1ISSN 1313-9827

- , ,

EGFR hTERT

, ,

( )

IN MEMORIAM -

II 2010 1

-

.

2 - , , . , . , . , . 6

. , . 13

. - 19

EGFR hTERT . , . , . , . 24

, , . , . , . , . , . 31

( ). 36

. , . , . , . 40

. , . , . 45

LEOPOLD AUENBRUGGER (1722 1809): . , . , . 50

56

, , , 2010 58

64

in memoriam

3in memoriam

CENTRAL SLEEP APNEA CHEYNE-STOKES RESPIRATION PATHOPHYSIOLOGY, DIAGNOSIS, PROGNOSTIC AND TREATMENT ASPECTS K. Terziyski, A. Hristova, S. Kostianev, D. Iluchev 6

BRONCHIECTASIS IN CHILDHOODG. Petrova, P. Perenovska 13

OCULAR MANIFESTATIONS OF SARCOIDOSISM. Konareva-Kostianeva 19

EXPRESSION OF EGFR AND hTERT AS DIAGNOSTIC MARKERS OF NONSMALL CELL LUNG CANCER IN HIGH RISK PATIENTSR. Cherneva, O. Georgiev, D. Petrova, D. Toncheva 24

COMPARATIVE ESTIMATION OF CLINICAL INDICES CONCERNING ANTIBIOTIC RESISTANCE IN PATIENTS WITH COMMUNITY ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS TREATED IN PULMONARY WARD AND INTENSIVE CARE UNITP. Glogovska, Y. Ivanov, P. Pavlov, . Borissova, P. Hristova 31

LAZER PULMONARY METASTASECTOMY (NEW LIGHT IN THE TUNNEL)D. Jordanov 36

OBSTRUCTIVE SLEEP APNEA SYNDROME AND CEREBRAL BLOOD FLOWD. Petkova, V. Nestororva, S. Andonova, B. Banova 40

SLEEP APNEA AND DENTISTRY CROSSING POINTSL. Grozev, V. Jordanov, G. Todorov 45

LEOPOLD AUENBRUGGER (1722 1809): THE FATHER OF PERCUSSION D. Paskalev, D. Radoinova D. Petkova 50

PROFESSOR VANKO NICHEV 56

3-RD CONGRESS OF THE BULGARIAN SOCIETY OF PULMONARY DISEASES, PLOVDIV, June, 2010 PRELIMINARY - SCIENTIFIC PROGRAM 58

MEETING CALENDAR 64

CONTENTSeditorials

reviews

original articles

great persons in medicine

news

5 2010 , . - . 10 2010 . 11.00 . -

, , - 2010. 2010: -

, 2009 . - , 40- , , .

, . - 7% 4% - . -- . , 230 000 . 17 000 - - . 3 600 . 10 . 13 15 26%, 17%. 2010 - :- - ;

- , , - ;

- -, , , - ;

- ;

- -, - ;

- , - . -

Zdrave.net, - . . . -

, - , . . - , - , , - . -, , - - . - , , , . - .

: . - , . - , - - - . 2010

: , 2010 . . , - , , , , , - , .

. ,

.

2010: , www.2010yearofthelung.org.

6 - , ,

- () () --

(). loop gain, , -, . loop gain central gain, plant gain mixing gain. - -, , . (20-40%

) , , . ( ). -

, , . () . - (BiPAP), (ASV), CO2 Acetazolamid.

: , - , -, ,

. , . , . , . ,

T II, 2010, .1

7CENTRAL SLEEP APNEA CHEYNE-STOKES RESPIRATION PATHOPHYSIOLOGY, DIAGNOSIS, PROGNOSTIC AND TREATMENT ASPECTS

AbstractCheyne-Stokes Respiration (CSR) in chronic heart failure (CHF) is the most common form of central

sleep apnea (CSA). CSR reflects typical loop gain mechanism, used to describe the response of any negative feedback system to changes in the controlled parameter. The key components of the loop gain are central gain, plant gain and mixing gain. The pathogenesis of CSR is based on the presence of non-metabolic ventilatory stimuli resulting from increased pulmonary capillary wedge pressure, upregulation of chemoreceptors due to sympathoadrenal activation, and decreased functional residual capacity, and prolonged circulatory time in result of decreased cardiac output.The clinical significance of CSR in CHF is determined by its high frequency (20-40% of CHF patients)

and negative impact on the prognosis, mortality and quality of life. On the other hand, CSR is hardly recognizable due to the poor clinical profile of the patients and the need of highly specialized medical investigation (laboratory polysomnography). The therapeutical approaches to treat CSR have shown good results in terms of improving the

quality of life, mortality reduction, reduction in hospitalization and emergency visits rate. The most common treatments are continuous positive airway pressure (CPAP) and oxygen therapy. The alternatives include bilevel positive airway pressure (BiPAP), adaptive servo ventilation (ASV), CO2 and Acetazolamid.

Key words: central sleep apnea, Cheyne-Stokes respiration, chronic heart failure, polysomnography, noninvasive ventilation

K. Terziyski, A. Hristova, S. Kostianev, D. IluchevSleep Apnea Laboratory, Pathophysiology DepartmentMedical University - Plovdiv

- , ,

T II, 2010, .1

8I. -

80 , 4 - (1):1. ;2. ;3. - , , ;

4. . ()

. : , -, - - () (34).

II. - - ,

, loop gain. - . - loop gain - - - (34). , PaCO2. Loop gain : plant gain (PCO2/VA ) controller gain (VE/PaCO2) (34). - - mixing gain (PCO2 /PCO2 - ) (10).Plant gain -

CO2. , plant gain : - (); -; ; - /; PCO2 (10, 34). , controller gain, - - - (VA) PCO2 ( , VA PCO2). (PCO2/VA), - plant gain - PCO2. PCO2 , - PCO2 .Controller gain

- (34). : . - -

PaCO2 (set-point), .. -- (). PaCO2 (/). PaCO2 , , - (35). - , .

- (mixing gain). - - - (34). - .

III. - (-) -

. , 3 -- 60 5 / - - 10 (12). .1. 10-

. (AIRFLOW) (THOR = , ABDO = ) . ( ) - . - - (SpO2).- -

, , , PaO2 PaCO2 (18). controller gain -

PaCO2 () ( ) (- ) (35). - - PaCO2 ( ()) (35). , -

-

, ,

T II, 2010, .1

9 - , ,

- - - (35). , -, -, - (16). : PaCO2 / PaCO2 , PaCO2 PaCO2 . plant gain

(

. 1. - .

. 2. - ( Naughton). (18) ; - ;

.

) - - (18). - PaCO2 - , - . -

, -, - --. - (70 ) ( mixing gain) (18, 27). - . 2.

T II, 2010, .1

10

IV. - - - . -

, / (18). -

, - . 1. -

, - 30 50%, () 20-40% (18). - (23). 2. -

-

- , , (2, 8, 16). , 353 , + - / (2.5 4.5, 6.5 ) (2). - Somers, - (28). , - (19, 20). - - , - (19, 20). Ancoli-Israel - , (2). ,

: -, - - (2). - - , , - (2, 16). - , , - (17, 23, 33). ,

, - , -- , -

: , ; - ; , ; - - ; 20-30 (26).3. -

- - , , -. - . ,

-. , - (4). -

+ -, - - () . -, - (11). , , , -, , , 1-2%, (30, 33). - (2, 11, 33). - , - (15). , -

( NYHA ) ( - MLHFQ), (4, 9, 11, 17, 33). ,

- , , - . (), - (), -

-

, ,

T II, 2010, .1

11

- () - - (hsCRP).

4 - (14, 23), (VE/VCO2 ) (4, 17), (30, 33), (8, 9). - - -, (9, 33). - Roshe et al, , - (92.9%), (94.1%) - (93.3%) (23). , , CO2., -

- - , - , (. , hsCRP). , , .

V. - -

- (Continuous Positive Airway Pressure - CPAP) - - (18). -, , : 1) - , ; 2) , ; 3) - - - ( ); 4) (6, 18) , 258 - (CANPAP), 2 , - - (), , . , , , - (7). post-hoc ,

- , ,

-18 50-69% 5,7; 2-4 5

7; 3

3,5,7,18; 7; 7; 7

O2 , 7

( 50%)18; 18; 18

24; 24; 24; 24

24,25,32; 24,25,32; ()24,25,32; 32; 32; 32; 25,32

BiPAP ; 6

ASV BiPAP; >80% 31

;

; ; 21,22

CO2 29;

29

Acetazolamid

13

: , O2 - , BiPAP - 2 , ASV , CO2 , - , , , - .

.1. , , - .

T II, 2010, .1

12

13

, , -

, . - , , - , -. ,

, , -, . -. , - , . : , , -, , , . , -

, . 83% - . .

