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This paper discuss some concern and challenges regards the Bulgarian- Greec transborder cooperation with respect the protection, surveillance and control of some endemic for this transborder region diseases like: Q-fever, Brucellosis, Lyme disease, Crimean-Congo hemorrhagic fever and Marseilles fever. The study examines transborder activities, including a background for the infection diseases state for the period 2004-2007, the problems of training and equipment of the specialists for sampling and identification of these diseases, development of strategy and conception for control of spreading of the infectious agents in 4 bulgarian regions / Blagoevgrad, Haskovo, Smoljan and Kardjeli/ and in the corresponding regions in Greece - Seres, Drama, Ksanti and Evro. Additionally, there is presented the role of local governmental representatives to manage these transnational border issues. [ABSTRACT FROM AUTHOR]

(1) Background: We aimed to analyze currently available studies with intraoperative radiotherapy (IORT) as a choice of treatment where the Xoft Axxent ® electronic brachytherapy (eBx) system was used as a single-dose irradiation and an exclusive radiotherapy approach at the time of surgery in patients with early breast cancer (EBC). We also compared the results of the systematic review to the Bulgarian experience. (2) Methods and Materials: We performed a systematic review of the studies published before February 2021, which investigate the application of a single-fraction 20 Gy radiation treatment, delivered at the time of lumpectomy in EBC patients with the Xoft Axxent ® eBx System. A systematic search in PubMed, Scopus, and ScienceDirect was performed. The results are reported following the PRISMA guidelines. The criteria on patients' selection for IORT (the additional need for EBRT), cosmetic outcomes, and recurrence rate from the eligible studies are compared to the treatment results in Bulgarian patients. (3) Results: We searched through 1032 results to find 17 eligible studies. There are no published outcomes from randomized trials. When reported, the cosmetic outcomes in most of the studies are defined as excellent. The observed recurrence rate is low (1-5.8%). Still, the number of patients additionally referred to postoperative external breast radiotherapy (EBRT) is up to 31%. Amongst the 20 patients treated in Bulgaria, the cosmetic outcomes are also evaluated as excellent, five of which (25%) are referred for EBRT. Within median follow-up of 39 months, there was one local and one distal recurrence. (4) Conclusions: Current evidence demonstrates the Xoft Axxent ® eBx system as a safe and feasible technique for IORT delivery in EBC patients. There are no randomized controlled trials conducted at this time point to prove its long-term effectiveness. Better patient selection and a reimbursement strategy have to be proposed to extend the application of this technique in Bulgaria.

In 2012 there were nearly 1 million new gastric cancer cases (952,000 cases or 6.8% of all cancer cases). That has put the gastric cancer on 5th place in frequency, and on 3th placeas leading cause of death in both sexes in the world--723,000 fatalities or 8.8% of all. According to the data of the World Health Organization, in 2005 Bulgaria was on 23rd place in absolute number of gastric cancer deaths among the men and on 25th place among the women. In 2011, we were on 11th place in absolute number of gastric cancer deaths among the men and on 12th place among the women. According to NCCN (National Comprehensive Cancer Network) there are 2 basic types of surgical interventions that are used for radical gastric cancer treatment- total and subtotal gastrectomy. The scientific society however is still divided on the matter of the volume of lymph dissection. The gastrectomy with D2 lymph dissection is the standard treatment for resectable gastric carcinoma in Asia. In the Western countries, the D2 lymph dissection is considered an advisable, but not mandatory procedure. Despite that, there is a rule that the removal of more than 15 lymph nodes is in favor of the NCCN. Nowadays in Japan the comparative studies between D1 and D2 gastrectomy are considered unethical.

