[Prognostic factors for survival in primary liver cancer].

BACKGROUND: The aim of this study was to identify the prognostic factors of survival after curative resection of primary liver cancer (PLC). STUDY DESIGN: Thirty four patients underwent resection PLC between January 1991 and December 2000. Univariate and multivariable analysis were used to retrospectively identify factors associated with overall survival when resection was curative for primary tumor. RESULTS: Overall 1, 2, 3 and 5 - year survival rates were 76.0%, 57.5%, 35.2% and 6.0% respectively. Recurrence after one year was 35%. Eleven predictive factors - clinical, laboratory, pathological and surgical were analyzed. Independent prognostic factors for overall survival were vascular invasion (p = 0.006) and stage (p = 0.023). CONCLUSIONS: Hepatic resection is an effective treatment for PLC, even in advanced cases. The overall survival were low, because of late diagnosis and recurrence of the tumors.

[The surgical treatment of carcinoma of the extrahepatic bile ducts]. / Operativnoto lechenie na kartsinoma na ekstrakhepatalnite zhluchni putishta.

The authors have carried out a retrospective analysis of 157 patients with Ca in the extrahepatic biliary system, treated at the Clinic for Hepato-Biliary and Pancreatic Surgery within the period 1982-1992. From them 68 patients (43.31%) were with Ca in vesicule biliary and with Ca in the biliary tracts--89 patients (56.69%). The ratio men:women was respectively 1:4.67 and 1.12:1. The medium age of the patients was 63.08 years. In the group of the patients with Ca in biliary tracts the carcinoma was located in the upper third in 20.22% of the cases, in the middle third--in 24.72%, in the distal third--in 55.06%. Radical operations were made in 31.46% of the patients, with lethality 28.57%, whereas the postoperative lethality of the patients with duodeno-hemipancreatectomy was 6.67%, and the average postoperative survival was 32 months. The palliative operated patients constituted 65.17% in the general series, with lethality 15.52% and average postoperative survival 10.4 months. The explorative laparatomies constitute 3.37% from the operated patients. The total operative lethality was 19.1%. In the article the authors discussed the diagnostical methods, stated the preference for echography, computer axial tomography and retrograde cholangio-pancreatography in the mentioned sequence. The endoscopic procedures were discussed as and alternative for the non-resectable carcinomas of the biliary tracts.

[A modified Sugiura operation]. / Vurkhu modifitsiranata operatsiia na Sugiura.

This is the first report in Bulgaria of the application of the modified method of Sugiura. The operation is less traumatic than the original one, the postoperative mortality is essentially reduced, patient survival to 7 years is increased and there is no encephalopathy. This operation is technically easier to perform than splenorectal anastomoses and may be performed both as planned and emergency intervention. Two personal observations on two patients operated by the modified technique of Sugiura are reported. The results were very good.

[Our initial experience with Shouldice's hernioplasty]. / Nashiiat nachalen opit s khernioplastikata na Shouldice.

For the first time in Bulgaria the authors herniotomy of inguinal hernias by the method of Shouldice. This method is anatomo-physiological and is pathogenetically well-grounded. Shouldice's method is considered the method of choice in inguinal hernias.

[A modified Sugiura operation]. / Vurkhu modifitsiranata operatsiia na Sugiura.

The modified method of Sugiura is reported for the first time in Bulgaria. The operation is less traumatic than the original one, the postoperative case fatality rate is lower, patient survival rate up to 7 years is high and there is no encephalopathy. This operative technique is more practicable than splenorenal anastomosis and may be applied both for planned and for emergency operations. Two patients have been operated by the authors, using the modified technique of Sugiura, with very good results.

[Fiber gastroscopy in the diagnosis of gastroduodenal diseases and of primary cancer of the gastric stump in particular]. / Fibrogastroskopiiata v diagnostikata na stomashno-duodenalnite zabolevaniia i na purvichniia rak na stomashniia ostatuk v chastnost.

Data available in the literature are adduced and personal experience recorded with 5930 fiber gastroscopies, leading to the conclusion that fiber gastroscopy is a valuable method for diagnosis of diseases of the upper part of the gastrointestinal tract. Some aspects of primary cancer of the gastric residue and its inevitable accompanying pathology--the gastroduodenal reflux--are discussed, analyzing 313 fiber gastroscopies of patients, who had undergone in the past gastric resection for benign diseases. The authors adduce motives for the need of periodic fiber gastroscopic control of operated patients, aimed at early prophylaxis of primary cancer of the gastric residue. The need of regular medical control on these patients is also emphasized.