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V Dimitrova

Publications and source records attributed to V Dimitrova.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Hepatic echinococcosis: radical or conservative surgical treatment].

UNLABELLED: Hydatid liver disease remains an actual medical and social problem for Bulgaria as an endemic region. Because of the lackage of medicines with satisfactory therapeutic effect the surgical treatment is still the treatment of primary importance. AIM: The aim of this study was too check the correctness of the following hypothesis: "Radical surgical procedures on hydatid liver disease have lower rates of morbidity and mortality compared to conservative ones". MATERIAL AND METHODS: In order to achieve the above mentioned aim we analysed the results of 361 patients with hydatid liver disease (267 (74%) of whom retrospectively and 94 (26%) prospectively), treated at the Clinic of General, Liver and Pancreatic Surgery during the period 1st, Jan., 1985-1st, Jan., 2001. The patients were divided in two main groups: 102 (28.25%) of them received radical surgical procedures and 250 (69.25%)--conservative ones. Nine of the patients (2.50%) had multiple echinococcal cysts and received surgical procedures of both types. That's why the results of those patients did not correspond to the aim of the study and they were not included in it. The analysis consisted of a comparison between the two main groups according to several criteria: sex, age, location and average size of the cysts, postoperative complications, reoperations, mean postoperative stay at hospital and mortality rate. RESULTS: There was a prevalence of the female in the ratio male/female in the group of patients who received a radical procedure. The location of echinococcal cysts in the left hepatic lobe was found to be more frequent. In the group of radical surgical operations the postoperative morbidity and mortality rates were lower and the postoperative stay at hospital was shorter, compared to the group of conservative procedures. CONCLUSION: Radical surgical procedures showed better postoperative results. But those procedures had to be performed only on patients who had certain indications and according to criteria described in surgical literature. The proper surgical equipment and well experienced surgical team were the other important conditions for good outcome.

Adolescent↗
PubMed2002

[Anterior rectal resection--early postoperative results].

BACKGROUND: The development of the mechanic staplers gave the opportunity to perform sphincter-saving operations in patients with middle and low rectal carcinoma. It has been gained experience in performing this operation as the anastomosis was sewed in both ways--manually and mechanically. PURPOSE: The purpose of this retrospective research is to analyse the early postoperative results after anterior rectal resection with manually and mechanically made anastomosis. MATERIAL AND METHODS: For the period 01.01.1995-01.012000 in the DEPARTMENT OF GENERAL, LIVER AND PANCREATIC SURGERY, 69 patients with rectal carcinoma underwent the operation anterior rectal resection. In 60 cases (89.96%) the anastomosis was made manually and in 9 cases (13.04)--with mechanical staplers. Both patient groups are studied and classified by sex, age, tumor localisation, type of anastomosis, early postoperative results. RESULTS: From the group with manually sewn anastomosis 6/10%/ of the patients had complications in the early postoperative period, one of them terminated (1.7%). From the second group 3 (33.3%) of the patients had complications in the early postoperative period. The average postoperative hospitalisation was 13.5 vs. 19.2 days. CONCLUSION: The results achieved in anterior rectal resection depend on a complex of factors among which more important is the early diagnosis of the disease and the skills of the surgeon in coloproctology.

Aged↗
PubMed2002

[Pregnancy complications with abnormal results of biochemical screening for Down syndrome in second trimester and normal fetal karyotype].

