G. Buttigieg, K. M. Stafrace, M. Mavrov, A. Mihaylova, E. Uchikova
The southern Mediterranean island of Malta, strategically located between North Africa and Europe and a full member of the European Union, offers an excellent European standard obstetric service. Yet, this obstetric service, like all other medical disciplines, is undergoing a severe evolutionary challenge imposed by rapid demographic shifts. It also finds itself without significant and relevant medico-legal legislation which is likely to lead to serious acute needs at the interface between the rapidly changing nature and number of foreigners residing in Malta and their medical needs, especially in the obstetric sector. The article looks at several factors, which argue for the immediate need of implementation of such legislation. One aspect of crucial importance is the demographic fact of rapidly changing profile of the patients making use of the Maltese Obstetric Service (MOS). This is the result of an influx of both EU nationals as well as irregular migrants, mostly of sub-Saharan origin. Both provide their own form of challenges to the MOS. In both, albeit more likely in the case of EU nationals, these challenges may easily find expression and resolution in eventual medico-legal action.
{"title":"Medico-legal and obstetric challenges of recent demographic increases in Malta","authors":"G. Buttigieg, K. M. Stafrace, M. Mavrov, A. Mihaylova, E. Uchikova","doi":"10.14748/ssm.v51i2.6422","DOIUrl":"https://doi.org/10.14748/ssm.v51i2.6422","url":null,"abstract":"The southern Mediterranean island of Malta, strategically located between North Africa and Europe and a full member of the European Union, offers an excellent European standard obstetric service. Yet, this obstetric service, like all other medical disciplines, is undergoing a severe evolutionary challenge imposed by rapid demographic shifts. It also finds itself without significant and relevant medico-legal legislation which is likely to lead to serious acute needs at the interface between the rapidly changing nature and number of foreigners residing in Malta and their medical needs, especially in the obstetric sector. The article looks at several factors, which argue for the immediate need of implementation of such legislation. One aspect of crucial importance is the demographic fact of rapidly changing profile of the patients making use of the Maltese Obstetric Service (MOS). This is the result of an influx of both EU nationals as well as irregular migrants, mostly of sub-Saharan origin. Both provide their own form of challenges to the MOS. In both, albeit more likely in the case of EU nationals, these challenges may easily find expression and resolution in eventual medico-legal action.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90835444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Fractures of the calcaneus still remain some of the most challenging injuries that an orthopedic surgeon should manage. The difficulties about these fractures arise from the specific anatomy of the region, from the unique shape and morphology of the bone, and from the mechanism of the injury (in most cases high energy trauma). Despite the progress of the medical implants that can be used for fracture fixation in the last decade there are a lot of controversies, regarding the best option. Aim The aim of the study is to present our experience with the use of cannulated screws for fixation of dislocated fractures of os calcis. Materials and Methods Twenty patients with dislocated fractures of os calcis using cannulated screws for fixation were operated on for a period of two years (2017-2018). The classifications used in the study included: the Essex-Lopresti x-ray classification modified by Stulik and Stehlik and the CT classification of Sanders. Two of the patients were with dislocated extraarticular fractures of tuber calcanei, three patients with `extreme beak` type fractures, the remaining 15 patients were with intraarticular fractures with more than 2 mm step off in the subtalar joint: 9 patients with tongue type and 5 patients with joint depression type. Gender distribution: 18 men, 2 women. Results Evaluation of the results was made by using the Maryland Foot Score. Satisfaction from the treatment was graded using the Visual Analogue Scale (VAS) score (mean 7,5). The reduction is evaluated by measurement of the angle of Gissane, Bohler and Preis pre- and postoperatively. Assessment of the calcaneal height, length and width was initiated on lateral, axial and Broden views. Conclusion Fixation of displaced calcaneal fractures by cannulated screw is effective and reliable method. These screws are introduced by stab incisions which leads to minimal soft tissue dissection in such complex area of the hindfoot. It is an enormous advantage for fracture healing and reduces the percentage of possible complications.
