Morphology of the Vasculature and Blood Supply of the Brown Adipose Tissue Examined in an Animal Model by Micro-CT.

We performed micro-CT imaging of the vascular blood supply in the interscapular area of the brown adipose tissue in three mice with the use of intravascular contrast agent Aurovist™. Resulting 3D data rendering was then adapted into 2D resolution with visualization using false color system and grayscale images. These were then studied for the automatic quantification of the blood vessel density within this area. We found the highest most occurring density within arterioles or venules representing smaller blood vessels whereas with the increase of the vessel diameters a lower percentage rate of their presence was observed in the sample. Our study shows that micro-CT scanning in combination with Aurovist™ contrast is suitable for anatomical studies of interscapular area of brown adipose tissue blood vessel supply.

Clostridium difficile infection and colonisation in children under 3 years of age: prospective comparative study.

AIMS: Despite an increasing trend in Clostridium difficile infections (CDI) and high C. difficile colonization rate especially among younger children, infants remain quite resistant to the disease. The goals of this study were to distinguish whether there exists a difference in CDI between children with or without diarrhoea, ascertain the prevalence of CDI, and assess CDI severity in children under 3 years with diarrhoea in our institution. METHODS: A prospective study was conducted from May 2015 to June 2016. Children 3 years of age or younger were enrolled and into two groups. Every faecal sample was tested using a diagnostic two-step screening algorithm including an immunochromatographic test and polymerase chain reaction. RESULTS: The study enrolled 147 children with diarrhoea and 75 control patients. The prevalence of CDI in children with diarrhoea was 2% (3/147), the prevalence of toxigenic C. difficile in the diarrhoeal group compared to the control group was 11.6 % (17/147) vs. 10.6% (8/75) (p.

Clinical and microbiological characteristics of Clostridium difficile infection in children hospitalized at the Departement of Paediatric Infectious Diseases in Brno between 2013 and 2017.

AIMS: Clostridium difficile (C. difficile) plays a minor but important role in paediatrics. The aims of this study were to objectivise data, to show their significance in clinical practice, and to present our experience with the treatment of paediatric patients. MATERIALS AND METHODS: A retrospective study was conducted in patients (0-19 years of age) hospitalized for Clostridium difficile infection (CDI) in the Department of Paediatric Infectious Diseases, University Hospital in Brno between 2013 and 2017. Each patient was tested using a two-step diagnostic screening algorithm including immunochromatography and polymerase chain reaction assays. RESULTS: Thirty-five patients with a median age of 10.3 years (range 1-17.5 years) were enrolled in the study. Almost 70% of patients were aged between 6 and 19 years. No risk factor was identified in one patient, 41.6% of cases were patients with malignancy or inflammatory bowel disease, and 2.5% of patients had short bowel syndrome. After targeted CDI treatment, the median time to resolution of diarrhoea was 2.5 days. Metronidazole was used in more than half of cases. Five patients received fidaxomicin, which was well tolerated. Metronidazole failed in three cases. Recurrence after incomplete treatment with metronidazole occurred in one patient. Health care-associated CDI was recorded in 86% of cases. Recurrent CDI was reported in four children (two with malignancy, one with inflammatory bowel dissease, and one with short bowel syndrome). CONCLUSIONS: The course of CDI is generally mild in the paediatric population. CDI without a risk factor is rare. Paediatric patients respond well to metronidazole. Fidaxomicin was well tolerated by all patients. We prefer the treatment with fidaxomicin in high-risk groups (immunocompromised condition, inflammatory bowel disease, and short bowel syndrome).

The year 1848 - a significant turning point in the history of Czech surgery.

