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Vol 6, No 1 (2019)

Original papers
ORGAN-PRESERVING TREATMENT IN GYNECOLOGICAL TYPES OF CANCER
Silkina M.O., Sosnova E.A.
Abstract
Over the past 10 years, the treatment of malignant gynecological tumors has changed dramatically. For many years, a radical approach - extended hysterectomy with appendages at any stage of tumor development of internal genital organs was considered to be the only correct approach. However, many young women want to preserve their fertile function, and in this regard, the treatment tactic was improved and optimized towards the development of organ-preserving methods for the treatment of gynecological cancer. Based on the literature studied from the MedLine database, an analytical review of information on the possibilities of organ-preserving treatment for gynecological cancers in 2013-2018 was prepared and the implementation of a successful integrated organ-preserving treatment was found to be available only at early stages of cervical, endometrial and ovarian cancer. The overall survival after treatment correlates with the histological structure of the tumor, the degree of its differentiation and involvement of the underlying tissues in the pathological process, as well as the volume of surgical intervention. In most cases, after an organ-preserving treatment, the risk of tumor recurrence is low, and a woman regains a chance to become pregnant and give birth to a healthy child.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):4-7
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MODERN METHODS OF DIAGNOSTICS AND TREATMENT OF CHLAMYDIA INFECTION
Kaptilnyy V.A., Lystsev D.V.
Abstract
The review reflects the current understanding of the etiology, pathogenesis, and treatment of chlamydia. The advantages of new methods for the diagnosis of chlamydial infection using methods such as real-time polymerase chain reaction (PCR-RV) and real-time NASBA transcription amplification (NASBA-Real-Time) are described. Comparison with older methods, such as bacteriological, immunomorphological and immunological, has been made; diagnostic and treatment algorithms for chlamydial infection in pregnant women have been compiled.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):8-14
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TACTICS OF MANAGEMENT OF PATIENTS WITH ATYPICAL ENDOMETRIAL HYPERPLASIA (LITERATURE REVIEW)
Bakhtiyarov K.R., Apsalyamova A.V., Bogacheva N.A., Parsyan A.L.
Abstract
In the past few years, there has been a gain in the prevalence of hyperplastic processes of the reproductive system in women, among which atypical endometrial hyperplasia (AEH) occupies a special place. Such peculiarities of the clinical manifestation of this disease as the high prevalence, relapsing course, reduced reproductive function and high risk of malignancy reflect the urgency of the problem of prevention and increasing the effectiveness of treatment of endometrial hyperplastic processes. The purpose of the study is to analyze the data presented in modern literature on the tactics of management and treatment of AEH patients. Different tactics of management of AHE patients with effective methods of treating these patients are considered. Hysteroresectoscopy of hyperplastic areas before high-dose progestin therapy has been established to be a safe and highly effective approach to the management and treatment of AEH patients wanted to maintain their fertility. However, organ-preserving treatment must necessarily be accompanied by careful dynamic observation by the gynecologist or oncogynecologist. The optimal method of treating patients in pre- and postmenopausal disease is radical surgical treatment in the amount of extirpation of the uterus with appendages, which should be considered justified for this category of patients.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):15-18
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NEW APPROACHES IN THE TREATMENT OF CHRONIC VIRAL EPSTEIN-BARR INFECTION
Rakityanskaya I.A., Ryabova T.S., Todzhibaev U.A., Kalashnikova A.A.
