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Biomedical subjects

M Linhart

Publications and source records attributed to M Linhart.

12 recordsLinked to original sources
PubMed2006

[Electrical and pharmacological strategies for early cardioversion of atrial fibrillation].

Cardioversion of atrial fibrillation as an element of rhythm control strategy is indicated in patients with first episode of atrial fibrillation, hemodynamic instability, recurrent atrial fibrillation with low probability of spontaneous conversion, or severe symptoms. Early cardioversion is performed within 48 h of onset of atrial fibrillation. The best point in time is still unknown. It can be performed by pharmacological, or, preferentially, by electrical cardioversion. The advantages of electrical cardioversion are higher efficacy and no proarrhythmic risk, however, short time general anaesthesia is needed. Electrical cardioversion is most effective when biphasic shocks are delivered. For pharmacological cardioversion, several antiarrhythmic drugs are available which have to be considered individually. Thromboembolic risk does not differ between the two methods. Early cardioversion and maintenance of sinus rhythm is most effective in atrial fibrillation of short duration, normal left atrial size and no or only mild structural heart disease.

Anti-Arrhythmia Agents↗
PubMed2006

[Hip joint arthroplasty following surgical treatment of acetabular fracture].

PURPOSE OF THE STUDY: A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study. MATERIAL: In the period from 1997 to 2004, 49 patients, 35 men and 14 women, with posttraumatic arthritis following acetabular fracture were treated in our department. The average age was 42 years, with 67 % of the patients being younger than 40 years. The average follow-up was 42 montsh (range, 18 to 92). The acetabular fractures evaluated by the AO classification included type A1 in 17 patients, type A2 in seven, type B1 in nine, type B2 in six, type B3 in seven, type C1 in three and type C2 in two patients. METHODS: In 11 patients with aseptic necrosis of the femoral head without acetabular deformity, cementless Zweymüller Bicon or Spotorno CLS acetabular components were used. Twenty-nine patients with acetabular defects of type I and II, according to the American Academy of Orthopedic Surgeons (AAOS) classification, underwent acetabular reconstruction with the bone impaction grafting technique, using allogenic grafts and cementless Zweymüller Bicon acetabular components. Four patients with AAOS type III acetabular defects were treated with impacted morsellized bone allografts, using titanium mesh and cemented polyethylene acetabular cups. Three patients were treated with solid bone grafts fixed with osteosynthetic material. In two patients with type IV defects, osteosynthesis using a plate completed with allogenic bone graft, a mesh and a cemented cup were used. RESULTS: The patients were evaluated with the use of Harris hip scores. In 20 patients (43 %) the outcomes were excellent, and very good in 18 (37 %), satisfactory in six (12 %) and poor in four (8 %) patients. DISCUSSION: Hip joint arthroplasty following the surgical treatment of acetabular fracture is indicated in patients with post-traumatic hip arthritis. This frequently occurs due to complications associated with surgery for acetabular fractures, or the cause remains unknown. Some types of these fractures show a high proportion of poor results. The group can be divided into two different subgroups: the patients with a spherical, healed acetabulum and the patients with acetabular deformity or defect, of which the most serious condition is pseudoarthrosis of one or both columns. In the first subgroup, the surgical technique of acetabulum replacement is the same as in cases with arthritis due to degenerative disease. In the other subgroup, the procedure for cup implantation resembles revision arthroplasty for acetabular loosening. The options for treating defects or deformities and the implants used are identical in both situations. Therefore the results should be compared with those of revision arthroplasty and not primary implantation. Scars, fibrotic changes in muscles, para-articular ossification, bone defects, residual deformities of the acetabulum, devitalized bone fragments or hindering previous implants make the surgical procedure more difficult and interfere with good results. CONCLUSIONS: Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.

Acetabulum↗
PubMed2004

[Personal experience with treatment of acetabular fractures].

