Solitary primary intraosseous xanthoma of the mandible in a 15-year-old boy: a case report.

BACKGROUND: A xanthoma is a rare bone condition consisting of a predominant collection of lipid-rich, foamy histiocytes. The central xanthoma of the jaws is a unique benign tumor. CASE REPORT: A 15-year-old Caucasian male has been presented to our department. He had radiological changes in the area of the left mandibular angle, with an area of diffuse osteolysis of 3.0 cm by 2.0 cm. Computed tomography reveals an area of diffuse osteolysis that starts from the distal root of the lower second molar and reaches the ascending process. A bone biopsy was performed, which revealed a benign proliferative process composed of histiocytic cells involving and infiltrating trabecular bone in a background of loose fibrous connective tissue devoid of any other significant inflammatory infiltrate. The size of the formation was 2.9 cm by 2.0 cm. Immunohistochemical staining for CD68 was strongly positive and negative for S-100 and CD1a. From routine blood tests, cholesterol, triglycerides, and blood sugar are within normal values, which excludes systemic metabolic disease. Subsequent to the surgical intervention, the patient underwent postoperative assessments at intervals of 14, 30, 60 days, and a year later, revealing the absence of any discernible complications during the aforementioned observation periods. CONCLUSION: The diagnosis of primary xanthoma of the mandible is rare and can often be confused with other histiocytic lesions. A differential diagnosis should be made with nonossifying fibroma and Langerhans cell histiocytosis, as in our case. In these cases, immunohistochemistry with CD 68, S-100, and CD1a, as well as blood parameters, are crucial for the diagnosis.

High-Intensity Focused Ultrasound Thermotherapy for Scar Treatment.

The formation of pathological scars is a common medical and aesthetic problem worldwide. Surgical interventions, burns and injuries are the most common cause. Treating these scars is a challenge for any surgeon. The Clinic of Plastic-Reconstructive and Aesthetic Surgery with Thermal Trauma and Imaging Diagnostics applied an innovative method of thermotherapy with high-intensity, focused ultrasound in 20 patients with hypertrophic scars and keloids of different age, etiology and parameters. After a series of procedures, we got excellent results, reducing scar size, pigmentation, pain and itching. This type of thermotherapy is successfully applied to pathological scars. In this way, a change in scar density is achieved by converting hard collagen into a gelatin-like mass.As a subsequent procedure, moderately compressive massages are applied for faster resorption of the pathological collection. Our results show that high-intensity focused ultrasound thermotherapy of pathological scars is a non-invasive method of treatment with reasonably good results as regards both aesthetic and functional aspects.

Les cicatrices pathologiques sont un problème médical et esthétique ubiquitaire, rencontré principalement après traumatisme, brûlure ou intervention chirurgicale, dont le traitement est un défi pour tout chirurgien. Le service de chirurgie plastique, reconstructrice et esthétique a utilisé une méthode innovante de thermothérapie par ultrasons à haute intensité focalisés pour traiter les cicatrices hypertrophiques ou chéloïdes, d'origine variée, de 20 patients. Après une série de procédures, nous avons obtenu d'excellents résultats sur la taille, la pigmentation, la douleur et le prurit. Cette technique permet de transformer les fibres collagènes en une masse gélatineuse, qui se résorbe plus rapidement après massages. La thermothérapie ultrasonique focalisée à haute intensité est une méthode non invasive de traitement des cicatrices pathologiques qui donne des résultats corrects, tant du point de vue esthétique que fonctionnel.

[Structure of Neuroglobin from Cold-Water Sponge Halisarca dujardinii].

