Placing a biliary stent under intraoperative ultrasound control in primary and secondary hepatic carcinoma

PURPOSE: To explore the opportunities to place a biliary stent under intraoperative ultrasound control in primary and secondary hepatic carcinoma.MATERIAL AND METHODS: We used ultrasound apparatus Aloka SDD 4000+ provided with UST-MC11-8731 Aloka ultrasound electronic convex intraoperative transducer for this ultrasound-guided manipulation. We placed a biliary stent in 12 patients. Of them, five patients presented with primary hepatic carcinoma and seven ones with metastatic hepatic disease.RESULTS: This manipulation was carried out under ultrasound control in cases of inoperability and mechanical jaundice because of hepatic malignancies.CONCLUSION: Biliary stent placement under ultrasound control because of inoperability and mechanical jaundice in primary and secondary hepatic carcinoma is an effective interventional procedure. It can be performed easily and safely.Scripta Scientifica Medica 2013; 45(1): 21-23

Hyperbaric oxygen therapy for severe ulcerative colitis refractory to conventional therapies. Case report

Ulcerative colitis (UC) is a disease of unknown etiology characterized by inflammation of the mucosa and occasionally the submucosa of the colon. Conventional drug therapy for UC involves use of aminosalicylates (oral, topical, or both) for mild to moderate disease, corticosteroids, azathioprine/6-mercaptopurine, cyclosporine and anti-tumor necrosis factor therapy for a more severe disease. Those patients who do not respond to that therapy may require colectomy. In this article the successful use of hyperbaric oxygen therapy in the treatment of ulcerative colitis refractory to conventional therapies is described

Does intraoperative ultrasound examination improve the detection of hepatic metastases of pancreatic carcinoma?

PURPOSE: The aim of the study was to estimate the value of intraoperative ultrasound (IOUS) in detecting the hepatic metastases of pancreatic carcinoma.MATERIAL AND METHODS: A total of 16 patients, 6 women and 9 men, were considered suitable for hepatic resection of pancreatic carcinoma with transcutaneous ultrasound examination (US) and contrast enhanced computer tomography. Intraoperatively, they are examined by inspection, bimanual palpation and US. Both number and localization of the lesions were compared. IOUS influence on the operative plan was evaluated.RESULTS: IOUS detected 60 liver metastases which were histologically confirmed. Preoperative US examination found out 28 lesions or 46.66% of all lesions and the preoperative computer tomography (CT) did 29 ones or 48.33%. The information gained from IOUS changed the operative plan in 8 out of 16 patients. A biliary stent was placed under IOUS control in one patient with severe hyperbilirubinemia of 466 µmol/L.CONCLUSION: IOUS detects by more than two times hepatic metastases in comparison to the preoperative US and CT. It enables the change of the medical strategy in half of the patients and in the patients with mechanical icterus. Besides it allows stent placement to alleviate patient's status. This leads us to the conclusion that IOUS should be applied as a routine practice in hepatic resections of pancreatic carcinoma metastases.Scripta Scientifica Medica 2013; 45(1): 62-65

Modern radiological diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma is the most common primary tumour of the liver. It is characterized by a quick evolution and poor prognosis. The hepatocellular carcinoma is found out in patients with chronic liver diseases, mostly with chronic hepatitis B and C, where the risk is by 100 times higher than in the patients with cirrhosis of other etiology. The treatment is operative. Chemotherapy and radiotherapy don't exert any significant effect. The hepatocellular carcinoma is diagnosed by imaging examination methods. This review shows the opportunities of different contemporary methods for diagnosis of the hepatocellular carcinoma, its staging and subsequent treatment.Scripta Scientifica Medica 2013; 45(2): 7-10

Mercury self-poisoning. Case report

A clinical case of a self-poisoning with a single ingestion of 40-45 mL of alleged metal mercury with suicid­al purpose by a 50-year-old man is described. On the following day he was admitted to the Toxicology Clinic with symptoms of nausea, strong abdominal colic, diarrhea, and feces with macroscopic admixture of mer­cury drops. At the inspection of the residue of the substance, an unusual black-grey color on its surface was noted. Later, mercurous oxide was proven by chemical analysis. No toxic symptoms of the central nervous system, respiratory system or kidneys were observed. X-rays of the abdomen were performed and tracked dynamically: the first one showed numerous round shadows with metal density along the whole colon, the second - after 5 days - showed reduced number of similar shadows only in the distant colon, and the third X-ray on the 9th day was normal. Mercury was discovered in the blood: 0.250 μmol L-1 on the fourth day after the ingestion and 0.120 μmol L-1 - on the tenth day. Some therapeutic problems of acute mercury intoxica­tion of present interest are discussed

Our experience with the use of intraoperative ultrasound in surgery for colorectal liver metastases

