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Biomedical subjects

P Havránek

Publications and source records attributed to P Havránek.

At least 19 recordsLinked to original sources
PubMed2006

[Spinal injuries in children and adolescents].

PURPOSE OF THE STUDY: Spinal injuries in children are rare and account for a low proportion of all childhood injuries. Due to anatomical and biomechanical properties of the growing spine, there are great differences between spinal injury in childhood and adulthood. Because of higher mobility and elasticity of the spine and a lower body mass in children, spinal injuries are not frequent and represent only 2 to 5 % of all spinal injuries. In this retrospective study, the effectiveness of conservative and surgical treatment of injured spines in children is evaluated in a 10-year period. MATERIAL: All patients from birth to the completed 18th year of age treated in our departments between 1996 and 2005 were included in this study. The patients, evaluated in three age categories (0-9, 10-14, 15-18), were allocated to two groups according to the method of treatment used (conservative or surgical). The information on patients treated conservatively was drawn from medical records; the surgically treated patients were invited for a check-up. METHODS: We used conservative treatment in patients with stable spinal injury who had no neurological deficit and in patients with neurological deficit but without apparent injury to the skeleton. Surgery was indicated in patients with unstable spinal injury and in those with neurological deficit and apparent injury to the skeletal structures. Injuries to the cervical spine were treated conservatively using a Philadelphia collar or a halo-vest in more serious cases. For treatment of injury to the thoracolumbar spine, the Magnuson method was preferred, together with rest in bed until subsidence of acute pain, followed by application of a vest and active rehabilitation to strengthen postural muscles. When surgery was used, the procedure was selected on a strictly individual basis in patients under 12; in older patients it was carried out according to the adult treatment protocol. RESULTS: During 1996 through 2005, we treated a total of 15 646 patients with injury to the skeleton, aged 0 to 18 years. The spine was affected in 571 cases, which is 3.6 %. We used conservative treatment in 528 (92.5 %) and surgery in 43 (7.5 %) children. The period between surgery and evaluation ranged from 6 to 120 months (average, 46.3 months) in the patients treated conservatively, and from 6 to 66 months (average, 27 months) in the surgically treated patients. The group of patients treated conservatively consisted of 292 boys (55. 3 %) and 236 girls (44.7 %); of these 219 (41.5 %) were in the 0-9 year category, 251 (47.5 %) were between 10 and 14 years and 58 (11 %) were 15 to 18 years old. The average age in this group was 10.2 years. The most frequent cause of injury was a fall (277; 52.2 %), then sports activity or games (86; 16.3 %), car accidents (34; 6.4 %) and diving accidents (30; 5.7 %). Pedestrians were injured on 25 occasions (4.7 %) and other causes of injury were recorded in 76 patients (14.4 %). In all age categories, injury to the thoracic spine was most frequent (340; 64.4 %). Three and more vertebrae were injured (multi-segment injury) in 124 patients (23.5 %). The thoracolumbar spine was affected in 22 patients (4.2 %), and lumbar vertebrae were injured in 28 patients (5.3 %). Injury to the cervical spine, both upper and lower, was least frequent, including four (0.8 %) and 10 (1.9 %) patients, respectively. None of the patients in this group showed neurological deficit. The surgically treated group included 29 (67.4 %) boys and 14 (32.6 %) girls; two (4.7 %) children were between 0 and 9 years, nine (20.9 %) between 10 and 14 years, and 32 (74.7 %) between 15 and 18 years, with an average of 15.1 years for the whole group. The frequent causes of injury were car accidents and falls in 21 (48.8 %) and 14 (32.6 %) children, respectively. Other causes were infrequent. The upper cervical spine was operated on in five (11.6 %), lower cervical spine in eight (18.6 %), thoracic spine in 13 (30.2 %), thoracolumbar spine in five (11.6 %) and lumbar vertebrae in 12 (27.9 %) patients. Thirty-six (83.7 %) patients had fractures, five had dislocated fractures (11.6 %) and two (4.7 %) had a dislocation. Of the 43 children in this group, neurological deficit was recorded in nine (20.9 %); this included a complete spinal cord lesion, an incomplete spinal cord lesion and a nerve root lesion in three, five and one patient, respectively. DISCUSSION: The results of this study confirm, in the majority of aspects, the conclusions of previously published papers. In some of the characteristics described above, however, our results are different, which can be explained by some specific features of care for injured children in the Czech Republic. CONCLUSIONS: Childhood spinal injuries account for only 2 to 5 % of all spinal injuries and for 3.6 % of all skeletal injuries in children. Particularly at the age of 11 to 12 years, they differ significantly from spinal injuries in adults and therefore require different therapeutic approaches. The cervical spine is affected most often in younger children, while the thoracolumbar spine in older children. Multi-segment injuries are typical in the childhood spine, particularly in smaller children. Typically, children show SCIWORA and a more rapid improvement of neurological deficit than adults. Conservative treatment is preferred; surgery before 12 years of age is strictly individual, while after 12 years therapy is similar to that used in adults.

