Aim of investigation: to study immediate and remote results of standard and extended lymphodissection in patients with rectal cancer. Material and methods: 132 patients with rectal cancer were performed radical surgery with lymphodissection in D2 and D3 volume according to a height of tumor location. In immediate postoperated period there were noted complications in 4 patients that made up 3,03%. Observation time was 5 years. Tumor recurrence was reported in 5 patients (3,8%). In remote period metastases were revealed in 8 patients (6,6%). 5year total survival rate was 78,5±4,2% at stage II. 5year total survival rate was 56,4±3,7% at stage III. Comparing the results of standard and extended lymphodissection it was noted statistically authentic increase of 5 year survival rate in patients at stage III. Obtained data allow to come to the conclusion about reasonability of performance of different variants of lymphodissection for patients with rectal cancer at stages II and III., Navruzov S. N., Abdujapparov S. B., Akbarov E. T., Navruzov B. S., Islamov H. D., and Literatura
To improve the results of radiotherapy for cervical cancer used local and systemic radiomodification drugs. Materials and methods: 1984 patients with locally advanced cervical cancer (2b 3a stage), which at one stage of complex treatment by a course indoarterial of regional longterm polychemotherapy (EARDPHT) mode: methotrexate 50 mg/m2, the first 12 hours, fluorouracil 1000 mg/m2, over the next 12 hours and cisplatin 100 mg/m2, for 48 hours, 2 stage surgical treatment in the volume expanding hysterectomy 3 type (modification of Wertheim Meigs). Results: The results of treatment of locally cervical cancer using VADRPHT, depending on the unilateral and bilateral tumor invasion in parametrial tissue showed that under unilateral lesion of parametrium results of treatment were higher than for the bilateral involvement of parametrium. Medical pathomorphosis in tumors of different severity was observed in 86.9% of patients, metastasis to regional lymph nodes were detected in 36% of operated patients, and also studied the degree of therapeutic pathomorphosis in lymph nodes. There was revealed that the complete regression of tumors, 5 year survival rate is 98%, whereas in tumor regression of more than 50% of the original volume 78.5%, with stabilization of tumor no more than 58.4%. Conclusion: The study of molecularbiological parameters of the tumor cells show the effectiveness of conducted neoadvent indoarterial chemotherapy and play an important role in further treatment and prediction of disease., Navruzova V. S., Yuldasheva N. Sh., and Literatura
Cíl: Cílem práce bylo vyhledat důkazy na podporu intervence žvýkaní žvýkačky v pooperační péči u pacientů podstupujících operační výkon v břišní dutině ke snížení rizika paralytického pooperačního ileu, a to snížením času do prvního odchodu větrů a času do první stolice. Metodika: Za účelem nalezení důkazů pro použití žvýkaní žvýkačky v pooperační péči u pacientů podstupujících operační výkon v břišní dutině jako strategie na snižení rizika paralytického pooperačního ileu (snížením času do prvního odchodu větrů a času do první stolice) byl proveden přehled vybraných metaanalýz a randomizovaných kontrolovaných studií (RCT). Vyhledávání probíhalo v následujících databázích: OVID Medline®, CINAHL, and PubMed. Vyhledávání se zaměřilo na publikace v anglickém jazyce v recenzovaných časopisech v období 2002 až 2012. Z metaanalýz byl abstrahován rozdíl vážených průměrů (weighted mean difference) jako míra účinku (effect size) žvýkaní žvýkačky na čas do prvního odchodu větrů a na čas do první stolice. Z výsledků randomizovaných kontrolovaných studií bylo vypočítáno Cohenovo d (effect sizes) na určení míry účinku (effect size) žvýkání žvýkačky na čas do prvního odchodu větrů a na čas do první stolice. Na znázornění míry účinku (effect size) z RTC byly vytvořeny grafy (forest plots). Výsledky: Ke kritickému zhodnocení byly vybrány čtyři randomizované kontrolované studie a dvě metaanalýzy. Všech šest studií prokázalo statisticky významný a velmi velký až střední učinek na čas do prvního odchodu větrů a na čas do první stolice. Na základě míry ůčinků (effect sizes) byl vyvozen závěr, že žvýkaní žvýkačky v pooperačním období klinicky významně zkracuje čas do prvního odchodu větrů a čas do první stolice. Závěr: Silné důkazy podporují žvýkaní žvýkačky v pooperační péči u pacientů podstupujících operační výkon v břišní dutině, co vede ke snížení rizika paralytického pooperačního ileu, a to snížením času do prvního odchodu větrů a času do první stolice., Aim: The aim of the paper was to search for evidence that the use of gum chewing in the postoperative care of patients who had undergone abdominal surgery decreases the risk of paralytic postoperative ileus by significantly reducing the time to first flatus and time to first bowel movement. Methods: A literature review of selected meta-analyses and randomized control trials (RCT) was conducted to find the evidence