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Appendiceal mucocele (AM) was described for the first time by Rokitansky in 1842.1 Its incidence is 0.2 - 0.4% of all apendectomies performed, as it is observed predominantly in women with the ratio of 4/1 versus men and most frequently at the age of 50.2,3 We present to your attention a 64-year-old woman, who was referred to diagnostic further clarification after a preventive gynaecologic exam. Appendiceal mucocele with retrocecal location, enveloped by additional Jackson'™s membranes was determined intraoperatively. The formation has been dissected and appendectomy was performed without mucocele integrity being compromised. The permanent histological specimen revealed mucinous cystadenoma with clear resection lines, without any data on the appendiceal base being affected. The patient was discharged on the third day after surgery without any complications, and further follow-up was scheduled in 6 months.

For the first time extraskeletal osteosarcomas (ESOS) were described by Wilson in 1941. They are extremely rare neoplasms, presenting 4% of all osteosarcomas and 1,2% of all soft-tissue sarcomas. About 300 cases have been reported in the literature up to date. We present a 66-year-old female patient, admitted in the clinic because of acute bleeding in retroperitoneal space. Revision of the retroperitoneal space and haemostasis were performed. The patient was re-operated because postoperative bowel obstruction. The reason for it was intestinal infiltration from large tumor of the omentum, determined histopathologically as ESOS. The case was considered as an unresectable neoplasm so a colostomy was performed. In the literature we found 3 case reports of ESOS, originated from omentum.

Perineal hernia is the protrusion of intra-abdominal viscera through the pelvic floor. We present a patient with recurrent perineal hernia - 12x9 cm with a palpable soft, hardly adjustable in the pelvic tunnel formation and attenuated skin over it. The patient was operated by abdominoperineal approach. We performed two layer Titanium mesh plasty of the pelvic floor with the use of the omentum and the pelvic muscles.

Retroperitoneal soft tissue sarcomas remain a serious therapeutic problem. The aim of the study is to define the optimal treatment strategy of patients with locally recurrent or metastatic retroperitoneal soft tissue sarcomas.A retrospective study was performed.Between 2001 and 2013, 89 patients with retroperitoneal soft tissue sarcomas were surgically treated in the University Hospital Queen Joanna ISUL and the Specialized Hospital for Active Treatment in Oncology Sofia. Clinicopathological data were investigated with SPSS 19.The mean time of onset of the first and second relapse of sarcomas was 23 and 13 months, respectively. Over 40% of the studied patients underwent more than one operation because of recurrence. Ability of radical extirpation of the tumour decreased with each subsequent relapse. The 5 year survival rate was 60% for patients with primary combined radical resection versus 28% for patients with partial resection. In the presence of metastatic lesions the 3 year survival rate was only 22%.Local recurrences, the presence of distant metastases and the ability of radical extirpation are the main long term prognostic factors.

Polyposis of the colon is a colon cancer predisposition syndrome. Familial adenomatous polyposis (FAP) accounts for 1% of the cases of inherited colorectal cancer (CRC). The National Register of inherited CRC and polyposis of the intestines keeps track of 18 patients from 14 families with FAP. Eight of them have been operated of CRC, on 6 patients preventive colectomy with ileorectal anastomosis has been done and four patients refused surgery. Colectomy has been done due to the malignant development also on a female patient with difused juvenile polyposis with adenomatosis. Of three patients under surveillance with the Peutz-Jeghers syndrome, surgery has been done on one female patient with ileus and bleeding large polyps.

The aim of this study is to determine the diagnostic potential of endoluminal echography and the pitfalls sources in the preoperative staging and postoperative follow-up in patients with rectal cancer. 245 patients with rectal carcinoma are evaluated during 10 years period (Jan. 1993-Jan. 2002 years). 96 patients are monitored in the early and late postoperative periods for the early detection of local recurrence as well as for the anorectal physiology assessment after low anterior rectal resection or coloanal anastomosis. Lineal transducer UST-657-5MHz (Aloka 620) and 10MHz miniprobe are applied. The accuracy for T-staging is 84% and for N-staging is 82%. The local recurrence is detected in 21 patients, on average 12.6 months after curative surgery. The local recurrence is more often in cases of lymph node involvement as well as if some specific echographic features for extramural vascular invasion are present. Endoluminal echography provides individual therapeutic management and postoperative control in patients with rectal cancer.

