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Case reports

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Vol. 46, 2010

 

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4'2010

Immune deviations in a patient after in vitro fertilization and concomitant family history of rheumatic diseases - 46, 2010, № 4, 73-76.
F. Martinova(1) and M. Panchovska-Mocheva(2)
(1) Department of Transfusional Hematology and Immunology, MHATEM “N. I. Pirogov” --Sofia, (2)Clinic of Internal Diseases, MMA --MHAT, MU -- Plovdiv
Summary: The contemporary protocols of assisted reproductive technologies include panels of immunologic investigations in patients with repeated reproductive failure. A lot of medicaments, concretely hormonal ones, may induce considerable number of autoimmune deviations. Part of the rheumatic diseases exhibit association with certain autoantibodies and antigens of the HLA system. The autoimmune rheumatic diseases make often their debut in women of reproductive age followed by increased infertility. However, there are no specific HLA alleles, the carriage of which could predispose to infertility. We present a case of a 30-year-old woman with failed assisted reproduction. After a consecutive attempt on in vitro fertilization and hormonal ovarial hyperstimulation the patient exhibited arthralgias in the small hand joints and in the joints of the knees, ankles and shoulders. Immunologic investigation showed enhanced ANA titre and presence of antibodies against dsDNA. Eight months after cessation of the hormonal preparations the arthralgias with morning stiffness and the immune deviations showed reversibility. Patient’s mother suffers from rheu­ma­toid arthritis with concomitant Sjоgren’s syndrome and Raynaud’s syndrome. The immunofenotyping of the patient and her mother revealed carriage of HLA haplotype -- A*01, B*08, Cw*07, DRB1*03, DQB1*02. The reported case shows an expressed predisposition to autoimmune rheumatic diseases associated with carriage of the specified haplotype. The autoimmune diseases of the mother are clinically manifested whereas the reversible joint symptoms and immune deviations in the young woman necessitate follow up in regard to autoimmune rheumatic disease.
Key words: assisted reproductive methods, reproductive failure, immunologic deviations, genetic predisposition
Address for correspondence: Assoc. Prof. Maria Panchovska-Mocheva, M. D., Clinic of Internal Diseases, Military Hospital, 81, Hr. Botev Blvd., Bg -- 4000 Plovdiv, e-mail: panchovska@abv.bg

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1'2010

Thyrotoxicosis and myasthenia gravis -- a case report - 46, 2010, No 1,   75-80.
Zh. Boneva(1) , K. Kostov(2), P. Yovchevski(3), Y. Assyov(4), S. Yordanova(4), V. Evtimova(4), V. Marinov(4) and D. Dimitrova(4)
(1)Department of Endocrinology, (2)Department of Neurology, (3)Department of Nephrology -- Medical Institute -- Ministry of Interior -- Sofia, (4)Medical University -- Sofia
Summary: Myasthenia gravis (MG) and Graves’ disease are autoimmune diseases and their coexistence is well-known in the literature. 5 to 10% of the MG cases have also an autoimmune thyroid disease, while only 1% of the patients with Graves’ disease suffer from MG. We present a case of hyperthyroidism and MG, debuted primarily with bulbar involvement. The symptoms of both diseases started almost simultaneously, but the diagnosis of MG was established a couple of months after the thyrotoxicosis. The treatment of the latter did not lead to an improvement of the MG symptoms (dysphagia and dys­phonia), and only the initiation of anticholinesterase and immuno­sup­pres­si­ve therapy led to an improvement of the patient’s condition.
Key words: myasthenia gravis, thyrotoxicosis, dysphagia
Address for correspondence:
Zhivka Boneva, M. D., Department of Endocrinology, Medical Institute -- Ministry of Interior, 79, Gen. Stoletov Blvd., Bg -- 1606 Sofia, tel. +359 9821351, fax: +359 981 45 94, e-mail: zhbonevaa@abv.bg

 

 

A rare case of myoepithelial hamartoma -- immunohistochemical findings - 46, 2010, No 1, 80-82.
E. Poryazova(1), Z. Zapryanov(1), G. Paskalev(2) and V. Uzunova(2)
(1)Department of General and Clinical Pathology, (2)Department of Thoracic Surgery, Medical University -- Plovdiv
Summary: A case of myoepithelial hamartoma of the small intestine, which is rare among benign tumors of the small intestine, was observed. We describe a 49-year-old man who presented with acute abdominal pain. Histology of the mass revealed disorderly arrangement of smooth muscle, dilated and nondilated ducts, pancreatic acinar tissue and mucus glands.
Key words: myoepithelial hamartoma, small intestinе wall
Address for correspondence:
Elena Poryazova, M. D., Department of General and Clinical Pathology , Medical University, 15A, V. Aprilov Blvd., Bg -- 4002 Plovdiv, e-mail: eporiazova@abv.bg

 

 

Complications following teeth extractions in а female patient with diabetes mellitus - 46, 2010, No 1, 83-90.
P. Sapundzhiev
Department Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU -- Sofia
Summary: The aim of this case report is to present clinical development of buccal and submasseteric cellulitis originated from retained lower wisdom tooth, complicated with osteomyelitis of the mandible in a 65-year-old female patient with a great number of associated diseases -- diabetes mellitus, cardiac disease, high blood presure, glaucoma, IIIth degree of obesity, bronchial asthma. The patient developed haemorrhage with melena from nondiagnosed duodenal ulcer. Prognosis about vitality of the bone tissue when an inflammation occurs in mandible is difficult and depends on a great number of factors -- immuno­resistance of patient’s organism, virulence of pathological flora and sensibility of the patient. Every inflammation seat may become a reason for decompensation of by this time compensated diabetes mellitus, and the inflammation process may assume unfavourable development with necrosis of the underlying bone. When a haemorrage from duodenal ulcer or complication of other organs and systems arise, it is necessary to hospitalize the patient in adequate clinic for emergency treatment and parallel treatment of inflammation in oral region and associated diseases. The surgical treatment (odontectomy) in combination with intravenous antibiotics according antibiogram to sensitivity as well as daily irrigation of the wound with antiseptics (0,2% Hibitan) and protheolytic ferments was performed after stabilization of the patient’s general condition and treatment of the life threatening complication.
Key words: cellulitis, diabetes mellitus, haemorrhage, mandible, melena, osteomyelitis
Address for correspondence:
Assoc. Prof. Peter Sapundzhiev, Department Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU, 1, Sv. G. Sofiiski Blvd., Bg -- 1431 Sofia, GSM +359 886 629 425, e-mail: psapundjiev@abv.bg

 

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