Journal
of IMAB
Annual Proceeding
(Scientific Papers)
ISSN: 1312-773X (Online)
Issue: 2006, Book 3, part Medicine
P:
CONTENTS:
CCHARACTERISTICS OF ERYTHROMYCIN-RESISTANT CLINICAL
ISOLATES OF STREPTOCOCCUS PYOGENES
A.
Decheva, V. Karjeva, D. Beshkov, I. Alexiev, S. Bianco*, D. Savoia*
National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria;
* Department of Clinical and Biological Sciences, University of Torino,
Italy
ABSTRACT: Erythromycin resistance of clinical isolates
Streptococcus pyogenes recovered in Bulgaria during 1995-2005 was studied
by phenotypic and genetic methods. The frequency of erythromycin resistance
was low during the whole period tested (0.5 to 4.1%). Fifty percent of
the resistant isolates belonged to the MLS-inducible resistance phenotype,
38.9% were from the M phenotype and 11.1% were from the MLS-constitutive
resistance phenotype. Two thirds (63.9%) of the erythromycin-resistant
isolates were additionally resistant to tetracycline and / or chloramphenicol.
Our data suggest that the resistance itself is not associated with increased
pathogenicity of the clinical isolates S. pyogenes. The statistical analysis
revealed that there was no difference between resistant and susceptible
isolates regarding the following factors tested: production of protease,
possession of speA (encoding streptococcal pyrogenic exotoxin A), speF
(encoding streptococcal pyrogenic exotoxin F) and prtF1 (encoding protein
F1). The MLS-inducibly resistant isolates were more frequently serum-opacity
factor positive (81.3%) than susceptible isolates (32.4%) (p<0.05).
Emm sequence typing revealed that the erythromycin resistant isolates
were a heterogenous group. Overlapping of sequence types between isolates
of different resistance phenotypes was very rare. For isolates with the
target site modification mechanism of resistance, emm 44/61 was the most
frequent sequence type. For isolates with efflux mechanism, emm 12.10
was the most common one. The group of erythromycin-susceptible isolates
was also heterogenous as a whole with emm 1, emm 3 and emm 12 being most
common types. Overlapping of sequence types between susceptible and resistant
isolates was observed for emm 1, emm 12, emm 75 and emm 77.
SKIN SIGNS OF A PATIENT WITH T-CELL NHL
Stoyan Pavlov, Vl. Gerov**, St.
Racheva, M. Slavova
Department of Dermatology and Venerology, * Department of Hematology,
Medical University – Varna, Bulgaria
RESUME: T-cell non-Hodgkin lymphomas (NHLs) are uncommon
malignances that represent approximately 12% of all lymphomas. The most
common extranodal sites for NHL are the gastrointestinal tract and nasopharynx;
other common sites include skin, brain, bone, thyroid, breast, lung, and
testis.
We presented 50 years male patient with peripheral CD30+Tcell NHL with
skin and liver involvement. The diagnosis was made on the base of clinicopathologic
and immunophenotypic examination.
When the treatment was conducted, the patient responds to systemic chemotherapy
with resolving of skin nodules and liver infiltrates.
Our case illustrates that even in secondary cutaneous lymphomas, skin
manifestations may be the first sign of systemic disease, and a diagnosis
may be achieved on examination of specimens of a cutaneous lesion.
A CASE OF CERVICOFACIAL ŔCTINOMYCOSIS
St. Racheva,
Zh. Dimitrova, St. Pavlov, Zl. Lolev
Department of Dermatology and Venerology, Medical University – Varna,
Bulgaria
RESUME: The Ŕctinomycosis in humans is rarely observed
in Europe. It is presented as a chronic, suppurative, granulomatous infection,
originally caused by Actinomyces israelii (found as normal microflora
in the mouth cavity) and dependent on the associative bacterial flora.
The most frequent form of Ŕctinomycosis in humans is the Cervicofacial,
followed by the thoracal, abdominal etc.
The slow development of the infection, the thick tumorlike nodules which
it forms and the abscesses and fistulas usually hinder the diagnosis of
the Ŕctinomycosis and lead to other initial diagnoses – tumors, phlegmons,
etc.
This is a case of Cervicofacial Ŕctinomycosis in a 59-year-old patient,
with whom a tumoral nodule in the facial area tends to grow slowly. Originally
the nodule was diagnosed as a planocellular papillomatous on the right
side of the gums and the hard palate, affecting the skin of the zygomatic
area secondarily with formation of fistulas.
Key words: Ŕctinomycosis, cervicofacial
ETIOLOGY OF COMMON CONTACT DERMATITIS
St. Racheva
Department of Dermatology and Venerology, Medical University Prof.
Dr. Paraskev Stoyanov – Varna, Bulgaria
RESUME: Contact dermatites (allergic and non-allergic)
are frequently observed dermatosĺs and they pose a serious problem to
the dermatologist. They are usually common dermatites, but a considerable
number of the cases are occupational dermatites. The clarification of
each concrete case is of great significance for a precise therapeutic
approach and efficient prophylactics.
