[A clinico-morphological parallel in peptic ulcer in middle and old age]. / Kliniko-morfologichen paralel na iazvenata bolest v naprednalata i starcheskata vuzrast.

Based of clinical and obduction case material covering the period 1990-1997, the clinical profile, morphological patterns and therapeutic approach, consistent with the specificity of age, complications of the basic disease and presence of concomitant diseases, are summed up. The results of biopsy and necropsy studies, following statistical processing by the methods of variation and correlation analysis, afford information on the morbidity in either gender, as well as on the location and morphological patterns of ulcers, their complications and associated diseases. Over the period 1990 through 1997, a total of 5425 cases are subjected to obduction study. Of them 799 (14.7 per cent) are with ulcers, 543 men and 256 women at 2.1-to-1 male-to-female ratio. Four-hundred fifty-nine (54.4 per cent) are in advanced and old age, at male-to-female ratio 1.9-to-1. There are 362 gastric ulcer patients (45 per cent), 237 men and 125 women, at male-to-female ratio 1.8-to-1. Of the latter 176 (48.6 per cent) are in advanced and old age, 94 men and 82 women at approximative male-to-female ratio 1-to-1.

[Relaparotomy in middle-aged and elderly patients with peritonitis following a primary operation for digestive pathology--II]. / Relaparotomiia pri bolni v naprednalata i starcheskata vuzrast s peritonit sled purvichna operatsiia po povod digestivna patologiia--II chast.

The study covers 39,233 patients presenting biliodigestive pathology of which 12,230 in advanced and senile age, admitted to the emergency surgery section of the EMI "NI Pirogov" over a 12-year period (1985 through 1996). Of the total number, 6555 or 53.71 per cent are subjected to operation, with postoperative deaths amounting to 477 (7.27 per cent). In 320 cases (4.88 per cent) 218 men and 102 women, relaparotomy is done for postoperative peritonitis with 55 per cent lethality. Postoperative peritonitis is usually observed after operative treatment of ulcers. Operations for bleeding ulcers are performed in 175 patients of which 32 (18.28 per cent) are relaparotomized. Those operated for postoperative peritonitis are 65 per cent with 21 fatal outcomes; the commonest cause of death is insufficiency of the anastomosis or duodenal stump, followed by subhepatic and interfold abscesses.

[Hemorrhages from the gastrointestinal tract in middle-aged and elderly patients--the diagnostic-treatment procedures and mortality dynamics]. / Kruvotecheniia ot gastrointestinalniia trakt pri bolni v naprednala i starcheska vuzrast--diagnostichno-lechebna taktika i dinamika na mortaliteta.

Hemorrhages from the upper part of the gastrointestinal tract pose serious surgical problems because of their rather elevated incidence, diverse etiopathogenesis, difficulties in diagnostic and therapeutic approach, and last but not least, owing to the high mortality rate. The incidence of patients with ulcers amount to 420 per 100,000 population, with those in advanced and old-age accounting for 15-40 per cent of the total number of affections. In this contingent ulcers run a course associated with a number of peculiarities conditioned by severe lesions, caused by an acute and prolonged blood loss, not infrequently associated with a serious co-morbidity typical of this age. For this reason periodic analysis of lethality due to hemorrhages in the upper segments of the gastrointestinal tract contribute greatly: to evaluate the factors affecting thanatogenesis of this particular disease. establish the dynamic pattern of mortality, and specify the therapeutic tactics influencing such dynamics.

[The surgical treatment of perforated gastric and duodenal ulcers in middle-aged and elderly patients--an analysis of the 1985-1996 period]. / Khirurgichno lechenie na perforiralata stomashna i duodenalna iazva na bolni v naprednala i starcheska vuzrast--analiz za perioda 1985--1996 g.

The problem relating to perforated gastric and duodenal ulcers (PGDU) treatment is still pressing nowadays not only on account of the constant mortality rate (6.7-14.55 per cent according to personal data), but also on account of the lack of universally accepted tenets for their management, irrespective of the fact that the first operative interventions were done more than 100 years earlier, and so far, more than 50 palliative and radical procedures have been suggested. Between 20 and 40 per cent of all ulcer patients are individuals in advanced and senile age. In this contingent a characteristic feature is the elevated incidence of complications, one of them being perforation, necessitating operative treatment and exposing elderly patients to serious surgical and anesthesiological hazards.

[Organization, diagnosis and the treatment procedure in chest, abdominal and combined trauma]. / Organizatsiia, diagnostika i lechebna taktika pri grudna, koremna i suchetana travma.

Thoracic and associated injuries pose problems demanding enormous interdisciplinary efforts regardless of the improved organizational, diagnostic and treatment potentialities. As shown by the experience of the Emergency Surgery Section at the Pirogov Institute, rendering medical services to patients presenting chest and associated injuries require coordinated integration of specialists from various profiles along with specification of the priorities and hierarchy of the emergency measures undertaken. Over a 12-year period (1985 through 1996), a total of 6983 patients with chest, abdominal and multiple trauma are admitted. They are distributed as follows: chest trauma casualties--3286, abdominal trauma--679, and multiply injured--3018. Chest injuries are divided in close and open injuries--2843 and 444, respectively; the latter include 29 gunshot and 415 penetrating-incise wounds. The abdominal trauma group includes 679 cases, distributed as follows: spleen rupture--341, disruption of liver and mesenterium--151, and lesion to a hollow abdominal organ--187.

