MEDICAL REVEIW
MULTIPROFILE MEDICAL JOURNAL FOR ORIGINAL STUDIES - REVIEW ARTICLES, ORIGINAL PAPERS, CASE REPORTS
 
CML Home

Review articles

Volume 39, 2003

4/2003

Hyperbaric medicine – history and development - 39, 2003, № 4, 3-7.
H. Bozov(1), V. Alexandrov(2)and N. Petrov(2)
(1)Clinic of Anesthesiology, Hyperbaric and Intensive Medicine, Naval Hospital – Varna, Military Medical Academy
(2)Department of Anesthesiology, Resuscitation and Intensive Care, Military Medical Academy - Sofia
Summary: The subject of the hyperbaric medicine are all the changes that occur in human organism under the impact of increased pressure of various gas and water environments. The hyperbaric oxygenation is a branch of hyperbaric medicine. It studies the clinical application of hyperbaric oxygen. The history and contemporary state of hyperbaric medicine, the clinical application of the hyperbaric oxygenation method, the technical security and the opportunities for development are presented.
Key words: hyperbaric medicine, hyperbaric oxygenation, decompression chamber
Address for correspondence: Hristo Bozov, M. D., Ph. D., Naval Hospital, 3, Hristo Smirnensky Str., Bg, 9010 Varna,) +359 52-38-62-20, e-mail: bozov@mnet.bg, hr_bozov@yahoo.com

Mandibular micrognathia: aetiology, characteristics and surgical methods for treatment - 39, 2003, № 4, 8-16.
A. Jorov(1) and I. Jorova(2)

(1)Department of Oral and Maxillo-facial Surgery, Dental Faculty, Medical University - Sofia
(2)Student in Dental Faculty, Medical University - Sofia
Summary: The surgical treatment of the mandibular micrognathia requires knowledge of all of her forms. They are in connection with the etiological moments during the neonatal development and the growth of the mandible and the orofacial system. Under the influence of both exogenous and endogenous factors, the rotations of the jaws during the growth may become uncoordinated and there is a possibility that abnormalities may arise in the facial development. The article presents the actual surgical methods for reconstruction of the temporomandibular joint in treatment of hemifacial microsomia and ankylosis, the orthognathic mandibular surgery for mandibular deficiency, genioplasty and lengthening of the mandible by distraction osteogenesis. We point at the role of the multidisciplinary approach in planning and treatment of the mandibular micrognathia.
Key words: micrognathia, hemifacial microsomia, microgenia, arthroplastic, temporomandibular joint, mentoplastic, orthognathic surgery, distraction osteogenesis
Address for correspondence: Anton Jorov, Department of Oral and Maxillo-facial Surgery, Dental Faculty, Medical University, 1, Sv. G. Sofiiski Str., Bg 1431 Sofia, e-mail: dental-mfs@sun.medun.acad.bg

Molecular mechanisms of myocardial relaxation - 39, 2003, № 4, 17-26.
D. Vassilev and Al. Doganov

National Hospital of Cardiology - Sofia
Summary: Myocardial relaxation is the first event of diastole according to the classic concepts of Wiggers from the beginning of last century. Our modern concepts include relaxation in the systolic part of cardiac contraction, because of their inherent community and common mechanism, determining myocardial performance. Many factors, myocardial and extramyocardial, could change relaxation performance. In this review, we discuss different factors influencing relaxation process as a base for understanding of changes determined by disease process.
Key words: relaxation, myocard, diastole
Address for corespondence: D. Vassilev, 20, Iskar Str., Bg 1000 Sofia, ) +359 2 980-50-11, е-mail: dvassilev@emmonya.com

The role of leptin in reproduction - 39, 2003, № 4, 27-34.
M. Todorova(1), Z. Kamenov(2), S. Lazarov(1) and V. Christov(2)

