Nowadays, NIRS is usually used in cardiac surgery to reduce possible risks of neurological damage. The importance of the role of pCO2 in the cerebral vascular resistance and in cerebral blood flow has already been proven. This research demonstrates a relationship between pCO2 and the NIRS value. This paper could introduce an important correcting tool when an inadequate NIRS value occurs although the level of oxygenation, haematocrit and mean arterial pressure are acceptable and the arterial line is accurately positioned.

The frequency of EGFR mutations we found in lung squamous cell carcinomas in a Southern Bulgarian region is lower than that in European countries. Ethnic diversity in the region does not play role of an independent predictive factor in terms of mutation frequency.

Background: Invasive mucinous lung adenocarcinomas are rare and account for 2%-10% of all lung adenocarcinoma cases. It is believed that Napsin A exhibits a weaker expression in mucinous adenocarcinomas compared with TTF1, but such correlation is still poorly researched. Aim: The aim of the study was to determine the frequency of mucinous to nonmucinous adenocarcinomas and compare specifi city and sensitivity of monoclonal Napsin A with TTF1 in mucinous adenocarcinomas and defi ne the frequency of EGFR mutations. Materials and methods: Eighty-four resected lung carcinomas were prospectively evaluated. All biopsies were analysed with p63, TTF1, monoclonal Napsin A, CK7, CK20 and CDX2 and were studied with real-time PCR technology. Results: In resected material we detected 49/84 (58.3%) adenocarcinomas and selected 21 mucinous adenocarcinomas out of 46 non-mucinous adenocarcinomas (45.6%). The most common pattern of mucinous adenocarcinomas is papillary -24% and colloidal -24%, followed by acinar -19.2% and lepidic -19.2%. mNapsin A was positive in 18/21 (85.7%) mucinous adenocarcinomas v/s 17/21 TTF1 positive (80.9%). EGFR mutations were detected in 3/21 cases with mucinous adenocarcinomas (14.3%): mucinous papillary, mucinous acinar and "salivary gland-like". Conclusion: Our study demonstrates a high proportion of primary mucinous lung adenocarcinomas to primary non-mucinous adenocarcinomas. Sensitivity and specifi city of mNapsin A and TTF1 did not show signifi cant diff erence in pulmonary mucinous and non-mucinous adenocarcinomas, as mNapsin A gave greater sensitivity to mucinous adenocarcinomas. Our results indicate the same mutation frequency of EGFR in mucinous adenocarcinomas as mutation frequency detected in non-mucinous adenocarcinomas in the Bulgarian region.

Citation: Kehayov I, Genova S, Gicheva M, Nuri B, Kitov B. Intradural extramedullary metastasis of the upper thoracic spine -case report and literature review. Folia Med (Plovdiv) 2019;61(4):624-9. AbstractIntradural extramedullary metastases of systemic neoplasms are extremely rare and associated with progression of the underlying disease.We report a case of 46-year-old male operated on for moderately differentiated lung adenocarcinoma. Postoperatively, he underwent six courses of chemotherapy and radiotherapy. He developed progressive severe inferior paraparesis accompanied by excruciating pain between the shoulders two years later. Magnetic resonance imaging revealed metastases in the bodies of T2 and T3 vertebrae with adjacent intradural extramedullary lesion compressing the spinal cord. The patient underwent surgical decompression and vertebral body cement augmentation that lead to pain relief and partial neurological recovery. The histological examination was consistent with metastases from low differentiated pulmonary adenocarcinoma. Surgical resection of intradural extramedullary metastasis improves patient quality of life by reducing pain intensity and neurological deficit.

We demonstrated that cerebral oximetry decreases with the loss of pulsatile flow regardless of the mean arterial pressure and, furthermore, is not directly related to the haematocrit value in patients with reduced pulmonary blood flow.

Parathyroid carcinoma accounts for about 4% of all diseases of the parathyroid glands. It usually presents as a tumor mass in the neck region. Mediastinal parathyroid carcinoma has been reported very rarely. The present paper reports an ectopic parathyroid carcinoma in the anterior mediastinum in a 54-year male that failed to be recognized antemortem. The markedly elevated serum calcium levels were repeatedly put down to laboratory errors, and the clinical features of primary hyperparathyroidism were misjudged and managed only symptomatically. The terminal cardiogenic shock was associated with myocardial infarction. Coronary plastic surgery was carried out and a stent was placed. The postmortem examination found a solid elastic tumor mass (4 cm) fi rmly encapsulated in the upper half of the anterior mediastinum having trabecular structure, mild nuclear and cellular polymorphism, single irregular mitoses and an area of necrosis. The mass invaded the capsule and the surrounding adipose tissue, there were tumor emboli found in the lymph and blood vessels. Immunohistochemical study showed diffuse expression of low molecular weight cytokeratin, chromogranin A and synaptophysin, and more than 20% of the tumor cells were Ki-67 positive. Glycogen granules were found in their cytoplasm. There were clearly seen metastatic calcifi cations in the intramural coronary vessels, the cardiomyocytes, the kidneys and the lungs. The present case report contributes considerably to the differential diagnosis of hypercalcemia.

Background: Eosinophilic gastritis is an eosinophilic inflammation of the stomach mucosa characterized by eosinophilia in the absence of other known causes. It is usually the result of contact with a food allergen. Allergy to cow’s milk is one of the possible reasons. It often presents with different symptoms, one of these being hematemesis. From the current literature, we know that eosinophilic disease can result in severe tissue damage. Case presentation: We report two patients who were admitted to the gastroenterology department with severe hematemesis and were diagnosed via gastroscopy with the rare presentation of erosive gastropathy. Our patients eventually recovered after initiation of hydrolyzed milk. Conclusion: It is important to consider gastroscopy to aid in the rapid diagnosis of eosinophilic gastritis, even in the case of a relatively young child. This is because the strongest evidence for diagnosis is histological biopsy.

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