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CURRENT ISSUE /1-2011

OSTEOCLASTOMA OF METACARPAL BONES
H. Georgiev, B. Matev, N. Dimitrov and P. Georgiev
University Specialized Hospital for Active Treatment of Orthopaedics “Prof. B. Boychev” – Sofia

Summary. Osteoclastoma is a locally aggressive tumor, very rarely located in bones and joints (locomotory system). In 1987, Matev presented his 20-year study of 502 tumors of the hand, where no osteoclastoma cases were observed. In our study which tracks a period of 20 years, we found and treated 3 cases of osteoclastoma of the metacarpal bone and for the first time in Bulgaria we are presenting them. We follow consecutively the clinical picture, the applied treatment and the results. The conclusions show that it is an extremely rare aggressive tumor, complicated to treat, so that early diagnosis and therapy is the key to a comprehensive treatment, for organ and hand-function preservation.
Key words: osteoclastoma, giant cell tumor, hand

 

HEMOSTATIC MONITORING OF THE PERIOPERATIVE FIBRINOLYTIC ACTIVITY DURING LIVER
TRANSPLANTATION

A. Stancheva(1), L. Spassov(1) and K. Tzatchev(2)
(1)University Hospital “Lozenets”, Sofia, Bulgaria
(2)Medical University, Sofia, Bulgaria

Summary. Rotation thrombelasthometric analysis (ROTEM®) is a global hemostatic method, initiating the coagulation process both by contact surface activation and by additional activating reagents. The graphical and numerical ROTEM® results reflect the whole clot formation process and the next-coming fibrinolysis, as well as a great number of hemostatic and therapeutic factors, changing the kinetics of the hemostatic process.The performance of an extended perioperative fibrinolytic and therapeutic control during liver transplantation becomes possible with the development of the rotation thrombelastometry method ROTEM®. Perioperative hemostatic monitoring was performed to 30 patients undergoing orthotopic liver transplantation (13 male – 42% and 17 female – 58%), age (mean ± SD): 21±17 years. A STA Compact instrument (Diagnostica Stago-Roche, France, chronometric method) was used to determine prothrombin time (PT/INR), activated partial thromboplastin time (APTT) and fibrinogen (FIB). Rotation Thrombelastometry analyses were performed on ROTEM® analyzer (Pentapharm GmbH, Munich, Germany) in citrated blood, based on reagent activation of the hemostatic processes with thromboplastin tissue factor (TF) for EXTEM test and aprotinin for APTEM test. The correlation between MCF and A15 parameters was assessed to explore the possibility for application of A15 during the monitoring. The correlation between MCF and A15 parameters was excellent for EXTEM, INTEM and FIBTEM tests (r=0,98 p<0,001). The highest percentages of patients from the general group with increased fibrinolytic activity (33,33%) and with hyperfibrinolytic activity (8,7%) were determined during the anhepatic period R4. 16 % from the group with heavy coagulopathy displayed hyperfibrinolytic activity in the anhepatic period R4, while no patient from the moderate coagulopathy group developed hyperfibrinolysis during all perioperative periods R1-R6. During the anhepatic period (R4), the percentage of adults with increased fibrinolytic activity was significantly higher than the percentage of children (adults 41,66% and children 25,00%). Conclusions are that EXTEM and APTEM parameters could be used for determing the increased fibrinolytic and hyperfibrinolytic activity during the preanhepatic, anhepatic and reperfusion periods (R3, R4, R5) of liver transplantation. Patients with considered preoperative heavy coagulopathy are more risky to develop hyperfibrinolysis during the preanhepatic and anhepatic periods ( R3-R4). The established excellent correlations between MCF and A15 parameters suggest the application of A15 as satisfactory for the monitoring of fibrinolytic activity.
Key words: rotation thrombelastometry ROTEM®, fibrinolysis, liver transplantation

 

UNCOMMON CLINICAL PRESENTATION OF FIBROSARCOMA OF THE THYROID GLAND
IN A PATIENT WITH FATAL OUTCOME: THE ROLE OF IMMUNOHISTOCHEMISTRY FOR CONFIRMATION
OF THE DIAGNOSIS

