Dreyfus Health Foundation
DHF, 205 East 64 Street, Suite 404
New York, NY 10021
Fax # 212-371-2776
Web page: http://www.dhfglobal.org
On November 10-12, a Problem Solving for Better Health workshop focused on hospital hygiene was held in Varna, with participants from St. Marina University Hospital – Varna and St. Anna Hospital – Varna. The workshop was organized by Dreyfus Health Foundation, the Association for Better Health - Pleven, the Bulgarian-Swiss Hospital Hygiene project, Medical University – Pleven, in collaboration with the management of St. Marina.
Problems of hospital hygiene, that can be identified and solved using the methodology of the Problem Solving for Better Health program were presented to the participants by Dr. Assen Pachedjiev, coordinator of the Bulgarian-Swiss Hospital Hygiene program.
The programs of Dreyfus Health Foundation were presented by Ms. Shelagh Murphy, international nursing program consultant. Mrs. Yanka Tzvetanova, country coordinator, presented the programs of Dreyfus Health Foundation in Bulgaria, run in collaboration with the Association for Better Health in Pleven.
The participants prepared plans of action, assisted by Ms Shelagh Murphy and the local facilitators - Assoc. Prof. Angelika Velkova, Mrs. Yanka Tzvetanova, Mrs. Evgeniya Dimitrova and Dr. Emilia Kanyouvska (Medical University – Pleven), Mrs. Polya Zhivkova (Alexandrovska Hospital – Sofia), Mrs. Slava Rouseva (Stara Zagora University Hospital) and Mrs. Gergana Momova (Medical University – Varna).
Plenary presentations: Dr. Assen Pachedjiev(left) and Ms. Shelagh Murphy
In December 2006, a follow-up workshop was organized in Stara Zagora with participants in the PSBHN workshop, held in June 2006. Details about the progress made by participants will be published in our next issue. Follow-up meetings are planned for participants in the Initiative for Better Children’s Health (Pleven, 2006) and PSBH - Hospital Hygiene (Dobritch 2005 and Varna 2006 workshops).
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From the organizing committee
HISTOLOGICAL RE-CLASSIFICATION OF CERVICAL “MIXED” CARCINOMAS WITH IDENTIFICATION OF MUCIN – PRODUCING CARCINOMAS
A. Kalcheva, L. Zamfirova, M. Nikolova
Department of General and Clinical Pathology
Medical University – Pleven, Bulgaria
Key Words: mucoepidermoid carcinoma, adenosquamous carcinoma, invasive cervical carcinoma
Eighty-one invasive cervical carcinomas, treated by radical hysterectomy during 2005, were histologically reviewed according to World Health Organization (WHO) criteria from 2003. Tumors were re-classified as follows: squamous carcinomas (70), adenocarcinomas (4) and adenosquamous carcinomas (5) cases. Two mucoepidermoid carcinomas were identified, using PAS-reaction with diastase as an indicator of mucin production. All tumors were clinically staged. A comparison between histological type of the tumors, patients’ age and clinical stage of the disease was done. The median age of the patients was 45 years. Both patients with mucoepidermoid carcinomas Stage III were under 40.
Conclusions: Mucoepidermoid carcinomas are rare tumors. Although not regarded as a separate entity, they have specific and well-defined morphology, which can be seen on H&E stain, and using of PAS-reaction with diastase as a routine stain is not necessary. It should be used for recognition of these tumors only in doubtful cases, because their association with poorer prognosis is not excluded.
PROTECTIVE EFFECTS OF MAGNESIUM OROTATE ON BRAIN ISCHEMIA IN RATS
D. Papazova, R. Totsev, P. Kostova, S. Konstantinov, D. Ferdinandov, K. Yakimova
Department of Pharmacology and Toxicology
Faculty of Medicine, Medical University – Sofia, Bulgaria
Key words: magnesium orotate, brain ischemia, neuroprotection
In brain ischemia, glutamate is released in excessive amounts, which lead to oxidative stress and damage. It is hypothesized that magnesium can prevent injury by regulating the activity of glutamate receptors. Magnesium orotate was used, which is known to pass through membrane barriers more easily as compared to other magnesium salts. The aim was to affect the mechanisms of ischemic brain damage through oral administration of the compound.
Brain ischemia was provoked by 20-minute bicarotid occlusion of male Wistar rats, maintaining constant body temperature during surgery. Magnesium orotate was administered for five days consecutively or once an hour before ischemia. Learning abilities and memory, locomotion, nociception and body weight were examined. Histological analysis of brain slices from the hippocampal region was done.
The groups treated with higher dose of magnesium orotate showed significant improvement of learning abilities and memory compared to the lower dose groups and the ischemic controls. No significant changes in locomotion, nociception and body weight were found. Histological analysis verified the results from the in vivo experiments. Magnesium orotate lead to improvement of the learning abilities and memory of the rats in higher doses independently of duration of treatment.
The data obtained suggest that magnesium orotate prevents cell death in transient forebrain ischemia by regulating the activity of glutamate receptors in the pathogenesis of neuronal damage.
APOPTOSIS - THE BIRTH OF A NEW CONCEPT IN MOLECULAR BIOLOGY OF CANCER
Department of Pharmacology and Toxicology
Medical University - Sofia, Bulgaria
Key words: apoptosis, extrinsic and intrinsic pathways, p53, BCL-2, cancer
Multicellular organisms have developed a highly organized and carefully regulated mechanism of cell suicide to craft the development of multiple lineages and to maintain cellular homeostasis. Normal development and morphogenesis proceed by the production of excess cells, which are then removed by a genetically programmed, evolutionarily conserved process. This same program of cell death is used by the organism to remove pathologically damaged cells, including virally infected cells.
Apoptosis or Programmed Cell Death is a specialized form of cell death that, in contrast to necrosis, does not generally provoke inflammation, unless something goes wrong with the clearing up. Apoptosis is a major barrier to oncogenesis, and suppression of apoptosis is a prerequisite for cancer formation. "Extrinsic" and "intrinsic" pathways for apoptosis have been described involving distinct upstream apical capiases. Capiases are cysteine proteases that cleave hundreds of cellular proteins and ultimately lead to a series of morphological changes characteristic of apoptotic cell death. Inhibitors of apoptosis proteins are a family of proteins that are able to inhibit apoptosis by directly binding and inhibiting specific caspases. The BCL-2 family of proteins comprises of both proapoptotic and antiapoptotic members, the balance of which determines whether or not a cell commits suicide - apoptosis. Up-regulation of antiapoptotic BCL-2 family proteins is common to many human tumors. The tumor suppressor p53 can prevent cells from becoming malignant by inducing growth arrest or inducing apoptosis. There are several proapoptotic transcriptional targets of p53, such as BAX, NOXA and PUMA, that promote cytochrome c release from the mitochondria. Oncogenic proteins, such as c-MYC, that possess mitogenic action also induce apoptosis unless a survival signal is also received - this mechanism may operate as a "failsafe" to prevent cancer formation if an oncogene become deregulated.
In the final throes of apoptosis, cells display "eat me" signals, like phosphatidylserine, and these signals are recognized by phagocytes such as macrophages, which then dispose of the corpse without provoking an inflammatory response.
CLEAVAGE OF THE FAS/FAS LIGAND BY MATRIX METALLOPROTEINASE-7 IN ADVANCED COLORECTAL CANCER
Institut Clinic de Malalties Hematologiques i Oncologique
Hospital Clinic de Barcelona, Catalunya
Key words: FAS/FASL, MMP-7, chemosensitivity, advanced colorectal cancer, Oxaliplatin
Introduction: The FAS (CD95) receptor is a cell surface protein that mediates apoptotic cell death on triggering by FAS Ligand (FASL/CD95L). This interaction leads to activation of the caspase cascade (apoptotic extrinsic pathway). Tumor cells frequently exhibit de novo expression of FASL. FASL expression on tumor cells could confer a double advantage to these cells by stimulating their own proliferation. FAS and FASL are also implicated in chemosensitivity through leading to apoptosis in response to DNA-damaging drugs. Today, the proapoptotic role of FAS and FASL has been well described but the function of their soluble forms as predictors of chemosensitivity remains unknown. Matrix Metalloproteinases (MMPs) are proteinases that play an important role in the tumor biology (tissue remodeling, tumor invasion, as well as distant metastasis). Matrix Metalloproteinase-7 (MMP-7) cleaves FAS/CD95. MMP-7 is of unique importance because it is produced by the tumor cells themselves at early stages of tumor development.
Aims: The aim of the present research is to show the effects of FAS/FASL cleavage by MMP-7 on the chemosensitivity of advanced colorectal cancer cells to Oxaliplatin.
Materials and Methods: Blood samples were obtained from 68 patients treated with Oxaliplatin in first-line therapy for advanced colorectal cancer. Specific ELISA techniques and different statistical methods were used.
Results: We analyzed the levels of soluble FAS (sFAS) and soluble FAS Ligand (sFASL). We found a significant increase in sFAS levels and significant decrease in sFASL levels after 3 months compared with baseline, and significant increase in sFASL levels up to 9 months of therapy compared with first to third extractions. We determined that less that 1.2-fold increase in sFAS/sFASL ratio was a marker of chemosensitivity (P=0.001).
Discussion: An increment of sFAS/sFASL ratio after treatment could be an excellent marker of chemosensitivity in advanced colorectal cancer. A decreased ratio can be a predictor of chemoresistance despite initial response. These findings can lead to clinical strategies that may become relevant to current cancer treatment.
DIAZEPAM DECREASES BRAIN DAMAGE AND TEMPERATURE IN A RAT NEUROINFLAMMATORY MODEL
P. Kostova, R. Totsev, M. Peev, D. Papazova, R. Nikolov, D. Ferdinandov, K. Yakimova
Department of Pharmacology and Toxicology
Faculty of Medicine, Medical University – Sofia, Bulgaria
Key words: Diazepam, neuroinflammation, lipopolysaccharide, hyperthermia
Lipopolysaccharide induces hyperthermia and brain damage mediated by endogenous inflammatory substances. It is supposed that diazepam decreases the activity of thermoregulatory hypothalamic neurons and antagonize the hyperthermia. Also, it stabilizes the membrane potential of neurons and cells are more resistant to oxidative stress during neuroinflammation. We aimed to affect the mechanisms of hyperthermia and brain damage due to lipopolysaccharide with administration of single dose of diazepam.
Neuroinflammation was provoked by intracerebroventricular injection of lipopolysaccharide (Escherichia coli, 200 mcg/10 mcl/10 min) in male Wistar rats (220-250 g). Immediately after that diazepam (5 mg/kg) was administered intraperitoneally. Rectal temperature was monitored with thermocouple for 5 hours. Learning abilities and memory (active avoidance test), locomotion (rota rod test), nociception (tail-flick test) and body weight were examined. Histological analysis of brain slices from the hippocampal region was made.
The group treated with diazepam showed significant (p<0. 05) temperature decrease in the first 4 hours in comparison with the group treated with lipopolysaccharide. The same was observed in the learning and memory tests. No significant changes in locomotion, nociception and body weight were found between groups. Histological analysis verified the results from the in vivo experiments.
Diazepam antagonizes the hyperthermia induced by lipopolysaccharide, probably by modulating the activity of the hypothalamic thermoregulatory center. Also, it improves the learning abilities and memory of the rats with neuroinflammation. The data suppose that diazepam influences the mechanisms of cell death and thermoregulation in neuroinflammation
HEALTH MANAGEMENT THROUGH APPLIED NUTRITION AND LIFESTYLE MODIFICATION
M. Sachdeva, G. Variaah, A. Nishit, K. Manish
Medical University-Pleven, Bulgaria
Key words: very low calorie diet (VLCD), coronary heart disease (CHD)
Nutrition is the science of food and its relationship to health concerns mainly the part played by nutrients in body growth, development, and maintenance whereas health is social, physical mental and spiritual well-being of a person .But now with the changing time scenario in the world is changing too mainly due intake of food lacking in essential nutrients. People are getting vulnerable to more diseases due to poor nutrition and sedentary lifestyle, obesity being the top most problems among them. The connection between obesity & premature death from diabetes, hypertension and CHD is well established.
Solution lies in change of life style through nutritional supplements aiming towards VLCD. And lastly, eliminating all the common myths related to eating and cooking habits prevalent in our society, which have been prevalent for a very long time. People need to be aware of the facts.
TOPOGRAPHIC RELATIONS AND ANATOMICAL VARIANTS BETWEEN SPLENIC ARTERY AND VEIN IN THE HILUS OF THE SPLEEN
N. Kovachev, D. Dardanov, P. Marinova, S. Trifonov, E. Ivanov
Department of Anatomy, Histology and Cytology
Medical University - Pleven
Key words: topographical relations, spleen, a. splenica, v. splenica
Detailed knowledge of topographical relations and positions of the splenic artery and vein is extremely important for surgical interventions in this area. The aim of the study is to define and further elucidate the topographic position of the vessels in relation to one another in the spleen hilus, for which purpose 25 spleens obtained from fixed cadavers were dissected. We defined two main topographic positions for the upper branch of artery above (67%) and below (33 %) the vein; two for the inferior arterial branch – in front (93. 4 %) and behind (6.6 %) the vein. These topographic variants have practical importance for the laparoscopic surgery in this area. The data could be used for surgery planning of partial resection of the spleen or total splenectomy.
THERAPIES AND CURES FROM THE TRADITIONAL CULTURE OF INDIA
S. Rathee, S. Ohri, S. Mann
Medical University- Pleven
Key words: traditional home remedy, India, therapy
Home remedies are prepared at home and work out less expensively than other alternative forms of medicines. Generally, homemade remedies are harmless when compared to other forms of modern medicines and rarely cause reactions or side effects. For ages, herbal remedies and homemade medicines have been used by our ancestors to cure common ailments. It might have been an experience-based or even accidental remedy or cure prepared from herbs, plants, or other available ingredients for common people when modern medical help was unavailable (or hadn’t been devised yet).
Defining home remedy as a treatment or cure for a disease or other ailment that employs certain foods or other common household items Home remedies usually have actual medicinal properties that serve to treat or cure the disease or ailment in question. A significant number of home remedies have been demonstrated to effectively treat conditions such as constipations, headaches, and even common cold. While some ailments require specific medications, others may be treated with simple home remedies that have withstood the test of time. Generations ago, people began using home remedies and have passed their knowledge on to their families as time progressed. Still, many are unaware of the large number of home remedies that can provide instant, safe and effective relief.
