No 5 (2011)

This study attempted to systematize and summarize the hypotheses concerning the pathophysiological mechanisms of development of neurological complications due to eclampsia, which had been advanced in the considered studies and clinical trials, on the basis of the data obtained during their performance. The recommendations proposed in these studies for the treatment and prevention of neurological complications of eclampsia were also collected and systematized. The material collected was analytically reviewed to reveal major problems to be further investigated and to raise the questions to which there were so far no clear answers objectively confirmed by clinical trials.

Data are given on the prevalence of sexual disorders in women with urogynecological diseases. Various studies of female sexual function are analyzed. General and special questionnaires, which are used to rate female sexual function with a high degree of validity and reliability, are considered. Investigations evaluating female sexual function in urogynecological diseases, (удалить) during medical and surgical treatments for different types of urinary incontinence and pelvic dysfunction are reviewed.

Objective. To study the rate of peripheral blood monocyte absorption of lipids from the autologous sera of healthy nonpregnant women, women with physiological pregnancy, and pregnant women with gestosis. Material and methods. Peripheral blood monocytes were cultured for 24 hours in the presence of autologous sera and stained with OIL RED O (ICN, USA) to detect intracellular lipids. The levels of intracellular lipids were estimated by a computer imaging system and the Morphology 4.0 program (Videotest, Russia). Results. The rate of peripheral blood monocyte lipid absorption from the sera of pregnant women with gestosis was signif icantly higher than that in healthy pregnant and non-pregnant women. The fact that the peripheral blood monocytes obtained from patients with gestosis give rise to foamy cells suggests their activation and possible role in the development of generalized endothelial dysfunction.

Development of Russia, Moscow Objective. To determine cervical secretion pro- and anti-inflammatory cytokines as indicators of local immunity in pregnant women with bacterial vaginosis (BV). Subjects and methods. The study enrolled 45 pregnant women seeking medical advice in early gestation. A study group included 32 pregnant women with the verified diagnosis of BV; a comparison group consisted of 13 pregnant women with normal vaginal microbiocenosis. The levels of pro- (TNF-а, IFN-y, IL-1a, IL-2, IL-6, and IL-8) and anti-inflammatory (IL-4 and IL-10) cytokines were measured in the cervical canal mucus. Results. Pretreatment local immunity in pregnant women with BV showed a significant increase in the levels of pro- and anti-inflammatory cytokines in reference to their production in pregnant women with normal vaginal microcenosis. After BV treatment, the content of cytokines approximated those in healthy pregnant women; however, the levels of TNF-а and IL-8 changed little, which would be accounted for by the low production of these cytokines since the leukocytic reaction is not marked in the vaginal epithelial locus in vaginosis. Conclusion. Qualitative and quantitative changes in the levels of cytokines reflect the activation of immunocompetent cells during any pathological process. The f indings suggest certain autonomy of immune reactions in the lower female genital tract.

Ministry of Health and Social Development of Russia, Moscow 2Research Institute of Physicochemical Medicine, Federal Biomedical Agency, Moscow Objective. To search for molecular genetic factors involved in the development of endocrine and metabolic disturbances in polycystic ovary syndrome (PCOS), which may contribute to the clarification of the pathogenetic mechanisms of development of the disease. Subjects and methods. A study group included 98 women with verified PCOS; a comparison group (without PCOS) comprised 62 patients with tuboperitoneal and male factors of infertility. The investigators employed molecular genetic studies, such as polymerase chain reaction, minisequencing, agarose gel electrophoresis, and mass spectrometry. SGTA, FST, IRS1, IRS2, PPARg, HSD17B5, HSD17B6, FTO, FEM1B, and FEM1A gene polymorphisms were analyzed. Results. The carriage of either the minor allele T of the IRS2 and IRS1 genes in the heterozygous state or the homozygous genotype TT involves a three- to ten-fold risk for PCOS. That of the minor allele T of the IRS2 gene determines a double risk for higher HOMA scores and a trend risk for glucose intolerance. The homozygous genotype CC of the IRS1 gene produces a protective effect against the risk for glucose intolerance in the presence of PCOS. The carriage of the homozygous genotype TT of the IRS1 gene is associated with a five-fold risk for increased HOMA scores. In minor allele A carriage, HSD17B6 gene polymorphism was ascertained to involve a three-fold risk for higher HOMA scores and the carriage of the homozygous genotype GG determined its protective effect against the same sign. HSD17B5 gene polymorphism was responsible for a two-fold risk for increased HOMA scores with minor allele A carriage. Investigation of the other (FST, FTO, FEM1A, FEM1B, PPARg, and SGTA) gene polymorphisms in question revealed no signif icant associations either in the PCOS group or the comparison one. Conclusion. The molecular genetic study has revealed associations of the gene polymorphisms with the risk for just PCOS and its metabolic symptoms.

