Summary We performed a retrospective evaluation of the criteria for suspected pulmonary embolism (PE) and requests for computed tomography angiography (CTA) by the emergency room (ER) teams. Simultaneously, we tried to find irregularities in their work. Then we designed new behavioral protocols, and yearly we evaluated the effect on the workload of the computed tomography (CT) unit of the Roentgenology and Radiology at the University Hospital – Pleven and the total impact on the behavior of the teams in cases of suspected for PE. The data from before and after the intervention was evaluated. After the implementation of the protocols, matching the criteria of PE rule-out criteria (PERC), the number of D-dimer testing, echocardiography, and computed tomography pulmonary angiographies (CTPA) was significantly higher. We found that the number of patients urgently transported for primary thrombectomy had increased, and the reduction of PE mortality in the Emergency Unit proves the safety of our intervention. Overall, the intervention in the attitude of the ER teams has a significant positive effect on the management of patients with suspected PE.

Summary In the past two decades, the demographic crisis in Bulgaria has been widely debated. According to the National Statistical Institute (NSI), the proportion of people aged 65 and over is increasing, despite the general population decline in the country. To investigate whether the age structure of patients operated on has changed during the past 10 years and assess the need to reorganize the training of anesthetists,aretrospective study in the anesthesia electronic database of the University Hospital in Rouse was carried out. The data of anesthesia performed by anesthesiologists in 2005, 2010 and 2015 in patients aged 65 and over were summarized. The distribution of these patients by ASA Physical Classification System and frequency of complications during anesthesia were analyzed. The average annual number of anaesthesias for the three years was almost unchanged and amounted to about 5500. The proportion of patients aged 65 and over increased from 30.54%in 2005 to 35.72%in 2010, and 37.81%in 2015. The distribution of patients in according to the ASA Classification changed significantly: the percentage of patients ASAI-IIdropped from 36.19%in 2005 to 11.85%in 2015. The patients in the ASA III-IVgroups for the three analyzed years was 41.86%, 58.66%and 65.30%, respectively, and this was mainly due to the increase in the ASAIVpatients. It is necessary to build multidisciplinary teams and prepare specialized protocols for behavior in geriatric patients. It is imperative that anesthesiologists possess specialized knowledge about age-related organ changes and their effects on anesthesia.

Summary Cancer of the cervix causes internal, external compression or both of the upper urinary tract in 50-60%of patients in advanced stages. Retrograde stenting is the most widely used technique for desobstruction of the upper urinary tract in urology practice. Diversion of urine flow is an alternative, achieved by nephrostomy of one or both kidneys.We studied retrospectively 33 women with upper urinary tract obstruction caused by carcinoma of the uterine cervix operated on between March 2014 and March 2015 in the urology clinic at the University Hospital in Pleven, Bulgaria. Apercutaneous nephrostomy (PNS) was placed in 17 patients, and 11 patients hadaretrograde catheterization with ureteral stent type JJ. Five patients were treated with both methods. Placement ofa JJstent was the first choice procedure for all patients since it providesabetter quality of life. PNSimproves renal function faster than retrograde JJstenting. Therefore, the first method of choice for patients with an untreated primary cervical, uterine cancer is the placement of PNS. Retrograde JJstenting is the method of choice in patients who undergo surgery and radiation therapy withoutarelapse of the disease.