[Expression of human papilloma virus (HPV) and P16ink4a in cervical intraepithelial neoplasia (CIN) and papilloma].

UNLABELLED: p16ink4a Is a tumor-supressor gene and a key regulator of the cell cycle. The neoplastic cervical epithelium (squamous and cylindric) intensely expresses the cyclin-dependent kinase inhibitor p16ink4a. It was shown that the expression of p16ink4a in the squamous cervical cancer was induced by HPV. The aim of our study was to reveal the frequency of expression of p16ink4a and of HPV in the different grades of CIN and in the papilomatous cervical lesions. We used biopsy material (n=11) and cone biopsies (n=10), collected from women with different grades of CIN and with papillomatous lesions, having different grades of koilocytotic dysplasia. The biopsy material, collected from one woman with squamous cervical cancer was also studied. Using the immunohistochemical procedure we determined the expression of p16ink4a and HPV in the changed squamous cervical epithelium. RESULTS: We found that the neoplastic epithelium in CIN II and CIN III intensely expressed p16ink4a. We observed positive immune reaction for HPV in only 22.7% from the cases with papillomatous lesions, having koilocytic dysplasia. In conclusion we can state that p16ink4a could be used as a marker for the exact determination of CIN lesions in the cervix uteri. The koilocytic dysplasia, determined histologically was not always HPV-positive.

[Mola hydatidosa of the uterine tube]. / Mola hydatidosa na matochnata truba.

A case of only rare localization of hydatidiform mole in fallopian tube is described. This localization is, recent clinical as ectopic pregnancy. In the last 25 years (1974-1999) was described only 30 cases of tubal localysation of hydatidiform mole.

[Surgical operations in women over 60 years of age in the gynecological practice (according to the data from Obstetric and Gynecology Clinic of Stara Zagora during 1998-2002 years)]. / Operativni interventsii v ginekologichnata praktika pri zheni nad 60 godini (po materiali na AG klinika Stara Zagora za perioda 1998-2002 god).

In period of 1998 to 2002 year in Klinik of Obstetric and Gynecology Stara Zagora was performed 2161 small and 1122 great gynecologic operations in women older 60 years. The most patients was in age of 60 to 70 years (79%), 17.9% was in age of 70 to 80 years and over 80 years was 2.9%. The neoplasm disorders perform 34.6% and static disorders--29.6%. By 84.5% in women with postmenopausal bleeding no established neoplasm and by 15.5% was established endometrial cancer. The great operations included 55.6% abdominal hysterotomy, 13.6% vaginal hysterectomy and 9.8% urogynecologic operations. Postoperative complications perform 3.7% (2 patients).

[National neonatal hearing screening and Central Registry for Hearing Loss in Children]. / Natsionalen neonatalen slukhov skrining i Tsentralen Registur na Slukhovite Uvrezhdaniia pri Detsata.

Implementation of Central Registry for hearing loss in children can answer many questions about the frequency, etiology and habilitation of hearing impairment by infant. Precondition for realize is implementation of universal newborn hearing screening. With introduction this screening we decrease dramatically the age of children, of which we predict, diagnosed and intervened bilaterally hearing loss. Despite the progress of the medicine, in particularly of the genetic, the etiology of some cases with hearing loss stay unknown. Future investigations in this field, inclusive molecular-genetic, is necessary to determine hereditary hearing loss by children in Bulgaria.

[Vaginal sonography as a method for examination of women with pre- and postmenopausal bleeding]. / Vaginalna sonografiia kato metod za izsledvane pri zheni s pre- i postmenopauzalni kruvotecheniia.

At present time abrasio probatoria of the cavum uteri is a method of choice in diagnostic of the endometrial pathology.

[Application of Nd YAG laser for the treatment of preneoplastic lesions of the uterine cervix]. / Prilozhenie na Nd YAG laser pri terapiiata na preneoplaziite na matochnata shiika.

The authors represented the data of treatment for CIN with Nd YAG laser by 266 women Two laser methods was use--direct by 93 women and indirect by 173. The effect of treatment with direct Nd YAG laser application for all cervieaf lesions ist 100%. There was no one patients with relapse by use the second method the effect ist for 92 to 96.7%. The persistence of lesion ist 3 to 7%, and relapse--3%.

[Microbiological investigation of the vaginal flora during pregnancy]. / Mikrobiologichno prouchvane na vlagalishtnata flora pri bremenni zheni.

The infections complications during pregnancy and delivery are jet unsolved problem in obstetrics and neonatology. Most of them are due to anaerobic and aerobic organisms. The authors show the rate and distribution of the bacterial vaginal infections during pregnancy. 1330 pregnant women are investigated, 10% of them are with normal vaginal flora, 27% anaerobic organisms, 15% aerobic organisms, then Candida albicans and Gardnerella vaginalis. Those results are seen most frequently during the last trimester of pregnancy, which leads to the complications in delivery and postpartum.

