Transient perivascular inflammation of the carotid artery-A transient but potentially recurrent disease.

Transient perivascular inflammation of the carotid artery (TIPIC syndrome) is a rare, unclassified vascular syndrome that usually affects the distal part of the common carotid artery and has a favorable prognosis. The disease is often misdiagnosed even by neurologists due to the moderate intensity of clinical symptoms and their transient character. We present a case of a 52-year-old man who experienced two episodes of transient neck pain and moderate local tenderness one and a half years apart. Different imaging modalities, such as ultrasound, CT angiography, and high-resolution 3T MR, were applied to better visualize the perivascular inflammation of the common carotid arteries. Based on the clinical-radiological characteristics of our case and applying the diagnostic criteria, we established the diagnosis of TIPIC syndrome. The patient was treated with nonsteroidal anti-inflammatory drugs for few weeks, and reduction in perivascular changes was observed in both episodes. The case raises questions about the phases of the disease, its duration and the intervals between follow-ups. Our article also increases the awareness of this rare clinical-radiological entity and presents recent data from the literature.

Few dental indices in modern Bulgarian population from southern Bulgaria.

AIM: The aim of the present study is to evaluate the reduction of the distal teeth towards the medial ones in one functional dental group in southern Bulgarian population. MATERIALS AND METHODS: The study included 232 Bulgarians aged 20-40 years. Mesiodistal dimensions of the teeth were measured by Dentistry Sliding Vernier Caliper and analyzed with SPSS 23.0. Four interdental indices were calculated: inter-incisive, premolar, upper, and lower molar indices. RESULTS: We found a decrease in the percentage ratio of the lateral to the central incisors of people from the Bulgarian population compared to those dating from the Eneolithic period on the territory of Bulgaria. Furthermore, we found a reduction in the percentage ratio of the upper and lower second molars compared to the first ones. The biggest reduction in the percentage ratio (more than 6%) was found in the lower second premolars compared to the first ones, which is characteristic for southern Bulgarians. CONCLUSION: There was a dental reduction in all the distal members compared to the medial ones participating in one morphological dental group. As a result, we think that interdental indices can be used for explaining historical, cultural, and biological macro and microevolutionary processes and thus for understanding the origin, formation, contacts, and migration pathways of the different populations leading to ethnic variation of humanity. Therefore, they can be a reliable source of information in physiological anthropology.

Ultrasound fusion imaging system in neurology practice.

The ultrasound fusion imaging (UFI) system is a new promising imaging modality that combines live ultrasound investigations with preregistered CT, MRI, or PET images. In this study, we want to present our initial experience with the new method that combines the transcranial color-coded sonography (TCCS) in different insonation planes and the 3T-weighted MRI cerebral images. The study validates the diagnostic capabilities of the system to detect different normal cerebral structures in healthy volunteers. In the present paper, we also discuss the advantages of US fusion imaging technology and its clinical applications in Neurology.

Inter-incisive index in Bulgarians and its application in dentistry / Indice interincisivo en búlgaros y su aplicación en odontología

SUMMARY: In recent years, aesthetic dentistry has become a major focus for the public. Facial attractiveness plays a key role on modern society and the creation of harmonious smile is an aim for every dentist. The objective of this study was to define certain values of the inter-incisive index in Bulgarians, the sexual dimorphism and bilateral asymmetry and to verify differences of this index between Bulgarians and other Balkan populations. The present study included 121 males and 111 females of Bulgarian origin aged 20- 40 years. Mesiodistal dimensions of maxillary central and lateral incisors were measured by Dentistry Sliding Vernier Caliper. We used the technique of direct anthropometry, modified by Prof. Y. Yordanov. We calculated the inter-incisive index as ratio of the mesiodistal dimension of maxillary lateral incisor to the mesiodistal dimension of the maxillary central incisor. The measurements were analyzed with SPSS 23. The level of statistical significance was set at P< 0.05. The inter-incisive index showed no statistically significant differences between left and right side of the dental arch in both sexes. We did not find statistically significant differences between males and females as well. On the other hand, we found statistically significant differences in MD values of incisors between Bulgarians and other Balkan nations. Inter-incisive index shows no sexual dimorphism and bilateral asymmetry in Bulgarians. This can be helpful in aesthetic dentistry, in prosthodontics and in orthodontic treatment planning.

