Dobromir Dimitrov - Academia.edu (original) (raw)

Papers by Dobromir Dimitrov

Research paper thumbnail of sj-zipx-1-fao-10.1177_24730114211061405 – Supplemental material for Comparison of Outcomes Between Suture Button Technique and Screw Fixation Technique in Patients With Acute Syndesmotic Diastasis: A Meta-analysis of Randomized Controlled Trials

Supplemental material, sj-zipx-1-fao-10.1177_24730114211061405 for Comparison of Outcomes Between... more Supplemental material, sj-zipx-1-fao-10.1177_24730114211061405 for Comparison of Outcomes Between Suture Button Technique and Screw Fixation Technique in Patients With Acute Syndesmotic Diastasis: A Meta-analysis of Randomized Controlled Trials by Nikolai Ramadanov, Simon Bueschges and Dobromir Dimitrov in Foot & Ankle Orthopaedics

Research paper thumbnail of Is high-intensity focused ultrasound (HIFU) an option for neoadjuvant therapy for borderline resectable pancreatic cancer patients? – a systematic review

International Journal of Hyperthermia, 2021

Abstract Introduction Pancreatic cancer is with the poorest prognosis of all common cancers world... more Abstract Introduction Pancreatic cancer is with the poorest prognosis of all common cancers worldwide. Despite the advances in treatment the results are poor throughout the different methods. Pancreatic resection still yields the best outcome. However only a quarter of the patients present at operable stage. HIFU is a noninvasive technique that can be used to treat pancreatic cancer. Aim The aim of this review is to perform a systematic review on the data about the resection rate after HIFU ablation in patients with borderline resectable pancreatic cancer (BRPC) and the impact of this technique over the oncological results. Materials and methods The PubMed and Wanfang databases were searched using keywords: pancreatic cancer, HIFU ablation and high-intensity focused ultrasound. All found articles were reviewed. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard guidelines. This study was financially supported by 2019 ‘Kuan-Ren Elite’ Program of 2nd Affiliated Hospital of Chongqing Medical University, China (Grant no. KY2019G019). Results The English database search showed 109 papers, of which 3 met the inclusion criteria. The Wanfang database resulted in 110 papers; however, none met the inclusion criteria of the review. From the included studies 97 patients underwent neoadjuvant HIFU ablation ± chemotherapy. Thirty-four patients reached resection (35.1%). In two patients, residual tumor (R) classification was not reported. R0 resection rate in all reported patients is 30.5% (29/95). R1 resection rate is 3.2% (3/95). Conclusion HIFU is found to be safe and feasible in locally advanced and metastatic pancreatic cancer with proven downstaging and downsizing effects. Further research on role of HIFU ablation as a neoadjuvant treatment for borderline resectable pancreatic cancer is needed.

Research paper thumbnail of The Use of Ultrasound Guided High Intensity Focused Ultrasound (Hifu) in the Treatment of Uterine Fibroids: An Overview

Wiadomości Lekarskie, 2022

Uterine fibroids are the most common benign gynecological neoplasms, with a higher prevalence in ... more Uterine fibroids are the most common benign gynecological neoplasms, with a higher prevalence in women aged between 30 and 50 years old. Fibroids may be asymptomatic, but in some cases, they can affect seriously the quality of life of the patients. In some cases, we can recommend expectant management for asymptomatic patients. Management depends on the size and location of fibroids, the age of the patient, symptoms, desire for future childbearing and the experience of the gynecologist. Medical therapy includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs (reduce heavy menstrual bleeding). Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are used mostly preoperatively. Surgical treatment includes hysterectomy, myomectomy – invasive and minimally invasive. Non-surgical management include uterine artery embolization, and focused ultrasound surgery.This review aims to present the role of High-Intensity Focused Ul...

