Cíl: Cílem výzkumu bylo popsat, jak vnímají a prožívají svou kvalitu života senioři s infekční tuberkulózou, jejíž léčba je dlouhodobá a součástí léčebných opatření je izolace ve zdravotnickém zařízení. Metody: Byla zvolena kvalitativní výzkumná metoda. Pro sběr dat byl použit nestandardizovaný rozhovor. Výzkumný soubor tvořilo 8 pacientů starších 65 let (s diagnózou infekční tuberkulóza) hospitalizovaných ve vybraných zdravotnických zařízeních oboru Pneumologie a ftizeologie a jeden rodinný příslušník pacienta. Rozhovory s respondenty byly realizovány v různém časovém období léčby tuberkulózy. Na základě kvalitativní analýzy dat byly vytvořeny 4 hlavní kategorie kvality života: 1. Prožívání nemoci v oblasti psychické, 2. Prožívání nemoci v oblasti fyzické, 3. Prožívání nemoci v oblasti sociální a 4. Životní hodnoty, názory. Výsledky: Z analýzy rozhovorů vyplynulo, že tuberkulóza je pro seniory stigmatizující chorobou, má negativní vliv na vlastní prožívání a vnímání kvality ţivota. Zhoršené vnímání kvality života je způsobeno více faktory, především skutečností, že mohli nakazit své blízké infekční chorobou. Mezi nejčastější emoce, které respondenti prožívali, patřily strach, úzkost, pocit zahanbení a viny, pocity osamělosti s beznadějí a pocity méněcennosti. Závěr: Problém geriatrické tuberkulózy je významný, neboť se jedná o potenciální zdroje tuberkulózní infekce ve zdravotnických zařízeních a v pobytových zařízeních sociální péče. Je proto důležité, aby si odborníci pečující o seniory uvědomovali existenci problémů při diagnostice a léčbě tuberkulózy., Aims: The aim of the research was to describe how the elderly with infectious tuberculosis, whose treatment is long-term matter and component of therapeutic measure is isolation in health care facility, perceive and experience their quality of life. Methods: A qualitative research method was chosen. For data collection was used non-standardized interview. The research file consisted of 8 patients over 65 years of age (diagnosed with infectious tuberculosis) hospitalized in selected health care facilities of pneumology and phthisiology and one family member of the patient. Interviews with respondents were conducted in different time periods of treatment of tuberculosis. Based on qualitative data analysis were created 4 major categories of quality of life: 1. Experiencing the illness in the area of psychic, 2. Experiencing the illness in the area of physical, 3. Experiencing the illness in the area of social and 4. Life values, beliefs. Results: The analysis of interviews revealed that tuberculosis is for the elderly stigmatizing disease, has a negative effect on their own experiencing and perception of quality of life. Deteriorated perception of quality of life is caused by several factors, primarily by the fact, that they could have infected their loved ones with infectious disease. The most common emotions experienced by respondents included fear, anxiety, feel of shame and guilt, feelings of loneliness with despair and feelings of inferiority. Conclusion: The problem of geriatric tuberculosis is significant because it is a potential source of tuberculous infection in health care facilities and in residential social care facilities. It is therefore important that professionals caring for the elderly realize the existence of problems in diagnosis and treatment of tuberculosis., Jarmila Siverová, Radka Bužgová, and Literatura 16
Přehled problematiky: Magnézium je čtvrtým nejčastějším kationtem v lidském organizmu a po draslíku druhým kationtem v intracelulárním prostoru. Účastní se jako kofaktor enzymů metabolických reakcí, tvorby a utilizace energie a je nezbytný k udržení elektrolytové rovnováhy. Tělo dospělého člověka obsahuje asi 0,043 % (535-730 mmol) magnézia, což je v přepočtu asi 22-30 g (60 % v kostěném skeletu, 40 % intracelulárně ve svalovině a měkkých tkáních, 1 % (7,5-10 mmol) je obsaženo v extracelulární tekutině). Denní potřeba magnézia se odhaduje na 10-20 mmol, tj. 200-400 mg. Ve vztahu k podané dávce pak platí, že čím vyšší podaná dávka, tím nižší procento rezorbce ze střeva. Z doporučené denní dávky 15 mmol (365 mg) se rezorbuje pouze okolo 1/3. Význam magnézia v těhotenství: Důsledkem manifestního nedostatku magnézia může být: 1. zvýšené riziko potratu - předčasný porod (inkompetence hrdla děložního, předčasný odtok vody plodové), 2. placentární insuficience a hypotrofizace plodu, 3. rozvoj gestózy u matky, 4. zvýšené riziko astmatu a ekzému u dětí. Magnézium sulfát, podávaný těhotným ohroženým předčasným porodem (23+0 -30+0), snižuje riziko dětské mozkové obrny u přežívajících novorozenců. Souhrn: Nedoporučuje se používat intravenózní magnézium sulfát v indikaci léčby hrozícího předčasného porodu déle jak 5-7 dní. Tato omezení se nijak nevztahují na perorální užívání magnézia., Objectives: Magnesium is the fourth most common cation in the human body, and the second cation to potassium in the intracellular space. It participates as a cofactor of enzymes in the metabolic reactions, creation and utilization of energy