No 2 (2008)

Objective: to determine the clinical and diagnostic value of sVCAM1 in the development of endotheliosis in gestosis. Setting: Department of Obstetrics and Gynecology, Faculty for Postgraduate Education of Physicians, I. M. Sechenov Moscow Medical Academy; V. P. Serbsky State Research Center of Social Forensic Psychiatry, Moscow Design: a prospective study. Subjects: 68 pregnant women, including 24, 25, and 19 patients with mild, moderate, and severe gestosis, respectively, as well as 25 apparently healthy pregnant women (a comparison group). Methods: clinical and statistical studies, enzyme immunoassay. Results: blood sVCAM1 is detectable in subthreshold concentrations in patients with physiological pregnancy. When gestosis develops, the expression of cell adhesion molecules begins to increase at gestational week 22. There is a direct correlation between the level of sVCAM1 in varying gestosis with its clinical manifestations (the degree of proteinuria, edema, and blood pressure). There is a direct relationship between the degree of endotheliosis, the severity of gestosis, and the concentration of sVCAM1. Conclusion: sVCAM1 may be used to diagnose and predict gestosis.

Objective: to study changes in the expression of the Toll-like receptor (TLR)2 and TLR4 genes by cervical canal mucosal epitheliocyles and placental cells in pregnant women with urogenital infection. Setting: Russian State Medical University, Moscow. Subjects: 105 pregnant women (late second-to-early third trimester of pregnancy), including 30 women with physiological pregnancy, 45 pregnant women with urogenital infection, and 30 pregnant women with intrauterine infection (a control group). Methods: RNA was isolated from the cervical canal trophoblastic and mucosal cells by the acid-phenoi extraction technique. The real-time polymerase chain reaction was used to determine the level of expression of the TLR2 and TLR4 genes. Results: in the pregnant women with urogenital infection (caused by cytomegalovirus, herpes simplex virus, Ureaplasma, Chlamydia, Gardnella, or Candida), the expression of TLR2 and TLR4 was observed to be 5 and 2 times greater, respectively, than that in the control group. With intrauterine infection, the expression of the TLR4 gene significantly increased by 7 times. Hyperactivation of congenital immunity mechanisms led to premature tabor in more than 70%. Conclusion: TRL-mediated trophoblastic apoptosis is a new pathogenetic mechanism that is responsible for the impact of infection on the development of pregnancy complications. Polymorphism of the TLR genes determines the body 's response to the causative agents of virai and bacteria! infections and the possibility of realizing an intrauterine infection in the fetus and the newborn and plays an important role in the prediction of pregnancy outcomes. TLR may serve as markers of pregnancy complications and as a potential target of therapeutic interventions.

Objective: to estimate the incidence of viral and bacterial infection in pregnant women with Hodgkin's lymphoma (HL) and the specific features of their immunity depending on the duration of remission or the activity of the disease. Setting: Research Center of Obstetrics, Gynecology, and Perinatology, Russian Agency for Medical Technologies, Moscow. Design: a prospective study. Subjects: 40 pregnant women with HL were examined in 2003 to 2006. According to the activity of the disease and the duration of remission, ail the females were divided into 2 groups: 1) 20 women in the active phase of the disease or with less than 5-year remission before the occurrence of pregnancy; 2) 20 women with more than 5-year remission. The data on immune and interferon states in Groups 1 and 2 women were compared with those in women with physiological pregnancy (a control group), which had been obtained at the Laboratory of Immunology, Research Center of Obstetrics, Gynecology, and Perinatology. Methods: immunological, molecular biological (PCR diagnosis) and serological studies, as well as statistical data processing by a package of applied programs (Excel, version 7.0). Results: pregnancy was normal in 6 (30%) Group і patients and 14 (70%) Group 2 patients with HL. Among the complications of pregnancy, virai and bacterial infections were most common in 12 (60%) females in Group 1 and in 4 (20%) in Group 2. Immunological study revealed a significant reduction in the absolute and relative count of lymphocytes: CD3 + and CD4 + phenotypes and a statistically significant increase in CD8 + (T killer cells) and CD16 +CG56 + (natural killer cells) in Group 1 pregnant women as compared with Group 2 and control group women. There was a statistically significant increase in the circulation of serum interferon (1FN) (6.5 U/ml) in Group 2 as compared with that in Group 1, which was equal to the norma! value (2 U/ml). In both Group I and Group 2, this was associated with a statistically significant reduction in IRL on α-IFN and γ-IFN inductors, as compared with the controls. The physical development and the incidence of congenital and acquired diseases in the babies bom to females who had sustained HL did not differ from those in the general population. Conclusion: the high incidence of viral and bacterial infections in pregnant women with an active stage of HL or a short (less than 5 year) remission was due to the signs of immunodeficiency as a result of both the disease itself and the use of polychemotherapy in radiotherapy. Therefore, the less than 5-year interval after chemotherapy, which is required to recover the activity of functional systems, should be regarded as the optimum time of pregnancy occurrence.

Objective: to study the efficiency of treatment for background and precancer diseases of the cervix uteri and endometrial hyperplastic processes (EHP) by photodynamic therapy (PDT). Setting: Department of Obstetrics and Gynecology, Faculty of Therapeutics, , Russian State Medical University, Russian Agency for Health Care, Moscow. Design: a prospective study. Subjects: 102 patients with background and precancer diseases of the cervix uteri and 24 patients with EHP. Methods: PDT was performed in 72 patients with abnormalities of the cervix uteri; a control group comprised 30 patients with background and precancer diseases of the cervix uteri treated by diathermic surgery. Photodynamic endothelial destruction was carried out in 24 patients with EHP. Results: the efficiency of PDT in the treatment of background and precancer diseases of the cervix uteri was 88.9%. There was a significantly low incidence of adverse reactions and complications as compared with the controls. The efficiency of photodynamic endothelial destruction was 83.3%. Conclusion: PDT is a highly effective treatment for background and precancer diseases of the cervix uteri, preferable in nulliparas of reproductive age. It is an effective, sparing EHP treatment requiring no anesthesia, which is of particular importance in patients with extragenital pathology that is a contraindication to hormonal or surgical treatment.

