 |
Journal
of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski
ISSN: 1312-773X (Online)
Issue: Volume 15, Book 1, 2009,
Subject Collection: Medicine
Page: 3 -97
Date of close:
CONTENTS :
THE ROLE OF THE GENERAL PRACTITIONER IN THE CAMPAIGN
AGAINST THE MUMPS
Tsvetelina
Valentinova, Ìilena
Karcheva*
Sector „General Medicine”, *Sector „Epidemiology, Parasitology and
Tropical Medicine”; Medical University,
Pleven, Bulgaria
SUMMARY: During the last 3-4 years the number of
the sick with mumps in Bulgaria increased considerably. Therefore, the
scientists focused on two major issues in the campaign against the disease.
Aims: To study the opinion of the general practitioners concerning the
issues occurring during immunization with the MMR (measles, mumps, rubella)
triple vaccine, diagnostics and treatment of already existing mumps among
their patients. Materials: The participants in the research have been
selected at random among the general practitioners specializing in general
medicine at the Medical University-Pleven. Conclusion: The general practitioners,
considered to be the first unit in the health care system of the country,
are the basic participants in the prevention of that disease by executing
the immunization schedule.
Key words: mumps, general practitioners, control measures.
/Page
3-5/
Published online - June 10, 2009
Mechanisms of cell resistance in glioblastoma
multiforme
Victoria Sarafian1,
Ilian Koev2, Dmitrii Staykov3
1 Department of Biology; 2 Department of Neurosurgery, 3 Department of
General and Clinical Pathology; Medical University - Plovdiv, Bulgaria
SUMMARY: Glioblastoma multiforme is the most common
brain tumor in adults. It is characterized by a rapid clinical course
and extremely unfavorable prognosis. The etiology and the molecular pathogenetic
mechanisms are not entirely clear yet. Active proliferation, resistance
to apoptosis and high angiogenicity are basic factors limiting the effect
of standard therapy.
A significant problem is the resistance of glioblastoma cells to apoptosis
induced by most of antitumor drugs and radiotherapy. The functional activity
of several tumor-suppressor genes is inhibited. The antiapoptotic effect
of the normal brain matrix and the altered expression of integrin aVb3
act as main regulators of angiogenesis, invasion and proliferation of
glioblastoma cells.
Therapeutic strategies are based on cellular and molecular mechanisms
leading to: activation of apoptosis, inhibition of growth factors and
receptors, and blocking of angiogenesis. Crucial moment in modern therapy
is the activation of autophagy. Its effectiveness depends on the expression
level of genes mTOR and MTMG. The most promising approach is the complex
one combining surgery, radiotherapy and targeted molecular therapy directed
simultaneously to different cellular pathogenetic mechanisms.
Key words: glioblastoma, apoptosis, autophagy, resistance.
/Page
6-8/
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DIFFICULTIES IN THE ECHOCARDIOGRAPHIC DIAGNOSIS
OF BLAND-WHITE-GARLAND SYNDROME
P. Shivachev, Lachezar
Marinov
Department of Pediatrics
Medical University “Prof. Dr Paraskev Stoyanov”-Varna, Bulgaria
SUMMARY: The Bland-White-Garland Syndrome (BWG)
is a rare, but serious congenital cardiac anomaly, found in 1/300 000
life born children or is 0,25-0,5% of the congenital heart anomalies (CHA).
At the same time it is the most frequent congenital coronary anomaly –
90%. It is described for the first time in 1866, but the full clinical-anatomic
description is given from Bland, White and Garland in 1933, and that is
why it takes their names. It represents anomaly of the start of the left
coronary artery from the trunk of the pulmonary artery (ALKAPA), most
often from the left sinus with signs of myocardial ischemia in the relevant
zones. In evolution develop collaterals between both coronary arteries
and the syndrome of “stealing” because of the presence of significant
left-right shunt on vascular level. Connected to this there are two forms
of the disease: infantile and adult.
The aim of this report is to present the ECG and EchoCG results, clinical
manifestation and result of the held conservative and operative treatment
in three children, hospitalized in the clinic during the last years, establishing
diagnostic difficulties in the echocardiograph examination and specifying
of the type of the congenital cardiac malformation.
Key words:Bland-White-Garland syndrome, EchoCG, ECG,
clinical manifestation, outcome of the disease.
/Page
9-12/
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INFECTIVE ENDOCARDITIS IN CHILDREN – CLINICAL
AND OUTCOME EVOLUTION
Lachezar Marinov,
P. Shivachev
Department of Pediatrics
Medical University “Prof. Dr Paraskev Stoyanov”-Varna, Bulgaria
SUMMARY: For a 15- year period (1992 – 2007) in
the clinics of the department of pediatrics were hospitalized 10 children
with endocarditis from 1 to 13 years of age. One of the children was hospitalized
twice during a period of two years.
All children were with preceding congenital defects: ventricular septic
defects in 5 cases; valvular aortic stenosis in 1 case; transposition
of the great vessels – 1 case; hyperthrofic cardiomyopathy – 1 case; ventricular-atrial
anastomosis in two child with internal hydrocephaly. Three of the cases
were patients with prosthetic endocarditis.
