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Case reports

Volume 42, 2006



Diagnosis and conservative treatment of tuberculous spondylitis – with contribution of one clinical case  – 42, 2006, No 4, 103-105.
K. Kostov and Iv. Petrov

Clinic of Neurology, Medical Institute – Ministry of Internal Affairs - Sofia
Summary: Tuberculous spondylitis is the most common form of skeletal tuberculosis. Certain approval of the diagnosis is not always possible even with the most modern diagnostic facilities. We describe a clinical case of conservative treatment of tuberculous spondylitis which is diagnosticated late at the stage of marked bone destruction with signs of neurological deficit. We discuss the diagnosis, clinical manifestation and treatment.
Key words:  tuberculous spondylitis, clinical manifestation, diagnosis, treatment
Address for correspondence: K. Kostov, M. D., Clinic of Neurology, Medical Institute of Ministry of Interior, 79, Scobelev Blvd., Bg – 1606 Sofia, tel. +359 2 9821576, Fax: +359 2 9531235, e-mail:


Fracture of processus styloideus – presentation of a clinical case - – 42, 2006, No 4, 110-111.
R. Kolarov and A. Djorov
Specialized Hospital of Maxillo-Facial Surgery-Sofia
Summary: Presented is a clinical case of an 80-year-old woman with a fracture of processus styloideus. After a fall and hiting in the occipital area, a characteristic symptomatic occurred that disappeared in about ten days without surgical interference. The described case contributes to the knowledge of this rare type of fractures.
Key words:  processus styloideus, fracture, clinical case
Address for correspondence: Rosen Kolarov, M. D., Specialized Hospital of Maxillo-Facial Surgery - Sofia, 1, Sv. G. Sofiiski, Str., Bg 1431 Sofia





Cecal diverticulitis mimicking acute appendicitis - a case report and review of the literature - 42, 2006, No 3, 96-99.
R. Dimov, H. Protohristov, I. Apostolov, G. Deenichin and E. Moshekov

IIIrd Surgery, Department of General Surgery, University Hospital "Sv. Georgi" - Plovdiv
Summary: Isolated cecal diverticulosis, or combined diverticulosis of the right colon is a relatively rare pathology in Europe and North America. Hence, proper diagnosis and treatment of cecal diverticulitis in emergency arouse some hesitation. The aim of the article is to present contemporary aspects of diagnosis and treatment of this disease as well as to present a case report illustrating some problems mentioned above. As a material for analysis, we used the patients with complicated colonic diverticulosis for a period from 1.01.2000 to 1.09.2005. One of the six patients operated in the clinic was with cecal diverticulitis. The rest of them were with complicated diverticulosis of the sigmoid. Cecal diverticulosis and its complication are a relatively rare condition in our country. Its diagnosis and proper treatment require adequate clinical approach and non-standard decisions.
Key words: cecal diverticulitis, diagnosis, treatment

Address for correspondence:
Rosen Dimov, M. D., IIIrd Surgery, Department of General Surgery, University Hospital "Sv. Georgi", 66, Peshtersko shouse Str., Bg - 4000 Plovdiv, GSM +359 888 938 220, e-mail:



Association of type 2 diabetes mellitus and membranous glomerulonephritis - 42, 2006, - 3, 100-102.
M. Nikolova(1), A. Iliev(1), G. Venkov(2), B. Bogov(1), T. Todorov(3), R. Djerassi(1) and B. Kiperova(1)

(1)Clinic of Nephrology, (2)Department of Urology, (3)Department of Clinical Pathology, University Hospital "Alexandrovska" - Sofia
Summary: Diabetic nephropathy is one of the leading causes for the development of end-stage renal disease. It is often associated with other conditions leading to the development of renal failure. The authors present an association of type 2 diabetes mellitus with membranous glomerulonephritis.
Key words: type 2 diabetes mellitus; membranous glomerulonephritis
Address for correspondence:
Milena Nikolova, M. D., Clinic of Nephrology, University Hospital Alexandrovska, 1 Sv. G. Sofiiski Str., Bg - 1431 Sofia, e-mail:





Stratification of the risk of complications and treatment with tirofiban in patients with acute coronary syndrome - 42, 2006, № 2, 93-97.
J. Uzunangelov(1), Al. Doganov(2), M. Tsekova(1) and V. Tomova(1)

