No 6 (2018)

According to WHO, about 20 million people worldwide are currently infected with human papillomavirus (HPV). Low sexual culture of the population, frequent change of sexual partners increase the risk of developing HPV infection, contribute to the growth of the number of inflammatory diseases of the genital tract, which subsequently leads to violations of the reproductive function, as well as to the development of precancerous cervical diseases. The above-mentioned facts determine the search for effective therapy of HPV infection in order to prevent the development of cervical cancer. The article presents modern data on the feasibility of comprehensive treatment of HPV, which includes not only influence on pathologically altered tissues, but also non-specific antiviral and immunomodulating therapy

This review is devoted to the analysis of the state of the problem of «thin» endometrium. One of the main ways to solve the problem of overcoming reproductive failures includes the correction of endometrial dysfunction associated with a violation of endometrial receptivity and the reparative potential, called «thin» endometrium. The features of the clinical manifestation and diagnosis of the syndrome of «thin» endometrium are described; the principles of choice of therapy aimed at restoring the morphofunctional state of the endometrium are determined. Diagnostic possibilities regarding the endometrial receptivity are currently insufficient. Their search will allow to increase the effectiveness of overcoming reproductive failures associated with the syndrome of «thin» endometrium in the future

Background. Lichen sclerosus et atrophicus (LSA) - a chronic inflammatory lesion of the skin and mucous layers, most often found in the anogenital region and manifested by itching, soreness, atrophy and scar deformation of tissues. The problem of LSA in genitals in women of different age is not currently solved due to the lack of standard methods of treatment. To prevent atrophic processes in stratified squamous epithelium of the genitals and recurrence of the disease, prolonged local therapy with glucocorticoids is carried out. However, long-term local use of strong glucocorticoids (according to the European classification Miller & Munro) cause epithelial atrophy and worsen the course of the disease. In this regard, it is advisable to use glucocorticoids with the absence of this side effect, including the cases of conjunction with drugs of other pharmacological groups. The appearance on the market of topical corticosteroids containing emollients (fats and fat-like substances that can create a protective lipid layer on the surface of the skin), as well as drugs with anti-inflammatory action, proved the development of a scheme for their effective use in LSA. Objective. To evaluate the effectiveness of topical corticosteroids of Methylprednisolone aceponate with ceramides (Komphoderm K) and topical calcineurin inhibitor Tacrolimus (Tacropic 0,03%) in the treatment of LSA in women at different age periods. Methods. 60 women with LSA voluntarily participated in the study. The first group consisted of 22 patients aged 18-45 years (reproductive period), the second - 46-75 years (menopausal transition, menopause and postmenopause). All patients were prescribed complex therapy: application of the cream containing topical GCS/ceramides (weak activity class), once a day for 2 weeks; after - 2 times a week for 4 weeks; from the 15th day after the start of treatment - application of topical calcineurin inhibitor (tacrolimus 0.03%) 2 times a day for 6 months were carried out. The effectiveness of treatment was evaluated at 2, 6, 12 weeks and 6 months after the start of treatment by the dynamics of the presence/absence of symptoms, as well as the severity of the most frequent of them (itching, atrophy and pallor of the vulva), revealed by the results of the pre-treatment examination. Results. The most labile symptoms of SAL, mostly occurring within 6 months after the start of treatment, were: in patients of all age groups (18-75 years) - itching, scaling, burning and lichenification of the vulva; In addition, in women of reproductive age (18-45 years) -dyspareunia, sclerosis, atrophy, hemorrhage and rigidity. Symptoms, relatively resistant to the therapy, were characteristic of older women and included dyspareunia, sclerosis, pallor, atrophy and vulva rigidity. The severity of the most significant symptoms of SAL (itching, atrophy, pallor) in the first 2 weeks after the start of treatment was significantly reduced, which indicates the early effectiveness of the therapy. Conclusion. Complex application of topical drug Komfoderm K (unhalogenized topical corticosteroid of a weak class of activity with a high level of safety, capable of long-term stay in the affected tissues, with the addition of humectants in the form of ceramides with emollient functions) and a topical inhibitor of calcineurin (Tacropic 0,03%) showed a high effectiveness in the treatment and prevention of recurrence of LSA in women in different age periods.

Background. In the past decade, worldwide attention has been focused on reducing maternal morbidity and mortality. At the same time, there is an increase in the number of pregnancies against the background of extragenital pathology, among which a special role is assigned to diseases of the nervous system. Objective: to evaluate the features of the course of cerebral pathology in pregnant women for the expansion of the possibilities of differential diagnosis of various neurological complications during pregnancy. Methods. Archival medical records of pregnant and puerperant women who were admitted to intensive care units with suspicion of acute neurologic pathology for the period from 2012 to 2016 were analyzed. The study was conducted at the premises of a city multifield hospital in St. Petersburg. The analysis included 28 case histories. The patient age, gestational age, the final diagnosis, the results of instrumental methods of diagnosis during hospitalization, the results of laboratory methods of examination at admission and at discharge, as well as the blood pressure level of arterial pressure at admission were registered. Results. It was found that the age of patients during the study period ranged from 19 to 46 years. All patients were delivered at gestational age of 28-41 weeks. The structure of neurological pathology during pregnancy was multiform and included encephalopathy, strokes, brain tumors, and epilepsy. The most common cause of hospitalization of pregnant women was mixed encephalopathy. As for laboratory data, it should be noted that the presence of anemia, dyslipidemia, hypoalbuminemia, and hyperfibrinogenemia contributed to the development of neurological complications in pregnant women. Conclusion. Diagnosis of cerebral pathology in pregnant women causes significant difficulties. During pregnancy, particular attention should be paid to the such manifestations as headache, nausea and vomiting, which are considered the first symptoms of the pathology of the nervous system. Neurological complications during pregnancy remain an interdisciplinary problem requiring involvement of such specialists as obstetrician-gynecologist, neurologist, ophthalmologist, therapist and neurosurgeon in diagnostics and treatment.

