Fungal Planet description sheets: 868-950

Novel species of fungi described in this study include those from various countries as follows: Australia, Chaetomella pseudocircinoseta and Coniella pseudodiospyri on Eucalyptus microcorys leaves, Cladophialophora eucalypti, Teratosphaeria dunnii and Vermiculariopsiella dunnii on Eucalyptus dunnii leaves, Cylindrium grande and Hypsotheca eucalyptorum on Eucalyptus grandis leaves, Elsinoe salignae on Eucalyptus saligna leaves, Marasmius lebeliae on litter of regenerating subtropical rainforest, Phialoseptomonium eucalypti (incl. Phialoseptomonium gen. nov.) on Eucalyptus grandis × camaldulensis leaves, Phlogicylindrium pawpawense on Eucalyptus tereticornis leaves, Phyllosticta longicauda as an endophyte from healthy Eustrephus latifolius leaves, Pseudosydowia eucalyptorum on Eucalyptus sp. leaves, Saitozyma wallum on Banksia aemula leaves, Teratosphaeria henryi on Corymbia henryi leaves. Brazil, Aspergillus bezerrae, Backusella azygospora, Mariannaea terricola and Talaromyces pernambucoensis from soil, Calonectria matogrossensis on Eucalyptus urophylla leaves, Calvatia brasiliensis on soil, Carcinomyces nordestinensis on Bromelia antiacantha leaves, Dendryphiella stromaticola on small branches of an unidentified plant, Nigrospora brasiliensis on Nopalea cochenillifera leaves, Penicillium alagoense as a leaf endophyte on a Miconia sp., Podosordaria nigrobrunnea on dung, Spegazzinia bromeliacearum as a leaf endophyte on Tilandsia catimbauensis, Xylobolus brasiliensis on decaying wood. Bulgaria, Kazachstania molopis from the gut of the beetle Molops piceus. Croatia, Mollisia endocrystallina from a fallen decorticated Picea abies tree trunk. Ecuador, Hygrocybe rodomaculata on soil. Hungary, Alfoldia vorosii (incl. Alfoldia gen. nov.) from Juniperus communis roots, Kiskunsagia ubrizsyi (incl. Kiskunsagia gen. nov.) from Fumana procumbens roots. India, Aureobasidium tremulum as laboratory contaminant, Leucosporidium himalayensis and Naganishia indica from windblown dust on glaciers. Italy, Neodevriesia cycadicola on Cycas sp. leaves, Pseudocercospora pseudomyrticola on Myrtus communis leaves, Ramularia pistaciae on Pistacia lentiscus leaves, Neognomoniopsis quercina (incl. Neognomoniopsis gen. nov.) on Quercus ilex leaves. Japan, Diaporthe fructicola on Passiflora edulis × P. edulis f. flavicarpa fruit, Entoloma nipponicum on leaf litter in a mixed Cryptomeria japonica and Acer spp. forest. Macedonia, Astraeus macedonicus on soil. Malaysia, Fusicladium eucalyptigenum on Eucalyptus sp. twigs, Neoacrodontiella eucalypti (incl. Neoacrodontiella gen. nov.) on Eucalyptus urophylla leaves. Mozambique, Meliola gorongosensis on dead Philenoptera violacea leaflets. Nepal, Coniochaeta dendrobiicola from Dendriobium lognicornu roots. New Zealand, Neodevriesia sexualis and Thozetella neonivea on Archontophoenix cunninghamiana leaves. Norway, Calophoma sandfjordenica from a piece of board on a rocky shoreline, Clavaria parvispora on soil, Didymella finnmarkica from a piece of Pinus sylvestris driftwood. Poland, Sugiyamaella trypani from soil. Portugal, Colletotrichum feijoicola from Acca sellowiana. Russia, Crepidotus tobolensis on Populus tremula debris, Entoloma ekaterinae, Entoloma erhardii and Suillus gastroflavus on soil, Nakazawaea ambrosiae from the galleries of Ips typographus under the bark of Picea abies. Slovenia, Pluteus ludwigii on twigs of broadleaved trees. South Africa, Anungitiomyces stellenboschiensis (incl. Anungitiomyces gen. nov.) and Niesslia stellenboschiana on Eucalyptus sp. leaves, Beltraniella pseudoportoricensis on Podocarpus falcatus leaf litter, Corynespora encephalarti on Encephalartos sp. leaves, Cytospora pavettae on Pavetta revoluta leaves, Helminthosporium erythrinicola on Erythrina humeana leaves, Helminthosporium syzygii on a Syzygium sp. bark canker, Libertasomyces aloeticus on Aloe sp. leaves, Penicillium lunae from Musa sp. fruit, Phyllosticta lauridiae on Lauridia tetragona leaves, Pseudotruncatella bolusanthi (incl. Pseudotruncatellaceae fam. nov.) and Dactylella bolusanthi on Bolusanthus speciosus leaves. Spain, Apenidiella foetida on submerged plant debris, Inocybe grammatoides on Quercus ilex subsp. ilex forest humus, Ossicaulis salomii on soil, Phialemonium guarroi from soil. Thailand, Pantospora chromolaenae on Chromolaena odorata leaves. Ukraine, Cadophora helianthi from Helianthus annuus stems. USA, Boletus pseudopinophilus on soil under slash pine, Botryotrichum foricae, Penicillium americanum and Penicillium minnesotense from air. Vietnam, Lycoperdon vietnamense on soil. Morphological and culture characteristics are supported by DNA barcodes.

