No 2 (2012)

The paper gives the current views of the pathogenesis of endometriosis, the mechanisms responsible for the development of infertility in this disease, and therapeutic approaches with regard to the necessity of fertility recovery. It shows that it is expedient to make the stepwise management of patients with genital endometriosis, which comprises suppressive therapy with gonadotropin-releasing hormone agonists with further pregravid preparation with progestagens.

Objective. To study the parameters of peripheral blood, the outcomes of pregnancy and labor in gestosis and anemia. Subjects and methods. Thirty-five pregnant women with gestosis and anemia and 20 women with physiological pregnancy were examined. The specific features of the course of pregnancy and labor and the parameters of peripheral blood were analyzed. Results. In pregnant women with gestosis and anemia, the course of a gestational process was found to be accompanied by the high frequency of maternal and fetal complications. In gestosis, anemia is normochromic, normocytic, with a tendency for hyperchromic macrocytosis with the impaired structural and metabolic status of red blood cells, erythropoiesis, and iron metabolism, and it is characterized by relative thrombocyto- and leukopenia, an altered leukogram, endogenous intoxication signs, and lower integral peripheral blood indices. Conclusion. In gestosis, anemia refers to that in chronic diseases and must not be treated with iron preparations.

Objective. To determine a correlation between the expression of sperm protamine type 1 and 2 (PRM-1 and PRM-2), fertiline-β (ADAM-2) mRNA, and the outcomes of treatment for infertility in the use of assisted reproductive technologies (ART). Material and methods. Quantitative reverse-transcription polymerase chain reaction was used to study the PRM-1, PRM-2, and ADAM-2 gene mRNA profile in 79 married couples with different results of in vitro fertilization and embryo transfer ((IVF-ET) treatment for infertility. Of them, 13 couples had a successful outcome of the IVF and ET program; 66 couples had an unsuccessful outcome (10 couples with spontaneous miscarriage before 11 weeks gestation, 19 couples with biochemical pregnancy, and 37 couples with failed IVF-ET). The clinical pregnancy rate with reference to ET was 29.1% (23/79). Results. The expression of ADAM-2 mRNA was shown to be significantly decreased in the biochemical pregnancy and failed IVF groups as compared to the control one. In addition, that of PRM-1 and PRM-2 was less in the biochemical pregnancy group as compared to the control group. Conclusion. To study a role of sperm mRNA in the prediction of the outcome of ART programs is promising for the investigation of a parental contribution to embryo development. The poor prognosis of ART programs is associated with the decreased expression of the ADAM-2, PRM-1, and PRM-2 mRNA genes.

Objective. To ascertain the specific features of spontaneous expression of peritoneal macrophage scavenger receptors in women with external genital endometriosis and to define the nature of the effect of autologous endometrial cells on the expression of macrophage scavenger receptors in patients with endometriosis. Material and methods. Peritoneal fluid and uterine endometrial biopsy specimens were studied in 32 women with external genital endometriosis, 10 women with tuboperitoneal infertility (a comparison group) and 9 healthy fertile women admitted for elective surgical sterilization (a control group). The spontaneous and endometrial cell-stimulated expression of scavenger receptors (CD204 and CD36) was estimated by a flow cytometric technique. Results. The women with external genital endometriosis were found to have a lower CD204 and CD36 expression by peritoneal macrophages regardless of the extent of a pathological process. Unlike the control and comparison group women, the patients with endometriosis had not increased expression of scavenger receptors in response to the autologous endometrial cell-induced stimulation of macrophages. Conclusion. The depressed expression of scavenger receptors onto the surface of peritoneal macrophages is an important factor determining an impaired local immune response in the perinatal cavity on ectopic endometrial cells.