In blood cultures were established Streptococcus viridans in 3 cases;
Streptococcus á - haemoliticus in 2 case; Staphylococcus epidermidis in
2 cases and Staphilococcus aureus in 1 case. In 84.44% of the cases were
found positive blood cultures before starting the antibacterial therapy.
In patients who had received antibiotics before – 18.17% were with positive
cultures.
With echocardiography was detected vegetation in 8 (73.27%) cases.
In the course of the disease were found the following complications: cardiac
deficiency – in 7 children, pleuropericardial effusions – in 4 cases,
septic embolism in 3 patients and purulent mediastinitis – 1 case. Three
of our IE cases have had a lethal outcome (27,3%).
Key words: Infective endocarditis, children, clinical
evolution, complications.
/Page
13-15/
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Changes in the left ventricular muscle mass in
adolescents
Lachezar Marinov
Department of Pediatrics
Medical University “Prof. Dr Paraskev Stoyanov”-Varna, Bulgaria
SUMMARY: In the resent short review are presented
some of the main reasons for development of left ventricular hypertrophy
(LVH). LVH is a multifactor condition caused mainly by arterial hypertension
(AH). The changes in the target organs in AH are a function of the levels
of blood pressure (BP) and the duration of the disease. The primary changes
because of Arterial Hypertension (AH), independently to its etiology,
start in the myocardium of the left ventricle (LV), the arterioles and
small arteries of the systemic circulation. The vascular changes in AH
are two types: expression of morphological adaptation to the increased
BP, observed in the early stages – most often spasm, causing the subsequent
changes in the organs, followed by the complications connected with the
increased development of atherosclerosis in different vascular regions
leading to ischemic heart disease, brain-vessel disease, chronic arterial
insufficiency, arrhythmia, sudden death. As a result to the increased
requirements to the myocardium in AH, starts adaptive hypertrophy, which
at the beginning improves the function of the left ventricle. With the
start of the structural changes and remodeling the compensatory abilities
of the LV lower and develop heart insufficiency. The increased LV pressure
and enlarged muscle mass increase the oxygen needs of the myocardium,
which additionally increase the requirements to the coronary blood stream.
Some other additional factors which influence the LVH are discussed like
physical development of the children, overweight and obesity. The diagnostic
abilities of EKG and EchoCG are discussed for the proving of the LVH.
EchoCG and Doppler EchoCG have significantly more abilities, as most informative
index for LVH is the index of left ventricular muscle mass.
Key words: left ventricular hypertrophy, index of left
ventricular muscle mass, adolescents, EchoCG.
/Page
16-18/
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Pheochromocytoma during childhood – a case report
Lachezar Marinov
Department of Pediatrics
Medical University “Prof. Dr Paraskev Stoyanov”-Varna, Bulgaria
SUMMARY: Pheochromocytoma is a rare tumor during
childhood, originating from the chromafine tissue. According to literature
its frequency is approximately 1/100 000. Its clinical manifestation is
with signs of catecholamine excess: hypertension, heartbeat, headache,
sweating, nausea, vomiting, trembling, weakness, irritation, abdominal
and chest pain, dyspnea, red warm face, constipation, polyuria, polydipsia.
These symptoms can be observed every day in severe disease or rarely.
The clinical manifestation can be variable and assembling many other diseases,
so the pheochromocytoma is called “the Great imitator”. We are presenting
a case - a 15 years old girl, hospitalized for hypertonic crisis. After
the clinical, paraclinical investigations and image test was proved that
this was a pheochromocytoma. The surgical intervention was held in planned
order. During the following months the blood pressure became normal and
the hypertension treatment was ceased. The possibility of relapses of
the tumor necessitates the following of the child for the next years.
Key words: Pheochromocitoma, childhood, hypertension.
/Page
19-22/
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Surgical treatment of tongue base carcinoma using
upper lateral pharyngotom
Tsvetan
Tonchev, Savina
Nencheva
Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine,
Prof. Paraskev Stojanov Medical University of Varna, Bulgaria
SUMMARY: The patients with tongue base carcinoma
are usually diagnosed in an advanced stage of the disease. The authors
present a retrospective analysis of four patients treated in the period
2006-2008 using the method of upper lateral pharyngotomy in order to remove
the tumor. On the basis of the preoperative evaluation two of the patients
had ipsilateral neck dissection. The authors report the survival rate
giving the account of the combined treatment and the necessity of extra
procedures. The article describes the operative techniques and the important
moments of making a decision. A review of the literature concerning this
matter has been mades.
Key words:Tongue base carcinoma; Approach; Surgical
treatment; Upper lateral pharyngotomy.
