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No 8 (2015)

Articles

Blood extracellular DNA sequencing-based noninvasive prenatal diagnosis of fetal aneuploidies in a pregnant woman

Pantyukh K.S., Shubina E.S.

Abstract

The review deals with different approaches to noninvasive prenatal diagnosis using a high-performance DNA sequencing method. It gives the basic principles, possibilities, advantages, and disadvantages of both whole-genome and targeted approaches. The results of the papers published in the last 4 years, which determine the sensitivity and specificity of tests and compare the latter with conventional methods, are described. The paper depicts the technical and biological limitations of the technique and discusses whether it is reasonable to use it for diagnosis and screening.
Obstetrics and Gynecology. 2015;(8):5-11
pages 5-11 views

Current ideas on the pathogenesis of renal injury in preeclampsia

Merkusheva L.I., Kozlovskaya N.L.

Abstract

Renal injury in preeclampsia (PE) remains an urgent problem in modern obstetrics and nephrology, which is due to its high prevalence (2-14% of all pregnancies) and outcome unpredictability. The pathogenesis of renal injury in PE, like a balance of pro- and antiangiogenic factors that are today considered to be one of the major pathogenetic mechanisms of PE, has not been practically investigated. The paper presents an update on the pathogenesis of renal injury in PE and shows the impact of a soluble fms-like tyrosine kinase-1/vascular endothelial growth factor system imbalance on the clinical manifestations of nephropathy in PE.
Obstetrics and Gynecology. 2015;(8):12-17
pages 12-17 views

Invasive mycoses in neonatology: Prevention, diagnosis, and therapy

Nikitina I.V., Ionov O.V., Prikhodko N.A., Priputnevich T.V., Antonov A.G., Lyubasovskaya L.A., Kirtbaya A.R., Balashova E.N., Zubkov V.V., Degtyarev D.N.

Abstract

Objective. To study current approaches to the diagnosis, therapy, and prevention of invasive mycoses in neonates on the basis of the data available in the literature and the results of the authors’ investigations. Subject and methods. Current microbiological and proteometric techniques (time-of-flight MALD-TOF-MS) were used to study the species composition of fungi obtained when testing 391 biological samples from 187 babies treated at the Research Center of Obstetrics, Gynecology, and Perinatology in 2013-2014 and to estimate the isolation rates of yeast fungi in different neonatal departments. Results. Analysis of the data available in the literature and the results of the authors’ investigations could identify risk factors for the development of a fungal process in neonatal infants, determine indications for targeted antifungal therapy, and describe a group of drugs used for the therapy and prevention of invasive candidiasis in the neonatal period. Conclusion. Current diagnosis, early initiation of antifungal therapy, and observance of preventive measures will reduce the incidence of invasive candidiasis in the group of very low and extremely low birth weight neonates, increase survival rates, and decrease the pharmacoeconomic costs of their treatment.
Obstetrics and Gynecology. 2015;(8):18-25
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Systemic inflammation and insulin resistance in the pathogenesis of polycystic ovary syndrome

Rasin M.S., Zhitnik V.P.

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of ch ildbearing age, which affects 5-7% of the population and is associated with a broad spectrum of diseases: hypertension, dyslipidemia (DL), atherosclerosis, type 2 diabetes mellitus (T2DM), and gestational diabetes, increased risk of myocardial infarction, stroke, and higher cardiovascular and overall mortality rates. Inflammation, insulin resistance (IR), and hyperinsulinemia are permanent components of the pathogenesis of PCOS in obese women and in the majority of normal weight women due to the presence of a multitude of factors initiating systemic inflammation (SI) and IR. Metformin (MF) and pioglitasone (PG) are the only drugs that reduce SI and IR in different ways, which themselves used alone or in combination with hormonal agents make it possible to restore ovulation, fertility, and pregnancy carrying in 90% of the women, by minimizing the need for surgical intervention, as well as to prevent, stop, and ensure the regression of T2DM, dyslipidemia, non-alcoholic fatty liver disease, atherosclerosis, and hypertension. The administration of MF is completely safe and limited only by an individual’s intolerance that is mainly associated with gastrointestinal disorders. PG treatment requires monitoring the state of the bladder, eyeground, and bone mineral density due to rare changes in these organs and tissues.
Obstetrics and Gynecology. 2015;(8):26-32
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Vitamin D and breast cancer in women

Maltseva L.I., Garifullova Y.V.

