STRATEGY OF DIAGNOSIS, PROGNOSIS AND MANAGEMENT OF ACUTE DESTRUCTIVE PANCREATITIS

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Operative Techniques for Placement of Peritoneal Catheters

As a renal replacement therapy, peritoneal dialy- sis has been applied in the clinic since the 1970s. Com- pared with hemodialysis, it has a unique superior- ity since it requires only simple equipment and sur- gery and it is more effective at protecting residual re- nal function. In recent years, with significant improve- ment of the peritoneal dialysis connecting system and peritoneal dialysis solution biocompatibility, as well as increasing standartization of patients` training has be- come the best method of early renal replacement ther- apy for patients with end-stage renal disease.We present you a review of different techniques, the cost effectiveness and comparison of the most frequent complications and we share our ten years` experience in peritoneal catheter placement in our clinic

LIVER INJURY

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Complicated Colonic Diverticulosis. Diagnostic And Therapeutic Strategy

Rarely diagnosed before the twentieth century, complicated diverticulosis is the most common surgically treated colon disease after colorectal cancer in Western countries.A retrospective analysis of 213 patients with colonic diverticulosis was performed. Of them, 94 were male and 109 were female. Their mean age was 60.9 (32–91); 10% were under 50; 33% were aged 50–60; 42% were aged 60–80; and 15% were over 80.We analyzed demographics, severity of disease, surgical outcomes: time to intervention, recovery passage, feeding, length of hospitalization, complications, reinterventions, and lethality.Diverticulitis is classified as complicated or uncomplicated based on: CT data, medical history, the severity of clinical symptoms, and diagnostic imaging data

Practical aspects of vascular access application of Echo-Doppler and algorhythm for management

The creation and maintenance of effective and functioning vascular access together with successful management of its frequent complications cause still more close collaboration of different specialists engaged with the morbidity, hospitalization and treatment of patients with chronic kidney diseases (CKD). The organization of follow up, including adequate assessment and monitoring of clinical parameters of vascular access as well as the quality of dialysis should be unified in all dialysis centers. This proactive approach and care are expected to lower the incidence of thrombosis, infections and achieve good long term results. Imaging and functional testing methods are crucial for the duration of dialysis treatment and better quality of life for patients.Collaboration between specialists nephrologists and other reference points (vascular surgeons, imaging specialists, general surgeons and therapists) underlies the modern algorithm for ECC treatment. Imaging and other functional, methods have a decisive significance for the duration of dyalisis treatment and the good quality of life of the patients. The collaboration between nephrologists and other specialists (vascular surgeons, image specialists, general surgeons and internists) is the basis for contemporary algorhythm for extracorporeal treatment

Diagnostic and treatment strategy in complicated colon diverticulitis

Acute diverticulitis is a disease with a wide clinical spectrum, ranging from a phlegmon (stage I a) to localized abscesses (stages I b and II), to free perforation with purulent (stage III) or feculent (stage IV) peritonitis. The planned therapy of colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. While there is a little debate about the best treatment for mild episodes, uncertainty persists about the optimal management for severe episodes and complicated diverticulitis

Metastatic colorectacal carcinoma, associated with pyogenic liver abscess

Introduction: A liver abscess represents capsulated purulent focus in the liver parenchyma, due to bacterial, fungal or parasite invasion. In the recent years their frequency rate related to malignant diseases has increased, including abscesses in liver metastases. Aim: We present four cases of metastatic colorectacal carcinoma, associated with pyogenic liver abscess, which were treated in the Second Department of Surgery, St. Marina University Hospital, Varna.Results:  We registered synchronous metastases and in two patients and the remaining two had metachronous metastases. The average age of our patients was 60 years (range 45-80). The patients were operated on and the following interventions were performed – in one - segmentectomy; in two - liver resection with right hemicolectomy; in one - incision, biopsy and drainage; and in one – percutaneous drainage. We established the following systemic complications: pleural effusion in one patient, in one – arrhythmia, subphrenic abscess – in two patients.  The bacterial strains showed K. pneumoniae  in one patient, two – sterile and in one S. epidermidis.Discussion:  In the recent years a lasting tendency of increasing of the frequency rate of malignant diseases of the GIT has been observed.  The liver abscesses complicating a malignant disease can be treated like an abscess due to benign pathology – via aspiration, drainage and antimicrobial therapy.  Surgical treatment is applied in larger (more than 5 cm) abscesses or with colorectal cancer. The prognosis in these cases is unfavorable due to the malignant diseases and the higher frequency rate of the septic complications

Thromboembolic prophylaxis for oncological patients - general recommendations

Scripta Scientifica Medica 2010;42(1):31-3

Emergency surgical treatment for malignant bowel obstruction

Bowel obstructions are one of the most frequent reasons for emergency surgery in advanced staged cancer patients. The aim of the study was to review the presentation, treatment procedures and outcomes of malignant bowel obstructions and to identify the risk factors related with poor prognosis. 376 patients were studied. Data included age, sex  and medical history, presenting symptoms, physical findings on admission, ASA class, operative procedures, post operative morbidity and mortality. The most common complaints were abdominal pain, vomiting, nausea and constipation. Distension, altered bowel sound, pain and tenderness were most common find ings. Greatest value for exact diagnosis had US, X-ray examination and endoscopic examination. Primary neoplasm of the bowel was found in 84%. Obstruction due to recurrence/metastasis - in 16%. 87% were with large bowel obstruction; ileum - in 3%; both ileum and colon were involved in 8%. Perforation found in 14%. Curative resection was performed in 74,8%. Extended bowel resection - in 24%. Palliative procedures performed in patients with distant metastasis or locally advanced cancer - 25,2%. Overall morbidity - 26,9% and mortality - 11,6%; but patients with serious coexisting disease had significantly higher incidence of postoperative death - 33%.Scripta Scientifica Medica 2007;39(1):53-5