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Article ; Online: An Intra-Hospital Spread of Colistin-Resistant

Popivanov, Georgi / Markovska, Rumyana / Gergova, Ivanka / Konaktchieva, Marina / Cirocchi, Roberto / Kjossev, Kirien / Mutafchiyski, Ventsislav

Medicina (Kaunas, Lithuania)

2024 Volume 60, Issue 3

Abstract: Background and Objective: Klebsiella ... ...

Abstract	Background and Objective: Klebsiella pneumoniae
MeSH term(s)	Humans ; Colistin/pharmacology ; Colistin/therapeutic use ; Klebsiella pneumoniae/genetics ; Klebsiella Infections/drug therapy ; Klebsiella Infections/epidemiology ; Drug Resistance, Bacterial/genetics ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Carbapenems/therapeutic use ; Hospitals ; beta-Lactamases/genetics
Chemical Substances	Colistin (Z67X93HJG1) ; Anti-Bacterial Agents ; Carbapenems ; beta-Lactamases (EC 3.5.2.6)
Language	English
Publishing date	2024-03-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina60030511
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Article: Localized retroperitoneal Rosai-Dorfman-Destombes disease as a cause of fever of unknown origin in adults. Case report and review of the literature.

Popivanov, Georgi / Baymakova, Magdalena / Bochev, Pavel / Penchev, Dimitar / Konaktchieva, Marina / Mutafchiyski, Ventsislav

International journal of surgery case reports

2022 Volume 97, Page(s) 107414

Language	English
Publishing date	2022-07-19
Publishing country	Netherlands
Document type	Journal Article
ISSN	2210-2612
ISSN	2210-2612
DOI	10.1016/j.ijscr.2022.107414
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Article ; Online: Successful Negative Pressure Therapy of Enteroatmospheric Fistula after Right Colectomy for Complicated Crohn's Disease -A Proposal for a Three-Drain Wound-Separation Technique.

Popivanov, Georgi / Cirocchi, Roberto / Penchev, Dimitar / Kjossev, Kirien / Konaktchieva, Marina / Mutafchiyski, Ventsislav

Medicina (Kaunas, Lithuania)

2022 Volume 58, Issue 2

Abstract: Enteroatmospheric fistulas (EAFs) are still the worst complication of the open abdomen. They lead to a significantly prolonged intensive care unit and hospital stay and to high mortality. Despite the various techniques described in the literature EAFs ... ...

Abstract	Enteroatmospheric fistulas (EAFs) are still the worst complication of the open abdomen. They lead to a significantly prolonged intensive care unit and hospital stay and to high mortality. Despite the various techniques described in the literature EAFs remain "a nightmare" for the patient, the surgeon, and the hospital. Here we describe a case of right colectomy for obstructing Crohn's disease in a 26-year-old. On the 19th postoperative day, he developed a superficial EAF. Due to the frozen abdomen, neither resection of the anastomosis, nor implementation of the known techniques for treatment of EAFs were possible. This prompted us to modify the Pepe technique. The EAF was isolated from the upper and lower parts of the wound through deep-skin and subcutaneous sutures and the application of two small pieces of non-adherent plastic foil. The lower holes of a single drain, put through a piece of black foam, were placed over the fistula. The upper holes, which were enveloped with the foam, remained in contact with the wound. The drain was connected to a negative pressure of 125 mmHg. NPWT (negative pressure wound therapy) was also applied by two separate sponges and drains in the upper and lower part. The mainstay of EAF treatment is the isolation of the EAF from the abdominal cavity and subcutaneous tissue, supported by control of the sepsis and adequate nutrition. The proposed technique is applicable in cases with a single, superficial EAF on the background of the frozen abdomen with minimal lateral fascial retraction. As of today, due to the rarity of the condition and lack of randomized trials, EAFs still represents a unique challenge often requiring improvisation.
MeSH term(s)	Abdominal Wound Closure Techniques/adverse effects ; Adult ; Colectomy/adverse effects ; Crohn Disease/complications ; Crohn Disease/surgery ; Humans ; Intestinal Fistula/etiology ; Intestinal Fistula/surgery ; Male ; Treatment Outcome
Language	English
Publishing date	2022-01-28
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina58020199
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Article ; Online: Delayed diagnosis of parathyroid cancer manifested with pubic bone lesions and chronic kidney failure. Tricks and pitfalls of management.

