Journal of IMAB
Annual Proceeding
(Scientific Papers)
ISSN: 1312-773X (Online)
Issue: 2007, Book 1, part Medicine
P: 3 - 127

CONTENTS:

FELINOSIS (CAT SCRATCH DISEASE) –DIAGNOSIS AND TREATMENT
Kr. Kalinova
University Hospital, Stara Zagora, Bulgaria
ABSTRACT: Cat scratch disease, caused by Bartonella henselae, typically presents with a localized lymphadenopathy with a brief period of fever and general symptoms.We review the diagnosis and treatment of this infection in three adults and two children.
Key words: Bartonella henselae; cat-scratch disease; lymphadenopathy

< back > Received May 5, 2007; Published online May 22, 2007, /Page 3-4/

PRIMARY RENAL ECHINOCOCCOSIS-EXPERIENCE WHIT 14 CASES
Kr. Kalinova, N. Usunov
University Hospital Stara Zagora, Bulgaria
ABSTRACT: Cystic hydatid disease may be found in any organ, although involvement of the urinary tract is relatively uncommon. Preoperative diagnosis of renal hydatid disease is difficult even in an endemic zone. A short review of the literature regarding diagnosis and management of renal echinococcosis is also presented. The treatment of hydatid cyst of the kidney is surgical. Renal-sparing surgery, cystectomy plus pericystectomy, is possible in most cases (75%). Nephrectomy (25% of cases) must be reserved for destroyed kidneys resulting from aged cysts opening into the excretory cavities and complicated by renal infection. Whether conservative or radical, the first surgery performed is cystectomy, with germinate membrane removal after controlled evacuation and opening of the cyst, making the subsequent steps of surgery easier.

< back > Received May 5, 2007; Published online May 22, 2007, /Page 5-7/

ANALYSIS OF BODY COMPOSITION IN OVERWEIGHT AND OBESE WOMEN USING BIOIMPEDANCE (BIA) SYSTEM
Shishkova A., P. Petrova*, A. Tonev*, P. Bahlova, O. Softov, E. Kalchev
Medical center “Medica-Albena” EAD, resosrt Albena, Bulgaria; Medical University Varna, Bulgaria*
ABSTRACT: BACKGROUND: Knowledge of body composition in health and disease has been a continuing interest for clinicians, because components of the body often provide more useful information than the whole-body measurements of weight, height, and the derived parameter, body mass index. Bioelectrical impedance analysis (BIA) is a widely used method to estimate body composition. The technology is relatively simple, quick, and noninvasive. The porpose of this study was to determine the body composition changes of 11-days clinic-based weight management program. SUBJECTS AND METHODS: For a period of two years (2004-2005) we studied 519 overweight and obese women (BMI, X±SD, 32,94±6,51 kg/m2). The diagnostic protocol included antropometric data, body composition analyse with Tanita ® leg-to-leg BIA system (model TBF – 300A), blood analysis, cardiological, dietological and physiotherapeutical specialist consult. All of patients keep to a low-calory diet, intensive everyday exercise and physioterapy procedures. The lectures course included of basis nutrition, healthy eathing, long-term exercise programm. RESULTS: Weight loss for the group was 2.57 kg. The fat-mass loss was 1.25 kg, free-fat mass was also decrease 1.31 kg. Reductions in circumferenses of waist and hip for the group was 3.9 cm and 3.09 cm respectively. Basal metabolic rate was significantly reduced (p<0.001). Patients had improved some components (total cholesterol, HDL cholesterol, fasting glucose, blood pressure).CONCLUSION: These results support the field use of BIA for estimating changes in fat mass as it is simple to use, requires minimal training and is used across a spectrum of ages, body weights, and disease states.
Key words: bioelectrical impedance analysis, body composition, fat mass.

< back > Received - May 6, 2007; Published online - June 22, 2007, /Page 8-12/

RARE INTRAABDOMIAL TUMOR
Ignatov V., Kr. Ivanov, R. Madjov*, N. Kolev, A. Tonev, T. Temelkov
Department of General and operative Surgery; *Department of Hepato-Biliary Surgery; University Hospital “St. Marina" - Varna, Bulgaria
ABSTRACT: Pseudomyxoma peritonei (PMP) is a rare neoplastic, chronic and insufficient disease, which has the characteristics of the disseminated mucinous ascites and the presence of peritoneal implants. The making of precise and well-timed diagnosis is a difficult process because of the lack specific symptoms. The exact preoperative diagnosis ‘PMP” can be prescribe after CT-imaging, which is sensitive with its ‘mussel shell’ symptom on the surface of the visceral organ, resulting from the compression of the vicouse mucinous ascites and the presence of fibrosis. We report a rare case of our practice, with anamnesis of abdominal swelling, lost of apetite, consumative syndrome – more than 10 kilos for two months. The difficulties in diagnostic process were overwhelmed. Despite of the quantity of the studies, directed to the treatment of PMP, this disease stay constantly enigmatic with prorogated clinical elapsing and the high level of recurrence in the complex treatment and have to be discussed the application of operative methods and chemotherapy.

< back > Received - May 6, 2007; Published online - June 22, 2007, /Page 12-16/

Comparative analysis of endoscopicaly submucosal vs. open surgery subserosal application Patent Blue V – intraoperative method for detection of lymph mode metastasis in patients with colorectal cancer
Ignatov V., K. Ivanov, R. Madjov*, T. Temelkov, N. Kolev, D. Hristov, A. Tonev
Department of General and operative Surgery; *Department of Hepato-Biliary Surgery; University Hospital “St. Marina" - Varna, Bulgaria
ABSTRACT: Introduction: The lymphatic status is acknowledged as the most important prognostic factor in patients with colorectal cancer. In our clinic, the intraoperative sentinel lymph node mapping with Patent Blue V is routine method of choice for better staging of lymph node status and achieves an adequate extent of surgical procedure in patients with colorectal cancer. Aim: To compare the results from application of methods of intraoperative endoscopic submucosal and open surgery subserosal sentinel lymph node mapping in patients with colorectal cancer. Results: The study was undergone in 136 patients with diagnosis of colorectal cancer and sentinel lymph node mapping. An analysis and comparison is done and the results of the two methods were compared. Our data show that the sensitivity is comparable and is respectively 97% and 100% and the methods are reliable enough. Conclusion: Endoscopic submucosal application of the dye marker is the only eligible method for the subperitoneal localization of rectal cancer. The surgical approach and the extent of the lymph dissection have to be conformable to the status of lymph node basin, staged with the help of objective diagnostic tool, such as intraoperative sentinel lymph node mapping. This leads to increasing level of curative surgical treatment in cases of colorectal cancer.
Key words: Sentinel lymph node mapping, endoscopy.