(1)Department of Pathophysiology, (2)Clinic of Endocrinology, Alexandrovska University Hospital, Medical University - Sofia
Summary: The discovery of leptin provided new insights not only in the pathogenesis of human obesity, but proved its role in reproductive function and some of its disturbances. Leptin has central effects on the hypothalamus and pituitary regulation of gonadotropin secretion. It was found that leptin is required for sexual maturation, initiation of puberty, normal menstrual cycle and pregnancy. Patients with nutritition disorders and hypothalamic amenorrhea were found to have significantly decreased serum leptin levels. Though there are interspecies differences and the extrapolation of data from rodent to human physiology is not feasible, the successive application of leptin in experimental studies and in rare cases in humans gives new perspectives for therapeutic approach in reproductive and nutritition disorders.
Key words: leptin, regulation of reproduction, reproductive disorders
Addres for correspondence:   M. Todorova, M. D., Department of Pathophysiology, Medical University, 1, Sv. G. Sofiiski Str., Bg 1431 Sofia

Current trends in the treatment of renal anemia - 39, 2003, № 4, 35-38.
L. Kambova(1) and Ts. Baldev(2)
(1)Clinic of Dialysis, Alexandrovska University Hospital
(2)Department of Dialysis, Tsaritsa Ioanna University Hospital, Medical University - Sofia
Summary:  After more of a decade of clinical use of recombinant human erythropoietin (rh-EPO) for the treatment of renal anaemia, there remains a considerable debate as to optimal target hemoglobin levels. Conflicting results from clinical trials indicate that there is no clear scientific rationale for setting a single hemoglobin target for all patients, suggesting that individualized treatment targets would be a more logical and patient-centred approach. This patient-centred approach would do much to restore the unfulfilled promises of rh-EPO therapy for individual patients.
Key words: chronic renal failure, renal anemia, erythropoietin
Address for correspondence: Clinic of Dialysis, University Hospital “Alexandrovska”, Medical University, 1, Sv. G. Sofiiski Str., Bg – 1431 Sofia, ) +359 2 92-30-463, e-mail: dr_kambova@abv.bg

Recombinant human parathyroid hormone – a new bone-building agent for the treatment of osteoporosis - 39, 2003, № 4, 39-44.
M. Boyanov
Clinic of Endocrinology, Department of Internal Medicine, Medical University – Sofia
Summary:   The main biological function of the parathyroid hormone (PTH) is maintenance of calcium homeostasis. This review article displays data on the use of recombinant human PTH (rhPTH) in the treatment of osteoporosis. Data are shown on the binding to different receptor domains of the N- and C-terminal fragments of the intact hormone. Possible mechanisms of action on target cells are listed. A number of studies in animal models for osteoporosis are cited, in which the PTH treatment has led to an increase in bone mass and strength. The results of the largest study on the effect of subcutaneous PTH in postmenopausal women with osteoporosis are presented. The still scarce data on combined use of rhPTH and anti-resorptive agents are listed. Future developments of this promising bone anabolic therapy are outlined.
Key words: osteoporosis, bone-building agents, recombinant human parathyroid hormone
Address for correspondence: M. Boyanov, M. D., Clinic of Endocrinology, Alexandrovska University Hospital , 1, Sv. G. Sofiiski Str., Bg 1431 Sofia, ) + 359 2 923-03-46, e-mail: boyanov@sun.medun.acad.bg

Nonsteroidal anti-inflammatory drugs and their adverse effects on the gastrointestinal tract - 39, 2003, № 4, 45-51.
M. Pantchovska

Clinic of Rheumatology, Medical University - Plovdiv
Summary:  Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in medial practice. The frequency of their use increases with the age of the patients. Serious adverse effects are quite often and they may threaten the patient’s life. The pathogenetic mechanisms associated with gastrointestinal complications, the risk factors of their development and the risk groups are presented in this review. The pharmacoeconomical aspect of the treatment with NSAIDs is considered. Regardless of the synthesis of a new class  selective cyclooxygenase-2 inhibitors, the “old” NSAIDs remain the most frequently prescribed drug forms.
Key words:  nonsteroidal anti-inflammatory drugs, adverse effect, gastrointestinal tract
Address for correspondence:  Maria Pantchovska, M. D., P. B. 136, Bg  4023 Plovdiv, )0888-60-23-81
e-mail: mar_pan@abv.bg  

