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It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.
It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.
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UNLABELLED: The most of European registries of congenital anomalies (CA) collected information of CA in livebirths, stillbirths and terminated pregnancies following prenatal/ultrasound diagnosis. OBJECTIVES: to assess terminated pregnancies after prenatal/ ultrasound diagnosis of CA as a part of register of CA performed in University Hospital-Pleven. Among 21 202 births monitored during the study period (1996-2005), 679 CA were detected. The total prevalence of CA was 32/ 1000 births. The outcome of pregnancy for all cases of selected CA by register was 620 livebirths (91.3%), 36 stillbirths (5.3%), 23 terminated pregnancies (TP) (3.4%). The percentage of pregnancy termination was higher in the case of isolated anomalies, mainly lethal and CA associated with a low survival rate (61%), than with multiple ones. The most common CA detected after prenatal/ ultrasound diagnosis were neural tube defects (NTD) - the main reason for TP (52% of cases). The low proportion of these CA in TP (1/3) compared to their proportion in livebirths (50%) demonstrated an insufficiency of prenatal diagnosis of NTD as a part of register of CA performed in University Hospital-Pleven. Prenatal diagnosis of CA allows an early genetic counseling of mother presenting information on neonatal prognosis and recurrence risk for subsequent pregnancies. It helps family to take an adequate decision for termination of pregnancy with bad prognosis about heavy fetal CA.
UNLABELLED: Endometriosis /E/ is a frequently met disease in women in reproductive age. One of its most typical clinical manifestations is chronic pelvic pain /CPP/ and as components of the chronic pain syndrome- dysmenorrhoea, dyspareunia, intermenstrual pain, and sometimes dyschezia and dysuria. PURPOSE OF THE STUDY: To build up pain profile of patients with E by using quantitative and qualitative characteristics. MATERIALS AND METHODS: The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, body mass index, blood group affiliation, stage of the disease, etc. The following methods were used for the purpose of the study: pain map, monthly pain calendar, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide; documentary method, R-AFS classification of E. Factors that provoke appearance and manifestation of pain, and factors that alleviate pain were studied too. RESULTS AND DISCUSSION: The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. They corroborated the hypothesis for typical pain profile of women with E. CONCLUSION: The building up of pain profile in total with other diagnostic methods /ultrasonography, magnetic resonance imaging/ has a determining role in the further diagnostic and therapeutic management of women with E and CPP. Pain profile can also be used as an assessment tool of conducted treatment /conservative or surgical/.
AIM: The aim of the present study is to show the evolution of the conduct for ectopic pregnancy for 7 years' period after introduction in gynecological practice of contemporary diagnostic and therapeutic methods for ectopic pregnancy. For the fulfillment of this aim was made a prospective study for 7 years' period of the patients with diagnosis "Ectopic pregnancy", treated in Gynecological clinic of "UMBAL - D-r G. Stranski" EAD, Pleven. MATERIALS AND METHODS: The objects of observation were 198 women with diagnosis: "Ectopic pregnancy". There were used the following methods: clinical, technical devices, statistical methods. RESULTS: The authors analyze the results of the use of laparoscopy, conventional surgery and application of Methotrexate describing the indications and the risk for the patient. CONCLUSION: The authors emphasized the advantages of the gynecological laparoscopy for precise diagnosis and contemporary treatment of the intact ectopic pregnancy.
A follow-up of 180 women was carried out. The patients having endured different gynecological operations (laparoscopy, laparohysterectomy, etc.) were divided into two main groups: half of them were treated with Dynastat (new selective COX-2 inhibitor) and the others were treated with Profenid (conventional nonsteroidal anti-inflammatory drug). The groups were compared by the quality of the achieved analgesia and appeared side effects, especially postoperative nausea and vomiting. These parameters were assessed by both medics and patients. In conclusion we accept that the new COX-2 selective inhibitor Dynastat does not have advantages over traditional nonsteroidal anti-inflammatory drug as Profenid especially for postoperative nausea and vomiting and quality of analgesia.
PURPOSE OF THE STUDY: To determine the severity of the separate components of chronic pelvic pain syndrome/dysmenorrhoea, dyspareunia, dysuria, dyschezia ,etc/ in the different stages of the disease and according to the localization of endometriotic lesions. To determine to what extent the severity of the separate chronic pain components correlates with stage of the disease and localization of endometriomas. MATERIALS AND METHODS: The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004 - 01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, type of the disease - internal or external genital endometriosis, adenomyosis, stage of the disease, localization of endometriotic lesions. The following methods were used for the purpose of the study: visual analogue scale, documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide. RESULTS AND DISCUSSION: The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. When the mean value of pain assessment was reported, there was noted a non-correspondence between severity of pain and stage of the disease. It was found no significant correlation between the extent of manifestation of the separate components of the pain syndrome according to the stage of the disease. The severity of the separate components of the pain syndrome was determined according to the localization of the E-lesions. Statistically significant correlation was found between the extent of manifestation of dyspareunia, postcoital ache and dyschezia, and the localization of the E- lesions /p<0,05/ and that correlation was strongly supported in cases of adenomyosis and the components mentioned above. Statistically significant differences were found between the extent of manifestation of the relevant component of the chronic pain syndrome and some of the localization of E foci. CONCLUSION: It was established a correlation between localization of E lesions and the severity of the separate components of the chronic pain syndrome. No correlation was found between the extent of pain manifestation, when assessed in total and in each pain component, and the stage of endometriosis.
