Background: Talipes equinovarus, also termed club foot, is a congenital deformity of the ankle joint. Despite its prevalence of approximately 1 per 1000 live births, fetal talipes is relatively poorly studied since the introduction of percutaneous tendo Achilles tenotomies. Objectives: To document the associations, outcomes and prognosis of patients with antenatally diagnosed fetal talipes. The study aims to examine the association between, and prevalence of, fetal talipes and other abnormalities, structural and chromosomal, as well as the outcome in relation to postnatal surgery. The accuracy of prenatal ultrasound in diagnosing fetal talipes is also examined. Methods: A retrospective observational study was made of all cases presenting to the Fetal Medicine Unit between 1 January 2009 and 31 December 2014. All the identified cases were analysed to identify isolated talipes, associated abnormalities, and chromosomal abnormalities. The pregnancy outcomes were determined using the Astraia database as well as maternity records. When the outcome resulted in a live infant, these infants were followed up using the files at the referral hospital to determine the treatment method used and the number requiring surgery. Results: There were 155 cases, all referred to the Fetal Medicine Unit. Antenatal data included 75 who had other structural abnormalities and 75 who had isolated talipes. In five of the cases were no sufficient data could be found. Twenty-five cases were lost to follow-up, and 12 cases had no clubfoot at birth. Only one was labelled as having positional clubfoot. There were 91 live births. Of the cases of talipes with associated abnormalities, 21.19% were live births (excluding ENND). All terminations of pregnancy as well as 90.9% of intrauterine fetal deaths were complex talipes, and 94.52% of the cases of isolated talipes were live births. The most common associated abnormalities were of the central nervous system. Seventeen of the live births were lost to follow-up. Of the cases of isolated talipes, 53.19% had tenotomies and Ponseti treatment. The false positive rate of detecting fetal talipes on ultrasound was 7.74%. Conclusion: The study made it evident that complex talipes is associated with a poor pregnancy outcome defined as pregnancy loss, where isolated talipes is usually associated with a good pregnancy outcome. Ultrasound is a good diagnostic tool when diagnosing talipes antenatally but cannot diagnose the severity of the clubfoot. False negatives were not studied. The introduction of tenotomy can make a difference in the outcome of clubfoot in comparison with previous studies where tenotomies were not performed. Medical professionals need to address the importance of counselling, and a multidisciplinary team should be involved in cases involving prenatal counselling.

Charles University Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Veronika Šulová Supervisor: doc. PharmDr. Lukáš Červený, Ph.D. External supervisor: pplk. doc. MUDr. Jaroslav Pejchal, Ph.D. et Ph.D. Title of diploma thesis: Changes of internal organs after percutaneous exposure to sulfur mustard Sulfur mustard is a chemical warfare agent belonging to the group of blistering agents. The theoretical section of the thesis is mainly focused on the description of acute toxic effects, the mechanism of action, and deals with the current possibilities of poisoning therapy. The experimental section is focused on monitoring the effect of sulfur mustard poisoning in the liver, lung, and kidney of female C57BL/6J mice after the percutaneous administration. This work aimed to evaluate markers of oxidative stress and histopathological changes of the selected organs at 3, 5, and 7 days after the poisoning. Ferric reducing antioxidant power (FRAP) and thiobarbituric acid reactive substances (TBARS) methods were used to determine markers of oxidative stress. Histopathological changes were evaluated microscopically using the hematoxylin-eosin staining method. The airness of the lung parenchyma was also assessed by computer image analysis. First, the LD50 of sulfur mustard was...

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Purpose of Review: This article reviews the evidence on optimal medical therapy (OMT) versus coronary revascularization in patients with stable ischemic heart disease (SIHD) and advanced chronic kidney disease (CKD). Recent Findings: A post hoc analysis of the COURAGE trial in patients with SIHD and CKD showed no difference in freedom from angina, death, and nonfatal myocardial infarction (MI) between OMT and percutaneous intervention plus OMT compared with patients without CKD. The ISCHEMIA-CKD trial of 777 patients with advanced CKD revealed no difference in cumulative incidence of death or nonfatal MI at 3 years between OMT and revascularization but the composite of death or new dialysis was higher in the invasive arm. Additionally, there were no significant or sustained benefits in related to angina-related health status in invasive versus conservative strategy. Summary: An initial revascularization strategy does not reduce mortality or MI or relieve angina symptoms in patients with SIHD and advanced CKD.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第20228号 / 医博第4187号 / 新制||医||1019(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 小池 薫, 教授 福原 俊一, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24474号 / 医博第4916号 / 新制||医||1062(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 永井 洋士, 教授 大鶴 繁 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Purpose of Review: Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) have emerged as the invasive diagnostic tools of choice for hemodynamic assessment of the severity of CAD (coronary artery disease). We sought to comprehensively review the evidence on the utility of hemodynamic assessment of the coronary stenoses after percutaneous coronary intervention (PCI) using FFR/iFR, mechanisms of positive post-PCI iFR/FFR, and the clinical impact of significant residual ischemia. Recent Findings: The evidence on the utility of the post-PCI hemodynamic assessment has accumulated over the last few years. The post hoc analysis from the FAME 1 and FAME 2 data shows that higher post-PCI FFR is associated with better symptomatic improvement and lower event rate with larger increase in delta FFR (∆ FFR: post-PCI FFR – pre-PCI FFR). Unlike pre-PCI FFR, a consensus has not been established on the optimal value of post-PCI FFR, though multiple studies point toward better clinical outcomes with higher post-PCI FFR and larger ∆ FFR. Summary: Visual assessment of adequate stent apposition by coronary angiography is insufficient in evaluating for residual ischemia. The hemodynamic evaluation of residual ischemia by post-PCI FFR/iFR yields clinically relevant data and allows for appropriate post PCI optimization.

