CHEK2 I157T and colorectal cancer in Bulgaria.

Purpose: Germline variants of the CHEK2 gene have been shown to act as low-penetrance cancer susceptibility alleles for a wide range of human malignancies. CHEK2 I157T has particularly been linked to colorectal cancer (CRC) risk. We aimed at establishing the population frequency and contribution of this variant to colorectal carcinogenesis in Bulgaria.

A case of exocrine-endocrine neoplasm of the pancreas in a patient with ulcerative colitis with literature review.

Until now only Japanese authors have reported 4 cases of pancreatic neoplasm associated with ulcerative colitis (UC). We report on a case of a 44-year-old woman who was operated on for complicated UC and an exocrine-endocrine neoplasm of the pancreas, where the endocrine component was presented by pancreatic polypeptide (PP)-producing cells. By means of molecular genetics methods we found microsatellite instability (MSI) in the markers D18S35, FGA and p53 in the colonic lining, and loss of heterozygosity (LOH) in the p53 marker in the pancreatic tumor.

Novel MLH1 frameshift mutation in an extended hereditary nonpolyposis colorectal cancer family.

Aim: To present novel frameshift mutation c.31delC [p.L11X] in the MLH1 gene identified in an extended Bulgarian hereditary non-polyposis colorectal cancer (HNPCC) family and to analyze the molecular and clinical findings within the pedigree concerning the proposal of adequate individual prophylactic strategy for all mutation carriers.

Vitamin D and estrogen receptor gene polymorphisms and the risk of colorectal cancer in Bulgaria.

Background And Aims: Different epidemiological studies report the protective effect on colorectal cancer (CRC) exerted by vitamin D(3) intake, estrogen replacement therapy, and increase of the risk of microsatellite instability (MSI) in CRC by withdrawal of estrogens. The aim of our study was to search for association between CRC and polymorphisms in estrogen receptor-alpha (ER-alpha) and Vitamin D receptor (VDR) genes.

Materials And Methods: We analyzed the PvuII and XbaI polymorphisms from the ER-alpha gene and the BsmI polymorphism of the VDR gene in 140 patients with CRC (subsequently divided according to their MSI status) and 94 controls.

[A case of a 47 years old hydatid cyst of the liver].

This is a presentation of a clinical observation of a hydatid cyst of the liver, accidentally diagnosed 47 years before the first complains. There were no calcifications on the X-rays before the operation, besides the long duration of its existence. There were no complications before the surgery, and the operation and postoperative period were smooth.

[Pouchitis, on the basis of a single observation].

The observing of pouchitis at a patient with ulcerative colitis with onset 4 months after the closing of the ileostoma, protecting the reservoir and with good response to metronidazole, was the reason for performing a literature review of the modern problems of this complication. The suspected pre-, intra- and perioperative factors, taking part in its pathogenesis, its clinical features and treatment are reviewed. We share most authors' opinion that this complication probably is connected with the disease.

[Basic principles of conventional inguinal hernioplasty without prosthesis].

Probably in the near future the conventional hernioplasty without prosthesis will be applied, so it is important its basic principles to be well-known. According to literature data they are: the sac of the indirect hernias should be ligated high; the suture line must not be under tension; the repair of the defect in f. transversalis is mandatory; identical tissues of the same layer should be sutured together.

[Problems in the surgical treatment of Crohn's disease and our experience].

The analysis of the surgical treatment of 16 patients was made according to the modern concept for the role of the surgical treatment of Crohn's disease. The surgical methods for treatment of the perineal disease, Crohn's disease with acute onset and the complications of the chronic disease are discussed. The long-term results at 1 patient with double stricturoplasty is the basis for our opinion, that this procedure should be the alternative of the resection at the most serious forms of the disease--at patients with multiple resections for multifocal intestinal stenoses, which inevitably lead to the development of the short intestine syndrome.

[Pros and cons of some conventional groin hernioplasties used for repair of combined hernias].

Using their experience the authors analyze the surgical methods of repair of groin hernias of McVay, Kukudjanov and Shouldice as a method of choice for combined groin hernias. Using their own anatomical researches, the authors prove that it is possible to explore and using Cooper's ligament extrafascially. The combination of duplication of the transversal fascia (as in Shouldice repair) and moderate change of the medial insertion point of the internal oblique abdominal muscle and the transversal abdominal muscle and suturing the Cooper ligament (as in Kukudjanov repair method), but extrafascially, a new repair method evolve, which strengthens the three weak points in the area.

[Reservoir ileo-anal reconstruction in the surgical treatment of ulcerative colitis].

The authors describe the evolution of the conception and the realisation of the ileo-anal anastomosis (IAA) in the surgical treatment of the ulcerative colitis. Thus, one can get a better idea of the problems of this reconstruction in that disease. On the basis of the review from the available literature, the authors make a summary of the basic factors, responsible for the functional results in the reservoir IAA: physiologic disturbances from the operative destruction; physiologic disturbances from the operative trauma; anatomic reconstruction; the possibilities for a functional adaptation to anatomic reconstruction; postoperative complications.

[Polyposis of the colon and cancer].

Polyposis of the colon is a colon cancer predisposition syndrome. Familial adenomatous polyposis (FAP) accounts for 1% of the cases of inherited colorectal cancer (CRC). The National Register of inherited CRC and polyposis of the intestines keeps track of 18 patients from 14 families with FAP.

