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Background: Abdominal compartment syndrome (ACS) manifests with increase of intra abdominal pressure (IAP) and organ dysfunction resulting in multiple organ failure. ACS presents with respiratory failure, hemodynamic changes, and impaired renal function. ACS is most often observed in critically ill patients with peritonitis, gastric dilatation, intestinal obstruction intra abdominal abscesses, abdominal trauma, and sepsis. In the absence of complex treatment mortality can reach 100%., Objective: Examine the IAP changes in the postoperative period in ICU patients with complicated abdominal surgery., Methods: Ten patients after abdominal surgery on mechanical ventilation were examined. From the existing methods for measurement of IAP we chose to determine the pressure in the bladder., Results: We observed IAP changes, hemodynamic instability, oliguria, and acid base balance impairment. In two patients IAP reached levels above 25 mmHg while the increase in the other eight patients was moderate between 8 and 17 mmHg. Two of the patients had an anastomotic leak which necessitated relaparotomy., Conclusions: IAP level above 25 mmHg is associated with impairment of the blood flow in the major abdominal vessels which can lead to respiratory, cardio circulatory, liver, and renal failure. Currently the surgical decompression is the only treatment leading to significant mortality reduction.

FAP is an autosomal dominant disorder characterized by the appearance of thousands of adenomatous polyps. FAP is associated with a deletion of chromosome 5q21 (known as the APC gene). Surgical prophylaxis in FAP consists of resection of the entire large bowel, to prevent malignant transformation. Hereditary Nonpolyposis Colorectal Cancer(HNPCC), like FAP, is an autosomal dominant disorder. In contrast to FAP, HNPCC is associated with an unusually high frequency of cancers in the proximal large bowel. If an adenoma or adenocarcinoma of the colon is identified, total abdominal colectomy with an ileorectal anastomosis is recommended.

Laparoscopic surgery approved itself as "golden standard" in treatment of cholelithiasis. However, in cases with common bile duct stones (CBDS), still there are several methods of management: 1.) Preoperative Endoscopic Retrograde Cholangio-pancreato graphy (ERCP), endoscopic papiloshpyncterothomy (EPS) and stone extraction, followed by Laparoscopic cholecystectomy (LC). 2.) LH with intraoperative common bile duct exploration and stone extraction. 3.) LH, followed by EPS and CBDS extraction. CBDS are present in about 10-15 % of patients, treated by laparoscopic cholecystectomy. In most cases choledocholithiasis is suspected. In small percentage it is unsuspected and it's found during the operation. In present days still there is no clear conclusion about treatment of CBDS. In our clinic we use a multidiscipline method - ES with stone extraction on first stage and LC on second stage. In small percentage of patients we use LC with intraoperative common bile duct exploration and stone extraction, and LH, followed by ES and CBDS extraction. Our aim is to represent a prospective study of our results.

The contemporary classification of the acute peritonitis, the etiology, the special features of the pathogenesis, the difficulties of the diagnostics with some of the kinds and the contemporary aspects of the healing tactics related to the clinical experience of the treatment of that severely and life-threatening disease are included in the present report for 10 years period. 341 laparotomies because of various kinds of peritonitis with patients aged 11-89 years old were performed at the Department of Surgery, University Hospital "Aleksandrovska" -Sofia for the period of 1996-2006. A diffusous fibrino-purulented peritonitis was founded out in most of the cases (41.6%) and the perforations constituted the most common etiologic cause. Total mortality is 25.8% (88 cases). The cause of death was not directly connected to the surgical suffering in 2.34% (8 cases). The death rate is high as expected with the groups of pregressed widespread peritonitis, the 3rd group by Mannheim peritonitis Index (MPI), the postoperative peritonitis, accompanied usually by atypical clinical features, for the elderly patients and patients with worsening the prognosis with premorbid pathology. A complex approach was applied not only for the peritonitis but also for the pathologic processes caused life-threatening complications. The applied treatment depends on the contemporary methods. The results are in accordance with those of the international experience.

