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Case reports


Vol. 44, 2008


bullet 4'2008

Dorsocommisural flap
M. Kateva

Department of Hand Surgery, MHATEM “N. I. Pirogov” -- Sofia
Summary: We present a patient with a composite posttraumatic skin and tendon defect of the back of the IIIrd finger at the level of PIP joint, 1.7/1.5 cm large, reconstructed by the use of retrograde dorsocommisural flap. Anatomical basis of this flap are the constant anastomoses between the dorsal and volar arterial pool. The transplant is distally pedicled on the dorsal branch of the proper palmar digital artery and relies on blood supply by the anastomosis with terminal branches of the dorsal metacarpal artery. This cutaneous-subcutaneous flap provides adequate coverage of the extensor aponeurosis and possibility to achieve full range of movement in the interphalangeal joints.
Key words: skin defect, fingers, retrograde flap
Address for correspondence: Margarita Kateva, M. D., Department of Hand Surgery, MHATEM “N. I. Pirogov”, 21, Totleben Blvd., Bg -- 1606 Sofia, e-mail: mkateff@mail.bg


Rosai-Dorman disease -- a clinical case and review of literature
P. Pechalova(1), I. Hubavenska(2) and B. Anavi(2)
(1)Department of Maxillo-facial Surgery, Medical University -- Plovdiv, (2)Department of Pathoanatomy, Medical University -- Plovdiv
Summary: Rosai-Dorfman disease is a rare benign systemic histioproliferative disorder with unknown etiology that chiefly affects the cervical lymphnodes. A case with involvement of submandibular lymph node is described. Pertinent literature is reviewed.
Key words: Rosai-Dorfman disease, submandibular lymph node
Address for correspondence: Petia Pechalova, M. D., Department of Maxillo-facial Surgery, Medical University, 66, Peshtersko shoes Str., Bg -- 4000 Plovdiv, e-mail: pechalova@abv.bg, GSM 0898 468 498


A continuing problem: axillary tuberculous lymphadenitis -- a case report
O. Engin(1), M. Yilmaz(2), S. Budak(2), E. Yilmaz(2), R. Atci(2), E. Unluturk(2) and O. Gore(3)
(1)SB Izmir Training and Research Hospital, 2. Surgery Clinic, Bozyaka -- Izmir, Turkey, (2)SB Buca Seyfi Demirsoy Large General Hospital, Surgery Clinic, Buca -- IzmirTurkey, (3)SB Buca Seyfi Demirsoy Large General Hospital Pathology Department, Buca -- Izmir,Turkey
Summary: Axillary tuberculous lymphadenitis is rare and generates case reports. Our case had right axillary mass and pain at admission. Multiple fixed right axillary lymphadenopathies were found. They were excised. Antituberculous therapy was given. No recurrence was seen in postoperative three years.
Key words: Tbc, axillary lymphadenitis, breasts, antituberculous therapy
Address for correspondence: Omer Engin, M. D., Maliyeciler mah. 52/165 sok. Camlikent sitesi B 1 blok, No: 2, D:16, Esenderе-Konak -- Izmir -- Turkey, e-mail: omerengin@hotmail.com


A 20-year-old female patient with postburn lower extremities joint stiffness -- case report
A. Murtezani(1), H. Terziqi(2), I. Dallku(1), V. Krasniqi(1) and B. Rama(1)

(1)Physiatric Clinic; (2)Plastic and Reconstructive Surgery Clinic of the University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
Summary: This case study deals with implementation of physical exercise intended to achieve muscular strength modification, motor function- and psychological improvement. The goal of this case report presentation is to describe the results of an ambulatory rehabilitation program with components of musculoskeletal system exercise in children with severe burn injuries. The subject of our study is a female patient with severe burn injuries, dermatogenic stiffness, muscular hypotrophy and difficult walking with ambulation. Muscular strength and motor function improvements were observed. Patient started to walk without crutches. This research demonstrates the fact that regardless of how extensive the rehabilitation program is, the end results usually are good if physical therapy is integrated into the healing process.
Key words: burn injuries, stiffness, rehabilitation
Address for correspondence: Ardiana Murtezani, M. D., Physiatric Clinic, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo, e-mail: ardianna@yahoo.com



