Maisonneuve ankle fracture.

Maisonneuve fracture (MF) is defined as an ankle fracture-dislocation associated always with a fracture of the proximal quarter of the fibula and rupture of the anterior and interosseous tibiofibular ligaments. Other injuries are variable. Recent CT studies have demonstrated that MF is a far more complex injury than initially supposed. Therefore it is necessary to change substantially the current concepts related to this issue. MF is combined in about 80% of cases with a fracture of the posterior malleolus and also with malposition of the distal fibula in the fibular notch. An exact assessment of these injuries requires post-injury CT examination which should be used as a standard in MFs. The main goal of treatment is anatomical reduction of the distal fibula into the fibular notch. In case of avulsion of a larger fragment of the posterior malleolus, it is necessary to perform as the first step its reduction and fixation from the posterolateral approach and thus restore integrity of the notch. Closed reduction of the distal fibula is associated with malposition in up to 50% of cases and therefore open reduction from a short anterolateral approach is preferred. Accuracy of reduction should be always checked by postoperative CT scan.

RADON INHALATION EXPERIMENTS TO TEST RADON EXHALATION KINETICS.

Three experiments were conducted with a volunteer to test the kinetics of the 222Rn exhalation after a short-time exposure to an elevated 222Rn air concentration. Radon concentration in an exhaled air was measured, complemented by whole body counting of 222Rn decay products in a body. Exhaled activities are compared with the prediction of the recent ICRP biokinetic model for radon. While a rapid equilibration of the exhaled radon activity concentration with that in the air inhaled corresponded with the model, the measured 222Rn exhalation rate was significantly less than modelled. Five hours after termination of the inhalation phase, the radon concentration in the exhaled air decreased to levels expected for non-elevated indoor radon activity concentration. Whole body activities of the 222Rn decay products were found higher than expected. Inhalation of the unattached fraction or residual activity of decay products in the air inhaled may be the explanation.

Anatomy of the dens and its implications for fracture treatment: an anatomical and radiological study.

PURPOSE: The most common injuries to the upper cervical spine are fractures of the dens axis. Therefore, the purpose of our study was to answer three questions, namely (1) whether the size of the dens is adequate at all levels to accommodate two screws, (2) what the angle of the posterior tilt of the dens is in a healthy individual and (3) compare the measured variables between the sexes. METHODS: The cohort comprised 50 males and 50 females CT examination of the craniocervical junction. We measured the five diameters of the dens and posterior dens angulation angle (PDAA) and screw insertion angle (SIA). The same dimensions were measured in a control group, consisting of 40 non-pathological second cervical vertebrae specimens. RESULTS: On CT scans, the mean PDAA was 162.7 degrees in males and 160.26 degrees in females; the mean SIA was 62.0 degrees in males and 60.2 degrees in females. On specimens, the mean PDAA was 169.47 degrees in males and 166.95 degrees in females; the mean SIA was 65.42 degrees in males and 64.47 degrees in females. All obtained values were higher in males; regardless of their measuring on either CT scans or specimens, differences between males and females were statistically significant (p < 0.05) in a, c, d and e values. CONCLUSIONS: The values of our measurements correlate with the dimensions identified previously in other studies. Based on our clinical experience and measurements, we presume that two 3.5-mm screws can be inserted into the dens of all adult patients, except for those with pronounced anatomical anomalies. Posterior dens angulation angle is slightly larger than we expected. The dens is significantly larger in males almost in all measurement. These slides can be retrieved under Electronic Supplementary Material.

[Iatrogenic biliary tract lesions requiring surgical reconstruction - presentation and classification of the lesions, their reconstruction and evaluation of the results]. / Iatrogénne lézie zlcových ciest vyzadujúce chirurgickú rekonstrukciu prezentácia a klasifikácia poranení, spôsob rekonstrukcie, hodnotenie výsledkov.