[Congenital malformations in newborns during the period of 1995-1999 according to the department of obstetrics and gynecology--Stara Zagora]. / Vrodenite malformatsii u ploda prez perioda 1995-1999 godina po materiali na akushero-ginekologichnata klinika--Stara Zagora.

UNLABELLED: During the last 2-3 decades there is a tendency for increasing the rate of the congenital malformation of the fetus and newborn. Every year in Bulgaria 5000-6500 children are born with some defects. The purpose of this investigation is to show the rate of the congenital malformation as a reason for death among the newborn/babies in the Clinic of Obstetrics Stara Zagora during the period of 1995-1999 and some rick factors for the malformations. RESULTS: Perinatal lethality for this period is 20.03% (190 children), 40 (21.05%) are with heavy lethal malformations. The authors annualize the localization of the malformations.

[Colposcopic findings in HPV lesions of the uterine cervix]. / Kolposkopski nakhodki pri HPV lezii na matochnata shiika.

Colposcopics Finding in HPV Lessions of Uterine Cervix, Busalov S, Todorova M, Vasilev I, Galabova M. Medical Faculty, Thracian University Stara Zagora. For 10 years period 6690 colposcopics examinations were provided. In 247 patients (3.69%) is determined atypical colposcopics findings suspected for HPV infection and is done target biopsy of PVCU. According to hystological results the cases are divided in 2 groups: with CIN and without CIN. The most frequently observed lesions of the uterine cervix in HPV infection are: flat papilloma--65.9%, inverting papilloma--25%, exotic papilloma--4.25% and mixed papilloma--4.79%. In 188 (75.8%) patients HPV lesions are without association with CIN and in 59 (23.7%)--they are in association with various CIN diseases. The most common age is to 35 years old.

[Surgery for uterine myoma]. / Operativna aktivnost pri mioma na matkata.

The authors present one supervision of surgically activity and myoma of the uterus in the period 1995-2000 year. 456 women with myoma are surgical treatment; by 319 are perform LHT cum and., by 63-LHT sine and., by 37 myomectomia and by 37-LHT sine and dex/sin.

[Prenatal diagnosis of bilateral fetal renal polycystosis]. / Antenatalna diagnoza na vrodena dvustranna polikistoza na b'bretsite na ploda.

Congenital abnormalities of the renal and urinary tract (CARUT) of the foetus constitute about 20-30% of all abnormalities. The frequency of infant mortality of genito-uretral malformations is about 10 to 100,000 lye-burts. The early and opportune antenatal diagnosis of these abnormalities by ultrasound examination of the foetus improves considerably the prognosis of children having such divergences in their renal and urinary tract. The authors represent a clinical case of antenatal diagnosis of a foetus with congenital bilateral renal polycystosis in the first half of the period of pregnancy and emphasize the importance of systematic ultrasonographic screening of the pregnant patients. A bibliographical survey of the CARUT is made together a review of the potentialities of ultrasonographic screening for diagnosing in time for due action in the presence of any abnormalities of the renal and urinary tract.

[Inborn laryngeal cysts - description of a case with fatal outcome]. / Vrodeno laringomukotsele - opisanie na edin sluchai s letalen krai.

The authors describe a case of a newborn baby with inborn laryngomucocaele, living 14 days after birth. The newborn baby was looked after with artifical lentilation. Because of the inability of self breathing the baby underwent tracheostomia. The autopsy revealed the presence of laryngomucocaele.

[Condylomata acuminata. The correlation between affecting sexual partners and the risk of developing preneoplasia of the cervix uteri. The therapeutic potentials of the Nd-Yag laser]. / Condylomata acuminata. Korelatsiia mezhdu zasiagiane na seksualnite partn'ori i riska ot razvitie na preneoplazii na matochnata shiika. Terapevtichni vuzmozhnosti na Nd YAG laser.

The present study summarized results from 206 patients (120 females and 80 males) with diagnosis condylomata acuminata. The diagnostic and surveillance methods used in the present work were: clinical, colposcopic, histologies and microbiological examination. 114 from all patients--46.5% females, and 62.2% males were sexual partners. In 25 women (43.8%) from that group HPV-lesions were found. In 8 patients with cervical lesions CIN I-III was diagnosed. Our results confirmed the previously announced literary data about an enhanced risk for CIN development in women with HPV infection, whose sexual partners had clinical data of Condylomata acuminata. Our therapeutic protocol with Nd-YAG laser treatment in a determined scheme and number of applications according to the stage of the disease and pathological diagnosis was very successful, as compared to data from the literature.

