[WOUND HEALING PROPERTIES OF THE RECOMBINANT HUMAN ANGIOGENIN IN THE GEL MEDICINAL FORM USED AS A TREATMENT IN THE MODEL OF PLANAL MUSCULOCUTANEOUS AND LINEAR WOUNDS].

The aim of the study was to evaluate the wound healing properties of the recombinant human angiogenin drug in the gel form on the models of planar musculocutaneous wound and a linear wound. The rats were divided into 3 groups: 1st group - control animals, that did not get any treatment of wounds; 2nd group - experimental, where animals' wound surface was treated with recombinant human angiogenin in a gel medicinal form; and the 3rd group - a comparison group, where animals were treated with "Solcoseryl" drug. The resulted morphology data and the time of complete epithelialization of planar wounds suggest that the human angiogenin drug in gel form has a pronounced wound healing activity. The latter surpasses the studied parameters of the reference drug "Solcoseryl", by contributing to the acceleration of healing process of planar musculocutaneous and linear wounds in rats.

EPIDEMIOLOGICAL REGISTRY OF NEUROENDOCRINE TUMORS IN BULGARIA--A PILOT SURVEY.

The National registry of patients with neuroendocrine tumors (NET) in Bulgaria was established in 2013 as a joint initiative of the Bulgarian Surgical Society and the Institute for Rare Diseases. The register aims to explore the epidemiology of NET in Bulgaria, as well as the different diagnostic and treatment approaches for the disease throughout the country. This the first of its kind retrospective study of NET in the country is covering the period January 2012 - January 2013. A total of 127 patients with NET were identified. At the time of the survey the average age of patients with NET was 58.61 ± 15.59 years. The data show almost equal distribution between the genders with a slight predominance of women. The largest relative part of NET is those of NET located in the gastrointestinal tract (54.10 ± 4.51%), followed by those located in the pancreas (12.30 ± 2.97%) and in the lungs (10.66 ± 2.79%). In 72.44 ± 3.96% of the patients a immunohistochemical diagnosis was performed. The study confirmed the leading role of the surgery method of the NET management. In 65.83 ± 4.33% of the patients a radical removal of the tumor was conducted, while the relative part of the undertaken partial resection was 7.50 ± 2.40%. A statistically significant association between the type of surgical treatment and during the follow-up of patients was found. An update of the information in the register will allow a more precise determining of the distribution and management of NET in Bulgaria.

Surgical treatment of chronic pancreatitis and its complications. Comparative analysis of results in 91 patients.

There is a large variety of proposed conservative, invasive, endoscopic and surgical methods for treatment of chronic pancreatitis and its complications. This study presents a comparative analysis of the results from each group of patients subjected to drainage, resection, denervation and other operative techniques for a total of 91 patients with chronic pancreatitis and its complications. Drainage and resection operative techniques yield comparable results in terms of postoperative pain control 93.1% and 100%, perioperative mortality--3.17% and 5.8%, perioperative morbidity--7.9% and 11.7%, respectively. There is a significant increase in the instances of diabetes in the resection group. Right-side semilunar ganglionectomy is a good method for pain control as an accompanying procedure in the course of another main operative technique.

Some aspects of the etiology and the pathogenesis of chronic pancreatitis.

The development of modern technology and advances in medical science make possible understanding of etiology of chronic pancreatitis. From a century ago, the ethanol is connected to chronic pancreatitis. In the last decades medical science made a big footstep in understanding of so called "idiopathic pancreatitis". Factors as autoimmune disturbances, toxins, gene mutations, geographic characteristics are already known as cornerstones in etiology and pathogenesis of the disease.

[Extrinsic obstruction of the ureter in colorectal cancer--aspects of pathogenesis, diagnosis and treatment].

