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Maisonneuve fracture - anatomy, diagnostics, operative approaches and technics of osteosynthesis
Kašper, Štěpán ; Tuček, Michal (advisor) ; Kachlík, David (referee) ; Hromádka, Rastislav (referee)
Although Maisonneuve fracture (MF) is a well-known type of ankle fracture-dislocation, there are a number of misconceptions that can lead to wrong choice of treatment. The concept of Maisonneuve fracture is also not understood by all authors in the same way and the recent CT studies confirmed that this is much more complex and variable injury. The dissertation was divided into two main parts: anatomical (experimental) and clinical. In the experimental part, the aim was to describe the appearance and shape and demonstrate the clinical significance of the crista malleoli lateralis (CML), which is located on the lateral side of the distal fibula and which previous anatomical and clinical studies neglected. Knowledge of this structure is essential to correct placement of syndesmal screws. The aim of the clinical part was the precise description of the pathoanatomy and associated injuries within the "classic" and less frequent forms of Maisonneuve fracture based on CT examination and intraoperative findings. Anatomical studies were performed on 352 dry bone specimens of adult fibula. Clinical studies were conducted on a set of 54 adult patients with "classic" MF occuring in the period 2012-2018 and 11 adult patients with "double" MF occuring in the period 2012-2020. In the anatomical part of the...
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Microscopic Structure of Intestinal Anastomoses and the Use of Animal Models in Experimental Intestinal Surgery
Kural, Tomáš ; Tonar, Zbyněk (advisor) ; Kachlík, David (referee) ; Kocián, Petr (referee)
Despite extensive research and the implementation of modern surgical methods, the incidence of anastomotic leaks remains high. The exact pathophysiological mechanisms responsible for these leaks are still unknown, making prevention a challenge. The use of animal models is extensive in the research of intestinal anastomotic leakage. The literature review of this thesis, therefore, presents a brief history of the usage of experimental animals as well as major differences in terms of anatomy and histology between humans and the experimental mammals utilized in intestinal healing studies. The thesis is based on four studies describing the possibilities of using quantitative histological methods in different applications, animal models, and experimental surgical techniques in the research of intestinal anastomotic healing. The conclusions of these four studies can be summarized as follows: Conclusion 1: TeIGen software is readily accessible to scientists researching fibrous and porous materials using micro-CT analysis. This software aids in producing virtual image sets with defined morphometric attributes, and it can also help with fine-tuning of quantification tools required to examine micro-CT scans. The software also enables the identification of material morphological properties and image...
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Anatomical possibilities of the suprascapular nerve reconstruction by dorsal approach
Krajcová, Aneta ; Kaiser, Radek (advisor) ; Kachlík, David (referee) ; Měšťák, Ondřej (referee)
The presented dissertation primarily investigates new possibilities of targeted reconstruction of the lower branch of the suprascapular nerve for the infraspinatus muscle in patients with palsy of external rotation of the arm. It arises either on the basis of the brachial plexus palsy or during fractures of the scapula. The aim of the first part of the thesis was to use a systematic review of the literature and a subsequent meta-analysis to define data on the epidemiology and etiopathogenesis of severe injuries to the brachial plexus, which are indicated for surgical treatment. The second part describes two experimental studies on the reconstruction of the lower branch of the suprascapular nerve using the spinal accessory and lower subscapular nerves. Determining the values of the frequency of different types of brachial plexus lesions and their dependence on gender and causal mechanisms can be used as a basic reference when informing patients and the professional public about these types of injuries. In the experiment, it was proven that both methods of the suprascapular nerve reconstruction can be used in the vast majority of cadavers. They are thus potentially usable in clinical practice depending on the type of injury.
