bmj
About the journal| Current issue| Archive | Editorial board | CML | Contacts

Clinical practice -- difficulties in the diagnostics 2008

SUMMARIES 2008
REVIEWS more...
ORIGINAL ARTICLES more...
DIFFICULTIES IN THE DIAGNOSTICS more...

2/2008
PNEUMOPERITONEUM IN UROLOGICAL LAPAROSCOPIC PROCEDURES
Tzv. Genadiev, D. Gaydarov and V. Veleva


Clinic of Urology, University Hospital “Lozenets” – Sofia

Summary: Laparoscopy is a widely used minimally invasive method for therapy of several diseases. The method is based on gas insufflations by the Veress needle or by incision of the peritoneum – the Hasson method. Our goal was to analyze the laparoscopic procedures according to the pneumoperitoneum access. Between 2003-2007, here were made 52 urological procedures with 75% (n=13) Veress and 25% (n=39) Hasson access. Complication in Veress access was retroperitoneal emphysema, whereas in Hasson access, there was one injury of the ileum. Time of insufflation in Veress access – 5 to 10 minutes and in Hasson access is 10 minutes. We concluded that the duration of insufflation in Veress and Hasson method is almost the same or a little bit shorter in Veress. The Hasson access is suitable in the beginning on learning curve.

Key words: laparoscopy, urology, pneumoperitoneum

Address for a correspondence:
Tzvetin Genadiev, MD, Clinic of Urology, University Hospital “Lozenetz”, Bg –1407 Sofia, 1 Kozjak str.,
tel. +35929607669, e-mail: genadievi@abv.bg
RARE FORMS OF MALE INFERTILITY – GENETICALLY DETERMINED AZOOSPERMIA
V. Ivanov¹, S. Pashkunova¹, V. Kamenova1 and L. Mitev²


1Clinic of Endocrinology, Military Medical Academy
2Clinical Laboratory – Department of Cytogenetic, Military Medical Academy

Summary: AZF deletions are genomic deletions in the euchromatic part of the long arm of the human Y chromosome (Yq11) аssociated with azoospermia or severe oligozoospermia. Consequently, it can be assumed that these deletions remove Y chromosomal genes required for spermatogenesis. However, these ‘classical’ or ‘complete’ AZF deletions, AZFa, AZFb and AZFc, represent only a subset of rearrangements in Yq11. With the benefit of the Y chromosome sequence, more rearrangements (deletions, duplications, inversions) inside and outside the classical AZF deletion intervals have been elucidated and intra-chromosomal non-allelic homologous recombination (NAHRs) of repetitive sequence blocks have been identified as their major cause. These include duplications in AZFa, AZFb and AZFc and the partial AZFb and AZFc deletions, some of which were summarized under the pseudonym ‘gr/gr’ deletions. At least some of these rearrangements are associated with distinct Y chromosomal haplogroups and are present with similar frequencies in fertile and infertile men. This suggests a functional redundancy of the AZFb/AZFc multi-copy genes. Alternatively, the functional contribution(s) of these genes to human spermatogenesis might be different in men of different Y haplogroups. That raises the question whether, the frequency of Y haplogroups with different AZF gene contents in distinct human populations leads to a male fertility status that varies between populations or whether, the presence of the multiple Y haplogroups implies a balancing selection via genomic deletion/amplification mechanisms.

Key words: AZF deletions, amplifications in Yq11/Y chromosomal haplogroups and branches; Y sequence polymorphisms, AZF genetic redundancy/AZF gene content,  male fertility status

Address for correspondence:
V. Ivanov, MD, Clinic of Endocrinology, Military Medical Academy, 1 Sv. G. Sofiiski str., Bg – 1431 Sofia
3/2008

A CASE OF RETROPERITONEAL FIBROSIS
A. Balanova

Department of Propedeutics of Internal Diseases, Medical University – Sofia

Summary: Retroperitoneal fibrosis is a rare disease, whose etiology often remains obscure in most of the cases. It is characterised by the proliferation of fibrotic tissue and/or chronic inflammatory infiltrates in the retroperitoneal region. Fibrosis encompasses the aorta, iliac vessels and urethers. In two thirds of the cases, the disease is idiopathic and in the rest it is a result of other conditions such as neoplasms in the retroperitoneal space, small pelvis surgical interventions, hemorrhages, radio-or chemotherapy, tuberculosis, actinomycosis, systematic diseases, the intake of some medicaments, the presence of a foreign body. This condition is rare – 1:200 000. Men are more prevalently affected. No racial differences are encountered. Here we present a challenging for the therapist case of a woman with many predisposing factors for retroperitoneal fibrosis.

