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Biomedical subjects

Kh Kumanov

Publications and source records attributed to Kh Kumanov.

At least 19 recordsLinked to original sources
PubMed2000

[A modification of Freyer's typical prostatectomy].

Adenomectomy in its present-day modality has a millennium-long history. Chronologically, its development, justly or not, is marked by a great number of names among which it is worth noting Sir Peter Freyer (London) and his paper published in 1901, dealing with the radical treatment of the hypertrophied prostate by urinary bladder exposure. E. Fuller (USA) claims that the first practical implementation of the method six years previously is credited to him. Since then, there are no different opinions on the need of total gland enucleation, with some differences remaining in terms of operative access and hemostasis. Over the period 1998-1999, thirty-two adenotomies are performed according to Freyer's original method in the Department of Urology--University Hospital "Alexandrovska". An indwelling catheter with inflated balloon is inserted into the prostate bed for hemostasis without using packs or placing sutures. The obtained results are estimated as good.

Adult↗
PubMed2000

["Fossa" carcinoma - a relapse or "rest" carcinoma of the kidney?].

The local relapse represents a unique variant of the advanced stage of a disease (A Esrig et 1992). Presumably, "fossa" carcinoma may result from incomplete resection or persisting tumor in the regional contiguous lymph nodes (JB D Kernion 1978). The average time interval for a relapse to occur is 31 months after nephrectomy, and in most patients it becomes manifest with symptoms, such as losing weight, fatigability and lumbar discomfort (D Esrig et al 1992). In cases with local recurrence a long-term survivorship may be attained by resorting to aggressive surgical intervention (S Tanguag et al 1996). This is a report on twenty-three patients with "fossa" carcinoma covering the period 1994 through 1999, with a total of 425 patients with renal carcinoma operated during the same period of time. All patients undergo operation--lumbar access is used in 22 cases, and transperitoneal--in one. In one patients resection of colon is necessitated, whereas in five the neoplastic mass hardly lends itself to complete excision, with enucleation alone being done. At follow-up study the survival terms are as follows: up to 1 year--18 patients, up to 3 year--16 patients, up to 5 year--12 patients.

Adult↗
PubMed1999

[Live-donor kidney transplantations. The problems of vascular reconstructions].

The aim of the study was to evaluate the vascular surgery problems in 59 kidney transplantations from live donor, performed by the team for kidney transplantations (vascular surgeons and urologists) of Medical University--Sofia, for the period from April 1996 to May 1999. Nephrectomy was performed on 59 relatives (44 female and 15 males)--54.33 years average age. Donor kidneys were transplanted to 37 males (55.71 years average age) and 22 females (36.85 years average age). The average duration of hemodialysis prior to transplantation was 60.18 months (5.015 years). Most of donor kidneys were right--38, while only 21 were left. In six kidneys duplex renal veins were presented (10.16%), while in other 7 cases (11.76%) there were duplex renal arteries. We preferred termino-terminal anastomoses of donor renal artery to the hypogastric artery of the recipient, which provides not only better regional hemodynamics guaranteeing long term patency of the anastomoses, but presents optimal positioning of new kidney to the retroperitoneal space of recipient avoiding external compression of renal vessels. The standard performance of venous anastomoses was termino-lateral to the iliac vein of the recipient. In 7 cases, saphenous vein graft was used to replace or prolong the donor arteries or veins. Postoperative results of live donor kidney transplantation were successful in all cases, except one case (1.74% of 71 venous anastomoses) with late deep venous thrombosis of recipient's iliac vein resulting in kidney rupture and unavoidable nephrectomy. There were also 5 cases of haemorrhage (8.47%): in 3 of them from the renal hilus and in 2--profuse bleeding from the operative approach, all successfully treated after reoperation. Our satisfactory results in live donor kidney transplantation prove this method as a method of choice in certain cases of chronic renal insufficiency, especially in lack of cadaver kidneys. Contemporary vascular surgery disposes of various techniques that makes possible transplantation even in cases with serious anomalies of renal vessels. The atraumatic nephrectomy of donor kidney remains one of the main factors contributing to the successful outcome of kidney transplantation.

Adolescent↗
PubMed1999

[The most common complications associated with nephrectomy].

Access to the kidney and technical performance of nephrectomy should be related to the stage of the disease and degree of pathological process development (I. Viktorov 1983, S. Lambrev and T. Andreev 1961, T. Patrashkov 1982, F. S. Judy et al 1995). Advanced pathoanatomical changes in the kidney and pararenal space greatly interfere with the operation, especially in the event of adhesions to peritoneum and contiguous tissues (N. A. Lopatkina et al 1986, N. Minkov 1987, T. Patrashkov and H. Kumanov 1988). In the authors' reports presented are analyzed 388 patients nephrectomized in the University Hospital "Alexandrovska", covering the period 1990 through 1995. All updated methods are used in diagnosing. The commonest intraoperative complications recorded in a series of 188 nephrectomies (48.45%) include: 1. Pus collections in the kidney--88 cases (46.80%). 2. Opening of peritoneum--64 (34.04%). 3. Decompressive puncture of the kidney--15 (7.97%). 4. Neoplastic masses escaping from the renal parenchyma into the operative field--7 (3.72%). 5. Opening of pleura--5 (2.66%). 6. Purposeful opening of the tumor itself for decompression--3 (1.95%). 7. Kidney removal gives rise to diffuse bleeding necessitating inserting a tampon for hemorrhage control--2 (1.06%). 8. Splenectomy--1 (0.53%). 9. Because of advanced neoplastic process only biopsy is taken--1 (0.53%). 10. Hemicolectomy--1 (0.53%). 11. Injury to v cava inferior--1 (0.53%). As shown by the experience gained, nephrectomy is a technically difficult operation, particularly in case of altered topoanatomical interrelations during secondary interventions on the kidney and ureter, or in case of concomitant pyelonephritis. Intraoperative complications are not life endangering provided treatment is undertaken in opportune time.

