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Spiriev T.,Tokuda Hospital Sofia | Tzvetanov P.,Medical Center Medica
Clinical Neurology and Neurosurgery | Year: 2010

Objective: The objective of this study is to investigate the application of transcranial magnetic stimulation combined with neuronavigation for preoperative mapping of the language area in neurosurgical interventions on the opercular area of the dominant hemisphere. Methods: Five patients were operated upon gliomas in the opercular area. For localization of the speech area a transcranial magnetic stimulator MEDTRONIC-MagPro was used. BrainLAB- VectorVision Neuronavigation system was utilized for precise planning of the operative approach. Results: Gross total resection was achieved in all patients. Three-month postoperative follow-up was done. Three of the patients had a transient postoperative motor aphasia which resolved within 1 month. Conclusion: This method is useful for preoperative localization of the speech area, as well as preoperative planning of the operative approach and intra-operative planning of the direction of brain retraction and operative corridor. © 2010 Elsevier B.V. All rights reserved.


Spiriev T.,Tokuda Hospital Sofia | Sandu N.,University Paris - Sud | Schaller B.,University Paris - Sud | Schaller B.,Tokuda Hospital Sofia
Methods in Molecular Biology | Year: 2013

Stem cell transplantation is a promising new therapeutic option in different neurological diseases. However, it is not yet possible to translate its potential from animal models to clinical application. One of the main problems of applying stem cell transplantation in clinical medium is the difficulty of detection, localization, and examination of the stem cells in vivo at both cellular and molecular levels. State-of-the-art molecular imaging techniques provide new and better means for noninvasive, repeated, and quantitative tracking of stem cell implant or transplant. From initial deposition to the survival, migration, and differentiation of the transplant/implanted stem cells, current molecular imaging methods allow monitoring of the infused cells in the same live recipient over time. The present review briefly summarizes and compares these molecular imaging methods for cell labeling and imaging in animal models as well as in clinical application and sheds light on consecutive new therapeutic options if appropriate. © Springer Science+Business Media New York 2013.


Traykov V.B.,Tokuda Hospital Sofia
Tachycardia: Risk Factors, Causes and Treatment Options | Year: 2014

This is an edited collection covering a wide range of topics in the field of tachyarrhythmias. Among them is the general approach to the patient with supraventricular tachycardia. The management of patients with atrial fibrillation has also been extensively covered. The important topic of differential diagnosis of wide QRS tachycardia has been touched upon as well with a comprehensive and well-illustrated review. Special emphasis has been put on the assessment of the risk for sudden cardiac death in patients with ischaemic and non-ischaemic dilated cardiomyopathy. The chapters covering these topics provide a useful update to the novel risk factors that might help to better assess the sudden cardiac death risk. A substantial part of the book is devoted to catheter ablation of arrhythmias as a non-pharmacological treatment option. The approach to catheter ablation of narrow QRS tachycardias and typical atrial flutter has been reviewed in detail. Another detailed review summarizes the methods for catheter ablation of atrial fibrillation starting from the very introduction of this technique and ending with the current state-of-the-art technology used to successfully ablate atrial fibrillation. The approach to catheter ablation of ventricular tachyarrhythmias in structurally normal hearts and in the presence of structural heart disease has been described in a series of two chapters. Last but not least, the book reviews the role of implantable cardioverter-defibrillators (ICD) in the prevention of sudden cardiac death. It focuses on the current indications for implantation and also describes some basic principles in device programming. With the wide area of topics that are covered by the different chapters, this book is interesting to fellows, clinical cardiologists and electrophysiologists and all physicians involved in the diagnosis and treatment of cardiac arrhythmias. © 2015 by Nova Science Publishers, Inc. All rights reserved.


Darlenski R.,Tokuda Hospital Sofia | Kazandjieva J.,Medical University-Sofia | Tsankov N.,Tokuda Hospital Sofia
Clinics in Dermatology | Year: 2015

Skin is often affected in adverse drug reactions. Although the majority of cutaneous adverse drug reactions are benign and self-limiting, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug rash with eosinophilia and systemic symptoms (DRESS), affecting multiple organs and systems, are potentially fatal. Many organs can be affected, including the mucosal membranes, gastrointestinal tract, liver, lungs, kidneys, and eyes. We discuss the causes, pathophysiologic aspects, and main clinical features of SJS, TEN, and DRESS as systemic diseases with skin involvement. © 2015 Elsevier Inc.


Staikov I.N.,Tokuda Hospital Sofia | Neykov N.V.,Tokuda Hospital Sofia | Kazandjieva J.S.,Medical Faculty Sofia | Tsankov N.K.,Tokuda Hospital Sofia
Clinics in Dermatology | Year: 2015

Orofacial herpes simplex virus infections are usually caused by herpes simplex virus 1 (HSV-1), and HSV-2 infections have been accepted as a sexually transmitted disease. HSV establishes a latent infection in the dorsal root ganglia of the host and remains there for the rest of life. HSV affects mainly skin and genitalia, although in immunocompromised patients it may cause local infection with vast skin involvement, chronic herpetic ulcers, or widespread mucous membrane damage, as well as systemic infections localized in the central and peripheral nervous systems, gastrointestinal tract, and ocular system. Usually, HSV infections are in the domain of dermatology, but the accumulating facts for localization of the disease in many systems of the human body give us the possibility to pose the question: Is herpes simplex a systemic disease? © 2015 Elsevier Inc.


