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Clinical practice -- difficulties in the diagnostics 2009

SUMMARIES 2009
REVIEWS more...
ORIGINAL ARTICLES more...
DIFFICULTIES IN THE DIAGNOSTICS more...

1/2009
RETROPERITONEAL CYSTIC HAMARTOMA – A CASE REPORT AND LITERATURE REVIEW
V. Tasev1, D. Bulanov1, A. Gegova2, L. Popov2 and A. Taseva3

1Clinic of General and Hepatobiliary Surgery, University Hospital “Alexandrovska” – Sofia
2Department of Clinical Pathology, University Hospital “Alexandrovska” – Sofia
3Medical Faculty, Medical University – Sofia

Summary: Retroperitoneal cystic hamartoma is a rare congenital cystic lesion arising from the remnants of the embryonic tailgut gut. It occurs exclusively within the retrorectal space, rarely in the retrovesical area and extremely rare in the perirenal area. These lesions present in a vague manner and so mimic the presentation of more common mass lesions in the pelvic region. They most frequently afflict middle-aged women, causing vague pelvic pains and discomfort during defaecation or sitting. We describe an unusual case of retroperitoneal cystic hamartoma developed in the retrorectal and perirenal space in a 20-year-old man. A computed tomography scan, ultrasonography, intravenous urography and pathology reports are included in the study, and findings at operations are discussed.

Key words: retroperitoneal hamartoma, retrorectal cystic hamartoma, tailgut cyst

Address for correspondence:
Assoc. Prof. Vladimir Tasev, MD, Clinic of General, Hepatobiliary and Pancreatic surgery,
University Hospital “Alexandrovska”, 1 “G. Sofiyski” str., Bg-1431 Sofia, tel. 9230262, e-mail: vntasev@abv.bg
A CASE OF REZIDIVATION OF HYPERTHYROIDISM AND HYPERCORTICISM IN MEN SYNDROME – FAVORABLE EFFECT OF SOMATOSTATIN
A. Balanova1, I. Krestev1 and P. Genov2

1Department of Propedeutics of Internal Diseases, Medical University – Sofia
2Department of Medical Imaging, UMBAL “Alexandrovska”

Summary: We describe a case with rezidivation of hypercorticism and hyperthyroidism after bilateral adrenalectomy and subtotal thyroidectomy. A very good curative effect was achieved with the application of somatostatin.

Key words: MEN syndrome, case record

Adress for correspondence:
Ivan Krestev, MD, Department of Propedeutics of Internal Diseases,
Medical University, 1 Sv. G. Sofiyski str., Bg-1431 Sofia, mobile 0888514777
A CASE OF PANCYTOPENIA WITH UNCLEAR ETIOLOGY
K. Plochev¹, I. Dikov¹, G. Popov¹, D. Dimitrova¹, I. Gigov², V. Коvaleva4, L. Andonova³ and T. Cherveniakova³


¹Clinic of Infectious, Parasitic and Tropical Diseases, Military Medical Academy – Sofia
²Clinic of Hematology and Oncology, Military Medical Academy – Sofia
³Chair of Infectious and Tropical Diseases, Medical University – Sofia
4Center of Military Epidemiology and Hygiene, Military Medical Academy – Sofia

Summary: A case of a 47-year-old man who probably had contact with ticks and developed severe toxoinfectious syndrome, and moderate hemorrhagic syndrome with еpistaxis, cutaneous and mucosal petechiae and small hemorrhagic spots is described. Agiants the background of clinical improvement, severe pancytopenia was marked: аnemia – hemoglobin 46 G/l, hematocrit 0,22; leucopenia – leuca 0,8.10 G/l, neutropenia; thrombopenia – platelets 2.10 G/l, Westergreen 135 mm, which persisted more than 60 days, in spite of intensive therapy with infusions of erythrocytes, thrombocytes, neupogen, calcium foline, methylprednisolone, antibiotics and diflucan. Positive serology for R. Burnetti was established in dynamics. All serological tests for other agents were negative (except transitive presence of anti CCHF antibodies, but there were no clinical symptoms for Crimean- Congo hemorrhagic fever. Eventuality of Q-fever with affect of hemopoiesis was discussed.