The study aimed at etiological and pathogenetic clarification of common
contact dermatitis in a group of 210 patients. The clarification was achieved
through dynamic clinical study, anamnestic data, and skin tests (epicutaneous
tests – chamber method). In 123 patients (58.5%) of all studied patients
allergic contact dermatitis was diagnosed, and in 87 patients (41.4%)
– irritant contact dermatitis.
The analysis of the received 213 positive epicutaneous tests revealed
that detergents are the most frequent allergens (16.43%), followed by
metals (15.02%), rubber additives (14.80%), parabens (10.79%), antiseptics
(10,32%), formaldehyde (9.38%), and scents (8.92%).
The most frequent irritant etiological agents were detergents (28.73%),
followed by soaps (27.58%), additives to rubber (13.79%), acids and bases,
organic solvents.
Key words: allergic contact dermatitis, irritant contact
dermatitis, contact allergens, contact irritants.
OUR TRAIL IN TREATMENT AND PROPHYLAXIS OF COLD
URTICARIA WITH DESLORATADINE
St. Racheva,
P. Drumeva, F. Georgieva*
Department of Dermatology and Venerology, Medical University Prof.
Dr. Paraskev Stoyanov – Varna, Bulgaria; *Medical University and “St.
Anna” Hospital- Varna,
RESUME: Cold urticaria presents in quite a lot of cases (31%) with physical
urticaria. Its effective treatment and prophylaxis are a problem that
is solved by using H1 blockers.
Good alternative method nowadays is Desloratadine - Aerius, having maximal
effect with minimal risk of adverse reactions.
Our study included 30 patients with different forms of cold urticaria:
hereditary cold urticaria – 4 patients, acquired cold urticaria (contact
and refectory) – 13 patients, symptomatic cold urticaria (coexisting with
viral infections, medicaments, mycoses) - 8 patients, cold cholinergic
urticaria – 5 patients.
All the patients were treated with Desloratadine 1 tablet daily till the
end of the clinical features. Afterwards all the patients were prophylacted
in the following two months with the same medicament.
The results were: the clinical features disappeared in all the patients
in the next 2 weeks; the prophylaxis with Desloratadine was effective
in 80% of the treated patients. These allow us to make the conclusion
that Desloratadine is a good choice in the treatment and prophylaxis of
cold urticaria.
IATROGENICALLY INDUCED SARKOMA KAPOSI IN A PATIENT
WITH PEMPHIGUS VULGARIS
St.
Racheva, St Pavlov, P. Drumeva
Department of Dermatology and Venerology, Medical University Prof.
Dr. Paraskev Stoyanov – Varna, Bulgaria
RESUME: This is a case of iatrogenically induced Sarkoma
Kaposi in a 68-year-old patient suffering from Pemphigus vulgaris. The
Pemphigus in question is mucous, localized in the mouth cavity, and two
years old.
In the course of treatment with parenterally applied corticosteroid products
was observed the appearance and dynamic spread of numerous tumor-like
formations of Kaposi Sarcoma type on the limbs, torso and face.
The appearance of Kaposi sarcoma as a result of the continuous immunosuppressive
therapy with corticosteroids and cytostatics is discussed.
Key words: iatrogenic, Kaposi‘s sarcoma
TENDENCIES OF THE DYNAMIC AMBIENT POLLUTION AND
RESULTING HOSPITALIZATION DUE TO ACUTE CARDIO-VASCULAR DISEASES IN VARNA
REGION
T. Dimitrova, A.
Penev*, I. Zlatarov
Department of Hygiene and Disaster Medicine, Prof. Paraskev Stoyanov
Medical University of Varna; *Intensive Clinic of Cardiology, St. Marina
University Hospital of Varna
SUMMARY: The purpose of the research is to analyze the
dynamics of the basic atmosphere pollutants in the city of Varna and the
relation to pollution of atmosphere air with ozone, sulfuric dioxide and
nitrogen oxides as a risk factor, affecting the frequency of hospitalizations
with regards to acute cardiovascular diseases in the city of Varna. A
seasonal dynamics of the average diurnal concentration of basic atmosphere
pollutants was established. The relative risk of acute myocardial infarct
(AMI) increases to a statistically significant value in the days of increasing
of ozone concentration with 5 and more µg/m3 , while concentration increase
of nitrogen oxides does not increase the risk of AMI and ischemic cardiac
disease - unstable angina pectoris (IHD – unstable AP). The researched
data indicates the early effect of the ozone exposition and is related
to the increased frequency of AMI-related hospitalizations for the same
day. The significantly low content of nitrogen oxides and sulfuric dioxide
are a likely reason for not establishing a statistically significant relation
of the early effects of its effect to the acute coronary incidents.
Key words: ambient air pollution, acute cardio-vascular
disease, hospitalization rates
LOW-CONTRAST ACUITY BEFORE AND AFTER SURGERY
IN PATIENTS WITH PITUITARY ADENOMA
N. Deleva, Al. Tzoukeva, A. Kaprelyan
Department of Neurology, Prof. Paraskev Stoyanov Medical University
of Varna, Bulgaria
SUMMARY: Background: Pituitary adenomas account for about
10-15% of all surgically and histologically diagnosed intracranial neoplasms.