: , , ,

. , . ,

T II, 2010, .1

14

T II, 2010, .1

BRONCHIECTASIS IN CHILDHOOD

AbstractBronchiectasis is defined as congenital or acquired localized, permanent irreversible dilatation of

part of the bronchial tree, caused by destruction of the muscular and elastic components of bronchial walls due to chronic inflammatory secretions and microbial invasion. The most common symptoms in children with bronchiectasis are obstinate chronic cough with malodorous expectoration, sometimes accompanied by hemoptysis, recidive respiratory infections, persistent findings at chest x-ray and physical examination.In developed countries, the frequency of non-cystic fibrosis bronchiectasis is reduced through

application of broad-spectrum antibiotics, immunization programmes, improved health care and quality of life. The predominant treatment is conservative. Successful management depends on the early recognition of bronchiectasis and is aimed to relieve symptoms, to prevent complications, and to control exacerbations. Generally, medical management of bronchiectasis includes antibiotic therapy, mucolitics and chest physical therapy with postural drainage and chest clapping. Provisional follow up and early detection of the entities, associated with bronchiectasis, ensures

early management. Up to 83% of pediatric patients with bronchiectasis benefit from the conservative treatment. In the rest of the patients surgical intervention is required.

Key words: bronchiectasis, chronic cough, recidive respiratory infections, broad-spectrum antibiotics

G. Petrova, P. PerenovskaPediatric clinic, UMHAT Alexandrovska Sofia

15

T II, 2010, .1

- , , , (1, 2, 6).

, , . Rene Laennec 1819 (18). - 19 William Osler 50- Reid, - , . - H. influenzae, S. aureus P. aerugenosa (11).

, . , - - - 0.6/1000 (5, 7, 16). , -

- (>2 mm ), , , , - . - , -. e , -. 40%

6 -, 20% - 6 7 . -- ( : 1:1,5) (4). -

- (15). : 1. -

, - (Mounier-Kuhn syndrome), - (William-Campbell syndrome) , 1 ;

2. -;

3. , , -, , HIV, , , Pseudomonas, Klebsiela, Staphilococcus;

4. IgA, IgM, , , Sjgren;

5. ; 6. ;7. ;8. , -

, , , - , -, .

Reid - , -. (17). --

. , , . - , 30-51%. - . - ; ; ( 1.5 - ) (14). --

. - , 6 7 ( - 20). ( ). -

. - 4-5 ( ) . - , -- - . . -

- (. , ), (3). -

- ( .1)

16

T II, 2010, .1

- , - : ( , -), ( -, , -) ( , , - ).

, - , -- , . . - - - 97% , - - 82% (- , - ) - 47%. - - 46%, 21%, - 14%, 7% 5% (12).

, -

/

,

1.

3. :

( ,

, - -

);:

(- -

)

2. -

-

- , (. 2) .

- , -: , , , - , , , . - cor pulmonale.

- : -

;

; (.3) -

; ,

; ; (.4) -

; ; Mantoux;

Mycoplasma pneumonie; -1-; ;

(.5)

17

T II, 2010, .1

4. -, , 100. - , , , - ,

5. - - , II

: -, , . . : , - - , , - (21).

-, -, .

: , , ,

, , , .

- - - , , (23).

-, -

- . . - - -, - - - - (20). - , . -

, - . , -, (22). -

, - - . , - (10). - . . - 7 10 , - 7-10 . Davis . - (8).

18

T II, 2010, .1

2006 - Rossen . e - . , - P. aeruginosa, - -, (19). -

- , , , , (13).

: 1. ; 2.

, - , - (13). 83%

. (1).

: , ,

, , - , - , , ;

, - ;

, ;

, / /;

(7).

-. - - , , -, . - - 50% , , (9).

( - ), , .

:1. . , 1999, 2:19-222. , , , 19783. . - , II , 2008 ,. 80-81 4. ., . , 7, 2005 2 29-325. . , In Spiro 2008;4:33-376. , . In Spiro 2008;4:28-327. Agasthian T et al Surgical management of bronchiectasis. Ann Thorac Surg. Oct 1996;62(4):976-8; 8. Davies G, Wilson R. Prophylactic antibiotic treatment of bronchiectasis with azithromycin. Thorax 2004;59(6):540-1.9. Elborn S, Colombo C End-of-life management Study with experts Cystic fibrosis, ERS School courses 2006, 247-262 10. Evans DJ, Bara AI, Greenstone M Prolonged antibiotics for purulent bronchiectasis. Cochrane Database Syst Rev. 2003;CD00139211. Kecelj P et al The microbiological isolates in patients with non-CF bronchiectasis in stable clinical situation and in disease exacerbation Clinical Microbiology and Infection 2007; 13 (s1): S32812. King PT et al Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med, 2006;100(12):2183-9.13. Langenderfer B. Alternatives to percussion and postural drainage. A review of mucus clearance therapies: percussion and postural drainage, autogenic drainage, positive expiratory pressure,

flutter valve, intrapulmonary percussive ventilation, and high-frequency chest compression with the ThAIRapy Vest. J Cardiopulm Rehabil. Jul-Aug 1998;18(4):283-914. Radiology, 2005;236(1):10-21.15. Nikolaizik WH, Warner JO. Aetiology of chronic suppurative lung disease. Arch Dis Child. Feb 1994;70(2):141-2. 16. Prieto D et al Surgery for bronchiectasis, Eur J Cardiothorac Surg 2001;20:19-24 17. Reid LM. Reduction in bronchial subdivision in bronchiectasis. Thorax. 1950;5(3):233-47.18. Roguin A Rene Theophile Hyacinthe Lannec (17811826): The Man Behind the Stethoscope Clin Med Res, 2003, 4 (3): 2303519. Rosen MJ.Chronic cough due to tuberculosis and other infections: ACCP evidence-based clinical practice guidelines.Chest 2006;129(1 Suppl):197S-201S20. Sheikh A, Nolan D, Greenstone M Long-acting beta-2-agonists for bronchiectasis. Cochrane Database Syst Rev. 2001;(4):CD00215521. Smyrnios NA, Irwin RS, Curley FJ Chronic cough with a history of excessive sputum production. The spectrum and frequency of causes, key components of the diagnostic evaluation, and

outcome of specific therapy. Chest 1995;108(4):991-722. Tsang KW, Tipoe GL Bronchiectasis: not an orphan disease in the East. Int J Tuberc Lung Dis. Jun 2004;8(6):691-70223. Tsang KW et al. Inhaled fluticasone in bronchiectasis: a 12 month study Thorax Mar 2005;60(3):239-43

:-

. . 1 1431

. 9230 357e-mail: gal_ps@yahoo.co.uk

19

, -

, , . , , , 8.7/100 000, -. - , - 1-2 , . 25-30% . - - . ( ) - 70% . - : , (/), / , ( ), - , / , () / , -. . , , -, , , , , . -- . - 2 .

: , , .

. - ,

T II, 2010, .1

20

T II, 2010, .1 OCULAR MANIFESTATIONS OF

SARCOIDOSIS

AbstractSarcoidosis is a multi-system disease with unknown etiology with the following characteristics: hilar

lymphadenopathy, pulmonary infiltrations, ocular and skin damage with formed immune granulomas in the affected organs. The incidence of the disease depends on age, gender, race and geographical location. The incidence for Bulgaria is 8.7/100 000. The disease occurs in different ways: from benign, recovered for 1 2 years to life-long with developing multi-organ dysfunction. Ocular sarcoidosis occurs in 25 30% of the patients. There are extra- and intraocular manifestations. The most frequently affected of uvea 70%. There are certain international criteria for intraocular sarcoidosis: fat corneal precipitates, iris nodules (Koppe/Busacca), nodes of the trabecular apparatus, opacities in vitreous body (snow balls, pearls), horioretinal peripheral damage, segment periphlebitis and/or retinal microaneurism in the sore eye, optical disk granulomas, and/or solitary horioid nodes, bilateral spread of the disease. Firstly it is a differential diagnosis with tuberculosis. The treatment of ocular sarcoidosis include corticosteroids, antimalarial drugs, immunosuppressors, nonsteroid anti-inflammatory drugs, vasodilatators, cyclosporine A, calcium absorbents, antifibrotic drugs. The diagnosis of ocular sarcoidosis is difficult necessitating a biopsy of conjunctiva. In each patient with ocular sarcoidosis monitoring is needed not less 2 years after the subsidence of the disease.

Key words: Intraocular sarcoidosis, extraocular sarcoidosis, sarcoid uveitis

M. Konareva-KostianevaDepartment of Ophthalmology, Medical University Plovdiv

21

T II, 2010, .1

- , . - - , , , (5, 7). - , - , . - , , , , -, . - - . , - -- . , , , . - HLA-B8/A1, - , . / 10:1. - , - -. , , - , - 16.5/100 000 19/100 000 (4). - 8.7/100 000. - -. : . - 25 40 , - (1), 50 . - . - - , , , , - .

-, , - , Langhans, , , . : , , , . - -

, 1-2 , . ,

( 100% ), ( 60-90% ), (

- 60-90% -), ( 30% ), (20%), (5-15%), (- ), (3%), ( -).

