[Polyposis of the colon and cancer]. / Polipoza na debeloto chervo i rak.

Polyposis of the colon is a colon cancer predisposition syndrome. Familial adenomatous polyposis (FAP) accounts for 1% of the cases of inherited colorectal cancer (CRC). The National Register of inherited CRC and polyposis of the intestines keeps track of 18 patients from 14 families with FAP. Eight of them have been operated of CRC, on 6 patients preventive colectomy with ileorectal anastomosis has been done and four patients refused surgery. Colectomy has been done due to the malignant development also on a female patient with difused juvenile polyposis with adenomatosis. Of three patients under surveillance with the Peutz-Jeghers syndrome, surgery has been done on one female patient with ileus and bleeding large polyps.

[Continence of anorectal sphincter complex in the early postoperative period after direct colo-anal anastomoses with colo-colic J pouch]. / Kontinentnost na anorektalniia sfinkteren kompleks v ranniia sledoperativen period sled direktni koloanalni anastomozi i koloanalni anastomozi s kolokolichen J pouch.

UNLABELLED: According to up-to-date concepts for local spread of a rectal cancer it is possible to perform a radical rectal resection with a restorative anastomosis inspite of the fact that the tumor is located in the middle or the distal third of the rectum. Usually a total resection of the rectum and coloanal anstomosis have to be performed. There are two ways to restore the continuity of the gut: a straight coloanal anstomosis or J pouch anastomosis. 22 patients with rectal cancer localized between 4 and 9 cm from the anal verge, were operated and restorative anastomoses were performed. The first 18 patients were with a straight coloanal anastomosis. In the last 4 cases coloanal anastomoses were done between the anus and colocolic 7 cm J pouch. During the first month there were 6 patients with total and 9 with partial incontinence in the group with straight coloanal anastomosis. Transrectal sonography confirmed contractility of the puborectal muscle and sphinctermanometry showed lower resting tone and squeeze pressure in cases with incotinence. No incontinence was observed in the group with J pouch and the shinctermanometry data were the same as these of healthy controls. CONCLUSION: The rectal ampula has reservoir function and its loss after total resection of the rectum is the reason for frequent bowel movements, urgency and leakage. Reconstruction with a colonic J pouch is associated with better bowel function compared to the straight coloanal anastomosis.

[Anorectal functional tests--essence and value]. / Anorektalni funktsionalni testove--sushtnost i stoinost.

Anorectal disturbances are one of the most frequent functional bowel disorders. A lot of motor- and sensor anorectal tests are available. At the same time in Bulgaria anorectal disorders are unknown for the most of the gastroenterologists and surgeons, and that's why they are misdiagnosed and not treated correct. The aim of our paper is to summarize the experience with these techniques in patients with anorectal disorders. We are giving the definition of fecal incontinence, constipation, levator ani syndrome and proctalgia fugas. We revue some aspects of anatomy and physiology of the anorectum. We introduce all anorectal functional tests, the place of the tests in diagnostic algorithm, and the real value of each single test to conform diagnosis of common syndromes.

[Endoluminal echography in rectal cancer--preoperative staging and postoperative control]. / Endolumenna exografiia pri rak na rektuma -- predoperativno stadiirane i sledoperativen kontrol.

The aim of this study is to determine the diagnostic potential of endoluminal echography and the pitfalls sources in the preoperative staging and postoperative follow-up in patients with rectal cancer. 245 patients with rectal carcinoma are evaluated during 10 years period (Jan. 1993-Jan. 2002 years). 96 patients are monitored in the early and late postoperative periods for the early detection of local recurrence as well as for the anorectal physiology assessment after low anterior rectal resection or coloanal anastomosis. Lineal transducer UST-657-5MHz (Aloka 620) and 10MHz miniprobe are applied. The accuracy for T-staging is 84% and for N-staging is 82%. The local recurrence is detected in 21 patients, on average 12.6 months after curative surgery. The local recurrence is more often in cases of lymph node involvement as well as if some specific echographic features for extramural vascular invasion are present. Endoluminal echography provides individual therapeutic management and postoperative control in patients with rectal cancer.

