[OPEN LAPAROSCOPY--A MODIFIED HASSON TECHNIQUE].

The open technique was first described by Hasson in 1970. This technique consists of creating a small umbilical incision under direct visualization to enter the abdominal cavity followed by the introduction of a blunt trocar. Pneumoperitoneum is then rapidly created. Hasson proposed its potential benefits to be the avoidance of blind insertion of the Veress needle and bladed trocar, prevention of visceral and vascular injuries, preperitoneal insufflation and gas embolism, guaranteed pneumoperitoneum, and a more anatomical repair of the abdominal wall. Since that time, many surgeons have made some modifications to first Hasson technique. Here we described the way we do the open laparoscopy in our hospital and different positive and useful details we put to original Hasson version.

Single centre experience with surgical treatment of hilar cholangiocarcinoma.

UNLABELLED: BACKGROUND /AIMS: Surgical resection is a radical treatment option for hilar cholangiocarcinomas. However it is still difficult to cure and patient prognosis is poor. An evaluation of the surgical options and results may elucidate effective treatments. METHODOLOGY: We retrospectively examined the demographic characteristics, surgical records and outcome in 64 patients with hilar cholangiocarcinoma undergoing surgical resections or palliative surgical procedures for the period of 2004-2012. RESULTS: The patients included 43 males and 17 females with a mean age of 61.4 ± 10.4 years (±SD, range 35-81 years). Forty four resections were done - R0-22 cases (34.4%), R1 - 10 (15.6 %) cases, R2 -12 cases (18.7%) and 20 palliative (31.3%) operations were performed. R0 - resection of common bile ducts with right hepatectomy with Sg 1 was done in 8 cases, resection of common hepatic duct with left hepatectomy with Sg 1 in 9 cases and resection of common hepatic duct in 5 cases. The total percentage of postoperative morbidity is 51.5 %. The types of complications are as follows: intra abdominal bleeding 31.25 %, temporary biliary leakage - 26.56 %, leakage of hepatico-jejunostomyâ7.81 %, biliary fistula 7.81%, liver insufficiency 17.18 %, pleural effusion 48.13 %, intraabdominal abscess 28.13 %, surgical site infection 48.3 %. The mean five-year overall survival for R0 - resection is 32%, for R1 - and R2 - resection is 12% and for the palliative operations - 0%. The mean overall survival for R0-resection is 37 months, for R1 - and R2 - resection is 19 months and for the palliative operations 7 months. CONCLUSIONS: Radically extended surgical resection for hilar cholangiocarcinoma is necessary to obtain improved patient survival.

Behavior of Transplanted Multipotent Cells after in Vitro Transplantation into the Damaged Retina.

The use of stem cell technologies in retinal defect reparation therapy has produced beneficial results. Nowadays, numerous protocols exist which provide a neural differentiation of the stem cells transplanted into the retina. However, questions concerning the functional replacement of the missing retinal neurons by transplanted cells thus far remain unanswered. The organotypic culture protocol was used in this study in order to prove the possibility of transdifferentiation of bone marrow stromal cells (MMSCs) and neural stem/progenitor cells (NSPCs) from EGFP-positive mice and the functional integration of these cells. This technique enables a detailed characterization of cell behavior post-transplantation. Using atomic force microscopy, we reliably demonstrated the difference (p < 0.01) between the thickness of the outgrowths formed by glial and endothelial retina cells and the thickness of neurites and neuro-like transplanted MMSC outgrowths. MMSCs are also shown to form synapses up to 2.5 ± 0.06 µm in diameter on day 4 after the transplantation. Following electrical stimulation (20V, 0.5Hz, 200ms), clear depolarization of retinal neurons and their outgrowths is detected. It is shown that some of these GFP+ MMSCs, which changed their morphology after the transplantation in retinal explants to neuro-like MMSCs, are capable of depolarizing after exogenous stimulation.

Cell technology employing femtosecond laser pulses.

Practical advantages of using femtosecond laser pulses for manipulations in cell surgery were demonstrated. The use of femtosecond laser pulses enables precision punching of the zona pellucida of the embryo without damaging its cells. With the help of femtosecond laser tweezers/scalpel, auxillary laser hatching was performed and a technique of optical biopsy of mammalian embryo was developed, which enabled non-contact sampling of embryonic material for preimplantation diagnostics. Our findings suggest that about 90% embryos retained the ability to develop at least to the blastula stage after this manipulation.

Identification of proteins overexpressed in papillary thyroid tumors.

