[The Injury-Treatment Time Interval of the Most Frequent Limb Fractures - 1-Year Monocentric Study]. / Interval úraz-osetrení u nejcastejsích zlomenin skeletu koncetin ­ jednoletá monocentrická studie.

INTRODUCTION The purpose of the study was to evaluate the injury-treatment time interval in a group of patients with limb bone fractures over the period of one year; and to compare this interval in the most frequent fractures of the upper and lower limb. MATERIAL AND METHODS The followed-up group of the prospective one-year monocentric study included 3,148 patients treated consecutively for 3,909 fractures. For the purpose of sub-analysis of the injury-treatment time interval in limb bone fractures, excluded from the group were the patients with multiple fractures (520 pts), patients with spinal fractures (356 pts) and pelvic fractures (210 pts). The statistical significance of the achieved results was tested with the use of contingency tables (chi-square test of independence). The significance level for the quantified tests was set at 5%. RESULTS The sub-analysis covered 1,727 patients whose medical records mentioned the exact time of injury and first examination. Within the first 6 hours after the injury, 536 (56.0%) patients with an upper limb bone fracture and 429 (55.7%) patients with a lower limb bone fracture were treated. Within 24 hours after the injury, 683 (71.4%) patients with an upper limb bone fracture and 572 (74.3%) patients with a lower limb bone fracture were treated. Within the first 24 hours after the injury, 104 (76.4%) patients with a proximal humerus fracture, 240 (84.5%) patients with a distal radius fracture and only 174 (55.5%) patients with metacarpal and phalanx fractures were treated. In the first hours after the injury, most frequently treated were the patients who sustained a distal radius fracture, and the longest injurytreatment time interval was seen in patients with hand bone fractures. The difference in the 24hour injury-treatment interval was significant when comparing distal radius fractures and proximal humerus fractures (p = 0.047) and when comparing distal radius fractures and hand bone fractures (p < 0.001). Within 24 hours after the injury, 166 (83.3%) patients with a proximal humerus fracture, 128 (79.1%) patients with an ankle fracture and 142 (63.4%) patients with metatarsal and phalanx fractures were treated. The shortest injury-treatment interval was reported in patients with a proximal femoral fracture and an ankle fracture, and relatively the lowest number of treated patients in the first hours after the injury was reported among patients with metatarsal and toe fractures. When evaluating the 24hour injury-treatment time interval, this difference was significant only when comparing proximal femoral fractures and metatarsal and phalanx fractures (p < 0.001), while when comparing proximal femoral fractures and ankle fractures the difference was not significant (p = 0.283). DISCUSSION There are not many studies of other authors focused on monitoring the injury-treatment time interval in the most frequent limb bone fractures. They also confirm that the treatment is sought out most quickly by patients with fractures that make walking or self-care impossible. CONCLUSIONS The results of the study confirmed that the fastest treatment was requested in patients with fractures which made the selfcare (distal radius) or walking (proximal femur, ankle) impossible; less painful fractures (metacarpal, phalanx fractures) and fractures that do not compromise walking (metatarsal fractures) were treated in the first 24 hours after the injury significantly less frequently. The patients with ankle fractures sought out treatment the most quickly compared to the patients with other fractures; it concerned largely occupational or sports injuries sustained by young men who were brought for treatment immediately after the injury, directly from their workplace or sports ground. The treatment of osteoporotic fractures (proximal humerus, distal radius, proximal femur) was spread over the first 6 hours due to the lack of independence of elderly patients after sustaining a fall at home; in majority of them transport to treatment was arranged for by relatives or neighbours only with a certain delay, once they became aware of their injury. Key words: fracture epidemiology, limb bone fractures, trauma-treatment time interval.

[Comparison of functional outcomes in angle-stable osteosynthesis of comminuted fractures of the proximal humerus with those in percutaneous Kirschner-wire fixation. A prospective study of mid-term results]. / Porovnání funkcních výsledku úhlove stabilních osteosyntéz víceúlomkových zlomenin proximálního humeru a perkutánní fixace Kirschnerovými dráty ve strednedobém horizontu: prospektivní studie.

