[Case report with multiple variations of blood vessels originating from the fossa axillaris]. / Opisanie na sluchai s monozhestveni variatsii na sudovete, vodeshti nachaloto si ot fossa axillaris.

In the course of a dissection of a male's cadaver, fixed in formol carbol solution, we identified the following arterial variations: A) Regio axillaris dextra: a musculi teretis major (9 cm long); a. musculi subscapularis (of insignificant calibre and length); a. thoracica lateralis accessoria prima (10 cm long, with a course along the surface of m. subscapularis); a. thoracica lateralis accessoria secunda (25 cm long, with a course within the conjunctive tissue of the axilla); B) Regio axillaris sinistra: a musculi subcapularis prima et secunda (of insignificant calibre and length); a. musculi teretis major (9 cm long); a. thoracica lateralis accessoria secunda (20 cm long); a. thoracica lateralis accessoria tertia (25 cm long); All three additional arteria had a course along the surface of m. serratis anterior. We called the identified vessels after the name of the muscle blood-supplied by them. Only the vessels ending in m. serratus anterior did we call aa. thoracicae laterales accessoriae.

[The rare combination of liver echinococcosis and beta-thalassemia]. / Riadko suchetanie na chernodrobna ekhinokokoza s beta-talasemiia.

A rare case of an unusual association of liver hydatidosis (LH) and beta-thalassemia (beta-Thal) was reported. In a 43 year old white man, who has no connection to endemic areas of echinococcosis or beta-Thal (but was operated probably for splenic echinococcus 25 years ago), an intermediate form of beta-Thal according hematologic morphologic, and hemoglobin-electrophoretic criteria was diagnosed. Common and different criteria to another anemias (especially of iron deficiency) was discussed and authors believed that this splenomegaly (as specific sign of hereditary beta-Thal) isn't indication for operation. Conventional X-ray, US, and CT was characteristic for LH, and intraoperative cytology was performed. Correlation to a very interesting and rare analogous case, but of homozygous hemoglobinopathy C was made.

[Classifications and prognosis of hepatocellular carcinoma]. / Klasifikatsii i prognoza na khepatotselularniia kartsinom.

In this study are included 78 patients with hepatocellular carcinoma (HCC). In 22 the diagnosis is verified pathologically (obduction), while in the other patients the diagnosis is made by laparoscopy, laparoscopical ultrasonography and morphological verification (through FNAB cytology and/or histology). In 69.2% HCC is associated with cirrhosis. The prognosis of HCC associated with cirrhosis is evaluated through the classification of S. Chevret et all., and is compared to the Child-Pugh scoring system. 38.9% of patients in Chevret's class C score are in class B in the Child-Pugh score, while 25.9% of patients are in class C in both classifications, but Child-Pugh's class C patients are most often in B-C transition. It might be assumed that the prognosis of HCC depends more on the tumor prognosis than on the prognosis of the liver cirrhosis itself. Every classification which does not take in to account the liver function (like TNM system) and the whole characteristics of the tumor, would be incomplete, in some extent, in the prognosis of HCC with cirrhosis. In HCC without cirrhosis, the BCLC classification reflects both the liver function and the tumor characteristics. In BCLC class A patients hepatic resection or transplantation is recommended but hyperbilirubinemia and ascites, which might be seen in A3 and A4 classes contraindicate resection of the liver. All scoring systems define lower HCC stage than it is really found (personal and reference data), so there are no arguments to take classification scores as absolute treatment decision making rules.

[Hemobilia caused by gallbladder's polyps in liver cirrhosis]. / Khemobiliia ot polip na zhluchniia mekhur pri chernodrobna tsiroza.

Extremely unusual cause of hemobilia from polypus of the Gallbladder in 29 years old patient with liver cirrhosis is reported. The patient died with clinical features of hepatic encephalopathy. The olygosympthomatic clinical course is the reason for unrecognized hemobilia. The ultrasonographic diagnosis was "cholelithiasis" instead of gallbladder's polypus and endoscopy established large ulcer in the duodenum. The role of hemorrhagic diathesis in chronic liver disease is discussed. As is the extent of liver cirrhosis, cholestasis and hepatic encephalopathy deterioration caused by bleeding. Whether timely cholecystectomy could change the course and prognosis of chronic liver disease is also discussed.

