[COMPLICATIONS OF DIAGNOSTIC AND OPERATIVE HYSTEROSCOPY--REVIEW].

Hysteroscopy is a diagnostic or surgical mini-Invasive gynecologic operating procedure. The complications of this standard procedure are relatively rare. According to retrospective studies they are 0.95-13.6%. They occur more often by an operative rather than a diagnostic hysteroscopy. These complications could be divided into two groups of an approximately equal occurrence--due to a dilation and passing through the cervix uteri (cervical laceration, creative a false cervix uteri, perforation, bleeding, impossibility to pass through the inner orifice of the cervical canal, insufficiency of the cervix uteri) and due to the operative technique itself (uterine perforation, fluid overload, thermal or mechanical trauma of the inner urinaiy and gastrointestinal tract, infection, rupture of the uterus during a subsequent pregnancy). The most occurring complication is namely the uterine perforation--1-9%, the most severe could indeed be the fluid overload--0.01-11%. The gynecologist performing the hysteroscopy should be well grounded in the typical complications. Unveiling and performing a quick intervention of the latter could prevent unwanted consequences for the patient and the legal issues that could follow occur.

[Maternal biochemical screening -- an approach for genetic prevention. part 1. first and second trimester screening].

UNLABELLED: The aim is to perform our eight-year experience on prenatal (matemal) screening for Down syndrome (DS). METHODS: Pregnant women underwent screening in second trimester (ST2) - 14(+4)-19(+3) gestational week using serum AFP and free beta-hCG biochemical markers. A more sensitive first trimester test has been implemented in 11(+0)-13(+6) gestational weeks since the end of 2009. This combined screening test (CST1) was based on US measurements of NT (nuchal translucency) and NB (nasal bones) supplemented by biochemical markers of serum free beta-hCG and PAPP-A. Uniform methodology, web-based software and system for laboratory quality control had been used. False positive ratios for DS were estimated at cut-offs 1/250 for Down syndrome and 1/100 for Edwards syndrome. RESULTS: The test was performed on 17 468 pregnant women: 13 016 by biochemical screening 2 test (BHS2) and 4452 by first trimester test CST1. High risk for a chromosome disorder by BHS2 test was found in 1097 (8,4%) cases (5,96% < 35 years and 21,13% > 35 years). 7 fetuses were diagnosed with chromosome disease (5 fetuses with trisomy 21,1 - trisomy 18 and 1 - triploid); false positive were 1090 (8,4%). High risk for a chromosome disorder by CST1 test was found in 102 (2,3%) cases. 4 affected fetuses were diagnosed (3 with trisomy 21 and 1 with trisomy 13). Verified diagnosis for DS by first and second trimester tests were 43% (3 out of 7 cases) with 57% false negative results and 45,5% (6 out of 11 cases) with 54,5% false negative results respectively. Description of biochemical values/MoMs and US measurements are applied. CONCLUSIONS: We comment on the importance of US measurements in CST1 test and correct analysis of biochemical and US markers in counseling of every individual patient, beyond final risk number.

[Maternal biochemical screening -- an approach for genetic prevention. part 2. sequential approach with integrated risk assessment].

UNLABELLED: Performance of 2,5 year experience onprenatal (maternal) screening by integrated risk for Down syndrome and Edwards syndrome is presented in pregnant women underwent first (11(+0)-13(+6) g.w) and second trimester screening (14(+4)-19(+3) g.w), assessed by an integrated risk. Since the end of 2010 the most common strategy has been combination of both risks after contingent screening approach (serummarkers and US measurments from first test with indication to second trimester screening if the risk is intermediate or high and CVS diagnosis has been refused). Serummarkers were measured by fluorimetric immunoassay (Delfia) and risks were calculated using LifeCycle 3.2 software. RESULTS: The test was performed on 491 women, less than 4452 and 13 016 women first and second trimester respectively. We found highrisk for a chromosome disorder in 32 (6,5%) cases: 19 (6,35%) women < 35 and 13 (6,7%) women > 35). Diagnosis of a chromosome diseases was found in 4 fetuses out of 32 (12,5%): 3 fetuses with trisomy 21 and 1 with trisomy 18. False positive results were found in 28 out of 491 (5,7%) women. Verified diagnosis on lyfor DS was found in 3 out of 4 cases (75% sensitivity), and false negative results in 25%. Discussion is focused on the comparison of the screening approaches - the sensitivity, limitation sand the step wise sequential testing way with integrated risk of achieving a high performance of screening.

[The experience in genetic laboratory Varna in amniocentesis and genetic analysis for the period 2006-2010].

The aim of this report is to present and discuss the results from diagnostic amniocenteses, performed in Varna. The test started as a part of a prophylaxis program for pregnant women with calculated high risk for chromosomal disorders after a screening test. Amniocentesis was performed in total of 283 pregnant women. Of all patients who underwent the screening test, amniocentesis was performed in 1.55% of women under 36 years of age and 5.0% of women over 36 years. In the selected group with calculated high risk for chromosomal disorder these percentages were 28.5% and 26% respectively. Fetal chromosomal disorder was found in 5% (in 7 out of 141) in women under 36 and 3.82% (in 7 out of 83) in women over 36 years. Genetic tests (DNA and cytogenetic analysis) of amniocytes revealed chromosomal disorders in 16 (5.65%) fetuses (8 with trisomy 21, 3 with trisomy 18, 1 with trisomy 13, 1 case with triploidy, 3 cases with structural chromosomal rearrangement). Three additional amniocenteses were performed, indicated by family history of monogenic disorder (thalassaemia, spinal muscular atrophy). The effect of the introduced method for prenatal diagnosis, its interaction with the screening tests and their future as genetic prophylaxis program are discussed.

