Mammary gland papilloma--diagnostic and therapeutic behavior.

Papillary lesions of the mammary gland represent a serious disease and incorporate a broad spectrum of lesions. The goal of the current article is to reveal the diagnostic methods and therapeutic behavior in patients with pathological discharge from the nipple of the mammary gland. In this article we present 15 cases of histologically proven mammary gland papilloma. Mammographic, ultrasonographic and cytologic methods are applied for diagnostic specification. The chosen therapeutic behavior in all of the women is surgical. We take into consideration the possibilities of the different diagnostic methods as well as the therapeutic behavior-conservative or surgical approach. We reckon that when there is suspicion for mammary gland papilloma a surgical intervention is necessary to be carried out--due to the functional discomfort and due to the possibility intraductal carcinoma in situ to be missed out in some cases.

[VATS in patients with solitary periferal pulmonary tumors].

UNLABELLED: The patients with periferal solitary pulmonary nodule often present a serious diagnostic and therapeuthic challenge.The aim of our study is to present our experience in VATS for diagnosis and treatment of patients with solitary periferal pulmonary tumors. MATERIAL AND METHODS: For the period of 1997-2009, 146 patients with periferal pulmonary tumors underwent VATS for resection of the tumor. RESULTS: 112 (74.2%) of the patients underwent radical VATS resection of the tumor after intraoperative frozen sections for diagnosis. In the rest 39 cases (25.8%) due to different reasons VATS was converted to open thoracotomy and wedge resection. 54.55% of the resected tumors were malignant and 45.45% of them were benign. In 18 patients the intraoperative frozen sections confirmed primary lung cancer, and the procedure was converted to thoracotomy and radical resection. In 13 patients the results from the intraoperative frozen sections were not definite and we were not able to differ wether the tumor was a pulmonary metastase or a primary lung cancer, and after the final histological examination the patients were submitted to radical resection in interval. In 33 of the cases we resected pulmonary metastases from an extrapulmonary primary tumor. CONCLUSIONS: Despite the advances in diagnostic technics, only the VATS resection of the pulmonary tumor and the histological examination assures definitive diagnosis, it allows the definitive treatment for the benign lesions and indicates the correct treatment for malignant lesions.

[Postoperative survival in patients with inoperable lung cancer].

UNLABELLED: Despite the advances in treatment in the last two decades, the prognosis in lung cancer remains infavourable. Only 20-25% of the patients are suitable for operative treatment. Almost 75% of the patients are inoperable at the time of diagnosis. MATERIAL AND METHODS: We present 148 patients, who underwent non-radical operation for the period 01.01.1997 - 31.12.2005 - 129 men (87.16%) and 19 women (12.84%), age range - 29-65 years (53.67 +/- 0.60). RESULTS: The mean time of survival for the group submitted to radiotherapy is 13.74 months, while for the group without postoperative radiotherapy is 9.31 months. The mean time of survival for the group submitted to chemotherapy is 9.99 months, while for the group without adjuvant chemotherapy is 10.27 months. CONCLUSIONS: The radiotherapy significantly improves the survival in the patients with inoperable lung cancer, while the chemotherapy don't increase the survival.

[Stage of disease as a prognostic factor in radically operated patients with non-small cell lung cancer].

UNLABELLED: Despite the better diagnostic and therapeutic opportunities, lung cancer is still the major cause for cancer mortality. The surgical-pathological TNM-stage is known as the most reliable prognostic factor for survival in patients with lung cancer. MATERIAL AND METHODS: We present 440 patients with non-small cell lung cancer, radically operated in the Clinic of Thoracic and abdominal surgery of University Hospital "St.George" - Plovdiv for the period 01.01.1997 - 01.09.2004 - 378 men (85.91%) and 62 women (14.09%), age range 23-82 years. RESULTS: The mean time of survival according to the stage is as follows: IA - 77 months, IB - 67, IIA - 55, IIB - 42, IIIA - 33 IIIB - 14, IV - 27 months. CONCLUSIONS: The stage of the disease is an important prognostic factor for patients with lung cancer. We found the lowest survival in stage IIIB. For selected patients in stage IV, the operative treatment leads to good results.

[Extent of resection as a prognostic factor in patients with non-small cell lung cancer].