/Page
23-25/
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UP TO DATE GASTRIC CANCER SURGERY
N. Kolev, Krassimir
Ivanov, A. Tonev, V. Ignatov
I-st Clinic of Surgery, University Hospital “St. Marina”
Medical University of Varna, Bulgaria
SUMMARY: BACKGROUND: Effective palliation rather
than cure is often the most appropriate goal in the management of patients
with advanced gastric cancer.The literature to date is limited by the
imprecise use of the term palliative and subsequent variable designation
of patients into evaluable groups. STUDY DESIGN: Between 2000 and 2007,
303 patients underwent a operation for gastric adenocarcinoma. Patients
who received a noncurative (R1/R2) resection were identified. A procedure
was defined as palliative if it was performed explicitly to palliate symptoms
or improve quality of life. RESULTS: One hundred and ninety five of them
(65%) received a noncurative gastric resection. The operation was palliative
in 47% (92/195) and nonpalliative in 53% (103/195). Palliative no curative
operations aimed preservation of tumor-engaged organ’s function, enhanced
quality of patient’s life till dead, but not prolonged his life. No curative
no palliative operations aimed cytoreductive effect by removing the organ
engaged with primary tumor and improve the results of postoperative complex
treatment and prolong the patient’s life. CONCLUSIONS: There are important
differences among patients undergoing noncurative operations for gastric
cancer. Studies designed to measure palliative interventions would benefit
from precise designations of palliative intent in patients receiving noncurative
operations.
/Page
26-31/
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New trends in rectal cancer surgery. Case of
the practice
V. Ignatov, A. Tonev, N. Kolev, Krassimir
Ivanov
I-st Clinic of Surgery, University Hospital “St. Marina”
Medical University of Varna, Bulgaria
SUMMARY: BACKGROUND: Sphincter preservation, disease
control, and long-term survival are the main goals in the treatment of
rectal cancer. Although transanal local excision is attractive because
it is a sphincter sparing procedure, some contradictory data exist in
the literature about its ability to locally control disease and provide
overall survival comparable with radical procedures, even for patients
with early stage tumor. In patients with early rectal cancer (T1), local
excision may be an alternative approach in highly selected patiients.
For more advanced rectal cancer, radical surgical resection is the treatment
of choice. METHODS: We reviewed the literature to identify the current
recurrence and survival rates of both techniques as well as the salvage
surgery success, only 1 study was prospective, 5 were comparative, and
5 were case reports. We present a case report of a woman with local excision
of rectal tumor. Five years later a rectal recurrence has showed up. We
describe the case and make some conclusions.
/Page
32-35/
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MLSB genotype is predominant molecular genetic
mechanism among erythromycin - resistant Streptococcus pneumoniae
for the period: 2006-2008
Alexandra
Alexandrova1, L. Setchanova1, M. Sredkova2, I. Haydoushka3, B. Markova4,
U. Proevska4, K. Bojkova5, I. Mitov1
1- Department of Microbiology, Medical University, Sofia; 2-
Department of Microbiology, Medical University, Pleven; 3- Department
of Microbiology, Medical University, Plovdiv; 4- Alexander Hospital,
Sofia; 5- Department of Microbiology, Medical University, Varna,
Bulgaria
SUMMARY: In total, 413 clinical isolates of Streptococcus
pneumoniae were collected from four University laboratories in Sofia,
Pleven, Plovdiv and Varna for the period of 2006-2008.
150 strains (36, 3%) of all 413 tested S. pneumoniae were erythromycin-resistant
(ERSP). The most prevalence of ERSP were observed in children under 5
years (80.0%).
The results of conventional PCR showed presence of erm(Â)gene
among 64.7% of the strains, mef(Å) gene among 29.3%, and 9 strains
(6%) carried both erm(Â)+mef (Å). Serotypes 6Â, 19F
and 19A were the most prevalent among ERSP with erm(Â) gene,
and serotype 14 was predominant among strains harboring mef (E)
gene.
Phenotypic characterization of ERSP with the triple-disc test (4) completely
confirmed the genotype: 106 strains were with MLSb phenotype (70.7%, including
the 9-th strains harboring both erm (Â)+mef (Å) genes
) and 44 were with Ì phenotype (29.3%).
Ìacrolides are widespread used antibiotics in therapy of pneumococcus
infections in our country and ERSP increased with accelerated rates: from
20% in 2000, to 25% in 2005 (5), till 36% in the present research.
The efflux mechanism of macrolide resistance, which were predominant before
in Bulgaria (5), now give place to widely spread MLSB phenotype and genotype
reffering with target modification. The dissemination of macrolide resistance
encoded by erm (Â) gene were 30% in 2000, increased to 43% in
2005 and 70% in 2008.
Key words: Streptococcus pneumoniae, macrolide
resistance, MLSB genotype, Bulgaria.
/Page
36-38/
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EPIDEMIOLOGIC, ECOLOGIC AND MICROBIOLOGIC STUDIES
OF TULAREMIA IN BULGARIA FOR 1997-2006 PERIOD
Milena
Karcheva, Victoria Doycheva*, Todorka Dimitrova*, Krastu Marinov**
Department of Infectious diseases, Epidemiology, Parasitology and
Tropical Medicine, Medical University, Pleven; *Department of
Epidemiology, Medical University, Sofia; ** Microbiologic Laboratory,
Military Medical Academy, Sofia, Bulgaria
SUMMARY: Tularemia is a zoonotic, acute, infectious
disease caused by the bacterium Francisella tularensis. It is a major
problem on the Europe and Balkan Peninsula. In Western Bulgaria two new
foci originated during the last 10 years. Aims: To study epidemiology,
ecology, nosogeography, conflict and prevention of tularemia that originated
during 1997 - 2006 in Bulgaria. Materials and methods: Epidemiological
method, Ecological method, Microbiological method, Clinical method, Statistical
method. Results: During the last 10 years two endemic foci originated
in the physic - geographic regions: Nishav - Borel (near Slivnitsa) and
Kraishten (near Pernik) with 40 permanent noso - areas. The study determined
that in the Sofia region the number of diseased with tularemia during
1997-2006 is 111 with morbidity 37,16%îîî, and in Pernik region the number
of the diseased during the same period is 137 with morbidity 80,38%îîî.
