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Biomedical subjects

M Daskalov

Publications and source records attributed to M Daskalov.

At least 19 recordsLinked to original sources
PubMed2004

Conduction block--the diagnostic value in the early stage of Guillain-Barre syndrome.

Immune-mediated segmental demyelination is the basic pathomorphological substrate of the Guillain-Barre syndrome (GBS). The aim of the study is to determine the diagnostic value of the conduction block in the early stage of GBS, as well as its changes during of the development of the disease. Sixteen patients with GBS were examined. Electroneurography (motor nerve conduction studies) was performed at interval from the third day of the onset till the first year. Partial CB in the early stage of the disease (range 0-15 days) was registered in 81,2% of the patients. In demyelinating forms of GBS partial CB was determined in 61% of the investigated nerves. It is the most often observed in peroneal nerves, followed by tibial, ulnar and median nerves in the same order. The maximal reduction of the amplitude of the CMAP (maximal CB) was registered before the 30th day from the onset of the disease with following recovery on the sixth month and first year. Partial CB is more often observed in the early phase of GBS, when it could be the only sign of demyelination. When patients reached a clinical plateau, progressive slowing of motor nerve conduction and increasing CB were registered. Proximal CB was revealed more often than distal CB, because of the typical initial localization of the process. In the early phase of GBS, proximal CB is most often found in lower limbs (in peroneal nerve, followed by tibial nerve). In patients with axonal damage, CB was more severe than in demyelinating group. Partial CB is an important diagnostic criterion for segmental demyelination, which helps for confirming the diagnosis of early GBS, when conduction velocity and other electrodiagnostic criteria for demyelination are normal.

Adolescent↗
PubMed1998

[Pathophysiologically advisable operations on the biliary-hepatic-pancreatic system].

Nowadays, the modern operative treatment of biliary-hepatic-pancreatic diseases is pathogenetically substantiated. In lithiasis and cholecystitis removal of the gallbladder should be undertaken only after assessment of the patency and output of the biliary tree (i.e. from the biliary canal) following visual, instrumental and if necessary--manometric and intraoperative cholangiographic study. To eliminate an obstacle--calculus or postampullar papillitis--it is necessary to perform papillotomy or papilloplasty using a balloon catheter introduced through the choledochus and electric knife if practicable. Since 1970, an operation of the kind is carried out in 79 patients, and with deperitonization (denervation and delymphatization)--in eleven patients presenting cholangiohepatitis and biliopancreatitis. In twelve patients, owing to pathological changes in the preampullar portion of choledochus, choledochoduodenostomy according to a modified technique, type "frog mouth", is done in the distal choledochus with formation of a distal convex flap from the anterior wall of te choledochus with an anti-reflux effect. In pre-combined with postampullar stenosis papillotomy and papilloplasty are performed, and if necessary dilatation or osteowirsungotomy plus drainage. In unobstructued cholangiohepatitis and biliopancreatitis, it is sufficient to supplement cholecystectomy with Kehr drainage. The ideal echinococcotomy is done according to a personal modification through hydraulic stratification of the fibrous capsule (1958). Segmental resection is necessitated in marginal, petrified and suppurated cysts in 28 patients, and lobectomy--in two. Resections are performed by hydraulic and instrumental division and hemostasis along the lines of anatomical separation or in the pericyst space.

Biliary Tract↗
PubMed1998

[Atraumatic procedures in common abdominal operations].

The surgical tactics and technical improvements are discussed against the background of personal experience with some common abdominal operations, among which the appendectomy variant leaving the cecum intra-abdominally and using chain retrograde ligature in some cases, with choice of access according to the requirements of the individual case. Special attention is called to retrocecal extraperitoneal complications and Meckel's diverticulum--clinical picture and operative tactics. Emphasis is laid on the advantages of intestinal anastomoses--latero-lateral variant, termino-terminal technique in colo-colostomy and possibilities of latero-terminal sigmoidorectoanastomosis.

Abdomen↗
PubMed1997

[Liver resections and operations in portal hypertension viewed via the experience of our practice].

After listing the indications for liver resection, the operative technique used is discussed with a special reference to an original modification implemented in practice. The case material is made of 52 liver resections and 6 lobectomies with a favourable outcome. In one lobectomy with subtotal proximal resection jejunogastroplasty is performed, supplemented by isolated antireflux anisoperistaltically interposed invagination esophagojejunostomy, duplicated by suturing its two portions. Application of catheter, inserted into the recanalized umbilical vein, is described under the heading of locoregional chemotherapy. In carcinomas involving the confluence of hepatic ducts a variant of Rodney Smith's operation is used while in hepatocholedochus resection plastic repair is done over Kerr drainage. In portal hypertension, after discussing the various methods existing, attention is called to the indirect shunts: splenectomy with omentoreno- and omentoparietopexy, Charsky and fenestration of Glisson's capsule using electric knife and argon with omentohepato- and hepatoparietopexy, as well as implantation of the recanalized v. umbilicalis into m. rectus abdominis dexter. In 15 cases operated on by parenchyma stimulating procedures, survivorship ranging from 3 to 26 years is achieved. For the purpose of prophylaxis against cholangiohepatitis and cirrhosis the following operations are performed: 68 papillotomies and plastic repairs over balloon catheter, passed through the choledochus and papilla, using an electric knife, 12 choledochoduodenostomies type "frog mouth", and 11 deperitonizations-desympathizations with a successful cure being attained.