Pregnancy complications were studied in the following groups of pregnancies with structurally and chromosomally normal fetuses: 1) 216--with elevated free beta-hCG above 2 MoM and 134--above 2.5 MoM; 2) 37--with elevated alpha-fetoprotein [AFP] above 2 MoM; 3) 67 screen-positive patients below the age of 35. The following complications were compared in the studied and the control groups: preterm delivery and premature rupture of membranes [PROM], preeclampsia (in general and severe one), IUGR without preeclampsia, delivery of small for gestational age [SGA] and low birth weight [LBW] infants and perinatal fetal loss. Pregnancy outcome in cases with free beta-hCG above 2 MoM was not different from that in the control group. With 2.5 cut-off level the incidence of preeclampsia and of LBW infants was higher in the studied than in the control group. Elevated AFP above 2 MoM alone was associated with more frequent preeclampsia including severe one (in all the latter cases--IUGR present). In the screen-positive group the incidence of preeclampsia (in general and severe one with IUGR), SGA and LBW infants and perinatal mortality rate were significantly higher than in the control group. No difference was found between the studied and the control groups regarding subsequent development of IUGR without preeclampsia, preterm delivery and PROM. Abnormal second trimester serum screening test results (elevated free beta-hCG or AFP alone above 2.5 and 2 MoM respectively) in pregnancies with normal fetal karyotype indicate higher risk for subsequent development of preeclampsia. Screen-positive patients, being a heterogeneous group (including ones with elevated free bb-hCG alone and ones with elevated both free beta-hCG and AFP), are at increased risk for other pregnancy complications too.

Adult↗
PubMed2001

[Frequency of antiphospholipid antibodies and Leiden mutation of hemostasis Factor V in unexplained recurrent fetal and embryo loss].

Object of the study are women with a history of unexplained recurrent embryo, fetal and early neonatal death, severe preeclampsia, fetal growth retardation, abruptio placentae, puerperal thromboses. Quite often placental insufficiency is linked to abnormal vascular system and hemostatic disturbancies. In about 65% of the women with a complicated and in 18% of the women with a normal pregnancy are observed different genetic anomalies that lead to a hypercoagulative state. A major place is taken by the Leiden mutation of hemostasis factor V, by protein C and protein S deficiency, etc. Another disease that leads to arterial and venous thromboses and is most often linked to recurrent miscarriage is the antiphospholipid syndrome. Many authors confirm the findings of large placental infarctions and thromboses in women who are positive for antophospholipid antibodies.

Abortion, Habitual↗
PubMed2001

[Pregnancy with Rh-isoimmunization. Results of a retrospective analysis in the maternity hospital "Maichin Dom"].

UNLABELLED: The aim of the study is to analyze the outcome of pregnancies complicated by Rh-isoimmunization for the period 1996-2001 and to outline the aspects of optimization of the obstetrical conduct. MATERIAL AND METHODS: The current study includes 39 pregnant women with Rh-isoimmunisation to whom amniocentesis and cordocentesis was performed. All cases were analyzed using medical history, serology (indirect Coombs, PAP test), ultrasound examination, amniocentesis, cordocentesis, NST. RESULTS: From 39 pregnancies, complicated by severe Rh-isoimmunization 36 resulted in a live delivery, 2 resulted in intrauterine death of the fetus and 1 in early neonatal death. The titre of the antibodies is of prognostical value only in the first isoimmunised pregnancy. In this case there is a reliable correlation between the condition of the newborn and the zone from the Liley curve, antenatally found. With history of former immune pregnancies with unfavourable perinatal outcome most precise information about the condition of the foetus gives the cordocentesis. CONCLUSION: In all of the discussed cases the Rh-isoimmunization is a result of no andi-D immunoglobulin profilaxis post partum or following abortion. That is why the efforts should be directed towards conduction of proper profilaxis to all Rh-negative pregnant women.

Blood Transfusion, Intrauterine↗
PubMed2000

[The attitude of pregnant women to the possibilities for the prenatal screening and diagnosis of Down's syndrome in the 2nd trimester].

The aim of the study was to assess pregnant women's attitude and receptivity for second trimester prenatal screening and diagnostic tests for fetal Down syndrome [DS], factors that influence attitude formation, sufficiency of patients' information, advisability of introduction of these tests in routine prenatal care Interviews with 129 pregnant women were conducted after they had received written information concerning prenatal DS screening and diagnostic tests Five questions to the point of the matter as well as 14 related to the personal characteristics of the interviewed were included. Ultrasound screening rt]. accepted by 98.4% serum screening--by 93% and invasive prenatal testing--by 90% of the pregnant women Patients receptivity for serum screening and invasive testing Was influenced by factors like age, past obstetric history educational level, religiosity, attitude towards patient's own health For some of the factors statistically significant relationships were present while for others only some trends were outlined Regarding patients' high receptivity for prenatal DS screening and diagnostic tests the latter can be recommended as an element of the routine prenatal care in our country.

