Estimate of B(B(over) -->Xgamma) at O(alpha(s)2).

Combining our results for various O(alpha[s]) corrections to the weak radiative B-meson decay, we are able to present the first estimate of the branching ratio at the next-to-next-to-leading order in QCD. We find B(B[over ]-->X[s]gamma)=(3.15+/-0.23) x 10(-4) for Egamma>1.6 GeV in the B[over ]-meson rest frame. The four types of uncertainties:nonperturbative (5%), parametric (3%), higher-order (3%), and m(c)-interpolation ambiguity (3%) have been added in quadrature to obtain the total error.

[Abdominal adhesion disease--the diagnostic and surgical problems in emergency surgery]. / Abdominalnata adkhezivna bolest--diagnostichen i khirurgichen problem v speshnata khirurgiia.

Reviewing the literature, the authors discuss the diagnostic and surgical problems of abdominal adhesion disease in emergency surgery. The etiology and pathogenesis of adhesion disease is complex and still poorly understood. A number of etiologic factors are considered responsible. The authors formulate the current concepts on the pathogenesis of this disease and some classifications in the world literature. Adhesion disease is a major problem in emergency surgery, especially the form known as acute breed ileus. The prophylaxis, conservative and adequate operative treatment are of great importance.

[The surgical and endoscopic therapeutic procedures in acute hemorrhages of the upper digestive tract]. / Khirurgichna i endoskopska lechebna taktika pri ostrite kruvotecheniia ot gornite otdeli na khranosmilatelniia trakt.

A total of 2995 patients with esophagogastroduodenal bleeding have been treated the Department of Emergency Surgery for the period 1984-1988. A significant group were patients in advanced and senile age (beyond 65--42.4 per cent). The therapeutic and surgical approach to gastroduodenal bleeding was based on the solution of the following diagnostic-tactic problems: cause, source, localization and intensity of the bleeding, temporary or definitive hemostasis patterns, severity of blood loss. Essential is also the underlying disease, patient age and accompanying diseases. Express emergency endoscopy allows early and explicit visualization of the pathologic area and enables to gain knowledge on the nature and intensity of the bleeding or the character of spontaneous hemostasis. In this respect, express endoscopy is a guiding principle in managing upper digestive tract bleeding at the Department of Emergency Surgery. Of all hospitalized patients in this study were operated 203. Operations were performed after obligatory attempt for endoscopic hemostasis. The operative case fatality rate for the study period was, as follows: in gastric and duodenal ulcer 21.6 per cent, in gastric cancer 42.0 per cent, in hemorrhagic gastritis 33.3 per cent and in Mallory-Weiss syndrome 9.1 per cent.

[Hemorrhage from the digestive tract in the Mallory-Weiss syndrome]. / Kruvotechenie ot digestivniia trakt pri sindroma na Malori--Vais.

Thirty-three patients with Mallory-Weiss syndrome have been treated at the Clinic of Emergency Surgery in Sofia for a period of 11 years (1980-1990). According to treatment and outcome they were classified as follows: conservative treatment--7 patients, electrocoagulation--16, sclerosing procedure--10, successful endoscopic hemostasis--17, emergency surgical intervention--9, relapse of bleeding after endoscopic surgery--9, death from hemorrhage--4, total case fatality--12.1 per cent, operative case fatality rate--33.3 per cent.

[The immediate results of transendoscopic sclerotherapy in hemorrhaging varices, tumors and polyps and in the Mallory-Weiss syndrome]. / Neposredstveni rezultati ot transendoskopskoto sklerozirane na kurviashti varitsi, tumori, polipi i pri sindroma na Malori--Vais.

In 1982 four Japanese authors Okaba, Honda, Toshiba and Asami reported at the International Symposium in Tokyo on successful transendoscopic sclerosification of bleeding ulcer, around which a sclerosifying agent or absolute alcohol was injected with or without epinephrine. Alcohol suppresses bleeding, causing local dehydration, coagulation and sclerosis of the bleeding tissue, thus producing hemostasis. For the last two years the authors have gained some experience in the application of periulcer and peritumor sclerosification with the sclerosifying agent etoxysclerol (3 per cent solution) and pure 96 per cent ethanol + 1 ampoule epinephrine. As regards the bleeding site, patients with the following nosologic entities were treated: gastric ulcer--24 patients; duodenal ulcer--13; gastric cancer--6; anastomotic ulcer--2; acute ulcer--7; Mallory-Weiss syndrome--10 patients. The results may be summarized as follows: temporary hemostasis was achieved in 21 patients, bleeding recurred in 8 and 9 patients required emergency surgery. Complete and ultimate hemostasis was attained in 29 patients (46.7 per cent). Nine patients died of hemorrhage.