{"title":"Cannulated screw fixation for dislocated fractures of the calcaneus","authors":"S. Ivanov","doi":"10.14748/SSM.V51I1.5882","DOIUrl":"https://doi.org/10.14748/SSM.V51I1.5882","url":null,"abstract":"Introduction Fractures of the calcaneus still remain some of the most challenging injuries that an orthopedic surgeon should manage. The difficulties about these fractures arise from the specific anatomy of the region, from the unique shape and morphology of the bone, and from the mechanism of the injury (in most cases high energy trauma). Despite the progress of the medical implants that can be used for fracture fixation in the last decade there are a lot of controversies, regarding the best option. Aim The aim of the study is to present our experience with the use of cannulated screws for fixation of dislocated fractures of os calcis. Materials and Methods Twenty patients with dislocated fractures of os calcis using cannulated screws for fixation were operated on for a period of two years (2017-2018). The classifications used in the study included: the Essex-Lopresti x-ray classification modified by Stulik and Stehlik and the CT classification of Sanders. Two of the patients were with dislocated extraarticular fractures of tuber calcanei, three patients with `extreme beak` type fractures, the remaining 15 patients were with intraarticular fractures with more than 2 mm step off in the subtalar joint: 9 patients with tongue type and 5 patients with joint depression type. Gender distribution: 18 men, 2 women. Results Evaluation of the results was made by using the Maryland Foot Score. Satisfaction from the treatment was graded using the Visual Analogue Scale (VAS) score (mean 7,5). The reduction is evaluated by measurement of the angle of Gissane, Bohler and Preis pre- and postoperatively. Assessment of the calcaneal height, length and width was initiated on lateral, axial and Broden views. Conclusion Fixation of displaced calcaneal fractures by cannulated screw is effective and reliable method. These screws are introduced by stab incisions which leads to minimal soft tissue dissection in such complex area of the hindfoot. It is an enormous advantage for fracture healing and reduces the percentage of possible complications.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79761821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetes mellitus is the most common chronic disorder of carbohydrate metabolism, which leads to progressive atherosclerosis and failure of multiple internal organs, which in turn results in an early and severe disability. Diabetic nephropathy is one of the main microvascular complications of this disease. The article explores the usefulness of abdominal Doppler ultrasonography to validate the early changes of renal hemodynamics in patients with diabetes mellitus.
{"title":"The role of abdominal Doppler ultrasonography in diabetic nephropathy diagnostics","authors":"L. Stoyanova, M. Dimova, E. Marinova, A. Dinkov","doi":"10.14748/SSM.V50I4.5861","DOIUrl":"https://doi.org/10.14748/SSM.V50I4.5861","url":null,"abstract":"Diabetes mellitus is the most common chronic disorder of carbohydrate metabolism, which leads to progressive atherosclerosis and failure of multiple internal organs, which in turn results in an early and severe disability. Diabetic nephropathy is one of the main microvascular complications of this disease. The article explores the usefulness of abdominal Doppler ultrasonography to validate the early changes of renal hemodynamics in patients with diabetes mellitus.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89625983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Šímová, Mladena N Radeva, D. Grupchev, C. Grupcheva
Introduction The construction of the main incision is crucial for the outcome of cataract surgery. There are many considerations including: wound preparation and stability, surgically induced astigmatism, stability of anterior chamber, and wound closure stability with rising intraocular pressure (IOP). Irrespective of modality, the main goal is to achieve stable watertight self-sealing wound in order to avoid possible intra- and postoperative complications. Therefore, evaluating the architecture and healing of the surgical wound would be of benefit, as the integrity of incisions may decrease the risk of endophthalmitis or other problems. Anterior segment OCT (AS-OCT) provides the opportunity to visualize anterior chamber structures and cornea in particular. In the interest of the current study this was used to examine the anatomy of the main incision in vivo and evaluate its changes over time. Aim The aim of this article is to examine the architecture of the main incision in vivo and evaluate its changes over time, using anterior segment optical coherence tomography (AS-OCT). Materials and Methods Patients diagnosed with senile cataract, scheduled for surgery, were enrolled in this prospective study. All underwent uneventful cataract surgery with phacoemulsification and intraocular lens (IOL) implantation, performed by the same experienced surgeon. A standardized technique of cataract extraction, under local anesthesia, was used. Patients with previous ocular surgery or trauma, and other ocular pathology, as well as cases with complications were not included in the study. Wound anatomy was visualized using AS-OCT (Topcon 3D SD OCT 2000) at three postoperative visits: day 1, day 7, and day 30. The following features were examined and analyzed: external gaping, endothelial (internal) alignment and gaping, localized DMD, loss of coaptation, wound retraction, and other changes on the external or the internal side of the wound. Results Sixty eyes of 51 patients were examined, of whom 23 were men and 28 women, aged between 53 and 87 years (mean 72 years). The scleral tunnel incisions had a three-plane architecture and all of them were watertight with no leakage at any time. Several architectural features were assessed, including epithelial gaping, endothelial gaping and misalignment, local Descemet’s membrane detachment (DMD). Conclusion AS-OCT is a risk-free, quick, high-informative method for visualization of the morphological characteristics of cataract surgical incisions and their evolution over time. Hence, this technology is indispensable in evaluating the integrity of the wound, and the information obtained could be used to develop a consistent technique to create self-sealing incisions and decrease the risk of endophthalmitis.
