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Original papers

Volume 39, 2003



Neuropathy in patients with heroin dependence. Clinical and eleсtromyographic investigations - 39, 2003, ¹ 4, 52-55.
J. J. Petrova
Section of Neurovegetology, Department of Neurology, Alexandrovska University Hospital, Medical University - Sofia
Summary: Heroin (diacetylmorphine) is a synthetic derivative of the morphine produced in 1874. His increasing usage causes different complications, including damages of the nervous system. The mean quantity of heroin usage i.v. is 1.48 g. There was a clinical characteristic made of the patients with heroin dependence. Electromyographic (EMG) investigation was made in all of the patients. The motor and sensory nerve fibers of the extremities were investigated. The EMG investigations and the clinical characteristic show that the changes are more expressed, in the lower extremities. The pathophysiologic profile of the neuropathy shows that the motor and sensory nerve fibers are damages to nearly the same extent with some prevalence of the sensory nerves.
Key words: heroin, abuse, neuropathy, EMG
Address for correspondence: J. J. Petrova, Section of Neurovegetology, Department of Neurology, Alexandrovska University Hospital, Medical University - Sofia, 1, Sv. G. Sofiiski Str., Bg 1431 Sofia

Is tidal breathing analysis (Tpef%Te) useful for detection of airflow obstruction in children? - 39, 2003, ¹ 4, 56-62.
S. Filtchev, A. Kufardjieva, V. Dimov, T. Stoeva and I. Kalev
Clinic of Pediatrics, Chair of Pediatrics, Alexandrovska University Hospital, Medical University - Sofia
Summary:  The aim of the study was to assess the reliability of tidal breathing (TB) parameter such as Tpef%Te (percent ratio of time to reach peak tidal expiratory flow to the total expiratory time) for detecting airway obstruction in children. For TB analysis we used an on-line computer analysis program (Masterscreen, Jaeger). TB and forced expiratory patterns were analysed in 72 healthy controls, 105 asthmatics, and 17 children with cystic fibrosis (CF). The three groups differed significantly in forced expiratory volume in 1 second (FEV1 as percent of predicted: 114.5% in controls; 87.7% in asthmatics, and 67.1% in CF). The Tpef%Te did not differ among the groups: 34.8% in controls; 33.5% in asthmatics; and 34.3% in CF patients. Tpef%Te ratios did not correlate with any of anthropometrical parameters in controls nor with forced expiratory flow values in children with asthma. Twenty eight of asthmatics with severe obstruction underwent measurements before (FEV1 67.0%; Tpef%Te 28.1%) and after bronchodilation with albuterol (FEV1 97.1%; Tpef%Te 33.5%). In contrast to FEV1, for Tpef%Te the differences were not significant. We conclude that TB parameter Tpef%Te is not sensitive enough for detecting airway obstruction in children. It could not be applied to quantify bronchial challenge in particular patients.
Key words: tidal breathing analysis, asthma, children, airway obstruction
Address for correspondence: Clinic of Pediatrics, Alexandrovska University Hospital 1, Sv. G. Sofiiski Str., Bg 1431 Sofia, ) +359 2 923-03-73; fax+359 2 923-06-59; GSM 0887-30-00-74, е-mail:;

Changes in humoral immune response in patients with Henoch-Schoenlein vasculitis - 39, 2003, ¹ 4, 63-67.
K. Nikolov(1), Pl. Jakovliev(2), M. Baleva(3) and N. Dobreva(4)
(1)Clinic of Dermatology and Venereology, Medical Faculty - Sofia
(2)MHAT  Stara Zagora
(3)Clinic of Allergоlogy, Medical Faculty - Sofia
(4)Clinical Centre of Nephrology, Medical Faculty - Sofia
Summary: The concentration of circulating immune complexes (CIC), IgG, IgA, IgM, C3 and C4 complement fraction, anti-nuclear (ANA), anti-neutrophil cytoplasmic (ANCA) and anti-cardiolipin (ACL) antibodies and rheumatoid factor (RF) was investigated in the sera of 31 patients with Henoch-Schonlein vasculitis. The data were compared with those of healthy persons. The levels of CIC, IgA and IgG were elevated. Positive RF, ACL, ANA and ANCA were found in some of the sera. The authors underline the significance of the determination of IgA RF, as well as of ACL and ANCA of IgA class in this disease.
Key words: Henoch-Schoenlein vasculitis, immunoglobulins, ANA, ANCA, anticardiolipin antibodies
Address for correspondence: Prof. Marta Baleva, M. D., Department of Allergology, 1, Sv. G. Sofiiski Str., Bg  1431 Sofia, P. B. 45, e-mail:

