[Adnexal torsion and concominant appendicitis during third trimester of pregnancy--a case report].

Adnexial torsion is a rare, but important cause for abdominal pain during pregnancy. During pregnancy, its frequency is 10-20%, with highest frequency in the first trimester. We present a case of 24 year primigravida, with an acute onset of clinical symptoms with concominant disease chronic pyelonephritis. The initial diagnosis was exacerbation of the concominant disease and acute inflammation of the appendix. The intraoperative diagnosis was right adnexial torsion and inflammation of the appendix; the diagnosis was pathologically proved. Although rare, it can be included in the differential diagnosis of acute abdomen during pregnancy.

[Clinical study of two monophase oral contraceptives with desogestrel].

AIM: To compare the influence of two contraceptive combinations with 20 microg EE/ 150 microg DSG u 30 microg EE/ 150 microg DSG upon menstrual cycle, BMI, blood pressure and the side effects. MATERIALS AND METHODS: The study is prospective, continues one year and consisted of 70 clinically healthy women, who use two monophase oral contraceptives with desogestrel. RESULTS: The use of both contraceptive formulas have PI = 0.00. The intermenstrual bleeding are more frequent at the group with 20 microg EE/ 150 microg DSG. The more frequent side effects were: headache and breast tenderness. We do not find statistically significant changes in the BMI and blood pressure with the use of the presented contraceptive combinations. CONCLUSION: Contraceptive combinations with 20 microg EE/ 150 microg DSG u 30 microg EE/ 150 microg ensure good control upon the menstrual cycle, high contraceptive safety and good tolerance.

[Changes in the subsystems of haemostasis during normal pregnancy].

Haemostasis is complex, dynamic and self-regulated system; the maintenance of this balanced equilibrium is achieved by complex regulation between coagulation (pro- and anticoagualants) and fibrinolysis (pro- and antifibrinolytics). During normal pregnancy the cganges in haemostasis are complex, inspite of that the haemostatic balance is preserved and the ratio coagulation/fibrinolysis remains constant. Despite marked changes in the different subsustems of haemostasis and the dominant procoagulant effects, the incidence of VTE remains relatively small.

[Changes in haemostasis by the use of oral contraceptives].

It is observed that the combined oral hormonal contraceptives affect significantly haemostasis and induce changes of many factors taking part in it. Some of them increase their concentrations, while others decrease. The changes in haemostasis during oral contraceptive use with third generation gestagens and same dose of ethynilestradiol and the biological plausibility for eventually increased risk of VTE at women using these drugs, are not cleared and continue to be an object of investigation and discussion.

[Transcervical resection of the endometrium--an alternative of hysterectomy or not?].

Menorrhagia is frequent at women at reproductive age. Nowadays the standart for diagnosis of menorrhagia is hysteroscopy with histological verification. When there is no effect of the conservative treatment, an operative treatment is applied--hysterectomy or ablation of the endometrium. The aim of the present study is to present our experience with transcervical resection of the endometrium with classic abdominal hysterectomy as a therapeutic management for women with menorrhagia. Transcervical resection of the endometrium at selected patients (proved menorrhagia and length of the endometrium <10-12 sm) is a safe alternative of hysterectomy.

[Body mass index in pregnant teenagers].

The frequency of obesity is increasing worldwide. Among the group of teenagers who are pregnant there is a tendency of increasing of BMI. We present BMI at the beginning and at the end of pregnancy at pregnant teenagers, according to the scheme of Institute of Medicine. The optimal weight gain during teenage pregnancy would minimize the risk of overweight and obesity postpartum and during subsequent pregnancy as well the associated complications.

[Effect of oral contraceptives on vaginal flora].

The contraceptive and non contraceptive advantages of oral chormonal contraceptives as well as the good control on fertility, make it one of the most preffered method of contraception. The normal vaginal flora is a dynamic ecosystem and itsequilibrium and status of eubyosis amongst its inhabitants is an important mechanism against exogenous infections. The use of oral contraceptives is not associated with significant changes in the vaginal microbial flora; the normal concentration of the lactobacillli is preserved.

[Thrombophilia and pregnancy].

The incidence of venous thromboembolism is increased five to six times in pregnancy; and it is estimated that thromboembolic episodes- superficial and deep venous thromboembolism and pulmonary embolism occur in 1:1000 to 1:1500 pregnancies. These complications during pregnancy and puerperium, are not common but serious and leading cause of maternal morbidity and mortality. Thrombophilias--acquired or inherited, result of anticoagulant regulatory proteins deficiency, could compromise normal pregnancy by increasing the risk of developing first or recurrent thromboembolic incidents and adverse obstetric events.

[The effect of contraceptive with 20 ug ethinylestradiol and 150 ug desogestrel on some acute phase proteins].

