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CURRENT ISSUE /1-2013

GENETIC ABERRATIONS IN ADULT CD10 POSITIVE/CYTOPLASMIC IgM NEGATIVE B-CELL
ACUTE LYMPHOBLASTIC LEUKEMIA

M. Velizarova(1), D. Popova(2), E. Hadzhiev(3) and I. Dimova(4)
(1)Department of Clinical Laboratory and Clinical Immunology,
University Hospital Aleksandrovska, Sofia, Bulgaria
(2)Department of Clinical Laboratory and Immunology, Military Mediacal Academy, Sofia, Bulgaria
(3)Clinic of Hematology, University Hospital Aleksandrovska, Sofia, Bulgaria
(4)Department of Medical Genetics, Medical University, Sofia, Bulgaria

Summary. In the recent years progress in the basic laboratory science has allowed for implementation of many advanced methods in the clinical practice. Flow cytometry is a method, which is most commonly used for clinical diagnosis of ‘de novo’ acute leukemias, and in combination with molecular-cytogenetic studies provides more opportunities for determination of patients’ risk factors and disease prognosis. We report on high percentage of adult CD10(+)/cyIgM(-) B-cell acute lymphoblastic leukemia (56% of all studied B-ALL) and unusual for this group chromosome findings - (8q24)/C-MYC, trizomy 8, t(1;19), no ploidy changes and low t(9;22) frequency.
Key words: cytogenetics, adult acute lymphoblastic leukemia, CD10(+) acute leukemia

 

THREE CASES OF ACUTE MYELOID LEUKEMIA AND DELETION OF THE LONG ARM OF CHROMOSOME 9
L. Mitev(1), M. Velizarova(2), V. Uzunova(1), R. Stanchev(3), I. Gigоv(3), J. Rainov(3), R. Vladimirova(1) and K. Tsachev(2)
(1)Military Medical Academy, Department Clinical Laboratory and Immunology, Sofia
(2)University Hospital Aleksandrovska, Department of Clinical Laboratory and Clinical Immunology, Sofia
(3)Military Medical Academy, Clinic of Hematology, Sofia

Summary. Deletion of the long arm of chromosome 9 (del 9q) is a recurrent cytogenetic abnormality in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We describe the first three de novo AML cases with del(9q) in our country, found as the sole karyotypic anomaly. Karyotyping indicated two areas of deletion – in the regions 9q21-22 and 9q13-34. There was found the association of del(9q) with characteristic phenotypic abnormalities: blasts with or without cytoplasmic granulations, dysplastic changes in granulocyte lineage, giant myeloperoxidase positive cytoplasmic granulations (pseudo-Chediak-Higashi type) and CD7(+) and CD34(+)/CD34(-) antigen expressions. In one of the patients there was also an association with dysplastic changes in erythroid, granulocytic and megakaryocytic lineages. It is likely that del(9q) is a clonal event in the pre-leukemic stage of the disease, probably in unrecognized MDS. Deletion of tumor-suppressor genes in 9q chromosome regions may relate with leukemogenesis in AML.
Key words: acute myeloid leukemia, 9q abnormalities, cytogenetics of acute leukemia

 

BIOCHEMICAL AND TUMOR MARKERS IN THE FOLLOW-UP OF PATIENTS WITH LUNG CANCER
A. Musliu(1), M. Boncheva(2), O. Behxhet(4), M. Koni(1), M. Shabani(1), T. Arbneshi(3) and B. Mustafa(1)
(1)Department of Biology, Faculty of Natural Sciences, University of Tirana, Albania
(2)Chair of Clinical Laboratory, Medical University of Varna, Bulgaria
(3)Department of Chemistry, Faculty of Natural Sciences, University of Prishtina, Kosovo
(4)Department of Oncology and Pulmology, Medical Faculty, Tirana, Albania