[ANTITHROMBOTIC MEDICATION IN PREGNANT WOMEN WITH PREVIOUS INTRAUTERINE GROWTH RESTRICTION]

AIM

To analyze pregnancy outcome in patients who were on antithrombotic medication (AM) because of previous pregnancy with fetal intrauterine growth restriction (IUGR).

MATERIALS AND METHODS

The studied group (SG) included 21 pregnancies in 15 women with history of previous IUGR. The patients were on low dose aspirin (LDA) and/or low molecular weight heparin (LMWH). Pregnancy outcome was compared to the one in two more groups: 1) primary group (PG) including the previous 15 pregnancies with IUGR of the same women; 2) control group (CG) including 45 pregnancies of women matched for parity with the ones in the SG, with no history of IUGR and without medication. The SG, PG and CG were compared for the following: mean gestational age (g.a.) at birth, mean birth weight (BW), proportion of cases with early preeclampsia (PE), IUGR (total, moderate, and severe), intrauterine fetal death (IUFD), neonatal death (NND), admission to NICU, cesarean section (CS) because of chronic or acute fetal distress (FD) related to IUGR, PE or placental abruption. Student's t-test was applied to assess differences between the groups. P values < 0.05 were considered statistically significant.

RESULTS

The differences between the SG and the PG regarding mean g. a. at delivery (33.7 and 29.8 w.g. respectively) and the proportion of babies admitted to NICU (66.7% vs. 71.4%) were not statistically significant. The mean BW in the SG (2114,7 g.) was significantly higher than in the PG (1090.8 g.). In the SG compared with the PG there were significantly less cases of IUFD (14.3% and 53.3% respectively), early PE (9.5% vs. 46.7%) moderate and severe IUGR (10.5% and 36.8% vs. 41.7% and 58.3%). Neonatal mortality in the SG (5.6%) was significantly lower than in the PG (57.1%), The proportion of CS for FD was not significantly different--53.3% in the SG and 57.1% in the PG. On the other hand, comparison between the SG and the CG demonstrated significantly lower g.a. at delivery in the SG (33.7 vs. 38 w.g.) an lower BW (2114 vs. 3094 g). There were significantly more cases with IUGR in the SG compared to the CG--total, moderate and severe (47.4 %, 10.5% and 36.8% in the SG vs. 8.9%, 6.7% and 2.2% in the CG) and NICU admissions (66.7% vs. 4.4%). There were no cases in the control group with severe PE (9.5% in the SG), IUFD (14.3% in the SG), and CS for FD (53.3% in the SG). The proportion of pregnancies without complication in the SG (23.8%) was significantly lower than in the CG (86.7%).

