[A case of metachronous carcinoma of the colon diagnosed and radical operated with restorative anastomosis after more than 5 years from the first left hemicolectomy]. / Sluchai na metakhronen kartsinom na kolona, diagnostitsiran i radikalno operiran s restorativna anastomoza sled poveche ot 5 godoni ot prekhodnata liava khemikolektomiia.

The authors described their observation about the female patient with an advanced carcinoma (T4) of the descendent colon where left hemicolectomy was done in the beginning of 1998. The patient is operated again after more than 5 years because of the cancer in the site of the anastomosis. Radical reresection with restorative anasomosis is performed and for this reason the colon is putting via mesenteric radix. The case is analyzed and there are suggestion about is this a local recurrence or "de novo" carcinoma It is important to follow up the patients during lifetime for early uncovering of local recurrence. Endocoloscopy and scener are preferable for this aim.

[A case of two simultaneous carcinoma lesions of the colon and rectum with different differentiation and stage of neoplastic process]. / Sluchai s dve simultantni kartsinomni lezii na kolon i rektum s razkichna diferentsiatsiia i stadii na neoplastichniia protses.

It considers a patient with simuitant colorectal carcinoma. Both tumor lesions are from different stage and different histological type. The grade of invasion of tumor process does not correspond to the histological type of neoplasma and nider to the size of the primer tumor. The different evolution of those simuitants lesions does not correspond with criteria for histological type and with the stage of primer tumor as a prognostic factors.

Budd-Chiari syndrome and inferior vena cava thrombosis in a nephrotic child.

We observed Budd-Chiari syndrome in a boy aged 2 years 6 months with nephrotic syndrome due to hepatic vein and inferior vena cava thrombosis, confirmed by Doppler imaging. Normal values of the routine hemostatic parameters proved that they are of little predictive value for the thrombotic state. Immediate heparin infusion was initiated. High doses of heparin up to 59 IU/kg per hour were required for efficient anticoagulation. A remission of the nephrotic syndrome was achieved with vincristine. Oral anticoagulation with a vitamin K antagonist was continued for 6 months. Doppler imaging then indicated full re-establishment of the blood flow through the affected vessels. The clinical and Doppler data in this case are compatible with acute Budd-Chiari syndrome due to incomplete outflow obstruction of the hepatic veins and inferior vena cava. The favorable outcome was due to the immediate heparin infusion and prompt remission of the nephrotic syndrome. Doppler imaging was an important tool for non-invasive diagnosis and follow-up.

[Plastic surgical repair according to Lazar da Silva in large median eventrations]. / Plastika na Lazaro da Silva pri golemi sredinni eventratsii.

Lazaro da Silva's technique is postulated as a method free of relapses provided autologous endogenous tissues are made use of. It consists in the raising of three flaps cut from the hernial sac, anterior and posterior sheats of the rectus abdominis muscles. The suture lines lie in three different anatomical planes, thereby promoting restoration of the integrity and anatomical patterns of the anterior abdominal wall. The procedure is used in three patients presenting xiphopubic eventration of > 5 years longstanding. During the follow-up study (1.5 to 3 years) no relapses are registered. The technique described yields very encouraging results. Further comprehensive studies along this line will demonstrate whether or not the reputation of the procedure gained abroad will be confirmed.