Acta Medica Bulgarica
Постоянни адреси на тази колекция
Многопрофилно списание, излизащо само на английски език от 1973 г. и до момента. Съдържа авторски статии от водещи български медицински специалисти, отразяващи върховите постижения на българската медицина наука и практика. Публикуват се материали, отразяващи резултати от експериментални проучвания, клиника и казуистика. ***** Излиза 2 пъти годишно. ***** ISSN:0324-1750 ***** Уебсайт: http://www.medun.acad.bg/cmb_htm/AMB/index.html
***** About 30 years ago - in 1973, on the initiative of the Publishing House „Medicine and Physical Culture", namely its former director Mr. Traian Ivanov, the Ministry of Health set up and accepted to subsidize a new medical magazine that was to be published only in the English language and had to reflect the status and the achievements of the Bulgarian medical science.
Thus the language barrier was overcome and stable relations were established with the international medical society, large libraries, and university centers. The famous internationally known scientist professor Assen A. Hadjiolov was elected edition-in-chief by the first editorial staff and the magazine was named Acta Medica Bulgarica. For over 20 years, the staff of „Medicine and Physical Culture" did all the work related to the publishing of AMB regardless of the fact that the magazine kept on its appearance as organ of the Medical Academy, respectively of the Sofia Medical University. Editors-in-chief throughout the years were prof. Atanas Maleev, prof. Nikolay Belovezhdov, prof. Dimitar Djerov and prof. Vladimir Ovcharov. Gradually a greater number of scientists from all over the world as well as universities and scientific institutes demonstrated stronger interest in publishing their papers in AMB. The magazine is in demand by over 300 world medical libraries working on the exchange principle. For the last couple of years, AMB has been organ of the Sofia Medical University has been published by the Central Medical University Library - department of Medical Information. More than 30 years prof. Wenzeslav Bossnev has been responsible for the scientific edition of the magazine, while prof. Stoian Danev was later committed to the English version. The editorial staff respectfully marks out the joint efforts of all the colleagues that have of to the publishing of the magazine during the years of complex changes in social life and wishes the next generation of scientists to further develop and improve its scientific level and consolidate its position among international medical literature. ***** ISSN:0324-1750 ***** Website: http://www.medun.acad.bg/cmb_htm/AMB/index.html
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- ДокументMedical and social model of chronic cardiovascular system disease treatment(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Milanova, M.Chronic cardiovascular diseases (CVD) impose new challenges to the physician-patient relationship in modern society. The ageing of the population and the social deadaptation necessitate a medical and social model of treatment of the chronic CVD. In the cases of acute conditions, the physician dominates in the treatment process, removes the cause and prevents the consequences. In the cases of chronic conditions, the patient needs are mainly social and psychosocial and not so much medical ones. The chronic patient has got a certain potential of health and adaptation. It is the physician's task to prescribe the treatment, but at the same time to control such potential, to teach the patient how to live with the disease and to improve his or her quality of life. In their everyday life, people look for health, and not for medical care. In that aspect, a number of factors of the social-cultural-economic model have to be taken into account.
- ДокументValproate-induced parkinsonism in epilepsy patient – a case report(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Maximov, K.; Maximov, G.Valproate (VPA) is one of the most commonly used anti-epileptic drugs troughout the world. It is generally considered to have a good safety profil. Among the side effects due to valproate administration, parkinsonism is the rarest in frequency. This side effect is often unsuspected. Clinical features of valproate-induced parkinsonism (VPA-P) can mimic Parkinson’s disease and may be confusing especially when they occur in older men. A case of a 75-year-old man with ten years history of epilepsy treated with Depakine Chrono who developed parkinsonism in the last two years is described. Antiparkinsonian treatment with Madopar HBS even in high dosage was ineffective. The characteristics and possible mecha-nisms of VPA-P are described. Despite the good safety of VPA therapy for several years, clinicians should have a high suspicion for VPA-P especially in old patients and this possibility should be considered in the differential diagnosis.
