[Application of total intravenous anesthesia with propofol in laparoscopic cholecystectomy: specific properties of propofol as an antioxidant]. / Prilozhenie na totalna intravenozna anesteziia s propofol pri laparoskopska kholetsistektomiia: osobenosti i kachestva na propofola kato antioksidant.

The authors reveal the formation of free radicals in biologic objects stressing upon the influence of Propofol (Diprivan; Zeneca; London, UK) as an intravenous agent during laparoscopic cholecystectomy (LCCE) lipid peroxidation. Some LCCE surgical details help this process resulting in free radical synthesis. The antioxidant effect of Propofol in vitro constitutes a peculiar interest. This generates idea that Propofol may be used as an anesthetic or as a sedative in patients with disturbances in free radical formation.

[Percutaneous puncture treatment of hepatic cystic echinococcosis under ultrasound guidance]. / Perkutanno punktsionno lechenie na kistichnata chernodrobna ekhinokokoza pod UZ kontrol.

Introducing of the alternative PAIR (puncture-aspiration-injection-reaspiration) method for treatment of hepatic echinococcosis in practice dates from 1992 year. A Working group dealing with the problems and standardization of the method has been created by WHO. The major aspects of this treatment are summarized in the bulletin of WHO of 1996 year. On the last World Congress of Ultrasound, held in Florence, Italy in 1999 this method was reported as safe and effective treatment modality. The necessity for further prospective studies was also emphasized. The aim of the Working group for performing of PAIR, created at the Clinical Centre of Gastroenterology, University Hospital "Queen Joanna" in 1999 is to report the preliminary results and declare the possibilities for its application. Nine patients (6 males, 3 females) with 11 cysts (I, II and IIIa types after Gharbi) measured 3-9 cm were punctured and followed up for a 6 months period. 95% ethanol was used as protoscolicidal agent with concomitant preventive oral treatment with Mebendazole. No serious complications were observed. In all patients separation of the germinative membrane was verified. 2/5 cysts < 3.5 cm completely disappeared, 7/11 diminished their size without signs of vitality, while 2/11 remained vital. One ofe the cysts had a biliary communication which necessitated the injection of 20% NaCl instead of ethanol. The serological ritres significantly decreased in all patients. The risk of anaphylaxis and seeding is negligible while keeping the technique of PAIR precisely. The PAIR treatment of hepatic echinococcosis presents great progress with its safety, low risk and excellent therapeutic results.

[Pancreatic cancer. The experience with its surgical treatment]. / Rak na pankreasa. Opit vurkhu khirurgichnoto lechenie.

Experience had with the surgical management of 483 patients, operated for cancer of the pancreatic gland in the Clinic of Abdominal Surgery over the period 1971 through 1994, is presented. Distribution of the patients by gender and age shows noteworthy consistency. Preoperatively, exact diagnosis in the clinic is made in 91.1 per cent, but usually the patients are admitted in advanced stage of the disease (91.6 per cent). Merely 42 cases (7.6 per cent) are free of metastases in regional lymph nodes or carcinomatous infiltration. The neoplasm is located in the head of the gland in 350 patients (66.5 per cent) with resectability attained in 10.1 per cent, in the body and tail--in 96 patients (19 per cent) with resectability 6.5 per cent; the neoplasm involves the total gland in 55 cases (10.2 per cent), and derives from the papilla in 25 (5.2 per cent) with operability 44 per cent. Operability for the total group amounts to 9 per cent, morbidity--17 per cent and overall lethality--15 per cent; of the latter following radical interventions 4 per cent, palliative interventions 8 per cent and explorative laparotomy 3 per cent. The details of the operative technique are comprehensively discussed.

[Pancreatoduodenal resection for carcinoid of Vater's papilla]. / Pankreatoduodenalna rezektsiia za kartsinoid na papilla Vateri.

Papilla Vateri carcinoid is among the very rarely occurring locations of the lesion. The small lumen of the papilla is the underlying cause of becoming clinically manifest with icterus rather early. Accessibility of the process for endoscopic biopsy facilitates the diagnosis. Even histologically it is very difficult to differentiate benign from malignantly altered carcinoids. Only the existence of metastases confirm with certainty their malignant nature. An observation on papilla Vateri carcinoid in a 60-year-old woman, proved preoperatively through cytological study, is reported. Intraoperative--no metastases are discovered. Sparing pancreatoduodenal resection is performed with a good functional outcome, recorded at the checkup examination after two years.