EVOLUTION OF THE IEC AND EN STANDARDS FOR INDIVIDUAL MONITORING OF IONISING RADIATION.

This article presents the evolution of the International Electrotechnical Commission (IEC) and the European standards for individual monitoring of ionising radiation issued, respectively, from the committees IEC/Sub Committee 45B and European Committee for Electro-technical Standardization/Technical Committee 45B 'Radiation protection instrumentation'. Standards for passive individual photon and beta dosimetry systems as well as those for active individual monitors are discussed. A neutron ambient dose equivalent (rate) meter standard and a technical report concerning the determination of uncertainty in measurement are also covered.

Video-assisted thyroid resections in the treatment of papillary thyroid carcinoma.

UNLABELLED: One of the challenges of the minimally invasive video-assisted thyroid resections is their application for the surgical treatment of papillary thyroid carcinoma. AIM: To present our experience with the use of video-assisted thyroid resections with harmonic scalpel in the surgical treatment of patients with papillary thyroid carcinoma. MATERIAL AND METHODS: 259 patients with thyroid nodules were operated in our Clinic for a five-year period--from 2008 to 2013--via a video-assisted technique. Thyroid carcinoma was found in 53 patients (46 female patients and seven male patients, aged 18 to 52 years). The patients were selected according to the established criteria, developed and adopted in our Clinic. The resection was performed using endoscopic harmonic scalpel (Ultracision CS-14C; produced by Ethicon Endo-Surgery Care). The surgical incision length, extent of surgery, duration of operative time, type and incidence of complications (intraoperative and postoperative), period of hospital stay, and safety and radicality of the surgical procedure were examined. RESULTS: The length of the surgical incision was from 1.5 to 2.5 cm in all operated patients. The tumor size varied from 0.5 to 2.0 cm. Papillary carcinoma was found in 42 patients and follicular variant of papillary thyroid carcinoma--in eleven patients. Minimally invasive video-assisted thyroidectomy (MIVAT), using harmonic scalpel and 5 mm optics, was performed in 42 patients and video-assisted lobectomy with near-total resection of the contralateral lobe was performed in the remaining eleven patients. Lymph node micrometastases in the central cervical compartment were found in four patients. Draining of thyroid gland bed was performed in three patients. Transient hypocalcemia was found in one patient. All patients were discharged within the first 24 postoperative hours. CONCLUSION: Our results confirm that, if the criteria for selection of patients are followed, the video-assisted thyroid resections with harmonic scalpel have a place in the surgical treatment of selected patients with papillary thyroid carcinoma.

Hormones of hypothalamic-pituitary-thyroid axis are significant regulators of synthesis and secretion of vitamin K-dependent plasma coagulation factors.

Present data about hormonal regulation of haemostasis are often contradictory and are mostly based on clinical observations. The aim of the current research is to study the effects of the hormones of hypothalamic-pituitary-thyroid (HPT) axis on plasma levels (i.e. on the synthesis and secretion) of vitamin K-dependent coagulation factors in rats. The study was carried out on 65 male Wistar rats, divided into five groups. The animals were injected subcutaneously (s.c.) once daily for three consecutive days as follows: the first group was injected with Thyrotropin releasing hormone (TRH), in a dose of 0.06 mg/kg b.w.; the second group by Thyroid stimulating hormone (TSH), with a dose of 1 MU/kg b.w., the third and the fourth group respectively with Liothyroninum (Triiodothyronin ? T3) and Levothyroxinum (Thyroxin ? T4) with a dose of 0.08 mg/kg b.w. each. The control group rats were injected with saline (the solvent of the hormones), following the same schedule and volume per kg b.w. The necessary quantity of blood was acquired by a cardiac puncture under ether narcosis, and antigen levels of plasma factors II, VII, IX and X (FII:Ag, FVII:Ag, FIX:Ag and FX:Ag) were determined by ELISA kits (Diagnostica Stago, France). TRH, TSH, T3 and T4 significantly decreased the plasma antigen levels of FII and FVII (p<0.001). TRH, T3 and TSH reduced significantly FIX:Ag level( p<0.001 for TRH and T3 and p<0.05 for TSH) while T4 did not exert significant changes ( p>0.05). FX:Ag level was also significantly reduced by TRH, T3 (p<0.001), TSH and T4 (p<0.01). Plasma levels of vitamin K-dependent coagulation factors FІІ:Ag, FVІІ:Ag, FІХ:Ag and FХ:Ag are significantly reduced under the influence of the hormones of hypothalamic-pituitary-thyroid axis which signifies their decreased synthesis and secretion. T4 does not induce substantial changes in FIX:Ag plasma level.

