[Evolutionary and prognostic studies of patients with primary liver cancer. II. Multifactorial analysis using a stepped-regression mathematical model and graphics]. / Prouchvane na evoliutsiiata i prognozata pri bolni s purvichen chernodroben rak. II. Multifaktoren analiz s pomoshtta na stupkov regresionen matematicheski model i grafika.

The subject of this study is the evolution and prognosis of 63 patients with primary liver carcinoma assessed bu multifactor regression mathematical model realized with the aid of the program 2R of the statistical package VMDR and by graphic expression of the functions of survival, mortality, speed of mortality function growth and graphic assessment of survival according to Okuda's method. The step regression analysis in 2 steps of the regression mathematical model of the clinical indices pointed out the factors age, edema and liver encephalopathy. By 7 steps in the regression mathematical model of the combined clinical and clinico-chemical indices as basic prognostic factors were selected: prothrombin time, liver encephalopathy, direct bilirubin, age, GGTP and sex.

[An evolutionary and prognostic study of patients with liver cirrhosis. I. A particular correlation analysis of the data from clinical observation and clinico-laboratory and instrumental studies in relation to the survival of patients with liver cirrhosis]. / Prouchvane na evoliutsiiata i prognozata pri bolni s chernodrobna tsiroza. I. Chasten korelatsionen analiz na dannite ot klinichnoto nabliudenie, klinikolaboratornite i instrumentalnite izsledvaniia vuv vruzka s prezhiviaemostta pri bolni s chernodrobna tsiroza.

The influence of some clinical indices, clinico-laboratory and instrumental examinations on the survival of patient with liver cirrhosis was studied by implication of the programs 1D and 2D of the statistical package BMDP. The separate statistical comparisons show that of their own importance for the survival of the cirrhotic patients are the initial clinical manifestations (the latent and subclinical cirrhosis have a better prognosis), the size of the liver and the degree of portal hypertension assessed by laparoscopy according to the authors' classification in 4 grades (the patients with portal hypertension even in the absence of ascites show a significantly lower survival). The presence of concomitant diseases, the treatment applied and the cause of death do not play a significant role in the survival of the patients with liver cirrhosis.

[Evolution and prognosis in patients with liver cirrhosis. II. A multifactorial analysis using a stepped regression mathematical model]. / Prouchvane na evoliutsiiata i prognozata pri bolni s chernodrobna tsiroza. II. Multifaktoren analiz s pomoshtta na stupkov regresionen matematicheski model.

The multivariant approach offers best possibilities for assessment of liver function. The role of the different clinical, clinico-laboratory and combined clinical and clinicochemical indices in the prognosis of liver cirrhosis was studied in patient in ambulatory conditions. A step regressive mathematical model with the help of the program 2R of the statistical package BMDP was used. The regression of the clinical indices by 5 steps of the mathematical model showed that of greatest importance for the survival are the following indices: ascites, months since its onset, collaterals, anorexia and vascular nevi. By 4 steps of the regressive model of the clinico-chemical indices the following indices were chosen: prothrombin time, albumin, total bilirubin, cholesterol and alkaline phosphatase. The regression of the combined clinical and clinico-chemical indices pointed out as basic factors 3 clinical indices (ascites, months since its onset, collaterals) and 3 clinico-chemical indices related to the disturbed liver function (prothrombin time, total bilirubin, albumin).

[The evolution and prognosis of liver cirrhosis patients. III. An evaluation of the survival rate and mortality using graphic mathematical models]. / Prouchvane na evoliutsiiata i prognozata pri bolni s chernodrobna tsiroza. III. Otsenka na prezhiviaemostta i smurtnostta chrez grafichni matematicheski modeli.

The survival and mortality were assessed in 474 patients with liver cirrhosis followed up for a long time in outpatient conditions. The programme 2R of the statistical package BMDP was used and the following mathematical methods were applied: function of survival (for men and women) assessed by the method of Kaplan-Meyer; function of mortality assessed by the hazard-model of Link; velocity of growth of the function of mortality and method of the cumulative function of mortality for the remainders. The achievement of data, confirming each other, by the four mathematical graphic models applied allows the assertion that the selected method for assessment of the prognosis of liver cirrhosis is correct. It may be concluded with great certainty that there is no difference in the survival between men and women suffering from liver cirrhosis.

