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Reviews 2010

ARCHIVE

1/2010

OCCUPATIONAL RADIATION EXPOSURE – CANCER RISK FOR NUCLEAR INDUSTRY WORKERS
N. Chobanova
National Centre of Radiobiology and Radiation Protection – Sofia
Summary:
Ionizing radiation is one of the most studied factors in our environment for which cancer effect is proved. A particular area of interest with view of the radiation protection represents the radiation with relatively low doses, protracted or fractional radiation such as occupational exposure. In cases of radiation with relatively low doses, only stochastic effects are probable. The stochastic effects are without threshold and their probability of appearance is function of the dose. Epidemiological studies on workers in nuclear industry allow direct evaluation (direct dose measurement through use of personal dosimeters) of exposure at low doses and dose rate. The excess relative risk per sivert is defined. To increase statistical power and to summarize data from large worker groups in nuclear industry, several combined analyses have been conducted recently. This article summarizes the findings from these studies.
Key words: cancer risk, occupational exposure, nuclear workers, leukemia, solid tumor
Address for correspondence: N. Chobanova, MD, National Centre of Radiobiology and Radiation Protection – Sofia, 3 Sv. G. Sofiiski str., yard of MMA, building 7, Bg-1431 Sofia, e-mail: n.chobanova@ncrrp.org

2/2010

ANTIRETROVIRAL THERAPY – HISTORY AND GROUPS ANTIRETROVIRAL DRUGS
I. Elenkov, N. Yancheva, T. Tchervenyakova and T. Tomov
Specialized Hospital for Infectious and Parasitic Diseases „Prof. Ivan Kirov” – Sofia

Summary: There isn’t any field of medicine that has been through such dramatic developments as that of antiretroviral therapy. The beginning of this therapy was in 1987, but there weren’t satisfying results, because of monotherapy. In the next years, there were gradually synthesized different drugs. These drugs operate by different mechanism, because of that there are several groups antiretroviral drugs. In June 1996, the World AIDS Conference in Vancouver reported on the new „AIDS cocktails”, and the strangely unscientific (and rather ridiculous) expression „highly active antiretroviral therapy” (HAART) began to spread irreversibly. Due to HAART, morbidity and mortality in HIV – patients diminished. In this review, we present history of antiretroviral therapy, groups of antiretroviral drugs, their mechanism of action, effectiveness and side effects.

Key words: HIV, antiretroviral therapy, HAART, nucleoside analogs (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitor – PI, entry inhibitors, integrase inhibitors, viral load, CD4, viral success, immunologic success

Address for correspondence: Nina Yancheva, MD, Department for Patients with HIV/AIDS, Specialized Hospital for Infectious and Parasitic Diseases „Prof. Ivan Kirov”, Bg-1606 Sofia, 17 Ivan Evst. Geshov blvd., email: dr.yancheva@abv.bg

OXIDATIVE STRESS AND INFLAMMATION IN ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (I PART)
L. Terziev
Section “Clinical Immunology and Allergology”, MU – Pleven

Summary: The aim of the present review is to summarize the role of oxidative stress and inflammation in the pathogenesis of social significant lung diseases such as bronchial asthma and chronic obstructive pulmonary disease. Schemes describing the involvement of inflammatory and immune cells in different pathogenetic mechanisms are given. Evidences of imbalances between oxidants and antioxidants, as well as data for increased peroxidation in the lung of patients with these diseases are presented. The participation of different types of inflammatory cells and mediators in pathogenesis, and consequences of inflammation in both diseases are described.

Key words: lung, oxidative stress, asthma, chronic obstructive pulmonary disease

Address for correspondence: L. Terziev, MD, Ph D., Clinic of allergology, Section “Clinical Immunology and Allergology”, Medical University – Pleven, 1 Kliment Ohridski str., Bg-5800 Pleven, e-mail: luterzi@mail.bg

3/2010

ЕКОЛОГИЧЕН ПОДХОД ПРИ ЗООНОЗИТЕ
В. Монев
Национален междуведомствен експертен съвет по трансмисивните кърлежовопреносими инфекции при МЗ – София

