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Case reports

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Volume 51, 2015

 

bullet 6'2015

Case study of a rare comorbidity between schizophrenia and ankylosing spondylitis - Medical Review (Meditsinski pregled), 51, 2015, № 6, 47-52.
D. Ignatova and G. Onchev
Department of Psychiatry, Medical University -- Sofia
Summary: A rare case of comorbidity between schizophrenia and ankylosing spondylitis is presented in a 45-year-old male who has family history of rheumatoid diseases and is positive for HLA B7 antigen. Both disorders are chronic disabling illnesses with early onset, atypical presentation, episodic course with gradual worsening and growing disability over time. A chronological parallel between the two co-occurring disorders in the case is presented, showing clear temporal co-incidence of the episodes and remissions of both disorders. Beneficial effect of combining antipsychotic treatment with disease-modifying anti-rheumatic agents is discussed, as well as the growing body of evidence suggestive of a negative correlation between the disorders resulting in diminished rates of rheumatoid arthritis in schizophrenic patients. Consequently, the hypothesis of the autoimmune nature of schizophrenia and a review of the relation of HLA and autoimmune mechanisms in schizophrenia are discussed.
Key words: schizophrenia, ankylosing spondylitis, HLA B27, disease-modifying antirheumatic drugs, autoimmune mechanism of schizophrenia
Address for correspondence: Desislava Ignatova, M. D., Clinic of Psychiatry, University Multiprofile Hospital for Active Treatment “Aleksandrovska”, 1, Sv. G. Sofiyski, St., Bg -- 1431 Sofia, e-mail: d.a.ignatova@gmail.com

 

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bullet 5'2015

Gilbert’s syndrome manifestation in patient with schizophrenia during administration of olanzapine - Medical Review (Meditsinski pregled), 51, 2015, 5, 42-49.
R. Iakimova and M. Pandova
Second Clinic of Psychiatry, UMHATNP “Sv. Naum” -- Sofia
Summary: We present a case study of manifestation of Gilbert’s syndrome in a schizophrenic patient during treatment with olanzapine. After its substitution with risperidone the bilirubin level dropped twice, but remained elevated in the absence of jaundice and somatic complaints. We discuss the prevalence of Gilbert’s syndrome in schizophrenia as well as its pathogenic and pathophysiologic mechanisms, the risk factors for its manifestation and the appropriate therapeutic approaches in the presence of such comorbidity.
Key words: Gilbert’s syndrome, schizophrenia, olanzapine
Address for correspondence: R. Iakimova, M. D., Second Clinic of Psychiatry, UMHATNP “Sv. Naum”, 1, Luben Rusev St., Bg -- Sofia, tel. +359 887 80 25 61, e-mail: rosica.iakimova@abv.bg

 

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bullet 4'2015

Post-varicella immune thrombocytopenia -- a rare complication of a common disease   - Medical Review (Medicinski pregled), 51, 2015, 4, 44-49.
R. Komitova(1), I. Boev(1), I. Mumd
zhiev(2), A. Tsoneva(1) and A. Gocheva(1)
(1)Department of Infectious Diseases, University Hospital “Sv. Georgi” -- Plovdiv, (2)Department of Pediatrics and Genetic Diseases, University Hospital “Sv. Georgi” -- Plovdiv
Summary: Immune thrombocytopenia (ITP) continues to intrigue pediatricians and hematologists alike. Patients can have a dramatic presentation with wide-spread bleeds over a few days. Recent guidelines recommend a conservative, observation-based approach for the majority of patients with newly diagnosed childhood ITP. However, difference of opinion among physicians in treatment recommendation is not uncommon. The manuscript is an update on newly diagnosed ITP in children. Pros and cons of the first line drugs, such as corticosteroids, intravenous immunoglobulin and anti-D Immunoglobulin are listed. Two different cases with post-varicella ITP with favourable outcome are presented and followed-up. The collaboration with pаediatrician hematologist for proper management is underlined as ITp is a relatively rare disorder and should always be managed based on a team approach.
Key words: immune thrombocytopenia, post-varicella, management, paediatrics
Address for correspondence: Assoc. Prof. R. Komitova, M.D., Department of Infectious Diseases, University Hospital “Sv. Georgi”, 66, Peshtersko shose Blvd., Bg -- 4000 Plovdiv

 

 