Popivanov, Georgi / Daskalova, Ivon / Zlatev, Borislav / Piperkova, Elena / Konaktchieva, Marina / Ivanova, Stefka / Tabakov, Mihail / Kjosev, Kirien / Dimova, Ivanka / Mutafchiyski, Ventsislav

Annali italiani di chirurgia

2023 Volume 12

Abstract: Introduction: Parathyroid cancer (PTC) is an extremely rare malignancy with an incidence of 5.7 per 10 million people. The exact preoperative or intraoperative diagnosis is difficult, but of paramount importance, because resection with negative margins ... ...

Abstract	Introduction: Parathyroid cancer (PTC) is an extremely rare malignancy with an incidence of 5.7 per 10 million people. The exact preoperative or intraoperative diagnosis is difficult, but of paramount importance, because resection with negative margins is the only effective treatment. Case report: A 46-years-old female was referred from another hospital with a diagnosis of "hyper-functioning thyroid nodule", based on the ultrasound showing a lesion of the right thyroid lobe and elevated FT4. At the admission, she had severe pain in the right inguinal area, fatigue, muscle weakness, and excessive diuresis. The blood assay demonstrated serum calcium of 4.02 mmol/l, parathyroid hormone of 1433.2 pg/ml, FT4 of 17.49 pmol/l, creatinine of 296 μmol/l. CT showed a tumor of the right thyroid lobe with a size of 2.5. A right lobectomy was performed. Right parathyroid glands were not found. Because of the constellation for hyperparathyroidism and suspicion of parathyroid malignancy ipsilateral and central lymph node dissection and partial removal of the right sternothyroid muscle were performed, which correlated with a significant intraoperative drop in the parathyroid hormone. Three months later, a re-resection was performed because of SPECT-CT evidence for residual parathyroid tissue. Conclusion: The timely diagnosis of PTC is a prerequisite for a good outcome. The best preoperative indicators are serum parathyroid hormone > 4 times above the upper limit, serum calcium > 14 mg/dL, a palpable neck mass, and a local invasion found intraoperatively. The only curative treatment is the complete removal of the tumor with a negative margin. Key words: Delayed diagnosis, Hyperparathyroidism, Parathyroid cancer, Surgery.
MeSH term(s)	Female ; Humans ; Middle Aged ; Parathyroid Neoplasms/complications ; Parathyroid Neoplasms/diagnosis ; Parathyroid Neoplasms/surgery ; Calcium ; Delayed Diagnosis ; Pubic Bone ; Precancerous Conditions ; Kidney Failure, Chronic
Chemical Substances	Calcium (SY7Q814VUP)
Language	English
Publishing date	2023-07-18
Publishing country	Italy
Document type	Case Reports ; Journal Article
ZDB-ID	418927-9
ISSN	2239-253X ; 0003-469X
ISSN (online)	2239-253X
ISSN	0003-469X
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Article ; Online: Perirectal hematoma after stapled surgery for hemorrhoidal prolapse and obstructed defecation syndrome: case series management to avoid panic-guided treatment.

Mascagni, Domenico / Eberspacher, Chiara / Naldini, Gabriele / Arcieri, Francesco Leone / Mascagni, Pietro / Cirocchi, Roberto / Popivanov, Georgi / Sileri, Pierpaolo / Arcieri, Stefano

Updates in surgery

2023 Volume 75, Issue 3, Page(s) 627–634

Abstract: Perirectal hematoma (PH) is one of the most feared complications of stapling procedures. Literature reviews have reported only a few works on PH, most of them describing isolated treatment approaches and severe outcomes. The aim of this study was to ... ...

Abstract	Perirectal hematoma (PH) is one of the most feared complications of stapling procedures. Literature reviews have reported only a few works on PH, most of them describing isolated treatment approaches and severe outcomes. The aim of this study was to analyze a homogenous case series of PH and to define a treatment algorithm for huge postoperative PHs. A retrospective analysis of a prospective database of three high-volume proctology units was performed between 2008 and 2018, and all PH cases were analyzed. In all, 3058 patients underwent stapling procedures for hemorrhoidal disease or obstructed defecation syndrome with internal prolapse. Among these, 14 (0.46%) large PH cases were reported, and 12 of these hematomas were stable and treated conservatively (antibiotics and CT/laboratory test monitoring); most of them were resolved with spontaneous drainage. Two patients with progressive PH (signs of active bleeding and peritonism) were submitted to CT and arteriography to evaluate the source of bleeding, which was subsequently closed by embolization. This approach helped ensure that no patients with PH were referred for major abdominal surgery. Most PH cases are stable and treatable with a conservative approach, evolving with self-drainage. Progressive hematomas are rare and should undergo angiography with embolization to minimize the possibility of major surgery and severe complications.
MeSH term(s)	Humans ; Hemorrhoids/surgery ; Defecation ; Retrospective Studies ; Surgical Stapling/adverse effects ; Surgical Stapling/methods ; Prolapse ; Hematoma/etiology ; Hematoma/therapy ; Treatment Outcome ; Postoperative Complications/therapy ; Postoperative Complications/surgery
Language	English
Publishing date	2023-03-10
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2572692-4
ISSN	2038-3312 ; 2038-131X
ISSN (online)	2038-3312
ISSN	2038-131X
DOI	10.1007/s13304-023-01490-y
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Article ; Online: Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery

Fedeli Piergiorgio / Justin Davies Richard / Cirocchi Roberto / Popivanov Georgi / Bruzzone Paolo / Giustozzi Michela

Open Medicine, Vol 15, Iss 1, Pp 709-

2020 Volume 713

Abstract: Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin ... ...

Abstract	Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke’s encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke’s encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke’s encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke’s encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.
Keywords	wernicke’s encephalopathy ; parenteral nutrition ; malpractice ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	De Gruyter
Document type	Article ; Online
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Article: The Dilemma of the Level of the Inferior Mesenteric Artery Ligation in the Treatment of Diverticular Disease: A Systematic Review of the Literature.

Cirocchi, Roberto / Mari, Giulio / Amato, Bruno / Tebala, Giovanni Domenico / Popivanov, Georgi / Avenia, Stefano / Nascimbeni, Riccardo

Journal of clinical medicine

2022 Volume 11, Issue 4

Abstract: Background and aim: Although sigmoidectomy is a well-standardized procedure for diverticular disease, there are still unclear areas related to the varying morphology and vascular supply of the sigmoid colon. The level of vascular ligation could affect ... ...

Abstract	Background and aim: Although sigmoidectomy is a well-standardized procedure for diverticular disease, there are still unclear areas related to the varying morphology and vascular supply of the sigmoid colon. The level of vascular ligation could affect the functional outcomes of patients operated on for diverticular disease. The aim of this review is to primarily evaluate sexual, urinary and defecatory function outcomes, as well as postoperative results, in patients who underwent surgery for diverticular disease, with or without inferior mesenteric artery (IMA) preservation. Materials and methods: The MEDLINE/PubMed, WOS and Scopus databases were interrogated. Comparative studies including patients who underwent sigmoidectomy for diverticular diseases were considered. Bowel function, genitourinary function, anastomotic leak, operation time, conversion to open surgery, anastomotic bleeding, bowel obstruction were the main items of interest. Results: Twelve studies were included in the review, three randomized and nine comparative studies. Bowel and genitourinary function are not differently affected by the level of vascular ligation. The site of ligation of IMA did not influence the rate of functional complications, anastomotic leak and bleeding. Of note, the preservation of IMA is associated with a higher conversion rate and longer operative time. Conclusions: Despite the heterogeneity of patient groups, and although the findings should be interpreted with caution, functional and clinical outcomes after sigmoidectomy for diverticular disease do not seem to be affected by the level of vascular ligation as long as the IMA is ligated far from its origin.
Language	English
Publishing date	2022-02-10
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm11040917
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Article ; Online: Intraductal Papillary Mucinous Neoplasm of the Pancreas: Need for a Tailored Approach to a Rare Entity.

Konaktchieva, Marina / Penchev, Dimitar / Popivanov, Georgi / Vladova, Lilia / Cirocchi, Roberto / Penkov, Marin / Karagyozov, Petko / Mutafchiyski, Ventsislav

Folia medica

2022 Volume 63, Issue 6, Page(s) 970–976

Abstract: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new entity that has gained increased attention because of its unique features - presence of different subtypes with different malignant potential, biological behavior, and ... ...

