[CHARACTERISTICS OF VAGINAL ECOSYSTEM IN ENDOCERVICITIS CHLAMYDIALIS].

The study aims: 1. To analyze and study the specifics of microbiocenoses of exocervix at endocervicitis chlamydialis, to differentiate the spectrum of stimuli, and establish the leading role of Chl. trachomatis in the genesis of this process. 2. To determine the leading role of the method of direct (bed-side) microscopy for early and rapid diagnosis of cervicitis and conducting etiotropic therapy. We determined the incidence of endocervicitis chlamydialis, with cause Chl. trachomatis-45.1%, (319 DIF (+) patients out of 708 surveyed), p <0.05, in the Rousse region. Studies indicator presence or absence of vaginal infection, Trichomonas vaginalis, Gardnerella, Candida, Staphiloocus aureus, E. coli, Proteus, Streptoccocus agalactae, the differences between the two samples in terms of the variable was not statistically significant. In our study, in patients with endocervicitis, the incidence of Trichom. vaginalis is 7.0%, Gardnerella-24.4%, Candida-21.4%, Streptococcus agalactae-7.1%, Staphylococcus aureus-6.3%, E. coli-0.4%, Proteus-0.2%. The frequency of Trichomonas vaginalis, npu nauueHmku c endocervicitis chlamydialis e 3.2%, Gardnerella-10.8%, Candida alb. -9.2%, Candida tropicans-0.2% Streptoccocus agalactae-3.3%, Staphyllococus aureus-2.4%, E.coli-0.0%, Proteus-0.0%.The majority of patients with endocervicitis chlamydialis, no other co-infection unless Chl. trachomatis.

[INFLUENCE OF STIMULATION PROTOCOL ON MATURITY AND MORPHOLOGICAL FEATURES OF OOCYTES IN PATIENTS WITH LOW OVARIAN RESERVE: STUDY OF 72 IVF/ICSI TREATMENT CYCLES].

UNLABELLED: The current study presents the results of a retrospective and prospective observation of the maturity and morphological features of the oocytes and the way they are influenced by the therapeutic approaches and the protocol for controlled ovarian hypersimulation (COH) in patients with low ovarian reserve. MATERIALS AND METHODS: The study includes 184 oocytes, derived from 72 patients with low ovarian reserve involved in an infertility treatment program through in vitro fertilization from February 2011 to February 2014. The applied therapeutic approaches and COH protocols are microdose agonist short protocol, antagonist short protocol, mild stimulation protocol and natural cycle in vitro fertilization. RESULTS: Our study hasn't found a statistically significant dependence between the applied ovarian stimulation protocol and the maturity and morphology.

[POSSIBILITIES AND LIMITATIONS ANALYSIS OF SCREENING IN PREGNANT WOMEN FOR DOWN SYNDROME AND OTHER COMMON CHROMOSOMAL DISORDERS OVER A PERIOD OF TWO YEARS].

Maternal biochemical screening and the new non-invasive prenatal screening tests as well as prenatal diagnostic tests as tools to fight serious chromosomal diseases have their possibilities and limitations. The article presents analysis of the results in 7 201 pregnant women: 4426 first trimester and 2775 second trimester biochemical screening, together with 994 calculated integrated risks performed in the Laboratory of medical genetics in 2013 and 2014 year. A matter of mass screening in both periods is the criterion of efficiency--financially justified reasons on the basis of comparison "sensitivity" of different approaches. First trimester screening revealed 5 (71.42%) cases of chromosomal disease and 1 (14.28%) case with large congenital anomaly. From second trimester biochemical screening 3 (60%) cases were revealed. Chromosomal pathology in pregnant women with calculated integrated risk was found in 7 (70%) cases. From a total of 22 screened pregnant women with prenatal or postnatal verified diagnosis of Down syndrome, Edvards, Patau or Turner, highest detection rate is found in first trimester screening--6 of 7 (85.7%). Contingent approach is most widely used in Europe and we confidently recommend it.

[PRIMARY CYTOREDUCTIVE SURGERY VERSUS NEOADJUVANT CHEMOTHERARY IN TREATMENT OF ADVANCED OVARIAN CANCER (STAGE III C-IV). OUR AND FOREIGN EXPERIENCE].