CONCLUSIONS

The outcome of pregnancies with AM because of previous fetal IUGR is improved compared to the index ones. However, it is less favorable compared to the outcome in matched cases with no history of IUGR in previous pregnancies.

[INDICATIONS FOR ANTITHROMBOTIC MEDICATION DURING PREGNANCY--ANALYSIS OF CURRENT PRACTICES IN BULGARIA]

AIM

To analyze current practices in Bulgaria regarding antithrombotic medication (AM) during pregnancy, and to compare them with the ones recommended in literature.

MATERIALS AND METHODS

In 84 pregnant women who were low dose aspirin (LDA) or/and low molecular weight heparin (LMWH) or unfractionated heparin (UH), data about AM were collected and analyzed. A descriptive analysis was performed of the indications for AM, its type, the applied doses and therapeutic regimens.

RESULTS

39/84 pregnant women (46.4%) had indications for AM. In 18/84 cases (21.4%) the type of AM was precisely selected according to the indications. Of them 12 were on LDA alone (8--history of early preeclampsia/IUGR, 2--diabetes, 1--autoimmune disease, 1--chronic hypertension), 4--on LMWH/UF alone (2--venous thromboembolism, 2--essential thrombocytemia) and 2 received both LMH and LDA (1--antiphospholipid syndrome, 1--phlebothrombosis and stillbirth). Another 21/84 cases (25%) had indications for AM but its type was not appropriately selected. This subgroup included cases with high risk inherited thrombophylia (IT), history of placental mediated disease (PMD) in previous pregnancies and/or accompanying medical disorders. These patients had indications for either LDA or LMA administration, but were on combined medication. In 45/84 cases (53.6%) with uneventful past obstetric history or early pregnancy losses (before 10 w.g.) but no PMD there were no indications for AM. Among them, 17/84 (20.2%) had low risk IT in 18/84 (21.4%) IT was ruled out and 10/84 (12%) were not tested for IT at all. In total, 64/84 patients (76.2%) were on LDA--alone (25/84 - 29.8%), or in combination with LMWH (39/84 - 46.4%). Treatment with LDA was indicated in 45/64 (70.3%) cases--12/25 (48%) of the ones who were on LDA alone and 23/39 (59%) of those on LDA and LMW In 19/64 cases (29.7%) LDA administration was not indicated. 59/84 (70.2%) of the patients were on LMW/UH- alone (20/84 - 23.8%) orin combination with LDA (39/84 - 46.4%). This therapy was indicated in only 6/59 cases (10.2%), treated with LMWH/UH - 4/20 (20%) of the ones on LMWH/UH alone and 2/39 (5.2%) of the ones on LDA plus LMWH. In 53/59 cases (89.8%) the administration of LMWH was not indicated. LDA was started preconceptionally, in the Ist or in the lind trimester in 12/64 (18.7%), 32/64 (50%) and 6/64 (9.4%) of the cases respectively. LMWN/UH was started preconceptionally, in the Ist orin the lind trimester in 5/59 (8.6%), 33/59 (56.9%) and 5/59 (8.6%) of the cases respectively. The information when AM was started was not reliable in 14/64 (21.9%) cases on LDA and in 16/59 (27.1%) - on LMWH. In 12/84 cases (14.3%) LDA and LMWH were administered every other day. This referred to 5/64 (7.8%) cases on LDA and to 7/58 (12.1%) - on LMWH. LDA and LMWH were administered in PAI 4G/4G polymorphism despite the fact that in'these cases fibrinolysis but not coagulation was affected.

CONCLUSIONS

AM was administered according to strict indications and with appropriately selected preparations in only 21.4% of the studied cases. In another 25% there were indications for AM, but its type was not precisely selected. 53.6% of the patients had no indications for AM. LDA administration (alone or in combination with LMWH) was indicated in 70.9% of the cases; the same referred to only 10.2% of the ones who were on LMWH. Application/administration of AM every other day was inappropriate given the pharmacokinetics of the preparations. AM was also applied in IT with decreased fibrinolysis but not increased coagulability.

