Biomedical subjects

K Koudela

Publications and source records attributed to K Koudela.

At least 19 recordsLinked to original sources

PubMed2006

[Peripheral primitive neuroectodermal tumor -- PNET].

The authors describe three cases of peripheral primitive neuroectodermal tumor. The tumor was found in soft tissues of the crus, shoulder girdle and perineum, and was also located paravertebrally and epidurally at the level of L1-L2 vertebrae. Radiological findings were not specific for this disease. The results of imaging methods (sonography, CT, MRI, DSA) were important for the assessment of tumor size, its boundary and invasion of the surrounding tissues, and for the evaluation of tumor response to therapy and detection of recurrent disease. The PNET diagnosis was based on immunohistochemical, biochemical and cytogenetic examinations. One patient died 5 months after the first clinical signs were manifested; the two patients surviving for 2 and 1 3/4 years after first sign manifestation, respectively, remained in the care of cancer specialists. Key words: skeletal Ewing's sarcoma, extra-skeletal Ewing's sarcoma, Ewing's sarcoma family of tumors, peripheral primitive neuroectodermal tumor.

Adolescent↗

PubMed2005

[Primary obturator pyomyositis].

BACKGROUND: The main objective of our work was to draw attention to the possible occurrence of a serious and life-threatening illness, primary pyomyositis of the obturator muscles in countries with a mild climate, and to establish basic diagnostic criteria for the illness, including differential diagnostics, and to propose a treatment method. METHODS: The authors describe two cases (a boy of 11 and a woman aged 47 years) with the occurrence of primary pyomyositis of the obturator muscles in the Czech Republic and they focus on the most important clinical symptoms and imaging methods necessary for the establishment of the diagnosis. RESULTS: Repeated clinical examinations are important for the establishment of the diagnosis, particularly the presence of the symptom triad (pain in the hip joint, limping, febrile state), positive inflammatory markers and, first and foremost, the demonstration of pyomyositis on CT or MR. Differential diagnosis must also consider inflammatory diseases of the locomotor system (coxitis, sacroiliitis, osteomyelitis), of the digestive tract (Crohn's disease, a tumour, an obturator hernia) and of the urogenital system (gonorrhoea). CONCLUSION: The therapy of pyomyositis must be initiated in time by bed rest and administration of antibiotics and, if an abscess develops, surgical intervention is unconditionally necessary, consisting either in percutaneous abscess puncture or incision, perfusion, and application of antibiotics. The failure to diagnose an abscess of the obturator muscles and late therapy can result in serious complications, septic shock and death.

Abdominal Abscess↗

PubMed2005

[Metaphyseal fibrous defect].

PURPOSE OF THE STUDY: The aim of the study was to identify predisposition to the development of metaphyseal fibrous defect (MFD) on the skeleton and to select appropriate imaging methods and examination for detection of atypically located or larger cortical lesions. MATERIAL: A group of 38 randomly selected patients with MFD was analyzed. It comprised of 27 boys and 11 girls at average ages of 13.7 years and 15.5 years, respectively. The youngest child was 4 and the oldest patient was 30 years old. METHODS: Thirty-two patients with a history of trauma and six patients with problems associated with sports activities were examined by plain radiography. Additional examination included CT scans in eight, MRI in two, scintigraphy in 17, angiography in seven and genetic examination in three patients. Histological evaluation confirming the presence of MFD was carried out in seven patients. RESULTS: The majority of lesions (75.6 %) were found around the knee, 17 in the distal femur and 17 in the proximal tibia. Eight lesions (17.8 %) were present in the distal tibia and three (6.6 %) were at other sites. Multifocal lesions, when detected, were associated with von Recklinghausen's neurofibromatosis, Marfan's disease or familiar occurrence. In most cases the diagnosis was made on the basis of plain radiographic findings. For large lesion in atypical locations, examination by CT, MRI, scintigraphy or biopsy were recommended. DISCUSSION: In this section the authors discussed other pathologic conditions that must be distinguished from MFD. CONCLUSIONS: The bones around the knee were affected most often. Multifocal MFD lesions were associated with von Recklinghausen's neurofibromatosis, Marfan's disease or familiar occurrence. The diagnosis was usually based on plain X-ray examination. To diagnose atypical and large lesions, advanced imaging (CT, MRI), scintigraphy or biopsy were recommended.

