Assessment of students' satisfaction with virtual robotic surgery training.

Objective: Nowadays, in Bulgaria there is a trend of increasing entry into the surgical field of robot-assisted surgery operations, which suggests a need for the establishment of a large number of specialists in this field in a short period. Based on these arguments, the Medical University of Varna was the first university in the country to introduce a robotic surgery training program for medical students. The study aims to investigate the medical students' satisfaction on robotic surgery training provided at Medical University of Varna with da Vinci Skills Simulator. Design: During the summer semester of the academic 2020/2021 and 2021/2022 years, a pilot training of robotic surgery was conducted with 5th year students in Medicine. Within one month, the students had the opportunity to get acquainted with the simulator of da Vinci Xi robotic system. The training was divided into two modules: a two-week theoretical module and a two-week practical module. After completing the training, students filled out a questionnaire dedicated to assess their satisfaction with the proposed training. Correlation between their responses and the objective parameters assessed on the simulator was calculated. Results: Thirty participants (16 men and 14 women) shared their opinion on easiness of use and usefulness of the robotic simulator in training of surgery activities. Students' responses highly evaluated both aspects with average five-point Likert scale scores of 4.3 and 4.5, respectively. 93% of the participants would continue their further education and training in robotic surgery field. In addition, there was no correlation between objective evaluation by the simulator and students responses. Conclusions: Training in robotic surgery proves to be a useful approach for training students to develop skills and profession in the field of surgery. The results suggest that training in this field may be accomplished even at the student level, by exploiting the robotic surgery in realistic scenario and thus, in a timely manner to find out the surgical direction they want to be further evolved.

A rare case of isolated lung metastasis in the kidney.

Renal metastases are very rare condition in the clinical practice. The treatment is individualized and it depends on general status of the patient, involving of other organs and also the control of primary tumor. We are presenting a 64 years old woman, who had episodes of intermittent hematuria for two weeks. CT scan showed a large heterogeneous left kidney mass. The patient underwent open transabdominal radical left nephrectomy and the final diagnosis was isolated lung adenocarcinoma metastasis of the kidney.

A rare case of liposarcoma of the spermatic cord.

We present a 42 year old man, who was admitted in the Urology Department with symptoms of unilateral, painless, hard and firm slow-growing mass of the left scrotum for 4 months. Pelvic computed tomography (CT) scan showed a 8 cm3 mass lesion in the left hemiscrotum. Left radical orchiectomy and wide excision were performed and a yellowish soft tissue mass measuring closely attached to the spermatic cord was resected during surgery. Histopathologic evaluation revealed a tumor mass composed of well-differentiated liposarcoma.

A rare case of extramedullary hematopoiesis in adrenal mass.

Extramedullary hematopoiesis (EMH) is a compensatory mechanism for deficient formation or function of red blood cells. Very rarely, extramedullary hematopoiesis is finding out in the kidneys as well as adrenals. We present a 50 year old man, who was admitted in the Urology Department with symptoms of renal colic. A contrast enhanced computed tomography (CT) of the abdomen and pelvis revealed right adrenal lesion of 80/79 mm in coronary size. The final diagnosis was myelolipoma of the right adrenal gland. We presented a rare case of adrenal tumor mass in patient without any haemotological disease that requires surgical excision.

Management and diagnosis of Nutcracker syndrome-a case report.

Nutcracker syndrome (NCS), also known as left renal vein (LRV) entrapment syndrome is a condition that leads to stenosis of the aorto-mesenteric region of the LRV, with dilatation of the distal portion of the vessel. A 43-year-old woman was admitted to the Urology department with symptoms of intermittent painless hematuria and mild to moderate left lumbar pain for the last three months. The patient underwent cystoscopy under general anesthesia. Bloody urine was noticed to appear from the left ureter ostium and an intra-venous contrast CT of the abdomen was performed. The final diagnosis was anterior Nutcracker syndrome.

Management of Leydig cell tumors of the testis-a case report.

We report 1 case of Benign Leydig cell tumor. A 45-year-old male was admitted to the Urology department with a large painless mass in the right testis of 1 year duration. The patient underwent radical high right orchiectomy, with a preliminary diagnosis of right testicular tumor. On the basis of the pathologic and immunohistochemical findings, the testicular mass was diagnosed as a benign Leydig cell tumor. Long-term follow-up is necessary to exclude recurrence or metastasis and also the endocrine profile and imaging investigations need to be repeated periodically.

Paratesticular leiomyosarcoma: A clinical case report.

We present you a Case of 62 year old man with Paratesticular leiomyosarcoma (LMS) localized to the right sctotal half. Detailed pathological and immunohistochemistry characteristic of the tumor was done. For staging was used the classification of French Federation of Cancer Centres Sarcoma Grading System. The final grading of the tumor is grade 3. Paratesticular LMS is rare identity and serves as a diagnostic and treatment challenge.

Late results of bilateral scrotal flap.

