No 5 (2012)

This review analyzes the topical data available in the literature on the little studied high-risk oncogenic types (Asian) of human papillomavirus (HPV) and the controversial issues of the hazard of persistence of HPV, depending on its type and persistence duration and female age, as the most important factor for progression of precancer and cancer of the cervix uteri. It also gives the data of epidemiological studies of the prevalence of different types of HPV in the Asian and European Regions and their relationship to the development of cervical intraepithelial neoplasia of the cervix uteri. The role of molecular phylogeography is f irst considered in defining an association of different types of HPV with cancer of the cervix uteri. There is also an update of the role of molecular genetic methods for their diagnosis as potential screening tests to predict the course of HPV infection, in its persistence in particular.

Subjects and methods. Pregnant women at risk for preeclampsia who underwent cordocentesis at 22—24 weeks gestation for certain reasons, as well as their fetuses were prospectively examined. A study group comprised 82 patients who were divided into 2 subgroups: 1) pregnant women who were found to have abnormal uteroplacental and/or fetoplacental blood flow (AUPFPBF) at 22—28 weeks’ gestation (n=42); 2) those without signs of hemodynamic disorders in the maternal-placental-fetal system (n=40). Solid-phase enzyme immunoassay (ELISA) was used to examine sera from the pregnant women and their fetuses to determine antibodies against NSE and GFAP. Results. The probability of preeclampsia in pregnant women with AUPFPBF at 22—28 weeks’ gestation was 47.6% and the risk of this pregnancy complication was as great as 96.4% at 22—24 weeks if the levels of neuroantibodies signif icantly increased. The concentrations of neuroantibodies at 22—24 weeks’ gestation were signif icantly higher in the patients whose pregnancy was accompanied by symptoms of preeclampsia, particularly in the presence of AUPFPBF. The significant fetal serum concentrations of neuroantibodies were also detectable only if the mother developed preeclampsia. The maximum serum neuroantibody levels were found in both pregnant women and their fetuses in the cases of early clinical symptoms of preeclampsia, its severe forms attended by placental insufficiency, intrauterine growth retardation, AUPFPBF, placental detachment. Conclusion. The elevated concentrations of antibodies against neurospecific proteins in both the maternal and fetal sera are of high prognostic value for further progression of preeclampsia.

Objective. To estimate the significance of allelic variants of SERPINE1 (PAI-1) gene polymorphism in chorionic detachment and placental abruption in early pregnancy. Subjects and methods. A study group consisted of 67 women with recurrent miscarriage in early pregnancy. A control group included 53 healthy primigravidas. SERPINE1: 5G>4G gene polymorphism was determined using the method of adjacent probes with commercial test systems (OOO «NPO DNK-Tekhnologiya», Russia). Ultrasound study was made employing a 512-channel digital scanner (Siemens SonoLine Elegra, Germany). Results. The average detection time for retrochorial and retroamniotic hematomas was 8.3±0.4 and 12.1±0.5 weeks, respectively. Premature detachment of the chorion and placenta was shown to be associated with the number of 4G alleles of the SERPINE1 (PAI-1) gene in the genotype of a patient. In the 4G/4G genotype, the detachments are 1.5 times more common than those in the 5G/4G genotype. The use of selective antifibrinolytics in combination with antiaggregants and/or low-molecular-weight heparins improves pregnancy outcomes. Conclusion. The 4G allele of the SERPINE1 (PAI-1) gene polymorphism is associated with the development of chorionic and placental detachments in early pregnancy. Moreover, in the 4G/4G genotype, the detachments are 1.5 times more frequently encountered than those in the 5G/4G genotype.