The iron-containing protein neuroglobin (Ngb) involved in the transport of oxygen is generally considered the precursor of all animal globins. In this report, we studied the structure of Ngb of the cold-water sponge Halisarca dujardinii. In sponges, the oldest multicellular organisms, the Ngb gene contains three introns. In contrast to human Ngb, its promoter contains a TATA-box, rather than CG-rich motifs. In sponges, Ngb consists of 169 amino acids showing rather low similarity with its mammalian orthologues. It lacks Glu and Arg residues in positions required for prevention of hypoxia-related apoptosis. Nevertheless, Ngb contains both proximal and distal conserved heme-biding histidines. The primary structure of H. dujardinii neuroglobin predicted by sequencing was confirmed by mass-spectrometry analysis of recombinant Ngb expressed in E. coli. The high level of Ngb expression in sponge tissues suggests its possible involvement in the gas metabolism and presumably in other key metabolic processes in H. dujardinii.

The Role of Epibionts of Bacteria of the Genus Pseudoalteromonas and Cellular Proteasomes in the Adaptive Plasticity of Marine Cold-Water Sponges.

It was found that cells of different color morphs of the cold-water marine sponges Halichondria panicea (Pallas, 1766) of the class Demospongiae differ in the content of epibionts of bacteria of the genus Pseudoalteromonas. The sponge cells with elevated levels of epibionts of bacteria of the genus Pseudoalteromonas showed an increased expression of Hsp70 proteins but had a reduced level of the proteasomal catalytic beta 5 subunit, which was accompanied by a change in their activity. Probably, epibionts of bacteria of the genus Pseudoalteromonas may affect the ubiquitin-proteasome system in the cells of cold-water marine sponges and, thereby, ensure their adaptive plasticity.

Prevention, management and rehabilitation of patients with cerebral palsy.

UNLABELLED: The aim of this paper is to present the importance of orthopaedics in the prevention, treatment and rehabilitation of persons with cerebral palsy. MATERIAL AND METHODS: The paper is based on a study realized at the University Orthopaedic Clinic, Medical School, Ss. Cyril and Methodius University in Skopje, with application of documentary analysis, observation and clinical analysis of 76 patients with cerebral palsy, aged between 1 and 15 years. RESULTS: Orthopaedics is a surgical field of medicine, in which context there have been, are and will be, as a challenge, many questions for the present and future generations. Data analysis pointed out that surgical treatment in combination with conservative treatment give a hope that a definite or prolonged cure is possible, with maximal and possibly preserved function of the loco-motor system or, in the most serious cases, abatement of the impaired locomotor system symptoms. SUMMARY: Early diagnosis and appropriate application of surgical treatment enable better functioning of persons with cerebral palsy by maximal exploitation of their remaining abilities.

[Administration of activated recombinant factor VII (novo seven) for the control of massive bleeding in gynecology]. / Prilozhenie na aktiviran rekombinanten faktor VII (novo seven) za kontrol na masivno kruvotechenie v ginekologichnata praktika.

We report our clinical opinion for recombinant activated factor VII (NovoSeven, Novo Nordisk, Copenhagen, Denmark) administration in gynecology patients with massive haemorrhage. 3 women with gynecology deseases and severe bleeding in recieved NovoSeven in bolus IV. The blood loss and laboratory changes in hematology and haemostasis parameters are monitored. The bleeding was ceased in all cases. Decrease in values of Hb, Er and PTT was noted. The use of recombinant factor VIIA in gynecology patients with severe bleeding is effective and safe enough and could be an alternative to the extreme surgical procedures.

[A case of invasive cervical carcinoma associated with pregnancy]. / Sluchai na invaziven kartsinom na matochnata shiika i bremennost.

The cervical cancer is the most usual neoplastic disease, which takes place during the pregnancy. The prognosis for the women depends mostly of the clinical stage and the presence of nodal metastasis. The principes of the treatment do not differ from the standard oncologic therapy in nonpregnant women. Differencies exist in the way and the time of the terminanation of the pregnancy. The authors present y case of pregnancy and invasive cervical adenocarcinoma diagnosticated in m. 1.X. immeadiately after cesarean section an extended hysterectomy y modo Piver 111 with pelvic nodal dissection is done.

