CML Home

Original papers

Volume 41, 2005




The focus of tularemia in West Bulgaria - 41, 2005, № 4, 52-56.
K. Marinov
(1), E. Tsvetkova(1), K. Mladenov(1), S. Ivanova(2), N. Korudjiiski(2), V. Kasovski and N. Gotev
(1)Military Medical Academy Sofia
(2)National Diagnostic Research Veterinarian Medical Institute
Summary: Subject of our researches was the tularemia focus, that appeared in 1998 in the west part of Bulgaria, in the Slivnitsa region. A tularemic strain isolated from human was studied in a comparison to F. tularensis strains isolated from natural sources in the focus. Morphologic, cultural and biochemical characteristics of the strain were determined. The human strain was identified as F. tularensis subsp. holarctica. The virulence of the human strain in vivo was assessed by subcutaneous inoculation of experimental animals. High virulence and no differences with other strains investigated were established. The illness was confirmed in 25 people by serological test (significant titre 1:80 – 1:160). 1220 sera obtained from domestic animals were studied for presence of antibodies against F. tularensis. A significant serologic reaction (titre > 1:20) was established in a considerable number of animals (11%). Short sequence tandem repeats were assessed as genetic markers for epidemiological typing by PCR based method.
Key words: F. tularensis, tularemia focus, epidemiological typing
Address for correspondence:
K. Marinov, M.D., Military Medical Academy, 1, Institutska Str., Bg – 1632 Sofia, tel. +359 2 922-64-25, 922-64-78, e-mail:


Clinical implication of initial coagulation status for the outcome of the fibrinolytic therapy in patients with acute myocardial infarction - 41, 2005, № 4,57-59.
J. Uzunangelov
(1) and A. Ruseva(2)
Department of Intensive Cardiology Care, Clinic of Cardiology, University Hospital – Pleven
(2)Central Clinical Laboratory, University Hospital – Pleven
Summary: The final result from the fibrinolytic therapy in patients with acute myocardial infarction with ST elevation (STEMI) depends on the interaction of many factors. Prospective data from 72 patients with fibrinolytic therapy are analyzed in the study. Evaluated are the values of аPTT and fibrinogen at admission to the Department of cardiology before starting the fibrinolytic therapy. Its effectiveness is assessed with help of uninvasive criteria for reperfusion used in TIMI trials: 1. Disappearing of the pain of the patient. 2. Quick normalization of the ST-segment to the izoelectrical line. 3. Early peak value of an enzymatic marker of necrosis in the blood. An excellent result from the fibrinolysis is observed relatively most frequently in patients, by whom the initial levels of аPTT are more than 75 sec and of fibrinogen are below 2 g/l. The observed increased initial values of аPTT in a part of the patients are to be explained with the action of the heparin, which they receive at admission to an intensive care unit. The low levels of fibrinogen may be due to activated fibrinolysis or to existing disturbances in the protein synthesis function of the liver.
Key words: acute myocardial infarction, aPTT, fibrinogen, fibrinolytic therapy
Address for correspondence:
Jordan Uzunangelov, M.D., Clinic of Cardiology, University Hospital, 8A, G. Kochev Str., Bg – 5800 Pleven


Hypertensive hypertrophic cardiomyopathy in adults – Doppler echocardiography response - 41, 2005, № 4, 60-64.
Tzv. Katova
National Heart Hospital – Sofia
The objective of the study was to analyze the Doppler response of the left ventricle (LV) flow in women with hypertensive hypertrophic cardiomyopathy and by pulse mapping to assess the benefit of using the transmission time of E and A waves of LV input and output tract as index of changes in LV compliance. Pulse Doppler mapping shows two velocity peaks of this diastole flow in the spectrogram of LV input and output tract. The first peak is E(1), just after the transmitral E wave and A waves from the mitral spectrogram. Our working hypothesis was that in state of LV hypertrophy (LVH) and hypercontractive LV, the decrease of this interval would be a more reliable index of changes in the LV compliance and probably will correlate with the extent of LV muscle mass and the clinical findings for diastole dysfunction in hypercontractive ventricle during systole. It was found that A – A(1) interval is the longest in the group with concentric LV remodeling (mean 44 +/- 14 ms), followed by the group with eccentric LV remodeling (mean 40 +/- 10 ms) and shortest, but without significant differences compared to the eccentric model (38 +/- 12 ms), in the group with concentric hypertrophy. The results show that the time of transmission of transmitral A wave to the LV output tract is shorter in patients with marked LVH. As the transmission of the E wave is realizing during early diastole, when an active relaxation could still exist, E – E(1) interval could not fully reflect the elasticity of the ventricle. On the contrary, transmission of A wave occurred in late diastole, when the active relaxation has been completed and the transmission time of A wave from the mitral valve to LV output tract (measured as A – A(1) interval) would fully reflect LV late diastole rigidity. Thus A – A(1) interval could be assumed as an additional, logic opportunity for analysis of LV diastole rigidity.
Key words: hypertensive hypertrophic cardiomyopathy, left ventricle hypertrophy, early diastole, active relaxation, late diastole, diastole rigidity, transmission of E and A waves, mitral spectrogram, output tract
Address for correspondence:
Tzvetana Katova, M. D., Krassno selo, bl. 202, entr. 3, app. 25, fl. 1, Bg – 1618 Sofia, tel. +359 2 855 72 68, GSM +359 887 239 441


Contemporary hemorheologic references – a contribution to the common theory of unified pathogenetic mechanism of the cardiovascular diseases - 41, 2005, № 4, 65-71.
S. Stoeff

Department of Physics and Biophysics, Medical University – Sofia
Summary: The subject of the “key” hemorheologic references published during the last decade wins through the blood viscosity and/or its determinants to be accepted as primary risk factors for development of cardiovascular diseases and in the same breath as equivalent annex to the conventional risk factors. The hemorheological theory commits methodological premises for the understanding of the interrelationship between the hemodynamical changes of the blood flow and the blood fluidity. The studies of hemodynamical- and hemorheological alterations as well form generalized notions of unified pathogenetic mechanism in the advancing of cardiovascular diseases and the evolution of atherosclerosis.
Key words: hemorheological parameters, cardiovascular diseases, atherosclerosis
Address for correspondence:
Stilian Stoeff, M. D., Department of Physics and Biophysics, Medical University, 2, Zdrave Str., Bg – 1431 Sofia, е-mail:, tel.  + 359 2 91-72-516


Antiribosomal P antibodies in patients with systemic lupus erythematosus and disorders of the nervous system - 41, 2005, № 4, 72-75.
S. Monov
(1), R. Rashkov(1), T. Argirova(2), D. Monova(3) and L. Popov(4)
(1)Clinic of Rheumatology, Medical University – Sofia
(2)Biological faculty, Sofia University “Sv. Kliment Ohridski” – Sofia
(3)Medical Institute – Ministry of Internal Affairs, Medical University – Sofia
(4)Clinic of Neurology, University HospitalAlexandrovska
Summary: Systemic lupus erythematosus (SLE) is an autoimmune disease with leading impairment of the humoral immunity. The antibodies to the ribosomal P proteins in SLE are described 1985 by K. Elkon and coll. Studies on ribosomes and their components as autoantigens show that the antibodies react to a relatively small part of the numerous ribosomal components – ribonucleic acids and some ribosomal proteins. As autoantigens, ribosomal phosphoproteins of the major subunit are most often found. Study on antiribosomal antibodies in 225 patients with SLE and disorders of the nervous system showed that they are mostly detected in patients with systemic lupus and clinically manifested neuropsychic disorders, the correlation being most expressed in the presence of psychoses.
Key words: systemic lupus erythematosus, neuropsychiatric systemic lupus erythematosus, antiribosomal P antibodies
Address for correspondence: Simeon Monov, M. D., Clinic of Rheumatology, Medical University, 13, Urvitch Str., Bg – 1612 Sofia, tel. +359 2 958-29-27