Key words: aplastic anemia, pancytopenia, hemorrhagic syndrome, Q-fever, Crimean-Congo hemorrhagic fever


Address for correspondence:
Assoc. Prof. K. Plochev, MD, Military Medical Academy, 3 Sv. G. Sofiyski str., Bg-1431 Sofia, tel. 92-253-36, е-mail: plochev@mail.bg
2/2009

RETINITIS PIGMENTOSA WITHOUT PIGMENT
K. Koev, R. Georgiev and I. Kamenov
Clinic of Ophthalmology, University “Aleksandrovska” Hospital – Sofia
Summary: Retinitis pigmentosa without pigment is a variant of retinitis pigmentosa which is a hereditary disorder. It is characterized by decreased visual acuity, night blindness and contraction of visual field in both eyes. A 26-year-old male patient was with a decreased visual acuity and night blindness. The visual acuity was 0,02 of both eyes. The disorder was diagnosed as retinitis pigmentosa without pigment by clinical symptoms and signs, ophthalmoscopic findings, fluorescein angiography and electro­re­ti­no­gram. Authors report a case of retinitis pigmentosa without pigment and a brief review of literature.

Key words: computed perimetry, fluorescein angiography, retinitis pigmentosa sine pigmento, ERG

Address for correspondence: Krassimir Koev, MD, Clinic of Ophthalmology, UMBAL “Aleksnadrovska”,
1 Sv. G. Sofiyski Str., Bg 1431 Sofia, tel. +3592 8365504

4/2008

FAHR’S SYNDROME IN SECONDARY HYPOPARATHYROIDISM DUE TO THYROID SURGERY – A CASE REPORT
Zh. Boneva1 , P. Yovchevski2, К. Tsalovski3, K. Kostov2, Y. Assyov4, S. Yordanova4, V. Evtimova4 and V. Marinov4
1Department of Endocrinology
2Department of Nephrology
3Department of Neurology – Medical Institute – Ministry of Interior – Sofia
4Medical University – Sofia
Summary:
Fahr’s syndrome is a rare neurodegenerative disease, characterized by bilateral symmetrical deposition of calcium in basal ganglia, thalamus, dentate nucleus and centrum semiovale. Fahr’s syndrome can originate from more than 30 medical conditions including some infections, genetic disorders and parathyroid dysfunction, and may lead to neurological, psychiatric and cognitive abnormalities. We report a case of Fahr’s syndrome that presented with dementia аnd cognitive impairment. The patient was a 66-year-old woman who had been operated for nodular goiter 10 years ago. We detected abnormalities in the calcium metabolism and believe that they are due to postoperative hypoparathyroidism which led to Fahr’s syndrome. Early treatment of hypoparathyroidism with supplementation of calcium and vitamin D can prevent calcifications and eventual neurophysiological disorders.
Key words: Fahr’s syndrome, hypoparathyroidism, basal ganglia calcifications
Address for correspondence: Jivka Boneva, M. D., Department of Endocrinology, Medical Institute - Ministry of Interior, 79, Gen. Stoletov Blvd., Bg – 1606 Sofia, tel. +359 2 9821351, fax: +359 2 981 45 94, e-mail: zhbonevaa@abv.bg

MALIGNANT CARCINOID SYNDROME – A CASE REPORT AND REVIEW OF LITERATURE
V. Tasev1, K. Dimitrov1, D. Bulanov1 and A. Taseva2
1Clinic of General and hepatobiliary surgery, University Hospital “Alexandrovska” – Sofia
2Medical Faculty, Medical University – Sofia
Summary:
Carcinoid tumors are rare, slow-growing tumors of diffuse endocrine system of humans. They represent about 2% of all tumors of the gastrointestinal tract, and are most often localized in different parts of the small intestine and appendix, but may be found in the lungs, ovaries and others. Although generally less aggressive than adenocarcinomas of the gastrointestinal tract, they are often malignant with metastatic potential in the liver. The clinical presentation of the disease is unspecific or there are no subjective complaints. In about 10% of patients, the tumors secrete bioactive mediators which may lead to manifestations of so-called carcinoid syndrome. We report a case of small bowel carcinoid with multiple liver metastases in a 59-year-old female patient. Presented are the findings from computed tomography and surgical treatment and a diagnostic and treatment algorithm.
Key words: carcinoid, carcinoid tumors, carcinoid syndrome, surgical treatment
Address for correspondence: Assoc. Prof. Vladimir Tasev, MD, PhD, Clinic of General, Hepatobiliary and Pancreatic Surgery, University Hospital “Alexandrovska”, 1 “G. Sofiiski” blvd., Bg – 1431 Sofia, tel. +359 2 9230262, e-mail: vntasev@abv.bg

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