PURPOSE OF THE STUDY: The article presents a retrospective evaluation of a group of 119 patients treated for acetabular fractures between 1996 and 2002. MATERIAL: In the monitored period 119 patients, (89 men, 30 women) average age 35 years, were hospitalized with an acetabular fracture. Surgically treated were 91 patients (70 men, 21 women), average age 29 years. Prevailing in this group were Type A fractures which accounted for 45%, Type B was represented by 35% and Type C included 19%. Twenty-eight patients were treated conservatively. METHOD: Indication for surgical treatment was instability, hip incongruence or combination of both. Conservative treatment was chosen in the fractures without displacement, in fractures with secondary congruency and in case of contraindication of surgical treatment. The indication was always based on CT examination with a three-dimensional reconstruction. The surgery was performed within 24 hours in 42%, within 48 hours in 64%, within 72 hours in 87%. Posterior Kocher-Langenbeck approach was used in 54%, anterior ilioinguinal approach in 22% and the combination of both approaches in 24%. Posterior approach was indicated in A1, A2, B1 fractures, ilioinguinal approach in A3, B3, C1 Types, the combination of both approaches in B2, C2, C3 fractures. Osteosynthetic material was chosen according to the fracture type, bone quality and fragment size. RESULTS: The evaluation was based on subjective complaints, radiograph and clinical examination using Harris Hip Score. In the group of 91 patients treated surgically we achieved excellent result in 41 cases (45%), very good result in 28 cases (31%), fair result in 7 cases (9%) and poor result in 13 cases (15%). We recorded 17 peroperative complications--11 times inadequate reduction, 5 times nerve injury, once vascular injury. Early complications included infect--twice and loosening of implant--once. Late complications occurred in 26 cases--paraarticular ossification in 17 cases, aseptic necrosis of the femoral head in 8 cases. DISCUSSION: The treatment of fractures of the acetabulum as any intraarticular fracture is based on a precise anatomical reduction, stable fixation and early mobilization. Difficulties of the treatment of the acetabulum arise from the anatomical relations. Decisive for the indication, the method of treatment and prognosis is the type of the injury of the weight-bearing area of the acetabulum. In order to understand the type of the fracture it is necessary to make a careful preoperative examination based particularly on CT examination with a three-dimensional reconstruction. The indication and treatment strategy--surgical approach, method of reduction, type of fixation--is selected accordingly. Each surgical approach has its limits and also the possibilities of fixation are limited by the type of the fracture. The outcomes depend directly on the quality of the reconstruction of the articular surface and the incidence of complications, caused either by the injury or preoperatively. CONCLUSION: The treatment of displaced fractures of the acetabulum is on principle surgical. Satisfactory results are produced only by anatomical reconstruction of the weight-bearing area of the acetabulum. Surgical treatment is highly demanding and the long-term results not always correspond to the efforts made.

Acetabulum↗
PubMed2003

[Osteosynthesis of proximal femoral fractures using short proximal femoral nails].

PURPOSE OF THE STUDY: A group of 147 patients with proximal femoral fractures treated with the use of the proximal femoral nail, manufactured by the Synthes company, in the period between October 1997 and June 2001 were retrospectively evaluated. MATERIAL: The group of 147 patients whose average age was 69 years consisted of 59 men (average age, 59 years) and 88 women (average age, 75 years). The most frequent fracture occurring in 54% of the patients was an unstable pertrochanteric fracture (Kyle III); persubtrochanteric and subtrochanteric fractures were treated in 27% and 19% of the patients, respectively. METHODS: In 1997, a new implant, the proximal femoral nail manufactured by the Synthes company (PFN), was introduced in the Czech Republic. In addition to all advantages of a nail to be implanted intramedullary, it has several other favorable characteristics: its length is 240 mm, pre-drillings is not necessary, it can be dynamically locked, it has a high rotation stability, and mechanical stress concentration on the implant-bone interface is low. This evaluation is based on the type of fracture, the duration of healing, the duration of surgery and X-ray exposure. RESULTS: The patients were followed up at 6 months, 3, 6 and 12 months, and once a year. The fracture healed in the anatomical position by 6 months in 95% of them. The average operative time was 56 min and X-ray exposure lasted on average 1 min. We recorded 14 intra-operative complications in nine patients, which included incomplete reduction in four cases, fixation in distraction in two, incorrect length of screws in one, fracture at the site of distal locking in two and incorrect insertion of femoral neck screws in five cases. Early post-operative complication involved seven cases of hematoma in the operation wound with the necessity to re-operate in five cases. Late complications occurred in two patients and included pseudoarthrosis and necrosis of the femoral head after healing. Most of the complications were found in subtrochanteric fractures. DISCUSSION: The treatment of unstable fractures of the proximal femur is still associated with some failures. The reasons are: disregard for biomechanics, overestimation of the potentials of new surgical techniques or new implants or poor adherence to established procedures. PFN is a novel, modern implant based on experience with the gamma nail. Since relevant literature data are very few, any comparison of our results is very difficult. The lower average age of our group was due to the intentional selection of our patients for this type of surgery. CONCLUSIONS: PFN is an excellent implant for the treatment of unstable fractures of the proximal femur. The terms of successful outcome include a good understanding of fracture biomechanics, correct indication and exactly performed osteosynthesis.

Aged↗
PubMed2002

[Purulent Salmonella arthritis of the ankle joint].

