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Congenital heart abnormalities are rare and most often occur separately. These structural and functional disorders can cause a range of diseases that vary in severity, from mild or even asymptomatic to severe and life-threatening. Occasionally these conditions could cause no symptoms in which case they are found accidentally when the patient is examined for other reasons or during autopsy. In this article we present the case of a 47-year-old male patient with triple congenital heart anomaly detected in two consecutive tests performed in pre-hospital medical care.

Placenta previa is characterized by the abnormal placenta overlying the endocervical os. It is one of the most feared adverse maternal and fetal-neonatal complications in obstetrics. The condition is frequently complicated by placenta accreta or increta. Women with placenta previa have often an increased risk of postpartum hemorrhage. The risk factors for placenta accreta are previous uterine surgery, as cesarean sections (CS)., dilatation, curettage, the advanced maternal age, multiparity etc. A 31-year-old woman, P.T.S., who went in for delivery with moderate bleeding from the genitals and regular labor. Childbirth with cesarean section was performed (C.S), because of intrapartum asphyxia of the fetus. A female fetus was born, weighing 3270 g. Finding that the placenta is located on the posterior uterine wall and descends to the cervical canal. Immediately after CS, profuse bleeding from the uterus begins. After a control revision of the uterine cavity, cervical placenta was established. An emergency total hysterectomy without the adnexa was performed. It must be known that any bleeding during the third trimester of pregnancy, low blood counts and worsening general conditions of the woman should be considered as a warning of possible placenta previa isthmicocervicalis. [ABSTRACT FROM AUTHOR]

The objective of the present study is to establish regression models defining the relations between physicochemical parameters of bee honey and the type of honey. 89 samples of bee honey (acacia honey, coriander honey, limetree honey, rapeseed honey, sunflower honey, and multifloral honey) collected from different regions of Bulgaria were used in the study. The following parameters have been defined: water content (WC); content of fructose (F), glucose (G), electrical conductivity (EC), refractive index (RI), and pH. Moderate to strong negative correlation between WC and RI has been found for all studied types of bee honey. In the samples from lime tree, coriander, and multifloral honey, positive but different in strength correlation has been observed - from weak to moderate correlation between pH and EC. The analysis of the samples with acacia honey showed differences in strength and direction of: lime tree and multifloral honey in terms of the correlations between pH and total F + G content; of lime tree, rapeseed, and sunflower honey in the correlations between F+G and RI and between WC and F + G. General Linear Models (1-5) have been compiled based on the connections between the considered physicochemical parameters and the different types of honey, which would allow subsequent estimation of the studied parameters. [ABSTRACT FROM AUTHOR]

The hygienic behaviour of 26 bee colonies of apiaries in different regions of Bulgaria was tested. The degree of expression of hygienic behaviour was evaluated by the pin-killing method. A test field of square 5 x 5 cm was stuck onto a section of a honeycomb with a sealed worker brood. The bee colonies are divided into two groups: hygienic (cleaned over 95% of cells in the testing area on the 48th hour) and nonhygienic (cleaned less than 95% of the cells in the testing area on the 48th hour). Haemolymph has been taken from bees from each bee colony at 48th hour and lysozyme levels and total protein content has been defined. Multivariate analysis (ANOVA) was used to determine significant differences between hygienic and nonhygienic colonies. The results obtained show significant differences between both groups (P<0.05) according to percent cleaned cells after killing the brood at 3rd, 24th and 48th hours and insignificant differences between hygienic and nonhygienic colonies (P<0.05) for both parameters-lysozyme and total protein. Bivariate correlation was applied to investigate the impact of hygienic behaviour on lysozyme levels and total protein content. Low negative correlation (r=-0.33) between total protein and hygienic behaviour was established which means that an increase of the activities related to the cleansing of honeycomb cells leads to a decrease in the total protein content. Low correlation (r=0.35) between hygienic behaviour and lysozyme levels was found i.e. higher levels of lysozyme are reported with more pronounced hygiene behaviour. The calculated regression model for lysozyme (P=0.24826) is statistically insignificant but the regression model for total protein is statistically significant (P=0.003153) and can be used to predict the relation between total protein content in the haemolymph and hygienic behaviour of bee colonies. [ABSTRACT FROM AUTHOR]

