[Immunological aspects of postoperative analgesia after abdominal hysterectomy]

BACKGROUND

Prostaglandins modulate cytokine release though increases in cAMP, regulating interleukin-6 and interleukin-10. Ketoprofen inhibits cyclo-oxygenase activity and hence prostaglandin production.

AIM

We hypothesized that ketoprofen would affect release of IL-6 and IL-10 and modulate the immune response.

METHOD

We have evaluated 40 women, divided into four groups by the model of postoperative pain treatment: control group (only opioid) and experimental group (combination of i.v. ketoprofen and opioid). Serum IL-6 and IL-10 were measured before surgery, 24 and 72 hours after skin incision. Due to days in hospital we detected temperature and severe complications.

RESULTS

IL-6 increased at 24h and normalized at 72h. In contrast IL-10 did not change significantly.

CONCLUSION

The two models of postoperative analgesia have both modulated immune response after abdominal hysterectomy in same way.

[Manganese and selenium content in plasma of women with uterine myoma]

OBJECTIVE OF THE STUDY

To determine plasma concentration of manganese and selenium in women with uterine fibroids.

MATERIALS AND METHODS

The study included 22 women with uterine fibroids (group A) and a control group of 25 women (group B). Flame atomic-absorbable spectrometry was used for the purpose of the study. The patients were admitted in the Clinic of Gynaecology of UMPHAT "Dr. G. Stransky" in the period 01.01.2007-01.07.2007.

RESULTS AND DISCUSSION

No significant difference was found between the plasma concentrations of manganese in group A and B. Selenium plasma concentration of group A was determined as significantly lower in comparison with that of group B. The obtained results can serve as a precondition for investigations on a larger scale.

[Comparison and analysis of pain profiles in women with endometriosis and pelvic congestion syndrome--part II]

PURPOSE OF THE STUDY

To compare and analyze the pain profiles of patients with endometriosis /E/, adenomyosis /A/, and pelvic congestion syndrome /PCS/ in order to specify the factors that make closer the profiles of these conditions, and the factors, that make the differences between them clearer.

MATERIALS AND METHODS

A prospective study was conducted in the Clinic of Gynaecology, Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006. It included 98 patients consequently admitted in the Clinic--66 patients suspected of or with proven E, and 32 patients with PCS. For the purpose of the study the following methods were used: pain chart, visual-analogue scale /VAS/, monthly pain calendar, documentary method, R-AFS classification of endometriosis and inquiry method.

RESULTS AND DISCUSSION

The object of interest in this study were the pain profiles of E, A and PCS, and the dependence and association of severity of manifestation of the particular components of the pelvic pain syndrome /dysmenorrhoea, dyspareunia, postcoital ache, etc./ of the conditions mentioned above, on: stage of endometriosis, localization of endometriotic foci, diameter of maximal dilation and location of varicosely altered pelvic veins in women with PCS. It was found that the intensity and specificity of component demonstration of pelvic pain syndrome of women with endometriosis were not dependent on the stage of the disease, but on location of endometriotic lesions. In patients with PCS the severity and specific character of chronic pain syndrome were dependent on diameter of maximal dilation and site of varicose pelvic veins. According to its characteristics, pain profile of women A takes a specific place between the peculiar profiles of patients with E and PCS.

[Comparison and analysis of pain profiles of women with endometriosis and pelvic congestion syndrome--part I]

Pain is a general symptom in the clinical evolution of endometriosis /E/, particularly of adenomyosis /A/, and pelvic congestion syndrome /PCS/-conditions with different incidence and contingent of women with specific characteristics.

PURPOSE OF THE STUDY

To build up and compare the pain profiles of patients with E, A, and PCS by the use of quantitative and qualitative characteristics.

MATERIALS AND METHODS

A prospective study was conducted in the Clinic of Gynaecology, Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006. It included 98 patients--66 consequently admitted in the Clinic patients /for diagnostic specification or operative treatment/, suspected of or with proven E, and 32 patients with PCS. For the purpose of the study the following methods were used: pain chart, visual-analogue scale /VAS/, monthly pain calendar, documentary method, R-AFS classification of endometriosis and inquiry method.

RESULTS AND DISCUSSION

It was made a specification of and comparison between qualitative, quantitative and topical characteristics of chronic pelvic pain syndrome of women with E, A and PCS. Factors that aggravate and alleviate pain symptomatic were determined and the most frequent additional symptoms besides pain were pointed out. Discriminating between pain profiles of patients with E, A and PCS contributes to more precise differential-diagnostic specification together with other diagnostic means.

