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Olomouc, Czech Republic

Hobzova M.,Klinika plicnich nemoci a tuberkulozy | Kolek V.,Klinika plicnich nemoci a tuberkulozy | Zapletalova J.,Ustav lekarske biofyziky
Studia Pneumologica et Phthiseologica | Year: 2014

Obstructive sleep apnea (OSA) is characterized by pauses in breathing during sleep, decrease in blood oxygen saturation and micro-awakenings with subsequent excessive daytime sleepiness and fatigue. OSA may be present together with bronchial asthma (BA) or chronic obstructive pulmonary disease (COPD). Treatment of OSA with positive airway pressure may contribute to more effective therapy of both BA and COPD. The aim was to determine the prevalence of BA and COPD in two groups OSA patients. In a group of retrospectively assessed patients with OSA newly diagnosed in 2012 (n = 300), BA and COPD was noted in 8.7 % and 12.3 % of patients, respectively. In another group of OSA patients newly diagnosed over a period of five years (n = 286), the BA and COPD rates were 7.3 % and 13.3 %. There was no significant difference in the prevalence of BA or COPD between treated and untreated OSA patients (p = 0.408). There was no correlation between OSA severity and the presence of BA or COPD in either treated (p = 0.099) or untreated (p = 0.093) individuals. The study revealed a relatively high prevalence of BA and COPD in patients with OSA. Source

Aim: To assess the value of exercise tissue Doppler echocardiography in the prognostic stratification of patients with congestive heart failure with impaired systolic function. Patients and methods: We enrolled 106 patients with congestive heart failure and LVEF ≤ 45% on optimal pharmacotherapy. Thepatients underwent blood sampling for BNP level analysis, resting echocardiographic examination, cardiopulmonary exercise test usingbicycle ergometry, and a post-exercise echocardiographic study. We formed two groups of patients according to their prognostic classification. Group I included 21 patients with a poor prognosis defined as predicted value of pVO2 < 76%, together with both VE/VCO2slope > 32.7 pg/ml and BNP > 210 pg/ml, and Group II with 85 patients not meeting the above criteria for poor prognosis.Results: There were significant differences in indexed left atrial volume, mitral regurgitation severity, systolic mitral annulus velocity atrest and after exercise, and in E/Em at rest and in E′/Em′ after exercise. Multivariate analysis identified E/Em as the only independentpredictor of prognosis. An E/Em at rest (after exercise) ≥ 16.6 (18.7) identified a poor prognosis with a sensitivity of 71% (86%) andspecificity of 71% (71%).Conclusion: Exercise tissue Doppler echocardiography may be superior to resting parameters in the prognostic stratification of patients with congestive heart failure. Source

Lostak J.,Ortopedicka klinika Lekarske fakulty | Gallo J.,Ortopedicka klinika Lekarske fakulty | Zapletalova J.,Ustav lekarske biofyziky
Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca | Year: 2016

