[Description of a case of renal transplantation in autosomal dominant polycystic disease with hepatic and renal involvment]. / Opisanie na sluchai s avozomnodominantna polikistroza na bubretsite i cherniia drob i uspeshno izvurshena bubrechna transplantatsiia.

Autosomal dominant renal polycystic kidney disease (ADPKD) is one of the major causes for the development of chronic renal failure and renal transplantation. In 85.7% of the cases ADPKD is associated with hepatic polycystosis that could worsen the prognosis of the patient. We report a case of successful renal transplantation from related living donor in a patient with autosomal dominant polycystic disease with renal and hepatic involvement. Renal transplantation after good evaluation of the hepatic involvement is a safe renal replacement therapy in chronic renal failure patients. Due to a significantly high risk of postoperative infections after the transplantation close monitoring is recommended as well as prophylactic hepatitis A and B vaccination.

[Surgical treatment in complications of renal transplantation]. / Khirurgichesko lechenie na uslozhneniiata sled bubrechna transplantatsiia.

The increasing number of renal transplantations in Bulgaria and the increased survival rate of renal transplantation patients lead to an increase of the number of complications (vascular, urological, liquid collections) requiring surgical intervention. One hundred and ninety renal transplantation patients have been treated in the Department of Renal Transplantation for the period 1997-2003. Of these 12 were admitted to the Clinic of Vascular Surgery. We observed 36 surgical complications: arterial thrombosis--7, venous thrombosis--1, arterial stenosis--7, lymphocoele--4, hematoma--4, ureteral fistula--6, ureteral stricture--6, ureterolithiasis--1. We undertook following surgical interventions: vascular reconstruction, thrombectomy, lymphocoele punction, fenestration towards peritoneal cavity, reimplantation techniques (a modo Gregoari, Boeminghausi, Boari), termino-terminal anastomosis with native ureter, uretero-enteric anastomosis, ESWL of ureteral stone. Renal transplantation complications requiring surgical interventions are serious urological problem. The severity, the type (vascular, liquid collection, urological), and the diagnosis of these complications determine patients' prognosis. Urgent surgical interventions lead to rapid recovery of graft function, eradication of the infection, amelioration of blood flow, and improved graft survival.

[Treatment with cefrom (cefpirom) in severe urological infections]. / Terapiia s Cefrom (Cefpirom) na tezhki infektsii pri urologichno bolni.

Severe uro-genital infections frequently complicate a wide range of urological conditions. The favorable outcome of these infections depends mainly on the choice of appropriate antimicrobial treatment. Cefrom is bactericidal beta-lactamase-resistant IV generation cephalosporine antibiotic. In 2003 we treated 20 patients with severe urinary tract infections with Cefrom. We achieved excellent therapeutic results--urinary tract infections were eradicated in all patients, as shown by the microbiological investigations of urine specimen after the antibacterial course of treatment. The wide antimicrobial spectrum, the good tissue permeability in the organs of the genito-urinary tract and the good tolerability of Cefrom make this antibiotic a drug of choice in patients with acute and complicated urological infections.

[The role of polyclonal anti-T-lymphocyte antibodies (ATG) in the kidney transplantation]. / Miasto na poliklonalnite anti-T-limfotsitni antitela (ATG) pri bubrechnata transplantatsiia.

UNLABELLED: The successes in the kidney transplantation are closely connected with the successes of the immunology and the advance of the immunosuppressive therapy. The main task of the modern immunosuppressive therapy is the insurance of medicines with a minimum nephro-toxicity, and the optimum protection regarding the adoptive body against an early reaction of rejection. The polycomponent anti-T-limphocitic antibodies (ATG) give us the opportunity of that. The polycomponent anti-T-limphocitic antibodies or the antilimphocitic serum (ALS) are xenogenetic polycomponent antibodies, that are directed to the human T-limphocites, i.e. antitimocitic globuline (ATG). They are received by immunization of rabbits or horses with human thymus limphoid cells. They are received for the first time by horses, and later on by rabbits. The last patent medicines have more powerful effect. In spite of the side effects of the polycomponent ATG, the patent medicine is used for inductive treatment after transplantation of organs and for a treatment of acutely rejection of the graft. We have treated 15 patients after kidney transplantation with ATG for a period of an year in the ward of kidney transplantation in The Clinic of Urology. The patients with transplantation are at the age of 21 to 50 years old, and by sex--11 male and 4 female patients. 9 of them are transplanted from alive donor and 6--from a dead body. We have applied the patent medicine of ATG Timoglobuline in a phial of 5 mg\ml intravenally in a bank of 500 ml physiological solution according to the weight and the blood test of the patients. We have applied a fourfold immunosuppressive therapy: Urbazon, Imuran, CyA(Neoral) +ATG. CONCLUSIONS: ATG is a mixture of monocomponent polyspecific antibodies, which, in spite of its side effects, has been applied successfully in transplantation for more than 30 years. In the course of many years anti-CD3 patent medicine OKT3 has been the only one monocomponent antibody for the treatment of an acute rejection of the graft for inductive therapy in transplanted patients.A chimerical (baziliksimab) and humanized (daklizumab) monocomponent antibodies of the alpha-chain of the receptor for IL-2 (CD25) are used for the prophylaxis of the episodes of acutely rejection of the transplanted kidney during the last 10 years. ATG does not consists of anti-CD25 antibodies. That is why the simultaneously application of ATG with baziliksimab or daklizumab is expected to have an additional effect with a complementary mechanism of efficacy.

