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Atypical intracranial vascular malformations: their behavior, treatment and follow-up
Voldřich, Richard ; Netuka, David (advisor) ; Haninec, Pavel (referee) ; Přibáň, Vladimír (referee)
Therapy and follow-up of patients with atypical vascular malformations are not standardized. The goals of this dissertation are the comparison of relevant treatment and imaging methods, the determination of an optimal follow-up program based on the type of lesion or the character of therapy, and the documentation of the behavior of atypical malformations after incomplete closure. Long-term observation of 195 embolized dural arteriovenous malformations (DAVM) confirmed the high success rate of Onyx embolic material compared to other agents - complete occlusion was achieved in 88% of cases compared to 35% in the control group. A total of 93% of DAVMs treated with Onyx were closed at the last follow-up. The material also proved to be stable in the long term. Recurrence was diagnosed in 1,8% of patients. The recurrences of DAVM occur due to the accentuation of originally negligible vascular fistulas that are not visible on post-interventional digital subtraction angiography (DSA). Prospective comparison of magnetic resonance angiography (MRA) and DSA concluded that patients after complete embolization of dural fistula can be safely followed using only MRA. In the case of carotid-cavernous fistulas (CCFs), imaging and clinical outcomes of traditional and new endovascular materials, as well as...
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Embolisation of urinary bladder as an alternative to endoscopy and open surgery
Kleinbauerová, Zuzana ; Kachlířová, Zuzana (advisor)
The group of patients consists of 13 patients with embolization bleeding treatment of unresectable tumors of the urinary bladder, hemorrhagic cystitis and iatrogenically caused bleeding during surgery. The patients underwent digital substraction angiography of internal iliac arteries from the retrograde femoral approach and after pathological findings of hypervasculazation or extravasation in 10 patients was followed by bilateral embolization of both internal iliac arteries, one just the right internal iliac artery. In all patients the bleeding cessation occured in few days after surgery. In 8 patients relapsed hematuria occurred averaged over 2 and a half months.
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Case study of the physiotherapy treatmen of a patient after embolisation procedure of spinal arteriovenosus malformation with a nidus in the Th12-L1 segment with developed severe paraparesis of lower limbs
Zámečník, Marek ; Neuwirthová, Svatava (advisor) ; Vrhel, Otakar (referee)
Autor: Marek Zámečník Title: Case study of the physiotherapy treatment of a patient after embolisation procedure of spinal arteriovenous malformation with a nidus in the Th12-L1 segment with developed severe paraparesis of lower limbs. Objective: The aim of this work is a summary of theoretical and practical knowledge, approach the issue of spinal arteriovenous malformations. And from the perspective of a physiotherapist to manage a case report of a patient who underwent embolisation treatment of spinal arteriovenous malformation of ThL spine, after which developed severe paraparesis of lower limbs. Methods: The work is divided into two parts - general (theoretical) and special (practical). Theoretical part is based on the research of specialised literature and summarises the basic information about spinal cord lesions and in great detail about the arteriovenous malformation of spinal cord, about diagnostics and treatment of individual types of malformations and finally a physiotherapy of this kind of diagnosis. Practical part documents the process of physiotherapy of the patient after embolisation treatment of spinal arteriovenous malformation with developed severe paraparesis of lower limbs. Results: The therapy reached the best results in the area of better overall condition of the patient,...
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Structural and functional impacts of infective endocarditis
Pazderník, Michal ; Šochman, Jan (advisor) ; Veselka, Josef (referee) ; Beneš, Jiří (referee)
Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Despite the severity of illness in this country, very few data have been reported previously regarding investigations of IE in the Czech Republic. Consequently, a retrospective evaluation of local IE cases at one of the country's largest medical centers was conducted. Our aim was to analyze the characteristics of this disease in our country. The greatest interest was devoted to Staphylococcus aureus (S. aureus), etiological agent that has been associated with the worst course of IE episodes. The hypothesis of our study was that infective endocarditis caused by S. aureus, in comparison with other etiological agents, is associated with worse course of the disease. We evaluated the structural (abscess formation, impaired integrity of heart valves, systemic embolism) and functional (incidence of heart failure and conduction disturbances, in-hospital mortality) manifestations of IE. Of all studied parameters, only embolism and S. aureus as the causative agent were...
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Case study of the physiotherapy treatmen of a patient after embolisation procedure of spinal arteriovenosus malformation with a nidus in the Th12-L1 segment with developed severe paraparesis of lower limbs
Zámečník, Marek ; Neuwirthová, Svatava (advisor) ; Vrhel, Otakar (referee)
Autor: Marek Zámečník Title: Case study of the physiotherapy treatment of a patient after embolisation procedure of spinal arteriovenous malformation with a nidus in the Th12-L1 segment with developed severe paraparesis of lower limbs. Objective: The aim of this work is a summary of theoretical and practical knowledge, approach the issue of spinal arteriovenous malformations. And from the perspective of a physiotherapist to manage a case report of a patient who underwent embolisation treatment of spinal arteriovenous malformation of ThL spine, after which developed severe paraparesis of lower limbs. Methods: The work is divided into two parts - general (theoretical) and special (practical). Theoretical part is based on the research of specialised literature and summarises the basic information about spinal cord lesions and in great detail about the arteriovenous malformation of spinal cord, about diagnostics and treatment of individual types of malformations and finally a physiotherapy of this kind of diagnosis. Practical part documents the process of physiotherapy of the patient after embolisation treatment of spinal arteriovenous malformation with developed severe paraparesis of lower limbs. Results: The therapy reached the best results in the area of better overall condition of the patient,...
