[Paradoxical embolism: clinical situation and approaches to treatment].

The authors describe two clinical cases of paradoxical embolism of greater-circulation vessels in patients with thrombosis of deep veins of the lower extremities and patent foramen ovale, also discussing different variants of clinical course of paradoxical embolism, as well as approaches to treatment and prevention.

[Short and long-term results of endovascular treatment of bifurcational coronary stenosis].

Short and long-term results of endovascular treatment of true bifurcational coronary stenosis were analyzed in 229 patients. 68 patients received a "provisional-T" stenting on the first stage of the study. On the next stage 40 patients received the same "provisional-T" stenting, a total bifurcational stenting was conducted in 37 patients. Only coated stents were used. Independent risk factors of "provisional-T" stenting conversion to total bifurcational stenting were revealed. There were no differences between "provisional-T" and total bifurcational stenting considering the short-term treatment results. Long-term results (12-18 months) were analyzed in 70 patients. There were no restenosis of the main artery, whereas restenosis of the lateral branch was noticed in 5.5 and 2.94%, respectively, in the groups of "provisional-T" and total bifurcational stenting. Late thrombosis was registered in 1 case from the group of total bifurcational stenting.

[Hermetization of aortic sutures - the comparative analysis of methods].

Leakage of the ascending aortic sutures after the aortic valve replacement with the use of various methods of surgical hemostasis was studied. Results of 244 operations were analyzed. Thus, aortic leakage took place in 50 (20,5%) patients. One- or two-fold sewing was successfully used in 16 (32%) cases. The rest benefited from aortic suture fixation with the use of pericardial flap. Algorythm, implying usage of the auto- or xenopericardial flap after two-fold sewing failure, enabled exclusion of repeated aorta cross-clamping, decrease of the blood loss and hemotransfusion, and, therefore, decrease of postoperative complication and lethality rates.

[Left ventricular ruptures after the mitral valve replacement].

7 cases of left ventricular rupture after the mitral valve replacement, which occurred per 900 operations performed in our clinic, were analyzed. A successful closure of the defect has been managed in 2 cases. In all cases the external closure with liners and patch plasty was used. In two cases the autopsy revealed a transmural myocardial infarction, underdiagnosed preoperatively, which had caused a rupture.

Acute iliac artery thrombosis and pulsatile femoral and popliteal veins in the same extremity: a case report.

Systemic venous pressure is elevated in right heart failure, and this elevation may be reflected in pulsatile venous flow when there is significant tricuspid regurgitation. The presence of this systolic reversed flow in the femoral and popliteal veins may result in major difficulties for diagnosis and treatment. We report the case of a patient with signs and symptoms of acute ischemia of the right lower limb with palpable pulse in the groin and popliteal fossa. Tricuspid regurgitation was suspected by clinical examination, and Doppler ultrasonographic examination of the extremity revealed pulsatile flow in the femoral and popliteal veins while the iliac arterial axis was occluded. A preoperative angiogram revealed an underlying iliac artery thrombosis, which was successfully treated.

Ligadura accidental de arteria mesentérica superior como complicación de nefrectomía mediante cirugía laparoscópica / Accidental ligation of superior mesenteric artery as a complication of laparoscopic nephrectomy

Introducción. La cirugía laparoscópica en sus distintos campos de aplicación, especialmente cirugía general, urología y ginecología, a pesar de sus grandes ventajas, es también origen de complicaciones iatrógenas, entre ellas vasculares. Ocupa un lugar importante la nefrectomía por la proximidad de estructuras vasculares importantes, tales como la aorta, vena cava inferior, arterias mesentéricas superior e inferior y vasos colaterales de la arteria mesentérica superior (AMS). Las lesiones directas sobre la AMS son muy raras y apenas hay publicaciones en la literatura. Caso clínico. Paciente de 52 años diagnosticado de hipernefroma izquierdo, y se indica nefrectomía. En el transcurso de la intervención y posiblemente debido a rotación de la cámara, la AMS se confundió con la arteria renal y, por ello, de forma accidental, se ligó y seccionó, con la consiguiente isquemia intestinal; se necesitó proceder a su revascularización mediante un bypass aortomesentérico con un segmento de vena safena interna. El postoperatorio cursó sin complicaciones. Conclusiones. Se realiza una revisión de la literatura concerniente a las complicaciones de la cirugía laparoscópica y en particular las vasculares; si bien la incidencia de complicaciones en general ha disminuido a medida que la experiencia ha mejorado, no llegando en la mayoría de las estadísticas al 3%, se ponen de manifiesto lesiones tan graves, especialmente en cirugía urológica, como la sección y/o ligadura de aorta o de vena cava inferior, que ponen en peligro la vida del paciente y requieren en la mayoría de los casos conversión a cirugía abierta

