Intraperitoneal perfusion chemotherapy with hyperthermia in some malignant ascites.

Intraperitoneal administration of chemotherapeutic drugs with hyperthermia (HIPEC) increases their local effect on malignant peritoneal diseases and reduces systemic cytotoxicity. The most commonly used are cisplatin, doxorubicin, and mitomycin C. A major disadvantage of intraperitoneal chemotherapy is limited penetration of the drug in the tumor lesion depth (1-3 mm). Extended exposure and increased pressure in the abdominal cavity solution increases penetration of the agent into the tumor and hyperthermia has synergy with cytostatic agent on the permeability of cell membranes and metabolism of the drug. Real clinical hyperthermia is achieved at 41 degrees C. Of greatest importance is the concentration of the drug, but crucial for the prognosis is complete cytoreductive surgery. A major disadvantage of the closed technique is the uneven distribution of the perfusion solution in the peritoneal cavity, and the main advantage is better control of the perfusion, keeping of constant hyperthermia of the solution and regular repetition of manipulation, like intravenous chemotherapy. Laparoscopy determines the stage of the tumor process, refines the indications and preoperative selection for HIPEC, monitors the effects of treatment and determines locations for introducing catheters. In the review the results of the inraperitoneal chemotherapy with hyperthermia in gastric, colorectal, ovarian and other cancers are discussed as well as in diffuse malignant peritoneal mesothelioma and others.

Diagnosis of spontaneous and secondary bacterial peritonitis in patients with hepatic cirrhosis and ascites.

Spontaneous bacterial peritonitis (SBP) is an infection that is not caused by intra-abdominal source requiring surgery. Nowadays SBP is the main cause of death in patients with cirrhosis. Treatment is carried out with third generation cephalosporins and albumin infusions. The aim of the study is to identify patients with SBP and to be distinguished from the cases with secondary bacterial peritonitis (SecBP) in patients with cirrhosis and ascites. We studied 167 patients with cirrhosis and ascites and SBP was observed in 25 of them, while SecBP--in 22. The diagnosis of SBP is set in neutrophilic leukocytes in ascites > or = 250 cells/mm3 as bacterial cultures are positive in only 16% of them. Completely asymptomatic course had 16% of patients with SBP. Diagnosis of SecBP (according to Runyon's criteria) is based on increased total protein in ascitic fluid > 10 g/l (in 63.7% of patients > 30 g/l), elevated lactate dehydrogenase in ascites (LDH is > 240 U/l in all patients) and glucose < 2,7 mmol/l (only 4.5% of cases with secondary bacterial peritonitis). In support of SecBP are the polymicrobial flora, the isolation of anaerobes, enterococci, fungi, and the very high number of neutrophilic leukocytes in the peritoneal effusion and the refractoriness from conservative treatment. The examination of ascites with Multistix is more informative in secondary than in spontaneous bacterial peritonitis. In suspected secondary bacterial peritonitis CT is indicated.

[Sectio caesarea in extremely low birth weight newborn babies--modern tendency or objective necessity].

UNLABELLED: Obstetrician-gynecologists in a team with neonatologists contributed to saving of many children with extremely low birth weight /ELBW/, increasing many times SC frequency, considering it to be a sparing method for successful delivery, favorably influencing the outcome for the newborn. Many authors put emphasis on the better results however others point out reasons for a certain level of skepticism, assuming that survivability should not be the only criteria. Thus our objective was to find out the role of the abdominal delivery on the favorable outcome for ELBW newborn babies. MATERIAL AND METHODS: The study is retrospective, including 40 deliveries of children weighing from 500 to 999 g, at the Clinic in Obstetrics at Dr. Georgi Stranski University Hospital--Pleven, for a period of 5 years /2000-2004/. The newborn babies were divided into two groups depending on the method of delivery: I group--per vias naturales /PN/--31 cases--77.5% II group--per SC--9 cases--22.5%. RESULTS AND DISCUSSION: Attention was paid in our study to the most frequently asked question about the survivability of the newborn babies until their discharge, neonatal diseases and mortality rate, respectively. Survivability rate in the first group was 32.2% compared to 66.6% for the newborn babies per SC. The main reasons for mortality in the newborn babies are massive brain hemorrhages--70% of the cases, respiratory insufficiency--25% and extreme immaturity--5%. CONCLUSIONS: 1. Operative delivery is an objective necessity as a method improving the final favorable outcome for ELBW newborn babies. 2. The intensive neonatal cares accompanied by precise application of surfactant sharply increase the survivability rate and reduce diseases and mortal rate of ELBW newborn babies. 3. The preventive cares in the maternity consultation rooms could become a landmark for reducing the number of pre-term deliveries.