Adolescent↗
PubMed2005

[Monteggia's lesion in childhood--proposal for a new classification system].

PURPOSE OF THE STUDY: The former classification systems have failed to provide an exact characterization of Monteggia's lesions (ML) in a growing skeleton. We studied the stability of both ulnar fracture and injury to the radio-humero-ulnar joint and our clinical findings fully warrant the proposal of a new classification system. MATERIAL: We carried out a retrospective study of 76 children, aged 2 to 15 years, treated for Monteggia's lesion in our department during 12 years, from 1990 till 2001. METHODS: X-ray images of all injured limbs were evaluated and each injury was categorized as stable, potentially unstable or unstable. This concerned both ulnar fractures and lesions affecting the radio-humero-ulnar joint. An assessment of the therapeutic method used was also included. RESULTS: The final assessment of each injury involved the category of ulnar fracture and the category of radio-humero-ulnar joint lesion and produced three ML types, namely, stable, potentially unstable and unstable types. A stable ML type was found in 30 (39.5 %) patients and, in most of them, conservative treatment was sufficient. Osteosynthesis was required in only 6.7 % of the cases. A potentially unstable ML type was recorded in 27 (35.3 %) patients. Fifteen of these (55.6 %) underwent osteosynthesis because conservative treatment had failed. An unstable ML type was diagnosed in 19 (25 %) children and nearly all of them (89.5 %) had to undergo osteosynthesis. DISCUSSION: The previous classification systems have been based on either anatomical aspects (direction of ulnar fragment displacement and proximal radius dislocation) or the type of ulnar fracture. In our view the characterization of each ML type in children involves the stability of ulnar fraction as well as the stability of injury to the radio-humero-ulnar joint. CONCLUSIONS: Our classification allows us to predict the stability of each Monteggia's lesion and to choose an appropriate approach to its treatment.

Adolescent↗
PubMed2005

[Pathologic proximal femoral fractures in children in an unicameral bone cyst].

PURPOSE OF THE STUDY: Proximal femoral fractures in children are rare, pathologic fractures being extremely rare. Despite many meanings these fractures are still "unsolved" there are some definite rules for treatment of true accidental injuries. Pathologic fractures are outstanding with their extremely rare incidence. The aim of the study is to overview a large clinical material, find out the incidence of this pathologic fracture, the extent and shape of the unicameral bone cyst (UBC), specific therapeutic approach, technical problems of eventual osteosynthesis, number of reoperations and sequels. MATERIAL: Altogether 49 children with 50 accidental and pathologic fractures of proximal part of the femur treated in the Regional Pediatric Trauma Centre of the Department of Pediatric and Trauma Surgery, 3rd Faculty of Medicine, Charles University, Prague. METHODS: Retrospective and prospective study of children (0 to 15 years of age) treated with proximal femoral accidental and pathologic fractures during the 20 year period (from August 1984 to November 2004). Classification of fractures according to Delbet and Colonna. Diagnosis of bone cyst with plain X-rays, eventually CT scans. RESULTS: During the 20 years period (August 1984 to November 2004) 49 children with 50 proximal femoral fractures were treated in the Department. Four patients sustained a pathologic fracture through an unicameral bone cyst. Two of these latter children were treated by an open reduction and osteosynthesis with the use of the proximal femoral AO-ASIF angled-plate and two children nonoperatively using skeletal traction because of impossibility of insertion of the osteosynthetic material without a damage of the growth plate. Subsequent operations of the UBC were necessary in these two children. All four patients recovered well without sequels. DISCUSSION: Pathologic fractures in UBC are usually treated nonoperatively and the cyst itself is treated after fracture healing. Proximal femoral impairment is the exception from this rule because of weigh bearing necessity. However, there may be problems with insertion of the implant when the cyst is very near to capital physis and traction treatment is then the method of choice with a delay of operative treatment of the cyst. CONCLUSIONS: Pathologic proximal femoral fractures in UBC are extremely rare and need individual approach. Some of them should be operated on the others primarily treated by traction with secondary operation of the cyst. Complications can be frequent.

