Pharmacogenetic research and data protection--challenges and solutions.
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Biomedical Research↗
Biomedical subjects
D Petrov
Publications and source records attributed to D Petrov.
Reduction of postprandial hyperglycemia in patients with type 2 diabetes reduces NF-kappaB activation in PBMCs.
AIMS/HYPOTHESIS: Short-lasting hyperglycemia results in activation of the transcription factor NF-kappaB in peripheral blood mononuclear cells. We therefore studied whether the postprandial increase in glucose is sufficient to induce mononuclear NF-kappaB activation and whether blunting postprandial hyperglycemia with the alpha-glucosidase inhibitor acarbose reduces NF-kappaB activation. METHODS: 20 patients with type 2 diabetes were included in a double-blind randomized trial receiving 100 mg acarbose or placebo three times a day over a period of eight weeks. Peripheral blood mononuclear cells were isolated before and 120 minutes after a standardized breakfast. NF-kappaB binding activity was estimated by electrophoretic mobility shift assay and NF-kappaB-p65; translocation was determined by Western blot. RESULTS: Eight weeks of treatment with acarbose significantly reduced postprandial hyperglycemia (p = 0.004 when compared to placebo), postprandial mononuclear NF-kappaB-binding activity (p = 0.045) and nuclear translocation of NF-kappaB-p65 (p = 0.02). CONCLUSION: Reduction of postprandial glucose peak levels by acarbose reduces postprandial mononuclear NF-kappaB activation.
Acarbose↗
[Indications for the surgical treatment in bronchiectasis and postoperative results].
During Jan. 1990 and Dec. 2002 a total of 14 patients with bronchiectasis were operated on. They were 5 female and 9 male with mean age of 35.7 years. In two of them (14.3%) the disease was with bilateral localization. Patients were typically presented with cough and purulent sputum production 12(85.7%), recurrent pulmonary infections 8(57.1%), halitosis 6(42.9%) and hemoptysis 4(28.6%). The mean duration of clinical manifestations was 8.4 years. The indications for surgery were failure of medical treatment in 10(71.4%) patients, hemoptysis in 2(14.3%) and lung abscesus, as a complication in 2(14.3%) patients. The operative methods included 9(64.3%) lobectomies, 1(7.1%) pleuropneumonectomy, 1(7.1%) pneumonectomy, 1(7.1%) bilobectomy with broncho-esophageal fistula resection, 1(7.1%) middle lobectomy with polysegmental resection S7-10 and 1(7.1%) polysegmental resection S7-10. No 30-day postoperative death was faced. Major complications, followed by rethoracotomy, were found in 2(14.3%) of the cases. The postoperative results were excellent in 8(57.1%) of the patient, very good in 5(35.75) of them and in only 1 patient there was no clinical improvement. In conclusion, surgery for bronchiectasis is followed by acceptable postoperative complications and better long-term result after radical operation.
Adolescent↗
[Diagnosis and surgical treatment of pulmonary sequestration].
Between Jan. 1988 and Jan. 2003 4 patients (3 male, 1 female, mean age of 20 years) were operated on for lung sequestration. Sequestration was intralobar in 3 cases and extralobar in 1 case. The abnormality was discovered by chance in 1 patient. The most frequent clinical manifestation was those of recurrent bronchopneumonia. X-ray films of the chest showed an apparently benign, posterobasal image in 80% of the cases. Arteriography was performed in 1 patient and revealed an abnormal systemic artery. Computerized tomography imaging with i.v. contrast confirmed the diagnosis in 3 patients. The intralobar type of sequestration was treated by lobectomy and polysegmental resection--S7-12, and the extralobar type--by sequestrectomy. The operative mortality and the morbidity rate were nil. The mean stay in hospital was 10 days. The long-term postoperative results are considered excellent.
Adolescent↗
[Video-assisted thoracoscopic surgery (VATS) for treatment of pleural empyema].