Adolescent↗

PubMed2004

[Post-traumatic anterior shoulder instability--arthroscopic stabilization method using bone anchors].

PURPOSE OF THE STUDY: To evaluate the short-term results of re-insertion of the ventral labrum associated with plication of the capsular structures in anterior post-traumatic instability of the shoulder. MATERIAL: The patients treated in our institution between April 2000 and December 2002 and followed up for periods ranging from 3 to 20 months were included. A total of 65 patients were treated for post-traumatic ventral instability. Open capsular shift, after a final evaluation of preoperative examination under total anesthesia and arthroscopic inspection of the labroligamentous complex affected, was used in four patients. Arthroscopic stabilization was carried out in 49 men and 12 women, aged 18 to 49 years (average, 28.5). These patients were allocated to groups according to the number of previous dislocations as follows: group 1 (24 patients), one to five dislocations; group 2 (27 patients) six to ten dislocations; and group 3 (10 patients) 11 and more dislocations. The glenohumeral joint was inspected arthroscopically to find out potential lesions and evaluate them in relation to the number of previous dislocations. METHODS: Stabilization was carried out by means of non-absorbable anchors. It involved re-insertion of the ventral labrum and plication of the ventral capsular structures. The patients were evaluated on the basis of a modified system of Rowe and Zarins. RESULTS: In group 1, the anterior labrum or capsule showed only isolated lesions; most injury-related lesions were found in group 3. With the increasing number of dislocations, there was an increase in associated findings and severity of injury to the labroligamentous complex. The average score before the operation was 37.87 points (range, 20 to 60). After rehabilitation was completed, 57 (93.44%) patients scored good or excellent (70 or more points), with 29 (47.54%) having over 90 points; only four (6.56%) patients scored less than 70 points. Fifty-seven patients resumed their previous sports and four patients carried on with recreational sports activities. DISCUSSION: Open stabilization has been reported as being slightly more effective in maintaining stability, as compared with arthroscopic procedures. The major advantages of arthroscopy include a good view of the intra-articular structures, minimal invasiveness and less restricted range of postoperative motion. However, the arthroscopic stabilization technique becomes more difficult with an increasing number of dislocations sustained before this procedure. The ventral structures of the shoulder joint, known as labroligamentous complex, should be regarded in their complexity and anterior stability should be achieved both by re-insertion or adaptation of the glenoid labrum and by stretching the capsular structures, particularly the inferior glenohumeral ligament. Studies reporting a high degree of recurrence after the initial dislocation in subjects aged 20 to 30 years are discussed. In top, active sportsmen and sportswomen, stabilization after the first dislocation followed by instability appears to be a very effective therapy. CONCLUSIONS: Arthroscopic stabilization with the use of non-absorbable anchors for the treatment of anterior post-traumatic instability of the humeral joint is a method that, in indicated cases assessed mainly by mobility of the labrum and laxity of the anterior capsule, shows a high success rate. Indications are based on medical histories, clinical and radiographic findings and, most importantly, clinical tests under total anesthesia and arthroscopic confirmation of lesions of the ventral structures of the joint.

Adolescent↗

PubMed2004

[Marfan's syndrome--application of revised criteria and differential diagnosis in clinical practice].

PURPOSE OF THE STUDY: To design a system of diagnostic criteria that would allow us to differentiate benign articular hyperelasticity from Marfan's or Ehlers-Danlos syndromes and, on the basis of clinical, anthropometric, radiological, biochemical and densitometric findings, their specificity and statistical significance, to draw definitive conclusions for clinical practice. MATERIAL: A total of 240 patients who presented with the diagnosis of one of connective tissue disorders were included. They all were examined and, in 182 of them, the findings were completed to meet the criteria required by differential diagnosis. METHODS: Revised criteria were used for Marfan's syndrome (MFS), Ehlers-Danlos syndrome (EDS), osteogenesis imperfecta (OI), juvenile idiopathic osteoporosis (JIO), cutis laxa (CL) or benign articular hyperelasticity (BAH). All patients provided their medical histories, and underwent clinical, radiological, anthropometric, echocardiographic and biochemical examinations, including that for markers of bone formation and resorption. The anteroposterior bulb length was assessed by ultrasonography; densitomery was performed and vital capacity was measured. All data obtained were processed by computer software and the definitive diagnosis was established. RESULTS: Out of 82 patients initially diagnosed with MFS, only 43 (52.4%) met the revised criteria; of the 53 EDS patients initially, 30 (56.6%) met the revised criteria. Four patients who had been referred to us with MFS were found to meet the criteria for EDS (two) and OI (two). Out of 35 patients with OI, 22 (62.8%) met the diagnostic criteria. All 24 patients with BAH were confirmed to have this diagnosis. On the basis of the revised criteria, none of the patients was diagnosed as having JIO or CL. DISCUSSION: The authors compare their results of decreased levels of procollagen I, the occurrence of scoliosis or acetabular protrusion and reduced vital capacity with the relevant reports in the literature. CONCLUSIONS: The specific criteria for Marfan's syndrome include lens dislocation or an anteroposterior bulb axis longer than 24 mm, ascending aortic dilatation, greater body height and the ratio of lower extremities to the body and that of arm-span to height higher than 1.05. However, some criteria, such as the metacarpal-phalangeal index, are not characteristic of Marfan's syndrome only and, therefore, cannot be regarded as a major diagnostic feature of this disorder.