Key words: retroperitoneum, fibrosis, space, corticosteroids

Address for correspondence:
Anna Balanova, Assoc. Prof., MD, Department of propedeutics of internal diseases,
Medical University, 1 Sv. G. Sofiyski str., Bg-1431 Sofia, tel.: 92-30-604/470

A RARE CLINICAL CASE OF PELVIC CARCINOMA WITH SQUAMOUS CELL DIFFERENTIATION IN A DYSTOPIC KIDNEY
V. Belovezhdov1, S. Zdravchev2, Dm. Staykov1, G. Ivanov1, Y. Delchev2 and A. Dimitrov2

1Department of General and Clinical Pathology
2Department of Urology
Medical University – Plovdiv

Summary: Primary neoplasms of the renal pelvis are only 7% of all kidney tumors and these with squamous cell differentiation are even more rare. To our best knowledge, such casuistry – rare pelvic tumor variant – carcinoma with squamous cell differentiation in dystopic kidney has not been derscibed in Bulgarian medical literaturе. Its clinico-pathological features, methods for diagnosis and therapy solutions are discussed. 

Key words: renal pelvis, carcinoma, squamous cell differentiation

Address for correspondence:
V. Belovezhdov, MD, Department of General and Clinical Pathology,
Medical University, 15A V. Aprilov str., Bg-4002, Plovdiv, tel.: 032/602 440, e-mail: vesbel@abv.bg

4/2008

A CASE OF GONADAL DYSGENESIA ACCOMPANIED BY HYPOPHYSEAL DISORDERS (A NEW SYNDROME?)
I. Krestev, A. Balanova, R. Cherneva, B. Milev and R. Anastasova


Department of Propedeutics of Internal Diseases, Medical University – Sofia

Summary: Here we present a case of gonadal dysgenesia, which is very similar clinically to the Turner syndrome, but is with normal genotype and is accompanied by hypophyseal disorders that include the growth- and gonadotropin hormone secretion. The secretion of both the adenocorticotropin and thyroid stimulatory hormone is preserved. The patient is twenty-one-year-old and is with growth retardation, incomplete skeletal development, bone anomalies, undeveloped ovaries and uterus. She is blind, with short vagina, and lack of axillary and pubic hair. The magnetic resonance shows structural anomalies in the hypophysis.
A detailed literature review is given.

Key words: gonadal dysgesia, hypophyseal disorders, magnetic resonance

Address for correspondence:
Ivan Krestev, MD, Department of Propedeutics of Internal Diseases, Medical University,
1 G. Sofiyski, Str., Bg-1431 Sofia, GSM: 0888/514777, e-mail: Thyroidites_ivan@yahoo.com

TWO CASES OF PULMONARY ECHINOCOCCUS DIAGNOSED IN SPUTUM AFTER CYST PERFORATION
I. Krestev1, A. Balanova1, R. Cherneva1 and S. Dobrev2


1Department of Propedeutics of Internal Diseases
2Department of Clinical Laboratory

Summary: The incidence of the pulmonary form of echinococcosis is recently growing. The poor social conditions and the increasing number of homeless, veterinary uncontrolled dogs are considered the major reasons. The most commonly affected part of the population are young children without developed hygienic habits. The disease is treatable but there are often relapses even after surgical intervention. Both cases presented here were diagnosed in sputum after perforation of the hydatid cyst. The cases are diagnosed during hospitalization and were previously not detected by general practitioner. This publication aims at calling the doctors’ attention to the increasing incidence of echinococcosis among the population.

Key words: echinococcus, echinococcal cyst

Address for correspondence:
Ivan Krestev, MD, Department of Propedeutics of Internal Diseases,
1 G. Sofiyski, Str., Bg-1431 Sofia, GSM: 0888/514777, e-mail: thyroidites_ivan@yahoo.com


MORE JOURNALS: Medical Reveiw | General medicine | Cardiovascular diseases | Scripta periodica | Acta Medica Bulgarica
Copyright © 2007-2009 Medical University -- Sofia/Central Medical Library