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

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

Acute Appendicitis in Older Patients

Introduction: The aim of this project is to aid in finding and distinguishing the diagnosis of acute appendicitis in older patients.As a result of socio-economic development and achievements in the field of medical science, the average life expectancy is increasing in Bulgaria, as in most countries. This has led to an increase in the number of older patients diagnosed with acute appendicitis. Acute appendicitis is one of the most common diseases presenting with severe abdominal pain and requiring surgery in all cases. While it is typically associated with younger patients, the demographic changes lead to an increased rate of incidence in adult or elderly patients, in which the diagnosis of acute appendicitis is a more complex and challenging process compared to young or middle-aged patients. The reasons for this could be the atypical clinical presentation and enhanced communication problems, as well as several differential diagnoses.Materials and Methods: During the period between 2007 and 2016 a total of 243 patients with acute appendicitis were admitted and operated at the St. Marina University Hospital. Of them, 141 were women (58.1%) and 102 - men (41.9%) with the ratio 1.4: 1. The patients were divided into two groups: of up to 60 years old and over 60 years. The most frequent reported symptoms were: pain in the right lower quadrant, elevated values of leucocytes, fever and anorexia.Results: The ratio of destructive forms of acute appendicitis between the two groups was 64.8% (over 60y) and 35.2% (up to 60y).Conclusion: Acute appendicitis is one of the most common diseases occurring with abdominal pain, requiring surgery. In elderly patients, the diagnosis is difficult because of atypical clinical presentation, extended differential diagnosis, delayed hospital visit and communication difficulties

Non surgical disease as a motive for difficult operative approach in laparoscopic surgery

Laparoscopic antireflux surgery is the gold standard procedure for treatment of patients with reflux esophagitis. The purpose of this study is to report personal experience by a rare case from our practice with many concomitant diseases in laparoscopic antireflux surgery, analyzing the clinical and functional outcomes of this procedure and review of the literature. We report a woman with a long standing anamnesis for hiatal hernia, with impossibility for laparoscopic approach because of multi pleconcomitant diseases as Schoerman syndrome - deforming spondylarthrosis, progressing astenoadynamy, attaining to impossibility to move, chronic kidney insufficiency, heart insufficiency, chronic anemia. The laparoscopic approach was found as flexible and adaptive enough to the different anatomical variations. Smooth early and late postoperative period, under protection of substitutional therapy.Scripta Scientifica Medica 2007; 39(2):165-16

Advantages of laparoscopic management of hydatid cyst of the liver: a Case Report

Scripta Scientifica Medica 2007; 39(2):161-16

Sentinel lymph node mapping in patients with colorectal cancer

BACKGROUND/AIMS: In about 1/3 of the patients with colorectal cancer without metastases which have been radically operated recurrences are observed and these patients die from cancer. This requires improvement of the surgical methods radicality as well as a more accurate determination of the indications for adjuvant chemotherapy administration.The introduction of a method for evaluating the degree of the metastases in colorectal cancer would highlight these issues. To this purpose we apply the method of sentinel mapping.METHODOLOGY: For a period of one year we performed intraoperative sentinel mapping on 103 patients who had been operated for colon or rectal cancer. We used the dying method with Patent Blue V. An algorithm was worked out for sentinel mapping in colorectal cancer.RESULTS: We achieved 100% performance success and 97% sensitivity. We increased the volume of the surgical intervention in 100% of the patients and elevated the clinical stage of 20% of the patients in Ist and IInd stage by means of ultrastaging with immunohistochemistry.CONCLUSIONS: We conclude that sentinel lymph nodes mapping in colorectal cancer is a diagnostic method which is convenient for the surgeons allowing them for an individualized approach toward each patient.Scripta Scientifica Medica 2008;40(1):47-5

Diagnosis and treatment of liver abscesses

Pyogenic abscesses are rare and difficult problem for modern surgery because of the high mortality rate. After the 70s of the last century the introduction of new image methods as ultrasound diagnostics, percutaneous and direct cholangiography and biliary drainage, guided aspiration, and percutaneous drainage of the abscess cavity dramatically changed both the diagnosis and treatment of these patients. The routine diagnostic methods are ultrasound and CT scan. Percutaneous aspiration and drainage under ultrasound or CT control is applied as first-line treatment of hepatic abscesses.Scripta Scientifica Medica 2008; 40(2): 137-139

PYOGENIC LIVER ABSCESS - ETIOLOGICAL SPECTRUM AND SENSITIVITY TO ANTIBIOTICS

Introduction: Pyogenic liver abscess (PLA) is a serious challenge in modern medical practice. The aim of this study was to investigate the etiology and antimicrobial susceptibility of PLA-associated microbial pathogens, diagnosed in hospitalized patients at St. Marina University Hospital of Varna during the period between 2001 and 2016.Materials and Methods: A total of 84 clinical samples (pus aspirates, n=72, bile samples, n=7, and blood cultures, n=5), collected from PLA patients, hospitalized in the Second Surgery Clinic were analyzed. Species identification was performed by conventional methods. Antimicrobial susceptibility was studied by disk diffusion method and Phoenix 100 (BD). The results were interpreted according to CLSI and EUCAST standards.Results: Causative bacterial agents belonging to 15 different species were isolated in 59 cases (in 70%). E. coli (23.7%), K. pneumoniae (20%), E. cloacae (13.5%), E. faecalis (8.5%), P. mirabilis (5%) and P. aeruginosa (5%) dominated in the etiological spectrum. E. coli demonstrated the following levels of antimicrobial susceptibility: imipenem, amikacin, piperacillin/tazobactam, 100%; ceftazidime, cefepime, 90.9%; cefuroxime, 83.3%; amoxicillin/clavulanic acid, 77.8%; gentamicin, 75%; levofloxacin, cefalothin, 66.6%; ciprofloxacin, 63.6%; piperacillin, 58.3%; ampicillin, 45.5%. The following antimicrobial susceptibility rates were determined for K. pneumoniae: imipenem, 100%; amikacin, 92.3%; ceftazidime, cefepime, 80%; cefalothin, cefuroxime, 75%; levofloxacin, gentamicin, 66.6%; ciprofloxacin, 62.5%; piperacillin/tazobactam, 57.1%; piperacillin, 25% and amoxicillin/clavulanic acid, 22.2%.Conclusions: E. coli and K. pneumonia are the predominant pathogens in PLA patients. Carbapenems are the most active antimicrobial agents followed by ceftazidime and cefepime. In the aminoglycoside group, amikacin demonstrates the best in vitro activity