< back > Received - May 6, 2007; Published online - June 22, 2007, /Page 16-21/

Immunohistochemical investigations of p16 INK 4a expression in carcinomas and high grade cervical lesions
M. Karcheva, S. Popovska*, R. Nachev*
Department of Epidemiology of Infectious Diseases, Medical University-Pleven, Bulgaria; *Department of General and Clinical Pathology, University Hospital-Pleven, Bulgaria
Summary: During the years the role of viruses as a cause of oncological illness was known. One of them is cervical carcinomas, related to Human papilloma viruses (HPV’s). There are about 450000 new cases of cervical cancer worldwide each year, and 250000 deaths of this diagnosis. By the diagnosis cervical cancer get there with two procedures: after mass scrinning or clinical suspicious for ill. By the availability apparent tumor diagnosis is put with biopsy. By the discreet lesions require utilization modern diagnostic methods. One of them is immunohistochemical method. In situ hybridization (ISH) assays for high-risk human papillomavirus (HR-HPV) and immunohistochemical (IHC) assays for surrogate markers such as p16 INK 4a can be useful in detecting HR-HPV in cervical dysplasia. The aim of the following study was to find difference the level for expression of the tumor specific gene p16 INK 4a in reactive, dysplastic and invasive changes in biopsy specimens from uterine cervix. In the lesions of the uterine cervix, overexpression of p16 INK 4a is induced by HPV and is associated with the process of cancerogenesis in the epithelium. Almost 100% of the high grade lesions and the invasive carcinomas demonstrated high level of expression of p16 INK 4a while non displastic epithelium is always negative.
Key words: cervical carsinomas, human papilloma viruses, p16 INK4a expression

< back > Received - July 16, 2007; Published online - Sept. 10, 2007, /Page 22-24/

COMPARATIVE STUDY IN LEPTOSPIROSIS AND ACUTE VIRAL HEPATITIS
Gancheva G., Chr. Tzvetanova, P. Ilieva, I. Simova
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine; Medical University, Pleven, Bulgaria
SUMMARY: Retrospectively have been studied clinical signs and routine laboratory investigations of patients with leptospirosis (n 1=94) and acute viral hepatitis (AVH) (n 2=1705). The comparison of results in two groups have revealed significant differences in the frequency of acute onset in leptospirosis and AVH with fever (respectively in 100% and 58,01%; p<0,005); pains in calf muscles (in leptospirosis in 85,11%, in AVH have not been observed); headache (resp. in 68,08 and 18,96%; p<0,005); anorexia (resp. in 64,89 and 87,36%; p<0,005); lumbar pains (in leptospirosis in 40,43%, in AVH have not been observed); clay colored stool (resp. in 6,38 and 93,60%; p<0,005); heaviness in abdomen (resp. in 3,19 and 84,38%; p<0,005); hepatic tenderness (resp. in 41,49 and 76,63%; p<0,005); conjunctival injection only in leptospirosis (86,17%). Routine laboratory investigations have been demonstrated anemia, leucocytosis, granulocytosis, increased erythro­cytes sedi­men­tation rate (ESR) and thrombocytopenia significantly often in leptospirosis than in AVH (p<0,005). The comparison of results of liver biochemical investi­gations have been established increased serum bilirubin in lepto­spirosis and AVH (resp. in 75,00 and 93,60%; p<0,05); mildly increased aminotransferases activities in leptospirosis and extremely increased in AVH (p<0,005); increased creatinkynase in leptospirosis; increased fibrinogen level in leptospirosis (av. 6,74 g/L), normal to decreased in AVH (av. 3,01 g/L) (p<0,005). Nitrogen parameters have been increased in leptospirosis with ARF.
Key words: leptospirosis, acute viral hepatitis, acute renal failure, liver biochemical parameters, creatinkynase, nitrogen parameters.

< back > Received - Aug. 23, 2007; Published online -Sept. 10, 2007, /Page 25-28/

SERUM ELECTROLYTES IN LEPTOSPIROSIS
Gancheva G., M. Atanasova, P. Ilieva
Department of Infectious Diseases, Epidemiology, Parasitology and Tropical Medicine; Medical University, Pleven, Bulgaria
SUMMARY: Serum levels of electrolytes (sodium, chlore, potassium and ionized calcium) in ninety four cases of leptospirosis have been investigated dynamically with routine laboratory methods. Twenty six cases had been with mild course (27,66%), thirty eight with moderate (40,43%), and thirty with severe leptospirosis (31,91%) (ð>0,1). The comparison of different serum levels (decreased, normal and increased) of the electrolytes and their averages have revealed significantly increasing only of sodium average before discharge (p<0,05). Analysis of the percentage of cases with different serum levels (normal, below and above normal) of electrolytes in different severity of the disease has been found significantly higher occurrence of hyponatriemia in moderate and severe leptospirosis (p<0,05). Decreased serum levels of ionized calcium have been established in thirteen cases, twelve of them with severe leptospirosis (p<0,05). The dynamical control on the serum levels of sodium, chlore, and potassium have not revealed significant differences in percentage of the disorders (p>0,05). Marked prevalence of the cases with decreased ionized calcium during the hospital period has been observed (p<0,02). In conclusion: electrolytic disorders have not been significant for diagnosis of leptospirosis because they have been observed in ARF independent of the etiology but they have been important for evaluation of the severity and correct treatment of the disease.
Key words: leptospirosis, acute renal failure, serum electrolytes, sodium, chlore, potassium, ionized calcium.

< back > Received - August 23, 2007; Published online -Sept. 10, 2007, /Page 29-32/

TREATMENT OF PERFORATED INFECTIOUS CORNEAL ULCERS WITH PENETRATING KERATOPLASTY
Chavdar Balabanov, Snezhana Murgova, Boriana Parashkevova
Eye Clinic, University Hospital “Dr George Stranski” - Pleven, Bulgaria
ABSTRACT: Introduction: Corneal perforation due to keratitis requires penetrating keratoplasty to preserve eye integrity, eradication of the infectious process and visual rehabilitation. Purpose: To evaluate anatomical and functional outcomes of urgent penetrating keratoplasty in perforated infectious corneal ulcers. Patients and methods: Five consecutive patients (5 eyes) who underwent therapeutic penetrating keratoplasty (PK) for perforated infectious corneal ulcersduring a 2 year-period (2004-2006) were followed-up for a mean period of 8.5 months. All patients underwent penetrating keratoplasty by a similar method. In one case a triple procedure including implantation of intraocular lens was performed. Results: Anatomical integrity was achieved in all five eyes perforated by corneal disease. Clear grafts were obtained in 80% (4 eyes) and semi-transparent in 20% (1 eye). Four eyes obtained a final best corrected visual acuitybetween 0.2 and 0.9; in one eye it was unchanged due to mature cataract and secondary glaucoma. In the latter case, glaucoma surgery was performed 4 months after PK. Conclusion: Our results confirm that therapeutic penetrating keratoplasty for keratitis, especially in corneal perforation, is successful in restoring anatomic integrity and visual rehabilitation in most eyes. Without therapeutic surgery, these eyes would have been lost.
Key words: cornea, keratitis, corneal perforation, penetrating

