Banks-Firms Nexus under the Currency Board: Empirical Evidence from Bulgaria

This study analyses bank lending in the larger context of bank-firm relations within the Bulgarian specificity of currency board. It focuses on the ‘intersection’ of credit supply and demand on the side of banks and firms simultaneously. We suggest both traditional and new hypotheses corresponding to the specific conditions of the Bulgarian ownership change, transitional corruption and other institutional and political factors. The model is based on a survey on Bulgarian banks and a unique database on firms. The study found that the dynamics and structure of credit is affected mainly by the features of the institutional environment, whereas the ‘resource’ and traditional factors became secondary. During the period 1998 – 2001, there is separation of the banking sector activity from the activity of the real sector in Bulgaria. In the new conditions of currency board, the dual sector of enterprises and the specific institutional environment continue their existence. Despite its disciplining effect the currency board by itself is not sufficiently effective to overcome the remaining ‘institutional obstacles, associated mainly with the inefficiency of the judicial system, corruption, state capture, uncertain property rights, etc.corporate governance, bank lending, currency board, corruption, transition economy

SURGICAL MANAGEMENT OF SYMPTOMATIC LOW BACK PAIN AND MONORADICULAR LEG PAIN IN ADOLESCENT AND YOUNG ADULT PATIENTS

Objectives: The purpose of the present retrospective study is to draw attention to symptomatic low back pain in adolescent patients, in order to encourage earlier diagnosis and surgical treatment. The study assessed the radiological, clinical features and surgical outcomes of 13 of this kind of patient. Materials and Methods: Out of a series of 983 consecutive cases (1999–2011) of lumbar disc excisions from our neurosurgical institution, 13–1,32% of the patients were between the ages of 15 and 20 mean 17,84. Fifteen operations, including two reoperations,were performed on this patient group, by a conventional microsurgical procedure. The indications for surgery were failure of conservative treatment, in tractable pain and/or progressive neurological impairment. Results: Low back pain and monoradicular sciatica were the main complaints in 77%, but findings of neurological deficits were rare — 1 case. The surgical findings revealed a protruding disc in eleven cases, one lateral recess stenosis and one lumbar synovial cyst. Initially, all patients were treated conservatively by their physicians more than 3 months without success. On the day of discharge, Kirkaldy-Willis criteria results were excellent or good in 92% of patients. The follow-up period ranged from 6 months to 2 years with an average of 1 year and 2 months. The results were excellent in 10 patients and good in 3 patients. Discussion: We demonstrate that the cause of low back pain and monoradicular leg pain in adolescent patients may not only be a cause of herniated lumbar disc or lateral recess narrowing. Very rarely these symptoms may be caused by lumbar synovial cysts. Conclusion: Surgical treatment of adolescent patients is able to relieve the clinical symptoms quickly. Clinical symptoms such as low back pain and leg pain and the neurologic deficit disappear within 3 months after surgery

Contemporary surgical treatment of the osteoporotic compression fractures

SUMMARY Aim and object of the study: The vertebral compression fractures (VCF) are one of the most common complication of the osteoporosis that could be a cause for permanent and debilitating pain, restricted mobility and hence significant worsening of the quality of the life. The surgical treatment of the VCF is indicated after a failure of the conservative treatment or after established spinal instability or neurological deficit. The most commonly used surgical procedures are the percutaneous vertebroplasty with poly - methyl methacrylate(PMMA) and the transpedicular screw fixation-reconstruction. The aim of the present investigation is to summarize and elucidate the indications for the different types of spinal techniques, the potential complications and their treatment.Methods: Analyzed were 72 consecutive patients with compression spinal osteoporotic fractures treated in our clinic from January 2009 to July 2012. Of these, 38 patients (M14 / F24) with average age 66.8 years (54-80) underwent PV on 46 levels. All the fractures were without neurological deficit and classified as A1 type in Magerl. The remaining 34 patients (M5 / F29) with average age 67.3 years (56-85) underwent transpedicular screw spinal reconstruction addressing incomplete burst compression fractures in which were damaged the anterior two columns. A total of 40 levels were addressed The indications for surgery were severe pain syndrome, neurological deficit, presence of bone fragments in the spinal canal or spinal instability.Results: In our series the VCF most commonly are located in the thoracolumbar (Th11-L2) segment of the spine - 75.6%, (65/86) levels. In 7 patients 2 levels were treated in one settings, 2 patients had 3 levels treated and one patient 4 levels. Our PV subgroup showed very good outcome in 84.2% (32/38) of patients. Due to migration of the cement in the spinal canal, two patients underwent surgical decompression. The results in the spinal instrumentation subgroup are good in 82.4% (28/34) of the cases. In 6 of the instrumented cases a revision surgery had been performed, due to progressing neurological deficit and persistent pain. The surgery addressed screw pull-outs and implant mallposition/displacement.Conclusion: Our results indicate that modern surgical treatment of osteoporotic patients with symptomatic VCF presents low incidence of complications and allows for a significant reduction of pain, spinal stability, improved quality of life and prolonged active life. PV is minimally invasive procedure with a good effectiveness and uncommon complications that are clinically significant. The spinal instrumented reconstruction is indicated in case of severe multilevel VCF, spinal instability and compression of the neural structures