[Our experience with diathermy coagulation as a form of therapeutic endoscopy in acute upper digestive tract hemorrhages]. / Nashiiat opit ot diatermokoagulatsiiata kato forma na lechebna endoskopiia pri ostrite gornodigestivni kruvotecheniia.

In addition to sclerosifying by use of fibroendoscope which acts upon the source of bleeding, to achieve hemostasis and prevent bleeding relapses nowadays other methods have also gained acceptance. Major importance among these is attached to diathermocoagulation. It may principally be assumed that diathermocoagulation is indicated for critically ill patients with serious accompanying diseases of primary or secondary importance, as well as in the event of persistent bleeding during the clinical examination and impending resumption of bleeding soon after the examination. Hemostasis by electrocoagulation should not be attempted in patients in agonal state when endoscopic examination is in its self dangerous. It is contraindicated also when the source of bleeding can not be established, in cases of severe arterial bleeding, blurring the optics, and in severe concave ulcers carrying the risk of perforation. The method was applied on 173 patients; in 96 (55 per cent) electrocoagulation was successful and in 78 (45 per cent) was unsuccessful. Electrocoagulation was considered a success in patients with acute ulcers and cardiovascular disease, in cases of large erosive units of drug origin, in posteriorly located gastric ulcers, in Mallory-Weiss syndrome and in gastric cancer.

[The results and a discussion of the esophagogastroduodenoscopic studies performed successfully, early and postponed in patients with upper digestive tract hemorrhages in 1980-1990]. / Rezultati i obsuzhdane na provedenite speshni, ranni i otsrocheni ezofagogastroduodenoskopski izsledvaniia pri bolni s kruvotecheniia ot gornata polovina na digestivniia trakt za perioda 1980-1990 godina.

For a period of 10 years (1980-1990) a total of 2034 emergency, early and postponed endoscopies have been performed in patients with upper digestive tract bleeding at the Department of Emergency Surgery in Sofia. Duodenal ulcer has been the leading cause of bleeding--41.19 per cent of the cases, with gastric ulcer ranking second--14.94 per cent. There followed in descending rank order: gastric and duodenal erosions--12.34 per cent; gastric cancer--5.06 per cent; hemorrhagic gastritis--2.56 per cent; esophageal varices--7.27 per cent; Mallory-Weiss syndrome--1.62 per cent. Bleeding from the digestive tract of patients with CNS trauma based on acute stress ulcer and erosions and activated old callous ulcer occupied the 12th place in rank order. On the 13th place ranked upper digestive tract bleeding in patients who had undergone thermic trauma (2.01 per cent). Much fewer wer the cases of bleeding secondary to peptic ulcer of the jejunum, gastric and duodenal diverticulosis, acute ulcers in patients with cardiovascular diseases, blood diseases, liver, bile duct and pancreas diseases, aorto-duodenal fistulas and drug-induced diseases. The cause remained unknown in 1.77 per cent of the patients. On the basis of the indisputable achievements in [correction of ti] the diagnosis of acute upper digestive tract hemorrhage, the approach to these grave nosologic entities has essentially been altered.

[The current aspects of the diagnosis and procedure in gastroduodenal hemorrhages of ulcerous origin]. / Vurkhu niakoi suvremenni aspekti na diagnostikata i taktikata pri stomashno-duodenalnite kruvotecheniia ot iazven proizkhod.

Basic problem in all discussions on bleeding gastroduodenal ulcers is the one pertaining to the surgical tactics and to the ascertainment of the indications for surgical intervention and the time for its performance. Adequate answer to this question comes from recognition of the following points: 1. Endoscopically established bleeding source and intensity; 2. Considerations on other endoscopic criteria, clinical manifestations of bleeding--hematemesis, melena or both, changes in the controlled hemodynamic and hematologic parameters, as well evaluation of the accompanying diseases of major and secondary importance on the part of the cardiovascular and respiratory system; 3. Site and time of application of electrocoagulation and periulcer sclerosification in patients considered adequate for them, complying with the indications and contraindications; 4. Adequately chosen operative method. For the period 1985-1990 a total of 81 patients with bleeding from gastroduodenal ulcers, uncontrollable by conservative treatment, have been operated; 37 of them died (overall lethality 13.96 per cent, operative lethality 45.67 per cent). The choice of surgery depended on the localization, nature and extent of the pathologic process, the type and anatomical position of the pathologic focus, correlation with tissues adjacent to the pathologic process, presence of adhesions, callosity, etc. The method of choice was gastric resection by Billroth I, which was preferred to Billroth II resection. Other methods being used were: excision and pyloroplasty, excision, pyloroplasty + vagotomy, suture + vagotomy--mainly for ulcers localized on the anterior duodenal wall, suture, suture + vagotomy, ligation of a. gastrica sin., etc.