Topical mononitrate treatment in patients with anal fissure.

AIM: To assess the efficacy and patient compliance of topical mononitrate hydrogel for the treatment of anal fissure. MATERIALS AND METHODS: Nineteen patients with symptomatic chronic anal fissures were randomly allocated to receive either active (10 patients) or placebo (nine patients) gel treatment. Rectal administration of hydrogel containing 0.2% isosorbide-5-mononitrate was prescribed. Patients were instructed on its application to the anal canal twice daily for 3 weeks. A questionnaire was used to determine patient compliance with therapy. Anal manometry was performed before and after therapy. RESULTS: At the end of therapy, the fissures were healed in 80% of actively treated patients compared with 22% of the control group. There was a mean reduction of 28% in mean resting anal pressure. Two actively treated patients (20%) suffered from mild headache relieved with oral analgesics and menthol lozenges. Faecal incontinence was not observed. There were no recurrences during at least 3 months of follow-up. CONCLUSIONS: Topical mononitrate gel therapy of anal fissures is an effective and safe approach. In this study, the few cases of headache were rapidly relieved with oral analgesia and menthol lozenges.

Endosonography for assessment of anorectal changes in patients with fecal incontinence.

Our aim was to evaluate the anorectal changes in patients with fecal incontinence by using different endoultrasound techniques. Eighteen females with fecal incontinence and 14 healthy controls (females) were examined. Rigid linear transducer and 10 MHz radial scanning miniprobe were used. Statistically significant difference was found in the mean percentage of decreasing of the anorectal angle during contraction between healthy subjects (21.4%) and incontinent patients (7.5%). The mean percentage of shortening of the puborectal muscle length during squeezing was significantly lower in patients (9.6%) than in controls (17.9%). By means of miniprobe the anal sphincter defects were clearly demonstrated. Endosonography with a radial scanning miniprobe and rigid linear transducer ensures complex morphological and functional assessment of the anorectal region.

[Congestive heart failure--some current problems]. / Zastoina surdechna nedostatuchnost--niakoi aktualni problemi.

The congestive heart failure (CHF) has become one of the most common syndromes afflicting the population. The long-term prognosis of these patients is bad. The CHF shows a tendency toward fast progressive development. The aim of our study was a retrospective investigation on CHF patients, a determination of CHF functional class by NYHA and its type, a determination of the most important diseases leading to heart decompensation and of the reasons for dead in these patients. For a 6-year period we investigated 6428 patients. 1095 (17.03%) of them were with a different degree of CFH. More of them were with II and III functional class of CHF by NYHA. In the age decade from 61 to 70 years the frequency of CHF increased significantly. The most important diseases leading to CHF syndrome were chronic ischemic disease, arterial hypertension, COPD with chronic cor pulmonale and valve diseases. The average age of deceased CHF patients was 67.8 +/- 7.4 years. After the manifestation of the first group of symptoms the mean life duration of CHF patients was 13.2 +/- 4.1 years.

[Adult respiratory distress syndrome]. / Respiratoren distres-sindrom pri vuzrastni.

Adult respiratory distress syndrome (ARDS) represents an excessively dangerous acute respiratory failure, as result of diffuse damage of alveolocapillary membranes in stiff noncompliant lungs. ARDS is a widely disseminated syndrome caused by severe etiologic factors. ARDS usually appears within 12 to 72 hours of an identifiable clinical event and progresses through three phases: 1. exudative phase; 2. alveolar membrane damage and pulmonary surfactant systems; and 3. proliferative phase. Nearly all of the deaths occur within 30 days of the onset of the syndrome. The mortality rate varies according to the causes and the age. ARDS progresses through three clinical phases: 1. basis respiratory failure; 2. progressive respiratory failure; and 3. total respiratory failure. The therapy of ARDS is complex. It consists of: 1. background general therapy of ARDS; 2. background supportive therapy of ARDS; 3. definitive therapy to interrupt mechanisms of inflammation and pulmonary injury; 4. new pharmacologic supportive therapy.