In the case study the authors focus on Salmonella enteritidis which caused purulent osteoarthritis of the ankle and sepsis. Salmonella osteoarthritis is one of the nidal forms of the salmonella infection. The authors briefly present etiology, pathogenesis, diagnosis and principles of the treatment of infectious osteoarthritis. They analyze a case of a 56 years old immunocompromised patient who was treated at the authors' department for a late diagnosis with an already developed septicemia. They describe the course of the disease, complications and the result of the treatment and discuss the pitfalls of the diagnosis and treatment. Only a timely diagnosis followed by a sufficiently vigorous surgical intervention with drainage of the joint and combined with a timely, targeted and long-term antibiotic therapy leads to the management of this severe nosologic unit.

Arthritis, Infectious↗
PubMed2001

[Using interaction-intensive therapeutic nursing measures and "home remedies" in nursing care. An explorative study as a plea for integrated nursing practice].

BACKGROUND: Until today there existed no major studies about the wide range of currently utilized methods or potential sociodemographic and institutional influences on utilization despite an immense interest among nurses in alternative nursing methods (in this study referred to as home remedies). METHODS: In this study, from standardized questionnaires with a convenience sample of three different settings of nursing practice, i.e. acute-care, nursing homes, and home health care were analyzed using the statistical program SPSS. RESULTS: Our analysis showed that a wide range of traditional home remedies is being utilized, e.g. application of heat and cold or herbal infusion (herbal teas). Furthermore, lay approaches such as aromatherapy were also commonly used. The statistical analysis revealed complex influences of age, duration of nursing practice and institutional setting in the utilization of home remedies. CONCLUSION: There is need for more systematic studies to further examine the alternative methods or home remedies so popular among nurses and their patients. Regarding a more consistent naming of the variety of different methods coming from naturopathy, folk and lay medicine, the authors suggest the term "integrative nursing care".

Adult↗
PubMed1995

[Work satisfaction and working conditions of the nursing staff as the basis of internal interventions].

Satisfaction and working conditions of nursing staff as a basis for internal interventions Can analyzing the working situation of nursing staff by means of a questionnaire contribute to improving working conditions and thus reduce fluctuation and increase work-satisfaction? This was the basic question of this investigation and aimed at creating an instrument that could help work out existing resources and strategies for possible interventions. Therefore, an anonymous questionnaire containing 114 questions concerning the current situation was presented to the nursing staff in two departments of internal medicine and one surgical department of a university hospital in southern Germany in April 1993. Analysis of the data of the different working fields (ordinary/intensive care, clinics) showed individual differences regarding resources and possible interventions. Furthermore, the assumption could be confirmed that by means of such a project the nursing management gains specific starting points for the preparation of change. The prospects of improving working conditions seem quite good, as these findings are based upon the statements of the staff concerned. It has to be emphasized that the nursing staff were able to identify themselves with the conclusions when the results were presented to them.

Hospitals, General↗
PubMed1993

Tissue polypeptide antigen in bronchogenic carcinoma.

Serum concentrations of tissue polypeptide antigen (TPA) were examined by an immunoradiometric technique in 114 patients with bronchogenic carcinoma and in 55 patients with noncancerous lung diseases. The sensitivity of TPA examination in bronchogenic carcinoma was 67.5% and was increased in advanced stages of the disease. No statistically significant differences were observed between histologic types of bronchogenic carcinoma. In nonmalignant lung diseases, elevated levels of TPA were observed in 21.8% of patients. TPA is of little value in the diagnosis of bronchogenic carcinoma; however, it may be useful as an auxiliary criterion for staging.

Adenocarcinoma↗
PubMed1979

[On the contamination of the citric acid fermentation. II. Sodium 5-nitrofurylacrylate as an antiseptic against representatives of the Enterobacteriaceae (author's transl)].

In context with the first communication which deals with the characterization of the so-called brown contamination called forth by Enterobacteriaceae in the citric acid fermentation of molasses, the present paper describes the screening of antiseptic substances able to suppress the contamination mentioned without damaging the normal growth of the producing mould Aspergillus niger and its ability of producing citric acid. Among the substances tested the sodium salt of 5-nitrofurylacrylic acid (5-NFA) excelled partly because of its antiseptic effect in relatively small concentrations and partly because the mould tolerates appreciable amounts of this antiseptic. Therefore there may be applied, in the presence of a heavy contamination, relatively high concentrations of the antiseptic without fear of damaging the producing mould. Usually a dose of 10 to 15 mg 5-NFA in 11 of medium was sufficient to suppress the brown contamination.

Acrylates↗