[Effective tocolysis without ß-agonists].

UNLABELLED: Many years the ß-mimetics (Partussisten, Gynipral) were first line tocolytic agents in terms of delaying premature delivery in our country. As these medicaments have been withdrawn from the pharmacy network, some concerns began to appear among our colleges considering the administration of other tocolytics and their effectiveness. Our goal is to compare the efficacy of other tocolytics with ß-mimetics. That is why we reviewed the structure of premature deliveries in the University Hospital "Stoyan Kirkovich", Stara Zagora for two periods: 01.01.2013 - 31.12. 2013 and 01.01.2014 - 01.06.2014. RESULTS: 45 of 326 pregnancies (13.8%) > 20 weeks of gestation for 2013, treated with Gynipral have ended with a premature delivery vs. 13 of 110 pregnancies (11.8%), treated with magnesium (Mg SO4, Magnerich, Magnerot), calcium channel blockers and spasmolyticsfor the period - 01:01.2014 - 01.06.2014. CONCLUSION: The results show, that at this stage, several months after the cessation of use of ß-mimetics, there is no rise of number and percentage of premature deliveries, but there is even a tendence of decline. Larger periods and greater number of cases are needed to formulate conclusions with greater significance.

[Tumor size and prognosis for patients with epithelial ovarian carcinoma at early stage].

UNLABELLED: The goal of the research is to discover and analyze the dependence of survival on the tumor size in a cohort of 215 female patients with early epithelial ovarian cancer fallowed up for 13 year period (2000-2012). After multiple analyze among 18 other prognostic factors, using Cox proportional regression, tumor size remained one of five most significant. CONCLUSION: The bigger the size of the tumor, the poorer the prognosis for the overall survival (p = 0.0001) and progression free survival (p = 0.4) of patient with epithelial ovarian cancer at early stage.

[Laparoscopy and early ovarian cancer].

UNLABELLED: Review of modern opinions and tendencies, concerning the role of laparoscopic surgery for the staging and treatment of ovarian cancer stage I-II. CONCLUSION: The laparoscopic approach of surgical staging of early ovarian cancer is equal and even has more advantages then conventional laparotomy if it is performed from gynecologists- oncologists with enough skills and experience in laparoscopic surgery.

[Operative treatment--prognostic factor in patients with ovarian cancer stage I-II].

OBJECTIVE: The authors present and analyze the modern concepts of the role of surgery as a prognostic factor for patients with early epithelial ovarian cancer (st. I-II). They review, synthetize and summarize the information from 15 studies, published in the recent years, and concerning the subject. CONCLUSION: Surgery treatment for early epithelial ovarian cancer is one of the most important prognostic factors. The appropriate surgical performance contributes either for complete staging or for optimal primary cytoreduction and strongly influence the development and outcome of disease.

[The role of adjuvant chemotherapy as a prognostic factor in patients with early stage of epithelian ovarian cancer (I - II stage)].

UNLABELLED: The authors present and analyze the modem concepts of the role of adjuvant chemotherapy as a prognostic factor for patients with early epithelial ovarian cancer (st. I-II). They review, synthetize and summarize the information from studies and researches, published in the recent years, and concerning the subject. CONCLUSION: Adjuvant chemotherapy for early epithelial ovarian cancer improves overall survival of patients having tumors with grade 2 or 3, stagelC or grater and suboptimal surgical staging.

[Impact of the ammount of medicaments, administered as adjuvant chemotherapy, over the survival of female patients with early epitelial ovarian cancer].

UNLABELLED: A cohort of 215 female patients with early epithelial ovarian cancer, researched for 13 year period (2000-2012). The authors are setting a goal to investigate how does the amount of chemotherapeutic medicaments, administered as adjuvant therapy influences the survival of these patients. CONCLUSION: The application of three or more chemotherapeutic agents does not improve the survival of female patients with early epithelial ovarian cancer, indicated for chemotherapy.

[Postoperatively conformed effectiveness of preoperative radio therapy, combined with chemotherapy - cysplatin].

The authors present a case of a 35 years old female patient with spinocellular carcinoma of the cervix, diagnosed after byopsy and treated with radiotherapy 30 Gray, combined with Cisplatin 50 mg. per square meter, per week, 6 months before radical histerectomy and lymphonodulectomy was performed. The postoperative histology shows only traces of dysplastic epithelia, which proves preoperative therapy effective.

[Female with severe multiorgan damage and algetic myoma utery].

Painfull myoma utery in a patient with poor health condition and many disfunctional organs: Diabetes mellitus, Chronic renal insufficiency Gr. III (most probably a result of compression of the ureters causing bilateral hydronephrosis), arterial hypertony, anemia. The authors introduce their therapeutic model and manage to perform successfull operation after stabilizing the patient and intensive postoperative care. They point out the team work and good synchronization between the hospital divisions as crucial for the success of the treatment.