During 1996-2003 a total of 359 patients were treated for empyema. Forty eight of them (with parapneumonic empyema) were prospectively randomized into 2 groups of 24 patients who underwent early decortication either by thoracotomy or VATS. Comparing to thoracotomy group, VATS group had a significantly shorter chest tube duration (5.8+/-1.1 vs 9+/-1.3 days; p=0.03) and postoperative in-hospital stay with parapneumonic empyema (8.7+/-0.9 vs 12.8+/-1.1 days; p=0.009). VATS has been found to be particularly useful for treating the fibrinopurulent phase of empyema, in which multiple loculations could be easily disrupted to allow adequate drainage of a "cleaned" pleural space. On the other hand, although VATS is highly effective, it is not indicated in every patient and it's indiscriminate use may lead to none required operative interventions.
Adult↗
[Surgical treatment of chronic pleural empyema--seven years' experience].
During a 7 years period a total of 112 patients with chronic pleural empyema were operated on. There were 92 male and 20 female with mean age of 48.4 years. The mean duration of empyema clinical manifestation up to the operation was 59 days. Pleurectomy and decortication were carried out in 99 patients and in the other 5 cases they were associated with pulmonary resection. Additional thoracoplasty was necessary in only 7 patients. Rethoracotomy for hemostasis was performed in 5 (5.6%) patients. The overall postoperative mortality was 5.6%. The mean hospital stay after pleurectomy and decortication was 13 days and after the thoracoplasty it was 19 days. The follow-up period was 6 months for 84 (75%) and 12 months for 70 (62%) of the patients. No disease relapse was observed. Pulmonary function was improved after 3 to 6 months in the majority (89%) of the patients. Fully recovered working capacity was found in 44% of the patients.
Adult↗
[Surgical treatment of chronical pulmonary abscesses--contemporary treatment].
Between Jan 1991 and Dec 2000 a total of 67 patients were operated on for chronic primary pulmonary abscesses. They were 57 men and 10 women with mean age of 46.2 (range, 12 to 72) years. The indications for surgery was mainly "delayed closure" following medical therapy and percutaneous tube drainage (3), as well as a massive hemoptysis in 4 cases. CT scanning and brochoscopy were performed in all patients. The majority of them had multiple isolates (51/67) of both aerobic and anaerobic (predominantly Bacteroides sp., Fusobacterium sp., and Peptococci) organisms. The following operations were carried out: lobectomy (52) including 8 decortications, bilobectomy (5), pneumonectomy (4) including two pleuro pneumonectomy, polysegmentectomy (4) and segmental resection (2). The 30-day hospital mortality rate was 1.49% (1 patient died following rethoracotomy for bronchial stump fistula with empyema and polyorganic insufficiency). Major postoperative complications were 6 (8.9%) and included 3 pleural empyema (additional drainage), two rethoracotomy for intrapleural bleeding and one residual pleural cavity, treated by thoracoplasty. Minor postoperative complications (atelectasis, wound infection and prolonged air-leakage) were observed in 9 patients (13.4%). The long-term results (following-up ranged from 6 to 112 weeks) are considered very good. In conclusion, surgery is indicated for patients with significant hemoptysis, suspected malignancy and those with "late healing" abscesses with acceptable postoperative results, although the rate of major postoperative complications remains relatively high.
Adolescent↗
Fluticasone propionate in asthma: a long term dose comparison study.
BACKGROUND: Few dose ranging studies have investigated optimal dosing with inhaled corticosteroids in children with asthma. AIMS: To compare the efficacy and tolerability of fluticasone propionate 100 or 200 microg twice daily in children with moderate to severe asthma for one year. METHODS: One year, randomised, double blind, parallel group, multicentre study. Children aged 4-11 years (n = 528) with moderate to severe asthma who had previously received high dose inhaled corticosteroids were given fluticasone propionate 100 or 200 microg twice daily for the 52 week treatment period. Efficacy (exacerbations, lung function, and symptoms) and tolerability (adverse events and cortisol levels) were measured. RESULTS: There was a non-significant decreased risk of experiencing an exacerbation at any time with fluticasone propionate 200 microg twice daily compared with fluticasone propionate 100 microg twice daily. This difference reached significance among patients with more severe asthma (defined by previous inhaled corticosteroid dose >800 microg/day). Daily record card morning peak expiratory flow (PEF) in the total population improved significantly more with the higher dose of fluticasone propionate (between group difference, weeks 1-52: 11.4 l/min). Clinic visit mean PEF improved from baseline with both doses, but the response was significantly greater with the higher dose (between group difference, week 52: 17.8 l/min). Both doses were equally well tolerated and overnight urinary cortisol concentrations were unchanged or slightly increased during treatment with either dose. CONCLUSION: This long term dose comparison study shows that treatment with fluticasone propionate 200 micro g twice daily may offer benefits over a lower dose, particularly in children with more severe asthma.