[Our experience in the diagnosis and treatment of traumatic pneumothorax]. / Nashiiat opit v diagnostikata i lechenieto na travmatichniia pnevmotoraks.

The clinical material summarized is derived from the observation of 150 patients. The accent is put on the faults in the X-ray interpretation of the pneumothorax and on the mistaken tactics in the treatment of the pneumothorax, which led to four lethal cases. The attention is drawn to the importance of the prompt physical study of traumatic patients, which gives the opportunity for prompt diagnosis and urgent adequate treatment. The indications have been precised relating pleurocentesis, pleural drain and when lacking aerostasis for thoracotomy.

[Changes in the water-electrolyte and protein balance of the body in acute gastrointestinal ulcerative hemorrhage]. / Promeni na vodno-elektrolitniia i beltuchniia balans na organizma pri ostrata gastrointestinalna iazvena khemoragiia.

The authors studied 127 patients, divided into 4 groups, relating to the haemorrhage stage in accordance with the classification of Lutsevich. It has been established that there exist changes in the hydroelectrolytic and protein balance of the patients having acute gastrointestinal ulcerative haemorrhage.

[Experimental and clinical results of autotransplantation of part of the spleen]. / Experimentelle und klinische Ergebnisse der Autotransplantation mit einem Milzteil.

Eleven patients with traumatic rupture of the spleen were subjected to splenectomy and autotransplantation of part of the spleen. The technique of the operation is described: 5--20% of the spleen is incised into transversal slices of 2--3 mm of thickness which are placed along the periphery of omentum majus, they are enveloped in it and are studied. The number of the applied transplants is 3--6. By means of hematological tests the authors prove that the transplants have functions close to those of the spleen. The clinical and laboratory investigations have revealed that in 9 of the patients operated no symptoms of asplenia were present, whereas in another two patients signs of hyposplenism were detected. Immune studies have demonstrated that no autoimmune reactions have followed autotransplantation of part of the spleen. The indications for the operation are mentioned: traumatic rupture of the spleen, benign tumours and cysts of the spleen with splenic parenchyme being preserved. Contraindications for autotransplantation of part of the spleen are all cases with the syndrome of hypersplenism and systemic blood disorders--lymphogranulomatosis, leucemia, reticuloses and others.

[Hemorrhage from acute erosive processes in the upper digestive tract in thermal trauma]. / Kruvotechenie ot ostri erozivni protsesi ot gornata polovina na digestivniia trakt pri termichna travma.

Forty-six patients with thermic trauma complicated by bleeding from the gastroduodenal tract have been observed during the period 1975-1985. The nosologic entities with bleeding symptom were as follows: hemorrhagic gastritis--2 patients, acute ulcer--5, inveterate callous ulcer--5. Transendoscopic operation (electrocoagulation + sclerosification) was performed in 5 patients with acute ulcers, and conventional surgery--in patients. Nine patients died, 7 of them operated. Overall case fatality rate was 19.6 per cent, operative case fatality rate--87.5 per cent. Type of surgical intervention: gastric resection by Billroth II technique--5 patients; gastrotomy with suturing of the ulcer--3 patients.

[Therapeutic esophagoscopy based on a portal and preportal block in hemorrhaging varices of the esophagus and portal hypertension]. / Vurkhu terapevtichnata ezofagoskopiia pri kurviashtite varitsi na khranoprovoda i portalna khipertoniia na bazata na portalen i preportalen blok.

Parallel with the hitherto known methods of treatment of bleeding esophageal varicosities in portal hypertension with Seinkstaken-Blackmore's probe and by surgical approaches for controlling the hemorrhage from ruptured esophageal varicosities, such as Cryle's and Linton's operations, azigoportal deconnection by Tanner's technique, splenectomy, omentohepatoplexy, Sugiura's operation, esophagus ligation by the method of Fosschulte and V. Mateev (1983), the authors apply the method of transendoscopic sclerosification of bleeding varicosities in adults and children with cirrhosis of the liver and prehepatic block. The indications and contraindications of the method and the etiologic factors underlying portal and preportal block in adults and children (in adults--cirrhosis of the liver, in children--mostly preportal block secondary to portal vein thrombosis dating back to early childhood after exchange transfusion through the umbilical vein) are discussed. Of 11 sclerosified children 3 to 14 years of age, 10 are still alive (100 per cent survival of living patients). For the period 1985-1990 a total of 60 adult patients with bleeding ulcers were sclerosified and resclerosified. Hemostasis attempted in 11 patients provided successful obliteration in 42 per cent; endoscopic failure--in 15 patients (57.69 per cent). Seven patients were operated, 5 of them died. Fourty-off of 53 nonoperated patients died. Overall case fatality rate was 78.33 per cent, operative case fatality rate--71.42 per cent. Fifteen of the deceased nonoperated patients died of uncontrollable persistent bleeding, 27 of severe hepatic failure, progressive jaundice, ascites hepatorenal insufficiency and hepatargia.(ABSTRACT TRUNCATED AT 250 WORDS)

[Gunshot injuries of chest and abdomen (author's transl)]. / Schussverletzungen der Brust- und Bauchhöhle.

