[Transcutaneous drainage of pancreatic pseudocysts]. / Chreskozhnoe drenirovanie pankreaticheskikh psevdokist.

The clinical study includes 76 pancreatic pseudocysts localized in the head (24), body (37), and tail (15). The effect of treatment by means of a single or repeated purposeful aspiration in ultrasonic control is discussed. Recovery occurred in 83.3% of cases with cysts measuring up to 5 cm, in 61.3% in those with cysts measuring from 5 to 10 cm, and in 11.1% of cases in which the cysts measured more than 10 cm. As the result of 15 draining manipulations of cysts which were irresponsive to aspiration (9 of them measuring from 5 to 10 cm and 6 larger than 10 cm) complete recovery occurred in 13 cases. The authors discuss the indications for single, two, and many punctures on basis of a complex appraisal of the gland, the size and type of the cyst, and the cytologic results. The indications for percutaneous drainage, the period and techniques of its performance and preliminary and postmanipulation treatment with drugs are determined and the occurring complications are shown.

[Guided punctures in the treatment of hepatic and perihepatic abscesses under ultrasonic control]. / Tselenapravlennye punktsii pri lechenii pechenochnykh i okolo- pechenochnykh abstsessov pod kontrolem ul'trazvuka.

The authors discuss the possibilities of ultrasonic tomography and subsequent performance of purposeful punctures for establishing the precise diagnosis of hepatic and perihepatic abscesses. In most cases the method helps in revealing the cavities measuring no more than 1.5-2.0 cm. The indications are determined, as well as the techniques of topical treatment with the use of single and multiple punctures and prolonged percutaneous drainage. Seventy-three patients (32 with hepatic and 41 with perihepatic abscesses) underwent clinical examination. Topical therapy was applied in 21 patients with discovered hepatic abscesses, 17 of them recovered. Operations were avoided in 25 in a group of 34 patients with perihepatic abscesses (in 7 the abscesses were not identified). The success of this treatment is determined by exact diagnosis and precise manipulations.

[Percutaneous cholecystectomy and litholysis with methyl tert-butyl ether under ultrasonic control]. / Perkutanna kholetsistektomiia i litoliza s metil-tretichen butileter pod ultrazvukov kontrol.

The first percutaneous cholecystostomies under ultrasound control with therapeutic purpose, performed in Bulgaria, are reported. They furnish the opportunity for local treatment of acute cholecystitis and chemical litholysis in biliary calculosis. Control of the latter was realized by microscopic determination of the amount of cholesterine crystals in periodically aspirated bile. Indications for this procedure are defined after thorough discussion by internist and surgeon. Transhepatic approach and long-term treatment with methyltertiary-butyl ether are considered obligatory.

[The place of echography in the clinical diagnosis of hepatic hemangioma]. / Miastoto na ekhografiiata v klinichnata diagnosa na chernodrobniia khemangiom.

On the basis of 104 hemangiomas diagnosed in 81 patients an ultrasound classification of the disease is made which includes four basic variants. Echotomography detects the tumor most successfully in group I (well outlined homogenous hyperechogenisity) while in the other groups it shows a low percentage of correct diagnoses. The average sensitivity of the method is 60.6%. The possibilities of the other basic diagnostic methods are discussed and a scheme for clinical investigation is proposed. Scintigraphy is of no substantial help, computed tomography increases the percentage of the correct diagnoses, angiography and correctly indicated laparoscopy most often end the clinical investigation. The patients with hemangioma are subjected to a prolonged clinical follow up and ultrasound tomography is the best suitable method for this.

[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.

[Echography with fine-needle aspiration biopsy of the pancreas]. / Ekhografiia s tunkoiglena aspiratsionna biopsiia na pankreasa.

The results from 116 echographic investigations of 74 females and 42 males with confirmed pancreas carcinoma are discussed, the patient aged from 27 to 80 years. The diagnosis has been confirmed operatively in 92, at necropsy--in 16 and clinically--in 8. Thin needle aspiration biopsy (TAB), under echographic control was performed to 47 patients. The results were compared with the results obtained by computer tomography, endoscopic retrograde cholangiopancreatography and selective angiography. It has been established that the combination of echography with TAB results in 81.9% accuracy of the method, in 6% presumed neoplastic diagnosis and in 22.1% the diagnosis was not made. The results are significantly better than those obtained only by echography (p less than 0.01). A diagnostic scheme for the timely diagnosis of pancreatic cancer is presented.

[Diagnostic value and the criteria for abdominal echography in cancer of the gallbladder and bile ducts]. / Diagnostichna stoinost i kriterii na abdominalnata ekhografiia pri raka na zhluchniia mekhur i zhluchnite putishta.

Sixty one patients were studied during a three-year clinical investigation: 39 patients with cancer of gallbladder and 22 with cancer of biliary ducts. The diagnostic values of echography in those diseases was assessed. The method proved to be sensitive in 84,6 per cent in cancer of gallbladder, with specificity in 94,6 per cent and accuracy in 90,5 per cent and in cancer of biliary ducts, with the exception of papilla of Vater, those values were 66,6, 96,2 and 95,5 per cent respectively, and in papilla--28,6, 98,8 and 93,7 per cent. The good diagnostic values of the method in cholestasis and the place of biliary stop is stressed upon. Various echographic images of cancerous alterations of gallbladder and biliary ducts are described.

[Case of light-chain plasmacytic leukemia]. / Sluchai na levoverizhana plazmokletuchna levkemiia.

A female patient aged 60, is described, with plasmacellular leukemia, with disturbance in the light chains of immunoglobulins--light chain plasmacellular leukemia. The clinical picture combines the signs of blast leucosis with those of the light chain disease. The disease had an acute course, failing to respond to the treatment, with a lethal end, about 40 days after the manifestation of the clinical symptoms, better resembling blast leucosis than myeloma.

[Effect of alcohol on pancreatic exocrine secretion]. / Vliianie na alkokhola vurkhu pankreasnata ekzokrinna sekretsiia.

Pancreas exocrine secretion was studied in 10 patients viapancreocymine-secretin test, determining the volume of pancreatic secretion, concentration and quantity of the secreted bicarbonate and total quantity of secreted pancreas amylase and lipase. Acute effect of alcohol was studied in the same patients and two-three days after the first determination of pancreatic secretion, a second pancreocymine-secretin test was performed, with 150 ml 40 per cent alcohol being introduced into the stomach prior to pancreocymine stimulation. The results prior to and post alcohol loading were compared in each patient. A statistically significant inhibition of pancreas bicarbonate and enzime secretion developed under the effect of alcohol. The probable pathogenetic mechanisms of alcohol effect upon pancreas are discussed.