Immunosuppression and hemoglobin level after renal transplantation - 39, 2003, ¹ 4, 68-71.
E. Paskalev
Clinic of Nephrology and Transplantation, Alexandrovska University Hospital, Sofia
Summary: Persistent anemia is one of the factors affecting the long-term outcome after transplantation. Many reasons account for its persisting. Immunosuppression is one of them. The goal of the study is to show the effect of immunosuppression on hemoglobin level and its importance for persistent anemia after renal transplantation. Subjects of studying were renal transplant recipients with serum creatinine under 130 micro-mol/l in order to exclude impaired renal function as a confounding factor. We examined 163 patients of mean age 44.5 ± 7.6 years (range 18-65 years). The period after transplantation was 45.5 ± 11.5 months and male:female ratio was 1:1.3. The study excludes patients in the first six months after transplantation and patients with other established causes for anemia. The most commonly used immunosuppressive agents were corticosteroids (CS) 91%, cyclosporin (CYS)86%, and azathioprine (AZA)   61%, followed by mycophenolate mofetil (MMF)36%, and sirolimus (SIR) 3%. We established that patients treated with drug combination MMF/CYS/CS had mean hemoglobin (Hb) concentration 128 g/l, these with combination CYS/AZA/CS had Hb level 135 g/l, with CYS/CS 144 g/l, MMF/CS 132 g/l, CYS/MMF  130 g/l, AZA/CS 137 g/l, and SIR/MMF/CS  132 g/l. We observed lower Hb levels in patients with MMF in their drug combination  MMF/CYS/CS, CYS/MMF, MMF/CS, and a highest Hb in those given the combination CYS/CS. There were significantly lower Hb levels for immunosuppressive regimens including MMF    130.5 ± 2.3 g/l versus 138.6 ± 1.9 g/l for regimen without MMF (p < 0.05). Our study demonstrates that immunosuppressive therapy including MMF may reduce Hb level and in this way may cause persistent anemia after transplantation.
Key words: renal transplantation, immunosuppression, anemia
Address for correspondence: Emil Paskalev, M. D., Clinic of Nephrology and Transplantation, Alexandrovska University Hospital, 1, Sv. G. Sofiiski Str., Bg 1431 Sofia, ) + 359 2 92-30-240, e-mail:

Changes in the fatty acid composition of the alveloar surfactant phospholipids in septic respiratоry distress syndrome caused by experimental fecal peritonitis - 39, 2003, ¹ 4, 72-76.
E. Yanev(1), S. Lazarov(1), G. Hadjinedelchev(2) and A. Momchilova(3)
(1)Department of Pathophysiology, Medical University - Sofia
(2)Department of Anatomy, Medical University - Sofia
(3)Institute of Biophysic, Bulgarian Academy of Sciences
Summary: The Gram-negative sepsis represents a great problem in the clinical practice, affecting more than 1% of hospitalized patients. Usually it is developed on the basis of acute fecal (bacterial) peritonitis. In many patients the Gram-negative sepsis leads to a septic shock followed by respiratory distress syndrome which is developed on the basis of severe injuries of the structure and function of the lung surfactant system respectively of the alveolar surfactant. We studied the total quantity and the percent content of the fatty acid residues in the phospholipids with highest surface activity and the activity of phospholipase A2.
Key words: acute fеcal peritonitis, septic shock syndrome, experimental respiratory distress syndrome, alveolar surfactant, surfactant phospholipids, fatty acid composition
Address for correspondence: Simeon Lazarov, M. D., Department of Pathophysiology, Medical University, 1, Sv. Georgi Sofiiski Str, Bg 1431, ) +359 2 951-69-96/318, GSM 098-23-32-32