Gastrointestinal stromal tumors (GIST) are specific, generally Kit (CD117) - positive, mesenchymal tumors of the gastrointestinal tract encompassing a majority of tumors previously considered gastrointestinal smooth muscle tumors. They are believed to originate from interstitial cells of Cajal or related stem cells. Diagnosis is based on histological and immunohistochemical examination, and these rare tumors are characterized by c-kit (CD117) staining. We present an analysis of clinical presentation and course, surgical management and pathological features of 11 patients with gastrointestinal stromal tumors treated in our institution from 2002 to 2007. 2 patients with malignant retroperitoneal GIST had disease progression/recurrence and died. They received adjuvant imatinib therapy. 9 patients are disease free on the 3-d year of the follow-up. Our results confirm that in stromal tumors complete surgical resection remains the mainstay of treatment in localized gastrointestinal stromal tumors. Complete removal of the tumor is often curative in localized gastrointestinal stromal tumors and is always recommended. Clinically, their behavior is difficult to predict, and mitotic count and tumor size seem to be the most effective prognostic factors. It is conceivable that treatment and prognosis of metastatic and non - resectable gastrointestinal stromal tumors, as well as the adjuvant treatment of high-risk, radically excised gastrointestinal stromal tumors will be strongly impacted by the c-kit target therapy.

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.

Ischemic colitis is the most common form of intestinal ischemia. The damage produces ulcers in the lining of the large intestine. Ischemic colitis affects primarily people who are 50 or older. The disease was first described by Boley and associates [1] as a "reversible vascular occlusion" of the colon, and Marston and colleagues [2] went on to detail the gangrenous, stricturing, and transient forms. Two mechanisms may cause bowel ischemia: The first and most common is diminished bowel perfusion due to low cardiac output often seen with in patients with cardiac disease or in prolonged shock of any etiology. The second mechanism is occlusive disease of the vascular supply of bowel due to atheroma, thrombosis, or embolism in which the collateral circulation is not adequate to maintain bowel integrity.

Subtotal thyroidectomy is a widely accepted surgical procedure for Basedow disease. The purpose of this work is to evaluate functional long-term results and determine predictive prognostic factors of postoperative thyroid function. This is a retrospective study conducted on 207 patients with Basedow disease undergoing subtotal thyroidectomy during the period 1983-2004. Predictive prognostic factors of final thyroid status were investigated and probability of hypothyroidism during the years of follow-up was obtained by the Kaplan-Meier method. Surgery controlled hyperthyroidism in 199 out of 207 patients (97%). The probability of hypo-, eu-, and hyperthyroidism at 5 years was 63%, 36%, and 2%, respectively. No statistical change in thyroid function occurred in the follow-up after 5 years. Multivariate analysis by a logistic ordinal regression analysis showed that weight of the remnant, age, and gender seemed to influence long-term thyroid function. The higher rates of euthyroidism were obtained when the remnant weight was between 6 and 8 g. No recurrence or persistence of hyperthyroidism occurred with remnant weights under 5 g. Subtotal thyroidectomy controlled hyperfunction symptoms in 97% of our patients. Cure (euthyroidism) of Basedow disease patients should be attempted by leaving a thyroid tissue remnant between 6 and 8 g. Even more significant, our results suggest that euthyroidism rates could be improved by leaving a smaller remnant in elderly women and greater remnants in young men. No need for long term medical therapy is emphasised.

To determine the level of tumor marker pyruvate kinase dimer (M2-PK) in the feces of patients with colorectal cancer and benign polyps, as well as in individuals with chronic inflammatory bowel diseases. Fecal M2-PK determination could be outlined as a highly reliable non-invasive approach to the diagnosis of colorectal carcinoma. The establishing of elevated values in patients with chronic inflammatory bowel diseases decreases the specificity of M2-PK as a tumor marker. However, this does not compromise its essential clinical significance, because the precise diagnosis in both diseases imposes an obligatory performance of colonoscopy.

Anal incontinence remains a largely hidden problem, with many patients which are long-term health and mobility problems. Anal incontinence is a symptom or sign rather than a disease, and that there are often multiple contributory factors. Anal incontinence affects both sexes and all age groups. Approximately 2% of the adult population have it on a frequent basis. Treatments include pelvic muscles training, drugs, surgery. Artificial bowel sphincters and sacral nerve stimulation (or neuromodulation) is a relatively new operative techniques for treating anal incontinence and are used in patients with an intact or repaired sphincter complex.

