[Changing susceptibility patterns of surgical site infection pathogens after the introduction of modern perioperative chemotherapy in the emergency surgery clinic]. / Promeni v chuvstvitelnostta na prichinitelite na raneva infektsiia sled vuvezhdaneto na suvremenna perioperativna khimioprofilaktika v klinikata po speshna khirurgiia.

993 surgical site infection aerobic pathogens are isolated over a six-year period (I.1994-I.2000) by the Microbiology Laboratory at University Hospital "Tzaritza Joana". 224 (22.6%) of them are isolated from patients undergoing abdominal surgery in the Emergency Surgery Clinic. The period covers 3 years before the introduction of current single-dose perioperative prophylaxis (i.e. under the conditions of long-term one) as well as the next 3 years following its introduction in the Emergency Surgery Clinic. The changes of pathogens susceptibility patterns to single-dose drug schemes in both hospital elective abdominal surgery and emergency surgery clinics are followed during the whole period. Our microbial susceptibility data support the ecological expedience of single-dose approach categorically.

[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.

[Volvulus of the small intestine]. / Volvulus na tunkoto chervo.

Volvulus of the small intestine is a condition of bowel obstruction due to knotting and twisting of the small intestine. Two types of volvulus are described: 1) primary small intestinal volvulus where no predisposing factors exist, and 2) secondary volvulus where congenital or acquired conditions promote twisting of the small intestine. Over a 5-year period, 18 patients (eleven men and seven women) presenting volvulus of the small intestine are operated in the Emergency Surgery Clinic of the University Hospital "Queen Giovanna", representing 8.7 per cent of the total of 206 cases of small intestinal mechanical ileus (incarcerated herniations involving the small intestine are not included in the series). Primary volvulus is found in one patient. In those presenting secondary volvulus adhesions are the commonest underlying cause of small intestinal rotation--13 cases, next ranking primary tumor of the small intestine--one case, Meckel's diverticulum--one, carcinosis of peritoneum--one, and one patient with small intestine volvulation around colostomy. The most frequently encountered symptoms and laboratory examinations performed are analyzed. Intestinal necrosis is established in four instances (22 per cent). One patient dies of peritonitis and polyorganic insufficiency. Volvulus of the small intestine should be mandatorily considered in patients presenting mechanical ileus of the small intestine. Early operative intervention is a therapeutic approach contributing to preclude intestinal necrosis.

[Current antibiotic prophylaxis in colorectal surgery]. / Suvremenna antibiotichna profilaktika v kolorektalnata khirurgiia.

Over a one-year period (November 1996 to November 1997), in the Emergency Surgery Clinic perioperative parenteral antibiotic prophylaxis during colorectal operations is performed in a series of 32 patients, admitted on an emergency and deferred urgency basis, or for routine operative treatment. Of them 30 present malignant processes involving colon and rectum, and two--inflammatory diseases. All patients receive single i.v. injections with Cephalothin/Cefazolin at dose 2.0 g and Metronidazole 0.5 g immediately after anesthesia induction. In nine cases additional early treatment is necessitated--within 24 hours after the operative intervention--by administration of the same drug combination 4 times at 6-hour intervals, and in another two prophylaxis is substituted for continuous 5-day treatment using the same therapeutic scheme. In 30 patients the postoperative period runs a course free of noteworthy complications. In two instances there is evidence of operative wound suppuration, and in further two--urinary tract infection development unrelated to the antibiotic prophylaxis applied. The specific features characterizing the application of antibiotic prophylaxis during colorectal surgery are discussed, and appropriate drug therapy schemes are recommended, consistent with worldwide and Bulgarian experience along this line, as well as with the concrete hospital and economical conditions in this country. Special emphasis is laid on two aspects: optimization of the timing of antibiotic agent/agents injection, and reaching peak serum and tissue bactericidal concentrations in the immediate vicinity of the surgical incision; optimization of the duration of antibiotic prophylaxis on the ground of well established indications for the application of antibiotic prophylaxis in colorectal surgery in compliance with the dynamic patterns of intra- and postoperative septic risk. The modest number of patients subjected to updated parenteral perioperative antibiotic prophylaxis does not warrant a definitive interpretation of the data from the comparative clinical and pharmaco-economical analyses performed. Nevertheless, the preliminary results point to the economical expedience of the therapeutic approach suggested.

[Aggressive muscular-aponeurotic fibromatosis. Its clinical picture and morphological study]. / Agresivna muskulno-aponevrotichna fibromatoza. Klinika, morfologichno prouchvane.

The authors report 24 cases with aggressive muscle-aponeurotic fibromatosis for the period 1985-1990. Eleven cases with proved fibrosarcoma have been studied as well. From the total 35 cases the authors have observed 5 cases with localization on the front abdominal wall in women, and the remaining cases are as follows: 9 patients with thoracic girdle (c. membri superioris); 9 patients--in the head area; 5--in the chest area; 12--in the limbs; 2--in the lumbar area.

[Primary malignant non-Hodgkin's lymphoma of the large intestine]. / Purvichen malignen nekhodzhkinov limfom na debeloto chervo.

A case is reported of primary malignant non-Hodgkin's lymphoma of the colon of a 85-year-old woman. The clinical manifestations and the X-ray pattern were those of cancer. The diagnosis was established on post-mortem examination. Histologically this was a centroblastic-centrocytic lymphoma of Brill-Symmers with low-grade malignancy. The clinical, diagnostic, prognostic and therapeutic problems in malignant non-Hodgkin's lymphomas of the colon are discussed.

[Intra-arterial chemotherapy in the treatment of liver metastases from colorectal carcinoma]. / Intraarterialnata khimioterapiia v lechenieto na chernodrobnite metastazi ot kolorektalen kartsinom.

After a brief review of the literature the authors analyse the different invasive methods for treatment of liver metastases, rendering preference on intraarterial chemotherapy (IACT). The indications and contraindications for IACT and the possible complications of this approach are determined. The drugs for IACT, the types of implantable devices and the techniques for their application are shown. Criteria for assessment of the effect of treatment are determined. Experience is recorder with 3 patients with anterior resection of rectum and nonresectable liver metastases. The result was failure in 1 patient and very good in the other two.

[Our experience in treating rectovaginal fistulae]. / Nashiiat opit v lechenieto na rektovaginalnite fistuli.

Twenty six cases of acquired rectovaginal fistulas, operated during the period 1982-1989 are reported. The intervention in 18 patients was modified Gabriel's operation, in four patients combined with the modified method of sphincterolevatorplasty and in 4 patients--preternatural anus. Inferences are made that the results of the authors' approach to the treatment of rectovaginal fistulas are encouraging, despite the small number of cases (26 patients). With good technique and fulfillment the operative treatment is reliable.