Biomedical subjects

R Madzhov

Publications and source records attributed to R Madzhov.

6 recordsLinked to original sources

PubMed2003

[Acute necrotizing pancreatitis--diagnostic and treatment strategy].

Despite of the current achievements of medicine, the mortality of necrotizing pancreatitis (NP) is still too high--up to 35-40% and stands as a serious diagnostic and treatment problem. The results of treatment of 148 patients, admitted in the clinic with diagnosis NP, 95 males and 53 females, are discussed. The ratio between patients with acute oedematic and acute NP is 81.1% to 18.9%. According to the hystopatology findings, the results are as follows: pancreatic necrosis--128 patients, peripancreatic necrosis--42 patients, retropancreatic necrosis--29 patients, phlegmonous cholecystitis--31 patients. For the exact diagnostic estimation of the development and prognosis of NP, we are based on: Clinic symptomatology, biochemical constellations (the prognostic scale of Ranson), ultrasonography, CT, ERCP, ES, laparoscopy (48 pts), and laparoscopic drainage (34 pts) of the abdominal cavity with one or two drains, in order to decrease the intoxication and manage intraperitoneal irrigation with antibiotics and enzymes. The operative intervations consists of a thorough exploration, broad necrectomy combined with lavage and large drainage. COLD (controlled open lesser sac drainage) has been performed at 34 cases. In 31 pts cholecystectomy and choledochotomy with T-tube drainage of d. choledochus (Kehr drainage) was performed. Reoperations have been made at 34 pts (22.9%); in 11 of them--2 operative revisions have been carried out, in 3 cases--three, and in 3 cases--4 operative revisions were performed. The total postoperative death rate was 21.6% (32 patients). The most common postoperative complications were as follows: pulmonary complications at 11 cases, pleural effusions--9 pts, intraabdominal abscesses--6 patients, postnecrotic pseudocysts--9 cases, pancreatic fistulas--6 cases, fistulas of the colon--2 pts, bleeding--4 patients.

Adult↗

PubMed2003

[Gastric cancer. Treatment results in 237 patients].

Although current achievements of diagnostic and treatment process, including D II-III gastrectomy and neoadjuvant chemotherapy, the results from the treatment of patients with gastric cancer (GC) are still unsatisfactory. Retrospective study was performed analyzing the early and late results from the treatment of 237 pts admitted in the department with GC. 218 of them underwent operative treatment; 131 men and 87 women, aged between 26-88 years. Patients with esophageal cancer were excluded from the study. In 19 pts preoperative laparoscopy and staging of the process lead to refusal of surgery. The distribution according to clinical stage was: I st.--5; II st.--37; III st.--101 and IV st.--75 patients. Greatest importance for the exact preoperative diagnosis and staging of the process had: Fibrogastroscopy + biopsy; Ultrasonography; CT scan and Laparoscopy. Radical surgery was performed in 119 pts (54.58%). Total gastrectomy--59 /27.06%/, subtotal gastrectomy--36 /16.51%/, gastrectomy + splenectomy + pancreatic resection--14 /6.42%/; gastrectomy + hepatic resection--5; gastrectomy + hemicolectomy--2; gastrectomy + resection of c. transversum--3. The preferred method for reconstruction was Roux-en-Y. Palliative resections were performed in 18 pts. Only Gastroenteroanastomosis was performed in 41 pts. Postoperative morbidity was registered in 41 pts /18.8%/. Most common were wound complications--in 21 /9.61%/, cardio-pulmonal--14 /6.42%/, thromoemboly--3 /1.38%/. Early reoperations--13 /5.96%/ performed in 7 pts. Early postoperative mortality--7 /3.21%/, but for the radical operations it was 5.88%. The major risk factors for the postoperative morbidity and mortality were: coexisting diseases, advanced age, pancreatic resection, splenectomy and extended lymphadenectomy.

Adult↗

PubMed2001

[Diagnostic and therapeutic strategy by patients with abdominal and thoracoabdominal traumas].

