hypertension – diagnostic and therapeutic challenge
- 41, 2005, № 4, 5-11.
Department of Pulmonology, Medical University – Plovdiv
In the first
half of the XX century, the published reports on primary pulmonary
hypertension (PPH) were confined to clinical pathological correlations.
In 1950s, the physiological epidemiologic studies emerged triggered
by an epidemic of PPH, due to the ingestion of an appetite suppressant,
аminorex fumarate. Progress in the understanding of PPH
catalysed the classification of all pulmonary hypertensive diseases.
The etiologic basis of the classification enhances the prospects for a unified approach to diagnosis
words: primary pulmonary hypertension, secondary
pulmonary hypertension, clinical pathological correlations, classification
Address for correspondence: Assoc. Prof. Zl.
Iankova, M. D., Department of Pulmonology, Medical University, 66, Peshtersko
shose Str., Bg – 4004 Plovdiv, е-mail: zl_yankova @mail.bg
Neoplasms in patients with
renal transplantation - 41, 2005, № 4, 12-15.
Clinic of Nephrology and Transplantation, University Hospital "Alexandrovska"
Summary: Renal transplant
recipients need immunosuppressive therapy. The long-term use of immunosuppressive
agents increases the risk of neoplasms in
patients after renal transplantation. The types of cancers encountered
in transplant recipients are different from those found in normal
population, with a higher frequency of squamous cell carcinomas of the skin, non-Hodgkin
lymphomas, in situ carcinomas of the uterine cervix, hepatobiliary carcinomas, and variety of sarcomas. The frequency
of tumors in the transplant population is 100 times higher than that
in general population, and the frequency of tumors seen commonly
in the general population – lung, breast, prostate, colon, does not
increase and may in fact be even lower after transplantation. If all cancers are
considered, the average time of their appearance is 61 months after
transplantation. The most common post-transplant cancers are those of the skin and lips, with
a frequency of 37%. Of the skin cancers, squamous
cell carcinomas are more common than basal cell carcinomas, whereas
the reverse is true in the general population. Next to cancers of
the skin, lymphoproliferative disorders are among the most serious and
potentially fatal, accounting for 21% of all malignant neoplasms
in this population. The other neoplasms
like hepatobiliary carcinomas, in situ carcinomas of the uterine
cervix, and a variety of sarcomas have lower frequency than those
of skin and lymphomas. The goal of the review is to show the importance
of neoplasms in renal transplant patients.
words: renal transplantation, immunosuppression, neoplasms
Address for correspondence: Assoc. 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: email@example.com
Q-fever - basic clinical features- 41, 2005, № 4, 16-21.
M. Tiholova and A. Goceva
Department of Infectious Diseases and Tropical Medicine,
Medical University - Sofia
Summary: Q-fever is a zoonosis
caused by Coxiella burnetii. It has been reported from all continents. It occurs in epidemic
or sporadic forms. The infection in humans is variable in its clinical
manifestation, in its severity and its natural course – acute or chronic.
As an acute disease, it can be manifested as fever, pneumonia, hepatitis,
cardiac involvement, meningitis or encephalitis. In some patients,
acute infection can lead to chronic infection, and in pregnancy, stillbirth
or prematurity can be the result. Endocarditis
may occur in patients with valve lesions or cancer. Because of the
wide spectrum of clinical manifestations, the non specific nature
of symptoms and the ignorance of the disease, the diagnosis is
usually late and the patients are treated unproperly.
This poses the necessity to summarize and to
present the clinical symptoms of the still not wellknown disease.
Key words: Q-fever, Coxiella
Address for correspondence: Assoc. Prof. M. Ticholova,
M. D., Department of Infectious Diseases and Tropical Medicine, Medical
University, Bg – 1431 Sofia, 17, Acad. Iv.
Geshov Str., tel. +359 2 952-26-97,
renin-angiotensin system in blood
pressure regulation and pathogenesis of experimental arterial hypertension - 41, 2005, № 4, 22-28.
Department of Pathophysiology and General Biology, Medical University – Pleven
Summary: The local brain
renin-angiotensin system (RAS) exists independently
of classical circulatory RAS. The brain RAS components have been identified
in brain neurons and glial cells by different
methods of biochemistry, histochemistry
and molecular biology. The brain RAS plays
an important role in short- and long-term blood pressure regulation
increasing sympathetic activity, blunting baroreflex sensitivity, stimulating pituitary hormone secretion,
as well as water and salt intake. Experimental results show that angiotensin and its metabolites are important brain peptidergic mediators in different animal models of hypertension:
spontaneous hypertension in rats (SHR), chronic phase of one-clip, two-kidney hypertension, DOCA-salt hypertension,
and transgenic models of hypertension. New trends in antihypertensive
therapy under experimental and clinical conditions will be derived
from our undеrstanding of the brain RAS
dysfunction in hypertension.
Key words: brain renin-angiotensin,
blood pressure, arterial hypertension
Address for correspondence: Emilia Lakova,
M.D., Ph.D., Medical University, 1, Kl. Ochridski Str.,
Bg – 5800 Pleven, tel. + 359 64 884 252, e-mail: firstname.lastname@example.org
GABA and modulators of GABA-mediated neurotransmission - 41, 2005, № 4,29-33.
