No 37 (2015)

ИСТОРИЯ МОНИКИ

PLAGUE EPIDEMICS IN XVIII CENTURY AND DEVELOPMENT OF HEALTHCARE IN MOSCOW

Paleev F.N., Onoprienko G.A., Molochkov A.V.

Abstract

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Almanac of Clinical Medicine. 2015;(37):6-9
pages 6-9 views

EDITORIAL

ON THE 85TH ANNIVERSARY OF THE MOSCOW REGIONAL RESEARCH INSTITUTE OF OBSTETRICS AND GYNECOLOGY

Krasnopol'skiy V.I.

Abstract

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Almanac of Clinical Medicine. 2015;(37):10-11
pages 10-11 views

OBSTETRICS

THE PROCALCITONIN TEST AS A NEARLY CRITERION TO DIAGNOSE SEVERE FORMS OF INTRAUTERINE INFECTIONS AND TO MONITOR ANTIBACTERIAL TREATMENT IN EARLY NEONATAL PERIOD

Aksenov A.N., Bocharova I.I., Bashakin N.F., Troitskaya M.V., Yakubina A.A., Bukina M.Y., Budykina T.S.

Abstract

Background: Research in the field of reliable and available tests to diagnose infectious and inflammatory disorders in newborns in their first two days of life, as well as for determination of indications to antibacterial treatment and its monitoring in the early neonatal period are of utmost importance. 

Aim: To improve quality of diagnostics of intrauterine infections and to optimize management strategies for newborns with a high risk of infections by means of the procalcitonin test in the early neonatal period.

Materials and methods: We assessed 40 normal (on-term) and 10 pre-term newborns born to mothers with infectious and inflammatory urogenital disease. Group 1 (n = 21) included patients with intrauterine pneumonia, group 2 (n = 6), those with intrauterine infection without a clearly defined primary locus, group 3 (n = 13), those with non-infectious disorders and group 4 (n = 10) comprised clinically normal (healthy) newborns. All infants underwent standard clinical and laboratory assessments, including an assessment of procalcitonin level by means of a semi-quantitative procalcitonin express-test (BRAHMS) at days 1, 2 and 3 of life. 

Results: At day 1, during primary assessment of newborns from group 1, procalcitonin values above 2 ng/mL were measured in 67% (10 of 15) cases; at days 2 and 3 also in 67% (4 of 6). Two patients with low procalcitonin values (below 0.5 ng/mL) had a disease of viral etiology (in 1, enteroviral and in 1, cytomegaloviral). In group 2, procalcitonin values exceeded 2 ng/mL in 3 of 5 newborns. In none of the infants from groups 3 and 4 procalcitonin values exceeded 2 ng/mL during their first 3 days of life. For assessment of efficacy of antibacterial treatment based on procalcitonin levels, all newborns with intrauterine infections were divided into group А (n = 11), where an antibacterial regimen was changed, and group B (n = 16), with no change in antibacterial treatment. During the treatment, 5 newborns from group A (45.5%) had their procalcitonin levels unchanged, whereas in 6 (54.5%) patients it decreased. In group B, 12 (75%) of newborns had their procalcitonin levels unchanged, in 2 (12.5%) it went down and in 2 (12.5%) of patients it went up. 

Conclusion: A semi-quantitative procalcitonin expresstest is characterized by its high informativity and availability when used in newborns of various gestation ages in the early neonatal period. An increase of procalcitonin level above 2 ng/mL, starting from the first day of life, can be used as an early diagnostic criterion of severe forms of intrauterine infections associated with systemic inflammatory response and symptoms of organ insufficiency. The results of procalcitonin test can be used for monitoring of antibacterial treatment in newborns.

Almanac of Clinical Medicine. 2015;(37):12-17
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OBSTETRIC AND PERINATAL OUTCOMES IN PREGNANT TYPE 2 DIABETIC PATIENTS

Gur'eva V.M., Burumkulova F.F., Petrukhin V.A., Morokhotova L.S., Troitskaya M.V.

