[Difficulties and biases of interpretation in cases of the trophoblast disease]. / Trudnosti i greshki pri interpretatsiia na sluchai s trofoblastna bolest.

The trophoblastic disease (TD) is an unifying term for the nosologicunits: Mola hydatidosa, Mola hydatidosa invasivum, Chorionepithelioma. This kind of trophoblast pathology has geographic differences in the expression but the its overall incidence is not high. The clinicians often fail to consider the possibility of trophoblastic disease due to its low incidence rate. The forms of TD have clinical manifestations that are not specific. There are principles, which taken into account, could help the clinicians put the right diagnosis. Two cases of the clinical practice are reviewed in maintenance of this opinion.

[Results of preventive mammography before initiation of hormone replacement therapy]. / Rezultati ot prevantivna mamografiia pri zheni, zapochvashti khormono-zamestitelna terapiia.

INTRODUCTION: Breast cancer is the most common neoplasm among women, with a peak incidence at an age between 40 and 60. The contemporary guidelines for prophylactic breast cancer screening emphasize on performing an annual mammography, starting at the age of 40. OBJECTIVE: To analyze the results of the prophylactic mammography and clinical examination in a group of climacteric women before initiation of HRT. MATERIAL AND METHODS: 108 women were screened for a period of 12 months. The average age of participants was 51.4 +/- 3.67 years. RESULTS: In two patients in the absence of evidence for breast cancer from the clinical exam the mammogram was evaluated as indicative for breast neoplasm. In both of the cases the diagnosis was confirmed hystologically. DISCUSSION: The results from the selected group of patients represents a 2% incidence of breast cancer, unrecognized by the clinical exam. The mammography proves its high effectiveness and the recommendation for timely prophylactic mammography referring the climacteric women is in concordance with the latest world standards for breast cancer screening.

[Endometriosis as an unexpected finding during laparoscopy on sterile women]. / Endometriozata kato nepodozirana nakhodka po vreme na laparoskopiia pri sterilni zheni.

OBJECTIVES: Assessment of the laparoscopy as endoscope method at diagnosing as unsuspected finding at sterile women. MATERIALS AND METHODS: Studying is retrospective and includes 20 years period of time (1976-1996). We have examined the documentation of 912 patients on whom performed laparoscopy. 678 from them have been primary and 234 have been with secondary sterility. RESULTS: We have established the following findings: cases only with endometriosis--164 patients; endometriosis and polycystic disease of the ovaries--11 patients; endometriosis and tubal sterility--42 patients; endometriosis and pelvic inflammatory disease (PID)--56 patients; endometriosis and uterus myomatosus--6 patients. DISCUSSION: Diagnosis of endometriosis by laparoscopy effectively helps in the further treatment of sterile women.

[The choice of the uterine-contraction agent in managing the placental period of labor based on our data]. / Izbor na kontrakhirashto sredstvo pri vodene na platsentarniia period na razhdaneto po nash material.

Every obstetrician is acquainted with the existing risk during the placental stage. The danger of a greater blood loss is always present. The use of uterotonic medicines reduces the post-delivery bleeding. The authors have carried out observations over 422 delivery cases. In 153 of them ergotamine has been applied in the placental stage, in 121 oxytocine, and in 148 delivery cases the placental stage has passed without uterotonic drugs. The authors have concluded that the application of contracting medicines reduces the blood loss, but their usage has to be selective and after delivery of the fore shoulder of the foetus.

Clinical characteristics of women with endometriosis.

The author followed prospectively the clinical presentation of endometriosis in 413 patients with subsequently confirmed endometriosis in 1994 laparotomies performed between 1984 and 1988. Age at menarche and at the time of clinical presentation of the disease, menstrual cycle abnormalities and the rest of the symptoms and signs of the condition, together with the findings on examination are presented. The correlations between the signs and symptoms and the clinical characteristics are presented by the author expand the previously published reports in the literature.

[The characteristics of labor in multifetal pregnancy based on our data]. / Kharakteristika na razhdaneto pri mnogoplodna bremennost po nash material.

