Akusherstvo i ginekologiia最新文献

In the presented methodical scheme, consecutively and systematically are scrutinized the epidemiology, the risk factors, the etiopathogenesis, the histopathology and the clinical signs of the uterine sarcoma. The diagnostic possibilities, as well as the staging principles are pointed. The current treatment factors, the prognostic factors and follow-up corresponding to the requirements of the oncological doctrine are presented.

It is described the clinical evaluation of eight cases with gonadal dysgenesis syndrome type 46XY diagnosed and followed in our division of Pediatric-Adolescent Gynecology since 1992 to January 2000. Two out of eight patients presented pure gonadal dysgenesis (Swyers syndrome), one presented 17-beta-hydroxysteroid-deydrogonase deficiency and the rest five presented Testicular Feminization Syndrome. The adolescents visited our department for the first time while being fifteen years old because of primary amenorrhea and growth retardation of secondary sex features. Apart from interview, physical and gynecological examination we performed complimentary haematological, biochemical, hormonal tests and confirmed the diagnosis by chromosomal analysis. Studying the upper and lower abdomen by the means of imaging methods (U/S and CT) we found out the presence of uterus and in few cases the gonadal position. Because of the high risk of malignancy all the patients underwent surgical gonadectomy. Postoperatively hormonal replacement therapy was administered to reinforce the female sex features and prevent the hormonal deficiency consequences like osteoporosis. The follow up included haematological, biochemical and hormonal tests. If uterus existed the endometrium thickness measured by ultrasound. Furthermore bone density, palpative and ultrasonography breast examination and investigation of possible psychological disorders insure the complete screening of the young "female" patients.

Purpose: This study aimed at establishing the link between clinical manifestations, microbiological diagnosis and the therapeutically approach in the treatment of vulvovaginitis candidosa in childhood.

Patients and methods: 35 patients aged 1-18 years were studied and divided into two groups. The criteria for establishing the diagnosis included the clinical symptoms, the native microscopic investigations and the microbiological control of the materials taken on the 14th and 30th day before and after treatment by means of a vaginal swab.

Results: Etiologically, vulvovaginitis was diagnosed as candidose in 35.71% and 80.95% for the two groups, respectively, by means of the native microscopic preparation. The mycological investigations confirmed the diagnosis in 23.81% of the cases. Other bacterial findings included enterococci, intestinal bacteria and staphylococci. Positive results of the local and combined therapy were reported in 67% of the cases on the 14th day, and in 65%--on the 30th day.

Conclusions: Vaginal fluorine tends to persist as compared to the remaining symptoms. Vulvovaginitis candidosa most commonly occurs in conjunction with other specific bacteria. Local therapy is recommended in acute infections and the combined therapy is more efficient in chronic conditions. Combined treatment should be administered in at least two 10-day courses because of a tendency to recurrence.

The use of nonhormonal drugs in order to ameliorate climacteric symptoms makes it possible to treat also those women in whom there are some contraindications or lack of compliance for taking hormonal replacement therapy. The drugs with complex effects on the whole body functions are more widely used recently. The aim of the present study is to assess the therapeutic effect of Cavinton (vinpocetin) on the degree of climacteric symptoms and to verify its complex beneficial influence. The study comprises of three groups of women in early menopause--control group (n = 30), treatment groups with normolipidaemia (n = 32) and with hyperlipidaemia (n = 29). All women presented with moderately expressed climacteric symptoms as assessed by Kupperman menopausal index and Hamilton-Anxiety-Skala (HAMA). The women in the 2nd and 3rd groups have been taking Cavinton in an oral dose of 5 mg three times daily for 3 months. The following parameters of lipid metabolism were determined in the beginning and at the end of the study: total, HDL- and LDL-cholesterol, triglycerides, and two indexes of lipid atherogenic risk--total/HDL-cholesterol ratio and atherogenic index (AI) = total--HDL/LDL-cholesterol. The menopausal complaints were assessed by Kupperman index and HAMA. Blood vessels reactivity was determined by pulsation index (PI). Statistically significant decrease in total cholesterol and LDL-cholesterol levels as well as amelioration of atherogenic indexes was observed in the 3rd group. Kupperman index and HAMA decreased significantly on the 45th day and the 3rd month in the women under treatment. No significant changes in PI were observed but a tendency towards a decrease was seen in the 3rd group. Our data suggest that Cavinton possesses complex beneficial effects in climacteric women significantly ameliorating climacteric symptoms as well as some parameters of lipid metabolism in women with hyperlipidaemia.