Abstract

Background: In the last years, an increase in numbers of pregnant patients with type 2 diabetes mellitus (T2DM) has been observed. Nevertheless, obstetricians/gynecologists and endocrinologists are not sufficiently aware of this problem. 

Aim: To analyze specific features of pregnancy course and outcomes in female patients with T2DM. 

Materials and methods: We performed a retrospective and prospective analysis of specific characteristics of pregnancy course and outcomes in 70 females with T2DM who were seen from 2008 to 2013. These 70 patients delivered 72 babies (including two twins). 

Results: Seventeen (24.3%) patients in their past history had perinatal losses or disability of babies. 81.4% of patients were obese. Twenty seven (38.6%) patients had arterial hypertension. Thirty (41.3%) patients had good diabetes control pre-pregnancy, whereas others were sub-optimally or poorly controlled. At trimester I, 45 (64.3%) of patients were treated with oral hypoglycemic agents. Thirteen (18.6%) of patients were hydramniotic and 4 (5.7%) were olygoamniotic. Mild gestosis was observed in 12, moderate, in 10 and severe, in 2 patients. Preterm delivery was performed in 9 (12.9%) of patients, among them in 5 cases due to a critical state of the fetus. Natural deliveries occurred in 34 (48.6%) of females. Deliveries of big fetuses were observed in 10 (13.9%) of cases. Thirty four (47%) of newborns had diabetic fetopathy, 4 (5.5%) had birth trauma. The rate of congenital abnormalities was 9.7%. All patients whose babies had congenital abnormalities, had concepted while taking sensitizers, and 7 of them were poorly controlled by that time. Any unfavorable perinatal outcome was registered in 32%. 

Conclusion: Female patients with T2DM have a high frequency of unfavorable perinatal outcomes (birth defects, disability in babies, prolonged intensive care in the neonatal period), and among complications of pregnancy, a high rate of gestosis (in particular in patients with baseline arterial hypertension). Improvement of perinatal and obstetric outcomes would require an optimization of management of such patients. Thus, it is reasonable to establish a multi-disciplinary team of specialists, including obstetrician/gynecologists, endocrinologists, internists and neonatologists, on the bases of centers for perinatal care or multifield hospitals with big in-patient department of obstetrics.

Almanac of Clinical Medicine. 2015;(37):18-23
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СOMPLICATIONS OF PREGNANCY IN WOMEN WITH DIABETES MELLITUS AND POSSIBILITIES OF THEIR CORRECTION

Gur'eva V.M., Burumkulova F.F., Budykina T.S., Morokhotova L.S., Buyvalo T.A.

Abstract

Reproductive disorders in women with pre-gestational diabetes mellitus lead not only to poorer fertility, but to complicated course and poor outcomes of pregnancy for mother and fetus. Compared to general population, patients with pre-gestational diabetes mellitus have higher frequencies of ovulation delay, ovarian dysfunction and infertility, and if they become diabetic before their puberty, they have later menarche and earlier menopause. All this is caused by functional disorders of hypothalamic-hypophyseal-adrenal axis and ovarian insufficiency with significant decrease in progesterone levels. Pre-conceptional existence of diabetes mellitus is associated with high probability of menstrual cycle disorders, infertility, and in case of pregnancy – with its complicated course (congenital malformations, miscarriage, fetoplacental insufficiency, pre-eclampsia). The risk of these abnormalities is increased in case of late diabetic complications and poor glucose control. Babies born to diabetic mothers, beyond fetopathy and fetoplacental insufficiency, suffer from long term central nervous system disorders that may lead to problems in social adaptation. 

