Rare case of pure testicular seminoma in adult patient

Карциномът на тестисите представлява най-честото злокачествено заболяване при мъжете на възраст между 15-34 години (1). В този доклад ние представяме 65-годишен пациент, които постъпва в нашата клиника със симптоми на невъзможност да уринира спонтанно и с анамнеза за подуване на левия скротум с продължителност от три години. Досега не е търсил лекарска помощ за този проблем. От компютърния томограф, който му бе направен, се установи голямо абдоминално фуникулоцеле в лява коремна половина, минаващо през ингвиналния канал, достигащо и обхващащо целия ляв скротум, като в него се установява голяма Ту маса 10/10 см, произлизаща от тестиса, който плува в лимфоцелето. Пациентът бе опериран по отворения метод, извърши се орхифуникулектомия. Патологичният резултат бе чист семином на тестиса стадий I.Последващите контролни образни изследвания бяха извършени на 3 месеца след операцията, при което не се установи рецидив на заболяването, както и не се установиха засегнати лимфни възли и други анатомични структури. Пациентът се подлага на редовни наблюдения и прегледи, назначени по протокол.Testicular cancer represents the most common malignancy in males aged 15-34 years [1]. In this abstract we present 65 years old men, who present in our clinic with symptoms of inability to void, and a history of swelling in the left scrotum with duration of three years. From CT scan which was done we found abdominal funiculocele and all testical was involved with big 10/10 cm, mass. The patient was operated by open approach, it was done funiculorchiectomy. The pathological result was pure seminoma stage I. The follow-up imaging studies performed on 3 months after surgery, and physical examination confirmed no recurrence and the patient is undergoing regular observation and check-ups

Laparoscopic nephropexy: Treatment outcome and quality of life

INTRODUCTION: Surgical treatment of nephroptosis is rarely performed nowаdays and is done only in symptomatic patients. Here we present the results of our laparoscopic nephropexy in patients with symp­tomatic nephroptosis.MATERIALS AND METHODS: For a period from March 2014 to March 2015, a total of 8 women at an av­erage age of 54 years were operated on in our clinic . Four of the patients were with nephroptosis of the left kidney, three of the right one and one had bilateral nephroptosis. Most of the patients complained of pain and discomfort in active movement, only one individual had complaints consisting of intermittent macro­scopic hematuria. One patient had been operated on in the past by a classic open method of the same kidney. Preoperatively, for all patients, intravenous urography in supine and standing position was performed. All patients were operated on trans-peritoneally through 3 ports: 1x10 mm and 2x5 mm. The kidney was com­pletely mobilized and kidney fat was dissected. The upper and middle pole of the kidney were fixed to mus­culus psoas major, using a single non-absorbable suture and intracorporeal technique for tying.RESULT: All operations were performed with minimal blood loss, an average operating time of 45 minutes and a hospital stay of 4 days. No conversion was required in any of the cases. Postoperatively, patients were tracked and monitored by ultrasound examination. At 3 months we did IVP, which showed the correct loca­tion of the kidney. All patients remained asymptomatic for an average of 11 months after surgery.CONCLUSION: Laparoscopic transperitoneal nephropexy is a safe and effective procedure and a promising method for correction of symptomatic nephroptosis

Laparoscopic radical cystectomy - initial experience

Introduction: Radical cystectomy with extended pelvic lymph node dissection is the standard treatment for muscle-invasive bladder cancer. The aim of this study is to report our initial experience of our series of 22 patients who underwent laparoscopic radical cystectomy with different urinary diversion.Materials and Methods: Between March 2015 and March 2016, 22 patients underwentlaparoscopic radical cystectomy with different types of extracorporeal urinary diversion. Patients were aged 54 to 85 (average age 66.3) with different clinical stages of the disease.Transperitoneal laparoscopic radical cystectomy with five ports in all cases was performed with bilateral extended pelvic lymph node dissection.Results: In 5 cases we performed radical cystectomy with subsequent ureterocutaneostomy, in 7 cases we performed ileal conduit according to the method of Bricker, and in 10 cases we formed orthotopic bladder from ileal loop by the method of Hautmann. All operations were performed with an average blood loss of 270 ml, with an average operating time of 5 hours, and an average hospital stay of 7 days. No conversion was required in any case. The patients were observed postoperatively. Early complications (within 30 days) occurred in 2 patients, and late complications occurred in 3 patients.Conclusion: Laparoscopic radical cystectomy is possible, although technically difficult, with significant reduction in patient morbidity. With more experience and an improvement of the surgical technique, laparoscopic radical cystectomy with different types of derivation becomes an alternative surgical method for treating patients with localised muscle invasive bladder carcinoma

