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A review of the literature is made on the complicated course of infectious and parasitic diseases, in which acute surgical abdomen syndrome develops. Surgical treatment of complicated infectious and parasitic diseases is a complex endeavour both from surgical and epidemiologic aspect. The high mortality rate after operations in complicated forms is associated with tactical errors in the surgical treatment and erroneously estimated extent of the surgical intervention.

Results of the use of abdominal intraoperative echography are reported for the first time in this country. The diagnostic precision, the scanning technique and the problems encountered in examining 56 patients are discussed. The high value of the method in small hepatic tumors, hepatic cysts and abscesses, common bile duct calculosis and pancreas cancer is pointed out. In operative interventions on gastrointestinal neoplasms intraoperative echography may be used for continuing surgical palpation into the butt. To master the method and introduce it as a routine method in clinical practice it is necessary, to use modern equipment, to be skilled in scanning technique and to have thorough knowledge on the characteristics of the intraoperative images of the different pathologic processes.

In a survey of the literature the authors discuss the problem of double-barreled colostomy closure, which a remains controversial. The high percentage of postoperative complications--up to 50 per cent and mortality up to 2.1 per cent are responsible for nondetermination of the method of choice, depending on the type of colostomy, of the colostomy complications and the absence of indications for choice of the time of colostomy closure.

Particular attention is called to the localization and metastasizing of the tumor in different organs and systems of the body of males and females. To this end, a rather ample postmortem case material was used. Included in the study were 25,589 autopsies performed over a period of 25 years (1963-1987). Pancreas cancer was detected in 419 autopsies--274 males (65.4 per cent) and 145 females (34.6 per cent). The neoplastic process was analyzed by sex in two directions: metastasizing in near and remote organs and study of the connection between cancer localization in the pancreas and metastasizing in the body. Difficulties are pointed out, encountered with cancers in advanced biological development, when metastases in the gall bladder from primary cancer of the pancreas and from primary cancer of the bile ducts are to be differentiated. It follows from this analysis that metastases of pancreas cancer were most frequent in the regional lymph nodes, with metastases in the liver and lungs ranking next in both sexes. Metastases in other organs were relatively seldom encountered.

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.

A case is reported of acquired immunodeficiency, in whom operative intervention was performed. A series of problems of surgical and deontologic aspect are raised, which ought to be solved without inducing mental trauma to the patients. Paralleling this, measures should be taken, to reduce to a minimum the risk of nosocomial infection to the medical staff.

Eighty-three patients with surgical abdominal pathology were included in the study. On the isotopic nephrogram they all had bilateral symmetric and analogous pathologic changes with varying degree of severity. The most common cause of renal function changes in patients with abdominal pathology was the reduced intravascular volume or vascular capacity changes, registered on the isotopic nephrogram with characteristic symmetrical pathologic curves. The sharp renal perfusion decrease, leading to decrease of glomerular filtration and diminution of diuresis explains the bilateral changes in the isotopic nephrogram which most frequently resemble obturation. The curves returned to normal 1 to 2 weeks after the physiologic state of the patients was stabilized, indicating extrarenal origin of the registered changes in the isotopic nephrogram. The latter should carefully be interpreted, in view of the possible influence of it of extrarenal factors.

A study of ample postmortem case material of 25589 autopsies for a period of 25 years (1963-1987) revealed great diversity of the histologic forms of pancreas cancer both in males and in females, associated with numerous local complications (infiltration in adjacent organs). The major number of cases--144 (34.4 per cent of the total number) had histologic characteristics of adenocarcinoma: 88 cases in males (32.1 per cent) and 56 in females (38.6 per cent). Second in incidence--109 cases (26 per cent of the total number) had histologic characteristics of adenoscirrhous cancer--77 in males (28.1 per cent) and 32 in females (22.1 per cent). This is in keeping with the concept that adenocarcinoma is the most common from of pancreas cancer. The next most common forms are adenocarcinoma combined with nondifferentiated cancer, gelatinous carcinoma, adenoscirrhous with nondifferentiated scirrhous carcinoma, etc. An interesting fact is that the general trend of predominance of carcinoma of almost all histologic forms in males keeps on being valid. It is logical to expect that adenocarcinoma will keep on being the most common histologic form of pancreas cancer in the future.

The literature on the problem of enteral insufficiency is reviewed. Secondary enteral insufficiency is of interest both to clinicians and to physiologists and pathophysiologists, who might join their efforts for studying the fine mechanisms of the intestinal functions and refine the methods of treatment of enteral insufficiency.

The literature on the current concepts of the immunologic processes underlying the appearance and development of gastroduodenal ulcer is reviewed. The immunopathogenesis of the disease is presented and the role of the immunocompetent tissues of the gastrointestinal tract in this pathology is outlined.

Under observation there were 26 men and 15 women with villous tumors of the colon. Radical operations were performed on 26 patients. Two of them died in the postoperative period. Eighteen patients survived for more than 5 years.