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Biomedical subjects

N Iarŭmov

Publications and source records attributed to N Iarŭmov.

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↗
PubMed1991

[A modified Sugiura operation].

This is the first report in Bulgaria of the application of the modified method of Sugiura. The operation is less traumatic than the original one, the postoperative mortality is essentially reduced, patient survival to 7 years is increased and there is no encephalopathy. This operation is technically easier to perform than splenorectal anastomoses and may be performed both as planned and emergency intervention. Two personal observations on two patients operated by the modified technique of Sugiura are reported. The results were very good.

Adult↗
PubMed1991

[Our initial experience with Shouldice's hernioplasty].

For the first time in Bulgaria the authors herniotomy of inguinal hernias by the method of Shouldice. This method is anatomo-physiological and is pathogenetically well-grounded. Shouldice's method is considered the method of choice in inguinal hernias.

Adult↗
PubMed1991

[The treatment of suppurative and atonic wounds with the CO2 laser and the helium-neon laser].

The doctrine on wounds is the most important and current one in general surgery and reflects the level and development of medicine. Each surgeon should be well acquainted with all processes and stages of wound healing, because treatment of a suppurative wound requires keen knowledge and art. The basic principle of the local treatment of a septic wound is the thorough knowledge on the objective criteria underlying the course of the wound process and on the etiopathogenetic therapy. Laser therapy of wounds accomplishes adequate necrotomy, acts aseptically on the wound surfaces, inhibits the wound microbial flora and stimulates the regeneration processes. The authors record their experience in CO2 laser and helium-neon treatment of 120 patients with suppurative, atonic and decubital wounds over the period 1984-1990.

Adult↗
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↗
PubMed1991

[A modified Sugiura operation].

The modified method of Sugiura is reported for the first time in Bulgaria. The operation is less traumatic than the original one, the postoperative case fatality rate is lower, patient survival rate up to 7 years is high and there is no encephalopathy. This operative technique is more practicable than splenorenal anastomosis and may be applied both for planned and for emergency operations. Two patients have been operated by the authors, using the modified technique of Sugiura, with very good results.

Adult↗