PANCREATIC RESECTIONS FOR MALIGNANT NEOPLASMS OF BILIARY-PANCREATICO-DUODENAL REGION
A. Dinets, O. Dronov
Ukraine, Kyiv, National O.O.Bogomolets Medical University, General Surgery Department №1
Key words: resection, pancreas, quality of life.
Introduction: Among tumors of biliary-pancreatico-duodenal region (BPDR) the malignant neoplasm occurs in the pancreas more frequently, and usually 60% neoplasms localize in the pancreatic head.
The aim of the study was to analyze experience and assess results of pancreatic resections for malignant neoplasms of BPDR during period 2003-2006.
Materials and methods: Seventy-seven patients (pts) with malignant neoplasms of BPDR were included in this study. There were 35 males, 42 females; mean age 52, 7 ± 5, 8 years (range 14-79 years). Pancreatic cancer (PC) was diagnosed in 40 pts, pancreatic malignant cystic neoplasm of pancreas – in 6 pts, cancer of papilla Vateri – in 17 pts, intraabdominal advanced malignant tumors with pancreatic involvement and metastatic pancreatic lesions – 13 pts, malignant neuroendocrine pancreatic tumors – in 1 pt. Pancreatoduodenectomy (PD) with extended lymphadenectomy were performed on 54 pts, central pancreatic resection – in 1 pt, distal pancreatectomy (PE) (standard and extended) – in 14 pts, total PE – 8pts. PC among these patients was defined as pT2-4 N0-1b M0 (TNM-classification of UICC 1997). Quality of life was estimated by using core questionnaire EQLQ-C30 and PAN-26 before operation and for 3, 6, 12 months (ms) after operation. All patients with PC received adjuvant chemotherapy 5-FU or hemcitabine.
Results and discussion: On the average, patients stayed in hospital for 10 days (range 5-32). Average blood loss in cases of PD was 700 ml (range 400 – 2500), volume of blood transfusion was 120 ml (0 – 300), time of operation was 360 min (240 – 960). Frequency of complications after PD was 32. 5% (25 cases in 19 pts), postoperative mortality was 13% (10 pts); median survival was 16 months, 3-year actuarial survival was 34%. Among patients who underwent PD for cancer papilla Vateri, 3-year actuarial survival was 32%. Mortality in the group of pts with intraabdominal neoplasms was 23% (3 pts); median survival time was 10.7 months. Among patients with PC who underwent biliary bypass, median survival was 7 ms, 3-year survival was 0%. Disease progress was diagnosed in 70% of the patients in a period of 7 ms after operation, the most frequent location of metastasis was in the liver.
Conclusions: Extended radical operations are important step of treatment patients with PC and tumors of BPDR that give chance to increase life’s period and improve quality of life.
SEX DIFFERENCES IN PROTEIN PEROXIDATION IN EXPERIMENTAL MODEL OF ABDOMINAL COMPARTMENT SYNDROME
A. Stróżyk, M. Sieczkowski, J. Meyer-Szary, Ł. Smyk, A. Szatewicz, J. Kobiela
Poland, Medical University of Gdansk, Department of General Endocrine and Transplant Surgery, Department of Medical Chemistry
Key words: abdominal compartment syndrome (ACS), peroxidative damage
Introduction: Abdominal Compartment Syndrome (ACS) represents the pathophysiological consequences of increased intra-abdominal pressure (IAP). Various clinical conditions are associated with this syndrome. The clinical research has shown that ACS can lead to the failure of heart, kidneys, lungs and metabolic disturbances of other organs. Decompression preceded by organ ischemia releases toxic metabolites and causes reperfusion-induced oxidative damage. Organ specificity and sex differences in peroxidative damage have not been deeply investigated.
Aims: The aim of this study was to estimate organ specificity and sex differences in oxidative damage of the particular abdominal organs exposed to abnormally high IAP.
Materials and methods: ACS was induced in 50 Syrian hamsters (25 females and 25 males) by IAP=30 mmH20 for 90min. with modified Hsu et al. procedure. The control group comprised 20 sham-operated animals with normal IAP. The liver, spleen, kidneys, stomach, large intestine and pancreas were retrieved 1 and 6 hours after decompression and frozen in the liquid nitrogen. The tissues of these organs underwent biochemical analysis.
Results: ACS can lead to peroxidative damage to abdominal organs. Organ specificity and damage severity depend on sex and duration of ACS. The severity of the damage was different in individual organs.
Discussion: The majority of males’ organs were more sensitive to the induced changes, which could be likely caused by lack of protective effect of female sex hormones-estrogens. The antioxidative effect of these hormones could possibly be used in prevention of peroxidative damage to the organs in ACS.
OMPHALOCELE COMBINED WITH ATRESIA OF THE ASCENDING COLON AND TOTAL AGANGLIONOSIS OF THE ATRETIC COLON - DIAGNOSIS AND OPERATIVE TREATMENT
A. Alexandrov, M. Mladenova, E. Dimitrova, I. Bakardzhiev
Medical University - Plovdiv, Bulgaria
Key Words: omphalocele, colonic atresia, total aganglionosis
Introduction: Omphalocele, colonic atresia and total aganglionosis of the atretic colon are individually rare congenital malformations. An association between colonic atresia and total aganglionosis has been reported, but the co-occurrence of all three malformations has been described only in few reports.
Aim: The aim of the study was to present two very rare cases of combined defect, manifested as omphalocele with atresia of the ascending colon and total aganglionosis of the atretic colon, as well as the diagnostic and therapeutical approach towards the patients.
Materials and methods: The cases of two girls with omphalocele are presented, with concomitant atresia of the ascending colon. The girls underwent a three-stage surgery. Microcolon due to total aganglionosis of the atretic colon was found in the course of the investigations. This required a total colonectomy by using Soave - Lenuishkin's operation.
Results: The staged operative interventions had no surgical complications. The girls had short bowel syndrome, which required parenteral nutrition with gradually reduced dosages of aminoacid and glucose solutions. The children showed a stable tendency to gain weight in a hospital setting.
Discussion: These cases represent three uncommon congenital malformations occurring in a single patient. The association between the three congenital abnormalities is described only in few reports. This very rare abnormality causes great diagnostic and therapeutical problems.
Conclusion: Children with such a rare abnormal combination require an individual approach and individually determined diagnosis and surgical tactics.
EARLY EXTERNAL OSTEOSYNTHESIS IN THE FRACTURES OF PELVIS
Nicolae Testemitanu State Medical and Pharmaceutical University, Chisinau, Moldova
Key words: external osteosynthesis, pelvis fractures, bleeding
Introduction: Massive bleeding is a major cause of death of patients with severe unstable pelvic injuries. The source of this hemorrhage is the injury of intrapelvic magistral blood vessels, presacral vein plexus and one around the urinary bladder and big vessels of spongy pelvic bones.
Aim: to reveal the main causes of intraosseous bleeding in pelvic bones fractures and to ground the necessity of external fixation in the early terms of treatment.
Materials and methods: This study is based on literature references of pelvic injuries treatment, our materials of morph pathological research of 12 subjects with pelvic fractures. We also observed the clinical and radiological dynamics in 17 patients (one group) with multiple pelvic fractures after osteosynthesis by device for reposition and fixation of pelvic bones and 8 patients (two groups) that were treated conservatively. The morphological studies demonstrated that the main extraorganic arteries of pelvic bones were the branches of internal iliac arteries; they had not been injured in all the cases. However, there were retroperitoneal and intrapelvic hematomas because of bleeding from spongy bone.
Results: In the first group, the patients were most active after external pelvis osteosynthesis. We did not observed the clinical signs of retroperitoneal hematoma. This proves a tamponade haemostatic effect as a result of pelvic ring stabilization and bone fragments reposition. On the 3rd-5th day we diagnosed perineum hematoma spreading to the internal surface of femur in some patients in the first group who had undergone a delayed pelvis osteosynthesis and in patients of second group. Some of them have had different dysuric disorders right up to complete anuria, intestinal paresis. The main cause of these complications is an uncontrolled massive bleeding, caused by fragment displacement and injury of the intraosseous vessels.
Conclusions: pelvis fractures are always accompanied by injuries of nutritive vessels; in the first 24 hours pronounced hypovolemia is developed, large retroperitoneal and intrapelvic hematomas are formed. Reposition and fixation of pelvic bones provides a stabilization of pelvis fragments and prevents the development of massive bleeding thus improving treatment results.
Does the ILIAC LyMPH NODES ARE INVOLVED IN MIDDLE AND LOWER RECTAL CANCER?
D. Dimitrov1, T. Deliyski1 , D. Dardanov1, M. Donchev2, I. Ivanov1 , N. Semerdjieva1
1Department of Surgical Oncology, University Hospital-Pleven
2 Clinical Center of Nuclear Medicine, University Hospital-Pleven
Medical University - Pleven, Bulgaria
Key words: iliac lymph nodes, rectal cancer, ILN biopsy
Introduction: Most surgeons believe that the iliac lymph nodes (ILN) are not important for lymph spread of rectal carcinoma. Nevertheless, the 6th edition of TNM classification defines ILN as regional for rectal cancer.
Aim: To find if there are metastases in the ILN in patients with middle and lower rectal cancer (MLRC).
Methods and Materials: Thirty consecutive patients with MLRC were operated with different staging and localization: low anterior resection with TME (19 patients), abdominoperineal extirpation (7 patients), Hartman resection (2 patients) and intersphinteric resection (2 patients). Two versions of sentinel lymph nodes mapping were made: version 1 – preoperative radionuclide method, combined with intraoperative injection of Patent Blue and Indocyanine green and version 2 - intraoperative injection of Patent Blue and Indocyanine green. If no data for Sentinel lymph nodes were found, an observation of pelvic walls and sampling biopsy followed.
Results: Three patients macroscopic suspected for lymph node metastases were found, 1-3 sampling biopsy removed lymph nodes (0.73 % per patient); SLN dye or radionuclide mapped ILN were found in 6 patients. Metastases were found only in one of the three macroscopically suspected patients.
Conclusion: The three methods of ILN biopsy yield results that do not support the theory of common ILN metastases (10-15%). Our research shows that there are sentinel ILN in MLRC in 20 % revealed by lymphatic mapping techniques, basically in local advanced tumors pT3, T4 - 83%. MLRC was proved to produce metastases in ILN only in 3 % of our patients.
A CASE OF MERKEL CELL CARCINOMA IN PATIENT WITH PAST MEDICAL HISTORY SIGNIFICANT FOR GELATINOUS CARCINOMA OF THE BREAST
I. Ivanov 1, G. Baitchev 1, T. Betova 2, I. Nenov 1, V. Rizov 1
1 Department of Surgical Oncology, Circle of Surgery
2 Department of General and Clinical Pathology
Medical University -Pleven, Bulgaria
Key words: Merkel cell carcinoma, breast carcinoma, immunodeficiency, chemotherapy, radiotherapy
INTRODUCTION: Merkel cell carcinoma MCC is a rare malignant primary cutaneous neoplasm with epithelial and neuroendocrine differentiation. Main risk factors for this malignancy are age over 70, UV-radiation and immunodeficiency (acquired or congenital).
MATERIALS AND METHODS: The case of a 58-year-old female with non-tender plaque of pink-red color, histologically proven as MCC was revealed through a retrospective analysis of tumor registries from the University Center of Oncology Pleven. Her past medical history showed that she had suffered from gelatinous carcinoma of the breast. Her clinical records and pathology specimens were reviewed.
RESULTS: Light microscopy and immunohistochemistry showed histological findings, typical for MCC. Our patient was in stage II of the disease.
Curative measures such as surgery, adjuvant radiotherapy, dissection for clinically positive nodes and chemotherapy were taken. Despite all curative measures the MCC showed a rapid progress. The patient died from MCC within one year. Radiation therapy was effective in palliating symptoms resulting from the systemic disease.
CONCLUSIONS: When MCC appears after pervious malignancy, it shows proclivity towards rapid progress. In this case, the early appearance and fast progress were due to the immunosuppressive effect of chemotherapy and radiotherapy which the patient received during treatment for her breast carcinoma. Patients with a history of previous malignancy who develop MCC have low survival chance.
PATHOLOGIC NIPPLE DISCHARGE- CLINICAL AND MORPHOLOGICAL CHARACTERISTICS, DIFFERENTIAL DIAGNOSIS
I.Ivanov 1, G. Baitchev 1, S. Tomov 2, I. Nenov 1, P. Vasilev 1, T. Ignatova 1, T. Betova 3
1Department of Surgical Oncology,
2Circle of Surgery Department of Gynecology
3Department of General and Clinical Pathology
Medical University -Pleven, Bulgaria
Key words: nipple discharge, papilloma, duct ectasia, breast cancer
Introduction: Spontaneous nipple discharge can be due to some pathological changes in the breast or neuroendocrine abnormalities. It is associated with breast cancer in 10 to 15 % of the cases.
Aim: The aim of the study was to investigate clinical and morphological characteristics of nipple discharge in patients suffering from the most frequent diseases that cause it.
Materials and Methods: The study included 59 consecutive female patients, treated surgically in the Department of Surgical Oncology for pathological spontaneous nipple discharge. In 25 of the cases, duct ectasia was obtained and it was both clinically and histologically verified. In 21 cases, the cause of spontaneous nipple discharge was intraductal papilloma or papillomatosis. Breast cancer was found in 13 cases. Data concerning risk factors, symptoms and their duration, localization and type of the discharged secretion, as well as other parameters were revealed and systematically studied.
Results: Our results showed that in the cases of intraductal papilloma the nipple discharge was usually from one single duct in one breast and had a serous-hemorrhagic appearance. In the patients suffering from duct ectasia the nipple discharge was usually from two or more ducts and affected both breasts. It was yellowish or brownish in color. In 50% of all cases there was data significant for local inflammatory processes. In the cases with breast cancer, the nipple discharge was usually from one single duct in one breast and had serous-hemorrhagic appearance and often a tumor formation was palpated.
Conclusion: Despite the fact that in most of the cases the spontaneous nipple discharge is not due to oncological disease, this symptom needs careful diagnostic investigation and appropriate treatment.