主切口的构造对白内障手术的疗效至关重要。需要考虑的因素包括:伤口的准备和稳定性、手术引起的散光、前房的稳定性以及眼内压(IOP)升高时伤口闭合的稳定性。无论采用何种方式，主要目标是实现稳定的水密自密封伤口，以避免可能的内、术后并发症。因此，评估手术伤口的结构和愈合将是有益的，因为切口的完整性可以降低眼内炎或其他问题的风险。前段OCT (AS-OCT)提供了观察前房结构和角膜的机会。在当前的研究中，这被用来检查体内主要切口的解剖结构，并评估其随时间的变化。本文的目的是利用前段光学相干断层扫描(AS-OCT)检查活体主切口的结构并评估其随时间的变化。材料与方法本前瞻性研究纳入诊断为老年性白内障并计划手术的患者。所有患者均接受了由同一位经验丰富的外科医生进行的白内障超声乳化手术和人工晶状体植入术。在局部麻醉下，采用标准化的白内障摘除技术。既往眼部手术或外伤患者，以及其他眼部病理，以及有并发症的病例不包括在研究中。在术后第1天、第7天和第30天三次就诊时，使用AS-OCT (Topcon 3D SD OCT 2000)观察伤口解剖。检查和分析以下特征:外部间隙，内皮(内部)对齐和间隙，局部DMD，配合丧失，伤口回缩以及伤口外部或内部的其他变化。结果检查51例患者60只眼，其中男性23例，女性28例，年龄53 ~ 87岁，平均72岁。巩膜隧道切口为三平面结构，所有切口均不透水，任何时候均无渗漏。评估了几种建筑特征，包括上皮间隙，内皮间隙和错位，局部Descemet膜脱离(DMD)。结论AS-OCT是一种无风险、快速、高信息量的白内障手术切口形态特征及其随时间变化的可视化方法。因此，该技术在评估伤口完整性方面是不可或缺的，所获得的信息可用于开发一致的技术，以创建自密封切口并降低眼内炎的风险。
{"title":"Assessment of sclerocorneal incision architecture after phacoemulsification using AS-OCT","authors":"J. Šímová, Mladena N Radeva, D. Grupchev, C. Grupcheva","doi":"10.14748/SSM.V50I4.5583","DOIUrl":"https://doi.org/10.14748/SSM.V50I4.5583","url":null,"abstract":"Introduction The construction of the main incision is crucial for the outcome of cataract surgery. There are many considerations including: wound preparation and stability, surgically induced astigmatism, stability of anterior chamber, and wound closure stability with rising intraocular pressure (IOP). Irrespective of modality, the main goal is to achieve stable watertight self-sealing wound in order to avoid possible intra- and postoperative complications. Therefore, evaluating the architecture and healing of the surgical wound would be of benefit, as the integrity of incisions may decrease the risk of endophthalmitis or other problems. Anterior segment OCT (AS-OCT) provides the opportunity to visualize anterior chamber structures and cornea in particular. In the interest of the current study this was used to examine the anatomy of the main incision in vivo and evaluate its changes over time. Aim The aim of this article is to examine the architecture of the main incision in vivo and evaluate its changes over time, using anterior segment optical coherence tomography (AS-OCT). Materials and Methods Patients diagnosed with senile cataract, scheduled for surgery, were enrolled in this prospective study. All underwent uneventful cataract surgery with phacoemulsification and intraocular lens (IOL) implantation, performed by the same experienced surgeon. A standardized technique of cataract extraction, under local anesthesia, was used. Patients with previous ocular surgery or trauma, and other ocular pathology, as well as cases with complications were not included in the study. Wound anatomy was visualized using AS-OCT (Topcon 3D SD OCT 2000) at three postoperative visits: day 1, day 7, and day 30. The following features were examined and analyzed: external gaping, endothelial (internal) alignment and gaping, localized DMD, loss of coaptation, wound retraction, and other changes on the external or the internal side of the wound. Results Sixty eyes of 51 patients were examined, of whom 23 were men and 28 women, aged between 53 and 87 years (mean 72 years). The scleral tunnel incisions had a three-plane architecture and all of them were watertight with no leakage at any time. Several architectural features were assessed, including epithelial gaping, endothelial gaping and misalignment, local Descemet’s membrane detachment (DMD). Conclusion AS-OCT is a risk-free, quick, high-informative method for visualization of the morphological characteristics of cataract surgical incisions and their evolution over time. Hence, this technology is indispensable in evaluating the integrity of the wound, and the information obtained could be used to develop a consistent technique to create self-sealing incisions and decrease the risk of endophthalmitis.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82472200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Vlkova, M. Gospodinova, D. Radkova, I. Todorov, V. Gadzhovska, Minas Kozmidis, Guldjan Mollova
