Biomedical subjects
Publications and source records attributed to N Penkov.
In this reivew the historical aspects are presented about the sindroma of Mirrizi. It's forms and pathogenesis are described. We define the modern imaging techniques of diagnose--ultrasonography, ERCP, CT, MRI as well as the mandatory intraoperative cholangiography. A number of classifications of the sindroma are discussed, which are the guide of the surgical stategy, surgical and non-surgical methods of treatment.
It was established that the decrease up to absence flow biliary ow in the intestinal tract by the presence of extrahepatal biliary obstruction led to increased resorption of endotoxins in the system of v. portae and their getting into the systematic blood circulation. The article explores Obstructive jaundice-caused translocations of bacteria from the Gut, endotoxins, portal Endotoxaemia, entrance of endotoxins in the blood stream, Suppression of cellular immuniby, Liver ishemia, and shunting of Portal blood with development of systematic Endotexaemia. The article also discusses Functional Renal Failure, disturbance of coagulation, acute upper gastrointestinal bleeding, and disturbed wound beating that are characteristic of Biliary Obstruction.
The article reviews literature and the different variants of the syndrome, as well as its clinical picture, complications, methods of diagnosis and variants of surgical and endoscopic treatments. The article describes the case of a rare combination between Bouveret syndrome and gall-bladder carcinoma (the first such instance in our literature) in a 68 year old mate, who lived more than 3 years after being subjected to a radical treatment.
In the survey a review is made of the etiological factors (CBD obstruction and infected bile under increased pressure) as well as the mechanisms of developing acute bacterial cholangitis, acute Suppurative cholangitis, increased biliary pressure, cholangio-venus reflux, damaged function of the Kuppfer cells and the routes of bacterial penetration. The bacterial specter of the infection is analyzed alongside with the classification and staging of acute cholangitis. Current treatment of acute cholangitis is related to the high-priorirty, widespread use of endoscopic methods of biliary decompression. Emergency surgical treatment is associated with high mortality.
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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.
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.
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Experience is recorded with lincomycin treatment of 59 patients with acute surgical abdomen. The primary anaerobic flora was eradicated in 86 per cent of the patients. For the very good therapeutic results essential was the early instituted adequate antibiotic therapy in adequate dose and for adequate length of time.
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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.
A case is reported of primary malignant non-Hodgkin's lymphoma of the colon of a 85-year-old woman. The clinical manifestations and the X-ray pattern were those of cancer. The diagnosis was established on post-mortem examination. Histologically this was a centroblastic-centrocytic lymphoma of Brill-Symmers with low-grade malignancy. The clinical, diagnostic, prognostic and therapeutic problems in malignant non-Hodgkin's lymphomas of the colon are discussed.
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).
The relation between the results of the early submaximal symptom-limited bicycle ergometry [correction of veloergometric] test and coronary angiography were examined in 127 patients with unstable angina pectoris stabilized by medicaments. In 19 (15.0%) patients the test was negative and in 108 (85%) patients the test was positive (angina pectoris and/or ST depression greater than or equal to 0.1 mV at 80 ms after the point J of the ECG). Between the results of the early bicycle ergometry [correction of veloergometric] test and the coronary angiography, performed soon after the test, there was a close correlation. By using strict criteria or a combination of criteria for assessment of residual ischemia the test can with great accuracy differentiate the patients with multivascular from those with monovascular disease or with healthy coronary vessels.
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