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

Clinical practice -- difficulties in the diagnostics 2013

ARCHIVE

1/2013

HYPOPITUITARISM DUE TO PITUITARY STALK AGENESIS – A REVIEW OF THE LITERATURE AND A CASE REPORT
V. Grozeva and M. Boyanov
Endocrinology Clinic, University Hospital Aleksandrovska
Department Internal Medicine, Faculty of Medicine, Medical University – Sofia


Summary: The pituitary stalk agenesis is a rare disorder, characterized by total insufficiency of anterior pituitary hormones. We describe a case of a woman with hypogonadotropic hypogonadism and primary hypothyroidism, diagnosed at the age of 15 because of lacking puberty. The imaging revealed pituitary stalk agenesis. In addition, secondary hypocorticism was proven. Moreover, data collected pointed at partial secondary hypothyroidism and hyposomatotropism. We comment on the lack of hyperprolactinemia and diabetes insipidus. The timely diagnosis and treatment of multiple pituitary hormone deficiencies are of vital importance for the growth and development. The patients with untreated hypopituitarism have elevated mortality rates due to cardiovascular and cerebrovascular events.

Key words: pituitary stalk, panhypopituitarism, agenesis

ACUTE RADIATION ESOPHAGITIS- A COMPLICATION IN PATIENTS WITH THORACIC MALIGNANCIES UNDERGOING RADIOTHERAPY
(Diagnosis and therapeutic problems with presentation of a clinical case)

P. Karagyozov, C. Minchev, R. Lazarov, G. Kirova and S. Stoynov
Tokuda Hospital Sofia

Summary: Radiation esophagitis is the most important dose-limiting acute toxicity during radiotherapy for thoracic malignancies.These toxicities can limit the maximum dose of radiation therapy (RT) and chemotherapy, and, thus, may limit the efficacy of treatment. The combination with chemotherapy increases the risk of developing an acute esophageal injury. The first symptoms of radiation esophagitis are dysphagia and odynophagia. They are seen usually 2-3 weeks after beginning of the therapy. The majority of patients do not develop severe complications and the symptoms resolve spontaneously for few weeks. Some of them, however, may develop severe esophagitis with complications, such as ulcers, stenosis, fistula, spontaneous esophageal perforation, severe bleeding. Histologically, acute radiation esophagitis is primarily due to effects on the basal epithelial layer. This causes a thinning of the mucosa, which can progress to denudation. The diagnosis is done by X-ray or better upper gastrointestinal endoscopy. Endoscopically, mucositis and ulceration may be observed. We present a clinical case with acute radiation esophagitis after definitive radiotherapy for pulmonary cancer and the evolution of the complications from acute inflammation and ulcers developed immediately after RT to aerodigestive fistula. We used PEG for enteral feeding in the acute phase with severe dysphagia and odynophagia and semicovered metal stent for treating the tracheoesophageal fistula. Three months after the complete closure of the fistula we removed the PEG-tube and the patient did not have any esophageal complains 6 months later. This is a typical case of acute esophageal injury after definitive RT. The dynamic endoscopic control is an important tool in order to diagnose the changes in the pathological findings and to choose the best treatment modality.

Key words: acute radiation esophagitis, definitive radiotherapy, lung cancer, complications, upper gastrointestinal endoscopy

MULTIDISCIPLINARY APPROACH TOWARDS PAIN AROUND THE RIGHT EYE --A CASE REPORT
K. Trifonova1, A. Stefanov2, K. Slaveykov1, Zl. Trifonov1 and L. Despotova-Toleva3
1Deparment of Ophthalmology and General Medicine, Trakia University Stara Zagora
2Department of Dermatology and Otorhinolaryngology, Trakia University Stara Zagora
3Department of General Medicine, Medical University – Plovdiv


Summary: A multidisciplinary approach is required during diagnosis of a patient with a headache, in which general practitioners, neurologists, neurosurgeons, psychiatrists, ophthalmologists, otorhinolaryngologists (ENT specialists) and dentists are involved. This paper aimed at building a differential diagnosis for a patient with pain in the right eye area. Clinical case report: A patient with pain in the area of the right eye was hospitalized in the department of ophthalmology because of borderline levels of intraocular pressure. After the consultations with neurologist and ENT specialist, a cyst in the maxillary sinus was found. The patient was referred to surgical treatment in the ENT department. Differential diagnosis for pain in the head is very complicated. Here comes the role of general practitioners in correctly referring the patients to the right specialists.

Key words: intraocular pressure, maxillary sinus, differential diagnosis

RESPIRATORY SYMPTOMS IN CHILDREN WITH GASTROESOPHAGEAL REFLUX DISEASE
M. Burlea, V. Lupu, G. Paduraru, Sm. Diaconescu and A. Ignat
Pediatrics Department, University of Medicine and Pharmacy „Gr. T. Popa”, Iasi, Romania

Summary: The Gastroesophageal Reflux Disease (GERD) is a frequent entity in pediatrics, which is still under-diagnosed (“the disease of the third millennium”). The polymorphic clinical symptoms are dominated not only by post-feeding vomiting, but in many cases also by respiratory symptoms (from night cough to apnea episodes, recurrent wheezing, aspiration pneumonia and even sudden death syndrome). The GERD therapy consists in: general measures, pharmacological and/or surgical therapy. The original drugs (prokinetic agents) have been replaced lately by the proton-pump inhibitors (PPIs), as these are considered medication able to generate the disappearance of the reflux symptoms in most cases. When GERD is associated with respiratory manifestations, the PPIs therapy is controversial. Therefore, the specialized literature is to be reviewed in order to highlight such cases of this complex disease.