Adenocarcinoma of the colon is the most common visceral cancer. The incidence of multiple primary colorectal carcinoma varies from 0.6% to 7.6%. A review of 837 cases of colorectal carcinoma showed 32 cases (3.8%) of colorectal multiple primary malignant tumors and 11 cases (1.3%) of colorectal primary malignant tumor associated with extracolonic primary malignant tumor. A total of 78 tumors were involved: 24 in the sigmoid, 12 transverse colon; four in the cecum; 30 in the rectum; 3 in the ascending and 5 in descending colon; 2 each in the bladder, prostate; two each in the breast, cervix, and one each in the skin, nasopharynx, lungs. If synchronous carcinomas are located in the same anatomic region, a conventional resection should be performed. When the carcinomas are widely separated, a subtotal colectomy is the operation of choice. Survival of patients with synchronous carcinomas is not significantly different from survival of patients with same-stage solitary carcinomas.

Recently the endoscopic surgery enters widely in clinical practice. Laparoscopic surgery has gained rapid acceptance in the anaethesiological community, mainly due to its advantages to patients in postoperative period. Recognition of pathophysiological changes in hemodynamic, respiration associated with pneumoperitoneum helps to prevention of possibly fatal complication during surgery, general anaesthesia, and also during early postoperative period. The aim of present review is using our experience and available bibliographic data to introduce anaethesiologists and surgeons to recent trends of anaesthesia in laparoscopic surgery.

Hydatid surgery in Bulgaria dates back of a hundred years. Most of famous Bulgarian surgeons have worked about problem of all locations of the Echonococcus granulosus in the human organism. Their scientific achievements are covered in more of two hundred theses, publications, dissertations. The hydatid disease always was in the schedule of every scientific forums - congresses, conferences, etc. A Bulgarian scientific council has been established with a great experience and very good postoperative results. It's many innovations in diagnostics and surgical treatment, accepted all over the world. Renovations of work in this field are develop. Prophylactic measures for this severe and common disease have been undertaken.

Adrenal cavernous hemangiomas are rare non-functional tumors. This article describes the case of a patient with a cavernous adrenal hemangioma. Prior to surgery, the mass was diagnosed as an incidentaloma. It was successfully removed by means of endoscopic retroperitoneal adrenalectomy without any intraoperative, nor postoperative complications and histologycally verified as "adrenal cavernous hemangioma".

This is a report on radical operative interventions performed in 513/755 patients presenting complicated colorectal carcinoma, covering the period 2000 through 2007. One hundred and four patients are subjected to combined and extended operations, distributed as follows: 61 combined and 43 extended. In thirty three patients with abdominoperineal extirpation the combined interventions include: hysterectomy (7), ovariectomy (9), resection of vagina (8), prostate gland resection (5) and bladder resection (4). In case of resection of rectum after Hartmann, combined intervention is done in seventeen patients - small intestine resection - 7, ovariectomy - 2, appendectomy - 3 and cyst extirpation from lethality amounts to 12.9 per cent of patients with complicated colorectal carcinoma undergoing combined and extended surgical interventions.

Haemorrhage due to upper digestive tract diseases is one of the major complications and is relatively common. The cause for haemorrhage depend on the main disease and in many cases has complicated mechanism. The frequency is 100 cases over 100 000 people. There is no proven alternative to the surgical treatment. The issue with second time haemorrhage is controversial. The goal of every surgeon, when dealing with haemorrhage from upper digestive tract, especially with patient with bleeding ulcer, is surgical treatment, when conservative and endoscope treatment have failed. Every patient with bleeding stomach or duodenal ulcer should undergo FGS for Forrest haemorrhage demonstration, endoscope haemostasis and HP examination. Eradication should be applied to every HP positive patient for haemorrhage prevention.