There are no effective treatments for advanced clinical pre-eclampsia and uncontrolled fetoplacental insufficiency that necessitates the pregnancy to be terminated in the interests of mother or fetus. Due to this, in women with pre-gestational diabetes it is reasonable to implement preventive measures including those aimed at the main components of pathophysiology of a number of obstetric complications. In particular, to correct potential complications of pregnancy in women with diabetes mellitus, administration of active forms of folinic acid and normalization of eicosanoid balance with oral polyunsaturated ω-3 fatty acids is indicated during pregnancy planning and during gestation. 

Almanac of Clinical Medicine. 2015;(37):24-31
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MANAGEMENT OF PREGNANCY AND DELIVERY IN MULTIPLE PREGNANCY

Krasnopol'skiy V.I., Novikova S.V., Tsivtsivadze E.B., Zharova A.A.

Abstract

The problem of multiple pregnancy management is of scientific and pragmatic interest, because in the last years, there is an increase of numbers of multiple pregnancies, especially due to wider use of assisted reproductive technologies. As a female organism has been evolutionally adapted to carriage of a single fetus, the multiple pregnancy is a classic model of fetoplacental insufficiency. Multiple pregnancy is a high risk pregnancy, with a high percentage of preterm deliveries, high perinatal mortality and infant morbidity. In pregnancy with two and more fetuses a certain observational algorithm is necessary that would allow timely performing of diagnostic and treatment activities, as well as taking adequante strategic decisions to ensure prolongation of pregnancy. The review deals with literature data summarizing a many years’ international experience of management of women with multiple pregnancies, as well as the results of the author’s own studies.

Almanac of Clinical Medicine. 2015;(37):32-40
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THE POSSIBILITIES TO DETERMINE FETAL MATURITY BY ULTRASOUND DIAGNOSTICS

Lysenko S.N., Chechneva M.A., Petrukhin V.A., Aksenov A.N., Ermakova L.B.

Abstract

Background: Extragenital disorders in a pregnant patient, as well as complications of pregnancy often necessitate preterm delivery, when the state of the fetus is one of the criteria determining terms and type of delivery. In connection with this, the physician faces the challenge of accurate assessment of fetal maturity. 

Aim: To identify ultrasound signs of functional fetal maturity. 

Materials and methods: 120 pregnant patients were assessed at 35 to 40 weeks of gestation. Beyond a standard fetometry, we assessed interhemispheric cerebellar size, the biggest size of the Beclard’s nucleus, the ratio of cortical to medullar substance of fetal adrenal glands (adrenal coefficient), the ration between ultrasound density of lungs, liver and ultrasound density of fetal urine (histogram analysis). 

Results: Up to 36 weeks of gestation, the interhemispheric cerebellar size was below 52 mm, starting from 37 weeks, above 53 mm and from week 40 on, above 58 mm. All newborns, which had their interhemispheric cerebellar size ≥ 53 mm antenatally, were assessed as being mature at birth (p < 0.05). All newborns, which had Beclard’s nucleus size ≥ 5 mm antenatally, were assessed as being mature at birth (p < 0.05). At 35–35.6 weeks of gestation, mean adrenal coefficients in all cases exceeded 1. Starting with full 36 weeks of gestation onwards, this parameter decreased to 0.94 and showed a steady decrease thereafter. There were no signs of functional immaturity or respiratory distress among newborns with antenatal adrenal coefficient of ≤ 0.99 (p < 0.05). The ratio between ultrasound density of lungs to ultrasound density of bladder contents increases up to 37 weeks of gestation and remains stable up to 40 weeks. The ratio of liver density to the same substrate is non-significantly lower due to lower ultrasound density of the liver itself. The ratio of ultrasound density of the lung to that of the liver up to 36 weeks was at least 1.41 and decreased from 37 to 40 weeks of gestation. 

