 |
Journal
of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski
ISSN: 1312-773X (Online)
Issue: 2008, Book 1,
Subject Collection: Medicine
Pages: 3 - 97
Date of close: April 2009
CONTENTS:
FLOWCYTOMETRY IN LEPTOSPIROSIS
Galya Gancheva,
M. Atanasova , Tz. Lukanov*, P. Ilieva
Department of Infectious Diseases, Epidemiology, Parasitology, and
Tropical Medicine; *Sector of Clinical Immunology; Medical
University, Pleven, Bulgaria
SUMMARY:Differential count of leucocytes and six
lymphocyte populations and subpopulations were investigated by flow cytometry
in fourteen cases with leptospirosis. Marked granulocytosis and lymphopenia
were found in 100%. The percentage of the monocytes was significantly
decreased (mean 6,65%; 0,7 to 14,0%; sd 5,49). Immunophenotypization of
lymphocyte populations and subpopulations by flow cytometry was revealed
prevalent tendencies for decreasing of the number of total T-lymphocytes,
T-helpers, T-suppressors, T-helpers/T-suppressors index; increasing of
the number of the activated T-lymphocytes, subpopulation of NK cells (CD3-/
CD16+56+), and B-lymphocyte. These data are suggested that cell-mediated
immunity plays a role in later stages of the diseases.
Key words: leptospirosis, immunogenesis, flow cytometry,
lymphocyte subpopulations, dysregulation.
<
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3-5/
A CASE OF SWIMMING POOL GRANULOMA
St. Racheva ,
St. Pavlov , I. Krasnaliev*
Sector of Education and Science, and Clinic of Dermatology and Venerology
*Department of General and Clinical Pathology, University
of Medicine - Varna, Bulgaria
Resume: The described case is of an infected patient
with proven atypical mycobacterial infection and with developed granolomatous
clinical picture, localized on the distal upper limb. The infection started
several weeks after skin contact with aquarium water and a skin cut. Several
nodular, purple reddish lesions developed, which spread and formed a compact
mass of about 3 cm. Wrongly diagnosed, the patient was subjected to numerous
unsuccessful treatments for six years.
The patient was diagnosed after a histological test.
The treatment started initially with Vibramycin, which was not effective
enough. It continued with Claritromycin and after a 90-day therapy led
to the complete disappearance of the nodular lesions on the skin.
Key Words: Swimming pool granuloma, Mycobacterium marinum
- infection, Atypical mycobacterial skin infection, treatment
<
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6-8/
INFECTIOUS MONONUCLEOSIS – DIAGNOSTIC POTENTIALS
M. Karcheva ,
Tz. Lukanov*, S. Gecheva*, V. Slavcheva**, G. Veleva*, R. Nachev***
Department of Epidemiology, Medical University,
Pleven; *) Department of Immunology,
University Hospital, Pleven;
**) Clinic of Haematology, University
Hospital, Pleven; ***) Clinic
of Pathology, University Hospital,
Pleven , Bulgaria
Summary: Infectious mononucleosis is a disease in
children and adolescents. It is common mainly in countries with temperate
and cold climate. Patients usually present with fever, sore throat, lymphadenopathy,
often hepatosplenomegaly. Haematologic abnormalities include a peripheral
blood lymphocytosis, more than 10 % of the leucocytes in blood consisit
of atypical lymphocytes. Epstein-Barr virus (EBV) is an etiologic agent.
In organism it leads to characteristic immunopathogenetic process which
is visualized by various diagnostic tests. Aims:
To analyze the possibilities of flowcytometric immunophenotypization of
lymphocyte populations and subpopulations in peripheral blood in order
to differentiate the infectious mononucleosis from other benign lymphocytoses
and malignant lymphoprolific diseases. Materials and
metods: Lymphocyte subsets from whole blood were examined
in 25 acute infectious mononucleosis patients with FACSort flow cytometer.
We used monoclonal antibodies against CD3 (T-cells), CD4 (T-helper cells),
CD8 (T-cytotoxic cells), CD19 (B cells), CD56 and CD16 (natural killer
cells), CD3/HLA-DR (activated T cells), CD2 (T-cells), CD5 (T-cells),
CD7 (T-cells). Results: The levels of
CD8 T-cytotoxic cells were significantly increased in all 25 patients.
The T-cells in all cases expressed activation antigen HLA-DR and displayed
down-regulation of CD7 in the CD8+ population. Ňhree cases showed down-regulation
of CD5 in the CD8+ population. We found also that CD19 B cells and CD4/CD8
ratio were significantly decreased in all patients with acute infectious
mononucleosis. Conclusion: The data
in the present study show that acute infectious mononucleosis is characterized
by an activated CD8+ T-cell population with antigenic aberrancy (down-regulation)
of CD7 and occasionally of CD5, in addition to a decrease in B-cells and
CD4/CD8 ratio. There is specific flow cytometric constellation which makes
possible for the patients to be differentiated by infectious mononucleosis
and other lymphocytosis.
