[Lymph node dissection in early ovarian cancer].

AIM: Our aim was to evaluate and summarize our experience in surgical treatment for early ovarian cancer, the way and extend of metastases, as well as the need and effectiveness of applying radical pelvic and paraaortic lymph node dissection. We compared our results with the results of prominent clinics all over the world in this special field. MATERIAL AND METHODS: We researched retrospectively patients, operated for early ovarian cancer for 15 years period. We evaluated the use of lymph node dissection and the level of its radicality. Examining the volume and borders of the lymph node dissection we tried to sintesize the main practical conclusions and refferences, which can be applied practically by the colleagues working in gynaecological and oncogynaecological clinics in our country RESULTS: According to us and the most foreign authors the ovarian cancer, must be removed intact, and frozen section biopsy must be used. The surgical staging includes: total abdominal histerectomy, bilateral salpingooophorectomy and total pelvic and/or paraaortic lymph node dissection. The surgical staging in all patients is obligatory and includes: a) cytological examination of ascites. b) when ascites is absent--cytological smear. c) Examination of intraabdominal organs and surfaces. d) Biopsies are taken from all suspicious regions. e) The diaphragm is examined by biopsy and scraping. f) Infracolic omentectomy is performed. g) Retroperitoneal spaces are dissected and examined. h) The paraaortal area is examined. When enlarged lymph nodes are found--they are resected and examined. If enlarged paraaortal lymph nodes are found--total paraaortic lymph node dissection is performed. DISCUSSION: The extend of the lymph node dissection in early ovarian cancer is connected with better survical rate in these patients. CONCLUSIONS: The lymph node dissection helps for precise surgical staging in early ovarian cancer. The volume of the lymph node dissection is significant prognostic factor for better survical rate, as well as age, stage, histological type and the grade of the disease.

[Our and foreign experience in modern surgical treatment of cervical adenocarcinoma stage T(1A1)].

AIM: The aim of this research work was to evaluate the distant results in patients with cervical adenocarcinoma stage T(1A1) treated conservatively only by conization. MATERIAL AND METHODS: 60 patients were) examined for 10 years period with cervical adenocarcinoma stage T(1A1) (stromal invasion to 3 mm in deapth and 7 mm horizontal spread). RESULTS: 50 patients were surgicaly treated by cold knife conization and 10 patients by LLETZ. In 40 patients a total hysterectomy was additionally performed. 20 patients (age range from 20 to 40 years) were treated only by conization because they desired to preserve fertility. In 12 patients an attempt was made for to get pregnant. In 7 patients there was a successful pregnancy. CONCLUSIONS: The conization of the uterine cervix as the only treatment in patients with cervical cancer T(1A1) adenocarcinoma is effective and safe therapy. It is very important when patients desire to save their reproductive functions. The individualization of this treatment method is not yet obligatory because of the small number of treated patients.

[Our and foreign experience in diagnosis and treatment of preeclampsia].

AIM: Our aim was to evaluate our experience in diagnosis and treatment of preeclampsia in the clinic of Pathological pregnancy--Varna Medical University. We compared our results with the results of prominent western clinics. MATERIAL AND METHODS: We evaluated 140 patients with preeclampsia for the period of 2010 to 2013. A special file was fulfilled. It included: age, parity, gestational age, value of arterial blood pressure, urea, creatinine, common protein in blood, duration of treatment, oedema, urine protein. RESULTS: The mean age of the patients was 30 years. The urea and creatinine were normal. The mean hospital stay was 5,71 days. The blood protein was 61 g/l, only 4.17% of the patients were with protein lower than 58 g/l. In 87.5% of the patients the systolic blood pressure was between 135 and 160 mmHg, in 12.5% the systolic blood pressure was over 160mm Hg. In 58.34% there was a proteinuria. The mean gestational age was 33 gestational weeks. The delivery was performed in the most suitable for the preeclampsia gestational age. CONCLUSIONS: According to our research work the patients with preeclampsia have a very high risk for cardio-vessel diseases and again of preeclampsia in their future pregnancies from 30%-40%. High prenatal care can prevent most of the complications connected with this disease.

[Clinical application of the natural cervical dilatators (Laminaria) in obstetrics and gynecology].

Laminaria tents are used in obstetrics and gynecology for dilatation and/or ripening of the cervix. They are effective in labor induction, abortion, endometrial biopsy, treatment of cervical stenosis, difficulty in inserting and removing intrauterine pessaries.

