[Retroperitoneal approach and pelvic peritoneoectomy in the surgical management of advanced ovarian cancer].

OBJECTIVE: To share our experience in surgical management of advanced ovarian cancer applying a retroperitoneal approach and performing pelvic peritoneoectomy for the achievement of an optimal debulking in this disease. MATERIAL: Thirty eight patients age ranging from 36 to 77 years (average 55,7 years) staged: I - 2 (5,3%), II - 4 (10,5%), //III/ - 28 (73,7%) and IV - 4 (10,5%) had been operated on. Thirty patients presented without previous therapy, 3 - after total abdominal hysterectomy with adnexes, 1 - after supravaginal hysterectomy with adnexes, 1 - after unilateral adnexectomy and 3 - after neoadjuvant chemotherapy. METHODS: All 38 patients had been submitted to retroperitoneal approach during the laparotomy and it had been performed surgical procedures including various degrees of radicalness towards the pelvic structures (uterus, parameters vagina) with or without pelvic peritoneoectomy. The latter had been performed in 28 patients (73,7%). Selective lymph node dissection is carried out in 21 cases (55,3%), total omentectomy - in 36 cases (94,7%) and appendectomy - in 23 (60,5%). RESULTS: Maximal (no evidence of disease) and optimal (less than 2 cm lesion) cytoreduction is achieved in 23 (60,5%) and 8 (21,1%) patients, respectively - totally in 81,6% of all patients. The most common site of suboptimal (> 2 cm) residual masses is the anterior rectal wall and cavum Douglasi - 85,7%, Lymph node metastases is detected in 33%, metastases in omentum - in 75%, parametrial invasion - in 25%, vaginal metastases - in 8,3%, metastases in appendix and Fallopian tubes - in 47,8% and 8,8%, respectively and invasion of tumor's capsula - in 34, 2%. CONCLUSION: Retroperitoneal approach and pelvic peritoneoectomy are feasible and safe and lead to high percentage of optimal debulking, which is the main prognostic factor in advanced ovarian cancer patients.

[Complications following surgery and radiotherary in 108 patients with cervical cancer].

OBJECTIVE: To evaluate the most common complications following surgery and radiotherary of cervical cancer based on own experience and to compare them to the complications rates reported by other authors. MATERIAL: One hundred eight patients with invasive cervical cancer, staged (IB-IVB) are enrolled in the study. They all had been operated on in Varna between the period XI.2003-VI.2006 by the author. METHODS: Surgical management includes radical hysterectomy class ll-IV, selective and total pelvic and paraaortic lymph node dissection. Radiotherapy is preoperative 30-52 Gy and adjuvant postoperative 52 Gy TGT Cisplatin-based neoadjuvant chemotherapy had been administered 3 courses at intervals of 21 days before surgery. Peritonization with two retroperitoneal drains in fossa obtoratoria had been performed in 91 patients. Seventeen patients were non-peritonized with abdominal drianage. RESULTS: In the group of patients with peritonization and retroperitoneal drainage the incidence rates of fistulas,lymphocysts, ureteral strictures, urinary infections, ileus, radiation-induced proctitis are: 1,1%, 5,5%, 2,2%, 3,3%, 1,1% and 2,2%, respectively. In the group of patients without peritonization the incidence rates of same complications are: 5,9%, 17,6%, 0%, 0%, 29,4% and 11,8%, respectively. CONCLUSION: Pelvic peritonization and retroperitoneal drainage decreases significantly the early and late postoperative complications, especially the incidence rate of fistulas, lymphocysts, lymphedema, ileus, radiation- induced proctitis and proctosygmoiditis and makes them comparable to these complication rates,reported by other authors and centres. This method allows the patients to be discharged at the light postoperative day, optimizes the quality of life and the survival.

[Our 3-years experience in surgical management of cervical cancer].

OBJECTIVES: To share our experience in surgical management of cervical cancer, combined adiotherapy (RT) and neoadjuvant chemotherapy (NCT) and to evaluate the 2-year overall and desease free survival, the incidance and sites of relapses. MATERIAL: One hundred eight cervical cancer patients, staged IB-IVB according to FIGO had been operated on by the author between the period XI. 2003-VI. 2006. Eighty one patients were evaluable for 2-year survival (follow-up ranging from 6 to 44 months, average - 25 months). METHODS: Surgical management includes radical hysterectomy class II-IV, selective an pelvic and paraaortic lymph node dissection. Radiotherapy is preoperative 30-52 Gy adjuvant postoperative 52 Gy TGT Sixteen patients with positive lymph node metastases (LNM) were submitted to prophylactic field irradiation up to 46 Gy Cisplatin-based neoadjuvant chemotherapy had been administered 3 courses at intervals of 21 days before surgery. RESULTS: Two-year overall survival is 95,1%, 2-year desease free survival (DFS)--90,1%, 2-year local control rate - 100%. The incidance rate of distant metastases is 9,9% (lungs--2,5%, liver--3,7%, bones--2,5%, vulva--1,2%). LNM are detected in 19,5% (IB1--14,5%, IB2--35,7%, IIA--11,1% stages), parametrial invasion--2,8% and metastases in ovaries--0,9%. Two-year DFS of patients with LNM is 84% and without LNM is 96,8%. CONCLUSION: Surgical management, combined with RT of above mentioned 108 patients leads to 100% 2-year local control rate. Two-year DFS of patients with LNM is 84%. NCD should to be administered concurrently or consecutively with RT in patients at high risk of distant relapses (11B, IB2 stages).

[COX-2 expression and ovarian cancer].

The aim of the present review is to study the significance of the COX-2 expression for unfavourable prognosis and aggressive clinicopathological parameters in certain malignancies. The main directions for future research on COX-2 as a prognostic factor of decreased survival and predictive factor of chemotherapy resistance in ovarian cancer are discussed.

