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CURRENT ISSUE /2-2011

IOL DISLOCATION AND RETINAL DETACHMENT – A STUDY BY ULTRASOUND BIOMICROSCOPY
B. Kutchoukov
Department of Ophthalmology
University Hospital “Alexandrovska” – Sofia, Bulgaria

Summary. A retrospective consecutive noncomparative case series of 5 eyes (5 patients) with IOL dislocation and retinal detachment is reported. Following thorough ophthalmic exam, an ultrasound biomicroscopy (UBM) of the ciliary area was performed in order to evaluate the position of the IOL haptics, the ciliary body area, the vitreous base and far retinal periphery. In all eyes, the haptics were in various positions – behind the iris, in the capsular bag, in the ciliary sulcus, in front of pars plana. UBM proved to be a very useful imaging technique for assessment of IOL haptic subluxation and the accompanying changes in the ciliary body and anterior vitreous, which may play a role in the occurrence of retinal detachment in pseudophakic eyes and its unsuccessful scleral buckling surgery.
Key words: IOL, dislocation, retinal detachment, ultrasound biomicroscopy

 

UNCOMMON CLINICAL PRESENTATION OF  BALANITIS CIRCUMSCRIPTA PLASMACELLULARIS ZOON
ASSOCIATED WITH MONOCLONAL GAMMOPATHY OF IGG-TYPE AND ACUTE EXACERBATION
OF SEROPOSITIVE RHEUMATOID ARTHRITIS – COMPLETE REMISSION AFTER SYSTEMIC
ADMINISTRATION OF DOXYCYCLINE

J. Ananiev(1), G. Tchernev(2), M. Penev(3), M. Gulubova(1), G.  Kupcova(4) and N. Sucha(5)
(1)Department of General and Clinical Pathology, Medical Faculty, Trakia University – Stara Zagora
(2)Department of Dermatology and Venerelogy, Medical Faculty, Trakia University – Stara Zagora
(3)Department of II-nd Internal Clinic, Medical Faculty, Trakia University – Stara Zagora
(4)Department of Dermatology and Venerelogy Kezmarok, Slovak Republic
(5)Department of Dermatology and Venerelogy, Stara Lubovna Medical Faculty, Slovak Republic

Summary. We present a case of a uncircumcised 82-year-old man with clinical and histopathologic features of ulcerating balanitis circumscripta plasmacellularis  (Zoon’s balanitis). Zoon’s balanitis is a benign condition of the genital area that typically presents as a solitary, persistent plaque on the glans penis of uncircumcised, middle-aged to older men. Its etiology and pathogenesis remain speculative. The eosin haematoxylin staining in our patient showed lymphocytic infiltrates with some eosinophils. Immunohistochemically, there was evidence of chronic histiocytic (macrophagocytic) and fibrosing plasmacellular balanitis. Histopathologic features of plasma cell balanitis in current textbooks and publications vary considerably in the different stages of the disease. Some authors suggest that Zoon’s balanitis represents a non-specific inflammatory response to a unknown exogenous agent. Therefore, it is often associated with plasma cell infiltration by IgG producing cells, suggesting a non specific polyclonal stimulation of B cells, as is common in chronic infections. We are presenting a patient with an acute form of rheumatoid arthritis and monoclonal gammopathy of the IgG type, who has developed a rare ulcerating type of Zoon’s balanitis. After a therapeutic course with doxycyline, 100 mg twice daily for a period of 3 weeks, and local application of octenidine dihydrochloride solution (Octenisept) we were able to observe a complete remission of the disease.
Key words: zoon’s, balanitis, rheumatoid arthritis, therapy

 

EFFECT OF MENTAL WORK LOAD ON AUTONOMIC CARDIOVASCULAR CONTROL
R. Nikolova(1) and S. Danev(2)
(1)National Center of Public Health Protection, Laboratory for Work Physiology and Psychology
(2)Medeia, Sofia, Bulgaria