A modified method of proteome comparative analysis based on preliminary removal of cell structural proteins by extraction using salt buffer and subsequent separation of extracts by two-dimensional gel electrophoresis was developed. Identification of differentially expressed proteins by mass spectrometry has revealed three proteins with noticeably increased level of synthesis in most samples of papillary thyroid tumors compared to normal tissues. An increase in ubiquitin content was found for the first time. Oncomarker search efficiencies by two-dimensional gel electrophoresis and bioinformatic search were compared.

[Present-day therapeutic policy in patients with chronic ischaemia of lower limbs: trans-Atlantic inter-society consensus].

The authors have reviewed the available literature dedicated to the development of the treatment policy for managing the patients presenting with lower limb ischaemia. Central to the work is the analysis of the latest guidelines on therapeutic policy to pursue in patients presenting with chronic ischemia of the lower extremities, namely the Trans-Atlantic Inter-Society Consensus Document. This is followed by a detailed discussion of the indications for surgical and endovascular operative interventions in various-type lesions of the aortofemoral and femoropopliteal segments. Summarized herein are the main trends and tendencies in the present-day strategy of managing the patient cohort concerned.

[Pancreatic cancer--multidisciplinary approach and possibilities for surgical treatment].

Pancreatic cancer is one of the most serious and severe diseases and takes a significant part of malignant diseases in Bulgaria, during the last years. The fast progression of this disease requires complex treatment and is still a considerable challenge for the conservative and the surgical approaches. We present a series of 196 consecutive patients operated in our clinic for the period September 2003-February 2008. 106 radical pancreatic resections and 90 palliative procedures were performed. All of the patients were assessed before operation by multimodality team using standard protocols. The criteria for respectability are absence of distant metastasis as well as absence of data for infiltration of celiac trunk and superior mesenteric artery. In the presented series the percent of respectability is 54.1%. 35 Whipple procedures. 49--Traverso-Longmire (PPPD--resections), 15-distal pancreatectomies and 7 papillectomies were performed. In 28 cases the pancreatic resection was combined with vessel resection. 17 patients underwent extended resections. The average postoperative stay for the patients with radical operations is 16.1 days. 39 patients (36.8%) had complications. Six patients among the radically operated died (5.6%). The average survival rate for the patients with radical surgical interventions is 16.2 months. The surgical resection is the only method of choice for radical treatment of pancreatic cancer and periampular tumors. The indications for pancreato-duodenal resections have expended thanks to the development of the surgical technique and reanimation care during the last ten years. In order to achieve better results it's recommended that type of surgery to be concentrated in highly specialized centers.

[Contemporary aspects in the performance of pancreatic anastomosis after pancreatoduodenal resecions].

BACKGROUND: Historically, the pancreatic anastomosis has a significant impact on the high morbidity levels in pancreatoduodenal resections. This leads to parallel development of alternative techniques for reconstruction. The major methods are pancreato-jeuno and pancreato-gastroanastomosis. MATERIAL AND METHODS: We present 82 consecutive cases with pancreatoduodenal resections for the reason of pancreatic head malignancies. Pancreato-jeunal anastomosis is the preferred method and the evolution in the anastomosing technique of pancreatic rermnat is presented. RESULTS: Nine patients had pancreatic fistula (10.9%) and in six cases (7.3%) intra abdominal abscess was observed. CONCLUSIONS: Our experience as well as the analysis of different investigations confirmed the thesis that each center should choose one of the major techniques and develop it--clear tendency of decrease of the frequency of pancreatic fistulas with the growth of the experience, is observed.

[Combined trauma of the abdomen and pelvis]. / Sochetannaia travma zhivota i taza.

Experience in treatment of 164 patients with combined trauma of abdomen and pelvis is analyzed. Mean age of the patients was 40.1+/-17 years, 94 patients were male, 70 -- female. ISS was 28.6+/-11 points. Lethality was 44.5%, during first day -- 61.6%. High lethality may be associated with mistakes in surgical and traumatological policy. Abdominal surgery was performed in 64 (39%) patients, only in 24 (14.6%) of them laparotomy was curative, the rest 40 (85.4%) patients underwent diagnostic laparotomy. It is demonstrated that diagnostic laparotomy has negative influence on prognosis of combined trauma of the abdomen and pelvis. Adequate traumatological policy has also great influence on lethality, particularly during the first day. Overall lethality of patients with rotary-vertical instability of the pelvis was lower in the group with fixation of the pelvis than in conservatively treated patients (41.7 and 56.6%). Lethality during day 1 in patients with fixed pelvis was 0, without fixation of the pelvis -- 82%. It is concluded that verified indications for laparotomy and active traumatological policy improve treatment results in patients with combined trauma of abdomen and pelvis.