INTRODUCTION: The incidence of biliary duct injuries requiring surgical reconstruction has stabilised between 0.30.7%. Biliary reconstruction in the hands of a trained hepatobiliary surgeon may lead to better short- and long-term outcomes in patients with this infrequent, but serious complication. METHODS: This study presents a retrospective analysis of single surgeon experience with biliary injury repair during the period of 20072016. Extramucosal hepaticojejunostomy on the excluded segment of the jejunal loop was performed without the use of any transanastomotic drain. Immediate reconstruction of on-table recognised injuries was carried out; patients presenting with biliary leak were reconstructed early and patients presenting with biliary stricture underwent reconstruction depending on the degree of obstruction, presence of cholangitis and feasibility of endoscopic or percutaneous intervention. Postoperative complications were evaluated using Dindo-Clavien and ISGLS classification, and the effect of reconstruction was assessed according to McDonald criteria. RESULTS: 15 biliary reconstructions in 14 patients were performed during the study period. More than a half of the patients experienced some postoperative complication (53.33%); serious complication occurred in 2 patients. One patient (82 years old) died of non-surgical postoperative complications. Biliary leak occurred in three patients (20%), and deep surgical site infection (fasciitis) in four patients (33.33%). The average length of stay was 12.13 days. There was no revisional surgery during the index hospitalisation in any of the patients. There were two readmissions up to 90 days after biliary reconstruction (13.33%). The patients are currently followed up for an average of 4.01 years; compliance with follow-up is 100%. Successful reconstruction was achieved in 92.86% of patients; one patient required rehepaticojejunostomy (7.14%). According to McDonald criteria excellent results were accomplished in 6 patients (42.86%), good results in another 5 patients (35.71%) and 2 patients underwent percutaneous intervention on the reconstruction (14.28%). CONCLUSION: When comparing results among various centres, we should take into account: 1. Experience of the centre/surgeon; 2. Case-mix (exact classification); 3. Timing of reconstruction; 4. Criteria for successful reconstruction; and 5. The length of follow-up. Patients in our centre who fulfil McDonald A and B criteria during the whole follow-up period are considered to have a successful repair. Reconstruction in McDonald C patients is also considered as a success by some authors, although this remains debatable as an early intervention on the reconstruction may be appropriate.Key words: cholecystectomy - bile duct injury - hepaticojejunostomy stricture.

LESSONS LEARNED FROM THE EURADOS SURVEY ON INDIVIDUAL MONITORING DATA AND INTERNAL DOSE ASSESSMENTS OF FOREIGNERS EXPOSED IN JAPAN FOLLOWING THE FUKUSHIMA DAIICHI NPP ACCIDENT.

European Radiation Dosimetry Group e.V. (EURADOS) survey on individual monitoring data and dose assessment has been carried out for 550 foreigners returning home after being exposed in Japan to intakes of radionuclides (mainly (131)I, (132)I, (132)Te, (134)Cs and (137)Cs) as a consequence of the Fukushima Daiichi NPP accident. In vivo and in vitro measurements were performed in their respective countries at an early stage after that accident. Intakes of radionuclides were detected in 208 persons from Europe and Canada, but the committed effective dose E(50) was below the annual dose limit for the public (<1 mSv) in all the cases. Lessons learned from this EURADOS survey are presented here regarding not only internal dosimetry issues, but also the management of the emergency situation, the perception of the risk of health effects due to radiation and the communication with exposed persons who showed anxiety and lack of trust in monitoring data and dose assessments.

MONTE CARLO SIMULATION OF THE BREMSSTRAHLUNG RADIATION FOR THE MEASUREMENT OF AN INTERNAL CONTAMINATION WITH PURE-BETA EMITTERS IN VIVO.

Rapid measurement techniques are required for a large-scale emergency monitoring of people. In vivo measurement of the bremsstrahlung radiation produced by incorporated pure-beta emitters can offer a rapid technique for the determination of such radionuclides in the human body. This work presents a method for the calibration of spectrometers, based on the use of UPh-02T (so-called IGOR) phantom and specific (90)Sr/(90)Y sources, which can account for recent as well as previous contaminations. The process of the whole- and partial-body counter calibration in combination with application of a Monte Carlo code offers readily extension also to other pure-beta emitters and various exposure scenarios.

A simple physical phantom for an intercomparison exercise on 241Am activity determination in the skull.

A simple hemispherical phantom has been designed and prepared for the EURADOS intercomparison exercise on (241)Am activity determination in the skull (2011-13). The phantom consists of three parts that substitute bone and soft tissues. (241)Am is deposited on the surfaces of the bone-substituting part. The design and assumed composition of phantom parts are discussed. A preparation of the voxel representation of the phantom is described. The spectrum of a real measurement of the physical phantom agrees well with the simulation. The physical phantom, and its voxel representation, is provided to the participants of the intercomparison exercise.

Cool water vs warm water immersion for minimal sedation colonoscopy: a double-blind randomized trial.