 

3/2003

Malignant skin diseases in renal transplant patients
Z. Demerdjieva (1) Е. Paskalev (2)
(1)Department of Dermatology and Venereology(1)Department of Dermatology and Venereology
(2)Department of Nephrology and Transplantation
University Hospital “Alexandrovska” - Sofia
Summary: The long-term use of immunosuppressive agents in renal transplant recipients increases the risk of neoplasms after transplantation. The types of cancers encountered in transplant recipients are different from those found in the normal population, with a higher frequency of squamous cell carcinomas of the skin, non-Hodgkin lymphoma, Kaposi sarcoma, carcinoma of the uterine, hepatobiliary carcinoma. The most common post-transplant cancers are those of the skin and lips, with a frequency of 35-40%. There is a linear increase in the frequency of skin cancer with length of follow-up after transplantation. Of the skin cancers, squamous carcinomas are more common than basal cell carcinomas. The tumors are more aggressive than in general population and more likely to recur after resection. The goal of this review is to show frequency and importance of skin malignant diseases in renal transplant recipients.
Key words: kidney transplantation, renal transplant patients, malignant skin diseases
Address for correspondence: Zdravka Demerdjieva, M. D., Clinic of Dermatology and Venereology, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, e-mail: zdemerdjieva@bol.bg

The nervous system involvement in primary Sjoegren’s syndrome
M. Pantchovska(1), J. Sheitanov(2) and R. Ikonomov(3)
(1)Clinic of Rheumatology, Medical University - Plovdiv
(2)Clinic of Rheumatology, Medical University - Sofia
(3)Neurologic Clinic, Medical Institute, Ministry of Internal Affairs
- Sofia
Summary: The primary Sjоgren’s syndrome may manifest with systemic features, which include engagement of the nervous system. There are registered involvement of the peripheral nervous system and the central nervous system. The cognitive disorders are characteristic. Rare instances of myelopathia are observed. The wide spеctrum of neurologic manifestations requires a differential diagnosis with various neurologic diseases and determines the therapeutic approach.
Key words: primary Sjоgren’s syndrome, nervous system
Address for correspondence: Maria Pantchovska, M. D., P. B. 136, Bg - 4023 Plovdiv, e-mail: mar_pan@abv.bg

Erythema migrans - past and present
R. Komitova(1) and I. Hristova(2)
(1)University Hospital "Sv. I. Rilski" - Sofia
(2)National Center of Contagious and Parasitic Diseases
- Sofia
Summary
: Erythema migrans is the most common manifestation of the early Lyme disease. Because this phase of infection with B. burgdorferi offers an excellent opportunity to treat this potentially systemic infection, front-line physicians must be familiar with its diagnosis. Although much attention has been paid to the classic form - the target lesion or bull's eye - there are variations that are more common. These include homogenous configuration, lesions with shapes that are not round or oval. These findings must be interpreted in epidemiologic context. Serologic testing at this phase of the illness should be done when lesions are not typical. Prompt initiation of appropriate antibiotic therapy for 3 weeks cures most patients at this early stage of the disease. Clinicians should be aware that 15% of patients may be coinfected with a second tick-borne pathogen, which could alter the usual clinical manifestations and the response to treatment.
Key words: Borrelia burgdorferi, erythema migrans, Lyme borreliosis
Аddress for correspondence: Radka Komitova, MD, Clinic of Infectious, Parasitic and Tropic diseases, University hospital "Sv. I. Rilski", 15, Acad. I. Geshov Blvd., Bg - 1431 Sofia, e-mail: rkomitova_56@yahoo.com

