[Surgical interventions on the stomach during a glucagon-induced decrease in its tonus]. / Operativnye vmeshatel'stva na zheludke v usloviiakh snizheniia ego tonusa gliukagonom.

Different operations were performed on 15 patients with the Glucagon decreased tonus of the stomach and intestine. The drug was injected in doses 0.2, 0.3 and 0.5 mg. The resulting hypotonia of the stomach and duodenum facilitated performing the operations. No complications were noted.

[Villous tumors of the colon]. / Vorsinchatye opukholi tolstoi kishki.

Under observation there were 26 men and 15 women with villous tumors of the colon. Radical operations were performed on 26 patients. Two of them died in the postoperative period. Eighteen patients survived for more than 5 years.

[Hypotonic effect of glucagon in the x-ray contrast study of the gastrointestinal and biliary tracts]. / Gipotonicheskii éffekt gliukagona pri rentgenokontrastnom issledovanii zheludochno-kishechnogo i biliarnogo trakta.

On the basis of the experience with examination of 35 patients glucagon is recommended by the authors for radiopaque examinations of the gastrointestinal tract and bile ducts under conditions of hypotonia. It increases the diagnostic modality of the roentgenological examination.

[Complicated colorectal cancer--new trends in its diagnosis and surgical treatment]. / Uslozhnen kolo-rektalen rak--novi nasoki v diagnostikata i operativnoto lechenie.

Colorectal carcinoma is among the commonest cancer diseases of the alimentary canal in this country. The morbidity and mortality rates show an increase on an annual basis. A total of 1094 patients presenting colorectal carcinoma are analyzed over the period 1985 through 1996. In 690 cases (63.1 per cent) a complicated form of the basic disease is established. For the first time in this country, assessment of the total amount of bile acids in feces using thin-layer chromatography is done, as well as of cholesterol, beta-lipoproteins and triketosteroids in the serum. As shown by the investigations, there is a correlation between increased bile acid concentrations in the feces, decreased values of serum cholesterol, high concentrations of triketosteroids and severe dysbacteriosis, revealing in turn new aspects in the etiopathogenesis, early diagnosis and prophylaxis against colorectal carcinoma. The new principles of surgical management in complicated colorectal carcinoma improve considerably the 5-year survivorship, amounting to 22.1 per cent for T4.

[Our experience in introducing current antibiotic prophylaxis into abdominal surgery--the initial results]. / Nashiiat opit pri vuvezhdane na suvremenna antibiotichna profilaktika v koremnata khirurgiia--nachalni rezultati.

Over a one-year period (Nov. 1996-Nov. 1997), a total of 154 patients are admitted on an emergency basis, with deferred emergency and for routine treatment in the Clinic of Emergency Surgery. They are distributed in three groups, as follows: patients not requiring perioperative antibiotic prophylaxis and postoperative antibiotic therapy--27, patients subjected to perioperative parenteral antibiotic prophylaxis under adequate hospital conditions--121, and patients undergoing antibiotic prophylaxis in conditions inappropriate for its application--six. The drug schemes elaborated are in conformity with worldwide and Bulgarian experience along this line, and with the concrete hospital and economical conditions in this country. In all patient indicated for antibiotic prophylaxis the listed below antibacterial agents (presented as drug schemes) are administered i.v. a single time prior to anesthesia induction: in operations on the gastrointestinal tract except for interventions in acute appendicitis: cephalotin/cefazolin 2.0 g and metronidazole 0.5 g i.v.; in operations for acute appendicitis: amoxicillin/clavulanate 1.2 g and petronidazole 0.5 f i.v.; biliary surgery free of extrahepatic cholestasis: cephalotin/cefazolin 2.0 g i.v.; biliary surgery with present or preceding extrahepatic cholestasis: cefotetan 2 g i.v.; contaminated liver cysts (parasitic and nonparasitic): cefotetan 2 g i.v.; abdominal trauma without perforation of a hollow organ: cefotetan 2 g i.v.; in plastic repair of the anterior abdominal wall (congenital defects, postoperative eventration) and in poor risk patients (local and general status: cephalotin/cefazolin 2.0 g i.v. In 135 patients the postoperative period runs a course free of complications worthy of notice. Complications directly linked to introduction of the method proposed are recorded in ten cases: operative wound suppuration (4) and hospital infection (6). Complications not related directly to the procedure are observed in nine cases: urinary tract infection (4), bronchopneumonia (2), fever with unknown source of infection (including negative hemoculture) necessitating additional antibiotic therapy (2) and secondary infection (within a week of intervention) necessitating further therapy with antibiotics. The specific features of antibiotic prophylaxis used in the various types of operative interventions are discussed from microbiological, clinical and pharmacotherapeutic viewpoints. The obtained results are compared with pertinent literature data on the issue with a special reference to the clinical efficacy attained. They mirror the approach against the background of the concrete hospital conditions in this country. The method developed is fully consistent with the level of surgical expertise in Bulgaria. All efforts should be aimed at intrahospital environment improvement by means of meticulous asepsis and antisepsis.

