[Prospects for a passive acoustic research method in otorhinolaryngology]. / Perspektivy passivnogo akusticheskogo metoda issledovaniya v otorinolaringologii.

The authors of the article reviewed acoustic research methods in otorhinolaryngology. All acoustic diagnostic methods are divided into active and passive. Active acoustic methods are based on the emission of acoustic vibrations, in some cases with the subsequent reception and processing of reflected vibrations. Passive acoustic research methods are based on the recording and analysis of sounds arising during the physiological functioning of the studied organs and systems. In otorhinolaryngology, active acoustic methods of studying the ENT organ are more widespread: audiometry, acoustic impedance measurement, ultrasound examination of hearing, auditory evoked potentials, sonotubometry, acoustic rhinometry, ultrasound examination of soft tissues of the neck and paranasal sinuses. Among passive acoustic research methods, the greatest development in clinical practice in otorhinolaryngology was obtained by computer acoustic analysis of the voice - an assessment of the phonatory function of the larynx. Using similar technologies, a technique for acoustic analysis of nasal breathing was developed - a functional assessment of the external nasal valve. Separate groups of authors have carried out an experimental study of the sounds that occur when the auditory tube is opened. Achievements in acoustics and the introduction of advanced technologies in medicine create prerequisites for improving existing and developing new methods of acoustic analysis of the work of ENT organs.

Holographic and e-Beam Image Recording in Ge5As37S58-Se Nanomultilayer Structures.

Processes of e-beam and holographic recording of surface relief structures using Ge5As37S58-Se multilayer nanostructures as registering media were studied in this paper. Optical properties of Ge5As37S58, Se layers, and Ge5As37S58-Se multilayer nanostructures were investigated. Spectral dependencies of refractive index were analyzed within the frames of single oscillator model. Values of optical band gaps for Ge5As37S58, Se layers, and Ge5As37S58-Se multilayer nanostructures were obtained from Tauc dependencies. Using e-beam and holographic recording, diffraction gratings were fabricated in Ge5As37S58-Se multilayer nanostructures. Images of Ukraine and Moldova state emblems were obtained by e-beam recording. Image size consisted of 512 × 512 pixels (size of 1 pixel was ~2 µm). Ge5As37S58-Se multilayer nanostructures are perspective for the direct recording of holographic diffraction gratings and other optical elements.

[OPEN LAPAROSCOPY--A MODIFIED HASSON TECHNIQUE].

The open technique was first described by Hasson in 1970. This technique consists of creating a small umbilical incision under direct visualization to enter the abdominal cavity followed by the introduction of a blunt trocar. Pneumoperitoneum is then rapidly created. Hasson proposed its potential benefits to be the avoidance of blind insertion of the Veress needle and bladed trocar, prevention of visceral and vascular injuries, preperitoneal insufflation and gas embolism, guaranteed pneumoperitoneum, and a more anatomical repair of the abdominal wall. Since that time, many surgeons have made some modifications to first Hasson technique. Here we described the way we do the open laparoscopy in our hospital and different positive and useful details we put to original Hasson version.

[The mechanical properties of the bone tissue from the middle facial region].

The objective of the present work was to study age-related features of the reaction of the maxillary sinus cavity walls to a variety of impacts associated with the surgical interventions. To this effect, a variety of stress-strain conditions were simulated that are known to arise in the maxillary sinus cavity walls under the action of different force vectors taking into consideration the age-specific peculiarities of the mechanical structure of the bone tissue. The 3D model of the maxillary sinus cavity was built up based on the results of spiral computed tomography with the use of the Solid Works 2012 software package (USA). The finite element method (FEM) was employed to construct the grid. Three variants of force application were simulated, one to the canine fossa region, another to the upper portion of the alveolar process at the border between the upper and lower walls of the sinus, and the third to the anterior part of the inferior nasal passage. The study has demonstrated that the bone wall of the maxillary sinus differently responds to the impacts of similar magnitude depending on the application point and age-related physical and mechanical properties of the bone tissue. This finding should be taken into account in the choice of the optimal surgical approach to the maxillary sinus. It was calculated that endonasal interventions should be preferred for the treatment of patients above 60 years of age as the minimally injurious ones to the bone tissue. Moreover, special caution is needed when the intervention is performed beneath the canine fossa, where the bone is extremely fragile and the risk of injury extension to the floor of the maxillary sinus is especially high.