PURPOSE OF THE STUDY: To evaluate the mid-term results in a group of patients with displaced comminuted (three- and four-fragment) fractures of the proximal humerus treated by angle-stable plate osteosynthesis and compare them with the results in the patients in whom the method of percutaneous Kirschner-wire (K-wire) fixation was used. MATERIAL AND METHODS: The group treated with angle-stable implants (ASI group) consisted of 55 patients, 13 men and 42 women. A Targon Ph nail was used in 32 and a Philos plate in 23 patients. These patients were compared with a group of nine patients, one man and eight women, treated by percutaneous K-wire fixation (K-wire group). At a follow-up of 12 months at least, final Constant (CS) and DASH scores were assessed. The CS was related to the values for the unaffected limb, and an individual relative CS was calculated and expressed in percent. The mean follow-up was 30 (range, 13-55) months in the ASI group and 58 (range, 39-76) months in the K-wire group. The following seven characteristics were evaluated : fracture type, surgical technique, dominance of the affected limb, patient age, injury-surgery interval, and individual relative CS and DASH scores. The results were statistically analysed with a 5% level of statistical significance set for all tests. RESULTS: The average age in the ASI group was 62.1 years, with 64.7 (range, 29-95) years for women and 35.5 (range, 26-76) years for men. In the K-wire group the average age was 66.1 (range, 53-84) years. The functional outcomes in four-fragment fractures were significantly worse than in three-fragment fractures (mean relative CS and DASH scores of 56 and 21 versus 72 and 32). The K-wire group showed a significantly worse functional outcomes than the ASI group in both the mean relative CS score (p<0.001) and the mean DASH score (p=0.003). No significant relationship was found in any other pair of variables. The patient's age had no effect on functional outcome, as assessed by CS (p=0.412) and DASH (p=0.076) and the injury-surgery interval had no influence, either (CS, p=0.220; DASH, p=0.118). There was no relation between the patient's age and choice of the surgical method (p=0.467), between the patient's age and a fracture type (p=0.356) and between the patient's age and injury to either a dominant or a non-dominant limb (p=0.659). Dominance or non-dominance of the affected limb had no effect on CS or DASH scores (p=0.662 and p=0.302, respectively) or on a type of fracture (p=0.183). DISCUSSION: Several surgical techniques used for the treatment of proximal humerus fractures suggest the absence of consensus in therapy. Novel angle-stable implants show better biochemical properties and meet criteria required in minimally invasive techniques. Some authors prefer intramedullary nailing for three-fragment fractures and the use of an angle-stable plate for four-fragment fractures. These indication criteria were also confirmed by the results of our study. CONCLUSIONS: The analysis of functional outcomes showed that the therapeutic effect of K-wire transfixation was significantly worse than the effect of the angle-stable plate technique, and therefore the authors stopped using this method. At present intramedullary nailing is indicated in two- and three-fragment fractures and in some less displaced four-fragment fractures. An angle-stable plate is used in severely displaced four-fragment fractures. If the head is broken or dislocated, older patients are primarily indicated for hemiarthroplasty and younger ones for humeral head reconstruction.

[Pressure ulcer and mortality risk after surgical treatment of proximal femoral fractures in the elderly]. / Dekubitus a riziko úmrtí senioru operovaných pro zlomeninu proximálního femuru.

