DESCRIPTION OF GASTROESOPHAGEAL REFLUX DISEASE IN DIFFERENT ETHNIC GROUPS, LIVING IN THE NORTH.

UNLABELLED: INTRODUCTIOD: Over the past 15 years, the relative frequency of detection of erosive form of GERD has increased from 3,1 to 16%. Manifestations of GERD in different ethnic populations of Yakutia are not well understood. AIM: Studying kliniko-endoscopic and the morfofunktsionalnykh of features of GERD in various ethnic groups living in conditions of Yakutia. MATERIALS AND METHODS: The study included 168 patients with GERD of different ethnic origins. Yakuts, Evens and Evenks, were considered as indigenous people and newcomers were all persons of other nationalities, who arrived at different times from other regions of Russia. The average age was 41.75 ± 24.73 years. RESULTS: Clinical manifestations of GERD in different ethnic groups living in Yakutia. Leukoplakia of the esophagus was detected in the indigenous population are four times more likely than newcomers. With GERD associated with thyroid disorders prevalent low level of contamination of Helicobacter pylori. Helicobacter pylori infection in patients with GERD in Yakutia was higher among immigrants than among the indigenous, with a high degree of contamination of Helicobacter pylori was detected more frequently in immigrants than among the indigenous. Pathological gastroesophageal reflux during the daily pH-metry of the esophagus was detected more frequently in patients visiting than among the indigenous. CONCLUSIONS: The found features of a current of GERD can be further the basis for the individualized and differentiated approaches to treatment of this disease.

[Richter's sacrospinous ligament fixation and its place in current gynecology].

In 1968 K. Richter treated post-hysterectomy prolapse of the vaginal stump by fixating the vaginal stump to the sacrospinous ligament via transvaginal route. Nowadays most authors perceive this technique as an inseparable component of vaginal hysterectomy, for the purpose of preventing vaginal stump prolapse. The authors present the results of Richter's operation among 53 patients, 33 of whom operated on in the Department of General and Oncological Gynaecology at the Military Medical Academy (Sofia), 12 operated on in the Department of Gynaecology at the Military Medical Academy (Varna), 4 in the Municipal Maternity Hospital "St Sofia" (Sofia) and 4 in the Department of Obstetrics and Gynaecology at the Multi-profile Hospital for Active Medical Treatment (Samokov) during the period 2009-2013. In 26 of the cases (49%) the operative indication was a severe vaginal descensus, in 23 (44%)--total uterine prolapse, in 4 (7%)--prolapse of the vaginal stump following hysterectomy. Twenty-six of those women (56%) didn't have any symptoms of urinary incontinence, as 20 (38%) had symptoms of urinary stress incontinence. The median age of operated women is 64 (age range: 43-78 y.o.). All of them experienced at least once a vaginal birth (average parity: 2). The average duration of subjective complaints caused by their condition was 41 months (range: 2-120 months.) The average duration of the operation was 122 minutes (range: 60-210 min). The average amount of blood lost during the operation was 218 ml (range: 60-400 ml). No intraoperative complications were registered. Early postoperative complications consisted in 3 cases of considerable bleeding through the stitches which faded without any special measures, blood transfusion included. One patient developed a haematoma in the ischiorectal fossa which was incised and evacuated. The long-term results, recorded at post-op visits 1 and 6 months after the operation, were satisfactory: regardless their age and their preoperative genital status, surgery in 93% of the cases has led to stable correction of the pelvic statics and disappearance of urinary incontinence in case the latter did exist. Recurrent prolapse was noted in 4 cases (7%), in two of which the condition was diagnosed as a partial recurrence. The authors regard those recurrences as resulting from technical errors, rather than as a shortcoming of the surgical procedure.

[Radical trachelectomy -- surgery for preserving woman's fertility in patients with invasive cervical cancer].