[Variations of clinical and functional characteristics of nasal cavity mucosa in the patients of different age groups presenting with acute rhinosinusitis].

The objective of the present study was to evaluate changes in the functional properties of nasal cavity mucosa during the treatment of the patients of different age groups presenting with acute rhinosinusitis. The following methods were used for the purpose: daily measurement of pH, body temperature, pain sensitivity threshold in the intranasal mucous membrane, mucociliary transport (MCT) time; in addition, joulemetry was performed to examine the patients suffering from acute rhinosinusitis. The study has demonstrated marked differences in the functional conditions of nasal cavity mucosa associated with the treatment. The aged and elderly patients were characterized by lowered mucosal temperature at all stages of therapy, elevated pain sensitivity threshold, and long duration of the recovery of ciliary epithelium activity that reflected non-responsiveness inherent in the patients of this age group. The direct joulemetry technique made possible the most detailed evaluation of dynamics of these pathological changes in nasal cavity mucosa and its age-specific features. It is concluded that the clinical manifestations of acute rhinosinusitis are characterized by well apparent age-specific features that should be taken into consideration in diagnostics and treatment of this condition. The comprehensive evaluation of the parameters of the functional state of nasal cavity mucosa associated with this pathology allows the severity of inflammation and the effectiveness of its treatment to be estimated; moreover, it permits to correcte in due time the scope of the prescribed therapy.

[The combined application of thermography and local thermometry for diagnostics, prognostication, modeling, and evaluation of the effectiveness of the treatment of acute sinusitis].

The objective of the present work was to study the possibilities of the combined application of thermography and local thermometry for diagnostics of acute sinusitis, characteristic of dynamics of the clinical course of this pathology, and evaluation of the effectiveness of its treatment. The study included 23 patients presenting with acute rhinosinusitis and 21 ones free from pathology of paranasal sinuses. Contact thermometry was performed with the use of the electronic thermometer applied to the anterior surface of the inferior turbinated bone. An infrared thermovision camera was employed to carry out thermographic measurements. The study demonstrated variations in endonasal and surface temperature under effect of the treatment. Positive dynamics of the patients' conditions was manifested as a drop of endonasal temperature and relatively constant surface temperature. A rise in the surface temperature was associated with the pathological process. In the patients showing slightly positive dynamics of the disease, the surface temperature on the side of the pathological process was lower than on the unaffected side. This difference was interpreted as an indication of the reduced microcirculatory activity in this region. It was hypothesized that dynamics of the inflammatory process is to a large extent determined by the character of blood circulation in the affected region. The authors conclude that the combined application of thermometry and thermography not only improves the quality of diagnostics of acute rhinosinusitis but also facilitates the evaluation of its dynamics and the effectiveness of the treatment.

Liver transplantations in Bulgaria--initial experience.

The filed of liver transplantation (LT) continues to evolve and is highly effective therapy for many patients with acute and chronic liver failure resulting from a variety of causes. Improvement of perioperative care, surgical technique and immunosuppression in recent years has led to its transformation into a safe and routine procedure with steadily improving results. The aim of this paper is to present the initial experience of the transplant team at Military Medical Academy - Sofia, Bulgaria. For the period of April 2007 - August 2014 the team performed 38 liver transplants in 37 patients (one retransplantation). Patients were followed up prospectively and retrospectively. In 36 (95%) patients a graft from a cadaveric donor was used and in two cases--a right liver grafts from live donor. The mean MELD score of the transplanted patients was 17 (9-40). The preferred surgical technique was "piggyback" with preservation of inferior vena cava in 33 (86%) of the cases and classical technique in 3 (8%) patients. The overall complication rate was 48%. Early mortality rate was 13% (5 patients). The overall 1- and 5-year survival is 81% and 77% respectivelly. The setting of a new LT program is a complex process which requires the effort and effective colaboration of a wide range of speciacialists (hepatologists, surgeons, anesthesiologists, psychologists, therapists, coordinators, etc.) and institutions. The good results are function of a proper selection of the donors and the recipients. Living donation is an alternative in the shortage of cadaveric donors.

