|
|
Effect of Surgical Cerebral Revascularization on Hemodynamics, Clinic and Neurocognitive Performance
Košťál, Petr ; Přibáň, Vladimír (advisor) ; Grus, Tomáš (referee) ; Šámal, Filip (referee)
4 Abstract Introduction Since 2016, we know that the neuron responds to chronic hypoperfusion by reducing its performance. Cerebral revascularization using extra-intracranial bypass in internal carotid occlusion has also been shown to improve this reduction in function. In the case of asymptomatic internal carotid stenosis (ACS), hypoperfusion of the brain may occur due to insufficient collateralization. It is not clear whether this condition can lead to changes in cognitive performance. Likewise, the impact of hemodynamic changes on cognition in patients with ACS after carotid endarterectomy (CEA) remains unclear. The aim of this study was to evaluate the results of CEA for ACS at one year by assessing the changes in anterior, middle, and posterior cerebral artery blood flow in tandem with changes in cognitive efficiency. Methodology As part of the prospective study, the flow volume in cerebral arteries using quantitative magnetic resonance angiography was measured in a group of 14 males and 5 females before and at one year after CEA for ACS. Cognitive efficiency was assessed by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The values of flow volume were processed using simple ratio (SR) and were used for analyses with changes in cognitive skills after CEA. Results One year...
|
|
|
Changes in Ascending Aorta Wall in Aortic Valve Diseases - Clinico-Pathological Correlation
Stejskal, Václav ; Šteiner, Ivo (advisor) ; Grus, Tomáš (referee) ; Ehrmann, Jiří (referee)
Changes in ascending aorta wall in aortic valve diseases - clinico-pathological correlation Ascending aorta is an initial portion of the thoracic aorta. Ascending aorta and aortic valve share an intimate anatomical position and influence each other hemodynamically. Surgical specimens from the ascending aorta are mostly removed for aortic aneurysm or dissection, which are the consequences of a wide range of risk factors, diseases, syndromes, or ageing. In most cases, aneurysms are asymptomatic being diagnosed incidentally during imaging for another reason. The dangerous clinical manifestation of aneurysms is called an acute aortic syndrome, including aortic dissection. Surgical replacement of the affected aorta by a prosthesis in either case (aneurysm and dissection) represents the method of choice. If the aortic valve displays a defect, it is possible to replace it as well. In 2015 and 2016, The Society for Cardiovascular Pathology and The Association for the European Cardiovascular Pathology published consensus documents on the aortic wall. The nomenclature and grading schemes are unified and specified in detail. The incidence and grading of particular lesions significantly differed in various studies until the consensus documents were published. Diseases of the aortic wall include medial...
|
|
|
Aneurysmorrhaphy using exoprothesis. New surgical treatment for haemodialysis arterio-venous fistula aneurysm.
Rokošný, Slavomír ; Baláž, Peter (advisor) ; Grus, Tomáš (referee) ; Tomka, Ján (referee)
Introduction: Haemodialysis arterio-venous fistula aneurysm (AAVF) prevalence varies between 7-43%. When they are symptomatic, they should be referred for treatment. It is unclear which is the optimal surgical treatment and if fistula flow reduction is beneficial for heart remodeling in patients with high-flow AAVF. Aims: (1) introduction of a new surgical technique - aneurysmorrhaphy using exoprothesis (AuE) and evaluation of its patency and complication rates. (2) analysis of flow reduction impact on heart remodeling in high-flow AAVF. (3) systematic review and meta- analysis of various surgical techniques to identify the best treatment option of haemodialysis arterio-venous fistula aneurysm. Methods: (1) retrospective analysis with prospectively collected surgical and postoperative data, patency evaluation using Kaplan - Meier curve, early and late complication rates analysis. (2) retrospective analysis prospectively collected echocardiographic parameters before and after surgery. (3) systematic review and meta- analysis following the PRISMA guidelines - registered in the international prospective register of prospective reviews PROSPERO (registration number: CRD42016029692). Results: (1) primary assisted patency rate at 12 months was 80 %, infection rate was 4.5 % and AAVF recurrence rate was 0...