[Results of diagnostic hysteroscopy in a 7-year period in the gynecological clinic of "UMBAL-Pleven"].

The aim of the authors is to show the data for the reception diagnosis, age, histological results and the conduct after the performed diagnostic hysteroscopies in Gynecological clinic of UMBAL-Pleven. For the fulfillment of this aim was made a prospective study for 7 years' period: from 01/01/1997 to 31/01/2003. The objects of observation were 74 women of age from 16 to 65 years, with performed hysteroscopies for gynecologic complaints. There were performed 74 diagnostic hysteroscopies for the studied period. The hysteroscopic findings were 20 cases with endometrial polyposis, 14--submucosal myoamatic nodes, deforming the uterine cavity, 4--cervical polyp, 19--increased endometrium, 9--Asherman syndrome, 1--bicomous uterus, 1--a suspected section for endometrial carcinoma and 6 cases without pathologic findings. There were performed 59 trial abrasions and the removed materials were sent for histological examination The performed comparative analysis between the hysteroscopic presentation and histological findings showed a coincidence of the diagnosis. It was made the conclusion, that the hysteroscopy is an easy, accessible and inexpensive diagnostic method, which must take its place as one of the basic contemporary diagnostic methods in gynecology.

[Correlation between receptive wall analysis of benign ovarial cysts and their clinical conduct].

UNLABELLED: The biological behaviour (conduct) of benign ovarial cysts is interesting due to their comparatively high frequency of appearance and clinical manifestation. (During the last five years their frequency is between 62%-65% of the gynaecological surgical interventions). With this current survey the authors try to set up a target for research study of the wall receptive status of benign ovarial cysts. This study should be treated as a start up point rendering a prognosis for their eventual biological development. MATERIALS AND METHODS: An immunohistochemical survey was carried on with 50 patients who have already reached the surgical treatment in retrospective order for the period 2001-2003 (three years' period). The survey search is in direction receptive analysis of Estrogene /E2/ and Progesterone /P/ wall receptor in the ovarial cyst. A perspective observation was also carried on (control group of 50 cases) of hormonal-gestagene treatment of the benign ovarial cystogenesis. It appears to be the necessary prove material for hormonal receptors' participation in the cyst wall as an active factor for its development and involution. RESULTS: In the basic group /surgical treatment/ it was stated: In 39 patients--E2/-/, P/-/; in 4 patients--E2/+/, P/+/ In 5 patients--E2/+/, P/-/; in 2 patients--E2/-/, P/+/ CONCLUSION: The executed retrospective analysis demonstrates statistical importance in receptor competency lack in the wall of benign ovarial cysts as the probable grounds for them not being influenced during the conservative treatment method. This method led to the surgical elimination of the cyst. The statistical reliability, connected with the receptor E2 participation in the therapeutic behaviour of the benign ovarial cysts, is not stated. The final conclusions acquired from the executed research work would be a discussion issue after the correlative aspects in the prospective group are surveyed. The benign ovarial cysts' hormonal profile would be taken into consideration also.

[Ferro-Folgamma--a drug for treatment and prophylaxis of iron deficiency anemia in pregnant women]. / Ferro-Folgamma--medikament za lechenie i profilaktika na zheliazodefitsitnata anemiia pri bremenni.

The problem of iron deficiency anaemia (IDA) in pregnant women is not a new one, but the flashback to it is justified because of the fact that its significance is not appreciated properly. The growing foetus has increased needs of different active for blood formation substances such as iron (Fe), folic acid, vit. B12, which are taken away from the mother. If her supplies are not enough, an anaemic syndrome can be promoted. The only suitable way in the presence of iron deficiency is the administration of drugs for equilibration of iron balance. We used Ferro-Folgamma--a new medicine for our pharmaceutical market, for treatment of IDA in 42 pregnant women and we rendered an account of the results of its administration. All pregnant women had starting data of Hb<110 g/l and Hct<0.33 L/L. One capsule of Ferro-Folgamma contains 100 mg iron sulfate siccatum (that corresponds to 37 mg Fe), folic acid - 5 mg, cyancobalamine 10 mg. It is administered a capsule 3 times daily in 1 to 3 courses of treatment and a course has 20 days duration. After a treatment course was carried out the starting data of Hb were increased with 8.73 g/l, and of Hct with 0.02. In 8 pregnant women after the first therapeutic course, a 20-days - treatment was conducted too and Hb rose with 18.14 g/l in comparison with the starting data, and of Hct - with 0.037. The authors recommend the utilization of Ferro-Folgamma for treatment and prophylaxis of IDA in pregnant women, because of its good gastric acceptance, a few side undesired reactions, and the supplement of Folic acid and vit B12 increases the iron resorbtion.

