[Acute necrotizing pancreatitis--diagnostic and treatment strategy]. / Ostur nekrotichen pankreatit--diagnostichna i terapevtichna strategiia.

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.

[Gastric cancer. Treatment results in 237 patients]. / Kartsinom na stomakha. Rezultati ot lechenieto na 237 bolni.

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.