Summary. Psychophysiological and occupational medicine determination of mental work load of air traffic controllers (ATC) reveal that ATC are exposed to increased level of work load. The purpose of the study is to determine the effect of mental work load on autonomic cardiovascular control assessed with Heart Rate Variability (HRV) measures in air traffic controllers from Sofia airport. Results of our study indicate that the effect of mental work load in ATC might accelerate the ageing process and induces changes in autonomic cardiovascular control – decrease of parasympathetic activity and increase of sympathetic activity. The level of work load of ATC working at the airport control might induce change of the pattern of autonomic cardiovascular control with prevalence of the sympathetic activity. The results of our study indicate that HRV measures might be a useful tool for the assessment of the effect of work load on autonomic cardiovascular control.
Key words: mental work load, autonomic cardiovascular control, heart rate variability, air traffic controllers

 

EFFECT OF CHRONIC ALCOHOL CONSUMPTION ON APOPTOSIS OF LYMPHOCYTES:
ROLE OF CASPASE-3 AND FAS LIGANDS

N. Boyadjieva and G. Bocheva
Department of Pharmacology and Toxicology, Medical Faculty, Medical University – Sofia

Summary. Ethanol has been shown to acutely increase the apoptosis in various cells. But the effect of ethanol on FasL-mediated apoptosis of lymphocytes is not well established. The aim of present study is to evaluate the mitogen-induced proliferation in vitro and apoptosis of lymphocytes obtained from the spleens of alcohol and nonalcohol fed rats. We also determined whether caspase-3 or soluble FasL play a role in apoptotic effect of ethanol on lymphocytes. Here, we found that chronic alcohol administration increased both apoptosis and caspase-3 activity and decreased the number of T lymphocytes via depressing the proliferation and activating the apoptotic cell death in cultured splenocytes. Furthermore, we identified that caspase-3 and soluble FasL play a role in apoptosis of lymphocytes.
Key words: apoptosis, Fas, Fas ligand (FasL), alcohol, caspase-3, T cells


FACTORS INFLUENCING ACUTE ALCOHOL POISONING IN ADOLESCENTS IN BULGARIA
A. Loukova
Psychiatry Sector, Toxicology Clinic, Emergency Hospital Pirogov – Sofia, Bulgaria

Summary. The aim of the current study is to analyse the medical and social dimensions of acute alcohol poisoning in children with regard to improve prevention of addictive habitis and develop effective preventive strategies for reducing underage alcohol consumption. We studied the patients at the age up to 18 years with acute alcohol poisoning hospitalized in the Children Toxicology Department of Emergency Hospital Pirogov, Sofia, Bulgaria, from January 1, 2007 to June 31, 2008. All of them were at teen years – between 12 and 17 years old. Data on children were retrieved from hospital medical records (age, sex, level of consciousness, blood ethanol level). The initial blood ethanol level was measured on admission by thin-layer chromatography for each patient. We used the inquiry method - specially created for the purpose of the survey questionnaire comprising 39 questions (location and the reason for drinking, type of alcoholic beverage, аge at first drink, combination alcohol-illicit drug, type of family, education and employment of parents, frequency of alcohol consumption by parents, consecutiveness of the children in family, presence of siblings, presence of children in a single room, interests etc.). Psychiatric interview was used. We studied 137 adolescents with acute alcohol poisoning. 77 were boys and 60 girls. The results demonstrated tendency to increase of the poisonings in weekends and in late afternoon and evening. On admission to hospital most of them had different levels of depressed consciousness. Blood ethanol level was over 2.00 mg/ml in 40.2%. No repeated hospitalization for acute alcohol poisoning in the study group for that period was registered. Children most often used one type of alcoholic beverage. The most frequent alcoholic beverage leading to intoxication was vodka (63.1%). 64% of the children came from complete families. Both parents had secondary education in 79.7% and in 53.3% both parents were employed. 60% were the first born child in the family. The most frequent reason for alcohol consumption was meeting with friends. The students had approximately 1.20 euro daily. The research concerns one important medico-social problem – alcohol consumption among children. The increasing alcohol consumption leads to increasing number of acute alcohol poisonings and associated problems. The proposed preventive program may play an important role in decreasing the consequences of alcohol consumption among young people. It should be further developed and popularized among physicians.
Key words: influencing, alcohol