and is necessary for the maintenance of electrolyte balance. The body of an adult contains about 0.043% (535-730 mmol) of magnesium, which is the equivalent of about 22-30 g (60% in the bony skeleton, 40% intracellular in muscles and soft tissue, 1% (7.5-10 mmol) in extracellular fluid). The daily requirement of magnesium is estimated at 10 to 20 mmol, i.e. 200-400 mg. As for dosage, the higher the dose, the lower the percentage of absorption from the intestine. Of the recommended daily dose of 15 mmol (365 mg), only about a third is absorbed. The importance of magnesium in pregnancy: implications of a manifest lack of magnesium may include: 1. increased risk of miscarriage – preterm labor (cervical incompetence, premature rupture of membranes); 2. placental insufficiency and fetal hypotrophy; 3. development of maternal gestosis; 4. increased risk of asthma and eczema in neonates. Magnesium sulfate given to pregnant women with threatened preterm labor (23+0 – 30+0) reduces the risk of cerebral palsy in surviving infants. Summary: In cases of threatened preterm labor it is not recommended to administer magnesium sulfate intravenously for more than 5-7 days. This restriction does not apply to the oral application of magnesium., and Pavel Calda
Atrioventrikulární nodální re-entry tachykardie (AVNRT) je nejčastější formou supraventrikulární tachykardie (SVT), která se vyskytuje v těhotenství a po porodu. Nefarmakologická léčba zahrnuje použití dobře tolerovaných vagových manévrů (Valsalvův manévr, masáž karotid, ponoření obličeje do chladné vody). Adenosin a betablokátory jsou léky první linie k terminaci epizody SVT. Léčba těchto pacientek vyžaduje úzkou mezioborovou spolupráci gynekologa, internisty a intenzivisty. Ideálně by supraventrikulární dysrytmie měly být vyřešeny ještě před vlastní graviditou, například radiofrekvenční ablací. Symptomatická léčba malou dávkou betablokátoru je možná i v průběhu těhotenství., Atrioventricular nodal re-entrant tachycardia (AVNRT) is the most common supraventricular tachycardia (SVT) detected during pregnancy and labour. Non pharmacological treatment including vagal manoeuvres such as Valsalva manoeuvre, carotid massage and facial ice immersion are well tolerated and aid in diagnosis. Adenosine and beta-blocking agents are the first line drugs of choice to terminate an episode of SVT. The treatment requires interdisciplinary cooperation. Ideally, management of supraventricular arrhythmias should start before conception, for example by radiofrequency ablation. A small dose of beta-blocking agents can be used during pregnancy., Alena Derbak, Jaroslav Hojny, Ladislav Rychtárik, Jiří Štětka, and Literatura
Acenocoumarol is a vitamin K antagonist that is used for the treatment of acquired and congenital, both arterial and venous, thrombotic diseases. Its use is complicated by the narrow therapeutic range. Bleeding following oral anticoagulation, despite rare, remains the major complication. Most cases of hemorrhagic episodes usually require short hospitalization and transfusion, while surgical drainage of the hematoma is not recommended. However, in cases that conservative treatment isn’t successful, surgical intervention remains an option. We present a case of severe spontaneous bleeding of the rectus abdominis muscle which was successfully managed surgically., Orestis Ioannidis, George Paraskevas, Anastasios Kotronis, Stavros Chatzopoulos, Athina Konstantara, Nikolaos Papadimitriou, Apostolos Makrantonakis, Emmanouil Kakoutis, and Literatura 15
Epidermal inclusion cysts are common benign cutaneous cysts which arise from hair follicles. These cysts usually present as asymptomatic, small, smooth, firm, round, slow growing swellings on hair bearing areas such as scalp, face, neck and trunk. Epidermal inclusion cysts are easily diagnosed by their clinical features. However, trichilemmal cyst, dermoid cyst, neurofibroma, hemangioma, lipoma and liposarcoma should also be kept in mind in differential diagnosis of cutaneous cystic lesions. As malignant transformation of epidermal inclusion cysts has been reported, histopathological evaluation of epidermal inclusion cysts is mandatory in order to rule out malignancy. Moreover, giant epidermal inclusion cysts with ulceration, rapid growth, resistance to treatment, recurrence and fistula drainage may have malignant potential. Therefore, epidermal cysts should be surgically removed. There are several different types of surgical techniques to remove cutaneous cysts. A proper surgical technique should facilitate the complete removal of the cyst wall to prevent recurrence. In addition, it should provide minimal scarring and a low wound infection rate. Epidermal inclusion cysts can be easily removed surgically with squeeze technique. In this technique, the cyst is squeezed out through a small incision using both index fingers. Thus, the cyst is not ruptured. The squeeze technique allows the cyst capsule to remain intact. Therefore, the risk of wound infection, recurrence and scar formation is minimized. Hereby, we present a 48-year-old male with multiple epidermal inclusion cysts on the scalp treated surgically with squeeze technique., Mehmet Eren Yuksel, Funda Tamer, and Literatura