[The organization and function of donor transplantation units]. / Organizatsiia i funktsiia na donorskite bazi za transplantatsiia.

The donor unit are organized in hospital centers for brain death patients. They function as emergency centers with the possibility to admit patients presenting multiple injuries and neurosurgical problems. Multidisciplinary teams aided by the local coordinator take part in the process of explantation and transplantation. Emphasis is laid on the implantation role played by anesthetist-resuscitator, surgeon and local coordinator.

[The vascular aspect of kidney transplantation]. / Sudov aspekt na bubrechnata transplantatsiia.

The vascular aspect of renal transplantation is a factor of major importance throughout the various phases of surgery. It includes nephrectomy from living donors, or intact cadaveric kidney with a sufficiently long renal artery and vein (with or without patch), organic ex situ surgery, and implantation surgical technique. In 1994 fifteen renal transplantations are performed in the Clinical Center of Urology. In thirteen patients the kidneys transplanted are obtained from living donors, and in two-from cadavers. The vascular surgery techniques used, and the problems faced during their application are surveyed. Vascular surgery performed successfully is among the factors guaranteeing good survival of the organ transplanted.

[Vascular complications in kidney transplantation (a review of the literature and the authors' own experience)]. / Sudovi uslozhneniia pri bubrechna transplantatsiia (pregled na literaturata i sobstven opit).

Vascular complications following renal transplantation are by no means rare. Usually they are multifactorial in nature, and eventually require operative management. Arterial and venous thromboses, arterial stenosis and hemorrhages are among the most frequently encountered vascular complications. In 1994, in the renal transplantation department of the Clinical Center of Urology three patients presenting vascular complications after renal transplantation are observed and treated. Two of them undergo surgery: resection of the stenotic segment of arteria renalis is done in one of them, and explantation-in the second. In the third case it is a matter of tense terminoterminal anastomosis due to technical reasons with ensuing venous thrombosis-here no operative correction is considered owing to intercurrent ischemic attack. In patients with transplantation the timely made diagnosis of vascular complications, and their surgical management prolongs the survival term.

[The restoration of urinary tract continuity in kidney transplantation]. / Vuzstanoviavane kontiniuiteta na urinarniia trakt pri bubrechna transplantatsiia.

In 1994, fourteen kidney transplantations are done in the Clinical Center of Urology--FAH over a 4-month period. The patients are with age ranging from 11 to 44 years. In twelve cases the kidneys are obtained from living related donors, and in the remainder--from cadavers. The surgical techniques used to restore urinary tract continuity include: ureteroneocystostomy--in 7 cases, pyeloureterostomy--six, and ureteroureterostomy--one. The choice of a surgical method in transplantation depends on the state of the urinary tract. Assessment of the efficacy of these surgical procedures is practicable after long-term follow-up with a view to eventual late urological complications development.

[The introduction of microcomputerization into the uro- and andrological fields]. / Navlizane na mikrokompiuterizatsiiata v uroandrologichnata oblast.

Microcomputer systems are used wider and wider in medicine after their incorporation in the diagnosis and treatment of large number of diseases. Computer dispensary of patients with retained testes was used in the chair of urology in 1987 for the first time. Half of the used computer programme was written on the language DBABE. DBABE are 16 beat computers. The functional possibilities for the programme are the following: introduction of data from the first clinical examination, adding new data from the control examinations, correction of the old data, search for data according to a definite criterium, printing of informations in accordance with assigned criterium for seeking in table type, all functional possibilities for generation of informations, printed post communications. The created system for coding data allows their further mathematical processing both with practical and with scientific purposes.

[The combined treatment of male infertility in patients with idiopathic varicocele]. / Kombinirano lechenie na muzhkiia infertilitet pri bolni s idiopatichno varikotsele.

The author reports on 1066 patients with idiopathic varicocele and fertility disturbances, in whom surgical intervention was made by the method of Ivanissevich--a high resection of the internal testicular vena. Stimulating hormonal therapy of spermatogenesis with gonadotropic preparation Pregnyl was used according to a scheme in 246 patients, nonaffected by surgical treatment with a number of spermatozoa under 40 millions/cm3. Improvement of spermatozoa parameters was found in 31.70% of the operated patients; pregnancies of their wives occurred in 15.85% of the examined men.

