Vol 1, No 3 (2010)

Articles
QUALITY CONTROL OF MEDICAL CARE IN MULTIFIELD HOSPITAL
Nikonova E.V., Laktionova L.V.
Abstract
The article is devoted to the regulation of the technological process of treatment in medical facilities, quality and control care. We consider a modern system of quality control of medical care includes the study of patient satisfaction with medical care, identification of defects, medical errors and other factors that adversely effect and resulting in a decline in the quality and effectiveness of medical care, assessment of the completeness and timeliness of diagnostic measures, the adequacy of the selection and compliance with therapeutic measures, correct and accurate diagnosis, choosing the most rational management decisions and conduct rapid corrective actions, monitor the implementation of management decisions.
Journal of Clinical Practice. 2010;1(3):9-14
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THE MODERN VIEW ON THE COMPLEX TREATMENT OF PATIENTS WITH UTERINE FIBROIDS
Levakov S.A., Kedrova A.G., Kojurina K.V., Vanke N.S.
Abstract
Uterine fibroids are the most common solid tumours in the female pelvis. The purpose was to examine the long term results of treatment uterine myoma through combined therapy in 54 patients. To assess the reproductive health of patients with uterine fibroids after treatment included to use ana logues of gonadotropinreleasing hormone (GnRH) with or without embolization of uterine artery(UAE) and myomectomies. . The introduction of gonadotrophinreleasing hormone agonists (GnRHa) has been found to be useful in the management of patients of reproductive age with uterine fibroids for minimization of risk of relapse.
Journal of Clinical Practice. 2010;1(3):15-20
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CLINICAL AND MOLECULAR ASPECTS OF MUCINOUS OVARIAN TUMORS: ETIOPATHOGENESIS, INDIVIDUALIZATION OF TREATMENT
Kedrova A.G., Levakov S.A., Shablovskiy O.R., Vanke N.S., Nechaeva O.V., Maksimenko T.A.
Abstract
To determine the prognosis and prognostic factors in series of mucinous tumors of the ovary (MTO) we included 34 patients in our retrospective review. Criteria were defined: 1.centralized histological review by our expert pathologist; 2. high risk of peritoneal pseudomyxoma or any synchronous malignant tumor in the abdominal cavity; 3. available data on the management and outcomes of patients. We found specific markers overexpression in mucinous ovarian tumors compared to their normal ovary tissues and serous type ovarian tumors by analysis of serum CA 19,9, CEA and immunohistochemistry. These results suggest that mucinous tumors of the ovary have distinctive cancergenesis and may attribute to the progression of the mucinous ovarian cancer.
Journal of Clinical Practice. 2010;1(3):21-31
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EXPERIENCE OF USING SYNTHETIC PROSTHESES PROLIFT ® (GYNECARE) FOR CORRECTION OF GENITAL PROLAPSE
Levakov S.A., Wanke N.S., Shablovskiy O.R., Kedrova A.G., Shirshov V.N., Wanke E.S.
Abstract
The aim was to evaluated anatomical and symptom specific outcome measures of prolapse repair with PROLIFT ® (Gynecare). In this longitudinal prospective observational study we collected data on a total of 85 women with pelvic organ prolapse stage 2 or more. Objective success rate was 85.9% at 6 months respectively. Patients required a blood more 500 ml - 7,1% and need transfusion. The mesh erosion rate or the displacement of the mesh were 3,5%. Vaginal surgery with prolift mesh® is an effective and safe procedure to correct pelvic organ prolapse over one year follow up.
Journal of Clinical Practice. 2010;1(3):32-37
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POSSIBILITY OF ULTRASOUND METHODSNTO DETERMINE THE TACTICS OF TREATMENT FOR STRESS URINARY INCONTINENCE IN WOMEN WITH VAGINAL PROLAPSE
Shirshov V.N., Levakov S.A., Nechaeva O.E., Krutova T.V., Obolonkov V.Y.
Abstract
Stress urinary incontinence is an actual medical and social problem and involves more than 30% women in developed countries spoiling quality of life. Ultrasonic sings of urethra and bladder changes revealed in 136 women with urinary incontinence and slight anterior vaginal fornix prolapse are analyzed in the article. 67 women were treated conservatively and the rest of them survived surgery: sling or pelvic prolift or their combination. The choice of treatment method was based on ultrasonic data. Clinical efficacy was 100% in both groups. The results showed ultrasonic data to be informative for revealing low urinary tract changes in women with urinary incontinence and useful for treatment method choice.
