evaluation were better in the patients undergoing ligament reconstruction - ligamentoplasty. This can probably be explained by different subjective comparison of pre- and post-operative conditions in each group. Even though the subjective assessment was almost identical in both groups, we definitely find an advantage in acute treatment of a scapholunate ligament tear by suture. A technically easier procedure, a shorter period of restricted hand and arm function for the patient, no degenerative changes due to instability and a lower risk of complications - they all give support to this technique. Later conversion to another type of stabilisation if ligamentoplasty fails may bring problems and give much worse results than a failure of acute sutures CONCLUSIONS: An acute operative treatment of scapholunate ligament injury is regarded as a more suitable method for scapholunate dissociation. Ligamentoplasty, because of technical demands and risk of post-operative complications, can be used as a method of choice if the acute sutures of a torn scapholunate ligament fail or scapholunate dissociation is diagnosed at a late stage.

RESULTS OF 15 YEARS OF COLLABORATION BETWEEN THE DEPARTMENTS OF OPHTHALMOLOGY AND STOMATOLOGY IN ONCOLOGICAL SURGERY OF THE ORBIT: A DIAGNOSTIC AND THERAPEUTIC APPROACH.

AIM: To report an overview of the most frequent tumors of the orbit, suggest diagnostic approach and possible solution according to experience with own cohort of patients. MATERIAL AND METHODS: From patients files from the Department of Ophthalmology and Department of Stomatology, First Medical Faculty, Charles University, and General Faculty Hospital in Prague, Czech Republic, there were selected patients, who underwent the surgery due to the suspicion of malignant development in the orbit during the period 2005 - 2019. From the surgical records we found information about 497 cases. At the Department of Stomatology, there were 282 surgeries under general anesthesia performed, and at the Department of Ophthalmology, there were 215 surgeries, mostly under local anesthesia performed. RESULTS: The number of surgeries in men and women was equal; patients of all ages were present. The median of patients age operated on at the Department of Stomatology was 53 years, and at the Department of Ophthalmology 63 years. The most common primary benign tumor was the cavernous hemangioma (9 %), the most common non-tumorous expansion was the dermoid cyst (7 %); the most common malignant tumor was the lymphoma (17,5 %). The last mentioned tumor was the most common diagnosis in the whole cohort as well. CONCLUSION: Our cohort of patients is comparable with large cohorts published in the literature concerning age and gender distributions. Differences in frequencies of some lesions may be explained by that our cohort includes patients after the surgery only. The malignant lymphoma is the most common diagnosis indicated to surgical procedure, mostly biopsy. Comparing the two cohorts from our departments 20 years apart, the malignant lymphoma remains the most common indication for surgery, but the incidence of adenomas and adenocarcinomas of the lacrimal gland decreased. It is not the goal of this paper to evaluate all possible orbital affections. Suggested surgical approaches are just recommendations according to years of experience; however, in some situations, to choose an individual surgical approach is necessary.

Optimized Kalpha x-ray flashes from femtosecond-laser-irradiated foils.

We investigate the generation of ultrashort Kalpha pulses from plasmas produced by intense femtosecond p-polarized laser pulses on Copper and Titanium targets. Particular attention is given to the interplay between the angle of incidence of the laser beam on the target and a controlled prepulse. It is observed experimentally that the Kalpha yield can be optimized for correspondingly different prepulse and plasma scale-length conditions. For steep electron-density gradients, maximum yields can be achieved at larger angles. For somewhat expanded plasmas expected in the case of laser pulses with a relatively poor contrast, the Kalpha yield can be enhanced by using a near-normal-incidence geometry. For a certain scale-length range (between 0.1 and 1 times a laser wavelength) the optimized yield is scale-length independent. Physically this situation arises because of the strong dependence of collisionless absorption mechanisms-in particular resonance absorption-on the angle of incidence and the plasma scale length, giving scope to optimize absorption and hence the Kalpha yield. This qualitative description is supported by calculations based on the classical resonance absorption mechanism and by particle-in-cell simulations. Finally, the latter simulations also show that even for initially steep gradients, a rapid profile expansion occurs at oblique angles in which ions are pulled back toward the laser by hot electrons circulating at the front of the target. The corresponding enhancement in Kalpha yield under these conditions seen in the present experiment represents strong evidence for this suprathermal shelf formation effect.

