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Biomedical subjects

R Petkov

Publications and source records attributed to R Petkov.

At least 19 recordsLinked to original sources
PubMed2004

[Thymectomy for myastenia gravis: 25-year experience].

OBJECTIVE: Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis (MG). We reviewed our 25-years experience with surgical treatment of MG with respect to long-term results and factors affecting outcome. METHODS: Between 1978 and 2002, we performed 232 thymectomies for MG. Fifteen patients were lost to follow-up; the remaining 217 form the object of our study. 32 patients (28.4%) had thymoma. Myasthenia was graded according to a modified Osserman classification: 51 patients (23.5%) were in class I, 81 (37.3%) in class IIA, 52 (24%) in class IIB, 26 (12%) in class III and seven (3.2%) in class IV. Mean duration of symptoms before the operation was 14 +/- 10 months. Fifty-eight thymectomies for thymoma were performed through a median sternotomy and four through a clamshell incision. Forty-six thymectomies for non-thymomatous MG were performed through a standard cervicotomy, 155 procedures through a partial upper sternal-splitting incision and eight through a complete median sternotomy. RESULTS: Operative mortality was 0.92% (two patients). After a mean follow-up of 119 months, 77% of all patients improved their clinical status (26% without medications and asymptomatic; 45% with a reduction of medications and/or clinically improved); 39 (18%) have a stable disease with no clinical modifications; 12 (5%) presented a deterioration of their clinical status with worse symptoms, required more medications, or both. Thirteen patients (6%) died because of MG (mean survival 34.3 +/- 3.6 months). The presence of a thymoma negatively influenced the prognosis. Younger patients showed a more favorable outcome as well as patients with a shorter duration of symptoms before the operation; patients with lower classes of myasthenia showed a higher rate of remission. CONCLUSIONS: Thymectomy is effective in the management of patients with MG at all stages with low morbidity. Patients with thymoma present a less favorable outcome.

Adult↗
PubMed2004

[Possibilities of retroperitoneal endoscopic surgery in treatment of adrenal diseases].

UNLABELLED: After introduction of the transperitoneal endoscopic adrenalectomy in 1992 and retroperitoneal adrenalectomy (RA) in 1994, the both techniques were widely accepted in the routine surgery practices. Now some authors described them as a "golden standard" in the surgical treatment of adrenal disorders. MATERIAL AND METHOD: 34 retroperitoneal endoscopic adrenalectomy were performed in our clinic for the period of May 1996-December 2002. RESULTS: The mean operating time was 125 minutes (45-220 min.) The average itraoperative blood loss was 70 ml. Only in one case the blood loss was 300 ml, causing conversion to open adrenalectomy. In 6 cases we converted to open adrenalectomy for other reasons--17.6%. In the last 15 cases we had no need of conversion to open adrenalectomy. Intraoperative complications were minor--2 cases (5.88%). Consumption of analgesics was low. Hospitalization period was 3 days. CONCLUSIONS: In summary, EA is associated with fewer complications than have been reported with OA. Despite the limitations of retrospective analysis, the results of this technique are very impressing in relation to diminishing the operative trauma, postoperative pain syndrome and faster recovery. EA is to become a method of choice in surgical treatment of the benign adrenal disorders.

Adolescent↗
PubMed2004

[Video-assisted thoracoscopic surgery (VATS) for treatment of pleural empyema].

During 1996-2003 a total of 359 patients were treated for empyema. Forty eight of them (with parapneumonic empyema) were prospectively randomized into 2 groups of 24 patients who underwent early decortication either by thoracotomy or VATS. Comparing to thoracotomy group, VATS group had a significantly shorter chest tube duration (5.8+/-1.1 vs 9+/-1.3 days; p=0.03) and postoperative in-hospital stay with parapneumonic empyema (8.7+/-0.9 vs 12.8+/-1.1 days; p=0.009). VATS has been found to be particularly useful for treating the fibrinopurulent phase of empyema, in which multiple loculations could be easily disrupted to allow adequate drainage of a "cleaned" pleural space. On the other hand, although VATS is highly effective, it is not indicated in every patient and it's indiscriminate use may lead to none required operative interventions.