Abstract

Recent investigations have revealed an association of vitamin D deficiency with a wide spectrum of diseases, such as cardiovascular diseases, depression, diabetes mellitus, Alzheimer’s disease, and different types of cancer. Numerous studies have established a direct relationship between low vitamin D levels and breast cancer incidence, a risk for distant metastases and overall survival rates. Clinical and experimental findings have shown the implication of not only of the absolute concentration of vitamin D, but also the regulatory effect of vitamin D and major enzymes governing its local metabolism. Vitamin D receptor gene polymorphism and different expression of enzymes involved in the synthesis of the biologically active form of vitamin D and in the catabolism of the vitamin finally determine the local concentration of vitamin D. The latter in turn controls cell proliferation in the breast, which is the basis for its benign and malignant lesions. Examining the specific features of the effect of vitamin D on breast tissue in health and disease allows correction of vitamin D deficiency to be regarded as one of the effective methods for primary prevention of breast cancer.
Obstetrics and Gynecology. 2015;(8):33-38
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Deep infiltrating endometriosis: Postoperative recurrences and possible ways of their prevention

Chernukha G.E., Ilyina L.M., Adamyan L.V., Pavlovich S.V.

Abstract

Endometriosis is one of the rather common gynecological diseases and diagnosed in 10% of reproductive-aged women. The problem of endometriosis is assuming an increasing sociomedical importance, which is due to the severe clinical manifestations and recurrent course of the disease, which have a negative impact on quality of life and working ability in women. The review discusses the high rate and unpredictability of recurrences of deep infiltrating endometriosis after surgical treatment. Adequate postoperative drug therapy is important for the prevention of recurrent pelvic pain and endometriotic foci and can reduce poor health consequences for women when repeated and more radical surgical interventions are needed.
Obstetrics and Gynecology. 2015;(8):39-46
pages 39-46 views

Premature ovarian failure and cardiovascular diseases

Pozdnyakova A.A., Marchenko L.A., Runikhina N.K., Sharashkina N.V.

Abstract

The impact of estrogen deficiency in women with timely menopause on the risk of cardiovascular diseases (CVD) is now widely discussed. However, there are very few papers dealing with this problem in female patients with premature ovarian failure (POF). Objective. To summarize the data of current clinical trials of the problem of CVD development in women with POF. Subject and methods. Good-quality bibliographic references published in the PubMed database on the studies of surrogate markers and endpoints for the development of CVD in women with POF were reviewed. Results. Analysis of the performed investigations has shown that POF-induced estrogen deficiency is a significant and traditional CVD risk-independent predictor of coronary heart disease and strokes, the relative risk of which in this pathology is 2.11 and 2.10, respectively. Conclusion. To confirm the significant role of POF-induced estrogen deficiency in the development of CVD, it is necessary to conduct large-scale randomized controlled trials, by not only thoroughly analyzing the predictors of CVD, but also by necessarily accounting cardiovascular events in this category of patients.
Obstetrics and Gynecology. 2015;(8):47-52
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Current suture materials used in myomectomy

Dobrokhotova J.E., Nasyrova N.I., Gavrilov M.V.

Abstract

Uterine myoma is one of the most commonly diagnosed benign tumors among gynecological diseases. The optimal choice of a suture material favoring the formation of a qualitative uterine scar after nodular enucleation is one of the basic points during laparoscopic myomectomy. The objective of this paper is to review the data available in the literature on the application of different types of suture materials used in laparoscopic myomectomy.The literature data-based conclusion is that monofilament, absorbable, self-locking, nodeless suture materials are most effective.
Obstetrics and Gynecology. 2015;(8):53-58
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Evaluation of the efficiency of uterine artery embolization in reducing intraoperative blood loss in pregnant women with complete placental presentation

Tskhai V.B., Pavlov A.V., Garber J.G., Bryukhovets S.M., Yametov P.K., Raspopin J.S., Glyzina J.N., Brezhneva N.V., Levanova E.A., Dudina A.Y.