[The basement membrane proteins collagen type IV and laminin and the preinvasive reorganization of the stroma in carcinoma in situ of the cervix uteri]. / Izsledvane na bazalnomembranni proteini kolagen tip IV i laminin i predinvazivnoto preustroistvo na stromata pri kartsinom in situ na matochnata shiika.

The migration of tumor cells through the basal membrane (BM) is a key event in the cascade of tumor infiltration and metastasizing. The aim of the present study is to investigate BM proteins larniriin and collagen IV in cervical carcinoma in situ and the preinvasive reorganization of the underlying stroriia. 15 worileri with biopsy diagnosis of cancer in situ are studied. The immunohistochemical PAP-reaction on fresh and parafiri sections is used. Light microscopically there are features of characteristic reorganization of the stroma lying under the neoplasia: neocapillarization next to BM and lack of vascular proliferation far away front it; localized swelling and expressed iriflariiriiatory irifiltrate in these regions. The immunolocalization of laminin and collagen type IV is important for the assessment of BM under the intraepithelial cancer.

[Combined gynecological operations]. / Suchetani ginekologichni operatsii.

During the objective examination of patients admitted for operation, changes in the gynaecological status, corresponding to primary disease and demanding also operation, were determined. The authors studied clinical status of 33 women with the following primary diseases: myoma uteri, static anomalies of female genitalia and accompanying diseases like urinary stress incontinence, uterine cervical laceration and the accompanying static anomalies. Authors applied combined operative techniques, abdominal and vaginal (hysterectomy with colpouretherosuspension by Burch, vaginal hysterectomy with colpouretherosuspension by Ratz, myomectomy with colpouretherosuspension and ligamentopexy by McColl, etc.), in order to treat definitively the primary disease and the accompanying ones as well. The results showed that in appropriately selected cases and operative techniques, a good therapeutic outcome was achieved. In conclusion we may say that the operative approach should include simultaneously all pathological deviations of women genitalia.

[The late results of the surgical treatment of stress urinary incontinence]. / Kusni rezultati ot operativnoto lechenie na pikochnata stres inkontinentsiia.

The severe stress urinary incontinence is a condition, which traumatize women psychology. Amongst numerous well-known operative techniques for treatment of the stress urinary incontinence authors apply the following ones: suprapubic colpouretherosuspension by Burch, colpouretherosuspension by Ratz, sling operation with synthetic stuff--Ampoxen. The evaluation of late results from the applied operative approaches in 30 patients displaced a long term overcome of stress incontinence. The authors emphasized that during clinical follow up of all cases in the course of 3 years the best results were obtained after application of suprapubic and sling methods. Our conclusion is that the choice of operative approach have to be individual and is in dependence with every clinical case. The postoperative outcome depends on the exactness of the operation.

[Combined diagnostic methods for women in the pre- and postmenopause]. / Suchetani diagnostichni metodi pri zheni v pre- i postmenopauzata.

UNLABELLED: During one-year period, 20 women with pre- and post-menopausal problems were investigated. The diagnostic examination included transvaginal sonography (TS), hysteroscopy with separative abrasion and histopathological examination. The data from the three diagnostic methods were compared. RESULTS: In 6 patients the endometrial thickness (ET) was lower than 8 mm. The hysteroscopic finding (HF) comprised in endometrial atrophy, confirmed also histologically. ET was higher than 8 mm in 14 patients, and the HF revealed endometrial polyps and endometrial hyperplasia. The hystological examination confirmed cystic endometrial hyperplasia in 4 cases, endometrial secretary phase in 5 cases, endometrial polyp in 3 cases and endometrial carcinoma in 2 cases. The authors accepted that the combination of 3 diagnostic methods of examination, applied in the described consequence, gave the possibility for precise diagnostic investigation and adequate treatment.

[The treatment of neglected cases of condylomata acuminata in pregnant women with the Nd:Yag laser]. / Lechenie na zapusnati sluchai na condylomata acuminata pri bremenni zheni s Nd:YAG laser.

The authors report for the therapeutical application of Nd:YAG Laser with wave length 106 nm--MEDILAS 4060N on a genital acute condyloma, caused by human papilloma virus at 19 pregnant women between 10-38 gestation week (g.w.). It is clinical studied a lot of exophytic formations on wide area included vulva, vagina, vaginal portion of uterine cervix (PVCU), perineum and anus. It is marked histological research of the biopsy material from the condyloma for excluding a malignant process, microbiological research of the attendant vaginal and cervical flux, as well as colposcopy of the cases with cervical localisation. It is done a destructive laser-therapy from 1 to 3 seances, depending on the condyloma, a size, count and localization with starting power between 20-30W with exposition time from 0.5 to 1 sec. and diameter of the focal ray--2mm. At the control studies it is found an epithelialization without cicatrices, absence of complications and recurrences during on year.