[Changing susceptibility patterns of surgical site infection pathogens after the introduction of modern perioperative chemotherapy in the emergency surgery clinic].

993 surgical site infection aerobic pathogens are isolated over a six-year period (I.1994-I.2000) by the Microbiology Laboratory at University Hospital "Tzaritza Joana".

[Tactics and operative methods in treating complicated colorectal cancer].

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.

[Large-intestine perforations caused by primary colorectal cancer].

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.

[The long-term results in complicated colorectal cancer (survival for over 3 and 5 years)].

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.

[The pathomorphology of complicated colorectal cancer and the stages in the development of the tumor process].

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.

[The pre- and postoperative monitoring of the immunological indices and tumor markers in colorectal carcinoma].

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.

[Acute surgical abdomen in middle and old age].

Proceeding from a comprehensive literature survey the urgency of acute abdomen conditions in elderly and senile patients is thoroughly discussed. Not infrequently, geriatric surgeons face serious difficulties of diagnostic and therapeutic character relating to the severity of clinical picture and elevated postoperative lethality, explaining in turn the great surge of interest in the problem. Recent achievements along this line, surgery in particular, provide for adequate conditions for performing early surgical interventions with reduced intraoperative risk in elderly and old age patients presenting acute abdomen.

[Our experience in introducing current antibiotic prophylaxis into abdominal surgery--the initial results].

Over a one-year period (Nov. 1996-Nov. 1997), a total of 154 patients are admitted on an emergency basis, with deferred emergency and for routine treatment in the Clinic of Emergency Surgery.

[Current antibiotic prophylaxis in colorectal surgery].

Over a one-year period (November 1996 to November 1997), in the Emergency Surgery Clinic perioperative parenteral antibiotic prophylaxis during colorectal operations is performed in a series of 32 patients, admitted on an emergency and deferred urgency basis, or for routine operative treatment. Of them 30 present malignant processes involving colon and rectum, and two--inflammatory diseases. All patients receive single i.

[Volvulus of the small intestine].

Volvulus of the small intestine is a condition of bowel obstruction due to knotting and twisting of the small intestine. Two types of volvulus are described: 1) primary small intestinal volvulus where no predisposing factors exist, and 2) secondary volvulus where congenital or acquired conditions promote twisting of the small intestine. Over a 5-year period, 18 patients (eleven men and seven women) presenting volvulus of the small intestine are operated in the Emergency Surgery Clinic of the University Hospital "Queen Giovanna", representing 8.

[The views and attitudes of the Clinic of Emergency Surgery of the Clinical Emergency Medical Center at the Queen Ioanna State University Hospital on the potentials of surgical endoscopy in upper digestive hemorrhages].

Transendoscopic sclerotherapy of esophageal varix in children and adults is introduced in the clinic of emergency surgery ever since 1973. In children aged 3 to 14 years presenting preportal block a 100 per cent survivorship is recorded 20 years after the manipulation. The outcome of endoscopy in adult patients is successful in 57.

[Anaerobic surgical infection and septic shock].

In the period 1990 through 1995, one-hundred patients operated for acute abdomen or admitted on a routine basis, presenting evidence of anaerobic infection, undergo treatment in the clinic of emergency surgery. Septic shock develops in 10/100 patients (10 per cent). In six of the latter the outcome is fatal--three with infection caused by spore-forming anaerobes (gas gangrene of the inguinal region--of Fournier, and anterior abdominal wall--anus praeternaturalis--two), and three with infection caused by non-spore-forming anaerobes (mixed anaerobic-aerobic infection).

[The place of endoscopic transpapillary (peroral) cholangioscopy in the diagnosis and treatment of biliary tract diseases].

The introduction of intraoperative, and later postoperative cholangiography, results in the reduction of residual concrements in the bile ducts, but by no means in their total removal. Cholangioscopy was used as an alternative to this method (1, 5, 10). In 1923, J.

[Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder].

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6).

[Complicated colorectal cancer--new trends in its diagnosis and surgical treatment].

Colorectal carcinoma is among the commonest cancer diseases of the alimentary canal in this country. The morbidity and mortality rates show an increase on an annual basis. A total of 1094 patients presenting colorectal carcinoma are analyzed over the period 1985 through 1996.

[Necretomy and prolonged local postoperative lavage in the surgery of necrotic pancreatitis].

Over an 8-year period, sixty-one patients with mean age 52.5 years are operated on for necrotic pancreatitis in the clinic of emergency surgery at the Faculty Hospital "Queen Giovanna"--Sofia. The initial prognosis of the severity of disease scores 4.

[The treatment of acute cholecystitis complicated by mechanical jaundice].

After analyzing the summed up treatment results in 368 patients with acute cholecystitis, complicated by obstructive jaundice, the inference is reached that it is a matter of a complication, unfavourable in terms of prognosis, with a definite impact on both immediate and long-term therapeutic results. Early operative intervention following intensive preoperative preparation (including ERHPG with endoscopic papillosphincterotomy and ensuing biliary decompression, or echographic percutaneous cholecystectomy) contribute to control the acute inflammatory process in the gallbladder, and preclude the development of liver (or hepato-renal) failure against the background of obstructive jaundice. Proceeding from the severe, irreversible changes in liver and kidney, hardly responding to treatment, and persisting deterioration of the general condition, acute cholecystitis complicated by obstructive jaundice is defined as an emergency life-endangering condition, requiring a priority operative approach.

[Our experience with treating acute noncalculous cholecystitis].

Based on a comprehensive literature survey, personal experience with the management of 89 patients, presenting acute noncalculous cholecystitis, is shared. All patients are clinically observed in the acute phase of the disease. In 60 cases the latter becomes manifest with recurrent attacks, and in 29 there are no previous signs or symptoms of biliary diseases.