Objective. To assess the role of genetic factors in osteoporosis and related fractures in postmenopausal women. Subjects and methods. A clinical genetic examination was performed in 413 women. Of them there were 375 persons who formed a control group of elderly healthy women without signs of osteoporosis and 38 osteoporotic women of the same age who had a menopausal length of more than 5 years. Seven polymorphisms in the promotor regions of the interleukin (IL) genes were investigated: TNF-α at positions С-863А, G-308A, G-238A, IL1ß T-31C, IL6 G-174C, IL10 C-592A, and VEGFA С-2578А. The polymorphisms examined were analyzed using the restriction assay of amplification products (restriction fragment length polymorphism analysis). Results. The distribution pattern of combinations of the genotypes of IL-1, IL-6, and IL-10, TNF-α at three positions and VEGFA among the elderly menopausal women with developed osteoporosis shows a number of significant distinctions from that in those with normal bone mineral density. The algorithm developed to calculate the mixed genetic signs including the combinations of all 7 study polymorphisms could reveal a number of highly significant associations with the development of osteoporosis. Conclusion. The high values of odds ratios and specificity of the obtained indicators are associated with the detection of a large number of genetic combinations among the women with postmenopausal osteoporosis, which are practically absent in the comparable group of menopausal women with normal bone mineral density.

Objective. To study the efficiency of optoelectronic scanning of the cervix uteri in female patients with morphologically verified cervical intraepithelial neoplasias (CIN I—III). Subjects and methods. The study included 56 patients aged 19 to 48 years who were diagnosed as having uterine cervical pathology. The preliminary comprehensive examination of the cervix uteri involved colposcopy, cytology of ecto- and endocervical smears, and HPV test using polymerase chain reaction techniques for viral typing by hybrid capture in order to estimate a viral load and to make a histological examination of biopsy specimens. Optoelectronic scanning was carried out after varying uterine cervical dysplastic processes were histologically verified. The examination was carried out, by slightly touching the cervix uteri surface with a probe under the control of light indicators. 15 to 25 points (mean 21 points) were scanned according to the area of involvement. The session took 3—4 min. Results were given to a paper carrier in two variants: 1) abnormal (pathological changes were detected in uterine cervical tissue, CIN was present) and 2) normal (CIN was absent). Cytological and histological diagnoses and optoelectronic scanning findings were tabulated. Results. The optoelectronic technology demonstrated the sensitivity comparable with that of cytological (LSIL, 65.3%; HSIL, 86.7%), histological (CIN I, 64.7%; CIN II, 78.9%; CIN III, 88.9%), and colposcopic methods in diagnosing both cervical intraepitalial lesions as a whole and high-severity ones. Conclusion. The study using the TruScreen optoelectronic technique demonstrated its high sensitivity in the diagnosis of cervical intraepitalial lesions, mainly high-severity ones. The use of the TruScreen in addition to cytological examination allows the sensitivity of cervical screening to be increased.

