[PHYTOESTROGENS AND VITAMIN D FOR BONE HEALTH IN MENOPAUSAL TRANSITION].

Phytoetrogens and vitamin D administered in a dose-dependent manner effectively prevents bone loss in postmenopausal women and reduces the incidence of fractures. Recently, genistein has been found to stimulate the production of osteoprotegerin by human paracrine osteoblasts, providing a further mechanism for the bone-sparing effects of isoflavones.

[AN HPV-ASSOCIATED DISEASES AND CERVICAL CANCER AND PROPHYLACTIC HUMAN PAPILLOMAVIRUS (HPV) VACCINES].

Human papillomavirus (HPV) infection is the central cause of invasive cervical cancer (ICC) and its precursor lesions. Both vaccines can prevent most cases of cervical cancer. In addition, both can prevent vaginal and vulvar cancer in women, and HPV-related cancers. HPV4 can prevent genital warts in women and men. Routine vaccination of 12-year-old girls with HPV4 vaccine appears to be cost-effective in addition to providing both short-term and long-term health gains.

[CHRONIC RENAL FAILURE AND PREGNANCY--A CASE REPORT].

Pregnancy in women with chronic renal failure is a complex therapeutic problem requiring a multidisciplinary approach. It is associated with a higher risk of many perinatal complications. The most common abnormalities are related to: progression of renal failure, development of preeclampsia development of nephrotic syndrome, anemic syndrome, IUGR and fetal death. The prognosis depends on the values of serum creatinine prior to pregnancy, the degree of deterioration of renal function, development of additional obstetric complications and the specific etiological reasons that have led to the occurrence of renal failure. Determining the optimum time for authorization birth depends on the condition of the mother, the condition of the fetus and the rate of progression of renal failure, and the deadline the pregnancy should be terminated is 35 weeks. We present a case of a patient with chronic renal failure, with favorable perinatal outcome.

[Human papillomavirus infection and pregnancy].

There is growing evidence that HPV infection is possible through non-sexual routes like mother to-child transmission in the perinatal period. Human papillomavirus (HPV) infection has traditionally been regarded as a sexually transmitted disease (STD), but recent evidence implicates that an infected mother can transmit HPV to her newborn during pregnancy, at delivery, perinatal period or later. There is evidence of vertical transmission, presumably occurring during passage of the fetus through an infected birth canal. The virus could also be transmitted by ascending infection, principally after premature rupture of membranes. Elective cesarean delivery could not prevent transmission of the virus from HPV-positive mothers. There is insufficient evidence to recommend the generalization of cesarean section for all HPV DNA-positive mothers. The critical question is not how often infants are contaminated with HPV, but how often they are infected with HPV

[Antenatal diagnosis of placenta accreta].

Placenta accreta is a potentially life-threatening obstetric condition. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality The diagnosis is usually established by 2D, 3D Ultrasonography and Color Doppler ultrasonography and occasionally supplemented by Magnetic Resonance Imaging.

[Sildenafil--for treatment of preeclampsia and intrauterine growth restriction].

Pre-eclampsia and intrauterine growth restriction (IUGR) are responsible for approximately 15-20% of serious maternal and neonatal diseases. These complications are related to very early anomalies of the uteroplacental circulation, accompanied, at least secondarily, by thromboxane-prostacyclin-related imbalances. Studies have failed to show a beneficial effect of betamimetics and calcium channel blockers for the treatment of IUGR. Sildenafil citrate, a type 5-specific phosphodiesterase inhibitor, augments the vasodilatory effects of NO by preventing the degradation of cGMP There is a selective effect of Sildenafil on the uteroplacental circulation. Sildenafil improves uterine artery blood flow.

[A rare case of successfully pregnancyand delivery in a woman with paroxysmal nocturnal hemoglobinuria].

We report a case of a pregnant woman with PNH. She was at 31 w.g. During the pregnancy our patient was hypertransfused and used anticoagulation treatment. The patient developed Preeclampsia, Intra-uterine growth retardation and Oligohydramnion. An induced vaginal delivery was done. A healthy child was delivered. There were no other postpartum complications. She was discharged from hospital in satisfactory condition.

[Preoperative sonovue contrast color Doppler in patients with cervical cancer. Preliminary report].

OBJECTIVE: Angiogenesis has gained much attention in oncology in recent years. The purpose of this pilot study was to describe the preoperative sonographic patterns of SonoVue Contrast-Doppler ultrasound and the standard Color Dopper ultrasound of cervical cancer tumor angiogenesis. MATERIALS AND METHODS: This is a prospective observational study. The study included fifteen patients with proven cervical cancer. RESULTS: Contrast Doppler US after the SonoVue injection gave a good picture of the intense intralesional tumor angiogenesis. Of the 15 patients with FIGO stage lb1 Contrast-sonography showed 12 patients stage Ib1, 1-stage Ib2, 1-stage IIb and 1-stage Iva at final diagnosis. CONCLUSIONS: SonoVue Contrast Doppler Ultrasound gave a better definition of the margins of the neoplastic lesions in the cervical cancer Because contrast agents increase the sensitivity of detection of parametrial invasion and lymph node metastases, they could pay an important role in the evaluation of uterine cervical cancer

[The effect of vaginal sildenafil citrate on uterine blood flow and endometrium in the infertile women].

