Hradec Králové, Czech Republic
Hradec Králové, Czech Republic

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Smrcka M.,Neurochirurgicka Klinika | Sprlakova A.,Radiologicka Klinika | Smrcka V.,Neurochirurgicka Klinika | Kerkovsky M.,Radiologicka Klinika
Ceska a Slovenska Neurologie a Neurochirurgie | Year: 2010

The diagnostics of intramedullary lesions remain difficult even in these days of MRI. Verification of the aetiology of the pathological process is very important from a neurosurgical point of view, because it plays a substantial part in indications for operative treatment. It is vital that such indication be clearly established, since operations for intramedullary lesion involve a high risk of iatrogenic damage to the patient. In general, tumour and vascular malformations are considered sufficient reasons for operation. On the other hand, conservative treatment is usually preferred for non-tumorous expansions. Differential diagnosis with the aid of MRI is difficult, not only in terms of the type of the tumour but further in terms of distinguishing between tumorous and non-tumorous lesions (inflammation, ischemia, demyelinisation). Sometimes even the patient's history and neurological examination cannot help. The authors of this article illustrate this difficult topic by means of several case reports. They recommend that, should some doubt exist about the aetiology of the process, operative treatment (including biopsy) always be delayed, and a follow-up MRI performed after some time. In the end, the natural course of the disease will usually indicate how best to proceed.

Komarek J.,Ortopedicka Klinika | Valis P.,Ortopedicka Klinika | Repko M.,Ortopedicka Klinika | Chaloupka R.,Ortopedicka Klinika | And 4 more authors.
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca | Year: 2010

PURPOSE OF THE STUDY The authors present the long-term results of surgical treatment of deep chondral defects of the knee (medial or lateral femoral condyle). They used the transplantation of autologous cultured chondrocytes in the form of a solid chondral graft. MATERIAL AND METHODSIndications for autologous chondrocyte transplantation most frequently included acute trauma to the knee. Patients with chondral lesions categorized as grades IIIa and IIIb by the Noyes-Stabler classification were indicated for this treatment. A small sample of healthy cartilage was harvested arthroscopically from the non-weight-bearing area of the knee and was sent to the Tissue Bank for chondrocyte cultivation. After 4 to 5 weeks the cultured chondrocytes were formed into a solid chondral graft, implanted at the damaged site of the medial or lateral femoral condyle and fixed with fibrin glue (Tissucol). RESULTS Fifty-two patients, 34 males and 18 females (average age, 29 years range, 17 to 45 years) were treated using this method in the period from 2001 to 2009. Follow-up was 6 to 84 months, with an average of 46 months. Thirteen patients were examined by magnetic resonance imaging (MRI) 7 to 39 months (average, 19 months) after the implantation. Full incorporation the chondrograft was observed in 12 patients (92.3%). The clinical results were evaluated by the Lysholm scoring system (1, 2 and 5 years after the operation) and showed significant improvement. In 24 patients, the chondrograft quality was evaluated by immunohistochemical methods in samples taken by second-look arthroscopy from the borders of implantation sites. Hyaline chondral tissue was detected in 100% samples by microscopic examination, and collagen type II was present in 100% samples examined by imnunohistochemistry using haematoxylin-eosin staining. CONCLUSIONS A significant improvement in knee function was recorded when the pre-operative and final follow-up stages were compared. The autologous chondrocyte transplantation showed a potential for the treatment of large cartilage defects. The excellent results achieved allowed the patients to return to normal activity levels. This method is also convenient when ligament reconstruction is necessary during one operation.

This article deals with the diagnostics of axillary lymph nodes and status of core-needle biopsy in the diagnostic algorithm of breast cancer. Ultrasonography is still considered as the basic method for investigation of lymph nodes. This article describes the normal appearance of lymph nodes and their suspicious or pathological appearance. Suspect and unclear findings of lymph nodes are followed by ultrasound-guided core-needle biopsy. The technical implementation of this biopsy is simple and safe with adequate knowledge and the awareness of possible complications. In case of unclear lymph nodes, their histological verification determines the following treatment.