Abstract

Subject and methods. A comparative study of the results of operative delivery of 78 pregnant women with placental presentation, which were divided into 2 groups. The first group included 64 patients, in whom surgical delivery was carried out without performing UAE. The second group - 14 patients to whom selective embolization was performed in the course of surgical delivery. In most cases, a median laparotomy and bottom cesarean section were performed. In cases of localization of the placenta on the rear wall and in its absence the lower segment is capable of performing laparotomy by Pfannenstiel "high " cross-section in the uterus. UAE and caesarean section were performed under angiographic operating. Results. The value of the average blood loss in the group of patients who underwent UAE amounted to 2428,5 ± 869,4 ml, in the control group - 1725,7 ± 486,9 ml. In the group of patients who underwent EMA physiological postoperative blood loss in volume to 1000 ml (50 and 12.5%, respectively) significantly more often were observed, meanwhile significantly less blood loss (in the amount of 1000 to 1500 ml - 14.3 and 46.8%, respectively). We have not found signif icant differences in the frequency of massive blood loss from 1500 to 3000 ml, and the massive "critical" blood loss over 3000 ml in patients in the two comparison groups. Significant frequency of hysterectomies reduction in the group of patients who had performed EMA, compared with the control group (7.1 and 6.2% respectively), was not assigned. A case of a patient with a hysterectomy performed UAE, accompanied by blood loss of 12 000 ml, is described Conclusion. We have not received significant evidence to support the effectiveness of intraoperative UAE during delivery patients with placenta previa.
Obstetrics and Gynecology. 2015;(8):59-64
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A noninvasive prenatal test in the diagnosis of chromosome aneuploidies

Kurtser M.A., Gnetetskaya V.A.

Abstract

Objective. To evaluate the efficiency of a noninvasive prenatal test in the identification of trisomies 21, 18, and 13 and sex chromosome aneuploidies in maternal blood samples. Patients and methods. Results of an analysis of fetal DNA in maternal blood were obtained in 2010 pregnant women. Preparation of samples involved PCR amplification, sequencing, and information analysis of the results of sequencing that could separate fetal and maternal genomic DNA. Results. SNP-based investigation of fetal extracellular DNA in the serum of a pregnant woman correctly identif ied all cases of autosomal trisomies 13, 18, and 21, Turner’s syndrome, Klmefelter’s syndrome, polyploidy and determined the sex of a fetus in all cases. In our investigation, the Panorama test for Down’s syndrome achieved a sensitivity of 100 at 0.05% false-positive rates. Conclusion. The noninvasive prenatal test is an exact method to detect fetal trisomies 21, 18, and 13 and sex chromosome aneuploidy and may be recommended as a highly effective prenatal screening test in pregnant women at 9 weeks’ gestation.
Obstetrics and Gynecology. 2015;(8):65-69
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Current aspects of combination antibiotic therapy for nonspecific vaginitis and cervicitis: Results of the noninterventional study Balance

Apolikhina I.A., Gorbunova E.A., Dodova E.G., Gasanova G.F.