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Clinical Anatomy of the Arteries of the Trumb and the First Web Space
Miletín, Jakub ; Kachlík, David (advisor) ; Stingl, Josef (referee) ; Měšťák, Ondřej (referee)
The thumb is absolutely essential for the flawless function of the hand, and the loss of the structure or function of the thumb almost always means a partial or total invalidation of the patient. Thus, salvage and reconstruction of the thumb is one of the foremost topics in hand surgery. Modern conservation and reconstructive procedures of hand surgery require a completely new insight into the knowledge of vascular anatomy. In order for the information to be comprehensible and well communicated, it is necessary to have a sufficiently detailed, clear and, above all, uniform nomenclature. When taking a closer look at the anatomy of the vessels of the hand, it turns out that authors often do not use generally accepted terms or do not agree on the interpretation of the correctly used ones. The above stated facts led us to the conclusion that, although the anatomy of the hand arteries seems to have been well studied and described in the past, there is still considerable room for sorting out the previously described data, revising the nomenclature, completing the missing detailed description of some anatomical variations and assessing the significance and usefulness of individual structures in relation to trauma and reconstructive hand surgery. This work describes in detail the systemic and topographical...
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Clinically relevant anatomical variations in the hand and forearm
Kunc, Vojtěch ; Kachlík, David (advisor) ; Stingl, Josef (referee) ; Dvořák, Zdeněk (referee)
There is undoubtful importance of the knowledge of anatomical variations during surgical procedures and diagnostic in the upper limb. They can not only confuse surgeon during the surgical approach and lead to iatrogenic damage or be misdiagnosed for pathological conditions, but they might also be used during reconstructive procedures as tendon transfers, nerve grafts or free flaps. It is even hypothesized that superficial anatomical variations might be used to predict the variable course of deeper structure. Many of those hypotheses still need experimental verification as they are often used in clinical practice without proper evidence. Anatomical variability includes all structures such as bones, ligaments, muscles, nerves, vessels as well as superficial palmar creases. Each of these structures might be divided, multiplied or absent; they can differ in their origin, insertion, course, or branching. In some cases even completely accessory bony or muscular structures might be present. The goal of this dissertation is to provide review of the anatomical variability of the hand and forearm with particular interest given to accessory bones around the elbow joint. We proposed their radiological definition, proposed a new classification, and stated their overall prevalence, which is 0.77 % with the most...
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Clinical impact of anatomical variation of the pancreas and its vascular supply
Rousek, Michael ; Kachlík, David (advisor) ; Liška, Václav (referee) ; Šubrt, Zdeněk (referee)
Knowledge of the anatomy of the pancreas, its vascular structures and their anatomical variations is crucial for the hepato-pancreato-biliary surgeon. Some anatomical variations of the pancreas can cause specific diseases in patients. Our work aims to provide a detailed review of clinically important variations in the anatomical structure of the pancreas and its vascular supply. The other goal was to identify the clinically important anatomical variations in the two most frequently performed pancreatic resections. The next goal was to describe the vascular supply of postresection pancreatic remnants and to determine a potentially critical anatomical arrangement that could influence postoperative perfusion of the remnant. The results were confirmed in a retrospective analysis of the patients after pancreatic resections. The most critical variations in the vascular supply of the pancreas were identified as a result of the experiment. Critical anatomical variations in the vascular supply of the postresection remnant after pancreaticoduodenectomy were found. In these cases, the vascular supply of the pancreatic remnant is provided only through non-constant anastomosis between the splenic artery and the transverse pancreatic artery. In the retrospective analysis, these patients had a significantly...