Newman . 25% , (6). - - - .

: -

. - 50 - , - - (9). - (.1). / , - -. , . 6-40% - 67% (8). - , - - - , , , , .

: -

. ( - ) . - , . . ( -

) - 70% - (3).

. 1.

.

22

. , 40% , - -, . - 60% , - , - . - - (.2).

, , -, - . . . Koppe Busacca . Koppe - (.3),

T II, 2010, .1

Busacca - , (.4).

. 3.

.

. 6.

.

. 4. .

. 5.

.

. 2.

.

. 7. .

-. - ( -

) (.5), - .

( , , - ) ( , ). , 28% (7). , . - , , , - - , - . (.6) , - .

. , - , ( . . Landers). -. - . - . ,

, -, -, . ( ), ( ) (.7), - ( - - ).

23

I

II ( )

III ( )

< 31 . -

> 31 .

( )

( )

1

-

T II, 2010, .1

:1. ATS/ERS/WASOG Committee. Statement on sarcoidosis. Am J Respir Crit Care Med 1999, 160: 736-755.2. Bradley D., RP Baughman, L Raymond, AH Kaufman. Ocular manifestations of sarcoidosis. Semin Respir Crit Care Med 2009, 23(6) : 543-548.3. Herbort C. P., N.A. Rao, M. Mochizuki et al. International Criteria for the Diagnosis of Ocular Sarcoidosis: Results of the First International Workshop on Ocular Sarcoidosis (IWOS). Ocular Imm

unology&Inflammation,2009,17,3: 160-169.4. Hillerdal G., E. Niou, K. Osterman, B. Schmekel. Sarcoidosis. Epidemiology and prognosis. A 15-year European study. Am RevRespr Dis 1984, 130: 29-32.5. James DG. Sarcoidosis 2001. Postgrad Med J 2001, 77: 177-180.6. Newman LS, CS Rose, LA Maier. Sarcoidosis. N Engl J Med 1997, 336 (17) : 1224-1234.7. Nunes H., D. Bouvry, P. Soler, D. Valeyre. Sarcoidosis. Orphanet J Rare Dis. 2007, 2: 46.8. Ohara K., MA Judson, RP Baughman. Clinical aspects of ocular sarcoidosis. Eur Respir Monograph. 2005,10: 188-209.9. Prabhakaran V.C., P. Saeed, B. Esmaeli, T. J. Sullivan et al. Orbital and Adnexal Sarcoidosis. Arch Ophthalmol 2007,125 (12): 1657-1662.

:. -, . 664000 . 032 602 536-mail: marieta_ikk@abv.bg

(3) : 1. /

/ (Koppe/Busacca);

2. / - ;

3. , - -;

4. / ;

5. / ( ) / - ;

6. ()/() / ;

7. . -

, - ( - ) ( ).

- - . - , , - . , , -- ( ), , -

, , ( ), , - , , , - .

-, : , , , - - , , -, , Stevens - Johnson, , - .

- , , -, , , , - , - (), , , . . 1.

, . - .

, - . - - 2 .

24

EGFR hTERT . 1, . 1, . 1, . 2

1, , 2,

T II, 2010, .1

() -

. - EGFR hTERT . : EGFR hTERT 45 40 . < 70%, 1< 70%, 25 . : - RQ (relative quantity). EGFR . RQ = 29.39. hTERT 88% . RQ = 17.31. 50% , , EGFR RQ = 2.09. hTERT 17 (32.5%) , RQ = 1.02. (p=0.0001). EGFR hTERT ,

- .

: (EGFR) , (hTERT) , ,

25

EXPRESSION OF EGFR AND hTERT AS DIAGNOSTIC MARKERS OF NONSMALL CELL LUNG CANCER IN HIGH RISK PATIENTS

R. Cherneva1, O. Georgiev1, D. Petrova1, D. Toncheva2

Clinic of Internal Diseases Pulmonology1, UMHAT Alexandrovska, Medical University SofiaDepartment of Medical Genetics2, Medical University - Sofia

EGFR hTERT

T II, 2010, .1

AbstractThe early detection of nonsmall lung cancer (NSCLC) is of importance because it provides chances

for better outcomes. The aim of the study was to explore the clinical utility of EGFR and hTERT mRNA expression as markers for diagnosis of NSCLC. Methods: EGFR and hTERT mRNA were quantified by quantative reverse transcription real time polymerase chain reaction in plasma of 45 non-small cell lung cancer (NSCLC) and 40 chronic obstructive pulmonary disease (COPD) patients, selected by certain spirometric characteristics that made them at high risk of developing lung cancer in future. Results: The gene expression level of each gene was calculated and given as a relative quantity RQ. EGFR gene expression was found in all lung cancer patients. The mean level of expression was RQ = 29.39. hTERT mRNA could be detected in 88% of the patients. The mean expression ratio in them was RQ = 17.31. Only 50% of the high risk patients turned to be positive for EGFR. The level of their expression was RQ = 2.09. The plasma levels of hTERT could be detected in 17 (42.5%) patients of the high risk COPD group. Their mean level of expression was RQ=1.02. A statistically significant difference in EGFR and hTERT mRNA expression could be observed between the two groups of patients (p=0.0001). EGFR and hTERT mRNA are potential markers for lung cancer diagnosis, whose clinical importance

should be replicated in a larger cohort of patients.

Key words: epidermal growth factor receptor (EGFR) mRNA, human telomerase reverse transcriptasae (hTERT) mRNA, gene expression, non-small lung cancer

26

, : - (I II), - . . -

EGFR hTERT - , - .

, . 45 , -, 2007 - 2008, . , , - ( , - N ), - - (22). - 2004 (34). 9 ml , - (-, .) - . 40 - () : 1/ ( ) < 70%, 1< 70% . -

. 9 ml K3EDTA. 12 000 g 15 . 4C. 20 . -80C . -

-/ (2). Nanodrop 1000. - 260/280 nm. (- > 1.8) . - . -

(2g)

- . - - , . , , - - . , (), ( , -) ( -). - . - , - , . -

. -, - - - (1, 13), (4, 9), - (19, 24). - , (8, 15, 17).

. , - - (6, 16, 28, 29). - . - - - - (3, 14). (26, 33). -

-19 - (8, 10, 11, 25). c-met hnRNP (2, 5, 21, 30). Mitas et al, - (19). , .

EGFR hTERT

T II, 2010, .1

27

- High Capacity Reverse Transcription Kit - 2x Reverse Transcription Master Mix (N#4368814, Applied Bisystems). 20l , Multiscribe 1l, -1l, 10x 2l, 10 x - 2l; 25 x dNTP - 0.8l, 100ng/l . 2 . 37C

- TaqMan PreAmp Master Mix (2x) 25l; TaqMan Gene Expression Assay - 2.5l 250ng/l , 12.5/l . 95C 10 . 40 . PCR PCR

ABI PRISM 7500 Sequence Detection System (Taqman); Perkin-Elmer Applied Biosystems. 5l , 4l H2O, 10l TaqMan Universal MasterMix (2x), 1l TaqMan Gene Expression (20X). . - 96 . - PCR , . - - EGFR, hTERT beta-actin TaqMan Gene Expression (20X) Hs 00193306_m1 EGFR, Hs 99999903_m1 ACTB, Hs 00972650_m1 hTERT. PCR

; 2min/50C; 40 - 15sec/95C; - - 60sec/60C. PCR - . - -actin . (.1, 2). PCR -

- 1.3. . - . ( - RQ (relative quantity)) Livak delta delta Ct (18).

SPSS 13.0. Mann-Whitney - EGFR hTERT .

28

, , - (27, 31, 32).

, - - - , -, , .

- : 1) - ; 2) , -, ; 3) - - (27). , - -

- , -. 30-60% - (6, 28, 29). -

- Fleischhacker et al (11). hnRNPB1 HER2 . - Miura et al, (20). - - 112. , hTERT . Sher et al, (26) , - - . , Sheu et al, (27) CEA, CK-19 c-met 72% 69 , - - 85.5% 85%. - 80% 1. , -, 34.7% . , - - . -

, - - , - .

- (12, 23). , - . - (16), < 70%, O1< 75%, - .

, - . (, - ) - . - . EGFR , hTERT 88% . EGFR

RQ = 29.39. - EGFR 50% RQ = 2.09. hTERT

RQ = 17.31. hTERT 42.5% RQ = 1.02.

EGFR hTERT -, - p

29

. - - , - .

: EGFR hTERT - - .

EGFR hTERT

T II, 2010, .1

RQ EGFR p- RQ hTERT - 30.75 p=0.996 19,04 p=0.711 28.77 16.46 G1 29.55 9.12 G2 32.07 p=0.009 19.21 p=0.350 G3 12,49 17.74 S I 33.28 13.23 S II 23.51 p=0.949 15.44 p=0.189 S III 23,09 22.46 S IV T1 25.31 9.29 T2 24.15 p=0.798 17.46 p=0.642 T3 26.71 17.42 T4 20.92 22.54 N N0 30.76 p=0.809 14.22 p=0.256 N1-3 27.95 20,08

.1. EGFR hTERT -

. 3. EGFR hTERT

. 2. EGFR (), hTERT () -actin ()

. 1. EGFR (), hTERT () -actin ()

. RQ delta-delta Ct. -.