DETERMINATION OF THE EFFECT OF LEAD-INDUCED SUBCLINICAL
TOXICITY ON AUTONOMIC CARDIOVASCULAR FUNCTION

R. Nikolova(1) and S. Danev(2)
(1)National Center of Public Health Protection, Laboratory for Work Physiology and Psychology
(2)Medeia, Sofia, Bulgaria

Summary. One of the main principles of physiological strategy for assessment of subclinical lead toxicity at concentrations below threshold limit value is determination of the effect on the autonomic nervous system function. The aim of the study is to determine the effect of lead-induced subclinical toxicity on autonomic cardiovascular function assessed with heart rate variability (HRV). Lead-exposed group showed significant increase of ratio of spectral power of cardiointervals in the temperature band (0.01-0.05 Hz) (PT) to the spectral power of cardiointervals in the respiratory sinus arrhythmia (RSA) band (0.15-0.50 Hz) (PRSA) (PT/PRSA ratio), and reduction of classification index (CI) when compared with the control group. The results of our study reveal significant dependencies of PT/PRSA ratio and CI on work practice duration. Chronic lead toxicity induced by prolonged exposure to lead may cause disturbed autonomic balance with sympathetic predominance. The assessment of health risk associated with chronic exposure to lead at concentrations below threshold limit value may be performed with HRV measures which reflect quantitatively the association “exposure time – toxic concentrations”.
Key words: autonomic cardiovascular function, lead, Heart Rate Variability, subclinical toxicity, health ris


CLINICAL ASSESSMENT AND MOLECULAR GENETICS OF AN AUTOSOMAL DOMINANT
RETINITIS PIGMENTOSA IN A BULGARIAN ROMA FAMILY

K. Koev(1), S. Cherninkova(2), Ch. Chakarova(3), R. Georgiev(1), S. Dimitrova(4),
R. Kaneva(5) and S. Bhatacharya(3)
(1)Department of Ophthalmology, MU – Sofia, Bulgaria
(2)Department of Neurology, University Hospital “Alexandrovska”, Sofia, Bulgaria
(3)Department of Genetics, Institute of Ophthalmology, UCL, London, UK
(4)Molecular Medicine Center, MU – Sofia, Bulgaria
(5)Molecular Medicine Center and Department of Medical Chemistry and Biochemistry, MU – Sofia, Bulgaria

Summary. Purpose was to make a clinical assessment and molecular genetic analysis in patients with autosomal dominant form of retinitis pigmentosa (adRP) in a Bulgarian Roma family. Clinical assessment and genealogical analysis in a Bulgarian Roma family suggested the presence of RP with autosomal dominant inheritance with at least 12 affected in 4 generations. Clinical results showed best corrected visual acuity. Performed were kinetic Goldmann perimetry; direct and indirect ophthalmoscopy; ERG; fluorescein angiography. The molecular genetic analysis involved screening of 15 known adRP genes using microarray panel of Asper Biotech in the index patient. T in exon 4 of the RP1 gene, leading to an amino acid substitution T373I was found in heterozygous condition. Conclusion shourd adRP is a severe and genetically heterogeneous retinal degeneration. We present a Bulgarian Roma family with typical clinical symptoms of RP and heterozygous change in the RP1 gene, which has previously been described as a possible disease causing mutation in a Pakistani family with adRP and in homozygous condition leading to a severe arRP in 2 consanguineous families of Pakistani origin. The clinical and genetic analysis of additional affected and unaffected family members is ongoing. This will allow better genotype-phenotype correlations to be made.
Key words: autosomal dominant retinitis pigmentosa, molecular genetic analysis, tunnel visual field, ERG, fluorescein angiography


ACUTE INTERMITTENT PORPHYRIA DURING PREGNANCY AND NORMAL DELIVERY: A CASE REPORT
A.Tsonev(1), E. Kovachev(1), I. Bakardzhiev(2), S. Ivanov(1), A. Abbud(1) and M. Veseli(1)
(1)Department of Obstetrics and Gynecology, Medical University of Varna, Bulgaria
(2)Medical College, Varna, Bulgaria

