Incidence of acute spinal cord injury in the Czech Republic: a prospective epidemiological study 2006-2015.

STUDY DESIGN: A prospective study. OBJECTIVES: Analysis of epidemiological data about acute spinal cord injury (SCI) in the Czech Republic over a period of 10 years (2006-2015). METHODS: A data collection system was implemented in the rehabilitation centres which provides care to patients with acute SCI in the Czech Republic. The recorded variables are as follows: age at time of SCI; gender; cause of injury; neurological level of injury (NLI); and its severity (ASIA Impairment Scale (AIS)). Data from 2006 to 2015 were analysed and trends were determined. RESULTS: The overall number of acute SCI ranges between 250 and 300 cases annually. Two-third of the affected population are males. The average age at time of SCI is 49.1 years. The average incidence of traumatic SCI is 15.5 cases per year and is gradually decreasing. The leading cause of SCI are falls (44.5%), followed by traffic accidents (28.2%) and sports injuries including diving into water (19.7%). The incidence of non-traumatic SCI is 8.6 cases per year on average and has an upward trend. Inflammatory lesions account for 26.7% of cases, tumours account for 20.9%, and vascular related injuries make up 17.7%. The NLI occurs most often in the cervical segments (45.3%). The most frequently occurring lesions are motor incomplete: AIS D (33.3%). CONCLUSION: This study shows a stable occurrence of SCI in the Czech Republic, with cervical and motor incomplete cases being the leading ones. Epidemiological data are needed to improve the care of SCI patients and to promote an active life following it.

Leg raise increases pressure in lower and upper esophageal sphincter among patients with gastroesophageal reflux disease.

The purpose of this study was to determine the relation between posturally increased intra-abdominal pressure and lower/upper esophageal sphincter pressure changes in patients with gastroesophageal reflux disease. We used high resolution manometry to measure pressure changes in lower and upper esophageal sphincter during bilateral leg rise. We also examined whether the rate of lower and upper esophageal sphincter pressure would increase during leg raise differentially in individuals with versus without normal resting pressure. Fifty eight patients with gastroesophageal reflux disease participated in the study. High resolution manometry was performed in relaxed supine position, then lower and upper esophageal sphincter pressure was measured. Finally, the subjects were instructed to keep their legs lifted while performing 90-degree flexion at the hips and knees and the pressure was measured again. Paired t-test and independent samples t-test were used. There was a significant increase in both lower (P < 0.001) and upper esophageal sphincter pressure (P = 0.034) during leg raise compared to the initial resting position. Individuals with initially higher pressure in lower esophageal sphincter (>10 mmHg) exhibited a greater pressure increase during leg raise than those with initially lower pressure (pressure ≤10 mmHg; P = 0.002). Similarly individuals with higher resting upper esophageal sphincter pressure (>44 mmHg) showed a greater pressure increase during leg raise than those with lower resting pressure (≤44 mmHg; P < 0.001). The results illustrate the influence of postural leg activities on intraesophageal pressure in patients with gastroesophageal reflux disease, indicating by means of high resolution manometry that diaphragmatic postural and sphincter function are likely interrelated in this population.

Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment.

The aim was to describe diaphragmatic behavior during postural limb activities and examine the ventilatory and stabilizing functions of the diaphragm. Thirty healthy subjects were examined in the supine position using a dynamic MRI system assessed simultaneously with specialized spirometric readings. The diaphragmatic excursions (DEs) were measured at three diaphragmatic points in the sagittal plane; the diaphragm positions (DPs) as related to a reference horizontal baseline were determined. Measurements were taken during tidal breathing (TB) and isometric flexion of upper or lower extremities against external resistance together with TB. Mean DE in both upper and lower postural limb activities was greater compared with the TB condition (P < 0.05), with the effect greater for lower limb activities. Inspiratory DPs in the upper and lower extremity activities were lower compared with TB alone (P < 0.01). Expiratory DP was lower only for lower extremity activities (P < 0.01). DP was most affected at the apex of the crescent and crural (posterior) portion of the diaphragm. DEs correlated strongly with tidal volume (Vt) in all conditions. Changes in DEs relative to the initial value were minimal for upper and lower extremities but were related to lower values of Vt (P < 0.03). Significant involvement of the diaphragm in the limb postural activities was found. Resulting DEs and DPs differed from the TB conditions, especially in lower extremity activities. The differences between the percent changes of DEs vs. Vt found for lower extremity activities were confirmed by both ventilatory and postural diaphragm recruitment in response to postural demands.

