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Case reports

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Volume 52, 2016

 

 

bullet 6'2016

Tinea capitis adultorum – case series – Medical Review (Medicinski pregled), 52, 2016, № 6, 40-44.
L. Zisova1, A. Chokoeva1, G. Tchernev2, T. Lotti3
1Department of Dermatology and Venereology, Medical University – Plovdiv
2Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior – Sofia
3Chair of Dermatology, University “G. Marconi”, Rome – Italy
Summary: Tinea capitis is a fungal infection of the scalp, which is more typical in childhood, while its occurrence in the elderly is usually considered casuistic. A wide range of diversities in the epidemiology as well as in the etiology of Tinea capitis have been reported recently and the new trend with the changing pattern of the disease raises the attention of scientists from all over the world. Nowadays, etiology is considered to vary with age, gender and general health condition. Also, a new trend in the epidemiology of the disease is the increasing incidence among adult patients. If the incidence of TC in adults previously accounted for less than 1% of all cases, currently, the increased incidence regarding the infection in the elderly is widely reported, from 1% to 3-5%, even to 11%, according to different studies. Herein, we present a case series of otherwise healthy adult patients, with confirmed Tinea capitis, as we focus the attention on the atypical clinical manifestation of the infection in the elderly, which often could lead to misdiagnosis with other scalp infection or alopecia-like conditions. On the other hand, we emphasize the dynamic pattern of this disease, depending on multiple factors, including age, gender, geographic region and also the investigated period. Physicians should be aware that Tinea capitis adultorum is no longer rarely seen and therefore should be kept in mind as differential diagnosis also in adult patients.
Key words: Tinea capitis, adults, diagnosis, treatment
Address for correspondence: Prof. Georgi Tchernev, MD, Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior (MVR), 79 General Skobelev blvd, Bg  1606 Sofia, e-mail: georgi_tchernev@yahoo.de

 

 

A case with a giant hiatal hernia – Medical Review (Medicinski pregled), 52, 2016, № 6, 45-48.
A. Kotsev1 and N. Chernev2
1Department of Propedeutics of Internal Diseases, Medical University – Sofia
2Department of Diagnostic Imaging, Medical University – Sofia
Summary: The frequency of hiatal hernia increases with the age. The etiology of hiatal hernia is not elucidated. Most of the patients with hiatal hernia do not have any symptoms. Occasionally hiatal hernia is called the „great mimic“, because it can mimic many medical conditions. We present a case of а giant hiatal hernia in an elderly woman with complaints, a part of which could be attributed to the presence of the diagnosed hiatal hernia.
Key words: hernia, stomach, esophagus, endoscopy, radiological examination
Address for correspondence: Andrey Kotzev, M. D., Gastroenterology Unit, University Hospital „Aleksandrovska”, 1, “Sv. G. Sofiyski” Blvd., Bg − 1431 Sofia, е-mail: dr_andrey_kotzev@abv.bg

 

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bullet 5'2016

Globulomaxillary cyst – case report. – Medical Review (Medicinski pregled), 52, 2016, № 5, 46-48.
Ts. Tsvetanov1, G. Ivanov2
1Department of Oral Surgery, Faculty of Dental Medicine
2Department of General and Clinical Pathology, Medical Faculty; Medical University – Plovdiv
Summary: In the historical aspect the first description of the globulomaxillary cysts has been ascribed to Thoma (1937). The globulomaxillary cyst is a cyst which is situated between the maxillary lateral incisor and the adjacent canine. It exhibits as an “inverted pear-shaped radiolucency”. The aim of this publication is to show the rare case of a globulomaxillary cyst, surgically extracted through reflection of a buccal mucoperiosteal flap.
Key words: globulomaxillary cyst, symptoms, treatment
Address for correspondence: Tsvetan Tsvetanov, Ph.D, D.D.S., Department of Oral Surgery, Dental Faculty, Medical University; 3, Hristo Botev Bvd, Bg – 4000 Plovdiv, Tel. +359 898325332

 

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bullet 4'2016


Dangerous duet syphilis and HIV infection
R. Komitova(1, 4) , K. Chudomirova(2, 3) , E. Trayanova (3) and V. Georgieva(1, 4)
(1)Department of Infectious Diseases, Medical University -- Plovdiv
(2)Department of Dermatology and Venerology, Medical University -- Plovdiv
(3)Dermatology and Venereology Clinic, University Hospital “Sv. Georgi” -- Plovdiv
(4)Infectious Diseases Clinic, University Hospital “Sv. Georgi” – Plovdiv
Summary: HIV and syphilis affect similar patient groups, men who have sex with men (MSM), in particular, and coinfection is common. Syphilis can enhance HIV transmission, thus diagnosing and treating syphilis can probably help to reduce HIV transmission. Despite an improved understanding of the interaction of these two pathogens, many controversies still remain. Syphilis develops similarly in HIV-infected and non-infected patients with minor differences. All HIV-positive should be considered for an evaluation of syphilis, including neurosyphilis. Prolong treatment duration with penicillin may be needed in early syphilis with HIV-coinfection. Early identification and treatment of recent sex partners can potentially prevent the spread of both infections.
Key words: HIV, syphilis, coinfection, neurosyphilis
Address for correspondence: Assoc. Prof. R. Komitova, M.D., Department of Infectious Diseases, University Hospital “Sv. Georgi”, 66, Peshtersko shose Blvd., Bg -- 4000 Plovdiv, e-mail: radkakomitova@yahoo.com

 

 