Multiple myeloma presenting with renal failure - Medical Review (Medicinski pregled), 51, 2015, № 4, 50-54.
M. Nikolova, A. Iliev, Vl. Milenova, T. Tsocheva, Zh. Hristova, E. Hadzhiev, N. Houbanov, D. Kochev, Yu. Petrova, R. Krasteva, M. Krupev and B. Bogov
University Hospital “Alexandrovska”, Medical University -- Sofia
Summary: Multiple myeloma is a clonal plasma cell proliferative disease with monoclonal protein production (immunoglobulins or light chains), hypercalcemia and bone le­sions. At the diagnosis the majority of patients have renal functional im­pairment and proteinuria. The authors present four patients (two female and two male, aged 62-74 years) with multiple myeloma diagnosed in the course of diagnostic evaluation for newly found renal failure with anemia, increased ESR, proteinuria, and in two patients -- with bone pains, too.
Key words: myeloma, renal failure, proteinuria
Address for correspondence: Milena Nikolova, M. D., Clinic of Nephrology, University Hospital “Alexandrovska”, 1, Sv. G. Sofiiski St., Bg -- 1431 Sofia, e-mail: milena_i_dani@abv.bg

 

 

Oral lichenoid lesions on the buccal mucosa due to methotrexate -- a case report   - Medical Review (Medicinski pregled), 51, 2015, 4, 55-58.
T. Sbirkova(1) and G. Tomov(2)
(1)Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv, (2)Division of Oral Pathology, Faculty of Dental Medicine, Medical University -- Plovdiv
Summary: Many drugs are associated with lichenoid lesions of the skin and oral mucosa. In this study, we report a case of bilateral oral lichenoid lesions on the buccal mucosa that appeared during low-dose methotrexate treatment. The patient is a 63-year-old woman on methotrexate for rheumatoid arthritis. The pathogenic mechanism underlying the development of oral lichenoid lesions due to drugs is unknown. There is no specific test for the diagnosis of oral lichenoid lesions induced by drugs. In most of these cases topical steroid treatment is ineffective. Usually the lesions disappear after discontinuation of the drug.
Key words: oral lichenoid lesions, methotrexate, rheumatoid arthritis
Adress for correspondence: Tanya Sbirkova, M.D., Department of Oral Surgery, Facultry of Dental Medicine, Medical University, 3, “Hristo Botev” Blvd., Bg -- 4000 Plovdiv, tel. +359 888493145, e-mail: tanya_sbirkova@abv.bg

 

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bullet 3'2015

Impacted fourth maxillary molar teeth -- two cases in nonsyndromic patients - Medical Review (Medicinski pregled), 51, 2015, № 3, 47-50.
T. Sbirkova and P. Pechalova
Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv
Summary: Hyperdontia is defined as presence of extra (supernumerary) teeth. The etiology of supernumerary teeth is still unknown. Different theories have been presented based on epidemiological studies. Supernumerary teeth are asymptomatic in most cases. They may lead to malocclusions, aesthetic, functional and psychological problems. This article provides an overview of the literature of frequency, distribution and classification of supernumerary teeth. We describe two clinical cases in nonsyndromic patients with impacted fourth maxillary molar teeth.
Key words: supernumerary teeth, hyperdontia, impacted fourth molar teeth
Address for correspondence: Tanya Sbirkova, D.D., Department of Oral Surgery, Faculty of Dental Medicine, Medical University, 3, Hristo Botev Blvd., Bg -- 4000 Plovdiv, tel. +359 888493145, e-mail : tanya_sbirkova@abv.bg

 

 

Coronectomy of impacted mandibular premolar -- a case report with 4-years follow-up - Medical Review (Medicinski pregled), 51, 2015, № 3, 51-54.
N. Pavlov(1) and P. Pechalova(2)
(1)Oral Surgeon, Private Practice -- Plovdiv, (2)Department of Oral Surgery, Faculty of Dental Medicine, Medical University -- Plovdiv
Summary: Coronectomy is a method for treatment of impacted mandibular third molars located nearby the mandibular channel. Coronectomy is recommended for treating of ankylosed teeth too, but mainly as a method for preservation of alveolar ridge for subsequent prosthetic rehabilitation. The authors describe a case of coronectomy of the impacted second mandibular premolar. After 4-years follow-up the residual root is covered with healthy bone. The advantages and disadvantages of the technique are discussed.
Key words: mandibular premolar, coronectomy, advantages, disadvantages
Address for correspondence: Nikolai Pavlov, M. D., 15А, Lozarska St., Bg -- 4000 Plovdiv, tel. +359 888254906, e-mail: nikolai.v.pavlov@gmail.com

