Our entire planet is filled by communication routes, and as a result of the evolving information technologies, their numbers will continue to grow in the future. Demand for their reliability and hence the importance of protecting related technologies from all kinds of interference is increasing as well. Therefore, it is necessary to develop new materials in order to protect these routes against negative influences of the environment such as the atmospheric discharge. The main aim of the research is to develop and verify the properties of the cement composite that can be applied in systems of protection of building structures against lightning strike and overvoltage. The first step in the development of this material was the selection of suitable feedstocks, which by their presence in the newly developed material will increase its electrical conductivity respectively reduce its electrical impedance. For this purpose, a spectrum of potential raw materials with a high content of metals and organic carbon was chosen. By means of a suitably selected set of laboratory methods which consisted of determination of specific surface, impedance and total organic carbon content (TOC), materials with the most suitable properties were selected and their parameters determined also in a cement matrix. In order to realize this goal specimens with each conducive material as filler were created with incorporated copper electrodes. Impedance has been significantly reduced compared to the reference samples. The lowest values in the tens of ohms were obtained from samples containing carbon grit 0.5–4.0. This fact proves that the tested fillers can be used in order to produce electrically conductive cement composites.

V předloženem dokumentu jsou uvedeny hlavni zasady prodiagnostiku a lecbu sepse během těhotenstvi na pracovistichoboru gynekologie a porodnictvi. Text vychazi z dokumentu RoyalCollege of Obstetricians and Gynaecologists – Bacterial Sepsisin Pregnancy vydaneho v roce 2012 a nazorů clenů autorskehokolektivu. Implementace v textu formulovaných doporuceni musibýt vždy zvažovana v aktualnim klinickem kontextu a z pohledupoměru přinosu a rizika jednotlivých konkretnich postupů.Dokument je urcen primarně zdravotnickým pracovnikům oborugynekologie a porodnictvi. Nenahrazuje zakladni odborne zdrojedane problematiky a neuvadi povinnosti zdravotnickýchpracovniků urcene jinými zakonnými ci profesnimi normami.

The aim of our study is to introduce a new objective method of perioperative evaluation of the size of diaphragmatic defect to enable comparison of results among various centres and methods used for diaphragmatic reconstruction.

The aim of study was to compare growth, nutritional status and incidence of chest wall deformities and scoliosis in survivors of large congenital diaphragmatic hernia (CDH) defect (Gore-Tex patch reconstruction) with survivors with smaller defects and primary reconstruction.

The purpose of this study was to evaluate the outcome in neonates with congenital diaphragmatic hernia (CDH) either presenting within the first 24 h of life or diagnosed prenatally. The study was particularly focused on the time of onset of respiratory distress and on the use of the Gore-Tex (GT) patch for diaphragmatic reconstruction. Records of 104 neonates with CDH were retrospectively reviewed. The data were analyzed by ANOVA, Kruskal-Wallis test or chi (2) test as appropriate. The result showed that the overall survival rate was 73.1% (76/104). Survival of operated neonates was 91.6% (76/83). Postnatally diagnosed neonates with the onset of respiratory distress within the first minute of life survived in 67%, with the onset between 2 and 10 min survived in 89%, whilst neonates with the onset of respiratory distress after l0 min survived in 100% (P = 0.007). Birth weight, gestational age, time of onset of respiratory distress and Apgar score significantly differed between survivors and nonsurvivors. Primary closure of the diaphragmatic defect was performed in 62 patients while the GT patch was used in 21 patients. The survival of patients with a large defect treated with a GT patch was lower (76.2 vs. 96.8%, P = 0.003). There was only one case of recurrence in our series with the GT patch. Survival depends on the time of onset of respiratory distress and size of the defect, both of which correlate with the degree of pulmonary hypoplasia. The term high-risk CDH is appropriate only for children with respiratory distress within the first 10 min of life and those diagnosed prenatally. The GT patch is a suitable material for the diaphragmatic reconstruction; we suppose that the recurrence is caused by incorrect attachment of the patch to the thoracic wall.

The occurrence of coexisting congenital diaphragmatic hernia (CDH) and esophageal atresia (EA) with distal tracheoesophageal fistula (TEF) is extremely rare and is considered highly lethal. The combination of CDH with EA/TEF and truncus arteriosus communis (TAC) has not been reported in the literature to date. The authors describe a premature neonate with this association.