Bisphosphonates-related osteonecrosis of the upper and lower jaw -- a case report
Ts. Tsvetanov and А. Bakardjiev

Department of Oral Surgery, Dental Faculty, Medical University – Plovdiv
Summary: Bisphosphonates (BPs) are stable analogs of pyrophosphate, which are naturally occurring modulators of bone metabolism and have been synthesized and used since the 19th century but their in-vitro ability to inhibit the precipitation of calcium phosphate was applied clinically in 1960s. BPs associated osteonecrosis of the jaw is a rare but serious clinical condition caused by antiosteoclastic, antiangiogenic and antihuman endothelial cell proliferation effects of bisphosphonates which inhibit bone turnover. The aim of this publication is to show the case of a woman with bisphosphonates induced osteonecrosis of the upper and lower jaw after tooth extraction and intravenous appliance of Zometa® used extensively to treat bone metastasis of breast cancer. The treatment plan in these case includs antibiotics and antifungal drugs.
Key words: bisphosphonates, tooth extraction, necrosis
Address for correspondence: Tsvetan Tsvetanov, Ph.D, D.D.S., Department of Oral Surgery, Dental Faculty, Medical University, 3, Hristo Botev Bvd, Bg -- 4000 Plovdiv, Tel. +359 898-32-53-32

 

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bullet 3'2016

Abrikossoff’s tumor (Granular cell tumor) -- а mysterious diagnosis – Medical Review (Medicinski pregled), 52, 2016, № 3, 59-62.
P. Rusenov(1), S. Nikolova(1), O. Oltyan(2), D. Staykov(3) and S. Bachurska(3)
(1)Students, Faculty of Medicine, (2)Student, Faculty of Dental Medicine, (3)Department of General and Clinical Pathology, Medical University -- Plovdiv
Summary: Granular cell tumor, also known as Abrikossoff’s tumor, is an unusual and rare neo­plasm which can develop in any part of the human body. Hypotheses of the histogenesis of the tumor are many, but the most widespread and widely accepted one is that it originates from upset metabolism of Schwann cells. We present a case of granular cell tumor of the tongue in a young woman in the context of differential diagnostic difficulties in morphological diagnosis of this rare neoplasm.
Key words: granular cell tumor, Abrikossoff’s tumor, tongue
Address for correspondence: Svitlana Bachurska, M. D., Department of General and Clinical Pathology, Medical University , 15A, Vasil Aprilov Blvd., Bg -- 4000 Plovdiv, tel. +359 32 602 458, e-mail: svitba@gmail.com

 

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bullet 1'2016

Measurement of blood formic acid and its significance in diagnosis and treatment of methanol poisoning - Medical Review (Medicinski pregled), 52, 2016, № 1, 46-50.
L. Neykova(1), B. Mechkarska(2), K. Kanev(1) and V. Atanasov(2)
(1)Emergency Toxicology Clinic, Military Medical Academy -- Sofia, (2)Analytical Toxicology Laboratory at Emergency Toxicology Clinic, Military Medical Academy -- Sofia
Summary: The fast and accurate diagnosis of methanol poisoning and its early treatment are crucial for the prognosis. The blood methanol analysis confirms poisoning but it does not allow estimating the severity and progression of the intoxication. The presented clinical case demonstrates the application of blood formic acid analysis (blood formate) as a main toxic metabolite of methanol, responsible for the poisoning. The monitoring of blood formate concentration during the clinical course of poisoning allows optimization of the dialysis treatment and antidote (ethanol) application. Using the presented protocol it is possible to ensure fast and effective elimination of methanol and its toxic metabolites and to reduce their harmful effects.
Key words: methanol, formic acid (formate)
Address for correspondence: L. Neykova, M. D., Emergency Toxicology Clinic, Military Medical Academy, 3, Sv. G. Sofiyski St., Bg -- 1606 Sofia

 

 

Оrgan-indulgent treatment of iatrogenic perforation of the oesophagus: clinical case report - Medical Review (Medicinski pregled), 52, 2016, № 1, 51-53.
S. Sopotensky(1), Z. Antonova(2), G. Garvanska(3), A. Tchervenyakov(1) and I. Sopotenska(4)
(1)First Surgical Clinic, UMHATEM N. I. Pirogov -- Sofia, (2)Children’s Surgical Clinic, UMHATEM N. I. Pirogov -- Sofia, (3)Clinic of Diagnostic Imaging, UMHATEM N. I. Pirogov -- Sofia, (4)Department of Scientific Study and Postgraduate Training, UMHATEM N. I. Pirogov -- Sofia
Summary: There is a wide variety of factors that may cause a perforation of the oesophagus. Main premise for that condition are the preexisting morphological changes due to different pathologies. Even seldom observed in the daily practice, the esophageal perforation often leads to multiple complications including death. We present a clinical case report of a patient with symptoms of achalasia of the gastric cardia after two fiberoptic gastroscopies performed elsewhere which has resulted in a perforation of the oesophagus. An open surgical intervention is conducted in three main directions: restoration of the integrity of the oesophagus, treatment of complications and cardiomiotomy with an application of fibrin glue to overcome the distal stenosis. A special emphasis is put on the operative technique that we have applied.
Key words: perforation of the oesophagus, gastroscopy, achalasia
Address for correspondence: Stoyan St. Sopotensky, MD, PhD, First Surgical Clinic, UMHATEM "N. I. Pirogov", 21 Eduard Totleben Blvd., Bg -- 1606 Sofia, tel. + 359 888 222 415, e-mail: sopotensky@abv.bg

 

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