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Postoperative Outcomes of Elective Pancreatic Surgery in a Low-Volume Academic Surgical Clinic

Summary

According to the volume-outcome concept the postoperative outcome after major pancreatic surgery in high-volume institutions compares favorably to low- volume centers. However, it is not clear whether this is applicable to all low-volume institutions nowadays. The aim of the study was to evaluate the postoperative outcome after major elective pancreatic surgery in a low- volume academic surgical clinic. All consecutive elective major pancreatic cases operated within a 10-year period till October 2013 have been retrospectively reviewed. During the studied period, 36 patients (15 females, 21 males, mean age 54 years, age range 37-76) were scheduled for elective pancreatic surgery and underwent pancreatic resection (n=31, 18 proximal and 13 distal pancreatic resections) or complete pancreatic duct drainage procedure (n=5). Eleven patients had chronic pancreatitis and 25 patients had malignant or benign tumors. Vascular or adjacent organ resection was performed in 9 patients (29% of resections). The overall postoperative morbidity was 36% (n=13), and complications requiring re-operation occurred in 5 patients (14%). The median postoperative hospital stay was 11 days for patients without complications vs. 25 days for patients with any complication. There was no 60- day postoperative mortality or hospital readmission. Major elective pancreatic surgery can be safely performed today in a low-volume academic general surgical clinic, with postoperative outcomes similar to those reported by high-volume centers.

Open access
Predisposition to Thrombophilia and Hypofibrinolysis in Pulmonary Embolism: Analysis of Inherited Factors

Summary

Pulmonary embolism (PE) is a relatively common cardiovascular emergency, though its exact incidence is difficult to assess. Accurate diagnosis is critical because of the high 30-day mortality in patients in whom the diagnosis is missed on admission. Doubt for PE is often raised by the presence of risk factors for venous thromboembolism (VTE), which are categorized into inherited and acquired. Among these, the importance of inherited/genetic thrombophilic factors is increasingly recognized. The most frequent markers of inherited thrombophilia are Factor V Leiden (FVL) and G2021OA prothrombin gene mutation. Among the inherited factors causal to thrombophilia, the C677T variant in methylentetrahydrofolate reductase (MTHFR) gene as well as factors like P1A1/P1A2 polymorphism in platelet glycoprotein Ilb/IIIa (P1A2) and hypofibrinolytic polymorphism 4G/4G in PAI-1 gene are discussed with controversial results. In our study, thrombophilic and hypofibrinolytic genetic variants were identified in 54.2% of 115 patients with PE. The most common significant genetic defects were FVL- 16.5% in patients versus 6.2% in controls (OR=3.102; p=0.05), G20210A PT 5.7% versus 2.1% (OR=2.983; p>0.05). P1A2 was found in 27.3% patients versus 19.9% in controls (OR= 1.523, p>0.05) and PAM 27.8% versus 22.6% (OR =1.501 p>0.05). MTHFR C677T carriage was inverse: 6.7% in patients versus 13.4% in controls. (OR=0.461 p=0.05). Of all the patients studied, 15.65% had a history of recurrent embolic incidents. The risk of recurrence was higher for the carriers of FVL and G20210A prothrombin gene mutation. The association between carriage of thrombophilic genetic factor and the early onset of the first embolic episode was found in the patients with PE. The awareness of risk factors and risk stratification is a critical issue in treatment and prevention policy. Preventive measures should be taken in particular medical conditions.

Open access
Rare Case of Human Visceral Linguatuliasis in Bulgaria Diagnosed on Biopsy Specimen

Summary

We report a rare case of visceral linguatuliasis in a 9-year-old boy. The diagnosis was made incidentally on a biopsy specimen obtained during laparotomy on account of an acute appendicitis. An encysted parasite was found in a mesenteric lymph node and diagnosed as Linguatula serrata larva mainly based on its typical appearance. The vermiform appendix showed only lymphoid hyperplasia and no features of inflammation. The patient made an uneventful recovery after the operation and was discharged. He is being followed up. To our knowledge this is the first officially reported case of human linguatuliasis in Bulgaria.

