Journal
of IMAB
AnnualProceeding
(Scientific Papers
ISSN: 1312-773X (Online)
Issue: 2004, Book 1
Pages: 3 - 57
CONTENTS:
Vl.
Bencko, P. Franik, M. Gotzl, J. Rames
Human exposure to arsenic related cancer epidemiology and risk
analysis 20 years follow up
SUMMARY: The subject of our analysis was a database
of 1503 non-melanoma skin cancer cases (756 in men and 747 in women) and
1 117 lung cancer cases (1007 in men and 110 in women) collected from
1977 to 1996 in a region polluted by emissions of a power-plant rising
from burning of coal with high arsenic content ranging between 900 to
1,500 g per metric ton of dry coal.
Exposure assessment of the local population of the district was based
on biological monitoring. Determination of arsenic was done in groups
of 10 year old boys as samples of non-occupationally exposed general population
by analyzing of hair and urine samples at different localities situated
up to the distances of 30 km from the local power plant.
Basic epidemiological data of the cancer cases were obtained in a questionnaire
which covered basics of personal, family, residential and occupational
history.
Over study base represent 1,328 thousands man/year and 1,334 thousands
woman/year of a population of approximate size of 125 000 inhabitants.
The age standardized incidence of non-melanoma skin cancer (each confirmed
by histological examination) in non-occupational settings ranged from
45.9 to 93.9 in men and from 34.6 to 81.4 in women. Relevant data for
lung cancer (each confirmed by biopsy or autopsy histological examination)
ranged from 10.8 to 89.8 in men and from 1.1 to 10.1 in women per 100,000.
Analysis of our database reconfirms a positive correlation of human cumulative
arsenic exposure with non-melanoma skin cancer risk.
A less pronounced relationship was noted between arsenic exposure and
incidence of lung cancer. This is most likely to be due to the presence
of confounding variables such as cigarette smoking.
Key words: cancer epidemiology, biological monitoring,
arsenic toxicity, non-melanoma skin cancer incidence, and lung cancer
incidence
N.
Bakracheva
Nosocomial Infections: prevention and treatment
V.
Ouzounova, J. Haralambieva, J. Jankov, D. Petrov, I. Mitov
Prevalence of Chlamydia trachomatis infections in symptomatic
patients in Bulgaria
Abstract: The aim of the study is to investigate
the prevalence of C. trachomatis infection in symptomatic patients and
to compare our data with similar studies made in Bulgaria. 822 patients
were includet with a suggestion of possible chlamydial infection - urethritis,
prostatitis, Reiter syndrome, cervicitis, salpingitis, pelvic inflammatory
disease, ectopic pregnancy, infertility, etc. The samples were cell cultured
on McCoy and detected in immunofluorescence with anti-lipopolysaccharide
monoclonal antibody. The prevalence of C. trachomatis infection in symptomatic
patients addressing the specialists was about 37% in the investigated
822 urogenital samples (568 women and 254 men). Active infection with
C. trachomatis was detected in 39% of the women and in 33% of the men.
Our study shows a relatively high prevalence of C. trachomatis infection
in symptomatic patients; lower prevalence of the infection in comparison
with other bulgarian studies, using different methods for detection. The
results prove the high sensitivity and specificity of the cell-culture
method for the detection of chlamydial infections and the need for screening
of the symptomatic patients and their sexual partners for chlamydial infection.
Key words: C. trachomatis, immunofluerescence
B.
Ivanov, V. Valkanova, N. Deleva,
Cardiovascular autonomic disturbances in early Parkinson‘s disease
Abstract: Aim of this study was to assess the cardiovascular
autonomic function in early Parkinson‘s disease.
D.
Peychinska, M. Danovska, D. Chakarov, V. Simeonova, Ch.
Lilovski
Dynamic follow up of Aphasic disorders in patients with ishemic
stroke in acute stage
Summary: The dynamic follow up of aphasic disorders in
patients with acute ischemic stroke is of great importance because of
its prognostic value for their future recovery.
The purpose of that clinical study is to compare the type of aphasia with
the CT data about the infarction localization and to evaluate the prospective
aphasia recovery.
In the clinical study were included 37 patients with ischemic stroke and
aphasia, theated in II-nd Neurology Clinic, Medical University Pleven.
The diagnosis ischemic stroke was confirmed by clinical and CT investigations.
Partial and full recovery of sensory aphasia was registered in all the
patients with total aphasia, while motor aphasia showed little tendency
of reduction in acute ischemic stroke. Aphasic disorders were more severe
in cases with ischemic infarctions localized in the specific anatomical
regions responsible for the speech function. The dynamic follow up of
aphasic disorders has prognostic value for the speech recovery. Better
prognosis show sensory and amnestic aphasia. Lesion localization also
influences the prognosis.
Key words: ischemic infarction, aphasia, prognosis
B.