[Acute surgical abdomen in idiopathic haemochromatosis]. / Ostur khirurgichen korem pri idiopatichna khemokhromatoza.

The acute abdomen (AA) is a typical but very rare complication of idiopatic haemochromatosis (IH). The possible mechanisms are not sufficiently clarified. We report a case with IH who died with clinical features of (AA) 20 hours after gastroscopy was performed. The histological examination established nonspecific damage of visceral peritoneum and ascites. Fulminant form of spontaneous bacterial peritonitis (SBP) as a reason of death is discussed, nevertheless endoscopic esophageal varices sclerotherapy was not performed. The role of pulmonary infection and intestinal bacterial overgrowth with possible bacterial translocation in mesenterial lymph nodes, ascitic fluid, and blood is also discussed. The source of infection is usually unknown. The iron is important factor for bacterial growth. The pluriglandular deposition of iron including the suprarenal glands is precondition to development of collapse. The possible pathogenesis of SBP in IH is discussed. It is important to mention that unlike SBP the clinical course of IH AA might appear which does not necessary require surgical management.

[Gastroduodenitis and ulcers--statistical study for 1998]. / Gastroduodenit i iazvena bolest--statistichesko prouchvane za 1998 g.

The ulcer disease is a chronic, cyclical and recrudescing illness, based on disturbing of the regulatory mechanisms of the stomach and duodenum. The ulcer disease is one of the social significant illnesses of our century, because approximately 10% of the people at least once in their life have clinical symptoms of ulcus duodeni.

[Preoperative staging on liver metastasis from colorectal carcinoma]. / Predoperativno stadiirane na chernodrobnite metastazi ot kolorektalen kartsinom.

Preoperative staging of metastatic liver cancer (MLC) from colorectal carcinoma (CRC) is conducted with the purpose to identify potentially resectable MLC cases. Fifty-two patients undergo laparoscopic study (4.1% all endoscopies), and three--laparoscopic ultrasonography. Laparoscope E Wolf and 7.5 MHz linear transducer obtained from the Aloka Company are employed. The study covers 24 women and 28 men with mean age 61.6 years (range 23-87 y). MLC is diagnosed in 35.1% (13/37) of colonic, and in 73.3% (11/15) of rectal carcinoma cases. Furthermore, 69.3% of the patients (36/52) are in M-stage, accounted for by peritoneal or hepatic metastases. The size of lesions measures less than 2 cm in 25.0%, and less than 1 cm in 12.5% of the cases. Solitary metastasis is recorded in 8.3 per cent. In the event of isolated involvement of the left lobe the location of MLC is in the region of II-III segment. In one patient a single metastasis in VII segment, measuring 0.5/1.0 cm, missed by the imaging methods and laparoscopy, is documented by laparoscopic ultrasonography. Echographic diagnosis proves inaccurate in 16.7%, and false negative--in 12.5 per cent. In further three patients (12.5%) the conclusion reached is uncertain, with primary liver cancer being also considered. In 23.1% MLC from colonic carcinoma is situated entirely intrahepatally, and is not accessible to endoscopic inspection without laparoscopic and/or intraoperative ultrasonography; the latter is indicated in all T3 and T4 patients. Potential resectability is established in 16.7% of cases with liver metastases from CRC.

[Retinoic acid--a teratogenic factor in caudal dysgenesis. Experimental models and hypothesis for pathogenesis]. / Retinoevata kiselina--teratogenen faktor za kaudalnata disgeneziia. Eksperimentalni modeli i khipotezi za patogenezata.

Using teratogen--trans-retinoic acid (Sigma Chemical)--caudal malformations are experimentally induced in mice of the Spriche-Dolly breed. For the purpose the aforementioned reagent is injected into pregnant mice at 6-hour intervals dose 29 mg/kg. In stages between two and four paired somites, supravital staining with Nile blue sulfite (in 1:50,000 Ringer solution at 37 degrees C for 30 min) is done, followed by histological assessment of tissue sections. The malformation noted are summed up in an attempt to draw conclusions about their presumable pathogenesis.