Objective. To generalize the experience with the dry remaining umbilical stub management procedure recommended by the WHO and to analyze the efficiency of the prevention, diagnosis, and treatment of neonatal omphalitis. Material and methods. A population study — a retrospective analysis of 2527 case histories of the neonatal infants treated in the newborn and premature infant pathology unit (NPIPU) of a third-level obstetrical facility in the Central Federal District of the Russian Federation in 2006—2010 — was made. A total of 1833 case histories of patients with infectious and inflammatory diseases (sepsis, congenital and acquired pneumonia, omphalitis, rhinitis, conjunctivitis, vesiculosis, and enterocolitis) were selected using the elaborated audit model for the above neonatal diseases. The trend of infectious and inflammatory diseases, including omphalitis, in the structure of morbidity in the NPIPU patients and the frequency of antibacterial therapy were investigated. Results. The umbilical cord was clamped a minute after birth; a Kocher clamp was applied to the umbilical cord at a distance of 10 cm from the umbilical ring; another Kocher clamp was placed on the umbilical cord as close to the parturient’s external genitals as possible; the third clamp was put 2 cm outside from the first one; the umbilical portion between the f irst and third Kocher clamps was wiped with a 95% ethyl alcohol-soaked gauze ball and cut across with a sterile scissors. For secondary treatment of the umbilical cord, the investigators used a disposal plastic clamp that was applied to the remaining umbilical stub; the optimal distance from the belly skin to the clamp being 2—3 cm. Application of the clamp too close to the skin might cause skin roughness of the umbilical ring. After clamping, the remaining umbilical cord was cut off above the clamp, rubbed off blood, and treated with 95% alcohol. A plastic clamp was applied to the remaining umbilical stub after putting the baby to the breast for the first time. For declamping, the authors used special forceps that failed to injure the remaining umbilical stub and enabled, if required, vein catheterization. Thereafter the umbilical stump is subject to natural mummification and spontaneous detachment within 2 weeks. Final epithelization of an umbilical wound occurs within 3—4 weeks after birth. Daily examination of the umbilical stump reveals the steps of natural umbilical separation: the remaining umbilical stump dries, shrivels, becomes thicker and dark brown, and falls off. After the umbilical cord falls off, the bottom of the belly button is epithelized. If there is purulent discharge, the umbilical wound should be treated with 3% hydrogen peroxide and then 5% potassium permanganate or aqueous solutions of aniline dyes (1—2% aqueous brilliant green or 10% aqueous methylene blue) and thereafter covered with a 5—10% hypertonic saline dressing. Antiseptic ointments (levosin, levomicol, 5% syntomycin emulsion, bactroban, bepanthene plus) may be used during topical treatment. Phlegmonous omphalitis requires surgery, antibacterial therapy, and intravenous immunoglobulins A, M, and G (pentaglobin). The necrotic form needs surgical intervention (the necrotic tissues are excised to the border of the intact skin), massive antibiotic therapy, disintoxication therapy, and intravenous globulins. Conclusion. The proposed algorithm for the diagnosis and treatment of omphalitis has been introduced since 2009. The analysis of the pattern of infectious and inflammatory diseases notified in 2006—2011 has established a reduction in the proportion of omphalitis from 31.1 to 3.0% despite the fact that there were increases in the total number of infants admitted to the unit and in the proportion of premature neonates among all the children admitted to the unit in the past three years. Since 2009, the unit has been continuously auditing neonatal infectious and inflammatory diseases, allowing reductions in the hyperdiagnostic rate of infectious and inflammatory diseases and in the number of infants receiving antibacterial therapy.

Objective. To study the incidence of congenital heart disease (CHD) in the newborn and the frequency of the specific features of the history of mothers having neonates with CHD in Azerbaijan. Subjects and methods. Five hundred and forty-eight CHD children born in 2000-2005 in Azerbaijan were followed up. During the above period, the diagnosis of CHD was established on the basis of clinical and postmortem findings. The study included all the regional registry infants with CHD who were born alive or dead or died. Only cases of CHD in infants the parents of whom were the residents of Azerbaijan were considered. Results. In the study period, the average long-term population frequency for CHD was 2.5:1000, which was below the international registry values (5.0:1000-7.0:1000) and may be associated with the low diagnosis rates of these malformations in the newborn. The largest proportion among the antenatal factors included female extragenital pathology, complicated current pregnancy, the high rate of maternal urogenital infection and gynecological diseases in infants with CHD, and their family history of malformations. Conclusion. Information on the rate of CHD in Azerbaijan has been first obtained in accordance with the international principles for monitoring systems.