Mortality and pathoanatomic data on acute myocardial infarction with and without Q-wave
M. Tzekova(1) and M. Grigorov(2)

(1) Cardiology Clinic, Higher Medical Institute - Pleven
(2)Second Multiprofile Hospital for Active Treatment - Sofia
Summary: Тhe reported proportion of acute myocardial infarction with Q-wave (QWMI) to acute non-Q-wave myocardial infarction (NQWMI) is 3:1. 977 patients with acute myocardial infarction hospitalized in Intensive Care Unit, Cardiology Clinic, Medical University - Pleven during 1992-1996 are followed. In the first group 701 patients with acute QWMI are included. In the second group, there are included 276 patients with NQWMI. 159 (16.3%) patients died during, acute phase of myocardial infarction. The mortality in patients with QWMI is 17.7%, and is significantly higher than in patients with NQWMI (12.7%). The most frequent causes of death in the both groups are cardiogenic shock and heart failure. Three-vessel coronary artery disease is found more frequently in patients with NQWMI.
Key words:
acute myocardial infarction, Q-wave, ST depression, necrosis, cardiogenic shock, heart failure, coronary artery disease
Address for correspondence: Maria Tzekova, M. D., Intensive Care Unit, Cardiology Clinic, Higher Medical Institute, 1, Kl. Ohridski Str., Bg - 5800 Pleven, tel. + 359 64/80-33-88, GSM +359 888-32-18-02, e-mail:

Postoperative spondylodiscitis in patients with lumbar spine disk herniations – with contribution of 5 cases
K. Kostov and Iv. Petrov

Clinic of Neurology, Medical Institute, Ministry of Internal Affairs - Sofia
The authors report on 5 cases of infection discitis that occurred after surgery of disk herniation. The disease started on the average at the 19-th day after the surgery. Acute cutting pain and expressed vertebral syndrome were the clinical manifestations. In all the five cases, the ESR was increased, one of the patients had fever. The diagnosis was confirmed on the average at the 55-th day from the begin of the complains. Treatment consisted of bed rest and antibiotic courses for 7-10 weeks, 4 of which applied parenterally. In one of the patients, the disease reappeared 3 months after an applied 5-week antibiotic course. The symptoms eased on the average at the 20-th day. The patients were permitted to get up at the average on the 33-th day after the beginning of the treatment. The clinical picture, X-ray findings, the treatment and the outcome are discussed.
Key words:
discitis, spondylodiscitis, disk herniation
Address for correspondence: Kosta Kostov, M. D., Clinic of Neurology, Medical Institute, Ministry of Internal Affairs, 79, Skobelev Blvd., Bg - 1606 Sofia, Tel./Fax +359 2 98 27 31 19, GSM 0888 76 49 43

Cytokine profile in women with pre-eclampsia
E. Dimitrakova(1), J. Dimitrakov(2), B. Pechlivanov(1), N. Milchev(1) and D. Terzieva(3)

(1)Chair of Gynecology and Obstetrics
(2)Clinic of Nephrology and Hemodialysis
(3)Central University Clinical Laboratory
Summary: The aim of the present study is to evaluate serum interleukins IL-2, TNF-alpha, IL-6 and IL-10 in pregnant women with pre-eclampsia and in those with normal pregnancy. Blood samples are taken during the IX month of pregnancy in 24 women with pre-eclampsia. ELISA - immunoassociated, immunosorbent analysis has been carried out. The comparison of the results of IL-2 analysis among women with and without pre-eclampsia shows the presence of strongly expressed statistical difference - p < 0.001, which is due to the almost fourfold higher value of IL-2 in women with pre-eclampsia. Data correlation of IL-6 in pregnant women with pre-eclampsia and women with normal pregnancy also shows a statistically significant difference - p < 0.001. It is explained with the over threefold higher value of IL-6 in women with pre-eclampsia. There is no difference in IL-10 and TNF-alpha among the groups of pregnant women with and without pre-eclampsia. In conclusion, the significance of the cytokine profile for the more precise evaluation of the immune status in pregnant women is discussed, which is responsible for the course and outcome of pregnancy.
Key words: pre-eclampsia, interleukins
Address for correspondence: E. Dimitrakova, M. D., Chair of Gynecology and Obstetrics, Medical University, 2, Zdrave Str., Bg - 1431 Sofia

