Theophil Sedloev

• M.D., PhD
• Medical University of Sofia

Background McKittrick–Wheelock syndrome is an uncommon and severe disorder caused by large hypersecretory tumors located in the distal colorectal area. Excessive secretion from adenomas is an unusual clinical manifestation that leads to severe electrolyte and fluid depletion, subsequently resulting in kidney injury. Successful treatment relies on q...

BACKGROUND Malignant hyperthermia (MH) and anesthesia-induced rhabdomyolysis (AIR) are rare, yet life-threatening complications that need prompt therapeutic actions and logistic preparedness for treatment success. Both conditions are triggered by general anesthetics, particularly volatiles and depolarizing muscle relaxants. In comparison with MH, w...

Necrotizing pancreatitis (NP) is a severe form of acute pancreatitis associated with high morbidity and mortality. The management of infected necrotizing pancreatitis (INP) has evolved from open surgical necrectomy to minimally invasive techniques, such as percutaneous catheter drainage (PCD). We report the case of a 71-year-old male with a history...

Introduction: Neoadjuvant chemotherapy (NACT) has been increasingly used in patients with breast cancer (BC) to achieve downstaging of the primary tumor and metastatic axillary lymph nodes, as well as to achieve an accurate prognostic assessment in these patients. Performing subcutaneous mastectomy with immediate reconstruction in suitable patients...

Laparoscopic treatment of benign biliary diseases, particularly cholelithiasis (gallstone disease), is the first-choice method and the gold standard. However, in complicated forms of cholelithiasis such as Mirizzi syndrome and cholecystoenteric fistulas, the open approach has traditionally been preferred. Internal biliary fistulas are found in only...

Abstract: The incidence of pancreatic pseudocysts (PP) as a complication of acute pancreatitis varies between 5% and 16%. These cysts are well-demarcated fluid collections (typically with high amylase activity), located outside the pancreatic parenchyma, with an oval shape, homogeneous content without solid components, and a "wall" thickness of ove...

Introduction: Restorative proctocolectomy (RPC) is the surgery of choice for patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). Since the beginning of the 21st century, scientific evidence has emerged indicating that there is a group of patients with Crohn's disease who are suitable for this surgical approach. This surg...

Analysis of the prognostic role of the number of cancer foci in Bulgarian patients with multiple breast cancer

Impaired wound healing in diabetic individuals presents a significant clinical challenge, and this study explores the impact of low-temperature microwave plasma in an argon atmosphere, a type of cold atmospheric plasma (CAP), on wound regeneration in diabetic rats. The findings reveal that this CAP treatment accelerates wound regeneration in diabet...

Initial breast cancer staging with unclear local status after mammography and ultrasonography is by guidelines done with magnetic resonance imaging (MRI); however, a diagnostic and methodologic problem arises when MRI is contraindicated or impossible to perform. Deformation, distortion, change of density and location of the mammary glands (includin...

Fine-needle aspiration biopsy (FNAB) is one of the most used techniques for obtaining cytological material for further evaluation. The authors have developed and present a different technique in order to obtain a larger amount of material. In comparison with the standard methods, in FNAB "Modus Spirdonov 1" after achieving a vacuum, rotational move...

Rectovaginal and/or colovaginal fistulas are difficult-to-treat conditions that can cause vaginitis, abnormal flatulence through the vagina, skin excoriations, and more. Depending on the type of fistula, they can be rectovag-inal, anovaginal, colovaginal, enterovaginal, vesicovaginal, ureterovaginal, urethrovaginal, with the most common being vesic...

Ureteral lesions are a rare complication of colorectal surgery. This type of surgical procedure is the second most common cause of such complications, second only to gynecological operations, which account for around 50%. According to the localization of the lesion, they аre grouped into three types: injury to the proximal, middle, and distal part...

Introduction Malignant non-melanoma skin cancers (NMSC) are of two main types: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). In rare occasions, some of the malignant skin lesions show histopathological characteristics of both BCC and SCC and are known as basosquamous carcinomas (BSC). In some cases of large tumors, extensive reconst...

Introduction and importance: Mucocele of the appendix is a rare pathology with an estimated incidence of less than 1 % of all appendectomies. Here is a report of a 67-year-old Bulgarian female, diagnosed with a low-grade appendiceal mucinous neoplasm (LAMN) after immunohistochemical analysis, which changed the therapeutic strategy. Case presentat...

Introduction: We present a case of a 69 years old Bulgarian patient with a Triple Negative (TN) MBC. One year after the Breast-Conserving Surgery (BCS), adjuvant chemo- and radiotherapy she was diagnosed with metastases in the sigmoid colon, mesosigmoid, loco-regional lymph nodes and in the brain. Case report: The patient was initially diagnosed wi...

