Recurrent perineal hernia -- case report and review of the literature.

Perineal hernia is the protrusion of intra-abdominal viscera through the pelvic floor. We present a patient with recurrent perineal hernia - 12x9 cm with a palpable soft, hardly adjustable in the pelvic tunnel formation and attenuated skin over it. The patient was operated by abdominoperineal approach. We performed two layer Titanium mesh plasty of the pelvic floor with the use of the omentum and the pelvic muscles.

Management of recurrent or metastatic retroperitoneal soft-tissue sarcomas.

UNLABELLED: Retroperitoneal soft tissue sarcomas remain a serious therapeutic problem. The aim of the study is to define the optimal treatment strategy of patients with locally recurrent or metastatic retroperitoneal soft tissue sarcomas. MATERIAL AND METHODS: A retrospective study was performed.Between 2001 and 2013, 89 patients with retroperitoneal soft tissue sarcomas were surgically treated in the University Hospital Queen Joanna ISUL and the Specialized Hospital for Active Treatment in Oncology Sofia. Clinicopathological data were investigated with SPSS 19. RESULTS: The mean time of onset of the first and second relapse of sarcomas was 23 and 13 months, respectively. Over 40% of the studied patients underwent more than one operation because of recurrence. Ability of radical extirpation of the tumour decreased with each subsequent relapse. The 5 year survival rate was 60% for patients with primary combined radical resection versus 28% for patients with partial resection. In the presence of metastatic lesions the 3 year survival rate was only 22%. CONCLUSION: Local recurrences, the presence of distant metastases and the ability of radical extirpation are the main long term prognostic factors.

[Study on the efficacy of famotidine (Quamatel) in the complex treatment of erosive gastroduodenitis, stress stomach ulcer and peptic duodenal ulcer]. / Prouchvane vurkhu efekta na famotidine (Quamatel) v kompleksnoto lechenie na uslozhnenite s khemoragiia ostur eroziven gastroduodenit, stres stomashna iazva i peptichna iazva na duodenuma.

The haemorrhage of upper gastrointestinal tract is one of the serious problem in urgent surgery. Clinical effect of treatment with Quamatel purposely research was holded comparison of results in two groups patients. In group A with general medical treatment was included Quamatel--2 x 20 mg i.v. a day. In group B the patients was treated without H2 blocker. In cases of erosive gastritis was reported favorable effect in 76.47% at second day. The patients with stress stomach ulcer same effect was observed in third day--83.3%. In cases with peptic duodenal ulcer in I B--Forest group the bleeding was taken possession of 61.9%, in group II--79.31% and III--90.91% of patients.

[Volvulus of the small intestine]. / Volvulus na tunkoto chervo.

Volvulus of the small intestine is a condition of bowel obstruction due to knotting and twisting of the small intestine. Two types of volvulus are described: 1) primary small intestinal volvulus where no predisposing factors exist, and 2) secondary volvulus where congenital or acquired conditions promote twisting of the small intestine. Over a 5-year period, 18 patients (eleven men and seven women) presenting volvulus of the small intestine are operated in the Emergency Surgery Clinic of the University Hospital "Queen Giovanna", representing 8.7 per cent of the total of 206 cases of small intestinal mechanical ileus (incarcerated herniations involving the small intestine are not included in the series). Primary volvulus is found in one patient. In those presenting secondary volvulus adhesions are the commonest underlying cause of small intestinal rotation--13 cases, next ranking primary tumor of the small intestine--one case, Meckel's diverticulum--one, carcinosis of peritoneum--one, and one patient with small intestine volvulation around colostomy. The most frequently encountered symptoms and laboratory examinations performed are analyzed. Intestinal necrosis is established in four instances (22 per cent). One patient dies of peritonitis and polyorganic insufficiency. Volvulus of the small intestine should be mandatorily considered in patients presenting mechanical ileus of the small intestine. Early operative intervention is a therapeutic approach contributing to preclude intestinal necrosis.

[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.

[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.

[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)

[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.