Search

Non puerperal inversion of the uterus is very uncommon. Patients may present with pelvic pain, vaginal bleeding or hemodynamic shock. We report a fifty five old woman with uterus inversion second stage.

A case of a Mullerian tract defect in a 26-years old patient is reported. The anomaly is detected during an undesired pregnancy. Diagnostic methods used in that case are described. Diagnostic difficulties in determining the type of the defect and classifying it according to AFS classification (1988) are discussed. The variety of Mullerian tract defects and necessity of individually designed plan for diagnosis and treatment of every particular patient are discussed.

The authors present their own attempt of miniinvasive management of pelvic inflammatory disease. Two groups of patients are compared--in the first one the women are treated only conservatively, while the second one has undergone miniinvasive surgical treatment. The preferences of combined therapy are pointed out.

The authors show their own experience with endoscopic operative treatment of tubal pregnancy. They describe the different types of operative treatment.

Methods and Materials: The study is prospective and involves 112 patients suffering from pelvic endometriosis aging from 19-38 years. (28.6 average age). The disease was diagnosed via laparoscopy and the stage was determined using the revised AFS classification. Zoladex (Goserelin depot--3.6 mg) is being applied every 28 days for 6 months in the hypodermic tissue of the front abdomen wall. All patients are being examined monthly after every Zoladex application (for subjective complaints--dysmenorrheal, dyspareunea, pelvic pain; serum estradyol-E2; amenorrhea; side effects) and every 24 months (recuperation of the menstrual cycle, pregnancy)., Results: In 88% of the patients amenohrea is obsereved in the first eight weeks of therapy. The menstrual cycle takes an avarege of 68 (31-139) after the last Zoladex application to reappear. At the end of the first month after the first application the serum level of estradyol E2 is lowered to a menopause level (from 750-800 to 120-130 Pmol/L) and it remains as low till the end of the treatment. Eight weeks after the completion of the therapy it goes back to its normal values. During the course of the first month of amenorrhea condition a 38% fall in the level of complaints (dysmenorrheal, dyspareunea, pelvic pain) is observed. After the 6th month 88% of the patients have no complaints. Side effects observed during the course of treatment include warm waves, sweating, vaginal dehydration (60-80%) which do not in any way disturb the patients to the point of quitting the therapy and do disappear with its end. The focus group contains 54 infertile patients with endometrioses willing to get pregnant. In 12 months after the completion of the treatment 16 of the patients become pregnant, followed by 12 more in the next one year., Conclusion: Zoladex causes amenorrhea, which lasts till the end of the treatement. It causes a rapid drop of the serum consentration to a menopause level. Causes a strong and durable treatment of the symptoms of endometriosis. The side effects disappear with the end of the therapy. The treatment is easy to go through and there no cases of a quitting patient. The treatment has a curable effect over the endometriosys and in cases of infertility provides a possibility for pregnancy.

Intrauterine insemination (IUI) is a method for the treatment of marital infertility involving the intrauterine or fallopian deposition of washed spermatozoa, depending on the amount of inseminated semen. Numerous factors may be affect of pregnancy rates after IUI.

The authors present their experience from operative laparoscopies performed with lower than usually accepted intaabdominal pressure.

The authors review the effect of the oral contraceptive Mercilon on menstrual cycle, contraceptive efficacy, lipid profile, safety profile and adverse effects in a group of 32 women, included in the survey. The results of the trial show excellent contraceptive effect with Pearl Index of 0.00 and good control over the menstrual cycle. No negative or unfavorable effects were seen on the lipid profile as well as on the liver kidney and coangulant system function. Minor side effects were seen in only 5% of the patients.

Thirty-four patients at the end of pregnancy were treated with ciclopiroxolamine (Dafnegin) vaginally for the period from January to October 1998. The effect of therapy was evaluated. One hundred women were examined and 34 (34%) of them had vaginal candidiasis. All patients were treated with ciclopiroxolamine (Dafnegin) vaginal creme once time daily for 14 days. Thirty-two patients (94.11%) were healthy, in two patients (5.88) candidiasis was reduced to minimal colonies.