Laparoscopic treatment of large hydatid kidney cyst

Въведение: Участието на бъбреците е много рядка клинична проява в случаите на ехинококова инфекция, дори много по-рядко се наблюдава изолирано ангажиране само на бъбреците. Пациентите най-често са асимптоматични или имат болки в лумбалната област, при някои от тях се наблюдава хематурия и хидатидурия. Хирургичното лечение е основният терапевтичен подход, който най-често се извършва по класически отворен метод, при възможност със запазване на бъбрека. Минимално инвазивни хирургични техники са описани наскоро и са въведени като възможност за лечение от първа линия в някои страни.В този доклад представяме рядък случай на първична бъбречна ехинококоза, изразяваща се с голяма киста на десния бъбрек, лекувана чрез лапароскопския метод (фенестрация).Материал и методи: Представяме пациентка на 21 год., приета в нашата клиника по повод на неспецифични болки в дясна лумбална област с продължителност от една година. Пациентката не съобщава за други симптоми като гадене, повръщане или фебрилитет. След извършената абдоминална ехография ние установихме голяма киста на десния бъбрек, което наложи извършването на компютърна томография (КТ) с интравенозен контраст на гръдния кош, корема и малък таз. От направения КТ се потвърди ехографската диагноза: голяма хидатидна киста на десен бъбрек с размери 10х10 см, причинявайки мас ефект на бъбрека и околните структури, включително черния дроб. Преди операцията пациентката бе консултирана с паразитолог с оглед находката от КТ, който назначи да се започне консервативно лечение с антипаразитен медикамент два пъти дневно 400 мг Albendazole. След 10-дневен прием на медикамента и предоперативна подготовка пациентката бе оперирана чрез трансперитонеален лапароскопски метод под обща анестезия в лявата странична позиция.Резултати: Операцията се извърши с минимална загуба на кръв, оперативното време бе 60 мин. Ранният следоперативен период премина гладко и без усложнения. Контактният дрен бе отстранен 24 часа след процедурата. Пациентката бе изписана клинично здрава на четвъртия ден след операцията.Заключение: Лапароскопско лечение на големи хидатидни кисти на бъбреците е минимално инвазивен безопасен метод. След щателна подготовка на пациента и правилна хирургична техника, за да се предотврати десиминация, както и запазване на бъбреците, когато това е технически възможно, трябва да се направи на всички пациенти поради доброкачествеността на заболяването.Introduction: The involvement of the kidneys is very rare clinical manifestation in cases of hydatid infection even rarer isolated (alone) engaging only the kidneys. Patients most often are asymptomatic or they have pain in the lumbar region, haematuria, hyda- tiduria. Surgery is the main therapeutic approach, which is most often performed with classic open method with preserving of kidney if possible. Minimally invasive surgical techniques are described and introduced as a treatment option in the recent yearend in the some countries.In this abstract we present a rare case of primary renal hydatid cyst of the right kidney treated by laparoscopic method (fenestration).Material and methods: We present 21 years female patient, admitted in our clinic with right nonspecific flank pain from duration of one year. the patient does not have other symptoms like nausea, vomiting or fewer. After ultrasonography we found large cyst on the right kidney, which required to performed computed tomography (CT) scan with i.v contras, of the chest, abdomen, and pelvis, which finds large hydatid cyst 10Ñ…10 cm, on the right kidney, causing mass effect on the kidney and surrounding structures including the liver. Before the operation patient started twice a day 400 mg Albendazole, which was prescribeded form parasitologist. After preoperative preparation patient was operated by transperitoneal laparoscopic approach. The patient was operated under general anesthe-sia in the left lateral position, the pneumoperitoneum was made with Veres needle. Four laparoscopic trocars were used 2x5mm and 2x10 mm, and they were inserted under optic vision. After dissection the attachments of the mseocolon to the kidney, incision is made along the white line of Told, to reflect the colon off the cyst. After placing the well-moistened 30% solution of sodium chloride around the cyst, we used large bore needle to make puncture and aspiration of fluid from the cyst. Two hundred milliliters of Braunol were gradually injected in the cyst for 15 min, in two consecutive intervals, and the cyst was then completely emptied carefully followed by aspiration and evacuation of all scolexes. Again we repeat flushing with 200 ml of solution of Braunol placed in the cyst for 15 min. Suturing of the opening of the cyst, and placing the contact drain.Results: The operation was done with minimal blood loss, for operating time of 60 min. Early postoperative period went smoothly and without complications. Drain was removed on 24 hours after the procedure. The patient was clinically healthy discharge four days after surgery.Conclusions: Laparoscopic treatment of large hydatid cysts of the kidney is safe feasible method. After preparation of the patient and respect for the surgical technique in order to prevent desimination, preserving the kidney should be made to all patients where technically is possible because to the benign of the disease