Introducing of the alternative PAIR (puncture-aspiration-injection-reaspiration) method for treatment of hepatic echinococcosis in practice dates from 1992 year. A Working group dealing with the problems and standardization of the method has been created by WHO. The major aspects of this treatment are summarized in the bulletin of WHO of 1996 year. On the last World Congress of Ultrasound, held in Florence, Italy in 1999 this method was reported as safe and effective treatment modality. The necessity for further prospective studies was also emphasized. The aim of the Working group for performing of PAIR, created at the Clinical Centre of Gastroenterology, University Hospital "Queen Joanna" in 1999 is to report the preliminary results and declare the possibilities for its application. Nine patients (6 males, 3 females) with 11 cysts (I, II and IIIa types after Gharbi) measured 3-9 cm were punctured and followed up for a 6 months period. 95% ethanol was used as protoscolicidal agent with concomitant preventive oral treatment with Mebendazole. No serious complications were observed. In all patients separation of the germinative membrane was verified. 2/5 cysts3.5 cm completely disappeared, 7/11 diminished their size without signs of vitality, while 2/11 remained vital. One ofe the cysts had a biliary communication which necessitated the injection of 20% NaCl instead of ethanol. The serological ritres significantly decreased in all patients. The risk of anaphylaxis and seeding is negligible while keeping the technique of PAIR precisely. The PAIR treatment of hepatic echinococcosis presents great progress with its safety, low risk and excellent therapeutic results.

The incidence rate of local recurrences after radical operative treatment of rectal carcinoma and the risk factors involved, methods of early diagnosis and surgical therapeutic approach are comprehensively analyzed. Reference is also made to 86 scientific publications on the issue. During the 20-year follow-up period, no tendency of the incidence of local rectal carcinoma relapses to decrease is noted. The risk factors contributing to their occurrence are distributed in two groups depending on the primary tumor characteristics (location, stage of development, locoregional spreading, differentiation degree, genetic features), and operative intervention used (type, distal resection line, application of total mesorectal excision, extensive minor-pelvis lymph dissection etc.). The early diagnosis is based on mandatorily performed procedures, such as rectoscopy (coloscopy), endo-ultrasonography with purposeful thin-needle biopsy, assessment of tumor markers and immunoscintigraphy. The surgical tactics in coping with a local recurrence of rectal carcinoma becomes increasingly aggressive and radical by resorting to re-resection, abdomino-perineal extirpation, en-bloc resections and even minor pelvic exenteration. Postoperative 5-year survivorship amounts to 54.5 per cent.

Mucinous breast carcinomas, denominated also gelatinous, mucoid and colloid (collomas), represent a heterogeneous group of neoplasms. More than half of them exhibit signs of neuroendocrine differentiation. Eighteen mucus producing carcinomas of the breast are subjected to morphological study. On the ground of demonstrating argyrophilia by the methods of Grimelius and Churukian--Shenk, and presence of secreting granules during electron microscopic study, they are assigned under the heading apudomas, i.e. tumors of the diffuse endocrine system, or the so-called APUD-system. The important practical implications of demonstrating neuroendocrine cells with a special reference to the biological patterns of this particular type of tumors are discussed.

The progress of pancreatic surgery naturally leads to broadening the scope of indications for resection of the gland. Over the period 1970 through 1993, in the Clinic of Abdominal Surgery are performed 99 pancreatic resections for carcinoma of the pancreas (including cancer of papilla Vateri (45), endocrine-active tumor of pancreas (5), benign tumor (1), chronic pancreatitis (4), pseudocysts of the pancreas (4), cancer of an adjacent organ infiltrating the pancreas (36), benign lesions to a neighbouring organ (4). The size of resection depends on a number of factors of which location of the neoplasm and stage of the disease are the leading ones. Operations done: duodenopancreatic resection--47, left side hemipancreatectomy--13, resection of the body region and tail of pancreas--14, and partial resection--19. The choice of operative technique is discussed against the background of the variety of indications for pancreatic resection. Special attention is focused on the operative technique used in pancreatoduodenal resection. The practicability of performing pylorus-preserving intervention, the need of vagotomy and its scope are precisely determined. Also discussed are issues relating to the choice of organ for anastomosis with the pancreas and its protection, as well as the variants of successiveness of anastomoses with the biliary canal, residual pancreas and stomach. Morbidity and mortality rates show a decrease parallel to the surgical experience gained.