Folinic acid modulated bolus 5-FU or infusional 5-FU for adjuvant treatment of patients of UICC stage III colon cancer: Preliminary analysis of the PETACC-2-study

3563

Background: Patients with stage III colon cancer have a high risk for recurrence. Infusional 5-FU may be more active than bolus application. Methods: From 01/1997 to 03/2004 a total of 1601 patients with UICC stage III colon cancer were randomized to receive the Mayo-Clinic regimen or infusional 5-FU either the weekly high dose AIO regimen, the bi-weekly LV5FU2 regimen or the Spanish weekly high dose TTD-regime. The major aim of this study was to demonstrate a difference of 7 % in the 5 year survival rate in favour of the infusional arm for which a total of 424 events were required. Results: After a median follow-up of 31 months 478 events have occurred. 804 patients received the standard arm and 797 the experimental arm (AIO N=331, EORTC N=92, FFCD N=211, TTD N=163). The median age was 64 years; patients were well distributed according to TNM-category (T3 73 vs. 75%, T4 17 vs. 16%, N2 31 vs. 34%), vascular and lymphatic invasion and grading. The bolus regimen induced a higher rate of grade 3 or 4 leukopenia (7.1% versus 2.0%), stomatitis grade 3 or 4 (9.8% versus 3.3%) or diarrhea grade 3 or 4 (16% vs. 15%). Hand-Foot-Syndrome was more frequent in the experimental arm (4.4% versus 0.4%). There was no difference in the recurrence free survival at 5 years (57% versus 56%; hazard ratio 1.00, 95% CI, 0.84 to 1.21; P=0.9) or overall survival at 5 years 71% versus 72%; hazard ratio 0.91, 95% CI, 0.71 to 1.16; P=0.44). Conclusions: Infusional 5-FU does not improve RFS or overall survival of stage III colon cancer compared to the Mayo regimen but is less toxic. Supported by Deutsche Krebshilfe

No significant financial relationships to disclose.

[Terminated pregnancy following prenatal diagnosis of congenital anomalies--a part of register of congenital anomalies]

The most of European registries of congenital anomalies (CA) collected information of CA in livebirths, stillbirths and terminated pregnancies following prenatal/ultrasound diagnosis.

OBJECTIVES

to assess terminated pregnancies after prenatal/ ultrasound diagnosis of CA as a part of register of CA performed in University Hospital-Pleven. Among 21 202 births monitored during the study period (1996-2005), 679 CA were detected. The total prevalence of CA was 32/ 1000 births. The outcome of pregnancy for all cases of selected CA by register was 620 livebirths (91.3%), 36 stillbirths (5.3%), 23 terminated pregnancies (TP) (3.4%). The percentage of pregnancy termination was higher in the case of isolated anomalies, mainly lethal and CA associated with a low survival rate (61%), than with multiple ones. The most common CA detected after prenatal/ ultrasound diagnosis were neural tube defects (NTD) - the main reason for TP (52% of cases). The low proportion of these CA in TP (1/3) compared to their proportion in livebirths (50%) demonstrated an insufficiency of prenatal diagnosis of NTD as a part of register of CA performed in University Hospital-Pleven. Prenatal diagnosis of CA allows an early genetic counseling of mother presenting information on neonatal prognosis and recurrence risk for subsequent pregnancies. It helps family to take an adequate decision for termination of pregnancy with bad prognosis about heavy fetal CA.

[Pain profile of women with endometriosis and chronic pelvic pain-determining factors and significance]

PURPOSE OF THE STUDY

To determine the severity of the separate components of chronic pelvic pain syndrome/dysmenorrhoea, dyspareunia, dysuria, dyschezia ,etc/ in the different stages of the disease and according to the localization of endometriotic lesions. To determine to what extent the severity of the separate chronic pain components correlates with stage of the disease and localization of endometriomas.

MATERIALS AND METHODS

The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004 - 01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, type of the disease - internal or external genital endometriosis, adenomyosis, stage of the disease, localization of endometriotic lesions. The following methods were used for the purpose of the study: visual analogue scale, documentary method, R-AFS classification of E, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide.