R. Nikolov and
Department of Pharmacology, Medical University – Sofia
of gamma-aminobutyric acid (GABA) as an
inhibitory neurotransmitter, as well as the discovering of a highly
selective process of GABA-reuptake and cloning of specific GABA-ergic receptors can be characterized as a big progress in
the pharmacology of GABA. In the present review, there are described
the modern conceptions about GABA synthesis and activation of specific
GABA-ergic receptors, as well as neuronal and glial reuptake mechanisms and GABA metabolism. The contemporary
view of main GABA-ergic receptors (GABA(А),
GABA(В) and GABA(С)) is presented, as well as of drugs and other pharmacologically
active agents, modulating GABA-ergic neurotransmission.
Key words: gamma-aminobutyric
acid, GABA(А) receptors, GABA(В) receptors, GABA(С) receptors
Address for correspondence: Rumen Nikolov, M. D., Department
of Pharmacology, Medical University, 2, Zdrave
– 1431 Sofia, tel. +359 2 91-72-622, e-mail: email@example.com
resistance in metabolic syndrome and methods for its measurement - 41, 2005, № 4, 34-40.
M. Petkova, N. Petrova
and S. Ganeva
Clinic of Endocrinology, University Hospital – Pleven
Summary: In recent years, a new clinical syndrome
has been described, that is a major concern of serious clinical researches.
It features a cluster of clinical disorders, which are interdependent.
It is considered that the insulin resistance is the cause of all the
components of the syndrome. This syndrome has been given many names,
but its most populare name is the insulin
resistance syndrome. This name is justified by the idea that insulin
resistance is the major common denominator of the abnormalities involved
in the syndrome. The importance of insulin resistance is connected
with its role as risk factor for development of glucose intolerance,
cardiovascular morbidity and mortality. The early recognition and
treatment of insulin resistance seems to have investigational and
clinical relevance in screening and prevention subjects at high risk
of type 2 diabetes mellitus and cardiovascular disease. Therefore,
measurement of insulin resistance is important for identifying of
the affected individuals. This article summarizes some of the moleculare
mechanisms of insulin resistance and some of the most useful techniques
for assessing insulin resistance. It makes a review of the use of
HOMA-model and comparison with other well validated methods. HOMA
has the advantage of requiring only a single sample assayed for insulin
or glucose. The HOMA-model is validated as a rapid, accurate and low-cost
method, which can be used in large epidemiological studies.
Key words: metabolic syndrome, insulin
resistance, quantitative estimation
Address for correspondence: Natalia Petrova, M. D., Clinic of Endocrinology,
University Hospital, 8A,
G. Kochev Str., Bg
– 5800 Pleven,
tel. +359 64 886 642, +359 887 553856, e-mail:
views on the surgical treatment of serous otitis media in childhood - 41, 2005, № 4, - 41, 2005, № 4, 41-43.
Department of Otorhinolaringology, Medical University – Plovdiv
media with effusion is defined as the presence of fluid in the middle
ear without symptoms of acute ear infection. In most children and
especially following an episode of acute otitis
media, otitis media with effusion will resolve
for 2 or 3 months. Hearing loss is usually mild, but may impair cognitive
and language function in children and result in disturbances in psychosocial
Key words: otitis media with effusion, children, surgery
Address for correspondence: Dilyana Vicheva, M. D.,
Department of Otorhinolaringology, Medical University, 81A, Il.
Bg – 4000 Plovdiv, e-mail: firstname.lastname@example.org
surgery – helping surgical interventions and mandibular reconstructions - 41, 2005, № 4, 44-51.
Department of Oral and Maxillofacial Surgery, Faculty
of Stomatology, Medical University – Sofia
Summary: The paper presents the most used auxiliary
surgical interventions (extractions, frenulotomies,
germectomies, uncovering and moving of teeth,
reductional plastics of the tongue, compactosteotomies)
of the complex treatment of dento-maxillo-facial
anomalies and deformations. The correct indications help for more
effective, faster and stable result. Presented are segmental
reconstructions of the body and ramus mandibulae, and the temporo-mandibular joint,
and the mentoplasty. The basic indications
of their use are shown. The methods are characterized on the base
of literature data and own surgical experience of the author.
Key words: orthognatic
surgery, mandibular reconstructions,
Address for correspondence: Anton Djorov,
D. D., Department of Oral and Maxillofacial surgery, Faculty of Stomatology,
Medical University, 1, Sv. G. Sofiiski
Str., Bg – 1431 Sofia, tel. +359 2 9625579, +359 2 8684365, e-mail: email@example.com
Primary insomnia - 41, 2005, № 3, 5-9
I. Staikov and E. Vavrek
Department of Neurology, University Hospital “Tzaritza
Ioanna” – Sofia
Summary: Insomnia is a frequent health problem, which
afflicts about one third of the population. Women and elderly people
have higher prevalence. Insomnia is usually a symptom of a somatic
or psychic disease. The group of primary insomnia merges disorders
without another sickness – psychophysiological
insomnia, idiopathic insomnia, sleep state misperception. The diagnosis
of insomnia includes history, examination and polysomnography.
Patients with psychophysiological insomnia
demonstrate true sleep difficulties. Excessive worries about not being
able to fall asleep maintain the insomnia. Usually an external stress
event is necessary to start insomnia. It is characterized by increasing
the sleep latency and sleep is more difficult in regular setting.
The patients with idiopathic insomnia have organic hyperarousal.