UNLABELLED: Evaluation of endometrial receptivity remains a challenge in clinical practice. Ultrasound evaluation of endometrial thickness and texture and measurement of uterine artery blood flow has been used for endometrial assessment. AIM: To investigate the role of combination of sildenafil citrate and serophene on endometrial thickness, endometrial volume, endometrial FI and VFI on Angiohistogram, RI and PI to a. uterine on the day of hCG, in prediction of IUI outcome in infertile women. MATERIALS AND METHODS: Forty two patients were selected randomly who had anovulatory infertility. In Sildenafil citrate plus Serophene group (Group I), patients got 25 mg sildenafil citrate (Silden) vaginally and Serophene 100-150 mg orally, and in Serophene group (Group II), 100-150 mg of Serophene was given orally. RESULTS: Mean endometrial thickness and endometrial volume was 11.8 +/- 2.6 v/s 10.2 +/- 2.8 and 5.2 +/- 1.4 v/s 3.6 +/- 1.8 respectively in group I and in group II (p < 0.05). There was significant decrease in PI and RI to a. uterina in group I. CONCLUSIONS: Combination of Sildenafil citrate and Serophene is an effective agent as a first-line of treatment for ovulation induction.

[Postmenopausal osteoporosis. Role of vitamin K in the prevention of osteoporosis].

Low vitamin K1 intake and low plasma vitamin K1 levels are associated with low bone mineral density (BMD) and increased osteoporotic fracture risk in postmenopausal women. Despite the lack of a significant change or the occurrence of only a modest increase in bone mineral density, high-dose vitamin K(1) supplementation improved indices of bone strength in the femoral neck and reduced the incidence of clinical fractures.

[Periodontal disease and preterm birth].

Preterm birth (PB) is a primary public health challenge in both developed and underdeveloped nations. Despite improvements in obstetric care, rates of preterm birth have not decreased during the last 10 years. The etiological role of maternal infection, either in the genital tract or elsewhere, on preterm delivery remains unclear. Periodontal disease (PD) is one of the most common chronic infectious diseases. This type of infection is caused primarily by Gram-negative anaerobic, and microaerophilic bacteria that colonize the subgingival area and produce significant amounts of proinflammatory cytokines, mainly interleukin 1 beta and interleukin 6, prostaglandin E2, and Tumor necrosis factor alpha. PD may therefore influence PB through an indirect mechanism involving inflammatory mediators or through a direct bacterial assault on the amnion.

[Stillbirth rate and perinatal mortality--criteria for quality of prenatal obstetric care].

AIM: To determine the frequency and structure of stillbirth rate, its relative share compared to PM, the trends for the period of 2007-2012 and their dependence to birth weight of the fetus and newborn. MATERIAL AND METHODS: The birth rate, stillbirth rate and PM for the period of 2007-2012 have been followed up retrospectively according to data provided by the department of Obstetrics & Gynecology in University hospital "St. George" Plovdiv. The trends of those two indicators have been established, their relationship to and dependence of fetal and newborn birth weight. Representative and correlative analyses have been used. RESULTS: During the period being analyzed 13 558 deliveries have been registered. 13.4 per thousand (183) of them are stillbirths, and 92.3% (169) died antenatal. After 2010 the birth rate decreases. Stillbirth rate increases from 13 per thousand in 2009 to 20.6 per thousand in 2012. It is mostly due to prematurity, which for the past two years are mostly with extremely low birth weight (57.2%). Antenatal stillbirth rate prevails. Intranatal fetal death is being observed significantly less, but in those cases where it is, the premature with weight 600-999 grams play a major role. Increased stillbirth rate maintains a high PM and constitute more than 2/3 of it. CONCLUSIONS: Against the backdrop of lower birth rate, the stillbirth rate and PM remain high. In the last 2 years they are presented mainly by premature weighing 600-999 grams. The prevalence of antenatal stillbirth rate means good control of delivery but refers to the prenatal period, which is related to the quality of the obstetric care.

[Ovarian vein syndrome during pregnancy--diagnostic and treatment].