that the use of gum chewing in the postoperative care of patients who had undergone abdominal surgery decreases the risk of paralytic postoperative ileus expressed as the time to first flatus and time to first bowel movement. The following databases were searched: OVID Medline®, CINAHL, and PubMed. The search focused on material published in English in peer-reviewed journals between the years 2002 and 2012. Weighted mean difference was the effect size abstracted from the meta-analyses of gum chewing on time to first flatus and time to first bowel movement. From the RCT, Cohen’s d effect sizes were calculated to determine the strength of the gum chewing intervention on time to first flatus and time to first bowel movement. Forest plots were created to present the effect sizes from the RCT. Results: Four randomized controlled trials and two meta-analyses were selected and critically appraised. All six studies concluded that gum chewing has a statistically significant and very large to medium effect on time to first flatus and time to first bowel movement. Based on the effect sizes, the conclusion was drawn that chewing gum during the postoperative period leads to a clinically significant reduction in time to passage of first flatus and time to first bowel movement. Conclusion: Strong evidence supports the use of gum chewing in postoperative care of patients who have undergone abdominal surgery to reduce the risk of paralytic postoperative ileus., and Renáta Zeleníková, Anthony Chao, Gloria Enright, Mary Rogers Schubert, Kaitlin Shotsberger, Cecelia Wise, Elizabeth A. Schlenk
Aim: The aim of this paper is to develop an evidence-based clinical protocol for the use of gum chewing in postoperative care to reduce the risk of paralytic postoperative ileus in patients who have undergone abdominal surgery. Methods: A clinical question (For adult patients who have undergone abdominal surgery, does the use of gum chewing postoperatively reduce the risk of paralytic postoperative ileus in comparison with the usual care regimen?) was formulated, a population and setting were defined, and the databases OVID Medline®, CINAHL, and PubMed were searched for relevant material. Six data-based research articles were chosen for review: four randomized controlled trials and two meta-analyses. Finally, the articles were critically appraised to generate evidence on which to base the clinical protocol. Results: The development team created a detailed description of the clinical protocol as well as a protocol algorithm to assist clinicians in determining patient eligibility. In addition, protocol implementation and evaluation plans were proposed. Conclusion: An evidence-based clinical protocol was developed to provide a template for identification of patients eligible for gum chewing, implementation, and evaluation of this intervention to reduce the risk of paralytic postoperative ileus after abdominal surgery., Renáta Zeleníková, Anthony Chao, Gloria Enright, Mary Rogers Schubert, Kaitlin Shotsberger, Cecelia Wise, Elizabeth A. Schlenk, and Literatura
Článek nabízí několik tipů a triků, které by měly napomoci v procesu psaní přesvědčivého a čtivého rukopisu. S pomocí webových stránek zmiňovaných v článku, by měl být proces psaní vědeckého článku jednodušší, zejména pro nezkušené autory., In this manuscript some writing tips and tricks are offered which can be of help in the process of creating a convincing and readable manuscript. The process of writing a manuscript itself should become easier, in particular for the inexperienced writer, with help of the websites mentioned in this article., and Assoc. Prof. Jitse P. van Dijk MD PhD
Mediterranean spotted fever (MSF) in Bulgaria shows increasing severity, especially in patients over sixty years. As T lymphocytes are the primary effector cells in MSF and are altered by the ageing process we aimed to specify the changes in their numbers in elderly patients. We performed a clinicoepidemiological study, haematological and biochemical analysis of 132 patients of 60+ and 30 patients between 19 and 57 years with MSF. We investigated the cell immunity of 20 patients of 60+ using immunofluocytometry. The control group consisted of 10 younger patients and 10 healthy individuals of 60+. MSF showed more unfavourable course in the elderly.We found T-lymphocytes depletion in all patients with MSF. Activated T lymphocytes were increased in elderly patients with MSF. We found significant differences between the number of activated T lymphocytes in elderly patients and healthy elderly persons. The observed T-lymphocytes depletion in MSF corresponded to the disease severity. The increase in the activated T lymphocytes in patients over 60 years contributes to an adequate immune response., Margarita Gospodinova, and Literatura