The sleep disturbances like increased sleep latency, disturbed sleep
activity, increased frequency and duration of awakenings are accompanied
by daily symptoms. Subjective complaints of persistent insomnia are
typical for sleep state misperception when there is a lack of objective
polysomnographic data for sleep disturbance.
The treatment of primary insomnia consists of behavioral therapy,
sleep hygiene and medical treatment, which is strongly individualized
in idiopathic insomnia.
Key words: primary insomnia, psychophysiological insomnia, idiopathic insomnia
Address for correspondence: Ivan Staikov,
M. D., Neurology Clinic, University Hospital “Tzaritza
Ioanna”, 8, Bialo more Str., Bg - 1527 Sofia,
tel. +359 2 943-25-71, е-mail: firstname.lastname@example.org
in asthma epidemiology: expenditure of health resources and impairment
of quality of life life - 41, 2005,
№ 3, 10-18.
Clinic of Allergology, University Hospital
“Alexandrovska” – Sofia
Summary: In spite of all efforts that have been exerted
to develop, promote and stick to different international guidelines
for diagnosis, differential diagnosis and treatment of bronchial asthma,
the trends in its epidemiology are permanently negative. The increase
in disease’s mortality and morbidity as well as in the level of utilization
of health resources is more than clear. Bronchial asthma nowadays
is an illness with great social and economic impact on patients’ and
their families’ quality of life through the impairment it causes.
The author reviews recently published data on the use of health care
resources for asthma treatment.
Key words: asthma, epidemiology, health resources,
quality of life
Address for correspondence: George Christoff, M. D., Clinic of Allergology, University
Bg - 1431 Sofia, 1, “Sv.
Str., e-mail: email@example.com
trauma - 41, 2005, № 3, 19-22.
Department of Otorhinolaryngology, Medical
University – Plovdiv
Summary: The diagnosis of nasal trauma begins in
various settings, because the population of patients and injuries
involved are diverse. Rhinologists may have
initial contact with patient who has sustained nasal injuries in the
outpatient setting, the emergency room, or the operating room. To
diagnose nasal trauma accurately in each of these settings, the history,
examination, and ancillary investigations should be performed scrupulously.
Key words: nasal trauma, diagnosis
Address for correspondence: Dilyana
Vicheva, M. D., Department of Otorhinolaryngology, Medical University, 81A,
Il. Makariopolski Str., Bg - 4000 Plovdiv, e-mail: firstname.lastname@example.org
features of renal transplantation in childhood - 41, 2005, №
K. Kirov and E. Jordanov
Clinic of General and Operative Surgery, University Hospital “Sv. Marina” – Varna
Summary: Every year 1 of 65 000 children in USA develops end stage
renal failure (ESRF). Till 1955 this disease was incurable. Thanks
to progress in surgical techniques and immunosuppression,
death rate in children due to ESRF has dramatically decreased. Approximately
1 of 4 children with ESRF is hospitalized for transplantation because
of urologic abnormalities. Renal transplantation has become a method
of choice in the treatment of ESRF in children population. Because
of lack of cadaver organs, a score system for a just distribution
of kidneys was developed. Urological complications are the most frequent
surgical complications after transplantation. In the past, 70% of
transplant patients have developed infection. The incidence of infections
now is decreased to 15-44.1%, and the mortality caused by infections
is less than 5%.
Кey words: transplantation, donors,
recipients, immunosuppression, children, surgery,
Address for correspondence: K. Kirov,
M. D., Clinic of General and Operative Surgery, University Hospital
1, Hr. Smirnenski Str., Bg - 9010 Varna
of obesity in renal transplant patients - 41, 2005, № 3, 31-35.
Clinic of Nephrology and Transplantation, University
Summary: Renal transplantation is currently considered
the treatment of choice for most patients with end-stage renal failure.
Survival of renal allograft is limited by many factors. Based on previous
studies and local data and experience, some centers currently consider
obesity as a significant risk factor for renal transplantation. The
goal of this review is to make a survey of current literature regarding
the relationship between obesity and outcome of renal transplant patients.
Data were analyzed with regard to patient morbidity, mortality, graft
survival, acute rejection, delayed graft function, and many complications.
We established that obesity is important risk factor significantly
associated with higher mortality, reduced allograft survival and higher
frequency of perioperative complications. Obesity and extremely increase
of body weight following transplantation are significant causes of
diabetes and cardiac complications. Reductions of body weight by 5-10%
in a period of at least six months may reduce the risk related to
renal transplantation in obese patients with end-stage renal failure.
Key words: renal transplantation, risk factors,
Address for correspondence: Assoc. 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: email@example.com
agents - a new therapeutic approach to rheumatoid
arthritis - 41, 2005, № 3, 36-44.
