Apolipoproteins as predictors of cardiovascular risk in patients with chronic pancreatitis.

OBJECTIVE: Patients with pancreatic diseases are at increased risk of cardiovascular events. Investigating various apolipoprotein forms as important atherogenesis components may improve cardiovascular risk (CVR) prediction. This study aimed to investigate CVR factors in patients with chronic pancreatitis. PATIENTS AND METHODS: The study enrolled 70 patients (40 males and 30 females, mean age 55.2 years) with chronic pancreatitis and treated pancreatic exocrine insufficiency. We assessed CVR by apolipoproteins A-I, A-II, B, and C-III, lipid profile; score systems [SCORE risk chart and Framingham Risk Score (FRS)], diabetes mellitus; chronic pancreatitis by M-ANNHEIM classification. Statistics were performed via SPSS v. 22. RESULTS: Low apolipoprotein A-I and high apolipoprotein B levels with increased atherogenic potential were observed in 37 and 26 patients. 45.71% demonstrated a high risk of myocardial infarction with high apolipoprotein B/apolipoprotein A-I ratio. Men are at higher CVR risk. Apolipoproteins A-I and A-II correlated with the cardioprotective high-density lipoprotein (HDL) in contrast to apolipoproteins B and C-III, which correlated strongly with low-density lipoprotein (LDL), total cholesterol (TC), and triglycerides (TG). Increased CVR assessed by FRS correlated with significantly lower apolipoprotein A-I and higher apolipoprotein B and apolipoprotein B/apolipoprotein A-I ratio. With the increase in chronic pancreatitis severity, we observed decreased apolipoproteins and increased apolipoprotein B/apolipoprotein A-I ratio. CONCLUSIONS: Apolipoproteins are valuable CVR indicators. Further studies are required to establish a CVR screening panel in this population.

Screening for Helicobacter pylori infection and Clarithromycin resistance using Real-Time Polymerase Chain Reaction.

OBJECTIVE: Helicobacter pylori (H. pylori) infection is spread worldwide and affects at least half of the world's population. Infected people are at increased risk of several diseases' development, including gastric adenocarcinoma. The aim of this study was to screen patients with dyspeptic symptoms for H. pylori infection and assess Clarithromycin resistance prevalence among the infected patients. PATIENTS AND METHODS: Screening for H. pylori infection was performed in all patients using molecular test based on Real-Time Polymerase Chain Reaction (RT-PCR) in feces after RNA-DNA extraction. Stool samples from all participants were collected 1 to 3 days after patients' hospitalization. The positive results were furthermore assessed for confirmation by breath test and stool antigen test. By point mutations detection in 23S rRNA gene was possible to detect Clarithromycin resistance. Statistical analysis was performed via SPSS 22.0 (IBM Corp., Armonk, NY, USA). RESULTS: This study enrolled 50 patients (18 males) at mean age 46.46±15.10 years. Using molecular test based on RT-PCR in feces we identified H. pylori infection in 24 patients (48.00%). Clarithromycin resistance was observed in 7 of them (29.17%). None of those patients was eradicated before. There was no significant difference by age and gender between infected and non-infected patients. Gastrointestinal symptoms were more often reported in infected patients (p<0.05). The molecular test showed 85.71% sensitivity and 100% specificity, with a diagnostic accuracy of 92.00%. CONCLUSIONS: H. pylori screening by molecular test based on RT-PCR in feces might be beneficial as the test's accuracy is high and include Clarithromycin resistance assessment, which could improve the outcome of eradication therapy.

Macroscopic and microscopic fluorescence spectroscopy of colorectal benign and malignant lesions - diagnostically important features.

Fluorescence spectroscopy is a sensitive, fast and non-invasive tool for a diagnostics of cancerous gastrointestinal lesions. It could be applied for in situ detection of tumours during primary endoscopic observations or as add-on measurement modality during microscopic observations of tissue histology slides for their initial or retrospective diagnosis. Therefore, we are looking for diagnostically important features of normal and cancerous tissue areas in a broad spectral range for gastrointestinal tissues ex vivo using two steady-state macroscopic fluorescent spectroscopic modalities and by confocal fluorescent microscopic detection. Results obtained from autofluorescence spectroscopy of benign and malignant lower part gastrointestinal tract (GIT) lesions from freshly excised tissues during surgical removal of the lesions in 18 patients (22 lesions), were compared with the spectral measurements obtained during confocal fluorescent microscopy observations of unstained tissue slides using 405 nm excitation. Excitation-emission matrices (EEMs) were used for ex vivo measurements with applied excitation in 280-440 nm spectral region and emission observed between 300 and 700 nm. Synchronous fluorescence spectroscopy (SFS) approach was also applied to improve the spectral resolution of the observed complex emission spectra. Specific fluorescent features observed, related to presence of structural proteins, co-enzymes and endogenous porphyrins in the tissues investigated, allow discriminating normal mucosa from benign polyps and malignant carcinoma lesions with diagnostic accuracy up to 94.4%.