Research paper thumbnail of Treatment of Patient with Uterine Fibroid Using Focused Ultrasound Surgery - Clinical Case

Research paper thumbnail of Ultrasound guided high intensity focused ultrasound for advanced pancreatic cancer: A comparative study between Chinese and Bulgarian patients

Objective: This study is to determine the efficacy of the Chinese clinical program of Ultrasound ... more Objective: This study is to determine the efficacy of the Chinese clinical program of Ultrasound Guided High-Intensity Focused Ultrasound (USgHIFU) in the Bulgarian patients with advanced pancreatic adenocarcinoma. Methods: Patients with advanced pancreatic adenocarcinoma from China and Bulgaria were enrolled in the study. All patients received the same clinical procedure of USgHIFU treatment and follow-up. The patient characteristics, the USgHIFU treatment and evaluation parameters including complications, Visual Analogue Scale (VAS) pain scores, tumor size, serum CA19-9 levels, survival rates and survival times were comparatively studied in Chinese and Bulgarian patients. Results: There was no significant difference in clinical parameters of Chinese and Bulgarian patients with advanced pancreatic adenocarcinoma, such as the ratio of male/female, mean age, tumor size, and TNM stage. Similarly, no statistical significance was found in USgHIFU procedure including treatment time, the ...

Research paper thumbnail of Introducing clinical protocol for ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids in patients in Europe, provided from experienced Chinese center-prospective comparative

Biomedical Research, 2018

Introduction: This study aims to determine whether the Chinese clinical protocol, ultrasound guid... more Introduction: This study aims to determine whether the Chinese clinical protocol, ultrasound guided high-intensity focused ultrasound (USgHIFU) combined with real-time monitoring using a contrast enhanced ultrasound (CEUS), also applies well in European patients with uterine fibroids. Methods: Seventy-five patients with 87 nodules of uterine fibroids from China and Bulgaria were treated with USgHIFU from April 2015 to July 2016, in the study. In Group A (Bulgarian) 26 (33 nodules) patients and in group B (Chinese) 49 (54 nodules) patients were included in the study. The same clinical procedure of USgHIFU treatment as well as a follow-up was performed on patients from China and Bulgaria. The general characteristics of the patients, the USgHIFU treatment and evaluation parameters, including; complications, fibroid size, tumor volume, subcutaneous fat size, non-perfused volume (NPV) and shrinkage process, were comparatively studied in Chinese and Bulgarian patients. Results: There were no significant differences in clinical parameters of Chinese and Bulgarian patients with uterine fibroids, such as vertical, left-right and аnterior-posterior size, treatment time, USgHIFU time. After USgHIFU treatment, no complications were recorded in both groups. On the 6 th and 12 th month after USgHIFU, fibroid nodules shrunk and the NPV was statistically significant compared to NPV before USgHIFU, but there were no statistically significant differences. Conclusions: The initial results of our study showed that CEUS clinical protocol for real time monitoring of efficacy and quality of the USgHIFU for uterine fibroid treatment that had been used in Chinese centers may also be applicable for European patients.

Research paper thumbnail of Clinical Effectiveness and Complication Rate of Core Needle Breast Biopsy

Introduction: Core needle biopsy is a standard method in breast cancer diagnosis. It gives infor... more Introduction: Core needle biopsy is a standard method in breast cancer diagnosis. It gives information about the breast cancer type, the hormone receptor and HER2 status, which determines the further behavior and treatment. Our aim is to establish the effectiveness of the core needle biopsy and the complications that might follow. Materials and Methods: A retrospective clinical study of all patients with suspicious for malignancy breast mass who have undergone core needle biopsy followed by operative treatment between January 2014 and December 2015 at UMHAT `Georgi Stranski` - Pleven, was undertaken. Core needle biopsy was performed using a Tru-cut gun with an 18-gauge needle. The lesion was manually immobilized and the needle was inserted under visual control or ultrasound guided. Results: A total of 79 Tru-cut biopsies followed by operative treatment were performed on patients with palpable lesions during the study period. All of the patients were women. The median age was 64 ...

Research paper thumbnail of A meta-analysis on RCTs of direct anterior and conventional approaches in total hip arthroplasty

Scientific Reports, 2021

To conduct a systematic review and meta-analyses on short-term outcomes between total hip arthrop... more To conduct a systematic review and meta-analyses on short-term outcomes between total hip arthroplasty (THA) through direct anterior approach (DAA) compared to THA through conventional approaches (CAs) in treatment of hip diseases and fractures. We performed a systematic literature search up to March 1, 2021 to identify RCTs, comparing THA through DAA with THA through CAs. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, using the DerSimonian and Laird method and a random effects model. We calculated odds ratios (ORs) with 95% CIs for dichotomous outcomes, using the Mantel–Haenszel method and a random effects model. Ten RCTs met the criteria for final meta-analysis, involving 1053 patients. Four studies were blinded RCTs with a level I evidence, the other 6 studies were non-blinded RCTs with a level II evidence. DAA had a longer operation time than CAs (MD = 17.8, 95% CI 4.8 to 30.8); DAA had similar results compared to CAs for incis...