[Laparoscopy in diagnosis of abdominal injuries in patients with combined trauma]. / Laparoskopiia v diagnostike povrezhdenii zhivota u patsientov s sochetannoi travmoi.

Importance of laparoscopy (LS) in diagnosis of intraabdominal catastrophe in patients with combined trauma (CT) is determined. Based on analysis of treatment results in 1,118 patients with CT it was revealed that real LS requirement does not exceed 10%, and it may influence negatively trauma outcome. Low diagnostic value of this method was revealed: sensitivity 98.4%, specificity 51%, accuracy 69.2%. It is concluded that LS is not a method of choice in diagnosis of intraabdominal injuries in patients with CT.

[Modern concepts and methodology of means, methods of protection, and safety measures for servicemen affected by nonionizing radiation]. / Sovremennye konseptsiia i metodologiia razrabotki sredstv, metodov zashchity i obespecheniia bezopasnosti voennosluzhashchikh pri deistvii neioniziruiushchikh izluchenii.

The given information classifies the protection means and methods containing the known for today and prospective decisions, as well as process elements of development, creation and testing of these means Presented as whole, these protection group comprise all the possible aspects of the service-men safety problem in operation of military equipment objects, being the source of non-ionizing radiation.

[Possibilities of computerized immunodiagnosis of tuberculosis and related lung diseases]. / Vozmozhnosti komp'iuternoi immunodiagnostiki pri tuberkuleze i slozhnykh s nim zabolevaniiakh legkikh.

The results of a computer analysis of immunograms for the differential diagnosis of tuberculosis, cancer, pneumonia and sarcoidosis are presented. The findings indicate that computer immunodiagnosis may be used as a supplementary tool that increases the effectiveness of diagnosis in difficult cases. The advantage of the elaborated system is to rapidly apply a systemic approach to the assessment of the patient's immune status and to objective diagnosis by using computer algorithms.

[Errors in the diagnosis and treatment of thyroid cancer]. / Oshibki v diagnostike i lechenii raka shchitovidnoi zhelezy.

The analysis of the data on 744 patients with thyroid tumors showed inadequate examination to be the main cause of untimely diagnosis of cancer of the organ. Cytologic examination of tumor punctate proved most effective for diagnosis since it confirmed cancer in 92.3% of cases. Adequate examination and extrafascial surgical procedure with intraoperative contrasting of the thyroid assured five-year survival rate of 95.9% and a decrease in the risk of injury to n. recurrens by 23%.

[Value of thyroid lymphography in diagnosing thyroid cancer]. / Znachenie tireoidolimfografii v diagnostike raka shchitovidnoi zhelezy.

The results of thyroidlymphography carried out in 122 patients with thyroid cancer and 82 cases of benign tumor were analysed. Reliable thyroidlymphographic criteria of malignancy were established on the basis of a comparison of roentgenomorphologic and statistical findings. The significance of the said criteria for making timely diagnosis of cancer with concomitant adenomatosis and chronic thyroiditis is discussed.

Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities.

Results of a prospective randomized clinical trial conducted by the WHO Collaborating Centers for the Evaluation of Methods of Diagnosis and Treatment of Melanoma are reported. Five-hundred-fifty-three Stage I patients whose limbs were affected entered the study; 267 were submitted to wide excision and immediate node dissection and 286 had wide excision and node dissection at the time clinically positive nodes were detected. Survival curves of the two treatment groups could be superimposed. No subsets of patients benefitted from immediate node dissection. The authors conclude that delayed node dissection is as effective as the immediate dissection in Stage I melanoma of the extremities if the patient can be checked every three months. If the quarterly follow-up is not guaranteed, immediate node dissection is advisable, at least for melanomas thicker than 2 mm.

[Current diagnostic and treatment problems in thyroid cancer]. / Aktual'nye voprosy diagnostiki i lecheniia raka shchitovidnoi zhelezy.

The paper deals with a 10-year experience (1971-1980) of treating tumors of head and neck at the Institute. Different aspects of early diagnosis of thyroid carcinoma, its adequate therapy and organisational measures required for its prevention are discussed on the basis of 1,304 case histories of thyroid cancer. Up-to-date methods of early diagnosis of thyroid cancer (diagnostic puncture and thyroidlymphography), which can be integrated with general medical practice, are recommended. Causes of errors leading to failure to remove the whole malignancy are discussed. Recommendations how to obviate this difficulty are given and measures aimed at ensuring a 5-year survival in 98% of cases and adapted to different groups of cancer patients are suggested.