Acute Management of Deep Periorbital Burns: A 10-Year Review of Experience.

Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted to the Department of Burns and Plastic Surgery of St George's University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5%) and 284 male (63.5%) aged from 5 months to 92 years. Deep periorbital burns accounted for 74.8% of hospitalized deep facial burns. Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precise surgical approach was preferred, aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment.

La gravité des brûlures péri- orbitaires profondes tient à la nécessité de préserver la vision. Il n'existe pas de consensus quant à leur prise en charge. Nous avons revu les dossiers de 446 patients victimes de brûlure péri- orbitaire profonde traités dans le CTB du CHU St Georges de Plovdiv (Bulgarie) sur une période de 10 ans. On comptait 284 hommes (63,5%) et 162 femmes (36,5%) âgés de 5 mois à 92 ans. Un atteinte péri- orbitaire était présente dans 74,8% des brûlures faciales profondes dans le cadre d'une brûlure touchant en moyenne 19,6% SCT (0,5 à 80%), dues dans la plupart des cas à une flamme ou à un ébouillantement. Une atteinte oculaire était objectivée dans 14% des cas (63 patients). Une excision précoce et soigneuse, visant à recouvrir les lésions tout en préservant le maximum de tissu était la stratégie habituelle. La durée de suivi médiane était de 37 mois (3 mois à 5 ans). Trente- trois patients (7,4%) ont souffert de séquelles oculaires, sans toutefois de perforation cornéenne ni perte de vision. Un traitement adapté techniquement et temporellement permet de limiter les dégâts initiaux et la survenue de séquelles. Nous préconisons une première intervention chirurgicale entre J2 et J10, la préservation de la fonction visuelle étant le marqueur d'une prise en charge adaptée.

Expression of selected inflammatory proteins and metalloproteinases in periodontitis.

OBJECTIVE: Periodontitis is a chronic inflammatory disease caused by microbial dental plaque which leads to the destruction and loss of supporting tissues of the tooth. Microbial plaque alone, however, is not enough to cause the disease. The body's response plays an important role, in which an imbalance between the pro-inflammatory and anti-inflammatory effects of cytokines leads to an inflammatory reaction. PATIENTS AND METHODS: We detected changes in mRNA expression and protein levels of MIP-1α, and metalloproteinases (MMP-2, MMP-9) contributing to cascades in the initiation and progression of inflammatory bone resorption and destruction of periodontal soft tissues in patients with aggressive (AP) or chronic (CP) forms of periodontitis in comparison with healthy individuals (control). RESULTS: MIP-1α mRNA levels were highest in AP (280 ± 23% higher than the control) also in comparison with CP. The difference in protein level was less pronounced. MMP-2 mRNA expression values were similar (300 ± 12% higher in comparison with control), but protein levels were lower, also when compared to CP. Only in CP MMP-9 mRNA levels were significantly higher than the control (30 ± 8%), while protein levels were again higher in AP. Both AP and CP showed a positive correlation between the level of MIP-1a and MMP-2 (0.879, and 0.954 respectively). However, a strong positive correlation was only found between the levels of MMP-2 and MMP-9 in CP (0.812). CONCLUSIONS: MIP-1α, MMP-2 and MMP-9 mRNA expression, along with the concentration of proteins in saliva in patients with periodontal disease, is higher than in healthy individuals and correlates with the severity of the disease.

[112 years of hydatid surgery in Bulgaria (1895-2007)].

Hydatid surgery in Bulgaria dates back of a hundred years. Most of famous Bulgarian surgeons have worked about problem of all locations of the Echonococcus granulosus in the human organism. Their scientific achievements are covered in more of two hundred theses, publications, dissertations. The hydatid disease always was in the schedule of every scientific forums - congresses, conferences, etc. A Bulgarian scientific council has been established with a great experience and very good postoperative results. It's many innovations in diagnostics and surgical treatment, accepted all over the world. Renovations of work in this field are develop. Prophylactic measures for this severe and common disease have been undertaken.

Hydatid bone disease: a case report and review of the literature.

Hydatid disease may develop in almost any part of the body and can be identified with a combination of clinical history, imaging findings, and serologic results; however, the diagnosis of bone hydatidosis is primarily based on radiographic findings. Bone hydatid disease is often asymptomatic, and its diagnosis is usually made at an advanced stage when lesions have become extensive. We present a case of a 45-year-old woman who was admitted to the University Hospital, Stara Zagora, Bulgaria complaining of pain in her left tibia. Radiographs revealed an oval cyst with a diameter of 3.5 cm, located in the diaphyseal part of the tibia. The cyst was excised, and no recurrence was observed on follow-up. Functional outcome was excellent.

[Historical aspects of oesophageal surgery in pediatric surgical practice].

An attempt is made to explore those aspects of the history of esophageal surgery relevant to pediatric practice. Esophageal artesia is a classic example of the significance pediatric group. Its incidence is about 1/4000. It was first described 1670. Surgical correction was started only in 1920s. The first survivors were reported in 1939. Extrapleural approach was reported in 1941.

[Complex diagnosis and treatment of hepatic echinococcosis in childhood]. / Kompleksna diagnostika i lechenie na chernodrobnata ekhinokokoza pri detsa.