Abstract	Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a relatively new entity that has gained increased attention because of its unique features - presence of different subtypes with different malignant potential, biological behavior, and prognosis, higher rates of recurrences and concomitant or metachronous pancreatic duct cancer. It is rare with an incidence of 4 to 5 cases per 100 000. The relative lack of experience significantly hampers decision making for surgery (pancreatic head resection, distal pancreatectomy or enucleation) or follow-up.Herein we present two cases managed by diametrically different tactic according to the risk stratification - distal pancreatectomy with splenectomy and observation, respectively. An up-to-date literature review on the key points in diagnostics, indications for surgery, the extent of surgery, follow-up, and prognosis is provided.The tailored approach based on risk stratification is the cornerstone of management. Absolute indications for surgery are the lesions with high-risk stigmata, whereas the worrisome features should be evaluated by endoscopic ultrasound and fine-needle aspiration. Main duct and mixed type are usually referred to surgery, whereas the management of a branch type is more conservative due to the lower rate of invasive cancer. Strict postoperative follow-up is mandatory even in negative resection margins due to a high risk for recurrences and metachronous lesions.Despite the guidelines, the intraductal papillary mucinous neoplasm remains a major challenge for clinicians and surgeons in the balance the risk/benefit of observation versus resection. Risk stratification plays a key role in decision-making. Future trials need to determine the optimal period of surveillance and the most reliable predictive factors for concomitant pancreatic duct cancer.
MeSH term(s)	Adenocarcinoma, Mucinous/diagnosis ; Adenocarcinoma, Mucinous/pathology ; Adenocarcinoma, Mucinous/surgery ; Carcinoma, Pancreatic Ductal/diagnosis ; Carcinoma, Pancreatic Ductal/pathology ; Carcinoma, Pancreatic Ductal/surgery ; Humans ; Pancreas/pathology ; Pancreas/surgery ; Pancreatectomy ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery ; Recurrence ; Retrospective Studies
Language	English
Publishing date	2022-07-18
Publishing country	Bulgaria
Document type	Journal Article ; Review
ZDB-ID	300275-5
ISSN	1314-2143 ; 0430-8638 ; 0204-8043
ISSN (online)	1314-2143
ISSN	0430-8638 ; 0204-8043
DOI	10.3897/folmed.63.e63071
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Article ; Online: Two distinct episodes of life-threatening hemobilia due to a lesion of common bile duct and delayed intrapancreatic arteriobiliary fistula managed by emergency pancreatoduodenal resection.

Popivanov, Georgi / Vladov, Nicola / Penchev, Dimitar / Konaktchieva, Marina / Ilcheva, Boriana / Kostadinov, Radoslav / Nikolov, Vladimir / Stefanov, Daniel / Mutafchiyski, Ventsislav

Folia medica

2022 Volume 64, Issue 2, Page(s) 359–364

Abstract: Hemobilia is an extremely rare cause of upper gastrointestinal bleeding. It often has intermittent manifestation, which may lead to significant diagnostic delay. In 65% of the cases, the causes are iatrogenic, in 7% the cause is malignancy, in 5% - ... ...

Abstract	Hemobilia is an extremely rare cause of upper gastrointestinal bleeding. It often has intermittent manifestation, which may lead to significant diagnostic delay. In 65% of the cases, the causes are iatrogenic, in 7% the cause is malignancy, in 5% - gallstones, in 8% it is inflammation (cholecystitis, parasites, reflux cholangitis), vascular abnormality is the cause in 7% (most commonly pseudoaneurysm of the hepatic artery), and pancreatic pseudocyst causes hemobilia in 1%. In almost all cases, the bleeding originates from intrahepatic or extrahepatic bile ducts, and rarely from the pancreas.
MeSH term(s)	Common Bile Duct ; Delayed Diagnosis/adverse effects ; Fistula/complications ; Fistula/diagnosis ; Fistula/pathology ; Hemobilia/diagnosis ; Hemobilia/etiology ; Hemobilia/therapy ; Hepatic Artery/diagnostic imaging ; Hepatic Artery/pathology ; Hepatic Artery/surgery ; Humans
Language	English
Publishing date	2022-06-13
Publishing country	Bulgaria
Document type	Journal Article
ZDB-ID	300275-5
ISSN	1314-2143 ; 0430-8638 ; 0204-8043
ISSN (online)	1314-2143
ISSN	0430-8638 ; 0204-8043
DOI	10.3897/folmed.64.e62513
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Article: Total parenteral nutrition-induced Wernicke's encephalopathy after oncologic gastrointestinal surgery.

Fedeli, Piergiorgio / Justin Davies, Richard / Cirocchi, Roberto / Popivanov, Georgi / Bruzzone, Paolo / Giustozzi, Michela

Open medicine (Warsaw, Poland)

2020 Volume 15, Issue 1, Page(s) 709–713

Abstract: Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke's disease is mainly observed in alcoholic patients, due to decreased vitamin ... ...

Abstract	Carl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke's disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke's encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke's encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke's encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke's encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.
Language	English
Publishing date	2020-07-20
Publishing country	Poland
Document type	Case Reports
ZDB-ID	2829380-0
ISSN	2391-5463
ISSN	2391-5463
DOI	10.1515/med-2020-0210
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