The author reveal the results of treatment with ciclopiroxolamine of women suffering from mycotic colpitis and using OC's. The research covers 26 women users of monophasic OC's with mycotic colpitis during the last 2-3 weeks before the research. The cause for the colpitis in 92% of cases is Candida albicans. The treatment was successful in 84.6% of the cases after the first 6-day-course with Batrafen creme. With 7.7% the treatment course with Batrafen creme was repeated, and with another 7.7% was included oral antimycotic (itraconazol). After treatment was performed microbiological check-up that confirmed the positive result of treatment. The authors' conclusion is that Batrafen creme is an effective device suitable for application on patients, CO's users.

A prospective study was carried out a State Institute Hospital "Maĭchin dom" aiming to estimate the efficacy of GnRH-agonist Nafarelin in treating patients with endometriosis. Nafarelin was used by 40 women with endometriosis. The drug was applied as a nasal spray according to a therapeutic scheme and regarding definite criteria. Every patient was followed while using the drug and the following sings were registered: occurrence of amenorrhea, clinical sings, side effects, the period of control lasting for a year after the end of the treatment. In 27 women a quick and long-lasting amenorrhoea was induced with standard doses of the drug, while other 13 needed higher dosage to achieve the same effect. Relief of complaints was registered on 35 women. Improved palpatory status was found in 23 patients. In 4 women the disappearance of endometriomas was confirmed by laparoscopy. The existing side-effects are dos to the appearing hypoestrogenemia. After treatment with Nafarelin, during the period of observation, 5 women got pregnant.

The conservative treatment of the condylomata acuminata by Solcoderm is local, painless and ambulatory. One application of Solcoderm by a capillary pipette covering the pathologic formations is enough--they become rapidly devitalized and disappear within 4 weeks. Secondary infections on the treated area are extremely rare.

The authors compare the reliability of an enzyme method for diagnostics of chlamydial endocervicitis versus Clearview chlamydia test. The results suggest that the enzyme test may be applied with sufficient diagnostic reliability.

The authors are analyzing their results of the treatment with roxithromycin 150 mg of the pelvic inflammatory disease, caused by chlamydia trachomatis. 29 patients with proved chlamydial infection were treated. The most popular diagnosis was cervicitis. 23 patients were totally cured, 4 patients were with considerable better status after the treatment, and 2 of the patients were with insignificant amelioration of the status. A conclusion can be made, that the roxithromycin is a very good alternative of the existing treatment with doxycicline.

The Mg's low level in the sera and the urine correlate with clinical symptoms of uterine contraction in pregnant women from the 16th-36th gestation week. The authors present their experience with the use of removal tocolytic curing with Magnerot tabl. in the cases of 60 pregnant women with uterine pain and contractions from 16th to 36th gestation week and Pelvic Score after Bishop under 4. The effect of the curing is remarkable till from the beginning in the first 4-7 days of it, which is demonstrated with disappearing of the objective and subjective contractions (overviewed in obstetric monitor) and there is normalising of the paraclinical levels of the Mg in the sera and the urine, with normal pregnancy and birth of a healthy and alive child.

The authors present two cases of women with unruptured tubal pregnancies who were treated by methods of laparoscopic surgery. A salpingotomy as well as an aspiration of the pregnancy was performed. The operations reported are the first in gynaecological practice in Bulgaria and the operative technique is described.

Endometriosis is one of the main causes of female sterility, leading not only to subjective complaints, such as anovulatory menstrual cycles and LUF syndrome, but also to appearance of antisperm antibodies due to the increased number of macrophages, We present our experience in the treatment of endometriosis with the GnRH analogue Zoladex, product of Zeneca, as well as in the treatment of antisperm antibodies with methyiprednizolon acetate, Depomedrol of Upjohn.

By means of the serum level of estradiol and the vaginal smear indexes the antigonadotropic activity of the preparation Danoval (2-3-isoxasol-17-ethinyltestosterone) is indirectly evaluated on 15 infertility patients with laparoscopic proved endometriosis. After 5 month's course of treatment with 400 mg daily the level of estradiol decreased from 1.54 to 0.31 nmol/l, IA from 20.8 to 10.4 and IP from 32 to 17.3. The side effects are slight and descend from the pharmacological properties of the preparation. Two patients became pregnant in three months after the treatment.