A. Tontcheva(1) and D. Ianeva(2)
(1)Clinic of Cardiology and Rheumatology, NMTH “Tzar Boris III” - Sofia
(2)University Hospital "Sv. Anna" - Sofia
Summary: Rheumatoid arthritis
(RA) is a chronic progressive inflammatory disease of multifactorial
etiology. The proinflammatory cytokines
have a pivotal role in the pathogenesis and perpetuation of rheumatoid
synovitis. Biological agents are monoclonal antibodies or
recombinant forms of natural inhibitory molecules, which selectively
interact with molecules or cell receptors affecting immune or inflammatory
processes. In RA, etanercept, infliximab
and adalimumab are shown to suppress tumour necrosis factor and interleukin-1 receptor antagonist
inhibits IL-1 activity. Trials have shown benefits as monotherapy, although the best results for disease control
are seen when biological agents are coadministered
with methotrexate. The use of these agents
in clinical trials and in practice has resulted in dramatic improvements
in RA disease control, and in delay and prevention of radiographic
damage. The adverse effect profile is evolving and includes, for anti-TNF
therapy, an increased risk of infections associated with immune suppression,
injection and infusion reactions, and a risk of drug induced autoimmune
syndromes such as systemic lupus erythematosus.
Where these drugs are affordable, the prognosis of individuals for
control of severe RA is better than ever before.
Key words: rheumatoid arthritis, new
treatment, biological agents
Address for correspondence: Assoc. Prof. Antoaneta
Tontcheva, M.D., Clinic of Cardiology and
Rheumatology, NMTH “Tzar Boris III”, 108
Maria-Luiza Blvd., Bg – 1202 Sofia
treatment of prolactinomas
– 41, 2005, № 3, 45-48.
T. Shumkova and N. Boyadjieva
Department of Pharmacology and Toxicology, Medical University – Sofia
Summary: Prolactinoma is
the most frequent benign and hormone-secreting tumor of the pituitary
gland occuring in women and men. It represents
about 40% of the pituitary tumors and the etiology of these tumors
is still unknown. The article summarizes basic characteristics of
prolactinomas and pharmacological drugs causing hyperprolactinemia. Presented are drugs for medical treatment
of prolactinomas that are an appropriate
first-line treatment for both micro- and macroprolactinomas.
Key words: prolactinoma,
treatment, dopamine agonists
Address for correspondence: Teodora
Shumkova, Department of Pharmacology and Toxicology, Medical
University, 2 Zdrave Str.,
Bg – 1431 Sofia, tel. +359 887-34-92-68,
disorders of the esophagus - 41, 2005, № 3, 49-54.
M. Kirkova and S. Janev
Institute of Physiology, Bulgarian Academy of Science – Sofia
the organism, alendronate disintegrates
to alendronic acid that has tissue-damaging
activity. At delayed empting of the esophagus and release of alendronic acid in it, its mucosa could be injured, leading
to esophagitis, ulcerations, strictures,
and even perforations. In Bulgaria, 2 tablet forms, containing 10 mg alendronate,
are registered: Fosamax (Merck) and
Lindron (Krka). The results from the performed analysis showed that the tablets Lindron (Krka) are disintegrated 7.6 fold faster.
The faster disintegration of these tablets in patients with prolonged
esophageal transit is the reason for the increased risk of esophageal
injury. The prolonged esophageal transit is occurring rather frequently
in senile patients with esophageal motor dysfunctions and/or other
Key words: biphosphonates,
Address for correspondence:
S. Janev, 23, Acad. G.
Bonchev, Str., Bg - 1113 Sofia, tel.
+359 2 979-21-07
oxide, reactive nitrogen species and nitroxidergic processes - clinical application - 41, 2005, №
S. Lazarov (1), Е. Ianev(1) and M. Penev(2)
(1) Department of Pathological
Physiology, Medical University - Sofia
(2) Department of Propedeutics of Internal Diseases,
Medical University - Sofia
Summary: Nitric oxide (NO) represents
a very important inter- and intracellular signal molecule. It is a
neurotransmitter and local mediator which is produced by almost all
cells in the human organism. NO and its species, called “reactive
nitrogen species” (RNS), take part in the regulation of the function
of certain tissues and organs. They are important mediators in the
pathogenesis of different pathologic processes and diseases. Pharmacological
modulation of NO and RNS production and biological effects take a
very important place in the modern therapy.
Key words: nitric oxide, reactive nitrogen
species, nitric oxide synthase, nitroxidergic processes, pharmacological modulation
Address for correspondence: Simeon Lazarov,
M. D., Department of Pathological Physiology, Medical University,
1, Sv. G. Sofiiski Str., Bg - 1431 Sofia,
tel.+359 2 952-04-61
diagnosis of chronic inflammatory demyelinating
polyneuropathy - 41, 2005, № 2, 5-9.
I. Petrov, K. Kostov and
Clinic of Neurology, Medical Institute, Ministry of Internal Affairs Sofia
Summary: Chronic inflammatory demyelinating polyneuropathy (CIDP)
is an acquired demyelinating disease of
the peripheral nervous system with unclear etiology and autoimmune
pathogenesis. Its clinical course covers slow development of proximal-distal
polyneuropathic syndrome with sensory and motor disorders,
electrophysiological and morphological evidence for segment demyelination
and axonal degeneration. The diagnosis is defined on the basis of
complex clinical, electrophysiological, liquor and biopsy criteria.
The disease is relatively well affected after administration of corticosteroids,
intravenous immunoglobulin or plasmapheresis.