Adult↗
PubMed2004

[Retrospective analysis of the results of surgical treatment of 407 patients with differential thyroid gland cancer over a period of 23 years].

Over a period of 23 years (1980-2002) 407 cases of differential thyroid gland cancer were operated, monitored and analyzed at the Endocrine Surgery Clinic of Alexandrovska University Hospital. Of them 71.7% were monitored over a period of more than 10 years (up to 23 years), and 39.3% were monitored between 15 and 23 years. The youngest patient was 12 years old, and the oldest--78 years old. All patients were at a T(1-3) N(a-b) M0 stage. 308 (75.7%) patients had papillary carcinoma, and multi-centric localization was established in 3.9%, while capsular invasion and unilateral lymph-nodular metastases--in 6.2% of those patients. Follicular cancer was found in 24%, and vascular invasion--in 15.1%. 72.4% of the patients fall within the low-risk age groups (women under 50 years of age and men under 40). The treatment of 22.1% (90) of the patients comprised thyroidectomy with a follow-on 131J therapy. 77.9% (317) of the patients underwent radical thyroid gland resections of various size. Bilateral subtotal resections were applied most often--in 64.5% of all cases, and the rest of the patients underwent lobectomy with contra-lateral subtotal resection. The recurrence rate among the patients treated with radical resections is 6.1%, mainly within the high-risk age group. No correlation was established between the recurrence rate and the type of organ-saving surgery. In the group of patients treated with thyroidectomy and 131J, recurrences of the disease were established in 16.2%, again mainly within the high-risk age group. Remote metastases and mortality were established in 3% and 2.5% respectively. In conclusion, preference is given to organ-saving surgical treatment of differential thyroid gland cancer, and it is recommended that in the high-risk age groups the operations be of a broader scope.

Adenocarcinoma, Follicular↗
PubMed2004

[Surgical treatment of the diabetic septic foot].

An opening and a major stage of the diabetic septic foot surgical treatment is the primary surgical processing that is usually combined with amputation of separate fingers or with various types of transmetatarsal amputations. Out of the total of 379 operated patients 35.7% underwent amputation of separate fingers, combined with resection of the metatarsal bone head. 18.3% of the patients underwent transmetatarsal amputations by Sharp with plantar lambo shaping, and 14.9% had oblique resections with dermatological plastic surgeries. As a result of this treatment the foot amputations were reduced to 5.7%. The extended use of conservative treatment combined with primary surgical processing is a major precondition for restricting the suppurative gangrenous process. Staged surgical treatment ensures a drastic decrease in the number of foot amputations. The reconstruction plastic foot operations enable the shaping of an adequate foot area with good biomechanics.

Amputation, Surgical↗
PubMed2004

[Surgical treatment of creeping infections of the flexor foot tendons in diabetic patients].

UNLABELLED: The creeping infections of the flexor foot tendons are a common reason for amputation of limbs in diabetic patients. Usually the process starts from the fingers and spreads through their long flexors. METHODS: Of the total of 149 operated patients, 49 underwent selective removal of the m. flexor hallucis longus tendon, and amputation of the 1st finger. The long flexors of the foot fingers were totally removed through a transmethatarsal amputation in 78 patients, and in 22 the long flexor tendons of the 4 lateral fingers were selectively removed through an oblique foot resection. After this type of surgical operations, limb amputation as a result of losing control over the suppurative-gangrenous process, became necessary in 7 patients. CONCLUSIONS: The infection spreading through the long flexors of the foot fingers in diabetic patients is a serious surgical complication that can only be treated surgically. The method of selective resection and removal of the infected long flexors of the foot fingers allows to avoid the limb amputation in most patients. Following this type of surgical interventions the foot biomechanics and the steadiness of the patient is inconsiderably disrupted.

Amputation, Surgical↗
PubMed2000

[Diagnosis and surgical treatment of adrenocortical carcinoma. A review of the literature and report of two cases].

