Influence of Er:YAG Laser on Objective and Subjective Parameters of Stress during Sealant Application in Children.

BACKGROUND: Acceptance of lasers as alternatives and accessory tools to traditional methods in dental medicine has created an explosion of interest. Er:YAG laser is recommended for enamel conditioning. There is no study evaluating the anxiety in children during fissure sealing procedures when using Er:YAG laser compared to the routine application technique. AIM: To evaluate the objective and subjective stress parameters in children during a preventive procedure when using Er:YAG laser for additional enamel conditioning before pit and fissure sealant application compared to the routine clinical application technique. MATERIALS AND METHODS: The study included sixty-four 6-12-year-old children, divided into two equal treatment groups. A standardized fissure sealant application was performed, as in the intervention group before acid etching, the occlusal surfaces of teeth were conditioned with Er:YAG laser (2940 nm). During the procedure, objective and subjective stress parameters were recorded. RESULTS: Significantly lower degree of dental anxiety was found at the end of the dental visit of the study group (p<0.001). During the professional cleaning of the tooth surface, the mean heart rate was low (95.55±14.29 bpm) within the physiological normal range. The objective and subjective stress parameters show no significant differences between the two subgroups during sealing procedure (p>0.05). CONCLUSIONS: Application of Er:YAG laser during sealant application does not provoke anxiety and is well accepted by children in dental environment. Preventive procedures at the beginning of a dental visit decrease the initial levels of dental anxiety and contribute to an effective treatment process.

Clinical Evaluation of CAD/CAM Indirect Zirconia Restorations of Severely Destroyed Vital Teeth in the Posterior Area - Early Clinical Results.

BACKGROUND: Dental applications of CAD/CAM concept have been available for almost 30 years. They have allowed dentists to work with novel materials with better properties. One of these materials is zirconia ceramic. AIM: To evaluate prospectively the longevity of CAD/CAM indirect zirconia restorations of severely destroyed vital molars and to study the risk factors associated with restoration failures. MATERIALS AND METHODS: Thirty-two indirect zirconia restorations were made in 19 patients. The treated teeth were extremely destroyed vital molars. Thermal and electrical tests for pulp vitality were performed for all teeth. Radiographs were made pre-operatively, post-operatively, and at the 6-month recall. Cvar and Ryge criteria were used for direct clinical evaluation of each restoration at the 6-month recall. RESULTS: All 32 zirconia restorations were evaluated at 6 months. As per Cvar and Ryge criteria, discrepancies were found in two of the cases: postoperative sensitivity in only one of the teeth immediately after cementing the restoration; a partial fracture of one of the restorations after six months. Good marginal and gingival adaptation of the indirect restorations, good periodontal condition and no peri-apical lesions were observed clinically and radiographically. The thermal and electrical pulp tests were within the normal range for vital posterior teeth. CONCLUSIONS: The present study suggests that the new restorative zirconia materials are promising clinical alternative. They can give the clinicians a broader scope of opportunities in the treatment of their patients, aiming at more sustained and improved results.

YKL-40 and cytokines - a New Diagnostic Constellation in Rheumatoid Arthritis?

BACKGROUND: Rheumatoid arthritis (RA) causes chronic inflammation and alteration of articular tissue and joints. The pathogenesis of the disease remains unclear although it is known that proinflammatory cytokines play a major role in its induction. YKL-40 is a chitinase-like glycoprotein produced by activated macrophages, neutrophils, arthritic chondrocytes and cancer cells. It has been shown that YKL-40 is implicated in tissue remodeling, angiogenesis and inflammation. AIM: to investigate serum and synovial YKL-40 levels in relation to IL-1ß, TNF-α, and IL-6 in RA patients. MATERIALS AND METHODS: Serum and synovial concentrations of YKL-40, TNF-α, IL- 6, and IL-1ß were determined by ELISA in 39 patients (mean age 53.18 ± 16.54 yrs) with active RA. RESULTS: Serum YKL-40 levels were increased in all patients. The highest levels were found in synovial fluid (P<0.01). Our study showed a strong association between serum and synovial levels of YKL-40 and serum TNF-α and IL-1 ß (P<0.05). CONCLUSION: This is the first study finding a significant correlation between serum TNF-α and IL-1ß and YKL-40 in active RA. We suggest that these molecules together might play a dominant role in the pathogenesis and disease activity and could possibly serve as a new diagnostic constellation in rheumatoid arthritis.