PEMBE-Growth of Gallium Nitride on (0001) Sapphire: A comparison to MOCVD grown GaN

Thin films of GaN on c-plane sapphire were grown by plasma-enhanced molecular beam epitaxy (PEMBE). The influence of different growth conditions on the quality of the epitaxial layers was studied by x-ray diffraction (XRD), atomic force microscopy (AFM) and Hall measurements. For low deposition temperatures, the growth of a thin buffer layer of AlN results in a decrease of the XRD rocking curve full width at half maximum (FWHM) but also in poorer quality in electronic and optical properties. Samples of 3μm thickness with 570 arcsec FWHM in the XRD rocking curve, a near band gap PL-emission FWHM at 5 K of 7 meV, charge carrier densities of ne = 2 × 1017 cm−3, and Hall mobilities of 270 cm2/Vs at 300 K were grown without a buffer layer. A comparison of the morphology and XRD rocking curves with those of GaN films deposited by metalorganic chemical vapour deposition (MOCVD) shows that the two methods have different growth mechanisms.

[Biometry and assessment of the levator hiatus by three-dimensional pelvic floor ultrasound]

Images of the levator hiatus in 40 nulliparous, 40 asymptomatic parous women and 40 women with pelvic organ prolapse were obtained by transperineal/translabial three-dimentional ultrasonography of the pelvic floor. Volumes were taken at rest and during squeezing. Recontructed images of the levator hiatus at the plane of minimal dimentions were obtained by off-line processing of the stored volumes. The transverse, the longitudinal diameter and the area of the levator hiatus were measured at rest and during squeezing in the three groups. Qualitative assessment of the shape and the symmetry of the levator hiatus at rest was made, too. The average hiatal dimentions (transverse, longitudinal diameter and hiatal area) measured at rest in the three groups were: 35.8 mm, 43.1 mm and 11.84 cm2 in the nulliparous; 43.6 mm, 47.1 mm and 15.1 cm2 in the asymptomatic parous women and 50.5 mm, 57.2 mm and 25.8 cm2 in women with pelvic organ prolapse. Nulliparous women achieved the greatest reduction of hiatal area during squeezing (by 21% average). In asymptomatic parous women the hiatal area reduction averaged 12% while in women with pelvic organ prolapse the average reduction was by 4% only. Levator injury was detected in 7.5% of the asymptomatic parous women and in 22.5% of the women with pelvic organ prolapse. Left-sided injuries predominated. Three-dimentional ultrasound provides easy and high-quality imaging of the pubovisceral miscles for the objective assessment of the levator hiatus in static and dynamic conditions.

Ionization Energy and Electron Affinity of Clean and Oxidized AlxGa1−xN(0001) Surfaces

Ionization energies and electron affinities of clean AlxGa1−xN(0001) surfaces were investigated by ultraviolet photoemission spectroscopy over the whole composition range. The samples were cleaned with cycles of N+-ion sputtering and annealing partly within a Ga atom flux. The ionization energy is measured as 6.5 eV and is almost independent of the aluminum content in good agreement with the general chemical trend. The electron affinity decreases linearly with composition from 3.1 eV for GaN to 0.25 eV for AlN. No evidence for negative electron affinity at AlN(0001) surfaces was found. Adsorption of oxygen at room temperature leads to a significant increase of the ionization energy and electron affinity. With AlN(0001) surfaces, an oxygen uptake of 0.6 monolayers is observed after exposures of 108 Langmuirs and the ionization energy increases by approximately 2 eV.

Lateral polarity heterostructures by overgrowth of patterned AlxGa1-xN nucleation layers

In this study thin AlxGa1−xN nucleation layers on sapphire were patterned and overgrown by plasma-induced molecular beam epitaxy (PIMBE) and metalorganic chemical vapor deposition (MOCVD) to obtain adjacent regions of GaN and AlGaN/GaN heterostructures with different polarities. The role of polarity on the structural and electrical properties of epitaxial layers and AlGaN/GaN heterostructures was investigated for samples grown on patterned AlN or GaN nucleation layers. Epitaxial GaN and AlGaN/GaN heterostructures grown on Al-face AlN or N- face GaN nucleation layers were found to be Ga-face or N-face, respectively, independent of the technique used for the overgrowth.