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Structural and functional impacts of infective endocarditis
Pazderník, Michal ; Šochman, Jan (advisor) ; Veselka, Josef (referee) ; Beneš, Jiří (referee)
Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Despite the severity of illness in this country, very few data have been reported previously regarding investigations of IE in the Czech Republic. Consequently, a retrospective evaluation of local IE cases at one of the country's largest medical centers was conducted. Our aim was to analyze the characteristics of this disease in our country. The greatest interest was devoted to Staphylococcus aureus (S. aureus), etiological agent that has been associated with the worst course of IE episodes. The hypothesis of our study was that infective endocarditis caused by S. aureus, in comparison with other etiological agents, is associated with worse course of the disease. We evaluated the structural (abscess formation, impaired integrity of heart valves, systemic embolism) and functional (incidence of heart failure and conduction disturbances, in-hospital mortality) manifestations of IE. Of all studied parameters, only embolism and S. aureus as the causative agent were...
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Embolisation of urinary bladder as an alternative to endoscopy and open surgery
Kleinbauerová, Zuzana ; Kachlířová, Zuzana (advisor)
The group of patients consists of 13 patients with embolization bleeding treatment of unresectable tumors of the urinary bladder, hemorrhagic cystitis and iatrogenically caused bleeding during surgery. The patients underwent digital substraction angiography of internal iliac arteries from the retrograde femoral approach and after pathological findings of hypervasculazation or extravasation in 10 patients was followed by bilateral embolization of both internal iliac arteries, one just the right internal iliac artery. In all patients the bleeding cessation occured in few days after surgery. In 8 patients relapsed hematuria occurred averaged over 2 and a half months.
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Function of radiographer at embolization procedure
KŘÍŽOVÁ, Pavlína
As a radiographer can be regarded an educated health worker who is prepared to perform demanding work in medical branches. One of them is radiology and its important subspecialty, interventional radiology, where they perform a very responsible work. They communicate with patients, cooperate with medical personnel and operate a complex angiographic apparatus. Therefore it is essential for them to have finished a profes-sional training and to possess the required qualities. A person becomes a radiographer after they have completed a specialised educational programme, which can nowadays be studied at a college and it is completed by achieving a title Bc. (written before the na-me). During the studies they acquire proficiency and competence in the field of radiology which is needed for the experience in the interventional radiology working place. During both theoretical and practical education skills in the field of technical equipment (angiography equipment) and required IT technologies (HIS, PACS) are mastered, as well as the anatomic orientation in examinated area. They learn the latest procedure in the embolization techniques from the medical personnel, orientate themselves in the instrumentarium. Moreover, they are accustomed to the contrasting materials and their undesirable reactions to them. If needed, they are fully able to give the first aid.In addi-tion to that, a non-medical personell who participate in carrying out the embolizations should possess following qualities: communication skills - proficient cooperation with the medical personnel and the patients, empathy - patient awareness, ability to handle stressful situations. Working with an ill person demands a psochologically accurate individual approach and strict following of the medical ethic principles. Embolization is a way of occluding (closing) one or more blood vessels that are doing more harm than good. Various materials may be used, depending on whether vessel occlusion is to be temporary or permanent, or whether large or small vessels are being treated. The material is passed through a catheter with its tip lying in or near the vessel to be closed. This approach can be used to control or prevent abnormal bleeding as well as shut down the vessels that support a growing tumor. Therapeutic embolization may also serve to eliminate an arteriovenous malformation (AVM), an abnormal connection between an artery and a vein. The term "embolization" derives from embolus, which can be any object that circulates in the bloodstream until it lodges in a blood vesel - in this case, a synthetic material or medication specially designed to occlude the blood vessels.
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Vascular disorders of gastrointestinal tract - Diagnostics and endovascular therapy
MOKRÁ, Michaela
An important group of diseases affecting gastrointestinal tract is derived from impaired function of the blood vessels. These disorders involve bleeding (arterial and venous), aneurysms and intestinal ischaemia. Interventional approaches to treat gastrointestinal haemorrhage differ in arterial and venous bleedings. In treatment of arterial bleeding, embolization techniques are utilized for selective occlusion of a damaged artery. In case of venous varices, transjugular intrahepatic portosystem shunt (TIPS) must be introduced. Chronic mesenteric ischaemia is relieved by angioplasty with a stent placement. Endovascular extraction in acute intestinal ischaemia is performed with aspiration thrombectomy of the blood clot at the site of peripheral vascular occlusion. In our department, we treated 99 patients with disorders of gastrointestinal blood vessels in the course of two years. In 27 patients, we searched for the cause of arterial bleeding (in 33.3%, the bleeding was not confirmed). We performed 24 embolizations. In 55 patients, TIPS was placed; of these, additional embolization of portosystemic collateral was performed in 44 patients. Two patients suffering with mesenteric ischaemia were treated with PTA and stent placement. Seven patients with intestinal ischaemia were treated with the use of aspiration thrombectomy with a promising result - a complete recanalization was reached in 4 cases. Nowadays, endovascular therapy is a method of choice in therapy of vascular disorders of the gastrointestinal tract. In correct indications, endovascular therapy represents a save and effective method that shows a relatively good technical and clinical efficacy.
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