Forensic Aspect of Injuries Associated with Cardiopulmonary Resuscitation

IHNÁT RUDINSKÁ, Lucia: Forensic Aspect of Injuries Associated with Cardiopulmonary Resuscitation. Charles University, Faculty of Medicine in Hradec Králové; Hradec Králové: 2017, 97 s. Injuries associated with cardiopulmonary resuscitation (CPR) present the actual issue on the boundary of several medical specialities. The prevalence of CPR associated injuries is very high; the spectrum of these injuries is wide (from clinically irrelevant to injuries incompatible with life). The primary aim of the study was to evaluate frequency and seriousness of CPR associated injuries; the secondary aim was the analysis of factors, which might have participated in the development of CPR associated injuries. In total, 80 persons were enrolled in the study. All included individuals were resuscitated before death and underwent an autopsy at the University Hospital Ostrava within the study period (1. 9. 2012 - 30. 8. 2015). Injuries associated with CPR were revealed in 93.7% of resuscitated persons; injuries were multiple in the vast majority of these persons. Skin injuries, head and neck injuries, rare intra- abdominal injuries and frequent intrathoracic injuries were identified within the study group. Clinically serious injuries associated with CPR were revealed in 41.2% of persons (lung contusions or lacerations,...Souhrn IHNÁT RUDINSKÁ, Lucia: Soudnělékařský aspekt poranění vznikajících při kardiopulmonální resuscitaci. Univerzita Karlova, Lékařská fakulta v Hradci Králové; Hradec Králové: 2017, 97 s. Poranění vznikající v souvislosti s kardiopulmonální resuscitací (KPR) představují velmi aktuální problematiku na rozhraní medicínských oborů. Frekvence výskytu těchto poranění je velmi vysoká, spektrum poranění široké od klinicky bezvýznamných až po poranění neslučitelná se životem. Cílem práce bylo hodnocení prevalence a závažnosti poranění vznikajících v souvislosti s KPR, jakož i analýza faktorů, které se mohou podílet na vzniku závažných resuscitačních poranění. Do prospektivní pitevní studie bylo v rozmezí tří let (1. 9. 2012 - 30. 8. 2015) zařazeno 80 osob, u kterých byla ve Fakultní nemocnici Ostrava provedena zdravotní pitva a které byly před smrtí neúspěšně resuscitovány. Poranění asociovaná s KPR byly zaznamenány u 93,7 % resuscitovaných osob, u převážné většiny těchto osob byla poranění vícenásobná. Diagnostikována byla poranění kožního krytu, hlavy, krku, ojedinělá nitrobrišní poranění a především častá poranění hrudníku a nitrohrudních orgánů. Závažná poranění asociovaná s KPR byla zaznamenána u 41,2 % osob (kontuze nebo lacerace plic, hemotorax, kontuze srdce, hemoperikard, lacerace jater, ruptura...Ústav soudního lékařstvíDepartment of Forensic MedicineLékařská fakulta v Hradci KrálovéFaculty of Medicine in Hradec Králov

Colorectal cancer liver metastases: laparoscopic and open radiofrequency-assisted surgery

Introduction: The liver is the most common site of colorectal metastases (colorectal liver metastases – CLM). Surgical treatment in combination with oncological therapy is the only potentially curative method. Unfortunately, only 10–25% of patients are suitable for surgery. Traditionally, open liver resection (OLR) is usually performed. However, laparoscopic liver resection (LLR) has become popular worldwide in the last two decades. Aim: To evaluate the effectiveness and benefits of radiofrequency minor LLR of CLM in comparison with OLR. Material and methods: The indication for surgery was CLM and the possibility to perform minor laparoscopic or OLR not exceeding two hepatic segments according to Couinaud’s classification. Results: Sixty-six minor liver resections for CLM were performed. Twenty-five (37.9%) patients underwent a laparoscopic approach and 41 (62.1%) patients underwent OLR. The mean operative time was 166.4 min for LLR and 166.8 min for OLR. Average blood loss was 132.3 ±218.0 ml during LLR and 149.5 ±277.5 ml during OLR. Length of hospital stay was 8.4 ±2.0 days for LLR and 10.5 ±5.8 days for OLR. All resections were R0. There was no case of mortality. Postoperative complications were recognized in 9 (13.6%) patients: 8 in the group of OLR patients and 1 in the LLR group. The median survival time for LLR was 70.5 months and for OLR 61.9 months. The 5-year overall survival rate was higher for LLR vs. OLR – 82.1% vs. 69.8%. The average length of disease-free interval after LLR was greater (52.2 months) in comparison with OLR (49.4%). The 5-year disease-free interval was 63.2% for LLR and 58% for OLR. Conclusions: Outcomes and oncological radicality of minor laparoscopic liver resections of CLM are comparable to outcomes of OLR.Web of Science10221220

New semi-spherical radiofrequency energy device for liver resection: an experimental study in pigs

The aim of this experimental study was to verify a new semi-spherical surgical tool for bipolar radiofrequency liver ablation, which can solve some of the disadvantages of the commonly used device, such as long duration of ablation. A total of 12 pigs which were randomly divided into two groups were used. Each pig underwent resection of the two liver lobes. In group 1, pigs were treated with the commonly used device; in group 2 the newly developed semispherical device was used. During surgery and the post-surgical period, many categories were observed and later analyzed. The blood count and biochemistry were monitored on days 0, 14 and 30 from the operation. On day 14 since the liver resection, pigs underwent diagnostic laparoscopy to evaluate their condition focusing on the site of the liver lobe resection. On day 30 after operation, all pigs were euthanized and subjected to histopathological examination. Histopathological evaluation of thermal changes at the resection margin showed strong thermal alteration in both groups. Data between both groups were compared using median test for continuous variables and Fisher’s exact test for categorical variables. Statistical analyses were performed with IBM SPSS software version 18.0. Statistical analysis of collected data did not prove any significant (P < 0.05) differences between the commonly used device and the newly designed surgical tool.Web of Science84439

Impact of the coronavirus disease 2019 pandemic on the management of acute peptic ulcer perforation: to be reconsidered(?)

OBJECTIVE: Peptic ulcer perforation presents the most serious complication of ulcer disease with mortality that varies significantly depending on the age and conditions. The coronavirus disease 2019 pandemic was effective worldwide in 2020 and continues to date. The aim of this study was to investigate the initial clinical parameters and short-term outcomes of patients with acute peptic ulcer perforation before and during the coronavirus disease 2019 pandemic. METHODS: A retrospective cohort study was conducted in the Department of Surgery, University Hospital Ostrava, Czech Republic. The patients undergoing surgical modality of a simple suture of peptic ulcer perforation with/without omentoplasty in the post-coronavirus disease 2019 (January 1, 2020 to December 31, 2021) and the pre-coronavirus disease 2019 (January 1, 2018 to December 31, 2019) had been incorporated in this study. RESULTS: This study included a total of 46 cases (26 in the pre-coronavirus disease 2019, 20 in the post-coronavirus disease 2019). The age, body mass index, Boey score, duration of symptoms, surgery time, and length of hospital stay were comparable in both study subgroups. During the coronavirus disease 2019 pandemic, patients were admitted with a statistically significantly lower degree of perioperative risk according to the American Society of Anesthesiologists classification (p=0.013). Notably, 30-day postoperative morbidity was significantly higher in pre-coronavirus disease 2019 (73.1 vs. 55.0%, p=0.038). The mortality rate in the laparoscopic group was 13.6%, in the laparotomy group 41.4%, and the mortality rate was higher in pre-coronavirus disease 2019 than in post-coronavirus disease 2019 (34.6 vs. 20.0%, p=0.166). CONCLUSION: In fact, the coronavirus disease 2019 pandemic had not significantly influenced therapeutic management and short-term outcomes of patients undergoing acute surgical repair of peptic ulcer perforation

Obesity in cases undergoing the surgical procedure of lung lobectomy: risk or benefit?

OBJECTIVE: The aim of the study was to evaluate the effect of body mass index on patients’ short-term results following lung lobectomy. METHODS: In this retrospective study, we compared the perioperative and short-term postoperative results of obese (BMI≥30 kg/m2) versus nonobese patients (BMI&lt;30 kg/m2) who underwent anatomical lung resection for cancer. The two groups had the same distribution of input risk factors and the same ratio of surgical approaches (thoracoscopy vs. thoracotomy). RESULTS: The study included a total of 144 patients: 48 obese and 96 non-obese patients. Both groups had the same ratio of thoracoscopic vs. thoracotomy approach (50/50%), and were comparable in terms of demographics and clinical data. The g roups did not significantly differ in the frequency of perioperative or postoperative complications. Postoperative morbidity was higher among non-obese patients (34.4 vs. 27.1%), but this difference was not statistically significant (p=0.053). Hospital stay was similar in both study groups (p=0.100). Surgery time was significantly longer among obese patients (p=0.133). Postoperative mortality was comparable between the study groups (p=0.167). CONCLUSIONS: Obesity does not increase the frequency of perioperative and postoperative complications in patients after lung lobectomy. The slightly better results in obese patients suggest that obesity may have some protective role. © 2022 Associacao Medica Brasileira. All rights reserved.MZ ČR – RVO-FNOs/201

Skeletal Muscle–Derived Cell Implantation for the Treatment of Fecal Incontinence: A Randomized, Placebo-Controlled Study

Background and Aims: Fecal incontinence (FI) improvement following injection of autologous skeletal muscle–derived cells has been previously suggested. This study aimed to test the efficacy and safety of said cells through a multicenter, placebo-controlled study, to determine an appropriate cell dose, and to delineate the target patient population that can most benefit from cell therapy. Methods: Patients experiencing FI for at least 6 months were randomized to receive a cell-free medium or low or high dose of cells. All patients received pelvic floor electrical stimulation before and after treatment. Incontinence episode frequency (IEF), FI quality of life, FI burden assessed on a visual analog scale, Wexner score, and parameters reflecting anorectal physiological function were all assessed for up to 12 months. Results: Cell therapy improved IEF, FI quality of life, and FI burden, reaching a preset level of statistical significance in IEF change compared with the control treatment. Post hoc exploratory analyses indicated that patients with limited FI duration and high IEF at baseline are most responsive to cells. Effects prevailed or increased in the high cell count group from 6 to 12 months but plateaued or diminished in the low cell count and control groups. Most physiological parameters remained unaltered. No unexpected adverse events were observed. Conclusions: Injection of a high dose of autologous skeletal muscle–derived cells followed by electrical stimulation significantly improved FI, particularly in patients with limited FI duration and high IEF at baseline, and could become a valuable tool for treatment of FI, subject to confirmatory phase 3 trial(s). (ClinicalTrialRegister.eu; EudraCT Number: 2010-021463-32)

A novel labeling modality of intra-abdominal lesions with Magseed magnetic marker and extirpation by Sentimag probe navigation

OBJECTIVE: This study aimed to evaluate our experience with the use of Magseed, the magnetic metallic marker, as a localization technique followed by Sentimag probe detection in patients with solitary intra-abdominal local metastases with subsequent resection of the lesions. METHODS: Five patients underwent resection after the lesion was marked with the Magseed magnetic marker. Prior to the surgery, a computed tomography scan of the chest and abdomen and/or positron emission tomography was performed to rule out the dissemination of the disease. The indication for surgery was evaluated in a meeting of a multidisciplinary team, and the placement of the magnetic marker under computed tomography control had been performed the day before the planned procedure. RESULTS: The present preliminary outcomes have revealed that Magseed might be a promising technique that is feasible and safe, particularly when the postsurgical anatomic conditions in the abdominal cavity are altered and the lesions are not visible or palpable. Surgical extirpation of lesions occurred without complications in each case. In all the cases, the resection was complete and curative, and one wound infection in all (20%), without any major complications, had occurred. The mean hospital stay was 6.6 days. CONCLUSION: Magseed utilization, as a localization technique, followed by Sentimag probe detection in intra-abdominal tumors has not been reported before. Improving the visualization and, consequently, the precise marking of the lesion with subsequent radical removal can prevent insufficient or excessive removal of healthy tissue, leading to a faster diagnosis and better overall clinical outcomes

Optimalization of the management system of tool cribs in Siemens Elektromotory, s.r.o., company Mohelnice

Import 30/11/2009Prezenční345 - Katedra mechanické technologieNeuveden

The metod development for determination of diazodinitrofenol explosive

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Analytical Chemistry Consultant: Doc. RNDr. Dalibor Šatínský, PhD. Diploma Thesis Title: The method development for determination of diazodinitrofenol explosive A new HPLC method for determination of diazodinitrophenol alongside with sodium picramate was developed and optimized. Column Ascentis® Express C18 10cm x 3mm; 2.7µm particles was select as most suitable one. Detection of compounds was performed at 220 nm using UV detector. Mobile phase consist of mixture 0.085% H3PO4 and acetonitrile in ratio 70/30. Flow rate was determined at 0.8 ml/min. Column oven temperature was set to 50řC. Retention times under these condition was tDDNP=1.324 min a tPikNa=4.012 min. Keywords: determination, diaziodinitrophenol, sodium picraminate, HPLC, chromatography, dinol, DDN