INTRODUCTION: The purpose of this study was to highlight the historical importance of the events of the year 1848 for Czech surgery and to provide a brief report on medical dissertations written in Prague between the years 1832 and 1846, focused on the surgical treatment of incarcerated hernias. METHODS: The study was designed as a literary search using original materials of the Archive of Charles University, the National Library of the Czech Republic, and international sources. RESULTS: In the year 1848 surgery became an official part of the university medical curriculum after a long process of integration. We identified and analysed ten medical dissertations on anatomy, diagnosis and treatment of incarcerated hernias, completed in the above mentioned period. CONCLUSION: Our results illustrate both the successful completion of implementation of surgery into the medical curriculum, as well as the ways and the quality of both conservative and surgical treatments of incarcerated hernias between 1832 and 1846.

A plea for extension of the anatomical nomenclature. Part 1: Nervous system and senses.

A correct, exact, concise and detailed anatomical nomenclature is a cornerstone of communication not only in anatomy and related subjects but also in other medical branches and in the whole medical education. Terminologia Anatomica fulfils this task but some important structures are still missing there. The authors have collected and present here a list of terms including their definitions or explanations to provoke discussion about possible extension of the Terminologia Anatomica. The first part of this contribution, presented in this article, comprises 113 terms concerning the regulation systems of the human body: endocrine glands, central and peripheral nervous system, and senses. It also contains some corrections of anatomical mistakes, systemic inconsistencies and grammar changes.

[Conservative and Surgical Treatment for Distal Ulna Fractures Associated with Distal Radius Fractures]. / Konzervativní a operacní lécba zlomenin distální ulny pri soucasné osteosyntéze zlomenin distálního radia.

PURPOSE OF STUDY: Fractures of the distal radius and distal ulna require anatomical reconstruction for good restoration of wrist and hand function. In this study we compared the results of conservative treatment with those of plate osteosynthesis management in distal ulna fractures of patients who had concomitant fractures of the distal radius indicated for plate osteosynthesis. Our objective was to specify indications for plate osteosynthesis of a distal ulna fracture in the case of an associated distal radius fracture. MATERIAL AND METHODS: A total of 27 patients were evaluated. In 17 of them, distal radius fractures were treated by plate osteosynthesis and distal ulna fractures conservatively (CONS group). In 12 patients, both distal radius and distal ulna fractures were treated by plate osteosynthesis (SURG group). Osteosynthesis was carried out using an APTUS variable-angle locking system (Medartis, Basel, Switzerland). In two SURG group patients with distal radioulnar joint (DRUJ) instability, the radius and ulna in anatomical position were secured with two Kirschner wires. RESULTS: Fracture union of the distal radius was achieved in all patients. Non-union of the distal ulna was recorded in one patient of each group. No secondary displacement of distal radius fragments during bone union was found in either group. Displacement of fragments during the healing of distal ulna fracture occurred in one (6.7%) patient of the CONS group. Out of the parameters evaluated, the restriction of motion below 80% of the original range in volar flexion, dorsal flection and supination was recorded in three CONS patients (20.0%) and two SURG patients (16.7%). No DRUJ instability was found. Intra-operative swelling preventing closure of surgical wounds was managed by secondary wound suture in one SURG patient (8.3%). There were no other complications. DISCUSSION: Views vary on whether the distal ulna should be treated by plate osteosynthesis when, after distal radius fixation, its fracture managed by closed reduction heals well. A distal ulna plate often causes pain and has to be removed. The acute cases of DRUJ instability caused by comminuted distal ulna fracture can be treated by osteosynthesis of the distal ulna and two Kirschner wires inserted into the fracture site in an ulnar-to-radial direction. For chronic radioulnar instability, various methods involving free tendon grafts and dynamic tenodesis are used. Other options include the Sauvé-Kapandji procedure based on inducing artificial non-union of the distal ulna diaphysis and radioulnar arthrodesis; in our modification of this technique we use a single cancellous malleolar screw. In severely comminuted fractures of the distal ulna with injury to articular cartilage, ulnar head replacement can be indicated. CONCLUSIONS Distal ulna fractures can be treated conservatively if osteosynthesis of the distal radius in the anatomical position is achieved together with anatomical reduction of bone fragments of the distal ulna. When a distal radius fracture managed by osteosynthesis is not accompanied by anatomical reduction of distal ulna fragments, or the ulna is shorter or longer than the contralateral bone, an open reduction and stabilisation using an angle-stable locking plate, set at an adequate radius-toulna length ratio, is the method of choice.