29,39

1,022,09

0

5

10

15

20

25

30

35

EGFR hTERT

NSCLC COPD

RQ

NSCLC COPD

17,31

30

:1. Andriani F, Conte D, Mastrangelo T, Leon M, Ratcliffe C, Roz L, Pelosi G, Goldstraw P, Sozzi G, Pastorino U. Detecting lung cancer in plasma with the use of multiple genetic markers. Int J Cancer

2004; 108: 9196.2. Bustin SA. Quantitation of mRNA using real-time reverse transcription PCR (RT-PCR): trends and problems. J Mol Endocrinol 2002; 29: 23-39.3. Castaldo G, Tomaiuolo R, Sanduzzi A, Ponticiello A, Marchetiello I, Salvatore F: Carcinoembryonic antigen mRNA analysis detects micrometastatic cells in blood from lung cancer patients. Eur

Respir J 2003; 22: 418421. 4. Chen XQ, Stroun M, Magnenat JL, Nicod LP, Kurt AM, Lyautey J, Lederrey C, Anker P: Microsatellite alterations in plasma DNA of small cell lung cancer patients. Nat Med 1996; 2: 10331035 5. Cheng TL, Chang MY, Huang SY, Sheu CC, Kao EL, Cheng YJ, Chong IW: Overexpression of circulating c-Met mRNAs is signifi cantly correlated with nodal stage and early recurrence. Chest 2005;

128: 145314606. Chomczynski P, Sacchi N. Single-step method of RNA isolation by acid guanidinium thiocyanate-phenol-chloroform extraction. Anal Biochem 1987; 162:156159.7. Clarke LE, Leitzel K, Smith J, Ali SM, Lipton A: Epidermal growth factor receptor mRNA in peripheral blood of patients with pancreatic, lung, and colon carcinomas detected by RT-PCR. Int J

Oncol 2003; 22: 425430.8. Dingemans AM, Brakenhoff RH, Postmus PE, Giaccone G: Detection of cytokeratin-19 transcripts by reverse transcriptase-polymerase chain reaction in lung cancer cell lines and blood of lung

cancer patients. Lab Invest 1997; 77: 213220.9. El-Hefnawy T, Raja S, Kelly L, Bigbee WL, Kirkwood JM, Luketich JD, Godfrey TE:Characterization of amplifiable, circulating RNA in plasma and its potential as a tool for cancer diagnostics. Clin

Chem 2004; 50: 564 573.10. Esteller M, Sanchez-Cespedes M, Rosell R, Sidransky D, Baylin SB, Herman JG: Detection of aberrant promoter hypermethylation of tumor suppressor genes in serum DNA from non-small cell

lung cancer patients. Cancer Res 1999; 59: 6770.11. Fleischhacker M, Beinert T, Ermitsch M, Seferi D, Possinger K, Engelmann C, Jandrig B: Detection of amplifiable messenger RNA in the serum of patients with lung cancer. Ann N Y Acad Sci

2001; 945: 179188.12. Gonzalez R, Silva JM, Sanchez A, Dominguez G, Garcia JM, Chen XQ, Stroun M, Provencio M, Espana P, Anker P, Bonilla F: Microsatellite alterations and TP53 mutations in plasma DNA of small-

cell lung cancer patients: followup study and prognostic signifi cance. Ann Oncol 2000; 11: 10971104.13. Hoon DS, Wang Y, Dale PS, Conrad AJ, Schmid P, Garrison D, Kuo C, Foshag LJ, Nizze AJ, Morton DL: Detection of occult melanoma cells in blood with a multiple-marker polymerase chain

reaction assay. J Clin Oncol 1995; 13: 21092116.14. Johnson PJ, Lo YM: Plasma nucleic acids in the diagnosis and management of malignant disease. Clin Chem 2002; 48: 11861193.15. Kerr KM. Pulmonary preinvasive neoplasia. J Clin Pathol 2001;54: 257-271.16. Kopreski MS, Benko FA, Gocke CD: Circulating RNA as a tumor marker: detection of 5T4 mRNA in breast and lung cancer patient serum. Ann N Y Acad Sci 2001; 945: 172178.17. Kurusu Y, Yamashita J, Ogawa M: Detection of circulating tumor cells by reverse transcriptase- polymerase chain reaction in patients with resectable non-small-cell lung cancer. Surgery 1999;

126: 820826.18. Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) Method.Methods. 2001; 25(4): 402-819. Mitas M, Hoover L, Silvestri G, Reed C, Green M, Turrisi AT, Sherman C, Mikhitarian K, Cole DJ, Block MI, Gillanders WE: Lunx is a superior molecular marker for detection of non-small cell lung

cancer in peripheral blood. J Mol Diagn 2003; 5: 237242.20. Miura N, Nakamura H, Sato R, Tsukamoto T, Harada T, Takahashi S, Adachi Y, Shomori K, Sano A, Kishimoto Y, Ito H, Hasegawa J, Shiota G. Clinical usefulness of serum telomerase reverse

transcriptase (hTERT) mRNA and epidermal growth factor receptor (EGFR) mRNA as a novel tumor marker for lung cancer.Cancer Sci. 2006;97(12):1366-73.21. Miura N, Shiota G, Nakagawa T, et al. Sensitive detection of hTERT mRNA in the serum of patients with hepatocellular carcinoma. Oncology 2003; 64: 430-4.22. Mountain CF. Revisions in the International System for Staging Lung Cancer. Chest 1997; 111: 1710 -7. 23. Purdue MP, Gold L, Jarvholm B, et al. Impaired lung function and lung cancer incidence in a cohort of Swedish construction workers. Thorax 2007; 62:51-56. 997;111:1710-7.24. Ramirez JL, Sarries C, de Castro PL, Roig B, Queralt C, Escuin D, de Aguirre I, Sanchez JM, Manzano JL, Margeli M, Sanchez JJ, Astudillo J, Taron M, Rosell R: Methylation patterns and K-ras

mutations in tumor and paired serum of resected non-small-cell lung cancer patients. Cancer Lett 2003; 193: 207216.25. Ruud P, Fodstad O, Hovig E: Identification of a novel cytokeratin 19 pseudogene that may interfere with reverse transcriptase-polymerase chain reaction assays used to detect micrometastatic

tumor cells. Int J Cancer 1999; 80: 119 125.26. Sher YP, Shih JY, Yang PC, Roffl er SR, Chu YW, Wu CW, Yu CL, Peck K: Prognosis of non-small cell lung cancer patients by detecting circulating cancer cells in the peripheral blood with multiple

marker genes. Clin Cancer Res 2005; 11: 173179.27. Sheu CC, Chang MY, Chang HC, Tsai J et al .Combined Detection of CEA, CK-19 and c-met mRNAs in Peripheral Blood: A Highly Sensitive Panel for Potential Molecular Diagnosis of Non-Small

Cell Lung Cancer. Oncology 2006; 70:203-211.28. Sidransky D: Emerging molecular markers of cancer. Nat Rev Cancer 2002; 2: 210219.29. Sueoka E, Sueoka N, Iwanaga K, Sato A, Suga K, Hayashi S, Nagasawa K, Nakachi K: Detection of plasma hnRNP B1 mRNA, a new cancer biomarker, in lung cancer patients by quantitative

real-time polymerase chain reaction. Lung Cancer 2005; 48: 77-83.30. Taback B, Chan AD, Kuo CT, Bostick PJ, Wang HJ, Giuliano AE, Hoon DS: Detection of occult metastatic breast cancer cells in blood by a multimolecular marker assay: correlation with clinical

stage of disease. Cancer Res 2001; 61: 88458850.31. Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC. Tumours of the lung. In: WD Travis, E Brambilla, HK Muller-Hermelink, CC Harris (Eds.), Pathology and Genetics: Tumours of the Lung,

Pleura, Thymus and Heart. Lyon: International Agency for Research on Cancer (IARC), 2004:9;124-134.32. Tsou JA, Hagen JA, Carpenter CL, Laird-Offringa IA: DNA methylation analysis: a powerful new tool for lung cancer diagnosis. Oncogene 2002; 21: 54505461.33. Valasek MA., Joyce JR. The power of real-time PCR. Adv Physiol Educ 2005; 29: 151-159.34. Yamashita J, Matsuo A, Kurusu Y, Saishoji T, Hayashi N, Ogawa M: Preoperative evidence of circulating tumor cells by means of reverse transcriptase-polymerase chain reaction for

carcinoembryonic antigen messenger RNA is an independent predictor of survival in nonsmall cell lung cancer: a prospective study. J Thorac Cardiovasc Surg 2002; 124: 299305.