Introduction: Rotaviruses are a leading cause of diarrheal mortality in children less than five years old. Mixed forms with other intestinal pathogens have been reported, interfering with the severity and outcome of the illness. Aim: The aim of this article is to analyze the characteristics of mixed infections among rotaviruses and other intestinal pathogens. Materials and Methods: Twenty-seven patients up to 5 years of age, diagnosed with a co-infection from the rotavirus group and other intestinal pathogens were analyzed during the period from March, 2016 to December, 2017. A clinical epidemiologic study was conducted. The diagnosis was made by stool cultures for bacterial pathogens/feces analyses for viral antigens in the microbiology/virus laboratory of the St. Marina University Hospital, Varna. Statistic methods were used for data processing. Results: For the aforementioned period, 483 patients, up to 5 years of age, with rotaviral gastroenteritis were hospitalized. Mixed forms of intestinal infection were registered in 27 children (5.59%). Early childhood (between 1 to 3 years of age) was the most commonly affected age group. Cases were separated into two groups: rotavirus-virus association and rotavirus-bacterium association. Cases with rotavirus-virus association were more predominant (55.6%) than rotavirus-bacterium ones (44.4%). The clinical presentation included fever, vomiting, diarrhea, and lasted 6.53±1.53 days among the patients in the first studied group. In rotavirus-bacterium mixed infections vomiting was not a generally present symptom, but distinct complications ordinary occurred (83.33%) and the average hospitalization period was 10±1.98 days. Conclusion: Mixed infections including rotavirus and other intestinal pathogens are rarely diagnosed and mainly affect young children. Compared with rotavirus-bacterium association, rotavirus-virus association is more commonly registered, its clinical course is milder, the prognosis of the disease is auspicious and the in-patient stay is shorter.
{"title":"Clinical manifestations of mixed infections between rotaviruses and other intestinal pathogens","authors":"E. Vlkova, M. Gospodinova, D. Radkova, I. Todorov, V. Gadzhovska, Minas Kozmidis, Guldjan Mollova","doi":"10.14748/SSM.V50I4.5632","DOIUrl":"https://doi.org/10.14748/SSM.V50I4.5632","url":null,"abstract":"Introduction: Rotaviruses are a leading cause of diarrheal mortality in children less than five years old. Mixed forms with other intestinal pathogens have been reported, interfering with the severity and outcome of the illness. Aim: The aim of this article is to analyze the characteristics of mixed infections among rotaviruses and other intestinal pathogens. Materials and Methods: Twenty-seven patients up to 5 years of age, diagnosed with a co-infection from the rotavirus group and other intestinal pathogens were analyzed during the period from March, 2016 to December, 2017. A clinical epidemiologic study was conducted. The diagnosis was made by stool cultures for bacterial pathogens/feces analyses for viral antigens in the microbiology/virus laboratory of the St. Marina University Hospital, Varna. Statistic methods were used for data processing. Results: For the aforementioned period, 483 patients, up to 5 years of age, with rotaviral gastroenteritis were hospitalized. Mixed forms of intestinal infection were registered in 27 children (5.59%). Early childhood (between 1 to 3 years of age) was the most commonly affected age group. Cases were separated into two groups: rotavirus-virus association and rotavirus-bacterium association. Cases with rotavirus-virus association were more predominant (55.6%) than rotavirus-bacterium ones (44.4%). The clinical presentation included fever, vomiting, diarrhea, and lasted 6.53±1.53 days among the patients in the first studied group. In rotavirus-bacterium mixed infections vomiting was not a generally present symptom, but distinct complications ordinary occurred (83.33%) and the average hospitalization period was 10±1.98 days. Conclusion: Mixed infections including rotavirus and other intestinal pathogens are rarely diagnosed and mainly affect young children. Compared with rotavirus-bacterium association, rotavirus-virus association is more commonly registered, its clinical course is milder, the prognosis of the disease is auspicious and the in-patient stay is shorter.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82515427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Panayotov, D. Panayotova, N. Nikolova, N. Donchev, S. Ivanova, L. Mircheva, V. Petrov, K. Tenekedjiev