Objective. To improve pre- and intraoperative echography to perform the optimal surgical volume in women with tuboperitoneal infertility. Subjects and methods. One hundred and thirty-two infertile women examined and endoscopically operated on using pre- and intraoperative echographic diagnostic techniques were followed up. A control group included 59 patients undergoing conventional small pelvic ultrasound studies pre- and postoperatively. General clinical, echographic, radiological, and endoscopic studies were used. Results. Comparing the capacities of transvaginal echography and laparoscopy indicated that the sensitivity and specificity in diagnosing a commissural process in the small pelvis were 91.2 and 92.6%, respectively; the prognostic value of a positive result (PVPR) was 81.6% and that of a negative result (PVNR) was 89.3%; diagnostic accuracy (DA) was 84.8%. Their sensitivity and specificity in diagnosing hydrosalpinx were 50 and 98.7% and PVPR and PVNR were 84.2 and 93.5%, respectively; DA was 92.8%. The sensitivity and specificity of laparoscopic chromohydrotubation were 100 and 49.2%; PVPR and PVNR were 18.4 and 100%, respectively; DA was 54.4%. DAfor a grade 1—2 and 3—4 commissural process was 72.7 and 88.9%, respectively; in its absence, it was 87.5%. In the comparison group, a recurrence was observed in 5.1% of the women with hydrosalpinx; no recurrences were seen in the study group. Pregnancy occurred in 20% of the women in the study and control groups and in 16.9% in the comparison group. Laparoscopic echography makes it possible to examine the uterine tubes all the way to the uterine angle, to evaluate their patency, to define the site of the fimbrial part, and to perform adequate surgical intervention. Conclusion. Intraoperative echography is a valuable technique that, in hydrosalpinx concurrent with a pronounced commissural process, estimates more clearly the volume of surgical intervention, assures its safety, and preserves the appendages in young women with unrealized reproductive function.

Objective. To compare the clinical, morphological, and virologic characteristics of severe epithelial lesions and microcarcinomas of the cervix uteri in pregnant and nonpregnant women, to study disease and pregnancy outcomes, and to assess prognosis. Subjects and methods. Thirty-six pregnant women with cervical intraepithelial neoplasias (CIN), including 7 patients with CIN II, 23 with CIN III/carcinoma in situ (CIS), and 6 with microinvasive carcinoma of the cervix uteri, and 248 nonpregnant women with the same diagnoses. The clinical course of the disease was comparatively analyzed on the basis of cytological, virologic, colposcopic, and histologic findings and the results of treatment and follow-up. Results. All the patients were found to have varying epithelial lesions concurrent with colposcopic changes; viral load was significantly higher in pregnant women. Progressive gravid ectopy favored the hyperdiagnosis of a presumptive grade of CIN. The results of postpartum histological examination agreed with those of pregnancy biopsy in 44.4%; the degree of lesions was less in 22.2% and higher in 33.4%. Thirty-three of the 36 women successfully carried pregnancy. The mean follow-up was 26 months. All the patients are alive and have no recurrence of CIN and cancer of the cervix uteri. The infants are developing normally. Conclusion. Full-term pregnancy does not worsen disease prognosis in CIN II-III, including CIS. Targeted biopsies under colposcopic guidance are safe and advisable to define the degree of a lesion, they are indicated for suspected cases of severe CIN and invasion and are, however, also acceptable in other cases. If microinvasion is found, treatment may be delayed until after cesarean section.

The paper presents the results of a multicenter trial of the efficiency of treatment for bacterial vaginal infections of nonspecific etiology, by using various therapy regimens in non-pregnant women of reproductive age. Their clinical and morphological efficiencies were evaluated according to the uniform protocol in 20 centers of the Russian Federation. The anti-infective efficiency of the broad-spectrum fluomycin (dequalinium chloride) was found to be similar to that of other most commonly used agents in treating nonspecific vulgovaginal infections. The drug containing lactobacteria and estriol (gynoflor E) was proved to be highly effective in restoring normal vaginal biocenosis after a course of anti-infective therapy.