Summary. We report a case of a 27-year-old woman, gravida 1, para 1 with acute intermittent porphyria during pregnancy and normal delivery, who had a generalized seizure and hypertension during delivery of her 1st child at 37 weeks gestation. Proper treatment in collaboration with hematologist greatly improved the outcome in this otherwise debilitating and potentially life-threatening disease.
Key words: porphyria, pregnancy, delivery

 

LATE RADIATION RETINOPATHY IN A PATIENT TREATED FOR RETINOBLASTOMA
B. A. Lafaut(1), J.-J. De Laey(1), F. M. Meire(1) and B. M. Kutchoukov(2)
(1)Department of Ophthalmology, Ghent University Hospital, Belgium.
(2)Department of Ophthalmology, University Hospital “Alexandrovska” – Sofia, Bulgaria

Summary. We report a case of a young man who developed radiation retinopathy 12 years after irradiation for retinoblastoma. With a history of bilateral retinoblastoma, our patient presented clustered retinal teleangiectasias in the non-enucleated but treated with radiation eye. The lesions were associated with hemorrhages and gradually increasing retinal exudation that deteriorated best corrected visual acuity (BCVA) from 0.25 to 0.1. Detailed ophthalmic examination was performed incl. fluorescein angiography (FA), indocyanine green angiography (ICG) and optical coherence tomography (OCT). The ICG highlighted the vascular anomalies that were clearly hyperfluorescent in the late phase. After 3 sessions of focal ALC the outlined edema on Oct scans diminished and BCVA improved to 0.2. Some retinoschisis-like cystic changes remained on OCT retinal scans. The manifested changes had common features with those found in diabetic retinopathy. ICG staining of the retinal vascular anomalies was found. Radiation retinopathy may occur more than a decade following radiation treatment for retinoblastoma. Appropriate laser treatment may overcome the advancing process.
Key words: radiation retinopathy, OCT, ICG, retinoblastoma

 

SEVERE BACLOFEN SELF-POISONING – A CASE REPORT
J. Radenkova-Saeva
Toxicology Clinic, MHATEM “N. I. Pirogov” – Sofia, Bulgaria

Summary. Baclofen is a lipophilic analogue of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in central nervous system. It is a muscle relaxant used in persons with neuromuscular disorders to control spasticity. Intentional or accidental overdose of this drug can cause profound central nervous system depression, including coma, seizures, respiratory depression, and cardiovascular effects such as bradycardia, hypotonia. A case of baclofen self-poisoning was presented in a 21-year-old woman, hospitalized in the Toxicology Clinic, MHATEM “Pirogov” with coma and respiratory depression. Primary importance in the treatment and management of such ingestions should focus on airway and respiratory support.
Key words: baclofen, self-poisoning, coma, seizures, respiratory depression

 

MESANGIAL LIPOIDOSIS WITH CHOLESTEROL DEPOSITION – A NEW CASE WITH NEPHROTIC
SYNDROME AND RAPIDLY PROGRESSING RENAL FAILURE

R. Robeva(1), T. Todorov(2), V. Dimitrova(1) M. Yordanov(1) and D. Doychinov(1)
(1)Clinic of Internal Disease Therapy, Nephrology, Dialysis and Clinical Pharmacology,
Univ. Hospital ”Sv . Ivan Rilski”
(2)Department of Pathology, Medical University – Sofia

Summary. More than 140 years ago, first Virchow associated observed lipid abnormalities with the concomitant renal disease. Despite a large body of clinical and laboratory evidence, the precise role of the lipids in the development of the renal disease remains unclear. In 1988, D. Doychinov described a new autosomal dominant hereditary disease leading to cholesterol accumulation within the glomerular mesangium. We report the case of a young man (a member of the affected family) with the same biopsy proven disease but with different clinical abnormalities and course. This patient had an overt nephrotic syndrome from the onset: 5 g/24h proteinuria, hypoproteinemia (52 g/l), hypoalbuminemia (28 g/l), hypercholesterolemia (8.5 mmol/l), edema as well as severe hypertension (180-200/110-120 mm Hg). Five years later he developed renal failure and after another three he was put on hemodialysis
Key words: mesangial lipoidosis, nephrotic syndrome, renal insufficiency

 

А CASE OF GIANT SQUAMOUS CELL CARCINOMA OF THE TONGUE
– A RARE FINDING WITHIN THE FRAMEWORK OF DERMATOLOGICAL SCREENING?