Reoperations of the biliary apparatus is a branch of biliary surgery still not well enough clarified and difficult to cope with. A total of 169 patients are subjected to operation and investigation in the clinic of abdominal surgery. In 71 of them reoperation is undertaken over the period 1952-1973, and in 97--in the period 1974 through 1993, representing 8.7 per cent of all biliary operations done for benign diseases of the biliary apparatus. In 95 per cent of cases the primary operation is related to cholelithiasis (ChL). One-hundred fifty-five cases (92.6 per cent) are reoperated once, nine (5.3 per cent)--twice, and four (0.7 per cent)--three, four and five times. What is more, 56 of the patients are operated in the clinic of abdominal surgery, and 112--elsewhere in surgical units and departments throughout the country. The severer clinical picture, prolonged postoperative period, increased operative risk and worsened prognosis in the latter group are underscored. The underlying causes necessitating secondary corrective intervention are analyzed--76 per cent are conditioned by ChL, and 24 per cent--by the primary operation. The indications for reoperation are classified in three groups: a) failure to remove or partially removed gallbladder, b) in case of preexisting primary, or secondary postoperative development of various forms of cholelithiasis, c) in surgery induced morbid conditions. A table is presented illustrating the character of secondary operations, performed in the series of 168 patients under study, namely: in 20 per cent the gallbladder is operated on, and in 80 per cent--the extrahepatic bile ducts. Postoperative morbidity is higher as compared to the one in primary operations and not infrequently it is conditioned by preexisting complications. Postoperative mortality rate amounts to 10 per cent.

Experience had with the surgical management of 483 patients, operated for cancer of the pancreatic gland in the Clinic of Abdominal Surgery over the period 1971 through 1994, is presented. Distribution of the patients by gender and age shows noteworthy consistency. Preoperatively, exact diagnosis in the clinic is made in 91.1 per cent, but usually the patients are admitted in advanced stage of the disease (91.6 per cent). Merely 42 cases (7.6 per cent) are free of metastases in regional lymph nodes or carcinomatous infiltration. The neoplasm is located in the head of the gland in 350 patients (66.5 per cent) with resectability attained in 10.1 per cent, in the body and tail--in 96 patients (19 per cent) with resectability 6.5 per cent; the neoplasm involves the total gland in 55 cases (10.2 per cent), and derives from the papilla in 25 (5.2 per cent) with operability 44 per cent. Operability for the total group amounts to 9 per cent, morbidity--17 per cent and overall lethality--15 per cent; of the latter following radical interventions 4 per cent, palliative interventions 8 per cent and explorative laparotomy 3 per cent. The details of the operative technique are comprehensively discussed.

This is a report on retrospective summed-up analysis of the therapeutic approach to 296 patients presenting postoperative peritonitis (PP). They account for 1.4 per cent of the total number of patients operated on in the clinic. The latter percentage differs in the single groups of patients, distributed by organic localization of the pathological process, as follows: 1.3 per cent in hepatobiliary and pancreatic diseases, and 1.9 per cent in gastroduodenal ones. In colorectal diseases the percentage grows to 8, and after the 80th year of life it falls to and below 4, amounting to 2.2 per cent during the last five years. The overall mortality rate is 69 per cent--57.7 and 72.5 per cent respectively for the three separate groups-mainly at the expense of patients presenting oncological diseases, 73.5 per cent. The underlying causes of PP development comprise: insufficiency of the anastomosis, intraoperative contamination and infection of the abdominal cavity, intraoperative oversights-technical errors, iatrogenic and foreign body, circulation derangement in the organ operated on, suture applied to cancer infiltrated and infected tissue and persisting peritonitis for which the intervention is undertaken. The diagnosis is difficult regardless of the biochemical, instrumental and microbiological examinations performed. Early relaparotomy is the only possible life-salvaging approach to the patient, its immediate goal being sanation of the source, peritoneal lavage, wide drainage and ileostomy. PP remains a problem difficult to handle irrespective of the progress of antibiotic and resuscitation treatment.

