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Case reports

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Vol. 47, 2011

 

bullet 4'2011

Post traumatic desmoplastic malignant melanoma -- a rare case from the clinical practice - 47, 2011, №  4, 73-76.
Yu. Ananiev(1), G. Tchernev(2) and M. Galabova(1)
(1)Department of General and Clinical Pathology, Medical Faculty, Trakian University -- Stara Zagora, (2)Department of Dermatology and Venerеology, Medical Faculty, Trakian University -- Stara Zagora
Summary: Desmoplastic melanoma (DM) is an uncommonly encountered type of malignant melanoma. Various authors report that besides sun irritation, etiopathogenetic role can play trauma. However, often the diagnosis of DM can be delayed and due to that the neoplasm is found at an advanced stage. We announce a patient presenting with lesions evolving for more than 10 years and without histological verification. In multiple dermatological examinations conducted within this period, there was not established clinical and dermatoscopic evidence for melanocytic lesion. We could not found melanocytic pigment nets, regression areas, pigmented points and pigmented oval conglomerates. Slight asymmetry regarding structure and color was established clinically and dermatoscopically. After performed oval excision and histopathological examination, it was found that the diagnosis is desmoplastic malignant melanoma evolving probably on the basis of post-traumatic lesion.
Key words:  desmoplastic melanoma, trauma, morphology
Address for correspondence: Assoc. Prof. Georgi Tchernev, M.D., Ph. D., Department of Dermatology and Venerеology, Faculty of Medicine, Trakian University, 11, Armeyska Str., Bg -- 6000 Stara Zagora, tel. + 359 885 588424, e-mail: georgi_tchernev@yahoo.de

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bullet 3'2011

Basal cell carcinoma with atypical localisation and uncommon clinical presentation: complete remission after surgical excision - 47, 2011, № 3, 60-63.
Yu. Ananiev(1), G. Tchernev(2) and M. Galabova(1)

(1) Department of General and Clinical Pathology, Medical Faculty, Trakian University -- Stara Zagora, (2) Department of Dermatology and Venereology, Medical Faculty, Trakian University -- Stara Zagora.
Summary: Basal cell carcinoma (BCC) is the most common malignancy of the skin accounting for approximately 80% of all cutaneous cancers. There are multiple causes leading to its occurrence, and the most important are related to intense ultraviolet radiation and lighter skin patients. Basal cell carcinomas develop in the basal cell layer of the skin. Sun light exposure leads to the formation of thymine dimers, a form of DNA damage. While DNA repair removes most UV-induced damage, not all crosslinks are excised. There is, therefore, cumulative DNA damage leading to mutations. Apart from the mutagenesis, sunlight depresses the local immune system, possibly decreasing immune surveillance for new tumor cells. Basal cell carcinoma is the most common skin cancer. It occurs mainly in fair-skinned patients with a family history of this cancer. Sunlight is a factor in about two-thirds of these cancers; therefore, doctors recommend early skin screening. One-third occur in non-sun-exposed areas. The typical localizations of BCC are face and neck, but rarely, this neoplasm can be found in other areas of the body. In this paper, we present a patient with BCC with atypical localization and atypical clinical course, requiring regular therapeutic approach and histological verification in order to properly diagnose and monitor the patient.
Key words: basal cell carcinoma, elliptical excision, histologic verification
Address for correspondence: Assoc. Prof. Georgi Tchernev, M.D., Ph. D., Department of Dermatology and Venerеology, Faculty of Medicine, Trakian University, 11, Armeyska Str., Bg -- 6000 Stara Zagora, tel. + 359 885 588424, e-mail: georgi_tchernev@yahoo.de

 

 

Paranoid schizophrenia: a case study - 47, 2011, № 3, 64-69.
E. Bozhkova(1), D. Zhekova(1) and G. Onchev(1, 2)

(1)Psychiatric Clinic, Alexandrovska University Hospital, (2)Department of Psychiatry, Medical University -- Sofia
Summary: A clinical case of a patient with paranoid schizophrenia with sophisticated system of delusions described in a book written by the patient, is presented. The treatment is carried out by a team lead by a psychiatrist and a psychoanalyst, firstly in hospital, and afterwards in a day centre, following which the patient started a new job. The approach used by the team is described -- including assurance of adherence to treatment, intake of conventional neuroleptics, psychoeducation, and psychological work based on a series of cautious confrontations coupled with showing respect, interest and support.
Key words: paranoid schizophrenia, psychoanalysis, psychoeducation
Address for correspondence: Elka Bozhkova, MSci, Psychiatric Clinic, Alexandrovska University Hospital, 1, Sv. G. Sofiisky Str., Bg -- 1431 Sofia, e-mail: mail@bozhkova.info

