Cortical laminar necrosis after subarachnoid hemorrhage

Кортикалната ламинарна некроза е рядко наблюдавана при пациент след емболизиране на мозъчна аневризма. Съобщаваме случай на 51-годишна пациентка, която след емболизация на мозъчната аневризма на дясната средна мозъчна артерия остава в коматозно състояние.От извършения ядрено-магнитен резонанс имаше висок интензитет на сигнала в темпоралния лоб на мозъка на T2- изображенията, и линеарен хиперинтензитет по протежение на мозъчните кората на T1-изображенията с дифузно усилване на мозъчната кора.Cortical laminar necrosis has rarely been observed in a patient after coil embolization. We report a 51-year-old female patient who became comatose after the embolization of an aneurysm in the right middle cerebral artery. There were high signal intensities in the temporal brain on T2-weighted MRI images and linear hyperintensities along the cerebral cortices on T1-weighted images with a diffuse gyriform enhancement

Examining The Effect Of The Online Radiological Consultation Platform StatDx

StatDx е онлайн платформа за бърза справка в полза на клиничните радиолози и образни диагностици. Състои се от редица свързани помежду си статии за диагнози и диференциални диагнози, позволяващи бързо и интуитивно търсене, сортиране и сравнение на нозологични единици и образни белези. Системата е снабдена с богат диапазон от изображения, включително схеми и образи от различните образни модалности, всички от които подробно анотирани. Тази система бе въведена за ползване в Клиниката по образна диагностика в УМБАЛ „Света Марина“ – Варна в началото на 2017 г. Над година след това бе проведено вътрешно анонимно проучване на индивидуалните мнения на ползващите я лекари – в това число 14 специалисти по образна диагностика и 8 специализанти. Добитите данни демонстрират преобладаващо позитивна оценка на платформата StatDx в клиниката.StatDx is an online consultation platform for clinical radiologists and diagnostic imaging specialists. It comprises a large database of interconnected articles on diagnoses and differential diagnoses, allowing for quick and intuitive searches, sorting, and comparison between varying disease entities and between their imaging characteristics. This system is richly illustrated with vast amounts of drawings, schematics and imaging studies, all of which comprehensively annotated. StatDx was introduced to the Department of Diagnostic Imaging at St. Marina University Hospital, Varna in early 2017. Over a year later an anonymous internal study was conducted among the physicians using this system – including 14 specialists in Radiology and 8 Radiology interns. The data acquired pointed at a predominantly positive assessment of StatDx at the Department

Embolization of bronchial arteries in cases of life-threatening bleeding

Massive hemoptysis is a frightening and potentially life-threatening clinical event. Hemoptysis represents a sig­nificant clinical entity with high morbidity and potential mortality. Bronchial artery angiography with embolization has become a mainstay in the treatment of hemoptysis. Bronchial artery embolization offers a minimally invasive procedure for even the most compromised patient serving as first-line treatment for hemorrhage as well as providing a bridge to more definitive medical or surgical intervention focused upon the etiology of the hemorrhage

Three-year results from the surgical treatment of diseases of the aortic valve and aortic root

PURPOSE: Pathology of the aortic root and aortic valve is subjected to adult cardiac surgery and includes Stanford A aortic dissection, annuloaortic ectasia or chronic aneurysm of the ascending aorta. In such cases, Bentall-De Bono procedure is usually preferred. Aortic valve reimplantation by using Tirone David's technique presenting with the advantages of valve-sparing surgery can be performed in selected cases.MATERIAL AND METHODS: A retrospective analysis of a three-year experience with the complex surgical treatment of diseases of the aortic valve and root was carried out. During the period from January 1, 2009 to December 31, 2012, fifty-three patients with aortic valve and aortic root pathology were treated in the Division of Cardiac Surgery, St. Marina University Hospital of Varna. Bentall procedure was carried out in 37 patients (Group B). In 19 of them (51%) emergency surgery was done for acute aortic dissection of type Stanford A. The rest 18 patients underwent elective surgery for dilated ascending aorta and aortic valve dysfunction. Aortic valve-sparing surgery by David's technique for aortic aneurysm was accomplished in 16 patients (Group D). This technique was emergently applied in one patient with aortic dissection, too. Baseline data, intraoperative details, early results and complications were compared.RESULTS: Early (30-day) mortality after Bentall-De Bono procedure was 10.5% (0% after elective surgery and 21.1% after dissection repair). All the patients survived after David's procedure that proved the significant advantages of the valve-sparing surgery.CONCLUSION: The aortic valve reimplantation provides long-term results that are comparable to those after the Bentall-De Bono procedure such as high survival rates, low incidence rate of endocarditis, and slightly higher risk of reinterventions. There is no need of life-long anticoagulation that improves patient's quality of life.Scripta Scientifica Medica 2013; 45(4): 50-55

Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies

Отворената хирургия е златен стандарт за лечение на хепатоцелуларен карцином (НСС) и чернодробни метастази от рак на дебелото черво. Днес чернодробната резекция е все още само лечебен вариант за пациенти с рак на черния дроб, с 5-годишната преживяемост между 25-60%, в сравнение с 0% 5-годишна преживяемост без никакви лечение. Само 5-15% от пациентите с НСС или с чернодробни метастази могат да бъдат подложени на чернодробна резекция поради различни противопоказания: голям брой тумори, тумори на труднодостъпни места, недостатъчен чернодробен обем за резекция.Open surgery is a gold standard for treating hepatocellular carcinoma (HCC) and hepatic metastases of colorectal cancer. Today, liver resection is still only a radically option for patients with liver cancer, with a 5-year survival rate of 25-60%, compared with 0% 5-year survival without any treatment. Only 5-15% of patients with HCC or liver metastases may undergo hepatic resection due to different contraindications: a large number of tumors, tumors in hard-to-reach places, insufficient hepatic volume for resection

Minimally invasive ablative techniques of liver tumors

Само 5-15% от пациентите с НСС или с чернодробни метастази могат да бъдат подложени на чернодробна резекция, поради различни противопоказания: голям брой тумори, тумори на трудно достъпни места, недостатъчен чернодробен обем за резекция. Вариантите за перкутанно лечение могат да бъдат: Химичната аблация: инжектиране на етанол или оцетна киселина; Термалната аблация: (а) криохирургични аблация (CSA/КХА): използване на течен азот, аргон, или NO2; (б) коагулационната: използване на радиочестотен ток (RFA/РФА); Микровълнова аблация (MWA/МВ); лазерна интерстициална термотерапия (ЛИТТ) или високоинтензивен фокусиран ултразвук (HIFU/ ВФУ); Необратима електропорация (IRE).Only 5-15% of patients with HCC or liver metastases may undergo hepatic resection due to different contraindications: a large number of tumors, tumors in hard-to-reach places, insufficient hepatic volume for resection. The options for percutaneous treatment can be: Chemical Ablation: Injection of Ethanol or Acetic Acid; Thermal ablation: (a) cryosurgical ablation (CSA): use of liquid nitrogen, argon, or NO2; (b) Coagulation: Radio Frequency Ablation (RFA); Microwave ablation (MWA); Laser Interstitial Thermotherapy (LITT) or High Intensive Focused Ultrasound (HIFU); Irreversible electroporation (IRE)