Abstract

Objective. To evaluate the efficacy and safety of flemoclav solutab (amoxicillin/clavulanic acid) and wilprafen (josamycin) in treating nonspecif ic vaginitis and cervicitis in real clinical practice. Subject and methods. A multicenter, non-interventional, prospective observational study was conducted in 15 centers from six cities of Russia in 2013 to 2014. The clinical efficiency of therapy was evaluated on the basis of clinical findings (the complete or partial disappearance of clinical signs and symptoms) and investigating physicians’ opinion. Microbiological efficacy was estimated in view of the trend in the eradication of an etiological agent. Results. The study enrolled 711 women (mean age 31.3±7.0years). According to the underlying nosological entity and indications for the use of the drugs, 67.9% of the patients with nonspecific vaginitis received mainly flemoclav solutab; 69% of the patients with cervicitis took wlprafen; 51.5% of the patients with nonspecific vaginitis and cervicitis had a combination of flemoclav solutab and wilprafen. Clinical recovery was observed in the majority of the patients irrespective of their diagnosis: in 212 (98.6%) cases of nonspecific vaginitis, in 220(90.9%) cases of nonspecific cervicitis. No clinical effect of the therapy under study was seen in 3 cases of cervicitis and in 7 cases of nonspecif ic vaginitis and cervicitis. Eradication of etiological agents was recorded in most cases: in 203 (94.4%)patients with nonspecific vaginitis, in 216 (89.3%)patients with cervicitis. The study recorded 14 (1.97%) adverse events, including 5 (0.7%) serious cases. Conclusion. Based on the findings, flemoclav solutab (amoxicillin/clavulanic acid) and wilprafen (josamycin) have confirmed the high efficacy and safety in the treatment of nonspecific vaginitis and/or cervicitis in real clinical practice.
Obstetrics and Gynecology. 2015;(8):70-77
pages 70-77 views

Surgical treatment for deep infiltrating endometriosis: Long-term results

Chuprynin V.D., Melnikov M.V., Pavlovich S.V., Khilkevich E.G., Gorshkova O.N., Khachatryan A.M., Abraamyan M.S., Gus A.I.

Abstract

Objective. To evaluate the clinical symptoms of deep infiltrating endometriosis and its surgical treatment in women with this condition. Subjects and methods. Fifty-two patients with deep infiltrating endometriosis were followed up in 2010 to 2013 and allocated into groups according to their age: 1) 4 (4.7%) women of early reproductive age; 2) 33 (63.5%) women of middle reproductive age; 3) 11 (21.15%) women of late reproductive age; 4) 4 (7.7%) women aged 46 years or older. All the patients underwent clinical, laboratory, and instrumental examination involving ultrasonography, magnetic resonance imaging, colonoscopy with biopsy, as well as surgical treatment. The diagnosis was verified by histological examination. After testing for the normality of data distribution, Spearman’s rank correlation coefficient was calculated to determine a relationship (correlation) between the variables. The data were statistically processed using the freely distributed software product WINPEPI version 9.7 (Abramson J.H. WINPEPI (PEPI-for-Windows): computer programs for epidemiologists. Epidemiologic Perspectives & Innovations 2004, 1: 6), Statsoft Statistica 8.0.725, IBM SPSS Statistics 19.0 for Windows. Results. The volume of surgical treatment depended on the site and depth of injury. The investigators excised and coagulated endometriotic foci, resected the vaginal wall and ovaries, and carried out segmental bowel resection. After performing surgical treatment, pain syndrome and dyspareunia were absent in 14 (27%) and 8 (15.4%) patients and remained only in 8 (15.4%) and 2 (3.8%) patients, respectively. Reproductive function was recovered in 14 (27%) patients; 12 (23%) women reported to have persistent infertility. Twenty (38.5%) patients pointed to the recovery of their menstrual cycle; menstrual dysfunction persisted in 10 (19%). After surgical treatment, all the patients who had previously complained of dyschezia, cyclic intestinal bleeding, diarrhea, and abdominal distension pointed out that these symptoms were absent. Complaints of blood and mucus in the stool were retained in 1 (1.9%) woman. Those of hematuria and dysuria were absent after treatment for urinary tract endometriosis. Pregnancy occurred in 21 women; delivery took place in 12 women. The correlation analysis revealed a weak positive correlation (p = 0.35822) between the older age of patients and the volume of surgical intervention (sigmoid colon resection). Conclusion. Our findings have indicated that single treatment with its maximum volume improves the results of surgery.
Obstetrics and Gynecology. 2015;(8):78-82
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Impact of menopausal hormonal and nonhormonal therapy on cytokine production with pe-ripheral blood cells in postmenopausal women

Isakova O.V., Bazhenova L.G., Zorina R.M., Tretyakova T.V., Markina L.A., Zorina V.N., Zorin N.A.