 

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bullet 2'2015

Tinea barbae profunda caused by Trichophyton rubrum --  an uncommon finding, due to an unusual mechanism of infection? - Medical Review (Medicinski pregled), 51, 2015, № 2, 49-53.
A. Chokoeva(1), L. Zisova(1) and A. Chapanova(2)

(1)Department of Dermatology and Venereology, Medical University --  Plovdiv, (2)University Clinic of Dermatology and Venereology, University Hospital “Sv. Georgi” --  Plovdiv
Summary: Tinea barbae is a fungal infection of the beard, which is usually caused by zoophilic dermatophyte species. The infection is most commonly affecting farm workers and livestock breeders, but it can also occur in immunocompromised individuals, as well as in patients with diabetes mellitus. The anthropophilic dermatophyte T. rubrum can be the causative agent of this type of infection extremely rarely. We present a case of a healthy patient with Tinea barbae, caused by T. rubrum, due to autoinoculation by concomitant Tinea pedis et ungium, treated with antibiotic therapy --  without effect, as a result from misdiagnosis. An excellent therapeutic result was achieved with a course of antifungal therapy for 2 months. We emphasize the importance of additional diagnostic procedures in healthy patients, who are clinically suspected for bacterial folliculitis. A targeted examination for concomitant fungal infection is necessary. The autoinoculation is a relatively rare mechanism of infection, which often leads to misdiagnosis.
Key words: tinea barbae, Trichophyton rubrum, autoinoculation, tinea pedis
Address for correspondence: A. Chokoeva, M.D., Department of Dermatology and Venereology, Medical University, 15A, Vasil Aprilov Blvd., Bg --  4000 Plovdiv

 

 

Tracheal bronchus in a one-year old child identified by conventional computed tomography - Medical Review (Medicinski pregled), 51, 2015, № 2, 54-56.
S. Mileva(1), M. Yankova(1), I. Galeva(1), S. Georgieva(2) and D. Zlatareva(2)
(1)Pediatric Department, Alexandrovska Hospital, Medical University --  Sofia, (2)Imaging Clinic (Radiology), Alexandrovska Hospital, Medical University --  Sofia
Summary: Tracheal bronchus is a rare congenital tracheobronchial anomaly. It occurs most often asymptomatic and is incidental bronchoscopic or radiographic finding. It can present with clinical manifestations such as stridor, persistent or recurrent pneumonia, and atelectasis. We present this case as a rare anomaly discovered during diagnostic specification of other underlying problem.
Key words: tracheal bronchus, tracheobronchial anomaly
Address for correspondence: Sirma Mileva, M.D., Pediatric Department, Alexandrovska Hospital,
1, Sv. G. Sofiyski St., Bg --  1431 Sofia

 

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bullet 1'2015

 

Diagnostic and therapeutic management of Wernicke’s encephalopathy based on one case - Medical Review (Meditsinski pregled), 51, 2015, №1, 41-44.
R. Ikonomov(1), E. Krastev(2), V. Hinkova(2) and V. Georgieva(2)
(1)Department of Neurology, University Hospital Sofiamed -- Sofia, (2)Clinic of Neurosurgery, University Hospital Sofiamed -- Sofia
Summary: Aim: Wernicke’s encephalopathy is a serious neurological disease caused by a deficiency of vitamin B1 (thiamin), as described by the Polish neurologist Carl Wernicke during 1881. It is found most commonly in alcoholics. We present a clinical case of a 29 year-old man with Wernicke’s encephalopathy. Methods: The patient is hospitalized when having complaints including acute weakness in the left limbs, double vision, difficulties with speech and swallowing, and qualitative changes in consciousness. Once MRI is performed, the patient is diagnosed with having a glial brainstem tumor. After the performed biopsy and histological verification of the process, non-specific inflammatory alterations are found. Results: With a view to the clinical signs, the patient’s clinical history regarding alcohol abuse, and the histological data, it is established that Wernicke’s encephalopathy is concerned. After treatment with high doses of vitamin B1 and nootropic drugs has been performed, a significant part of the neurological symptoms are reduced and a decrease in the MRI pathological findings is noticed. Conclusion: Despite being a rare disease, Wernicke’s encephalopathy should still be taken into account when differentially diagnosing patients with unclear brainstem signs and with psycho-organic pathology especially in combination with chronic alcohol abuse. Timely diagnosis of the disease is important for allowing adequate treatment.
Key words: Wernicke’s encephalopathy, thiamin, chronic alcohol abuse
Address for correspondence: Rosen Ikonomov, M.D., Department of Neurology, University Hospital Sofiamed -- Sofia, e-mail: drros@abv.bg

