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Novel treatment modalities for pelvic floor dysfunction
Macková, Kateřina ; Krofta, Ladislav (advisor) ; Džupová, Olga (referee) ; Čelko, Alexander (referee)
We aimed to test selected novel treatment modalities for pelvic floor dysfunctions and genitourinary syndrome of menopause. Both conditions are common in female, they negatively affect their quality of life, and current treatment options are not optimal. We started our research with an extensive literature search. First, we summarized the information on animal models for, and the utility they may have in the investigation of the pathophysiology of POP and novel therapies. We systematically searched 7426 articles from which 51 fulfilled the inclusion criteria. From all screened animals, only the non-human primate develops POP spontaneously, however their use is controversial. We concluded that many studies have methodological shortcomings and lack standardization in reporting outcomes. Also, several other animals can be used as a model of surgery for POP, each of them with different purposes. For our later research we chose the rat model to simulate POP repair with synthetic mesh. We also systematically reviewed the literature on the objective effects of non-ablative Er:YAG LASER on the skin and vaginal wall. We identified 7187 articles of which we included 15 in our review, including four that tested Er:YAG LASER on vaginal tissue. Er:YAG LASER energy induces measurable changes in the deeper skin...
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Differential Diagnostics,Prevention and Treatment of Back Pain Using the Computer Kinesiology System
Honců, Pavla ; Čelko, Alexander (advisor) ; Konečný, Petr (referee) ; Siegelová, Jarmila (referee)
Musculoskeletal disorders are the second most common cause of sick leave in people at working age, for this reason it is necessary to search ways of early detection of reversible functional disorders of the locomotor system before they develop into irreversible structural disorders. The aim of this thesis has been to examine the Medical Expert Information System Computer Kinesiology (MEIS CK), to present its effectiveness and to compare the results of therapy with the MEIS CK system in a group of participants with subacute and chronic back pain in the lumbar spine and in a group of participants without any back pain. The results of these two groups have been compared with the control group without MEIS CK therapy. The pilot study included 55 participants with subacute and chronic back pain (Group 1) and 51 participants without back pain (Group 2). Both groups were treated by MEIS CK therapy. In the third group, there were 67 healthy participants without back pain and without MEIS CK therapy. All 173 participants underwent MEIS CK tests three times during our research, which included 46 standard physiotherapy tests. The effect of MEIS CK therapy was assessed using the H score. Improvement after the therapy was defined by a reduction in the H score by at least 1 point. Data were statistically...
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Current interventional approach to coronary artery disease
Klinčeva, Milka ; Widimský, Petr (advisor) ; Čelko, Alexander (referee) ; Hradec, Jaromír (referee)
Coronary artery disease is the main cause of death in both genders worldwide. Many preclinical and clinical studies present the concept of modifiable and non modifiable cardiovascular risk factors. The basic management of the coronary artery disease is medical, but the prognosis in many patients can be improved by potentially invasive procedures, such as the percutaneous coronary intervention (PCI) and the coronary artery bypass grafting (CABG). The cardiovascular risk scores may help cardiologists and cardiac surgeons alike to individualize the risk profile of patients in order to better define the revascularization strategy and to appropriately counsel the patient, in same time reducing the morbidity and mortality. The first part of the thesis evaluates the validity of both forms of the most used cardiovascular tool in the present day, the European System for Cardiac Operative Risk Evaluation (EuroSCORE). The second part of the thesis concentrates on the prevalence of stress-induced myocardial stunning (Tako-Tsubo syndrome) among patients undergoing urgent coronary angiography for suspected acute myocardial infarction. The third part of the thesis obtains a realistic contemporary picture of how patients with STelevation myocardial infarction (STEMI) are treated in different European countries.
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Possibilities of prevention reflecting geriatric principles: Functional status and depressivity in old age
Vaňková, Hana ; Čelko, Alexander (advisor) ; Dohnal, Karel (referee) ; Jirák, Roman (referee)
Possibilities of prevention reflecting geriatric principles: Functional status and depressivity in old age Hana Vaňková, MD Abstract Background: Given the population ageing in Europe and in the Czech Republic, strategies aiming to prevent functional decline in older age are of great importance. Depression in old age increases functional decline and is also associated with increased morbidity, mortality and deterioration of quality of life (Anstey et al., 2007; Karakaya et al., 2009). Therefore, there is a need for a comprehensive intervention addressing both functional status and depressive symptoms. Methods: Using comprehensive geriatric assessment, the relationship between functional status and depressive symptoms was examined in 308 residents of long-term care facilities (RCFs) in the Czech Republic. Depressive symptoms were measured using the 15-item Geriatric Depression Scale. An additional randomized control trial (RCT) evaluated the effect of a dance-based therapy on depressive symptoms in 162 institutionalized older adults with average age over 80 years. Results: A multiple regression analyses adjusted for sociodemographic factors and for taking antidepressants found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms. The ability to...
