[LAPAROSCOPIC TREATMENT OF INTRALIGAMENTAL LEIOMYOMA PER MAGNA].

Uterine myoma is the most frequent benign tumor of female organs. Intraligamentary myomas in the broad ligament are rare. We present a case of 50 years old patient with 22 cm intraligamentary myoma with cystic degeneration, who is referred to the Gynecological Department of Ob/Gyn Hospital "Dr. Shterev" with complains of severe pain. This case is interesting for its rareness and diagnostic dilemma, because degenerative myomas can imitate malignant mass. Total laparoscopic hysterectomy with ablastic vaginal morcellation of the specimen in endobag was performed. The patient was discharged from the clinic next day.

[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.

[TRANSVAGINAL LAPAROSCOPY FOR PELVIC ENDOMETRIOSIS.]

Transvaginallaparoscopy (TVL) has been described by S. Gords in 1990's. Comparig to histerosaqlpingograpy (HSG) it allows visualization of tubal mucosa. Transvaginal laparoscopy is alternative of conventional laparoscopy for infertility patients. It has significant advantage regarding minimal invasiveness and absence of abdominal incisions. Literature data shows 96.1% accuracy of TVL against laparoscopy regarding operative findings. Presence of operative port ensures possibility of doing minimal interventions like adhesiolysis, ovarian drilling and endometrioma ablation. Although these advantages this procedure is not very popular in our country yet.

[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.

[COMBINED APPLICATION OF FETAL FIBRONECTIN AND INSULIN-LIKE GROWTH FACTOR IN PRETERM DELIVERY DIAGNOSIS--OUR RESULTS].

The insulin-like growth factor IGFBP-1 is a binding protein (IBP-1), also known as placental protein (PP12), is encoded in people as IGFBP-1 gene. The IGFBP-1 is an especially vital hormone in the female reproductive physiology. The presence of it in large quantities in the amniotic fluid can be used as a biochemical marker for preterm birth and premature rupture of membranes. Fetal fibronectin is a high-molecular glycoprotein, that is produced during pregnancy and has a role as biological glue, binding the foetus membranes to the endometrium. fFN can be found in the cervicovaginal secretions until 22nd gestational week and later on during the last trimester (1 to 3 weeks before birth). fFN is usually absent between 24th and 34th gestational week. Thirty sixth (30%) of all the 120 females tested had positive fFN test results and were, therefore, at high risk for preterm delivery. Despite the implemented tocolytic therapy, 15 (12.5%) of them delivered before the 37th gestational week. The results from the investigation for the presence of pLGFBP-1 in 120 pregnant women show that 35.8% (43 women) were positive and 15(12,5%) of them delivered before the 37th gestational week despite the implemented tocolytic therapy In both tests, the average gestational age of the premature fetus was 32.5 ÷ 2.8 gestational weeks.

[Pelvic exenteration--our experience].

Pelvic exenteration is an operative method for one-moment removal of pelvic organs, including reproductive tract, bladder and rectosidgmoid. It most common indicated in gynecologic oncology for treatment of locally advanced cancer or recidive with central location. Pelvic exenteration can be used for healing of patients with genital cancer. Frequency of serious complications can reach 50%, that emphasizes the need of careful discuss of risks and benefits with the patients who are indicated for that kind of operation. For the period 2004-2012 common 46 exenterations are performed at FSHOG "St. Sofia", form which 9 are total (TE), 14 anterior (AE), 7 posterior (PE), 16 modified posterior exenterations (MPE). Average operative time is 459 min (237-620 min), depending on the type of operation. Average blood loss is 1200 ml (800-2500 ml). Report of the complications shows that eight patients have had 1-st degree complication.

[Laparoscopic vs abdominal myomectomy].

The aim of this study is to determine the most appropriate method for operative treatment of uterine myoma through comparison of laparoscopic myomectomy (LM) and abdominal myomectomy (AM). We will examine perioperative indicators and results for patients with uterine myomas. We operated 172 women for the period from January 2011 to April 2014. 106 patients were operated by abdominal myomectomy and 66 were operated by laparoscopic myomectomy. In this study were included only cases with intramural fibroids bigger than 5 cm. We explored the following indicators: age, BMI, preoperative Hgb, preoperative Hct, size, number and location of the myomas for both groups. We analyzed intra- and postoperative indicators operating time, hospital stay, postoperative Hgb and Hct. Data shows less postoperative decrease of Hgb and Hct, less blood loss, shorter hospital stay for the group with laparoscopic myomectomy, but significantly increased operative time compared to the group with abdominal myomectomy.

["Second look" after laparoscopic myomectomy--is that a prevention of postoperative adhesions].

OBJECTIVE: To investigate the risk of adhesions after laparoscopic myomectomy (LM). To establish the percentage of adhesions, their kind, situation and magnitude. MATERIALS AND METHODS: For the period form June 2011 to November 2013 totally 81 patients were operated by LM. In the study only patients with intramural leymyomas bigger than 5 sm were included. For this period 14 patients had second-look because of the need of another operation--LS or Ceasarean section. 22 myoma incisions were checked. We established 35.7% adhesions per patient. After LM adnexas were engaged in 14.2%. CONCLUSION: The factors, responsible for the formation of postoperative adhesions are: the location of the myoma in the posterior uterine wall, excessive accumulation of suturing materials and additional operative interventions. For patients underwent LM and willing pregnancy we recommend second look laparoscopy.

[Laparoscopic burch colposuspensio--our experience].

Stress incontinence is involuntary loss of urine that occurs during periods of increased intraabdominal pressure, such as sneezing, coughing or exercise. Retropubic Burch colposuspension has been considered by many to be the "gold standard" procedure for treatment of female stress urinary incontinence for almost 50 years. The firs reported retropubic surgery performed via the laparoscopic approach was described by Vancaillie and Schuessler in 1991. We present a clinical case of a female patient with stress incontinence who has been operated by laparoscopic approach by our team.

[3D laparoscopy system in gynecological practice].

Laparoscopic gynecologic procedures have become increasingly popular but their widespread use has been limited by training issues. Recent technological advancements have led to the introduction of new three-dimensional (3D) cameras in laparoscopic surgery. The use of 3-dimensional (3 D) vision may aid in training and performance of laparoscopic tasks. 3-D visualization improves the learning curve forlaparoscopic surgery. Surgeons must consider 3D systems when leaming complex laparoscopic surgeries.

[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.

Changes in phagocyte activity in patients with ischaemic stroke.

The activity of peripheral phagocytes to generate reactive oxygen species (ROS) was studied in healthy individuals and patients with ischaemic stroke. The aim was to clarify the relationship between phagocyte activity, the time elapsed after the onset of disease and stroke severity. The total and extracellular production of ROS were evaluated by luminol chemiluminescence. Simultaneously the plasma oxidant activity was determined. When stimulated by opsonized zymosan, phagocytes in patients with stroke (regardless of its severity) showed fast activation. The total ROS generation increased over time in all stroke cases studied. However, the extracellular ROS generation was found to be greater in patients with severe stroke than in those with mild neurological deficiency. When stimulated by formyl-methionyl-leucyl-phenylalanine, the total oxidative phagocyte capacity (regardless of stroke severity) increased over time, but there was no change in the amount of extracellularly generated ROS. In patients with stroke the oxidant activity of plasma was enhanced. We conclude that circulating phagocytes in patients with ischaemic stroke are primed for enhanced ROS production by opsonin receptor-mediated stimulation and for increased secretion of myeloperoxidase by opsonin receptor-independent stimulation. The enhanced extracellular generation of ROS through opsonin receptor-dependent stimulation may be considered an oxidative stress biomarker in cerebral ischaemia.

Functional states of polymorphonuclear leukocytes determined by chemiluminescent kinetic analysis.

