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The esophageal diverticula are divided into pharyngoesophageal, parabronchial and epiphrenic. They could also be divided into congenital and acquired, true and false, pulsion and traction. Pulsion diverticula are usually formed in motor disorders of the esophagus, above the place of hypertension and uncoordinated peristalsis. They are pseudo-diverticula caused by increased intramural pressure, leading to herniation of the mucosa and submucosa through the focal areas of the esophageal wall. We present a 65-year-old woman who underwent left-sided transthoracic diverticulectomy, modified Heller esophagocardiomyotomy, and modified Belsey-Mark IV fundoplication due to a huge epiphrenic esophageal diverticulum.


The aim of the work was to study the agglutination and hemolysis of erythrocytes under diff erent conditions in vitro in a patient with unknown cause of anemia and concomitant secondary instability of endoprosthesis.

Material and methods. One percent (1%) suspension of erythrocytes of a woman, 61 years old, A (II) Rh- (negative) presented with anemia was incubated with her serum and plasma at pH 7.3, pH 5.8 and 9.0, as well as with IgM α and β antibodies. Unithiol was used to destroy IgM antibodies. The samples were incubated for 12 hours at 37° C, and the presence of the agglutination and hemolysis was evaluated.

Results. The incubation of the plasma with unwashed erythrocytes of the patient led to the agglutination of the erythrocytes and the usage of the complement led to the hemolysis. After inactivation of IgM in the plasma the agglutination was absent and the hemolysis was present under usual conditions and at pH 5.8, whereas at pH 8.0 the hemolysis was attenuated, however a slight degree agglutination appeared. The usage of the complement led to the agglutination and the hemolysis, absent at pH 8.0. The plasma incubated with washed red blood cells and the complement led to the hemolysis. The incubation of the serum with washed erythrocytes led to the hemolysis at pH 5.8, attenuated after the usage of the complement. The contact of terbinophine with plasma and unwashed red blood cells led to the absence of both the hemolysis and the agglutination. Candida lusitaniae growth was detected in the plasma.

Conclusions. The agglutination of unwashed erythrocytes by own plasma, attenuated in the alkaline medium and enhanced in the acid medium, as well as the absence of the agglutination after the usage of terbinophine and the hemolysis in the presence of the complement might be the signs of mycogenic and autoimmune origin of anemia with the activation of autoimmune complement – binding antibodies.


The purpose of the study is to create computer program for the achievement of precise digital data processing of records performed with the “Facebow Mini-Maxi” and the facilitation of information transfer to the articulator.

Material and method: A conceptual project was developed in order to create a new software product and requirements were defined towards its capacities, which are to provide guidance for its creation. With the assistance of computer programmer, the project was implemented.

Results: The computer program “Facebow Mini-Maxi Analyzer” for digital data processing of registrants performed with the auricular type facebow was created. The program provides automatic recognition, reading, calibration and measurement of data obtained by “Facebow Mini-Maxi”. The main module gives us opportunities for measuring the values of: the sagittal condylar pathway; the arrow point angle and the length of the hinge axis. After finalizing the calculations, the software automatically generates a scheme with visualization of the parameters that significantly supports the dental technician when it comes to defining the accurate position of the models in dental articulator with individual parameters.

Conclusion: The computer program provides accurate analysis of facebow records and assists in determining individual patient movement parameters of the lower jaw. The obtained results from the analysis improve the precision of casts mounting in articulator. The program cuts down the risk of subjective error when analysing the data via manual measurement of the recorded parameters on paper carrier.


Cutaneous xanthogranuloma is a rare benign tumor and both adults and children could be affected. Head and neck area of the human body is the most commonly affected one which often poses a serious reconstructive challenge for the plastic surgeon who is in charge of removing the lesion. We report on a clinical case of an adult female patient who presented with cutaneous xanthogranuloma of the upper lip, involving the subnasal area. Both diagnosis and surgical treatment were difficult, considering the clinical behavior and location of the tumor. An innovative surgical approach going out of the dogmas of plastic surgery was applied and an excellent result was achieved.


Introduction: Determination of the curvature of root canals at present is accomplished by complicated or expensive methods. Therefore, there is a need to develop a new digital method by which this curvature can be determined quickly, easily and accurately.

The aim of this in-vitro study is to determine the angles of curvature of the root canals of extracted teeth by comparing a new digital method of measurement with an established digital method.

Material and Methods: Forty-eight (48) root canals of extracted teeth were studied to achieve the goal. In all roots, curvature is measured by three methods: Method 1 – new digital photographic method and special Software (Screen Protractor); Method 2 – a new digital radiography method and special software (Screen Protractor); Method 3 – approved method, digital by X-ray and special Software (Durr dental).

Results: The mean degrees of the measured curvature of the root canals in all three groups are similar and are about 22°. There are no statistically significant differences between them (p > 0.05).

Conclusion: This shows that the new digital photographic and x-ray methods for measuring root curvature can accurately determine the curve angle for extracted teeth.