BACKGROUND: Primary or recurrent colorectal cancer (CRC) may lead to extrinsic obstruction of the ureter (EOU) necessitating differentiated and individual approach based on the genesis of the lesion. AIM: Analysis of the pathogenesis, risk factors, clinical presentation, diagnosis and treatment of cases of EUO in our experience. MATERIAL AND METHODS: From Jan., 2003 to Dec., 2005 21 patients with EUO were treated at the authors' institutions. The study was prospective and clinical, laboratory and instrumental data were collected and analyzed. The EUO's were classified as carcinomatous infiltration by the primary or recurrent tumor (Group A), post radiation therapy (Group B) and operative lesions (Group C). Cases of involvement of the ureter and urinary bladder as well as such of distant metastases were not included in the study. Methods of treatment consisted of resection and end-to-end uretero-ureterostomy or ureteroneocystostomy (11 cases), insertion of a double-J catheter (4 cases), nephrostomy (6 cases). RESULTS: The early postoperative mortality and morbidity rates were 0% and 28.57% respectively. Urinary infection was the most often specific complication. CONCLUSIONS: EUO remains a challenging complication of CRC. It is most often observed in patients between 51 and 60 years of age with recurrent rectal cancer stage III (Dukes C). Cases of group B and group C are indicated for radical ureteral resection and reconstruction while those of group A need just conservative measures for overcoming urinary stasis.

[Cystopericystectomy for the treatment of hepatic hydatid disease].

UNLABELLED: Hepatic hydatid disease is current problem in Bulgaria as the country in endemic region. The treatment include PAIR, various type surgical procedures and medical therapy. Surgical treatment is conductive. Cystopericystectomy is one of radical procedures. AIM: The aim of this study is to present the experience of Department of General and Liver-Pancreatic Surgery in Uiversity Hospital "Alexandrovska", Sofia with cystopericystectomy. MATERIAL AND METHODS: During the period of 18-years (1988-2005) done 90 cystopericystectomies on the 79 patients--57 (72.15%) female and 22 (27.85%) male. Diagnosis has become easier with advances in ultrasonic imaging, immunological tests and CT scanning. The cysts ware localised in left lobe--56 (62.2%) and right lobe--34 (37.8%). RESULTS: There was complication in 4 (5.0%) of patients. Median postoperative stay is 10.3 days. There wasn't reoperacions and lethal outcome. CONCLUSION: Cystopericystectomy is difficult operative procedure, but it followed with better results. It's necessary strictly abidance of the evidences.

[Dirofilariasis--a rare antroponosis. Review of the literature and a report of two clinical cases].

Dirofilariasis is a rare anthroponotic endemic disease caused by nematodes. The dog is the reservoir of this parasite and men are accidentally infected by mosquitoes. A subcutaneous mass or pulmonary nodules are the typical clinical presentation. Here, we present two cases of human dirofilariosis and a make a review of the literature.

[Postoperative entero-cutaneus fistulas--a study of 24 cases].

AIM: To perform a retrospective study on the experience of the Clinic of General, Liver, Biliary and Pancreatic Surgery, Alexandrovska Hospital in the diagnosis and treatment of patients with acquired entero-cutaneus fistulas and to analyse the early postoperative results. MATERIAL AND METHODS: We treated 24 patients with postoperative entero-cutaneous fistulas in the period Jan., 2000 - Aug., 2004. The male sex and the age above 50 were dominent. The primary disease was of oncological origin in 22 cases (91.66%). Anemia, hypoprotenemia and hypoalbuminemia were predisposing and risk factors in 19 cases (79.17%). Fistulography was routinely used for establishing the diagnosis. Surgical treatment was received by all the 6 patients (100%) with small bowel fistulas and by 15 from the 18 patients with large bowel fistulas (83.33%). EARLY POSTOPERATIVE RESULTS: The mortality rate was 4.54% (1 fatal outcome from 22 operated patients). The morbidity rate was 36,36% (8 cases) but none of the complications needed a reoperation. CONCLUSIONS: 1. The most frequent causal factor for entero-cutaneus fistulas in our material was an anastomotic leakige after bowel resection (95.83%); 2. The risk for such a coplication is higher in cancer patients with other predisposing pathological factors; 3. From the pahtological and clinical point of view the entero-cutaneus fistulas caused significant disturbances in base-alkaline and electrolyte balance, malnutrition and cahexia; 4. The clinical signs and the fistulography prooved to be reliable diagnostic methods; 5. The preoperative substitution and nutritional therapy had a significant benefit on the postoperative results, especially in cases of small bowel fistulas; 6. The open surgery was the main therapeutical method in the complex treatment of those patients.