< back > Received - Sept. 02, 2007; Published online - Nov. 07, 2007, /Page 33-37/

Conservative treatment of cavernous hemangioma on eyelids
Snezhana Murgova, Chavdar Balabanov
Eye Clinic, University Hospital “Dr George Stranski” - Pleven, Bulgaria
Abstract: Cavernous Hemangiomas on the eyelids are congenital benign tumors in children. They vary in size and shape, and present medical and cosmetic problems. Different methods of treatment have been used with different outcomes, but treatment with intralesional corticosteroids remain among the most commonly used. A 3-month-old boy with hemangioma on the right upper eyelid is presented. He was successfully treated with repeated injection of betamethasone (celestone) in the lesion for a period of four years. At the end of the third year, the aesthetic result and regression of the tumor were significant.
This case and our experience show that intralesional steroid is an efficient therapy for eyelid hemangioma even during spontaneous regression.
Key words: hemangioma; corticosteroids; intralesional therapy

< back > Received - Sept. 02, 2007; Published online - Nov. 07, 2007, /Page 38-40/

Epidemiological Study of Eye Injury in Pleven , Bulgaria
Dessislava Stateva, Chavdar Balabanov , Boriana Parashkevova , K. Statev *
Eye Clinic, University Hospital “Dr George Stranski” - Pleven , *Department Of Management Of Health Care, Medical Ethics And Information Technology, Medical University Pleven , Bulgaria
Summary: Aim: To determine some of the epidemiological characteristics of eye injuries in the region of Pleven , Bulgaria. Materials and Methods: We studied the medical records of Eye Clinic – Pleven covering a period of 3 years (2004 – 2006). Results: Out of 318 eyes with trauma, the distribution of causes was as follows: 154 lacerations (both of eyeball and apparatus accessories), 63 contusions, 43 foreign bodies, 40 eye burns (23 chemical and 17 thermal) and 18 penetrating injuries.
Keywords: eye injury, ocular trauma, visual acuity

< back > Received - Sept. 02, 2007; Published online - Nov. 07, 2007, /Page 40-43/

ORBITAL TUMORS - CLINICAL CASES PRESEN­­­TATION
Boriana Parashkevova, Chavdar Balabanov , Dessislava Stateva
Eye Clinic, University Hospital “Dr George Stranski” - Pleven, Bulgaria
ABSTRACT: Introduction: Tumors of the orbit are rare diseases in ophthalmic pathology – 3.5 - 4 %. They are a great challenge for the ophthalmologist. Purposes: Presentation of epidemiology, clinical signs and symptoms, histology, methods for diagnosis and treatment and follow up of patients with orbital tumors for the period 2001-2005. Materials and methods: A retrospective study was carried out of 28 patients with orbital tumors for the period 2001-2005. Results: The study includes 28 patients with diagnosis Orbital tumor - 17 males and 11 females. The greater number being in the sixth and the seventh decade -17 patients (61 %). Conclusion: Tumors of the orbit are always a great diagnostic problem.In orbital processes all diagnostic methods have to be used and the results from the treatment should be followed regularly.
Key words: orbital tumor, neoplasm, eye, proptosis

< back > Received - Sept. 02, 2007; Published online - Nov. 07, 2007, /Page 44-47/

BENIGN INTRACRANIAL HYPERTENSION - ETIOLOGY, CLINICAL AND THERAPEUTIC ASPECTS
Tzoukeva Al., N. Deleva, A. Kaprelyan, I. Dimitrov
I-st Clinic of Neurology, Department of Neurology, Prof. P. Stoyanov Medical University of Varna
ABSTRACT: Introduction: BIH is a syndrome defined by increased intracranial pressure, normal CSF composition, absence of ventriculomegaly and intracranial lesion. Review of the literature reveals unknown etiology in majority of patients, various clinical symptoms and different treatment options. Objective: to study the etiology, clinical and therapeutic features in patients with BIH. Material and methods: Twelve patients with BIH, admitted to the hospital for the last 5 years were included in the study. The diagnosis was established on the basis of physical and neuro-ophthalmologic examinations, CT or MRI, and CSF evaluation. The major outcome criterion was the regression of papilledema. Results: All patients were young women. The most frequent clinical manifestations were transient visual obscurations, nausea, and headache. Neuro-ophthalmologic examination showed normal visual acuity, bilateral papilledema, enlarged blind spots, and bilateral abducent nerve paresis in two patients. Obesity, recent increase of weight and menstrual irregularities were potential risk factors. Papilledema resolved over the next 2-3 months after different treatments. In one patient three relapses were registered. Conclusion: Our own notes suggest that BIH most commonly associates with young age, female sex, and obesity. Neuro-ophthalmologic examination, neuro­imaging, and CSF evaluation are the most useful diagnostic tools. The application of diuretics and corticosteroids most often provides a successful control over clinical symptoms and papilledema.
Key words: benign intracranial hypertension, clinical manifestation, risk factors, treatment

< back > Published online - Nov. 07, 2007, /Page 48-50/

CRANIAL AND SPINAL NEUROPATHY IN LYME NEUROBORRELIOSIS
N. Deleva, A. Kaprelyan, S. Geneva, Al. Tzoukeva , I. Dimitrov
I st Clinic of Neurology, Department of Neurology, Prof. P. Stoyanov Medical University of Varna, Bulgaria
ABSTRACT: Introduction: Lyme borreliosis is a multisystem inflammatory disease caused by the spirochete Borrelia burgdorferi, transmitted to humans by infected ticks. The neurological involvement most frequently presents with various types of neuropathy or may include symptoms and syndromes caused by cerebral and spinal cord damage. Objective: to study the clinical manifestations and outcome of cranial and spinal neuropathies in patients with Lyme neuroborreliosis. Material and methods: Twelve patients (6M/6F, between 22 to 57 years of age) with cranial and spinal neuropathy of various types were included in the study. The diagnosis of neuroborreliosis was based on the medical history, neurological examination, EMG, and specific laboratory tests. Up to 3 years patients’ follow-up was done. Results: Two patients had optic neuritis with asymmetrical reduction of vision in both eyes. Two patients presented with involvement of cranial nerves and two with unilateral facial nerve palsy. Eight of all patients demonstrated clinical features of asymmetrical sensory-motor polineuropathy with distal paresthesias and loss of vibration sensation. EMG study showed axonal degeneration in eight patients, segment demyelination - in three, and involvement of central motor neuron - in one. Conclusion: Our study focus on cases with various types of isolated and rarer concomitant cranial and spinal neuropathies. Special attention should be paid to patients with vasculitis-associated opticopathy, particularly with regard to the prognosis of severe papilledema development. Although the benign clinical course of spinal neuropathies, we emphasize on the medico-social significance of neuroborreliosis as a potential cause for neurological disabilities.
Key words: Lyme neuroborreliosis, neuropathy, clinical manifestation, outcome

