Author: BCI

Patient initially underwent surgery for cervical cancer and underwent radiotherapy

The urology specialists at ‘Heart and Brain’ Burgas performed a unique and first-of-its-kind surgery for the region. The complex surgical intervention to build a new ureter from the small intestine of a patient whose left ureter had been damaged in a previous cancer surgery was successful. The fifty-six-year-old woman initially underwent surgery for cervical cancer and underwent radiation treatment. Disturbing changes prompted her to contact doctors at the high-tech hospital complex. They conducted imaging tests and found a connection between her left ureter and vagina.

“This clinical case is extremely challenging due to the fact that about half of the ureter was damaged as a result of the previous surgery and subsequent radiotherapy. In order to restore normal urine output, a new ureter had to be constructed from a thin-walled segment,” says Dr. Statelov, head of the urology department and part of the operating team.

Thanks to the excellent professional training and multidisciplinary approach that the medics of ‘Heart and Brain’ Burgas can guarantee to the patients, this complex case is another successfully solved health case in Burgas.

Assoc. Prof. Haritonov, why did you decide to devote more time to the patients in Burgas?

I am honoured to be able to contribute to improving the quality of healthcare in Burgas. My decision is based on the desire to provide high quality neurosurgical care to the people of the region and to support the development of medical services here. I see great potential and am convinced that I can help many patients.

What innovations do you plan to introduce in the hospital in Burgas?

-I believe that modern medicine requires continuous improvement and adaptation of the latest technologies and methodologies. I plan to introduce minimally invasive surgical techniques and robotic surgery, both in spinal and cranial surgery, which will reduce recovery time and improve treatment outcomes. I will also work on creating multidisciplinary teams to provide comprehensive patient care.

We already have enough experience and expertise and my teams are the first to apply these innovative treatment methods and most importantly, they are now available in our country thanks to the super modern equipment of the Heart and Brain Hospitals.

People suffering from oncological diseases, degenerative diseases of the spine, vascular diseases of the central and spinal cord, as well as those with traumatic injuries or congenital malformations will receive adequate, high-quality and highly specialized neurosurgical health care at the Heart and Brain Hospital Burgas.

We are talking about an extremely minimally invasive method, where the patient does not feel any pain and can return to his normal rhythm of life hours after the procedure. The indications for the application of this method are mainly aimed at patients up to 45 years of age. The method is mainly recommended for the initial stage of disc disease. The intervention is performed in an operating room, but in practice it is an injection. The injection is placed directly into the nucleus of the intervertebral disc itself, where the appropriate amount of discogen is inserted under X-ray control. Half an hour after the procedure, the patient can get up and move around on his own without the need for any aids. The only restriction is the refinement of physical exertion within 3 to 4 weeks after the procedure. Discogel treatment has been successfully applied in the USA and Europe for several years and now also in our country. At this stage ‘Heart and Brain’ is the only one in Bulgaria where the innovative treatment is available.

– What does disc disease represent?

– Disc disease (discopathy) is one of the most common diseases in human pathology, the main symptom of the disease being recurrent neck, back and low back pain. Usually, the pain is provoked by exertion, sudden movement, weight lifting, cold, and intensifies with movement. At some stage in the development of the disease (onset of disc protrusion or herniation) the pain begins to radiate to the arms and legs, sometimes with numbness and weakness. Diagnosis is made after examination by a neurologist and conducting so-called neuroimaging studies – X-ray, CT scan and MRI. It should be borne in mind that a simple X-ray cannot prove the presence of a protrusion or hernia. For this, it is necessary to conduct a computed tomography or, preferably, an MRI, which has the highest diagnostic value.

– Can everyone develop disc disease or are there more vulnerable groups of people?

-Absolutely anyone can at some stage in their life face this health problem. Disc herniation is one of the most common causes of back pain. It can form between any two vertebrae of the spine and at any age no matter the gender. Since this problem is associated with wear and tear of the discs, its occurrence is typical in people with occupations involving a lot of physical exertion, also in people with frequent injuries. Apart from systematic strain and wear of the discs, the problem can occur after sudden movements or strain that cause tearing of the fibrous ring.

In rare cases, disc herniation is due to congenital anatomical features of the spine.

– How does disc disease manifest itself in its early stages and which symptoms indicate that the disease is progressing?

