[PROGNOSTIC MODELS IN MODERN MANAGEMENT OF VULVAR CANCER].

AIM: The aim of the research was to evaluate and analyse prognosis and prognostic factors in patients with squamous cell vulvar carcinoma after primary surgery with individual approach applied during the course of treatment. MATERIALS AND METHODS: In the period between January 2000 and July 2010, 113 patients with squamous cell carcinoma of the vulva were diagnosed and operated on at Gynecologic Oncology Clinic of Medical University, Pleven. All the patients were monitored at the same clinic. Individual approach was applied to each patient and whenever it was possible, more conservative operative techniques were applied. The probable clinicopathological characteristics influencing the overall survival and recurrence free survival were analyzed. Univariate statistical analysis and Cox regression analysis were made in order to evaluate the characteristics, which were statistically significant for overall survival and survival without recurrence. A multivariate logistic regression analysis (Forward Wald procedure) was applied to evaluate the combined influence of the significant factors. While performing the multivariate analysis, the synergic effect of the independent prognostic factors of both kinds of survivals was also evaluated. RESULTS: Approaching individually each patient, we applied the following operative techniques: 1. Deep total radical vulvectomy with separate incisions for lymph dissection (LD) or without dissection--68 (60.18 %) patients. 2. En-bloc vulvectomy with bilateral LD without vulva reconstruction--10 (8.85%) 3. Modified radical vulvactomy (hemivulvectomy, patial vulvactomy)--25 (22.02%). 4. wide-local excision--3 (2.65%). 5. Simple (total /partial) vulvectomy--5 (4.43%) patients. 6. En-bloc resection with reconstruction--2 (1.77%) After a thorough analysis of the overall survival and recurrence free survival, we made the conclusion that the relapse occurrence and clinical stage of FIGO were independent prognostic factors for overall survival and the independent prognostic factors for recurrence free survival were: metastatic inguinal nodes (unilateral or bilateral), tumor size (above or below 3 cm) and lymphovascular space invasion. On the basis of these results we created two prognostic models: 1. A prognostic model of overall survival 2. A prognostic model for survival without recurrence. CONCLUSIONS: Following the surgical staging of the disease, were able to gather and analyse important clinicopathological indexes, which gave us the opportunity to form prognostic groups for overall survival and recurrence-free survival.

[Effect of 6-month treatment with oral antiandrogen alone and in combination with insulin sensitizers on body composition, hormonal and metabolic parameters in women with polycystic ovary syndrome (PCOS) in order to determine therapeutic strategy].

UNLABELLED: PCOS is a complex disorder with variability of phenotypes, characterized by hyperandrogenic, anovulatory and metabolic components. The later is a result of specific insulin resistant state with compensatory hyperinsulinaemia. Oral hormonal contraceptives (OHC) are a treatment of first choice in hyperandrogenic PCOS women who do not desire conception. Addition of insulin sensitizers might counteract unfavourable metabolic consequences of OHC monotherapy and could result in additional benefits for treated PCOS women. AIM: To compare the effects of 3 therapeutic regimens widely used in practice--OHC alone and in combination with metformin or rosiglitazone on body weight and anthropometric proportions, hormonal and metabolic alterations. MATERIAL AND METHODS: The study comprised of 44 women with proven PCOS, divided in 3 therapeutic groups: 1st group--with Diane35 alone; 2nd group--with Diane35 + metformin; 3rd group--with Diane35 + rosiglitazone. Body weight, fat mass and distribution, hormonal levels, metabolic parameters (insulin and blood glucose during oGTT lipid profile) were studied before and after a 6-month treatment. RESULTS: Monotherapy with Diane35 did not lead to changes in body weight, fat mass and distribution; had beneficial influence on some of the hormonal alterations in PCOS, but did not achieved significant antiandrogenic effect; did not induce changes in carbohydrate tolerance while having mild negative effect on insulinaemia; had an unfavourable although mild influence on lipid parameters including atherogenic indices except the HDL-cholesterol; did not show side effects on liver and vascular function. Combined treatment with Diane35 and metformin led to reduction of weight, fat mass and abdominal fat distribution; possessed significant antiandrogenic effect; did not decrease blood glucose levels; supressed glucose-stimulated insulin levels; had beneficial effect on HDL-cholesterol and neutral effect on other lipid parameters and atherogenic indices; decreased diastolic blood pressure. Combined treatment with Diane 35 and rosiglitazone did not induce changes in body weight, fat mass and abdominal fat distribution; possessed significant antiandrogenic effect; did not influence fasting and postchalange glucose levels; suppressed fasting hyperinsulinaemia and HOMA-index, respectively; had neutral effect on the levels of lipid parameters and atherogenic indices.