Mathematical modelling for the comparison of plate and intramedullary osteosynthesis stability in intraarticular distal radius fractures.

BACKGROUND: A comparison between plate and intramedullary osteosynthesis techniques in terms of the biomechanical stability of distal radius fracture fixation. METHODS: Mathematical modelling was used to simulate distal radius fractures, type C1 and type C2, and to compare the stability of osteosynthesis in both techniques under several wrist joint load conditions: axial compressive loading of the radius, bending loads in volar and dorsal flexion and radial and ulnar deviation, and axial torsional loading of the forearm. RESULTS: For both type C1 and type C2 fractures, the stability of intramedullary osteosynthesis was comparable with plate osteosynthesis in dorsal flexion. Plate osteosynthesis proved to be more stable only in ulnar deviation. The intramedullary X-screw technique provided more stability when loads were applied in volar flexion, radial deviation, pronation and supination, and in axial loading of the radius. CONCLUSIONS: The result of mathematical simulations was comparable for both types of fracture. It showed a higher stability of intramedullary osteosynthesis. Although when lower force intensity was applied, both techniques were comparable (Fig. 8, Ref. 16).

The deep venous system of the lower extremity: new nomenclature.

The correct and precise nomenclature of the veins of the lower extremity is a necessary tool for communication. Three important changes have been done over the last 13 years. Terminologia Anatomica, the latest version of the Latin anatomical nomenclature, was published in 1998, extended in the area of the lower extremity veins with two consensus documents, in 2001, during the 14th World Congress of the International Union of Phlebology and in 2004 during the 21st World Congress of the International Union of Angiology. This article is a free continuation of two previous articles, reviewing the detailed anatomy and correct nomenclature of the superficial veins of the lower extremities and veins of pelvis. Now, it is concentrated on the deep venous system, in which 15 new terms have been added in both Latin and English languages.

Achilles tendon: the 305th anniversary of the French priority on the introduction of the famous anatomical eponym.

This article presents a detailed chronology regarding the development of terminology relating to the calcaneal tendon, from ancient times to modern day nomenclature. The notable contributions of Flemish anatomist Philip Verheyen, French surgeon Jean-Louis Petit, German anatomist and surgeon Lorenz Heister, along with the actual origin of the famous anatomical eponym "Achilles tendon" are analysed. During the study of the aforementioned authors, it was revealed that the term was first adopted, in its original French form, by J.-L. Petit in 1705 and later in 1717, in its Latin form, by L. Heister.

[Is there circadian variation of big endothelin and NT-proBNP in patients with severe congestive heart failure?]. / Existuje diurnální variabilita big endotelinu a NT-proBNP u nemorných s tezkým chronickým srdecním selháním?

INTRODUCTION: Circadian rhytmus have long been recognized to occur in many biologic phenomena, including secretion of hormones as well as autonomic nervous system. There is increasing evidence that circadian rhythms have been also found in cardiovascular events, for example, myocardial infarction, sudden cardiac death as well as stroke have shown a circadian pattern of the distribution. The pathophysiology and the mechanism underlying these variations are the focus of much investigation, while i tis not full understood up to date. Heart rate, blood pressure, neurohumoral vasoactive factors, such as plasma norepinephrine levels and renin activity, and probably also contractility are increased in the morning hours. THE AIM OF OUR STUDY: To evaluate the circadian variability of plasma big endothelin and NT-proBNP level in patients with severe heart failure. PATIENTS: 13 patients with severe heart failure, stable for at least one month, male/female--8/5, NYHA III/IV--11/2, mean left ventricle ejection fraction 23 +/- 5%, mean cardiothoracic ratio 59 +/- 7%, all treated with RAAS blocade (11 x ACE-I, 2x ARB), all treated with diuretics, 12 patients treated with beta-blockers, 7 with digoxin. The cause of heart failure was ischemic heart disease (9) or dilated cardiomyopathy (4). METHODS: Blood samples for big endothelin and NT-proBNP were taken every two hours during a standartised daily regime. RESULTS: Mean plasma level of big endothelin (ranging from 1.25 to 1.71 pmol/l) had significant diurnal variability (upper limit of normal values 0.7 pmol/l). Mean plasma level of NT-proBNP (ranging from 782 to 934 pmol/l) had no diurnal variability (upper limit of normal values of 350 pmo/l). SUMMARY: Plasma level of NT-proBNP is stable during 24 hours and shows no circadian variability. Plasma big endothelin showed a morning peak after a systematic increase during bed rest. NT-proBNP could be evaluated any time during the day, big endothelin sample should be taken during standartised condition.