Objective: to reveal the dominant genotypes of high cancer risk human papillomaviruses (HCR-HPV) and to determine their association with epithelial dysplasias and cancer in situ of the cervix uteri in the Republic of Belarus. Setting: Gomel State Medical University. Design: a prospective study. Subjects: 97 patients aged 18 to 55 years who had abnormalities of the cervix uteri: stratified squamatous epithelial koilocytosis, first-to-third-degree epithelial dysplasias (CIN I-III), cancer in situ (Ca in situ), and microinvasive carcinoma (FIGO Ia1 stage). Methods: simple and extended colposcopy, morphological study, polymerase chain reaction. Results: 86 (88.6%) out of the 97 patients, were found to have HCR-HPV DNA and 11 (11.4%) were HCR-HPV negative. In 31 (40.8%) cases, epithelial dysplasias and cancer in situ of the cervix uteri were associated with both HPV type 16 as monoinfection and other HCR-HPV types. HPV-33 and HPV-31 rank second and third in occurrence, amounting to 22.4 and 14.5%, respectively. HPV-18 that fills the second place in occurrence in precancer and cancer of the cen'ix uteri in many countries has ranked eighth in our study and accounted for 6.6%. Conclusion: differences have been established in the prevalence of HPV genotypes in the development of epithelial dysplasias and cancer of the cervix uteri in the Republic of Belarus us compared with North America and Western European countries. This information gives grounds to continue studies in this area, so that during population-based studies investigators can obtain reliable values of dominant HPV genotypes in the development of epithelial dysplasias and cancer of the cervix uteri and develop an optimally adapted virus panel for the designing a prophylactic vaccine that will satisfy the specific features of the epidemiology of genital HPV infection in the Republic of Belarus.

Objective: to study the impact of uni- and bilateral interventions into the ovaries in infertile patients with polycystic ovary syndrome (PCOS) in order to achieve natural fertility and in the in-vitro fertilization (IVF) programs. Setting: Moscow Regional Research Institute of Obstetrics and Gynecology; Central Hospital, Medical Center of the Special Construction Committee of Russia. Design: a prospective comparative study. Subjects: 109 patients with infertility caused by PCOS. Methods: clinical and laboratory studies. Results: in patients with PCOS, an operation on one ovary yields the results comparable with bilateral intervention in criteria for ovulation recovery and spontaneous pregnancy achievement. The use of an IVF procedure showed worse treatment results in PCOS patients who had undergone bilateral ovarian surgery than in those who had been operated on one ovary. Conclusion: It has been established that it is expedient to use unilateral ovarian interventions in the surgical treatment in PCOS patients, the main aim of which is to eliminate infertility.

Objective: to enhance the efficiency of surgical treatment in patients with concomitant gynecological diseases accompanied by internal genital prolapse, by applying a combined (laparovaginai) access. Setting: Obstetrics and Gynecology Department One, Faculty of Therapeutics, I. M. Sechenov Moscow Medical Academy. Design: a prospective study. Subjects: 47 patients aged 39 to 64 years who had concomitant gynecological diseases accompanied by internal genital prolapse Methods: clinical, laboratory, ultrasound, endoscopic studies, X-ray study using a metallic marker, combined 2-3-stage (laparovaginai) surgical intervention with laparoscopic supravaginal hysterectomy (Stage 1), followed by extraperitoneal ligature cervicosuspension to aponeurosis via laparoscopic access (Stage 2) and colpoperineorrhaphy (Stage 3). Results: laparoscopic supravaginal hysterectomy was carried out at surgery stage 1; if there were indications, the surgeons removed uterine appendages or tubes (46.8%), resected ovaries (38.2%), dissected small pelvic adhesions (12.7%), and coagulated the foci of external genital endometriosis (12.7%). At Stage 2 of surgical treatment, laparoscopic extraperitoneal ligature cervicosuspension to aponeurosis was made in all the patients. At stage 3 of surgery, colpoperineorrhaphy with levatoroplasty was performed in most (57.4%) patients, 40.4% of the patients underwent anterior colporrhaphy and colpoperineorrhaphy with levatoroplasty, and one postmenopausal patient had midline colporrhaphy with perineorrhaphy. The total duration of surgical treatment averaged 123.5±25 min. Total intraoperative blood loss was 50 to 300 ml (mean 188.2±1.5 ml). There were no postoperative complications. Median postoperative inpatient stay was 7±2 bed/days. Conclusion: combined 2- or З-stage surgery via laparovaginai access in patients with internal genital prolapse concurrent with benign diseases of the corpus uteri and appendages, performed within one operation is a highly effective therapeutic measure with partial preservation of the organ (cervix uteri) in which stage 2 insignificantly prolongs the total time of surgery and causes no increase in blood loss. Extraperitoneal ligature cervicosuspension to anoneurosis via laparoscopic access ensures a reliable correction of genital prolapse and a reduction in intra- and postoperative complications, promotes the cervical stump position close to the physiological one and the recovery of normal anatomic relations of small pelvic organs. The satisfaction of the results of surgical treatment, the improvement of life quality, and the absence of relapses of internal genital prolapses during a long-term follow-up have allowed the proposed procedure for surgical treatment to be regarded as highly effective.