OBJECTIVE:To evaluate some perinatal and neonatal risk factors of occurrence of necrotising enterocolitis (NEC) and the current possibilities of treatment.DESIGN:A retrospective data analysis.SETTING:Mother and Child Care Institute, Prague.METHODS:The clinical course in 28 neonates treated for NEC on the worksite of the authors in the period 1999-2003. Only neonates with NEC in the second and third Bell's stages were included in the group.RESULTS:From a group of 14,275 neonates born during the reference period, NEC was diagnosed in 28 neonates. In all cases, they were neonates with very low birth weight (VLBW). The average gestation age was 26.6 weeks (the range was 23-35; the median was 25.5); the average birth weight was 822 grams (the range was 340-1,490g; the median was 735). Incidence was between 1.08 and 2.37/1,000 live births (the average was 1.94). On the average, NEC occurred on the 17th day after birth (the range was 5-59; the median was 14). 14 neonates (50%) in the acute stage of NEC were operated on; 9 children (32%) were only treated conservatively. In eight children at the acute stage, who were operated on, divided ileostomy was created; in four children, a T-drain was used for removal of the intestinal content and an abdominal drain was used for this purpose in one child. Repeated surgery was necessary in five children. Of the conservatively treated ones, five children recovered as a result of conservative treatment and four children died as a result of fast progression of NEC without surgical treatment. All the children treated for patent ductus arteriosus (PDA) with Indometacin died. The overall mortality in the group was 39.3% (11 children died).CONCLUSION:Prematurity seems to be the common denominator of the occurrence of NEC. Treatment of NEC in highly immature neonates with birth weight below 1,500g requires comprehensive cooperation of a neonatologist and a children's surgeon. Resection of a necrotic intestine with creation of a stomy remains a standard procedure, which is followed in unstable neonates with a localised form of the illness. Prevention of premature birth, antenatal steroids, frequent feeding (trophic feeding) and the corresponding correction of water management seem to be a reasonable strategy to reduce the incidence of NEC. The resulting incidence, mortality, the time of the occurrence of NEC and the therapeutic procedures are within the limits stated in the international literature.

AIM:The aim of this study is to assess a contemporary treatment potential for necrotizing enterocolitis in newborns with birth weights under 1000 g. METHODOLOGY AND SUBJECTS: This is a retrospective study of clinical and pathological data in a group of 19 newborns with birth weights under 1000 g treated for necrotizing colitis (NEC) by the authors' team from 1999 to 2003. Only newborns with the second and third grade NEC according to Bell were included in the trial group.RESULTS:The trial group included 19 newborns born in the 26th gestation week, on average (ranging from 23- to 31) with a mean birth weight of 711 grams (the range between 460-980 g). Their NEC appeared on the 18th postnatal day, on average (the range between 6-59). Ten newborns were operated in the acute stage of their NEC, nine were treated conservatively. Five infants operated in the acute stage had separational ileostomy conducted, four had a T-drain introduced and one had an abdominal drain introduced. In the conservatively managed group, three infants were consequently operated for intestinal strictures following their NEC, two recovered during the conservative treatment and four exited due to a fast progress of their NEC without surgery. The total mortality rate of the trial group was 42% (8 infants exited).CONCLUSION:The NEC treatment in the extremely immature newborns with birth weigts under 1000 g requires complex cooperation of a neonatologist and a paediatric surgeon. The necrotic intestine resections followed by stomic procedures remain standard procedures in unstable newborns with a localised form of the disease.

OBJECTIVE:Nosocomial infections caused by the coagulase-negative staphylococci are among the most frequent complications in an intensive care unit for neonates. The authors describe three cases of successful treatment of this complication in which the new antibiotic Linezolide was used.DESIGN:Analysis of three clinical cases.SETTING:Mother and Child Care Institute, Prague.METHODS:Description of cases of nosocomial sepsis in 3 immature neonates where the usual treatment of multiresistant strains of coagulase-negative staphylococci, based on the use of Vankomycin, was not successful.CONCLUSION:Administration of Linezolide proved to be very effective in all of the described cases. In spite of the high effectiveness and relative safety of this preparation, its precise role in the treatment of infection-related complications caused by coagulase-negative staphylococci has not yet been established. For the time being, we recommend administering this preparation only in strictly indicated cases after the usual therapy fails.