Резюме: На основата на учението за природната огнищност се разглеждат от екологична гледна точка зоонозните заболявания. Епизоотичният процес представлява постоянно взаимодействие между популациите на причинителя, вектора, хазаина и околната среда, така че се осигуряват условия за съществуване на причинителя като биологичен и екологичен вид. Схващането за епизоотичния и епидемичния процес при зоонозите е екологична концепция. Най-важната характеристика на едно гръбначно като хазаин на инфекция е степента му на чувствителност и възприемчивост към даден причинител. Тук следва да се различават филогенетичният (конституционалният) имунитет от онтогенетичния. Разбиранията за възприемчивостта на хазаина към инфекции трябва да се опират на популационната екология и генетика. Индивидуалните вариации във възприемчивостта на живите преносвачи на заразата (векторите) към инфекциозни болести и способността им да предават инфекциозните агенти са генетично и екологично обусловени. Степента на вирулентност на причинителя към главния вектор и способността му да преживява и да се репродуцира в него са също вариабилни. Съществува вътрешноспецифична хетерогенност на причинителя, която определя отношенията с хазаина и преносвача. Развитието на епизоотичния и епидемичния процес във връзка с хетерогенността на популациите на хазаина, причинителя и преносвача определя еволюцията им и представлява екологичният модел на дадена инфекция.
Ключови думи: епидемиология, екология, зоонози
Адрес за кореспонденция: Проф.  В. Монев, ул. „Юрий Венелин” № 19, вх. 1, 1142 София, тел.: 989-83-98

OXIDATIVE STRESS AND INFLАMMATION IN SOME PULMONARY DISEASES (PART II)
L. Terziev
Section “Clinical Immunology and Allergology”, MU – Pleven

Summary: Oxidative stress and inflammation are responsible for development of a part of pulmonary diseases such as ARDS, pulmonary fibrosis and lung cancer. In the present study, the mechanisms of participation of the reactive oxygen species (ROS) in the development of these and other pulmonary diseases are shown as well as the proposed pathogenic schemes of acute respiratory distress syndrome (ARDS) and pulmonary fibrosis. The availability of oxidative stress in these diseases supposes the possibility of antioxidant therapy in their treatment schemes.
Key words: lungs, oxidative stress, ARDS, pulmonary fibrosis, lung cancer
Address for correspondence: L. Terziev, MD, Ph. D., Clinic of allergology, Section “Clinical Immunology and Allergology”, Medical University – Pleven, 1 Kliment Ohridski str., Bg-5800 Pleven, e-mail: luterzi@mail.bg

HORMONES OF THE ADIPOSE TISSUE AND INSULIN RESISTANCE
V. Ivanov and S. Pashkunova
MMA

Summary: The adipose tissue in human is an enormous source of energy. Until recently, the adipocytes were considered hormonally dependent, but hormonally inactive. Today it is known, that the adipose tissue is hormonally active, and secretes substances that induce obesity, insulin resistance and low-level of inflammation, which could be the binding link between diabetes mellitus type 2 and the atherosclerosis. These substances are leptin, tumor necrosis factor-alpha (TNF-α), adiponectin, resistin and interleukin-6 (IL-6). It was found that there is a positive correlation between leptin and insulin resistance and that resistin is the possible link between obesity and insulin resistance. Today it is almost a common knowledge that the obesity and the related with it insulin resistance, which are characteristic of diabetes mellitus type 2, are represented with high levels of leptin, resistin, IL-6, TNF-α and low levels of adiponectin. This supports the Hopkins` hypothesis, that the obesity underlies the syndrome of insulin resistance.
Key words: adipose tissue, adipocytes, insulin resistance, diabetes mellitus type 2, leptin, resistin, adiponectin, TNF-α, IL-6, obesity
Address for correspondence: Assoc. Prof. Valentin Ivanov, Clinic of Endocrinology, Military Medical Academy, 3 Sv. G. Sofiyski str., 1606 Sofia

ECO-CATASTROPHES THREATEN THE BIODIVERSITY OF THE WORLD OCEAN
Hr. Romanova1, N. Radeva1, D. Tomov1 and N. Popov2
1Medical University – Varna
2Nikola Vaptsarov Naval Academy – Varna

Summary: Analysis and prognosis are made for the anthropological eco-catastrophes that threaten the biodiversity of the World Ocean and propositions for the most significant measures for fight with them. The break-downs with oil tankers and the suddenly split of oil from rigs in the seas are considered a small share for the general pollution, but the consequences are specially heavy, because of the split big amount for short time and this threatens the life and the existence of hundred species birds and sea inhabitants. The biological effect of the oil and the oil products on sea organisms is strongly toxic, cancerogenic and lasting. The fight with the anthropological ecological catastrophes with oil split consists first of all in measures for non-admission of break-downs, i.e. prevention through legislative measures, cosmic methods and means for warning and early announcement, rising of the safety of the navigable equipments and approval of new alternative energy sources.
Key words: eco-catastrophes, pollutions with oil and oil products
Address for correspondence: Assoc. Prof. Dr. Hr. Romanovа, MD, Head of the Department of Hygiene and Disaster Medicine, Medical University – Varna, 55 “Marin Drinov” Str., Bf9002 Varna, tel. 0878 58 448, e-mail: romanova_hr@abv/bg

