COMPUTER TOMOGRAPHY IN PATIENTS WITH TRANSITORY DISORDER OF BRAIN CIRCULATION (TDBC)

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Risk Factors for Hypoxic-Ischemic Encephalopathy in Full-Term Neonates

Hypoxic-ischemic encephalopathy (HIE) is a clinically defined syndrome of disturbed neurological function in the earliest days of life in the term infants manifested by respiratory distress, subnormal level of consciousness, seizures and depression of tone and reflexes. The authors identified antepartum and intrapartum risk factors for HIE in full term newborns. Between January 1st, 2001 and December 31st, 2003, 54 term infants (gestational age >37 weeks) in NICU of the Clinic of Neonatology, Department of Obstetrics and Gynecology, Prof. Paraskev Stoyanov Medical University of Varna were retrospectively studied. All of them met the criteria for moderate or severe HIE (seizures, abnormal consciousness (stupor, coma), respiratory distress, difficulty feeding, abnormal tone and reflexes). Birth prevalence of moderate or severe neonatal HIE was 4,42% term live births. More important antepartum risk factors for HIE were infections, preeclampsia, bleeding in pregnancy, and postmaturity. HIE incidence in infants born after 42 weeks is by 2,5 fold higher. Significant intrapartum risk factors for HIE were intrapartum asphyxia (24% of cases with HIE - OR=6,91), operative vaginal delivery (OR=l,65) and emergency Caesarean section (OR=3,78). The study of the significant risk factors for HIE contributes to prevention of neonatal morbidity and mortality

STUDY OF HEAT SHOCK PROTEINS IN THALASSAEMIC PATIENTS

When cells are exposed to a variety of stimuli, there is increased expression of stress or heat shock proteins, a major representative of which is hsp70. The objective of the present work was to investigate the endogenous expression of hsp70 in peripheral blood mononuclear cells and erythrocytes of patients suffering from b-thalassaemia and to correlate hsp70 levels with patients' antioxidant status. Blood samples were obtained from thalassaemia major patients aged 16-24 years. Hsp70 was identified with a mouse monoclonal anti-human hsp70 antibodies using the Western blot procedure. The total antioxidant status was determined by means of a commercial kit of RANDOX. It was established that: i) Hsp70 levels were low in mononuclear cells, ii) Hsp70 was not appreciably induced by incubation at 43°C, Hi) in erythrocytes, however, there was a marked endogenous expression ofhsp70 - thalassaemics express more hsp70 than control subjects, iv) the antioxidant status of thalassaemics was by about 20 % less than the control one. The increased endogenous hsp70 in thalassaemic erythrocytes was consistent with the hypothesis that the elevated levels of denaturated globins induced the expression of stress proteins during erythopoiesis. We are currently investigating whether there is a correlation between the severity of the clinical symptoms and hsp70 levels

COMPLEX INVESTIGATIONS OF ISCHEMIC CEREBRAL LESIONS

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Results of the method of transanal Haemorrhoid dearterialization for treatment

Purpose: Hemorrhoidal disease is a polyetiologic disorder at active age. Recently, the methods of hemorrhoidal artery ligation (HAL) and transanal hemorrhoid dearterialization (THD) were introduced. The aim of the present study was to analyze the initial results from THD treatment of hemorrhoidal disease.Material and methods: The study covered 26 patients, 14 males and 12 females, at a mean age of 46 years, with hemorrhoidal disease. Physical examinations, rectal examination and colonoscopy were preoperatively performed. THD was done of 6 arteries along with mucoplication of the distal rectalmucosa.Results: There were no early postoperative complications requiring surgery. Patients` complaints were dominated by low to medium pain not requiring any narcotic analgesics. One patient reported bleeding and pain necessitating re-hospitalization on the 11th day and conservative treatment without blood transfusion. Five patients reported mild pain complaints and 7 ones complained of discomfort in the anal area until the end of the second week. In two patients a residual mucous prolapse up to the 6th month without other symptoms was found out.Conclusion: THD is an effective and minimally invasive method after which application mild to moderate pain and good patient`s comfort are reported. The relative share of the intra- and postoperative complications is low

CLINICAL AND NEUROPHYSIOLOGICAL CORRELATION IN PATIENTS WITH ISCHAEMIC CEREBROVASCULAR DISEASE

The aim of this study is to objectify the functional state of the brain in Ctnegative cases with clinical diagnosis of acute cerebrovascular disease (CVD). The CT scan, cerebral SPECT, brainstem auditory evoked potential (BAEP) and EEG with quantitative analysis (qEEG) were performed in 20 patients with ischaemic CVD. Of them, 6 were with transitory ischaemic attack (TIA), 8 with ischaemic stroke (IS) in the territory of the middle cerebral artery and 6 with brainstem infarction (BI). The zones with increased slow-wave activity described by the brain maps showed a good correlation (r=0,47) with the revealed decreased radiotracer uptake. The investigation of brain perfusion by SPECT alone cannot objectify the brainstem stroke. In these cases, the data from BAEP can help the topical diagnosis. Our results confirm the clinical importance of the qEEG for diagnosis of acute CVD, especially in relation with other electrophysiological and neuroimaging methods