Adaptation and Validation of a Burnout Inventory in a Survey of the Staff of a Correctional Institution in Bulgaria.

BACKGROUND: Burnout syndrome is a phenomenon that seems to be studied globally in relation to all types of populations. The staff in the system of correctional institutions in Bulgaria, however, is oddly left out of this tendency. There is no standardized model in Bulgaria that can be used to detect possible susceptibility to professional burnout. The methods available at present only register the irreversible changes that have already set in the functioning of the individual. V. Boyko's method for burnout assessment allows clinicians to use individual approach to patients and affords easy comparability of results with data from other psychodiagnostic instruments. Adaptation of the assessment instruments to fit the specificities of a study population (linguistic, ethno-cultural, etc.) is obligatory so that the instrument could be correctly used and yield valid results. Validation is one of the most frequently used technique to achieve this. AIM: The aim of the present study was to adapt and validate V. Boyko's burnout inventory for diagnosing burnout and assessment of the severity of the burnout syndrome in correctional officers. MATERIALS AND METHODS: We conducted a pilot study with 50 officers working in the Plovdiv Regional Correction Facility by test-retest survey performed at an interval of 2 to 4 months. All participants completed the adapted questionnaire translated into Bulgarian voluntarily and anonymously. Statistical analysis was performed using SPSS v.17. RESULTS: We found a mild-to-strong statistically significant correlation (P<0.01) across all subscales between the most frequently used questionnaire for assessing the burnout syndrome, the Maslach Burnout Inventory, and the tool we propose here. The high Cronbach's α coefficient (α=0.94) and Spearman-Brown coefficient (rsb=0.86), and the low mean between-item correlation (r=0.30) demonstrated the instrument's good reliability and validity. CONCLUSION: With the validation herein presented we offer a highly reliable Bulgarian variant of Boyko's method for burnout assessment and research.

Minimal Invasive Approach for Lips Venous Lake Treatment by 980 nm Diode Laser with Emphasis on the Aesthetic Results. А Clinical Series.

INTRODUCTION: A venous lake (VL) is a vascular lesion with common occurrence in many patients, manifested as a dark blue-to-violet compressible papule, caused by dilation of venules. The main reasons for the treatment of VL are aesthetic. The haemorrhaging episodes or impairment of oral normal functions are also under considerations. Treatment of lip VL includes surgical excision, selective photocoagulation, cryotherapy, sclerotherapy and electrodessication. The high-intensity diode laser is an option. The 980 nm diode laser is selectively absorbed by haemoglobin and selectively destroys blood vessels, minimising injury to the surrounding healthy skin. AIM: The purpose of this study was to evaluate the effectiveness of diode laser in the treatment of VL lesions with the accent on the postoperative defects and aesthetic results. METHODS: 35 patients aged 37 to 71 were included in this study. A 980 nm diode laser was used in noncontact mode, under local anaesthesia in continuous wave (2-3W, for 20-60s). All patients received only one procedure. RESULTS: Healing process was completed within 2 to 4 weeks after treatment with no scarring. None of the typical adverse effects were observed in the process of healing. CONCLUSIONS: Selective photocoagulation is an effective method for treatment of VL. Lower morbidity, minimal patient discomfort and satisfactory functional and aesthetic results are favourable for patients. To optimise the results and to reduce the adverse effects, basic knowledge on lasers and laser-tissue interactions is requisite.

Sexual Fears and Avoidant Sexual Behavior in Medical Students.