Morphologic featurеs of microangiopathy in early stage of systemic sclerosis and clinically isolated Raynaud's syndrome
S. G. Radenska-Lopovok, Т. А. Nevskaja and N. G. Guseva

Institute of Rheumatology, Russian Academy of Medical Sciences - Moskow
Summary: The aim of the study was to compare histological featurеs of microvascular lesion in early stage of systemic sclerosis (SSc) and clinically isolated Raynaud's phenomenon (RP). Skin biopsy specimens were obtained from 65 patients: 30 - early SSc (including 10 probable SSc), 20 RP and 15 late SSc. Early microvascular damage of SSc consisted mainly of mucoid and edematous intimal lesion, however 23% of the patients showed irreversible changes: sclerosis and reduction of vessels. Prominent histological features in eSSc included perivascular infiltrating monocytes with prevalence of CD4+ T cells and a large number of degranulated mast cells. Perivascular cellular infiltration and expression of intercellular adhesion molecule-1 (lCAM-1) on endothelial cells were strongly associated (c2 = 6,12, p < 0,01) and reflected disease activity. In RP group functional spastic disorders prevailed (c2 = 11,9, p < 0,0005). In some cases of RP we revealed mucoid intimal lesion accompanied by monocyte infiltrating, ICAM-1 expression, increased number of mast cells, ecxess deposition of collagen and serological autoimmune disturbances that allowed to suspect secondary RP. Mucoid intimal lesion, prominent perivascular infiltrates, a large number of degranulated mast cells and ICAM-1 endothelial expression are the main features of vascular damage in the early stage of SSc, prior to the onset of skin fibrosis and probably suitable for the diagnostic use in the patients with clinically isolated RP.
Key words: microangiopathy, early systemic sclerosis, Raynaud's syndrome
Address for correspondence: Stefka Radenska-Lopovok, M. D., Division of Pathology, Institute of Rheumatology, Russian Academy of Medical Sciences, 34A, Kаshirskoe shosse, 115522 Moskow, Russia, е-mail:

Biochemical and biophysical changes of the alveolar surfactant in septic respiratory distress syndrome caused by experimental fecаl peritonitis
E. Yanev(1), S. Lazarov(1), G. Hadjinedelchev(2) and A. Momchilova(3)

(1)Department of Pathological Physiology, Medical University - Sofia
(2)Department of Anatomy, Medical University - Sofia
(3)Institute of Biophysics, Bulgarian Academy of Sciences
Summary: The acute fecаl (bacterial) peritonitis represents a major problem in the clinical practice. It affects more than 1% of hospitalized patients. It leads to a Gram-negative sepsis, resulting in septic shock and multiple organ dysfunction syndrome leading to death in 40-45% of hospitalized patients. It is due to the respiratory distress syndrome (RDS) in adults in more than 90%. RDS developsed because of irreversible structural and functional injuries in the lung surfactant system and mainly in the alveolar surfactant (AS). That is why we investigated the АS of rats in experimental model of sepsis, septic shock syndrome and respiratory distress syndrome. We studied the total quantity and the percent content of the phospholipids in the lung and AS, the lipid transfer proteins, phospholipase A2 and steady-state fluorescent anisotropy.
Key words: acute fecаl peritonitis, sepsis, septic shock syndrome, adult respiratory distress syndrome/experiments, alveolar surfactant, surfactant phospholipids, lipid transfer proteins, phospholipase A2, steady-state fluorescent anisotropy
Address for correspondence: Simeon Lazarov, M. D., Clinic of Pathological Physiology, Medical University, 1, Sv. G. Sofiiski Str., Bg – 1431 Sofia, + 359 2 951-69-96/318, GSM 098-23-32-32