Abstract
Introduction. Epstein-Barr virus (EBV) causes recurrent infectious mononucleosis-like symptoms. Today poisons of insects and animals were shown to be rich sources of antimicrobial substances (peptides) and contain a wide range of active biological compounds. Antimicrobial peptides play an important role in the immune response of the host’s innate immunity to pathogenic microorganisms. Based on antimicrobial peptides in Russia, an antiviral drug allokin-alpha has been developed. The active ingredient of the drug is cytokine-like peptide alloferon. The purpose of the study is to evaluate the effect of allokin-alpha therapy on the amount of EBV DNA in saliva samples and clinical complaints in patients with chronic Epstein-Barr viral infection (EBI). Material and methods. 59 chronic EBI patients (45 women and 14 men; mean age 32.52 ± 1.75 years) were examined. Patients were subjected to quantitative determination of Epstein-Barr virus DNA in saliva samples by the method of polymerase chain reaction (PCR) with real-time hybridization-fluorescence detection. The analytical sensitivity of the test system is 400 copies/ml. The patients were divided into two groups: 26 patients who received allokin-alpha therapy (9 injections subcutaneously with 1.0 mg every other day) were included in the 1st group; the 2nd group included 33 patients who received Valtrex (500 mg 2 times/day, orally) for 2 months. Results. After treatment with allocin-alpha, negative results of PCR were obtained in 59.67% of patients. After two months of Valtrex therapy, negative PCR results were obtained in only 27.27% of patients. The correlation analysis revealed a significant effect of the initial number of copies of EBV DNA on the severity of clinical complaints in the general group of EBV patients. Discussion. Allokin-alpha improves the recognition of virus-infected cells and helps to suppress viral replication. Conclusion. Allokin-alpha therapy can be recommended for the treatment of chronic EBV infection in a dose of 1 mg subcutaneously every other day with a course dose of at least 9 injections.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):19-26
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BIOCHEMICAL MARKERS OF ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ACUTE INFLAMMATORY DISEASES OF THE ORGANISM OF THE PELVIC ORGANS AGAINST THE BACKGROUND OF DIFFERENT TREATMENT OPTIONS
Burova N.A., Serdyukov S.V., Sadovskaya K.A., Zharkin N.A.
Abstract
Inflammatory diseases of the pelvic organs (IDPO) remain one of the most pressing and debatable problems of modern gynecology. Currently, IDPO acquired an erased course due to immune and vascular changes at the local and systemic level, leading to endothelial dysfunction, which, in the absence of acomprehensive, step-by-step treatment, causes chronicity and disrupts the fertility of women. We examined 184 patients with acute episodes of IDPO divided into 2 groups: the main group included 94 patients and the comparison group consisted of 90 patients. All patients started comprehensive drug anti-inflammatory therapy. Patients of the main group additionally received a vaginal laser-magnetopuncture from the 2nd to the 7th day of treatment. To assess the state of endothelial function, the enzyme-linked immunosorbent assay (ELISA) in the serum was used to determine the level of a metabolite of nitric oxide (NO) iNOS - inhibited endothelial NO synthase and endothelin-1. Similar markers were determined in the blood serum of 20 healthy women volunteers of the reproductive age. As a result of the study, in the acute phase of inflammation there was found an increase in both the vasodilator NO and the vasoconstrictor - endothelin-1, which was 2.5 times higher than in healthy women, which confirms the presence of endothelial dysfunction in IDPO patients, which cannot be stopped when carrying out traditional therapy. The use of improved complex treatment with the inclusion of preformed exposure factors contributed to the reduction in the production of NO and endothelin-1, the normalization of epithelial cells and the restoration of the vasomotor function of the endothelium. The use of laser-magnetic vaginal exposure in the early period of treatment and rehabilitation of IDPO patients may help prevent chronic inflammation and normalize the specific functions of the female body.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):27-31
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LEPTIN LEVEL IN WOMEN OF REPRODUCTIVE AGE WITH THE SYNDROME OF THE POLYCYSTIC OVARY IN COMPARISON WITH HEALTHY WOMEN
Beglova A.Y., Elgina S.I.