Conclusion: In the complex studies of both regions where tularemia developed
we found out that the parasite system functioned with its components:
a large number of sources and vectors, favourable climatic and geographic
conditions and considerable number of factors of the ecologic socio -
ecosystem.
Key words: Tularemia, Incidence, Epidemiological investigation.
/Page 39-41/
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Smoking, Alcohol Consumption and Dementia in
Persons over the Age of 65 from the City of Varna, Bulgaria
Ivan Dimitrov,
N. Deleva, A.
Kaprelyan, B. Ivanov
Department of Neurology, Medical University, Varna; First
Neurological Clinic, MHAT “Sveta Marina“, Varna, Bulgaria
SUMMARY: Findings about the possible relation between
smoking and dementia are ambiguous. Earlier research is dominated by the
statement that smoking is a protective factor for Alzheimer’s disease
while later reports affirm that it could increase the risk for AD, and
cessation could lower it to a certain degree. Some studies fail to establish
an association between smoking and dementia or AD. The role of alcohol
consumption as a risk factor for these disorders is also subject to discussion.
Smoking, alcohol consumption and their possible relationships with dementia
in persons over the age of 65 were assessed in the framework of a dementia
prevalence study in the city of Varna, Bulgaria. No statistically significant
correlations were found between the diagnosis of dementia, Alzheimer’s
disease, vascular dementia, MCI, and the above-mentioned risk factors.
This corresponds to the ambiguous data in the literature, where no clear
statement exists whether smoking and alcohol consumption could be regarded
as risk factors for dementing disorders or not.
Key words:Smoking, Alcohol consumption, Dementia, Risk
factors.
/Page 42-45/
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SINGLE- AGENT CAPECITABINE AS FIRST- LINE TREATMENT
OF PATIENTS WITH METASTATIC COLORECTAL CANCER
Deyan Davidov
Department of Chemotherapy, Oncological Center, Medical University,
Pleven, Bulgaria
SUMMARY: Background: Capecitabine
is an oral fluoropyrimidine carbamate that is at least as effective than
Fluorouracil / Leucovorin as first- line treatment for patients with metastatic
colorectal cancer /CRC/. Aim: The aim of this study was
to evaluate the efficacy and toxicity of single- agent Capecitabine as
first- line therapy in patients with metastatic CRC. Methods:
In the period 2007- 2009 17 consecutive patients with /CRC/ entered
the study. The treatment schedule consists of Capecitabine 1250 mg/m2
p.o. twice daily for 14 days with a 7- day rest period. Results:
Overall response rate was 23,6% with one complete remission. Median survival
was 12,4 months. Nausea, vomiting and diarrhea were the most common side
effects. Conclusions: That data suggest that single-
agent Capecitabine will offer opportunity to treat patients with advanced
/CRC/.
Key words: Metastatic colorectal cancer, First- line
therapy, Single- agent Capecitabine, Survival.
/Page
46-49/
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OUR EXPERIENCE WITH IRINOTECAN AND BOLUS FLUOROURACIL
/ LEUCOVORIN IN THE TREATMENT OF PATIENTS WITH METASTATIC COLORECTAL CANCER
Deyan Davidov
Department of Chemotherapy, Oncological Center, Medical University,
Pleven, Bulgaria
SUMMARY: Background: Irinotecan
is a topoisomerase I inhibitor that prolongs survival as first- line therapy
in patients with advanced or metastatic colorectal cancer Aim:
The aim of this study was to evaluate the efficacy and toxicity
of Irinotecan combined with bolus Fluorouracil and Leucovorin. Methods:
In the period 2006- 2008 38 consecutive patients with metastatic
colorectal cancer entered the study. The treatment schedule consists of
Irinotecan 180 mg/m2 i.v. day 1, Fluorouracil i.v. bolus 450 mg/m2 days
2- 5 and Leucovorin i.v. bolus 35 mg/m2 day 2- 5 with repetition every
21 days. Results: Overall response rate was 34,2% with
two complete remissions. Median survival was 15,4 months. Diarrhea, nausea,
vomiting and mucositis were most common side effects. Conclusions:
The combination of Irinotecan with bolus Fluorouracil / Leucovorin as
first- line therapy for patients with metastatic colorectal cancer offer
consistently improved tumour control and prolonged survival.
Key words: Metastatic colorectal cancer, First- line
reatment, Irinotecan, Response rate.
