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.

Acute Management of Deep Periorbital Burns: A 10-Year Review of Experience.

Deep periorbital burns are an important issue mainly due to the presence of the eyes in the region, and the crucial importance of preservation of vision. There is no consensus regarding their treatment. A retrospective analysis of the treatment and outcome of 446 patients with deep burns of the periorbital region admitted to the Department of Burns and Plastic Surgery of St George's University Hospital in Plovdiv, Bulgaria over 10 years was conducted. The study covers 446 patients, 162 female (36.5%) and 284 male (63.5%) aged from 5 months to 92 years. Deep periorbital burns accounted for 74.8% of hospitalized deep facial burns. Most frequent burn agents were hot liquids and flames. The mean total body surface area affected was 19.6% (min 0.5%, max 80.0%). Concomitant ocular pathology was diagnosed in 14% (n=63) of the patients. An early, staged and precise surgical approach was preferred, aimed at fast wound closure without sacrificing survived tissues. Follow up time ranged from 3 months to 5 years, median 37 months. Late ocular sequelae occurred in 7.4% (n=33) of the patients. There was no incidence of secondary corneal perforation or definitive loss of vision. Timely and adequate treatment during the acute period can minimize initial damage and late sequelae. Favor is given to the early, balanced surgical approach aimed at rapid wound closure between day 2 and 10 post burn. Preservation of vision is a determining factor for the significance of trauma and the effectiveness of treatment.

La gravité des brûlures péri- orbitaires profondes tient à la nécessité de préserver la vision. Il n'existe pas de consensus quant à leur prise en charge. Nous avons revu les dossiers de 446 patients victimes de brûlure péri- orbitaire profonde traités dans le CTB du CHU St Georges de Plovdiv (Bulgarie) sur une période de 10 ans. On comptait 284 hommes (63,5%) et 162 femmes (36,5%) âgés de 5 mois à 92 ans. Un atteinte péri- orbitaire était présente dans 74,8% des brûlures faciales profondes dans le cadre d'une brûlure touchant en moyenne 19,6% SCT (0,5 à 80%), dues dans la plupart des cas à une flamme ou à un ébouillantement. Une atteinte oculaire était objectivée dans 14% des cas (63 patients). Une excision précoce et soigneuse, visant à recouvrir les lésions tout en préservant le maximum de tissu était la stratégie habituelle. La durée de suivi médiane était de 37 mois (3 mois à 5 ans). Trente- trois patients (7,4%) ont souffert de séquelles oculaires, sans toutefois de perforation cornéenne ni perte de vision. Un traitement adapté techniquement et temporellement permet de limiter les dégâts initiaux et la survenue de séquelles. Nous préconisons une première intervention chirurgicale entre J2 et J10, la préservation de la fonction visuelle étant le marqueur d'une prise en charge adaptée.

Primary signet-ring cell adenocarcinoma of the bladder-A case report and review of literature.

Cases of adenocarcinoma of the bladder are extremely low - 2%, respectively. Primary signet-ring cell carcinoma (SRCC) of the bladder accounts for 0.12-0.6% among the different histological subtypes of bladder carcinomas. We present a rare case of SRСС with clinical manifestations of hematuria (two times) treated with transurethral resection of the bladder (TURB). Primary ring cell carcinoma of the bladder is an extremely rare and aggressive tumor. In this case, presented by us, probably due to early diagnosis and radical resection, the prognosis is encouraging.

[THE ROLE OF ESTROGENS IN THE CARCINOGENESIS OF LUNG CANCER].

Morbidity and mortality from lung cancer has dramatically increased in women as compared to men over the past few years. Historically, smoking has been considered the major risk factor for lung cancer regardless of gender. Several recent lines of evidence implicate gender differences in the observed differences in prevalence and histologic type which cannot be explained based on the carcinogenic action of nicotine. Several recent studies underscore the importance of reproductive and hormonal factors in the carcinogenesis of lung cancer Lung cancer morbidity and mortality in Bulgaria was 16.2/100000 women and 14.6/ 100000 women, resp. Lung cancer morbidity in Europe was 39/100000 women. Lung cancer is extremely sensitive to estrogens. The latter act directly or as effect modifiers for the relationship between smoking and lung cancer. Further research examining the relationship between serum estrogen levels and the estrogen receptor expression in normal and tumor lung tissue samples can help elucidate the importance of reproductive and hormonal (exogenous and endogenous) factors in the carcinogenesis of lung cancer.

[OBESITY AND ENDOMETRIAL CARCINOGENESIS].

Endometrial cancer is one of the main cancers occurring in industrialized countries. According to the National Cancer Registry in Bulgaria, cancer of the uterine body occupies 8.6% from all cancers in women and ranks second in frequency. It is found that over weight and obesity are a major risk factor for the development of endometrial cancer and the mortality associated with it. Adipose tissue is seen as endocrine organ, synthesizing so called adipocytokine - leptin, adiponectin, vistafin, that play a key role in the carcinogenesis of endometrial cancer and can be used as new markers for establishing the potential risk of this disease. The link between obesity, insulin resistance and endometrial cancer that has been proven, determines it as a socially significant disease. All this makes it necessary to clarify and specify the role of obesity in endometrial carcinogenesis and the development of strategies for the prevention and early diagnosis.

