[Extramammary Paget´s disease of the vulva - a case report]. / Extramamární Pagetova choroba vulvy - kazuistika.

OBJECTIVE: Analysis of one case of vulvar extramammary Paget´s disease (EMPD) and associated well differentiated endometrial adenocarcinoma.Desing: A case report. METHODS AND RESULTS: On this case report we present current theoretical knowledge about EMPD, difficulty of diagnostics, treatment and dispensarization the patients with this rare intraepithelial non-squamous neoplasia. We report a rare case of a 62 years old female patient with extramammary Paget´s disease of vulva and associated well differentiated endometrial adenocarcinoma. CONCLUSIONS: EMPD is a rare intraephitelial non-squamous neoplasia, which represents less then 1% vulvar tumors. Predominantly it affects white women between 60 and 80 years of age. EMPD occurs in cutaneous areas bearing apocrine glands - vulva, perineum, perianal area, axilla, penis, scrotum and rarely region of tights or buttocks. It is characterized microscopically by the presence of specific tumor cells called Paget´s cells - atypical large cells with pale clear cytoplasm and large round nuclei. KEYWORDS: extramammary Paget´s disease, EMPD, Paget´s cells, vulvectomy, imiquimod 5%, photodynamic therapy, imunotherapy, radiotherapy.

Perceptual differences regarding health and environmental problems and their remedies in two states of the former Czechoslovakia.

In the framework of the Central European Study on Air pollution and Respiratory Health (CESAR), a risk perception and risk communication study was carried out in a total of 25 areas in Bulgaria, the Czech Republic, Hungary, Poland, Romania and the Slovak Republic. This paper is focused on the differences of perception between the Czech (CR) and the Slovak Republic (SR), and the other involved countries. The analysis is based on the data of a structured risk perception questionnaire survey of a random population sample. 6,043 completed questionnaires were collected from the total number of 14,400 distributed ones in 25 areas of the 6 countries. The risk perception was different in the CR and the SR, mainly concerning local environment and health of children in the CR and drug abuse including alcohol consumption and AIDS in the SR. In both countries environmental and health problems were seen as important, but the perceived responsibility for finding a solution was placed with different kinds of institutions.

[The assessment of the noise factor and the state of the auditory analyzer in workers in metal rolling production]. / Otsenka na shumoviia faktor i sustoianieto na slukhoviia analizator pri rabotnitsi ot prokatnoto proizvodstvo.

At main workplaces in F. "Stomana" (Pernik City) sorting and sheetrolling works, measurements and evaluation of the noise factor were carried out, and hearing sensitivity of workers was investigated in 229 subjects of mean age 36.1 +/- 9.8 years and mean occupational experience 9.7 +/- 7.4 years. Findings at workplaces indicated presence of noise of excessive equivalent levels and pulsing nature varying in degrees. Hearing thresholds for 4 and 6 kHz and average speaking frequency were elevated, and the proportion of subjects with hearing threshold above 30 dB for all frequencies tested was larger among the job groups of roller workers, furnace men, cutters, crane workers, markers, packers, quality control surveyors, and dispatchers as compared to subjects working at lower noise levels or exposed for shorter times to intense noise, notably, operators, fitters, welders, electrotechnicians. Regression analysis revealed the dynamics of change in hearing sensitivity to be more closely related to age than to duration of occupational experience.

Noise evaluation and estimation of some specific and non-specific health indicators in telephone operators.

Noise loading has a considerable effect on the working conditions of telephone operators. This study comprises noise field and laboratory measurements and field investigation of workers at three departments of the Telephone and Telegraph Communication Services in Sofia. Noise measurements revealed a background noise in the range of 57.4-70.6 dB A in the International Department, 70.6-71.7 dB A in the Intercity Department and 68.7-70.1 dB A in the Information Department and highest intensities of 63.5, 62.1 and 58.2 dB for frequencies of 0.5, 1 and 2 kHz. The registered noise (Leq) from the inner telephone receiver-microphone (type Star-set) was in the range of 78.4-86.6 dB A. Peaks of 90-96 dB A were registered during different working operations ("dialing", "speaking", "fax", "occupied") with duration less than 5s and stochastic appearance during the 15 min measuring periods. A total of 260 female telephone operators (mean age 36.7 +/- 8.22 years and mean length of employment 12.7 +/- 7.12 years) with similar job activities at the three departments were investigated. No marked decreased hearing sensitivity for 0.5, 1, 2, 4, 6 and 8 kHz was observed. A high percentage of the examinees gave positive answers in different questionnaires regarding subjective symptoms (psychological, neurovegetative, neurological), mental health, depression and anxiety. An elevated urine excretion of catecholamines (11-OCS, adrenalin and noradrenalin) was found during the morning and afternoon working shifts. The intensity of the noise and its annoying effect were subjectively estimated as "high" and "very high" by most of the examined telephone operators. In a large percentage of operators in the Intercity Department, the changes of the audiometric, psychological and biochemical examinations were more pronounced. The obtained results indicate that redesign of the work place should be undertaken in order to prevent health effects on the telephone operators.

[An estimation of the prevalence of risk factors for the cardiovascular system among female telephone operators]. / Otsenka na razprostranenieto na niakoi riskovi faktori za surdechno-sudovata sistema pri telefonistki.

The dissemination of the standard risk factors for the cardiovascular system--smoking, family history of hypertension and abnormal weight in telephone operators is evaluated by including one, two or three of these factors (p = 260). A high relative part is taken by persons in the presence of the evaluated factors--75.8%, as the most highly spread is the factor "smoking" (58.8%) and smoking and family predisposition (15.4"). In persons with high blood pressure the dissemination of one or two of the examined risk factors is nearly the same, with heightened presence of "smoking and abnormal weight". In spite of the lack correlation between the studied risk factors and the arterial blood pressure, their dissemination on a large scale as well as the specific character of the telephone operators work certify a heightened risk of diseases of the cardiovascular system and the necessity of special attention to these endangered people.

[Not Available]. / [Achievements by Soviet forensic psychiatry]

In the past 50 years, Soviet forensic psychiatry has directed its main endeavours towards solution of the problems of organization of forensic psychiatric expert examination, finding the most appropriate forms of handling law offenders--mental patients--as well as towards elucidation of the phenomenology of the morbid process under conditions of preliminary inquest, with prison, and finding with greatest precision the criteria for irresponsibility and incapacity in various diseases.