UNLABELLED: Sexual fears, sometimes in the form of phobias, lead to aversive or sexually avoidant behavior blocking sexual closeness and resulting in deep personal and interpersonal distress. OBJECTIVE: To determine the types of sexual fears and aversive behavior in young people of reproductive age (students) and their degree of markedness as to encourage a further implementation of prevention programs and interventions. MATERIALS AND METHODS: The study included 116 fifth-year medical students in Plovdiv Medical University. Of these, 55 men and 61 women were assessed with the Sexual Aversion Scale, a 30-item self-rating questionnaire. The Diagnostic and Statistical Manual of Mental Disorders criteria of sexual aversion were used. The statistical analyses used were descriptive statistics and independent samples t-test. RESULTS: Sexual fears and aversive or blocking behavior are mild to moderate, mean score of 1.54 ± 0.04, without statistically significant gender differences. Both sexes have established fear-related sexual aversive motives of sexual behavior related to the risk of unwanted pregnancy and HIV infection. Women have significantly higher average scores for the following statements: fear of sexual intercourse (1.61 vs 1.25), avoidance of situations in which they may be involved sexually (1.95 vs 1.51), avoidance of genital sexual contact (1.44 vs 1.16), fear of catching a sexually transmitted disease (2.46 vs 2.09 ), fear of pregnancy (2.61 vs 2.15) and concerns what other people think of them (2.34 vs 1.93 ). CONCLUSIONS: Sexual fears and aversive or blocking behavior were mild to moderate. In both sexes similar fears--aversive or blocking patterns of sexual behavior were found, mainly associated with the fear of unwanted pregnancy and the risk of HIV infection, more expressed in women.

25 Hydroxyvitamin D and Cytokines in Multiple Sclerosis.

INTRODUCTION: Clinical trials of patients with multiple sclerosis (MS) have produced inconsistent results for the profile of cytokine secretion in serum and cerebrospinal fluid in patients with multiple sclerosis during periods of relapse and remission. Epidemiological and clinical observations data reveal an association of the changes in vitamin D serum concentration with the risk of developing MS. AIM: To evaluate changes in serum concentrations of 25(OH)D, IL17, IFN-gamma, TGFß1, IL4, IL10 in relapse and remission and their correlation with the severity of disability. PATIENTS AND METHODS: Fifty-three persons (30 clinically healthy controls and 23 patients with relapsing-remitting multiple sclerosis) living between 41° and 42° northern latitude were registered during the astronomical winter period (October 2012- May 2013). -Patients were diagnosed according to Mc Donald 2010 criteria. The degree of neurological deficit was assessed by EDSS. Serum concentrations of 25(OH)D (nmol/l) and cytokines (pg/ml) were tested by ELISA - once for controls and twice for patients (during relapse and remission). RESULTS: In the studied population average levels of 25(OH)D were close to insufficiency, most pronounced in patients in relapse, as differences were not statistically significant. A reverse correlation was found between the levels of 25(OH)D and the deficit in relapse and remission. Concentrations of TGFß1 significantly increased in remission compared with exacerbation and controls. Serum level of IL4 was significantly lower in relapse compared with controls. In remission there was a marked tendency of increase compared with exacerbation. During clinical improvement IL17 and IFN-gamma tended to decrease compared to the average levels in relapse. In both periods, the average concentrations of IFN-gamma in patients were significantly lower compared with controls. No statistically significant differences were found comparing cytokine changes with those of 25(OH)D and deficit. CONCLUSION: Persistent cytokine imbalance in patients compared with controls is a marker for Th1-mediated CNS demyelination. Anti-inflammatory TGFß1, IL4 are indicators of immune response intensity. The deficit severity does not depend on changes of the tested cytokines, but correlates with 25(OH)D levels during periods of relapse and remission.

Serum melatonin in women with polycystic ovary syndrome.