Introduction: Homografts and bovine jugular vein are the most commonly used conduits for right ventricular outflow tract reconstruction at the time of primary repair of truncus arteriosus., Methods: We reviewed all truncus patients from 1990 to 2020 in two mid-volume centers. Inclusion criteria were primary repair, age under one year, and implantation of either homograft or bovine jugular vein. Kaplan-Meier analysis was used to estimate survival, freedom from reoperation on right ventricular outflow tract, and freedom from right ventricular outflow tract reoperation or catheter intervention., Results: Seventy-three patients met the inclusion criteria, homografts were implanted in 31, and bovine jugular vein in 42. There was no difference in preoperative characteristics between the two groups. There were 25/73 (34%) early postoperative deaths and no late deaths. Follow-up for survivals was 17.5 (interquartile range 13.5) years for homograft group, and 11.5 (interquartile range 8.5) years for bovine jugular vein group (P=0.002). Freedom from reoperation on right ventricular outflow tract at one, five, and 10 years in the homograft group were 100%, 83%, and 53%; and in bovine jugular vein group, it was 100%, 85%, and 50% (P=0.79). There was no difference in freedom from reoperation or catheter intervention (P=0.32)., Conclusion: Bovine jugular vein was equivalent to homografts up to 10 years in terms of survival and freedom from right ventricular outflow tract reoperation or catheter intervention. The choice of either valved conduit did not influence the durability of the right ventricle-pulmonary artery conduit in truncus arteriosus.

Aorto-ventricular tunnel (AoVT), a rare congenital anomaly, is a channel originating in the ascending aorta just above the sinotubular junction and leading to the cavity of the left ventricle (AoLVT), or, rarely, the right (AoRVT). This study reviews our collective 30-year experience with the surgical treatment of AoVT. Data were submitted by 15 participating centers on 42 patients who underwent correction of AoVT between 1987 and 2018. Of these, 36 had AoLVT, and 6 AoRVT. The tunnel originated above the right coronary sinus in 28 (77.8%) patients. For AoLVT, most operations were performed early (median age 25 days, range: 1 day-25 years). In contrast, AoRVT was diagnosed and repaired later (median age 6 years, range: 1 month-12 years). Surgically important coronary ostial displacement was common. Patch closure of the aortic orifice only was the commonest surgical repair for AoLVT (23 patients), while in AoRVT, both orifices or only the ventricular one was closed. Aortic valvar insufficiency, severe or moderate, coexisted in 11 (30.5%) patients with AoLVT, and aortic valvuloplasty was performed in 8, mainly due to aortic valve stenosis. Aortic valvar insufficiency at discharge ranged from trivial to mild in almost all patients. Early mortality was 7.14%, with 3 patients with AoLVT succumbing to cardiac failure. There were 2 early reoperations and 1 late death. AoVT is a rare malformation. AoLVT usually necessitates surgery in early life. AoRVT is rarer, diagnosed and repaired later in life. Surgical repair by patch closure, with concomitant aortic valve repair as needed, is associated with good results., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Harpactea popovi sp. n. is described and illustrated based on males. It was collected in beech forest habitats (Fagus orientalis) in Strandzha Mountain, Southeastern Bulgaria. The new species belongs to the Harpactea rubicunda species group as defined by Deeleman-Reinhold (1993) and is closely related to H. ice Komnenov Chatzaki, 2016 and H. sturanyi (Nosek, 1905). The following synonymies were established: H. camenarum Brignoli, 1977 = H. sturanyi (Nosek, 1905) syn. n., H. lyciae Brignoli, 1978 = H. sturanyi (Nosek, 1905) syn. n. New illustrations and photographs for the discussed species are also presented.