[The diagnostic approach in hepatic lesions--the role and place of laparoscopy with laparoscopic echography]. / Diagnostichen podkhod pri chernodrobnite lezii--rolia i miasto na laparoskopiiata s laparoskopska ekhografiia.

The study is designed to cases the potentials of laparoscopy with laparoscopic echography, and the role they play in the diagnostic algorithm, with the purpose to develop an optimal therapeutic approach to hepatic lesions. Laparoscope R. Wolf and 7.5 MHz linear transducer, obtained from the Aloka Company are employed in work. A total of 303 patients presenting primary and metastatic carcinoma of liver (58 and 145, respectively), cholangiocarcinoma (11), hemangioma(28), adenomatous hyperplasia (38) and other lesions (23) are studied. Morphologic verification of the diagnosis is done in over one third of cases. In 30 to 40 per cent of the series reviewed laparoscopic echography supplements the laparoscopic finding depending on the type of lesion. Without pretending to create a diagnostic algorithm in individual hepatic lesions, abiding to the following diagnostic approach is strongly recommended: stage one--echography (a noninvasive, not irradiating, cheap, readily accessible and often resolving method), stage two--noninvasive, stage three--invasive, stage four--preoperative or final (laparoscopy plus laparoscopic echography). In the event of properly established indications, the invasive methods of study (thin-needle biopsy under ultrasonographic control plus laparoscopy) may be considered as a second stage, without any need to apply the complete spectrum of examination accessible. Not infrequently, laparoscopy with laparoscopic ultrasonography play a crucial role in diagnosing liver lesions, exact determination of the stage and resectability of the neoplastic process, planning and shortening the duration of operation with simultaneous identification of intractable patients.

[Diaphragmatic hernias--the clinico-anatomical aspects]. / Diafragmalni khernii--kliniko-anatomichni aspekti.

The present research has been taken over 56 cadavers from the dissecting material of the Department of Anatomy and Histology in the time of four dissecting courses. Tissue defects of the diaphragma with or without diaphragmatic hernias has been searched for. Also it has been followed the frequency of the sliding and the paraesophageal hiatus hernias. The tissue changes has been carefully described. In 12 of the cases it has been determinate defects of the diaphragma, as in two of the cases has been found parahiatal hernias as well. In 7 of the cases it has been found relatively wide hiatus esophageus, as 3 of them were accompanied with hiatus hernias. It has been determinate one case with combined defect--hiatal and parahiatal hernia. It has been discuss the possible reasons for their appearance and simply anatomical aspects of the surgical correcting techniques, which are known to us.

[The topographic anatomical aspects of some kidney anomalies]. / Topografoanatomichni aspekti na niakoi ot bubrechnite anomalii.

On 50 cases of the dissecting material of the Department of Anatomy and Histology were worked out the kidney's vessels, the basin and the ureters, as the varieties in number and situation of the vessels, the cases of nephric ectopy and comparatively rare case of combined anomaly as well were traced and described. This anomaly is expressed in bilateral nephric ectopy, bilateral double ureter, which begins from independent calices set, and four pairs of polar kidney arteriae, which are situated bilateral as well. In the right they pass before v. cava inf. The vessels are equally calibrated, as the three pairs are branches of aorta abdominalis and the fourth of a. iliaca comm. The cases which were described attract the surgeons' interest because the zone of the kidney, its vessels and the way of the ureter are an object of frequent surgical interventions.

[Laparoscopy and laparoscopic echography in the diagnosis of pancreatic diseases]. / Laparoskopiia i laparoskopska ekhografii v diagnostikata na pankreasnite zaboliavaniia.

The potentials of laparoscopy (LS) and laparoscopic ultrasonography (LUS) in diagnosing pancreatic diseases are assayed. The study covers forty-five patients of which 36 presenting carcinoma of the pancreas, and nine-acute peritonitis. APUD (VIP) is documented in one case. For the purpose laparoscope R. Wolf and 7.5 MHz echolaparoscopic linear probe obtained from the Aloka company are employed. The LUS technique used in pancreatic diseases is described in details. In the group of pancreatic carcinoma patients 72.2 per cent prove to be inoperable. Emphasis is laid on the superiorities of LUS over transabdominal echography and laparoscopy in diagnosing, staging and resectability evaluation of pancreatic carcinomas, as well as in terms of establishing the indications and practicability of the procedure in acute pancreatitis. LS and LUS are the only preoperative alternative to intraoperative echography, since imaging, endoscopic and histomorphological diagnostic methods are combined. LS in conjunction with LUS are no longer considered as a synonym of peritoneoscopy which in turn, considerably augments the possibilities of the method in handling diseases of the pancreas.

