[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.

Extremely rare complications in cerebrospinal fluid shunt operations.

The cerebrospinal fluid shunt operation, from its first realization in 1908 by Kausch till our days, is still of a significant importance for the long-term treatment of the internal hydrocephalus. Well known are many complications connected with the use of the valve systems (malfunction, infectious, overdrainage, secondary craniosynostosis and etc.). For a period of 17 years (1984-2000) at the Clinic of Pediatric Neurosurgery, Department of Neurosurgery, Sofia Medical University, 414 cerebrospinal fluid shunt operations were performed on children. 216 were drained to the right atrium of the heart, 198 to the peritoneal cavity. They were followed up by catamnesis until the year 2001. The authors describe 2 extremely rare cases with post-shunt complication as a result of a malfunction of the valve system, owing to a migration of the distal catheter: 1) in the anus; 2) in the urethra. In the first case the distal catheter perforated the colon transversum and by the way of the intestines went out through the anus. In the second case the distal catheter protruded out of the body through the bladder and the urethra. Their clinical appearance, the diagnostic examinations and the operative treatment are shown.

Hydrophobic Zn(II)-naphthalocyanines as photodynamic therapy agents for Lewis lung carcinoma.

Four Zn(II) 2,3-naphthalocyanines (unsubstituted ZnNc1, tetracetylamido substituted ZnNc2, tetramino substituted ZnNc3 and tetramethoxy substituted ZnNc4) incorporated into unilamellar liposomes of dipalmitoylphosphatidylcholine have been injected intra-peritoneally (i.p.) (0.25-0.3 mg kg-1) to male C57/Black mice bearing a transplanted Lewis lung carcinoma. The pharmacokinetic investigations show that three of the four studied ZnNcs, 1, 2 and 4, are good tumor-localizers in Lewis lung carcinoma. The highest concentration is detected after ZnNc1 administration. The lowest tumor concentration as well as the lowest phototherapeutic effect were established with ZnNc3. In previous work it was shown that this ZnNc did not differ from the other three studied ZnNcs regarding the quantum yield of 1O2-formation and the photoinduced electron transfer. Obviously not only the good photochemical properties but also the tumor drug uptake can be an important factor of effective PDT. The biodistribution investigations also show that 72 h after drug injection, the skin concentration of the studied ZnNcs returns to the original base line. Indeed, we can expect that the skin photosensitivity will last for no longer than three days after PDT. The established higher drug concentration in the tumor rather than in the liver tissue (20 h after injection) shows again the tumor targeting selectivity of the applied liposome-sensitiser delivered procedure. Evaluating the PDT effect as reflected in the dynamics of the mean tumor diameter, we obtained unambiguous data on the potential capacity of ZnNcs 1,2,4 as PDT-photosensitisers. The data obtained from the assessment of the cytotoxic effect of PDT on the basis of the degree of induced necrosis, gave an adequate characterization of the tumor tissue destruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term follow-up after surgical treatment of cerebellar astrocytomas in 100 children.

A retrospective study was performed in 100 children, who were operated on between 1954 and 1984 for cerebellar astrocytoma. Twenty-nine patients died during the 1st month after the operation. Of the patients who survived, 24 lived up to 5 years, 17 up to 10 years, and 30 lived 20 or more years. In 22 cases, tumor recurrence was the reason for reoperation. Radiation therapy was used in 25 cases with histological malignancy and/or after partial removal of the tumor. The analysis in 6 cases with brainstem involvement allowed us to conclude that in such cases the prognosis is poor with regard to survival. Although total removal of cerebral astrocytomas appears to be the most effective form of treatment, we are of the opinion that even subtotal excision may be compatible with long-term survival. This suggests that many of these tumors may show benign biological behavior.

[Our experiences in the treatment of bleeding duodenal ulcer by means of proximal gastric vagotomy]. / Nasa iskustva u leucenju krvareceg duodenalnog ulkusa sa PGV-om

Gastric Vagotomies were performed on fifty four patients suffering from bleeding Duodenal Ulcers. Forty-three cases were operated on following a spontaneous cease in hemorrhaging, and necessary examinations. The remaining eleven patients were opereted on immediately as conservative measures would not be able to stop the bleeding. The procedure used following the admittance of a patient with a bleeding ulcer to the hospital was discussed. A detailed explanation of the technical procedure used in handing the bleeding duodenal ulcer was also presented. The authors believe that a Duodenotomy performed without cutting the pylorus has its advantages inasmuch as hemostasis has been successfully accomplished. All the cases had good clinical results, however, bleeding did recur in a few instances. There were no recidive ocurrences. Ever though many patients were chronically ill ie; Diabetes Mellitus, Myocardiopathia, secondary anemia, exitus lethalis did not occur. P.V.G. in the treatment of bleeding ulcers has a definte advantage over the other radical procedures.