[Evolution and prognosis in patients with primary liver cancer. I. The effect of individual factors on the survival of patients with primary liver cancer]. / Prouchvane na evoliutsiiata i prognozata pri bolni s purvichen chernodroben rak. I. Vliianie na otdelni faktori vurkhu prezhiviaemostta pri bolni s purvichen chernodroben rak.

The data of the frequency, evolution and prognosis of 63 patients with primary liver carcinoma which had developed on the basis of liver cirrhosis are presented. An attempt is made to assess the importance of the etiologic factors, type of liver cirrhosis, macroscopic type of the tumor, histologic pattern of the cancer, sex and age for the evolution and prognosis of the disease. The patients with primary liver carcinoma without cirrhosis have a better prognosis. As high risk factors may be accepted: male sex, age over 50 years, toxic factors, hepatitis B virus infection and chronic alcoholism. The macroscopic type of the tumor also affects the prognosis. The histologic pattern of the cancer does not influence the survival of the patients with primary liver carcinoma.

[A case of chronic recurrent pancreatitis with multiple severe complications]. / Vurkhu edin sluchai s khronichen retsidivirasht pankreatit s monozhestvo tezhki uslozhneniia.

A case of a man 33 years of age with severe hemorrhagic-necrotic chronic recurrent alcoholic pancreatitis is reported. The diagnosis was confirmed by clinical, laboratory-biochemical and ultrasound examinations. The last recurrence of the disease was marked by two cysts in the left hypochondrium proved by ultrasound examination. The laparoscopy revealed two very large pseudocysts filled with hemorrhagic liquid originating from the pancreas. In spite of the active postoperative treatment the patient died of severe hemorrhage--manifested by hematemesis, melaena and hemorrhagic shock. The postmortem examination revealed severe hemorrhagic-necrotic pancreatitis with sequestrations, pancreatic lithiasis and 3 large cysts in the abdomen: of the omentum, subhepatic and in the left hypochondrium as well as a perforated ventricular ulcer.

[A case of severe methacycline damage to the liver and bone marrow]. / Vurkhu edin sluchai s tezhko metatsiklinovo uvrezhdane na cherniia drob i kostniia mozuk.

A case of a male patient with bronchopneumonia incorrectly treated for a long time with methacycline (rondomycin), an oxytetracycline drug, is reported. methacycline was applied in a dose of 8 capsules daily (2 capsules 4 times) in the course of 2 1/2 months, the total dose amounting to about 150 g. The patient developed severe toxic hepatitis as a result of this incorrect treatment. The hepatitis was manifested by jaundice and cytolysis. The bone marrow was also affected--hypoplasia marked by combined depression of leuko-, erythro- and thrombopoiesis and peripheral pancytopenia. In addition chloramphenicol treatment was applied which increased the toxic impairment of the liver and the bone marrow. The liver and bone marrow impairment are most probably due to the direct toxic action of methacycline applied for a very long time in an unusually high dose.

[Lipid fraction content of puncture biopsy material from the liver of patients with diabetes mellitus and obesity]. / Sudurzhanie na lipidnite fraktsii v punktsionnobiopsichen material ot cheren drob na bolni sus zakharen diabet i zatlustiavane.

The quantity of the main lipid classes in hepatic tissue has been determined via thin layer chromatography on silica gel, the tissue obtained by blind hepatic biopsy in 20 patients with diabetes mellitus and obesity and in a control group of 5 patients with no hepatic disease. A considerable increase of lipid in liver was established in the patients with diabetes mellitus and obesity-the fraction of neutral lipids mainly. The fatty infiltration of liver in diabetics was accompanied by a considerable increase of triglyceride concentration--3,78 g/100 g wet body mass as compared with the controls--0,95 g/100 g wet body mass. Increased concentration of esters and cholesterol (80%) was established in the liver of the patients with diabetes and obesity as well as increased fraction of free fatty acids (230%). The concentrations of total phospholipids and free cholesterol in liver in both groups of patients proved to be rather close. The fatty infiltration of liver of diabetics with obesity was accompanied by marked increase of percentage content of triglycerides--from 17.3% in the control group to 42.1% from the total lipids in the patients with diabetes and obesity. Reverse alterations were established for the fraction of total phospholipids. Pronounced increase of the coefficient triglycerides/total phospholipids was established in case of diabetes and obesity.

[Effect of carsil and legalon in treating chronic liver diseases]. / Efekt na karsila i legalona pri lechenieto na khronichnite chernodrobni zaboliavaniia.