Introduction: There is a significant percentage of Bulgarians suffering from ischemic heart disease (IHD) and its complications, such as ischemic mitral regurgitation (IMR). It plays an important role in Bulgarian society. Surgical treatment of this pathological conditions could have positive impact on life expectancy and the medical quality of life of patients. Aim: The purpose of the study is to establish a reproducible algorithm to advise the appropriate surgical treatment of patients with IHD and significant, but not severe IMR based on their condition. Materials and Methods: The study is based on the data collected prospectively at the Department of Cardiac Surgery, St. Marina University Hospital in Varna, Bulgaria. IHD and significant IMR (i.e. more than mild 1+, but less than severe 4+ degree) were diagnosed in 186 patients. Applying inclusion and exclusion criteria, 140 patients with pure secondary IMR remained in the study group. The data was analyzed in a retrospective fashion. We discussed two possible treatment strategies: coronary artery bypass grafting + mitral valve repair (CABG+MVRep) and isolated revascularization (CABG only). To obtain comparable data for those treatment strategies, we needed a formal stratification of the patients, allowing comparison between the groups. Results: Creating formal algorithms we are able to divide the patients into comparable Group A (CABG+MVRep) and Group B (CABG only), and surgical strategy is based on characteristics of the individual pathology of every patient. Discussion : Despite data from small randomized and non-randomized trials, to date there is no clear agreement and strategy regarding concomitant mitral valve repair with CABG during the first-time operation Conclusion: Formal stratification with the algorithms created and applied gave us the opportunity for reliable comparison of relatively different patients, and to draw conclusion for the practice. This approach should be applied in such small non-randomized trials to achieve better understanding of the problem of secondary IMR.
{"title":"Algorithms for formal stratification of patients with ischemic mitral regurgitation","authors":"P. Panayotov, D. Panayotova, N. Nikolova, N. Donchev, S. Ivanova, L. Mircheva, V. Petrov, K. Tenekedjiev","doi":"10.14748/SSM.V50I4.5644","DOIUrl":"https://doi.org/10.14748/SSM.V50I4.5644","url":null,"abstract":"Introduction: There is a significant percentage of Bulgarians suffering from ischemic heart disease (IHD) and its complications, such as ischemic mitral regurgitation (IMR). It plays an important role in Bulgarian society. Surgical treatment of this pathological conditions could have positive impact on life expectancy and the medical quality of life of patients. Aim: The purpose of the study is to establish a reproducible algorithm to advise the appropriate surgical treatment of patients with IHD and significant, but not severe IMR based on their condition. Materials and Methods: The study is based on the data collected prospectively at the Department of Cardiac Surgery, St. Marina University Hospital in Varna, Bulgaria. IHD and significant IMR (i.e. more than mild 1+, but less than severe 4+ degree) were diagnosed in 186 patients. Applying inclusion and exclusion criteria, 140 patients with pure secondary IMR remained in the study group. The data was analyzed in a retrospective fashion. We discussed two possible treatment strategies: coronary artery bypass grafting + mitral valve repair (CABG+MVRep) and isolated revascularization (CABG only). To obtain comparable data for those treatment strategies, we needed a formal stratification of the patients, allowing comparison between the groups. Results: Creating formal algorithms we are able to divide the patients into comparable Group A (CABG+MVRep) and Group B (CABG only), and surgical strategy is based on characteristics of the individual pathology of every patient. Discussion : Despite data from small randomized and non-randomized trials, to date there is no clear agreement and strategy regarding concomitant mitral valve repair with CABG during the first-time operation Conclusion: Formal stratification with the algorithms created and applied gave us the opportunity for reliable comparison of relatively different patients, and to draw conclusion for the practice. This approach should be applied in such small non-randomized trials to achieve better understanding of the problem of secondary IMR.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87574539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rowell syndrome is a rare skin disease described as an association of erythema multiforme and systemic lupus erythematosus, immunologically characterized by speckled antinuclear, anti-Ro, and anti-La antibodies. The majority of described cases affect middle-aged women. We report a case of a 53-year-old man with no previous history of lupus erythematosus, who developed erythema multiforme-like lesions and immunological findings consistent with Rowell syndome upon an intake of non-steroidal anti-inflammatory drugs. The patient responded well to systemic steroids and hydroxychloroquine. A short overview, emphasizing the specific clinical, laboratory and histology findings of this peculiar syndrome, is also presented.
