[POSSIBILITIES AND LIMITATIONS ANALYSIS OF SCREENING IN PREGNANT WOMEN FOR DOWN SYNDROME AND OTHER COMMON CHROMOSOMAL DISORDERS OVER A PERIOD OF TWO YEARS].

Maternal biochemical screening and the new non-invasive prenatal screening tests as well as prenatal diagnostic tests as tools to fight serious chromosomal diseases have their possibilities and limitations. The article presents analysis of the results in 7 201 pregnant women: 4426 first trimester and 2775 second trimester biochemical screening, together with 994 calculated integrated risks performed in the Laboratory of medical genetics in 2013 and 2014 year. A matter of mass screening in both periods is the criterion of efficiency--financially justified reasons on the basis of comparison "sensitivity" of different approaches. First trimester screening revealed 5 (71.42%) cases of chromosomal disease and 1 (14.28%) case with large congenital anomaly. From second trimester biochemical screening 3 (60%) cases were revealed. Chromosomal pathology in pregnant women with calculated integrated risk was found in 7 (70%) cases. From a total of 22 screened pregnant women with prenatal or postnatal verified diagnosis of Down syndrome, Edvards, Patau or Turner, highest detection rate is found in first trimester screening--6 of 7 (85.7%). Contingent approach is most widely used in Europe and we confidently recommend it.

[PRIMARY CYTOREDUCTIVE SURGERY VERSUS NEOADJUVANT CHEMOTHERARY IN TREATMENT OF ADVANCED OVARIAN CANCER (STAGE III C-IV). OUR AND FOREIGN EXPERIENCE].

INTRODUCTION: The advanced ovarian cancer usually have bad prognosis. The main methods for treatment of these types of tumors are: primary cytoreductive surgery and platin-based chemotherapy. AIM: Our aim was to evaluate our and foreign experience in treatment of advanced ovarian cancer stage III C--IV treated by neodjuvant chemotherapy followed by cytoreductive surgery and patients treated by primary cytoreductive surgery followed by adjuvant chemotherapy. We wanted to research the survival rate, postoperative adverse effects, mortality rate, the size of residual tumor and the metastases in these patients. MATERIAL AND METHODS: We researched for 10 years period--50 patients treated by primary cytoreductive surgery and 50 patients treated by neoadjuvant chemotherapy. RESULTS: The postoperative adverse effects and mortality rate are lower by neoadjuvant chemotherapy followed by cytoreductive surgery. The most important independent prognostic factor for overall survival rate was the lack of residual tumor in both types of treatment. CONCLUSION: The neoadjuvant chemotherapy followed by cytoreductive surgery in ovarian cancer stage III C--IV is considered as a standard treatment.

[RECONSTRUCTIVE AND COSMETIC SURGERY IN TREATMENT OF VULVAR CANCER].

UNLABELLED: The aim of our research work was to show our results in the field of reconstructive and cosmetic surgery for vulvar cancer. MATERIAL AND METHODS: We evaluated 18 patients for 10 years period. RESULTS: We applied all surgical techniques that are possible at the moment in the world: laps from mons pubis, rhomboid flaps, myocutaneous flaps from gluteal region. We used surgical techniques with the following muscle groups: musculus gracilis, musculus gluteus maximus, musculus tensor fasciae latae, musculus rectus abdominis. CONCLUSIONS: With our research work we tried to better the quality of life of our patients, to achieve better esthetic and cosmetic effect after very radical surgical interventions connected with vulvar cancer.

[THE ROLE OF COLPOSCOPY AS A METHOD OF METHODOLOGY FOR EARLY AND RAPID ETIOLOGIC DIAGNOSIS IN THE STUDY OF ENDOCERVICITIS CHLAMYDIALIS.]

