[Three cases of vaginal adenosis after topical 5-fluorouracil therapy for vaginal HPV-associated lesions].

Three cases of vaginal adenosis after topical 5-fluorouracil therapy for vaginal HPV-associated lesions are reported. Three patients with colposcopic, histologic and viral evidences for subclinical papillomavirus infection (in combination with low-grade vaginal intraepithelial neoplasia in of them) are treated with 5-FU. In follow-up control examinations persistent ulcerations were found without regression after applied therapy. By colposcopic and histologic examinations vaginal adenosis was proved without histories of intrautering DES exposure. After the destructive therapy the reported lesions were regressed without appearance of new lesions in follow-up control examinations. The application of 5-fluorouracil has to be used only in cases of recurrent vaginal warts and in cases of high-grade vaginal intraepithelial neoplasia with strict folow-up cytological and colposcopic control examinations.

[Using GnRH-agonists (Zoladex) in the treatment of genital endometriosis].

METHODS AND MATERIALS: The study is prospective and involves 112 patients suffering from pelvic endometriosis aging from 19-38 years. (28.6 average age). The disease was diagnosed via laparoscopy and the stage was determined using the revised AFS classification. Zoladex (Goserelin depot--3.6 mg) is being applied every 28 days for 6 months in the hypodermic tissue of the front abdomen wall. All patients are being examined monthly after every Zoladex application (for subjective complaints--dysmenorrheal, dyspareunea, pelvic pain; serum estradyol-E2; amenorrhea; side effects) and every 24 months (recuperation of the menstrual cycle, pregnancy). RESULTS: In 88% of the patients amenohrea is obsereved in the first eight weeks of therapy. The menstrual cycle takes an avarege of 68 (31-139) after the last Zoladex application to reappear. At the end of the first month after the first application the serum level of estradyol E2 is lowered to a menopause level (from 750-800 to 120-130 Pmol/L) and it remains as low till the end of the treatment. Eight weeks after the completion of the therapy it goes back to its normal values. During the course of the first month of amenorrhea condition a 38% fall in the level of complaints (dysmenorrheal, dyspareunea, pelvic pain) is observed. After the 6th month 88% of the patients have no complaints. Side effects observed during the course of treatment include warm waves, sweating, vaginal dehydration (60-80%) which do not in any way disturb the patients to the point of quitting the therapy and do disappear with its end. The focus group contains 54 infertile patients with endometrioses willing to get pregnant. In 12 months after the completion of the treatment 16 of the patients become pregnant, followed by 12 more in the next one year. CONCLUSION: Zoladex causes amenorrhea, which lasts till the end of the treatement. It causes a rapid drop of the serum consentration to a menopause level. Causes a strong and durable treatment of the symptoms of endometriosis. The side effects disappear with the end of the therapy. The treatment is easy to go through and there no cases of a quitting patient. The treatment has a curable effect over the endometriosys and in cases of infertility provides a possibility for pregnancy.

[Cytolytic vaginosis--clinical and microbiological study].

47 women at reproductive age were diagnosed with cytolytic vaginosis according to their clinical and microbiological findings, including abundant lactobacilli/score 0 by Nugent/, free nuclei due to cytolysis, paucity of leucocytes, over 200 colony of HP/+/Lactobacillus spp., but no fungal growth. Heavy growth of HP/+/Lactobacillus spp. creates conditions under which the intensified cytolysis, displayed as abundant fluor, is likely to be due not only to the increased quantity of lactic acid but as well as to hyper production of hydrogen peroxide. 32 patients report improvement of their condition after at an average of 2 cycles of vaginal douches with sodium bicarbonate.

[A case of advanced genital tuberculosis--differential diagnostics and surgical aspects].

The authors report a case of advanced genital tuberculosis. The diagnostic difficulties and treatment are discussed.

[Cell proliferation in endometrium of women with endometriosis]. / Kletuchna proliferatsiia v endometriuma na zheni s endometrioza.

The purpose of this study was to describe the endothelial cell activity of the endometrial tissue in women with and without endometriosis, and find out the diagnostic opportunities for everyday gynecologic practice. There were 30 women with laparoscopic proved endometriosis involved in our study and 27 women with no endometriosis used as a control group. The histological findings were scored after Noyes criteria and classified according to the phase of the menstrual cycle. We found out a significant difference between the two groups, especially during the proliferate phase of the menstrual cycle.

[Vaginal ecosystem]. / Vlagalishtna ekosistema.