Introduction. Despite the various advantages of the laparoscopic surgery and its application in several fields (preferably general surgery, gynecology and urology), it is also true that these techniques have become a source of yatrogenic vascular complications. Because of the neighboring vascular structures: aorta, inferior vena cava, superior and inferior mesenteric arteries, collateral branches of the mesenteric superior artery, etc, nephrectomy is one of the laparoscopic surgical techniques that more frequently leads to vascular complications. Injuries to the superior mesenteric artery are rare and there are very few publications on this subject. Case report. A 52 year-old man was diagnosed to have a left hypernephroma and evaluated to undergo laparoscopic nephrectomy. During the procedure and possibly because of a rotation of the camera, the superior mesenteric artery was thought to be the renal artery and thus accidentally ligated and transectioned. The subsequent intestinal ischemia had to be treated and an aorto-mesenteric bypass was performed using a long saphenous vein segment. There were no complications in the postoperative period. Conclusions. A review of the literature shows that the incidence of vascular complications during laparoscopic surgery is decreasing, not reaching 3% in almost all the publications as a consequence of the better experience in these techniques. However, some of these complications are more frequent in urologic surgery, especially ligation and transection of aorta, or inferior vena cava, that are life threatening and their repair requires in most cases the conversion to open surgery

[Surgical treatment of chronical pulmonary abscesses--contemporary treatment]. / Khirurgichno lechenie na khronichniia belodroben abstses--suvremenni postanovki.

Between Jan 1991 and Dec 2000 a total of 67 patients were operated on for chronic primary pulmonary abscesses. They were 57 men and 10 women with mean age of 46.2 (range, 12 to 72) years. The indications for surgery was mainly "delayed closure" following medical therapy and percutaneous tube drainage (3), as well as a massive hemoptysis in 4 cases. CT scanning and brochoscopy were performed in all patients. The majority of them had multiple isolates (51/67) of both aerobic and anaerobic (predominantly Bacteroides sp., Fusobacterium sp., and Peptococci) organisms. The following operations were carried out: lobectomy (52) including 8 decortications, bilobectomy (5), pneumonectomy (4) including two pleuro pneumonectomy, polysegmentectomy (4) and segmental resection (2). The 30-day hospital mortality rate was 1.49% (1 patient died following rethoracotomy for bronchial stump fistula with empyema and polyorganic insufficiency). Major postoperative complications were 6 (8.9%) and included 3 pleural empyema (additional drainage), two rethoracotomy for intrapleural bleeding and one residual pleural cavity, treated by thoracoplasty. Minor postoperative complications (atelectasis, wound infection and prolonged air-leakage) were observed in 9 patients (13.4%). The long-term results (following-up ranged from 6 to 112 weeks) are considered very good. In conclusion, surgery is indicated for patients with significant hemoptysis, suspected malignancy and those with "late healing" abscesses with acceptable postoperative results, although the rate of major postoperative complications remains relatively high.

[Traumatic surgeries on organs of gastrointestinal tract without components of donor's blood]. / Travmatichnye operatsii na organakh pishchevarutel'nogo trakta bez ispol'zovaniia komponentov donorskoi krovi.

The authors propose a complex program aimed to refuse completely using donor's blood components in surgeries on organs of digestive tract. This method was used in 25 patients who underwent surgeries with 380-1500 ml of blood loss. No patients received transfusion of donor's blood components before, during and after surgery.

[One-stage esophagoplasty without transfusion of donor blood components]. / Odnomomentnaia plastika pishchevoda bez ispol'zovaniia komponentov donorskoi krovi.

Six patients aged from 27 to 62 years were operated for subtotal burn strictures, cancer and glandular polyp of a low-thoracic part of the esophagus using a complex program of non-blood surgery. The following methods were used: collection of autoplasma before surgery by plasmapheresis, collection of autologic packet red cells, normovolemic hemodilution during surgery, use of perftoran for oxygen transport and recombinant human erythropoetin to stimulate erythropoiesis and raise preporative level of hemoglobin. Components of donor blood were not used in these patients. There were no complications associated with these methods. Partial failure of esophagol-colonic anastomosis on the neck was seen in 1 patient. The complex program permits one to avoid completely transfusion of donor blood components in esophagol surgery.

The Bulgarian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation into the Bulgarian language of the parent's version of two health related quality of life instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. The Bulgarian CHAQ CHQ were fully validated with 1 forward and 1 backward translations. 137 subjects were enrolled: 77 patients with JIA (36% systemic onset, 30% polyarticular onset, 4% extended oligoarticular subtype, and 30% persistent oligoarticular subtype) and 60 healthy children. The CHAQ clinically discriminated between healthy subjects and JIA patients, with the polyarticular and extended oligoarticular subtypes having a higher degree of disability, pain, and a lower overall well-being when compared to their healthy peers. Also the CHQ clinically discriminated between healthy subjects and JIA patients, with the polyarticular onset and extended oligoarticular subtypes having a lower physical and psychosocial well-being when compared to their healthy peers. In conclusion the Bulgarian version of the CHAQ-CHQ is a reliable, and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Further characterization of the actin-related protein Act3p/Arp4 of S. cerevisiae through mutational analysis.

