[Intraoperative effect of preoperative embolization of the renal artery in patients with kidney carcinoma]. / Intraoperativen efekt ot predoperativna embolizatsiia na bubrechnata arteriia pri bolni s kartsinom na bubreka.

Aim of the embolization of the renal artery is to provoke ischemia or shut out from blood supply of the kidney tissue including pathologically changed area. As a result of this procedure the affected kidney becomes suitable for surgical removal without significant loss of blood. In this study there are included 116 nephrectomies due to kidney carcinoma. Clinical diagnosis and treatment of the patients are held at the Clinic of Urology of the Alexandrovska Hospital for the period 1990-1995. Embolization of the renal artery is accomplished in 52 subjects (63.41%). The procedure was contraindicated in 10 subjects (8.62%). It was established intraoperatively that the affected kidney had good embolization in 46 subjects (88.46%), in 4 subjects (3.44%) it had excellent embolization, and in 2 subjects (1.72%) there was just peripheral embolization. Authors conclude that: 1) Nevertheless this method is invasive it still has a place in urologists' practice. 2) Preoperative embolization of the renal artery is a devise for surgical removal of the kidney as well as achieving maximum effect.

[Radical operative treatment (nephrectomy and nephroureterectomy) in urology. Aspects and opinions]. / Radikalni operatsii (nefrektomiia i nefroureterektomiia) v urologiiata. Aspekti i mneniia.

The review of literature offerred discusses the opinions of different authors about indications and contraindications for radical oncological procedures in cases of renal and ureteral diseases.

[Surgical treatment of hydrocele--modern aspects]. / Operativno lechenie na khidrotsele--suvremenni aspekti.

Basically no one has ever introduced into practice any better procedure in cases of hydrocele than those of Winkelmann and Bergman. We recommend always a resection of the covering sheets of the testis as a profilactic measure against recurrency. Our study included 192 patients with hydrocele who were operated during the period 2000-2001 in the Clinic of Urology, Medical University of Sofia. The surgical procedures included: Winkelmann's procedure--in 118 cases (61,45%); Bergman's procedure--in 63 cases (32,81%);Orchiectomy--in 3 cases (1.56%) of total testicular atrophy; Combination of hydrocele and co-existing groin hernia was found in 4 cases (2,08%); Orchiectomy--in 1 case (0.52%) of bleeding which lead to hematoma on the 4th postoperative day; Reoperation--in 1 case (0.52%) of compression of the testicular blood vessels (after Winkelmann's procedure); Suppuration of the operative wound-- in 2 cases (1.02%) after Winkelmann's procedures. The authors consider that: 1. Winkelmann's and Bergman's procedures prooved to be quite satifactory as surgical treatment of patients with hydrocele. 2. Diagnosis and surgical treatment are easy to be performed. Postoperative complications are possible in cases of poor surgical technics, damaged local status and shortened time for hemostasis. 3. The well-known method of Lord was not used in our practice, but we do not deny it.

[Lansinoh in the treatment of sore nipples in breastfeeding women]. / Prilozhenie na lansinoh pri vuzpalenie na grudnite zurna u kurmachki.

UNLABELLED: The aim of the study was to assess the efficacy and side effects of purified lanolin (Lansinoh) in the prophylactics and treatment of sore nipples. Fifty-seven women aged 20-35 years have been treated - 41 (72%) with phototype III-IV and 16 (28%) with phototype I-II. Thirty-seven (65%) of them were primiparous and 20 (35%) were multiparous. Pre-delivery preparation of the breast has been performed in 16 (28%) of the women. Two groups of patients were formed: I gr. - 10 women (17,5%) with no complaints applying the preparation with preventive aim and II gr. - 47 (82,5%) women with sore nipples of different severity. Therapeutic efficacy was assessed according to the nipple attribute score. In the first group of patients due to the application of Lansinoh the skin remained smooth and elastic and breast-feeding was not disturbed. In the II group Lansinoh lead to a statistically significant difference in the nipple attribute score before and after treatment. The improvement was most pronounced in patients with light and moderate forms of inflammation, in women with phototype III-IV, in multipara and in patients with pre-delivery preparation of the breast. CONCLUSION: Lansinoh is purified lanolin suitable for prophylactics and treatment of sore nipples.

[Early and late complications following 388 nephrectomies in different diseases of the kidney and the ureter]. / Ranni i kusni uslozhneniia sled 388 nefrectomii pri razlichni zaboliavaniia na bubrek i ureter.