Adolescent↗

PubMed2004

[Fractures of the intercondylar eminence of the tibia].

PURPOSE OF THE STUDY: We analyzed a group of patients surgically treated for fractures of the intercondylar eminence of the tibia in the Department of Orthopedics in Pilsen between 1992 and 2002, and evaluated the results of this treatment on the basis of objective examination and comparison with the relevant literature data. We describe indications for surgical treatment and the surgical methods used, including different fixation materials. MATERIAL: In the period from 1992 to 2002, 27 patients underwent surgery for a fracture of the intercondylar eminence of the tibia in our Department. The group included 19 men and 8 women aged between 8 and 49 years; the average age was 16.2 years. METHODS: Surgery was indicated in type II and type III fractures of the intercondylar eminence of the tibia, as classified according to the Meyers and McKeveer system. Medial arthrotomy was used in 16 patients, nine of whom had undergone diagnostic arthroscopy. Arthroscopic surgery from the classical, either anterolateral or anteromedial, approach was performed in 11 patients. After arthroscope insertion, the knee joint was irrigated and inspected. The meniscus or transversal ligament, if interpositioned, were released and, subsequently, a dislocated fragment was reduced and fixed. Fixation was carried out with a Kirschner's wire, cannulated screw, wire loop or absorbable suture. RESULTS: The patients were examined in 2003, after a follow-up ranging from 1 to 10 years. A total of 17 patients turned up. The outcome of treatment was evaluated on the basis of X-ray and clinical findings. Union of the eminence in an appropriate position was found on X-ray films in all patients. Clinical evaluation included the range of motion and knee joint stability. Restricted motion was found in three patients. No positive anterior drawer or Lachman's tests were recorded. DISCUSSION: No failure of osteosynthesis was recorded in our patients although different fixation materials were used. This is in agreement with the results of other authors who did not report any failure of osteosynthesis due to insufficient stability provided by different fixation materials. The outcomes of surgical treatment in comparable patient groups were also similar. CONCLUSIONS: Arthroscopy is considered the most suitable technique for the treatment of fractures of the intercondylar eminence of the tibia, because it is minimally invasive and provides a good view of the operative field. The outcome of surgery is not dependent on the fixation material used. However, metal implants, in contrast to absorbable materials, have to be removed in an additional surgical procedure.

Adolescent↗

PubMed2003

[Primary hyperparathyroidism (osteitis fibrosa cystica generalisata Recklinghausen)].

The case of a 67-year-old man presenting with parathyroid gland adenoma associated with multiple organ manifestations of a rare normocalcemic form of primary hyperparathyroidism is described. The authors draw attention to the importance of correlating clinical and laboratory examinations with histological, radiological and scintigraphic findings for the establishment of diagnosis. They emphasize the role of two-phase 99mTC-MIBI (methoxyisobutyl-isonitril) scintigraphy not only for diagnostic purposes but also for exact localization of the adenoma by means of a gamma probe during surgery. They also point out the possibility of accompanying pathological conditions, in this case, the development of a tumor described as "brown tumor". This was shown by angiography as a hypervascularized and strongly stained expanding lesion. The authors conclude that the early surgical removal of this parathyroid gland adenoma was important for the patient's successful recovery.

Aged↗

PubMed2002

[Periosteal desmoid].

