Proangiogenic signature in advanced laryngeal carcinoma after microRNA expression profiling.

The aim of this study is to evaluate which dysregulated angiomiRs compose the specific proangiogenic microRNA signature of advanced laryngeal cancer and review the literature. Thirty-six samples from twelve patients with advanced laryngeal carcinoma were collected. Total RNA was extracted and microRNA global profiling was performed using Agilent Technologies Microarray Kit. Fifty-nine microRNAs were found to have significantly different expression levels. Eleven microRNAs from the whole group were sorted as regulators of tumor angiogenesis (angiomiRs): seven were up-regulated-miR-1246, miR-181b 5p, miR-18a 5p, miR-21 3p, miR-210 3p, miR-503 5p, miR-93 5p and four were down-regulated-miR148a 5p, miR-145 5p, miR-204 5p, miR-125b 5p. For none of those microRNAs we found heterogeneity in tumor tissue. We are the first to report the specific proangiogenic microRNA signature in advanced laryngeal carcinoma and we confirm and amplify findings from previous studies that expand our perception of a specific "molecular state" of angiogenesis that is distinctive only for laryngeal cancer.

Higher doses of fentanyl during bronchoscopy in infants significantly reduces perioperative complication rates.

OBJECTIVES: The specific aim of this study was to assess the effect of higher fentanyl doses on reducing perioperative complication rates among infants undergoing rigid bronchoscopy. METHODS: Sixty children who underwent rigid bronchoscopy for foreign body removal were enlisted in our 2-year prospective cohort study at the Department of ENT and Head & Neck Surgery, Medical University - Sofia. Infants were randomly distributed into two groups according to fentanyl dose (group 1 - 1-2 µg/kg vs group 2 - 6-7 µg/kg). Hemodynamic parameters and perioperative complications were recorded. RESULTS: The mean age of the whole study group was 1.94 years. Five minutes prior to anesthesia both groups presented with similar parameter levels and no statistically significant difference was found. In contrast, at 5th and 10th minutes after intubation the heart rate, systolic and diastolic blood pressure levels were recorded at significantly higher levels in group 1 compared to group 2 (p = .000). Same results were obtained five minutes after extubation. Additionally, after performing the Pearson chi-Square test we found that bronchospasm and laryngospasm were significantly more frequent among patients from group 1 infused with lower dosage of fentanyl in comparison to the infants that were administered with a higher dose of this medication (p = .020). Phi and Cramer's V tests both display moderate strength of this association (V = 0.302). CONCLUSION: In the current study we propose refinement of current anesthetic protocols by using higher doses of fentanyl during rigid bronchoscopy in infants. This significantly reduces perioperative complication rates and improves intraoperative hemodynamics without presenting any newly formed risks.

[Continuous thoracic epidural anesthesia in abdominal surgery]. / Produlzhitelna torakalna epiduralna anesteziia v abdominalnata khirurgiia.

General anesthesia, applied under emergency conditions in both geriatric patients and patients presenting considerable in severity concomitant diseases (pulmonary and cardiovascular), is associated with serious risks in terms of restoring adequate consciousness, effective spontaneous respiration and pulmonary drainage, not infrequently requiring continuous mechanical ventilation of the patients. A procedure alternative to general anesthesia in abdominal surgery is described, consisting in the application of continuous thoracic epidural anesthesia (CTEDA), reaching i.v. thoracic segment, providing for analgesia of the whole abdomen and myorelaxation promoting accomplishment of the operative intervention against the background of preserved consciousness and spontaneous respiration. This is a report on 70 patients operated under CTEDA in the clinic of emergency surgery, University Hospital "Queen Giovanna"--Sofia, in the period June 1994 through April 1998. The methodology, superiorities and general organic effects of this particular type of anesthesia are comprehensively discussed. Emphasis is laid on the important role played by CTEDA in postoperative analgesia of patients in intensive care units, and on the contribution of the method to exclude any opiates, till recently considered as the most effective for pain relief in the post-operative period.

[Orthotopic liver transplantation - recipient selection criteria]. / Ortotopna chernodrobna transplantatsiia - kriterii za podbor na retsipienta.

In a great number of patients with progressive liver diseases whose terminal phases are cirrhosis and hepatic insufficiency, liver transplantation is the only feasible therapeutic alternative. However, the undertaking of liver transplantation is largely dependent on the availability of donor organs. Hence, the process of selecting the most adequate recipient is of critical importance from both medicolegal view-point, and in terms of the likelihood of a successful outcome of transplantation. The study is designed to asses the problems faced with a special reference to indications, contraindications and timing of liver transplantation.