[Retroperitoneal drainage for apostematous pyelonephritis in a patient with severe COVID-19 infection and diabetes mellitus type 1]. / Retroperitoneal'noe drenirovanie pri apostematoznom pielonefrite na fone tyazhelogo techeniya Covid-19 pri sakharnom diabete 1-go tipa.

The authors report successful surgical treatment of apostematous pyelonephritis complicated by sepsis in an 18-year-old patient with severe COVID-19 pneumonia (CT-2) and diabetes mellitus type 1. Active surgical approach with retroperitoneal drainage and decapsulation of the right kidney ensured positive dynamics in the treatment of destructive pyelonephritis, course of diabetes mellitus and elimination of sepsis. These aspects determined favorable outcome of disease.

[Some features of the diagnostics of thrombophilia. Case report].

Differential diagnosis of causes of the pulmonary embolism in patients can be associated with certain difficulties and requires the exclusion of a wide range of diseases. There is a description of a clinical case of pulmonary embolism caused by verified thrombophilia. Features of tactics of management and treatment of the patient according to modern views are given.

Oxidized Cell-Free DNA Role in the Antioxidant Defense Mechanisms under Stress.

The present study focuses on the investigation of the oxidized cell-free DNA (cfDNA) properties in several experimental models, including cultured cerebellum cells, peripheral blood lymphocytes (PBL), plasma, and hippocampus under an acute and chronic unpredictable stress model in rats. Firstly, our study shows that Spectrum Green fluorescence-labeled oxidized cfDNA fragments were transferred into the cytoplasm of 80% of the cerebellum culture cells; meanwhile, the nonoxidized cfDNA fragments do not pass into the cells. Oxidized cfDNA stimulates the antioxidant mechanisms and induction of transcription factor NRF2 expression, followed by an activation of NRF2 signaling pathway genes-rise of Nrf2 and Hmox1 gene expression and consequently NRF2 protein synthesis. Secondly, we showed that stress increases plasma cfDNA concentration in rats corresponding with the duration of the stress exposure. At the same time, our study did not reveal any significant changes of 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG) level in PBL of rats under acute or chronic stress, probably due to the significantly increased Nrf2 expression, that we found in such conditions. 8-oxodG is one of the most reliable markers of DNA oxidation. We also found an increased level of 8-oxodG in the hippocampal homogenates and hippocampal dentate gyrus in rats subjected to acute and chronic stress. Taken together, our data shows that oxidized cfDNA may play a significant role in systemic and neuronal physiological mechanisms of stress and adaptation.

[Peculiarities of clinical and X-ray picture of pneumonia in patients with influenza A (H1N1)].

A distinctive feature of pneumonia in influenza A (H1N1) is interstitial infiltration of lung tissues and high frequency of pulmonary lesions leading to acute lung injury/acute respiratory distress syndrome in half of the patients. Severe clinical course of the disease and complications (pleuritis, abscess, pulmonary thromboembolism) diagnosed by X-ray were recorded in 29% of the patients. The final X-ray examination revealed normalization of the lung structure only in 15.5% of the cases mostly the patients with mild pneumonia. 15.5% of them developed post-pneumonic changes in the form of diffuse pneumosclerosis, pleural adhesions, and dry cavities in the lung tissue. Pulmonary CT is believed to be the most informative method for diagnostics of pneumonia and its complications during influenza A (H1N1).

[Structural-functional parameters of the myocardium in patients with chronic iron deficiency anemia].

Aim of the study was investigation of structural-functional parameters of the myocardium and assessment of segmental diastolic left ventricular function with myocardial tissue dopplerography in 56 patients with iron deficiency anemia (IDA). We studied parameters of structure of the myocardium, its systolodiastolic function, as well as velocities of early (Ve) and late (Va) diastolic waves, Ve/Va ratio, isovolumic relaxation times in 15 segments of the left ventricle. We revealed changes of myocardial structure appearing as LV hypertrophy, dilation of chambers of the heart, as well as disturbances of global and segmental diastolic LV function. Most pronounced changes were observed in patients with IDA of II and III degree of severity. The method of myocardial tissue Doppler echocardiography allows to diagnose LV diastolic dysfunction at early stages and can be used for detection of preclinical stage of myocardial dystrophy.

[Laser therapy of carcinoma of the penis].

