[Total inversion of the uterus].

Non puerperal inversion of the uterus is very uncommon. Patients may present with pelvic pain, vaginal bleeding or hemodynamic shock. We report a fifty five old woman with uterus inversion second stage.

[Gynazol for treatment of vulvo-vaginal candidiasis--our experience].

OBJECTIVE: to have a personal experience concerning the therapeutic characteristics of the new product GYNAZOL (Gedeon Richter, Ltd)--5 g. vaginal cream for treatment of vulvo-vaginal candidosis (VVC). MATERIAL: 31 women in reproductive and climacteric age suffering from acute or chronic VVC. METHODS: inquiry, clinical and laboratory. RESULTS: 25 patients were clinically cured of VVC, 5 reported an improvement, 1-changed for the worse; in 27 microscopic investigation is negative for yeasts; in 20 the improvement is established in 1-3 days; the patient's evaluation is very good and good in 26 of them; 25 patients reported high acceptance. CONCLUSION: Vaginal cream GYNAZOL (Gedeon Richter, Ltd) is high effective for the treatment of vulvo-vaginal candidosis and leads to fast relieve of the symptoms. It seems to be more effective in acute than in chronic VVC. The main advantages are very convenient and easy way of application using a single dose applicator and reported an excellent compliance. The patients did not reported adverse effects in practice. On the basis of literature and our experience we can recommend GYNAZOL vaginal cream for wide use in everyday gynecological practice.

[Sectio ceasarea isthmicolongitudinalis--a forgotten beginning and/or groundless fear?]. / Sectio caesarea isthmicolongitudinalis--zabraveno nachalo i/ili neobosnovan strakh?

A retrospective analysis of the frequency, indications, intra- and postoperative complications in isthmicotansverse (ITS) and isthmicolongitudinal (ILS) cesarean section has been conducted with a view to justifying the wider application of ISL in modern obstetrics. For a five-year period (1996-2000) at the Obstetrics and Gynecology Clinic of St. Ann Hospital-Sofia a total of 522 cesarean section were performed of which 348 (66.7%) with isthmicotansverse incision and 174 (33.3%) with isthmicolongitudinal incision. The data show that ILS were ith less blood loss and with less intra- and postoperative complications and it was applied in all types of obstetric indications and urgent cases. Having in mind the good results and the fact that ILS is a technique which could be performed by every obstetrician familiar with ITS, The authors are convinced that isthmicolongitudinal cesarean section can find a wider application in everyday obstetric practice.

Efficacy and safety of phospholipid liposomes in the treatment of neuropsychological disorders associated with the menopause: a double-blind, randomised, placebo-controlled study.

A double-blind, randomised, placebo-controlled clinical trial was performed to evaluate the efficacy and safety of phospholipid liposomes (Liposom Forte) administered parenterally in the treatment of anxiety and depression linked to the menopause. A total of 64 females aged 40-60 years were randomised to receive the active drug or placebo intramuscularly; 58 patients completed the study. Treatment lasted 60 consecutive days. One i.m. administration of 2 ml active drug or placebo every other day was carried out. Efficacy was evaluated by the Hamilton Anxiety Scale (HAMA) and the Climacteric Index. An intention-to-treat analysis was performed, defined as all patients administered with at least one dose of the study medications with at least one return visit. A highly significant (p < 0.001) decrease in HAMA total score in both groups was noted. However, the decline in the HAMA score was significantly greater in patients administered phospholipid liposomes after 40 days (p = 0.006), 60 days of treatment (p < 0.001) and at the last follow-up visit (p < 0.001). Also, there were statistically significant differences between treatment groups after 60 days of therapy for individual items, such as anxious mood (p = 0.006), tension (p = 0.024) and fear (p = 0.009), with significantly less patients experiencing these symptoms in the phospholipid liposomes-treated group. When the Climacteric Index was evaluated, a highly significant (p < 0.001) decrease in the total score in both groups was noted. However, the decline was significantly greater in patients administered phospholipid liposomes after 40 days of treatment (p = 0.017), 60 days of treatment (p = 0.0013) and at the last follow-up visit (p = 0.0012). Significant differences between treatment groups were recorded after 60 days in asthenia (p = 0.05), dizziness (p = 0.024) and restlessness (p = 0.019) in favour of the active treatment. Twelve patients reported at least one adverse event, nine in the phospholipid liposomes group and three in the placebo group (p = 0.062). The most commonly reported event was drowsiness with two reports in each group. These findings further demonstrate that phospholipid liposomes administered intramuscularly are active against mild anxiety and depressive symptoms in menopausal women.

[Pregnancy, delivery and perinatal outcome in adolescent pregnancy]. / Bremennost, razhdane i perinatalen izkhod pri adolestsentni bremenni.

Retrospectively 398 adolescent primiparas have been analyzed in respect of the process of pregnancy, antenatal complications, mode of delivery and perinatal outcome. The researched contingent was divided into 2 age groups--up to 15 years and between 16-18 years. The results obtained were compared to a control group of 398 primiparas at the age of 20-24 years. The results indicate that the process of adolescent pregnancy is related to a substantially higher relative share of some complications like anemia, premature rupture of the membranes and preeclampsia. The frequency of pre-term labor has essentially increased. A basic model of birth-giving is the vaginal delivery, and the duration of delivery of the adolescent does not differ from that of the adult primiparas. There is not a significant difference between the adolescent and the adult pregnant in the placental and in the early puerperal period. An increased frequency of the fetal retardation is missing at the adolescent pregnancy.

[The possibility for treating the premenstrual syndrome with Periodin]. / Vuzmozhnost za lechenie na premenstrualniia sindrom s Periodin.

We examined the possibility of treatment of premenstrual syndrome (PMS) with Periodin (Walmark). Periodin is a combination of polyvitamins, oligoelements and phytoextracts which have a relation with prostaglandin's synthesis and regulation of prolactin secretion. A group of 24 women with PMS and regular cycles in premenopausal period (mean age of 44.7) was examined and took Periodin 1-2 caps daily for a period of 3 months as a food supplement. The assessment was made by modified J. Mortola score system. After treatment the PMS symptoms decreased with 52.3% compared with the beginning. The authors conclude that Periodin has a considerable influence on PMS symptoms, no contraindications and could be useful widely in gynecological practice.

[Mercilon - the optimal oral contraceptive]. / Mercilon - optimalniiat oralen kontratseptiv.

The authors review the effect of the oral contraceptive Mercilon on menstrual cycle, contraceptive efficacy, lipid profile, safety profile and adverse effects in a group of 32 women, included in the survey. The results of the trial show excellent contraceptive effect with Pearl Index of 0.00 and good control over the menstrual cycle. No negative or unfavorable effects were seen on the lipid profile as well as on the liver kidney and coangulant system function. Minor side effects were seen in only 5% of the patients.

[Influence of the phytoestrogen drug, SoyaVital, on climacteric symptoms]. / Povliiavane na klimakterichnata simptomatika chrez fitoestrogenen preparat, SoyaVital.

The results of phytoestrogen drug SoyaVital on the climacteric symptoms are presented. The preparation consists of 35 mg isoflavones with high content of genistein in one capsule. A group of 26 patients having climacteric symptoms have been treated by one capsule per day for a period of 12 weeks. The evaluation of the symptoms by Kuppermann score decreased statistically significant by 30.06%. The authors recommend SoyaVital as an alternative to the hormonal replacement therapy.

[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.