Kapronczay Károly szerk.: Orvostörténeti Közlemények 190-193. (Budapest, 2005)

KÖZLEMÉNYEK - COMMUNICATIONS - Paskalev, Dobrin - Kircheva, Anna B.: Bulgarian contributions to the development of medicine - Bolgár hozzájárulások az orvostudomány fejlődéséhez

activation and reducing reactive oxygen species (ROS) production, respectively. Thus, K exhibits an organ-protective effect in hypertension (16). According to Chilov, if indicated, unsalted diet can serve not only as amethod of treatment but also as mode of prevention: "Unsalted diet in hypertension retards and prevents the progression of disease; removes and reduces the heart events; prevents the development of brain complications; and finally, prevents the appearance of kidney damages, which are extremely unfavourable in the course of disease..." (p.H0)(9). Many years later, several research groups confirmed the relationship between dietary salt intake and left ventricular hypertrophy, which was independent of blood pressure. Notable is the fact that it is the sodium, not the chloride, which influences this pathological event. Dietary salt intake can exert trophic actions on the myocardium via the sympathetic nervous system, since the activity of this system is influenced by the sodium balance. In addition, the inadequate suppression of angiotensin II in response to high dietary salt intake in some hypertensive patients seems to aggravate left ventricular hypertrophy (17). On the other hand, salt retention with associated volume expansion plays a central role in the development of renal parenchymal hypertension (18). Thus, therapeutic modalities of salt restriction can be effective in such patients. The change of life style, including reduced salt intake, is the cornerstone in the modern non-pharmacological treatment of hypertension (19). Being a true scientist, Chilov warned about the harm of going to the other extreme limiting too much the salt intake: "Salt depletion in the organism might also lead to pathological state" (p.

95). He criticized the non-indicated application of a salt-free diet: "Many physicians relate the term "albuminuria" with "unsalted diet". But such thinking leads to additional suffering for the patient" (p.l04)(9). In this respect, Chilov pointed out:" Not all nephrites should be treated by means of unsalted diet... Such treatment can lead to complication due to salt deficiency (p.l05)(9). According to the author, unsupported salt-free diet is contraindicated in cases of nephrites without oedema and hypertension, because "restricted salt intake is accompanied by urea retention to some degree" (p.l06)(9). Contemporary dietetics recommends that water and salt regimen should be adjusted to each patient. It is well known that a very low salt intake can lead to volume depletion, hypotension, and further to reversible reduction in glomerular filtration rate (20). The author's own observations are given at the end of the book. A very interesting case of "severe hypochloremia" (i.e. hyponatremia) is described. The patient was comatose and the treatment with NaCl injections was without any effect. The patient died several days later and Chilov concluded that "the coma is irreversible and cannot be influenced by salt treatment" (p.l96)(9). At present, the cause of this phenomenon can be related to neurological disorder - the so-called "central pontine myelinolysis" (CPM). CPM usually evolves several days after correction of hyponatremia and is often fatal (21). In summary, we will add a few lines on the Bulgarian aspect of the history of salt: The war between the Bulgarian Kingdom and the Byzantine Empire (894) was mainly about the salt market. Salt was used to conserve the corpse of Tzar Kaloyan after his death and thus to preserve it during its transportation from Thessalonica (Byzantium) to the Bulgarian