Introduction: Bilateral BC is a rare clinical presentation with primary synchronous BC occurring in about 0,2–3% incidence of all newly diagnosed cases (Chaudery et al. 1984). Here is a case of an elderly Bulgarian female with locally advanced bilateral BC with different immunohistochemical markers, who was operated in an emergency setting due to a...

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign mesenchymal tumor-like formation of the breast without malignant potential. PASH was first described by Vuitch et al as a grossly circumscribed formation, with a distinct histological appearance. According to the literature this disease has a local recurrence rate of 13-26%. Our patients...

Breast cancer (BC) is a socially significant illness. Radiotherapy (RT) is an important part of the complex treatment of early BC after a breast preserving surgery (BPS). Partial breast irradiation (PBI) has been established as a suitable treatment option for appropriately selected women with early stage BC by numerous clinical trials dating back t...

The immunohistochemical expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) is a routine test in every form of breast cancer. The role of ER and PR in the molecular mechanisms as promotors of tumorigenesis of breast cancer is an object of intensive studying for many years. In comparison, the e...

Background: Desmoid tumors, also known as aggressive fibromatosis, are extremely rare, accounting for less than 3% of soft-tissue sarcomas and less than 0,03% of all neoplasms. The diagnosis is usually delayed because of the lack of specific symptoms, and can sometimes lead to serious and, even fatal complications. Case presentation: We report t...

Background/aim: Metastatic breast cancer (MBC) represents a wide spectrum of heterogeneous conditions with different secondary spread sites, time to relapse and biology. MBC is still considered an incurable disease despite the fact that survival rates have improved in the last years. Cutaneous metastases are a rare site for metastatic spread and i...

The purpose of the paper is to present the imaging findings from magnetic resonance imaging (MRI), mammography and ultrasonography in connection with a female patient with carcinomas of mammary glands (with different, rarely encountered histology) that simultaneously developed in both, left and right breasts. The following conclusions can be drown...

Background: The single nucleotide polymorphisms (SNPs) of the VEGF-A, +936C>T and −634 G>C, have been shown to be important prognostic and predictive factors for breast cancer patients. The aim of the current study was to evaluate the role of these SNPs as a prognostic and risk factors in the Bulgarian population. Material and Methods: An approval...

A case of a 51-year-old woman with mastitis in her right breast 17 years after Augmentation Mammoplasty with PAAG produced in Ukraine is presented, the MRI and mammary US findings are discussed. Solid areas in the background of the non-structural gel are established, hardly to be distinguished from primary mammary lesions. At a control US examinati...

Problem statement: Patients with ductal carcinoma in situ (DCIS) of the breast have excellent prognosis, but ipsilateral breast tumor recurrence (IBTR) after breast conserving surgery (BCS) remains a major concern. The Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram uses 10 clinicopathological characteristics to predict 5- and 10-year prob...

The intraoperative radiotherapy (IORT) is an innovative method for treatment of breast cancer, which can be used as a substitute of postoperative external beam radiotherapy )EBRT), or boost treatment to EBRT (1). Radiobiological advantages of IORT compared to EBRT are higher relative biologic effectiveness of low-dose radiation therapy and the pres...

Appendiceal mucocele (AM) was described for the first time by Rokitansky in 1842.1 Its incidence is 0.2 - 0.4% of all apendectomies performed, as it is observed predominantly in women with the ratio of 4/1 versus men and most frequently at the age of 50.2,3 We present to your attention a 64-year-old woman, who was referred to diagnostic further cla...

The association of juvenile papillomatosis with carcinoma is proven, but very rare, as there exist several reported cases. A 15-year-old girl with no family history of breast cancer presented with two masses in the left breast. The excisional biopsy on both lumps revealed juvenile fibroadenoma and juvenile papillomatosis epithelial proliferation mu...

Background: About 3885 women are diagnosed with breast cancer and 1285 die from the disease each year in Bulgaria. However no genetic testing to identify the mutations in high-risk families has been provided so far. Methods: We evaluated 200 Bulgarian women with primary invasive breast cancer and with personal/ family history of breast cancer fo...

Background: This is the annual report of the project for establishment of a breast cancer biobank at the Molecular Medicine Center, Medical University of Sofia. The aim of this biobank is to collect DNA, plasma, tumour and normal tissues samples, as well as the exact clinical and pathological information of Bulgarian breast cancer patients, and to...

Perineal hernia is the protrusion of intra-abdominal viscerathrough the pelvic floor. We present a patient with recurrentperineal hernia - 12x9 cm with a palpable soft, hardlyadjustable in the pelvic tunnel formation and attenuated skinover it. The patient was operated by abdominoperinealapproach. We performed two layer Titanium mesh plasty ofthe p...

