[Laparoscopic hysterectomy--the initial experience in Bulgaria]. / Laparoskopska khisterektomiia--purvi opit v Bulgariia.

The paper presents the first cases of laparoscopic-assisted vaginal hysterectomy and laparoscopic hysterectomy with removal of the uterus through the vagina performed in Bulgaria as well as the experience gained by the team from II gynaecology clinic at State University Hospital "Maichin dom" in Sofia from seven patients operated on by these techniques. The indications, the conditions and the implemented technique with its advantages and difficulties are described. The procedures are associated with less trauma and blood loss than abdominal surgery and are followed by a very smooth postoperative period which is very well tolerated by the patients. No intraoperative complications occurred. The postoperative period was free of any problems in 5 of the patients while in two there were minor complications. Marked shortening of the duration of the procedures is achieved with the initial experience.

[The use of GnRH agonists in severe uterine hemorrhages in adolescence caused by congenital aplastic and hypoplastic anemias]. / Izpolzuvane na GnRH-agonisti pri tezhki matochni kruvotecheniia v adolestsentnata vuzrast, prichineni ot vrodeni aplastichni i khipoplastichni anemii.

GnRH agonists, applied for a long period of time or as depot forms, lead to blocking of gonadotropin and ovarian steroid synthesis. We used their property to induce amenorrhea for treating menorrhagic and menometrorrhagic bleeding in adolescence caused by inborn aplastic and hypoplastic anaemia. In patients with uterine bleeding during the first regular menstrual period or recurring during menstrual periods Zoladex (depot GnRH agonist) has been applied, resulting in stop of bleeding in 2 to 4 days. The drug-induced amenorrhea provides the possibility for physiologic restoring of hemoglobin levels, improvement of therapeutic results from adjuvant antianaemic therapy. Thus a more favourable basis for treating of the main disorder is being created. When surgery is indicated, GnRH agonists provide the opportunity for planning of operating management or for laser ablation of endometrium.

[Our 3- to 5-year experience with Anteovin]. / Nash tri-pet godishen opit s Anteovin.

Anteovin was used in the treatment of dysmenorrhoea, climax precox, dysfunctional uterine bleeding, bleeding with IUD and oral contraceptive. 247 women and adolescents for 6761 cycles were treated with Anteovin for period of 3-5 years. Results were excellent. 21 women--8.17% had side effects.

[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.

[Laparoscopic fenestration of the ovaries]. / Laparoskopska fenestratsiia na iaichnitsite.

The authors have performed an ovary fenestration in 220 women with primary or secondary amenorrhea. This was made with the help of instrumentation for laparoscopy and a monopolar electrodiathermic coagulator with differently shaped endings. The power supply was provided from Martin Elektrotom 2000. A spontaneous recovers of the menstruation was achieved in 36.84% of the cases as a result of the endoscopic intervention. A follows up pregnancy was achieved in 12.4% of the women. Considering the obtained results, the authors recommend the use of a laparoscopic ovary fenestration when a women with ovarian cysts is treated.

[The testicular feminization syndrome--a report of 9 cases]. / Kum sindroma na testikularnata feminizatsiia--s prinos ot 9 sluchaia.

We present the data of analysis of 9 cases (girls and young women) aged 14 to 20 years, with syndrome of testicular feminisation. The patients were diagnosed and treated at the departments of Paediatric and Adolescent Gynaecology and of Gynaecological Endocrinology at the University Ob. & Gyn. hospital in Sofia. The diagnosis was based on the clinical picture, karyogram and radioimmunoassay of gonadotropic and sex hormones. Described were some data as family history, clinical picture, from of the disease, appearance, genital and hormonal status, and histodiagnosis of the removed gonads. Out of nine, primarily diagnosed as a syndrome of testicular feminisation girls and women one ws with an incomplete from, in another further investigations evoked a suspicion of Swyer syndrome (a 14-years-old girl, on whom surgical treatment due to big gonadoblastoma was performed, she died a year later). One patient also developed an ovarian tumour, in six we performed gonadectomy. One patient did not come for any treatment. The differential diagnosis with some relatively rare syndromes, as well as the treatment of this patients were discussed.

[The treatment of synechia labiorum minorum]. / Kum vuprosa za lechenieto na synechia labiorum minorum.