[Comparative diagnostic characteristics of carbohydrate metabolism disorders in women with polycystic ovary syndrome (PCOS)]. / Sravniavane na diagnostichnite pokazateli za otsenka na narusheniiata vuv vuglekhidratniia metabolizum pri zheni sus sindrom na polikistozni iaichnitsi (PCOS)

The aim of the study was to compare the information provided by both fasting and stimulated during a standard oral glucose tolerance test (oGTT) levels of glucose and insulin as regards glucose tolerance and insulin resistance in women with PCOS. Few criteria are used in practice to verify insulin resistance in PCOS--elevated fasting insulin, decreased basal glucose/insulin ratio (< 6 for glucose in mg/dl or < 0.333 for glucose in mmol/l), insulin increase of more than 100 lul during an oGTT, and HOMA index > 2. The study comprised of 94 women (mean age 21.8 +/- 5 = 8 ys, mean BMI-30.38 +/- 7 = 7 kg/m2), divided in 4 groups according to BMI--group with BMI < 25, n = 21; group with BMI25-30, n = 27; group with BMI = 30-35, n = 23 and group with BMI > 35, n = 23. An oGTT with parallel determination of blood glucose and insulin was performed in all patients. The ratio basal glucose/insulin and HOMA index were calculated. Glucose levels on the 2 md hour during the oGTT pointed at IGT (impaired glucose tolerance) and/or diabetes in 8.5% of the investigated patients while the fasting levels indicated disturbances in only 2.2% of them. Fasting insulin levels were in the normal range in a considerable part of PCOSE women, mainly those with normal weight, and were not predictive for the response of insulin to glucose load. Relative percent of patients with elevated fasting insulin rose with the increasing of BMI. Decreased glucose/insulin ratio, elevated HOMA index, and abnormal stimulation of insulin were seen in more than 2/3 of the PCOS women including nonobese ones. Information provided by the above three markers was similar and they could be used alternatively according to the particular case and assessment of the cost/benefit ratio.

Cancer in populations living in regions with radioecological problems in Bulgaria.

PURPOSE: To analyse the incidence and mortality of some malignant diseases among the population living in regions of past uranium extraction in Bulgaria. MATERIAL AND METHODS: A retrospective study on cancer incidence and mortality in the population living around two regions with radioecological problems was conducted. According to the expected individual annual effective doses for the population, regions with expected highest radiation risk (average effective dose > 10 mSv per year) were the villages Yana, Eleshnitza and Seslavtzi (group A), and with expected relatively high radiation risk (average effective dose > 5 mSv per year) were the town of Buhovo, and the villages Dolni Bogrov and Gorni Bogrov (group B). The ecologically clean village German was chosen as a control settlement. The incidence and mortality of gastrointestinal tract cancers, bronchus and lung cancer, breast cancer, thyroid cancer, and myeloid leukaemia for the period 1995- 2001 were studied. RESULTS: The incidence of the gastrointestinal tract cancers in the population of German was significantly lower than those for Bulgaria and for group B. The mortality from this disease of groups A, B and Bulgaria were significantly higher than in the control settlement. Standardized mortality of lung cancer in the population of the villages with highest and relatively high radiation risk was significantly higher than in German and Bulgaria. CONCLUSION: The incidence and mortality changes of diseases studied are a consequence of the impact of many factors. Moreover, they do not characterize the impact of the radiation factor.

Does alcohol protect against ischaemic heart disease in Bulgaria? A case-control study of non-fatal myocardial infarction in Sofia.

