[The role of bacterial translocation and endotoxemia in pathogenesis of obturation ileus, caused by colorectal carcinoma. Limulus test--a method for quick diagnostics of endotoxemia]. / Roliata na bakterialnata translokatsiia i endotoksinemiiata v etiopatogenezata na obturatsionen ileus, predizvikan ot kolorektalen kartsinom. Limulus test--metod za burza diagnostika na endotoksinemiiata.

Colorectal carcinoma is one of most common diseases in human body. Often it is presented for the first time by its complicated forms--obturation, perforation, bleeding etc. Most common is the obturation of the large bowel. His clinic is caused not only by intoxication of carcinoma, but by massive flow of endotoxin in systemic circulation. In this publication we are trying to explain changes in human body and we offer a test for quick and early diagnosis--Limulus test.

[Papillary and cystic tumor of pancreas--Frantz's tumor]. / Papilaren i kistichen tumor na pankreasa--tumor na Frantz.

The aim of the authors is to introduce one rare known pathology which the Frantz's tumor is, his clinical characteristic, clinical signs, diagnostic and treatment. We have observed two separate cases of this illness in Clinic of Surgery (University Hospital "Queen Yoanna") in comparison with evidence of famous world surgeons. We have made an attempt to introduce one disease, which even though not often observed is significant by the fact that affect young women (girls) and only surgical resection is a treatment of choice.

[Our experience on the effect of complex treatment with gordox in patients with acute and chronic-recurrent pancreatitis]. / Nashiiat opit vurkhu efekta na gordox v kompleksnoto lechenie na ostriia i khronichno-retsidivirasht pakreatit.

AIMS: In this retrospective trial we assess how acute pancreatitis patients respond to nonoperative therapy; operative methods and results after surgery for acute and chronic-recurrent pancreatitis. METHODS: We present 738 acute pancreatitis patients, treated from 1991 to 2001 in our clinic. In all cases we start a nonoperative therapy comprising losses replacement, analgesics (including narcotic ones), spasmolytics, antibiotics, protease inhibitors-Contrical or Gordox (only during 1997 and 1998) and/or somatostatine (Sandostatin), H2-blockers, naso-gastric tube. Monitoring of the main parameters as blood pressure and pulse rate, number of leukocytes, values of serum amylase, urea and creatinine is performed. RESULTS: 576 responded to this therapy and recovered. The ones who worsened--162 acute pancreatitis patients--underwent surgery: necrectomy followed by postoperative prolonged local lavage in the area of pancreatic couch or laparostomy. This method contributes to a prolonged evacuation of biologically active substances and devitalized tissues. The average number of Ranson's Prognostic Criteria was 4.5. Furthermore, mortality is reduced to 19%. A mortality analysis is done. Surgery (cholecystectomy and bile duct exploration) is offered to patients who recovered from acute pancreatitis caused by cholelythiasis and/or choledocholythiasis. CONCLUSIONS: The majority of patients respond to the nonoperative therapy. Despite the recent improvement in diagnostics and treatment of acute pancreatitis morbidity and mortality rates are still high.

[Tactics and operative procedures in the management of complicated forms of malignant tumors of the left colon and rectum on emergency conditions]. / Taktika i operativni metodi pri lechenieto na uslozhnenite formi na malignenite tumori na leviia kolon i rektuma v usloviiata na speshnost.

Over the period 1996-2001, a total of 130 patients with complicated cancer of the left colon and 164 patients with complicated cancer of the rectum are subjected to treatment in the Clinic of Emergency Surgery at University Hospital "Queen Joanna", Sofia. Obturation is the commonest form of complication--136 patients (46.2%), followed by perforation either within the tumor or diastatic noted in 21 cases (7.1%), paratumor abscesses and infiltrates in 31 patients (10.5%) and rectohaemorrhage in 12 patients (4.0%). The optimal surgical approach to complicated forms of colorectal cancer of the left colon and rectum remains controversial especially when the patients underwent emergency surgery. Recently there has been a trend towards resection and anastomosis in selected patients. In each patient it's mandatory to make a precise and individual choice of the extend of the operative intervention, consistent with the patient's general condition and contributing to eliminate the life-endangering underlying cause. It must be realized by means of one-stage surgery when it's possible. Authors represent their personal experience with resolve of these actual problems.

[Surgical treatment of complicated gastrointestinal forms of non-Hodgkin lymphomas]. / Khirurgichno lechenie na uslozhnenite gastrointestinalni lokalizatsii na non-Hodgkin limfom.

Authors represent their experience in surgical treatment of gastrointestinal forms of No-Hodgkin's lymphomas (NHL) combined with adjuvant therapy. We also represent an Ann Arbor Staging System and an Updated Kiel Classification. From 1991 to 2001 we analyzed 39 patients with different localization of gastro-intestinal NHL's lymphomas. In this aspect more common are stomach's lymphomas--27 patients (71%); small bowel's lymphomas--3 patients (8%); more uncommon are the localizations in colon--3 patients (8%), predominantly in caecum and right colon; rectum--3 patients (5%). Add to thus we described one mechanical icterus caused lymphoma, one multi-lobular spleen lymphoma and one case of anterior abdominal wall lymphoma. All patients underwent surgery. Eight of them were operated as an emergency cases. Operative treatment of NHL isn't radical but in combination with adjuvant therapy can be life saving event in complicated forms.