M. Ticholova(1) and Tz. Gancheva(2)
(1)Department of Infectious Diseases and Tropical Medicine, Medical University - Sofia,
(2)Department of Virology, National Center of Contagious and Parasitic Diseases

Summary: The emerging biological terrorism and warfare in the whole world has put humanity in front of unsolved problems of some forgotten in the past infectious diseases. Smallpox (Variola major) is a particularly dangerous biological weapon threat because of its clinical and epidemiological peculiarities Smallpox vaccination is the unique safe and effective means of preventing smallpox. However, in a number of individuals, it can result in untoward effects and adverse reactions. We describe the characteristic features of the major response and the untoward effects and adverse reactions. The medications that may help persons who have certain serious reactions to the vaccine are discussed. The results of adverse reactions observed during the period of mass smallpox immunization in Bulgaria are carried out.
Key words: smallpox, vaccination, adverse reaction, complications
Address for correspondence:
Ass. prof. M. Ticholova, M. D., Department of Infectious Diseases and Tropical Medicine, Medical University, Bg - 1431 Sofia, 17, Acad. Iv. Geshov Str., phone +359 2 952-26-97

E. Kinova and H. Kozhuharov
Clinic of Cardiology, University Hospital "Tzaritza Ioanna" - Sofia
Summary: Objectives: The aim of this study was to determine the utility of myocardial velocities of the mitral annulus by Doppler tissue echocardiography in addition to Doppler indices of mitral flow in diagnosing stages of diastolic dysfunction in acute myocardial infarction.
Methods: Echocardiography was performed in 53 patients with myocardial infarction and 20 normal subjects. Patients were divided into 4 groups with different diastolic function according to the E/A ratio of mitral inflow and the Ea/Aa ratio (early/late diastolic myocardial velocity).
Results: In patients with acute myocardial infarction, early diastolic myocardial velocity Ea and the ratio Ea/Aa were significantly reduced (ð < 0.0001) and the ratio E/Ea was increased (ð < 0.0001). Doppler indices of mitral filling presented a parabolic distribution from normal function to restrictive filling, while myocardial velocity Ea remainåd reduced even in severe diastolic dysfunction.
Conclusions: Diastolic myocardial velocities are useful in defferentiating patients with normal from those with abnormal diastolic function and in addition to Doppler mitral flow indices identify accurately the stages of left ventricular diastolic function in acute myocardial infarction.
Key words: pulsed tissue Doppler imaging, diastolic function, myocardial infarction
Address for correspondence:
Elena Kinova, M. D., Clinic of Cardiology, University Hospital "Tzaritza Ioanna",
8, Bialo more Str. Bg - 1527 Sofia, phone + 359 943-22-97, Fax: 46-73-45, GSM 087-50-48-83

Sv. Torbova, V. Stoianovski, V. Mintcheva, A. Tontcheva, V. Tzanova and I. Gruev
Clinic of Cardiorheumatology, NMTH "Tzar Boris III" - Sofia for the Study Group
Summary: The aim of the open-labeled multi-center study was to assess the efficacy, safety and side effects of monopril in the treatment of mild to moderate hypertension. 393 outpatients - 51.6% female and 48.3% male (mean age 56 years), with mild to moderate hypertension, according to the WHO/ISH (1999) classification, were investigated. The treatment was started with 10 mg monopril once a day. If the target blood pressure was not achieved, at the end of the first month the dose was doubled (20 mg) and hydrochlorothiazide was added at the end of the second month. The efficacy of monopril tends to increase during the treatment period. At the end of the first week 19.6% of the patients had normal blood pressure (< 140/90 mm Hg), at the end of the first month - 37.6%, at the end of the second month - 58.1 %, and at the end of the third month - 71.1%. Side effects were reported in 15 cases (3.8%). The common side effect was cough - 11 patients (2.7%). There was no significant difference in the efficacy and tolerability in the aged over 60 years group. Monopril is a once-a-day ACE inhibitor of a new generation. In 71% of the patients with mild to moderate hypertension, an adequate control of the blood pressure can be achieved with monopril as monotherapy. Monopril has high efficacy and tolerability - the incidence of side effects (especially cough) was lower, compared to other ACE inhibitors. That makes monopril suitable for the treatment of wide range of hypertensive patients.
Key words: hypertension/treatment, ACE inhibitors, Fosinopril, multicenter study
Address for correspondence:
Prof. Svetla Torbova, Clinic of Cardiorheumatology, NMTH "Tzar Boris III",
108, Maria Luiza Blvd., Bg - 1202 Sofia, phone + 359 2 932-21-34