Erythropoietin and erythropoietin therapy. Part I. Background. Erythropoietins. Erythropoietin treatment in anemia of chronic renal disease and cancer
M. Nikolova
Clinic of Nephrology, University Hospital "Alexandrovska" - Sofia
Summary: To procure the continuous renewal of red blood cells the human body produces approximately 2.5 x 106 new erythrocytes per second. Erythropoiesis is stimulated mainly by a specific sialoglycoprotein called erythropoietin (EPO). After the introduction of recombinant human EPO in the clinical practice for the treatment of anemia of different origin it has reduced significantly the need of hemotransfusions and the transfusion-related risks and expenses. This review is focused on the indications and side effects of EPO treatment and the therapeutic strategies in patients with anemia of chronic renal disease and malignancy.
Key words:
erythropoietin, anemia of chronic renal disease, anemia of malignancy, treatment
Addres for correspondence: Milena Nikolova, M. D., Clinic of Nephrology, University Hospital “Alexandrovska”, Bg - 1431 Sofia, P. B. 45, e-mail: milenchenceto@yahoo.com

Topical corticosteroids in the treatment of chronic rhinosinusitis
G. Christoff

Clinical Centre of Allergy, Medical University - Sofia
Summary: Sinusitis is a common disorder and a significant burden on society. Up to 15% of the population in some countries are affected by the disease. In the USA, it accounts for more than 11.5 million out-patients annually and for 13 million prescriptions for treatment with antibiotics. Individuals with sinusitis have a significantly impaired quality of life. It has been suggested that the term rhinosinusitis is more accurate than sinusitis for the following reasons: rhinitis often precedes sinusitis; sinusitis without rhinitis is rare; the mucosa of the nose and the sinuses is continuous, and nasal obstruction and nasal discharge are present in sinusitis. The most common key factors that predispose an individual to development of sinusitis are viral upper respiratory tract infections and allergic rhinitis. Edema of the nasal mucosa charcteristic of these conditions results in ostial obstruction, decreased ciliary action in the sinuses, and increased mucus production and viscosity. In that way, a vicious cycle leading to a chronic inflammation of paranasal sinuses is formed. In most cases, it is accepted that the combination of an acute bacterial rhinosinusitis with predisposing factors, such as allergy, subtle immune deficiency and occasional anatomic variation, leads to a dysfunction of mucociliary clearance mechanism resulting in a vicious cycle of obstruction in the ostiomeatal complex and chronic inflammation. What is more, many cells of the immune system and their mediators take a crutial role in the pathogenesis of chronic rhinosinusitis
Key words: allergic rhinitis, chronic sinusitis, nasal corticosteroids, asthma
Address for correspondence: G. Christoff, M. D., Clinical Centre of Allergy, Medical University, 1, Sv. G. So­fiiski Str., Bg - 1431 Sofia, e-mail: christoff_g@yahoo.com.

Alternative mechanisms of action of the long-acting beta2-adrenergic agonist salmeterol in COPD
D. Popov

Clinic of Pulmonology, Allergology and Haematology, Medical Institute, Ministrty of Internal Affairs
Summary: Beta2-adrenergic agonists are widely used as bronchodilators in the treatment of COPD. In addition to bronchodilation, long-acting beta agonists have other so-called "non-bronchodilating" effects, which are of significant clinical relevance. These include inhibition of the proliferation of bronchial smooth muscle cells, the reduction of the release of inflammatory mediators, the stimulation of the mucocilliary transport, cytoprotection of the respiratory epithelium and the decrease in the mobilisation and activation of neutrophils. This position paper looks in detail at the numerous alternative mechanisms of action of the long-acting beta2 agonist salmeterol in COPD.
Key words: COPD, long-acting beta2-adrenergic agonists, salmeterol
Address for correspondence: Assoc. Prof. Dimitar Popov, Clinic of Pulmonology, Allergology and Haematology, Medical Institute of Ministrty of Internal Affairs, 79, Skobelev Blvd., Bg - 1606 Sofia, tel. +359 2 982-74-653, e-mail: dimpopov@mail.bg