Laser-Processing for Patterned and Free-Standing Nitride Films

Films of GaN and related materials can be processed by methods that invoke thermal decomposition, induced by intense illumination with a pulsed laser. At elevated temperatures, the nitride semiconductors undergo decomposition, with the effusion of nitrogen gas. We exploit this mechanism as an alternative to etching for the patterning of nitride films and for the opening of buried interfaces. Films of GaN have been etched to a depth of 1 μm in less than three seconds. This interface decomposition allows in particular the separation of nitride films from transparent growth substrates such as sapphire.

[Solifenacin in treatment of the overactive bladder syndrome--diagnosis, clinical management and results]

The overactive bladder syndrome (OAB) is a pathological condition that affects millions of people round the world. Its incidence increases with ageing. The main therapeutic option for OAB nowadays is anti-muscarinic drug therapy.

AIM

To define and implement the diagnostic criteria, clinical guidelines in our country and to evaluate the results of Solifenacin therapy in patients with OAB.

MATERIAL AND METHODS

Along a three years period (2006-2009) 163 OAB patients were analyzed followed and treated. In our group of patients 106 (65.2%) are females and 57 (34.8%)--males. The diagnosis is based mainly on the complaints of the patient, evaluated thoroughly with a detail anamnesis and questionnaires. Urodynamic studies were performed In some of the patients. The efficacy of Solifenacin therapy has been validated with the same methods used in SUNRISE and VENUS studies.

RESULTS AND DISCUSSION

The mean age of female patients in our group is 63.8 years, and 65.6 years for males. The most commonly observed symptoms of OAB are urgency--88.3% and frequency--92%. Urge-incontinence is observed in 48.8% of the cases. Therapy with Solifenacin 5 and 10 mg has alleviated urgency in 82% and urge-incontinence in 88.9%. Mean number of pads used for 24 hours has decreased from 2.6 to 0.4 after therapy.

CONCLUSION

Urgency is the main mandatory symptom for the diagnosis OAB. Therapy with Solifenacin 5 and 10 mg guarantees very good clinical results, and high degree of compliance of the patients.

Characterization of clonogenic stromal cells isolated from human endometrium

Human endometrium is an object of extensive restructuring and remodeling during the female reproductive life and it is quite tempting to assume that these periodic changes happen with the participation of cells that should have the basic characteristics of multipotent cells. The aim of this study was to search for the presence of cells with plastic adherence, clonogenicity, and differentiation in human endometrium. To this end, human endometrial stromal cells were cultured in vitro for more than 15 passages. Flow cytometry analysis of the cultured cells showed that they were positive for CD29, CD73 and CD90, which are considered to be the markers of cells with mesenchymal origin. The cells were negative for the hematopoietic cell markers (CD45, CD34, CD14, CD3, CD19, CD16/56, and HLA-DR). Further, it was shown that the cultured cells had 15% clonogenic efficiency and could be induced to differentiate into adipogenic cells containing typical lipid-rich vacuoles. These results demonstrate that the human endometrium contains a low number of cells with the characteristics of endometrial stromal stem/progenitor cells, which seem to belong to the family of the mesenchymal stem cells. It can be speculated that these cells are engaged into the monthly restructuring and remodeling of human endometrium.

[Surgical treatment of post hysterectomy vesicovaginal fistulas: our experience of more than a decade]

The results of the surgical treatment of 21 consecutive patients with posthysterectomy vesicovaginal fistulas admitted in Second gynaecology clinic of the University Hospital of Ob&Gyn in Sofia between 1993 and 2006 are presented. 19 of the patients had no previous attempts of repair, 2 had 2 and 4 failed attempts for surgical repair respectively. All 21 patients were operated using one and the same technique of transperitoneal transvesical fistula repair. All operations were successful. There were no intra or postoperative complications and all patients had an uneventful recovery. The authors appreciate the technique used for its utmost reliability which warrants its greater complexity and surgical trauma compared to the other approaches for vesicovaginal fistula repair.