Adolescent↗
PubMed2000

[Carcinoma of extrahepatic bile ducts - operative management of lesions located in the distal segments].

Experience with operative management of patients presenting carcinomas located in the distal third of the extrahepatic bile ducts, accumulated in the Department of General and Operative Surgery of the Medical University--Sofia, is analyzed. The condition is characterized by manifestation of clinical signs typical of a well advanced pathological process, found in a considerable number of patients with obstructive jaundice syndrome, and necessitating surgery on an emergency basis because of the danger of hepatorenal failure development with a fatal outcome. Over a 10-year period (1989-1998), a total of 219 patients with histological evidence of carcinoma in various segments of the extrahepatic bile ducts are operated on. The series includes 107 men (48.9%) and 112 women (51.1%) at mean age 59.2 years. In 64 cases (29.2%) the process involves the distal third only (terminal choledochus and papilla Vateri). In this group 41 radical and 23 palliative operations are performed. The indications for radical resection, the basic principles of radical and palliative interventions, and the results of their practical implementation are comprehensively discussed. The basic parameters--resectability, survivorship, early postoperative lethality (EPL) and morbidity--are comparable to the ones presented in recently published reports on biliopancreatic oncosurgery.

Adult↗
PubMed1999

Placental teratoma--a case report.

A rare case of a mature placental teratoma in a 32-year-old woman is reported. We discuss the mechanism responsible for the development of this rare tumor in the placenta as well as the differential diagnostic difficulties encountered in fetus acardius amorphus, underlining the clinical significance of the exact diagnosis.

Adult↗
PubMed1999

Pharmacokinetic variability of nimodipine disposition after single and multiple oral dosing to hypertensive renal failure patients: parametric and nonparametric population analysis.

OBJECTIVES: To explore the contribution of renal failure to nimodipine overall pharmacokinetic variability after single and multiple oral dosing and to develop a population pharmacokinetic model by means of the nonparametric expectation maximization (NPEM2) algorithm based on sampled individual drug concentrations close to the estimated patients' C(SS)avs (NPEM2-C(SS)av). PATIENTS, MATERIALS AND METHODS: 24 hypertensive patients with normal and reduced renal function, without clinical and laboratory data for hepatic dysfunction, were enrolled in the study and their nimodipine plasma levels were analyzed by means of a parametric and nonparametric population pharmacokinetic modeling using a maximum a posteriori Bayesian (MAPB) estimator in an iterative two-stage Bayesian population modeling program and NPEM2-algorithm. RESULTS: Comparison of parameter dispersion revealed higher variability of nimodipine disposition after the first dose than at steady-state except for apparent volume of distribution at steady-state, V(SS)/F, whose variability increased from 98% to 223%. The most variable was mean residence time, MRT, whose coefficient of variation (CV) was 288% after the first dose and decreased by more than 2 times at steady-state, followed by terminal elimination half-life, t(1/2el), with CV = 171% after the first dosing and decreasing by more than 3 times at steady-state. Concerning the impact of renal failure on disposition parameters variability, patients with slightly to moderately reduced renal function, creatinine clearances between 51 to 80 and 25 to 50 ml/min, resp., stated higher variation than patients with more definitively altered renal function. The validation of NPEM2-C(SS)av population model was performed by using a set of 272 individual plasma drug concentrations, including trough levels as well as concentrations belonging to mono-exponential elimination phases after single and multiple dosing. Bayesian forecasting, using 4 trough levels per patient as Bayesian priors, revealed highly significant correlation between observed and population model predicted drug concentrations (r = 0.526, p < 0.0001). The predictive performance of NPEM2-C(SS)av population model was characterized by low bias (mean error = -0.48 microg/l, 95% CI = -0.99-0.04 microg/l), and good precision (root mean squared error = 4.32 microg/l, 95% CI = -2.53-11.17 microg/l). CONCLUSIONS: As predicted for high hepatic clearance drugs [Rowland 1985], nimodipine parameters variability decreased after reaching steady-state. NPEM2-C(SS)av population model demonstrated high accuracy and precision in predicting drug levels from terminal exponential phase including trough levels at steady-state.