Summary. The aim of this study was in the period January 2010-September 2011 (21 months) to evaluate patients with lung cancer and to analyze the changes of several specific biochemical and tumor markers after chemotherapy with cisplatin and carboplatin. The study included 213 randomly selected patients with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). They were compared with a control group of 40 patients with nonmalignant pulmonary disease (10 infectious diseases and 30 chronic obstructive pulmonary diseases). The concentracion of biochemical markers (ALP, LDH, total protein, albumin, urea, creatinine, creatinine clearance) and tumor markers (CEA, NSE, Cyfra 21-1) were assayed with chemical methods level A, using Medonic, Cobas Integra and Abbott Axsym analyzers. Either cisplatin or carboplatin was aplicated in therapeutic doses. The level of biochemical and tumor markers was determined before and after chemotherapy in both men and women population with different stage of the disease and age range from 50-70 years to over 70 years . In patients with NCSLC, serum AP and LDH did not significantly differ between patients with limited and extensive disease. Also, there was no statistically significant difference in AP and LDH before and after chemotherapy. However, the activity of these enzymes in patients with SCLC differed significantly between limited and extensive diseases (p < 0.001). In all cases with NSCLC we observed elevated levels of serum NSE (50.4%), Cyfra 21-1 (29.6%) and CEA (28.4%). In patients with SCLC, NSE was elevated in 61.1% and values were significantly higher compared with the NSCLC patients (p < 0.001). Moreover, the change in the concentration of Cyfra 21-1 showed a high significance in patients with NSCLC. In conclusion, there were significant differences between the frequency of different types and stages of lung cancer in different age groups of the general population. The results demonstrated the benefit of early detection and therapy of subjects with different types and stage of lung cancer.
Key words: lung cancer, small cell lung cancer, non-small cell lung cancer, tumor markers

 

FOCAL BRONCHIECTASIS AND PULMONARY FIBROSIS AFTER NEGLECTED FOREIGN BODY ASPIRATION IN A YOUNG BOY
Sm. Diaconescu(1), M. Burlea(1), Cl. Olaru(1), G. Păduraru(1), I. Albu(2), V. V. Lupu(1) and A. Rugină(2)
(1)5th Pediatric Clinic, “St. Mary” Children Clinical Emergency Hospital,
University of Medicine and Pharmacy “Gr. T. Popa” – Iasi, Romania
(2)2nd Pediatric Clinic, “St. Mary” Children Clinical Emergency Hospital,
University of Medicine and Pharmacy “Gr. T. Popa” – Iasi, Romania

Summary: Bronchiectasis in children is caused by infection, obstruction, congenital or acquired disorders. We present a case of a little boy in which neglected foreign body aspiration led to focal bronchiectasis and pulmonary fibrosis, surgically cured by left inferior lobectomy. A nine-year-old boy was admitted into our clinic for chronic productive cough and persistent pulmonary crackles, which occurred approximately 4 months ago. His father had pulmonary tuberculosis, for which the little boy was tested and was found to be negative (intradermal reaction, gastric lavage). Despite the use of various antibiotics, the findings on auscultation of the chest were persistantly abnormal. History revealed foreign body aspiration (sunflower seed) six years ago, followed by lung abscess, complicated with empyema, pyopneumothorax and cardiorespiratory arrest successfully resuscitated. Physical examination showed good general status, paleness, old linear scar on the left hemithorax, productive cough, wet crackles at the left lung base. CBC, ESR, PCR, serum immunoglobulins, α1-antitripsine, sweat chloride values were normal, sputum culture was negative. Esophageal pH-metry was negative for GERD. Chest X-ray showed left basal hypertransparent area and accentuated basal interstitium. Broad-spectrum antibiotics, mucolytics, chest percussion and postural drainage were started with no clinical amelioration. CT scan showed cylindrical dilatations (bronchiectasis) in segments 9 and 10 of the left lung with interstitial fibrosis. An inferior left lobectomy was performed; and histology of the specimen confirmed bronchiectasis and fibrosis, and revealed no congenital anomalies. The patient was discharged in good general condition after 3 weeks; clinical and radiological findings after 3 months showed absence of respiratory symptoms and expansion of the left lung to the thoracic cage. In foreign body aspiration early diagnosis and appropriate treatment are important in order to prevent long-term complications. In our case, because of delayed referral and lack of early bronchoscopy, the neglected foreign body produced focal bronchiectasis and basal fibrosis that necessitated surgery.
Key words: bronchiectasis, pulmonary fibrosis, foreign body, children


EVALUATION OF THE DISORDERS IN RENAL FUNCTIONS IN SEXUALLY IMMATURE RATS WITH SUBLIMATE NEPHROPATHY
UNDER SALT LOAD AND BLOCKADE OF RENAL PROSTAGLANDINS