Early and late complications of nephrectomy include: chronic renal failure (CRF), haemorrhagic events, lumbar fistulas and other complications of different origin. This study covers 388 nephrectomies due to different diseases of the kidneys and the urethra. Clinical diagnosis and treatment of the patients are held at the Chair of Urology of the Alexandrovska Hospital for the period 1990-1995. There are established the following early and late complications: renal failure--in 37 patients (9.53%), haemorrhagic events--in 2 patients (0.51%), lumbar fistulas--in 4 patients (1.03%). Other complications are calculous anuria in 1 patient (0.25%), nephrectomy following plastic surgery of a kidney calyx--in 1 patient (0.25%), nephrectomy in a case with one functionally preserved kidney--1 patient (0.25%), nephrectomy in a case following kidney transplantation--1 patient (0.25%), and fatal outcome through the early postoperative period--in 2 patients (0.51%). Authors conclude that: 1) nephrectomy is followed by complications through the early and the late postoperative period; 2) complications following nephrectomy are rare but they are one of the most serious and important sequella in urologic surgery.

[A case of penis self-injection of liquid paraffin--operative treatment and results]. / Sluchai na avtoinzhektirane na techen parafin v penisa--operativno lechenie i rezultati.

The authors describe a rare clinical case named penis "paraffinoma" or "lipogranuloma". This problem has been discussed in only 6 scientific reports and articles during the period 1996-2002 [1, 2, 4, 5, 6]. Jh. Jeong et al. (1996) operated 13 patients with penis paraffinoma and concluded that the plastic and reconstructive procedures are safe and without any complications.

[For and against non-obstetrical indications for cesarean section]. / Za i protiv neakysherskite indikatsii za sectio caesarea.

The authors have made a retrospective study on the nonobstetrical indications for SC from 1996-2000 year, with the help of special documents belonging to VMI, Obstetric Clinic, Pleven. There have been 10,465 deliveries in the same period, 1096 with SC (10.47%). The main indications in 56 cases (5.11%) were non-obstetrical complications of pregnancy and delivery. The most frequent non-obstetrical indications were: ophthalmological in 18 (32.14%), orthopedical in 10 (17.86%), cases CNS diseases in 5 (8.93%) and cancer in 3 (5.36%). We have included: Condylomata accuminata--5 (8.93%), acute thrombophlebitis and thromboembolic diseases--5 (8.93%), a condition after plastic repairs of the perineum, virgin and vulvae--3 (5.36%). Special interest was taken on another group of patients with some rare diseases about the other specialist recommended SC. The ovarian age of the patients was 20-29 years--in 36 (64.28%). The SC has been performed in 30 cases (53.57%) in the first stage, in 14 (25.00%) in the second stage of delivery and in 12 (21.43%) cases was emergency. The conclusions of the authors is that the Obstetricians, who manage the delivery, may not always been comparted with that of the other specialist. This comes from the fact that the responsibility is mainly for him.

[Rational method for prostaglandin use in cases with postpartal uterine hypotonia]. / Ratsionalen podkhod v upotrebata na prostaglandini pri sledrodova matochna khipotoniia.

The authors aim is to find out the most common dosages, roads of administration and the effect of 15-Methyl PgF2a (Prostin 15 M) during the treatment of postpartal uterine hypotony 1 to 3 amp. Of Prostin 15 M-1 ml. (250 mg Carboprost) were used deeply muscular, intracervical or intramyometrial, by 51 patients with postpartal hypotony. The most common risk factors associated with the development of postpartal haemorrhage are PIH, prolonged labour, the general anaesthesis and higli multiparity. The adequate treatment with Prostin 15 M woned reduse the life threatening complication in the Labour room. The most efficient is the intracervical way of administration, a good effect could be achieved even with 1 amp. Prostin 15 M when it is applied after the conventional methods and manipulations. The lacu of effect grow Prostin 15 M (in 5.88% in this study) shows that there is another pathology responsible for postpartal hemorrhage and life threatening hemorrhage and this usually requires Laparotomy. We offer every Obstetric Clinic to have 3 amp. Prostin 15 M available and these would spare a lot of negative feelings or emotions and it wont supply a better obstetric outcomes.

[Therapeutic approach to upper urinary tract obstructions (UUTO) of gynecologic nature]. / Lechenie na obstruktsiite na gornite pikochni p'tishta (OGPP) ot ginekologichen kharakter.

The existence of numerous treatment methods for upper urinary tract obstructions (UUTO) following gynecological interventions, taken alone demonstrates that it is a matter of a complex surgical problem, hardly lending itself to solution. There is no ideal operation, manipulation or procedure. It is precisely the role of the urologist to choose and implement in practice the most adequate therapeutic approach to each individual case. Urology is an interdisciplinary and extensive surgical speciality, disposing of both classical, well-tried operative procedures, and vast possibilities for performing minimum invasive interventions and manipulations. All treatment approaches to UUTO after gynecological operations used in the Chair of Urology are described and comprehensively discussed.