RESUMEN: En los últimos años, la odontología estética se ha convertido en un foco importante para el público. El atractivo facial juega un papel clave en la sociedad moderna y la creación de una sonrisa armoniosa es importante para todos los dentistas. El objetivo de este estudio fue definir ciertos valores del índice interincisivo en búlgaros, el dimorfismo sexual y la asimetría bilateral y verificar diferencias de este índice entre búlgaros y otras poblaciones balcánicas. El presente estudio incluyó a 121 hombres y 111 mujeres de origen búlgaro entre 20 y 40 años de edad. Las dimensiones mesiodistales de los incisivos superiores centrales y laterales se midieron con un calibrador Vernier deslizante de odontología. Utilizamos la técnica de antropometría directa, modificada por el Prof. Y. Yordanov y se calculó el índice interincisivo como la relación entre la dimensión mesiodistal del incisivo lateral superior y la dimensión mesiodistal del incisivo central superior. Las medidas se analizaron con SPSS 23. El nivel de significancia estadística se fijó en P<0,05. El índice interincisivo no mostró diferencias estadísticamente significativas entre los lados izquierdo y derecho de la arcada dentaria en ambos sexos. Tampoco encontramos diferencias estadísticamente significativas entre hombres y mujeres. Por otro lado, encontramos diferencias estadísticamente significativas en los valores de DM de los incisivos entre búlgaros y otras naciones balcánicas. El índice interincisivo no muestra dimorfismo sexual ni asimetría bilateral en los búlgaros. Esto puede ser útil en odontología estética, en prostodoncia y en la planificación de tratamientos de ortodoncia.

Central retinal artery occlusion in a patient with sickle cell disease treated with recombinant tissue plasminogen activator.

Central retinal artery occlusion is a rare ophthalmological complication of sickle cell disease, usually provoked by additional contributing risk factors and its treatment remains controversial. We describe a patient with sickle cell disease and a spontaneous central retinal artery occlusion of his left eye that probably has good result from intravenous thrombolysis. We want to add sickle cell disease as rare etiological cause of central retinal artery occlusion and perpetuate evidence of intravenous recombinant tissue plasminogen activator administration in this condition.

The role of fibrinogen in acute ischaemic stroke.

AIM: This study aimed to explore associations between fibrinogen and acute ischaemic stroke, neurological impairment, cerebral ischaemia, and clinical evaluation of stroke patients. MATERIALS AND METHODS: The study involved 153 patients categorised into two groups: patients with acute ischaemic stroke, and patients with risk factors but who had not had a stroke. Blood samples were collected to analyse the serum level of fibrinogen. The time from stroke onset to blood test was noted. The National Institutes of Health Stroke Scale was used to determine the neurological disability of the stroke patients upon hospital admission and upon discharge. Cerebral CT was performed on the same group of patients during the first 24 h after stroke onset and evidence of early ischaemic lesions was recorded. The stroke cases were divided into subgroups according to the TOAST classification. RESULTS: Patients with ischaemic stroke had a significantly increased mean level of fibrinogen (> 4g/l). Analysis of stroke subtypes shows that patients with undetermined cause of stroke and patients with atherosclerotic stroke had a significantly higher median level of fibrinogen compared to patients with some other types of stroke. No significant connection was found between fibrinogen level and neurological deficit. A positive linear relationship was established between fibrinogen and blood sample time. A negative relation was established between the clinical evolution of ischaemic stroke patients and fibrinogen level. A significant relation between fibrinogen level and the presence of ischaemic lesions on cerebral CT was observed: patients with a fibrinogen level > 3.41g/l showed a 3.29-times increased risk of ischaemic lesions. CONCLUSION: Fibrinogen is a reliable biomarker that could characterise acute ischaemic stroke.

Characteristics of Unstable Carotid Plaques - New Image Modalities.

Ischemic stroke is a socially significant health problem due to high mortality and disability. One of the leading causes for cerebrovascular accidents is the carotid atherosclerosis. The mechanism of its formation presents not only lipid accumulation in the arterial wall but a complex inflammatory disease. The aims of this review are to point the new methods and approaches for diagnostic of the unstable and high-risk carotid plaques. The old plaque imaging modalities emphasized mainly to the degrees of luminal stenosis. The new possibilities reveal plaque morphology so detailed even compared to histological verification. Recent techniques as Shear wave elastography, optical coherence tomography, Superb microvascular imaging, USPIO MRI give information about the pathological mechanisms of carotid atherosclerosis. The efforts are directed to predict the atherosclerotic burden, plaque instability and the occurrence of cerebrovascular events for each patient and to optimize personal management.

A case of encephalocraniocutaneous lipomatosis syndrome with epilepsy (Haberland syndrome).

Encephalocraniocutaneous lipomatosis is a rare congenital neurocutaneous syndrome characterized by scalp, facial, and ocular lesions and multiple intracranial malformations. Approximately 50 cases have been described in the literature. We report a 34-year-old woman with a 6-year history of epilepsy, without mental retardation, with predominantly ipsilateral skin lesions evident at birth, with limbal lipodermoid of the left eye and multiple non-progressive, ipsilateral intracranial structures of soft, cystic components. The described malformations are congenital, mostly unilaterally located and with similar lipomatous structure.