Key words : infectious mononucleosis, Epstein-Barr virus,
flow cytometric analysis
<
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9-13/
INVESTIGATION OF SPERM DNA FRAGMENTATION BY
SPERM DNA INTEGRITY ASSAY
Tzvetan Lukanov */** , D. Lichev
*/** , E. Konova */** , A. Emin */** , N. Ayvazova * , R. Kotzev *** ,
A. Velkova **** , G. Veleva ** , R. Roussev */*****
* Medical Center “Clinical Institute for
Reproductive Medicine”, Pleven; **
Center for Reproductive Health; *** Department of Surgical
diseases, Sector of Urology; **** Department of Social
Medicine, Medical University , Pleven
, Bulgaria ; ***** Millenova Immunology
Laboratories, Chicago , USA
ABSTRACT: Male-factor infertility plays a role
in approximately 50% of infertile couples. In at least 30% of cases, repeated
standard semen analyses of the male partner of an infertile couple reveal
normal results. When diagnostic work-up of the female partner is also
normal, they are classified as unexplained or idiopathic. The objective
of this study was to evaluate the levels of sperm DNA fragmentation, respectively
a sperm nuclear DNA integrity, in normospermic infertile men, by a flow
cytometric method. Materials and methods : Semen samples
were obtained from 53 normospermic infertile men and 30 fertile donors.
Flow cytometry was used to study sperm DNA fragmentation by Sperm DNA
Integrity assay and the results were expressed as a percentage of sperm
DNA fragmentation index (DFI). Results: Increase levels
of DFI were observed in 21 of 53 (39,62%) normospermic infertile men.
The %DFI in normospermic infertile men was significantly higher than fertile
donors (P = 0.03). There were statistically significant negative
correlations between DFI and sperm motility (r = –0.48, P
= 0.0001) and normal morphology (r = –0.37, P =
0.022) in normospermic infertile men, but not in fertile donors. Conclusion:
Our study indicates that the levels of sperm DNA fragmentation
in normospermic infertile men were significantly higher compared with
the levels in the fertile group. Sperm DNA Integrity assay is an independent
test of sperm quality that may have better diagnostic capabilities than
standard sperm parameters.
Key words: sperm DNA integrity, flow cytometry, male
infertility, sperm
<
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14-17/
A NON-FATAL CASE OF LYELL SYNDROME
Julia
Radenkova - Saeva
Toxicology clinic, MHATEM “ N. I. Pirogov
”, Sofia , Bulgaria
ABSTRACT: Lyell syndrome îrňoxic
epidermal necrolysis is a rare, severe a potentially life-threatening
disorder, characterized by extensive epidermal loss, suggestive of severe
scalding. The mortality associated with toxic epidermal necrolysis is
in the neighborhood of 30%. Lyell syndrome most commonly is drug induced.
However, other etiologies, including infection, malignancy, and vaccinations,
may exist. The drugs incriminated in most cases of toxic epidermal necrolysis
were the same in both groups (NSAIDs, antibacterials and anticonvulsants).
A non-fatal case of Lyell
’s syndrome is described, that have been managed in the Toxicology
clinic and Burn Centre, MHATEM “ N. I. Pirogov ”. 20-yr-old woman, suffering
from fever, accompanied by laryngo-pharyngeal pain had been treated with
Upsarin and Fervex. Her state worsened during the next days with the appearance
of facial rash, which progressively extended to the extremities and trunk,
with severe mucosal damage and bullous legions, a fever of 40°C, Intensive
care was given together with parenteral feeding. Evolution was satisfactory
with epidermization occurring in about 10 days. The patient remained in
hospital for one month.
Conclusion: Severe adverse drug reactions as
toxic epidermal necrolysis are rare. Treatment of Lyell ’s syndrome includes
prompt recognition and withdrawal of suspected drug and hospitalization.
<
back > Published online July 04, 2008, /Page
18-20/
PREGNANCY AND ISSUES WITH INHERITED AND ACQUIRED
THROMBOPHILIA
Elena Pavlova,
T. Chemev, A. Chemev, Zh. Karagiozova
University Hospital Maichin Dom, Medical University, Sofia, Bulgaria
ABSTRACT: Pregnancy is hypercoagulable state. The
field of thrombophilia; the tendency to thrombosis, has been developed
rapidly and has been linked to many aspects of pregnancy. It is recently
that severe pregnancy complications such as severe preeclampsia, intrauterine
growth retardation, abruptio placentae and stillbirth has been shown to
be associated with thrombophilia. Recurrent miscarriage has also been
associated with thrombophilia. The incidence of all types of thrombophilia
(inherited and acquired) in women with obstetrical complications is not
so rare and every specialist should think about these conditions and has
to investigate and to suspect them in their patients with recurrent fetal
loss or severe complication of the pregnancy. .
