The role of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients with upper abdominal involvement

Ovarian cancer has the highest mortality rate of all gynecologic cancers as 62% of cases are diagnosed at an advanced stage. The main concern in the surgical management of ovarian cancer is to achieve optimal cytoreductive surgery. Effective cytoreductive surgery at the time of initial therapy has been identified as the most important prognostic factor in the management of advanced ovarian cancer. This aggressive approach can cause unusual surgical management modalities including diaphragm stripping/resection, bowel resection, hepatic resection and splenectomy. Thus, splenectomy occasionally happens to be part of the ovarian cancer surgery.The indications and technique of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients were described. The authors have presented the indications and techniques of splenectomy and distal pancreatectomy as cytoreductive procedures in ovarian cancer patients. Intraoperative and postoperative complications were reported in this study

Mechanisms underlying the development of gastroesophageal reflux disease

In recent years, a large deal of new information accumulated concerning the pathogenesis, diagnosis, and therapy of gastroesophageal reflux disease (GERD). Gastric contents, mucosal resistance and clearing, and gastric emptying, along with incompetence of the lower esophageal sphincter, are now recognized as contributing factors to the development of GERD. In this review, the discussion is concentrated on the diagnostic tests for detecting GERD and their accuracy as well as on the potential mechanisms underlying the development of GERD.Biomedical Reviews 1997; 8: 101-109

ON SOME ASPECTS IN ULTRASONOGRAPHY OF THE UPPER ABDOMEN

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Transit-time flowmetric evaluation of coronary artery bypass graft flow after off- and on-pump myocardial revascularization

Introduction: Incorrect performance of anastomoses to the target coronary arteries often causes coronary artery disease and patient`s death following myocardial revascularization. Coronary graft patency evaluation is obligatory for prevention of peri- and postoperative myocardial ischemia.Aim: The objective of the present study was to comparatively assess the values of mean coronary flow and pulsatility index in arterial and venous grafts in patients after on-pump- and off-pump myocardial revascularization.Materials and Methods: During the period between January 1, 2014 and December 31, 2017, 143 coronary artery disease patients, 111 males at a mean age of 63.29±9.78 years and 32 females at a mean age of 66.43±9.58 years were operated on in the Department of Cardiac Surgery, St. Marina University Hospital of Varna. Myocardial revascularization was performed by using 92 arterial and 65 venous coronary grafts in the on-pump group (ONCAB) and 137 arterial and 45 venous grafts in the off-pump group (OPCAB). Coronary graft blood flow was assessed by means of coronary angiography and transit-time flowmetry (TTFM).Results: There were different values of the mean coronary flow and pulsatility index (PI) in arterial and venous conduits, both intervention types, as well as in males and females. The difference between male and female patients in terms of the mean values of venous grafts is statistically reliable (χ2=11.410; р≤0.022 and r=-0.310; p=0.001). The PI values in arterial grafts differed statistically significantly between both intervention types (p=0.003). Much more revisions of arterial and venous conduits on the occasion of insufficient patency were performed in the ONCAP than in the OPCAB group.Conclusion: Based on our results and literature data available, we could recommend the wide application of the method of TTFM for exact recognition of the circulatory disorders in the coronary graft following CAGB in Bulgaria

Massive bleeding in small bowel diverticulosis

INTRODUCTION: Diagnosis of small bowel diverticulosis complications is difficult in the emergency set­ting and often delays surgical management. The aim of this study was to report our experience with three patients presenting with surgical complication of small bowel diverticulosis with massive bleeding.PATIENTS AND METHODS: From January 2015 to February 2017, three patients, two males and one fe­male, presenting with bleeding as a complication of small bowel diverticulosis were included in this study. Their mean age was 70 years.RESULTS: The mean duration between the complication onset and its management was 8.3 days. Gastroen­doscopy and colonoscopy were used to eliminate stomach and colon bleeding. All the patients were operated on. Segmental small bowel resection was performed with primary anastomosis without any complications.CONCLUSION: Small bowel diverticulosis is a rare pathology. In cases of gastrointestinal hemorrhage, di­agnosis is performed by eliminating the bleeding from gastroduodenal and colonic segment of the gastro­intestinal tract. The diagnosis has been established through exploratory laparotomy only. Scr Sci Med 2017; 49(3): 40-44INTRODUCTION: Diagnosis of small bowel diverticulosis complications is difficult in the emergency set­ting and often delays surgical management. The aim of this study was to report our experience with three patients presenting with surgical complication of small bowel diverticulosis with massive bleeding.PATIENTS AND METHODS: From January 2015 to February 2017, three patients, two males and one fe­male, presenting with bleeding as a complication of small bowel diverticulosis were included in this study. Their mean age was 70 years.RESULTS: The mean duration between the complication onset and its management was 8.3 days. Gastroen­doscopy and colonoscopy were used to eliminate stomach and colon bleeding. All the patients were operated on. Segmental small bowel resection was performed with primary anastomosis without any complications.CONCLUSION: Small bowel diverticulosis is a rare pathology. In cases of gastrointestinal hemorrhage, di­agnosis is performed by eliminating the bleeding from gastroduodenal and colonic segment of the gastro­intestinal tract. The diagnosis has been established through exploratory laparotomy only. Scr Sci Med 2017; 49(3): 40-4