We present you a late result of 27 year old man, who was operated in 2009 using bilateral scrotal flap (BSF) for paraffinoma localized to the penis, scrotum and pubic area. In 2010 the patient was operated again, because horseshoe relapse engaged the penis base, doing simple excision.Ten years later, the patient have excellence functional and cosmetic results.

Classical form of Kaposi sarcoma localized in penis.

We present you a case of 43 year old man with classical form of Kaposi sarcoma (KS) localized to the Penis who was HIV negative. Detailed pathological and immunohistochemistry characteristic of the tumor was done. Pathology reported it as KS with nodular and polypoid form. Classical form of KS with localization in male genitalia is rare identity and serves as a diagnostic challenge.

Premature ejaculation-operative management after failure of conservative treatment.

We report 1 case of microsurgical denervation of penis in men with lifelong premature ejaculation after failing to be treated conservatively. Although premature ejaculation is the most common sexual dysfunction in men, it is not well studied. Our aim was to investigate Micro-surgical denervation of penis (MSDP) as a method of treatment in men with lifelong PE after failure of different conservative treatment and to analyse the results. Much improving of ejaculatory control, distress, bother and IELT were identified from PEDT and PEP questionnaires. Furthermore investigations are needed to prove the role of operative treatment in men with lifelong PE.

A rare case of Bellini duct carcinoma.

We present a rare clinical case of renal cell carcinoma from the collection tubules-carcinoma of Bellini. A 69 years old patient, enters in our department with symptoms of massive hematuria. From the studies carried out-blood tests, CT and cystoscopy there are no data of neo process of lower urinary tract, but shows horseshoe-shaped kidney, cystic deformation of the left kidney and aortic dissection. A left radical nephroureterectomy was performed, with preoperative diagnosis of renal tumor at stage T3. The histopathological diagnosis was Bellini duct carcinoma of papillary tubular type. The patient currently remains disease -free.

A rare clinical case of penile gangrene in a patient with chronic renal failure and diabetes mellitus.

We report here a case of penile gangrene due to penile calciphylaxis in a patient with diabetes mellitus and chronic renal failure. Initially the patient demonstrated dry gangrene of the glans penis, which turned to wet after partial amputation. The main cause of the gangrene was considered to be circulatory insufficiency induced by severe arteriosclerosis. Despite high mortality rate associated with ischaemic penile gangrene aggressive management is recommended for those who are not terminal.

[PRIMARY CYTOREDUCTIVE SURGERY VERSUS NEOADJUVANT CHEMOTHERARY IN TREATMENT OF ADVANCED OVARIAN CANCER (STAGE III C-IV). OUR AND FOREIGN EXPERIENCE].

INTRODUCTION: The advanced ovarian cancer usually have bad prognosis. The main methods for treatment of these types of tumors are: primary cytoreductive surgery and platin-based chemotherapy. AIM: Our aim was to evaluate our and foreign experience in treatment of advanced ovarian cancer stage III C--IV treated by neodjuvant chemotherapy followed by cytoreductive surgery and patients treated by primary cytoreductive surgery followed by adjuvant chemotherapy. We wanted to research the survival rate, postoperative adverse effects, mortality rate, the size of residual tumor and the metastases in these patients. MATERIAL AND METHODS: We researched for 10 years period--50 patients treated by primary cytoreductive surgery and 50 patients treated by neoadjuvant chemotherapy. RESULTS: The postoperative adverse effects and mortality rate are lower by neoadjuvant chemotherapy followed by cytoreductive surgery. The most important independent prognostic factor for overall survival rate was the lack of residual tumor in both types of treatment. CONCLUSION: The neoadjuvant chemotherapy followed by cytoreductive surgery in ovarian cancer stage III C--IV is considered as a standard treatment.

[RECONSTRUCTIVE AND COSMETIC SURGERY IN TREATMENT OF VULVAR CANCER].

UNLABELLED: The aim of our research work was to show our results in the field of reconstructive and cosmetic surgery for vulvar cancer. MATERIAL AND METHODS: We evaluated 18 patients for 10 years period. RESULTS: We applied all surgical techniques that are possible at the moment in the world: laps from mons pubis, rhomboid flaps, myocutaneous flaps from gluteal region. We used surgical techniques with the following muscle groups: musculus gracilis, musculus gluteus maximus, musculus tensor fasciae latae, musculus rectus abdominis. CONCLUSIONS: With our research work we tried to better the quality of life of our patients, to achieve better esthetic and cosmetic effect after very radical surgical interventions connected with vulvar cancer.

[FEMALE STEROID HORMONES - MODULATORS OF IMMUNE RESPONSE TO GENITAL CHLAMYDIA TRACHOMATIS INFECTION.]

