Hormones of hypothalamic-pituitary-thyroid axis are significant regulators of synthesis and secretion of vitamin K-dependent plasma coagulation factors.

Present data about hormonal regulation of haemostasis are often contradictory and are mostly based on clinical observations. The aim of the current research is to study the effects of the hormones of hypothalamic-pituitary-thyroid (HPT) axis on plasma levels (i.e. on the synthesis and secretion) of vitamin K-dependent coagulation factors in rats. The study was carried out on 65 male Wistar rats, divided into five groups. The animals were injected subcutaneously (s.c.) once daily for three consecutive days as follows: the first group was injected with Thyrotropin releasing hormone (TRH), in a dose of 0.06 mg/kg b.w.; the second group by Thyroid stimulating hormone (TSH), with a dose of 1 MU/kg b.w., the third and the fourth group respectively with Liothyroninum (Triiodothyronin ? T3) and Levothyroxinum (Thyroxin ? T4) with a dose of 0.08 mg/kg b.w. each. The control group rats were injected with saline (the solvent of the hormones), following the same schedule and volume per kg b.w. The necessary quantity of blood was acquired by a cardiac puncture under ether narcosis, and antigen levels of plasma factors II, VII, IX and X (FII:Ag, FVII:Ag, FIX:Ag and FX:Ag) were determined by ELISA kits (Diagnostica Stago, France). TRH, TSH, T3 and T4 significantly decreased the plasma antigen levels of FII and FVII (p<0.001). TRH, T3 and TSH reduced significantly FIX:Ag level( p<0.001 for TRH and T3 and p<0.05 for TSH) while T4 did not exert significant changes ( p>0.05). FX:Ag level was also significantly reduced by TRH, T3 (p<0.001), TSH and T4 (p<0.01). Plasma levels of vitamin K-dependent coagulation factors FІІ:Ag, FVІІ:Ag, FІХ:Ag and FХ:Ag are significantly reduced under the influence of the hormones of hypothalamic-pituitary-thyroid axis which signifies their decreased synthesis and secretion. T4 does not induce substantial changes in FIX:Ag plasma level.

Effects of the hormones of the thyroid axis on the vitamin K-dependent plasma factors of blood coagulation (II, VII, IX, and X).

The hormonal regulation of haemostasis is a problem which has not received much attention. The data concerning the influence of hormones from the hypothalamic-pituitary-thyroid axis are scarce, contradictory and based mainly on clinical observations. The objective of the current research is to study the influence of the Thyrotropin releasing hormone (TRH), Thyroid stimulating hormone (TSH), Triiodothyronine (T3) and Thyroxin (T4) on the activity level of the vitamin K-dependent plasma factors of blood coagulation--factor II (F II), factor VII (F VII), factor IX (F IX) and factor X (F X). This study was carried out on 40 male Wistar rats. The necessary quantity of blood was obtained by cardiac puncture under ether narcosis. The indicators studied were activated partial thromboplastin time (aPTT), protothrombin time (PT), F II, F VII, F IX and F X, and were determined by means of Diagnostica Stago tests and with the help of an automatic coagulometer. The hormones studied were: TRH (0.06 mg/kg b.w.), TSH (1 MU/kg b.w.), T3 (0.08 mg/kg b.w.) T4 (0.08 mg/kg b.w.) prolonged aPTT (p<0.001) and PT (p<0.001). TRH and T3 significantly reduced the activity level of factors II, VII, IX and X; T4 only reduced the level of F II (p<0.05), and TSH did not induce significant changes in the haemocoagulation factors studied. The TRH, TSH, T3 and T4 hormones, although elements of one and the same axis, have an ambiguous effect on the vitamin K-dependent factors of blood coagulation. The results obtained show that the determined changes in the activity levels of the vitamin K-dependent plasma factors of blood coagulation are undoubtedly related to the hypocoagulation observed in the intrinsic and extrinsic pathways under the influence of the hormones of the thyroid axis.