PURPOSE OF THE STUDY: We aimed to determine the incidence of pressure sores and their effect on survival in patients older than 70 years who underwent surgery for hip fracture, and to identify the factors which were associated with an increased risk of pressure sores. MATERIAL AND METHODS: The group comprised 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fractures in the Trauma center between January 2003 and June 2005. Follow-up ranged from 12 to 18 months. In a prospective study we assessed relevant medical history, demographic and clinical data, pre-, intra-, and post-operative factors and the presence, location and depth of pressure sores. Statistical significance at a 5 % level of probability was determined by testing null hypotheses for qualitative and quantitative variables, using multivariate analysis adjusted for selected baseline characteristics. RESULT: The average age of the patient group was 81 years (range, 70-99). Pressure ulcers developed in 92 patients (34.2 %); their presence in the post-operative period significantly reduced patient survival (p=0.037). In terms of location, pressure ulcers in the calcaneal region had a more significant effect on patient mortality (p=0.011) than those in the sacral region (p=0.130). Age was not significantly associated with pressure ulcer development (p=0.547), in contrast to male gender (p=0.007). A lower mobility score before injury was a significant risk factor (p=0.007). Co-morbidities adjusted for age and gender had a significant effect (p=0.003). The factors that did not significantly increase the risk of pressure ulcers were as follows: the patient's living environment before injury (p=0.113), AO type of fracture (p=0.653), type of anaesthesia (p=0.702), surgical procedure used (p=0.946), morbidity before injury (p=0.267) and time to surgery (p=0.180). The presence of acute complications was of boundary significance (p=0.083). DISCUSSION The study included only the patients with proximal femoral fractures who underwent surgery. It was the authors' view that, by excluding conservatively treated patients, a more homogenous group was achieved. There is only sparse information in the literature concerning the effect of pressure ulcers on reduced patient survival, and the significance of pressure ulcer location has not been evaluated at all. Similarly, the effect of pre-morbidity on pressure ulcer development has not been reported in any of the studies available. In contrast to other studies, the authors did not find age to be a risk factor for increased ulcer development. They believe that the quality and quantity of the input data (prospective data collection, large sample size, long follow-up) guarantee the validity of the results obtained in this study. The incidence of pressure sores is in agreement with the results of relevant studies involving large numbers of patients and prolonged follow-up. CONCLUSIONS: In patients older than 70 years undergoing surgery for hip fracture, the development of pressure ulcers had a significant effect on reduced survival, with the highest significance for ulcers in the calcaneal region. Factors significantly increasing the risk of ulcer development were male gender, morbidity before injury and pre-existing chronic complications. The presence of acute complications was of boundary significance. The study did not show any significant effect of age, pre-morbidities, time to surgery, patient's living environment before injury, fracture type, type of anaesthesia or surgical procedure used on the incidence of pressure ulcers.

[Malignant prostatic neoplasms in the Czech Republic. Hospital case-control study]. / Zhoubný novotvar prostaty v Ceské republice. Nemocnicní analytická studie prípadu a kontrol.

In a hospital-based analytical case-control study of prostate cancer conducted during 1996-1997 at the Urological clinics of FNKV Prague 10,181 cases of prostate cancer and 277 controls of males with non cancerous urological disease were analysed. Mean age of newly diagnosed cases of prostate cancer was 70.8 years, mean age of death (83) from this cancer was 72.8 years. At the time of diagnosis 44.2% cases had already remote metastases in bones. Five-year cumulative survival rate of the cases was in this study 53.4%. Statistically significant differences were observed in examination of prostatic specific antigene (PSA) and alkaline phosphatase. Results of other biochemical examinations, digital rectal examination or sonography of the prostate did not show statistically significant differences between cases and controls. Implementation of both digital rectal examination and PSA examination into the scheme of preventive medical examination of males over 50 years of age represents the only possibility how to increase the proportion of the prostatic cancer diagnosed in early latent stage and thus therapeutically and prognostically more favourable.

Breast cancer epidemiology in Czech Republic.

Breast cancer is the most commonly diagnosed cancer and a leading cause of malignant neoplasms death in Czech female population. Only about half of all new breast cancer cases are diagnosed in early stage, consequently therapeutically and prognostically favourable. The benefit of conceptual breast cancer screening, showing an absolute decrease in mortality, can be expected after 5-7 years of screening. That is why early start of mammography hand in hand with clinical examination of the breast will have to be one of the highest priority in the national health promotion programmes.

Prostate cancer in Czech Republic 1959-1992. Descriptive survey.

