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CURRENT ISSUE / 1-2009


DIRECT ELECTROTHERMAL ATOMIC SPECTROPHOTOMETRIC METHOD FOR DETERMINATION OF GOLD
IN HUMAN PLASMA AND URINE

B. Atanassova, K. Tzatchev, V. Vassilev, S. Kyriaky and A. Tzakova
Department of Clinical Laboratory and Clinical Immunology
Medical University – Sofia

Summary. Gold compounds are successfully used in the treatment of rheumatoid arthritis and there is good evidence that they make an effective contribution to therapy of this disease. The aim of the present study is to develop a direct method for gold analyses in human plasma and urine using graphite furnace with Zeeman correction and matrix modification. The optimized furnace conditions and evaluation of the analytical reliability indicate that the atomic absorption assay is especially suitable for routine monitoring of plasma and urine gold levels during the treatment of rheumatoid arthritis. Such approach would improve the effectiveness of chrysotherapy.
Key words: gold, atomic absorption, graphite furnace, analytical reliability, rheumatoid arthritis, aurotherapy, chrysotherapy



BGA AND TUMOR PROGRESSION
V. Sarafian
Department of Medical Biology, Medical University – Plovdiv, Bulgaria

Summary. Human blood group antigens (BGA) are genetically determined glycoproteins found in different tissues and body fluids. Their physiological and pathophysiological role is not entirely clear yet. It is believed that BGA share diverse biological functions. They do not serve for blood group typing only as initially discovered. Personal data and recent research in the field are discussed focusing on the participation of these molecules in normal and pathological processes and cell phenomena as proliferation and apoptosis. ABH BGA are related to complex biological events like cell differentiation, proliferation and death, intercellular communications and cell motility – all of them closely linked with tumorigenesis and tumor progression.
Key words: blood group antigens, tumor cells, apoptosis, invasion, metastasis



FATAL INVASIVE PULMONARY MOULD INFECTION DUE TO FUSARIUM DIMERUM AND ASPERGILLUS FUMIGATUS
IN A PATIENT WITH ACUTE MYELOID LEUKEMIA

P. Nenoff(1), S. Stengel(2), G. Ackermann(3), M. Erhard(4), M. Seibold(5), and A. Oltmann(6)
(1)Laboratorium für medizinische Mikrobiologie
(2)Klinik und Poliklinik für Anästhesiologie und Intensivmedizin, Uni­versitätsklinikum Leipzig AöR
(3)Medizinische Kooperationsgemeinschaft für Laboratorium­sme­di­zin und Mikrobiologie
(4)AnagnosTec, Gesellschaft für analytische Biochemie & Dia­gno­s­tik mbH, Potsdam-Golmy
(5)Robert-Koch-Institut
(6)Institut für Medizinische Virologie, Helmut Ruska Haus, Charité Univer­sitätsmedizin Berlin

Summary. A 68-year-old woman suffered from acute myeloid leukemia and breast cancer. During neutropenia, a respiratory failure occurred and Aspergillus (A.) fumigatus was detected in bronchial secretion. After treatment with voriconazole was started, Fusarium (F.) dimerum was cultured from tracheal secretion. In addition, A. niger was cultured. Despite of treatment with voriconazole, the woman died. So far F. dimerum has not been described to cause human infections in Germany. Treatment of Fusarium infections is difficult in particular due to the high percentage of isolates showing in vitro resistance against amphotericin B. The best prognosis factor remains recovery from neutropenia. New azoles, including voriconazole and posaconazole, are considered promising therapeutic options. However, the F. dimerum isolate in this case showed high in vitro resistance/MICs against these antifungals. In vitro susceptibility testing of F. dimerum isolate was performed according to NCCLS (CLSI) M 38-A. Minimum inhibitory concentration values were 2 µg/ml for amphotericin B, >16 µg/ml for caspofungin, 8 µg/ml for voriconazole, and >16 µg/ml for posaconazole. Thus growth of F. dimerum from bronchial aspirates could be indicative of a breakthrough infection under treatment with voriconazole.
Key words: invasive fungal pulmonal infection, pulmonal mycosis, acute myeloid leukemia, Fusarium dimerum, Aspergillus fumigatus, Aspergillus niger, voriconazole, in vitro susceptibility testing, posaconazole, amphotericin B, in vitro resistance