Ivanov, N. Deleva, A. Kaprelyan, I. Dimitrov
Questionnaire - based assessment of autonomic dysfunction in Parkinson’s
disease
ABSTRACT: Questionnaire - based assessment of different
autonomic dysfunctions was performed in 500 patients with Parkinson’s
disease (PD): 273 males and 227 females, aged from 42 to 81 years and
with disease duration from 2 months to 17 years. Patients with co-existing
diseases affecting the autonomic nervous system (ANS) were not included
in the study. The distribution of cases according to the Hoehn-Yahr scale
was as follows: 41 patients at stage I, 197 - at stage II, 214 - at stage
III and 48 - at stage IV. Sixty-one patients were free of antiparkinsonian
drug treatment.
Three hundred and fifteen patients (63%) described one or more complaints
concerning the autonomic nervous system: 16 (5%) were at stage I according
to Hoehn-Yahr scale, 82 (26%) at stage II, 164 (52%) at stage III and
45 (14%) at stage IV. The most common complaints involved the gastrointestinal
system - 67%, urologic - 39%, thermoregulatory - 29% and cardiovascular
- 27%. Seven patients with dysautonomic complaints receive no antiparkinsonian
medication.
Our results showed that questionnaire - based assessment confirms the
presence of dysautonomic manifestations in more than 50% of the patients
with PD. These manifestations were present even in untreated patients
at the early stage of the disease. Having in mind that dysautonomias engage
practically all somatic systems with autonomic control, we consider that
evaluation of autonomic dysfunction could contribute to the management
of quality of life of PD patients.
J. Jekov, St.
Pavlova
Problem about the dysgrafia in frames of the paradigma “Specific
learning disabilities”
Abstract: Disgraphy as a disturbance of the written
form of speech is one of the common forms of speech pathology with students
of the primary grades. It often leads to difficulties in gaining new knowledge
and skills, and impedes the successful end of training process. For that
reason it is of prime importance for the logopedic theory and practice
to define and separate its symptoms, to separate it as independent nosology
unit or being part of other distrubances.
S. Pavlov, M.
Slavova
A case of secondary syphilis with condilomata lata location on
the oral comissure
Abstract: Condylomata lata are frequently observed
in patients with secondary recurrent syphilis - up to 35% of cases (2).Their
location on the oral comissure is a relatively rare finding, that comprises
a matter of interest both for dermatologist and non-dermatologist specialists
(6).The extra genital locations of condylomata lata can easily be omitted
or misdiagnosed, especially in cases when other skin manifestation are
absent.
Key words: syphilis, condylomata lata
S. Pavlov, M.
Slavova
Antibiotic therapy and prophylaxy of patients with Erysipelas
Abstract: 78 patients with Erysipelas, treated in
the Varna clinic of dermatology are evaluated regard to clinical manifestation
and treatment modalities. The duration of therapeutic courses varies 3
to 33 days (med. 12, 7 days). All patients received parenteral antibiotic
therapy in a regimen depending on location and severity of infection and
number of recurrences. The mild and moderate cases are treated with penicillin
and cephalosporines- I and II generation. Severe and complicated erysipelas
cases are managed with III generation cephalosporines. Penicillin with
depo action is applied as a prophylaxy in 33 (42%) patients. Predisposing
causes for recurrence of infection are reported as follows:
- tinea pedis - 32%
- lymphostasis and edema - 23%
- obesitas - 19,2%
- diabetes - 22%
- trauma - 16,7%
- palmo - plantar psoriasis-7,7%
Key words: erysipelas, therapy
D.
Gospodinov, A. Tsvetanova, M. Trashlieva
Familial alopecia areta, atopy and thyroiditis Hashimoto
A.
Tsvetanova, D. Gospodinov, M. Donchev
Serum-concentrations of dehydroepyandrosterone-sulfate in men
with androgenetic alopecia
S.
Valkova
Treatment of melasma with glycolic versus trichloroacetic acid
peel: comparison of clinical efficac
ABSTRACT: Melasma is one of the most common, therapy-resistant
forms of acquired hyperpigmentation. The aim of the present study was
to assess the efficacy and side effects of chemical peels with 35% glycolic
and 15% trichloroacetic acid (TCA) in conjunction with 20% azelaic acid
cream in the treatment of melasma. Twenty-six women aged 22-54 years with
different forms of melasma have been treated. Six of them were with phototype
II, 11 with phototype III and 9 with phototype IV. Disease severity was
assessed at the beginning and at the end of therapy according to the Melasma
Area and Severity Index (MASI). Patients were randomly divided in two
groups – Group I (n=12) treated with 35% glycolic acid and Group II (n=14)
treated with 15% TCA. A significant reduction in MASI values after therapy
was observed in all patients without significant difference between Group
I and Group II (t=0,12; ð>0,05). No statistical difference was established
among final MASI values of women with phototypes II, III and IV (t=0,25;
ð>0,05). Side effects were light and negligible. Therapy was positively
assessed by the patients. In conclusion, chemical peels with 15% TCA and
35% glycolic acid in conjunction with 20% azelaic acid reduce significantly
MASI values after therapy and are equally effective in the treatment of
melasma.
Key words: melasma, peel, glycolic acid, TCA
S.
