Volume 10 (2017): Issue 1 (November 2017)

In recent years focus has been increasingly placed on impulse control disorders (ICDs) in patients with Parkinson’s disease (PD). ICDs include pathological attraction to gambling, compulsive shopping, compulsive eating and compulsive sexual behaviour and are associated mostly with the intake of dopamine agonists. Another impulsive and compulsive behaviour in PD is the dopamine dysregulation syndrome, which is associated with compulsive intake of L-dopa, and short-acting dopamine agonists. Diagnostics and prevention of this group of disorders is essential, considering the difficulties related to their treatment and their negative impact on the patients themselves as well as on their relatives.

Anemia is an important public health problem worldwide. Although iron (Fe) deficiency is considered the main factor in the pathogenesis of anemia, only 40-60% of anemia cases are responsive to Fe supplementation. Considerable data exist that other micronutrient deficiencies, such as selenium (Se), could be possible causes of anemia. The issue of Se deficiency as a risk factor for the development of anemia is of particular interest to our country since the Balkan region is known by a low Se content of soils. The aim of the study was to examine the contemporary conception of the influence of Se deficiency on the development of anemia by a review of the scientific literature. Most animal studies have shown a significant relation between Se deficiency and anemia, but one study indicates that there is no impact of Se deficiency on the hematological parameters. Associations of low serum Se with anemia have been found in a number of human studies including subjects of various age groups and pathological conditions. Three possible biological mechanisms have been suggested for the involvement of Se deficiency in the development of anemia: increased oxidative stress, modulation of inflammation through induction of interleukin-6, and increased expression of heme oxygenase-1. A more categorical clarification of the relationships between Se deficiency and development of anemia is needed with respect to appropriate trace element supplementation in cases of anemia with insufficient or absent therapeutic response to Fe treatment.

The impact of hypertension on the kidney is associated with a number of morphological changes, which gradually lead to development of end-stage kidney disease. The aim of the present study was to trace the postnatal histological changes in the morphology of nephrons and renal interstitium in spontaneously hypertensive rats. In this study, we described and compare alterations in renal histology as a consequence of hypertension in two age groups of spontaneously hypertensive rats, aged 2 and 6 months (n=3; per age group). The description of the alterations in renal morphology was made by light microscopic analysis using routine haematoxylin and eosin staining, periodic acid Schiff (PAS) reaction and Mallory’s trichrome staining. We did not observe significant changes in renal histology in 2-month-old rats: renal corpuscles were relatively well preserved, proximal and distal tubules were clearly demarcated, and no pathological changes in the larger intrarenal blood vessels were found. There was evidence of glomerular and tubular basement membranes thickening and focal interstitial fibrosis. In 6-month-old rats, we noted pronounced glomerulosclerosis, periglomerular and periarteriolar fibrosis and expansion of interstitial fibrosis. The vascular alterations depended on the size of the blood vessels and included hyaline arteriosclerosis, fibrinoid necrosis and myointimal thickening of interlobular arteries. Untreated hypertensive nephrosclerosis is associated with progressive renal alterations, which cause impaired renal function – a lifelong limiting factor.

A Transient Ischemic Attack (TIA) is a state of emergency and an independent risk factor for ischemic stroke. The social significance of the disease is determined, based on the probability of occurrence of subsequent cerebrovascular incidents and their frequency among groups. The purpose of the present study was to perform a comparative analysis of clinical features and outcome in patients with TIA for at least 24 months after onset had been registered, according to the pathogenesis and to ABCD (2) score. Two hundred and fifty-seven patients were monitored at the Neurology Clinic, First MHAT – Sofia after suffering an initial TIA. All subjects were studied using a clinical evaluation of pathogenetic mechanisms and an ABCD (2) algorithm. A diagnosis of TIA was confirmed by neuroimaging. The comparison between specific pathogenetic mechanisms demonstrated a statistically significant difference. Two TIA subgroups were involved – thromboembolic and cryptogenic (p<0.05). Also, according to the ABCD (2) score results, significant differences were found between groups at low (1-3) and high (6-7) risk, and those at intermediate (4-5) and high risk (p<0.01). Detailed investigation and assessment of patients with TIA are important concerning the prognostic outcome.