HUMAN PAPILLOMAVIRUS INFECTIONS FROM DERMATO-VENEREOLOGICAL POINT OF VIEW: IMPORTANT INVASIVE
AND NONINVASIVE TREATMENT OPTIONS

G. Tchernev(1) and P. Nenoff(2)
(1)Department of Dermatology, Venereology and Dermatosurgery, MVZ Kirchheim, Germany
(2)Laboratory for Medical Microbiology, Mölbis, Germany

Summary. Genital papillomavirus infections are among the most common sexually transmitted diseases in humans. Sexually transmitted HPV infections are often associated with a spectrum of diseases ranging from benign genital warts to malignant tumors of the cervix, vulva, anus and penis. Genital HPV is in most cases sexually transmitted, but non-sexual routes of transmission are also possible (perinatal/autoinoculation). Men can be a reservoir of the virus that lives in latent form on the genital area. Such an asymptomatic infection could be an oncogenic factor for the development of cervical cancer for example. Lesions associated with sexually transmitted human papillomavirus affect at least 1% of sexually active adults. The treatment for condyloma acuminatum is classified into invasive and non-invasive therapies. Removal of lesions by means of different invasive methods, such as electrodessication, cryotherapy, and/or laser therapy, may be successful and postoperatively combined with local application of some substances, such as podophylic toxin, imiquimod, cidofovir and interferon. The different therapeutic methods must be applied in accordance with clinical picture, taking into account the patient’s general status, the presence of concomitant diseases, as well as the local and systematic compatibility of the side effects of each remedy.
Key words: cidofovir, dermatosurgery, treatment, HPV, interferon



LAPAROSCOPIC RADICAL PROSTATECTOMY - FIRST RESULTS IN BULGARIAN UROLOGICAL PRACTICE
Ts. Genadiev, D. Gaydarov and V. Veleva
Universiry Hospital “Lozenets” – Sofia, Bulgaria

Summary. Purpose of the report is to present the first results from laparoscopic radical prostatectomy in Bulgarian urological practi­ce. The first laparoscopic prostatectomy in Bulgaria was performed during the first course of endoscopic urology, organized in 2003 in Sofia. Guest operator was Professor J. U. Stolzenburg from Leipzig, Germany. Bulgarian urological team performed laparoscopic urological operations for the first time in 2003 at the University Hospital “Lozenets” – Sofia. For the period 2005-2008, we performed 30 laparoscopic radical prostatectomies, 23 of them being transperitoneal by the method of Montsouris (group A) and 7 – extraperitoneal by the method of J.-U. Stolzenburg – EERPE (group B). All the patients had adenocarcinoma of the prostatic gland proven by biopsy. Complications were rectovesical fistula – 1 case, paravesical urinoma – 3 cases. No blood transfusion and conversion were needed. In conclusion, we define our first cases of radical endoscopic prostatectomy as successful.
Key words: laparoscopic prostatectomy, Bulgaria, first results



ESTHETIC SOLUTIONS USED TO RESTORE THE SOFT TISSUE IN REMOVABLE PARTIAL DENTURE TREATMENT
O. C. Andrei
Department of Removable Prosthodontics, University “Carol Davila” - Bucharest, Romania
Summary. Obtaining an esthetic replacement of the missing teeth using a removable partial denture includes efforts to create a good relation between the artificial tooth and the soft tissue. The restoration of the space between the denture and the abutment tooth, the interdental papilla and the surrounding soft tissue contribute to the esthetic success.
Key words: esthetic, removable partial denture, soft tissues.



