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Introduction: Primary tumor resection can prevent future tumor-related complications in patients with stage IV colorectal cancer. This may influence the quality of life and prevent colostomies associated with the emergency surgery. Laparoscopic approach plays an important role in attempts to reduce perioperative complications in this specific group of patients. Purpose: The aim is to assess early perioperative results in a group of 17 patients with stage IV colorectal cancer—multiple incurable liver metastases and/or pulmonary/peritoneal metastases of the disease. On the other hand, postoperative complications may delay administration of chemotherapy and influence survival. Materials and methods: We analyze retrospectively the perioperative results in a group of 17 patients with laparoscopic palliative colorectal resections for stage IV colorectal cancer. Assessment includes perioperative complications, median hospital stay, perioperative blood loss, need for blood transfusion, operative time, and type of surgical procedure. Results: We performed totally laparoscopic 10 sigmoid resections, five left colectomies, and two right colectomies. Fourteen simultaneous liver biopsies were performed during laparoscopy. No perioperative deaths were registered. Perioperative mortality rate is 0%. Perioperative morbidity rate is 0%. No perioperative complications. The median perioperative stay is 5.3 days. Median blood loss is 47.9 mL. Overall, three units of blood were transfused. The median transfusion rate is 0.17 units per patient. The median operative time is 130.2 minutes. Conclusion: The laparoscopic approach is associated with very good perioperative results in patients with stage IV colorectal cancer and palliative resection of the primary tumor. Early hospital discharge and minimal operative trauma may not influence early administration of chemotherapy.

In this article, we present a clinical case of a 63-year-old patient who was treated in the COVID unit of the Clinic for Internal Diseases of UMBALSM (University General Hospital for Active Care and Emergency Medicine) “N. I. Pirogov” on the occasion of a proven coronavirus infection with a PCR positive test for SARS-CoV2-virus, clinical symptoms of severe coronavirus pneumonia, and with accompanying disease - lymphoma with skin localization, condition after lower right lobectomy, chemotherapy and checkpoint therapy for squamous cell carcinoma of the lung. We also examined the role of the transcription factor NF-kB in the course of the coronavirus infection in a patient with the indicated lymphoproliferative disease and a history of active smoking. We tried to clarify questions such as “Do severe forms of coronavirus infection and the relatively rare disease lymphoma with cutaneous localization have a common pathogenesis?” Is it possible to effectively pharmacotherapeutically influence two, at first glance, so heterogeneous diseases?’’ The conclusions drawn can help us to specify certain nosological units as “more vulnerable” to severe forms of COVID19 infection.

The cytokine storm has been identified as one of the leading causes of the severe course and, in some cases, the fatal outcome of COVID-19 infection. Other factors aggravating the course of the disease are accompanying disorders such as cardiovascular diseases, diabetes mellitus, diseases of the respiratory system, and oncological diseases. In this article, we present the course of the coronavirus infection in patients with an accompanying malignant disease, chronic lymphocytic leukemia (CLL), namely. The study included 8 patients with proven PCR-positive tests for SARS-CoV2 and confirmed chronic lymphocytic leukemia as a comorbidity. The course of the coronavirus infection in the CLL group was compared with that in the control group of 100 patients. In both groups, we compared subjective complaints such as tiredness, fatigue, and joint and muscle pain with objective criteria such as temperature, laboratory markers of inflammation, X-ray imaging, and frequency of necessary intubation. Despite the expected poor prognosis in patients with concomitant oncological disease, in the case of chronic lymphocytic leukemia, our results showed a quite different milder coronavirus infection course. Obviously, patients with CLL cannot develop a pronounced cytokine storm, most probably due to certain immunosuppression related to the pathogenesis and drug treatment options for the comorbidity of CLL.