Enteric bacterial infections are characterized by the location of causative agents in the intestine and their distribution in the environment with excrements. Intestinal bacterial infections in Bulgaria are caused by Salmonella spp., Shigella spp., E. coli, Campilobacter spp., Yesinia enterocolitica. For the period 2016-2018, the incidence rate of salmonellosis in Bulgaria was close to that of the European Union (EU). It was 11,21 per 100 000 population in 2017 (14,6%ooo in the EU). The incidence rate of typhoid fever in Bulgaria was lower than that in the EU for the period 2016-2018 – 0.01-0.03 per 100 000 population. Bulgaria had the highest rate of shigellosis in the EU. For the period 2016-2018 it was between 3,33%ooo and 4,07 per 100 000. The incidence of Campylobacter infection in Bulgaria during the period 2016-2018 was between 2,72%ooo and 2,88%ooo and was lower than the EU average. Data on yersiniosis in Bulgaria is incomplete. For the period 2016-2018, 36 cases were reported. E. coli enteritis had a higher average annual notification rate in the 0 to 1 age group (142,65 cases per 100 000 population). The main means of controlling intestinal infection are sanitary measures that prevent the transmission of pathogenic microorganisms with food, water, insects, contaminated hands, etc.


A vital aspect of the medical activity on which the medical care quality directly depends has been the doctor-patient relationship; it is of complex nature and is formed by a number of factors: professional ethics, communication culture of the doctor, the patients’ confidence in the doctor, etc. From an ethical point of view, the confidence of the patient has been an ethical indicator and criterion of particular importance for the quality and interpersonal relationship between the doctor and the patient. Data from the overview of a number of papers, as well as data from our own empirical study, has indicated the presence of a number of unresolved problems in this relationship. That has raised the significant necessity of a more thorough and comprehensive training of the medical staffin professional medical ethics in undergraduate and postgraduate training.


The gastrointestinal tract perforation is one of the leading causes of acute abdomen. Mycotic infections have become a significant clinical problem over the last few decades. Despite the advance in diagnostics and treatment of patients with fungal peritonitis, the mortality remains high.

Objective. The objective of the study was to determine the type and incidence of causative pathogens of acute peritonitis in patients with gastroduodenal perforation, and to estimate the impact of microbial flora on the disease outcome.

Materials and methods. We performed a retrospective study among 83 adult patients with acute peritonitis due to gastroduodenal perforation treated at our centre.

Results. A total of 40 mycotic agents were isolated in 39 of the abdominal samples. The primary mycotic isolates were Candida albicans (52.5%) and C. glabrata (64.3%); C. krusei (14.3%) and C. tropicalis (7.1%) predominated among non-albicans Candida species (35.0%). The most common bacterial agents were Escherichia coli (24.0%) and Enterococcus spp. (24.0%). 77.1% of all enrolled patients survived, and 19 of them deceased due to sepsis and multiple organ dysfunction syndrome.

Conclusion. Candida albicans is the most common mycotic pathogen in patients with acute peritonitis due to gastroduodenal perforation. It is obligatory to examine the peritoneal fluid samples for bacterial and fungal pathogens with determination of their antimicrobial susceptibility profile. Timely initiation of adequate treatment and multidisciplinary approach is crucial for the outcome of patients with fungal peritonitis.


Objective: The aim of the study was to determine the molecular mechanisms of mutagenesis in Bulgarian patients with Angelman syndrome (AS). AS is a severe neurodevelopmental disorder caused by loss of expression in brain of the maternally inherited UBE3A gene as a result of various 15q11.2-q13 alterations.

Material and Methods: In total 24 patients (11 boys, 13 girls) from 22 unrelated families with suspected clinical diagnosis AS were analysed. We used methylation specific PCR, multiplex ligation-dependent probe amplification, methylation sensitive MLPA, and direct sequencing of the UBE3A gene.

Results: In 9 families (41%) pathogenic mutations were detected, which confirmed the clinical diagnosis on а molecular-genetic level. In 4 (44%) of these families we found 15q11-q13 region deletion with breakpoints BP1-BP3 or BP2-BP3. In 1 (11%) of the families we found imprinting defect: deletion of the AS-SRO regulatory region (part of the PWS-AS imprinting center). In 1 (11%) of the families we detected a rare finding – paternal uniparental disomy of chromosome 15. In 3 (33%) of the families diff erent point mutations in the UBE3A gene were detected: two novel missence mutations c.488T > C; p.Leu163Ser and c.1832A > T; p.Gln611Leu, and one known frameshift mutation c.2576_2579delAAGA; p.Lys859Argfs*4.

Conclusion: The obtained results helped us to develop a systematic diagnostic algorithm in order to provide proper diagnosis for the patients with AS. Combining excellent knowledge of the molecular mechanisms of mutagenesis and proper molecular-genetic testing approaches is a cornerstone in the management of AS patients, ensuring AS families would receive both adequate genetic counseling and prophylaxis of the disease in the future.


The process of neoangiogenesis is one of the classic hallmarks of a cancer. Its intricate mechanisms have long been one of the major domains in cancer research and a hope for a therapeutic breakthrough. Last decade a new subgroup of non-coding RNA molecules was reported called microRNAs. Literally hundreds of new molecules in this class are being uncovered as pivotal regulators in virtually all intracellular processes. The aim of this study is to classify and review those microRNA molecules that have a role in the processes of tumor angiogenesis and map their places in the regulatory framework of the classical proangiogenic genes and their canonical cascades.