During the respiratory burst, upon stimulation with both soluble and particulate matter, polymorphonuclear leukocytes (PMN) generate reactive oxygen species (ROS) and emit chemiluminescence (CL) as a result of metabolic activation. The measurement of CL has been demonstrated to be a useful tool for in vitro assessment of the opsonophagocytic function of PMN. Using component analysis of CL kinetics, we characterized the functional state of PMN by three parameters of the respiratory burst: capacity, effectiveness and velocity (CEV space). The possibility of delimiting eight different functional states of PMN is discussed. The CL kinetics shown by blood PMN in different functional states was analysed, and revealed six out of eight functional states. We conclude that CEV-estimated functional states of PMN are relative, depending on both PMN readiness to generate ROS and conditions of the CL test.

Modification of Lowry's method for collagen concentration measurement.

A procedure for the determination of collagen concentration is described. It is simple and sensitive and is based on a modification of Lowry's method. The modification includes an initial heating of collagen samples in alkaline solution and changes in the concentrations of reagents used. It may be used for different collagen types, i.e. I, II, V and XI, from various sources as well as for gelatine. The influence of different buffers, salts, detergents, etc. on the precision of the method was studied. The precision of the measurements was not influenced by pH, the turbidity of the sample and the presence of certain salts, osmolytes and preservatives, routinely used in biochemical, microbiological and immunological experimental protocols. The modification is suitable for routine determinations of collagen concentration in a wide variety of samples.

Model components of luminol chemiluminescence generated by PMNL.

The production of activated oxygen species (AOS) by neutrophils (PMNL) is thought to play a key role in the host defence against invading microorganisms. However, the oxygen metabolites are toxic not only to the invading bacteria but also to the surrounding tissue. The oxidative metabolites production can be evaluated by means of chemiluminescent methods. In this study, the possibility of a new analytical approach for quantitative assessment of chemiluminescent kinetics (AOS generation) of isolated PMNL was estimated. Based on the assumption that the kinetics of luminol-amplified chemiluminescence (LCL) of stimulated PMNL possesses a time-probabilistic nature, this kinetics was described with three components. These components, obtained from different investigated systems, were analyzed and a conclusion was made that the first and the second component represent the processes resulting in extra-and intracellular myeloperoxidase (MPO)-dependent light emission (AOS generation), respectively. The second component was found to be completely dependent on the stimulus ingestion. The third component was not completely MPO-dependent and complicated for interpretation. This component was weakly dependent on the stimulus ingestion, and presents at least some intracellular processes different from those presented by the second component. A conclusion is made that the examined approach for analysis of LCL kinetics allows an assessment of extra-and intracellularly generated quantities of AOS by stimulated PMNL. The assessment could be done for emitting systems in which no additional modifications are used.

A new approach for analysis of chemiluminescent kinetics of activated phagocytes in blood.

Luminol chemiluminescence (LCL) is a simple, sensitive and time-saving tool to elucidate the oxidative activity of polymorphonuclear leukocytes (PMNL). In this study, a new approach for analysing the LCL kinetics, recorded from stimulated PMNL, and for a more accurate elucidation of their functional state, is proposed. This approach is based on the proposal that the LCL kinetics of stimulated PMNL is a result of time-probabilistic nature of the processes, leading to light emission. On this basis the LCL response was described by the parameters of a Poisson-type distribution. Relationships between these parameters and some factors influencing LCL kinetics (number of PMNL and erythrocytes, temperature, stirring) were investigated. The model descriptions of the LCL responses obtained had two components (modes). Their development in time was different. It was suggested, that the two phases of the model LCL response were connected with extracellular and intracellular LCL. The terms and the advantages of this approach for analysis of phagocyte oxidative capacity are discussed.

Inert characteristic and functional refractory period of the atrioventricular node in rabbit heart preparation.

The effect of heart rate on the functional refractory period (FRP) of the atrioventricular node (AVN) is studied. A conclusion is reached that FRP, being a complex characteristic of AVN, should not be directly related to conduction time, but it can serve as a measure of the maximum moment acceleration which AVN is capable of transmitting to the lower-lying structures. It is proposed to use the coefficient of relative acceleration for quantitative estimation of the inert (dynamic) properties of the node at different heart rates. It is concluded that for a longer basic cycle length (BCL) AVN is characterized by greater reserve possibilities for transformation of accelerations of the input rhythm.