Vol 47, No 3-4 (1998)

Authors, on the basis literary given and by the results of researches present the detailed analysis of efficiency and expediency of endovideosurgical methods of diagnostics and treatment in GYN practice. There are considered indications, contra-indication, features of the methodical approaches with use of specified methods under urgent condition and in planned GYN. Prospective directions of development of the new technological approaches in modern operative GYN are also considered.

It has been created the new technology of uterine surgery based on laparoscopy assisted suprapubical middle minilaparotomy. This operative method allows to minimize the surgical injure in the cases when laparoscopy itself may be difficult because of some reasons and typical laparotomy is undesirable. The first experience of these operations has shown that using of this technology does allow to decrease intraoperative blood loss considerably, reduce very much postoperative hospital stay of patients in comparison with laparotomy, minimize the necessity of analgetics, optimize the suture of the uterus in myomectomy and diminish the zone of coagulative necrosis of tissues.

The results of pelvic echography in postpartum period and after Cesarian sections were analyzed. Echography on the 2,4,5 and 7 days of postpartum period as a screening method of the puerperal of risk groups offers an early diagnosis and adequate management of patients with pyo-inflammatory diseases, are therefore required to reduce these severe forms of complications.

Morphological features of placentas were investigated in practically healthy puerperants (12) and women with weight deficient (19) in a case of urgent delivery. In 30% of placentas in control group pathologic immaturity coupling with dissociated development (40%) were seen, which were, combined with slight involutiv-dystrophic processes (IDP) and maximal realization of compensatory processes in placentas that promotes delivery of healthy neo-nates with normal body weight. In a case of weight deficiency in mothers, significant IDP can be seen together with large amount of immature (63.2%) and dissociated (21%) placentas, suppression of compensatory processes with starting of mechanisms characteristic for embryonal period of development, which promotes delivery of alive neonates but with small for gestational age body weight and high rate of cerebral blood flow disturbances. The listed features are results of the influence of climate-geographical, ecological and social-economic live conditions of women in Tajikistan.

Some groups of women with normal pregnancy with pregnaizcy aggravated by gestosis and diabetes I and II were examined. The level of middle molecules (MM) and protein peroxidation (PP) were measured in the blood serum. The activity of ceruloplasmin (CP) and oxitocinase (ОС) were evaluated too. The level of MM was measured in the urine. More active processes of protein degradation were shown under normal pregnancy in comparison with unpregnant group. These processes reflect both free radical reaction and proteolitic processes. Activation of proteolisis results in evaluated level of MM. The MM content and PP level were not increased significantly in the group with gestosis. But the elevated activity of ceruloplasmin (on 15%) under gestosis reflects an activation of «oxidative stress» and free radical processes. It was found an increased serum and decreased urine level of MM and in the group of women with complicated diabetes I. The women with diabetes II have shown elevated CP activity (on 14%) too and increased level of PP (on 14%). It was supposed that MM may be a toxic factor witch damage placenta and foetus under diabetes I and II. The free radicals may be a factor which hurt tissue of placenta and foetus under diabetes II.

Positive effect was obtained in lactostasis therapy with” Lactopulse” apparatus in 58 puerperal women. In all puerperants quick and effective resolution of lactostasis was observed. This method of treatment allowed to preserve lactation function in most women (82,8 %). The method can be used in the conditions of obstetric inpatient department.

The results of treatment of chronic endometritis in 92 women by vaginal and intrauterine infrared laser irradiation were studied. The diagnosis has been verified by endometrial biopsy. If chronic endometritis is associated with adnexitis, the treatment was begun from vaginal laser irradiation. On the next cycle intrauterine laser therapy was performed.

In 40% of the patient’s pathogenic microflora was revealed, and in these cases the antibacterial therapy have been carried out. All women showed clinical improvement after laser therapy. The control biopsy of endometrium was performed in 23 months after the treatment. In 84,8% women the patterns of inflammation were not revealed. In 8,7% cases have been found residual effects of the inflammation.We suppose the complex vaginal and intrauterine infrared laser therapy combined with antioxydants and gestagenes to be an effective method of treatment of chronic endometritis.

In the article the data on clinical-microbiological researches in pregnant woman is shown. The high frequency of bacterial vaginosis and urogenital candidiasis in all trimesters of pregnancy is shown. For bacterial vaginosis treatment (13) and urogenital candidosis (12) we used local application of the combined terginan preparation in pregnant women in III trimester. The efficiency of its application estimated in 2 weeks after termination of treatment. Is ascertained, that at 84 % of the pregnant women with bacterial vaginosis and urogenital candidiasis positive result is observed. It is recommended to apply terginan for bacterial vaginosis urogenital candidiasis treatment in pregnant women.

Domestic and foreign literature on problems and prospects of transplantology at the last 30 years is analyzed. The scientific and practical preconditions for it development are considered. The main factors, detaining active introduction of transplantology in clinical activity are marked. Are mentioned legal and ethic questions. Problems transplantation immunity and storage donor organs are designated. Necessity of wider study of opportunities female genitale transplantation in experiment and in clinic is justified.

In lecture the urgent aspects of classification, principles of diagnostics and replacement hormonal therapy of therapy and hormonal prophylaxis of climacterical disturbances are considered.

In abstracts there are a considered information about the causes of acute abdomen in gynecology of children. The clinics, diagnostics, tactics of treatment and methods of treatment are considered.

In the article the original sight of the authors on heliophysical aspects of embryogenesis is submitted. The new approaches in perinatal pathology reduction are revealed.

«Both the separate citizens, and all community and whole country require of the doctors, whose knowledge, results of their works were not left on the shelfs in libraries, but that they were done by real, common property of mankind, that they were spilled a «wide wave» along the country, bringing in everywhere a simplification of sufferings, reducing lethality and physical inability of the population, including mothers and born generation » ...

G.E. Rein (1912).

The comparative analysis of changes in adaptational leucocyte reactions of blood and leuco-index of intoxication in reply to surgical stress at 334 women (1-st group) with not complicated current postoperative period and at 133 women with postoperative purulent - inflammatory complications (2-nd group) is carried out. It is established, that the displacement of adaptational reactions of the patients towards the reactions to stress and adverse reactions in a combination with high meanings of leuco-index of intoxication as early, as on the 3-rd day of postoperative period allows to diagnose initial signs of postoperative purulent - inflammatory complications.