[Acute surgical abdomen in idiopathic haemochromatosis]. / Ostur khirurgichen korem pri idiopatichna khemokhromatoza.

The acute abdomen (AA) is a typical but very rare complication of idiopatic haemochromatosis (IH). The possible mechanisms are not sufficiently clarified. We report a case with IH who died with clinical features of (AA) 20 hours after gastroscopy was performed. The histological examination established nonspecific damage of visceral peritoneum and ascites. Fulminant form of spontaneous bacterial peritonitis (SBP) as a reason of death is discussed, nevertheless endoscopic esophageal varices sclerotherapy was not performed. The role of pulmonary infection and intestinal bacterial overgrowth with possible bacterial translocation in mesenterial lymph nodes, ascitic fluid, and blood is also discussed. The source of infection is usually unknown. The iron is important factor for bacterial growth. The pluriglandular deposition of iron including the suprarenal glands is precondition to development of collapse. The possible pathogenesis of SBP in IH is discussed. It is important to mention that unlike SBP the clinical course of IH AA might appear which does not necessary require surgical management.

[Treatment of peptic ulcer with sucralfate]. / Lechenie iazvennoi bolezni sukral'fatom.

Sucralfate made in Bulgaria (Farmaphim) and its Yugoslavian analogue venter have been tried in gastroduodenal ulcer. The drugs were given per os (1 g, 1 tablet) 4 times a day before meals for 20 days. Sucralfate treatment was assigned to 26 patients with gastric and 26 with duodenal ulcer. The other 20 gastric ulcer patients received venter. 10 patients with gastric and 20 with duodenal ulcer entered the control group receiving placebo. Attenuation of the symptoms was reported as early as on day 4 of the treatment in 85-100% of the patients both with gastric and duodenal ulcer. The 20-day course of sucralfate treatment brought about a complete epithelization on gastric ulcer in 54% while in venter treatment in 55% of those treated versus placebo group 10%. Duodenal ulcer epithelization occurred in sucralfate-treated group in 58% against placebo group 17%. The differences in treatment results between sucralfate and venter are immaterial, whereas against placebo they are significant (p less than 0.05). Side effects were not serious.

[Treatment of duodenal ulcer with ranitidine]. / Lechenie na duodenalnata iazva s ranitidin.

30 patients with endoscopically proved duodenal peptic ulcer were treated with Bulgarian drug Ranatidin in a dose of 150 mg twice daily in the course of 20 days. The pains were relieved up to the third day in 90% of the patients treated and the dyspeptic complaints disappeared in 1-3 days in 96-100% of the patients. Following the treatment course a statistically significant decrease of the gastric secretion indices was established (V, V1) and of the basic acid production (BAO, MAO, PAO) in comparison with the values before the treatment. Full epithelialization of the ulcer was found endoscopically in 60% of the patients treated and in the remaining 40% the size of the ulcer has diminished. The ulcer epithelialization is related to its initial size. The results achieved do not differ from those achieved with the analogous English drug Zantac. No side effects were observed in the course of treatment with Ranatidin.

[The carcinoembryonic antigen in chronic pancreatitis]. / Kartsinoembrionalen antigen pri khronichen pankreatit.

The fasting carcinoembryonal antigen (CEA) concentrations in the serum and duodenal juice and after venous stimulation of the exocrine pancreas with the hormones CCK and secretin (Boots) were studied. Radioimmunologic test with a kit of the firm "Labimex"--PPR was used. 28 patients with clinically proved chronic pancreatitis and a control group of 27 healthy persons were examined. The fasting CEA serum concentrations in the patients with chronic pancreatitis were statistically significantly higher than those of the healthy persons--mean--16.5 ng/ml vs mean--8.2 ng/ml (p less than 0.001). In 14% of the healthy persons and 57% of of the patients with chronic pancreatitis the basic CEA concentrations were significantly increased. After stimulation with CCK and secretin the serum CEA concentration did not change substantially. The duodenal juice CEA concentrations after CCK and secretin stimulation were about 11 times higher than those in the serum--mean--113 ng/ml and mean--104 ng/ml for the control group vs mean--118 ng/ml and mean--110 ng/ml for the patients with chronic pancreatitis. No statistically significant difference between the patients with chronic pancreatitis and the control group of healthy persons was established. The results reveal the low specificity of the CEA as a "tumor marker".