J. Ananiev(1), M. Gulubova(2), I. Manolova(3), G. Tchernev(4), V. Ramdan(5), V. Velev(6) and J. Gerenova(7)
(1,6)Department of General and Clinical Pathology, Medical Faculty – Trakia University, Stara Zagora
(3)Laboratory of Clinical Immunology, University Hospital, Stara Zagora
(4)Department of Dermatology and Venereology, Medical Faculty, Trakia University, Stara Zagora
(5)Department of Anesthesiology and Intensive Care Medicine, University Hospital, Stara Zagora
(7)Department of Internal Medicine, Clinic of Endocrinology, University Hospital, Stara Zagora

Summary. We report a case of a rare thyroid gland tumor – fibrosarcoma, and autopsy findings. A 79-year-old woman presented with a twenty-year history of a thyroid gland enlargement. Since twenty days she had respiratory failure and dull pain in the anterior neck region. Preliminary cytological diagnosis confirmed undifferentiated thyroid gland tumor. The patient died four days after hospitalization with symptoms of complete respiratory failure, hypoxemia and suspected inflammation of the lungs. Autopsy revealed primary neoplasm оf the thyroid gland area, infiltrated trachea and adjacent tissues; acute tracheitis and lobular pneumonia. Histopathologically, the primary tumor showed proliferation of spindle-shaped tumor cells and was ultimately confirmed by immunohistochemistry as a primary fibrosarcoma of the thyroid gland.
Key words: fibrosarcoma, thyroid gland, immunohistochemistry, vimentin

 

FATTY ACID COMPOSITION OF FISH SPECIES FROM THE BULGARIAN BLACK SEA
M. Stancheva, A. Merdzhanova and L.Makedonski
Department of Chemistry, Medical University of Varna

Summary. The total lipids and fatty acid profile in the edible tissue of two traditionally consumed fish species from Bulgarian Black Sea coast – shad and red mullet in two seasons are determined. The fatty acid composition was analysed by GC/MS. The total content of omega-3 fatty acids was significantly higher than the total content of omega-6 fatty acids in shad whereas red mullet showed opposite trend. The omega-3/omega-6 FA ratio, an useful indicator for evaluation the relative nutritional value of a given fish, was within the recommended range for the studied Black Sea fish species. Obtained results for FA composition, omega-3/omega-6 and polyunsaturated /saturated fatty acids ratios indicate that these Black Sea fish species in both seasons – spring and autumn are good sources of essential fatty acids.
Key words: omega-3, omega-6, fatty acids, GC/MS, fish species


RHEUMATOID ARTHRITIS IN THE GENERAL PRACTITIONER'S RACTICE
V. Paskaleva-Peycheva(1), M. Panchovska-Mocheva(2) and E. Kavrakov(3)
(1)UMBAL “Sveti Ivan Rilski” – Sofia, Rheumatology Clinic, Medical University – Sofia
(2)Military Medical Academy – Plovdiv, Clinic of Internal Diseases, Medical University – Plovdiv
(3)Medical student, MU – Plovdiv

Summary. Rheumatoid arthritis (RA) is a inflammatory joint disease with a variety of manifestations, decursus and treatment approaches. It is essential to stress the importance of the early proven diagnosis and early treatment which protect from serious complications in the musculoskeletal system and internal organs. This requires some highly specialized help from a rheumatologist. There has to be a good dialogue between general practitioner and rheumatologist who must work together. Such an approach would lead to quick and efficient treatment of patients with RA.
Key words: rheumatoid arthritis, patients, general practitioner


IMMUNOBIOLOGY OF ENDOMETRIOSIS
N. Manolova, D. Zasheva and M. Stamenova
Department of Immunochemistry, Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences

Summary. Endometriosis is a condition in which tissue similar to the lining of the uterus (endometrial cells and glands, which should appear only in the uterus) is found in other parts of the body. This tissue can be implanted itself and grow throughout the abdominal cavity. As a disease, it is a unique clinical and scientific challenge. This disease called “enigma wrapped in mystery”, is still etiologic and pathogenetic phenomenon. According to some authors in women with infertility, the rate of genital endometriosis is estimated at 20-55% and 30 to 50% of women with endometriosis are infertile. The disease leads to poor success rate in patients who undergo assisted reproductive technologies. Endometriosis is a benign, chronic, estrogen – dependent gynecological disease accompanied by pelvic pain. Because of the clinical, psychological and social significance of the problem, endometriosis is a widely studied disease. It affects the quality of life of women in their most active age and has serious economic consequences. For accurate diagnosis and proper treatment of endometriosis and prevention it is necessary to perfect knowledge of the mechanisms of emergence and development of pathological process. Basic environment for emergence and development of endometriosis is peritoneal fluid. Middle of the peritoneal fluid surrounding the endometrial implants is biochemically dynamic and it becomes a meeting of reproductive and immune systems.
Key words: endometriosis, implantation, infertility, peritoneal fluid, serum, reproductive system, immune cells, humoral immunity


ZINC – THE BREAKTHROUGH
S. S. Mileva
Department of Infectious Diseases, Epidemiology And Tropical Medicine,
Medical University of Varna

Summary. The essentiality of zinc for plants and animals has been established by science for decades. Nevertheless, its significance for human health has been revealed only at the end of sixties of the XX century. Since then the interest of medical scientists for that element keeps growing. As a consequence in the last 40 years we became witnesses of a dramatic breakthrough in the knowledge of this unique mineral and its applications in medicine. The aim of this review is to explore the current concepts of the zinc significance for human physiology and some pathologic conditions. Special importance is attached to its place in the treatment of infectious diarrhea, because acute diarrhea is a huge part of the infectious pathology in our country. There is no established practice yet for additional treatment with zinc in the cases of acute diarrhea in Bulgaria.
Key words: zinc, human physiology, diarrhea


USE OF POSTS IN DENTAL PRACTICE
E. Boteva
Department of Conservative Dentistry
Faculty of Dental Medicine – Sofia

Summary. Metal posts are often used in the dental practice for non vital teeth.There are different views in the dental literature about the indications for their use. The traditional approach to fix them always when a cusp or wall is missing, is not commonly used. In most of the cases, posts are fixed when a large amount of hard tissues is missing. The classical approach is accepted as based mainly on the experience from the preadhesive dental techniques. The aims of the present study are to evaluate the frequency of the complications in front and distal teeth, pins, casted posts and cores or cemented posts. The following parameters were registered: type of the post, length, diameter, complications including empty root canals, periapical lesions, etc. The results have shown that the aesthetic posts are not much used in the dental practice in Bulgaria. The most frequent use of posts is in front teeth and premolars (81.3%). The reason for that can be to avoid complications, more common in molars. Cemented prefabricated metal posts are used most frequently (60.3%), and casted less (8.9%). The study shows that the financial factor plays a central role in the choice of dental posts.
Key words: posts, dentistry

 

USE OF POSTS BY UNDERGRADUATE DENTAL STUDENTS
E. Boteva
Department of Conservative Dentistry
Faculty of Dental Medicine – Sofia

Summary. Metal posts are often used in the dental practice for non vital teeth. Teeth with large defects of the clinical crown are often treated during the undergraduate students practice. There are different views in the dental literature about the indications for their use. The traditional approach to fixed them always when a cusp or wall is missing, is not commonly used. In most of the cases, posts are fixed when a large amount of hard tissues is missing. The classical approach is accepted as based mainly on the experience from the preadhesive dental techniques. The aims of the present study are to evaluate the frequency of: the use of prefabricated metal posts and the complications frequency in front and distal teeth, and the type of the post – pins, casted posts and cores or cemented posts. The following parameters were registered: type of the post, length, diameter, complications including empty root canals, periapical lesions, etc. The results have shown that the aesthetic posts are not much used in the dental practice in Bulgaria. Posts are used in half of the restored teeth. The most frequent use of posts is in front teeth and premolars (88%) and only 11.5% in molars. The reason for that could be to avoid complications, more common in molars. Cemented prefabricated metal posts and pins are used mostly and equally, casted less only in 14.9%. Poor quality of the fixed posts was observed in 33.2%, and teeth suspected for future root fractures were 12.2% (teeth with over preparation of root dentine). We found essential to focus tutors attention on better choice of the particular post most suitable for the treated tooth and on the control of the preparation technique and x-ray control of the results.
Key words: post and core technique, indications, use