< back > Published online - Nov. 08, 2007, /Page 50-52/

Tc-99m MIBI SPECT AND CT FINDINGS IN STURGE-WEBER SYNDROME WITH CLINICAL DETERIORATION: A CASE REPORT
Kaprelyan A. , N. Deleva, P. Bochev *, A. Klissarova *, Al. Tzoukeva, B. Balev *, G. Kyuchukov **
I-st Clinic of Neurology; *Department of Radiology and Nuclear medicine; **Department of Neurosurgery, Prof. Paraskev Stoyanov Medical University of Varna , Bulgaria
ABSTRACT: Introduction: The SWS, also called encephalo­trigeminal angiomatosis, is an extremely rare neurocutaneous disorder. The most frequent neurological manifestations include intractable seizures, focal deficits, headaches, and developmental disorders. Although the angioma progression is very rare, it may cause alteration of seizures type, frequency and extension. Case presentation: We report a 25-year young male admitted to the hospital with increased frequency of focal seizures during the last six months. A large port-wine stain presented on the right forehead and upper eyelid of his face. On neurological examination he had mild left-sided facial palsy and hemiparesis. EEG found a focus of epileptic activity in the left temporal region. CT scans showed extended bilateral hyperdense lesions in the temporal and occipital regions. Tc-99m MIBI brain SPECT demonstrated lack of radioisotope uptake. Medical history revealed onset of generalized seizures at the age of six months. Primary CT scans and clinical findings were interpreted as cerebral angiomas with symptomatic epilepsy. After standard antiepileptic treatment a temporary seizures control was achieved. Conclusion: We suggest that Tc-99m MIBI SPECT and CT neuroimaging may be useful for the detection and differential diagnosis of brain lesions in SWS presenting with clinical deterioration.
Key words: SWS, angiomas, calcifications, intractable seizures, brain SPECT , CT

< back > Published online - Nov. 08, 2007, /Page 53-55/

Familial benign chronic pemphigus (Hailey-Hailey disease)
Ivelina Yordanova, Dimitar Gospodinov, Valentina Chavdarova, Savelina Popovska*
Department of Dermatology and Venereology, *Department of General and Clinical Pathology, Medical University - Pleven, Bulgaria
Summary: Familial benign chronic pemphigus (Hailey–Hailey disease) is a blistering dermatosis, which is inherited as an autosomal dominant trait and usually presents around the third and fourth decades. Painful erosions, vesico-pustules and scaly erythematous plaques appear at sites of friction such as the sides of the neck, the axillae, the groins and the perineum. A case of familial benign chronic pemphigus in a 54 year-old woman is presented. The disease started at the age of 35. The areas of predilection are the axillary and submammary folds and genital area. Erythematous, macerated plaques were found with multiple painful fissures, vesicles and crusts in its periphery. The diagnosis was established on the basis of physical examination and was confirmed by histological examination of a skin biopsy. A suprabasal cell separation (acantholysis) of the epidermis was found. A family history is present. An autosomal dominant mode of inheritance was confirmed by genealogical analysis. Thirteen members have been affected by the same disease. In the presented case topical and systemic antibiotics, antimycotics, corticosteroids and retinoids were applied with a transient result. The patient was treated with topical Pimecrolimus which showed a good result. Postlesional hyperpigmentations were found after this treatment.
Key words: Familial benign chronic pemphigus, Hailey–Hailey disease, acantholysis, Pimecrolimus.

< back > Received - Sept. 29, 2007; Published online - Nov. 14, 2007, /Page 56-58/

A familial case of Gorlin-Goltz syndrome.
Ivelina Yordanova, Dimitar Gospodinov , Veselin Kirov *, Verka Pavlova , Galja Radoslavova
Department of Dermatology and Venereology, *Department of Oncology, Medical University – Pleven, Bulgaria
Summary: Gorlin-Goltz syndrome (GGS) also known as Nevoid Basal Cell Carcinoma Syndrome is a rare autosomal-dominant disorder characterized mainly by the presence of multiple basal cell carcinomas (BCC), odontogenic keratocysts of the jaw and palmar pits. This syndrome is associated with a wide spectrum of developmental anomalies and neoplasms. A case of familial Gorlin-Goltz syndrome with many of the common manifestations is reported. A 29 year-old woman and her 50 year-old mother with GGS are presented. The disease started respectively at the age of 18 and 22, with multiple basal cell carcinomas on the face and upper extremities. Because of multiple odontogenic keratocysts of the jaws they two have been treated surgically. Clinical, cranial CT, histological and dermoscopy images from both patients were obtained. Multiple BCC in the mother and the daughter were detected, nodular and superficial spreading, 10 - 30 mm in diameter. The daughter has many pits on her palms. Palmar pits have a characteristic dermoscopy with red globules inside the flesh-colored, slightly depressed lesions. The histological examinations revealed different histological variants of BCC. The X-rays examination showed two jaw cysts in the daughter, calcifications of the brain falx and bridges of the sella turcica in both patients. The BCC in the patients were treated with cryosurgery and surgical excisions with good results. The patients are followed up. In conclusion our case demonstrated multisystemic involvement of GGS. The combination of clinical, imaging and histological findings is helpful in identifying GGS patients. It is important to make an early diagnosis and a proper management in GGS, which may have cancer predisposition. The genealogical analysis is important for the determination of the genetic risk and the prognosis for the proband’s relatives.
Key words: Gorlin-Goltz syndrome, basal cell carcinomas, jaw odontogenic keratocysts, palmar pits, dermoscopy, cryosurgery.

< back > Received - Sept. 29, 2007; Published online - Nov. 14, 2007, /Page 59-63/

Generalized morphea: a case report
Valentina Dimitrova, Ivelina Yordanova, Dimitar Gospodinov
Department of Dermatology and Venereology, Medical University – Pleven , Bulgaria
Abstract: Generalized morphea is a subtype of localized scleroderma, which lacks systemic manifestations and displays widespread, multiple, well-circumscribed, indurated plaques.
We represent a 46-year-old woman with generalized morphea. More than 3 years ago she developed multiple, nonpruritic plaques symmetrically on the trunk and extremities.
The patient’s clinical history, laboratory analysis and histopathologic examination were consistent with generalized morphea, a rare subtype of localized scleroderma.
Key words: localized scleroderma, morphea, generalized morphea

< back > Received - Sept. 29, 2007; Published online - Nov. 14, 2007, /Page 64-66/