EGFR hTERT

T II, 2010, .1

: ,

, . 1

1431Tel: 0889107854

E-mail: cherneva_radost@yahoo.com

31

, ,

. () . . 5 353 , . , . - .

: , ,

. 1, . 1, . 1, . 1, . 2

, 1

2

T II, 2010, .1

32

COMPARATIVE ESTIMATION OF CLINICAL INDICES CONCERNING ANTIBIOTIC RESISTANCE IN PATIENTS WITH COMMUNITY ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS TREATED IN PULMONARY WARD AND INTENSIVE CARE UNIT

AbstractCommunity acquired lower respiratory tract infections are diseases with medico social significance,

and their antibiotic resistance is a global problem. The aim of the study is to establish the differences between the main clinical indices of the patients in pulmonary ward and intensive care unit. 353 patients divided into two compared groups have been conducted during five year period. We found significant differences concerning some factors of development of the antibiotic resistance. There is necessity for more exhaustive studies for accurate estimation of the resistance.

Key words: infections, lower respiratory tract, resistance

P. Glogovska1, Y. Ivanov1, P. Pavlov1, . Borissova1, P. Hristova2

University lung diseases hospital1 Department of Social and Preventive Medicine2

Medical University Pleven

,

,

T II, 2010, .1

33

, - , , . - - - . - , .

-

, , - .

353

-, (), () - () - , . 70.2% 29.8% , 65,2 . (SD11,6.). : n1= 286 (81.1%) () n2 = 67 (18.9%). - : , , , , , - , .

-

. - (n1/n2 69.6%/73.1%). 59./61., >0,05. -

, - . (.1)

- . - (n1/n2 71.7%/71.6%), (n1/n2 10.1%/14.9%) (n1/n2 10.4%/9%). 9% -

(. 2). 28.3% (

34

3.

5.

4.

- 54.2% - 65.7% (0,05).

(.4), - - . (n1/n2 85.3%/77.6%). - / . -- (6.6%/14.9%). , - , : ceftriaxone (n1/n2 80.4%/53.7%); eftazidim 16.4% 2 -- ; amoxicillin/clavulanic acid (n1/n2 3.9%/13.4%), meropenem (n1/n2 0%/6%), levofloxacin n1/n2 0.4%/4.5%).

- 7 - (31.6%) 8 (23.8%). - 5 , . (n1/n2 - 88%/93.7%) - (>0,05). - - (. 5), (11.1%/34.3%;

35

. - -- , , , , . , 3-6 , , (4, 5, 10, 11, 12). - , - , - , - (13).-

, , , . , -

. , , - . Enterobacteriaceae. - (3, 7), - .

- , , - (1, 5). - , .

:1. ., , : , Abbot, 2004 .17-20 2. 2005-2007. www.mh.government.bg, 12.03.2009.3. Angrill J. et al., Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors, Thorax, Vol. 57(1), 2002, 15-19.4. Aspa J. et al., Drug-resistant pneumococcal pneumonia: Clinical relevance and related factors, CID, 2004:38 787-798.5. Aspa J. et al., Empirical treatment of community-acquired pneumonia: current guidelines, In: Community-acquired pneumonia: strategies for management, ed. by Torres A., R. Menendez,

2008, John Wiley & Sons, Ltd 64.6. Brown D. et al., Antibiotic prescriptions associated with outpatient visits for acute upper respiratory tract infections among adult medicaid recipients in North Carolina, N.C. Med. J., 2003,

Vol.64, 4, 148-156.7. Cabello H. et al., Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study, Eur. Respir. J., 1997; 10: 11371144. 8. Ewig S., S. Gatermann, Pathogen directed antimicrobial treatment of pneumonia, In: Community-Acquired Pneumonia: strategies for management, ed. by Torres A., R. Menendez, 2008, John

Wiley & Sons, Ltd. 64. 9. Florentino P., Antibiotic resistance is a global threat http://www.medscape.com/viewarticle/420069, 03.04.09.10. Ho P., W. Tse, K. Tsang, et al., Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case-control study, Clin. Infect. Dis., 2001, 32: 701707. 11. Hyde T., K. Gay, D. Stephens, et al. Macrolide resistance among invasive Streptococcus pneumoniae isolates, J. Am. Med. Assoc., 2001, 286: 18571862. 12. Laupland K., D.Church, J. Vidakovich, M. Mucenski, J. Pitout, Community-onset extended-spectrum beta-lactamase (ESBL) producing Escherichia coli: importance of international travel, J.

Infect., 2008, 57(6):441-8. 13. Lepape A., D.Monnet, Experience of European intensive care physicians with infections due to antibiotic resistant bacteria, 2009 Euro Surveill. 2009;14(45):pii=19393. Available online: http://

www.eurosurveillance.org/)14. Metlay J. et al., Impact of penicillin susceptibility on medical outcomes for adult patients with pneumococcal pneumonia, Clin. Infect. Dis., 2000, 30: 520528. 15. Spach D., D. Black, Antibiotic resistance in community-acquired respiratory tract infections: current issues, Annals of allergy, asthma, & immunology, 1998, Vol. 81, 293-303.

- - , , - (1, 8).

, - (14). - .

1. -

, - 60 .

2. , .

3. . - .

4. - - . ,

- , , - .

:- . . 81 5800. . 064886729. 0888 539 659email: pglogovska@gmail.com

, , T II, 2010, .1

36

( )

: -

, . - . , , - , . 2009 . , . - , . : 1319 nm Nd:YAG . 4

. - . : 4,5 . -

24- 48- . - . - . :

- . - ( 124), 14 cm .

: , ,

. - ,

T II, 2010, .1

37

LAZER PULMONARY METASTASECTOMY(NEW LIGHT IN THE TUNNEL)

AbstractIntroduction: The surgical treatment of pulmonary mtastases was only a stage of the palliation care

until now, usually after chemotherapy. It requires certain experience and a sparing surgical approach. The surgical techniques, used until now, have their advantages as well as some disadvantages, such as reduction of functional healthy lung tissue, which made them inapplicable for multiple lesions. Unique laser system has been used in the Department of Thoracic Surgery Military Medical Academy since December 2009. The parameters of the device allow precise resection of multiple pulmonary metastases, without significant reduction of respiratory volume.Material and method: We have used a 1319 nm Nd:YAG Laser system. The first four patients with

single lung metastasis from different primary malignancies were operated at the clinic. The surgical approach was thoracotomy. Results: The mean postoperative stay was four and a half days. The drainage systems were taken

out between the 24th and 48th hour. The pathological findings proved the location and type of the primary tumor. There were no complications and perioperative deaths.Conclusion: The precise resection in a close proximity to the tumor tissue, using laser systems for

thoracic surgery, does not confront the principles of the oncological radicalism as reported in the literature. The practical lack of reduction of breathing lung parenchyma using laser resection allows the removal of multiple lesions of different sizes up to 124, in both lungs and a size of biggest 14 cm in diameter.

Key words: lung metastases, lazer metastasectomy, thoracotomy

D. JordanovClinic for Thoracic Surgery, MMA - Sofia

( )

T II, 2010, .1

( )

T II, 2010, .1

38

2009 . - - . - - -, . - .

1. , .

2.

- .

3.

.

4.

, -

. - 1319 nm, , 10 -- Nd: YAG 1064 nm. 80% , - -- - . 0,4 mm, 3 mm, - 5 mm. - , . 01. 12. 15. 12. 2009 . -

4 . , , (. 1). , 48- -. 4- .

-

. , -. , . - (, ) - 5-7 mm - . - - . - - , , . - - . - - . , - - (. 2). -

, -. - . - , - - (. 3).

( )

T II, 2010, .1

39

( )

T II, 2010, .1

( )

T II, 2010, .1

- . - 5/0 - , (. 4). -

(. 5).

- . 28 24-48 . - - , - .

4,5 . .

-

- . - - - , - . - , - , , , . . . - -, -

5. .

. , - ( -), - - . 1-3 -, - (1, 2, 5). -

- . 1967 . Minton .

Nd:YAG 1064 nm. , 1985 . LoCicero . 2 , 1990 . , 1064 nm Nd:YAG - . - 1319 nm Nd:YAG e 10 - , 1064 nm. - . 5 mm (5, 6). -

. - - ( 124), - 14 m . :

. -

-, - (1, 3, 4, 5 ,6). ( )

, - , - , , . - - .

:- . . 3 1606

:1. . . . ? ,

2008, 1, 31-42.2. , .. . . ., , 19883. Loehe F. et all. Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy. Ann. Thorac. Surg. 2001, 72:225-9.4. Rolle A. Laser application in lung parenchyma surgery. Med. Lser Appl., 2003, 18:271-280.5. Rolle A., et all. Lobe sparing Resection of multiple pulmonary metastases with a new 1318-nm Nd:YAG Laser first 100 patients. Ann. Thorac. Surg. 2002, 74:865-9.6. Rolle A., et all. Laser resection technique and results of multiple lung metastasectomies using a new 1318-nm Nd:YAG Laser System. Lasers in Surg and Med 2006, 38:26-32.

