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The longitudinal study encloses 53 patients with PSS followed up for a period of 6 years. The most frequent changes in the parameters of pulmonary function are: diffusing capacity impairment--reduction in DICO (86.8% of the patients), restrictive lung disease pattern (50.9% of the patients) and arterial hypoxemia (43.4% of the patients). The duration of PSS and the follow up period do not cause significant changes in the pulmonary function parameters and the arterial blood-gas analysis in the group of patients studied.

Nineteen patients with active SLE and a control group of 20 healthy persons were investigated. We have made to all of them 99mTcDTPA-aerosol scintigraphy and the following pulmonary functional tests--Dc CO, Dm, Vc, HRCT. Accelerated clearance of 99mTcDTPA was found in all patients with active SLE. The half-elimination time T1/2 was shortened and varied between 22.6 +/- 4.7 min for the right one. It wasn't established correlative dependence between 99mTcDTPA and the pulmonary functional tests. In 36.8% of the patients HRCT was normal, while 99mTcDTPA clearance was accelerated. This fact shows, that 99mTcDTPA-aerozsol scintigraphy is more sensitive method for early diagnosis of pulmonary changes, than the pulmonary functional tests and HRCT.

Two clinical cases of women with primary hyperaldosteronism are reported. The patients presented with arterial hypertension, muscular weakness and paresthesia. Severe hypokalemia was found which was resistant to intravenous infusions of potassium but was successfully treated with low daily doses (100-200 mg) of spironolacton, an aldacton antagonist, in the course of 3-4 days. In one of the patients the primary hyperaldosteronism was related to aldosterone secretion by the cells of a malignant corticosteroma, proved histologically. A successful operation led to full recovery of the patient. In the other patient there was an idiopathic form of primary hyper aldosteronism caused by bilateral hyperplasia of the suprarenal cortex. Contemporary diagnostic and therapeutic possibilities in primary hyperaldosteronism as well as the importance of the examination of potassium serum level and kaliuria in the patients with arterial hypertension for the timely and successful diagnosis and treatment of primary hyperaldosteronism are pointed out.

In 24 patients with progressive systemic scleroderma the respiratory disturbances, X-ray, scintigraphic and clinical deviations as well as the statistical correlations between them are described. The functional examination of respiration revealed lowered diffusion capacity, restrictive type of ventilatory failure and hypoxemia as the most frequent disturbances. The functional examination of respiration is correlated with the X-ray changes in the lungs in these patients.

172 patients with systemic lupus erythematodes (SLE), mean age 35, 4 years and mean duration of the disease 5,9 years, were followed up with the aim to study the evolution of the disease in the Bulgarian population. After 44 months of observation the patients are classified in 3 groups: A. Subclinical SLE--32 patients, B--classical SLE without unfavourable prognosis and signs--62 patients, C. SLE with a heavy course and poor prognosis--78 patients. The three groups are compared according to: mean age of the onset of the disease, mean duration of the disease up to the time of the study, mean duration up to the appearance of poor prognostic signs, number and types of the complications in the three groups up to the time of the study, number of deaths. The patients with unfavourable prognosis are with an earlier onset of the disease compared with the other patients (p less than 0.001), rapid development of severe prognostic signs in relation to the mean duration of the disease in the three groups (p less than 0.001), frequent and severe complications. 25 patients from the group with a severe course have died. The patients with a favourable course of the disease from groups A and B are with a later onset of the disease, longer duration, do not develop severe prognostic signs, the complications are mild and rare and there are no deaths.

Sixty six females and 124 males were studied that were regular blood donors at the first, second, third, fifth, tenth, 20 th, 30 th, 40 th, 50 th blood donation, transversally. The level of hemoglobin, hematocrit, erythrocyte number were subjected to light fluctuations during the follow-up period, being essentially reduced towards the end of the study. Most dynamic changes were observed in erythrocyte iron, significantly growing after the second-third blood donation in males and after the fifth - in females, whereafter it was reduced under the initial level, that reduction persisting till the end of the follow-up period among the males. The percentage of saturation of hemoglobin with iron was respectively changed as well as the level of erythrocyte iron in litre blood, in litre erythrocytes, the absolute iron content in erythrocyte, and the index characterizing erythropoiesis activity (ICEA).

The incidence of HBsAg, anti-HBs, HBeAg and anti-HBe was studied in blood donor via various methods. HBsAg was established in 0.9 to 1.2% on the average among the blood donors paid; in 1.4 to 3.9% among the unpaid ones and 4.7 to 5.1% among the blood donors from organized population groups. Anti-HBs was established in 14.2%, HBeAg in 13.6% and anti-HBe in 38.2% from the HBsAg positive. With the comparative juxtaposition in the post-transfusion hepatitis (PTH) among the patients admitted to hospital for viral hepatitis a tendency was established to reduction from 0.9% for the period before the testing of the blood donors for HBsAg, 7.5% for the period tested by immunoelectrophoresis (IEP), and 4.5% for the period tested by reversal passive hemagglutination (RPHA). Patients HBsAg-positive were established by IEP in 39.2% on the average and by RPHA in 48.6%. A relative increase is reported of non-B PTH, non-A, non-B PTH in particular, with the introduction of more sensitive methods for investigations of blood donors for hepatitis B markers.

The esophageal atrial cardiac stimulation was applied to 93 patients divided into 4 groups: patients with typical, probable and atypical angina pectoris and clinically healthy controls. The tests positive for ischemic heart disease are classified into 3 classes according to the duration of ECG ischemic changes: I class--the ischemic changes are registered during the time of the test only; II class--the changes are seen in the first ECS complexes after the stimulation and III class--the changes persist after the second minute following the esophageal atrial stimulation. The test was worked out to diagnostic criteria in 92.5% of the cases and is undoubtedly positive in 77.5% of the patients with typical and probable stenocardia and in 36.6% of the patients with atypical precordial pain. Most important for the diagnosis of ischemic heart disease are: the early occurrence of ST-depression before the submaximal pulse rate is reached, registration of II and III degree of ST-depression and the appearance of chest pain during the time of the test. The esophageal atrial stimulation is a valuable method for the diagnosis of ischemic heart disease and it is surprisingly easy to perform. The method is harmless and can be applied to patients to whom the physical exercise test cannot be applied.

146 patients with systemic lupus erythematodes were followed up. The patients are classified into two groups: I group--includes 74 patients treated during the 1953-1980. II group--of 72 patients treated during the period 1980-1987. Of the 74 patients of the I group 38 (51%) are still alive and 38 patients (49%) have died. From the II group 67 (93%) are alive and only 5 patients (7%) have died. 56% of the deceased patients died during the first 5 years. The following 5 years the death rate is twice as small--II dead patients (27%). Only 3 patients survived more than 15 years. The leading causes of death are: lupus nephropathy--18 patients (44%), cardiovascular lesions--12 patients (30%), neurologic complications and lately--infectious complications. A correlation between age and evolution of the disease is found: in younger age the evolution is more rapid. The analysis of the treatment of the patients from the II group reveals that the longer survival is due to the correct application of antimalarial drugs, cortisone drugs, imuran, pylse therapy with cortisone or a combination of these drugs.

A case of a patient with mitral valvular disease with a mitral valve prosthesis type Björk-Shilley of two year duration is reported. The patient was admitted to the intensive care cardiac unit in grave condition--shock and left cardiac failure. The patient died after 14 hours in spine of the efforts to over come the cardiogenic shock. The post mortem examination revealed a broken prosthesis and lack of one of the cusps which was found in the abdominal section of the aorta 10 cm above the bifurcation.