[Minimally invasive open access thyoid surgery--main point, indications and effectiveness].

UNLABELLED: Various new, minimally invasive techniques, using endoscopic, video-assisted and non-endoscopic, open access have recently appeared in the surgical treatment of nodular thyroid disease. Aim of this study is to examine the feasibility, indications and efficacy of the minimally invasive open approach (MOATS) in the thyroid surgery. PATIENTS AND METHODS: 395 patients (368 (93.2%) females and 27 (6.8%) males, age 17 to 65 years with size of the dominant thyroid nodule less than 3.5 cm have been operated on in our institution over a four years period, using minimally invasive open access thyroid surgery. Preoperative ultrasound examination of the thyroid gland was performed in all patients and FNAB--in 121 (30.6%) of the cases. Central cervical access has been used in all patients. The surgical incision size has been measured in the beginning and at the end of the procedure, on the fourth day and when the sutures have been removed. RESULTS: Partial thyroid resection of one or both thyroid lobes has been performed in 59, respectively in 17 patients; subtotal lobar resection in 106 patients; lobectomy--in 111 patients; lobectomy with partial or subtotal resection of the opposite lobe--in 34, respectively 15 patients; subtotal bilateral thyroid resection--in 25 patients and thyroidectomy in 28 patients. Pathological examination revealed nodular goiter in 168 patients (solitary variant in 99 and multinodular--in 69 patients); toxic nodular goiter--in 13 patients; follicular adenoma--in 175 patients; Hashimoto thyroiditis--in 11 and thyroid carcinoma--in 28 patients. Main peri- and postoperative parameters have been compared with those of a group of patients (well matched by sex, age, nodule size and pathological findings) in witch conventional approach has been used. Minimal collar incision and scar, possibility to apply any extent of surgery witch may be necessary, comparable operative time with the conventional method and good cosmetic results are the undoubtedly good advantages of the technique. CONCLUSIONS: Our experience demonstrates that the minimally invasive open access in the thyroid surgery is a simple, safe and effective surgical technique, with very satisfactory cosmetic results in properly selected patients with small to middle-size thyroid nodules. The technique combines the advantages of an endoscopic resection with those of the conventional, classic technique.

[The importance of the presence of antisperm antibodies in serum and ejaculate of men with infertility].

UNLABELLED: There are multiple insults to the male genital tract that have been associated with an increased risk of antisperm antibodies (ASA) formation. The presence of ASA has been regarded as typical and specific for the immunological infertility. It has been suggested that the presence of agglutinated spermatozoa is suggestive of the existence of an immunological cause of infertility such as the existence of ASA. AIM: The objective of this study was to determine the clinical significance of serum and seminal plasma ASA as well as whether varying degrees of sperm agglutination can be a predictive indicator of positive serum and/or seminal plasma ASA. PATIENTS AND METHODS: 100 infertile and 30 fertile men were tested for ASA in seminal plasma and serum. The evaluation of patients included complete history, physical examination, scrotal ultrasound and semen analysis. ASA in serum and seminal plasma were tested by ELISA (Biosource, Belgium) and results were compared with the data of the semen analysis. RESULTS: 44 (44%) of the patients tested positive for ASA in seminal plasma, 9 of them had positive serum ASA. In the control group, seminal plasma ASA were not detected and two men (6.7%) tested positive for serum ASA. Correlation was established between seminal plasma ASA and two of the semen analysis markers: agglutination and increased viscosity. CONCLUSION: ASA in seminal plasma are much more predictive than ASA in serum and have major role in the pathogenesis and diagnostics of male infertility.

Effects of the hormones of the thyroid axis on the vitamin K-dependent plasma factors of blood coagulation (II, VII, IX, and X).