Intraperitoneal perfusion chemotherapy with hyperthermia in some malignant ascites.

Intraperitoneal administration of chemotherapeutic drugs with hyperthermia (HIPEC) increases their local effect on malignant peritoneal diseases and reduces systemic cytotoxicity. The most commonly used are cisplatin, doxorubicin, and mitomycin C. A major disadvantage of intraperitoneal chemotherapy is limited penetration of the drug in the tumor lesion depth (1-3 mm). Extended exposure and increased pressure in the abdominal cavity solution increases penetration of the agent into the tumor and hyperthermia has synergy with cytostatic agent on the permeability of cell membranes and metabolism of the drug. Real clinical hyperthermia is achieved at 41 degrees C. Of greatest importance is the concentration of the drug, but crucial for the prognosis is complete cytoreductive surgery. A major disadvantage of the closed technique is the uneven distribution of the perfusion solution in the peritoneal cavity, and the main advantage is better control of the perfusion, keeping of constant hyperthermia of the solution and regular repetition of manipulation, like intravenous chemotherapy. Laparoscopy determines the stage of the tumor process, refines the indications and preoperative selection for HIPEC, monitors the effects of treatment and determines locations for introducing catheters. In the review the results of the inraperitoneal chemotherapy with hyperthermia in gastric, colorectal, ovarian and other cancers are discussed as well as in diffuse malignant peritoneal mesothelioma and others.

Open core control software for surgical robots.

OBJECT: In these days, patients and doctors in operation room are surrounded by many medical devices as resulting from recent advancement of medical technology. However, these cutting-edge medical devices are working independently and not collaborating with each other, even though the collaborations between these devices such as navigation systems and medical imaging devices are becoming very important for accomplishing complex surgical tasks (such as a tumor removal procedure while checking the tumor location in neurosurgery). On the other hand, several surgical robots have been commercialized, and are becoming common. However, these surgical robots are not open for collaborations with external medical devices in these days. A cutting-edge "intelligent surgical robot" will be possible in collaborating with surgical robots, various kinds of sensors, navigation system and so on. On the other hand, most of the academic software developments for surgical robots are "home-made" in their research institutions and not open to the public. Therefore, open source control software for surgical robots can be beneficial in this field. From these perspectives, we developed Open Core Control software for surgical robots to overcome these challenges. MATERIALS AND METHODS: In general, control softwares have hardware dependencies based on actuators, sensors and various kinds of internal devices. Therefore, these control softwares cannot be used on different types of robots without modifications. However, the structure of the Open Core Control software can be reused for various types of robots by abstracting hardware dependent parts. In addition, network connectivity is crucial for collaboration between advanced medical devices. The OpenIGTLink is adopted in Interface class which plays a role to communicate with external medical devices. At the same time, it is essential to maintain the stable operation within the asynchronous data transactions through network. In the Open Core Control software, several techniques for this purpose were introduced. Virtual fixture is well known technique as a "force guide" for supporting operators to perform precise manipulation by using a master-slave robot. The virtual fixture for precise and safety surgery was implemented on the system to demonstrate an idea of high-level collaboration between a surgical robot and a navigation system. The extension of virtual fixture is not a part of the Open Core Control system, however, the function such as virtual fixture cannot be realized without a tight collaboration between cutting-edge medical devices. By using the virtual fixture, operators can pre-define an accessible area on the navigation system, and the area information can be transferred to the robot. In this manner, the surgical console generates the reflection force when the operator tries to get out from the pre-defined accessible area during surgery. RESULTS: The Open Core Control software was implemented on a surgical master-slave robot and stable operation was observed in a motion test. The tip of the surgical robot was displayed on a navigation system by connecting the surgical robot with a 3D position sensor through the OpenIGTLink. The accessible area was pre-defined before the operation, and the virtual fixture was displayed as a "force guide" on the surgical console. In addition, the system showed stable performance in a duration test with network disturbance. CONCLUSION: In this paper, a design of the Open Core Control software for surgical robots and the implementation of virtual fixture were described. The Open Core Control software was implemented on a surgical robot system and showed stable performance in high-level collaboration works. The Open Core Control software is developed to be a widely used platform of surgical robots. Safety issues are essential for control software of these complex medical devices. It is important to follow the global specifications such as a FDA requirement "General Principles of Software Validation" or IEC62304. For following these regulations, it is important to develop a self-test environment. Therefore, a test environment is now under development to test various interference in operation room such as a noise of electric knife by considering safety and test environment regulations such as ISO13849 and IEC60508. The Open Core Control software is currently being developed software in open-source manner and available on the Internet. A communization of software interface is becoming a major trend in this field. Based on this perspective, the Open Core Control software can be expected to bring contributions in this field.