GEMCITABINE/CISPLATIN CONTAINING CHEMO­THE­RAPY IN PATIENTS WITH STAGE III-IV NON SMALL CELL LUNG CANCER
Deyan Davidov,
Department of chemotherapy, Oncological center, Medical University, Pleven, Bulgaria
SUMMARY: Backgraund: A two- drug platinum- based regimens is the standard first- line treatment for inoperable non- small cell lung cancer /NSCLC/ patients with perfomance status /PS/ 0-2. The aim of this study was to evaluate the efficacy and safety of chemotherapy combination Gemcitabine- cis-Platinum in patients with advanced NSCLC. Methods: Thirty-four patients with unresectable, histologically proven stage III/IV NSCLC entered the study. Chemotherapy consist of Gemcitabine 1250 mg/m 2 on day 1 and 8 and CDDP 80 mg/m 2 with hyperhydration on day 1 with repetition after 21 days until progression. Results: One complete response and eleven partial response was obtained. The main grade toxicity included neutropenia, thrombocytopenia, nausea/vomiting, neuropathy. Conclusions: Gemcitabine/CDDP were feasible and effective in stage III/IV NSCLC patients with 35.5% response rate and mild to moderate toxicity.
Key words: Gemcitabine, Non small cell lung cancer, Response rate

< back > Received - Sept. 26, 2007; Published online - Nov. 15, 2007, /Page 67-69/

LETROZOLE IN THE TREATMENTOF PATIENTS WITH ADVANCED OR METASTATIC BREAST CANCER
Deyan Davidov
Department of chemotherapy; Oncological center Medical University, Pleven
Resume: Backgraund: Approximately 75 % of breast cancers are hormone sensitive, and hormonetherapy is effective for many of these patients. The aim of this study is to evaluate the efficacy and safety of treatment with Letrozole in postmenopausal women with advanced or metastatic breast cancer. Methods: Thirty two postmenopausal women with histologically or cytologically proven breast cancer who presented with either locally advanced or had metastatic breast cancer, entered the study. Tumors were required to be estrogen or progesterone receptor positive. Therapy consists of Letrozole 1 mg daily per os. Results: Thirty two patients were treated in Pleven Medical University- Department of chemotherapy. Three complete responses and seven partial responses were obtained. The main grade toxicity included rush and hot flushes. Conclusions: Letrozole was effective in patients with advanced or metastatic breast cancer with 38.2% response rate and mild to moderate toxicity.
Key words: Breast cancer, Letrozole, Survival

< back > Received - Sept. 26, 2007; Published online - Nov. 15, 2007, /Page 70-72/

Temporary henna tattoos - new aspects of allergy to para-phenylene diamine
Jana Kazandjieva, Nikolai Tsankov
Department of Dermatology, Medical University - Sofia, Bulgaria
Summary: Para-phenylene diamine is a powerful and well known allergen. Nevertheless PPD is widely used for the making of temporary henna tattoos. It is added to the henna paste and afterwards applied directly onto the skin. This way the popular henna tattoos may cause allergic reactions. We present two patients with allergic reactions due to temporary henna tattoos. Patch testing showed a strongly positive reaction to para-phenylene diamine. People with known reactions to PPD or cross-reacting allergens such as sulfon­amides, para-amino benzoic acid, sulfonylureas, dapsone, azo dyes or benzocaine should be especially cautious of black henna tattoo application.
Key words: contact dermatitis, henna, para-phenylene diamine, temporary henna tattoos

< back > Received - Oct. 26, 2007; Published online - Nov. 22, 2007, /Page 73-74/

PRECIPITATED WITHDRAWAL REACTION TO OPIATES IN CASES OF IMPROPER USE OF NALTREXONE
Marieta Iovcheva, Snezha Zlateva , Maria Asparuhova
Department of Toxicology, Hospital Base for Active Treatment- Varna, Military Academy- Sofia, Bulgaria
Summary: Lately Naltrexone is often used as a part of the complex overall drug rehabilitation program as an adjunct to maintenance of an opioid-free state in detoxified former opioid-dependent patients. However when the medicine is not applied properly according to the treatment safety protocol, different adverse effects can occur. The most important and dangerous of them is the occurrence of a strong precipitated withdrawal reaction to opiates. The authors describe 16 cases of Naltrexone precipitated withdrawal- 5 hospitalized and 11 ambulatory. Only 6 patients started Naltrexone treatment after a psychiatrist consultation. All the patients did not keep the necessary safety protocol of the medicine. 4 cases had a severe clinical presentation, 1 of them ended lethally. The treatment of the withdrawal is discussed and the necessity of strict clinical observation during the first days of Naltrexone use.
Key words: naltrexon, opioid, withdrawal, addiction.

< back > Received - Sept. 28, 2007; Published online - Dec. 12, 2007, /Page 75-77/

AN INVESTIGATION OF THE FREQUENCY OF EXOTOXIC COMAS IN VARNA REGION FOR A PERIOD OF 10 YEARS
Snezha Zlateva, Petko Marinov , Hr. Bozov *, Marieta Yovcheva, Stanimila Petrova
Military Academy- Sofia, Hospital Base for Active Treatment - Varna , Department of Toxicology, *Department of Anesthesiology, Hyperbaric and Intensive Medicine
Summary: Purpose : Study of the acute exogenic coma (frequency, degree and duration). Some specific and diagnostic procedures in coma status, and supportive and detoxic- removal treatment. Material and methods: 5381 patients (treated in Naval hospital – Varna ) with acute intoxication have been examinated in 10 years period (1995-2005). The coma status was defined with IV degree scale. The duration of the coma was measured in hours and days. The toxic substances were established after gas-chromatography analyses. Results : We establish 5.52 ± 0.31% coma frequency in all of the acute intoxications. In deep coma status was 38.72%, in superficial coma - 61.27%. Under endotracheal intubation was 38.72%, without - 61.27%, with SPV (supportive pulmonary ventilation)- 13.46%. The pool of patients with short coma (until 6 hours-37.71%) is with the most frequency, the next are - until 24 hours; 48 hours, until 3 days and more than 3 days. Our investigation gives information about actual xenobiotics that cause most often heavy intoxications, sometimes with exitus letalis.
Key words: acute intoxication, coma, shock, SPV, extracorporal detoxication.

< back > Received - Sept. 28, 2007; Published online - Dec. 12, 2007, /Page 77-78/

AN INVESTIGATION ON THE RELATIONSHIP BETWEEN THE COMATOSE STATE AND THE SERUM LEVELS OF THE TOXIC AGENTS IN PATIENTS WITH ACUTE EXOGENOUS INTOXI­CATIONS
Snezha Zlateva, Petko Marinov , Yulichka Sabeva *, Marieta.Iovcheva
Department of Toxicology, Hospital Base for Active Treatment - Varna, Military Academy - Sofia, *Laboratory for Chemical Toxicology Investigations
Summary: The aim of investigation of the relationship between the exotoxic coma and the serum levels of the toxic substances in patients with acute intoxications. We defined cerebral toxic agents were in 44 of the comatose patients. The established concentrations of the toxic substances at the admittance in the blood serum of comatose patients have been classified as fatal, toxic or therapeutic.These results show that in cases of mixed intoxications the coma can be associated more often with toxic or even therapeutic levels of the substance. We discuss that the plasma levels of a substance can not serve as criteria of severity of an intoxication in all cases as they are formed by the complex toxicokinetic of every medicament.; We can not predict the outcome of an intoxication using only it;. The plasma level of a substance can not be a precise criterion for the therapeutical scheme-a full volume of detoxic depuration measures should be carried out / sometimes the low plasma levels of a toxic agent can give a misleadi ng data about a light intoxication /. The plasma level by itself can not be a precise criterion when we take a decision to make an extracorporeal detoxification of the blood as we expect from this method to extract the medicaments from their tissue depot and to raise their serum concentrations after that.
Key words: plazma level, drugs, comma