The vagina is original biotype with its own ecosystem, according to medical ecology science. This ecosystem has dynamic, but very unstable equilibrium. Disturb equilibrium is known as a disbiosys. It was discussed different components of this ecosystem: morphology of vaginal walls, vaginal liquidity, lacto-acid and residental flora, "invader" microorganisms, vaginal acidity, immune processes. It was shared our own experience with medicine Polygynax, remedy of Laboratoire Innotech International (Paris, France). Polygynax has such an advantage - rapidly restore disturbed ecological equlibrium in case of bacterial vulvovaginitis, caused mainly of intestine pathogenic flora.

[A case of unruptured intrafollicular ovarian pregnancy diagnosed prior to operation]. / Sluchai na predoperativno diagnostitsirana nerupturirala intrafolikularna ovarialna bremennost.

A case of an unruptured intrafollicular ovarian pregnancy of 8 gestational weeks diagnosed by ultrasonography in a virtually asymptomatic patient is reported. A 32 year-old woman with 1 vaginal delivery 8 years ago presented with a history of intermittent spotting after removal of an IUD during her last menstrual period 4 weeks ago. IUD was inserted 6 years prior. The patient was symptom-free and showed no abnormal findings upon vaginal examination. Transvaginal ultrasonography however disclosed a gestational sac with a live embryo within the left ovary. The woman was operated on via laparotomy without delay. The intraoperative finding showed a normally appearing corpus luteum in the intact left ovary without any visible abnormality of the pelvic organs. Having in mind the US finding a resection of the corpus luteum was done revealing the gestational sac within it. The authors describe the following three US signs specific of unruptured intrafollicular ovarian pregnancy: extremely thickened uniformly echogenic wall of the sac, the sac is partially surrounded by ovarian structure, no corpus luteum is detected in either ovary. The essential role of transvaginal ultrasonography in the precise diagnosis of the ectopic pregnancy and its location is emphasized. The absence of specific complaints and findings until rupture of the ovary occurs and the association of ovarian pregnancy and IUD are also confirmed by the case-report.

[The diagnosis and management in suspected retained placenta in the late puerperal period]. / Diagnoza i povedenie pri sumnenie za zadurzhani platsentarni chasti v kusniia poslerodov period.

The aim of this retrospective study is to find out the reasons for RICU in late postpartum period and the reliability of methods for diagnosis of retained placental pieces. We investigated the medical records of all cases with RICU from 24th ours postpartum up to 2 weeks after it. The rate is 0.9% of all births. Hystological confirmation of retained placental tissue there are in 25% of cases. Our data shows that the anamnesis does not help in the diagnosis of retained placental tissue in late puerperium. Most often the curettage is undertaken because of hemorrhage and ultrasound data of retained placental tissue. At the same time the transabdominal ultrasound is of low diagnostic value for residua post partum. The febrility, the subinvolution of the uterus and the number of symptoms in given case are of no importance in the diagnosis of retained placental tissue. The suspicion in the integrity of the placenta after its birth is a reason for RICU in spite of well contracted uterus and lack of hemorrhage. As the diagnosis of retained placental tissue in late puerperium is uncertain the RICU should be undertaken after failed conservative management.

[The active management of the placental period with Remestyp]. / Aktivno vodene na platsentarniia period s Remestyp.

The aim of this prospective study is to asses, the possibility to use Remestyp after the delivery of the head as a prophylaxis of blood lost during the third stage of labor. The material includes 209 cases: 82 with bolus dose of 0.2 mg Methergin, 54 cases with 10 ME Oxytocin, 32 parturition with 200 mg Remestyp, and 41 controls without any uterostonics during the placental period. The blood lost is assessed by gravimetric method. The results show that the total blood lost from the delivery of the neonate to two hours after it is significantly lower in active management of labor than in expectant one. The type of uterostonic is not essential in regard of total blood lost. The prophylactics of blood lost with Remestyp has best results in cases of stimulated with Oxytocin infusion labor. The active management of third stage of labor with Methergin or Remestyp has less complication than are used oxytocin or without uterostonics. The mean time for delivery of placenta is shortest in the group with Remestyp. The three uterostonics in mansion doses do not influenced significantly the artery pressure. Our experience demonstrates that Remestyp can be used for active management of third stage of labor and the results are as those with Methergin. Remestyp is preferable when are expected significant lacerations of the birth canal.

[A comparative efficacy study of the preoperative use of GnRH agonists in women with uterine fibromyomas]. / Sravnitelno prouchvane efektivnostta ot preoperativno prilozhenie na GnRH agonisti pri zheni s fibromioma na matkata.