[Laparoscopy and laparoscopic echography in the diagnosis and staging of gastrointestinal carcinomas]. / Laparoskopiia i laparoskopska ekhografiia v diagnostikata i stadiiraneto na gastrointestinalnite kartsinomi.

The clinical relevance of laparoscopy (LS) and laparoscopic echography (LSEG) in diagnosing and staging gastrointestinal carcinomas is assayed in the light of diagnostic methods in current use. The study covers 257 patients undergoing LS, and 23-LSEG. For the purpose a rigid 7.5 MHz echolaparoscopic probe is used. In 16 per cent of the cases LS fails to resolve the basic diagnostic problems faced, whereas in 35 per cent it alters completely the preliminary clinical diagnosis. In over 90 per cent of cases LSEG supplements or modifies the laparoscopic diagnosis. Emphasis is laid on the role played by LSEG in defining the loco-regional stage of gastric and colorectal carcinomas, as well as on the contribution of the method to establish pancreatic carcinomas not lending themselves to resection. What is more, LSEG demonstrates inoperable cases by detecting small, unsuspected metastases, not prominating above the hepatic surface.

[Laparoscopy and laparoscopic echography in the diagnosis of hepatocellular carcinoma]. / Laparoskopiia i laparoskopska ekhografiia v diagnostikata na khepatotselularniia kartsinom.

The role of laparoscopy and laparoscopic echography (LSEG) in the early diagnosis and staging of hepatocellular carcinoma (HCC) are discussed in the light of the diagnostic methods in current use. The study covers 62 patients of which thirteen are subjected to LSEG using rigid 7.5 MHz echo-laparoscopic probe. In 87.1 per cent of the cases HCC develops against the background of cirrhosis. Adenomatous hyperplasia is established in 21 of 54 patients presenting HCC, pointing to the stage character of cancerogenesis, and demonstrating the LSEG potentialities in diagnosing precancer, multicentric HCC, intrahepatic metastases from HCC and vascular tumor invasion. The superiorities of echo-laparoscopic biopsy and LSEG contribution to the early diagnosis of HCC, staging according to ther TNM system, and reliable demonstration of cirrhosis, its severity and prognosis, are underscored.

[The place of echography in the clinical diagnosis of hepatic hemangioma]. / Miastoto na ekhografiiata v klinichnata diagnosa na chernodrobniia khemangiom.

On the basis of 104 hemangiomas diagnosed in 81 patients an ultrasound classification of the disease is made which includes four basic variants. Echotomography detects the tumor most successfully in group I (well outlined homogenous hyperechogenisity) while in the other groups it shows a low percentage of correct diagnoses. The average sensitivity of the method is 60.6%. The possibilities of the other basic diagnostic methods are discussed and a scheme for clinical investigation is proposed. Scintigraphy is of no substantial help, computed tomography increases the percentage of the correct diagnoses, angiography and correctly indicated laparoscopy most often end the clinical investigation. The patients with hemangioma are subjected to a prolonged clinical follow up and ultrasound tomography is the best suitable method for this.

[Changes in the serum lipid indices in acute pneumonia and their clinical significance]. / Promeni v nivoto na niakoi serumni lipidni pokazateli pri bolni ot ostri pnevmonii i tiakhnoto klinichno znachenie.

Some lipid indices were studied in the course of acute bacterial and viral pneumonias in 102 patients, aged from 18 to 45. Statistically significant increase of total lipids, NEFA and EFA was established as well as insignificant increase of triglycerides and significant decrease of alpha-lipoproteins. Bacterial pneumonias are distinguished by a more manifested increase of total lipids and EFA, the viral pneumonias--by a more markedly decrease of alpha-lipoproteins. The discrepancies are statistically significant. The changes are of a transitory character and on the 40 th day of the treatment significant tendencies for normalization of the indices changed were established.