[Acquierd entero-cutaneous fistulas--diagnostic and therapeutic approach].

The acquired entero-cutaneous fistulas are a current problem in the field of abdominal surgery. Most of them are postoperative--after an intestinal resection and/or anastomosis. Crohn's disease and coplicated colonic diverticulosis rank second as causal factors. The risk factors for the development of an entero-cutaneous fistula and for the poor prognosis at the same time are the next: (1) Most of the patients suffer of severe main and co-exhisting diseases; (2) The presence of previous laparotomies, radion and chemotherapy, significant disturbances in the base-acid and water-electrolyte balance; (3) The fistula itself worsens these disturbances and may doom to fail the substitutional and nutritional therapy. The diagnostics of a fistula, including its location is comparatively easy. The surgical treatment plays an important role in the therapeutic scheme, especially in cases of high-output fistulas of the small intestin. At the same time the adequate total parenteral nutrition and correction of the base-acid and water-electrolyte disbalance is also very important. Recently there are some new diagnostic methods and alternatives of the basic surgical procedures, some of them quite contraversial.

[Internal biliary fistulas--diagnostic and therapeutic problems].

BACKGROUND: Internal biliary fistula (IBF) is still a challenging condition. The preoperative diagnosis is established in less than 50% of cases. Treatment is based on individual approach but postoperative morbidity and mortality rates are high. AIM: To study the experince of our clinic in the diagnosis and treatment of IBF's and to make a review of the literature. MATERIAL AND METHODS: a retrospective analysis of the data of 7 patients with IBF (0,53% of all surgical interventions on the biliary system during a 4-years period). The preoperative diagnosis was correct in only 2 cases. All the 7 patients were treated surgically. RESULTS: The early postoperative mortality and morbidity rates were 0% and 42,86% respectively. The data of literature are reviewed and discussed. CONCLUSION: IBS is a rare condition affecting more often women above 65 yrs suffering of gallstones. There are no typival clinical and laboratory data but US, CT-scan, ERCP and MRI might be a 100% informative. Open surgery remains the basic method of treatment.

[Early and late complications following 388 nephrectomies in different diseases of the kidney and the ureter]. / Ranni i kusni uslozhneniia sled 388 nefrectomii pri razlichni zaboliavaniia na bubrek i ureter.

Early and late complications of nephrectomy include: chronic renal failure (CRF), haemorrhagic events, lumbar fistulas and other complications of different origin. This study covers 388 nephrectomies due to different diseases of the kidneys and the urethra. Clinical diagnosis and treatment of the patients are held at the Chair of Urology of the Alexandrovska Hospital for the period 1990-1995. There are established the following early and late complications: renal failure--in 37 patients (9.53%), haemorrhagic events--in 2 patients (0.51%), lumbar fistulas--in 4 patients (1.03%). Other complications are calculous anuria in 1 patient (0.25%), nephrectomy following plastic surgery of a kidney calyx--in 1 patient (0.25%), nephrectomy in a case with one functionally preserved kidney--1 patient (0.25%), nephrectomy in a case following kidney transplantation--1 patient (0.25%), and fatal outcome through the early postoperative period--in 2 patients (0.51%). Authors conclude that: 1) nephrectomy is followed by complications through the early and the late postoperative period; 2) complications following nephrectomy are rare but they are one of the most serious and important sequella in urologic surgery.

[Hepatic echinococcosis: radical or conservative surgical treatment]. / Chernodrobna ekhinokokoza: radikalno ili konservativno khirurgichno lechenie.