<
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21-22/
Effect of fenofibrate on the level ofasymmetric
dimethylarginine in type 2 diabetes mellitus
Lyudmila Vladimirova-Kitova
Clinic of Cardiology, Medical University, Plovdiv, Bulgaria
ABSTRACT: However, whether the beneficial effect
of fenofibrate on the endothelium is related to reduction of ADMA level
in individuals with diabetes mellitus (DM) is not known, and the current
study aimed to address this issue. Aim: A total of 60
patients with type 2 DM and dyslipidemia (aged 45 ± 8 years; mean ± SD)
were compared to 59 healthy controls without type 2 DM and normolipidemia
(aged 44 ± 9 years). Methods: Total cholesterol (TC),
triglycerides (TG), high density lipoprotein (HDL) cholesterol, Apolipoprotein-A1
(Apo-A 1) and Apolipoprotein-B (Apo-B) were investigated using biochemical
analyzer Konelab 60i, Thermo Electron Co, USA. The levels of asymmetric
dimethylarginine (ADMA), sICAM-1, sVCAM were determined by ELISA . Determination
of flow mediated vasodilatation of the brachial artery was performed based
on Celermajer’s guidelines and on %FMD manual (Celermajer et al., 1992;
Corretti et al., 2002). The diameter of the brachial artery was measured
using a 7.5 MHz transducer of Hewlett Packard 2 500 ultrasound equipment.
Automatic computer software MedicaSoft. IMT.lab was applied. The DM group
had significantly lower level of HDL cholesterol and significantly higher
levels of total cholesterol, triglycerides, LDL-cholesterol, Apo-B, Apo-A
1, ADMA, sVCAM-1, sICAM-1. The DM patients showed significantly redused
% FMD of the brachial artery in comparison to the controls. (p<0.01)
Therapy with 200 mg Fenofibrate for 1 month statistic significant reduced
total cholesterol, triglycerides, LDL-cholesterol, Apo-B, Apo-B/Apo-A
1, and ADMA. Same therapy statistical significant increased HDL-cholesterol,
Apo -A 1 and %FMD. These therapy don‘t change sVCAM-1 and sICAM-1. Conclusion:
Treatment with fenofibrate 200 mg/d for one month statistically significant
reduction in plasma levels of ADMA. (p<0.001) The present results suggest
that fenofibrate improves endothelium-dependent dilation of hypertriglyceridemic
individuals, and the beneficial effect of fenofibrate may be related to
a reduction of the level of ADMA.
Key words : diabetes mellitus, dyslipidemia, flow-mediated
vasodilation, fenofibrate
<
back > Published online July 15, 2008,
/Page 23-26/
Electronmicroscopical investigation of the small
neurons in trigeminal ganglion
Dimo
Krastev
Department of Anatomy and Histology; Faculty of Medicine, Medical
University, Sofia, Bulgaria
Summary: Trigeminal ganglion (TrG)
in its essence represents gathering of pseudounipolar neurons, situated
in trigeminl impression of the petrosal part of the temporal bone, wrapt
in connecting tissue “sleeve” of trigeminal cavity of the dura and aracknoid
maters in vicinity to back end of cavernous sinus. Peripheral tentacles
of pseudounipolar cells participate in formation of the first, second
and receptive part of the fifth cerebral nerve, and central tentacles
form the receptive root entering in middle cerebellar peduncle aside the
brainstem. .
Key words: receptive cells, small neurons, trigeminal
ganglion, pseudounipolar neurons
<
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/Page 27-29/
Trigeminal ganglium – electronmicroscopy of
large light pseudounipolar neurons
Dimo
Krastev
Department of Anatomy and Histology; Faculty
of Medicine, Medical University,
Sofia, Bulgaria
Summary: Pseudounipolar neurons in trigeminal ganglion
(TrG) 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: trigeminal ganglion, pseudounipolar neurons.
<
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/Page 30-32/
Electron-microscopical investigation of the satellite
cells
Dimo
Krastev, Krastev N.
Department of Anatomy and Histology; Faculty
of Medicine, Medical University,
Sofia, Bulgaria
Summary: Trigeminal ganglion is composed of ganglion
cells (pseudounipolar neurons), 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 > Published online July 15, 2008,
/Page 33-35/
Ultra-structure of trigeminal ganglion in human
Dimo
Krastev, Paloff A., Krastev N., Apostolov A.*, Ovtscharoff W.
Department of Anatomy and Histology; *Department
of Forensic medicine and deontology, Faculty of Medicine, Medical
University, Sofia, Bulgaria
Summary: The trigeminal ganglion (TrG) is built
of pseudounipolar neurons, their fibers and satellite cells. Neurons that
are different in size have been visualized using electronmicroscopic method.