EARLY DISTRIBUTION OF SQUAMOUS PENILE CARCINOMA

Introduction: Penile carcinoma is mostly a squamous cell carcinoma (SCC), usually originating from the epithelium of the inner prepuce or the glans. At least one third of the cases can be attributed to HPV-related carcinogenesis. The incidence of penile cancer increases with age, peaking during the sixth decade of life. However, the disease does occur in younger men.Materials and Methods: This abstract features case reports of two patients, aged 44 and 54, respectively, admitted for the first time at the Clinic of Urology at St. Marina University Hospital (Varna, Bulgaria) with similar complaints of non-healing tender lesions in the region of the penis, lasting more than one year.Results: After taking into consideration these complaints, patient no.1 (aged 44) was hospitalized and referred to a CT scan. The CT scan revealed a tumor formation in the corpus of the penis, as well as multiple swollen lymph nodes bilaterally. After the diagnostics an operative intervention - penile amputation and lymphadenectomy was chosen as treatment. Incision biopsy of the operative material revealed a highly differentiated penile squamous cell carcinoma - T2, N0, Mx, G1 (low-grade).Patient no. 2 (aged 54) was admitted into the Clinic of Urology with highly differentiated invasive penile squamous cell carcinoma, diagnosed a month prior. A CT scan of the abdomen and the lesser pelvis was made with the intention of staging the tumor. The scan confirmed an infiltration of the scrotum and the testes. Packages of lymph nodes were visible bilaterally as well as along the iliac blood vessels. Emasculation and lymphadenectomy were chosen as treatment. The incision biopsy confirmed the diagnosis - T3, N3, Mx, G1 (low-grade).Conclusions: The presented case reports prove that the lack of timely consultation with a specialist can lead to radical operative interventions on the male reproductive system, leading to psycho-social discomfort

Důsledek tloušťky vrstvy a žíhání na formaci křemíkových nanostruktur v multivrstevnatých superstrukturách a-Si:H/a-SiNx:H pro fotovoltaiku

Tvorba křemíkových nanostruktur zabudovaných do vrstev nitridu křemíku může být velmi zajímavá pro mikro- a optoelektronická zařízení, jako jsou energeticky nezávislé paměti a solární články. V této práci jsme připravili amorfní multivrstvy s více vrstvami a-Si: H / a-SiNx: H s různou tloušťkou na křemíkové a křemenné substráty metodou PECVD při 250 °C a použitím dusíku a silanu jako reaktivních prekurzorů. Následně bylo provedeno žíhání těchto struktur, které se skládaly ze střídajících se vrstev a-Si: H a a-SiNx: H, až do 1100 ° C ve vakuu za vzniku křemíkových nanostruktur. Byly zkoumány závislosti fotoluminiscence, strukturní a chemické vazebné charakteristiky nanostruktur na tloušťce křemíkové subvrstvy a teploty žíhání po depozici. Tvorba křemíkových nanokrystalů byla potvrzena elektronovou mikroskopií a rentgenovou difrakcí. Vývoj křemíkových nanoklastrů během vysokoteplotního žíhání byl také zkoumán Ramanovou rozptylovou spektroskopií. Změna konfigurace vazby během žíhání byla provedena Fourierovou transformační infračervenou spektroskopií. Optické vlastnosti byly studovány UV-VIS a fotoluminiscenční spektroskopií. Výsledky jasně ukazují, že strukturní a optické vlastnosti těchto systémů mohou být řízeny parametry depozice a žíhání.Formation of silicon nanostructures embedded in silicon nitride layers can be of great interest for micro and optoelectronic devices such as non-volatile memories and solar cells. In this work, we synthesized amorphous multilayered a-Si:H/a-SiNx:H superlattice structures with different thickness of sublayers grown on silicon and quartz substrates by the plasma enhanced chemical vapor deposition method at 250°C using nitrogen and silane gases as the reactive precursors. Subsequently, the post-deposition annealing of these structures, composed of alternating layers of a-Si:H and a-SiNx:H, was carried out up to 1100° in vacuum to form Si-nanostructures. The dependences of the photoluminescence, structural and chemical bonding characteristics of superlattice nanostructures on the silicon sublayer thickness and post-deposition annealing temperature were investigated. The formation of silicon nanocrystals was confirmed by the transmission electron microscopy and X-ray diffraction measurements. Evolution of Si nanoclusters during high temperature treatment was examined by Raman scattering spectroscopy. Changing of bonding configuration during the annealing was carried out by Fourier transform infrared spectroscopy. The optical properties were studied by UV-VIS and photoluminescence spectroscopy. Results clearly show that structural and optical characteristics of these systems can be controlled by deposition parameters and annealing