Background: Medullary thyroid carcinoma (MTC) accounts for 5% to 10% of all thyroid malignancies. Approximately 75% of cases are sporadic. Familial forms of medullary thyroid carcinoma account for the remaining 25% of cases--MEN IIa, MEN IIb and FMTC., Methods: Retrospectively 22 cases of medullary carcinoma of thyroid gland were analysed. Total thyroidectomy with selective lymph dissection was performed in all patients., Results: 18 patients were with sporadic form of medullary thyroid carcinoma, 4--with FMTC; 21 were with primary carcinoma, 1--with recurrent carcinoma Mean age--32 years (22-59). At the follow-up control (max 10 years) there is no evidence of disease recurrence., Conclusion: Recent advances in genetic testing allow early diagnosis and treatment of familial MTC syndromes. Despite some advances in treatment, optimal management is still controversial. Total thyroidectomy with selective lymph dissection remains the choice of surgical treatment. In the familial forms medullary carcinoma is associated with well-characterized, germline mutations in the RET protooncogene. Both genetic and biochemical screening are of essential significance for early diagnosis and adequate and optimal surgical treatment.

Purpose: To determine the safety and efficacy of retroperitoneal endoscopic adrenalectomy for benign cystic adrenal lesions., Patients and Methods: 4 patients underwent retroperitoneal endoscopic adrenalectomy of benign cystic adrenal lesions at our center between March-September 2006., Results: Retroperitoneal endoscopic adrenalectomy was successfully performed in all patents, no conversion was needed. The mean operative time was 60 minutes (range 45-90 min) and no complications were observed. The average hospital stay was 2 days. Neither clinical, no US-scan recurrence was observed on the first month postoperativelly., Conclusions: Retroperitoneal endoscopic adrenalectomy is a safe and efficacious procedure that offers a favorable minimally invasive alternative for the treatment of benign cystic adrenal lesions.

Recurrence of the liver echinococcosis is established in 22,30% of the surgically treated patients. Long-term research of the capsula fibrosa is conducted with histological, immunofluorescent and biological experiment with implantation in test animals and histological research of the hepatic parenchyma for presence of protoscolekses in the capsule and beyond its limits. The Napalkov theory for this type of recurrence mechanism is not confirmed. The exact reasons for recurrence are revealed: not diagnosed during the operation smaller cysts (38.89% in the analyzed specimens); intraoperative dissemination of germ elements' incomplete sterilization of the echinococal cyst during the operation; recontamination with oncospheres. A new method for 100% sterilization of the fibrous cavity is introduced. Conclusions are made over the types of operations and the safest of them are recommend in connection with the research.

A research is conducted over the Circulating immune complexes (CIC) of the T- and B- immunity blood cell systems. Statistical significant increase of the CIC is established and decrease of the T-lymphocytes, without changes in the B-lymphocytes count. The immunosuppressive effect of the echinococcosis over the T-lymphocyte system and the increase of the activity of the B-lymphocytes, without changes in their count is demonstrated. CIC deposits in the capilar intima causes allergic immunocomplex glomerulonephritis and other systemic damages. The research proves the necessity for immunomodulating therapy in the preoperative preparation of the patient and after ehinococcectomy.

Pseudomyxoma peritonei is a rare condition consisting of mucinous ascites, most commonly arising from mucinous tumors of the appendix and occasionally from the ovary. Ronnett et al. have suggested a classification based on tumor pathology where they place all pseudomyxoma peritonei in three groups in order of decreasing prognosis: disseminated peritoneal adenomucinosis (DPAM), peritoneal mucinous carcinoma with intermediate or discordant features (PMCA) and peritoneal mucinous carcinoma (PMCA). Treatments are now standardized as a combination of cytoreductive surgery and perioperative intraperitoneal chemotherapy.

In 1923 the French surgeon Henri Hartmann described an operation for resection of a cancer in the distal sigmoid and upper rectum, resulting in a permanent sigmoid colostomy. In the subsequent years, the indications for performing the Hartmann procedure have broadened to include complicated diverticulitis, ischemic bowel, iatrogenic perforations, volvulus, and colitis. Hartmann's procedure is recognised by most colorectal surgeons to be a blunt but effective method of dealing with left-sided colonic emergencies. Hartmann procedure is a safe and efficacious option for the surgeon confronted with the complex pathology of the rectosigmoid area, with acceptable morbidity and mortality.