The pregnancy and delivery in multifetal pregnancy most often are accompanied by complications and by a high degree of risk both for the mother and the foetus. The successful and of the delivery depends on the condition of the mother, the good obstetric status, the gestation age of the foetuses and their presentation. The authors have followed the characteristic of the delivery in multifetal pregnancy over 10-years material in 137 cases of pregnancy. After strict indications, in 26 cases the delivery has been completed though caesarean section. In 111 cases the delivery has been vaginal. A characteristic of the delivery has been made and it has been expressed in diagrams. The authors have been successful in the vaginal deliveries in multifetal pregnancy. They emphasize the active observation of the patient, especially in the first stage, and the monitoring of the foetus.

[The differential diagnostic importance of laparoscopy in pathology of the lesser pelvis]. / Diferentsialno-diagnostichna znachimost na laparoskpiiata pri malko-tazovata patologiia.

It is known that presently the diagnostic process is enriched by the application of endoscopic methods like laparoscopy and hysteroscopy. The aim of our work is to point out the importance of laparoscopy in differential diagnostical processes. 358 laparoscopies were carried out for the period 1988-92. After laparoscopy the authors correct clinical diagnoses of the different patients' groups. The results of our experience in application of laparoscopy to cases of pathologic changes in the pelvis enable us to recommend this additional method, having in mind ist considerable value for the differential diagnosis in the gynaecological practice.

[A procedure for delivery in multiple pregnancy based on our data]. / Nachin na rodorazreshenie pri mnogoplodna bremennost po nash material.

The multifoetal pregnancy has not lost its significance both in terms of its course and its method of delivery. Its frequency has increased in recent years. The authors have set the goal of observing the method of delivery at multifoetal pregnancy over a period of 10 years. In the Obstetrics Clinic there have been 134 bigemine and 3 trigemine deliveries. In 26 pregnant women 18.98% the delivery has been completed by caesarean section. The vaginal deliveries have been 91 (66.43%). In 7 deliveries a forceps has been applied (5.10%). Extraction has been carried out in 12 deliveries (8.&%). On the basis of the accomplished observations the authors have concluded that the vaginal delivery has priority over the abdominal delivery. The latter has to be strictly indicated.

[Pelvic pain as an indication for laparoscopy]. / Tazovata bolka kato indikatsiia za laparoskopiia.

During the practice of every gynaecologist there have been women whose only complaint have been pelvic pain. In recent years the pelvic pain occupies one of the leading positions as an indication for laparoscopy. The author has carried out observations over 69 patients with such problems. The phlogistic changes of the adnexa have been the most frequent endoscopic finding, followed by the endometriosis. The other pathological changes in the small pelvis combined with pelvic pain have been the varicose changes in the vascular net of the ovaries, the mesosalpinx and the parameters. The author recommends laparoscopy for objectivization of the changes in the small pelvis and for determining the appropriate medical approach.

[Genital diseases concomitant with endometriosis based on our data]. / Suputstvuvashti endometriozata zaboliavaniia na genitaliite po nash material.

There is constantly growing interest towards endometriosis due to its remaining a mystery for the researchers. Some of them call it the disease of civilization. The combination of endometriosis and different gynaecological diseases is often unsuspected and accidentally diagnosed. The author determines interesting relationships between the disease and uterine myoma, uterine and ovarian neoplasms, for a period of 5 years on 1994 laparotomies and histologically proved endometriosis in 413 cases. The established relationship is presented in the applied table. Through her findings the author looks forward to contributing to the variety of combinations, which this interesting disease, the endometriosis, is able to register.

Polycystic ovaries in association with pelvic endometriosis in infertile women diagnosed by laparoscopy.

The author studied the combination of the polycystic ovary syndrome and endometriosis in 274 infertile women by laparoscopy. 106 patients were diagnosed on clinical criteria as having the polycystic ovary disease which was confirmed in 93 of them (87.74%) at the time of the procedure. Coexisting endometrial focuses were found in 11 patients (11.83%). The results show that laparoscopy should be the modality of choice in the diagnostic work-up in women with infertility and clinical symptoms of the polycystic ovary syndrome. Extensive scrutiny for endometriosis should be performed in all of these cases since the combination of the two conditions is not infrequent.