The Enhanced Recovery After Surgery (ERAS) program in gynecological practice – socioeconomic benefits (first announcement)

The 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

Screening and prognostic factors for ovarian cancer

Ovarian cancer is one of the neoplastic gynecological diseases that is the most difficult subject to screening. This is the reason that most newly-diagnosed cases are at III-IV FIGO stage. The lack of an appropriate screening method affects the oncologic results and, therefore, the ovarian cancer presents with the worst prognosis of all neoplasms of female reproductive organs. This review attempts to discuss some methods for early diagnosis of ovarian cancer, especially in cases with adnexal formation. The prognostic factors in the literature available influencing on patients' survival and treatment outcomes are considered.Scripta Scientifica Medica 2013; 45(2): 27-31

Surgical staging in early ovarian cancer

Ovarian cancer can be intraoperatively staged only. This staging is based on intraoperative findings and histological postoperative result. In early-staged ovarian cancer, it is essential to exclude a higher FIGO stage as a result of intraoperative staging. This review presents the most significant aspects of the staging process and the importance of surgical treatment of early ovarian cancer.Scripta Scientifica Medica 2013; 45(2): 23-26

Retroperitoneal pelvic invasion in ovarian cancer: Possible modes of spread and survival impact

BackgroundOvarian cancer is the second-most common malignancy and the leading cause of death in women who develop cancers of gynaecologic origin and it spread primarily by direct exfoliation of cells along the peritoneal surface. Interesting fact, although not well studied, is that these tumours invade the mesothelium but very rarely they invade the peritoneum deeper through direct extension.AimsTo study the retroperitoneal pelvic invasion in parametrial ligaments and vagina in patients undergoing surgery for advanced epithelial ovarian carcinoma and the survival impact of it.MethodsThe study included 59 patients with advanced epithelial ovarian cancer that underwent radical hysterectomy during the 2004–2009 period. For the purpose of this study histopathologic examination was performed for the parametrial ligaments and vagina with inspection of the surgical resection lines.Results Retroperitoneal pelvic invasion was found in 42.4 per cent of the cases, involving different depths of parametrial ligaments and/or vaginal spread, and is associated to worse survival outcomes.ConclusionRetroperitoneal pelvic invasion is not a rare phenomenon and seems to be a feature of the more aggressive tumours. In the cases of distal retroperitoneal pelvic invasion (vaginal) the patients’ 5-year survival rate is similar to that of the stage IV ovarian cancer patients

Fetal fibronectin FFN. Biochemical markers of preterm birth

The use of biochemical markers for predicting preterm birth has a potential advantage because it provides direct evidence of changes in the extracellular matrix of the surface between fetal membranes and decidual tissue.  [1, 12] fFN is a protein that is produced during pregnancy and acts as a biological glue such as the amniotic sac kept attached to the endometrium. fFN can be found in cervico-vaginal secretions up to 22 weeks and late in the last trimester. [7] The purpose of this study is to determine the level of fetal fibronectin (fFN) in cervical mucus as a specific indicator of preterm birth in pregnant women with clinical symptoms. The study was attended by 90 women divided into two groups. First group of pregnant women at term gestation 24-34 weeks with clinical symptoms the PB and the second group of pregnant women with normal pregnancy occurs. In all women was conducted Full Term Test. The results were statistically processed by using SPSS v. 17. The presence of symptoms of preterm labor showed difference in the percentage of positive results of fFN test (p <0.05), women with clinical symptoms have - a high percentage of positive tests. When conducting Full term pregnancy test with positive results in the highest percentage with overt clinical RTD, Roma and second and third birth. Furthermore, pregnant women with a positive test result mainly born at 35 weeks, newborns weighed an average of 2 550.1 g, which explicitly includes them in the premature population