Research paper thumbnail of Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

The Lancet, 2021

Summary Background 80% of individuals with cancer will require a surgical procedure, yet little c... more Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.

Research paper thumbnail of Improving quality of life in pancreatic cancer patients following high-intensity focused ultrasound (HIFU) in two European centers

European Radiology, 2021

Pancreatic cancer patients often have a high symptom burden, significantly impairing patients’ qu... more Pancreatic cancer patients often have a high symptom burden, significantly impairing patients’ quality of life (QOL). Nevertheless, there are hardly any reports on the impact of high-intensity focused ultrasound (HIFU) on the QOL of treated patients. For the first time, this study evaluated the effect of HIFU on QOL and compared these results in two European centers. Eighty patients with advanced pancreatic cancer underwent HIFU (50 in Germany, 30 in Bulgaria). Clinical assessment included evaluation of QOL and symptoms using the EORTC QLQ-C30 questionnaire at baseline and 1, 3, and 6 months after HIFU. Pain intensity was additionally evaluated with the numerical rating score (NRS). Compared to baseline, global health significantly improved 3 and 6 months after HIFU treatment (p = 0.02). Functional subscales including physical, emotional, and social functioning were considerably improved at 6 months (p = 0.02, p = 0.01, and p = 0.01, respectively) as were leading symptom pain (p = 0.04 at 6 months), fatigue (p = 0.03 at 3 and p = 0.01 at 6 months), and appetite loss (p = 0.01 at 6 months). Moreover, pain intensity measured by NRS revealed effective and strong pain relief at all time points (p < 0.001). Reported effects were independent of tumor stage, metastatic status, and country of treatment. This study showed that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL by increasing global health and mitigation of physical complaints with a low rate of side effects, independent of the examiner. Therefore, HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease. • In a prospective two-center study, it was shown that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL. • HIFU in pancreatic cancer patients is associated with a low rate of side effects, independent of the performer. • HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease.

Research paper thumbnail of Мultimodality Treatment Options for Patients with Advanced Pancreatic Cancer: Chemotherapy Combined with Focused Ultrasound Surgery

European Journal of Surgical Oncology, 2020

Research paper thumbnail of Macroscopic Assessment of Total Mesorectal Excision Quality after Robotic Assisted Rectal Resection for Rectal Cancer in Bulgaria: A Prospective Trial

Journal of Biomedical and Clinical Research, 2017

Summary Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robot... more Summary Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robotic surgery has the potential to minimize the disadvantages of laparoscopic rectal resection. Circumferential margin and macroscopic quality assessment of the resected specimen are the major prognostic factors for local recurrence of the disease. The aim of this study was to research the macroscopic assessment of the quality of TME after robotic-assisted rectal resections for rectal cancer performed in a single center. Data was prospectively collected about macroscopic assessment of the quality of TME in thirteen patients after robotic-assisted rectal resections for rectal cancer between 09.04.2014 and 31.12.2016. After all robotic TMEs, a pathologist made macroscopic assessment of the completeness of the mesorectal excision. The quality of TME was complete in 12 cases and nearly complete in one case. The circumferential and distal resection margins were negative in all cases. The mean nu...

Research paper thumbnail of IMAGINE: Ileus Management International

Journal of Biomedical and Clinical Research, 2017

Research paper thumbnail of Recurrent pancreatic cancer patient treated by chemotherapy and focused ultrasound surgery. A case report

Medical Ultrasonography, 2019

We present a case of recurrent pancreatic cancer diagnosed by computer tomography (CT) and positr... more We present a case of recurrent pancreatic cancer diagnosed by computer tomography (CT) and positron emission tomography(PET), 7 months after Whipple radical surgery in a 61-year-old female patient. The patient was successfully treated byfocused ultrasound surgery (FUS) by innovative high intensity focused ultrasound device. The patient had no complications.Multiple cycles of chemotherapy were done. Twelve months after FUS the new PET-CT showed no evidence of metabolite activezone in the area of ablation and no progression of disease. The presented case is unique according to the literature as a localrecurrence after radical surgery for pancreatic cancer, successfully managed by local FUS ablation and adjuvant chemotherapy.