Valkova
Treatment of dermatophyte onychomycosis with terbinafine (Lamisil)
pulse therapy
ABSTRACT: Terbinafine is the most active
currently available antidermatophyte agent with fungicidal action. The
aim of the present study was to assess the efficacy of terbinafine pulse
therapy in the treatment of dermatophyte nail infections. Seven patients
(two with fingernail, four with toenail and one with mixed onychomycosis)
have been treated with 500 mg terbinafine daily for one week per month.
The duration of the treatment was four months for toenail and three months
for fingernail onychomycosis. At the end of the follow-up period (six
months after discontinuation of treatment) 6 out of 7 patients (87%) were
mycologically cured. In conclusion, pulse terbinafine therapy is an effective
regimen for the treatment of dermatophyte nail infections.
Key words: onychomycosis, terbinafine, pulse therapy
T.
Deliiski, S. Popovska, D. Dardanov
A method for marking the location of breast cancer tumor indicated
for neoadjuvant chemotherapy
ABSTRACT: Sometimes, histological investigation
of a tumor is impeded after neoadjuvant chemotherapy due to full clinical
remission, i.e. the tumor cannot be located through palpation, X-ray and
macroscopically after mastectomy.
The authors aim to landmark the tumor before after neoadjuvant chemotherapy,
thus facilitating its location through X-ray and dissection after changes
due to the cytostatic preparation admistered.
Materials and methods: The marker is a radio-opaque metal clip, introduced
through a puncture needle and placed in the center of the tumor.
After chemotherapy, contrast mammography helped identify the changes in
tumor size in relation to the marker. Intraoperatively, the pathologist
located the clip, the latter being in some cases the only landmark for
primary localization of the tumor.
Our initial results from the application of the method are encouraging:
mammography visualized the clip and served as a guide during surgery and
macro- and microscopic morphological investigation.
Key words: marking of tumor, neoadjuvant chemotherapy
T.
Deliiski
A clearing technique to increase detectability of lymph nodes
in radical surgery for colon and rectal cancer
ABSTRACT: A method is proposed to detect the smallest
lymph nodes located in adipose-lymph-vascular tissues of the meso of the
intraoperatively collected specimen. The method combines traditional dissection
with modified fat-clearing.
Immediately after surgery, the meso of the fresh specimen was dissected
into layers, and the lymph nodes detected by palpation and inspection
were removed. They were then grouped according to specificity of lymph
dissemination and staging of tumors. Thus detected, the lymph nodes were
investigated using routine histological methods. Fatty lymph vessel tissue
was separated from the organ and was further processed using a fat clearing
technique, by dipping it into 10% formalin solution with 0.01% methylene
blue, alcohol and xylol. The mass obtained was translucent, which allowed
detecting even minute bluish solid lymph nodes. The latter were dissected,
fixed and placed into formalin to be later histologically investigated.
After the experimental stage, the method was introduced into routine clinical
practice. So far, we found that in 15 cases the technique of processing
the specimens helped to detect 5 to 11 additional lymph nodes, otherwise
undetectable.
Key words: lymph nodes detection, clearing techniques
T.
Deliiski
A method for detecting more lymph nodes after radical operation
for gastric cancer
ABSTRACT: Removing and detecting as much as possible
lymph nodes in radical operations for gastric cancer is important part
of the modern approach in this disease.
The aim of the study is to evaluate the effect of fat-clearing technique
for detecting more lymph nodes after lymph node dissection in gastric
cancer surgery. Also to prove that putting the specimen consecutively
in solutions of formaldehyde, alcohol, acetone and xylol could help in
detecting more undetectable with classical methods lymph nodes.
15 surgical specimens containing perigastric lymph and adipose tissue
in great and leaser curvature, and the tissue derived from dissection
of second compartment. First with conventional method by inspection and
palpation as much as possible lymph nodes are detected in fresh specimen.
After that the stomach is removed and the remaining adipose and lymph
tissue is fixated with formaldehyde followed by fat-clearing technique.
Then searching of undetected with conventional method lymph nodes is performed,
using palpation and trans-illumination of the fat-cleared specimen.
With fat-clearing method 2 to 9 more lymph nodes per specimen were detected.
Most of them are smaller than 5 mm in diameter. Their color was bluish
or yellow and harder than rest of the tissue.
With fat-clearing technique is possible to improve detection of lymph
nodes after lymph dissection in gastric cancer
Key words: gastric cancer, lymph nodes detection
I. Simeonov, N. Tocev
A rare case of achalasia, clinically and diagnostically assumed
as a lung tumor
Hr.
Romanova, P. Vajarova
Provide for microbiological control over disastrous situations
and danger of epidemics
SUMMARY: It has been studied
the provide of microbiological control over disastrous situations and
danger of epidemics in Varna city. It has been put into effect mainly
by microbiological section of RIDCSH (regional inspection of defence and
control of social health) with especially enormous volume of functions
in 14 labs. It was supplied a daily acting microbiological control including
arising of disasters and especially dangerous infections – anthrax, cholera,
variola and plague. It has been duplicated on microbiological investigations
in Varna city for arising disastrous epidemical situations as for the
purpose there were revealed microbiological labs in 3 national hospitals
and 2 private labs.
Key words: disasters, epidemics, microbiological control
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