[The Czech Republic Register of Injuries (URCR)--experience with the database management in the Brno Faculty Hospital]. / Urazový registr Ceské republiky--zkusenosti s vedením databáze ve FN Brno.

INTRODUCTION: Injuries are the leading cause of mortality in age group of people junior to 45 years. Central data collection is important to survey basic injury causation and trauma care quality. The Czech Trauma Registry was started in 2004. The aim of study was to discover valid statistic analysis from current data collection and its clinical practice contribution. PATIENTS AND METHODS: Doctors working in the Centre of trauma care (University hospital Brno) collect and enter data to the Trauma Registry. Data collection is practiced continuously through the hospitalization. Abbreviated Injury Scale and Injury Severity Score are used for injury severity determining. In the University hospital Brno 161 patients (159 patients met validity criterion) were entered in trauma registry. RESULTS: 159 patients were evaluated, Injury Severity Score was 16-75, demographically from 6 regions. Traffic accident was the most frequent cause of injury. Average inpatient age was 43 years. Mortality in our patient file was 10.7%. Investing sum for 1 patient who was returned to Trauma Registry was 209 019 Czech crowns. DISCUSSION: Authors confront their results with the German Trauma Registry, results in basic parameters are analogous. Data collection should be proceeding correctly. Czech Trauma Registry should be the instrument of quality management and is waiting for its statutory provision. CONCLUSION: Trauma registry is going to afford plenty information for pre-hospital and hospital care improvement.

ANALYSIS OF BAROREFLEX FUNCTION BY MEANS OF MATHEMATICAL MODEL.

Re-evaluation of all functions of baroreflex by means of a simple mathematical model of circulation was the aim of the present study. The following states are modelled: 1. Rest. 2. Immediately after baroreceptor denervation. 3. Several days after denervation. 4. Physical exercise before denervation. 5. Physical exercise several days after denervation. Despite the same cardiac contractility and the same vasodilatation in working muscles as before denervation the cardiac output is by one third lower after baroreceptor denervation. In conclusion, a model simulation revealed the common regulation of blood pressure and blood volume by baroreflex and kidneys as a primary function of baroreflex.

THE RELATIONSHIP BETWEEN CIRCADIAN BLOOD PRESSURE VARIATION AND AGE ANALYSED FROM 7-DAY MONITORING.

The relationship between age and circadian blood pressure (BP) variation was the aim of the present study. One hundred and eighty-seven subjects (130 males, 57 females), 20-77 years old, were recruited for seven-day BP monitoring. Colin medical instruments (Komaki, Japan) were used for ambulatory BP monitoring (oscillation method, 30-minute interval between measurements). A sinusoidal curve was fitted (minimum square method) and the mean value and amplitude of the curve (double amplitude corresponds to the night-day difference) were evaluated on every day of monitoring. The average 7-day values of the mean (M) and of double amplitude (2A) for systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) were determined in each subject. The mean values of M (+/-SD) for the whole group were: SBP- 127+/-8, DBP - 79+/-6 mmHg, HR - 70+/-6 bpm; of 2A: SBP - 21+/-7, DBP - 15+/-5 mmHg, HR - 15+/-6 bpm. A linear relationship between M of SBP and age (r=0.341, p< 0.001) and DBP and age (r=0.384, p<0.001) was found (difference between 20 and 77 years: SBP - 16, DBP - 12 mmHg). 2A of SBP and DBP was increasing with age up to 35 years, then the curve remained relatively flat up to 55 years (maximum at 45 years), and then it decreased again (difference between 45 and 77 years: SBP - 13mmHg, DBP - 12 mmHg). Heart rate M and 2A were age-independent. The mean values of SBP and DBP were increasing with age up to 75 years, but the night-day difference of SBP and DBP reached its maximum value at 45 years and then decreased.

[Vascularization of the lateral heel in relation to extensive skin incisions in osteosynthesis of calcaneal fractures]. / Vaskularizace laterální strany paty ve vztahu k extenzivnímu koznímu rezu k osteosyntéze zlomeniny kalkanea.

