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Case reports

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Volume 50, 2014

 

bullet 5'2014

Spinal anesthesia in a patient with postpolio syndrome – Medical Review (Meditsinski pregled), 50, 2014, 5, 48-52.
M. P. Atanasova

Clinic of Anesthesiology and Intensive Care, UMHAT “Aleкsandrovska” -- Sofia
Summary: Postpolio syndrome is a disorder related to the recurrence of neuromuscular symptoms in survivors of paralytic poliomyelitis. Patients with preexisting disorders of the central nervous system such as postpolio syndrome present a challenge to the anesthesiologist. The use of regional anesthetic techniques in such patients has been considered relatively contraindicated. We used this case report to review pathophysiology, clinical features and anesthetic considerations and strategies in patients with postpolio syndrome. Our case report is an example of successfully performed regional anesthesia in a patient with postpolio syndrome. We conclude that the regional anesthesia should not be considered an absolute contraindication within this patient population and the decision about the anesthesia should be made on a case-by-case basis.
Key words:  postpolio syndrome, regional anesthesia, neuromuscular disorders
Address for correspondence:  Assoc. Prof. M. P. Atanasova, M. D., PhD, Clinic of Anesthesiology and Intensive Care, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia

 

 

Rare localization of carcinoid and the meaning of chromogranin A – Medical Review (Meditsinski pregled), 50, 2014, № 5, 53-55.
A. Ruseva(1), R. Lazarova(1), I. Kosturkov(1), V. Yanachkova(2), S. Yordanova(2) and D. Nikolovska(1)
(1)Clinic of Gastroenterology, Medical Institute, Ministry of Interior -- Sofia, (2)Department of Endocrinology, Medical Institute, Ministry of Interior -- Sofia
Summary: Carcinoid tumors are the most common neuroendocrine tumors of the gastrointestinal tract. Carcinoids are rare and slowly growing. They remain unnoticed until the metastasis or the carcinoid syndrome appears. The last one is peculiar especially for carcinoids originating from the middle part of the digestive system. Chromogranin A is a specific marker to estimate carcinoid volume and progression.
Key words:  carcinoid, chromogranin A, neuroendocrine tumors, radix mesenterii
Address for correspondence: A. Ruseva, M. D., Clinic of Gastroenterology, Medical Institute, Ministry of Interior, 79, Skobelev Blvd., Bg -- 1606 Sofia

 

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bullet 3'2014

Follow-up of a patient with superior orbital fissure syndrome after head gunshot injury -- 1 year later – Medical Review (Meditsinski pregled), 50, 2014, № 3, 42-45.
St. Valkanov(1), P. Valkanov(1), K. Slaveykov(2) and K. Trifonova(2)
(1)Department of Neurosurgery, (2)Department of Ophthalmology, University Hospital “Prof. Dr. Stoyan Kirkovich” -- Stara Zagora
Summary: Superior orbital fissure syndrome with purely traumatic etiology is a relatively ra­re complication of craniofacial trauma with frequency under 1%. This article reviews the existing literature about the syndrome and its treatment and presents a clinical case and the development of the symptoms during a one-year period.
Key words: trauma, head, superior orbital fissure syndrome, gunshot wound
Address for correspondence: St. Valkanov, M. D., Department of Neurosurgery, University Hospital “Prof. Dr. Stoyan Kirkovich”, 2, General Stoletov St., Bg -- 6000 Stara Zagora

 

 

 

Microsurgical reconstruction of the scalp -- a clinical case report – Medical Review (Meditsinski pregled), 50, 2014, № 3, 46-50.
Y. P. Yordanov(1), A. Shef(2) and J. M. Lasso(3)
(1)Unit of Plastic Surgery and Burns, Military Medical Academy -- Sofia, (2)Department of Dermatovenereology and Allergology, Military Medical Academy -- Sofia, (3)Unit of Plastic Reconstructive and Aesthetic Surgery, University Hospital Gregorio Marañón -- Madrid, Spain
Summary: Reconstruction of extensive scalp defects is challenging because of the paucity of adjacent extensible tissue, the critical nature of underlying structures and the aesthetic importance of the involved subunits. Microsurgical techniques have a pivotal role in achieving successful repair especially when deal with massive, complex and compromised defects. Detailed evaluation of the defect, appropriate flap and recipient vessel selection, meticulous microsurgical technique and appropriate postoperative care are crucial to uncomplicated healing. We present a case of a 44-year-old man, affected by an extensive multirecurrent squamous cell carcinoma in the left parieto-temporal region. At the time of the first visit the patient had already received several surgical interventions with local plasty techniques of repair. After a large tumor excision involving the underlying bone, a microsurgical reconstruction was performed with free latissimus dorsi muscle flap. A good functional, anatomic and aesthetic outcome was achieved. The reconstructive microsurgery plays a unique role in treating patients with advanced head and neck cancer. The functional and aesthetic outcomes are superior to those obtained with conventional reconstructive methods.
Key words: microsurgery, free flap, squamous cell carcinoma, tumor recurrence, advanced head and neck cancer
Address for correspondence: Yordan P. Yordanov, MD, PhD, Unit of Plastic Surgery and Burns, Military Medical Academy, 3, Sv. G. Sofiyski St., Bg -- 1606 Sofia, tel. +359 887 56 00 54, e-mail: yordanov_vma@abv.bg

