Quantitative expediency assessment of the zeta sedimentation ratio and the plasma viscosity in arterial hypertension research.

Accepted methods of the ESR methodology (the Westergren mode and ZSR mode) and its alternative the plasma viscosity were tested for diagnostic utility in pregnancy induced hypertension and pre-eclampsia. The receiver-operating characteristic curve (ROC) analysis approved moderate diagnostic accuracy for the ESR methodology and supplied support for its preliminary estimated cutoff values but failed to indicate cogent discernment of pathology by values of plasma viscosity. Likely pathological whole blood alterations boost the erythrocyte aggregation while the concomitant depletion of macromolecules degrades plasma viscosity values.

Serum sperm antibodies after diarrhoeal diseases.

The origin of 'natural' anti-sperm antibodies found in fertile humans, virgin girls, and boys before puberty, is quite obscure. One hypothetical mechanism relates their existence to inflammatory gastrointestinal entities: as a result of the disease, cross-reactive antibodies produced against gastrointestinal flora bind spermatozoa. To test this assumption, we evaluated the level of serum sperm antibodies after diarrhoeal infections. Serum samples from 17 patients with shigellosis and 12 patients with salmonellosis were screened for anti-sperm antibodies directed against sperm surface antigens (gelatin agglutination test - GAT, tray agglutination test - TAT, sperm immobilization test - SIT), profound sperm antigens [enzyme-linked immunosorbent assay (ELISA)], and anti-bacterial antibodies (slide agglutination test - SAT) upon diagnosis (group A) and 4-35 days later (group B). The patients from group B demonstrated an increased sperm antibody incidence by GAT (20.7%), TAT (13.8%) and ELISA (31%) when compared to group A and to healthy controls, although statistically significant data were acquired only for the latter group. The absorption of positive sera with bacteria and/or spermatozoa revealed significant reactivity changes in the antibody values by GAT and TAT for shigellosis, and by TAT and ELISA for salmonellosis patients. These data demonstrate increased serum sperm antibody levels in salmonellosis and shigellosis patients.

[Prevention of neural tube defects with folic acid]. / Profilaktika na defektite na nevralnata truba s folieva kiselina.

Neural Tube Defects (NTD's) include a large number of congenital malformations produced when the open neural tube presents a very early stages in the development of the human embryo fails to close on or before the first month post conception. NTD's are considered to be one of the most common forms of malformations with varying degrees depending of genetic and environmental conditions. The studies prove that the additional taken of folic acid plays an important role against the NTD's. Numerous studies prove this "B" vitamin has an important protective effect not only for the recurrence of NTD's, but for new cases too. In light of these, in 1992 the US Public Health Services issued the recommendation that all women in child-bearing age should consume at least 0.4 mg (400 micrograms) of folic acid daily.

[Prophylaxis with tercef of infection-related complications after cesarean section]. / Profilaktika s Tercef na infektsioznite uslozhneniia sled tsezarovo sechenie.

The purpose of this prospective and case controlled study is to determine the effectiveness and safety of antibiotic prophylaxis with Tercef (ceftriaxone) in women undergoing cesarean section and to compare the results with those of 24 hours regiment of Cefazolin and also with a group without prophylaxis. The study includes 122 cases of elective and emergency CS: 41 with a single intravenous dose of 1.0 g Tercef after clamping of the umbilical cord; 41 cases of antibiotic prophylaxis with Cefazolin three times 2.0 g for 24 hours and 40 low infectious risk CS without antibiotic prophylaxis. We take in account the existing before the CS risk factors for postoperative infectious complications as: hours of PROM; length of labor, number of vaginal examinations before CS, previous sections, duration of the operation, anemia, bacteriuria and diabetes. For post CS infection-related complications we take: febrile morbidity, endometritis, wound infections, infection of urinary tract. The results show infection complication in the three groups as follow: 14.6% for tercef, 17.1% for cefazolin and 20.0% for the group without antibiotic. There is not statistically significant difference. According our study in cases of CS with increased risk of post-operative infectious complications the antibiotic prophylaxis reduce the rate of infection-related complications even below that of CS with low infectious risk. The single dose of 1 g tercef i.v. is effective and suitable in comparison with 24 hours regiment of cefazolin.

[Hemorheological parameters in the prognosis of the risk of fetal retardation in pregnancy with arterial hypertension]. / Khemoreologichni parametri v prognozata na riska ot retardatsiia na ploda pri bremennost s arterialna khipertoniia.