The aim of the study was to document soft tissue vascularization of the lateral heel on cadavers and, therefore, to indirectly demonstrate the importance to perform perfectly precise incisions, in order to prevent ischemic complications. Sections of 8 human lower limb cadavers were performed in cooperation with the Anatomical Institute of the MU Medical Faculty in Brno, according to current common standards for anatomical preparations. In successive steps, cutaneous and subcutanous covers of the lateral ankle, malleolar and heel regions were preparated. Final branches of the individual arteries were followed and the authors aimed to demonstrate their vascular arcade consisting of anastomosis of the lateral calcaneal artery--LCA (a branch of a. peronea)--which is a clinical term for rami calcaneares laterales, ventrolateral tarsal arteries--LTA (a branch of a. dorsalis pedis) and lateral malleolar artery branching off medially--LMA (a branch of a. tibialis ant.). The course of the arteries and their location is related to a reference point--a lateral tip of the lateral ankle. The investigators found out that all three arteries, as well as the arterial arch, had standard courses. The course of the arch defines the outline of the lateral extensive incision during osteosynthesis in calcaneal fractures, which lies fairly close to the lateral outline of this vascular arcade. Incorrect performance of the incision results, invitably, in serious ischemic complications. Open reduction and internal fixation of intraarticular calcaneal fractures has become a standard surgical method. Correct indication, good timing and saving open reduction, internal fixation using arthroscopy and early mobilization are the prerequisites to prevent further postoperative complications and to achieve complete healing of the fracture. Considering the demandingness of these fractures treatment and their rare incidence, their management should be centred in specialized traumatological clinics.

Thalamic Iron Differentiates Primary-Progressive and Relapsing-Remitting Multiple Sclerosis.

BACKGROUND AND PURPOSE: Potential differences between primary progressive and relapsing remitting multiple sclerosis are the subject of ongoing controversial discussions. The aim of this work was to determine whether and how primary-progressive and relapsing-remitting multiple sclerosis subtypes differ regarding conventional MR imaging parameters, cerebral iron deposits, and their association with clinical status. MATERIALS AND METHODS: We analyzed 24 patients with primary-progressive MS, 80 with relapsing-remitting MS, and 20 healthy controls with 1.5T MR imaging for assessment of the conventional quantitative parameters: T2 lesion load, T1 lesion load, brain parenchymal fraction, and corpus callosum volume. Quantitative susceptibility mapping was performed to estimate iron concentration in the deep gray matter. RESULTS: Decreased susceptibility within the thalamus in relapsing-remitting MS compared with primary-progressive MS was the only significant MR imaging difference between these MS subtypes. In the relapsing-remitting MS subgroup, the Expanded Disability Status Scale score was positively associated with conventional parameters reflecting white matter lesions and brain atrophy and with iron in the putamen and caudate nucleus. A positive association with putaminal iron and the Expanded Disability Status Scale score was found in primary-progressive MS. CONCLUSIONS: Susceptibility in the thalamus might provide additional support for the differentiation between primary-progressive and relapsing-remitting MS. That the Expanded Disability Status Scale score was associated with conventional MR imaging parameters and iron concentrations in several deep gray matter regions in relapsing-remitting MS, while only a weak association with putaminal iron was observed in primary-progressive MS suggests different driving forces of disability in these MS subtypes.

Electron microscopic analysis of lymph node cellular activity in Hodgkin's disease.

Five hundred and two cells, selected at random within the pretreatment-involved lymph nodes of patients with the nodular sclerosis type of Hodgkin's disease, were analyzed by electron microscopy for in vivo subcellular activity and intercellular interaction. Subpopulations of neoplastic cells and of lymphocytes were recognized by ultrastructural criteria. Neoplastic cells displayed definite sequences of cell maturation, whereas lymphocytes displayed definite sequences of cell activation. Active lymphocytes were most often found apposed to the more active of the neoplastic cells, and the nuclei of such apposed lymphocytes displayed a progressive preferential asymmetry of distribution of active DNA templates into that half of the lymphocyte nucleus closest to the neoplastic cell. Such close apposition of active polysomal lymphocytes to neoplastic cells may correlate with increased patient survival in Hodgkin's disease.