[The importance of the presence of antisperm antibodies in serum and ejaculate of men with infertility].

UNLABELLED: There are multiple insults to the male genital tract that have been associated with an increased risk of antisperm antibodies (ASA) formation. The presence of ASA has been regarded as typical and specific for the immunological infertility. It has been suggested that the presence of agglutinated spermatozoa is suggestive of the existence of an immunological cause of infertility such as the existence of ASA. AIM: The objective of this study was to determine the clinical significance of serum and seminal plasma ASA as well as whether varying degrees of sperm agglutination can be a predictive indicator of positive serum and/or seminal plasma ASA. PATIENTS AND METHODS: 100 infertile and 30 fertile men were tested for ASA in seminal plasma and serum. The evaluation of patients included complete history, physical examination, scrotal ultrasound and semen analysis. ASA in serum and seminal plasma were tested by ELISA (Biosource, Belgium) and results were compared with the data of the semen analysis. RESULTS: 44 (44%) of the patients tested positive for ASA in seminal plasma, 9 of them had positive serum ASA. In the control group, seminal plasma ASA were not detected and two men (6.7%) tested positive for serum ASA. Correlation was established between seminal plasma ASA and two of the semen analysis markers: agglutination and increased viscosity. CONCLUSION: ASA in seminal plasma are much more predictive than ASA in serum and have major role in the pathogenesis and diagnostics of male infertility.

[Poland syndrome--clinical study].

UNLABELLED: Poland's Syndrome is a rare congenital abnormality involving functional and aesthetic impairments. Constitutive mark of the condition: partial or total absence of the pectoralis major and minor muscles, symmetric chest wall deformity, brachydactyly/syndactyly. This syndrome is occasionally associated with either unilateral or bilateral hypoplasia of breast. AIM: We present a case of a patient with Poland's Syndrome. This association has not been previously reported in the medical literature. Difficulties by preoperative diagnosis. The purpose of this article--to propose a classification system for the treatment of this anomaly requiring defining the age of the patients for plastic surgery on the chest. METHODS AND MATERIALS: A 16-year-old female with Poland's Syndrome complained of drastic mood changes consisting of depression and anxiety, regular menses, dysmenorrhea and hypomastia. Two reconstructive surgeries at the age of 12 years--surgical corrections of the sternal malformation. RESULTS AND CONCLUSION: This work shall describe Poland's Syndrome from a clinical, diagnostic, genetic and therapeutic point of view. The Italian Association for Poland Syndrome founded in October 2003 and two nationwide scientific conferences dealt with the position of scientific research and future prospects with regards to Poland Syndrome. Patients are subject to multi-specialist (surgical, gynecological, genetic, psychological, orthopaedic and plastic surgical) checkups, aiming at an accurate genetic and clinical organisation of a therapeutic programme.

Screening study of the effects of the hypothalamic-pituitary-thyroid axis on hemostasis in rats.

The hormonal regulation of hemostasis has had little attention in research, and the existing literature data are relatively contradictory. The possible effects of the hormones of the hypothalamic-pituitary-thyroid axis on hemocoagulation and the fibrinolytic system are studied here. The study was conducted on 80 white male rats of the Wistar breed. The necessary blood quantity was obtained by cardiac puncture realized under ether narcosis. The basic parameters of the hemocoagulation and fibrinolytic activity of the plasma were determined by Diagnostica Stago tests (France), using an automatic coagulometer (Italy). The hormones employed in the study: Thyreotropin releasing hormone (0.06 mg/kg bw), Thyroid stimulating hormone (1 MU/kg bw), Triiodothyronine (0.08 mg/kg bw), and Thyroxin (0.08 mg/kg bw) applied s.c. for three consecutive days, extended the activated partial thromboplastine time (p less than 0.001), proto-thromboplastine time (p less than 0.001), thrombin time (p less than 0.001), reptilase time (p less than 0.001), and shortened the euglobin clot lysis time of (p less than 0.001). These data indicate that each of the hormones used causes significant changes in hemostasis by suppressing the coagulability by the intrinsic and extrinsic system pathways, and transformation of fibrinogen into fibrin. The shortened euglobim clot lysis time may be recognized as a manifestation of increased levels of plasma plasminogen activators. The results obtained show that hypothalamic-pituitary-thyroid hormones are significant regulators of hemostasis, since they cause an expressed hypocoagulation and increase plasma fibrinolytic activity.

