SMALL INTESTINAL TUMORS.

UNLABELLED: Small intestine is the longest part of the gastrointestinal tract. It represents 75% of its length and 90% of the mucosal surface. Benign tumors are observed at 3-6% and the malignant--1-3% of all cancers of all GI malignancies. PATIENTS AND RESULTS: 23 patients with small intestinal tumors between 2001 and 2014 were admitted in Second Department of surgery. They were comparable in age, location and tumor characteristics. The reasons for hospitalization of patients were following symptoms: bowel obstruction, abdominal pain, GI bleeding, anemia. The diagnosis was established on the clinical presentation, performance status and imaging procedures (CT and MRI). The histological types of the tumor were adenocarcinoma--56.5%, GIST--17.4%, sarcoma--9.3% NET--8.7%, and lymphoma--8.1%. Surgical treatment was performed in all patients and included tumor resection, followed by side-to-side or end-to-end anastomosis. CONCLUSION: Small intestinal tumors are characterized by a low frequency. Diagnosis is made in advanced stage of disease because of lack of symptoms and difficult determination of the clinical presentation. Surgery is the only method that allows radical treatment. Chemotherapy is recommended in patients with malignant small bowel tumors.

Cat scratch disease.

Approximately 24,000 people are infected with cat scratch disease (CSD) every year. CSD is caused by the bacteria Bartonella henselae, a gram-negative bacteria most often transmitted to humans through a bite or scratch from an infected cat or kitten. Although CSD is often a benign and self-limiting condition, it can affect any major organ system in the body, manifesting in different ways and sometimes leading to lifelong sequelae. It is a disease that is often overlooked in primary care because of the wide range of symptom presentation and relative rarity of serious complications. It is important for health care providers to recognize patients at risk for CSD, know what laboratory testing and treatments are available, and be aware of complications that may arise from this disease in the future.

Pain affecting procedures in non-resectable pancreatic carcinoma.

UNLABELLED: Pancreatic cancer is third most common cancer of the gastrointestinal tract in Bulgaria, accouting for 11, 6% in 2008. The leading symptom in patients with pancreatic cancer is the pain. The pain can be related with neoplasms and their metastasis. We should use all kind of resourses for pain relief: conventional drugs (according to the three steps strategy of WHO), interventional or surgical procedures. AIM: To present the interventional and surgical techniques in our practice and to share our experience for pain control in patients with nonresectable pancreatic cancer to improve their quality of life. MATERIAL: In a seven year period (2004-2011) we performed 59 thoracoscopic splanhnicectomies/30--bilateral/ 4 intraoperative resections of celiac ganglion, 25 CT--control celiac plexus neurolysis and 90 cases pain relief with epidural analgesia. Concerning the quality of life we applied a questionnaire of a spannish medical center " City of Hope" adapted for patients with cancer and the level of pain with visual analogue scale VAS. RESULTS: The long-term duration of the pain relief technique depends on applied technic, of cancer invasion and of the technic itself. The technique with the longest effect are the intraoperative celiac ganglion removal and the bilateral thoracoscopic splanhnicectomy. On the other hand the shortest effect we report the celiac plexus neurolysis, and the epudural analgesia. These data are in correlation with the reduction of the pain shown using VAS thus improving the quality of life. CONCLUSIONS: The surgical and interventional methods for control of cancer pain have their own collocation improving the quality of life of these patients. New strategies for the pain control are need in the future.

[Particularities of splanchnic innervation of the upper abdomen organs - clinical experience].

Due to pain because of supramesocolic malignancies of the upper abdomen organs in 50 patients at nonoperative stage, we have performed 18 right sided, 11 left sided and 21 bilateral TSS interventions. Video recordings of all operations have been examined postoperatively and have been registered the anatomical variations of the splanchnic nerves formation. There have been made conclusions concerning the intraoperative behavior and tactics for surgical pain control in pancreatic, distal esophageal, gastric, extrahepatic bile ducts and liver neoplasms in nonoperative stage.

[Surgical pain control and quality of life improvement in patients with nonoperable supramesocolic neoplasm by using thoracoscopic splanchicectomy (TSS)].

In patients, suffering from malignancies, pain is still predominant symptom. The control of carcinogenic pain has to be led with all known sources and methods: medications, surgical methods and interventional methods. Since august 2004 in a period of 34 months there have been examined 50 patients with abdominal viscera malignancies, located in between transversal colon and diaphragm, i.e having the same sympathetic innervations and suffering from pain, located in the upper abdomen, due to the illness. There have been examined the influence of pain level and quality of life improvement after TSS of the investigated group. TSS is easy to perform surgical method with good possibilities in visceral pain control in supramesocolic neoplasmas, with insignificant intra and postoperative complications. TSS improves the quality of life of patients with nonoperable supramesocolic neoplasms.

[Post-gastrectomy reconstruction versus enteral alimentation--a one year follow-up study]. / Rekonstruktsiia sled gastrektomiia i enteralno khranenie--ednogodishni rezultati.

This is a report on various post-gastrectomy reconstructive procedures, proceeding from personal experience had with 14 patients undergoing gastrectomy for carcinoma of the stomach and five patients with operations of esophagus and stomach for various pathological conditions. An assessment is done of the reconstructive methods used on the ground of objective indicators. All patients are subjected to enteral alimentation through nutritive jejunostomy. In the pre- and postoperatived periods, the trophic state of patients is evaluated on basis of biochemical, anthropometric and immunologic study data. Postoperatively, in those with small-intestinal reservoir a lower degree negative symptomatology is established, along with life style improvement. Post-gastrectomy patients presenting I-II (UICC) stage of the oncological disease are indicated for small-intestinal reservoir formation. In the overall therapeutic approach to post-gastrectomy patients adequate clinical therapeutic feeding proves absolutely indispensable.