Objective. To give a comparative analysis of the efficiency of using native breast milk as the only nutritional substrate, multinutrient fortifier Friso-reinforced breast milk, and a specialized formula in the feeding of premature babies. Subjects and methods. Fifty-two premature neonates born at 26-to-32 weeks gestation and weighing less than 1500 g were examined. The exclusion criteria were severe congenital malformations, brain structural damages, sepsis, acute renal failure, and hemolytic disease of the newborn needing blood substitute transfusion. According to the type of a major enteral substrate, the premature neonates were divided into three groups: 1) 11 babies receiving native breast milk (NBM); 2) 23 babies taking native breast milk reinforced with the multinutrient fortifier Friso (Friesland, Foods, the Netherlands) (RNBM); 3) 18 infants having a specialized cow’s milk-based formula (SF) for the premature newborn. The results of clinical and laboratory studies were assessed from birth to 38th weeks of postconceptual age or to the baby’s hospital discharge if the latter occurred earlier. Results. The daily weight gain averaged 16.13 g/kg/day in the RNBM group versus 14.2 and 13.8 g/kg/day in the NBM and SF groups, respectively. At the 37th week of postconceptual age, the fat mass increase was maximally approximated to the fetal one in the RNBM group as compared to the SF and NBM groups (348 g versus 220 and 256 g, respectively). Conclusion. Comparison of the rate of weight and fat mass gains leads to the conclusion that breast milk reinforced with the multinutrient fortifier Friso is the best choice for feeding extremely and very low birth weight babies.

Objective. To evaluate the impact of acute respiratory infection (ARI) experienced in the second trimester of pregnancy during the 2009 A(H1N1) influenza pandemic on obstetric and perinatal outcomes. Material and methods. One hundred and thirty-five labor histories in the women who had experienced ARI in the second trimester (at 13-14-to-27-28 weeks gestation) during the 2009 A(H1N1) influenza pandemic and given birth to babies in the Territorial Perinatal Center, Chita, and their newborn infants’ histories were retrospectively analyzed. Results. The risk factors of ARI in the second trimester of pregnancy were smoking (37.7%), kidney diseases (36.2%), chronic herpesvirus and cytomegalovirus infection without exacerbations (34.8%), cardiovascular diseases (28.8%), chronic obstructive pulmonary diseases (7.4%), and alimentary-constitutional obesity (8.8%). The major pregnancy complication after prior ARI was subcompensated placental insufficiency (49.6%) that formed the basis for the development of complications, such as threatening miscarriage (14%), fetal hypoxia (49.6%), and gestosis (35.5%). The infants born to the women having a history of ARI were significantly more frequently to have impaired adaption in the early neonatal period (57%) with evolving grades I and II cerebral ischemia (46.6 and 13.3%), and neonatal hyperbilirubinemia (21.5%). Among the neonates, there were 7 (5.1%) babies with congenital malformations, of them there were 2 fatal cases (one had lobar holoprosencephalopathy, external and internal hydrocephalus; the other had multiple malformations of the cardiovascular, urinary, and osteoarticular systems) (1.48%) and 5 cases of other anomalies (ventricular septal defect (1.48%), polydactyly (1.48%), and vascular plexus cyst (0.74%). Conclusion. ARI experienced in the second trimester of pregnancy results in the complicated course of both pregnancy and early neonatality.

Objective. To evaluate the therapeutic efficacy of a combined monophasic contraceptive containing 20 μg ethinylestradiol and 3 mg drospirenone in adolescent and reproductive-age patients with premenstrual syndrome during 12 cycles. Subjects and methods. A non-randomized multicenter open-label clinical trial was conducted under active control. One hundred and twenty-six patients aged 15—45 years (mean age 29.5±6.12 years) receiving a continuous-use drug for 12 months for contraceptive and therapeutic purposes. The findings were processed by descriptive statistics methods. Results. The long-term effect of drospirenone well documented the amelioration of symptoms observing at a standard oral contraceptive-free interval. The results of treatment showed that this agent alleviated the signs of metabolic, endocrine, and autonomic vascular disorders and effectively reduced psychoemotional manifestations. The highest therapeutic efficacy of the continuous-use contraceptive was observed following 12-month therapy for all clinical forms. Its positive contraceptive, cosmetic effects and stable weight maintenance were also noted. Conclusion. The agent may be successfully used to optimize the treatment of premenstrual syndrome.