UNLABELLED: Despite the new methods of treatment during the last two decades, prognosis in lung cancer remains unfavourable. Only 20-25% of the patients are suitable for surgery, and the surgical resection is the unique alternative with curable intent. The extent of resection is an important prognostic factor in lung cancer patients. MATERIAL AND METHODS: We present 440 patients with non-small cell lung cancer, radically operated in the Clinic of Thoracic and abdominal surgery of University Hospital "St.George" - Plovdiv for the period 01.01.1997 - 01.09.2004.191 underwent lobectomy, 12 - limited resection, 39 - bilobectomy, and 198 - pneumonectomy. RESULTS: 63 patients underwent lobectomy for stage I, and the 5-year survival was 63.49%. For the 12 patients with limited resection we found mean time of survival of 50 months, and the 5-year survival was 50%.331 of our patients were in stage II and III. 123 of them underwent lobectomy--the 5-year survival was 28.46%. 208 patients underwent bilobectomy and pneumonectomy--the 5-year survival in this group was 17.79%. CONCLUSIONS: In conclusion we found that the extent of resection is an important prognostic factor for lung cancer patients in stage I. The patients submitted to lobectomy have better survival compared with those submitted to limited resection. The survival is better for the group of patients who underwent lobectomy,compared with the one for the group with bilobectomy and pneumonectomy, which is probably due to the earlier stage of the disease.

[Cysts of the mammary gland--surgical behavior and treatment].

The goal of the current article is to point the role of the different methods of surgical behavior in cases of mammary gland formations which have been ultrasonographically and mammographically diagnosed as cysts. Thirty-four women, clinically, ultrasonographicaly and mammographicaly diagnosed with cysts, are taken under consideration. Fine needle biopsy is carried out in all of the cases and the cysts' contents are cytologically and microbiologically tested. In 16 of the cases, puncture followed by pneumatocele represents the definitive treatment. In the end of the puncture, a control mammography is performed. Eighteen of the patients undergo surgical treatment due to the density of the cysts' contents, presence of bloody discharge, presence of a bilocular cyst and relapse following the puncture. As a result of the surgical treatment of 18 patients and of the histology are found as follows: benign cysts (13), carcinoma (1), papilloma (1), sclerotic adenosis (1), ADH (1), epidermoid cyst (1).

[The role of surgical treatment of primary non-small cell lung cancer with synchronous brain metastases].

UNLABELLED: Although several studies confirm the superiority of surgical resection of the primary lung cancer and metachronous brain metastases to other treatment modalities, the results of resection of the primary non-small cell lung cancer and synchronous brain metastases are still controversial. MATERIAL AND METHODS: In the clinic of Thoraco-abdominal surgery of the University Hospital "St.George" for the period 01.01.1997-01.09.2004 radically operated are 440 patients with non-small cell lung cancer, 6 of them had solitary brain metastases, succefully resected in clinic of neurosurgery. RESULTS: We found 5-year survival in only 1 of the patients, the mean survival for the rest of them was 16 months. CONCLUSIONS: Although the overall survival for the patients with non-small cell lung cancer and brain metastases is poor, the surgical resection may be beneficial in a select group of patients without lymph node metastases.

[The role of video-assisted thorascopy in determination of surgical behaviour in patients with non-small cell lung cancer and pleural effusion].

INTRODUCTION: Although of introduction of new methods for diagnosis in patients with lung cancer and pleural effusion, VATS remain "the gold standart". AIM OF THE STUDY: The aim of this study is to present our experience in using VATS for diagnosis and surgical behaviour in patients with lung cancer and pleural effusion. MATERIALS AND METHODS: Between January 2007 - March 2009 in Department of thoracic and abdominal surgery UMBAL St. George Plovdiv we made 62 VATS in patients with lung cancer and pleural effusion. RESULTS: In 30 patients we discover pleural carcinomatosis and we made pleurodesis. In other 32 patients, we didn't find pleural carcinomatosis and we made radical operations. CONCLUSION: On the basis of small number of complications. directly related with this manipulation, we can conclude that this technique is safe and help us to decrease the number of unnecessary thoracotomy until 50%.

[Postoperative complications in radically operated patients with non-small cell lung cancer].

SUMMARY: Lung cancer is the leading cause of cancer death. Despite the advances in medicine only 22% of the patients with lung cancer are candidates for radical operative treatment. Postoperative complications and mortality remain relatively high. MATERIAL AND METHODS: We present 320 patients, operated in our clinic for the period 2001-2005. 136 patients underwent lobectomy, 158--pulmonectomy, 22--bilobectomy, and 4--wedge resection. RESULTS: Postoperative complications occurred in 63 (19,61%) patients. Nine deaths (2,81%) occurred within 10 days after the operation. Five patients (1,56%) developed bronchopleural fistula. We observed inflammatory pulmonary complications in 14 (4,37%), atelectasis in 26 (8,12%), postoperative empyema in 6 (1,87%), and wound infection in 3 (0,93%) patients. CONCLUSIONS: The postoperative complications in radically operated patients with lung cancer remain relatively frequent. Precise preoperative evaluation and assessment of the patients are crucial to lower the risk of postoperative complications.

