[Solifenacin in treatment of the overactive bladder syndrome--diagnosis, clinical management and results].

UNLABELLED: The overactive bladder syndrome (OAB) is a pathological condition that affects millions of people round the world. Its incidence increases with ageing. The main therapeutic option for OAB nowadays is anti-muscarinic drug therapy. AIM: To define and implement the diagnostic criteria, clinical guidelines in our country and to evaluate the results of Solifenacin therapy in patients with OAB. MATERIAL AND METHODS: Along a three years period (2006-2009) 163 OAB patients were analyzed followed and treated. In our group of patients 106 (65.2%) are females and 57 (34.8%)--males. The diagnosis is based mainly on the complaints of the patient, evaluated thoroughly with a detail anamnesis and questionnaires. Urodynamic studies were performed In some of the patients. The efficacy of Solifenacin therapy has been validated with the same methods used in SUNRISE and VENUS studies. RESULTS AND DISCUSSION: The mean age of female patients in our group is 63.8 years, and 65.6 years for males. The most commonly observed symptoms of OAB are urgency--88.3% and frequency--92%. Urge-incontinence is observed in 48.8% of the cases. Therapy with Solifenacin 5 and 10 mg has alleviated urgency in 82% and urge-incontinence in 88.9%. Mean number of pads used for 24 hours has decreased from 2.6 to 0.4 after therapy. CONCLUSION: Urgency is the main mandatory symptom for the diagnosis OAB. Therapy with Solifenacin 5 and 10 mg guarantees very good clinical results, and high degree of compliance of the patients.

[Surgical treatment of post hysterectomy vesicovaginal fistulas: our experience of more than a decade].

The results of the surgical treatment of 21 consecutive patients with posthysterectomy vesicovaginal fistulas admitted in Second gynaecology clinic of the University Hospital of Ob&Gyn in Sofia between 1993 and 2006 are presented. 19 of the patients had no previous attempts of repair, 2 had 2 and 4 failed attempts for surgical repair respectively. All 21 patients were operated using one and the same technique of transperitoneal transvesical fistula repair. All operations were successful. There were no intra or postoperative complications and all patients had an uneventful recovery. The authors appreciate the technique used for its utmost reliability which warrants its greater complexity and surgical trauma compared to the other approaches for vesicovaginal fistula repair.

Microsatellite instability in Bulgarian patients with endometrial cancer.

PURPOSE: Microsatellite instability (MSI) is a frequent event in different types of cancer. In several studies MSI was shown to have both clinical and prognostic value. The aim of our study was to determine the frequency of MSI in Bulgarian patients with endometrial cancer (EC) and the possible relation of this phenomenon to their clinicopathological characteristics. PATIENTS AND METHODS: A total of 33 histologically confirmed EC patients were analyzed for tumor MSI using a panel of 6 microsatellite markers. RESULTS: We identified MSI in 30% of endometrial cancer cases. Six of them had high degree of MSI (MSI-H), and 4 displayed low degree of MSI (MSI-L). CONCLUSION: The frequency of MSI in Bulgarian EC patients does not differ significantly from that reported in other European studies.

Tissue microarray analysis of EGFR and erbB2 copy number changes in ovarian tumors.

The objective of this study was to assess the implication of copy number changes of epidermal growth factor receptor (EGFR) and erbB2 genes in the etiology and progression of ovarian tumors. In our study, we used the highly reliable method of fluorescent in situ hybridization, applied on tissue microarray, containing 1006 ovarian tumors from different malignancy, histologic type and grade, and tumor stage, in order to analyze the correlations between gene copy number changes and tumor phenotype. We established copy number changes of erbB2 in 15.30% of malignant ovarian tumors-8.16% amplifications and 7.14% gains. The frequency of EGFR copy number changes was 10.67%-3.65% amplifications and 7.02% gains. EGFR gains occurred with approximately the same frequency in malignant (7.02%), low malignant potential (8.33%), and benign (7.19%) ovarian tumors. ErbB2 amplification was associated with clear cell type of ovarian cancer (P < 0.04). No amplification of EGFR and erbB2 genes was established in tumors with low malignant potency and in benign tumors. Regarding cancer phenotype, there was no statistically significant association between erbB2 copy number changes and histologic grade as well as tumor stage of ovarian cancer. EGFR gains are early events in ovarian tumorigenesis. Our results showed similar frequencies of EGFR gains in different grade tumors, while EGFR amplification increased from grades 1 to 2 to 3.

