No 5 (2015)

Polycystic ovary syndrome (PCOS) manifests itself in adolescence and occurs in 2.2-7.5% of patients and in as high as 68% of girls with dysmenorrhea and hirsutism. PCOS is a chronic disease that is the most common cause of anovulatory infertility in young women. The etiology and the pathogenesis of this heterogeneous disease remain fully uninvestigated. The existing treatment options have no long-term effect. This paper summarizes the currently known characteristic features of the clinical manifestations of adolescent PCOS and present-day approaches to its diagnosis and management.

Objective. To cover the data available in the literature describing the causes and mechanism for the development of birth-related brachial plexus injury in the absence of a complication, such as fetal shoulder dystocia. Material and methods. Twenty-seven literary sources were found and analyzed using the medical search systems PubMed, Cochrane, Sage, and Wiley Online. Results. The literature describes a large number of cases of labor palsies in the absence of risk factors, birth complications, and obstetric care. The possible mechanisms of the injury are theoretically sound. Conclusion. The occurrence of birth-related brachial plexus injury is frequently unassociated with the development of shoulder dystocia and with obstetricians’ actions. There are a number of other causes. The development of brachial plexus injury in these cases is distinct in its mechanism; the clinical picture may commonly vary. There is no correlation with risk factors.

Objective. To assess the role of interleukin-2 (IL-2) polymorphism in women with recurrent pregnancy loss. Subjects and methods. The distribution of the IL-2 alleles and genotypes of the polymorphic loci: -330 T>G (rs 2069762) and +166 G>T (rs 2069763) was studied in 90 women. Group 1 consisted of 30 patients with recurrent early losses (at less than 22 weeks’ gestation). Group 2 included 30 patients with multiple very early preterm labors (at 22 to 28 weeks’ gestation). Group 3 comprised 30 patients with uncomplicated pregnancy and a history of at least 2 full-term births (a control group). Results. There were significant differences in the distribution of the IL-2 genotypes and alleles: -330 T>G (rs 2069762) in the group of pregnant women with early miscarriage versus that of women with physiological pregnancy. Conclusion. Determination of IL-2 gene polymorphisms: -330 T>G (rs 2069762) when planning pregnancy makes it possible to identify a group at risk for early miscarriage for more careful pregravid preparation and optimization of pregnancy management tactics.

Objective. To study the levels of α2-macroglobulin (α2MG), lactoferrin (LF), and albumin (ALB) in the serum and amniotic fluid (AF) of the parturient women in the carriage of TORCH infection pathogens or antibodies for the assessment of their role in the development of early neonatal infectious complications. Subjects and methods. The investigators determined the serum concentrations of α 2MG (by quantitative rocket immunoelectrophoresis), LF (by enzyme immunoassay (EIA)), and ALB (by a colorimetric method) and the AF levels of a 2MG, LF (by EIA), and ALB (by a quantitative immunoelectrophoresis) in 40 healthy parturient women at 38-40 weeks’ gestation), in 35 parturient carriers of TORCH infection pathogens or antibodies who had given birth to healthy babies, in parturient carriers of TORCH infection pathogens or antibodies who had given birth to infants with signs of intrauterine infection (IUI), including 18 with Candida albicans, 23 with Staphylococcus aureus, 40 with IgG antibodies to Chlamydia trachomatis, 25 with IgG antibodies to herpes simplex virus, and 32 women with mixed infection. Results. Birth of a full-term baby with signs of the infection is associated with significantly elevated LF levels in the carriage of IgG antibodies to Chlamydia trachomatis, with less elevated LF in the presence of Staphylococcus aureus and in mixed infection; on the contrary, the content of LF was decreased in the carriage of IgG to herpes simplex virus. The IUI infants showed lower serum ALB levels. Higher α 2MG levels were associated with the risk of IUI only in the presence of IgG antibodies to Chlamydia trachomatis in maternal blood. The parturient carriers with IUI had lower LF and higher α 2MG and ALB levels, except the carriers of Staphylococcus aureus as monoinfection. Conclusion. The found changes suggest a covert inflammatory response in parturient women in the carriage of TORCH infection pathogens or antibodies, increased fetoplacental unit permeability, and a decreased antibacterial/ antiviral potential of local protection from pathogenic organisms, which contributes to infection and may be used to predict the course of a neonatal period.

Objective. To study JEG-3 trophoblast cell proliferation and migration in the presence of placenta-secreted factors. Subject and methods. Trophoblast cells were cultured in the presence of placental secretory products in the third trimester of physiological or preeclampsia-complicated pregnancy. Cell proliferation and migration were assessed by culture methods and flow cytofluorometry. Results. In the third trimester, the placenta secretes factors that both stimulate and inhibit trophoblast cell proliferation and migration. The effect of trophoblast proliferation and migration inhibitors prevails over that of stimulants. The effect of placenta-secreted factors stimulating cell proliferation and migration is decreased in the placentas of women with preeclampsia. Conclusion. Impaired trophoblast invasion in preeclampsia is associated with a change in the production of placental factors controlling the proliferation and migration of these cells.

Objective. To study the gene expression of steroid receptors (mER, PR-A, GR, and AR) in the blood mononuclear cells from patients with uterine myoma in relation to the efficiency of therapy with mifepristone. Subjects and methods. The investigation enrolled 50 patients whose myomas were smaller than a 12 week pregnancy (interstitial, interstitial-subserous nodules). Oral mifepristone (gynestril, Stada) 50 mg was given daily for 3 months. The gene expression of the receptors in the patients’ mononuclear cell fraction was determined by RT-PCR. Results. 5-fold greater gene expression of nuclear glucocorticoid receptors (p = 0.02) was seen in patients with no mifepristone effect on myoma sizes. Conclusion. The receptor profile of the mononuclear cell fraction may serve as indirect prognostic sign of the efficiency and expediency of using mifepristone in the therapy of patients with uterine myoma.

