No 8-1 (2012)

Objective. Finding out significant pathogenetical changes of immune system and development of immunological prognostic criteria for spontaneous abortion in women with recurrent pregnancy loss due to hormonal disbalance to reduce frequency of perinatal complications. Materials and methods. 116 women with early pregnancy underwent examination. Among them, there are 59 women with recurrent pregnancy loss — study group - and 57 women with physiological pregnancy — control group. Population and subpopulation composition of peripheral blood, expression of the markers of activation and apoptosis, receptors toIL-4 (CD124), level of IL-1ß, IL-2, IL-4, IL-10, TNF-α, IFN-γ, activin-А, neopterin, steroids hormones( estriol, progesterone, chorionic gonadotropins ) in the blood were studied. Results. The significant cause of recurrent pregnancy loss associated with hormonal impairments of feto-maternal complex is disbalance of activation and apoptosis processes. Increasing of neopterin, shifting of cytokine balance to increasing proinflammatory cytokine synthesis in the blood, that associated to decreasing amount of lymphocytes, expressed receptor to IL-4, and increasing activine-А production. Revealed immune shifts indicate modulating effect of steroids hormones, which proves immune-hormonal homeostasis impairments and may be the markers of threaten abortions in women with hormonal disbalance of feto-placental complex. Comclusion. With the help of immune criteria prognosis algorithm of spontaneous abortion in women with recurrent fetal loss due to hormonal impairments of feto-placental complex was developed. This will help to choose an adequate and timely treatment and also prophylaxis measures against perinatal complications, which increase cases of favorable obstetrical outcomes.

Objective. The aim of the investigation was to evaluate the receptor status and proliferative activity of the endometrium after uterine artery embolization (UAE) for uterine myoma Subjects and methods. 40 patients of genesial age :30 reproductive-aged patients with simple and complex endometrial hyperplasia (a study group) and 10 patients without endometrial abnormality (a comparison group). Histological and immunohistochemical studies were conducted using endometrial scrapes prior to UAE and pipelle biopsy specimens 6 months after UAE. Results.After EMA, all the patients were found to have a proliferative-phase endometrium without additional hormonal correction. There was a certain correlation between Ki-67, mean values of the expression of estrogen and progesterone receptors, their ratio, and endometrial morphological structure before and after UAE. Conclusion. Absence of a morphological pathology эндометрия without carrying out of hormonal treatment at small group of patients of genesial age, and also the tendency to normalization of immunohistochemical indicators, allows to reconsider expediency of hormonal therapy after ЭМА.

Objective. To elaborate an ordinal integrated rating scale for the symptoms of an exacerbation of chronic inflammatory diseases of the uterus and appendages (SECIDUA), by providing a detailed substantiation of the reasonability of apply ing of th is approach in gynecological care. Subjects and methods. The study covered 124 patients of reproductive age (17—45 years) who had been urgently admitted to the unit of gynecology for a diagnosed exacerbation of chronic endometritis (ICD-10 N71) or salpingooophoritis (ICD-10 N70). The proposed ordinal rating scale for SECIDUA was used to make an integrated assessment of the clinical status of the patients within the first 24 hours of their hospital stay. The SECIDUA scale provided an ordinal record of 12 symptoms that were allocated into three subscales (genital status, abdominal status, and systemic inflammatory response syndrome). To prove the objectivity of the scores of the scale and its subscales, the findings were compared with the results of clinical and laboratory studies of peripheral blood and a pathohistological examination of endometrial biopsy specimens. Changes in SECIDUA scores were additionally evaluated during standard treatment. Results. There was a high internal consistency (validity) of both the SECINDUA scale as a whole (Cronbach’s alpha coefficient, 0.887) and its individual subscales (Cronbach’s alpha coefficient, 0.778 to 0.993). The scores of the SECINDUA scale and each of three components of its subscales were directly correlated with the spread of purulent dissolution foci and with the values of polynuclear and lymphocyte infiltration in the patients’ endometrial biopsy specimens (Spearman’s correlation coefficient, 0.20 to 0.68; р=0.02—<0.0001). The similar trend was seen in the level of proinflammatory cytokines, the values of leukocytosis, the proportion of stab neutrophils, the functional state of neutrophil granulocytes, and the concentration of IgM (Spearman’s correlation coefficient, 0.20 to 0.69; р=0.02—<0.0001). Standard drug treatment for chronic endometritis and salpingo-oophoritis resulted in a considerable reduction in SECINDUA scores. Conclusion. The SECINDU scale has a high internal consistency and a sufficient validity for practical application. Its application may be useful for the objective characterization of the clinical efficiency of new approaches to treating inflammatory gynecological diseases.