{"title":"Drug-induced Rowell syndrome in a male patient","authors":"V. Kantardjiev, Elena Stoikova, V. Broshtilova","doi":"10.14748/SSM.V50I4.5810","DOIUrl":"https://doi.org/10.14748/SSM.V50I4.5810","url":null,"abstract":"Rowell syndrome is a rare skin disease described as an association of erythema multiforme and systemic lupus erythematosus, immunologically characterized by speckled antinuclear, anti-Ro, and anti-La antibodies. The majority of described cases affect middle-aged women. We report a case of a 53-year-old man with no previous history of lupus erythematosus, who developed erythema multiforme-like lesions and immunological findings consistent with Rowell syndome upon an intake of non-steroidal anti-inflammatory drugs. The patient responded well to systemic steroids and hydroxychloroquine. A short overview, emphasizing the specific clinical, laboratory and histology findings of this peculiar syndrome, is also presented.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"1998 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78107926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Stoyanov, A. Renjilian, Boyko K Matev, M. Bliznakova, Velizar Gaydardzhiev, M. Levkova, D. Bliznakova, Kameliya Bratoeva, A. Tonchev, N. Sapundzhiev
Introduction: The preauricular sinus (PAuS) is a malformation of the auricula pinna. The structure may present isolated or as a component of a number of oto-renal syndromes. Aim: The aim of this study was to establish the incidence of PAuS in a Bulgarian cohort and propose a model for its inheritance, based on the transgenerational mechanisms derived from the genealogic trees of interviewed individuals. Materials and Methods: A total of 100 healthy individuals were prospectively evaluated for the presence of a PAuS on a random cohort sampling principle. A descriptive statistical approach was used when categorizing the individual features. Individuals were also assessed in terms of their genealogies and presence of renal symptoms. Results: Of all assessed individuals, 3% (n=3) had a structure complying with the criteria for a PAuS. No one having the structure reported renal symptoms. The genealogical trees were characteristic of a dominant trait with incomplete penetrance. Conclusion: The incidence of PAuS in our study cohort is similar to that of other Caucasian cohorts and gives a rare modern glimpse into the transgenerational inheritance of the PAuS, together with data on the oto-nephrological syndromes.
{"title":"Preauricular sinus: Incidence and inheritance","authors":"G. Stoyanov, A. Renjilian, Boyko K Matev, M. Bliznakova, Velizar Gaydardzhiev, M. Levkova, D. Bliznakova, Kameliya Bratoeva, A. Tonchev, N. Sapundzhiev","doi":"10.14748/SSM.V50I4.5650","DOIUrl":"https://doi.org/10.14748/SSM.V50I4.5650","url":null,"abstract":"Introduction: The preauricular sinus (PAuS) is a malformation of the auricula pinna. The structure may present isolated or as a component of a number of oto-renal syndromes. Aim: The aim of this study was to establish the incidence of PAuS in a Bulgarian cohort and propose a model for its inheritance, based on the transgenerational mechanisms derived from the genealogic trees of interviewed individuals. Materials and Methods: A total of 100 healthy individuals were prospectively evaluated for the presence of a PAuS on a random cohort sampling principle. A descriptive statistical approach was used when categorizing the individual features. Individuals were also assessed in terms of their genealogies and presence of renal symptoms. Results: Of all assessed individuals, 3% (n=3) had a structure complying with the criteria for a PAuS. No one having the structure reported renal symptoms. The genealogical trees were characteristic of a dominant trait with incomplete penetrance. Conclusion: The incidence of PAuS in our study cohort is similar to that of other Caucasian cohorts and gives a rare modern glimpse into the transgenerational inheritance of the PAuS, together with data on the oto-nephrological syndromes.