[Treatment modalities for conjunctival melanoma]. / Therapeutische Optionen in der Behandlung des malignen Melanoms der Bindehaut.

BACKGROUND: Because of high local recurrence rates after excision of conjunctival melanoma adjuvant local chemotherapy employing mitomycin C (MMC) or irradiation is recommended. Brachytherapy is possible with ruthenium-106-plaques ((106)Ru) or with the strontium-90-plaques ((90)Sr). PATIENTS AND METHODS: Fifty-six patients received an excision and adjuvant radiotherapy of conjunctival melanoma between 1992 and 2007. The mean follow-up was 42 months (12 - 151 months). Mean age was 62 (28- 86) years. As an adjuvant radiotherapy 15 patients received X-ray irradiation, 12 patients received (106)Ru-brachytherapy, 4 patients received proton beam therapy and 16 patients with conjunctival melanoma were treated with adjuvant strontium-90 brachytherapy after tumour excision. Four patients received proton beam irradiation and in 13 patients an exenteratio was performed. RESULTS: Twelve patients (21 %) developed tumour recurrences in or adjacent to the irradiated area. Thirteen patients (22 %) showed a recurrence distant from the primary site. Ten patients (18 %) developed systemic metastasis during follow-up. Seven patients (46 %) had no recurrence during the follow-up. Three patients (20 %) had a recurrence in the treated or adjacent areas. Eight patients (53 %) developed new tumours in non-treated areas. CONCLUSIONS: Adjuvant radiotherapy allows an acceptable local tumour control rate after excision of conjunctival melanoma. No obvious differences regarding tumour control or systemic metastasis could be seen between the different modes of radiotherapy used.

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.

[Frequency of antiphospholipid antibodies and Leiden mutation of hemostasis Factor V in unexplained recurrent fetal and embryo loss]. / Chestota na antifosfolipidni antitela i Leidenova mutatsiia Faktor V na kr'vos'sirvaneto pri povtariashta se neobiasnima fetalna i embrionalna zaguba.

Object of the study are women with a history of unexplained recurrent embryo, fetal and early neonatal death, severe preeclampsia, fetal growth retardation, abruptio placentae, puerperal thromboses. Quite often placental insufficiency is linked to abnormal vascular system and hemostatic disturbancies. In about 65% of the women with a complicated and in 18% of the women with a normal pregnancy are observed different genetic anomalies that lead to a hypercoagulative state. A major place is taken by the Leiden mutation of hemostasis factor V, by protein C and protein S deficiency, etc. Another disease that leads to arterial and venous thromboses and is most often linked to recurrent miscarriage is the antiphospholipid syndrome. Many authors confirm the findings of large placental infarctions and thromboses in women who are positive for antophospholipid antibodies.

Protein C activity in patients with antiphospholipid syndrome.

The interaction between antiphospholipid antibodies and the protein C system may explain at least a part of the mechanisms underlying thrombosis in the antiphospholipid syndrome (APS). We evaluated the protein C activity, factor V Leiden mutation and the presence of several types of antiphospholipid antibodies in 60 patients with antiphospholipid syndrome. Nineteen patients (31.6%) and 5 controls (8.3%) had decreased protein C activity (95% CI, 10%-37%). 14 patients with high levels of antiphospholipid antibodies and normal factor V molecule (37.8%) and none of the patients with antiphospholipid antibodies in normal ranges and normal factor V molecule had decreased protein C activity (95% CI, 24%-52%; (x 510.4; p 5 0.001). Leiden mutation was found in 5 controls (8.3%) and in 4 patients (8.3%; 95% CI, 8-24%). We found a strong association between decreased protein C activity and presence of anticardiolipin antibodies and antibodies against b2-glycoprotein I. The decreased protein C activity depended on the antibody titre. Although abnormalities of the natural anticoagulant proteins like protein C and protein S seem to be involved in the pathogenesis of the APS, activation of protein C also occurs during the process of clotting. Studies such as we describe may help us identify subsets of patients whose clotting is dependent on protein C-antiphospholipid interactions that may lead to future novel therapies.

[The effects of intramuscular and oral prophylaxis with vitamin K on the coagulation status of low-weight newborn infants]. / Efekti ot intramuskulnata i oralnata profilaktika s vitamin K vurkhu sustoianieto na koagulatsiiata pri novrodeni detsa s nisko teglo.

The present prospective study carried out in 1993 in the SFH "Maichin Dom"--Sofia, includes newborn infants with birth weight below 2500 g. and aims to compare the effect of the prophylaxis of the haemorrhagic disease of the newborn by intramuscular and peroral application of vit. K. For this purpose some coagulation screening tests were followed out in intervals of 4-5 days during the first two weeks of life. These two groups are compared between one another and with non-prophylacted with vit. K healthy newborn babies. The results so obtained allow to make the conclusion that, on one side, the haemostasis of newborns with low birth weight is very labile and, on another, that the peroral and the intramuscular ways of prophylaxis with vit. K have the same effectiveness.

[Coagulation screening tests of low-weight newborn infants--deviations and dynamics]. / Koagulatsionni skrining-testove pri novorodeni s nisko teglo--otkloneniia i dinamika.

A prospective study was performed in 1993 in our hospital, including newborns with low birth weight and a control group of term infants. It aims to give information about their coagulation status and its dynamics. Abnormalities in the carried out screening tests were noticed in both groups during the first day of life. After the performed vit. K prophylaxis PT had almost the same dynamics in the two groups and almost reached the normal values in adults. aPTT remains highly prolonged in the group of low birth weight infants. Comparing the haemostasiological test levels between the group of low birth weight newborns, having received a prophylactic dose of vit. K i.m. and the corresponding group without vit. K prophylaxis, we established the faster normalizing of these levels in the first group.

[Coagulation tests in newborn infants and their dynamics in relation to vitamin K prophylaxis]. / Koagulatsionni testove pri novorodeni i tiakhnata dinamika v zavisimost ot profilaktikata s vitamin K.

A prospective study of some coagulation screening tests in newborns is performed having in mind to elucidate coagulation status in healthy term newborns and the necessity of vitamin K prophylaxis. Two groups of newborn babies are formed: the first includes 29 babies without vit. K prophylaxis, the second--30 newborns who receive 1 mg/kg i.m. vit. K on the first day after birth. All the newborns have their prothrombin time (PT) and partial prothrombin time (aPTT) measured in day first, fourth, and in a small number on the seventh day as well. Low PT (54%) and moderately prolonged PTT (44.37 sec) are found on the first day after birth. It is established that the coagulation status is normalized faster in newborns who have received vit. K prophylaxis--as soon as fourth day, while the group without vit. K--until the end on the first or the beginning of the second week. The conclusion is made that it is wise to use vit. K prophylaxis not only with premature, but also in risk term infants.