Unlabelled: The purpose of the authors is to survey the effect that HRT has on uterine fibromas.

Methods: It was made a very prospective one-year study on 25 women with uterine fibromas, 33-55 years old (the majority of them had subserose uterine fibromas with normal sizes). We are used the HRT with Climent and Cyclo-proginova (Schering A.G.). According to the kind of the treatment that was used, two groups were formed: the 1st had treated with Climent (n = 18) and the 2nd--with Cyclo-proginova (n = 7). The changes in the growth of the fibromas were observed with echography at the 1st, 3rd, 6th and 12th months.

Results: The significant changes in the growth are absent in the 1st group, while in the 2nd group in 6 of the 7 cases showed a little increasing in the size of the fibromas (to 25 mm). However, in 2 of all women who had bleeding, were treated with abrasio residuorum, and the histological result is a simple glandular hyperplasia. The missing of important changes in the size of the fibromas can be explained with the progestogens compartment, which decreased of estrogen receptors and with the stimulating effect of the 17 beta-OH-steroiddehydrogenasis, which reduced the estradiol in the cells.

Conclusion: HRT could be used at women having fibromas without significant changes in the growth, under very strict control by echograpry.

A case of pregnancy, malformation of the foetus--Spina bifida, and hydatidosis hepatis is discussed. The patient is 19-year old, primigravida, pregnant in the 31st gestational week who was admitted to the ward with an observation of Hydrocephalia and fetal compromise (low beat-to-beat variability and lack of accelerations of the fetal heart rate). Un ultrasound scan of the foetus proved hydrocephalia and Spina bifida in the lumbal segment of the fetal spine. Un extended ultrasound scan proved a hydatid cyst of the liver with a 10 mm diameter, corresponding with the data of the serological tests--RAHA 1:400.

The purpose of this prospective and case controlled study is to determine the effectiveness and safety of antibiotic prophylaxis with Tercef (ceftriaxone) in women undergoing cesarean section and to compare the results with those of 24 hours regiment of Cefazolin and also with a group without prophylaxis. The study includes 122 cases of elective and emergency CS: 41 with a single intravenous dose of 1.0 g Tercef after clamping of the umbilical cord; 41 cases of antibiotic prophylaxis with Cefazolin three times 2.0 g for 24 hours and 40 low infectious risk CS without antibiotic prophylaxis. We take in account the existing before the CS risk factors for postoperative infectious complications as: hours of PROM; length of labor, number of vaginal examinations before CS, previous sections, duration of the operation, anemia, bacteriuria and diabetes. For post CS infection-related complications we take: febrile morbidity, endometritis, wound infections, infection of urinary tract. The results show infection complication in the three groups as follow: 14.6% for tercef, 17.1% for cefazolin and 20.0% for the group without antibiotic. There is not statistically significant difference. According our study in cases of CS with increased risk of post-operative infectious complications the antibiotic prophylaxis reduce the rate of infection-related complications even below that of CS with low infectious risk. The single dose of 1 g tercef i.v. is effective and suitable in comparison with 24 hours regiment of cefazolin.

Attempts to optimize quality of life in woman with epilepsy should include a reliable method for birth control, including oral contraceptives (OC). One of these methods is hormonal oral contraception. The classic antiepileptic drugs (AEDs)--Phenytoin, Phenobarbital, Ethosuximide and Carbamazepine induce hepatic microsomal enzymes and decrease the production of estradiol and progesterone, that may be compromise the effects of OC. Recommendation for women taking OC include possible use of noninducing AEDs (Valproic acid), new AEDs--Lamotrigine, Gabapentin, Topiramate, Tiagabine or for patients taking inducing AEDs use of an OC containing > or = 50 micrograms. estrogen. Patients should be warned that midcycle bleeding indicates possible OC failure and that the absence of such bleeding is not an indication of OC effectiveness. Additional contraceptive methods are also advised. The authors report their own experience in 12 women taking AEDs and OC.

The age of menopause in women is a key point, because early menopause is associated with increased risk for many diseases. The purpose of this study was to collect data on age of menopause in Bulgarian women and to detect possible changes in it. 6017 women aged 50 years and over were included, 5363 of them were postmenopausal. Mean age of menopause in the whole study group was 49.3 years. In younger menopausal women (age 51-59 yrs.) mean age of menopause was 47.7 yrs., whereas in elderly women (71-79 yrs.) it was 49.2 yrs. This shift down of the menopausal transition is due also to the increasing part of women with early or premature menopause, including iatrogenic causes. The main consequence is the "growing younger" of many common and socially important diseases among Bulgarian women, which require active prevention.