The differential diagnosis (DD) requires the distinction of idiopathic
CIDP (I-CIDP) from CIDP syndrome occurring together with some joint
diseases and other polyneuropathies. CIDP is found in patients with diabetes
mellitus, non-malignant monoclonal gamopathy,
hepatitis C, Sjogren’s syndrome, inflammatory
bone diseases, HIV-infection. When discussing CIDP diagnosis, other
metabolic neuropathies (at uremia, acromegalia,
hepatitis, amyloidosis and hypothyroidism),
paraneoplastic neuropathies (at lymphoma,
myeloma, carcinoma, etc.), polyradiculoneuropathies and polyneuropathies
associated with Lyme disease or other infections
have to be rejected. The DD of CIDP covers also other acquired demyelinating
neuropathies – sensory CIDP, multifocal
motor neuropathy, and multifocal acquired
sensory and motor neuropathy. The clinical differentiation between
CIDP and acute CIDP (syndrome of Guillain-Barre)
is important because of the different course, recovery perspectives
and therapeutic approach. When discussing DD of CIDP, some inherited
demyelinating polyneuropathies should also be considered.
Key words: chronic
inflammatory demyelinating polyneuropathy,
diagnosis, differential diagnosis
Address for correspondence:
Assoc. Prof. Ivan Petrov,
M. D., Clinic of Neurology, Medical Institute, Ministry of Internal
Affairs, 79A, Skobelev Blvd., Bg1606
Sofia, tel. +359 2 982-15-80
arthritis and cardiovascular risk - 41, 2005, № 2, 10-17.
А. Toncheva and S. Torbova
Clinic of Cardiology and Rheumatology, MNTH “Tzar
Summary: During the last few years, there has been
data for the increased risk of cardiovascular diseases (CVD) in patients
with rheumatoid arthritis (RA), as well as increased mortality from
cardiovascular events. It is considered that the inflammation of the
vessel wall is a common pathogenetic mechanism
both for atherosclerosis and rheumatoid arthritis. Along with the
usual risk factors for CVD, in patients with RA there is a statistically
reliable reduced insulin sensitivity as well as predisposition to
low HDL cholesterol. It is suggested that RA is considered a separate
risk factor for CVD, and more aggressive treatment and control of
cholesterol levels, blood glucose, C-reactive protein, blood pressure
and other risk factors are needed.
Key words: rheumatoid arthritis, atherosclerosis,
cardiovascular risk factors, endothelial disfunction,
Address for correspondence:
Ass. Prof. Antoaneta Toncheva, M.D., Clinic
of Cardiology and Rheumatology, MNTH “Tzar
Boris III”, 108 Maria-Luiza Blvd., Bg
– 1202 Sofia
Trends in asthma epidemiology: mortality and morbidity - 41, 2005, № 2, 18-25.
Clinic of Allergology, University Hospital “Alexandrovska”
Summary: In spite of all efforts that have been exerted to develop, promote
and stick to different international guidelines for diagnosis, differential
diagnosis and treatment of bronchial asthma, the trends in its epidemiology are
permanently negative. The increase in disease’s mortality and morbidity
as well as in the level of utilization of health resources is more
than clear. Bronchial asthma nowadays is an illness with great social
and economic impact on patients’ and their families’ quality of life
through the impairment it causes.
reviews the data on asthma epidemiology trends published recently.
Key words: asthma, epidemiology, mortality, prevalence,
Address for correspondence:
Georgi Christoff, M. D., Clinic of Allergology, University Hospital “Alexandrovska”, 1431 Sofia, 1, “Sv. G. Sofiiski” Str.,
antitrypsin deficiency in patients with
pulmonary diseases- 41, 2005, № 2, 26-32.
M. Mircheva and М. Baleva
Department of Allergology and Clinical
Immunology, University Hospital “Alexandrovska”
Summary: Alpha-1 antitrypsin
deficiency is one of the commonest genetic deficiencies in Caucasian (white) populations. Оver 100 different genetic variants of alpha-1 antitrypsin have been identified. Normal alpha-1 antitrypsin is labelled
M and the
two most important abnormal variants are called S and Z. Both are result from mutations of the alpha-1
antitrypsin gene. Аlpha-1 antitrypsin deficiency most frequently causes emphysema. Alsо, there
is an association between AAT deficiency and bronchiectasis. Тhis
deficiency is the most common genetic
or inherited cause of hepatitis and cirrhosis in infants and children. S type of the mutation has the highest frequency
in the Iberian Peninsula, North America, Australia and New Zealand and Z type has the highest frequency
in Northern and Western Europe, New Zealand, Thailand, Afghanistan.
Key words: alpha-1 antitrypsin deficiency,
genetics, emphysema, bronchiectasis, asthma
Address for correspondence: Mariana Mircheva, M.D., Department of Allergology
and Clinical Immunology, University Hospital Alexandrovska,
1, Sv. G. Sofiiski
1431 Sofia, e-mail: firstname.lastname@example.org
and bronchial asthma - a new look at “hygiene hypothesis” - 41, 2005, № 2, 33-38.
Pediatric Clinic, University Hospital “Alexandrovska”;
Summary: T helper type 2 immune responses against harmless
antigens (allergens) are critical in the pathogenesis of allergy and
asthma. A number of epidemiological studies have suggested that the
increase in the prevalence of allergic disorders that occurred over
the past few decades is attributable to a reduced microbial burden
during childhood (the “hygiene hypothesis”). However, the immunological
mechanisms that regulate and protect against the development of these
disorders are poorly understood. The initial interpretation proposed
a missing immune deviation of allergen-specific responses from a Th2
to a Th1 profile, as a result of the reduced production of interleukin-12
and interferons by natural immunity cells,
stimulated by bacterial products via their Toll-like receptors. More
recently, the role of reduced activity of the T regulatory cells has been emphasized. The T regulatory
cells include four groups of CD4+ T cells: Th3 cells, Tr1 cells, CD4+
CD25+ cells and NKT cells. A better understanding of the role of the
regulatory cells in allergic diseases and bronchial asthma is important
not only from a theoretical point of view, but also may lead to the
identification of novel therapies.