[Benign nodular formations of the thyroid gland and changes in cell and humoral immunity before and after surgical treatment].

INTRODUCTION: The main trends concerning the volume of surgery in benign thyroid disease - thyroidectomy or organ - preserved surgery, performed in detected immunological disorders, are not well motivated. The AIM of this study was to analyze changes in humoral and cellular immunity in diseases before and after surgical treatment as well as to assess the effects of surgical procedure and to precise its volume. PATIENTS AND METHODS: Changes in immune reactivity were investigated in 100 patients. They were selected with nodular (adenomatous) hyperplastic parenchymal processes in the thyroid gland, with or without hyperfunction - euthyroid or Basedowificated nodular goitre, solitary toxic adenoma and nodular form of lymphocytic thyroiditis. Serum anti - thyroglobulin and anti - microsomal antibodies were examined in these patients, and in 56 of them immunophenotypic flowcytometric analyses of peripheral lymphocytes was performed. RESULTS: Serum antithyroid antibodies gradually decrease in one year after surgery. Pre-surgical changes in lymphocyte subsets number in peripheral blood recovered to great extent. This tendency is best demonstrated in lymphocytic thyreoiditis. DISCUSSION: Study on immune parameters can help to evaluate the positive effect of organ - preserved and at the same time - radical surgical treatment. CONCLUSION: In immune thyroid disorders the organ - preserved radical resection of thyroid gland leaving normal parenchyma is method of choice compared to thyroidectomy since it allows definite treatment with hormonal compensation.

[Video-assisted thoracoscopic surgery in diagnostic and treatment of non-operable malignant pleural mesothelioma].

INTRODUCTION: Mesothelioma is characterized by aggressive follow-up, difficult diagnosis and treatment fatal issue. In one side the restricted possibility for operative treatment and the other side the resistance of tumors for chemotherapy are the mean reasons for bad results in patients with malignant pleural mesothelioma. We have aim to make a retrospective study of patients with malignant pleural mesothelioma in 3-th and 4-th stage, undergoing operation in our clinic and see VATS effectiveness. PATIENTS AND METHODS: In the clinic of thoracic surgery in University Hospital "St.George" - Plovdiv we made retrospective study in 21 patients undergoing operation in the occasion of advanced pleural mesothelioma. It was thoroughly men (14) in age between 45-72 years (58.6). In 18 (85%) patients the disease was proven intraoperative or on the final histological result after operation. Before operation in this patients in help of diagnosis, we have information by image examination (radiography, CT of thorax and if it necessary to mark pleural effusion - sonography of pleural cavity ) abdominal sonohography or CT of abdomen for exclusion of distant metastasis, fibrobronchoscopy (FBS) for confirmation or exclusion of endobronchial cancer and transthoracic aspiration biopsy (TTAB). RESULTS: We describe improvement in the most of patients. In 2 patients we have not improvement. In this situation we made Bulao drainage. Death issue in early postoperative period we have in 1 patient with increased breath insufficiency despite evacuation of pleural effusion and unfolded lung. DISCUSSION: Early diagnosis of malignant pleural mesothelioma is difficult, in some times impossible. After histological verification the diagnosis is proven. Image examination is still insufficient. The difficulty comes by insufficient cytologic and histologic verification before operation and also insufficiency of image examination. Because of the chemotherapy is insufficient, surgical treatment (radical or not) in huge number of cases help improvement of patient's condition. CONCLUSION: 1. Surgical treatment is decisive for diagnosis and treatment of malignant pleural mesothelioma even in advanced cases and have evident positive effects. 2. Surgical methods improve patient's condition, even in inoperable cases. 3. VATS surgery is modern method for diagnosis and treatment and if it necessary we can continue by conventional operation for definitive treatment of mesothelioma.

[Postoperative and remote outcome of non small cell pulmonary carcinoma in patients over 70 years old].

UNLABELLED: There is a worldwide increase in the frequency of pulmonary carcinoma The only radical treatment at such patients is the operative one, but it is associated with a lot of complications. MATERIAL AND METHODS: We presented 41 patients aged over 70 years old with non small cell pulmonary carcinoma who are performed pulmonary resection. The patients were staged as follows: stage IA - 5, stage IB - 7, stage IlIA - 9 patients. We performed 22 lobectomies, 4 bilobectomies and 15 pulmonectomies. RESULTS: Analyzing all the results, we found 5 years survival at 29.2%, 3 years survival at 46.3% and one year survival at 78% of the operated patients. We found complication in the postoperative period at 15 of the patients; only one patient died (2.4%). CONCLUSIONS: We consider, that the precisely selected patients at the age between 70-76 years old would not influence significantly the postoperative and long-term results at patients with non small carcinoma of the lungs.