– In its early stages, disc disease presents with pain in the spine that “descends” to the tailbone. It manifests with prolonged standing upright or with prolonged sitting. In older patients, this problem is also due to the so-called aging process or disc degeneration. The strength of the ligaments decreases and a seemingly small effort or rotational movement can cause a disc rupture.

– What more serious complications can result? Which of these cases in your practice can you share?

– Disc disease cannot lead to serious complications as it is a chronic relapsing disease and develops slowly unless there is a traumatic moment. So, if the patient hasn’t been paying attention for a long time and hasn’t been treated – then he comes to us in a pretty severe condition. After proper surgical intervention, this problem naturally gets under control. So again we come to the most natural and correct advice – seek medical help on time, before the onset of complications.

– From your observations in practice, could you tell us: are patients with this health problem increasing and is there a change in the age limit?

– There has definitely been an increase in the number of people with this health problem in recent years, and I can say that the age limit is dropping dramatically. We have had cases of operating on patients at the age of 19-20 with disc herniation, and this was not the case 10 to 15 years ago. I explain this fact by heredity, which is often underestimated as a factor, and the other by improper lifestyle and improper physical activity.

– What is your vision for the development of neurosurgery in Bulgaria?

– My teams in Pleven and Burgas work exactly as they work in the big university clinics in Europe and the USA. I have personally convinced myself during my visits to Switzerland, Germany, Great Britain, USA, etc. Their knowledge and skills are world class. Leading neurosurgeons who have chosen our clinics to present new technologies and innovative approaches regularly come here for inspections. For us, every method we apply must be as atraumatic as possible and the possibility of a rapid recovery for patients is paramount. We believe that only with appropriate investment in training and technology can we maintain a high standard of quality health care. It is important that we encourage young doctors to specialise in this field and provide them with opportunities for professional development.

– What would you like to say to the patients in Burgas who hope for your help?

-It is very important and a matter of honour for me to build trust and be there for them in every step of the treatment. My team and I will work hard to improve the quality of life of our patients.

Thanks to the expert knowledge and skills of specialists, modern equipment and multidisciplinary approach, the high-tech hospital complex ‘Heart and Brain’ in Burgas provides comprehensive care for patients from all over Southeastern Bulgaria

A young patient with abdominal bloating is admitted to the gastroenterology clinic of Heart and Brain Hospital in Burgas. From the examinations carried out – scanner and endoscopy, the doctors found a particular form of oncological disease affecting the stomach, namely non-cohesive carcinoma. At the time of diagnosis the cancer was at an advanced stage, unsuitable for surgery. The doctors immediately sent all the tests for an opinion from an oncology committee.

Two days later, on the eve of May 24, the patient suddenly became short of breath and had palpitations. The cardiology specialists at ‘Heart and Brain’ determined that it was pulmonary thromboembolism, the second leading cause of sudden death after heart attack. A scan confirmed massive bilateral pulmonary thromboembolism.

Given the patient’s condition and the newly diagnosed gastric carcinoma, the invasive cardiologists undertake fragmentation and thrombus extraction (breaking up and removing) of the massive amount of thrombi over a two-hour period. The entire procedure takes place without any blood loss, and the aspirated blood is filtered and returned to the patient’s body. During the procedure, the source of the pulmonary thromboembolism is also identified, namely a venous thrombosis in the patient’s abdomen. Given the location and presence of residual venous thrombosis, an empty vein filter is also implanted to protect the patient from a life-threatening recurrence of pulmonary thromboembolism. The entire vein cava filter extraction, fragmentation and implantation procedure is painlessly performed completely bloodlessly and percutaneously and the patient is fully conscious.

Due to the contraindications and polymorbidity in the young patient, the specialists cannot apply fibrinolytic therapy, which is the gold standard. Therefore, the physicians undertook an unconventional multidisciplinary approach that combined the capabilities of the cardiologists, cardiac surgeons and vascular surgeons teams, and yielded an excellent outcome for the young man.

The first course in minimally invasive gynaecological surgery at the Heart and Brain Hospital in Pleven marks the start of the only Training Centre of its kind in Bulgaria. It will take place on 6 and 7 June 2024 and is under the ‘GESEA4EU’ programme of the European Union and the European Association of Gynaecological Endoscopy.

During the two days, for the first time, 10 gynaecology specialists from Southeast Europe will undergo a theoretical part, live demonstrations and a training part on simulators and boxing simulators, under the guidance of Dr. Alexander Lyubenov, MD, Head of the Gynaecology Department, and Dr. Atanas Alexandrov, Obstetrician-Gynaecologist at ‘Heart and Brain’ Pleven, as well as mentors from a certified diploma centre of the programme in Naples.