Correlations between c-myc gene copy-number and clinicopathological parameters of ovarian tumours.

The objective of this study was to investigate increases in c-myc gene copy-number in ovarian tumours, and to analyze their correlations with clinicopathological parameters. Here we applied FISH on TMA (tissue microarrays) containing 507 ovarian tumour samples from different malignancy, histology, stage and grade. Overall, we found high frequency for c-myc copy-number increases (38.5%) in ovarian cancers: 22.1% amplifications and 16.4% gains. We established c-myc amplification in more than 30% in endometrioid and mixed epithelial ovarian carcinomas. c-myc gains were found in a high proportion (42.9%) of clear cell carcinomas. We found associations between c-myc copy-number changes and clinicopathological parameters of ovarian tumours such as degree of malignancy and histological type. We suggested that c-myc amplifications are characteristics for endometrioid, and c-myc gains for clear cell ovarian cancers. We suggest that copy-number increases of c-myc and 20q13.2 represent a possible mechanism for the regulation of the pathway STK15--c-myc--hTERT.

Association of 20q13.2 copy number changes with the advanced stage of ovarian cancer-tissue microarray analysis.

Overrepresentations in 20q have been reported in a number of ovarian cancers by comparative genomic hybridization. In order to study the relation of the increased copy number of 20q13.2 with tumor phenotype in ovarian cancer, we applied FISH on a tissue microarray. The TMA technology enables us to analyze a large number of different malignancy, histology, stage and grade tumors. Overall, the frequency of 20q13.2 alterations in epithelial ovarian cancer was 25.50% (10.74% gains and 14.76% amplifications). There was not statistically significant difference between the frequencies of 20q13.2 copy number changes in different grade tumors. The frequency of gains and amplifications increased significantly from stage I to stage II to stage III tumors. Our results showed strong association between increases 20q13.2 copies and advanced tumor stage. We concluded that genetic alterations in 20q13.2 may be of prognostic significance for stage progression of the ovarian cancer.

[The copper concentration in the blood serum of women with ovarian tumors (a preliminary report)]. / Kontsentratsiia na medta v kruvniia serum pri zheni s ovarialni tumori (predvaritelno suobshtenie).

The aim of the present study was to evaluate serum copper concentration changes in patients with benign cysts or carcinomas of ovary, and to compare these concentrations with the normal reference serum copper levels. Patients included in the study were as follows: benign ovarian cyst cases (n = 19), endometrial cyst cases (n = 5), ovarian carcinoma cases (n = 6), female patients with no ovarian disease (n = 161). Reference serum copper levels in apparently healthy subjects were 16.8 +/- 4.15 mumol/l (mean +/- SD). Serum copper concentration were significantly increased in ovarian carcinoma patients (22.98 +/- 3.90 mumol/l) in comparison with benign cyst patients (18.40 +/- 4.61 mumol/l) (p < 0.05), in with endometrial cyst patients (15.94 +/- 4.24 mumol/l) (p = 0.02), and in comparison with normal levels in controls (p < 0.001). Copper/zinc ratios were highest in ovarian carcinoma patients--1.68, intermediate in benign cyst patients--1.42, and lowest in endometrial cyst patients--1.08. The mechanisms underlying serum copper concentration variations in the different groups are briefly discussed with special emphasis on these in ovarian carcinoma patients.

[Laparoscopic hysterectomy--the initial experience in Bulgaria]. / Laparoskopska khisterektomiia--purvi opit v Bulgariia.

The paper presents the first cases of laparoscopic-assisted vaginal hysterectomy and laparoscopic hysterectomy with removal of the uterus through the vagina performed in Bulgaria as well as the experience gained by the team from II gynaecology clinic at State University Hospital "Maichin dom" in Sofia from seven patients operated on by these techniques. The indications, the conditions and the implemented technique with its advantages and difficulties are described. The procedures are associated with less trauma and blood loss than abdominal surgery and are followed by a very smooth postoperative period which is very well tolerated by the patients. No intraoperative complications occurred. The postoperative period was free of any problems in 5 of the patients while in two there were minor complications. Marked shortening of the duration of the procedures is achieved with the initial experience.

[A comparative study of the efficacy of antibiotic prophylaxis with cephalosporins in operative gynecology]. / Sravnitelno prouchvane vurkhu efektivnostta na antibiotichnata profilaktika s tsefalosporini v operativnata ginekologiia.

