Profundización en metodologías y espacios docentes innovadores

Fac. de FilologíaFALSEsubmitte

Multimodal use of indocyanine green endoscopy in neurosurgery: a single-center experience and review of the literature

During the last 10years, microscope-integrated indocyanine green fluorescence (m-ICG) has been widely used for assessing real-time blood flow during aneurysm surgery. More recently, an endoscope-integrated indocyanine green fluorescence (e-ICG) has been adopted as a versatile tool during different endoscopic neurosurgical procedures. The purpose of the present report is to evaluate multimodal applications of e-ICG during different endonasal, intraventricular, aneurysm and brain tumor surgeries and provide technical nuances. In addition, we reviewed the literature and identified and compare several overlapping case series of patients treated via an endoscopic integrated indocyanine green fluorescence technique. A total of 40 patients were retrospectively evaluated. Patients were divided into four main groups: (1) endoscopic endonasal approaches (n=14); (2) ventricular endoscopic approach including patients undergoing third ventriculostomy (n=8) and tumor biopsy (n=1); (3) aneurysms surgery (n=9); and (4) brain parenchymal tumors (n=8). All patients were successfully treated using the e-ICG dynamic endoscopic visualization, and there were no perioperative complications. Such unique features open up a promising field of applications beyond the use of m-ICG in different surgical field due to the longer duration of e-ICG fluorescence up to 35 +/- 7min. E-ICG represents a new and effective technique for longer real-time visualization of vascular structures preserving normal tissues and functions during different transcranial and endonasal approaches. As the technology and e-ICG resolution improves, the technique has the potential to become a critical tool for different applications in neurosurgery

MEDICO-LABORATORY SERVICES IN OUTPATIENT CARE IN NORTHEASTERN BULGARIA – STATE AND PROSPECTS

Aim: The aim of this article is to study the satisfaction of patients with laboratory services in outpatient care in Northeastern Bulgaria regarding access and quality of service. Study design: Prospective cohort study Material and methods: The survey was carried out on the territory of Northeastern Bulgaria and covered the districts of Varna, Dobrich and Shumen and thirty municipalities. The following methods were applied in the study: sociological method by applied direct anonymous questionnaire, documentary method and statistical methods for analysis and interpretation of the data in order to reveal the nature of the observed phenomena and their interrelations. Results: The research data show that 24,4% of the respondents live at a distance of more than ten kilometres from the nearest medico-diagnostic laboratory. The larger share of these patients are residents of small settlements in Northeastern Bulgaria. More than half (55%) of the respondents are not satisfied with their provision of laboratory services, but the majority of patients claim that the location of the selected laboratory is accessible (69,4%) and the quality of the laboratory service is high (83,7%). Conclusion: The main problems in outpatient care are related to the poor provision of medico-laboratory services and specialized outpatient care in the smaller settlements in Northeastern Bulgaria

Pure Endoscopic Lateral Orbitotomy Approach to the Cavernous Sinus, Posterior, and Infratemporal Fossae: Anatomic Study

Objective The aim of this anatomic study is to describe a fully endoscopic lateral orbitotomy extradural approach to the cavernous sinus, posterior, and infratemporal fossae. Material and Methods Three prefixed latex-injected head specimens (six orbital exposures) were used in the study. Before and after dissection, a computed tomography scan was performed on each cadaver head and a neuronavigation system was used to guide the approach. The extent of bone removal and the area of exposure of the targeted corridor were evaluated with the aid of OsiriX software (Pixmeo, Bernex, Switzerland). Results The lateral orbital approach offers four main endoscopic extradural routes: the anteromedial, posteromedial, posterior, and inferior. The anteromedial route allows a direct route to the optic canal by removal of the anterior clinoid process, whereas the posteromedial route allows for exposure of the lateral wall of the cavernous sinus. The posterior route is targeted to Meckel's cave and provides access to the posterior cranial fossa by exposure and drilling of the petrous apex, whereas the inferior route gives access to the pterygopalatine and infratemporal fossae by drilling the floor of the middle cranial fossa and the bone between the second and third branches of the trigeminal nerve. Conclusion The lateral orbitotomy endoscopic approach provides direct access to the cavernous sinus, posterior, and infratemporal fossae. Advantages of the approach include a favorable angle of attack, minimal brain retraction, and the possibility of dissection within the two dural layers of the cavernous sinus without entering its neurovascular compartment

