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Case reports

Volume 39, 2003


Establishment of multiple HPV infection in a patient with giant condylomata acuminata by polymerase chain reaction - 39, 2003, ¹ 4, 77-79.
P. Draganov(1), G. Mateev(2) and Z. Kalvatchev(1)
(1)Molecular Virology Laboratory, National Center of Infectious and Parasitic Diseases  Sofia
(2)Clinic of Dermatology and Venereology, Alexandrovska University Hospital, Sofia
Summary: Giant condylomata acuminata (Buschke-Loewestein syndrome) belong to the atypical forms of dermatoviroses, caused by human papilloma viruses (HPVs). The main approach to a precise etiologic diagnosis are the molecular virology investigations because of the insufficiency of the existing immunodiagnostic techniques. We had the opportunity to observe an interesting case of giant condylomata acuminata associated with multiple HPV infection, simultaneously caused by highly oncogenic HPV types 16, 18, and 33. HPV typing was made by polymerase chain reaction (PCR) adapted in our laboratory. The routine application of the PCR technique makes the objective estimate of the individual carcinogenic risk possible and allows the choice of a precise treatment approach.
Key words: giant condylomata acuminata, HPV, PCR
Address for correspondence: Assoc. prof. Z. Kalvatchev, M. D., Molecular Virology Laboratory, National Center of Infectious and Parasitic Diseases, 44-A, Stoletov Blvd., Bg – 1233 Sofia, tel: (02) 931-38-18, e-mail:

A case of chromosome 9 instability in the father – a possible predisposition factor for the appearance of a t(y,9) in the son - 39, 2003, ¹ 4, 80-82.
L. Mitev(1), B. Petrov(1), A. Angelov(2), V. Uzunova(1) and V. Ivanov(2)
(1) Department of Clinical Laboratory and Immunology
(2)   Clinic of Endocrinology
(3)   Military Medical Academy - Sofia
Summary: We describe the cytogenetic findings in the parents of a male recruit with tertiary poliglandular insufficiency and a mosaic karyotype with t(Y,9). His mother had normal female karyotype of 46,XX and less than 2% cells with chromosome abnormalities. His father was with normal male karyotype of 46,XY but with marked spontaneous chromosome instability (20% of the cells were with chromosome abnormalities), characterized by more frequent involvement of certain chromosomes, including chromosome 9. A possible relation between the instability of chromosome 9 in the father and the appearance of t(Y,9) in his son is discussed.
Key words: cytogenetics, chromosome aberrations, chromosomal instability
Address for correspondence: Lubomir Mitev, M. D., Cytogenetic Laboratory, Military Medical Academy, 3, Sv. G. Sofiiski Blvd., Bg 1606 Sofia, ) +359 2 922-53-15



Antihypertensive treatment with eprosartan mesylate (Teveten) in a child with renal transplantation
E. Paskalev
Clinic of Nephrology and Transplantation, University Hospital "Alexandrovska"
- Sofia
Hypertension is extremely common in the renal transplanted patients, with a prevalence of 50% in the stabilized patients and of 80% in the immediate post-transplant period. It is impossible to define a single etiologic factor for post-transplant hypertension. The most important factors are impaired renal function, cadaver donor, and cyclosporine administration. Post-transplant hypertension treatment strategies are varying, depending on the patient’s pre-existing medical condition and the response to therapy. There are many clinical evidences that blockade of the renin-angiotensin-aldosterone system by angiotensin II receptor blockers decreases proteinuria. Our case shows the effect of use of eprosartan mesylate (Teveten) in the treatment of post-transplant hypertension in a child.

Key words:
kidney transplantation in children, hypertension, eprosartan mesylate

Address for correspondence:
Emil Paskalev, M. D., Clinic of Nephrology and Transplantation, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, ) + 359 2 92-30-240, e-mail:



Sh. Mehrabian, R. Kalpatchki, P. Shotekov and L. Traikov
Clinic of Neurology, University Hospital "Alexandrovska"
Epileptic seizures are uncommon in patients with multiple sclerosis (MS), although they occur nearly three times as frequent as in the general population. In the majority of patients seizures occur when the diagnosis of MS is already established, rarely though they may be the first manifestation of MS prior to other neurological symptoms of the illness. Seizures are usually observed in relapsing-remitting or secondary progressive MS and more rarely in primary progressive MS. The lesions involved in the pathogenesis of these crises are plaques of demyelinization which affect the subcortical or cortical-subcortical areas. The predominant seizure types in MS patients are the generalized or the partial one with secondary generalization. Brain MRI is an appropriate method for diagnosis of MS, as well as for assessment of the relationship between EEG-findings and localization and size of lesions in central nervous system. For the treatment of patients with epileptic seizures as a sign of MS relapses, it is recommended that antiepileptic drugs be combined with intravenous steroids. The presented case of epilepsy as the first symptom of MS, appearing five years prior to other symptoms/signs of the illness, emphasizes the necessity of exclusion of MS in young patients with epilepsy and no evidence of other potentially epileptogenic pathology.
Key words: epilepsy, diagnosis, multiple sclerosis
Address for correspondence:
Shima Mehrabian, M. D., Clinic of Neurology, University Hospital "Alexandrov-ska",
1, Sv. Georgi Sofiiski Str., Bg - 1431 Sofia, å-mail:


M. Pravtchanska-Semkova, V. Mateev and M. Baleva
Clinic of Allergology and Clinical Immunology, University Hospital, "Alexandrovska" Medical University - Sofia
Summary: Food-dependent exercise-induced anaphylaxis is severe IgE-mediated reaction, provoked by the ingestion of certain foods combined with intensive physical exercising in the next few hours. Plant derived foods, such as fresh fruits, vegetables and nuts, frequently cause allergic symptoms in patients sensitive to tree pollens (birch) and weed pollens (mugwort). This condition is known as oral allergy syndrome and is due to an IgE-cross reactivity between similar antigen epitopes in plant foods and pollens. We describe 3 clinical cases of food-dependent exercise-induced anaphylaxis, provoked by vegetables (tomato, parsley, celery, carrot), nuts (peanut, hazelnut, almond), bee honey or wine, prepared with herbs (mugwort). Symptoms of anaphylaxis ocurred when ingestion of the food was combined with physical exercising. All patients had history of pollinosis and seasonal allergic rhinitis with or without asthma. We emphasize on the diagnostic approach to patients with food-dependent exercise-induced anaphylaxis which includes detailed history, performance of skin prick tests and serum specific IgE determinations to pollens and wide spectrum of food allergens. Prevention includes elimination of the implicated foods from the diet, especially before physical activities, and patient training for self-injection of adrenaline/epinephrine in case of emergency.
Key words: food-dependent exercise-induced anaphylaxis, oral allergy syndrome, specific IgE
Address for corresondence:
Maria Pravtchanska, M.D., Clinic of Allergology and Clinical Immunology, University Hospital, "Alexandrovska", Medical University, 1, Sv. G. Sofiiski Str., Bg - 1431 Sofia,
+359 2 923-05-43, GSM 098 606 699, e-mail:

R. Kabakchieva, P. Perenovska, V. Kenderova and I. Kalev
Clinic of Pediatrics, University Hospital "Alexandrovska"
Intracranial hemorrhage remains a serious problem in hemophilia, occurring in 2-12% of sufferers. We present the case of a 6-year-old hemophiliac with a traumatic subarachnoid hemorrhage. A single dose of factor IX 600 U was applied done following a significant head trauma (he had fallen from a horse). 11 days later he had generalized tonic-clonic seizures for 20 minutes, followed by left-sided n. facial paralysis lasting for 12 hours. He had no other neurological abnormalities. CT revealed minor subarachnoid hemorrhage in the right frontoparietal region. Treatment with factor IX 600 U 24 hourly for 14 days was beneficial.
Key words: hemophilia B, subarachnoid hemorrhage
Addres for correspondence:
Radost Kabakchieva, M.D., Clinic of Pediatrics, University Hospital "Alexandrovska",
1, Sv. G. Sofiiski Str., Bg - 1431 Sofia, +359 2 92-30-322

B. Varbanova, E. Magunska and E. Diankov
Department of Pediatry, Medical University - Varna
Summary: We present a case of a patient with typical features of CINCA/NOMID syndrome. The first symptom of the disease was rash, which started from the first day of his life. Up to the age of 3 he gradually developed fever, acute phase response with marked neutrophilia, hepato-splenomegaly, peripheral lymphadenopathy, aseptic meningitis, arthritis, mild communicative hydrocephaly, physical and mental retardation. No erosive arthropathy was observed, but it was accompanied by the typical bonå enlargement and patellar overgrowth. Over the years, the hydrocephaly remained non-progressive, with no increased intracranial pressure, but progressive deafness and impaired vision occurred. Morphological changes such as macrocephaly, frontal bossing, blond hair, saddle-back nose, clubbing of fingers and wrinkled appearance of palms and soles were found. Examination of the cerebro-spinal fluid (CSF) at the age of 18 by flowcytometric analysis of cerebro-spinal fluid leucocyte subpopulations and CSF-electrophoresis proved a persistent inflammatory process in the central nervous system.
Key words: CINCA/NOMID syndrome, cerebro-spinal fluid - flowcytometry, cerebro-spinal fluid - elecrtophoresis
Address for correspondence: Boriana Varbanova, Department of Pediatric, Medical University,
55, Marin Drinov Str., Bg - 9002 Varna


I. Delibaltov, Y. Marinova and S. Stoichkova
National Cardiological Hospital - Sofia
Summary: Cardiovascular diseases are the main cause for mortality in patients with end-stage renal diseases (ESRD) undergoing dialysis. Due to the prevalence of risk factors in this group, cardiovascular incidents increase and take 30% to 50% of the lethal complications. Ever since the first operative revascularization of the myocard of a patient with ESRD and implanted kidney took place in 1974, cardiac surgery indications are expanding progressively despite the existing vital risk and peri- and post-operative problems. The present notice describes the first case of a patient with ESRD on dialysis in Bulgaria who underwent cardio-surgical intervention - aorto-coronary bypass. Pre- and post-operative problems in relation with chronic hemodialysis are identified and analyzed.
Key words: hemodialysis, cardiac surgery, aorto-coronary bypass
Adress for correspondence:
Ivan Delibaltov, M.D., National Heart Hospital,
65, "Konioviza" Str., Bg - 1309 Sofia, tel. +359 2 22-08-64


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