Aseptic osteonecrosis of the maxilla after severe COVID-19 infection and its treatment.

The course of the new SARS-CoV-2 (COVID-19) is unpredictable and is still being investigated. Although the majority of complications are expected to affect the respiratory system, there have been reports in literature concerning the adverse effects of the infection on bone and joint tissue. Several complications have been observed in the maxillofacial area in people who suffered from the infection, including osteonecrosis and osteomyelitis of the jaw. These complications have been subject to various hypotheses. They may result either from the disease pathogenetic mechanism or from a response to the therapeutic modalities used to treat the underlying disease, and overuse of particular medications - glucocorticoids, antirheumatics, interleukin-6 inhibitors, and antibiotics. This article presents a case of osteonecrosis of the maxilla after severe COVID-19 infection.

GIANT MORGAGNI HERNIA IN A FEMALE WITH MALROTATION SYNDROME AND THORACIC TRANSPOSITION OF SMALL BOWEL, COECUM, ASCENDING AND TRANSVERSE COLON.

The sterno-costal hernia of Morgagni is a congenital vice in which is represented unfinished fusion of the transverse septum and the muscular diaphragmal wall. The malrotation syndrome is an embryonic vice as well, with various degree of incomplete and even reverse rotation of the gut, because of disturbed or unfinished development of the midgut. The described case presents a 37 years old female without anamnesis of any previous complains, who was pointed to the clinic after a X-ray photograph because of breathless and asteno-adynamic syndrome. After a precise CT investigation performance was found the presence of the above described anomalities, as well as ectopy of the right kidney and the right liver part. An operative treatment was performed with correction of the hernia and the bowel malrotation. The patient was followed up to the 12th month post-operatively. After a review of the literature in the discussion we inspect the diagnostics and the definition of the right surgical tactics and operative approach in this case with combined malformative pathology.

Follow up by CT-colonoscopy of patients with colostoma after resection on the occasion of colorectal cancer.

The follow up of patients operated for colorectal cancer (CRC) and the early detection of recurrences and metachronous tumors improves significantly the results of treatment and the survival of the patients. Computed Tomography (CT) and fibro-colonoscopy (FCS) are the main applied image diagnostic methods for this aim. Alternative unified method is the CT colonoscopy (CTC -"virtual colonoscopy" ) with i.v. appliance of contrast. A particular group of patients liable to control are those after Miles and Hartmann operation with created colostoma. The performance of CTC and its informativeness in these cases is specific and represents a challenge. For a two-year period were implemented generally 48 "virtual colonoscopies" (CTC) in stoma patients--21 male and 27 female, average age 53.2 ± 9 years. The postoperative interval to the CTC varied 8 to 29 months. The studies were performed on a 32 detector CT - GE: 32 x 0.625mm and rotation time 0.6 sec. with automatic modulation of the dose. The CT images are processed with special software for CTC and analyzed according to standardized system for reporting of findings in CTC - C-RADS. The specific technique for CTC in stoma patients is described. CTC was entirely accomplished in all 48 cases (100%). The duration of the studies varied 10 to 25 min. (average 17 min.). No essential side effects or according to the procedure complications were marked. To one patient a conventional FCS was recommended for accurate assessment of a collapsed bowel segment. Adequate marking of the fecal odds with barium sulfate was marked in all cases. The CTC findings were assessed as normal in 23 cases (48%). In 25 patients (52%) were described pathologic findings of colonic and extra-colonic origin. Conclusions that CTC in patients operated according to the methods of Miles and Hartmann is technically feasible and could be executed for complex assessment of large bowel and extra-colonic abdominal structures. CTC possess the advantage of the possibility for synchronous assessment of the organs and structures in the abdominal cavity, which is economically profitable, saves time and psychical suspense for the patients and avoids the risk of complications and unpleasant experiences of the patient durinf a conventional FCS.

[MDCT features of visceral vessel occlusion and malperfusion of the parenchyma in abdominal organs].