G. Tchernev(2), J. Ananiev(1) and M. Gulubova(1)
(1)Medical Faculty, University Hospital Lozenetz, Polyclinic for Dermatology and Venereology,
University Saint Kliment Ohridski – Sofia
(2)Department of General and Clinical Pathology, Medical Faculty, Trakia University

Summary. Carcinomas of the mouth cavity, and in particular of the tongue, are a comparatively rare form of pathology. For the correct establishing of the stages of the tumor and for defining of the diagnosis and survival of the patients, a correct histological verification is needed as well as defining the stages as per the TNM criteria. In this publication we present a rare case of a female patient with a tongue carcinoma, diagnosed within the framework of a dermatological screening. The tumor has been classified as a squamous carcinoma of the tongue with formed cornea and a moderate degree of differentiation. Quite often, such an asymptomatic clinical finding creates diagnostic and from there prognostic difficulties, which appear as a result of both the late discovery of the tumor as well as the impossibility for its complete surgical elimination. The patient underwent a partial glossectomy of the right part of the tongue with a laser, selective functional neck dissection on levels I – III under intubation anesthesia. Subsequently, a stabilisation of the clinical status followed and one year after the operation no metastases and clinical complaints were registered. The careful examination of the oral and genital mucosa, within the scope of the dermatological screening is of primary importance for the timely diagnosis of the precancers and the tumors of the transitional mucosa and in particular the mouth cavity.
Key words: squamous carcinoma, tongue, TNM classification

 

Р53 – “THE GUARDIAN OF GENOME”
J. Ananiev(1), G. Tchernev(2), J. W. Patterson(3), M. Gulubova(1) and G. Ganchev(4)
(1)Department of General And Clinical Pathology, Medical Faculty, Trakian University – Stara Zagora, Bulgaria
(2)Department of Dermatology and Venereology, Medical Faculty, Trakian University – Stara Zagora, Bulgaria
(3)Division of Surgical Pathology & Cytopathology, University of Virginia,
University of Virginia Hospital Health System, Charlottesville, VA, USA
(4)Second Surgical Department, MHAT "Prof. Stoyan Kirkovich" – Stara Zagora, Bulgaria

Summary. p53 is a transcription-suppressing factor, which participates in control of cell cycle and apoptosis and in the regulation of cell genomic integrity. p53 is a tumor suppressor protein that in humans is encoded by the TP53 gene. p53 is crucial in multicellular organisms, where it regulates the cell cycle and, thus, functions as a tumor suppressor that is involved in preventing cancer. The name p53 is in reference to its apparent molecular mass: It runs as a 53-kilodalton (kDa) protein on SDS-PAGE. But, based on calculations from its amino acid residues, p53's mass is actually only 43.7 kDa. This difference is due to the high number of proline residues in the protein, which slow its migration on SDS-PAGE, thus making it appear heavier than it actually is. This effect is observed with p53 from a variety of species, including humans, rodents, frogs, and fish. Mutations of p53 are observed in 50% of all human carcinomas and in 90% of melanomas being the most frequently genome disturbance in carcinomas. Also, allele loss and mutation of the p53 gene are detected in more than 60% of gastric cancers regardless of histological type. Different mechanisms of activation, physiological functions and the role of p53 in cancerogenesis and in different neoplasms are viewed. Immunohistochemical recognition of p53 in normal cells and neoplastic altered cells gives information about genesis, prognosis and sensitivity to therapy of different types of cancers. Nevertheless, prospective studies need to address this issue definitely and this marker need further investigation and confirmation.
Key words: p53, activation, biological function, immunohistochemical expression, malignant melanoma, gastric cancer

 

AN IN VITRO STUDY ON THE SIZES OF PULP CHAMBERS AND CLINICAL CROWNS OF MOLARS
E. Boteva
Department of Conservative Dentistry, Faculty of Dental Medicine – Sofia, Bulgaria

