Diversity of mitochondrial D-loop haplotypes from ancient Thracian horses in Bulgaria.

The domestication of the horse began possibly more than 5000 years ago in the western part of the Eurasian steppe, and according to the leading hypothesis, horses first spread from the Steppe toward the region of the Thracian culture, starting in the second half of the 2nd millennium BCE and flourished from the fifth to first centuries BCE, mainly located in present-day Bulgaria. We analyzed 17 horse bone remains excavated from Thracian archaeological sites (fourth to first centuries BCE) in Bulgaria and successfully identified 17 sequences representing 14 different haplotypes of the mitochondrial D-loop. Compared with the mtDNA haplotypes of modern horses around the world, ancient Thracian horses in Bulgaria are thought to be more closely related to modern horses of Southern Europe and less related to those of Central Asia.

Is Sutureless Pancreaticogastrostomy More Effective than Single-Layer Duct-to-Mucosa Pancreaticojejunostomy in Pancreaticoduodenectomy?

Objective: The present study aimed to assess the safety of pancreatic anastomosis after pancreaticoduodenectomy (PD) and to compare the results of sutureless pancreatogastrostomy (PG) with those of single-layer duct-to-mucosa pancreatojejunostomy (PJ) after PD in patients with malignant disease of the pancreatic head and of the periampullary region.

Materials And Methods: The study included 173 consecutive patients undergoing PD from May 2009 to December 2015 at a single surgical center. Single-layer duct-to-mucosa PJ was performed in 52 patients and sutureless PG in the remaining 123.

Prognostic factors related to surgical outcome of liver metastases of breast cancer.

Purpose: The role of hepatectomy for patients with liver metastases of breast cancer (LMBC) remains controversial. The purpose of this study is to share our experience with hepatic resection in a relatively unselected group of patients with LMBC and analyse the prognostic factors and indications for surgery.

Methods: In 2000 to 2006, 42 female patients with a mean age of 58.

Anatomical preconditions for operative-technical errors in right trisectionectomy.

Objective: Certain anatomical variations may represent preconditions for technical operation errors in right trisectionectomy. These variations include: the confluence of the common bile duct, the length of the left hepatic duct, the localization of the bile duct confluence for segments 2 and 3 of the umbilical portion of the left portal vein and the peculiarities of the afferent and efferent blood supply of these two segments. The aim of the present study is to identify and discuss such preconditions.

Decompressive hemicraniectomy, strokectomy, or both in the treatment of malignant middle cerebral artery syndrome.

Objective: We sought to evaluate the impact of a craniotomy for strokectomy (CS) with bone replacement, decompressive hemicraniectomy (DHC), or DHC with a strokectomy (DHC+S) on outcome after malignant supratentorial infarction.

Methods: We conducted a retrospective cohort study of cases of malignant supratentorial infarction treated by CS (n = 18), DHC (n = 17), or DHC+S (n = 33) at our institution from 2002 to 2008. End points included functional outcome measured by the modified Rankin Scale and incidence of mortality at 1 year.

Repair of intracranial vessel perforation with Onyx-18 using an exovascular retreating catheter technique.

Numerous techniques have been described to treat intracranial vessel perforation during endovascular interventions. We describe a novel application of Onyx-18 for the treatment of intracranial catheter perforations by sealing the vessel from the outside while retracting the catheter into the arterial lumen.

Six rare biliary tract anatomic variations: implications for liver surgery.

Objective: The variations in the anatomy of the biliary tract need to be recognized in modern liver surgery. The purpose of this clinical and anatomical study is to describe several novel biliary tract variations and to outline their practical importance for liver resections and transplantations.

Materials And Methods: Over the previous 10 years, the anatomic variations of the bile ducts were examined during 600 intraoperative cholangiographies, 104 segmentectomies and 54 hemihepatectomies in patients with liver diseases.

Accessory hepatic lobe.

Purpose: The aim of the present communication was to describe an accessory hepatic lobe in two patients and to outline the significance of the timely identification of this very rare anatomic variation for the clinical practice.

Methods: In the course of right hemihepatectomy, accessory liver lobes were detected in two patients. Their diagnosis was confirmed by histopathology and cholangiography.

Benign perimesencephalic hemorrhage occurring after previous aneurysmal subarachnoid hemorrhage: a case report.

Introduction: Both aneurysmal subarachnoid hemorrhage and benign perimesencephalic hemorrhage are well-described causes of spontaneous subarachnoid hemorrhage that arise as a result of different pathologic processes. To the best of the authors' knowledge, there have been no reports of both vascular pathologies occurring in the same individual.

Case Presentation: A 51-year-old Caucasian woman with a history of aneurysmal subarachnoid hemorrhage presented five years after her initial treatment with ictal headache, meningismus, nausea and emesis similar to her previous bleeding event.

Endovascular revascularization of chronic symptomatic vertebrobasilar occlusion.