UNLABELLED: There has been a surge of interest in recent years in studying the changes of serum melatonin concentrations in disorders that are associated with insulin resistance such as diabetes mellitus type 2 and polycystic ovary syndrome (PCOS). AIM: The present study was designed to investigate the day-time and night-time levels of serum melatonin and the cortisol rhythm in women with PCOS and compare them with those of healthy women. PATIENTS AND METHODS: This is a case-control study which included 30 women with PCOS and 25 healthy women. All hormonal measurements in both the study group and controls were carried out between days 3 and 5 counted from the beginning of the last regular menstrual cycle; they included serum levels of melatonin and cortisol at 03:00 a.m and 08:00 a.m, total testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), luteinizing hormone (LH), follicle stimulating hormone (FSH), and immunoreactive insulin at 08:00 a.m. RESULTS: Women with PCOS were found to have a significantly higher melatonin level at 08:00 a.m. and smaller mean night-day difference in the concentrations of melatonin in comparison with those of healthy women (natural log (Ln) night-day difference 0.60 +/- 0.10 pg/ml versus 1.15 +/- 0.14, p < 0.002). Melatonin to cortisol ratios at 03:00 a.m. and 08:00 a.m. showed no statistically significant differences between the two groups (Ln melatonin/cortisol 03:00 a.m., 1.01 +/- 0.06 versus 1.05 +/- 0.05; Ln melatonin/cortisol at 08:00 a.m., 0.62 +/- 0.01 versus 0.56 +/- 0.03, p > 0.05). CONCLUSION: The results we obtained about the changes of melatonin in women with PCOS could help in elucidating the complex pathophysiological pattern of this disease.

Repeat transrectal prostate biopsies in diagnosing prostate cancer.

UNLABELLED: Patients with negative prostate biopsy and persistent suspicion of prostate cancer (PCa) can pose a serious diagnostic problem. The AIM of our study was to determine the frequency of PCa found on repeat prostate biopsy and the factors leading to higher possibility of cancer positive histological result. PATIENTS AND METHODS: We studied retrospectively 113 patients (82 from University Clinic, Jena, Germany and 31 from Department of Urology, Plovdiv, Bulgaria) with initial negative biopsy for cancer who underwent repeat biopsies. The patients were examined between January 1999 and May 2010. The target group included patients with Prostate Specific Antigen (PSA) level lower than 12.5 ng/ml and without suspicious finding on digital rectal examination (DRE). Different biopsy schemes were used in the initial and the following biopsies, depending on patient age and total prostate volume. RESULTS: Overall PCa detection rate was 22.1% (25 of 113). The repeat biopsy found PCa in 15.9% (18 of 113). In patients with 3 biopsies the PCa detection rate was considerably lower--only 8.6% (3 of 35). PCa was found in only 1 patient of 18 (5.5%) who underwent four or more biopsies. Transurethral resection of the prostate (TURP) was performed in 15 patients with at least two previously negative biopsies. The pathohistological examination of the resected tissue showed PCa in 3 of the patients (20%). CONCLUSION: The interval between biopsies is not a significant predictive factor for positive prostate biopsy. The chance for detecting PCa after the second negative transrectal biopsy procedure is low. Therefore, TURP can be used as an alternative procedure to harvest adequate tissue material for pathologic examination, especially in patients with obstructive voiding symptoms.

Reliability and cross-cultural validity of the Bulgarian version of IRES-3.

INTRODUCTION: The IRES-3 questionnaire (Indicators of rehabilitation status, version 3) was developed to evaluate the rehabilitation effect in patients with psychosomatic, cardiac, orthopedic, oncologic, neurologic, gastroenterological and other disorders. AIM: The aim of the present study was to validate the Bulgarian version of IRES-3 and assess its reliability and internal consistency. MATERIALS AND METHODS: Validation of the IRES-3 questionnaire was carried out at the Specialized Rehabilitation Hospital, the National Complex PLtd, the Hisar branch. The study included 46 patients: 14 males (30.43%) and 32 females (69.57%). Patients' age ranged between 43 and 75 years (mean age 63.52 +/- 1.27). All participants got preliminary instructions and after that, within a period of one week, they completed the questionnaire two times. To evaluate IRES-3 reliability we used the split-half-reliability model and calculated the Spearman-Brown coefficients (rsb) for each of the scales. Internal consistency was estimated using Cronbach's alpha coefficient. We used the mean value of the inter-item correlation coefficients as well. RESULTS: The high values of rsb and Cronbach's coefficient alpha as well as the low values of the inter-item correlation coefficient which were obtained in our study demonstrate that the questionnaire under investigation is of high reliability and internal consistency. Our results are very similar to the results of the original German questionnaire which have been reported in literature. CONCLUSION: The Bulgarian version of the IRES-3 questionnaire shows high reliability and cross-cultural validity and can be applied widely for evaluation of the effect of rehabilitation.

