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We present a case of a 29-year-old Bulgarian woman with autoimmune thyroiditis and recurrent angioedema. The patient presented with a one-year-long history of recurrent angioedema and Hashimoto’s thyroiditis. Physical examination showed oedema surrounded by erythema on the forearms, and erythematous, itchy plaques spreading over her face, neck, chest, abdomen, and extremities. Blood tests showed elevated total immunoglobulin E (IgE). The patient had been diagnosed with Hashimoto’s thyroiditis and hypothyroidism. She had been taking levothyroxine 50 μg/d, resulting in a good hormonal control; however, her anti-thyroid peroxidase (anti-TPO) antibodies were high. She was started on methylprednisolone and antihistamines. In three weeks, we observed a good therapeutic response to the treatment and the lesions remitted. IgE dropped within normal range. Levels of anti-TPO antibodies were persistently high. In conclusion, patients with angioedema should be tested for thyroid autoimmunity. Further delve into the pathogenesis of angioedema in them is warranted in order to explore the possibility of an underlying atopy in those not responding to the standard treatment with levothyroxine.


In the following article we present a case of postoperative chylothorax as rare and severe complication after cardiac surgery. We present a case of 56-year-old man after double-valve replacement procedure and aorto-coronary artery bypass grafting, including pedicled left internal mammary artery towards left anterior descending artery. By the tenth postoperative day the total amount of drained milky white fluid from the left pleural cavity reached the colossal volume of 13 040 ml, despite the conservative therapy with intravenous Sandostatin (Octreotide) and parenteral feeding with a solution rich in medium chain triglycerides and amino acids – OliClínomel. The results of the biochemical analysis confirmed the diagnosis chylothorax. On the tenth postoperative day, a revision of the left pleural cavity through left thoracotomy was performed and lesion of the thoracic duct was identified. The lesion was sutured and secured with fibrin tissue glue – Tissucol for definitive treatment of the lymphorrhagia. The combined therapeutic and surgical approach concerning this serious complication turned out to be effective, and the patient was discharged on the thirty-second postoperative day with significant clinical improvement without ultra-sound and x-ray data for left pleural effusion.


Abnormalities in the number of teeth are conditions that occur predominantly in childhood. Therefore, monitoring the prevalence and early diagnosis is very important for the timely and appropriate therapeutic approach. The aim of the study was to investigate the incidence of supernumerary teeth in patients from the city of Plovdiv.

Methods and equipment: 1,000 dental patients were studied. Data were collected from patients seeking medical attention at the Faculty of Dental Medicine in Plovdiv. We used clinical, X-ray and statistical methods for investigation.

Results: A 1.1% prevalence of supernumerary teeth (ST) was observed in the studied patients. A statistically significant difference was found between the presence of ST in the permanent and mixed dentition, with a 3% relative proportion of ST in the mixed and 0.62% in the permanent dentition (p < 0.05). The relative proportion of ST in the maxilla was 90.9%, and in the mandible – 9.1%. A statistically significant difference (p < 0.05) was found in the distribution of ST by jaws. In our study, a higher frequency of mesiodens and distomolar (1.08% and 0.22%, respectively) was found in males, and a decreasing relative proportion from the midline to distally in females (mesiodens – 0.56%, paramolar – 0.19%, distomolar – 0.19%).

Conclusion: Supernumerary teeth are a relatively rare dental abnormality in the Bulgarian population. Its distribution by sex and morphology corresponds to the prevalence in Caucasians and populations of southern countries.


The aim of the study was to perform a comparative data analysis of the values of sagittal condylar path and arrow point angle, obtained through measurements based on facebow records, by applying two methods: manual and digital by using the Mini-Maxi Facebow Analyzer computer program.

Material and method: The program was tested through processing the data of 101 subjects (52 men and 49 women). The left and right sagittal condylar path was registered by using the Mini-Maxi facebow and the mandibular central position was determined by intraoral graphic registration. The data of each subject were entered into the program and the individual values of the registered parameters were calculated. Then, a comparative statistical analysis of the data obtained by the conventional manual measurement with a protractor and the computer program was performed.

Results: The mean value of the sagittal condylar path obtained through the computer program was 34.89˚ for the right side and 35.86˚ for the left side. The mean value of the arrow point angle obtained through the computer program was 107.52˚. The differences between the data for men and women were not statistically significant (р < 0.05).

Conclusions: The computer program provides an accurate analysis of facebow records and assists in determining individual patient’s movement parameters of the lower jaw. The comparative analysis of the accuracy of parameters obtained through conventional and digital measurements demonstrates the high product reliability of the computer program.


Aim/objective: Corneal kindling mouse test is a model of decreasing the seizure threshold after repetitive subchronical electrical stimuli. Ketogenic diet (KD) is used for the treatment of children with pharmacoresistant epilepsy since more than 100 years. Surprisingly, very few studies testing the effect of the KD in corneal kindling test were published. The aim of this study was to evaluate the effect of the KD on the seizure activity in corneal kindling mouse model.