[The metastasis of prostatic cancer and the methods for its demonstration]. / Metastazirane na raka na prostatnata zhleza i metodi za dokazvaneto mu.

Metastasizing of prostate gland carcinoma is an essential and characteristic feature of its biological manifestation. The high capacity of prostate tumor cells to spread via lymphatic and blood stream explain the development of metastases in 52 to 80 per cent of patients presenting for primary diagnosis. Metastatic lesions are usually located in the lymph nodes (24.12 per cent), spinal cord (50.37 per cent), pelvis (56.27 per cent) and femur (2.09 per cent). It is impressive that according to personal experience and pertinent literature data, lymph and bone localizations vary in a wide range--29 to 66 per cent--thereby necessitating to resort to all well known diagnostic methods for demonstrating the presence of both contact and distant metastases.

[The treatment of prostatic carcinoma with cyproterone acetate]. / Lechenie na prostatniia kartsinom s tsiproteron-atsetat.

Prostate gland carcinoma is a common and serious disease affecting males. Application of steroid and nonsteroid antiandrogens for the purpose of palliative management of prostate carcinoma dates back to 1973. It is endowed with a dual action-central (antigonadotrophic) and peripheral (antiandrogenic). The preparation is used in the form of monotherapy and as a combined therapeutic approach with the analogues of LHRH or orchiectomy. The obtained results undergo comparative assessment. It is believed that the combination cyproterone acetate with other hormonal preparations or orchiectomy yield optimal results in all groups of patients. One is impressed by the fact that the combination used at the onset of treatment is more effective than late inclusion of the second preparation.

[A comparative study of the effect of Zoladex treatment versus orchiectomy in patients with advanced prostatic cancer]. / Sravnitelno prouchvane efekta ot lechenieto sus Zoladex spriamo orkhiektomiiata pri bolni s naprednal rak na prostatnata zhleza.

The study entered sixty patients with advanced carcinoma of the prostate that were treated and followed-up by the authors. The median age was 70.3 years (range 58-83 years). In all patients a prostatic carcinoma has been morphologically proven. Orchiectomy was performed in 27 of them. Conservative treatment with Zoladex-monotherapy was applied in 21 patients and a combination of orchiectomy plus Zoladex-in 12 of the remaining. All patients were followed-up for the period of 3 months. Subjective and objective parameters were evaluated at 2, 4, 8 and 12 weeks during the treatment. Positive response to treatment was reported in 76% of the patients from the group of orchiectomy alone, 72% among the patients in the group of Zoladex depot and up to 80% in patients treated with orchiectomy plus Zoladex. The average time to achieve positive response was stated to be seven weeks for orchiectomy and Zoladex as a monotherapy and six weeks for the combination therapy.

[The transurethral use of laser therapy in urology]. / Transuretralno prilozhenie na lazerterapiia v urologiiata.

The utilization of laser energy plays an ever increasing role in medicine, surgical practice in particular. This is most clearly expressed in the field of urology where endoscopic access to the entire urogenital system is possible against the background of a continuous improvement of the surgical armamentarium over the past few years. The various types of lasers available, qualities of the laser source, and the physical and biophysical principles of their action are comprehensively described. The creation of this particular type of energy (laser), transmissible along flexible quartz fibers and not absorbed by water, considerably increases the interest in laser treatment of diseases of the urinary bladder and urethra. Laser therapy has important clinical implications, and broadens the scope of endoscopic treatment of a variety of urological diseases involving the upper urinary ways.

[The diagnosis, biopsy and treatment follow-up by ultrasound in patients with prostatic carcinoma]. / Diagnoza, biopsiia i kontrol na lechenieto chrez ultrazvuk pri bolni s kartsinom na prostatnata zhleza.

Prostate carcinoma accounts for 1-5 per cent of all neoplasms affecting men, and represents 29.2 per cent of the tumors involving the urogenital system. It is a disease encountered in advanced age mainly--between 60 and 70 years, and recently even earlier. It is pointed out that transrectal ultrasound examination is usually used for diagnosing prostate carcinoma, determination of its stage, and follow-up study of the treatment effect. The clinical relevance of transrectal echography augments whenever performed in conjunction with biopsy of the prostate under ultrasound control, especially in the event of impalpable neoformation, or in uncertain negative, digitally oriented biopsies. The screening method proposed is capable to provide for a sufficiently accurate orientation towards the site for performing control biopsy of the prostate, but it could hardly serve as a reliable, independent criterion for estimating the effect of the nonoperative treatment in course.

[The C-reactive protein level of patients after the extracorporeal lithotripsy of urinary calculi]. / Nivo na C-reaktivniia protein pri bolni sled ELPK.