[Treatment of peptic ulcer using proglumide (Milid)]. / Lechenie na iazvenata bolest s proglumid (milid)]

20 patients with peptic gastric ulcer and 30 patients with peptic duodenal ulcer were treated with Milid (Proglumid). The following results were achieved: in 85% of the patients with peptic gastric ulcer and in 93% of the patients with duodenal ulcer the pain was relieved on the 4th day on the average. In 95-96% of the patients treated the dyspeptic complaints disappeared on the 2-3 day. The endoscopic examination performed on the 20th day revealed full epithelization of the ulcer in 30% of the patients with gastric ulcer and in 43.3% of the patients with duodenal ulcer. Following the treatment course the basic secretion and acid production fell statistically significantly in the patients with gastric ulcer while in the patients with duodenal ulcer the basic and stimulated secretion and acid production were suppressed. The drug Milid does not change the serum gastrin level but suppresses the gastrin secretion in the gastric juice. The Milid treatment leads to an increase of the quantity of the N-acetylneuraminic acid in the gastric juice which partly reflects the cytoprotective action of Milid. The drug can be used in the everyday practice for the treatment of peptic ulcer.

[Biotidin treatment of duodenal ulcer]. / Lechenie na duodenalna iazva s biotidin.

The results of the treatment with the Bulgarian drug biotidin of 30 patients with endoscopically proved duodenal peptic ulcer are presented. The drug was given in a dose of 150 mg twice daily in the course of 20 days. The pain ceased up to the third day in 93.3% of the patients treated and the dyspeptic complaints vanished up to the second day of treatment in 96.6% of the patients. Following the treatment a statistically significant lowering of the indices of gastric secretion (V abd V1) and acid production (BAO, MAO, PAO) was found compared to those before the treatment. Endoscopically full epithelialization was found in 63.3% of the patient, in 33.3% of the patients the size of the ulcer diminished and in only 3.4% of the patients there was no change of the ulcer size. The ulcer epithelialization was related to the initial ulcer size. The results achieved do not differ substantially from those achieved with the English drug Zantac. In the course of treatment with biotidin no side effects were observed and no changes of the basic biochemical indices were found.

[The differential diagnosis of chronic pancreatitis and pancreatic cancer]. / Vurkhu diferentsialnata diagnoza na khronichniia pankreatit i raka na pankreasa.

The following examinations were carried out in patients with chronic pancreatitis and pancreatic cancer: pancreozymin-secretin test, sonography, computed axial tomography, endoscopic retrograde cholangiopancreatography (ERCP) and thin-needle aspiration pancreatic biopsy. In 93.4% of the patients with chronic pancreatitis and in 93.8% of the patients with pancreatic cancer statistically significant changes in the pancreatic exocrine secretion were found after pancreozymin-secretin stimulation. Changes in the pancreatic function cannot be used as a reliable criterion for the differential diagnosis between chronic pancreatitis and pancreatic cancer. The ultrasound examination ensured correct diagnosis in 79% of the patients with chronic pancreatitis and in 76.4% of the patients with pancreatic cancer while the computed tomography gave the correct diagnosis in 80% and 79.4% of the patients respectively. The endoscopic retrograde pancreatography enabled correct diagnosis in 90% of the patients with chronic pancreatitis and in 86.2% of the patients with pancreatic cancer. The thin-needle biopsy revealed malignant cells in 97.5% of the patients with pancreatic cancer. The differential diagnosis between chronic pancreatitis and pancreatic cancer was not decided in 16.2% of the patients examined by sonography, 12% of the patients examined by computed tomography, 7.4% of the patients examined by ERCP and in only 2.5% of the patients examined cytologically.

[Computed tomography in cholestasis]. / Kompiuturna tomografiia pri kholestaza.

116 patients with jaundice were examined by computer tomography. In 92.3% of the patients examined the computer tomography gave correct information for the etiology of the jaundice: in 36 patients (31%) obstructive jaundice was established; in 71 patients (61.3%) the jaundice was nonobstructive and in 9 patients (7.7%) the etiology was not established. The characteristics of the CT findings in obstructive and nonobstructive jaundice are discussed. The causes of the diagnostic mistakes in CT examinations of patients with jaundice are also discussed.