Eleven retired sportsmen, who had a career in contact sports (three boxers, four footballers, four wrestlers) and one cyclist with a history of several falls from a bicycle and had been diagnosed with a cerebrovascular trauma, were investigated with auditory cognitive P300. The age range was aged between 26 and 63 years. Ten out of the twelve presented cognitive wave latency between 512 msec and 928 msec. This finding made us conclude that repetitive minor head injuries (mHI) that they inevitably had experienced during their carrier has led to cognitive problems in older age.

Osteoporosis is a systemic skeletal disease characterized by decreased bone mass, destruction of the microarchitectonics of bone structure and a high risk for fracture. One of the criteria for altered bone homeostasis includes the changes in serum levels of alkaline phosphatase (ALP) and the activity of matrix metalloproteinases (MMPs). The purpose of this study was to determine the serum concentrations of calcium (Ca²⁺), phosphorus (P), magnesium (Mg²⁺), alkaline phosphatase (ALP) and MMP-9 in ovariectomized rats. We used 35 female Wistar rats at reproductive age (2 months) divided into 2 groups: a control group (G1-SHAM) – 20 animals subjected to “false” ovariectomy and placebo-operation, and an ovariectomized group (G2-OVX) – 15 animals subjected to bilateral ovariectomy. Blood was collected from the abdominal aorta for testing levels of Ca^{2 +}, P, Mg²⁺, ALP and MMP-9. No statistically significant differences in serum concentrations of Ca²⁺, P and Mg²⁺ were found between G2 and G1 (p>0.05). The values of ALP and MMP-9 in rats of G2 were statistically significantly increased, as compared to G1 (p<0.05). The serum activity of ALP, which is a marker for bone formation, was increased in OVX-induced osteoporosis. Elevated serum MMP-9 levels in G2 confirmed the hypothesis that it is a marker for osteoclast activity.

The reaction of anti-sperm antibody-positive sera from infertile women with fractionated mouse ovarian antigens was measured by enzyme-linked immunosorbent assay (ELISA). Antigens were obtained by extraction for nuclear matrix and intermediate filaments (NM-IF) producing three protein fractions – soluble, cytoskeletal and NM-IF. The results showed that sera from some infertile patients, but not control sera, react with either the soluble fraction or the NM-IF fraction. The reaction with soluble proteins was most likely directed against surface antigens, possibly aggravating the fertility problems, while the anti-NM-IF antibodies could indicate release of insoluble intracellular components by tissue damage of unknown origin.

During the last few years, prostate cancer is more frequently diagnosed in young patients. This lays emphasis on the necessity to preoperatively evaluate the sexual function in patients undergoing bilateral nerve sparing radical retropubic prostatectomy (BNSRRP). The aim of our study was to make an objective evaluation of the basic sexual function in patients with clinically localized prostate cancer and candidates for BNSRRP, using internationally validated questionnaires. We also tried to find a correlation between these questionnaires and the individual assessment of candidates, on one hand, and between comorbidities of the patients and degree of erectile dysfunction (ED), on the other hand. From January 2014 to March 2017, at the urology clinic of University Hospital – Pleven, 64 patients opted BNSRRP and reported to have preserved erectile function (EF), wishing to maintain this function after surgery. The patients’ histories and comorbidities were recorded on the day of hospitalization. The subjective assessment of the patients’ potency was compared with International Index of Erectile Function (IIEF). According to the EF domain of the IIEF, baseline EF was assessed in 28 patients. Twelve patients had mild ED, 9 patients had mild to moderate ED, seven patients had moderate, and eight had severe ED. The results showed that a significant number of patients with clinically localized prostate cancer who were candidates for BNSRRP reported to be fully potent but actually had impaired EF preoperatively. There was also a pronounced correlation between concomitant diseases and EF.

