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Biomedical subjects

L Kovachev

Publications and source records attributed to L Kovachev.

At least 19 recordsLinked to original sources
PubMed1998

[Technics for laparoscopic cholecystectomy--their use and results].

In mini-invasive surgery mainly two operative techniques for laparoscopic cholecystectomy are familiar and implemented in practice--"American" and "French" technique. Over the period May 1993 to September 1997, in the two surgical clinics of H. M. I.--Pleven a total of 311 laparoscopic cholecystectomies are performed. Of them 218 are done according to the "American" technique, 87--according to the "French" technique, and six patients are operated using the so-called "lifting" technique. In the appear submitted the advantages and shortcomings of the two techniques for laparoscopic cholecystectomy are comparatively studied. The timing of operative intervention CO2 quantity expenditure and intraoperative complications are analyzed. The choice of technique for laparoscopic cholecystectomy depends on the surgeon's personal judgement, but under given situations one of the two techniques or a combination thereof should be mandatorily used.

Acute Disease↗
PubMed1998

[Decontamination in colorectal surgery].

The results of perioperative decontamination in a series of 136 patients presenting diseases of the colon and rectum are evaluated. Of the total 74 are subjected to operation according to schedule, and 62 are operated on an emergency basis. Perioperatively, metronidazole plus a cephalosporin antibiotic (cephazolin, cephalothin or cephamandol) are administered. Primary anastomoses are done in 32 cases operated according to schedule, and in fourteen patients operated in the emergency room. Insufficiency of the anastomosis is recorded in 3.5 per cent in the former group, and in 15 per cent in the latter group (p > 0.05). Operative wound suppuration occurs in 5.4 per cent against 13 per cent (p > 0.05), with lethality amounting to 1.3 per cent and 19 per cent, respectively (p < 0.001). Postoperative pneumonia is registered in 4 per cent of those operated on schedule and in 9.6 per cent of those operated by urgency (p > 0.05). In either group there is not a single case of operative wound dehiscence. In colorectal operations antibacterial prophylaxis applied perioperatively proves effective in combating systemic and local inflammatory complications.

Aged↗
PubMed1998

[The role of the surgeon in treating multiple organ failure].

Over the period 1990 through 1995, thirty-five patients with multiorgan insufficiency (MOI) undergo treatment. Abdominal operations are performed in all of them, except for one male patient aged 31 years, dying of bilateral pneumonia and metabolic disorders resulting from duodenal stenosis. Overall mortality rate amounts to 77 per cent (20 cases). Programmed peritoneal lavage (PPL) is done in seventeen patients with lethality 77 per cent (13 cases). In two instances iatrogenic damage to the spleen contribute to fatal septic complications development. All PPL treated patients with fatal outcome have bilateral pneumonia. MOI prevention is still closely linked to prophylaxis against the complications producing it. Programmed peritoneal lavage in immunocompromised and malnourished patients is a risk factor equally serious as the septic noxa being attacked, and what is more it runs the risk of inflicting additional iatrogenic noxae. General endotracheal anesthesia in PPL is likewise a factor demanding further clarification.

APACHE↗
PubMed1997

[Emergency reoperations in surgery of the gastrointestinal tract].

Data concerning the therapeutic approach in a series of 28 patients, representing 1.3 per cent of the total number of abdominal operations performed in the Chair of Propedeutics of Surgical Diseases over the period 1990-1995, are retrospectively analyzed. In 19 of them primary operative interventions are done on an emergency basis. In further 19 cases the complications have inflammatory character. A total of 31 operations are done with lethality amounting to 36 per cent (10 patients). Multiorganic insufficiency develops in five of them (mean age 39 years). The remainder, dying of septic complications, are with mean age 76 years. The successful treatment of intraabdominal postoperative complications is largely dependent on the surgeon's experience and skills, material equipment and facilities available and on the algorithm of the therapeutic approach adopted.

