The Lozenetz University Hospital, also known as "the former Governmental Hospital" is one of the biggest hospitals in Bulgaria.[citation needed]The hospital was founded in 1948 – similar to the practice in former socialist countries – as a governmental clinic with the purpose of providing health care to employees of high state[clarification needed] and government institutions. In 1999 the hospital became a national multispecialty hospital under the management of Council of Ministers of Bulgaria.Today the Lozenetz Hospital is a multispecialty hospital, which budget is funded by the state. All clinics in the hospital have a third level of competence,[clarification needed] with the exception of the emergency department (first level), virology and neonatology (2nd level).The Lozenets Hospital performs: Diagnosis, treatment and rehabilitation of patients, monitoring of pregnant women and maternity care, monitoring of chronic diseases and patients at risk of such disease, prevention and early detection of diseases and to healthcare measures, transplantation of organs, tissues and cells.As a multispecialty hospital, all pointed out prophylactic, diagnostic and treatment activities are being performed both as well to representatives of government and public institutions, members of the Diplomatic Corps in Bulgaria and the official foreign delegations, as to all Bulgarian and foreign citizens on the basis of contracts with the National Health Insurance Fund or private health insurance funds.University Hospital for Active Treatment "Lozenets" specializes in modern and leading diagnostic and therapeutic activities such as medical imaging, cardiac surgery, invasive cardiology, endoscopic surgery and more.The hospital is multifarious and has 32 clinics and departments, three operating units in 22 surgical rooms, cardiac surgery, Invasive cardiology, broad and modern diagnostic center, high-tech equipment, a center for preventive and occupational medicine.Director of the hospital is Lubomir Spasov cardiac surgeon and specialist in liver transplantation. Under his leadership and with direct participation in the University Hospital "Lozenets" for the first time in our country have done unique operations such as coronary artery bypass without ESC, etc. "Beating heart" (April 5, 2000), mitral-valve prosthesis via a unique endoscopic method (May 22, 2003), a liver transplantation from a living donor (November 26, 2004) and others.University Hospital "Lozenets" has a modern diagnostic equipment and laboratories of the last generation..
Background Involvement of major vascular structures by malignant tumors has historically been considered a contraindication to curative surgical resection. Advances in vascular reconstruction, perioperative management, and multimodal oncologic therapy have challenged this paradigm. Oncovascular surgery has emerged as a specialized field integrating radical oncologic resection with arterial and/or venous reconstruction, thereby expanding surgical resectability. Despite increasing evidence, the role of the oncovascular surgeon remains variably defined. Methods A narrative literature review was performed using PubMed/MEDLINE, Embase, and Scopus databases. Studies reporting oncologic resections involving major vascular ligation or reconstruction were included, focusing on soft tissue and retroperitoneal sarcomas, pancreatic cancer, hepatobiliary malignancies, pelvic and colorectal tumors, and renal cell carcinoma with caval involvement. Outcomes included perioperative morbidity and mortality, oncologic margins, survival, and contribution of the oncovascular surgeon. Results Across multiple tumor types, en bloc resection with vascular reconstruction is feasible and can be performed with acceptable perioperative risk in selected patients. Oncologic outcomes are primarily driven by tumor biology and margin status rather than vascular reconstruction. Early involvement of the oncovascular surgeon improves planning and facilitates safe execution of complex resections. However, these procedures remain concentrated in high-volume centers and underutilized in routine practice. Conclusion Major vascular involvement should no longer be viewed as an absolute contraindication to curative cancer surgery. The oncovascular surgeon plays a pivotal role in redefining resectability and enabling margin-negative resections within a multidisciplinary framework. Broader integration of oncovascular expertise and structured training pathways is needed to improve outcomes in locally advanced malignancies.
Abdominal aortic aneurysm (AAA) is a life-threatening vascular disease with rupture mortality exceeding 80
Renal cell carcinoma (RCC) may extend into the venous system, with tumor thrombus involving the inferior vena cava (IVC) in approximately 4–10% of patients. In advanced cases, the thrombus can reach the right atrium, making surgical treatment particularly demanding. This review discusses the current management of RCC with IVC involvement, focusing on preoperative assessment, surgical decision-making, and the technical challenges associated with tumor thrombectomy and caval reconstruction. We describe the role of vascular surgeons alongside urologists and the contribution of hepatobiliary and cardiac surgeons when dealing with extensive thrombi. The review also addresses systemic treatment, postoperative care, surveillance, and oncological outcomes. Finally, we consider how neoadjuvant therapies and newer approaches, including biomarkers, radiomics, and artificial intelligence, may influence future treatment strategies.
Glucagon-like peptide-1 receptor agonists (GLP1RAs) are widely used for the management of type 2 diabetes (T2D) and obesity, yet their safety profile in liver transplant recipients remains insufficiently characterized. We report a case of a 59-year-old liver‑retransplanted man with metabolic dysfunction-associated steatohepatitis (MASH) who developed acute disorientation and vomiting four days after initiation of dulaglutide therapy. Although a low tacrolimus trough level (2.1 µg/L) was measured upon admission to our hospital, this reflected temporary discontinuation of the drug for four days prior to sampling. Tacrolimus concentration during symptomatic episodes was not measured. Brain imaging showed cortical atrophy without evidence of posterior reversible encephalopathy syndrome (PRES) or acute ischemia. The patient had multiple risk factors for calcineurin inhibitor neurotoxicity, including hypomagnesemia (0.68 mmol/L), chronic kidney disease (glomerular filtration rate (GFR) 49 mL/min), and extensive portal-systemic shunting. Symptoms resolved after supportive therapy and adjustment of immunosuppression. This case raises the hypothesis that GLP1RAs might alter tacrolimus pharmacokinetics through delayed gastric emptying, but our case does not prove this mechanism due to the absence of contemporary tacrolimus measurement and the presence of multiple alternative explanations. We recommend enhanced monitoring when initiating GLP1RAs in transplant recipients with predisposing risk factors for neurotoxicity. Prospective pharmacokinetic studies are needed to validate this hypothesis.
BackgroundVisceral artery aneurysms (VAAs) are uncommon vascular lesions, representing less than 2% of all arterial aneurysms, yet they carry significant clinical relevance owing to their frequently silent course and potential for catastrophic rupture. Within this group, celiac trunk aneurysms (CTAAs) and hepatic artery aneurysms (HAAs) constitute a minority of cases but pose distinct diagnostic and therapeutic challenges. Endovascular therapy has gained prominence in recent years; however, open surgical repair remains an essential treatment modality, particularly in complex anatomical settings or when endovascular options are unsuitable.MethodsWe present a case series of 3 patients managed at our institution: 2 with CTAAs and 1 with an HAA. All patients underwent open surgical repair using tailored vascular reconstruction strategies, including splenic artery interposition, aorto-hepato-splenic bypass with a great saphenous vein graft, and superficial femoral artery interposition. Patient selection and operative planning were guided by preoperative imaging, aneurysm morphology, and comorbid conditions.ResultsThere was no perioperative mortality. Major postoperative complications occurred in 2 cases, including gastric ischemia requiring total gastrectomy and postoperative hematoma requiring re-exploration. At 1-year follow-up, all patients demonstrated 100% graft patency and preserved end-organ perfusion.ConclusionsThis experience highlights the importance of individualized surgical decision-making in the management of VAAs. While the rarity of these lesions limits large-scale comparative studies, our series reinforces that open surgical repair remains a safe and durable option when tailored to patient-specific anatomy. In the era of endovascular techniques, elective open surgical repair remains associated with low mortality and high technical success when performed by an experienced surgical team, offering satisfactory early and mid-term outcomes.