 

DENTIGEROUS CYSTS: A CLINICAL STUDY OF 146 CASES
Petia F. Pechalova
Department of Maxillofacial Surgery, Faculty of Dental Medicine,
Medical University – Plovdiv

Summary. Dentigerous cysts are epithelial cysts related to the development of tooth germ. The present study was aimed at providing a clinical and epidemiological analysis of patients with dentigerous cysts. The study was conducted over a ten-year period (1998-2007). Data were obtained from records of 146 patients. The mean age of patients was 22.63 ± 1.56. The ratio of patients at the age of up to 20 towards patients over 21 was 1.98:1. The ratio male: female was 1.12:1. Mandible was involved by dentigerous cysts 2.65 times more frequently than maxilla. Dentigerous cysts developed most commonly around mandible premolars (36.9%). The most common reason for diagnosis was the presence of asymptomatic swelling of the jaw bone (62.3%). The ratio between the extracted (110) and preserved tooth germs (104) was 1.06:1. It is concluded that dentigerous cysts were more common in younger patients and males.
Key words: dentigerous cysts, maxilla, mandible

 

PHARMACOECONOMICS OF RARE DISEASES THERAPY – AN EXAMPLE OF PHENYLKETONURIA
S. Desancic(1), A. Stoimenova(2), A. Savova(2), M. Manova(2), V. Petkova(2) and G. Petrova(2)
(1)University of Belgrade, Faculty of Pharmacy, Belgrade, Serbia
(2)Medical University, Department of Social pharmacy, Faculty of Pharmacy – Sofia, Bulgaria

Summary. Due to the limited number of patients and lack of market interest towards the development of medicines by pharmaceutical companies, the therapy of rare diseases is usually very expensive. Because of that the pharmacoeconomic assessment of the rare disease therapy is commonly unfavourable. In this study, the standards and cost of therapy of phenylketonuria (PKU) in Bulgaria and Serbia are analysed. The number of patients was gathered from the official databases of National Health Insurance Fund of Serbia and Ministry of Health in Bulgaria. The costs of low protein diet for patients with PKU were calculated. The lists of reimbursed medicinal products for rare diseases were reviewed. The preliminary results showed that the average cost per patient in Serbia is 528 EUR per month and 494 Euro in Bulgaria. In both countries, the dietetic foods for patients under 18 years are reimbursed. The prices of dietetic foods vary in wide range. No other therapy is provided to the patients with PKU. Our results show that in both countries the patients with phenylketonuria did not have an access to modern medicine therapy.
Key words: rare diseases, phenylketonuria, cost of therapy, orphan medicines, Bulgaria, Serbia

 

CONTINUING PROFESSIONAL EDUCATION OF BULGARIAN PHARMACISTS 2007-2009
A. Stoimenova(1,2), G. Petrova(1,2), I. Nikolov(2), M. Manova(1), G. Draganov(1,2), Z. Ivanova(2),
D. Dimitrov(2), G. Mihova(2) and A. Savova(1)
(1)Department of Social Pharmacy, Faculty of Pharmacy, Medical University – Sofia
(2)Quality Committee at the Bulgarian Pharmaceutical Union

