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Biomedical subjects

R Gaĭdarski

Publications and source records attributed to R Gaĭdarski.

At least 19 recordsLinked to original sources
PubMed2003

[Anterior approach for major hepatic resection for large liver malignancy].

The large liver cancers in the right lobe are difficult to be resected with conventional approach. We report for 2 cases--43 old year man with cholangiocellular carcinoma and 50-old year woman with metastatic liver tumor from breast cancer, both with diameter of 30 cm, successfully resected using nonconventional "anterior approach". The postoperative period was uneventful. They were discharged from hospital in 10 and 14 days.

Adult↗
PubMed2003

[Postoperative liver failure after hepatic resections for hepatocellular carcinoma].

Postoperative liver failure is a life-threatening complication after hepatic resection. The purpose of this study was to review the liver failure as a result of hepatic resection and to propose strategy for decreasing the risk of its developing. From January 1991 to December 2000 73 patients with primary liver cancer (PLC) were operated and identified in a retrospective database. Seven (13.2%) of resected 53 patients developed postoperative liver failure. There were 4 male and 3 female with mean age 52.3+/-29.2 (from 1 to 78). 3 patients had underlying cirrhosis. Major resections were 5 and minor--2. Mean hemotransfusion was 1012, 13 ml (370-2000 ml). Five patients (71%) died by the 30th day. The causes of liver failure were analyzed, based on both the preoperative data and the intraoperative findings. Significant prognostic factors were the preoperative serum level of bilirubin (p=0.024) and intraoperative hemotransfusion (0.031). The right hemihepatectomy was a prevalent hepatic resection in these patients.

Adolescent↗
PubMed2002

[Hepatic echinococcosis: radical or conservative surgical treatment].

UNLABELLED: Hydatid liver disease remains an actual medical and social problem for Bulgaria as an endemic region. Because of the lackage of medicines with satisfactory therapeutic effect the surgical treatment is still the treatment of primary importance. AIM: The aim of this study was too check the correctness of the following hypothesis: "Radical surgical procedures on hydatid liver disease have lower rates of morbidity and mortality compared to conservative ones". MATERIAL AND METHODS: In order to achieve the above mentioned aim we analysed the results of 361 patients with hydatid liver disease (267 (74%) of whom retrospectively and 94 (26%) prospectively), treated at the Clinic of General, Liver and Pancreatic Surgery during the period 1st, Jan., 1985-1st, Jan., 2001. The patients were divided in two main groups: 102 (28.25%) of them received radical surgical procedures and 250 (69.25%)--conservative ones. Nine of the patients (2.50%) had multiple echinococcal cysts and received surgical procedures of both types. That's why the results of those patients did not correspond to the aim of the study and they were not included in it. The analysis consisted of a comparison between the two main groups according to several criteria: sex, age, location and average size of the cysts, postoperative complications, reoperations, mean postoperative stay at hospital and mortality rate. RESULTS: There was a prevalence of the female in the ratio male/female in the group of patients who received a radical procedure. The location of echinococcal cysts in the left hepatic lobe was found to be more frequent. In the group of radical surgical operations the postoperative morbidity and mortality rates were lower and the postoperative stay at hospital was shorter, compared to the group of conservative procedures. CONCLUSION: Radical surgical procedures showed better postoperative results. But those procedures had to be performed only on patients who had certain indications and according to criteria described in surgical literature. The proper surgical equipment and well experienced surgical team were the other important conditions for good outcome.

Adolescent↗
PubMed2002

[Results of surgical treatment of primary liver cancer].

Using a single institution experience, the authors examine hepatic resections in treatment of primary liver cancer (PLC), the postoperative complications and mortality. Seventy-three patients were operated on between January 1991 and December 2000 and identified in a retrospective database. They were 53 men and 20 women of mean age 54.6 (from 1 to 78 years). Of the 73 operated patients with PLC, 53 underwent hepatic resection. Two patients had PLC at stage II, 43--stage III, 8--stage IV. 25 (34%) patients had underlying cirrhosis: 14--Child A and 11--Child B. 34 patients underwent major resections and 19--minor resections. 7 patients (13.2%) died of the hepatic resection--by the 30-th day. Mortality among cirrhotic patients was 25% (4 patients). 16 patients had postoperative complications. 6 patients developed liver failure. Hepatic resection is a basic method in treatment of the PLC. The presence of cirrhosis, especially Child B, increases surgical morbidity and mortality.

Adolescent↗
PubMed2002

[Hepatic resections for hepatocellular carcinoma and cirrhosis].