|
|
|
Contribution to the Hemodynamic of Vascular Anastomosis
Grus, Tomáš ; Lindner, Jaroslav (advisor) ; Adamec, Miloš (referee) ; Veverková, Lenka (referee)
The primary objective of the research project was the optimization of geometry of the infrainguinal prosthetic bypass in the site of the distal end-to-side anastomosis. Due to the negative influence of hemodynamics, it is most frequently this location, which is responsible for the longterm failure of the graft. Our prospective angiographic study in patients as well as experimental and computational simulations indicate that flow type in the anastomosis and wall shear stress (WSS) in particular are the key factors that determine the location of neointimal hyperplasia and promote its progression. Maximum of such changes was located in the toe, heel, and bottom of the anastomosis, and these clinical findings correspond with the results from the simulations. We carried out several clinical experiments that suggest the importance of the angle of the distal anastomosis of an infrainguinal prosthetic bypass as a key factor in the development (both location and quantity) of neointimal hyperplasia 6 to 24 months following the procedure. The construction of the anastomosis at a more acute angle results in WSS values that are closer to physiological flow. This reduces both mechanical impairment of the endothelial cells and stimulation of the smooth muscle cells. From the researched set of anastomotic angles (25ř, 45ř,...
|
|
|
Care of patients udergouing aortocoronary bypass grafting
Kozlová, Ivana ; Bartůněk, Petr (advisor) ; Grus, Tomáš (referee)
The thesis deals with coronary heart disease and focuses primarily on the surgical treatment and postoperative care. The theoretical part contains: anatomy and 5 physiology of heart and blood circulation; brief description of coronary heart disease; its preventative and non-surgical options of treatment; surgical revascularization of myocardium and lastly also care of patients undergoing aortocoronary bypass grafting from medical and paramedical point of view. Empirical part of dissertation is aimed to be a comparison of levels of knowledge of students attending further university education Intensive care and nurses working in postoperative wards of intensive care in VFN in Prague and FNKV in Prague. To obtain the data was used quantitative research method - the method of the knowledge test. On the basis of the results of the research was created educational brochure focused on the drugs given to patients in postoperative period.
|
|
|
Complete Care of Pacient with Acute Rupture of Aneurysm of Abdominal Aortis
Swárovská, Jana ; Bartůněk, Petr (advisor) ; Grus, Tomáš (referee)
The author introduces in her final work the summary of complex care of patient with rupture of aneuryzm of abdominal aortae in 6 case studies. In comparison with diffrent cases she introduces in summarry the most important aspects of care, which can significantly influence the next prognosis of patient. Similarly as the scheme of today vision of the world also the care about patient is global, complex and holistic. It is not possible to pass over in silence neither of factors of personality, desease, save system and hospital team. On the base of her long standing experience of nurce in acute attendant care in vascular surgery department, the author draw ours attention on the main important moments of care of patient with life - threatened indisposition and indikates the way to the standardization of procedures, of course by observance of individual and empathic approach of sanitary staff. Within work on project of final work the author except of her professional experience uses also scientific methods, as recognizing of reality and verification of hypothesis. (like secondary data analysis)
|
|
|
Fish collagen foam properties optimalization for medical and veterinary use.
Lukáč, Peter ; Grus, Tomáš (advisor) ; Rohn, Vilém (referee) ; Matia, Ivan (referee)
V průběhu projektu byly vyvinuty unikátní kolagenní pěny z kolagenu získaného z kůže sladkovodní ryby (kapr obecný, Cyprinus carpio). Pomocí síťování karbodiimidem byl překonán problém s nestabilitou kolagenní matrix z kolagenu získávaného z chladnokrevných živočichů při tělesné teplotě savců. Následně byly pěny impregnovány antibiotiky (gentamicin a vankomycin) a opětovně lyofilizovány, což je postup, který zajišťuje požadovanou koncentraci antibiotika bez rizika následného vymytí při dalších technologických krocích. Uvedený produkt je, na rozdíl od přípravků z nesíťovanéhokolagenu, stabilní i při sterilizaci gamma zářením. Finální sterilizovaný produkt byl testován in vivo na potkaním modelu infikované rány. Byla prokázána efektivita v léčbě potenciálně letální infekce Pseudomonas aeruginosa a kmene Stafylococcus aureus rezistentní k meticilinu (MRSA). Vzhledem k vysoké potřebě profylaxe a terapie infekcí pooperačních a jiných ran právě výše uvedenými polyrezistentními původci se jedná o slibný prostředek k budoucímu klinickému využití. Zkušenosti, které jsme získali v průběhu uvolnování ATB z kolagenních pěn budou v dalším vyvoji použity pro impregnaci zevní kolagenní vrstvy cévní protézy, čímž bychom mohli eliminovat jednu z největších nevýhod a rizik spojených s použitím umělých materiálu a tím je...
