No 3 (2014)

The review gives the literature data characterizing the autoimmune pathogenesis, diagnosis, clinical course, and treatments of systemic lupus erythematosus (SLE). It discusses the impact of pregnancy on the activity of the disease and the relationship of the pattern and outcome of pregnancy to the activity of SLE, indications for and contraindications to pregnancy prolongation in women with this disease, as well as problems in the prognosis, diagnosis, and management tactics of SLE in pregnant women. Analysis of the data available in the literature suggests that the optimal control of disease activity, the careful planning of pregnancy in conjunction with multidisciplinary monitoring and treatment substantially reduce maternal and infant risks.

The review covers the characteristics of some reproductive aging stages and the association of female endocrine and clinical changes from the late reproductive period to early postmenopause.

Objective. To determine the serum cytokine balance in women with fetal depletion syndrome and to estimate the importance of single nucleotide polymorphism (SNP) in the development of this condition. Subject and methods. Peripheral blood was tested in women with physiological pregnancy, in those with fetal depletion syndrome, and nonpregnant healthy women without reproductive losses. The level of cytokines and allelic polymorphism of their genes were determined. Results. The pregnant women with fetal depletion syndrome were found to have pro- and anti-inflammatory cytokine imbalance due to the elevated levels of IL-10, IL-6, IL-17α, and TNFα. Moreover, there were more frequently heterozygotes for the polymorphic markers of the genes IL-10 (mutation 1, G-1082A), IL-4 (C-589-T), TNFα (G-308A), IL-17f His161Arg (7488A/G). Conclusion. The preponderance of proinflammatory cytokines (TNFα and IL-17α) with the high level of antiinflammatory cytokines (IL-10 and IL-17α) suggests that the process of physiological rearrangement of the immune system is impaired in the immunosuppressive direction by the second trimester in the pregnant women with a history of fetal depletion syndrome. At the same time, heterozygotes for the polymorphic markers of the genes IL-10 (mutation 1, G-1082A), IL-4 (C-589-T), TNFα (G-308A), IL-17f His161Arg (7488A/G) are encountered much more frequently.

Objective. To study the pathomorphological and immunohistochemical lesions of the brain in patients who died from severe forms of preeclampsia and eclampsia. Subject and methods. Retrospective analysis of 8 histories of pregnancy, labor, and delivery and postmortem protocols, as well as immunohistochemical examination of brain tissue to visualize neurospecific enolase were made in patients who had died from severe preeclampsia/eclampsia (a study group). A comparison group included 3 patients who had died from other causes. Results. The pathological changes in the women who died from severe forms of preeclampsia/eclampsia are suggestive of severe ischemic encephalopathy with generalized vascular brain damage (to the point of total desquamation of endotheliocytes), including the vessels of the blood-brain barrier. Conclusion. The cause of most fatal complications in preeclampsia and eclampsia was inadequate cerebral flow autoregulation with loss of a regulatory role of the endothelium and breakthrough in the blood-brain barrier.

Objective. To compare the clinical, morphological, and immunohistochemical characteristics of resistant overactive bladder (OAB) and chronic cystitis in reproductive-aged and perimenopausal women. Subject and methods. Sixteen bladder wall biopsy specimens obtained from women with clinically verified chronic cystitis during standard cystoscopy with bladder wall biopsy and 14 from those with OAB. The patients’ mean age was 40.6±10.4years. In the group of patients with OAB and chronic cystitis, the mean age was 38.0±5.4 and 41.8±2.3 years, respectively. The biopsy specimens were morphologically examined and immunohistochemical markers (CD177 and TLR4) were studied. Results. The morphological examination of the biopsy specimens in the group of clinically verified cystitis, they generally displayed the surface layers of the bladder mucosa covered with the laminated squamous epithelium (LSE) with the signs of atrophy; the underlying stroma showed diffuse lymphoplasmacytic infiltration, sclerosis, hyaline degeneration of vessel walls, and hyperemia of muscle fibers. In the OAB group, there was an excellent histological pattern: the bladder mucosa was covered by the multirowed epithelium (MRE) or LSE hyperkeratosis; the submucosal layer exhibited edema, sclerosis, thin-walled vessels, focal inflammatory infiltration, as well as there was focal hypertrophy of muscle fibers. The investigation revealed significant differences in the magnitude of some morphological parameters: atrophy of the epithelium and that of the muscular layer were more pronounced in patients with chronic cystitis (p < 0.001), stromal edema (p < 0.06), and muscle layer hypertrophy (p < 0.001) in the OAB group. In the evaluation of the immunohistochemical expression of TLR4, the latter was as brown staining of epithelial cytoplasm, inflammatory cell infiltrate and in the cell cytoplasm of the vascular endothelium. Evaluation of CD117 expression in the stromal inflammatory infiltrate showed the high cellular accumulation of the marker in both groups; however, there was a tendency towards the higher expression of the marker. Conclusion. The f indings strengthen the hypothesis that OAB is inflammatory in genesis. Furthermore, analysis of the immunohistochemical expression of CD117 has shown that the stromal inflammatory infiltrate cells have high concentrations of the marker in the OAB and chronic cystitis group. This confirms the theory that due to pacemaker function, it is precisely these cells that provide spontaneous myogenic activity of their surrounding smooth muscle cells and give rise to their hypertrophy.

The quality of used gametes (both sperm and oocytes) serves as a key factor of successful in vitro fertilization programs. The first stages of early human embryogenesis largely depend on the state of an oocyte. The process of female sex cell maturation is a chain of complex rearrangements of nuclear and cytoplasmic structures. There is accumulation of energy and nutrients, which are needed at the early stages of zygotic division and cleavage. That is the reason that oocytic dysmorphisms found at the light microscope level are frequently associated with internal cell pathology. The paper gives an update on the structure of human oocyte at the metaphase II stage according to electron microscopic data. It also describes the anecdotal cases suggesting that the cause of female (commonly idiopathic) infertility may be oocyte abnormality identified when implementing in vitro fertilization programs.

To manage congenital diaphragmatic hernia concurrent with heart diseases is a serious problem for anesthetists/ resuscitation specialists, pediatric and cardiovascular surgeons. The authors describe a clinical case of successful surgical treatment for congenital diaphragmatic hernia concurrent with aortic coarctation in a perinatal center.

Objective. To evaluate the impact of combined therapy with chlorhexidine (hexicone) and lactic acid (femilex) versus that with fluomisin and gynoflor E on restoration of the vaginal microflora in patients with anaerobic dysbiosis and cervical neoplasia while preparing for destruction. Subject and methods. The efficiency of combined therapy with chlorhexidine (hexicone) and lactic acid (femilex) versus that with fluomisin and gynoflor E for recurrent anaerobic vaginal dysbiosis was studied in 60 patients with HPV-associated cervical neoplasias. Conclusion. The findings allow the procedure under study to be recommended to patients with cervical neoplasias when preparing for destruction.