Surgical complications and unwated events in the modern percutaneous vertebroplasty treatment

Aim and object of the study. The modern spinal surgery accepts the percutaneous vertebroplasty (PV) with polymethylmethacrylate(PMMA) as routine procedure for treatment of painful osteoporotic, neoplastic and traumatic compression fractures in the thoracic and lumbar region of the spinal column. Although considered to be minimal invasive and safe procedure, it could be complicated with severe disabling and even life-threatening complications. The aim of the present study is to evaluate the different potential complications with their clinical presentation, diagnostics and different treatment options.Methods: The study analyzes a cohort of 56 consecutive patients (66 levels) treated with PV in our clinic for the period January 2008 - July 2012. Of them 31(55,4%) are women and 25(44,6%) are men with mean age of 61,7 (23 - 80) years. The osteoporotic and traumatic compression fractures subgroup comprises of 44 (78,6%) patients, while the patients with neoplastic fractures are 12(21,4%). All the fractures are classified as A1 Magerl`s fractures with no neurologic deficit.Results: Complications and unwanted events are registered in 9(16,1%) patients. Of them 2 experienced transient increased pain syndrome intensity, one of the patients presented with index level radiculopathy, 2 patients were diagnosed with extravertebral leakage of the cement in the spinal canal with compression of the neural structures and subsequently operated, 1 patient had cement leak in the adjacent disk, 2 patients cement leak in the paravertebral soft tissues and the paravertebral venous system and one with cement pulmonary embolism.Conclusion: PV is minimal invasive and effective procedure that is used in the treatment of the painful osteoporotic, traumatic and neoplastic compression fractures on neurologically intact patients. The clinically significant complications and unwanted events are relatively rare encounter and in the majority of the cases are treatable with conservative measures. The epidural cement migration with neural elements compression is the only one indication for surgical decompression and removal of the compressing cement

SYNDROME OF HYDROCEPHALUS IN YOUNG AND MIDDLE-AGED ADULTS. REVIEW OF THE LITERATURE AND ILLUSTRATIVE CASES

Introduction: A multitude of underlying reasons result in hydrocephalus (HC), and its classification remains controversial. The current study looks at patients with the Syndrome of Hydrocephalus in Young and Middle-Aged adults (SHYMA) through a case series. Patients and methods: We report 35 patients with HC referred to St. Anna Multiprofile Hospital during the period 2008–2012. Inclusion criteria were decompensated congenital hydrocephalus, (DCH), acquired hydrocephalus (AHC), or idiopathic hydrocephalus (IHC) in the age range of 16–55 years, treated with a ventriculo-peritoneal shunt (VPS) — 17 patients were treated with Strata Adjustable Delta Valve (“Strata” group) and 18 patients had Medtronic Orbis Sigma valves inserted (“Orbis Sigma” group). Results: Eight patients (22.86%) had DCH, 14 (40%) had AHC, and 13 (37.14%) had IHC. Regardless the underlying cause for HC, all the patients had similar symptoms, mainly related to gait in 26 (74.3%), cognition in 30 (85.7%), bladder control in 20 (57.14%) and chronic headaches in 24 patients (68.57%). Symptomatic improvement was achieved in 34 of the shunted 35 patients (97.14%), but the postoperative complications rate was found to be significantly lower in the “Strata” group. Conclusion: The clinical presentation of hydrocephalus in the age 16–55 years has common features presenting with syndrome of hydrocephalus in young and middle-aged adults as separate clinical entity. VPS is a feasible treatment option in SHYMA. Due to the excessive, long standing ventriculomegaly, thus sensitive compliance of brain parenchyma and high tendency to develop subdural hematomas, adjustable VPS are advisable option