- ДокументLaparoscopic radical prostatectomy: report of initial 22 cases Bulgarian urological practice(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Genadiev, Ts.The urological laparoscopy is not widely used in Bulgaria. We report our early experience with 22 cases of laparoscopic radical prostatectomy in Bulgarian urological practice. Aim of the paper was to report and analyze our initial experience with laparoscopic radical prostatectomy for clinically localized prostatic cancer. Between March 2005 and December 2007, 22 consecutive patients underwent laparoscopic radical prostatectomy in a single urological center according to the "Montsouris technique", performed by one surgeon. The median age was 60,5 year old, the median preoperative prostate specific antigen 12 ng/ml and the median Gleason score of biopsy specimens was 6. Median operation time was 420 minutes (range 300 to 660). Median value of postoperative hemoglobin blood test was 120.5g/L (range 99 to 144 g/L). Median postoperative Foley catheterization period was 14 days (range 5 to 30). Intraoperative complications related to operation procedure were three bladder injuries, treated laparoscopically, one rectal injury and one case of paraurethral uri-noma. No conversion to open surgery or reoperation was required in all cases. Although the operation time is still longer than that of conventional open procedures, we believe that op-erative time will decrease with more experience.
- ДокументMethods of protein delivery into mammalian cells for gene therapy and genetic studies(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Todorova, R.Methods, lying on different principles for introducing proteins into mammalian cells were compared in the present study. Some of them rely on non-covalent complex formation (Chariot), osmotic lysisis of pinocytic vesicles (Influx pinocytic cell-loading reagent), electric power (electroporation), lipid-based delivery system (Bioporter), microinjection, small protein transduction domains (PTDs) from viral proteins, bacterial secretion system type III (T3SS). Thus, the delivery by many of the compared methods can give a sufficient number of uniformly loaded cells for different studies including transcription and translation, cell cycle regulation, control of apoptosis, oncogenesis and gene therapy.
- ДокументRussian centre of pathology as a basis of progress of Russian pathology in the future(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Zubritsky, Al.Nowadays in Russian Federation the necessary conditions seem ripe for the creation of a Russian Centre for Pathology which could function as a “brain” centre and at the same time be an office of the Russian Society of Pathology. The process of organizing the Russian Centre for Pathology is proposed in the form of brief outlines and considerations for scrutiny and analysis to be followed by a thorough discussion. The creation of such a Russian Centre for Pathology having no counterpart in the world pathoanatomical practice will undoubtedly be a powerful breakthrough in Russian Pathology.
- ДокументEvaluation of the questionnaires directed at the dermatologic knowledge level of students at Trakya univestity Kirklareli and Edirne health college(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Görgülü, A.; Metin, İ.; Mutlu, C.; Elmas, S.; Uzunali, E.In this study, the knowledge and attitudes of intern nursing students (n=142) about the dermatologic diseases and their treatments were investigated. The informations were collected by the students who are included in the study through questionnaires. It was observed that the students had advanced knowledge about the management of dermatologic diseases. However, they had missing information about the spreading manner of the infection, findings and treatment of the disease, and the pharmacologic features of the drugs used in the disease. The expectations of the patients and the community of the nurses increases every day. Those needs may only be met by using the theoretical and practical knowledge together during the education of the nurses. It was concluded that giving more education about the dermatologic diseases may improve the success of the nurses on the practice management, since the skin is the first met and the largest organ of our body.
- ДокументSleep–inducing effects of carbamazepine (tegretol) and clorazepate (tranxene) in the primary persistent insomnia(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Maximov, G.; Maximov, K.Primary persistent insomnia (PPI) occurs independently of any known physical or mental condition and is among the most difficult problems in sleep disorders. For the treatment of PPI, comedication of clorazepate (Tranxene) in dosage 1 capsule of 10 mg and carbamazepine (Tegretol) in dosage 1 tablet of 200 mg in 32 out-patients for 30 days was applied. Normalization of sleep was achieved in 29 patients (90,63%). Side effects were few (5 patients) and of little importance, and the treatment was well tolerated.
- ДокументDisloyal competition among Bulgarian general practitioners.(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Ivanova, M.; Tufkova, S.With market economy established in primary health care, new ethical problems arise. The increasing competition for a greater market share of patients among general practitioners poses a danger of its mutation into various non-correct forms. This study is aimed at establishing the presence of disloyal competition among general practitioners (GPs) regarding patients registration with GP practices. The need for new ethical and legal regulations in this sphere is obvious. 221 general medicine practices in several municipalities of Bulgaria were included in this study. The method of the direct individual questionnaire was employed. There is data regarding the illegal enlistment of patients with GP practices through patients’ personal data misuse. Professional relations among physicians lack the corresponding level of trust. The Ethical Code of Bulgarian Physicians requires adoption of new principles for loyal competition as well as rules for good medical practice in the condi-tions of the health care market.