AIM: Water-aided insertion as an alternative colonoscopy technique reduces patient discomfort. Warm water has been used in most published trials, but the use of cool water is easier and, if equally effective, could support the use of the water-aided technique in routine practice. METHOD: A double-blind, randomized, single-centre study was performed in which 201 patients were randomized to either cool (20-24 °C) or warm (37 °C) water immersion insertion. The primary outcome was caecal intubation time. The success rate of minimal sedation and patient discomfort were also assessed. RESULTS: The caecal intubation time for cool and warm water was similar (6.9 ± 3.5 vs 7.0 ± 3.4 min, P = 0.64). The respective success rates of minimal sedation colonoscopy (89.1% vs 90%, P = 1.00) and discomfort (P = 0.51) were no different. All other outcomes except a greater need for abdominal compression in the cool water arm (P = 0.04) were similar including the total procedure time, terminal ileum intubation rate, adenoma detection, length of the inserted scope, water volume, non-standard position rate, difficulty of the procedure and the patient's temperature sensation. CONCLUSION: The use of cool water did not modify the caecal intubation time compared with warm water. Exception for abdominal compression, all other end-points were no different. Cool water immersion is an alternative to the technically more demanding warm water immersion colonoscopy.

A case of occupational internal contamination with 241Am.

An internal contamination with (241)Am was detected in a worker during a routine monitoring of workers from a company producing Am sources for smoke detectors and Am-Be neutron sources. During the 4-year period after the exposure, the number of urine and faecal samples from the worker were analysed; in vivo measurements were also performed. Specific values for absorption parameters of the human respiratory tract model and particle transport values were applied to improve the model fit to the measurement data. A good agreement of the bioassay data with the so-modified model predictions was obtained.

[Screening of celiac disease in patients with osteoporosis and osteopenia]. / Screening celiakie a pacientu s osteoporózou a osteopenií.

The celiac disease is traditionally viewed as the children's disease with a typical form accompanied mainly by intestinal symptoms and malabsorption. This opinion is still generally accepted by the medical community. Findings based on the area-wide screening show that the prevalence has risen from the original 1 : 1 000-1 500 to 1 : 70-550. The average prevalence in the western countries is nearly 1 : 100. The prevalence of the celiac disease in the Czech republic is estimated to be approximately 1 : 200-250. It means that the number of people in the Czech republic who are likely to be affected is about 40,000-50,000 people. Currently only 10-15% of the total number of the ill people are diagnosed and monitored. Adult patients represent the main diagnostic problem because their clinical pictures are individual and the main symptoms are atypical (nonenteral). These are anaemia (mainly sideropnic), early/premature osteoporosis, herpetiformic (Duhring) dermatitis, polyneurititis, ataxia, depression, behavioural disorders, menstrual cycle disorders and infertility. Therefore our attention is currently focused on the screening of these groups of subjects. The purpose of our study was to check the frequency of the celiac disease with patients with diagnosed osteoporosis and osteopenia. In our study we have confirmed the assumption that the prevalence ofthe celiac disease in the group of subjects was 1 : 50, which means that 2.2% of patients with osteoporosis and osteopenia are affected by celiac sprue and therefore screening examination of these patients with the subsequent causal treatment (gluten-free diet) is recommended.

Impact of a metabolic stone clinic on management of patients with cystinuria: 5 years follow-up.

PURPOSE: Cystinuric patients develop new stones and exhibit stone growth despite conservative measures and often require surgical intervention. There have been reports of better outcome both in surgical intervention rates and compliance when patients were referred to dedicated metabolic stone clinics. We wish to report our experience in the running of a metabolic stone disease clinic and to compare our intervention rates to the pre-metabolic stone clinic period in our department. PATIENTS AND METHODS: We reviewed retrospectively our cystinuria patients' database between the years of 1992 and 2008. Patients were divided into two groups. Group A patients (n=28) were treated before the introduction of a dedicated stone clinic (years 1992-2002) and group B patients (n=28) after the establishment of the metabolic stone clinic but every group B patient had a minimum follow up of 5 years. 21 patients were common between the two groups. Main therapy included hyperdiuresis and alkalization. Parameters recorded included the number of clinic visits, whether the patients were stone free or asymptomatic at the time of our review and the nature and frequency of surgical intervention. RESULTS: A total number of 145 procedures were carried out in group A including 89 ESWL, 27 PCNL, 24 ureteroscopy retrograde lithotripsies and 5 open procedures. In group B, a total of 54 procedures were carried out and included 6 ESWL, 5 PCNL and 43 ureteroscopy laser lithotripsies. The average number of surgical interventions per patient per year was 0.74 and 0.34 in group A and B respectively. The number of clinic attendances increased in group B to 279 from 188 in group A. Stone free rates were 46% for group A and 50% for group B patients but all group B patients were asymptomatic at the time of our review. CONCLUSIONS: The introduction of a dedicated cystinuria clinic halved the intervention rate in this complicated group of patients. The majority of surgical procedures shifted towards ureteroscopies (both as inpatients and as day case procedures). We believe that cystine stone patients should be managed in a devoted metabolic stone clinic. With this approach, compliance is better achieved and surgical intervention is less, resulting in better clinical outcome, and less burden both for the patient and the urological services.

