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Case reports

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Vol. 45, 2009

 

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4'2009

Case of Crimean-Congo hemorrhagic fever confirmed by Real-time RT-PCR and nested RT-PCR - 45, 2009, No 4, 87-91.
N. Kalvatchev(1), L. Andonova(2), M. Baev(3), I. Christova(1), M. Tiholova(2) and T. Chervenyakova(2)
(1)National Center of Infectious and Parasitic Diseases -- Sofia, (2)Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University -- Sofia, (3)Hospital „Dr. Ivan Seliminski” -- Sliven
Summary:
Crimean-Congo hemorrhagic fever (CCHF) is a viral disease, often severe and sometimes lethal. It is described in about 30 countries around the world including Bulgaria, Albania, former Yugoslavia, Ukraine, Russia, Turkey, and recently, in Greece. Rapid and accurate diagnostic algorithm in suspected patients is essential for a proper treatment of infection, favorable outcome and prevention of its spread. Molecular techniques like polymerase chain reaction (PCR) and its modifications Real-time RT-PCR and Nested RT-PCR were recently introduced for diagnostics of CCHF in Bulgaria. Here we present a case of this viral hemorrhagic fever in a 66-year-old man from the city of Sliven that was confirmed by the above mentioned molecular methods. Modified and adapted by us one-step Real-time RT-PCR and Nested RT-PCR to demonstrate the virus of CCHF are fast, specific and sensitive methods suitable for early diagnosis of patients suspected for this infection.
Key words: Crimean-Congo hemorrhagic fever, Real-time RT-PCR, Nested RT-PCR
Address for correspondence: Nikolay Kalvatchev, M.D. National Reference Vector-borne Infections Laboratory, National Center of Infectious and Parasitic Diseases, 26, Yanko Sakazov Blvd., Bg -- 1504 Sofia, tel. + 359 2 931 81 31, e-mail: nkalvat@yahoo.com

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3'2009

Measles in the stage of elimination of the disease in Bulgaria: clinical and epidemiological study. a report of two imported cases 45, 2009, No 3, 71-76
I. Baltadzhiev (1), Y. Stoilova (2), O. Boykinova (1) and Z. Ambareva(3)
(1)Department of Infectious Diseases, Clinical Parasitology and Tropical Medicine, (2)Department of Hygiene, Ecology and Epidemiology, (3)Student, Medical University -- Plovdiv
Summary: Measles is a universal infection with about a 100% contagious index that causes severe complications and high lethality among children.Studies of measles morbidity in different groups have shown that elimination of the disease could not be based on a single dose administration of the MMR vaccine. The effectiveness of mass measles immunoprophylaxis and its influence on the epidemic process is a criterion for assessing the likelihood of its elimination in most European countries -- a priority of the WHO. However, the risk of imported cases from countries with poor epidemiological control increases. The authors describe two imported cases of measles in Bulgaria; one of themis that of a teenager who had not received the completevaccination scheme. An analysis of preventive measures and epidemiological control against the disease is performed. Measles morbidity and mortality trends from 1921-2009 in Bulgaria are discussed. A number of problems, remaining to be solved are listed, aimed at improvingthe vaccine coverage ofchildren from risk groups, and selectivebooster immunization of individuals who have lost their postvaccinal immunity.
Key words: measles, imported infection, vaccination, elimination
Address for correspondence: I. Baltadzhiev, M. D., Department of Infectious Diseases, Clinical Parasitology and Tropical Medicine, Medical University, 15A, Vasil Aprilov Str., Bg -- 4000 Plovdiv

 

