[Current progress and problems in oncourology].

One of the most serious problems of urology as specialized surgery is the oncological diseases. A large part of the scientific research is dedicated to their basic research, diagnostics and treatment as the results are then presented at the big international forums each year. The new achievements in the investigations of urological diseases excite special interest and mark the stages of the actual progress of the respective science. The overview is a panorama of the newest and at the same time most significant achievements of the science of urology in this field in 2006 presented at the biggest international congresses - the Congress of the European Association of Urology, the Annual Meeting of the American urologists and the Congress of the American Society of Clinical Oncology - ASCO. What is typical is the existence of the large number of researches of the carcinoma of the prostate - an issue on which the urological society focuses its attention quite often. Without any revolutionary breakthroughs being made new scientific proof has been added which considerably enriches our knowledge about this disease and places special focus on the real value and interpretation of the levels of the Prostate Specific Antigen (PSA). What is especially impressive in bladder cancer research is the discovery of a protein element called "survivin", which is of the family of the inhibitors of apoptosis and its level is connected with qualities of the tumors like aggressiveness, recurrence and progression of the disease and mortality rate. The weight of the scientific research in the field of kidney tumors is placed on the basic research of their oncogenesis. After quite a few years of standstill in the area of chemotherapy new drugs like Sunitinib, Sorafenib and Temserolimus are being introduced, some of which even have independent antitumor effect. As far as the testicle tumors are concerned, the necessity of an extensive lymphadenectomy is confirmed. The increased possibilities of conservative treatment of the lymph node metastases are stressed though radiation therapy and chemotherapy, especially in the cases of seminoma tumors. In the case of penis cancer the weight is placed on the timely diagnostics and treatment allowing organ-preserving operations. The summarized messages of the achievements that are part of the development of the oncourology have also been pointed out.

[Autotransplantation of a part of the spleen. Clinical study].

Experimental studies on the subject were released in the previous issue of the Journal. Due to the positive results, the method described before, was applied on 11 patients and this is the aim of the current article.

[Autotransplantation of a part of the spleen. Experimental studies].

Experimental studies on 38 dogs were carried out. As a result the proper site of transplantation was pointed out: the bigger omentum or any site along the mesentrium. The factors of a greater importance for the success were found to be: a) the thickness of the transplantat (2-3 mm) and b) the quantity of it (> 5% of the original spleen weight). Hematological and immunological tests proved the lack of asplenic syndrome and confirmed the normal functioning of the transplants. Morphological studies revealed normal macroscopic and microscopic picture of the latter one.

[An orthotopic bladder from the ileum after total cystectomy--the technic of the operation]. / Ortotopichen pikochen mekhur ot ileum sled totalna tsistektomiia--tekhnika na operatsiiata.

This is a description of the operation proper with explanation of the motivation for giving preference to one or another technique of execution. Presumably, proceeding from experience accumulated hitherto, it will serve the purpose of instructions to Bulgarian urologists willing to implement in practice this difficult and complex operative procedure. After careful assessment of the methods existing, and in compliance with the logic of anatomy and physiology of the structures involved, two innovations concerning the formation of new urinary bladder and implantation of the ureters therein are introduced. The latter merit special attention since they contribute greatly to improve the functions of the new organ.

Complete template-directed enzymatic synthesis of a potential antisense DNA containing 42 methylphosphonodiester bonds.

P alpha-Methyl thymidine triphosphate was prepared through the pyrophosphorolysis of P alpha-methyl thymidine diphosphate P beta-diphenyl ester and tested as an alternative substrate for E. coli DNA polymerase 1 (Klenow fragment) using several template-primer systems requiring the formation of 1 to 42 methylphosphono diester bonds. The enzyme catalyzes the incorporation of a P-methyl thymidylic residue with (Sp)-configuration at a single site in a recessive 3'-end as well as at multiple sites along a growing 167 nucleotide long chain. The synthesis of a full length product, containing 42 sites of methylphosphonate incorporation was observed.

[Tumors of the urethra]. / Tumori na uretrata.

For a period of 6 years 416 men with bladder tumors have been treated by transurethral resections and hemotherapy. The bladder disease was associated with tumors of the urethra: 15.6 per located in its prostate portion and 3.1 per cent in the cavernous part. The urethral tumors were also treated by transurethral resections, ureterotomy and total cystectomy. It was shown that the numerous transurethral resections of bladder tumors contribute to the appearance of urethral tumors: 79 per cent of these developed after the 5. transurethral resection. The results of this study led to a number of inferences: Tumors in the cavernous portion of the male urethra appeared at a relatively younger age (mean 57.8 years); the membranous portion of the urethra is a particular borderline in the histologic structure and the prognosis; appearance of tumors in the cavernous part of the urethra is a poor prognostic sign--tumors in this zone may run a fulminant course with rapid lethal outcome. Inferences were drawn on the methods of choice of treatment of combined bladder tumors and tumors in the cavernous portion of the urethra.

