No 3 (2013)

During pregnancy, folate deficiency leads to a significant increase in the frequency of congenital abnormalities due to violations of DNA methylation. Compensation of folate deficiency only with synthetic folic acid (FA) is not always successful, because it has to be transformed to the active form of folate (tetrahydrofolate) through specific enzyme systems. In many women, these systems may be lost due to genetic defects, drugs that block these enzymes, and other reasons. This necessitates the use of active folate (AF) for the improvement of efficiency and safety of compensation of folate deficiency, especially in the relevant risk groups. This review presents the results of a systematic analysis of fundamental and clinical medicine, indicating the perspectiveness of use of AF for the nutrient supplementation in pregnancy and for other indications in the field of obstetrics, and gynecology. It is shown that AF is characterized by pronounced antiteratogenic effect and significantly neutralizes the negative effects of retinoids, nitrogen oxides, valproic acid and methotrexate on the growing embryo. In contrast to the inactive FA, the excess of which leads to blockage of folate metabolism, excess of AF has no such effect. Therefore AF has no side effects typical of excessive consumption of FA, and has a positive impact in any genotype of folate biotransformation enzyme systems.

The results of the evaluation of 396 patients with complaints of erectile dysfunction (ED) are presented. Alprostadil was used for the pharmacological Doppler sonography of cavernous arteries. The test was assessed 15 minutes after intracavernosal injection of drug. The degree of erectile dysfunction was defined in accordance with the degree of penile tumescence and rigidity of the penis. Along with assessment of the effectiveness of alprostadil, the spectral characteristics of the cavernous artery blood flow were analyzed. Clinical result of intracavernous administration of alprostadil (degree of filling and rigidity of the penis) was most pronounced in young patients. The presence and type of risk factors did not significantly influence the clinical result of test. Clinical result of intracavernous administration of drug in patients with preserved sexual activity was significantly higher. Thus, application of 5 μg of alprostadil is an effective and safe method for evaluation of patients with ED of various origins and severity.

The present study aimed to compare the effectiveness of extracorporeal shock wave lithotripsy (ESWL) and contact ureterolithotripsy (CULT) included the results of treatment 481 patients with ureteral calculi: ESWL was performed in 224 patients, and CULT - in 257 patients. Complete destruction of the calculi using ESWL was observed in 94,7 %, and using CULT - in 86,4 % of cases. Postoperative complications rate in the application of ESWL was 4,0 %, in the application of CULT - 10,9 %. The average number of sessions of ESWL for 1 patient was 1.28 ± 0.05, the average duration of DLT session - 49,48 ± 2,16 minutes. CULT required one session for litholisis and removal of calculus, and the average duration of one session was 68,54 ± 3,14 minutes. The choice of method of treatment for patients with ureteral calculi (ESWL, CULT) depends on the location, size, density of calculus, state of the upper urinary tract, as well as the technical equipment of the clinic and the surgeon's experience.

The article presents the results of the evaluation of the efficacy and tolerability of dienogest in the combined treatment of 176 patients with external genital endometriosis and patients with associated hyperplastic processes in other organs of reproductive system. It is shown that dienogest at a dose of 2 mg is effective in the treatment of endometriosis, significantly reduces the severity of pain, and can be used for a long time; dienogest should be considered as the drug of choice for patients with recurrence of disease.

The article presents the results of the study involving 77 patients with urinary incontinence (UI) after radical prostatectomy; patients underwent pelvic floor muscle training with control of biofeedback for therapeutic purposes. In order to increase the effectiveness of treatment, 16 (20,8 %) patients have received М-anticholinergic drug trospium chloride as a part of complex therapy for the reduction of frequency of involuntary contractions of the detrusor. Pelvic floor muscle training in patients with UI led to reduction of incidence of involuntary detrusor contractions, and prevention of the reduction of pressure in the urethra in response to a sudden increase in intra-abdominal pressure. The use of trospium chloride for the complex treatment of urinary incontinence has strengthened inhibitory effect of voluntary contractions of pelvic floor muscles on detrusor.

The article describes the author's own concept that taking into account the known anatomical and functional unity of male reproductive system early sign of subclinical erectile dysfunction can be considered prostatostasis, a phenomenon that was previously associated with the initial stages of prostatitis. The article presents the epidemiological and pathophysiological basis and formulates principles and recommendations, allowing to implement this concept in routine clinical practice in the form of modeling and optimization of the use of some phytoadaptogens (ginseng) in the diagnosis and treatment for patients with prostatostasis and latent (preclinical) forms of erectile dysfunction.

The aggressive expansion in the market of medicine preparations has contributed to the rise of the number of registered drug’s side effects, especially during pregnancy. The influence of drugs during pregnancy is still poorly understood area, and opinions on the safety of their use are very controversial. Potentials for prevention of the negative effects of pharmacotherapy or their significant reduction consist of understanding of principles of pharmacotherapy, strict conformity of drugs used with modern knowledge level, as well as a competent interpretation of data of the clinical monitoring of pregnant women. All this allows to avoid both diagnostic and therapeutic polypragmasy.

This review article considers the issues of modern treatment of erectile dysfunction using oral drugs. The comparative data on the effectiveness of various phosphodiesterase type 5 inhibitors are presented. Information about the new drug of this group - Cialis (tadalafil) - 5 mg for daily use, is provided. It is emphasized that the innovative concept of therapy of erectile dysfunction with the use of specially designed phosphodiesterase type 5 inhibitor of for everyday application opens up new potentials for the correction of erectile dysfunction.