The authors describe a rare benign disease occurring in children and adolescents with an increased physical activity at the age of 8-20 years. It is a tumour-like lesion developed by a repeated micro-trauma of the origin of distal fibres of adductor magnus and aponeurotic origin of the medial head of the gastrocnemius. This disease must be paid increased attention as in the region of the knee joint in children it is a location of a frequent development of sarcoma and osteomyelitis. With the knowledge of this lesion such cases may be diagnosed merely by a classic radiograph, preferably in external rotation and CAT and MRI examinations. Of the highest value for the examination is the CAT examination. Radiograph changes are located in the region of the distal part of the medial crest of linea aspera, tuberculum adductorium and posteromedial part of the medial epicondyle of femur.

Adolescent↗

PubMed2002

[Injuries of extremity blood vessels, personal experience and results].

The authors evaluated the results achieved in 47 patients with injuries of the acral vesels where they performed a total of 50 vascular operations during the five-year period from 1998-2001. 21.3% injuries were part of multiple injuries. The mean period of hospitalization was 14.7 days. The 30-day mortality was 6.4% and the morbidity 12.8%. The upper extremity was saved in all instances (100%), the lower extremity in 77.3% of the injured. The reason for high amputations of the lower extremity were most frequently injuries of the popliteal artery associated with skeletal injury and extensive contusion of the soft tissues of the extremity. The authors discuss the optimal diagnostic and therapeutic procedures in injuries of the acral vessels. They emphasize a multidisciplinary approach without delay with early, frequently during the primary operation indicated fasciotomy, to prevent the development of compartment syndrome. The order of operations in concurrent injuries of the acral skeleton depends on the stage of ischaemia, type of injury and solution of the skeletal fractures. This type of injury frequently calls for repeated redressing in the operation theatre with repeated necrectomies of soft tissues to prevent infection which may prove fatal for the extremity. Injuries of the acral vessels should be nowadays treated in specialized departments with a 24-hour diagnostic and therapeutic traumatological service which comprises a highly specialized team of vascular surgeons.

Adolescent↗

PubMed2002

[Bilateral fractures of the femoral head (Pipkin I and Pipkin II)].

The author describes a rare case of bilateral dislocation of the hip joint accompanied by fracture of the femur head. The fracture (Pipkin I) on the left side was treated conservatively and the fracture (Pipkin II) on the right side surgically. At 18 months of follow-up, both fractures were healed but the fragment of the operated femoral head had a tendency to develop osteoporosis. Aseptic necrosis was absent, as evidenced by bone scan. Both hip joints, however, showed signs of developing arthritis, with clinical findings being less serious on the non-operated joint. The author discuses all cases of bilateral Pipkin fractures reported in the literature and be concluded that there is no report on a coincident occurrence of type I and type II fractures. When comparing conservative and surgical approaches to similar types of fractures, the author recommends the use of conservative therapy.

Accidents, Traffic↗

PubMed2001

[Reconstruction of the acetabulum during replacement of the aseptically loosened polyethylene cup].