Validation of pre- and postoperative nomograms used to predict the pathological stage and prostate cancer recurrence after radical prostatectomy: a multi-institutional study.

PURPOSE: To validate the preoperative and postoperative predictive tables of Johns Hopkins hospital, Baltimore, Maryland (JHH) and the prostate nomograms of Memorial Sloan Kettering Cancer Center, New York (MSKCC), most commonly used to predict the pathological tumor stage and postoperative freedom from recurrence, in a mixed cohort of Bulgarian prostate cancer patients. METHODS: Clinical and laboratory data of 282 prostate cancer patients, who underwent radical prostatectomy, were supplied from three different institutions in Bulgaria. Preoperative prostate specific antigen (PSA) values, clinical stage, biopsy Gleason score and the pathological features of the radical prostatectomy specimens were collected from each center and evaluated. Nomogram-predicted probabilities for the presence of unfavorable pathological parameters (extracapsular extension, seminal vesicle invasion/SVI, and lymph node involvement/LNI), and the 5-year freedom from recurrence were compared with actual patient outcomes. Areas under the receiver operating characteristic (ROC) curves (AUC) were determined for each variable to assess the predictive accuracy of the nomograms applied. RESULTS: The MSKCC prostate cancer nomograms showed superior accuracy for all parameters studied, as compared with the JHH predictive tables. AUC values for organ-confined disease (OCD), SVI and LNI were calculated as 0.763, 0.750, 0.756 and 0.868, 0.787, 0.874 for JHH and MSKCC nomograms, respectively. The AUC values for 5-year freedom from recurrent disease were 0.751, 0.812, 0.813 and 0.894 for pre- and postoperative JHH and MSKCC nomograms, respectively. CONCLUSION: Despite the potential for heterogeneity in patient selection and management, most predictions demonstrated high concordance with actual observations. All studied nomograms showed reasonable predictive values for the fi nal pathological features, like OCD, SVI and LNI, and for the 5-year freedom from recurrent disease. This multi-institutional study showed that each of the predictive tools studied could be used in Bulgarian patients with comparable accuracy. Compared with the JHH tables, the MSKCC prostate cancer nomograms showed higher predictive accuracy and should therefore be preferred.

Radioisotopic detection of sentinel lymph nodes in clinically localized high-risk prostate cancer.

PURPOSE: To explore the efficacy of a radioisotopic (RI) method in detecting sentinel lymph nodes (SLNs), known as sites of harboring metastases, in localized high-risk prostate cancer (HRPC). METHODS: The RI method was applied to 26 males with clinically localized HRPC, subjected to radical prostatectomy in 2006-2008. All had poor pathological characteristics: initial PSA > 15 ng/ml, Gleason score > 7, clinically suspected extracapsular extension, seminal vesicle invasion, and/or positive pelvic lymph nodes (LNs). The radiopharmaceutical (Tc-99m) was injected preoperatively at 4 zones of the periphery of the prostate. Tc-99m-nanocolloid particles were

A case of transitional cell bladder carcinoma prolapsed from the external urethral orifice: a 6-year follow-up after percutaneous suprapubic bladder.

A 30-year-old female was admitted in emergency with acute urinary retention due to bladder tumour prolapsed from the external urethral orifice. The patient underwent immediate endoscopic surgery via suprapubic percutaneous approach. The histological examination confirmed a superficial highly differentiated transitional cell bladder carcinoma. During the 6-year follow-up no evidence of local recurrence or metastatic tumour spread was revealed. The comprehensive Medline search confirmed that this is the fourth case of bladder tumour prolapsed from the external urethral orifice, reported so far. The case deserves the interest of practising urologists because of the exceptional rarity of the entity and the unconventional treatment approach which involves using a percutaneous suprapubic endoscopic technique. Based on the results achieved, we can recommend this unconventional endoscopic approach as specifically indicated in certain situations.

Superficial bladder tumours: analysis of prognostic factors and construction of a predictive index.