The article analyses a surgical treatment of 506 patients taking inpatient treatment in the Center for colon proctology. All the patients underwent a comprehensive examination including radiological and tool test methods in addition to conventional clinical and laboratory ones. On the basis of the complex study, indications, volume and terms of surgery performance were determined. Performance of preand postoperative management of patients is substantiated in details. Postoperatively, 28 (5.5%) had postoperative wound pyesis in the region of the previous colostomy. In the postoperative period 2 (0.4%) deaths of patients were caused with peritonitis which occurred due to incompetence of anastomosis sutures. Rehabilitation of stomed patients is one of challenges in colorectal surgery. Positive results treatment can be obtained only at carrying out of a comprehensive outpatient and inpatient preoperative preparation including recommendations in diet, colostome care, hydrogymnastics of the disconnected part of the intestine and prevention of infectious complications., Isakulov T. U., Mamatkulov Sh. М., Rahmanov S.T., Matkarimov S. R., and Literatura
Tento článek definuje trans jako širokou paletu osobnostních (genderových) projevů, které stojí v kontrastu s tendencí společnosti přijímat (přejímat) hluboce zakořeněné představy o tom, co je "normální" a "přirozené", a tendencí chovat podezření vůči takovým projevům osobnosti, které se zdají být s těmito normami v rozporu - změna pohlaví se pak zdá být "nepřirozená". Tento článek si klade otázky ohledně vztahu (trans) genderu k demokratické představivosti společnosti., This article defines the phenomenon of trans as an expression of the wide range of personal (gender) expressions and contrasts this idea with the tendency of societies to adopt deeply rooted ideas about what is "normal" and "natural", as well as the tendency to act with suspicion against such manifestations of personality that seem to be in conflict with these standards - sex change then appears to be "un-natural." This article raises questions about the relationship between (trans)gender and democratic imagination., Petr Agha, and Literatura
This article presents the author's technique and experience in the treatment of the flaccid "unhappy buttock" form with his surgical procedure of buttock lift by suture, without incision scars. The author first presented this new operation technique on a national level at the 2nd Annual Meeting of the National Bulgarian Society for Aesthetic Surgery and Aesthetic Medicine in Sofia on March 18, 1994 [1] and internationally at many scientific meetings over the world [2, 3, 4 ]. The result is a visual change in the buttock position to a higher one, which elongates the lower limbs and changes the proportions between lower and upper half of the body. The aim of this study is to describe a miniinvasive procedure of beautification of the buttock form without scars by creating a lifting effect on the buttock's subcutaneous tissue, using a suture that takes the inferiorly positioned deep fibrose tissue and fixes it upwards to the sacrocutaneous fascia, discovered by the author. Aesthetic and technical considerations required properly sculpting the buttocks into a higher position, demonstrating nicely rounded form. Preoperative shape is discussed and patient evaluations, operative techniques, postoperative management and results after 4 years of experience are emphasized. 1032 female patients, and 26 male patients aged 1862 years, with ptosis and cellulite on the buttocks were treated since 1993 on an outpatient basis by the "Serdev suture technique without visible scars". Important instrumentarium is a long, curved, elastic needle and Polycon semielastic Bulgarian antimicrobial polycaproamide long term (in 2 years) absorbable surgical threads Polycon, produced in Bulgaria. This operation has been performed either alone or after ultrasonic assisted liposculpture (UAL) that reduces the amount of fat and heaviness. All patients reported a high degree of satisfaction. A stable improvement in the buttock position and form was observed for the period described. In the postoperative period the complication rate was minimal and resolved in the first 45 days post operative period. The skin puncture in the perianal zone makes antibiotic prophylaxis obligatory as well as a strict follow up for the first 7 days. Some pain in the sitting position was observed for at least 5 to 10 days, but all other social and professional duties and activities were possible. This outpatient procedure is effective in the correction of buttock laxity and ptosis and creates a new form, universally accepted as "happy buttocks"., Nikolay P. Serdev, and Literatura
Toto speciální vydání Časopisu zdravotnického práva a bioetiky je číslem mono-tematickým, které se zaměřuje na problematiku translidí, pohlavní identity a právního diskursu v této oblasti. Poukazuje na problémy, se kterými se translidé v praktickém životě setkávají., This special issue of Journal of Medical Law and Bioethics is mono-thematic and focuses on transgender issues, sexual identity and legal discourse in this area. It highlights the problems transgender people meet in real life., and Adam Doležal, Petr Agha