[3D and 4D ultrasonography in obstetrics]

The review article analyses the practical application of 3D/4D ultrasound in modern obstetrics. The basic terms applied with this method are introduced including their equivalents in Bulgarian. The main volume rendering modes are described. The advantages of 3D/4D ultrasound in obstetrics are outlined including: 1) improved understanding of normal fetal anatomy and fetal anomalies by the parents; 2) improved maternal-fetal bonding; 3) enhanced diagnosis of fetal anomalies; 4) precise identification of the nature, size and location of certain fetal defects; 5) precise volume measurement of organs with irregular shape; 6) retrospective analysis, data exchange and education. Some specific advantages of 3D/4D sonography are listed regarding its application in the first trimester, for the diagnosis of fetal anomalies and for fetal growth assessment. Some myths about 3D/4D ultrasound popular among patients and medical professionals are discussed. The ethical aspects of 3D/4D ultrasound in obstetrics as well as the future perspectives of the method are also outlined.

Tissue microarray analysis of EGFR and erbB2 copy number changes in ovarian tumors

The objective of this study was to assess the implication of copy number changes of epidermal growth factor receptor (EGFR) and erbB2 genes in the etiology and progression of ovarian tumors. In our study, we used the highly reliable method of fluorescent in situ hybridization, applied on tissue microarray, containing 1006 ovarian tumors from different malignancy, histologic type and grade, and tumor stage, in order to analyze the correlations between gene copy number changes and tumor phenotype. We established copy number changes of erbB2 in 15.30% of malignant ovarian tumors-8.16% amplifications and 7.14% gains. The frequency of EGFR copy number changes was 10.67%-3.65% amplifications and 7.02% gains. EGFR gains occurred with approximately the same frequency in malignant (7.02%), low malignant potential (8.33%), and benign (7.19%) ovarian tumors. ErbB2 amplification was associated with clear cell type of ovarian cancer (P < 0.04). No amplification of EGFR and erbB2 genes was established in tumors with low malignant potency and in benign tumors. Regarding cancer phenotype, there was no statistically significant association between erbB2 copy number changes and histologic grade as well as tumor stage of ovarian cancer. EGFR gains are early events in ovarian tumorigenesis. Our results showed similar frequencies of EGFR gains in different grade tumors, while EGFR amplification increased from grades 1 to 2 to 3.

Correlations between c-myc gene copy-number and clinicopathological parameters of ovarian tumours

The objective of this study was to investigate increases in c-myc gene copy-number in ovarian tumours, and to analyze their correlations with clinicopathological parameters. Here we applied FISH on TMA (tissue microarrays) containing 507 ovarian tumour samples from different malignancy, histology, stage and grade. Overall, we found high frequency for c-myc copy-number increases (38.5%) in ovarian cancers: 22.1% amplifications and 16.4% gains. We established c-myc amplification in more than 30% in endometrioid and mixed epithelial ovarian carcinomas. c-myc gains were found in a high proportion (42.9%) of clear cell carcinomas. We found associations between c-myc copy-number changes and clinicopathological parameters of ovarian tumours such as degree of malignancy and histological type. We suggested that c-myc amplifications are characteristics for endometrioid, and c-myc gains for clear cell ovarian cancers. We suggest that copy-number increases of c-myc and 20q13.2 represent a possible mechanism for the regulation of the pathway STK15--c-myc--hTERT.

[LUTS in women and possible therapeutic effects of alfa1-adrenoblockers]

Lower Urinary Tract Symptoms (LUTS), including urinary incontinence, are one of the most common problems in women pathology.

OBJECTIVE

The objective of the authors is to determine the symptomatic index, to perform an urodynamic assessment and to establish the therapeutic possibilities of the alfa1-adrenoblokers in women with LUTS.