Research paper thumbnail of Clinical Safety of Focused Ultrasound Surgery in the Treatment of Advanced Pancreatic Cancer Patients - Single Center Prospective Study

Journal of IMAB - Annual Proceeding (Scientific Papers), 2019

Our purpose is to study the clinical safety of focused ultrasound surgery (FUS) in the treatment ... more Our purpose is to study the clinical safety of focused ultrasound surgery (FUS) in the treatment of patients with advanced pancreatic cancer. Methods: A single-center prospective study was conducted in the period 02. 2013-06. 2018 at HIFU department at University hospital St. Marina-Pleven, Bulgaria looking at the postoperative complications after focused ultrasound surgery of advanced pancreatic cancer patients. Results: 47 patients were included in the study with a III or IV stage pancreatic cancer. The complication rate was 10.6% and no severe complications were observed. Conclusions: FUS seems to be a safe method of treating patients with advanced pancreatic cancer. Large randomized trials in the area are needed.

Research paper thumbnail of Efficacy and safety of high-intensity focused ultrasound ablation for hepatocellular carcinoma by changing the acoustic environment: microbubble contrast agent (SonoVue) and transcatheter arterial chemoembolization

International Journal of Hyperthermia, 2019

Research paper thumbnail of Evaluierung der retroareolaren Farbstoffinjektion bei der Sentinellymphknotenbiopsie durch Doppelfarbstoffmethode

Senologie - Zeitschrift für Mammadiagnostik und -therapie, 2005

Research paper thumbnail of Challenges and Variables Affecting the Success of Sentinel Lymph Node Biospy in Malignant Melanoma a 4-Year Analysis of Clinical Results

Journal of Biomedical and Clinical Research, 2013

SummaryIn the last 15 years, sentinel lymph node biopsy (SLNB) for patients with malignant melano... more SummaryIn the last 15 years, sentinel lymph node biopsy (SLNB) for patients with malignant melanoma (MM) has been introduced into the clinical practice. Our aim was to make a retrospective analysis of clinical results in order to assess the success ratio of SLNB and the variables affecting it in MM patients, treated in the Oncology Center at the University Hospital “Dr George Stranski” - Pleven, Bulgaria for a 4-year period. A research index card was used to process the oncologic files of 82 out of 102 patients with MM, treated and monitored at the Oncology centre between 01.01.2008 and 31.12.2011. TNM-stages, Breslow and Clark levels, location, characteristics of the skin lesion, diagnostic excision, type of lymph node dissection, number of SLN, localization of SLN, etc. were registered in the index card. SLNB staging was carried out in 28 patients. Sentinel lymph nodes were found in 22 of them. The success ratio of the method was 78.6%. Histologically, metastatic SLN were found in...

Research paper thumbnail of Ultrasound Ablation in Advanced Pancreatic Cancer Patients – What should be the Next Step?

Pancreas - Open Journal, 2016

Research paper thumbnail of A Rare Case Of A Trans-Stomal Hernia, Combined With Undiagnosed Mediastinal Lymphadenopathy In A Patient With Rectal Cancer

Journal of Biomedical and Clinical Research, 2015

SummaryColon cancer is one of the most common malignant diseases with high grade of malignancy an... more SummaryColon cancer is one of the most common malignant diseases with high grade of malignancy and mortality at high rate. Approximately one million people are diagnosed with colorectal cancer each year. Metastases affect mostly the liver, followed by the lungs. Here is a rare case of a patient with rectal cancer without disease progression or recurrence who underwent surgery due to a trans-stomal hernia, combined with high transstomal fistula of the ileum. Acute respiratory failure developed in the postoperative period and led to fatal deterioration as a result of enlarged metastatic mediastinal lymph nodes, which was very difficult to diagnose.