Anastomosis, Surgical↗
PubMed1991

[A radionuclide study of esophageal motility disorders in patients with diabetic polyneuropathy].

The radionuclide method was used to examine transport function of the esophagus in 24 patients suffering from diabetes mellitus and symmetric distal polyneuropathy. 99Tc-sulfocolloid was employed as a radiopharmaceutical agent. Radioactivity movement was visualized by means of a gamma chamber. In 9 patients (37.5%), measurements were made of the prolonged transit time for the whole esophagus as well as the prolonged transit time for the interior, median and upper third of the esophagus. The same patients demonstrated a delay of the rate of evacuation of the entire esophagus and respective parts thereof. The radionuclide method described is rapid and noninvasive. It may be included into the diagnostic complex for early identification of vegetative disorders in patients suffering from diabetic polyneuropathy.

Adult↗
PubMed1991

[Radionuclide study of disorders of esophageal motility in patients with diabetic polyneuropathy].

Radionuclide method was used to examine transport function of the esophagus in 24 patients with diabetes mellitus and symmetric distal polyneuropathy. 99mTc-+sulfur colloid was employed as a radiopharmaceutical agent. The movement of radioactivity was elucidated visually with the aid of a gamma-chamber. In 9 patients, measurements were made of the prolonged transit time of the whole esophagus as well as prolonged transit time for the lower, median and upper third of the esophagus. The same patients manifested deceleration of the evacuation of the entire esophagus and respective parts thereof. That method can be included into the diagnostic complex intended for early diagnosis of vegetative disorders in patients with diabetic polyneuropathy and for evaluating the intensity of autonomous neuropathy.

Adult↗
PubMed1988

[Late deficiency states in patients with a surgically treated stomach].

37 patients with partial stomach resection because of peptic ulcer, performed 5 to 28 years before, were studied. In 29 patients the serum vitamin B12 and folic acid levels were determined by radioimmunoassay. In 19 patients several hematologic indices--hemoglobin, serum iron, erythrocyte morphology, proteinogram--were determined, too. The mean serum vit. B12 level was significantly lower than that of the control group of healthy persons. In 1/3 of these patients the low serum vit. B12 level was accompanied by manifested neurologic complications-myelopathy and polyneuropathy. The mean folic acid level was also low but statistically insignificantly and in patients the value was subnormal. In half of the patients a low degree hypochromic anemia was found. The role of vit. B12 deficiency in the pathogenesis of the neurologic manifestations is discussed and the determination of vit. B12 and folic acid levels is recommended in patients who had undergone gastric resection, especially after 5 years following the resection.

Adult↗
PubMed1984

[Changes in the mitral echogram in ischemic heart disease].

The patients with ischemic heart disease (IHD) have usually elevated end diastolic pressure (in the left ventricle (LVEDP). Such a change in LVEDP and to a certain extent the pathological ventricular contraction and the reduced compliance of the LV wall lead to definite pathological changes in the mitral echogram. The values, obtained by statistical-variation analysis, of the amplitudes and the velocity diastolic parameters of the mitral echogram in the group of the healthy subjects were compared with those of 60 patients with chronic IHD. A complex clinical-paraclinical study was carried out with the selected groups of healthy subjects and patients with IHD. It was established, that in patients with IHD without left ventricular insufficiency, EChO-C indices characterizing the mitral echogram, as well as EChO-C indices of the pump and contractile function of the left ventricle showed no value deviations from the norm. In the other two groups of patients with IHD the following was established; pathologically changed values of EChO-C indices reflecting the motion, amplitude and velocity parameters of the mitral echogram, more significantly manifested in patients with IHD with left ventricular insufficiency, II Stage. That EChO-C konstellation of the mitral echogram, correlates well with the increased end diastolic and systolic dimensions, left ventricular end diastolic pressure and left auricular systolic dimensions as well as with the reduced values of EChO-C indices of the pump and contractile function of the left ventricle: EF, FS (%), CFC, SV and MV.

Adult↗
PubMed1981

[Determination of the pulse wave spreading rate by the 1st rheographic derivative].