/Page
49-52/
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SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA
AND HEMOPERITONEUM-MANAGEMENT AND LONG TERM SURVIVAL
Ludmil
M. Veltchev
Fellow, Department of Surgical Oncology, The University of Texas M.
D. Anderson Cancer Center,Houston, USA
ABSTRACT: Aims: Complications
of HCC as spontaneous rupture and hemoperitoneum are life threatening
and have been observed particularly in patients with superficially dislodged
tumors with associated cirrhosis.
Methods: Retrospective analysis of patients from hepatobiliary
and liver transplantation units. Three cases for the past 15 years were
found.
Results: Of all three patients with ruptured HCC, one
was operated in emergency because of positive abdominal punction for hemoperitoneum
and active bleeding. In the other two patients, after emergency diagnostic
US, CT and angiographic study, it was decided to perform selective embolization
to stop bleeding and stabilize hemodynamic and in second stage proposed
liver resection. The age of the patients at time of first accident was
36, 58 and 75, respectively two men and a woman. All patients were diagnosed
with associated liver disease-cirrhosis.
Diagnostic procedures and pathologic specimens showed superficially localization
of ruptured tumoral nodules: predominantly in right liver lobe. The number
of lesion was between 1 and 3, and in later stage, after progressing of
the cancer process, it was diagnosed multiple.
The mean size of tumor nodule was 3.0 cm. Three times repeated rupture
was treated none surgically by chemoembolization.
The 3, 5 and 10 year survival was 100%. .
Key words: hepatocellular carcinoma; spontaneous rupture;
long-term management.
/Page
53-57/
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NEW TECHNIQUES OF RESECTION AND LONG-TERM SURVIVAL
FOR CHOLANGIOCARCINOMA
Ludmil
M. Veltchev, Manol A. Kalniev*
Fellow, Department of Surgical Oncology, The University of Texas M.
D. Anderson Cancer Center,Houston, USA; *Department
of Anatomy and Cytology, Medical University of Sofia,
Bulgaria.
ABSTRACT: Cholangiocarcinoma is
uncommon cancer with an incidence 1-2/100 000 in the USA. Predisposing
diseases for developing of cholangiocarcinoma include primary sclerosing
cholangitis (PSC), congenital biliary cystic disease and hepatolithiasis
with biliary infestations by Clonorchis siniensis, also called recurrent
pyogenic cholangiohepatatis ( mainly encountered in Japan and Southwest
Asia). The majority of bile duct tumors is relatively slow-growing. However,
this progression can be rapid in some patients. Blood-borne metastases
are uncommon, but nodal metastases, perineural and lymphatic involvement
as well as subepithelial spread are very common.
Key words: cholangiocarcinoma, diagnostic, surgical treatment.
/Page
58-61/
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ACCESSORY RIGHT HEPATIC ARTERY AS PRINCIPAL,
ARISING FROM PROPER HEPATIC ARTERY /CASE REPORT/
Ludmil
M. Veltchev1, Manol A. Kalniev2, Todor A. Todorov3
1) Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute, 12-14, avenue Paul Vaillant-Couturier,
94804 Villejuif Cedex; 2) Department of Anatomy, Cytology and
Histology, University of Medicine, Sofia, Bulgaria; 3) Department
of Pathology, University of Medicine, Sofia, Bulgaria.
ABSTRACT: The good knowledge for the normal hepatic
artery distribution and the possible anatomical variations is significant
in liver transplantation in order for the vascularity not to be disturbed
and to cause necrosis of the liver parenchyma postoperatively.
Disruption of an anatomical artery variation is uncommon in liver hilum
dissection, but non establishment of continuity in time of reconstruction
is an important cause for postoperative complications such as acute liver
failure and augment morbidity and mortality.
The aim of this case report is to present a non published anatomical variation
of accessory right hepatic artery arising from proper hepatic artery between
the branching of gastroduodenal artery and bifurcation of the proper hepatic
artery to right and left branches.
Key words:Accessory right hepatic artery, liver transplantation,
anatomical variations, significance.
/Page 62-63/
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ASSOCIATION OF ACUTE APPENDICITIS WITH TYPICAL
CLINIC AND ATYPICAL LOCATION DUE TO MALROTATION OF COLON, AND HYDROCEPHALUS
/CASE REPORT/
Ludmil
M. Veltchev1, Krassimir M. Iliev2, Ognian N. Vassilev2
1) Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute; 12-14, avenue Paul Vaillant-Couturier,
94804 Villejuif Cedex, France; 2) Deparment of general surgery,
State hospital of Biala Slatina, Bulgaria.
ABSTRACT: Atypical appendix location due to malrotation
of colon may suggest many different inflammatory diseases and may provoke
physician’s misdiagnosis. In the reported case the clinical findings suggested
typical right lower quadrant symptomatology for appendicitis but the cecum
and acutely inflamed appendix were located in the epigastria. Association
of congenital anomalies such as hydrocephalus and malrotation of the cecum
are found.
