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The objective of this study was to investigate increases in c-myc gene copy-number in ovarian tumours, and to analyze their correlations with clinicopathological parameters. Here we applied FISH on TMA (tissue microarrays) containing 507 ovarian tumour samples from different malignancy, histology, stage and grade. Overall, we found high frequency for c-myc copy-number increases (38.5%) in ovarian cancers: 22.1% amplifications and 16.4% gains. We established c-myc amplification in more than 30% in endometrioid and mixed epithelial ovarian carcinomas. c-myc gains were found in a high proportion (42.9%) of clear cell carcinomas. We found associations between c-myc copy-number changes and clinicopathological parameters of ovarian tumours such as degree of malignancy and histological type. We suggested that c-myc amplifications are characteristics for endometrioid, and c-myc gains for clear cell ovarian cancers. We suggest that copy-number increases of c-myc and 20q13.2 represent a possible mechanism for the regulation of the pathway STK15--c-myc--hTERT.

To ensure high-quality medical and dental care for the population, the health insurance system in Bulgaria and all relevant social relations, the Bulgarian Parliament adopted the Health Insurance Act, which aims to change the whole health system from a socialist system to a modern Western European-style health care system. The reform is partly financed by the World Bank, Washington D.C. One important component during this huge change is the definition of new health care processes and the conception and implementation of a new information system and infrastructure.

The aim of the present study was to evaluate serum copper concentration changes in patients with benign cysts or carcinomas of ovary, and to compare these concentrations with the normal reference serum copper levels. Patients included in the study were as follows: benign ovarian cyst cases (n = 19), endometrial cyst cases (n = 5), ovarian carcinoma cases (n = 6), female patients with no ovarian disease (n = 161). Reference serum copper levels in apparently healthy subjects were 16.8 +/- 4.15 mumol/l (mean +/- SD). Serum copper concentration were significantly increased in ovarian carcinoma patients (22.98 +/- 3.90 mumol/l) in comparison with benign cyst patients (18.40 +/- 4.61 mumol/l) (p0.05), in with endometrial cyst patients (15.94 +/- 4.24 mumol/l) (p = 0.02), and in comparison with normal levels in controls (p0.001). Copper/zinc ratios were highest in ovarian carcinoma patients--1.68, intermediate in benign cyst patients--1.42, and lowest in endometrial cyst patients--1.08. The mechanisms underlying serum copper concentration variations in the different groups are briefly discussed with special emphasis on these in ovarian carcinoma patients.

The paper presents the first cases of laparoscopic-assisted vaginal hysterectomy and laparoscopic hysterectomy with removal of the uterus through the vagina performed in Bulgaria as well as the experience gained by the team from II gynaecology clinic at State University Hospital "Maĭchin dom" in Sofia from seven patients operated on by these techniques. The indications, the conditions and the implemented technique with its advantages and difficulties are described. The procedures are associated with less trauma and blood loss than abdominal surgery and are followed by a very smooth postoperative period which is very well tolerated by the patients. No intraoperative complications occurred. The postoperative period was free of any problems in 5 of the patients while in two there were minor complications. Marked shortening of the duration of the procedures is achieved with the initial experience.

157 consecutive female patients complaining of urinary incontinence were studied by history and urodynamics. 21 of them (13.4%) demonstrated urge-incontinence due to severe detrusor instability, 20 (12.7%) showed mixed (both urge and stress) incontinence, 14 (9%) only detrusor instability and 12 (7.6%)--stress incontinence accompanied by detrusor instability. Pure stress incontinence was diagnosed in 79 cases (50.3%) while 11 patients (7%) manifested no abnormality during the urodynamics. A total of 67 patients (42.7%) showed urodynamic evidence of detrusor overactivity. In 55 (35% of the studied subjects) it was the main urodynamic finding. The prevalence of detrusor instability was higher among those with recurrent incontinence and was the highest (60%) among the women with more than one previous operations. When urge incontinence was present it occurred at detrusor pressures lower than the maximum urethral closure pressure, which implies possible failure of the sphincteric mechanisms associated with detrusor instability. 14% of the women with detrusor instability did not report complaints typical for this disorder but had history of stress incontinence alone. The authors confirm the necessity of objective assessment of the lower urinary tract in all cases with history suspicious of detrusor instability as well as when surgical treatment for stress incontinence is planned.