Bakgrund: Perkutan koronar intervention (PCI) är en etablerad behandling vid myokardiell infarkt men utförs även som planerat ingrepp vid angina pectoris. Efter en PCI kan patienten uppleva en förändrad livsvärld vilket kan påverka den psykiska hälsan negativt. Syfte: Syftet var att beskriva kranskärlspatienters upplevelser av psykisk hälsa inom det första året efter att ha genomgått PCI. Metod: En litteraturöversikt genomfördes som utgick från tolv artiklar med kvalitativ design där resultatet var byggt utifrån ett patientperspektiv. Publicering av artiklarna gjordes från 2008 till 2021. Data samlades in via databaserna Cinahl och Pubmed, vilken analyserades med hjälp av Fribergs analysmetod. Resultat: I resultatet framkom tre kategorier; ängslan över återhämtning efter utskrivning efter PCI, oro och rädsla över återgång till vardagen efter PCI samt en förändrad syn på livet efter PCI. Vidare identifierades sex underkategorier; behov av stöd och rehabilitering första tiden efter behandlingen, önskan om tillgänglig rådgivning om kvarvarande symtom och medicinering, osäkerhet i fysiska förmågor, rädsla över nya hjärthändelser, ökad meningsfullhet och drivkraft i att ta ansvar över levnadsvanor. Slutsats: Studien visar att behovet av tillgänglig rådgivning och uppföljning är en viktig faktor att beakta i patientens eftervård för att främja den psykiska hälsan. Vidare forskningsförslag är en intervjustudie för att kartlägga upplevda behov relaterat till tiden efter PCI. / Background: Percutaneous coronary intervention (PCI) is an established treatment of myocardial infarction but is also performed as a planned procedure during angina pectoris. After a PCI the patient may experience a changed life-world, which can negatively affect mental health. Aim: The aim was to describe coronary heart disease patients' experiences of mental health within the first year after undergoing PCI. Method: A literature review with a qualitative design was conducted including twelve studies that focused on the experiences from the perspective of the patients. The articles were published from 2008 to 2021. Data was collected through the databases Cinahl and Pubmed. Data was analyzed by the method of Friberg. Results: The results revealed three categories; anxiety about recovery after discharge after PCI, anxiety and fear over the return to everyday life after PCI, as well as a changed view of life after PCI. Furthermore, six subcategories were identified; need for support and rehabilitation the first time after the treatment, a desire for available advice on residual symptoms and medication, uncertainty in physical abilities, fear of new heart events, increased meaningfulness and the drive to take responsibility for lifestyle habits. Conclusion: The need for available counseling and follow-up is an important factor to consider to promote mental health. Further research to map perceived needs post PCI is needed.

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Žastikaulio viršgumburiniai lūžiai gana dažna vaikų trauma, ypač per pirmąjį gyvenimo dešimtmetį. Nėra vieningos nuomonės dėl šios patologijos gydymo taktikos bei chirurginio gydymo metodikų taikymo. Iki šiol neatlikta perspektyviųjų studijų, lyginančių kelių skirtingų chirurginių gydymo metodų pritaikymą viršgumburinių žastikaulio lūžių gydymui, įvertinant vėlyvuosius gydymo rezultatus. Todėl mūsų atliktos retrospektyvioji ir perspektyvioji studijos turės didelę įtaką formuojant naują požiūrį į šių lūžių diagnostiką, gydymą bei reabilitaciją. Remiantis atlikto tyrimo duomenimis, įvertinome skirtingų chirurginio gydymo metodų ankstyvuosius bei vėlyvuosius rezultatus, galimas komplikacijas, veiksnius, lemiančius gydymo sėkmę, ir rekomenduojam taikyti literatūroje iki šiol neaprašytą bei mūsų modifikuotą Dorgano perkutaninės osteosintezės metodą, gydant vaikus, patyrusius dislokuotą žastikaulio viršgumburinį lūžį. Taikant šį gydymo metodą, galima žymiai sumažinti jatrogeninių neurologinių komplikacijų skaičių. Vėlyvieji gydymo rezultatai, taikant šį gydymo metodą, nesiskiria nuo gydymo rezultatų įprastiniu osteosintezės būdu. / Supracondylar humeral fractures are rather common trauma in children, especially on the first decade of the life. There are no united opinion concerning therapy of this pathology and surgical technique. Still there is no high–quality perspective studies performed to compare several different surgery techniques for supracondylar humeral fracture that compare later results of the treatment. Therefore our retrospective and perspective studies will have great influence to form new viewpoint to diagnostics, treatment and rehabilitation of those fractures. Study performed will let us to evaluate early and late results, possible complications of different surgical techniques, will let us evaluate the factors that determine the success of the treatment. Summarizing the results of the studies, literature data and our practice we recommend an unpublished and modified by us pinning method of Dorgan percutaneous pining technique to treat children with displaced supracondylar humeral fracture. This technique leads to significant reduction of iatrogenic neurological complications. Late results of the treatment using this technique do not differ from standard pinning techniques in children.