Expression of low molecular weight stress proteins alpha B-crystallin and Hsp27 in thyroid tumors - 41, 2005, № 4, 76-79.
I. Mineva
(1), M. Stamenova(1) and L. Wagner(2)
(1)Institute of Biology and Immunology of Reproduction, BAS – Sofia
(2)Medical University of Vienna, Austria
: One of the main structural proteins of the vertebrate eye lens is the -crystallin subunit – alpha B-crystallin. It participates in the structure of the eye lens where it takes part in maintaining transparency. It is also a member of the small heat shock protein family. In addition, alpha B-crystallin has been shown to be expressed outside the lens in a number of tissues such as skeletal and cardiac muscle, skin, brain, and kidney, suggesting that it has a general cellular function. Its expression has also been demonstrated to varying extent in numerous epithelial tumors. In this study, we investigated the expression of the small heat shock proteins alpha B-crystallin and Hsp27 in de-differentiated anaplastic thyroid carcinomas (ATC, n = 3) and benign goiters (n = 7) by immunofluorescence analysis. We found marked down-regulation of alpha B-crystallin in all of the tested ATCs when compared with benign tumors. The immunofluorescence data were confirmed by immunoblot analysis. In conclusion, our data point towards a loss of alpha B-crystallin expression in thyroid tumors. Furthermore, the differential expression of alpha B-crystallin and Hsp27 indicates functional differences between both proteins.
words: alpha B-crystallin, Hsp27, thyroid tumors
Address for correspondence: Ivelina Mineva, Institute of Biology and Immunology of Reproduction, BAS, 73 Tzarigradsko shouse Blvd.,  Bg1113 Sofia, tel.  +359 2 870 72 85, e-mail:


Serum zinc in children with high blood pressure - 41, 2005, № 4, 80-83.
M. Angelova
(1), I. Sirakova(2), A. Alexiev(1) and G. Nikoloff(3)
(1)Department of Chemistry and Biochemistry, Physics and Biophysics, Medical University Pleven
(2)Department of Pathological Physiology, Medical UniversitySofia
(3)Department of General Biology and Pathological Physiology, Medical University Pleven
Summary: Zinc is a cofactor for several metalloenzymes and it is a part of large number of metallothioneins. Their role in the body is related with zinc homeostasis and regulation of blood pressure. It has been suggested that low serum zinc of hypertension patients as compared to patients with normal blood pressure correlates with development of arterial hypertension. These suppositions are derived from studies of adult patients. But in children with high blood pressure, serum zinc is not studied. In this study, the spectrophotometric method for determination of zinc in blood serum with chromogen 4-(2-pyridylazo) resorcinol sodium salt (PAR-Na) is used. Content of zinc in blood serum – 9.67 +/- 2.70 mcmol/l(-1) of children (n = 17) with high arterial pressure and serum zinc of a control group (n = 12) of healthy children – 18.28 +/- 2.32 mcmol/l(-1) is determined. The patients are aged from 7 to 16. The differences between zinc concentrations in the investigated groups of children are statistically significant: р < 0.001 (99.99%). The method has good analytical pa­rameters and is high informative. This makes the spectrophotometric method for determination of zinc in blood serum suitable for medico-biological investigations.
Кey words: hypertension, children, serum zinc, determination, spectrophotometric method
Address for correspondence
: Ing. M. Angelova, Department of Chemistry and Biochemistry & Physics and Biophysics, Medical University, 1 Kl. Ohridski Str., Bg – 5800 Pleven, e-mail:


Essential trace elements selenium, chromium and zinc – an addition to the therapy of type 2 diabetes mellitus - 41, 2005, № 4, 84-87.
S. Vladeva(1), D. Terzieva and D. Arabadjiska(2)
Clinic of Endocrinology, (2)Central Clinical Laboratory, Medical University Plovdiv
Summary: The aim of this study was to determine the influence of trace elements selenium, chromium and zinc on glycemic indices in type 2 diabetes mellitus.The research encompassed 96 patients with type 2 diabetes mellitus, divided into groups with bad and very good glycemic control and duration of diabetes mellitus up to and over 5 years. In a course of 60 days, the patients received a daily addition of 50 mcg selenium (n = 31), 30 mcg chromium (n = 34) and 10 mg zinc (n = 32). Serum concentrations of selenium, chromium and zinc were determined by atomic absorption. Prandial glycemia, glycosylated hemoglobin A(1)c and immunoreactive insulin were measured. HOMA-index was estimated also. There were confirmed significantly lower serum concentrations of selenium, chromium and zinc in diabetics. The addition of selenium, chromium and zinc led to a significant reduction of hyperinslinemia. There was a decrease of HOMA-index after taking of selenium.
Key words: diabetes mellitus type 2, selenium, chromium, zinc
Аddress for correspondence: S. Vladeva, M. D., Clinic of Endocrinology, Medical University, 15A V. Aprilov Blvd., Bg – 4002 Plovdiv; e-mail:


Use of Dexofen in patients with gonarthrosis - 41, 2005, № 4, 88-89.
M. Panchovska
(1), L. Sapundzhiev(1), E. Misheva(1), B. Paunova(2) and V. Slavova(3)
Clinic of Rheumatology, Medical University - Plovdiv
(2)III Diagnostic Consultative Center - Bourgas
(3)Clinic of Rheumocardiology, MHAT “Sv. Mina - Plovdiv"
Summary: The effect of Dexofen was evaluated in 33 patients with gonarthrosis and expressed pain syndrome under conditions of an open clinical trial. For a period of 10 days, the patients received 25 mg Dexofen 3 times daily 30 min before meal. There were assessed the pain and the movement capacity of the knee joint prior to treatment and on the 10th day of Dexofen administration. Adverse drug reactions and the general evaluation of the treatment by physicians and patients were analysed. There were registered a significant pain reduction and increased movement capacity in the knee joint as well as a very good tolerance to the drug.
Key words: gonarthrosis, dexofen, therapeutic effect
Address for correspondence:
Assoc. Prof. Maria Panchovska, M.D., Clinic of Rheumatology, Medical University, 15A, V. Aprilov Blvd., Bg 4000 Plovdiv,  tel.  +359 32 60-23-61


Assessment of effectiveness and tolerability of Diroton (Gedeon Richter) in treatment of mild and moderate arterial hypertension - 41, 2005, № 4, 90-95.
V. Shterev, I. Petev, G. Giuzelev and Zh. Kapitanov

Department of Rheumocardiology and Intensive Therapy, Therapeutic Clinic, Military Medical Academy – MHAT – Varna
Summary: RAAS can be considered as a system of feedback, participating in cardio-vascular regulation and homeostasis of liquids and electrolytes. Angiotensin II(AII) is a final product of complex chain of reactions of this system. In the last years, the variety of ACE-inhibitors increased enormously. They improve the clinical outcome in patients with different vascular diseases. This is the reason for recent increase in prescription of ACE inhibitors for hypertension and heart failure. Diroton (Lisinopril) is among the most effective ACE-inhibitors, which have been proved in large scale researches. The aim of the present observation is to verify the effectiveness of Diroton (Gedeon RichterHungary) in treatment of mild and moderate arterial hypertension alone or in combination with thiazide diuretic. One daily dose оf Diroton is 10-20 mg. The observation is open, non randomized, prospective and includes 31 patients.
Key words: arterial hypertension, ACE-inhibitors, Diroton
Address for correspondence:
V. Shterev, M. D., Department of Rheumocardiology and Intensive Therapy, Therapeutic Clinic, Military Medical Academy, MHAT, Bg 9000 Varna, tel. +359 888 71 77 94