Objective. To evaluate endometrial receptivity in infertile patients, by measuring the cervical mucus (CM) concentrations of leukemia inhibitory factor (LIF) and its receptor (LIF-R) and comparing with their immunohistochemical expression in endometrial tissue. Subjects and methods. Sixty patients aged 26 to 38 years with tuboperitoneal factor infertility who had a history of more than two in vitro fertilization (IVF) failures (a study group) and 20 healthy fertile women of the same age (a control group) were examined. Both groups of women underwent measurement of CM LIF and LIF-R concentrations by enzyme immunoassay, morphological examination of the endometrium, by identifying mature pinopidia, and its immunohistochemical examination, by estimating LIF and LIF-R expression in the implantation window of a natural cycle. Results. In the study group, the CM concentration of LIF was significantly lower than that in the control group on days 3 and 7 after urine luteinizing hormone (LH) surge (4.9±3.4 and 73±2.8 pg/ml, respectively; р < 0.05 and 27.2±9.6 and 32.2+7.3 pg/ml; р < 0.05) and that of LIF-R was also significantly lower than that in the control group on days 5 (113.0+37.4 and 156.0+18.7 pg/ml, р < 0.05), 7 (174.2+42.4 and 210.0+6.7 pg/ml, р < 0.05), and 9 (52.0+10.6 and 98.1+25.3 pg/ml, р < 0.05) after urine LH surge. Endometrial immunohistochemical examination revealed the diminished expression of LIF (4.4+0.2 and 6.0+0.1 scores, р <0.05) and LIF-R (4.2+0.4 and 6.0+0.2 scores, р < 0.05) in the study group as compared to the control one. A moderate direct correlation was found between the CM concentration of markers and the level of their expression in the endometrium: LIF (r = 0.67), LIF-R (r = 0.64). Conclusion. The CM concentrations of LIF and LIF-R and their immunohistochemical expression in the endometrium were decreased in infertile women with a history of repeated IVF failures. Determination of CM LIF and LIF-R concentrations may be used as a noninvasive method to estimate the implantation potential of the endometrium.

Цель исследования. Улучшение результатов лечения больных с гнойно-деструктивными воспалительными тубоовариальными опухолями, сочетающимися с доброкачественными гиперпластическими процессами тела матки. Материал и методы. В подгруппу А (n=26) отнесены пациентки с изолированными гнойно-деструктивными воспалительными опухолями придатков матки, в подгруппу Б (n=14) - в сочетании с доброкачественными гиперпластическими заболеваниями тела матки. Проводилась антибактериальная терапия цефтриаксоном 2,0 г в сутки путем внутривенной инфузии в течение 7 дней в послеоперационном периоде и интравагинальное введение препарата фемилекс (молочной кислоты 100 мг, в суппозиториях на основе полиэтиленоксидов) со 2-х суток послеоперационного периода в течение 10 дней. Оценку состояния вагинального биоценоза проводили трехкратно (в момент поступления, непосредственно перед выпиской и через месяц после оперативного лечения); в предоперационном периоде и интраоперационно проводили бактериологическую оценку отделяемого влагалища и содержимого деструктивного придаткового образования. Результаты исследования. Пациентки с тубоовариальными воспалительными опухолями придатков матки, нуждающиеся в оперативном лечении, имеют выраженные нарушения вагинального биоценоза - дисбиоз влагалища в 65% и вагинит в 25% случаев. В результате локальной коррекции вагинального биоценоза в послеоперационном периоде молочной кислотой в дозе 100 мг происходит достаточно быстрое восстановление влагалищного биотопа до состояния нормоценоза как в группе женщин, страдающих изолированными гнойными образованиями придатков (92,31±5,3% случаев, p<0,05), так и при сочетанном течении воспалительно-деструктивных опухолей придатков с доброкачественными гиперпластическими заболеваниями тела матки (57,14±13,73%, p<0,05). Через 1 месяц после оперативного лечения позитивный эффект восстановленного вагинального биоценоза сохраняется на уровне 73,08±8,87% и 71,43±12,53% случаев соответственно, а рецидив нарушенного влагалищного биоценоза (дисбиоз) - у 11,54±6,39% и 14,29±9,71% пациенток соответственно. Заключение. В результате выполненной работы можно сделать вывод о достаточно высокой эффективности локальной коррекции вагинального биоценоза препаратом молочной кислоты фемилекс у женщин, перенесших оперативное лечение по поводу гнойно-деструктивных воспалительных образований придатков матки, независимо от сочетания указанной патологии с доброкачественными гиперпластическими заболеваниями тела матки, требующими расширения объема оперативного лечения.

Gastroesophageal reflux disease (GERD) is one of the most common diseases accompanying pregnancy. Most of the drugs traditionally used in GERD are of limited application in pregnancy and lactation. The drugs from a group of alginates are safest, the administration of which is pathogenetically sound in gastroesophageal reflux. Their ability to prevent the reflux effectively and to eliminate the major symptoms of GERD rapidly and for a long time, the absence of their systemic action, and their safety proven in large randomized clinical trials for pregnant and breast-feeding women permit the considerable use of this drug group in the treatment of this category of patients.

The paper presents a literature review covering the current aspects of terminology, classification, pathogenesis, and possibilities for therapy of urogenital disorders in menopausal women. It shows the susceptibility of the lower urogenital tract to sex steroids, the implication of which in the genesis of vaginal and urinary symptoms is beyond question. The efficiency of systemic and local hormone replacement therapy and different treatment regimens is considered.