Summary. Continuing professional education is very important for the health professionals to maintain a high level of knowledge and for the improvement of their professional practice, patient outcomes and generally the social health. In 2007, a system for continuing education of pharmacists in Bulgaria was established, following the formation of Bulgarian Pharmaceutical Union. The aim of the current study is to analyse the system for the continuing professional education, preferred topics and number of courses accredited for the Bulgarian pharmacists for the period 2007-2009. The system for classification of the postgraduate education and number of accredited educational events were analysed. The retrospective analysis of the approved topics of educational events was performed during the observed period and systematized according to type of event, topics covered, geographic area of performance and event initiators and organizers. The established accreditation system contains 4 categories of continuing education programmes. 93 educational forms were accredited and performed for the studied period (n=26 in 2007, n=44 in 2008, n=23 in 2009). The most often organised forms are educational meetings (n=24 out of 26 forms in 2007; n=41 out of 44 forms in 2008; n=22 out of 23 forms in 2009). In general, the educational system is positively accepted by the pharmacists in the country. The lectures and short term events remain the most favourite format of continuing education for Bulgarian pharmacists although possibility for on-line training is foreseen in the near future. We recommend greater involvement of academia in continuing professional education of pharmacists.
Key words: pharmacists, continuing professional education, educational meetings, Bulgaria

 

BIOLOGICALLY ACTIVE COMPOSITION AND HEALTH IMPACT OF ALLIUM CEPA
S. Tsanova-Savova
Department of Chemistry, Faculty of Pharmacy, Medical University – Sofia

Summary. The aim of this study is to present contemporary information for the biologically active compounds in Allium cepa and correspondingly their health benefits, as well as to present analytical HPLC results for the content of the main antioxidants in Allium cepa – the flavonols quercetin and kaempferol, in different types of Bulgarian onion, and to submit data about onion consumption on national and international level. The potent antioxidant activity of the biologically active compounds in onion is an important factor for the prevention against different degenerative diseases like cardiovascular disease, cancer, diabetes. Results for content of the flavonols quercetin and kaempferol in different types of Bulgarian onions are presented. The red onion contains highest amount of quercetin – average value 452.5 mg/kg and a maximum value found – 832.2 mg/kg. It was determined that the green part of spring onion contains relatively equal values of quercetin (30.2 – 61.1 mg/kg) and kaempferol (27.4 – 52.3 mg/kg). This results characterize spring onion as very important dietary source of kaempferol in Bulgarian healthy diet emphasizing their role in development of different preventive diets.
Key words: Allium cepa, onion, health impact, quercetin, kaempferol

 

CARDIOVASCULAR FUNCTIONAL DIAGNOSTICS METHODS
R. Nikolova(1) and S. Danev(2)
(1)National Center of Public Health Protection – Sofia
(2)Medeia Inc. – Sofia

Summary. Effective functional diagnostics is a priority of EU strategy on prevention of health status. Effective non-invasive functional diagnostic cardiovascular methods are methods for examination of central nervous system and autonomous nervous system functions through analyses of heart rate variability, blood pressure variability, and baroreflex sensitivity. Cardiovascular functional diagnostic methods might enhance our understanding of physiological and pathophysiological mechanisms of mental work load and stress, etiopathogenesis of cardiovascular diseases.
Key words: functional diagnostics; heart rate variability; blood pressure variability; baroreflex sensitivity; cardiovascular diseases

 

MENTAL WORK CAPACITY AND RELIABILITY AMONG NUCLEAR POWER PLANT OPERATORS
A. Agovska and R. Kirkova
Department of Hygiene, Medical Ecology and Nutrition, Medical University – Sofia

Summary. Examination is performed on the mental work capacity of the operators in NPP – Kozloduy, and its importance for the control of the operative staff’s reliability. Psycho-physiological studies on 50 operators were performed. By computer-based psycho-physiometer (PPM) the following examinations were carried out: Simple sensorymotor reaction (SSMR), Visual-motor reaction of moving object (VMRMO), Landolt’s test, Dynamic and static tremor-reaction as well as the dynamic of their changes in the real work time. At the same time, there were measured the heart rate (HR) and the skin resistance (SR). The operators kept high level of mental work capacity during the whole shift, also an indicator for high reliability. In all tests at the end of the shift, the HR was slightly raised, an indicator for a higher “physiological price” of the fulfilment. The SR was constant, which shows emotional steadiness in the examined operators. The evaluation of operator’s behavioral reliability is closely related to the evaluation of their mental work capacity. The proposed PPM-system could be used for periodical control of the work capacity and the functional state of the operators and is suitable for work in the services of occupational medicine.
Key words: nuclear operators, reliability, mental work capacity

