Insulin therapy in sepsis

Severe metabolic derangement is characteristic of systemic inflammatory response in septic conditions. Changes in blood glucose levels are often deleterious further impairing organ functioning. Thus they are a subject of strict and sometimes even too aggressive control. Its disadvantages demand and stimulate research of new strategies. In the present paper we systematically review the current therapeutic options and recent research advances in the field of hyperglycemia in sepsis. They include the pathogenesis of sepsis and the role of insulin in this pathology. A special attention is paid to the glycemic control in sepsis. The correct strategy of glycemic control is combined approach with computerized infusion, continuous blood glucose monitoring and proper feeding support.Scripta Scientifica Medica 2013; 45(1): 7-11

The effects of BIS monitoring on sedation in intensive care units

Introduction. Sedation in intensive care units (ICUs) is crucial, especially for patients on mechanical ventilation. Deep sedation is associated with longer ICU stays and more days on mechanical ventilation. Aim. The aim of our study was to determine whether sedation levels based on BIS monitoring lead to a lower total dose of sedatives, fewer days on invasive ventilation, shorter stays in the ICU, and to create a revised sedation protocol for our unit.Materials and Methods. A total of 80 sedated ICU patients were included. The control group consisted of 40 patients whose sedation levels were monitored using the RASS scale. The experimental group consisted of 40 patients whose sedation levels were monitored using BIS.Results. Patients whose sedation levels were monitored with BIS and adjusted accordingly spent less time on the ventilator, less time in the ICU, had shorter hospital stays, and experienced lower mortality.Conclusion. The results of our study are promising, but there is still a need for more studies on the role of BIS monitoring in sedation management in ICUs

Laparoscopic treatment of liver hydatid disease

Surgical treatment has been considered the only available treatment of liver hydatid disease because of the complete removal of the parasite. According to the new standards for clinical approach to hepatic hydatid disease, there is no golden rule and the individual approach to every patient and cyst is of greatest importance. The laparoscopic method in the treatment of liver hydatid disease includes complete excision of the cyst, unroofing, evacuation and obliteration of the cyst cavity. Some authors perform a direct exploration of the cyst cavity in order to reject or confirm the presence of the communication of the cyst with the biliary tree. The laparoscopic method has advantages as a minimally invasive method with shorter hospital stay and minimal risk of wound complications. All the arguments prove the laparoscopy to be feasible and effective method of treatment of liver hydatid disease.Scripta Scientifica Medica 2013; 45(1): 17-20

Comparative analysis of application of conventional colonoscopy and NBI colonoscopy for detection of early colorectal cancer

PURPOSE: Extending life expectancy is one of the major causes for increasing cancer incidence rate. The objective of the present investigation is to compare the diagnostic value of conventional and narrow band imaging (NBI) colonoscopy for the early diagnosis of colorectal cancer.MATERIAL AND METHODS: We examined 163 patients hospitalized in the First Clinic of Surgery, St. Marina University Hospital of Varna, for a period from 2010 to 2012 and compared the diagnostic modalities of conventional colonoscopy and NBI-colonoscopy.RESULTS: NBI colonoscopy with magnifying endoscopy had the potential to detect more lesions remaining not identified by conventional endoscopy. The relative share of newly-increased mucosal changes increased by 1.9 times (52%). The newly-diagnosed lesions were mostly small sized. We diagnosed by 2.7 times more lesions sized less than one mm as well as by two times, 1.7 and 1.3 times more lesions sized 1-3 mm, 3-5 mm and 5-9 mm, respectively. The method did not establish any new formations larger than one cm or more. The main part of the newly-detected lesions presented with non-specific inflammatory changes, i.e. by 9.2 times more often when compared to conventional endoscopy and represented hyperplastic/ inflammatory polyps by 2-3 times more often. In four new lesions there were either an early cancer, or areas of high-grade dysplasia while in 12 ones there was a low-grade dysplasia.CONCLUSION: NBI colonoscopy with magnifying endoscopy represents a reliable method for the diagnosis of small neoplasms of the colon.Scripta Scientifica Medica 2013; 45(2): 43-47

Open surgery for liver hydatid disease

Hydatid cyst disease is a cosmopolitan parasitosis. E. granulosis species prevails in most countries around the world and especially in the Mediterranean region. We performed a retrospective literature search on liver hydatid cysts was carried out in ScienceDirect, Scopus, Web of Knowledge, InCites, and MEDLINE data-bases for the period 2000-2012. According to recent literature data, liver is the most commonly affected organ. The principles of surgical approach to the liver hydatid disease include the following: i) neutralization of the parasite; ii) evacuation of the cyst and removal of the germinative layer, and iii) treatment of the remaining cavity. The marsupialization of the remaining cyst is not accepted in case of suppurated hydatid cyst. There are numerous opinions about the most efficient scolicidal solution. The most intractable problem is the approach to the residual cavity of hydatid cyst. Major postoperative complications reported by different authors are mainly inflammatory processes. The radical surgical method is indicated in case of peripherally located hydatid cysts, several cysts grouped in a liver segment or lobe, and cysts located in the left lateral hepatic lobe. The surgical method still remains the golden standard for treatment of liver hydatid cysts.Scripta Scientifica Medica 2013; 45(3): 23-26

Hydatid liver disease - a review of the literature

Hydatid cyst disease of the liver is a worldwide parasitosis with significant debilitating effect on the patients. In Bulgaria, the most important biological reservoir and the final host is the dog. The distribution of the disease in the territory of the country is variable. Advances of laboratory and imaging diagnostic methods provide new options for multimodal approach. Surgery has been mainstay of treatment, however, new minimally invasive methods such as laparoscopic surgery and PAIR present with advantages in selected patients. Perioperative therapy diminishes postoperative relapses. In the present review, new data about the epidemiology and recent achievements in diagnosis and management of hydatid liver disease are presented.Scripta Scientifica Medica 2013; 45(2): 17-22