Technical considerations depending on the level of vascular ligation in laparoscopic rectal resection.

AIM: In addition to ischemia there is also anastomotic ends tension proven to be a risk factor for anastomotic leak. HT vascular ligation is accepted as a rule, in attempt to achieve tension-free anastomosis. LT is a preferred option, based on the more accurate preservation of proximal intestinal segment microperfusion and lower risk of damage to the hypogastric plexus. The aim of this study is evaluation of comparative indicators in high tie (HT) and low tie (LT) laparoscopic rectal resections. METHODS: A prospective nonrandomized comparative cohort study of patients in our department with cancer of the rectum in clinical stage I-III, operated on in laparoscopic approach over a 6-years period. RESULTS: For the period 2015-2020, a number of 208 laparoscopic surgeries have been done for rectal cancer. Patients were divided into three groups-group A with HT vascular ligation 116 pts. (69%), group B-53 pts. (25%), underwent low ligation-LT and group C-39pts. (19%) low tie plus lymph node dissection of the apical LN group (LT-appic LND). The distribution was made without randomization, based on the operators' expertise. Anastomotic leaks were 3.8% in group A, 3.0% in group B and 2.9% in group C (p > 0.05) with no significance difference. There is no significant difference in the number of lymph nodes obtained in group A and group B, while in group C the number of the harvested lymph nodes was higher (p < 0.05). The indicators for intestinal / defecation dysfunction, as well as for urinary/sexual dysfunction, according to our data, are significantly more favorable in patients with LT, in contrast to the other two groups. CONCLUSION: HT vascular ligation attempts to achieve tension-free anastomosis and more harvested lymph nodes. However, LT could be a preferred option, based on the lack of significant evidence for a difference in specific oncological survival and due to more accurate preservation of proximal intestinal segment microperfusion to prevent anastomosis dehiscence, also for its lower risk of damage to the hypogastric plexus. Splenic flexure mobilization provides elongation of the proximal intestinal segment, but has no proven effect on anastomotic leakage incidence. It increases surgical duration and is in fact necessary in up to 30% of the cases. At the present moment there is no precise data whether LT has an advantage in terms of prevention of autonomic nervous and urogenital dysfunction. New prospective randomized and highly probative studies are needed to standardize the procedures in specific clinical situations.

[The comprehensive approach to ensure the quality of forensic medical examination of a cadaver].

The objective of the present work was to estimate the effectiveness of the comprehensive monitoring system designed to enhance the quality of forensic medical expertise for determining the cause of death in the hanging cases. It was shown that the practical application of the algorithmization and automated quality control system improves the effectiveness of forensic medical examination of the cadavers in the hanging cases. The system performs the control, directing, and teaching functions. Moreover, it allows to estimate the completeness of the examination of the cadaver.

Attitudes of adolescents towards sexual health in three cities from Croatia and Bosnia and Herzegovina.

AIM: This study aimed to determine the attitudes of adolescents towards sexual health and to assess their understanding of contraception use and knowledge about sexually transmitted infections in three ethnically different areas of Croatia and Bosnia and Herzegovina. METHODS: A total of 146 adolescent high school students between 17 and 19 years of age from three different cities were enrolled in this cross-sectional study. The participants completed two anonymous questionnaires: one that measured attitudes towards safe sex practice and another that measured contraception and general sexual health knowledge. RESULTS: Shame was identified as the main factor why adolescents did not seek information about sexual health and contraception. On average, respondents correctly answered only 35% of questions regarding sexual health. Adolescents from East Mostar, with a predominantly Bosniak population, had more positive attitudes towards safe sex and showed less contraception knowledge in comparison to their colleagues from two cities in Croatia. LIMITATIONS: Our study design might be burdened by socially desirable reporting and other biases inherent to the survey design. CONCLUSION: Adolescents from Croatia and Bosnia and Herzegovina, countries that experienced war and are still undergoing post-communist socio-economic transition, generally did not have adequate knowledge with respect to safe sex lifestyles. Respondents had major problems identifying sexually transmitted infections and their knowledge about contraception was insufficient. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Providing care for adolescent populations should address specificities in local ethnical and socio-economical circumstances. There is a need for further studies to determine social, cultural and religious factors influencing the knowledge and attitudes towards sexual health in order to provide most effective interventions for specific adolescent populations.

[Impact of ambient air pollution on the prevalence of main symptoms of asthma in children].