Summary. The macromorphology of pulp chambers has been carefully studied in the last few decades. But there is a serious lack of knowledge on the sizes in different dimensions of the pulp chambers of molars. Aims of the present study are jo measure the range and mean dimensions of the pulp chambers of upper and lower molars; to detect the relation between the sizes of clinical crowns and pulp chambers for better endocavity preparation. 286 upper and lower molars, 161 first and second upper molars, 125 first and second lower molars – matured, fully mineralized and sound are used for the study. Measurements of the clinical crown- three dimensions for each tooth in mm: mesio-distal, from the approximal marginal ridge, bucco-lingual, from the top of buccal cusp to the top of the mesio-lingual (palatal) cusp. The height of the crown is measured from the buccal side. Measurements of the pulp chambers: 40 randomly selected upper and lower molars, 20 in each group without severe root canal curvatures are measured under the following technology: the pulp chambers are opened with horizontal cuts, 1 mm apically from the equator with diamond blend. After polishing the ridges the final size of the endocavity is 2 mm bellow the equator. Both buccolingual dimensions are measured as L1 and L2, and the mean as L with endodontic file and endoblock in mm. It can be useful for the lecture courses BL sizes less than ½ of the cusp distance to be avoided for endocavity preparation. A careful approach to this sizes of crowns and chambers can lead to safe hard dental tissues during endocavity preparation and especially careful approach to the approximal walls of the teeth. This findings are important for the prevention of crown fractures, of posts and pins and of crowns and bridges in young age groups.
Key words: macromorphology, pulp chambers, sizes, crowus, molars

 

ECONOMIC ANALYSIS OF THE COST SAVINGS AFTER IMPLEMENTATION OF ANTIBIOTIC POLICY IN HOSPITAL
M. Manova(1), A. Savova(1), A. Stoimenova(1), B. Angelovska(2) and G. Petrova(1)
(1)Department of Social Pharmacy, Faculty of Pharmacy, Medical University,
(2)University in Shtip, Faculty of Medical Sciences, Department of Pharmacy, Shtip, FYROM

Summary. The antibiotic policy is an essential part of the hospital pharmacy activities. It leads to decrease in the microbial resistance, optimisation of the medicine utilisation, and cost savings. The goal of the study is to analyse the results of implementation of antibiotic policy on the medicine utilization and related cost savings in a city hospital in Sofia. The study is a comparative retrospective and prospective analysis of the antibiotic prescribing and cost of therapy, before and after the introduction of the antibiotic policy. There were gathered and systematized 2582 prescriptions for hospitalized patients in 3 hospital departments (surgical, urology, and internal wards). For the evaluation of the most often prescribed combination, the sample was made for 30 patients from each unit. The selection of patients was made ​​at random for the most common diagnoses in the studied wards. The antibiotic utilization was also measured in monetary terms and cost savings were calculated for the period after the antibiotic policy introduction. The comparison of the cost of antibiotic therapy in urology, surgical and internal wards for 2004 and 2005, after the introduction of AB policy showed that in all three studied wards significant savings were realized. Reduction of costs in 2005 compared to 2004 was in total 26 832 BGN (28.48%). Total expenditures on medicines in the studied hospital were 447 810 BGN for 2004 and 396 659 BGN for 2005. Savings of 51 151 BGN were realized, which is a significant value and a significant proportion of the total costs (28.48%). Analysis of the results of the implementation of antibiotic drug policy confirmed that the optimization of drug administration leads to positive economic results. It also confirms the usefulness of measurement of utilization and cost saving, especially in hospital wards with high cost services. The antibiotic policy should be an obligatory part of drug policy in the hospitals with scarce resources. Measuring the impact of antibiotic policy implementation is a useful tool for optimization of the general hospital medicines policy and realization of cost savings. It gives possibility for practical solutions on medicines utilization optimization. Introduction of antibiotic policy in hospitals leads to the reduction of their usage, saves money and improves therapeutic options.
Key words: antibiotic, DDD, cost reduction, hospital

 
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