Current problems of deontology

The scope of knowledge in medical ethics continues to extend. Deontology as a science needs systematization of the accumulated data. This review may give impetus to classification of problems pertaining to this important area of medical activity.     

Revision total hip arthroplasty with cementing technique--five-year results.

AIM: To investigate the result of cemented revision hip arthroplasty. MATERIAL AND METHODS: Twenty-one revision hip arthroplasties for aseptic loosening with cementing technique during the period 1990-2002 were followed-up. There were 12 women and 9 men with mean age at the time of revision 61 years (33 to 76 years). The mean follow-up for the group was 5.2 years (range, 2 to 13 years). The clinical evaluation was performed with the Harris hip score. Implant survival, pain, function and complications were recorded. Plain radiographs were reviewed and the hips were graded for osteolysis and loosening. Wear of the polyethylene was measured. RESULTS: No component was exchanged. Three of the acetabular and three of the stem components in the hips with early cementing technique were loose. In two patients three surgeries were performed for trochanteric problems and persistent pain. Clinical result and bone defects preoperatively as well as wear and osteolysis correlated significantly. DISCUSSION: Stable fixation of the prosthesis is of paramount importance in revision surgery. In cases with severe bone defects stable interface is difficult to be achieved. This may change stress distribution and subsequently lead to loosening. CONCLUSION: Better preoperative planning and improvement in cementing technique may improve results. Other revision techniques may be considered in cases with severe bone deficiencies.     

Lung function and immunological changes in poultry breeders

Summary The results of the study of 61 persons occupationally exposed to the inhalation of dust from waste materials in chicken breeding are presented. The subjects were divided into three groups: 1. females in permanent exposure, 2. males in permanent exposure, 3. males in intermittent exposure. The following examinations were performed: case histories with special reference to symptoms of allergic alveolitis and/or chronic nonspecific lung disease, testing of skin hypersensitivity to allergens prepared from material collected in working places, blood analysis for the precipitins against chicken dropping and cock serum, testing of ventilatory lung function including measurements of residual volume, and testing of lung diffusion capacity. A very high prevalence of positive early and late skin reaction was found with no large differences between different groups of subjects. The highest percentage of precipitins was found in permanently exposed women. FVC, FEV₁ and MEF 25% values were significantly lower than predicted normal values. A statistically significant increase of the residual volume was recorded in all subjects in permanent exposure. Lung diffusion capacity in all the subjects was normal. The prevalence of acute respiratory symptoms indicative of allergic alveolitis was significantly higher in subjects in permanent than in those in intermittent exposure.     

Morphological changes in experimental duodenogastric reflux

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".     

Kainic acid microinjected into the cat raphe dorsal nucleus modulates the somatosensory evoked potentials and their cycles of excitability

Studies were made on the effect of the neuroexcitatory agent kainic acid, microinjected into raphe dorsal nucleus by glass micropipette and an air pressure system in doses ranging from 0.2 to 24.0 nmol (in volumes from 0.05 microliter to 0.47 microliter), on the somatosensory evoked potentials and their cycles of recovery (excitability) obtained from cortex (primary somatosensory and parietal associative), thalamus (ventral posterolateral nucleus and centre median nucleus), mesencephalic reticular formation and raphe dorsal nucleus. Kainic acid in doses higher than 3 nmol exerted an activating effect on the evoked potentials and their recovery cycles especially in thalamus and mesencephalic reticular formation. The analysis of these electrophysiological parameters revealed that the non-specific structures were involved to a larger extent in the activating effect of kainic acid than the specific ones. The morphological changes were not severe and were limited to a part of the raphe dorsal nucleus neurons. Our data indicate that kainic acid injected into raphe dorsal nucleus modulates (in direction of facilitation) the somatosensory evoked potentials and their cycles of excitability obtained in some brain structures. The results suggest that this nucleus is involved in the somatosensory information processing in a non-specific manner.     

Postoperative nausea and vomiting--possibility to prevent after long-lasting gynecological operations

The aim of this study is to establish the possibilities for effective influence upon the postoperative nausea and vomiting and to summarize the existing literature data. The observation is carried out upon 361 patients with performed hysterectomy, who were hospitalised at the Department of Obstetrics and Gynecology of the University Hospital "Saint George" Plovdiv for the period January-December 2003 year. We performed randomized study about the effect of the application of dexamethasone used in the introduction of anaesthesia and its effect upon the postoperative nausea and vomiting. Our observation confirms the literature data about the safe and effective application of dexamethasone as a method of choice for minimizing the frequency of the postoperative nausea and vomiting