[Radiofrequency ablation of hepatic metastases: clinical results].

AIM: To establish the effectiveness of radiofrequency ablation in the treatment of metastatic hepatic lesions. PATIENTS AND METHODS: 104 pts with 231 metastases were treated with RFA. The volume of achieved destruction was assessed using imaging method and cytology. Patients were followed-up for 1-37 months. RESULTS: 87.3% of metastases < 3.0 cm, 50.9% of tumors sized 3.0-5.0 cm and 14.3% of metastases > 5.0 cm were completely destroyed. Major complications occurred in 7.5% of the patients. 34% of the ablated tumors recurred. CONCLUSIONS: The effectiveness of RFA metastases depends on the size and location of the lesion. Lesions adjacent to the gallblader and main bile ducts are risky for manipulation.

[Bolus percutaneous ethanol injections in hepatocellular carcinoma--clinical results].

AIM: To establish the effectiveness of large-volume percutaneous ethanol injection under general anesthesia (Shot-PEI) as a local method for destruction of large hepatocellular carcinoma (HCC). PATIENTS AND METHODS: 46 patients with 48 HCC were treated with Shot-PEI. 1-4 sessions per lesion were performed with 12-138 ml ethanol per session. RESULTS: Complete destruction was achieved in 43.8% of the tumors. Major complications occurred in 10.9% of the patients. Local recurrences were 19%. CONCLUSION: Shot-PEI is an effective method for destruction of large tumors and multiplies the therapeutic options in HCC.

[Radiofrequency ablation of recurrent intrahepatic cholangiocarcinoma: a case report].

A 45-years-old patient with recurrent intrahepatic cholangiocarcinoma 3 years after resection is described. 2 sessions of percutaneous radiofrequency ablation (RFA) were performed and complete destruction of the tumor was achieved. The patient was followed-up for 15 months by means of power-Doppler, CT and tumor markers. No local or heterotopic recurrences were observed. The case demonstrates the possibilities of RFA in the management of postoperative recurrences of intrahepatic cholangiocarcinoma and confirms the significance of the method in the complex approach to the liver tumors.

[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.

Xanthoma of the stomach--some morphometrical peculiarities and scanning electron microscopy.

BACKGROUND/AIMS: "Lipid Iceland's" in gastric mucosa, a rare finding in gastroenterology, is described in this paper. The aim of our investigation was to evaluate the frequency of the so-called "gastric xanthoma" in biopsy specimens and to describe the picture elicited by scanning electron microscopy. METHODOLOGY: We investigated cell characteristics histochemically, morphometrically and with scanning electron microscopy. RESULTS: The frequency of xanthoma in our gastrobiopsy material was 0.018% (4 of 21,650 cases) over a 6-year period. The picture of stomach xanthoma given by scanning electron microscopy is very typical of the condition and is called "rolling stones". CONCLUSIONS: We suggest that this diagnostic method warrants further investigation.

[The role of laparoscopy and laparoscopic ultrasonography in the diagnosis and differential diagnosis of nodular hepatocellular lesions]. / Rolia na laparoskpiiata i laparoskopskata ekhografiia v diagnostikata i diferentsialnata diagnoza na nodularnite khepatotselularni lezii.

The diagnostic relevance of laparoscopy (LS) and laparoscopic echography (LE) in nodular hepatocellular lesions is studied. LS is done using a R. Wolf laparoscope, and LE--with a 7.5 MHz linear transducer, obtained from the Aloka Company. A total of 250 patients presenting 288 nodular hepatocellular lesions are investigated over 15 years (1983-1998), including: focal nodular hyperplasia (FNH)--1, nodular regenerative hyperplasia (NRH)--1, hepatocellular adenoma (HCA)--1, adenomatous hyperplasia (AH)--38, hepatocellular carcinoma (HCC)--58, Budd-Chiari syndrome--2, primary sclerosing cholangitis (PSCh)--2, and cirrhosis of liver--185. The lesions are distributed according to the updated classification of the International Working Party, published in 1995. In addition to the latter, a case of cholangiocellular adenoma undergoing malignant degeneration and a case presenting carcinoma, giving rise to differential diagnostic difficulties are also described. Some of the aforementioned diseases are reported for the first time in the Bulgarian literature. Emphasis is laid on the practicability of combining endoscopic with imaging diagnostics, attributable to laparoscopic echography and to the advantages of echolaparoscopic biopsy. Almost half of the foci (46.1%) are morphologically verified. The aim of cytological assessment is to establish the malignant character of the lesion, first and foremost, while the histological finding is essential for making a correct diagnosis.

Ebrotidine versus ranitidine in the treatment of acute duodenal ulcer. A multicentre, randomized, double-blind, controlled clinical trial.

