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Biomedical subjects

A Dimitrov

Publications and source records attributed to A Dimitrov.

At least 91 records · Page 5Linked to original sources
PubMed1999

[Administration of exogenous surfactant in premature very low birth weight infants with RDS].

A retrospective study is carried out with the aim of establishing the effect from surfactant therapy on pulmonary function, survival and complication from intensive therapy on VLBWI with RDS. 67 premature infants below 1500 grams are included in the study divided in 3 groups: I gr.--27 babies treated with Corosurf; II gr.--16 babies treated with Exosurf; III gr.--24 control babies without surfactant. The results show that in spite of relatively lower gestational age and higher incidence of inborn infection in group I, Curosurf treated babies spend shortest time on mechanical ventilation and oxygen therapy showing lower incidence of BPD, IVH and mortality rate.

Case-Control Studies↗
PubMed1999

[Use of the balloon catheter before induction of labor with oxytocin in cases with unfavorable pelvic score and premature delivery].

The purpose of this prospective work is to communicate the experience with preinduction treatment with Folly's catheter on the Pelvic score (Ps), labor and neonatal outcome in 52 cases in 27 to 34 wg, preterm premature labor and unfavourable cervix. The first control group consist of 24 pregnancies with the same characteristics but with favourable cervix at the begging of labor induction and the second control group include 31 cases with spontaneous premature labor. The Folly's catheter is introduced through the cervical canal and the bulb inflated with 75 ml of sterile normal saline. After the Foley's catheter dropped out the Ps is reassessed and proceed with oxytocin infusion. In the first control group with favourable cervix the induction of labor is only with oxytocin via infusion pump. More than half of all patients are treated with with tocolysis. The results show that for the period of tocolysis and/or PPROM there is significant improvement of the Ps (from 0.90 +/- 0.9 to 2.35 +/- 1.5). The change in the Ps doesn't depend on the g.w., the length of tocolysis or on the initial Ps. The balloon catheter improve the Ps from 2.35 +/- 1.5 to 6.24 +/- 1.3 for y period of 3 h 20 min (2 h 40 min to 4 h, 95% confidence). After the Foley catheter dropped out the duration of labor with oxytocin infusion is 6 h (5 to 7 h, 95% confidence) and is not different from this in the control groups. The time for the catheter to drop out, the achieved Ps and especially the effacement of the cervix are essential features in the prognosis of the difficulties in the labor process and the neonate state.

Case-Control Studies↗
PubMed1998

Spatial decorrelation in orientation-selective cortical cells.

We propose a model for the lateral connectivity of orientation-selective cells in the visual cortex. We study the properties of the input signal to the visual cortex and find new statistical structures that have not been processed in the retino-geniculate pathway. Using the idea that the system performs redundancy reduction of the incoming signals, we derive the lateral connectivity that will achieve this for a set of orientation-selective local circuits, as well as the complete spatial structure of a network composed of such circuits. We compare the results with various physiological measurements.

Linear Models↗
PubMed1998

[Pro and con the trend to an increasing frequency of cesarean sections].

The trend of increasing the CS rate is based on the improvement of skill and safety of operation, broadened and not well defined indications, some demographic, anthropological and social changes during recent decades. Most authors stress on the patient's will and on the role of nonclinical factors including the physician's training/experience, financial and convenience incentives. At the same time the increasing CS rate can not achieve the expectant medical benefits as abrupt decrease of prenatal mortality and morbidity, or intranatal trauma for the newborn and the women. Efforts to reduce unnecessary CS should focus on identifying the appropriate clinical indications for CS and spread this information to physicians. The trial to calculate the optimal rate of CS based on the prenatal mortality and morbidity, on the rate of the complication during pregnancy and labor requiring CS or the magnitude of delivery trauma nowadays is unsatisfactory. To compare the CS rate between countries or regions and draw conclusions from this is inadequate as many medical and nonclinical variables take place in the decision to perform cesarean delivery.

Cesarean Section↗
PubMed1998

[Cesarean section frequency and its indications at the State University Hospital Maternity Home over a 12-year period].

