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Biomedical subjects

D Damianov

Publications and source records attributed to D Damianov.

At least 37 records · Page 2Linked to original sources
PubMed1996

[The choice of the operation and management in cholangitis].

Irrespective of the high rate of bacterial flora (intestinal, respectively) penetration into the biliary apparatus, clinically manifested cholangitis cases are relatively seldom met with. The predisposing factors involved are: penetration of virulent flora (anaerobic inclusive) into the bile ducts, presence of conditions promoting delay or discontinuation of the bile passage (biliary hypertension), and longstanding of the disease. Cholangitis associated with cholangiohepatitis development is one of the severest conditions of cholelithiasis (ChL), being observed as an independent nosological entity also. Over the period 1974 through 1993, in the clinic of abdominal surgery a total of 144 patients presenting cholangitis undergo treatment, of which in 74 (8.7 per cent) it is associated with ChL, in 58 it is discovered during reoperation on the biliary apparatus, and in twelve it is diagnosed as an independent disease, unrelated to calculosis. Acute cholangitis runs a foudroyant course with a poor prognosis, whereas the chronic form is characterized by larvate (masked) development with exacerbation periods. The clinical picture is dominated by Charcot's triad. The disease runs a rather severe course in the contingent liable to reoperation. As a rule, it occurs as the result of stricture of the bile ducts or obliteration of bilidigestive anastomosis. 58 per cent of the patients are older than 50 years. Operative intervention in acute cholangitis should be done on an emergency basis. External drainage insertion is a palliative measure, practicable in heavily damaged patients. The operation in acute and chronic cases is aimed at maximum possible healing of the biliary tract and elimination of the underlying causes of obstructed passage. Lethality is higher than the medium rate, and the prognosis remains serious.

Acute Disease↗
PubMed1996

[The surgical and alternative treatment potentials in biliary tract cancer. I. Surgical treatment].

Biliary apparatus cancer is a rare condition characterized by low operability percentage. This is a comparative study of two series of patients, operated during the periods 1952-1979 and 1980-1994. In the first observation period (28 years) 119 patients are operated, and in the second 13-year period a total of 206 patients are subjected to operative and endoscopic treatment. One-hundred five patients present gallbladder carcinoma. The age, gender and clinical patterns characterizing the contingent being examined do not show noteworthy changes with time. Over the past few years, a variety of palliative operations are used, with the proportion of cases subjected to radical operation showing no increase. Carcinoma of bile ducts is diagnosed in 98 patients. During the second observation period, the number of women and patients in advanced and senile age augment. The diagnosis is delayed; thanks to puncture biopsy with cytological study, histological verification shows a three-fold increase. The number of radical operations is slightly increased while the percentage of explorative laparotomies is noticeably diminished. Carcinoma of papilla Vateri has optimal outlooks for surgical treatment. In the latter case too the number of women and patients above 60 years of age shows an increase. Radical intervention is resorted to in fourteen out of 33 patients.

Adult↗
PubMed1995

[Operations on the biliary system in liver damage].

Emphasis is laid on the correlation existing between liver and biliary apparatus pathology. On the one hand, attention is called to the development of reactive hepatitis in 60-75 per cent of patients presenting complicated cholelithiasis, and in nearly 30 per cent of the forms free of complications. Removal of the biliary pathology leads to complete regeneration of liver parenchyma in 80 per cent of the patients, especially in operation undertaken in opportune time. On the other hand, pathological conditions of the liver aggravate the developmental course and worsen the prognosis of biliary system diseases when operative management of the letter is necessitated. On the basis of personal experience, the unduely elevated risk in combining surgical intervention for biliary pathology with liver cirrhosis (27 observations), cholangiohepatitis (89 observations), and obstructive jaundice conditioned by a benign underlying cause--usually concrement (164 observations), is underscored. In established cholelithiasis it is fully justified to advise early operation. Surgical intervention in liver cirrhosis should be done after adequate preparation only if absolutely necessary. Obstructive jaundice requires urgent operation, within 10 days, as long as the pathomorphological changes are still reversible.

Adult↗
PubMed1994

[Pancreatoduodenal resection for carcinoid of Vater's papilla].

Papilla Vateri carcinoid is among the very rarely occurring locations of the lesion. The small lumen of the papilla is the underlying cause of becoming clinically manifest with icterus rather early. Accessibility of the process for endoscopic biopsy facilitates the diagnosis. Even histologically it is very difficult to differentiate benign from malignantly altered carcinoids. Only the existence of metastases confirm with certainty their malignant nature. An observation on papilla Vateri carcinoid in a 60-year-old woman, proved preoperatively through cytological study, is reported. Intraoperative--no metastases are discovered. Sparing pancreatoduodenal resection is performed with a good functional outcome, recorded at the checkup examination after two years.

Ampulla of Vater↗
PubMed1991

[Surgical complications following endoscopic diagnostic and therapeutic manipulations of the papilla Vateri].