The hormonal regulation of haemostasis is a problem which has not received much attention. The data concerning the influence of hormones from the hypothalamic-pituitary-thyroid axis are scarce, contradictory and based mainly on clinical observations. The objective of the current research is to study the influence of the Thyrotropin releasing hormone (TRH), Thyroid stimulating hormone (TSH), Triiodothyronine (T3) and Thyroxin (T4) on the activity level of the vitamin K-dependent plasma factors of blood coagulation--factor II (F II), factor VII (F VII), factor IX (F IX) and factor X (F X). This study was carried out on 40 male Wistar rats. The necessary quantity of blood was obtained by cardiac puncture under ether narcosis. The indicators studied were activated partial thromboplastin time (aPTT), protothrombin time (PT), F II, F VII, F IX and F X, and were determined by means of Diagnostica Stago tests and with the help of an automatic coagulometer. The hormones studied were: TRH (0.06 mg/kg b.w.), TSH (1 MU/kg b.w.), T3 (0.08 mg/kg b.w.) T4 (0.08 mg/kg b.w.) prolonged aPTT (p<0.001) and PT (p<0.001). TRH and T3 significantly reduced the activity level of factors II, VII, IX and X; T4 only reduced the level of F II (p<0.05), and TSH did not induce significant changes in the haemocoagulation factors studied. The TRH, TSH, T3 and T4 hormones, although elements of one and the same axis, have an ambiguous effect on the vitamin K-dependent factors of blood coagulation. The results obtained show that the determined changes in the activity levels of the vitamin K-dependent plasma factors of blood coagulation are undoubtedly related to the hypocoagulation observed in the intrinsic and extrinsic pathways under the influence of the hormones of the thyroid axis.

[Minimally invasive open thyroid resections with harmonic scalpel].

UNLABELLED: The harmonic scalpel has been widely used in the field of thyroid surgery in recent years. AIM: To present our initial results after the introduction of harmonic scalpel use during thyroid resections with minimally invasive open approach. PATIENTS AND METHODS: For the period from 01 January to 31 June 2008, 158 thyroid resections using harmonic scalpel have been done in our institution. In 73 of these procedures minimally invasive open approach has been used (69 females and 4 males, at the age of 18 to 54 years, mean age 34.3 years). Patients have been directed to the group with minimally invasive open approach on the ground of inclusion criteria and indications for minimally invasive surgery adopted in our institution. The size of the dominant nodule in multinodular goiters was less than 3.5 cm. In 38 (52%) patients with suspicious malignancy FNAB has been performed. In all procedures a central neck operative approach has been used with length of the incision between 2 and 3 cm (measured in the beginning and at the end of the procedure as well as on the 4th postoperative day). Thyroid resections have been performed using harmonic scalpel (Ethicon Inc.). The extent of thyroid resection, the amount of hemostatic instruments and ligatures, the number of drainages used during the procedures, as well as operative time and incidence of intra- and postoperative complications have been examined. RESULTS: In 8 patients subtotal unilateral thyroid resections have been performed, 42 patients underwent lobectomy, 5 patients--subtotal bilateral thyroid resection and 18 patients--thyroidectomy. The extent of surgery was: isthmusectomy with unilateral partial thyroid resection in 11 patients, isthmusectomy with bilateral partial thyroid resection in 8 patients, isthmusectomy with subtotal unilateral thyroid resection in 29 patients, lobectomy in 24 patients, subtotal bilateral thyroid resection in 17 patients and thyroidectomy in 18 patients. No hemostatic instruments for catching thyroid tissue and vessels, nor following suture ligatures have been used. Incision length reduction, absence of bleeding and shortened operative time have been observed. The reliable and steady hemostasis made the use of hemostatic instruments and stitches unnecessary. Regardless of the extent of surgery, the resections finished without draining. CONCLUSIONS: We have found the harmonic scalpel to be extremely effective device, giving possibility for widespread of minimally invasive thyroid resections with open approach.

[Poland syndrome--clinical study].