Many aspects of surgical treatment of intestinal malrotation in children remain to be debatable. In the opinion of the majority of the specialists, surgical treatment is required after the diagnosis taking into account serious complications of intestinal malrotation. Purpose. The purpose of this research was to conduct an analysis of surgical tactics and operative treatment method for isolated and associated intestinal malrotations in children. Material and methods. We observed 123 children at the age of one day to 15 years with malrotation during the period of 2002 to 2013. Results. We presented the data from observing 123 children at the age of one day to 15 years with various clinical-anatomic forms of intestinal malrotation over from 2002 to 2013. In 62 patients (50.4%), the evidences of the high intestinal obstruction were prevalent, while 61 (49.6%) showed signs of low intestinal obstruction. 116 patients (94,3%) were given operative intervention: radical – 95(81,9%) and palliative – 21 (18,1%). In 56 % of the cases, various simultaneous surgeries were required. There are proposed differential approaches in relation to anatomic form of malrotation and possibility of the fixation of large intestine in the physiological position. Conclusion. The results obtained from the operative treatment are presented. The lethal outcomes could be reduced from 54.7%, among the patients being observed from 2002 to 2010, to 16,7% in patients being operated during 2011 to 2013., Nasriddin Shamsiddinovich Ergashev, Jamoliddin Bahronovich Sattarov, and Literatura
Background. Nonunion of the lateral humeral condyle are of the complex pathology of the elbow joint, occurring relatively often and resulting in disability of children. The treatment of nonunion of the lateral humeral condyle of humerus with cubitus valgus remains controversial. Purpose of this report was improvement of the results of surgical treatment of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus with use of differential approach to the surgical strategy. Material and methods. We were observing 28 children (17 boys and 11 girls) with nonunion and longstanding nonunion of lateral condyle of humerus, with various degrees of severity. There were used MRI and Xray investigations for differential study of the patients divided into 3 groups in relation to stability and nonstability of the nonunion of the lateral humeral condyle of humerus with cubitus valgus of the lateral humeral condyle of humerus with cubitus valgus. Results. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarovs technique. The mean postoperative humerusulna angle was 6,0 degrees of cubitus valgus. All of reverse Tosteothomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of followup was 7 years. The overall results were excellent in 15(53,5%) patients, good in 11(39,3%) patients, and fair in 2(7,2%) patients. All 28 patients lateral humeral condyle nonunions with cubitus valgus achieved union within sixty five days after operative procedure using Ilisarovs technique. The mean postoperative humerusulna angle was 6,0 degrees of cubitus valgus. All of reverse Tosteothomies healed uneventfully, and there was no loss of correction postoperatively. The mean duration of followup was 7 years. The overall results were excellent in 15(53,5%) patients, good in 11(39,3%) patients, and fair in 2(7,2%) patients. Conclusion. We believe it is reasonable to use our treatment method when dealing with nonunion of the lateral humeral condyle with cubitus valgus. These differential techniques helps to shape the distal part of humerus, thus, restoring the function of the elbow joint., Ilkhom E. Khujanazarov, Iskandar U. Khodjanov, and Literatura
Článek se zabývá problematikou odmítání transfuze krve ze strany členů náboženské společnosti Svědkové Jehovovi. Danou otázku přitom zkoumá nejen z pohledu aktuální právní úpravy v zákoně o zdravotních službách (dříve vyslovených přáních) a vybrané judikatury, ale také z širšího právněfilozofického a politického pohledu. Dochází k závěru, dle něhož formálně právní úprava sice preferuje vůli pacienta, nicméně tento přístup může mít z obecnějšího společenského hlediska i některé sporné důsledky. Proto je nakonec přijat názor, že transfuzi je nutné poskytnout i proti vůli pacienta., The article deals with the issue of the blood transfusion rejection by the member of the religious community Jehovah's Witnesses. The issue is examined not only from the view of the recent legal provisions (living will) and the available judicature, but also from the broader philosophical and political view. It concludes that the legal provisions prefer the patient's autonomy but this approach can generally also have some controversial consequences. Therefore the author resumes that the blood transfusion should be provided although it infringes the patient's will., Pavel Uherek, and Literatura