Adult↗
PubMed1999

[History of nephrectomy].

Following animal experiments (Combair 1803, Prevost and Dumas 1823) and accidental removal of the kidney in humans (Spillgellberg 1867, Peaslee 1868, Wolcott 1886), it has been established that elimination of a single kidney does not lead mandatorily to fatal outcome if the second functioning kidney is preserved. The chronology of nephrectomy development on a worldwide scale, and in Bulgaria as well, after the first routinely scheduled nephrectomy performed by Gustav Simon (2 Aug 1869), is presented. In 1897, almost 30 years later, Ivan Mikhaylovsky from the Plovdiv Hospital performed the first nephrectomy in this country. In the late 19th and early 20th century, nephrectomy becomes one of the most often used kidney operations (H Kumill, 1913--49.3 per cent), but gradually parallel to improving the diagnostic technique it is less frequently applied (W Lutzer et al, 1976--28 per cent) at the expense of organ-salvaging interventions. The last decade marks the introduction of laparoscopic nephrectomy (RV Clayman et al, 1991, AD Joce et al, 1992, JJ Rassweller et al, 1993, Sy Nakada et al, 1996, CC Abbou et al, 1998) which is a safe procedure even in patients with malignant renal pathology and adequately selected cases presenting various urological diseases.

Bulgaria↗
PubMed1999

[Methods most frequently used in the diagnosis of renal diseases leading to nephrectomy].

In the past few years, the progress of science and technology, and introduction of new diagnostic and treatment methods (echography, isotope study, computerized axial tomography, renovasography, magnetic resonance imaging and others) have contributed greatly to early detection and timely treatment of pathological processes involving the kidney (ZK El-Zein, 1995). After practical implementation of new clinical methods of examination it becomes possible to gain better insight into the undelying causes and character of renal diseases (T. Patrashkov, 1982). The study covers 388 patients subjected to nephrectomy for various diseases of the kidneys and urether, diagnosed and treated in the Department of Urology-University Hospital "Alexandrovska", over the period 1990 through 1995. The commonest diagnostic methods used to make diagnosis prior to nephrectomy include: 1. Survey roentgenography of kidneys, urethers and urinary bladder (KUB)--364 (93.81%). 2. Venous urography--320 (82.47%). 3. Echography--302 (77.83%). (Antegrade pyelography--2 (0.51%). 4. Isotope nephrogram (ING)--212 (54.63%). 5. Scintography of kidneys--126 (32.47%). 6. Computerized axial tomography (CAT)--82 (21.13%)/(70.68%) among 116 renal tumor nephrectomies. 7. Renovasography--82 (21.13%). 8. Retrograde pyelography--48 (12.37%). 9. Gamma-camera--10 (2.57%). 10. Cystoscopy--6 (1.54%). 11. Ureterorenoscopy--2 (0.51%). Presumably, apart from the new "noninvasive" methods of study (computerized axial tomography--CAT and echography), the conventional venous urography has by no means lost its popularity.

Adult↗
PubMed1999

[Continent derivation of urine (a Modo) Mainz II].

The improved intestinal dissection technique and antibiotic agents, and the development of new resorptive suture materials have led to renewed surge of interest in ureterosigmoidostomy as a practicable procedure for continent derivation. Based on data from urodynamic assessment of diverse forms of urinary derivation, M Fisch and R Hohenfellner in 1991 propose a modification of the classical technique of ureterosigmoidostomy, coined with the term Sigmarectum pouch or Mainz pouch (M Fisch, R. Wammack, R Hohenfellner 1991). Over the period 1992 through 1999, 46 operations type "Mainz II" are performed in the Department of Urology--University Hospital "Alexandrovska". The series includes 41 men and 5 women with age range 42 to 80 years. All patients present urinary bladder tumors. The usual surgical technique is used. The severest postoperative complications include: urinary fistulae--3 (6.52%), local relapse--4 (8.69%) and distant metastases--2 (4.35%). In six patients the outcome is fatal (0.7%). This type of continent derivation following cystectomy is recommended since it is convenient, practically atraumatic and well tolerated by the patients. Complications encountered seldom necessitate operative intervention.

Adult↗
PubMed1999

[Kidney diseases most often considered as indications for nephrectomy].