- ДокументRating of the schools(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Spangenberg, St.The aim of the survey is to elaborate a rating of schools based on their complex evaluation considering the pedagogical, health and hygienic requirements to training. The survey covered 1160 schoolchildren from 10 schools (general education, profiled, including language, colleges, lycees) from Sofia. The selection of the schools is unintended and illustrates the current options for training in secondary schools. The survey used indicators characterizing the training environment, training and morbidity rate of the studied individuals. Grouped by their natural characteristics, those indicators are in the basis of the proposed criteria for school evaluation. Cluster analysis was used to group the schools. The neighbourhood criterion was “Furthest neighbourhood”. The compiled dendrogram presents the stepwise joining of the schools and following grouping by rank that forms the basis of schools’ rating that can be completed with other schools as well.
- ДокументHistorical development of toxicology(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Radenkova–Saeva, J.The traditional definition of toxicology is "the science of poisons." A more descriptive definition is "the study of the adverse effects of chemicals, biological or physical agents on living organisms". These adverse effects may occur in many forms, ranging from immediate death to subtle changes not realized until months or years later. Knowledge of how toxic agents damage the body has progressed along with medical knowledge. The historical development of toxicology began with early cave dwellers who recognized poisonous plants and animals and used their extracts for hunting or in warfare. By 1500 BC, written recordings indicated that hemlock, opium, arrow poisons, and certain metals were used to poison enemies or for state executions. With time, poisons became widely used. Notable poisoning victims include Socrates, Cleopatra and Claudius. By the time of the Renaissance and the Age of Enlightenment, certain concepts fundamental to toxicology began to take shape. Noteworthy in this regard were the studies of Paracelsus, a physician from the sixteenth century and one of the early “Fathers of Toxicology”, who is often quoted for his statement: "All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy." The Chemical (Industrial) Revolution of the mid-19th century released many naturally occurring chemicals into the environment in unprecedented amounts. Also, it produced and released new substances unlike any that had existed in the natural world. With the production and use of these chemicals, and the need to protect hu-mans from the toxic effects of industrial chemicals, toxicology eventually evolved to include its modern day branches: general toxicology, pharmacology, occupational toxicology, clinical toxicology, environmental toxicology.
- ДокументOpportunities for health promotion in the context of the present health reality in Bulgaria (part I).(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Karaslavova, E.The social-health aims, tasks and activities set in the current work are complied in priority with certain peculiarities of the inherent situation in Bulgaria which require not only control over the basic cardiovascular risk factors but also considerable improvement of our environment of living. The new theoretic concept and strategy of the practical healthcare “health promotion” puts the challenge to the “medicalization of health”. The promotional ideas underline the influence of the social and economic indicators over health and welfare both of the individual and society and reflect the changes in priorities of the health activities.
- ДокументLumbar myelography enhanced with ion free contrast medium – pro and against. Presentation a new technique improving quality of the image in the area of lateral recesus of vertebral canal(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Cholakov, D.; Kumchev, Y.; Karaslavova, E.; Cholakov, S.The causes of low back and leg pain should be sought thoroughly. They might be degenerative changes of the spine: disc prolapse, stenosis and their combinations. When the degenerative changes are in a phase of destabilization, the changes are in an early stage and can be discovered only during dynamic change of the position of the spine. In this study, our objectives are: to compare the data in the literature and to discuss the diagnostic value of the conventional myelography on the one hand, and of CT scan and MRI, on the other; to make lumbar myelography more tolerabl for the patients; to improve diagnostic abilities of the lumbar myelography to discover dynamic – position dependent, lumbar stenosis of the patients, especially in the cases where there is no image of compression in the CT scan or MRI. We studied two groups of 60 patients. In the first group, one neurorent-genologist did conventional myelography of the patients in sitting position. In the second group another neurorentgenologist performed myelography in the new way proposed by us. In that case, lumbar puncture was done of the patient in prone position on the x-ray table. After injection of the contrast medium, the position of the x-ray table was changed to vertical, and A-P, lateral, left and right oblique projections of x-ray images were taken. After that, x-ray table was moved back to horizontal position and x-ray images in A-P and both oblique projections were done. After the myelography, the patients in both groups were recom-mended to drink sufficient amount of fluid and to keep bed rest for 4 hours. We compared both groups of patients. It was found that when lumbar puncture was done in prone position less patients – 15 (25%) suffered from postdural puncture headache than those to whom dural puncture was performed in sitting position – 46 (77%). Conclusions: 1. Lumbar myelo-graphy is important method to obtain information about the condition of the lateral recessus, and helps to create preoperative plan in patients with position dependent lumbar stenosis. 2. The proposed by us method for performing myelography in prone position is better tolerated by patients and gives more information and better images of the lateral recessus. 3. It helps to plan the surgery in a way to prevent compromising outcome due to postoperative stenotic nerve root compression.