The aim of this study was: 1. To analyze and study the specifics of colposcopic picture of ecto-and endo-cervix in endocervicitis chlamydialis. 2. To demonstrate the leading role of colposcopy method as part of the methodology for early and rapid etiologic diagnosis of chlamydial cervicitis in order to conduct etriotropian treatment.Results 1. Determine the frequency of incidence of endocervicitis chlamydialis, to cause Chl.trachomatis 45,1%, (319 DIF(+) patients out of 708 surveyed), p <0.05 in the Ruse region. 2. Demonstrated statistically significant relationship between the incidence of endocetvicitis chlamydialis, examined by DIF, and the presence of colposcopic amendments Baza and Ectopia. The difference of the two samples in terms of variable baza e statistically significant. The difference of the two samples in terms of variable ectopia e statistically significant at α<0,05, and when α<0,1 statistically significant. 3. There was no statistically significant association between the incidence of endocervicitis chlamydialis, proven by DIF, and the presence of colposcopic changes - mosaic zone of transformation, presence of blood vessels. 4.It has been proven leading role of colposcopy method as a method complementary to the early and rapid diagnosis of endocervicitis chlaamydialis, in order to hold further etiotrop treatment.

[FEMALE STEROID HORMONES - MODULATORS OF IMMUNE RESPONSE TO GENITAL CHLAMYDIA TRACHOMATIS INFECTION.]

In the recent years according to WHO, genital chlamydia is the mos't common sexually transmitted infection. Chlamydia Trachomatis is an intracellular parasite which target are the tubular epithelial cells of the urethra, endocervix, endometrium, endosalpinx, conjunctiva, synovial lining of the joints, Glisson's capsule of the liver Our study, as well as some international researches, shows that in the cases of genital chlamydia there are changes in the ovarian hormones (estradiol and progesterone), their impact on the immune system and their importance for the development and the complications of the infection with Chlamydia trachomatis. The physiological level of the steroid hormones in its turn contributes for the normalization of the local immunity and reduces the possibility of recurrences.

[Preparation of Cervical Dilatation Before with Misoprostol and Laminaria - Advantages and Disadvantages.]

The surgical hysteroscopy became popular as a minimally invasive approach to interuterine changes. Dilatation is a real challenge during surgical hyseroscopy especially in first delivery patients, women in menopause and women with cervical stenosis. Apart from this, some long hysteroscopy operations such as myomectomy require adequate dilatation in order to facilitate the multiple insertions and drawing pulling of the resectoscope. Another technical problem is the need for a significant degree of cervical dilatation, as well as softening of the cervix, which will allow the extraction of the excised endometrial polyps or myomatose parts. Mysoprostol is analogous to prostaglandin El, which is commonly used in obstetrics to induce an abortion and birth, as well as after birth to control the excessive vaginal bleeding. Its use in gynecology is limited. In our study it is of vital importance. The vaginal administration of MysoproStol before surgical hysteroscopy facilitates dilatation. The eased hysteroscopy minimizes cervical complications. On the other hand, the natural dilatators Laminaria, made of Laminariajaponica orLaminaria Digitata sticks, are attractive natural substances which can cause dilatation with minimally observed systemic side effects. They have shown efficient results during the cervical preparation before surgical hysteroscopy. Despite of that, there are no comparative studies on the efficiency of the two methods for cervical preparation. The aim of this Study is to compare the efficacy of internally vaginal Mysoprostol against endocervical dilatators Laminaria before surmical hvSterosconv in certain cases.

[New Low-Dose Oral Contraceptive with 28 Midiana.]

As a representative of the low dose generation of oral contraceptives, Midiana 28 provides minimal intake of estrogens for the female organism in the presence of a new generation getation component- Drospierenone. Midiana has an excellent contraceptive effect - the control group of women showed no cases of impregnation during the intake, Pearl index =0.00. It also exercises a good control over the menstrual cycle with low frequency of intementrual bleeding /17%/ Midiana 28 shows a very good tolerability with minimal, detected, rapidly transient side effects.

[OVARIAN CANCER RECURRENCES IN PARAAORTIC LYMPH NODES].

The authors'surgical experience on 14 patients with ovarian cancer recurrences in paraortic lymph nodes --infrarenal and suprarenal-celiac and triad, were presented. Complete cytoreduction was achivied in all recurrent patients (no visible tumor). The median time to recurrence was 16,5 months (from 10 to 36 months). The median operating time was 90 min (range from 30 to 120 min). The median blood loss was 200 ml (from 100 to 300 ml.). No intra- or postoperative complications were noted. The median postoperative period was 5 days (from 4 to 6 days).

