Ocní klinika

Introduction: Songlines for Parkinson’s is a group-based, music-and-movement intervention co-developed with people with Parkinson’s (PwP) and a multidisciplinary team of scientists and practitioners for use in community settings (Rose et al., 2025). Three trials have been conducted in Switzerland and the UK demonstrating its effects on motor and non-motor symptoms. This study aimed to evaluate the application of Songlines within outpatient clinical settings in Switzerland (Köchli et al., 2025). Methods: The Songlines program was adapted for two clinical settings to evaluate its feasibility and impact. Study 1 focused on program development and comparison with a Gentle Gym program, while Study 2 assessed its implementation in an independent clinic. Pre- and post-intervention assessments included motor outcomes (e.g., MDS-UPDRS, 6-Minute Walk) and non-motor outcomes (e.g., HADS, PDQ-8). Acceptability and participant experience were further explored through qualitative methods and the Theory-Informed Intervention Acceptability Questionnaire. Results: In Study 1 (Gentle Gym n = 5; Songlines n = 6), mixed-effect models indicated post-intervention improvements in Romberg ratio (p = .021), reduced variability in stride length (p = .001), and increased stride velocity (p = .012) in both groups. In Study 2 (n = 6), Timed Up and Go performance (p = .042) and vividness of auditory imagery (p = .048) improved. Participants reported increased use of music for emotional regulation, and program acceptability was rated high (M = 4.5 [out of 5]). Discussion/Conclusion: Together, these two studies provide converging evidence that Songlines is a promising, flexible, and highly engaging intervention that can be delivered in a group setting, yet individualized according to patient needs. The program improves balance, gait stability, functional mobility and subjective wellbeing. Future research should develop sustainable models to expand access to this non-pharmacological, group-based intervention.

Tento narativní přehledový článek popisuje možnosti a limity využití jazykového modelu ChatGPT-4o v dětské chirurgii a urologii v prostředí českých nemocnic. Na základě rešerše 45 odborných a mediálních zdrojů publikovaných mezi lety 2023 a 2025 článek vysvětluje základní principy fungování chatbota a rozděluje možnosti využití ­ChatGPT-4o na reálné v současné praxi a potenciální v blízké budoucnosti. Model může sloužit jako nástroj ve výuce mediků a lékařů v přípravě na specializaci nebo jako užitečný asistent při psaní akademických prací. ChatGPT-4o lze využít v komunikaci s dětmi a jejich rodiči jako srozumitelný zdroj informací a odpovědí na laické otázky v přípravě před vyšetřením a operací. Lze využít jako nástroj sběru dat v monitorování dlouhodobých komplikací, kvality života a subjektivního vnímání perioperačního období. Lékařům může pomoci jako konzultační nástroj v diagnostickém a vyšetřovacím postupu nebo při psaní ambulantních zpráv a operačních protokolů. Mezi potenciální využití chatbota v budoucnosti patří integrace všech klinických údajů o pacientovi, generování přijímacích a propouštěcích zpráv nebo role intraoperativního multimodálního AI asistenta. Diskutována jsou etická rizika, zejména v oblasti autorství, spolehlivosti výstupů a ochrany osobních údajů. Zmíněna je zaváděná evropská legislativa v použití AI nejen ve zdravotnictví. Autoři na základě osobní zkušenosti doporučují zapojení nejnovějšího modelu ChatGPT jako užitečného podpůrného nástroje v každodenní praxi dětských chirurgů a věří, že časem bude praktická využitelnost chatbotů nadále narůstat. doi: 10.48095/ccrvch202620