Androstadienes↗
[Pleural tent after high partial lung resection--prospective randomised research].
OBJECTIVE: The aim of this study is to assess the role of the pleural tent in prophylactics of prolonged alveolar air leakage and apical residual pleural cavity formation after upper lobectomy/bilobectomy. METHODS: A total of 40 patients, who underwent upper lobectomy/bilobectomy were prospectively randomized into two homogeneous groups: (1) with pleural tent--20 pts and (2) control group without pleural tent--20 pts. The multivariate analyses were used to compare the chest tubes duration, the length of the hospital stay, the mean quantity of postoperative extravasation and the need of additional interventions to treat the persistent postoperative alveolar leak. RESULTS: No differences were detected between the two groups in terms of preoperative and operative characteristics. No 30-day operative death was faced. A significant reduction (p=0.001) of the number of days the chest tubes were required (7.7 days vs 12.38 days) and the length of the postoperative in-hospital stay (9.7 days vs 13.75 days) was found in pleural tent group compared to control group. The mean quantity of postoperative extravasation in pleural tent group was less compared to control group (1553 ml vs 1722 ml) without statistical significance (p=0.5485). Asymptomatic residual apical pleural cavities were found in 1 patient of pleural tent group and 2 patients of control group. In other 3 patients of the latter group an additional tube drainage was required to treat a residual apical cavity. CONCLUSIONS: Pleural tenting after upper lobectomy/bilobectomy reduces significantly the duration of the intrapleural drainages and the length of the in-hospital stay. It is simple, safe and effective additional method in the prophylactics of persistent alveolar air leakage and apical residual pleural cavity formation.
Female↗
[Corection of pectus excavatum with total sternal turnover].
A case of 23-year-old man with Pectus Excavatum (grade II) is reported on. The functional cardiorespiratory impairment was a leading symptom. The technique of sternal turnover with preservation of a vascular supply based on the internal mammary pedicle is introduced for the first time in Bulgaria. All procedure steps are described. Nine months after the operation cosmetic and functional results are considered excellent.
Adult↗
[One-stage operation for multi-organ echinococcosis (bilateral pulmonary, hepatic and splenic) by sterno-laparotomy].
Between 1990 and 2001 in Thoracic Surgery Department at SHATPD "Saint Sophia"--Sofia a total of 821 patients with pulmonary hydatidosis were operated on. In 5 (0.6%) of them the cysts were situated in the both lungs, lever and spleen. For the first time in the surgical practice a sterno-laparotomy were carried out for one-stage cysts' removal in this multi-organ localization. The stages of this approach as well as the indications and contraindications for its applications are described in detail.
Adult↗
[Surgical treatment of post-traumatic intrapulmonary haematomas].
In a 14-year period 18 patients with post-traumatic intrapulmonary haematomas (PIH) were diagnosed and treated in our departments. There were 14 men and 4 woman with mean age 42.1 year. The mean diameter of PIH was 7.5 cm and they were localized mainly in the left lower lobe. Three of the patients were successfully treated with conservative antibiotic and mucolytic therapy. The remaining 15 patients (83%) were operated on: lobectomy (7), segmental resection (2), extirpation with partial resection of the fibrous capsule and capitonnage (4) and total extirpation with fibrous capsule removal (2). Indications for surgery were as follows: infection, haemoptysis and suspicions of malignant lesion. The early and late results are excellent. We recommend the surgical approach to PIH as a safe and effective treatment.