PURPOSES: To share our experience of routine application of IOUS in resection of liver metastases of colorectal carcinoma. MATERIALS ANDMETHODS: This is a prospective study of 50 patients with colorectal liver metastases. The involvement of the liver is examined preoperatively by transcutaneous ultra-soundex am i na tion and con trast-enhanced computer tomography and inspection,palpation and intraoperative ultra sound during the operative intervention. The number and localization of the liver lesions are compared with the preoperative results and the focal changes are confirmed histologically.RESULTS: IOUS detected additional lesions in 23 patients /46%/ and lead to a change of the operative plan in 19 patients/38%/. The malignancy of the lesions is confirmed by histological examination. In 1 patient /2%/ the histological diagnosis was hemangioma in spite of the fact that the preoperative graphic examinations and IOUS showed malignant characteristics. 5 patients /10%/ were considered as inoperable due to IOUS because of the multiple bilobar lesions, and in 1 patient /2%/ the lesion described with the preoperative CECT was not found.CONCLUSIONS: The routine use of IOUS in patients with malignant diseases improves the detection of liver lesions and helps the surgeon to choose the appropriate strategy for liver resection.SSM, 2012;44(1):17-2

A UHPLC METHOD FOR SERTRALINE DETERMINATION

Purpose: To develop and implement a UHPLC method for quantitative determination of sertraline in biological samples – mostly human blood and urine. Material&Methods: Blood and urine samples available from Laboratory of analytical toxicology and Clinic for intensive treatment of acute intoxications and toxicoallergies were used during method validation and case monitoring. Analytical identification of sertraline and/or metabolites was done by GC-MS. Gas chromatography coupled with flame ionization detection was used for alcohols/volatiles screening of clinical samples. Ultra high-performance liquid chromatography system in tandem with diode-array detector has been used as the main quantitative instrument. Results: After critical consideration of available reference data a carefully set of experimental conditions for sertraline extraction and UHPLC determination were adopted and optimized. Preliminary liquid-phase sample purification was applied. Zorbax Extend-C18 column (150 x 4.6 mm, 5 µm) was used under isocratic conditions with phosphate buffer (pH 2.7; 10 mM) containing 1.5 ml L–1 triethylamine – acetonitrile (65:35, v/v) at 20oC, at the flow-rate of 1.0 mL/min and UV detection at 220 nm. This method was validated for the determination of sertraline in human plasma/serum samples (70% recovery). Conclusions: A simple yet sensitive and reliable method for sertraline determination was introduced. Linearity over 20-1000 ng mL–1 range was shown; LOQ was 20 ng mL–1. The method was clinically applied for monitoring the blood sertraline levels during a course of detoxication of a female patient

Acute Intoxications with Ethylene Glycol in Varna region: 25-Year Experience

Ethylene glycol (EG) is a bivalent alcohol. It is composed of many commercial and industrial products such as anti-freeze, coolants, deicing fluids, brake solutions, detergents and lacquers and is used as an organic solvent of many substances. Accidental and intentional poisonings with EG are rare, but potentially lethal and are a challenge to the clinical toxicology. Retrospectively, we followed the acute intoxications with EG for a 25-year period (1991-2015) in the Varna region, Republic of Bulgaria. The subject of the study were 95 patients with acute EG poisoning, at an average age of 46.8 years (21-77), who had received treatment at the Clinic of Toxicology and the diagnosis was confirmed by gas chromatographic method. EG intoxications are specific to the male gender, at male:female ratio of 6.9:1. All poisonings resulted from oral intake, mainly of anti-freeze, 92.6% of them being accidental and only 7.4% - deliberate. A lethal outcome was registered in 8 (8.4%) patients. Extreme renal insufficiency occurred in 9 (10.3%) of the surviving patients

Acute methanol intoxications registered in Varna region (Bulgaria) for a 25-year period

This retrospective study was conducted to follow out acute intoxications with methanol in Varna region (Bulgaria) for a 25-year period (1991-2015). At that time, 98 patients with methanol poisoning were regis- tered in the Clinic of Toxicology of Military Medical Academy in Varna, Bulgaria. The average age of the patients was 44.5 years. The diagnosis was made based on symptoms and was confirmed by gas chromato- graphic analysis of methanol concentration. The majority of poisonings were accidental - 88.9 %, and only   a small part was with suicidal intentions (9.2%). Lethal outcome was registered in 38 patients. Eight of the survived patients (13.3%) were with residual visual impairment and six of them had permanent neurologi- cal complications

ACUTE EXOGENOUS INTOXICATIONS WITH ORGANOPHOSPHORUS PESTICIDES: DURATION OF THE HOSPITAL TREATMENT AND CLINICAL CRITERIA FOR PROGNOSIS

Purpose: Several criteria have been suggested to estimate the intoxication severity, yet so far no system of clinical criteria has been developed to determine the duration of hospitalisation. The forecast is linked to the influence of the extended corrected QT interval and GCS (Glasgow Coma Scale) on the frequency of the developing acute pulmonary insufficiency and lethality. The average duration of hospital treatment is also crucial. First of all, it is determined by the intoxication severity and lasts from 3 to 26 days. The aim of this study is to develop an individual forecast about the duration of hospitalisation for patients suffering from acute exogenous intoxication with organophosphorus pesticides (OPP). Materials/Methods: The subjects are 160 patients. We use statistical regression analysis to study the significance of 5 of the most typical clinical indicators of organophosphorus intoxication on the duration of hospitalisation: type of conscience, presence of spasms, pulmonary oedema, shock and multi-organ insufficiency syndrome (MOIS). To forecast the treatment length, we obtain simplified mathematical expressions in the form of score estimates. Results: The significance of the clinical indicators “MOIS”, “conscience” and “spasm” has been confirmed. A forecast matrix that gives the opportunity to forecast the personal duration of hospital treatment for each patient has been built