4/2010

ETIOPATHOGENESIS AND FUNCTIONAL DIAGNOSTIC STUDY OF RENIN-ANGIOTENSIN SYSTEM ACTIVITY IN INDIVIDUALS WITH BALKAN ENDEMIC NEPHROPATHY
R. Nikolova(1) and S. Danev(2)
(1)Sektsiya "Physiology and Psychology, National Center for Public Health – Sofia
(2)"Medea" – Sofia

Summary. Balkan endemic nephropathy (BEN) is a tubulointerstitial kidney disease with gradual progressive renal insufficiency, latent onset and extended incubation period affecting individuals living in certain rural areas of Bosnia and Herzegovina, Bulgaria, Croatia, and Romania. Etiological factors and pathogenetic mechanisms inducing BEN are still not a defined medical case independently of research studies investigating the effect of environmental factors, genetic factors and immunological mechanisms. Specific subject in research studies of BEN associated with arterial hypertension and renal insufficiency is the activity of renin-angiotensin system (RAS). The significance of the cardiovascular functional diagnostic method heart rate variability for the study of RAS in the arterial blood pressure regulation system as well as for the study of autonomically modulated indices of cardiovascular function – the arterial blood pressure, vasomotor tone, heart rhythm, and the associated central neural regulation of cardiovascular function – is underlined. 
Key words: Balkan endemic nephropathy, renin-angiotensin system, cardiovascular function, functional diagnostic methods, urothelial carcinoma
Address for correspondence: Assoc. Prof. Dr. Ruzha Nikolova, MD, National Center for Public Health, Department of Physiology and Psychology, 15 Acad. Ivan Geshov  blvd. tel.: 8056 207

 

THE ROLE OF THE INTESTINAL BARRIER FUNCTION IN THE PATHOGENESIS OF CROHN’S DISEASE
V. A. Gerova
Clinic of Gastroenterology, UMHAT “Tsaritsa Yoanna” – Sofia

Summary. Despite of scientific efforts during the last decades, etiology and pathogenesis of the Crohn's disease (CD) remain unclear. Currently, it is widely accepted that the chronic intestinal inflammation in CD results from an inappropriate immune response that occurs in genetically susceptible individuals as the result of a complex interaction among environmental, genetic and immunological factors. A multifunctional cellular and secretory barrier separates the microbial flora from host tissues. Altered function of this barrier remains a major largely unexplored area in CD. Although there is evidence of barrier dysfunction in CD, it remains unclear whether this is a primary contributor to disease or a consequence of mucosal inflammation. The aim of this review is to summarize the recent advances in the intestinal barrier dysfunction in CD and its role in the disease pathogenesis.
Key words: intestinal barrier function, Crohn’s disease, pathogenesis, intestinal inflammation
Address for correspondence: V. A. Gerova, Clinic of Gastroenterology, UMHAT “Tsaritsa Yoanna – ISUL”, 8 Byalo more str.

 

EXTRAINTESTINAL MANIFESTATIONS OF INFLAMMATORY BOWEL DISEASES
P. Penchev
Clinic of Gastroenterology, University Hospital “Tsaritsa Yoanna” – Sofia

Summary. In recent years, in addition to the well-known extraintestinal manifestations of Inflammatory Bowel Disease (IBD) like arthralgia/arthritis, eye changes, skin changes, and hepatobiliary system changes thromboembolic events, osteoporosis with bone fractures, changes in respiratory and nervous systems have been more frequently described. Their recognition is a prerequisite for timely diagnosis and proper treatment of inflammatory bowel disease, Crohn’s Disease and ulcerative colitis.
Key words: extraintestinal IBD, Crohn’s disease
Address for correspondence: P. Penchev, MD, Clinic of Gastroenterology, University Hospital “Tsaritsa Yoanna”, 8 Byalo more, str., Bg-1527 Sofia, tel.: 9432-519, e-mail: penchev.dr@gmail.com