Key words: gastroesophageal reflux, respiratory manifestations, child

2/2013
THE ADVANTAGE OF GENOME SCANNING FOR DIAGNOSIS IN PATIENTS WITH MULTIPLE MYELOMA
T. Boneva1 аnd E. Nacheva2
1Cytogenetics Laboratory, Military Medical Academy – Sofia
2Molecular Cytogenetics Laboratory, UCL Medical School, Royal Free Campus – London


Summary: Multiple myeloma (MM) is characterized by neoplastic transformation of mature B cells in the bone marrow. It is heterogeneous disease at both the clinical and genetic levels. Recent advances in molecular genetics and genomic studies have demonstrated that the disease evolution is associated with specific genetic aberrations, which not only shed light on the pathogenesis of MM but allows risk assessment and treatment monitoring. Here we present 2 patients investigated by FISH and whole genome screening aiming to devise a diagnostic algorithm to offer a comprehensive genomic profiling of MM.

Key words: multiple myeloma, chromosome aberrations, genome profiling
3/2013

A SUCCESSFUL ONE-ACT BILATERAL POLYLOBULAR  LUNG RESECTION IN CONGENITAL BILATERAL ABSCESSED BRONCHIEСTASES BY ONGITUDINAL STERNOTOMY
P. M. Chervenyakov, P. А. Chervenyakov and А. М. Chervenyakov
Department of Surgery, Multiprofile Hospital for Active Treatment " Serdica"

Summary: We report the clinical case of a 36-year-old patient with the diagnosis of bilateral abscessed bronchiectases localized in the two lower right lobes and the lower lobe in the left. Anamnesis was taken and biochemical tests were performed. After a 10-day antibiotic premedication the patient underwent surgery. The used surgical technique is presented. The decision for the one-act bilateral sanitation of lungs was dictated by the severe abscessed bronchiectases that, in our judgment, required more active surgical treatment. Otherwise, if only sanitation of a single lung was performed, inflammatory process would exacerbate and could lead to either atelectasis following aspiration of ineffective discharge of sputum, which can be purulent or dense, or a recurrent infection of the bronchial stump, with insufficiency and the occurrence of empyema. The general postoperative status of the patient confirmed the adequacy of our behavior of surgical treatment and the volume of surgery. This patient is followed-up for more than 10 years yet and is in an excellent state, with effective work performance. The biochemical blood markers are within normal range and his functional parameters are also within the norm.

Key words: congenital abscessed bronchiectases bilaterally, surgical treatment, bilateral polylobular resection, longitudinal sternotomy
Address for correspondence: P. Chervenyakov, Surgical Ward, MHAT „Serdika“, 6 „Damiyan Gruev“, str., 1303 Sofia

A CASE OF TUBERCULOUS MENINGOENCEPHALITIS IN A CHILD AFTER THE SURGERY FOR LUNG "TUMOUR"
Sv. Velizarova and A. Spasova
University Paediatric Clinic of Pulmonary Diseases
Specialized Hospital for Active Treatment of Pulmonary Diseases "Sv. Sofia" ― Sofia


Summary: We present the casuistic case of a child operated for lung “tumour”. Histological result shows tuberculosis. Ten days after the surgery and after histological confirmation of tuberculous granuloma with caseous necrosis, clinical signs of meningoradicular irritation began and laboratory evidence of tuberculous meningoencephalitis was found. The review of literature found no other case of tuberculous meningoencephalitis as a complication after surgery for “tumor” formation in the lung, that later was proved to be tuberculosis. We demonstrate this case as an example that in countries with low morbidity and good anti-tuberculosis network, the most serious complication of tuberculosis – TB meningoencephalitis, can also occur.

Key words: childhood tuberculosis, meningitis, lung diseases 
Address for correspondence: Svetlozara Velizarova, MD, University Pediatric Clinic, SHATPD "Sv. Sofia", 17 Akad. Ivan Geshov blvd., tel.: +359 2 8054299, e-mail: velizarovasv@gmail.com

BULGARIAN CONTRIBUTION TO THE INVENTION OF MUMPS VACCINE
Hr. Odiseev

Summary: Meningeal reactions in patients with mumps are common due to involvement of the meninges by the mumps virus. With the introduction of the mumps vaccines all that was associated with the post vaccination reactions as well. In this paper the author state that all that pathological and inevitable effects are due to viral inflammation of choroid plexus by virulent or vaccine strains which increases the secretion of meningeal fluid and intracranial pressure that results in the presence of meningeal reactions. The morphological changes in choroid plexus in vaccinated children are minimal, the clinical symptoms are rare (1 per 5000-10 000 vaccinations), transient and with no residual consequences. Based on that evidence the author considered that the meningeal reactions are not contraindication for vaccination and started its clinical application in 1968. Afterwards that was confirmed and accepted in other countries and WHO (2007).

Key words: mumps (epidemic parotitis), virus of parotitis, vaccines, choroid plexus, meningeal reactions
Address for correspondence: Hristo Odisseev, MD, drMedSc, 52 "Tsvetna gradina", St., 1421 Sofia, tel.: 02/865 55 32


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