Bone Cysts↗
PubMed2003

Avulsion fracture of the pelvis: separation of the secondary ossification center in the superior margin of the acetabulum.

A 13-year-old female sustained a rare avulsion fracture of the secondary ossification center in the superior margin of the acetabulum as the result of contraction of the reflected head of the rectus femoris muscle. Diagnosis was made from plain films and CT scans with 3D image reconstruction. The patient was treated non-operatively by bed rest with semiflexion of the hip and knee, and appropriate analgesia.

Accidental Falls↗
PubMed2002

[Marginal indications for the Magerl method of fixation of C1-C2 (case report)].

The authors present a 4-year old girl who had a car accident as a passenger and hurt her head, chest and limbs as well as upper cervical spine. The patient with multiple injuries was taken to the FTN Centre of Children's traumatology, Prague. Here the basic vital functions were ensured and a diagnosis was made of contusion of the brain with quadriparesis and inhibition of the respiratory centre, contusion of the chest, epiphysiolysis of the distal femur and later also instability of C1-C2. A censor for measuring or intracranial pressure was immediately inserted with a subsequent reduction of the distal femur and elastic fixation. External lumbar drainage was performed in the next week instability of C1-C2 was not found out and therefore not treated. Three months after the injury a ventriculoperitoneal shunt for intracranial hypertension was inserted. MRI showed stenosis in the region of occipitocervical passage and dorsal decompression of craniocervical passage was performed which consisted in the removal of the posterior arch of C1 and a significant extension of foramen magnun dorsally and laterally to both sides. Due to persisting ligamentous instability of C1-C2 with a spastic quadriparesis and inhibition of the respiratory centre a surgical atlantoaxial stabilization was indicated, i.e. causal treatment of instability. Seven months after the injury Magerl fixation of C1-C2 was performed by 2.7 mm titanicum screws (Synthes). Preoperative stability of C1-C2 in the reduced position was satisfactory but with regard to iatrogenic instability the C0-C1 fixation was combined with occipitocervical fussion by Ransford loop extending over C0-C3. Further, the triangular flap of periost was overturned from the external occipital protuberance to C3 and all this was bridged by cortical cancellous bone grafts from iliac crest. After two months a check simple and functional x-ray examination showed a stable fusion of C0-C2. The neurological finding remained the same even after one year, i.e. a severe quadriparesis with the inhibition of the respiratory centre requiring artificial lung ventilation.

Cervical Vertebrae↗
PubMed2002

[Use of the elastic stable intramedullary nailing technique in non-typical pediatric fractures].