[Acute surgical abdomen in middle and old age]. / Ostur khirurgichen korem v naprednala i starcheska vuzrast.

Proceeding from a comprehensive literature survey the urgency of acute abdomen conditions in elderly and senile patients is thoroughly discussed. Not infrequently, geriatric surgeons face serious difficulties of diagnostic and therapeutic character relating to the severity of clinical picture and elevated postoperative lethality, explaining in turn the great surge of interest in the problem. Recent achievements along this line, surgery in particular, provide for adequate conditions for performing early surgical interventions with reduced intraoperative risk in elderly and old age patients presenting acute abdomen.

[Acute surgical abdomen in infectious and parasitic diseases]. / Ostur khirurgichen korem pri infektsiozni i parazitni bolesti.

A review of the literature is made on the complicated course of infectious and parasitic diseases, in which acute surgical abdomen syndrome develops. Surgical treatment of complicated infectious and parasitic diseases is a complex endeavour both from surgical and epidemiologic aspect. The high mortality rate after operations in complicated forms is associated with tactical errors in the surgical treatment and erroneously estimated extent of the surgical intervention.

[The immunology of gastric and duodenal peptic ulcer]. / Imunologiia na iazvenata bolest na stomakh i duodenuma.

The literature on the current concepts of the immunologic processes underlying the appearance and development of gastroduodenal ulcer is reviewed. The immunopathogenesis of the disease is presented and the role of the immunocompetent tissues of the gastrointestinal tract in this pathology is outlined.

[Acute abdomen and thermal burns]. / Ostur korem i termichni izgarianiia.

A review of the literature is made on the problem of the acute surgical abdomen under conditions of thermic shock. Such basic nosologic entities, as acute ulcers, acute cholecystitis, thrombosis and embolism of mesenterial vessels and hematogenous peritonitis, which may be directly related to thermic burns, are given detailed consideration. Thermic trauma raises complex and diverse problems; one of the pathways to reduce the lethal outcome in patients with burns is to face the acute abdomen problem with adequate approach to the pathogenesis, diagnosis and treatment of each nosologic entity.

[The long-term results in complicated colorectal cancer (survival for over 3 and 5 years)]. / Dalechni rezultati pri uslozhnen kolo-rektalen rak (prezhiviaemost nad 3 i 5 godini).

Colorectal cancer survival depends on: stage of primary neoplastic process development, clinical complication pattern and clinical course of the disease, type (radicalism) of the surgical intervention done and histological verification of blastoma. As shown by the results, postoperative lethality in complicated colorectal carcinoma cases amounts to 17.1 per cent, whereas in those undergoing radical surgery for uncomplicated carcinoma it amounts to 6.8 per cent. Patients presenting complicated colorectal carcinoma are admitted to the clinic with diagnosis advanced stage of development of the disease which explains the lower survival rate. The studies performed show that five-year survivorship in patients with complicated colorectal carcinoma amounts to 33.3 per cent, while among those operated for uncomplicated colorectal carcinoma it is 62.7 per cent in the average.

[Typical and atypical resections of the liver with 2 clinical cases]. / Vurkhu tipichnite i atipichnite rezektsii na cherniia drob s prinos ot dve klinichni nabliudeniia.

The development of resection liver surgery is discussed in a historical aspect. The basic topographic-anatomical guidelines, indications and different techniques of performance of atypical and typical liver resection are given. Two clinical cases of spacious liver resections are reported: resection of large hydatid cyst of the left lobe in a 16 years old girl and two liver resection for liver cystadenocarcinoma in a 25 years old woman. The advantages of applying top technical achievements in liver resection surgery are pointed out.

[Cancer of the pancreas. V. The characteristics of the histological forms and of local complications in carcinoma of the pancreas in both sexes]. / Rak na pankreasa. V. Osobenosti na khistologichnite formi i mestnite uslozhneniia na kartsinoma na pankreas u dvata pola.

A study of ample postmortem case material of 25589 autopsies for a period of 25 years (1963-1987) revealed great diversity of the histologic forms of pancreas cancer both in males and in females, associated with numerous local complications (infiltration in adjacent organs). The major number of cases--144 (34.4 per cent of the total number) had histologic characteristics of adenocarcinoma: 88 cases in males (32.1 per cent) and 56 in females (38.6 per cent). Second in incidence--109 cases (26 per cent of the total number) had histologic characteristics of adenoscirrhous cancer--77 in males (28.1 per cent) and 32 in females (22.1 per cent). This is in keeping with the concept that adenocarcinoma is the most common from of pancreas cancer. The next most common forms are adenocarcinoma combined with nondifferentiated cancer, gelatinous carcinoma, adenoscirrhous with nondifferentiated scirrhous carcinoma, etc. An interesting fact is that the general trend of predominance of carcinoma of almost all histologic forms in males keeps on being valid. It is logical to expect that adenocarcinoma will keep on being the most common histologic form of pancreas cancer in the future.

