Georgi S. Slavov, Maria G. Manova, Anastasiya G. Trenova, Ivanka I. Kostadinova, Pavel I. Pavlov, Nonka G. Mateva and Zahari I. Zahariev
To assess the changes in the serum concentrations of 25(ОH)D in relapse and remission and their relation to the degree of neurological deficit. We analyzed 53 subjects (30 controls and 23 patients) from October 2012 to Маy 2013. Diagnosis was based on McDonald 2010 criteria. The severity of neurological deficit was assessed by the Expanded Disability Status Scale. Serum concentrations of 25(ОH)D (nmol/l) were measured by ELISA once in controls and twice in patients - in relapse and remission. Mean levels in all groups were in the mild to moderate deficiency range, being lowest in the patients in relapse (controls 31.46±7.3; relapse 26.93±7.44; remission 28.06±7.28). There was a trend for lower levels of 25(ОH)D in healthy females in comparison to their male counterparts, and in female patients in relapse as compared to males (female controls - 26.56±8.4, male controls - 41.35±11.86; females in relapse - 26.33±10.03, males in relapse - 28.06±11.08). Negative statistically significant correlations between the concentrations of 25(ОH)D during relapse and remission and the degree of neurological deficit in the corresponding period were found (cc. -0.593, Sig 0.03, relapse; -0.46, Sig 0.024, remission). Assessment of the risk for development of MS, regarding the 25(ОH)D showed protective effect with respect to the risk of disease occurrence (ОR: 04125 relapse; 0.578 remission).
Maria G. Ganeva, Tanya T. Gancheva, Ivan D. Baldaranov, Nataliya J. Kiriyak and Evgeniya H. Hristakieva
Methotrexate (MTX) is a cytostatic agent used in oncology. Because of its immunosuppressive properties, MTX is also used in autoimmune disorders. Low-dose MTX regimens in the treatment of rheumatoid arthritis and severe psoriasis are considered to be safe. However, pharmacovigilance centers warn of serious and even fatal incidents due to errors in oral MTX administration. The aim of this case series presentation was to identify the specific factors related to the development of adverse drug reactions (ADRs) induced by MTX. A prospective pharmacovigilance study was conducted at the Clinic of Dermatology, University Hospital, Stara Zagora. We report 3 cases of patients with psoriasis vulgaris in which severe haematological abnormalities associated with previous administration of MTX were detected during hospitalization. A 73-year old female with malaise, vomiting and oral ulcers who had taken approximately 120 mg MTX was found to have pancytopenia. A 59-year old male hospitalized for psoriatic erythroderma who had erroneously taken 10 mg MTX daily instead of weekly for 8 days, was diagnosed with bicytopenia and toxic hepatitis. An 88-year old male with psoriatic arthritis presented with aphthous stomatitis, erosive crusted lesions, ecchymoses and aplastic anemia 2 weeks after treatment with 12.5 mg MTX once weekly plus i.m. Movalis®, followed by Diclophenac Duo®. The main predisposing factors for the development of these ADRs were patient-related dosage errors and concomitant administration of NSAIDs. Safe use of oral MTX requires clear dosing instructions and strict patient compliance. Potential drug interactions of MTX with other drugs should also be considered.
Tihomir P. Totev, Svetlana A. Mateva, Margarita R. Nikolova and Grigor A. Gorchev
Angiomyolipomas are benign mesenchymal neoplasms, presenting with a variable mixture of adipose tissue, smooth muscle and vascular component. Although they are typically found in the kidneys, many cases of extrarenal angiomyolipomas have been reported. They are extremely rarely present in the uterus. We describe a case of a 56-year-old woman, operated on for leiomyoma. Total laparohysterectomy and bilateral adnexectomy was performed. After histological and immunohistochemical examination, the final diagnosis of uterine angiomyolipoma was made. Renal and extrarenal angiomyolipomas are compared in regard to clinical and morphological aspect and their difference from PEComas is dicussed. PEComas have been defined during the last decade and there are still issues regarding terminological clarity and overlapping.
Maya P. Danovska, Margarita L. Alexandrova and Irena I. Gencheva
Individuals with hypertension and diabetes mellitus are at high risk of cerebrovascular and cardiovascular morbidity and mortality. Recent advances in the multifactorial pathophysiology of atherogenesis provide important information about the complex interrelations between traditional risk factors, inflammation and oxidative stress in mediating all stages of atherosclerosis. The objective of the study was to determine if some inflammatory and oxidative stress markers in patients with arterial hypertension and diabetes mellitus differ from those in healthy age-matched controls. Our results revealed a significant difference in blood pro/antioxidant activities in hypertensive diabetics and the controls. The investigation of inflammatory and oxidative stress markers along with traditional risk factors proves useful in complex assessment of vascular risk and primary prophylaxis of cerebrovascular and cardiovascular events.