Besides via sphygmography, the propagation rate of pulse wave (PRPW) could be determined also by a synchronous record of volume and differential rheograms of aorta and limbs. For that purpose, 110 clinically healthy subjects were examined, grouped in 3 age groups (15-40, 41-60 and over 60). Synchronous rheographic records from the initial and terminal part of descending aorta with determination of PRRPW along vessels of elastic type (Ve) and from the arch of the aorta-left forearm--for vessels of muscular type (Vm) were recorded. By variation analysis the average values of Vm, Ve and the ratio Vm/Ve for the separate age groups within a norm were derived. With the analysis of the values obtained, an increase of PRRPW with age advancing along both traces (Vm, Ve) in the first two groups was established. PRRPW increase was more significant in the elderly group (over 60); mainly on account of the vessels of elastic type (Ve). The ratio Vm/Ve, which in normal subjects is always over unity, in youths and at a moderate age tends to approach unity or to drop under unity with advanced age. In 15 of the patients, with hypertonic disease, second stage, both PRRPW along VE and the diminution of the ratio Vm/Ve to or under unity is more pronounced in patients with hypertonic disease, stage II, B. In 15 patients with advanced age, with clinically confirmed atherosclerosis, but without hypertension, PRRPW was the largest, the ratio Vm/Ve being always under unity. After a technical reconstruction the 3-canal ECG apparatuses type NEK-3 could adequately be used both for synchronous rheographic records and determinations of PRRPW along the vessels of elastic and muscular type.

Adult↗
PubMed1980

[Additional right pectoral leads].

A total of 476 subjects were examined. The control group was of 220 (170 healthy males and 50 females) and 256 cardiac patients (180 males and 76 females); with right ventricle loading -- 106 (6-70 years), left ventricle - 35 (average age 38), disturbed intraventricular conductivity -- 76, and myocardial infarction -- 39 patients. The additional right pectoral leads (ARPL) -- V3R--V8R are included in the extended ECG programme for investigation (routine 12 ECG leads, left precordial -- V7--V9 and Nehb). In normal cases, the auricular wave P is positive in V3R--V6R, biphasic in V7R--V8R, rarely isoelectric in V8R. The form of ventricular complex in ARPL depends closely on the electric cardiac position. The forms rS are present in horizontal position -- in V3R--V8R; in vertical -- the forms rSin V3R--V5R and qr, Qr in V6R--V8R. In the direction form V3R to V8R, a reduced amplitude of ventricular complex is established. In right ventricular hypertrophy, the characteristic changes in V1--V2 (high R deflection and negative T waves) are more distinctly manifested in V3R--V5R. In advanced cases of chronic pulmonary heart high amplitude qR predominates in V3R--V7R. Contrary to the physiological type syndrome S1S2S3, where no deviations are found in ARPL, in the pathological variety -- pathologically changed ventricular complexes are present. In myocardial infarction of the posterior wall, the presence of high elevation of the segment ST and QS in V3R--V4R is an indication for the involvement of the interventricular septum as well and is a prognostic unfavourable sign.

Adolescent↗
PubMed1978

[Differential diagnostic value of the aVR lead].

The one-pole peripheral AVR lead reflects the changes in the electromotive power of the heart in a frontal plane in a reverse (mirror) image. In 620 subjects with healthy hearts, with the aid of an extended ECG method; the variants of the auricle-ventricle complex in AVR lead in norm and the separate heart positions, were studied. The pathologically changed P-wave was established to be presented by its typical forms (P-mitrale, P-pulmonale), but in a mirror image in AVR lead. The positive auricle wave in AVR is an important sign for the presence of right-auricular ectopic rhythm. In 80 patients with left-ventricular loading, pathologically enlarged S deflection was found. In 232 patients with fight-ventricular loading (mitral stenosis, chronic pulmonary heart), the increase of the amplitude of the deflection R AVR and the change in the ratio R/Q aVR over 1, is a valuable information about the degree of the right-ventricular loading. Those changes closely correlate with the changes in the ventricular complex with the right thoracic leads and with the spirographic and X-ray examinations. the role of AVR lend in the differential diagnostic determination of the additional deflection r'R'aVR1 V1 in certain forms of disturbed intraventricular conductivity is emphasized. AVR lead reacts dynamically with the separate sites of myocardial necrosis, with the appearance of unusual forms of the ventricular complex in AVR (increased first R deflection AVR in posterior-inferior myocardial infarction, occurence of rSr' forms in AvR in posterior-basal infarction and wide split ventricular complexes in anterior (anteriorseptal)infarction, complicated with a bundle blockade. Myocardial ischemia (subpericardial and subendocardial) is represented in A V R in an image reverse to the left thoracic leads. A general conclusion is drawn that the separate interpretation of the changes in AVR lead is not reasonable. Its differential diagnostic value grows only with its synchronic analysis with the rest peripheral and especially precordial leads.

Adolescent↗