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No 8-1 (2012)
- Year: 2012
- Articles: 15
- URL: https://journals.eco-vector.com/0300-9092/issue/view/6342
Articles
MOLECULAR GENETIC TECHNIQUES FOR THE PRENATAL DIAGNOSIS OF CHROMOSOME ABNORMALITIES
Abstract
The given review considers the current molecular genetic methods used in prenatal diagnosis: interphase fluorescence in situ hybridization, quantitative fluorescence polymerase chain reaction, multiplex ligase chain reaction, prenatal BACs-on-Beads assay, and a comparative genomic hybridization technique. The methods complement the standard cytological technique and overcome its some restrictions. The presented review comparatively analyzes these methods, capacities and limitations. The technology of the methods is based on the attention focused in the hot spots of chromosomes, whose change gives rise to certain pathological syndromes; the notion of targeted molecular genetic karyotyping is introduced. The tactics of a genetic laboratory study in prenatal diagnosis are discussed. The advance of molecular genetic techniques poses a new data interpretation problem that is yet to be solved.
Obstetrics and Gynecology. 2012;(8-1):4-9
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IMMUNO-HORMONAL INTERACTIONS IN GENESIS OF EARLY PREGNANCY LOSS
Abstract
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.
Obstetrics and Gynecology. 2012;(8-1):10-14
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RETROSPECTIVE ANALYSIS OF UTERINE ARTERY EMBOLIZATION
Abstract
Subjects and methods. The case histories of 1500 patients who had undergone UMA for uterine myoma in 2003 to 2010 and had been followed up by the authors for 2—3 years were retrospectively analyzed. The patients aged 21 to 56 years; 81.3% were reproductive-aged. Before UMA, the authors performed a small pelvic ultrasound study, by determining the Doppler blood flow values in the uterine arteries (UAs) and their branches, aspiration to evaluate the endometrium, and, if indicated, hysteroscopy and separate diagnostic curettage of the uterine cavity walls. To evaluate ovarian function, the hormonal prof ile was examined before and after UAE. Results. UA catheterization failures occurred, when the procedure was being mastered, and were due to the anatomical features of UAs. The latter’s perforation was encountered in 10 patients. Two hundred and forty patients were observed to have abnormalities in the uterine vascular anatomic network: in 9 patients, blood supply to the uterus was from the hypertrophic ovarian arteries; there were specif ic origins of UAs in 10, giant UAs in 5, an abnormal network of blood supply to myomatous nodules in 15, and utero-ovary anastomoses of varying degrees in 200. After UAE, menometrorrhagias were ameliorated during 2—3 months; the degree of symptoms of small pelvic compression and chronic pelvic pains were reduced during 4-6 months. Thirty patients required repeat UAE due to its ineffectiveness and the presence of clinical symptoms: 20 patients had undergone partial or complete UA recanalization; 10 had ineffective embolization at the first attempt. Fourteen patients were found to have oligomenorrhea without changes in basal follicle-stimulating hormone levels; their menstrual cycle became normal within 4—6 months. Transient amenorrhea occurred in 7 (0.5%) patients; persistent amenorrhea was noted in 2 cases (patients were aged 44 and 46 years). Conclusion. UAE is highly effective in treating uterine myoma; the procedure can induce complications associated with iatrogenic errors and the anatomic features of blood supply to myomatous nodules. To avoid these complications, UAE must be performed by highly skilled X-ray vascular surgeons, by taking into account the specific features of the anatomy of small pelvic organs and blood supply to them.
Obstetrics and Gynecology. 2012;(8-1):15-19
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EVALUATION OF ENDOMETRIAL HISTOLOGICAL AND IMMUNOHISTOCHEMICAL CHANGES AFTER UTERINE ARTERY EMBOLIZATION FOR UTERINE MYOMA
Abstract
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.
Obstetrics and Gynecology. 2012;(8-1):20-24
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LEVELS OF ACTIVIN A IN THE BLOOD OF SPONTANEOUS ECTOPIC PREGNANCY
Abstract
Objective. Comparative the level of activin A in blood at patients with ectopic pregnancy and uteri pregnancy taking into account features of development cytotrophoblast till 7 weeks gestation. Subjects and methods. 38 patients of reproductive age are included in research from 18 till 42 years (30,8±5,3 year). The group of patients with trumpet pregnancy till 7 weeks гестации was made by 16 women, with trumpet pregnancy after 7 weeks - 5 women. Patients with маточной pregnancy: till 7 weeks — 12 women, after 7 weeks — 5. Level of β-hCG in blood serum was carried out immune fluorescent method, progesterone and activin A levels was detection with enzymoimmunoassay. Results. The level of activin A in the blood at spontaneous ectopic pregnancy till 7 weeks does not significant from uteri pregnancy. After 7 weeks level of activin A statistically significant was more low at ectopic pregnancy. Conclusion. The level of activin A in the blood at spontaneous uteri pregnancy should be used for processes cytotrophoblast invasion and placentation at dynamic supervision after 7 weeks gestation.
Obstetrics and Gynecology. 2012;(8-1):25-31
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AN ORDINAL CLINICAL RATING SCALE IN WOMEN WITH AN UNCOMPLICATED EXACERBATION OF CHRONIC INFLAMMATORY DISEASES OF THE UTERUS AND APPENDAGES
Abstract
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.