In the recent years according to WHO, genital chlamydia is the mos't common sexually transmitted infection. Chlamydia Trachomatis is an intracellular parasite which target are the tubular epithelial cells of the urethra, endocervix, endometrium, endosalpinx, conjunctiva, synovial lining of the joints, Glisson's capsule of the liver Our study, as well as some international researches, shows that in the cases of genital chlamydia there are changes in the ovarian hormones (estradiol and progesterone), their impact on the immune system and their importance for the development and the complications of the infection with Chlamydia trachomatis. The physiological level of the steroid hormones in its turn contributes for the normalization of the local immunity and reduces the possibility of recurrences.

[COMBINED APPLICATION OF FETAL FIBRONECTIN AND INSULIN-LIKE GROWTH FACTOR IN PRETERM DELIVERY DIAGNOSIS--OUR RESULTS].

The insulin-like growth factor IGFBP-1 is a binding protein (IBP-1), also known as placental protein (PP12), is encoded in people as IGFBP-1 gene. The IGFBP-1 is an especially vital hormone in the female reproductive physiology. The presence of it in large quantities in the amniotic fluid can be used as a biochemical marker for preterm birth and premature rupture of membranes. Fetal fibronectin is a high-molecular glycoprotein, that is produced during pregnancy and has a role as biological glue, binding the foetus membranes to the endometrium. fFN can be found in the cervicovaginal secretions until 22nd gestational week and later on during the last trimester (1 to 3 weeks before birth). fFN is usually absent between 24th and 34th gestational week. Thirty sixth (30%) of all the 120 females tested had positive fFN test results and were, therefore, at high risk for preterm delivery. Despite the implemented tocolytic therapy, 15 (12.5%) of them delivered before the 37th gestational week. The results from the investigation for the presence of pLGFBP-1 in 120 pregnant women show that 35.8% (43 women) were positive and 15(12,5%) of them delivered before the 37th gestational week despite the implemented tocolytic therapy In both tests, the average gestational age of the premature fetus was 32.5 ÷ 2.8 gestational weeks.

[SOME DIAGNOSTIC ASPECTS OF CHLAMYDIA TRACHOMATIS UROGENITAL INFECTIONS].

The following tests were used to make the diagnosis of Chlamydia Trachomatis: Ensime Immunoassay (EIA), Enzyme-Linked FluorescentAssay (ELFA), Polymerase Chain Reaction DNA amplification for Chlamydia Trachomatis, Neisseria Gonorrhoeae, Mycoplasma Genitalium and Ureaplasma Urealyticum. The subject of this study were 486 outpatients between the ages of 17 and 62, diagnosed with urethritis, epidydimitis, prostatitis, cervicitis, endocervicitis, pelvic inflammatory disease and sterility. Comparison PCR and EIA showed statistically significant difference between the positive results obtained by the two methods (p<0.001). Comparing PCR and ELFA on the other hand, did not show any statistically significant difference (p>0.1). EIA is the method that gives a higher percentage of nonspecific positive reactions, while the results obtained with ELFA are much closer to the ones obtained by PCR. According to contemporary evidence based medicine, the development of unified standart methods for diagnosis and evaluation is of vital importance, not only for the patient and the treating physician but also concerns for the healthcare system, the general public and the pharmaceutical companies as well.

[GLYCYRRHIZINIC ACID--AN ALTERNATIVE METHOD FOR TREATMENT OF CONDYLOMATA ACUMINATA].

Condylomata acuminata are benign proliferations of skin and mucosa caused by the human papilloma virus infection (hereinafter referredto as HPV). It is one of the most common sexually transmitted diseases in the world, whose incidence rate has increased in the last three decades. Current treatment involves the physical destruction of the infected cells. The fact that there are many different types of treatment goes to show that none of them are uniformly effective or directly antiviral.

[Diabetes and pregnancy].

UNLABELLED: We tried to summarize our and foreign experience in the field of diabetes and pregnancy AIM: Our aim was to detect pregnant women with diabetes mellitus, as well as to introduce screening method for early detection and apply a suitable diet and treatment for these patients. MATERIAL AND METHODS: Patients with diabetes and pregnancy were researched for the period of 2007-2014 (70 patients). RESULTS: Introducing a screening method in the second trimester between 24-28 gestational week, applying a suitable diet and treatment lead to better outcome of this disease and to more safe delivery outcome. CONCLUSION: Future research work will give additional light in this field.

[The insulin-like growth factor IGFBP-1--specific marker for preterm delivery in pregnant women with clinical symptoms].

The insulin-like growth factor IGFBP-1 is a binding protein (IBP-1), also known as placental protein (PP12), is encoded in people as IGFBP-1 gene. This gene encodes a protein in the domain of IGFBP-1 and domain thyroglobulin. During the last years highly phos-phorylated versions of IGFBP-1 (IGFBP-1 pM) have been found in decidual cells--a marker of threat for preterm birth. The quantity analysis of the insulin-like growth factor in the serum or heparinized plasma is used to locate diseases related to growth. Its levels in the plasma can scarcely be determined after birth and steadily rise with age while they reach their maximum during puberty. These levels rise constantly during pregnancy.