卷 31, 编号 3 (2024)

An analysis of literature data on epidemiology, morphofunctional changes and molecular mechanisms of remodeling of the connective tissue of the woman’s reproductive system during pregnancy, childbirth and the postpartum period was carried out. The search and analysis of publications in the PUBMED, ScienceDirect, eLIBRARY.RU databases was carried out. The importance of genes that control the processes of synthesis and degradation of connective tissue, in particular the genes for collagen, fibulin and lysyl oxidase-like protein, is described. The place of matrix metalloproteinases and their tissue inhibitors in the proteolytic degradation of the extracellular matrix of connective tissue is discussed. Modern data on methods for assessing the function and strength of the pelvic floor muscles in women during pregnancy are presented, and modern possibilities for conservative treatment of women with pelvic floor dysfunction namely, the use of high-frequency radiotherapy with a detailed description of the mechanisms of effectiveness, are revealed.

The article describes the medicinal properties of peloids, the mechanism of action and the possibilities of using peloid therapy in the treatment of patients with chronic infectious and inflammatory diseases of the pelvic organs. A search and study of publications containing information on the use of peloid therapy in gynecological practice was carried out in domestic and foreign databases (PubMed, CyberLeninka, Elibrary, Google Scholar). Also, authors have presented their own clinical experience of using Dead Sea mud in treatment, preventive and rehabilitation programs for women with infectious and inflammatory diseases of the urogenital tract.

Conclusion. Most publications on the use of peloid therapy cover the treatment of rheumatic or dermatological diseases. Data on the effectiveness of peloid therapy in gynecology are very limited. Analysis of available data and author’s own clinical experience using a gel based on Dead Sea mud confirmed the positive effect of peloid therapy in the rehabilitation of patients with chronic urogynecological diseases, such as vulvovaginitis, cervicitis, cystourethritis. However, further studies with a larger sample of patients are necessary to develop standardized algorithms for the prevention of chronic gynecological diseases.

Uterine fibroids (UF) are a common benign tumor of the female genital tract, diagnosed in almost a quarter of women of reproductive age. In case of infertility, UF is detected in 23.5% of cases. Submucosal localization of UF is the most common cause of infertility or pregnancy loss during reproductive age. There is also convincing evidence of the negative impact of UF with a submucosal node on the outcomes of in vitro fertilization (IVF). Currently, hysteroscopic myomectomy is considered the most effective treatment for submucosal UFs. Traditionally, monopolar and bipolar resectoscopes are used for this surgery. However, an increase in the frequency of postoperative complications after hysteroresectoscopy leading to a decrease in reproductive potential has also been noted: the formation of intrauterine synechiae up to total obliteration of the uterine cavity. In view of the fact, the relevance of various methods of preoperative preparation and postoperative management of patients with submucosal UF, aimed at reducing the incidence of complications, is increasing.

Background. Pelvic organ prolapse (POP) is detected in a third of patients of reproductive age during examination The main treatment method for the symptomatic form of POP is surgical correction with elimination of the anatomical defect. Despite solving the problem of correcting the anatomical defect, it is important to restore the woman’s quality of life, including her sexual function in the postoperative period.

Objective. Evaluation of the effect of preoperative preparation using dynamic quadripolar radiofrequency (DQRF) and PRP therapy on the sexual health of patients and the morphological structure of the vaginal mucosa of women of reproductive age with POP.

Methods. A randomized comparative prospective study included 52 sexually active women of reproductive age with stage II–III pelvic organ prolapse according to POP-Q (Pelvic Organ Prolapse Quantification) aged 31 to 49 years. The patients were divided into 3 groups using a random number generator. Group I (n=17) of patients underwent preoperative preparation using DQRF before surgical treatment, group II (n=14) – using PRP therapy, group III (n=21) – control. All patients underwent surgical treatment: anterior colporrhaphy, cystocele repair with own tissues and/or posterior colporrhaphy, levatoroplasty. Intraoperatively, histological material (vaginal mucosa) was obtained. Before the start of preoperative preparation and 4 months after surgical treatment, a survey using the FSFI questionnaire (The Female Sexual Function Index) was conducted.

Results. All patients who underwent surgical treatment of POP showed an increase in the sexual function index, but women in the group with preoperative preparation had better indicators in the domains of lubrication, desire and satisfaction with sexual life. According to histological examination, signs of mild chronic inactive inflammation and fibrosis were noted in the vaginal mucosa of the control group. In the preoperative preparation groups, there is less severity of the inflammatory reaction, absence of infiltration and fibrosis of the stroma. In addition to the above changes, when examining the vaginal mucosa in the DQRF group, significant vascularization and homogeneous ordered structure of collagen fibers were recorded.

