INTRODUCTION: Nowadays colorectal cancer (CRC) incidence rate increases in the Western world. The lack of effective screening programs results in diagnosis of advanced cases in our country. Combination of hematogenic, peritoneal or systemic CRC dissemination with present or potential complications from local disease is not an exception. The decision for palliative resection is not easy and is a matter of balance between potential risks of operative intervention and advances due to local tumour resection. Positive aspects of the laparoscopic approach are important in planning of these interventions. The aim of this study is to assess the indications for laparoscopic palliative large bowel resections in the literature available and to share our own experience. PATIENTS AND METHODS: During a two-year period, in the HPB and General Surgery Clinic, Acibadem City Clinic, Tokuda Hospital of Sofia, six laparoscopic palliative colon resections were performed. In the all cases, multiple liver metastases were diagnosed without possibility of liver resection. The early perioperative results were analyzed. RESULTS: Four left colon resections were performed with primary anastomosis due to high-level large bowel obstruction and two right colectomies were done for primary tumour bleeding. Three patients were over 77 years old and presented with comorbidity. Average hospital stay was 5,6 days. No perioperative complications were observed. CONCLUSION: Minimal surgical trauma, short recovery period and well-defined indications are important features in the process of planning of palliative large bowel resections in patients with disseminated CRC. The objective is to reduce risks of complications connected with primary tumour and to assure a good patient's quality of life.

The common cause of metastatic cervical lymphadenopathy is the spread from primary tumours in the head and neck region. However, in unusual cases, a primary site in head and neck region cannot be located. This calls for a complete clinical and radiological examination, focusing on the organs or areas where there is a high chance of an existing primary tumour. Sometimes, lymphatic metastases do not first develop in the lymph nodes nearest to the tumour. This is known as skip metastases. Тhe careful evaluation of these metastatic regional nodes is essential for appropriate treatment and to achieve the best outcome for the patient.

The paper explores a hybrid page layout (HPL), combining the advantages of NSM and PAX. The design defines a continuum between NSM and PAX supporting both e cient scans minimizing cache faults and e cient insertions and updates. Our evaluation shows that HPL fills the PAX-NSM performance gap.

РезюмеТуморното метастазиране, включващо няколко последователни стъпки, започвайки от инвазия на раковите клетки в околните тъкани, е ключовият фактор, който компрометира прогнозата на раково болните пациенти и отговаря за 90% от смъртността. 2/3 от диагностицираните пациенти са с локално авансирал процес и/ или метастатична болест (стадий III или IV). Проучването на молекулярни и клетъчни механизми, водещи до формирането и метастазирането на плоскоклетъчния карцином от ларингеален произход, би било от клинична полза за разработването на молекулярна таргетна терапия. На базата на обширен литературен обзор акцентът е поставен върху следните гени -TP53, CDKN2A -exons 1,2,3 and PIK3CA -exons 9, 20, като потенциални отговорници за повишаване метастатичния потенциал на плосколетъчния карцином от ларингеален произход. Изследването на генетично сродство между карцином и метастаза би имало теоретичен принос към опознаването на генотипа и мутационния статус на плоскоклетъчните карциноми на глава и шия, чийто практически потенциал се изразява като прогностична стойност за преживяемостта на онкоболните и подобряване на терапевтичния алгоритъм при диагностицирани пациенти. Ключови думи: плоскоклетъчен карцином на глава и шия, метастазиране, генотип, мутационен статус, таргетна терапия, прогностична стойност. Специфични аспекти в проучването на онкогенезата и метастазирането на ларингеален плоскоклетъчен карциномSpecific aspects of researching the oncogenesis and metastatasing potential of laringeal squamous cell carcinoma.