RECTOCELE - A LITERATURE REVIEW WITH A CASE REPORT.

Rectocele is defined as an herniation of the rectal wall through a defect in the posterior rectovaginal septum in direction of the vagina. A great variety of factors can cause a rectocle. Small rectoceles are asymptomatic, but the big ones are appearing with a great variety of symptoms. Diagnosis of a rectocele is based on the clinical signs, physical examination and imaging tests. There are nonsurgical and surgical methods for treament of rectocele. Here we share our experience of successful surgical treatment of a big, sacculiform, high rectocele appeared soon after a vaginal hysterectomy.

Clinical case of a patient diagnosed with sinister inguinal hernia and disembriogenesis of the inguinal canal.

Hernia (lat. - rupture, burst) or protrusion represents the act of escape of tissue, organ or an organ constituent through an innate or acquired fault of the muscle or the connective tissue membrane. The inguinal hernia, also known as groin hernia, rates one of the most frequent surgical conditions. It is manifested by all ages, however is more common in males. The inguinal hernia exhibits by the protrusion of abdominal organs or their segments, for instance portions of the small or large intestine, into the inguinal canal. The groin hernias classify into two subtypes--direct and indirect, and also acquired and inherited. Two kind of anomalies exist--anomalies connected with the obliteration of processus vaginalis peritonei and anomalies connected with the embryogenessis of the inguinal canal. We present a clinical case of a 59-years-old male presenting with emerged arch-like protuberance in the sinister groin region, enlarging during physical effort and strain, accompanied by a strong, harsh pain. Intraoperatively it was discovered a disembryogenessis of the inguinal canal, a total lack of the front wall of the canal itself, a lack of formed superficial inguinal opening and inobliterated processus vaginalis peritonei.

Clinical case of echinococcus of the pancreas.

Hydatid disease is a major health problem worldwide. Its frequency is different worldwide depending to the climate and locoregional factors. Primary hydatid disease of the pancreas is very rare. We report the case of a 61-year-old man who presented with a cystic lesion in the body and tail region of the pancreas. A diagnosis of hydatid cyst in tail region of the pancreas, measuring 55/75 mm, was established by abdominal computed tomography before surgery. The treatment consisted of a distal pancreatectomy. The postoperative period was uneventful.

Effect of rhamnolipids on pulmonary surfactant foam films.

The effect of a rhamnolipid biosurfactant on pulmonary surfactant is studied employing the black foam film method. Pulmonary surfactant is modeled by a commercially available lung surfactant preparation (LSP). The effect of rhamnolipid concentration on the formation and stability of films formed from mixtures of LSP and rhamnolipids is experimentally studied by measurements of the probability W of formation of black foam films as a function of both LSP and rhamnolipid concentrations at the physiologically relevant electrolyte concentration C(el) = 0.15 mol dm(-3) NaCl. The obtained curves show that addition of rhamnolipid at a concentration C(RhL) = C(c) (critical concentration of black foam film formation) to LSP suspensions causes destabilization of the foam films. In this case, additional quantities of lung surfactant preparation are needed to obtain black films with probability W = 100%. Rhamnolipid adsorption and formation of mixed adsorbed layers at the solution/air interfaces of foam films formed from mixtures of lung surfactant and rhamnolipids are experimentally studied by monitoring the effect of electrolyte and rhamnolipid concentrations on the thickness h of the foam films. The incorporation of rhamnolipid ions in the adsorbed layers at the film interfaces is evidenced also by direct measurements of the disjoining pressure Pi in the films. The Pi(h) isotherms demonstrate that the added rhamnolipids change the surface electric parameters of the films and their thickness and stability at higher pressures. The obtained results show that the different molecular components in the mixture and the increased surface charge at the film interfaces originating from the rhamnolipid ions have a significant effect on the surface forces operative in the studied films.

[Pulmonary surfactants: in vivo structure and in vitro biophysical models for investigation and its perspectives].

The metabolism, composition, structure and functions of the alveolar surfactant (AS) are described. The most adequate biophysical models for investigation of AS are considered. The principals and possibilities of three mostly used models are described in details: Monolayers, Spinning drop method and Thin liquid films. Some of the studies of Bulgarian biophysical, physicochemical, biochemical and medical groups on the structure and mechanism of action of AS in vivo using samples of amniotic fluid (AF), animal pulmonary lavages (PL) and tracheal aspirates (TA) of newborns and adults are summarized. The role of specific surfactant proteins (SP-A, SP-B, SP-C and SP-D) on the properties and function of AS is demonstrated. The opportunities of the model investigations for application in laboratory pre- and postnatal diagnosis of the respiratory distress syndrome (RDS), as well as for the efficiency of RDS therapy during exogenous surfactant therapy with ALEC (UK), Survanta (USA), Exosurf (USA), Curosurf (Italy) u Alveofact (Germany) are considered.