Systematic histological and ultra structural studies over operated patients and in experiment on white infantile mouse have revealed very serious liver alterations, when affected by echinococcosis. Alterations advance with disease progress and lead to cytological alterations in the organ in significant percent of the patients. Echinococcosis is accepted as etiological factor for cirrhosis. Echinococcosis should be included in the existing etiological classification: alcoholic, posthepatical, metabolic, biliar and cardiac. Early diagnosis and surgical treatment is recommended for prevention of development of cirrhosis and irreversible changes in the organ. Intensification of the prophylactic measures among population for reducing of morbidity are also recommended.

After the brief review of the diagnosis and operative treatment of the choledocholithiasis, be-nign stenosis of the distal common bile duct and inclaved common bile duct stone in papilla Vateri it is described laparotomiale antireflux transduodenal suprapapillare choledochoduodenostomy applied in the 13 patients.

Actinomycosis is an uncommocn inflammatory entity caused by the universally distributed anaerobic bacterium, Actinomyces Israeli. The most common sites of the abdominal form of the disease are the transverse colon and the cecum with the appendix. Actinomycosis can mimic other abdominal diseases as diverticulitis, abscesses, inflammatory bowel disease and malignant tumors, presenting a diagnostic challenge. In most cases surgical intervention is performed. Antibiotic administration should be a part of the complex treatment of the disease.

It is described operative method for the suture of rectal stump by tube management of dehiscence on the rectal stump after Hartmann's operation for the low proximal resection of the rectum for neoplasia. Es-sence for the method it is applied on the transrectal and -anal tube drainage.

Paliative surgery in carcinoma of the head of the pancreas have thoroughly task to carry out decompression of biliar tract, remove duodenal impassability and reduce the pain. Numerous variants for decompression of biliar tract were recommended, but stil now there is no agreement about optimal approach. As method of choise for decompression of biliar tract in patients with cancer our first alternative is making safeless, with little traumatic and easy performance anastomosis. Duodenostasis in patients with carcinoma of the head of the pancreas was determinated clinicly in 40-60% of casees. Some authors recommand making selective gastrojejunostomies based on preoperative and postoperative conclusions. Some other authors recommand in the time of making paliative biliodigestive anastomosis, making obligatory gastrojejunostomy. In fight against pain we used some base methods, as chemical splachinsectomy, intraoperative ganglionectomy and others.

The study is based on the methodology of the contemporary interdisciplinary cognitive images of the information entity of the surgical sphere, reflected in the phenomenology of the journal "Surgery", which is gathering --as a publication of the Scientific Society of Surgeons--the kaleidoscope of the genealogy of the scientific and practical thought in Bulgaria in the treated area for an impressive historical lapse of time. The information image observed is represented in the form of a triptych: I. Macrostructure of the periodicals in the field of medicine in the years 30 of XX century: Bibliographic analysis: Historiographical description [: Background]; II. Microstructure of the journal "Surgery" (1934-2004): Periodization [1934-1944: non-party system with priority of the monarchy; 1944-1989: totalitarian epoch; 1989-2004: democracy and pluralism]: Scientometrical synthesis: Transformatism of the information modeling [: History]; III. Status of the surgical field in the intelligible prism of the journal "Surgery" (1934-2004): Interdisciplinary deduction: Cognitological proscopy [: Classification]. The ontological synthesis concludes the study by which is expressed the systemic dynamical entity of the relation "surgical field"--"its scientific expression in a periodical" as a base of future scientific research--as well as a complex scientific and applied field of knowledge, and a social important phenomenon. The Supplements and References and notes are an empirical base and a fragment of the expose.

The haemorrhage of upper gastrointestinal tract is one of the serious problem in urgent surgery. Clinical effect of treatment with Quamatel purposely research was holded comparison of results in two groups patients. In group A with general medical treatment was included Quamatel--2 x 20 mg i.v. a day. In group B the patients was treated without H2 blocker. In cases of erosive gastritis was reported favorable effect in 76.47% at second day. The patients with stress stomach ulcer same effect was observed in third day--83.3%. In cases with peptic duodenal ulcer in I B--Forest group the bleeding was taken possession of 61.9%, in group II--79.31% and III--90.91% of patients.