Carcinoma of the prostate is the second most common cancer and fourth most common cause of death from cancer, among men in Czech Republic. Of all tumours, the prevalence of prostate cancer increases the most rapidly with age. A shift in age distribution favouring the older population as a consequence of health promotion and disease prevention programmes, will lead to a permanent increase in the number of patients diagnosed with prostate cancer in Czech males. Its incidence is raising steadily and about 2/3 of all new cases are diagnosed at the time of extra-prostatic or distant disease with poor prognosis for cure. Current evidence especially from the USA strongly suggests that combing the improving prostate-specific antigen test (Hybritech Tandem assay) with the digital rectal examination increases the early detection rate for prostate cancer. Implementation of this scheme to routine diagnostics can offer the best chance of increased survival, decreased morbidity and possible cure of the Czech males.

Transplacental antibodies. Part II: Maternal antibodies against the toxins of C. diphtheriae and C. tetani.

Examinations of 297 sera for diphtheria antitoxin and 160 sera for tetanus antitoxin were carried out in 1981. All sera were obtained from the cord blood of mothers between 15 and 34 years of age. The mothers were divided into four age groups each of which was further subdivided into the primipara and multipara subgroups. The aim was to assess the age-specific variations in response to active immunization against diphtheria and tetanus. The protective level of diphtheria antitoxin (at least 0.01 I.U./ml) was recorded in the serum of 96.3% of examinees and the rates of seropositivity were found to fall with increasing age. The protective level of tetanus antitoxin (at least 0.1 I.U./ml) was found in the serum of 95.2% of mothers. The serologic response encountered in groups of older mothers was a clear-cut demonstration that the country-wide mass immunization against tetanus carried out between 1974 and 1975 was highly effective and fully justified. The variations in the diphtheria and tetanus antitoxin levels found in the primipara and multipara subgroups were not statistically significant.

Transplacental antibodies. Part III: Maternal antibodies against polioviruses, M. parotitidis and M. parainfluenzae.

In 1981 we examined 247 sera for the presence of antibodies against all three types of poliovirus and 253 sera for antibodies against M. parotitidis and three types of M. parainfluenzae viruses. The sera were obtained from the cord blood of mothers between 15 and 34 years of age. All mothers were divided into four age groups, each with primipara and multipara subgroups. The rate of seropositivity for type 1 and type 2 poliovirus-specific antibody was in all age groups higher than 90%, the overall seropositivity rate for type 3 poliovirus antibody was 83.6%, with 73.1% as the lowest rate for age group of youngest mothers. Significant seropositivity variations between the primipara and multipara subgroups were recorded only for type 3 antibody in the two age groups of oldest mothers (25-29 and 30-34 years). This is consistent with the assumed booster effect of Sabin vaccine strains on mothers of families with more than one child. Antibodies specific to mumps virus were present in the cord blood of 78.6% of all mothers and the rates of seropositivity were found to rise with the increasing age. Seropositivity for M. parainfluenzae type 1-specific antibody was demonstrated in 95.8%, for type 2-specific antibody in 98.9% and for type 3-specific antibody in 100% of mothers, which is suggestive of high herd immunity levels in the population.

Transplacental antibodies. Part I: Maternal antibodies against B. pertussis and B. parapertussis.

In 1981 a set of 256 of the umbilical cord blood collected from mothers between 15 and 34 years of age was serologically examined for specific antibodies against B. pertussis and B. parapertussis infections. The mothers were divided into four age groups, each with primipara and multipara subgroups, with the aim to assess age-related variations in specific immunity levels acquired as a consequence of active immunization against pertussis, or by clinical or subclinical infection with B. parapertussis (no specific immunization against B. parapertussis infection is carried out in Czechoslovakia). The percentage of mothers with B. pertussis-specific antibody was found to fall from 81% and 70% in the two younger age groups (15--19, 20--24 years) to 21.3% and 16.3% in the two older age group (25--29, 30--34 years). The variations between the primipara and multipara subgroups were not statistically significant. Antibody against B. parapertussis infection was present in 38.6% of all mothers, which is suggestive of a relatively high circulation of this agent in the population. In the two older age groups (25--29 and 30--34 years) multiparous mothers were found to have B. parapertussis antibodies at significantly higher rates than primiparous mothers, which seems to confirm the theory that B. parapertussis infection may serve as booster to immunity in mothers of families with more than one child.