Mladen E. Ovcharov, Iliya V. Valkov, Milan N. Mladenovski and Nikolay V. Vasilev
Lumbar disc herniation (LDH) is the most common pathology in young people, as well as people of active age. Despite sophisticated and new minimally invasive surgical techniques and approaches, reoperations for recurrent lumbar disc herniation (rLDH) could not be avoided. LDH recurrence rates, reported in different studies, range from 5 to 25%. The purpose of this study was to estimate the recurrence rates of LDH after standard discectomy (SD) and microdiscectomy (MD), and compare them to those reported in the literature. Retrospectively, operative reports for the period 2012-2017 were reviewed on LDH surgeries performed at the Neurosurgery Clinic of Dr Georgi Stranski University Hospital in Pleven. Five hundred eighty-nine single-level lumbar discectomies were performed by one neurosurgeon. The diagnoses of recurrent disc herniation were based on the development of new symptoms and magnetic resonance/computed tomography (MRI/CT) images showing compatible lesions in the same lumbar level as the primary lumbar discectomies. The recurrence rate was determined by using chi-square tests and directional measures. SD was the most common procedure (498 patients) followed by MD (91 patients). The cumulative reoperation rate for rLDH was 7.5%. From a total number of reoperations, 26 were males (59.1%) and 18 were females (40.9%). Reoperation rates were 7.6% and 6.6% after SD and MD respectively. The recurrence rate was not significantly higher for SD. Our recurrence rate was 7.5%, which makes it comparable with the rates of 5-25% reported in the literature.
Cholesterol is a white, waxy substance that always takes part in building each cell in the human body. The role of cholesterol in the normal functioning of the human body has been known for a long time, however, it is mainly due to its elevated levels and the health risk of it. It is less well known that low serum cholesterol levels are associated with serious health problems. When it comes to intensive care unit (ICU) patients, hypocholesterolemia may indicate infectious complications, impaired hepatic synthesis, significant bodily injury. Surgical patients are judged for operative trauma and perioperative stress, as well as for the resuscitation process.
Zornitsa V. Gorcheva, Galya Ts. Stavreva, Negrin N. Negrev and Radomir G. Radomirov
In this experiment we studied the role of excitatory and inhibitory neurotransmissions in the ascending reflex pathways in isolated rat colon. Partitioned organ bath, electrical field stimulation (EFS), drugs and isolated preparations were used to evaluate motor activity of (LM) and circular muscles (CM). Ascending motor responses of LM and CM were frequency-dependent contraction, significantly more expressed in LM. Atropine (0.3 µM) decreased ascending contractions of LM. During atropine treatment spantide (0.1 µM) further suppressed ascending contractile motor responses. In the presence of atropine, L-NNA (0.5 mM) restored ascending contractions of LM, while contractions were strongly depressed after addition of L-arginine (0.5 mM). Ascending response in CM, caused by atropine, consisted of an initial relaxation followed by contraction. Spantide decreased the contraction. L-NNA reduced the relaxation and significantly restored the atropine-influenced contraction, while L-arginine induced a deep relaxation of CM. The presence of ChAT, SP-containing nerve cell bodies and fibers and NADPH-diaphorase-reactive cell bodies and processes in myenteric ganglia were detected. The results indicated that nitric oxide is an important modulator of ascending cholinergic and tachykininergic excitation in colonic region of the large intestine of rats.
Antonio Serafin Valero-Liñán, José Ignacio Miota de Llama, José Antonio Gonzalez-Masiá, Toni I. Stoyanov, Belén Conde-Inarejos, Olga Luengo-Ballester, Cristina Camacho-Dorado, Alba Sanchez-Gallego, Beatriz Aguado-Rodríguez, Kaloyan T. Ivanov and Pencho T. Tonchev
Gangliocytic paraganglioma (GP) is an uncommon finding in the periampullary region of the duodenum. In the Department of General and Digestive Surgery of the Albacete University Hospital Complex, a 45-years-old patient was diagnosed with a 17x13mm hypervascular nodular lesion in the descending part of the duodenum during an examination for hepatic hemangiomas. Ampullectomy was performed, followed by a favourable postoperative period. Histological analysis proved GP. There were no involvement of lymph nodes and a malignancy potential, so the clinical and radiological follow-up opted. In conclusion, because such tumours have unpredictable behavior, we recommend local resection of the tumour, except in cases in which local or ganglionic progression is suspected or confirmed, and thus cephalic pancreaticoduodenectomy (CPD) and lymphadenectomy are suggested.
Rossitza K. Iakimova, Daniil C. Aptalidis, Milena S. Pandova, Maria B. Stoyanova and Maya Y. Stoimenova-Popova
Premenstrual syndrome (PMS) is often co-morbid with panic disorder (PD). Selective serotonin reuptake inhibitors (SSRis) are the first-line treatment for both PMS and PD when they manifest separately, but their co-occurrence often complicates the treatment. Our objectives were to evaluate the clinical picture of PMS, co-morbid with PD and the way it changes under 6-month SSRI treatment course. For that purpose, we conducted a longitudinal interventional study. We examined 30 women suffering from PMS and a current episode of PD, verified through premenstrual screening tool (PSST) and Mini International Neuropsychiatric Interview (M.I.N.I.6.0.), respectively. Before treatment initiation, irritability, mood lability, anxiety, breast tension and tenderness, changes in appetite, headaches, palpitations, and abdominal bloating were most common. The somatic symptoms were more than twice as common as the psychological. After 6 months of treatment, most of the symptoms mentioned above were still present but less severe. Forty per cent of the women recovered completely. It seems that in cases of comorbidity between PMS and PD, though somatic symptoms are more common, SSRIs are an effective option for managing both somatic and psychological symptoms.