BACKGROUND: Many observational studies have shown that alcohol consumption is associated with a reduced risk of ischaemic heart disease (IHD). IHD mortality has generally fallen in established market economies but not in some countries of Eastern Europe. Since the level of consumption of saturated fat does not explain these differences in trends, other associations with risk need to be explored. We investigated whether alcohol consumption also presents a U or J-shaped association with IHD risk in a case-control study in Bulgaria. METHODS: Cases (n = 155) were admissions to the cardiology unit, Central Clinical Hospital, Sofia, aged 45 to 69, with confirmed diagnoses of ischaemic heart disease. Controls (n = 154) were concurrent admissions for minor elective surgery. Measurements were made of blood pressure, height and weight and a blood sample was taken around three days after admission. Subjects were interviewed before discharge and asked about the type and amount of alcohol they consumed. RESULTS: Reported alcohol intake demonstrated a J-shaped association with the risk of IHD. The odds ratio (adjusted only for age and sex) was 0.67 (95% CI 0.34-1.28) for patients reporting 0.01-18 g/d of alcohol consumption daily, and 0.36 (95% CI 0.18-0.73) for 18.01-36 g/d, compared to patients reporting to be abstainers. The associations with alcohol intake remained statistically significant and unaltered after adjustment for established IHD risk factors: HDL cholesterol, body mass index, systolic blood pressure, family history, education, physical activity and risk factors significantly related with IHD: fruit and vegetables consumption, type of fat used in cooking, bread consumption. CONCLUSIONS: Our results are consistent with previous studies showing a J-shaped association between alcohol intake and IHD risk. The highest protective effect we observed for levels of alcohol intake 18.01-36 g/d, which corresponds to 100-200 ml wine or 1-2 beers, or little more than 50-100 ml spirits.

[Secondary sclerosing cholangitis after echinococcectomy]. / Vtorichen sklerozirasht kholangit sled ekhinokokektomiia.

This is case report concerning secondary caustic sclerosing cholangitis following scolecide with concentrated sodium chloride solution (30%) during operation on a liver echinococcus cyst with involvement of the extrahepatic biliary apparatus only. Hepatojejunostomy is performed. Histological study of the liver demonstrates evidence of severe cholangitis, purulent cholangiolitis and suspected secondary biliary cirrhosis. In conclusion, it is stressed that dynamic postoperative follow-up of patients is mandatory to make early diagnosis of the complication and undertake operative treatment anticipating the development of a cirrhotic process. The search for new, effective scolicides, not damaging the biliary apparatus and hepatic parenchyma, is strongly recommended.

[The surgery of huge retroperitoneal tumors]. / Vurkhu khirurgiiata na ogromnite retroperitonealni tumori.

Observations of successfully operated huge retroperitoneal tumors, one of them weighing 14.700 kg, are reported. The advantages for precise diagnosis of modern visualizing techniques--echography and computer tomography--and the inability to establish always an exact cytologic diagnosis by puncture aspiration biopsy are demonstrated. Total extirpation of the tumor with subsequent combined chemo-, radio- and immunotherapy is advised.

[A case of epidermoid cysts in the spleen]. / Sluchai s epidermoidni kisti na slezkata.

A rare case of epidermoid cysts of the spleen in a 16-year-old boy, presenting with early clinical symptoms, is reported. In view of the extreme rarity of primary cysts of the spleen, the authors contemplate on the possibilities for establishing the diagnosis.

[The structure and function of an automated system for predicting neonatal body weight (the Sinodeta P/1)]. / Struktura i funktsii na avtomatizirana sistema za prognozirane na telesnata masa na novorodeno (Sinodeta P/1).

The structure and function of an automated nosometric system, created by the authors, for prognosis of the risk of delivery of a child with low weight is described. The system is designed for health services, which give direction to parturient (public health sectors) and obstetric wards without technique and specialists for management of such children. The summarized extract is made on 883 cases, but verification--on 463 cases. The total effectiveness of the system is 82.1% against 66.25% of exact results during intuitive prognosis.

[Pathomorphological research on chlamydial abortion in sheep]. / Patomorfologichni prouchvaniia vurkhu khlamidiiniia abort pri ovtsete.