Savelina L. Popovska, Ivan N. Ivanov and Dorian Y. Dikov
Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer (LABS). The aim of this study was to determine the effects of neoadjuvant chemotherapy on metastatic and nonmetastatic breast cancer axillary lymph nodes (ALNs). Seventy-seven patients with LABS and cytologically documented ALN metastases were treated in two prospective trials. Patients had breast surgery with level I and level II axillary dissection followed by additional chemotherapy or radiation treatment. Clinical nodal status was determined by physical examination and compared with histological and immunohistochemical findings. The regressive changes in primary tumor and ALNs were achieved using scoring systems. Objective clinical response in primary tumor was seen in 48.05% of patients. Histologic evidence of regression was noted in 46 cases (59.75%), with complete histologic regression achieved in 5 cases (6.49%). The number of cases according to the ALNs regression scoring system was as follows: 0 grade - viable metastases without effect - 21 patients (30%); 1 grade - cytotoxic effect in metastases - 20 patients (28.58%), 2 grade - micrometastasis - only3 patients (4.28%); 3 grade - no residual metastatic disease - 1 patient (1.43%); 4 grade - negative ALNs before and after treatment - 25 patients (35.71%). Nodular fibrotic area and iron-loaded macrophages suggested previous presence of tumor metastasis. There was significant relationship between histologic regression in the primary tumor and the presence of effect of cytotoxic agents on ALNs metastases (r=0.9123; p<0.00001). As chemotherapy is widely used in the treatment of breast carcinoma, pathologists should be aware of chemotherapy-induced changes in metastatic and in nonmetastatic ALNs.
Dobromir D. Dimitrov, Veselin I. Kirov, Borislav A. Ignatov, Boris D. Tsankov, Hyuliya E. Feradova, Vasya Vutova, Silviya P. Hristova, Vasil D. Nanev, Genoveva B. Valcheva and Tashko S. Deliyski
In the last 15 years, sentinel lymph node biopsy (SLNB) for patients with malignant melanoma (MM) has been introduced into the clinical practice. Our aim was to make a retrospective analysis of clinical results in order to assess the success ratio of SLNB and the variables affecting it in MM patients, treated in the Oncology Center at the University Hospital “Dr George Stranski” - Pleven, Bulgaria for a 4-year period. A research index card was used to process the oncologic files of 82 out of 102 patients with MM, treated and monitored at the Oncology centre between 01.01.2008 and 31.12.2011. TNM-stages, Breslow and Clark levels, location, characteristics of the skin lesion, diagnostic excision, type of lymph node dissection, number of SLN, localization of SLN, etc. were registered in the index card. SLNB staging was carried out in 28 patients. Sentinel lymph nodes were found in 22 of them. The success ratio of the method was 78.6%. Histologically, metastatic SLN were found in 4 cases. The Patent Blue Dye method was used in 22 of the cases (78%). A combined radiocolloid and dye method was used in 5 cases (18%). A radiocolloid method was used in 1 case (4%) only. Our research showed that more therapeutic lymph node dissections were performed in cases of locally advanced MM, which in turn worsened the clinical results. According to our research, the SLNB success ratio depends on the precision of diagnostic excision (p=0.019), lesion location (p=0.015), Clark level (p=0.0229), mapping method (p=0.08) and the type of melanoma (p=0.088).
Danelina E. Vacheva, Verjinia K. Simeonova and Boyko St. Stamenov
Bulgaria ranks first in the world in incidence, morbidity and death associated with cerebrovascular disease. The aim of the study was to investigate, follow-up and register recovery of activities of daily living (using the toilet and maintaining personal hygiene) in patients with sequelae from cerebrovascular disease in a subacute stage, who underwent physiotherapy and rehabilitation. Sixty-one patients were included and followed up. They were given tailored physiotherapy and rehabilitation. This included kinesitherapy, occupational therapy and electrotherapy. All the patients filled in self-assessment questionnaires before and after the rehabilitation course. Major parameters were assessed, irrespective of the limb affected -dominant or non-dominant. Results were analyzed using the Wilcoxon rank test. At the end of the rehabilitation course, the Wilcoxon curves were driven to the right, confirming improvement concerning independence, irrespective of involvement of dominant or non-dominant limb.
Pentcho T. Tonchev, Sergei D. Iliev and Ivailo M. Presolski
Internal hernias are rare and most of them are diagnosed intraoperatively. We present a case of a 53-year-old man with proximal intestinal obstruction, caused by incarcerated internal hernia. During the operation, a proximal portion of 40 cm of the jejunum was found herniated and strangulated in the lesser sac through an opening of the transverse mesocolon. The jejunum was necrotic and local purulent peritonitis was present. After resection of the proximal 40 cm of the jejunum, the passage was restored using an unconventional approach. The distal duodenum was closed and, to protect the stump, the duodenum was ligated between its second and third parts. A latero-lateral anastomosis was made between the first part of duodenum and the jejunum. Anatomical, clinical and radiological findings, diagnosis and treatment of paraduodenal hernias are discussed in brief.
Lyubomir Ts. Beshev, Angel P. Marinov, Tihomir V. Andreev, Nachko I. Totzev, Valentin Ch. Velikov, Tsvetomir G. Georgiev, Angel S. Grigorov, Boris D. Tsankov and Borislav A. Ignatov
Clinical manifestations, possibilities for accurate diagnosis of popliteal aneurysms, and operative approaches applied depending on their location are presented, as well as results from treatment over a four-year period. Popliteal artery aneurysms accounted for 5.63% of all 266 cases of acute arterial insufficiency. The mean age of the patients was 68.8 years, and the male:female ratio – 4:1. In five patients (33.33%), the localization of aneurysm was unilateral. In 80% of the cases with bilateral popliteal aneurysms, the aneurysms were combined with aneurysms of other locations. The surgical technique applied was posterior approach with resection of the aneurysm and interposition of a polytetrafluoroethylene (PTFE) prosthesis. The early patency rate of the reconstructed segment was 100%. Late patency rate of the reconstructed segment was 90.9%. Despite the better late results in femoropopliteal reconstruction, we think that a posterior approach with prosthesis implantation is better because it saves the great saphenous vein. The presence of multiple aneurysms in the patients studied (80%) determined the low survival at 5 and 10 years, which makes it comparable to the results from applying the two surgical methods.