The modern diagnosis of biliary tract cancer is still unsatisfactory regardless of the introduction of updated instrumental diagnostic methods. The latter may undergo development and transformation into therapeutic procedures. Patients with increased operative risk, and those presenting locally intractable neoplasm or metastases are indicated for this kind of alternative therapeutic approach. Experience had with endoscopic treatment of 89 patients with cancer of the biliary apparatus is shared. In forty of them (45 per cent) treatment with endoscopic papillotomy, prosthetic replacement or pernasal drainage proves successful. The procedure runs the hazards of early and late complications. Survivorship is prolonged by six months average, maximum 23 months. In eight cases permanent percutaneous (external) biliary drainage is undertaken as a final palliative measure, contributing to survival ranging from 1 to 3 months. In conclusion, the alternative methods have an actual place in the armamentarium of treatment procedures for this contingent of oncological patients.

Biliary apparatus cancer is a rare condition characterized by low operability percentage. This is a comparative study of two series of patients, operated during the periods 1952-1979 and 1980-1994. In the first observation period (28 years) 119 patients are operated, and in the second 13-year period a total of 206 patients are subjected to operative and endoscopic treatment. One-hundred five patients present gallbladder carcinoma. The age, gender and clinical patterns characterizing the contingent being examined do not show noteworthy changes with time. Over the past few years, a variety of palliative operations are used, with the proportion of cases subjected to radical operation showing no increase. Carcinoma of bile ducts is diagnosed in 98 patients. During the second observation period, the number of women and patients in advanced and senile age augment. The diagnosis is delayed; thanks to puncture biopsy with cytological study, histological verification shows a three-fold increase. The number of radical operations is slightly increased while the percentage of explorative laparotomies is noticeably diminished. Carcinoma of papilla Vateri has optimal outlooks for surgical treatment. In the latter case too the number of women and patients above 60 years of age shows an increase. Radical intervention is resorted to in fourteen out of 33 patients.

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). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

Irrespective of the high rate of bacterial flora (intestinal, respectively) penetration into the biliary apparatus, clinically manifested cholangitis cases are relatively seldom met with. The predisposing factors involved are: penetration of virulent flora (anaerobic inclusive) into the bile ducts, presence of conditions promoting delay or discontinuation of the bile passage (biliary hypertension), and longstanding of the disease. Cholangitis associated with cholangiohepatitis development is one of the severest conditions of cholelithiasis (ChL), being observed as an independent nosological entity also. Over the period 1974 through 1993, in the clinic of abdominal surgery a total of 144 patients presenting cholangitis undergo treatment, of which in 74 (8.7 per cent) it is associated with ChL, in 58 it is discovered during reoperation on the biliary apparatus, and in twelve it is diagnosed as an independent disease, unrelated to calculosis. Acute cholangitis runs a foudroyant course with a poor prognosis, whereas the chronic form is characterized by larvate (masked) development with exacerbation periods. The clinical picture is dominated by Charcot's triad. The disease runs a rather severe course in the contingent liable to reoperation. As a rule, it occurs as the result of stricture of the bile ducts or obliteration of bilidigestive anastomosis. 58 per cent of the patients are older than 50 years. Operative intervention in acute cholangitis should be done on an emergency basis. External drainage insertion is a palliative measure, practicable in heavily damaged patients. The operation in acute and chronic cases is aimed at maximum possible healing of the biliary tract and elimination of the underlying causes of obstructed passage. Lethality is higher than the medium rate, and the prognosis remains serious.

Transrectal echography using a high-frequency transducer is a well established method for preoperative rectal carcinoma assessment, and for postoperative follow-up of patients with anterior resection for rectal carcinoma. Having in mind the impossibility for follow-up study of patients with abdominal perineal extirpation of the rectum by transrectal echography, a new pattern of application of the transducer employed for endorectal examination is suggested. In five patients (4 women and 1 man) endocavitary echography through the anal canal is done. In women the examination is supplemented by transvaginal echography. A local recurrence in the course, of transvaginal study is recorded in one patient. The technique of examination and the superiorities of the procedure are discussed.

Emphasis is laid on the correlation existing between liver and biliary apparatus pathology. On the one hand, attention is called to the development of reactive hepatitis in 60-75 per cent of patients presenting complicated cholelithiasis, and in nearly 30 per cent of the forms free of complications. Removal of the biliary pathology leads to complete regeneration of liver parenchyma in 80 per cent of the patients, especially in operation undertaken in opportune time. On the other hand, pathological conditions of the liver aggravate the developmental course and worsen the prognosis of biliary system diseases when operative management of the letter is necessitated. On the basis of personal experience, the unduely elevated risk in combining surgical intervention for biliary pathology with liver cirrhosis (27 observations), cholangiohepatitis (89 observations), and obstructive jaundice conditioned by a benign underlying cause--usually concrement (164 observations), is underscored. In established cholelithiasis it is fully justified to advise early operation. Surgical intervention in liver cirrhosis should be done after adequate preparation only if absolutely necessary. Obstructive jaundice requires urgent operation, within 10 days, as long as the pathomorphological changes are still reversible.