Journal of Clinical Practice. 2010;1(3):38-42
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SYNTHETIC INOSINE ANALOGS IN TREATMENT OF CIN IIII
Levakov S.A., Kedrova A.G., Kozhurina E.V., Wanke N.S.
Abstract
Genes products of human papillomavirus (HPV) have been identified in more then 99,7% of cervical carcinomas. Several factors may be associated with higher rates of surgical treatment failure, including highgrade CIN, large lesion size, satellite HPVrelated lesions, involved margin, persistent HPV infection. Several pharmaceutical analogs of inosine have been using about 40 years to treat broad spectrum of viral infections. Clinical and experimental studies concerning efficacy and molecular mechanism of Inosine pranobeх are characterized this product as a safe and natural immune stimulating agent with beneficial results in patients with HPV. The purpose of the study is to evaluate the effect and toxicity of the antivirus therapy of Inosine pranobeх in the complex treatment of HPV infected patients affected CIN, CC in situ and recurrence of CIN in HPVpositive women after loop conization. Surgery with the antivirus therapy of Inosine pranobeх exhibited a protective effect on the recurrence of any CIN. Inosine pranobeх is characterized as a natural immune stimulating agent without pleiotropic effects of cytokines. Our data and global clinical studies have confirmed the safety and efficacy in the treatment of CIN Inosine pranobex.
Journal of Clinical Practice. 2010;1(3):43-51
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RESEARCH OF TISSUE ACTIVITY OF METALLOPROTEINASES AT VARIOUS FORMS OF AN ADENOMYOSIS
Levakov S.A., Korobeinikov A.P., Demura T.A.
Abstract
Enzymatic activity matrix metalloproteinase's 2 and 9 in an operational material (the amputated uteruses) concerning diffusive and nodal forms of an adenomyosis at women in the late genesial period was studied. Research was spent with use of an immunohistochemical method on paraffinic sections. Results of immunohistochemical reaction were estimated by a semiquantitative method in points by quantity of positively painted cells. Activation and expression intensifying gelatinase ММР2 and ММР9 has been shown at diffusive and nodal forms of an adenomyosis and their various degrees of a lesion of a myometrium. Also it has been shown, that in a stroma and myometriums at diffusive and nodal forms of an adenomyosis the expression gelatinanases ММР9 was more intensively.
Journal of Clinical Practice. 2010;1(3):52-55
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COMPARISON RESULTS OF SURGICAL TREATMENT LOCALIZED AND EXTENDED UTERINE CANCER
Ushakov I.I., Artoshina E.A., Brousov P.G., Nazvantsev I.V., Levakov S.A., Kedrova A.G.
Abstract
We selected 145 patients with endometrial carcinoma who had been treated with standard surgery (hysterectomy and BSO, peritoneal washing, palpation pelvic and para-aortic nodes) and with complete systematic pelvic lymphadenectomy (n=30 patients) or combined pelvic and para-aortic lymphadenectomy (n=30). Patients at intermediate or high risk of recurrence were offered adjuvant radiotherapy. The primary outcome measure was results of the surgical therapy.
Journal of Clinical Practice. 2010;1(3):56-61
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PREGNANCY AND CHILDBIRTH IN PATIENTS WITH PRECANCER AND CERVIX CANCER
Levakov S.A., Shablovskiy O.R., Kedrova A.G., Wanke N.S., Nechaeva O.V., Torubarov S.F.
Abstract
The purpose of our study was the choice of the method with minimal harm to the reproductive health of women with early cervical pathology. We have analyzed the different techniques that can be used for the treatment of CIN or the early stages of cancer. There are sold-knife conization, laser conization, cryotherapy (freezing and destroying abnormal cells), laser vaporization (using a laser to destroy abnormal cells), loop electrosurgical excision procedure (LEEP). All procedures are threatening complications of pregnancy, for example, risk of miscarriage. Method with minimal complications had LEEP, including data on CIN recurrences and complications during pregnancy. Therefore, women who are considering future pregnancies should be counseled about these risks and benefits of procedures.