Conclusion: The fetometric parameter of interhemispheric cerebellar size has the maximal correlation with the term of gestation and can serve as an indirect measure of functional fetal maturity. The size of Beclard’s nucleus and adrenal coefficient may serve as parameters that most clearly reflect fetal tissue maturity and allow predicting respiratory distress in a newborn. Linear sizes of the adrenal gland can not serve as a maturity criterion due to high error of measurements, depending on the level of section by its height (pyramidal form). Despite an increase of the ratio of ultrasound density of the lung to that of the liver with longer term of gestation, it cannot be considered a reliable parameter of lung maturity after 35 weeks of gestation.

Almanac of Clinical Medicine. 2015;(37):41-46
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OSTEOGENESIS IMPERFECTA AND PREGNANCY: PROBLEMS EVOLVING BY THE TIME OF DELIVERY

Mravyan S.R., Shuginin I.O., Novikova S.V., Upryamova E.Y., Bocharova I.I., Zhuchenko L.A.

Abstract

The article describes a case of pregnancy in a patient with osteogenesis imperfecta. It is of note that both local and foreign medicine this disorder is a contraindication to pregnancy due to a high risk of maternal and fetal complications. The authors review literature on pre-pregnancy planning and preparation, pregnancy management, types of deliveries and approaches to anesthesia in female patients with osteogenesis imperfecta. Special attention is paid to anesthesiological complications during delivery, ways of their management and correction. Due to a high inheritance rate of this disorder, genetic consulting and extracorporeal fertilization methods are of great importance.

Almanac of Clinical Medicine. 2015;(37):47-51
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COMPLICATIONS AND OUTCOMES OF PREGNANCY IN CHRONIC KIDNEY DISEASE

Nikol'skaya I.G., Prokopenko E.I., Novikova S.V., Budykina T.S., Kokarovtseva S.N., Yakubina A.A., Krupskaya M.S.

Abstract

Pregnancy in women with kidney disorders, even with preserved renal function, is associated with higher than in the population rates of obstetric and perinatal complications, such as eclampsia, preterm delivery, surgical deliveries and intensive care for newborns.

This article presents our own data on complications and outcomes of pregnancies in 156 women with various stages of chronic kidney disease (CKD). From these, 87 patients had CKD stage I, 29 with CKD stage II and 40 with CKD stages III, IV, V. For the first time in Russia, the authors summarize their unique experience in management of pregnancy with CKD, underline a high probability (27,5%) of its primary detection during pregnancy, discuss the algorithms of assessment, prevention and treatment of various gestational complications in CKD (pre-eclampsia, urinary tract infections, feto-placental insufficiency, anemia, acute renal damage), as well as the influence of pregnancy on renal function at long-term post-delivery. A direct correlation between the CKD stage, frequency of pre-eclampsia, feto-placental insufficiency, preterm deliveries, surgical deliveries by caesarean section and babies’ status at birth is demonstrated.

Based on their ample clinical material, they confirmprobability of favorable pregnancy outcomes in CKD patients with stable renal function without severe arterial hypertension during pregnancy: for a baby in 87%, for the mother in 90% (maintenance of the same CKD stage). The risk of persistent deterioration of renal function during pregnancy and puerperium in women with CKD is higher in CKD stage IV, as well as in the case of early development of pre-eclampsia; it also correlates with severity of the latter.

The probability of a favorable obstetric and nephrological outcome is higher when the pregnancy is planned and intensively co-managed by an obstetrician/gynaecologist and a nephrologist from early weeks of gestation onwards.

Almanac of Clinical Medicine. 2015;(37):52-69
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CLINICAL AND MORPHOLOGICAL CHARACTERIZATION OF FETOPLACENTAL COMPLEX IN PREGNANT PATIENTS WITH DIFFUSE TOXIC GOITER

Petrukhin V.A., Logutova L.S., Shidlovskaya N.V., Pavlova T.V., Malyutina E.S., Burumkulova F.F.

Abstract

Background: The course of pregnancy and delivery in patients with diffuse toxic goiter (DTG) is often complicated by preeclampsia, fetoplacental insufficiency, placental abruption and associated with higher maternal and perinatal mortality.