Objective. To study real clinical practice for using antimicrobial agents to treat inflammatory diseases of small pelvic organs (IDSPO) in the Russian Federation and its conformity with Russian and foreign guidelines. Material and methods. The authors conducted a multicenter retrospective pharmacoepidemiological study that included data on women who had sought medical advice at the out- and inpatient obstetric or gynecological institutions of the Russian Federation in 2007 to 2009. The inclusion criteria were the established diagnosis of acute IDSPO, use of at least one dose of a systemic or local antimicrobial agent in the study period. Results. A total of 1174 primary medical records of patients with acute IDSPO were analyzed. Forty-five different antimicrobial agents from 17 groups were found to be used to treat acute IDSPO. The drugs most commonly prescribed to treat IDSPO were as follows: the physicians prescribed most frequently the following drugs: metronidazole (32.7%), gentamicin (13.1%), doxycycline (5.2%), cefazolin (5.1%), and ciprofloxacin (4.9%). In addition, the study has revealed that the percentage of prescriptions for original drugs and branded and nonbranded generics is 1.7, 33.9, and 64.4%, respectively. Conclusion. The currently most common antimicrobial agents used to treat IDSPO in the Russian Federation are metronidazole (32.7%), gentamicin (13.1%), and doxycycline (5.2%). In Russian real clinical practice, the antibiotic combinations recommended by Russian and foreign scientists are used sporadically (less than 1%).

Objective. To analyze the reproductive function of patients undergoing organ-saving surgery for intraepithelial and early invasive carcinoma of the cervix uteri (CCU), to assess whether reproductive function can be realized, and to determine management tactics in these women. Subjects and methods. Twelve infertile patients previously operated on for intraepithelial and invasive CCU were followed up. Knife amputation of the cervix uteri was performed in 5 patients with intraepithelial carcinoma. Radical abdominal trachelectomy (RAT) was used in 7 patients with early invasive CCU. Examination involved evaluation of the reproductive system in spouses and estimation of the ovarian reserve in women. Attempts were made in some patients to achieve pregnancy by IVF during a natural cycle or after superovulation. Results. Normal ovarian reserve values were recorded in 6 women aged 31 to 36 years. Three 38- and 40-year-old patients had decreased ovarian reserve values. In 3 women aged 38, 39, and 40 years, the ovarian reserve values were estimated to be extremely low. An IVF program was implemented in 6 promising patients. In one of them, an oocyte was taken in a natural cycle, pregnancy occurred after the second attempt. Five women were superovulated according to a gonadotropin-releasing hormone antagonist-based protocol. Uterine pregnancy occurred in 4 women, which ended in delivery in 1 woman after high knife amputation of the cervix uteri. In 3 other women (2 patients after RAT and 1 after knife amputation of the cervix uteri), their pregnancies were interrupted at 18, 20, and 24 weeks. Conclusion. Half of the women who have asked to be treated for infertility after organ-saving treatment for CCU are unpromising for IVF pregnancy. Successful realization of reproductive function calls for a close collaboration of oncogynecologists and reproductologists who jointly determine a management tactic in each specific case.

Objective. To evaluate the efficiency of combination therapy for chronic genital herpes infection, by incorporating the immunomodulatory and anti-inflammatory drug galavit in order to stimulate the components of the immune system in patients. Subjects and methods. The study enrolled 30 women aged 19 to 53 years, who had manifestations of chronic recurrent genital herpes. Random sampling was used to form 2 groups: 1) 20 patients receiving basic therapy with valcyclovir (valtrex), 500 mg b.i.d., in combination with 5 daily intramuscular injections of 100 mg of galavit, then 15 more injections of 100 mg of this drug on alternate days (a study group); 2) 10 patients receiving only basic therapy with valcyclovir (a control group). Objective studies involving major symptom rating scales and laboratory tests were used before and 3 and 6 days after therapy. Long-term results of treatment were studied. Results. The study (galavit) group showed a significant increase in the count of CD4+ lymphocytes and NK cells to normal values, a rise in the levels of IFN-а and IFN-y, and restoration of the levels and functional activity of the cells (T helper and NK cells) involved in the suppression of virus replication, as reflected in longer remission. Conclusion. The immunomodulatory and anti-inflammatory drug galavit exerts a stabilizing effect on humoral and cellular immunity, resulting in a reduction in the recurrence rate of chronic genital herpesvirus infection in the late period.

The paper considers the prevention of infectious and inflammatory complications while removing an intrauterine device. The preventive antimicrobial therapy regimen using safocid and hexicon is shown to be highly clinical effective and may be used in practice.

The review of world literature has shown that there are currently unavailable scientifically founded data suggesting that it is necessary to discontinue the use of combined oral contraceptives (COC) every several years. On the contrary, the present-day specialists’ viewpoint that it is possible and necessary to use COC without interruption so long as there is a need for contraception is quite valid.