Aleksandar D. Lyubenov, Slavcho T. Tomov, Desislava K. Kiprova, Grigor A. Gorchev and Kameliya T. Tsvetanova
The aim of the study was to analyse the intraoperative parameters of hysteroscopic morcellation (HM) and conventional resectoscopy in the treatment of uterine polyps (UP). A total of 177 patients with ultrasound imaging of UP were included in a prospective study from February 2015 to February 2017. Out of them, 98 (55.4%) underwent HM and 79 (44.6%) had hysteroscopic resection (HR). We analyzed the following intraoperative parameters: total duration of the procedure, total operating time, time for dilation, actual operating time for HM/HR, the total amount of fluid distension media and fluid deficit. The mean operating time, measured as a total duration of the procedure, total operating time and actual operating time, was significantly shorter in the HM group, as compared to HR group, 8.27 and 19.48 minutes (min) – p<0.001, 6.15 and 16.33 min (p<0.001), 3.28 and 11.70 min (p<0.001), respectively. The total amount of fluid distension media was trustworthy lower in the HM group compared to HR, 446.02 ml and 2225.57 millilitres (ml) – p<0.001, respectively, as well as for the fluid deficit parameter – respectively 83.78 ml and 413.48 ml (p<0.001). This warrants the assumption that HM is an effective alternative to conventional resectoscopy for removal of UP with a favorable perioperative outcome.
George John, Mona Asghari, Vipin VP and Valsamma Eapen
This aim of this review was to examine the relationship between metabolic syndrome (MetS) and depression, which is complex and multifaceted with many inter-related factors includinggenetics, lifestylefactors, environmentalfactorsand other psychological factors at play. There is some evidence to suggest that depression may lead to the development of cardiovascular disease through its association with MetS. It has also been suggested that depressive symptoms may be a consequence rather than the cause of the MetS, as obesity and dyslipidemia have been shown as predictive of depressive symptoms. Thus, the relationship between MetS and depression seems to be a two-way street and bi-directional just as the two sides of the same coin.
Nowadays, infertility is a problem that affects an increasing number of people. The causes of infertility in a couple may be due to a variety of factors – female, male or unexplained. One of the common problems associated with infertility in women is related to uterine cervical diseases. The cervix is an essential part of the sperm passage, so various disorders in the cervix structure and function may be the cause of infertility. The study aimed to identify the leading cervical causes of female infertility, methods of treatment and their success. The most common problems of cervical origin are cervical polyps and stenosis of the cervical canal. They are easily diagnosed with a routine gynaecological examination and ultrasound examination. Polyps are removed through polypectomy, and after that, a natural pregnancy can be achieved. In the case of stenosis of the cervical canal, there are two treatment options – dilation or intrauterine insemination (IUI). In younger patients and lack of male factor in the couple, dilation is performed. Dilation is mechanical with classic Hegar dilatiors or with synthetic hygroscopic dilatiors (Dilapan). If, in addition to the stenosis of the cervical canal in a woman, there is a male factor, treatment with IUI is preferred. Methods for cervical factor treatment vary in their success rate but are generally characterised by good results.
Antonio Serafin Valero-Liñán, Toni I. Stoyanov, Alba Sanchez-Gallego, Elías Garcia-Grimaldo, José Antonio Gonzalez-Masiá, José Ignacio Miota de Llama, Belén Conde-Inarejos, Olga Luengo-Ballester, Beatriz Aguado-Rodríguez, Kaloyan T. Ivanov and Pencho T. Tonchev
The variations of the cystic duct are so common that only 30% of all humans present the classical anatomical arrangement between the common bile duct (CBD), the cystic duct, and adjacent arteries. Thus, it could be considered that anomalies of the biliary tree are a rule rather than an exception. Duplication of the cystic duct, however, is a very uncommon anatomical finding. In the Department of General and Digestive Surgery of the University Hospital Complex Albacete, a 73-year-old patient was admitted with symptoms of cholangitis. He underwent emergency surgery that found exacerbated chronic cholecystitis and dilation of the CBD. Cholecystectomy was performed with identification of a double cystic duct that drained separately in the CBD and exploration of the last revealed cholangitis without choledocholithiasis. The postoperative period progressed favourably, proceeding to discharge from the hospital with Kehr drainage closed. In conclusion, we consider that the routine use of intraoperative cholangiography when there is suspicion of anatomical variations of the biliary tree is mandatory to rule out lesions or alterations thereof.
Kremena K. Atanasova, Georgi N. Nikolov, Joana I. Simeonova and Boris I. Duhlenski
Early diagnosis of congenital hearing impairment is of great importance to later development and social life of the affected newborns. Otoacoustic emission screening test (OAEs) is a useful tool for early evaluation of hearing in neonates and infants. Some specific risk factors (RFs) associated with prenatal, birth and early postnatal periods may influence the first screening results and further diagnostic findings. Results from OAEs in newborns in University Hospital in Pleven between 2013-2015 years are analyzed. In low birth weight children (under 2500 grams or g), and those born before the 36th gestation week (GW), we found deviations in the OAEs. A negative test result proved higher in newborns subjected to oxygen therapy during the first hours after birth (15.5%), as well as in newborns with higher leucocytes count (11.0%) or higher serum bilirubin value immediately after birth. The average birth weight of the newborns was lower in the cases with negative test results (2848.7±506.5 g) and unilateral negative test results (2823.3±535.2 g), as compared with the group with positive test results (3191.9±387.9 g). Elevated bilirubin levels were more frequently established and can be expected with higher probability in low birth weight children. They shall be subject to a follow-up in time, and newborns with initial negative test result shall undergo a second test 2 months after birth. Long term monitoring is recommended for newborns with these risk factors.