EVOLUTION OF THE IEC AND EN STANDARDS FOR INDIVIDUAL MONITORING OF IONISING RADIATION.

This article presents the evolution of the International Electrotechnical Commission (IEC) and the European standards for individual monitoring of ionising radiation issued, respectively, from the committees IEC/Sub Committee 45B and European Committee for Electro-technical Standardization/Technical Committee 45B 'Radiation protection instrumentation'. Standards for passive individual photon and beta dosimetry systems as well as those for active individual monitors are discussed. A neutron ambient dose equivalent (rate) meter standard and a technical report concerning the determination of uncertainty in measurement are also covered.

[Administration of Perfalgan (paracetamol) for postoperative analgesia in obstetrics and gynaecology].

The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects.

[Morphological changes in experimental duodenogastric reflux]. / Morfologicheskie izmeneniia pri duodenogastral'nom reflekse v éksperimente.

The model of a total duodenal-gastric reflux was developed in 20 dogs and morphological changes in the stomach were studied. 5 dogs served as control. Histologic changes occurred 3.5 months and 1 year after the operation were characterized by metachromasia, increased mucus formation, proliferation of epithelial and parietal cells, moderate inflammation. Process of the disease had fluctuations. 6 months after the operation 5 dogs were reoperated for the elimination of reflux and were observed for another 6 months. A complete reversibility of all changes was established. Bacteriological studies showed a considerable increase of bacteria population in the stomach and a pH increase. The authors suggest the term 'reflux gastropathy" to replace the term "alkaline reflux-gastritis".

[A comparison between thiopental, midazolam-ketalar and midazolam-ketalar-aneksat for anesthesia during cesarean section]. / Sravnenie mezhdu tiopentala, midazolam-ketalar i midazolam-ketalar-aneksat za anesteziia pri tsezarevo sechenie.

The effect of dormicum-ketalar and dormicum-ketalar-anexat in comparison with thiopental was studied on 45 parturients at 39-40 weeks' pregnancy, operated electively, divided into three groups as each group consisted of 15 women. The representative groups were compared by the following parameters: duration of the operation, age, weight, duration of induction in anaesthesia-extraction of the fetus, premedication, anaesthesia after the extraction of the fetus. Usage of dormicum ketalar for induction in anaesthesia during cesarean section did not affect the basic metabolic parameters of the parturients, fetus and amniotic fluid. Such a combination of preparations during simultaneous neutralization of the action of dormicum by anexat affects positively the fetal state, transport of O2 and activity of enzymes, in order that the fetus could survive more favourably this critical state.

[The use of clofelin for the treatment of arterial hypertension and for the anesthesia of labor]. / Izpolzvaneto na klofelina za lechenieto na arterialnata khipertoniia i obezboliavaneto na razhdaneto.

Fourteen women in labor with pregnancy of 39.1 +/- 1.1 gestational weeks and arterial hypertension (BSP of 183.4 +/- 12.4 and BDP of 90.6 +/- 14.3 mm Hg) were given chlopheline with a rate of infusion 0.0005, 0.001 mg/kg/hr for 120 min. Decrease of arterial pressure began at minute 15.7 +/- 0.3 after starting perfusion, and the hypotensive effect lasted for 300 minutes. At minute 360, a new dose of chlopheline was needed. Against the background of arterial hypertension, a decrease of BSP, BDP and P was observed, and the central hemodynamics remained unchanged within statistically reliable range. The changes observed in the hemodynamics did not affect labor activity and the fetus. The analgesic effect of chlopheline was favorable. Perfusion of chlopheline at a rate of infusion 0.0005, 0.001 mg/kg/hr is a choice to provide a bulk of positive hypotensive and analgesic affect on the woman in labor.

