Casopís lékar̆ů c̆eských
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Casopís lékar̆ů c̆eských · Jan 2007
[Surgery tracheostomies and percutaneous dilatation tracheostomies--retrospective study].
Surgical tracheostomy (ST) is replaced by percutaneous dilatation tracheostomy (PDT), namely because the second one requires less equipment and it consumes less time. PDT is indicated and performed mostly in intensive-care units. We focused on the type of technique of both methods and on the frequency of their complications. ⋯ During the last five years an increase of PDT performed to secure airways was observed. When performing ST, horizontal incision of the skin and division of the thyroid gland isthmus were used most frequently. Griggs' technique was used to perform PDT. PDT was associated with the higher rate of early complications and there was no significant difference in late complications in both groups.
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Casopís lékar̆ů c̆eských · Jan 2007
Case Reports[Decompressive craniectomy in the treatment of posttraumatic edema and the contribution of new diagnostic methods].
The authors present a case report of a young male who suffered a brain injury complicated with malignant posttraumatic edema managed with bilateral decompressive craniectomy after conservative treatment failure. They further discuss current surgical approach to posttraumatic brain edema and contribution of new diagnostic methods in secondary brain damage management.
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Casopís lékar̆ů c̆eských · Jan 2007
Review[Obesity based on mutation of genes involved in energy balance].
Within the last decade an intensive research led to an identification of several genes which are involved in a regulation of energy balance. In most cases, carriers of these gene mutations do not exhibit further characteristic phenotypic features except for a severe obesity. Obesity based on mutation of one gene product is called monogenic obesity. ⋯ Mutations of the other genes involved in energy homeostasis are very rare. Although these mutations are sporadic we assume that further research of monogenic forms of obesity might lead to our understanding of physiology and pathophysiology of regulation of the energy homeostasis and eating behaviour. Additionally, they may open new approach to the management of eating behaviour and to the treatment of obesity.
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Adverse cardiac outcomes continue to be an important cause of perioperative morbidity and mortality in the non-cardiac surgery. This is related to the high prevalence of coronary artery disease in the aging surgical population. Beta-blockers were proved useful and efficacious in the treatment of perioperative myocardial ischaemia and arrhythmia. ⋯ However, one recent meta-analysis and several new studies have not confirmed the postulated beneficial effects of perioperative betablockade and gave rise to an animated controversy. Until the finalization of ongoing large trials in the next two years, the decision to start prophylactic perioperative beta-blockade remains at the discretion of the responsible physicians. This decision should be based on the patient's risk, the type of surgery and on the consideration of potential interactions and side-effects of the selected beta-blocker.
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Casopís lékar̆ů c̆eských · Jan 2007
Randomized Controlled Trial Comparative Study[Pilot study to evaluate blood glucose control by a model predictive control algorithm with variable sampling rate vs. routine glucose management protocol in peri- and postoperative period in cardiac surgery patients].
Increased blood glucose levels are frequently observed in critically ill patients. Recent studies have shown that the normalization of glycemia by intensive insulin therapy decreases mortality, length of the hospitalization and number of complications. ⋯ The results of our pilot study suggest that eMPC algorithm is more effective in maintaining euglycemia in peri- and post-operative period in patients after cardiac surgery and comparably safe as compared to RP.