Medical care for patients with tumors of the salivary glands - 41, 2005, № 4, 96-99.
R. Kolarov and A. Djorov
Specialized Hospital of Maxillo-Facial Surgery – Sofia
Summary: There is analysed the medical care for 52 patients with various tumors of the salivary glands, hospitalized 2003 at the Specialized Hospital of Maxillo-Facial SurgerySofia. The disease is well known by the medical specialists, who set in time a precise preliminary diagnosis in most cases with a relatively short route in the medical establishments. There are noticed single problems, associated with the place of residence of the patients. Because of lowered responsibility towards their own health, some patients are seeking late medical aid.
Key words: salivary gland tumors, medical care
Address for correspondence
: Rosen Kolarov, M.D., Specialized Hospital of Maxillo-Facial Surgery, 1, Sv. G. Sofiiski Str., Bg – 1431 Sofia




Features of variegate porphyria in Bulgaria - 41, 2005, № 3, 59-65.
P. Atanassova
(1), I. Grozdev(1), A. Trenova(1), A. Ivanova(2) and D. Adjarov(2)
(1)Clinic of Neurology, “Sv. Georgi” University Hospital, Medical University - Plovdiv,
(2)Clinic of Gastroenterology, “Sv. Ivan Rilsky” University Hospital,
Medical University - Sofia
Summary: The highly varied manifestations of variegate porphyria are reminded in detail and its clinical and epidemiologic features are outlined among the 29 Bulgarian patients established so far. A typical for our country clinical case is presented. Variegate porphyria in Bulgaria could be characterized as follows: 1. Photodermatosis, besides significantly expressed, is highly prevalent (96,2%). 2. Neurovisceral manifestations, whose leading symptom is the abdominal pain, are registered in the majority of the patients (59,3%) and 87,5% of the latters have photodermatosis. 3. The frequency of acute porphyric attacks amounts to 40,7%. 4. Most affected persons are females (75,9%). 5. There are two endemic centers and 72,4% of the patients are related to them. “Founder effect” is supposed for both endemic foci. All features of variegate porphyria which are typical for Bulgaria are concentrated in the presented clinical case. It is emphasized that the very late establishing of this disease in our country is due to the lack of diagnostic thinking towards porphyrias.
Key words: variegate porphyria, neurovisceral porphyrias, acute porphyric attack, photodermatosis
Address for correspondence:
Penka Atanassova, M. D., Clinic of Neurology, "Sv. Georgi" University Hospital, Medical University, 15A, V. Aprilov, Blvd., Bg - 4000 Plovdiv, tel. +359 32 62-04-02, 62-32-54, 64-99-39, Fax: +359 32 62-32-54, 64-99-39, e-mail:,


Clinical characteristics and comorbidity in patients with heart failure: results from the heart failure registry of the Prof. Chichovski Cardiology Clinic - 41, 2005, № 3, - 41, 2005, № 3, 66-69.
N. Stancheva(1), S. Tisheva(1), V. Iordanova(1) and A. Goudev(2)
(1)Clinic of Cardiology “Prof. K. Chichovski”, University Hospital - Pleven
Clinic of Cardiology, University Hospital “Tzaritza Ioanna” - Sofia
Summary: The aim of the present study is analysis of clinical characteristics and comorbidity in patients with symptomatic heart failure (HF) III and IV NYHA class. The results are from the heart failure registry of the Prof. Chichovski Cardiology Clinic in the University Hospital of Pleven. All consecutively hospitalized for decompensated HF III and IV NYHA class according to the Framingham criteria patients over a period of 10 months are included. Among the 166 patients 92 (55.4%) are men, 96 (59%) are over 65 years old and 81 (56.2%) have ejection fraction (EF) more than 45%. HF with preserved systolic function prevails in the women’s subgroup (n = 42/65.6%), while amongst the men it is the systolic dysfunction that prevails (n = 42/51.9%). Twenty four of the patients (14.4%) have COPD and 13 of them (54%) are men. 23.8% of the patients have anemia, of which 24.3% are IV NYHA class. Six patients have chronic kidney disease (3.6%). Diabetes mellitus type 2 is present in 39 patients (23.49%), among them 17 (43.5%) are men. Fifty two of the patients (31.3%) have anamnesis for myocardial infarction, among them 32 (61.5%) are men, and 115 (69%) have arterial hypertension, among them 63 (54.8%) are men. Hypotension at hospitalization is present in 18.6% of the patients, of them 54.5 are IV NYHA class. A large part of the patients with decompensated HF have preserved systolic function, and they are more often women. Men are younger, with prevalent systolic dysfunction and myocardial infarction as etiology of the heart failure. Anemia is frequent among patients with HF, especially in those with diabetes, and its frequency increases with the functional class. Diabetes mellitus prevails in patients with HF due to ischemic heart disease, more often after myocardial infarction. It is worth mentioning the high percentage of COPD.
Key words: heart failure, registry, comorbidity
Address for correspondence:
Nadia Stancheva, M. D., Clinic of Cardiology, University Hospital, 8A, G. Kochev Blvd., Bg - 5800 Pleven,tel. +359 64/886-370, GSM: +359 88 7749 946, e-mail:

Ataxic forms of chronic inflammatory demyelinating polyneuropathy - 41, 2005, № 3, 70-74.
I. Petrov, R. Ikonomov and K. Kostov

Medical Institute, Ministry of Internal Affairs – Sofia
Summary: Chronic inflammatory demyelinating polyneuropathy (CIDP) most often progresses with symmetric sensomotoric polyneuropathic syndrome and additional clinical signs such as cerebral nerve lesions, incoordination problems, pyramidal signs are also possible. The ataxic forms of the disease are scarce but are of great interest because of the yet insufficiently clarified genesis of the incoordination signs. The paper presents the evidence in 8 patients meeting the diagnostic criteria of the American Academy of Neurology who had clinical signs of ataxia. The patients were comprehensively clinically examined and additional laboratory methods were applied depending on the individual features of the disease, electrophysiological and biopsy tests were conducted. The clinical finding, besides ataxia, evidenced polyneuropathic syndrome, all patients had motor and reflex disturbances and 7 patients had disturbed superficial and inherent sensory function. Three patients showed pyramidal signs. The otoneurological tests revealed intact vestibular function and stabilography showed an elevated Romberg ratio in 5 patients. MRI tests showed that two patients had demyelination in the CNS too. The electrophysiological findings reported segment demyelination combined in some of the cases with superposed axonal degeneration. The biopsy examination showed demyelination and re-myelination in the biopsies of peripheral nerves and secondary neurogenic changes in the muscles. The study shows that, though more rarely, ataxia is present in the clinical signs of CIDP. This requires comprehensive differential diagnosis for those patients with other ataxic polyneuropathies. The authors support that the pathogenesis of ataxia in case of CIDP is complex; besides disturbed deep sensory function, central genesis is possible due to the engagement of CNS and particularly of the central coordination structures.
Key words: chronic inflammatory demyelinating polyneuropathy, ataxia, ataxic polyneuropathy, incoordination
Address for correspondence:
Rosen Ikonomov, M.D., Neurologic Clinic, Medical Institute, Ministry of Internal Affairs, 79 Skobelev Blvd, Bg – 1606 Sofia, tel. +359 2 982-15-81, e-mail:


Changes in the local immune response in patients with pneumonia - 41, 2005, № 3, 75-77.
K. Nikolov
(1), E. Goshev(2), D. Popov(2) and M. Baleva(3)
(1)Medical University – Varna
(2)Central Clinical Hospital, Ministry of Internal Affairs – Sofia
(3)University Alexandrovska Hospital – Sofia
Summary: Secretory IgA (sIgA) in the saliva of 35 patients with different forms of pneumonia (20 with unilateral pneumonia, 7 with bilateral and 8 with pneumonia and pleuritis) have been investigated. The results have been compared with those of 28 healthy persons. The mean concentration of sIgA in the saliva of the control group was 6,4 +/- 3,18 mg/l, i.e. from 3,22 tо 9,58 mg/l. The mean concentration of sIgA in the saliva of patients was lower 4,098 +/- 3,43 (р < 0,05). At the beginning of the disease, more than one half of the patients had sIgA bellow the lower limit for healthy persons (3,22 mg/l). After 14-21 days, only 15,38% of them had low levels of sIgA. Most frequently decreased IgA levels had patients with bilateral pneumonia or pleuritis. Our data show that sIgA has an important role in the course of the disease in patients with pneumonia.
Key words: secretory IgA, pneumonia
Address for correspondence:
Prof. Marta Baleva, M. D., Department of Allergology and Clinical Immunology, University Alexandrovska Hospital, 1, Sv. G. Sofiiski” Str., PO Box 45, Bg – 1431 Sofia, e-mail:

Evaluation of the atherothrombotic risk in type 2 diabetes mellitus patients by the Doppler sonographic intima-media thickness - 41, 2005, № 3, 78-82.
E. Harangozo
(1), J. Petrova(2) and V. Christov(1)
(1)Clinic of Endocrinology, Hospital “Alexandrovska - Sofia
Clinic of Neurology University, Hospital “Alexandrovska - Sofia
Summary: The aim of this study was the evaluation of the initial alterations in the intima-media thickness (IMT) of the a. carotis wall in twenty-one, type II diabetes mellitus patients with less than 5 years diabetes duration, and concomitant arterial hypertension. The study included 15 men and 6 women aged 53.79 +/- 3.96 years, with a mean duration of diabetes 2.79 +/- 1.55 years and a history of arterial hypertension for 11.61 +/- 9.62 years. The study was conducted bilaterally with an ATL (Phillips) ultrasound following a standard procedure. We also performed laboratory and anthropometric analyses. The t-test analysis could not detect any difference between the both sides. On the left side, the mean value of the IMT was 9.68 +/- 3.037, on the right side - 10.31+/- 4.07 (inter-site p = 0.591). We found no correlation between both sides (p = 0.086). Left side IMT values correlated with HDL-cholesterol (p = 0.033). Right side IMT values correlated with the duration of hypertension in years (p = 0.033), with the glycated HbA1c value (p = 0.027) and with the waist circumference (p = 0.028). From 21 examined patients, in 4 we detected IMT of a. carotis > 1,1 mm bilaterally. Unilaterally thickened wall was measured on the left in 2 patients, and on the right in 4 patients. The alterations in the IMT of a. carotis show that patients suffering from type 2 diabetes have parallel changes in the HDL-cholesterol, HbA1c, waist circumference and the duration of hypertension. We concluded that the alterations in the arteraial wall are an early precursor of atherogenesis and the atherothrombotic process.
Key words: type 2 diabetes mellitus, hypertension, macroangiopathy, carotid intima-media thickness
Аddress for correspondence:
Edit Harangozo, M. D., Clinic of Endocrinology, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel. +359 2 923-02-27, e-mail:

Treatment of acute renal failure and exogenous intoxications with renal replacement methods – data of a university clinic - 41, 2005, № 3, 83-88.
V. Todorov, B. Borisov, M. Yankova, B. Dimitrova, D. Dosev and R. Boneva
Clinic of Nephrology and Dialysis, University Hospital - Pleven
Summary: Subject of this retrospective study were 462 patients – 270 males (58,4%) and 192 females (41,6%). The average age of the patients was 44,2 +/- 19,0 years. The most common causes, requiring emergency treatment by extracorporeal blood depuration method, were: severe exogenous intoxication – 191 patients (41,3%); acute renal failure (ARF) - 174 patients (37,7%); obstructive uropathy - 65 patients (14%); exacerbated chronic renal failure - 32 patients (7%). 1462 renal replacement therapeutical procedures were done: hemodialysis – 1206 (82,5%); hemodiaperfusion - 249 (17%); hemofiltration - 7 (0,5%). Temporary vascular access was used only via catheter to: v. femoralis - 401 patients (86,8%); v. subclavia - 47 patients (10,2%); v. jugularis - 14 patients (3%). The overall mortality was 27%, and the etiologic distribution was: 44% - in the ARF group, 17% - in the group with intoxications. Males were distinctly more in the ARF group - 128 (74%), while females predominated in the exogenous intoxication group - 115 (60%) (р < 0,05). The patients suffering from ARF (average age 48,4 +/- 16,4 years) were older than the patients with intoxications (average age 34,0 +/- 18,5 years) (р < 0,05). The most frequent causes for development of ARF were surgery treatment, leptospirosis, and sepsis. The causes of intoxications were mainly drugs, phosphororganic chemicals, and mushrooms. The average period of dialysis treatment of patients with ARF was 8,5 +/- 11,9 days, whereas this period in patients with severe intoxications was 1,2 +/- 0,5 days (р < 0,001).
Key words: hemodialysis, acute renal failure, exogenous intoxication, obstructive uropathy
Address for correspondence:
Assoc. Prof. Vasil Todorov, M. D., Clinic of Nephrology and Dialysis, University Hospital, Medical University, 8AG. KochevStr., Bg - 5800 Pleven, tel. +359 887 421 968, е-mail:

Wear and aseptic loosening of total hip arthroplasty - 41, 2005, № 3, 89-93.
P. Kinov
(1), А. Gegova(2), D. Bukarev(1), V. Dimov(1) and P. Tivchev(1)
(1)Clinic of Orthopedics and Traumatology, University Hospital “Tzaritza Ioanna” – Sofia
(2)Section of Pathology, University Hospital “Tzaritza Ioanna” – Sofia
Summary: The aim of this prospective study is to illustrate the process of aseptic loosening and to establish correlation between wear debris and cellular reaction in periprosthetic tissues and osteolysis. Periprosthetic tissues from 20 consecutive revisions performed for aseptic loosening were investigated prospectively. The mean age of the 13 females and 7 males was 63.8 years (range, 39 to 83 years). The mean period from implantation of the primary prosthesis was 108 months (range, 13 to 168 months). Specimens were stained with hematoxilin-eosine, metal reaction of Perles, PAS reaction and after Mallory. Evaluation of wear debris and cellular reaction in periprosthetic tissues was performed semiquantitatively according to the method of Mirra et al. Large amounts of metal and polyethylene debris and a nonspecific chronic inflammatory reaction were established. Macrophages, giant cells, fibroblasts, endothelial cells and rare lymphocytes were observed in osteolytic lesions. Statistically significant correlation between amount of macrophages and polyethylene debris was established < 0.05). The amount of giant cells and wear debris correlated statistically significant < 0.05). Osteolysis correlated significantly with amount of giant cells (р < 0.05). Conclusion: Giant cells and macrophages with ingested wear debris may play a role in stimulation of osteoclasts resorbing bone.
Key words: wear, aseptic loosening, osteolysis, macrophages, giant cells
Address for correspondence:
Plamen Kinov, M. D., Clinic of Orthopedics and Traumatology, University Hospital "Tzaritza Ioanna", 8, Bialo more, Str., Bg - 1527 Sofia, tel. +359 2 943-23-12, fax: + 359 2 943-21-22, е-mail:

Possibility for prothrombin time measurement in capillary blood - 41, 2005, № 3, 94-96.
A. Ruseva, V. Ivanov and V. Petkova

Central Clinical Laboratory, University Hospital - Pleven
Summary: The prothrombin time (PT) is usually measured in citrated plasma from venous blood. The specification of the doses and the obligatory regular control of the patients, taking oral anticoagulants, require multiple venepuncture. A procedure for taking peripheral blood to determine PT and a program for automatic coagulometer are worked out. The analytic reproducibility of the method in the normal and pathological range is assessed. The values obtained by both methods are compared, r = 0.934. The lack of statistically significant difference in INR on changing of the hematocrit is proved. The influence of the proportion blood-citrate on the INR-values is assessed.
Key words: protrombin time, capillary blood, INR
Address for correspondence: Adelaida Ruseva, M. D. Central Clinical Laboratory, University Hospital, 8-A, G. Kotchev Str., Bg – 5800 Pleven, e-mail:


Original papers: history of medicine

Professor Dr. Stoyan Kirkovich (1875–1960): a memorable classic of Bulgarian internal medicine - 41, 2005, № 3, 110-115.
D. N. Paskalev(1) and A. B. Kirchevа(2)
(1)Clinic of Nephrology and Dialysis, University Hospital “Sv. Marina” - Varna
(2)Department of Epidemiology, MHAT “Sv. Anna” - Varna
Summary: Prof. Dr. Stoyan Kirkovich was a remarkable Bulgarian physician and scientist in the field of internal medicine as well as one of the founders of the Medical Faculty (1918) in Sofia. He was born in Sofia in 1875 in the family of Dr. Kirko Kirkovich, who served as the first Bulgarian physician in the same town before the emancipation of the country from Ottoman servitude (1878). In 1900, St. Kirkovich graduated medicine at the University of Vienna (Austria), where he later (1904-1906) obtained a speciality in internal diseases under the guidance of the famous Prof. E. Neusser. After his return home he was appointed as intern in the ward of internal medicine situated in the hospital “Alexandrovska” in Sofia. In 1920, Kirkovich was elected Associate Professor (since 1927, Professor) and served as the first director of the Chair of internal propedeutics until his retirement (1947). During his scientific career, Prof. Kirkovich wrote some of the first Bulgarian medical textbooks in the field of internal medicine. His greatest achievement was the “Propedeutics of Internal Diseases published in 1931, which had seven editions (last edition in 1954). The book has been recognized as one of the classical works in the Bulgarian medical literature.
Key words: Prof. Kirkovich, propedeutics, internal medicine, history
Address for correspondence:
Assoc. Prof. Dobrin N. Paskalev, M.D., Clinic of Nephrology and Dialysis, University Hospital “Sv. Marina”, Medical University, 55, Marin Drinov Str., Bg – 9002 Varna, tel.: +359 52 302-951, е-mail:




Clinical significance of early thrombolysis for the outcome in patients with acute ST-elevation myocardial infarction - 41, 2005, № 2, 62-68.
J. Uzunangelov (1), V. Pentchev (1) and Ml. Grigorov (2)
(1)Clinic of Cardiology,
UMHAT – Pleven
(2)Clinic of Cardiology, II MHAT – Sofia
Summary: The goal of our report was to analyse the data on the patients with acute ST elevation myocardial infarction treated with thrombolytic therapy who were divided into two groups. In the first one, the patients received this treatment up to the second hour from the oncet of the infarction (53) and in the second one – between the 4th and 6th hour (54). The research period was three years - from 2001 to 2003. We analysed the following indices – inhospital mortality, the efficacy of the lytic therapy, the postinfarction status of ventricular function measured by the ejection fraction of the left ventricle, the frequency of the thrombolytic complications and the frequency of reinfarction and recurrent ischemic events after thrombolysis. We found a statistically significant difference regarding the inhospital mortality between two groups – 0 vs 11,1%. The same statistical difference was found when we analysed the data about the efficacy of the thrombolytic treatment. A positive result was found in 68% of the patients in the first group and in 37% in the second one. No result after the lytic therapy was detected in 7,5% of the first group patients and in 20,4% in the second one. Reinfarction after thrombolytic therapy was found in 3,77% of the first group patients and in 11,1% of the patients in the second group. Statistically significant difference was found in the frequency of the reperfusion arrhythmias in both groups 32,1% vs 12,9%. No statistical differences were detected among the other analysed indices. We concluded that the most important reason for the possibly earliest opening of the occluded coronary vessel by the thrombolytic treatment in the patients with STEMI is to save as much as possible jeopardized but still vital myocardiocytes in the infarction area, that brings better prognosis in the future for these patients.
Key words: acute ST elevation myocardial infarction, early thrombolysis, inhospital mortality
Address for correspondence: J. Uzunangelov, M. D., Clinic of Cardiology, UMHAT, 8A, G. Kotchev Str., Bg 5800 Pleven


Tube thoracostomy for treatment of complicated postpnеumonic effusions - 41, 2005, № 2, 69-72.
I. Novakov
Department of Thoraco-Abdominal Surgery,
Medical University Plovdiv
According to the scientific data, in 36% to 75% of cases with bacterial pneumonia, pleural effusion is reported. In spite of the treatment of pneumonia, effusion persisted and loculated in some patients, andcomplicated postpneumonial pleural effusion developed. The aim of the article is to prove the effectivеness and relatively low traumatism of tube thoracostomy as a surgical treatment of postpneumonic pleural effusion. A selected group of 11 patients with accompanied diseases, older than 45, is included. Success was obtained in 9 of 11 (82%) cases with parietal loculations. The conclusion is that tube thoracostomy is effective in treatment of parietal loculations in patients, selected by CT and sonography.
Key words: pneumonia, pleural loculation, tube thoracostomy
Address for correspondence:
Ivan Novakov, M. D., Department of Thoracoabdominal Surgery, Medical University, 54, Petrova niva Str., Bg 4004 Plovdiv, e-mail:


Changes in coagulation in patients with acute ulcerative colitis - 41, 2005, № 2, 73-76.
D. Nikolovska, N. Doncheva and M. Petrova
Medical Institute – Ministry of the Internal Affairs Sofia
Summary: Patients suffering from inflammatory bowel disease are predisposed to thromboembolism complications. Large intestine bleeding is innate to ulcerative colitis but alterations of the coagulation are still vague. With routine coagulation tests and inhibitor measuring (antithrombin III and protein C) we aimed at investigating coagulation cascade alterations in 35 patients with active ulcerative colitis. We explored clotting time, platelets count, prothrombin time, activated partial thromboplastin time, factor V, fibrinogen, fibrin degradation products, antithrombin III activity, fibrinogen, protein C. There were found the average values of fibrinogen, protein C pathologically deviated of normal. Only protein C was significantly reduced (p < 0.01) probably because of the accompanying liver disorders. Coagulation test disturbances (88.5%), which were explored most likely play role in the pathogenesis of bowel hemorrhages in ulcerative colitis. Searching for any changes in inhibitors of coagulation as early and sensitive indices (assessment of protein C, AT ІІІ and fibrinogen) could contribute to discovery of thrombosis and bleeding tendency in patients with ulcerative colitis, as well as to a better clinical assessment of the disease progress.
Key words: ulcerative colitis, coagulation, antithrombin III, protein C, fibrinogen
Address for correspondence:
Nadejda Doncheva, M. D., Department of Clinical Lipidology, Medical Institute – Ministry of the Internal Affairs, 79A, Skobelev Blvd., Bg1606 Sofia, tel. +359 2 98-214-416, e-mail:


Continuous thoracic epidural analgesia with Fentanyl and Lidocain versus Tramal and Lidocain for post-operative pain control after elective thoracic surgery - 41, 2005, № 2, 77-82.
P. Petrov, P. Terzinacheva, E. Manolov, S. Alexov, Tz. Minchev, R. Petkov and D. Petrov
University Hospital for Pulmonary Diseases “Sv. Sofia ”Sofia
Summary: This prospective clinical trial was conducted with 135 patients scheduled for elective thoracotomy. They were divided into two groups аt random, group A 66 patients received Fentаnyl 5 mcg/ml + Lidocain 1% and Adrenalin 5 mcg/ml, and group B 69 patients received Tramal4 mg/ml + Lidocain 1% and Adrenalin5 mcg/ml for continuous post-operative thoracic epidural analgesia. The adequacy of analgesia was assessed in the condition of rest and during respiratory effort using visual analogue scale on hour 4, 6, 24 and every 24 hours. Additive analgesia demand was also assessed. Pain scores were higher in Tramal group patients in conditions of both rest and movement. They demanded more additive analgesia. There were no hemodynamical and respiratory differences between the groups. We conclude that Tramal-Lidocain combination in these doses provides less effective analgesia after thoracotomy than Fentanyl-Lidocain combination, using continuous epidural infusion.
Key words: thoracic surgery, post-operative pain control, thoracic epidural analgesia, Fentanyl, Lidocain, Tramal
Address for correspondence:
P. Petrov, M. D., Specialized Hospital of Maxillo-Facial Surgery, 1, Sv. G. Sofiiski Str., Bg 1431 Sofia