[Uterine contractile activity in the postoperative period depending on the type of anesthesia]. / Sukratitelna aktivnost na matkata v postoperativniia period v zavisimost ot vida na anesteziia.

The functional state of the uterus was studied on 75 parturients, divided into the following groups: a control group of 20 women with normal delivery, first group of 35 parturients with cesarean section anaesthetized by the method of ataralgesia and second group of 20 parturients with cesarean section anaesthetized by the method of neuroleptanaesthesia. The level of the enzyme oxytocinase was determined in sera of parturients. Contractile activity of the uterus during the postoperative period did not depend on the type of anaesthesia. It was established statistically significantly (p less than 0.05) that the combination (metacine, dimidrol, droperidol and phentanyl)--second group, had inhibitory effect on the efficient and rhythmic activity of the uterus in comparison with parturients of the first group (alcosine, diazepam and phentanyl).

[The effect of different types of premedication on gastric juice volume and pH]. / Vliianie na razlichni vidove premedikatsiia vurkhu obema i pH na stomashniia sok.

60 pregnant women and 60 parturients treated with selected surgery were studied according to the influence of different types premedication on the gastric juice volume and pH. Parturients were divided into six groups (AI-AVI) with 10 participants in each one. Groups were comparable for a variety of signs-age, type and duration of the surgical procedure and methods of carrying out the general anaesthesia. Surgically treated patients were also divided into six groups (from B 1 to B), each group containing ten patients with similar symptoms. This makes possible comparison between them. Parturients from group AI were given each 0.007 mg/kg/body weight atropine i.v. 20 min before introduction in anaesthesia; group A II-0.014 mg/kg/body weight metacin; group AIII-0.3 mg/kg/body weight alkosin; group AIV-o.014 mg/kg/body weight metacin and 0.21 mg/kg/body weight dimidrol. Parturients from AV were given each two measure spoons Almagel A per os-an antacid drug-30 min before introduction in anesthesia and 0.007 mg/kg/body weight atropine i.v., introduced 20 min before the beginning of anesthesia. The parturients from group AVI were given each 400 mg H2 blocker (2 tabl.) per os-cimetidine-2 hours before the beginning of anesthesia and atropine 20 min before introduction in anesthesia in the same dosage as for the parturients from group AV. Surgically treated patients from group BI received as a premedication the following drugs 20 min before the beginning of anesthesia: atropine-0.007 mg/kg/body weight, fentanyl-0.001 and droperidol-0.03 mg/kg/body weight introduced i.v. Group BII-geluzil liquid-2 tea spoons 30 min before introduction in anesthesia and atropine i.v. 20 min at the beginning of anesthesia; group BIII received as a premedication dormicum-0.1 mg/kg/body weight and atropine in the same dosage as for the patients from group BII. Group BIV received as a premedication 20 ml 8.4% solution of sodium bicarbonate per os 20 min before the beginning of anesthesia and atropine in the same dosage as the patients from group BIII; BV received 0.003 mg/kg/body weight gastrodin, introduced i.v. 20 min before the beginning of anesthesia. Patients from group BVI received as a premedication for 2 hours before the beginning of anesthesia gastrozepin 2 tabl. (50 mg) per os and atropine in the same dosage as the patients from group BII. Gastric juice was taken by means of nasogastric tubing immediately before premedication, introduction in anesthesia and its end to fix its pH. The volume of gastric juice generated during the surgical procedure was determined before extubation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Changes in the central and peripheral hemodynamics during combined electroanalgesia (CEA) during gynecological operations]. / Izmenenie na tsentralnata i perifernata khemodinamika v usloviiata na kombinirana elektroanalgeziia (KEA) pri ginekologichni operatsii.

