[112 years of hydatid surgery in Bulgaria (1895-2007)].

Hydatid surgery in Bulgaria dates back of a hundred years. Most of famous Bulgarian surgeons have worked about problem of all locations of the Echonococcus granulosus in the human organism. Their scientific achievements are covered in more of two hundred theses, publications, dissertations. The hydatid disease always was in the schedule of every scientific forums - congresses, conferences, etc. A Bulgarian scientific council has been established with a great experience and very good postoperative results. It's many innovations in diagnostics and surgical treatment, accepted all over the world. Renovations of work in this field are develop. Prophylactic measures for this severe and common disease have been undertaken.

[Causes for liver echinococcosis reccurence].

Recurrence of the liver echinococcosis is established in 22,30% of the surgically treated patients. Long-term research of the capsula fibrosa is conducted with histological, immunofluorescent and biological experiment with implantation in test animals and histological research of the hepatic parenchyma for presence of protoscolekses in the capsule and beyond its limits. The Napalkov theory for this type of recurrence mechanism is not confirmed. The exact reasons for recurrence are revealed: not diagnosed during the operation smaller cysts (38.89% in the analyzed specimens); intraoperative dissemination of germ elements' incomplete sterilization of the echinococal cyst during the operation; recontamination with oncospheres. A new method for 100% sterilization of the fibrous cavity is introduced. Conclusions are made over the types of operations and the safest of them are recommend in connection with the research.

[Liver cirrhosis caused by liver echinococcosis].

Systematic histological and ultra structural studies over operated patients and in experiment on white infantile mouse have revealed very serious liver alterations, when affected by echinococcosis. Alterations advance with disease progress and lead to cytological alterations in the organ in significant percent of the patients. Echinococcosis is accepted as etiological factor for cirrhosis. Echinococcosis should be included in the existing etiological classification: alcoholic, posthepatical, metabolic, biliar and cardiac. Early diagnosis and surgical treatment is recommended for prevention of development of cirrhosis and irreversible changes in the organ. Intensification of the prophylactic measures among population for reducing of morbidity are also recommended.

[Immunity changes in liver echinococcosis].

A research is conducted over the Circulating immune complexes (CIC) of the T- and B- immunity blood cell systems. Statistical significant increase of the CIC is established and decrease of the T-lymphocytes, without changes in the B-lymphocytes count. The immunosuppressive effect of the echinococcosis over the T-lymphocyte system and the increase of the activity of the B-lymphocytes, without changes in their count is demonstrated. CIC deposits in the capilar intima causes allergic immunocomplex glomerulonephritis and other systemic damages. The research proves the necessity for immunomodulating therapy in the preoperative preparation of the patient and after ehinococcectomy.

[Diagnostic puncture and puncture treatment of liver echinococcosis--"yes" or "no"]. / Diagnostichna punktsiia i punktsionno lechenie na chernodrobnata ekhinokokoza--"za" i "protiv".

The authors present as problematic and debatable the article about the diagnostic punction and punction treatment of the liver echinococcosis. Of many years scientific disputation about this problem exist. The risks of per cutaneum punction leads to many serious complications. This assess the revaluation of this method which must apply only in very limited evidence--small surface cysts without additional cysts and for diagnostic plan must be abandon.

[Acute surgical abdomen in idiopathic haemochromatosis]. / Ostur khirurgichen korem pri idiopatichna khemokhromatoza.

The acute abdomen (AA) is a typical but very rare complication of idiopatic haemochromatosis (IH). The possible mechanisms are not sufficiently clarified. We report a case with IH who died with clinical features of (AA) 20 hours after gastroscopy was performed. The histological examination established nonspecific damage of visceral peritoneum and ascites. Fulminant form of spontaneous bacterial peritonitis (SBP) as a reason of death is discussed, nevertheless endoscopic esophageal varices sclerotherapy was not performed. The role of pulmonary infection and intestinal bacterial overgrowth with possible bacterial translocation in mesenterial lymph nodes, ascitic fluid, and blood is also discussed. The source of infection is usually unknown. The iron is important factor for bacterial growth. The pluriglandular deposition of iron including the suprarenal glands is precondition to development of collapse. The possible pathogenesis of SBP in IH is discussed. It is important to mention that unlike SBP the clinical course of IH AA might appear which does not necessary require surgical management.

[Iatrogenic lesions of hepatocholedocus in cholecystectomy]. / Iatrogenni lezii na khepatikokholedokha pri kholtsistektomiia.

This is a report on nine patients presenting different intraoperative lesions to hepatocholedochus, some of them diagnosed in the course of operation, and others- after the intervention. A variety of plastic repairs of the hepatocholedochus, including simple suture, Saple's operation or hepatodigestive anastomosis after Longmayre are performed. The probability of inflicting lesions, the underlying causes and the therapeutic approach to concrete cases are analyzed. Abiding to the principles of surgery is strongly recommended, such as: sufficient and appropriate operative access, atraumatic manipulations, drainage of the gallbladder bed and the like, with a view to perclude serious and sometimes fatal complications' occurrence, as well as making early diagnosis and accordingly taking the most opportune surgical solution to the problem faced.