UNLABELLED: Hydatid liver disease remains an actual medical and social problem for Bulgaria as an endemic region. Because of the lackage of medicines with satisfactory therapeutic effect the surgical treatment is still the treatment of primary importance. AIM: The aim of this study was too check the correctness of the following hypothesis: "Radical surgical procedures on hydatid liver disease have lower rates of morbidity and mortality compared to conservative ones". MATERIAL AND METHODS: In order to achieve the above mentioned aim we analysed the results of 361 patients with hydatid liver disease (267 (74%) of whom retrospectively and 94 (26%) prospectively), treated at the Clinic of General, Liver and Pancreatic Surgery during the period 1st, Jan., 1985-1st, Jan., 2001. The patients were divided in two main groups: 102 (28.25%) of them received radical surgical procedures and 250 (69.25%)--conservative ones. Nine of the patients (2.50%) had multiple echinococcal cysts and received surgical procedures of both types. That's why the results of those patients did not correspond to the aim of the study and they were not included in it. The analysis consisted of a comparison between the two main groups according to several criteria: sex, age, location and average size of the cysts, postoperative complications, reoperations, mean postoperative stay at hospital and mortality rate. RESULTS: There was a prevalence of the female in the ratio male/female in the group of patients who received a radical procedure. The location of echinococcal cysts in the left hepatic lobe was found to be more frequent. In the group of radical surgical operations the postoperative morbidity and mortality rates were lower and the postoperative stay at hospital was shorter, compared to the group of conservative procedures. CONCLUSION: Radical surgical procedures showed better postoperative results. But those procedures had to be performed only on patients who had certain indications and according to criteria described in surgical literature. The proper surgical equipment and well experienced surgical team were the other important conditions for good outcome.

[Modified method of Sugiura-Futagawa for surgical treatment in patients with portal hypertension and esophageal varices]. / Modifitsiran metod na Sugiura-Futagawa za khirurgichno lechenie na patsienti s portalna khipertoniia i ezofagealni varitsi.

BACKGROUND: The esophageal transection and devascularization (Sugiura-Futagawa's operation) is the most frequently used ablative procedure in Japan for the treatment of patients with portal hypertension (PH) and esophageal varices (EV). Recently many authors, who are followers of this method, try to find an alternative one, aiming to shorten the skin-to-skin time and achieve better early and late results. AIM: To study the postoperative results of our modification of the original Sugiura-Futagawa's method and to conclude whether it is good and reliable or not. MATERIAL AND METHODS: From Jan. 1988 till Apr. 2001 we operated 25 patients with liver cirrhosis, PH and previous hemorrhage from EV, of whom 12 were male (48%) and 13--female (52%). Age of the patients--26-67 years. The ethiology of cirrhosis was alcoholic in 8 cases (32%) and post viral hepatitis--in 17 cases (68%). All our patients belonged to Child-Pugh's group A. The operative technique of our modification is described--transabdominal esophageal devascularisation, deconnection and reanastomosis. RESULTS: The early postoperative mortality rate after our modification of the Sugiura-Futagawa's method was 12% (in 3 cases). Death cause--fulminant hepatic failure with hepato-renal syndrome (in all three cases). The mortality rate was also 12% but no one of the complications was life threatening or an indication for reoperation. The 5-year survival rate accounted 78%, recurrent esophageal bleeding--7.14% and late hepatal encephalopathy--also 7.14% of the followed patients. DISCUSSION: The surgical treatment is of main importance for better survival in cases of PH and previously bled EV. A comparison between the results of other authors and our results is made. CONCLUSION: The proposed by us transabdominal esophageal devascularisation, deconnection and reanastomosis as a modification of the Sugiura-Futagawa's procedure is easy fro the technical point of view and leads to good results.

[Mesenteric-inferior-renal shunt--alternative of proximal and distal spleen-renal shunt for surgical treatment of portal hypertension]. / Mezenteriko-inferior-renalen shunt--alternativa na proksimalniia i distalniia spleno-renalen shunt za khirurgichno lechenie na portalna khipertoniia.