Prognostic Factors Related to the Surgical Treatment of Patients with Brain Metastases /// Прогностични фактори при хирургичното лечение на пациентите с мозъчни метастази

[EN] Although brain metastases are some of the most frequently diagnosed sequelae of systemic malignancy, their optimal management is not well defined yet. In that respect, the different diagnostic and therapeutic approaches of BMs patients is an issue for serious discussions. According the published data, the number of the patients with malignant diseases, and patients in the final IV stage (Classification of Malignant Tumours; TNM), respectively, the number of patients with brain metastases (BMs) constantly and steadily increases, despite the tremendous and continuous advancement of the modern medicine. The above inevitably results in increase of the number of the patients with metastases, and patients with BMs, in particular. Hence, nowadays the patients with BMs outnumber the patients with primary brain tumours. All the above points the great importance of the optimal surgical behaviour with the BMs patients. An extensive literature review treating the problems of BMs patients, along with a statistical analysis of retrospective and prospectively collected data in the Neurosurgical clinic of St. Anna Hospital - Varna, and other clinics as well, we have defined the major objective of our study: Defining the dynamic tendencies in the epidemiology of the BMs patients and hereof adapting the neurosurgeon’s behaviour to modern trends and requirements, along with improvement and modulation of present algorithms for treatment of the patients with metastatic brain tumours. The set objective investigated in four clinical studies: 1. Epidemiological investigation of oncologic patients in Varna and Dobrich region, Bulgaria. The survey provides information for the number of oncologic patients, stage IV patients (TNM) included, for the period 1983 – 2006. The BMs patients treated in the Neurosurgical clinic of St. Anna Hospital - Varna, were surveyed as well. The investigation gives the tendencies in the epidemiology of the BMs in the region compared to the global trends. 2. Immunohistochemical tests of BMs tissues were examined with CDC47 marker for proliferating cells. Based on that proliferation indexes were calculated and counterposed to the clinical presentation and behaviour of the BMs, aiming to define prognostic factors. 3. Retrospective investigation of 308 patients with BMs treated with Stereotactic Radiosurgery (SRS) for the period 2002 – 2008, selecting patients with subsequent neurosurgical resection of BMs in the area of the SRS treated brain volume, was performed. The investigation aimed to establish the role of the neurosurgeon and the delayed neurosurgical BMs resection among the MBs patients treated with SRS. 4. Retrospective investigation aiming to compare the results of the surgical BMs excision of single MM in two tertiary referring centres, with weight on the surgical technique (Piecemeal/ Enbloc) used, was performed.[BG] Въпросът за мозъчните метастатични тумори (ММТ) добива все по-важно значение и представлява сериозен проблем в медицинската практика поради тяхната висока честота и смъртност - почти 100 %. Те се явяват една от най – честите причини за неврологични компликации у болните от системни неопластични заболявания и са най-често срещащите се интракраниални тумори Независимо от средностатистически лошата прогноза, неусложнената с постоперативни компликации хирургична ексцизия предлага значително по-добро качество на живота чрез бързото ликвидиране на интракранилната хипертенсия, редуциране или изчезване на неврологичния дефицит и болката. Това прави въпросите свързани с оптималното хирургичното поведение при мозъчни метастази значими, а прогреса в третирането им особено актуален. Въз основа на прегледа на достъпната литература по проблемите на метастатичните мозъчни тумори(ММТ) и съпоставка с получените от нас резултати при статистическата обработка на събраната ретроспективно информация, както и проспективното наблюдение на болните с диагноза ММТ преминаващи през НХК- Варна и други клиники, ние дефинирахме следната цел: Установяване на динамичните тенденции в епидемиологията на пациентите с ММ и в тази връзка адаптиране на поведението на неврохирурга към съвременните насоки и изисквания за лечение на тази група пациенти, съответно подобряване и модулиране на настоящите алгоритми за лечение на пациентите с ММ. За достигане на поставената цел са разработени четири клинични проучвания: 1. Епидемиологично проучване на онкоболните от Варненски и Добрички регион, даващо информация за разпределението на всички регистрирани онкоболни, както и тези в IV-ти стадии (по ТNM класификация) за периода 1983 – 2006 . За периода 1993 – 2006 е събрана и обработена статистически информация за преминалите през Неврохирургична клиника – Варна/НХК-Варна/ болни с ММТ. Проучването позволява да се установят някои особеностите в епидемиологията на ММ в региона и да се съпоставят със световните тенденции. 2. Имунохистохимично изследване на ММ. Парафинови срези на тъкани от мозъчни метастатични тумори(ММТ) са обработени с имунохистохимични методи. Обработката следва протокол за оцветяване със CDC47 – маркер специфично изявяващ ядрата на пролифериращите клетки, което позволява да се изчислят индекси на пролиферативна активност, които от своя страна се съпоставят с особености на клиничното протичане, с цел дефиниране на прогностични фактори. 3. Ретроспективно проучване на 308 пациента с ММТ подложени на стереотаксична радиохирургия за периода 2002 – 2008, при което са селектирани пациенти с последваща неврохирургична резекция на ММТ в областта на третираният с радиохирургия мозъчен обем. Проучването има за цел да изясни ролята на неврохирургията и отложеното неврохирургично лечение при пациенти със симптоматични лезии след лечение със стереотаксична радиохирургия. 4. Ретроспективно проучване с цел да сравнят резултатите от хирургичната рецекция на единични ММ в два терциерни референтни центъра. Пациентите оперирани за 8 години(2003 – 2010) в двата референтни центъра са ретроспективно проучени, като резултатите са интерпретирани с акцент върху начина по който е осъществена резекцията на ММТ - (Piecemeal/ Enbloc)