A total of 51 patients with gunshot injuries of the chest and the abdominal cavity were treated at the Emergency Aid Institute "Pirogov" in Sofia from 1967 to 1976. The series included 45 men and 6 women, with a letality rate amounting to 21.5 per cent (11 patients). In 41 per cent it was a matter of abdominal injury where the letality was the highest (33 per cent). Chest injuries included 33 per cent with 12 per cent letality, while combined chest-abdominal injuries included 26 per cent with 14 per cent letality. Involvement of the small and large intestine showed the highest incidence of all abdominal organs (37 per cent). Traumatic-hemorrhagic shock and acute respiraotyr insufficiency prevailed. The operative tacties resorted to was strictly individual. In combined lesions of treatment of respiratory insufficiency, parenchymatous organs and major blood vessels has priority over the treatment of hollow organs.

[The problems of severe combined chest and heart trauma]. / Problemi na tezhkata grudna i surdechna suchetana travma.

On the basis of the experience and the analysis of 3818 cases of combined chest traumas the injuries in different anatomical areas have been observed. A special place was given for the diagnostics, the variety of the clinical conditions, the treatment and the prognosis of the reasons for lethality in cases with such traumas. With the increase of the affected anatomical areas the lethality increases proportionally too. At double, triple, fourfold, fivefold and sixfold combinations we have respectively 6.35 to 100% lethality. The indications for early surgical treatment have been stated. The acute respiratory failure (decompensation) and the shock in the combined traumas have been discusses as well.

[The diagnostic and treatment problems in closed diaphragmatic trauma]. / Diagnostichni i lecheni problemi pri zakriti travmi na diafragmata.

Twenty four patients with blunt trauma of the diaphragm comprise the study group. Four of them died of accompanying injuries in other anatomical regions. All patients had the left leaf of the diaphragm affected. Laceration was most frequently radial in the area of centrum tendineum or in the transition area to pars muscularis. In left-sided ruptures of the diaphragm protruded usually the stomach, left colon, spleen, omentum majus and seldomer small intestines. The clinical picture was multiform and depended mostly on the severity of the accompanying injuries and on the basic complications in ruptured diaphragm--incarceration and strangulation of the protruded abdominal organs. When rupture of the diaphragm is diagnosed operative treatment is as a rule mandatory. The surgical approach to left-sided ruptures of the diaphragm is the abdominal approach, because of the more frequent injury to the abdominal organs.

[Transendoscopic drug denervation of the stomach in emergency surgical diseases of the gastrointestinal tract (a preliminary report)]. / Transendoskopska medikamentozna denervatsiia na stomakha pri speshni khirurgichni zaboliavaniia na gastrointestinalniia trakt (predvaritelno suobshtenie).

This is the first, preliminary report on the implementation of transendoscopic medicamentous denervation of the stomach as a therapeutic approach to acute surgical diseases of the gastrointestinal tract. Diminishing the vagus nerve influence after the method described contributes to a substantial improvement of the treatment results in acute pancreatitis patients by shortening the term of therapeutic fasting, avoiding nasogastric tube insertion, and making unnecessary H2-blockers application. TEMDS is indicated in all instances of acute pancreatitis, bleeding duodenal ulcer, bleeding ulcus pepticum jejuni following BII resection of the stomach.

[The views and attitudes of the Clinic of Emergency Surgery of the Clinical Emergency Medical Center at the Queen Ioanna State University Hospital on the potentials of surgical endoscopy in upper digestive hemorrhages]. / Niakoi vizhdaniia i stanovishta na Klinikata po speshna khirurgiia pri KTsSM pri DUB "Tsaritsa Ioanna" po otnoshenie na vuzmozhnostite na operativnata endoskopiia pri gornodigestivnite kruvotecheniia.

Transendoscopic sclerotherapy of esophageal varix in children and adults is introduced in the clinic of emergency surgery ever since 1973. In children aged 3 to 14 years presenting preportal block a 100 per cent survivorship is recorded 20 years after the manipulation. The outcome of endoscopy in adult patients is successful in 57.69 per cent. Perilesional sclerosing is introduced in the CES in 1982, with a complete and definitive hemostasis attained in 46.7 per cent of the cases. In 1983, transendoscopic electrocoagulation is practically implemented in the CES, with the rate of successfully cured amounting to 55.49 per cent. Having in mind the limitations and contraindications of therapeutic transendoscopic hemostasis in massive hemorrhages, particularly those of ulcerative origin, preference is given to the safer hemostasis by surgical means.