The objective of this prospective double-blind study was to determine whether postoperative residual paralysis (PORP) after pancuronium or vecuronium results in hypoxemia and hypercapnia in the immediate admission period to the recovery ward. Eighty-three consecutive surgical patients received balanced or intravenous anesthesia with pancuronium for operations lasting longer than one hour or vecuronium for those lasting less than 60 min, both combined with neostigmine at the end of anesthesia. Standard clinical criteria assessed neuromuscular function intraoperatively. Postoperatively, we determined neuromuscular function (acceleromyography with supramaximal train-of-four (TOF) stimulation of the ulnar nerve, and a 5-s head lift) and pulmonary function (pulse oximetry: SpO2, and blood gas analysis: SaO2, PaCO2). We defined PORP as a TOF-ratio 70 %, hypoxemia as a postoperative SpO2³ 5 % below the pre-anesthestic level together with a postoperative SaO293 %, and hypercapnia as a PaCO2³ 46 mm Hg. Among the 49 pancuronium and 27 vecuronium patients studied, the PORP rates were 20 % in the pancuronium group and 7 % in the vecuronium group (p>0.05). Hypoxemia and hypercapnia occurred more often in pancuronium patients with PORP than in those without PORP namely 60 % vs. 10% (p<0.05) and 30 % vs. 8 % (p>0.05), respectively. We conclude that PORP after pancuronium is a significant risk factor for hypoxemia., U. Bissinger, F. Schimek, G. Lenz., and Obsahuje bibliografii
This paper presents a detailed analysis of the development of the postal network in the territory of Moravia during the period of its most significant expansion, based on hitherto largely unused archival material, chiefly from the Postal Museum in Prague and the Moravian Archive in Brno. Using these key sources, chronological lists were reconstructed of postmasters in each post office, allowing us to determine the exact period in which each official served. This data on periods of service made it possible to compile a list of the postal routes set up by individual offices in the period under consideration and trace changes that occurred due to military conflict or for logistical reasons. Attention was also given to the hitherto neglected network of letter collection points in Moravia, which grew rapidly towards the end of the 18th century. The study represents a paradigm shift in research into the Moravian postal network. Besides already known postal routes, we also reconstructed routes whose existence had only been deduced from the records of one or two stations, and others that had escaped the attention of researchers altogether. With regard to letter collection points, the study considers the issue of which "mother" stations they were attached to. More generally, the study deepens our knowledge of the structure of the communications network in Moravia in the second half of the 18th century and provides a more precise picture of how it was connected with centres beyond the country’s borders. These results will provide potential future researchers into the Moravian postal service with a solid factual platform in which to anchor and contextualize their findings on specific post offices, stations or entire routes. The study can thus be seen as a contribution to economic and social history, as well as to that of communications., Vojtěch Klíma., and Obsahuje bibliografické odkazy
Příspěvek obsahuje podrobný právní rozbor metod působení na zdraví z hlediska přírodního léčitelství a soukromého práva. Podstatná pozornost je věnována rozdílu mezi přírodním léčitelstvím a zdravotními službami na trhu podle českého práva. Část příspěvku se zaobírá otázkou dokazování účinnosti a bezpečnosti, jakož i vazby na veřejné zdravotní pojištění. Článek se týká právních otázek občanského a zdravotnického práva a obsahuje řadu konkrétních návrhů de lege ferenda. Autor podrobně analyzuje právní otázku postupu podle náležité odborné úrovně zdravotních služeb (lege artis medicinae) podle současného českého zdravotnického práva. Činí tak i v porovnání s péčí řádného odborníka podle občanského zákoníku. Uváděny jsou také podrobnosti z dějin práva duševního vlastnictví, které se týkají právní ochrany zdravotnických metod v současnosti a minulosti. Článek též obsahuje řadu konkrétních příkladů používání jednotlivých metod. Návrhy na změny zákonů nebo jiných předpisů se týkají práva zdravotnického, veřejného zdravotního pojištění, práva živnostenského, profesního a školského včetně dalšího vzdělávání. Autor si zároveň kriticky všímá i některých souvisících otázek světonázorových. V tomto ohledu