Ectopic pregnancy after assisted reproductive technology: a retrospective study

In this study from 2006 to 2010,1628 IVF-ET cycles were performed in our unit. Long protocol with GnRH agonist plus recombinant FSH, short protocol with GnRH antagonist, short protocol with microdoses of GnRH agonist (flare up), natural modified cycle with GnRH antagonist and hCG were applied. The serum level of the P-hCG was measured 12 days after embryotransfer (ET). When positive, the P-hCG level was determined every 4 days until the ultrasound examination 22 days after the ET. From 1628 IVF - ET cycles, we had 10 tubal pregnancies (0,61%) and one heterotopic pregnancy (HP). Salpingectomy was performed in all patients, 7 had laparoscopy, and 3 underwent emergent laparotomy due to hemorrhagic shock. Regarding the HP patient, an ultrasound scan confirmed a viable intrauterine 8-weeks gestation and an ectopic pregnancy (EP) in the left tube with fetal heartbeat corresponding to gestational age of 7-8 weeks. Laparoscopy with left salpingectomy was performed the following day. The intrauterine pregnancy proceeded uneventfully. The patient delivered by elective Cesarean section at 39 weeks of gestation due to breech presentation. Patients undergoing IVF-ET must be informed of the risk of EP and the possibility of HP should not be ignored

The Role of Vascular Endothelial Growth Factor and Antithrombin III In The Pathogenesis of the Ovarian Hyperstimulation Syndrome

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of controlled ovarian hyperstimulation (COH). Its pathogenesis is not clarified yet. In the recent years a number of studies focused on the vascular endothelial growth factor (VEGF) and antihtrombin III (AT III) indicators. VEGF is homodimeric, heparin-binding glycoprotein, stimulating vascular permeability. Antithrombin III is protease inhibitor of activated clotting factors. This study aimed at examining the VEGF-A165 and AT III indicators with two OHSS patients. Two methods were used for the determination of the indicators of VEGF-A165 and AT III: ELISA for VEGF and chromogenic assay for ATT III. Kits of R/D Systems and American Diagnostica Inc. were used to estimate VEGF and AT III indicators in serum and plasma. There were higher indicators of VEGF-A165 (180pg/ml) and reduction of AT III indicators (48%) in the patient with a severe form of OHSS than in the control group while these indicators were normal in the patient with a moderate form of OHSS. Our results confirmed some published data concerning the importance of VEGF and AT III in the genesis of OHSS. This study should include a larger group of patients in order tofollow-up statistically and authentically the variations of the indicators of both factors and their importance for OHSS

Proximal protective stoma by low anterior resection of the rectum - When? How? How long?

There is an evolution in the diagnostic algorithm of rectal cancer. In this condition preoperative investigations assist in deciding the optimal treatment. The relation of the tumor edge to the circumferential margin (CRM) is an important factor in deciding the need for neoadjuvant treatment and determines the prognosis. Those with threatened or involved margins are offered long course chemoradiation to enable R0 surgical resection. Endoanal ultrasound (EUS) is useful for tumor (T) staging; hence EUS is a useful imaging modality for early rectal cancer. Magnetic resonance imaging (MRI) is useful for assessing the mesorectum and the mesorectalfascia which has useful prognostic significance and for early identification of local recurrence. Computerized tomography (CT) of the chest, abdomen and pelvis is used to rule out distant metastasis. Identification of the malignant nodes using EUS, CT and MRI is based on the size, morphology and internal characteristics but has drawbacks. Most of the common imaging techniques are suboptimal for imaging following chemoradiation as they struggle to differentiate fibrotic changes and tumor. In this situation, EUS and MRI may provide complementary information to decide further treatment. Functional imaging using positron emission tomography (PET) is useful, particularly PET/CT fusion scans to identify areas of the functionally hotspots. In the current state, imaging has enabled the multidisciplinary team of surgeons, oncologists, radiologists and pathologists to decide on the patient centered management of rectal cancer. Functional imaging may play an active role in identifying patients with lymph node metastasis and those with residual and recurrent disease following neoadjuvant chemoradiotherapy in near future

Tactics of treatment of acute left colon cancer obstruction

Back ground: Advanced colorectal cancer is commonly associated with colon obstruction/between 15-20% of patients with colonic cancer/ or/and tumor infiltration to adjacent organs. We set out to study in-hospital morbidity and mortality after operations of acute left colon cancer obstruction.Methods: From 2000 to 2010 the medical records of 204 cases /15.1%/ of acute left colon cancer obstruction were reviewed from total of 1351 patients who were operated from colorectal cancer. Results: The types of operations were a Hartmann procedure in 78 patients /38.2%/, colostomy in 58 patients /29.4%%, a type of colectomy with ileo-coloanastomosis in 54 patients /26.5%/ and a standard resection in 14 patients /6.8%/. The following early complications were occurred: anastomotic leakage in 4 patients, wound infections in 5 patients, dehiscence of operative wound in 2 patients. The in-hospital mortality rate was 11.3%.Conclusions: The emergency management of acute left-sided colonic obstruction remains controversial. The one-stage resection anastomosis which could be subtotal colectomy or segmental resection is useful and the preferred choice for low risk patients. Simple colostomy or Hartmann procedure should be re served for high risk patients. Colonic stenting is the best option either for palliation or as a bridge to surgery