HEMIARTHROPLASTY OF THE SHOULDER – MID-TERM RESULTS
I. Černohousová, T. Pink, A. Chaker, J. Stoklas
Medical Faculty, Clinical Department of Orthopedics
Brno Masaryk University, Czech Republic
Key words: shoulder arthroplasty, proximal humerus, fracture
Introduction: The most frequent indication for the shoulder arthroplasty is acute trauma and posttraumatic states of proximal humerus. Non-traumatic indications are less frequent, mostly caused by osteoarthritis or rheumatoid arthritis.
Aims: The aim of the clinical study was to assess mid-term results of the shoulder arthroplasty in traumatological indications.
Materials and Methods: The group of 33 patients was observed after shoulder arthroplasty. Twenty-two of them turned for follow-up. These patients were divided into two groups according to indication: acute trauma (12 cases) and posttraumatic state (10 cases). The function of the shoulder was assessed using a modified Constant Scoring System. The following three types of implants were used – the Global Fix Shoulder Fracture System, Beznoska and Neer II.
Results: In patients with acute trauma, the average follow-up period was 23 months (range 1.5-87) and the average Constant Score was 56.6 points – good result (range 30–78). In patients with posttraumatic state, the average follow-up period was 64 months (range 36.5-118.5) and the average Constant Score was 56.2 points – good result (range 16–90).
Discussion: The Constant Score values measured in our study are comparable with those reported in literature. There were expectations for better average outcomes in the acute trauma group than in the group with posttraumatic state. In our study, the outcomes in both groups were almost same. Furthermore, the average follow-up period in the acute trauma group was significantly shorter and, in the majority of the cases, not long enough to achieve optimal shoulder function. Further improvement of the shoulder function in this group is expected.
USEFULNESS OF SF-36 SCALE IN EVALUATING LIFE QUALITY IN PATIENTS WITH CHRONIC ISCHEMIA OF LOWER EXTREMITIES
K. Gniadek, K. Kobryń
Medical University of Warsaw, Poland
Key words: quality of life, chronic ischemia of lower extremities
The SF-36 scale was used in this study as an instrument of the general group (a non-specific scale for vascular diseases) to evaluate the quality of life in patients with chronic ischemia of the lower extremities after an abdominal aorta operation.
Out of a group of 127 patients who underwent surgery on the aorto-iliac segment in the Vascular Surgery Ward of the Wolski Hospital in Warsaw in the years 1999-2004 and were invited , 60 presented at the Hospital to take part in the study (13 females and 47 males, aged 47-80, mean age 63). Apart from completing the SF-36 scale questionnaire, the patients underwent physical examination and were asked questions to determine their clinical condition (intermittent claudication distance, pulse presence in the extremities) as well as other burdening factors (age, nicotine consumption, history of accompanying diseases, such as diabetes, hypertension, cardiac ischemia, infarction or stroke), the influence of patients’ professional activity also being taken into account.
All the collected numerical data were processed using SAS (version 9) which allowed to establish a statistically significant correlation between improvement of the clinical state of the patient and evaluation of individual aspects of the life quality scale in relation to the times elapsed after the operation, after excluding factors such as: age (r=0.47; p=0.0002), claudication distance prior to operation (r=0.45; p=0.0004), education (r=0.48; p=1.0001), nicotine consumption (r=0.45; p=0.0004). The correlation coefficients referred to above concern one of the main SF-36 aggregation points which is the so-called general feeling of being in good health.
The obtained favorable correlations between the SF-36 scale results and the clinical condition evaluated on vascular examination seem to confirm that the SF-36 scale can constitute a good instrument in the evaluation of the results of a therapeutic procedure in patients with chronic ischemia of the lower extremities.
ASSESSMENT OF ANGIOPLASTY OF CAROTID ARTERY IN PATIENTS WITH CONTRAINDICATION TO SURGICAL TREATMENT
M. Jaguszewski, M. Duda, E. Masiewicz
I Department of Cardiology
Medical University of Gdansk, Poland
Kew words: carotid arteries, angioplasty, neuroprotection
Introduction: Arteriosclerosis changes in carotid arteries are responsible for one fourth of all strokes. The incidence of carotid artery stenosis is about 0.5% after the age of 60 and increases to more than 10% in octogenarians. Until now, endarterectomy has been the gold standard in treatment of carotid artery atherosclerosis. However, recently introduced endovascular procedures seem to be at least as effective as endarterectomy, which has been proved in many clinical studies. Stenting the carotid arteries (CAS) with the use of neuroprotection devices is a promising method of treatment of carotid artery stenosis.
Aims: The assessment of efficacy and safety of carotid artery stenting in the early period (30 days) and in a long-term observation.
Materials and methods: The group studied consisted of 31 patients (13 females, 18 males) with hemodynamically significant stenosis of a carotid artery, who had undergone stenting of carotid artery with neuroprotection, hospitalized in two departments (Department of Neurology and First Department of Heart Disease) of Medical University in Gdansk. The average age of the patients was 65±10 years. In 72% of the patients, the stenosis of carotid artery was symptomatic. 32% of the patients had had myocardial infarction. The average stenosis before PTA was 85±8%. In the studied group, 12% of the patients had restenosis following endarterectomy of carotid artery, 48% had contraindications for endarterectomy, and in 40% the primary CAS had been applied.
Results: Residual stenosis after PTCA procedure was 9.6±9, 1%. In 12% of patients there occurred undesirable reactions such as local haematoma (4%), hypotonia (4%), and headache (4%). These reactions disappeared 72 hours after the PTCA procedure. In the periprocedural period and the 30-day observation of our study group, neither stroke nor cardiovascular complications were observed (0%). There was no difference in the results from treatment in the groups with and without contraindications for surgical endarterectomy. In the long-term analysis of the study group there was one death.
Discussion: Our results confirm the safety and efficacy of CAS procedure in treating carotid artery occlusions in group with and without contraindications for surgical endartrectomy.
IMPORTANCE OF KNOWING ANGIOGRAPHIC CHARACTERISTICS OF THE TENSOR FASCIAE LATAE VASCULAR STALK
M. Icevic, T. Dakic
Medical Faculty Podgorica, University Of Montenegro
Key words: angiography, (lateral femoral circumflex artery (ACFL), external circumflex artery)
Atherosclerosis is the most important and most common type of arteriosclerosis, a general term for several diseases in which the wall of an artery becomes thicker and less elastic. The most common location for occurrence of atherosclerosis are arteries of lower extremities, while arteries of upper extremities, as well as visceral arteries are far less and far rarely affected with this degenerative process.
The most frequent ones are occlusive changes on bifurcation of the abdominal aorta (aortoiliac obstructive atherosclerosis “Morbus Leriche”), trunk of the femoral artery and initial part of the popliteal artery (femoropopliteal obstructive atherosclerosis).
Angiography, as an additional method in medicine, gives the most precise insight in anatomical changes on blood vessels. With intention of estimating a possibility of using a slice (lobe part) of the tensor fasciae latae (m.TFL) in plastic and reconstructive surgery, we have analyzed 50 angiograms of femoral arteries. The first group included Morbus Leriche patients (25 analyzed angiographies), while the second one was made of patients with femoropopliteal segment disease (also 25 analyzed angiographies). With angiographic analysis of the lateral femoral circumflex artery (ACFL) and its branch, which is dominant in vascularization of m.TFL slice, we discovered that the diameter of its source, as well as of its branches, is bigger in cases of femoropopliteal segment disease. Then reduction of the source diameter of ACFL and its branches, caused by vascular disease, leads to decreased blood supply of m.TFL, diminishing its quality and limiting its usage in surgery.
In Morbus Leriche cases, m.TFL slice cannot be used in plastic and reconstructive surgery, its quality being deteriorated due to low vascularization. In femoropopliteal segment disease cases, thanks to normal blood supply, m.TFL slice can be widely used for reconstructions or covering defects, especially in inguinal region, which is the most common place for infections in vascular surgery. Good cognition of angiographic characteristics of m.TFL vascular stalk is of great importance for prevention of its necrosis before using it for surgical purposes.
FIBROADENOMA OF THE BREAST – CLINICAL AND MORPHOLOGICAL CHARACTERISTICS AND RISK OF DEVELOPMENT OF BREAST CANCER
P. Vasilev 1, I. Ivanov1, I. Nenov 1, S. Gocevska 1, T. Ignatova 1, S. Tomov 2, M. Vasilev 1
Department of Surgical Oncology, Circle of Surgery 1
Department of Gynecology 2
Medical University -Pleven, Bulgaria
Key words: fibroadenoma, breast cancer, symptoms
Introduction: Fibroadenoma (FA) is one of the commonest benign breast lesions in pre-menopausal women.
Aim: The aim of this study was to analyze both clinical and morphological aspects of FA and the relative risk for breast cancer development in patients with FA.
Materials and Methods: One hundred and ninety-four cases both histologically and clinically verified as FA were revealed in a retrospective analysis of tumor registries at the University Center of Oncology Pleven. Data concerning risk factors, duration of symptoms, localization and other diseases that occur with FA was revealed and systematically studied.
Results: Our results showed that the commonest age during which the FA is due to appear, was between 20 to 29 years- 90 cases (47.7%) and women after the fourth decade of their life were the ones least likely to develop FA- 13cases(6.7%). The commonest pathomorphologic type of FA was the intracanalicular type - 85 cases (43.8%), followed by the pericanalicular type -69 cases (35.6%). The mixed type of FA was obtained in 40 cases (20.6%). Thirty-nine of our patients had other benignant diseases of the breast that occur with FA (20.1 %). In only one patient there was a carcinoma in situ, arising within a FA (0.5 %).
Discussion: Despite the fact that the FAs do not have malignant potential, the presence of epithelial components within the FA should always be considered and increased attention should be paid, especially to older patients.
DETECTION OF THE SENTINEL NODE
IN EARLY-STAGE BREAST CANCER
R. Pascanu, V. Pascanu, V. Rusu, L. Raileanu
Faculty of Medicine, Department of Nuclear Medicine
UMF „Gr. T. Popa” Iasi, Romania
Key words: sentinel node, breast cancer, gold standard
The purpose of this paper is to establish the role of the sentinel node in the algorithm of imaging explorations of the breast cancer.
Material and Methods: The group we studied included 44 female patients with breast cancer. This diagnosis was identified using computerized mammography, ultrasound examination, and fine-needle biopsy. From November 2003 until October 2004, we selected only the patients with primary breast cancer in whom the tumor was less than or equal to 2 cm in diameter shown at ultrasonography. The technique we used was injecting 4 x 40MBq of 99mTc-Nanocis (nano-particles with a diameter of 100nm) around the primary tumor.
The images were acquired after an hour and a half from the injection of the radiopharmaceutical agent, using a dual-head gamma camera Axis-Philips, identical with the one from the Department of Nuclear Medicine in St. Spiridon Hospital, Iasi.
The sentinel node is the first lymph node reached by metastasizing cells from a primary tumor. Use of this method can obviate the need for total axillary lymph node dissection in patients with a negative sentinel node (without lymph node micrometastases), thereby reducing postoperative morbidity (especially superior limb lymphedema) and hospitalization costs.
Results: In our study group, the sentinel node was visualized in 91% of the cases (40 patients); in 9% of the cases (4 patients) the sentinel node was not noticed even on the late images acquired after 12 hours. In 16% of the cases (7 patients) more than 3 sentinel nodes were identified, which led to classical surgery (excision of the tumor with total axillary lymph node dissection).
The study was made during a period of probation in France. Our desire is to also apply this method at the St. Spiridon Hospital Iasi in the closest future.
Conclusions: Identifying the sentinel node for 75% of the cases (33 patients) made it possible to avoid the axillary lymph node dissection in these patients. Reference studies relate with a low rate of relapsed metastasis (less than 1%). Sentinel node technique is predicted to become a gold standard method. It is noninvasive and easy to apply. For other types of cancer such as thyroidal cancer, malignant melanoma, neoplasm of cervix uteri, etc., the sentinel node technique is also used.
OCULAR LYMPHOMA (CASE REPORT)
Medical Faculty, Skopje, Macedonia
Key words: lymphoma, vitrectomy, uveitis
Introduction: Non-Hodgkin’s lymphoma can start in the eye. It is called ocular lymphoma when it has not started elsewhere, including the CNS (brain). It represents a difficult extranodal site to treat, and 77% of patients eventually develop cerebral involvement.
The most common ocular symptoms are blurred vision and floaters. Vision is often decreased. Although the disease may begin in one eye, bilateral involvement is common after several months. Fundus examination often shows subretinal yellow infiltrates.
Aim: To present a patient - male, 49 years old, who first noted decreased vision in the left eye in November 2004, then in the right eye in January 2005. He was examined by his ophthalmologist, who diagnosed "retinal inflammation." He was treated with prednisone 50 mg/day and prednisolone acetate (1%) every hour in both eyes. His vision improved minimally with the treatment. He was examined by a neuro-ophthalmologist, and had an MRI of the brain, which was normal.
The patient was referred in April 2005. The anterior segment examination results and intraocular pressures were within normal limits. The examination of the right fundus showed some attenuation of the retinal vessels and multiple creamy yellow-white lesions at the level of the RPE and superior to the optic disc. In the left eye multiple small yellow lesions were present throughout the posterior pole.
The patient underwent diagnostic vitrectomy of the right eye in May 2005. Cytological study of the vitreous specimen revealed markedly atypical lymphoid cells, suspicious for lymphoma. A complete neurological workup including neurological history, physical examination and MRI of the brain were all negative. In July 2005, radiation therapy was administered. Vision improved and the deep retinal lesions began to regress.
A year later, the patient started experiencing memory loss. An MRI of the brain showed a large mass in the splenium of corpus callosum. Brain biopsy of the lesion revealed CNS B-cell lymphoma. The patient was treated with chemotherapy and radiation therapy.
Discussion: Intraocular (large cell) lymphoma should be suspected when chronic uveitis is poorly responsive to corticosteroids, and when there is a characteristic vitritis with deep retinal lesions. Steroids can be cytolytic to CNS lymphoma cells. This sensitivity to steroids contributes to the difficulty in diagnosing this disease, since many patients with intraocular lymphoma are treated with corticosteroids at the time of vitrectomy for presumed chronic uveitis.
IS MMF EFFICIENT IN THE THERAPY OF IEG WITH NEPHROTIC SYNDROME, OR ARE WE JUST INTOXICATING OUR PATIENTS?