INTRODUCTION: The advanced ovarian cancer usually have bad prognosis. The main methods for treatment of these types of tumors are: primary cytoreductive surgery and platin-based chemotherapy. AIM: Our aim was to evaluate our and foreign experience in treatment of advanced ovarian cancer stage III C--IV treated by neodjuvant chemotherapy followed by cytoreductive surgery and patients treated by primary cytoreductive surgery followed by adjuvant chemotherapy. We wanted to research the survival rate, postoperative adverse effects, mortality rate, the size of residual tumor and the metastases in these patients. MATERIAL AND METHODS: We researched for 10 years period--50 patients treated by primary cytoreductive surgery and 50 patients treated by neoadjuvant chemotherapy. RESULTS: The postoperative adverse effects and mortality rate are lower by neoadjuvant chemotherapy followed by cytoreductive surgery. The most important independent prognostic factor for overall survival rate was the lack of residual tumor in both types of treatment. CONCLUSION: The neoadjuvant chemotherapy followed by cytoreductive surgery in ovarian cancer stage III C--IV is considered as a standard treatment.

[RECONSTRUCTIVE AND COSMETIC SURGERY IN TREATMENT OF VULVAR CANCER].

UNLABELLED: The aim of our research work was to show our results in the field of reconstructive and cosmetic surgery for vulvar cancer. MATERIAL AND METHODS: We evaluated 18 patients for 10 years period. RESULTS: We applied all surgical techniques that are possible at the moment in the world: laps from mons pubis, rhomboid flaps, myocutaneous flaps from gluteal region. We used surgical techniques with the following muscle groups: musculus gracilis, musculus gluteus maximus, musculus tensor fasciae latae, musculus rectus abdominis. CONCLUSIONS: With our research work we tried to better the quality of life of our patients, to achieve better esthetic and cosmetic effect after very radical surgical interventions connected with vulvar cancer.

[THE ROLE OF COLPOSCOPY AS A METHOD OF METHODOLOGY FOR EARLY AND RAPID ETIOLOGIC DIAGNOSIS IN THE STUDY OF ENDOCERVICITIS CHLAMYDIALIS.]

The aim of this study was: 1. To analyze and study the specifics of colposcopic picture of ecto-and endo-cervix in endocervicitis chlamydialis. 2. To demonstrate the leading role of colposcopy method as part of the methodology for early and rapid etiologic diagnosis of chlamydial cervicitis in order to conduct etriotropian treatment.Results 1. Determine the frequency of incidence of endocervicitis chlamydialis, to cause Chl.trachomatis 45,1%, (319 DIF(+) patients out of 708 surveyed), p <0.05 in the Ruse region. 2. Demonstrated statistically significant relationship between the incidence of endocetvicitis chlamydialis, examined by DIF, and the presence of colposcopic amendments Baza and Ectopia. The difference of the two samples in terms of variable baza e statistically significant. The difference of the two samples in terms of variable ectopia e statistically significant at α<0,05, and when α<0,1 statistically significant. 3. There was no statistically significant association between the incidence of endocervicitis chlamydialis, proven by DIF, and the presence of colposcopic changes - mosaic zone of transformation, presence of blood vessels. 4.It has been proven leading role of colposcopy method as a method complementary to the early and rapid diagnosis of endocervicitis chlaamydialis, in order to hold further etiotrop treatment.

[FEMALE STEROID HORMONES - MODULATORS OF IMMUNE RESPONSE TO GENITAL CHLAMYDIA TRACHOMATIS INFECTION.]

In the recent years according to WHO, genital chlamydia is the mos't common sexually transmitted infection. Chlamydia Trachomatis is an intracellular parasite which target are the tubular epithelial cells of the urethra, endocervix, endometrium, endosalpinx, conjunctiva, synovial lining of the joints, Glisson's capsule of the liver Our study, as well as some international researches, shows that in the cases of genital chlamydia there are changes in the ovarian hormones (estradiol and progesterone), their impact on the immune system and their importance for the development and the complications of the infection with Chlamydia trachomatis. The physiological level of the steroid hormones in its turn contributes for the normalization of the local immunity and reduces the possibility of recurrences.

[The Role of Chlamydia Trachomatis in Pregnant Women with Endocervicitis.]