/Page 64-65/
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BILE DUCT SYSTEM MALFORMATION - EMBRYOLOGICAL
AND PATHOLOGICAL ASSOCIATION. TREATMENT /REVIEW ARTICLE/
Ludmil
M. Veltchev1, Manol A. Kalniev2, Todor A. Todorov3
1) Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute, 12-14, avenue Paul Vaillant-Couturier,
94804 Villejuif Cedex; 2) Department of Anatomy, Cytology and
Histology, University of Medicine, Sofia, Bulgaria; 3) Department
of Pathology, University of Medicine, Sofia, Bulgaria.
ABSTRACT: Cystic diseases of the liver which are
in most cases hereditary, are related to an embryonic disorder know as
ductal plate malformation. These diseases correspond to partial or total
arrest of remodeling of the ductal plate, leading to more or less complete
persistence of the excess of embryonic biliary structures. The ductal
plate malformation may concern different segments of the intrahepatic
biliary tree (segmental bile ducts, interlobular bile ducts and the smallest
bile duct ramifications) leading to various pathoclinical entities Congenital
cystic lesions of bile ducts may affect intra or extrahepatic bile ducts.
Intrahepatic lesions include five entities: congenital hepatic fibrosis,
Caroli’s syndrome, von Meyenburg complexes, simple cyst of the liver and
polycystic liver disease. Congenital hepatic fibrosis and von Meyenburg
complexes are secondary to ductal plate malformation affecting the smallest
intrahepatic bile ducts.
Choledocal cysts, Caroli’s disease and Caroli’s syndrome belong to the
some family of congenital malformations of the large bile ducts (1). The
former affects the extrahepatic bile duct (including occasionally the
left and right branch of the hepatic duct) while the latter affects segmental
intrahepatic bile ducts. Both are extremely rare (in the order of 1:10.000
or 100.000 and 1:1.000.000 births respectively.
Key words: Caroli’s disease, biliary dilation, complications.
/Page 66-68/
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METACHRONOUS TESTICULAR SEMINOMA-16 YEARS LATER: EARLY DETECTION AND MANAGEMENT /CASE REPORT/
Ludmil
M. Veltchev1, Manol A. Kalniev2, Todor A. Todorov3
1) Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute, 12-14, avenue Paul Vaillant-Couturier,
94804 Villejuif Cedex; 2) Department of Anatomy, Cytology and
Histology, University of Medicine, Sofia, Bulgaria; 3) Department
of Pathology, University of Medicine, Sofia, Bulgaria.
ABSTRACT: A 28-year-old male presented at a regional hospital with a pulling sensation and feeling of unusual heaviness in the right scrotum. Pain and discomfort appeared two weeks ago.
The patient had no previous medical history.
Physical examination, US and CT confirmed 26 mm mass, localized centrally in the right testis without metastatic process and patient was treated with right inguinal orchiectomy, followed by 25 Gy radiotherapy. After 16 years and 3 months the same symptomatology started in the left side and US discovered two masses: 15 and 21 mm in left testis. Investigation included tumor marker assessment, scrotal US, CT and biopsy. Diagnosis metachronous testicular seminoma, stage T1N1M0.
Biopsy, radical orchiectomy, androgen substitution and follow-up were performed.
Key words: seminoma, bilateral, metachronous, germ-cell tumor.
/Page 69-71/ <
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TECHNIQUE FOR INFLOW BLOOD CONTROL IN LIVER SURGERY - /Review article/
Ludmil
M. Veltchev,
Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute, 12-14, avenue Paul Vaillant-Couturier,
94804 Villejuif Cedex;
ABSTRACT: Vascular occlusion is used to reduce blood loss during liver resection surgery.
For many decades liver resections have been performed with very high morbidity and mortality. Intraoperative blood loss has indeed repeatedly been shown to adversely influence the short-term prognosis of patients. In addition, there is evidence that blood transfusion may associate with an increased risk of recurrence of malignancy, through impairment of the patient’s immune response. The knowledge for liver anatomy permitted to perform safety control of vascular flow and reduce complications (1, 2).
Because of the numerous improvements of the liver resectional techniques, many cases became possible for radical operations. In this regard, pedicular intermittent clamping, with alternates sorts periods of clamping with intervals of restoration of blood flow, proved to be the best-tolerated clamping modality (3). The combination of preoperative anatomical knowledge, good medical team and use of good tools for liver parenchyma dissection makes major liver resection possible.
Key words:inflow blood control, Pringle’s maneuver, liver resection.
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back > Published online - Sept. 01, 2009,
OBESITY SURGERY: INDICATIONS, TECHNIQUES, WEIGHTLOSS AND POSSIBLE COMPLICATIONS -/Review article/
Ludmil
M. Veltchev,
Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute, 12-14, avenue Paul Vaillant-Couturier,
94804 Villejuif Cedex;
ABSTRACT: In long-term perspective, the conservative treatment of obesity is always doomed to failure and only the surgical method allows reducing obesity. At this stage, the surgery of choice remains the gastric bypass, which is reduces on average 60-70% of the overweight and which is effective in 80% of the operated patients. Preoperative preparation, surgical interventions and postoperative monitoring of the patients are crucial to its effectiveness.
Key words: obesity, surgical techniques, complications.