Serologic and morphologic studies were carried out with ewes and aborted fetuses, respectively, with regard to the Chlamydial infection in the flocks of some farms. The complement-fixation test was employed to examine a total of 656 blood serum samples. It was found that 20.2 per cent of these contained Chlamydial antibodies. Abortions were established with 6 to 8 per cent of the sheep in each flock. Material was sampled from 35 aborted fetuses. Featuring in the gross lesions of the fetal placenta in Chlamydial abortions were the wheat-bran type of whitish coatings on the surface. Characteristic histologic findings were desquamation, necroses, lympho-leukocytic infiltrations, and the partial deposits of calcium salts. Definite diagnostic value with the aborted fetuses were shown to have the lympho-histiocytic proliferations in the liver, adrenal glands, kidneys, lungs as well as the reticuloendothelial hyperplasia with the presence of gigantic cells of Langhans type in the mesenterial lymph nodes.

[Differential pathomorphological diagnosis of Q fever and Chlamydia and Toxoplasma abortions in sheep]. / Vurkhu patomorfologichnata diferentsialna diagnoza na Ku-treska, khlamidiiniia i toksoplazmozniia abort pri ovtsete.

Morphologic differential diagnostic investigations were carried out with a total of 134 aborted sheep fetuses. The studies were coupled by the examination of 665 blood serum samples from sheep that were pregnant or had miscarried. Parallel bacteriologic studies were also carried out. Positive serologic results were obtained in 43.74 per cent of the cases (toxoplasmosis), 20.2% (chlamydial infection), and 14.4% (Q-fever). Gross lesions were found in 64 fetuses (toxoplasmosis), 18 (Q-fever), and 35 (chlamydial infection). Histologically, diagnostic value in chlamydial abortions had the lympho-histiocytic proliferations in the liver, adrenals, and kidneys. The mesenterial lymph nodes presented diffuse reticuloendothelial hyperplasia with gigantic cells of Langhans type. Microscopically, in the case of Q-fever the aborted fetuses showed lympho- histiocytic proliferations and nonreactive micronecroses in the liver, adrenals, lymph nodes, and kidneys; nonpurulent meningoencephalitis was also found. The histopathologic picture seen in the aborted fetuses in the case of toxoplasmic abortion presented characteristic diffuse glial proliferation, and glial nodes and necroses in the white matter of the cerebrum and the cerebellum. In the liver, kidneys, adrenals, and lymph nodes there were focal lymphoid-cell proliferations and micronecroses. Macroscopically, the fetal placenta showed pathognomonic gray-whitish nodules; histologically, in such cases there were pseudo-cysts and vast deposits of calcium salts.

[Isolation of chlamydia in keratoconjunctivitis]. / Izolirane na khlamidiia pri keratokoniunktiviti.

Two isolates, identified as Chlamydia (neorickettsia) were obtained from the lacrimal secretion of calves with an acute infection on two of a total of four investigated farms with a record of infectious keratoconjunctivitis. In about 70% of the calves that survived there were complement-fixing antibodies against the neorickettsial antigen, the titers ranging from 1:8 to 1:64. Calves that yielded the causative agent were investigated in terms of the antibody dynamics. In the remaining herds no specific antibodies were demonstrated in animals that had survived. One of the isolated strains was used to infect (via the external camera oculi) a rabbit. Acute keratoconjunctivitis followed, and the blood serum of the rabbit was found to contain complement-fixing antibodies of a titer within the 1:8-1:16 range from the 30th day on. A neorickettsial strain was also isolated from the ocular secretion of a dog with serofibrinous keratoconjunctivitis, and this was regarded as a rarely encountered finding.

[Studies of the etiology of infectious abortion in cows in Ruse District]. / Prouchvaniia vurkhu etiologiiata na infektsioznite aborti po kravite v Rusenski okrug.