< back > Received - Sept. 28, 2007; Published online - Dec. 12, 2007, /Page 79-80/

DETERMINATION OF TOXIC SUBSTANCES IN SWEAT SECRET OF SEVERE FORMS OF POISONING - TOXIC COMA. CLINICAL MEANING.
Snezha Zlateva, Petko Marinov, Yulichka Sabeva*
Military Academy- Sofia, Hospital Base for Active Treatment- Varna, *Department of Toxicology, Laboratory for Chemical Toxicology Investigations
Summary: The aim is to i nvestigation of toxic substances in sweat secret, blood and urine of patients with toxic coma. Study includes 4 patients in toxic coma, caused by: amitriptyline, diazepam, carbamazepine, amitriptyline and clomipramine. The concentration of the drugs substances is determined in sweat samples, collected after stimulation of ecrine sweat glands, using the pilocarpin ionophoresis - a modificated method by Gibson and Cooc (1959), and in blood and urine, taken at the same time with the first sweat sample. The analytical procedure includes a separation of the drugs from the sample with organic solvent, concentrating the extract, followed by analysis of the extract with GC 5890-series II, equipped with MSD-5971 and LC 1090-series II, Hewlett Packard. We have proved that in all sweat samples drugs exist (amitriptyline, diazepam, carbamazepine, amitriptyline and clomipramine). The drug concentration in sweat, compared to blood and urine, is less in all samples.
Key words : amitriptyline, diazepam, carbamazepine, amitriptyline and clomipramine; sweat glands; toxic coma

< back > Received - Sept. 28, 2007; Published online - Dec. 12, 2007, /Page 81-83/

SOME PATHOGENICALLY ASPECTS OF THE SKIN-DYSTROPHIC SYNDROME IN ACUTE INTOXICATIONS
Snezha Zlateva, Petko Marinov
Department of Toxicology, Military Academy- Sofia , Hospital Base for Active Treatment - Varna ,
Summary: The pathogenesis of the skin lesions in acute intoxications is still not clear and the strict mechanism is not defined. Our 10 year investigation reveals considerable relationship between skin lesions appearance and frequency of coma status (RR = 25.59±2.53) and other clinical and laboratory factors connected with the coma. We discussed some mechanisms that may be important to form the skin lesions: 1.Neurotoxicants interacted with neuromediathors in CNS and their trophic function to skin cells is disturbed. 2.Neurotoxicants interacted with the skin microcirculation (permeability and motility) by three ways: direct toxic interaction; through neuromediathors and through vessel’s obstructions when there is pressure or fixation. 3.Through other trophic metabolites (CÎ 2, ATP, lactat, cADP, cAMP) in cells and interstitial space. 4. We discuss some hypothesis connected with the direct toxic mechanism of skin cell damage: through xenobiotics microsomal oxidation with cytochrome P450 and forming free oxygen species and in consequence - damage of the cells membrane; through excretion by sweat glands and hair follicles.
Key words: xenobiotics, neurotoxins, coma, CNS, poison, skin bullae lesions

< back > Received - Sept. 28, 2007; Published online - Dec. 12, 2007, /Page 83-85/

MODEL OF PREVALENCE AND TREATMENT OF SKIN-DYSTROPHIC DAMAGES BY EXOTOXIC COMMAS
Snezha Zlateva, Petko Marinov, Yulichka Sabeva *,
Military Academy - Sofia, Hospital Base for Active Treatment- Varna, *Department of Toxicology, Laboratory for Chemical Toxicology Investigations
Summary: Patients with severe acute intoxications induced by drugs, narcotics, alcohol and organophosphates (according to our observations) develop specific skin syndrome. It reveals early after ingestion and includes erythema spots, bullae, soft tissue infiltrations, decubitus ulcers and necrosis.The aim of our study is to assess the effect of applying different schemes for treating skin damages in patients with comma after different poisonings. To build a model for their prophylaxis and treatment. We have used following methods: Prevalence – nurses’ cure; clinetronic beds. Conservative cure- dry dressing; moist dressing with rivanol, jodasept, hibitan; fat dressing wih deflamol, Vishnevski fat, cortisone fat; enzyme necrectomia with 40% acidi bensoici, iruxol. Surgery methods- debridment, skin-muscle plastic. Hyperbaric oxigenation - 10 consecutive procedures, repeated again after 20-30 days. Physiotherapeutical methods- helium- neon laser, magnetic field, diadynamic electricity ( Bernard ’s current). Our results sho w a faster period of healing when skin lesions have been medically treated then left to heal spontaneously.
Key word: erythema spots, bullae, soft tissue infiltrations, decubitus ulcers and necrosis, drugs, narcotics, alcohol and organophosphates, comma, poisoning.

< back > Received - Sept. 28, 2007; Published online - Dec. 12, 2007, /Page 86-89/

Epidemiological Analysis of Acute In­toxications in Varna Region for a 15 Years Period
Petko Marinov, Sneza Zlateva, Yulia Sabeva*, Marieta Iovcheva
Department of Toxicology, *Laboratory of Chemistry Toxicology Investigations, Military Naval Academy – Hospital Base for Active Treatment – Varna , Bulgaria
Summary: The difficult transitional period to a market economy gives its reflection on the number of the acute intoxications. They can be used as a social barometer of the politico­economic changes in our country. During the last 15 years a steady tendency has been outlined in the dynamics of part of the acute intoxications expressed with minor deviations in the frequency. On the other side, the climate-related intoxications like mycetism or intoxications related to some stages of social development marked by “fashion trends” as use of narcotic substances and psychostimulants show significant differences.

< back > Received - Oct. 16, 2007; Published online - Dec. 12, 2007, /Page 90-91/

Denaturated Alcohol As A Frequent Source Of Methanol Intoxication
Yulichka Sabeva, Petko Marinov *, Sneza Zlateva*, Mariana Koleva
Toxico-chemical Laboratory, *Department of Toxicology, Naval Hospital-Varna
SUMMARY: Ethyl alcohol – spirit for technical designation, denaturated is used mostly as dissolving agent in chemical industry and in the everyday life as a spirit for burning. It consists of 95 % ethyl alcohol to which different substances are added and coloring agents to become not fit to drink. For the chemical industry the most often used substances are –methyl alcohol (5 –10%); pyridine bases (0.5 %); benzol (5-10%); chloroform (5%); acetone (10%), petrol (1%) and many others (4).
The spirit for burning in the household is denaturated with methyl alcohol (3-4%) or pyridine (0.25%) and is indicated with the coloring agent methyl-violet which gives it a special blue-violet color. According to the state standards the spirit for burning has to contain not less than 94.5% ethyl alcohol and not more than 1 % methyl alcohol as denaturating agent (1).
Key words: ethyl alcohol; methyl alcohol; acute poisoning

< back > Received - Oct. 16, 2007; Published online - Dec. 12, 2007, /Page 92/

SIGNIFICANCE OF THE TOXICOCHEMICAL ANALYSIS FOR THE TREATMENT OF THE ETHYLENE GLYCOL POISONING
Yulichka Sabeva, Petko Marinov *, Sneja Zlateva *
Toxico-chemical Laboratory, *Department of Toxicology, Naval Hospital-Varna
SUMMARY: Ethylene glycol can cause severe acute poisonings. In three patients the blood and urine concentration of ethylene glycol and its antidote ethyl alcohol is determined thanks to gas chromatographic methods. The monitoring of concentrations of ethylene glycol in blood and urine determinates the therapeutic methods.
Key words: Ethylene glycol; acute poisoning.