Brtkova J.,Radiologicka Klinika | Jirickova P.,Multiscan Radiologicke Centrum
Ceska Radiologie | Year: 2012

Aim. To summarize and display the imaging findings in patients with different types of both frequent and less frequent types of tarsal coalition, to discuss the imaging protocols, differential diagnoses and give brief information on clinical findings and treatment. Method. The authors display CT, MRI and X-ray findings in 8 patients with the main types of coalition (talocalcaneal, calcaneonavicular), with a bilateral talocalcaneal coalition and in a patient with a complex synostosis. Results. The encountered findings were: narrowed or absent joint space, thinned irregular cortical line, adjacent oedema and sclerosis and an unusual shape of the involved bones. Secondary degenerative changes in the adjacent joints were often encountered. Depending on the type of coalition and on the projection, this diagnosis presents with X-ray findings, which are either prominent (in calcaneonavicular coalition and an oblique X-ray) or subtle and indirect (all other cases). In MRI and CT the diagnosis is much more obvious. The pathognomonic signs as well as secondary degenerative signs will be pointed out together with the appropriate imaging protocols. A differential diagnosis will be discussed. The findings of the authors will be correlated with the literature. Conclusion. It is necessary to be aware of the findings in tarsal coalition, in order to establish the diagnosis even in cases unsuspected by the clinitian. This is more challenging in plain X-rays, in CT and MRI it is mandatory to include the subtalar and tarsal joints in the examination of the ankle.

Kocova E.,Radiologicka Klinika | Elias P.,Radiologicka Klinika
Ceska Radiologie | Year: 2015

Incidence and prevalence of idiopathic pulmonary fibrosis are increasing. The integral part of diagnostics of idiopathic pulmonary fibrosis is high resolution computed tomography. Radiological image of idiopathic pulmonary fibrosis is usual interstitical pneumonia. On high resolution computed tomography are changes of typical usual interstitial pneumonia, possible usual interstitial pneumonia or signs which are not typical for usual interstitial pneumonia. There was made uniform scoring system which is quite simple and reproducible.

Maly R.,Subkatedra Angiologie I. Interni Kliniky | Chovanec V.,Radiologicka Klinika
Vnitrni Lekarstvi | Year: 2010

Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes me-PADtus (DM) is fourfold higher compared to non-diabetic population. Patients with DM and PAD have a high risk of cardiovascular morbidity and mortality. Diabetes worsens the prognosis of patients with PAD; the onset of PAD in diabetics occurs at an earlier age, the course is faster than in non-diabetic patients and the disease is often diagnosed at its advanced stages. All these factors reduce the likelihood of revascularisation in DM patients with PAD. A range of factors (higher age, arterial hypertension, smoking, obesity, hyperfibrinogenaemia, insulin resistance etc.) contribute to the development of PAD in DM. Diabetes control is an independent risk factor of PAD as every 1% increase of hemoglobin A1C is associated with 28% increase of PAD. There are different clinical signs of PAD in diabetic and non-diabetic patients. In addition to the history of claudications, PAD diagnostic criteria include the presence of murmur over the large arteries, signs of chronic ischemia on the skin and distal ulcerations and gangrene. Among the imaging techniques, non-invasive investigations including Doppler pressure measurement, ankle brachial pressure index, color duplex ultrasonography, plethysmography, transcutaneous tension measurement, MR and CT angiography are preferred. Ankle brachial pressure index measurement is the easiest and the main investigation technique. The key principles of PAD treatment in diabetic patients include modification of risk factors, pharmacotherapy and revascularisation interventions aimed at improving clinical signs and prevention of cardiovascular morbidity and mortality. Antiplatelet treatment may prevent PAD progression and reduce cardiovascular events in DM patients. Early diagnosis of PAD in DM patients, rigorous prevention and aggressive management of the risk factors may significantly impact on the high incidence of amputations and decrease cardiovascular morbidity and mortality.

