Analysis of the morbidity with temporary incapacity for work among workers at the ship building and ship repairing company

Aim: To analyse the yearly morbidity with temporary in capacity among workers at the ship building and ship-repairing company as compared to norm groups after Batkis-Lekarev, previously defined values according to groups of disease - standard and registered illnesses of the population aged 18 and above in general hospitals in Varna district for the period 2004-2006. The comparative analysis for the period 2004-2006 shows that the negative tendencies in the morbidity with temporary in capacity for work have decreased during the past year. The structure of morbidity shows that the basic reasons for temporary in capacity for work of the working team as a whole are mainly diseases of the respiratory, musculo-skeletal system and diseases of the peripheral nervous system, which can be explained with the specific type of work. Special attention should be paid to the fact that the frequency of absences from work be cause of malignant growths grows double each following year. The progression of the sickness related to the peripheral nervous system, neuroses and eye diseases is similar. The presence of some of these diseases could be related directly with the working conditions.Scripta Scientifica Medica 2009; 41(2): 191-194

Endoscopic radical treatment in early rectal cancer

Purpose: Standard radical treatment for early rectal cancer includes a removal of the tumour with total mesorectal excision. There are numerous new techniques for endoscopic treatment which could shift the strategy for obtaining the postoperative results.Material and methods: We report our radical endoscopic treatment of early rectal carcinoma by endoscopic submucosal dissection (ESD ). Forty-five patients with early-stage rectal cancer (carcinoma in situ, T1sm1 and T1sm2) were enrolled. All of them were staged by 3-D endorectal ultrasound. In 43 cases, the tumours were endoscopically removed. The postoperative results were analyzed and presented only. No oncological results were reported.Results: The mean lesion size was 31,0 mm (range, 19-82 mm), and the mean operating time was 86 min. (range, 48-131 min.). Forty-two lesions were resected en bloc with tumour-free margins with a successful rate of 97,33% (42/43). Three lesions were understaged or their localization in the rectum was not suitable for endoscopic treatment. The following complications were observed: perforation of the rectum in one patient (4%) treated conservatively, and major bleeding in four patients (10%) stopped by endoscopic hemostasis. Neither systematic complications, nor mortality were observed.Conclusion: ESD procedure for early-stage rectal cancers is safe and effective. It has the advantage of a shorter hospital recovery. The postoperative results are significantly better in comparison of radical surgical treatment such as transanal excision. The perioperative morbidity is of different kind and the postoperative period is shorter

Postoperative follow-up of patients with liver resections on the occasion of colorectal metastases

Проучването обхваща 107 болни с чернодробни резекции по повод на чернодробни метастази от колоректален рак (КРР). Касае се за 54 мъже на средна възраст от 65,02 10,44 г. и за 53 жени на средна възраст от 65,13 8,48 г. Извършени са 50 би- и трисегментектомии, 45 - моносегментектомии, 20 хемихепатектомии и 5 клиновидни резекции. Установяват се различия по отношение на основните оперативни показатели, преживяемостта и смъртността на болните в зависимост от броя на резецираните чернодробни сегменти и поредността на резекцията. Препоръчва се извършването на моно- и бисегментектомии при случаите с онкохирургическа целесъобразност.The study covered 107 patients who had undergone liver resections on the occasion of colorectal cancer (CRC). There were 54 males at a mean age of 65,02 10,44 years and 53 females at a mean age of 65,13 8,48 years. Fifty bi- and trisegmentectomies, 45 monosegmentectomies, 20 hemihepatectomies and 5 wedge resections were done. Certain differences in respect of the main operative parameters, patients` survival and mortality rates in dependence on the number of resected segments and the consecutive number of the resection were established. The performance of mono- and bisegmentectomies in the cases with oncological surgical advisability was recommended

