Biomedical subjects
Publications and source records attributed to V Novachkov.
The authors present their own attempt of miniinvasive management of pelvic inflammatory disease. Two groups of patients are compared--in the first one the women are treated only conservatively, while the second one has undergone miniinvasive surgical treatment. The preferences of combined therapy are pointed out.
The authors show their own experience with endoscopic operative treatment of tubal pregnancy. They describe the different types of operative treatment.
A case of a Mullerian tract defect in a 26-years old patient is reported. The anomaly is detected during an undesired pregnancy. Diagnostic methods used in that case are described. Diagnostic difficulties in determining the type of the defect and classifying it according to AFS classification (1988) are discussed. The variety of Mullerian tract defects and necessity of individually designed plan for diagnosis and treatment of every particular patient are discussed.
METHODS AND MATERIALS: The study is prospective and involves 112 patients suffering from pelvic endometriosis aging from 19-38 years. (28.6 average age). The disease was diagnosed via laparoscopy and the stage was determined using the revised AFS classification. Zoladex (Goserelin depot--3.6 mg) is being applied every 28 days for 6 months in the hypodermic tissue of the front abdomen wall. All patients are being examined monthly after every Zoladex application (for subjective complaints--dysmenorrheal, dyspareunea, pelvic pain; serum estradyol-E2; amenorrhea; side effects) and every 24 months (recuperation of the menstrual cycle, pregnancy). RESULTS: In 88% of the patients amenohrea is obsereved in the first eight weeks of therapy. The menstrual cycle takes an avarege of 68 (31-139) after the last Zoladex application to reappear. At the end of the first month after the first application the serum level of estradyol E2 is lowered to a menopause level (from 750-800 to 120-130 Pmol/L) and it remains as low till the end of the treatment. Eight weeks after the completion of the therapy it goes back to its normal values. During the course of the first month of amenorrhea condition a 38% fall in the level of complaints (dysmenorrheal, dyspareunea, pelvic pain) is observed. After the 6th month 88% of the patients have no complaints. Side effects observed during the course of treatment include warm waves, sweating, vaginal dehydration (60-80%) which do not in any way disturb the patients to the point of quitting the therapy and do disappear with its end. The focus group contains 54 infertile patients with endometrioses willing to get pregnant. In 12 months after the completion of the treatment 16 of the patients become pregnant, followed by 12 more in the next one year. CONCLUSION: Zoladex causes amenorrhea, which lasts till the end of the treatement. It causes a rapid drop of the serum consentration to a menopause level. Causes a strong and durable treatment of the symptoms of endometriosis. The side effects disappear with the end of the therapy. The treatment is easy to go through and there no cases of a quitting patient. The treatment has a curable effect over the endometriosys and in cases of infertility provides a possibility for pregnancy.
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The authors present their experience from operative laparoscopies performed with lower than usually accepted intaabdominal pressure.
Intrauterine insemination (IUI) is a method for the treatment of marital infertility involving the intrauterine or fallopian deposition of washed spermatozoa, depending on the amount of inseminated semen. Numerous factors may be affect of pregnancy rates after IUI.
The authors review the effect of the oral contraceptive Mercilon on menstrual cycle, contraceptive efficacy, lipid profile, safety profile and adverse effects in a group of 32 women, included in the survey. The results of the trial show excellent contraceptive effect with Pearl Index of 0.00 and good control over the menstrual cycle. No negative or unfavorable effects were seen on the lipid profile as well as on the liver kidney and coangulant system function. Minor side effects were seen in only 5% of the patients.
Thirty-four patients at the end of pregnancy were treated with ciclopiroxolamine (Dafnegin) vaginally for the period from January to October 1998. The effect of therapy was evaluated. One hundred women were examined and 34 (34%) of them had vaginal candidiasis. All patients were treated with ciclopiroxolamine (Dafnegin) vaginal creme once time daily for 14 days. Thirty-two patients (94.11%) were healthy, in two patients (5.88) candidiasis was reduced to minimal colonies.
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The author reveal the results of treatment with ciclopiroxolamine of women suffering from mycotic colpitis and using OC's. The research covers 26 women users of monophasic OC's with mycotic colpitis during the last 2-3 weeks before the research. The cause for the colpitis in 92% of cases is Candida albicans. The treatment was successful in 84.6% of the cases after the first 6-day-course with Batrafen creme. With 7.7% the treatment course with Batrafen creme was repeated, and with another 7.7% was included oral antimycotic (itraconazol). After treatment was performed microbiological check-up that confirmed the positive result of treatment. The authors' conclusion is that Batrafen creme is an effective device suitable for application on patients, CO's users.
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A prospective study was carried out a State Institute Hospital "Maĭchin dom" aiming to estimate the efficacy of GnRH-agonist Nafarelin in treating patients with endometriosis. Nafarelin was used by 40 women with endometriosis. The drug was applied as a nasal spray according to a therapeutic scheme and regarding definite criteria. Every patient was followed while using the drug and the following sings were registered: occurrence of amenorrhea, clinical sings, side effects, the period of control lasting for a year after the end of the treatment. In 27 women a quick and long-lasting amenorrhoea was induced with standard doses of the drug, while other 13 needed higher dosage to achieve the same effect. Relief of complaints was registered on 35 women. Improved palpatory status was found in 23 patients. In 4 women the disappearance of endometriomas was confirmed by laparoscopy. The existing side-effects are dos to the appearing hypoestrogenemia. After treatment with Nafarelin, during the period of observation, 5 women got pregnant.
The authors are analyzing their results of the treatment with roxithromycin 150 mg of the pelvic inflammatory disease, caused by chlamydia trachomatis. 29 patients with proved chlamydial infection were treated. The most popular diagnosis was cervicitis. 23 patients were totally cured, 4 patients were with considerable better status after the treatment, and 2 of the patients were with insignificant amelioration of the status. A conclusion can be made, that the roxithromycin is a very good alternative of the existing treatment with doxycicline.
The authors present two cases of women with unruptured tubal pregnancies who were treated by methods of laparoscopic surgery. A salpingotomy as well as an aspiration of the pregnancy was performed. The operations reported are the first in gynaecological practice in Bulgaria and the operative technique is described.
Endometriosis is one of the main causes of female sterility, leading not only to subjective complaints, such as anovulatory menstrual cycles and LUF syndrome, but also to appearance of antisperm antibodies due to the increased number of macrophages, We present our experience in the treatment of endometriosis with the GnRH analogue Zoladex, product of Zeneca, as well as in the treatment of antisperm antibodies with methyiprednizolon acetate, Depomedrol of Upjohn.
The authors compare the reliability of an enzyme method for diagnostics of chlamydial endocervicitis versus Clearview chlamydia test. The results suggest that the enzyme test may be applied with sufficient diagnostic reliability.
The conservative treatment of the condylomata acuminata by Solcoderm is local, painless and ambulatory. One application of Solcoderm by a capillary pipette covering the pathologic formations is enough--they become rapidly devitalized and disappear within 4 weeks. Secondary infections on the treated area are extremely rare.