Abstract

Objective. To comparatively analyze the levels of cytokines (TNF-α, IL-6, and IFN-γ) in the serum and peripheral blood cell culture supernatants of women using the drugs of menopausal hormonal (Πβ-estradiol 1 mg + dydrogesterone 5 mg) and nonhormonal (genistein 60 mg) therapy and to study the relationship of their concentrations to the serum levels of pregnancy-associated α -glycoprotein (PAG). Subjects and methods. The levels of cytokines (TNF-α, IL-6, and IFN-γ) and PAG in the serum and cell culture supernatants (spontaneous and mitogen-induced cytokine production) were determined in 15 healthy women and 40 patients with moderate menopausal syndrome, who received hormonal (17ß-estradiol 1 mg + dydrogesterone 5 mg) and nonhormonal (genistein 60 mg) therapy for 3-6 months and for 2-5 years. Results. It was ascertained that there were increases in the stimulation index of TNF-α and IFN-γ and in mitogen-activated IFN-γ synthesis and a decrease in spontaneous IL-6 synthesis when a hormonal drug was used for 3-6 months. The administration of a nonhormonal drug for the same period reduced mitogen-induced synthesis and stimulation index for TNF-α. The use of a hormonal drug for 2-5 years failed to affect the functional activity of blood cells and the production of the study cytokines. Serum PAG concentrations were elevated in 26.3% of the women taking a hormonal drug for 3-6 months and in 40% of those using the same agent for 2-5 years. A correlation was established between blood PAG levels and mitogen-induced cytokine production: it was positive with TNF-α (r = 0.41; p = 0.037) and negative with IFN-γ (r = -0.4; p = 0.03) in the use of hormonal drugs regardless of its duration. Conclusion. The found correlations between the levels of cytokines (TNF-α and IFN-γ) in the mitogen-induced culture supernatants and the concentrations of the pregnancy protein PAG in the serum could identify a group at risk for oncoproliferative processes in the estrogen-dependent organs during menopausal hormonal therapy for more than 2 years.
Obstetrics and Gynecology. 2015;(8):83-88
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Results of the study of the efficiency and safety of vaginal ornidazole in the treatment of bacterial vaginosis

Kira E.F., Rogovskaya S.I., Artymuk N.V., Savicheva A.M., Gushchin A.E., Rumyantseva T.A., Ivanova O.V.

Abstract

Objective. To optimize the efficiency and safety of bacterial vaginosis (BV) therapy with combinations of metronidazole or ornidazole and a drug containing lactic acid and glycogen. Subjects and methods. An open-label multicenter randomized trial was conducted to study the efficiency and safety of vaginal ornidazole and its combination with lactagel versus oral metronidazole and its combination with lactagel. Four representative groups were made up from 142 reproductive-age patients (18-45 years old) included into the trial. These were: 1) oral metronidazole (n = 39); 2) vaginal ornidazole (n = 34); 3) oral metronidazole + vaginal lactagel (n = 35); 4) vaginal ornidazole + vaginal lactagel (n = 34). The investigators made objective gynecological examination, pH-metry, vaginal smear microscopy using the Nugent scoring system, key cell detection, an amino test (Amsel’s criteria), and PCR: florocenosis for diagnosing BV and AmpliSens-NCMT for detecting C. trachomatis, N. gonorrhoeae, M. genitalium, and T. vaginalis. The findings were statistically analyzed. Results. There were positive vaginal pH changes in all the groups, but they were signif icantly fewer in Groups 3 and 4. After a month of treatment completion, this indicator remained stable (<4.5) in the majority of women in Groups 2, 3, and 4 whereas Group 1 exhibited its increase >4.5. There was a similar tendency in the detection rate for key cells in the smears and in the amino test. By analyzing the eff iciency of treatment according Amsel’s criteria, the investigators could not reveal statistically significant differences (p = 0.544): 95, 94, 97, and 100% in Groups 1, 2, 3, and 4, respectively. At visit 2, the Nugent scores were significantly lower in Groups 3 and 4; a score of > 8 (BV) was seen only in Groups 1 and 2. The posttreatment Nugent scores were significantly lower in Groups 3 and 4. Prior to treatment, all the groups were matched for the levels of Gardnerella vaginalis detected at equally high concentrations (= 109 GE/ml) in all the patients. Following treatment, the concentration of G. vaginalis was decreased in all the groups, but it was significantly lower in groups 3 and 4 (p = 0.022). On the contrary, there was a consecutive rise in the number of lactobacilli during treatment. After treatment, the concentration of lactobacilli was significantly higher in Groups 3 and 4. In Groups 1 and 2, lactobacilli levels were also increased but to a lesser extent. Adverse reactions occurred in each group; however, they were not a reason for medication discontinuation in any of the cases or for exclusion of the patients from the trial. Conclusion. There is evidence that two-component treatment using metronidazole and ornidazole with lactic acid is more effective in treating BV than monotherapy with 5-nitroimidazole drugs.
Obstetrics and Gynecology. 2015;(8):89-95
pages 89-95 views

