75 research outputs found
B. Slavchev. Medical care for unmarried pregnant women: current problems.
No full textАдрес за кореспонденция:
Божидар Славчев
СБАЛАГ „Майчин дом”
ул. „Здраве” № 2
1431 СофияИзследвани са проблемите на медицинското обслужване на извънбрачно бременните. Извънбрачната раждаемост се обуславя от редица социално-икономически, семейно-битови, културни, възпитателни, психологични и други фактори. Наложително е подобряването на медикосоциалната помощ за извънбрачно бременните, като се осъществи тяхното ранно обхващане и системно наблюдение.
***** Author studies the medical services for unmarried pregnant women. The extramarital birthrate is determined by a variety of factors: social, economic, family, domestic, cultural, educational, psychological. There is urgent need to improve the medical and social care for unmarried pregnant women by ensuring their early dispensary control and systematic supervision
Enhanced Recovery After Surgery (ERAS) protocol in minimally invasive gynecological surgery: a review of the literature
No full textEnhanced Recovery After Surgery (ERAS) is a complex system of procedures that necessitates multidisciplinary patient care during the preoperative, intraoperative, and postoperative phases. Over the last two decades, the ERAS protocol, which was initially described in colorectal surgery, has gradually expanded to other surgical specialties. Gynecological surgery is no exception, whether for benign or malignant conditions. The ERAS program's primary objective is to overcome the pathophysiological processes associated with surgical stress and to facilitate the patient's rapid recovery, while minimizing complications, hospital stays, and costs. The objectives of minimally invasive surgical procedures largely overlap with the objectives of the ERAS program. We analyzed scientific data from studies examining the ERAS system's application in minimally invasive gynecological surgery (MIGS) and present them in this review. The central question is whether the ERAS protocol can provide additional benefits beyond those inherent in minimally invasive surgical procedures.
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The Role of Radical Hysterectomy with Pelvic and/or Aortic Lymph Node Dissection for Optimal Cytoreductive Surgery in Advanced Stage Epithelial Ovarian Cancer // Ролята на радикалната хистеректомия с илиачна и/или парааортална лимфна дисекция за оптималната циторедукция при авансирал епителен яйчников карцином
No full textВъпреки развитието на радикалната хирургия и съвременните методи за химиотерапия, овариалният рак е най-честата причина за смърт сред жените с гинекологичен карцином. Терапевтичната роля на лимфаденектомията и нейния обем при авансирал овариален карцином (АОК) не са напълно изяснени, както и значението на туморната инвазия в параметри и влагалище. Цел: да се установи ролята на разширената хистеректомия с тазова и/или парааортална лимфна дисекция и ретроперитонеалния подход при хирургичното лечение на АОК. Изследвани са 104 пациентки с АОК, които са оперирани в Гинекологична клиника на МБАЛ "Св.Анна" - Варна от 2004-2012 г. и са проследени до края на 2014 г. Данните са анализирани чрез регресионен корелационен анализ и анализ на преживяемостта на Каплан-Майер. Изводи: Честотата на хистологично доказаните лимфни метастази е функция на обема на лимфна дисекция. Системната лимфна дисекция при пациентките с остатъчен тумор под 1 см може да допринесе за намаляване на резидуалния туморен обем, но нейната роля по отношение на преживяемостта е обект на продължаващи проучвания. Туморната инвазия в параметри и влагалище може да бъде установена единствено след извършване на разширена хистеректомия с ретроперитонеален подход. Дълбочината на ретроперитонеалната тазова инвазия е белег за агресивност на тумора и обуславя непълна циторедукция. Разширената хистеректомия е метод за радикално отстраняване и на невидими (микроскопски) тазови туморни лезии, като способства за пълнотата на циторедуктивната хирургия. Директната туморна екстензия към параметри и влагалище е свързана със статистически значимо по-ниска преживяемост, което подлежи на допълнителни проучвания и трябва да е задължителна част от хисто-патологичните доклади.Ovarian carcinoma remains leading cause of death among women with gynaecologic cancer, despite the advancement of radical surgery and novel chemotherapy. The therapeutic role of lymph node dissection and its extent in advanced ovarian carcinoma (AOC) is not fully established as well as the significance of tumour invasion of the parametria and vagina. Aim: To determine the role of radical hysterectomy with pelvic and/or aortic lymph node dissection and the significance of the retroperitoneal approach in the surgical management of AOC. Material and methods: During the period 2004 - 2012, 104 patients with AOC underwent surgery at the Clinic for Gynaecology at St. Anna Multiprofile Hospital for Active Treatment – Varna, with a follow-up observation until the end of 2014. The data was analysed using regression, correlation and Kaplan-Meier survival analysis. Conclusions: The incidence of histologically proven lymph node metastases is a function of the extent of the lymph node dissection. The systematic lymph node dissection in patients with residual tumour below 1 cm can contribute to the reduction of the tumour mass, but its role for the survival is a subject of ongoing studies. There is a significant correlation between the survival and the expansion of retroperitoneal pelvic invasion - the lowest overall survival is for the group of patients with vaginal invasion with/without parametrial invasion. Radical hysterectomy is a method for complete excision of the invisible pelvic tumour lesions, thus helping the maximal debulking surgery. The direct tumour extension to the parametria and the vagina is associated with a statistically significant lower survival rate, has to be further investigated and should be a mandatory part of pathology reports
Enhanced Recovery after Surgery (ERAS – Enhanced Recovery After Surgery Protocol) In Gynecologic Surgery // Ускорено възстановяване след оперативно лечение (ERAS - Enhanced Recovery After Surgery протокол) в гинекологичната хирургия
No full textПрограмата за бързо възстановяване след хирургия ERAS (Enhanced Recovery After Surgery) е сложна система от процедури, изискваща мултидисциплинарен екип от обучени специалисти – медицински, анестезиолози, гинеколози, психолози, които участват в пред-, интра- и постоперативните грижи за пациента. Понастоящем, тази система се разглежда като глобална инициатива подобряваща качеството на хирургията, която в крайна сметка се отразява върху клиничните ползи и върху понижението на болничните разходи. ERAS протоколът включва последователно изпълнение на различни процедури: обучение на пациента и предоперативна консултация, предоперативно натоварване на пациента с течности и въглехидрати с цел намаляване на предоперативното гладуване, мултимодален подход за овладяване на болката, ограничаване на опиоидните аналгетици, превенция на инфекциите свързани с хирургичния разрез, превенция на венозния тромбоемболизъм, ранно раздвижване. Ефективността на ERAS системата се базира на патофизиологичните процеси свързани с всяко хирургично вмешателство, като тя има за цел да преодолее последствията от хирургичния стрес и в крайна сметка да доведе до по-бързо възстановяване на пациента след операция.
Първоначално, тази програма възниква през 1997 г. в областта на коремната хирургия и постепенно печели привърженици сред другите хирургични специалности, както и в сферата на миниинвазивната хирургия. В гинекологичната практика тя навлиза през 2003 година и впоследствие научните данни за нейните ползи се увеличават. През 2016 г. ERAS дружеството публикува препоръки в две части за пред-, интра- и следоперативните грижи в гинекологичната/онкологична хирургия. Ръководните правила са актуализирани през 2019 г. във връзка с натрупването на научни доказателства и опит в областта на ERAS и гинекологичната онкологична хирургия. През 2020 г. ERAS дружеството публикува препоръки, касаещи специфични процедури при приложението на системата ERAS в циторедуктивната гинекологична хирургия с или без хипертермична интраперитонеална химиотерапия.
Дисертационният труд представя проспективно проучване проведено в Клиника по гинекология в МБАЛ „Св. Анна“ върху 121 пациентки оперирани в планов порядък за доброкачествени и злокачествени заболявания като при тях е приложен предварително изготвен протокол по системата за ускорено възстановяване след хирургия ERAS (Enhanced Recovery After Surgery).
Целта на изследването е да се оцени приложимостта и ефекта на ЕRAS протокола в оперативната гинекология чрез одит и отчет на периоперативните резултати.Enhanced Recovery After Surgery (ERAS) program is a complex system of procedures requiring a multidisciplinary team of trained experts, including nurses, anesthesiologists, gynaecologists, and psychologists, who engage in the pre-, intra-, and postoperative care of the patient. This system is considered a global initiative to improve surgical quality, resulting in clinical advantages and decreased hospital expenses. The ERAS protocol includes
the sequential implementation of several procedures, including patient education and preoperative consultation;
preoperative intake of fluids and carbohydrates to reduce preoperative fasting;
a multimodal approach to pain management;
the limitation of opioid analgesics;
prevention of infections associated with the surgical incision;
prevention of venous thromboembolism; and
early mobilization.
The efficacy of the ERAS system relies on overcoming the pathophysiological processes associated with surgical intervention. It aims to mitigate the effects of postoperative stress and eventually contributes to a faster patient recovery post-surgery. In 1997, the program emerged in the field of abdominal surgery and gradually attracted followers in other surgical specialities, including minimally invasive surgery. It was introduced to the gynaecological practice in 2003, and scientific evidence of its benefits has since grown. In 2016, the ERAS Society published guidelines for preoperative, intraoperative, and postoperative care in gynaecological and oncological surgery. Due to the accumulation of scientific information and experience with ERAS implementation in gynaecological oncology surgery, the guidelines were revised in 2019. In 2020, the ERAS Society published recommendations for particular procedures of the ERAS system during cytoreductive gynaecological surgery with or without hyperthermic intraperitoneal chemotherapy.
The thesis describes a prospective study conducted at the Clinic of Gynecology at St. Anna Hospital - Varna on 121 patients who underwent surgery for benign and malignant conditions following a predetermined ERAS protocol. This study aims to assess the ERAS protocol's applicability and efficacy in operative gynaecology by auditing and reporting perioperative outcomes. A total of 11 specific tasks were set: on the applicability of the individual elements of ERAS in the protocol in gynaecological surgery and their effects in terms of recovery of intestinal function, blood loss, and, in particular, in minimally invasive and oncological gynaecological surgery
Research on transient thermal process of a friction brake during repetitive cycles of operation
No full textPregnancy and Childbirth in Uterus Didelphys: A Report of Three Cases
No full textUterus didelphys is a rare form of congenital anomaly of the Müllerian ducts. The clinical significance of this anomaly of the female reproductive tract is associated with various reproductive issues: increased risk of preterm birth before 37 weeks’ gestation, abnormal fetal presentation, delivery by caesarean section, intrauterine fetal growth restriction, low birth weight less than 2500 g, and perinatal mortality. We present three cases of uterus didelphys and full-term pregnancy, which resulted in favorable birth outcomes of live-born, full-term infants. In two of the cases, delivery was performed via Caesarean section: due to lack of labor activity in one of the cases and lack of response to oxytocin stimulation in the second case. The weight of two of the new-born infants was lower than expected for the gestational age
The Enhanced Recovery After Surgery (ERAS) program in gynecological practice – socioeconomic benefits (first announcement)
Get PDFThe ERAS program is a standardized system of pre-, intra-, and postoperative measures designed to alleviate surgical stress, provide an individualized approach to each patient, and enable rapid recovery following surgery. It requires a multidisciplinary team of surgeons, anesthesiologists, and nurses. ERAS’s clinical benefits in gynecological practice are supported by a substantial body of evidence. ERAS results in a shorter hospital stay and a reduction in postoperative compli-cations, which reduces hospital expenses. In spite of staff training expenses, the evidence points to lasting economic benefits. Despite earlier discharge, the ERAS program was also associated with patient satisfaction. The socioeconomic effects of ERAS in gynecological surgery meet the current system requirements due to limited hospital resources as well as the contemporary goals of surgery concerning rapid patient recovery
Юридическата литература на Здравко Славчев The Juridical literature of Zdarvko Slavchev
Get PDFBibliosphere for the first time is presenting the very productive author of legal literature – Zdravko Slavkov. Separate titles are annotated, accompanied with light remarks from the author on topics, related to editing, how are the feelings of Bulgarians towards state and municipal tax administration, are they defrauded; should students visit more often libraries
Avascular Spaces of the Female Pelvis—Clinical Applications in Obstetrics and Gynecology
No full textThe term “spaces” refers to the areas delimited by at least two independent fasciae and filled with areolar connective tissue. However, there is discrepancy regarding the spaces and their limits between clinical anatomy and gynecologic surgery, as not every avascular space described in literature is delimited by at least two fasciae. Moreover, new spaces and surgical planes have been developed after the adoption of laparoscopy and nerve-sparing gynecological procedures. Avascular spaces are useful anatomical landmarks in retroperitoneal anatomic and pelvic surgery for both malignant and benign conditions. A noteworthy fact is that for various gynecological diseases, there are different approaches to the avascular spaces of the female pelvis. This is a significant difference, which is best demonstrated by dissection of these spaces for gynecological, urogynecological, and oncogynecological operations. Thorough knowledge regarding pelvic anatomy of these spaces is vital to minimize morbidity and mortality. In this article, we defined nine avascular female pelvic spaces—their boundaries, different approaches, attention during dissection, and applications in obstetrics and gynecology. We described the fourth space and separate the paravesical and pararectal space, as nerve-sparing gynecological procedures request a precise understanding of retroperitoneal spaces
An Unusual Case of Fulminant Generalized Peritonitis Secondary to Purulent Salpingitis Caused by Prevotella bivia – Case Report with Literature Review
No full textIntroduction: Prevotella bacilli are prevalent in the body as members of the normal flora and in some cases they can be involved in infections throughout the body. Prevotella bivia is a member of a nonpigment group found in the resident flora of the female genital tract and it is occasionally seen in the oral cavity. Case report: We describe the very rare case of a 39-year-old woman with fulminant generalized peritonitis secondary to purulent salpingitis caused by Prevotella bivia. Discussion: In most cases described in the literature, Prevotella bivia was mixed with aerobes and caused bacterial vaginosis and pelvic inflammatory disease, whereas in our case study Prevotella bivia was the only microbe that was isolated. The infection was fulminant and caused generalized peritonitis. Rapid and systemic infections typically occur in immunocompromised hosts, however our patient was in good health condition and immunocompetent. Conclusions: Prevotella bivia may cause rapid and systemic infections, even in immunocompetent hosts. Multidisciplinary team management is mandatory in order to estimate the optimal treatment regimen
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