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J of IMAB 2004; 10(1):3-8
HUMAN EXPOSURE TO ARSENIC RELATED CANCER EPIDEMIOLOGY AND RISK ANALYSIS 20 YEARS FOLLOW UP
Vl. Bencko^{*, **}, P. Franik^*, M. Gotzl^***, J. Rames^{*, **}
*Charles University in Prague, First Faculty of Medicine & General University Hospital, Institute of Hygiene & Epidemiology, Prague, Czech Republic
**European Centre for Medical Informatics, Statistics and Epidemiology - Cardio, Prague, Czech Republic
***Department of Oncology District Hospital of Bojnice, Slovak Republic

SUMMARY:
The subject of our analysis was a database of 1503 non-melanoma skin cancer cases (756 in men and 747 in women) and 1 117 lung cancer cases (1007 in men and 110 in women) collected from 1977 to 1996 in a region polluted by emissions of a power-plant rising from burning of coal with high arsenic content ranging between 900 to 1,500 g per metric ton of dry coal.
Exposure assessment of the local population of the district was based on biological monitoring. Determination of arsenic was done in groups of 10 year old boys as samples of non-occupationally exposed general population by analyzing of hair and urine samples at different localities situated up to the distances of 30 km from the local power plant.
Basic epidemiological data of the cancer cases were obtained in a questionnaire which covered basics of personal, family, residential and occupational history.
Over study base represent 1,328 thousands man/year and 1,334 thousands woman/year of a population of approximate size of 125 000 inhabitants. The age standardized incidence of non-melanoma skin cancer (each confirmed by histological examination) in non-occupational settings ranged from 45.9 to 93.9 in men and from 34.6 to 81.4 in women. Relevant data for lung cancer (each confirmed by biopsy or autopsy histological examination) ranged from 10.8 to 89.8 in men and from 1.1 to 10.1 in women per 100,000.
Analysis of our database reconfirms a positive correlation of human cumulative arsenic exposure with non-melanoma skin cancer risk.
A less pronounced relationship was noted between arsenic exposure and incidence of lung cancer. This is most likely to be due to the presence of confounding variables such as cigarette smoking.

Key words: cancer epidemiology, biological monitoring, arsenic toxicity, non-melanoma skin cancer incidence, and lung cancer incidence

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J of IMAB 2004; 10(1):9-10
Nosocomial Infections: prevention and treatment
N. Bakracheva
Department of Clinical Pharmacology and Therpeutics, University Hospital "Queen Giovanna" - Sofia
Medical University - Sofia, Bulgaria

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J of IMAB 2004; 10(1):11-14; DOI: 10.5272/jimab.2004101.11
PREVALENCE OF CHLAMYDIA TRACHOMATIS INFECTION IN SYMPTOMATIC PATIENTS IN BULGARIA
Vesela Ouzounova, J. Haralambieva, J. Jankov, D. Petrov, I. Mitov
Department of Microbiology,
Medical Faculty, Medical University, Sofia, Bulgaria

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J of IMAB 2004; 10(1):15-18
Cardiovascular autonomic disturbances in early Parkinsons disease
B. Ivanov, V. Valkanova, N. Deleva,
Neurology Department, *Department of Propedeutics of Medicine,
Medical University - Varna , Bulgaria
ABSTRACT:
Aim of this study was to assess the cardiovascular autonomic function in early Parkinsons disease.

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J of IMAB 2004; 10(1):19-21; DOI: 10.5272/jimab.2004101.19
DYNAMIC FOLLOW UP OF APHASIC DISORDERS IN PATIENTS WITH ISCHEMIC STROKE IN ACUTE STAGE
Dora Peychinska, Maya Danovska, Dimitar Chakarov, V. Simeonova, Ch. Lilovski
Neurology Clinic, University Hospital Pleven, Medical University of Pleven, Bulgaria

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J of IMAB 2004; 10(1):22-25
Questionnaire - based assessment of autonomic dysfunction in Parkinsons disease
B. Ivanov, N. Deleva, A. Kaprelyan, I. Dimitrov
Department of Neurology, Medical University of Varna, Bulgaria