Posttraumatic therapy
Hr. Popov

Department of Psychiatry, Medical University - Sofia
Summary: The purpose of this paper is to enlarge on the foundation of posttraumatic therapy (PTT) and to clarify some of the clinical techniques that stand upon this foundation. Since traumatized and victimized individuals are, by definition, reacting to abnormally stressful events, they may confuse the abnormality of the trauma with abnormality of themselves. For this reason, several principles are fundamental to PTT: the normalization principle, the collaborative and empowering principle and the individuality principle. These three principles can be expressed in various ways and supplemented by other important tenets. The techniques of PTT can be classified into four categories: the first one is educational; the second grouping falls within the category of holistic health; the third category includes methods that enhance social support and social integration. Finally, there are clinical techniques that are best categorized as therapy. These comprise working through grief, extinguishing the fear response that accompanies traumatic imagery, judicious use of medication for target symptoms, the telling of the trauma story, role play, hypnotherapy, and many individualized methods that are consistent with the principles of PTT.
Key words: education, holistic health, social integration, clinical techniques
Address for correspondence: Hristo Popov, M. D., Psychiatric Clinic, Alexandrovska University Hospital, 1, Sv. G. Sofiisky Str., Bg - 1431 Sofia, tel. + 359 2 92-30-283, e-mail: hristopopov2002@yahoo.com

Perspectives of application of Helium-Neon-low-intensity laser therapy in corneal diseases
L. Avramov

Institute of Electronics, Bulgarian Academy of Sciences - Sofia
Summary: The perspectives of application of Helium-Neon (He-Ne)-low-intensity laser therapy are shown. In this study by different authors, the positive clinical results of therapy with He-Ne-laser of burns and damages of cornea and inflammatory diseases of the eye are shown. Authors established histologically, electron microscopically and via investigations of some enzymes acceleration of the regenerative processes of the cornea treated with He-Ne-laser radiation. A new He-Ne-laser system was created to treat the traumatic damages and burns of the cornea with antiinflammatory and antiherpetic action. Comments were made on influence of low-intensity He-Ne-laser radiation on multiplication of Herpes simplex virus, cultivated in cell cultures, where a cleare effect of virus reproduction was found in late stages of the multiplication cycle. Hypotheses on the therapeutical effect of He-Ne-laser on the eye are discussed.
Key words:cornea, Helium-Neon laser therapy
Address for correspondence: Luchezar Avramov, Institute of electronics, Bulgarian Academy of Sciences - Sofia, GSM 098445587

 

2'2003

DISASTER PSYCHIATRY: PRINCIPLES AND PRACTICE
Hr. Popov
Department of Psychiatry, Medical University, Sofia
Summary: A wide host of traumatic events and natural as well as man-made disasters have become part of everyday life. The term "disaster psychiatry" has been coined to describe an epidemiological approach to understanding and treating the effects of mass casuality situations. Psychiatrists can play an important role in assisting individuals and communities to manage the consequences. They bring a unique set of skills and experience that can be invaluable in minimizing morbidity and facilitating recovery. This paper discusses psychological, physiological, behavioral, and community responses encountered in the aftermath of a disaster. A preventive medical model of understanding disaster response is presented in which the psychiatrist delineates traumatic stressors and high-risk populations. The importance of psychiatric participation in disaster preparedness is emphasized. Psychiatric interventions targeted at the various longitudinal phases of disaster response are discussed. Basic principles of disaster psychiatry are reviewed and ways in which psychiatrists can effectively intervene following community catastrophes are suggested.
Key words: disaster/trauma; "at-risk" populations/assessment; psychiatric interventions
Address for correspondence:
Dr. Hristo Popov, Psychiatric Clinic, Alexandrovska University Hospital, Bg - 1431 Sofia, Bulgaria, 1 Sv. G. Sofiisky Str, тел. + 359 2 92-30-283, e-mail: hristopopov2002@yahoo.com