Papilla Vateri carcinoid is among the very rarely occurring locations of the lesion. The small lumen of the papilla is the underlying cause of becoming clinically manifest with icterus rather early. Accessibility of the process for endoscopic biopsy facilitates the diagnosis. Even histologically it is very difficult to differentiate benign from malignantly altered carcinoids. Only the existence of metastases confirm with certainty their malignant nature. An observation on papilla Vateri carcinoid in a 60-year-old woman, proved preoperatively through cytological study, is reported. Intraoperative--no metastases are discovered. Sparing pancreatoduodenal resection is performed with a good functional outcome, recorded at the checkup examination after two years.

Proceeding from personal clinical experience gained during many years of studies, the authors discuss the diagnostic and surgical problems of biliopancreatitis. In recent years biliary calculosis has been basic etiologic factor in 70 per cent of the cases; 76.8 per cent of the patients had complaints of long standing, while in the rest the history was shorter. The duration did not correspond to the morphologic findings. Only 43 per cent of the patients had clinical symptoms suggestive of accompanying pancreatitis, and echographic examination helped to establish the diagnosis in only 21 per cent of the cases. Two thirds (64 per cent) were patients in advanced and senile age, 5.8 per cent had severe preoperative complications and 52 per cent had systemic diseases affecting organs other than the liver and pancreas. The operations were primary in 169 patients (82 per cent) and repeat in 38 (18 per cent). The remote results were very good in 82 per cent, good in 9 per cent and satisfactory in 9 per cent. It is considered that treatment of chronic biliopancreatitis keeps on being surgical; endoscopic manipulations rather seldom produce ultimate therapeutic effect.

The indications for retrograde cholangiopancreatography and for endoscopic papillotomy from the surgeon's view point are discussed. Endoscopic papillotomy is an operation of insufficient volume in chronic pancreatitis with obstacles along the Wirsungian's duct and in bile duct calculosis in younger age. These cases require surgical intervention or its association with endoscopic manipulations. Summarized data are reported on the risk after diagnostic or therapeutic procedures: complications may develop in 1 to 3.6 per cent after retrograde cholangiopancreatography and in 4 to 10 per cent after endoscopic papillotomy. Mortality rates are accordingly 0-0.015 per cent after the diagnostic and 0-5.8 per cent after the therapeutic procedure. Eight personal observations are described, 5 of them after endoscopic papillotomy. Six operated patients died. It is emphasized that, regardless of the existing risk, endoscopic manipulations should be performed with strict observance of the indications.

Proceeding from a review of the literature and the personal observation of a case of tubulovillous adenoma of the large duodenal papilla, which had undergone malignant degeneration, the authors outline the diagnostic problems in this pathology. Since its clinical manifestations are not specific enough, it comes into consideration only after the possible more common diseases in the region of the right subcostal space have been ruled out. Preoperative diagnosis can be established mainly with fiber duodenoscopy. The demand from the pathologist is not only to give a histologic diagnosis, but to define the biologic nature of the tumor formation, since this predetermines the operative approach. It is sometimes difficult to give answer to the latter requirement even through and intraoperative express biopsy specimen examination.

The still rather limited application of laser in biliary surgery is pointed out, to experience gained so far, including personal one, laser is being used in extirpation of the gall bladder, for treatment of the bladder bed, for choledochotomy and for papillosphincterotomy. Laser papillosphincterotomy was performed in a 65-year-old female patient--the first case in this country. This method has some advantages--adequate hemostasis, absence of reactive edema, early re-establishment of bile flow, adhesion of the incision edges.

The clinical study includes 76 pancreatic pseudocysts localized in the head (24), body (37), and tail (15). The effect of treatment by means of a single or repeated purposeful aspiration in ultrasonic control is discussed. Recovery occurred in 83.3% of cases with cysts measuring up to 5 cm, in 61.3% in those with cysts measuring from 5 to 10 cm, and in 11.1% of cases in which the cysts measured more than 10 cm. As the result of 15 draining manipulations of cysts which were irresponsive to aspiration (9 of them measuring from 5 to 10 cm and 6 larger than 10 cm) complete recovery occurred in 13 cases. The authors discuss the indications for single, two, and many punctures on basis of a complex appraisal of the gland, the size and type of the cyst, and the cytologic results. The indications for percutaneous drainage, the period and techniques of its performance and preliminary and postmanipulation treatment with drugs are determined and the occurring complications are shown.