The study aims to demonstrate that the newly developed method of automated EEG analysis can detect abnormal phenomena in the neonatal EEG and can quantify the severity of the deviation from the norm. EEG records from 36 neonates with clinically indicated EEG examination were analyzed. Five-minutes samples of EEG activity during a standardized behavioral state were processed using a computer-supported four-stage analysis and described with 312 numerical items, providing the information on amplitude, power in five frequency bands, on signal shape and its stability or variability. Each of these items was automatically compared to normative data acquired from the examination of 21 healthy, full term neonates and tested whether it differs by one or two standard deviations from the norm. The number of patient's items differing from the norm was proportional to the severity of their abnormality. A cursory comparison of the results of automatic and visual analyses of patient' EEG records showed good agreement. The method shows promise for the clinical practice, where it can significantly contribute to both acceleration and greater objectivity of neonatal EEG assessment.

In this study the authors present a method of conversion of external fixations to closed intramedullary ones in the treatment of complicated diaphyseal fractures of the calf and femur. According to the conditions, the fixation is secured by a pin. The above mentioned procedure is advantageous especially in cases of patients with open fractures, in patients with polytraumas as well as in patients with a threatening or with a present compartment syndrome. Treatment of the above fractures is not always simple and represents a serious problem in everyday traumatological practice. Treatment of fractures using the above procedure has very good results with a minimum of complications. Although, nowadays, the skeletal defect can be solved and therefore the bearing capacity of the extremity be renewed, damages to the muscles are often irreparable and cause a permanent invalidity.

OBJECTIVETo assess the risk and the degree of possible unfavourable development in neonates with bronchopulmonal dysplasia and with congenital diaphragmatic hernia.DESIGNLongitudinal monitoring of the mental, motoric and neurological development until the age of 2 years. Comparison of the findings with the result of polygraphic examination carried out at the expected time of birth.METHODSThe following children were monitored: a) 38 children with bronchopulmonal dysplasia born between the 24th and 33rd post-conception weeks; b) 18 children with congenital diaphragmatic hernia, of whom 3 children were born between the 34th and 36th post-conception weeks, while the remaining 15 children were born on the expected date. All children underwent polygraphic examinations (EEG - 8 channels, respiration, EKG, EOG and EMG) between the 38th and 42nd post-conception weeks. During the 1st and the 2nd years, their psychomotoric development and neurological status were repeatedly evaluated according to Bayley and Vlach, respectively.RESULTSUp until the 2nd year of life, approximately 2/3 of the children in both monitored groups were developing favourably or satisfactorily. However, the development of the remaining 1/3 was not favourable: The children were mentally or motorically retarded and/or cerebral palsy developed in them. The polygraphic examination in the neonatal period predicted the favourable or unfavourable development of the monitored children with high probability.CONCLUSIONThe study showed that in accordance with the data stated in the literature, the development of neural functions is seriously affected in a relatively high percentage of neonates with severe pneumopathy. Neonatal polygraphy can contribute to timely determination of the prognosis for these children. Children with serious neonatal pneumopathies need to be provided with dispensary care on a long-term basis, and professional consultancy and intervention programmes need to be ensured for them.

BACKGROUND:Treatment of the Congenital Diaphragmatic Hernia in neonates with early manifestations has been accompanied with significant mortality. Authors present the treatment protocol employed in such children and results from the period January 1994 to December 2003.METHODS AND RESULTS:Since January 1994 to December 2003 96 children were cured for the Congenital Diaphragmatic Hernia. Ratio F:M was 36:60. 29 children (30%) were diagnosed prenatally, the remaining newborns were diagnosed on the basis of thoracic X-ray, which was required for the early signs of respiratory insufficiency. The postnatal treatment protocol included circulation-ventilation stabilisation, operation, early extubation and initiation of the peroral nourishment. Altogether 78 (81%) of children were operated after the stabilization using the standard laparotomy method, 5 children (6%) were operated with extra corporal membrane oxygenation, in 20 children (26%) a Goretex patch was used to cover an extensi e defect in the diaphragm. Overall survival was 74%, survival of operated children was 91%, 75% of children with a patch survived, survival of children operated with ECMO was 40%. Relapse occurred in one child (1%) with a patch.CONCLUSIONS:Specification of the prenatal diagnosis and collection of patients with CDH into tertiary centres with ECMO possibility can improve prognosis of neonates with the malformation.

When formulating indications for surgery of the thoracic outlet syndrome (TOS) the authors use as a basis their own experience with treatment of 42 patients and data from the literature. The basis is the fact that to the great majority of patients at the time after establishment of the diagnosis comprehensive and systematic rehabilitation care was not available either because lack of time or due to the absence of a department within their reach which could ensure adequate care. The authors discuss the reasons why they prefer after accurate establishment of the diagnosis a primary surgical approach and elimination of the cause of further mechanical damage of the neurovascular bundle with necessary and obvious continuation with long-term intensive rehabilitation. This is a reverse procedure than that recommended by some others concerned with this problem.