The article presents the results of a comparative study on the efficacy of perioperative prophylaxis with cefalosporins in abdominal gynaecological operations. A total of 155 women meeting certain inclusion criteria were operated on and were randomly assigned to one of the following regimens: Cefoxitin 3 x 1 g--14 subjects, Cefotetan 2 x 1 g--43 subjects, Cefalotin 3 x 2 g for 24 hours--27 subjects, Cefalotin 3 x 2 g for 72 hours--41 subjects and a control group of 30 subjects without prophylaxis. The course of the postoperative period, the hospital stay and the average costs in each group were assessed and compared. None of patients receiving any prophylaxis developed infectious complications, while such complications occurred in 10% of the control without prophylaxis. The authors conclude that antibiotic prophylaxis effectively prevent the infectious complications and shortens the postoperative hospital stay. Despite its narrower anti-bacterial spectrum Cefalotin is not inferior in its efficacy to the second and the third-generation cefalosporins. While providing equal effect, the 24-hours Cefalotin regimen is from 2.8 to 4.9 times cheaper then the other prophylaxis regimens and is twice cheaper than the no-prophylaxis regimen. The longer 72-hours Cefalotin scheme shows no advantages to the 24-hours one but almost triples the expenses. Additional antibacterial treatment in the postoperative period needs more precise indications since unequivocal reasons for its administration are missing in a number of cases.

The study presents the results from the use of cefotetan for perioperative prophylaxis in 43 gynaecology patients compared with 29 controls without perioperative antibiotic prophylaxis with similar diseases and operations. Both groups show equal percentage of the cases with smooth postoperative period (70 and 72% respectively). 13 of the patients on cefotetan prophylaxis received additional antibiotic treatment (9 because of temperature up to 37.5 degrees and 4 because of temperature from 37.6 to 38.5 degrees). Mo major infections postoperative complications occurred among the patients on cefotetan prophylaxis. 8 of the non-prophylacted patients needed antibiotic treatment postoperatively including 4 with temperature above 38.5 degrees. Two infections of the operative wounds also occurred in the same group. The conclusion is that cefotetan effectively prevents the major infection postoperative complications in gynaecology. The administration of additional antibiotic treatment is most often not warranted.

16 patients received twice daily 60-90 mg DHC-Continus. The evaluation of the pain was done with use of visual linear scale from 1-10 (Scott-Huskisson). Four complications occurred: headache, nausea, vomiting, constipation. The authors conclude that the orally administration of DHC is an effective alternative for postoperative treatment of pain in gynecological patients.

The study discusses the frequency of operative obstetric deliveries (cesarean section, forceps extraction and vacuum extraction) over a period of 18 years from 1976 till 1993. A total of 100,545 deliveries with 100,192 livebirths took place during this period with a decrease of the annual number of deliveries in the last years. The frequency of the various kinds of operative deliveries shows different tendencies. The frequency of cesarean section has increased from 4.87 per cent in 1976 to 19.58 per cent in 1993, this increase being particularly marked during the last 6 years. Meanwhile the vaginal operative deliveries have decreased their frequency. The decrease of forceps extraction is from 4.33 to 2.22 per cent (steadily about 2 per cent during the last years). The frequency of vacuum extraction has dropped from 1.89 per cent to 0 by the end of the 1980 and the beginning of the 1990. The tendencies of the development of obstetric operations are analysed as well as their influence on perinatal outcome.

The study includes 56 cases of women admitted at Second gynaecology clinic of the University Maternity Hospital Sofia with evidence or suspicion of having an ectopic pregnancy who had their serum beta-HCG levels determined quantitatively. 27 of them showed no beta-HCG in their sera and none turned out to have pregnancy, neither intrauterine nor ectopic. All cases of ectopic pregnancies (a total of 20) were associated with detectable beta-HCG levels in the serum. The great diagnostic value of serum beta-HCG is emphasized in the cases of old disturbed ectopic pregnancies accompanied by mild and uncommon symptoms and very low beta-HCG levels. In case of unruptured pregnancies or tubal rupture the diagnosis is verified before the result is available by the clinical and sonographic data. On the other hand the high sensitivity of the method leads to an increased number of cases with elevated beta-HCG in which the location of the pregnancy cannot be proven. The precise quantitative evaluation of serum beta-HCG enables us to follow the tendency of beta-HCG which may according to the clinical manifestations warrant invasive diagnostic procedures or just observation without active interference.