[Pancreatitis accompanying inflammatory bowel diseases, and our observations].

According to the literature data the modern concepts of the etiological factors, the pathomorphological features, the diagnosis, the clinical features and the treatment of the drug-induced and the idiopathic pancreatitis, accompanying the IBD are reviewed. The results of a retrospective review of the clinical data of 50 patients, operated on--16 with Crohn's disease and 34 with ulcerative colitis, are shown. Postoperative hyperamylasemia was found in 2 patients with Crohn's disease and in 3 patients with ulcerative colitis.

[About the endometriosis and its intestinal localization, an observatio in one case].

A clinical case of endometriosis of the distal part of the sigmoid colon in a 57 year-old woman is shown, with a clinical presentation of incomplete bowel obstruction. The patient underwent a total hysterectomy and bilateral salpingo-oophorectomy for the chocolate cysts of the left ovary 16 years ago. The condition was estimated as a carcinoma of the sigmoid colon, on the basis of the contrast enema studies and clinical presentation, despite of the endoscopic changes.

[About the protective physiologic mechanisms of the groin area].

Each anatomic structure in the groin area has certain function, which is demonstrated during the increases of intraabdominal pressure. Functionally, the area is a multi-element perfectly synchronized system. According to the literature data its physiologic protective mechanisms against the pressure are: the oblique direction of the inguinal canal in the abdominal wall; the tension mechanism of transversal fascia; the internal and the external mechanism for protection of the inguinal canal; the sphincter mechanism of Lytle; the tamponade function of cremaster muscle; the mechanisms for constricting the internal femoral ring.

[A case report of vascular tumors of the spleen].

The authors present literature data on the problem of vascular tumours of the spleen and describe clinically and morphologically primary epitheloid hemangioendothelioma. They paid attention on detailed characteristic of the tumours and differential diagnosis of with vascular neoplasms of the spleen.

[Pancreatic cancer. The experience with its surgical treatment].

Experience had with the surgical management of 483 patients, operated for cancer of the pancreatic gland in the Clinic of Abdominal Surgery over the period 1971 through 1994, is presented. Distribution of the patients by gender and age shows noteworthy consistency. Preoperatively, exact diagnosis in the clinic is made in 91.

[The choice of the operation and management in cholangitis].

Irrespective of the high rate of bacterial flora (intestinal, respectively) penetration into the biliary apparatus, clinically manifested cholangitis cases are relatively seldom met with. The predisposing factors involved are: penetration of virulent flora (anaerobic inclusive) into the bile ducts, presence of conditions promoting delay or discontinuation of the bile passage (biliary hypertension), and longstanding of the disease. Cholangitis associated with cholangiohepatitis development is one of the severest conditions of cholelithiasis (ChL), being observed as an independent nosological entity also.

[Postoperative peritonitis].

This is a report on retrospective summed-up analysis of the therapeutic approach to 296 patients presenting postoperative peritonitis (PP). They account for 1.4 per cent of the total number of patients operated on in the clinic.

[The gastrointestinal tract as the possibility for a reservoir for the urinary system. A modification of the Mainz pouch technic].

Experience accumulated over the past decade with utilization of the gastrointestinal tract in the formation of a reservoir of the urogenital system shows that the Mainz-pouch technique contributes greatly to obtain a continent reservoir, mainly by Bauhin's valve reconstruction. A procedure is suggested enabling retroperitoneal implantation of the reservoir, formed by the original Mainz-pouch technique, in the lower right quadrant of the posterior abdominal wall, instead of suspending it in the abdominal cavity where it anastomoses with the umbilical anulus and augments the hazard of ileus. The 63-year-old woman with urinary bladder carcinoma, operated according to the modification described, tolerates the intervention free of complications with very good immediate outcome in terms of continence.

[Peritoneal carcinosis diagnosed during herniotomy].

A case of inguinal hernia is described where metastasis from adenocarcinoma with mucinous products in the bottom of the sac are discovered intraoperatively. Prior to operation, the patient is suspected for abdominal organ carcinoma, but no evidence of such a lesion is documented. Persistent complaints of painfulness in the region of hernia is the cause prompting the undertaking of herniotomy.

[An anatomicophysiological validation of hernioplasty in inguinal hernias].

Contemporary understanding of the pathogenesis of inguinal hernias modifies the approach to solution of the problem from elementary anatomical to anatomical and functional. This in turn implies a number of specific demands on their treatment, such as: 1) preserving the oblique course of the canal in the abdominal wall, 2) endeavours to utilize the functionally synergetic elements of the respective layer for plastic repair of the defect, and 3) attempt at noninterference with the pump-valve function of the canal during plastic modelling of either of the openings. In both types of inguinal hernia, posterior plasties are pathogenetically justified.

[A pathogenetic approach to the surgical treatment of large postoperative hernias].

Intractable intraoperative retraction of the abdominal musculature, associated with large postoperative hernias, give rise to reduced abdominal cavity volume, increase of intra-abdominal pressure and pulling along the suture line. These are factors considered as preconditions of the development of postoperative complications and recurrences. Experience with intraoperative facilitation by the application of relief incisions on the aponeurosis of the external oblique abdominal muscles according to Borodin et al during restoration of the abdominal wall continuity at the site of defect is shared.