[Proximal resection of carcinoma of the gastric cardia]. / Gornopoliusni rezektsii pri kartsinom na kardiiata.

Carcinoma of the gaster remains one of the major problems of the operative oncology, because of its high freguency, late diagnosis and low rate of five years survival. Although there are a lot of researches in this field, there is still a controversy about the size of the operative treatment of carcinoma of the gastric cardia. Some of the surgeons advocate gastrectomy as the only radical operation. Others prefer proximal resection as a method, saving a part of gaster, and in that way its important physiological functions for the organism.

[The effect of surgical treatment of benign thyroid disease on serum anti-thyroid antibodies]. / Vliianie na operatsiite pri dobrokachestveni zaboliavaniia na shtitovidna zhleza vurkhu serumnite nati-tiroidni avtoantitela.

The mechanisms of development of benign thyroid disease are still not entirely clarified. Immune disorders are possibly engaged in the thyroid pathological conditions. The aim of this prospective study was to follow up the dynamics of serum levels of anti-thyroid antibodies in patients with benign thyroidal disease as well as the local lymphocytic reaction. The autoantibodies to thyroglobulin and thyroid microsomes were detected prior to the surgery and on the 12th month after it using microhemaglutination test. Thyroid resection was performed depending on changes in patients. Lymphocytic infiltration of the thyroid gland from surgical histological specimens was found in various degree in the patients. Serum titres of anti-thyroid antibodies tended to fall in the majority of the patients a year after the surgical treatment. Anti-thyroglobulin antibodies were found in 60% of the patients prior to the surgery and anti-microsomal--in 31.4%. A year after surgery they were detected in 4.3% and 1.4% of the patients respectively. The described changes show that the dynamics of anti-thyroid antibodies may correlate with the effect of surgical treatment and eventual prognosis of relapse.

[About the surgical treatment of oesophageal cancer]. / Vurkhu operativnoto lechenie na raka na khranoprovoda.

Oesophageal cancer is among the most malignant tumors with bad prognosis. Surgery offers the best chance for treatment. Subjects of our retrospective study are 56 patients with oesophageal cancer, treated at the Clinic of thoracic and abdominal surgery, University Hospital-Plovdiv, for 9 years period. Palliative surgery was performed at 18 of the patients, and resection of the oesophagus at 38 of them. Neoesophagus from the stomach we made in 30 of the patients, and in 9--from large intestine. In radically treated complications were observed in 14 (36.8%) cases. Six (15.8%) patients died.

[Bowel injuries after blunt abdominal traumas]. / Chrevni uvrezhdaniia pri zakriti koremni travmi.

Authors present 28 cases of bowel injuries after blunt abdominal trauma. Patients were from 14 to 71 years of age, 18 (64%) men and 10 (36%) women. The most common cause for the trauma was the car accident--in 18 cases. In the rest 10 the trauma was result of household activities. The small bowel was injured in 16 patients, the large bowel in 9 and in 3--the duodenum. In 15 cases the trauma was only abdominal and in the rest 13 it was accompanied by other traumas. Three of the 28 patients reported herein died.

[Surgical treatment of chronic nonspecific empyemas]. / Operativno lechenie na khronichnite nespetsifichni empiemi.

Approximately 4% to 20% of all acute empyema turn into chronic empyema despite the up-to-date complex treatment. The authors report their results of the surgical treatment of 38 patients with chronic nontuberculous empyema within a 5 years period. The age of the patients range from 18 to 72 years and they include 26 men and 12 women. Twenty eight were treated by thoracotomy and decortication, 7 underwent video-assisted thoracoscopy and decortication, and 3 thoracoplasty. In one of the patients a latissimus dorsi muscle flap was used.

[Main lymphocyte populations and their subpopulations in patients with acute pancreatitis studied in the course of disease]. / Osnovni limfotitni populatsii i tekhnite subpopulatsii pri bolii s ostur pankreatit, izsledvani v dinamika na zaboliavaneto.

The aim of the study was to establish the changes in the main lymphocyte populations and their subpopulations in peripheral blood of patients with acute pancreatitis. Seventy-one patients were studied in the course of disease. They were classified on the basis of severity of pancreatitis--mild and severe form. Percentage and absolute numbers of CD19+ (B lymphocytes), CD2+ (total T cells), CD3+ (immunocompetent T cells), CD3+CD4+ (helper T cells), CD3+CD8+ (suppressor/cytotoxic lymphocytes), CD4+CD29+ and CD4+CD45-RA+ (helper/inducer and suppressor/inducer subpopulations of helper lymphocytes). Immunophenotype analysis was performed using a flowcytometer Epics XL-MCL, Coulter, USA and monoclonal antibodies by the same company. In the early stage of disease the fall of total CD2+, immunocompetent CD3+ T lymphocytes and their subpopulations (more expressed in the severe form) is an indicator of determining the severity of pancreatitis. These results along with the elevated CD4+CD29+ subpopulation are a sign of both activation of these links in the local immune reaction and development of secondary infectious complications. The observed fall in CD4+CD45-RA+ suggests increased risk of development of autoimmune process. The recovery of most of the studied parameter after day 3 shows unimpaired host compensatory capabilities for both forms of disease.