The study presents the results of urethral pressure profile measurements in 3 groups of women: continent nulliparous, continent parous and stress incontinent women. The maximum urethral closure pressure, the functional urethral length and the length of continence zone are compared. The healthy control groups (both parous and nulliparous) show much higher maximum urethral closure pressures than those mentioned in literature. No difference is evident between continent parous and continent nulliparous which suggests that vaginal delivery at term does not necessarily impair urethral sphincteric function. On the other hand women with similar age and parity with stress incontinence have a marked decrease of maximum urethral closure pressure at rest and demonstrate inability to increase it by volitional contraction of the pelvic floor. These findings support the idea of the leading role of sphincteric incompetence in stress incontinence. The functional urethral length and the length of continence zone show no significant differences among the investigated groups which implies that they are of no importance for the occurrence of stress incontinence.

Patients with proven stress incontinence were subjected to surgical treatment which combined both sling and Stamey-Pereyra techniques. A 3-4 cm long and 1,5-2 cm wide sling of Bulgarian polyamide mesh was placed under the urethrovesical junction using a small vaginal incision. Two long polyamide sutures were tied to either end of the mesh and were retrieved from the vagina to the abdomen by Pereyra needle inserted through two small suprapubic incisions and guided by the vaginal forefinger. The technique of the procedure is described. A total number of 27 patients were operated on. Two of them has their suspending sutures cut postoperatively because of prolonged urinary retention. The remaining 25 were continent. The technique proposed combines the advantages of the sling procedures (high efficiency especially in cases of severe and recurrent incontinence) and the simplicity of Stamey-Pereyra suspension technique. On the other hand the Bulgarian polyamide mesh showed very good qualities. No infection, rejection or sling erosion were observed.

Background: We selected 5 oncogenes with well-established roles in carcinogenesis – CCND1, ErbB1, ErbB2, c-mycand ZNF217– to investigate the coexistence of their copy imbalances in relation to the clinico-pathological characteristics of ovarian tumors. Materials and Methods: Fluorescence in situ hybridization for the 5 genes was applied to a preexisting tissue microarray. 38 ovarian tumors were successfully analyzed for copy number changes of the 5 genes. Results: At least one of these oncogenes was gained/amplified in 27 out of 38 tumors (71.1%). We report the highest frequency of c-mycgenetic gain/amplification since it affected 42.1% of the ovarian tumors. We observed sequential involvement of copy number alterations of the other genes in the presence of c-mycdisruption. The incidence of copy number changes of the 5 oncogenes – both single and combinatorial – was higher in high-grade tumors. All double aberrations in the serous group comprised c-mycand ZNF217copy number increases. Conclusions: Our results revealed a combination between copy number increases of c-mycand ZNF217, associated with serous histology. The data from this combined analysis of the 5 oncogenes could be used as a basis in considering the combined approach in molecular-based therapy of ovarian cancer.

The authors describe the rare botryoid sarcoma--histomorphology, clinic, diagnosis, treatment and prognosis with a contribution of 4 own cases at the age up to 18 years. They indicate the difficulties in the establishment of the diagnosis-early clinical and histological-in three of the cases the histological examination did not establish immediately the exact diagnosis--the material was considered as "granulation tissue" or "fibroma mole". The results of the treatment are summarized as well as the choice of therapeutic methods and drugs. The applied therapeutic scheme consists of radical hysterectomy with systemic pelvic lymph dissection and postoperative chemotherapy. The described four cases are alive at the present moment and without data for tumourous relapse--respectively 11 years and 2 months, 3 years and 4 months, 2 years and 8 months after establishment of the diagnosis.

An original Bulgarian phyto-preparation laxafer was used in 97 women, operated for gynecological complaints, with the aim to overcome postoperative paresis of intestines and recovery of peristalsis within the first ten postoperative days. It was established that the preparation, given from the second postoperative day in a dose of 2-4 pills daily in women, operated by nonabdominal approach due to the fact that the abdominal cavity was not open during the operation and intestinal peristalsis, was preserved to a great degree. In women, operated by abdominal approach, the optimal time for the onset of treatment was the third postoperative day in a dose of 3 pills daily. The most frequent effect side effect was swelling of the abdomen, which was observed usually during the first day since the onset of treatment. The side effects were minimal after the second day, but they disappeared completely on the fifth postoperative day.