REHABILITATION OF PATIENTS AFTER CEREBROVAS­CULAR ACCIDENT
H. Hundozi-Hysenaj(1), A. Murtezani(1), Q. Hysenaj(3), Z. Hundozi(2), N. Baftiu(4)
(1)Physical Medicine and Rehabilitation Clinic
(2)Clinic of Neurology
(3)Clinic of Otorhinolaringology
(4)Clinic of Aneshthesiology
University Clinical Center of Kosovo

Summary. Cerebrovascular accident (CVA) is a pathology more frequently fround among population age group 45-60 years old, causing disability that requires specific care and treatment. Purpose of this research work is determination of effectiveness of the rehabilitation treatment after the stroke based on which treatment algorithm is defined. The patients with stroke included in this research program were hospitalized in the Neurological Clinic of University Clinical Centre of Kosova in Prishtina within the period of 5 years (January 2000 – January 2005), implementing the methodology of prospective description. During this study, following methods of physical therapy were implemented: electrotherapy, kinesi­therapy, seating and standing balancing, respiratory exercises, massage, ergonomic therapy, gait exercises as well as speech therapy. Among the total number, females were 59.7% of the cases, persons over 60 years were more affected, the majority of cases were facing the consequences of motor and functional impairment at the affected side as well as swallowing and speech disorders. According to the presented scheme of the rehabilitation algorithm, it can be expected to achieve satisfactory results on improving the ROM and functionality of the affected side.The most frequent cause of CVA based on etiology is the ischemic incident, in 73% of strokes. Physical therapy should start as soon as possible, and the presented algorithm of rehabilitation should be taken into consideration.
Key words: CVA, treatment algorithm, rehabilitation



IFE THREATENING HEMORRHAGIC DIATHESIS IN EXOGENIC POISONINGS. A CASE OF ISOLATED THROMBOCYTOPENIA
IN POISONING WITH SELECTIVE HERBICIDE TROPHY

P. Atanasov(1), E. Stankova(2) and I. Grabchev(3)
(1)Clinic of Emergency Internal Diseases, UMHATEM “N. I. Pirogov” – Sofia
(2)Toxicology Clinic, UMHATEM “N. I. Pirogov” – Sofia
(3)Institute of Polymers, BSA – Sofia

Sumary. High technologies are an integral part of modern human life. They are continually being imposed and established both in the manufacturing field - industry, agriculture and in our mode of living as well. For the last few decades, modern living conditions have imposed a rather frequent contact of private manufacturers with the so-mentioned technological methods, without them being well-trained and grounded to work with these technologies, without having sound knowledge of the correct ways of their application and furthermore, without having sufficient command of labour protection and safety measures in modern life conditions. It is of frequent occurrence nowadays when new methodologies, toxic substances in particular, are being made use for the purposes of household or agricultural needs. These substances bring about to a raise in yield whether we speak about products of a small-scale domestic agricultural activity aiming at supplying the family needs or a family business designed as a basic means of earning their living, which naturally results in one’s ambition and aspiration for higher earnings. One of the outstanding characteristic features of the transitional period will probably be the non-regulated and hard to control application of agricultural poisons and the ones used for household purposes. We present a clinical case of a twenty-three-year-old patient who entered the medical institution of CSVB in order to undergo treatment of hemorrhagic diathesis conditioned by isolated thrombocytopenia after having worked with a poison for agricultural purposes while cultivating a small private farm against weeds. The clinical pattern and the course of illness cannot be related to any other reason but the herbicide used in the particular case. There is no evidence of severe intoxication. All the family worked with the poison, with the exception of the patient’s brother, his identical twin, but none of the other members of the family had whatsoever symptoms of the illness. This points to the existence of the so-called “terrain/ground/area” and the important part it plays when the external pathogenic factors and agents exert influence.
Key words: thrombocytopenia, poisoning, herbicide, hemorrhagic diathesis, Trophy



STUDY ON ACUTE METHANOL POISONING
J. Radenkova-Saeva(1) and R. Atanassova(2)
(1)Toxicology Clinic,
(2)Sector for Toxicological Analysis and Control,
Emergency Hospital “N. I. Pirogov” - Sofia