Abstract
Material and methods. The study included 200 women of reproductive age, of whom the 1st group included 100 PCOS female patients and the 2nd group included 100 healthy women examined using clinical, instrumental, laboratory, and statistical methods. Results. Metabolic syndrome was diagnosed in 38 (38.0%) PCOS women of early reproductive age, while in healthy women only in 25 (25.0%) (p = 0.102). The serum leptin content in PCOS women amounted of 13.85 ng/ml (4.15-17.6), which was not significantly different from that of healthy women - of 8.9 ng/ml (5.5-18.4) (p = 0.732). However, in women with manifestations of metabolic syndrome (overweight and obesity), the level of leptin was higher than in women without metabolic syndrome - 16.7 ng/ml (15.6-18.8) and 19.3 ng/ml (17.4-22.8) in PCOS women - 31.7 ng/ml (21.6-38.6) and 27.3 ng/ml (20.1-32.1) in healthy women (p = 0.045 and 0.604, respectively). An increase in its level correlated with an increase in BMI (p = 0.001). We found that an increase in leptin levels in PCOS women of reproductive age correlated with its main manifestations: menstrual disorders, infertility and ultrasound parameters of the ovaries, with an increase in BMI, the relationship was stronger. Conclusion. Thus, in PCOS women of reproductive age, metabolic syndrome is more often diagnosed than in healthy women. Overweight and obesity are of major importance in the formation of metabolic disorders. Increased leptin levels exacerbate metabolic manifestations, leading to impaired ovulation and fertility. The results show the need to determine the level of leptin as an additional diagnostic criterion for metabolic syndrome in PCOS cases.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):32-37
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INTEGRATED PREPARATION OF PREGNANT WOMEN WITH A UTERINE SCAR TO VAGINAL PARTURITION
Shevtsova E.P., Miroshnikov A.E., Shatilova Y.A., Zharkin N.A.
Abstract
Attempts of vaginal delivery in cases with a scar on the uterus after a previous cesarean section are more successful after appropriate psycho-prophylactic preparation during pregnancy. The purpose of the study is to reduce the frequency of repeated cesarean section operations. A comparison was made of the methods of delivery for pregnant women with a scar on the uterus after comprehensive training on an improved program and unprepared pregnant women. A total of 158 women were included in the study. Among them were those who had a cesarean section in history, but not trained for the current childbirth, only 5% gave birth independently. At the same time, women trained under the improved program had independent deliveries in 45.6% of cases (OR 5.813; 95% CI 0.826-40.885). The results confirm the effectiveness of the proposed improvements in the preparation of pregnant women with a scar on the uterus. The intention of such women to give birth through the natural birth canal, formed as a result of preparation, is an important factor for successfully overcoming the difficulties of the delivery process.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):38-42
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TREATMENT OF UTERINE MYOMA IN WOMEN PLANNING PREGNANCY BY FOCUSED ULTRASOUND ABLATION UNDER MRI CONTROL
Malysheva Y.R., Sosnova E.A.
Abstract
The purpose of this study is to evaluate the effectiveness of focused ultrasound (FUS) ablation as monotherapy for uterine fibroids in women planning a pregnancy. Of the 195 patients included in the study, long-term pregnancy occurred in 38. At the same time, immediately after FUS ablation, without prescribing additional methods of treatment, 7 patients became pregnant. Given the high frequency of additional surgical treatment methods (conservative myomectomy, hysteroresectoscopy), as well as additional procedures for FUS ablation, this method, despite its high efficacy in treating symptomatic myomas, cannot be recommended by us as the only treatment for uterine fibroids in women planning a pregnancy.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):43-46
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ATYPICAL HEMOLYTIC-UREMIC SYNDROME DURING PREGNANCY. PRESENT AND LATEST RESULTS OF TREATMENT
Zharkin N.A., Statsenko M.E., Stazharova M.M., Burova N.A., Prokhvatilov S.A.
Abstract
Atypical hemolytic-uremic syndrome being referred to autoimmune diseases appears to be one of the most severe forms of thrombosis and microangiopathy. Difficulties in diagnosis cause a delay in pathogenetic therapy, which causes a high maternal mortality rate. Pathogenetic therapy with eculizumab, suppressing the terminal activity of complement, may contribute to the recovery of blood coagulation properties, but the long-term prognosis for chronic renal failure remains unfavorable. The article deals with a clinical case confirming this conclusion.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):47-50
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PREGNANCY IN SUBMUCOUS LOCATION OF THE MYOMATOUS NODE
Sinchikhin S.P., Karavayev V.E., Stepanyan L.V., Khanmirzoeva S.K.
Abstract
There are presented own data on the prevalence of uterine fibroids in women in different age groups, as well as with infertility, miscarriage and other diseases of the internal genital organs. An unusual case of a combination of the uterine form of pregnancy associated with a large submucous myoma node is considered. The use of new original technologies was shown to contributes to the reduction of blood loss during simultaneously performing surgical delivery and myomectomy.
V.F.Snegirev Archives of Obstetrics and Gynecology. 2019;6(1):51-54
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