The article presents the results of a comparative study on the efficacy of perioperative prophylaxis with cefalosporins in abdominal gynaecological operations. A total of 155 women meeting certain inclusion criteria were operated on and were randomly assigned to one of the following regimens: Cefoxitin 3 x 1 g--14 subjects, Cefotetan 2 x 1 g--43 subjects, Cefalotin 3 x 2 g for 24 hours--27 subjects, Cefalotin 3 x 2 g for 72 hours--41 subjects and a control group of 30 subjects without prophylaxis. The course of the postoperative period, the hospital stay and the average costs in each group were assessed and compared. None of patients receiving any prophylaxis developed infectious complications, while such complications occurred in 10% of the control without prophylaxis. The authors conclude that antibiotic prophylaxis effectively prevent the infectious complications and shortens the postoperative hospital stay. Despite its narrower anti-bacterial spectrum Cefalotin is not inferior in its efficacy to the second and the third-generation cefalosporins. While providing equal effect, the 24-hours Cefalotin regimen is from 2.8 to 4.9 times cheaper then the other prophylaxis regimens and is twice cheaper than the no-prophylaxis regimen. The longer 72-hours Cefalotin scheme shows no advantages to the 24-hours one but almost triples the expenses. Additional antibacterial treatment in the postoperative period needs more precise indications since unequivocal reasons for its administration are missing in a number of cases.

[The zinc concentration of the blood serum in women with ovarian tumors (preliminary report)]. / Kontsentratsiia na tsinka v kruvniia serum pri zheni s tumori na iaichnitsite (predvaritelno suobshtenie).

The aim of the study is to determine the concentration of blood serum zinc of women with ovarian tumors. The patients included in the study are as follows: 15 women with benign ovarian cysts, 5 with endometrial cysts and 5 with ovarian carcinoma. The control group consists of 157 healthy women whose serum zinc concentration was 13.50 +/- 2.60 mmol/L. We could not demonstrate a significant difference in serum zinc concentration of different groups: benign cysts, endometrial cysts and ovarian carcinoma in comparison control group.

[Detrusor instability--an important but underestimated factor in urinary incontinence in women]. / Detruzornata nestabilnost--vazhen, no podtseniavan faktor za inkontinentsiiata na urinata pri zhenite.

157 consecutive female patients complaining of urinary incontinence were studied by history and urodynamics. 21 of them (13.4%) demonstrated urge-incontinence due to severe detrusor instability, 20 (12.7%) showed mixed (both urge and stress) incontinence, 14 (9%) only detrusor instability and 12 (7.6%)--stress incontinence accompanied by detrusor instability. Pure stress incontinence was diagnosed in 79 cases (50.3%) while 11 patients (7%) manifested no abnormality during the urodynamics. A total of 67 patients (42.7%) showed urodynamic evidence of detrusor overactivity. In 55 (35% of the studied subjects) it was the main urodynamic finding. The prevalence of detrusor instability was higher among those with recurrent incontinence and was the highest (60%) among the women with more than one previous operations. When urge incontinence was present it occurred at detrusor pressures lower than the maximum urethral closure pressure, which implies possible failure of the sphincteric mechanisms associated with detrusor instability. 14% of the women with detrusor instability did not report complaints typical for this disorder but had history of stress incontinence alone. The authors confirm the necessity of objective assessment of the lower urinary tract in all cases with history suspicious of detrusor instability as well as when surgical treatment for stress incontinence is planned.

[The use of cefotetan for the prevention of infectious postoperative complications in gynecology]. / Prilozhenie na tsefotetan za profilaktika na infektsioznite postoperativni uslozhneniia v ginekologiiata.

The study presents the results from the use of cefotetan for perioperative prophylaxis in 43 gynaecology patients compared with 29 controls without perioperative antibiotic prophylaxis with similar diseases and operations. Both groups show equal percentage of the cases with smooth postoperative period (70 and 72% respectively). 13 of the patients on cefotetan prophylaxis received additional antibiotic treatment (9 because of temperature up to 37.5 degrees and 4 because of temperature from 37.6 to 38.5 degrees). Mo major infections postoperative complications occurred among the patients on cefotetan prophylaxis. 8 of the non-prophylacted patients needed antibiotic treatment postoperatively including 4 with temperature above 38.5 degrees. Two infections of the operative wounds also occurred in the same group. The conclusion is that cefotetan effectively prevents the major infection postoperative complications in gynaecology. The administration of additional antibiotic treatment is most often not warranted.

[The use of dihydrocodeine for postoperative analgesia in gynecological operations]. / Prilozhenie na dikhidrokodein za sledoperativno obezboliavane pri ginekologichni operatsii.