Banks-Firms Nexus under the Currency Board: Empirical Evidence from Bulgaria

This study analyses bank lending in the larger context of bank-firm relations within the Bulgarian specificity of currency board. It focuses on the ‘intersection’ of credit supply and demand on the side of banks and firms simultaneously. We suggest both traditional and new hypotheses corresponding to the specific conditions of the Bulgarian ownership change, transitional corruption and other institutional and political factors. The model is based on a survey on Bulgarian banks and a unique database on firms. The study found that the dynamics and structure of credit is affected mainly by the features of the institutional environment, whereas the ‘resource’ and traditional factors became secondary. During the period 1998 – 2001, there is separation of the banking sector activity from the activity of the real sector in Bulgaria. In the new conditions of currency board, the dual sector of enterprises and the specific institutional environment continue their existence. Despite its disciplining effect the currency board by itself is not sufficiently effective to overcome the remaining ‘institutional obstacles, associated mainly with the inefficiency of the judicial system, corruption, state capture, uncertain property rights, etc.http://deepblue.lib.umich.edu/bitstream/2027.42/39940/3/wp555.pd

Banks-Firms Nexus under the Currency Board: Empirical Evidence from Bulgaria

University of MichiganWilliam Davidson Institute Working Paper n°555, 28p

OUR EXPERIENCE WITH MAGERL’S MODIFIED TECHNIQUE FOR STABILIZATION OF SUBAXIAL CERVICAL SPINE

Aim: There are different surgical techniques for massa lateralis screw instrumentation of subaxial cervical spine--those of Roy-Camille, Magerl, Anderson, and An. Each has different starting point and trajectorys of screw implantation.For each technique there is a potential risk to affect vascular and neural structures.In this paper we share our experience in using a modified Magerl's technique for stabilization of subaxial cervical spine. Method:We present a retrospective study and clinical follow-up of 27 patients operated on the occasion of cervical injury that we have used the modified technique of Magerl. In 8 patients was carried and an anterior decompression and stabilization. Results: In these patients was carried posterior or combined -- posterior and anterior stabilization. The posterior fixation was massa lateralis with this modified technique of Magerl with multiaxial screws. With this technique were inserted 160 multiaxial screws and the most common length of the implants were 108 mm (108 from 160 or 67.5%). Conclusion: Based on world literature, experience and analysis of clinical cases, we believe that this modified technique for subaxial cervical fixation is effective (the pull-out strength approach to the strength of pedicle screw instrumentation) and is much safer

Severe head injury associated with multisystem injuries

The incidence of severe head injury (SHI) varies between 20-30/100000. In the developed countries, the SHI contributes for over 50% of the dead outcomes among the trauma patients. Many investigations statistically prove that associated with SHI multisystem injuries negatively affect the outcome. In the present study we aim to investigate which organs and system having concomitant injury with SHI have a maximal negative influence to the outcome. We also aim to systematize the influencing factors, also to revise the treatment strategy. Our investigation is based on a cohort of 57 consecutive patients with dead outcome admitted to `St. Anna` Hospital for the period 2004 - 2006 year. The patients are classified according the localization of the associated injuries. A clinical-therapeutic classification was also made based on the severity of the patient`s condition, also according to the necessary urgent management.Scripta Scientifica Medica 2009; 41(1): 17-19