For the past 15 years gynecological oncologists have been seeking ways to preserve woman's fertility when treating invasive cervical cancer. Many cases of cervical cancer are diagnosed in young woman who wish to preserve their fertility. As more women are delaying childbearing, fertility preservation has become an important consideration. The standard surgical treatment for stage IA2-IB1 cervical cancer is a radical hysterectomy and bilateral pelvic lymphadenectomy. This surgery includes removal of the uterus and cervix, radical resection of the parametrial tissue and upper vagina, and complete pelvic lymphadenectomy. Obviously, the standard treatment does not allow future childbearing. For some women with small localized invasive cervical cancers, there is hope for pregnancy after treatment. Radical trachelectomy is a fertility-sparing surgical approach developed in France in 1994 by Dr. Daniel Dargent for the treatment of early invasive cervical cancer. The radical trachelectomy operation has been described and performed abdominally, assisted vaginally by laparoscopy and robotically.

[Clinical efficacy of a new method for LEEP conization with pistol-shaped electroknife].

The aim of this study is to establish clinical efficacy of a new method for LEEP conization of uterine cervix. The study is open, retrospective, performed at Department of General and Oncogynecology - Military Medical Academy (Sofia, Bulgaria) for the duration from 2007 till Mar 2010. The study includes 37 women at age from 19-50 years with proved high grade CIN (included Ca coil uteri in situ) by abrasion or biopsy. Medical history was collected from all patients enrolled in the study as well as gynecological examination and colposcopy was performed to them. A LEEP with short intra venues anesthesia was performed to the patients. An innovation system for LEEP conization and generator for monopolar currency ERBE VIO 300D was used. The follow up visit was performed one month after the treatment procedure and included gynecological examination and colposcopy (positive/negative atypical colposcopy results). The clinical efficacy of the method was evaluated on the base of histological results. The patients whose histological results show negative endocervical margins were accepted for cured. From 37 patients in total with different stage of dysplasia and carcinoma in situ hospitalized at Clinic of surgical gynecology for surgical treatment, in 33 (89%) there are negative endocervical margins. These patients formed the cured group. In four patients (10.8%) were discovered histological evidences for positive endocervical margins. The LEEP was not the final operative procedure for them. They were included in the uncured group. The final results achieved from the study about the efficacy of the used method LEEP has statistical significance (d.f .= 1, X2 = 2.82, p < 0.05). The data shows that the LEEP eliminate completely the affected by malignant process areas of cervix uteri. The LEEP can be used as a common surgical method in the treatment of the women with high stage of pre-carcinoma and carcinoma in situ coli uteri.

Cytotoxic activity of a podophyllotoxin-like lignan from Linum tauricum Willd.

The present study describes the preliminary evaluation of the cytotoxic activity of a podophyllotoxin-like compound 4'-demethyl-6-methoxypodophyllotoxin (4'-DM-6-Mptox), isolated as one of the main lignans of Linum tauricum Willd. ssp. tauricum. The cytotoxic effects 4'-DM-6-Mptox were assessed by the MTT-dye reduction assay against the human leukemic cell lines HL-60, BV-173 and LAMA-84. DNA-fragmentation analysis and NF-kB inhibition assay were performed in order to elucidate some of the mechanistic aspects of the cytotoxic action of the investigated compound. 4'-DM-6-Mptox was found to exert prominent cytotoxicity, with IC50 values being several-fold lower than those of the referent antineoplastic agent etoposide. The DNA-fragmentation analysis revealed that 4'-DM-6-Mptox treatment triggered apoptosis in BV-173 and HL-60 cells. In our hands 4'-DM-6-Mptox was found to induce concentration-dependent NF-kB inhibition in HeLa cells as assessed by the IL-6 luciferase gene reporter assay, which though not quite prominent, at least partly contributes to the cytotoxic potential of the tested lignan. On the basis of the results obtained it could be concluded that 4'-DM-6-Mptox necessitates further pharmacological and toxicological evaluation as a possible chemotherapeutic agent. Furthermore due to its relatively high concentrations in the described plant source the possibility for its use as a precursor for the semisynthetic production of lignan-based drugs, could be considered.

Cytotoxic activity of extracts from Linum cell cultures.

Callus and suspension cultures of Linum narbonense and Linum leonii were developed to study the production of lignans and their cytotoxic activity. Justicidin B was determined to be the main lignan. The maximal yield of justicidin B up to 2.22 mg/g of the cell dry weight was detected in the callus cultures of L. leonii, followed by the callus cultures of L. narbonense (1.57 mg/g dwt). The cytotoxicity of the obtained extracts was measured using the MTT-dye assay. L. narbonense and L. leonii both showed cytotoxic activity.