Key words: asthma, hygiene hypothesis, Th2
immune response, T regulatory cells
Address for correspondence: Iren Tzotcheva, M.D., Pediatric
Clinic, University Hospital “Alexandrovska”,
1, Sv. G. Sofiiski str., Bg1431 Sofia, tel. +359 2 923-03-73, GSM +359 887-20-70-28, e-mail: email@example.com
resistance of etiologically significant bacteria
opportunities of antimicrobial resistance surveillance systems - 41, 2005, № 2, 39-44.
National Reference Laboratory “Control and Monitoring of Antimicrobial Resistance”,
Microbiology Department, National Center of Infectious
and Parasitic Diseases, Sofia.
Summary: In the last few years, the rising tide of ever-increasing
antimicrobial resistance among clinically important microorganisms
has become one of the most serious concerns and disputed problems
in the healthcare systems worldwide. Surveillance of antimicrobial
resistance has proven to be an essential tool in the strategy to contain
and reduce resistance. The article describes and compares The Bulgarian
Surveillance Tracking Antimicrobial Resistance
BulSTAR and some of the main national and
international longitudinal surveillance systems. Some universal limitations
and difficulties of monitoring process are pointed and special emphasize
is given to specific local BulSTAR impediments.
Comments and conclusions on the advantages and shortcomings of the
Bulgarian surveillance system are made. Finally, some proposals for
future improvements of the system are given and analyzed.
words: BulSTAR, surveillance, antimicrobial resistance, antibiotics,
Bulgarian Association of Microbiologists
for correspondence: Mihail
Petrov, M. D., National Reference Laboratory “Control and Monitoring of Antimicrobial Resistance”, Microbiology Department, National
Center of Infectious and Parasitic Diseases, 26, Yanko Sakazov Blvd.,
Bg 1504 Sofia, tel. +359 2944-69-99/312, e-mail: firstname.lastname@example.org
Free radicals, neurodegenerative and psychiatric diseases and antioxidants
- 41, 2005, № 2, 45-51
M. Varadinova, D. Drenska,
G. Dimitrov and N. Boyadjieva
Department of Pharmacology and Toxicology, Medical
Summary: In our modern world there are too many environmental
factors, e.g. ecological imbalance, tension, fear, terrorism, wars,
that act aggressively on the human organism. On the cellular level,
these stressors lead to oxidative stress. There is a growing body
of data indicating that free radicals generated by oxidative stress
take substantial part in the pathogenesis of many diseases, including
neurodegenerative and psychiatric diseases. The harmful environmental
factors added to the genetic base may be the main reason for the high
frequency of these diseases. The antioxidants are substances which
act as scavengers for the free radicals and support the physiological
antioxidant system. We believe that if we add antioxidants to conventional
therapy of neurodegenerative and psychiatric diseases we will improve
their treatment and will help the patient to lead a better life.
words: free radicals,
neurodegenerative and psychiatric diseases, antioxidants
Address for correspondence:
Diana Docheva-Drenska, M.D., Department of Pharmacology and Toxicology,
Medical University, 2, Zdrave Str., Bg – 1431 Sofia, tel. +359 2 917-26-15, e-mail: email@example.com
development of radical hysterectomy- 41, 2005, № 2, 52-54.
Gynecology Clinic, MHAT “Sveta Anna”; Varna
Summary: The present review traces the stages of development
of radical hysterectomy from its introduction in practice in the end
of XIX century to the middle of XX century. During this period, many
investigators had used their own knowledge, experience and failures
to improve the technique of radical hysterectomy, to decrease the
complication rate and to increase the survival rate of the operated
patients. These investigators had laid the basis of the pelvic surgery
and the modern surgical treatment of gynecological malignancies.
Key words: radical hysterectomy, history
Address for correspondence: Yavor Dimitrov Kornovski, M. D., 39 Chaika, apt.
51, Bg 9010
Varna, GSM +359 887-62-47-50, fax +359 52 31-24-15
Practical clinical aspects of microbiological
examination in pre-analytical stage - 41, 2005, № 2, 55-61
and M. Murdjeva(2)
(1)Department of Infectious Diseases, University Hospital “Sv. Anna“ Sofia
of Microbiology and Immunology, Medical University – Plovdiv
Summary: The pre-analytical stage of clinical microbiological
testing requires competence from the time of collection through all
stages of transport, storage and processing of the patient’s specimen.
Based on information in guidelines, instructions and Medical Standard
of Clinical Microbiology, the present review aims to help the general
practitioners and specialists in the pre-analytical stage of the microbiological
diagnosis. The practical approach is presented for collection, transport
and storage of the most frequently examined specimens – nasal and
throat swabs, sputum, feces, urine, blood, cerebrospinal fluid.
words: clinical microbiology, pathological specimen, collection,
transport, storage, procedure
Address for correspondence: R. Komitova, M. D., Department of Infectious Diseases, University Hospital „Sv. Anna”, 309, Slivnica Blvd., Bg1202
Sofia, е-mail: firstname.lastname@example.org
manifestations, risks and trends regarding human Parvovirus B19 infection–
41, 2005, No 1, 5-14.