40

,

. (SAS) . 20 (15 5 ) 42.4 (15.9) (BMI) 33.7 (6.16). - OSAS , . . - . . (VS), (VD) (VM) . : (VS = 69.1cm/s v/s 92.8 cm/s,

VD =32.2 v/s 40.6, VM = 44.2 cm/s v/s 59,3cm/s) - OSAS, OSAS. , OSAS , , .

: , ,

. 1, . 2, . 3, . 4

, ., 1

, ., 2

, ., 3

, ., 4

T II, 2010, .1

41

OBSTRUCTIVE SLEEP APNEA SYNDROME AND CEREBRAL BLOOD FLOW

AbstractSeveral studies have demonstrated a clear association between snoring, sleep apnea and increased

risk of stroke. The aim of our study was to investigate cerebral haemodynamic changes during the waking state in patients with obstuctive sleep apnea syndrome (OSAS). Materials and methods: 20 patients (15 males and 5 females) with mean age 42.4 (15.9) years and mean body mass index (BMI) 33.7 (6.16) participate in the study. Ten of them were with polysomnography documented severe OSAS end ten were control subjects. All participants were studied by transcranial Doppler ultrasonography. The dynamics of cerebral blood flow velocity (CBFV) were investigated in the middle cerebral artery in both groups. Left and right middle cerebral arteries were examined. The systolic (VS) diastolic (VD) and mean (VM) cerebral blood flow velocities were determined. Results: All three velocities (VS = 69.1cm/s v/s 92.8 cm/s, VD =32.2 v/s 40.6, VM = 44.2 cm/s v/s

59,3cm/s) were significantly lower in patients with OSAS, than those in the control subjects. In conclusion our results suggest that patients with OSAS have decreased cerebral blood flow

velocities. These may lead to decrease in cerebral perfusion, to lead to cerebral atherosclerosis, and to increase risk of stroke.

Key words: sleep apnea, cerebral haemodynamic, transcranial doppler ultrasonography

D. Petkova1, V. Nestrorova2, S. Andonova3, B. Banova4

Clinic of pulmonology, MHAT St Marina, MU Varna1

Clinic of occupational diseases, MHAT St Marina, MU Varna2

Clinic of Neurology, MHAT St Marina, MU Varna3

Clinic of Otorhinolaryngology, MHAT St Marina, MU Varna4

T II, 2010, .1

42

T II, 2010, .1

, - (1, 9). - (SAS) . , - (7). - , , - , .. (2, 4). -

, OSAS -, (3, 5).

-, - . -

(SAS) - SAS.

10 SAS 10

SAS. - . - - . - MEPAL, (MAP, Medizin-Technologie, Martinsried, Germany). - ( 5-15 / ), ( 16-30 / ) ( 30 / ). - DWL 2000, 4 Mhz . -

, . SAS

: - : 42.415.9 ;- : 9 1 ;- BMI: 33.76.16;- / (HI):

69.5818.0;- ESS -

:14.9;- : 70%

-.

.1 2 -

(cm/s) -: (VM), (VS), (VD), (LMCA) (RMCA) - OSAS, - OSAS. 3

- OSAS OSAS. - , OSAS OSAS.

SAS - . SAS - - - . - OSAS , - - - SAS (8).

OSAS

0

20

40

60

80

100

120

140

1 2 3 4 5 6 7 8 9 10

(n)

cm

/s

LMCAVS

LMCAVD

LMCAVM

RMCAVS

RMCAVD

RMCAVM

1. cm/s OSAS

43

T II, 2010, .1

- - - (6). , -

- . , - - . - OSAS. -, . - -. , - - . - , - -

- , . . - , - , - . , - . , - , , , - - . ,

- .. . - - . -

OSAS

0

20

40

60

80

100

120

140

1 2 3 4 5 6 7 8 9 10

(n)

cm/s

LMCAVS

LMCAVD

LMCAVM

RMCAVS

RMCAVD

RMCAVM

OSAS OSAS

p

44

:-

.

. . 1

9010e-mail: dipetkova@hotmail.com

:1. Arzt M, Young T, Finn L, Skatrud JB, Bradley TD. Association of sleep disordered breathing and the occurrence of stroke. Am J Respir CritCare Med 2005;172:14471451.2. Barcelo A, Miralles C, Barbe F, Vila M, Pons S, Agusti AG. Abnormallipid peroxidation in patients with sleep apnoea. Eur Respir J 2000;16:644647.3. Carlson JT, Rangemark C, Hedner JA. Attenuated endotheliumdependentvascular relaxation in patients with sleep apnoea. J Hypertens 1996;14:577584.4. Christou K, Markoulis N, Moulas AN, Pastaka C, Gourgoulianis KI.Reactive oxygen metabolites (ROMs) as an index of oxidative stressin obstructive sleep apnea patients. Sleep Breath

2003;7:105110.5. Kato M, Roberts-Thomson P, Phillips BG, Haynes WG, Winnicki M, Accurso V, Somers VK. Impairment of endothelium-dependent vasodilation of resistance vessels in patients with obstructive

sleep apnea. Circulation 2000;102:26072610.6. Kaynak D, Goksan B, Kaynak H, Degirmenci N, Daglioglu S:Is there a link between the severity of sleep-disordered breathing and atherosclerotic disease of the carotid arteries? Eur J Neurol

10: 487493, 2003.7. Schulz R: The vascular micromilieu in obstructive sleep apnoea. Eur Respir J 25: 780782, 2005.8. Schulz R, Seeger W, Fegbeutel C, et al.: Changes in extracranial arteries in obstructive sleep apnoea. Eur Respir J 25: 6974, 2005.9. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:20342041.

- . - SAS. - - . , - - , , - - - .

. - . -

- (6). , (8). - . , , , BMI , - (9). o , . SAS --

-- , OSAS. OSAS - - . - - , .

T II, 2010, .1

45

. - : , - . - - .

: , , - , -

.1, .2, .1

1

2

, ,

T II, 2010, .1

46

SLEEP APNEA AND DENTISTRY CROSSING POINTS

AbstractThe purpose of this study is to show the intersections between the sleep apnea and dental medicine.

Oral appliances are intended to treat Obstructive Sleep Apnea (OSA) and Upper Airway Resistance Syndrome (UARS) by keeping the airway open in one of three ways: by pushing the lower jaw forward with a mandibular advancement device; by preventing the tongue from falling back over the airway with a tongue-retaining device, or by combining both. They are the proper treatment solutions for the patients with mild to moderate OSA.

Key words: obstructive sleep apnea, upper airway resistance syndrome, mandibular advancement device, tongue-retaining device

L. Grozev1, V. Jordanov2, G. Todorov1

Department of Prosthetic Dentistry1

Department of Orthodonty2

Faculty of Dental Medicine, Medical University, Plovdiv

T II, 2010, .1

47

T II, 2010, .1

() , - , - NCPAP BiPAP, -. 1966 , Gastaut et al , 90- - - . , - . , - , , . -

?

- - . - , , - , . - . - , . 1995 -

, 320 , . American Academy of Sleep Medicine (AASM) , - (7). AASM , , - NCPAP. - - - (2, 3, 4). -

, - - , .

-

, - (1). - 15 () 44 (38 72.). - - . , - - . , - , - . -

- . , - . 40 (3). S -

, : () (.1)

(.2)

- - - - (9). : - (.3)

(.4)

- (.5)- -

, , - . , -, (5, 7). -

. -, .

.1

.2 -

.3 -

.4 -

.5 -

48

59 92 ./. ,

- . - , , -, , . : NCPAP, .

. - . , - . , - , NCPAP. - -, - . , - -. - - .

- , . . , , , -. , (8). ,

, - (1, 3). - , - , . - - -, - - (1, 2).

, -

, , - . : - , - (), - (6, 8). ,

- , . - , - , - . - 2-2,5 mm. (. 6)

, - . (. 7)

, - , . (. 8)

- -- (), - . -.

, -

, - , , - , . , - , . - - . , - , , - . 35 37, 10 17 - - - . 5.5%. -

T II, 2010, .1

. 6 I- -

. 7 II- -

. 8 III-

49

, . - . , -

- - - . - - . Sleep Centers,

, (4).

. , -, . - - - , - -- - .