Prostate cancer is a complex disease, with many controversial aspects of management in almost all stages of disease. The natural history of this tumor is variable and is influenced by multiple prognostic factors. Radical prostatectomy and radiotherapy are standard treatment options for disease limited to the prostate. The data in literature does not provide clear- cut evidence for the superiority of any treatment. Neo- adjuvant or adjuvant hormonal therapy improves local control and survival in locally advanced disease. The patients treated with radiotherapy would have a relatively long life expectancy, not great risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a significant potential for cure, it is well tolerated in the majority of men especially when the modern techniques of conformal radiotherapy and intensity modulated therapy are used and it is non-invasive therapeutic options with no anesthesia risk. Expected complications like radiation cystitis, impotence and proctitis are registered in about 1% of patients.
BACKGROUND: Prostate cancer is an age related neoplasm, with high incidence in the group of elderly man. The correct management must to be balanced between the benefits of the treatment and its disadvantages. Radiotherapy as definitive treatment is commonly reserved for older patients and patients with high surgical risk and is widely used as a treatment of choice. AIM: The aim of this study was to determine the role of radical radiotherapy for localized prostate carcinoma in patients 70 years age or older concerning treatment morbidity, local control, disease free and overall survival. MATERIAL AND METHODS: A clinical prospective non-randomized study was performed including 103 elderly patients with an age 70 or above, between January 1991 and April 2005, at the Institute for Oncology and Radiology of Serbia. Median age of patients was 74,89 years (range 70- 80 years). Stage distribution was as follows: stage A--3 patients (2.9%), stage B--69 patients (67%) and stage C--31 patients (30.1%). Out of 103 patients, initial PSA value was noted in 87 patients. The mean value of initial PSA was 18,06 ng/ml. Radical radiotherapy was conducted on megavoltage linear accelerators with high energy photons (10, 18 MeV) and total tumor dose of 65 Gy. RESULTS: Low grade acute complications were registered in 70 patients (65%). Mean follow up time was 40, 13 months. The disease outcome at the last follow up show that 79 patients (76.7%) had no evidence of disease and 24 patients (23.3%) relapsed. Overall survival rates were 65, 29% and 44, 52% and disease free survival 66, 59% and 63, 26% at 5 and 10 years. Disease specific survival was at 5 and 10 years 73,32% and 65, 42% respectively. Late sequelas (gradus I and II) are registered in 22 patients (21.36%), out of 103. CONCLUSION: Radical radiotherapy for localized carcinoma of the prostate is effective treatment option in elderly patients with good local control, present treatment tolerance providing good quality of life and long-term cure.
The authors presented the importance of the gynecological laparoscopy for diagnosis of the external genital endometriosis in its different forms. In the last 20 years, it was seen that laparoscopy is not only the basic method for diagnostics but also for the surgical treatment of the endometriosis. Thirty to fifty percent of the females with endometriosis in reproductive age have available sterility. The authors presented the cases, which have been laparoscopically proven for endometriosis and sterility for 7 years' period in Gynecological clinic in MBAL-Pleven and the results from the treatment with analog of the Gonadoliberins (Zoladex).
AIM: To determine the influence of some of the risk factors on fetal macrosomia. MATERIALS AND METHODS: A retrospective study was provided at the Department of Obstetrics and Gynecology, Medical University, Pleven, from January, 1, 2001 to December, 31, 2002 over 625 deliveries: 225 cases of fetal macrosomia--fetal birth weight (FBW) more than 4000 g and/or over 90. percentile (macrosomic group--MG) and 400 cases of singleton term newborns--with FBW between 10. and 90. percentile (nonmacrosomic group--NMG). Analysis included influence of: maternal age, height, prepregnant weight, BMI, weight gain and weight before delivery, previous delivery of macrosomic infant, maternal diabetes mellitus, fetal sex and gestational age. RESULTS: A comparative analysis of data for both of groups was performed. It was found significant correlation (p = 0.001) for influence of maternal age (r = 0.34); height (r = 0.33); prepregnant weight (r = 0.42); BMI (r = 0.32); weight before delivery (r = 0.49); weight gain (r = 0.34); previous delivery of macrosomic infant (r = 0.41); maternal diabetes mellitus (r = 0.54); fetal sex (r = 0.37) and gestational age (r = 0.39). Correlations are different in both of groups. CONCLUSION: Positive correlations between analysed factors and delivering of macrosomic infants and differences in both of groups suggest that analysed factors can't explain completely fetal macrosomia.