DERMATOLOGICAL CHANGES AFTER RENAL TRANSPLANTATION
Z. Demerdjieva(1) and Е. Paskalev(2)
(1)Department of Dermatology and Venereology
(2)Department of Nephrology and Transplantation, University Hospital "Alexandrovska" - Sofia
Summary: Skin changes in patients with kidney transplantation are diverse. They develop on the base of preceding skin lesions typical of chronic renal insufficiency especially for the dialysis period. Some of the disorders are transitional, others persist transforming under the influence of the obligatory immunosuppressive therapy. The immunosuppressive therapy influences directly the skin and provokes some specific disorders. On their part, immunosuppressive drugs indirectly lead to development of nonmalignant skin changes in patients with renal transplantation. The skin pathology differs from that in nonimmunocompromised patients with the frequent recurrences, the atypical characteristics of the skin lesions and the therapeutic resistance. The aim of this survey is to present the most frequent, nonmalignant skin changes in patients with renal transplantation.
Key words: renal transplant patients, non-malignant skin changes
Address for correspondence:
Z. Demerdjieva, M. D., Clinic of Dermatology and Venereology,
University Hospital "Alexandrovska", 1, Sv. G. Sofiiski Str., Bg - 1431, e-mail: zdemerdieva@bol.bg

PROTEIN RESTRICTION AND CHRONIC RENAL FAILURE
Е. Paskalev
Clinic of Nephrology and Transplantation, University Hospital "Alexandrovska" - Sofia
Summary: Dietary protein restriction is effective in reducing signs and symptoms of renal failure. A protein-restricted regimen can be effective only if other complications of chronic renal failure are controlled, such as Na+ balance and blood pressure, acidosis and serum K+ level, uric acid, Ca++ and phosphorus balance, and anemia and iron stores. In cases of advanced renal insufficiency - glomerular filtration rate values less than 25 ml/min - a diet providing 0.6 g protein/kg body weight/day may slow progression and delay end-stage renal disease. The goal of the review is to show the importance of protein restriction diet on progression of renal failure.
Key words: renal disease, chronic renal failure, dietary protein intake, progression
Address for correspondence:
Emil Paskalev, M. D., Clinic of Nephrology and Transplantation,
University Hospital "Alexandrovska", 1, Sv. G. Sofiiski Str., Bg - 1431,
phone +359 2 92-30-240, e-mail: emilpaskalev@abv.bg

DIAGNOSTIC VALUE OF SOME LABORATORY PARAMETERS IN PATIENTS
WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND LUPUS NEPHRITIS
M. Nikolova
University Hospital "Alexandrovska" - Sofia
Summary: Systemic lupus erythematosus (SLE) is a systemic disease with autoimmune pathogenesis. In SLE patients cytotoxic antibodies directed against cell antigens (nuclear, cytoplasmic or membrane structures) and/or circulating immune complexes cause tissue and organ damages. The diagnostic and prognostic role of some autoantibodies, C3 and C4 complement fractions, and acute-phase proteins in patients with SLE and lupus nephritis are discussed.
Key words: systemic lupus erythematosus, lupus nephritis, autoantibodies, complement system, acute-phase proteins
Address for correspondence:
Milena Nikolova, M.D., Clinic of Nephrology,
University Hospital Alexandrovska, 1, Sv. G. Sofiiski Str., P. O. Box 45, Bg - 1431 Sofia,
e-mail: milenchenceto@yahoo.com