The indications for retrograde cholangiopancreatography and for endoscopic papillotomy from the surgeon's view point are discussed. Endoscopic papillotomy is an operation of insufficient volume in chronic pancreatitis with obstacles along the Wirsungian's duct and in bile duct calculosis in younger age. These cases require surgical intervention or its association with endoscopic manipulations. Summarized data are reported on the risk after diagnostic or therapeutic procedures: complications may develop in 1 to 3.6 per cent after retrograde cholangiopancreatography and in 4 to 10 per cent after endoscopic papillotomy. Mortality rates are accordingly 0-0.015 per cent after the diagnostic and 0-5.8 per cent after the therapeutic procedure. Eight personal observations are described, 5 of them after endoscopic papillotomy. Six operated patients died. It is emphasized that, regardless of the existing risk, endoscopic manipulations should be performed with strict observance of the indications.

Adult↗
PubMed1991

[The diagnostic and surgical problems in chronic pancreatitis due to biliary calculosis].

Proceeding from personal clinical experience gained during many years of studies, the authors discuss the diagnostic and surgical problems of biliopancreatitis. In recent years biliary calculosis has been basic etiologic factor in 70 per cent of the cases; 76.8 per cent of the patients had complaints of long standing, while in the rest the history was shorter. The duration did not correspond to the morphologic findings. Only 43 per cent of the patients had clinical symptoms suggestive of accompanying pancreatitis, and echographic examination helped to establish the diagnosis in only 21 per cent of the cases. Two thirds (64 per cent) were patients in advanced and senile age, 5.8 per cent had severe preoperative complications and 52 per cent had systemic diseases affecting organs other than the liver and pancreas. The operations were primary in 169 patients (82 per cent) and repeat in 38 (18 per cent). The remote results were very good in 82 per cent, good in 9 per cent and satisfactory in 9 per cent. It is considered that treatment of chronic biliopancreatitis keeps on being surgical; endoscopic manipulations rather seldom produce ultimate therapeutic effect.

Adult↗
PubMed1991

[Villous adenomas of the major duodenal papilla: apropos a case].

Proceeding from a review of the literature and the personal observation of a case of tubulovillous adenoma of the large duodenal papilla, which had undergone malignant degeneration, the authors outline the diagnostic problems in this pathology. Since its clinical manifestations are not specific enough, it comes into consideration only after the possible more common diseases in the region of the right subcostal space have been ruled out. Preoperative diagnosis can be established mainly with fiber duodenoscopy. The demand from the pathologist is not only to give a histologic diagnosis, but to define the biologic nature of the tumor formation, since this predetermines the operative approach. It is sometimes difficult to give answer to the latter requirement even through and intraoperative express biopsy specimen examination.

Adenoma↗
PubMed1991

[Surgical laser papillosphincterotomy].

The still rather limited application of laser in biliary surgery is pointed out, to experience gained so far, including personal one, laser is being used in extirpation of the gall bladder, for treatment of the bladder bed, for choledochotomy and for papillosphincterotomy. Laser papillosphincterotomy was performed in a 65-year-old female patient--the first case in this country. This method has some advantages--adequate hemostasis, absence of reactive edema, early re-establishment of bile flow, adhesion of the incision edges.

Acute Disease↗
PubMed1990

[Percutaneous cholecystectomy and litholysis with methyl tert-butyl ether under ultrasonic control].

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.

Acute Disease↗
PubMed1990

[Guided punctures in the treatment of hepatic and perihepatic abscesses under ultrasonic control].

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.

Adult↗
PubMed1990

[Transcutaneous drainage of pancreatic pseudocysts].

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.

Adult↗
PubMed1990

[Sphincter-sparing operations in rectal cancer].

Data on 564 patients who underwent operation for cancer of the rectum are analysed. Amputation of the rectum was resorted to most frequently because of the low localization of the neoplastic process in the majority of patients. Mortality was higher in amputation than in anterior resection of the rectum. Criteria for sphincter-preserving operations are determined. Preference is given to anterior resection of the rectum as a more physiological operation which was also performed on elderly patients.

Adult↗
PubMed1990

[Hemorrhage from esophageal varices].

Bleeding from varicose veins (VV) of the esophagus remains a serious therapeutic problem to date. From experience in operative treatment of 164 and nonoperative management of 33 patients the authors discuss the modern trends of the treatment of this disease. New drugs are applied to reduce pressure in the portal system, on the one hand, and new operative techniques are studied, on the other. Endoscopic sclerotherapy of VV is resorted to more and more extensively. The authors applied it in 48 patients with a satisfactory effect. The authors claim that planned surgical treatment produces the best effect.

Adult↗
PubMed1989

[The differential diagnosis of chronic pancreatitis and pancreatic cancer].

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.

Biopsy, Needle↗
PubMed1989

[Sugiura's operation in portal hypertension].

The opportunities for surgical treatment of gastro-esophageal varices in patients with portal hypertension are discussed. The results of portal systemic shunts and ablative (devascularizing) operations are compared. The operative technique of Sugiura is described in detail and the modifications aimed at reducing the operative risk and the duration of the intervention are reviewed. Personal experience is recorded with two cases and the positive impressions of this operation. Proceeding from the good postoperative results, especially in patients with nonalcoholic cirrhosis, prevailing in this country, the authors suggest this surgical intervention an alternative method for planned and emergency treatment of part of the patients with hemorrhage from esophageal varices.

Esophageal and Gastric Varices↗