< back > Received - Oct. 16, 2007; Published online - Dec. 12, 2007, /Page 93-94/

Cases of non-clinically manifested methanol intoxications – diagnostics and behaviour
Stanimila Petrova, Yulichka Subeva*, Petko Marinov, Marieta Yovcheva
Clinic of Toxicology, *Toxico-chemical Laboratory, Naval Hospital-Varna
Summary: The high toxicity of methyl alcohol is usually related to the created formaldehyde and formic acid in organisms. Some researchers, however, assign the high toxicity to other factors such as the long-time circulation of methyl alcohol in blood in an unaffected fashion. For that reason, in cases of non clinically manifested intoxications, the results of the chemical and toxicological analysis play core and very important role for the diagnostics and follow up treatment procedures.
Key words: methyl alcohol; acute poisoning.

< back > Received - Oct. 16, 2007; Published online - Dec. 12, 2007, /Page 95-96/

EPIGENETIC SILENCING OF MLH1 AND p16 INK AND THEIR RELATION TO CERTAIN CLINICOPATHO­ LOGICAL FEATURES IN PATIENTS WITH COLORECTAL CANCER
Milko Mirchev, I. Kotzev, P. Kahl*, R. Buttner*, L. Angelova**, B. Manevska***, T. Kadyiska****
Clinic of Gastroenterology, MHAT ”St. Marina”, Varna, Bulgaria; *Institute of Pathology, Medical University of Bonn, Germany, **Department of Genetics, ***Department of Pathology, MHAT “St. Marina”, Varna, Bulgaria, ****Molecular Pathology, MHAT “Maichin dom”, Sofia, Bulgaria
ABSTRACT: Introduction: Promoter methylation as a cause of gene inactivation has been studied mainly by qualitative methods. MLH1 and p16 INK are important tumor-suppressor genes that are often silenced in cancer. Aim: To study the level of mlh1 and p16 and to correlate the data with certain clinico-pathological features. Materials and methods: 181 colorectal cancer patients were included in the study. DNA was extracted from all of them, subjected to bisulfite treatment, PCR and pyrosequencing allowing quantitative methylation analysis. Results on MSI status, TNM classification and histology were previously available. Results: Only high level and dense mlh1 methylation caused loss of protein expression. Those tumors tended to be proximal, low differentiated, had elevated mucin production, and were seen in elderly patients. No correlation between the level of p16 INK methylation and tumor location, age, sex, stage and degree of differentiation was found. However, a group of tumors with T4, presence of lymph node and liver metastasis exhibited higher level of p16 INK methylation. About 6% of the cases showed dense and elevated methylation in both genes. These were proximal, low differentiated, had high mucin production, and were present in older and female subjects. None of them had liver metastasis which did not reach statistical significance. Conclusions: Different levels of promoter methylation in the studied genes are observed. These molecular features are associated with certain clinico-pathological parameters and allow additional stratification of tumors.
Key words: colorectal cancer; promoter methylation; quantitative analysis; pyrosequencing

< back > Received - Dec. 12, 2007; Published online - Jan. 10, 2008, /Page 97-102/

Asymmetric dimethylarginine in hyper­cho­lesterolemic patients
Lyudmila Vladimirova-Kitova, Dora Terzieva *, Fedya Nikolov , Nonka Mateva **
Department of Cardiology, *Department of Clinical Laboratory, **Department of Social Medicine and Medical management, Medical University , Plovdiv, Bulgaria
ABSTRACT: Background: In the medical literature, data on the levels of ADMA in patients with HH is scarce. Aim: To study the level of asymmetric dimethylarginine in asymptomatic, marked, never-treated hypercholesterolemia. Methods: 30 asymptomatic patients with marked, nevertreated hypercholes-terolemia and 30 controls were evaluated. The plasma level of asymmetric dimethylarginine (ADMA) was tested by ELISA method. Results: A statistically significant difference was found between patients and controls, regarding all tested parameters, including lipid and non-lipid marker - asymmetric dimethylarginine. (p<0.001) Conclusion: It is concluded that asymptomatic, marked, nevertreated HH is associated with elevated levels of ADMA, and this is related to the proportional increase in total cholesterol.
Key words: LDL-cholesterol, apolipoproteins, endothelium- dependent vasodilation, ultrasound.

< back > Received - Feb. 12, 2008; Published online - Apr. 11, 2008, /Page 103-105/

Apolipoprotein-B as a predictor of asymmetric dimethylarginine in hyper­cholesterolemic patients
Lyudmila Vladimirova-Kitova, Dora Terzieva *, Fedya Nikolov , Nonka Mateva **
Department of Cardiology, *Department of Clinical Laboratory, **Department of Social Medicine and Medical management, Medical University , Plovdiv, Bulgaria
ABSTRACT: Background: Regarding the correlative dependence of ADMA with biomarkers of atherogenic risk in HH, reviews of the literature reveal contradictory findings. Aim: Determinate a predictor of high level of ADMA in patients with asymptomatic, marked, never-treated hyper-cholesterolemia. Methods: Thirthy asymptomatic patients with marked, never-treated hypercho-lesterolemia and total cholesterol < 7.5mmol/l and age above 16 years. Lipid profil, creatinine, apolipoprotein-A 1 and apolipoprotein-B were investigated using biochemical analyzer Konelab 60i, Thermo Electron Co, USA . The plasma level of asymmetric dimethylarginine (ADMA) was tested by ELISA method. Results: A statistically significant and strong correlation dependence between ADMA and age (r xy = 0.688; p<0,0001) Statistically significant correlation dependence between ADMA and other atherosclerotic biomarkers (cholesterol of lipoproteins with high density (HDL), cholesterol of lipoproteins with low density /HDL-cholesterol, apolipoprotein-B, apolipoprotein-B/À 1) is found. Conclusion: It is concluded that ADMA is the basic modulator of %FMD among all tested atherogenic risk biomarkers in asymptomatic, marked, never-treated hypercholesterolemia.
Key words : LDL-cholesterol, apolipoproteins, asymmetric dimethylarginine, predictor

< back > Received - Feb. 12, 2008; Published online - Apr. 11, 2008, /Page 105-107/

GANGLION TRIGEMINALE – LARGE LIGHT PSEUDOUNIPOLAR NEURONS
Dimo Krastev
Department of Anatomy and Histology, Preclinical University Center, Faculty of Medicine, Medical University, Sofia, Bulgaria
Summary: Pseudounipolar neurons in ganglion trigeminale (GT) were described citologically by Retzius(1880). Cells vary in size in rather wide diapason in the ganglion itself of the same individual, and in ganglia of different species as well. Size of the cells are from 10 to 110 µm and biggest pseudounipolar neurons were described by Buhler(1898) in human spinal ganglion with size of 120 µm.
Key words : ganglion trigeminale, pseudounipolar neurons.