- ДокументAcute exogenic intoxications and level of the antioxidant selenium(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-06) Tufkova, S.; Karaslavova, E.The human organism possesses a well built antioxidant defence system having as a purpose neutralizing the free radical processes. The antioxidant defence of the human organism can be divided in to three functional levels. Great importance is given to the second level represented by enzyme and non-enzyme components which defuse the already formed free radicals. Here a main representative is the microelement selenium. Aim of the study was tracing the level of selenium – a main element of the secondary antioxidant defence system of the human body in acute exogenic intoxications with cerebrotoxic medicaments, alcohol and heroin. The study is prospective and longitudinal comprising 118 patients with average and heavy degree of acute poisoning with cerebrotoxic medicaments (n=45), alcohol (n=40), heroin (n=33) and control (n=35). The clinical laboratory tests are made under definite standards of the clinical laboratory. Following statistical analyses are used: variational analysis/u-criterion for normal distribution, t-test of Student, dispersive analysis under the method of ANOVA test and non-parametric analysis. Our results show a statistically significant decrease of serum concentration of selenium in acute exogenic intoxications with cerebrotoxic medicaments, alcohol heroin – Р<0,001, without it correlating with the weight of the acute intoxication – Р>0,05. As a reliable marker for a complex estimate of the antioxidant system of humans is the tracing the serum level of selenium and its careful interpretation.
- ДокументMesothelioma revisited(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Zubritsky, A. N.Presented herein is a review of the literature on mesothelioma, namely: etiology, pathological anatomy, diagnosis, treatment, and prognosis.
- ДокументForensic and epidemiological research of lethal traumatism caused by atmospheric electricity in the district of Varna(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Dokov, W.World literature describes single cases or small series of cases on this topic. In spite of our meticulous search through literature, we did not find references to such cases in Bulgaria, including the district of Varna. These circumstances initiated our research. Our purpose was to present the forensic and epidemiological characteristics of the victims of atmospheric electricity (VAE) in the district of Varna. Subject of this study were 27 death cases caused by atmospheric electricity. The data had been put to alternative- (mean ± SEM), variation- (Student t test) and graphical analysis. The calculations had been made by statistical soft-ware (SPSS 11.0). The building of a linear trend had been accomplished by the method of the least squares. Values of P<0.05 had been accepted as significant. VАЕ account for 9.71% of all death cases resulting from atmospheric electricity and represent 0,16% of all forensic medical autopsies, or 0.13 per average 100 000 residents of the district of Varna of average age 42.22 years. Out of these males account for 92.59% or 0,126 per 100 000. Their average age was 39.44 years. Females account for 7.41% or 0.01 per 100 000. Their average age was 50 years. Children and adolescents aged between 0 and 17 account for a total of 22.22% out of which 100% were boys of average age 13.83 years. The research of circumstances at which the lethal end appeared revealed that in 92.59 % of the cases the death was not connected with the exercising of occupational activities; in 7.41% of the cases, the death resulted from accidents at work.
- ДокументTomov, D. Marketing of university medical education – the foreign and Bulgarian experience(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Tomov, D.Modern planning and management of university medical education and public health should obligatorily take into consideration the principles of marketing in this specific area of social life. The idea of implementing marketing of university medical education is supported by evidence from several foreign countries such as England, Germany, Japan, etc. The educational infrastructure is an obligatory precondition for state-of-the-art university medical education in any country. In the Medical University of Varna, rich experience has been gained with teaching students from abroad. The diploma received by Bulgarian citizens is accompanied by European certificate. Proper incorporation of Bulgarian research on marketing of university medical education into the international scientific community could help meeting the rising requirements of competitive and collaborative world health markets.