Quality of life in patients with Parkinson's disease.

BACKGROUND: Health-related quality of life has been increasingly recognized as an important outcome measure for patients with Parkinson's disease because both motor and non-motor symptoms affect patients' functioning and well being. OBJECTIVE: To assess the quality of life (QoL) of patients with Parkinson's disease (PD) and to determine the extent of negative impact of disease on various aspects of their lifestyles. PATIENTS AND METHODS: A sample of 866 patients with PD, at the mean age of 73.76 +/- 0.25 years (range 46 to 88 years) was studied. We used the specific tool PDQ-39 Bb (a validated Bulgarian version of PDQ-39 Eng). The QoL was assessed in all patients and analyzed by gender and residence (urban-rural). SPSS v11.5 software was used for the statistical analyses. We used descriptive statistics and the Mann-Whitney U test for the comparisons between groups. RESULTS: Highest average scores in relative points (corresponding to poor QoL) were obtained for the dimensions "mobility" (57.08), "bodily discomfort" (55.68), "activities of daily living" (54.25) and "emotional well-being" (53.70). Women gave significantly more negative assessment of their QoL than men in the aspects "mobility", "emotional well-being", "social support" and "bodily discomfort", and rural residents gave more negative assessment of "mobility", "activities of daily living" and "stigma". CONCLUSIONS: The study demonstrated that PD had a significantly negative impact on patients' QoL. In some aspects the impact was significantly more aggravating in women and rural residents.

Evaluation of the factors affecting the quality of life and total costs in epilepsy patients on monotherapy with carbamazepine and valproate.

OBJECTIVES: To evaluate the effect of different demographic and clinical factors on the quality of life and cost of treatment of epilepsy patients on monotherapy with carbamazepine and valproate. PATIENTS AND METHODS: A total of 146 patients (67 male, 79 female, age range 18-80 years) with focal and generalized seizures were studied for one year. The patients were allocated into two groups depending on the drug they received: group one--46 patients on carbamazepine, and group two--100 patients on valproate. Quality of life (QOL) and total costs per patient per year were calculated. QOL was assessed using a questionnaire--Quality of Life in Epilepsy Inventory (QOLIE-31). Costs included direct medical, non-medical and indirect costs related to either epilepsy or its treatment. The assessed demographic and clinical factors were: age, gender, type of seizures, number of registered adverse events (AE) per three months, interval between seizures and seizure reduction percentage. RESULTS AND CONCLUSIONS: In both groups, age, gender and type of seizures didn't cause significant differences in the formation of QOL and costs. In the carbamazepine patients costs were influenced by the incidence of AEs, the time between seizures and seizure reduction percentage. In the valproate patients costs were mainly influenced by the time period between seizures while QOL by the incidence of AEs.

Circulating levels of interleukin-17A, tumor necrosis factor-alpha, interleukin-18, interleukin-10, and cognitive performance of patients with relapsing-remitting multiple sclerosis.