K. Slobodian and Yu. Rohoviy
Bukovinian State Medical University, city of Chernovtsy, Ukraine

Summary. The primary purpose of the experiment was to evaluate the indices of renal function after salt-loading with 3% sodium chloride solution in volume equal to 5% of the body weight under conditions of blockade of renal prostaglandins production with indomethacin, on a background of sublimate nephropathy. Experiments on 40 white non-linear immature (one-month-old) male rats were performed. The results showed inhibition of diuresis and decrease in the signs of the syndrome of sodium ions loss with urine, with hypernatremia on the background. Disorders of glomerular-tubular balance were characterized by the loss of positive correlation of relative reabsorption of water with glomerular filtration, filtration fraction and absolute reabsorption of sodium ions. The defined changes in glomerular-tubular balance confirm the effect of prostaglandins on the above processes in immature rats. The decrease in the compensatory abilities, such as the development of the syndrome of sodium ions loss, leads to disorders in sodium homeostasis and development of hypernatraemia in the experiment.
Key words: sublimate nephropathy, 3% sodium chloride solution loading, indomethacin, immature rats


LESIONS OF THE NEUROVASCULAR BUNDLE DURING SURGICAL TREATMENT OF DUPUYTREN’S CONTRACTURE
V. Petrov, B. Matev, Pl. Tsekov and Hr. Georgiev
2nd Orthopedic Clinic
University Orthopedic Hospital “Prof. B. Boychev”, Sofia, Bulgaria

Summary. With this article we want to focus the reader’s attention on lesions of the neurovascular bundle that occur during the surgical treatment of Dupuytren’s contracture, which represent relatively rare, but associated with serious consequences intraoperative complications. We present our clinical experience with these complications and compare it with the available publications in English literature. We present a clinical case of a rare anatomical variation, including dislocation of the common palmar digital artery in a patient with Dupuytren’s contracture.
Key words: complications, lesions of the neurovascular bundle, Dupuytren’s contracture


SCREENING OF THE RECOVERY OF EVERYDAY LIFE ACTIVITIES AMONG PATIENTS
WITH CEREBROVASCULAR DISEASE

D. Vacheva(1), A. Mircheva(1), V. Simeonova(2) and B. Stamenov(2)
(1)Clinic of Physical Medicine and Rehabilitation, University Hospital – Pleven, Bulgaria
(2)Clinic of Neurology, University Hospital – Pleven, Bulgaria

Summary. The objective of the research was to examine, follow up and report on the self-service recovery among patients with consequences of cerebrovascular disease (CVD). Sixty-one patients with consequences of CVD were included and followed up in the research. They underwent physiorehabilitation program which was in line with their indivdidual condition and included kinesitherapy, labour therapy (ergotherapy and everyday life activites) and electrotherapy. All patients were tested in the beginning and at the end of the rehabilitation course. They self-evaluated basic parameters in their own condition not taking into consideration which of the limbs – the dominant (DL) or the non-dominant (NDL) one, was paretic. The comparative analysis of the results showed that in the beginning of the recovery period patients with paretic NDL met less difficulty in performing everyday life activities (AEL) than those with paresis and palsy of a DL. Later on in the rehabilitation process, patients with paretic DL showed significant improvement in the test assessment. For better results in the rehabilitation of patients with consequences of CVD and for enhancing the ability for self-service, of significant importance was the early initiation of the rehabilitation and the implemented labour activities and elements of AEL, given as instructions. Functional labour therapy stimulates the independence of patients and facilitates their recovering to independent everyday life and social activities.
Key words: labour therapy, ergotherapy, self-service, rehabilitation, cerebrovascular disease


METHODS FOR DIAGNOSING DENTAL FLUOROSIS: QUANTITATIVE LASER FLUORESCENCE AND LIGHT-INDUCED FLUORESCENCE
K. Peycheva and E. Boteva
Department of Conservative Dentistry,
Faculty of Dental Medicine, Medical University – Sofia

Summary. Fluoride ion affects the crystal growth of hydroxiapatite crystals. Chronic endemic fluorosis leads to elongated apatite crystals with low density and heterogenic lay down. The up-to-date dental caries treatment and preventive strategies are related to many fluoride sources. The aim of the present study was to investigate and compare the ability of quantitative laser fluorescence (QLF) – DIAGNOdent Classic and quantitative light-induced fluorescence – SoproLife – lamp and intraoral camera, to diagnose dental fluorosis. Thirteen molars of 116 extracted mature human molars from the same dental practice area were diagnosed with fluorosis according to Luckomski scale from 1947. All teeth were exposed to QLIF – SoproLife (Acteon, France) in modes “day light”, “macro image”, “blue light”, and to QLF – DIAGNOdent Classic (Germany). All fluorotic teeth were sectioned in mirror images through the body of stains and lesions – BL or MD with diamond blade – 0.2 mm and observed under magnification x5, x30, x100. Results from cross-sectional histology showed sections with porous enamel, hypomineralized dentine and fissure fluoride caries. Moderate and severe fluorosis (n = 11) was diagnosed by QLF-DIAGNOdent Classic device, with scores 99-which indicates dentine caries. Mild fluorosis (n = 2) was diagnosed by DIAGNOdent Classic device, with scores 30-45-56-, which indicates dentine caries. DIAGNOdent Classic diagnosed fluorosis as caries lesions. QLIF also did not recognize fluorosis from caries lesions. SoproLife “day light” and “macro image” showed a realistic appearance of all tooth surfaces under magnification x 30-100.
Key words: fluorosis, dental caries

