DRUG RELATED NITROSOGENESIS, PHOTOCARCINOGENESIS AND ONCOPHARMACOGENESIS OF NODULAR MELANOMA: A CASE RELATED ANALYSIS CONCERNING THE POLYCONTAMINATION OF THE POLYMEDICATION WITH VALSARTAN/HYDROCHLOROTHIAZIDE AND BISOPROLOL.

Despite the fact that the pathogenesis of cutaneous melanoma is shrouded in mystery, factors that have been neglected or unnoticed until now have come to the attention in recent years, and in all likelihood, they could also be pivotal. These factors, known as nitrosamines or NDSRIs, are characterized by high carcinogenic and mutagenic potency, and some of them have demonstrated these properties to human DNA as well. Unfortunately, these ingredients also turn up as contaminants in about 300 of the most widely distributed drugs worldwide. According to the most recent literature, some of these ingredients are also identified as potent photocarcinogens, as well as human carcinogens. The intake of these carcinogens in the context of polycontamination of polymedication, has been associated for years with the occurrence of melanomas. The need for cataloguing of nitrosamines , as well as their accurate labelling on drug packaging, would help to classify them even more accurately as carcinogens affecting human DNA. We present once again a patient , who developed nodular melanoma within the context of the intake of 3 potentially nitrosamine/ NDSRIs contaminated antihypertensive drugs (valsartan/ Hydrochlorothiazide/ bisoprolol). Pathogenetic aspects concerning drug-induced nitrosogenesis, photocarcinogenesis and oncopharmacogenesis of skin cancer are discussed. Nitrosogenesis' of Cancer as concept in the medical literature has been known for decades, but in relation to other forms of human cancer. Exogenously mediated drug-mediated nitrosogenesis is a logically conditioned and newly defined concept whose significance with respect to the clinical manifestation of skin cancer is only beginning to grow.

[Mini-invasive approach in the treatment of acute necrotizing pancreatitis].

OBJECTIVES: The study aims to evaluate the efficacy of percutaneous necrosectomy performed under ultrasound control and endoscopic necrosectomy trough secondary sinus track (ENTSST) using nephroscope and cystoscope. MATERIAL AND METHOD: Puncture of fluid collections in the pancreas was performed under ultrasonographic control to 23 patients with acute necrotizing pancreatitis (ANP). ENTSST using nephroscope and cystoscope was performed to 47 patients after open or percutaneous necrosectomy and persistent sepsis (without satellite collection of CT). RESULTS: Seventeen (74%) patients treated with percutaneous necrosectomy recovered without open surgery. Two of this group died. The average hospital stay was 42 days. Twenty-three patients required an average of two (from 1 to 4) ENTSST. CONCLUSIONS: Based on our initial results we believe that the percutaneous necrosectomy and ENTSST in well selected patients might be the better choice than the open necrosectomy and postoperative lavage. Common solution of these methods has not been reached yet.

[Gunshot injuries of the ureters--retrospective study of 12 patients over 27 years period].

AIM: To retrospectively study the gunshot injuries of the ureters, operated in the surgical departments of Military Medical Academy, Sofia and Medical Institute Ministry of Interior, Sofia for a period of 27 years. MATERIAL AND METHOD: The gunshot injuries of the ureters of twelve patients are retrospectively studied in the period 1980 to 2007. For all patients the localization of the injuries, urinanalysis, imaging examination results, the associated injuries, the operative procedures and complications were reviewed. RESULTS: All patients are males aged 19-28 years. Seven patients have right ureteral injuries and five have left ureteral inuries. In three patients the urinanalysis is normal, five have microscopic and four have gross hematuria. The injury is located in the proximal third of the urether for six patients, in four it is in the mid and in another two in the the distal ureter. Complications are registered in 40% of the cases. CONCLUSIONS: Due to the high ratio of false negative results from the urinanalysis and the imaging studies, careful and precise exploration of the retroperitoneum in order no to omit a possible injury of the ureters.

[Surgery strategies for management of gunshot wounds to urogenital system].

The gunshots injuries of the spleen are relative uncommon by comparison with others abdominal trauma. The rate is 1 to 3% of all injuries to the abdomen. This review presents the most widespread classifications of spleen trauma, current diagnostic--physical examination, sonography, CT, DPL, laparoscopy. The surgical treatment is discussed in the following trends--nonoperative and operative approach depending on patient's condition. The nonoperative treatment is applied to hemodynamically stable patients with established superficial lesions and ceased hemorrhage. In the other cases the operative approach is indicated. The splenectomy is the method of choice and in defined situations spleen tissue autotransplantation is applicable. Other procedures are outlined: spleen preserving resections, splenorrhaphy, mesh repair, ligation of sanguinating vessels, omentoplastic, hemostatic glue or mesh, argon plasma electrocoagulation. Most reported complications following spleen trauma are hemorrhage, infections, thrombocytosis, partial necrosis of stomach, pancreatitis, postsplenectomy sepsis. The mortality varies between 5 and 65%.