Multiple sclerosis (MS) is associated with cytokine imbalance and high rate (40-70%) of cognitive impairment. The objective of this study is to investigate the relationship between serum concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-17A, IL-18, IL-10, and cognitive performance in patients with relapsing-remitting MS (RRMS). Methods The study comprised 159 patients with RRMS (mean age 40.08 ± 8.48 years) in remission phase and 86 age-, gender-, and education-matched healthy controls. Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities test (SDMT), and Isaacs test were used for assessment of working memory, attention, visuo-perceptual abilities, information processing speed, and executive functions. Serum cytokine concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results Patients had significantly increased serum concentrations of TNF-alpha and IL-17A and decreased levels of IL-10 compared to the controls (p < 0.05). Negative correlation was found between serum TNF-alpha and SDMT score in patients with disease evolution longer than 10 years (rxy = -0.258 p = 0.033); PASAT and SDMT scores were in negative correlation with concentration of IL-17A (rxy = -0.229 p = 0.004; rxy = -0.166 p = 0.041). Cognitive impairment was established in 46.5% (n = 74) of the patients. Cognitively impaired patients had significantly higher serum IL-17A than cognitively preserved individuals (p = 0.007). Multiple linear regression analysis revealed IL-17A as a significant predictor of cognitive performance in RRMS patients. Conclusion The results from this study suggest that pro-inflammatory cytokines IL-17A and TNF-alpha simultaneously with decreased IL-10 are involved in cognitive deterioration in RRMS.

A Three-Year Course of House Dust Mite Sublingual Immunotherapy Appears Effective in Controlling the Symptoms of Allergic Rhinitis.

Background Allergic rhinitis is the most common allergic disorder. Although the management of the disease is successful in many patients, based on guidelines, some of them remain with symptoms uncontrolled with pharmacotherapy. Presently, there is no substantiated information on the control of allergic rhinitis in patients who underwent sublingual immunotherapy. Objective The purpose of this prospective follow-up study was to assess the control of allergic rhinitis in adults after a three-year course of house dust mite sublingual immunotherapy. Methods This prospective real-life study was designed to include adults with moderate to severe allergic rhinitis sensitized to house dust mite who underwent a three-year course of sublingual immunotherapy. Control of symptoms was assessed by Rhinitis Control Assessment Test (RCAT) after three years of house dust mite sublingual immunotherapy. Additionally, patients assessed their symptoms by utilizing a visual analog scale. Results A total number of 86 consecutively enrolled patients (46 (53.49%) men; mean age 26.10 years (SD = 5.85)) with moderate to severe allergic rhinitis and clinically relevant sensitization to house dust mite were evaluated. When assessed by RCAT on the third year, 74 (86.05%) had well-controlled symptoms and 20 (27.03%) of them were completely controlled. A significant reduction in visual analog scale scores-from 7.52 cm at baseline to 2.31 cm-was established ( P < 0.0001). There was a strong negative correlation between RCAT scores and visual analog scale (r = -0.65; P < 0.01). Conclusion This study provided evidence that a three-year course of house dust mite sublingual immunotherapy appears effective in controlling the symptoms of allergic rhinitis.

Familial study of chronic lymphocytic leukemia: aggregation of different malignant processes in families with individuals affected with chronic lymphocytic leukemia.

UNLABELLED: There has been evidence that familial factors play a certain role in some cases of chronic lymphocytic leukemia. It is possible in one or more family members to observe chronic lymphocytic leukemia alone, other malignant disorders or combination of both of them. THE AIM: of our study was to analyze the association of family history of malignances with the onset of chronic lymphocytic leukemia. PATIENTS AND METHODS: We conducted a case-control study through direct inquiry of the families of 126 patients with chronic lymphocytic leukemia. The control group consisted of 124 patients with benignant disorders. For statistic data processing we used Fisher's exact test in 2x2 table and Kaplan-Meier survival analyses. RESULTS: 35.71% of the investigated individuals had first degree relatives with malignant disorders, while in the control group their percentage was 17.7%. Significant correlation between positive family history of malignancy and the onset of chronic lymphocytic leukemia was found (P = 0.0016). The risk of development of chronic lymphocytic leukemia in individuals with family history of malignant disorders was 1.69 times higher than in individuals with negative family history RR = 1.697, 95% C.I. [1.177; 2.448]. There was no significant difference in the general survival between groups with positive and negative family history of malignancy. Stomach cancer was particularly often diagnosed in families with individuals affected with chronic lymphocytic leukemia. Other lymphoproliferative disorders were also registered in 3.9% of the families from the control group. CONCLUSION: Our data show that there is a high risk of getting chronic lymphocytic leukemia in close relatives of affected individuals with malignant disorders. There was no data for greater aggressiveness of chronic lymphocytic leukemia in patients with positive family history of malignancy.