Liver resection in a patient with cirrhosis carries increased risk. The purposes of this study were to review the results of cirrhotic liver resection in the past decade and to propose strategies for low morbidity and mortality. From January 1991 to December 2000 73 patients with primary liver cancer (PLC) were operated and identified in a retrospective database. Twenty five (34%) patients had underlying cirrhosis: 14--Child A and 11--Child B. There were 18 male and 7 female with mean age 60.9 +/- 9.2 (from 44 to 78). There were 16 (64%) resections: 11--stage Child A and 5--stage Child B. Major resections were 7 and minor--9. Eight patients received hemotransfusion--mean 939.13 ml (370-2000 ml). Four patients (25%) died of the hepatic resection--by the 30-th day. Seven patients had postoperative complications. 4 patients developed liver failure. Major resections had 42.86% mortality, minor resections--11.11%. Hepatic resection is potentially curative therapy for HCC and cirrhosis especially in Child A. Child B produce high rate of postoperative morbidity and mortality.

Adult↗
PubMed2002

[Modified method of Sugiura-Futagawa for surgical treatment in patients with portal hypertension and esophageal varices].

BACKGROUND: The esophageal transection and devascularization (Sugiura-Futagawa's operation) is the most frequently used ablative procedure in Japan for the treatment of patients with portal hypertension (PH) and esophageal varices (EV). Recently many authors, who are followers of this method, try to find an alternative one, aiming to shorten the skin-to-skin time and achieve better early and late results. AIM: To study the postoperative results of our modification of the original Sugiura-Futagawa's method and to conclude whether it is good and reliable or not. MATERIAL AND METHODS: From Jan. 1988 till Apr. 2001 we operated 25 patients with liver cirrhosis, PH and previous hemorrhage from EV, of whom 12 were male (48%) and 13--female (52%). Age of the patients--26-67 years. The ethiology of cirrhosis was alcoholic in 8 cases (32%) and post viral hepatitis--in 17 cases (68%). All our patients belonged to Child-Pugh's group A. The operative technique of our modification is described--transabdominal esophageal devascularisation, deconnection and reanastomosis. RESULTS: The early postoperative mortality rate after our modification of the Sugiura-Futagawa's method was 12% (in 3 cases). Death cause--fulminant hepatic failure with hepato-renal syndrome (in all three cases). The mortality rate was also 12% but no one of the complications was life threatening or an indication for reoperation. The 5-year survival rate accounted 78%, recurrent esophageal bleeding--7.14% and late hepatal encephalopathy--also 7.14% of the followed patients. DISCUSSION: The surgical treatment is of main importance for better survival in cases of PH and previously bled EV. A comparison between the results of other authors and our results is made. CONCLUSION: The proposed by us transabdominal esophageal devascularisation, deconnection and reanastomosis as a modification of the Sugiura-Futagawa's procedure is easy fro the technical point of view and leads to good results.

Adult↗
PubMed2002

[Mesenteric-inferior-renal shunt--alternative of proximal and distal spleen-renal shunt for surgical treatment of portal hypertension].

Surgical operations are important for the prevention of recurrent bleeding and better survival rates in patients with portal hypertension and previous haemorrhage from esophageal varices, stopped by conservative treatment. Spleno-renal shunts are among the most frequently used procedures in these cases. Sometimes the proximal spleno-renal shutting operation of Linton or the distal one of Warren may be impossible from the technical point of view due to anomalies or varieties of the lienal vein. This makes it necessary to look for an alternative decision. This case report is about a 33-year old man indicated for surgical treatment because of portal hypertension, caused by prehepatic portal vein obstruction and esophageal varices with previous bleeding. Performing Linton's or Warren's procedure was not the proper decision. That's why we made a shunt between the inferior mesenteric vein and the left renal vein. The surgical technique and the postoperative results are described and discussed.

Adult↗
PubMed1998

[Rare forms of abdominal echinococcosis complicated by rupture].

This is a report on a series of twelve patients presenting ruptured echinococcus in the abdominal cavity, hollow abdominal organ and retroperitoneal space, observed in the period 1985 to 1997. The diagnostic and therapeutic problems faced are discussed with a special reference to the necessity of giving due consideration to these comparatively rare, but by no means less precarious complications in the clinical course of hydatid disease, particularly in endemic regions, such as Bulgaria.

Abdomen↗
PubMed1996

[A variant of the authors' own method for transhepatic biliary drainage in high malignant obstruction of the bile ducts].

A modified technique for bilio-digestive anastomosis in high malignant obstruction of extrahepatic bile ducts, officially approved as an innovation (registration '29/1993), and a new variant of the technique with definite advantages, are described. The superiorities of the methods are discussed against the background of numerous procedures for bilio-digestive drainage in high biliary obstruction reported in the literature, with a special emphasis laid on liver parenchyma preservation, more reliable anastomosis application, no bile loss involved, and technically more readily and promptly executed.

Anastomosis, Surgical↗
PubMed1994

[The Echinococcus and complicated forms of hepatic echinococcosis--their surgical treatment].