A total of 28,159 blood serum samples have been examined for brucellosis, 87--for leptospirosis, 84--for toxoplasmosis, 554--for the presence of rickettsii and neoreckettsii, and 193--for total protein content, albumin, and protein fractions, taken from cows in the course of the years on 40 dairy farms in the district of Rousse. Bacteriologically were examined 349 aborted fetuses, 178 samples of estral secretion, 57 placentae, and 1002 samples of washings and seminal fluid from bulls for vibriosis. Bacteriologic investigations were also carried out on 383 fetuses for salmonellosis, listeriosis, and colibacteriosis, and virologic studies of 398 placentae and parenchymal organs of fetuses. Twenty-eight fetuses were studied parasitologically for toxoplasmosis, and 118 blood smears were examined for hemosporidiosis. It was established that most important in the etiology of the infectious abortions in cows in the district of Rousse were Vibrio organisms. They were found in 36.9 per cent of the studied bovine fetuses and in 24.4 per cent of all materials examined bacteriologically. Only 4 cases were noted of neorickettsii from fetuses and placentae. Serologically, there were 23.6 per cent cases positive for neorickettsiosis, and 12.6 per cent--for Q fever; 56.4 per cent of the investigated sera proved positive for leptospirosis. In 0.8 per cent of the examined fetuses there was Escherichia coli. Abortions in cows were also due to anaplasmosis and francaillelosis; 14.2 per cent of the investigated respective sera were positive for toxoplasmosis. On the days of abortions the amount of total protein was 7.13 mg%, that of albumins--36%, and of globulins--64%. It is considered imperative to elucidate the cause of abortions of infectious nature in cows in connection with the establishing of cattle-breeding complexes.

[Experimental Q-rickettsiosis in lambs]. / Eksperimentalna ku-riketsioza po agnetata

The clinical course, serologic response, and morphologic changes were followed up in month-old lambs infected nasally and via the trachea with Rickettsia burneti at the rate of 10,000 ID50/cm3. Rickettsiae were found in the parenchymal organs, the blood clot, the nasal cavity, the trachea, and the feces of the animals killed on the 7th and 21st day of infection. Complement-fixing antibodies were established in the infected lambs with the use of the complement-fixation test from the 5-6th up to the 160th day (period of testing), the highest value of the titer (1:160) being observed on the 32nd day. Demonstrated were changes in the vessels, and degeneration was found in the liver, kidneys, and other viscera along with proliferative changes in the spleen. Guinea pigs and albino mice were successfully made use of to isolate Rickettsia burneti from the infected parenchymal organs, feces, and others of affected lambs.

[Epizootiological and parasitological status of the flocks at a poultry combine]. / Vurkhu epizootologichniia i parazitologichniia status na stadata v edin ptitsekombinat

A comprehensive epizootiologic study has been carried out at one of the large poultry dressing combines in this country. Results have shown that the part played by infections as against the remaining diseases established in the various technologic categories is as follows: 9 to 23.8 per cent in growing parents; 16.0 to 24.6 per cent in adult parents; and 4.8 to 13.4 per cent in broilers. So far as parasitic diseases are concerned the respective figures are 3.2 to 9.9 per cent, 3.0 to 3.3. per cent, and 2.9 to 3.0 to per cent. The import of birds from France and England intended for satisfying the needs of the poultry dressing combine in Roussé has contributed to the introduction of infections which have later on assumed an epizootic course, such as infections encephalomyelitis, infectious bronchitis, and Marek' disease. The epizootic status has been aggravated with the development of a number of diseases already existing in this country--fowl pox, lymphoid leukosis, chronic respiratory disease, salmonellosis, and above all infections caused by the so-called occasionally pathogenic agents--coli organisms, staphylococci, and Pseudomonas. Of the parasitic diseases only coccidiosis has developed, being caused by a variety of species: Eimeria acervulina, Eimeria necatrix, Eimeria maxima, Eimeria muvati and Eimeria tenella. The absence of helminth infections is due to the routinely adopted technological practice of raising birds in confinement and the strict veterinary control and guard. On the basis of the results obtained and the conclusions drawn some more effective prophylactic measures are suggested correcting and supplementing the existing prophylactic programme.

[Passive immunity in calves born of cows that have recovered from foot-and-mouth disease or been vaccinated against it]. / Prouchvane na pasivniia imunitet pri teleta, proizkhozhdashti ot preboleduvali i ot vaksinirani sreshtu shap kravi

It has been found that the antibody titers in the case of passive immunity in calves from cows that have recovered from foot-and-mouth disease or have been vaccinated against it rise immediately following the intake of colostrum. They have been found to reach a peak level, displaying maximal values for a long period of time. Later on the antibody titers decline gradually. Specific antibodies have also been demonstrated at the age of more than two months following birth. Higher values of passive immunity have been established in calves from survivals and from cows that have been vaccinated twice and this is explained by the presence of a higher content of foot-and-mouth disease antibodies in the dams. The importance of passive immunity for the prevention of the disease in growing animals is discussed.