[Diagnostic potentials of computed tomography in focal liver diseases]. / Diagnostichni vuzmozhnosti na kompiuturnata tomografiia pri ognishtnite zaboliavaniia na cherniia drob.

98 patients with focal liver diseases were examined by computer tomography: 29 patients with primary liver cancer, 44 patients with liver metastases, 16 patients with liver cysts, 4 patients with hemangioma and 5 patients with liver abscess. In 92.9% of the patients examined the computer tomographic examination gave accurate information about the focal liver disease. Only in 7 patients (7.1%) the examination failed. The characteristics of the liver changes found by computer tomography in primary liver cancer, liver metastases, cysts, hemangioma and liver abscess are discussed as well as the factors for the failure of the examination.

[Effect of Pharmachim's cimetidine preparation in 200- and 1000-mg ampules on the gastric secretion of duodenal ulcer patients]. / Vliianie na preparata cimetidin-Pharmachim v ampuli ot 200 i l000 mg vurkhu stomashnata sekretsiia na bolni s duodenalna iazva.

Gastric secretion was studied in 30 patients with duodenal ulcer. The trial was carried out in the following way: the patients were divided into two groups of 10 patients each. To the first group of 10 patients on the first day of the examination pentagastrin test was performed by subcutaneous application of Acignost (GDR) in a dose of 6 micrograms/kg body mass; on the second day the same dose of Acignost was injected with simultaneous i. v. application of 200 mg of Cimetidin-Pharmachim. To the second group of 10 patients on the first day pentagastrin test was also performed but on the second day the same dose of Acignost was injected together with 1000 mg of Cimetidin. The i. v. application of 200 mg and 1000 mg of Cimetidin-Pharmachim inhibits significantly the gastric secretion and acid production in patients with duodenal ulcer stimulated by Acignost. The inhibiting action of Cimetidin begins 30 minutes after its application and lasts more than an hour and is better expressed by injecting of 1,000 mg than of 200 mg Cimetidin-Pharmachim. Cimetidin-Pharmachim for parenteral application exerts a strong inhibiting action on gastric secretion and acid production. Its use is recommended for everyday practice since its efficacy equals that of the English drug Tagamet (Smith Kline) for parenteral application.

[Treatment of stomach ulcer with the Bulgarian preparation Farmaxolon]. / Lechenie na stomashnata iazva s bulgarskiia preparat Farmaksolon.

Thirty-four patients with gastric ulcer were treated with the new Bulgarian preparation pharmaxolon-Pharmachim, for 20 days under clinical conditions. A favourable effect on the clinical symptoms by the pharmaxolon treatment was established but the differences with the control placebo group were statistically insignificant. A total of 47.1% from the gastric ulcers were healed after 20-day treatment and in 32.3% were reduced in size but here the difference from the control placebo group was insignificant. Pharmaxolon, with its therapeutic effect equals the related foreign (Biogastrone, Ultranyl, Caved-S) and Bulgarian preparations (Alcid-V), hence it is recommended for the practice. Elevated transitory arterial pressure was observed in 41% of pharmaxolon-treated patients, not necessitating the discontinuation of the treatment. That requires a periodic control of the arterial pressure of the patients, treated with that new Bulgarian preparation.

[Differential diagnosis of jaundice]. / Diferentsialna diagnoza na zhultenitsite.