Objective. To define clinical and morphological criteria for scar consistency after sustained myomectomy for the formation of groups of pregnant and parturient women for further vaginal delivery and to reveal the expediency of hormonal rehabilitation with the drospirenone-containing contraceptive Midiana in the postoperative period. Subjects and methods. A prospective study of 115 pregnant and parturient women with a uterine scar after preceding myomectomy and 60 patients after experienced myomectomy who underwent hormone rehabilitation with Midiana. The study involved morphometry and examination of the state of microcirculation and a cytogram of tissue leukocytes in the uterine scar and marginal tissues in women; ultrasound study in patients with the intact uterus and in parturients after myomectomy. Results. After laparotomic myomectomy, by suturing the bed with a double-row synthetic stitch, and after laparoscopic myomectomy, by extracorporeally applying stitches, the myometrial scar is a thin scar with the parallel arrangement of fibers and with solitary hemorrhages. Dilated plethoric vessels were well visualized. The cellular component was presented by solitary lymphocytes and neutrophils. The border between the myometrium and scar after laparatomic and laparoscopic myomectomy, by suturing the bed was characterized by plethora and bleeding. With laparoscopic myomectomy and bed coagulation, there was a chaotic fiber alignment and extensive hemorrhages in the scar tissues. The vascular component appeared as abundant vessels with sclerosed walls. Noteworthy is the higher numerical density of all white blood cells, neutrophils in particular, as well as red blood cells. After laparoscopic myomectomy with bed coagulation, the border between the myometrium and scar clearly demonstrated as large vessels with sclerosed walls, plethora, and bleeding, and a multitude of minor vessels resembling granulation tissues. Spontaneous labor occurred in 35 (51.5%) of the 68 patients with a uterine scar who had been managed for vaginal delivery. Repeat cesarean section was performed in 33 (48.5%) women. Threatening metrorrhexis was one of the reasons for emergency abdominal delivery with the sutured bed with a double-row synthetic stitch only in 18.2 and 15.4% of the women, respectively; and that after lararoscopic myomectomy with bed coagulation was in 33.3% in the parturient women. Conclusion. Reproductive-aged women should undergo laparotomic or laparoscopic myomectomy, but by obligatorily extracorporeallly suturing the bed with a double-row stitch. Bed coagulation is impermissible since the risk for histopathic metrorrhexis is high during pregnancy. It is also demonstrated that it is basically expedient to use hormonal rehabilitation with the drospirenone-containing contraceptive Midiana after myomectomy. Slight and transient side effects are successfully replaced by qualitative uterine involution, which creates favorable conditions for scar healing and opens up new avenues for spontaneous labor after conservative plastic surgery.

The paper describes a case of successful treatment for catastrophic antiphospholipid syndrome (CAPS) in a multigravida with a complicated somatic history (systemic lupus erythematosus, secondary antiphospholipid syndrome) and with complicated current pregnancy (placental insufficiency). The pregnant woman was emergently delivered at 28 weeks’ gestation because of the worse condition of hers and her fetus. In the early postoperative period, the diagnosis was timely made and combination therapy (glucocorticoids, plasma exchange, immunoglobulin) was initiated. The patient was discharged in a satisfactory condition on day 15 to be further followed up by a local rheumatologist.

The review considers the role of magnesium in the body and presents an update on the prevalence and causes of magnesium deficiency, its clinical manifestations, including those in pregnant women. It shows the ways of correcting magnesium deficiency and the benefits of organic salts and gives recommended dosages. There is evidence for the choice of magnesium orotate for the treatment of pregnant women, main indications for its use in obstetric care, and the results of clinical application of magnerot.

Hemorrhoids are one of the most common human diseases. The disease has two main forms (acute and chronic) and manifests itself as thrombosis, inflammation, bleeding, and prolapse of hemorrhoids. Two main causes of the disease are identified; there are vascular disorders and mechanical damages. Chronic and acute forms are identified in the course of the disease. Internal, external, and mixed types are distinguished by the form of the disease. Its chronic course is divided into four stages. Acute hemorrhoids are a complication of the chronic course and classified into three grades according to the degree of thrombosis and inflammation. This classification corresponds to the pathogenesis of hemorrhoids, is rather convenient, and provides a possibility of objectively defining indications and choosing the required treatment option in practical work in accordance with the stage and degree of the disease. Bleeding, various inflammation intensities, and pinched hemorrhoids may complicate one of the manifestations, which is characteristic of the early development of the disease (perianal itch, discomfort). The diagnosis of hemorrhoids encompasses examination, rectal study, anoscopy, colonoscopy, and proctosigmoidoscopy. Conservative treatment for acute and chronic hemorrhoids is directed towards relieving the symptoms of acute hemorrhoids, eliminating complications, and preventing exacerbations during their chronic course. The drug therapy is incorporated into preoperative preparation and postoperative rehabilitation. The used medicaments have anti-inflammatory, analgesic, and hemostatic activities and improve blood flow and microcirculation in the cavernous masses. The paper gives data on the drug of choice due to its combined properties in treating hemorrhoids in women.