UNLABELLED: Poland's Syndrome is a rare congenital abnormality involving functional and aesthetic impairments. Constitutive mark of the condition: partial or total absence of the pectoralis major and minor muscles, symmetric chest wall deformity, brachydactyly/syndactyly. This syndrome is occasionally associated with either unilateral or bilateral hypoplasia of breast. AIM: We present a case of a patient with Poland's Syndrome. This association has not been previously reported in the medical literature. Difficulties by preoperative diagnosis. The purpose of this article--to propose a classification system for the treatment of this anomaly requiring defining the age of the patients for plastic surgery on the chest. METHODS AND MATERIALS: A 16-year-old female with Poland's Syndrome complained of drastic mood changes consisting of depression and anxiety, regular menses, dysmenorrhea and hypomastia. Two reconstructive surgeries at the age of 12 years--surgical corrections of the sternal malformation. RESULTS AND CONCLUSION: This work shall describe Poland's Syndrome from a clinical, diagnostic, genetic and therapeutic point of view. The Italian Association for Poland Syndrome founded in October 2003 and two nationwide scientific conferences dealt with the position of scientific research and future prospects with regards to Poland Syndrome. Patients are subject to multi-specialist (surgical, gynecological, genetic, psychological, orthopaedic and plastic surgical) checkups, aiming at an accurate genetic and clinical organisation of a therapeutic programme.

Screening study of the effects of the hypothalamic-pituitary-thyroid axis on hemostasis in rats.

The hormonal regulation of hemostasis has had little attention in research, and the existing literature data are relatively contradictory. The possible effects of the hormones of the hypothalamic-pituitary-thyroid axis on hemocoagulation and the fibrinolytic system are studied here. The study was conducted on 80 white male rats of the Wistar breed. The necessary blood quantity was obtained by cardiac puncture realized under ether narcosis. The basic parameters of the hemocoagulation and fibrinolytic activity of the plasma were determined by Diagnostica Stago tests (France), using an automatic coagulometer (Italy). The hormones employed in the study: Thyreotropin releasing hormone (0.06 mg/kg bw), Thyroid stimulating hormone (1 MU/kg bw), Triiodothyronine (0.08 mg/kg bw), and Thyroxin (0.08 mg/kg bw) applied s.c. for three consecutive days, extended the activated partial thromboplastine time (p less than 0.001), proto-thromboplastine time (p less than 0.001), thrombin time (p less than 0.001), reptilase time (p less than 0.001), and shortened the euglobin clot lysis time of (p less than 0.001). These data indicate that each of the hormones used causes significant changes in hemostasis by suppressing the coagulability by the intrinsic and extrinsic system pathways, and transformation of fibrinogen into fibrin. The shortened euglobim clot lysis time may be recognized as a manifestation of increased levels of plasma plasminogen activators. The results obtained show that hypothalamic-pituitary-thyroid hormones are significant regulators of hemostasis, since they cause an expressed hypocoagulation and increase plasma fibrinolytic activity.

[Sentinel lymph node biopsy in patients with papillary thyroid carcinoma].

UNLABELLED: The concept of sentinel lymph node (SLN) has been proven to be successful and accurate in surgical decision making for the treatment of some solid tumors. The AIM of this study is to investigate the feasibility and accuracy of the SLN biopsy in patients with papillary thyroid carcinoma. PATIENTS AND METHODS: Twenty eight patients underwent SLN biopsy for the period from 01 January 2003 to 30 June 2006 in our institution.Twenty three of them were females and 5 males, at the age of 21 to 57 years. All patients have had a solitary thyroid nodule, 0.8 to 3.0 cm in size. Patients with any palpable or ultrasonografically detectable cervical LNs or history for previous neck surgery and/or radiation in the same region have been excluded from the study. Blue dye (Patent blue V) injection around or inside the thyroid nodule was utilized for the SLN detection followed by SLN biopsy. RESULTS: SLN have been detected and obtained in all 22 patients with papillary thyroid carcinoma. One SLN in the central compartment was found in 19 (40,9%) patients and one in lateral compartment in 3 (13,6%) patients. In 2 (9,1%) patients one SLN was found in both, central and lateral compartments. Metastasis in SLN was found in 9 (40,9%) patients. SLN in last 13 (59,1%) patients were negative for metastases. From patients with metastasis-positive SLN, metastasis in a next regional lymph node was found in 3 (13,6%) patients. In the remaining 6 cases next lymph nodes in both compartments were metastasis-negative. Metastatic disease in regional lymph nodes was not found in anyone from the patients with metastasis-negative SLN. CONCLUSIONS: Sentinel lymph node biopsy provides reliable information about the pathomorphological lymph node status in patients with papillary thyroid carcinoma, thus making possible to avoid unnecessary neck dissections and to minimize the risk from local surgical complications and disease recurrencies. The initial results with SLN biopsy give us a reason to accept this technique as a feasible, accurate and safe option in the surgical treatment of papillary thyroid carcinoma.