[Macrolides: pharmacology and clinical use]. / Makrolidi: farmokologiia i klinichno prilozhenie.

Members of macrolides are Erythromycin, Oleandomycin, Spiramycin, Roxithromycin, Josamycin, Midecamycin, Clarithromycin, Azithromycin and Dirithromycin. This review present mechanism of action, pharmacokinetic, adverse drug reactions and main clinical uses of the macrolides.

[Contemporary views on the etiology and pathogenesis of atherosclerosis]. / S'vremenni v'zgledi za etiologiiata i patogenezata na ateroskelrozata.

Atherosclerosis is caused by a large range of exogenous and endogenous risk factors and does not result simply from the hypercholesterolemia and the accumulation of lipids. Atherogenesis is a dynamic multifactor and multi-stage inflammatory process, where different cells, cytokines and growth factors interacte as results of endothelial cell damage. This process is characterized by a focal subintimal deposition of lipids and lipoproteins in "foam cells" with a further development of chronic focal inflammation and expanditure of fibrosis, stenosis of the arterial lumen and development of further organ complications. The same are found in 50% of the patients, affected by atherosclerosis and are at the root of the death-rate in USA and Europe.

[Results of the long-term observation and treatment of patients with arterial hypertension]. / Rezultati ot dulgogodishno nabliudenie i lechenie na bolni ot arterialna khipertoniia.

48 patients, 40 men (mean age 57.4 years) and 8 women (mean age 56.7 years) with stable arterial pressure--II B and III stage according to A. L. Miasnikov's classification, were treated and followed up dynamically in the course of 8 years. The treatment with diuretics, beta-blockers and reserpin has led to a permanent and satisfactory regulation of arterial pressure in most of the patients. Only in 10.4% of the patients the therapeutic results were not satisfactory. In spite of the normalization of the arterial pressure the number of patients with various forms of ischemic heart disease is high--79.2%. The risk factors and their combinations play an important role for this condition (diabetes mellitus, gout, obesity, lipid metabolism changes, etc.). These data imply a new assessment of the drugs used in the treatment of arterial hypertension.

[Left heart ventricle in chronic cor pulmonale patients. Etiological, pathomorphological and organ weight measurement studies]. / Liava surdechna kamera pri bolni s khronichno belodrobno surtse. Etiologichni, patomorfologichni i teglovno-metrichni prouchvaniia.

The histories and the results of the postmortem examinations of 507 patients with chronic pulmonary heart disease were studied. In 62.6% of them left ventricular hypertrophy was found. As probable causes for this left ventricular hypertrophy are suggested: arterial hypertension, ischemic heart disease, hypoxemia, hypercapnia, heart failure, diabetes mellitus. The weight measurement correlations between the left and the right heart ventricles were studied in: "normal hearts", hearts with right ventricular, hypertrophy only, hypertrophy of both ventricles, left ventricular hypertrophy only. A correlation between the mass increase and the wall thickness of the ventricles was established. In the patients with chronic pulmonary heart disease and hypertrophy of both ventricles the mass and the wall thickness of the ventricles increase simultaneously. The possible pathogenetic mechanisms of the left ventricular involvement in patients with chronic pulmonary heart disease are discussed.

[Favorable therapeutic results in a patient with alcoholic cardiopathy]. / Blagopriiatno terapevtichno povliiavane na bolen s alkokholna kardiopatiia.

A case of a 52-year-old man with alcoholic myocardiopathy with significant enlargement of the heart and heart failure is described. After a long treatment, improvement of the pump and contractile functions of the myocardium was achieved. The case indicates that significant improvement could be achieved by a long treatment and prompt discontinuance of alcohol abuse.