NADPH-diaphorase-positive neurons in the human inferior colliculus: morphology, distribution and clinical implications.

Using the nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) reaction with nitroblue tetrazolium, we provided a detailed investigation of the distribution, dimensional characteristics and morphology of NADPH-d-positive neurons in the three main subdivisions of the human inferior colliculus (IC): central nucleus, pericentral nucleus, and external nucleus. In accordance with their perikaryal diameter, dendritic and axonal morphology, these neurons were categorized as large (averaging up to 45 µm in diameter), medium (20-30 µm), small (13-16 µm) and very small (7-10 µm). Their morphological differences could contribute to varying functionality and processing capacity. Our results support the hypothesis that large and medium NADPH-d-positive cells represent projection neurons, while the small cells correspond to interneurons. Heretofore, the very small NADPH-d-positive neurons have not been described in any species. Their functions-and if they are, indeed, the smallest neurons in the IC of humans-remain to be clarified. Owing to their location, we posit that they are interneurons that connect the large NADPH-d-positive neurons and thereby serve as an anatomical substrate for information exchange and processing before feeding forward to higher brain centers. Our results also suggest that the broad distribution of nitric oxide (NO) synthesis in the human IC is closely tied to the neuromodulatory action of NO on collicular neurotransmitters such as GABA and glutamate, and to calcium-binding proteins such as parvalbumin. A deeper understanding of the relationship between NADPH-d-positive fibers in all IC connections and their co-localization with other neurotransmitters and calcium-binding proteins will assist in better defining the function of NO in the context of its interplay with the cerebral cortex, the sequelae of the aging process and neurodegenerative disorders.

[CONGENITAL UNILATERAL HYDROTHORAX--A CASE REPORT].

A case of isolated unilateral congenital hydrothorax with unknown etiology, graduated abortion for medical reasons in 23 weeks. The patient was later covered by antenatal care and during the examination one foetus with the massive right-sided hydrothorax was found, (diagnosed by ultrasonography and NMR) The incidence of congenital fetal hydrothorax is estimated at approximately 1 in 15,000 pregnancies. Early ultrasound diagnosis is of paramount importance for the adequate monitoring of the pregnancy and timely proof of deviation in normal fetal development.

[A FETUS FROM VARNA WITH A CYSTIC HYGROMA OF THE NECK].

UNLABELLED: The cystic hygroma of the neck in fetuses is a congenital anomaly, usually detected by ultrasound during the prenatal morphological study. It is a rare anomaly that is diagnosed relatively easy by an examination of the nuchal fold. The frequency of the cystic hygroma in the world is approximately 1/6000 live births, but there is no data for diagnosed cases in Bulgaria. The purpose of this work is to present a case of cystic hygroma of the neck in a fetus from Varna, Bulgaria. The method used is an autopsy. The fetus is female, weighing 250g, the result of a spontaneous abortion during the 19th gestational week. RESULTS: The autopsy found a cystic bilocular hygroma of the neck and a unilateral ptosis of the kidney CONCLUSION: The cystic hygroma of the neck can be isolated, but it is often associated with trisomy 21 or with other malformation syndromes, which confirms the importance of morphological examinations of the neck during the prenatal ultrasound.

[Foetus from Varna with thanatophoric nanism type 2].

UNLABELLED: The first Bulgarian case of Thanatophoric nansim of foetus is presented, which is diagnosed by foetopathological autopsy, histological and postnatal X-ray examination. MATERIALS AND METHODS: The foetus is a result of a still-birth. X-ray examination, autopsy of the foetus and microscopic examination were performed. RESULTS: A female foetus, 28 gestation week, with micromelia, relative macrocrania with configuration "three leaved clover" type, shortened median cranial fossa, hypertrophy of temporal lobes of hemispheres with radial convolutions. Hypoplasia of the lungs. X-ray examination: Platispondylia, rectilinear femoral diaphysis, pelvis--square, lowered arches of acetabulums with lateral processes. CONCLUSIONS: The present examination establishes the importance of the application of foetopathological autopsy as a routine method in all spontaneous abortions and still-births in view of control of hypo- and achondrodysplasias.

[Our and foreign experience in diagnosis and treatment of preeclampsia].

