Background and Objectives Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). Methods We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. Results There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations. Discussion There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.
Uvod: Ileokolicka invaginace patři mezi nejcastějsi přiciny nahle přihody břisni u kojenců a batolat. Cilem studie bylo zhodnoceni lecby ileokolicke invaginace v Ceske republice v roce 2019.Metody: Multicentricke retrospektivni studie se zucastnilo 14 pracovisť dětske chirurgie. Data pacientů s ileokolickou invaginaci byla ziskana anonymně prostřednictvim dotazniku SurveyMonkey Inc. Questionnaire.Výsledky: Ileokolicka invaginace byla v roce 2019 diagnostikovana u 162 pacientů, median věku byl 30 měsiců (3 měsice−9,5 roku). 133 pacientů bylo indikovano k hydrostaticke desinvaginaci, 14 pacientů k primarni operaci a u 15 pacientů doslo ke spontanni desinvaginaci. Vsechna pracovistě provaděla hydrostatickou desinvaginaci s celkovou uspěsnosti 89,5 %, na 12 pracovistich byla provaděna v celkove anestezii (7 pracovisť přidavalo myorelaxans) a na 2 pracovistich v analgosedaci. Hydrostaticka desinvaginace provedena v celkove anestezii (nezavisle na podani myorelaxans) byla statisticky významně uspěsnějsi než hydrostaticka desinvaginace provedena v analgosedaci (108/113, 95,6 % vs. 11/20, 55 %; p<0,0001). Operovano bylo celkem 28 pacientů, z toho primarně 14 pacientů. Na pracovistich, kde je hydrostaticka desinvaginace provaděna v analgosedaci, je statisticky významně vice pacientů s ileokolickou invaginaci operovano než na pracovistich, kde je hydrostaticka desinvaginace provaděna v celkove anestezii (9/20, 45 % vs. 19/142, 13,4 %; p=0,0018). Pocet provedených střevnich resekci je statisticky významně vyssi na pracovistich, kde se hydrostaticka desinvaginace provadi v analgosedaci ve srovnani s pracovisti, kde se hydrostaticka desinvaginace provadi v celkove anestezii (7/9, 77,8 % vs. 5/19, 26,3 %; p=0,0166).Zavěr: Uspěsnost hydrostaticke desinvaginace v CR byla 89,5 %. Nejvyssi uspěsnosti se dosahuje při provedeni v celkove anestezii.
Prezentujeme kazuistiku 70lete pacientky se sporadickými bilateralnimi angiomyolipomy. Pro spontanně vznikle krvaceni z angiomyolipomu do retroperitonea a hemodynamickou nestabilitu pacientky bylo nutne provedeni akutni revize s nefrektomii vlevo, kontralateralni angiomyolipom byl ve druhe době selektivně embolizovan a nasledně resekovan.
Placenta accreta is a diagnosis, which will gynecologists have to face probably more often, than in previous years. The reason is the increasing number of cesarean sections, one of the most important risk factors. The following case shows, that a placenta accreta not treated primary by hysterectomy, can have consequences even after a longer period. This time the manifestation was a severe bleeding one year after the delivery per cesarean section, which had to be treated by an acute hysterectomy.
OBJECTIVE:An analysis of indication and limits of laparoroscopic myomectomy with regard to clinical usefulness.DESIGN:A short review article.SETTING:Department of Obstetrics and Gynecology, Endoscopic Training Centre, Hospital, Kladno, Czech Republic.SUBJECT AND METHOD:One of the primary goals of laparoscopic myomectomy is preservation of the uterus for the future fertility and psychosomatic integrity of women through minimally invasive way. A comparison is made of advantage and disadvantage of different types of myomectomy.CONCLUSION:Laparoscopic myomectomy is surgical alternative for women with symptomatic subserosal and intramural fibroids. The indication for this technique is limited. Removal of large fibroids and repair of myometrial defect are challenges to gynecologic laparoscopists, and also the main limitations. A well trained laparoscopic surgical team can operate any fibroid. In our experience, as well as reflected by the literature, a consensus gradually emerges that a maximal size of 8-10 cm and a total number of fibroids should not exceed four.