 

Aim: To study particulars of fetoplacental complex functioning in DTG.

 

Materials and methods: We assessed pregnant patients with DTG (n = 92) and their newborns (n = 94). By the time of delivery, 86 of patients were clinically and biochemically euthyroid. Functions of fetoplacental complex (by levels of placental lactogen, α-fetoprotein, estriol, progesterone and cortisol) were assessed by radioimmune and immunoenzyme assays. Fetometrical parameters of fetuses were studied by ultrasound method. Complex assessment of placentas was done by light and electronic microscopy.

 

Results: Eighty seven (94,6%) patients with DTG had combined complications of pregnancy. The most frequent were: the threat of termination of pregnancy, in 68 (73.9%) of cases, low placenta placement, in 23 (25%), anemia, in 56 (60.9%), pre-eclampsia, in 56 (60.9%). In 59 of patients (64.1%), fetoplacental insufficiency was diagnosed, with predominance of strain or exhaustion reactions. Critical status of fetoplacental complex was found in pregnant patients with uncontrolled DTG and duration of control of less than 20 weeks, as well as in pregnant patients with DTG relapses. The values of main hormones (placental lactogen, α-fetoprotein and progesterone) were below 10th percentile.

According to the results of the ultrasound assessments, fetuses from mothers with DTG during gestation demonstrated decrease of the majority or percentile parameters, such as biparietal cranial size, fetal femoral length, abdomen diameter, that was especially prominent in the groups with relapsing DTG.

Eighty eight of 94 newborns (93.6%) were born full-term. In total, every third baby (29.3%) had some degree of intrauterine developmental delay at birth. Among the cases with controlled DTG in mothers, there were 21.2% of such babies, whereas among those with DTG relapses, 40%. There was an association between the length of DTG control during pregnancy and mass and body parameters of newborns: the shorter was duration of DTG control during gestation, the higher was the risk of low birth weight fetuses (р < 0.05).

Histological assessment of placentas from DTG patients showed changes of endothelial microlandscape with sprouting of cell plasmolemma, blood cell adhesion and fibrin deposition. In 86% of placentas there were stasis, sludge formation and thrombosis in cord vessels.

Conclusion: Pregnancy starting during uncontrolled DTG is typically associated with primary placental insufficiency that is morphologically characterized by profound metabolic abnormalities (stromal fibrosis, immaturity of the villous tree, blood flow abnormalities and ischemia). Morphological and functional placental abnormalities correlated with duration of uncontrolled DTG and lead to high rate of intrauterine developmental delay.

Almanac of Clinical Medicine. 2015;(37):70-78
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VALIDATION OF THE MECG-DP-NS-01 MONITOR IN OSCILLOMETRY AND AUSCULTATION MODES IN PREGNANCY, ACCORDING TO ESH IP-2, BHS AND AAMI PROTOCOLS

Fedorova S.I., Kulakov N.V., Pronina V.P., Mravyan S.R.

Abstract

Background: Arterial hypertension in pregnancy is a major cause of maternal death and perinatal mortality. According to the Russian recommendations, only devices that have been evaluated according to international protocols may be used for ambulatory blood pressure monitoring in pregnancy.

Aim: Validation of the MECG-DP-NS-01 upper arm blood pressure monitor manufactured by the DMS Advanced Technologies Ltd., in oscillometry and auscultation modes for ambulatory blood pressure monitoring in pregnancy, according to the ESH International Protocol revision 2010 (ESH-IP2), the BHS protocol revision 1993 and the AAMI standard.

Materials and methods: A group of 39 pregnant women at various gestation time (from 9 to 40 weeks, 29.2 ± 9.9 weeks) aged 25 to 43 years (31.9 ± 4.3 years) was recruited for the validation study. Expert and device blood pressure measurements were taken for each patient according to the international protocols.