Epidemiology, diagnostic and therapeutic problems for carcinoma of the penis in the regions of Plovdiv, Pazardzhik and Smolyan between 1993 and 2002.

INTRODUCTION: Carcinoma of the penis is a malignant tumour which is uncommon in the male population of the Plovdiv, Pazardzhik and Smolyan regions. Recently however, its occurrence in the clinical practice has been on the increase. In the present study we analyse the incidence of penile carcinoma in these regions and address some problems related to late diagnosing of the condition and its therapy. MATERIAL AND METHODS: The study included fifty one patients newly diagnosed with carcinoma of the penis between 1993 and 2002. The patients were registered in the Plovdiv Oncological Centre database. The available data were studied in detail analysing the incidence and mortality rates of the disease. RESULTS: The incidence and mortality rates carried by carcinoma of the penis showed a tendency to simultaneous increase with time--by 0.1355 and 0.0392 per 100000 men per annum, respectively. There is a relatively high number of patients diagnosed with carcinoma of the penis in the stage of invasive local tumor (82.35%). The distribution of the cases by stages is highly unfavourable--over 33% of them were diagnosed very late (stage III and IV). The greatest number of cases (70.59%) received only surgical treatment. The 5-year survival rate of the diagnosed patients is only 58.86%. CONCLUSION: These data about the incidence of the disease and the diagnosis and treatment of penile cancer in the studied regions are indicative of highly unfavourable tendencies for this disease which are reflected in the low efficaciousness of cancer control in the studied localisation.

Prerequisites for the occurrence of burnout syndrome in oncology nurses.

BACKGROUND: The burnout syndrome, as defined in literature, is the ultimate result of prolonged stress in the professional life of nurses characterised mainly by emotional exhaustion, depersonalization and reduced personal accomplishment. AIM: The purpose of the present study was to investigate and analyse those factors of the work environment that have an effect on the development of burnout syndrome in nurses working in an oncology in-patient clinic. MATERIAL AND METHODS: The study was designed as a questionnaire survey. Our study sample consisted of 70 nurses representing 78% of the medical nursing staff in the Plovdiv Oncology In-patient Clinic. Descriptive statistics and the analysis of proportions were used in the statistical analysis of data. Calculations and graphical presentation were done using MS Excel 97 and SPSS 11.0. RESULTS AND DISCUSSION: Most of the respondents (98.5%) said that the pain experienced by patients was the most significant factor contributing to their emotional exhaustion. The following factors were ranked by the respondents given in ascending order of strength: strong pain--100%, fear of death--59.4%, the thought that the patients leave their relatives for good--55.1%. Most of the respondents (56.5%) reported that it was the everyday encounter with pain and lack of hope that depressed them most; 67% of them said they were demotivated by the everyday encounter with death. We should also note the fact that more than half of the respondents said that their professional life affected their social life and the relations within their families. CONCLUSION: Our results are consistent with those reported by Haberman MR according to whom the care for a dying cancer patient is the most difficult aspect of nursing as a profession.

Early hypothyroidism after subtotal thyroidectomy in patients with Graves' disease--the role of the preoperative conservative treatment and hormonal status.

