Molecular biology of esophageal adenocarcinoma (EAC) is not fully elucidated. The aim of this study was to assess the expression of cycle regulator and tumor suppressor p16 in esophageal adenocarcinoma. The expression of p16 at protein and gene level was investigated using immunohistochemistry and fluorescence in situ hybridization in thirteen EAC specimens obtained by endoscopic biopsies and surgical resections. The mean age of enrolled patients was 62 years and a male predominance was observed. Loss of p16 protein expression was detected in 77% of the cases and loss of p16 gene was found in 69% of cases as hemizygous deletion was the most common. Significant correlation was found between the absence of p16 protein expression and p16 allelic loss. Cell cycle disturbances seem to play role in the EAC carcinogenesis and probably p16 gene deletions are connected with the loss of p16 protein expression.
St. Valkanov, P. Valkanov, K. Trifonova and K. Slaveykov
Dermoid and epidermoid cysts are among the most common orbital tumors, comprising 3% to 9% of all orbital masses. We report a rare case of upper medial orbital epidermoid cyst of a 2-year-old patient. The patient was complaining of pain in the right eye and infrequent vomiting. The neurological and radiographic examinations showed no pathological findings, only after CT scan was performed a tumor formation was found. After the extirpation a histological examination was performed proving the diagnosis.
M. A. Boyanov, E. Czerwinski, A. Shinkov, V. Palička, P. Lakatos, C. Poiana, J. Payer, Z. Killinger, T. Kocjan, O. Lesnyak, G. Holzer and H. Resch
To assess the current practice patterns in the diagnosis and treatment of male osteoporosis based on questionnaires. Questionnaires were presented and filled out by osteoporosis experts from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, Slovenia and Russia. The questions included focused on the proportion of male referrals to DXA, the main reasons for referral, the preferred measurement sites and reference database, the definition of male osteoporosis, needed laboratory investigations, data on calcium and vitamin D supplementation as well as on treatment modalities and their reimbursement rate. Men comprised 5 to 10% of all DXA referrals. The main reasons for referral were low back pain and fractures. Most of the respondents used the International male reference database. The diagnosis of osteoporosis was based mainly on a T-score below −2.5 after the age of 50, but a few respondents added fractures as a necessary condition. Only 1/3 of men visiting DXA sites are expected to have normal BMD. A consensus for the use of laboratory investigations in male osteoporosis is practically lacking. Treatment modalities include alendronate, risedronate, zoledronate, denosumab, rhPTH and strontium (with some restrictions for the latter three). Data on treatment adherence and persistence are generally lacking except for Austria, Romania and Slovakia. The levels of reimbursement vary a lot across countries. Osteoporosis in men is an under-recognized problem in CEE countries, leading to a tremendous gap in the diagnosis and treatment.
The pulp hyperaemia is associated with increased blood flow in the pulp. Diagnosis of this condition is very important for the outcome of a dental treatment. There are new methods, which can detect the pulp blood flow. Such method, gaining increasing popularity nowadays, is pulse oximetry. In this study, intact teeth and teeth with diagnosis of hyperaemia pulpae are examined by pulse oximeter and electric pulp test. The results show that the threshold of irritation is decreased in teeth with hyperemia, and the saturation of the pulp is increased by 12.34% in frontal teeth and 7.27% in distal teeth. There is a statistically significant difference (p < 0,05) in the values measured with pulse oximeter in the intact frontal and distal teeth and the teeth with hyperemia. Pulse oximetry can detect changes in pulp microcirculation in state of hyperemia. It is an extremely valuable method for early, objective diagnosis of pulp blood flow, as well as for its monitoring in dynamics.
Patients with chronic obstructive pulmonary disease (COPD) have high risk of cardiovascular events due to the remodeling of the heart and vessels. We investigated whether in COPD cardiac remodeling is associated with immune response to the inflammation by studying activated T-lymphocytes, CD3+, CD4+, CD8+ subsets of T-lymphocytes autoimmune lymphocytotoxic and granulocytotoxic antibodies, circulating immune complexes, bacterial sensibilization and hypersensitivity by the delayed type to the host heart tissue antigens. It turned out that progression of COPD is characterized by the decrease of cell immunity with formation of bacterial sensibilization and autosensibilization to the heart tissue antigens, strongly associated with cardiac remodeling. Thus, the presence of autoimmune response significantly contributes to the changes of heart geometry in patients with COPD.