RESULTS AND DISCUSSION

The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. When the mean value of pain assessment was reported, there was noted a non-correspondence between severity of pain and stage of the disease. It was found no significant correlation between the extent of manifestation of the separate components of the pain syndrome according to the stage of the disease. The severity of the separate components of the pain syndrome was determined according to the localization of the E-lesions. Statistically significant correlation was found between the extent of manifestation of dyspareunia, postcoital ache and dyschezia, and the localization of the E- lesions /p<0,05/ and that correlation was strongly supported in cases of adenomyosis and the components mentioned above. Statistically significant differences were found between the extent of manifestation of the relevant component of the chronic pain syndrome and some of the localization of E foci.

CONCLUSION

It was established a correlation between localization of E lesions and the severity of the separate components of the chronic pain syndrome. No correlation was found between the extent of pain manifestation, when assessed in total and in each pain component, and the stage of endometriosis.

[Modern aspects of perioperative analgesia by using nonsteroidal anti-inflammatory drugs in gynecology (Part II)]

It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.

[Modern aspects of perioperative analgesia by using nonsteroidal anti-inflammatory drugs in gynecology (Part I)]

It is an actual problem how to treat acute postoperative pain by using nonsteroidal anti-inflammatory drugs. Modern concepts for perioperative administration of these drugs are very important for the usual practice. The possibilities for optimal application of nonselective or selective COX-2 inhibitors are examined in this review.

[Endometriosis and chronic pelvic pain]

Endometriosis /E/ is a frequently met disease in women in reproductive age. One of its most typical clinical manifestations is chronic pelvic pain /CPP/ and as components of the chronic pain syndrome- dysmenorrhoea, dyspareunia, intermenstrual pain, and sometimes dyschezia and dysuria.

PURPOSE OF THE STUDY

To build up pain profile of patients with E by using quantitative and qualitative characteristics.

MATERIALS AND METHODS

The study was conducted in the Clinic of Gynaecology at the Department of Obstetrics and Gynaecology, Medical University-Pleven in the period 01.03.2004-01.02.2006 Sixty-six patients were included in the study. They were consecutively admitted in the Clinic for diagnostic specification or operative treatment, and in whom E was suspected or proved before. The patients were grouped according their age, fertility, body mass index, blood group affiliation, stage of the disease, etc. The following methods were used for the purpose of the study: pain map, monthly pain calendar, inquiry method-by a questionnaire /form/, based on instruments for pain assessment, which are accepted worldwide; documentary method, R-AFS classification of E. Factors that provoke appearance and manifestation of pain, and factors that alleviate pain were studied too.

RESULTS AND DISCUSSION

The obtained results were statistically processed and were presented by the means of tables, graphics and numerical quantities. They corroborated the hypothesis for typical pain profile of women with E.

CONCLUSION

The building up of pain profile in total with other diagnostic methods /ultrasonography, magnetic resonance imaging/ has a determining role in the further diagnostic and therapeutic management of women with E and CPP. Pain profile can also be used as an assessment tool of conducted treatment /conservative or surgical/.

[An evolution in the conduct for ectopic pregnancy in gynecological clinic, "UMBAL - D-r G. Stranski", Pleven for 7 years' period]

AIM

The aim of the present study is to show the evolution of the conduct for ectopic pregnancy for 7 years' period after introduction in gynecological practice of contemporary diagnostic and therapeutic methods for ectopic pregnancy. For the fulfillment of this aim was made a prospective study for 7 years' period of the patients with diagnosis "Ectopic pregnancy", treated in Gynecological clinic of "UMBAL - D-r G. Stranski" EAD, Pleven.

MATERIALS AND METHODS

The objects of observation were 198 women with diagnosis: "Ectopic pregnancy". There were used the following methods: clinical, technical devices, statistical methods.

RESULTS

The authors analyze the results of the use of laparoscopy, conventional surgery and application of Methotrexate describing the indications and the risk for the patient.

CONCLUSION

The authors emphasized the advantages of the gynecological laparoscopy for precise diagnosis and contemporary treatment of the intact ectopic pregnancy.

[Usage of the new parenteral selective cox-2 inhibitor dynastat in the gynecologic practice]

A follow-up of 180 women was carried out. The patients having endured different gynecological operations (laparoscopy, laparohysterectomy, etc.) were divided into two main groups: half of them were treated with Dynastat (new selective COX-2 inhibitor) and the others were treated with Profenid (conventional nonsteroidal anti-inflammatory drug). The groups were compared by the quality of the achieved analgesia and appeared side effects, especially postoperative nausea and vomiting. These parameters were assessed by both medics and patients. In conclusion we accept that the new COX-2 selective inhibitor Dynastat does not have advantages over traditional nonsteroidal anti-inflammatory drug as Profenid especially for postoperative nausea and vomiting and quality of analgesia.

