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Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2008, Volume 14, book 1,
DOI: 10.5272/jimab.14-1-2010
Subject Collection: Medicine
Page: 3 - 97
Date of close: April 3, 2009


J of IMAB 2008; 14(1):3-5; DOI: 10.5272/jimab.14-1-2010.3
Galya I. Gancheva1ORCID logo email, Maria Atanasova1, Tzvetan Lukanov2, Penka Ilieva1
1) Department of Infectious Diseases, Epidemiology, Parasitology, and Tropical Medicine, Medical University, Pleven, Bulgaria.
2) Sector of Clinical Immunology, Medical University, Pleven, Bulgaria.


J of IMAB 2008; 14(1):6-8
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

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

< back > Published online May 22, 2008,

J of IMAB 2008; 14(1):9-13 .
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

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. Тhree 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

< back > Published online Jun 11, 2008,

J of IMAB 2008; 14(1):14-17 .
Tzvetan Lukanov1/2 , D. Lichev1/2, E. Konova1/2, A. Emin1/2, N. Ayvazova2, R. Kotzev3, A. Velkova4, G. Veleva3, R. Roussev1/5
1) Medical Center “Clinical Institute for Reproductive Medicine”, Pleven; 2) Center for Reproductive Health; 3) Department of Surgical diseases, Sector of Urology; 4) Department of Social Medicine, Medical University, Pleven, Bulgaria; 5) Millenova Immunology Laboratories, Chicago, USA

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

< back > Published online Jun 19, 2008,

J of IMAB 2008; 14(1):18-20 .

Julia Radenkova - Saeva
Toxicology clinic, MHATEM "N. I. Pirogov", Sofia, Bulgaria

Lyell syndrome оrтoxic 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,

J of IMAB 2008; 14(1):21-23 .
Elena Pavlova, T. Chemev, A. Chemev, Zh. Karagiozova
University Hospital Maichin Dom, Medical University, Sofia, Bulgaria

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. .

< back > Published online July 07, 2008,

J of IMAB 2008; 14(1):23-26 .
Effect of fenofibrate on the level ofasymmetric dimethylarginine in type 2 diabetes mellitus
Lyudmila Vladimirova-Kitova
Clinic of Cardiology, Medical University, Plovdiv, Bulgaria

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,

J of IMAB 2008; 14(1):27-29 .
Electronmicroscopical investigation of the small neurons in trigeminal ganglion
Dimo Krastev
Department of Anatomy and Histology; Faculty of Medicine, Medical University, Sofia, Bulgaria

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

< back > Published online July 15, 2008,

J of IMAB 2008; 14(1):30-32 .
Trigeminal ganglium – electro­nmicros­copy of large light pseudounipolar neurons
Dimo Krastev
Department of Anatomy and Histology; Faculty of Medicine, Medical University, Sofia, Bulgaria

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.

< back > Published online July 15, 2008,

J of IMAB 2008; 14(1):33-35 .
Electron-microscopical investigation of the satellite cells
Dimo Krastev, Krastev N.
Department of Anatomy and Histology; Faculty of Medicine, Medical University, Sofia, Bulgaria

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,

J of IMAB 2008; 14(1):36-39 .
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

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

< back > Published online July 15, 2008,

J of IMAB 2008; 14(1):40-41 .
Treatment of acne vulgaris with FINACEA – GEL

Stefka Racheva, P. Drumeva, R. Bachvarova
Department of Dermato-Venereology, Medical University - Varna, Bulgaria

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

< back > Published online July 22, 2008,

J of IMAB 2008; 14(1):42-44 .
Treatment of psoriasis vulgaris with Elidel

Stefka Racheva, R. Bachvarova, J. Dimitrova
Department of Dermato-Venereology, Medical University - Varna, Bulgaria

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,

J of IMAB 2008; 14(1):45-47 .

Stefka Racheva, P. Drumeva, J. Dimitrova
Department of Dermato-Venereology, Medical University - Varna, Bulgaria

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

< back > Published online July 22, 2008, /Page 45-47/

J of IMAB 2008; 14(1):48-50. DOI: 10.5272/jimab.14-1-2010.48

Deyan DavidovORCID logoemail,
Department of chemotherapy, Oncological center, Medical University, Pleven, Bulgaria


J of IMAB 2008; 14(1):51-54. DOI: 10.5272/jimab.14-1-2010.51
Deyan DavidovORCID logoemail,
Department of chemotherapy, Oncological center, Medical University, Pleven, Bulgaria


J of IMAB 2008; 14(1):55-58 .