Objective. To study the clinical efficacy of a combined drug containing dexpanthenol (D-panthenol), 0.1 g; chlorhexidine bigluconate (chlorhexidine), 0.016 g; a polyethylene oxide base (macrogol 1500, macrogol 400), the amount sufficient to prepare a 3.0-g suppository, after destructive therapies in the rehabilitation stage for uterine cervical pathology associated with papillomavirus infection. Subjects and methods. All the patients (n=95) underwent microscopic and bacteriological tests of the contents of the vagina and cervix uteri before and after treatment, expanded colposcopy, a cytological study of ecto- and endocervical smears, a histological study of biopsy specimens from the cervix uteri; secretory immunoglobulin A (sIgA) levels, interferon status, and proinflammatory cytokines were determined. Sixty patients with grade 1 cervical intraepithelial neoplasia were treated with spray argon plasma ablation of the cervix uteri (APACU) by a FOTEK EA140 apparatus, 60-80 watt, without electrode-tissue contact. After APACU, the cervix uteri was once treated with an aqueous chlorhexidine solution in all the patients. Further, the latter were randomized into 2 groups. Group 1 included 30 patients who used for 10 days a vaginal depanthol suppository twice/day on day 7 after destruction. Group 2 comprised 30 patients who did not use depanthol. A control group consisted of 20 patients with the visually unaltered cervix uteri and without virus infection as evidenced by polymerase chain reaction. The efficiency of using depanthol after destructive treatments for pathology of the cervix uteri was evaluated by the following criteria: the time of termination of epithelization and its adequacy; a change in local immunity parameters; a bacterioscopic study of the contents of the vagina and cervical canal; recurrence rates. Results. After destruction of the cervix uteri, there were significantly reduced sIgA and interferon status parameters, which could be indicative of an immune deficiency state. After depanthol therapy, the parameters of nonspecific resistance and interferon status were significantly increased as compared to those obtained in Group 2, which contributed to the acceleration of reparative processes and the values of proinflammatory cytokines were considerably decreased, which was suggestive of the anti-inflammatory effect of one of the depanthol components — chlorhexidine and the normalization of vaginal microbiocenosis. Conclusion. The use of the combined drug depanthol in the rehabilitation stage after APACU was ascertained to normalize local immunity parameters, to assist in significantly reducing the time of epithelization and decreasing the number of recurrencies.

This paper describes a case of successful medical treatment in a menopausal patient with paraurethral cysts. After her complete clinical and laboratory examination, the woman received adequate hormone replacement therapy and antibacterial therapy, then angioprotective, local proteolytic, and probiotic therapy.

Objective. To study of the effect of micronized progesterone on the clinical manifestations of mastopathy, the biometric characteristics of the parenchyma, and the rate of breast circulation. Subjects and methods. Micronized progesterone as skin applications was used to treat mastopathy in 42 patients. For the objective characterization of the intensity of pain syndrome, the authors employed the incidence of mastopathy, its mean duration, the nature of pain (distending, aching pain, a sensation of heaviness, exercise-induced pain syndrome; the intensity of mastalgia according to the visual analog scale: mild with a 1-to-3-cm section; moderate, from 4 to 7 cm; severe, from 7 cm or more). Follow-up monitoring of the clin ical picture of the disease, Doppler ultrasound parameters of resistance to blood flow in the breast parenchymal arteries was made before and 3 and 6 months after the initiation of therapy. Results. With the use of micronized progesterone, the rate of mastalgia decreased 2.5- and 3-fold (from 100 to 36% and from 36 to 12%) following 3 and 6 months, respectively. After 6 months of therapy, the thickness of the glandular layer was reduced to 10.78±0.47 mm, which was 1.3 mm time less than that after 3-month therapy (p<0.05). Following 3-month therapy, there were increases in the pulsatility index (PI) by 1.8 times (from 0. 80 to 1. 44%; p<0.001) and resistivity index (RI) by 1.6 times (from 0.46 to 0.76; p<0.001). Following 6 months, there were significant 2-fold increases in PI (from 0.80 to 1.64; p<0.001) and RI (from 0.46 to 0.90; p<0.001), and a 1.5-fold rise in the systolic/diastolic ratio (from 2.89 to 4.39; p<0.05). Conclusion. The use of micronizedprogesterone in patients with mastopathy causes reductions in the duration, intensity, and nature of mastalgia, a change in biometric (decreases in the thickness of the parenchyma, the number of cysts, and the diameter of lactiferous ducts) and functional (hemodynamic) characteristics of the breast.

The paper analyzes the data available in the literature on the causes of fetal maceration. It details the macroscopic and microscopic characteristics depending on the time of intrauterine fetal death. Possible morphological diagnostic errors are shown.