Infectious endocervicitis is a common disease in women of reproductive age. Itis of great clinical importance because the infection can spread over the genital tract and it can transfer both in horisontal way (sexual partner) and vertical way (foetus and new-bom). One of the most common causers for the infections endocervicitis is Chlamydia trachomatis. The aim of the study was to define the frequency of the chlamydial endocervicitis among women with desired pregnancy and examining them while pregnant and until the birth to define the possible complications.

[Preparation of Cervical Dilatation Before with Misoprostol and Laminaria - Advantages and Disadvantages.]

The surgical hysteroscopy became popular as a minimally invasive approach to interuterine changes. Dilatation is a real challenge during surgical hyseroscopy especially in first delivery patients, women in menopause and women with cervical stenosis. Apart from this, some long hysteroscopy operations such as myomectomy require adequate dilatation in order to facilitate the multiple insertions and drawing pulling of the resectoscope. Another technical problem is the need for a significant degree of cervical dilatation, as well as softening of the cervix, which will allow the extraction of the excised endometrial polyps or myomatose parts. Mysoprostol is analogous to prostaglandin El, which is commonly used in obstetrics to induce an abortion and birth, as well as after birth to control the excessive vaginal bleeding. Its use in gynecology is limited. In our study it is of vital importance. The vaginal administration of MysoproStol before surgical hysteroscopy facilitates dilatation. The eased hysteroscopy minimizes cervical complications. On the other hand, the natural dilatators Laminaria, made of Laminariajaponica orLaminaria Digitata sticks, are attractive natural substances which can cause dilatation with minimally observed systemic side effects. They have shown efficient results during the cervical preparation before surgical hysteroscopy. Despite of that, there are no comparative studies on the efficiency of the two methods for cervical preparation. The aim of this Study is to compare the efficacy of internally vaginal Mysoprostol against endocervical dilatators Laminaria before surmical hvSterosconv in certain cases.

[New Low-Dose Oral Contraceptive with 28 Midiana.]

As a representative of the low dose generation of oral contraceptives, Midiana 28 provides minimal intake of estrogens for the female organism in the presence of a new generation getation component- Drospierenone. Midiana has an excellent contraceptive effect - the control group of women showed no cases of impregnation during the intake, Pearl index =0.00. It also exercises a good control over the menstrual cycle with low frequency of intementrual bleeding /17%/ Midiana 28 shows a very good tolerability with minimal, detected, rapidly transient side effects.

[OVARIAN CANCER RECURRENCES IN PARAAORTIC LYMPH NODES].

The authors'surgical experience on 14 patients with ovarian cancer recurrences in paraortic lymph nodes --infrarenal and suprarenal-celiac and triad, were presented. Complete cytoreduction was achivied in all recurrent patients (no visible tumor). The median time to recurrence was 16,5 months (from 10 to 36 months). The median operating time was 90 min (range from 30 to 120 min). The median blood loss was 200 ml (from 100 to 300 ml.). No intra- or postoperative complications were noted. The median postoperative period was 5 days (from 4 to 6 days).

[COMBINED APPLICATION OF FETAL FIBRONECTIN AND INSULIN-LIKE GROWTH FACTOR IN PRETERM DELIVERY DIAGNOSIS--OUR RESULTS].

The insulin-like growth factor IGFBP-1 is a binding protein (IBP-1), also known as placental protein (PP12), is encoded in people as IGFBP-1 gene. The IGFBP-1 is an especially vital hormone in the female reproductive physiology. The presence of it in large quantities in the amniotic fluid can be used as a biochemical marker for preterm birth and premature rupture of membranes. Fetal fibronectin is a high-molecular glycoprotein, that is produced during pregnancy and has a role as biological glue, binding the foetus membranes to the endometrium. fFN can be found in the cervicovaginal secretions until 22nd gestational week and later on during the last trimester (1 to 3 weeks before birth). fFN is usually absent between 24th and 34th gestational week. Thirty sixth (30%) of all the 120 females tested had positive fFN test results and were, therefore, at high risk for preterm delivery. Despite the implemented tocolytic therapy, 15 (12.5%) of them delivered before the 37th gestational week. The results from the investigation for the presence of pLGFBP-1 in 120 pregnant women show that 35.8% (43 women) were positive and 15(12,5%) of them delivered before the 37th gestational week despite the implemented tocolytic therapy In both tests, the average gestational age of the premature fetus was 32.5 ÷ 2.8 gestational weeks.

