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Introduction Synovial lipomatosis, also called lipoma arborescens, is an extremely rare chronic, benign disease. Less than 100 cases have been reported in the available literature. It is characterized by substitution of the sub-synovial connective tissue with mature fat cells and villous proliferation of the synovium. The etiology in most cases remains unknown, although some authors attribute it to trauma, degenerative changes in the joint, septic arthritis, psoriatic arthritis, chikungunya viral disease, etc. The most common locations of synovial lipomatosis are the knee, shoulder, elbow and bracelet, exceptionally affecting the hip and ankle joints, etc. Locations in the foot region are extremely rare. The patient described in this article has a unique location. Aim The aim of this article is to draw attention to a rare disease, with an even rarer localization. Material s and M ethod s The presented patient is a man at the age of 53 with synovial lipomatosis on the plantar side of the left foot. Results Up to this moment, three and a half years after the operation, the patient has no complaints and no recurrence data. The functional condition of the limb is excellent. Conclusion Synovial lipomatosis, especially that located in the foot area, is extremely rare, almost casuistic. However, it should not be excluded from the differential diagnosis.

Introduction Liposarcoma is a heterogeneous group of adipocyte tumors in which cells differentiate into lipoblasts and lipocytes. Tumor localized in the extremities affects men more often. It rarely occurs before age 20. Diseases such as obesitas, gout, psoriasis, etc. seem to predispose to the development of this type of tumor. Lipomas (liposarcoma) are considered "giant", if they exceed 10 cm in one dimension or weigh at least 1000 grams. The thigh liposarcoma described in this article is the biggest reported in Bulgaria and one of the largest excised in the world practice. A im The aim of this article is to draw attention to the difficulties associated with the surgical removal of a giant de-differentiated femoral liposarcoma, as well as the late metastases of such tumors. Patients and methods The patient presented is a 74-year-old male with a giant thigh liposarcoma weighing 7.65 kg, which has been subjected to an en bloc tumor excision. Results Up to now, a year and a half after surgery, no recurrence or metastases have been detected. The functional state of the limb is very good. Conclusion Giant thigh liposarcomas are a real surgical challenge. They are always located near the femoral vesels, engaging muscles and vessels, often growing proximal to lig. inguinale .

Fibrohistiocytic tumors of the skin comprise a large range of lesions. One such tumor is the atypical fibroxanthoma (AFX), which is widely considered as a "pseudomalignant" tumor. It is derived from fibroblasts and expresses a variety of histiocytic markers. We present a case of AFX, localized in the right temporal region of the scalp, successfully treated with surgical excision. Immunohistochemical staining helps differentiate this tumor from others in the clinical differential diagnosis, including malignant melanoma, squamous cell carcinoma, and other nonmelanocytic spindle cell tumors such as leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, liposarcoma, and dermatofibrosarcoma protuberans. Historically, AFX was believed to be a superficial variant of malignant fibrous histiocytoma (MFH). However, MFH is now considered a more generalized term for a sarcomatous neoplasm of the subcutaneous tissue. The histopathology of MFH shares features with some malignant mesenchymal neoplasms such as liposarcoma, leiomyosarcoma, rhabdomyosarcoma, and angiosarcoma, but can be differentiated using immunohistochemistry and/or electron microscopy. More recently, the examples of MFH that do not exhibit a more specific line of differentiation have been reclassified as undifferentiated pleomorphic sarcoma (UPS). Many authors currently cannot draw a distinction between AFX and UPS. The clinical and histopathological differences between AFX and UPS are often difficult to delineate. It is probable that they represent two poles of the same disease. Surgical excision in the patient we describe resulted in excellent aesthetic results with lack of recurrence in the 7-month postoperative period.

The combined effect of rimantadine and oseltamivir in a prophylactic context (therapy beginning 4 h pre-virus infection) and therapeutic context (therapy started at 24 h post-viral inoculation) course on influenza H3N2 virus infection in mice was studied. In the prophylactic course 5 and 10 mg/kg/day rimantadine with 0.2 and 0.4 mg/kg/day (25:1 dose ratio) oseltamivir showed a protection index (PI) of 79.6% and 75%, respectively and a mean survival time (MST) of 13.1 and 12.9 days. The individual effects of the same doses ranged from 0% to 33.3% PI and 8.2 to 10.3 days MST, respectively. Lung virus titers were decreased 630-fold in the combination-treated groups as compared to monotherapy and placebo groups. The reduction of surface lung pathology in combination-treated groups demonstrated a protective effect for the combination of both antivirals. In the therapeutic course 5 and 10 mg/kg rimantadine combined with 0.2 and 0.4 mg/kg oseltamivir showed no beneficial effect. At higher dosage (0.8, 1.6, 3.2 mg/kg oseltamivir and 20, 40, 80 mg/kg rimantadine) preserving the 25:1 ratio, the resultant PI ranged from 57.6% to 80.5% and the MST was 12.8-13.4 days. Used alone at the same doses the compounds' protection varied between 10.7% and 71.8% PI, MST 9.8-12.8 days (8.7 days in PBS control). Compared to vehicle and individual treatment, a decrease in infectious viral titers of up to 1000-fold and other viral pneumonia parameters were also recorded. The therapeutic effect of the drugs' optimal effective doses combinations was characterized as synergistic. Survival of animals was 81.2-100% and MST was extended by 5-7 days compared to placebos. Monotherapy protection was from 9.1% to a maximum of 56.5%, MST being prolonged only by 1.3-4.2 days compared to 7.5 days in the PBS control group. Lung viral titers were decreased 1445-fold for the most efficacious combination groups and a significant reduction in lung parameters was observed. These data emphasize that prophylactic and therapeutic courses using a combination of oseltamivir and rimantadine have a significant protective effect in mice experimentally infected with drug-sensitive influenza virus A (H3N2).

