[Tactics and operative procedures in the management of complicated forms of malignant tumors of the left colon and rectum on emergency conditions]. / Taktika i operativni metodi pri lechenieto na uslozhnenite formi na malignenite tumori na leviia kolon i rektuma v usloviiata na speshnost.

Over the period 1996-2001, a total of 130 patients with complicated cancer of the left colon and 164 patients with complicated cancer of the rectum are subjected to treatment in the Clinic of Emergency Surgery at University Hospital "Queen Joanna", Sofia. Obturation is the commonest form of complication--136 patients (46.2%), followed by perforation either within the tumor or diastatic noted in 21 cases (7.1%), paratumor abscesses and infiltrates in 31 patients (10.5%) and rectohaemorrhage in 12 patients (4.0%). The optimal surgical approach to complicated forms of colorectal cancer of the left colon and rectum remains controversial especially when the patients underwent emergency surgery. Recently there has been a trend towards resection and anastomosis in selected patients. In each patient it's mandatory to make a precise and individual choice of the extend of the operative intervention, consistent with the patient's general condition and contributing to eliminate the life-endangering underlying cause. It must be realized by means of one-stage surgery when it's possible. Authors represent their personal experience with resolve of these actual problems.

[Surgical treatment of complicated gastrointestinal forms of non-Hodgkin lymphomas]. / Khirurgichno lechenie na uslozhnenite gastrointestinalni lokalizatsii na non-Hodgkin limfom.

Authors represent their experience in surgical treatment of gastrointestinal forms of No-Hodgkin's lymphomas (NHL) combined with adjuvant therapy. We also represent an Ann Arbor Staging System and an Updated Kiel Classification. From 1991 to 2001 we analyzed 39 patients with different localization of gastro-intestinal NHL's lymphomas. In this aspect more common are stomach's lymphomas--27 patients (71%); small bowel's lymphomas--3 patients (8%); more uncommon are the localizations in colon--3 patients (8%), predominantly in caecum and right colon; rectum--3 patients (5%). Add to thus we described one mechanical icterus caused lymphoma, one multi-lobular spleen lymphoma and one case of anterior abdominal wall lymphoma. All patients underwent surgery. Eight of them were operated as an emergency cases. Operative treatment of NHL isn't radical but in combination with adjuvant therapy can be life saving event in complicated forms.

[Colorectal carcinoma and molecular genetics]. / Kolorektalen rak i molekuliarna genetika.

In the last few years, problems relating to genetic determination of colorectal carcinoma are comprehensively discussed by a number of authors. The new elaborations concerning the familial polypoid and carcinoid syndromes discovered, as well as molecular researches along this line answer a great number of questions posed in connection with substantiating the old idea about many-staged cancerigenesis. As much as 94 per cent of colorectal carcinoma cases are assigned to the sporadic cancer diagnosis category. Familial polyposis accounts for 1 per cent of all neoplasms of the colon, while the remainder 5 per cent make part of diverse familial carcinoid syndromes. Most of the data on genetic etiology of colorectal carcinoma so far elucidated are presented in a summed up fashion.

[Tactics and operative methods in treating complicated colorectal cancer]. / Taktika i operativni metodi za lechenie na uslozhneniia kolo-rektalen rak.

Over the period 1993-1998, a total of 385 patients with complicated colorectal cancer are subjected to treatment in the clinic of emergency surgery--University Hospital "Queen Giovanna", Sofia. Obturation is the commonest form of complication--43.8 per cent, perforation within the tumor or diastasis noted in 27 cases (7.01%), paratumor abscesses and infiltrates--in 8.3 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.

[Large-intestine perforations caused by primary colorectal cancer]. / Debelochrevni perforatsii, predizvikani pri purvichen kolo-rektalen rak.

Twenty-seven cases of perforation, produced by primary colorectal carcinoma over the period 1993-1998, are described. The underlying causes of colorectal carcinoma complication and types of perforations observed are discussed. This is a report on personal experience with the therapeutic approach and operative management of this severest complication of colorectal carcinoma.

[The pathomorphology of complicated colorectal cancer and the stages in the development of the tumor process]. / Patomorfologiia na uslozhneniia kolo-rektalen rak i stadii na razvitie na tumorniia protses.

A comprehensive pathomorphological assessment is done in 385 patients presenting complicated colorectal carcinoma, covering the period 1990 through 1995. The patients are distributed in 4 groups according to stage, with those in stage III being the most numerous--141 cases. The growth pattern of the neoplasm is as follows: exophytic growth--110 cases, ulcerous growth--57, cup-like growth--13, and endophytic growth--205 cases. On establishing metastatic lymph nodes within I and II lymph collectors, prophylactic postoperative chemo- and immunotherapy are undertaken. In case of lymph nodes present in III lymph collector, the operation is taken to be relatively radical, and for that reason chemo- and immunotherapy assume a therapeutic character.

[Combined and extended radical operations in colorectal carcinoma patients]. / Kombinirani i razshireni radikalni operativni interventsii pri bolni s kolo-rektalen rak.

This is a report on radical operative interventions performed in 273/385 patients presenting complicated colorectal carcinoma, covering the period 1993 through 1998. Fifty-four patients are subjected to combined and extended operations, distributed as follows: 31 combined and 23 extended. In fifteen patients with abdomino-perineal extirpation the combined interventions include: hysterectomy (6), ovariectomy (8), resection of vagina (7), prostate gland resection (3) and bladder resection (2). In case of resection of rectum after Hartmann, combined intervention is done in five patients--small intestine resection, ovariectomy, appendectomy and cyst extirpation from pelvis minor, respectively. Postoperative lethality amounts to 12.9 per cent, or 7/54 patients with complicated colorectal carcinoma undergoing combined and extended surgical interventions.

[Primary colorectal carcinoma as an underlying cause of obturation of the ileum]. / Obturatsionen debelochreven ileus, predizvikan ot p'rvichen kolo-rektalen rak.

This is a report on 169 patients presenting colorectal carcinoma with complication assuming the form of occlusive ileus, observed over the period 1993 through 1998. Obturation is the commonest complication of colonic carcinoma (48.9%) with the left colon being more often involved (58.3%), recorded in a total of 108 patients. During the same period of time, occlusive ileus against the background of carcinoma of the rectum is diagnosed in 61 cases, representing 37 per cent of complicated forms of this malignant neoplasm. The scope of operative management and the procedure used are largely determined by the location of primary malignancy. The timing of undertaking one or another operative intervention depends on the efficacy of preoperative preparation, degree of occlusive ileus progress, patient's age, concomitant diseases and the like. Failing to comply with or overlooking some of the aforementioned factors invariably exerts an unfavourable effect on the final outcome of treatment. In each patient presenting colorectal-carcinoma-induced occlusive ileus it is mandatory to precisely specify the scope of surgery, consistent with the patient's general condition, and eliminate the underlying cause jeopardizing his life.