[A rare case of Gardner's syndrome complicated with rectal carcinoma].

Gardner's syndrome is a rare variant of the Familial Adenomatous Polyposis (FAP) in which affected individuals develop thousands of polyps within the gastrointestinal tract, with a 100 % risk of eventual malignant change. They also have a variety of extraintestinal abnormalities - various soft and hard tissues tumors like fibroma, osteoma, epidermoid cysts, sebaceous cysts on the scalp. Gardner's syndrome is an autosomal dominant disease, caused by mutations in APC ( adenomatous polyposis coli ) gene, which is located in chromosomal locus 5q21- q22. Firstly it has been described in 1953 by Gardner and Richards. They have investigated a family of 51 members with polyposis, some of them with multiple epidermoid cysts, fibromas and jaw osteomas. Eight of them have died by colorectal carcinoma. If undetected or untreated virtually all patients develop colonic carcinoma at a young age. Due to this high risk of malignancy the patients with Gardner's syndrome usually undergo surgical treatment by total or subtotal proctocolectomy. We report a case with Gardner's syndrome - a 36 year-old male who has been operated on in Department of Surgery in Vth city clinical hospital in October 2003. He had multiple adenomatous polyposis of colon, rectal cancer, osteomas of skull bones, subcutaneous fibromas and lipomas. We discovered also by ultrasound examination a polyp of gall bladder. His father has had also multiple polyposis with malignancy and metastatic lesions and he has died at age of 49 years. We performed total proctocolectomy with definitive iliac anus and cholecystectomy.

[A study on distribution of surgical site infections in risk hospital wards in Bulgaria (2000-2004)].

Surgical site infections are some of the most widely distributed nosocomial infections. The study covers the period 2000-2004. It follows the frequency of surgical site infections in various in profile hazardous hospital wards: surgery wards (general surgery, cardiac surgery, pediatric surgery, neurosurgery, orthopaedic surgery, burn/trauma wards), wards of intensive therapy and reanimation, gynaecological and urological wards. The study gives the etiological characteristics of the surgical site infections during the studied period. The most frequent etiological agents are Staphylococcus spp. (S. aureus and coagulase-negative Staphylococci) and from the group of Gram-negative bacteria--E.coli, Pseudomonas spp. The enterococcus spp. is of great significance in the gynaecological and urological wards.

Factors for development of secondary failure to sulfonylurea drugs in non-insulin-dependent diabetes mellitus.

Thirty-five non-insulin-dependent diabetic subjects were divided into two groups, according to therapeutical approach. The first group consisted of 17 diabetics receiving sulfonylureas and maintaining a satisfactory metabolic control. The second group included 18 patients who were transferred from sulfonylureas to insulin treatment, i.e. patients developing secondary failure to sulfonylurea drugs. We established that the patients with secondary failure to sulfonylurea drugs show a significantly lower B-cell secretory response following stimulation with i.v. tolbutamide, a significantly lower peripheral insulin sensitivity by euglycemic hyperinsulinemic clamp, and an increased frequency of HLAB21 and HLADR1 antigens. This latter study was performed in 42 patients. We thus conclude that in these patients diabetes mellitus may be considered as a separate form of the disease, which needs reevaluation of the criteria concerning therapeutical approach, prognosis, and evolution.

[The HLA system of patients with psoriatic arthritis]. / HLA-sistema u bol'nykh psoriaticheskim artritom.

Sixty patients with psoriatic arthritis were examined for the rate of demonstration of A, B and DR loci of the HLA system. As compared to the control group, the patients manifested an increase of the rate of demonstration of A24, B27 antigens as well as of DR4 and DR7, which may serve an adjuvant criterion for the disease diagnosis. The highest rate of B27 antigen demonstration was seen in patients with spondylitis.

[The relationship of HLA antigens to certain clinical forms of diabetes mellitus]. / Vurkhu vruzkata na HLA antigenite s niakoi klinichni formi na zakharniia diabet.

In 79 diabetic patients, 37 patients with diabetes mellitus type I and 42 patients with diabetes mellitus type II, the HLA-A, B and DR antigens were examined. An association of diabetes mellitus type I with HLA-B8, DR3 and DR4 was found. For the first time a relation between diabetes mellitus type I and HLA-B21 antigen was established. The early onset of the disease and the exhaustion of the endogenic insulin secretion are linked with B8 and DR3 carrier state while the late manifestations of diabetes mellitus and the preservation of one's own insulin production correlate with antigen B21. In the patients with diabetes mellitus Type II the frequency of antigen B21 and DR1 is increased and the carriers of B21 develop in the course of the disease relative insulin insufficiency and a secondary resistance toward sulfanilurea drugs.