E. Mihajloska, Mentor: B. Dussol
Medical faculty ”St. Cyril and Methodius”, Skopje, Republic of Macedonia
Key words: glomerulopathy, Mycophenolate mofetil (MMF), nephritic syndrome
Introduction: Glomerulopathy (GN) is a disease characterized by structural or functional changes which occur initially and primarily in the glomeruli, most often caused by the deposition of immune complexes in the glomerulus. Proteinuria is the most prominent sign of membranous GN. Therapy for immune complex GN may include removal of antigens, correction of immunologic disturbances, inhibition of inflammation, coagulation and supportive and symptomatic therapy. Efficiency of treatment with immunosuppressors is questionable in the treatment of IEG with nephritic syndrome. Mycophenolate mofetil decreases proteinuria in the non-controlled studies of IEG.
The aim of the study: to show the significance of treatment for idiopathic extramembranosus glomerulopathy with nephrotic syndrome with Mycophenolate mofetil MMF in a randomized study.
Patients and methods: We carried out a made a multi-center pilot study to evaluate the efficiency and effects of MMF in 31 adults with IEG who had been recently diagnosed with nephrotic syndrome without renal insufficiency. Patients were randomized to receive (group A, n= 16) symptomatic treatment (IEC or ARA2 + diuretic + statines + hypo sodium regime) and group B n=15 that would receive the same symptomatic treatment plus MMF 2g/day for one year. Principal criteria of judgment were the evolution of the relation between proteinuria and creatininuria (Pu/creat, g/mmol) in effects of the treatment at a given time. Complete remission (RC, Pu < 0.3 g/day) and partial reemission (RP, Pu <3 g/day with stable creatinemia) were also studied for one year. The patients were 29 males and 2 females, aged 51±15 years, IMC 26±3, Pu/creat at the beginning of 0.74± 0,75, albuminemia 21±7 g/l, creatininemia 95±33 mol/l. Nine patients were hypertensive, and 4 had diabetes type II.
Results: The ratio between Pu/creat (proteinuria/creatinemia) was not significantly different in the 2 groups within the time (0.25± 0.47 in group A, and 0.01±0.31 in group B, p=ns), in group A, 1RC and 1RP were found opposite to 1RC and 3RP noted in group B. The renal function had not changed and had remained normal and equivalent in both groups.
Conclusion: In patients - carriers of IEG with nephritic syndrome, the treatment with MMF for one year does not modify the debut of proteinuria in correlation with creatinuria nor the number of RC and RP in comparison with regular symptomatic treatment.
THE INFLUENCE OF A PROCEDURE SUCCESS ON PROGNOSIS AFTER CTO RECANALIZATION OF CORONARY ARTERIES
M. Duda, E. Masiewicz, M. Jaguszewski
Medical University of Gdańsk, Poland, I Department of Cardiology, Gdańsk, Poland
Kew words: chronic total occlusion, coronary arteries
Over the last decade, we have
observed very intensive development of percutaneous coronary
intervention techniques (PCI). Despite the ongoing technological
progress and the introduction of more advanced equipment, the group of
chronic total occlusions (CTO) of coronary arteries remains a challenge.
Technical difficulties imply higher exposure to contrast media and
radiation; simultaneous clinical benefits of re-canalization of the CTO
are not well documented yet.
Methods and materials: The study group included 426 patients (72.5% males, 27.5% females) who underwent the PCI of the CTO in Department One of Heart Diseases in Gdansk between 2003 and 2005. We analyzed the frequency of occurrence of adverse events and CCS angina class in group with (1) successful procedure and in (2) group with procedure failure. The data from at least 6 months follow-up was collected through phone calls, using a special form.
Results and discussion: The results of the study showed considerable improvement in patients with angina symptoms after effective re-canalization of the CTO (improvement of the CCS in 84.5% of the patients), as compared with the patients where re-canalizations failed.
Мoreover, the patients with ineffective re-canalization of the CTO had to undergo the CABG much more often than the patients with effective re-canalization of the CTO. The analysis of angiographic parameters of primary lesion showed statistically significant association of vessel size ( arteries < 2.5 mm in diameter – 73.4% ineffective re-canalizations of the CTO; p<0,01) and side branch take-off from occlusion side (branches are present in 66.5% of ineffective CTO re-canalizations; p=0,02; OR=2.3), with procedure outcome.
A CASE OF BARTTER’S SYNDROME
M. Spasova, S. Ganeva, M. Petkova
Medical University – Pleven, Bulgaria
Key words: Bartter’s syndrome, hypokalaemia, hypomagnesaemia
Bartter’s syndrome is a rare disorder, manifested by primary inherited renal tubular hypokalaemic metabolic alkalosis, marked elevation in plasma renin and aldosterone activity, pressor insensitivity to angiotensin II and normal or low values of plasma sodium, plasma chloride, low blood pressure and hyperplasia of the juxtaglomerular apparatus. Bartter’s syndrome is an autosomal recessive disease. We reported a case of 21-year-old man who was referred to the Clinic of Endocrinology one week after tetany associated with hypokalaemia, severe muscle weakness and fatigue. The blood pressure of the patient was 100/60 mm Hg. Chest, heart and abdomen examinations were normal. At presentation, the following results were obtained: WBC - 10.3x109 (41% lymphocytes), hemoglobin - 107g/l, RBC - 3.6x106, serum creatinine 128 µmol/l, creatinine clearance 64 ml/min/1.73m2, uric acid 711µmol, with normal serum total protein and serum albumin. Serum potassium was 2.4mmol/l, sodium - 148mmol/l, chloride - 97mmol/l, magnesium - 0.9mmol/l. A remarkable metabolic alkalosis was present: pH 7.6. Marked elevations of aldosterone (226pg/microg.) and renin (16.1ng/microg/h) plasma levels were found, while the abdominal computerized tomography was normal – no tumor formation were found. The condition of the patient improved slowly. Bartter’s syndrome can be subdivided into at least three clinical phenotypes with different clinical entities: the hypercalciuric antenatal Bartter's or hyperprostaglandin E syndrome; the classic Bartter’s syndrome and the hypocalciuric–hypomagnesaemic. We concluded that the patient had a Gitelman Syndrome because of late manifestation of the disease.
RESEARCH OF THE CONNENCTION BETWEEN AGE AND DEVELOPMENT OF ACUTE MYOCARDIAL INFARCTION AMONG PATHIENTS WITH DIABETES MELLITUS
A. Parashkevova, N. Ivanova, I. Bankova, M. Petkova
Medical University - Pleven; Bulgaria
Key words: IMA, DM, primary and secondary prophylaxis
Myocardial infarction is
among the most common diseases of the cardiovascular system. Its
development is promoted by different etiological factors. In this study,
we made a research at the Intensive cardiologic clinic (ICC) of the
University Hospital – Pleven. The patients were divided in groups
according to age, and presence or absence of Diabetes Mellitus (DM) in
their case history.
Results: The patients, suffering from DM, were more likely to develop early complications, including myocardial infarction, as compared to patients without DM.
Concussion: We suggest that the primary and secondary prophylaxis among patients with DM would avoid early cardiovascular complications. This is a possibility to increase the life span in this risk group and for reduction of complications after myocardial infarction.
METABOLIC CONTROL AND RISK OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
N. Semerdjieva, N. Spasova, N. Hristova, G. Doneva, M. Valkova, M. Petkova
Department of Endocrinology
Medical University – Pleven, Bulgaria
Key words: Metabolic control, cardiovascular complications, diabetes mellitus type 2
Introduction: Patients with diabetes mellitus type 2 (DM 2) are treated either with insulin or with oral anti-diabetic drugs (OAD).
The aim of this study was to assess the metabolic control in patients,
treated with insulin and OAD.
Conclusion: Permanent proceeding of serum glucose levels in patients with DM 2 gives the opportunity for precise metabolic control by administration of insulin or OAD. Optimal glycaemic control is essential for prevention of chronic diabetic complications.
RISK FACTORS FOR DIABETES AND ISCHEMIC HEART DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
N. Semerdjieva, N. Spasova, M. Valkova, I. Ivanov, G. Doneva, N. Hristova, M. Petkova
Department of Endocrinology,
Medical university - Pleven, Bulgaria
Key words: Risk factors, ischemic heart disease, diabetes mellitus type 2
Genetic predisposition for diabetes mellitus type 2(DM 2) is a
significant, but not the only risk factor for developing the disease.
Lifestyle should be also taken in consideration.
Methods and materials: Retrospective analysis of the data from hospital history of 55 patients with DM 2 was made. Forty-three of them did not report any family history for diabetes. Twelve of all patients had a family history: four of them reported close relatives, suffering from ischemic heart disease, one of them - one parent with DM, and seven patients had both predispositions. Three of all the four patients were smokers. The patient with a parent with DM 2 was a smoker. One from the seven patients with both predispositions consumed alcohol frequently, three of them were smokers, and three were non-smokers.
Conclusion: The results from the study indicated that a generation with genetic predisposition and unhealthy habits is at a greater risk to develop DM 2, as compared with a generation with genetic predisposition, but not leading unhealthy lifestyle.
STAGING OF GASTRIC CANCER
V. Joksimovic, E. Mujovic, P. Davitkov, Mentor: Prof. Z Karadzov
Clinic of abdominal surgery
Medical Faculty Skopje, Macedonia
Key words: gastric cancer, staging
In order to decrease mortality, quick and urgent diagnostic approach is necessary, including the operability stage concerning histopathological finding that indirectly influences prognosis. Making an initial diagnosis of gastric cancer does not completely influence treatment. Endoscopic ultrasonography (EUS) is a unique method that displays the transmural tumor lesions in the gastric wall. In this study we focused on the preoperative gastric cancer staging by EUS.
Aims: To evaluate the incidence of gastric cancer according localization and histology and to provide EUS criteria for its differentiation.
Material and Methods: This study is a prospective clinical investigation that included 225 patients, out of which 69 patients were diagnosed with gastric cancer, and determined as operable by EUS.
Results: According to investigation, the patients were divided into 3 groups. The first group of 81(36%) pts had benign gastric lesions (polyps and gastric ulcers). The second group of 69 (30.5%) pts had gastric cancer. In accordance with EUS findings, this group consisted of two subgroups: 49 (71%) operable patients and 20 (29%) inoperable patients with gastric cancer. The third group of 75 (33.5%) pts had no changes in the gastric wall. The EUS findings in all of the patients were compared with complementary methods (sonography, roentgenography, endoscopy, CT scan ECT). The endosonographic findings in the first subgroup that underwent surgery correlated with the final intraoperative stage and pathohistology, and in second subgroup were compared with the operative finding during the palliation procedure and the final diagnosis after additional investigation.
Conclusion: The diagnostic value of EUS was evaluated in the operable and inoperable group separately and summarized for the whole series. The sensitivity was 98% and the specificity was 97% with positive predictive value of 96.5%.
MYOPERICARDITIS, COMPLICATED WITH SEVERE CARDIOGENIC SHOCK: A CASE REPORT
G. Saska, C. Jacques
ULB, Hospital Erasme, Brussels, Belgium
Key words: myopericarditis, cardiogenic shock, young patient
Introduction: Concomitant severe myocarditis is rare and often under-recognized.
Aim of study: We report a case of myopericarditis complicated with severe cardiogenic shock with spectaculous evolution and auspicious outcome.
Materials and methods: We describe a case of a 23-year-old man hospitalized in shock after a week of a fly-like illness and hyperpyrexia. The patient was referred from a tertiary hospital to a highly-specialized hospital. The diagnosis was made based on clinical signs, laboratory tests and noninvasive methods.
Results: The 2 D-echocardiography in ICCU revealed diffuse cardiac alteration and systolic left ventricular dysfunction (ejection fraction of 34%) and ECG signs of myopericarditis. Laboratory tests showed elevated cardiac enzymes with normal CKMB/ CK index. NTpro BNP was augmented at 8942 pg/ml. The invasive measurement of PAP (pulmonary artery pressure), RVEDP and RVESP (right ventricular diastolic and systolic pressure) and OPAP (occlusive pressure of pulmonary artery) showed high levels. All microbiological tests for bacterial, viral and parasite contamination were negative. The presence of drugs in the blood was also excluded. IRM made 10 days after admission was negative for myopericarditis. The medical treatment included diuretics (Furosemide), sympaticomimetics (Vasopressin, Dobutamine), antibiotics (Rocephine, TMP/Sulfometaxasol) and Xigris (Protein C for sepsis).Conclusion: We concluded that correct diagnosis and early treatment provided a good opportunity to safe the patient’s life.
PRIMARY INFERTILITY AFTER
GENITAL MUTILATION IN GIRLHOOD
Sakher, Lars Almroth, S. El Musharaf, N. El Hadi, A. Obeid, M. A. El Sheikh, S. M. El Fadil, S. Bergström
Faculty of Medicine, University of Khartoum, Sudan
Key words: female genital mutilation.
Introduction: Theoretically, infections following female genital mutilation (FGM) in childhood might ascend to the internal genitalia causing inflammation and scarring, with ensuing tubal factor infertility. To investigate the possible relationship between FGM and primary infertility, we performed a hospital-based case-control study in Khartoum, Sudan.
Aims: To confirm or reject the hypothesis that FGM is significantly associated with primary infertility.
Methods: The patients were women with primary infertility, among whom hormonal and iatrogenic causes (previous abdominal surgery), as well as male factor infertility were excluded. The patients underwent diagnostic laparoscopy. Controls were primigravidae women recruited from antenatal care. Exact conditional logistic regression, stratifying for age and controlling for socio-economy, education, Gonorrhea and Chlamydia were used to compare cases and referents.
Results: Ninety nine cases underwent laparoscopy, of which 48 showed adnexal pathology, indicating previous inflammation. A total of 180 referents were recruited. After controlling for covariates, cases with primary infertility had a significantly higher risk of having undergone the most extensive form of FGM involving labia majore than controls. (OR 4.69; 95% CI 1.49, 19.7%). Similar associations were found for the subgroup of cases with tubal pathology and the subgroup with normal laparoscopy findings, both with borderline significance. The anatomical extent of FGM, rather than whether or not the vulva has been sutured/closed, was associated with primary infertility.
Discussion: This case-control study shows strong positive association between the anatomical extent of FGM and primary infertility. Laparoscopic post-inflammatory adnexa changes are not the only explanation for this association, since cases without such pathology showed similar association. The association between FGM and primary infertility is highly relevant for preventive work against this ancient practice.
ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN – CLINICAL AND LABORATORY CHARACTERISTICS
K. Bainova, E. Peteva, I. Georgieva
Medical University –Varna, Bulgaria
Key words: children, acute lymphoblastic leukemia, symptoms
Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. It represents one third of all pediatric cancers and is with a peak of incidence in patients aged 2 – 5 years. The clinical and laboratory symptoms and signs of the disease are due to the disregulated proliferation of a lymphoid progenitor cell, leading to bone marrow failure and blast infiltration of different organs and systems.
Aim: The aim of this research is to analyze the clinical and laboratory symptoms and signs at the beginning of ALL in children.
Materials and methods: The study included 43 children with ALL hospitalized at the Clinic of Oncohematology of Hospital “St. Marina” – Varna for the period January 2002 – June 2006. In all the patients the clinical and laboratory signs at the onset of the disease were observed.
Results and discussion: The highest frequency ALL was found at the age between 1- 10years (31 children, 73%) and was significantly higher in boys – 28 boys (65%). According to the history, leading signs were anemia (70%), hemorrhagic diathesis (51%) and fever (30%). Hepatosplenomegaly was found in all the children (100%), and peripheral lymphadenopathy - in 36 children (84%). From the laboratory tests anemia (Hb < 110g/l) was found in 30 children (70%), thrombocytopenia in 36 children (84%) and hyperleucocytosis (Leu > 50.109) in 13 children. Immunophenotyping proved B-cell leukemia in 37 children.
Conclusion: ALL is diagnosed mostly between 1 – 10 years of age and in boys. Leading clinical symptoms are hepatosplenomegaly, lymphadenopathy, anemia and thrombocytopenia. Having a good knowledge of the symptoms and signs of ALL and its laboratory constellation is a premise to early diagnosis and beginning of treatment.
DRUG USE AMONG PEDIATRIC PATIENTS – A PROSPECTIVE STUDY
M. Spasova, L. Nikolov, S. Dencheva, M. Tomova, T. Genadieva
Medical University – Pleven, Bulgaria
Key words: drug usage, pediatrics, complications of drug use
Introduction: Drug usage is spreading very rapidly. Young people are the highest risk. Children who use drugs might develop various complications such as respiratory, cardio-vascular, and neurological. These health problems should be solved by pediatrics.
Materials and Methods: Questionnaires about drug use among pediatric patients were implemented by medical students and doctors from Medical University-Pleven, under the EU Leonardo da Vinci programme.
Aim: The main objective of the questionnaire was to find out:
· How often do pediatricians face patients, who use narcotic drugs?
· What are the main health problems of drug users?
· How do pediatricians make diagnoses?
· How are these patients treated?
Results: Pediatricians very rarely see patients with drug-related problems patients in their practices - approximately 1-2 case a year. The explanation might be that general practitioners (GP) treat these patients and refer them to specialists (psychiatrists, toxicologists). Most common are nicotine users (68%), alcohol users (23 %), and marihuana users (19%). Inhalants, mushrooms and heroin are not widely used. Most doctors consider that children from families with such problems and minority children are at higher risk. The average age of children using drugs is 14-17 years. The most frequent health problems that relate with chronic drug usage are hepatic dysfunction, respiratory disorders, neurological disorders, cardio-vascular problems.
Doctors should regularly receive adequate information and update on the drug problem, since new methods of diagnosis and treatment and new information about complications come into existence.
Only 27% of pediatricians are concerned that they have good competence to treat these patients. In spite of good competence most of them agree that it will be very useful to organize a short course for more new information about drug intoxication, addiction and modern methods of treatment.
GOODPASTURE SYNDROME - CASE REPORT
G. Petrova, R. Kabakchieva, R. Markova, P. Perenovska1, M. Baleva, D. Iliev
Alexandrovska University Hospital, Sofia, Bulgaria
Key words: hemoptysis, hematuria
A triad of diffuse pulmonary hemorrhage, glomerulonephritis and circulating anti-glomerular basement membrane antibodies characterizes Goodpasture syndrome.
The authors present a 17-year-old girl, active smoker, who was admitted to hospital because of hemoptysis for 1.5 mo. Diffuse pulmonary infiltrates and iron-deficiency anemia were followed by hematuria. The presence of hemosiderin-laden macrophages in sputum, detection of anti-glomerular basement membranes (GBM) antibody in serum and linear deposition of IgG along the glomerular basement membrane on immunofluorescence testing of kidney biopsy confirmed the diagnosis. She is in good health after treatment with steroids and cyclophosphamide.
Goodpasture’s syndrome can have a rapidly progressive and fulminant course, and prompt diagnosis and initiation of therapy are very important.
PROTEIN ENERGY MALNUTRITION – “A BIG THREAT"
Medical University- Pleven, Bulgaria
Key words: protein energy malnutrition, severe dehydration, Zn supplementation
Protein energy malnutrition (PEM) occurs in both developing and developed countries. Approximately one million children die every year because of malnutrition around the world. Basically, there is a deficiency of protein and energy but PEM is almost always accompanied by deficiencies of other nutrients. Historically, the most severe forms of PEM are: Kwashiorkor and Marasmus.
Main factors include: 1)Social and economical factors. 2)Environmental factors. 3)Biological factors.
There is chronic diarrhoea and dehydration in patients with PEM.
There is also an increased susceptibility to various infections and failure to gain weight, which makes the disease more severe, and lethal for the patient. We would like to highlight that, due to chronic diarrhoea and dehydration in PEM, there is deficiency of zinc alongside with deficiency of protein and other microelements.
Promotion of zinc supplementation in children with PEM may reduce the period of chronic diarrhoea and its severity.
ATTENTION DEFICIT / HYPERACTIVITY DISORDER - A DIFFICULT DIAGNOSIS
V. Donev, S. Shopova
Clinic of Pediatrics,
Alexandrovska University Hospital, Sofia, Bulgaria
Key words: ADHD, Behavior, Diagnostic Criteria
Attention deficit / hyperactivity disorder (ADHD) is a behavioral disorder affecting 3-5% of the child population. Three types of ADHD are defined: - ADHD, Predominantly Inattentive Type; - ADHD, Predominantly Hyperactive-Impulsive Type; - ADHD, Combined Type.
In this communication we present two cases of school-age girls with ADHD, both with a long history before the precise diagnosis was made.
The first one is a 10-year-old girl with normal perinatal history, normal physical development and mild facial dysmorphism. She was first treated for general developmental disorder, then for autism. When she turned 9, the diagnosis ADHD became clear by excluding other potential causes by means of psychological tests, IQ test, psychiatric counseling, chromosomal analysis, neurological counseling, EEG and MRI investigations. Medical treatment with Rispolept was started with good efficacy.
The second girl is 13-year old, born with intrauterine hypotrophy, suffered inborn infection and neonatal hepatitis. She has impaired hearing specified when she started going to school. The girl had been put through psychological tests, IQ test, psychiatric counseling, chromosomal analysis, neurologic counseling and EEG investigation. By exclusion we came up to the diagnosis ADHD, Predominantly Inattentive Type.
With this report we try to emphasize that the diagnosis of ADHD is often not considered, and often not recognized by pediatricians, neurologists, psychologists, psychiatrics, teachers, parents and the community. On the other hand, there are no precise and objective evaluation tests for ADHD and diagnosis is made on the basis based mainly of behavioral criteria.
PSYCHOTIC PERSONALITY TRAITS EXPRESSION AMONG A SUBPOPULATION OF SECONDARY SCHOOL STUDENTS IN SERBIA
A. Hedrih, V. Hedrih
Scholarship researcher of Ministry of Science and Environment
Protection of Serbia
Key words: psychoticism, students, expression, DELTA-9
Introduction: Psychoticism is a personality trait commonly associated with occurrence of various types of serious psychiatric disorders. The most well-known concept of psychoticism as a personality trait was the one proposed by Hans Eysenk. However, this concept has been seriously criticized on various accounts. Due to this Knezevic et al. proposed a reconceptualization of general psychoticism as a composite of 9 types of dissociation.
Aims: The aim of this research was to obtain a general measure of the level of expression of various psychoticism subdimensions among secondary school students in a part of Serbia.
Materials and Methods: The sample consisted of 383 last year secondary school students from three secondary schools in Nis, Serbia. They were asked to complete the DELTA-9 personality inventory (Knezevic et al.) for measuring psychoticism.
Results: Results showed that levels of acceptance of items representing various psychotic traits were generally very low, but there were students who scored high on these indicators (i.e. high degree of psychoticism, or of a certain type of psychoticism). The highest average scores were obtained for subdimensions hypomania (overactivity, inflated mood, grandiosity) and absorption (synesthesia, heightened awareness, dyssociative involvement). Much lower average scores, but still above minimum, were obtained for general executive disorder and flattened affect.
Discussion: The results provide general insight into most common types of conative dyssociation. Some types of dyssociation are more common in the examined population than others, and we can expect these differences to be related to frequencies of psychotic sympotoms observed in psychiatric practice.
CHRONOTYPE IN MEDICAL AND PSYCHOLOGICAL FACULCY STUDENT POPULATION
J. Meyer-Szary, M. Jakitowicz, M. Sieczkowski, J. Manikowska, J. Jakitowicz
Medical University in Gdansk, Poland
Key words: sleep disturbances, chronotype, student, morningness, eveningness
Introduction: You can frequently hear one is an “early bird” or a “night owl”. The common knowledge refers to what is called chronotype, or morningness-eveningness. People of the first type prefer to get up early and go to bed early. They claim to be most efficient in the morning. The other group is the opposite. Although most people stand somewhere in the middle, some strongly identify themselves with one of the two extremes.
Aims: The aim of the study was to check if OCI, the scale we used, correlates with self-identification, sleep quality (SQI) and some psychological and habitual factors.
Material and Methods: 259 students, 66 male and 193 female, aged from 19 to 26 years (M = 20.82; SD = 1, 13). Population included 103 first-year students of Warsaw School of Social Psychology in Sopot and 156 third year medical faculty students of Medical University in Gdansk.
1. Sleep Questionnaire “SEN” by J.Kasperczyk (34 items). Total score in questions 1 to 15 (using scale: never=1, seldom=2, often=3, always=4) was used as Sleep Quality Index (SQI; minimal score: 15 points – suggesting very good sleep quality, maximum 60 points – indicating a poor sleep).
2. Questionere “Chronotype”, where summing questions 1 to 18 was calculated to assess OCI (objectified chronotype index). Low OCI – morningness, high- eveningness.
Statistical calculations were prepared using SPSS.
OCI strongly correlated with self-identification (r=0,564)
OCI strongly correlated with SQI (r=0,364)
OCI also correlated with claims to have less time for pleasures and rest since beginning university studies, feeling of sadness, studying at night, using internet at night and drinking more coffee.
Ad1. One can accurately identify one’s chronotype, although people tend to choose extreme types to describe themselves.
Ad2. Evening-chronotype people reported more symptoms of bad sleep. This could be attributed (basing on complementary studies) to the need to comply with morning classes in this population.
Ad3. How strongly the chronotype is related to biological basis and how strongly dependent on habits needs further investigation, using objective measurement methods like actograpthy, hormone excretion patterns and concentration and efficiency tests.
MANAGEMENT AND OUTCOME OF ACUTE INTRACEREBRAL HEMORRHAGE (AICH)
U. Erebakan, M. Ovcharov, M. Danovska, B. Stamenov, S. Boginov
Department of Neurology and Neurosurgery
Medical University – Pleven, Bulgaria
Key words: acute intracerebral hemorrhage, management, surgical evacuation
Introduction: Acute intracerebral hemorrhage (AICH) is still a vexed clinical problem. Despite many therapeutic options, including surgical evacuation, the absence of established guidelines for management of AICH often forces clinicians to make decisions case-by-case, based on their own experience.
The purpose of our study is to compare recent meta-analysis of clinical trials, concerning modern management of AICH with our results in an attempt to establish an optimal therapeutic option for AICH patients.
Material and Methods: Our study included 85 patients with AICH, treated at the Neurology Clinic, Medical University Pleven in 2005, and 34 patients who underwent surgical evacuation at the Neurosurgery Clinic for the same period.
All the patients were neurologically tested, and CT scans performed. The severity of neurological deficit, Glasgow coma scale score, and the location of hematoma were evaluated.
Conclusions: We support the view that that removal of the hematoma may help minimize the brain damage due to ICH.. In this way, a surgical evacuation performed in the best therapeutic window (up to the 24th hour) reduces both mortality and morbidity.
AMYOTROPHIC LATERAL SCLEROSIS AND CERVICAL SPONDYLOTIC MYELOPATHY – A DIAGNOSTIC DILEMMA
M. Markov, M. Milenkova, I. Raychev, I. Milanov
Specialized Hospital of Neurology and Psychiatry, “St. Naum”, Sofia, Bulgaria
Key words: amyotrophic lateral sclerosis, cervical spondylitic myelopathy, cervical decompression, denervation
Introduction: Cervical spondylitic myelopathy is a condition in which progressive compression of the spinal cord occurs together with ongoing degenerative changes of the cervical segment of the spine. This condition can sometimes mimic clinical manifestations of amyotrophic lateral sclerosis (ALS), fatal neurodegenerative disorder that affects upper and lower motor neurons. Cervical spondylosis may coexist with ALS because both diseases mostly affect individuals of middle or old age. Distinguishing between cervical spondylitic myelopathy and ALS can be difficult, as illustrated by this report on a patient who had both disorders.
Materials, methods and results: We present a case of a 55-year old woman who came for the first time to our clinic in November 2005 and reported pain in the neck, pain and weakness and tingling in the hands, accompanied with fasciculation and hypotrophy of distal muscles in the right hand, stiffness and weakness of the legs and difficulty to walk, which had all started three months before. After EMG, CT scan and MRI of the cervical part of the spinal column were performed, she was diagnosed with cervical spondylitic myelopathy, cervical disc herniation (C5-C6) and degenerative spinal stenosis. The patient was referred to the Department of Neurosurgery and underwent cervical decompression, after which she felt better for a month. Few months later she developed generalized weakness, fasciculations of all four limbs, dysphagia, dysphonia and inability to walk. She was admitted for a second time to our clinic, and after EMG demonstrating diffuse denervation signs, she was diagnosed with ALS.