It is particularly interesting that stored pigments are a result of age
alterations. Pseudounipolar neurons in (TrG) are sensory cells and they
receive nerve impulses from sensory nerve terminals. In conclusion, (TrG)
is a related station that receives information, arranges it and transmits
the signal to the central nervous system (CNS).
Key words: trigeminal ganglion, pseudounipolar neurons,
sensory cells
<
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/Page 36-39/
Treatment of acne vulgaris with FINACEA – GEL
Stefka Racheva,
P. Drumeva, R. Bachvarova
Department of Dermato-Venereology, Medical University - Varna, Bulgaria
Summary: Acne vulgaris is its various clinical forms
presents a therapeutic problem. Different therapeutic schemes of combined
local and systemic treatment exist and their aim isspecific effect on
infundibular hyperkeratosis or inflammation. The drugs, containing azelaic
acid ( Skinoren, Finacea) meet the criteria of ibfluencing the inflammation
and infundibular hyperkeratosis. FINACEA ( 15% Azelaic acid) is gel, designed
for treatment of acne and acne-lice eruptions. The aim of the present
study was to follow up the curing effect of Finacea – gel in patients
with acne vulgaris (mild and moderate forms), when it is applied as a
separate drug. The treated patients were 25; they all presented acne vulgaris
with predominant papulo-comedon, papulous lesions in the clinical picture.
The control checks up were perfomed every two weeks.Beside the curing
effect, the eventual side effects of the drug were also followed up. In
most of the treated with Finacea patients fast whitening and diminishing
of the papulous lesions was observed together with reducing the number
of comedons,wtich is consistent with data in literature.In patients with
acne vulgaris Finacea – gel shows comparatively fast and stable curing
effect,when applied for sufficiently long time.
Key words: Finacea - gel, Acelaic acid, acne vulgaris
<
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/Page 40-41/
Treatment of psoriasis vulgaris with Elidel
Stefka Racheva,
R. Bachvarova, J. Dimitrova
Department of Dermato-Venereology, Medical University - Varna, Bulgaria
Summary: The local calcineurin inhibitors (Pimecrolimus,
Tacrolimus) seems to be a good alternative for exeternal treatment of
atopic dermatitis and other dermatoses. Their selective effect on skin
is evidently therapeutically effective and the same time non aggressive.One
of the widen indications for both these products is Psoriasis – plaque
forms (small plaques). Pimecrolimus (Elidel) is determined as highly effective
local remedy for threatment of plaque psoriasis and a product with good
safety profile, allowing longterm treatment. We present our unpretentious
experience in local treatment of patients with Psoriasis vulgaris – plaques
forms (small plaques) with Elidel. The study includes 12 patients with
only with small plaques psoriasis lesions. Elidel 1% cream was used –
twice a day. On the basis of the performed clinical observations of patients
with plaquepsoriasis, treated with Elidel-cream, it can be concluded,
that this is an inspiring alternative for local treatment of the plaque
forms of this disease, and especially of psoriatic plaques, localized
on the face and the folds.
Key words: local calcineurin inhibitors, Elidel cream,
Pimecrolimus, Psoriasis vulgaris –small plaques
<
back > Published online July 22, 2008,
/Page 42-44/
NON – SEDATING ANTIHISTAMINS IN THE THERAPY OF
SOME DERMATOSES
Stefka Racheva,
P. Drumeva, J. Dimitrova
Department of Dermato-Venereology, Medical University - Varna, Bulgaria
SUMMARY: The formation of the contemporary non-sedating
and low sedating antihistamins (AH) brings a new stage in treatment of
allergodermatoses, as well as the dermatoses connected with intensive
pruritus. The use of 2-nd and 3-nd generation AH - non sedating or with
a low sedating potential gives an improvement of quality of life of the
patients. The aim of such treatment is to inhibit the effect of the liberated
from mast cells mediators upon the target tissues and suppression of the
symptoms. The mechanism of this inhibition is realized by suppressing
of H-1 receptors, so the act as H-1 blokers. The main characteristics
of the new generation non- sedating AH. Basic principal of treatment allergodermatoses
with non-sedating AH: urticaria (chronica, holinergica, idiopatica, physical,
cold, solar, urticaria due to pressure) and endogenous eczema.
Key words: antihistamine, non-sedating antihistamins,
urticaria, endogenous evzema
<
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/Page 45-47/
IRINOTECAN, FLUOROURACIL AND LEUCOVORIN IN PATIENTS
WITH METASTATIC COLORECTAL CANCER
Deyan Davidov
Department of chemotherapy, Oncological center, Medical University, Pleven,
Bulgaria
SUMMARY: Background: Irinotecan
is a topoisomerase I inhibitor that prolongs survival as second- line
therapy in patients with metastatic colorectal cancer, treated with Fluorouracil
and Leucovorin only. Aim: The aim of this study was to
evaluate the efficacy and toxicity of the combination Irinotecan, Fluorouracil
and Leucovorin. Methods: In the period 2006- 2007 34
patients with metastatic colorectal cancer entered the study. The treatment
schedule consists of Irinotecan 180 mg/m2 day 1, Fluorouracil 400 mg/m2
day 1 and 2 and Leucovorin 200 mg/m2 day 1 and 2 every 14 days. Results:
Overall response rate was 36,7% with three complete remissions. Median
survival was 20,3 months. Diarrhea, vomiting and mucositis were most common
side effects. Conclusions: That data suggest that the
addition of Irinotecan to Fluorouracil and Leucovorin will offer opportunity
to treat patients with metastatic colorectal cancer.
Key words: Irinotecan, Colorectal cancer, Treatment,
Survival.
<
back > Published online Sept. 24, 2008, /Page
48-50/
GEMCITABINE / PLATINUM VS. VINORELBINE- PLATINUM
IN PATIENTS WITH ADVANCED NON- SMALL- CELL LUNG CANCER
Deyan Davidov
Department of chemotherapy, Oncological center, Medical University, Pleven,
Bulgaria
SUMMARY: Background: A platinum- based doublets
with a third- generation agents /Gemcitabine, Vinorelbine/ represent the
standard first- line treatment for advanced patients with non- small-
cell lung cancer /NSCLC/ and good performance status. Aim: The aim of
this study was to evaluate the two commonly used newer platinum- based
regimes in response rate and survival. Methods: In the period 2005- 2007
ninety- four inoperable patients with NSCLC entered the study. The treatment
schedule consist of Gemcitabine 1250 mg/m2 day 1 and 8 and cis- Platinum
80 mg/m2 with hydratation day 1- 46 patients /arm GP/ and Vinorelbine
30 mg/m2 day 1 and 8 and cis- Platinum 80 mg/m2 with hydratation day 1-
48 patients /arm VP/, every 21 days. Results: Overall response rate was
39% for GP and 32% for VP. Median survival was 10,3 and 9,8 months respectively.
Neutropenia was significantly higher in arm VP as was thrombocytopenia
on the GP arm. Conclusions: That data suggest that both regimes remain
reasonable choices for patients with advanced NSCLC with slight prevalence
of GP.
Key words: Gemcitabine, Vinorelbine, Non- small- cell
lung cancer, Response rate, Survival.
<
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51-54/
CLINICAL, IMMUNOLOGICAL AND PARASITOLOGICAL PARALLELS IN PATIENTS WITH BLASTOCYSTOSIS
Ivelin Angelov, Tz. Lukanov*, N. Tsvetkova**, V. Petkova***, G. Nicoloff****
Department of infectious diseases, epidemiology and parasitology, University of Medicine, Pleven, Bulgaria; *Department of Clinical Immunology, University of Medicine, Pleven, Bulgaria; **National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria; ***Central Clinical Laboratory, University of Medicine, Pleven, Bulgaria; ****Department of Biology & Pathological Physiology, University of Medicine, Pleven, Bulgaria
ABSTRACT: On clinical and prophylactic indications, 7905 patients were parasitologically examined, and Blastocystis hominis was detected in 273 (3.4%) of them. Detailed investigations were carried out in 82 of the infected patients (19 males and 63 females), divided into two groups: individuals with clinical symptoms and asymptomatic carriers. A correlation was found between the number of parasites detected, the clinical presentation and the changes in the levels of total serum immunoglobulins (IgG, IgA, IgM) in the persons infected with B.hominis. Half of the patients investigated presented with gastrointestinal and allergic symptoms. Significant decrease of levels of serum immunoglobulin IgA, correlating with the number of parasites detected was found in 43 patients, irrespective of the presence or absence of clinical symptoms.
Key words: Blastocystis hominis; morphological forms; serum immunoglobulins; clinical presentation.
<
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55-58/
Epidermolysis Bullosa Simplex Dowling-Meara - A case report
Yordanova Ivelina1, Vassileva Snejina2, Demerjieva Zdravka2, Gospodinov Dimitar1, Tsankov Nikolai2
1Department of Dermatology and Venereology, Medical University – Pleven, Bulgaria; 2Department of Dermatology and Venereology, Medical University – Sofia, Bulgaria
ABSTRACT: A case with Epidermolysis bullosa simplex Dowling-Meara is presented. It concerns a 20 days breast-fed girl with severe blistering and erosions on the skin formed at birth after minor mechanical trauma. There are no other affected relatives. A medical examination showed normal somatic and visceral status. There were multiple herpetiform grouped bullous and erosive lesions on the face, trunk, upper and lower limbs, palms and soles. The mucous membranes were not affected. There was also a marked nail dystrophy on the fingers and toenails. The electron microscopic examination revealed cytolysis of the basal keratinocytes with clumping of the perinuclear tonofilaments in the lesional skin. Because of the clinical features and the results of the electron microscopic examination of the skin the case here reported should be considered as an Epidermolysis bullosa simplex Dowling-Meara. The child is followed up to the age of three. The course of the disease was benign with a decreased formation of blisters and erosions. The marked nail dystrophy was persistent. There was palmar and plantar hyperkeratosis. The child’s growth, neural and psychic development was normal. The early diagnosis of the bullous epidermolysis is helpful in the prognostic assessment of the disease and in the medical and genetic advice for the parents.
Key words: Epidermolysis bullosa simplex Dowling-Meara, tonofilament clumps, electron microscopy.
<
back > Published online Oct. 07, 2008, /Page
59-62/
A CASE OF NEUROFIBROMATOSIS TYPE 1
Valentina Dimitrova1, I. Yordanova1, V. Pavlova1,V. Valchev1,D. Gospodinov1, B. Parashkevova2, Ch. Balabanov2
1Department of Dermatology and Venereology, 2Department of Ophthalmology, Medical University – Pleven, Bulgaria
ABSTRACT: Neurofibromatosis (NF) is a term that has been applied to a variety of related syndromes, characterized by neuroectodermal tumors arising within multiple organs and autosomal-dominant inheritance. Neurofibromatosis type I (NF-1), known as well as Recklinghausen’s disease, is the most common type of the disease accounting 90% of the cases. We present a case of 52-year-old men with NF-1. The disease started in childhood with the appearance of multiple hyperpigmented skin macules. At the age of 46 a lot of cutaneous tumors appeared and started growing bigger all over the body surface. Because of a vision problem due to an upper left eyelid neurofibroma, the patient came for a clinical examination at the age of 52 years.
Key words: Neurofibromatosis, Neurofibromatosis type I, Recklinghausen’s disease.
<
back > Published online Oct. 07, 2008, /Page
63-67/
Keratoderma blenorrhagicum in a patient with Reiter syndrome
Valentina Dimitrova1, V. Valtchev1, I. Yordanova1, H. Haidudova1, D. Gospodinov1, S. Tisheva2
1Department of Dermatology and Venereology, 2Department of Rheumatology and Cardiology, Medical University – Pleven, Bulgaria
ABSTRACT: Reiter syndrome is a systemic disorder, originally defined as a triad of arthritis, urethritis and conjunctivitis. This symptoms complex usually follows an episode of either urethritis or dysentery. Skin and mucosal involvement is observed in about 10% of the cases. We present a case of Reiter’s syndrome in a 55-year-old man who developed the typical skin lesions - kerathoderma blenorrhagicum. The disease started with a severe asymmetric oligoarthritis a month after the patient had urethritis. Two weeks after the onset of the arthritis red patches on the palms and plants appeared, which transformed quickly in harder and elevated plaques.
Key words: Syndroma Reiter, Keratoderma blenorrhagicum.
<
back > Published online Oct. 07, 2008, /Page
68-71/
SNEDDON’S SYNDROME
Valentin Valtchev1, V. Simeonova2 , D. Gospodinov1, I. Yordanova1,V. Dimitrova1, V. Pavlova1, E. Konova4, S. Popovska3 , B. Stamenov2
1Department of Dermatology and Venereology, 2Department of Neurology, 3Department of General and Clinical Pathology, 4Department of Immunology, Medical University – Pleven, Bulgaria
ABSTRACT: Sneddon’s syndrome is usually characterized by the association of an ischemic cerebrovascular disease and a widespread livedo reticularis. The incidence of Sneddon syndrome is 4/1000 000. We present 42-year-old woman with livedo reticularis, recurrence ischaemic cerebrovascular accidents, two repetitive miscarriages and positive anti-2GPi antibodies. Skin biopsy specimens reveal inflammatory changes of small- to medium-sized arteries and subendothelial proliferation and fibrosis. The diagnosis Sneddon syndrome is confirmed by skin biopsy, and MR evidence.
We suggest that anti-2GPi antibodies may be pathophysiologically related to the clinical manifestation observed in some patients with Sneddon syndrome.
Key words: Sneddon syndrome, livedo reticularis, ischemic cerebrovascular disease.
<
back > Published online Oct. 07, 2008, /Page
72-75/
ACUTE MEDICAMENTOUS INTOXICATIONS IN VARNA REGION
FOR A 15 YEARS PERIOD
Petko Marinov,
M. Iovcheva, S. Zlateva, S. Petrova, Yu. Sabeva*
Department of Toxicology; *Laboratory of Chemical Toxicological Investigations;
Military Medical Academy-Naval Hospital, Varna, Bulgaria
SUMMARY: The acute intoxications with medicines
/ AIM / take the leading place among the other acute intoxications. A
retrospective analysis of acute intoxications with medicines in Varna
region for a 15-years period / 1991- 2005 / has been done. It was established
that they were the cause of hospitalization of 5018 patients / 39.94%/of
the total number 12 565 patients, treated for acute intoxications
during the period. 3578 / 71.3% / were women and 1440 / 28.7% / were men.
