Ústí nad Labem, Czech Republic
Ústí nad Labem, Czech Republic

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Kubackova K.,Fakultni Nemocnice V Motole | Finek J.,Fakultni Nemocnice Plzen | Vyzula R.,Masarykuv Onkologicky Ustav | Zvarikova M.,Masarykuv Onkologicky Ustav | And 9 more authors.
Klinicka Onkologie | Year: 2011

Backgrounds: The Yondelis® (trabectedin) project was initiated in January 2011 with the aim to obtain basic epidemiological information on patients with soft tissue sarcomas, standard treatment procedures, and results of trabectedin therapy in routine clinical practice. Expert patronage is provided by the Czech Society for Oncology, CzMA JEP. The project covers a representative sample of Comprehensive Cancer Care centres established to provide systematic treatment to patients with soft tissue sarcoma. Patients and Methods: 45 patients diagnosed with soft tissue sarcoma were retrospectively included in the database. Median age at the initiation of trabectedin therapy was 51 years (23-72 years). Leiomyosarcoma was the most frequent tumour (35.6%), synovial sarcoma occurred in 13.3% of patients; liposarcoma, peripheral nerve sheath tumours and unspecified sarcomas contributed 6.7% each. 62.2% of sarcomas were larger than 5 cm. Trabectedin was administered in a dose of 1.5 mg/m 2 once in 3 weeks. 40% of patients received trabectedin as the 2nd line treatment, 35.6% as the 3rd line, and 34.4% as the 4th line. Results: Median number of administered cycles was 4(1-10 cycles). Neutropenia (28.9% of patients) and elevated liver enzymes (26.7% of patients) were the most frequent adverse affects. 73.8% of patients terminated the therapy due to disease progression. Treatment response was recorded in 6.6% of patients (complete and partial remission), stable disease in 26.7%, and progression in 53.3%. Median overall survival (95% CI) was 11.7 months (9.6; 13.8), median progression-free survival (95% CI) was 3 months (2.4; 3.6). Conclusion: Expert cancer societies have recently recommended trabectedin as the 2nd line palliative treatment for soft tissue sarcomas with documented effectiveness, particularly in liposarcomas and leiomyosarcomas, and good safety profile.


Josef T.,KHS Usteckeho kraje | Ivo P.,Vyzkumny ustav veterinarniho lekarstvi | Petra V.,Vyzkumny ustav veterinarniho lekarstvi | Ladislava M.,KHS Usteckeho kraje | And 3 more authors.
Epidemiologie, Mikrobiologie, Imunologie | Year: 2012

Until recently, viral hepatitis E (VHE) has typically been an imported infection, related to travel to developing countries. A number of travel-unrelated VHE cases currently diagnosed in the Czech Republic. Outcomes of the epidemiological investigations of two VHE outbreaks associated with the consumption of pork and pork products at pig-slaughtering feasts are presented. Thirteen cases have been reported in the first outbreak and eight cases in the second outbreak. The epidemiological investigations are described and the experience gained in analysing suspected biological specimens is presented. The source of infection has not been identified in the first outbreak while in the other one, a link between human cases and infection in farm pigs was revealed for the first time. Although the epidemiological investigation may not always lead to the detection of the VHE source, it must be conducted in any outbreak and can only be successful when done in cooperation of the public health authorities with the veterinary health agency. © Česká lékařská společnost Jana Evangelisty Purkyně, Praha 2012.


Edelmann K.,Masarykova nemocnice Usti nad Labem | Obruba P.,Masarykova nemocnice Usti nad Labem | Kopp L.,Masarykova nemocnice Usti nad Labem | Cihlar J.,Usti nad Labem | Celko A.M.,Ustav epidemiologie 3. LF UK
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca | Year: 2011