Sv. Balev(1), V. Nenov(2), Sv. Staikova(2) and Â. Varbanova(3)
1)Laboratory of Clinical Immunology, MU - Varna
(2)Clinic of Nephrology and Hemodialysis, MU - Varna
(3)Clinic of Pediatrics, MU - Varna
The course of a series of kidney diseases is characterized by impaired immunity additionally altered during hemodialysis. This study covered 42 patients: 18 with chronic renal failure (CRF) and 24 on periodic hemodialysis (PHD). The immunophenotypic characterization of lymphocytes in peripheral blood expressing antigens CD3, CD4, CD8, CD19, CD16+56, marker of late activated T-lymphocytes - HLA-DR, and adhesion molecules ICAM-1 (CD54) and LFA-1 (CD11a) was investigated with the aim to reveal the changes in the cell immunity. Statistically significant increased expression was established in regard of total T-lymphocytes (80% in PHD, 72% in CRF and 65.8% in controls), the subtypes of T-helpers and T-suppressors and adhesion molecule LFA-1 on T-cells. Decreased percent age of B-lymphocytes, NK-cells and adhesion molecule ICAM-1 on T-lymphocytes was found. A conclusion was drawn that immune response damage in PHD patients resulted mainly from the impaired expression of the adhesion molecules.
Key words: chronic renal failure, hemodialysis, immunophenotyping, adhesion molecules, flow cytometry
Address for correspondence:
Ä-ð Svetlozar Balev, Laboratory of Clinical Immunology,
University Hospital "Sv. Marina", Bg - 9010 Varna, 1, Hr. Smirnenski Str.,
GSM 088/85-08-05, phone + 359 52 30 28 52 (476), e-mail:

M. Markova, S. Hadjieva and V. Stoeva
Chair of Clinical Laboratory and Immunology, University Hospital "Alexandrovska"
Summary: The field of clinical laboratory tests is facing an increase in the number of test items as well as a corresponding diversification due to the demands of medical institutions and improvements in analytical techniques. To respond to this situation, medical institutions have been promoting systematization of their testing procedures. Information exchange among the institutions has likewise expanded with the use of media such as on-line systems and Internet. The increasing number and diversity of the critical care laboratory investigations in the emergency laboratory of the Chair of clinical laboratory made indispensably their systematization. Its designation was: a) to facilitate data processing, b) easier evaluation of individual information bites, c) direct and free approach of the user (laboratory stuff/clinical stuff) to all the information, access and admission, d) control and optimizing activity of the critical care laboratory unit.
Key words: clinical laboratory, critical care laboratory analysis, software
Address for correspondence:
eng. Maria Markova, University Hospital "Alexandrovska",
1, Sv. G. Sofiiski Str., Bg-1431 Sofia, e-mail:


N. Golemanov and V. Dodunekova
Center of Population Studies, Bulgarian Academy of Sciences

Summary: A segment of the results of a comprehensive study on mortality regime of the elderly in Bulgaria during the period 1981-2000 is presented. Important differences between the active age (15-64 years) and the third age (65+ years) are established:

  Active age Third age
Population size Declining Rising
General mortality Rising Stable
Cardiovascular mortality (class VII, ICD-IX)
men Rising Stable
women Rising Stable
Cerebrovascular disease mortality
men Rising Declining
women Rising Declining