[A multicenter study of the antimicrobial effect of Macmiror and Macmiror Complex in the treatment of vaginal infections]. / Multitsentrichno prouchvane antimikrobniia efekt na Macmiror & Macmiror Complex v lechenieto na vaginalnite infektsii.

UNLABELLED: The aim of the present multicentre study was to examine the therapeutic possibilities of the wide-spectrum medicament MACMIROR & MACMIROR COMPLEX for the treatment of the vaginal infections. MATERIALS AND METHODS: The study included 159 nonpregnant women among 15 and 54 years (middle age 35.6) with different by kind and intensity colpitis complaints. The following microbiological characteristic was established: in 26 cases Gardnerella vaginalis, in 46 Candida spp., and in the rest 87-mixed aerobic bacterial flora, with a combination of Gardnerella, yeast and Trichomonas. The treatment of the patients was done in combined scheme: peroral and vaginal administration, simultaneously with local treatment of the partner. The control examination was performed bistagely: on 7-10 day and on 30-40 day. RESULTS: The good clinical and microbiological influence of the treated patients was established, for the first control examination the effect was found in 88.1% and 86.8% and for the second--respectively in 81.1% and 82.4%. CONCLUSIONS: The received results give us a cause to approve, that the combination "Nifuratel and Nystatin" (Macmiror & Macmimor complex) has the good possibilities to influence the mixed forms of vaginal infection.

[A rare case of a variant cervical polyp in adolescence]. / Riaduk sluchai na raznovidnost na tservikalen polip v adolestsentna vuzrast.

The authors, stress on the importance of the examination of the vagina and the cervix in case of a mucous bleeding at adolescent girls. The following case is being introduced: after examination of a 16-year-old patient who had undergone a two-year treatment for a vaginal discharge, a bleeding polyp, the size of an egg and attached to a leg was found and extirpated. The histological examination read as "a myomatous polyp of the cervical canal with hemorrhagic necrosis". This case has been compared with the already published classes. The authors discuss some possibilities for differential diagnosis of the subjective symptoms and biopsy in adolescence. The conclusion is that gynecologists should use vaginoscopy as additional diagnostic method.

[Endometriosis in clinical practice]. / Endometriozata v klinichnata praktika.

The authors are investigated the frequency of the cases of genital endometriosis, its most frequent localization and the choice of treatment on 864 women patients who have undergone operations connected with other gynaecological disorders and on 32 women patients, suffering sterility and proved endometriosis. Most frequent are the cases of combination between uterine myoma and endometriosis of the uterine wall-5.74% and with the patients who have undergone surgery for malignant disease between endometrium carcinoma and uterine endometriosis. The conservative treatment is the method of choice with the infertile women suffering a slight stage of endometriosis and the least conservative method is the surgical treatment, followed by a hormonal treatment resulting in the increase of the fertility of women who have the average stage of development of endometriosis.

[Indices of a threatened pregnancy in the first trimester]. / Prouchvaniia na niakoi pokazateli pri narushena bremennost v purviia trimestur.

Studies were carried out on 167 pregnant women, divided into 4 groups in accordance with the values of human chorionic gonadotropin (HCH). Fetal death was established by ultrasound in 41 of the pregnant women including all cases with HCG under 5000 IU, but it was also found in 19.18% of women with values of HCG over 10,000 IU. Pregnancy advanced unfavourably in other 16 pregnant women of altogether in 34.13%. Prognosis was unfavourable in the presence of decidual hematoma. The gestational sac was enlarged on the average. 1.3 mm per day in normal development. Treatment was made in two groups: with hormones, spasmolytics and vitamins and only with spasmolytics and vitamins. The results showed that progesterone preparations, used singly or in combination with estradiol, did not improve the results.

[The course of pregnancy and labor following artificial insemination]. / Protichane na bremennost i razhdane sled izkustvena inseminatsiia.

The course of pregnancy and its final outcome--delivery of alive and viable fetus, is of special significance for women becoming pregnant after artificial insemination because of their limited possibilities for new pregnancy. 131 pregnancies, occurring after artificial insemination with fresh and frozen seminal plasma, were investigated. Analysis of the results showed that in basic lines the course of pregnancy and delivery as well as the state of the newborns did not differ substantially from those of normally conceived women. There was no statistical difference (p greater than 0.05) in the frequency of still-births, preterm deliveries and congenital anomalies of the fetus. In the course of pregnancy of women with artificial insemination two risk periods are determined. a) first trimester because of the greater frequency of spontaneous abortions b) delivery because of the increased operative activity and greater frequency of multiple pregnancy.

[Septic shock following a criminal intervention on the nonpregnant uterus]. / Septichen shok sled kriminalno vmeshatelstvo v nebremenna matka.

PIP: A case history of a 23-year old woman with criminal abortion complicated by septic shock and acute kidney insufficiency is reported. 2 days after abortion, the patient developed high fever, chills, uterine hemorrhage, abdominal and muscle pain, jaundice, and hepatomegaly. Gynecological examination showed hypertrophy of the cervix uteri, enlargement of the uterus, and the presence of bloody secretion. Urine culture indicated the presence of Pseudomonas aeruginosa sensitive to amikain. Clinical diagnosis was of septic shock and acute kidney insufficiency, and the patient underwent laparotomy followed by total extirpation of the uterus with adnexa. Histological examination of the uterus indicated suppurative-necrotic endometritis without signs of pregnancy. Postoperatively, the patient received hemodialysis in combination with antibiotics, corticosteroids, blood transfusions, and vitamins. She was discharged on day 53 after the onset of disease. It was concluded that criminal abortion can lead to severe septic shock and acute kidney insufficiency requiring intensive conservative therapy.^ieng