Ivelin Angelov1,  Tz. Lukanov2, N. Tsvetkova3, V. Petkova4, G. Nicoloff5
1) Department  of infectious diseases, epidemiology and parasitology, University of Medicine, Pleven, Bulgaria; 2) Department of Clinical Immunology, University of Medicine, Pleven, Bulgaria; 3) National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria; 4) Central Clinical Laboratory, University of Medicine, Pleven, Bulgaria; 5) Department of Biology & Pathological Physiology, University of Medicine, Pleven, Bulgaria

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.

< back > Published online Oct. 03, 2008,

J of IMAB 2008; 14(1):59-62 DOI:10.5272/jimab.14-1-2010.59
Epidermolysis Bullosa Simplex Dowling-Meara - A case report

Ivelina Yordanova1ORCID logoemail, Snejina Vassileva2ORCID logo, Zdravka Demerjieva2, Dimitar Gospodinov1ORCID logo, Nikolai Tsankov2
1) Department of Dermatology and Venereology, Medical University – Pleven, Bulgaria;
Department of Dermatology and Venereology, Medical University – Sofia, Bulgaria


J of IMAB 2008; 14(1):63-67 DOI:10.5272/jimab.14-1-2010.63
Valentina Dimitrova1email, Ivelina Yordanova1ORCID logo, Verka Pavlova1, Valentin Valtchev1, Dimitar Gospodinov1ORCID logo, Boryana Parashkevova2, Chavdar Balabanov2
1) Department of Dermatology and Venereology, Medical University – Pleven, Bulgaria
2) Department of Ophthalmology,
Medical University – Pleven, Bulgaria


J of IMAB 2008; 14(1):68-71 DOI:10.5272/jimab.14-1-2010.68
Keratoderma blenorrhagicum in a patient with Reiter syndrome
Valentina Dimitrova1email, Valentin Valtchev1, Ivelina Yordanova1ORCID logo, Hristina Haidudova1, Dimitar Gospodinov1ORCID logo, Snejana Tisheva2
1) Department of Dermatology and Venereology, Medical University – Pleven, Bulgaria.
2) Department of Rheumatology and Cardiology, Medical University – Pleven, Bulgaria.


J of IMAB 2008; 14(1):72-75 DOI:10.5272/jimab.14-1-2010.72
Valentin Valtchev1email, Virginia Simeonova2, Dimitar Gospodinov1ORCID logo, Ivelina Yordanova1ORCID logo, Valentina Dimitrova1, Verka Pavlova1, Emiliana Konova4, Savelina Popovska3, Boyko Stamenov2
1) Department of Dermatology and Venereology, Medical University – Pleven, Bulgaria
2) Department of Neurology, Medical University – Pleven, Bulgaria
3) Department of General and Clinical Pathology, Medical University – Pleven, Bulgaria
4) Department of Immunology, Medical University – Pleven, Bulgaria


J of IMAB 2008; 14(1):76-78 .
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

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,

J of IMAB 2008; 14(1):79-82.
Marieta Iovcheva, S. Zlateva, P. Marinov, Yu. Sabeva*
Department of Toxicology; *Laboratory of Chemical Toxicological Investigations; Military Medical Academy-Naval Hospital, Varna, Bulgaria

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,

J of IMAB 2008; 14(1):83-86.
Lyudmila Vladimirova-Kitova
Clinic of Cardiology, Medical University, Plovdiv, Bulgaria

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,

J of IMAB 2008; 14(1):87-88 .
Elena Kinova, Assen Goudev
Department of Cardiology, University Hospital Queen Giovanna, Sofia, Bulgaria

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,

J of IMAB 2008; 14(1):89-94. DOI: 10.5272/jimab.14-1-2010.89
Nadya Stancheva1email, 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


J of IMAB 2008; 14(1):95-97.
Aleksandra Tzoukeva, Nadejda Deleva, Ara Kaprelyan
Department of Neurology, Medical University Prof. Dr. Paraskev Stoyanov, Varna, Bulgaria

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,

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