Journal of Clinical Practice. 2010;1(3):62-70
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MYOMECTOMY AT CESAREAN SECTION
Torubarov S.F., Levakov S.A., Korobeynikov A.P.
Abstract
The article summarizes current opinion and personal experience of authors of organ therapy in pregnant women with major sites of uterine fibroids. Features of myomectomy during cesarean section are presented in 14 patients.
Journal of Clinical Practice. 2010;1(3):71-75
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PROPHILAXIS ANEMIA IN PREGNANCY
Levakov S.A., Kozhurina E.V., Kedrova A.G., Stuklov N.I., Torubarov S.F.
Abstract
Pregnancy anemia is one of the important public health problems not only in Russian but also in another countries. Indeed, it is a known risk factor for many maternal and fetal complications. Anemia put to the worse many risk factors: young age, obstetrical factors (history of previous preterm or small- for gestational-age deliveries, plurality of pregnancy multiple or singleton); behavioral factors (smoking or tobacco usage, alcohol usage); medical conditions (diabetes, renal or cardio-respiratory diseases, chronic hypertension). If all pregnant women receive routine iron and folic acid, it is possible to prevent nutritional anemia. Therefore, 50 -100milligrams elemental iron and 500-1000 micrograms of folic acid daily for 100 days must be taken into national nutritional anaemia prophylaxis program to all pregnant women.
Journal of Clinical Practice. 2010;1(3):76-83
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MASTODYNIA: POSSIBILITIES OF THERAPY USING MICRONIZED PROGESTERONE
Prilepskaya V.N., Bebneva T.N.
Abstract
Pain in the mammary gland (mastodynia) is one of the most common complaints, with which women address themselves to a gynecologist. Mastodynia might be conditioned by various causes: inflammation process, hormonal imbalance, intake of varied groups of medication, including hormonal contraceptives, tumors, intercostal neuralgia, etc. The article presents current data on prevention of the appearance and possible therapies of mastodynia.
Journal of Clinical Practice. 2010;1(3):84-91
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MODERN LOOK AT INFERTILE MARRIAGES
Levakov S.A., Pavlova S.A., Bugrova T.I., Kedrova A.G.
Abstract
Infertility is a common clinical and a public problem. It affects 13% to 15% of couples worldwide. Today, many patients do not receive the recommended medical care that based on the best available evidence. This paper, as a comprehensive review, deploys a new strategy to translate the research findings and evidence-based recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care of infertile couple to the practicing clinicians. According to the literature survey, the most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility; where no obvious cause could be detected. Treatment begins with the reasons for having a high priority. Initially eliminate anatomical changes, then the functionality. The paper presents a clinical case of successful pregnancy after combined treatment of the couple.
Journal of Clinical Practice. 2010;1(3):92-97
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MODERN TRENDS TO LAPAROSCOPIC SURGERY IN GYNECOLOGY
Levakov S.A., Kedrova A.G., Wanke N.S.
Abstract
Gynecologic laparoscopy has evolved from a limited surgical procedure used only for diagnosis and tubal ligations to a major surgical tool used to treat a multitude of gynecologic indications. Today, laparoscopy is one of the most common surgical procedures performed by gynecologists. The review presents the main trends of development of modern surgery in gynecology with the author's personal views on the key contentious issues of endoscopic sinus surgery.
Journal of Clinical Practice. 2010;1(3):98-102
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EXPERIENCE OF UTERINE ARTERY EMBOLIZATION IN UTERINE ARTERIOVENOUS MALFORMATION
Levakov S.A., Kedrova A.G., Nechayeva O.E., Sitnikov A.V., Lebedev D.P., Kaganovskaya L.M., Wanke N.S.
Abstract
Uterine arteriovenous malformation (AVM) is a rare condition. Congenital AVMs have multiple vascular connections, may manifest at other sites, and involve surrounding structures, whereas acquired AVMs usually have a single connection between an artery and a vein. AVMs may be diagnosed by Doppler ultrasonography, computed tomography, magnetic resonance imaging and angiography. The article presents the literature and case report of AVM with the tactics of treatment of rare diseases.
Journal of Clinical Practice. 2010;1(3):103-110
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