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Factors with negative impact on functional outcome and mortality in elderly pati ens treated surgically for proximal femoral fracture: their identification and r elevance for prevention
Kopp, Lubomír ; Čelko, Alexander (advisor) ; Janout, Vladimír (referee) ; Jahoda, David (referee)
AIM: Increase in one-year mortality following proximal femoral fractures in elderly patients was seen in many studies. Identification of factors increasing the risk of mortality is decisive for prognosis of these patients. Our aim was to identify significance of single factors on shortening of survival time and worsening of functional outcome. We have dominantly concentrated on influence of pressure sores and impairment of cognitive functions. METHODS: In a prospective consecutive manner, we have observed 275 patients treated in our department in period from January 2003 to June 2005. We have observed altogether 25 prehospitalisation, hospitalisation and posthospitalisation factors. Using statistical tests (log-rank, Mann-Whitney, logistic regression), we have analysed relationship between length of survival and different observed factors on a 5 % level of significance. RESULTS: In our study, we have identified factors significantly shortening survival time. These were: age, male sex, comorbidities, decreased mobility before injury, acute general complications, development of pressure sores after surgery, insufficiency of osteosynthesis requiring revision surgery, deep wound infection and low ADL and MMSE scores. CONCLUSION: Our study has identified simple predictors of poor functional outcome and...
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Risk factors of malignant melanoma, its possibilities of prevention and early diagnosis
Kulichová, Daniela ; Čelko, Alexander (advisor) ; Rosina, Jozef (referee) ; Dohnal, Karel (referee)
Background Ultraviolet radiation is one of the most important environmental risk factors for cutaneous melanoma. Nonetheless, information concerning ultraviolet exposure in many populations, including the central European population, is lacking. Objectives The aim of our study was to investigate risk factors for malignant melanoma, particularly those related to ultraviolet exposure behavior in two European neighboring countries, Germany and the Czech Republic. Methods We conducted a hospital-based case-control study. 224 consecutive patients were diagnosed with melanoma in two dermatological clinics (Prague and Munich). Controls were 268 patients with other conditions from the same hospitals. All subjects completed a questionnaire on socio-demographic data and factors related to ultraviolet exposure. Associations between melanoma, ultraviolet exposure and other variables were assessed by multivariate logistic regression. Results Patients with red hair had higher risk of developing melanoma than those with other hair color (odds ratio 3.597, 95% confidence interval 1.341-9.646). A similar trend was seen when comparing phototypes; subjects with phototype I and II had a higher likelihood of melanoma than those with phototype III (OR 4.028 and 4.837, 95%CI 1.929-8.411 and 2.574- 9.086). Frequent...
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A comparison of various systems of urgent care and their future directions
Pokorný, Jiří ; Čelko, Alexander (advisor) ; Kalvach, Pavel (referee) ; Špunda, Jan (referee)
While a relatively young field of medicine, emergency care (EC) has recently witnessed dramatic advances which will definitely continue. At present, there are 2 main systems of EC provision, the Anglo-American and the Franco-German ones. Both systems have their indisputable advantages; however, they are also fraught with major drawbacks. Given my long-term personal experience with emergency medical service as well as my appointments in hospital resuscitation wards, emergency departments, and operating theaters, I am convinced there is still considerable room for improvement in the organization of pre- and in-hospital EC in our country. To develop this thesis, I have collected as much as possible information about the organization of EC in various countries of the world and in the CR. Based on my knowledge and data from the above sources and, also, using my long-standing experience, I have evaluated and compared individual EC systems assessing both their advantages and disadvantages. The analysis has shown that the system of EC should meet both the geopolitical and economic status of the country involved, and the standard of currently available therapeutic options. The outcome of my study is a proposal to modify the system of EC in the CR. It should be an adaptable system, with its main advantage being it...
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New Surgical Techniques to Prevent Serious Permanent Disability of Proximal Hume ral Fractures
Edelmann, Karel ; Čelko, Alexander (advisor) ; Janout, Vladimír (referee) ; Landor, Ivan (referee)
NEW SURGICAL TECHNIQUES TO PREVENT SERIOUS PERMANENT DISABILITY OF PROXIMAL HUMERAL FRACTURES AIM: Fractures of the proximal humerus are the third most common fracture in adults. In the treatment of displaced three-and four-part fractures in the last decade we have witnessed the advent of new angular stable implants, which have better biomechanical stability in osteoporotic bone in these patients very frequent. The purpose of this study was to determine whether these new implants are a better prevention of severe permanent disability, compared with the earlier technique of percutaneous pinning with K wires. METHOD: The detailed analysis for publishing rich area of research literature on treatment history, epidemiology and prevention of proximal humerus fractures was accomplished. Medium-term results were evaluated in a prospective randomized study of 55 patients treated with angular stable implants with an average age of 62.1 years (Targon PH nail 32 patients, Philos plate 23 patients). For comparison was used a group of 9 patients treated with percutaneous K wire fixation, combined monitored prospectively and retrospectively. With a minimal follow up of 12 months in all patients was determined the final individual relative Constant score and DASH score. For patients in the sample were obtained...
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