Congenital cystohepatic duct found during laparoscopic cholecystectomy.

This case shows the need for in-depth knowledge also on congenital biliary anomalies that can become subject to iatrogenic damage. The patient is 44-years old with echographically proven cholelithiasis with complaints of intermittent pain in the right upper quadrant. During laparoscopic cholecystectomy, after identification of cystic duct and cystic artery, after their clipping and resection and subsequent mobilization of the gallbladder from the liver parenchyma, a bile duct was opened.

Sigmoid stenosis caused by diverticulosis mimicking advanced colorectal cancer.

Stenosis is a rare complication of acute diverticulitis, difficult to differentiate from colon cancer. We present a 63-year-old woman with right lumbar pain radiating to the back. A sigmoid stenosis was detected by magnetic resonance imaging.

SINGLE-ACCESS TRANSUMBILICAL LAPAROSCOPIC APPENDECTOMY USING CURVED REUSABLE INSTRUMENTS: AN INITIAL REPORT OF THREE CASES.

Introduction: The continuous evolution of laparoscopic surgery and the ambition of better cosmetic results raise the need for less invasive procedures. The umbilicus represents a natural scar and constitutes a well-healing site of access to the peritoneal cavity. Single-access Transumbilical Laparoscopy (SATL) is gaining popularity and can be an alternative surgical treatment for acute appendicitis.

Comparative analysis of the four-port and three-port trocar access of the conventional laparoscopic cholecystectomy--review of the literature.

Introduction: The presented analysis focuses on the first stage in the development of the laparoscopic technique forsurgical removal of the gall-bladder. The scope of the study starts with the period of its introduction in the clinical practice of the laparoscopic cholecystectomy and ends with the recognition of the three-port technique for surgical intervention.

Aim: The aim of this analysis is to review the studies, focused on the indications applying different techniques of conventional laparoscopiccholecystectomy, to summarize their advantages and disadvantages and to pinpoint the future guidelinesfor the development of the surgical techniques.

COMPARATIVE ANALYSIS OF THE FOUR-PORT AND THE THREE-PORT TROCAR ACCESS AND THE SINGLE PORT ACCESS IN LAPAROSCOPIC CHOLECYSTECTOMY--REVIEW OF THE LITERATURE.

Introduction: In the last few years, the search for less invasive procedures led to the development of the innovative technologies of SILS (Single incision laparoscopic surgery) and NOTES (Natural orifice translumenal endoscopic surgery). Lately, SILS's popularity increased in the same manner as the laparoscopic cholecystectomy did in the early 90's of the last century.

Aim: The aim of this analysis is to review the studies, focused on the indications for applying the different techniques of the single-port laparoscopic cholecystectomy, their advantages and disadvantages and the future guidelines for the development of the new trocar access surgical techniques.

Postoperative complications after Nissen fundoplication.

Anti-reflux laparoscopic operations replaced conventional surgery and are now widely available, because of the advantages of this type of surgery. One of the main reasons for the high complications rate in this type of operations is the lack of experience of the surgeons, although recently in the reports of most leading authors complications and increased mortality rate is due to the older patients undergoing this type of surgery. The main causes of death were gastrointestinal hemorrhage, necrosis with perforation of the esophagus or stomach, cardiac arrest, respiratory and inflammatory complications, and pulmonary thromboembolism.

Single-access retroperitoneal adrenalectomy.

Aim: To report the first case in our country of a single access--adrenalectomy with lateral retroperitoneal approach by using SILS port and to evaluate the feasibility and safety of this new technique.

Materials And Methods: A 50-year-old man presented with 38 mm right adrenal incidentaloma, functionally nonactive and without radiologic characteristics suggestive of a malignant lesion, discovered on abdominal computed tomography for nephrolithiasis. The single access adrenalectomy was attempted with multichannel SILS port (Covidien), inserted through a 3 cm transverse incision at the tip of rib XII on the right side.

[Medullary thyroid carcinoma--current surgical aspects. Overview and retrospective analysis of 22 cases].

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.