The aim of this retrospective study is to analyse the tendency of change of the rate of CS and the indications for them. The data are taken from the hospital medical documentation. For each year is determine the rate of CS and the indications. Only the first two leading indications are taken because next are most often consequence or subgroup of them. The incidence of each indications is calculate on the sum of this indications from different cases to the sum of indications from all CS. From 1986 to 1997 year there were 49,855 deliveries and 9384 CS. CS rate at 1986 was 13.9 and increased to 24.0 at 1997 year. The mean CS rate for the period is 18.75. The leading indications are: dystocia (39.2%), previous CS (20.9%), fetal distress (16.9%), breech presentation (14.6%). In more than half of CS in the leading indication there are relative indications. For the period there is significant tendency of decrease of the indications: previous CS, hearth diseases, myoma, elderly patients. We found increase in the indications like: unfavorable pelvic score, atypical or pathological cephalic presentations, ophthalmic diseases, prolonged period of ruptured membranes. The increase of CS rate is mainly due to the relative indication and to the indications based on the subjective assessment of the fetal well-being and of the obstetric status.

Analysis of Variance↗
PubMed1998

Four-quadrant assessment of gestational age-specific values of amniotic fluid volume in uncomplicated pregnancies.

BACKGROUND: The purpose of this study was to establish a normative scale of amniotic fluid index (AFI) throughout gestation in uncomplicated singleton pregnancies, and to identify the lower and upper limits for each gestational week. METHODS: Four-quadrant assessment of amniotic fluid volume (AFV) was performed prospectively in 750 uncomplicated pregnancies between 16 and 43 weeks. The logarithmic transformations were used to get the data in Gaussian distribution. The means, and the 90%, 95% and 98% confidence intervals at each week of gestation were calculated from polynomial regression equation. Statistical differences in AFIs among gestational age groups were tested. RESULTS: The amniotic fluid index observations from regression equation curve were stratified in week-specific normative curve. The variations between mean AFI of the total population and the means of the preterm, term and postdate pregnancies were statistically significant (p<0.0001). The 90%, 95% and 98% confidence limits about the mean (12.5 cm) were 5.4 to 20.6, 4.2 to 22.3, 1.8 to 25.8 cm, respectively in term gestation. The 5th and 95th percentile serves as lower and upper limits of normal, respectively. CONCLUSIONS: Gestational age-specific values of AFI were established, determining the significant trends of changes in the AFV with gestation. The normogram may have a clinical benefit to accurate, reliable and semiquantitative diagnosis of oligohydramnios and polyhydramnios.

Amniotic Fluid↗
PubMed1998

[The effect of antenatal corticosteroid prophylaxis in premature newborns with the use of surfactant therapy].

The study is retrospective aiming to elucidate the effect of antenatal corticosteroids (CS) for prevention of RDS in preterm deliveries, followed by surfactant therapy. 28 premature babies from 26 to 31 gest. weeks, receiving Curosurf at birth, were included in the study. They were divided in two groups: group A-17 babies of mothers with CS prophylaxis and group B-11 babies from deliveries without prenatal CS. All babies were followed for incidence and severity of RDS, duration of artificial ventilation and oxygen therapy. Although mean gestational age and body weight are lower in group A, incidence of severe RDS is lower (23.5% versus 36.4% in group B); duration of artificial ventilation with FiO2 > 0.60 and as a whole is smaller (mean 28.9 hrs and 186 hrs v/s 50.3 hrs and 228 hrs resp. in group B; p < 0.05), duration of oxygen therapy is shorter (mean 428 hrs v/s 540 hrs in group B; p < 0.05), smaller is the incidence of pneumothorax, IVH gr. III-IV, inborn infections and death rate although not statistically significant. The conclusion is made that antenatal use of CS improves lung function in premature babies and potentiates the effect of surfactant.

Betamethasone↗
PubMed1998

[Sphincter-preserving operations in the treatment of carcinoma of the middle and lower third of the rectum].