Adolescent↗
[Major respiratory tract traumas].
Between 1988 and 2000 a total of 33 patients with traumatic tracheobronchial lesions were diagnosed and treated. The trauma was penetrating in 7 (stab and gun-shot), blunt in 10 (car accidents, compression and falling from heights) and iatrogenic in 16 of them (postintubational--15, after foreign body extraction--1). The main clinical and radiological features were subcutaneous emphysema, hemoptysis, respiratory insufficiency, pneumomediastinum and pneumothorax. The diagnosis was confirmed in all patients by early fiberoptic bronchoscopy. "Watch and see" tactics with massive antibiotics therapy was followed in 4 (12%) patients. A surgical treatment was carried out in 29 (88%) patients as follows: simple repair--19 (58%), left pneumonectomy--2 (6%), tracheal resection and anastomosis "end to end"--2 (6%), tracheostomy--1 (3%), thoracocenthesis and drainage--3 (9%) and cervical mediastinotomy--2 (6%). The operative mortality was 9%. The cause of death in these 3 patients were associated brain and spinal cord injuries. In the rest of patients the early and long-term postoperative results were considered very good.
Adolescent↗
Cross-reaction between the genus-specific lipopolysaccharide antigen of Chlamydia spp. and the lipopolysaccharides of Porphyromonas gingivalis, Escherichia coli O119 and Salmonella newington: implications for diagnosis.
Seven hybridoma clones, secreting monoclonal antibodies (MAbs) against the genus-specific chlamydial lipopolysaccharide (LPS) antigen were obtained after immunization of BALB/c mice with formalin killed Chlamydia psittaci. The antigen-binding properties of the MAbs were characterized in different immunologic reactions with purified chlamydial elementary bodies and LPS antigens from S- and R-forms of Gram-negative bacteria. Four MAbs reacted with the heterologous LPS antigens of Salmonella R-mutants, Escherichia coli Re chemotype and Acinetobacter calcoaceticus. Two MAbs demonstrated in addition a significant reactivity with Porphyromonas gingivalis, E. coli O119 and Salmonella newington LPS in ELISA, dot-ELISA and passive hemolysis assay (for clone 204G9). One MAb cross-reacted only with Salmonella minnesota Re LPS in ELISA. In indirect immunofluorescent assay six MAbs produced bright green fluorescence with all tested chlamydial strains and five of them reacted with the Re and Rb2 chemotypes of S. minnesota. The results demonstrate a wide cross-reactivity of the produced MAbs with LPS antigens of various Gram-negative bacteria, posing the question for careful consideration and interpretation of serology results for Chlamydia spp.
Animals↗
Anaerobic cocci and their resistance patterns to penicillin, cefoxitin, clindamycin and metronidazole: a Bulgarian study.
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Anti-Bacterial Agents↗
[Operative procedure for treatment of large and oversize cysts with interlobar location in pulmonary hydatid disease].
A procedure for treating large and oversize cysts with interlobar location, consisting in supplementary post-echinococcotomy draining of the respective interlobar groove using No. 18-20 catheter, is developed. It allows for maximal unfolding of the adjoining parenchyma, adherence of the fibrous capsule walls without any risk of a residual cavity formation. The procedure is successfully used in thirteen patients at average postoperative hospitalization 13.4 days. Both the early and long-term results are estimated as very good.
Adolescent↗
[Methods for aerostasis in pulmonary surgery].
Insufficient intraopertive aerostasis is a serious, actual, and yet unsolved problem of pulmonary surgery. It is a frequent cause for the development of postoperative complications that compromise the results of surgery. The authors investigate the development and modification of the contemporary surgical methods for aerostasis--surgical techniques for suturing the lung parenchyma, additional methods for buttressing and hermetization of the suture line, parietal pleurectomy, tissue glues, and fibrine adhesives. The advantages and disadvantages of the different methods for aerostasis are analyzed and their rationality and efficacy in various surgical conditions are discussed.
Adhesives↗
[Case report of one-stage lower lobectomies in complicated bilateral pulmonary echinococcosis by longitudinal sternotomy].
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Adult↗