Toxic epidermal necrolysis or Lyell’s syndrome is a severe life-threatening adverse drug reaction with a high mortality rate. The drugs most commonly involved are: antibiotics; anticonvulsants; antiretroviral drugs; nonsteroidal anti-inflammatory drugs, allopurinol. Case report: A 68-year-old female, presented with complaints of fever and extensive rashes on the skin of the face, the neck and the trunk, severe itching of the skin, ulcerations and erythema of the conjunctiva and the oral cavity and difficulty in swallowing. She has a period of two or three days of general discomfort and fatigue, rash, fever up to 38°C, sore throat, arthralgia, myalgia, loss of appetite and have been treated with antipyretics, antibiotic – ampicillin, antihistamines, vitamins. Her state worsened during the next 3 days, therefore she was hospitalized in the Toxicology clinic of University Hospital “N. I. Pirogov”. Multiple maculopapular and bullous eruptions, plaques were present all over the body, blisters that cover a substantial portion of the body. The entire skin covering the body surface was denuded and peeled off with minor manipulation – the Nikolsky’s sign. Intraorally, multiple oral ulcers of the buccal mucosa, tongue, palate, labial mucosa, and soft palate were seen. Hemorrhagic erosions were also seen on both the upper and lower lips. Conjunctivitis and ulceration of genitalia were also noted. The lesions got slowly better with serum therapy, fluid and electrolyte replacement, systemic corticosteroids, antihistamines, antibiotic, vitamins, H2 blockers, topical care of mucosal changes. Evolution was satisfactory with epidermization and the patient was discharged from the hospital after 1 month.
I. Valkov, R. Ivanova, C. Marinova, A. Alexiev, K. Antonov, D. Jelev, R. S. Ivanova and L. Mateva
Serum lipids abnormalities are widespread among patients with chronic hepatitis C (CHC), but the impact of concomitant hepatic steatosis [steatosis, nonalcoholic steatosis (NAS)], as well as distinctions between it and nonalcoholic fatty liver disease (NAFLD) are not well established yet. The aim of the study was to assess and compare the serum lipids in patients with genotype 1 CHC with and without steatosis, those with NAFLD, and healthy controls (HC). A total of 1010 subjects were included in this study: 366 CHC genotype 1 patients with steatosis (n = 227) and without steatosis (n = 139), 403 NAFLD patients, and 241 HC without fatty liver or other disease, matched for age and gender. Serum lipids, body mass index (BMI), components of metabolic syndrome (MS), and serum insulin levels were evaluated. In addition serum lipoprotein (a) [Lp(a)] levels were studied in 112 CHC and 80 NAFLD patients. The mean levels of total cholesterol, LDL-cholesterol and triglycerides (Tg) were higher and the mean levels of HDL-cholesterol were lower in all patients with steatosis (CHC and NAFLD) than in CHC cases without steatosis (p < 0.05 and p = 0.001, resp.). Higher prevalence and severity of lipid abnormalities, including Lp(a), were observed in patients with NAFLD than in those with CHC (p < 0.001). No difference was found between CHC patients without steatosis and HC. Higher prevalence and grade of glucose metabolic abnormalities were also observed in patients with NAFLD and CHC with steatosis than in cases without steatosis (p < 0.05 and p = 0.001, resp.). Lipid and glucose metabolic abnormalities in patients with CHC were dependent on steatosis. CHC with steatosis and NAFLD were associated with insulin resistant type dyslipidemia, with total cholesterol and LDL-cholesterol being generally lower in CHC.
Cancer as a financial value is one of the most expensive diseases. Costs, including the cost of new cancer drugs, are increasing at an unsustainable rate, threatening the permanent access of patients to treatment. Prices for new treatments against cancer have doubled over the past 10 years and now are usually between USD 6000 and USD 10,000 per month, this increase is often not correlated with reimbursement and implemented public health benefits. According to various authors, these results lead to debate whether the cost differences between EU countries and the US for the treatment of oncologic diseases are transformed into improved outcomes for patients, and must also take into account key factors such as lifestyle, late diagnosis, and management approach for treatment, reimbursement of oncology treatment and control of various institutions on spending.
Detecting new units of pathogenesis in the liver fibrosis due to alcoholism, chronic viral Hepatitis B and C, non-alcoholic fatty liver disease (NAFLD), autoimmune, parasitic and metabolic diseases and other, reveals perspective for new non-invasive serum biomarkers. In fibrosis, from the wide variety of markers enzymes, proteins and cytokines are mainly used. While direct biomarkers reflect the stage of fibrosis and fibrinogenesis, indirect markers allow assessment of the general liver functions. The combination of direct and indirect markers increases the diagnostic reliability and therefore these panels and indices are investigated quite intensively in recent years in order to decrease the number of liver biopsies without completely replace it, which is still regarded as the reference method.
The aim of this study is to build a suitable physiotherapy program for recovery of patients undergoing surgery in combination with platelet-rich plasma (PRP) therapy of the ankle joint, intended for implementation in the period of home treatment. This delineation of physiotherapy program contains an aim, the tasks set for realization of the aim and the used physiotherapy means. It is developed for the period of home treatment from postoperative week 2 (days 8-15) to the postoperative week 8 (days 56-63), the period that is very important for the normal recovery of the ankle/foot complex. The physiotherapy program is arranged into weeks and each of them contains the used physiotherapy means, the exercise duration and the therapeutic effect.