 

 

Life-threatening... „varicella infection” - Medical Review (Meditsinski pregled), 51, 2015, №1, 45-47.
A. Chokoeva(1), J. Ananiev(2) and G. Tchernev(3)
(1)”Onkoderma” -- Policlinic of Dermatology, Venereology and Dermatologic Surgery -- Sofia, (2)Department General and Clinical Pathology, Medical Faculty, Trakia University -- Stara Zagora, (3)Policlinic for Dermatology and Venereology, University Hospital Lozenetz -- Sofia
Summary: Malignant cutaneous tumors in childhood are very rare, as they often differ in behavior and prognosis from this type of neoplasms in adults. Differentiation between congenital dysplastic nevi and cutaneous tumors should be of paramount importance to every dermatologist and General Practice physician. In cases with absence of proper diagnostic and therapeutic concept, these patients should not be left under observation, but to seek consultation with dermatologic surgeons and dermato-oncologist instead. The delay of therapy in this group of patients, not rarely could lead to fatal consequences for their health. We present a case of a 6-month old child consulted on the occasion of chickenpox, as within the dermatological examination a congenital dysplastic nevus was established in the skin of the abdominal wall, with suspected transition in superficial spreading form of cutaneous melanoma. According to data from the anamnesis, the lesion was twice a reason to seek consultation with general practitioner and gynecologists, without further referral to a specialist like a dermatologist or surgeons. The thorough dermatological examination within various cutaneоus complaints may be often life-preserving. Even in case of the smallest suspicion of melanocytic tumor type or dysplastic nevi, it is recommended patients to be referred to specialized units, where lesions can be surgically eradicated.
Key words: congenital melanocytic nevus, malignant melanoma, excision
Address for correspondence: Assoc. Prof. Georgi Tchernev, M.D., Policlinic for Dermatology and Venerology, University Hospital Lozenetz, 1 Koziak St., Bg -- 1407 Sofia, GSM: +359 885 588 424, e-mail: georgi_tchernev@yahoo.de

 

 

Metatypical basal-cell carcinoma of the nose: description of a clinical case - Medical Review (Meditsinski pregled), 51, 2015, №1, 48-51.
V. Ivanov(1), A. Chokoeva(2), G. Tchernev(3), J. Ananiev(4) and S. Philipov(5)
(1)Medical University -- Plovdiv, (2)”Onkoderma” -- Policlinic of Dermatology, Venereology and Dermatologic Surgery -- Sofia, (3)Policlinic for Dermatology and Venereology, University Hospital Lozenetz -- Sofia, (4)Department of General and Clinical Pathology, Medical Faculty, Trakia University -- Stara Zagora, (5)Department of General and Clinical Pathology, University Hospital Lozenetz -- Sofia
Summary: Basal-cell carcinoma (BCC) is the most common malignant cutaneus cancer. The causes leading to its occurrence are various, as the most important of them are associated with the intense ultraviolet light and the bright skin type in the affected patients. It accounts for approximately 80% of all non-melanoma skin cancers. Metatypical BCC is a rare subform of BCC which combines the clinical and histopathological features of BCC and squamous cell carcinoma, simultaneously, while the risk of metastasis in these lesions is assessed in approximately 5%. The clinical manifestation is rather atypical, leading to misinterpretation, not infrequently with an inadequate diagnostic and subsequent therapeutic approach. The atypical clinical features, manifested in the affected patients are often a major problem, leading to fetal outcome in some of the cases. We present a case of metatypical basal-cell carcinoma of the nose, initially treated with cryotherapy, electrocauterization, as well as local destructive therapy, without histology being taken. The subsequent tumor progression, as well as the conducted surgical excision, proved the presence of a metatypical basal-cell carcinoma. An excellent aesthetic result was achieved.
Key words: metatypical, basal-cell carcinoma, elliptical excision, histologic verification
Address for correspondence: Assoc. Prof. Georgi Tchernev, M.D., Policlinic for Dermatology and Venerology, University Hospital Lozenetz, 1 Koziak St., Bg -- 1407 Sofia, GSM: +359 885 588 424, e-mail: georgi_tchernev@yahoo.de


 

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