Department of Virology, NCIPD - Sofia
Summary: The review
presents information about Parvovirus B19 – the only human representative
of Parvoviridae family,
which became known for the first time during 80’s of 20th
century. The etiological role of this pathogen is accentuated in wide
area of diseases, syndromes and pathological states running acutely
and chronically. Viral tropism and persistence, variable transmission,
clinical polymorphism as well as treatment, contingents at risk and
future trends in application of molecular and viral mechanisms for
therapeutic purposes are discussed.
Key words: parvovirus B19, viral tropism, persistent-infection,
Address for correspondence: Zefira
Mihneva, M. D., Department of Virology, NCIPD, 44A Stoletov Blvd., Bg - 1233 Sofia, tel. +359
2 931-07-13/254, e-mail:
will be defeated– 41, 2005, No 1, 15-20– 41, 2005, No 1,
National Center of Infectious and Parasitic Diseases - Sofia
Summary: Significant progress is being made towards the global eradication of poliomyelitis
since this initiative was launched by the General Assembly of the
World Health Organization in 1988. By the end of 2003, poliomyelitis
had been eliminated from all but 6 contries
in the world. Although endemic polio transmission is now geographically
restricted, wild poliovirus importation continues to paralyse
children in polio-free areas. Poliomyelitis remains a real threat.
The current report reviews the actual problems regarding pathogenesis,
clinical manifestations, epidemiology, vaccine strategy, diagnosis
and control of poliomyelitis. Data of the latest epidemic outbreak
of poliomyelitis in Bulgaria in 2001 are presented.
Key words: poliomyelitis, polioviruses,
acute flaccid paralyses, eradication, vaccines
Address for correspondence: Assoc. Prof. Neli
Korsun, M. D., National Referent Enterovirus
Laboratory, National Center of Infectious and Parasitic Diseases,
44A Stoletov Blvd., Bg - 1233
Sofia, tel. +359 2 931-07-13/247, e-mail: email@example.com
of the uterus– 41, 2005, No 1, 21-25.
Iа. Kornovski(1) and V. Ivanova(2)
Clinic, MHAT “Sveta Anna” - Varna
of General and Clinical Pathology, Medical University - Pleven
Summary: This review presents clinical classification, histologic
subtypes and treatment strategies for one of the rare but with extremely
malignant nature uterine tumors. The low incidence rate of this disease
leads to inconclusive survival rates reported by different centers,
using one or another type of management. This urges the need to perform
meta-analysis and reviews including large numbers of patients in order
to determine the appropriate treatment strategy.
Key words: sarcoma uteri, chemotherapy, radiotherapy
Address for correspondence: Iavor
M. D., 39 Chaika, apt. 51, Bg
- 9010 Varna, GSM +359 887-62-47-50,
fax +359 52 31-24-15
legs syndrome – 41, 2005, No 1, 26-30.
and J. J. Petrova(2)
(1)Clinic of Neurology, University Hospital “Tzaritza
Ioanna” - Sofia
(2)Clinic of Neurology, University
Summary: Restless legs syndrome is one of
the most common neurological disorders, with a prevalence of 5 to
15%. RLS manifestations are unpleasant sensations in the lower extremities
that are accompanied by an urge to move. Symptoms predominantly occur
at rest, are more pronounced in the evening and/or at night, are relieved
by movement and may lead to severe sleep disturbances. Characteristically,
RLS patients have nocturnal periodic movement during sleep and while
being awake. Typical history and normal neurological examination lead
to the clinical diagnosis. Additional laboratory and neurophysiological
investigations are necessary to rule out associated diseases. Polysomnography is needed to record periodic limb movements
in sleep. After differential diagnosis, pharmacotherapy should be
started if RLS symptoms restrict the patient’s well being and if sleep
disturbances are present. Treatment strategies are recommended individually
according to the disease severity. In the article, an overview of
the etiology, clinical symptomatology, diagnosis
and treatment of restless legs syndrome is presented.
Key words: restless legs syndrome, sleep
disorders, periodic limb movements
Address for correspondence: Ivan Staikov, M. D., Clinic
of Neurology, University Hospital “Tzaritza
Ioanna”, 8, Bialo more Str., Bg - 1504 Sofia, tel. +359 2 943-25-71, е-mail: firstname.lastname@example.org
hypertension – a powerful risk factor for stroke. Pathogenetic mechanisms
and possibility for therapeutic modification – 41, 2005, No 1,
Clinic of Cardiorheumatology, NMTH “Tzar Boris III” - Sofia
Summary: Arterial hypertension is the most powerful and significant independent risk factor
for stroke. The stroke risk rises progressively with the level of
blood pressure – systolic, as well as diastolic. Systolic blood pressure
is directly related to risk of stroke, particularly after 65 years
of age. Isolated systolic hypertension has twice the risk of stroke
in men and 1.5 times increased risk in women. Analyses of a large
number of clinical trials suggest that the blood pressure should be
< 125/85 mm Hg to reduce the risk of stroke. Hypertension contributes
directly to the occurrence of stroke in at last 3 major ways and indirectly
by exacerbating several other degenerative processes. There are several
proposed mechanisms relating renin-angiotensin
system with stroke. Diroton (Lisinopril)
has many well established vasoprotective
effects. Diroton has more than class effects and must be proposed for
successful prevention of stroke.