Patients with jaundice and hyperbilirubinemia over 34 mumol/l have been examined by different methods in order to assess the diagnostic value of the methods. 340 patients were examined clinically and by laparoscopy, 168 patients and 92 healthy persons were examined by 10 laboratory indices, 639 patients--by ultrasonography, 95 patients--by scintigraphy, 116 patients--by computer tomography, 83 patients--by endoscopic retrograde cholangio-pancreatography (ERCPG), 17 patients--by percutaneous transhepatic cholangiography (PTC), 70 patients--by directed liver biopsy. In the patients with cholestasis the 5'-nucleotidase, alkaline phosphatase, glutamyl transpeptidase (lipoprotein X is positive in 92% of the patients) and cholesterol are increased most. The extrahepatic obstructions are diagnosed by ultrasonography in 94.8% of the patients (the biliary ducts are dilated), in 88.7% of the patients the localization of the obstruction and in 74.7% of the patients the cause of the obstruction are found. In parenchymal jaundice the sonography reveals the disease which has caused jaundice in 62.1% of the patients. The scintigraphy gives correct diagnosis in 50% of the patients with hepatitis and jaundice, in 78% of the patients with cirrhosis and jaundice and in 87.5% of the patients with liver cancer. The computer tomography reveals the obstructive jaundice in 94.7% of the patients and the focal processes in the liver in 96.7% of the patients. The ERCPG gives a clear picture of the biliary ducts in 72.28% and of the pancreatic duct in 83.13% of the patients with jaundice, simultaneously the biliary and the pancreatic ducts--in 45.78% of the patients and correct diagnosis in 83.1% of the patients examined.(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of duodenal ulcer with the Bulgarian preparation gastralgin]. / Lechenie na duodenalnata iazva s bulgarskiia preparat gastralgin.

The effect of the new Bulgarian preparation gastralgin was studied in 20 patients with duodenal ulcer. The preparation was given three times daily in the course of 20 days--I bag, 1/2 to 1 hour before meals and in the evening before going to bed. Gastralgin contains in one bag--alginic acid 0.500, sodium alginate 0.500, aluminium hydroxide 0.200, magnesium hydroxide 0.100, calcium carbonate 0.500 and corrigent up to 7g. Favourable effect on the separate symptoms was attained in 50 to 80% after the treatment, epithelialization of the ulcer in 40% and reduction of its size in 25%. No change in gastric secretion was observed. Gastralgin, with its therapeutic effect, is equivalent to the preparations almagel and flatugel and their improved variants. The preparation is well tolerated and gives no adverse effects, hence it is recommended for the treatment of duodenal ulcer.

[Effect of carsil and legalon in treating chronic liver diseases]. / Efekt na karsila i legalona pri lechenieto na khronichnite chernodrobni zaboliavaniia.

The clinical effect from the treatment of 48 patients with carsil and 24 patients with legalon is studied. The patients were subdivided into three groups in the base of the clinical, laboratory-chemical and instrumental examination: light hepatic lesions--hepatic steatosis, chronic persisting hepatitis (ChPH), post-hepatitis states, chronic active hepatitis (ChAN) and cirrhosis of the liver (CL). Both preparations were administered 3 three times, 2 tablets daily for 3 months. The results obtained revealed that the bioflavonoid preparation carsil did not much differ in its clinical effect from the preparation legalon. The preparations carsil and legalon had a good effect, but not with statistical significance, on the subjective symptoms--pain, sense of heaviness and upper dyspeptic syndrome in the patients studied. Both preparations had a good effect on the biochemical indices: thymol test, SGOT, gamma-globulins, immunoglobulin G, blood bilirubin. The three month administration of carsil and legalon did not essentially change the histological findings in liver. The preparations carsil and legalon are indicated in light and moderate hepatic affections--hepatic steatosis, ChPH, post-hepatitis states. No contraindications have been reported for the administration of those preparations even in advanced hepatic disorders where they could be included as "basis" therapy.

[Case of sarcoidosis with predominant involvement of the liver and lymph nodes]. / Vurkhu sarkoidozata s preimushtestveno zasiagane na cherniia drob i limfnite vuzli s prinos na edin sluchai.

After brief literature data, a clinical case is reported with generalized sarcoidoses with predominant affection of liver and lymph nodes. A detailed clinical-laboratory characteristics is presented and the diagnosis has been histomorphologically objectivized. The hepatocytes were electron-microscopically studied and disorders in carbohydrate metabolism established with predomination of glyconeopoiesis. Bacterial-like structures were established in hepatocytes, providing grounds to look for further possibilities in that aspect for throwing light upon the etiology of sarcoidosis. The clinical case presented confirmed the high diagnostic value of liver biopsy in sarcoidosis, even in the cases with obvious extrahepatal localization of the changes. The therapeutic effect attained confirms, once again, the therapeutic possibilities of the corticosteroids, administered in proper doses.