A case of a pathogenic active scar.

Soft tissues follow every movement of bones and joints. Their free movement is essential for normal functioning of the motor system. Scars form mainly in the soft tissues, and if abnormal, or 'active', can interfere with the function of the motor system as well. For diagnosis and treatment the barrier phenomenon is a most useful concept: a pathological barrier restricts movement and does not spring when engaged. After engaging the barrier and waiting, release, relief and normal mobility are obtained. An illustrative case with an active appendectomy scar is presented, with both low back and abdominal pain. Extensive and costly examination were all negative. After diagnosis and treatment of the active scar symptoms were promptly relieved. Diagnosis and treatment of active scars should become part of the physical therapist's approach to the patient's problems.

[Long-term follow-up of the etiology of diarrhea with emphasis on the role of rotaviruses in hospitalized patients at the Infectious Disease Clinic of the Medical School Hospital in Plzen]. / Dlouhodobé sledování etiologie prujmu u hospitalizovaných nemocných na Infekcní klinice Fakultní nemocnice v Plzni se zamerením na uplatnení rotaviru.

During 1986-1994 the etiological structure of diarrhoea in hospitalized patients at the Infectious Diseases Clinic, University Hospital Plzen was analyzed. In children under four years most frequently (in 26%) rotaviruses were involved, in older patients their ratio was lower and the decisive pathogenetic organism were salmonellae. In rotavirus infections the shortest hospitalization period was recorded. These infections were encountered all round the year with a maximum prevalence in the winter months.

[Findings from a prospective study of nosocomial infections from 1985 to 1988 at the Surgical Clinic]. / Nekteré poznatky z prospektivní studie nosokomiálních nákaz v letech 1985-1988 na chirurgické klinice.

During 1985-1988 the authors followed up in a prospective investigation 3240 patients admitted to one of the departments in a Surgical Clinic. In the course of hospitalization 430 (13.3%) patients had at least one infection. Among infections urinary infections predominated which were found in 92% of catheterized patients. As to the aetiology, E. coli was found most frequently. From the whole group 1642 (51%) patients were operated. In the category of clean surgical wounds an early infection was detected in 3.7% of the operated patients; depending on the degree of contamination in the other categories this complication was found in 6.8, 19.5 and 28.0% of the operated patients.

[Clinical and epidemiologic findings in studies of Campylobacter infections]. / Klinické a epidemiologické poznatky ze sledování kampylobakterióz.

During the period between May 1987 and April 1989 from 929 patients hospitalized at the Clinic for Infectious Diseases with acute diarrhoeal disease Campylobacter infection was detected in 10.6%; a bacterial aetiology was confirmed in 29%. The maximum incidence of campylobaterioses was in the summer months, among those affected children aged 1-14 years predominated. Analysis of the course of the disease in children under three years revealed typical high fever and blood in the faeces--in half the patients. Carriership of Campylobaters was short, as a rule 2-3 weeks. In cases reported to the hygiene service in the region contact with animals was reported by half the patients. In particular chickens and smoked meat products were considered a suspect vehicle.

[Clinical and epidemiologic findings from a study of rotavirus infections in hospitalized children]. / Kliniké a epidemiologické poznatky ze sledování rotavirových infekcí u hospitalizovaných detí.

The authors examined in 1986-1988 the aetiology of acute diarrhoea in 323 children hospitalized at the Infectious Diseases Clinic in Plzen. An infectious aetiology was proved in 47.7% of the children, the most frequently detected aetiological agent were rotaviruses which caused 28% of the recorded diseases. Their prevalence culminated in December--May; as to age, children between 7 and 24 months predominated. In 41.1% of the subjects with rotavirus infection respiratory symptoms were present all round the year, in 65.5% children transiently pathological transaminase values were recorded. Of 145 children where by laboratory methods nosocomial intestinal infections were monitored, this infection was contracted by 14 children (9.6%). The most frequent causal agent of these diseases were rotaviruses.