[The attitude of pregnant women to the possibilities for the prenatal screening and diagnosis of Down's syndrome in the 2nd trimester]. / Otnoshenie na bremennite kum vuzmozhnostite za prenatalen skrining i diagnostika na sindroma na Daun vuv vtori trimestur.

The aim of the study was to assess pregnant women's attitude and receptivity for second trimester prenatal screening and diagnostic tests for fetal Down syndrome [DS], factors that influence attitude formation, sufficiency of patients' information, advisability of introduction of these tests in routine prenatal care Interviews with 129 pregnant women were conducted after they had received written information concerning prenatal DS screening and diagnostic tests Five questions to the point of the matter as well as 14 related to the personal characteristics of the interviewed were included. Ultrasound screening rt]. accepted by 98.4% serum screening--by 93% and invasive prenatal testing--by 90% of the pregnant women Patients receptivity for serum screening and invasive testing Was influenced by factors like age, past obstetric history educational level, religiosity, attitude towards patient's own health For some of the factors statistically significant relationships were present while for others only some trends were outlined Regarding patients' high receptivity for prenatal DS screening and diagnostic tests the latter can be recommended as an element of the routine prenatal care in our country.

[A clinico-morphological study of cancer of the gastric stump following an operation for benign disease]. / Klinikomorfologichnoto prouchvane na raka na stomashniia ostatuk sled operatsiia po povod na dobrokachestveno zaboliavane.

The study covers 108 patients with stomach resection (Billroth II), performed over a period of six years (1988-1993). Endoscopic and biopsy findings are described. Carcinoma of the gastric stump is established in 16 cases (14.8 per cent), high degree epithelial dysplasia-in six (5.5 per cent), and signs of acute or chronic anastomositis, superficial of atrophic gastritis, intestinal metaplasia, lipid islands and single hyperplastic polypoid lesions are present in all cases. Dysplasia III degree and carcinoma in the gastrojejunal junction are observed in the older age group with 10-15 years postoperative follow-up study. Patients with stomach resection should undergo check-ups and multiple biopsies at 3-5 years intervals, especially those with high-degree epithelial dysplasia.

[Our experience of treating urological infections with a single dose of gentamycin]. / Nashiiat opit pri lechenie na uroinfektsiite s ednokratna doza gentamitsin.

31 patients with a urological infection caused by a bacterial strain susceptible to gentamycin were treated by a single injection of 240 mg of gentamycin. 11 patients (35.5%) fully recovered, the infection was eliminated and the clinical symptoms and signs disappeared. Better results were achieved in patients with infection of the lower urinary tract without pyelonephritis, 7 out of 15 patients (46%) recovered. Out of 16 patients with pyelonephritis only 4 were cured (25%). Of 10 patients with nephrolithiasis only 1 was cured, in the remaining 9 patients the treatment was without effect. In the group of patients who recovered the patients with E. coli infection prevailed while in the group of unsuccessfully treated patients other bacteria prevailed. No side effects were found. The conclusion is that the treatment with a single gentamycin dose could be applied successfully in patients with an infection of the lower urinary tract without pyelonephritis, morphologic changes in the urinary system or nephrolithiasis.

[Nifedipine in the treatment of arterial hypertension]. / Nifedipin pri lechenie na arterialnata khipertoniia.

The results are reported from the administration of nifedipine to 39 patients with arterial hypertension. Thirty one of the patients suffered from hypertonic disease, and 8 had symptomatic hypertension. Light hypertension was established in 26 of the patients, moderate--10 and grave--3. In 22 of the patients (66.6%)--16 with light and 6 with moderate hypertension, the arterial pressure was normalized by the administration of nifedipine alone, 40 mg daily. In 16 patients the arterial hypertension was coped with the addition of beta-blockers, diuretic and clonidine. Only one patient failed to respond to the treatment. The effect advanced on 3rd--4th day on the average with the treatment with nifedipine alone and after 4-6 days after the inclusion of the double combination. Negligible and transitory adverse effects were observed in single patients. Nifedipine, administered alone or in combination with beta-blockers, diuretic and clonidine is an excellent agent in the treatment of light and moderate arterial hypertension.

[Systemic lupus erythematosus in elderly patients]. / Sistemen lupus erythematodes pri bolni v naprednala vuzrast.

Two patients are described with lupus erythematosus, aged over 60. A brief literature survey is presented of the characteristics of SLE in advanced age, analyzed, in the light of the communications by other authors, were the manifestations in the described patients--fever, accelerated ESR, onset with preceding articular syndrome, skin changes as well as the complications--fresh myocardial infarction with the signs of activation of lupus in one of the patients.

[Mesangial IgA glomerulonephritis with atypical clinical manifestations and course]. / Mezangialen IgA-glomerulonefrit s netipichni klinichni proiavi i protichane.

The authors describe three female-patients with mesangial IgA-glomerulonephritis with non-typical clinical manifestations and course. Manifest nephrotic syndrome was established in one of them, favourably influenced by glucocorticosteroid treatment, and advanced renal insufficiency--in the other two.