 

DETECTION OF DENTAL HYPOPLASIA – ABILITY OF FLUORESCENCE METHODS
E. Boteva and K. Peycheva
Department Conservative Dentistry, Faculty of Dental Medicine, Medical University – Sofia

Summary. Third molars are a challenge because of the large varieties of crowns and roots, difficulties in the access, differences in the level of mineralization and root development. The aim of this study was to test the ability of quantitative laser fluorescence (QLF) method and light-induced fluorescence (LIF) method to detect dental hypoplasia of third molars. Forty-nine third molars from the same geographical and practice area were diagnosed for fissure caries: clinically – by ICDAS II, and paraclinically – by QLF method, using as a tool DIAGNOdent Classic and LIF method – applied with SoproLife diagnostic lamp. Eleven third molars with non-completed root development were separated in a group and examined using the same methods. Four of them with almost the same development of the roots were examined by X-ray. Different clinical manifestations of hypoplasia were observed. The diagnosed defects were: enamel hypoplasia, idiopathic white spots, hypomineralization of enamel – “etched enamel”. For dental hypoplasia the LIF method served as an intraoral camera with magnification – x 30 – x 100 times. DIAGNOdent incorrectly measured mineral loss as a carious lesion with different depth. In conclusion, only best clinical knowledge and experience can diagnose properly hypoplastic teeth. Magnification of intraoral cameras like SoproLife can facilitate clinical decision making.
Key words: dental hypoplasia, third molars, dental caries

 

PENETRATION OF IR LASER RADIATION IN HUMAN TEETH: ANGULAR DISTRIBUTION OF LIGHT AND COEFFICIENTS
OF ABSORPTION AND SCATTERING

P. Uzunova(1), M. Deneva(2), Ts. Uzunov(3), St. Rabadzhiyska(2), Hr. Kisov(2),
N. Kaymakanova(4), E. Dinkov(2) and M. Nenchev(2)
(1)Faculty of Medicine, Medical University – Sofia,
(2)Technical University – Sofia, Plovdiv branch,
(3)Faculty of Dental Medicine – Medical University – Sofia,
(4)Plovdiv University “Paisiy Hilendarski”

Summary. We have developed techniques and practical set-ups and have studied comparatively the propagation of a traditional 1.06 µm laser emission and a non-familiar 1.36 µm line of the widespread Nd:YAG laser in human dentin (pure) samples and in combined enamel-dentin samples. The wavelength 1.36 µm can be obtained with high energy output using some non-complicated modification of Nd:YAG laser, as it is further shown in this work. This wavelength is of potential interest for application in dentistry due to its known higher absorption in comparison with a 1.06 mcm line in human soft tissues. Thus, it is possible that it would also be highly absorbed in hard dental tissues. As a result of our investigation on human pure dentin samples and combined enamel-dentin samples, we have obtained the following parameter estimates: 1) reflectivity of these two tissue substances; 2) the full coefficient of the extinction and angular distribution of the intensity (in the cross-sections) of the penetrated light in the examined dental substances; 3) as a main point, combining the optical and calorimetric techniques, we have obtained separately the absorbed and the diffused part of the light, and have calculated separately the coefficients of absorption and scattering in the dentin. The study is based on in vitro examination of fresh teeth samples from participants from Bulgaria, Sofia region.
Key words: Nd:YAG laser treatment, human tooth, dentin’s light absorption

 

CROSS-TALK BETWEEN THE SIGNALLING PATHWAYS OF THE RECEPTOR FOR INTERLEUKIN 2 AND THE T-CELL
ANTIGEN RECEPTOR IN HUMAN T-BLASTS

K. Hristov, J. Lindquist and B. Schraven
Institute of Molecular and Clinical Immunology, Otto-von-Guericke University, Magdeburg, Germany