Uncommon extragenital form of lymphogranuloma venereum: a “new” therapeutic option foran “ancient disease”?
G. Tchernev(1), P. Nenoff(2), M. Costa(3) and C. Salaro(3) – 45, 2009, No 3, 77-82.
(1)Department of Dermatology, Venereology and Dermatosurgery, MVZ  Kirchheim, Germany, (2)Laboratorium fuer Medizinische Mikrobiologie -- Moelbis, Germany, (3)Instituto de Dermatologia Professor Rubem David Azulay/Santa Casa de Misericórdia do Rio de Janeiro -- Brazil
Summary: Lymphogranuloma venereum (LGV), also known as lymphogranuloma inguinale, tropical bubo, Nicholas-Favre disease, and sixth venereal disease, is an infection caused by a variety of the bacterium Chlamydia trachomatis (so called invasive serovars L1, L2, or L3). LGV is spread by direct sexual contact through the genitals, rectum, or mouth. Once in the body, Chlamydia spp. could reproduce themselves in the lymph nodes and could spread to other organs provoking different complications. Due to their non-typical clinical picture, extragenital manifestations of this disease represent serious diagnostic pitfalls,thus leading to progression and dissemination of the infection. The manuscript hereby presents a rare case of extragenital LGV, clinically mimicking cutaneous tumour. The article also focuses also on alternative therapeutic approaches, such asthe surgical excision at stage 1a, leading to good therapeutic results in certain patient groups. The question if the surgical method we propose could be used as a standard therapy at stage 1a, remains open. Further studies on a larger number of patients are needed to better evaluate efficacy and feasibility of this option.
Key words: Lymphogranuloma venereum, cutaneous tumour, dermatosurgery, extragenital lymphogranuloma.
Address for correspondence: Georgi Tchernev, M.D., Department of Dermatology, Venereology and Dermatosurgery, MVZ Kirchheim unter Teck/VOP, Steingaustrasse 13, 73230 Kirchheim unter Teck, Baden Wuerttenberg, Germany, tel. 0049 7021 9300220, fax: 0049 7021 9300221, GSM 0049 1745814312, e-mail: georgi_tchernev@yahoo.de

 

Microsporum canis as a cause of tinea capitis profunda -- experience with oral terbinafine in an infant – 45, 2009, No 3, 83-87.
A. Laumanns(1), I. Schulze(1), G. Tchernev(2) and P. Nenoff(3)
(1)MVZ Dr. Matthias Schulze & Ina Schulze -- Markkleeberg, Germany, (2)Department of Dermatology, Venereology and Dermatosurgery, MVZ -- Kirchheim, Germany, (3)Laboratorium fuer medizinische Mikrobiologie -- Moelbis, Germany
Summary: An 1 1/2-year-old girl suffered from tinea capitis profunda caused by Microsporum canis. In addition to a topical antifungal therapy, the infant was treated with terbinafine per os as an individual treatment trial. The tolerability of this antifungal substance was excellent. Four-week-treatment of kerion celsi was enough to achieve restitutio ad integrum.
Key words: tinea capitis profunda, kerion celsi, dermatophyte, Microsporum canis, terbinafine
Address for correspondence: Prof. Pietro Nenoff, Laboratorium fuer medizinische Mikrobiologie, Strasse des Friedens 8, D-04579 Moelbis, Germany, tel.: +49-34347-50 323, fax: +49-34347-50 123, e-mail: nenoff@mykologie-experten.de

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2'2009

Medial reduction mammoplasty with areolar recentralisation -- a surgical resection model for medial breast quadrant cancer – 45, 2009, No 2, 77-80.
V. Molov(1), Iv. Traikov(1), R. Romanski(2) and K. Yanev(2)
(1)Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University – Plovdiv, (2)Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University -- Sofia
Summary: Oncoplastic breast cancer surgery is a novel approach to surgical treatment. Medial breast quadrant tumors face the surgeon with specific features. The aim of this study is to assess the early postoperative results of medial reduction mammoplasty with areolar recentralisation as an oncoplastic breast cancer surgical model. The clinical case of BBK -- 69-year-old patient with diagnosis of left breast cancer T2N0M0 is presented. The tumor location was at the border of inner superior/inferior quadrants. The choosen surgical treatment was medial reduction mammoplasty with areolar recentralisation. The tumor was included in the resected part. Thus the oncological part of operation was a Veronesy quadrantectomy with axillary dissection through a separate incision. Uncomplicated postoperative period and excellent cosmetic result were the additional motivation factors for the patient to accept postoperative radio- and chemotherapy as a part of treatment protocol. Surgical resection model of medial reduction mammoplasty is well accepted for the treatment of early stage breast cancer. The model is associated with wider resection than the standard quadrantectomy and ensures good cosmetic results. More researches are needed on the oncological safety of oncoplastic surgery.
Key words: mammoplasty, medial breast quadrant cancer
Address for correspondence:
V. Molov, M. D., 76, Al. Stamboliiski Blvd., Bg -- 4000 Plovdiv, е-mail: oncoplasticsg@abv.bg

 