Discussion: Attempts to differentiate between ALS and cervical spondylitic myelopathy should persist until a diagnosis of one (or both) of the disorders is made, since both prognosis and treatment of the two are different. Careful neurological examination with attention to clinical details, neuroimaging (CT scan and MRI) and routine EMG will eventually lead to the proper diagnosis.
COGNITIVE PERCEPTION IN PANIC DISORDER AND AGORAPHOBIA IN RELATION TO THE PRESENCE OF MEDICAL ILLNESSES
S. Adnadjevic, T. Adnadjevic, M. Simovic
School of Medicine, Belgrade, Serbia
Key words: cognitive perception, panic disorder, medical illness
The study investigated the influence of the presence of comorbid somatic illness on the patient cognitive perception in panic disorder. Our sample included 64 patients referred to the Day Clinic of Institute of Psychiatry in Belgrade for assessment and treatment of panic disorder and agoraphobia. The presence of comorbid medical illnesses was estimated by the modified National Institute of Mental Health Panic Questionnaire (NIMHPQ). Panic Appraisal Inventory (PAI) was used for cognitive perception assessment. Statistical analysis of the results showed decreased capability of perception in handling panic attack in patients with comorbid medical illness. Patients with gastrointestinal and urological illnesses had worse perception of capability for handling panic attack, unlike patients with cardiovascular and endocrine illnesses. The differences observed indicate that a treatment program for patients with comorbid medical illness deserves greater attention because of specific cognitive perception of panic attack.
CORRELATION BETWEEN PERSONALITY TRAITS AND PSYCHOTICISM AMONG SECONDARY SCHOOL STUDENTS IN A PART OF SERBIA
V. Hedrih, A. Hedrih
Department of Psychology, Faculty of Philosophy, University of Nis, Serbia
Key words: psychotisim, personality traits, big five
Psychoticism is a personality
trait commonly associated with various types of serious psychiatric
disorders. The best known concept of psychoticism as a personality trait
was the one proposed by Hans Eysenk. This concept has been seriously
criticized on various accounts. Knezevic et al. proposed a
reconceptualization of general psychoticism trait as a general factor of
9 types of dissociation.
CAN HOME MEASURES ALONE PREVENT
El-Mamoun El-Mahdi, Bashar
Salman, Waiel Abdulgader
University of Khartoum, Khartoum, Sudan
Key words: breast self examination, teenager, risk factors, home measures
Using the guidelines for early
detection of breast cancer like breast self examination (BSE) and the
early clinical visits has saved many thousands of lives. Also, the
knowledge about risk factors has played an important role, as compared
with finding a large lump by chance. Moreover, there is a very great
chance for people to modify certain changeable risk factors, thus
decreasing the chance to acquire the disease.
ORGANISATION OF POPULATION DEFENCE FROM BIOLOGICAL WEAPONS IN PEACETIME
J. Ananiev1, R. Plachkova1, D. Skerleva2, V. Popzaharieva1
1 Thracian University - Stara Zagora, 2 Medical University - Sofia, Bulgaria
Kew words: biological weapons, microorganism, anti-epidemic supplementation
The report aims to present a
retrospective analysis of the leading disease agents, used to create
biological weapon, and a plan-methodology for effective actions in the
case such weapons are used. A biological weapon is created on the basis
of existing toxic bioproducts - results of the metabolism of bacteria,
viruses, fungi, which cause severe high deadly diseases in people. There
exists a great variety of virus-bacterium associations created by using
genetic engineering methods. All microorganisms are claimed as
"proper": if they meet criteria such as efficacy of small doses, highly
pathogenic effect, long life span in environment, difficult to identify
in the surrounding area and in laboratory conditions, various and easily
available ways of invasion, cause of severe and devices, therapy,
prevention; simplified and cheap technology of production. The
Organization of Population Defense from Biological Weapon in peacetime
is a complex and responsible task. Anti-epidemic supplement during a
threat of bioterrorism is based on:
CHANGES IN PLATELET COUNT AND MEAN PLATELET VOLUME: A PROPOSAL FOR A NEW PROGNOSTIC FACTOR IN LUNG CANCER PATIENTS
T. Hristov; M. García-Arranz; L. Royo Dujardin; P. Diaz-Agero; J.L.Gil-Alonso; J.Girón; D. García-Olmo
Thoracic Surgery Department and Cell Therapy Laboratory
Hospital Universitario La Paz; Madrid, Spain
Key words: thrombocytosis, mean platelet volume, prognostic value, lung cancer
Introduction: Thrombocytosis (>400x109/l) was found in all types of malignant diseases (from 3.7% of the breast cancer patients to 87% of mesothelioma patients) and its predictive value indicating poor prognosis has been well described. Although the pathogenic role of platelets in metastasis development has been proved, there remain many answers to be found.
Patients and methods: We studied the clinical files of 50 non-small cell lung cancer patients (stage I – IIIA), operated by radical resection (lobectomy or pulmonectomy) between January and November 2005. All the existing pre- and postoperative analyses of the platelet count (PC) and mean platelet volume (MPV) were collected. The period of study was different for each patient (between 1 month and 20 years preoperatively, and 1 year postoperatively for all the patients). The aim of the study was to investigate whether there is a correlation between the PC changes (increasing or decreasing), other clinical pathological findings and the morbidity and mortality rate.
Results: The patients were divided in 3 groups: Group 1 – patients with preoperative PC>400x109/l, Group 2 – patients with preoperative PC<400x109/l, but higher than previous analysis, and Group 3 - patients with preoperative PC<400x109/l that remained without significant changes in previous analyses.
Group 1 patients (PC>400x109/l) had a significantly poorer prognosis than those in Groups 2 and 3 (PC<400x109/l). Group 2 patients, however, had a poorer prognosis than Group 3 patients. In all the cases with PC changes, the MPV changes were opposite to the PC (if PC was increasing – MPV was decreasing). Furthermore, within Group 1 we described some patients with PC that remained unchanged in comparison with the previous analyses. None of them had thromboembolic events.
Conclusion: We found that better prognoses in lung cancer patients were related to low preoperative PC, as it is already known from previous studies. Furthermore, we found out that constant values of PC (no matter if higher or lower than 400x109/l) and MPV within all the preoperative analyses, could be considered a new factor bound to a better prognosis. Although this is a small study, it represents a new consideration of PC as a prognostic indicator and shows that more investigations on the cancer pathogenesis should be done.
ADMINISTRATION OF LITHIUM FOR PROPHYLAXIS AND TREATMENT OF CHEMOTHERAPY-INDUCED NEUTROPENIA: IS IT WELL-FOUNDED AND SAFE?
T. Paseka, J. Gombošová, F. Folber, M. Chobola, T. Andrašínová,
1st Surgical Clinic, St. Anna Faculty Hospital, Brno, Czech Republic
Key words: lithium, chemotherapy, hematological toxicity, neutropenia
Background: Hematological toxicity belongs to the most common adverse effects of cancer chemotherapy and can lead to serious iatrogenic harm. Lithium is traditionally used for prophylaxis and treatment of chemotherapy- induced neutropenia, because its application induces a reversible leukocytosis. Recent investigations have demonstrated that Lithium inhibits apoptosis and stimulates cell proliferation through a direct effect on GSK-3 and Akt/PKB kinase. Simultaneously, both kinases play an important role in survival process and chemoresistance of tumor cells.
Materials and methods:We carried out 151 MTT tests of chemoresistance to selected cytotoxic drugs in the presence or absence of lithium in 53 primary tumors. In the group of 106 patients, lithium effect on hematopoesis and on the development of cancer was evaluated. We analyzed 349 pair examinations of blood counts and measured the time to progression.
Results: We found an enormous increase in chemoresistance of primary tumors tested in-vitro to doxorubicin (p=4.53x10-7) and paklitaxel (p=2.78x10-4) in the presence of lithium. In the selected group of patients, we demonstrated that a higher rate of lithium applications leads to early disease progression (p=0.0061). Lithium administration resulted in increased leukocyte and neurtophil count, but the effect was not significant.
Conclusion: Administration of lithium for prophylaxis and treatment of chemotherapy-induced neutropenia is unjustified and causes increased tumor chemoresistance.125
CHIKUNGUNYA FEVER…GOING…GOING…NOT GONE!!!
Sharma, T. Cariappa, G. Malik, A. Mohan
Department of Internal Medicine, Medical University, Pleven, Bulgaria,
Key words: Chikungunya fever, Chikungunya virus, morbidity
Chikungunya fever is caused by the Chikungunya virus, transmitted by a bite by an infected Aedes aegypti or Aedes albopictus mosquito. Several epidemics have been identified in West, Central and South Africa and in many areas of Asia, including India. This communication describes an epidemic of Chikungunya fever in southern India. The aim of this communication is to raise the awareness about Chikungunya fever.
Patients, attending a tertiary care teaching hospital during the period January-August 2006 were prospectively studied. Detailed history, clinical examination and laboratory investigations were recorded in a structured proforma. Relevant laboratory investigations were done. All patients received symptomatic supportive treatment with paracetamol orally, and Aceclofenac and Chloroquine were given to patients with severe arthralgias. Dehydration was corrected with administration of intravenous fluids.
The group studied included 876 patients with Chikungunya fever (mean age 38.4±18.2; range 14–84 years; 456 males). Mean duration of symptoms was 3±1.8 days. Major symptoms included fever, headache, arthralgias, myalgias, nausea, chills, vomiting and photophobia. Physical signs included elevated temperature, conjunctival suffusion, painful swollen joints and skin rash. Important laboratory abnormalities at presentation included hyponatremia, pre-renal acute renal failure, altered hepatic transaminases. In the majority of patients (88%), the fever resolved in 2-3 days. Severe arthritis persisted for a variable period, and 62 patients were admitted for diagnostic work-up. None of the patients died.
As the clinical presentation of Chikungunya fever mimics several other viral fevers and infections, meticulous evaluation to rule out other treatable causes of fever is required. Chikungunya fever appears to be a self-limiting disease with significant morbidity in some patients. Complications should be carefully observed. There is a need for setting up a network of quality virology laboratories in countries with a background of epidemics for providing rapid diagnosis during large outbreaks.
GENETIC PRENATAL DIAGNOSIS - PSYCHOLOGICAL ASPECTS AND REPRODUCTIVE BEHAVIOR OF FAMILIES
M. Peev, A. Shopova
Medical Univesity, Sofia, Bulgaria
Key words: reproductive behavior, genetic prenatal diagnosis
Aim: Study on the influence of genetic prenatal diagnosis on the emotional state of patients, significance of medical and informational factors on the reproductive decision of the family.
Methods: Information interview; anxiety questionnaire; grief scale.
Material: 90 pregnant women and 30 controls.
Results: Women with previous reproductive failure and those with higher educational level proved to be well informed. Most of the women had been informed by a gynecologist or a genetic counsellor. Most of the women considered the diagnostic and prognostic potential of the prenatal genetic diagnosis reliable. The type of procedure had an insignificant influence on the reproductive decision.
Conclusions: 1.The reproductive decision depends on the quality of genetic counseling. 2. The level of anxiety is determined by the kind of procedure and reproductive history. 3. Age, previous loss and type of loss are decisive factors for coping with the loss.
BLOOD PRESSURE, CALCIUM, MAGNESIUM AND PHOSPHATE EXCRETIONS AFTER UNILATERAL NEPHRECTOMY AND NITRIC OXIDE SYNTHESIS INHIBITION
T. Ivanova, I. Chakalov
Department of Physiology, Medical Faculty, Medical University Sofia, Bulgaria
Key words: nitric oxide synthesis inhibition, unilateral nephrectomy
The aim of this study was to determine the role of nitric oxide synthesis inhibition (NOSI) with L-NAME on renal excretory function and arterial blood pressure in unilateral nephrectomy.
The experiments were performed on conscious Wistar rats with intact kidneys (n=15) and on the 8th day after unilateral nephrectomy (n=10). One day before the experiments catheters were inserted in the femoral vein for L-NAME administration (10mg/kg b.w.), in the femoral artery - for blood pressure registration and in the bladder - for urine collection. Nephrectomy and catheter implantation were performed under general anesthesia. Blood pressure was measured and urine was collected during 40 min control clearance periods. Urine flow rate was determined gravimetrically, plasma and urine concentrations of calcium and magnesium concentration were measured by flame atomic absorption spectrophotometry (Perkin-Elmer, Analyst 300), and phosphate concentration was determined spectrophotometrically. Blood pressure was measured directly by blood pressure transducer (Gould Statham P23ID).
Unilateral nephrectomy did not significantly change arterial blood pressure and urine flow rate but it lead to an increase in magnesium excretion by 110% and phosphate excretion by 100%, and a decrease in calcium excretion by 35% (p<0.05). L-NAME administration caused an enhancement in arterial blood pressure, urine flow rate, calcium and phosphate excretions in both intact and unilaterally nephrectomized rats (p<0.05). NOSI did not change magnesium excretion significantly. Unilateral nephrectomy led to changes in electrolyte excretion without influencing blood pressure. NOSI increased arterial blood pressure and calcium and phosphate excretion in both intact and nephrectomized rats but did not change magnesium excretion. Magnesium excretion did not depend on the hypertensive effect of L-NAME.
TUBEROUS SCLEROSIS (BOURNEVILLE DISEASE): A CASE REPORT
D.Germanova, S. Debaize
Hospital Moliere Longshamp, Brussels, Belgium
Key words: tuberous sclerosis, Bourneville disease
Tuberous sclerosis complex (TSC) is a dominantly inherited, multisystemic, genetic disorder involving the development of harmartias and hamartomas in multiple organ systems- it involves abnormalities of the skin - hypomelanotic macules, facial angiofibromas, fibrous facial plaques, ungual fibromas, brain/cortical tubers, subependymal nodules, seizures, mental retardation (developmental delay), kidney angiomyolipomas,cysts and heart/rhabdomyoma arrhythmias.
The diagnosis and further evaluation of all-risk persons involve careful examination of the skin, hearth, eyes, brain, and kidneys. Presenting features may be in any of these organs and the prognosis can be difficult to predict, with variability ranging from mild disease manifesting only as skin findings and asymptomatic brain lesions, to a more severe course involving seizures, mental retardation and extensive renal disease. Definite TSC has two major features or one major plus two minor features.