Bulgaria↗
PubMed1997

[The treatment problems of soft-tissue infections].

The treatment results is a series of twenty-six patients running a very serious course of soft-tissue infections are analyzed. Of the total number ten have diabetes mellitus. The sepsis severity score is 23 average according to the APACHE II rating system. Operative management is undertaken without any delay. It is preceded by comprehensive correction of the metabolic disorders present and antibiotic treatment, initially substantiated by presumable microbial causing agents. A total of 62 operations are done. In 36 per cent of cases being examined, the microbiological study contributes to a proper orientation of the antibiotic therapy performed. Bacteremia is documented in three instances. Total mortality rate amounts to 32 per cent (8 patients). Infections running a serious clinical course may be caused by one or more microorganisms, but in either case the lethality is noteworthy. Active surgical management may prove effective provided it is initiated in the most opportune time. It is only part of the complex therapeutic approach to sepsis.

APACHE↗
PubMed1994

[Our experience with the surgical treatment of cholelithiasis].

The treatment results in 312 patients with cholelithiasis, covering the period 1989 to 1993, are retrospectively analyzed. Overall postoperative lethality amounts to 4.4 per cent. The obtained results are fully comparable in terms of both missed concrements left behind within the extrahepatic bile ducts, and in terms of postoperative complications, associated with the indications for choledochotomy. This is attributed to the therapeutic approach algorithm adopted with respect to the indications for intraoperative cholangiography and choledochotomy.

Acute Disease↗
PubMed1994

[The possibilities for organ-preserving operations on the spleen].

Experience had with application of spleen salvaging operations in adult patients is shared. They are used traumatic lesions of the spleen in eleven patients, employing the method of Delany, as modified with the Bulgarian polyamide meshwork Ampoxen. In two of them the hemostasis fails, and splenectomy is resorted to. Preservation of the spleen is accomplished in one patient with chronic pancreatitis where left pancreatectomy with spleen preservation according to the technique of Pradere et al is done. In another female patient, presenting echinococcus of the spleen, echinococcectomy with preservation of the organ is performed. Based on updated knowledge of the role played by the spleen in promoting protection against infection, the strive for its salvage whenever possible is fully justified.

Caprolactam↗
PubMed1993

A case of intraduodenal diverticulum imitating choledochocele.

An intraduodenal diverticulum in 54 year old woman which caused alcalculous cholecystitis and pancreatitis is described. The diverticulum was missed at the first operation, performed for acute cholecystitis. Before the second it was interpreted as a pancreatic cyst. At the second intervention, the cyst wall was excised through a duodenotomy. Histological examination of the wall of the diverticulum is crucial for correct diagnosis.

Choledochal Cyst↗
PubMed1990

[Smooth-muscle sphincteroplasty in constructing a colostomy].

A method is described for producing continent colostomal by smooth-muscle sphincteroplasty. There are variants of operative technique: autogenic smooth-muscle intestinal grafting and pediculated plasty. A 10 cm long intestinal segment is split along the free tenia, mucosectomized and wrapped around the precolostomal part of the colon. Essential element of the operation is the 100 per cent stretching of the seromuscular flap when fixed. A tight sphincter-like cuff results. The method is unassociated with specific complications. The first impressions of the sphincteroplasty with encouraging results are recorded. In cases when no sphincter effect was obtained there was inadequacy in some elements of the operation. Then the stoma functions as a conventional one.

Colostomy↗
PubMed1990

[Acute inflammatory diseases of the extremities].

A total of 208 patients with diseases of the extremities, 56 of whom with diabetes mellitus, were included in the study. Septicemia developed in 6 patients, in 4 of them being caused by anaerobic pathogens. The following surgical interventions were performed: 193 incisions, 32 amputations of varying extent and 15 large-scale necrotomies. The case fatality rate was 1.44 per cent. To achieve superior therapeutic results and a better life for patients with diabetes mellitus, it is necessary to change the former approach to their long-term medical surveillance.

Abscess↗