The prerequisites for sphincter-salvaging interventions in the operative management of carcinoma of the middle and lower third of rectum are analyzed. Reference is made to 96 scientific publications of the issue, with due consideration given to the anatomical and physiological prerequisites for coloanal anastomoses. Updated knowledge of intramural diffusion of the neoplastic process in distal direction promotes the performing of ablastic surgical intervention with resection line 2 cm beneath the tumor. The practical implications of total mesorectal excision for reducing local recurrences are underscored. Analysis of the summed up literature data warrant the assumption that in the event of differentiated carcinoma of the rectum, located 1.5-2 cm above linea dentata, sphincter-salvaging operation should be undertaken with a priority given to direct manual coloanal, transanal anastomosis. This type of surgical interventions are attractive on account of the likelihood to preserve the anal sphincter complex--a fact having an essential practical bearing on the lifestyle of patients. Eventual local relapses lend themselves readily to diagnosis and treatment by abdominoperineal extirpation. Thus the latter may be deferred in time, and in most patients it may prove unnecessary altogether.

Anal Canal↗
PubMed1998

[Secondary sclerosing cholangitis after echinococcectomy].

This is case report concerning secondary caustic sclerosing cholangitis following scolecide with concentrated sodium chloride solution (30%) during operation on a liver echinococcus cyst with involvement of the extrahepatic biliary apparatus only. Hepatojejunostomy is performed. Histological study of the liver demonstrates evidence of severe cholangitis, purulent cholangiolitis and suspected secondary biliary cirrhosis. In conclusion, it is stressed that dynamic postoperative follow-up of patients is mandatory to make early diagnosis of the complication and undertake operative treatment anticipating the development of a cirrhotic process. The search for new, effective scolicides, not damaging the biliary apparatus and hepatic parenchyma, is strongly recommended.

Acute Disease↗
PubMed1997

UN/EDIFACT based medical documentation and messages.

New documentation and messages conforming to the rules of EDIFACT are created and an attempt is made to follow internationally standardised and wordwide available commercial experience. A set of medical documents, aligned with United Nations Layout Key for trade documents is designed. The approach is to develop a set of paper documents and to standardise the data which are filled in these documents. There is a possibility to fill the data directly in medical documents and to print them from the Clinical Information System in our University Hospital.

Bulgaria↗
PubMed1997

[An analysis of the indications for episiotomy in current obstetrical practice].

The aim is to analyze the accepted indications for episiotomy in nowadays practice. The investigations is retrospective for the period from April to May 1996. The material includes 459 term singleton pregnancy in vertex presentation and 46 cases of premature neonates with weight from 1300 to 1499 g. The results show high risk (77.1%) of episiotomy in nulliparous women. The multiparity, the length of second period and the high risk pregnancies have not effect on the use of episiotomy. The wight of the fetus is essential factor. The highest rate of episiotomy is at premature births (65.2%) followed by the group of neonates with weight over 4000 g (61.5%). The lowest rist of episiotomy is then the weight of newborn is between 2500 and 3800 g (21.8%). Almost hundred percent rate of episiotomy in operative vaginal and breech deliveries show that we accept the episiotomy as obligatory of these vaginal deliveries.

Adult↗
PubMed1997

[The results of the limited use of episiotomy in managing the second stage of labor].

The purpose is to asses the effect of restrictive use of mediolateral episiotomy on the spontaneous laceration of the low birth canal. The material includes 613 labors some of which gave birth with indication for episiotomy and control group of 441 retrospective cases with routine management of the second period of labor. The restrictive use of episiotomy decreases the rate from 45.6% in the routine practice to 32.8%. The reduced rate of episiotomy has as a consequent increase rate of second degree perineal laceration adn insignificant increase of vaginal lacerations. The management of restrictive and liberal use of mediolateral episiotomy has not effect on third and four degree perineal laceration, on the accessory tears of the vagina and on the rate of perineotomy. If from all labors are subtracted operative deliveries, surgical intervention for repairing the laceration of the birth canal and pathology of the placental period the rate of labors without any intervention is only 13.3%. Our results suggest that labor nowadays is operative activity.

Bulgaria↗
PubMed1997

[Perforations of hepatic hydatid cysts].

Out of a total of 753 patients operated for liver echinococcosis, in 43 (5.71 per cent) various perforations are observed, namely: in the biliary apparatus, chest, abdominal cavity, gastrointestinal tract, subphrenic and subcutaneous tissue. Their incidence in bile ducts is the highest. The lethality is rather elevated with two patients dying on the operating table. In conclusion, proceeding from the severity of the complication emphasis is laid on the necessity of early diagnosis of the disease, before development of serious complications, successfully achieved in the last few years.

Aged↗