[Hartmann's operation--urgent operative technique in complicated colorectal cancer].

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.

[Pseudomyxoma peritonei--a case report].

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).

[Clinical experience and current aspects of treatment of abdominal actinomycosis].

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.

[Economical and social effectiveness of one day surgical treatment in patients with hernial defects of anterior abdominal wall - results of 7 year study].

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.

[A 10-years experience in the treatment of the acute peritonitis].

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.

[Tactics and approach to the treatment of choledocholithiasis--7-year follow up study].

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).

[Correlation between ventricular potentials and QT dispersion in patients with myocardial infarction].

We investigated QT dispersion (QTcd) and QT apex dispersion (QTad), corrected in relation to heart rate and the presence of ventricular late potentials (VLP) in 27 patients with previous myocardial infarction. VLP were considered positive when two of following tree criteria were satisfied: 1. HF QRS > 114 ms; 2.

[A comparison of the diagnostic reliability of the results of isotopic and routine clearance studies in essential and symptomatic hypertension].

40 patients with arterial hypertension II stage, 51 patients with chronic pyelonephritis and glomerulonephritis and a control group of IO healthy persons were examined during a free from medicamentous treatment period by a group of clearance tests in order to study the excretory system function and the degree of its affection in the earliest phases of the diseases studied. By means of the isotopic clearances of 169Yb-EDTA for determinations of the glomerular filtration, 131-I-hippuran for effective renal plasma circulation, the electrolytic clearances of Na, K, Ca, Cl and creatinine, the volume of the water excretion and the lithium clearance, the degree of the renal lesion was determined in every patient examined by the deviations from the normal values and the role of the different nephron sections as well. The results of the study revealed that the best tests for evaluation of the renal function in chronic renal diseases are the electrolyte clearances of Na, K, Ca, Cl, and in arterial hypertension--the lithium clearance.

[Mesangial IgA glomerulonephritis with atypical clinical manifestations and course].

The authors describe three female-patients with mesangial IgA-glomerulonephritis with non-typical clinical manifestations and course. Manifest nephrotic syndrome was established in one of them, favourably influenced by glucocorticosteroid treatment, and advanced renal insufficiency--in the other two.

[Plasma levels and the antihypertensive effect of the preparation celiprolol].

The antihypertensive activity of the new cardioselective adrenergic blocker celiprolol in hypertonic disease, stage I-II, according to WHO as compared with the preparation acebutolol was assessed under the conditions of double blind study. Thirty patients with arterial hypertension were included in the study if after one week placebo period, met the criteria for inclusion. Blood samples from each patient, were collected for the determination of plasma concentrations of celiprolol before the beginning, by 2, 15 and 29 day of the treatment, 24 hour after the last intake and before the following intake.

[Treatment with Pharmachim's Chlophazolin of hypertension and symptomatic hypertonia].

A total of 127 patients with arterial hypertension--64 with symptomatic and 63 with essential, were treated with chlophazolin "Pharmachim" at the Clinic of Therapy of Internal Diseases and Clinical Pharmacology for a period of one year. The drug was used alone in part of the patients and in the rest--in combination with other drugs. Satisfactory effect on the clinical symptoms and the level of blood pressure was attained in all patients treated and in only a small part of them diuretics and beta-blockers were necessary so as to attain better effect in coping with the arterial hypertension.

[Mycoplasma as the causative agent of kidney infections].

A total of 185 patients were investigated for M. hominis and mycoplasmal infection was established in 28 patients. In 2 of the patients mixed infection with E.

[Clinical trial of drugs for treating urological infections--pipemidic acid].

A method was elaborated for clinical trial of pharmaceuticals for the treatment of infections of kidneys and urinary ducts. The main requirements are as follows: definitive diagnostic criteria for urological infection, monotherapy, systematic control for the drug intake, precisely formulated indices for assessment of the effect, strict follow-up of adverse and toxic effects. The effect was assessed according to a three-stage scale: very good, good and poor, consideration given not only to the clinical and laboratory indices but to adverse effects as well.