One of the surgical treatment options for advanced ankle joint destruction with various etiologies is the total joint replacement. Its significant upside is the preservation of range of motion of the ankle joint and less stress on forefoot joints compared to ankle arthrodesis. Since 2022, we have been using the Zimmer Trabecular Metal Total Ankle inserted via a lateral transfibular approach. This study aims to evaluate the initial outcomes and experience with this implant. Between 2022 and 2024, 65 total ankle replacements were performed in 63 patients using the lateral transfibular approach. Long oblique osteotomy is newly performed in the frontal plane, replacing the original type of osteotomy in the sagittal plane. After releasing and removing the distal fragment of the fibula distally and dorsally, the lower limb and ankle are placed in an alignment frame, which is fixed with Steinmann pins to the calcaneus, anterior border of the tibia, and the talus bone. The centre of rotation of the ankle is identified using the side bars anchored in the frame. Using the burs, guided by Cutting Guides that are locked to the frame, the talus and distal tibia are removed. After testing, rail holes are drilled in the resected surfaces for the original implants. After releasing the tourniquet, the original components are inserted and osteosynthesis of the fibula is performed. During the study, the previously performed fibula osteosynthesis with LCP was replaced by lag screws. Postoperatively, the ankle is supported with a brace for the period of 5 weeks, after which the patient is permitted to fully weight-bear. A total of 63 patients (32 women and 31 men) were followed, in whom 65 total ankle replacements were performed. The mean age of the patient was 56 years (age range 30 to 80 years). The mean follow-up period was 14.6 ± 9.3 months (3 to 38 months). The most frequent indication was post-traumatic ankle arthritis, namely in 46 cases (70.8%). Furthermore, there were 5 patients (7.7%) with post-traumatic ankle ankylosis, 9 patients (13.8%) with primary osteoarthritis, and in 5 patients (7.7%) the indication was the damage caused by rheumatoid arthritis. Deep bacterial infection of the prosthesis requiring revision was reported in 3 cases (4.6%). Superficial infection of the surgical wound was seen in 4 other cases (6.2%), which did not require hospitalization. Plate osteosynthesis of the fibula was removed in 7 cases (13.8%), 5 times due to infection and 2 times due to soft tissue irritation. One case of asymptomatic non-union of fibula was observed. The benefit of total ankle replacement is the preservation of motion of the operated joint, whereas the complication rate is twice as high as in arthrodesis. Contraindications for ankle replacement include significant varus and valgus deformities of the ankle, ankle instability, necrosis of the talus, severe diabetes mellitus, and severe limb ischemia. The advantage of the transfibular approach is the ability to partly correct deformities of the ankle joint and the position of varus or valgus. It provides a better view of the dorsal structures of the ankle and allows accurate identification of the centre of rotation. Another advantage is the low thickness of the components, requiring minimal bone resection. The main disadvantage is the longer operative time and longer learning curve. Other disadvantages include the complications associated with osteosynthesis and fibula healing, such as non-union or soft tissue irritation by plate. The incidence of superficial and deep infection is also slightly higher compared to the anterior approach. The Zimmer Trabecular Metal Total Ankle system is one of the treatment options for ankle joint destruction provided it is correctly indicated. However, the surgical procedure is a challenge and requires an experienced surgeon. When the indication is correct, the system brings very good short-term outcomes. Nonetheless, longer follow-up period is necessary since the incidence of complications will certainly increase over time.

Lung carcinoma represents a malignancy with the highest global mortality rate. Surgical treatment remains the cornerstone of curative therapy, with minimally invasive techniques currently dominating the field. This study aimed to compare post-operative pain in patients undergoing lobectomy for lung cancer via uniportal video-assisted thoracoscopic surgery (UVATS) vs. robotic-assisted thoracic surgery (RATS). This prospective study included 140 patients (70 RATS, 70 UVATS) undergoing lobectomy with mediastinal lymphadenectomy. Patients assessed their pain using the Short-Form McGill Pain Questionnaire and visual analogue scale (VAS) on the 3rd and 14th postoperative days. We also analyzed the influence of age, gender, and BMI on pain perception and analgesic requirements. Patients following RATS exhibited significantly higher pain intensity compared to UVATS on both the 3rd (VAS 5.8 ± 2.0 vs. 3.8 ± 1.6; P < 0.00001) and 14th postoperative days (VAS 2.7 ± 1.1 vs. 2.2 ± 1.1; P = 0.00133). Combined analgesic therapy was more frequently required in the RATS group. Female patients demonstrated markedly higher pain intensity and analgesic requirements in both surgical approaches. Age and BMI had no significant impact on pain perception. Robotic-assisted surgery is associated with higher postoperative pain compared to uniportal video-assisted thoracoscopy, with differences being more pronounced in female patients. We recommend implementing targeted analgesic strategies for robotic procedures and considering the use of 8-mm ports instead of standard 12-mm ports to reduce chest wall trauma.

An analysis of literature data on the risk, mechanisms and methods of preventing the formation of seroma as the most common complication during abdominoplasty was conducted. The literature search was carried out from 2011 to 2024 using Pubmed, Springer, eLIBRARY websites in both Russian and English. It is assumed that the pathogenesis of seroma is based on the disruption of the integrity of lymphatic and vascular ducts, the formation of closed spaces, tissue trauma, which contributes to the release of in˜ammatory mediators. The incidence of seroma after abdominoplasty averages about 10%, although literature provides data on the level of this indicator up to 25%. Although seromas often resolve on their own, lack of treatment can lead to serious complications, such as wound edge dehiscence, infection, skin ˜ap necrosis, and pseudocyst formation. These complications signi†cantly compromise the cosmetic results of the surgery and increase the duration of hospitalization for patients. Considering that abdominoplasty is a planned operation, it is important to minimize the likelihood of seroma formation. A number of methods have been proposed to prevent seroma after abdominoplasty, including the placement of suction drains, the use of †brin glue, quilting sutures, progressive tension sutures, and the preservation of Scarpa’s fascia. The established e—ectiveness of the use of progressive tension sutures, sutures for tissue †xation, surgical glue and preservation of Scarpa’s fascia is con†rmed by data with a high level of evidence. The need for further randomized comparative prospective studies aimed at analyzing the use of various methods for preventing the occurrence of seroma after abdominoplasty is indicated.