Background. For rational antibacterial therapy of postpartum endometritis, it is important to choose the right drug based on the local sensitivity of the pathogen to antibiotics. Objective. Evaluation of the etiological structure of endometritis after cesarean section and identification of the most effective antibacterial drugs based on in vitro studies. Methods. Bacteriological study of metoaspirate with determination of antibiotic susceptibility of obtained isolates in 70 puerperas with postpartum endometritis. Results. The microbiological studies have revealed that conditionally pathogenic microorganisms inhabiting the gastrointestinal tract (enterobacteria and enterococci) were predominantly isolated. Their proportion was 44%. In 15% of cases, the cause of metroendometritis was Staphylococcus aureus and Streptococci. In general, the isolated flora had a low resistance to the antibiotics most often used in maternity hospitals. Only a small number of strains had multiple drug resistance. Conclusion. Beta-lactam antibiotics remain the most effective drug in the treatment of endometritis after cesarean section.

Objective: to evaluate the results of the use of dose-intensive neoadjuvant chemotherapy (NACT) with doxorubicin and cisplatin in patients with locally advanced cervical cancer stage IB2-IIB. Methods. In the patients participating in the study, the efficacy and toxi-city of 3 cycles of intravenous dose-intensive NACT according to the AP scheme (cisplatin 75 mg/m2, doxorubicin 35 mg/m2) and subsequent radical surgical intervention in 62 (89%) cases were evaluated. Results. The study involved 70 patients with locally advanced cervical cancer at the age of 27-68 years (mean age, 45 years). Against the background of the treatment, an objective response was received from 58 (83%) patients. Progression of the disease was detected in 6 (8.6%) cases; relapse of the disease was diagnosed in 2 (2.8%) patients. Neoadjuvant therapy allowed to perform radical surgical intervention in 61 (87.1%) patients. The tumor pathomorphological response of various degrees was obtained in 58 (82.8%) cases; complete clinical regression of the tumor was confirmed by a complete pathomorphological response in 5 (7.14%) of these cases. The dose-intensive regimen of chemotherapy did not lead to significant complications at the pharmacological and surgical stages of treatment. Conclusion. Analysis of the study results has showed that dose-intensive NACT is an effective method and can be considered as an alternative to standard treatment of locally advanced cervical cancer.

Background. Peripartum cardiomyopathy (PPCM) is one of the most severe forms of extragenital pathology, which often results in a fatal outcome. Actually, PPCM is variant of dilated cardiomyopathy, which develops in the last trimester of pregnancy and in the early postpartum period, leads to the development of congestive heart failure, and can be accompanied by thromboembolic complications and life-threatening rhythm disorders. Description of the clinical case. The article presents a 10-year clinical follow-up in the settings of the cardiological department of the female patient with PPCM, which managed to achieve stabilization of hemodynamics, reduction of the size of the heart cavities, increase in the myocardial contractility. The complexity of diagnosis and selection of adequate therapy are described. Conclusion. Each clinical experience in the management of patients with PPCM seems to be useful for developing a general concept of diagnostic and therapeutic approaches for this disease.

The article presents the experience of treating patients with infectious-inflammatory postpartum complications (IIPCs) in the gynecological department of the St. Petersburg Mariinsky City Hospital, whose history history dates back for 40 years. The department employs the fifth generation of doctors who have approaches to diagnosing and treating these serious diseases. Treatment of severe forms of IIPCs, taking into account the increasing resistance of pathogens of the disease, and concomitant extragenital pathology, requires an individual approach, large time, moral and material costs. The average cost of only medicinal provision for a septic patient is 59,254 rubles, not including laboratory and instrumental examinations, stay in intensive care units, etc.

Background. Currently, the use of checkpoint inhibitors in the treatment of bladder cancer (BC) is one of the most promising directions. PD-L1 expression in patients with EBV-associated BC is associated with an unfavorable prognosis of the disease. Description of case series. PD-L1 expression in patients with urothelial BC and the presence of viral DNA (cytomegalovirus - CMV, Epstein-Barr virus - EBV, high-risk human papillomavirus - HPV) in tumor tissue was determined in the study. PD-L1 expression of in tumor cells in patients with the presence of viral DNA in tumor tissue >60% was detected in 3 of 8 patients, in immune cells >1% occurred in 9 of 10 patients. Conclusion. Thus, in patients with BC, including non-muscle invasive BC, and with the signs of latent viral infection, especially combined (EBV+CMV+HPV), it is reasonable to determine the PD-L1 expression as a marker of unfavorable course of the tumor process. In this category of patients, treatment with anti-PD-L1 agents is possible in order to increase the disease-free period and cancer-specific survival. However, further research is required.