[Angioleiomyoma utery in a female patient with damaged health condition. Diagnostic and terapeutic difficulties].

35 years old patient with many health problems, on a haemodialysis and a big abdominal tumor originating from the pelvis. The authors share their clinical approach and their diagnostic and terapeutic difficulties in this case and refer to one of their previous publications.

[Rare form of cervix carcinoma, infiltrating cervical myoma].

The authors describe rare case of carcinoma colli uteri, which grows to infiltrate submucose cervical myoma.

[Operative method of cervix conisation].

The authors describe an operative method of cervix conisation, which they used by 41 patients in a 11-years period (1998-2009). Shearing their experience of the results they achieved, they are making some conclusions.

[Pulmonary surfactant system]. / Belodrobna s'rfaktantna sistema.

The lung surfactant system (LSS) has a complex morphological and biochemical structure. LSS contains two components: cellular and non-cellular. The cellular component comprises three types of alveolar epithelium cells (type I, II, and II pneumocytes), alveolar macrophages (AM) and Clara bronchiolar cells. The non-cellular component consists of alveolar surfactant (AS), hypo(epi)phase and alveolar epithelium cell glycocalix. AS represents phospholipids, proteins and carbohydrates mono-molecular layer. AM lamellar bodies (LB) and tubular myelin (TM) are disposed in the hypophase. LB and TM represent the depot-forms of lung surfactant (LS). Lung surfactant (LS) has a complex biochemical structure and comprise the following components: phospholipids, neutral lipids, glycolipids, surfactant-specific proteins, plasmaproteins, enzymes, carbohydrates and aminoacids. LS is synthesized in type II pneumocytes and Clara cells. LS catabolism is mainly effected by AM. The LSS has a fundamental role in the physiological functions of lungs. Through its antiatelectatic and antioedematic functions, LSS sustains the basic physiological functions of lungs--alveolar ventilation and gas diffusion through the alveolar-capillary wall. Besides this, LSS performs several protecting functions--antioxidant defense, non-specific defense mechanisms, immunodulatory action, cytotoxicity agents metabolism and others. The injury of the structure and functions of LSS is an important pathogenic mechanism in the pathogenesis of different lung diseases. Practically, a pathological process in lungs, which is not related to changes in LSS structure and functions, does not exist. Recently developed surfactant replacement therapy with natural and synthetic surfactants has an important place in the therapy of several lung diseases.

[Adult respiratory distress syndrome--etiology and pathogenesis]. / Respiratoren distres-sindrom pri vuzrastni--etiologiia i patogeneza.

Adult respiratory distress syndrome (ARDS) is not a specific lung disease. It represents an acute respiratory insufficiency syndrome in patients with non-injured lung as a result of severe multiple lung lesions of different etiology and pathogenesis. ARDS is provoked by a great number of etiologic factors of two main groups: 1) etiologic factors directly injuring the alveolo-capillary wall and 2) etiologic factors indirectly injuring the alveolo-capillary wall. ARDS develops in three phases: phase of exudation, phase of injury of the alveolocapillary wall and phase of proliferation (chronic phase).

[Interleukins and endocrine function]. / Interlevkini i endokrinni funktsii.

Views and experimental data on the role of interleukins in the regulation of the endocrine functions of hypothalamus, pituitary gland, thyroid gland, suprarenal gland and pancreas are presented. The role of interleukin-1 and interleukin-6 in the regulation of normal and pathological processes is examined. Data on cellular and molecular operation mechanisms of some interleukins on functions of the endocrine glands are included in the survey. The clarification of these mechanisms leads to new pharmacotherapeutical approaches to endocrine diseases treatment.

[Adult respiratory distress syndrome]. / Respiratoren distres-sindrom pri vuzrastni.

Adult respiratory distress syndrome (ARDS) represents an excessively dangerous acute respiratory failure, as result of diffuse damage of alveolocapillary membranes in stiff noncompliant lungs. ARDS is a widely disseminated syndrome caused by severe etiologic factors. ARDS usually appears within 12 to 72 hours of an identifiable clinical event and progresses through three phases: 1. exudative phase; 2. alveolar membrane damage and pulmonary surfactant systems; and 3. proliferative phase. Nearly all of the deaths occur within 30 days of the onset of the syndrome. The mortality rate varies according to the causes and the age. ARDS progresses through three clinical phases: 1. basis respiratory failure; 2. progressive respiratory failure; and 3. total respiratory failure. The therapy of ARDS is complex. It consists of: 1. background general therapy of ARDS; 2. background supportive therapy of ARDS; 3. definitive therapy to interrupt mechanisms of inflammation and pulmonary injury; 4. new pharmacologic supportive therapy.