ENCAPSULATING PERITONEAL SCLEROSIS – DIAGNOSIS AND TREATMENT
L. M. Veltchev, R. Pararajasingam and B. Forgas
Department of Kidney, Pancreas and Intestine Transplantation
Manchester Royal Infirmary, Manchester, UK

Summary. EPS is a progressive inflammatory complication in patients under prolonged peritoneal dialysis. It is characterized by intestinal adhesions, coverеd with thick membrane formed by inflammatory secreted fibrin compound. Impairing of bowel peristaltic leads to incomplete GI obstruction. Usually the syndrome is observed after peritoneal dialysis (PD) withdrawal. The severity is proportional to the duration of dialysis and association with infections. The diagnosis of EPS is based on the: Clinical presentation- disturbance of intestinal motility with impairment of absorptive functions presented with malabsorption syndrome – weight loss and cachexia, nausea, vomiting, abdominal pain and anorexia, abdominal mass and suspicion of obstructive ileus; imaging studies that are used for confirmation of thickenings and encapsulation include abdominal US and CT; pathomorphologic examination of specimen – structural analysis of peritoneal membranes. Treatment of EPS includes conservative medication (tamoxifen, cyclosporine, rapamycin and corticosteroid). Most appropriate at present time in the renal transplant centres is the surgical procedure named Peritoneoectomy with Enterolysis.
Key words: EPS, peritoneal dialysis, bowel obstruction, ileus, diagnosis, treatment
Address for correspondence: Ludmil Marinov Veltchev, MD, Manchester Royal Infirmary, Department of Kidney, Pancreas and Intestine Transplantation, tеl: +359876259685, е-mail: drlmarinov@yahoo.com

PSEUDOCYSTS VERSUS OTHER PANCREATIC LESIONS-CONVENTIONAL AND INTERVENTIONAL IMAGING DIAGNOSIS
A. Hilendarov, K. Velkova, N. Traikova and A. Nedeva
Department of Imaging Diagnostics, UMHAT “Sveti Georgi” – Plovdiv

Summary. Although the clinical, radiologic, and pathologic features of cystic pancreatic lesions are well known, preoperative diagnosis is difficult. Primary cystic neoplasms of the pancreas – serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs) and intraductal papillary mucinous neoplasms (IPMNs) are lesions of emerging importance. With the wide availability of modern imaging methods – computed tomography (CT), ultrasound tomography (US), magnetic resonacie imaging (MRI) and invasive procedures under imaging control, these neoplasms are being recognized with increasing frequency. Differentiation between a pancreatic pseudocyst and a cystic pancreatic neoplasm is crucial in determining the proper treatment. This differentiation is very important for the clinicians, since these neoplasms have radically different biologic behavior. The aim of the study of this survey is to illustrate the spectrum of imaging findings of cystic pancreatic lesions and highlight the role, advantages, and limitations of various imaging modalities in the differential diagnosis of pancreatic cystic neoplasms and pancreatic pseudocysts.
Key words: pancreatic cystic neoplasms, pancreatic pseudocysts, diagnostic imaging methods, invasive procedures
Address for correspondence: Assoc. Prof. N. Traykova, MD, Center of medical imaging, “Sv. Georgi”, 66 blvd. Peshtersko shosse, Bg-4000, Plovdiv, GSM: 0888 27-27-65

ELECTRORETINOGRAPHIC ANALYSIS OF CONGENITAL STATIONARY NIGHT BLINDNESS DISORDERS
K. Koev
Department of Ophthalmology, University Hospital "Tsaritsa Yoanna” – Sofia

Summary.  The autosomal–recessive, X – linked recessive and autosomal – dominant forms of congenital hereditary diseases with stationary night blindness is are discussed. The types of Nougaret, Schubert-Bornschein, Riggs and the corresponding ERG and VEP are presented changes. ERG changes and VEP are presented in Morbus Ogushi which is an autosomal-recessive inherited disease where the photopic ERG function is normal or sometimes subnormal while the scotopic "a" wave and "b" wave amplitudes are reduced. ERG changes and VEP are presented in fundus albipunctatus which is autosomal-recessive disorder, characterized by the early onset of non-progressive night vision and presence of numerous discrete matte-white spots.
Key words: congenital stationary night blindness, ERG, VEP
Address for correspondence: K. Koev, Department of Ophthalmology, University Hospital “Tsaritsa Yoanna”, 8 str. Byalo more”, Bg-1427, Sofia, tel.: 836-55-04, e-mail: sofia56@abv.bg

 

 

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