Nephrectomy is a radical operation successfully used over more than a century. It should be resorted to only in exceptional situations whenever an organ salvaging operation is precarious for the patient's health (T Patrashkov, 1980). The indications for nephrectomy depend on the type of disease, extent of renal damage, state of the second kidney and the patient's general condition, established by the basic examination methods in urology (T Patrashkov 1982). The study covers 388 nephrectomies in cases presenting diverse diseases of the kidney and ureter, diagnosed and treated in the Department of Urology--University Hospital "Alexandrovska" in the period 1990 to 1995. The commonest causes leading to nephrectomy comprise: 1. Neoplasms of kidney and ureter--134 (34.54%). 1.1. Parenchymal tumors--116 (29.90%)/ 1.2. Papillary tumors--18 (4.64%). 2. Pyonephrosis--88 (22.68%). 3. Nephrolithiasis (presence of renal calculi)--53 (13.66%). 4. Secondary operations of the kidney and ureter--46 (11.86%). 5. Hydronephrosis--38 (9.80%). 6. Anomalies (hypoplasia)--8 (2.06%). 7. Cystic diseases--7 (1.80%). 8. Tuberculosis of kidney--6 (1.55%). 9. Renovasal hypertension--4 (1.02%). 10. Nephrectomy for other diseases--4 (1.02%). As shown by the results the rate of nephrectomy undertaken for renal malignancy is still the highest which is by no means considered as a favourable diagnostic sign.

Humans↗
PubMed1997

[The current treatment of superficial bladder tumors].

This is a report on 754 new patients with urinary bladder tumors, registered on a nationwide scale during 1993. In 540 of them (70 per cent) the lesion is superficially located with involvement of mucosa and submucosa alone (Ti(s), T(a), T1). It is pointed out that after introduction of the modern treatment methods using intrabladder instillation of chemical agents and immunotherapeutics, the rate of relapses shows a significant decrease, and the tendency of the tumor to infiltrate is decreased.

Antineoplastic Agents↗
PubMed1997

[The metastasis of prostatic cancer and the methods for its demonstration].

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.

Adult↗
PubMed1997

[The incidence of kidney carcinoma and its occupational distribution in patients in the Republic of Bulgaria].

As pointed out by J. R. McLaughlin et al. (1983), in the various countries worldwide there is considerable difference in incidence and mortality rates of renal carcinoma. In the period 1973 to 1994, a total of 509 patients with renal carcinoma are admitted to the Department of Urology (Clinical Center of Urology, Medical University--Sofia). They represent 0.82 per cent of the total number of admissions during the stated period, and 7.71 per cent of the patients with diseases of the urogenital system. According to data submitted by the National Center of Oncology, the incidence of renal carcinoma amounts to 1.53 per 100,000 of population. As shown by the results most of the patients come from Vratsa and Vidin districts. By incidence rate of the disease Bulgaria is assigned to the moderate morbidity type in Europe. Patients in active age amount to 66.46 per cent, and old age pensioners--to 31.74 per cent.

Adult↗
PubMed1997

[Strictures of the urethra--the etiological factors and therapeutic management].

Strictures of the urethra pose problems still disputable in the literature owing to the variety of etiological factors involved, and difficulties encountered in choosing the most adequate therapeutic approach. Ninety-six patients presenting urethral stricture are studied over a 5-year period (1991-1995). The commonest causes of stricture formation are postinflammatory (51 per cent), postoperative (34.4 per cent) and posttraumatic (14.6 per cent). The study covering 578 patients, treated by transurethral resection for other disease during the aforementioned period, shows that postoperative strictures develop in 2.6 per cent of them. In 81.2 per cent of cases the stricture involves the anterior urethra, and in 18.8 per cent--the posterior. The presence of multiple strictures is found in 27.1 per cent. Visual internal urethrotomy is the operative procedure most frequently used--in 85.4 per cent of cases. In 3.1 per cent urethroplasty with a pedicled preputial flap is performed. Recurrences are recorded in 7.3 per cent. Emphasis is laid on the direct interdependence existing between etiological factors and pathoanatomical stage having an essential practical bearing on the choice of optimal therapeutic approach.

Adolescent↗
PubMed1997

[The treatment of severe and complicated urethral strictures].

Stricture of the urethra is produced by a cicatrix causing narrowing of the urethral lumen subsequent to trauma or inflammation. The strictures are considered as serious whenever the meatus is involved, and total--in the event of obliteration of the urethra (H. Sachse, 1978). The complications are associated with perineal, scrotal or suprapubic fistulae (C. Devine, P. Devine 1989). This is a report on 37 men presenting severe complicated strictures of the urethra, treated over the period 1981-1995 in the Clinical Center of Urology. According to underlying cause the strictures are divided in: postoperative--7 cases, iatrogenic--6, inflammatory--1, traumatic--23, and patients with scrotal fistulae--3. The patients are operated using a combined method through open and endoscopic manipulation; in 3 cases plastic repair of the urethra with a preputial flap is done. The overall results are estimated as good.

Acute Disease↗
PubMed1997

[Tumor mimicry].

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Diagnosis, Differential↗
PubMed1996

[The treatment of prostatic carcinoma with cyproterone acetate].

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.

Aged↗