TROPONINS - NEW BIOCHEMICAL MARKERS IN MYOCARDIAL DAMAGES
Bl. Dishlianova and A. Tsakova
Department of Clinical Laboratory and Clinical Immunology, Medical University - Sofia
Summary: The troponins form а part of the regulatory mechanism of muscle contraction. Specific cardiac isoforms of troponin T and I exist and commercially available immunoassay systems have been developed for their measurement. A large number of clinical and analytical studies confirm, that the measurement of cardiac troponins is now considered the "gold standard" biochemical test for diagnosis of myocardial damage. There have been advances in understanding the structure and functions of troponins and their release following myocardial cell necrosis. Greater clinical use has also highlighted areas of analytical and clinical assay. The assays are reviewed based on manufacturers information, current published material as well as the authors in-house experience.
Key words: myocardial damage, troponin T and I, methods
Address for correspondence:
Ass. Prof. Bl. Dishlianova, M. D.,
Department of Clinical Laboratory and Clinical Immunology, Medical University - Sofia, Bg-1431, 1, Sv. G. Sofiiski Str., phone +359 2 51-66-371, e-mail: dishlian@medfac.acad.bg

EFFECTS OF BETA-BLOCKERS ON NEUROHORMONAL ACTIVATION IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION AND HEART FAILURE
S. Lazarov(1), M. Penev(2), V. Bogdanova(2) and Е. Ianev(1)
(1)Department of Pathophysiology, Medical University - Sofia
(2)Department of Internal Medicine, Medical University - Sofia
Summary: Until recently now it has been assumed that beta-blockers are contraindicated in heart failure (HF). The development of pathology and clinical medicine at the end of 20th century led to a change of this conception. Facts that the application of beta-blockers could be useful in the treatment of HF arose. It was found out that chronic activation of sympathoadrenal system could be fatal in case of HF and leads to a decrease of the survival rate. It was noted that beta-blockers reduce the mortality in patients with HF, preventing the myocardium from the catecho-la-mines, reduce the down-regulation of beta-receptors, prolong the time of diastolic filling and lower the heart rate. They could be very useful in severe HF.
Key words: heart failure, left ventricular dysfunction, neurohormonal activation, catecholamines, beta-blockers
Address for correspondence:
Simeon Lazarov, M.D., Department of Pathophysiology,
Medical University - Sofia, Bg - 1431, 1, Sv. Georgi Sofiiski Str., phone +359 2 951-69-96/318, GSM 098-23-32-32.

THE PLACE OF HYDROCHLOROTHIAZIDE IN THE TREATMENT OF ARTERIAL HYPERTENSION
А. Gоudev
Higher Medical Institute - Pleven
Summary:
Hydrochlorothiazide was introduced 50 years ago for the treatment of arterial hypertension. In large randomized trials, it was proven that treatment of arterial hypertension with hydrochlorothiazide and other thiazide diuretics decreases the risk of stroke, major coronary events, heart and renal failure. Due to their proven efficiency, once a day dosage and low prize thiazide diuretics are recommended as a first line therapy of hypertension.
Key words: hydrochlorothiazide, diuretics, arterial hypertension
Address for correspondence:
Assoc. Prof. Assen Goudev, P. B. 12, Bg - 1431 Sofia, e-mail: goudev@hotmail.com


1'2003

PANNICULITIDES
R. Pantcheva and B. Varbanova
Clinic of Pediatrics, Medical University - Varna
Summary: Panniculitis refers to a specific group of inflammatory diseases within the subcutaneous fat. It reflects a dynamic process that begins predominantly with neutrophils, progresses through lymphocytes and histiocytes and ends with fibrosis (Callen). The exact nature of the infiltrate depends on when the biopsy is taken in relation to the age of the lesion. Definitive diagnosis of different types of panniculitis is extremely difficult because of the similar clinical features, broad categories of causative conditions, fast development of the lesions. Panniculitis could be found in association with connective tissue diseases, as well as with joint disorders, even in non-rheumatic diseases. We present up-to-date opinions about classification, etiology, clinical features, histopathological findings and therapy of panniculitides.
Key words: panniculitis, erythema nodosum, lipoathrophy, Weber-Christian
Address for correspondence:
R. Pantcheva, Department of Pediatrics, Medical University,
Bg - 9000 Varna, 55, Marin Drinov Str.