The aim is to broaden the knowledge and skills of the young specialists in the field of laparoscopic and hysteroscopic gynaecological surgery and to acquire an internationally recognised European certificate.

The idea is that in the future the Training Centre will also offer courses in other specialties such as urology, surgery, orthopaedics, gastroenterology, and the interest from specialists from South-East Europe is enormous. There have also been many enquiries from international students.

The parient, Dimitar Dimitrov expresses his gratitude to the doctors from both wards after the complicated operation

“I came back to life”: a multidisciplinary team of electrophysiologists and thoracic surgeons at ‘Heart and Brain’ Burgas helped a patient with life-threatening arrhythmia

Dimitar Dimitrov calls April 2nd “The day I came back to life!”. This is the day the specialists carried out the final stage of treatment for his life-threatening arrhythmia. They surgically sever the nerves that stimulate the heart and cause it to go out of rhythm. The team is led by Dr. Dimo Mitev and Dr. Nedyalko Dragnev.

Up to this point, the patient had experienced the encounter with death almost daily – his heart worked in a chaotic rhythm and only the electrical impulse from the defibrillator implanted in his body saved him. The implantation was carried out by Dr. Mihail Protic, a doctor with serious experience in charge of electrophysiology at the high-tech hospital complex. Without this device, Dimitri would have lost his life in a second.

Dr. Protic: “A patient was admitted to us with dilated cardiomyopathy, severely depressed cardiac function, an implanted cardioverter-defibrillator resynchronization therapy system and multiple recurrent ventricular tachycardias leading to seizures with activation of the implanted defibrillator. In this patient, we performed catheter ablation, which was able to achieve a significant reduction in cardiac arrhythmia episodes but not complete suppression. According to the state-of-the-art treatment recommendations, a surgical intervention, bilateral sympathectomy, is performed in addition to catheter ablation.”

Dr. Mitev: “The last stage of Dimitar’s treatment was in the thoracic surgery department. It took place surgically. In patients with a resynchronizing pacemaker, it is very dangerous to use a monopolar, and in some cases, when close to the heart, a bipolar current. In this case, it was extremely dangerous because of the high frequency of defibrillations required.  For maximum patient safety, we used high-energy ultrasound equipment at every stage of the operation. The outcome of the procedure exceeded even our wildest expectations. Compared to the daily “restart” of the heart by the implant prior to surgery, the patient has not had a single ICD defibrillator activation in the last 40 days.”

“Patients indicated for ICD-defibrillator implantation have rhythm-conduction disorders and are at risk for abnormal heart rhythms. They have had a heart attack, have a weak heart, or have inherited heart disease,” explains Dr. Protich. “The ICD is as big as the face of a smartwatch. Once implanted under the skin, usually on the left side of the chest, it detects and regulates abnormal, life-threatening rhythm-conduction disturbances and can prevent fainting, even sudden death.”

“If you have an abnormal heart rhythm that the device determines to be dangerous based on established algorithms, it will respond to return the heart rhythm to normal. This may involve receiving an electrical impulse, as in CPR,” the electrophysiology specialist explained. “Rather than being applied externally, the pulse is delivered from the implant into the body immediately. This helps save lives.”

Many of the patients of , Heart and Brain’ Burgas suffer from cardiovascular diseases. The hospital employs some of the best electrophysiologists on the Balkan Peninsula, such as Dr. Mirazciiski, Dr. Protic, cardiologist Dr. Dimov and cardiologist-specialist Dr. Anastasov. This is the only electrophysiology center in Southeastern Bulgaria and provides access to the most advanced treatment of rhythm-conduction disorders. “Instead of patients having to travel periodically to Sofia, ‘Heart and Brain’ provides all care related to the implanted devices here in Burgas. Long-term follow-up is also important because many patients need device-related care for years. We ensure continuity of care: we know the patient before implantation and communicate closely with them and their treating cardiologists afterwards.”

Some of these devices don’t just prolong life expectancy, they also improve its quality. This procedure is minimally invasive and low-risk. In cases such as Dimitri’s, close collaboration between multiple specialists is extremely effective and has the added benefit of improving patients’ quality of life. Video-assisted thoracoscopic sympathectomy has also recently been performed at the hospital to improve the overall treatment outcome for complex and life-threatening arrhythmias.