A series of 137 patients presenting Echinococcus of which 132 (96.3 per cent) with hepatic location, operated in the clinic of hepatobiliary and pancreatic surgery over the period 1984 to 1994, are analyzed. Right-side location is documented in 59.1 per cent, left-side--in 26.5 per cent, and bilateral--in 14.4 per cent of the patients operated on. In 18.2 per cent it is a matter of a multiple process, and in 27.3 per cent--complicated course. Conservative operative procedures are used in 56.1 per cent, mixed--in 18.9 per cent, and radical--in 25 per cent. Overall mortality in the series amounts to 3.03 per cent; in patients subjected to radical operation--0 per cent, and in cases with serious postoperative complications requiring relaparotomy--similarly 3.03 per cent. Biliary fistulas as postoperative complications are noted in 4.5 per cent, and recurrences in the late postoperative period--in 1.5 per cent. The clinical relevance of the diagnostic methods used, and the indications for performing various operative procedures are discussed. The early and long-term postoperative results are assayed against the background of current literature reports on the issue.

Adolescent↗
PubMed1994

[Liver resections. Malignant diseases of the liver].

Proceeding from current literature data, personal experience had with resection surgery of the liver, carried out in a series of 64 patients, operated in the clinic of hepatobiliary and pancreatic surgery over the period 1984 through 1994, is analyzed. Thirty-four patients are operated on for benign, and 30--for malignant conditions, with five of the latter group presenting primary tumor of the liver. Seven partial resections, 33 segmentectomies and 24 lobectomies--7 typical and 17 atypical; 6 right and 18 left resections, are performed. Operative lethality in the total series amounts to 0 per cent. The early postoperative lethality in benign diseases is 0 per cent, and in complicated cases--2.9 per cent. In patients with malignant lesions--6.7 and 10 per cent, respectively. The indications for operative treatment, and the possibilities of other therapeutic approaches are discussed.

Adolescent↗
PubMed1993

[The surgical treatment of pancreatic carcinoma (a retrospective study)].

The authors report the data from the surgical treatment of 426 patients with pancreatic carcinoma, treated at the Academy of Medicine-General and Operative Surgery, within the period 1983-1992, as well as from their own material, consisting of 70 right-sided resectio of the pancreatis, done within the period 1978-1992. The patients with explorative laparatomies constituted 10.8% and had postoperative lethality 15.2%. Palliative operations were 73%, with postoperative lethality 13.2% and average survival 6.47 months. The radically operated patients constituted 16.19%, with postoperative lethality 14.28% in the general series and 7.14% in the personal series and postoperative survival 18.7 months. From the radically operated with a right-sided localization of the process 10.7% patients had 5 years survival. The early lethality of the left-sided resectio was 0% and the postoperative survival--5-10 months.

Adult↗
PubMed1993

[The surgical treatment of carcinoma of the extrahepatic bile ducts].

The authors have carried out a retrospective analysis of 157 patients with Ca in the extrahepatic biliary system, treated at the Clinic for Hepato-Biliary and Pancreatic Surgery within the period 1982-1992. From them 68 patients (43.31%) were with Ca in vesicule biliary and with Ca in the biliary tracts--89 patients (56.69%). The ratio men:women was respectively 1:4.67 and 1.12:1. The medium age of the patients was 63.08 years. In the group of the patients with Ca in biliary tracts the carcinoma was located in the upper third in 20.22% of the cases, in the middle third--in 24.72%, in the distal third--in 55.06%. Radical operations were made in 31.46% of the patients, with lethality 28.57%, whereas the postoperative lethality of the patients with duodeno-hemipancreatectomy was 6.67%, and the average postoperative survival was 32 months. The palliative operated patients constituted 65.17% in the general series, with lethality 15.52% and average postoperative survival 10.4 months. The explorative laparatomies constitute 3.37% from the operated patients. The total operative lethality was 19.1%. In the article the authors discussed the diagnostical methods, stated the preference for echography, computer axial tomography and retrograde cholangio-pancreatography in the mentioned sequence. The endoscopic procedures were discussed as and alternative for the non-resectable carcinomas of the biliary tracts.

Adult↗
PubMed1993

[Transduodenal papillosphincteroplasty in the treatment of choledocholithiasis and benign stenosis of the terminal choledochus and papilla Vateri].

The article contains data form the surgical treatment of 297 patients with choledocholithiasis and benign stenosis of choledochus terminal and papilla Vateri, treated in the Academy of Medicine-General and Operative Surgery within the period 1983-1992. The data relate to 59 patients with biliodigestive anastomosis, 114 patients with choledochotomy and T-drainage (Kehr drainage) and 124 patients with transduodenal papillosphincteroplastica. The postoperative lethality in the general series of patients was 3.03%, for the patients with transduodenal papillosphincteroplastica--0.8%. The serious complications in the postoperative period in the cases of papillosphincteroplastica represent 0%, while the excellent and very good results in the distant period--95.16%. The authors state the precise moments of the surgical techniques in the cases of transduodenal papillosphincteroplastica and their importance for the postoperative results. The authors specify the indications and the contraindications for carrying out the different surgical and endoscopic procedures.

Adult↗