The venous system of the pelvis: new nomenclature.

The clinical venous anatomy of the pelvis and its veins featured a break-through during the past few years. Not only the diagnostic and therapeutical methods but also the knowledge of the functional anatomy and nomenclatures of the veins underwent substantial changes. Eleven years ago, the most recent revision of the Latin anatomical nomenclature, Terminologia Anatomica (TA, 1998) was issued. In 2004, during the 21st World Congress of the International Union of Angiology, a consensus document (under the auspices of Federative International Committee on Anatomical Terminology and International Federation of Associations of Anatomists), reflecting phlebologists' requests for new terms and replacing several insufficient ones, was accepted. Six new terms were added in both Latin and English languages in the chapter concerning the veins of the pelvis. Eponyms are not considered equal synonyms and moreover only one of them was recommended for general use. Detailed anatomy of the veins of the pelvis is discussed. This consensus document will be incorporated in the next version of the Teminologia Anatomica.

[Peroral hormonal contraception and risk of venous thromboembolism]. / Perorální hormonální antikoncepce a riziko vzniku zilního tromboembolizmu.

Oral contraceptives increase the risk of thromboembolism. Recent studies have indicated that the risk of thromboembolic disease in users of combined oral contraceptive pills varies not only with estrogen dose, but also with the type of gestagen in pills with the same estrogen dose. We describe 8 women from our intensive care unit who developed a deep venous thrombosis while on oral contraceptives. The aim of this article is also to discuss other risk factors for the potential risk of venous tromboembolism in users of combined oral contraceptive.

Calcaneus, calcaneal tendon and retrocalcaneal bursa. Historical overview and plea for an accurate terminology.

Diseases and injuries of several specific structures in the heel region have been an enduring focus of medicine: The anatomical terminology of many of these structures has not been established until recently. The aim of the study was a historical analysis of the advances of anatomical terminology of three selected morphological units in the heel region--the Achilles tendon, calcaneus and retrocalcaneal bursa. It starts with a critical evaluation of the mythological eposes, the Illiad and Odyssey, describing the exploits of heroes in the Trojan war, followed by a review of relevant terms used for the designation of selected heel structures in the Middle Ages as well as in the 18" and 19" centuries. Principal versions of Latin anatomical terms used for the denotation of the mentioned structures are discussed. Recently applicable Latin terms and their recommended English synonyms, according to the latest version of Terminologia Anatomica (1998) are summed up. It surveys examples of "not very appropriate" terms, which are frequently used in clinical literature. The authors consider the use of official anatomical terms (both Latin and English) as an important step for the improvement of the clinical expressions and formulations.

The superficial venous system of the lower extremity: new nomenclature.