PURPOSE OF THE STUDY: The "Elastic Stable Intramedullary Nailing" (E.S.I.N.) of French authors as a method of treatment of children's diaphyseal long bone fractures is well known from nineties of the last century. After we got familiar with the technique we wanted to introduce it in other indications, especially some metaphyseal long bone fractures and injuries of metacarpals, meta-tarsals and phalangeal bones in the growing skeleton. MATERIAL: During two last years, i.e. 1999-2000, ESIN procedure in 97 children was performed in our Regional Pediatric Trauma Centre. That was 39% of all osteosyntheses and 3.05% of all children's fractures treated during this period. Children treated by ESIN procedure were divided into three groups (see in Methods), 52 being in group one, 28 in group two and 17 in group three. METHODS: In our series of patients managed with the use of ESIN procedure according to the type of fractured bone and physical behavior of the implants three groups were formed. In the first group called "Classic ESIN Procedure" were children with diaphyseal long bone fracture (femur, tibia, humerus and forearm bones), in the second group "Non-typical ESIN Procedure" metaphyseal long bone fractures (humerus, radius, tibia) and in the third group, "ESIN-like Procedure" patients with metacarpal and phalangeal digital fractures were included. In all children the technique was very similar to original French (Nancy) description. Supraphyseal trepanation of the bone and introduction of usually two prebent elastic nails intramedullary. RESULTS: All 97 children healed good. In four children we saw little problems. In one patient it was necessary to change the ESIN osteosynthesis of open tibia fracture to external fixation. In the other boy we saw delayed union of forearm bones and in the third a 2 centimeter overgrowth of the affected tibia was recorded. In the last boy where non-typical ESIN procedure was performed for proximal radial fracture separation the angulation of radial head, overgrowth and subluxation occurred. However, we were surprised by simplicity, short time of the procedure and good results in two new groups of patients with metaphyseal and metacarpal resp. phalangeal fractures. DISCUSSION: Though in metaphyseal long-bone fractures (Non-typical ESIN Procedure) and metacarpal and phalangeal digital fractures (ESIN-like Procedure) the technique does not respect original physical suggestions of three point fragment fixation it works very well. Already the French authors from Nancy mention the indication of the ESIN technique for some metaphyseal fractures (supracondylar humeral and proximal radial). We do not use the method in supracondylar fractures but found it excellent in earlier problematic proximal humeral and radial fractures and especially phalangeal digital fractures. Also we were able to establish three main indication groups for this procedure. CONCLUSIONS: The ESIN technique can be used in three groups of children's fractures. "Classic ESIN Procedure" in diaphyseal long bone fractures, "Non-typical ESIN Procedure" in metaphyseal long bone fractures and "ESIN-like Procedure" in metacarpal and phalangeal digital fractures.

Bones of Upper Extremity↗
PubMed1999

[Ureteroureteral end-to-side anastomosis in kidney transplantation--personal experience].

The most widely used way of reconstruction of the urinary pathways in transplantations of the kidney is at present a ureteroneocysto anastomosis. In some patients this type of reconstruction is difficult, if not impossible (adhesions in the lesser pelvis of the recipient, atrophic urinary bladder, short ureter of the graft, transplantation of child kidneys). In these instances the authors indicated a uretero-uretero end-to-side anastomosis. The authors performed in 13 patients a total of 17 uretero-uretero end-to-side anastomoses. In six transplantation of child kidneys en bloc was involved. During the postoperative period one female patient developed a urinary fistula from the renal pelvis of the graft which healed after conservative treatment. End-to-side uretero-uretero anastomosis is a simple and safe way of reconstruction of the urinary pathways in renal transplantations.

Adult↗
PubMed1997

[Percutaneous osteosynthesis of childhood fractures].

Percutaneous osteosynthesis in child traumatology is no new issue. It has been used for half a century in the treatment of supracondylar fractures of the humerus. With improvement of X-ray amplifiers and osteosynthetic materials its use can be, however, substantially extended and it can be considered one of the surgical methods for the treatment of fractures in children. For osteosynthesis most frequently a Kirschner wire is used, however, also a wire with a fine thread can be used, various types of intramedullary implanted rods, screws of different dimensions and modern absorbable materials. The prerequisite of percutaneous osteosynthesis is the possibility of successfully performed manual reduction of the fragments under X-ray control, anatomical access to the percutaneous introduction of suitable implants and a type of fracture where the fragments can be sufficiently stabilised by the selected material. For operation in addition to an X-ray amplifier suitable implants are needed, and frequently, e.g. in intramedullary fixations, also special instruments. The advantage of percutaneous osteosynthesis is slight devastation of soft tissues, in particular periarticular structures, slight exposure of the site of fracture to possible infection. This results in safer and more rapid healing and restored function as compared with open reduction. The main disadvantage of the percutaneous method is greater exposure of the patient, and in particular the surgical team, to X-ray radiation. Percutaneous osteosynthesis can be used in indicated cases at many different sites in fractures of long and short bones of the child skeleton.