The aim of the authors is to introduce one rare known pathology which the Frantz's tumor is, his clinical characteristic, clinical signs, diagnostic and treatment. We have observed two separate cases of this illness in Clinic of Surgery (University Hospital "Queen Yoanna") in comparison with evidence of famous world surgeons. We have made an attempt to introduce one disease, which even though not often observed is significant by the fact that affect young women (girls) and only surgical resection is a treatment of choice.

Colorectal carcinoma is one of most common diseases in human body. Often it is presented for the first time by its complicated forms--obturation, perforation, bleeding etc. Most common is the obturation of the large bowel. His clinic is caused not only by intoxication of carcinoma, but by massive flow of endotoxin in systemic circulation. In this publication we are trying to explain changes in human body and we offer a test for quick and early diagnosis--Limulus test.

Over the period 1996-2001, a total of 130 patients with complicated cancer of the left colon and 164 patients with complicated cancer of the rectum are subjected to treatment in the Clinic of Emergency Surgery at University Hospital "Queen Joanna", Sofia. Obturation is the commonest form of complication--136 patients (46.2%), followed by perforation either within the tumor or diastatic noted in 21 cases (7.1%), paratumor abscesses and infiltrates in 31 patients (10.5%) and rectohaemorrhage in 12 patients (4.0%). The optimal surgical approach to complicated forms of colorectal cancer of the left colon and rectum remains controversial especially when the patients underwent emergency surgery. Recently there has been a trend towards resection and anastomosis in selected patients. In each patient it's mandatory to make a precise and individual choice of the extend of the operative intervention, consistent with the patient's general condition and contributing to eliminate the life-endangering underlying cause. It must be realized by means of one-stage surgery when it's possible. Authors represent their personal experience with resolve of these actual problems.

Authors represent their experience in surgical treatment of gastrointestinal forms of No-Hodgkin's lymphomas (NHL) combined with adjuvant therapy. We also represent an Ann Arbor Staging System and an Updated Kiel Classification. From 1991 to 2001 we analyzed 39 patients with different localization of gastro-intestinal NHL's lymphomas. In this aspect more common are stomach's lymphomas--27 patients (71%); small bowel's lymphomas--3 patients (8%); more uncommon are the localizations in colon--3 patients (8%), predominantly in caecum and right colon; rectum--3 patients (5%). Add to thus we described one mechanical icterus caused lymphoma, one multi-lobular spleen lymphoma and one case of anterior abdominal wall lymphoma. All patients underwent surgery. Eight of them were operated as an emergency cases. Operative treatment of NHL isn't radical but in combination with adjuvant therapy can be life saving event in complicated forms.

The authors present as problematic and debatable the article about the diagnostic punction and punction treatment of the liver echinococcosis. Of many years scientific disputation about this problem exist. The risks of per cutaneum punction leads to many serious complications. This assess the revaluation of this method which must apply only in very limited evidence--small surface cysts without additional cysts and for diagnostic plan must be abandon.

The postoperative pancreatitis is a well-known complication. More than eighty-five drugs have been reported to have induced postoperative pancreatitis. Twenty-five cases of Propofol-induced pancreatitis have been reported till now. The relation of pancreatitis to Propofol (Diprivan; Zeneca; London, UK) is considered as a possible one, but has been proved. The goal of the authors is to reveal the plasma lipid and amylase level dynamics in patients after Propofol anaesthesia. The clinicians have to consider this possible relation, because of the growing use of Propofol recently.