Purpose: Tumors occurring in the retrorectal space are heterogeneous and uncommon. The utility of newer imaging techniques has not been extensively described, and operative approach is variable. This study examined the diagnosis, treatment, and outcome ofretrorectal tumors at a tertiary referral center., Methods: Patients with primary, extramucosal neoplasms occurring in the retrorectal space were identified using a retropectively maintained, procedural database of all adult colorectal surgical patients (1995-2009). Exclusion criteria included inflammatory processes, locally advanced colorectal cancer, and metastatic malignancy. Medical records, radiology, and pathology reports were reviewed retrospectively., Results: Thirty-eight patients with retrorectal tumors were treated. Malignant tumors comprised 21 percent. Older age, male gender, and pain were predictive of malignancy (P < 0.05). All benign tumors were resected with normal histologic margins and none recurred. Nine patients with malignancy had recurrence/recrudescence of their disease., Conclusions: Retrorectal tumors remain a diagnostic and therapeutic challenge. Pain, male gender, and advanced age increase the likelihood of malignancy. Various imaging modalities are useful for planning resection but cannot establish a definitive diagnosis. Whereas benign retrorectal tumors can be completely resected, curative resection of malignant retrorectal tumors remains difficult.

Objectives: estimating the prevalence of colonic diverticulosis and its complications studied at the clinic for 10-years period as well as the approaches for its operative treatment and analysis of the subsequent results. CASES AND APPROACHES: During the period 1998-2008 56 patients were hospitalized (31 women and 25 men) at the Surgical department of the University hospital "Alexandrovska". They had different forms of colonic diverticulosis. The average age of the patients was 66.7. The retrospective analysis divides the patients into three clinical groups: 1st group--peritonitis and pericolic abscess caused by diverticulosis--present in 49 patients. 2nd group--chronic non-specific inflammatory infiltrate and fistula--present in 5 patients. 3rd group--severe haemorrhage and anaemic syndrome--present in 2 patients, Results: Mortality-rate is 12.5% (7 patients). 10 patients with complications were registered--5 with suppuration of the surgical wound and 5 with pneumonia and pleural effusion., Conclusion: Colonic diverticulosis is a disease of great surgical interest because of its complicated forms requiring conventional or surgical treatment. Various forms of peritonitis which are part of the emergency surgical abdomen domain are relatively frequent complication of the gastrointestinal (in particular of the colon) diverticulosis. They are difficult to diagnose in the pre-operative period and its not easy to take a decision about the particular operative approach. All that is related with the relatively high morbidity and mortality.

A hernia is a protrusion of a tissue, structure or part of a organ through the muscular tissue or the membrane by which it is normally contained. Most frequently hernial deffect is seen in anterior abdominal wall. Usually contents of hernial sac are abdominal organs or portion of organs. Hernia is classified according to the operating methods combining with type and grading of hernia. Recent surgical treatment of hernia can be divided in to 3 major groups: 1) Hernioplasty with double breasting techniques ( Bassini, McVay, Schouldice, Halsted). 2) Hernioplasty using tension free techniques (Lichtenstein, Gilbert-Rutkow). 3) Laparoscopic hernioplasty. One day surgery is a diagnostic and operative procedure in hospitalized patients in a single day, without night stay in hospital.

From 1987 till 1997 110 patients with stage-I ovarian malignant tumors were treated and follow-up at the Department of Gynaecological Oncology, National Oncological Center. Papillifery-adenocarcinoma were in 40 cases, serous carcinoma were in 26 cases, mucinous carcinoma were in 15 cases, malignant granulosa cell tumor were in 14 cases, endometrioid carcinoma were in 6 cases, dysgerminoma were in 6 cases, Teilum's tumour were in 2 cases, and 1 case of ovary sarcoma were detected. Radical operated on the first operation were 69 patients (62.8%), and in 37 cases (33.6%) second operation for radicality were performed. In 4 cases only adnexectomy were done. In all cases post operative adjuvant chemotherapy were used. The patients were follow-up by tumour markers, sonography and CT. Follow-up period is from 5 months till 11 years. Alive were 80 patients (73%), and 30 patients (27%) were died. The patients with stage Ic and those nonradical operated in the first operation have worst prognosis then patients with stage Ia and stage Ib. The patients with ovarian tumours must be operated only in the hospitals with possibility of urgent hystological diagnosis for better prognosis in the cases of stage-I malignant ovarian tumours.