bullet 3'2008

Ulnar metacarpal retrograde neurocutaneous flap – 44, 2008, No 3, 88-90.
M. Kateva
Department of Hand Surgery, MHATEM “N. I. Pirogov” – Sofia
Summary: It is known that there are arteries that go along with the sensory nerves and from a rich vascular network around them. The network sends perforator branches towards the overlying skin. Distally, the perineural arteries anastomose with similar branches from the dorsal metacarpal arteries. Thus the perineural subcutaneous vascular complex is in constant connection with the volar vascular pool. This anatomical fact is the base for raising distally pedicled flaps. The transplant is dissected from proximal to distal in the IV-th web space, centered longitudinally over ramus dorsalis n. ulnaris. Its pivot point is the metacarpophalangeal joint. It receives blood by the retrograde flow from the volar digital arteries through their constant anastomosing branches (around the metacarpophalangeal joints) with the perineural vessels. The article presents a case of skin reconstruction.
Key words: dorsal branch of n. ulnaris, hand defect, neurocutaneous flap
Address for correspondence:
Margarita Kateva, M. D., Department of Hand Surgery, MHATEM “N. I. Pirogov”, 21, Totleben Blvd., Bg -- 1606 Sofia, e-mail: mkateff@mail.bg -- Sofia




bullet 2'2008

Human granulocytic anaplasmosis in Bulgaria -- confirmed cases and review of the literature – 44, 2008, No 2, 63-67.
I. Hristova(1), E. Taseva(1), T. Gladnishka(1), K. Bakardzhiev(2), R. Komitova(3), P. Ilieva(3), L. Andonova(4), G. Goranova(5), K. Yordzheva(6) and N. Balnikova(6)

(1)NCIPD -- Sofia, (2)MHAT -- Burgas, (3)UMHAT -- Pleven, (4)UMHAT “Sv. Iv. Rilski” -- Sofia, (5)SHATIPD -- Sofia, (6)MHAT – Gabrovo
Summary: Clinical and laboratory findings of 6 out of 24 recently identified cases of acute human granulocytic anaplasmosis (HGA), confirmed serologically by detection of IgM antibodies against A. phagocytophilum, are described. Two of these cases revealed typical for the diseases clinical and laboratory constellation, but the other 4 cases presented confirmed Lyme borreliosis (three patients with erythema migrans and one patient with multiple erythema) together with serological data for HGA, i.e. clinical and laboratory confirmation of coinfection with B. burgdorferi and A. phagocytophilum. A review of the literature concerning etiology, pathogenesis, distribution, clinical manifestation and diagnosis of HGA is also presented. Investigations on HGA in Bulgaria are added. The results reveal the wide spread of HGA in Bulgaria as well as a need for clinical attention to avoid misdiagnosing of the disease.
Key words: Anaplasma phagocytophilum, anaplasmosis, Lyme borreliosis, erythema migrans
Address for correspondence:
Iva Hristova, М. D., NCIPD, 26, I. Sakazov Blvd., Bg -- 1504 Sofia, tel. +359 2 944 6999/229, e-mail: iva_hristova@yahoo.com


Type 2 diabetes and obstructive sleep apnea -- case report – 44, 2008, No 2, 68-72.
Zh. Boneva(1), M. Boyanov(2), P. Yovchevski(3) and Y. Asyov