Investigation of anxiety levels in high-risk pregnancy

Бременността е период, в който съществуват физиологични, психически, хормонални и социални промени, повишаващи риска от емоционално страдание и психиатрична заболеваемост в този етап от живота на жената. Цел: Оценка на случаите на тревожност при бременни жени и факторите, свързани с появата ѝ; сравнявайки наличието на тревожност във всеки гестационен триместър. Материал и методи: За периода март–август 2018 чрез използването на анонимна анкетна карта са изследвани 120 бременни жени. Резултатите са обработени статистически, като са използвани сравнителен и корелационен анализи. Резултати: Тревожност се наблюдава при 26,8% от бременните жени, като е по-честа през третото тримесечие (42,9%) (p=0.04), усложнения при предходни бременности (р=0.00), история на риска от спонтанен аборт (p=0.05), майчинство по отношение на бременността (p = 0.01) и броят на пушените ежедневно цигари (p=0.00) е статистически свързан с появата на тревожност по време на бременност.Заключение: Тревожност се случва често по време на бременност. Разбирането на факторите, свързани с появата ѝ, позволява разработването на превантивни мерки при пренаталното лечение.Introduction: Pregnancy is a period in which physiological, psychic, hormonal and social changes are present, increasing the risk of emotional suffering and psychiatric morbidity in this stage of a woman’s life.Aim: The aim of this article is evaluating the occurrence of anxiety in pregnant women and the factors associated with its occurrence; comparing the presence of anxiety in each gestational trimester. Materials and Methods: For the period March - August 2018, 60 pregnant women were examined using an anonymous questionnaire. The results were statistically processed using comparative and correlation analyzes. Results: Anxiety was seen in 26.8% of pregnant women, and was more common in the third trimester (42.9%) (p=0.04), complications from previous pregnancies (p=0.00), history of the risk of spontaneous abortion (p=0.05), maternal pregnancy (p=0.01), and the number of smoked daily cigarettes (p=0.00) are all statistically associated with the occurrence of anxiety during pregnancy. Conclusion: Anxiety often occurs during pregnancy. An understanding of the factors associated with its occurrence allows the development of preventive measures in prenatal treatment

Pregnancy and depression

Въведение: Критериите за диагностициране на депресия са еднакви независимо от състоянието на бременността. Въпреки това депресията често се пренебрегва по време на бременност, тъй като симптомите на депресия често са подобни на соматичните преживявания, свързани с бременността. Рисковите фактори за развитието на депресията по време на бременност включват недостатъчна социална подкрепа, живеещите сами, брачни несъгласия, нежелана бременност или многото деца. Целта на настоящото изследване е да се направи систематичен преглед на литературата относно влиянието на депресията върху бременността. Материал и методи: За проучването са използвани следните изследователски бази данни: MEDLINE, Scopus, EMBASE и PubMed за десетгодишен период, съсредоточени върху проучвания, изследващи депресията при бременни. Резултати: Между 12% и 15% от жените отговарят на критериите за депресия в даден момент по време на бременността или след раждането. Не е ясно защо вторият и третият триместър на бременността се свързват с повишен риск от депресия (в сравнение с първия триместър). Изводи: Няколко рискови фактори предразполагат към депресия по време на бременност. Някои от тях са лоша пренатална грижа, лошо хранене, стресови събития, предишна история на психиатрични разстройства, предшестващи усложнения в пубертета, събития по време на бременност, като предишни аборти. Други фактори включват възраст, семейно положение, планирана или непланирана бременност, предишна история на мъртво раждане и ниво на социална подкрепа. По този начин оценката на депресията по време на бременност е от съществено значение за откриването на бременни жени, нуждаещи се от интервенция, за да се запази благосъстоянието на майката и бебето.Introduction: The criteria for the diagnosis of depression are the same regardless of the pregnancy status. However, depression is often overlooked in pregnancy, as the symptoms of depression are often similar to the somatic experiences associated with pregnancy. Risk factors for the development of depression in pregnancy include insufficient social support, living alone, marital discord, having an unwanted pregnancy, or having multiple children. Aim: The aim of this study is to make a systematic review of the literature on the impact of depression on pregnancy. Materials and Methods: The following research databases were searched: MEDLINE, Scopus, EMBASE and PubMed for a 10-year period. The focus was on studies investigating depression in pregnant women. Results: Between 12% and 15% of women meet the criteria for depression at a time during pregnancy or after birth. It is unclear why the second and third trimesters of pregnancy are associated with an increased risk of depression (compared to the first trimester). Conclusion: Several risk factors predispose to depression during pregnancy. Some of them are poor prenatal care, poor nutrition, stressful events, a previous history of psychiatric disorders, pre-existing complications of puberty, pregnancy events like previous abortions. Other factors include age, marital status, planned or unplanned pregnancy, previous birth history, and level of social support. Thus, the evaluation of depression during pregnancy is essential for the detection of pregnant women in need of intervention to maintain maternal and infant wellbeing