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81159983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The problem discussed in the article `Transit-Time Flowmetric Evaluation of Coronary Artery Bypass Graft Flow after Off- and On-Pump Myocardial Revascularization` by V. Kornovski et al. is of huge clinical importance. The routine use of a graft flow verification tool is mandatory for the surgeon in order to remove any doubts about the anastomotic patency at the end of coronary artery bypass surgery. This can eliminate the possibility of a technical error during the intervention and thus, to minimize the possibility of developing a serious perioperative complications. The results of the author are encouraging. There is an important fact: the good quality of the anastomoses in both operative methods - off-pump and on-pump coronary artery bypass is a very persuasive evidence that this diagnostic tool is of great practical value. If we consider that reoperations for graft failure are time- and money-consuming, together with additional work in the operating room for the heart team, the meaning of this device is of even greater importance. In experienced hands this method is quick and reliable, and provides the surgeon with evidence of patency of the grafts postoperatively, which is an important factor in the early postoperative period, especially when some hemodynamic or other problems occur. Citation: `Our results indicated that both clinical effectivity and safety of OPCAB surgery can be compared to those of the ONCAB one in terms of postoperative graft patency, coronary graft blood flow and PI values.`
V. Kornovski等人在“停泵和开泵心肌血运重建术后冠状动脉旁路移植血流的瞬时流量评估”一文中讨论的问题具有重要的临床意义。外科医生必须常规使用移植物流量验证工具，以消除冠状动脉搭桥手术结束时对吻合口通畅的任何疑虑。这可以消除干预过程中出现技术错误的可能性，从而最大限度地减少发生严重围手术期并发症的可能性。作者的研究结果令人鼓舞。有一个重要的事实:两种手术方法吻合口的良好质量-无泵和有泵冠状动脉搭桥术是一个非常有说服力的证据，证明该诊断工具具有很大的实用价值。如果我们考虑到移植失败的再手术既费时又费钱，再加上心脏团队在手术室的额外工作，那么这个装置的意义就更加重要了。在经验丰富的操作者中，这种方法快速可靠，并为外科医生提供了术后移植物通畅的证据，这是术后早期的一个重要因素，特别是当出现一些血流动力学或其他问题时。引文:“我们的研究结果表明，在术后移植物通畅度、冠状动脉血流和PI值方面，OPCAB手术的临床有效性和安全性都可以与ONCAB手术相比较。”
{"title":"Transit-time flowmetric evaluation in coronary artery bypass grafting","authors":"V. Petrov","doi":"10.14748/SSM.V50I3.5608","DOIUrl":"https://doi.org/10.14748/SSM.V50I3.5608","url":null,"abstract":"The problem discussed in the article `Transit-Time Flowmetric Evaluation of Coronary Artery Bypass Graft Flow after Off- and On-Pump Myocardial Revascularization` by V. Kornovski et al. is of huge clinical importance. The routine use of a graft flow verification tool is mandatory for the surgeon in order to remove any doubts about the anastomotic patency at the end of coronary artery bypass surgery. This can eliminate the possibility of a technical error during the intervention and thus, to minimize the possibility of developing a serious perioperative complications. The results of the author are encouraging. There is an important fact: the good quality of the anastomoses in both operative methods - off-pump and on-pump coronary artery bypass is a very persuasive evidence that this diagnostic tool is of great practical value. If we consider that reoperations for graft failure are time- and money-consuming, together with additional work in the operating room for the heart team, the meaning of this device is of even greater importance. In experienced hands this method is quick and reliable, and provides the surgeon with evidence of patency of the grafts postoperatively, which is an important factor in the early postoperative period, especially when some hemodynamic or other problems occur. Citation: `Our results indicated that both clinical effectivity and safety of OPCAB surgery can be compared to those of the ONCAB one in terms of postoperative graft patency, coronary graft blood flow and PI values.`","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74305640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Ivanova, Nikolay Mladenov, Atanas Zanev, V. Platikanov, K. Ilieva
Introduction: The article discusses the use of dexamethasone as an adjuvant to local anesthetic solution for ultrasound (US)-guided femoral nerve block in patients after total knee joint replacement. A literature review on the clinical use of other adjuvants is also presented. Design: This was a clinical prospective randomized study. Aim: The aim of this article is to investigate the effect of dexamethasone adjuvant on the local anesthetic solution when performing a US-guided femoral block in patients after total knee joint replacement. Methods: The study included 53 patients, randomized into two groups : Group 1: single shot femoral nerve block (FNB) + constant infusion through a perineural catheter 15 mL bolus (ropivacaine 