Vol 50, No 3 (2001)

To improve the diagnostics and treatment of urgent gynecological diseases 1000 patients with the pathology were examined. 700 women were subjected to laparoscopy. The following structure of acute gynecological diseases was defined: 47% — ectopic pregnancy, 24% — acute inflammatory diseases of adnexa uteri, 17% — ovarian apoplexy, 7% — torsion of ovarian cyst pedicle, 4% — uterine myoma associated with the disturbances of alimentation of the ganglion, 1% — perforation of the uterus. On the basis of the analysis of complains, anamnesis, clinical symptoms and results of supplementary examinations the algorithm of management of patients with suspected acute gynecological diseases including diagnostic laparoscopy was elaborated

Comparative analysis of two modem methods of women’s genital prolapse treatment was carried out. Comparing close and some remote results of MESH- vaginopexy (97patients) andtransvaginal retroperitonealsacrovaginopexy with laparoscopic control (24 patients), the authors determine particular indications, advantages and expediency of the elaborated methods.

Peritoneal cytological investigation was carried out inpatients with endometrial cancer, who were subjected to hysteroscopy before the operation (37patients) or were operated on without hysteroscopy. Comparative analysis of the data didn’t reveal the role of hysteroscopy in tumor cell dissemination.

The experience of using laparoscopic hysterectomy for the period of 5 years is represented. 594 laparoscopic hysterectomies were performed since 1996 up to 2000. Indications and contraindications to this kind of operation were defined, optimal technique of the surgical intervention was offered. The analysis of complications was carried out, ways of prophylaxis having been elaborated.

The research aims at studying the effectiveness of plasmapheresis and ozonotherapy in treatment of women of reproductive age in early postoperative period after reconstructive-plastic operations. 110 patients with different factors of infertility who passed surgical laparoscopy were examined. All the patients were rehabilitated applying medicinal plasmapheresis (70 patients) and ozonotherapy (40 patients). The results of the study showed the advantages of these methods of treatment in comparison with traditional therapy (antibacterial and physiotherapy in comparative group, 72 patients). So, early rehabilitation of patients including medicinal plasmapheresis and ozonotherapy makes it possible to increase essentially the course of postoperative period, to stabilize adaptive reactions, to recover reproductive function in considerable amount of infertile women.

The experience of combined application of hysteroscopy and laparoscopy in treatment of infertile women is analyzed. An alternative technique of treating occlusion of the uterine tubes with the method of their transcervical recanalization using ureteral catheter is represented. The statement is made about the perspectives of applying combined hysteroscopy and laparoscopy in treatment of patients with infertility.

The results of treating urinary stress incontinence in women with the help of some combined methods are demonstrated. Original methods — laparoscopic retropubic colpopexy by lateral approach, MESH-vaginopexy, laparoscopic retropubic colpopexy — are analyzed considering the type of urinary incontinence to substantiate pathogenetically the prophylaxis of stress incontinence recurrence.

The state of regional blood flow in 65 patients before and after endoscopic myomectomy was studied using modem methods such as Doppler examination and color Doppler sonography. It was determined that blood flow velocity indeces obtained during the Doppler examination of myoma vessels and uterine arteries allow to estimate the morphological structure of myomas uninvasively and can be used to define the indications for conservative endoscopic surgical procedures in patients with myoma uteri. Doppler monitoring of regional blood flow during postoperative period makes it possible to evaluate the effectiveness of surgical treatment previously performed.

The aim of the study was to determine the endometrial safety of oral 17/3- oestradiol combined continuously with dydrogesterone in preventing endometrial proliferation. The low dose group comprised three 52-week (13 cycles of 28 days) studies (two of which were double blind) using a 17ft- о estradiol dose of 1 mg daily combined with dydrogesterone 2,5; 5; 10 or 20 mg daily. The high dose group comprised two 24-week double-blind studies using a 17ft-oestradiol dose of 2 mg daily combined with dydrogesterone 2,5; 5; 10 or 15 mg daily. Endometrial safety was verified by aspiration endometrial biopsies. Inadequate progestational response was defined as proliferative endometrium, endometrial polyp, hyperplasia and carcinoma. Endometrial protection was achieved with dydrogesterone at doses of 5 mg or higher combined with 1 or 2 mg 17^-oestradiol. So, 5 mg daily dydrogesterone appears to be the lowest effective dose to ensure endometrial safety in a continuous combined regimen with 1 or 2 mg 17p-oestradiol.

The new method of radical uterine surgery combining endoscopic approach
and minilaparotomy is represented. 105 operative invasions on the uterus were performed using this method. Characteristic features of the surgical method, which was elaborated, are minimum blood loss and tissue injury, simple technique, low requirement of analgetics, fast rehabilitation of patients’ activity and capacity for work, using common equipments and materials.

On April 19, 1901, at a meeting of the St. Petersburg Obstetric and Gynecological Society, Professor Dmitry Oskarovich Ott for the first time made a report on the method he developed for illuminating the abdominal cavity when performing operations with a vaginal access. He called the proposed method ventroscopy (ventroscopia; Latin venter stomach + Greek skopeo consider). The latter used terms such as celioscopy, abdominoscopy, pelvioscopy, etc. At present, it is customary to call the examination of the abdominal organs using an endoscope inserted through the anterior abdominal wall, the method of laparoscopy, and when the endoscope is introduced through the posterior vaginal fornix - cultoscopy.

The new method of radical uterine surgery combining endoscopic approach
and minilaparotomy is represented. 105 operative invasions on the uterus were performed using this method. Characteristic features of the surgical method, which was elaborated, are minimum blood loss and tissue injury, simple technique, low requirement of analgetics, fast rehabilitation of patients’ activity and capacity for work, using common equipments and materials.

The article carries information about D. 0. Ott’s work as a Court physician. It
touches upon the events connected with the birth о f children in the Imperial Family. The article is written on the basis of the archive documents and the memoirs.