[Course of pregnancy and delivery in cases with cervical deciduosis].

AIM: The aim of this study was to establish influence of cervical deciduosis on pregnancy and time and route of delivery. MATERIAL AND METHODS: The study included 28 pregnant women with diagnosis of cervical deciduosis. We followed progress of pregnancy, genital bleeding manifestation and time and route of delivery. RESULTS: We found that 90% of cervical deciduosis cases were diagnosed in the first half of pregnancy. 71.4% were diagnosed after they completed 12 gestational weeks. In case of disruption of deciduosis foci, because of trauma or infection, bleeding occurs. Four of pregnancies were terminated before 28 weeks gestation (14.3%)--two of them miscarriages, one cessation of pregnancy because of polymalformative fetus and one with Cesarean Section. Five of the pregnancies ended in preterm deliveries (17.9%)--three vaginal deliveries and two Cesarean Sections. Nineteen cases ended in term deliveries (67.8%)--seventeen vaginal deliveries and two Cesarean Sections. DISCUSSION: In cases with cervical deciduosis we found increase in preterm rupture of membranes. For this reason these patients have increased risk for miscarriage and preterm delivery.

[Hysteroscopy in cases of benign intrauterine formations in the postmenopause].

UNLABELLED: Submucous myomas and especially endometrial polyps are often found in the postmenopause. There are no reliable clinical or ultrasound criteria to predict their malignancy potential. The D&C is insufficient diagnostic and therapeutic method in case of benign intrauterine formations. The potentialities of the hysteroscopy make it a particularly appropriate method in these cases. AIM: The aim of the research is to estimate the results of the applying of the hysteroscopy in the postmenopause for diagnosis and treatment of the benign intrauterine formations. MATERIAL AND METHODS: The research included 62 women in postmenopause with bleeding, pains or sonographically-found formations in the intrauterine cavity. Their age varied from 50 to 78 years and 62.3% of women were over 55 years. Thirty patients suffered from serious concomitant illnesses. Seventeen of the women had already undergone one or more D&C. RESULTS: Hysteroscopy with resection of the formations was performed in all of the cases. Eighty formations have been evacuated--18 submucous myomas and 62 endometrial polyps. The average size of the submucous myomas was 24.0 mm (from 5 to 70 mm). The average operational time in the cases of endometrial polyps was 15.2 min. (from 5 to 50 min) and 18.3 min. (from 10 to 40 min.)--in the cases of submucous myomas. Intraoperational complications developed in two of the cases (heavy bleeding and perforation). Forty nine patients have been observed postoperatively. Out of 14 women with submucous myomas 10 have been observed and all of them had no complaints or recurrences. Thirty nine out of 48 women with endometrial polyps have been observed and 36 of them had no complaints or indications of a recurrence. In one case a new polyp was found after two years and a new hysteroresection was performed. Two women underwent hysterectomy subsequently because of bleeding and endometrial hyperplasia. DISCUSSION: The hysteroscopic polypectomy is an effective and harmless procedure. It gives the possibility that the object be seen, localized, sampled and evacuated entirely. The approach is miniinvasive, the general anesthesia and laparotomy is avoided. This is especially important for women with serious concomitant diseases. A histological examination of the whole formation is possible. CONCLUSION: Hysteroscopy is the most appropriate modern method for diagnosis and treatment of benign intrauterine formations in the postmenopause.

[A case of advanced genital tuberculosis--differential diagnostics and surgical aspects].

The authors report a case of advanced genital tuberculosis. The diagnostic difficulties and treatment are discussed.

[Endometriosis in the surgical scar from cesarean section]. / Endometrioza v operativen tsikatriks ot tsezarovo sechenie.

The frequency of endometriosis in and around the surgical scar from cesarean section is from 0.03%-0.04% to 0.8% in some reports. It is difficult to be diagnosed, in spite of the typical symptoms: aching swelling in the area of the surgical scar, which is influenced by the phases of menstruation. Sonography and fine-needle biopsy can be used, but it is usually diagnosed through the surgical treatment. Hystological diagnosis can also be a matter of some difficulty, as sometimes it is necessary to differentiate from adenocarcinoma, pseudomyxoma peritonei and metastatic carcinoma. The treatment is surgical. It is examined a case of endometriosis, which occurred in the surgical scar from a cesarean section about a year after the operation. The treatment is surgical by means of wide cutting-out of damaged musculus rectus abdominis and the surrounding tissues. After the operation a seroma is formed, which is healed with aspiration drainage and compressive bandage. Three years after operation a recurrence is not established.

[Diagnosis and differential diagnosis of space-occupying disorders of the umbilical cord]. / Diagnoza i diferentsialna diagnoza na prostranstvo-zaemashti obrazuvaniia na p'pnata vr'v.

In connectiin with a clinical case of a circumscribed edema of the umbilical cord the authors considered the space-occupied disorders of the umbilical cord. The tumorous and nontumorous lesions of the umbilical cord as well as the criteria and their diagnostic difficulties are discussed. The authors pay attention to the complications of such disorders in the pregnancy and their possible influence on the fetus.