What Is the Best Sequence of Chemotherapy in Advanced Colorectal Cancer? Final Results of a Five-Arm Study

One hundred and ninety-three patients were assigned to receive 5-FU/LV, irinotecan and oxaliplatin in five different sequential treatment groups: Mayo Clinic Regimen (MCR) + LV5FU2 (group A); MCR + irinotecan (350 mg/m(2)) (group B); MCR + FOLFIRI (group C); MCR + FOLFOX4 (group D); FOLFIRI + FOLFOX4 (group E). The results were as follows: group A (32 patients), median overall survival (OS) 14 months, median time to progression (TTP1) 6 months, median TTP2 5 months, response rate (RR1) 22%, RR2 25%; group B (27 patients), OS 11 months, TTP1 6 months, TTP2 3 months, RR1 22%, RR2 19%; group C (43 patients), OS 14 months, TTP1 5 months, TTP2 5 months, RR1 12%, RR2 19%; group D (45 patients), OS 15 months, TTP1 5 months, TTP2 4 months, RR1 18%, RR2 20%; group E (46 patients), OS 19 months, TTP1 9 months, TTP2 5 months, RR1 39%, RR2 25%. There was a significant difference in OS (p < 0.005) between groups E vs. B and A, D vs. B. Sequential therapy with 3 active drugs (FOLFIRI + FOLFOX4) was the most efficacious combination in comparison with any other two drug combinations applied in our study.

Histopathology of residual rectal carcinoma following preoperative radiochemotherapy

Preoperative radiotherapy with (CRT) or without chemotherapy (RT) in the management of patients with locally advanced rectal carcinoma is increasingly accepted as therapeutic modality to reduce local recurrence and improve survival, decrease tumor size and/or stage, has less toxicity compared to postoperative therapy, improves sphincter preservation and the ability to perform a curative resection. In a brief review of literature we discussed the possible prognostic role of most important pathologic parameters and their clinical implications. At present, predictive value of tumor response to neoadjuvant therapy remains uncertain, whether evaluated as five-point histological tumor regression grade (TRG) or recently proposed three-point rectal cancer regression grade (RCRG). However, most reports emphasize reduced local reccurence rates and disease-free survival advantage in patients with complete tumour regression or tumour down-staging, occuring in up to 20% and 60% of cases, respectively. Patients with advanced post-treatment tumour stage (ypT3/4), positive lymph nodes (ypN1/2), vascular invasion, positive circumferential resection margin, clearance < 2mm, or absence of tumor regression are shown to have poor clinical outcome. Among CRT-induced morphological features, only "fibrotic-type" stromal response with minimal inflammatory infiltrates and absence of surface ulceration are correlated to recurrence-free survival. Preliminary unpublished results of a pilot study from our multidisciplinary prospective trial relate to correlation of histopathologic parameters and morphologic changes to rectal cancer regression grade (RCRG). Therefore, we studied 22 consecutive patients, mean age 56 (range 23-69) years, with transmural cT3/4 stage and were subgrouped as follows: RCRG-1 (7 patients, 31.8%), RCRG-2 (9 patients, 40.,9%) and RCRG-3 (6 patients, 27,2%). In addition, 14 patients (63%) showed tumour downstaging and only 1 patient (4.5%) nodal down-staging after ypTNM restaging. There was the predominance of fibrotic-type stroma (16 patients, 72.8%) versus fibro-inflammatory response (6 patients, 27.2%), frequent tumoral necrosis (13 patients, 59%) but infrequent surface ulceration (5 patients, 22.7%) and peritumoural eosinophylic infiltration as well as endocrine cell differentiation (4 patients, 18%). The second aim of our study was to investigate determinants of radiosensitivity, i.e. the relationship between proliferative activity indices (Ki-67 and PCNA) as well as the induction of apoptosis (p53) and the tumour regression (RCRG) after neoadjuvant CRT. The interaction between Ki-67 and PCNA immunoexpression levels and the benefit of CRT was significant for Ki-67 (p = 0.03), but not for PCNA (p = 0.08) and p53 levels (p = 0.4). In a conclusion, high percentage of Ki-67-positive tumor cells in the preoperative biopsy predicts an decreased treatment response after preoperative CRT of rectal cancer. However, long-term follow-up and large studies are necessary to establish the value of regression grade and the need for its prediction by reliable biological markers.