Summary. TCR regulates differentially the signalling network in peripheral, quiescent T-cells and T-blasts. IL2R stimulates a number of signalling pathways, maintaining cellular survival and proliferation that share signalling components with the TCR network. Here we describe the dose- and time-dependence of IL2-induced increase in the phosphotyrosine protein levels, and the maintenance of proliferation, as well as the involvement of SRC-PTKs in the regulation of RAS-ERK, p38 MAPK, and PI3K-PKB/AKT signalling pathways. Furhter, we find TCR-triggered STAT activation in peripheral, quiescent T-cells and T-blasts, and investigate the possible mechanism for cross-talk between the two receptor networks.
Key words: cellular signalling, system biology, T-cell antigen receptor, interleukin 2 receptor, tyrosine phosphorylation, ERK and JNK signalling pathways, PI3K – PKB/AKT signalling pathway, JAK – STAT signalling pathway

 

IS THE ТIME OF COMBINED ALLERGIC SYNDROMES COMING?
S. Dermendzhiev and P. Deleva
Section of Professional Diseases, Department of Internal Diseases II, Faculty of Medicine, Medical University of Plovdiv
Departement of Occupational Diseases and Allergology – University Hospital “St. George” Plovdiv

Summary. We present a patient with a combination of four allergic diseases – rhinitis, conjunctivitis, urticaria and angioneurotic edema along with other concomitant problems with objectified or suspected allergic pathogenesis. The cases of simultaneous presentation of allergic diseases in one and the same individual are not uncommon in practice. Most often, it refers to the inclusion of another syndrome or symptom from another organ/system in the allergic process with the already diagnosed allergic disease in the background. A typical example of that is the proven higher risk of developing asthma when there has been allergic rhinitis diagnosed, especially in juvenile and young patients. We reckon that the presented case would draw attention not only with the number but also with the variety of symptoms of registered allergic syndromes. Nowadays and in the near future, the likelihood of this type of combined allergic pathology getting more common is substantial, considering the increasing number and variety of environmental factors, influencing the immune system on one hand, and the relationship of those factors with the unique in its essence phenomenon called atopy and with the individual reactivity of each organism, on the other.
Key words: combined allergic syndromes, rhinitis, conjunctivitis, eczema/dermatitis, urticaria, angioneurotic edema, atopy

 

SUPERFICIAL SPREADING MALIGNANT MELANOMA: COMPLETE REMISSION AFTER SURGICAL EXCISION
K. Semkova(1) and G. Tchernev(2)
(1)Department of Dermatology and Venereology, University Hospital Aleksandrovska,
Medical University – Sofia, Bulgaria
(2)Polyclinic for Dermatology and Venereology, Medical Faculty, Sv. Kliment Ohridski University, University Hospital Lozenetz, Sofia, Bulgaria

Summary. Superficial spreading type of malignant melanoma (SSM) is usually characterized as the most common form of cutaneous melanoma in Caucasians. The average age at diagnosis is in the fifth decade, and it tends to occur on sun-exposed areas of the skin, especially on the backs of males. Surgery to remove melanoma is the standard initial treatment. However, the surgical approach to every melanoma should be customized based on the specific details of the patient and the melanoma, location of the primary tumor, and how the resultant wound could be finally closed. A simple excision of a melanoma can usually be accomplished by sewing the skin together, resulting in a linear scar, as in our patient. We present a 72-year-old patient with SSM on his back. Eliptical excision with 2 cm margins and very good cosmetic results was performed. The examination of the slides revealed clear margins. The patient remained disease-free at 6 months follow-up.
Key words: SSM, surgery, sun exposure, Melan A, S-100

 

FIBROSING ALOPECIA IN A PATTERN DISTRIBUTION IN TWO BROTHERS WITH PILI MULTIGEMINI
B. Kamoona, D. Serafimova, V. Broshtilova, Zh. Kazandzhieva and S. Marina
Department of Dermatology and Venereology,
Medical Faculty, Medical University – Sofia

Summary. Pili multigemini is a rare hair shaft defect. Simply it means the presence of several hairs in a single follicle; each hair has its own inner root sheath and the hairs are surrounded by a common outer root sheath. Fibrosing alopecia in a pattern distribution is a distinct type of cicatricial alopecia which is currently classified as a subtype of lichen planopilaris, characterized by inflammation and fibrosis with accelerated hair loss in the distribution of typical male or female pattern hair loss. We present 25- and 26-year-old brothers with increase hair loss of two years duration. The clinical and histological examination of the scalp area revealed the presence of pili multigemini hair follicles defect combined with fibrosing alopecia in a pattern distribution, involving the vertex area of the scalp in both patients. In our opinion the hair follicle defect pili multigemeni may have an impact over the pathogenesis of the fibrosing alopecia in a pattern distribution in our two cases.
Key words: pili multigemini, cicatricial alopecia, androgenic alopecia, two brothers

 

 
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