16 patients received twice daily 60-90 mg DHC-Continus. The evaluation of the pain was done with use of visual linear scale from 1-10 (Scott-Huskisson). Four complications occurred: headache, nausea, vomiting, constipation. The authors conclude that the orally administration of DHC is an effective alternative for postoperative treatment of pain in gynecological patients.

[Clinical and urodynamic findings in women with recurrent urinary incontinence]. / Klinichni i urodinamichni nakhodki pri zheni s retsidivirashta pikochna inkontinentsiia.

The study includes 40 subjects with recurrent urinary incontinence who were subjected to a detailed clinical examination to detect descent of the bladder neck and the proximal urethra and to a full urodynamic investigation in the aim to determine the reasons for operative failure. A high incidence of urge-incontinence was found (37.5%), as well as of extremely and very low urethral closure pressure (35.7%). In 67.7% of the recurrences the bladder neck was not adequately elevated but many of them also showed very low urethral closure pressure failure are probably not the technical ones but those concerning the exact preoperative estimation of the disorder and the prospects for surgical treatment.

[The dynamics and trends in surgical delivery at the Maternity Home of the State Institutional Hospital]. / Dinamika i tendentsii na operativnoto rodorazreshenie v DIB "Maichin dom".

The study discusses the frequency of operative obstetric deliveries (cesarean section, forceps extraction and vacuum extraction) over a period of 18 years from 1976 till 1993. A total of 100,545 deliveries with 100,192 livebirths took place during this period with a decrease of the annual number of deliveries in the last years. The frequency of the various kinds of operative deliveries shows different tendencies. The frequency of cesarean section has increased from 4.87 per cent in 1976 to 19.58 per cent in 1993, this increase being particularly marked during the last 6 years. Meanwhile the vaginal operative deliveries have decreased their frequency. The decrease of forceps extraction is from 4.33 to 2.22 per cent (steadily about 2 per cent during the last years). The frequency of vacuum extraction has dropped from 1.89 per cent to 0 by the end of the 1980 and the beginning of the 1990. The tendencies of the development of obstetric operations are analysed as well as their influence on perinatal outcome.

[The role of serum beta-HCG levels for the diagnosis of ectopic pregnancy]. / Rolia na serumnite niva na beta-ChKhG za diagnozata na ektopichnata bremennost.

The study includes 56 cases of women admitted at Second gynaecology clinic of the University Maternity Hospital Sofia with evidence or suspicion of having an ectopic pregnancy who had their serum beta-HCG levels determined quantitatively. 27 of them showed no beta-HCG in their sera and none turned out to have pregnancy, neither intrauterine nor ectopic. All cases of ectopic pregnancies (a total of 20) were associated with detectable beta-HCG levels in the serum. The great diagnostic value of serum beta-HCG is emphasized in the cases of old disturbed ectopic pregnancies accompanied by mild and uncommon symptoms and very low beta-HCG levels. In case of unruptured pregnancies or tubal rupture the diagnosis is verified before the result is available by the clinical and sonographic data. On the other hand the high sensitivity of the method leads to an increased number of cases with elevated beta-HCG in which the location of the pregnancy cannot be proven. The precise quantitative evaluation of serum beta-HCG enables us to follow the tendency of beta-HCG which may according to the clinical manifestations warrant invasive diagnostic procedures or just observation without active interference.

[The treatment of urinary stress incontinence with the sling and Pereyra's suspension]. / Lechenie na pikochnata stres-inkontinentsiia sus "Sling" i okachvane po Pereira.

Patients with proven stress incontinence were subjected to surgical treatment which combined both sling and Stamey-Pereyra techniques. A 3-4 cm long and 1,5-2 cm wide sling of Bulgarian polyamide mesh was placed under the urethrovesical junction using a small vaginal incision. Two long polyamide sutures were tied to either end of the mesh and were retrieved from the vagina to the abdomen by Pereyra needle inserted through two small suprapubic incisions and guided by the vaginal forefinger. The technique of the procedure is described. A total number of 27 patients were operated on. Two of them has their suspending sutures cut postoperatively because of prolonged urinary retention. The remaining 25 were continent. The technique proposed combines the advantages of the sling procedures (high efficiency especially in cases of severe and recurrent incontinence) and the simplicity of Stamey-Pereyra suspension technique. On the other hand the Bulgarian polyamide mesh showed very good qualities. No infection, rejection or sling erosion were observed.