The acute medicamentous were significantly more frequent in women. The
proportions women to men were 2.48:1. In most cases these poisonings were
in the age group up to 24 years – 2640 patients / 52.61% /. Only 249 /
4.96%/ patients were over 60 years old. The prevailing part of the medicamentous
intoxications were with a suicidal purpose- 4609 patients / 91.85%/. Mixed
medicamentous intoxications had the highest relative share – 1478 / 29.45%/,
followed by benzodiazepine intoxications – 1350 / 26.9%/. The medicamentous
intoxications were the cause of 20.24% of the lethality rate of all the
acute intoxications.
Key words: acute intoxications, medicines.
<
back > Published online Oct. 16, 2008, /Page
76-78/
TOXOALLERGIC REACTIONS AFTER A BITE FROM MYRIAPODA,
GENUS SCOLOPENDRA IN VARNA REGION DURING THE PERIOD 2003 – 2007
Marieta Iovcheva, S. Zlateva, P. Marinov, Yu. Sabeva*
Department of Toxicology; *Laboratory of Chemical Toxicological Investigations;
Military Medical Academy-Naval Hospital, Varna, Bulgaria
SUMMARY: The bite by the centipede scolopendra results
in a significant local syndrome with pain and swelling of the bitten limb
and also in minor to moderate expressed general toxoallergic symptoms.
In some cases differential diagnostic problems are possible. The authors
describe 39 patients with scolopendra envenomation. All of them were bitten
in Varna region during the period 2003 - 2007. 22 patients were hospitalized
with a severe local syndrome and/or general toxic syndrome with medium
severity. The rest were treated as out-patients. In 3 cases a great edema
of the bitten extremity lasting 3 to 9 days was observed. All of the patients
restored completely to health without complications. 4 of the patients
had been bitten by scolopendra before. The real frequency of Scolopendra
bites is difficult to be estimated as we lack information about some of
the minor cases.
Key words: myriapoda, centipedes, scolopendra, envenomation,
intoxication, pain, edema, anaphylactoid.
<
back > Published online Oct. 16, 2008, /Page
79-82/
INVESTIGATION OF THE REFERENCE VALUES OF THE ANKLE-BRACHIAL INDEX IN ASYMPTOMATIC SEVERE HYPERCHOLESTEROLEMIA
Lyudmila Vladimirova-Kitova
Clinic of Cardiology, Medical University, Plovdiv, Bulgaria
ABSTRACT: The issue with the different levels of ankle-brachial index,which are in the normal reference range is less studied, but quite interesting. There have not been any studies on ankle-brachial index in patients with severe hypercholesterolemia in Bulgaria. Aim: To study the relationship between the ankle-brachial index and the lipid markers of the atherogenic risk (routine lipid profile, Apolipoprotein-B, Apolipoprotein-A) in asymptomatically severe hypercholesterolemia (without peripheral vascular disease). Methods and materials: 50 patients with documented severe hypercholesterolemia >7.5 mmol/l satisfying the Simon-Broom criteria for clinically established and probable Familial Hypercholesterolemia were studied. All of the patients had a negative stress echocardiography and not known coronary artery disease. There were 30 controls without hypercholesterolemia.The laboratory used was the Clinical Laboratory at the Medical University Plovdiv. The total cholesterol and triglycerides were measured with enzyme-colorimetry and cholesterol in high density lipoprotein and cholesterol in low density lipoprotein with direct automatic analyses. Apolipoproteins were calculated by immunoturbodimetric method. The biochemical analyzer Konelab 60i was used in all the measurements. Results: The median baseline ankle-brachial index in both groups differ significantly, 1.06+-0.12 in the hypercholesterolemia group and 1.25 +-0.03 in the controls ( u=2.44, p<0001) The ankle-brachial index reference range divides them in borderline 0.9-0.99, low normal 1.0-1.29 and normal 1.1-1.29 .The first two groups were combined in one including 35 patients (70 %) and the third included 15 patients (30 %).There is a very strong inverse relationship between ankle-brachial index value and age. It reflects the age related changes in the vessel structure and function in subclinical atherosclerotic accumulation, in this case affecting the circulatory system of the lower extremities. A strong inverse statistically significant relationship was found between ankle-brachial index and Apolipoprotein-B, ankle-brachial index and Apolipoprotien-B/A1 index. These two variables explain the variations in ankle-brachial index. Conclusion: In the population with manifested hypercholesterolemia, Apolipoprotein-B and not the routine lipid profile and atherogenic indexes ,is a predictor of structural blood vessel damage ,verified through ankle-brachial index.
Key words: hypercholesterolemia, ankle-brachial index, peripheral vascular disease, biomarkers.