The aim of the study is to establish the efficacy of preoperative use of GnRH agonists in women with uterine fibromyomas. The study is a randomized prospective one and includes 34 patients, divided in two groups: group I--with preoperative application of GnRH agonists--Zoladex and group II--without medication. In Zoladex group amenorrhea was achieved in 76% of patients after 7-8 weeks of treatment. After a 3-months treatment with Zoladex Hb levels increased from 8.9 +/- 0.9 gl/l to 11.7 +/- 1.2 g/l; levels of serum Fe--from 7.3 +/- 4 mumol/l to 18.5 +/- 5 mumol/l. Total uterine volume decreased by 30% before surgery (from 328 +/- 85 ml to 233 +/- 61 ml), while myoma volume decreased by 39% (from 178 +/- 62 ml to 109 +/- 44 ml). Mean blood loss during surgery (hysterectomy) is definitely less in patients, treated with Zoladex--194 +/- 75 ml., compared to 287 +/- 102 ml in control group. The significant reduction in myoma volume in 6 patients due to presurgical treatment with Zoladex made smaller operation--myomectomy, possible. Side effects, related to GnRH agonist Zoladex, are well tolerated and transitory and did not lead to retreatment from the trial.

[Translabial sonography of the lower uterine segment]. / Translabialna sonografiia na dolniia matochen segment.

The aim of this prospective study is to asses the possibilities of translabial (transperineal) sonography for observation the cervix uteri and to compare it with the transabdominal sonography. The material consists of 58 pregnant women in third trimester of pregnancy. We use abdominal transducer (3.5 Mhz) of Kranzbuhler ultrasound for abdominal and transperineal scanning. The ultrasound examination of the cervix includes: endocervical length, cervical weight, weight of the cervical canal and in case of tunneling its parameters. The satisfying image for ultrasound biometry of the cervix we achieved in 92% of the cases with transabdominal scanning and in 97% with translabial scanning. The mean values of the ultrasound examined parameters of the cervix are not significantly different with transabdominal and translabial measurement. The translabial ultrasound method is feasible and well accepted by the pregnant women.

[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.

[The treatment of vaginal infections with Macmiror and Macmiror Complex]. / Lechenie na vaginalni infektsii c Macmiror & Macmiror Complex.

UNLABELLED: The aim of the present 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 52 nonpregnant women among 20 u 54 years (middle age 30.5) with different by kind and intensity colpitis complains. The following microbiological characteristic was established: in 26 cases Candida spp., in 19 Gardnerella vaginalis, in 1 Trichomonas vaginalis and in the rest 6 mixed infection. 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 89.5% u 84.2% go of the cases with bacterial vaginosis and in 84.6% u 69.2% in those with mycotic colpitis. Relatively high values were found also at the second control, respectively 83.3% and 72.2% for the amine colpitis and 69.5% and 52.2% for vaginal candidosis. The similar favorable influence received also in the rest of the patients. CONCLUSIONS: Our results do show good possibilities of the nifuratel and nystatin combination (Macmiror & Macmiror complex) to influence vaginitis with different etiology, which give us founding to consider, that the drug is suitable for the mixed forms of vaginal infection.

[The efficacy and safety of nafarelin in treating genital endometriosis]. / Efikasnost i sigurnost na nafarelin za lechenie na genitalnata endometrioza.

A prospective study was carried out a State Institute Hospital "Maichin dom" aiming to estimate the efficacy of GnRH-agonist Nafarelin in treating patients with endometriosis. Nafarelin was used by 40 women with endometriosis. The drug was applied as a nasal spray according to a therapeutic scheme and regarding definite criteria. Every patient was followed while using the drug and the following sings were registered: occurrence of amenorrhea, clinical sings, side effects, the period of control lasting for a year after the end of the treatment. In 27 women a quick and long-lasting amenorrhoea was induced with standard doses of the drug, while other 13 needed higher dosage to achieve the same effect. Relief of complaints was registered on 35 women. Improved palpatory status was found in 23 patients. In 4 women the disappearance of endometriomas was confirmed by laparoscopy. The existing side-effects are dos to the appearing hypoestrogenemia. After treatment with Nafarelin, during the period of observation, 5 women got pregnant.

[Systen--transdermal estradiol for substitution following surgical menopause]. / Systen--transdermalen estradiol za substitutsiia sled khirurgichna menopauza.

The authors investigate the clinical effect of transdermal system delivering 17 beta-estradiol for treatment of 23 patients after bilateral ovariectomy for benign genital tumors. During four to six months treatment Kuppermann index falls and karyopyknotic and maturation indices rise significantly. The side effects are extremely rare. The authors recommend the widely use of Systen for replacement therapy in surgically induced menopause.