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Biomedical subjects

I Viiachki

Publications and source records attributed to I Viiachki.

At least 19 recordsLinked to original sources
PubMed1994

[Our experience with treating acute noncalculous cholecystitis].

Based on a comprehensive literature survey, personal experience with the management of 89 patients, presenting acute noncalculous cholecystitis, is shared. All patients are clinically observed in the acute phase of the disease. In 60 cases the latter becomes manifest with recurrent attacks, and in 29 there are no previous signs or symptoms of biliary diseases. Diagnosis is made on the ground of active echographic and clinical observation. Conservative therapy is effective in 28 cases. The remainder (61) are operated at 1 to 4-day intervals after the onset of the disease because of persisting symptomatology and/or deterioration of the patient's condition. During laparotomy the gallbladder presents marked enlargement with thickened, exudate-imbibed wall. Cholecystectomy is done in all 61 cases. In twelve of them, owing to dilatation of the common bile duct and minimal serum bilirubin increase, stenosing papillitis is diagnosed by intraoperative cholangiography, treated by external biliary drainage and endoscopic sphincterotomy, undertaken after improvement of the general condition. Acute inflammation, free of fibrosis, with isolated foci of gangrene and necrosis of the bladder wall are histologically documented. In four senile patients presenting serious concomitant diseases, with exceptionally high operative risk, echographic percutaneous transhepatic cholecystectomy is resorted to, followed by antibiotic bladder instillations with a very good outcome. The summed up results of acute noncalculous cholecystitis treatment are estimated as very good.

Acute Disease↗
PubMed1994

[The treatment of acute cholecystitis complicated by mechanical jaundice].

After analyzing the summed up treatment results in 368 patients with acute cholecystitis, complicated by obstructive jaundice, the inference is reached that it is a matter of a complication, unfavourable in terms of prognosis, with a definite impact on both immediate and long-term therapeutic results. Early operative intervention following intensive preoperative preparation (including ERHPG with endoscopic papillosphincterotomy and ensuing biliary decompression, or echographic percutaneous cholecystectomy) contribute to control the acute inflammatory process in the gallbladder, and preclude the development of liver (or hepato-renal) failure against the background of obstructive jaundice. Proceeding from the severe, irreversible changes in liver and kidney, hardly responding to treatment, and persisting deterioration of the general condition, acute cholecystitis complicated by obstructive jaundice is defined as an emergency life-endangering condition, requiring a priority operative approach.

Acute Disease↗
PubMed1994

[Necretomy and prolonged local postoperative lavage in the surgery of necrotic pancreatitis].

Over an 8-year period, sixty-one patients with mean age 52.5 years are operated on for necrotic pancreatitis in the clinic of emergency surgery at the Faculty Hospital "Queen Giovanna"--Sofia. The initial prognosis of the severity of disease scores 4.5 points average according to Ronson's rating system. The indications for operative treatment are clinically determined and further specified by ultrasonographic echo-ranging and computerized axial tomography. Necrectomy associated with prolonged local postoperative lavage are used as a method considered the most adequate from tactical viewpoint. The criteria for this particular therapeutic approach are substantiated. At 19.6 per cent lethality the postoperative results are estimated as satisfactory, and fully consistent with worldwide experience along this line.

Acute Disease↗
PubMed1993

[Biliary ileus].

This is a report on nine cases presenting biliary ileus. All patients undergo operative management. Two female patients present Bouveret's syndrome. The inference is reached that gallstone induced intestinal obstruction is characterized by atypical clinical patterns, conditioning in turn the diagnostic difficulties encountered, and the necessity to undertake operative treatment against the background of advanced ileus. The latter is one of the rarest forms of intestinal obstruction. Biliary ileus treatment consists in the removal of small intestinal impatency. The concretion is pushed in oral direction, and its evacuation is successfully accomplished by enterotomy, duodenotomy or gastrotomy. Two fatal outcomes due to severe advanced form of ileus are reported.

Aged↗
PubMed1993

[Echinococcosis--the current surgical aspects].

Over the period 1985 through 1992, forty-four patients presenting echinococcosis (echinococcus of the liver--33 cases, lung--nine, and spleen--two), aged 12 to 79 years, are operated in the emergency surgery clinic of the State Faculty Hospital "Queen Giovanna". The up-to-date methods of diagnosing are comprehensively described, followed by illustration and discussion of the operative procedures used in the treatment of echinococcosis. The early and long-term results are estimated as satisfactory.

Adolescent↗
PubMed1993

[Our experience in the diagnosis and treatment of traumatic pneumothorax].

The clinical material summarized is derived from the observation of 150 patients. The accent is put on the faults in the X-ray interpretation of the pneumothorax and on the mistaken tactics in the treatment of the pneumothorax, which led to four lethal cases. The attention is drawn to the importance of the prompt physical study of traumatic patients, which gives the opportunity for prompt diagnosis and urgent adequate treatment. The indications have been precised relating pleurocentesis, pleural drain and when lacking aerostasis for thoracotomy.