In the course of functional analysis of the yeast ARP4 (ACT3) gene, we further characterized the role of its protein product Arp4p in the cell. We report that although it is localized in the nucleus, Arp4p performs its function independently of binding to DNA directly. The roles of the core actin structure (the ATP-binding pocket) and a putative Nuclear Localization Signal (NLS) of Arp4p were tested by targeted mutagenesis. The results suggest that under normal conditions, the ATPase activity and the NLS are dispensable for the essential function of this protein in the cell. Furthermore, the use of reporter genes confirmed that Arp4p could be involved in some general mechanism of transcriptional regulation.

The pea (Pisum sativum L.) genes sym33 and sym40 control infection thread formation and root nodule function.

Two novel non-allelic mutants that were unable to fix nitrogen (Fix ) were obtained after EMS (ethyl methyl sulfonate) mutagenesis of pea (Pisum sativum L.). Both mutants, SGEFix(-)-1) and SGEFix(-)-2, form two types of nodules: SGEFix(-)-1 forms numerous white and some pink nodules, while mutant SGEFix(-)-2 forms white nodules with a dark pit at the distal end and also some pinkish nodules. Both mutations are monogenic and recessive. In both lines the manifestation of the mutant phenotype is associated with the root genotype. White nodules of SGEFix(-)-1 are characterised by hypertrophied infection threads and infection droplets, mass endocytosis of bacteria, abnormal morphological differentiation of bacteroids, and premature degradation of nodule symbiotic structures. The structure of the pink nodules of SGEFix(-)-1 does not differ from that of the parental line, SGE. White nodules of SGEFix(-)-2 are characterised by "locked" infection threads surrounded with abnormally thick plant cell walls. In these nodules there is no endocytosis of bacteria into host-cell cytoplasm. The pinkish nodules of SGEFix(-)-2 are characterised by virtually undifferentiated bacteroids and premature degradation of nodule tissues. Thus, the novel pea symbiotic genes, synm40 and sym33, identified after complementation analysis in SGEFix(-)-1 and SGEFix(-)-2 lines, respectively, control early nodule developmental stages connected with infection thread formation and function.

[The diagnostic value of echography in hepatic echinococcosis]. / Dianostichna stoinost na ekhografiiata pri ekhinokok na cherniia drob.

The ultrasound method of examination led to revolutionary changes in the diagnosis of liver echinococcosis [correction of Echinococcus]. The ultrasound image of this disease, which is common in the region, is presented. The ultrasound method is compared with other diagnostic methods and its importance is pointed out. The ultrasound method of examination is a reliable means for the diagnosis of liver echinococcosis [correction of Echinococcus].

[Index of microcirculatory changes in experimental dehydration in animals]. / Ob indekse izmenenii mikrotsirkuliatsii pri éksperimental'nom obezbozhivanii zhivotnykh.

On the basis of morphokinetic synthesis principles the method of determination of summarizing criterion of microcirculatory system changes was developed. It consists of marked characteristics of changes of a number of the most important morphofunctional phenomena of each of this system compartments -- interstitial, lymphatic, blood and cellular -- with their successive summation to obtain the systemic microcirculation index. The experimental dehydration in rats being a model has shown that systemic microcirculatory index was 2 times as large in 3 days of dehydration, more than 3 times -- in 6 days, and 4, 5 times -- in 12 days. In the initial stage of the experiments maximal changes were found in interstitial compartment of the microcirculatory system. The intermediate period of dehydration differed by predominant changes of vascular compartment when the lymphatic phenomena were more evident than the hemomicrocirculatory ones. In the later stage of dehydration the cellular component changes of tissues and organs were predominant.

[Reaction of lymphocytes of the endometrium to the intrauterine administration of antigens]. / Reaktsiia limfotsitov éndometriia na vnutrimatochnoe vvedenie antigenov.

In the mucosal membrane of the uterine horns in Wistar white rats mainly small and middle lymphocytes (predominantly T-cells) and rather small amount of plasmocytes and macrophages are presented. After intrauterine administration of bacteria and viruses (BCG vaccine, influenza inactivated liquid vaccine of A type) the local immune reaction develops according to the cellular type with maximum at the first week, before the total immune response, with its peak occurring on the 14th day of the experiment.

[Use of cell cultures in the pharmacological experiment]. / Ispol'zovanie kletochnykh kul'tur v farmakologicheskom éksperimente.

A statistical method is proposed which makes it possible to evaluate quantitatively the significance and reliability of the effects of pharmacological agents during their study on cell cultures using a little scope of material samples. The method substantially reduces the expenditures of the researcher's time and labour.

[Hospital and prehospital mortality from acute myocardial infarct during 1982-1984]. / Bolnichen i dobolnichen letalitet ot ostur miokarden infarkt za perioda 1982-1984 g.

The hospital and pre-hospital lethality is discussed for the period 1982-1984 according to the materials of the Clinic of cardiology and the necropsy protocols of the chairs of forensic medicine and pathological anatomy. The role of the risk factors, age and sex for hospital lethality during all three years is given consideration. Hospital lethality was reduced during the last (1984), the relative share of the deceased of cardiogenic shock was decreased. Almost identically high level of pre-hospital lethality persisted during all three years, bringing up the problem of the effectiveness of the primary prophylaxis of ischemic heart disease and improved work at the level of regional and workshop physicians and emergency medical aid.