/Page 74-77/ <
back > Published online - Sept. 01, 2009,
ENDOTHELIUM-DEPENDENT VASODILATION AND SCREENING FOR MOLECULAR DEFECTS OF THE LDL-R GENE IN BULGARIANS WITH UNTREATED AYMPTOMATIC SEVERE HYPERCHOLESTEROLEMIA
Lyudmila G. Vladimirova-Kitova,
Clinic of Cardiology, Medical University-Plovdiv, Bulgaria;
SUMMARY: Background: Severe hypercholesterolemia and family history of early vascular diseases are important determinants of the development of the endothelium dependent vasodilation in familial hypercholesterolemia. Mutations of the LDL-R-gene (low-density lipoprotein receptor gene) are characterized by a high genetic heterogenicity. Nearly 80% of the population specific heterogenicity are due to point mutations along the LDL-R gene. The different expression of the defect gene in LDL-R mutation carriers as well as the presence of elevated LDL levels in non-mutation carriers makes diagnosis difficult. So far, there is no optimal diagnostic algorithm in familial hypercholesterolemia. Objective To study the endothelium-dependent vasodilation (flow-mediated vasodilation) in carriers and noncarriers of LDL-R defective gene and utilize them to screen for defects in the LDL receptor (spot mutations and polymorphisms) in severe hypercholesterolemia (HC) in molecular biological analysis. Study was conducted in patients with diagnosed and presumed familial hypercholesterolemia according to Simon-Broome criteria. Ìaterials and methods: 464 first relatives of families with familial hypercholesterolemia were tested, of them 120 meet Simon-Broome inclusion criteria. Total cholesterol, triglycerides, cholesterol of high density lipoproteins, cholesterol of low density lipoproteins are determined, using the enzyme- colorimetric method. Molecular analysis included: DNA isolation, amplification of a target DNA fragment by polymerase chain reaction, Single Strand Conformation Polymorphysm (SSCP) and direct DNA sequencing. The Hewlett Packard SONOS 5500 with a 7.5 MHz triplex transducer and the MedicaSoft.IMT lab software packet were used to determine the flow-mediated vasodilation. Results: According to the presence or absence of genetic mutations, patients were assigned into two groups - carriers of LDL-R gene point mutations - 22 (18.33%) patients - of them 16 (13.33%) were carriers of an unknown mutation (not registered in the available data bases—1073G>A) and non-carriers - 98 patients – 81.67%. All 18 exons of the LDL-R gene were tested. Median age of non-carriers is 43.41±0.43 years, that of carriers –45.40±0.27 years (ð<0.001). There is no statistically significant difference in the patients’ distribution according to sex (x2=0.06; ð>0.05). There is not statistical significant difference on all biomarkers of the atherogenic risk between two group (p>0.05), as for flow-mediated vasodilation (p>0.05). Conclusion: Endothelium-dependent vasodilation (flow-mediated vasodilation) are not an indicator of the presence of point mutations and polymorphisms of the LDL-R gene.
Key words:hypercholesterolemia, low-density lipoprotein, LDL-R, flow-mediated vasodilation, apolipoproteins.
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back > Published online - Sept. 11, 2009,
ROSAI-DORFMAN DESEASE WITH INFRATENTORIAL LOCALIZATION: A CASE REPORT
Tony Avramov
Department of Neurosurgery, St Anna Hospital, Medical University „Prof. P. Stoyanov”, Varna, Bulgaria;
SUMMARY: Rosai-Dorfman disease (RDD), or sinus histiocytosis with massive cervical lymphadenopathy, occurs mostly in children and young adults. RDD extremely rarely affects the infratentorial region, without involvement of other anatomical structures. We report a case of a 36-year old woman with isolated RDD in the cerebellum. Clinical features were presented with a neocerebellar syndrome. Brain MRI showed a lesion with varying density, located in the left cerebellar hemisphere. No extracranial lesions were detected, The patient was operated on, and recovery was full. Microscopically, the process presented with lymphoplasmatic and multinucleate histiocytic infiltration. The prognosis is good.
Key words: Rosai-Dorfman disease. cerebellar tumor, surgery.
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back > Published online - Sept. 29, 2009,
RESULTS OF SPINAL TUMORS SURGERY
Tony Avramov, G. Kyuchukov, I. Kiryakov, N. Obreshkov, D. Handjiev, R. Nedelko,
Clinic of Neurosurgery and Neurology, St. Anna Hospital, Varna; Department of Neurosurgery, Eye diseases and ENT, Medical University „Prof. P. Stoyanov”, Varna, Bulgaria;
SUMMARY: The clinical files of 122 operated patients in our Clinic of neurosurgery St. Anna Hospital – Varna during 5-year period were retrospectively reviewed. 68 had significant episodes of radicular pain, 100 - motor deficit and 62 - bladder disfunction. X-ray, bone CT and MRT were performed in 56, 23, 79 patients, respectively. 112 episodes of laminectomy and spinal cord compression were treated surgically. MRI effectively showed intra- extravertebral mass lesions. Overall treatment led to improvements in pain and motor deficit of 45 % of patients. Vertebral metastases strongly alter QL in all 51 patients. Radicular pain, neurological deficit, infection, venous thrombosis, pneumonia and other complications before and after surgery are the major problems. The mortality rate in our series is 7,3 %. Is needed to determine the optimal timing of treatment strategies chemotherapy, radiation therapy and especially of surgery.
