Exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis.

1. The impact of ventilatory efficiency on reduced exercise capacity and recovery oxygen kinetics has not been addressed in cirrhotic patients. The aim of the present study was to investigate exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis (LC). 2. Nineteen male non-hypoxic patients with LC (age 51.3 +/- 9.1 years; body mass index (BMI) 25.6 +/- 3.6 kg/m(2)) classified by the Child-Pugh score as class A (n = 7) and class B (n = 12) and 19 age- and BMI-matched controls participated in the study. Subjects undertook maximal incremental exercise testing on a treadmill using the Bruce protocol. 3. Patients with LC showed a reduced diffusion capacity (D(L,CO)%) compared with controls (74.6 +/- 15.2 vs 95.6 +/- 12.9%, respectively; P < 0.001), but a comparable volume standardized diffusion coefficient (1.33 +/- 0.22 vs 1.45 +/- 0.18 mmol/min per kPa per L, respectively; P = 0.74). Patients with LC had a significantly lower exercise capacity compared with controls (VO(2 max) 23.8 +/- 3.8 vs 30.6 +/- 4.4 mL/min per kg, respectively; P < 0.001). Recovery oxygen kinetics were also impaired in LC patients compared with controls (104.6 +/- 19.3 vs 84.4 +/- 22.7 s, respectively; P = 0.012). The chronotropic index was significantly lower in the LC group compared with controls (0.67 +/- 0.19 vs 0.82 +/- 0.17, respectively; P = 0.030) and LC patients showed higher ventilatory equivalents (30.4 +/- 3.8 vs 26.3 +/- 2.3, respectively; P < 0.001) and lower oxygen uptake efficiency slope values (2187 +/- 445 vs 2745 +/- 473 mL/min per log(10)L, respectively; P < 0.001) compared with controls, which is indicative of decreased ventilatory efficiency. Patients with LC also had a higher standardized maximal exercise perception score (SMEPS) compared with controls (0.62 +/- 0.18 vs 0.46 +/- 0.15, respectively; P = 0.011). Moderate negative correlations were found between Child-Pugh score and VO(2 max)% (r = -0.496; P = 0.031). 4. In conclusion, patients with mild and moderate LC have reduced exercise capacity, which correlates with Child-Pugh score, as well as reduced chronotropic index and prolonged recovery oxygen uptake kinetics. The results suggest worsened ventilatory efficiency during exercise and cardiopulmonary reasons for the higher SMEPS in these patients.

Diagnostic strategies for evaluation and prognosticating the outcome of jaundice among patients with cholestasis caused by neoplastic diseases of the hepatobiliary system and the pancreas.

The purpose of the present study was to assess the diagnostic approach and the outcome of neoplastic diseases of the hepatobiliary system and the pancreas that develop cholestasis. 84 patients over 40 years of age treated in our Department between January 1994 and January 1998 were included. The etiological cause of jaundice was established by ultrasonography, computed tomography, thin needle biopsy with cytological and histological examination of the obtained material or ERCP. 11 of the 84 patients died, 9 underwent surgery and 64 were referred to the Oncologic Center for further treatment.

Estimation of trends of morbidity of colorectal cancer in Plovdiv district for the period from 1985 to 1996.

The present study concerns the incidence rate of colorectal cancer (CRC) in Plovdiv region (population 1,269,464). The study was carried out over a 12-year period and aimed at establishing the increase rate of this disease. Results show that incidence rate of CRC increased progressively for the mentioned period from 22.14 to 34.98 per 100,000 people and was almost twice as high as that for the country. It is a particularly disturbing fact that the morbidity and mortality rates due to colorectal cancer is rising--2.36 times for 12 years. We propose screening for asymptomatic and high risk patients with considerable results for opportune diagnostics.

Trends in the incidence of colorectal carcinoma in three regions of south Bulgaria for the period 1985-1998.

The purpose of the present study was to evaluate the increase of colorectal carcinoma incidence in three regions of South Bulgaria (a total population of 1,269,464 persons) over a 14-year period (1985-1998). The data about the incidence rate are retrieved from the oncological hospital records of the patients and Bulgarian National Oncological Register. The census data are provided by the National Institute of Statistics, Sofia. The results show that the incidence rate of colorectal carcinoma for the studied period increased steadily from 22.14/100,000 to 37.18/100,000 (an increment of 15.04/100,000) which is almost twice the average for the country. Compared to the baseline year of 1985 the increase in these three regions is 67.93% or approximately 5% annually. The incidence rate in Plovdiv region was almost twice that of Smolyan region. The incidence rate of colorectal carcinoma in both genders was greater than that of stomach cancer. The highest incidence rate was found in the 70-79-year-age group (193.5/100,000). A major part of our study was to find the stage in which colorectal carcinoma (CRC) is detected. In 1985 only 0.57% of the patients were diagnosed as being in the I-st clinical stage, 37.76%--in the II-nd, and 61.67%--in III-IV clinical stages. This unfavorable trend was preserved in 1998, when only 3.17% were diagnosed as having the first clinical stage, 38.62%--the II-nd and 58.21%--the III-IV clinical stages. The 14-year pronounced trend of increase of the prevalence rate (a 2.91 times increment) and the mortality rate (a 2.50 times increment) of colorectal carcinoma is especially alarming. We propose screening of the asymptomatic patients and high-risk persons which gives considerable results in the timely diagnostics of colorectal carcinoma.

A rare case of fibrosarcoma of the inferior vena cava expanding into the right atrium.

The authors report in detail a case of fibrosarcoma of the inferior vena cava. A 53-year-old female presented with echographic and computed tomographic evidence of a solid formation in the porta hepatis that fused with the inferior vena cava. Because of appearance and rapid development of symptoms of right cardiac failure, the patient was transferred to the Clinic of Cardiac Surgery and underwent an emergency operation. A solid formation arising from the inferior vena cava and expanding into the right atrium was found during the operation. The operation performed was not a radical one. Fibrosarcoma of the inferior vena cava was proved on histological examination. A single therapeutic course with vincristine and farmorubicin was administered. The patient died from recurrence of the malignancy 26 months after the operation. The epidemiologic, diagnostic, and therapeutic aspects of the case are discussed in relation with the literature data.