[CONGENITAL UNILATERAL HYDROTHORAX--A CASE REPORT].

A case of isolated unilateral congenital hydrothorax with unknown etiology, graduated abortion for medical reasons in 23 weeks. The patient was later covered by antenatal care and during the examination one foetus with the massive right-sided hydrothorax was found, (diagnosed by ultrasonography and NMR) The incidence of congenital fetal hydrothorax is estimated at approximately 1 in 15,000 pregnancies. Early ultrasound diagnosis is of paramount importance for the adequate monitoring of the pregnancy and timely proof of deviation in normal fetal development.

[SOME DIAGNOSTIC ASPECTS OF CHLAMYDIA TRACHOMATIS UROGENITAL INFECTIONS].

The following tests were used to make the diagnosis of Chlamydia Trachomatis: Ensime Immunoassay (EIA), Enzyme-Linked FluorescentAssay (ELFA), Polymerase Chain Reaction DNA amplification for Chlamydia Trachomatis, Neisseria Gonorrhoeae, Mycoplasma Genitalium and Ureaplasma Urealyticum. The subject of this study were 486 outpatients between the ages of 17 and 62, diagnosed with urethritis, epidydimitis, prostatitis, cervicitis, endocervicitis, pelvic inflammatory disease and sterility. Comparison PCR and EIA showed statistically significant difference between the positive results obtained by the two methods (p<0.001). Comparing PCR and ELFA on the other hand, did not show any statistically significant difference (p>0.1). EIA is the method that gives a higher percentage of nonspecific positive reactions, while the results obtained with ELFA are much closer to the ones obtained by PCR. According to contemporary evidence based medicine, the development of unified standart methods for diagnosis and evaluation is of vital importance, not only for the patient and the treating physician but also concerns for the healthcare system, the general public and the pharmaceutical companies as well.

[GLYCYRRHIZINIC ACID--AN ALTERNATIVE METHOD FOR TREATMENT OF CONDYLOMATA ACUMINATA].

Condylomata acuminata are benign proliferations of skin and mucosa caused by the human papilloma virus infection (hereinafter referredto as HPV). It is one of the most common sexually transmitted diseases in the world, whose incidence rate has increased in the last three decades. Current treatment involves the physical destruction of the infected cells. The fact that there are many different types of treatment goes to show that none of them are uniformly effective or directly antiviral.

[Gestational surrogacy - sin, whim or necessity].

The authors propose the gestational surrogacy to be permitted but only for medical indications and under exact requirements. The surrogate mother if married, her husband, too, sign with the commissioning adopting couple a legal agreement at the beginning of the procedures.

[Diabetes and pregnancy].

UNLABELLED: We tried to summarize our and foreign experience in the field of diabetes and pregnancy AIM: Our aim was to detect pregnant women with diabetes mellitus, as well as to introduce screening method for early detection and apply a suitable diet and treatment for these patients. MATERIAL AND METHODS: Patients with diabetes and pregnancy were researched for the period of 2007-2014 (70 patients). RESULTS: Introducing a screening method in the second trimester between 24-28 gestational week, applying a suitable diet and treatment lead to better outcome of this disease and to more safe delivery outcome. CONCLUSION: Future research work will give additional light in this field.

[The insulin-like growth factor IGFBP-1--specific marker for preterm delivery in pregnant women with clinical symptoms].

The insulin-like growth factor IGFBP-1 is a binding protein (IBP-1), also known as placental protein (PP12), is encoded in people as IGFBP-1 gene. This gene encodes a protein in the domain of IGFBP-1 and domain thyroglobulin. During the last years highly phos-phorylated versions of IGFBP-1 (IGFBP-1 pM) have been found in decidual cells--a marker of threat for preterm birth. The quantity analysis of the insulin-like growth factor in the serum or heparinized plasma is used to locate diseases related to growth. Its levels in the plasma can scarcely be determined after birth and steadily rise with age while they reach their maximum during puberty. These levels rise constantly during pregnancy.