The role of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients with upper abdominal involvement

Ovarian cancer has the highest mortality rate of all gynecologic cancers as 62% of cases are diagnosed at an advanced stage. The main concern in the surgical management of ovarian cancer is to achieve optimal cytoreductive surgery. Effective cytoreductive surgery at the time of initial therapy has been identified as the most important prognostic factor in the management of advanced ovarian cancer. This aggressive approach can cause unusual surgical management modalities including diaphragm stripping/resection, bowel resection, hepatic resection and splenectomy. Thus, splenectomy occasionally happens to be part of the ovarian cancer surgery.The indications and technique of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients were described. The authors have presented the indications and techniques of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients. Intraoperative and postoperative complications were reported in this study

Three-year results from the surgical treatment of diseases of the aortic valve and aortic root

PURPOSE: Pathology of the aortic root and aortic valve is subjected to adult cardiac surgery and includes Stanford A aortic dissection, annuloaortic ectasia or chronic aneurysm of the ascending aorta. In such cases, Bentall-De Bono procedure is usually preferred. Aortic valve reimplantation by using Tirone David's technique presenting with the advantages of valve-sparing surgery can be performed in selected cases.MATERIAL AND METHODS: A retrospective analysis of a three-year experience with the complex surgical treatment of diseases of the aortic valve and root was carried out. During the period from January 1, 2009 to December 31, 2012, fifty-three patients with aortic valve and aortic root pathology were treated in the Division of Cardiac Surgery, St. Marina University Hospital of Varna. Bentall procedure was carried out in 37 patients (Group B). In 19 of them (51%) emergency surgery was done for acute aortic dissection of type Stanford A. The rest 18 patients underwent elective surgery for dilated ascending aorta and aortic valve dysfunction. Aortic valve-sparing surgery by David's technique for aortic aneurysm was accomplished in 16 patients (Group D). This technique was emergently applied in one patient with aortic dissection, too. Baseline data, intraoperative details, early results and complications were compared.RESULTS: Early (30-day) mortality after Bentall-De Bono procedure was 10.5% (0% after elective surgery and 21.1% after dissection repair). All the patients survived after David's procedure that proved the significant advantages of the valve-sparing surgery.CONCLUSION: The aortic valve reimplantation provides long-term results that are comparable to those after the Bentall-De Bono procedure such as high survival rates, low incidence rate of endocarditis, and slightly higher risk of reinterventions. There is no need of life-long anticoagulation that improves patient's quality of life.Scripta Scientifica Medica 2013; 45(4): 50-55

Right ventricle hydatid cyst with a pericardial cavity involvement: a case report

The echinococcal disease with a cardiac location of the hydatid cyst is uncommon and potentially fatal for the patient's life. The diagnosis could be difficult because no specific symptoms ever occur. However, this pathology should be always kept in mind in endemic regions. Herein we report a rare case of hydatid cyst situated in the right ventricular free wall. The diagnosis was ensured by transthoracic and transesophageal echocardiography, CT and MRI. The patient underwent a total cardiopulmonary bypass without aortic cross-clamping. Several ruptured daughter cysts were removed. The fibrous capsule was opened and the germinative membrane was extirpated. Postoperatively, albendazole therapy was administered. No complications were reported.Scripta Scientifica Medica 2013; 45(4): 84-87

Precancerous lesions of the cervix — aetiology, classification, diagnosis, prevention

The present review introduces the aetiology and classification of cervical precancers. The principles of diagnosis based on colposcopy are reviewed. The indications for colposcopy and targeted biopsy are steps in the diagnostic process of cervical precancers. Prophylaxis of these diseases prevents cervical cancer as high-grade precancerous lesions represent a direct precursor to cervical cancer. The basics of primary and secondary prevention, the types of screening, and the behaviour of the already-alerted patients after different screenings are presented

Pregnancy and malignant diseases — principles of management

Pregnancy-associated malignant diseases introduce multiple dilemmas to the multidisciplinary boards, related to both the oncological treatment as well as to obstetrical management. The most frequent oncological diseases diagnosed during pregnancy are breast cancer, oncohematological conditions, uterine cervix cancer and skin cancers. There are different clinical scenarios: interruption of the pregnancy and further use of the most appropriate oncological strategy; it is also possible to postpone the oncological treatment for the postpartum period with a watch-and-wait strategy until the foetus is mature and the delivery is planned. The third scenario includes concurrent treatment of both conditions: use of chemotherapy, radiotherapy and surgery during an ongoing pregnancy. Choosing among these scenarios is considering many factors, including type and stage of the malignant tumour, pregnancy term, desire and informed decision of the pregnant woman to keep or interrupt the pregnancy. The current review is focused on the basic principles of the oncological modalities (surgery, chemotherapy and radiotherapy) during pregnancy as well as their influence over the pregnant woman and the foetus, over the obstetrical management and the timing and mode of delivery, delivery anaesthesia, lactation and breastfeeding from the point of view of the evidence-based medicine