[Minimally invasive non-endoscopic thyroid resections].

UNLABELLED: The interest in the application of the minimally invasive procedures in the thyroid surgery vastly increased in recent years. AIM: To present our experience with the application of minimally invasive nonendoscopic resections in the thyroid surgery. MATERIAL AND METHODS: 145 patients with various thyroid diseases were operated on with minimally invasive open approach for the period from 1 Janyary 2003 to 30 June 2004 in our institution. Nodular thyroid pathology has dominated. All patients were females, mean age 28.5 years. An preoperative ultrasonographic assessment of thyroid volume, nodular count, size and localization was performed in all cases. The mean thyroid lobe volume was 11.2 ml the size of the removed thyroid nodules was 9 to 33mm (21 +/- 12 mm). The incision length was measured at the beginning, at the end and one week after the operation. RESULTS: The extent of thyroid resection was as follows: partial thyroid resection of a lobe in 28 patients; bilateral partial thyroid resection in 16 patients; subtotal lobectomy in 35 patients; lobectomy in 50 patients; lobectomy with partial thyroid resection of the other lobe in 8 patients; subtotal thyroidectomy in 5 patients; thyroidectomy in 3 patients. The incision length at the end of operation was 3.0 +/- 0.5 cm. Mean operative time was 41.5 +/- 8.4 min. The postoperative hospital stay was 24 +/- 6 hours. Postoperative complications were not observed, except a little haematoma in one case at the beginning of the study, that did not required any additional intervention. The early and late postoperative cosmetic results we have observed, were undoubtedly better. CONCLUSION: Our experience demonstrates that miniinvasive nonendoscopic thyroid resections represent a simple, safe and feasible surgical procedure in selected patients with small to middle-size thyroid nodules.

[Argon plasma thyroid resections--main points and advantages].

UNLABELLED: Here in we present our experience with a new surgical technique of Argon Plasma Thyroid Resections which was developed in our institution to avoid the use of lots of haemostatic instruments and various size blood vessels ligations. AIM: To demonstrate the results we achieved and the advantages of APR, compared with the conventional thyroid resection. MATERIAL AND METHODS: For the period from 01. Feb. 2003 to 31. May 2004 85 patients underwent argonplasma resection (APR) of the thyroid gland in our institution. All patients were females, mean age 38, 5 years. Preoperative ultrasound examination of the thyroid has been performed in all patients for more precise determination of both thyroid lobes volume and echoic pattern of the thyroid gland. FNAB has been performed in 37 (43.5%) patients with suspicious malignancy. The distribution of patients according to the nature of the thyroid disease was as follows: 12 patients with Grave's disease, 7 patients with diffuse goiter, 20 patients with nodular goiter, 28 patients with thyroid adenoma, 14 patients with Hashimoto thyroiditis and 4 patients with thyroid cancer. The procedure has been made by means of an Argon Plasma Coagulation System (Berchtold GmbH). A power setting at 20 W has been used, with time of exposition at 15 seconds and gas-flow at 2 l/h. RESULTS: Twenty one isthmusectomies with partial resection of one lobe, thirty one isthmusectomies with subtotal resection of one lobe, nine isthmusectomies with partial resection of both lobes, six isthmusectomies with partial resection of one lobe and subtotal resection of the other lobe fourteen subtotal thyroidectomies and four thyroidectomies were performed. Lack of bleeding, smooth resection line, without need for haemostatic instruments and blood vessels ligation, minimal injury on the remaining thyroid tissue as well as shortening of the operative time have been observed. CONCLUSIONS: The experience we've gained delineates the newly developed technique of APR as a safe and promissing technique in the surgical treatment of selected patients with indications for thyroid sugery.

[Hashimoto's thyroiditis: indications for surgical treatment].