The haemorheological theory creates the notions of the interrelationship between the haemodynamic alterations in the blood flow and the whole-blood viscosity. The whole-blood viscosity is a variable parameter in close relation to the vessel geometry and blood flow rate, the blood plasma viscosity, the volume concentration of the blood cells, mostly of the red blood cells (the haematocrit) as well as to the hydrodynamically effective haemorheological phenomena of the aggregation and deformability of the erythrocytes. In the onward development of pregnancy in Bulgarian women with pre-eclamptic signs an increase of the haematocrit, the haemoglobin concentration and the erythrocyte aggregation were found. These data could be of benefit as reference point of possible risk-conditions for the mother during the pregnancy advance and in the same time of manifestation a retardation and/or stillbirth or neonatal death.

Prospective study of contraception with levonorgestrel.

PIP: A 6-month prospective study of 120 clients of the Bulgarian Family Planning Association was undertaken to document the use, effectiveness, and side effects of the postcoital contraceptive Postinor. 40 of the women used Postinor during 6 cycles, 31 during 5 cycles, 29 during 4 cycles, and 20 during 3 or fewer cycles (total of 570 cycles). Most took 1 tablet within an hour of each intercourse (they were instructed not to use the method more than 4 times per month), but some took 2-4 tablets simultaneously. This misuse resulted in badly tolerated side effects. Side effects occurred in 50% of the clients and included bleeding, delayed menstruation, nausea, headaches, breast tenderness, severe menstrual bleeding, irritability, and weight gain. Four of the subjects became pregnant (these women took the pill a day or more after intercourse). The side effects occurred more frequently in the women who took the most tablets during a month. It was concluded that Postinor should be reserved for emergency use and that clients must be properly counseled about its use and side effects.^ieng

[The incidence of clinical forms of female endocrine sterility in 1990-1993 at the III Gynecological Clinic of the Maternity Home of the State Institutional Hospital]. / Chestota na klinichnite formi na endokrinniia sterilitet pri zhenata za period 1990--1993 g. v III ginekologichna klinika na DIB "Maichin dom".

The high frequency of the female endocrine sterility and the favorable therapy results are showing categorically the importance of the endocrine sterility as a medical and a social problem. For the period 1990-1993 in Third Gynaecological clinic--Sector of Gynaecological Endocrinology, were observed 584 patients with proved endocrine sterility. The present research has the goal to discuss the frequency of the different clinical forms of the endocrine sterility. The most frequent one is PCO--30.59%, followed by corpus luteum insufficiency--23.58%, and hyperprolactinaemia--20.05%. The results are interpreted on the basis of similar research for the period 1976-1985 with analog contingent. Conclusions are made for the essential directions of the diagnostic and therapy process in the clinic.

[The medicosocial aspects of contraception for teenagers]. / Niakoi mediko-sotsialni aspekti na kontratseptsiiata pri tiineidzhuri.

The authors study and examine the influence of some medical and social factors on the teenagers use of contraceptives. The study is based on the questionnaires fulfill by 568 teenagers (aged 13-19). In the enquêtes are shown the role of the family status of the parents the involvement of the family and the school in the sex education, and also are indicated the favorite teenager's contraceptive methods. The positive attitude on contraception and on this kind of researches is very characteristic for 94% of the analyzed teenagers. The authors made a conclusion on optimizing the use of modern contraceptives for teenagers.

[The use of the triphasic contraceptive preparation trisiston for therapeutic purposes]. / Prilozhenie na trifazniia kontratseptiven preparat trisiston za lechebni tseli.

After a brief review of the qualities of the new triphasic contraceptive preparation Trisistone and some of its advantages in comparison with the other combined contraceptive drugs the authors report on the results from the first study, carried out in our country, on the therapeutic effect of Trisistone. Thirty-eight women with various gynecological diseases were treated. The largest group was that of women with irregular bleedings. In this group the effect was not good in all women. It was found that Trisistone had limited possibilities to control irregular uterine bleedings, which most probably was connected with its comparatively low dose of steroid hormones. The side effects were comparatively slight and not quite frequently. The most frequent side effect was the occurrence of irregular bleeding in 9.5% of the treated women. The state without any side effects was improved in 30.1% of the patients. Best results were found in women with postcastration syndrome, hypoestrogenism and congenital anomalies in the development of ovaries--primary ovarian dysgenesis. Trisistone is especially suitable for substituted treatment in women with ovarian hormonal deficit.