[Epizootiology, prevention and control of salmonellosis in swine]. / Epizootologiia, profilaktika i borba sus salmonelozite po svinete.

Microbiologic studies were carried out in 1981-1985 with a total of 25,561 samples--12,878 were cadavers and viscera, 574 were fetuses, 6,208 were swabs of rectal samples. 844 were feces, 4,096 were washings, 493--feed samples, etc. A number of prophylaxis and control programmes were tested under productional conditions with the use of drugs and vaccinations with a live and a killed autovaccine. Salmonella organisms were isolated as follows: 9.05% from cadavers, 2.5% from fecal samples, 1.35% from rectal swabs, 1.2% from washings from the environment, 0.6% from feed samples--all belonging to 19 serologic types. Greatest importance was shown to have S. cholerae suis, which was epizootically specific for swine, however, the part played by var. america also grew as compared to var. kunzendorf. With the exception of several sporadic cases all other serologic types of Salmonellae were isolated from carriers, rectal and fecal samples, and others. In the event of swine salmonellosis under productional conditions better results were obtained with the use of drugs. Both morbidity and mortality rate dropped twice as low with animals treated with a live vaccine once, and with a killed autovaccine four times. Suggested is a prophylactic and control program, following a definite pattern in dealing with swine salmonellosis in enzootic foci, with the use of complex measures.

[Etiology of salmonellosis in swine raised commercially]. / Kum etiologiiata na salmonelozite po svinete, otglezhdani pri promishleni usloviia.

A total of 25,561 samples from swine (cadavers, internal organs, rectal swabs, feed, and washings of premises) were investigated microbiologically over the 1981-1985 period via routinely employed methods for the isolation and typing of Salmonella organisms, following the Kauffmann-White pattern. Tested was the susceptibility of 411 strains by the disk-diffusion method, using drugs of the general practice, and the results were recorded after Bauer. In 5.32 per cent of the samples 19 Salmonella serotypes of the B. C. D, and E groups were isolated. Greatest in the etiology of salmonelloses was still the relative share of S. cholerae suis (85.22%), represented by the two-phase var. america and the autochthonous var. kunzendorf. Second ranked S. typhimurium--5.14%, followed by S. agona--2.20%, S. menden--1.25%, S. thompson--1.18%, S. derby--1.10%, S. bovis-morbificans--0.81%, and others. A change was ascertained in the serotypes isolated from pigs with regard to the exotic types. Sensitive to gentamycin proved 89.9%, to chloramphenicol--79.1%, to carbenicillin--71%, to kanamycin--70%, etc; 75% were resistant to ampicillin, 54.6%--to streptomycin, 51.3%--to tetracycline, and 33.8%--to furazolidone.

[Study of the HLA system in rheumatoid arthritis]. / Prouchvaniia vurkhu HLA sistemata pri revmatoidniia artrit.

A statistically significant, after correction of P value, increased incidence of the antigen HLA-DR4 chi 2 = 32.81, p less than 0.001, was established in the comparison of the antigen incidence of HLA-A, B, C and DR antigens in 59 patients with classical and positive rheumatoid arthritis and control healthy subjects. No essential difference in the distribution of DR4 was established that depended on sex, age of occurrence of the disease, presence of rheumatoid factor and the form of the disease.

[Species structure of Salmonellae isolated from mammals, poultry, feed mixtures and the environment 1976-1980]. / Vidova struktura na salmonelite, izolirani ot bozainitsi, ptitsi, furazhni smeski i vunshna sreda za perioda 1976-1980 g.

Studied was the species structure of Salmonella strains isolated in this country from mammals, birds, food products, combined feeds, and objects of the environment over the 1976-1980 period. Differentiated were a total of 10,794 Salmonella cultures, belonging to 67 serotypes of 10 serologic groups after Kauffmann-White's scheme. Most wide-spread proved to be the S. choleraesuis, S. oranienburg, S. dublin, S. typhimurium, S. gallinarum-pullorum, S. enteritidis, S. derby, S. abortusovis, and S. agona serotypes. Combined feeds and individual components were most often found to be the source of S. senftenberg, S. muenster, S. meleagridis, S. oranienburg, S. mission, and S. agona. A dropping trend was established with the relative share of Salmonella organisms isolated from combined feeds and their components as against the total count of isolated Salmonellae in comparison with the 1970-1975 period (2.51 and 8.12 per cent, respectively).

On the association of the HLA system with epilepsy in children.