Central and peripheral hemodynamics was examined in 180 women with gynecological diseases, divided into the following groups: 130 women of the basic group, operated under the conditions of combined electroanalgesia, and 50 women of the other group, operated under the conditions of combined endotracheal anesthesia, using the preparations droperidol and phentanyl. Both central and peripheral hemodynamics in both groups were characterized by stability at all stages of the operation. Both types of anesthesia protect reliably the organism from operative trauma. The concentration of cortisol in both groups presented values higher than the initial values before premedication, which proved that adequate reaction of the organism was preserved during operation under the conditions of anesthesia.

[The effect of spinal analgesia on the hemodynamic indices in cesarean section]. / "Vliianie na spinalnata analgeziia vurkhu niakoi pokazateli na khemodinamikata pri sectio caesarea".

We studied systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse frequency (P.F) and mean blood pressure (MBP) among 30 pregnant women in 39.5 +/- 0.3 gestational weeks of pregnancy, age 23 +/- 0.9 years, height 162.0 +/- 1.4 cm and weight 75.5 +/- 2.55 kg. The above indices were studied dynamically in the Ist, 2nd, 3rd, 5th, 7th, 9th, 12th and 15th minute from the onset of the analgesia. We founded that SBP an DBP in the 7th min (the time for spinal block) were lowest. PF and MBP also decreased significantly in the 7th minute in comparison to the inmal values. We can conclude that the haemodynamic indices of the pregnant woman decrease wrong initiation of spinal analgesia for c.s., but remain in the region of normal reference values.

[Changes in body temperature during anesthesia]. / Promeni v telesnata temperatura po vreme na anesteziia.

The skin and esophageal temperature was investigated in 60 pregnant women on whom Cesarian section (cs) was performed. The patients were divided into four groups randomly in accordance with the type of anaesthesia. It was found that general, epidural and spinal anaesthesia during elective Cesarian section did not disturb thermal balance of the pregnant woman and parturient. The indicated types of anaesthesia did not have negative influence on the skin and esophageal temperature. The induced vasodilation of epidural and spinal anaesthesia caused an increase in the skin temperature with 1.7% of the initial values.

[Enzyme activity in the blood serum and lymphocytes of patients with chronic salpingo-oophoritis combined with benign tumors of the genitalia]. / Fermentnata aktivnost v seruma na kruvta i v limfotsitite na bolni s khronichen salpingooforit v suchetanie s dobrokachestveni tumori na polovite organi.

The activity of some enzymes was examined in blood serum and lymphocytes of women with chronic salpingo-oophoritis in combination with tumourous processes of the genital organs. The objects of the study were 96 women, divided into three groups: first group (control)-20 healthy women, second group-37 women with chronic salpingo-oophoritis and third group-39 women, who suffered from chronic salpingo-oophoritis together with tumours and tumourous processes of genital organs-uterine myoma, endometriosis, cysts and cystomas of the ovaries. The studies showed that in women with continuous course of inflammatory processes there were phenomena in the lymphocytes characteristic of tension of adaptation-compensatory reactions, but inhibition and lowering of the activity of energy metabolism was observed in women with tumours and tumourous processes at the same time. Lymphocyte acid phosphatase, asparataminotransferase, hydroxy-butiratdehydrogenase and lactatdehydrogenase appears to be a prognostic sign for early discovery of features of tumourous process in the female organism on the background of chronic inflammatory process of genital organs.

[Consciousness during anesthesia for cesarean section]. / Nalichie na suznanie po vreme na anesteziia pri tsezarevo sechenie.

47 women on which sectio cesarean has been done in occasion of belvic-fetal disproportion, anatomical abnormalities of the pelvis, bad position of presentation. We studies presence of consciousnes spontaneous realtion to pain and possibility for contact according the method of Tunstall M.E. It was proved that the use of benzodiazepin derivate--Dormicum impacts substantially influensences of the studied processes. Introduction anaesthetics (thiopental-kalipsol, dormicum-kalipsol and thiopental and helothan in 0.3%) are reliable protection against the operative stress during sectio cesarean and give adequate anaesthesia until baby is born.