[GLYCYRRHIZINIC ACID--AN ALTERNATIVE METHOD FOR TREATMENT OF CONDYLOMATA ACUMINATA].

Condylomata acuminata are benign proliferations of skin and mucosa caused by the human papilloma virus infection (hereinafter referredto as HPV). It is one of the most common sexually transmitted diseases in the world, whose incidence rate has increased in the last three decades. Current treatment involves the physical destruction of the infected cells. The fact that there are many different types of treatment goes to show that none of them are uniformly effective or directly antiviral.

[Laparoscopic myomectomy using bidirectional barbed suture: report of the new technique in 82 cases].

Bidirectional barbed suture introduces a new paradigm in laparoscopic suturing. The aim of our study is to evaluate the efficacy and safety of using bidirectional barbed suture in laparoscopic myomectomy. It included 102 women, requiring a laparoscopic myomectomy for symptomatic uterine fibroids from June 2011 to May 2014. They are divided into two groups according to the thread used for closing the uterine incision. We used bidirectional barbed suture Quill and Vicryl in the control group. The mean operative time was shorter in the Quill group than in control group. Both intraoperative blood loss and drop of hemoglobin were significantly lower in the Quill group. The use of bidirectional barbed suture appears to be safe for closing the hysterotomy site during a laparoscopic myomectomy.

[Prognostic factors and prognostic groups for overall survival of cervical cancer patients FIGO stage IB1].

A petro-prospective study on 132 women with early invasive cervical cancer was performed. According to Log-Rank test, Breslow and Tarone-Ware tests we analyzed the following factors: age, type of histology, tumor grading, tumor localization (exo-, endocervix), lymph node metastases, postoperative histologic findings, blood transfusion and Hb on the day of discharge. We found as an independent prognostic factors for overall survival: tumor localization, postoperative histologic findings and blood transfusion. Based on these factors two profnostic groups were created with favorable and unfavorable prognosis. The median survival for these two groups was 106 and 57 months, respectively.

[Our experience in using liquid based cytology in cervical screening (LBC)].

AIM: Our aim is to summarize our experience in screening for cervical cancer using liquid-based cytology system and the Bethesda system. MATERIAL AND METHODS: We did a clinical study of 92 patients, aimed to summarize the results of liquid-based cytology based on various criteria such as specificity, sensitivity, positive and false negative results. All patients had conventional Pap smear as well. RESULTS: The better results stand out of the LBC, mainly due to the reduced number of unsatisfactory results and higher specificity and sensitivity for low-grade lesions--LSIL. There is better standardization of samples, because of the automation of the process. The method is much better quality and more economical. CONCLUSION: The results obtained by us confirm the diagnostic quality and efficiency of the method, so we offer routine use in Bulgaria, as it is in some developed countries.

[Our and foreign experience in modern surgical treatment of cervical adenocarcinoma stage T(1A1)].

AIM: The aim of this research work was to evaluate the distant results in patients with cervical adenocarcinoma stage T(1A1) treated conservatively only by conization. MATERIAL AND METHODS: 60 patients were) examined for 10 years period with cervical adenocarcinoma stage T(1A1) (stromal invasion to 3 mm in deapth and 7 mm horizontal spread). RESULTS: 50 patients were surgicaly treated by cold knife conization and 10 patients by LLETZ. In 40 patients a total hysterectomy was additionally performed. 20 patients (age range from 20 to 40 years) were treated only by conization because they desired to preserve fertility. In 12 patients an attempt was made for to get pregnant. In 7 patients there was a successful pregnancy. CONCLUSIONS: The conization of the uterine cervix as the only treatment in patients with cervical cancer T(1A1) adenocarcinoma is effective and safe therapy. It is very important when patients desire to save their reproductive functions. The individualization of this treatment method is not yet obligatory because of the small number of treated patients.

[Oncologucal results after surgical and radio-surgical treatment in patients with cervical cancer stage Ib1].