[Macrolides: pharmacology and clinical use]. / Makrolidi: farmokologiia i klinichno prilozhenie.

Members of macrolides are Erythromycin, Oleandomycin, Spiramycin, Roxithromycin, Josamycin, Midecamycin, Clarithromycin, Azithromycin and Dirithromycin. This review present mechanism of action, pharmacokinetic, adverse drug reactions and main clinical uses of the macrolides.

[Contemporary views on the etiology and pathogenesis of atherosclerosis]. / S'vremenni v'zgledi za etiologiiata i patogenezata na ateroskelrozata.

Atherosclerosis is caused by a large range of exogenous and endogenous risk factors and does not result simply from the hypercholesterolemia and the accumulation of lipids. Atherogenesis is a dynamic multifactor and multi-stage inflammatory process, where different cells, cytokines and growth factors interacte as results of endothelial cell damage. This process is characterized by a focal subintimal deposition of lipids and lipoproteins in "foam cells" with a further development of chronic focal inflammation and expanditure of fibrosis, stenosis of the arterial lumen and development of further organ complications. The same are found in 50% of the patients, affected by atherosclerosis and are at the root of the death-rate in USA and Europe.

[The role of cell adhesion molecules and proinflammatory mediators in the pathogenesis of endotoxin adult respiratory distress syndrome]. / Roliata na klet'chnite adkhezionni molekuli i prov'zpalitelnite mediatori v patogenezata na endotoksinoviia respiratoren distres-sindrom.

The Gram-negative bacterial sepsis that is resistant to therapy results in the development of septic shock and the multiple organ dysfunction syndrome (MODS). It is established that the adult respiratory distress syndrom (ARDS) as a component of MODS is the reason for high mortality in these patients. The basic pathogenetic link between ARDS and the septic shock are the lesions of the alveolo-capillary membrane. They result from the sequestrated neutrophil cells in the lungs. Neutrophil extravasation is manifested by the following steps (stages): 1) weak initial adhesion; 2) rolling; 3) stable adhesion; and 4) extravasation. These processes are mediated by cell adhesion molecules that belong to four classes: selectins, selectin ligands, integrins and immunoglobulin superfamily. Thus cell adhesion molecules mediate the sequestration of neutrophil cells in the lungs and the damage of the pulmonary surfactant system.

[The role of bacterial endotoxins, receptors and cytokines in the pathogenesis of septic (endotoxin) shock]. / Roliiata na bakterialnite endotoksini, na tekhnite retseptori i na tsitokinite v patogenezata na septichniia (endotoksinov) shok.

Sepsis, resistant to therapy, results in the development of septic (endotoxin) shock. The latter is caused by the endotoxins of different Gram-negative bacteria. Endotoxin (bacterial lipopdisacharide--LPS) interacts with cells through specific membrane or plasma soluble endotoxin receptors (sCD14, mlD14, LBP, CD13/CD14, CD16, CD116/CD18, L-selectin, etc.). Endotoxin interaction with the mCD14 receptor of the monocytes, macrophages and the neutrophils results in the production of a number of proinflammatory cytokines--tumor necrosis factor alpha (TNF alpha), interleukines 1 and 6 (IL-1 and IL-6, etc), antiinflammatory cytokines--interleukines 10 and 12 (IL-10 and IL-12), cell adhesion molecules (P-selectin, E-selectin, ICAM-1, VCAM-1, etc.) and inducible enzymes: inducible NO synthase (iNOS), inducible phospholipase A2 (cPL-A2), inducible cyclooxygenase (COX-2). All pathologic processes in the structure and function of human body during endotoxin shock are a result of the disbalance of a number of mediators with a proinflammatory and antiinflammatory effects.

[Pulmonary repair after adult respiratory distress syndrome]. / Pulmonalna reparatsiia sled respiratoren distres-sindrom pri v'zrastni.

The adult respiratory distress syndrome (ARDS) represents a particulary dangerous form of acute respiratory failure. The processes of reparation of the lungs start in the course of several hours following the acute pulmonary damage and ARDS. They imply: 1) lysis of intraalveolar fibrin, phagocytosis of the necrotic products and resorption of the edematous fluid from the alveolar lumen and the pulmonary interstitium. 2) reparation of the pneumocytes and the bronchiolar Clara cells. 3) reparation of the pulmonary interstitium (pulmonary fibrosis and sclerosis). These processes of reparation in the lung are modulated by cell adhesion molecules of the integrin group and a number of growth factors (PDGF, AMDGF, EGF, FGF, IGF-I). Apoptosis is the main factor that controls the correct outcome of the processes of pulmonary reparation.