[Endoscopic diagnostics and treatment of flat intestinal lesions]. / Endoskopická diagnostika a lécba plochých nádorových lézí strevních.

The aim of the article is to provide information on current options for endoscopic diagnostics and treatment of flat tumor intestinal lesions. These neoplasms are frequently and inaccurately described as sessile polyps, which have different genetic and diagnostic features, different prognosis and therapy. Although until recently, the lesions have been managed using surgery, the current approach is predominantly endoscopic.

The fragile X chromosome (GCC) repeat folds into a DNA tetraplex at neutral pH.

UV absorption and CD spectroscopy, along with polyacrylamide gel electrophoresis, were used to study conformational properties of DNA fragments containing the trinucleotide repeat (GCC)(n) (n = 4, 8 or 16), whose expansion is correlated with the fragile X chromosome syndrome. We have found that the conformational spectrum of the (GCC)(n) strand is wider than has been shown so far. (GCC)(n) strands adopt the hairpin described in the literature under a wide range of salt concentrations, but only at alkaline (>7.5) pH values. However, at neutral and slightly acid pH (GCC)(4) and (GCC)(8) strands homodimerize. Our data suggest that the homodimer is a bimolecular tetraplex formed by two parallel-oriented hairpins held together by hemi-protonated intermolecular C.C(+) pairs. The (GCC)(16) strand forms the same tetraplex intramolecularly. We further show that below pH 5 (GCC)(n) strands generate intercalated cytosine tetraplexes, whose molecularity depends on DNA strand length. They are tetramolecular with (GCC)(4), bimolecular with (GCC)(8) and monomolecular with (GCC)(16). i-Tetraplex formation is a complex and slow process. The neutral tetraplex, on the other hand, arises with fast kinetics under physiological conditions. Thus it is a conformational alternative of the (GCC)(n) strand duplex with a complementary (GGC)(n) strand.

Conformational properties of DNA dodecamers containing four tandem repeats of the CNG triplets.

We studied DNA dodecamers (CAG)4, (CCG)4, (CGG)4 and (CTG)4by CD spectroscopy and polyacrylamide gel electrophoresis. Each dodecamer adopted several ordered conformers which denatured in a cooperative way. Stability of the conformers depended on the dodecamer concentration, ionic strength, temperature and pH. The dodecamers, having a pyrimidine base in the triplet center, generated foldbacks at low ionic strength whose stem conformations were governed by the GC pairs. At high salt, (CCG)4 isomerized into a peculiar association of two strands. The association was also promoted by high oligonucleotide concentrations. No similar behavior was exhibited by (CTG)4. At low salt, (CGG)4 coexisted in two bimolecular conformers whose populations were strongly dependent on the ionic strength. In addition, (CGG)4 associated into a tetraplex at acidic pH. A tetraplex was even observed at neutral pH if the (CGG)4 concentration was sufficiently high. (CAG)4 was very stable in a monomolecular conformer similar to the known extremely stable foldback of the (GCGAAGC) heptamer. Nevertheless, even this very stable conformer disappeared if (CTG)4 was added to the solution of (CAG)4. Association of the complementary strands was also strongly preferred to the particular strand conformations by the other couple, (CCG)4 and (CGG)4.

[Selected biogenic elements in the blood of hares (Lepus europaeus Pall.)]. / Vybrané biogenní prvky v krevní plazme zajecí zvere (Lepus europaeus Pall.)

Blood samples were collected through aortic punctures in hares coming from different agricultural regions. Base biogenic elements (Ca, P, Mg, Na, K, chlorides) were determined in blood plasma not showing haemolysis. The values obtained in hares born and kept in captivity are presented for the purposes of comparison. Changes in element levels are described for different pollution load of ecosystems, from physiological aspects for more advanced stages of gravidity, for a higher lactation number and for young growth. The problems of qualitative fasting of hares can also be documented by mineral contents in blood plasma. The levels of some elements were evaluated for a group of adult male and female hares, and the youngs regardless of their sex until the disappearance of Stroh's outgrowth. The results were processed statistically and are summarized in tables (Tabs. 1-12) and they are compared with available literature.