Endorectal power Doppler ultrasonography is a reliable method for evaluation of rectal cancer angiogenesis.

OBJECTIVE: We aimed to assess the preoperative rectal cancer angiogenesis with Endorectal Power Doppler Ultrasonography by using the Power Doppler Vascularity Index (PDVI) calculated by imaging analysis software, and to compare it with the microvessel density (MVD) in surgical specimens PATIENTS AND METHODS: This study included 110 patients (39 females; mean age 61.5 years) with rectal cancer. Immunohistochemical staining of surgical specimens with anti-CD-31 antibody was used for MVD evaluation. The PDVI of each tumor was calculated using Endorectal Power Doppler with computer-assisted quantification of colour pixels. RESULTS: Mean MVD - 163 ± 69 microvessels/mm2 (50-328) was used as a cutoff point, differentiating two groups of tumors with high (> 160 mm2) and low (≤ 160 mm2) angiogenic activity. Mean PDVI of 8.9 ± 6.0% (0-27.3) was used as a cutoff point, dividing two groups of tumors with high (> 8%) and low (≤ 8%) PDVI. The MVD and the PDVI showed a good positive correlation (r = 0.438, p = 0.002). Patients with low PDVI had 25 months longer overall survival (p < 0.05) than patients with high PDVI. Patients with low MVD had 36 months longer survival (p < 0.05). CONCLUSIONS: Endorectal Power Doppler Ultrasonography is a reliable and noninvasive method for assessment of the extent of rectal cancer angiogenesis. Tumor angiogenesis assessed by the PDVI correlated with histological MVD determination and could predict survival rates. Endorectal Power Doppler examination is a useful and reproducible method for in vivo preoperative quantitative assessment of tumor vascularization.

Complicated small bowel diverticulosis--a case report and literature review.

We report herein the case of a small bowel diverticulum perforation which has caused peritonitis and consequently has led to operation. The patient, a 79-year old woman, was hospitalized due to etiological clarifying and specifying of a newly diagnosed diffuse liver pathology. During the hospital stay, she has received severe abdominal pain with features of peritonitis. Suspecting perforated appendicitis she has undergone an operation. The explorative laparotomy has identified a purulent exudation in the abdominal cavity, resulting from a perforated inflammatory jejunal diverticulum and multiple middle-size diverticula all along the small bowel and the colon. The reported case as well as the review of the literature have shown that various and sometimes potentially fatal complications could occur even for such a relatively banal insignificant entity as is diverticular disease in elderly patients.

[Papillary and cystic tumor of pancreas--Frantz's tumor]. / Papilaren i kistichen tumor na pankreasa--tumor na Frantz.

The aim of the authors is to introduce one rare known pathology which the Frantz's tumor is, his clinical characteristic, clinical signs, diagnostic and treatment. We have observed two separate cases of this illness in Clinic of Surgery (University Hospital "Queen Yoanna") in comparison with evidence of famous world surgeons. We have made an attempt to introduce one disease, which even though not often observed is significant by the fact that affect young women (girls) and only surgical resection is a treatment of choice.

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. A literature review concerning the coexistence of these two conditions showed that PP is involved in the pathogenesis of the UC and that UC increases the risk of development of extracolonic neoplasms.

[Multiple primary malignant neoplasms (MPMN), with case reports]. / Vurkhu purvichnata mnozhestvenost na zlokachestvenite tumori (PMZT) s opisanie na sluchai.

In this work the authors reviewed the literature on multiple primary malignant neoplasms (MPMN). This termin includes two or more tumours with different histologic appearance developing in different organs and giving metastases. The authors present 4 case reports of MPMN payng particular attention on the importance of the correct diagnosis of the tumours for the treatment of the patients.

[Endoluminal echography in rectal cancer--preoperative staging and postoperative control]. / Endolumenna exografiia pri rak na rektuma -- predoperativno stadiirane i sledoperativen kontrol.

The aim of this study is to determine the diagnostic potential of endoluminal echography and the pitfalls sources in the preoperative staging and postoperative follow-up in patients with rectal cancer. 245 patients with rectal carcinoma are evaluated during 10 years period (Jan. 1993-Jan. 2002 years). 96 patients are monitored in the early and late postoperative periods for the early detection of local recurrence as well as for the anorectal physiology assessment after low anterior rectal resection or coloanal anastomosis. Lineal transducer UST-657-5MHz (Aloka 620) and 10MHz miniprobe are applied. The accuracy for T-staging is 84% and for N-staging is 82%. The local recurrence is detected in 21 patients, on average 12.6 months after curative surgery. The local recurrence is more often in cases of lymph node involvement as well as if some specific echographic features for extramural vascular invasion are present. Endoluminal echography provides individual therapeutic management and postoperative control in patients with rectal cancer.