Preoperative staging of metastatic liver cancer (MLC) from colorectal carcinoma (CRC) is conducted with the purpose to identify potentially resectable MLC cases. Fifty-two patients undergo laparoscopic study (4.1% all endoscopies), and three--laparoscopic ultrasonography. Laparoscope E Wolf and 7.5 MHz linear transducer obtained from the Aloka Company are employed. The study covers 24 women and 28 men with mean age 61.6 years (range 23-87 y). MLC is diagnosed in 35.1% (13/37) of colonic, and in 73.3% (11/15) of rectal carcinoma cases. Furthermore, 69.3% of the patients (36/52) are in M-stage, accounted for by peritoneal or hepatic metastases. The size of lesions measures less than 2 cm in 25.0%, and less than 1 cm in 12.5% of the cases. Solitary metastasis is recorded in 8.3 per cent. In the event of isolated involvement of the left lobe the location of MLC is in the region of II-III segment. In one patient a single metastasis in VII segment, measuring 0.5/1.0 cm, missed by the imaging methods and laparoscopy, is documented by laparoscopic ultrasonography. Echographic diagnosis proves inaccurate in 16.7%, and false negative--in 12.5 per cent. In further three patients (12.5%) the conclusion reached is uncertain, with primary liver cancer being also considered. In 23.1% MLC from colonic carcinoma is situated entirely intrahepatally, and is not accessible to endoscopic inspection without laparoscopic and/or intraoperative ultrasonography; the latter is indicated in all T3 and T4 patients. Potential resectability is established in 16.7% of cases with liver metastases from CRC.

On 50 cases of the dissecting material of the Department of Anatomy and Histology were worked out the kidney's vessels, the basin and the ureters, as the varieties in number and situation of the vessels, the cases of nephric ectopy and comparatively rare case of combined anomaly as well were traced and described. This anomaly is expressed in bilateral nephric ectopy, bilateral double ureter, which begins from independent calices set, and four pairs of polar kidney arteriae, which are situated bilateral as well. In the right they pass before v. cava inf. The vessels are equally calibrated, as the three pairs are branches of aorta abdominalis and the fourth of a. iliaca comm. The cases which were described attract the surgeons' interest because the zone of the kidney, its vessels and the way of the ureter are an object of frequent surgical interventions.

The present research has been taken over 56 cadavers from the dissecting material of the Department of Anatomy and Histology in the time of four dissecting courses. Tissue defects of the diaphragma with or without diaphragmatic hernias has been searched for. Also it has been followed the frequency of the sliding and the paraesophageal hiatus hernias. The tissue changes has been carefully described. In 12 of the cases it has been determinate defects of the diaphragma, as in two of the cases has been found parahiatal hernias as well. In 7 of the cases it has been found relatively wide hiatus esophageus, as 3 of them were accompanied with hiatus hernias. It has been determinate one case with combined defect--hiatal and parahiatal hernia. It has been discuss the possible reasons for their appearance and simply anatomical aspects of the surgical correcting techniques, which are known to us.

This is a literature survey on all complicated forms of colorectal carcinoma. A detailed assessment is done of emergency diagnostics in patients presenting complicated forms of colorectal carcinoma. Proceeding from numerous literature reports on the issue, the current views on the tactics and operative approach to complicated forms of colorectal carcinoma are outlined. Patients with complicated CR carcinoma are with poor prognosis, as compared to those with uncomplicated lesion. Intraoperative lethality is much higher, and not infrequently oncologic development grade IV (metastatic disease) is established during operative intervention. The 5-year survivorship among colorectal carcinoma patients is much lower by comparison with that in uncomplicated carcinoma cases.

A comprehensive pathomorphological assessment is done in 385 patients presenting complicated colorectal carcinoma, covering the period 1990 through 1995. The patients are distributed in 4 groups according to stage, with those in stage III being the most numerous--141 cases. The growth pattern of the neoplasm is as follows: exophytic growth--110 cases, ulcerous growth--57, cup-like growth--13, and endophytic growth--205 cases. On establishing metastatic lymph nodes within I and II lymph collectors, prophylactic postoperative chemo- and immunotherapy are undertaken. In case of lymph nodes present in III lymph collector, the operation is taken to be relatively radical, and for that reason chemo- and immunotherapy assume a therapeutic character.

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.

Over the period 1993-1998, a total of 385 patients with complicated colorectal cancer are subjected to treatment in the clinic of emergency surgery--University Hospital "Queen Giovanna", Sofia. Obturation is the commonest form of complication--43.8 per cent, perforation within the tumor or diastasis noted in 27 cases (7.01%), paratumor abscesses and infiltrates--in 8.3 per cent and rectohemorrhage--in 4.2 per cent. The therapeutic and operative approach, and the scope of surgery are dependent on a multitude of factors which should be given due consideration by the surgeon. In each patient presenting complicated colorectal carcinoma it is mandatory to make a precise and individual choice of the extent of operative intervention, consistent with the patient's general condition and contributing to eliminate the life-endangering underlying cause.