Behavior of the psychology specialist with women with breast carcinoma

Опитът с рак на гърдата има няколко отделни фази, всяка от които се характеризира с уникален набор от психосоциални проблеми. Тези фази съвпадат с аспектите на клиничния ход на заболяването и свързаните с него лечения. Цел: Литературен преглед на характерните психосоциални нужди, свързани с диагнозата, първичното лечение, специалните въпроси, свързани с неинвазивния рак на гърдата, завършването на лечението и повторното влизане в обичайния живот, оцеляването, повторението и облекчаването на напреднал рак. Материал и методи: За проучването са използвани следните изследователски бази данни: MEDLINE, Scopus, EMBASE и PubMed за десетгодишен период, съсредоточени върху проучвания, изследващи психологичните проблеми при жени с карцином на гърдата. Резултати: психосоциалното въздействие на карцинома на гърдата трябва да се разбира и в контекста на други въпроси, които засягат справянето на жените, качеството на живот и благополучието, като например социално-икономически фактори и културни фактори, наличието на социална подкрепа, достъп до здравни грижи и наличието на други хронични заболявания или жизнени кризи. Изводи: Проучвания при ранен стадий на карцинома на гърдата и при пациенти с други ракови заболявания са показали ползи от индивидуалните психологични грижи, но те не са били адекватно оценени при метастазирал карцином на гърдата. Настоящите изследвания не предоставят достатъчно информация, за да определят оптималния вид грижа, която да бъде използвана, или оптималното време и продължителност на такива грижи при жени с напреднал карцином на гърдата. Поради тази причина е необходимо да се направят изследвания в тази област, именно защото с наближаването на смъртта пациентите с карцином имат най-голяма нужда от психологична подкрепа.Introduction: Breast cancer experience has several distinct phases, each characterized by a unique set of psychosocial problems. These phases coincide with aspects of the clinical course of the disease and related therapies. Aim: A literature review of the characteristic psychosocial needs associated with diagnosis, primary treatment, special issues related to non-invasive breast cancer, completion of treatment and re-entry into the normal life, survival, recurrence and relief of advanced cancer was conducted. Materials and Methods: The following research databases were searched: MEDLINE, Scopus, EMBASE and PubMed for the ten-year period with a focus on studies exploring the psychological problems of women with breast cancer. Results: The psychosocial impact of breast carcinoma should be understood also in the context of other issues affecting women's care, quality of life and well-being, such as socio-economic factors and cultural factors, the availability of social support, access to health care and the presence of other chronic diseases or life crises. Conclusion: Early breast cancer studies and cancer patients have been shown to benefit from individual psychological care, but they have not been adequately evaluated for metastatic breast carcinoma. Current studies do not provide sufficient information to determine the optimal type of care to be used or the optimal time and duration of such care in women with advanced breast cancer. For this reason, research needs to be done in this area, precisely because with the approach of death, carcinoma patients have the greatest need for psychological support

Precancerous lesions of the cervix — aetiology, classification, diagnosis, prevention

The present review introduces the aetiology and classification of cervical precancers. The principles of diagnosis based on colposcopy are reviewed. The indications for colposcopy and targeted biopsy are steps in the diagnostic process of cervical precancers. Prophylaxis of these diseases prevents cervical cancer as high-grade precancerous lesions represent a direct precursor to cervical cancer. The basics of primary and secondary prevention, the types of screening, and the behaviour of the already-alerted patients after different screenings are presented