Summary. The aim of the study was to examine methyl alcohol poisoning cases, to define the demographic features and determine mortality rates of the patients. The medical records of the Toxicology Clinic, MHATEM “N. I. Pirogov”were reviewed retrospectively for all methyl alcohol poisonings during the period from January 1, 2001 to December 31, 2006. The patient’s age, gender, methyl alcohol blood levels and outcome of intoxication were recorded. The number of patients, hospitalized in Toxicology Clinic, due to methyl alcohol poisoning was 30 during that period of time. There were 22 men (73.3%) and 8 women (26,7%), median age 46,6 (range 28-76). The largest age group was 41-50 years old (40%). Methyl alcohol blood concentrations ranged widely from 0,12 to 5,1%o. The reason for ingestion was accidental in 22 cases (18 men and 4 women), suicide attempt in – 8 cases (4 men and 4 women). The number of deaths due to methyl alcohol poisoning was 19 (63,3%). It is concluded that methanol poisoning is a rare but extremely hazardous form of intoxication, generally occurring after suicidal or accidental events. In order to decrease the mortality due to methyl alcohol intoxication, some precautions should be developed that could prevent the production and consumption of alcoholic beverages illegally produced.
Key words: methyl alcohol, poisoning, demographic features, mortality rates



DIAGNOSTIC RELIABILITY OF ROTATION THROMBELASTOMETRIC METHOD (ROTEM®)
A. Stancheva, L. Spassov and G. Mutafov
“Lozenetz” University Hospital - Sofia

Summary. The Rotation Thrombelastometric Method (ROTEM®) is a global diagnostic approach to quick differentiation of hemostatic disorders in acute bleeding, leading to hypercoagulation, hypocoagulation or hyperfibrinolytic states. In the present study, the predictive potential of rotation thrombelastometry ROTEM® for the necessity of blood product infusions during liver transplantation has been determined - cut off levels of ROTEM parameters, diagnostic sensitivity, diagnostic specificity, positive predictive values (PPV) and negative predictive values (NPV) –  with the objective of optimizing the intraoperative transfusions. Cut off values have been determined according to transfusion threshold values based on conventional coagulation parameters. The significant correlations between prothrombin time (PT) and EXTEM_CFT (r = 0,834 p < 0,001), between activated partial thromboplastin time (APTT) and INTEM_CFT (r = 0,707 p < 0,001) and between platelets concentration (Plt) and INTEM_MCF (r = 0,784 p < 0,001) have been used. The determined ROTEM® indices EXTEM_CFT, INTEM_CFT and INTEM_MCF have presented high sensitivity and specificity in the diagnostics of transfusion demanding coagulopathies. Cut off values of EXTEM_CFT at 130 s, of INTEM_CFT at 136 s and INTEM_MCF at 38 mm have presented high sensitivity (70%, 65% and 100%), good specificity (75%, 57% and 83%) and high positive predictive value (93%, 79% and 100%) to detect PT and APTT > 1,5 of control values and Plt < 50 x 10 L, respectively. A suggestion has been made that ROTEM indices - EXTEM_ CFT (Cloth Formation Time EXTEM) > 130 s, INTEM_ CFT (Cloth Formation Time INTEM) > 136 s and INTEM_ MCF (Maximum Cloth Firmness INTEM) < 38 mm, could be helpful in guiding transfusion in each of the operative phases during liver transplantation.
Key words: Rotem®, ROC curves, diagnostic sensitivity, diagnostic specificity, positive predictive value, negative predictive value



COMPARATIVE AND EXPERIMENTAL STUDY ON THE EFFECTS OF HELIUM-NEON LASER IRRADIATION AND POLARIZED
MONOCHROMATIC LIGHT ON THE OXIDATION-REDUCTION PROCESSES OF THE FRONT EPITHELIUM AND THE STROMA
OF THE CORNEA AFTER CHEMICAL BURN

K. Koev(1), V.Tanev(1) and A. Mihova(2)
(1)Aleksandrovska Hospital, Clinic of Ophthalmology – Sofia
(2)Medical University, Department of Pathoanatomy – Sofia