Premature ejaculation (PE) is the most common sexual dysfunction in men, yet it is not well studied. Its frequency reaches 30% for men from 18 to 59 years of age in different countries. The aim of this article was to investigate the quality of sexual life in men with primary PE operated on with microsurgical penile denervation, using the Brief Male Sexual Functional Inventory (BMSFI). From September 2011 to March 2014, 22 patients were operated on with microsurgical penile denervation in the urology clinic of the University Hospital - Pleven and the Department of Urology at UMHAT Ruse AD. The mean result from the BMSFI in patients was 22 points preoperatively, indicating significant worsening of sexual function and quality of life in all five questionnaire domains. After surgery, the results increased to 28, 33 and 39 respectively, at 3, 6 and 12 months, respectively. Premature ejaculation not only leads to problems in controlling ejaculation but also worsens the overall sexual function and quality of life of patients.

The aim of the cross-sectional study was to estimate the absolute 10-year risk for fatal cardiovascular disease (CVD) in patients with hypertension by Systematic Coronary Risk Estimation (SCORE). The study was carried out in 2016 as part of Project No 4/2016. Ninety-one patients aged 40-89 years were included. The mean age of the sample was 66.0±11.0, and 44.0% were males. Information of the patients’ risk profile included about age, gender, blood pressure, smoking and total cholesterol. The patients with hypertension were stratified according to a 10-year absolute risk of CVD. Data were processed by Statistical Package for Social Science versions 19.0 (SPSS.v.19.0). Over two-thirds of the patients had 1 stage hypertension (31.9%) and 2 stage hypertension (37.4%). Median systolic blood pressure on admission to the clinics was 160 mg Hg, and median diastolic blood pressure was 90 mm Hg. Total serum cholesterol values exceeded 4.9 mmol/L in 64.0% of the patients. Smokers accounted for about one-fourth of the patients, most of them having smoked for 40 years. The mean number of risk factors for CVD was 3.0. Over 65% of the patients were found to be at a very high 10-year absolute risk of fatal CVD by SCORE. Cardiovascular risk assessment has important role in prevention of morbidity, premature death and disability of CVD.

Desmoid-type fibromatosis is a rare mesenchymal neoplasm with locally aggressive, infiltrating and destructive growth that is not characterized by a metastatic potential. According to their anatomical position, desmoid-type fibromatoses can be divided into three groups: extra-abdominal, intra-abdominal, and fibromatoses of the abdominal wall. Mesenteric fibromatoses account for 8% of the intra-abdominal ones. The latter are characterized by myofibroblastic proliferation and infiltration of both the pelvic and abdominal organs. We report a 26-year-old woman who complained of abdominal enlargement, feeling of heaviness, discomfort and reflux, which symptoms dated back 1-2 months prior to hospitalization. The patient underwent laparotomy due to subocclusive symptoms. Intraoperatively, a tumor sized 30 cm in diameter was found. The tumor originated from the mesentery and infiltrated in the jejunum, the entire ileum, and part of the caecum with perforation towards the abdominal cavity. The histological and immunohistochemical examinations are important for clarification of the diagnosis. The treatment requires a multidisciplinary approach, in which the surgical method has the key role.

The presence of functioning endometrial glands and stroma outside the uterine cavity is defined as endometriosis. Its incidence is approximately 10-15% of women of fertile age. Incisional endometriosis following obstetric or gynecologic surgery is reported in 0.03-1.08% of women. Most of the cases reported in the literature are related to caesarean section and have required a differential diagnosis with a hernia, abscess, granuloma or lipoma. The diagnosis is based on histological findings. We describe incisional endometriosis in four patients operated on at St. Marina Hospital – Pleven for one year.