Introduction: Stomach cancer patients have one of the lowest 5-year survival rates from all cancer patients in Europe. The tumor markers like carcinoembryonic antigen (CEA) and carbohydrate antigen 72-4 (Ca 72-4) have already proven their significant value for patient’s prognosis. There are strong evidences supporting that the levels of serum album...

The ductal carcinoma in situ (DCIS) is the most rapidly growing subgroup in the family of the cancerous diseases of breast. The unclarified biology and pathogenesis of the DCIS result in uncertainty in the therapeutic measures, which leads to major variations in its treatment on a global scale. Contrary to the consensus reached for the complex ther...

Introduction: The average 5-years survival rate from gastric cancer in Europe for the period from 1999 to 2007 is 25.1%. Bulgaria has the lowest 5 years survival rate from all European countries – 11.9%. Methods: We performed a retrospective study of all patients operate from gastric cancer for 9 years period of time from January 2005 to December...

Analysis of recently investigated prognostic factors of breast cancer Vasileva M.1, Sedloev T.1, Angelov K.1, Todorov G.1 1. Department of Surgery, Medical University of Sofia Background: Randomized controlled trials are considered as the strongest form of evidence for decision making in clinical practice. The significant value of the prognostic fa...

Background: The incidence of Ductal Carcinoma In Situ of the breast (DCIS) according to data of the Bulgarian National Cancer Registry is about 40 women per year. The incidence rate is 0.9 per 100,000 in setting with only opportunistic screening available and 5-year survival is over 95%. There are various prognostic factors and indices for assessin...

Background: The incidence of breast carcinoma in situ (BCIS) in 2010 was 10 per 1,000,000 women in Bulgaria. Although rare, it has been increasing by 2% annually during the last 10 years due to the opportunistic screening among women. Previous studies reported a twofold to sevenfold increased risk of breast cancer after the diagnosis of BCIS, repre...

Radionuclide lymphatic mapping is accepted technique in the management of patients with breast cancer especially in initial stages, it is important for the exact anatomic location of the SLN (sentinel lymph node) preoperatively, aiming to reduce the morbidity of lymphatic dissection. The aim of the study is to compare the planar and SPECT/CT techni...

The presented overview thoroughly covers the issues of application of neo-adjuvant loco-regional chemotherapy in the complex treatment of breast cancer and the consecutive opportunities for surgical treatment. The current use of intra-arterial infusion chemotherapy is mainly in locally advanced breast cancer, including inflammatory carcinoma, as we...

A hernia is a protrusion of a tissue, structure or part of a organ through the muscular tissue or the membrane by which it is normally contained. Most frequently hernial deffect is seen in anterior abdominal wall. Usually contents of hernial sac are abdominal organs or portion of organs. Hernia is classified according to the operating methods combi...

Actinomycosis is an uncommocn inflammatory entity caused by the universally distributed anaerobic bacterium, Actinomyces Israeli. The most common sites of the abdominal form of the disease are the transverse colon and the cecum with the appendix. Actinomycosis can mimic other abdominal diseases as diverticulitis, abscesses, inflammatory bowel disea...

Family history of breast carcinoma, multicentric tumor foci in one breast, and in situ lobular carcinoma increase the risk of bilateral breast cancer (BBC), synchronous or metachronous. Synchronous tumors are designated as simultaneous breast carcinoma if they appear at the same time. The CD44 family and cadherin/catenin immunophenotype of this gro...

The aim of this study was to evaluate clinicopathological characteristics and immunophenotypes of simultaneous bilateral adenocarcinomas of the breast and their axillary metastases. Immunohistochemical analysis and in situ hybridization were performed using formalin-fixed/paraffin-embedded tissues. In total, 15 primary and 9 metastatic tumors from...

Pilomatrix carcinoma is a rare skin tumor with an origin from hair matrix cells. The tumor is locally aggressive with a great tendency for recurrence, but the metastatic potential is limited. A pilomatrix carcinoma in 76-year-old female with lymph node metastases is presented. In addition to classical histopathological criteria and DNA ploidy analy...

Breast hypoplasia is encountered as part of genetic syndromes or as a result of iatrogenic factors. The incidence of this malformation and the occurrence of breast carcinoma in such cases are unknown. The authors present a 66-year-old patient with a severe breast hypoplasia and invasive lobular carcinoma. The advanced clinical stage required neoadj...

Phyllodes tumors are mixed tumors of the mammary gland. They account for 0.3 to 0.5 per cent of all breast tumors. This is a report on nineteen cases presenting phyllodes tumors. Depending on the number of mitoses, growth pattern and atypism degree, the neoplasms are classified as benign (12 cases), borderline (2) and malignant (5). Fourteen of the...