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In 93 decreased patients, 31 with first myocardial infarction and 62 with repeated myocardial infarction, the following indices were studied: risk factors, previous history, clinical onset, complications, ECG localization, time and cause of death, pathologicoanatomical changes. There was a tendency toward a greater frequency of cardiogenic shock in the patients who died during their first infarction. In the patients who died during a repeated infarction the following events were significantly more frequent: pulmonary thromboembolism (9.6%), dilatation (8.1%), recurrence (8.1%) (p less than 0.01); chronic cardiac failure (25.8%), episodes of clinical death (25.8%) (p less than 0.001); conduction-rhythm disturbances (75.8%) (p less than 0.05). Transmural infarction was found in 96.7% of the patients of the first infarction group vs 82.2% of the patients of the repeated infarction group (p less than 0.05). A statistically significant difference for the time of death was found only for the group patients who died after the 7th day of the infarction--0% for the first infarction group and 25.8% for the repeated infarction group (p less than 0.001). Cardiogenic shock was a significantly more frequent cause of death for the patients of the first infarction group (87.1%) than for the patients of the repeated infarction group.

The term "postcholecystectomy syndrome" indicates etiologically and pathogenetically various lesions of the organism related to variably expressed symptoms of pain and dyspepsia. The author has performed endoscopic retrograde cholangiopancreatography (ERCP) to 60 patients with "postcholecystectomy syndrome" to find out what underlies this syndrome. In 34 (56%) of the patients the biliary ducts were dilated. The most frequent cause of this was Vater's papilla stenosis, which was found in 26 patients (43%). The author is of the opinion that this stenosis preceded the cholecystectomy and was the result of inflammatory processes related to cholelithiasis. In 20 patients stones were found in the biliary ducts, single or multiple. In most cases the stones in the biliary duct had been missed during the cholecystectomy. In some patients the stones in the biliary duct were formed after the operation. In 26.6% of the patients ERCP helped in discovering other diseases such as chronic pancreatitis, duodenal ulcer and peripapillary diverticulum which are in the basis of the "postcholecystectomy syndrome". The author recommends to every patients with persistent complaints after cholecystectomy ERCP to be performed in order to find out the cause of the complaints and determine the correct treatment--medicamentous or surgical.

A brief review of the spread of visceral leishmaniasis in Bulgaria and data about the disease are presented. A case of probably nonautochtonous form of visceral leishmaniasis is described. The clinical evolution of the disease is followed up and the large number of examinations which were carried out for the etiological diagnosis are presented. The diagnosis is based on the characteristic clinical symptoms, epidemiological history, positive serologic tests but with a negative myelogram. The diagnosis was proved ex juvantibus by the antimony treatment and the full recovery of the patient. This is the first case of visceral leishmaniasis in the 40 year history of the hospital.

A case is presented of a woman with drug disease related to the use of non-steroid antiinflammatory drugs. The disease was manifested by combined impairment of several organs and systems: arthralgia, febrility, anorexia, fibroscopic data for superficial gastritis, iron deficiency anemia, angiospastic syndrome, impairement of the liver and the kidneys. The renal lesions differed from the usual for such cases tubulointerstitial changes and a mild mesangioproliferative glomerulonephritis without manifested clinical symptoms was found. Discontinuance of the treatment with the non-steroid antiinflammatory drugs lead to the disappearance of the complaints and normalization of all laboratory indices.

156 patients with hypertension II stage according to the WHO classification and left ventricular hypertrophy proved by echocardiographic examination were treated in the course of one year with various class beta-blockers. At the end of the first month of treatment the thickness of the interventricular wall, of the posterior wall and of the left ventricular muscular mass does not change. Till the end of the 6th month the thickness of all these three decreases (p less than 0.0001). The additional decrease at the end of the 12-ve month of treatment is insignificant to that at the 6th month. The mean percentage decrease is greater by treatment with beta-blockers without inner sympathomimetic activity than with beta-blockers with such activity. There is no difference in relation to the cardioselectivity of the drug. Till the end of the 12-ve month of treatment the left ventricular muscular mass becomes normal in 35.9% of the patients on the background of normalized arterial pressure. In 6.4% of the patients the left ventricular muscular mass does not change in spite of the decrease of the arterial pressure. The percentage reduction of the left ventricular muscular mass correlates with the percentage decrease of the systolic (r = 0.603), diastolic (r = 0.457) arterial pressure and the heart rate (r = 0.636).

108 patients, 75 men and 33 women, mean age 35 years, with reactive arthritis were studied by microbiological and serological methods for identification of a probable triggering infection. In 32 of the patients a Chlamydia infection, in 30 patients--Yersinia infection, in 7 patients--Staphylococcus infection and in 4 patients--Shigella infection were found. In 27 patients no infectious agent was found but in 4 of them a positive CBR for chlamydia in the sex partner was found. The course of the arthritis is acute or subacute, oligo- or polyarthritis, involving mainly the large joints of the legs. The clinical picture of the arthritis is similar for all etiological forms. This implies a systematic microbiological and serological examination of the patients in order to find out the triggering infection and its appropriate treatment with antibiotics.

172 patients with systemic lupus erythematodes (SLE), mean age 35, 4 years and mean duration of the disease 5,9 years, were followed up with the aim to study the evolution of the disease in the Bulgarian population. After 44 months of observation the patients are classified in 3 groups: A. Subclinical SLE--32 patients, B--classical SLE without unfavourable prognosis and signs--62 patients, C. SLE with a heavy course and poor prognosis--78 patients. The three groups are compared according to: mean age of the onset of the disease, mean duration of the disease up to the time of the study, mean duration up to the appearance of poor prognostic signs, number and types of the complications in the three groups up to the time of the study, number of deaths. The patients with unfavourable prognosis are with an earlier onset of the disease compared with the other patients (p less than 0.001), rapid development of severe prognostic signs in relation to the mean duration of the disease in the three groups (p less than 0.001), frequent and severe complications. 25 patients from the group with a severe course have died. The patients with a favourable course of the disease from groups A and B are with a later onset of the disease, longer duration, do not develop severe prognostic signs, the complications are mild and rare and there are no deaths.