HLA typing was done in 51 unrelated children with epilepsy of unknown origin. The frequency of the antigens of the loci A, B, C, and DR were compared with control groups as follows: (1,085 for the loci A and B, and 200 for C and DR). Statistically significant increased frequency of HLA-DR5 (X2 = 13.08, p less than 0.001) in the patients was demonstrated. Association between HLA-DR5 with different type of seizures was not found in this study.

[HLA B27-negative forms of Bechterew's disease]. / HLA B27 negativni formi na bolestta na Bekhterev.

For an 8 year period 45 patients with Bechterew's disease were found who had no antigen HLA-B27. 35 of the patients were tested for HLA--A, -B or -C. In 12 patients antigens of the cross-reacting group B27 (B7, Bw22 and B40) were found. In patients without psoriasis antigens B13, B16, B17 which are known to be related to psoriasis vulgaris were found. 9 patients were antigen Cw2 carriers which is in unbalanced linkage with B27. The B27 negative forms present several clinical features: late onset of the disease, slow and favourable course, development of spinal forms only, lack of iridocyclitis and heart lesions.

[Epizootiological research on salmonellosis in swine]. / Epizootologichno prouchvane na salmonelozite po svinete.

The epizootiology of Salmonella infections in swine was studied in 1970-1980 in 7 districts of this country on a number of farms and industrial complexes in order to elucidate some aspects of the epizootiologic process. A total of 26,957 samples taken from swine and the environment were studied bacteriologically. An industrial complex in each district served as a test one to investigate samples from various groups of swine in the technologic process. It was found that salmonelloses did exist, and Salmonella organisms were isolated from pigs on all studied farms and complexes, however, no diseases and organisms were recorded with both animals and the environment in Swine Nucleus Bases. On the complexes Salmonellae were isolated from pigs of all technologic groups, and, in most cases, the Salmonella species coincided by sows and pigs. This explained the stationary character of the disease on some complexes where a sui generis epizootic process ran its course, exhibiting particular aspects and correlations. Salmonella organisms were isolated in 0.95 per cent of the investigated samples from the test groups on the test complexes as well as in 4.13 per cent of the groups out of the experiment. In samples taken from other complexes, farms of AIC, IAC, auxilliary farms, etc., there were positive findings in 5.32 per cent of the cases. Enzootics on the complexes were most common with pigs aged 40-50 days as against farms with traditional types of technology where 2-4-month-old pigs were involved.(ABSTRACT TRUNCATED AT 250 WORDS)

[Etiological studies of salmonellosis in swine]. / Etiologichni prouchvaniia na salmonelozite po svinete.

A total of 25,114 samples taken from fetuses, pigs, adult swine, feces, environmental objects, etc. in 6 regions of this country were studied bacteriologically in 1976-1980, and in 1970-1975 a retrospective analysis was made of data of investigations with pigs in the same regions. The sample study led to the isolation of 1,495 strains of 21 Salmonella species of the B, C, D, and E groups. At the same time 9 Salmonella species were isolated from pigs, while during the second period the number of the isolated Salmonella spp. was 16. It was found that the strains belonging to S. cholerae-suis were highest in number (87.61 per cent of all isolated strains), whereupon beside the autochtonic var. kunzendorf there were also findings of var. america. By frequency of isolation the ubiquitous S. typhi-murium ranked four as isolated from pigs, and washings from environmental objects as well as from sewage water, rats, and common flies. Of the exotic Salmonella species more important proved S. agona, S. jerusalem var. 14, S. tennessee, and others. Considerable diversity was established with the Salmonella species in pigs on the industrial complexes (17 spp.), the farms of the Agro-Industrial and the Industrial Agrarian Complexes (8 spp.), and on some other farms (5 spp.). Only two species of Salmonellae were found in pigs on the private farms, and one species--on the auxilliary farms.

HLA system and therapy of psoriasis.

In 192 patients with psoriasis an increased frequency of the antigens HLA-B13 (19.79%, X2 = 32.79, p less than 0.001), HLA-B17 (24.47%, X2 = 64,84, p less than 0.001), and HLA-B27 (19.27%, X2 = 11.07, p less than 0.001) in comparison with the control group of 1,085 clinically healthy persons, was established. After 4 weeks of thalassotherapy 3 groups of patients could be distinguished: (1) those with full clinical remission - 50 (26.8%), (2) those with great or moderate improvement - 116 (60.4%), and (3) those with no improvement - 26 patients (13.6%). In the first two groups there is a statistically significant association with the HLA antigens B13 and B17. In the third group (no improvement) there is no such association with HLA-B13 (p less than 0.01). Consequently, patients in whom psoriasis is associated with HLA-B13 were better influenced by the thalassotherapy. The variability in the therapeutic efficiency means that perhaps there is a genetic heterogenicity in the group of common psoriasis.