Renal osteodystrophy with maxillary deformity in a patient on hemodialysis -- a case report and review of the literature – 45, 2009, No 2, 81-85.
P. Pechalova(1), A. Bakardzhiev(2), E. Poryazova(3), G. Hadzhigeorgiev(4), Z. Zapryanov(3), P. Mandev(5) and S. Dimitrov(1)
(1)Maxillofacial Surgery Department, Faculty of Dental Medicine, (2)Oral Surgery Department, Faculty of Dental Medicine, (3)General and Clinical Pathology Department, (4)Diagnostic Imaging Department, (5)Anesthesiology and Resuscitation Department, Medical University -- Plovdiv
Summary: Renal ostedystrophy is one of the most common complications affecting patients with chronic renal failure on maintenance dialysis, while macrognathia secondary to renal ostedystrophy is rare. A case of a 20-year-old man with a 7-year history of dialysis and macrognathia of the upper jaw is described. The patient was treated with corrective surgical intervention. Pertinent literature is reviewed.
Key words: renal ostedystrophy, upper jaw
Address for correspondence: Petya Pechalova, M. D., Maxillofacial Surgery Clinic, UMHAT „Sv. Georgi”, Medical University, 66, Peshtersko shoes Str., et. IV, Bg -- 4000 Plovdiv, e-mail: pechalova@abv.bg, GSM 0898 468 498

Odontogenic cellulites of the orbit – 45, 2009, No 2, 86-90.
P. Sapundzhiev
Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine -- Sofia
Summary: Orbital cellulites and visual sequel like temporary or permanent loss of visual acuity and vision, may occur as a result of: 1 -- direct extension of odontogenic infection to the orbit, or by an ascending facial thrombophlebitis, and 2 -- local extension of paranasal sinus infection to the orbit. Abscesses that extend to the posterior orbital space can even be lifethreatening, as the infection may spread through the lower and upper ophthalmic veins to the cavernous sinus and through the optic canal to the brain. Although orbital space infections are a relatively rare sequellae of dental or maxillary sinus infection, such cases have been reported. We present a 23-year-old female and a 60-year-old male with unfavourable cellulites of the orbits with odontogenic origin. In the first case, orbital cellulitis developed as a sequela from infected odontogenic cyst in the left maxillary sinus, and in second case from acute purulent sinus infection in the right maxillary sinus. In the first case when the infection was cured, a permanent loss of vision in the left eye was registered. In the second case, a significant decrease in visual acuity was repaired. These two cases demonstrate the need for early diagnosis and close collaboration between dentists, ophthalmologists and oral or maxillofacial surgeons, using adequate treatment to orbital cellulites with odontogenic origin.
Key words: orbital cellulites, maxillary sinus, odontogenic cyst
Address for correspondence:
Assoc. Prof. Peter Sapundzhiev, M. D., Ph. D., Specialized University Hospital for Active Treatment in Maxillofacial Surgery, 1, Sv. G. Sofiiski Blvd., Bg -- 1431 Sofia, e-mail: psapundjiev@abv.bg, GSM +359 886 629 425

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1'2009

Metastasis of malignant melanoma in adrenal gland -- a case report – 45, 2009, No 1, 77-81.
Zh. Boneva(1) , G. Kirov(2), P. Yovchevski(3), V. Paskalev(4), N. Koleva(4), N. Smilov(5), Y. Assyov and M. Hristova
(1)Department of Endocrinology, (2)Clinic of Surgery, (3)Department of Nephrology, (4)Department of Pathology, (5)Department of Urology, Medical Institute, Ministry of Interior -- Sofia
Summary: The formations in the adrenal glands often present a diagnostic challenge. A large part of them are functioning adenomas. However, in the differential diagnostic algorithm, there should be taken into consideration primary or secondary malignant tumors and especially metastases of malignant melanomas. Melanoma sometimes has the unique capability to metastasize with isolated metastases after a long period. We present a case of isolated metastasis in the left adrenal gland 8 years after surgical treatment and chemotherapy for a malignant melanoma. The patient underwent adrenalectomy followed by chemotherapy and remained asymptomatic for 6 months after treatment. Serum levels of LDH were normal pre- and postoperatively. Taking into consideration the data in the literature and on the current case, we believe that adrenalectomy should be considered in highly selected patients, such as those with limited extra-adrenal metastatic disease in whom the operation may improve the prognosis.
Key words: malignant melanoma, adrenal metastasis, adrenalectomy
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 2 981 45 94, e-mail: zhbonevaa@abv.bg

 

 

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