Adrenocortical carcinomas (ACC) are rare and represent only 0.05 to 0.2% of all cancers. They can be hormonally active, appearing clinically by one or more endocrine syndromes, or can be hormonally non-active. Commonly most of the cases with AC are diagnosed when the neoplastic process have spread out of the suprarenal gland (stage III or IV). Computed tomography and magnetic resonance imaging are the most useful diagnostic methods of ACC but the latter is more accurate, especially in estimation of the local invasion of the tumor. Surgery is the main and the most effective method for treatment of both primary and recurrent ACC, and in selective cases--of metastasis. The chemotherapy with mitotane has a limited role and is indicated in cases of inoperable ACC (primary or recurrent) and/or presence of metastasis. Two cases of ACC treated in our department are reported. Case I: a 26-years-old female with ACC in stage II, which was diagnosed incidentally by ultrasound investigation for other consideration. Although the urine levels of free cortisol were elevated, the woman had no endocrine symptoms. Case II: a 50-years-old female with a second recurrence ACC appeared 5 years after a resection of the first recurrence tumor and 6 years after an operation for the primary tumor. Problems in diagnose and surgical treatment of these cases are discussed.

Adrenal Cortex Neoplasms↗
PubMed1999

Effect of mebendazole on human cystic echinococcosis: the role of dosage and treatment duration.

Fifty-three patients with single, multiple and/or multi-organ hydatid cysts were treated with mebendazole, in varying dosages (30-70 mg/kg.day) and over varying periods (6-24 months). Treatment failure was recorded if the mebendazole had no apparent effect on cyst morphology (monitored by radiology, ultrasonography and computed tomography) or only a parasitostatic effect (characterized by mixed and transitory, hypo- and hyper-echoic changes in the lesions). Cure was indicated by a parasitocidal effect (characterized by a totally echogenic picture, increased density of the cyst contents, reduction in the size or complete disappearance of the cysts, complete detachment of the endocysts and/or calcification of the cyst wall). Treatment failure was seen in about 40% of the patients and cure in about 38%; the other 23% had an intermediate result considered as an improvement. Cure rates increased both with dosage and duration, daily dosages of 60-70, 50 and 30-40 mg/kg curing 48%, 33% and 25%, respectively. The pre-treatment condition of any cysts should be taken into consideration when determining dosage and treatment duration.

Adolescent↗
PubMed1999

Congenital cataracts facial dysmorphism neuropathy syndrome, a novel complex genetic disease in Balkan Gypsies: clinical and electrophysiological observations.

During a study of hereditary motor and sensory neuropathy-Lom in Bulgaria, a previously unrecognized neurological disorder was encountered, mainly in Wallachian Gypsies, who represent a relatively recent genetic isolate. The disorder has been termed the congenital cataracts facial dysmorphism neuropathy (CCFDN) syndrome to emphasize its salient features. Fifty individuals from 19 extended pedigrees were identified and examined clinically and electrophysiologically. At least 1 patient from each family was admitted to the hospital in Sofia for full investigation. Pedigree analysis indicates autosomal recessive inheritance. The disorder is recognized in infancy by the presence of congenital cataracts and microcorneas. A predominantly motor neuropathy beginning in the lower limbs and later affecting the upper limbs develops during childhood and leads to severe disability by the third decade. Associated neurological features are a moderate nonprogressive cognitive deficit in most affected individuals together with pyramidal signs and mild chorea in some. Accompanying nonneurological features include short stature, characteristic facial dysmorphism, and hypogonadotrophic hypogonadism. Nerve conduction studies suggest a hypomyelinating/demyelinating neuropathy, confirmed by nerve biopsy. The CCFDN syndrome is thus a pleomorphic autosomal recessive disorder displaying a combination of neurological and nonneurological features.

Adolescent↗
PubMed1999

[Omentoplasty in surgical management of postpulmonectomy pleural empyema].

