[The participation of nitric oxide in the functions of the central nervous system and the cardiovascular system]. / Uchastie na azotniia oksid vuv funktsiite na tsentralnata nervna sistema i surdechno-sudovata sistema.

Nitric oxide (NO) exerts its vasodilatator effect in smooth muscle by activation of guanylyl cyclase. This in turn leads to decreases in intracellular calcium and dephosphorylation of myosin light chains and relaxation. NO is synthesised from L-arginine by a family of enzymes called Nitric oxide synthase (NOS). In the vascular system two isoenzymes of NOS are largely expressed: the constitutive NOS and the inducible NOS. The constitutive NOS identified in the endothelium generates NO continuously providing the vasodilatator tone and modulating platelet function. NOS type 1 is expressed in preoptic and infundibular nucleus of hypothalamus. NO acts as presynaptic agonist of glutamatergic NMDA-receptor mediation in the motor nucleus of nervus vagus. NO decreases the frequency of the spontaneous discharges in the carotid bodies. NO is involved in the processes of synaptic plasticity in the hippocampus.

[Our experience in the diagnosis and treatment of traumatic pneumothorax]. / Nashiiat opit v diagnostikata i lechenieto na travmatichniia pnevmotoraks.

The clinical material summarized is derived from the observation of 150 patients. The accent is put on the faults in the X-ray interpretation of the pneumothorax and on the mistaken tactics in the treatment of the pneumothorax, which led to four lethal cases. The attention is drawn to the importance of the prompt physical study of traumatic patients, which gives the opportunity for prompt diagnosis and urgent adequate treatment. The indications have been precised relating pleurocentesis, pleural drain and when lacking aerostasis for thoracotomy.

[The problems of severe combined chest and heart trauma]. / Problemi na tezhkata grudna i surdechna suchetana travma.

On the basis of the experience and the analysis of 3818 cases of combined chest traumas the injuries in different anatomical areas have been observed. A special place was given for the diagnostics, the variety of the clinical conditions, the treatment and the prognosis of the reasons for lethality in cases with such traumas. With the increase of the affected anatomical areas the lethality increases proportionally too. At double, triple, fourfold, fivefold and sixfold combinations we have respectively 6.35 to 100% lethality. The indications for early surgical treatment have been stated. The acute respiratory failure (decompensation) and the shock in the combined traumas have been discusses as well.

[The diagnostic and treatment problems in closed diaphragmatic trauma]. / Diagnostichni i lecheni problemi pri zakriti travmi na diafragmata.

Twenty four patients with blunt trauma of the diaphragm comprise the study group. Four of them died of accompanying injuries in other anatomical regions. All patients had the left leaf of the diaphragm affected. Laceration was most frequently radial in the area of centrum tendineum or in the transition area to pars muscularis. In left-sided ruptures of the diaphragm protruded usually the stomach, left colon, spleen, omentum majus and seldomer small intestines. The clinical picture was multiform and depended mostly on the severity of the accompanying injuries and on the basic complications in ruptured diaphragm--incarceration and strangulation of the protruded abdominal organs. When rupture of the diaphragm is diagnosed operative treatment is as a rule mandatory. The surgical approach to left-sided ruptures of the diaphragm is the abdominal approach, because of the more frequent injury to the abdominal organs.