Bulgaria↗
PubMed1993

[The problems of severe combined chest and heart trauma].

On the basis of the experience and the analysis of 3818 cases of combined chest traumas the injuries in different anatomical areas have been observed. A special place was given for the diagnostics, the variety of the clinical conditions, the treatment and the prognosis of the reasons for lethality in cases with such traumas. With the increase of the affected anatomical areas the lethality increases proportionally too. At double, triple, fourfold, fivefold and sixfold combinations we have respectively 6.35 to 100% lethality. The indications for early surgical treatment have been stated. The acute respiratory failure (decompensation) and the shock in the combined traumas have been discusses as well.

Emergencies↗
PubMed1993

[Aggressive muscular-aponeurotic fibromatosis. Its clinical picture and morphological study].

The authors report 24 cases with aggressive muscle-aponeurotic fibromatosis for the period 1985-1990. Eleven cases with proved fibrosarcoma have been studied as well. From the total 35 cases the authors have observed 5 cases with localization on the front abdominal wall in women, and the remaining cases are as follows: 9 patients with thoracic girdle (c. membri superioris); 9 patients--in the head area; 5--in the chest area; 12--in the limbs; 2--in the lumbar area.

Adolescent↗
PubMed1993

[The modern differential diagnostic possibilities in chordoma].

The authors report five cases with chordoma. The diagnosis has been determined histologically on the basis of the operative material. The chordomas have a slow growth and a tendency to infiltrate the adjacent tissues and organs. That makes their surgical treatment difficult. A characterizing feature for them is the tendency to make recidivations and the difficulty in setting the differential diagnosis in metastasis of light-cell carcinomas.

Aged↗
PubMed1991

[Gastric polyposis in surgical practice. Apropos 12 cases].

Personal experience is recorded in the surgical treatment of 12 patients with gastric polyposis at the Department of Propaedeutics of Surgical Diseases of the Research Institute of Surgery, for a period of 10 years (1981-1990). They accounted for 75 per cent of the benign neoplasms of the stomach and 4.08 per cent of all gastric tumors. The results of operative treatment, both in patients treated by gastric resection according to Billroth I technique (58.3 per cent) and in patients who were treated only by removing the polyps (41.7% per cent) were considered good within a follow up period of 1 to 5 years after the intervention. Proceeding from modern achievements and reports in the literature, the authors place accent on some important current aspects of treatment and observation on gastric polyps, their correlation with a number of hyperplastic diseases and malignant neoplasms of the stomach and colon.

Adult↗
PubMed1991

[Intra-arterial chemotherapy in the treatment of liver metastases from colorectal carcinoma].

After a brief review of the literature the authors analyse the different invasive methods for treatment of liver metastases, rendering preference on intraarterial chemotherapy (IACT). The indications and contraindications for IACT and the possible complications of this approach are determined. The drugs for IACT, the types of implantable devices and the techniques for their application are shown. Criteria for assessment of the effect of treatment are determined. Experience is recorder with 3 patients with anterior resection of rectum and nonresectable liver metastases. The result was failure in 1 patient and very good in the other two.

Antineoplastic Agents↗
PubMed1991

[The surgical and endoscopic therapeutic procedures in acute hemorrhages of the upper digestive tract].

A total of 2995 patients with esophagogastroduodenal bleeding have been treated the Department of Emergency Surgery for the period 1984-1988. A significant group were patients in advanced and senile age (beyond 65--42.4 per cent). The therapeutic and surgical approach to gastroduodenal bleeding was based on the solution of the following diagnostic-tactic problems: cause, source, localization and intensity of the bleeding, temporary or definitive hemostasis patterns, severity of blood loss. Essential is also the underlying disease, patient age and accompanying diseases. Express emergency endoscopy allows early and explicit visualization of the pathologic area and enables to gain knowledge on the nature and intensity of the bleeding or the character of spontaneous hemostasis. In this respect, express endoscopy is a guiding principle in managing upper digestive tract bleeding at the Department of Emergency Surgery. Of all hospitalized patients in this study were operated 203. Operations were performed after obligatory attempt for endoscopic hemostasis. The operative case fatality rate for the study period was, as follows: in gastric and duodenal ulcer 21.6 per cent, in gastric cancer 42.0 per cent, in hemorrhagic gastritis 33.3 per cent and in Mallory-Weiss syndrome 9.1 per cent.

Acute Disease↗
PubMed1991

[Abdominal adhesion disease--the diagnostic and surgical problems in emergency surgery].

Reviewing the literature, the authors discuss the diagnostic and surgical problems of abdominal adhesion disease in emergency surgery. The etiology and pathogenesis of adhesion disease is complex and still poorly understood. A number of etiologic factors are considered responsible. The authors formulate the current concepts on the pathogenesis of this disease and some classifications in the world literature. Adhesion disease is a major problem in emergency surgery, especially the form known as acute breed ileus. The prophylaxis, conservative and adequate operative treatment are of great importance.

Abdomen, Acute↗