(1)Clinic of Cardiology and Intensive Treatment, UMHAT Pleven
(2)Section of Invasive Diagnostic, National Cardiologic Hospital  Sofia
Summary: The inhibitors of IIb/IIIa receptors of the platelets found place in the treatment protocols of the patients with acute coronary syndrome (ACS) and high risk of death and ischemic complications. The stratification of these patients with NSTEMI is a part of the treatment plan and it must be made at admission, during treatment time and at the patient’s discharge. Tirofiban is a nonpeptide IIb/IIIa glycoprotein receptor antagonist, that can be used in patients with ACS. We present two clinical cases where tirofiban was used after initial patient’s stratification before invasive procedure and follow up therapy. Presented are the coments of the cardiologist and invasive cardiologist and the final result. In conclusion, we mark that the correct and dynamic stratification of patients with NSTEMI leads to its correct treatment. An obligatory circumstance for this is the well-timed start with IIb/IIIa GPI in the therapy and early coronary intervention.
Key words:acute coronary syndrome, complications, risk groups, tirofiban
Address for correspondence:
Jordan Uzunangelov, M. D., Clinic of Cardiology and Intensive Treatment, UMHAT „Dr. Georgi Stranski”, Bg - 5800 Pleven, tel./fax +359 64 886-227, e-mail:



A rare case of angiocentric lymphoma - 42, 2006, № 2, 98-100.
V. Vrachev(1), S. Vladeva(1) and M. Baleva(2)

(1)Department of Internal Medicine, Thracian University – Stara Zagora
(2)Clinical Center of Allergology, Medical University – Sofia
Summary: We describe a patient with a rare lymphoproliferative disease – angiocentric lymphoma. The disease began with a local lesion of the nose, complicated by necrosis, combined with fever syndrome. Conclusion of the first histological analysis was Wegener’s granulomatosis. Because of lacking effect of treatment with corticosteroid and progression of the disease a new biopsy with immunohistochemical analysis was made, which proved the diagnosis angiocentric lymphoma.
Key words: angiocentric lymphoma, differential diagnosis, Wegener’s granulomatosis
Address for correspondence:
V. Vrachev, M. D., Department of Internal Medicine, Thracian University, 11 Armeiska Str., Bg – 6000 Stara Zagora



Successful radiofrequency ablation of middle coronary vein accessory pathway in an adolescent - 42, 2006, № 2, 101-106.
B. Dinov(1), R. Dobrev(1), G. Hristov(1) and S. Stoimenov(2)

(1) National Cardiology Hospital – Sofia
(2) University Hospital “Prof.St. Kirkovich” – Stara Zagora
Summary: We report the case of a 17-year-old girl with Wolff-Parkinson-White (WPW) syndrome who underwent radiofrequency (RF) ablation. The resting ECG revealed preexcitation pattern suggestive of a left paraseptal accessory pathway. Intracardiac study found a large, sharp spike recorded from the proximal part of the coronary sinus. Orthodromic circus movement tachycardia was induced by coronary sinus pacing. An attempt at ablating the pathway from the coronary sinus was undertaken. No left-heart catheterization was performed. The successful ablation site was located in the proximal middle cardiac vein where a large accessory pathway potential with an atrioventricular conduction interval of 60 ms were recorded. Two short radiofrequency applications abolished conduction over the bypass tract. No complications occurred. Radiofrequency ablation from the coronary sinus and its venous tributaries as a primary approach may be effective in children and adolescents with specific findings from the intracardiac study even when the ECG is not suggestive of such a location.
Key words: accessory pathway, catheter ablation, middle cardiac vein, coronary sinus
Address for correspondence:
Borislav Dinov, M. D., National Cardiology Hospital, 65 Koniovitza Str., Bg 1309 Sofia, tel. +359 2 92 114 71, e-mail:



Morphological and biological indices in primary and recurrent intracranial chondrosarcoma - 42, 2006, № 2, 107-110.
Z. Zaprianov(1), Y. Kumthcev(2), S. Genova(1), St. Djambazova(1), G. Ivanov(1), I. Bivolarski(1) and B. Kalnev(2)