Background: Laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a relatively new method of inguinal hernia surgical repair that, at theory, provides a good view of the inguinal anatomy and sac contents and, as a laparoscopic procedure, is considered less invasive and with fewer complications compared to total extraperitoneal (TEP) inguinal hernia repair. Purpose: This study aims to assess the short-term outcome of laparoscopic transabdominal preperitoneal inguinal hernia (TAPP) repair. Material and methods: The retrospective clinical data for 138 patients with unilateral and bilateral hernia, operated in the Department of General, Visceral, and Emergency Surgery of the University Emergency Medicine Hospital ‘N. Pirogov’ from 01 January 2022, to 01 January 2023, were included. The risk profile of the patients, the intraoperative and postoperative complications, the duration of hospital stay, the frequency, and the type of analgesics used were analyzed. Results: Forty-one women (29.7%) were included; men comprised 97 (70.29%) of the cohort. Of the selected group, 63 (45.7%) patients had indirect inguinal hernias, 34 (24.6%), and 25 (18.1%) were diagnosed with direct inguinal hernia and accreta inguinal hernia, respectively. A history of repeatedly occurring hernias was found in 16 patients (11.6%). The average hospital stay was 32 hours (or 1.3 days) and ranged from 24 hours (1 day) to 48 hours (2 days). Complications occurred in 11 (7.97%) patients. The need for analgesics and anti-inflammatory agents was reliably reduced compared to the patients undergoing conventional surgical treatment of inguinal hernia. The patients were followed for three months post-discharge for the occurrence of surgical morbidity associated with the TAPP hernia repair. None of the patients used an antimicrobial agent, as indicated by a possible complicating bacterial infection. Rehabilitation was started within the first 12 hours after the operation, thus contributing to a significantly shorter hospital stay compared to patients undergoing conventional surgical repair of an inguinal hernia. Conclusion: Our results demonstrate that TAPP inguinal hernia repair is a safe procedure with reduced postoperative pain. It has fewer complications, with no significantly longer operative time and a shorter overall hospital stay.

The complexity of the movements of the bones of the knee joint requires an anatomical study to construct a knee prosthesis. The reasons for knee replacement are related to wear of the articular cartilage, which leads to pain, deformation, and limitation of movements. The consequences of the surgical intervention allow functional restoration of the knee joint and the supporting function of the lower limb. Kinesitherapy begins the day after surgery and aims to reduce pain, restore mobility of the knee joint, actively lock the knee during extension, increase and maintain muscle strength, and ensure the functional independence of patients. To a large extent, the volume of movement is restored, and the pain symptoms are reduced. Patients have the comfort of everyday movements and the possibility of participating in certain sports activities—swimming, cycling, and golf. The paper deals with pharmacological prophylaxis, the kinesitherapeutic program, and total knee arthroprosthesis.

Cardiovascular diseases (CVD) are socially significant diseases due to high morbidity and loss of people of working age. In Bulgaria, they are the leading cause of mortality among the population and are a consequence of the effect of cardiovascular risk factors. The draft of the National Health Strategy (NHS) 2021–2030 reports on their wide distribution, as well as on the insufficient knowledge, skills and motivation for their prevention and control. The purpose of this review is to address the prevention of cardiovascular disease, which is a significant problem worldwide. Prevention goals for patients with established cardiovascular disease and those at high risk include smoking cessation, healthy eating, physical activity, and lowering body mass index. There are various methods that are part of health promotion to reduce CVD risks. These methods include motivational interviewing, non-pharmacological means, the use of certain medications for CVD prevention, as well as physical activity. Strategies for effective primary prevention refer to engaging the patient to change their lifestyle and identifying risk factors, while secondary prevention is aimed at activities to detect the disease early and to slow down its progression. It is necessary to create a strategy for timely preventive actions with a view to preventing the negative influence of risk factors and improving people‘s heart health.

According to the International Classification of Diseases, osteochondrosis is included in the group of diseases of the musculoskeletal system, mainly the spine. The mechanism of the disease is expressed in the disturbance of blood circulation, which nourishes the bone, and hence the damage to bone and cartilage tissue. Objective: This paper aims to present the effect of applied pharmacological and active treatment in 10 patients diagnosed with lumbar osteochondrosis. Methods: We conducted a comprehensive treatment of 10 patients diagnosed with lumbar osteochondrosis without any neurological symptoms during the period 2017–2020. This pharmacological and active treatment lasted from 15 to 17 days. The intensity of the pain symptoms, the general mobility of the spine, and the mobility of the lumbar spine were measured to determine the deficit of the patients. The strength of the flexor and extensor muscles of the body was tested. Results: A decrease in pain intensity, increase in the strength of the abdominal and back muscles and improvement of the mobility of the back muscles were found in all patients after the complex treatment. As a result of the therapy, a reduction in the patient’s dysfunctions and the risk of developing disabilities was found. Conclusion: The application of a multidisciplinary approach in patients with osteochondrosis is of great importance for reducing pain intensity and achieving a good functional recovery of motor and stabilizing function of the muscles of the spine.