[Surgical treatment of complicated gastrointestinal forms of non-Hodgkin lymphomas]. / Khirurgichno lechenie na uslozhnenite gastrointestinalni lokalizatsii na non-Hodgkin limfom.

Authors represent their experience in surgical treatment of gastrointestinal forms of No-Hodgkin's lymphomas (NHL) combined with adjuvant therapy. We also represent an Ann Arbor Staging System and an Updated Kiel Classification. From 1991 to 2001 we analyzed 39 patients with different localization of gastro-intestinal NHL's lymphomas. In this aspect more common are stomach's lymphomas--27 patients (71%); small bowel's lymphomas--3 patients (8%); more uncommon are the localizations in colon--3 patients (8%), predominantly in caecum and right colon; rectum--3 patients (5%). Add to thus we described one mechanical icterus caused lymphoma, one multi-lobular spleen lymphoma and one case of anterior abdominal wall lymphoma. All patients underwent surgery. Eight of them were operated as an emergency cases. Operative treatment of NHL isn't radical but in combination with adjuvant therapy can be life saving event in complicated forms.

[Oncocytoma of the pancreas. A case report]. / Vurkhu edin sluchai s onkotsitom na pankreasa.

For the first time in the bulgarian literature a case with pancreatic oncocytoma is described, initially diagnosed as carcinoma. The patient survived for 13 years being nowadays in perfect condition.

[Plasmacytomas of the upper respiratory tract]. / Plazmotsitomi na gornite dikhatelni putishta.

Nine cases of plasmocytoma of the upper airways in the current biopsy material are studied over a three-year period (1991-1993). Initially, all nine cases are clinically diagnosed as neoplasms: hemangiofibroma--one, chondrosarcoma--one, suspected carcinoma--five, and unspecified diagnosis--two. "Plasmocytoma" diagnosis is made on the ground of histological investigation of the material, supported histochemically and electron-microscopically. Some diagnostic problems (differential diagnosis inclusive) are discussed, as well as issues relating to the clinical and morphological evolution of the disease, and predilected gender and age groups.

[Shock and acute kidney failure because of not taking fluids]. / Shok i ostra bubrechna nedostatuchnost poradi nepriemane na technocti.

A case is presented of shock and acute renal failure due to dehydration in a woman with a psychic disease who had not taken food and fluids for a long time. The post mortem examination revealed the pathomorphologic pattern of shock with microthrombi in the inner organs, brain and leptomeninges.

[Histological, histochemical and x-ray angiographic studies of the blood circulation in the myocardium in cardiac infarct]. / Khistologichni, khistokhimichni i rentgenoangiografski proucvaniia vurkhu kruvnata tsirkulatsiia v miokarda pri infarkt na surtseto.

The hearts of 11 necropsy cases--nine with myocardial infarction and two with pulmonary embolia were investigated--histologically, histochemically and roentgenoangiographically. The author recommends, for the complete investigation of myocardium blood circulation, a successive filling of the heart vascular system, first of all with Indian ink-gel mass--for to follow up the microcirculation state and then--with roentgen-contrast mixture of Hauch and Tolgskaja--for to establish the changes in the large arterial vessels. Severe microcirculation disorders in the cardiac muscle were found in acute myocardial infarction, involving all heart segments, manifested with focal phenomena of stasis with ischemic changes in myofibres. With the establishment of a similar microcirculatory picture in pulmonary embolia, the author explains the differential-diagnostic difficultes in those two states. The thromb-formation in small arterial and venous vessels in those regions, developing on the background of a blood stasis with a consequent hypoxy of the vessel wall is stressed to be of importance for the intensification of the changes in the ischemic zone and for the widening of the necrotic area in case of fresh myocardial infarction. These observations support the application of anticoagulants and fibrinolytics as an important prophylactic measure against myocardial infarction in stenocardiac paroxysms and against the extension of the necrosis in an already developed infarction. The poor vascular, especially microcirculatory, network in the area of the postinfarction cicatrices is admitted to be the most likely cause for the frequent development of repeated infarctions in the preserved among and around them myofibres.

[Changes in the microcirculation of the myocardium in pulmonary embolism]. / Promeni v mikrotsirkulatsiiata na miokarda pri belodrobna emboliia.

The author induced experimental lung embolia by venous administration of liquid fat or licopodium spores in 26 rabbits. Materials, obtained from myocardium of the experimental animals, were examined histologicaly and histochemicaly. The method of Lie et al. (1971) was used for establishing early ischemic changes in myofibers. The author recommended licopodium embolia as a good model for examining changes in myocardium after lung embolia. She indicated development of shock phenomena in animals with lung embolia, presenting signs of coronary insufficiency, including formation of sites of ischemic myofibers. With these changes the author explained the serious difficulties at the clinic in diagnosing and differentiating lung embolia from myocardial infarction even after electrocardiographic control.