PURPOSE OF THE STUDY The aim of the study was, first, to assess satisfaction of our patients after primary total knee arthroplasty (TKA) at various intervals of follow-up. Second, a list of pre- and peri-operative factors with potential effects on patient satisfaction was analysed. The third objective was to identify conditions under which a result of replacement could be considered definite with a little probability of further unexpected development. A more detailed knowledge of unsatisfied patients may provide valuable information for use in pre-operative evaluation, indication for surgery, as well as in the surgery itself. MATERIAL AND METHODS This prospective study consisted of 826 patients who underwent primary TKA between September 2010 and March 2015 and had at least one complete post-operative examination. Our group included 296 men and 530 women. The average age at primary TKA was 68.9 (45-87). Primary osteoarthritis was the most frequent indication to surgery (82.6 %). The follow-up period ranged from 1 month to 3 years. On each follow-up examination, every patient received an original questionnaire with 24 questions concerning the course of their post-operative period (between the discharge from hospital and the planned follow-up). The patients assessed the degree of satisfaction with surgery outcomes on a scale ranging from "fully satisfied" to "dissatisfied" and expressed their overall satisfaction in percents. RESULTS At the final follow-up, 6.5% of the patients were not satisfied with the outcome. The patients' overall satisfaction was 90.2 % (i.e., responses to the question of how you were satisfied with surgery). Significantly more satisfied patients were among those with primary osteoarthritis. Their satisfaction was related to the level of the UCLA activity rating, feelings of uncertainty when walking and to the functional ability component of the KSS system. On the other hand, more dissatisfied patients were found among those with several previous operations, a higher ASA score or a higher number of risk factors (Charlson comorbidity score etc.). The duration of pre-operative complaints had no relation to post-operative satisfaction. Similarly, there was no relation between VAS-evaluated pain intensity before TKA and patient satisfaction after arthroplasty. Obesity and satisfaction were not inter-related either. DISCUSSION Assessment of satisfaction is one of the Patient Reported Outcome Measures (PROMs) used by patients to evaluate the effect of a therapeutic method. These instruments aid in assessing the degree to which the method has met the needs and expectations of patients. It is relevant to emphasise that subjective factors, such as expectation or satisfaction, do not depend on the therapeutic procedure only. Recent reports have shown that, in 10% to 30% of the patients, the TKA outcome has not met their expectations. More detailed studies draw attention to the fact that there are more dissatisfied patients after TKA than those after THA. When satisfaction with pain relief is considered, the number of dissatisfied patients is even lower (72%-86%). CONCLUSIONS An analysis of the patients' responses shows that the rate of satisfaction is high shortly after surgery but declines gradually thereafter. The overall satisfaction is stable about 12 months after the surgery. The number of dissatisfied patients or those reporting pain after TKA in our study is in agreement with the results reported in relevant literature. The associations found here will be used in preparing a tool for clinical outcome prediction. © Česká společnost pro ortopedii a traumatologii 2006. Source

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. Source

Markova I.,Ustav Genetiky A Fetalni Mediciny | Pilka R.,Porodnicko gynekologicka Klinika | Duskova M.,Ustav Patologicke Anatomie | Zapletalova J.,Ustav lekarske biofyziky | Kudela M.,Porodnicko gynekologicka Klinika
Ceska Gynekologie | Year: 2010

Objective: To assess the immunohistochemical expression of p53, bcl-2, c-erbB-2, Ki-67, estrogen (ER) and progesterone (PR) receptors in endometrial cancer patients. To assess the relation between steroid receptors positivity and other markers. To evaluate the prognostic significance of clinicopathologic and immunohistochemical markers on patient disease free survival. Design: Experimental prospective study. Setting: Department of Obstetrics and Gynaecology, Institute of Human Genetics, Department of Pathology, Department of Biophysics, Palacky University Medical School and University Hospital, Olomouc. Methods: We studied 144 cases of primary untreated endometrial carcinoma in which the p53, bcl-2, c-erbB-2, Ki-67, ER and PR antigens were investigated with the use of an immunohistochemical method. In a group of 122 patients we assessed disease free survival (DFS) in relation to clinicopathologic and immunohistochemical factors. Results: From the total group of 144 patients, 122 were included for survival analysis. We found 15 (12,3%) patients with recurrence of the disease. Mean age was 64,5 (34-88) years. Immunohistologic expression was p53 positive in 29 (23,8%), bcl-2 positive in 87 (71,3%), c-erbB-2 positive in 34 (27,9%), Ki-67 positive in 56 (45,9%), ER positive in 97 (79,5%) and PR positive in 106 (86,9%) of cases. In the survival analysis significantly shorter DFS was present in tumours with poor differentiation (G3), deep myometrial invasion (M2) and positive lymphoinvasion (N). Conclusion: Only poor differentiation (G3) and deep myometrial invasion (M2) are significant independent factors for the length of DFS. Source

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