The authors present a 66-year old female patient with mental retardation who was admitted to the surgical department for an abdominal mass, suggesting tuberous sclerosis (Bourneville disease). She presented with kyphoscoliosis, facial dysmorfism, shagreen patches at the level of the back, paranasal angiofibroma, swollen legs. The CT scan revealed a perirenal mass on the right side (7.8x 7.1 cm) connected with an inter-parenchymal renal mass on the left (2.9x 2.6cm). The cerebral RMN was negative. The mass on the right (well iencapsulated and retro-peritoneal) was removed and the right kidney was saved. The pathoanatomical investigaton proved epithelioid angiomyolipoma. The immune markers - HMB45 and actine, were positive. Four months later she presented with a peritoneal carcinomatosis and ascites. A second laparotomy was performed, the mass was not removed. Skin biopsy revealed angiomiolipome epithelioide.
The progress of the disease was followed up, and the patient was placed in a home for palliative care where she died 3 months later.
IMPORTANCE OF ANDROGENS, ESTROGENS, GONADOTROPINS FOR GERM AND SERTOLI CELLS OF DEVELOPING RAT TESTIS
E. Pavlova, N. Atanassova
Bulgaria, Sofia, BAS, Institute of Experimental Morphology and Anthropology with Museum
Key words: estrogens, androgens, spermatogenesis, Sertoli cells, testis
The negative effect of estrogens on the testis were attributed to suppression of gonadotropin (Gn) secretion during the treatment that result in suppression of testosterone (T) production by Leydig cells. The effect of estrogens (E) in particular diethylstilboestrol (DES) on different steps of germ cell (GC) differentiation was not investigated.
In this respect the aim of the present study was to characterize the E-effect on different types of GC in tandem with Sertoli cell (SC) support that would reveal their differential sensitivity to DES. We used an experimental model for manipulation of E-, T- and Gn-levels that involved neonatal treatment with DES-10µg or DES-0.1µg (2-12 day); GnRH antagonist -10mg/kg (2 and 6 day); co-administration of 10 µg DES and 200 µg T. In situ detection of germ cell apoptosis by TUNEL method and subsequent 121-point counting of 25 fields (3025 p) were applied. End points investigated were absolute nuclear volume of SC, Total GC, spermatogonia (A-sg, In+B-Sg) and spermatocytes (Pl, Lep+Zyg, Pach-Sc), as well as the ratios of GC/SC. Neonatal treatment with DES and GnRHa suppressed testis development involving profound GC apoptosis and retardation of lumen formation on day 18 and 25. They exerted similar negative effects on Sg, whereas SCs were more affected by DES compared to GnRHa. Among the Sg, more differentiated types In+B-Sg underwent more pronounced changes,as compaed to A-Sg. In the population of Sc, L-Z stages were most sensitive to hormonal imbalance, and the effect of DES was more severe than those of GnRHa. Co-administration of T with DES-10 partially prevented negative E-effects on SC and GC.
In conclusion, DES caused retardation of testis development at puberty and suppressed spermatogenesis, acting on differentiation of Sg, initiation and proceeding of meiosis via direct and indirect mechanisms. Differential effect of DES and GnRHa on Sg and Sc and their subtypes demonstrated their differential sensitivity to neonatal hormonal imbalance.
SEROLOGY DIAGNOSIS OF EPSTEIN-BARR VIRAL INFECTION IN MONTENEGRO DURING THE PERIOD BETWEEN OCTOBER 2005 and MAY 2006
I. Barovic, M. Bogetic, S. Vujovic
University School of Medicine Podgorica, Montenegro
Key words: Epstein Barr viral infection, serology diagnosis, ELISA
Mononucleosis infection, known as “kiss disease” is a viral infection caused by the Epstein-Barr virus, presenting with fever, pharyngitis and lymphadenopathy. At the end of incubation period, the specific IgM antibodies are found in serum and they present the marker of an actual infection.
The purpose of this study was to find the number of newly-infected in regard to the number of tested patients.
During the period from October 2005 to May 2006, sera from 167 patients were tested for EBV IgM antibodies presence. Patients were referred from various healthcare institutions in Montenegro. Anti-EBV antibodies were tested, using ELISA (“Organics”).
Presence of anti EBV IgM antibodies was found in 32 (19%) of the 167 patients investigated, and 18 out of these 32 patients were positive for IgG as well. Anti EBV IgG antibodies were not found in 30 out of the 167 patients.
Based on the results obtained, it be concluded that EBV infection has a high occurrence rate in Montenegro. Since the syndrome of mononucleosis infection has various causes, the percentage of the patients with the anti- EBV IgM antibodies in the serum indicates that it is necessary to introduce serology methods to diagnose the disease.
ANALYSIS OF MORBIDITY AND MORTALITY RATES IN CHILDREN FROM THE REGION OF PLEVEN DURING THE PERIOD 2000 – 2006
N. Kolarova, R. Koleva-Kolarova, N. Yanev, V. Nedkova
Medical University – Pleven, Bulgaria
Key words: morbidity, mortality, analysis, children
Introduction: Morbidity and mortality rates of children are an important problem for both health institutions and the community. One of the priorities of modern health care systems is protection of health and life of children.
Aim: Our aim is to analyze morbidity and mortality rates in neonates, children and adolescents in the region of Pleven during the period of 2000 – 2006.
Materials and methods: The authors analyze statistical data for pediatric morbidity and mortality for the region of Pleven and the country during the period of 2000 – 2006. Rates are compared to those of some European countries.
Results and discussion: The most common causes for morbidity and mortality are infectious lung diseases, gastro-intestinal diseases, hypotrophy, iron deficiency anemia due to insufficient feeding, incidents in pediatric age, neoplasms, tuberculosis, and echinococcosis. Serious illnesses are observed in children of low health education level families.
The analyses are useful and indispensable for the advance of medical profession and improvement of organization, management and quality of health care.
Conclusion: Pediatric morbidity and mortality rates are main indicators for the nature and severity of pediatric health problems. They demonstrate the necessity to include a plan for decrease of pediatric mortality in the national health strategy of Bulgaria.
FREQENCY RATES OF ROAD TRAUMATISM IN CHILDREN FROM THE REGION OF PLEVEN
N. Yanev, N. Kolarova, V. Nedkova
Medical University - Pleven, Bulgaria
Key words: children traffic traumatism
Introduction: Safety of children taking part in road traffic is one of the most complicated problems of society today. This current issue is now strongly related to preservation of children’s health and life.
Aim: To investigate frequency rates of road traumatism in children from the region of Pleven.
Materials and methods: The authors studied the records of pediatric patients who suffered road injuries and were treated at the pediatric emergency room. Another method used was inquiry of patients.
Results: During the period 2000 – 2004 in Bulgaria, 326 children died in traffic injuries and other 5928 were injured; of these; 2699 were pedestrians hit by a car, accounting for 95.3 % of all road traumas. Other 1091 children were injured while riding a bicycle.
Discussion: The analysis of road traumatism in the region of Pleven shows a high level of confrontation on the road, insufficient field of vision for both pedestrians and drivers and lack of understanding among participants in road traffic. The authors discuss different measures for reducing road traumatism rates in children – pedestrians. They plan to conduct educational seminars for school children.
AUTOMATED TESTING SYSTEMS (ATS) IN MEDICOBIOLOGICAL (MB) EDUCATION
O. Tikhonov, K. Khudyakov
Students’ International Department
Students’ Scientific Society
Key words: automated testing systems, medical education.
Introduction: Innovative educational models in teaching medical biology (MB) branches of science can not be implemented without using computer-aided technologies. The specificity of theirs application at different stages of the educational process is various, and is determined by pedagogical problems posed. At present, the level of implementation of information technologies is insufficient. The lack of applicable software products (SP), universal and pluripotent for use in teaching MB subjects is to be observed. Therefore, creation SPs for dataware of auditorium learning process, students’ self-instruction and above all for realizing qualitative, regular and rapid control is still one of the most important problems.
Aims: To create an automated testing system that allows to optimize lectures, decrease laboriousness of the students’ knowledge control and provide more objectivity.
Materials and methods: Programming language is C++/Assembler inline. Development environment is MS Visual C++NET 7.10. Database (DB) management system: MS Access, MS SQL Server, MySQL. Beta release testing and application were realized on the base of The “Dubna” International University for Nature, Society and Man.
Results: Program system (PS) and DB of test problems and solutions were developed. PS contained programs for providing the testing process in a local university network, self-installation of the testing program on all computers of the local area, collection and processing of the results, possibility of automated DB creation (test builder for a lecturer). DB of test problems were also composed on the following subjects: nervous, endocrine, immune, cardiovascular, digestive, urogenital, respiratory, musculoskeletal human systems, blood and lymph, metabolism, vitamins, human genetics.
Discussion: Developed ATS provides conditions to conduct testing of great number of students at a time, to select subjects of problems, time of testing particularly, atomize processing the results. At present, the system of medical education demands application of such systems and their development by universities is economically attractive.
ARTERIAL HYPERTENSION AND OVERWEIGHT - EPIDEMIOLOGICAL STUDY
S. Tsonev, K. Vitlianova, T. Donova
Medical University of Sofia, Bulgaria
Key words: arterial hypertension, overweight, risk factors
Introduction: Hypertension is one of the most common worldwide diseases afflicting humans. It is at the top place among the 26 risk factors associated with the highest morbidity and mortality and it is an important public health challenge.
A question of a great importance is the accurate control and decrease of risk factors for arterial hypertension (AH): overweight, high percentage of body fat tissue, diminished motive activity, smoking. Over the past several decades, several worldwide studies reported the increasing percentage of people with overweight suffering from AH. The overweight is a major risk factor affecting to a various degree both men and women in different age groups.
Aim: Using a random selection of subjects from the central region of Sofia and standardized instrumental and inquiry methods, the study comes to asses the dissemination of AH among the studied group, control of the AH and the range of the overweight as a major risk factor for AH.
Material and methods: The study is randomized and all 543 subjects were volunteers (223 males and 320 females), aged 8 to 85years, mean age 53±18, 75 years. Using a standardized method, the blood pressure of the subjects with or without antihypertensive therapy was measured. Other measurements for the percentage of the fat tissue, body mass, height and waistline were also made. All data obtained in the study was analyzed using the SPSS package.
Results: Blood pressure (BP) measurements showed that in out of 543 subjects, 164 (30. 4%) had RR>140/90. Of these, 74 (45.12%) were males and 80 (48.78%) were females. People suffering from AH without therapy were 42 (25.61%. One-drug therapy was registered in 52 subjects (42.68%) and combined therapy – in 70 (57.32%). Only 28 (53.73%) of the males and females on one drug therapy had BP<140/90, and 32 (45.55%) on combined were found with the target BP.
Measuring the percent of fat body tissue showed that 117 (52.6 %) of the males and 137 (42.8%) of the females ranked high as a parameter.
The waistline as an indicator for visceral obesity was, on the average, above the normal range in both groups of males (94.1% ±13.7) and females (81.9±14.84) (p<0,001). In the group, 253 (46.59 %) were overweight (Quetelet index >25). The correlation between waistline length and % body fat tissue was statistically proved (0.28; p<0,001).
Conclusion: The high percentage of subjects from the studied group with BMI>25 (46.7%) and the average value of the waistline length in the groups of males and females above the standard range shows that overweight is one of the main risk factors for arterial hypertension among them. There is a high percentage of controlled AH- more than half of the group, which shows a high level of health knowledge and adherence to the therapeutic rules.
APPLIANCE OF CONFIRMATORY TESTS FOR HIV AND HCV INFECTIONS IN MONTENEGRO
S. Radoman, J. Vujovic
Medical Faculty of University of Montenegro, Podgorica, Montenegro
Key words: HIV, HCV, ELISA test, confirmatory tests
Serological diagnosis of human immunodeficiency virus (HIV) and Hepatitis C virus (HCV) infection implies proving anti virus antibodies in human serum using the ELISA test. Confirmatory tests are used to evaluate the reliability of positive results which are obtained by using the ELISA test. Confirmatory tests in use are RT - PCR and Western blot for HCV RNA.
The aim of this research was to fortify the number of positive results obtained by the confirmatory test in comparison with the number of preliminary positive results which we got by using the ELISA screening test.
From 12.10.2005. to 12.06.2006, by using the confirmatory test, we examined 8 samples of the sera from patients in which case the screening ELISA test for discovering anti HIV antibodies was positive, and 37 samples of the serums with the presence of anti HCV antibodies presented by the positive screening test. The sera used in this research were sent from the different boards of health to the Department of virology and serology, the part of Public Health Institute, the only one in Montenegro which does this kind of diagnosis.
In this research, BIORAD firm confirmatory tests were used: DECISCAN HCV plus in order to prove anti HCV antibodies, and for anti HIV antibodies - NEW LAV blot 1 and 2.
The results showed that in the case of HCV infection, from 37 examined samples of sera found positive by using the ELISA test, only 2 were positive after the confirmatory test was done. Using the test also showed that even 17 from 37 tested samples of sera remained indeterminable. From 8 samples of sera tested with confirmatory test for the presence of anti HIV antibodies, 2 were positive and 1 was indeterminable.
The huge numbers of indeterminable cases obtained by using the confirmatory test create difficulties in establishing the right diagnosis and requires further examination. In the case of HIV infection, confirmatory test appeared as confident in discovering specific anti HIV antibodies preliminary detected with ELISA screening test.
IMPLICATION OF CHROMOSOME 1 IN THE TUMORAL PROGRESSION OF MENINGIOMA
A. Bataller-Calatayud, C. Lopez-Gines, M. Cerdá-Nicolás, R. Gil-Benso
University of Valencia, Spain
Key words: meningioma, brain tumor, cytogenetics, chromosome 1, progression
Introduction: Meningiomas are neoplasms that arise from the leptomeningeal covering of the brain and spinal cord, accounting for 15-20% of all central nervous system tumors. Although the majority of these are histologically benign, some meningiomas show signs of malignancy such as marked vascularity, focal necrosis or infiltration to the adjacent brain. The World Health Organization (WHO) classifies meningiomas into three histological grades: Grade I (benign), Grade II (atypical), and Grade III (anaplastic) in accordance with clinical prognosis. Atypical and anaplastic meningiomas tend to recur. Formation of meningiomas has been associated with the loss of genetic material on chromosome 22. Partial or complete loss of the short arm of chromosome 1 seems to be the second most common chromosomal abnormality found in such neoplasms.