Objective. To analyze the results of infertility treatment using operative laparoscopy postoperatively supplemented with ovulation inducers during artificial insemination with husband’s semen (AIHS) in patients with different manifestations of peritoneal and ovarian endometriosis (PE and OE). Subjects and methods. Two hundred and eighty-eight 288 infertile patients not older than 38 years with PE or OE manifesting as uni- or bilateral endometrioid ovarian cysts (EOC) were examined. Surgery was performed at the first stage. The second treatment stage, namely: in vitro fertilization (IVF), was switched if surgical treatment of infertility and ovulation inducers during AIHS were ineffective. Results. Endometriosis-associated infertility treatment successively using surgical methods, ovulation inductors during AIHS and IVF is highly effective in relatively mild peritoneal and ovarian endometriosis. In severe forms of the disease (Stage 3—4 PE, bilateral EOC), it is advisable to use IVF as early as possible after surgical treatment since the probability of spontaneous pregnancy or successful administration of ovulation inducers in the postoperative period is extremely low in these cases.

Objective. To establish the nature of changes in the parameters of lipid peroxidation and antioxidant defense system and to estimate the alterations of mastalgia when using the herbal agent mastodynon in patients with diffuse mastopathy (benign breast disease). Subjects and methods. The prospective, non-randomized, parallel-group comparative trial enrolled 43 patients (mean age 38.83±1.85 years) with diffuse mastopathy; 30 of them received the herbal medicine mastodynon for 3 months (a study group), 13 patients formed a control group. The intensity of mastalgia was recorded using a visual analog scale and the serum levels of lipid peroxidation products and antioxidants were estimated at baseline and 3 months after therapy. Results. The study group, unlike the control one, showed a significant reduction in the incidence of severe mastalgia, a decrease in the serum levels of lipid peroxidation products, an increase in total antioxidant activity, and a decline in oxidized/reduced glutathione ratio. Conclusion. The trial has demonstrated the antioxidant properties of the herbal agent mastodynon, which can, along with other mechanisms, determine its clinical efficacy in diffuse mastopathy and call for further investigation.

The prevalence of primary hyperparathyroidism (PHPT) in pregnant women is 0.15 to 1.4%. The literature reports not more than 200 cases of this condition. The authors describe their own observation. Pregnant woman I. was admitted to the Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology for the following diagnosis: 37 week pregnancy; unstable fetal position; moderate preeclampsia; asymmetric pelvis. It was confirmed that the patient had PHPT with a more than 4—8-fold increase in bone remodeling markers, which gave rise to severe hyperparathyroid osteodystrophy. There was a complete spectrum of visceral lesions characteristic of PHPT: involvements of the musculoskeletal system (severe hyperparathyroid osteodystrophy, muscular atrophy), gastrointestinal tract (chronic gastritis), and kidneys (nephrocalcinosis, nephrolithiasis complicated by urinary tract infection). Moreover, the patient had a history of manifestations of insipid syndrome (polyuria, polydypsia). The patient delivered via cesarean section in the lower segment. After delivery, a 4.5x2.0x3.0 cm ectopic parathyroid mass located near the aortic arch was thoracically removed in its capsule (this was a parathyroid adenoma showing clear cells, as evidenced by its histology). Six months after surgery for PHPT, the patient was diagnosed as having a remission. After birth the baby was intravenously given calcium and magnesium preparations, thus giving rise to normocalcemia. The infant was discharged on day 33 of his life. Thus, persistent maternal hypercalcemia retards the development of fetal parathyroid glands and, possibly, may be toxic to the fetus. In this connection, the infants born to mothers with PHPT, with its severe form in particular, need a meticulous long-term follow-up and correction to prevent hypocalcemia.

The paper describes a rare case of multiple leiomyomatous hamartoma of the lung developed in a perimenopausal patient, the incidence of which is 1—2 cases per 1 million women. A relationship has been found between the progression of leiomyomatous hamartoma of the lung and the high expression of estrogen and progesterone receptors. Since the morphological structure of the described tumor-like process in the lung is similar to that of uterine leiomyoma, the authors have chosen empirically optimal drug therapy regimens. The highest efficiency has been shown by gonadotropin-releasing hormone agonists, whose use relieved clinical symptoms, showed positive X-ray tomographic changes, and stabilized the pulmonary process.