Patients with non-functional pituitary adenomas most frequently demonstrate
visual disturbances. The routine neuroophthalmological examination detects
most commonly tumor-related loss of visual acuity and visual field or
both. Contrast sensitivity (CS) assessment with sine-wave gratings has
not been routinely used, but demonstrates a good agreement with low contrast
letter chart findings. Recent studies demonstrate that low-contrast Sloan
letter charts are the most eligible and often are used in these cases.
A special attention is directed to visual function after surgery. Improvement
of visual acuity and CS is reported.
Cases report: We present the results of a neuroophthalmological examination
in two patients with parasellar pituitary adenoma before and after surgery.
The twelve months follow-up of visual dysfunction includes standard Snellen
visual acuity and Goldmann perimeters as well as low contrast number visual
acuity. For the needs of low-contrast testing we choose standard for Bulgaria
number charts, administered monoculary at 3% and 1.5% contrast.
Conclusion: The presented cases indicate that the low contrast acuity
tests in patients with parasellar pituitary adenoma are sensitive indicators
just like CS yields information for the visual dysfunction when other
visual tests are normal. The loss of low contrast visual acuity improved
after surgery as did other visual measures, except in cases with significant
low contrast deficit at 1.5% contrast.
Key words: pituitary adenoma, low-contrast visual acuity,
follow-up
CNS GERMINOMA WITH SYNCHRONOUS LESIONS IN THE
SUPRASELLAR AND PINEAL REGIONS: CLINICAL, CT AND IMMUNOLOGICAL FOLLOW-UP
A. Kaprelyan, N. Deleva, A. Tzoukeva, B. Balev*, Kr. Metodiev**,
G. Kuchukov***
Department of Neurology; *Department of Radiology; ** Department of
Microbiology; ***Department of Neurosurgery; Prof. Paraskev Stoyanov Medical
University of Varna, Bulgaria
ABSTRACT: Germinomas are the most frequent type of germ
cell tumors that constitute only 2-5% of all central nervous system malignancies.
Most of them arise in the pineal and suprasellar regions but in about
5% to 10% the simultaneous location is found. Although their strategic
location, they respond well to surgery, radiation and chemotherapy and
the prognosis is very good. We report a case of 23-years young male presented
with gait disturbance, weakness in lower extremities, visual impairment
and moderate fatigue. His medical history revealed that he was symptomatic
by DI (polyuria, polydypsia and weight loss) and received treatment with
adiuretin for a period of 3 years. Computed tomography (CT) scans demonstrated
well circumscribed tumor lesions with a homogeneous contrast enhancement
in the suprasellar and pineal regions. A germinoma was verified histologically.
A good treatment response to surgery, radiation, chemotherapy and management
of endocrine insufficiency was achieved. The postoperative neurological,
CT and immunological follow-up corresponded with the clinical course of
the disease and the results of therapeutic procedures.
Key words: germinoma, synchronous location, clinical
presentation, CT imaging, immunological monitoring
Tc-99m MIBI SPECT AND CT NEUROIMAGING IN PATIENT
WITH TUMOR-ASSOCIATED POSTOPERATIVE REFRACTORY SEIZURES: IS IT A TUMOR
RELAPSE
A. Kaprelyan, N.a Deleva, P. Bochev*, A. Klissarova*, G.
Kuchukov**, I. Dimitrov
Department of Neurology; *Department of Radiology and Nuclear medicine;
**Department of Neurosurgery, Prof. Paraskev Stoyanov Medical University
of Varna, Bulgaria
ABSTRACT: Seizures are the presenting symptom in about
20% to 40% of patients with brain tumors and occur in about half of them
during the course of the disease. Mixed gliomas, oligodendrogliomas and
astrocytomas are most frequently associated with epilepsy. In patients
with postoperative seizures neuroimaging should be performed to exclude
tumor recurrence. We reported a case of 56-years old female admitted to
our hospital with clinical signs of increased postoperative partial seizures
activity and mild focal deficit. Medical history revealed that patient
became symptomatic by brain tumor with sudden onset of generalized tonic-clonic
seizure sixteen years ago. A low-grade astrocytoma was verified histologically
after surgery. Ten years later the patient experienced right-sided partial
motor and sensory seizures. Antiepileptic therapy was initiated and temporary
good control of epilepsy was achieved. Current EEG findings showed left
frontotemporal focus of epileptic activity. On contrast-enhanced CT scans
no recurrent tumor mass was visualized. Brain SPECT images demonstrated
no Tc-99m MIBI uptake. Despite the clinical presentation of refractory
partial seizures, tumor recurrence was not detected. Based on the literature
analysis and our own data, different etiological mechanisms underlying
tumor-associated epilepsy were discussed.
Key words: Tc-99m MIBI brain SPECT, CT scan, tumor-associated
epilepsy, refractory seizures, tumor relapse, etiological mechanisms
Last edition: may 05, 2007
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