Cause-consequence-dependences between serum cytokines and some clinical, immunologic and angiogenic parameters in pre-eclampsia - 41, 2005, № 2, 83-86.
E. Dimitrakova(1), N. Miltchev(1), B. Kuzmanov (1) and D. Dimitrakov (2)
(1) Department of Gynecology and Obstetrics, Medical University – Plovdiv
(2) Department of Internal Diseases, Medical University Plovdiv
Summary: The aim of the study was to investigate cause-consequence-dependences between serum cytokines and some clinical, immunologic and angiogenic parameters in 30 pregnant women with pre-eclampsia. Laser flowcytometry and ELISA were used. Analysis of these dependences showed synergic effects between some clinical, immunologic and angiogenic features with serum cytokines IL-1, IL-6, IL-10, TNF-
a, and antagonistic effects between another. This confirms the difficult pathogenesis of pre-eclamptic syndrome.
Key words: pre-eclampsia, cytokines, lymphocytic population, angiogenic proteins
Address for correspondence: E. Dimitrakova, M. D., Chair of Gynecology and Obstetrics, Medical University,
15А, V. Aprilov Blvd., Bg 4002 Plovdiv

Diagnostic approach to patients with acute myocardial infarction, treated at University HospitalSv. Anna” – Sofia for the period 1996-2003 - 41, 2005, № 2, 87-94.
T. Taseva and Ch. Nachev

Internal Diseases Clinic, University Hospital “Sv. Anna” – Sofia
We present a retrospective analysis of the hospital treatment of 987 patients, residents of the Sofia district, discharged with diagnosis of acute miocardial infarction (AMI) from University Hospital “Sv. Anna” – Sofia for the period 1996-2003. We have analysed the diagnostic approach, clinical presentation, therapeutic behaviour, rehabilitation, hospital lethality, stratification of the risk and treatment, prescribed at discharge. There are discussed the factors, having influence on the implementation of these hospital stay elements. We have compared the results for the period 1996-2000 on the one hand, and 2001-2003 on the other, as the latter coincides with the onset of the Health System Reform. We propose solutions for the optimization of the hospital-treatment stage of therapeutical care in acute myocardial infarction.
Key words: acute myocardial infarction, diagnostic approach, chest pain, ECG, enzyme diagnostics, echocardiography, optimization
Address for correspondence:
Tatiana Taseva, M. D., Internal Diseases Clinic, University Hospital “Sv. Anna”, 1, Al. Mollov Str., Bg1756 Sofia, GSM +359 888-97-33-05
, е-mail: drtaseva@


Isolation and purification of human alpha-fetoprotein from human fetal material - 41, 2005, № 2, 95-99.
D. Tz. Zanev (1), H. B. Divanyan (1), B. Tz. Galunska (2), D. Kovachev (1) and S. Stoyanov (1)
(1) Department of Medical Physics, Chemistry and Biology, (2) Department of Preclinical, Clinical Pharmacology and Biochemistry, Medical University Varna
Summary: Alpha
-fetoprotein (aF) was isolated and purified from abortion material (6-10-th gestation week), using three-step purification procedure. Affinity chromatography on Affi Gel Blue, followed by second affinity chromatography on Con-A Sepharose and preparative isofocusing were performed. The protein content of the purified aF was 1,12 mg 87% of the total protein content. The highest levels of aF were detected at pH 4,86 and pH 5,24. The purity of the isolated aF was checked using analytical isofocusing and electrobloting. It is not necessary to perform immunoaffinity chromatography, requiring a sufficient quantity of antibody coupled to CNBr-Sepharose 4B for the purification of aF by the described procedure. The purity of the produced aF was about 87,1%. In conclusion, the purity and the quantity of the produced aF allow its usage as antigen for immunoaffinity chromatography procedures and as diagnostic tool.
Key words: alpha-fetoprotein, affinity chromatography, Affi Gel Blue, Con-A Sepharose, preparative and analytical isofocusing
Address for correspondence:
Bistra Galunska
, M. D., Department of Preclinical, Clinical Pharmacology and Biochemistry, Medical University, 55, Marin Drinov Blvd., Bg 9002 Varna, tel. + 359 52/60-67-86/251,


Characteristics of the welder’s pneumoconiosis - 41, 2005, № 2, 100-107.
E. Petrova
Chair of Occupational Diseases, Medical University Sofia
Summary: The aim was analyze the clinical, radiological, functional deviations, lung complications as well as the role of the harmful factors with a view to perform more clear diagnostic criteria for the welders’ pneumoconiosis (WP). A cross-sectional study of 45 workers exposed to electric welding, suffering from WP with average age 66.16 +/- 8.15 yrs., and average exposure length 20.27 +/- 7.79 yrs. was performed. The relative share of the tobacco smokers in the group was 77.3%, and the share of the patients, who have used high quantity of alcohol, was 76.2%. The clinical examination consisted of interview about subjective symptoms and previous diseases as well as physical examination. The ventilatory respiratory parameters, gases in arterial blood, as well as alkaline acid parameters, conventional chest posterior-anterior radiographies, according to ILO’80 were performed. 41 (91.1%) patients with WP had subjective respiratory symptoms (cough with/without expectoration as well as with/without breathlessness). The patients with WP, accompanied by respiratory symptoms (4191.1%) and positive physical respiratory phenomena (34 рts.75.6%) predominated. A chronic bronchitis with physical phenomena of rails was established in 35 (77.8%) patients with WP. There was a significant correlation between accompanying chronic bronchitis with physical phenomena in 31 (88.6%) patients with WP (R = 0.567; Р < 0.0001). The average duration of the occupational exposure was longer (25.19 yrs.) in the cases with positive physical phenomena in patients with WP. The shorter average exposure (16.23 yrs.) was related with the lack of physical phenomena in the patients (Р < 0.05). The average period of electric welding was longer (23.90 yrs.) in patients with WP, accompanied by chronic bronchitis in comparison with the average duration of exposure (19.85 yrs.) in cases of WP without accompanying bronchitis (Р = 0.396). The mixed respiratory ventilatory insufficiency predominated (14 pts.31.1%), followed by obstructive respiratory insufficiency (11 pts.24.4%), as well as restrictive respiratory insufficiency (7 pts.15.6%), and small airway obstruction (6 pts.13.3%). The respiratory ventilatory impairments were not significantly related with the duration of average occupation exposure. The restrictive respiratory defect predominated (571.4%), followed by obstructive (11 pts.100.0%), as well as mixed respiratory insufficiency (9 pts.69.2%) in tobacco smokers with WP; there was a light significant correlation (R = 0.386; Р < 0.01). There were X-ray chest findings of small round irregular s/t opacities of category of 0/1 up to category 1/2 in 7 (15.6%) patients, and s/t irregular opacities of category 2/1 up to 3/3+ in 36 (80.0%) patients, u irregulary opacities with predominating category of u 2/1 in 26 (57.8%) patients, enlarged hilus shadows – in 45 pts. (100.0%), phenomenon of the type “honey comb” – in 30 pts. (66.6%), bullous emphysema – in 28 (62.2%), emphysema – in 38 (84.4%), mediastinal and tracheal distortion – in 41 (91.1%), changed heart configuration – in 42 (93.3%), Plin 23 pts. (51.1%). The X-ray pulmonary findings were established more frequently in patients with WP with average duration of a work environment exposure 21.06 years.
Key words
: welder’s pneumoconiosis, diagnostics, chest X-ray findings, functional respiratory impairments
Address for correspondence: Assoc. Prof. Elisaveta Petrova, M. D., Clinic of Occupational Diseases, University HospitalSv. Iv. Rilski”, 15, Acad. Ivan Geshov Blvd., Bg 1431 Sofia, tel. +359 58-12-809, GSM 0887-79-43-77,