[Problems of diagnosis and treatment of cervicitis]. / Problemi pri diagnozata i lechenieto na tservitsata u zhenite.

Infectious cervicitis is a common disease in women of reproductive age. The symptoms are not characteristic and they are often neglected by the patient and the physician. Cervicitis is a very important clinical entity, because the infection can ascend to the genital tract. The most common causes for the infectious cervicitis are Chlamydia trachomatic and Neisseria gonorrhoeae. A variety of methods for the precise diagnosis must be employed--gynecologic examination, colposcopy, pathomorphology and cytology and bacteriological examination as well. Therapeutic modalities must include coverage for both Chlamydia trachomatis and Neisseria gonorrhoeae. Bacteriological test of cure is mandatory.

[The etiology of infectious cervicitis in women]. / Etiologiia na infektsiozniia tservitsit u zhenite.

Infectious cervicitis is a common disease in women of reproductive age. A prospective study was carried out including 70 women with clinical manifestations of cervicitis during gynecological and colposcopic examination. In 19 women (27%), Chlamydia trachomatis was demonstrated by direct immunofluorescence in cervical smears. Neisseria gonorrhoeae was isolated in 2 women and 1 had a concomitant infection with Neisseria gonorrhoeae and Chlamydia trachomatis. Mycoplasma hominis and Ureaplasma urealyticum were isolated in 7 patients and 4 had cytological smears consistent with Human Papilloma Virus infection. In the rest 47 patients no etiological agent was found. The results of the present study indicate that the most common etiological cause for infectious cervicitis can be Chlamydia trachomatis and an examination for this organism should me mandatory in women with infectious cervicitis for guiding the correct diagnosis and treatment.

[The correlation between the study data on the Papanicolaou cytological smear and the data on direct immunofluorescence for C. trachomatis]. / Korelatsiia mezhdu dannite ot izsledvaneto na tsitonamazkata po Papanicolaou i dannite ot direktnata imunoflurestsentsiia za C. trachomatis.

A study was carried out to examine the relationship between the clinical data, the data from the Papanicolaou smear and the direct immunofluorescence for C. trachomatis in 70 women with infectious cervicitis. The prevalence of Chlamydial infection in the study population was 27%. The study showed that one third of the women in whom the Papanicolaou smear revealed inflammatory changes might be expected to be infected with C. trachomatis. The probability of not having infection when no inflammatory changes were observed in the Papanicolaou smear was 0.74--negative predictive value which means that more than two thirds of the women without inflammatory changes in cytology smear will not be infected with C. trachomatis.

[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.

[Pelvic actinomycosis]. / Tazova aktinomikoza.

Actinomycosis is an uncommon inflammatory disease of the female genital tract predominantly affecting the upper sections. Its appearance is in close connection with expended use of different IUDs. Its histological demonstration needs the detection of the specific sulphur granules. Because they often are rare it is recommended working of 8-12 paraffin blocks from suspected cases. The exact diagnosis is of high significance for preventing possible recivides after surgical intervention.

[The diagnostic value of dilatation and curettage in endometrial carcinoma]. / Diagnostichna stoinost na probnoto abrazio pri kartsinom na endometriuma.

The diagnostic accuracy of endometrial curettage is studied in 75 patients treated for endometrial cancer with respect to: 1. Detection of endometrial cancer; 2. Histologic type and grade of the cancer; 3. Spread to the cervical canal. It is found that: 1. The diagnosis of cancer by D&C is correct in 84% of cases; 2. The diagnosis of adenosquamous cancer is made by D&C in 25%; 3. Evidence of spread to the cervical canal by D&C is found in 24 cases and confirm ed by surgery in 7 (29.2%) cases, giving a false positive rate of 70.8%. Negative finding in py with target biopsy is advisable in cases of: 1. Positive cervical finding in the D&C specimen; 2. Negative finding in D&C specimen amd persisting symptoms.

[Tumors in childhood and adolescence]. / Tumori v detsko-iunosheskata vuzrast.

The trial present the results for the incidence and histology of tumours in patients below 18 years, examined at the State University Hospital Maichin Dom in Sofia for two consequent periods of 4 years each. An increase is registered in the incidence of neoplastic disease from 1.85% to 3.42%. There is no significant difference in hystological characteristics of the tumours when comparing I and II period: 85.7% versus 77.4% benign tumours (mucous cysts, dermoid ovarian cysts and polyps) and 14.3% versus 22.6% malignant tumours (ill differentiated teratomas, cystadenocarcinomas, dysgerminomas, ovarian embryocarcinomas and rhabdomyosarcomas). Accurate diagnostics requires detailed gynaecological examination, including a rectal one, vaginal probing, vaginal scopia, ultrasound, laparoscopy. Early discovery followed by surgery provides a possibility for adequate and definite treatment.

[The differential diagnostic criteria in metastatic ovarian tumors]. / Diferentsialno-diagnostichni kriterii pri metastatichni iaichnikovi tumori.

Ovaries often are a target organ for metastases from another primary locus, especially in young women in reproductive age. This review focuses on the diagnostic difficulties in distinguishing between primary and metastatic ovarian tumors.