T II, 2010, .1

:- , .. 3 4000: 0888 915 971 e-mail: doktorgrozev@gmail.com

:1. , , . . . , --

; 10-11.I.20052. Dukes Ph. Sleep laboratory testing. Dent Clinics N Am 2001; 45:839-51

3. Ferguson KA, Cartwright R, Rogers et al. Oral appliances dnd OSA: A Review. Sleep 2006; 29 (2):244-624. Ivanhoe JR, Attanasio R. Sleep disorders and oral devices. Dent Clinics N Am 2001; 45:733-525. Ghazal A, Sorichter S, Jonas I, Rose EC. A Randomized prospective long-term study of two oral appliances for sleep apnoea treatment. J Sleep Res 2009; 18(3):321-286. Lamont J, Baldwin DR, Hay KD, Veale AG. Effect of two types of mandibular advancement splints on snoring and Obstructive sleep apnea. Eur J Orthod 1998; 20 (3):293-77. Ono T, Lowe AA, Ferguson KA, Pae EK, Fleetham JA. The effect of the tongue retaining device on awake genioglossus muscle activity in patients with obstructive sleep apnea. Am J Orthod

Dentofac Orthop 1996; 110:28-358. Sachin J, Mervyn FL, Stephen WB, Donald AC, Robin O. Ten-year follow-up of mandibular advancement devices of snoring and sllep apnea. J prosthet Dent 2008; 99:314-219. Yuehua L, Xianglong Z, Minkui F, Xizhen H, Lowe AA. Effects of a mandibular repositioner on Obstructive sleep apnea. Am J Orthod 2000; 118 (3):248-56

50

LEOPOLD AUENBRUGGER (1722 1809)

2009 200 Lepold Auenbrugger,

, . Lepold Auenbrugger 19.11.1722 . , , . , - Gerhard van Swieten (1700-1772). 1751 . 1758 . , 1758-1762 . . -, - . , . L. Auenbrugger , , - . , 1761 Inventum novum e percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi ( , , ). , . 1808 . Jean Nicolas Corvisart (1755-1822), , Inventum novum, , Auenbrugger. R. Laennec 1816, - .

. : L. Auenbrugger, ,

1, 2, 3

, -1

, -2

, -3

, - .

- , - -,

...

( . . .)

T II, 2010, .1

51

LEOPOLD AUENBRUGGER (1722 1809)

T II, 2010, .1

LEOPOLD AUENBRUGGER (1722 1809): THE FATHER OF PERCUSSION

AbstractIn the year 2009 was the 200th anniversary of Leopold Auenbruggers death, a famous Viennese

physician who developed and introduced the percussion technique to the medical practice. Leopold Auenbrugger was born on 19.11.1722 in Graz, Austria in a family of innkeepers. He received his medical education in the viennese faculty of medicine where his tutor and professor was the famous doctor and chemist Gerhard van Swieten (1700-1772). From 1751 till 1758 the young doctor worked at the Spanish military hospital in Vienna and in the period 1758-1762 he was in charge of the internal division there. He daily confronted severe cases of lung illnesses mostly caused by pulmonary tuberculosis. Often they were accompanied by pleural effusions, that were undetectable in life and were found only on the autopsy table. For 7 years L. Auenbrugger was developing a physical method which he decided to call percussion with which it was made possible to diagnose the effusions in the thorax before the examination of the patient. As a result of his studies was his famous work which he published in Vienna in 1761 by the title Inventum novum e percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi (A New Discovery that Enables the Physician from the Percussion of the Human Thorax to Detect the Diseases Hidden Within the Chest). In his work he describes not only the pathological findings by the pulmonary illness, but gave a classical description of the cardio aneurism and pericardial effusion. In 1808 Jean Nicolas Corvisart (1755-1822), the personal physician of Napoleon Bonapartem, later recognized Inventum novum and translated it in French and added his own observations reminding in the preface that the sole developer of the technique was Auenbrugger. In this way the percussion technique found fame in the medical world and together whit the discovery of the auscultation technique by stethoscope by R. Laennec in 1816 widen the diagnostic capability by the bed of the patient.The percussion and auscultation techniques stay a classical method even in modern days for

examining patients. Key words: L. Auenbrugger, percussion , history of medicine

D. Paskalev1, D. Radoinova2, D. Petkova3

, -1

, -2

, -3

52

LEOPOLD AUENBRUGGER (1722 1809)

T II, 2010, .1

2009 . - 200 Leopold Auenbrugger, , - - - .

(460-377

. . .), - , , . , - . - , , , , , - . - , - . , () - . , - , - . , (1, 11). Thomas Sydenham (1624-

1689) , , , . - - - (, 1648), () , . - (1640-1649) Cromwell , - . - - . , , , - . - . . T. Sydenham -

( . nsos logos ). , - (scarlet fever) (measles), -, , chorea Sydenhami. -, , (1683). - T. Sydenham - (1, 11). -

, : Ubi est morbos, .. () ? Giovanni Batistta Morgagni (1682 1771). 19 , - . Antonio Valsalva (1666 1723) Ippolito Albertini (1662 1738), - Marcello Malpighi (1628 1694). 1706 1719 . Morgagni Adversaria anatomica ( ), , . 1715 . , - 1222 ., 1404 . - (8,10). 1761 ., 79 , Morgagni , , De sedibus et causis morborum per anatomen indagatis libre quinque ( -, -). , - -. 640 , Morgagni , - post mortem. - 70 , . Morgagni - . , , . De sedibus et causis morborum ( ), , - , - , , . , . - .

53

LEOPOLD AUENBRUGGER (1722 1809)

T II, 2010, .1

Morgagni , De sedibus et causis morborum 1769 . - 1774 . (8, 10, 11).

. 1761 . 95 . Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi ( , - , ) (4). - , - Inventum novum, , 39 Leopold Auenbrugger. Leopold Auenbrugger L. Auenbrugger e 19.11.1722 . ,

. - , Zum schwarzen Mohren ( ), . Leopold Auenbrugger- - . [13, 19, 21].- L. Auenbrugger -

, - 18.11.1752 . Gerhard van Swieten (1700-1772), Hermann Boerhaave (1668-1738) . van Swieten Commentarii in Boerhaavi aphorismos de cognoscendis et curandi morbis (- Boerhaave ) - (2,16). - , Experimentum nascens de remedio specifico sub signo specifico in mania virorum ( ) (5). L. Auenbrugger - , - . , Auenbrugger 30- , (17). - Von der stillen Wut oder dem Triebe zum Selbstmorde als einer wirklichen Krankheit, mit originaellen Beobachtungen und Anmerkungen. ( - ) (6).

1751 1758 . . - , . - 1758 1762 . L. Auenbrugger - . - - Maria-Theresia, . , - - (12, 13,17, 19). L. Auenbrugger

, - . - , 1781 . Der Rauchfangkehrer (), - Antonio Salieri (1750-1825). - -. Auenbrugger Maria Katharina Marianna, J. Haydn (1732-1809) 6 - (2, 12,17). 12.11.1783 . -

, Inventum novum, L. Auenbrugger - Franz Joseph - Joseph Leopold Auenbrugger, Edler von Auenbrugg (2, 12, 17,19). 18.05.1809 .

87 , 2 , .. 14 , (17).

54

Inventum novum , L.

Auenbrugger - , - . , . - , - (11). Post mortem - , . , Auenbrugger - , . , , : Thorax sani homini sonat si percutitur ( ). , , , - - (4). , Auenbrugger : sonus altior (), sonus carnis (, -), sonus obscurior ( ) [4]. , - : - - - . , , - - (4). Auenbrugger , - : - ... ( - )... , , .. . , , , - . , . - - . , , - ... [4]. Auenbrugger : , , - , (4).

: ... - , - , . , , - , () - ... - - , ... - , , ... - , , - - (4). L. Auenbrugger -

- , . , , . 7 -, 1761 ., Inventum novum - . Auenbrugger :... , , -. () - , . , - , 7 - (4). , - - , , , , , -, - ... (4). , Inventum novum

-. XLVI , Auenbrugger ( ), , . XLVIII , , . - ( Auenbrugger)

LEOPOLD AUENBRUGGER (1722 1809)

T II, 2010, .1

55

. (4). Per aspera ad astera (

, .) Inventum novum,

. - Gerhard van Swieten Anton de Haen (1704-1776) (1,19). - , Oliver Goldsmith , London Public Ledger 27.08.1761 . - Auenbrugger (1,12). - 1763 . - Maximilian Stoll (1742-1788), Wiener Allgemeines Ktankenhaus, - , , (12, 14, 21). Rozire de la Chassagne (1770, ), , , (2, 7, 21). 1808 . -

Jean Nicolas Corvisart (1755-1822), - , - Maximilian Stoll. , , - Auenbrugger : - , , , - Auenbrugger. Auenbrugger

; , , , - Inventum novum (9). 1826 . PierreAdolph Piorry (1794-1879)

, 5 cm 2,5 mm, - . , , (18). William Stokes James Hope, Piorry, - , , - Joseph Skoda (1805-1881), - (20, 21). 1841 . Max Wintrich , . - (15). (1816)

Ren Lannec (1781-1826), - , W. Rntgen (3). , -

, Leopold Auenbrugger, -. 18.05.1909 ., 100-- , , Kapuzinerkirche, Neuer Markt 9 (19).

: Inventum novum .