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Comparison of particular parameters of kinesiologic and dental examination in patients with symptomatic temporomandibular joint disorders
Mičánková, Kateřina ; Šedý, Jiří (advisor) ; Kachlík, David (referee)
This thesis focuses on the comparison of results of dental and kinesiological examination, medical history, PHQ-4 questionnaires and X-rays between a group with symptoms of temporomandibular disorder and an asymptomatic group. The theoretical part summarizes anatomy and kinesiology of the temporomandibular joint and also epidemiology, etiology, symptomatology, classification, examination and treatment of temporomandibular disorders. The main goal was to compare differences between the two groups in muscle tenderness or pain on palpation, range of active depression of the mandible and active dorsiflexion of the cervical spine. Methods: A total of 30 patients were included in the study, out of which 18 were in the symptomatic group (mean age 44.8, SD ± 11.6 years) and 12 in the control group (mean age 36.9, SD ± 13.9 years). The participants underwent a clinical examination, which consisted of thorough collection of medical history, dental and kinesiological examination and X-rays (anteroposterior, lateral, panoramic), the participant also filled in the PHQ-4 questionnaire. Results: Muscle tenderness or pain on palpation in the symptomatic group was significant (p = 0.019). There was not a significant difference in depression of the mandible between the groups (p = 0.26). Range of active dorsiflexion...
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Histological Evaluation of Experimental Models of Liver Diseases
Malečková, Anna ; Tonar, Zbyněk (advisor) ; Kachlík, David (referee) ; Čížková, Dana (referee)
Animal models are widely used for research of liver diseases pathogenesis and progression and for development of new treatment strategies in hepatology. The dissertation thesis focuses on large animal model, specifically swine. The use of animals, which are anatomically and physiologically close to humans, allows us to bridge the gap between the experimental and human medicine. Histopathological analysis of the liver biopsies is still a fundamental part of liver disease diagnosis and therefore, it is also a part of the experimental design of the studies using the porcine liver. Our aim was to apply qualitative and quantitative histological methods of evaluation on porcine liver and to assess their usability in experimental medicine. The quantitative methods included automated image analysis as well as stereological methods, which guaranteed high reproducibility and comparability of the experimental results. The dissertation thesis is based on 10 manuscripts. Three of them are published reviews associated with the main topic of the thesis. Seven original manuscripts resulted from six experimental studies - their six conclusions are listed bellow: Conclusion 1: We developed an open-source software QuantAn for quantification of microvessels visualized by 3D imaging methods, such as computed tomography...
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Porcine Liver Anatomy Applied in Biomedicine
Mik, Patrik ; Eberlová, Lada (advisor) ; Kachlík, David (referee) ; Stingl, Josef (referee)
Introduction: This dissertation summarizes our research published in seven articles where we described both the ways of utilization of porcine liver in biomedical research and the basic morphometric parameters of hepatocytes and liver connective tissue useful in experimental surgery followed by liver regeneration experiments. We set off with the description of anatomical concepts of human liver applied to clinical investigation followed by summary of porcine liver morphology with special stress on its potential clinical utilization. The studies in experimental surgery followed by liver regeneration where the porcine liver model proved its utility, reveals that the distribution of portal blood to the liver parenchyma, the number and the volume of mononuclear and binuclear hepatocytes, and the amount and the distribution of liver connective tissue being among the most useful ones. Methods: For the mapping of portal vein branching we used µCT scans of porcine liver corrosion casts, and both the quantitative parameters of the hepatocytes and of the connective tissue were evaluated on systematic uniform random paraffin-embedded samples that were harvested from three different regions of interest (ROI) of liver parenchyma (peripheral, paracaval and paraportal). For the quantification, we followed...
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Modern technologies in the assessment and treatment of pelvic organ prolapse - experimental and clinical studies
Urbánková, Iva ; Krofta, Ladislav (advisor) ; Mašata, Jaromír (referee) ; Kachlík, David (referee)
This project has shown that pelvic organ prolapse is linked with maternal age and delivery-related injuries. Up to every eight women may have a symptomatic prolapse already one year after their first delivery. Moreover, those with muscle injury have a higher short-term risk of pelvic organ prolapse development. To improve our knowledge we further explored the potential of an ovine model for prolapse and vaginal surgery. We showed that many anatomical and morphological features and vaginal wall changes induced by specific lifespan factors (first delivery, artificial menopause, and hormonal replacement) are similar to what is observed in women. We further used this model for testing novel implants and mesh visualization techniques. We believe that the ovine model can be used in future research on pelvic organ prolapse pathophysiology and novel treatment modalities.t
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