Vaginal discharge in gynecological patients: Etiology and approaches to diagnosis

Rumyantseva T.A., Sursyakov V.A., Khairullina G.A., Chernyshova L.A., Gushchin A.E.

Abstract

Objective. To estimate the informative value of clinical and laboratory data in examining patients complaining of vaginal discharge. Subjects and methods. The investigation enrolled 200 non-pregnant women who had sought gynecological advice for complaints of vaginal discharge. Examinations of all the patients and collection of their history data allowed the investigators to obtain materials for further laboratory studies using microscopy and real-time polymerase chain reaction (RT-PCR). Results. The examinees were found to have sexually transmitted infections in 18 (9.55) cases, bacterial vaginosis in 52 (27.5%), vulvovaginal candidiasis in 58 (30.7%), and aerobic vaginitis in 7(3.7%). The diagnostic sensitivity and specificity of clinical findings and microscopy proved to be low for all nosological entities. Conclusion. The most rational approach to examining patients with vaginal discharge was microscopy for evaluation of mucosal inflammation and RT-PCR for detection of the causative agents of respiratory infections.
Obstetrics and Gynecology. 2015;(8):96-101
pages 96-101 views

Dissecting aortic aneurysm and pregnancy

Smolnova T.V., Konysheva O.V., Tyulkina E.E., Bayandin N.L., Mikhsin S.V.

Abstract

Objective. To familiarize practitioners with diagnosis and treatment policy in patients with dissecting aortic aneurysm during pregnancy, labor, delivery, and the postpartum period. Subjects and methods. Two clinical cases of dissecting aortic aneurysm during pregnancy, labor, delivery, and the postpartum period were analyzed. Results. The paper analyzes 2 clinical cases of dissecting aortic aneurysm in the pregnant women and puerperas, one of which had a tragic end. It considers the urgency of the problem in pregnant women: its incidence is 0.6%; 4.5-6 and 20% of the cases are for Marfan syndrome and Loeys-Dierz syndrome, respectively. In urgent disease development, the survival rates are not greater than 9-13%. Follow-up prenatal visits according to the current order No. 572-н and clinical recommendations in the specialized health care facilities (HCF) will be able to prevent maternal mortality. Recommendations for diagnosis, management and treatment are given. Conclusion. The stages of examination and management of patients with cardiovascular diseases (in the context of connective tissue syndromes in this case), moreover, in the specialized HCF, guarantee successful management and prevention of fatal outcomes.
Obstetrics and Gynecology. 2015;(8):102-108
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Bilateral congenital diaphragmatic hernia: Complexities of prenatal prognosis and reproductive counseling of a family

Zaretskaya N.V., Burov A.A., Podurovskaya U.L., Voevodin S.M., Ekimov A.N., Trofimov D.Y., Lyapin V.M., Shchegolev A.I., Luzhina I.M., Demidov V.N., Degtyarev D.N.