Introduction: Kinesiophobia, or the fear of movement, arises from various causes, with irrational fear of pain induced by movement playing a key role. It also includes concerns about fatigue, increased physical activity, discomfort, disease progression, and potential complications. Among patients with chronic diseases, kinesiophobia can be a crucial factor influencing their engagement in physical activity, whether in rehabilitation or leisure time. Objective: To provide an overview of the prevalence of kinesiophobia in selected chronic diseases and identify barriers affecting physical activity. Methods: A review study utilizing electronic sources from the National Medical Library, the Central Sports Library of FTVS UK, and databases such as PubMed, EBSCO, SCOPUS, Medline, and Web of Science. Results: The study summarizes the causes, manifestations, diagnostic tools, and treatment options for kinesiophobia. It maps its prevalence in patients with chronic lower back pain, ischemic heart disease, chronic obstructive pulmonary disease (COPD), multiple sclerosis, post-stroke conditions, and Parkinson’s disease. The main barriers include chronic pain, functional impairment, depression, anxiety, low educational level, and insufficient understanding of the importance of physical activity. Conclusions: Long-term avoidance of movement negatively impacts overall health. Therefore, it is essential to identify kinesiophobia and adapt treatment strategies accordingly. Raising awareness of this issue is crucial for effective and long-term successful therapy.

Watch-and-wait (WW) strategy offers an alternative to radical resection with total mesorectal excision (TME) in selected patients with distal rectal adenocarcinoma after achieving complete clinical response (cCR) to neoadjuvant therapy. This approach is based on intensive follow-up, where a multidisciplinary team, especially the surgeon, is confronted with a demanding follow-up regimen including repeated anorectoscopies, per rectum examinations and magnetic resonance imaging. The prediction of pathological complete response in cCR is particularly problematic. The risk of recur-rence (regrowth) in cCR is a key factor, which occurs in 26-36% of patients, especially during the first 3 years of follow-up, and increases the risk of metastasis. Early salvage R0 resection is indicated when regrowth is detected and is feasible in more than 90% of cases. WW offers comparable oncologic outcomes in compliant patients and better functional outcomes compared to TME in patients with pCR.

Significant changes have recently occurred in the treatment of locally advanced rectal cancer. These include a complete administration of systemic therapy in the neoadjuvant phase of treatment, nonsurgical interventions in case of clinically complete response and using of immunotherapy in patients with the deficiency ofmismatch repair. Although there is no universally accepted treatment standard, the concept of total neoadjuvant therapy, immunotherapy and non-operative management is widely accepted in clinical practice. The care of patients with rectal cancer is multimodal, comprehensive and should be based on consensual recommendations. A uniform approach in diagnostic and therapeutic procedures within the individual departments of the oncology center is a condition for high quality standard care. At the same time, unusual clinical situations and the specific wishes of patients should be taken into account. The listed recommended treatment procedures are a reflection of the efforts to unify patient care with rectal cancer at individual workplaces of the comprehensive oncology center in Brno. Defining general recommendations is not the goal.

We present a case report of a 26-year-old patient with an incidental finding of intra-abdominal fibromatosis (desmoid) in the small pelvis who presented to the urology outpatient clinic for erectile dysfunction. Ultrasound examination revealed hydronephrosis of the right kidney with parenchymal reduction, and a bulky tumor was detected in the small pelvis, which was compressing the right-sided ureter. The patient was followed up with a CT scan which confirmed a solid tumour in the small pelvis of unclear origin, the nature of the tumour and the treatment were discussed by the multidisciplinary team and a decision was made to resect the tumour. Pathologist confirmed sporadic variant of desmoid. Desmoid tumors are characterized by both locally aggressive carcinomas mimicking growth and frequent recurrences after resection, which may require subsequent oncological treatment. For these reasons, patients with desmoids should be fol-lowed up by an oncologist, ideally at centers experienced in treating this rare disease.

Neuroblastomas are the most common solid tumours in early childhood. Currently, the prognosis of patients is evaluated almost exclusively on the basis of molecular-genetic markers from a biopsy sample of tumour tissue. This study is focused on evaluating the potential use of 3‑methoxytyramine as an alternative non-invasive prognostic marker for patients with neuroblastoma. For this purpose, a method was developed to determine free 3‑methoxytyramine in urine using liquid chromatography coupled with tandem mass spectrometric detection. The method was fully validated and subsequently tested on 25 pediatric urine samples. In the group of patients with a poor prognosis, the median value of free 3-methoxy­tyramine was 666.7 nmol mmol−1Krea, while in the group with a favourable prognosis, it was 168.4 nmol mmol−1Krea. The analysis of pediatric urine samples from neuroblastoma patients revealed statistically significant differences in the concentration of free 3‑methoxytyramine (P < 0,05) between the low/medium-risk group and the high-risk group.