ABSTRACT:
Questionnaire - based assessment of different autonomic dysfunctions was performed in 500 patients with Parkinsons disease (PD): 273 males and 227 females, aged from 42 to 81 years and with disease duration from 2 months to 17 years. Patients with co-existing diseases affecting the autonomic nervous system (ANS) were not included in the study. The distribution of cases according to the Hoehn-Yahr scale was as follows: 41 patients at stage I, 197 - at stage II, 214 - at stage III and 48 - at stage IV. Sixty-one patients were free of antiparkinsonian drug treatment.
Three hundred and fifteen patients (63%) described one or more complaints concerning the autonomic nervous system: 16 (5%) were at stage I according to Hoehn-Yahr scale, 82 (26%) at stage II, 164 (52%) at stage III and 45 (14%) at stage IV. The most common complaints involved the gastrointestinal system - 67%, urologic - 39%, thermoregulatory - 29% and cardiovascular - 27%. Seven patients with dysautonomic complaints receive no antiparkinsonian medication.
Our results showed that questionnaire - based assessment confirms the presence of dysautonomic manifestations in more than 50% of the patients with PD. These manifestations were present even in untreated patients at the early stage of the disease. Having in mind that dysautonomias engage practically all somatic systems with autonomic control, we consider that evaluation of autonomic dysfunction could contribute to the management of quality of life of PD patients.

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J of IMAB 2004; 10(1):26-28; DOI: 10.5272/jimab.2004101.26
PROBLEM ABOUT THE DYSGRAFIA IN FRAMES OF THE PARADIGMA SPECIFIC LEARNING DISABILITIES
Jivko Jekov¹, Stanislava Pavlova²
1) Department of Education, University of Shumen “Ep. K. Preslavsky” - Shumen, Bulgaria
2) Department of Health Care, Medical University Varna, Bulgaria

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J of IMAB 2004; 10(1):29-30
A case of secondary syphilis with condilomata lata location on the oral comissure
S. Pavlov, M. Slavova

ABSTRACT:
Condylomata lata are frequently observed in patients with secondary recurrent syphilis - up to 35% of cases (2).Their location on the oral comissure is a relatively rare finding, that comprises a matter of interest both for dermatologist and non-dermatologist specialists (6).The extra genital locations of condylomata lata can easily be omitted or misdiagnosed, especially in cases when other skin manifestation are absent.

Key words: syphilis, condylomata lata

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J of IMAB 2004; 10(1):31-33
Antibiotic therapy and prophylaxy of patients with Erysipelas
S. Pavlov, M. Slavova
ABSTRACT:
78 patients with Erysipelas, treated in the Varna clinic of dermatology are evaluated regard to clinical manifestation and treatment modalities. The duration of therapeutic courses varies 3 to 33 days (med. 12, 7 days). All patients received parenteral antibiotic therapy in a regimen depending on location and severity of infection and number of recurrences. The mild and moderate cases are treated with penicillin and cephalosporines- I and II generation. Severe and complicated erysipelas cases are managed with III generation cephalosporines. Penicillin with depo action is applied as a prophylaxy in 33 (42%) patients. Predisposing causes for recurrence of infection are reported as follows:
- tinea pedis - 32%
- lymphostasis and edema - 23%
- obesitas - 19,2%
- diabetes - 22%
- trauma - 16,7%
- palmo - plantar psoriasis-7,7%
Key words: erysipelas, therapy

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J of IMAB 2004; 10(1):34-37; DOI: 10.5272/jimab.2004101.34
FAMILIAL ALOPECIA ARETA, ATOPY AND THYROIDITIS HASHIMOTO
Ani Tsvetanova, Dimitar Gospodinov, Mariana Trashlieva
Department of Dermatology and Venereology, Medical University - Pleven, Bulgaria

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J of IMAB 2004; 10(1):38-41; DOI: 10.5272/jimab.2004101.38
SERUM-CONCENTRATIONS OF Dehydroepyandrosterone-sulfate IN MEN WITH ANDROGENETIC ALOPECIA
Ani Tsvetanova¹, Dimitar Gospodinov¹, Miroslav Donchev²
1) Department of Dermatology and Venereology, 2) Clinical center of nuclear medicine, Medical University, Pleven, Bulgaria

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J of IMAB 2004; 10(1):42-44; DOI: 10.5272/jimab.2004101.42
TREATMENT OF MELASMA WITH GLYCOLIC VERSUS TRICHLOROACETIC ACID PEEL: COMPARISON OF CLINICAL EFFICACY
Sonia Valkova
Department of Dermatology and Venereology, Medical University - Pleven, Bulgaria

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J of IMAB 2004; 10(1):45-46; DOI: 10.5272/jimab.2004101.45
TREATMENT OF DERMATOPHYTE ONYCHOMYCOSIS WITH TERBINAFINE (LAMISIL) PULSE THERAPY
Sonia Valkova
Department of Dermatology and Venereology, Medical University - Pleven, Bulgaria