Methods: 50 adult male ICR mice (25-35 g) were randomly distributed in four groups, as follows: group 1 – standard diet (SD) treated controls (n = 10); group 2 – KD treated (n = 10), group 3 – kindled mice on SD treatment (n = 15); group 4 – kindled mice on KD treatment (n = 15). The diet was started at day one, one week before the start of the kindling and it continued for four weeks. At the end of the experiment, kindled mice were challenged with 6-Hz test and their behavior was assessed.

Results: In kindled mice on SD the seizure latency time significantly decreased at days 14, 21 and 28. Mice on KD displayed relatively constant seizure latency during the experiment. At day 28 the duration of provoked seizures was statistically higher as compared with mice on KD (median values 101 vs 2 sec, p < 0.05). Blood ketone levels were statistically higher (p < 0.05), and blood glucose level was statistically lower (p < 0.05) in the KD treated group, as compared with SD treated mice.

Conclusion: KD effectively suppressed the seizure activity in corneal kindling test. Further studies are needed for elucidating the molecular mechanisms which can explain this effect.


The group of congenital limb overgrowth syndromes associated with vascular malformations include various disorders, often with variable clinical expression. Klippel-Trenaunay syndrome is the most common syndrome in this group, compared to other similar disorders such as Proteus, Parkes-Weber, Sturge-Weber, Cobb, Maffucii and CLOVES syndromes. We present a case of a 55-year-old male who presented with swelling, pain, heaviness, numbness and increased local temperature, involving the right upper extremity and the right side of the chest wall and associated with a livid erythema. The patient had several comorbidities including arterial hypertension and ischemic heart disease. He also had a family history of diabetes mellitus. A multidisciplinary team-based treatment approach, including physicians with expertise in various medical and surgical specialties was applied with the patient being “the unifying focus” of all these experts and their efforts. A personal approach tailored to the patient’s preferences was the key to a successful treatment.


Neuropsychiatric disorders, including depression contribute significantly to global disability and possess high social and health burden. Management is dominated by pharmacotherapy and psychotherapy; nevertheless, such treatments prevent or treat less than half of the patients, suggesting that alternative approaches are required. Emerging data suggest that diet may be an adjustable risk factor for psychiatric disorders. Caloric restriction (CR) possesses protective effects in almost all organs including the brain. However, the precise molecular pathways of these effects remain uncertain. In this review, we will discuss the putative neurobiological mechanisms of CR on the brain. The article will address also the molecular basis of the antidepressant effects of CR, primarily including ghrelin signaling, CREB neurotropic effects and ketone bodies production. Then we will highlight the probable effect of CR on the neuroinflammation, which emerges as a key pathogenetic factor for the majority of neuropsychiatric disorders. Finally, we discuss the so called caloric restriction mimetics, compounds that reproduce properties of CR. Further research will be required to verify the safety and efficacy of CR before a general approval can be proposed to introduce it and its mimetics in clinical practice for the treatment of neuropsychiatric disorders.


Neurofibromatosis type I is an autosomal dominant genetic disorder with an incidence of about 1 in 3000 births. Apart from the typical skin involvement NF1 may affect multiple organs with ocular, neurological, skeletal and cardiovascular manifestations. We present a case of a 38-year-old man with multiple café-au-lait macules and hundreds of neurofibromas disseminated on the trunk and extremities dating from childhood. To establish the diagnosis and to exclude any complications we performed multiple examinations, including skin biopsy, laboratory investigations, ophthalmologic assessment, consultations with a neurologist, internist and orthopedist, etc. The treatment of cutaneous NF1 is mainly symptomatic. Surgical excision aims to achieve cosmetic results. Recently novel and perspective conservative therapies have been investigated. In order to ensure better outcome for the patients with NF1 long-term multi-disciplinary approach is advised.


Gastric cancer (GC) is suitable for immunotherapy because 80% of it display microsatellite and chromosomal instability, some mutations and DNA hypermethylation. Therefore, GC is more immunogenic. The immunotherapy with monoclonal antibodies, adoptive cell therapy and checkpoint inhibition are discussed. The commonly used monoclonal antibodies are Trastuzumab targeting HER2 and Bevacizumab suppressing VEGF and tumor angiogenesis. Treatment with tumor-specific T cells is called adoptive cell therapy. There is experience with the application of tumor infiltrating lymphocytes (TILs), cytotoxic T lymphocytes (CTLs) and cytokine-induced killer cells (CIK). This review discusses the therapy with innate immune cells with anti-tumor activity such as dendritic cells and NK cells. The checkpoint inhibition was also reviewed. In conclusion, it could be stated that the immunotherapy of GC has the potential to provide a more favorable outcome to patients with GC, but it also have some limitations which need to be considered.