Research paper thumbnail of sj-zipx-1-fao-10.1177_24730114211061405 – Supplemental material for Comparison of Outcomes Between Suture Button Technique and Screw Fixation Technique in Patients With Acute Syndesmotic Diastasis: A Meta-analysis of Randomized Controlled Trials

Supplemental material, sj-zipx-1-fao-10.1177_24730114211061405 for Comparison of Outcomes Between... more Supplemental material, sj-zipx-1-fao-10.1177_24730114211061405 for Comparison of Outcomes Between Suture Button Technique and Screw Fixation Technique in Patients With Acute Syndesmotic Diastasis: A Meta-analysis of Randomized Controlled Trials by Nikolai Ramadanov, Simon Bueschges and Dobromir Dimitrov in Foot & Ankle Orthopaedics

Research paper thumbnail of Is high-intensity focused ultrasound (HIFU) an option for neoadjuvant therapy for borderline resectable pancreatic cancer patients? – a systematic review

International Journal of Hyperthermia, 2021

Abstract Introduction Pancreatic cancer is with the poorest prognosis of all common cancers world... more Abstract Introduction Pancreatic cancer is with the poorest prognosis of all common cancers worldwide. Despite the advances in treatment the results are poor throughout the different methods. Pancreatic resection still yields the best outcome. However only a quarter of the patients present at operable stage. HIFU is a noninvasive technique that can be used to treat pancreatic cancer. Aim The aim of this review is to perform a systematic review on the data about the resection rate after HIFU ablation in patients with borderline resectable pancreatic cancer (BRPC) and the impact of this technique over the oncological results. Materials and methods The PubMed and Wanfang databases were searched using keywords: pancreatic cancer, HIFU ablation and high-intensity focused ultrasound. All found articles were reviewed. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard guidelines. This study was financially supported by 2019 ‘Kuan-Ren Elite’ Program of 2nd Affiliated Hospital of Chongqing Medical University, China (Grant no. KY2019G019). Results The English database search showed 109 papers, of which 3 met the inclusion criteria. The Wanfang database resulted in 110 papers; however, none met the inclusion criteria of the review. From the included studies 97 patients underwent neoadjuvant HIFU ablation ± chemotherapy. Thirty-four patients reached resection (35.1%). In two patients, residual tumor (R) classification was not reported. R0 resection rate in all reported patients is 30.5% (29/95). R1 resection rate is 3.2% (3/95). Conclusion HIFU is found to be safe and feasible in locally advanced and metastatic pancreatic cancer with proven downstaging and downsizing effects. Further research on role of HIFU ablation as a neoadjuvant treatment for borderline resectable pancreatic cancer is needed.

Research paper thumbnail of The Use of Ultrasound Guided High Intensity Focused Ultrasound (Hifu) in the Treatment of Uterine Fibroids: An Overview

Wiadomości Lekarskie, 2022

Uterine fibroids are the most common benign gynecological neoplasms, with a higher prevalence in ... more Uterine fibroids are the most common benign gynecological neoplasms, with a higher prevalence in women aged between 30 and 50 years old. Fibroids may be asymptomatic, but in some cases, they can affect seriously the quality of life of the patients. In some cases, we can recommend expectant management for asymptomatic patients. Management depends on the size and location of fibroids, the age of the patient, symptoms, desire for future childbearing and the experience of the gynecologist. Medical therapy includes hormonal contraceptives, tranexamic acid, and nonsteroidal anti-inflammatory drugs (reduce heavy menstrual bleeding). Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators are used mostly preoperatively. Surgical treatment includes hysterectomy, myomectomy – invasive and minimally invasive. Non-surgical management include uterine artery embolization, and focused ultrasound surgery.This review aims to present the role of High-Intensity Focused Ul...