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J of IMAB 2004; 10(1):47
A method for marking the location of breast cancer tumor indicated for neoadjuvant chemotherapy
T. Deliiski¹, S. Popovska², D. Dardanov¹
1) University Oncology Cente, 2) Department of pathological anatomy, Medical University, Pleven, Bulgaria
ABSTRACT:
Sometimes, histological investigation of a tumor is impeded after neoadjuvant chemotherapy due to full clinical remission, i.e. the tumor cannot be located through palpation, X-ray and macroscopically after mastectomy.
The authors aim to landmark the tumor before after neoadjuvant chemotherapy, thus facilitating its location through X-ray and dissection after changes due to the cytostatic preparation admistered.
Materials and methods: The marker is a radio-opaque metal clip, introduced through a puncture needle and placed in the center of the tumor.
After chemotherapy, contrast mammography helped identify the changes in tumor size in relation to the marker. Intraoperatively, the pathologist located the clip, the latter being in some cases the only landmark for primary localization of the tumor.
Our initial results from the application of the method are encouraging: mammography visualized the clip and served as a guide during surgery and macro- and microscopic morphological investigation.
Key words: marking of tumor, neoadjuvant chemotherapy

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J of IMAB 2004; 10(1):48-49
A clearing technique to increase detectability of lymph nodes in radical surgery for colon and rectal cancer
T. Deliiski
University Oncology Center, Medical University, Pleven, Bulgaria
ABSTRACT:
A method is proposed to detect the smallest lymph nodes located in adipose-lymph-vascular tissues of the meso of the intraoperatively collected specimen. The method combines traditional dissection with modified fat-clearing.
Immediately after surgery, the meso of the fresh specimen was dissected into layers, and the lymph nodes detected by palpation and inspection were removed. They were then grouped according to specificity of lymph dissemination and staging of tumors. Thus detected, the lymph nodes were investigated using routine histological methods. Fatty lymph vessel tissue was separated from the organ and was further processed using a fat clearing technique, by dipping it into 10% formalin solution with 0.01% methylene blue, alcohol and xylol. The mass obtained was translucent, which allowed detecting even minute bluish solid lymph nodes. The latter were dissected, fixed and placed into formalin to be later histologically investigated.
After the experimental stage, the method was introduced into routine clinical practice. So far, we found that in 15 cases the technique of processing the specimens helped to detect 5 to 11 additional lymph nodes, otherwise undetectable.
Key words: lymph nodes detection, clearing techniques

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J of IMAB 2004; 10(1):50-51
A method for detecting more lymph nodes after radical operation for gastric cancer
T. Deliiski
University Oncology Center, Medical University, Pleven, Bulgari
ABSTRACT:
Removing and detecting as much as possible lymph nodes in radical operations for gastric cancer is important part of the modern approach in this disease.
The aim of the study is to evaluate the effect of fat-clearing technique for detecting more lymph nodes after lymph node dissection in gastric cancer surgery. Also to prove that putting the specimen consecutively in solutions of formaldehyde, alcohol, acetone and xylol could help in detecting more undetectable with classical methods lymph nodes.
15 surgical specimens containing perigastric lymph and adipose tissue in great and leaser curvature, and the tissue derived from dissection of second compartment. First with conventional method by inspection and palpation as much as possible lymph nodes are detected in fresh specimen. After that the stomach is removed and the remaining adipose and lymph tissue is fixated with formaldehyde followed by fat-clearing technique. Then searching of undetected with conventional method lymph nodes is performed, using palpation and trans-illumination of the fat-cleared specimen.
With fat-clearing method 2 to 9 more lymph nodes per specimen were detected. Most of them are smaller than 5 mm in diameter. Their color was bluish or yellow and harder than rest of the tissue.
With fat-clearing technique is possible to improve detection of lymph nodes after lymph dissection in gastric cancer
Key words: gastric cancer, lymph nodes detection

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J of IMAB 2004; 10(1):52-54
PROVIDE FOR MICROBIOLOGICAL CONTROL OVER DISASTROUS SITUATIONS AND DANGER OF EPIDEMICS
Hr. Romanova, P. Vajarova*
Medical University - Varna,
*RIDCSH
SUMMARY:
It has been studied the provide of microbiological control over disastrous situations and danger of epidemics in Varna city. It has been put into effect mainly by microbiological section of RIDCSH (regional inspection of defence and control of social health) with especially enormous volume of functions in 14 labs. It was supplied a daily acting microbiological control including arising of disasters and especially dangerous infections anthrax, cholera, variola and plague. It has been duplicated on microbiological investigations in Varna city for arising disastrous epidemical situations as for the purpose there were revealed microbiological labs in 3 national hospitals and 2 private labs.
Key words: disasters, epidemics, microbiological control

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