[Diagnostic and surgical treatment aspects of mediastinal tumors and cysts]. / Vurkhu niakoi aspekti ot diagnostikata i khirurgichnto lechenie na mediastinalnite tumori i kisti.

A detailed study is made of the anatomy and physiology of the mediastinum. Proceeding from the anatomo-physiologic peculiarities of the mediastinum, the clinical picture, pathoanatomy and diagnostic possibilities of mediastinal tumours and cysts are comprehensively discussed. Seventeen patients with primary true mediastinal tumours and cysts, of which 16 cases with benign neoplasms and one - with malignant blastoma are reported. The results of the surgical treatment of benign mediastinal tumours and cysts are estimated as very good.

[The place of endoscopic transpapillary (peroral) cholangioscopy in the diagnosis and treatment of biliary tract diseases]. / Miastoto na endoskopskata transpapilarna (peroralna) kholangioskopiia v diagnostikata i lechenieto na zaboliavaniiata na zhluchnite putishta.

The introduction of intraoperative, and later postoperative cholangiography, results in the reduction of residual concrements in the bile ducts, but by no means in their total removal. Cholangioscopy was used as an alternative to this method (1, 5, 10). In 1923, J. Bakes employed a rigid choledoscope, and in 1970 J. M. Shore-a flexible one. Nowadays, technical improvement of the procedure makes possible to use cholangioscopy by one of two basic routes--transhepatic and peroral transpapillary (4, 6, 7, 9, 11). The former is recommended in the event of impossible or failing examination through papilla Vateri, or in the presence of stones and strictures within the intrahepatic bile ducts which cannot be reached by transpapillary route (4, 6, 9, 11). Peroral choledoscopy is used in clinical practice for a short time, and the early experience is still insufficient for definitive evaluation (2, 3, 7, 8, 9, 11).

[Cancer of the pancreas. VI. The characteristics of the localization and metastasis of tumors of the gland in both sexes]. / Rak na pankreasa. VI. Osobenosti na lokalizatsiiata i metastaziraneto na tumora na zhlezata u dvata pola.

Particular attention is called to the localization and metastasizing of the tumor in different organs and systems of the body of males and females. To this end, a rather ample postmortem case material was used. Included in the study were 25,589 autopsies performed over a period of 25 years (1963-1987). Pancreas cancer was detected in 419 autopsies--274 males (65.4 per cent) and 145 females (34.6 per cent). The neoplastic process was analyzed by sex in two directions: metastasizing in near and remote organs and study of the connection between cancer localization in the pancreas and metastasizing in the body. Difficulties are pointed out, encountered with cancers in advanced biological development, when metastases in the gall bladder from primary cancer of the pancreas and from primary cancer of the bile ducts are to be differentiated. It follows from this analysis that metastases of pancreas cancer were most frequent in the regional lymph nodes, with metastases in the liver and lungs ranking next in both sexes. Metastases in other organs were relatively seldom encountered.

[Gastric polyposis in surgical practice. Apropos 12 cases]. / Stomashnata polipoza v khirurgichnata praktika. Po povod na 12 nabliudeniia.

Personal experience is recorded in the surgical treatment of 12 patients with gastric polyposis at the Department of Propaedeutics of Surgical Diseases of the Research Institute of Surgery, for a period of 10 years (1981-1990). They accounted for 75 per cent of the benign neoplasms of the stomach and 4.08 per cent of all gastric tumors. The results of operative treatment, both in patients treated by gastric resection according to Billroth I technique (58.3 per cent) and in patients who were treated only by removing the polyps (41.7% per cent) were considered good within a follow up period of 1 to 5 years after the intervention. Proceeding from modern achievements and reports in the literature, the authors place accent on some important current aspects of treatment and observation on gastric polyps, their correlation with a number of hyperplastic diseases and malignant neoplasms of the stomach and colon.

[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.

[Extrarenal changes in the isotopic nephrogram of surgical patients with abdominal pathology and the potentials for an erroneous interpretation]. / Ekstrarenalni promeni v izotopnata nefrograma pri khirurgichno bolni s koremna patologiia i vuzmozhnosti za pogreshna interpretatsiia.

Eighty-three patients with surgical abdominal pathology were included in the study. On the isotopic nephrogram they all had bilateral symmetric and analogous pathologic changes with varying degree of severity. The most common cause of renal function changes in patients with abdominal pathology was the reduced intravascular volume or vascular capacity changes, registered on the isotopic nephrogram with characteristic symmetrical pathologic curves. The sharp renal perfusion decrease, leading to decrease of glomerular filtration and diminution of diuresis explains the bilateral changes in the isotopic nephrogram which most frequently resemble obturation. The curves returned to normal 1 to 2 weeks after the physiologic state of the patients was stabilized, indicating extrarenal origin of the registered changes in the isotopic nephrogram. The latter should carefully be interpreted, in view of the possible influence of it of extrarenal factors.