INFLUENCE OF IMMUNOREACTIVITY TYPE UPON POSTOPERATIVE STATUS OF PATIENTS WITH COLO-RECTAL CANCER (CRC)

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Three-year results from the surgical treatment of diseases of the aortic valve and aortic root

PURPOSE: Pathology of the aortic root and aortic valve is subjected to adult cardiac surgery and includes Stanford A aortic dissection, annuloaortic ectasia or chronic aneurysm of the ascending aorta. In such cases, Bentall-De Bono procedure is usually preferred. Aortic valve reimplantation by using Tirone David's technique presenting with the advantages of valve-sparing surgery can be performed in selected cases.MATERIAL AND METHODS: A retrospective analysis of a three-year experience with the complex surgical treatment of diseases of the aortic valve and root was carried out. During the period from January 1, 2009 to December 31, 2012, fifty-three patients with aortic valve and aortic root pathology were treated in the Division of Cardiac Surgery, St. Marina University Hospital of Varna. Bentall procedure was carried out in 37 patients (Group B). In 19 of them (51%) emergency surgery was done for acute aortic dissection of type Stanford A. The rest 18 patients underwent elective surgery for dilated ascending aorta and aortic valve dysfunction. Aortic valve-sparing surgery by David's technique for aortic aneurysm was accomplished in 16 patients (Group D). This technique was emergently applied in one patient with aortic dissection, too. Baseline data, intraoperative details, early results and complications were compared.RESULTS: Early (30-day) mortality after Bentall-De Bono procedure was 10.5% (0% after elective surgery and 21.1% after dissection repair). All the patients survived after David's procedure that proved the significant advantages of the valve-sparing surgery.CONCLUSION: The aortic valve reimplantation provides long-term results that are comparable to those after the Bentall-De Bono procedure such as high survival rates, low incidence rate of endocarditis, and slightly higher risk of reinterventions. There is no need of life-long anticoagulation that improves patient's quality of life.Scripta Scientifica Medica 2013; 45(4): 50-55

Right ventricle hydatid cyst with a pericardial cavity involvement: a case report

The echinococcal disease with a cardiac location of the hydatid cyst is uncommon and potentially fatal for the patient's life. The diagnosis could be difficult because no specific symptoms ever occur. However, this pathology should be always kept in mind in endemic regions. Herein we report a rare case of hydatid cyst situated in the right ventricular free wall. The diagnosis was ensured by transthoracic and transesophageal echocardiography, CT and MRI. The patient underwent a total cardiopulmonary bypass without aortic cross-clamping. Several ruptured daughter cysts were removed. The fibrous capsule was opened and the germinative membrane was extirpated. Postoperatively, albendazole therapy was administered. No complications were reported.Scripta Scientifica Medica 2013; 45(4): 84-87

EVALUATION OF GASTRIC EMPTYING IN REFLUX DISEASE AND DUODENAL ULCER PATIENTS

Thirty healthy volunteers, 77 hiatus hernia and reflux disease patients as well as 26  duodenal ulcer ones were studied by means of echographic planimetry and volumetry of antrum and corpus ventriculi and gamma camera as well in order to evaluate the gastric emptying before and after surgery. The mean semi-emptying antral time after esophagocruroplasty plus frontal semi-fundoplication was determined as 9,5 min whereas after Nissenfundoplication it reached the rate of 19,2 min (range 8-32 min; p < 0,001). The latter was related to a higher incidence rate of postoperative stomach bloating complaints with the N is sen patients. Ultrasound measurements of gastric emptying were of comparable sensitivity to scintigraphy in quantifying the fluid bolus evacuation