The pointed tendency towards increasing incidence and heaviness of the trauma patients in the last decades led to the emphatic increasement of the hospitalized patients with abdominal and/or thoracoabdominal trauma. For the time-period 1990-2000 total 431 pts with abdominal trauma were admitted. 283 of them underwent operative intervention. Male--221 and female--62, aged from 15 to 83 years (mainly pts under 40 years--188--66.43%). With blunt abdominal trauma were 164 pts (115 male and 49 female); with open wound trauma--119 (107 male and 12 female). According to the injured organ the distributiOn of the patients was: liver--61; spleen--47; pancreas--6; stomach--16; duodenum--2; small intestine--32; colon--27; diaphragm--18; mesenterium--33; omentum--21; kidney--4; "lucky" penetrating wounds--12. Most valuable for the exact diagnosis were: careful examination of the patient, U S, Plain abdominal X-ray, Abdomenocenthesis (68 pts), Laparoscopy (34 pts), Thoracoscopy (16 pts). Almost all of the patients underwent operative procedure during the first 12 hours (276 pts), and even in 45% of them, operation was performed in the first 2-4 h. Intraoperative autohaemotransfusion was performed in 19 pts with parenchymal lesions (liver and spleen). Reoperations were performed in 9 pts (3.53%). Postoperative morbidity--13.78%, and postoperative mortality--4 pts (1.41%).

Abdominal Injuries↗

PubMed1998

[Choledochoduodenal anastomosis--pro and contra].

Choledochoduodenostomy (CDS), suggested by T. Roth, and performed for the first time by O. Sprengel (1891), became a definitely affirmed operation after the publications of F. Sasse (1913). From purely anatomical standpoint, CDS contributes to bypass all problems relating to obstruction in the retroduodenal, transpancreatic and intramural segments of the hepatocholedochus with a wide orifice for spontaneous passage of eventual newly formed or residual concrements being secured. The basic indications for performing CDS include: multiple concrements in the extrahepatic biliary ducts, ampullar stenosis, cholangitis, chronic pancreatitis, cyst induced enlargement of choledochus and the like. It is worth noting that in most patients more than a single indication are present. The major shortcomings of the procedure with a reference to the long-term results are attributed to potentialities of cholangitis and cholangiohepatitis development, and "blind sac" formation between the anastomosis and p. Vateri. It is established that all patients with poor post-CDS results have stenosis of the anastomosis, or else, the restoration of papillary patency fails (endoscopically confirmed), i.e. they are most frequently a sequel of technical errors. CDS is a safe, readily performed and effective surgical procedure with few (sporadic) postoperative complications, including patients undergoing long-term follow-up study.

Choledochostomy↗

PubMed1994

[Postoperative choledochoscopy (transparietal, trans-drainage choledochoscopy)].

Residual biliary stones can be treated with: direct dissolution; endoscopic papillotomy and extraction; extracorporeal lithotripsy, repeated operations, removal via T-tube tract. Authors describe the employment in clinical practice (on 3 patients) the original method of extraction of residual common bile duct stones with the help of fiber choledochoscope introduced through the drainage channel in the common bile duct. Pros and coins of this method are discussed in comparison with the routine methods and it is recommended to be used in the early postoperative period in patients with T-tube drainage.

Common Bile Duct↗

PubMed1994

[Diagnosis and the therapeutic strategy in gallbladder carcinoma].

Authors analyse the results of the treatment of 39 patients with gallbladder carcinoma for period of 6 years (1987-1992). In relation to all the patients with gallstone disease treated in the clinic for the some period, patients with gallbladder carcinoma were 2.9%, and respectively 4.7% of all biliary operations. Gallstone disease was diagnosed in 28 patients (72%) with gallbladder carcinoma. Important for diagnosis were characteristic clinical signs and symptoms, supplemented by imaging methods (most important ultrasonography--performed in 34 patients). Radical operations were performed in 11 patients (28%), with one year survival rate 82% (9 patients). Authors discuss the relation between the clinical stage of gallbladder carcinoma, performed operation and survival rate in operated patients.

Adenocarcinoma↗