One hundred thirty two patients with cervical cancer stage IB1 were evaluated for desease free (DFS) and overall survival (OS). All women were submitted to surgery-radical hysterectomy class III and pelvic and/or paraaortic lymph node dissection. Ninety three women were irradiated after surgery-telegamma therapy (TGT) 50-52 Gy. After median period of follow-up 44 months (from 1 to 114) OS and DFS were estimated using Kaplan-Meier method. Five-year OS and DFS were 83% and 82%, respectively.

[Intraoperative complications of surgical treatment of cervical cancer stages I and II in FIGO].

With this study are presented the types of intraoperative complications and their frequency in radical hysterectomy and lymph node dissection (pelvic and paraaortic) as surgical treatment of 294 patients with invasive cervical cancer FIGO stages I and II.

[Early postoperative complications in surgical treatment of cervical cancer stages I and II in FIGO].

Presented are the types of early postoperative complications and their frequency in radical hysterectomy and lymph node dissection (pelvic and paraaortic) as surgical treatment of 294 patients with invasive cervical cancer FIGO stages I and II.

[Late postoperative complications of surgery and radiosurgical treatment of invasive cervical cancer].

Presented are the types of late postoperative complications and their frequencies combined radio-surgical and surgical treatment of 294 patients with invasive cervical cancer FIGO stages I and II.

[A rare case of pregnancy combined with a large ovarian tumour].

AIM: Our aim was to demonstrate the diagnostic difficulties as well as the atypical clinical development of ovarian tumours in combination with pregnancy. MATERIAL AND METHODS: We present a rare case of large mucinous cystadenoma in 32-year old patient, who is 20 gestational weeks pregnant. Ultrasound examination and MRI were performed, which visualized a huge multilocular ovarian tumour formation with a small amount of ascites. RESULTS: We performed laparatomy adnexectomy which included the ovarian cyst, partial omentectomy and we took 4 samples of smears from the whole abdominal cavity, as well as ascites samples for cytology. The pregnancy was preserved. The histological examinations reported: mucinous cystadenoma without morphological data for malignant transformation. CONCLUSIONS: In our rare case the organ preserving operation was a completely sufficient surgical staging procedure.

[Comparison of conventional PAP smear with liquid based cytology method (LBC)].

AIM: Our aim was to summarize our and foreign experience in screening of cervical cancer, using conventional PAP smear and liquid-based cytology-LBC. MATERIAL AND METHODS: In the Department of Obstetrics and Gynecology of Medical university of Varna, Bulgaria we made clinical trial on 100 patients, that has the goal of comparing the results of liquid -based cytology with conventional PAP smear in different criteria. RESULTS: There are significant advantages of LBC mainly due to the lower number of unsatisfactory results and higher specificity for LSIL. Compared to foreign results our results are showing the same tendencies and values. CONCLUSIONS: Our and foreign authors results for the benefits of LBC are undisputable, although this method is still rarely used in our country.

["Flare up" and modified natural cycle IVF for patients with expected poor response].

UNLABELLED: The aim of this study is to compare the efficiency of the "flare up" protocol (mini-dose GnRH-ag, macro-dose FSH, GnRH-ant, HCG)-gr. A, with a modified natural cycle IVF (GnRH-ant, HCG)-gr. B. RESULTS: In gr. A 140 and in gr. B 17 patients were assessed. The average age is 35.5 in gr. A and 35 years in gr. B. The embryo transfer is realized 48-72 hours after ovarian puncture in 98 cases (70%) in gr. A and 11 cases (64.7%) in gr. B. Clinical pregnancy is registered in 32 cases (22.8% per cycle, 32.6% per transfer) in gr. A and 4 cases (23.5% per cycle, 36.3% per transfer) in gr. B. In gr. A the cancellation rate is 30%-42 cases and in gr. B--35.3%--6 cases. CONCLUSION: The preliminary results indicate that the 2 methods are equal as regards cancellation and success rate. The natural and modified natural cycle IVF have the following advantages: minimization of severe early and late complications and multifetal pregnancies as well as cost-effectiveness and better chance for pregnancy cumulation rate. There is no doubt that the "mild" and natural, resp. modified natural protocols will displace the conventional hyperstimulation regimens.