[Contamination during transurethral manipulations of the upper urinary tract]. / Kontaminatsiia pri transuretralni manipulatsii vurkhu gornite pikochni putishta.

A four-year observation was carried out on a series of 289 patients who had undergone miscellaneous transurethral operations and manipulations on the upper urinary tract. Clinical and microbiological studies were performed in an attempt to record the incidence of urinary tract infections as a consequence of contamination following transurethral manipulations. Random groups of in-lying patients at two urologic clinics served as controls. It was found that the hazard of contamination with pathogenic bacteria causative agents of urinary tract infections in the study group was smaller than usually believed. The mean infection rate was 17.3 per cent, vs. 35.6 and 45.5 per cent respectively in the control groups. Higher was the risk of contamination after manipulations terminating without temporary drainage of the urine from the upper urinary tract. In the contamination processes was involved a broader spectrum of microorganisms with more resistant strains. Conclusions are drawn on the possibilities to reduce the contamination levels and to prevent the consequences of infection. This should be achieved not by limiting the manipulations, but by mastering the endoscopic technique and nontraumatic work with this technique.

[A comparison between clinical and echographic staging in bladder tumors]. / Sravnenie mezhdu klinichen i ekhografski staging pri tumorite na pikochniia mekhur.

In a series of 94 consecutive unselected patients with bladder tumors the authors determined the tumor infiltration stage (tumor staging) by two methods. In all patients the echographic stage was previously and independently established by transurethral echography. The clinical staging was subsequently made according to the requirements of the International Union for Cancer Control (IUCC). The results obtained by the two methods were compared and a high degree of coincidence (81 per cent) was found. The lack of coincidence in the borderline stages between superficial and infiltrative lesions is discussed. The ultimate staging in bladder tumors is recommended to be based on the complex data of all methods: echography, computer axial tomography and clinical examination.

[Correlations in bladder tumors]. / Korelatsii pri tumorite na pikochniia mekhur.

Detailed and complete investigations for determining the tumor characteristic were made in 137 patients with bladder tumors. The study included: establishing the gross parameter (gross appearance, localization, size, multiplicity, mode of growth and dissemination), infiltration stage, degree of differentiation, cytophotometric parameters (ploidy and proportion of cells in S-phase) and immunologic data (indirect immunofluorescence and serum IgA and IgG levels). The results were correlated and a number of correlations between the individual qualities of the tumors were determined. On the basis of proven interrelations, staging and grading the two basic tendencies in tumor development--weak or strong malignancy--were outlined. Conclusions were drawn on the need of more detailed investigation of the correlations in bladder tumors, in order to facilitate the diagnostic process, when full-fledged investigations are not available, as was the case in the author's patient series.

[The prevention of postoperative suppurative complications in stomach cancer]. / Profilaktika na sledoperativnite gnoini uslozhneniia pri stomashen rak.

Bacteriologic studies of gastric juice and purulent drainage fluids in the event of complications were carried out in 80 patients who had undergone gastric resections and had been on conventional parenteral antibiotic treatment (control group). Another (experimental) group of 37 patient, having undergone the same operations, received prophylaxis of the suppurative complications with 5-nitrox and Flagyl solutions through nasogastric probe once in 3 hours for 6 to 8 days. The suppurative complications in the experimental group were reduced from 47.5 to 8.1 per cent and of the postoperative lethality due to suppurative complications from 22.5 to 0 per cent.

[Clinical chemical parameter changes in patients with liver metastases]. / Promeni v niakoi kliniko-khimichni parametri pri bolni s chernodrobni metastazi.

Certain biochemical serum parameters: GOT, GPT, LAP, HK, AP and Regan isoenzyme, GGTP, CE, ESR, Weltman test, thymol test, serum bilirubin and urine urobilogen were determined in 39 patients with different localization of malignant processes in the abdominal cavity (stomach, large intestines, pancreas, ovaries). The patients were subdivided into two groups, depending on the presence or absence of liver metastases, confirmed at laparatomy, laparascopy or necropsy material examination. The results revealed that in patients with liver metastases AP, CE, GOT, GGTP, ESR and Weltman test are most commonly and simultaneously abnormal. In patients without liver metastases, those indices are also changed but to a lesser degree, whereas LAP and Regan isoenyzme are with elevated activity in a higher per cent of these cases, than in the patients with liver metastases, being in unison with literature data. The determination of the above biochemical parameters could direct the clinicist to the presence of liver metastases but the more reliable diagnostic methods as laparascopy and laparatomy cannot be substituted for.