Herpes Simplex Virus and Endothelium

Човекът е единственият естествен гостoприемник на Херпес Симплекс Вирус (ХСВ). Инфекцията с него води до разнообразни по форма, проявление и локализация очни изменения. Причинява рецидивиращи роговични инфекции-херпетичен кератит и кератоувеит, чийто усложнения са причина за намалено зрение.Цел: Да представим проява на локализирана роговична ендотелна декомпенсация, стромален оток, нови съдове и намалено зрение, при пациент с рецидивиращ хек ( >4 рецидива за 6 г.) след рутинна, некомплицирана факоемулсификация.Материал и методи: Представяме мъж на 53 г., с анамнеза за множество рецидиви на херпетичен стромален кератит, започнали преди 7 години и трайно намалено зрение в дясното око, поради цикатрикс и комплицирана катаракта. Роговичните изменения са документирани с фотография на преден очен сегмент, топография (Atlas 9000, Carl Zeis Meditec), анализатор на вълновия фронт ('NASCA, Carl Zeis Meditec) и ендотелен анализ (Pentacam, Oculus).Резултати: Анализът на топографията, вълновия фронт, ендотелната карта и съпоставката им с локализацията на процеса на фотографиите на предния очен сегмен ни дават обяснение за механизма на намалено зрение в очи с рецидивиращи стромални кератити.Заключение: Рецидивиращият ХСК може да бъде предпоставка за локализирана ендотелна декомпенсация, увеличена корнеална дебелина (в активната фаза), изразени цякатрициални промени при пореден пристъп, неоваскуларизация на роговицата след катарактална хирургия - всички те водещи до трайно намалено зрение. Считаме, че разбиранията ни за кратка медикаментозна профилактика при херпетичен стромален кератит ( 800 мг Aciclovir дневно в периода след острото възпаление) се нуждаят от съществена ревизия. Предвид отдалечеността във времето - 6 месеца след интервенцията, вероятността вътреочната хирургия да е отключващ фактор за поредния рецидив на HSV кератит е минимална.Human is the only natural host of herpes simplex virus (HSV). The infection caused by this double-strained DNA virus has various clinical forms and localizations in the eye. Most common is the corneal manifestation - keratitis and keratouveitis, which is often recurrent and results in low vision.Purpose: To explore a localized corneal endothelial decompensation, stromal oedema, neovascularization and low vision in ô€‰š patient with recurrent HSV keratitis (more than 4 recurrences in 6 years) six months after routine, uncomplicated cataract surgery.Material and methods: Male, 53-year-old with history of multiple recurrences of HSV keratitis, started 7 years ago, and reduced visual acuity in the right eye due to cicatricial corneal changes and complicated cataract.Findings are documented with anterior segment photography, topography (Atlas 9000, Carl Zeis Meditec), wavefront analyzer (WASCA, Carl Zeis Meditec) and endothelial analysis (Pentacam, Oculus).Results: Analysis of corneal topography, wavefront data, endothelial cell count and matching them with the localization of the lesion with anterior segment photography give us a possible explanation of the mechanisms leading to reduced vision in eyes with recurrent stromal keratitis.Conclusion: Recurrent HSV keratitis may be a prerequisite for localized endothelial decompensation, increased corneal thickness (in active phase), marked cicatricial scaring in the convalescent period, corneal neovascularization after cataract surgery - reasons for permanently reduced vision altogether.We believe that our understanding for short-term antiviral drug prophylaxis ( 800 mg per day after the acute phase of the infection )in herpetic stromal keratitis requires substantial revision. Given the remoteness in time - six months after the cataract surgery, the chance of a surgery trauma to be another triggering factor for recurrence of HSV keratitis is minimal

BPIFA1 Protein: An essential ingredient to the future of the Diagnostic Therapeutic strategy for Chronic Rhinosinuitis

A number of complex processes of interaction between the macroorganismand a great deal of pathological microorganisms take place in the mucosa of the nasal and paranasal sinuses. One of the primary mechanisms of the mucosa counteraction is utilizing the secretion proteins (9). The BPIFA1 (bactericidal/permeability-increasing protein fold–containing family member A1) protein is a characteristic representative of this group. It is a multifunctional protein with various defensive mechanisms. Recently, there has been an upraise in research regarding the BPIFA1 role when treating chronic rhinosinuitis. Experimental drugs for treating chronic diseases of the upper respiratory tract are being developed based on BPIFA1

Variations in the squamous part of the occipital bone in medieval and contemporary cranial series from Bulgaria

The squamous part of the occipital bone is a place of many different variations. They are a result of faulty ossification in the occipital squama or due to the presence of sutural bones in the lambda region. As their differentiation is intricate because of the various criteria used, the issue of their recognition in the adult skull still remains difficult even though they can be clearly distinguished at a younger age. The aim of the present study was to compare the frequency of interparietal, preinterparietal and sutural bones in the lambda region in medieval male and female cranial series as well as between medieval and contemporary male series from Bulgaria. We also discuss the development of the occipital squama in order to set clearer criteria for further differentiation of such variations in the adult skull. In the reviewed 3 cranial series, the variations in the squamous portion of the occipital bone were observed with a low frequency. The incidence of preinterparietal bones was more common than the interparietal ones. The sutural bones in the lambda region were numerous in the series. No statistically significant sex or intergroup differences were established. So even if these anatomical variations are relatively rare, the understanding of them is of significance for many disciplines like anthropology, comparative and developmental anatomy, clinical and forensic medicine.

Juvenile Nasopharyngeal Angiofibroma – Characteristics, Diagnosis and Treatment

Ювенилният назофарингеален ангиофибром е рядък съдов тумор, срещащ се с честота под 0,5% от всички тумори на главата и шията. Въпреки че е хистологично бенигнен, той притежава локална инвазивност, подобно на злокачествените неоплазми. Лечението до ден-днешен е сериозно предизвикателство, криещо множество рискове от тежки, понякога животозастрашаващи усложнения.Juvenile nasopharyngeal angiofibroma is a rare high vascular tumor with a frequency of less than 0,5% of all head and neck tumors. Although histologicaly benign, it possess invasiveness similar to malignant neoplasms. The treatment is still a challenge with risk of sometimes lifethreatening complications