Endometriosis and risk of ovarian cancer

Endometriosis is common in premenopausal women and affects about 10% of women of reproductive age. It is a benign condition but demonstrates malignant behaviour with recurrences and metastases. Its tendency to increase the risk of specific subtypes of ovarian cancer is being discussed, because they exhibit specific clinical features that distinguish them from classical ovarian cancer. Malignant transformation of endometriosis goes through its transition to atypical endometriosis. Although endometriosis-associated ovarian carcinomas have a good prognosis, adequate follow-up and monitoring after treatment of endometriosis are recommended

Cryoablation for simultaneous surgical treatment of atrial fibrillation and valvular or ischemic heart diseases - our early experience in Varna

Atrial fibrillation (AF) is a problem with rising frequency and importance in developed countries. The consequences of that condition are a significant medical, social and economic problems: high risk of development of heart failure, ischemic stroke, decreased quality of life and lowered life expectancy. With the development of theoretical knowledge and technical means in medicine, new surgical methodshave been established and validated for the treatment of AF, among them is cryoablation. We present our early experience with the concomitant treatment of AF with cryoablation for patients undergoing surgical treatment of coronary artery disease (CAD), mitral and aortic valvular pathology. The system used for cryoalbation uses nitrous oxide (N2O). The results from patient follow-up show higheffectiveness of the procedure even in the initial phase of mastering the skill

Endometrial carcinoma in patients under 40 years of age: insights from the bulgarian cancer registry

Objectives: We aimed to investigate the overall survival (OS) of young women with endometrial cancer (EC) in Bulgaria and the impact of histological type on survival. Material and methods: This is a population-wide retrospective study of patients with EC (≤ 40 years at diagnosis) registered at Bulgarian National Cancer Registry (BNCR) between 1993 and 2020. Patients were re-classified according to the 8th edition of the TNM classification. Results: In total, 30 597 patients were registered and histologically confirmed with malignant tumors of the uterine body. From that, 29 065 of them (95%) had ECs, and the rest had sarcomas. Around 1.64% of all malignant tumors of the uterine body are diagnosed in women under the age of 40. Most of them are diagnosed in the early stage. There was no significant difference in median OS for patients diagnosed before or after 2003. In recent years there was a slight improvement in survival and patients from the last cohort of this study had a 5-year survival rate of 92.5%. Patients with favorable pathology (T1, G1/2) had no lymph node involvement at the time of diagnosis and their 10-year survival rate was 94%. Conclusions: EC in young women is a rare disease. In most cases, patients are diagnosed in early stageT1, G1/2, N0 and their prognosis is excellent. However, the lack of improvement of OS of young patients with EC in the last three decades shows the need for treatment optimization

Endometrial carcinoma in patients under 40 years of age : insights from the Bulgarian cancer registry

Objectives: We aimed to investigate the overall survival (OS) of young women with endometrial cancer (EC) in Bulgaria and the impact of histological type on survival.Material and methods: This is a population-wide retrospective study of patients with EC (≤ 40 years at diagnosis) registered at Bulgarian National Cancer Registry (BNCR) between 1993 and 2020. Patients were re-classified according to the 8th edition of the TNM classification.Results: In total, 30 597 patients were registered and histologically confirmed with malignant tumors of the uterine body. From that, 29 065 of them (95%) had ECs, and the rest had sarcomas. Around 1.64% of all malignant tumors of the uterine body are diagnosed in women under the age of 40. Most of them are diagnosed in the early stage. There was no significant difference in median OS for patients diagnosed before or after 2003. In recent years there was a slight improvement in survival and patients from the last cohort of this study had a 5-year survival rate of 92.5%. Patients with favorable pathology (T1, G1/2) had no lymph node involvement at the time of diagnosis and their 10-year survival rate was 94%.Conclusions: EC in young women is a rare disease. In most cases, patients are diagnosed in early stageT1, G1/2, N0 and their prognosis is excellent. However, the lack of improvement of OS of young patients with EC in the last three decades shows the need for treatment optimization.peer-reviewe