Neurotoxicity of cancer agents

Невротоксичните ефекти на химиотерапията се появяват относително често и са причина за модификация на дозата на медикаментите - дозолимитираща токсичност. Рискът от развитие на невротоксичност се увеличава с повишаване на приложената доза и за разлика от миелотоксичността (основния ограничаващ фактор при повечето химиотерапевтични режими), която може да бъде преодоляна с растежни фактори или трансплантация на костен мозък, няма стандартно поведение, което да я ограничи.Противотуморните препарати водят до два типа токсичност - периферна невротоксичност, състояща се основно от периферна невропатия и централна невротоксичност, която включва от незначителни когнитивни увреждания и дефицити до енцефалопатия с деменция или дори кома.Не съществуват утвърдени алгоритми за поведения и профилактика на невротоксичността, причинена от противотуморните препарати. Поведението основно се свежда до редукция на дозата или отлагане във времето на приложението, особено при пациенти, които са с по-висок риск от развитие на невротоксични странични ефекти. На този етап не съществуват невропротективни агенти, които се препоръчват за стандартна употреба при развитие на невротоксичност.Neurotoxic side effects of chemotherapy occur frequently and are often a reason to limit the dose of chemotherapy. Chemotherapy dosing is often limited due to a frequently occurring side effect of the treatment - neurotoxic. The risk of neurotoxicity is increased by the possibility of higher dose usage, since bone marrow toxicity (the major limiting factor in most chemotherapeutic regimens) can be overcome with growth factors or bone marrow transplantation.Chemotherapy may cause both peripheral neurotoxicity, consisting mainly of a peripheral neuropathy, and central neurotoxicity, ranging from minor cognitive deficits to encephalopathy with dementia or even coma. Neurotoxicity caused by the chemotherapy can be of two types - peripheral, mainly consisting of peripheral neuropathy and central, from minor cognitive deficits through encephalopathy with dementia to even coma.Data management and neuroprotective agents are still in discussion and there are no current accepted guidelines yet. Management mainly consists of cumulative dose-reduction or lower dose-intensities, especially in patients who are at higher risk to develop neurotoxic side effects. None of the specific neuroprotective agents can be recommended in daily practice for standard use at the moment, and further studies are needed to confirm their beneficial effects

Estudio de viabilidad sobre la transformación de un motor de encendido provocado para su funcionamiento a GLP

Bachvarov, GN. (2011). Estudio de viabilidad sobre la transformación de un motor de encendido provocado para su funcionamiento a GLP. http://hdl.handle.net/10251/15123.Archivo delegad

Recertificación de la ISO/TS 16949 En Prisma Soporte Industrial, S.L

Este proyecto tiene como objetivo la descripción del sistema de gestión de calidad adoptado por la empresa Prisma Soporte Industrial S.L. El sistema en cuestión está basado en la norma ISO 16949 TS, debido a que la empresa realiza su actividad en el sector de automoción y es imprescindible para que la empresa pueda desarrollar su actividad. En este proyecto se mostrará la historia, el proceso en la empresa, la documentación, el manual de calidad, los procedimientos y los formatos que constituyen el sistema de gestión de calidad.Bachvarov, GN. (2016). Recertificación de la ISO/TS 16949 En Prisma Soporte Industrial, S.L. http://hdl.handle.net/10251/84706.Archivo delegad

Tibiopedal access in patients with lower limb peripheral artery disease

Introduction: Peripheral artery disease (also known as PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. Atherosclerotic vascular disease affecting the lower extremities is the most common form of peripheral vascular disease. Patients with critical limb ischemia have significant rates of amputation. However, percutaneous options for minimally in­vasive revascularization exist for most of these patients. In recent years, the retrograde tibiopedal ap­proach is increasingly being used for revascularization of complex chronic total occlusions.Methods and materials: In cases where traditional ipsilateral antegrade or contralateral cross over approaches fail, pedal access approaches utilizing the dorsalis pedis, posterior tibial, or even pero­neal arteries (most difficult of the three) have been used. The technique is performed by ultrasound guidance using arterial introducers, hydrophilic wires and vasodilators which allow for better access and easier manipulation.Results: In this particular study from a total of 39 cases, a total of 34 cases (87,2%) were successful. Access through ATA was used in 26 of the patients and through PTA in 6 patients. Recanalization of total occlusions was achieved in 14 cases.Conclusion: Preventing amputations can potentially save patient lives and improve quality of life. Tibiopedal access has emerged as an important tool to facilitate successful revascularizations. One of the major advantages of retrograde tibiopedal access is that it allows quick therapy and short pro­cedure time with less observation time in the hospital. The procedure can be used as a viable alterna­tive to antegrade access interventions. Further well-conducted studies are crucial in generating more high-quality evidence in the field of critical limb ischemia management