[Current position on the treatment and prevention of pre-eclampsia-eclampsia with magnesium sulfate]. / Suvremenno stanovishte otnosno lechenie i profilaktika s magneziev sulfat pri preeklampsiia-eklampsiia.

The study was retrospective, encompassing 2 years period of time (2000-2001), as it was carried out at the First and the Second Clinics of Obstetrics at the Higher Institute of Medicine-Pleven. Fifty pregnant women and women in-child-birth having Praeeclampsia-Eclampsia (PE-E) were treated during this period, as 26 of them were administered Cormagnesin (first group) and 24 (second group) were not treated with magnesium preparations. In the first group 6 pregnant women had severe PE and 4-E, total 10 (38.4%). All E pregnant women and the PE cases with RR > or = 180/120 were treated with Cormagnesin. In the second group there were 4 pregnant women with severe PE (16.67%) but proteinuria was predominant (> or = 5 g/l) as RR was not higher than 160/110, so we did not have the reason to administer them Cormagnesin. The highest total dose MgS was 100 g and it was applied only in 1 E case (20g /daily for the duration of 5 days). In the remaining E cases the total dose was 60, 48, 2 g, respectively, as the number of applications was from 1 to 4 times daily, and the duration from 1 to 4 days. Cormagnesin gave excellent results in 80% of the cases with severe PE-E. The frequency rate of s.c. in the first group was 57.69%, in the second group--25%. The authors made the conclusion that the severity of PE-E and mainly the high values of RR and the other accompanying symptoms determined treatment with MgSO4. Cormagnesin application scheme was strictly individual. MgSO4 application allowed the possibility for conducting the delivery under more favourable conditions when convulsions were under control and RR was stabilised.

[Pros and cons of magnesium sulfate as a tocolytic]. / Za i protiv magnezieviiat sulfat kato tokolitichno sredstvo.

Magnesium sulphate (MgSO4) is with a proved effectiveness in cases of praeclampsia/eclampsia, but its use as a tocolytic is discussed in the last few years. That is why we had for an object to study its effect as a tocolytic in cases of abortions and premature labours. The study is prospective and if is made in I-st obstetric clinic of High Medical School--Pleven. Treatment with Cormagnesin was carried out to pregnant women for suppressing the uterine activity. Cormagnesin 200 (1 amp-10 ml) contains 1000 mg MgSO4, and Cormagnesin 400 (1 amp-10 ml) contains 2000 mg MgSO4. The medicine was administered in dosage of 4 or 5 g for 30 min, and after that if there were any uterine contractions the infusion was carried on with additional 5 g MgSO4 for 6 to 12 h. The total dosage was from 4 to 60 g MgSO4. The authors reported on very good effect in cases with pains and increased uterine tone--18 (36.73%), as well as in cases with pains and irregular uterine contractions 5 (10.21%), while the treatment was without any effect in cases with uterine contractions on 15-20 min, increased uterine tone, bleeding and Pelvic score 1-3 points in spite of high dosages of MgSO4 and longer duration of treatment. The authors made the conclusion, that the subjective complaints should not be accepted as an indication for administration of MgSO4, and MgSO4 should be administered in cases with increased uterine tone and irregular uterine contractions. Every genital bleeding and suspicion for placental abruption should be defined more precisely, because lately diagnosed placental abruption and unjustified expectation for suppression of uterine activity by MgSO4, may lead to increase of perinatal morbidity and mortality. In spite of the controversial data about MgSO4 as a tocolytic, its administration is justified and necessary.

[Dostinex - the most effective medicine for inhibition of postpartal lactation]. / Dostinex - visokoefektiven preparat za potiskane na puerperalnata laktatsiia.

The aim of the authors is to confirm the efficiency of the Dostinex for prevention an inhibition of the puerparal Lactation. Dostinex is a dopamine ergoline derivation that strongly decrease the Prolactin secretion and has a long-lasting effect. 20 parturients were treated with Dostinex and the most common indication was: death fetus (12 cases), disorders of the nipples (2 cases) and 1 occasion with epilepsy, thrombophlebitis and thromboembolic disease of the V. ileofemoralis, polymastia and polythelia and fetal malformations and in 2 women with hypergalactemy was given for inhibition of the lactation (1/2 table. For 4 days). The treatment is based on two tablets daily in the first 24 h. after delivery in 6 cases and for the other--2 x 1/2 table. daily for 2 days. Our conclusion is that Dostinex is the most effective agent for prevention of the postpartal lactation given once a day (2 table.) in the first 24 h. post delivery. We read good effect when the medicine was taken twice daily x 1/2 table. for 2 days. Dostinex shows vary good compliance and low rate of relapse of the Lactation.