Different epidemiological studies report the protective effect on colorectal cancer (CRC) exerted by vitamin D(3) intake, estrogen replacement therapy, and increase of the risk of microsatellite instability (MSI) in CRC by withdrawal of estrogens. The aim of our study was to search for association between CRC and polymorphisms in estrogen receptor-alpha (ER-alpha) and Vitamin D receptor (VDR) genes.We analyzed the PvuII and XbaI polymorphisms from the ER-alpha gene and the BsmI polymorphism of the VDR gene in 140 patients with CRC (subsequently divided according to their MSI status) and 94 controls.We have demonstrated that the presence of the PvuII pp genotype increased the risk of developing MSI(+) tumors about three times compared to MSI(-) tumors [odds ratio (OR)=3.09, 95% confidence interval (CI) 0.88-10.91]. The effect of the XbaI xx genotype was similar (OR=2.08, 95% CI 0.49-8.81). Our results for the VDR BsmI polymorphism showed an increased risk for CRC in bb carriers (OR=1.8, 95% CI 0.81-4.05).We conclude that PvuII and XbaI polymorphisms in the ER-alpha gene were associated with the risk of developing MSI in CRC patients. The BsmI polymorphism in the VDR gene was linked to the risk of developing CRC.

Hereditary non-polyposis colorectal cancer (HNPCC) is an autosomal dominant disease, caused by germline mutations in DNA mismatch-repair genes (MMR). These mutations lead to microsatellite instability (MSI). It has been found that the MSI is not confined to the setting of hereditary disease and may be seen in approximately 12-17% of the sporadic CRCs. In 1998 a National Registry for CRC was instituted in Queen Giovanna Hospital, Sofia. A total of 150 patients have been selected for MSI analysis and 25 tumors showed to be unstable, 14 with loss of heterozygosity (LOH). These tumors were further analyzed for MLH1 promoter hypermethylation and a significant association between this epigenetic change and MSI/LOH sporadic cases. We proposed this method as a step that follows the analysis for MSI and prior to the screening for MMR mutations. The mutation screening detected four known and two novel mutations, one unpublished and four known intronic polymorphisms in both hMLH1 and hMSH2 genes. The use of IHC analysis has been found effective in the investigation of some unclear molecular variations. We developed an efficient diagnostic strategy for HNPCC testing and the mutation status of 80% MSI HNPCC cases could be detected.

The liposarcoma are not rare in the thigh area. Two patients both men, 56 and 39 years of age were operated within a few months because of giant liposarcoma in the left thigh region. The liposarcoma of these patients was strikingly similar. Upon suspicion of malignancy, resection of the tumor without prior diagnostic biopsy is recommended. The early postoperative period of both patients passed smoothly. The full range of movement was achieved in left hip and knee joints. Operative wounds healed per primam intentionem. Up till now, several months after tumors removal, both patients have no data of local or distant metastases.

Tankova Ludmila1, Daniel Kovatchki2, Georgi Stoilov3, Antonina Gegova4 and Ivan Terziev5 1Clinical Centre of Gastroenterology, Clinic of Gastroenterology, University Hospital „Queen Joanna”, Sofia 2Golden Cross Private Clinic, Vienna 3Institute of Mechanics, Bulgarian Academy of Sciences, Sofia 4Department of Pathology, Medical Faculty, University „Kliment Ohridski”, Sofia 5Department of Pathology, University Hospital „Queen Joanna”, Sofia 1,3,4,5Bulgaria 2Austria

The analysis of the received digital signal by computer microprocessor in high‐frequency electrocardiography, used in our research, makes possible synthesis of vectorcardiographic images and loops, allowing improved qualitative and quantitative diagnosing of the myocardial injury.

In Sofia Medical University the medical physics is strongly profiled. The purpose of this investigation was to evaluate and discuss the results from student’s inquiry.