Administration, Oral↗
PubMed1999

[The dry period in preterm birth and premature rupture of the fetal membranes].

It is widely believed that premature rupture of membranes accelerates fetal pulmonary maturity. The purpose of our study was to determine the duration of the latent phase, in the cases of premature rupture of membranes, required to achieve this effect. Retrospective analysis of our database yielded a group of 42 patients, who were delivered between 26 and 34 weeks gestation. The results of this study suggest that pulmonary maturation continues but is not accelerated after premature rupture of membranes. Delaying delivery for more than 72 hours after rupture of membranes is more likely to result in chorioamnionitis than accelerated pulmonary maturation.

Adolescent↗
PubMed1999

[Therapeutic regimens for treating bacterial vaginosis in pregnant women].

The study comprises 128 pregnant women examined at different gestational weeks. The diagnosis of bacterial vaginosis was made using: a) the complex clinical criteria--vaginal discharge, vaginal pH, amine test and "clue cells" b) Nugent scoring system c) Spiegel criteria. Two therapeutic regimens were compared--intravaginal 2% clindamycin creme (Dalacin V) 5 g three consecutive days and intravaginal metronidazole (Flagyl) 500 mg once daily for 5 consecutive days. Control examination was carried out 5-7 days after completion of therapy using the same protocol. 28 women from the first group and 31 women from the second group had the control examination. Bacterial vaginosis was eradicated in 93% of women using intravaginal clindamycin and in 87% of women using intravaginal metronidazole. Both regimes were more effective compared to treatment with oral ampicillin for 7 days, where the cure rate was 62%.

Administration, Intravaginal↗
PubMed1999

[The preoperative preparation of the vagina with Betadine before abortion on demand].

Recent evidence has associated bacterial vaginosis and trichomoniasis with several postoperative complications. We carried out a prospective study aiming to estimate the frequency of vaginitis in women wanting to make an artificial abortion and the possibility to influence this infections by local application of vaginal BETADINE suppositories in all forms of infectious vaginitis: Candida albicans, trichomonas vaginalis and bacterial vaginosis.

Abortion, Legal↗
PubMed1999

[Second trimester pregnancy termination with and without prostaglandins].

The effectiveness of three methods for second trimester pregnancy termination [TOP) was compared. A retrospective analysis was made in 34 cases with TOP by intraamniotic saline instillation and 19 cases with extra-amniotic appreciation of y ballon-catheter, followed by stimulation of uterine contractions by intravenous oxytocin infusion. The results were compared with the ones in 13 prospectively studied cases in which the extra-amniotic appreciation of the ballon-catheter was preceded by treatment of the cervix with 0.5 mg prostin E2 intracervically. In nulliparous patients the treatment of the cervix with y single dose prostaglandins did not shorten the mean abortion time neither reduced the percentage of unsuccessful and prolonged abortions. In parous patients the abortion time was significantly reduced. No failed or prolonged abortions were registered.

Abortifacient Agents↗
PubMed1999

[Prenatal ultrasonographic diagnosis of four cases of sacrococcygeal teratoma].

