Clinical practice: Vol.11, 2017

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Clinical practice

Vol 11, 1/2017

Vol 11, 2/2017

Vol 11, 3/2017

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Phthisiatry

Evolution of the tuberculosis process in twins in early childhood under the conditions of a profuse everyday contact  - Bulgarian medical journal (Български медицински журнал), 11, 2017, №2, 45-50.
Е. Georgieva

University Pediatric Clinic of Pulmonary Diseases, MHATPD “Sveta Sofia”; Medical University - Sofia
Abstract. Bulgaria and Hong Kong fi rst in the world introduced in 1951 specifi c immunization with oral BCG vaccine and create objective conditions for limiting the spread of tuberculosis. After decades of successfully combating this specifi c illness becomes again a problem for the society. The existence of hidden prevalence among adults with late diagnosis and inconsistently performed treatment creates conditions for the involvement of more and more children in infancy. The infancy is the period of diminished natural and yet lack of specifi c immunity and also time of closed contact with family members. This makes the transmission of the infection and the sensitization of the body available followed by lymph-haematogenous distraction. We present twins with different forms of tuberculosis under the age of one: severe paratracheal lymphadenitis and hematogenous – disseminated tuberculosis. The age and the degree of the involvement made the diagnosis and treatment a long and diffi cult process.
Key words: tuberculosis, infants, hematogenous – disseminated tuberculosis, bronchadenitis
Address for correspondence: Еlena Georgieva, MD, University Pediatric Clinic of Pulmonary Diseases, MHATPD “Sveta Sofia”, 19 Akad. Iv. E. Geshov bvl., Bg  1606 Sofi a, e-mail: goell@abv.bg




arrow Vol.11, 1/2017

Gastroenterology

Syndrome of inappropriate antidiuretic hormone in a case of small cell lung cancer - Bulgarian medical journal (Български медицински журнал), 11, 2017, №1, 61-64.
B. Teneva

Gastroenterology Department, Second Clinic for Internal Diseases, MHAT Acibadem City Clinic
Tokuda Hospital – Sofia
Abstract. Syndrome of inappropriate antidiuretic hormone (SIADH) is considered to be the most common cause ofeuvolemic hyponatremia. Small cell lung cancer is the most common malignant disease that is responsible for SIADH. We present a 70-year old male patient admitted toGastroenterology Departmentwith signs of dysphagia, nausea, asthenia and weight loss in the last month. Two days after hospitalization he became confused, disorientated and presented with dysarthria. Laboratory tests showed severe hyponatriemia, hypochloremia, normal plasma and urine osmolality in the context of SIADH. After several examinations we found small cell lung cancer which is the cause of this syndrome. Water restrictions and increased consumption of salt had good effect on hyponatremiaand the patient was referred to oncologist. The case shows that hyponatremia as part of SIADH precedes the clinical manifestation of lung cancer. It should be managed adequately because of the risk of severe neurological complications and death.
Key words: syndrome of inappropriate antidiuretic hormone, hyponatriemia, lung cancer
Address for correspondence: B. Teneva, MD, Gastroenterology Department, Second Clinic for Internal Diseases, MHAT Acibadem City Clinic Tokuda Hospital, 51B Nikola Vaptsarov Buld, Bg - 1407 Sofia

Atypical case of familial mediterranean fever with initial clinical suspicion of Crohn’s disease - Bulgarian medical journal (Български медицински журнал), 11, 2017, №1, 65-67.
B. Teneva and R. Tsonev

Gastroenterology Department, Second Clinic for Internal Diseases,
MHAT Acibadem City Clinic Tokuda Hospital – Sofia

Abstract. Familial Mediterranean fever (FMF) is a geneticautoinflammatory disease characterized by recurrentfever associated with pain in the abdomen,the chest or in the joints. We present a clinical case of 20-year old Bulgarian woman with history of selflimited attacks of abdominal pain, nausea and sometimes fever in the last two years. After being hospitalized inthegastroenterolo gydepartmentthe imaging (abdominal ultrasound and CT) and endoscopy methods did not prove the presence of Crohn’s disease as it was initially suspected.Because of the clinical course of the disease a molecular genetic test was performed in the patient anda heterozygous variant of MEFV gene was found. After starting therapy with Colchicinethe number of the attacks reducedwhich proved the diagnosis of FMF. Conclusion: The differential diagnosis of abdominal pain with fever in young patients should include notonly Crohn’s disease but also FMF.
Key words: Familial Mediterranean fever, abdominal pain, Crohn’s disease
Address for correspondence: B. Teneva, MD, Gastroenterology Department, Second Clinic for Internal Diseases, MHAT Acibadem City Clinic Tokuda Hospital, 51B Nikola Vaptsarov Buld, Bg - 1407 Sofia

Last update: 29.11.2017

 

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