The phlebology in the area of lower limbs is the only medical field in which the terminological needs of clinicians were met. Ten years ago, the latest revision of the Latin anatomical nomenclature, Terminologia Anatomica (TA), was issued. But almost none of the chapters reflected the clinicians' need to be a relevant theoretical base for correct diagnostics and appropriate treatment. In 2001, during the 14th World Congress of the International Union of Phlebology, a consensus document (under the auspices of Federative International Committee on Anatomical Terminology and International Federation of Associations of Anatomists) was laid to expand the nomenclature of the lower extremity venous system. Some terms have been changed and several new have been added, corresponding to their clinical significance and anatomical positions. Sixteen new terms have been added in both Latin and English languages in the chapter concerning the superficial veins of the lower limb. This consensus document will be incorporated into the next version of the TA. The international anatomical nomenclature serves as a communication base for research, diagnostic, therapy and information exchange in phlebological sciences.

[Recurrent unsustained ventricular tachycardia in pregnancy]. / Rekurentní nesetrvalá komorová tachykardie v tehotenství.

The incidence of arrhythmias in pregnancy is more frequent. Arrhythmias can develop in women withstructural heart disease as well as in healthy population. Palpitations, dizziness, vertigo or syncope are the most common symptoms of arrhythmias. Rarely life threatening arrhythmias requiring acute therapy occur. The treatment of the pregnant patient with cardiac arrhythmias requires important modifications of the standard practice. We describe pregnant patient in 33rd week of pregnancy with new onset of recurrent unsustained ventricular tachycardia, which did not regress after the pharmacological therapy. Patient was indicated to cesarean section, after which the arrhythmias completely regressed.

[Surgeon Josef Hohlbaum--life story]. / Zivotní príbeh profesora Josefa Hohlbauma.

Professor Josef Hohlbaum (*Sept. 6, 1884 in Oberlindewiese, Northern Moravia) studied medicine in Graz, Austria. His main place of work was Leipzig, Germany, where he became an outstanding surgeon and a very good university teacher. Between 1941 and 1945, he was the last chairman of Surgery of the German University in Prague. On May 9, 1945, he was arrested by the Czech police and imprisoned in the internment camp in Klecany. At the end of June 1945, during farming work, his left leg was seriously injuried by an explosive, found by a Czech guard and thrown under Hohlbaums' foot. J. Hohlbaum received first wound treatment and was admitted to the Surgical Department of the Královské Vinohrady Hospital in Prague 10, where he spent 6 weeks. Thereafter, at his request, he was transferred to the German Military Hospital in Prague 5. During the autumn of 1945, he was transferred to Germany, his condition grew more and more worse, and, consequently, his left lower extremity had to be amputated in femore. On December 30, 1945, he died of sepsis in the Surgical department of the Hospital in Markkleeberg, near Leipzig. The authors could not find any evidence that Hohlbaums' professional contemporary, the Czech surgeon professor A. Jirásek, presented a non-ethical attitude to the injured J. Hohlbaum, and that Jirásek refused to treat him, as it has been repeatedly presented in German publications. On the contrary, it is evident from the documents found, that the care he got in Prague--with respect to the difficult circumstances--was lege artis. Hohlbaunt's life thus ended as a consequence of the situation at the end of WWII.

[Hypertension in HIV positive patients]. / Hypertenze u HIV pozitivních pacientu.

Survival of HIV-positive patients on highly active antiretroviral therapy (HAART) has significantly improved. Although traditional heart complications of the infection such as pericarditis or myocarditis has become rather rare owing to the therapy, wide range of metabolic abnormalities have been described. We focused on the evaluation of prevalence of hypertension among HIV positive patients with respect to their high cardiovascular risk. We examined 40 HIV positive patients (28 males and 12 females) followed in AIDS center in Brno. All probands underwent 24-hour ambulatory blood pressure monitoring as a part of their cardiological examination. 40 age- and gender-matched healthy controls were recruited. We evaluated the average value of systolic (SBP) and diastolic (DBP) blood pressure as well as the average value of heart rate (HR) within 24 hours of monitoring. Following values were found in the group of healthy controls: SBP 124.1 +/- 8.6 mm Hg, DBP 71.6 +/- 6.9 mm Hg and HR 67.9 +/- 9.7/min. HIV positive patients presented with the following values: SBP 118.5 +/- 9.3 mm Hg, DBP 76.8 +/- 5.7 mm Hg a HR 78.6 +/- 9.7/min. All the differences were statistically significant at p < 0.05. We diagnosed 14 patients with hypertension defined as SBP higher than 125 mm Hg and/or DBP higher than 80 mm Hg in both of the groups. Prevalence of hypertension in HIV positive patients was comparable to that seen in healthy controls. HIV positive patients had lower SBP but higher DBP and HR.