Open access
A Rare Case of Subtentorial Arterio-Venous Malformation Case Report

Summary

The majority - over 80%, of arteriovenous malformations (AVMs) are supratentorial. The infratentorial AVM are uncommon and different from other intracranial AVMs in terms of history, diagnosis, treatment, prognosis, and follow up. The authors present a case of an intracranial hemorrhage, caused by rupture of an AVM in the posterior cranial fossa. Native (unenhanced) CT and computed tomography angiography (CTA) images of this rare location of AVM are presented.

Open access
Risk Factors for Coronary Artery Diseases: A Study Among Patients With Ischemic Heart Disease in India (Kerala)

Summary

Coronary artery disease (CAD) is a condition that develops due to accumulation of atherosclerotic plaque in the epicardial coronary arteries, leading to myocardial ischemia. It is the leading cause of death worldwide and is a common complex disease. A study was carried out in a group of 496 patients with acute coronary syndrome or with angiographic or stress test evidence for coronary artery disease, admitted to the Department of Cardiology at Lourdes Heart Institute and Neuro Centre during the period June-August 2012. The risk factors studied were hypertension, diabetes mellitus, dyslipidemia, body mass index, smoking and family history of CAD. The results demonstrated that in both males and females of the Indian population studies, diabetes and dyslipidemia were major risk factors for CAD, while hypertension was not a major risk factor. Therefore, early detection and treatment of diabetes mellitus and dyslipidemia play a vital role in prevention of CAD in Indian population.

Open access
Study of the Carrier State for Five BRCA1/BRCA2 Deleterious Mutations in Bulgarian Women with Breast Cancer

Summary

Genetic testing for BRCA 1/2 mutation is a well recognized medical management tool. Identification of healthy carriers of such mutations allows effective risk reduction procedures to be performed. There is no data reported on the founder mutations in the Bulgarian population. To evaluate the contribution of genetic factors to breast cancer (BC), we investigated the carrier state of Bulgarian women with BC for five common (according to BIC database) deleterious BRCA1/2 mutations. The list of patients diagnosed with BC between January 2011 and April 2012 was obtained from the Cancer Registry of University Hospital, Pleven. Eighty-two women with BC were interviewed and a pedigree was constructed of each of them. The patients were classified into seven categories, according to personal, disease and family history. Based on the preliminary prepared selection criteria and the personal family history, we defined a target group of 33 Bulgarian women with BC. They were screened for five deleterious mutations: 5382insC in BRCA1 and 6174delT, 6079del4, 8138del5, 5946delCT in BRCA2, by DNA sequencing. The genetic analysis detected none of the tested mutations. Two polymorphic variants were found in BRCA2 gene: c.5744C>T (rs4987117, SNP database) in exonl 1E in one patient and c.7806-14T>C (rs9534262, SNP database) in exonl7 in 22 patients. In conclusion, without basic information on the founder mutations in the population, the genetic screening for the specific mutations in a small group of tested patients is ineffective.

Open access
An Angiosarcoma in the Right Atrium: A Case Report

Summary

Angiosarcoma is a rare malignant tumor of vascular endothelial cell origin, accounting for 1-2 % of all sarcomas. We present a 24-year-old female patient, initially diagnosed and treated for tuberculous pleurisy for one month. Then transthoracic echocardiography (TTE) revealed a rare cause for the pleural and pericardial effusion - a tumoral mass apparently arising from the right atrium and extending into the upper vena cava. The patient presented with worsening dyspnea, stabbing pain in the right hemithorax and persistent, irritating cough, a recent history of haemoptysis, bilateral pleurisy and hemorrhagic pericardial effusion. The ECG showed sinus rhythm with negative T-waves in leads DI, Dll, aVL, V3 to V6. The TTE showed an irregularly shaped right atrial tumoral mass, not resembling a thrombus, which extended to the upper vena cava. The transesophageal echocardiography showed an invasion of the serous (parietal and visceral) pericardium and a dilated right atrium almost completely occupied by the tumoral mass. The CT scan revealed invasion of the upper vena cava ostium and anterior mediastinum with pretracheal adenopathies, and hemorrhagic pleural and pericardial effusion suggestive of a sarcoma. The histological examination and immunohistochemistry confirmed the diagnosis of angiosarcoma. Although a rare form of malignant tumor that affects the head, neck, breast, bone, liver, spleen and heart, angiosarcoma must be considered as a possible cause of pleural and pericardial effusion, especially in previously healthy young patients.