BACKGROUND: Hashimoto's thyroiditis (HT) is the prototypical example of autoimmune thyroiditis and the primary way to treat the disease is conservative. However, there are patients with HT, in which surgical treatment is mandatory. AIM: Summarizing our institutional experience, to formulate the indications for surgical treatment of Hashimoto's thyroiditis. MATERIALS AND METHODS: 132 patients (131 females and 1 man, mean age 45 years) underwent surgery for HT in the period from 1.01.1987-1.01.2004. Serum thyroid hormone levels, autoimmune and ultrasonographic findings and FNA biopsy confirmed the diagnosis of HT in 115 (87.1%) patients. In the remaining 17 (12.9%) cases, the diagnosis was based on the intraoperative findings as well as on the histological results. From 1987 to 2002 year 110 patients with HT underwent surgery and for the period 01.01.2003 to 01.01.2004 - 22 (54.6%) patients 10 (45.4%) underwent conventional thyroid resection and 12 (54.6%)--argon plasma resection (APR/introduced in our practice since 2003). The indications for surgery were: thyromegaly with compression symptoms, non-responding to L-thyroxin treatment; nodular form of HT with dominant thyroid nodul over 2 cm in size; suspicion for neoplasm or an unsightly neck appearance due to a large goiter. RESULTS: 17(12.9%) patients with diffuse form of HT were surgically treated. Isthmectomy with bilateral medial partial thyroid resection was performed (in 14 cases by conventional method and in 3 by APR). In 81 (61.4%) patients with nodular form of HT isthmectomy with bilobar or unilobar partial or near total thyroid resections were performed (74 conventional resections and 7 APRs). Seven (5.5%) patients have had pseudonodules. In 6 from these cases conventional isthmectomy was performed and in 1 isthmectomy by APR. Coexistent HT with thyroid carcinoma was diagnosed in 27 (20.4%) patients. All underwent thyroidectomy (1 by APR). CONCLUSIONS: Surgery has it's place and efficacy in the treatment of selected patients with Hashimoto's thyroiditis and compression symptoms or nodular forms with dominant nodules over 2 cm, suspicion for neoplasm or an unsightly neck appearance due to a large goiter. Argon plasma resection (APR) is a new, safe and promising technique of thyroid resection, particularly appropriate for patients with Hashimoto's thyroiditis.

[Minimally invasive open thiroydectomy--our initial experience].

UNLABELLED: A crescent number of reports concerning the use of minimally invasive approach in thyroid surgery arise in the last years. AIM: This report describes the recently developed technique of minimally invasive open thyroidectomy and represents our initial experience. PATIENTS AND METHODS: Thirty seven patients underwent a minimally invasive open thyroidectomy in the Clinic of Thoracic Surgery, Medical University of Varna between February the 1th and May the 31th, 2003. Nodular thyroid diseases were the dominant cause. All patients were females. In all cases a preoperative ultrasonography was made to evaluate the volume of each thyroid lobe, as well as the number, size and location of the thyroid nodules. RESULTS: The length of the skin incision varied from 2 to 3,5 cm. Operative time was at 45,4 +/- 10,3 min. Postoperative hospital stay was at 24 +/- 8 hours. There were not any postoperative complications. The extent of thyroid resections was as follows: partial lobe resection in 6 patients; lobectomy in 16 patients; lobectomy and partial counter lateral lobe resection in 4 patients; lobectomy with subtotal thyroidectomy of the other lobe in 2 patients and thyroidectomy in 1 patient. The cosmetic results we have observed were undoubtedly better. CONCLUSIONS: Although initial, our experience shows that minimally invasive open thyroidectomy provides surgeons with an adequate operative field, and that it has proven to be simple, safe, quick and practical for selected patients with small to middle sized thyroid nodules.

[Administration of Perfalgan (paracetamol) for postoperative analgesia in obstetrics and gynaecology].

The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects.

[The application of argon plasma coagulation in thoracic surgery: principles, surgical technique and clinical results]. / Prilozhenie na argon-plazmena koagulatsiia v grudnata khirurgiia--printsipi, operativna tekhnima, klinichni rezultati.