Objectives: Our goal was to evaluate the early and late results of the surgical management of congenital supravalvular aortic stenosis (SVAS)., Methods: We performed a retrospective, multicentre study using data from the European Congenital Heart Surgeons Association. Exclusion criteria were age >18 years, operation before 1990 and redo supravalvular aortic stenosis operations. Multivariate Cox regression analysis was performed to detect independent predictors of adverse events., Results: Of a total of 301 patients (male/female = 194/107; median age 3.9 years, range 13 days-17.9 years), 17.6% had a prior surgical or interventional procedure. Pulmonary artery stenosis was present in 41.5% and coronary anomalies in 13.6%. The operation consisted of a single patch repair in 36.7%, a pantaloon-shaped patch in 36.7%, a 3-patch technique in 14.3% and other techniques in 11.7%. Postoperative complications occurred in 14.9%, and the early mortality rate was 5%. At a median follow-up of 13 years (interquartile range 3.5-7.8; follow-up completed 79.1%), there were 10 late deaths (4.2%). A surgical reoperation or an interventional cardiology procedure occurred in 12.6% and 7.2%, respectively. No significant differences in outcomes between the techniques were found. Age at repair <12 months and pulmonary artery stenosis were associated with an increased risk of early (P = 0.0001) and overall mortality (P = 0.025), respectively. Having an operation after 2005 and co-existing pulmonary artery stenosis were significant predictors of late reintervention (P = 0.0110 and P = 0.001, respectively)., Conclusions: Surgical repair of congenital stenosis is an effective procedure with acceptable surgical risk and good late survival, but late morbidity is not negligible, especially in infants and when associated pulmonary artery stenosis is present., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX., Methods: A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%)., Results: The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30 days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9 years (range 0-23.7 years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04)., Conclusions: Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Unlabelled: Many years the β-mimetics (Partussisten, Gynipral) were first line tocolytic agents in terms of delaying premature delivery in our country. As these medicaments have been withdrawn from the pharmacy network, some concerns began to appear among our colleges considering the administration of other tocolytics and their effectiveness. Our goal is to compare the efficacy of other tocolytics with β-mimetics. That is why we reviewed the structure of premature deliveries in the University Hospital "Stoyan Kirkovich", Stara Zagora for two periods: 01.01.2013 - 31.12. 2013 and 01.01.2014 - 01.06.2014., Results: 45 of 326 pregnancies (13.8%) > 20 weeks of gestation for 2013, treated with Gynipral have ended with a premature delivery vs. 13 of 110 pregnancies (11.8%), treated with magnesium (Mg SO4, Magnerich, Magnerot), calcium channel blockers and spasmolyticsfor the period - 01:01.2014 - 01.06.2014., Conclusion: The results show, that at this stage, several months after the cessation of use of β-mimetics, there is no rise of number and percentage of premature deliveries, but there is even a tendence of decline. Larger periods and greater number of cases are needed to formulate conclusions with greater significance.

A total of 294 species from 31 families have been found in Galichitsa Mt. Of them, 85 species are new to the mountain, while 20 are also new to the fauna of FYR of Macedonia. According to their current distribution the established species can be assigned to 17 zoogeographical categories, grouped into 5 complexes (Cosmopolitan, Holarctic, European, Mediterranean, Endemics of Balkans). Dominant are Holarctic species (66.0%) followed by European (16.5%) and Mediterranean (9.3%). The endemics (6.2%) and Southeast European species (1.7%) emphasize the local character of this fauna, but its low percentage suggests an important process of colonization.

Unlabelled: Review of modern opinions and tendencies, concerning the role of laparoscopic surgery for the staging and treatment of ovarian cancer stage I-II., Conclusion: The laparoscopic approach of surgical staging of early ovarian cancer is equal and even has more advantages then conventional laparotomy if it is performed from gynecologists- oncologists with enough skills and experience in laparoscopic surgery.

Objective: The authors present and analyze the modern concepts of the role of surgery as a prognostic factor for patients with early epithelial ovarian cancer (st. I-II). They review, synthetize and summarize the information from 15 studies, published in the recent years, and concerning the subject., Conclusion: Surgery treatment for early epithelial ovarian cancer is one of the most important prognostic factors. The appropriate surgical performance contributes either for complete staging or for optimal primary cytoreduction and strongly influence the development and outcome of disease.

Unlabelled: The authors present and analyze the modem concepts of the role of adjuvant chemotherapy as a prognostic factor for patients with early epithelial ovarian cancer (st. I-II). They review, synthetize and summarize the information from studies and researches, published in the recent years, and concerning the subject., Conclusion: Adjuvant chemotherapy for early epithelial ovarian cancer improves overall survival of patients having tumors with grade 2 or 3, stagelC or grater and suboptimal surgical staging.

