Search PubMed⌕ Search

Biomedical subjects

A Dimitrov

Publications and source records attributed to A Dimitrov.

At least 73 records · Page 4Linked to original sources
PubMed2000

[Causes for healing complications in episiotomy].

UNLABELLED: The aim of the study is to look for the most probable causes of disturbed healing of episiotomy. The study is prospective and includes 33 early puerperal women without data of infection disease or risk factor like: PPROM, vulvovaginitis, chorioamnionitis, diabetes, obesity and others. The cases are divided in two groups: the first group are 12 women with normal healing of episiotomy; the second group 21 cases with wound healing complications, divided in three subgroups: 13 with edematous and erythematous edges; 5 with superficial dehiscence in me aria of introitus vaginae; 3 with entirely open episiotomies. RESULTS: For a period of 5 years the mean rate of entirely open episiotomy is 1.07%. According our data the process of episiotomy healing is not influence by: age of me women, parity, duration of labor, the weight of the neonate. For the episiotomy outcome is important the experience of the obstetrician. The shorter time between ROM during labor and delivery and use of cat-gut stitches on the skin of the perineum show tendency of poor healing of the episiotomy.

Episiotomy↗
PubMed2000

[Fetal oxygen saturation during normal delivery].

The aim of the study is to monitor fetal oxygen saturation--SpO2 during uncomplicated labour; to assess normal values and compare them to the data from fetal blood analysis and from clinical finding in the newborn. The study includes 53 pregnant women in term during active labour without evidence of fetal distress. Study is carried out with Nellcor-N 400--a system for measuring fetal pulse oxymetry and fetal pulse rate; oxygen sensor FS-14 and printer P-400 /Nellcor Bennet Incorporation/. Fetal pulse rate is monitored by cardiotograph Hewlett Packard. Mean duration of monitoring during first stage of labour is 98 +/- 48 min, versus 37 +/- 11 min during second stage. Mean values of SpO2 are 48.8 +/- 10% during the first stage of labor v/s 46 +/- 9.6% during second stage. Baby is born in good health--Apgar score more than 7 and mean pH value from umbilical artery 7.25. The conclusion is made that pulse oxymetry is an easy non invasive method for fetal monitoring without side effects concerning woman on labour and fetus. A relatively large range of variations of normal values is observed.

Adult↗
PubMed2000

[Diagnosis and differential diagnosis of space-occupying disorders of the umbilical cord].

In connectiin with a clinical case of a circumscribed edema of the umbilical cord the authors considered the space-occupied disorders of the umbilical cord. The tumorous and nontumorous lesions of the umbilical cord as well as the criteria and their diagnostic difficulties are discussed. The authors pay attention to the complications of such disorders in the pregnancy and their possible influence on the fetus.

Adult↗
PubMed2000

[Influence of elective abortion, up to the 12th week of pregnancy, on the dimensions of the cervix].

The conflicting data in the literature about the influence of the voluntary abortion on the cervix uteri and its effects has lead us to the idea to examine by ultrasound the changes in the cervix uteri as a result of elective abortion. 137 healthy women at the average age of 26.7 years have been examined, out of which 31 were pregnant for the first time. 15 with no child-births but with one previous voluntary abortion, 30 with no child-births but with more than one voluntary abortion, 35 with one child-birth and 26 with more than one child-birth. Out of the total 76 women, 64 come back for ultrasound examination of the parameters of the cervix uteri between the first and the second week after the abortion (10 + 3 days). The abortion has been done up to 12 guest. week under intravenous anesthesia, I Hegar dilatation of the cervical canal and vacuum aspiration. Each ease has been examined with an ultrasound (Kontron--France), supplied with a 7.5 MHz vaginal transducer. The results show that the measured length and width of the cervix uteri among the groups with differing number of elective abortions but with no child-births do not reveal a great statistical difference. With the increase of the number of abortions the width of the cervical canal shows a tendency to expand minimally. With women pregnant for first time and having elective abortion, of all parameters of the cervix only OECC remains a little wider than before the abortion. Child-births change dramatically the dimensions of the cervix uteri--the cervical canal expands, the cervix shortens and at the same time becomes wider. We can safely assume that the elective abortion under intravenous anesthesia within 8-9 g.w. with Hegar dilatation about 10 mm and vacuum aspiration has not shown traumatic effect on the cervix uteri according to its dimensions.