AIM: Our aim was to evaluate our experience in diagnosis and treatment of preeclampsia in the clinic of Pathological pregnancy--Varna Medical University. We compared our results with the results of prominent western clinics. MATERIAL AND METHODS: We evaluated 140 patients with preeclampsia for the period of 2010 to 2013. A special file was fulfilled. It included: age, parity, gestational age, value of arterial blood pressure, urea, creatinine, common protein in blood, duration of treatment, oedema, urine protein. RESULTS: The mean age of the patients was 30 years. The urea and creatinine were normal. The mean hospital stay was 5,71 days. The blood protein was 61 g/l, only 4.17% of the patients were with protein lower than 58 g/l. In 87.5% of the patients the systolic blood pressure was between 135 and 160 mmHg, in 12.5% the systolic blood pressure was over 160mm Hg. In 58.34% there was a proteinuria. The mean gestational age was 33 gestational weeks. The delivery was performed in the most suitable for the preeclampsia gestational age. CONCLUSIONS: According to our research work the patients with preeclampsia have a very high risk for cardio-vessel diseases and again of preeclampsia in their future pregnancies from 30%-40%. High prenatal care can prevent most of the complications connected with this disease.

[A rare case of pregnancy combined with a large ovarian tumour].

AIM: Our aim was to demonstrate the diagnostic difficulties as well as the atypical clinical development of ovarian tumours in combination with pregnancy. MATERIAL AND METHODS: We present a rare case of large mucinous cystadenoma in 32-year old patient, who is 20 gestational weeks pregnant. Ultrasound examination and MRI were performed, which visualized a huge multilocular ovarian tumour formation with a small amount of ascites. RESULTS: We performed laparatomy adnexectomy which included the ovarian cyst, partial omentectomy and we took 4 samples of smears from the whole abdominal cavity, as well as ascites samples for cytology. The pregnancy was preserved. The histological examinations reported: mucinous cystadenoma without morphological data for malignant transformation. CONCLUSIONS: In our rare case the organ preserving operation was a completely sufficient surgical staging procedure.

[Stepwise uterine devascularization in postpartum hemorrhages]. / Stupalovidna devaskularizatsiia na matkata pri postpartalnite khemoragii.

The authors reported the results from a retrospective investigation of 10121 deliveries for a three-year period (1981-1983) as well as from a prospective study of 6239 child-births during a three-year period after a 20-year-long time lag, i.e., in 2000-2002. The cases with early post-partum hemorrhages (EPH) and with accomplished laparotomy were examined. The causes for EPH, the obstetric therapeutic measures and manipulations prior to the laparotomy as well as the surgical interventions after opening the abdomen were considered. The authors emphasized that 20 years ago three uteri only could be "saved" by means of ligation of the uterine vessels. A hysterectomy was carried out in 21 cases with massive EPH after the laparotomy. After two decades the situation changed dramatically. The hysterectomies amounted to only 22.22% of the cases (n = 4) while in the rest females (n = 14) the copying of the massive hemorrhages was performed by means either of stepwise ligation of the uterine vessels, or of ligation of the hypogastric ones in 3 cases with additional vaginal lacerations. It was outlined that mother's mortality rate was zero during these two periods. The conclusion has been drawn that the ligation of the uterine vessels represents an alternative to the hysterectomy when copying the EPH and preserves the child-bearing functions of some females because of the subsequent vascular recanalization.

[Association between Mycoplasma genitalium and preterm labor]. / Vruzkata na mycoplasma genitalium s prezhdevremennite rozhdaniia.

M. genitalium was identified by using polymerase chain reaction (PCR). The samples were obtained from the posterior vaginal fornix between 21-25 gestation weeks and investigated for PH, Gram Stain for bacterial vaginosis; Chlamidia trachomartis; Neisseria gonorrhoeae; Trichomonas vaginalis. Of 102 pregnant women, only five had a PCR-positive for M. genitalium. The occurrence of M. genitalium in posterior vaginal fornix at midtrimester is infrequent in pregnant women and unlikely to be a contributing factor for spontaneous preterm birth.

The use of Methenamine as an antiperspirant for amputees.

The socket of a prosthesis is a tightly closed container. Sweating inside the socket is annoying and may also irritate the skin over the stump or lead to local infection such as folliculitis. The most effective method of preventing sweating is by the use of astringent agents. Formaldehyde is a very strong astringent but is not pleasant to use and may cause skin irritation and systemic reactions. Methenamine, in water or when applied to the skin, decomposes to generate formaldehyde in small quantities which do not cause side effects. Methenamine was used on the stump of sixteen amputees. The trial was conducted as a double blind study using two different solutions market as solution A and as solution B. The effectiveness of the solutions as an antiperspirant was evaluated clinically by the subjects and the physician. Solution A containing Methenamine, was found significantly effective, both by the subjects and physician when compared with the solution B the blank one. The use of Methenamine as an antiperspirant is recommended in amputation stumps.