Results: The MECG-DP-NS-01 upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. for ambulatory blood pressure monitoring was validated in oscillometry and auscultation modes in pregnancy, according to the BHS protocol revision 1993, the ESH-IP2 and the AAMI standard. The device met an A/A grading for the BHS protocol revision 1993 both in the oscillometry and auscultation modes. The device maintained its A/A grading throughout the low-pressure, medium-pressure and high-pressure ranges.

Conclusion: The MECG-DP-NS-01 met all the requirements and, fulfilling the standards of the protocols, is recommended for ambulatory blood pressure monitoring in pregnancy according to BHS protocol revision 1993, ESH-IP2 and AAMI standard. According to the Declaration of Blood Pressure Measuring Device Equivalence signed by the manufacturer, there are no differences that will affect blood pressure measuring accuracy between the MDP-NS-02s “Voshod” upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. and the MECG-DP-NS-01, which passed the ESH-IP2, BHS and AAMI protocols.

Almanac of Clinical Medicine. 2015;(37):79-84
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CAUSES OF INEFFICIENT UTERINE SCARRING AFTER CAESAREAN SECTION AND METHODS OF ITS PREVENTION

Shchukina N.A., Blagina E.I., Barinova I.V.

Abstract

Increased interest of investigators to the problem of post-caesarean uterine scar is to be explained by changes of obstetric strategies towards significant rise of surgical delivery rates. At present, every fourth pregnant woman in the world delivers by caesarean section. Presence of a uterine scar is often seen as an “automatic” indication to repeat caesarean section, which is associated with 3 to 4-fold higher rate of complications compared to natural deliveries. It is because of this fact that the problem of quality of reparation of post-caesarean uterine scars is becoming more and more of importance. The review presents data from literature on issues of delivery after a caesarean section. The analysis has shown ambiguity and deficiency of evidence on inefficient uterine scarring after caesarean section that necessitates further research in this field.

Almanac of Clinical Medicine. 2015;(37):85-92
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GYNECOLOGY

ULTRASOUND DIAGNOSTICS OF RETROCERVICAL ENDOMETRIOSIS

Barto R.A., Chechneva M.A.

Abstract

Background: Endometriosis is one of the major problems in current gynecology due to steady increase of its incidence, involvement of young females, high frequency of infertility and difficulties with diagnostics and treatment. Confirmation of diagnosis of advanced endometriosis is still within the competence of research centers and big federal treatment establishments.

Aim: To improve ultrasound diagnostics and to develop an algorithm of assessment in retrocervical endometriosis.

Materials and methods: Seventy two females were assessed laparoscopically due to a gynecology disorder or infertility. Based on intraoperational data and results of pathomorphological assessments, two groups were formed: group 1 (control group, n = 26) comprised patients in reproductive age who had been admitted for elective surgery due to a gynecological disorder. Group 2 (main group, n = 46) included patients with various types of endometriosis. Patients from group 2 were divided into 3 subgroups: 2а (n = 17) – with superficial forms of external genital endometriosis; 2b (n = 18) – with endometrioid cysts; 2c (n = 11) – with deep infiltrative types of endometriosis.

Results: Patients with superficial external genital endometriosis were characterized by positive symptom of “folding” (“freezing”) of posterior uterine surface and of the walls of adjacent intestine. In endometriosis of posterior surface of cervix uteri, the diagnosis made by an ultrasound assessmentin 100% matched the diagnosis set during surgery, whereas if sacrouterine ligaments were involved, the diagnostic match was only 3%. In the group of patients with endometrioid cysts, in most of cases the cysts had specific ultrasound signs; coincidence of an ultrasound and a morphological diagnosis was seen in 98% of cases. Most cases of deep infiltrative endometriosis showed involvement of sacrouterine ligaments (72%) and of parametrium (81%). There was a positive folding sign and a “Indian headdress symptom”. Retrocervical endometriosis was characterized by involvement of adjacent organs, such as rectum and rectosigmoideal flexion of the colon, vaginal walls, vaginorectal septum, parametrium, as well as obstructive uretheral adhesions with a pyeloectasy on the site of involvement. Diagnostic mismatches between the ultrasound method and surgery was seen in 4% of females. False positive results were found in 2% of cases. Based on the assessments performed, an original algorithm of ultrasound diagnostics of endometriosis is proposed.