Research paper thumbnail of Treatment of Patient with Uterine Fibroid Using Focused Ultrasound Surgery - Clinical Case

Research paper thumbnail of Ultrasound guided high intensity focused ultrasound for advanced pancreatic cancer: A comparative study between Chinese and Bulgarian patients

Objective: This study is to determine the efficacy of the Chinese clinical program of Ultrasound ... more Objective: This study is to determine the efficacy of the Chinese clinical program of Ultrasound Guided High-Intensity Focused Ultrasound (USgHIFU) in the Bulgarian patients with advanced pancreatic adenocarcinoma. Methods: Patients with advanced pancreatic adenocarcinoma from China and Bulgaria were enrolled in the study. All patients received the same clinical procedure of USgHIFU treatment and follow-up. The patient characteristics, the USgHIFU treatment and evaluation parameters including complications, Visual Analogue Scale (VAS) pain scores, tumor size, serum CA19-9 levels, survival rates and survival times were comparatively studied in Chinese and Bulgarian patients. Results: There was no significant difference in clinical parameters of Chinese and Bulgarian patients with advanced pancreatic adenocarcinoma, such as the ratio of male/female, mean age, tumor size, and TNM stage. Similarly, no statistical significance was found in USgHIFU procedure including treatment time, the ...

Research paper thumbnail of Introducing clinical protocol for ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids in patients in Europe, provided from experienced Chinese center-prospective comparative

Biomedical Research, 2018

Introduction: This study aims to determine whether the Chinese clinical protocol, ultrasound guid... more Introduction: This study aims to determine whether the Chinese clinical protocol, ultrasound guided high-intensity focused ultrasound (USgHIFU) combined with real-time monitoring using a contrast enhanced ultrasound (CEUS), also applies well in European patients with uterine fibroids. Methods: Seventy-five patients with 87 nodules of uterine fibroids from China and Bulgaria were treated with USgHIFU from April 2015 to July 2016, in the study. In Group A (Bulgarian) 26 (33 nodules) patients and in group B (Chinese) 49 (54 nodules) patients were included in the study. The same clinical procedure of USgHIFU treatment as well as a follow-up was performed on patients from China and Bulgaria. The general characteristics of the patients, the USgHIFU treatment and evaluation parameters, including; complications, fibroid size, tumor volume, subcutaneous fat size, non-perfused volume (NPV) and shrinkage process, were comparatively studied in Chinese and Bulgarian patients. Results: There were no significant differences in clinical parameters of Chinese and Bulgarian patients with uterine fibroids, such as vertical, left-right and аnterior-posterior size, treatment time, USgHIFU time. After USgHIFU treatment, no complications were recorded in both groups. On the 6 th and 12 th month after USgHIFU, fibroid nodules shrunk and the NPV was statistically significant compared to NPV before USgHIFU, but there were no statistically significant differences. Conclusions: The initial results of our study showed that CEUS clinical protocol for real time monitoring of efficacy and quality of the USgHIFU for uterine fibroid treatment that had been used in Chinese centers may also be applicable for European patients.

Research paper thumbnail of Clinical Effectiveness and Complication Rate of Core Needle Breast Biopsy

Introduction: Core needle biopsy is a standard method in breast cancer diagnosis. It gives infor... more Introduction: Core needle biopsy is a standard method in breast cancer diagnosis. It gives information about the breast cancer type, the hormone receptor and HER2 status, which determines the further behavior and treatment. Our aim is to establish the effectiveness of the core needle biopsy and the complications that might follow. Materials and Methods: A retrospective clinical study of all patients with suspicious for malignancy breast mass who have undergone core needle biopsy followed by operative treatment between January 2014 and December 2015 at UMHAT `Georgi Stranski` - Pleven, was undertaken. Core needle biopsy was performed using a Tru-cut gun with an 18-gauge needle. The lesion was manually immobilized and the needle was inserted under visual control or ultrasound guided. Results: A total of 79 Tru-cut biopsies followed by operative treatment were performed on patients with palpable lesions during the study period. All of the patients were women. The median age was 64 ...

Research paper thumbnail of A meta-analysis on RCTs of direct anterior and conventional approaches in total hip arthroplasty

Scientific Reports, 2021

To conduct a systematic review and meta-analyses on short-term outcomes between total hip arthrop... more To conduct a systematic review and meta-analyses on short-term outcomes between total hip arthroplasty (THA) through direct anterior approach (DAA) compared to THA through conventional approaches (CAs) in treatment of hip diseases and fractures. We performed a systematic literature search up to March 1, 2021 to identify RCTs, comparing THA through DAA with THA through CAs. We calculated mean differences (MDs) with 95% confidence intervals (CIs) for continuous outcomes, using the DerSimonian and Laird method and a random effects model. We calculated odds ratios (ORs) with 95% CIs for dichotomous outcomes, using the Mantel–Haenszel method and a random effects model. Ten RCTs met the criteria for final meta-analysis, involving 1053 patients. Four studies were blinded RCTs with a level I evidence, the other 6 studies were non-blinded RCTs with a level II evidence. DAA had a longer operation time than CAs (MD = 17.8, 95% CI 4.8 to 30.8); DAA had similar results compared to CAs for incis...