Unlabelled: The goal of the research is to discover and analyze the dependence of survival on the tumor size in a cohort of 215 female patients with early epithelial ovarian cancer fallowed up for 13 year period (2000-2012). After multiple analyze among 18 other prognostic factors, using Cox proportional regression, tumor size remained one of five most significant., Conclusion: The bigger the size of the tumor, the poorer the prognosis for the overall survival (p = 0.0001) and progression free survival (p = 0.4) of patient with epithelial ovarian cancer at early stage.

Unlabelled: A cohort of 215 female patients with early epithelial ovarian cancer, researched for 13 year period (2000-2012). The authors are setting a goal to investigate how does the amount of chemotherapeutic medicaments, administered as adjuvant therapy influences the survival of these patients., Conclusion: The application of three or more chemotherapeutic agents does not improve the survival of female patients with early epithelial ovarian cancer, indicated for chemotherapy.

The authors present a case of a 35 years old female patient with spinocellular carcinoma of the cervix, diagnosed after byopsy and treated with radiotherapy 30 Gray, combined with Cisplatin 50 mg. per square meter, per week, 6 months before radical histerectomy and lymphonodulectomy was performed. The postoperative histology shows only traces of dysplastic epithelia, which proves preoperative therapy effective.

35 years old patient with many health problems, on a haemodialysis and a big abdominal tumor originating from the pelvis. The authors share their clinical approach and their diagnostic and terapeutic difficulties in this case and refer to one of their previous publications.

Painfull myoma utery in a patient with poor health condition and many disfunctional organs: Diabetes mellitus, Chronic renal insufficiency Gr. III (most probably a result of compression of the ureters causing bilateral hydronephrosis), arterial hypertony, anemia. The authors introduce their therapeutic model and manage to perform successfull operation after stabilizing the patient and intensive postoperative care. They point out the team work and good synchronization between the hospital divisions as crucial for the success of the treatment.

Objective: This study aims to analyse the collective experience of participating European Congenital Heart Surgeons Association centres in the surgical management of complications resulting from trans-catheter closure of atrial septal defects (ASDs)., Methods: The records of all (n=56) patients, aged 3-70 years (median 18 years), who underwent surgery for complications of trans-catheter ASD closure in 19 participating institutions over a 10-year period (1997-2007) were retrospectively reviewed. Risk factors for surgical complications were sought. Surgical outcomes were compared with those reported for primary surgical ASD closure in the European Association of Cardio-thoracic Surgery Congenital Database., Results: A wide range of ASD sizes (5-34mm) and devices of various types and sizes (range 12-60mm) were involved, including 13 devices less than 20mm. Complications leading to surgery included embolisation (n=29), thrombosis/thrombo-embolism/cerebral ischaemia or stroke (n=12), significant residual shunt (n=12), aortic or atrial perforation or erosion (n=9), haemopericardium with tamponade (n=5), aortic or mitral valve injury (n=2) and endocarditis (n=1). Surgery (39 early emergent and 17 late operations) involved device removal, repair of damaged structures and ASD closure. Late operations were needed 12 days to 8 years (median 3 years) after device implantation. There were three hospital deaths (mortality 5.4%). During the same time period, mortality for all 4453 surgical ASD closures reported in the European Association of Cardio-Thoracic Surgery Congenital Database was 0.36% (p=0.001)., Conclusions: Trans-catheter device closure of ASDs, even in cases when small devices are used, can lead to significant complications requiring surgical intervention. Once a complication leading to surgery occurs, mortality is significantly greater than that of primary surgical ASD closure. Major complications can occur late after device placement. Therefore, lifelong follow-up of patients in whom ASDs have been closed by devices is mandatory., (Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

The authors describe an operative method of cervix conisation, which they used by 41 patients in a 11-years period (1998-2009). Shearing their experience of the results they achieved, they are making some conclusions.

The authors describe rare case of carcinoma colli uteri, which grows to infiltrate submucose cervical myoma.