[Abdominal TB. Peritonitis due to perforated intestinal TB & upper intestinal fistulas. Surgical treatment].

Nowadays tuberculosis--TB is most popular chronic infections disease in the world. The mortality is high, 3 million approximately death every year in the world. TB affects predominantly the lungs (pulmonary--90%) and exra-pulmonary) skin; bones; joints; urinary tract-UT; gastro intestinal tract-GIT; abdominal TB. There is an increase in diagnosed cases of pulmonary TB last years in Bulgaria. There are very rare cases of diagnosed abdominal TB described. We present a case operated from us in Multi Pro File Hospital Cherven Bryag. A 54 years old male patient with peritonitis due to perforated intestinal TB and upper intestinal fistulas. The patient was not aware of suffering from pulmonary TB in the past.

Reconstructive renal surgery using a water jet.

PURPOSE: We describe the successful application of a water jet to reconstructive renal surgery. MATERIALS AND METHODS: Two consecutive patients underwent reconstructive renal surgery using a waterjet apparatus for a 4.0x6.5 cm. well encapsulated tumor of the lower pole of the left kidney and a 4.5x2.5 cm. staghorn calculus of the left kidney, respectively. The water jet apparatus (Parenchimotom 01) consists of a pressure generating pump and a flexible hose connected to the hand piece, and a nozzle with a pinhole opening of 0.3 mm. RESULTS: Both patients underwent surgery through a left lumbar incision. Partial nephrectomy was performed in 1 patient and anatrophic nephrotomy for stone removal in the other. Dissection time was 25 and 12 minutes, with blood loss of 150 and 100 ml., respectively. No temporary vascular clamping or local hypothermia was necessary. Both patients were discharged home 10 days after surgery and at followup no negative sequelae were attributable to the procedure. CONCLUSIONS: The operative procedures proved easy, fast and effective. No temporary vessel clamping or hypothermia was required. Using a water jet is a novel approach that is helpful in renal surgery.

[Extensive right-sided hepatectomy for a metastatic process in patients operated on for colonic carcinoma]. / Desnostranna razshirena khepatektomiia zaradi metastatichen protses pri operirani za kartsinoim na kolona.

Proceeding from experience with a large number of liver resections performed for single or multiple metastases atypical in appearance, including left lobectomies, a description is presented of wide right-sided hemihepatectomy, done for the first time (13 May 1997) in the surgical clinic of the National Oncological Center. The intervention is undertaken because of two metastases in the liver subsequent to radical operation for carcinoma of the sigmoid colon. The single stages of the operation are likewise described. The effectiveness of application of Penchev's "Parenchymatome" (made in Bulgaria--Military Medical Academy) and "Tisomat" apparatus is evaluated. Using the latter the resection liver surface is sprayed with a bicomponent fibrin adhesive "Tisucol", obtained from the firm Immuno-AG.

Application of a new water jet apparatus in open hepatobiliary surgery: hepatic resection, cholecystectomy, common bile duct lavage.

The presently accepted technologies for hepatobiliary surgery have some limitations and disadvantages. Use of water jet dissection is rapidly spreading and its indications are continuously being widened. In 1988 we developed a new bimodular jet-cutter "Parenchimotom-01". After the experimental application on 110 dogs, the apparatus was introduced into clinical practice. Between 1992-1995 we have successfully performed 11 liver resections, 14 cholecystectomies, and 2 lavages of the common bile duct on 25 patients. Marked decrease in blood loss, operative time, rate of complications, and length of hospitalization were noted. We suggest the water jet dissection to be a sophisticated and maximally effective instrumental technology that offers numerous advantages over the other techniques so far commonly accepted in hepatobiliary surgery and which may improve the treatment and prognosis in patients with different hepatobiliary disease entities.

[2 cases of malignant insulinoma of the pancreas]. / Dva sluchaia na malignen insulinom na pankreasa.

Two cases are reported of malignant insuloma: in one of the patients the tumor was hormonally active in the other inactive. Treatment was operative. The great difficulties in establishing the diagnosis preoperatively and the complications accompanying this grave disease are pointed out. The clinical and laboratory examinations which may help to reach at the correct diagnosis are discussed.

A Bacillus subtilis regulatory gene product for genetic competence and sporulation resembles sensor protein members of the bacterial two-component signal-transduction systems.

A Bacillus subtilis gene, required for genetic competence, was identified immediately upstream from the previously characterized gene comA. The comA gene product has been found to exhibit amino acid sequence similarity to the so-called effector class of signal-transduction proteins. DNA sequencing of the new determinant, named comP, revealed that the carboxy-terminal domain of the predicted ComP protein is similar in amino acid sequence to that of several sensor members of the bacterial two-component signal-transduction systems. The predicted amino-terminal domain contains several hydrophobic segments, postulated to be membrane-spanning. In vitro-derived comP disruptions are epistatic on the expression of all late competence genes tested, including comG, comC, comD, and comE, but not on expression of the early gene comB. Although comA has its own promoter, some transcription of comA, especially later in growth, occurs via readthrough from comP sequences. A roughly twofold epistatic effect of a comP disruption was noted on the downstream comA determinant, possibly due to interruption of readthrough transcription from comP to comA. Overexpression of comA fully restored competence to a comP mutant, providing evidence that ComA acts after ComP, and consistent with a role for the latter protein in activation of the former, possibly by phosphorylation. ComP probably is involved in transmitting information concerning the nutritional status of the medium, particularly the presence of nitrogen- and carbon-containing nutrients. ComP was also shown to play a role in sporulation, at least partly interchangeable with that of SpoIIJ, another putative sensor protein.

[Electron microscopic study of the liver after experimentally resecting it and covering its surface with BAPP and BAPK]. / Elektronno-mikroskopicheskie issledovaniia pecheni posle ee rezektsii s pokrytiem poverkhnosti BAPP i BAPK v éksperimente.

An analysis of data of electron microscopic investigations of liver preparations within the terms of from 7 to 425 days after resection of the liver in which the liver wound was covered by the antimicrobial polycaproamid gauze made in Bulgaria has shown that the polymer material does not cause alterations in the liver structure and cell organelles of hepatocytes not preventing regeneration of the liver.