The clinical effect from the treatment of 48 patients with carsil and 24 patients with legalon is studied. The patients were subdivided into three groups in the base of the clinical, laboratory-chemical and instrumental examination: light hepatic lesions--hepatic steatosis, chronic persisting hepatitis (ChPH), post-hepatitis states, chronic active hepatitis (ChAN) and cirrhosis of the liver (CL). Both preparations were administered 3 three times, 2 tablets daily for 3 months. The results obtained revealed that the bioflavonoid preparation carsil did not much differ in its clinical effect from the preparation legalon. The preparations carsil and legalon had a good effect, but not with statistical significance, on the subjective symptoms--pain, sense of heaviness and upper dyspeptic syndrome in the patients studied. Both preparations had a good effect on the biochemical indices: thymol test, SGOT, gamma-globulins, immunoglobulin G, blood bilirubin. The three month administration of carsil and legalon did not essentially change the histological findings in liver. The preparations carsil and legalon are indicated in light and moderate hepatic affections--hepatic steatosis, ChPH, post-hepatitis states. No contraindications have been reported for the administration of those preparations even in advanced hepatic disorders where they could be included as "basis" therapy.

[Clinical-dispensary finding of patients with primary biliary cirrhosis]. / Klinichno dispanserno nabliudenie pri bolni s purvichna biliarna tsiroza.

Ten patients with primary biliary cirrhosis (PBC) were clinically followed under the conditions of follow-up care. The diagnosis of the patients was made vie biochemical immunologic, histological and instrumental investigations. The average term for follow up was 4 years and 5 months. All patients were actively checked up by summoning every 6 months. The average incidence of hospitalization at the clinic was 1 year and 5 months. Pruritus preceded all other symptoms--1 year and 11 months on the average. Jaundice was established 1 year and 7 months after the manifestation of pruritus and the dirty greyish pigmentation of the skin--1 year and 11 months after pruritus. Hepatomegaly was established 1 year and 7 months after pruritus. Increased alkaline phosphatase, blood bilirubin and cholesterol were observed in all patients and increase of IgM in 80 per cent, and antimitochondrial antibodies--in 70 per cent. Xanthelasma and xanthoma were found only in patients with high levels of cholesterol and total fats. The treatment with dihydrocortison induced stomach complaints (erosive gastritis), intersifying bone chanes in 20 per cent of the patients. X-ray and instrumental methods have a relative value in making the diagnosis of PBC. It could be concluded from the complex treatment that corticosteroids give complications and the treatment with cholestiramine--to attenuation of pruritus. The average survival after making the diagnosis is 6 years.

[Causes of death in liver cirrhosis patients seen on an outpatient basis]. / Prichini za smurtta pri bolni s chernodrobna tsiroza, nabliudavani pri dispanserni usloviia.

The immediate cause of death were studied in 122 patients with cirrhosis of liver, out of 236 patients with cirrhosis of liver under follow-up care observation in the course of 12 years. The average age of the deceased is 53,8 years, with a ratio males: females--2,3:1. The deceased were grouped according to the type of liver cirrhosis as follows: micronodular--63,1%, macronodular--15,6%, mixed--9,8%, primary biliary--6,6%, hemochromatosis--, 4,1% and the disease of Wilson--Konovalov--0,81%. Decompensated stage of cirrhosis was established in 77,9% from the deceased at the last examination and compensated--21,1%. Immediate cause for the death in the summed up group cirrhoses is: hepatic coma in 42,2%, acute hemorrhage with or without coma--32,3%, other causes--18,9%. Degeneration of liver cirrhosis into cancer was established in 9,01%. Cirrhosis degenerated more frequently in males. Hemochromatosis and micronodular cirrhosis are the ones that most frequently degenerated.

[Case of a patient with liver cirrhosis and Silvestrini-Corda syndrome]. / Sluchai na bolen s chernodrobna tsiroza i sindrom na Silvestrini--Corda.

A case with alcoholic cirrhosis of liver is described that was combined with manifested gynecomastia, atrophia of testes and impotence--Silvestrini--Corda syndrome. Changes in the endocrine state of the patient were established--a tendency to reduced estrogens in plasma (estradiol), increased blood cortisol and reduced excretion of its metabolites in urine. The case is of clinical interest because the severe alcoholic hepatic lesion became the cause of the affection of endocrine state and in this way led to manifested classical syndrome of Silvestrini--Corda.