[Clinical difficulties and errors in making a diagnosis of chronic papillo-odditis]. / Klinichni trudnosti i greshki pri postaviane na diagnozata khronichen papiloodit.

138 patients with chronic papillooditis were investigated, 15 of them in a stage of decompensation. In 83.3% of the cases, the diagnosis was not clinically determined (including 68 of 92 endoscoped before their hospitalization--82.9%). 34 patients were diagnosed as having chronic gastroduodenitis, 15--ulcer, 42--chronic cholecystitis, 11--chronic pancreatitis, 4--cholangitis, 9--postcholecystectomic status. All these diseases developed simultaneously with the papillitis. In a second endoscopic check-up with an examination of papilla Vateri, the patients were in all the cases diagnosed without difficulties and the diagnose was confirmed by biopsy. In 21 patients there was confirmed primary papillooditis and in 127--accompanying disorders: chr. gastroduodenitis--29, chr. atrophic gastritis--18, ulcer--15, chr. cholecystitis--42, postcholecystectomic status--9, choledocholithiasis--14, chr. pancreatitis--11. Most often misdiagnosis occurs if: 1) during the routine endoscopic investigation the endoscopist does not examine papilla of Vater; 2) chr. papillitis exists simultaneously with one of the already mentioned diseases that are easier of approach for diagnostics and explanation of the disorders; 3) the clinical picture of papillitis cannot be differentiated from the one of the basic or accompanying disease; 4) the bile drainage is not prevented; 5) the result of the venous biligraphy does not lead to the diagnosis and ERCP is carried out only in a case of a clinical suspicion.

[Relaparotomy in middle-aged and elderly patients with peritonitis following a primary operation for digestive pathology--II]. / Relaparotomiia pri bolni v naprednalata i starcheskata vuzrast s peritonit sled purvichna operatsiia po povod digestivna patologiia--II chast.

The study covers 39,233 patients presenting biliodigestive pathology of which 12,230 in advanced and senile age, admitted to the emergency surgery section of the EMI "NI Pirogov" over a 12-year period (1985 through 1996). Of the total number, 6555 or 53.71 per cent are subjected to operation, with postoperative deaths amounting to 477 (7.27 per cent). In 320 cases (4.88 per cent) 218 men and 102 women, relaparotomy is done for postoperative peritonitis with 55 per cent lethality. Postoperative peritonitis is usually observed after operative treatment of ulcers. Operations for bleeding ulcers are performed in 175 patients of which 32 (18.28 per cent) are relaparotomized. Those operated for postoperative peritonitis are 65 per cent with 21 fatal outcomes; the commonest cause of death is insufficiency of the anastomosis or duodenal stump, followed by subhepatic and interfold abscesses.

[The morphological changes in the liver in experimentally induced hypercholesterolemia]. / Morfologichni promeni v cherniia drob pri eksperimentalno predizvikana khiperkholesterolemiia.

The authors examined the liver of 20 rabbits "Newzeland white" and "Chinchila", undergone atherogenic diet with cholesterol (0.3-0.5 g/kg body weight) for 30 and 60 days. They determined cholesterol, lipids, triglicerides and beta-lipoproteins in the serum. The morphologic study revealed accumulation of cholesterol in the hepatocytes, fibrosis, proliferation of the bile ducts and signs of hepatic cirrhosis.

[Morphological and morphometric studies of the pancreas in type-2 diabetes mellitus]. / Morfologichni i morfometrichni izsledvaniia na pankreasa pri zakharen diabet ot vtori tip.

The authors investigated histologically and immunohistochemically 60 cases with diabetes mellitus type 2. By means of the morphometric method of Weibel et al. (1969) they established diminished volume density of the insular tissue in total pancreas. The morphologic and morphometric data revealed evidence that diabetes mellitus most probably presented a heterogeneous group of pancreatic lesions manifested by disturbances of carbohydrate homeostasis.