Key words: hypertension, stroke, ACE inhibitors,
Address for correspondence: Prof. Svetla
Torbova, Clinic of Cardiorheumatology,
NMTH “Tzar Boris III”, 104, Maria-Luiza
Blvd., Bg - 1202 Sofia, tel.
+ 359 2 932-21-34
and cardiac renin-angiotensin systems under
normal and pathological conditions
– 41, 2005, No 1, 37-42.
Department of Pathophysiology, Medical University - Pleven
components of renin-angiotensin system (RAS) - angiotensinogen, renin, angiotensin-converting enzyme, angiotensins
and angiotensin receptors are identified
in vascular wall and cardiomyocytes. Expression
of these components in vasculature depends on gene polymorphism, sodium
intake, steroid hormones, while in myocardium it depends on mechanical
stretch, and neurohumoral influences. Vascular angiotensin
is not only a potent vasoconstrictor, but also inflammatory mediator,
inductor of oxidative stress, and regulator of cell growth apoptosis
and migration of vascular smooth muscles. It participates in pathogenesis
of hypertension, atherosclerosis and their complications. Cardiac
RAS regulates heart contractility and impulse propagation, stimulates
myocyte growth, triggers apoptosis and is
involved in myocardial hypertrophy, development of heart failure,
and cardiac remodeling after myocardial infarction. Blocking of angiotensin
actions rather than hemodynamic changes may account for the beneficial effects
of angiotensin antagonists and ACE-inhibitors
in cardiovascular disease.
Key words: vascular renin,
cardiac renin, angiotensin,
Address for correspondence: Emilia
Lakova, M.D., Department of Pathophysiology, Medical University,1,
Str., Bg - 5800 Pleven, tel. +359 64 88-42-52, e-mail: email@example.com
syndrome and pregnancy – 41, 2005, No 1, 43-47.
Clinic of Rheumatology, Medical University - Plovdiv
syndrome (APS) is a specific clinical-laboratory complex of symptoms,
manifested by recurrent arterial and venous thromboses, habitual abortions
and thrombocytopenia. A wide spectrum of autoantibodies
associated with the disease besides classic antiphospholipid
antibodies – lupus anticoagulant and anticardiolipin
antibodies were established during the last years. Obstetric pathology
in APS includes premature birth, intrauterine fetal death, pre-eclampsia
and eclampsia, HELLP syndrome, postpartal
thrombosis. The frequency of these complications may be reduced by
adequate prophylaxis and treatment. The review presents basic manifestations
of APS in pregnant women and a therapeutic algorithm.
Key words: antiphospholiid syndrome, manifestations, pregnancy, treatment
Address for correspondence: Assoc. prof.
Maria Pantchovska, M. D., Clinic of Rheumatology,
- Plovdiv, tel. +359 32 60-23-61,
with Cyclosporin A of nephrotic
syndrome – 41,
2005, No 1, 48-55.
Clinic of Nephrology and Kidney Transplantation, University Hospital
“Alexandrovska” - Sofia
Summary: Cyclosporin A (CA) is used in the therapy of many immune diseases including the renal
ones. Limit factor of that is its nephrotoxicity.
CA leads to a dose-dependent reduction of glomerular
filtration rate and renal plasma flow (functional toxicity). Superimposed
on functional toxicity morphological changes in the vascular-interstitial
space (small vessels) and tubules may also occur. The present knowledge
on the pathogenesis of cyclosporine nephrotoxicity
suggests that glomerular filtration rate
is mainly reduced due to a preglomerular
vasoconstriction. The goal of the study is to show the efficacy, the
dosage and administration, and the limits of CA in glomerular
diseases associated with nephrоtic syndrome.
Key words: cyclosporin A, nephrоtic
syndrome, treatment, nephrotoxicity
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: firstname.lastname@example.org
ranelate – the contemporary application
of an old principle in the treatment of osteoporosis
– 41, 2005, No 1, 55-59.
D. Bakalov and M. Boyanov
Endocrinology Clinic, Department of Internal Medicine, Medical University
Summary: This review article displays the
use of strontium salts of the raneleic acid
in the treatment of osteoporosis. The main biological actions of strontium
ranelate are listed. Data are shown on the
in vivo and in vitro experiments in animal models. The results of
the two largest up-to-date studies on the treatment of osteoporosis
with strontium ranelate are commented. The Spinal Osteoporosis Therapeutic
Intervention assesses the effect of strontium ranelate
on the risk of vertebral fractures, whereas The Treatment of Peripheral
Osteoporosis Study assesses its effect on the risk of peripheral (non-vertebral)
fractures. Strontium ranelate showed significant anti-fracture efficacy in both
studies. The relative risk reduction of new fractures was about 40%.
Strontium ranelate seems to be a promising agent for the treatment and
prevention of osteoporosis.
Key words: osteoporosis, bone-building and antiresorptive
agents, strontium ranelate
Address for correspondence: D. Bakalov,
M. D. Endocrinology Clinic, University Hospital
“Alexandrovska”, 1, Sv.
G. Sofiiski Str., Bg - 1431 Sofia,
tel. + 359 2 923-03-46