Darlenski R.,Tokuda Hospital Sofia | Fluhr J.W.,Charite University Clinic
Clinics in Dermatology | Year: 2012

The intact skin represents a barrier to the uncontrolled loss of water, proteins, and plasma components from the organism. Owing to its complex structure, the epidermal barrier with its major layer, the stratum corneum, is the rate-limiting unit for the penetration of exogenous substances through the skin. The epidermal barrier is not a static structure. The status of different functions of the epidermis can be monitored by assessing specific biophysical parameters such as transepidermal water loss, stratum corneum hydration, and skin surface pH. Variables originating from the individual as well as exogenous factors have an important influence on the epidermal barrier parameters. © 2012 Elsevier Inc.


Petrov I.S.,Tokuda Hospital Sofia
Folia medica | Year: 2011

INTRODUCTION: Tako-tsubo syndrome is a novel cardio-vascular disease affecting predominantly postmenopausal women exposed to unexpected strong emotional or physical stress, in the absence of significant coronary heart disease. It is characterized by acute onset of severe chest pain and/or acute left ventricular failure, ECG-changes, typical left ventricular angiographic findings, good prognosis and positive resolution of the morphological and clinical manifestations. First described in 1990 in Japan by Sato, Tako-tsubo cardiomyopathy is characterized by transient contractile abnormalities of the left ventricle, causing typical left ventricular apical ballooning at end-systole with concomitant compensatory basal hyperkinesia. There are also atypical forms, presenting with left ventricular systolic dysfunction which affects the mid-portions of the left ventricle. The etiology of the disease still remains unclear. Many theories have been put forward about the potential underlying pathophysiological mechanisms that may trigger this syndrome among which are the theory of catecholamine excess, the theory of multivessel coronary vasospasm, the ischemic theory, and the theory of microvascular dysfunction and dynamic left ventricular gradient induced by elevated circulating catecholamine levels. Adequate management of Tako-tsubo syndrome demands immediate preparation for coronary angiography. Once the diagnosis is made, treatment is primarily symptomatic and includes monitoring for complications. Patients with Tako-tsubo syndrome most frequently develop acute LV failure, pulmonary edema, rhythm and conductive disturbances and apical thrombosis. Treatment is symptomatic and includes administration of diuretics, vasodilators and mechanical support of circulation with intra-aortic balloon counterpulsation.


Determining the chamber of origin of focal atrial tachycardias (FATs) arising at or close to the septum might require biatrial mapping. This review focuses on the available tools and methods used to distinguish right atrial from left atrial origin before left atrial access is obtained. These include analysis of P wave morphology, assessing the timing of right atrial septal activation, the sequence of right atrial and/or biatrial activation and analysis of earliest electrogram morphology. The electroanatomical properties of the interatrial septum and coronary sinus that provide the basis for the above mentioned tools have also been briefly described.


Darlenski R.,Tokuda Hospital Sofia | Fluhr J.W.,Charite University Clinic
Journal of Biomedical Optics | Year: 2013

Photodynamic therapy (PDT) is a noninvasive therapeutic method first introduced in the field of dermatology. It is mainly used for the treatment of precancerous and superficial malignant skin tumors. Today PDT finds new applications not only for nononcologic dermatoses but also in the field of other medical specialties such as otorhinolaryngology, ophthalmology, neurology, gastroenterology, and urology. We are witnessing a broadening of the spectrum of skin diseases that are treated by PDT. Since its introduction, PDT protocol has evolved significantly in terms of increasing method efficacy and patient safety. In this era of evidence-based medicine, it is expected that much effort will be put into creating a worldwide accepted consensus on PDT. A review on the current knowledge of PDT is given, and the historical basis of the method's evolution since its introduction in the 1900s is presented. At the end, future challenges of PDT are focused on discussing gaps that exist for research in the field. © 2013 SPIE.


Petrov I.,Tokuda Hospital Sofia | Grozdinski L.,Tokuda Hospital Sofia | Kaninski G.,Tokuda Hospital Sofia | Iliev N.,Tokuda Hospital Sofia | And 2 more authors.
Journal of Endovascular Therapy | Year: 2011

Purpose: To evaluate the safety of endovascular treatment of chronic cerebrovascular insufficiency (CCSVI) in patients with multiple sclerosis (MS). Methods: In a 1-year period, 461 MS patients (261 women; mean age 45.4 years, range 21-79) with CCSVI underwent endovascular treatment of 1012 venous lesions during 495 procedures [34 (6.9%) reinterventions]. While balloon angioplasty was preferred, 98 stents were implanted in 76 patients for lesion recoil, restenosis, or suboptimal dilation. The procedures were analyzed for incidences of major adverse events (death, major bleeding, or clinical deterioration of MS), access site complications, procedure-related complications, and procedural safety-related variables (fluoroscopy and contrast times). The complication rates were compared to published data for similar endovascular methods. Results: There were no deaths, major bleeding events, or clinical deterioration of MS. Access site complications included limited groin hematoma (5, 1.0%); there were no arteriovenous fistulas or puncture site infections. Systemic complications included only rare cardiac arrhythmias (6, 1.2%). Procedure-related complications included vein rupture (2, 0.4%), vein dissection (15, 3.0%), acute in-stent/in-segment thrombosis (8, 1.6%), and acute recoil (1, 0.2%); there was no stent migration or fracture or distal embolization. Mean fluoroscopy time was 22.7 minutes, and mean contrast volume was 136.3 mL. Conclusion: Endovascular therapy appears to be a safe and reliable method for treating CCSVI. Innovations such as purpose-specific materials and devices are needed, as are case-controlled and randomized data to establish efficacy in ameliorating MS symptoms. © 2011 by the International Society of Endovascular Specialists.

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