The impact of ambient air pollution on the prevalence of main symptoms of asthma was analyzed in children. A total of 3,506 children were interviewed using the ISAAC questionnaire. The prevalence of the abnormality was studied via continuous questioning in children aged 7-8 and 13-14 years, who lived in areas with varying aerogenic loads. The higher rates of main asthma-like symptoms and clinically diagnosed asthma were ascertained in the children living in higher ambient air pollution areas.

[Complicated colorectal cancer--aspects of surgical tactics].

Over the period 2000-2011 (6th m) a total of 856 patients with complicated colorectal cancer are subjected to treatment in the Clinic of surgical diseases--Department of Surgery in University Hospital "Alexandrovska", Sofia. Obturation is the commonest form of complication--47 per cent, perforation within the tumor or diastasis noted in 74 cases (8.6 %), paratumor abscesses and infiltrates--in 7.6 per cent and rectohemorrhage--in 4.2 per cent. The therapeutic and operative approach, and the scope of surgery are dependent on a multitude of factors which should be given due consideration by the surgeon. In each patient presenting complicated colorectal carcinoma it is mandatory to make a precise and individual choice of the extent of operative intervention, consistent with the patient's general condition and contributing to eliminate the life-endangering underlying cause. Postoperative mortality in patients with complicated colorectal cancer is 17.1% whereas in radical operated patients without complicated cancer mortality is only 6.8%.

[Using dietary supplement containing dietary fiber, fermented wine yeasts, vitamins and minerals, under the influence of dust-gas mixture. The experiments on laboratory animals].

In chronic experiment in rats pro for show, what of food biologically active "Rekitsen-RD", promotes increase of efficiency of mechanisms of detoxication, antioxidant activity and immune protection of an organism.

[Combined endovascular and surgical management of carotid paraganglioma].

Surgical intervention is the only method of radical treatment of carotid paraganglioma (CP). Intraoperative blood loss may exceed 2 litters. Ligation of the external carotid artery (ECA) is not always possible technically due to tumour invasion to the ECA's walls. Prior to operation, in order to diminish blood loss it is suggested to perform endovascular embolization (EE) of the vessels feeding the tumour. The case report presented herein concerns an 18-year-old male patient with CP after comprehensive diagnosis including ultrasonographic duplex scanning with Doppler colour mapping, enhanced-contrast spiral computed tomography, selective carotid angiography. The patient was subjected to selective. EE of the afferent vessels of CP. Embolization of the branch of the ascending pharyngeal artery travelling to the lower pole of the tumour, and that of the large branches feeding the upper pole of the tumour from the initial portion of the occipital artery with poly vinyl alcohol (PVA-300) and hydrogel "Embox" was followed by surgical intervention: removal of the tumour, closure of the ostia of the tumour's own arteries, ligation of the EC A. The volume of intraoperative blood loss amounted to 350 ml. The postoperative period proved uneventful with nothing to report. During the check-up examinations of the patient, performed 3, 6, 12 and 24 months after the operation, a good postoperative therapeutic outcome was noted to persist.

[Surgical treatment of the perianal and rectovaginal fistulas by means of Surgisis AFP anal fistula plug].

Symptoms of painful and uncomfortably occurred in patients with anal and rectovaginal fistulas witch worsened their quality of life. The introduce of Biodesign Fistula Plug is called "dramatic jump in surgery of the fistulas". We can avoid from the traditionally and technicaly difficult treatment of perianal and rectovaginal fistulas through this advice. Therefore like this surgeons can avert frequently complications of the anal sphyncteric apparatus like incontinence or stenosis. We have only two cases like attempt for now but with excellent result followed up about 31 and 33 months.

[Malignant melanoma of the anus and rectum].

There is approximately 300 cases of malignant melanoma written in the world literature. We write up 13 operated from us for 15 years cases of melanoma of the anus and rectum. The neoplastic localization is usually at linea dentate area. The patients complains are foreign-body filling and rectohaemorrhagy. This formation considers like haemorrhoid frequently. The pain is not common symptom but ulceration occurs in many percent. The metastasing is in the inguinal lymph nodes. The tumor colour is between light-brown to red-purple in 50% of the cases. The colouring matter is absent in the other half of the cases and these tumors consider like nonpigmentous melanoes. Despite the complex treatment--surgical, chemotherapy etc. the prognosis is at large poor.

[Retrorectal tumors--15 years experience and literary review].