 

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bullet 2'2014

Prevention of mother-to-child transmission of HIV   - Medical Review (Meditsinski Pregled), 50, 2014, No 2, 54-57.
R. Komitova
Department of Infectious Diseases, University Hospital “Sv. Georgi” -- Plovdiv
Summary: Dramatic reduction in mother-to-child transmission (МТСТ) of HIV has been achieved due to combination of antiretroviral therapy regimen before the third trimester of pregnancy, intrapartum treatment, postpartum maternal treatment and some form of neonatal treatment. Other prevention methods include caesarean section and refrainment from breastfeeding where possible. The 2010 revised WHO guidelines on MTCT provide more effective regimens. Once implemented, these recommendations could reduce the risk of MTCT to less than 5% in breastfeeding women and to less than 2% in non-breastfeeding populations and will ensure increased maternal and child survival. Here a case of successful prophylaxis of MTCT was presented. The child was born to a mother diagnosed with HIV infection in the third trimester of pregnancy.
Key words: mother-to-child transmission, antiretroviral therapy, antiretroviral prophylaxis
Address for correspondence: Assoc. Prof. Radka Komitova, MD, PhD, Infectious Diseases Department, University Hospital “Sv. Georgi”, 66 Peshersko shose Blvd., Bg -- 4002 Plovdiv, tel.+359 32 602 931, e-mail: radka.komitova@yahoo.com

 

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bullet 1'2014

Methotrexate-induced pneumonitis -- two case reports  - 50, 2014, № 1,47-51.
M. P. Atanasova, A. Todorov and St. Hinev
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Clinic of Anesthesiology and Intensive Care, UMHAT “Aleksandrovska” -- Sofia
Summary: Methotrexate is one of the most widely used disease-modifying drugs in the treatment of rheumatoid arthritis. Methotrexate-induced pneumonitis is rare, but represents one of the most serious side effects of methotrexate. It is necessary to highlight the epidemiology, pathophysiology, clinical features and diagnostic criteria of methotrexate-induced pneumonitis. We present two patients with rheumatoid arthritis who developed methotrexate-induced pneumonitis with high probability. The following conclusions can be made: methotrexate-induced pneumonitis is a diagnosis of exclusion; patients with a probable diagnosis methotrexate-induced pneumonitis are admitted to ICU with severe clinical features and with an increased risk of death; a few more studies are required in order to establish guidelines for adequate treatment.
Key words: methotrexate, rheumatoid arthritis, pneumonitis, intensive care
Address for correspondence: M. P. Atanasova, M. D., Clinic of Anesthesiology and Intensive Care, UMHAT “Aleksandrovska”, 1, Sv. G. Sofiyski St., Bg -- 1431 Sofia .

 

 

 
Microsurgical reconstruction
of a complex mid-facial defect -- a case report  - 50, 2014, № 1,52-58.
Y. P. Yordanov(1), A. Shef(2) and J. M. Lasso(3).
(1)Unit of Plastic Surgery and Burns -- Military Medical Academy -- Sofia, (2)Department of Dermatovenereology and Allergology, Military Medical Academy -- Sofia, (3)Unit of Plastic Reconstructive and Aesthetic Surgery, University Hospital Gregorio Marañón -- Madrid, Spain
Summary: Reconstructive microsurgery is a branch of plastic surgery that includes a variety of surgical techniques requiring an operating microscope or magnifying loupes. Microsurgical free tissue transfer has become the gold standard for reconstruction of large tri-dimensional defects affecting the head and neck area. The functional and aesthetic outcomes are superior to those obtained with conventional reconstructive methods. A 56-year-old woman with xeroderma pigmentosum presented with an extensive, invasive multirecurrent basal cell carcinoma in the left naso-orbital region with affectation of the anterior skull base. At the time of the first visit the patient had already received a full course of radiotherapy, several surgical interventions and bilateral neck dissection. After a large tumor excision, a free flap microsurgical reconstruction was performed, with tissue harvested from the abdominal area. At the moment in Bulgaria such patients are treated only with chemotherapy and radiotherapy as a unique palliative option. The reconstructive microsurgery plays a unique role in treating patients with advanced head and neck cancer.
Key words: microsurgery, free microvascular flap, advanced basal cell carcinoma, tumor recurrence, head and neck reconstruction
Address for correspondence: Yordan P. Yordanov, MD, PhD, Unit of Plastic Surgery and Burns, Military Medical Academy, 3, Sv. G. Sofiisky Blvd, Bg -- 1606 Sofia, tel. +359 887560054, e-mail: yordanov_vma@abv.bg

 

Last update of the page: 12.12.2014

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