[The surgical treatment of pancreatic pseudocysts following acute pancreatitis]. / Otnosno operativnoto lechenie na pankreatichnite psevdokisti sled ostur pankreatit.

The tactics and results of the operative treatment of pancreatic cysts, complicating severe destructive pancreatitis in a series of thirteen patients, are discussed. The following operative methods are made use of: marsupialization (1), Yurash (10), cystojejunoanastomosis with Braunova (2). The character and scope of surgical intervention are determined intraoperatively, depending on the anatomical situation faced. In pancreatic cysts operated according to Yurash (cystogastroanastomosis), an original drainage method with two probes introduced nasally is used--one wider into the anastomosis, and a narrower one into the duodenum for feeding. The probes are retained for periods ranging from 9 to 35 days. No relapse of the cysts operated by different methods are registered, with the exception of a female patient undergoing marsupialization. In one case operated according to Yurash where no preoperative preparation is done the outcome is fatal, with the patient dying of hemorrhage on the third postoperative day. All patients are operated within 3 months after the formation of cysts. The preoperative preparation includes Kontrikal, Petphtoruracil, atropine, heparin and antibiotic; in some patients the listed drugs are introduced intraarterially into truncus celiacus. A number of inferences are reached and recommendations made: 1. Waiting for the generally accepted 3-month term is unnecessary. 2. In cysts involving the head of the pancreas, tightly adherent to the posterior wall of the stomach, the method of Yurash with the modification suggested for probing should be given preference. 3. In cysts of the body region and tail cystojejunoanastomosis with Braunova is practicable. 4. Proceeding with the preoperative medication in the postoperative period is advisable.

[Genetic susceptibility to pancreatitis]. / Genetichno predrazpolozhenie kum pankreatit.

Pancreatitis is a complicated polyetiological disease rather frequently met with. Inflammatory degenerative changes in the pancreas are the underlying cause of the condition which in acute cases may give rise to irreversible pancreonecrosis, and in chronic ones--to fibrosis development and severe pain syndrome. Of utmost importance is the patient's genetic susceptibility to pancreatitis. The purpose of the study is to assay the role of genetic factors involved in the etiopathogenesis of pancreatitis. The interest focused on alpha1 antitrypsin (alpha 1 AT) arises from the fact that its mutant forms are implicated in the destructive processes within the organism. The reduced inhibitory activity of alpha 1 AT enhances the action exerted by the proteolytic enzymes--trypsin and chymotrypsin [correction of hemotrypsin]. Impairment of the balance between proteases and their inhibitors plays certain role in pancreatitis development. Seventy patients, 44 men and 26 women, are covered by the study, with 42 of them presenting acute pancreatitis, and 28--chronic relapsing form. A high rate of alpha 1 AT mutant genes carrier state is established--14.28 per cent, exceeding statistically significantly the incidence of alpha 1 AT variants in the Bulgarian population--4.95 per cent (p < 0.01). In acute pancreatitis patients the incidence of alpha 1 AT variants is 2.38 per cent, and in chronic forms--32.14 per cent. In pancreatitis patients alpha 1 AT deficit brings about genetic predisposition to serious complications, e.g. chronification of the process. Individual therapeutic approach is mandatory, with Kontrikal used in chronic relapsing pancreatitis in the form of substitutive medication, and in acute pancreatitis--according to judgement depending on the clinical picture and laboratory findings.

[Intra-arterial therapy as a treatment method in acute pancreatitis]. / Intraarterialnata terapiia kato metod za lechenie pri ostriia pankreatit.

Intra-arterial therapy has a definite place in the complex management of pancreatitis. Drug infusion into the celiac trunk and a. mesenterica superior is a procedure bringing about the highest concentration (16-18 times) in the pathological focus (Briskinikol), inactivation of vasoactive and toxic products, interference with autolysis of the gland, allowing in turn the administration of smaller drug amounts. Intraarterial therapy (IT) is carried out in 18 patients presenting destructive pancreatitis: total necrosis--2, focal necrosis--8 and hemorrhagic pancreatitis--8, with ages ranging from 25 to 65 years, in a poor general condition. IT is conducted after catheterization of truncus celiacus and celiacography, with infusion effected through single time introduction of 0.5 per cent novocain solution, heparin, kontrikal, Petphtoruracil, antibiotic and atropine.