Epidural anaesthesia and analgesia in hepatic resections

Eпидуралната анестезия и аналгезия намират все по-широко приложение в съвременната чернодробна онкохирургия. Изследването обхваща 29 болни на средна възраст от 58,410,7 г., подложени на чернодробни резекции през 2013-2015 г. При болните с нормален коагулационен статус и съхранена хемодинамика са използвани висок епидурален блок с повърхностна обща инхалаторна или венозна анестезия и малки дози релаксант с ендотрахеална интубация. Анализирани са няколко показателя на коагулационния статус: INR/PТ, тромбоцити, аПТТ, фибриноген и Д-димер. Установяват се скъсяване на PТ, намаляване на броя на тромбоцитите, леко намаляване на фибриногена и повишаване на Д-димера. Тези изменения са изразени предимно при болните с трисегментектомия и хемихепатектомия до 5-ия следоперативен ден. Постига се намаляване на болката при всички оперирани болни. Необходимо е индивидуализирано приложение на епидуралната анестезия и аналгезия и непрекъснатото мониториране на статуса на кръвосъсирването на болните, избрани за чернодробни резекции.Epidural anaesthesia and analgesia are more widely applied in contemporary oncological liver surgery. The study covered 29 patients at a mean age of 58,410,7 years who underwent hepatic resections in 2013-2015. In the patients with a normal coagulation status and preserved haemodynamics, a high epidural block with superficial general inhalation or venous anaesthesia and small dosages of relaxant with endotracheal intubation were applied. Several parameters of the coagulation status such as INR/PТ, platelet count, aPTT, fibrinogen and D-dimer were analyzed. PT shortening, platelet count reduction, a slight fibtinogen diminution and D-dimer elevation were established. These changes were predominantly outlined among the patients with trisegmentectomy and hemihepatectomy until the fifth postoperative day. Pain reduction was achieved in all the patients operated. An individualized application of the epidural anaesthesia and analgesia as well as continuous monitoring of the coagulation status of the patients selected for liver resections

Diagnostic modalities for early rectal cancer - review of the literature

Rectal carcinoma represents a significant health problem in the modern world. Its high rate of occurrence and mortality in the late stages of the disease stresses the need for better diagnostic, prognostic and predictive methods. We present a review of the literature concerning the staging modalities, including the characteristics of early rectal carcinoma. Endoscopy, endoluminal ultrasound and magnetic resonance imaging play a major role in the preoperative staging and the restaging of rectal carcinoma. The new devices and technologies improve the diagnostic process thus providing an option for new management strategies and better results

Laparoscopic treatment of liver hydatid disease

Surgical treatment has been considered the only available treatment of liver hydatid disease because of the complete removal of the parasite. According to the new standards for clinical approach to hepatic hydatid disease, there is no golden rule and the individual approach to every patient and cyst is of greatest importance. The laparoscopic method in the treatment of liver hydatid disease includes complete excision of the cyst, unroofing, evacuation and obliteration of the cyst cavity. Some authors perform a direct exploration of the cyst cavity in order to reject or confirm the presence of the communication of the cyst with the biliary tree. The laparoscopic method has advantages as a minimally invasive method with shorter hospital stay and minimal risk of wound complications. All the arguments prove the laparoscopy to be feasible and effective method of treatment of liver hydatid disease.Scripta Scientifica Medica 2013; 45(1): 17-20

Intraoperative ultrasound of the liver

RESUME: Intraoperative ultrasound has become an essential tool for the surgeon in the field of hepatobiliary surgery. No preoperative study has been able to duplicate the sensitivity and specificity of intraoperative ultrasound (IOUS) in the identification of occult lesions. With recent improvements in technology, IOUS has now become an indispensable means of defining the extent of disease and respectability, and providing a guide to an atomic and non-anatomic hepatic resections and minimally invasive and percutaneous ablative techniques. The contrast-enhanced intraoperative ultrasound (CE-IOUS) makes IOUS more accurate, thus enhancing the impact of this technique on operative decision-making for liver tumors. The concept of intraoperative ultrasound (IOUS) was first introduced in the mid-1960s and was used primarily in evaluating choledocholithiasis. More advanced applications were not pursued until the early 1980s, secondary to the limitations of ultrasound technology, which involved large bulky transducers and a relatively poor image quality [1]. Presently, IOUS is a main stay in all oncologic hepatobiliary procedures. Despite all of these technical advances, preoperative detection of preoperative liver lesions remains 60% to 80%. As a reflection of these shortcomings, false negative rates with CT and MRI range from 40% to 70% Table 1 summarizes these findings, the significance of which are demonstrated by several groups citing that in 27% to 49% of cases the operative plan will be changed based on new IOUS findings. These conclusions hold true even in the modern era of advanced preoperative staging. As a result, IOUS has now become a standard part of almost all hepatobiliary cases