Conclusion: Ultrasound assessment has a proven diagnostic value in retrocervical endometriosis.

Almanac of Clinical Medicine. 2015;(37):93-99
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АBNORMAL UTERINE BLEEDING DURING МENOPAUSAL HORMONAL THERAPY

Zaydieva Y.Z.

Abstract

Postmenopausal women using continuous combined estrogen/progestin therapy are likely to have irregular bleedings or spotting. Up to now, their causes remain unclear. Most investigators believe that a potential mechanism of abnormal bleedings during menopausal hormonal therapy could be a change in the ratio of pro- and anti-angiogenic factors, namely, of vascular endothelial growth factor to thrombospondin-1; alterations in metalloproteinases and their tissue inhibitors; changes in a tissue factor that is a mediator of endometrial hemostasis; as well as an increased number of endometrial leukocytes with predominance of uterine natural killer cells. As long as no link between bleeding discharge during continuous combined hormonal treatment and any of these  actors has been established, each and every of them is the subject of in vivo and in vitro investigations. At present, there are no  herapeutic methods to correct this complication of hormonal treatment. Patient monitoring to exclude neoplastic abnormalities in endometrium are of paramount importance.

Almanac of Clinical Medicine. 2015;(37):100-104
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EFFICACY OF VACCINE PREVENTION OF HPV-ASSOCIATED DISEASES AND CERVICAL CANCER IN THE MOSCOW REGION

Krasnopol'skiy V.I., Logutova L.S., Zarochentseva N.V., Belaya Y.M., Tamazyan G.V., Gridchik A.L.

Abstract

Data on high prevalence of papilloma virus infection and associated disorders in adults as well as in adolescents are becoming more and more frequently published in the world and domestic literature. The most severe outcome of the infection is cervical cancer which takes the second place in women of reproductive age. At present, the armamentarium of obstetricians, gynecologists, pediatricians and oncologists is enriched by a recombinant vaccine protecting against human papilloma virus and representing one of effective methods of prevention of HPV-associated disorders. There are two prophylactic vaccines in the world (quadrivalent Gardasil® and bivalent Cervarix®), which are used in 44 countries. One of the first results proving efficacy of vaccination is a decrease of incidence of anogenital warts that is well described in foreign literature. In the Moscow region, as a result of vaccination performed from 2008 to 2013, a decrease of incidence of anogenital warts in girls is also observed.

Almanac of Clinical Medicine. 2015;(37):105-110
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FACTORS OF WOMEN’S HEALTH FROM THE PERSPECTIVE OF REPRODUCTIVE AGEING AND RISK OF CARDIOVASCULAR DISORDERS

Lopatina O.V., Balan V.E., Tkacheva O.N., Sharashkina N.V., Zhuravel' A.S.

Abstract

Prevalence of cardiovascular abnormalities in women of reproductive age is not high. However, it is during this period that the risk factors of cardiovascular disorders are being formed. They include obesity, arterial hypertension, dyslipidemia, insulin resistance, diabetes mellitus, etc. The review demonstrates the link between cardiovascular risk factors and obstetric and gynecological  isorders, starting from menarche and ending up with menopause. Degree of vascular ageing is considered to be one of indicators of age-related changes of cardiovascular system. There is an association between markers of ageing, such as length of telomers and telomerase activity, and estrogen deficiency.

Almanac of Clinical Medicine. 2015;(37):111-117
pages 111-117 views

THE EXPERIENCE OF THE USE OF SYNTHETIC PROSTHESES FOR TREATMENT OF SEVERE GENITAL PROLAPSE IN ELDERLY FEMALES

Mgeliashvili M.V., Buyanova S.N., Marchenko T.B., Rizhinashvili I.D.