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bullet 2'2011

Febrile catatonia: a case report - 47, 2011, 2, 52-58.
G. Onchev
(1, 2) and L. Kavrakova(2)
(1)Department of Psychiatry, MU -- Sofia, (2)Clinic of Psychiatry, UMHAT “Alexandrovska” -- Sofia
Summary: An unusual episode of febrile catatonia in 52-year old male patient with 20 year history of mental illness is described. Differential diagnosis is made with malignant neuroleptic syndrome, and in wider context, with amentia in severe physical conditions. Electro-convulsive therapy is the life-saving treatment. The syndrome escalation in the illness trajectory is interpreted as a psychotic continuum illustrating the limitations of categorial diagnoses. The presented review of catatonias shows that they are not indicative of schizophrenia, and are more common in organic and affective states. Their prevalence is parallel to that of the infectious illnesses: steadily decreasing in the developed countries, and still high in the Third world. Catatonias (like all psychiatric syndromes) may be phenocopies of different non-psychiatric pathologies.
Key words: febrile catatonia, catatonias, malignant neuroleptic syndrome, electro-convulsive therapy, phenocopies
Address for correspondence: Assoc. Prof. Georgi Onchev, M. D., Department of Psychiatry, Medical University, 1, Sv. G. Sofiisky Str., Bg -- 1431 Sofia, e-mail: georgeonchev@hotmail.com

 

 

Polyuria in a patient with diabetes mellitus hides an accompanying high-grade hypercalcemia - 47, 2011, 2, 59-63.
V.Evtimova(1), Y. Asyov(1), D. Dardanov(2), Zh. Boneva(3), Pl. Yovchevski(4), N. Koleva(5), V. Marinov(1) and S. Yordanova(1)
(1)Medical University -- Sofia, (2)Clinic of Surgery, (3)Department of Endocrinology, (4)Department of Nephrology, (5)Department of Pathology, Medical Institute -- Ministry of Interior -- Sofia
Summary: Polyuria is a serious symptom, which should never be underestimated due to its clinical severity and the multiple underlying pathophysiological processes. The diagnosis of the current disease is sometimes very difficult and depends on its association with other symptoms. From a differential-diagnostic point of view, multiple conditions might be discussed such as endocrinologic disorders, electrolyte balance disorders, drugs, renal, psychiatric or other diseases. We present a clinical case of a patient with diabetes mellitus and manifested polyuria, which has for a long time been considered a symptom of the diabetes. Despite the insulin treatment, for a two-year period a worsening of the polyuria to a degree of a heavy dehydration was observed in the patient which led to hospitalization. Biochemistry showed a severe hypercalcemia with ECG manifestations. Hormonal, ultrasound and scintigraphic evidence of a para­thy­roid adenoma and a primary hyperpara­thyroidism were also observed in the pa­tient. The surgical removal of the parathyroid adenoma has led to management of the extreme hypercalcemia which has lowered the risk of rhythm and other disorders related to that condition. The presentation of this case has the purpose of focusing the attention of physicians on the plethora of diseases that may cause the same symptom, polyuria, and on the fact that the outcome of the disease depends on active and persistent search for correct diagnosis.
Key words: polyuria, hypercalcemia, primary hyperparathyroidism, diabetes mellitus
Аddress for correspondence: Veselina Evtimova, M. D., Department of Endocrinology, Medical Institute -- Ministry of Interior, 79, “Gen. Scobelev” Blvd., Bg -- 1606 Sofia, tel. +359 2 9821351, e-mail: v_ess@abv.bg

 

 

Whirlpool dermatitis associated with non-puerperal mastitis -- a diagnostic challenge - 47, 2011, 2, 64-66.
G. Kupcova
(1), J. C. Cardoso(2), G. Tchernev(3), N. Sucha(4), J. Ananiev(5) and M. Penev(6)
(1)Department of Dermatology and Venereology -- Kezmarok, Slovak Republic, (2)Dermatology and Venereology Department, University Hospital -- Coimbra, Portugal, (3)Department of Dermatology and Venereology, Trakian University, Faculty of Medicine -- Stara Zagora, (4)Department of Dermatology and Venereology -- Stara Lubovna, Slovak Republic, (5)Department of General and Clinical Pathology, Faculty of Medicine, Trakian University -- Stara Zagora, (6)Department of II Internal Clinic, Trakian University, Faculty of Medicine -- Stara Zagora
Summary: Infections caused by Gram-negative bacteria are ranked among the rare skin diseases. They occur predominantly in immunodeficient patients or induce the outburst of nosocomial infections. At present, the significance of potential pathogens-related risk is increasing, especially in relation to massive atten-dance of aquatic facilities with whirlpools and hot tubs. Numerous papers dem-onstrate the necessity of adhering to principles of accurate installation, opera-tion and control of whirlpool baths, as well as disinfection and maintenance of these facilities. For the physician, each follicular rash, especially that after hav-ing a whirlpool bath, is a signal which can be associated with a poorly main-tained whirlpool facility. The article presents a rare case of a female patient who had a whirlpool bath followed by eruption of folliculitis with non-puerperal masti-tis and locoregional lymphadenitis caused by Pseudomonas aeruginosa. After systemic treatment with Ciprofloxacin, complete remission was observed.
Key words: Gram-negative folliculitis, non-puerperal mastitis, lymphadenitis, potential pathogens
Address for correspondence: Assoc. Prof. Georgi Tchernev, M.D., Ph. D., Department of Dermatology and Venerology, Trakian University of Stara Zagora, Faculty of Medicine, 11, Armeyska Str., Bg -- 6000 Stara Zagora, tel. + 359 885 588424, e-mail: georgi_tchernev@yahoo.de

Last update of the page: 17.02.2012


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