0.5%/levobupivacaine 0.375%) with a subsequent infusion of 5-9 mL per hour, including 20 patients; Group 2: single shot FNB 20 mL bolus (ropivacaine 0.5%/levobupivacaine 0.375%) +/- dexamethasone 4 mg, including 33 patients. In Group 2, 2 subgroups were formed: patients with single shot FNB with chirocain - 10 patients; patients with single shot FNB with ropivacaine - 23 patients. Of these, 15 patients were fasted with single shot FNB with ropivacaine + dexamethasone 4 mg, and 8 patients with pure ropivacaine. Evaluation of effective control of pain relief symptoms was done on 2nd, 4th, 6th, 12th, 18th, 24th, and 36th hours postoperatively according to the Visual Analogue Scale (VAS). Results: No statistically significant difference in VAS scores was observed between the two groups in the 2nd, 6th, 12th, 18th and 36th hours. Such was found only in the 24th hour. We did not detect statistically significant benefits of this adjuvant. We do not have clinically registered adverse drug reactions (ADRs). We have not established a correlation between these occurrences and the use of dexamethasone. Conclusion: Although our results correspond to those of authors who refute the benefits of dexamethasone as an adjuvant to the peripheral nerve block (PNB), we believe, based on clinical observation data, that it actually attenuated reversible hyperalgesia (patients did not report abruptly, acute, sudden onset of pain), therefore prolongation of the analgesic effect was observed until the 18th, 20th postoperative hour.
{"title":"Application of dexamethasone as an adjuvant to the local anesthetic in the performance of a US-guided femoral block for postoperative analgesia on patients after total knee joint replacement","authors":"P. Ivanova, Nikolay Mladenov, Atanas Zanev, V. Platikanov, K. Ilieva","doi":"10.14748/SSM.V50I3.5482","DOIUrl":"https://doi.org/10.14748/SSM.V50I3.5482","url":null,"abstract":"Introduction: The article discusses the use of dexamethasone as an adjuvant to local anesthetic solution for ultrasound (US)-guided femoral nerve block in patients after total knee joint replacement. A literature review on the clinical use of other adjuvants is also presented. Design: This was a clinical prospective randomized study. Aim: The aim of this article is to investigate the effect of dexamethasone adjuvant on the local anesthetic solution when performing a US-guided femoral block in patients after total knee joint replacement. Methods: The study included 53 patients, randomized into two groups : Group 1: single shot femoral nerve block (FNB) + constant infusion through a perineural catheter 15 mL bolus (ropivacaine 0.5%/levobupivacaine 0.375%) with a subsequent infusion of 5-9 mL per hour, including 20 patients; Group 2: single shot FNB 20 mL bolus (ropivacaine 0.5%/levobupivacaine 0.375%) +/- dexamethasone 4 mg, including 33 patients. In Group 2, 2 subgroups were formed: patients with single shot FNB with chirocain - 10 patients; patients with single shot FNB with ropivacaine - 23 patients. Of these, 15 patients were fasted with single shot FNB with ropivacaine + dexamethasone 4 mg, and 8 patients with pure ropivacaine. Evaluation of effective control of pain relief symptoms was done on 2nd, 4th, 6th, 12th, 18th, 24th, and 36th hours postoperatively according to the Visual Analogue Scale (VAS). Results: No statistically significant difference in VAS scores was observed between the two groups in the 2nd, 6th, 12th, 18th and 36th hours. Such was found only in the 24th hour. We did not detect statistically significant benefits of this adjuvant. We do not have clinically registered adverse drug reactions (ADRs). We have not established a correlation between these occurrences and the use of dexamethasone. Conclusion: Although our results correspond to those of authors who refute the benefits of dexamethasone as an adjuvant to the peripheral nerve block (PNB), we believe, based on clinical observation data, that it actually attenuated reversible hyperalgesia (patients did not report abruptly, acute, sudden onset of pain), therefore prolongation of the analgesic effect was observed until the 18th, 20th postoperative hour.","PeriodicalId":21710,"journal":{"name":"Scripta Scientifica Medica","volume":"82 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77433825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：