[Rib fractures and flail chest in closed chest trauma--stabilizing operations and the results]. / Rebreni frakturi i grudni kapatsi pri zakrita grudna travma--stabilizirashti operatsii i rezultati.

A contingent of patients presenting closed chest injuries, sustained over a 12-year period (1985-1996), are analyzed. Of the total of 6938 traumas, chest injuries amount to 3286 (47.06 per cent) of which 2842 (40.7 per cent)-closed. Of the latter 2248 (79.09 per cent) are located in the left thoracic half, 420 (14.77 per cent)-in the right thoracic half, and in 174 (6.12 per cent) it is a matter of bilateral involvement. At the point of heaviest impact, involving 5th to 9th rib segment, left side injury is recorded in 2034 cases (71.56 per cent), right side--408 (14.35 per cent), and bilateral--in 155 (5.45 per cent). There are 28 fractures of the sternum (0.85 per cent). Of the latter 14 are located in the manubrium sterni region, twelve--in the middle portion, and two in the distal part of the sternum. Over the last 5 years (1991 through 1995), of 63 casualties with flail chest 16 are with indications for stabilization osteosynthesis, and accordingly subjected to operation. A Schimelmann plate is used in 13 cases, artificial rib type "Ampar"--in three, and sternal stabilization--in one.

[Bronchoscopic assessment algorithms for the practical evaluation of the rheological properties of the tracheobronchial secretion and the classification of the degree of the disordered drainage function of the tracheobronchial tree (TBT) in chest and combined trauma with chest trauma as the leading injury]. / Bronkhoskopski otsenuchni algoritmi za prakticheska otsenka na reologichnite svoistva na trakheobronkhialniia sekret i klassifikatsiia na stepenta na narushena drenazhna funktsiia na trakheobronkhialnoto durvo (TBD) pri grudni i suchetani travmi s vodeshta grudna travma.

Ventilation impairment, due to ineffective elimination of the mucous-hemorrhagic content from the tracheobronchial tree (TBT), obstructs the upper airways with the ensuing ventilation reduction giving rise to atelectases and progressive alveolar block. There is evidence of transudation and exudation into the pulmonary pathways and pleural cavity. A series of 276 patients presenting closed chest trauma are subjected to fibrobronchoscopy (FBS) and follow-up study. In 92 of them bronchoscopy is performed 2 to 15 times per patient, accordingly: in 75-twice, in 10-five times and in 15-twice. One-hundred twenty-nine of the total of 276 cases under study are on mechanical ventilation. In 56 instances FBS is carried out through a tracheostomy cannula, in 73-by intubation, in 18-through the mouth, and in two--through the nose. Based on the obtained results, algorithms for assessment of the rheological properties of tracheobronchial secretion and degree of impairment of TBT drainage function during emergency FBS in closed chest injuries are worked out, having an essential practical bearing on the diagnostic and therapeutic approach to closed thoracic trauma.

[Diaphragmatic injuries in thoracoabdominal trauma]. / Naraniavane na diafragmata pri torakoabdominalni travmi.

In closed thoracoabdominal trauma the diagnosis rupture of the diaphragm is usually made in 5 per cent of the casualties. Over a 12-year period (1985 through 1996), in the Pirogov Institute are admitted 3018 cases presenting polytrauma. Among the contingent of closed thoracoabdominal trauma lesions to the diaphragm are registered in 151 cases, and among those with open injuries--in 21 cases. There are 71 closed injuries in PTP, and 80 closed thoracoabdominal injuries caused by high falls. Open injuries associated with lesion to the diaphragm are due to gunshot wounds in two cases, and inflicted by knife and other pointed objects in nineteen. In closed trauma there is 2:1 male-to-female ratio, and in open injuries--5:1.

[Combined trauma--an analysis of a 10-year period]. / Suchetanata travma--analiz na desetgodishen period.

Proceeding from retrospective analysis of 1802 casualties presenting open and closed combined trauma (CT), treated in the Emergency Medicine Institute "Pirogov" over the period 1985 through 1994, attention is focused on the changes in incidence and patterns of associated injuries. Problems relating to organization of the treatment of such patients at the various stages are discussed. The basic requirements of diagnosing and establishing the indications for operation are outlined from the standpoint of general surgery. Finally, the main developmental trends of the therapeutic approach to CT, and the possible ways to find a solution of the most important problems along this line are summed up.

[Percutaneous transthoracic drainage in pleural collections--the pros and cons from the surgical viewpoint]. / Perkutanniiat transtorakalen drenazh pri plevralni kolektsii--za i protiv ot khirurgichna gledna tochka.

An attempt is made at specifying the indications for inserting percutaneous transthoracic drain after Seldinger's method. The clinical case material analyzed for the purpose covers 761 patients over a three-year period (1993 through 1995), with 329 of them drained for pneumothorax, 266--hemothorax, and 66--hemopneumothorax. In 54 cases (7.1 percent) switching to surgical draining is necessitated, in 41 (5.39 percent) correction of the drain is done because of inefficiency, and in 96 (12.61 percent)--patency checking and its restoration on the serioscope table. A classification of pathological pleural collections is suggested which proves helpful in estimating whether or not a tube thoracic or percutaneous drain should be employed. The surgeon is cautioned that his assessment should be by no means influenced by the easier procedure under the excuse that it is the method of choice for the patient. Last but not least, one should give due consideration to the financial aspects: percutaneous drainage of the pleural cavity costs about 80 DM, whereas a cigarette thoracic drain costs about 100 leva at the time of analyzing the material.