[Biophysical models in investigations of exogenous surfactant activities on the surface tension and their theurapeutic effectiveness].

Surfactant therapy leads to significant clinical improvement in infants at risk for, or having, respiratory distress syndrome (RDS). The development of exogenous surfactant (ES) as a therapy for neonatal respiratory disorders was a significant advance in neonatal intensive care that has led to a decrease in neonatal mortality. Two broad categories of surfactants are available for exogenous therapy: surfactants derived from animal sources or 'natural' surfactants; and synthetic surfactants. The physical properties of natural and synthetic surfactants have been studied using techniques such as the Wilhelmy surface balance and the bilayer black film (BBF) method. Here we report some data from a comparative study of ES (Exosurf, Survanta, Curosurf and Alveofact) and clinical samples of tracheal aspirate (TA) of newborns with RDS treated with Curosurf. Measured interfacial physico-chemical parameters prove "better" properties in vitro of the surfactant proteins (SP-B and SP-C) containing preparations Curosurf and Alveofact. Their properties are similar, Alveofact showing a higher surface tension lowering capacity under dynamic conditions. A compendious comparison of results for dynamic surface properties of monolayers of TA from newborns treated with Curosurf with data for newborns treated with Exosurf is presented. Both ES yield the desired lowering of the surface tension during cyclic film compression, being larger after treatment with Curosurf. Observations concerning the properties of BFF of ES (dependence on surfactant concentration, adsorption time, film drainage time and BFF formation time) are also reported and discussed.

Electric light scattering from single-stranded DNA in linear polyacrylamide solutions.

The electric light scattering (ELS) of ssDNA (calf thymus, 10 kbp, 55 micrograms/mL) in denaturing polyacrylamide (PAA) solutions was studied as a function of applied sinusoidal electric field and polymer concentration. Electric fields of strengths up to 300 V/cm and of frequencies between 100 and 5000 Hz were applied. It was found that the ELS effect increases with the field strength and decreases at high frequencies. The dependence of the ELS effect of ssDNA on polymer concentration passes through a maximum at 1% PAA. The relaxation times of decay of the ELS effect increase with increasing polymer concentrations. It was demonstrated that ELS is a useful method for investigation of ssDNA behavior in the course of pulse-field electrophoresis in polymer solutions.

Peroxynitrite is not a major mediator of endothelial cell injury by activated neutrophils in vitro.

OBJECTIVE: Human polymorphonuclear leukocytes (PMN) produce nitric oxide (NO), superoxide (O2.-) and peroxynitrite (ONOO-) upon stimulation. We investigated the role of ONOO- in PMN-induced injury to cultured bovine aortic endothelial cells (BAEC). METHODS: BAEC were cocultured with phorbol 12-myristate 13-acetate (PMA)-activated human PMN (effector-to-target ratio, 10:1) and injury to BAEC was evaluated at intervals by 51Cr release assay. The levels of NO, O2.-, ONOO- and nitrotyrosine, a reaction product of ONOO-, were also measured, and the influence of NO synthase inhibitors, O2.- and hydroxyl radical scavengers and other effectors was examined. RESULTS: In BAEC cocultured with PMA-activated PMN, 51Cr release was significantly increased [14.6 +/- 2.2% at 2 h (p < 0.05) and 42.6 +/- 2.7% at 4 h (p < 0.01); control (nonactivated PMN), < 4%]. Superoxide dismutase (100 U/ml) reduced 51Cr release to 4.6 +/- 2.2% at 2 h (p < 0.05). N-Iminoethyl-L-ornithine (L-NIO, 0.1 mM) potentiated 51Cr release (30.6 +/- 3.8% at 2 h, p < 0.01), and the potentiation was eliminated by anti-CD18 monoclonal antibody. The 51Cr release was completely prevented by dimethyl sulfoxide or by deferoxamine. Treatment of PMN with L-NIO inhibited NO generation and increased O2.- production. The nitrotyrosine level did not increase in BAEC cocultured with PMA-activated PMN. CONCLUSION: NO-derived ONOO- is not a major cytotoxic mediator in BAEC injury by activated PMN. NO may have a cytoprotective effect by inhibiting PMN adherence to endothelial cells.

Molecular mobility in the monolayers of foam films stabilized by porcine lung surfactant.