< back > Received - Jan. 22, 2008; Published online - Apr. 14, 2008, /Page 108-110/

LIGHT – MICROSCOPIC STRUCTURE OF TRIGEMINAL GANGLION IN HUMANS
Dimo Êrastev, Adrian Paloff, Dimka Hinova-Palova, Alecsander Apostolov *, Wladimir Ovtscharoff
Department of Anatomy and Histology, Preclinical University Center, *Department of Forensic medicine and deontology, Faculty of Medicine, Medical University, Sofia, Bulgaria
Abstract: Neurons in the trigeminal ganglion (TG)that are different in size have been visualized using light-microscope methods. Pseudounipolar neurons in trigeminal ganglion are sensory cells. The trigeminal ganglion is à main generator of information from the orofacial complex in the human as well as in different types of mammals. In conclusion, trigeminal ganglion is à related station that receives information, arranges it and transmits the signal to the brain.
Key words : trigeminal ganglion, pseudounipolar neurons, sensory cells, cytoarchitectonic.

< back > Received - Jan. 22, 2008; Published online - Apr. 14, 2008, /Page 111-113/

SATELLITE CELLS OF TRIGEMINAL GANGLION
Dimo Krastev
Department of Anatomy and Histology, Preclinical University Center, Faculty of Medicine, Medical University, Sofia, Bulgaria
Summary: Trigeminal ganglion is composed of ganglion cells (pseudounipolar neuron), satellite cells and their fibers. Altman and Bayer (1982) tend to see the origin of these cells in the trigeminal ganglion, emphasizing on the fact that they are part of the neuronal ridge/arch. Davis and Lumsden(1990) in their publications describe development of the trigeminal ganglion, confirming their standpoint concerning the origin from neuronal ridge/arch and ectodermic placoids. This standpoint was confirmed by Rhoades (1991).
Key words: Trigeminal ganglion, satellite cells, neurons.

< back > Received - Jan. 22, 2008; Published online - Apr. 14, 2008, /Page 113-115/

SMALL NEURONS IN SENSORY GANGLI
Dimo Krastev
Department of Anatomy and Histology, Preclinical University Center, Faculty of Medicine, Medical University, Sofia, Bulgaria
Summary: Ganglion terminale (GT) in its essence displays gathering of pseudounipolar neurons, situated in impressio ganglion trigeminale of the pyramid. Peripheral tentacles of pseudounipolar cells take place in formation of first, second and third reception parts of the third branch of V cerebral nerve and central ones form receptive root entering into middle cerebellar peduncle.
Key words : receptive cells, small neurons, ganglia, pseudounipolar neurons.

< back > Received - Jan. 22, 2008; Published online - Apr. 14, 2008, /Page 116-118/

Biliary Complications After Orthotopic Liver Transplantation
Ludmil M. Veltchev
Department Abdominal surgery, CHUV, University Hospital – Lausanne
Summary: Biliary complications after liver transplantation occurred as frequent cause of morbidity and mortality after liver transplantation. They are considerate as the technical ‘’Achilles heel’’(1).
In this article we have described and analyzed the frequency and the characteristics of the most common biliary complications after liver transplantation based on our experience in University Hospital in Lausanne, Switzerland.
Over a 15-year period from December 1988 to March 2003, 185 orthotropic transplantations were performed on 168 patients. Of the all patient 103 patients were males and 65 females. The average age for males was 51 and for women were 49. End-to-end choledochocholedochostomie with tutor (CC-T) or without (CC) was the first choice method of biliary reconstruction and he was performed on the 168 patients. In 17 causes patients received choledochojejunostomies (CJ) with a long Roux-Y-loop.Biliary complications were identified in 30 (16%) of the 185 OLT. The percent of the early deaths (after detection and treatment the complications) were 0%. The most common biliary complication was bile duct strictures (anstomotic or nonanastomotic), bile leaks and biliary stones.
The biliary complications remain an important cause of surgical morbidity but rarely associated cause of dead. Diagnosis relies on laboratory analysis, abdominal imaging and cholangiographic studies. Management of the detected biliary complications includes nonsurgical and surgical methods. Nonoperative interventions have an increasing role in the treatment. Biliary complications were identified in these series are representatives when the results observed by the other medical centers the Liver Transplantation.
Key words: Orthotropic liver transplantation; Biliary complications; Management of biliary problems after liver transplantation

< back > Received - Apr. 2, 2008; Published online - Apr. 25, 2008, /Page 119-122/

Echinococcus multilocularis-helminto­sis with “malign” developmen
Ludmil M. Veltchev
Department Abdominal surgery, CHUV, University Hospital – Lausanne
Summary: Echinococcus multilocularis v.alveococcosis has become an increasingly serious public health issue. In endemic areas of Southern Germany , Eastern France and North West Switzerland the estimated prevalence is 1-10/100000. Its evolution is chronic and heavy, with primary tumor like multymicrocyst proliferation in the liver and secondary “spread” in other organs. Without adequate surgical treatment morbidity and mortality are significant.
The author presents two cases ref. patients treated in Department of Surgery at University Hospital of Lausanne, located in an endemic region for this disease.
Key words: Echinococcus multilocularis, malign development

< back > Received - Apr. 2, 2008; Published online - Apr. 25, 2008, /Page 123-124/

RECURRENT HYDATID CYSTS - REPORT OF 9 CASE
Ludmil M. Veltchev
Department of General Surgery; Medical University Sofia , Bulgaria
Abstract: The hydatid disease is widely spread and is rare zooantroponous parasitosis in endemic regions, one of which is The Balkan Peninsula. The size of the cyst is different: from a diameter in millimeters, which is undetectable, to prominent in epigastria. Many patients return after operation for hydatid cyst with a recurrence. The aim of this report is to present 9 cases with recurrent hydatid cysts: 7 patients after previous treatment and 2 with rupture and abdominal cavity dissemination of the cyst containing multiple laparotomies.
Key words: echinococcosis, hydatid disease, cyst, recurrence

< back > Received - Apr. 2, 2008; Published online - Apr. 25, 2008, /Page 125-127/

Last edition: April 25, 2008

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