[Dynamic biochemical indices of parturients with uterine inertia against a background of hyperbaric oxygen and drug treatment]. / Dinamika na biokhimichnite pokazateli pri rodilki s rodova slabost na fona na khiperbarno kislorodno i medikamentozno lechenie.

Acid-base balance, lactate dehydrogenase, creatine phosphokinase, hydroxybutyrate dehydrogenase, oxytocinase and the final products of peroxide oxygenation of lipids-malonate dialdehyde and antioxidant activity were studied on 60 parturients, divided into two groups as each group had 30 women. Hyperbaric oxygen treatment in combination with oxytocin was studied on uterine inertia. The control group consisted of 20 parturients with normal course of delivery.

[The function of the hepatobiliary system in patients who have had inflammatory diseases of the uterus and adnexa]. / Funktsionalno sustoianie na khepato-biliarnata sistema pri bolni, prekarali vuzpalitelni zaboliavaniia na matkata i adneksite.

The function of the hepatobiliary system was studied on 60 women, undergone inflammatory diseases in the uterus and adnexa. The women of the basic group (n = 60) were divided into two subgroups in accordance with the state of genital organs. The first subgroup (n = 39) included women with residual manifestation of chronic salpingo-oophoritis. The second subgroup (n = 21) included women with tumours and tumour-like processes of genital organs, occurred on the back ground of a continuous inflammatory process. The control group included 10 healthy women. Dynamic scintigraphy of the liver and gallbladder utilizing Tc99 radionuclide with short duration of life, was used to determine the functional state of the liver and gallbladder together with biochemical parameters of blood. The obtained results showed that there were significant changes in hepatobiliary system of women with residual manifestations of chronic salpingo-oophoritis. In women with tumours and tumour-like processes of genitals, occurred on the background of continuous inflammatory process, there were significant disturbances in the engulfing-depurating function of the liver and gallbladder of hypokinetic type.

Video-assisted thyroid resections in the treatment of papillary thyroid carcinoma.

UNLABELLED: One of the challenges of the minimally invasive video-assisted thyroid resections is their application for the surgical treatment of papillary thyroid carcinoma. AIM: To present our experience with the use of video-assisted thyroid resections with harmonic scalpel in the surgical treatment of patients with papillary thyroid carcinoma. MATERIAL AND METHODS: 259 patients with thyroid nodules were operated in our Clinic for a five-year period--from 2008 to 2013--via a video-assisted technique. Thyroid carcinoma was found in 53 patients (46 female patients and seven male patients, aged 18 to 52 years). The patients were selected according to the established criteria, developed and adopted in our Clinic. The resection was performed using endoscopic harmonic scalpel (Ultracision CS-14C; produced by Ethicon Endo-Surgery Care). The surgical incision length, extent of surgery, duration of operative time, type and incidence of complications (intraoperative and postoperative), period of hospital stay, and safety and radicality of the surgical procedure were examined. RESULTS: The length of the surgical incision was from 1.5 to 2.5 cm in all operated patients. The tumor size varied from 0.5 to 2.0 cm. Papillary carcinoma was found in 42 patients and follicular variant of papillary thyroid carcinoma--in eleven patients. Minimally invasive video-assisted thyroidectomy (MIVAT), using harmonic scalpel and 5 mm optics, was performed in 42 patients and video-assisted lobectomy with near-total resection of the contralateral lobe was performed in the remaining eleven patients. Lymph node micrometastases in the central cervical compartment were found in four patients. Draining of thyroid gland bed was performed in three patients. Transient hypocalcemia was found in one patient. All patients were discharged within the first 24 postoperative hours. CONCLUSION: Our results confirm that, if the criteria for selection of patients are followed, the video-assisted thyroid resections with harmonic scalpel have a place in the surgical treatment of selected patients with papillary thyroid carcinoma.