Background and purpose: The aim of the present study was to verify whether the proposed method of computer-supported EEG analysis is able to differentiate the EEG activity in quiet sleep (QS) from that in active sleep (AS) in newborns. A quantitative description of the neonatal EEG may contribute to a more exact evaluation of the functional state of the brain, as well as to a refinement of diagnostics of brain dysfunction manifesting itself frequently as 'dysrhythmia' or 'dysmaturity'.Patients and methods: Twenty-one healthy newborns (10 full-term and 11 pre-term) were examined polygraphically (EEG-eight channels, respiration, ECG, EOG and EMG) in the course of sleep. From each EEG record, two 5-min samples (one from QS and one from AS) were subject to an off-line computerized analysis. The obtained data were averaged with respect to the sleep state and to the conceptional age. The number of variables was reduced by means of factor analysis.Results: All factors identified by factor analysis were highly significantly influenced by sleep states in both developmental periods. Likewise, a comparison of the measured variables between QS and AS revealed many statistically significant differences. The variables describing (a) the number and length of quasi-stationary segments, (b) voltage and (c) power in 5 and 0 bands contributed to the greatest degree to the differentiation of EEGs between both sleep states.Conclusion: The presented method of the computerized EEG analysis which has good discriminative potential is adequately sensitive and describes the neonatal EEG with convenient accuracy. (C) 2003 Elsevier B.V. All rights reserved.

The authors describe the group of 23 patients (16 women, 7 men), who were operated during 2000-2003 on ulna-carpal impingement or the syndrome of ulna impact on the basis of "plus variant" of ulna or also "long ulna". There was a fracture of distal radius in anamnesis of all these patients. The condition was solved in 18 patients (mean age 51 years) by reducing the ulna by 4.5 cm on the average (range 2-10 mm). In five patients (mean age 49 years), the radius-ulna desis sec. Sauvé-Kapandij was performed. The results are evaluated with the time lapse of 6 months on the average (range 3-26). The resulting evaluation indicates that in all patients, who were not affected by radius-ulna arthrosis, a simple reduction of ulna resulted in an improvement of the extent of movements and improved subjective complaints. Patients with radius-ulna arthrosis, where the ulna-carpal impingement was solved by radius-ulna desis, suffer from worse long-term functional results. The authors also analyze complications of the interventions. Posttraumatic deformations in the area of distal forearm should be solved early before degenerative changes develop. The is the only way how to expect good results of the operation and favorable effect for the patient.

The authors describe very rare complication (pseudopleural effusion) after peripheral venous cannulation (Introcan-W 24G3/4 through v. axilaris) in extremely premature newborn with birth weight 600 grams, which lead to worsening of patient's respiratory insufficiency. Ultrasonographic examination confirmed extrapleural process without necessity of surgical intervention. Cannula extraction and infusion interruption were followed by spontaneous regression of the complication, thereafter artificial ventilation was discontinued and baby was discharged.

The authors present their experience with the reconstruction of the diaphragm with a synthetic polytetrafluoroethylene patch in a group of 66 neonates with a congenital diaphragmatic hernia. After preoperative stabilization 53 neonates (80%) were operated, simple reconstruction of the diaphragm was made in 39 neonates (74%), reconstruction of the diaphragm with a polytetrafluoroethylene patch was indicated in 14 patients (26%). Nine patients recovered after reconstruction of the diaphragm by a synthetic patch without complications. The only relapse of diaphragmatic hernia when using a patch was recorded in a neonate with a bilateral diaphragmatic hernia, sternal cleft and omphalocele. After simple reconstruction of the diaphragm there was no relapse of hernia. The total mortality in the group was 27% (18 neonates). After surgery five neonates died. Two of them died of serious haemorrhagic complications during extracorporeal membrane oxygenation and three died after operations performed at borderline oxygenation and ventilation values and subsequent deterioration of the general condition. In four of them a polytetrafluoroethylene patch (GORE-TEX) was used. Reconstruction of the diaphragm by a polytetrafluoroethylene patch is a suitable surgical method in the treatment of neonates with a congenital diaphragmatic hernia. Indication for the use of a patch is agenesis of the diaphragm and major diaphragmatic defects with hypoplastic borders. The use of a non-absorbable synthetic patch is from the aspect of the long-term effect on growth and the development of skeletal deformities equivocal and will call for further detailed studies.