PURPOSE: Tumors occurring in the retrorectal space are heterogeneous and uncommon. The utility of newer imaging techniques has not been extensively described, and operative approach is variable. This study examined the diagnosis, treatment, and outcome ofretrorectal tumors at a tertiary referral center. METHODS: Patients with primary, extramucosal neoplasms occurring in the retrorectal space were identified using a retropectively maintained, procedural database of all adult colorectal surgical patients (1995-2009). Exclusion criteria included inflammatory processes, locally advanced colorectal cancer, and metastatic malignancy. Medical records, radiology, and pathology reports were reviewed retrospectively. RESULTS: Thirty-eight patients with retrorectal tumors were treated. Malignant tumors comprised 21 percent. Older age, male gender, and pain were predictive of malignancy (P < 0.05). All benign tumors were resected with normal histologic margins and none recurred. Nine patients with malignancy had recurrence/recrudescence of their disease. CONCLUSIONS: Retrorectal tumors remain a diagnostic and therapeutic challenge. Pain, male gender, and advanced age increase the likelihood of malignancy. Various imaging modalities are useful for planning resection but cannot establish a definitive diagnosis. Whereas benign retrorectal tumors can be completely resected, curative resection of malignant retrorectal tumors remains difficult.

[Surgical treatment of esophageal achalasia--20 years experience].

Achalasia comes from a Greek word that means "failure to relax." Cardiospasm and achalasia refer to the same condition. This report addresses esophageal achalasia--its history, diagnosis, pathophysiology, and treatment options. We report our experience in treating this disorder surgically using modified Heller myotomy combined or not with partial gastric fundoplication. 47 patients with achalasia surgically operated in 20-years period are reported by authors. These features make it reasonable to reasses the relative indications for surgery and nonsurgical therapy in achalasia of the esophagus.

[Diverticulosis of the colon end its complications under the mask of emergency surgical abdomen--10 years experience].

OBJECTIVES: estimating the prevalence of colonic diverticulosis and its complications studied at the clinic for 10-years period as well as the approaches for its operative treatment and analysis of the subsequent results. CASES AND APPROACHES: During the period 1998-2008 56 patients were hospitalized (31 women and 25 men) at the Surgical department of the University hospital "Alexandrovska". They had different forms of colonic diverticulosis. The average age of the patients was 66.7. The retrospective analysis divides the patients into three clinical groups: 1st group--peritonitis and pericolic abscess caused by diverticulosis--present in 49 patients. 2nd group--chronic non-specific inflammatory infiltrate and fistula--present in 5 patients. 3rd group--severe haemorrhage and anaemic syndrome--present in 2 patients RESULTS: Mortality-rate is 12.5% (7 patients). 10 patients with complications were registered--5 with suppuration of the surgical wound and 5 with pneumonia and pleural effusion. CONCLUSION: Colonic diverticulosis is a disease of great surgical interest because of its complicated forms requiring conventional or surgical treatment. Various forms of peritonitis which are part of the emergency surgical abdomen domain are relatively frequent complication of the gastrointestinal (in particular of the colon) diverticulosis. They are difficult to diagnose in the pre-operative period and its not easy to take a decision about the particular operative approach. All that is related with the relatively high morbidity and mortality.

[Experience of vascularized autotransplants use for lower jaw defect substitution after its resection with disarticulation].

To 17 patients after lower jaw resection with disarticulation (on the occasion of neoplasm and traumas) the defects were replaced by vascularized autotransplants of the 2nd radius of pedis and vascularized fibula autotransplants in combination with titanium implants. In all cases positive results were received. The authors consider that microsurgery with vascularized fibula autotransplants in combination with titanium implants was an optimal way to replace lower jaw defects after its resection with disarticulation in TMJ.

[Tactics and approach to the treatment of choledocholithiasis--7-year follow up study].

Laparoscopic surgery approved itself as "golden standard" in treatment of cholelithiasis. However, in cases with common bile duct stones (CBDS), still there are several methods of management: 1.) Preoperative Endoscopic Retrograde Cholangio-pancreato graphy (ERCP), endoscopic papiloshpyncterothomy (EPS) and stone extraction, followed by Laparoscopic cholecystectomy (LC). 2.) LH with intraoperative common bile duct exploration and stone extraction. 3.) LH, followed by EPS and CBDS extraction. CBDS are present in about 10-15 % of patients, treated by laparoscopic cholecystectomy. In most cases choledocholithiasis is suspected. In small percentage it is unsuspected and it's found during the operation. In present days still there is no clear conclusion about treatment of CBDS. In our clinic we use a multidiscipline method - ES with stone extraction on first stage and LC on second stage. In small percentage of patients we use LC with intraoperative common bile duct exploration and stone extraction, and LH, followed by ES and CBDS extraction. Our aim is to represent a prospective study of our results.

[Obstructive ileus of the large intestine caused by ischemic colitis--literature review and report of 7 cases].

Ischemic colitis is the most common form of intestinal ischemia. The damage produces ulcers in the lining of the large intestine. Ischemic colitis affects primarily people who are 50 or older. The disease was first described by Boley and associates [1] as a "reversible vascular occlusion" of the colon, and Marston and colleagues [2] went on to detail the gangrenous, stricturing, and transient forms. Two mechanisms may cause bowel ischemia: The first and most common is diminished bowel perfusion due to low cardiac output often seen with in patients with cardiac disease or in prolonged shock of any etiology. The second mechanism is occlusive disease of the vascular supply of bowel due to atheroma, thrombosis, or embolism in which the collateral circulation is not adequate to maintain bowel integrity.

[Environmental hygiene and comprehensive processing of copper sulphate ore]. / Voprosy gigieny okruzhaiushchei sredy pri kompleksnoi pererabotke mednosul'fidnykh rud.

The modern comprehensive processing of copper-sulphate ores is based on using the fire, chemical and combined fire-and-hydrometallurgy processes. The existing schemes of comprehensive ore processing do not provide for a total utilization of the metallurgical cycles wastes due to the inherent technological and design shortcomings; besides, they are a source of environmental pollution. Contamination of the atmospheric air with discharge elements has unfavorable effects on the health condition of population; it worsens the natural body resistance and contributes (through the induction of chromosome aberrations) to a higher general morbidity and mortality due to malignant neoplasms. Health-improve measures are supported by modern achievements in the sphere of copper-sulphate ore processing technologies--they ensure the hygienic and ecological rational management and usage at all stages of the processing of raw materials and secondary products. Institutions of the territorial medical-and-ecological monitoring are the corner stones for ecological safety of persons residing in areas of comprehensive copper-and-sulphate ore processing.

[The hygienic characterization of atmospheric pollution and indices of the health status of females and children under metal processing of naturally alloyed ores]. / Gigienicheskaia kharakteristika zagriazneniia atmosfery i pokazatelei sostoianiia zdorov'ia zhenskogo i detskogo naseleniia pri metallurgicheskoi pererabotke prirodno-legirovannykh rud.

The agglocoking blast-furnace processing of naturally alloyed ores gives rise higher volumes of dust and gas wastes which on air dispersal yield to higher concentrations of air pollution with dust, sulfur-containing substances, as well as compounds of carbon monoxide, phenol, and ammonia than that of magnetic iron ore, which yields a higher prevalence of comparable forms or reproductive disorders in women and higher general morbidity in children.

Broad indications for the application of simultaneous oral-nasal manometering method.

UNLABELLED: The purpose of the study is to enlarge and define the perimeter of application of manometrical method for investigation of nasal breathing. METHOD: We studied patients with congenital or acquired pathological communications of the maxilla as well as patients with perforation of the sinus after teeth extractions that have been treated by prostheses. An original electronic pneumatic device was constructed for our method. RESULTS: Because of the objectiveness of the method and the device we obtained good results in closing the pathological communications in all of the patients. When used in the diagnosis of sinus perforations the method and the device showed the same effectiveness, CONCLUSION: When realization is possible the method guarantees absolute effectiveness in defining leakage of breathed air through pathological communications of the maxilla. With this device, constructed for the study we optimized the application of the method.

[Experience in using complex flaps on microvascular anastomoses in treating with skin cancer on the face and scalp, appearing in scarred areas]. / Opyt ispol'zovaniia slozhnykh loskutov na mikrososudistykh anastomozakh v lechenii bol'nykh rakom kozhi litsa i volosistoi chasti golovy, voznikshim iz rubtsov.

The authors describe 11 patients operated upon for carcinoma of the face skin and hairy part of the head developing from scars of various etiology. The substitution of vast defects which had appeared after dissection of a tumor was performed by means of microsurgical autotransplantation of tissue complexes. The following vascularized autotransplants were used: musculus serratus anterior, scapular and radial grafts. Positive results were obtained in all the cases. The authors consider the microsurgical autotransplantation of tissue complexes to be a necessary component of surgical treatment of carcinoma of the skin and hairy part of the head developed from vast and deep scars.