A method of treating postpulmonectomy pleural empyema, practically implemented in this country for the first time, is described. Three patients are subjected to operation. Right pulmonectomy for lung cancer and chronic inflammatory process is done twice, and left pleuropulmonectomy for tuberculosis--once. Postpulmonectomy empyema persists in all three cases regardless of the adequate continuous suction drainage and intrapleural antiseptic management. Anaerobic and gram-negative flora is isolated. The size and location of the intrapleural cavity being cured are assayed by CT, thoracic ultrasonography and fistulography. In none of the patients is clinical and FBS evidence of bronchopleural fistula established. The operative procedure consists in resection of a 4 cm segment from the underlying rib in the drainage zone, and further cavity treatment under thorascopic control. Minor median laparotomy and skeletization of the greater omentum are performed preserving a major nutrient vessel depending on the location of the cavity. The omentum is drived into the pleural cavity through a parietal opening of the diaphragm, measuring 3-4 fingerbreadths. Pleural cavity drainage is carried out according to Redon. Two patients run an uneventful postoperative course. One female patient develops pylorospasm successfully cured by spasmolytic therapy and H2 blockers. CT and thoracic echography do not show presence of residual cavities. The patients are free of any complaints over periods ranging from 6 to 16 months postoperatively. The inference is reached that omentoplasty is a new method promoting successful elimination of both postpulmonectomy empyema, and other residual pleural cavities as well, with or without bronchopleural fistula.

Adult↗
PubMed1997

[The surgical treatment of cervical lymph node metastases in differentiated thyroid carcinoma].

Over the period 1980 through 1994, a total of 297 patients presenting histological evidence of differentiated carcinoma of the thyroid gland are studied. In thirty-two of them (10.8 per cent) palpable metastases in the lymph nodes are found at the time of making the diagnosis. A higher frequency of palpable lymph nodes is established in younger patients with histological diagnosis papillary carcinoma (62.5 per cent). In the 32 patients with palpable metastases in the lymph nodes, discovered during diagnosing of the disease, lymph node dissection is undertaken. The obtained results show that the modified cervical dissection yields favourable results, and at the same time preserves intact the neck structure.

Adenocarcinoma, Follicular↗
PubMed1996

[Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder].

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

Aged↗
PubMed1995

[Differentiated thyroid cancer--a study of the pathomorphological variants in 216 patients].

Two-hundred sixteen patients presenting differentiated carcinoma of the thyroid gland are subjected to operative treatment over the period 1980 through 1993. The distribution of cases by histological type is as follows: papillary carcinoma--127 cases, follicular--58, and mixed type (papillary-follicular)--thirty one. In the group presenting papillary lesions, infiltration of the capsula is noted in nine cases, multifocal location--in five, and microcarcinoma--in twenty three. In the follicular carcinoma group a markedly expressed vascular invasion is established in four cases, multifocal location--three, and microcarcinoma--five. Assessment of the morphological patterns of differentiated thyroid carcinoma reveals a marked predomination of noncomplicated histologic variants, enabling the wide use of minor conservative operative procedures, compared to thyroidectomy, with a positive outcome. Over he past few decades, the incidence of differentiated forms of thyroid gland carcinoma shows an increase, and nowadays it caries in the range 60 to 90 per cent. Papillary forms are prevailing, while follicular carcinomas are detected in 8 to 20 per cent of cases. An overall shift of morbidity towards younger ages and female gender is observed.

Adenocarcinoma, Follicular↗
PubMed1995

[Hypophyseal-thyroid function following partial thyroid resections for euthyroid struma nodosa].

The serum levels of svT3, svT4, TTH, T3 and T4 are evaluated at two, six and twelve months after partial resection of the thyroid gland in patients with euthyroid struma nodosa. The patients are divided up in two groups: group one--given hormonal substitution therapy, and group two--untreated. The results are estimated with a special reference to the need of hormonal administration in view of precluding recurrences.

Adolescent↗
PubMed1995

[The incidence and morphological aspects of thyroid cancer].

A total of 10,736 biopsy specimens presenting diverse thyroid gland pathology are studied over the period 1974 to December 1993. The histopathological investigation shows that 5.45 per cent of them (n = 585) are with carcinoma. Comparative analysis of the incidence of thyroid carcinoma in the series reviewed, covering the two decades, points to a tendency of the incidence rate to augment from 4.03 per cent in the first decade to average 6.63 per cent in the second decade of study, with a frequency peak reached in the period 1986-1993. There is a clearcut tendency of the incidence of malignant conditions of the thyroid to rise among younger age groups. A markedly expressed tendency of the number of patients with papillary carcinoma of the thyroid, affecting mainly women and younger persons, to increase is also documented.

Adult↗