MATERIAL AND METHODS

In the course of a three year period (2001-2003) 74 women, ranging in age from 26 to 76 years old (average age of 48.6), have been examined and monitored. The symptomatic index was measured by a questionnaire, developed on the basis of IPSS and BFLUTS. The urodynamic study was performed with a multi-channel system Dantec-Meneut and includes multi-chanel cystrometry, followed by measuring of the pressure and the speed of urinary flow before the treatment and after it. Therapy with the L1-adrenoblocker Doxazosin was applied to 42 (56.7%) of the patients.

RESULTS

51 (68.9%) women were with predominantly irritative symptoms, and 23 (31.1%)--with predominantly obstructive. The urodynamic studies reval: 1. Obstruction of the lower urinary tract--7 (9.4%); 2. Obstruction with detrusor hyperactivity--15 (20.3%); 3. Detrusor hyperactivity--33 (44.6%); 4. Sensory urge-syndrome--6 (8.1%); 5. Disturbed contractility of the urinary bladder--4 (5.4%); 6. With no significant deviations--9 (12.2%) Total disappearance of the symptoms was achieved in 64.3% of the patients with the prescribed therapy, while in 11.9% symptoms have relapsed after discontinuation of the therapy.

CONCLUSIONS

LUTS in women is not only a gerontology problem. It affects more and more often women in active and child-bearing age. The therapeutic use of alfa1-adrenoblockers is one alternatives in the treatment of these patients.

[Potentialities of immunodiagnostics in endometriosis]

In this study, the authors tried to figure out the value of immunodiagnostics, and especially the protein characteristics of the peritoneal fluid in women with endometriosis. The main purpose was to establish whether this kind of diagnostics is reliable enough for clinical purposes.

[A case of unruptured intrafollicular ovarian pregnancy diagnosed prior to operation]

A case of an unruptured intrafollicular ovarian pregnancy of 8 gestational weeks diagnosed by ultrasonography in a virtually asymptomatic patient is reported. A 32 year-old woman with 1 vaginal delivery 8 years ago presented with a history of intermittent spotting after removal of an IUD during her last menstrual period 4 weeks ago. IUD was inserted 6 years prior. The patient was symptom-free and showed no abnormal findings upon vaginal examination. Transvaginal ultrasonography however disclosed a gestational sac with a live embryo within the left ovary. The woman was operated on via laparotomy without delay. The intraoperative finding showed a normally appearing corpus luteum in the intact left ovary without any visible abnormality of the pelvic organs. Having in mind the US finding a resection of the corpus luteum was done revealing the gestational sac within it. The authors describe the following three US signs specific of unruptured intrafollicular ovarian pregnancy: extremely thickened uniformly echogenic wall of the sac, the sac is partially surrounded by ovarian structure, no corpus luteum is detected in either ovary. The essential role of transvaginal ultrasonography in the precise diagnosis of the ectopic pregnancy and its location is emphasized. The absence of specific complaints and findings until rupture of the ovary occurs and the association of ovarian pregnancy and IUD are also confirmed by the case-report.

[Laparoscopic hysterectomy--the initial experience in Bulgaria]

The paper presents the first cases of laparoscopic-assisted vaginal hysterectomy and laparoscopic hysterectomy with removal of the uterus through the vagina performed in Bulgaria as well as the experience gained by the team from II gynaecology clinic at State University Hospital "Maĭchin dom" in Sofia from seven patients operated on by these techniques. The indications, the conditions and the implemented technique with its advantages and difficulties are described. The procedures are associated with less trauma and blood loss than abdominal surgery and are followed by a very smooth postoperative period which is very well tolerated by the patients. No intraoperative complications occurred. The postoperative period was free of any problems in 5 of the patients while in two there were minor complications. Marked shortening of the duration of the procedures is achieved with the initial experience.