BACKGROUND: In recent years, together with the well-known high-frequency electro-coagulation, the application of plasma coagulation has been also introduced in the clinical practice. The argon plasma coagulator (APC) is one of the representatives of this surgical technique. By its nature, the APC represents a non-contact electrothermal tissue coagulation, combining the principle of the augmented surface and enhanced autogenous haemostatic mechanisms. AIM: The main objective of this study was to evaluate whether APC is an effective and safe modality in the open pulmonary surgery. MATERIALS AND METHODS: For the period from 01.01.2003 to 30.01.2004 year, in the Clinic of Thoracic Surgery, we have applied the technique of APC to 15 patients. The distribution by sex was: 10 males and 5 females. According to the nosological units, the distribution was as follows: pulmonary carcinoma in 3, pulmonary echinococcosis in 4, pleural empyema in 6, pulmonary abscessus in 1 and esophageal ahalasia in 1 patient. In our practice, we have used an argon plasma coagulator of BERCHTOLD GmbH. A power setting of 20W with exposition time 15 s and an argon gas flow setting of 1,5-2 1/h have been used in our series. Energy dose applied in our patients didn't exceed 300 J/cm2. RESULTS: The results we have obtained demonstrate the following fundamental advantages of APC: a possibility to work with long electrode--tissue distance; a possibility for large surface coagulation as well as coagulation under variable angle, limited and well controlled depth of penetration, substantial reduction of carbonization; regular distribution of the energy over the whole coagulating surface, a possibility to treat effectively larger bleeding surfaces. CONCLUSIONS: Although initial, our experience gives us the confidence to recommend the use of APC as an effective and safe procedure in the pulmonary surgery.

[Acute necrotizing pancreatitis--diagnostic and treatment strategy]. / Ostur nekrotichen pankreatit--diagnostichna i terapevtichna strategiia.

Despite of the current achievements of medicine, the mortality of necrotizing pancreatitis (NP) is still too high--up to 35-40% and stands as a serious diagnostic and treatment problem. The results of treatment of 148 patients, admitted in the clinic with diagnosis NP, 95 males and 53 females, are discussed. The ratio between patients with acute oedematic and acute NP is 81.1% to 18.9%. According to the hystopatology findings, the results are as follows: pancreatic necrosis--128 patients, peripancreatic necrosis--42 patients, retropancreatic necrosis--29 patients, phlegmonous cholecystitis--31 patients. For the exact diagnostic estimation of the development and prognosis of NP, we are based on: Clinic symptomatology, biochemical constellations (the prognostic scale of Ranson), ultrasonography, CT, ERCP, ES, laparoscopy (48 pts), and laparoscopic drainage (34 pts) of the abdominal cavity with one or two drains, in order to decrease the intoxication and manage intraperitoneal irrigation with antibiotics and enzymes. The operative intervations consists of a thorough exploration, broad necrectomy combined with lavage and large drainage. COLD (controlled open lesser sac drainage) has been performed at 34 cases. In 31 pts cholecystectomy and choledochotomy with T-tube drainage of d. choledochus (Kehr drainage) was performed. Reoperations have been made at 34 pts (22.9%); in 11 of them--2 operative revisions have been carried out, in 3 cases--three, and in 3 cases--4 operative revisions were performed. The total postoperative death rate was 21.6% (32 patients). The most common postoperative complications were as follows: pulmonary complications at 11 cases, pleural effusions--9 pts, intraabdominal abscesses--6 patients, postnecrotic pseudocysts--9 cases, pancreatic fistulas--6 cases, fistulas of the colon--2 pts, bleeding--4 patients.

[Consciousness during anesthesia for cesarean section]. / Nalichie na suznanie po vreme na anesteziia pri tsezarevo sechenie.

47 women on which sectio cesarean has been done in occasion of belvic-fetal disproportion, anatomical abnormalities of the pelvis, bad position of presentation. We studies presence of consciousnes spontaneous realtion to pain and possibility for contact according the method of Tunstall M.E. It was proved that the use of benzodiazepin derivate--Dormicum impacts substantially influensences of the studied processes. Introduction anaesthetics (thiopental-kalipsol, dormicum-kalipsol and thiopental and helothan in 0.3%) are reliable protection against the operative stress during sectio cesarean and give adequate anaesthesia until baby is born.