In dependence of size, localization, observed complications and associated forms of disease, the clinical symptomatology is characterized whith a different view. Three stages are made out during the illness. Infrequently associated and complicated forms of disease are special interest. Surgical treatment is the basic method of treatment in hydatidosis. It's specificity at children keeps special because of age. The surgery of the hydatidosis has been simpified and except for some cases. Surgical procedurs is great variability of pathology amond hydatid cyst, logically a inform treatment can not be recommended. Surgical approaches were: 1. Conservative methods--leaving of pericyst in situ; or 2. Radical methods--total pericystectomy of liver resection. Modern surgical treatments must be individualized for each cases.

[Research on the problems of recurrence in childhood hydatidosis]. / Prouchvaniia vurkhu problema za retsidivite pri detsa s ekhinokokoza.

One of the very important problems in hydatidosis in childhood is the problems to diagnosed recidives, their ethyology and treatment. In diagnosing such cysts intraoperative ultrasonography is considered as absolutely necessary and mandatory. After surgery treatment for complicated and fertiled cyst, dispensary outpatient observation and chemotherapy of the hydatid disease are recommended with a view to promote radical cure. We observed a higher rate of recidives in conservative methods than in radical ones.

[Bowel injuries after blunt abdominal traumas]. / Chrevni uvrezhdaniia pri zakriti koremni travmi.

Authors present 28 cases of bowel injuries after blunt abdominal trauma. Patients were from 14 to 71 years of age, 18 (64%) men and 10 (36%) women. The most common cause for the trauma was the car accident--in 18 cases. In the rest 10 the trauma was result of household activities. The small bowel was injured in 16 patients, the large bowel in 9 and in 3--the duodenum. In 15 cases the trauma was only abdominal and in the rest 13 it was accompanied by other traumas. Three of the 28 patients reported herein died.

[Therapeutic approach to pulmonary hamartoma patients]. / Povedenie pri bolni s belodroben khamartom.

Hamartoma is one of the most common benign tumour of the lung. The authors report their results of the surgical treatment of 17 patients with lung hamartoma. Twelve of them underwent open thoracotomy and 5 video-assisted thoracoscopy. Lobectomy was performed in 6 patients, segmentectomy in 3 and patients atypical lung resection in 8. All of the patients did not have complications.

[Anaerobic nonclostridial soft-tissue infection]. / Anaerobna neklostridialna infektsiia na melkite tukani.

Over the period 1985 through 1994, observations are conducted on forty-eight patients, 35 men and 13 women, with age ranging from 11 to 56 years, presenting anaerobic non-spore-forming infection of the soft tissues (necrotizing fasciitis (3), postinjection nonclostridial myositis (7), crepitant cellulitis in diabetic gangrene (21), neck phlegmon (5), perineal phlegmon (9), and progressive bacterial synergistic gangrene against the background of chronic osteomyelitis (3). Infection development is characterized by local necrotic processes, intoxication, crepitations, fetor, fever, and in part of the patients--septic shock and DIC syndrome. The microbiological study shows presence of anaerobes, as mono- and polyinfection, aerobic-anaerobic associations, and gram-negative aerobes--in one patient alone. Invariably, the general condition is rather serious. Lethality amounting to 12.5 percent is ascribed to the late detection and unspecified and inadequate treatment protocol in the initial period of observation. The treatment is complex: incisions with successive many-staged necrectomies, antibiotics, metronidazole, hyperbaric oxygenation and hemadsorption. If several (2-3) of the aforementioned symptoms are present, evidence of anaerobic flora should be mandatory and purposefully seeked.

[The treatment of extensive burns using a primary biological dressing in the Clinitron fluidized bed]. / Lechenie na obshirni izgarianiia posredstvom purvichna biologichna prevruzka v usloviia na fluidno leglo "Klinitron".

The treatment of extensive burns using a method recently adopted in this country, namely application of primary biological dressing in patients undergoing treatment under conditions of "Clinitron" fluid bed, is discussed. The ten-year follow-up study covers 1100 patients with extensive burns, distributed in three groups according to the method of local treatment employed: 1) Patients treated by closed method in conventional conditions. 2) Patients treated by closed method under fluid bed conditions. 3) Patients treated on a fluid bed plus primary dressing with the newly obtained biopreparations for local application--Cypocol and skin collagen transplant. The approach outlined is consistent with the traditional treatment procedures. By combining the curative properties of biopreparations, used as primary biological dressing, with those of the fluid bed, a clinical effect considerably superior over the one thus far recorded is attained. Emphasis is laid on the advantages of the therapeutic approach proposed-suppressing endo-and exogenous infections, and substantial reduction of the hospitalization term.

[The advantage of biological explants in covering donor areas]. / Predimstvo na biologichnite eksplanti pri pokrivane na donorni zoni.

A new method of treating raw donor wounds by biological resurfacing in conjunction with fluid bed is described. The classical method of donor area treatment and the newly developed procedure are comparatively studied. Inferences are reached warranting recommendation of the new approach as a routine method for operative management of patients with extensive burns, and all cases where free skin grafting is used as well.