je ale nutno vycházet z ústavního zákazu vázanosti státu výlučnou ideologií nebo náboženstvím. Autor dospívá k závěru, že přírodní léčitelství patří mezi běžné služby na českém i světovém trhu, které často souvisí s tradiční západní nebo východní medicínou., The paper contains a detailed legal analysis of the methods concerning the effects on the health in the terms of natural healing and private law. Substantial attention is paid to the difference between the natural healing and health services in the market under the Czech law. The part of the paper is dealing with the issue of evidence of efficacy and safety, as well as the relations to the public health insurance. The article concerns the legal issues of the civil and medical law and includes a number of specific proposals de lege ferenda. The author analyzes in detail the legal question of the appropriate professional level of medical services (lege artis medicinae) by the recent Czech health care law also in the comparison with the proper professional care under the Czech Civil Code of 2012. The details of the history of intellectual property rights relating to the legal protection of the medical methods in the past and present are also featured in this contribution. The article also contains a number of real examples of the using of various methods. The proposals for changes in the laws or regulations are affecting the health care law, the health insurance law, commercial law and educational law including the professional and further educational training. The author also critically examines some interrelated issues concerning the ideology and the world-view. In this regard it must be based on the constitutional prohibition of bounding of the state by the exclusive ideology or religion. The author concludes that natural healing belongs to the normal services in the Czech market and globally, too. The natural healing is usually associated with the traditional western or eastern medicine., Ivo Telec, and Literatura
The study is aimed to examine balance control of slightly obese young adults during quiet stance and during gait initiation with and without crossing an obstacle. Forty-four young subjects were divided in two groups: control (BMI<25 kg/m2 ) and slightly obese (BMI from 25 to 35 kg/m2 ). Center of foot pressure (CoP) and kinematics of fifth lumbar vertebra (L5) were evaluated using a force plate and a motion capture system. During quiet stance with eyes open slightly obese group showed increased mean amplitude and velocity of CoP in anterior-posterior direction compared to normal weight subjects. During unloading phase of gait initiation significantly greater and faster lateral CoP shift was observed in slightly obese group compared to normal weight peers. Presence of an obstacle increased amplitude and velocity of the lateral CoP shift similarly in both groups. No BMI-related differences were found on L5 segment during gait initiation, which may indicate that postural control was already successfully performed in feet (CoP). We have shown that increased CoP parameters values and thus increased postural instability during quiet stance and during unloading phase of gait initiation is present not only in morbidly obese, but already in slightly obese subjects.
The aim of the study was to evaluate the effect of surgical reconstruction of anterior cruciate ligament (ACL) on postural stability and responses to lower limb (LL) muscles vibrations.Centre of pressure (CoP) was measured in 17 subjects during stance on firm/foam surface with eyes open/closed and during unilateral vibrations of LL muscles (
m. triceps surae – TS, m. quadriceps femoris – Q, m. quadriceps femoris and hamstrings simultaneously – QH). The measurements were performed: 1) preoperatively, 2) six weeks and 3) three months
after the reconstruction. Decreased postural stability was documented six weeks after the reconstruction compared to preoperative measurement. Three months after the reconstruction significant improvement was observed during stance on foam surface with eyes closed. Preoperatively, altered reactions of LL with ACL lesion compar
ed to intact LL were manifested by slower response in first 3 s of TS vibration and by increased CoP shift in last 5 s of QH vibration. After the reconstruction, we observed slower CoP reaction and decreased
CoP shift during TS vibration of LL with ACL lesion compared to
preoperative level. Posturography during quiet stance and during TS vibration reliably detect postural changes due to ACL reconstruction and can be potentially useful in clinical practice.