<
back > Published online Jan. 29, 2009,
/Page 83-86/
AORTIC ROOT ABSCESS RUPTURED INTO THE RIGHT ATRIUM IN INFECTIVE ENDOCARDITIS OF BICUSPID AORTIC VALVE
Elena Kinova, Assen Goudev
Department of Cardiology, University Hospital Queen Giovanna, Sofia, Bulgaria
ABSTRACT:Even in the modern era of antibiotic therapy and advanced diagnostic imaging, infective endocarditis continues to be a disease with a persistently high mortality and morbidity.
We report a serious complication of infective endocarditis of bicuspid aortic valve with aortic root abscess ruptured into the right atrium with fatal outcome, registered by transthoracic echocardiography.
This complication should be suspected in all patients with endocarditis associated with continuing sepsis or acute haemodynamic deterioration. Early accurate echocardiographic diagnosis and emergent surgical treatment are of grate prognostic importance.
Key words:endocarditis complications, abscess, rupture.
<
back > Published online Feb. 16, 2009,
/Page 87-88/
NTProBNP and HRV and outcome in patients with heart failure with reduced vs. preserved systolic function.
Nadia Stancheva1, Snezhana Tisheva1, Virginia Jordanova1, Stanimir Kurkchiev2,Assen Goudev3
1 – Clinic of Cardiology and Rheumatology, UMHAT “G. Stranski” - Pleven;
2 – Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Science - Sofia;
3 – Clinic of Cardiology with Intensive care Unit, UMHAT “Tsaritsa Ioanna” – Sofia, Bulgaria
ABSTRACT: Background: Heart failure /HF/ is usually associated with reduced systolic function. Elevated plasma concentrations of NTproBNP and heart rate variability /HRV/ are predictive of worse outcome in HF patients but there are few data about its predictive value in patients with HF and preserved systolic function.
Purpose and methods: The aim of this study was to determine the prognostic value of predischarge NT-proBNP and heart rate variability (HRV) in patients with reduced vs. preserved systolic function admitted for decompensated congestive HF. One hundred and twenty-seven patients were evaluated at the time of discharge by means of echocardiography, conventional laboratory tests, plasma for NTproBNP and Holter ECG for HRV. The primary endpoints of the study were defined as readmission for HF during the first 6 months after discharge, more than 2 hospitalizations for 1 year, or cardiac death.
Results: One hundred and twenty-one patients /95.3%/ were followed for mean of 387 ± 117 days. Fifty-four patients /44.6%/ had reduced systolic function. Despite of the significant differences in the clinical characteristics of the patients with HF with reduced vs preserved systolic function, prognosis in both groups was poor. Predischarge NTproBNP levels were predictive of worse outcome irrespectively of the systolic function. Kaplan-Meier survival curves showed that NTproBNP > 300 pg/ml was associated with significantly worse outcome in both groups and HRV<20 ms was predictive of event occurrence in the reduced systolic function group. HRV reflected the severity of the systolic dysfunction in the reduced systolic function group.
Conclusions: In hospitalized HF patients predischarge NTproBNP levels are associated with poor prognosis in HF patients irrespective of systolic function while HRV reflects the severity and poor prognosis only of heart failure with reduced systolic function.
Key words:brain natriuretic peptide, heart rate variability, heart failure, prognosis.
<
back > Published online Apr. 03, 2009,
/Page 89-94/
Localized choroidal haemangioma associated with Sturge - Weber syndrome: a case report
Aleksandra Tzoukeva, N. Deleva, A. Kaprelyan
Department of Neurology, Medical University Prof. Dr. Paraskev Stoyanov, Varna, Bulgaria
ABSTRACT: Sturge-Weber syndrome (SWS) is a sporadic congenital neurooculocutaneous disorder that may present with glaucoma and vascular malformations of the conjunctiva, episclera, choroid and retina. We report a case of localized choroidal haemangioma associated with SWS Type I. A 26-year-old male with a port-wine stain birthmark on right side of the face was admitted to our clinic with complaints of photophobia, pain, and blurred vision in his right eye. Anterior segment examination of the right eye revealed dilatation and tortuosity of conjunctival vessels. Snellen visual acuity was 0.4 (20/50) and intraocular pressure - normal. Fluorescein angiography demonstrated a small-spotted hyperfluorescent mass nasal to the optic disc and exudative retinal detachment in the central zone. Testing of the left eye found no abnormalities. Brain CT scans showed bilateral tram-track calcifications. This case report arouses certain clinical interest because of its rare incidence, continued asymptomatic development, and delayed diagnosis only after the presentation of exudative retinal detachment with subsequent visual deficit. Neuroophthalmological monitoring of patients with SWS may be useful for early detection of ocular involvement before the appearance of serious visual complications.
Key words: Sturge-Weber syndrome, localized choroidal haemangioma, exudative retinal detachment, neuroophthalmological monitoring.
<
back > Published online Mar. 18, 2009,
/Page 95-97/
Last edition: April 03, 2009