Four cases of SCT, diagnosed antenatally by the authors are reported. The reasons for referal to the department, the sonographic findings, the obstetric management, the outcome for the fetus and the histologic findings are summarized for each particular case. In the first case y 23 years old primigravida was admitted to the Hospital because of hydramnious and threatened premature labour in 30 w.g. The ultrasound examination revealed an AGA fetus with y tumor mass with y mixed structure protruding from the sacrococcygeal region. Despite the tocolytic therapy two days after admission to the department y 2400 grams severely asphyxiated fetus was born. Neonatal death occurred 15 minutes after delivery. In the second case y 28 years old primigravida was referred to the hospital because of acute hydramnios in 31 w.g. The ultrasound examination revealed an AGA fetus with y predominately solid mass with calcifications, 110/120 mm in dimentions in the sacrococcygeal region. Despite the indomethacin therapy on day 4th of admission spontaneous labour started. During a vaginal examination avulsion of the presenting "mass" occurred followed by rapid exsanguination of the fetus. In the third case the anomaly was diagnosed in the second trimester and genetic counseling of the couple was offered. The karyotype of the fetus was normal but the parents chose termination of pregnancy despite the advanced gestational age (29 w.g. by that time). A 1900 gramas live female infant was born and was emergently referred to the Neonatal Surgery Department and operated on 4th day after delivery. Unfortunately the baby died 24 hours after the operation from an accident, not related to the operation. In conclusion y protocol for obsteric management of pregnancies with SCTs of the fetus is proposed by the authors.

Adult↗
PubMed1998

[The obstetrical management of pregnant patients with spontaneous rupture of the fetal membranes after 37 weeks' gestation].

The purpose of the study was to analyze the obstetric management in pregnancies with spontaneous rupture of membranes (RM) after 37 w.g. and to find out is there a correlation between the cervical status and the pregnancy outcome. The study includes 66 primiparous women divided into two groups depending on the cervical status(CS) at admission: Group 1-44 patients with unfavourable cervix (PS < 4) according to the Bishop's original scoring system and Group 2-22 patients with favourable cervix (PS > 4). The delivery started spontaneously within the first 8 hours after the RM in 59% of the pregnant women with favourable cervix compared to 50% of women with PS < 4. There is no significant difference in the mean duration of the latent period between group 1 and 2-6.3 and 6.2 hours, respectively. The mean duration of delivery was 14.08 hours in Group 1 compared to 14.03 hours in Group 2. 72.7% of the pregnant women in Group 1 had normal vaginal delivery compared to 86.44% of the patients in Group 2. There were 3 newborn (one in Group 1 and 2 in Group 2) with signs of infection. There were no perinatal deaths. Postpartal endometritis was diagnosed in 2 of the patients with unfavourable cervix. There is no motivation to fear the development of ascendant infection in pregnancies with RM after 37 w.g. even if the time elapsed from the very beginning of the RM to the start of delivery is more than 24 hours. We favour both active and passive management of delivery in pregnancies with favourable cervix at the time of RM. We have to reevaluate the active approach in pregnancies with unfavourable cervix and ruptured membranes because of the higher incidence of operative deliveries because of non-progress of labour in these cases.

Adult↗
PubMed1998

[Factors influencing the cosmetic outcome in early breast cancer patients following salvage surgery and radioisotope teletherapy].

It is the purpose of the report to analyze the factors exerting effect on the cosmetic outcome in breast cancer patients (I-II clinical stage), following organ-salvaging operation in conjunction with telegammatherapy. Assessment of the cosmetic results in 100 female patients with early mammary gland cancer is done 5 years after complex treatment (conservative surgery, postoperative radiotherapy, and chemo- and/or hormonotherapy when indicated). The influence of eight factors on the cosmetic outcome attained is evaluated through correlative statistical analysis, namely: breast size, scope of the surgical intervention, number of lymph nodes dissected, type of operative cicatrix, dose exposure of the entire mamma, homogeneity of radiation dose distribution in tre entire mammary gland, dose exposure of the tumor bed and adjuvant therapy. The analysis performed points to the important practical implications of three of the factors: size of operative intervention (axillary dissection range), breast volume and homogeneity of the irradiation dose in the entire breast.

Axilla↗