Adolescent↗
PubMed1997

[Conservative treatment of phimosis in childhood].

Inborn or acquired stenosis of the prepuce is usually relieved by surgery. From the beginning of the nineties work was published where for treatment a steroid cream applied locally is used. The authors describe the method and achieved results of local non-surgical treatment using a corticoid cream made in the Czech Republic. The authors treated phimosis in a total of 44 boys. In 26 the phimosis was congenital, in 18 it was acquired. In the group of inborn phimoses cure was achieved in 100% and in the group of acquired affections in 72%. The final effect of treatment is according to the authors experience influenced by the interest and co-operation of the parents.

Administration, Topical↗
PubMed1996

Proximal fibular physeal injury.

Six children with a rare injury to the proximal fibular physis in a 5-year period were reviewed. This number of patients constituted only 0.09% of all children's fractures and 2.05% of all fibular fractures treated in our department. The group consisted of 4 girls and 2 boys. All patients incurred the fractures as pedestrians injured in traffic accidents by vehicles in motion and, all but one had multiple concomitant injuries. There were three type 2 injuries, one type 3 injury, and two type 4 injuries to the proximal physis of the fibula. All but one were treated with cylinder casts for 4-5 weeks. One boy with a type 4 injury was treated by open reduction and wire internal fixation. All patients healed uneventfully.

Casts, Surgical↗
PubMed1996

[Treatment of hypertension with a fixed combination of bopindolol and chlorthalidone (Sandoretic)].

A multicentric, prospective, 16-week open study evaluated the effectivity and tolerance of the fixed combination of the beta-blocking agent bopindolol with the diuretic chlorthalidone--Sandoretic in 81 patients with mild to moderate hypertension. The combination of these two drugs is appropriate, since both drugs have long-term effects. Sandoretic induced a decrease of the mean sitting initial systolic blood pressure of 162.5 +/- 16.5 mmHg to 134.2 +/- 12.8 mmHg at the end of the study, a decrease of 28.3 mmHg. Diastolic blood pressure decreased after 16 weeks of treatment from the initial value of 103.9 +/- 4.9 mmHg to 85.3 +/- 6.0, a decrease of 18.6 mmHg. Changes of the standing systolic and diastolic blood pressures were of similar magnitude. Sandoretic treatment led to a normalization of the diastolic blood pressure (90 mmHg and lower) in 80.3% of patients. In 49.4% of patients treatment with Sandoretic led even to a diastolic blood pressure of 85 mmHg and lower and 29.6% patients had at the end of treatment diastolic blood pressure 80 mmHg and lower. Tolerance of the drug was excellent in 75.3% patients. Sandoretic induced a mild, however, significant decrease of potassium plasma levels. The increase of the uric acid plasma level was also significant. Monitoring of potassium plasma levels is therefore necessary during the treatment with Sandoretic. In patients showing a decrease of the potassium plasma level, potassium sparing diuretic-amiloride should be added or the dosage of the drug should be halved.

Adrenergic beta-Antagonists↗
PubMed1996

[Acute scrotal syndrome in children].

The authors discuss different forms of acute scrotal syndrome in child age, its symptomatology, differential diagnosis and treatment. They emphasize in particular the importance of the time factor in torsion of the testis and the necessity of urgent surgery and the difficulty of differential diagnosis. Final treatment of children with acute scrotal syndrome should therefore be provided in time in a department with sufficient experience with this problem. In the department of paediatric surgery in the Thomayer Faculty Hospital in Prague during the four-year period (1992-1995) a total of 88 children with acute scrotal syndrome were treated. Inflammatory diseases predominated (39%), torsion of the testicular and epididymal appendages was recorded in 28%, and torsion of the testis in 14%. Children with testicular torsion came to the hospital on average 20 hours after the onset of symptoms, all were operated but only 58% of the testes were saved.