[For and against non-obstetrical indications for cesarean section]. / Za i protiv neakysherskite indikatsii za sectio caesarea.

The authors have made a retrospective study on the nonobstetrical indications for SC from 1996-2000 year, with the help of special documents belonging to VMI, Obstetric Clinic, Pleven. There have been 10,465 deliveries in the same period, 1096 with SC (10.47%). The main indications in 56 cases (5.11%) were non-obstetrical complications of pregnancy and delivery. The most frequent non-obstetrical indications were: ophthalmological in 18 (32.14%), orthopedical in 10 (17.86%), cases CNS diseases in 5 (8.93%) and cancer in 3 (5.36%). We have included: Condylomata accuminata--5 (8.93%), acute thrombophlebitis and thromboembolic diseases--5 (8.93%), a condition after plastic repairs of the perineum, virgin and vulvae--3 (5.36%). Special interest was taken on another group of patients with some rare diseases about the other specialist recommended SC. The ovarian age of the patients was 20-29 years--in 36 (64.28%). The SC has been performed in 30 cases (53.57%) in the first stage, in 14 (25.00%) in the second stage of delivery and in 12 (21.43%) cases was emergency. The conclusions of the authors is that the Obstetricians, who manage the delivery, may not always been comparted with that of the other specialist. This comes from the fact that the responsibility is mainly for him.

[Rational method for prostaglandin use in cases with postpartal uterine hypotonia]. / Ratsionalen podkhod v upotrebata na prostaglandini pri sledrodova matochna khipotoniia.

The authors aim is to find out the most common dosages, roads of administration and the effect of 15-Methyl PgF2a (Prostin 15 M) during the treatment of postpartal uterine hypotony 1 to 3 amp. Of Prostin 15 M-1 ml. (250 mg Carboprost) were used deeply muscular, intracervical or intramyometrial, by 51 patients with postpartal hypotony. The most common risk factors associated with the development of postpartal haemorrhage are PIH, prolonged labour, the general anaesthesis and higli multiparity. The adequate treatment with Prostin 15 M woned reduse the life threatening complication in the Labour room. The most efficient is the intracervical way of administration, a good effect could be achieved even with 1 amp. Prostin 15 M when it is applied after the conventional methods and manipulations. The lacu of effect grow Prostin 15 M (in 5.88% in this study) shows that there is another pathology responsible for postpartal hemorrhage and life threatening hemorrhage and this usually requires Laparotomy. We offer every Obstetric Clinic to have 3 amp. Prostin 15 M available and these would spare a lot of negative feelings or emotions and it wont supply a better obstetric outcomes.

[Diagnostic ultrasound and the intrauterine pessary]. / Diagnostichen ultrazvuk i vutrematochen pesar.

The aim of the authors is an analysis of the results in application of ultrasound technique in patients with intrauterine device (IUD). Using the ultrasound criteria for a correct and incorrect position of IUD, the criteria for an elevated risk for expulsion and contraindications for IUD application, the authors have used ultrasound technique for diagnosis in 65 patients with IUD. The causes for the "wrong" diagnosis were discussed: imperfection of the apparatuses, non-observance of the conditions for ultrasound examinations and lack of experience. Practical conclusions and recommendations for an increase of the effectively of this seemingly easy method for diagnosis and follow-up of the IUD were made.

[Pregnancy and labor in 335 cases of high multiparity]. / Bremennost i razhdane v 335 sluchaia na visok multiparitet.

It had been accomplished an investigation upon the pregnancy and the birth of 335 women in labour with high (> or = 5) parity (grandmultimaras = GM), including 11 736 labour, taking place in the Clinic of Obstetrics of Pleven Medical University. Controllable group had been formed out of a 655 women in labour with a parity from 1 to 4. It had been used a questionnaire method. Higher in the main group was the frequency of a hypertension, placental pathology (pl. praevia, abruptio et retention placentae) and that of a transverse and oblique presentation of the foetus. Lower in GM was the frequency of the neonates with a very low birth weight < 1500 g (VLBW), the frequency of induction and stimulation of the labour act, and of episiotomy and ruptures of the perineum. We come to the conclusion about the low level of obstetric risk with GM when there was an accessible and a competent obstetric assistance.