In vitro gas production of different feeds and feed ingredients at ruminants

Abstract. Investigation for determining the amount of in vitro gas production after feeding different groups of forages was performed at the Agricultural Institute- ® Stara Zagora. Forages from different regions were collected and analyzed for in vitro gas production at 24 h and 48 h by Ankom Technology . The following parameters of the tested forages were determinated: Neutral detergent fibre (NDF, %), Acid detergent fibre (ADF, %), Digestibility of dry matter (DDM, %), Dry matter intakе (DMI, %) and Relative Feed Value (RFV, %). RFV was calculated on the base of DDM and DMI in comparison with alfalfa biomass in flowering stage. Collected feeds (46 samples) were divided in 11 groups on the base of their composition and structure - fibre component content. Depending on the amount of gas production forages can be divided in 3 groups: 1) Grain feeds generating the highest amount of gas - average 387.93 ml/g DM; 2) Combined feeds, fresh forages, complete feed mixtures - average 213.87- 245.15 ml/g DM 3) Hay, silage, straw, complete feed mixtures + bioadditives - average 115.06 - 208.34 ml/g DM. Intensity of gas production in grain feeds was higher at 24 h, while on the opposite, was higher at 48 h in roughage feeds due to the different speed of degradation of feeds - concentrated had a very intensive and quick degradation, roughages - slow degradation. Supplementation of combined feeds with bioadditives Rumanol, Biolife, Bibor decreased the amount of gas production by 9.87% - 29.05%

Frontolateral Approach Combined with Endoscopic Endonasal Extradural Posterior Clinoidectomy to the Upper Clival Region: Anatomic and Feasibility Study

BACKGROUND: Surgical management of lesions located in the upper clival region is challenging. Complex open transcranial approaches have been used to reach surgical targets in these areas. The frontotemporozygomatic approach combined with an intradural posterior clinoidectomy has been proposed as the most reliable route to manage such lesions. We investigated combining a minimally invasive endoscopic endonasal extradural posterior clinoidectomy (EPC) with a standard frontolateral approach to expand the working area within the upper clival region. METHODS: Investigators dissected 10 human cadaveric heads at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. The heads were positioned to simulate a supine position, enabling the simultaneous use of both endonasal and frontolateral routes. The dissections were divided into 3 steps-standard frontolateral approach, EPC, and re-evaluation of the frontolateral route-aiming to compare the surgical exposure before and after EPC. RESULTS: After EPC, through the frontolateral pathway it was possible to improve visualization and working angles to the interpeduncular fossa and retrosellar and upper clival regions. Increase in extension of the carotid-oculomotor window was 7 mm and 10 mm before and after the posterior clinoidectomy, respectively. CONCLUSIONS: EPC provided extra working space for the frontolateral approach to the upper clival area with 42.8% expansion of the carotid-oculomotor triangle. Surgical series are needed to demonstrate clinical advantages and disadvantages of this novel combined approach

KETOGENIC DIET – FROM THE IMPLEMENTATION IN CLINICAL PRACTICE TO NOWADAYS

Introduction: The ketogenic diet (KGD) is a high-fat, adequate-protein, low-carbohydrate diet. In 1920`s the diet was developed to treat difficult-to-control epilepsy in children. Nowadays its efficacy has been proven in many other diseases, such as metabolic disorders, brain tumours, autism, Rett syndrome, and in other areas, it has been actively studied. Aim: The aim of this article is to represent the historical review of the therapeutic implication of KGD, as well as to reveal the contemporary clinical trends in which it is being used. Material and Methods: A literature review of 96 scientific reports in English has been made. Results and Discussion: The KGD was developed in the early 1920s. In the period 1970-1990, the therapeutic use of the diet was discontinued, due to the breakthrough of the new anticonvulsants for epilepsy. The interest in KGD was recovered after a meeting of the “American Epilepsy Society” in 1996. The diet demonstrates anticonvulsant efficacy in epilepsy therapy. According to a survey in 2013, the incidence of seizures among half of the number of children was reduced by at least a half, and 15% of them were completely discontinued. The diet is also used in the treatment of metabolic diseases, such as GLUT 1-deficiency syndrome, reducing the incidence of seizures, improving muscle coordination and concentration. It is also effective in pyruvate dehydrogenase deficiency syndrome by replacing the major energy source - glucose with ketones. Along with these, it is also used in patients with autism (in approximately 60% of patients it improves learning ability and social skills), Rett syndrome, Alzheimer's disease, Parkinson's disease, and others. Its mechanism of action is not fully clarified, as well as its degree of effectiveness in some areas. Conclusion: The ketogenic diet is widely implemented worldwide. It comprises a tremendous therapeutic potential that has been growing considerably during the past decades