EPIDEMIOLOGICAL REGISTRY OF NEUROENDOCRINE TUMORS IN BULGARIA--A PILOT SURVEY.

The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.

Economic burden of comorbidities in patients with psoriasis is substantial.

BACKGROUND: Psoriasis is frequently associated with comorbidities. OBJECTIVE: To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity. METHODS: Patients continuously enrolled ≥6 months after a randomly selected psoriasis diagnosis date were selected from the Ingenix Impact National Managed Care Database (1999-2004). Comorbidities identified during the 6-month study included: psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular diseases and peripheral vascular disease. Resource utilization and costs during the 6-month follow-up period were compared for patients with ≥1 comorbidity vs. those without and for patients with a specific comorbidity vs. those without. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using general linear models with log-link and gamma distributions or two-part models. Models controlled for age, sex and psoriasis severity. RESULTS: A total of 114,512 patients were included; 51% had ≥1 comorbidity. Hyperlipidemia (27%) and hypertension (25%) were most prevalent. Patients with comorbidities were more likely to experience urgent care [OR (95% confidence interval (CI))=1.58 (1.51-1.65)] than patients without comorbidities. They also had significantly greater hospitalization rates [IRR (95% CI)=2.27 (2.13-2.42)] and outpatient visits [IRR (95% CI)=1.53 (1.52-1.55)]. Compared with patients who did not have comorbidities, patients with comorbidities incurred $2184 (P<0.001) greater total costs. CONCLUSION: Comorbidities present a significant economic burden in patients with psoriasis.

[Mola hydatidosa of the uterine tube]. / Mola hydatidosa na matochnata truba.

A case of only rare localization of hydatidiform mole in fallopian tube is described. This localization is, recent clinical as ectopic pregnancy. In the last 25 years (1974-1999) was described only 30 cases of tubal localysation of hydatidiform mole.

On the interrelationships between erythrocyte aggregation, plasma viscosity and the total peripheral resistance in arterial hypertension.

A probable conjunction of hemodynamic- and rheological variables was tested in hypertensive patients. Most pronounced correlation was fixed for some indices (sizable in value for plasma viscosity and small but distinct for blood pressure and ZSR) vs. total peripheral resistance. These results of a small scale elaboration are encouraging to get up a study extension.

Experimental cadmium poisoning in sheep.

Pathomorphological investigations of internal organs were made in sheep given sublethal doses of cadmium. Early histological damages in kidneys were established by renal biopsy in some experimental animals. The main histological changes were characterized by granular degeneration in proximal tubules and glomerular endothelial proliferation in kidneys, granular degeneration in hepatocytes, pericapillary oedema and activation of capillary endothelium and Kupffer cells in liver, oedematous and degenerative changes in cerebrum and in the region of Purkinje cells of cerebellum, hyperplasia and proliferation of alveolar epithelium and perivascular or peribronchial mononuclear cell infiltration in lung, and degenerative changes in the medulla and zona glomerulosa of adrenal glands.

[Combined diagnostic methods for women in the pre- and postmenopause]. / Suchetani diagnostichni metodi pri zheni v pre- i postmenopauzata.

UNLABELLED: During one-year period, 20 women with pre- and post-menopausal problems were investigated. The diagnostic examination included transvaginal sonography (TS), hysteroscopy with separative abrasion and histopathological examination. The data from the three diagnostic methods were compared. RESULTS: In 6 patients the endometrial thickness (ET) was lower than 8 mm. The hysteroscopic finding (HF) comprised in endometrial atrophy, confirmed also histologically. ET was higher than 8 mm in 14 patients, and the HF revealed endometrial polyps and endometrial hyperplasia. The hystological examination confirmed cystic endometrial hyperplasia in 4 cases, endometrial secretary phase in 5 cases, endometrial polyp in 3 cases and endometrial carcinoma in 2 cases. The authors accepted that the combination of 3 diagnostic methods of examination, applied in the described consequence, gave the possibility for precise diagnostic investigation and adequate treatment.

[Histopathological, electron microscopic and microbiological studies in patients with obstructive large-bowel ileus of tumor origin]. / Khistopatologichni, elektronnomikroskopski i mikrobiologichni prouchvaniia pri bolni s obturatsionen debelochreven ileus ot tumoren proizkhod.

We have studied the Liver and colon of 23 patients histologically, and 15-electron microscopically. In the course of light microscopic observation of the colon wall above the obstruction we found: degeneration and desquamation of epithelial lining, decrease of goblet cells, increase of acid glycoproteins, hypertrophy of myofibrils in the muscle layer and fibrogenesis in the interstitial tissue in between. In liver: there was slight to moderate fibrosis in portal tracts and somewhere in the sinusoids, and moderate inflammatory infiltrate in them. Electron microscopic observations showed: a. in colon above the carcinomatous obstruction we found hypertrophy of muscle cells and in between collagenoblasts I-II type; b. in liver without metastases the space of Disse was distended, with bundles of collagen somewhere. Ito cells showed signs of fibroblast transformation. Our hypothesis is that these chronic changes are a reaction to the protracted obstruction and to colon carcinoma.

[The morphological characteristics of the pit cells in the rat liver after the use of the glycopeptide preparation Polyerga]. / Morfologichna kharakteristika na pit kletki v cheren drob na plukh sled prilozhenie na glikopeptidniia preparat Polyerga.

Pit cells are morphological equivalent of large granular lymphocytes with NK activity. The aim of our study is to define the morphological changes of pit cells in the liver of the rat after stimulation with the biological response modifier Polyerga. Polyerga was applied intramuscularly in a single dose of 6 mu g per kg body weight. The animals were perfused on the 24-th hour, 48-th hour, on the 4-th day and on the 7-th day after injection. The perfusion was done through the portal vein and the liver was processed for electron microscopical cytochemistry for endogeneous peroxidase demonstration. A 3-to-4-fold increase in the number of pit cells was observed within a period of 1 to 4 days after injection. Pit cell granules were negative for endogeneous peroxidase. After Polyerga stimulation pit cells showed a tendency of orientation of their organelles toward the contact area with Kupffer and endothelial cells. These changes are considered to represent the morphological expression of rat liver pit cell activation.

[The relationship between resorption and the morphological changes in the gastric mucosa of rats after acute and chronic exposures to acetylsalicylic acid]. / Zavisimost mezhdu rezorbtsiiata i morfologichnite promeni v stomashnata ligavitsa na plukhove sled ostro i khronichno vuzdeistvie s atsetilsalitsilova kiselina.

The effect of acute and chronic ASA administration on stomach and duodenal mucosa was studied on white male Wistar rats. ASA (250 mg/kg b.w.) was administered by esophageal intubation in a single dose, and the rats were sacrificed at 2, 6, 24 hours, or after two, three, ten and twenty days, 24 hours after the last ASA application. Two types of erosions were found in the first 24 hours: superficial and deep. Superficial erosions showed advanced healing by the 24th hour. Deep erosions appearing between 6 and 24 hours from the beginning of experiment became deeper, after two and three days ASA application. They had morphological features of chronic ones by the 10-20th day. ASA resorbtion was most expressed by the 3rd day from the experimental onset (plasma concentration 0.348 +/- 0.052 g/l). The resorbtion was decreased in chronic experiment, and plasma concentration (0.236 +/- 0.046 g/l, 0.244 +/- 0.045 g/l) showed statistically reliable lower values.