However, a sharp rise is found in cerebrovascular mortality of oldest old (90+ years), both in men and women, resulting in female overmortality. The authors explain general differences by cohort effects. According to them, female cere-brovascular overmortality in oldest old is due to social-economic crisis, accompanying the transition to market economy and affecting the most vulnerable subpopulations, i. e. infants and old people.
Key words: elderly, mortality, cerebrovascular disease
Address for correspondence:
Prof. Nikolay Golemanov, PhD., Center for Population Studies,
6, Acad. G. Bontchev Str., Bg - 1113 Sofia, + 359 2 979-30-30, e-mail:

Kr. Nikolov(1), R. Rashkov(2), Zl. Kolarov(2), Zl. Yankova(3), D. Petrova(4),
M. Baleva(5), B. Boianovski(5), Ch. Dikova(6), J. Karagiozova(7) and Pl. Iakovliev(8)
(1)Clinic of Dermatology and Venereology,
(2)Clinic of Rheumatology,
(3)Clinic of Pulmonary Diseases
(4)Department of Internal Diseases Propedeutics,
(5)Clinic of Allergology and Clinical Immunology,
(6)Clinic of Neurology,
(7)Clinic of Gynecology, Medical University - Sofia,
(8)MHAT - St. Zagora
Summary: Sera from 265 patients with different diseases - systemic lupus erythematosus, pulmonary embolism, systemic vasculitides, spontaneous abortions, Sneddon’s syndrome have been investigated for antiphospholipid antibodies. More frequently and with high values anticardiolipin antibodies from IgG, IgA and IgM subclasses have been found in the sera of patients with clinical data for antiphospholipid syndrome. Antibodies to beta-2 glycoprotåin I persist rarely in the sera of these patients, but are also important in the diagnosis of the antiphospholipid syndrome. The significance of the determination of antiphospholipid antibodies in patients with reccurent thromboses has been discussed.
Key words: antiphospholipid antibodies
Address for correspondence:
Krasimir Nikolov, M.D., Department of Dermatology and Venereology,
Medical University - Sofia, Bg - 1431, 1, Sv. G. Sofiiski Str.

S. Filtchev, V. Dimov, L. Raicheva, V. Issaev and I. Kalev
Chair of Pediatrics, University Hospital "Alexandrovska", Medical University - Sofia
Summary: Primary aim of the study was to assess the therapeutic efficacy and the side effects of long term inhalatory treatment with fluticasone propionate (Flixotide™) 200 micrograms b.i.d. in children with asthma aged 1-4 years. Twenty three patients were followed for 12 months: 15 of them treated with fluticasone propionate and 8 treated with antihistamines (control group). Fluticasone treatment significantly decreased the asthma symptoms, the number of exacerbations, and the hospitalization rate compared to the control group. A relative growth velocity reduction was observed in both patient groups without significant differences in growth velocity among fluticasone group (8.55 cm/year) and the control group (7.80 cm/year). In conclusion treatment with inhalatory fluticasone propionate is highly effective for asthma control in children aged 1-4 years. The slight growth velocity retardation is comparable to the negative growth influence of the asthmatic disease itself.
Key words: asthma, children, fluticasone propionatå, growth velocity
Address for correspondence:
Slavi Filtchev, M. D., Chair of Pediatrics, University Hospital "Alexandrovska",
Medical University, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, +359 923-03-73; GSM 087 3000 74