Systemic treatment of colorectal cancer in Serbia: what have we done and what can we offer in the new century?

The treatment of patients with metastatic colorectal cancer (mCRC) has changed dramatically over recent years in Serbia. The more optimal use of 5-fluorouracil (5-FU) in association with leucovorin (LV), the development of new drugs such as oxaliplatin and irinotecan and of the oral fluoropyrimidines, such as capecitabine, have increased therapeutic options and to the improved outcome of patients with mCRC. Throughout our 10-years published papers in international journals, we presented development of chemotherapy for mCRC and improvement in treatment outcome in Serbia. It is shown that combination therapy with 5-FU/LV and oxaliplatin or irinotecan is more active than 5-FU/LV in first line treatment of mCRC. Sequential therapy with FOLFIRI+FOLFOX was the most efficacious combination in comparison to any other 2 drugs combinations. The combination protocols in second line were superior to mono irinotecan and equal to LV5FU2 in terms of time to progression. The oral fluoropyrimidines seems to have an activity comparable to that of i.v. 5-FU/LV. New agents acting on novel targets are under development. Angiogenesis inhibitors, epidermal growth factor inhibitors, COX-2 inhibitors and farnesyl transferase inhibitors might play a role in the future in the treatment of CRC. We will present our first experience with bevacizumab, vascular endothelial growth factor inhibitor.

Radical radiotherapy for localized prostate cancer in elderly

BACKGROUND

Prostate cancer is an age related neoplasm, with high incidence in the group of elderly man. The correct management must to be balanced between the benefits of the treatment and its disadvantages. Radiotherapy as definitive treatment is commonly reserved for older patients and patients with high surgical risk and is widely used as a treatment of choice.

AIM

The aim of this study was to determine the role of radical radiotherapy for localized prostate carcinoma in patients 70 years age or older concerning treatment morbidity, local control, disease free and overall survival.

MATERIAL AND METHODS

A clinical prospective non-randomized study was performed including 103 elderly patients with an age 70 or above, between January 1991 and April 2005, at the Institute for Oncology and Radiology of Serbia. Median age of patients was 74,89 years (range 70- 80 years). Stage distribution was as follows: stage A--3 patients (2.9%), stage B--69 patients (67%) and stage C--31 patients (30.1%). Out of 103 patients, initial PSA value was noted in 87 patients. The mean value of initial PSA was 18,06 ng/ml. Radical radiotherapy was conducted on megavoltage linear accelerators with high energy photons (10, 18 MeV) and total tumor dose of 65 Gy.

RESULTS

Low grade acute complications were registered in 70 patients (65%). Mean follow up time was 40, 13 months. The disease outcome at the last follow up show that 79 patients (76.7%) had no evidence of disease and 24 patients (23.3%) relapsed. Overall survival rates were 65, 29% and 44, 52% and disease free survival 66, 59% and 63, 26% at 5 and 10 years. Disease specific survival was at 5 and 10 years 73,32% and 65, 42% respectively. Late sequelas (gradus I and II) are registered in 22 patients (21.36%), out of 103.

CONCLUSION

Radical radiotherapy for localized carcinoma of the prostate is effective treatment option in elderly patients with good local control, present treatment tolerance providing good quality of life and long-term cure.

[Enteral versus parenteral administration of a single dose of profenid after gynecological laparoscopy]

The aim of our study is to compare analgesic effect of single dose Profenid (Sanofi-Aventis)--100 mg administered per rectum or intravenously in woman endured gynecological laparoscopy (LS). We have evaluated 40 woman (divided into two groups each one of 20) sustained planned laparoscopy in department of gynaecology. The effect of administered Profenid over the postoperative pain has been estimated after standard general anaesthesia due to different objective and subjective parameters. As a result of our study we consider that postoperative analgesia with Profenid applied intravenously or by suppository is effective enough method for postoperative analgesia after laparoscopy in gynecology.