|
|
|
Aneurysmorrhaphy using exoprothesis. New surgical treatment for haemodialysis arterio-venous fistula aneurysm.
Rokošný, Slavomír ; Baláž, Peter (advisor) ; Grus, Tomáš (referee) ; Tomka, Ján (referee)
Introduction: Haemodialysis arterio-venous fistula aneurysm (AAVF) prevalence varies between 7-43%. When they are symptomatic, they should be referred for treatment. It is unclear which is the optimal surgical treatment and if fistula flow reduction is beneficial for heart remodeling in patients with high-flow AAVF. Aims: (1) introduction of a new surgical technique - aneurysmorrhaphy using exoprothesis (AuE) and evaluation of its patency and complication rates. (2) analysis of flow reduction impact on heart remodeling in high-flow AAVF. (3) systematic review and meta- analysis of various surgical techniques to identify the best treatment option of haemodialysis arterio-venous fistula aneurysm. Methods: (1) retrospective analysis with prospectively collected surgical and postoperative data, patency evaluation using Kaplan - Meier curve, early and late complication rates analysis. (2) retrospective analysis prospectively collected echocardiographic parameters before and after surgery. (3) systematic review and meta- analysis following the PRISMA guidelines - registered in the international prospective register of prospective reviews PROSPERO (registration number: CRD42016029692). Results: (1) primary assisted patency rate at 12 months was 80 %, infection rate was 4.5 % and AAVF recurrence rate was 0...
|
|
|
Complete Care of Pacient with Acute Rupture of Aneurysm of Abdominal Aortis
Swárovská, Jana ; Bartůněk, Petr (advisor) ; Grus, Tomáš (referee)
The author introduces in her final work the summary of complex care of patient with rupture of aneuryzm of abdominal aortae in 6 case studies. In comparison with diffrent cases she introduces in summarry the most important aspects of care, which can significantly influence the next prognosis of patient. Similarly as the scheme of today vision of the world also the care about patient is global, complex and holistic. It is not possible to pass over in silence neither of factors of personality, desease, save system and hospital team. On the base of her long standing experience of nurce in acute attendant care in vascular surgery department, the author draw ours attention on the main important moments of care of patient with life - threatened indisposition and indikates the way to the standardization of procedures, of course by observance of individual and empathic approach of sanitary staff. Within work on project of final work the author except of her professional experience uses also scientific methods, as recognizing of reality and verification of hypothesis. (like secondary data analysis)
|
|
|
Contribution to the Hemodynamic of Vascular Anastomosis
Grus, Tomáš ; Lindner, Jaroslav (advisor) ; Adamec, Miloš (referee) ; Veverková, Lenka (referee)
The primary objective of the research project was the optimization of geometry of the infrainguinal prosthetic bypass in the site of the distal end-to-side anastomosis. Due to the negative influence of hemodynamics, it is most frequently this location, which is responsible for the longterm failure of the graft. Our prospective angiographic study in patients as well as experimental and computational simulations indicate that flow type in the anastomosis and wall shear stress (WSS) in particular are the key factors that determine the location of neointimal hyperplasia and promote its progression. Maximum of such changes was located in the toe, heel, and bottom of the anastomosis, and these clinical findings correspond with the results from the simulations. We carried out several clinical experiments that suggest the importance of the angle of the distal anastomosis of an infrainguinal prosthetic bypass as a key factor in the development (both location and quantity) of neointimal hyperplasia 6 to 24 months following the procedure. The construction of the anastomosis at a more acute angle results in WSS values that are closer to physiological flow. This reduces both mechanical impairment of the endothelial cells and stimulation of the smooth muscle cells. From the researched set of anastomotic angles (25ř, 45ř,...
|
guest ::