The data of 89 girls aged 4 months to 12 years, with synechia labiorum minorum, diagnosed for the first time in 1991 at the Outpatient Department of Pediatric and Adolescent Gynecology at the University Ob. & Gyn. Hospital in Sofia were analyzed (age distribution, type of synechia, kind of treatment and the effects). The same girls were followed up during the next two years (healing, adverse reactions, reappearance). According to the treatment the girls were divided in two main groups. The first group (72 girls) were treated with blunt dissection of synechia under local anesthesia (two drops anesthetic jelly), followed by two weeks treatment with non-hormonal ointment. The second group, due to old, solid synechiae, the girls were treated only with oestriol ointment. Statistically there is no significant difference in the number of reappearances between the two groups. There were no cases of scars, narrows and adverse reactions. There are differences in the duration of the treatment and in it's costs. In the first group the duration was two weeks and the costs were several times lower than in the second group which duration is 4-8-12 weeks.

[Pelvioscopy in pediatric gynecology and gynecological endocrinology]. / Pelvioskopiia v detskata ginekologiia i ginekologichnata endokrinologiia.

The authors perform diagnostic-operative pelvioscopy on 32 patients with primary and secondary amenorrhea--87.5% and 12.5% respectfully. The follow-up included a comparison of the results from the gynaecologic examination, ultrasound evaluation of the ovaries, sex chromatin and histologic results from the gonadal biopsy material. No ovarian structures were scanned in 28.13% of the cases. In 15.63% of the cases 46XY karyotype was diagnosed and in 4 other cases--46 X iso Xq. The histologic results from ovarian biopsy are as follow: in 37.5% only primordial follicles, in 18.75%-fibrous tissue and in 6.25%-presence of testicular tissue. From the analysis of the results the authors conclude that pelvioscopy combined with gonadal biopsy in cases a distinct place in the diagnostic plan of evaluation.

[A trial of the inhibition of adrenal steroidogenesis in girls with hirsutism]. / Opit za inkhibirane na nadbubrechnata steroidogeneza pri devoiki s khirzutizum.

It was tested the influence of 1 tablet Parlodel on the concentration of hypophyseal-ovarian and hypophyseal-adrenal hormones. It was established, that 1 tablet Parlodel reduces the level of testosterone and cortisol of all tested persons at the second hour of the investigation. The influence of 1 tablet Parlodel is stronger with young girls showing higher initial levels of prolactin and testosterone.

[4 cases of botryoid sarcoma]. / Grozdoviden sarkom s prinos na chetiri sluchaia.

The authors describe the rare botryoid sarcoma--histomorphology, clinic, diagnosis, treatment and prognosis with a contribution of 4 own cases at the age up to 18 years. They indicate the difficulties in the establishment of the diagnosis-early clinical and histological-in three of the cases the histological examination did not establish immediately the exact diagnosis--the material was considered as "granulation tissue" or "fibroma mole". The results of the treatment are summarized as well as the choice of therapeutic methods and drugs. The applied therapeutic scheme consists of radical hysterectomy with systemic pelvic lymph dissection and postoperative chemotherapy. The described four cases are alive at the present moment and without data for tumourous relapse--respectively 11 years and 2 months, 3 years and 4 months, 2 years and 8 months after establishment of the diagnosis.

[A report of 2 cases of the Herlyn-Werner-Wunderlich syndrome]. / Kum sindroma na Herlyn--Werner--Wunderlich s prinos na dva sluchaia.

Two cases are described, illustrating two varieties of comparatively little known, but not rarely encountered syndrome--the syndrome of Herlyn-Werner-Wunderlich. The characteristic and the symptoms of the syndrome are presented and various concepts on therapeutic management are discussed. The question about future fertile capability of the patients is discussed as well.

[Vaginoscopy--a modern method in pediatric-adolescent gynecology]. / Vaginoskopiia--suvremenen metod v detsko-iunosheskata ginekologiia.

Inspection of the vagina is a compulsory part of the examination of sexually mature woman. However, the intact hymen is assumed as a barrier, which could not be surmount without physical or psychic traumatization of a girl at the infant-adolescent age. Fear of hymen traumatization in practice is stronger than fear to miss some gynecological diseases. The necessary instruments as well as the basic indications for vaginoscopy are described. A review is made on the cases admitted in 1987 to the ward of the infant-adolescent gynecology at Institute of Obstetric and Gynecology, in whom vaginoscopy has been performed. The findings and the succeeding therapy are discussed. An inference is made for necessity of knowing and usage of the method as well as for its possibility to establish exact diagnosis and application of adequate therapy.