Key words: spinal tumors. spinal cord compression. surgical treatment. laminectomy. transpedicular fixation. postoperative complications.
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back > Published online - Sept. 29, 2009,
PHLEGMASIA CERULEA DOLENCE- RISK FACTORS AND PREVENTION. /CASE REPORT/
Ludmil
M. Veltchev1, Manol A. Kalniev2, Todor A. Todorov3
1) Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute; 2) Department of Anatomy, Cytology and
Histology, University of Medicine, Sofia, Bulgaria; 3) Department
of Pathology, University of Medicine, Sofia, Bulgaria.
ABSTRACT: Phlegmasia cerulean dolens is a severe form of deep venous thrombosis characterized by severe venous outflow obstruction, marked limb swelling, pain, bluish discoloration, and even venous gangrene, if the condition is untreated. Etiological factors include malignancy, femoral vein catheterization, heparin-induced thrombocytopenia, antiphospholipid syndrome, surgery, heart failure, and pregnancy.
In our case, 71 year-old woman, with twenty three years treated diabetes mellitus was accepted for GI imaging study for suspicions of neoplastic process of stomach. On the third day she complained of edema, agonizing pain and cyanosis, many blisters and starting necrosis on the dorsal and lateral surface of right ankle, progressively extended to distal one third of leg. Anticoagulation with intravenous administration of heparin, and fluid resuscitation started immediately.
Key words:venous thrombosis, venous gangrene, anticoagulation, amputation.
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back > Published online - Oct. 07, 2009,
Mirizzi syndrome-rare cause of major biliary complications. /CASE REPORT/
Ludmil
M. Veltchev1, Manol A. Kalniev2, Todor A. Todorov3
1) Fellow, Master’s Program in Hepatobiliary Pancreatic Surgery, Henri
Bismuth Hepatobiliary Institute; 2) Department of Anatomy, Cytology and
Histology, University of Medicine, Sofia, Bulgaria; 3) Department
of Pathology, University of Medicine, Sofia, Bulgaria.
ABSTRACT: Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. It was described in 1948 by P. L. Mirizzi and presents unusual lodged gallstone in either the cystic duct or most frequently in Hartmann pouch of the gallbladder. Impaction, acute obstruction and wall ischemia are causative for inflammation and abscess formation. External common hepatic bile duct compression and obstruction result in clinical presentation of intermittent or constant jaundice. We report 57-year-old male with extensive mechanical icter, fever, nausea and vomiting, and upper abdominal pain in epigastria from five days. Abdominal US evaluation showed 17mm stone localized in infundibulum and shrunk of gallbladder. MRCT revealed impacted stone, chronic tissue inflammation, involved common hepatic duct with stricture. Mirizzi syndrome was diagnosed.
Intraoperatively was found an impacted gallstone in the Hartmann pouch, extensive fibrosis of hepatoduodenal ligament and abscess cavity formation in the Callot’s triangle with engagement of common hepatic bile duct wall. Antegrade cholecystectomy was made and T drain was placed. Second operation and Roux-Y limb anastomosis was performed after unsuccessful tentative for recanalization of distal CBD with clamping of T drain.
Key words: Impacted gallstone, Callot’s triangle abscess, cystic duct variation, common hepatic duct stricture, T-drain.
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Infections in urinary tract of patients with haematological malignancies undergoing antineoplastic therapy
S. Tancheva1, I. Micheva2, I. Marinova1, B. Bojchev1, M. Marinov3, K. Nenov4, R. Radev3
1 Department of Clinical Laboratory , 2 Department of Internal Medicine-Haematology Division, University Hospital, Medical University – Varna, 3Department of Preclinical and Clinical Medical Sciences, Medical University – Varna, 4Department of Internal Medicine-Nephrology and Haemodialysis Division, University Hospital, Medical University – Varna, Bulgaria.
ABSTRACT: The treatment of the malignant diseases requires the use of combination chemotherapy in multiple cycles administered to achieve adequate tumor cell kill without life-threatening toxicity or the development of tumor cell resistance. Patients and methods:72 patients (48 women and 24 men, median age – 47, from 24 to 71years with urinary tract infections (UTI), hospitalized in the Clinic of Hematology for the period January 2006-May 2008. Urinalysis: microscopic examination – white blood cells (WBC), bacteria; urine culture; sensitivities of culture. Blood tests: urea (kinetic UV test ), creatinin (Jaffe kinetic), CRP (immunoturbidimetric method), blood culture, sensitivities of culture. Results and conclusions:The urinary tract infections are a common complication during the combination chemotherapy patients with hematological malignancies. For the period 2006-2008, 72 patients undergoing combination chemotherapy were diagnosed with UTI.
Key words: urinary tract infections; antineoplastic therapy; Beta-2 microglobulin.
/Page 95-97/ <
back > Published online - Feb. 23, 2010,
Last edition: February 23, 2010