PIP: The therapeutic efficacy of the new triphasic contraceptive agent trisistone was evaluated in 42 women (20-35 years old) with various gynecological diseases. The group included 25 with uterine hemorrhage, 4 with post-castration syndrome, 4 with endometriosis, 4 with hypogonadism, and 5 with other diseases. The drug was dispensed monthly. The patients received 1 to 14 packages of trisistone (average number 3-4). The first phase consisted of 6 violet tablets containing 0.003 mg of ethinyl estradiol and 0.05 mg of levonorgestrel; the second phase consisted 6 pink tablets containing 0.04mg of ethinyl estradiol and 0.075 mg of levonorgestrel and third phase consisted of 9 orange tablets containing 0.03 mg of ethinyl estradiol and 0.125 mg of levonorgestrel. Of 42 patients, 16 had stopped taking the drug after the first cycle, while 26 showed clinical improvement. The treatment was the most effective in patients with estrogen and gestagen insufficiency, luteal insufficiency, and primary ovarian dysgenesis. Side-effects of trisistone included hemorrhage (9.5%), headache (7.1%), sensation of pregnancy (7.1%), dizziness (2.4%), and nausea (2.4%).

[Our experience in using the triphasic contraceptive trisiston for contraception]. / Nashiiat opit ot prilozhenieto na trifazniia kontratseptiv trisiston za kontratseptsiia.

The authors carried out studies on 80 women, using Trisistone, a preparation of Germed, Jenapharm, DDR, in the course of 250 cycles, taking into consideration the advantages of triphasic contraceptive preparations as well as the fact that till this moment there were not applied in our country. A good contraceptive efficiency was established. No case with conception was recorded. The side effects were mild and and their frequency varies between 2.4 and 9.7% Irregular bleedings were the only disadvantage of Trisistone, which caused refusal for its usage. It is proposed that Trisistone should be used as an initial contraceptive preparation like the preparations with "mini" doses. In cases with good tolerance women should continue to use it, but they should take another contraceptive preparation, when bleeding occurs.

PIP: Contraceptive efficacy of triphasic combined preparation trisistone (East German drug identical to triphasil) was evaluated in 80 women with the average age of 31 years. The trisistone package consisted of 6 violet tablets (0.030 mg of ethinyl estradiol and 0.050 mg of 1- norgestrel), 6 pink tablets (0.40 mg of ethinyl estradiol and 0.075 mg of 1-norgestrel), and 9 orange tablets (0.030 mg of ethinyl estradiol and 0.125 mg of 1-norgestrel). The women started to take trisistone on day 1 of the menstrual cycle and continued to take tablets in exact sequence. Indications and contraindications for trisistone were similar to those for monophasic combined contraceptives. A total of 250 cycles were followed-up. Throughout the entire trial period, no women became pregnant. Mild side-effects included subjective sensation of pregnancy (9.7%), headache (7.1%), vertigo (2.4%), and weight gain (2.4%). Almost 20% of women developed hemorrhage, usually following administration of 8-9 tablets in the middle of the 2nd phase. Repeated hemorrhage during the 2nd and 3rd cycle was an indication for discontinuation of trisistone administration.

[Diagnostic and therapeutic problems in typhoid fever complicated by severe enterorrhagia (apropos a patient successfully treated by surgery)]. / Diagnostichni i terapevtichni problemi pri koremen tif, uslozhnen s tezhka enteroragiia (po povod na bolen, uspeshno lekuvan s operatsii.

The case history of a 69-year-old patient with typhoid fever is described. The disease ran an atypical course; with early jaundice syndrome, severe enterorrhagia and late appearance of roseola. He was successfully treated by surgical intervention--hemicolectomy. The need of surgical treatment of patients with typhoid fever, who have severe, life-threatening enterorrhagia, is emphasized.

[Maternal mortality throughout the world and in Bulgaria]. / Maichinata smartnost v sveta i v Balgariya.

PIP: The authors analyze the structure of maternal mortality in Bulgaria and in selected other countries. Factors considered include parity, age, attitude toward pregnancy, socioeconomic conditions, and availability of maternal health services. Risk factors and differentials in rates among countries are noted. (SUMMARY IN ENG AND RUS)^ieng