Obstetrics and Gynecology. 2012;(8-1):32-39
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CURRENT CAPABILITIES OF THE ETIOLOGICAL DIAGNOSIS OF CHRONIC ENDOMETRITIS
Abstract
Objective. To study the microflora of the genital tract in women with or without chronic endometritis (CE) to provide a pathogenetic rationale for the etiological role of a microbial factor in the genesis of CE. Subjects and methods. The study enrolled 42 reproductive-aged patients who were divided into 3 groups according to histological findings: 1) 20 patients with CE; 2) 8 with endometrial polyps; 3) 14 without endometrial abnormality (a control group). Hysteroscopy and diagnostic endometrectomy were performed in 27 patients; aspiration endometrial biopsy was carried out with a Pipelle de Cornie curette in 15. All the women underwent microflora examination in the reproductive tract (vagina, cervical canal, endometrium) by cultural studies; polymerase chain reaction was used to detect absolute pathogens (Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium) and viruses (herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) and cytomegalovirus (CMV)). The Mann-Whitney test, χ 2 test, and Spearman’s correlation analysis were employed for statistical processing. The values of p<0.05 were considered statistically significant for all types of analysis. Results. Opportunistic microorganisms (OMs) were revealed in the endometrium of every two (55.0%) patients with CE. The endometrial homogenate most frequently showed the following OMs: Gardnerella vaginalis in 29.4% of cases, Enterococcus faecalis in 17.6%, and Escherichia œli in 11.8%. In the control group, there was no growth of OMs in the endometrial biopsy specimen. The etiological implication of absolute pathogens, genital Mycoplasma, HSV-1, and HSV-2 was not corroborated. CMV was found in 2.4% of cases. A strong direct relationship was established between the changes in the vaginal microflora and the detection of OMs in the endometrial biopsy specimen (r=0.76;p<0.05).
Obstetrics and Gynecology. 2012;(8-1):40-45
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EFFICIENCY OF TREATMENT FOR INFERTILITY ASSOCIATED WITH PERITONEAL AND OVARIAN ENDOMETRIOSIS
Abstract
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.
Obstetrics and Gynecology. 2012;(8-1):46-50
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REAL POSSIBILITIES FOR ECHOCARDIOGRAPHIC DIAGNOSIS OF FETAL AORTIC COARCTATION
Abstract
The paper gives the results of long-term observations by Russian and foreign specialists using ultrasound echocardiography in the diagnosis of aortic coarctation in the prenatal period. Since the diagnostic accuracy is not greater than 52% according to the specialists’ data worldwide, the author analyzes reasons for errors. The most common ultrasound changes that may be obtained by specialists in the prenatal diagnosis of aortic coarctation are presented.
Obstetrics and Gynecology. 2012;(8-1):51-55
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THE TIME COURSE OF CHANGES IN THE CLINICAL SYMPTOMS OF ANTIOXIDANDT DEFICIENCY AND ITS CORRECTION WITH THE HERBAL AGENT MASTODYNON IN WOMEN WITH DIFFUSE MASTOPATHY (BENIGN BREAST DISEASE)
Abstract
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.
Obstetrics and Gynecology. 2012;(8-1):56-59
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A CLINICAL CASE OF CONGENITAL CLOACAL ANOMALY OF PELVIC ORGANS
Abstract
The paper describes a clinical case of severe concomitant anorectal and urogenital malformation in an 11-year female patient who has undergone more than 20 reconstructive surgical interventions. Surgical correction in patients with cloacal malformation of pelvic organs is a major challenge because of concomitant anomalies and requires that urologists, proctologists, and gynecologists should jointly participate in the choice of the optimal volume of surgery and in the prevention of multiple interventions. At the first stage, the function of the vital organs of the digestive and urinary systems should be restored, followed by their repair where possible. If the concomitant genital anomaly is present, it is necessary to objectively assess whether adequate repair can be performed, by taking into account the magnitude of dysplastic changes and the degree of malformation of the uterus, vagina, and gonads.
Obstetrics and Gynecology. 2012;(8-1):60-63
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PRIMARY HYPERPARATHYROIDISM DURING PREGNANCY AND POSTPARTUM
Abstract
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.
Obstetrics and Gynecology. 2012;(8-1):64-68
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ULTRASOUND DIAGNOSIS OF FOREIGH BODIES IN THE PELVIS AND INTERNAL GENITALS
Abstract
The paper gives the population rates, mortality, classification, and clinical manifestations of foreign bodies at various sites. It describes the echographic signs of foreign bodies in the pelvis, uterus, and vagina, including the fetus papyraceous from old pregnancy, fetal bony skeletal fragments after pregnancy termination, abnormally located intrauterine contraceptives, gauze tampons and pads, suture material, sewing and operating needles and their fragments, slipping-out catheters, a plastic ball long staying in the pelvic cavity, and different vaginal foreign bodies. The echographic signs of vaginal foreign bodies are also shown.
Obstetrics and Gynecology. 2012;(8-1):69-73
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EXPERIENCE IN USING GONADOTROPIN-RELEASING HORMONE AGONISTS IN PATIENTS WITH MULTIPLE LEIMYOMATOUS HAMARTOMA OF THE LUNG (A clinical observation)
Abstract
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.
Obstetrics and Gynecology. 2012;(8-1):74-77
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EFFICACY AND TOLERANCE OF IRON PREPARATIONS IN THE PREVENTION AND TREATMENT OF ANEMIA IN PREGNANT WOMEN
Abstract
The given paper considers the efficacy and acceptability of oral drugs for the treatment of iron-deficiency anemia during pregnancy. It presents information on the recovery rate of hematological parameters, on the frequency and magnitude of side effects of different ferrous salts and iron III hydroxide polymaltose complex. Having equal clinical and laboratory effectiveness, ferric iron preparations as part of the hydroxide polymaltose complex show a higher degree of tolerability and safety in the prevention and treatment of iron-deficiency states in pregnant women.
Obstetrics and Gynecology. 2012;(8-1):78-83
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