 


GENETIC ASPECTS OF OVARIAN CANCER
I. Dimova
Department of Medical Genetics, Medical University - Sofia
Summary: Ovarian cancers vary considerably in their biological behaviour that is related to different prognosis and therapeutic answer in the different types. There is evidence that ovarian cancer may be derived from the progressive transformation of benign and/or borderline tumors accumulating genetic alterations in the cells. Mutations in different oncogenes and tumor suppressor genes are involved in the pathogenesis of familial and sporadic ovarian cancer. BRCA-1 and BRCA-2 act as classical tumor suppressor genes in hereditary tumors. Allele losses in 17q in sporadic tumors are often associated with serous types. Mutations in K-ras are specific for mucinous tumors. An important role in tumor progression has been proposed for both c-erbB-2 and p53 but their practical value in prognosis remains questionable.
Key words: ovarian cancer; oncogenes; tumor suppressor genes
Address for correspondence:
Ivanka Dimova, MD, Department of Medical Genetics,
Medical University, 2, Zdrave Str., Bg - 1431 Sofia; e-mail: dr_idimova@mail.bg

 


DIAGNOSTIC RADIOLOGY - RISK VS. BENEFIT
V. Hadjidekova(1) and J. Vassileva(2)
(1)National Centre of Radiobiology and Radiation Protection - Sofia
(2)Shumen University "Episkop Konstantin Preslavsky"
Summary: Diagnostic radiology is the main man-made source of radiation. The radiation exposure of the population due to this factor depends on the number of the diagnostic X-ray-examinations performed and on the dose from each examination. The main problem in diagnostic radiology is to obtain diagnostic images with needed quality at a minimum possible patient dose. Organizational and technical factors that determine the quality of the X-ray diagnostic examination and the patient dose are discussed in the article. The risk of radiation detriment is commented with a special emphasis upon the risk for the embryo and for the foetus. The risk versus benefits in screening, emergency and interventional X-ray examination is also discussed.
Key words: diagnostic radiology, diagnostic doses, radiation risk
Address for correspondence:
Valeria Hadjidekova, MD, PhD; National Center of Radiobiology and Radiation Protection, Bg - 1756 Sofia, + 359 2 62-60-37/326, e-mail: Hadjid@bgnet.bg

 


ТHE PLACE OF ORAL MAGNESIUM PREPARATIONS IN THE TREATMENT OF CARDIOVASCULAR DISEASES
A. Goudev
Higher Medical Institute - Pleven
Summary:
Magnesium has important physiological functions in human body. Data from epidemiological studies suggest a relationship between Mg deficiency and cardiovascular diseases. In some high risk patient groups, like diabetics, patients in intensive care units and treated with diuretics, Mg deficiency was established in more than 50% of the population studied. Treatment with per oral Mg preparations has proven effect in suppression of some ventricular arrhythmias. Data from small control trials have suggested that per oral Mg could improve functional capacity of patients with stable coronary heart disease.
Key words: Magnesium deficiency, per oral magnesium treatment, ventricular arrhythmias
Address for correspondence:
Assoc. prof. Assen Goudev, P. B. 12, Bg - 1431 Sofia, e-mail: goudev@hotmail.com

 

© MEDICAL REVEIW
Medical University
Central Medical Library
1, Sv. G. Sofijski Str., Bg- Sofia 1431
phone 952-05-09, fax 952-23-93
е-mail: iveta_miteva@abv.bg

© MEDICAL REVEIW 2003
Executive secretary, Manuscript Editor and Proofreader I. Miteva, Terminology controlB. Stantcheva, M.D., Web-site support - Dr. Zh. Surcheva
Medical University - Sofia, Central Medical Library

 

To the top

CML Home