[Malacoplakia involving the abdominal wall and urinary bladder: literature review and case report].

The authors describe a 44-year old woman's case where a tumor of her lower abdomen has been clinically found. CT of the abdomen showed involving the abdominal wall and urinary bladder. Histologically has been found the specific von Hansemann cells and Michaelis-Gutmann bodies warranting a diagnosis of malakoplakia Partial resection of urinary bladder and mm recti abdominis has been performed. The patient is clinically healthy until present (36 months) with normal laboratory indicators and CT find. The clinical symptoms of this very rare disease are different and depend upon the organ location. The soft tissue tumor-like lesions can mimic a variety of malignant, inflammatory, and infectious diseases. The accurate histologycal estimate leads to mild surgical intervention and postoperative comfort for the patient.

[Therapeutic and microbiologic aspects of pleural empyema]. / Terapevtichni i mikrobiologichni aspektu na plevralnite empiemi.

The pleural empyema is a severe disease which passes with respiratory insufficiency and general toxic symptoms. The early staged surgical treatment combined with total evacuation of the puss from pleural cavity is important for the successful outcome of the disease. We made retrospective study including 82 patients with pleural (61 with acute and 21 with chronic) empyema. We performed the following operative interventions: thoracocentesis with active aspiration--at 43, VATS--20, decortication and pleurectomy--in 16, thoracoplastic with muscle flap--3. Three patients died. The most common causes for the empyema were Gr (+) coccy. At most of the patients combined operative treatment and antibiotic therapy were the most effective.

[Proximal resection of carcinoma of the gastric cardia]. / Gornopoliusni rezektsii pri kartsinom na kardiiata.

Carcinoma of the gaster remains one of the major problems of the operative oncology, because of its high freguency, late diagnosis and low rate of five years survival. Although there are a lot of researches in this field, there is still a controversy about the size of the operative treatment of carcinoma of the gastric cardia. Some of the surgeons advocate gastrectomy as the only radical operation. Others prefer proximal resection as a method, saving a part of gaster, and in that way its important physiological functions for the organism.

[About the surgical treatment of oesophageal cancer]. / Vurkhu operativnoto lechenie na raka na khranoprovoda.

Oesophageal cancer is among the most malignant tumors with bad prognosis. Surgery offers the best chance for treatment. Subjects of our retrospective study are 56 patients with oesophageal cancer, treated at the Clinic of thoracic and abdominal surgery, University Hospital-Plovdiv, for 9 years period. Palliative surgery was performed at 18 of the patients, and resection of the oesophagus at 38 of them. Neoesophagus from the stomach we made in 30 of the patients, and in 9--from large intestine. In radically treated complications were observed in 14 (36.8%) cases. Six (15.8%) patients died.

[Diagnosis and treatment of retrosternal goiter]. / Diagnostika i lechenie na retrosternalnite gushi.

Retrosternal and intrathoracal goiters are actual surgical problem. This is because of the severe clinical symptoms, complications and some difficulties at the operative treatment. For the period of 1991-2002 at the Clinic of Thoraco-Abdominal Surgery at Medical University Plovdiv are operated 1131 patients with thyroid disease. Of them 38 were operated with cervical incision, 3 with median sternotomy, 2 with thoracotomy. There were complication at 7 patients. Only one patient died from pulmonary embolism.

[Surgical treatment of chronic nonspecific empyemas]. / Operativno lechenie na khronichnite nespetsifichni empiemi.

Approximately 4% to 20% of all acute empyema turn into chronic empyema despite the up-to-date complex treatment. The authors report their results of the surgical treatment of 38 patients with chronic nontuberculous empyema within a 5 years period. The age of the patients range from 18 to 72 years and they include 26 men and 12 women. Twenty eight were treated by thoracotomy and decortication, 7 underwent video-assisted thoracoscopy and decortication, and 3 thoracoplasty. In one of the patients a latissimus dorsi muscle flap was used.

[A clinical assessment of the computed tomographic potentials in the diagnosis of postoperative peritoneal abscesses]. / Klinichna otsenka na kompiuturtomografskite vuzmozhnosti v diagnozata na sledoperativnite peritonealni abstsesi.

Modern diagnosis of postoperative abscesses in the peritoneal cavity keeps on being a difficult problem in abdominal surgery. They often develop against the background of the operation and the underlying disease, which masks the clinical course. Fourty-six patients suspected of having postoperative abscess were examined. Computer tomographic examination presented unequivocal data on the presence or absence of abscess in 42 patients (91.3 per cent), whereas in 6.5 per cent the conclusion was not emphatic for abscess and in 2.2 per cent there was lack of coincidence. This makes the method particularly suitable when other methods fail to produce explicit evidence for abscesses and the clinical suspicion remains.