Summary. Aim was to perform a comparative and experimental study on the effects of He-Ne laser irradiation and polarized monochromatic light on the oxidation-reduction processes of the front epithelium and the stroma of the cornea after chemical burn. The experimental study was performed on 36 rabbits (72 eyes), divided into four groups of 9 rabbits (18 eyes) each. The corneas in the first three groups were exposed to a dozed chemical burn with 4% NaOH, and respectively, the first group was irradiated with He-Ne laser with wave length 632 nm, the second group – with polarized mono­chromatic light with wave length 625-635 nm, and the third group was used for reference with the first two ones. The corneas in the fourth group, which were not burned, were used for determination of the normal values of the examined enzymes. The oxidation-reduction processes were investigated through a histochemical analysis of the activity of following phosphatases: alkaline phosphatase, acidic phosphatase, adenosine triphosphatase, and the dehydrogenases: lactate dehydrogenase, succinodehydrogenase, and glucose-6-phosphate dehydrogenase. Helium-Neon laser irradiation activates quicker the oxidation-reduction processes of the burned corneas in comparison with corneas irradiated with polarized light and non-irradiated burned corneas, and it accelerates the regeneration reactions.
Key words: He-Ne laser irradiation, polarized light, oxidation - reduction, cornea



NITRITE AND NITRATE LEVELS IN PLASMA AND URINE OF PATIENTS WITH INTESTINAL INFECTIONS
AND DIARRHEA SYNDROME

P. Gatseva(1), M. Stoicheva(2) and A. Bivolarska(3)
(1)Department of Hygiene, Ecology and Epidemiology
(2)Clinic of Infectious Diseases
(3)Dept. of Chemistry and Biochemistry
 Medical University - Plovdiv

Summary. Nitric oxide is one of the inflammation mediators with cytotoxic and antibacterial activity and participation in the local vascular control. The aim was to study in dynamics plasma and urine nitrite and nitrate levels of patients with acute intestinal infections and diarrhea syndrome, and to look for a relation with the etiological characteristics, seriousness and outcome of the diseases. Subjects of the study were 50 patients with acute bowel infections and diarrhea syndrome, treated at the Clinic of Infectious Diseases, Medical University, Plovdiv, Bulgaria. Determination of patients plasma and urine nitrites and nitrates was done by modified cadmium-reduction method. Plasma and urine nitrite/nitrate levels were raised in the acute period of the disease with a tendency to decrease in the convalescence period. The lowest rates of plasma and urine nitrite/nitrate had patients with mild clinical forms, and the values of those with hemocolitis were significantly raised in plasma and urine. The results that we obtained give us a reason to corroborate the thesis, that nitrite/nitrate level in biological materials (plasma and urine) could be used as a good indicator for infectious-inflammatory processes in the intestinal tract.
Key words: nitrite, nitrate, plasma, urine, diarrhea



INFLUENCE OF AIR POLLUTION IN AN URBAN AREA ON HOSPITAL ADMISSIONS FOR ACUTE MYOCARDIAL
INFARCTION

T. Dimitrova(1), E. Karaslavova(2) and N. Donchev(3)
(1)Department of Hygiene and Disaster Medicine, Medical University – Varna
(2)Department of Social Medicine and Healthcare Management, Medical University – Plovdiv
(3)Vascular Surgery, MHAT “Sv. Anna” – Varna

Summary. It has been established that the episodes of huge atmospheric pollutions like the London fog of 1952 are responsible for an increased mortality, the larger part of which from cardiovascular events. Aim of the study was to investigate the relation between the levels of atmospheric pollutants and the frequency of hospital admissions for acute myocardial infarction (AMI) in the city of Varna. Five hundred and eighty five patients were investigated of those who were admitted to the Intensive Care Clinic (ICC) of Sv. Marina University Hospital in Varna with a diagnosis of acute myocardial infarction in the period from December 2004 to December 2005. For the period from October 2004 to December 2005, the relationship between the quality of the atmospheric air and the frequency of hospital admissions for AMI was investigated. For the period from 1 October 2004 to 31 December 2005, a total of 585 persons were admitted for treatment to the ICC with a diagnosis of AMI, of which 393 (67.2%) were men and 192 (32.8%) were women. The mean age of them was 64.05 +/- 0.49 years (from 18 to 93 years). The frequency of hospital admissions for AMI showed statistically significant correlational subordinations with almost all studied atmospheric pollutants. The atmospheric pollution in urbanised inhabited areas should be considered a risk factor for cardiovascular diseases. Monitoring of the quality of atmospheric air provokes multidisciplinary prophylactic interest, including the needs of cardiologic prevention.  
Key words: air pollution, acute myocardial infarction


 
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