[Fatal course of virus-associated pneumonia in patient with influenza A(H1N1)].

In 2009 pandemic caused by high-path fluenza A(H1N1), so called "swine" flu was registered in the world. Aphylaxis to this type of influenza lead to pandemic. The authors gave an example of fatal course of influenza A(H1N1)S-OIV in young patient with severe VA-pneumonia, acute respiratory distress syndrome, disseminated intravascular coagulation with progressive respiratory distress secondary to an metabolic syndrome. It led to patient's death. Patient was refractory to all modern methods of intensive therapy in conditions of multifield specialized medical and preventive treatment facility.

Single centre experience with surgical treatment of hilar cholangiocarcinoma.

UNLABELLED: BACKGROUND /AIMS: Surgical resection is a radical treatment option for hilar cholangiocarcinomas. However it is still difficult to cure and patient prognosis is poor. An evaluation of the surgical options and results may elucidate effective treatments. METHODOLOGY: We retrospectively examined the demographic characteristics, surgical records and outcome in 64 patients with hilar cholangiocarcinoma undergoing surgical resections or palliative surgical procedures for the period of 2004-2012. RESULTS: The patients included 43 males and 17 females with a mean age of 61.4 ± 10.4 years (±SD, range 35-81 years). Forty four resections were done - R0-22 cases (34.4%), R1 - 10 (15.6 %) cases, R2 -12 cases (18.7%) and 20 palliative (31.3%) operations were performed. R0 - resection of common bile ducts with right hepatectomy with Sg 1 was done in 8 cases, resection of common hepatic duct with left hepatectomy with Sg 1 in 9 cases and resection of common hepatic duct in 5 cases. The total percentage of postoperative morbidity is 51.5 %. The types of complications are as follows: intra abdominal bleeding 31.25 %, temporary biliary leakage - 26.56 %, leakage of hepatico-jejunostomyâ7.81 %, biliary fistula 7.81%, liver insufficiency 17.18 %, pleural effusion 48.13 %, intraabdominal abscess 28.13 %, surgical site infection 48.3 %. The mean five-year overall survival for R0 - resection is 32%, for R1 - and R2 - resection is 12% and for the palliative operations - 0%. The mean overall survival for R0-resection is 37 months, for R1 - and R2 - resection is 19 months and for the palliative operations 7 months. CONCLUSIONS: Radically extended surgical resection for hilar cholangiocarcinoma is necessary to obtain improved patient survival.

Behavior of Transplanted Multipotent Cells after in Vitro Transplantation into the Damaged Retina.

The use of stem cell technologies in retinal defect reparation therapy has produced beneficial results. Nowadays, numerous protocols exist which provide a neural differentiation of the stem cells transplanted into the retina. However, questions concerning the functional replacement of the missing retinal neurons by transplanted cells thus far remain unanswered. The organotypic culture protocol was used in this study in order to prove the possibility of transdifferentiation of bone marrow stromal cells (MMSCs) and neural stem/progenitor cells (NSPCs) from EGFP-positive mice and the functional integration of these cells. This technique enables a detailed characterization of cell behavior post-transplantation. Using atomic force microscopy, we reliably demonstrated the difference (p < 0.01) between the thickness of the outgrowths formed by glial and endothelial retina cells and the thickness of neurites and neuro-like transplanted MMSC outgrowths. MMSCs are also shown to form synapses up to 2.5 ± 0.06 µm in diameter on day 4 after the transplantation. Following electrical stimulation (20V, 0.5Hz, 200ms), clear depolarization of retinal neurons and their outgrowths is detected. It is shown that some of these GFP+ MMSCs, which changed their morphology after the transplantation in retinal explants to neuro-like MMSCs, are capable of depolarizing after exogenous stimulation.