THE PURPOSE OF THE STUDY: The aim of the study was to verify the method after Slooff in our modification, i.e. "a cemented cup--cancellous bone grafts--a metal net" for the revision surgery of aseptic loosening of cemented polyethylene acetabular cup in combined defects of acetabulum. MATERIAL: The followed-up group of 52 patients (36 women and 16 men), average age of 65 years (age range, 50-81 years) with aseptic loosened cemented polyethylene Poldi cups included 52 operated on hip joints. The average interval between the primary implantation and the revision surgery was 9 years (2-21 years). METHOD: We reconstructed acetabulum with combined bone defects (AAOS III Degree--as a result of aseptic loosening and migration of cemented acetabular cups) by means of cancellous bone allografts, a shaped Howmedica metal net, Simplex bone cement and a polyethylene cup. RESULTS: Average follow-up was 36 months (range, 14-49 months). Clinical evaluation of the group was performed after Harris Hip Score averaging 80 points. Radiological evaluation focused on the density and presence of bridging trabeculae between the grafts and the host bone. Positive finding was in 46 patients, i.e. 90%. Further, we evaluated migration of the cup after Conn. In 4 patients (7.7%) it was less than 2 mm and in 3 patients (5.7%) it was greater than 5 mm. Reconstruction failed in 1 patient (1.9%). Radiolucent line was found in the zone between the host bone and bone grafts only in III zone after De Lee and Charnley in 8 cases (15.3%), in zones I and II it was not encountered in any of the patients in the group. One case required another revision surgery in which Burch-Schneider ring, bone allografts and Müller cemented cup were used for the reconstruction. In two patients of this group there developed a phlebographically verified phlebothrombosis without signs of embolism into pulmonary artery. In two cases there occurred a superficial inflammation of the wound which subsided before the removal of the suture. No deep infection of the wound was encountered. Particular ossifications were assessed after Brooker. Type I occurred in 7 cases and Type II in 1 patient. DISCUSSION: At present several methods are used for the reconstruction of acetabulum and their choice is limited by the extent of the bone loss. For cavitary defects it is possible to use the combination of bone grafts with cementless cups. In segmental and combined defects the situation is more complicated and it can be solved by the application of a solid bone graft. In case the solid bone graft assumed greater load, the situation logically resulted in the fatigue fracture of screws and failure of the whole reconstruction prior to the bone graft-host bone osteointegration. In cementless cups and solid bone grafts the situation is slightly more favourable. If there is a timely biological (secondary) osteointegration of the cup the reconstruction has a chance to survive. The timeliness of biological (secondary) osteointegration is significantly influenced also by the quality of the applied bone graft and a good contact of the bone graft and the host bone and the surface of the cementless cup. Our method of the reconstruction of acetabulum by means of cancellous bone grafts, metal net and cemented cup allows a relatively good primary stability of the cup. Due to its partial elasticity the metal net does not prevent transmission of forces on the bone grafts which are placed under the net. As a result there occurs a faster union of bone grafts with the host bone. CONCLUSION: The method of cemented cup--cancellous bone grafts--metal net after Slooff is in our modification one of the accepted options of the reconstruction of acetabulum. Its benefit is the possibility of early weight bearing of the limb operated on. The stress on the bone grafts under an elastic construction conduces to a relatively fast good secondary osteointegration. The method can be recommended for II and III Degrees of acetabular bone loss according to AAOS classification. Of no less importance is also the economic aspect of the whole reconstruction.

Acetabulum↗

PubMed1996

Insect hormones in vertebrates: anabolic effects of 20-hydroxyecdysone in Japanese quail.

Ecdysteroids are hormones controlling cell proliferation, growth and the developmental cycles of insects and other invertebrates. They are occasionally present in various unrelated plants for no apparent reason; no phytohormonal function has yet been identified. In certain cases, ecdysteroids are accumulated to high levels in leaves, roots or seeds. Some ecdysteroid-containing plants have been known as medicinal plants for centuries. One of them, Leuzea carthamoides Iljin (Asteraceae), growing in Central Asia, contains 0.4% ecdysteroid in dry roots and 2% in seeds. A pharmacological preparation from this plant, "Ecdisten', is already available as a commercial preparation for its anabolic, tonic and other effects, for medical use (review). It remained problematic, however, whether ecdysteroids were truly responsible for these effects, because Leuzea contains a number of other biologically active compounds in addition to ecdysteroids. We extracted and purified ecdysteroids from the seeds of Leuzea. With 6 g of 96% 20-hydroxyecdysone (20E), we made a large-scale feeding assay with Japanese quail to find out whether ecdysteroid alone could duplicate the anabolic effects of the seeds. We found that the 96% ecdysteroid increased the mass of the developing quails in a dose-dependent manner, with the rate of increase proportional to the ecdysteroid content in the seeds; there was a 115% increase in living mass with 100 mg kg-1 of pure 20E compared with 109.5% increase with 100-180 mg kg-1 20E equivalents in the seeds. We conclude that the plethora of growth-promoting, vitamin-like effects induced in vertebrates by Leuzea is mediated by ecdysteroids.

Animals↗

PubMed1992

Induction of SOS repair by ionizing radiation. Results from experiments at accelerators.

beta-galactosidase and alkaline phosphatase activities of Escherichia coli strain PQ37 carrying the fusion gene of sulA and lacZ treated with different types of ionizing radiation were examined. The induction factor (ratio of beta-galactosidase to alkaline phosphatase activity), reflecting the SOS-induction potency, increases significantly with radiation dose. Maximum effectiveness to induce SOS-response has been found for deuterium and helium ions in comparison to gamma-rays, carbon or krypton ions. Increased energy of helium ions leads to greater SOS-induction potency of radiation.

Dose-Response Relationship, Radiation↗

PubMed1986