Open access
Comparison of Four Methods for Corneal Thickness Measurement

Summary

The aim of the study was to evaluate the thickness of the normal cornea in order to establish correlation between four methods of measuring including: ultrasound pachymetry (USP), anterior segment optical coherence tomography (ASOCT), non-contact tono/pachymetry (TONOPACHY) and laser-scanning confocal microscopy (LSCM). The study was based on evaluating repeatability and comparability of four different methods formeasuring the corneal thickness. Non contact specular microscopy was first performed on all 27 patients (aged between 20 and 24 years) to evaluate corneal characteristics and confirm the absence of pathological changes. Each participant was examined by USP, ASOCT and TONOPACHY, and 13 eyes of 10 persons were also examined by LSCM. The values of average central corneal thickness measured by USP, ASOCT, TONOPACHY and LSCM were 532.20±4.5 pm, 553.33±12.1 pm, were 548.20±5.62 pm and 573.33±7.22 pm, respectively. There was a high correlation between the instruments. The mean differences for central corneal thickness measurements were 41.43±1.67 pm between USP and LSCM, 20.43±2.4 pm between USP and ASOCT, and 22.1 ±3.88 pm between USB and TONOPACHY. Anterior segment optical coherence tomography overestimated corneal thickness as compared with that measured by USP, which is believed to be a gold standard. Anterior segment optical coherence tomography had better agreement with USP, as compared with LSCM. However, the results of measured cornea thickness by TONOPACHY were very close to cornea thickness measured by ASOCT.

Open access
Effect of Aronia Melanocarpa Fruit Juice on Fearning and Memory in the Two-Way Active Avoidance Task in Rats

Summary

Amnia melanocarpa fruits are one of the richest natural sources of phenolic substances, among them flavonoids, mainly from the subclass of anthocyanins. Flavonoids, which are constituents of Amnia melanocarpa fruit juice, have been found to localize in various brain regions that are important for memory. The aim of the present study was to investigate the learning and memory effects of Amnia melanocarpa fruit juice (AMFJ) in young/healthy male Wistarrats. AMFJ was applied orally for 21 and 30 days at a dose of 10 ml/kg b.w., and comparisons were made with saline-treated (10 ml/kg b.w.) controls. Learning and memory functions were evaluated, using the two-way active avoidance task (shuttle box). Administered for the two treatment periods, the juice significantly increased the number of avoidances on training days 1 and 2, as well as at the retention test (24 h after the 2nd training session). These effects were more pronounced in rats treated with AMFJ for 30 days. The learning and memory effects of AMFJ are probably due to its polyphenolic constituents. The findings from the present study suggest that AMFJ applied subchronically improved learning and memory in young/healthy rats.

Open access
Effects of Long-Term Treatment with Atorvastatin and Rosuaastatin on Active Avoidance Test in Intact Rats

Summary

Statins are widely used for treatment of hyperlipidemia. They have been shown to possess pleiotropic effects apart from their lipid-lowering activity - anti-inflammatory, immunomodulatory, and neuroprotective. Most studies suggest that statins can protect the brain against damage but it is not clear whether they improve cognitive function in patients without neuropathy. The aim of the present study was to investigate the effect of 3-month treatment with atorvastatin and rosuvastatin on learning and memory processes in rats without brain damage. Wistar rats were treated orally for 90 days with atorvastatin and rosuvastatin at a dose of 10 mg/kg b. w. in parallel with the vehicle-treated group. After that period, learning ability and memory retention was evaluated using an active avoidance test - automatic reflex conditioner (shuttle box). The learning session was carried out on 5 consecutive days. Memory retention test was performed on day 12. The following behavioral reactions were investigated: conditioned responses (avoidance), unconditioned responses (escapes), and intertrial crossings. We found increased number of conditioned responses in groups, treated with atorvastatin 10 mg/kg b.w., and with rosuvastatin 10 mg/kg b.w. during the learning session and on the memory retention test, as compared to the same-day control group. The atorvastatin-treated group showed an increased number of unconditioned responses on days 1 and 2, as compared to the control group. In the group treated with Rosuvastatin there was an increased number of escapes on days 1,2 and 4, as compared to the vehicle-treated group. Atorvastatin and rosuvastatin at a dose of 10 mg/kg b.w. improved processes of learning and memory retention after the 3-month treatment.

Open access