BACKGROUND: We present the influence of monophasic combined oral contraceptive with 20 mmicrog ethinylestradiol /150 microg desogestrel upon some acute phase proteins: C- reactive protein, fibrinogen, haptoglobin and the connection between the proinflammatory effect of oestrogens METHODS: Forty clinically healthy young women between 18 and 35 years, using oral contraceptives in the duration of 12 months, are included in this study. RESULTS: We don't find statistically significant differences in the plasma concentrations of C--reactive protein, fibrinogen, haptoglobin on the 12th month of the using of the oral contraceptives in comparision with the initial levels of the variables, before starting the study. CONCLUSION: The reduction of the dose of ethinylestradiol, definitely reduces the effects of oral contraceptives upon acute phase proteins and eventually the increased risk of cardiovascular disease.

[Postoperative and remote outcome of non small cell pulmonary carcinoma in patients over 70 years old].

UNLABELLED: There is a worldwide increase in the frequency of pulmonary carcinoma The only radical treatment at such patients is the operative one, but it is associated with a lot of complications. MATERIAL AND METHODS: We presented 41 patients aged over 70 years old with non small cell pulmonary carcinoma who are performed pulmonary resection. The patients were staged as follows: stage IA - 5, stage IB - 7, stage IlIA - 9 patients. We performed 22 lobectomies, 4 bilobectomies and 15 pulmonectomies. RESULTS: Analyzing all the results, we found 5 years survival at 29.2%, 3 years survival at 46.3% and one year survival at 78% of the operated patients. We found complication in the postoperative period at 15 of the patients; only one patient died (2.4%). CONCLUSIONS: We consider, that the precisely selected patients at the age between 70-76 years old would not influence significantly the postoperative and long-term results at patients with non small carcinoma of the lungs.

[Necrotizing sarcoid granulomatosis--case report and review of the literature].

The Necrotizing sarcoid granulomatosis is a rarely met angiitis. The disease is predominantly localized in the lung and has a good prognosis. The authors reported about a patient treated in their clinic; the diagnosis is made after histologic examination.

A fifteen-month survey of directly observed therapy--short course and antibiotic drug resistance in the region of Plovdiv.

OBJECTIVE: This study addresses the issue of antituberculosis drug resistance in a cohort of 213 patients from Plovdiv included in the pilot phase of a DOTS based project for a 15-month period. Between July 1. 1998 and September 30, 1999, ninety three culture-positive patients participated in the study. 89 of them were tested for drug susceptibility to rifampicin, izoniazid, etambutol, and streptomycin. RESULTS: Resistance to at least one antituberculosis drug was established in 24.7% of the patients. Monoresistance was found in 13.5% of the cases. The median prevalence of combined resistance to rifampicin and isoniazid was 6.7%. The prevalence of resistance to rifampicin or isoniazid was 21.4%. Drug susceptibility testing results were obtained within 67 days. In 33% of the patients continuation treatment phase was initiated before drug susceptibility data were available. CONCLUSIONS: During the observed period a considerably high rate of drug resistant tuberculosis was registered among the patients included in the pilot phase of the program based on Directly Observed Therapy--Short Course. The percentage of resistance to R and/or I gives better information about the risk of inadequate treatment during the continuation treatment phase. The high percentage of this pattern of resistance in our region requires the continued use of four first-line drugs for therapy until the results of drug-susceptibility testing are received.

Prostaglandin E2 in preinduction cervical ripening in postdate pregnancy.

UNLABELLED: Unripe cervix is a widely recognised factor contributing to the failure to induce labour. Its presence is associated with high frequency of operative delivery, adverse fetal outcome and high maternal morbidity. MATERIAL: We studied the efficacy of PGE2 application for preinduction cervical ripening in women with postdate pregnancy. Two PGE2-containing preparations were used--Prepidil-gel and Prostin E2 (Upjohn). They were administered to 42 women with postdate pregnancy, unripe cervices and indications for labour induction. The study sample was divided into two groups: group I (20 women) received Prepidil-gel, group II (22 women)--Prostin E2. RESULTS: 85.7% of the women responded favourably to the ripening effect of PGE2. There was no difference in the efficacy, safety and outcome of pregnancy between the two groups. CONCLUSION: Prostaglandin PGE2 is effective for preinduction cervical ripening in women with postdated pregnancy. The authors give their preference to Prostin E2 because it is easier to apply.

[The establishment of the MPEL for carboxylic acid derivatives in the air of a work area by using mathematical models]. / Obosnovanie PDK nekotorykh proizvodnykh karbonovykh kislot v vozdukhe rabochei zony s ispol'zovaniem matematicheskikh modelei.

Reports of MACs for carboxylic acid derivatives as sodium methoxyacetate (SMOA), methyl chlorpropionate (MCP) and acetoacetic ether (AAE). SMOA shows low toxicity, no cumulation and specific action MCP demonstrates moderate toxicity, low cumulation no specific action in concentrations close to Limac. AAE presents toxicity low in oral usage and moderate when inhaled, low cumulation, no irritation and sensitization. Tentative safe level of injury and MAC estimated for the aforesaid substances together with toxicity parameters compared with the substances studied before allowed the authors to set the MAC of SMOA--10, MCP--2, AAE--10 mg/m3.