Research paper thumbnail of Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

The Lancet, 2021

Summary Background 80% of individuals with cancer will require a surgical procedure, yet little c... more Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.

Research paper thumbnail of Improving quality of life in pancreatic cancer patients following high-intensity focused ultrasound (HIFU) in two European centers

European Radiology, 2021

Pancreatic cancer patients often have a high symptom burden, significantly impairing patients’ qu... more Pancreatic cancer patients often have a high symptom burden, significantly impairing patients’ quality of life (QOL). Nevertheless, there are hardly any reports on the impact of high-intensity focused ultrasound (HIFU) on the QOL of treated patients. For the first time, this study evaluated the effect of HIFU on QOL and compared these results in two European centers. Eighty patients with advanced pancreatic cancer underwent HIFU (50 in Germany, 30 in Bulgaria). Clinical assessment included evaluation of QOL and symptoms using the EORTC QLQ-C30 questionnaire at baseline and 1, 3, and 6 months after HIFU. Pain intensity was additionally evaluated with the numerical rating score (NRS). Compared to baseline, global health significantly improved 3 and 6 months after HIFU treatment (p = 0.02). Functional subscales including physical, emotional, and social functioning were considerably improved at 6 months (p = 0.02, p = 0.01, and p = 0.01, respectively) as were leading symptom pain (p = 0.04 at 6 months), fatigue (p = 0.03 at 3 and p = 0.01 at 6 months), and appetite loss (p = 0.01 at 6 months). Moreover, pain intensity measured by NRS revealed effective and strong pain relief at all time points (p < 0.001). Reported effects were independent of tumor stage, metastatic status, and country of treatment. This study showed that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL by increasing global health and mitigation of physical complaints with a low rate of side effects, independent of the examiner. Therefore, HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease. • In a prospective two-center study, it was shown that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL. • HIFU in pancreatic cancer patients is associated with a low rate of side effects, independent of the performer. • HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease.

Research paper thumbnail of Мultimodality Treatment Options for Patients with Advanced Pancreatic Cancer: Chemotherapy Combined with Focused Ultrasound Surgery

European Journal of Surgical Oncology, 2020

Research paper thumbnail of Macroscopic Assessment of Total Mesorectal Excision Quality after Robotic Assisted Rectal Resection for Rectal Cancer in Bulgaria: A Prospective Trial

Journal of Biomedical and Clinical Research, 2017

Summary Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robot... more Summary Total mesorectal excision (TME) is a standard surgical procedure for rectal cancer. Robotic surgery has the potential to minimize the disadvantages of laparoscopic rectal resection. Circumferential margin and macroscopic quality assessment of the resected specimen are the major prognostic factors for local recurrence of the disease. The aim of this study was to research the macroscopic assessment of the quality of TME after robotic-assisted rectal resections for rectal cancer performed in a single center. Data was prospectively collected about macroscopic assessment of the quality of TME in thirteen patients after robotic-assisted rectal resections for rectal cancer between 09.04.2014 and 31.12.2016. After all robotic TMEs, a pathologist made macroscopic assessment of the completeness of the mesorectal excision. The quality of TME was complete in 12 cases and nearly complete in one case. The circumferential and distal resection margins were negative in all cases. The mean nu...

Research paper thumbnail of IMAGINE: Ileus Management International

Journal of Biomedical and Clinical Research, 2017

Research paper thumbnail of Recurrent pancreatic cancer patient treated by chemotherapy and focused ultrasound surgery. A case report

Medical Ultrasonography, 2019

We present a case of recurrent pancreatic cancer diagnosed by computer tomography (CT) and positr... more We present a case of recurrent pancreatic cancer diagnosed by computer tomography (CT) and positron emission tomography(PET), 7 months after Whipple radical surgery in a 61-year-old female patient. The patient was successfully treated byfocused ultrasound surgery (FUS) by innovative high intensity focused ultrasound device. The patient had no complications.Multiple cycles of chemotherapy were done. Twelve months after FUS the new PET-CT showed no evidence of metabolite activezone in the area of ablation and no progression of disease. The presented case is unique according to the literature as a localrecurrence after radical surgery for pancreatic cancer, successfully managed by local FUS ablation and adjuvant chemotherapy.