PURPOSE OF THE STUDY To evaluate the mid-term results in a group of patients with displaced comminuted (three- and four-fragment) fractures of the proximal humerus treated by angle-stable plate osteosynthesis and compare them with the results in the patients in whom the method of percutaneous Kirschner-wire (K-wire) fixation was used. MATERIAL AND METHODS The group treated with angle-stable implants (ASI group) consisted of 55 patients, 13 men and 42 women. A Targon Ph nail was used in 32 and a Philos plate in 23 patients. These patients were compared with a group of nine patients, one man and eight women, treated by percutaneous K-wire fixation (K-wire group). At a follow-up of 12 months at least, final Constant (CS) and DASH scores were assessed. The CS was related to the values for the unaffected limb, and an individual relative CS was calculated and expressed in percent. The mean follow-up was 30 (range, 13-55) months in the ASI group and 58 (range, 39-76) months in the K-wire group. The following seven characteristics were evaluated: fracture type, surgical technique, dominance of the affected limb, patient age, injury-surgery interval, and individual relative CS and DASH scores. The results were statistically analysed with a 5% level of statistical significance set for all tests. RESULTS The average age in the ASI group was 62.1 years, with 64.7 (range, 29-95) years for women and 35.5 (range, 26-76) years for men. In the K-wire group the average age was 66.1 (range, 53-84) years. The functional outcomes in four-fragment fractures were significantly worse than in three-fragment fractures (mean relative CS and DASH scores of 56 and 21 versus 72 and 32). The K-wire group showed a significantly worse functional outcomes than the ASI group in both the mean relative CS score (p<0.001) and the mean DASH score (p=0.003). No significant relationship was found in any other pair of variables. The patient's age had no effect on functional outcome, as assessed by CS (p=0.412) and DASH (p=0.076) and the injury-surgery interval had no influence, either (CS, p=0.220; DASH, p=0.118). There was no relation between the patient's age and choice of the surgical method (p=0.467), between the patient's age and a fracture type (p=0.356) and between the patient's age and injury to either a dominant or a non-dominant limb (p=0.659). Dominance or non-dominance of the affected limb had no effect on CS or DASH scores (p=0.662 and p=0.302, respectively) or on a type of fracture (p=0.183). DISCUSSION Several surgical techniques used for the treatment of proximal humerus fractures suggest the absence of consensus in therapy. Novel angle-stable implants show better biochemical properties and meet criteria required in minimally invasive techniques. Some authors prefer intramedullary nailing for three-fragment fractures and the use of an angle-stable plate for four-fragment fractures. These indication criteria were also confirmed by the results of our study. CONCLUSIONS The analysis of functional outcomes showed that the therapeutic effect of K-wire transfixation was significantly worse than the effect of the angle-stable plate technique, and therefore the authors stopped using this method. At present intramedullary nailing is indicated in two- and three-fragment fractures and in some less displaced four-fragment fractures. An angle-stable plate is used in severely displaced four-fragment fractures. If the head is broken or dislocated, older patients are primarily indicated for hemiarthroplasty and younger ones for humeral head reconstruction.


PubMed | Masarykova nemocnice Usti nad Labem
Type: Comparative Study | Journal: Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca | Year: 2011

To evaluate the mid-term results in a group of patients with displaced comminuted (three- and four-fragment) fractures of the proximal humerus treated by angle-stable plate osteosynthesis and compare them with the results in the patients in whom the method of percutaneous Kirschner-wire (K-wire) fixation was used.The group treated with angle-stable implants (ASI group) consisted of 55 patients, 13 men and 42 women. A Targon Ph nail was used in 32 and a Philos plate in 23 patients. These patients were compared with a group of nine patients, one man and eight women, treated by percutaneous K-wire fixation (K-wire group). At a follow-up of 12 months at least, final Constant (CS) and DASH scores were assessed. The CS was related to the values for the unaffected limb, and an individual relative CS was calculated and expressed in percent. The mean follow-up was 30 (range, 13-55) months in the ASI group and 58 (range, 39-76) months in the K-wire group. The following seven characteristics were evaluated : fracture type, surgical technique, dominance of the affected limb, patient age, injury-surgery interval, and individual relative CS and DASH scores. The results were statistically analysed with a 5% level of statistical significance set for all tests.The average age in the ASI group was 62.1 years, with 64.7 (range, 29-95) years for women and 35.5 (range, 26-76) years for men. In the K-wire group the average age was 66.1 (range, 53-84) years. The functional outcomes in four-fragment fractures were significantly worse than in three-fragment fractures (mean relative CS and DASH scores of 56 and 21 versus 72 and 32). The K-wire group showed a significantly worse functional outcomes than the ASI group in both the mean relative CS score (p<0.001) and the mean DASH score (p=0.003). No significant relationship was found in any other pair of variables. The patients age had no effect on functional outcome, as assessed by CS (p=0.412) and DASH (p=0.076) and the injury-surgery interval had no influence, either (CS, p=0.220; DASH, p=0.118). There was no relation between the patients age and choice of the surgical method (p=0.467), between the patients age and a fracture type (p=0.356) and between the patients age and injury to either a dominant or a non-dominant limb (p=0.659). Dominance or non-dominance of the affected limb had no effect on CS or DASH scores (p=0.662 and p=0.302, respectively) or on a type of fracture (p=0.183).Several surgical techniques used for the treatment of proximal humerus fractures suggest the absence of consensus in therapy. Novel angle-stable implants show better biochemical properties and meet criteria required in minimally invasive techniques. Some authors prefer intramedullary nailing for three-fragment fractures and the use of an angle-stable plate for four-fragment fractures. These indication criteria were also confirmed by the results of our study.The analysis of functional outcomes showed that the therapeutic effect of K-wire transfixation was significantly worse than the effect of the angle-stable plate technique, and therefore the authors stopped using this method. At present intramedullary nailing is indicated in two- and three-fragment fractures and in some less displaced four-fragment fractures. An angle-stable plate is used in severely displaced four-fragment fractures. If the head is broken or dislocated, older patients are primarily indicated for hemiarthroplasty and younger ones for humeral head reconstruction.

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