Biomedical subjects
Publications and source records attributed to P Simeonov.
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.
Assessment of renal function in clinical medicine is of great importance especially in patients with renal transplants. Cystatin C has the characteristics of an ideal marker to assess renal glomerular filtration rate. Forty patients with renal transplants under steady-state post-transplant conditions were included in the study. Steady-state was defined as lack of acute rejection periods during the last 6 months and stable cyclosporin A medication during the past 4 weeks. Gender was balanced with 20 male and 20 female patients, the mean age was 51+/-14 years, time since transplantation was 5+/-3.5 years. Fifteen percent of the patients suffered from diabetes mellitus. Immunosuppression consisted of cyclosporin A, imuran, and prednisolon. To assess renal function cystatin C, creatinine clearance, serum creatinine, and serum beta2-microglobulin were tested. Creatinine was analysed in serum and urine to calculate the creatinine clearance related to 1.73 m(2) body surface. Cystatin C and beta2-microglobulin were determined by using a particle-enhanced turbidimetric assay. Cystatin C correlated best with creatinine clearance (r=0.66), beta2-microglobulin (0.57), and serum creatinine (0.56). The diagnostic accuracy of cystatin C was significantly better than serum creatinine (p<0.05), but did not differ significantly from creatinine clearance (p=0.73), and beta2-microglobulin (p=0.46). Our data show that patients with renal transplants, cystatin C has a similar diagnostic value as creatinine clearance. However, it is superior to serum determination of creatinine and beta2-microglobulin. Cystatin C allows for rapid and accurate assessment of renal function in patients with renal transplants and is clearly superior to the commonly used serum creatinine.
Work-related falls from roofs remain a significant problem for workers in the construction industry. Knowledge about the main causative or initiating factors leading to fall incidents is desperately needed for fall prevention intervention. From biomechanical and psychophysiological perspectives the majority of occupational falls, including falls from roofs, can be regarded as loss-of-balance incidents. The primary objective of this paper is to summarize the current knowledge from multiple fields about factors that are related to the control of balance during roofing work. An extensive literature review identified a number of environmental, task-related and personal factors that degrade the control of balance and could be associated with the initiation of falls from roofs. These factors include visual exposure to elevation; unstable visual cues and inadequate visual information in the work environment; 'confined' and inclined support surfaces; unexpected changes in roof surface properties; load handling; physical exertion; fatigue; task complexity that diverts workers' attention; individual differences; work experience and training; and personal protective equipment. Current measures to reduce falls from roofs focus mainly on fall protection procedures, such as the use of covers, guardrails, safety nets, and personal fall-arrest systems, or the application of warning-line systems, safety monitoring systems, and fall protection plans. In many instances, these procedures are not practical for the industry and current regulations allow the use of alternative means of fall protection, such as slide guards. Future research on preventing falls from roofs should consider the main effects and interactions of the environmental, task-related and personal factors that affect the balance control of workers. Research-supported improvements in the visual and physical characteristics of the roof work environment, the construction materials and methods, and work procedures and practices may result in improved workers' balance control as well as overall safety performance, and would ultimately reduce incidents of falling from a roof.
OBJECTIVES: To investigate the effects of height, surface firmness, and visual reference on standing balance in construction workers. DESIGN: Controlled laboratory study with balanced repeated measures. PARTICIPANTS: Twenty four construction workers. SETTING: Test subjects performed standing tasks at ground level as well as at 3 m and 9 m high balconies on firm or deformable surfaces with close visual references included or excluded from their visual field. METHODS: Standing balance was determined from center of pressure as measured by a force platform. Dependent variables were root mean square of sway in medial-lateral and anterior-posterior directions, area of sway, and velocity of sway. RESULTS: Heights without close visual references significantly increased all sway parameters. The effect of height in conditions without close visual references increased dramatically on deformable surfaces. CONCLUSIONS: Elevated work environments and deformable work surfaces negatively affect balance and may be associated with increased risk of fall incidents. Appropriate close visual references increase the ability to maintain balance.
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.
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.
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.
Echinococcus of the kidney is a rare form of hydatid disease, and accounts for 2 to 3 per cent of all echinococcoses. Over a ten-year period (1987-1996), eight patients with age ranging from 30 to 61 years are diagnosed and treated. Five of them (62.5 per cent) are discovered in the last two years. In seven instances (87.5 per cent) the diagnosis is made preoperatively on the ground of laboratory examinations; serological tests--intradermal test of Casoni and complement fixation after Ghedini-Weinberg, echographic and roentgenological methods. In two patients (33.3 per cent) scoleces and Echinococcus fragments are discovered in the urine. The serological tests are positive in five cases (62.5 per cent). All patients undergo operation, with nephrectomy performed in five (62.5 per cent), and capsula adiposa renis--in three (37.5 per cent). So far, no relapse of the disease is recorded.
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.
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.
Benign prostate hyperplasia is a potentially serious condition affecting men in advanced age. The treatment is conservative and operative. Proskar of Msd is one of the drugs yielding encouraging results. It is a synthetic 4-azosteroid compound, and represents a new class of specific inhibitors of 5-alpha reductase, promoting stabilization of testosterone and the more active androgen dihydrotestosterone (DHT). A total of 35 patients undergo treatment with Proskar at 5 mg daily dose (one tablet) over a 6-month period. The study includes six patients with complete urinary retention. The results are assayed by the change in prostate gland volume, residual urine and maximal urinary flow, 6 PsA. Completely responsive to treatment are 71.44 per cent of patients, partial effect is recorded in 22.85 per cent, and no effect whatsoever--in 5.71 per cent.
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A case of an 11-year-old boy is presented who had developed a severe nephrotic syndrome with massive edema, ascites, hydrothorax (protein loss with the urine up to 19 gr/24 h) 7 months after a successful kidney transplantation from a 16 years dead donor and a successfully treated crisis of transplant rejection by a good tissue compatibility. The needle renal biopsy revealed membranous glomerulonephritis I-II histological stage with data of rejection crisis by a basic disease of vesicoureteral refluxes and chronic pyelonephritis. Treatment with heparin, dipyridamole, human albumin, diuretics, sandimun and prednisolone led to a substantial improvement--mastered nephrotic syndrome, lowered to 1 g/24 h proteinuria and normal renal function.
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