 

CULTURES AND RELIGIOUS PRACTICES
J. Radenkova(1), E. Saeva(2) and V. Saev(2)
(1)Toxicology Clinic, Emergency Medicine Institute “N. I. P irogov” – Sofia
(2)University “La Sapienza” – Rome

Summary. Many drugs are used for their mood and perception change effects, including those with accepted uses in medicine and psychiatry. There is archaeological evidence for the use of psychoactive substances dating back at least 10 000 years, as well as historical data for cultural purposes in the last 5000 years. Some psychoactives, particularly hallucinogens, have been used for religious purposes since prehistoric times. Examples of traditional entheogens include: kykeon, ambrosia, iboga, soma, peyote, ayahuasca. Other traditional entheogens include cannabis, ethanol, ergine, psilocybe mushrooms, opium. Although entheogens are taboo and most of them are officially banned in Christian and Islamic societies, their ubiquity and importance in terms of different spiritual traditions of other cultures is unquestioned.
Key words: psychoactive substances, drugs, entheogens, hallucinogens

 

ANGIONEUROTIC EDEMA CAUSED BY DENTAL MATERIALS: A CASE REPORT
S. Dermendjiev(1) and Z. Stoyneva(2)
(1)Occupational Diseases and Toxicology Department, Medical University of Plovdiv, Bulgaria
(2)Clinic of Occupational Diseases, University Hospital Sv. Ivan Rilsky, Sofia, Bulgaria

Summary. The synthetic polymers are high-weight molecular organic substances which are formed from one compound (monomer) or by several compounds through chemical processes of polymerisation or polycondensation. Acrylamide, for example, is used in dentistry to harden compositions with high adhesion. Methyl methacrylate (MMK) is the main monomer in obtaining acrylic. It is widely used in households and in different industries – production of organic glasses, lacquers, resins, displays. MMK is often used as a substance in the preparation of various composites, used in dentistry, dental fillings, etc. MMK can be a health risk factor, both in terms of acute, often occupational exposure and prolonged effects on the human body. While acute exposure to high concentrations MMK produces clinical manifestations of intoxication, which clinical picture and course are well known, the adverse health effects arising from prolonged contact with this substance are very diverse, involve different organs and systems, and some are still poorly studied. It is known for example that MMK, like other polymeric substances and plastics exhibits sensitizing effect in contact with skin and mucous membranes. After exposure to methyl methacrylate, cases of contact dermatitis are described. Is it possible, however, MMK, and substances in which it participates, to create another type of allergic reactions? Responses to this question can provide the case we present.
Key words: Quinke’s edema, etiology, methyl methacrylate

 

A CASE REPORT OF A LARGE SUBSEROUS FIBROID AND INCOMPLETE ABORTION IN A JUVENILE PATIENT
P. Madzharov(1), P. Panchev(1), E. Kovachev(2), S. Ivanov(2), R. Minkov(1), A. Tsonev(2), A. Abbud(2)
and I. Bakardzhiev(3)
(1)Obstetrics and Gynecology Hospital – Varna, Bulgaria
(2)Department of Obstetrics and Gynecology, Medical University – Varna, Bulgaria
(3)Medical College – Varna, Bulgaria

Summary. We report a case of an 18-year-old patient with a large abdominal tumor, originating from the uterus and with positive β-hCG, without ultrasound indications for vital intrauterine or ectopic pregnancy. After the endometrial abrasion, which showed signs of incomplete abortion, we performed a laparotomy, where we found a large subserosal fibroid. Myomectomia was performed and the final histopathological report revealed a benign fibroleiomyoma with focal coagulation and hemorrhagic necroses.
Key words: fibroid, incomplete abortion, uterus

 
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