Within 24 to 48 hours of sustaining a variety of severe clinical conditions, such as general bacterial infection, tissue necrosis, acute rheumatism, myocardial infarction, active pulmonary tuberculosis and neoplastic processes, the serum level of C-reactive protein may show a considerable increase. It may also serve as a criterion for the evolution of the disease, and for the effect of the therapy in course. The task undertaken is to use the serum level of C-reactive protein as a criterion for evaluating the extent of renal parenchyma damage following extracorporeal lithotripsy of urinary calculi (ELUC). Proceeding from the results of the study, it is assumed that ELUC is a nontraumatic operative intervention for the renal parenchyma. In case of extreme increase in C-reactive protein level, a higher incidence rate of post-ELUC complications may be anticipated.

[A comparative assessment between transrectal echography, venous urography, CAT and morphology in patients with prostatic carcinoma]. / Sravnitelna otsenka mezhdu transrektalna ekhografiia, venozna urografiia, KAT i morfologiia pri bolni s kartsinom na prostatnata zhleza.

By incidence rate prostate gland carcinoma ranks second among all neoplastic diseases. As all tumorous neoformations, it is conspicuous for its progressive character. Clinical, laboratory and roentgen methods, thus far routinely used in practice, are hardly in a position to establish correct and accurate diagnosis alone. The diagnostic potentials of transrectal ultrasound examination, intravenous urography, CAT and morphological patterns are comparatively studied in patients presenting prostate gland carcinoma. The obtained results point to a greater diagnostic relevance of transrectal ultrasound examination, by comparison with CAT and intravenous urography. It is a matter of a noninvasive and highly effective procedure for primary diagnosis of the neoplastic process. Emphasis is laid on the necessity to confirm the echographic diagnosis in all instances by performing morphological study in conjunction with the remaining diagnostic methods.

[Clinical studies in prostatic carcinoma]. / Klinichni prouchvaniia pri kartsinoma na prostatnata zhleza.

Carcinoma of the prostate is a widespread disease posing serious problems, especially when patient in stage T3-T4 are concerned. Proceeding from clinical observations on 269 patients presenting the aforementioned condition, and on the basis of thorough clinical, laboratory and histologic studies, a combined therapeutic approach using cyproterone acetate is adopted, supplemented by orchiectomy in some patients, and transurethral resection in others. After 3-month treatment course, changes in the level of microelements, copper, zinc and iron in particular, are recorded. In some cases the level of prostate specific antigen is lowered. Control of the underlying disease is successfully attained in 72 per cent of the patients.

[The place of interventional ultrasound in urology]. / Miastoto na interventsionalniia ultrazvuk v urologiiata.

The search for new methods of diagnosis, treatment and prognosis and their introduction in practice is a stable process in world urologic practice. It was not until after the first echographic apparatuses were produced in the fifties that the introduction of interventional ultrasound in urology became feasible. The authors set themselves the task to study and summarize the possibilities of this method for treatment of diseases of the kidneys, upper urinary tract, bladder and prostate. Renal cysts were diagnosed by ultrasound in 312 patients; in 229 of them percutaneous puncture was performed under ultrasound control. To reduce relapses, different sclerosing substances were applied, peak success being obtained with tetraolean. For establishing the exact cause of obstruction of the upper urinary tract the authors used antegrade pyelography under ultrasound control in 92 patients. Percutaneous nephrostomy for drainage of the upper urinary tract, a new endourologic operation was performed in 67 patients. To raise the radical approach to transurethral resection of the prostate and of bladder tumors, intraoperative transurethral ultrasound control was adopted for all patients operated by this technique.

[The diagnosis, biopsy and treatment follow-up via ultrasound in patients with prostatic carcinoma]. / Diagnoza, biopsiia i kontrol za lechenieto chrez ultrazvuk pri bolni s kartsinom na prostatnata zhleza.

According to data available in the literature prostate cancer accounts for 0.2 to 0.4 percent of all cancer diseases, 1 to 5 per cent of all tumors in males and 29.2 per cent of the tumors affecting the urogenital system. The consensus today is that prostate cancer is the most common tumor of the urogenital system. It is a disease of the advanced age, being most common in the age group 60 to 70. It is pointed out that transrectal echography has gained acceptance basically for the diagnosis of prostate cancer, for determining its stage and for check-up of the effect of treatment. According to M. Devonec et al., J. Pointes et al, the specificity of this method is 79 per cent and its sensitivity 48 per cent. The echographic diagnostic criteria for prostate cancer are described. The value of transrectal echography increases when performed with biopsy specimen examination under ultrasound control, especially in nonpalpable neoplasms or when digitally directed biopsy specimens have yielded doubtful or negative result. The method is noninvasive, practicable and well tolerated; this makes it particularly valuable for control of the effect of treatment.