A total of 478 patients with endoscopically confirmed duodenal ulcer entered this randomized, parallel, double-blind trial. Patients were randomly assigned to receive ebrotidine (N-[(E)-[[2-[[[2-[(diaminomethylene)amino]- 4-thiazolyl]methyl]thio]ethyl]amino]methylene]-4-bromo-benzenesulfona mid e, CAS 100981-43-9, FI-3542) 400 mg or ranitidine 300 mg tablets (4:1) respectively, administered in single evening doses. Endoscopy, clinical examination and symptom assessment were performed at baseline and at weeks 4 and 8. Safety evaluations including laboratory tests, treatment compliance and antacid consumption checks were conducted at the beginning and/or at the 4 and 8 week visits. Patients whose ulcer showed endoscopic healing at the 4-week control left the study. Both groups were matched in all parameters studied. The healing rates at 4 weeks were 76.4% and 75.3% for ebrotidine and ranitidine respectively, while at 8 weeks the final rates were 95% and 91.8% respectively. Accompanying symptoms disappeared rapidly and the patients returned to normal. Smoking proved to be a highly significant negative risk factor, since healing rates were 83.4% and 71.2% at 4 weeks and 97.4% and 92.3% at 8 weeks in non-smokers and smokers respectively (p = 0.0046). Smokers treated with ranitidine showed significantly lower final healing rates than non-smokers (86% vs 100%; p = 0.0358), while the healing rates among patients treated with ebrotidine were similar regardless of whether they were smokers or not (93.9% and 96.7% N.S.). Ebrotidine (94%) proved to be more effective than ranitidine (86%) in smokers with higher healing rates (p < 0.05). Alcohol intake showed no significant relationship with the healing rates. Both drugs demonstrated an excellent safety. There were no changes in blood parameters, and no significant adverse events were reported.

Comparison of three urease tests for detection of Helicobacter pylori in gastric biopsy specimens.

OBJECTIVE: To propose two modified urease tests for the detection of Helicobacter pylori in gastric biopsy specimens. PATIENTS AND METHODS: The presence of H. pylori infection was determined in 237 patients undergoing upper gastrointestinal endoscopy. Three media were used for the urease tests: Christensen's 2% urea broth and two urea agar media, modified by increasing the concentration of urea (to 4% and 10%) and phenol red and omitting the nutrients. RESULTS: The modified tests had good sensitivity (> 78%), specificity (96%) and accuracy (> or = 86%) at 2 h using small amounts (15%) of biopsy homogenates. They were statistically more sensitive and accurate than Christensen's broth. CONCLUSION: Both the modified 4% and 10% urea agar tests are simple, sensitive and specific and can be performed with small amounts of sample.

[Laparoscopy and laparoscopic echography in the diagnosis and staging of gastrointestinal carcinomas]. / Laparoskopiia i laparoskopska ekhografiia v diagnostikata i stadiiraneto na gastrointestinalnite kartsinomi.

The clinical relevance of laparoscopy (LS) and laparoscopic echography (LSEG) in diagnosing and staging gastrointestinal carcinomas is assayed in the light of diagnostic methods in current use. The study covers 257 patients undergoing LS, and 23-LSEG. For the purpose a rigid 7.5 MHz echolaparoscopic probe is used. In 16 per cent of the cases LS fails to resolve the basic diagnostic problems faced, whereas in 35 per cent it alters completely the preliminary clinical diagnosis. In over 90 per cent of cases LSEG supplements or modifies the laparoscopic diagnosis. Emphasis is laid on the role played by LSEG in defining the loco-regional stage of gastric and colorectal carcinomas, as well as on the contribution of the method to establish pancreatic carcinomas not lending themselves to resection. What is more, LSEG demonstrates inoperable cases by detecting small, unsuspected metastases, not prominating above the hepatic surface.

[Computed tomography and echography in chronic pancreatitis and pancreatic carcinoma]. / Kompiuturna tomografiia i ekhografiia pri khronichen pankreatit i pankreasen kartsinom.

The diagnostic possibilities of computer tomography and echographic investigations were studied in 58 patients with chronic pancreatitis and 36 patients with carcinoma of pancreas. Positive morphological signs for the existence of chronic pancreatitis were established in 75,9 per cent in computer tomography and in 83,93 per cent in echographic investigations. The difference in the diagnostic sensitivity of both diagnostic methods is not significant (p greater than 0,05). The calcifications in pancreas are better detected by computer tomography whereas both methods are equivalent in the diagnosis of the pancreatic cystes. In carcinoma of pancreas computer tomography gives the correct diagnosis of the disease (p greater than 0,05) in 69,5 per cent and echography--in 78,8 per cent of the patients. With computer tomography false negative results amount to 30,5%; in 13,9 per cent normal pancreas was described and in 16 per cent--pseudocyst in pancreas. With echography--false negative results were established in 21,2 per cent of the patients; 12,1 per cent chronic pancreatitis was described, in 9,1 per cent--pseudocyst in pancreas but, at the same time, pancreas was not properly visualized in 8,3 per cent of the examined. Making use of both methods, accurate diagnosis was made in 83,3 per cent of the patients with carcinoma of pancreas.