Polak P.,Oddeleni klinicke hematologie | Husa P.,Oddeleni klinicke hematologie | Kerkovsky M.,Radiologicka klinika
Interni Medicina pro Praxi | Year: 2016

The authors present a clinical case of a secondary relapsing Salmonella-sepsis in a patient with systemic lupus erythematodes. A multilevel spondylodiscitis with paravertebral abscesses as a cause of the disease was diagnosed. The choice of antibiotics was complicated by allergy to co-trimoxazole and manifestations of postantibiotic colitis during the ciprofloxacin treatment. Meropenem and doxycyclin were used in the treatment without any other complications.

Mihal V.,Ustav Molekularni a Translacni Mediciny | Neklanova M.,Detska Klinika | Michalkova K.,Radiologicka Klinika
Pediatrie pro Praxi | Year: 2016

Whilst pituitary adenomas are the most common cause of a sellar mass, there is a number of other neoplastic, infection, inflammatory, developmental and vascular aetiologies that should by considered by the radiologist. Intracranial lipomas are rare developmental lesions that occur because of abnormal differentiation of embryogenic meninges. We describe and illustrate a 7-year-old boy with suprasellar lipoma associated with fever-induced convulsions in course of respiratory infection. Intracranial lipoma was demonstrated with magnetic resonance imaging.

The musculoskeletal system is one of the major regions, where changes caused by diabetes mellitus (DM) are often encountered causing severe impairment of the quality of patients' lives. These changes have therefore become an important focus of diagnostic and therapeutic procedures, with imaging methods - both plain radiography, computed tomography (CT), magnetic resonance imaging (MRI) and to a lesser extent ultrasound (US), being their cornerstones. In the article the images of musculoskeletal (MSK) manifestations of diabetes mellitus are presented, structured into changes directly caused by DM, metabolic consequences of DM, syndromes with increased coincidence with DM and septic complications. The CT, MRI and radiographic images of both initial and extensive changes are being displayed as well as evolution of the changes in a radiographic series. The concerning pathophysiologic remarks are only basic, as they are not the primary focus of radiodiagnostics. In conclusion it is stated, that imaging of the MSK system in diabetic patients is a large issue in radiologic units serving internal medicine departments, that the imaging methods should be applied specifically and that the radiologic findings influence further management of the patients in many respects, but also, that in some diagnostic questions, namely concerning septic complications of the diabetic foot, a fully reliable and unequivocal interpretation is not always possible.

PURPOSE OF THE STUDY Non-displaced or minimally displaced scaphoid waist fractures can be surgically treated using either the percutaneous volar or the limited dorsal approach. These techniques provide apossibility of early wrist physiotherapy throughout the healing period, better functional outcomes and ashorter sick leave duration. Many reports cite low complication rates. The purpose of this study is to compare both techniques based on the complication rate and functional outcomes. MATERIAL AND METHODS The authors compared 42 patients treated for an acute scaphoid waist fracture by percutaneous osteosynthesis and 38 patients treated by osteosynthesis using a limited dorsal approach after afollow-up of at least 12 months. The differences between the groups were tested statistically. RESULTS The overall complication rate was 11.9% for the percutaneous approach and 15.8% for the dorsal approach. There was one case of non-union in each group. The differences in the complication rates as well as in the range of wrist motion and in persistent complaints were statistically insignificant. We found significantly (p = 0.042) better grip strength for the percutaneous approach. DISCUSSION Most of the complications detected were due to atechnical error during surgery and can be minimized by meticulous adherence to the technique. The difference in grip strength is very close to the significance level set for the study, and this will be necessary to clarify in aplanned prospective study. CONCLUSIONS Based on the statistical analysis of the results of our clinical data, the two techniques are comparable. © Česká společnost pro ortopedii a traumatologii 2006.

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