Abstract

Background. Bilateral congenital diaphragmatic hernia (BCDH) in a neonate and a fetus is a rare congenital malformation with a poor prognosis. Case description. A clinical example has shown that the prenatal diagnosis of BCDH by visual methods is more effective in using not only ultrasonography, but also fetal magnetic resonance imaging. A clinical analysis of the genealogy and phenotypes of all family members is of importance in defining the type of BCDH inheritance and in predicting the future of descendants. Conclusion. Assisted reproductive technologies will be able to reduce the risk for rebirth of an infant with diaphragmatic hernia.
Obstetrics and Gynecology. 2015;(8):109-113
pages 109-113 views

Acute pyoinflammatory diseases in emergency gynecological practice

Baulina N.V., Usanov V.D., Baulin A.A., Klochkova E.A., Baulina E.A.

Abstract

Objective. To improve the immediate and late results of treatment in patients with acute pyoinflammatory diseases. Subject and methods. The basis for the investigation was 16-year archival paper and electron data, surgery journals, case reports, clinical observations, and investigations of the urban emergency gynecological service in the 0.5-million city. Results. In the past 8 years, in addition to single exhaustive operations, 94 programmed endoscopic sanitizations of the small pelvis have been performed in 38 patients, from 2 to 6 sanitations made in each 24-36 hours later. Re-entry technology did not involve leaving the ports; an entrance was made through the earlier puncture sites. The best result was obtained by programmed relaparotomies for disseminated peritonitis. Conclusion. The novel approach improved not only the results of treatment for genital inflammatory processes, but also reproductive function.
Obstetrics and Gynecology. 2015;(8):114-118
pages 114-118 views

The value of antiviral immunomodulatory therapy in improving the outcomes of treatment for HPV-associated diseases of the cervix uteri

Kononova I.N., Oboskalova T.A., Gizinger O.A., Voroshilina E.S.

Abstract

Objective. To investigate the clinical efficacy of the antiviral immunomodulatory drug Neovir in the combination treatment of patients with human papillomavirus (HPV)-associated cervical intraepithelial neoplasia grades II-III. Subjects and methods. Sixty patients aged 18 to 45 years with histologically verified HPV-associated cervical intraepithelial neoplasia grades II-III were examined and treated. Group 1 patients (n = 30) received the antiviral immunomodulatory drug Neovir at a dose of 250 mg intravenously once daily for 10 days. Group 2 women (n = 30) had traditional therapy: destructive treatment and electroconization. The evaluation of therapeutic efficiency was investigation of the pre- and posttreatment values of local immune parameters (sIgA, IFNa, IFN-γ, IL-1ß, IL-10, and TNF-α measured by Vector-Best test systems (Novosibirsk)), HPV elimination after 3-month therapy, and a reduced recurrence of a dysplastic process. Results. Local immune changes were characterized by a significant decrease in all the examined cytokine profile parameters. The neovir-treated patients were observed to have a 1.7-2.54-fold increase in the levels of the examined cytokines. Control examination demonstrated that every four patients had a normal colposcopic pattern requiring no destructive treatment. The postdestruction epithelization period was uncomplicated in Group 1 patients; complete epithelization was observed 3 weeks after therapy. In Group 2, epithelization was complicated by an additional inflammatory process in 5 patients and by bleeding in 2. A recurrence was found in 4 patients from Group 2 within 3 months. At 6 months after combination therapy, HPV was eliminated in 20 (66.7%) and 13 (43.3%) patients in Groups 1 and 2, respectively (U = 5.464; p = 0.004). Conclusion. It is appropriate to perform combination therapy including the use of the antiviral immunomodulatory drug Neovir before destructive treatment options to activate local immunity and interferonogenic parameters and to enhance the efficiency of treatment for cervical intraepithelial neoplasias associated with HPV infection.
Obstetrics and Gynecology. 2015;(8):119-123
pages 119-123 views

Issues of therapy for urogenital candidiasis in the context of immunology

Letyaeva O.I.

Abstract

The review deals with the state-of-the-art of vulvovaginal candidiasis. It gives data on the role of fungi of the Candida genus in biofilm formation, their substantial impact on the state of local anti-infection protective factors in non-pregnant and pregnant women. The issues of management tactics in patients with chronic recurrent vulvovaginal candidiasis are considered in accordance with basic orders and clinical guidelines.
Obstetrics and Gynecology. 2015;(8):124-130
pages 124-130 views

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