Certain physical properties of a range of foam film types that are believed to exist in vivo in the lung have been investigated. The contribution of different lung surfactant components found in porcine lung surfactant to molecular surface diffusion in the plane of foam films has been investigated for the first time. The influence of the type and thickness of black foam films, temperature, electrolyte concentration, and extract composition on surface diffusion has been studied using the fluorescence recovery after photobleaching technique. Fluorescent phospholipid probe molecules in foam films stabilized by porcine lung surfactant samples or their hydrophobic extracts consisting of surfactant lipids and hydrophobic lung surfactant proteins, SP-B and SP-C, exhibited more rapid diffusion than observed in films of its principal lipid component alone, L-alpha-phosphatidylcholine dipalmitoyl. This effect appears to be due to contributions from minor lipid components present in the total surfactant lipid extracts. The minor lipid components influence the surface diffusion in foam films both by their negative charge and by lowering the phase transition temperature of lung surfactant samples. In contrast, the presence of high concentrations of the hydrophillic surfactant protein A (SP-A) and non-lung-surfactant proteins in the sample reduced the diffusion coefficient (D) of the lipid analog in the adsorbed layer of the films. Hysteresis behavior of D was observed during temperature cycling, with the cooling curve lying above the heating curve. However, in cases where some surface molecular aggregation and surface heterogeneity were observed during cooling, the films became more rigid and molecules at the interfaces became immobilized. The thickness, size, capillary pressure, configuration, and composition of foam films of lung surfactant prepared in vitro support their investigation as realistic structural analogs of the surface films that exist in vivo in the lung. Compared to other models currently in use, foam films provide new opportunities for studying the properties and function of physiologically important alveolar surface films.

[Infusion treatment with nitrites of patients with acute myocardial infarct and unstable angina pectoris]. / Infuzionno lechenie s nitriti na bolni s ostur miokarden infarkt i nestabilna angina pectoris.

The results of prolonged infusion treatment with Trinitrosan and Isoket of 29 patients with acute myocardial infarction and unstable angina pectoris are reported. The drug action on the anginal syndrome, accompanying cardiac failure, heart rate and arterial tension is analysed. The action on the dynamic of enzyme activity and of the electrocardiograms during the treatment is compared with a control group of healthy persons. The results show full therapeutic efficacy in relation to the anginal syndrome and cardiac failure without any other medication in 1/2 of the patients; a partial antianginal effect is found in 1/4 of the patients treated. The examinations did not show any favourable action of the drugs on the enzymes and ECGs followed up in dynamics. The nitrites in the doses applied show no negative action on the heart rate and arterial tension and no special hemodynamics control is required.

[Clinical instrumental and clinical angiographic studies of patients with the anginose forms of ischemic heart disease]. / Kliniko-instrumentalni i kliniko-angiografski prouchvaniia u bolni s angiozni formi na iskhemichna bolest na surtseto.

The observations cover 96 male patients, aged from 30 to 61 suffering ischemic heart disease with clearly manifested stenocardia. The diagnosis in all patients was made on the base of a thorough clinical examination, the results from the electrocardiography and the selective coronarography. The data obtained from the clinical instrumental and clinical-angiographic examinations reveal that a correlation exists between the stage of the coronary arteries lesions, the patients's age, number of previous myocardial infarctions, severity of stenocardia and the state of the coronary reserve. The extent growth of the coronary arteries lesion goes in parallel with the patients' age advancement, the number of previous myocardial infarctions, severity of stenocardia and the diminution of coronary reserve. In this respect the character of stenocardia and the state of coronary reserve have the highest informative value. Our examinations failed to establish any correlation between the stage of the coronary arteries lesion and the stage and eytension of myocardial lesion on the electrocardiogram as well as between the stage of coronary arteries lesion and the duration of the illness.

[Ergospirometry study of the functional state of the cardiovascular system in chronic ischemic heart disease]. / Izsledvane na funktsionalnoto sustoianie na surdechno-sudovata sistema s pomoshtta na ergospirometriia u bolni s khronichna iskhemichna bolest na surtseto.

Sixty three patients were examined. The diagnosis of all was made on the base of clinical picture, electrocardiographic examinations and the results from the selective coronarography. The following indices of the oxygen consumption and gas metabolism were analysed in the paper: oxygen consumption per kilogram body weight, oxygen consumption per kilogramometer work performed, labour effectivity and restoration coefficient. The results obtained reveal that the adaptation ability of the respiratory and cardiovascular system in conditions of physical loading was disturbed in patients with chronic ischemic heart disease. At the same time, the physical capacity for work and the restoration coefficient were also disturbed. The decrease of oxygen consumption per kilogram body weight, deteriorated labour effectivity, restoration coefficient and the increased oxygen consumption per kilogramometer work performed occur in parallel with the extension of the lesions of the coronary arteries and the diminution of coronary reserve. The results from those examinations, together with the results from a series of non-invasive methods for the examination of cardio-vascular system could aid the thorough diagnostic-prognostic character of ischemic heart disease and give a tentative idea for the stage of the coronary arteries lesions prior to coronarography.