Radiotherapy in prostate cancer treatment

Prostate cancer is a complex disease, with many controversial aspects of management in almost all stages of disease. The natural history of this tumor is variable and is influenced by multiple prognostic factors. Radical prostatectomy and radiotherapy are standard treatment options for disease limited to the prostate. The data in literature does not provide clear- cut evidence for the superiority of any treatment. Neo- adjuvant or adjuvant hormonal therapy improves local control and survival in locally advanced disease. The patients treated with radiotherapy would have a relatively long life expectancy, not great risk factors for radiation toxicity and a preference for radiotherapy. The advantages of radiotherapy are that it has a significant potential for cure, it is well tolerated in the majority of men especially when the modern techniques of conformal radiotherapy and intensity modulated therapy are used and it is non-invasive therapeutic options with no anesthesia risk. Expected complications like radiation cystitis, impotence and proctitis are registered in about 1% of patients.

Photochemiluminescent detection of antiradical activity. VII. Comparison with a modified method of thermo-initiated free radical generation with chemiluminescent detection

The method of photosensitized chemiluminescence (PCL) allows the quantification of water- and lipid-soluble antioxidants and activity of superoxide dismutase (SOD) in the same measuring system. However, it needs a special device, which we have described in a previous paper in this series. Another method suitable for the assay of water- and lipid-soluble antioxidants is the thermo-initiated decay of azo-compounds combined with the measurement of O2 consumption (Niki, 1985; Wayner et al., 1985). Its long duration and the complicated measuring procedure is not acceptable for routine medical applications. We show that a modification using CL detection of free radicals with luminol, has results comparable with PCL for the determination of non-enzymic water- and lipid-soluble antioxidants, SOD activity and oxidative modification of proteins. In contrast to PCL, it is possible to use any luminometer with a heatable measuring cell and to investigate coloured samples. While the new method has an overall higher sensitivity and is scalable to microtitre plates, PCL measurements can be made at different pH. The advantages and analytical information content of certain components of the integral antioxidative capacity of blood plasma are discussed in comparison with other methods.

[Correlation between receptive wall analysis of benign ovarial cysts and their clinical conduct]

The biological behaviour (conduct) of benign ovarial cysts is interesting due to their comparatively high frequency of appearance and clinical manifestation. (During the last five years their frequency is between 62%-65% of the gynaecological surgical interventions). With this current survey the authors try to set up a target for research study of the wall receptive status of benign ovarial cysts. This study should be treated as a start up point rendering a prognosis for their eventual biological development.

MATERIALS AND METHODS

An immunohistochemical survey was carried on with 50 patients who have already reached the surgical treatment in retrospective order for the period 2001-2003 (three years' period). The survey search is in direction receptive analysis of Estrogene /E2/ and Progesterone /P/ wall receptor in the ovarial cyst. A perspective observation was also carried on (control group of 50 cases) of hormonal-gestagene treatment of the benign ovarial cystogenesis. It appears to be the necessary prove material for hormonal receptors' participation in the cyst wall as an active factor for its development and involution.

RESULTS

In the basic group /surgical treatment/ it was stated: In 39 patients--E2/-/, P/-/; in 4 patients--E2/+/, P/+/ In 5 patients--E2/+/, P/-/; in 2 patients--E2/-/, P/+/

CONCLUSION

The executed retrospective analysis demonstrates statistical importance in receptor competency lack in the wall of benign ovarial cysts as the probable grounds for them not being influenced during the conservative treatment method. This method led to the surgical elimination of the cyst. The statistical reliability, connected with the receptor E2 participation in the therapeutic behaviour of the benign ovarial cysts, is not stated. The final conclusions acquired from the executed research work would be a discussion issue after the correlative aspects in the prospective group are surveyed. The benign ovarial cysts' hormonal profile would be taken into consideration also.

[Administration of Perfalgan (paracetamol) for postoperative analgesia in obstetrics and gynaecology]

The aim of our study is to determine the quality of postoperative analgesia by using of Perfalgan (injectable paracetamol)--alone or in combination with other analgesics for different operations in obstetric and gynecology. We have evaluated 60 women, divided into four groups each one of 15 according to the kind of surgical intervention: section cesarean, laparoscopy, laparohysterectomy or cystectomy. The effect of administered Perfalgan over postoperative pain was estimated by different objective and subjective parameters after standard general anesthesia. As a result of our study we consider that postoperative analgesia with Perfalgan is suitable enough after section cesarean and laparoscopy. As a component of multimodal analgesic combination it gives a good quality of postoperative pain relief in condition of laparohysterectomy or cystectomy. It is very important that this is without any adverse effects.