Biomedical subjects
Publications and source records attributed to D Mladenov.
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.
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.
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.
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.
Upper urinary tract obstructions represent a problem faced by urological specialists for many decades. Regardless of the updated methods of diagnosing and management, as well as the attempts at early detection of neoplastic diseases and their complications, there is a permanent tendency of the morbidity rate of carcinoma of the uterine neck and body to increase. What is more, age stratified morbidity most frequently demonstrates involvement of women in the 40-49 years age group. In the daily routine urological practice cases presenting UUTO are by no means rare, and not infrequently urologists confront a queer challenge necessitating to make exact diagnosis in opportune time. It is the purpose of the study to present a summed up assessment of the diagnostic methods most frequently used.
The past few decades mark a rejuvenation of the contingent of benign prostate hyperplasia (BPH) patients. The condition affects mainly the active age in men, with the substantial financial burden of treatment leading to a surge of interest in the disease. The hazards of postoperative complications development constrain modern urologists to seek for new, safer and more effective methods of conservative management. The task undertaken is to assay the effect of application and possible side phenomena of Tamsulosin treatment in BPH patients, administered at dose 0.4 mg a single time on a daily basis over 12 to 24 weeks. A nationwide multicenter, parallel, randomized study is conducted in seven urological clinical units throughout the country, covering a one year period. For the purpose a total of 310 men, aged 52 to 68 years, presenting moderately expressed BPH symptomatology are investigated. IPSS improvement is documented in 229 patients (74%), and a significant MUD improvement is observed in 115 patients (37%), with the residual urine quantity decreasing significantly in 108 patients (35%). In conclusion, it is believed that Tamsulosin administration as a superselective alpha-1-A adrenoblocker is one of major achievements in the conservative therapeutic approach to prostate adenoma.
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.
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 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.
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.
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.
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.
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.
Prostate cancer is a rather common and severe disease in man. It affects the age beyond 50, a tendency being recently observed towards affecting subjects of younger age. In the early stage the symptoms are scarce and vague. The diagnostic possibilities of ultrasound examination, intravenous urography, computer axial tomography and biopsy specimen examination were compared in patients with prostate cancer. The authors consider the possibilities of transabdominal and transrectal echography for diagnosis of prostate cancer to be superior to those of intravenous urography. H. Watanabe even recommends and uses transrectal echography as screening method. The possibilities and results of transrectal echography and computer axial tomography for evaluating tumor growth and infiltration outside the prostate capsule are compared. Ultrasound examination is recommended as a more exact method, with a view to radical prostatectomy. The good correlation of the echographic patterns with tumor development are also recorded.
Fifty-nine patients, 58 to 88 years of age, with prostate cancer comprise the study group. Screening studies were made in doubtful diagnosis and vague complaints, as well as repeated scintigraphic controls in histologically proven cancer. The most common localization of the bone lesions were: pelvis, ribs, lumbar and thoracic vertebrae. Distribution of the zones of enhanced drosition, effect of treatment and eventual connection between scintigraphic and histologic finding are noted. Patients without X-ray evidence of bone metastases or with evidence of single metastases, frequently had extensive dissemination of the metastatic process when whole-body bone scintigraphy was made.
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.
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