OBJECTIVES: To analyze the efficacy and morbidity of laser treatment in 5 men with carcinoma of the penis METHODS: In a prospective study from 1991 year to 2005 year, 5 patients with penile cancer T1 diagnosis were followed. All of the patients were treated with neodymium YAG lasers. RASULTS: By 4 of the patients postoperative was no local recurrence. By 1 patient local recurrence was found 4 months after the laser treatment, and partial penectomy was made. CONCLUSIONS: The results of this study show that treating penile carcinoma with neodyme YAG laser can sfely be done with highly satisfactory cosmetic and functional results.

[Problems relating to vascular reconstruction in renal transplantation from a living donor]. / Problemi na s'dovite rekonstruktsii pri b'brechni transplantatsii ot zhiv donor.

We discuss vascular surgical problems in 59 kidney transplantations using alive donors. From April 96 till May 99 we harvested 59 kidneys from relatives (44 women and 15 men), mean age 54.33 years. Those kidneys were transplanted to 37 men (mean age 55.71 years), and 22 women (mean age 36.85 years). Preoperative dialysis was performed for a period of 5.015 years (mean). Thirty eight of the kidneys are right, and 21 of them are left. Six kidneys have two renal veins (10.16%), and 5 of them have two renal arteries (8.47%). We prefer end-to-end anastomosis between the donor renal artery and the recipient hypogastric artery. It ensures best regional hemodynamics, long-term patency and best positioning of the kidney avoiding vascular compression. The venous anastomosis is performed end-to-side to the iliac vein of the recipient. In 7 cases of short renal artery of the donor kidney greater saphenous vein is used as arterial conduit to ensure tension-free anastomoses. Only 1 patient (1.74%) of 59 cases (71 venous anastomoses) suffered thrombosis of the iliac vein, which caused kidney rupture. We had 5 cases of postoperative bleeding (8.47%), three of them were from the kidney hilus, and two from exposure sites. After reexploration all of them have normal function. Vascular anomalies and/or vascular disease do not preclude the procedure. Atraumatic harvesting of the kidney is critical.

[Live-donor kidney transplantations. The problems of vascular reconstructions]. / Bubrechni transplantatsii ot zhiv donor. Problemi na sudovite rekonstruktsii.

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.

[One-stage surgical techniques in various hypospadias locations]. / Ednoaktni khirurgichni tekhniki pri razlichni lokalizatsii na khipospadiia.

Hypospadias is a common developmental anomaly in the male (8.2@1000). Over the last twenty years, one-stage operative techniques for the correction of this anomaly have been widely adopted. Two-stage procedures remain a method of choice in strictly selected cases only. In the period 1992 through 1997, thirty patients aged 2-19 years presenting different locations of hypospadias are picked out in the Department of Urology-"Alexandrovska" University Hospital. The following operative techniques are used: Magpai-Duplay-Fierlit, Flip-Flap, Duket De-Sey, Huchson, Ducet-Duplay, Ducet-Flip-Flap. The complications resulting are operatively closed within 3 months of plastic repair, and in case of stenosis of the meatus meatoplasty is done. The good results of one-stage operations in hypospadias, irrespective of the location, justify their adoption as a plastic repair method of choice.

[The treatment of severe and complicated urethral strictures]. / Lechenie na tezhkite i uslozhneni strikturi na uretrata.

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.

[Initial clinical studies of the preparation Immucyst for immunotherapy in patients with carcinoma in situ (CIS) of the bladder]. / Nachalni klinichni prouchvaniia na preparata Immucyst za imunoterapiia pri bolni s kartsinom in situ (CIS) na pikochniia mekhur.

Over a 12-month period, thirteen patients, 10 men and 3 women, with recurrent surface transitional cell carcinomas of the urinary bladder in conjunction with CIS, are picked out and subjected to treatment. Distribution of the patients: primary multiple carcinomas combined with CIS, Ta-T1/G1-G2-4 cases; recurrent multiple carcinomas, with CIS, Ta-T1/G2-two, recurrent multiple carcinomas, combined with CIS, Ta-T1/G2-five, and T1/G3-two cases. In all instances transurethral resection (TUR) of both visible carcinomas, and CIS areas, is performed. Induction Immucyst therapy is carried out according to protocol: 3 vials BCG vaccine, dissolved in 50 ml serum, inserted intravesically once weekly over 6 weeks. The fluid is retained by the patients for up to 2 hours. Therapy is commenced within 7-14 days after TUR. Cystoscopy, cytology and biopsy of suspected areas ar done at 3, 6 and 12 days. Six of the patients reported on undergo 12-month follow-up study. The remainder (6 cases) are followed up for periods ranging from 3 to 6 months. At the actual stage of study, twelve patients are free of recurrences, and present negative cytological findings. One patient alone with carcinoma stage T1/G3 develops recurrence, treated with TUR and laser coagulation followed by immunotherapy. Two thirds of the patients sustain transitory pollakiuria and dysuria, and one third-subfebrile temperature persisting for 48 hours.