OBJECTIVES: To assess the prognostic factors that could be used to predict tumour recurrence and progression, and to construct and validate a predictive index. PATIENTS AND METHODS: Between June 1991 and December 2000, 533 patients (418 men and 115 women; mean age 55.4 years) underwent complete transurethral resection of histologically confirmed pTa and pT1 transitional cell carcinoma of the bladder, after which 377 (test series) were randomized into two subsequent studies, of six groups, to receive adjuvant intravesical sequential bacillus Calmette-Guérin (BCG) and epirubicin, BCG alone, epirubicin (50 or 80 mg), adriamycin 50 mg or no adjuvant therapy. Factors potentially affecting tumour recurrence or progression were assessed using univariate and multivariate analysis, i.e. tumour stage, histological grade, DNA ploidy, history of recurrence, multiplicity, size, tumour configuration, associated carcinoma in situ, recurrence at the first 3-month check cystoscopy and the use of adjuvant therapy. The regression coefficients determined by Cox regression analysis were used to construct a predictive index (PI). The algebraic sum of the regression coefficients of the factors with independent and significant association with disease-free survival for each case represented a proportional hazard score (PHS). The PI was validated in another series of 156 patients (validation series) in whom the same regression coefficients for the same significant factors as the test series were used to categorize it into three risk groups. Kaplan-Meier survival curves were plotted to compare the different risk categories in both test and validation series. RESULTS: The mean (sd, range) follow-up in the test and validation series were 58 (19, 5-96) and 28.3 (14.9, 2-94) months, respectively. In the test series, tumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration, cystoscopy result and the type of adjuvant therapy had independent significance for recurrence on multivariate analysis. For progression, the cystoscopy result, DNA ploidy and grade were the only independent and significant predictors. The ranges of PHS for the factors affecting recurrence-free and progression-free survival were 0.0-7.14 and 0.0-5.84, respectively, which were divided equally into three risk categories with significant differences on Kaplan-Meier curves and a log-rank test (P < 0.001). The three categories in the validation series were significantly different from each other and each was comparable with that in the test series. CONCLUSIONS: Tumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration and type of adjuvant therapy affected independently the rate of recurrence after resecting superficial bladder tumour. Recurrence at the 3-month cystoscopy, histological grade and DNA ploidy were the only predictors of progression to muscle-invasion. The PI dividing the patients into three risk groups with different treatment and follow-up strategies for recurrence and progression was reproducible in a validation series.

Fracture of the penis: treatment and complications.

Fracture of the penis is an unusual blunt traumatic injury of the erect penis. Twenty-five such cases, treated at the 2 main urological departments in the town of Varna between 1984 and 1999, were analyzed retrospectively. The average annual incidence in this series was 0.33 per 100,000 inhabitants. Most of the injuries occurred during vigorous sexual intercourse. Clinical diagnosis was mainly based on the patient's history and the physical findings. The diagnosis was verified by ultrasonography. In a few cases retrograde urethrography and cavernosography were used as additional diagnostic tools. Cavernosography was complicated by postprocedural priapism in 1 case. Unilateral tear of the corpora cavernosa was found in 24 cases. In 3 cases, partial (in 2) or complete (in 1) disruption of the corpus spongiosum and the urethra was found as well. The trauma was bilateral in 1 case in which 2/3 of the entire circumference of the penis was ruptured, including both corpora cavernosa and the urethra. Seventeen patients received immediate surgical repair. Most of them experienced an uneventful postoperative period with no serious consequences affecting their sexual function. Surgery was delayed in 6 and rejected in 2 cases. In all cases in which conservative (nonsurgical) management was the first treatment option, late complications (penile aneurysm, induration, penile curvature, erectile dysfunction) were observed and the final results were assessed as satisfactory or poor. We recommend immediate surgical treatment of all cases of penile fracture. Emergency surgical repair offers a chance for complete recovery and is the best method for providing a good functional prognosis.

Experimental testicular torsion--early and late morphological and enzymohistochemical changes.

It has been reported that testicular torsion leads to diminished fertility. This experimental study includes 32 mature male Wistar rats, divided into 3 groups. Group 1 (4 animals) served as a control group. Group 2 (16 animals) underwent an unilateral definitive ligature of the testicular vessels. Group 3 (12 animals) underwent right testicular torsion at 360 degrees, followed by detorsion at 4, 12 or 24 hours. Both testicles were removed at different terms after the operation and processed for histologic and enzymohistochemical studies. The results of the experiment indicate that a certain recovery of the structure and the enzyme activity may be expected only in case if the duration of the torsion lasts not more than 4 hours. After this period severe and irreversible changes in the ipsilateral testis and serious alterations in the contralateral testis occur.