[Contamination during transurethral manipulations of the upper urinary tract]. / Kontaminatsiia pri transuretralni manipulatsii vurkhu gornite pikochni putishta.

A four-year observation was carried out on a series of 289 patients who had undergone miscellaneous transurethral operations and manipulations on the upper urinary tract. Clinical and microbiological studies were performed in an attempt to record the incidence of urinary tract infections as a consequence of contamination following transurethral manipulations. Random groups of in-lying patients at two urologic clinics served as controls. It was found that the hazard of contamination with pathogenic bacteria causative agents of urinary tract infections in the study group was smaller than usually believed. The mean infection rate was 17.3 per cent, vs. 35.6 and 45.5 per cent respectively in the control groups. Higher was the risk of contamination after manipulations terminating without temporary drainage of the urine from the upper urinary tract. In the contamination processes was involved a broader spectrum of microorganisms with more resistant strains. Conclusions are drawn on the possibilities to reduce the contamination levels and to prevent the consequences of infection. This should be achieved not by limiting the manipulations, but by mastering the endoscopic technique and nontraumatic work with this technique.

[Immunological research in cryptorchism accompanied by infertility]. / Immunologicheskie issledovaniia pri kriptorkhizme, soprovozhdaiushchemsia infertil'nost'iu.

An overview of the recent literature shows that immune processes, primarily autoimmune events, occur in cryptorchid patients with infertility. The aim of this study was to examine cellular and systemic immune responses in these patients. Fifteen infertile cryptorchid patients have been investigated for the presence of circulating autoantibodies using immunofluorescence and immunoperoxidase techniques. The study evaluated selected testicular structures and levels of immune products (IgA, IgG, IgM or immune complexes) in testicular biopsy samples. The results of the study showed no relation of infertility to systemic immune disturbance in most cryptorchid patients.

[Fertility after the surgical treatment of cryptorchism]. / Oploditelna sposobnost sled khirurgichno lechenie na kriptorkhizma.

The authors carried out a study on the ejaculates of 85 men at the age of 16 to 38 years, who underwent surgical intervention for treatment of unilateral and bilateral cryptorchidism. The patients were divided into two basic groups: orchidopexy was made in 66 patients with cryptorchidism and unilateral orchidectomy was performed in 19 patients with atrophy of the cryptorchidic testis. Surgical treatment of cryptorchidism improved fertile capability in 15.30% of the patients. The high percentage of 84.70% of the infertile patients after surgical treatment of cryptorchidism raises the question for earlier surgical treatment of cryptorchidism up to 5 years of age. Orchidectomy is indicated in abdominal or highly retained in the inguinal canal testis with very short blood vessels. Orchidectomy is also indicated in patients with atrophic testes, in whom perspective for fertile capability lacks and presents high risk of malignization.

[The level of total estrogens in the urine of cryptorchid patients]. / Nivo na totalnite estrogenite v urinata pri kriptorkhichno bolni.

The authors carried out studies on total estrogens in urine of healthy men as well as in men with cryptorchidism. These studies were performed on 79 men, divided into the following groups: a control group of healthy men--31; nonoperated patients--5; operated patients with cryptorchidism up to the seventh years of age--7; operated patients with cryptorchidism between 7 and 12 years of age--15; operated patient with cryptorchidism over 12 years of age--21. The hormonal analysis of total estrogens in urine were made by the modified fluorometric method of Braun. The highest level of total estrogens was found by the authors in the men operated men with cryptorchidism, presenting mean values of means = 42, 1 M/mol for 24 hours. The results make strong impression that in all groups with of patients with cryptorchidism, operated and nonoperated, the total estrogens are increased twice in comparison with the control group of healthy men. These results question the role of the increased level of estrogens in the pathogenesis of distributed spermatogenesis and lacking fertile capability in men with cryptorchidism.

[Gamma-camera scintigraphy and radioimmunological study of the hormones of the hypophyseal-gonadal axis to evaluate testicular function in patients with hypogonadism and infertility]. / Gamakamerna stsintigrafiia i radioimunologichno izsledvane na khormonite ot khipofizo-gonadnata os za otsenka na funktsiiata na testisite pri bolni s khipogonadizum i infetilitet.

Gamma-camera and radioimmunological study of hormones of hypophyseal-gonadal axis were carried out on 34 patients with hypogonadism and infertility after successfully performed orchidopexy. The results from this study showed that gamma-camera scintigraphy was exact and noninvasive method for determining the structure and function of testes after operative intervention. The results of the established hormonal deviations in the secretion of hormones of hypophyseal-gonadal axis are sure and early criterium for diagnosis of infertility in these patients. They could indicate the therapeutic management in these patients.