Using teratogen--trans-retinoic acid (Sigma Chemical)--caudal malformations are experimentally induced in mice of the Spriche-Dolly breed. For the purpose the aforementioned reagent is injected into pregnant mice at 6-hour intervals dose 29 mg/kg. In stages between two and four paired somites, supravital staining with Nile blue sulfite (in 1:50,000 Ringer solution at 37 degrees C for 30 min) is done, followed by histological assessment of tissue sections. The malformation noted are summed up in an attempt to draw conclusions about their presumable pathogenesis.

Colorectal cancer survival depends on: stage of primary neoplastic process development, clinical complication pattern and clinical course of the disease, type (radicalism) of the surgical intervention done and histological verification of blastoma. As shown by the results, postoperative lethality in complicated colorectal carcinoma cases amounts to 17.1 per cent, whereas in those undergoing radical surgery for uncomplicated carcinoma it amounts to 6.8 per cent. Patients presenting complicated colorectal carcinoma are admitted to the clinic with diagnosis advanced stage of development of the disease which explains the lower survival rate. The studies performed show that five-year survivorship in patients with complicated colorectal carcinoma amounts to 33.3 per cent, while among those operated for uncomplicated colorectal carcinoma it is 62.7 per cent in the average.

Unlabelled: The onset of immunological reaction against colorectal carcinoma is based on superficial changes in the malignant cell components following the formation of antigen structures. This explains the interest in the issue and defines the aim of the study. Over a 5-year period, in the Emergency Surgery Clinic, 86 patients with histologically diagnosed colorectal carcinoma (46 men and 40 women) are examined prior to surgery, and 107 patients (55 men and 52 women)--after the operation. The tumor markers CEA, CA 19-9, AFP and immunoglobulin IgA are tested using ELISA and RIA methods. Conventional ultrasound, scintigraphic and CT studies are carried out to detect liver metastases. The obtained results undergo statistical processing with correlation analysis and sensitivity and specificity coefficients. Among those examined preoperatively elevated CEA levels (CEA > 2.5 ng/ml) are recorded in 42 cases (48.9%), and for CA 19-9 (CA 19-9 > 37 E/ml)--in 40 (46.5%). From the patients with complicated colorectal carcinoma in the postoperative period 83 are clinically healthy (77.6%); of the latter marker-positive are 16 (19.3%), and marker-negative--67 (80.7%). Relapses and metastases are registered in 24 cases (22.4%) of which marker-positive--19 (79.2%). Liver and abdominal lymph node metastases are detected by US, scintigraphy and CT study. All three imaging methods contribute to diagnose liver metastases in 14 patients (13%). In 32 patients (18 men and 14 women) postsurgical monitoring of immunological IgA levels and tumor markers is done over period ranging from 7-10 days to 2 years postoperatively. Correlative dependences between IgA and CEA (R = +0.99), and between IgA and CA 19-9 (R = +0.97) are also documented. The sensitivity of both markers (CEA and CA 19-9) is low, varying between 38 and 51 per cent, with specificity amounting to 61-67 per cent. The paradoxically high elevation of tumor markers prior to operation shows a constant decrease at 3 months after surgery., Conclusions: 1. The sensitivity of both markers (CEA and CA 19-9) is low (38-51%), and that is why their use in screening examinations lacks clinical relevance. 2. CEA specificity is by no means high (61-67%), and it may become positive in a number of nononcological diseases (liver cirrhosis and hepatitis, inflammation diseases of GIT and lungs). 3. Plasma CEA and CA 19-9 levels correlate well with the neoplastic process progression/regression. 4. Preoperative CEA level has a prognostic value for postsurgical relapses. 5. High IgA levels are indicators for relapses or metastases from colorectal carcinoma. 6. Tumor histological verification correlates also with the high CEA levels and with the depth of tumor infiltration into the intestinal wall. 7. The dynamic assessment of tumor markers postoperatively has a high informative value in all colorectal carcinoma patients. 8. Pre- and postoperative high CEA levels are observed in patients assigned to the poor prognosis group, and should be given adjuvant therapy.