[Francke's operation--a resolution for deep small echinococcal cysts of the liver]. / Operatsiia na Francke--reshenie pri dulboki malki ekhinokokovi kisti na cherniia drob.

The operation of Francke in hydatid disease treatment is described--puncture, aspiration, sterilization--with emphasis laid on the technical details. The indications for its practical implementation are specified--small echinococcus cysts, deeply located within the parenchyma of the organ, or diffuse abdominal echinococcosis. In diagnosing such cysts intraoperative ultrasonography is considered as absolutely necessary and mandatory. The operation is practicable in handling first-stage cysts according to Volynkin, containing thin echinococcus liquid only, whereas in the presence of daughter vesicles it is not indicated. Postoperatively, dispensary outpatient observation and chemotherapy of the hydatid disease are recommended with a view to promote radical cure.

[Secondary sclerosing cholangitis after echinococcectomy]. / Vtorichen sklerozirasht kholangit sled ekhinokokektomiia.

This is case report concerning secondary caustic sclerosing cholangitis following scolecide with concentrated sodium chloride solution (30%) during operation on a liver echinococcus cyst with involvement of the extrahepatic biliary apparatus only. Hepatojejunostomy is performed. Histological study of the liver demonstrates evidence of severe cholangitis, purulent cholangiolitis and suspected secondary biliary cirrhosis. In conclusion, it is stressed that dynamic postoperative follow-up of patients is mandatory to make early diagnosis of the complication and undertake operative treatment anticipating the development of a cirrhotic process. The search for new, effective scolicides, not damaging the biliary apparatus and hepatic parenchyma, is strongly recommended.

[Perforations of hepatic hydatid cysts]. / Vurkhu perforatsiite na ekhinokokovite kisti na cherniia drob.

Out of a total of 753 patients operated for liver echinococcosis, in 43 (5.71 per cent) various perforations are observed, namely: in the biliary apparatus, chest, abdominal cavity, gastrointestinal tract, subphrenic and subcutaneous tissue. Their incidence in bile ducts is the highest. The lethality is rather elevated with two patients dying on the operating table. In conclusion, proceeding from the severity of the complication emphasis is laid on the necessity of early diagnosis of the disease, before development of serious complications, successfully achieved in the last few years.

[Percutaneous puncture in hepatic echinococcosis]. / Perkutanna punktsiia pri chernodrobna ekhinokokoza.

This is a report on a case of severe anaphylactic shock and hemorrhage following liver puncture with diagnostic purpose. Based on literature data and personal experience, percutaneous puncture of a parasitic expanding cyst, done with diagnostic and therapeutic purpose, is discarded, assuming the method as an error of art. Its performing using updated imaging techniques--echography and computerized tomography--by no means reduce the risk of anaphylactic shock and secondary echinococcosis. In the event of being accidentally done, emergency operation followed by chemotherapy to preclude secondary echinococcosis is recommended. In cases with unspecified diagnosis, puncture under echographic control is done on the operating table with urgent cytological assessment of the punctate. The demonstration of echinococcosis is an indication for immediate operation. The percutaneous method is used in handling nonparasitic cysts.

[Pre-, intra- and postoperative allergic manifestations in hepatic echinococcosis]. / Pre-, intra- i postoperativni alergichni iziavi pri chernodrobnata ekhinokokoza.

Data obtained from 502 patients operated for echinococcosis (hydatid disease) are analyzed. In 61 of them (12,15 per cent) a variety of allergic manifestations are observed before the operation. Serious allergic shocks intraoperatively, and lethal outcome due to allergic shock in the postoperative period are described. Inferences are reached about the necessity of performing mandatory examination of all allergic patients for echinococcosis as an eventual underlying cause of allergy, as well as mandatory preoperative tests for allergy to drugs and anesthetics along with undertaking antiallergic prophylaxis of patients in the postoperative period to obviate eventual allergic accidents, regardless of their presence or not in the previous history.

[Intraoperative anaphylactic shock following the percutaneous puncture of a hepatic echinococcal cyst]. / Intraoperativen anafilaktichen shok sled perkutanna punktsiia na chernodrobna ekhinokokova kista.

This is a report on a case of severe intraoperative anaphylactic shock, developing within several hours of percutaneous puncture of a liver hydatid cyst, performed under echographic control, necessitating recovery from the shock state and discontinuation of the operative intervention. Inferences are reached regarding the most adequate treatment tactics to be adopted in handling such cases. Percutaneous puncture is discarded as a therapeutic approach because of the great risk of anaphylaxis with eventual lethal outcome, and the likelihood of severe abdominal echinococcosis development at a later period.