Background And Purpose: Acute basilar artery occlusion is associated with a high risk of stroke, mortality, and poor outcome in survivors. Timely vessel revascularization is critical to improve the clinical outcome in this condition. A subset of patients survives acute occlusion with mild or no disability and some of these individuals develop recurrent ischemic events despite optimal medical therapy.

In-stent thrombosis and stenosis after neck-remodeling device-assisted coil embolization of intracranial aneurysms.

Background: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms.

Objective: To examine the technical and anatomic factors that predict short- and long-term stent patency.

Methods: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device.

Endovascular treatment of basilar artery occlusion by manual aspiration thrombectomy.

Background And Purpose: Basilar artery occlusion remains one of the most devastating subtypes of stroke. Intravenous and intra-arterial therapy have altered the natural history of this disease; however, clinical results remain poor. Therefore, exploring more aggressive and innovative management is warranted.

Lower extremity monoparesis after aneurysmal subarachnoid hemorrhage.

Two patients presented with acute subarachnoid hemorrhage from a ruptured intracranial aneurysm. Both patients were treated via endovascular coil embolization, and both developed delayed lower extremity monoparesis without associated symptoms that resolved over the ensuing months. An extensive work-up lead us to propose the following hypothesis: the painless peripheral neuropathy likely resulted from nerve root irritation from abundant subarachnoid blood in the lumbar cistern.

Intraoperative computed tomography image-guided navigation for posterior thoracolumbar spinal instrumentation in spinal deformity surgery.

Object: Placement of thoracolumbar pedicle screws in spinal deformity surgery has a reported inaccuracy rate as high as 30%. At present, image-guided navigation systems designed to improve instrumentation accuracy typically use intraoperative fluoroscopy or preoperative CT scans. The authors report the prospective evaluation of the accuracy of posterior thoracolumbar spinal instrumentation using a new intraoperative CT operative suite with an integrated image guidance system.

Segmental liver resection for colorectal metastases.

Background: The question, whether to perform either a segmental, or a major liver resection if both procedures are technically feasible, continues to be under debate.

Methods: Outcomes from 188 liver resections for colorectal cancer liver metastases in the Naval Hospital of Varna in 2000-2007 were reviewed. All surviving patients were followed-up for a minimum of 2 years.

[Hepatocellular carcinoma complicated with echinococcal cyst of the liver].

Aim: We present a rare case of concomitant echinococcus and hepatocellular carcinoma in a single lesion, and discuss the possible pathogenesis.

Material And Methods: A 64-year-old woman was admitted to the hospital with a few months' history of weakness, weight loss and abdominal discomfort. Ultrasonography and computed tomography showed a cystic lesion measuring 10 cm in diameter in the segments 2 and 3 and multiple well-enhanced nodules adjacent to the cystic portion in the segments 4,5,8.

Cavernous malformation tumors: a case study and review of the literature.

Objective: To summarize the current literature on the surgical management of cavernous malformations of the cerebellopontine angle in accordance with the experience at our institution.

Methods: A systematic literature review on cavernous malformations of the cerebellopontine angle yielded 14 case reports relevant to the disease. In addition, the authors include their own report of a 16-year-old girl with such a lesion cured by surgical resection.

Endovascular treatment of atypical posterior circulation aneurysms: technical results and review of the literature.

Background: we report our technical success and complication rates in treating posterior circulation aneurysms at sites other than the basilar apex, superior cerebellar artery origin, or the posterior inferior cerebellar artery origin via endovascular embolization or sacrifice.

Materials And Methods: we retrospectively reviewed case records for patients undergoing coil embolization of atypical posterior circulation aneurysms from January 2003 to December 2007.

Results: thirty-two aneurysms in 32 patients were treated.

[Duct-mucosa pancreaticojejunostomy].

The subject of the study is operative-technical special features by fashioned a duct-mucosa pancreaticojejunostomy, which has been done by 15 patients. Three of the patients have been operated on a multivisceral caustic injury of an alimentary system and the rest twelve patients on a carcinoma of the pancreatic head or chronic pancreatitis. A subtotal duodenopancreatic resection has been performed on the cases with a carcinoma of the pancreatic head and chronic pancreatitis.

[Operative-technical special features of the left lobectomy in colorectal cancer liver metastases].

The indications of the liver resection are the primary and secondary malignant neoplasms of the liver, the benign liver tumors and some inflammatory diseases. Approximately 10-30% of the patients with colorectal cancer liver metastases are suitable to a curative liver resection. The aim of the study is to presenti of the operative-technical special features of the anatomical left lobectomy of patients with colorectal cancer liver metastases.

[A rare case of short bowel syndrome].

A rare case of short bowel syndrome combined with mechanical ileus due to numerous strictures of duodenum, a large part of the small and a half of the large bowel complicating radiotherapy after radical right nephrectomy for Wilms tumor 31 years ago was reported. The proximal 60cm of the jejunum were preserved only. A by-pass latero-lateral isoperistaltic retro-colonic gastrojejunoanal anastomosis was performed in combination with antiperistaltic interposition of 15cm of intact large bowel between the first proximal 40cm and the distal 20cm of the intact jejunum.