[Effect of psychopathological disorders in patients with unstable stenocardia on serum lipids and the indicators of lipid peroxidation]. / Vliianie psikhopatologicheskikh narushenii u bol'nykh nestabil'noi stenokardiei na syvorotochnye lipidy i pokazateli perekisnogo okisleniia lipidov.

A total of 193 males suffering from unstable angina pectoris (UAP) were examined against 20 control subjects with stable angina pectoris (SAP) for the serum levels of lipids and activity of lipid peroxidation. The parameters studied varied between the groups. 152 UAP patients exhibited psychopathological disturbances, mainly agitated melancholia. These patients (78.8%) were noticed to have atherogenic shifts in serum lipids and lipid peroxidation products levels increased as compared to those without psychoemotional problems. It was found that in UAP psychopathologic disturbances contribute to the progress of coronary insufficiency this justifying the use of psychotherapy in combination with drugs in UAP 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.

[A case of tertiary hyperparathyroidism following kidney transplantation complicated by lithiasis]. / Sluchai na tretichen khiperparatireoidizum sled bubrechna transplantatsiia, uslozhen s litiaza.

For the first time in Bulgaria the authors present a case of tertiary (autonomous) hyperparathyroidism, persisting in a patient who had successful kidney transplantation. Subtotal parathyroidectomy six months after the transplantation led to complete cure. Associated with the underlying disease, a rare complication was also observed in the patient--calculosis in the grafted kidney, spontaneously eliminated 40 days after the parathyroidectomy.

[Orthoclone OKT3 (Muromonab CD3)--the indications for and manner of its use. Side effects and their prevention]. / Ortoklon OKT3 (Muromonab--SD3)--indikatsii i nachin na prilozhenie. Stranichni iavleniia i profilaktika im.

In the last decade renal transplantation has gained considerable development. This is due to the achievements of clinical immunology and refinement of the surgical technique. In spite of all this, the achievements of renal transplantation are variable. This primarily is due to T-lymphocyte mediation, causing hazards for graft rejection. At present, numerous therapeutic agents, blocking the immune response of the organism, are applied. They are most effective when block selectively the activity of the immune cells responsible for immune response. The first synthesized preparation is Orthoclone OKT3 (Muronab-CD3). It is a sterile solution of murine monoclonal antibody to T3 (CD3) antigen in human T-cells and functions as immunosuppressor. The first experimental data on its application have been published in 1975. In 1980 the preparation was applied for the first time for treatment of acute reaction for grafted kidney rejection. The authors set themselves the task to give a brief review of the nature of this preparation, mode of its storage, indications for use, side reactions and their prophylaxis.

[The procurement and preservation of cadaveric kidneys for transplantation]. / Vzemane i konservirane na trupni bubretsi za transplantatsiia.

In comparison with other organ transplantations, renal transplantation has in recent years shown significant progress. It turned to be a routine and highly physiological method of treatment of patients with terminal renal failure who had been on chronic dialysis treatment. For a successful outcome of renal transplantation essential is the early and competent ascertaining that brain death of the potential donor has occurred. Intensive care (resuscitation) starts for saving the life and when this is impossible, the efforts turn into measures for conditioning the donor. Thus both kidneys are preserved for transplantation. Another important prerequisite for successful renal transplantation is the adequate sampling, effective perfusion and adequate storage of the donor kidneys. The donor-recipient couple is selected by up-to-date immunologic studies. The authors debate in brief the indications and contraindications for organ donorship, the legal aspects in establishing the brain death diagnosis. Measures for conditioning the donor and the surgical technique for obtaining the kidneys, their perfusion and storage are discussed.