AIM: The aim of the present study was to evaluate the role of the preoperative antithyroid drug treatment and hormonal status in the development of early postoperative hypothyroidism after subtotal thyroidectomy in patients with Graves' disease. MATERIAL AND METHODS: Eighty-five patients with Graves' disease (males : females ratio 1:5.54, age range 19 to 64, 37.52 +/- 1.09 yrs) who had previously undergone surgical treatment were enrolled in the study. All patients underwent bilateral subtotal thyroidectomy with the amount of remnant tissue of 2-3 g for each lobe (total 4-6 g). Development of early (within one year after the operation) postoperative hypothyroidism was analyzed regarding the type of the antithyroid drug, preoperative dose, duration of the preoperative medical treatment, FT3, FT4, FT3/FT4 and hTSH. RESULTS: Forty six percent of all examined patients (54.12%) were euthyroid and 39 (45.88%/)--hypothyroid. Postoperative hypothyroidism was developed by 33.33% of the patients that had received preoperatively propylthiouracil compared with 50.82% of those treated with methymazol (p > 0.05). The duration of the preoperative treatment was 38.36 +/- 3.53 months for the hypothyroid patients and 30.11 +/- 2.34 months for the euthyroid patients (p < 0.05). Postoperative hypothyroidism developed in 58.70% of the patients with preoperatively suppressed thyroid-stimulating hormone (hTSH) and in 33.33% of those with normalized values of hTSH (p < 0.05). No statistically significant between-group difference was found in the preoperative dose of antithyroid agent, mean values of free triiodothyronine (FT3), free thyroxine (FT4), FT3/FT4, thyrotropic hormone (TSH). CONCLUSIONS: Longer preoperative antithyroid drug treatment and suppression of hTSH in the preoperative period correlated with higher risk of hypothyroidism after subtotal thyroidectomy. The type and the preoperative dose of the antithyroid agent, as well as the mean values of thyroid hormones before the operation have no prognostic significance for postoperative thyroid hypofunction.

Evaluation of quality of life of patients with oral cavity cancer in three counties of south Bulgaria.

AIM: To evaluate the quality of life of patients with oral cavity cancer in three counties of South Bulgaria. MATERIALS AND METHODS: A standard questionnaire was developed to evaluate the social status. Twenty two patients with oral cancer were interviewed (diagnoses by ICD 9th Revision 141-149). SPSS statistical software version 8.0 was used for statistical analysis employing the alternative analysis and ANOVA. RESULTS AND DISCUSSION: Oral cancer affects 1) mostly men-68.2%, 2) smokers-59.1% (of the people we interviewed, smoking regularly twenty and more cigarettes daily), and 3) people who consume alcohol on regular basis - 40.9% of the interviewees. The life quality of the interviewed people was evaluated on a specially developed five-degree scale. 22.7% of the interviewed people were classified as first scale group characerised with speaking and alimentary disorders, impaired aesthetics and pains in the oral cavity. 36.4% were scored as the second scale group--these had speaking disorders and disorders of the alimentary tract, oral cavity pain without impairment of the orofacial aesthetics. 27.3% were classified as third scale group in which the patients had only two functions impaired. Group five contained 4.5% of all patients with no manifest disorders. CONCLUSIONS: The results suggest that oral cancer patients need a lot of prosthetic care to mend their oral defects and a lot of rehabilitation to restore their ability to function socially, a task which must be realized by a rehabilitation team including the general dental practitioner.

A helping computer system prognosing the survival of patients with Hodgkin's disease.

INTRODUCTION AND AIMS: Hodgkin's disease is an uncommon form of lymphoma occurring mainly at 15-35 years of age. Prognostic evaluation plays an important role by supplying a rational working linkage between the wide complexity of disease presentations and available therapeutic resources. Improved prognostic evaluation able to identify the likely outcome of a given patient would be of considerable clinical importance. The aim of this study was to develop and present a computer system and tools that will allow physicians to make more precise prognosis of the survival in such patients. MATERIAL AND METHODS: Several mathematical models were developed using multivariate statistical survival analyses. Data on 116 patients with Hodgkin's disease treated in the Clinic of Hematology (Plovdiv, Bulgaria) between 1974 and 2001, were collected. The patients' database consisted of general information for each patient (name initials, age, sex, date of diagnosis, etc.) as well as of specialized clinical information. RESULTS: The present system has provided different options for calculation of survival probabilities and prognosis using deterministic models for each patient. CONCLUSIONS: The use of the present system in routine practice has allowed physicians to facilitate the process of making more precise prognosis of survival. In this way, they have been able to optimize the treatment scheme and improve the quality of life of their patients.