(1)Department of Endocrinology -- Medical Institute -- Ministry of Interior, Sofia; (2) Clinic of Endocrinology -- University Hospital „Alexandrovska”; (3)Department of Nephrology -- Medical Institute -- Ministry of Interior, Sofia
Summary: Obstructive sleep apnea (OSA) can affect anyone, but it is more common in men. 50% of type 2 diabetic men have OSA. Diabetes and sleep apnea frequently coexist because obesity is a risk factor common to both conditions. Recent studies have shown that obstructive sleep apnea is independently associated with glucose intolerance and insulin resistance, and that continuous positive airway pressure (CPAP) improves insulin sensitivity. Treating sleep apnea with CPAP therapy can improve glycemic control and blood pressure. As this case demonstrates, clinicians need to assess sleep profiles among patients with diabetes.
Key words: obstructive sleep apnea, CPAP therapy, type 2 diabetes, polysomnography
Address for correspondence:
Zhivka Boneva, M. D., Department of Endocrinology, Medical Institute -- Ministry of Interior, 79, Gen. Skobelev Blvd., Bg -- 1606 Sofia, tel. +359 2 9821351, fax +359 2 9814594, e-mail: zhbonevaa@abv.bg


Molecular aspects of hemochromatosis – 44, 2008, No 2, 73-80.
T. Chervenkov(1), V. Glinkova(2), D. Gerova(1) and B. Galunska(1)

(1)Department of Biochemistry, Molecular Medicine and Nutrigenomics, Medical University -- Varna, (2)Clinics of Gastroenterology, University Hospital “Sv. Marina”, Medical University – Varna
Summary: Hemochromatosis is the most frequent hereditary disease, affecting the liver. It is characterized by excessive accumulation of iron in the parenchymal organs, leading to their injury. Iron homeostasis is mainly regulated by the absorption of iron in the intestine. This complex mechanism is carried out by numerous regulatory proteins like hepcidin and ferroportin. Among them, the peptide hormone hepcidin, secreted by the liver, is the major regulator of iron homeostasis in the organism. The information about the quantity of iron in the body is integrated by the liver and as a result of this the peptide hormone hepcidin is released. Increased iron levels stimulate the secretion of hepcidin which consequently inhibits the intestinal membrane iron transporter ferroportin and the iron absorption is suppressed. Transferrin receptors located on hepatocyte membranes respond to the iron levels in the blood. Their affinity to transferrin is diminished by the transmembrane protein HFE. The majority of cases of hereditary hemochromatosis are associated with mutations in the HFE gene. Recently mutations in other genes coding different iron regulatory proteins that play role in the pathogenesis of the disease were unveiled. The elucidation of their particular role will make possible to predict the phenotype from the genotype and thus to prevent the severe organ damage by effective preventive strategies.
Key words: hemochromatosis, HFE, hepcidin, ferroportin, transferrin receptor
Address for correspondence:  
Trifon Chervenkov, Department of Biochemistry, Molecular Medicine and Nutrigenomics, Medical University, 55, Marin Drinov Str., Bg -- 9002 Varna, tel.: +359 52 650061, 231, е-mail: trifon.chervenkov@gmail.com





Hypercalcitoninemia and papillary thyroid microcarcinoma -- a case report – 44, 2008, No 1, 84-88.
Zh. Boneva(1), G. Kirov(2), М. Protich(1), N. Кoleva(3), V. Paskalev(3) and Y. Assyov
(1)Department of Endocrinology, (2)Clinic of Surgery, (3)Department of Pathology, Medical Institute  --  Ministry of Interior  --  Sofia
Summary: Serum calcitonin assays are the most useful tumor marker for the diagnosis and follow up of medullary thyroid carcinoma. However, thyroid and extrathyroid conditions have been reported with elevated plasma calcitonin levels in the absence of medullary cancer, such as renal failure, endocrine tumors, Hashimoto’s thyrоiditis. We report a case of a 54-year-old patient with a thyroid nodule and an elevated basal plasma calcitonin level. The patient was asymptomatic, but underwent a left hemithyroidectomy. Interestingly, histopathological examination revealed a papillary microcarcinoma without C cell hyperplasia or medullary cancer.
Key words:  hypercalcitoninemia, рарillary thyroid cancer, medullary thyroid cancer, C-cells, diagnosis, treatment
Address for correspondence: Zhivka Boneva, M. D., Department of Endocrinology, Medical Institute  --  Ministry of Interior, 79, Gen. Skobelev Blvd., Bg  --  1606 Sofia, tel. +359 2 9821351, fax +359 2 9814594, e-mail: zhbonevaa@abv.bg




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