The effect of quitting smoking on the risk of unfavorable events after surgical treatment of oral potentially malignant lesions.

The aim of this study was to examine if cessation of smoking after surgical excision of oral potentially malignant lesions in smokers reduced the risk of recurrences, development of new lesions or malignancies. 51 patients with oral leukoplakia or erythroplakia were included. They were daily smokers at the time of diagnosis and were treated surgically. Patients were advised to quit smoking at each visit. The change of smoking habits and occurrence of unfavorable events were noted during follow-up. Descriptive statistics, Fischer's exact test, Kaplan-Meier curves with log-rank test, and Cox proportional hazards model were used for analysis. 16 patients (31%) quit smoking during the observation period. Only one quitter (6%) developed recurrence compared with 11 continuing smokers (33%) (p<0.05). There were no new lesions and no malignancies among quitters compared with 8 new lesions (p<0.05) and 5 carcinomas (p>0.05) in continuing smokers. Multivariate analysis showed continuing smoking to be the most significant factor for occurrence of unfavorable events, OR 23.7. In conclusion, cessation of smoking significantly reduced the risk of unfavorable events after surgical treatment of oral potentially malignant lesions in smokers.

[Polyposis of the colon and cancer]. / Polipoza na debeloto chervo i rak.

Polyposis of the colon is a colon cancer predisposition syndrome. Familial adenomatous polyposis (FAP) accounts for 1% of the cases of inherited colorectal cancer (CRC). The National Register of inherited CRC and polyposis of the intestines keeps track of 18 patients from 14 families with FAP. Eight of them have been operated of CRC, on 6 patients preventive colectomy with ileorectal anastomosis has been done and four patients refused surgery. Colectomy has been done due to the malignant development also on a female patient with difused juvenile polyposis with adenomatosis. Of three patients under surveillance with the Peutz-Jeghers syndrome, surgery has been done on one female patient with ileus and bleeding large polyps.

[The dynamics of psychologic distress in patients with maxillofacial and laryngeal malignancies]. / Dinamika narushenii psikhicheskogo statusa u bol'nykh so zlokachestvennymi novoobrazovaniiami cheliustno-litsevoi oblasti i gortani.

The study of psychological dynamics involved in malignancies of the maxillofacial area and larynx included 38 male patients (tumors in maxillofacial area--26; neoplasia of larynx--12). Patients were given different regimens of radiation and radiotherapy; 11 were operated on. Psycho-disorders induced by tumor disease and admission to cancer ward were reported in 35 (92%). With time, such disorders were progressively overshadowed by somato-psychic changes, with asthenic syndrome prevailing, and subsequently psychopath-like features developed. Psycho-organic syndrome was registered in 16 patients as they were approaching terminal stage.

Comparison of three urease tests for detection of Helicobacter pylori in gastric biopsy specimens.

OBJECTIVE: To propose two modified urease tests for the detection of Helicobacter pylori in gastric biopsy specimens. PATIENTS AND METHODS: The presence of H. pylori infection was determined in 237 patients undergoing upper gastrointestinal endoscopy. Three media were used for the urease tests: Christensen's 2% urea broth and two urea agar media, modified by increasing the concentration of urea (to 4% and 10%) and phenol red and omitting the nutrients. RESULTS: The modified tests had good sensitivity (> 78%), specificity (96%) and accuracy (> or = 86%) at 2 h using small amounts (15%) of biopsy homogenates. They were statistically more sensitive and accurate than Christensen's broth. CONCLUSION: Both the modified 4% and 10% urea agar tests are simple, sensitive and specific and can be performed with small amounts of sample.

Quantitative assessment of severity of biliary tract infection.

BACKGROUND/AIMS: It is very important for physicians to evaluate the severity of the biliary infection. At the moment, there is no useful quantitative system. In this study, we propose a scoring system for assessing the severity of biliary infections and evaluation of the efficacy of antibacterial and endoscopic treatments. MATERIALS AND METHODS: We created a biliary tract infection score (BTIS) including local physical and ultrasound findings, signs of inflammation and hepatobiliary involvement. The BTIS was calculated in 317 patients: group I-155 pts with cholecystitis and cholangitis, treated only by antibiotics and group II-162 pts with acute cholangitis treated by endoscopic procedures. RESULTS: The BTIS allowed the differentiation of the severity of biliary infections: 15.50 +/- 0.52 in acute cholangitis group and 5.77 +/- 2.79 in group I (p < 0.001). The BTIS significantly decreased after antibacterial therapy (excluding only the cefotiam subgroup) and in endoscopicaly treated patients. CONCLUSIONS: The BTIS is a combination of simple, reliable, acceptable and low cost parameters, reflecting the principal pathological processes and degree of abnormalities. A BTIS facilitated the assessment of severity of biliary infection and comparison of the results of various methods of treatment.