[Surgical treatment of complicated gastrointestinal forms of non-Hodgkin lymphomas]. / Khirurgichno lechenie na uslozhnenite gastrointestinalni lokalizatsii na non-Hodgkin limfom.

Authors represent their experience in surgical treatment of gastrointestinal forms of No-Hodgkin's lymphomas (NHL) combined with adjuvant therapy. We also represent an Ann Arbor Staging System and an Updated Kiel Classification. From 1991 to 2001 we analyzed 39 patients with different localization of gastro-intestinal NHL's lymphomas. In this aspect more common are stomach's lymphomas--27 patients (71%); small bowel's lymphomas--3 patients (8%); more uncommon are the localizations in colon--3 patients (8%), predominantly in caecum and right colon; rectum--3 patients (5%). Add to thus we described one mechanical icterus caused lymphoma, one multi-lobular spleen lymphoma and one case of anterior abdominal wall lymphoma. All patients underwent surgery. Eight of them were operated as an emergency cases. Operative treatment of NHL isn't radical but in combination with adjuvant therapy can be life saving event in complicated forms.

[Minicholecystectomy--the technical aspects]. / Minikholetsistektomiia--tekhnicheski aspekti.

In current interventional medicine operations on the gallbladder and biliary tracts, performed by "mini" access are ever more widely used in practice. Cholecystectomy done through minilaparotomy is an attractive procedure with well established superiorities, irrespective of the enthusiasm for laparoscopic accomplishment of the interventions in this particular field of surgery. Approbation of the method initiates in the early 80-ies, and ever since then it marks a ceaseless improvement in technical respect. In this report reference is made to a number of technical hints, rendering the procedure safer and readily accessible in the routine surgical practice, as well as successfully competing with laparoscopic cholecystectomy.

[The CO2 laser treatment of extensive skin changes to the vulva caused by the human papillomavirus (HPV) and refractory to other types of therapy]. / Lechenie s CO2-lazer na obshirni kozhni izmeneniia po vulvata, prichineni ot choveshkiia papilomen virus (HPV) i nepoddali se na drug vid terapiia.

The authors describe three cases of large vulvar lesions caused by HPV. One patient has condylomata covering entirely the labia majora and minora, the clitoris, the perineum and the perianal area. The lesions made the structures of the vulva hard to distinguish. She was treated with podophyllin, Solcoderm and diathermy without effect. After 2 applications of Laser vaporisation 40 days apart she was completely cured. The other patient had two big squamous papillomata 3.5 by 3.5 cm and 0.5 cm thick situated on both sides of commissura posterior. She was also treated unsuccessfully with Podophyllin, Solcoderm and surgical excision. She was completely cured by a single-stage CO2-laser treatment. The third patient had condylomata acuminata of the labia minora and majora, fossa navicularis, the perineum and the perianal area. No other treatment had been attempted before. After two sessions of laser vaporisation she was cured, too.

[Gynecological operations in high-risk patients (a preliminary report)]. / Ginekologichni operatsii pri bolni s visok risk (predvaritelno suobshtenie).

The incidence of post-operative complication has been studied in women with concurrent nor-gynaecological and gynecological diseases, such as: vascular diseases (varices, phlebothromboses, thrombophlebitis), hypertension, changes in cardiac status (age-associated. Angina pectoris, cardiac decompensations). ECG changes,valvular defects, increased blood sugar, pulmonary diseases, etc. The study was held retrospectively over 326 female patients who had undergone operations for the period 1992-1993.

[The demonstration of HPV DNA in cervical intraepithelial neoplasms and in invasive carcinomas of the cervix uteri by DNA-DNA in situ hybridization]. / Dokazvane na DNK na HPV v tservikalni intraepitelni neoplazii i v invazivni kartsinomi na matochnata shiika chrez DNK-DNK in situ khibridizatsiia.

Authors were applied a method of DNA-DNA in situ hybridization for demonstration of HPV 6, 11, 16 and 18 in cervical neoplasia and in invasion carcinoma of uterine neck. At 22 probes from CYV III and invasion carcinoma the results from hybridization with virus DNA were shown the presence of HPV-DNA at 15 patients. Some phases of method were optimized. Sensitiveness of method was controlled and compared with the results from the same probes, underlied to investigation with Southern-blot hybridization.