Conclusion. The use of DQRF and PRP therapy methods in women of reproductive age with POP as preoperative preparation demonstrated an improvement in sexual function in the postoperative period. According to a morphological study of the vaginal mucosa, the use of preoperative preparation using DQRF and PRP therapy has a positive effect on regeneration processes and reduces signs of chronic inactive inflammation. The DQRF stimulates tissue regeneration, regulates neoangiogenesis, neocollagenogenesis, as well as decreases chronic inactive inflammation, while PRP therapy acts exclusively in the form of a decrease in the morphological signs of chronic inflammation. DQRF can be considered as one of the methods of preoperative preparation for surgical treatment of genital prolapse to improve the quality of life of women and their sexual health in the postoperative period.

Background. Urethral strictures are a common urological disease characterized by narrowing of the lumen of the urethra, accompanied by a slower outflow of urine, pain in the perineum and lower back, possible dysfunction of sexual function, and the presence of micro- and macrohematuria. Urethroplasty (single-stage and stage-by-stage) using autologous grafts of buccal epithelium or part of the penis (dorsal part or skin flap) remains the “gold” standard in the treatment of urethral strictures (US). Despite the fact that considerable experience in urethroplasty has recently been accumulated, the risks of following complications remain: recurrence of strictures, development of fistulas, incontinence, deformation of the penis, bleeding from the graft collection site, etc. For this reason, attempts to create new and improve existing methods of surgical treatment SU continue. For example, urethroplasty using an acellular patch from bovine pericardium or a combined material with the addition of buccal epithelial cells are effective, but methods that are not available for widespread use. The success rate of using these materials varies from 58.2 to 88.9%. The effectiveness of drug-coated balloon dilatation is 67.0–74.6%, and the method itself may become widespread in the near future.

Objective. Comparison of the effectiveness of surgical treatment methods for male US.

Methods. We selected full-text articles published on the resources “PubMed” and “Scientific Electronic Library” in Russian or English on December 10, 2023 using the keywords: “urethra”, “stricture”, “urethral stricture”, “treatment of urethral stricture”, «urethroplasty», «tissue engineering». The selection criteria were: the topic of research on US and their treatment, tissue engineering, and the duration of the research less than 8 years.

Results. Our study showed that due to the great effectiveness of single-stage and stage-by-stage urethroplasty, internal optical urethrotomy and, despite the existing risks of dysfunction and shape of the penis, these methods remain leading among other methods of surgical treatment of male US.

Background. In children with bronchial asthma (BA), the upper respiratory tract pathology (URT; allergic rhinitis, adenoid hypertrophy) is often observed, which contributes to the uncontrolled BA course. Inflammation in both the upper and lower airways can be uniform, which may aggravate the BA course. However, it is necessary to differentiate the type of inflammation, which can be caused by a Th-2 or Th-1 immune response. Depending on the type of inflammation, further treatment tactics will depend. Therefore, it is important to study the local immunological status in patients with BA and URT pathology.

Objective. Evaluation of the interleukin-4 (IL-4), IL-5, IL-10, IL-8, IL-18, tumor necrosis factor-α (TNF-α) levels in nasal secretions in children with adenoid hypertrophy (AH), allergic rhinitis (AR) and their combination with BA.

Methods. The study involved 107 children aged 4 to 10 years. Group 1 consisted of children diagnosed with BA in combination with AR and AH (n=38); Group 2 (comparison) – children diagnosed with AR (n=32); Group 3 – children with AH (n=25); control group – 12 healthy children. The IL-4, IL-8, IL-18, IL-10, TNF-α levels were determined in nasal secretions using enzyme-linked immunosorbent assay (ELISA) kits from Vector-Best JSC (Russia, Novosibirsk). The IL-5 concentration was determined in nasal secretions by solid-phase ELISA using the IL-5 Human ELISA Kit from Invitrogen Thermo Fisher Scientific (USA). Cytokine concentrations were measured using a Multiscan Fc immunoassay analyzer (Thermo Scientific) and expressed in pg/ml.

Results. In children with BA in combination with AR and AH, a significant increase in the IL-4, IL-5, IL-10 and TNF-α levels was obtained, in children with AR – only IL-4 and IL-5 (p<0.05) .

Conclusion. The allergic process implies the same tendency for the production of cytokines, regardless of the nosological form, and the combination of nosologies leads to more pronounced inflammation. AH does not affect the local cytokine status, however, it contributes to the severity of clinical manifestations.