[Endoscopic sphincterotomy in choledocholithiasis and an intact gallbladder]. / Endoskopska sfinkterotomiia pri kholedokholitiaza i zapazen zhluchen mekhur.

Endoscopic sphincterotomy (ES) with extraction of calculi is a basic method of treating choledocholithiasis in post-cholecystectomy patients (8, 9). Endoscopic treatment contributes to a considerable reduction of the indications for reoperation. The existing views concerning ES done in patients with preserved gallbladder, especially in the era of laparoscopic surgery, are still conflicting (3, 6). There are several options: cholecystectomy with removal of calculi in the common bile duct by ES in a subsequent stage, or vice versa-primary ES with ensuring cholecystectomy. The undertaking of independent surgical or endoscopic treatment is likewise practicable (2, 6).

[The surgical and alternative treatment potentials in biliary tract cancer. II. Alternative potentials]. / Operativni i alternativni vuzmozhnosti za lechenie na raka na zhluchnata sistema. II. Alternativni vuzmozhnosti.

The modern diagnosis of biliary tract cancer is still unsatisfactory regardless of the introduction of updated instrumental diagnostic methods. The latter may undergo development and transformation into therapeutic procedures. Patients with increased operative risk, and those presenting locally intractable neoplasm or metastases are indicated for this kind of alternative therapeutic approach. Experience had with endoscopic treatment of 89 patients with cancer of the biliary apparatus is shared. In forty of them (45 per cent) treatment with endoscopic papillotomy, prosthetic replacement or pernasal drainage proves successful. The procedure runs the hazards of early and late complications. Survivorship is prolonged by six months average, maximum 23 months. In eight cases permanent percutaneous (external) biliary drainage is undertaken as a final palliative measure, contributing to survival ranging from 1 to 3 months. In conclusion, the alternative methods have an actual place in the armamentarium of treatment procedures for this contingent of oncological patients.

[The place of endoscopic transpapillary (peroral) cholangioscopy in the diagnosis and treatment of biliary tract diseases]. / Miastoto na endoskopskata transpapilarna (peroralna) kholangioskopiia v diagnostikata i lechenieto na zaboliavaniiata na zhluchnite putishta.

The introduction of intraoperative, and later postoperative cholangiography, results in the reduction of residual concrements in the bile ducts, but by no means in their total removal. Cholangioscopy was used as an alternative to this method (1, 5, 10). In 1923, J. Bakes employed a rigid choledoscope, and in 1970 J. M. Shore-a flexible one. Nowadays, technical improvement of the procedure makes possible to use cholangioscopy by one of two basic routes--transhepatic and peroral transpapillary (4, 6, 7, 9, 11). The former is recommended in the event of impossible or failing examination through papilla Vateri, or in the presence of stones and strictures within the intrahepatic bile ducts which cannot be reached by transpapillary route (4, 6, 9, 11). Peroral choledoscopy is used in clinical practice for a short time, and the early experience is still insufficient for definitive evaluation (2, 3, 7, 8, 9, 11).

[The surgical and alternative treatment potentials in biliary tract cancer. I. Surgical treatment]. / Operativni i alternativni vuzmozhnosti za lechenie na raka na zhluchnata sistema. I. Operativno lechenie.

Biliary apparatus cancer is a rare condition characterized by low operability percentage. This is a comparative study of two series of patients, operated during the periods 1952-1979 and 1980-1994. In the first observation period (28 years) 119 patients are operated, and in the second 13-year period a total of 206 patients are subjected to operative and endoscopic treatment. One-hundred five patients present gallbladder carcinoma. The age, gender and clinical patterns characterizing the contingent being examined do not show noteworthy changes with time. Over the past few years, a variety of palliative operations are used, with the proportion of cases subjected to radical operation showing no increase. Carcinoma of bile ducts is diagnosed in 98 patients. During the second observation period, the number of women and patients in advanced and senile age augment. The diagnosis is delayed; thanks to puncture biopsy with cytological study, histological verification shows a three-fold increase. The number of radical operations is slightly increased while the percentage of explorative laparotomies is noticeably diminished. Carcinoma of papilla Vateri has optimal outlooks for surgical treatment. In the latter case too the number of women and patients above 60 years of age shows an increase. Radical intervention is resorted to in fourteen out of 33 patients.

[The treatment of acute cholecystitis complicated by mechanical jaundice]. / Lechenie na ostriia kholetsistit, uslozhnen s mekhanichna zhultenitsa.

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.