[Pseudocontinent colostomy - a manometric study]. / Psevdokontinenten protivoestestven anus - manometrichno prouchvane.

The intraluminal pressure in terminal segment of colon has been studied at 42 patients undergone an exterpation of rectum and taken out pseudocontinent colostomy onto a front part of the abdomen. Schmidt's pattern smooth muscle muff, modified in the Clinic Surgery and Coloproctology at MU--Varna, has been transplanted around the colon, taken out as continent colostomy. The intraluminal pressure in the terminal segment of colon has been identified with an index of resistance on the side the smooth muscle muff against the spontaneous evacuation of the colon content. The pressure has been registrated at rest and after the mechanical dillatation of muscle muff. The pressure at the check group of 20 patients with taken out continent colostomy has been investigated manometrically. The basal intraluminal pressure at the patients with a transplanted smooth muscle muff has been 30 +/- 2.9 mmHg at the end of the first postoperative month, as it has been sustained permanent (29.7 +/- 3.0 mmHg) up to the second postoperative jear (0.001). The pressure has been increased up to the mean value of 42 +/- 2.5 mmHg, as it has been sustained at this level for a period of 120 sec. The basal intraluminal pressure at the patients with transplanted smooth muscle muff has been more then four times higher in comparison with the pressure in c. sigmoideum, which has been a prerequisite for stopping of the spontaneous evacuation. A conclusion has been done that the index of resistance in the terminal segment of colon has been depended on a functional potential of the smooth muscle muff directly. The transplanted muff has been an anatomic structure manifested a functional activity in terms of isolation.

[Continent colostomy and colon irrigation]. / Protivoestestven anus i kolonirigatsii.

The authors have studied a functional activity of a continent colostomy at 20 patients, undergone an abdomeno-perineal extirpation of rectum and carried out periodic colonirrigations, during a period of 6 months. A conus type, closed irrigating system has been used. The degree of an incontinency at patients has been compared before and after the beginning of the colonirrigations. The irrigating procedures have reduced spontaneous defications at patients during a week 28 times and have improved the quality of life significantly. The application of colostomy bags has been restricted in 8 (40%) patients. An intraluminal ultrasonographic investigation has been done at 12 (60%) patients at the end of 6 month irrigating period. No changes of the ultrasonographic image of the precolostomic segment of colon has been observed.

[A modified autotransplantation method providing for continence in preternatural anus]. / Modifitsiran avtotransplantatsionen metod za obezpechavane na kontinentnost pri bolni s protivoestestven anus.

Over the period 1996 through 1998, a series of 58 patients undergo operation in the clinic of coloproctology--Medical University, Varna and in the clinic of surgery at the Naval Hospital--Varna, for continent preternatural anus formation on the anterior abdominal wall. A personal modification of Schmidt's (1978) method is used where a smooth-muscle cuff exerting pressure on the terminal segment of the large bowel, brought out as an artificial anus, is created. The operative procedure is combined with periodic colon irrigations in the postoperative period for the purpose of stimulating controlled intestinal content evacuation. The degree of continence is evaluated clinically and manometrically in all cases at termination of the first postoperative month, and in 31 of them--at the end of the second postoperative year. The early and late results are good.

[Pseudocontinent colostomy - comparative experimental study]. / Psevdokontinentni kolostomi - sravnitelno eksperimentalno prouchvane.

The possibilities of smoothmuscle sphincteroplastic have been researched experimentally at 29 mongrel dogs. Six types smoothmuscle plastics have been studied--a method of Feodorov and Odariuc, a method of Musiani, a pylor as a sphincter, an own operative method in three versions. A comparatively research upon a functional fitness of the offered plastics and Schmidt's method has been done. The level of intraluminal pressure into the precolostomy segment of colon and a functional status of the taken out colostomy have been compared. The reliable lower level of intraluminal compression has been established (p < 0.05), using longitudinal muscle as a plastic material. The intraluminal pressure into the end segment of colon has been sustained raised, permanently, due to the tonus of circular muscle in to the transplant's wall. The degree of intraluminal compression seems to be directly proportional to the volume of stretching of smoothmuscle transplant (p < 0.001). There has been done a conclusion, that the smoothmuscle plastic gives operative-technical possibilities for raising of intraluminal pressure by changing the volume of stretching of the transplant.

[Continent preternatural anus--histomorphological and functional aspects]. / Kontinenten protivoestestven anus--khistomorfologichni i funktsionalni aspekti.

Transplantation of a free smooth-muscular cuff around a terminal large-intestinal segment, brought out as preternatural anus, secures high-degree continence and controlled evacuatory rhythm of the intestinal content. The preserved structure of the muscular layers in the cuff wall and the myogenic nature of smooth muscle tone are preconditions for functional activity manifestation in conditions of denervation, isolation and even after block of neurons and intramural ganglia. Five preparations comprising the smooth muscle cuff and recipient large-intestinal segment undergo histomorphologic and electromyographic study within a year of transplantation. In a series of 31 patients with drawn out continent preternatural anus the thickness of the abdominal wall together with the smooth muscle cuff graft is echographically registered at the end of the first postoperative year. The echographically documented abdominal wall thickness is compared with the histomorphologically established values of the indicator under study. Analysis of the functional activity of the smooth-muscle-cuff transplant is also done.

[Laser therapy as a method for treating condylomata at a prepubescent age]. / Lazer-terapiiata kato metod za lechenie na kondilomi v predpubertetna vuzrast.

The Nd:YAG Laser is one of the most effective methods for treatment of acute condylomata. This method has been used at the Children Gynaecological Consulting Room at the Desk of Obstetrics and Gynaecology--University of Medicine,Varna, for two years. During this period seven girls (children) were treated (0.6%) from all the patients treated for external genital inflammation. Only one of the cases needed a second laser coagulation (by a non-contact 40 W point with a duration of the impulse of 0.5(-1). A permanent healing was achieved by the 14th day with the application of epithelializing ointment.