OBJECTIVE: The purpose of our study was to describe CT features of aortic branch vessel occlusion and abdominal malperfusion in patients with aortic dissection (AD). MATERIAL AND METHODS: Between 01.2005 and 05.2008 in Hospital "St. Ekaterina" 153 patients with aortic dissection underwent multidetector CT. We retrospectively included in present study 95 patients with type I and III AD, with involvement of the abdominal aorta. We analyzed abdominal CT vessel and parenchymal abnormalities, including the presence of dissected abdominal aortic branches, a compressed aortic lumen, and low enhancement of the parenchyma in abdominal organs. Clinical features, methods of treatments, and in-hospital mortality was analyzed. RESULTS: Clinical signs of malperfusion occurred in 39 (41%) of 95 patients presenting with AD. Iliofemoral malperfusion was the most common occurred ischemic syndrome and was observed in 31 cases, followed by renal--in 19 cases and mesenterial ischemia--in 12 cases. Spinal ischemia was the most rare--5 cases. In-hospital mortality was 38.5% in patients presenting with any malperfusion syndrome, as in 7 of them we observed aortic rupture, before initial treatment. Post-treatment mortality was 20.5%. 16% was the mortality rate among patiens without ischemia. CONCLUSION: Early and precise diagnosis of ischemic abdominal and peripheral complications in patients with AD is the main goal of contemporary medicine. Multislice Computed Tomography is valuable imaging method in the evaluation of patient with AD, providing important information about aortic visceral branches and abdominal organs.

[Endovascular recanalisation of subclavian artery stenotic-occlusive lesions].

Recently, percutaneous transluminal angioplasty (PTA) with stent placement has gained greater acceptance for the treatment of hemodynamically significant atherosclerotic lesions involving the brachiocephalic, subclavian and vertebral vessels. PTA is performed instead of extratoracic bypass surgery, which is associated with several risks and complications. Main indications for PTA and stent include short occlusions and elderly patients with increased surgical risk. We present 4 cases with occlusion of the left subclavian artery, including 1 case ofthombosed distal anastomosis of carotid-subclavian bypass.

[Vascular complications of Baker's cyst].

The presence of Baker's cyst is clinically demonstrated as compression syndrome of the vessels and nervous stem in the popliteal area. This result frequent in deep venous thrombosis, nervous injuries and blood flow insufficiency distal to the compression site. We present two cases of compression stenosis of the popliteal vessels, clinically manifested. The patients underwent surgical decompression and cystic removal, thus leading to arterial perfusion and/or venous derivation improvement of the lower extremity.

[Endovascular procedures in case of cancers engaging the vessels of the small pelvis].

Cervix cancer is quite common nowadays. Its progress is followed by painful symptomatology, urosepsis, lymphedem, flebothrombosis and ischemia of the lower limbs. The surgical treatment and the following chemotherapy and radiotherapy causes proliferation of the fibroid tissue, which embraces and presses the vessels of the small pelvis. We are to depict two clinical cases in which the choice of the percutaneous transluminal angioplasty and the implementation of a covered stent - graft is preferable to the open surgery. During the predilatation with a balloon catheter, our first patient suffered of a vessel rupture, visualized on the intraoperative angiogram. The rupture of vessel during angioplasty usually demands open surgical correction, but endovascular procedure can provide a fast, efficient, and less aggressive method. Covered stent-grafts are applicable for both treatment and stabilization of vessel lesions.

[Initial experience in endovascular treatment of abdominal aortic aneurysms in Bulgaria].

The abdominal aneurysm imposes prominent epidemiological impact due to its high incidence and life threatening complications. The first steps in endovascular treatment of abdominal aneurysms in Bulgaria are herein described. Five bifurcated and one straight stent-grafts were implanted in the ,,St.Ekaterina" University Hospital for the period from February till May 2004. Satisfactory therapeutic result was achieved in all cases. The continuing follow-up of the patients proved favorable tolerability. The good therapeutic response, lack of perioperative mortality, and low complication rate provide evidence that endovascular repair can have beneficial implication in patients with abdominal aneurysms and high operative risk.