Background. Issues related to the safety of medicines in children are one of the pressing problems in the healthcare sector. The anatomical and physiological characteristics of a child’s body, especially at an early age, increase the risk of developing adverse drug reactions (ADRs).

Objective. Analysis of adverse drug reactions in children in the Voronezh region in 2020–2022.

Methods. An analysis of notifications of ADRs in children submitted to the Regional Drug Safety Center of the Voronezh Region in 2020–2022 was carried out. The analysis was carried out by gender, patient age, type of reaction, severity, predictability of reactions; clinical manifestations and number of drugs, treatment and outcome of ADR were assessed. Statistical processing was carried out in Microsoft Excel (2017).

Results. The study included 97 cases of ADRs, 45 reports in children under 5 years of age, 21 reports in children aged 5 to 11 years, and 31 reports in adolescents over 11 years of age. ADRs were more often registered in children under 5 years of age (46.4%), predominantly in boys. The incidence of serious ADRs increased with the age of children from 33.3% in young children to 45.2% in adolescents. 66.0% of ADRs were type B, 31.9% were type A, and there were 2 (2.1%) cases of lack of therapeutic effect. Main clinical manifestations: allergic reactions – urticaria (35.1%), angioedema (15.5%), depression of the nervous system (9.3%), hepatotoxicity (8.2%). The predominant drug reactions were to antibacterial drugs (43.3%) and drugs for the treatment of diseases of the nervous system (19.6%). In adolescents, serious ADRs requiring drug therapy were more often reported. The outcome of ADR in 87.6% of patients was recovery or improvement.

Conclusion. It is necessary to promptly identify emerging ADRs on drugs in children to prevent the development of complications, reduce the severity of the current process, as well as to prevent long-term consequences.

Tremendous progress has now been made in studying the etiopathogenesis of interstitial lung disease in children, with an understanding of how interstitial lung disease (ILD) in infants differs from the forms that occur in older children and adults. Diagnosis is difficult due to the rarity of diseases of this nosological group and the similarity of symptoms with other common respiratory diseases. Neuroendocrine cell hyperplasia of infancy (NEHI) today refers to diseases with a poorly understood etiology, but with a characteristic symptom complex and picture during diagnostic imaging. According to the literature, the prevalence of the disease has been little studied, because only individual cases are described. The disease is described in children of the first years of life and is characterized by constant tachypnea, slight hypoxemia, crepitus on auscultation of the lungs and a decrease in the rate of physical development. In the past, invasive diagnostic methods in the form of thoracoscopic lung biopsy were necessary to confirm the diagnosis, but now, due to accumulated experience and the description of characteristic changes on computed tomography in the form of a “mosaic perfusion” pattern involving at least 4 segments with a predominance in the projection of the middle lobe of the right and lingular segments of the left lung in combination with a characteristic symptom complex, does not require invasive research methods. Understanding the mechanisms of NEHI dictates a gentle tactics for administering the patient without the active use of therapy with systemic and inhaled glucocorticosteroids. At the same time, despite the described favorable prognosis of the disease, this nosological form remains poorly studied, and patients require special monitoring and long-term examination, because the effects on children’s health and pulmonary function in later life have not yet been described. The article presents a clinical case of diagnosis and follow-up of a child with NEHI, who was examined at the Pediatric Department of the N.N.Silishcheva Reginal Children’s Clinical Hospital, Astrakhan.

Background. When choosing the optimal type of surgical correction in patients with congenital heart defects (CHD), it is necessary to focus on a comprehensive echocardiographic study (Echo-CG). Coarctation of the aorta is a complex congenital heart disease in terms of diagnostics, therefore, it is important to use three-dimensional echo-CG in its diagnosis.

Description of the clinical case. In the presented clinical case, congenital heart disease (aortic arch hypoplasia) was detected in the fetus at the 19th week of gestation. An examination and long-term follow-up of a pregnant woman at the Cardiac Surgery Center in Astrakhan confirmed the diagnosis.

Results. Immediately after birth, the child underwent surgical treatment of a heart defect. Subsequently, during dynamic follow-up of the patient in the early and late stages of the postoperative period, no serious complications were identified.

Conclusion. Thus, accurate early antenatal diagnosis made it possible to determine the optimal routing of the child after birth and to pre-select tactics for timely correction of congenital heart disease, which ensured a favorable course of the postoperative period. This proves the great importance of prenatal diagnosis of critical heart defects using echocardiography.