- ДокументFacial nerve peripheral paralysis in 76 patients(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Klissurski, M.; Daskalov, M.; Ishpekova, B.Aim of the study was to evaluate the etiology, clinical profile and evolution of the facial nerve peripheral paralysis (FNPP) and to assess the relationship between the different etiological and treatment modalities that influence the prognosis and recovery. A total of 76 patients with idiopathic or symptomatic facial lesion were evaluated. The assessment of the paresis was done according to a modified scale of House and Brackmann. Complex treatment received 56 patients. The time of complete recovery (CR) and number of patients at day 30, 45 and 90 were estimated, considering the different risk and prognostic factors. Sixty eight percent of the patients had idiopathic Bell’s paralysis. The right side was affected in 42 patients; moderate paresis was observed in 34, and severe damage in 40 patients. The mean time of CR was estimated to be 34.7 +/- 12 days; 49.3% of patients improved completely in 30 days, 73.6% in 45 days, and 88.2% in 90 days. Most of the patients with FNPP improve in less than three months. Complex examination including EMG is needed to predict the evolution of FNPP. Unfavorable factors for recovery are the advanced age, herpetic infection, delayed initiation of a complex therapy, diabetes mellitus, recurrent paresis and severe EMG changes.
- ДокументA-waves in patients with Bell’s palsy(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Alexandrov, A.; Muradyan, N.; Christova, L.; Kosarov, D.; Daskalov, M.; Ishpekova, B.The aim of this study is recording and investigation of multiple A-waves from frontalis and orbicularis oris muscles in patients with Bell’s palsy. Twenty-one males and 34 females with Bell’s palsy participated in electrophysiological studies. The control group consisted of 28 subjects (16 women and 12 men). A-waves were obtained during conventional F-wave investigation with 16 supramaximal stimuli with a frequency below 1Hz. Electrical stimulation with square wave pulses 0.2 ms in duration was applied via a bipolar surface electrode fixed over the nerve just below the ear and anterior to the mastoid process. The evoked compound muscle action potential (CMAPs) of frontalis and orbicularis oris muscles was recorded with concentric needle electrode (diameter of 0.45 mm) at an amplification of 200 V/div. On the basis of the electromyographic manifestations (parameters of recorded CMAP of m. orbicularis oris and m. frontalis and conduction time (CT) of n. facialis), the patients were separated in three groups – with mild, moderate and severe facial paresis. A-waves were observed between CMAP and F-wave. They were with lower amplitude, approximately constant shape and latency. In 2 patients, A-waves were not found in both investigated muscles. Single A–wave recorded from frontalis muscle were observed in 8 (14.5%), multiple A-waves – in 35 (63.6%), and in 12 (21.8%) of patients, A-waves were not found. Multiple and single A-waves were observed in orbicularis muscle in 33 (60%) and 8 (14.5%) of patients respectively and in 14 (25.5%) of them, A-waves were not recorded. The multiple A-waves are common signs in the early stage of Bell’s palsy in cases of mild and moderate degree of paresis.
- ДокументInformation, philosophy and the inverse problem in optical tomography – a thought-provoking essay on how modern philosophy deals with information(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Müller, G. J.Starting from some general considerations on how information has to be valued as a third philosophical entity between subject and object, the problem on how signal transmission will be influenced by the environment is discussed. The environment with its non-predictable and unknown statistical fluctuations causes a disturbance of the information channel in use which is referred to as noise and becomes the ever important entity in questioning how we could understand our world. In this context the term “Erwartungswert, i.e. “expectation value” is introduced.
- ДокументAlcohol and children(Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia, 2008-12) Loukova, A.One of the major challenges faced by states and communities is the prevention of underage alcohol access. Underage drinking is widespread and, to a large extent, tolerated by society. It is also implicated in a range of health and social problems that are both tragic and costly. There are good reasons for a high level of concern about underage drinking: alcohol is the drug most commonly used by youth-more than tobacco and far more than marijuana or any other illicit drug; alcohol is one of the most common contributors to injury, death, and criminal behavior among young people; in addition to the immediate and potentially tragic consequences of underage drinking, early onset of alcohol use increases the risk for chronic alcohol addiction. The bad news is clear and all too visible. Underage alcohol use is a serious problem. But fortunately there is good news as well: a variety of effective strategies have been developed to reduce underage drinking. These strategies can be applied in all sectors of the nation, state, and community – in all areas of the systems that produce, distribute, promote, and consume alcohol. Preventing underage drinking saves lives and saves futures.