Abortion, Habitual↗
PubMed2000

[Iatrogenic lesions of hepatocholedocus in cholecystectomy].

This is a report on nine patients presenting different intraoperative lesions to hepatocholedochus, some of them diagnosed in the course of operation, and others- after the intervention. A variety of plastic repairs of the hepatocholedochus, including simple suture, Saple's operation or hepatodigestive anastomosis after Longmayre are performed. The probability of inflicting lesions, the underlying causes and the therapeutic approach to concrete cases are analyzed. Abiding to the principles of surgery is strongly recommended, such as: sufficient and appropriate operative access, atraumatic manipulations, drainage of the gallbladder bed and the like, with a view to perclude serious and sometimes fatal complications' occurrence, as well as making early diagnosis and accordingly taking the most opportune surgical solution to the problem faced.

Bile Ducts, Extrahepatic↗
PubMed2000

[Local recurrence after radical surgery for rectal carcinoma].

The incidence rate of local recurrences after radical operative treatment of rectal carcinoma and the risk factors involved, methods of early diagnosis and surgical therapeutic approach are comprehensively analyzed. Reference is also made to 86 scientific publications on the issue. During the 20-year follow-up period, no tendency of the incidence of local rectal carcinoma relapses to decrease is noted. The risk factors contributing to their occurrence are distributed in two groups depending on the primary tumor characteristics (location, stage of development, locoregional spreading, differentiation degree, genetic features), and operative intervention used (type, distal resection line, application of total mesorectal excision, extensive minor-pelvis lymph dissection etc.). The early diagnosis is based on mandatorily performed procedures, such as rectoscopy (coloscopy), endo-ultrasonography with purposeful thin-needle biopsy, assessment of tumor markers and immunoscintigraphy. The surgical tactics in coping with a local recurrence of rectal carcinoma becomes increasingly aggressive and radical by resorting to re-resection, abdomino-perineal extirpation, en-bloc resections and even minor pelvic exenteration. Postoperative 5-year survivorship amounts to 54.5 per cent.

Digestive System Surgical Procedures↗
PubMed1999

Irrationality: psychological, ethical and legal aspects.

A definition and a concise classification of irrational mentality and behaviour is proposed in the paper. The basic goal is to reveal the psychological mechanisms of inducing irrational individual and group behaviour by certain social agents. An attempt is made to apply the methodology of self-organization theory to the analysis of psychic equilibrium. The inducing of irrational behaviour is qualified as a crime against the freedom of the individual. In view of its grave social consequences a plea for its serious legal treatment is made.

Authoritarianism↗
PubMed1999

[The diagnosis and management in suspected retained placenta in the late puerperal period].

The aim of this retrospective study is to find out the reasons for RICU in late postpartum period and the reliability of methods for diagnosis of retained placental pieces. We investigated the medical records of all cases with RICU from 24th ours postpartum up to 2 weeks after it. The rate is 0.9% of all births. Hystological confirmation of retained placental tissue there are in 25% of cases. Our data shows that the anamnesis does not help in the diagnosis of retained placental tissue in late puerperium. Most often the curettage is undertaken because of hemorrhage and ultrasound data of retained placental tissue. At the same time the transabdominal ultrasound is of low diagnostic value for residua post partum. The febrility, the subinvolution of the uterus and the number of symptoms in given case are of no importance in the diagnosis of retained placental tissue. The suspicion in the integrity of the placenta after its birth is a reason for RICU in spite of well contracted uterus and lack of hemorrhage. As the diagnosis of retained placental tissue in late puerperium is uncertain the RICU should be undertaken after failed conservative management.

Adult↗
PubMed1999

[The active management of the placental period with Remestyp].

The aim of this prospective study is to asses, the possibility to use Remestyp after the delivery of the head as a prophylaxis of blood lost during the third stage of labor. The material includes 209 cases: 82 with bolus dose of 0.2 mg Methergin, 54 cases with 10 ME Oxytocin, 32 parturition with 200 mg Remestyp, and 41 controls without any uterostonics during the placental period. The blood lost is assessed by gravimetric method. The results show that the total blood lost from the delivery of the neonate to two hours after it is significantly lower in active management of labor than in expectant one. The type of uterostonic is not essential in regard of total blood lost. The prophylactics of blood lost with Remestyp has best results in cases of stimulated with Oxytocin infusion labor. The active management of third stage of labor with Methergin or Remestyp has less complication than are used oxytocin or without uterostonics. The mean time for delivery of placenta is shortest in the group with Remestyp. The three uterostonics in mansion doses do not influenced significantly the artery pressure. Our experience demonstrates that Remestyp can be used for active management of third stage of labor and the results are as those with Methergin. Remestyp is preferable when are expected significant lacerations of the birth canal.

Female↗
PubMed1999

[The problems and outcome with newborns who are extremely low birth weight, appropriate for gestational age and small for gestational age].

UNLABELLED: The aim of this study is to evaluate the consequences of being extremely low birth weight (ELBW) under 1000 g at birth, small (SGA) or appropriate for gestational age (AGA). METHODOLOGY: A retrospective comparison of two cohorts of ELBW AGA (n = 47) and SGA (n = 38) infants, admitted to the Intensive Care Unite of State Maternity Hospital "Maĭchin Dom" from 01, 1995 to 06, 1998 is carried out. Infants with major congenital anomalies and those, who died in the first two hours of life, being extremely premature and unviable, are excluded. RESULTS AND CONCLUSIONS: The mean birth weight of the AGA group is 863 g, their mean gestational age is 26.6 weeks of gestation and of the SGA group--795 g and 29.6 weeks respectively. In the Sga C-section is preferred in 85%, vs only 34% in the AGA group. SGA babies are with two times greater survival rate (61%) then AGA (32%). The causes of death are similar. The AGA survivors have a greater rate of stage III-IV intraventricular hemorrhage, more prolonged need for ventilatory support (19 vs 12 days for SGA) and oxygen supplementation (37.5 vs 30.7 for the SGA), more difficulties with enteral feeding and their median hospital stay is somewhat longer (81.9 days), compared with those of the SGA (76.6 days). The two groups show a similar rate of respiratory distress syndrome, chronic lung disease, infections and neurological complications among the survivors.

Bulgaria↗
PubMed1999

[Myomectomy during cesarean section].

The purpose of this prospective study is to assess the possibility of myomectomy during CS as a routine method. The material includes 21 cases of myomectomy during CS. 162 consecutive CS without myomectomy are control group for hemorrhage during the operation. The myomectomy is accomplish according classical technique. Our data show that the myomas and pregnancy is found mainly in women after 30 years of age and is prevalent in nulliparas (70%). Single myomas were found in 85% of cases, 63% located in the corpus uteri and 46% of all myomas are confined to the myometrium. Related to the isthmus uteri are 23% of myomas. Myomectomy as a separate operation during CS increases the hemorrhage by 10%. The analysis of the cases with severe hemorrhage point to the placental disorders (abruptio placentae and placenta praevia) as a main cause of overall increased blood lost. Our limited experience with myomectomy as a protocol during CS irrespective of number and magnitude of myomas shows that this is possible. The postoperative period is without complications.

Adult↗
PubMed1999

[Transvaginal sonography in the study of the cervix uteri in pregnancy].

The purpose of this prospective and cross sectional study is to evaluate the changes in the cervical length and wide of the cervical canal throughout normal pregnancy and the effect of parity on this process. The material consists of 215 unselected and non complicated pregnancies between 8th and 42nd weeks of gestation. 119 were nulliparous and 96 multiparous women. The cases are divided in subgroups through 5 weeks. The cervical length is measured between OICC and OECC by 5 MHz transvaginal transducer and the wide of the cervical canal at the middle of the cervix. In 6 cases there was a funneling and the pregnancies terminated in abortions or preterm labors, so they were excluded. Unlike other studies we find increase in the cervical length with advancing gestational age until 31 week and a progressive shortening to the end of pregnancy. The wide of the cervical canal is increasing to the end of pregnancy. The wide of the cervical is increasing to the end of pregnancy is between 2 to 6 mm. The parity has insignificant influence on the ultrasound measured cervical length and wide of cervical canal.

Adult↗
PubMed1999

[The Apgar score, acid-base equilibrium of the umbilical cord vessels and early postnatal adaptation in healthy term newborns].

UNLABELLED: The aim of the study is to establish a correlation between Apgar score, acid-base status (ABS) and blood gases (bg) from cord blood and the early postnatal adaptation in healthy term newborns. The study is prospective and includes 52 babies at term born at the State University Hospital Maĭchin Dom, Sofia during a three month period--03-05, 1998 without evidence of asphyxia before and during delivery. All babies are monitored for Apgar score at minute 1 and 5, ABS and bg from umbilical artery (u.a.) and vein (u.v.) examined at birth, as well as capillary ABS and bg 1 hour after birth. Early postnatal adaptation is judged by a neonatologist in the course of two hours. RESULTS: A significant difference is found between all the examined points in the ABS and the blood gases in samples from umbilical artery and vein (p < 0.05), most significantly differ pH, pO2 and O2 Sat (p < 0.001). There is a correlation between 1 minute Apgar score and ABS and bg from umbilical vessels, babies with 1 minute Apgar score 7 having significantly lower pH from u.a. requiring wider range of resuscitation. Babies with 1 minute Apgar score 9/8 and 5 minute Apgar score 10 have definitely less early adaptational problems. CONCLUSION: The use of a combination of evaluation criteria for the condition of the newborn after birth (Apgar score, ABS and bg from cord blood and strict monitoring of early cardio-pulmonary adaptation) guarantees adequate resuscitation in term babies.

Acid-Base Equilibrium↗
PubMed1999

[The overall and step-by-step duration of cesarean section].

The purpose of this study is to define the time for different steps of Caesarean section from the moment the women lays on the operating table to the last stitch on the skin. The study is prospective and include 82 elective and emergent CS. The traditional surgical technique is used without omitting any step. The mean stay of the women in the operating theater is 90 min. The preparation for the anesthesia/analgesia is 23 min (range 8-41). The proper time of the operation is 44.3 min. The laparotomy by Pannenstiel incision takes 3 min. The opening time of the uterus is 37 sec (10-190) and the closer on two layers is 17 min (10-35). The extraction of the foetus takes 53 sec (15-180). The exteriorization of the uterus doesn't affect the repair time. Leaving the visceral and parietal peritoneum unsutured can spare 5.5 min. The elective CS takes more time than the emergent one. The time from the beginning of the operation to the extraction of the foetus is longer in resection (7 min) than in first CS (5 min).

Anesthesia, Spinal↗
PubMed1999

[Translabial sonography of the lower uterine segment].

The aim of this prospective study is to asses the possibilities of translabial (transperineal) sonography for observation the cervix uteri and to compare it with the transabdominal sonography. The material consists of 58 pregnant women in third trimester of pregnancy. We use abdominal transducer (3.5 Mhz) of Kranzbuhler ultrasound for abdominal and transperineal scanning. The ultrasound examination of the cervix includes: endocervical length, cervical weight, weight of the cervical canal and in case of tunneling its parameters. The satisfying image for ultrasound biometry of the cervix we achieved in 92% of the cases with transabdominal scanning and in 97% with translabial scanning. The mean values of the ultrasound examined parameters of the cervix are not significantly different with transabdominal and translabial measurement. The translabial ultrasound method is feasible and well accepted by the pregnant women.

Analysis of Variance↗
PubMed1999

[The use of the vasoconstrictor hemostatic Remestyp in surgical obstetrics].

Terlipressin (Remestyp) or N-a-triglycyl-(8-lysme) vasopressin after parenteral application and slow enzymatic cleavage releases synthetic analog of vasopressin-8-lysine-vasopressin. It is potent myometrial stimulator in pregnant and non-pregnant uterus and at the same time decreases myometrial and endometrial blood flow. Remestyp has synergistic effect with oxytocin and/or methergin. Our experience shows good effect of Remestyp in the complex treatment of cases with hypotonic uterus, placenta praevia or adherence during and after abdominal or vaginal birth. Injection of Remestyp around the fibroids during cesarean section significantly decrease the blood lost and make the myomectomy safer. We observe decrease of oozing at the incision of the skin and stopping initial subfascial hematoma.

Female↗
PubMed1999

[Francke's operation--a resolution for deep small echinococcal cysts of the liver].

The operation of Francke in hydatid disease treatment is described--puncture, aspiration, sterilization--with emphasis laid on the technical details. The indications for its practical implementation are specified--small echinococcus cysts, deeply located within the parenchyma of the organ, or diffuse abdominal echinococcosis. In diagnosing such cysts intraoperative ultrasonography is considered as absolutely necessary and mandatory. The operation is practicable in handling first-stage cysts according to Volynkin, containing thin echinococcus liquid only, whereas in the presence of daughter vesicles it is not indicated. Postoperatively, dispensary outpatient observation and chemotherapy of the hydatid disease are recommended with a view to promote radical cure.

Echinococcosis, Hepatic↗