LEOPOLD AUENBRUGGER (1722 1809)

T II, 2010, .1

:1. . . .. 1983. .7-30; 139-1512. ., ., Inventum novum . 200- (1722-1809). (.) .2009; 13 (2).100-1133. ., .. . .. 2007. , 111-1144. Auenbrugger L. Inventum novum ex percussione thoracis humani ut signo abstrusos interni pectoris morbos detegendi.Joanis Trattner.Vindobonae , MDCCLXI5. Auenbrugger L. Experimentum nascens de remedio specifico sub signo specifico in mania virorum. J.Kurzboek.Viennae.MDCCLXXVI6. Auenbrugger L. Von der stillen Wut oder dem Triebe zum Selbstmorde als einer wirklichen Krankheit, mit originaellen Beobachtungen und Anmerkungen. Dessan.17837. Bedford D. E. Auenbruggers contribution to cardiology. History of percussion of the heart. Brit Heart J 1971; 33: 817-821. 8. Beneke K. Beitrage zur Geschichte der Kolloidwissenschaften, VIII Mitteilungen der Kolloid-Geselschaft, Verlag Reinhard Knof, Nehmten, 1999; 32-369. Corvisart J. N. Nouvelle mthode pour reconnaitre les maladies interes par la percussion de cette cavit, par Auenbrugger. Ouvrage traduit du latin et comment, Mignered. Paris.180810. Giovanni Battista Morgagni, http: //www.wohnamedit.com/doctor.cfm/312 11. Haggard H. W. The Doctor in History, Barnes & Noble.New York.1996.59-68; 317-31912. Josef Leopold Auenbrugger, http: //www.wohnamedit.com/doctor.cfm/30913. Karger-Decker B. Die Geschichte der Medizin.Albatros.Dsseldorf.2001; 286-28714. Koehler U, Gross V, Reincke C , Penzel T. Schalldiagnostische Verfahren die geschichte von Perkussion und Auskultation.Pneumologie.2004.58;525-53015. Lawrence L. How percussion hammers evolved into reflex hammers. Endocrine Today.2008;14;1116. Lesky E. Leopold Auenbrugger van Swietens Schuler, Deutsche med Wochenschr. 1959.84; 1017-102217. Pearse JMS. Leopold Auenbrugger: Camphor - induced Epilepsy remedy for manic psychosis. Eur Neurol 2008; 59: 105-10718. Piorry PA. De la percussion mediate et des signesobtenus aidede ce nouveau moyen exploration, dans les maladies des organs toraciques et abdominaux. Chaud et Baillire. Paris.1828

;62-9519. Regal W., Nanut M. Das Inventum novum von Leopold Auenbrugger (Altes Medizinisches Wien 31) rzte Woche 2003; 17: 1-220. Sakula S. Joseph Skoda 1805-1881. A contenary tribute to a pioneer of thoracic medicine. Thorax.1981;36;404-41121. Yernault JC, Bohadana AB. Chest percussion. Eur Respir J 1995; 8: 1756-1760

:. - . 1 9010e-mail: dobrinpaskalev@yahoo.com

56

. -

in memoriamT

II, 2010, .1

19.01.2003 . - - . - , . , , -

, .

, - - - . , , - , - .

. e . . . , 1953 . . 1956 . 1959 . . . 1959

., . 1972 . . 1975 . . 01.10.1984 - , , . 1987 . - -. 1988 . . - .

1960 .

, 1968 - - , - .

V - 1964 ; , 1964 ; - 1965 ; , , V V 1966 , . 1976 1980 .; V 1967 , . 1979 .; 1970 1975 .; 1973 . 1977 ; , 1974 .; 1986 .; 1987 . 1968

V - - 4 . - - . 1970-1979 . - - . 1972 -, . - , .

57

. -

T II, 2010, .1

in memoriam 1971 . -

. 1981 -- . 1968 - - . -

-, -, -- , . -

. , -

, .. 200

, 33 , - . .- . -

, -- . , - - . -

- , -,

-. -, -- -, . - , - . ,

, - , - . -- - - . ,

, -. -- .

-, - -- . (1979 .), 1981 ., 1982 ., 1984 ., 1981 . 1984 .

-

58

,

, , 2010

T II, 2010, .1

02.06.2010 02.06.2010, 15:00, : ,

.

.

.

.

.

.

-

: , , - . .

, , , . .

, , . .

. , . . .

. , . . .

. , , . .

. . . .

15:00 15:30

15:30 16:00

16:00 16:30

16:30 17:00

17:00 17:30

17:30 18:00

18:00 18:30

18:30 19:00

59

,

, , 2010

T II, 2010, .1

IGRA ?

MDRTB

XDR-TB

?

08:00

08:00 08:30

08:30 09:00

09:00 09:30

09:30 10:00

10:00 10:30

10:30 11:00

11:00 11:30

11:30 12:00

12:00 12:30

12:30 13:00

13:00 13:30

15:00 15:30

15:30 16:00

16:00 16:30

16:30 17:00

03.06.2010 03.06.2010, 08:00, : ,

S1.1 03.06.2010 , 15:00 : ,

18:00

60

04.06.2010 S2.1 : - 04.06 2010, , 08:00: ,

S 2.2 , 04.06. 2010, 10:30, : ,

S2.3 : , 04.06, 15:30, : ,

,

H1N1 , ,

08:00 08:30

08:30 09:00

09:00 09:30

09:30 10:00

10:30 11:00

11:00 11:30

11:30 12:00

12:00 12:30

15:30 16:00

16:00 16:30

16:30 17:00

17:00 17:30

,

, , 2010

12:45 13:45, - -

HL1 14:00 15:00 .

T II, 2010, .1

61

05.06.2010 S3.1 : , 05.06.2010, 08:00 : ,

E

state-of-the-art

-

10 ?

08:00 08:30

08:30 09:00

09:00 09:30

09:30 10:00

,

, , 2010

S2.4 18:00 19:30

SS 2.1 AstraZeneca 18:00 19:00

SS 2.2 Chiesi 18:00 19:00

SS 2.3 Bayer 18:00 19:00

21:00

S 3.2 .

S 3.3 : , 05.06.2010, 08:00

T II, 2010, .1

62

08:00 PS 1 PS 2 PS 3 PS 4

HL2 - 10:30 11:30 .

11:45 13:30

11:45 13:30

14:00 15:45OP1 OP2 OP3 OP4

14:00-15:45

S3.4 16:15 17:45 .

,

, , 2010

T II, 2010, .1

63

,

, , 2010

T II, 2010, .1

18:00 19:30SS 3.1 GlaxoSmithKline

18:00 19:00SS 3.2 Sanofi-Aventis

18:00 19:00SS 3.3

18:00 19:00SS 3.4

20:30

06.06.2010 S 4.1 : , 06.06, 08.00 : ,

S.4.2 ., 06.06.2010 .; 10.30 : ,

12:30

ATS/ERS

Langerhans

08:00 08:30

08:30 09:00

09:00 09:30

09:30 10:00

10.30 11.00

11.00 11.30

11.30 12.00

12.00 12.30

64

T II, 2010, .1

2010 -

A 14 - 19 - - USA

3 - 6 - -

20- (ERS)18 - 22 - -

9 - -

16 - -

(WORLD SPIROMETRY DAY)14

- 3 - 6 , 2010, ,

65

, 2010

04. 02. 2010 19. 03. 2010 24. 03. 2010 07. 04. 2010 10. 04. 2010 2010 04. 05. 2010 31. 05. 2010 2010 2010 2010 06. 06. 2010 2010 04. 10. 2010 14. 10. 2010 27. 10. 2010 24 30. 10. 2010 2010 02. 11. 2010 17. 11. 2010 18. 11. 2010 2010

66

, , - ., ( -

) , Word. .tif .jpg. , . 15 , - 10 - 7 ( 30 , 60 - 66 , 4). , :

. . - , .

250 6 . :

, , , , (). o 40 20 -

, , , . :* : ( , ). . ( Index Medicus), , , , (-).

* : . . , , -, .

* : . . . , -, , .

, - , , . - , . . .

:

: . . 1 1431e-mail: ssn@multicom.bg./ : 0887 250 037

67

:

Publisher:Bulgarian Union on Bronchial Deseases

. , ..

, Chief editor

assoc. prof. Daniela Petrova, MD, PhDDepartment of Internal Diseases

UMHATAlexandrovska Medical University, Sofia

. , .. . , .. . , ..

. , .. . , .. . , ... . , .. . , .. . , ..

-

Section editorsassoc. prof. Donka Stefanova, MD, PhDassoc. prof. Dencho Osmanliev, MD, PhDassoc. prof. Dimitar Popov, MD, PHD

assoc. prof. Dimitar Kostadinov, MD, PhDassoc. prof. Penka Nikolova, MD, PhDassoc. prof. Danail Petrov, MD, PhDassoc. prof. Iordan Radkov, MD, PhDassoc. prof. Marinka Peneva, MD, PhDassoc. prof. Vladimir Hodjev, MD, PhD

Tzania Popova, MD : -

, : -

:

ISSN 1313-9827