The authors discuss the possibilities of ultrasonic tomography and subsequent performance of purposeful punctures for establishing the precise diagnosis of hepatic and perihepatic abscesses. In most cases the method helps in revealing the cavities measuring no more than 1.5-2.0 cm. The indications are determined, as well as the techniques of topical treatment with the use of single and multiple punctures and prolonged percutaneous drainage. Seventy-three patients (32 with hepatic and 41 with perihepatic abscesses) underwent clinical examination. Topical therapy was applied in 21 patients with discovered hepatic abscesses, 17 of them recovered. Operations were avoided in 25 in a group of 34 patients with perihepatic abscesses (in 7 the abscesses were not identified). The success of this treatment is determined by exact diagnosis and precise manipulations.

Data on 564 patients who underwent operation for cancer of the rectum are analysed. Amputation of the rectum was resorted to most frequently because of the low localization of the neoplastic process in the majority of patients. Mortality was higher in amputation than in anterior resection of the rectum. Criteria for sphincter-preserving operations are determined. Preference is given to anterior resection of the rectum as a more physiological operation which was also performed on elderly patients.

By the method of molecular deposition, ions of CrO 2 2+ VO3+ and MoO 2 2+ were supported on a matrix of amorphous SiO2. Different types of organic ligands were supported subsequently on the surface compounds so formed. The catalytic activity of the samples was studied in the decomposition of comene hydroperoxide.

Decomposition of cumene hydroperoxide in the presence of the acetylacetonate complex of MoO 2 2+ supported on a matrix of SiO2 has been studied. The reaction is first order with respect to the catalyst. The initial rate remains unchanged at concentration at cumene hydroperoxide concentrations above 0.08 mol/dm3. A two-stage mechanism of hydroperoxide decomposition is suggested.

In three successive papers the clinical, diagnostic and surgical possibilities of biliary tract carcinoma are discussed on the base of 119 patients, undergone operation at the Chair of Abdominal Surgery for the period 1952-1979: 52 (44%) with gallbladder carcinoma, 48 (40% with biliary ducts carcinoma and 19 (16%) with duodenal papilla carcinoma. The authors report that gallbladder carcinoma is most frequent - 4.4 per cent of all biliary operations. The ratio males: females is 1:3 and the highest number of the patients is over the age of 60. The diagnosis is usually made with 6 months later due to the atypical clinical picture, progressing under the mask of cholelithiasis, found in 70-100 per cent of the cases. That is the reason in 5 per cent of the cases that carcinoma involved the whole gallbladder, metastases and infiltration of the adjacent organs being frequent. Resectable proved to be only 9 patients, the mortality rate kept high. A complex diagnostics is recommended with present-day methods and early prophylactic cholecystectomy in case of calculosis.

A small percent of the population in our country suffer chronic constipation, manifested in various degrees. To surgical treatment are subjected patients with severe decompensated forms of constipation, resulting in a general state deterioration, when the systematic conservative treatment failed to give an effect. In five patients, ileosigmoanastomosis below Balli sphincter was performed thus interrupting the pasage through the large intestine. All cases, followed for a period of one to three years, reported regular daily defecation. The results from the carried out control clinical, laboratory, X-ray, endoscopic and microbiological investigations are reported. The author's opinion is that the surgical treatment must be given consideration in thoroughly examined and selected patients with severe forms of chronic constipation.

Sixty one patients were studied during a three-year clinical investigation: 39 patients with cancer of gallbladder and 22 with cancer of biliary ducts. The diagnostic values of echography in those diseases was assessed. The method proved to be sensitive in 84,6 per cent in cancer of gallbladder, with specificity in 94,6 per cent and accuracy in 90,5 per cent and in cancer of biliary ducts, with the exception of papilla of Vater, those values were 66,6, 96,2 and 95,5 per cent respectively, and in papilla--28,6, 98,8 and 93,7 per cent. The good diagnostic values of the method in cholestasis and the place of biliary stop is stressed upon. Various echographic images of cancerous alterations of gallbladder and biliary ducts are described.