Non flowand slow flow phenomena in rotational atherectomy with percutaneous coronary intervention – 41, 2005, No 1, 60-62.
Vl. Grigorov
Hospital “Glynwood” – Johannesburg, SAR
Summary: The phenomena non flow” (“without blood flow”) and slow flow” (“retarded blood flow”) occur in rotational atherectomy (RA) with percutaneous coronary intervention (PCI). There are data about their relation to macro- and microvascular vasoconstriction.Slow flow is a more frequent phenomenon in RA with PCI, less dangerous, and also easier treatable. This phenomenon was observed by the author in 13 patients (25,49%) from a total of 54 coronary atherectomies, and in all cases it was overcome with intracoronary application of adenosine and nitrates, without lasting consequences for the patients.
Key words: rotational coronary atherectomy, percutaneous coronary intervention, non flowand slow flow phenomena, vasoconstriction, adenosine, nitrates
Address for correspondence: Vl. Grigorov, M. D., Hospital “Glynwood” – Johannesburg, SAR,


Our experience with Uro-Vaxom in patients with chronic pyelonephritis – 41, 2005, No 1, 63-66.
K. Ikonomova, P. Peshev and B. Miteva

National Transport Hospital “Tzar Boris III” - Sofia
Summary: The treatment of chronic pyelonephritis has become increasingly difficult since emergence of antibiotic resistance strains of organisms. In our study, the therapeutic value of Uro-Vaxom - an activator of immune defence mechanisms was explored in patients with pyelonephritis. We tested 25 patients with clinically and laboratory proven chronic pyelonephritis. Bacteriuria, leukocyturia, and proteinuria were examined. Sera compounds - urea, creatinine, uric acid, total protein and albumin were tested. Immunologic indices - IgG, IgA, IgM, C3 and C4 complement fractions and CRP were explored. Patients were treated for 3 months with 1 capsule of Uro-Vaxom daily. Four patients were given antibiotics for treatment of the initial acute episodes. Other patients received Uro-Vaxom as monotherapy. Laboratory parameters were tested at the begining of the examination, at the end of the first month and at the end of the third month. We found a significant reduction of bacteriuria and leukocyturia at the end of the first month. At at the begining of the treatment, in more than a half of the patients C3 complement fraction and CRP were elevated above the reference ranges. At the end of the treatment, a significant reduction of both inflammatory indexes were found. We consider that the application of Uro-Vaxom is an effective therapeutic tool for the patients with chronic pyelonephritis.
Key words: chronic pyelonephritis, immunotherapy, Uro-Vaxom
Address for correspondence: K. Ikonomova, M. D., National Transport Hospital “Tzar Boris III”, 108, Maria Luiza Blvd., Bg - 1202 Sofia


Cyclosporine A microemulsion - possibilities of effect on steroid-resistant nephrotic syndrome  – 41, 2005, No 1, 67-70.
E. Paskalev, P. Simeonov, M. Gitcheva, M. Vretenarska, M. Dimitrov, B. Zlatkov, M. Ortova, R. Markovska, Zh. Filipov and D. Genov

Clinic of Nephrology and Kidney Transplantation, University Hospital “Alexandrovska” - Sofia
Summary: Cyclosporin A (CA) is emerging as a potentially promising agent in the therapy of primary nephrоtic syndrome, particularly in steroid-resistant patients and in patients who have severe side effects from prolonged or recurrent glucocorticoid therapy and who fail to satisfactorily respond to cyclophosphamide or for some other reason cannot be treated with alkylating agents. The goal of the study is to show the effect from therapy of steroid-resistant primary nephrotic syndrome with cyclosporine A microemulsionSandimmun Neoral. We studied 15 patients with biopsy proven primary nephrоtic syndrome, primary crescentic glomerulonephritis, lupus-nephropathy. We performed a course of therapy (9,8 +/- 4 monthsfrom 3 to 37) with cyclosporine A microemulsionSandimmun Neoral 2,45 mg twice daily under continuous monitoring of blood levels (102 +/- 5,3 mcg/l). We achieved a total remission in 73,3% of all patients. The change of proteinuria was from 11,2 g/24 h to 1,2 g/24 h (p < 0,0001) and the change of serum albumin was from 18,4 g/l to 34,2 g/l (p < 0,001). Our results show that CA is a promising therapy of nephrotic syndro­me when other agents are not enough efficient or are contraindicated.
Key words: nephrotic syndrome, treatment, cyclosporin A
Address for correspondence: Ass. Prof. Emil Paskalev, M. D., Clinic of Nephrology and Transplantation, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, tel. +359 2 923-02-40, e-mail:


Changes in acid-base status and blood gases in acute intoxications with psychoactive drugs   41, 2005, No 1, 71-73.
J. Radenkova-Saeva and S. Todorova

Department of Clinical Pathophysiology, Clinic of Toxicology, MHATEM “N. I. Pirogov” - Sofia
Summary: The authors present the results of a study of the changes in acid-base status and blood gases in a group of patients with acute intoxication with psychoactive drugs. The aim of the study was to assess the respiratory and metabolic disorders in patients with acute heroin and mixed intoxication. The study included 42 patients (37 men and 5 women, mean age 21,85 +/- 4,59 years), treated in the Clinic of Toxicology at MHATEM “N. I. Pirogov”. The patients were divided into 2 groups: І - 11 patients with acute heroin intoxication and ІІ - 31 patients with acute mixed intoxication. The investigation of the acid-base status and blood gases was performed with apparatus Stat Profile M – NOVA – USA in the Department of Clinical Pathophysiology, MHATEM “N. I. Pirogov”. The results revealed acidosis in both groups. In the І group, the acidosis was of mixed type, in the ІІ group - of metabolic type. In the І group, there was evidence of hypoventilation and hypercapnia in 6 patients (54,5%). The maximal value of РаCO2 was 71,4 mm Hg and the mean value - 49,13 mm Hg. In the ІІ group, the mean value of РаО2 was 37,4 mm Hg. In 3 patients (9,7%), hypoventilation and hypercapnia were found. The results confirmed the significance of determining the acid-base status and the blood gases in assessment of respiratory and metabolic disorders, severity of the intoxication and in the adequate treatment.
Key words: acid-base status, blood gases, heroin, intoxication
Address for correspondence: Julia
Radenkova-Saeva, M. D., Department of Hemotransfusion and Immunogenetics, Clinic of Toxicology, MHATEM "N. I. Pirogov", 21, Totleben Blvd., Bg - 1606 Sofia, tel. +359 2 91-54-346,


Platelet activation markers and antiphospholipid antibodies in women with pregnancy complications  – 41, 2005, No 1, 74-78.
E. Vikentieva, D. Popova, A. Savov, M. Nikolova, K. Nikolov, A. Mladenova, K. Todorova, M. Baleva and J. Karagiozova

Medical University - Sofia
Summary: Spontaneous abortions are often due to thromboembolic complications. Hypercoagulation etiology includes acquired alterations, such as antibodies to phospholipids (APA), platelet activation and genetic defects related to proteins C and S, antithrombin III, coagulation factor V, prothrombin gene etc. The present study involved 19 women with complicated pregnancy - 15 with history of spontaneous abortions, 2 – of pre-eclampsia and 4 reported a fetal loss. Their results were compared to those of 9 healthy women without pregnancy problems. IgG and IgM antibodies to cardiolipin (ACL) and b2-glycoprotein I (b2-GPI) were measured by ELISA. aPTT, protein C and antithrombin III were read by spectrophotometry. Increased CD62P and CD63 expression and drop of CD42a provided evidence of platelet activation, revealed with flow cytometry. In most of the patients, PCR was used to detect genetic mutations for factor V (Leiden) and prothrombin (G20210A), related to venous thrombosis. Increased levels of IgG APA were found in women with pregnancy complications, compared to control subjects. It is worth pointing the increase of b2-GPI in 2 out of 4 patients reporting a fetal loss. In vitro platelet activation did not show differences between the groups under investigation. However, in women with pregnancy complications, platelet activation antigens were found significantly increased, compared to controls. A moderate correlation was noticed between IgG ACL and expression of the activation antigen CD63, related to platelet degranulation. Our results indicate that a search for alterations in both plasmatic and platelet section of coagulation is justified. Learning more about thеse defects is a prerequisite for adequate treatment in view of a successful next pregnancy.
Key words: antiphospholipid antibodies, flow cytometry, platelets, pregnancy, spontaneous abortions
Address for correspondence: Elena Vikentieva, M. D., Clinic of Allergology and Clinical Immunology, Medical University, 1, Sv. G. Sofiyski Str., Bg – 1431 Sofia, tel. +359 2 923-07-00, +359 2 923-05-43, e-mail:


Diagnostic opportunities of combined nuclear-medical methods for investigation of ventilation and perfusion in some respiratory diseases in children  – 41, 2005, No 1, 79-83.
Y. Palashev
(1) and P. Minchev(2)
(1)Department of Nuclear Medicine, University Hospital “Sv. Iv. Rilski” - Sofia
(2)University Clinic for Lung Disorders in Children, University Hospital ”Sv. Sofia” - Sofia
Summary: The methods of nuclear medicine for investigating the respiratory system take a special part in child’s respiratory diseases. The authors admitted a method of perfusion inhalator scintigraphy of lungs in 123 children suffering from: asthma, chronic pneumonia, hypoplasia of the lungs, cysts and tumors of the lungs. The obtained results give a reason to conclude that the nuclear-medical methods have a high informative value for diagnosis of children with different pulmonary disorders.
Key words: radionuclide, 99mTc, perfusion, ventilation, MRI
Address for correspondence: Yordan Palashev, M. D., Department of Nuclear Medicine, Universal Hospital "Sv. Iv. Rilski" - Sofia, tel. + 359 2 851-08-19
Assoc. prof. Petko Minchev, M. D., University Clinic for Lung Disorders in Children, University Hospital "Sv. Sofia” - Sofia, tel. +359 2 857-03-93


Еvaluation of intima-media thickness in patients with HIV infection. Preliminary results  – 41, 2005, No 1, 84-86.
J. J. Petrova
(1) and I. Staikov(2)
(1)Clinic of Neurology, University Hospital “Alexandrovska” - Sofia
(2)Clinic of Neurology, University Hospital “Tzaritsa Ioanna” - Sofia
Summary: The neurological complications in HIV affect both the peripheral and the central nervous system. They are expressed by global cerebral dysfunction, dementia, mycotic and bacterial meningoencephalitis, progressive multifocal leucoencephalopathy, primary lymphoma, secondary infections. The cerebrovascular symptoms are discussed in the literature. The majority of authors agree that the thickening of the vessel wall is an early sign of atherosclerosis. Some infections may cause atherosclerosis. The aim of the investigation was to evaluate the thickness of the intima-media (IMT) of the carotid arteries in patients with newly found AIDS. Eighteen healty subjects, 10 male and 8 female, aged 20-58 (mean 38) were investigated. The patients with AIDS were diagnosed according to the requirements of Center of Disease Control. Five untreated patients were investigated, 3 male and 2 female, aged 29-34 years (mean 31.5). Our investigation showed that there was an early thickening in the wall of the internal carotid arteries in the patients with AIDS. This is an early stage of the atherosclerotic process. Probably this is one of the patogenetic mechanisms of development of ischemic stroke.
Key words: intima-media thickness, HIV, ultrasound, atherosclerosis
Address for correspondence: J. J. Petrova, M. D., Department of Neurology, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia


Influence of some exogenous factors on X-ray findings in initial and advanced forms of pneumoconiosis   – 41, 2005, No 1, 87-94.
Е. Petrova

Chair of Occupational Diseases, University Hospital “Sv. Iv. Rilsky - Sofia
Summary: The aim of the study was to analyse the influence of different factors on the appearance of the р small round, and s, t and u irregular opacities as well as on the x-ray findings in border, and initial forms of silicosis, in cases with asbestosis, and in cases with mixed pneumoconiosis caused by quartz and asbestos containing dust. A nestled case control study of the р small round opacities on the posterior-anterior conventional radiography in patients with pneumoconioses (silicosis and mixed pneumoconiosis due to quartz containing dust) was done. The X-rays have been accounted according to ILO’80. The subject of the study were 600 dust exposed underground workers and led-zinc ore mines, and workers, exposed to asbestos containing dust in the period after 1985 up to 2003. 480 (80.0%) were underground miners, 120 (20.0%) were workers, exposed to asbestos containing dust. A referent group was consisted of 121 individuals, non-exposed to dust. All 721 workers and referent group have worked during the last two decades up to July 15 2003. The average age of the investigated workers was 41.38 years, and the workers exposed to asbestos containing dust had an average age of 45.57 years. The average age of the referents was 42.33 years. The average dust exposure in all miners varied from 10.95 years up to 12.59 years, and the average dust exposure for asbestos exposed workers was 16.52 years. An anamnesis, physical examination of the respiratory tract, posterior-anterior chest radiography accounted by ILO’80, and spirometry, including VC, FEV1, FVC, FEF25, FEF50%, FEF75%, PEF, and FEV1/VC were done. A statistical analysis was performed by the software statistical package SPSS that included nonparametric crosstabulation and variation analysis. There was found a significant tendency of an appearance of the p0/1, p1/0, p1/1 in pneumoconiotic patients with quartz dust exposure of 11 or more years of the dust exposure. The average duration of quartz exposure, related with the appearance of p0/1 small round opacities was 12.42 years. The similar was the tendency concerning relation between s, t and u small irregular opacities and length of the dust exposure. There was a statistical correlation between s and t irregular opacities and the exposure length (Pearson's R = 0.458; Р < 0.0001). There were a minimum number and relative share of s and t irregular opacities in no exposed individuals of the referent group. Synergistic effects of tobacco smoking and alcohol consumption on the one site, and the dust exposure length – on the other site, have played an important role in formation of the interstitial pulmonary fibrosis, which was the base of the chest x-ray findings of s, t, u irregular opacities, as well as of the p small round opacities in the lung parenchyma.
Key words: pneumoconiosis, p, s, t, u small opacities, dust, alcohol, smoking
Address for correspondence:
Assoc. Prof. Elisaveta Petrova, M. D., Clinic of Occupational Diseases, University Hospital “Sv. Iv. Rilski”, 15, Acad. Ivan Geshov Blvd., Bg - 1431 Sofia, tel. +359 58-12-809, GSM 0887-79-43-77,


Immunomodulating potentialities in different models of experimental immunosuppression – 41, 2005, No 1, 95-98.
L. Hadjiiski (1), P. Petrunov(1), A. Galev (1) , R. Marcova (2) and B. Giosheva (3)
(1)Military Medical Academy, (2)NZPB, (3)ELBI - Bulgaricum
Summary: The immunomodulating abilities of the immunomodulator diethyldithiocarbamate and different combinations of Lactobacillus Bulgaricus in experimental models under conditions of low-dose radiation or cyclophosphamide have been demonstrated. The results of our researches show that lactic acid products recover the functional activity of T-lymphocytes. It was established that diethyldithiocarbamate stimulated T-lymphocyte activity after low-dose radiation (0.35 Gy), but suppressed B-lymphocyte activity. The results presented here are grounds for the need of additional investigations and application of similar preparations in cellular immunodeficiencies.
Key words: immunomodulation, radioprotection, diethyldithiocarbamatе, Lactobacilus Bulgaricus
Address for correspondence: Plamen Petrunov, M. D., Department of Radiobiology and Radiation Protection, Military Medical Academy, 3, Sv. G. Sofiiski Str., Bg - 1606 Sofia, tel. +359 922-64-74, е-mail:

Medical University
Central Medical Library
1, Sv. G. Sofijski Str., Bg- Sofia 1431
phone 952-05-09, fax 952-23-93

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