Trauma Care on Geriatric Population in Trauma Centre Faculty Hospital Královské Vinohrady in Prague.

Higher incidence of injury in trauma patients older than 65 years is connected with growing morbidity and mortality, first of all in polytrauma. Incidence of preexisting diseases play a great role in development of postinjury reaction. There are risk factors for genesis of postinjury complications and also mortality of victims.

[Innovated Judet Ribs Plates - Preclinical Study, First Clinical Experience].

PURPOSE OF THE STUDY Based on the experience with using the Judet plates in stabilization of rib fractures an innovated Judet plate was constructed in cooperation with the Development Department of Medin company. During the preclinical part of the project, following the construction of the new Judet plate, a surgical technique was elaborated. Subsequently, the clinical application of rib osteosynthesis with innovated plates was commenced.

[Damage control surgery in thoracic trauma].

Damage control surgery (DCS) is an integral part of management in critically injured patients. These usually involve patients with profound hemorrhagic shock with the development of acidosis, hypothermia and coagulopathy. Three stages of DCS are widely accepted: 1) Limited operation to control bleeding and contamination.

[Complicated intraabdominal infections in surgical patients-empiric antimicrobial therapy management].

Any intraabdominal infection (IAI) is a complex disease that requires an assessment of a number of various aspectsimportant for determining proper therapeutic management, including an appropriate antimicrobial regimen. Current classifications of intraabdominal infections recognize various types of peritonitides (primary, secondary, tertiary); however, for clinical needs the cases are most commonly divided as non-complicated and complicated intraabdominal infections. In any intraabdominal infection, the surgical intervention includes perioperative empiric choice of antibiotics, which should take into account - in addition to the severity level of the infection - the epidemiological situation and risk factors of the presence of resistant bacteria in the patient.

[Surgical Stabilisation of Flail Chest Injury: Indications, Technique and Results].

Purpose Of The Study: Multiple rib fractures with segmental chest wall instability are caused by high-energy chest trauma and are associated with significant morbidity and mortality. Flail chest injuries are mostly combined with lung injury (contusion, rupture, laceration) and subsequent pneumothorax or haemothorax. Early mechanical ventilation with internal pneumatic splinting is a conservative treatment for flail chest in patients with respiratory insufficiency.

[Basic principles of diagnosis and treatment of secondary peritonitis - recommendations of experts with the support of SIS].

Secondary peritonitis is the most common cause of inflammatory acute abdomen treated at general surgery departments. Only early and correct diagnosis may improve the prognosis of these patients. The authors compiled an interdisciplinary review of the basic principles of diagnosis and treatment of secondary peritonitis, which reflects current findings supported by evidence-based medicine.

[Importance of interdisciplinary cooperation in multiple trauma management].

Multiple trauma represents the most serious type of trauma in which the result of the treatment depends on the quality of pre-hospital care according to ATLS (Advanced Trauma Life Support) as well as on the availability of emergency specialized care in traumatology centres. Resuscitation in the early post-injury phase involves prevention of the lethal triad (hypothermia, acidosis, coagulopathy) development, as early as during pre-hospital care and also during admission to a traumatology department (damage control resuscitation). Damage control resuscitation involves permissive hypotension and coagulopathy correction with red blood cells (RBCs), fresh frozen plasma and platelets administration with crystalloid solutions restriction.

[Present concept for management of severely injured patients in Trauma Centre Faculty Hospital Královské Vinohrady].

Background: The implementation of standardized protocols for management of polytrauma, multiple injuries and complicated monotrauma has led to improvement in trauma care with decrease in posttraumatic morbidity and mortality. The introduction of algorithm "Definitive Surgical Trauma Care" (DSTC) with concept of "damage control" surgery assumed the principal role in care of polytrauma patients. It can be accomplished only in the trauma- centre with implementation of care system for severely injured patients.

[Penetrating thoracic and abdominal injuries: diagnostic and therapeutic approach].

Introduction: Penetrating thoracic or abdominal or combined injuries are associated with high risk of life-threatening intraabdominal or intrathoracic organ injury. Most patients require acute surgery. When miniinvasive technique is available, thoracoscopic or laparoscopic intervention is indicated in hemodynamically stable patients to evaluate severity of the injury, as well as to treat the condition.