PURPOSE: To access the presence of Ovarian Vein Syndrome in second trimester pregnancy and safety and effectiveness of stents insertion in symptomatic hydronephrosis during pregnancy. MATERIAL AND METHODS: From 01.01.2007 to 30.12.2011, 66 women were hospitalized in the Urology Clinic at the University Hospital "St. George" Plovdiv. Sixty six patients presented acute pyelonephritis and painful hydronephrosis. 61 cases were with right hydronephrosis (92%), 2 (3%) on the left side and 3 (5%) with hydronephrosis in both sides. On the Ultrasound Doppler investigation, 61 cases with right hydronephrosis were with varicose right ovarian vein anomalies, which cause unilateral ureteral obstructions. Using ultrasound guidance, 66 retrograde ureteral stents were successfully placed under local anesthesia. RESULTS: In 66 patients with urinary infection, we observed remission of fever during the first 24-48 hours after the placement of the ureteral stents. CONCLUSIONS: Ovarian vein syndrome is a ureteral dilatation secondary to ovarian vein dilatation. The majority of cases are diagnosed during pregnancy, with a 90% predominance on the right side. Retrograde ureteral stenting is an effective, simple and safe method in treating symptomatic hydronephrosis during pregnancy.

[Clinical treatment in shorten cervix].

Preterm birth (PrTB) remains a major cause of perinatal morbidity and mortality. This article reviews the various diagnostic methods (midtrimester Cervical Length measurement on Transvaginal ultrasonography, fFN) and interventions in the different patient groups and proposes some algorithms for management women with short cervix.

[Selenium and glutathione peroxidase in patients with preeclampsia].

UNLABELLED: The incidence of preeclampsia is between 3% and 10% ofpregnancies. Pregnancy is associated with increased oxidative stress. OBJECTIVE: To investigate the level of Selenium and Glutathion peroxidise in women with normal pregnancy, and women with Preeclampsia. STUDY DESIGN: A total of 105 women (35 healthy nonpregnant, 35 healthy pregnant women and 35 pregnant women with PE) provided their blood at 28 to 37 weeks of gestation and were prospectively followed through delivery. These samples were used to assess a erythrocyte glutathione peroxidase and Selenium. RESULTS: Compared with women with uncomplicated pregnancies, and with nonpregnant women, significantly low glutathione peroxidase and Selenium levels were noted in women who developed preeclampsia. (P <0.001) CONCLUSIONS: The reduced selenium in the maternal circulation in preeclampsia was associated with lower maternal plasma GPx activity in the preeclamptic women, supporting the hypothesis that insufficient antioxidant defense may be a contributing i factor to the pathophysiological mechanisms associated with oxidative stress and preeclampsia.

[The use of doppler echography with contrast in gynecology].

The first studies on the clinical use of ultrasound contrast agents (UCAs) with contrast specific imaging techniques were published at the beginning of this century. A couple of years later sulphur hexafluoride (SonoVue, Bracco, Milan) was marketed in Europe. CEUS has a number of distinct advantages over CT and MRI. It can be performed immediately, without any preliminary laboratory testing. Neoangiogenesis is the typical process related to all malignant tumors, and attempts to investigate the abnormal vascularization of ovarian cancer have been performed using color and power Doppler. The addition of contrast media, could help to discriminate benign and malignant ovarian masses. Doppler enhancement in the ovarian arteries were significantly different, with faster onset, higher intensity, and longer duration in malignant tumors. The use of contrast media has been extensively applied to the diagnosis of adenomyosis, endometrial cancer cervical cancer and preoperative evaluation of the presence and the depth of invasion.

[Current echography diagnosis of pelvic congestion syndrome].

Chronic pelvic pain is a common condition. The sources of pelvic pain are multifactorial, and their causes are difficult to determine. Pelvic congestion syndrome (PCS) is associated with varicose ovarian veins and/or varicose veins in the pelvis. The syndrome is associated with constant dull pelvic pain, abnormal menstrual bleeding, tenderness to touch in lower abdomen, pain during intercourse, painful menstrual periods, vaginal discharge, PCOS. The specific diagnosis of Pelvic Congestion Syndrome is made using several tests which include ultrasound, CAT, MIR, MDCT (multidetector) and venogram. The ultrasound is the first test of choice. It can assess the uterus and other organs in the pelvis. Doppler ultrasound can also help visualize the blood flow and asses the presence of varicosities in the pelvis.

[Bacterial vaginosis. Treatment of the relapse].

Bacterial vaginosis (BV) is a common vaginal infection in women of reproductive age. Bacterial vaginosis is an ecological disorder that ensues when normal lactobacilli are replaced by large numbers of Gardnerella vaginalis, Prevotella sp., Bacteroides sp., Mobiluncus sp. and M. hominis. Numerous studies have consistently shown that BV at 12-24 weeks are associated with increased risks of preterm birth (PTB), preterm rupture of the membranes, chorioamnionitis, fetal infection and cerebral palsy. Deficiencies in local immunity may predispose women to BV.