Abstract

Background: Genital prolapse is one of the most difficult-to-solve problems of gynecology. Rates of relapse after surgical correction of this disorder amounts to 33–40%.

Aim: To analyze the use of alloplastic materials for correction of severe forms of ptosis and prolapse of internal genitals in the elderly.

Materials and methods: 228 females aged from 60 to 70 with genital prolapse grade III–IV (according to classification by Baden-Walker) were divided into 3 groups depending on the leading anatomical structure in the prolapse. In all patients, extraperitoneal colpopexy with a prolene mesh was performed, with additional perineal plastics, in 165 patients from Group 1 (mean age, 63 years) being an anterior plastics, in 47 patients from Group 2 (mean age, 65 years) – posterior, in 12 patients from Group 3 (mean age, 68 years) – total. Efficacy of surgery was assessed at 2 to 4 months according to degree of genital prolapse, absence of erosions of vaginal walls and absence of the alloplast shrinkage and/or displacement.

Results: Almost in 50% patients, a latent form of urine incontinence was diagnosed that required an urethropexy by a free synthetic loop through a transobturator approach. Frequency of intraoperational complications was low (n = 1). Among post-operation complications, 60% patients from Groups 1 and 3 had urination disorders that resolved by days 4–5 after surgery with anti-inflammatory treatment and with the use of agents increasing the detrusor tone. Frequency of vaginal wall erosions and of a partial prosthesis expulsion was 4.2% each in Groups 1 and 2. There were no vaginal wall erosions in Group 3. Clinically insignificant partial shrinkage of the prolene mesh was noted in 4.5, 4.2 and 5.9% of cases in Groups 1, 2 and 3, respectively. After the surgical correction, in 100% of patients from Groups 1 and 3 and in 70.6% of patients from Group 2 their genital prolapse was assessed as having grade I according to Baden-Walker, and in 29.4% of patients from Group 2, as grade II. However, there were many cases of prolapse progression of the contralateral vaginal wall: in 72 (44%) of patients in Group 1 and in 4 (23,5%) in Group 2, that in some cases (18,4%) necessitated the surgery to be repeated.

Conclusion: The use of prolene mesh for extraperitoneal strengthening of the pelvic fundus in the elderly is an effective way of treatment. With strict adherence to proper surgical technique it is associated with a minimal number of complications that are mainly easily eliminated.

Almanac of Clinical Medicine. 2015;(37):118-122
pages 118-122 views

IMMUNOLOGICAL ASPECTS OF ENDOMETRIAL DISEASE

Slobodyanyuk B.A., Popov A.A., Chanturia T.Z., Manannikova T.N., Machanskite O.V., Fedorov A.A., Budykina T.S.

Abstract

Background: Immunological processes involving peritoneal macrophages could play a critical role in pathophysiology of external genital endometriosis.

Aim: To assess levels of MCP-1, RANTES, and C-reactive protein and to identify their correlations with endometriosis.

Materials and methods: Seventy two patients were evaluated: 26 healthy controls and 46 with endometriosis. Patients were divided into groups as follows: 17 with superficial endometriosis, 18 with endometriomas and 11 with deep infiltrative endometriosis. All patients underwent a laparoscopy during the proliferative phase of the cycle; levels of peritoneal and serum MCP-1, RANTES and C-reactive protein were measured using standard ELISA assays.

Results: There were positive correlations between serum MCP-1 (p = 0.03) and C-reactive protein(p = 0.045) and severity of endometriosis, that could indicate malfunctioning of peritoneal macrophages in advanced stages of endometriosis. Conclusion: MCP-1 and C-reactive protein levels in peripheral blood can be used as markers of endometriosis activity.

Almanac of Clinical Medicine. 2015;(37):123-128
pages 123-128 views

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