Fifty-two of 304 infertile women were surgically treated by the time of diagnostic laparoscopy. Table 1 represents surgical treatment via laparoscopy. Forty-one (78.84%) patients had electrosurgery or laser surgery of endometriosis. Salpingo-ovariolysis was performed in 6 patients (11.53%). Salpingostomy was performed in 2 patients. Fimbrioplasty was performed by incising the peritoneal band surrounding the terminal end of the fallopian tube in 2 patients. Bleeding of vascular adhesions was followed by electrocautery. No patient required laparotomy for control of bleeding. In two patients (3.84%) with ectopic pregnancy had light arterial bleeding along the salpingostomy incision and was controlled by bipolar cautery. In three patients (5.76%) cysts up to 7 cm in diameter were treated. The capsule were dissected and removed how possible. Any residual capsule was vaporized.

The study was carried out on 192 women with normally progressing pregnancies during the second trimester, in whom the gestational age was determined by 291 echographic measurements of the fetal anatomic parameters-the biparietal diameter, length of the femoral bone and the transverse cerebellar diameter. The coefficients of correlation between each of the indicated parameters and gestational age as high values of correlation--0.96, 0.98, 0.98 were established. A brief literary review is made on the problem for determination of gestational age by measurement of the transverse cerebellar diameter of the fetus. Making more precise some technical details of the method, the authors recommend it for routine usage in the clinical practice.

The authors carried out studies retrospectively on 57 women, who became pregnant in insemination with donor frozen spermatozoa. Ovulation problems and luteal insufficiency were diagnosed in advance and treated before and during the occurring cycles. Women were divided into two groups. The first group of 25 women were examined by ultrasound transvaginal transducer for follow-up of follicle growth in the ovaries in addition to measurement of body temperature and determination of the cervical factor. The second group of 32 women, in whom follicle-metry was not performed. The frequency of conception was 0.24 in the first group, but 0.26 in the second group. It is concluded that inspite of the significance of follicle-metry for determination of ovulation the traditional methods are still valid criteria for ovulation and can be used as independent methods for determination of the time for insemination with therapeutic donor frozen spermatozoa.

The authors studied the effect of a single prophylactic dose of Cephalozoline in a dose of 2 g. used in 50 women, operated by microsurgical technique for tubal sterility. In comparison with 100 women with continuous prophylaxis with Ampicillin and gentamycin there was a reduction in infectious postoperative complications of the same 50 women without any disturbance in general state, pulse or laboratory parameters. Side effects due to Cephazoline were not established.

The study is carried out on 200 women, pregnant for first and second time with normally progressing, pregnancy and delivered by normal mechanism at term, who are divided into groups according to the localization of the placenta, established by ultrasound examination. The number of primiparas is 50% in each group. The authors find that when the placenta is located on the uterine fundus larger children are born and hypokinetic labour activity is observed as well as protracted delivery. The site of the placenta is extremely important factor, affecting course of pregnancy and delivery.

Analyzing the findings in diagnostic laparoscopy the authors describe in details and interpret the results from the examined organs in the pelvis and abdominal cavity. Object of the study are 200 sterile women, admitted to the clinic of Sterility and Gynecological Endocrinology of Research Institute of Obstetrics and Gynecology for examination. The mean age of the patients is 29 years as 128 of the women suffer from primary sterility, but 72--from secondary sterility. The results are summarized and interpreted in 5 groups. Uterine body--form, size, motility, measurements, adhesions, fibrillary apparatus, patency; Ovaries--form, size, position, motility, surface, follicles; Adhesions--type, dimensions, vascularization, position (in the pelvis and abdominal cavity); Data for endometriosis--presence, size and localization of endometriomas, endometriotic cysts and outgrowths, an increased vascular line. The inference, which the authors make, is that laparoscopy is basic (and necessary) current diagnostic method for obtaining real notion for the state of internal genital organs (especially for tubal factor in female sterility) and furthermore also for evaluation of the necessity and possibility for performance of microsurgical reproductive operations.