[Therapeutic approach to pulmonary hamartoma patients]. / Povedenie pri bolni s belodroben khamartom.

Hamartoma is one of the most common benign tumour of the lung. The authors report their results of the surgical treatment of 17 patients with lung hamartoma. Twelve of them underwent open thoracotomy and 5 video-assisted thoracoscopy. Lobectomy was performed in 6 patients, segmentectomy in 3 and patients atypical lung resection in 8. All of the patients did not have complications.

[Vascularized pedicle muscular flaps used in the treatment of postpneumonectomy chronic empyema: two case reports]. / Prilozhenie na vaskularizirani pedikulizirani muskulni lamba za lechenie na postpulmonektomichen i khronichen empiem: dva sluchaia.

Two cases treated for postpulmonectomy empyema and residual chronic empyema cavity with latissimus dorsi and pectoralis major muscle pedicle flaps are presented. The anatomic considerations for performing these two flaps, the indications and postoperative results are discussed.

Changes in plasma levels of acute phase proteins in pancreatitis.

UNLABELLED: The objective of our study was to determine whether the changes in the plasma levels of C-reactive protein, haptoglobin, transferrin, and alpha 1-acid glycoprotein (orosomucoid) in acute pancreatitis patients examined on days 1, 3, 5, 7, 9, and 14 after their admission to hospital can be used to assess the course and determine the severity of the disease, and to discriminate edematous from necrotizing pancreatitis. The study included 18 patients with mild pancreatitis and 20 patients with severe pancreatitis. Pancreatitis was classified as mild or severe according to Ranson and the Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Acute phase proteins were determined using the immunoturbidometric assay. The C-reactive protein in the mild pancreatitis patients was six-fold higher at admission, then gradually increased for 5 days and started to drop. In the severe clinical forms of pancreatitis the C-reactive protein had significantly high values throughout the whole time of study retaining this high level to day 14; these elevated levels correlated with the persistent severe general state of the patients and the extent of necrosis in the pancreas. The changes in the haptoglobin and transferrin levels were not significant. Orosomucoid level in mild pancreatitis cases remained constant whereas it was elevated and continuously above the reference values in severe pancreatitis. IN CONCLUSION: C-reactive protein level changes significantly in patients with acute pancreatitis; it is in the range of 100-120 mg/l in the mild forms of the disease and between 120 and 360 mg/l in the severe pancreatitis. This renders it a valuable indicator for the discrimination of edematous from necrotizing acute pancreatitis.

[Changes in some of the kallikrein-kinin system indices in patients with acute pancreatitis]. / Promiana na niakoi ot pokazatelite na kalikrein-kininovata sistema pri bolni s ostur pankreatit.

Proceeding from the major role played by kinins in the pathophysiology of endogenic intoxication among acute pancreatitis patients (AP), and the conflicting and scarce literature data on the issue, the changes in the level of prekallikrein, high-molecular kininogen, alpha 2-macroglobulin, alpha 1-antitrypsin, plasminogen and carboxypeptidase N in the blood are studied in dynamics at 1, 3, 5, 7, 9 and 14 days after admission of 48 patients with mild, and 121 with severe form of acute pancreatitis. Forty-eight individuals are used for control purpose. PK, KG and plasminogen are assayed using the colorimetric method of the Boehringer Company--Mannheim, KG--by chronometric test of the Sigma Diagnostics Company, CPO N--after Folk's method, as modified by Erdös, alpha 2-MG--by radial immunodiffusion according to Mancini, and alpha 1-AJ--by immunoturbidometric method. As shown by the results, in acute pancreatitis KKS activation occurs, demonstrated by the reduced PK, KG and alpha 2-MG values, and by the statistically significant enhancement of alpha 1-DJ, COP N and plasminogen activity. In patients presenting mild forms the aforementioned changes are rather weakly manifested and transient, while in the serious forms they are markedly expressed and persisting. In either form the deviations are rather pronounced in the first three days of disease. Coinciding with a clinical course characterized by cardiovascular changes similarly strongly manifested.

[The diagnostic value of changes in the kallikrein-kinin system indices in patients with acute pancreatitis]. / Vurkhu diagnostichnata stoinost na promenite na pokazatelite na kalikrein-kininovata sistema pri bolni s ostur pankreatit.

It is the purpose of the work to assay retrospectively the diagnostic value of KKS indicators--PK, KG, alpha 1-AT; alpha 2-MG, KOP N and plasminogen in the blood--studied in dynamics at 1, 3, 5, 7, 9 and 14 days after admission. For the purpose the percentage of patients showing abnormal values of the total number of cases being examined, with certain diagnosis acute pancreatitis and severity of the clinical form, is calculated. The highest is the rate of abnormal values for PK, next ranking KG, alpha 1-AT, KOP N and plasminogen the least. Presumably, PK and KG are adequate markers accurately mirroring the essence and dynamic pattern of the pathological process in acute pancreatitis patients.