[The zinc concentration of the blood serum in women with ovarian tumors (preliminary report)]

The aim of the study is to determine the concentration of blood serum zinc of women with ovarian tumors. The patients included in the study are as follows: 15 women with benign ovarian cysts, 5 with endometrial cysts and 5 with ovarian carcinoma. The control group consists of 157 healthy women whose serum zinc concentration was 13.50 +/- 2.60 mmol/L. We could not demonstrate a significant difference in serum zinc concentration of different groups: benign cysts, endometrial cysts and ovarian carcinoma in comparison control group.

[Detrusor instability--an important but underestimated factor in urinary incontinence in women]

157 consecutive female patients complaining of urinary incontinence were studied by history and urodynamics. 21 of them (13.4%) demonstrated urge-incontinence due to severe detrusor instability, 20 (12.7%) showed mixed (both urge and stress) incontinence, 14 (9%) only detrusor instability and 12 (7.6%)--stress incontinence accompanied by detrusor instability. Pure stress incontinence was diagnosed in 79 cases (50.3%) while 11 patients (7%) manifested no abnormality during the urodynamics. A total of 67 patients (42.7%) showed urodynamic evidence of detrusor overactivity. In 55 (35% of the studied subjects) it was the main urodynamic finding. The prevalence of detrusor instability was higher among those with recurrent incontinence and was the highest (60%) among the women with more than one previous operations. When urge incontinence was present it occurred at detrusor pressures lower than the maximum urethral closure pressure, which implies possible failure of the sphincteric mechanisms associated with detrusor instability. 14% of the women with detrusor instability did not report complaints typical for this disorder but had history of stress incontinence alone. The authors confirm the necessity of objective assessment of the lower urinary tract in all cases with history suspicious of detrusor instability as well as when surgical treatment for stress incontinence is planned.

[A comparative study of the efficacy of antibiotic prophylaxis with cephalosporins in operative gynecology]

The article presents the results of a comparative study on the efficacy of perioperative prophylaxis with cefalosporins in abdominal gynaecological operations. A total of 155 women meeting certain inclusion criteria were operated on and were randomly assigned to one of the following regimens: Cefoxitin 3 x 1 g--14 subjects, Cefotetan 2 x 1 g--43 subjects, Cefalotin 3 x 2 g for 24 hours--27 subjects, Cefalotin 3 x 2 g for 72 hours--41 subjects and a control group of 30 subjects without prophylaxis. The course of the postoperative period, the hospital stay and the average costs in each group were assessed and compared. None of patients receiving any prophylaxis developed infectious complications, while such complications occurred in 10% of the control without prophylaxis. The authors conclude that antibiotic prophylaxis effectively prevent the infectious complications and shortens the postoperative hospital stay. Despite its narrower anti-bacterial spectrum Cefalotin is not inferior in its efficacy to the second and the third-generation cefalosporins. While providing equal effect, the 24-hours Cefalotin regimen is from 2.8 to 4.9 times cheaper then the other prophylaxis regimens and is twice cheaper than the no-prophylaxis regimen. The longer 72-hours Cefalotin scheme shows no advantages to the 24-hours one but almost triples the expenses. Additional antibacterial treatment in the postoperative period needs more precise indications since unequivocal reasons for its administration are missing in a number of cases.

[The use of cefotetan for the prevention of infectious postoperative complications in gynecology]

The study presents the results from the use of cefotetan for perioperative prophylaxis in 43 gynaecology patients compared with 29 controls without perioperative antibiotic prophylaxis with similar diseases and operations. Both groups show equal percentage of the cases with smooth postoperative period (70 and 72% respectively). 13 of the patients on cefotetan prophylaxis received additional antibiotic treatment (9 because of temperature up to 37.5 degrees and 4 because of temperature from 37.6 to 38.5 degrees). Mo major infections postoperative complications occurred among the patients on cefotetan prophylaxis. 8 of the non-prophylacted patients needed antibiotic treatment postoperatively including 4 with temperature above 38.5 degrees. Two infections of the operative wounds also occurred in the same group. The conclusion is that cefotetan effectively prevents the major infection postoperative complications in gynaecology. The administration of additional antibiotic treatment is most often not warranted.