UNLABELLED: The biological behaviour (conduct) of benign ovarial cysts is interesting due to their comparatively high frequency of appearance and clinical manifestation. (During the last five years their frequency is between 62%-65% of the gynaecological surgical interventions). With this current survey the authors try to set up a target for research study of the wall receptive status of benign ovarial cysts. This study should be treated as a start up point rendering a prognosis for their eventual biological development. MATERIALS AND METHODS: An immunohistochemical survey was carried on with 50 patients who have already reached the surgical treatment in retrospective order for the period 2001-2003 (three years' period). The survey search is in direction receptive analysis of Estrogene /E2/ and Progesterone /P/ wall receptor in the ovarial cyst. A perspective observation was also carried on (control group of 50 cases) of hormonal-gestagene treatment of the benign ovarial cystogenesis. It appears to be the necessary prove material for hormonal receptors' participation in the cyst wall as an active factor for its development and involution. RESULTS: In the basic group /surgical treatment/ it was stated: In 39 patients--E2/-/, P/-/; in 4 patients--E2/+/, P/+/ In 5 patients--E2/+/, P/-/; in 2 patients--E2/-/, P/+/ CONCLUSION: The executed retrospective analysis demonstrates statistical importance in receptor competency lack in the wall of benign ovarial cysts as the probable grounds for them not being influenced during the conservative treatment method. This method led to the surgical elimination of the cyst. The statistical reliability, connected with the receptor E2 participation in the therapeutic behaviour of the benign ovarial cysts, is not stated. The final conclusions acquired from the executed research work would be a discussion issue after the correlative aspects in the prospective group are surveyed. The benign ovarial cysts' hormonal profile would be taken into consideration also.
The authors presented a short survey for application of Methotrexate for treatment of intact ectopic pregnancy and its usage in Gynecological clinic of MBAL-Pleven during the last five years. There was made a prospective study, and for the studied five years' period in the clinic there were treated 149 women with ectopic pregnancy, 33 of which were hospitalized with intact tubal pregnancy. Methotrexate was used by plan for 6 patients as for 3 of them the treatment was successful. The authors also described two of these cases according to the diagnosis, way and usage period of the cytostatic and the result from the disorder. In conclusion there was emphasized that the treatment of intact tubal pregnancy with Methotrexate has a place in gynecological practice in view of the fact that it decreased physical pain, psycho-emotional stress and bed staying of the patient, but the cases must be strongly selected.
The aim of our study is to compare analgesic effect of single dose Profenid (Sanofi-Aventis)--100 mg administered per rectum or intravenously in woman endured gynecological laparoscopy (LS). We have evaluated 40 woman (divided into two groups each one of 20) sustained planned laparoscopy in department of gynaecology. The effect of administered Profenid over the postoperative pain has been estimated after standard general anaesthesia due to different objective and subjective parameters. As a result of our study we consider that postoperative analgesia with Profenid applied intravenously or by suppository is effective enough method for postoperative analgesia after laparoscopy in gynecology.
UNLABELLED: In the basic appearance of chronic pelvic pain /CPP/, it is often found the symptomatology of Allen-Masters syndrome /AMS/, especially having in mind pelvic congestion syndrome /PCS/. PURPOSE OF INVESTIGATION: To determine the diagnostic approach to AMS on the basis of CPP and factors conducive to development of AMS. METHODS AND MATERIALS: A nine-year retro- and prospective study (in the period 1996-2004) was conducted in Gynaecological Clinic at the Department of Obstetrics and Gynaecology, Medical University - Pleven. Forty patients with verified AMS were included in it. A documentary and inquiry methods were used for the investigation purposes. The following conducive factors were studied: age, body mass index /BMI/, blood group belonging, deliveries, including that of macrosomic foetuses, abortions and other gynaecologic interventions. It was rendered an account of the beginning of CPP, its qualitative and quantitative characteristics, localization and irradiation, its dynamics according to menstrual cycle and day. Excel and Statgraphics plus for Windows were used for the statistical processing of the data obtained from the investigation. RESULTS: Major conducive factors to AMS are BMI, number of pregnancies (deliveries and abortions), weight/ body mass of baby born. CPP is clinically manifested with dysmenorrhoea, dyspareunia and postcoital ache. CONCLUSION: The determined specific pain profile and the presence of proved etiological factors, parallel with laparoscopic method, are auspicious means for diagnosing AMS.
A follow-up of forty women was carried out. The patients having endured a gynecological operation (laparohysterectomy) were divided into two groups: group A--treated with Dynastat (40 mg/24h) and group B--treated with Dynastat (80mg/24h) which was combined in both groups with Clexane. The hematological and hemostatic parameters were evaluated during the early postoperative period--the first 24 hours. The women were followed until they were discharged from hospital. No significant changes of these laboratory parameters were noticed and the clinical stability of the patients in both groups was unaffected. The results showed that Dynastat/Clexane combination could be applied in the clinical practice as it proved great extend of safety for usage after gynecological operations.
The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects.