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

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,..

Functional outcome of low rectal resection evaluated by anorectal manometry

Background: Low anterior resection syndrome (LARS) covers disordered bowel function after rectal resection, leading to deterioration in patients’ quality of life. The aim of this study was to evaluate anorectal function after laparoscopic low anterior resection (LAR) by means of standardized instruments. Methods: This was a prospective clinical cohort study conducted in a single institution to assess functional outcome of patients 1 year after laparoscopic LAR by means of LARS score and high-resolution anorectal manometry. Results: In total, 65 patients were enrolled in the study. Mean tumour height was 9.4 ± 1.8 cm; total mesorectal excision during laparoscopic LAR with low end-to-end colorectal anastomosis was performed in all patients. One year after the surgery, minor LARS was detected in 33.9% of patients, major LARS in 36.9% of patients. Anorectal manometry revealed decreased resting pressure and normal squeeze pressure of the anal sphincters in the majority of our patients. Rectal compliance and rectal volume tolerability (first sensation, urge to defaecate and discomfort volume) were significantly reduced. The statistical testing of the correlation between LARS and manometry parameters showed that with increasing seriousness of LARS, values of some parameters (resting pressure, first sensation, urge to defaecate, discomfort volume and rectal compliance) were reduced. Conclusion: This study indicates that the majority of patients after laparoscopic LAR experience symptoms of minor or major LARS. These patients have decreased resting anal sphincter pressures, decreased rectal volume tolerability and decreased rectal compliance. © 2017 Royal Australasian College of Surgeon