Research paper thumbnail of Clinical Safety of Focused Ultrasound Surgery in the Treatment of Advanced Pancreatic Cancer Patients - Single Center Prospective Study

Journal of IMAB - Annual Proceeding (Scientific Papers), 2019

Our purpose is to study the clinical safety of focused ultrasound surgery (FUS) in the treatment ... more Our purpose is to study the clinical safety of focused ultrasound surgery (FUS) in the treatment of patients with advanced pancreatic cancer. Methods: A single-center prospective study was conducted in the period 02. 2013-06. 2018 at HIFU department at University hospital St. Marina-Pleven, Bulgaria looking at the postoperative complications after focused ultrasound surgery of advanced pancreatic cancer patients. Results: 47 patients were included in the study with a III or IV stage pancreatic cancer. The complication rate was 10.6% and no severe complications were observed. Conclusions: FUS seems to be a safe method of treating patients with advanced pancreatic cancer. Large randomized trials in the area are needed.

Research paper thumbnail of Efficacy and safety of high-intensity focused ultrasound ablation for hepatocellular carcinoma by changing the acoustic environment: microbubble contrast agent (SonoVue) and transcatheter arterial chemoembolization

International Journal of Hyperthermia, 2019

Research paper thumbnail of Evaluierung der retroareolaren Farbstoffinjektion bei der Sentinellymphknotenbiopsie durch Doppelfarbstoffmethode

Senologie - Zeitschrift für Mammadiagnostik und -therapie, 2005

Research paper thumbnail of Challenges and Variables Affecting the Success of Sentinel Lymph Node Biospy in Malignant Melanoma a 4-Year Analysis of Clinical Results

Journal of Biomedical and Clinical Research, 2013

SummaryIn the last 15 years, sentinel lymph node biopsy (SLNB) for patients with malignant melano... more SummaryIn the last 15 years, sentinel lymph node biopsy (SLNB) for patients with malignant melanoma (MM) has been introduced into the clinical practice. Our aim was to make a retrospective analysis of clinical results in order to assess the success ratio of SLNB and the variables affecting it in MM patients, treated in the Oncology Center at the University Hospital “Dr George Stranski” - Pleven, Bulgaria for a 4-year period. A research index card was used to process the oncologic files of 82 out of 102 patients with MM, treated and monitored at the Oncology centre between 01.01.2008 and 31.12.2011. TNM-stages, Breslow and Clark levels, location, characteristics of the skin lesion, diagnostic excision, type of lymph node dissection, number of SLN, localization of SLN, etc. were registered in the index card. SLNB staging was carried out in 28 patients. Sentinel lymph nodes were found in 22 of them. The success ratio of the method was 78.6%. Histologically, metastatic SLN were found in...

Research paper thumbnail of Ultrasound Ablation in Advanced Pancreatic Cancer Patients – What should be the Next Step?

Pancreas - Open Journal, 2016

Research paper thumbnail of A Rare Case Of A Trans-Stomal Hernia, Combined With Undiagnosed Mediastinal Lymphadenopathy In A Patient With Rectal Cancer

Journal of Biomedical and Clinical Research, 2015

SummaryColon cancer is one of the most common malignant diseases with high grade of malignancy an... more SummaryColon cancer is one of the most common malignant diseases with high grade of malignancy and mortality at high rate. Approximately one million people are diagnosed with colorectal cancer each year. Metastases affect mostly the liver, followed by the lungs. Here is a rare case of a patient with rectal cancer without disease progression or recurrence who underwent surgery due to a trans-stomal hernia, combined with high transstomal fistula of the ileum. Acute respiratory failure developed in the postoperative period and led to fatal deterioration as a result of enlarged metastatic mediastinal lymph nodes, which was very difficult to diagnose.