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An epidemiological study on the wide spreading of nosocomial infections among patients admitted to intensive care units in Bulgaria is carried out, covering the period 1982 through 1996. The proportion of nosocomial infections registered in the aforementioned wards accounts for 4.66 +/- 0.33 per cent of the overall in patient infectious pathology. Eight per cent of the patients discharged from intensive care units develop infections originating in hospitals. The predominant nosological entities recorded include pulmonary infections, operative wound suppurations and urinary system infections. More than 15 microorganisms, causing agents of infectious processes, are isolated with E. coli ranking first, followed by Staphylococcus spp., Pseudomonas aeruginosa, etc. The partial registration of nosocomial infection cases in the various intensive care units interferes greatly with the practical implementation of updated and adequate measures for prophylaxis and struggle against the infections. Thus, conditions are created promoting prolongation and rising cost of the inpatient treatment, continuous disability, premature death and reduced efficiency of the medical cares delivered.

The wide-spreading of intrahospital infections in urological departments on a nationwide scale are analyzed over the period 1982 through 1996. Their epidemiological, etiological and nosological characterization is also defined. In this country over 6 per cent of all hospital infections occur in urological departments. Annually, in Bulgaria 5/100 discharged urological patients develop infection in hospital conditions. Both gram-negative and gram-positive microorganisms are the etiological causing factors identified, with E. coli and Proteus mirabilis being predominant. Among the patients in urological departments urinary tract infections are the leading infectious pathology so far documented -80.85% + 0.61. The low efficacy of the prophylactic and antiepidemiological measures undertaken correlate with the low rate of diagnosing such infections, and with the insufficient theoretical and methodological training of the medical personnel along these lines.

The epidemiologic, etiologic and clinical structure of HAI in the maternity and neonatal wards in the country for the 1982-1992 period has been specified. 934 women in child-birth and 2357 neonates acquire nosocomial infections at an average annually. A comparatively constant level in HAI epidemic process intensity is observed with inconsiderable diversions in the beginning and by the end of the studied period. Staphylococci like causative agents of HAI take up a leading place in both types of wards with especially marked incidence rate among the newborn children. The predominant clinical forms in the women in child-birth are the surgical wound infections, skin and genital infections and in the neonates--the staphylodermatites, upper respiratory airway infections, pulmonary and enteric infections.

The clinical course, diagnosis and treatment of Peutz--Jeghers's syndrome in childhood are discussed and a case reported in a eight-year-old girl. The disease presented with skin and mucosal melanin pigmentation in the mouth, frequent colic-like abdominal pain, due to chronic recurrent invaginations. On operation, the cause of the invaginations appeared to be 11 polypous formations in small intestines (8) and in the large intestines (3), which were subjected to radical operative removal. For an observation period the child had no complaints and was clinically healthy.

The authors analyse the results of surgical treatment of 316 patients with peptic ulcer after gastric resection completed by the formation of terminolateral gastroduodenoanastomosis after the Haberer-Finney techniques. In 189 patients vagotomy was carried out in addition to the operation. The postoperative mortality rate was 0.3% (due to incompetence of the sutures of the anastomosis). The incidence of nonfatal complications was 9.4%. The late-term results were good (according to Visick's grading) in 98.65% of patients.

Two cases of primary tumors of the stomach in children (7 and 10 years of age) are reported. One of them had non-Hodgkin's lymphoma and the other hamartoma, both radically operated. In the former case subtotal resection of the stomach was made followed by polychemotherapy. For an observation period of one year there was no evidence of recurrence or metastases of the neoplastic process. The incidence, histologic characteristics, clinical course, diagnostic and therapeutic problems in tumors of the stomach in children, with special reference to non-Hodgkin's lymphoma and hamartoma, are discussed.

In a series of 4350 children with abdominal surgical diseases operated at the Department of Pediatric Surgery in Sofia for a period of 3 years (1987-1989) the authors have observed 4 cases of pleuropulmonary complications (0.09 per cent). In two of these children the primary abdominal operation was for liver echinococcus, in 1--rupture of the liver and subphrenic abscess and in 1--perforative appendicitis and purulent peritonitis. Symptoms of respiratory failure developed in addition to the abdominal symptoms. Leading in the complex treatment was sanation of the abdominal cavity from the purulent process and double pleural drainage. The severe pathologic changes in the organs of the two adjacent cavities were responsible for the high case fatality rate (25 per cent).

One of the rare surgical diseases of the organs in the abdominal cavity in children are the splenic cysts. For a period of 20 years (1968-1988) 3 children have been observed and treated at the Clinic of Pediatric Surgery in Sofia. The use of modern diagnostic methods--echography, computer axial tomography, scintigraphy and laparoscopy furnished an opportunity for precise preoperative organ localization of the disease in the patients observed by the authors. Partial resection of the spleen in this pathology with good postoperative results, performed for the first time in Bulgaria, encouraged the authors to recommend organ-preserving operation as the method of choice in nonparasitic cysts of the spleen.

The combination of subphrenic abscess with purulent pericarditis is a rare postoperative complication of perforated appendicitis in children, with severe clinical course, difficult to diagnose and high case fatality rate. A 7-year-old child with this complication, successfully diagnosed and treated is reported. The importance of complex therapy--surgical and intensive and collaboration between pediatric surgeons, anesthesiologists, cardiac surgeons and cardiologists for the favourable outcome is emphasized.

The epizootiology of Salmonella infections in swine was studied in 1970-1980 in 7 districts of this country on a number of farms and industrial complexes in order to elucidate some aspects of the epizootiologic process. A total of 26,957 samples taken from swine and the environment were studied bacteriologically. An industrial complex in each district served as a test one to investigate samples from various groups of swine in the technologic process. It was found that salmonelloses did exist, and Salmonella organisms were isolated from pigs on all studied farms and complexes, however, no diseases and organisms were recorded with both animals and the environment in Swine Nucleus Bases. On the complexes Salmonellae were isolated from pigs of all technologic groups, and, in most cases, the Salmonella species coincided by sows and pigs. This explained the stationary character of the disease on some complexes where a sui generis epizootic process ran its course, exhibiting particular aspects and correlations. Salmonella organisms were isolated in 0.95 per cent of the investigated samples from the test groups on the test complexes as well as in 4.13 per cent of the groups out of the experiment. In samples taken from other complexes, farms of AIC, IAC, auxilliary farms, etc., there were positive findings in 5.32 per cent of the cases. Enzootics on the complexes were most common with pigs aged 40-50 days as against farms with traditional types of technology where 2-4-month-old pigs were involved.(ABSTRACT TRUNCATED AT 250 WORDS)