Cell technology employing femtosecond laser pulses.

Practical advantages of using femtosecond laser pulses for manipulations in cell surgery were demonstrated. The use of femtosecond laser pulses enables precision punching of the zona pellucida of the embryo without damaging its cells. With the help of femtosecond laser tweezers/scalpel, auxillary laser hatching was performed and a technique of optical biopsy of mammalian embryo was developed, which enabled non-contact sampling of embryonic material for preimplantation diagnostics. Our findings suggest that about 90% embryos retained the ability to develop at least to the blastula stage after this manipulation.

Identification of proteins overexpressed in papillary thyroid tumors.

A modified method of proteome comparative analysis based on preliminary removal of cell structural proteins by extraction using salt buffer and subsequent separation of extracts by two-dimensional gel electrophoresis was developed. Identification of differentially expressed proteins by mass spectrometry has revealed three proteins with noticeably increased level of synthesis in most samples of papillary thyroid tumors compared to normal tissues. An increase in ubiquitin content was found for the first time. Oncomarker search efficiencies by two-dimensional gel electrophoresis and bioinformatic search were compared.

[Efficacy of traditional therapy and chronotherapy using prestarium in elderly patients with polymorbid syndrome].

The aim of the work was to compare efficiency of traditional therapy with prestarium (tert-butylamine salt) and chronotherapy with prestarium A (arginine salt) in elderly patients with polymorbidity syndrome (diabetes mellitus, nephropathy, grade I-II chronic hepatic insufficiency). All patients underwent standard clinical and laboratory examination including measurement of glycemic profile, plasma urea, creatinine, K+ and Na+, AP monitoring, ECG, and echo-CG. The results suggest persistent hypotensive effect of prestarium and prestarium A within 4 days after the onset of therapy. However, in patients with a more severe disease, twice lower doses of prestarium A were needed to achieve positive effect and transform circadian AP rhythm from non-dipper to dipper pattern.

[Peculiarities of course of extramural pneumonia among military servicemen in conditions of local war and armed conflicts].

The aim of work was examination of peculiarities of outhospital pneumonia (OHP) among military servicemen, participants of local armed conflicts in areas of Prodnestrovie, Tadjikistan, North Ossetia, Abkhazia. There were retrospectively analyzed 139 archive patient histories of military servicemen, got pneumonia during 1990-1993. In structure of OHP of military servicemen predominating was pneumonia with not hard course of disease. Was educes a clear season dependence of appearance of pneumonia in described conditions with it's peculiarities. Each fifth patient form call-up contingent had deficit of weight. It influenced on course of disease. In 40% of cases of OHP there were coexistent diseases. Peculiarities in clinical forms of disease were not found. Using of antibacterial measures in treatment of OHP was empirical, during therapy of acute pneumonia were used 3 antibiotics simultaneously. For a more long-term of treatment had a need soldiers, participants of combat actions on the Northern Caucasus.

[Use of prestarium (perindopril) in patients with polymorbidity syndrome (AH, DM, nephropathy)].

The study included 20 patients aged 61-86 (mean 73.1 +/- 3.1) years with stage II hypertensive disease, type 2 diabetes and nephropathy with signs of grade I chronic renal insufficiency (CRI). The major parameters measured were AP, HR, laboratory characteristics of carbohydrate metabolism and renal function. Prestarium given at a dose of 4 mg BID had not only antihypertensive but also negative chronotropic effect, decreased energy consumption by myocardium, and normalized daily AP profile (24 hr AP monitoring). Adequate control of diabetes ensured close-to-normal carbohydrate metabolism. Prestarium therapy did not cause further aggravation of renal insufficiency in patients with grade I CRI, nor did it alter creatinine and urea levels.