E. Paskalev
Clinic of Nephrology and Transplantation, University Hospital "Alexandrovska" - Sofia
There are many clinical evidences that blockade of the renin-angiotensin-aldosterone system by ACE inhibitors or angiotensin II receptor blockers decreases proteinuria. There are also rising evidences that decreasing proteinuria is associated with improved renal outcome regardless of the underlying disease process. The goal of the study was to determine the importance of eprosartan for the control of hypertension and its influence on proteinuria in renal transplant patients. The study included eleven renal transplant patients with secondary arterial hypertension, based on primary renal disease. Mean age of the patients was 33 +/- 6 years, mean term of the transplantation - 44 +/- 11 months and mean duration of previous dialysis treatment - 3,5 +/- 1 years. Duration of the eprosartan treatment was 5,8 +/- 1,6 months. We followed systolic and diastolic blood pressure, heart rate, body weight, height, body mass index, and mean laboratory parameters of the renal function. We established a stable decrease of blood pressure in all patients - systolic blood pressure decreased by 35 mm Hg, diastolic blood pressure decreased by 15 mm Hg. All patients had systolic blood pressure less than 145 mm Hg and diastolic blood pressure less than 90 mm Hg (p < 0,05). The results concerning the proteinuria were of particular interest. There was a stable decrease of proteinuria in seven patients (63,6%) who had prior to treatment a low level of proteinuria (less than 1 g/24 h) and attained zero level afterwards. Eprosartan mesylate achieved fully control on systolic and diastolic blood pressure as well as a very good effect in low-grade proteinuria.
Key words: kidney transplantation, arterial hypertension, eprosartan mesylate
Àddress for correspondence:
Emil Paskalev, M.D., Clinic of Nephrology and Transplantation,
University Hospital "Alexandrovska", 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia,
+359 2 92-30-240, e-mail:

A. Iotov
II Clinic of Orthopaedic Trauma, "Pirogov" Emergency Hospital
The article presents the current principles of operative treatment of the displaced acetabular fractures. Classifications, modern imaging, indications and contraindications for surgery, common reduction and fixation techniques, postoperative management are all a matter of review. Controversies in the problem are discussed as well. The author’s clinical experience is reported based on 126 patients who were operated and followed up for 1-13 years. There were 101 males and 25 females of an age of 17-64 years. Forty eight fractures were of simple type and 78 - of complex type according to Judet-Letournel classification. The late results were evaluated according to the Merl d’Aubigne-Postel-Matta scale in 107 patients followed up over 1 year after surgery. Excellent results were noted in 53 cases (50%), good - in 34 (32%), fair - in 11 (10%) and poor - in 9 (8%). The ratio excellent/good to fair/poor results was similar in elementary and complex fracture types. The average range of complications was 20.8%. However, just 13.6% of complications, such like jatrogenic nerve lesions, intraarticular screw penetration, heterotopic ossification and infection, were directly related to the surgery. Most of them were caused by technical errors due to insufficient surgical experience at the early stage of the series. Considering its own experience and the review of the literature, the author concludes that the surgical treatment provides favorable results in the majority of the displaced acetabular fractures and should be recommended as a method of choice for these problem injuries.
Key words: fractures of the acetabulum, operative treatment
Address for correspondence:
Ass. Prof. Andrey Iotov, II Clinic of Orthopaedic Trauma,
"Pirogov" Emergency Hospital, 21, Totleben Blvd., Bg - 1606 Sofia

E. Yanev
(1), S. Lazarov(1), M. Balutzov(1), P. Kenarov(2), R. Pancov(3) and A. Momtchilova(4)
(1)Department of Pathologigal Physiology, Medical University - Sofia
(2)University Hospital "Tsaritsa Ioanna"
(3)National Institute of Íealth - Bethesda, USA
(4)Central Biophysik Laboratory, BAN
: Artificial blood, containing perfluorocarbon substances, is a preferable means for complete or partial substitution of the circulating blood in case of a lack of whole blood or erythrocyte mass. It is used for perfusion of organs in acute haemorrhages. Perfluorocarbon particles are excreted and released from the human body through the lungs. Two or three weeks are needed for their complete elimination. There is a possibility for structural and functional injury of the alveolar surfactant (AS). That’s why we investigated the ÀS of rabbits, perfused by artificial perfluorocarbon blood FC-43 Emulsion. We studied the total quantity and the percent content of phospholipids in the AS, the lipid transfer proteins, phospholipase A2, steady-state fluorescent anisotropy, blood pressure, acid-base and blood gase metabolism. No statistically significant alterations have been observed in the investigsted parameters between control and experimental values.
Key words: àlveolar surfactant, artificial perfluorocarbon blood FC-43 Emulsion, surfactant phospholipids, phospholipase A2, steady-state fluorescent anisotropy, lipid transfer proteins
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