Trauma system law in Bulgaria

The contemporary standard of emergency in the health care system (trauma system) has been voted in the USA in 1992, and after that (in a period of 2–4 years) in many other countries. It has been unknown in countries in Eastern Europe, but some have implemented it. In Bulgaria this system does not exist in its full capacity. It has never been voted as a law. In Bulgarian healthcare system we can see only a few elements from trauma system that work—ATLS, DCS, definitive treatment when it is possible, triage. But those components are not linked into a whole system, which makes them not as effective as they have to be. Contemporary standard of emergency (trauma system) in fact is around 70–80% of health care and that lack of such standard reflects on the quality of all procedures in our country

Integrating the military trauma system in civilian life—a key to lowering preventable death in polytraumatized patients

The goal of the current work is to pose the question of how to imply the new Trauma System protocol in Bulgaria. Historically the question of establishing a protocol, which would raise the overall survival of polytraumatized patients, is getting more and more recognition, especially after the wars in Korea and Vietnam. The war medics introduced organizational protocols, which are carried over in civilian life because of the unpreparedness and the lack of adequate and fast enough actions in polytrauma setting. The ATS (American Trauma Association) was created by war medics and helicopter pilots (who flew victims over in war settings)

The role of microglia in ischemic stroke

Cerebral ischemic stroke is a disease that belongs to the group of acute vascular disorders of the cerebral circulation. It is considered a major cause of disability and mortality worldwide. It has been shown that the integrity of the blood-brain barrier is impaired after an ischemic stroke, and this is the key factor in brain damage. An inflammatory reaction occurs, which is provoked and maintained by bioactive substances released by endothelial cells, brain glial cells, and blood immune cells. Microglial cells are the first to respond to an injury; they get activated through a series of molecular mechanisms and transformed into diverse functional subtypes. Activated microglia can have both aggravating and beneficial effects regarding tissue remodeling and recovery after ischemia. In addition to their functions, activated microglial cells also differ in their morphology, gene expression, and protein profile. Their type can also vary depending on the distance from the ischemic lesion. Microglial plasticity, as well as the complex relationships of microglia with other cells in the central nervous system under physiological conditions and after ischemic stroke, have been studied mainly in experimental animals: rodents and primates. However, more information has been generated by in vivo studies of post-stroke patients, applying highly specialized imaging methods. Nevertheless, the obtained results are insufficient and ambiguous, but they are a good basis for developing strategies to influence the recovery process after ischemic brain injury

Astrocyte heterogeneity under physiological conditions and after brain injury

There is a growing interest in astrocytes as glial cells in the central nervous system due to their important role in maintaining brain tissue homeostasis both under physiological conditions and after brain injury. A significant amount of evidence has been accumulated regarding their capacity to exert either pro-inflammatory or anti-inflammatory effects under different pathological conditions. In combination with their known high proliferative potential, they contribute not only to the limitation of brain damage and tissue remodeling but also to neuronal repair and the recovery of synaptic contacts in neurons. Moreover, reactive astroglia modulates the processes of neurogenesis, proliferation, and migration of neurons in the existing neural circuits in the adult brain. The identification of specific niche signals that regulate these sequential steps during adult neurogenesis may lead to the development of strategies for inducing functional neurogenesis in other areas of the brain after an injury or in degenerative neurological diseases

Postnatal cerebellar development in a mouse

The cerebellum is a part of the central nervous system, which plays an important role in cognitive functions, discriminative sensibility, and the coordination of voluntary movements. Its development takes place in two stages: prenatal and postnatal. The cerebellar germ originates from the rhombic lip. There are two major groups of cells: glutamatergic and GABAergic neurons, which are generated at different spatial-temporal intervals. In the postnatal period, Purkinje cells and their synaptic contacts undergo the most significant development. Another key point is the formation of anchoring centers and the foliation of the brain.The cerebellum is a part of the central nervous system, which plays an important role in cognitive functions, discriminative sensibility, and the coordination of voluntary movements. Its development takes place in two stages: prenatal and postnatal. The cerebellar germ originates from the rhombic lip. There are two major groups of cells: glutamatergic and GABAergic neurons, which are generated at different spatial-temporal intervals. In the postnatal period, Purkinje cells and their synaptic contacts undergo the most significant development. Another key point is the formation of anchoring centers and the foliation of the brain

Hip Arthroplasty - Method of Choice for Some Trochanteric Fractures

Introduction: We present 25 cases of operated patients, diagnosed with trochanteric fractures of the femur, which by definition should be treated by osteosynthesis.Materials and Methods: In these presented cases, we show an alternative method - hip arthroplasty (unipolar or bipolar), striving mainly to avoid both prolongation of bed healing and not putting pressure on the operated leg (which is needed after osteosynthesis  for a period of at least 45 days).Results: After arthroplasty, the patients can stand up and start putting pressure on the operated leg  two days after the operation (50% of body weight on the operated limb for a period of 15 to 30 days, and after that - 100% of body weight). More indications for arthroplasty are:1. Definite - coxarthrosis 3th and 4th grade. 2. Relevant:  a) when an early rising of old and/or frail patients is needed; b)severe osteoporosis, which would prolong the period of consolidation after osteosynthesis.When it is possible to put weight on the operated limb earlier, the probability of complications from prolonged bed rest is lower, and delayed weight putting can cause thromboembolism, hypostatic pneumonia and decubitus ulcers.Conclusions: We based our consideration on our database and results, comparing them with a group of 25 trochanteric fractures, operated by the method of osteosythesis. We defined arthroplasty in our study: 1. Patients with better chances to outlive the critical period; 2.  A method of less complications; 3. A method, after which a second surgery is not needed.We consider that arthroplasty after certain trochanteric fractures is a good alternative method when it is needed

Osteoplasty in Surgical Treatment of Chronic Exogenous Osteomyelitis

Introduction: The aim of our research is to show the role of osteoplasty and surgical treatment of chronic exogenous osteomyelitis and to present exact rules of performing its different types - primary osteoplasty (PO - right after the renovation of the area of the infection), primary delayed osteoplasty (PDO - till the 30th day after the renovation of the area of infection ) and secondary osteplasty (SO - after more than 30 days after the renovation of the area of infection ).Many authors recommend performing of PO and many others claim that the best way of performing the procedure is PDO, based on results of their own researches. The dispute PO or PDO (SO) has continued for many years, but recently with the improved possibilities of planning ahead, the various ways of antibacterial treatment, the osteoplasty suggestions of the second group authors is starting to sound more convincing.Materials and Methods: We present 255 patients suffering from chronic exogenous osteomyelitis with defect of the bones, which means cases, in which two types of activities need to be performed:1. Removing bone infection from the osteomyelitic area by sanitizing it; 2. Creating good conditions for the bone consolidation via fixation (internal, external) and osteoplasty.Results: In 205 cases, we have sanitized the osteomyelitic area by using fixation and osteoplasty at the same time (PO). In 50 cases, because of the inability to perform PO, we proceeded with PDO or SO later.A good result would be a lack of bone infection and presence of bone consolidation for the first year. We observed that in 90% of PO and 60% of PO and PDO. Because of our database, we consider that PO should be prioritized if sanitizing the osteomyelitic area is performed perfectly.Conclusions: Based on our data we consider that PO is a priority if the renovation of the area of infection is performed perfectly