Aims: This work allowed us to know the additional chromosomal events that affect progression of meningioma.
Material and methods: We present 14 meningiomas of
different histologic subtypes, with abnormalities of chromosome 1. The
cytogenetic analysis was performed by short-term culture from primary
tumors. For FISH studies whole chromosome painting probes (CP5601,
CP5614) were applied to the slides, to confirm the origin of rearranged
DOPPLER GUIDED HAEMORRHOIDAL
Medical Faculty, Thracian University - Stara Zagora, Bulgaria
Key words: HAL Doppler, haemorrhoids, hemorrhoidal artery, ligation
Introduction: Doppler-guided hemorrhoidal artery ligation is a new technique for treating grade 1-3 hemorrhoids by means of Doppler identification and submucosal ligation of the haemorrhoidal arteries.
Methods: The HAL Doppler procedure is performed with a special proctoscope that with an US probe on a side part of the proctoscope, to explore, above the dentate line, the arterial flux where the terminal branches of median rectal artery enter into the rectal wall before forming the CCR (corpus cavernosum recti). Across the proctoscope and with a special needle it is possible to suture precisely the artery found with the US probe, and also to verify immediately the result of suturing. This procedure is performed always above the dentate line, first at level of the principle haemorrhoidal peduncles (3, 7 and 11 hours), with the patient in gynaecological position) and then in the interposed side, substantially where it is possible to hear a haemorrhoidal branch. This procedure is possible to perform under local anesthesia but, because the operation time is normally takes 30- 40 min, some minutes more if in case colonoscopy is performed, we think that stronger sedation or a pharyngeal-mask anesthesia can improve the intraoperative comfort for the patient (and also for the surgeon!).
Results: One or 2 hours after surgery the patients generally did not feel any symptoms because of the absence of anal wounds. The first evacuation was without pain; and only a slight discomfort - an intra-anal weight persisted for 24-48 hours. The discharge was possible in the evening or in the morning of the second day. The sphincter tone was investigated in a group of 30 patients with a pre-operative anal-manometry and a control test after one month; and resting and squeeze pressure values were unchanged. Patients did not report stenosis or incontinence. The first effect after DGHAL was the interruption of the arterial flux to internal haemorrhoids and consequently a reduction or total elimination of hemorrhoid bleeding; this effect produces also the shrinkage of a cushions that after the first days begin to involve their intra-anal size and also to opposite the prolapse tendency because of the ano-rectal mucosa fixation with the suture. The risk of haematoma after suture is very low but it was present in 1% of the most important series.
Conclusion: Doppler-guided hemorrhoid artery ligation is a safe and effective method and can be performed as an outpatient procedure.
MOOOD AND AFFECTIVE DISORDERS IN PATIETS WITH
ALCOHOL ABUSE AND ALCOHOLISM – RESULTS FROM AN INVESTIGATION OF
POPULATION OF PATIENTS IN BULGARIA
Stoychev R.1, Alexandrova M.1,
Nakov V.2, Ivanov K.1, Kirov D.1
University Pleven, Department of Psychiatry, 2Private
including alcohol abuse and dependence affect multiple areas of
functioning and cause serious health problems to a significant number of
people in most countries around the world. Comorbid diagnosis,
particularly mood, anxiety or personality disorders, occurs in about 60 to
75% of the patients with substance related disorder. On the other hand,
drug induced syndromes may mimic the full spectrum of psychiatric
disorders including anxiety, mood and psychotic disorders. Therefore it is
obligatory in clinical practice to consider substance related disorders in
every patient presenting with psychiatric symptoms. Besides, patients
diagnosed with psychoactive substance abuse or dependence must be assessed
for the presence of comorbid psychiatric disorder (dual diagnosis), which
may be contributing to or directly causing the drug problem.
present work is a part of a larger study aimed at obtaining representative
information about the prevalence of comorbid mood and anxiety disorders
among the population of patients with alcohol abuse and dependence in
Methods: 20 in- and outpatients with ICD-10 diagnosis “Harmful use” and “Alcohol dependence” (assessed with AUDIT1) treated at the Drug Dependence and Comorbid Psychiatric Disorders Unit and the Outpatient General Psychiatric Unit of the University Hospital of Pleven were interviewed with the internationally standardized clinical tool Composite International Diagnostic Interview (CIDI6) – modules for assessment of lifetime and current prevalence of mood and anxiety disorders. CIDI is applied after a minimum 14 day detoxication to minimize the interference of mood and anxiety syndromes often occurring in the acute abstinence period.
Prevalence rate of comorbid mood and anxiety disorders of patients
with alcoholism in our study (50-60%) are compatible with those reported
earlier from other authors 2, 3,5,6,7 and
disagree with other investigator’s observations postulating lack of
increased risk from mood and anxiety disorders in patient with alcohol
the presented sample 13 of the patients (65%) have comorbid mood or
majority of the patients with anxiety disorder (8 of 12 patients or 66%)
also have co-occurring mood disorder mostly depressive episode or
only patient with bipolar disorder in our study has no comorbid anxiety or
the whole patients with anxiety/phobic disorder have attempted alcohol for
the first time earlier than those without comorbidity. (15.5 ± 4.1 versus
17.6 ± 3.8).
patients have begun regular alcohol use earlier than female ones
- (24.6 ± 7.5 versus 29.1 ± 9.6).
important limitation of the present study which does not allow for
generalization of the data obtained, is the small number of patients in
the sample – only 20. Many more patients are needed to derive reliable
more general shortcoming of the present study, is that prevalence of
comorbid mood and anxiety disorders was evaluated retrospectively. In this
respect, it is important to note that a carefully designed and conducted
prospective study would elicit more data.
Till the present moment, no adequate
studies of the psychiatric comorbidity in patients with alcohol misuse
have been performed in Bulgaria. Opinions of investigators are
contradictory – some claim much higher prevalence of mood and anxiety
disorders among patients with alcohol problem compared to the general
population13, while others do not consider alcohol abuse and alcoholism a
risk factor for mood and anxiety disorders. Therefore additional research
is needed in this area. However, if comorbid mood and anxiety disorders
increase the risk of secondary occurrence of alcohol misuse, their early
identification and treatment would theoretically reduce the prevalence and
severity of alcohol abuse and dependence.
CHRONOBIOLOGICAL DIFFERENCES IN THE PHARMACOKINETICS OF CARDIOVASCULAR DRUGS
Department of Clinical Pharmacology and Therapeutics,
Medical University ЁC Sofia, Bulgaria
Key words: Chronobiological differences, pharmacokinetics, cardiovascular drugs
Introduction: Diurnal differences of drug absorption, distribution, metabolism and elimination could alter drug pharmacokinetics. As a result, drug bioavailability may vary according to the time of administration in 24hours.
Aim: To investigate the chronobiological differences in the pharmacokinetics of cardiovascular drugs nifedipine and isosorbide dintrate as modified-release formulations. The active metabolite isosorbide-5-mononitrate was also investigated, and the hemodynamic changes (blood pressure and heart rate) were studied.
Methods: Both studies were performed as open, randomized, cross-over studies. The subjects were randomized in two groups and took the investigated drug as a single dose of 20 mg at 8.00 or 20.00 o'clock. Blood samples were taken at pre-dose, and up to 24.00 h post dosing. Plasma concentrations of the drugs were determined using a validated analytical method.
Results: The maximum plasma concentration and the extent of bioavailability of nifedipine were 2 times higher in the evening than in the morning. Pharmacokinetic parameters of isosorbide dinitrare did not differ significantly when the drug was administered at 8.00 as compared to 20.00 o'clock. A difference was apparent for its metabolite isosorbide-5-mononitrate. The maximum plasma concentration and the extent of bioavailability of isosorbide-5-mononitrate was 1.5 times higher in the evening than in the morning. The hemodynamic changes (blood pressure and heart rate) followed the chronobiological differences of the bioavailability of isosorbide-5-mononitrate.
Discussion: Pharmacokinetic parameters of nifedipine as modified-release formulation depend on the time of administration. Similar circadian dependency is determined for isosorbide-5-mononitrate, which is the principal metabolite of isosorbide dintrate. The chronopharmacokinetic differences of nifedipine and isosorbide dintrate as modified-release formulations may due to circadian variations in absorption, hepatic blood flow, hepatic microsomal metabolism and elimination.
STROKE, THE TRIGGER FOR EPILEPTIC SEIZURES
M. Bogdanovic, D. Puric, M. Ercegovac
School of Medicine, University of Belgrade, Serbia
Key words: stroke, epilepsy, seizure
Introduction:Many studies have shown that cerebrovascular diseases act as very common etiology of seizures, especially in the elderly. The cause for early one third of all symptomatic epilepsies in industrial countries are caused by CVD. Seizure frequency varies depending on the nature of cerebrovascular disease, with highest frequency in patients with intracerebral hemorrhages and embolic stroke. Seizures most often occur in the first 48 hours after the hemorrhagic stroke and in first 2-3 weeks from the beginning of ischemic cerebrovascular disease.
Aim:The aim of this study was to assess the frequency and semiological classification of the type of seizures, as one of neurological symptoms of stroke.
Patients and Methods: The sample consisted of 190 stroke patients, hospitalized at the Emergency neurological unit in Belgrade in 2005. Epileptic seizures were verified in 17 patients (male 8, female 9), age range from 19 to 77 (mean 49.7). Based on the clinical symptoms and using multiple neurological and neuroradiological diagnostic procedures, we defined the type, etiology and localization of the stroke.
Results:Ischemic cerebrovascular lesions were found in 12 patients and hemorrhagic lesions in 5 patients. In 5 patients, epileptic seizures occurred as an initial clinical symptom of stroke. Using International Classification of Seizure Type, focal seizures were verified in 8 patients (ischemic 7, hemorrhagic 1), focal seizures with secondary generalization in 5 patients (ischemic 2, hemorrhagic 3), while primary generalized tonic-clonic seizures were observed in 4 patients (ischemic 3, hemorrhagic 1). During the hospital stay, all patients were treated with AED (predominantly with valproic acid and carbamazepine). In one case with lethal outcome, seizures were uncontrolled and pharmacoresistant after primary medication.
Conclusion: Seizures are relatively common symptom of acute CVD, with incidence of 9% from our study, and also represented the first clinical symptom of stroke in 3% of these patients with stroke. Focal motor seizures mostly occurred, predominantly after ischemic lesions, while secondary generalized seizures were more frequent in patients with hemorrhage.
DIFFICULTIES IN MAKING THE CORRECT DIAGNOSIS IN DEMYELINATING DISEASES
M. Milenkova, M. Markov, V. Hadjidekova, T. Petrova, I.Milanov
Specialized hospital for active treatment in neurology and psychiatry "St. Naum", Sofia, Bulgaria
Key words: cerebral vasculitis, multiple sclerosis, MRI
Introduction: Cerebral vasculitis is a serious but uncommon condition which may be difficult to recognize. It can present with a great diversity of symptoms and sometimes may have a clinical picture similar to multiple sclerosis (MS). Neurological manifestations and magnetic resonance imaging (MRI) can be indistinguishable.
Material, methods and results: We present a 53 year-old male patient, hospitalized and suspected with MS based on his previous history and neurological examination. The diagnosis was not definitive because of the atypical MRI findings. During his stay at the hospital he developed a progressive right hemiparesis, motor aphasia with signs of sensory aphasia and Jacksonian motor seizures. A variety of laboratory examinations, CT-scans and electoencephalography were performed. After discussions, we diagnosed him with cerebral vasculitis.
Discussion: Although in the past few years MRI findings have become increasingly relevant in the differential diagnosis of MS, the specificity of a MRI is still limited. Sometimes a wide range of diseases like hypertension-related disorders, primary and secondary vasculitis, metabolic diseases and degenerative syndromes have to be taken into consideration.
THE DETECTION OF NEONATAL CMV INFECTIONS IN MONTENEGRO
Medical Faculty Podgorica, University Of Montenegro
Key words: CMV, anti-CMV IgM antibodies
The most frequent cause of congenital infections is HCMV. The percentage of congenitally infected children varies according to the examined region. The diagnosis of congenital infection is of essence because of a certain percentage congenitally infected, after being born asymptomatic children, who, in a letter development manifest neurological disorders.
The aim of this research is to show that serological diagnostics enables the detection of neonatal CMV infections in high percentage.
The number of 119 serums of new-born children received from the neonatology department of the Institute for Children Diseases in Podgorica from December 2005 to May 2006 was examined. The presence of anti-CMV antibodies was examined by the Orgenics firm test ELISA.
The results have shown that in one of 119 examined serums the presence of anti-CMV IgM antibodies was found, which indicates to congenital infection. In 111 examined serums the presence of IgG antibodies was shown, which indicates to high percentage (93%) of CMV ser-positive mothers.
Congenital CMV infection in the examined sample has shown the frequency which responds to the average frequency in the world. Concerning the high percentage of the infected mothers, we believe that the carry-out of the same research by a more sensitive method (PCR) is necessary.
CORRELATION BETWEEN GCS AND THE RISKS OF ASPIRATION PNEUMONIA IN SELF-POISONING PATIENTS
V. Ramdan, A. Petrov, G. Dimov, J. Karakolev
Medical Faculty, Clinic of Anaesthesiology, Emergency and Intensive Medicine Thracian University - Stara Zagora, Bulgaria
Key words: coma, GCS, endotracheal intubation, aspiration pneumonia
Introduction: Self-poisoning is a common cause of nontraumatic coma, especially in young people. The management of these patients aims to protect the airway in order to prevent aspiration pneumonia (AP).
Aims: The aim of our study is to evaluate the relation between GCS and the risk of developing this complication.
Materials and methods: We conducted a retrospective study covering a period of 7 years, including 52 patients with self-poisoning admitted to ICU. GCS was noted on admission or immediately before intubation. The diagnosis of AP was made based on routine criteria. Two groups were compared: G1 (without AP) and G2 (with AP). Data were expressed as a mean ± SD and percentage. For comparisons, the Q-square and Student’s t-tests were used.
Results: Fifty patients with self-poisoning were included. Eight of them (14.9%) had developed AP. GCS was significantly lower in G2. In patients with GCS 12 the frequency of pulmonary complications is high (78%). Conclusion: Criteria used to decide about intubation in patients with self-poisoning must be more rigorous. According to our study, patients with GCS < 12 should be considered for intubation.