Utility of rotational thromboelastometry in total hip replacement revision surgery (case-control study).

ABSTRACT: Total hip replacement revision surgery is accompanied by significant blood loss. Using rotational thrombelastometry (ROTEM) perioperatively to diagnose coagulopathy may help to provide rapid aimed therapy and thus decrease blood loss and the consumption of transfusion products. The aim of this case-control study was to find out whether point of care using of ROTEM may reduce blood loss and the consumption of blood transfusion products in hip replacement revision surgery.Data were prospectively collected from patients who underwent hip replacement revision surgery in the period 2017 to 2018 when the management of bleeding and coagulopathy was based on the results of ROTEM. Data were compared with a group of historical controls for the period 2015 to 2016 when bleeding and coagulopathy management was not based on ROTEM results. The consumption of blood transfusion products and perioperative blood loss were compared between the groups.The total number of analyzed patients was 90. Forty five patients were analyzed in the ROTEM group and the same number of patients were analyzed in the non-ROTEM group. Significantly decreased perioperative consumption of fresh frozen plasma and packed red blood cells was found in the ROTEM, as well as decreased perioperative blood loss comparing to non-ROTEM group. All data were statistically different with P < .05.Perioperative management of bleeding and coagulopathy based on the results of ROTEM during hip replacement revision surgery seems to help to decrease perioperative blood loss and the consumption of blood transfusion products, especially fresh frozen plasma.

[Disorder of vertebral metastasis]. / Metastatické onemocnení pátere.

The aim of this article is putting near problems of treatment vertebral metastasis to professional public. Because of improving of imagine methods the diagnosis of this disorder is early making and that is way patient benefit of early initiation of adequate therapy. Authors of this paper rate literary studies concerning of therapeutic methods for treatment of vertebral metastasis and comper to their group of patients.

[Problems due to workload after surgical treatment of carpal tunnel syndrome]. / Problematika pracovní záteze po operacním resení syndromu karpálního tunelu.

The authors present a group of patients operated on account of the carpal tunnel syndrome in 1998-2000 at the Neurosurgical department in Pardubice. The group comprised 37 patients. 15 men and 22 women. The main objective of the retrospective investigation was to assess the period of work incapacity and asset of the operation from the aspect to proceed with the usual workload. The authors also tried to evaluate the effect of age, sex, occupation, preoperative clinical and electromyographic finding on the resulting effect of the operation. The period of work incapacity after one operation was 114 days. 84% patients returned to their original job. In 11% it was necessary to enlist in different work and a disability pension was granted to 5% patients. The discussion is focused on the period of work incapacity, enlistment in work, the effect of operation on the patients complaints and the objective finding as regards the lesion of fibres of the median nerve and also on the asset of EMG in the diagnosis and postoperative follow up.

[Repair of traumatic lesions in peripheral nerves--initial experience with laser anastomosis]. / Soucasný stav a perspektivy reparace traumatických lézí periferních nervu--první zkusenosti s laserovou anastomózou.

Experience with conventional repair of peripheral nerves clearly indicates that there is still room for improvement, mainly in so far as functional results are concerned. It appears that the present microtechnique has reached its limitation given by physical and technological means, materials and methodology. The use of CO2 laser was tried on rat sciatic nerve. An equal number of nerves were severed surgically and sutured, using microsuture technique in one group and the same number of nerves were repaired using the CO2 laser technique. For the setting of the parameters, optimal for our purpose of reuniting the tissues, we have utilised morphological and electrophysiological qualitative and quantitative characteristics. The results were assessed by comparing both functionally and morphologically, the functional comparison being made electrophysiologically and the morphological comparison microscopically and morphometrically. The comparison shows a larger degree of scarring and constriction of the nerves anastomosed by classical microsuture than that of the laser technique. Action potentials going through the anastomosis have been noticed in both groups without significant difference in quality of CMAP, with the exception the latency.

[Repair of traumatic lesions in peripheral nerves--introduction]. / Soucasný stav a perspektivy reparace traumatických lézí periferních nervu--úvod do problematiky.

The reconstruction of traumatic lesions of peripheral nerves (PN) underwent the most significant improvement with the introduction of operating microscopes, microsurgical techniques and pertinent instruments, including microsutures. New information with respect to the pathophysiology of the degeneration and regeneration of peripheral nerves on a subcellular level also helped in the delineation of the rules and timing of optimal conditions for suturing. The present microtechnique seems to have reached its plateau with regard to capacity of available materials, technology and methodology. Despite this progress there is room for further improvement as addressed in this presentation. In this part of our work we would like to present a survey and analysis of the necessary theoretical knowledge of the basis of degeneration of a traumatized peripheral nerve at the level of molecular changes, as well as to indicate new technologies and materials. A detailed comparison of the classical method (microsuture) with the new technology (laser) has so far failed to demonstrate any significant difference. Therefore it appears necessary, when seeking advantages of the new methodology, to examine its application and not its quality, which will be the subject of the second part our work.