[A case report of visceral leishmaniasis]. / Vistseralna laishmanioza s prinos na edin sluchai.

A brief review of the spread of visceral leishmaniasis in Bulgaria and data about the disease are presented. A case of probably nonautochtonous form of visceral leishmaniasis is described. The clinical evolution of the disease is followed up and the large number of examinations which were carried out for the etiological diagnosis are presented. The diagnosis is based on the characteristic clinical symptoms, epidemiological history, positive serologic tests but with a negative myelogram. The diagnosis was proved ex juvantibus by the antimony treatment and the full recovery of the patient. This is the first case of visceral leishmaniasis in the 40 year history of the hospital.

[Adenoma of the large intestine]. / Vurkhu adenoma na debeloto chervo.

In 89 patients 107 adenomectomies in the colon have been performed with pathohistological examination of the adenomas. Fiber coloscopy of the whole colon was performed to all patients, and the results give basis for discussion of the problems of adenomas: their frequency and localization in the different parts of the colon, the relative frequency of their pathologic stages. Most often adenomas were found in the sigma (41.79-50.00%). 67 (62.92%) of the 107 adenomas studied were tubular, 24 (22.43%) were tubulovillous and 16 (14.95%) were villous. The percentage of the villous adenomas found by the authors is somewhat higher than found by other authors. Pathologic stages were found more often in the adenomas localized in the sigma. Most of the adenomas were benign--77.5%. Adenomas with dysplasia were 12.15%, with focal cancer--7.48% and with invasive cancer--2.80% of all adenomas studied.

[Barrett's esophagus]. / Baretov khranoprovod.

In 12 patients the endoscopic examination raised the suspicion of Barrett's syndrome. By means of guided biopsies and static scintigraphy with gamma camera and 99m-technetium pertechnetate ectopic gastric mucosa was found in the esophagus of 5 of the patients. In one patient a Barrett's ulcer was found. The establishment of a focus of increased radioactivity proximal from the stomach by static scintigraphy is a proof for the presence of ectopic gastric mucosa in the esophagus. Because of the high risk of malignancy a systemic endoscopic biopsy control is necessary for the patients with proved columnar-cell metaplasia in the esophagus.

[The Dubin-Johnson syndrome]. / Sindrom na Dubin-Johnson.

Three cases of Dubin-Johnson syndrome in close relatives--brother, sister and a brother's son--are reported. The clinical characteristics, evolution, diagnostic and differential diagnostic problems as well as the treatment and prognosis of the disease are pointed out.

[Case report of Gaucher's disease]. / Bolestta na Gaucher s prinos na edin sluchai.

The case of a 42 years old man suffering from Gaucher's disease is reported. The primary diagnosis was liver cirrhosis based on echographic and scintigraphic examinations. The following signs were found: thrombocytopenia, slight hemolysis, shortened life of the erythrocytes with considerable sequestration in the spleen, abnormal flocculation tests, increased acid phosphatase. The X-ray examination revealed irregularly oval light spots with different size and form and well cut outlines in the skull and a zone of bone resorption in the right shoulder joint. The liver needle biopsy showed parenchymal infiltration with Gaucher's cells. The above mentioned deviations and the family heredity of the patients suggested the diagnosis of an adult form of Gaucher's disease. The fibroplastic changes in the liver including formation of septa led to the suggestion of a link between Gaucher's disease and liver cirrhosis.

Effect of medazepam on benzodiazepine receptors in brain of mice with isolation syndrome.

The effect of medazepam in a model of isolation aggression in mice was studied according to Yen et al. It was established that the mean effective dose of medazepam was 250 micrograms/kg and the therapeutic index (LD50:ED50) 6200. The simultaneous biochemical investigations showed a reduction of the affinity and number of benzodiazepine receptors in the brain of aggressive animals. Medazepam 10 mg/kg p.o. led to the restoration of the number of benzodiazepine receptors at a single and 10-day treatment.