[Ten years after the latest revision International Anatomical Terminology]. / Deset let nového anatomického názvosloví.

Ten years ago, the latest revision of the Latin anatomical nomenclature was approved and published as Terminologia Anatomica (International Anatomical Terminology), and is acknowledged by the organization uniting national anatomical societies--International Federation of Associations of Anatomists. The authors concentrate on new terms included in the nomenclature and on the linguistic changes of terminology. The most frequent errors done by medical specialists in the usage of the Latin anatomical terminology are emphasized and the situation of eponyms in contemporary anatomy is discussed in detail as well. The last version of the nomenclature makes its way very slowly in the professional community and it is necessary to refer to positive changes and advantages it has brought. The usage of this Latin anatomical nomenclature version is suggested by the International Federation to follow in theoretical and clinical fields of medicine. The authors of the article strongly recommend using the recent revision of the Latin anatomical nomenclature both in the oral and written forms, when educating and publishing.

[Diagnostics of the retrocalcaneal bursitis: possibilities of the use of new anatomical data]. / Diagnostika retrokalkaneárních burzitíd: moznosti vyuzití nových anatomických poznatku.

The anatomy and histology of the normal retrocalcaneal bursa (RB) was studied on both embalmed and fresh cadaverous material. The bursa is a constant structure, its upper and posterior walls are completely covered with the unilayered synovial membrane. Its anterior wall represents the superior facet of the calcaneal tuberosity, the posterior one corresponds to the anterior surface of the insertional part of the Achilles tendon. The superior wall is formed by the adipose tissue of the inferior part of Kager's triangle, extending into the cavity of the bursa in a form of constant large and irregularly shaped synovial fold. The normal anatomical features as well as some pathological changes of the bursa and its neighbourhood were demonstrated on examples of some case reports, by use of the ultrasonography and magnetic resonance investigations. In healthy individuals the space of the bursa was not figured in the ultrasonographic investigations, but was well apparent in the MR images. The pathological changes of the bursa are detectable by using of both methods, but the MR images present substantially precise quality of depiction. The authors recommend the use of presented new anatomical data for the improvement in differential diagnostic of the wide spectrum of achillar enthesopathies.

Clinical anatomy of the retrocalcaneal bursa.

The goal of the study was to perform a detailed anatomical description of the retrocalcaneal bursa (RB). Its morphological arrangement was studied on 10 fresh and 30 embalmed lower extremities by microdissection and light microscopy. The RB was present constantly and in all the cases contained 1-2 cm long synovial fold, beginning on the upper wall of RB and distally interposed between the anterior surface of the Achilles tendon and the posterior surface of the calcaneal tuberosity. The volume of RB was 1-1.5 ml. The histological analysis confirmed that the inner surface of the superior and posterior wall of RB have been covered by unilayered synovial membrane, projecting into synovial villi of different shapes and sizes. In the ceiling of RB, delicate fascicle of skeletal muscle fibers was discovered, radiating distally into the regularly present synovial fold. The whole bottom of RB has been covered by 200-500 microm layer of fibrous cartilage into which the calcaneal tendon attached. The cartilagineous layer continued anteroproximally to cover the whole bursal surface of the calcaneal tuberosity, where the thickness of the cortical bone was reduced on mere 50 microm. The obtained results can be used in the improvement of the differential diagnostics and therapy of diagnostics and therapy of the retrocalcaneal bursitis as well as of other kinds of achillar enthesopathies and heel pain.