(1)Department of General and Clinical Pathology, Medical University – Plovdiv
(2)Clinic of Neurosurgery, UMHAT “Sv. Georgi” – Plovdiv
Summary: Intracranial chondrosarcoma is a rare tumor. For the present, there are about 60 cases published in the literature. Our case of recurrent intracranial chondrosarcoma is the first to be presented in Bulgaria. A 37-year-old man has been operated twice for intracranial blastoma with the morphological characteristics of meningeal chondrosarcoma. A detailed clinical investigation rejected the possibility of metastatic or osteogenic origin of the tumor. Thorough morphological, histochemical and immunohistochemical study with image analysis and morphometry of the positive cells have been applied to measure DNA and total RNA in tumor cells which is the first complex survey of this tumor. Prediction of the biological behavior of the tumor is made on the grounds of the indices obtained.
Key words: intracranial chondrosarcoma, complex survey, DNA, RNA, р53, Ki67, protein S 100, EGFR, biological behavior
Address for correspondence:
Asoc. Prof. Z. Zaprianov, M. D., Department of General and Clinical Pathology, Medical University, 15 A “V. Aprilov” blvd., Bg – 4002 Plovdiv



Fibrous hamartoma of infancy – a case report - 42, 2006, № 2, 111-113.
E. Poryazova
(1) and A. Jonkov(2)
(1)Department of Clinical Pathology, (2)Clinic of Pediatric Surgery
University Hospital “Sv. Georgi” – Plovdiv
Summary: Fibrous hamartoma of infancy is a rare benign tumor that occurres within the first 2 years of life. It shows a marked predeliction for males, and most commonly occurs on the upper body, particularly in the axillary region, upper arm, upper trunk and inguinal region. The lesions are circumscribed but poorly defined, occupy the deep dermis and subcutis. We describe a case of a 3-month-old male infant presented with a subcutaneous tumor on the right brest; the mass has been persistent since birth.
Key words: fibrous hamartoma of infancy, breast
Address for correspondence:
Elena Poryazova, M. D., Department of Clinical Pathology, UMHAT "Sv. Georgi", 15A, V. Aprilov Blvd., Bg 4200 Plovdiv, email:




Relapsing cardiac arrest and acute virus infection in heroin abusers on methadone therapy – case studies - 42, 2006, № 1, 114-119.
V. Bogdanova(1), J. Radenkova-Saeva(2), A. Ivanov(1), Al. Minthchev(2), S. Naydenov(1), E. Taneva(1) and T. Donova(1)
(1)University Hospital Alexandrovska” – Sofia
(2)MHATEM N. I. Pirogov” – Sofia
Summary:  Heroin dependence is a problem of increasing social importance, concerning different social strata of developing countries as well as socially and economically advanced ones. Methadone is a drug, that proved its efficiency when used as a maintenance therapy for long-term heroine addicts and prophylaxis of the abstinence syndrome. At present, however, there are a lot of reports about complications and even cases with lethal outcome, that occurred in the course of methadone therapy. Until
recently, it was considered that such unfavorable outcomes are due to methadone overdose and intoxication as a result. New researches show that adverse effects of methadone therapy are due most frequently to methadone intolerance, not to methadone overdose. Clarifying the reason for the adverse effects, occurring after initiation of methadone medication – overdose or intolerance, is important for planning the long-term therapeutical approach in such patients. Two case studies are presented – cardiac arrest in a 24-year-old woman and acute virus infection in a young man with long term heroin dependence on methadone therapy.
Key words: cardiac arrest, heroin, methadone, acute virus infection
Address for correspondence: Vera Bogdanova, MD, Clinic of Cardiology, Univercity Hospital “Alexandrovska”, 1 Sv. G. Sofiiski Str., Bg – 1431 Sofia, e-mail:,



Small bowel metastases of bronchogenic cancer – case reports - 42, 2006, № 1, 120-122.
D. Nikolovska(1), M. Petrova(1), V. Paskalev(2), K. Jeleva(1), D. Todorov(1) and N. Donova(1)
(1)Clinic of Gastroenterology, Medical Institute of Ministry of Internal Affairs – Sofia
(2)Department of Pathology, Medical Institute of Ministry of Internal Affairs – Sofia
Summary: Bronchogenic cancer is a common and severe disease, rapidly developing and characterized by high metastatic potential. The small bowel metastases are extremely rare and may be clinically missed due to the unspecific symptomatology. We report two cases of bronchogenic cancer with small bowel metastases, clinically presented with bowel obstruction and hemorrhage of the gastrointestinal tract, which necessitated surgical resection. Appearance of small bowel metastases supposes an advanced stage and bad prognosis.
Key words: lung cancer, bronchogenic cancer, small bowel metastases, small bowel obstruction, intestinal hemorrhage
Address for correspondence: 
Assoc. Prof. D. Nikolovska, M. D., Clinic of Gastroenterology, Medical Institute of Ministry of Internal Affairs, 79A,
Skobelev Blvd., Bg – 1606 Sofia


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