[Principles of the thoracic wall injury management].

The overview presents the current situation in the diagnostics and therapy of unstable thoracic wall injuries. The diagnostic spectrum is enlarged by multidetector computed tomography with 3D reconstruction imaging in rib fractures. The use of MDCT in routine examination of blunt thoracic injuries proved to bet the most sensitive imaging method in rib fractures detection, including their dislocations and assessment of the extent of thoracic wall deformity.

[The spectrum of diaphragmatic injuries managed in a Prague traumatology centre].

Introduction: Diaphragmatic injuries may result from blunt or penetrating injuries. The symptomatology is usually overlaid by symptoms of associated abdominal or thoracic injuries or by symptoms of other systems injuries in polytraumas. Multidetector computer tomography (MDTC) facilitates the improvement of preoperative diagnostics in blunt injuries.

[A contribution of multidetector computed tomography to indications for chest wall stabilisation in multiple rib fractures].

Purpose Of The Study: Multidetector computed tomography (MDCT) is more sensitive for the detection of injury to the thoracic wall and intra-thoracic organs than a plain chest radiograph. The chest wall deformity and instability following multiple rib fracture involves fractures of four or more adjacent ribs at two levels, sometimes including a sternal fracture. It may also be associated with lung trauma (pneumothorax, haemothorax, rupture, laceration or pulmonary contussion).

[The role of VATS in the treatment of thoracic empyema].

Introduction: Videothoracoscopy (VTS) and video-assisted thoracoscopic (VATS) decortication is commonly used in the treatment of early thoracic empyema. However, its conversion to thoracotomy is more frequent in chronic empyema cases. The authors evaluate the role of VTS/VATS in the pleural empyema therapy in the group of patients treated for thoracic empyema using VATS or thoracotomic decortication.

[Abdominal catastrophe--surgeon's view].

Abdominal catastrophe is a serious clinical condition, usually being a complication arising during treatment of intraabdominal nontraumatic disorders or abdominal injuries. Most commonly, inflamation- secondary peritonitis, is concerned. Abdominal catastrophe also includes secondary signs of sepsis, abdominal compartment syndrome and enterocutaneous fistules.

Increased proinflammatory cytokine production in adipose tissue of obese patients with chronic kidney disease.

Background: Obesity is a known high-risk factor for the development of vascular diseases and chronic kidney disease (CKD). In this study we aimed to elucidate the impact of adipose tissue on the inflammatory state in CDK patients with obesity.

Patients And Methods: A cohort of 40 patients with CKD (stages 3-4) with mild proteinuria (2.

[One-year survival outcomes in patients with pancreatic head and portomesenteric veins resection].

Introduction: Hemipancreatoduodenectomy is a standard technique for surgical management of pancreatic head carcinomas. However, so far, mesenteric and/or portal vein resections have not been commonly indicated. This original report presents one-year survival outcomes in a group of operated subjects.

[Antimicrobial treatment of nosocomial intra-abdominal infections--new treatment options with tygecycline].

Introduction: Nosocomial, intra-abdominal infections are extremely serious conditions, considering possibilities for their early diagnosis, as well as for their effective therapy. Multiresistant bacteria (Enterobacteriacae producing extended-spectrum beta-lactamases - ESBL Escherichia coli, Klebsiella species, vancomycin-resistant enterococci [VRE], and methicillin-resistant Staphylococcus aureus [MRSA]) are frequently isolated as pathogens of these infections. Tygecycline is among the novel wide- spectrum antibiotics affecting multiresistant bacteria, which are being introduced in clinical practice.

[Damage control laparotomy in blunt abdominal injury].

Purpose Of The Study: Damage control surgery is one of the major advances in surgical techniques used in polytrauma patients in the past 25 years. It is based on a foreshortened pre-operative examination during ongoing resuscitation which includes surgical intervention in an injured patient with severe hypotension due to haemorrhage. In this seven-year retrospective study the authors evaluate the results of damage control laparotomy in patients with injury to the abdominal organs, retroperitoneum and pelvis.