[Cytological and histological parallels in atypical colposcopic findings]. / Tsitologichni i khistologichni paraleli pri atipichni kolposkopski nakhodki.

The aim of the present study was to analyse the cytological and histological equivalents in 112 patients with atypical colposcopical findings. The results showed the follow distribution of the findings: for cytological examination in 66 of the patients-I gr. PAP, in 32-II gr. PAP, in 6 III-A gr. PAP, in 1-III-B gr. PAP, in 4-IV gr. PAP and in 3-V gr. PAP. The histological study of the obtained target biopsies established: 7 cases with normal epithelium, 82 with different findings of abnormal epithelium with or without nonspecific and specific inflammatory changes; 18 cases with dysplasia from I to III degrees, 2 cases with CIS and 3 with invasive cancer. The degree of correlation of the different findings, as well as the possible causes for hypo and hyperdiagnostic assessments are discussed.

[The role of serum beta-HCG levels for the diagnosis of ectopic pregnancy]. / Rolia na serumnite niva na beta-ChKhG za diagnozata na ektopichnata bremennost.

The study includes 56 cases of women admitted at Second gynaecology clinic of the University Maternity Hospital Sofia with evidence or suspicion of having an ectopic pregnancy who had their serum beta-HCG levels determined quantitatively. 27 of them showed no beta-HCG in their sera and none turned out to have pregnancy, neither intrauterine nor ectopic. All cases of ectopic pregnancies (a total of 20) were associated with detectable beta-HCG levels in the serum. The great diagnostic value of serum beta-HCG is emphasized in the cases of old disturbed ectopic pregnancies accompanied by mild and uncommon symptoms and very low beta-HCG levels. In case of unruptured pregnancies or tubal rupture the diagnosis is verified before the result is available by the clinical and sonographic data. On the other hand the high sensitivity of the method leads to an increased number of cases with elevated beta-HCG in which the location of the pregnancy cannot be proven. The precise quantitative evaluation of serum beta-HCG enables us to follow the tendency of beta-HCG which may according to the clinical manifestations warrant invasive diagnostic procedures or just observation without active interference.

[The treatment of urinary stress incontinence with the sling and Pereyra's suspension]. / Lechenie na pikochnata stres-inkontinentsiia sus "Sling" i okachvane po Pereira.

Patients with proven stress incontinence were subjected to surgical treatment which combined both sling and Stamey-Pereyra techniques. A 3-4 cm long and 1,5-2 cm wide sling of Bulgarian polyamide mesh was placed under the urethrovesical junction using a small vaginal incision. Two long polyamide sutures were tied to either end of the mesh and were retrieved from the vagina to the abdomen by Pereyra needle inserted through two small suprapubic incisions and guided by the vaginal forefinger. The technique of the procedure is described. A total number of 27 patients were operated on. Two of them has their suspending sutures cut postoperatively because of prolonged urinary retention. The remaining 25 were continent. The technique proposed combines the advantages of the sling procedures (high efficiency especially in cases of severe and recurrent incontinence) and the simplicity of Stamey-Pereyra suspension technique. On the other hand the Bulgarian polyamide mesh showed very good qualities. No infection, rejection or sling erosion were observed.

[The static and dynamic profiles of urethral pressure in women with stress incontinence and in healthy controls]. / Statichni i dinamichni profili na uretralnoto naliagane pri zheni sus stres inkontinentsiia i pri zdravi kontroli.

The study presents the results of urethral pressure profile measurements in 3 groups of women: continent nulliparous, continent parous and stress incontinent women. The maximum urethral closure pressure, the functional urethral length and the length of continence zone are compared. The healthy control groups (both parous and nulliparous) show much higher maximum urethral closure pressures than those mentioned in literature. No difference is evident between continent parous and continent nulliparous which suggests that vaginal delivery at term does not necessarily impair urethral sphincteric function. On the other hand women with similar age and parity with stress incontinence have a marked decrease of maximum urethral closure pressure at rest and demonstrate inability to increase it by volitional contraction of the pelvic floor. These findings support the idea of the leading role of sphincteric incompetence in stress incontinence. The functional urethral length and the length of continence zone show no significant differences among the investigated groups which implies that they are of no importance for the occurrence of stress incontinence.