"For" and "against" the use of cytotec in obstetrics and gynaecology

The aim of this outlook was to study the application of Misoprostol in obstetrics and gynaecology. Because this preparation is not approved for use in Bulgaria, publications on the topic from various journals cited in Medline, Cochrane library, Nature, Science, Lancet, GyneWeb and others have been taken into consideration. Indications, methods of administration, dosages and side effects in use of this drug were described.     

Women "healthcare" and obstetrics - "thoughts of farewell"

Medicine, and so within also gynecology and obstetrics is shaped in the process of the last decade by changes of interaction between female-patient and physician in "Arbeitszeitgesetz" (law upon daily working time), the introduction of payment-system an case by case based lump-sums and intrusion (interference) of the political administration into autonomy of medical faculties. The contribution concerns with these prevailing economical required changes, interacting and beyond inter-disciplinarity. The progress in medicine by research is causing potential capacity and secondary costs explosion. Including financing of health service and decisive determinants: the demographic development of society, the change in working sphere and particularly law-dominated prenatal-medicine. This, future of medicine determining political, ethical and legal challenge must be accepted by medical professions. Solutions are pointed out.     

"Planned" and "unplanned" pregnancy: deconstructing experiences of conception

This paper seeks to explore women's experiences of conception, and to deconstruct the dichotomy between the terms "planned" and "unplanned" pregnancy. It draws on interviews with 19 primagravidae conducted as part of a wider qualitative study of women's experiences of pregnancy and childbirth. Although the concept of pregnancy intention is widely regarded as ambiguous, and by some immeasurable, this paper draws on interview data to develop four categories of pregnancy intention. The first category (the planned pregnancy) is unambiguous and reflects the type of planned approach currently advocated by health professionals. The second category (the laissez-faire pregnancy) reflects the experiences of women who stop using contraception but adopt a more relaxed approach to pregnancy planning. The third category (the recalcitrant pregnancy) is far more ambiguous and describes the experiences of those who want to be pregnant but for whom it would not be socially acceptable to plan a pregnancy. The final category (the accidental pregnancy) is unambiguous and deals with pregnancies that could be described as unexpected, and arising due to genuine contraceptive failure. This paper concludes by highlighting the significance of pregnancy intention for health policy, health research, and for the health care providers. The importance of adopting a subjective approach to improve our understanding of women's experiences of conception is also highlighted.     

"Typhoid Mary" and "HIV Jane": responsibility, agency and disease prevention

The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of "professional responsibility". Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.     

Comparison between "short" and "long" protocols in an ICSI programme

In the present retrospective study we compare the efficacy of gonadotropin-releasing hormone (GnRH) agonist in a long protocol and a GnRH agonist in a short protocol administration for controlled ovarian hyperstimulation (COH) in an ICSI program. A total of 424 consecutive patients with a history of male factor were included in the present study. Three hundred and three patients were included in the long protocol and 121 in the short protocol. Patients treated with the short protocol were stimulated in a shorter time and achieved lower estradiol levels. A significantly higher percentage of oocytes transferred were found in the long protocol. The clinical pregnancy rate per embryo transfer was 39.3% in the long protocol and 19.2% in the short protocol (p=0.001).     

"Ts and Blues" in pregnancy

Data on the prenatal and postnatal effects of Talwin and Pyribenzamine ("Ts and Blues") abuse in pregnancy were compared with those from a control group. Anemia, syphilis, hepatitis and gonorrhea were more common in mothers abusing Ts and Blues. Their infants were more often growth retarded. Neonatal withdrawal was seen in 35%.     

"Morning-after pill" and antithrombin III

Plasma antithrombin III (AT III) was studied longitudinally in 15 subjects (13 patients and 2 volunteers), who used the "morning-after pill" (5 mg ethinylestradiol daily for 5 days). The mean decrease in AT III level in the 13 patients was 17% of the pre-treatment value. From additional observations made in 2 of the patients and in the 2 volunteers it is concluded that this decrease is caused by hemodilution due to salt and water retention rather than by a decreased synthesis or increased consumption.     

"Principles and practice of hysteroscopy"

In recent years the hysteroscopic method of examination has not become as widespread as we hoped. Its field of indication has not yet been clearly defined. In the diagnostic field hysteroscopy has not yet been utilized to the full. Colpo-hysteroscopy or contact hysteroscopy will possibly open up new opportunities for its use.     

Benign ovarian serous tumors: a re-evaluation and proposed reclassification of serous "cystadenomas" and "cystadenofibromas"

OBJECTIVE: Serous cystadenomas and cystadenofibromas of the ovaries are currently regarded as neoplasms and are considered the most common ovarian neoplasms. The purpose of this study is to determine what proportion of benign serous tumors contain an epithelial proliferation (the hallmark of a neoplastic process in nearly all other sites) that can be considered neoplastic as opposed to reactive in nature. METHODS: An unselected series of 113 ovarian serous tumors (76 serous cystadenomas and 37 serous cystadenofibromas) were histologically evaluated. A 1-mm in diameter area of epithelial proliferation was considered potentially neoplastic. RESULTS: Eight tumors (7%) displayed at least 1 mm of epithelial proliferation (1% of serous cystadenomas and 19% of serous cystadenofibromas). CONCLUSION: The vast majority of benign serous tumors may not be bona fide epithelial neoplasms, but rather, may represent cystically dilated glandular inclusions (cystadenomas) and fibromas with epithelial inclusions (cystadenofibromas). A recently published study evaluating clonality in serous cystadenomas found that the vast majority are polyclonal and thus supports this hypothesis. These findings have important implications for the pathogenesis of ovarian cancer, for the distribution of ovarian neoplasms, and for the interpretation of molecular biological studies of ovarian tumors.