Clinical Significance and Place of Laparoscopic Myomectomy in Modern Treatment of Myoma // Клинично значение и място на лапароскопската миомектомия в съвременното лечение на миомната болест

[EN] Over the last 20 years by virtue of achievement of technical progress innovative methods for surgical treatment take place in gynaecological surgery. One of these methods, which continues to be object of scientific research is laparoscopic myomectomy. Since 1990 laparoscopic myomectomy has been an alternative to laparotomy in case of removing of subserous and intramural myomas. Several techniques for laparoscopic myomectomy have been described in the literature. They vary according to equipment and instruments in use; by way of approach and different stages of the operation. In order an exact scientific research and analysis to be performed, introducing of standardized method for laparoscopic myomectomy is needed. Data for intra- and postoperative indicators operative time, hospital stay and blood loss are controversial in scientific publications. Little attention is paid to the factors that affect the duration of the operation. Controversial are the results for the frequency of complications in laparoscopic myomectomy due to the different types of studies (prospective, retrospective, randomized, non- randomized. meta-analysis). When performed by well-trained specialists the risk of perioperative complications doesn't exceed that in standard operative techniques.През последните 20 години благодарение на постиженията на техническия прогрес в гинекологичната хирургия навлизат иновативни методи за оперативно лечение. Един от тези методи, който продължава и днес да бъде обект на задълбочени научни изследвания е лапароскопската миомектомия. От 1990 г лапароскопската миомектомия представлява алтернатива на лапаротомията в случай на нужда от отстраняване на субсерозни и интрамурални миомни възли. В литературата са описани разнообразни оперативни техники за лапароскопска миомектомия. Те се различават както по отношение на използваната апаратура и инструментариум, така и по отношение на достъпа и отделните етапи на операция. За да се извършат точни научни сравнителни анализи е нужно въвеждане на стандартизиран метод за лапароскопска миомектомия. В научната литература данните за интра- и постоперативните показатели оперативно време, болничен престой и кръвозагуба са противоречиви. Сравнително малко се обръща внимание на факторите, оказващи влияние върху продължителността на оперативната интервенция. Противоречиви са резултатите за честотата на усложненията при лапароскопската миомектомия поради различните проучвания (ретроспективни, проспективни. нерандомизирани, рандомизирани, мета - анализи). Извършена от добре обучени специалисти рискът от периоперативни усложнения не надвишава стандартните оперативни техники

Serum anti-α-crystallin antibodies in women with endocrine disorders

There is a distinct group among the patients with unexplained infertility who are found to have enhanced humoral immune response. Recent studies focus on the expression of stress proteins being an important factor in the stages of gametogenesis, fertilization, implantation, early embryonic development and pregnancy. Increased expression of stress proteins and immune response against them was found in tissues exposed to stress. There is not enough data linking infertility to expression and immunity of α-crystallins in patients with endocrine diseases. The aim of this work was to study anti-α-crystallin antibodies in patients with polycystic ovary syndrome (PCOS), Graves’ disease, autoimmune thyroiditis, diabetes mellitus and obesity. Sera samples from 169 women with endocrine disorders (PCOS (n = 68); Graves’ disease (n = 26); autoimmune thyroiditis (n = 32); diabetes mellitus (n = 10); and obesity (n = 33)) were tested by ELISA. The statistical analysis was performed using SPSS program. The concentration of anti-α-crystallin antibodies is significantly elevated in the PCOS group compared to the control group (p = 0.021). The frequency of positive sera in the same group of patients is significantly higher compared to the control group (p = 0.029). In all other groups, no statistically significant elevation was observed. Elevated concentrations of anti-α-crystallin antibodies found in patients with PCOS suggest that the increased production of anti-α-crystallin antibodies in women with PCOS is most probably caused by failure of the immune tolerance and the induction of immune response. This is most likely due to an increased expression of this stress protein as a result of oxidative stress and chronic inflammation