Acute Disease↗
PubMed1992

Sacrococcygeal teratoma in Sweden: a 10-year national retrospective study.

Thirty-two children with sacrococcygeal teratoma have been treated during the last 10 years (1980 to 1989) in Sweden. A retrospective study was performed in four departments of pediatric surgery that treat sacrococcygeal teratomas in children from the whole of Sweden. Prenatal and perinatal histories were reviewed together with interval to diagnosis, Altman classification, histology, and serum alpha-fetoprotein. Details of surgical management +/- adjuvant chemotherapy and outcome of patients were also documented. In 8 patients the teratoma was diagnosed prenatally by ultrasonography and there was one postoperative death in this group. Multiagent chemotherapy was used in all but one of 11 patients with malignant teratomas (in 8 of them a cisplatin, bleomycin, vinblastine combination). Only one patient with a malignant tumor treated by single-agent chemotherapy died, 8 others were still alive and tumor-free after 1 to 9 years (mean time, 5.4 years). Two patients developed late relapses and were treated by surgical resection. Metastases occurred in five of the 11 malignant tumors, one at presentation and in four patients 10 to 29 months following surgery. All relapses had distant metastases as well as local disease. Serum alpha-fetoprotein was used in monitoring some of these patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Sacrococcygeal teratoma in Sweden between 1978 and 1989: long-term functional results.

Thirty-four patients operated with sacrococcygeal teratoma in Sweden between 1978 and 1989 were reviewed. Twenty-five children were available for functional follow-up. The patients and their parents were interviewed for bowel and micturition habits. Fourteen patients from this number were subjected to anorectal manometry (56%). Fifteen children reported normal bowel habits (60%). In 10 patients (40%) soiling was observed. However, four of them were under 3 years of age and wearing diapers, which made the functional evaluation difficult. The manometries showed normal and resting tone and squeezing pressures in 10 patients and subnormal values in four patients who also had soiling problems. All investigated children showed normal rectoanal inhibition reflex. Twenty-one patients reported normal micturition, in four (16%) urinary incontinence was recorded. Two of the latter children required intermittent clean catheterization, one was on medication and the last one lives without any treatment. No difference in functional outcome was noted between patients with intrapelvic or extrapelvic tumor location. Retrospectively, it is not possible to know whether the observed functional outcome is due to tumor growth or the result of surgery. Preoperative clinical investigation and in some cases anorectal manometry and cystometry could theoretically resolve this problem.

Adolescent↗
PubMed1992

Proximal tibial skeletal traction for femoral shaft fractures in children. Treatment to discard or retain.

A proximal tibial skeletal traction in the treatment of femoral shaft fractures in the growing child has been reported to result in complications such as knee pain, knee joint subluxation, and growth disturbance. For the last 15 years, the authors used a single screw (instead of the Kirschner wire) inserted in the tibia perpendicular to the surface and well below the tibial tubercle physis. With the traction applied to this screw and the leg in a 90-90 position or resting on a Braun splint, none of the previously described complications were observed. This modification of the proximal tibial skeletal traction is a simple, quick, and safe method in the treatment of femoral shaft fractures in children.

Adolescent↗
PubMed1991

Magnetic resonance imaging in the evaluation of partial growth arrest after physeal injuries in children.

The precise delineation of the size, shape, and location of an osseous bridge is a critical step in the management of children who have a partial growth arrest of the epiphyseal plate. Five children between the ages of ten and fourteen years were diagnosed, with the aid of conventional roentgenograms, as having a partial growth arrest. Magnetic resonance-imaging studies were carried out to determine the exact size, shape, and location of the osseous bridge. The information derived from the imaging studies was essential for the determination of the appropriate treatment and for the planning and undertaking of any operative intervention.

Adolescent↗