Surgical operations are important for the prevention of recurrent bleeding and better survival rates in patients with portal hypertension and previous haemorrhage from esophageal varices, stopped by conservative treatment. Spleno-renal shunts are among the most frequently used procedures in these cases. Sometimes the proximal spleno-renal shutting operation of Linton or the distal one of Warren may be impossible from the technical point of view due to anomalies or varieties of the lienal vein. This makes it necessary to look for an alternative decision. This case report is about a 33-year old man indicated for surgical treatment because of portal hypertension, caused by prehepatic portal vein obstruction and esophageal varices with previous bleeding. Performing Linton's or Warren's procedure was not the proper decision. That's why we made a shunt between the inferior mesenteric vein and the left renal vein. The surgical technique and the postoperative results are described and discussed.

[Carcinoma of the stomach - our experience with surgical treatment]. / Kartsinom na stomakha - nashiiat opit v khirurgichnoto lechenie.

Carcinoma of the stomach is among the commonest malignancies of the gastrointestinal tract regardless of the permanent tendency of its diffusion to decrease, observed in the last 25-30 years. The readily accessible methods of diagnosing the disease contribute greatly to its early detection. However, owing to diverse causes, in over 70 per cent of cases the diagnosis is usually made as late as in the advanced III-IV stages. The latter circumstance preordains largely the unfavourable long-term results of the treatment undertaken where surgery plays a major role. It is the purpose of this study to analyze the surgical strategy and tactics currently used in the management of gastric carcinoma. Over a 5-year period (Jan 1995 through Dec 1999), in the Chair of General and Operative Surgery of the Medical University--Sofia a total of 184 gastric carcinoma patients, including 116 men (63.1%) and 68 women (36.9%) with age ranging from 23 to 80 years, undergo operation. Diagnosing is based on past history, physical, laboratory and x-ray data, but first and foremost on evidence from FGS and histological assessment of biopsy material (carried out in all patients). With a view to precise preoperative staging of the lesion, roentgenoscopy + roentgenography of lungs, USD and CAT of the abdominal organs are also done. The following intervention are performed: gastrectomy 18 (9.8%), upper pole resection 43 (23.4%), subtotal resection of stomach 4 (2.2%), prosthetic replacement of cardia 8 (4.3%), derivations 22 (11.9%), and explorative laparotomies. Combined subtotal gastric resections of gastrectomies are necessitated in 73 patients (39.7%) because of carcinomatous infiltration of contiguous organs and/or presence of liver metastases. Morbidity involves 29 patients (15.7%) with lethality amounting to 16 (8.7%). The long-term postoperative results are discussed under a separate heading. Operative treatment of gastric carcinoma patients is the only chance of survival. The scope of indication for more aggressive surgical interventions, including combined resections and gastrectomies, are broadened leading in turn to a considerable reduction of the proportion of explorative laparotomies.

[Surgical treatment of insulinomas with observations on six cases in one year]. / Operativno lechenie na insulinomite s nablyudenie v'rkhu shest klinichnim sluchaya za edina godina.

Insulinomas are among the endocrine pancreatic tumors most commonly met with. Regardless of their small proportion compared to other tumors of the digestive system, they give rise to pressing surgical problems on account of a number of reasons, namely: 1) early clinical diagnosis and undertaking opportune operative management in those presenting benign neoplasms, even in oligosymptomatic cases, 2) exact topical preoperative diagnosis using echography, CAT, MRI, angiography and the like; 3) intraoperative identification of the tumor/tumors in the event of multiple involvement, and choice of the most adequate operative approach, 4) intra- and postoperative monitoring of the blood sugar levels and appropriate insulin therapy prescription. Over the period Jan/Oct 1997, six patients presenting clinical, laboratory and instrumental evidence of insulinomas are subjected to operation in Department of General and Operative Surgery of the Medical University-Sofia. The basic principles with a reference to preoperative topical diagnosis and surgical tactics adopted, as well as postoperative care and monitoring of hyperglycemia developing as the result of surgery, are thoroughly discussed. Good immediate and long-term postoperative results are recorded in all six patients.