[Present-day therapeutic policy in patients with chronic ischaemia of lower limbs: trans-Atlantic inter-society consensus].

The authors have reviewed the available literature dedicated to the development of the treatment policy for managing the patients presenting with lower limb ischaemia. Central to the work is the analysis of the latest guidelines on therapeutic policy to pursue in patients presenting with chronic ischemia of the lower extremities, namely the Trans-Atlantic Inter-Society Consensus Document. This is followed by a detailed discussion of the indications for surgical and endovascular operative interventions in various-type lesions of the aortofemoral and femoropopliteal segments. Summarized herein are the main trends and tendencies in the present-day strategy of managing the patient cohort concerned.

[The use of monopril in elderly patients with arterial hypertension and coronary heart disease].

We examined 20 patients (mean age 69.4 yr) with stage II AH and CHD. 13 ones suffered CHD with stable FC II and III angina, two others had myocardial infarction. The patients were given monopril, 10 mg BID (08.00 & 20.00). Those with CHD were additionally treated with cardiket (20 mg BID) or monocinque (20 mg BID). If appropriate, hypothiazide or triampur compositum (25 mg each) was given in the morning. Usual clinical examination was supplemented by dynamic studies and evaluation of clinical symptoms on day 21 after therapy including systolic and diastolic AP, pulse and mean dynamic AD, double product, heart rate, ECG, echoCG, AP and ACG monitoring. The above treatment produced marked antihypertensive and antianginal effects in the absence of adverse events.

[Pancreatic cancer--multidisciplinary approach and possibilities for surgical treatment].

Pancreatic cancer is one of the most serious and severe diseases and takes a significant part of malignant diseases in Bulgaria, during the last years. The fast progression of this disease requires complex treatment and is still a considerable challenge for the conservative and the surgical approaches. We present a series of 196 consecutive patients operated in our clinic for the period September 2003-February 2008. 106 radical pancreatic resections and 90 palliative procedures were performed. All of the patients were assessed before operation by multimodality team using standard protocols. The criteria for respectability are absence of distant metastasis as well as absence of data for infiltration of celiac trunk and superior mesenteric artery. In the presented series the percent of respectability is 54.1%. 35 Whipple procedures. 49--Traverso-Longmire (PPPD--resections), 15-distal pancreatectomies and 7 papillectomies were performed. In 28 cases the pancreatic resection was combined with vessel resection. 17 patients underwent extended resections. The average postoperative stay for the patients with radical operations is 16.1 days. 39 patients (36.8%) had complications. Six patients among the radically operated died (5.6%). The average survival rate for the patients with radical surgical interventions is 16.2 months. The surgical resection is the only method of choice for radical treatment of pancreatic cancer and periampular tumors. The indications for pancreato-duodenal resections have expended thanks to the development of the surgical technique and reanimation care during the last ten years. In order to achieve better results it's recommended that type of surgery to be concentrated in highly specialized centers.

[Contemporary aspects in the performance of pancreatic anastomosis after pancreatoduodenal resecions].

BACKGROUND: Historically, the pancreatic anastomosis has a significant impact on the high morbidity levels in pancreatoduodenal resections. This leads to parallel development of alternative techniques for reconstruction. The major methods are pancreato-jeuno and pancreato-gastroanastomosis. MATERIAL AND METHODS: We present 82 consecutive cases with pancreatoduodenal resections for the reason of pancreatic head malignancies. Pancreato-jeunal anastomosis is the preferred method and the evolution in the anastomosing technique of pancreatic rermnat is presented. RESULTS: Nine patients had pancreatic fistula (10.9%) and in six cases (7.3%) intra abdominal abscess was observed. CONCLUSIONS: Our experience as well as the analysis of different investigations confirmed the thesis that each center should choose one of the major techniques and develop it--clear tendency of decrease of the frequency of pancreatic fistulas with the growth of the experience, is observed.