Vol 67, No 6 (2018)

Hypothesis/aims of study. The current analysis was undertaken to assess the incidence of malignant diseases in patients with endometriosis.

Study design, materials and methods. This is a cohort study of women with surgically verified endometriosis retrieved from the Saint Petersburg 122 Clinical Hospital Discharge Register 1996–2006 (n = 1551). Data were linked to the Saint Petersburg Cancer Agency to identify cases of malignancy.

Results. Malignant diseases were identified in 6.3% (n = 98) of cases. The median follow-up was 12.2 (7.5) years. Breast cancer (n = 29), ovarian cancer (n = 7), endometrial cancer (n = 7), thyroid cancer (n = 7), colorectal cancer (n = 6), melanoma (n = 6), non-Hodgkin’s lymphoma (n = 4), and glioblastoma (n = 3) were prevalent.

Conclusion. The incidence of cancer in patients with endometriosis is low. Women with endometriosis have an increased risk of some malignancies, particularly ovarian cancer.

Hypothesis/aims of study. Patients with a history of pregnancy complications that meet the clinical criteria of antiphospholipid syndrome (APS), with circulation of autoantibodies not related to the laboratory criteria for APS, present difficulties in choosing a method for preventing recurrent complications. The aim of this study was to determine the frequency of autoantibodies in women with severe obstetric complications and habitual miscarriage and to evaluate the effectiveness of therapy used in APS for the prevention of recurrent reproductive losses in women with non-criteria autoantibodies.

Study design, materials and methods. 358 women with a history of APS clinical criteria or two pregnancy losses up to 10 weeks were examined. Anti-beta2-glycoprotein I and anti-cardiolipin (IgG/IgM) antibodies, as well as non-conventional autoantibodies for phosphatidylinositol, phosphatidylserine, phosphatidyl acid, annexin V, and prothrombin were determined in serum, with lupus anticoagulant test performed. In 39 women with clinical criteria for APS and circulating anti-annexin V or prothrombin antibodies during pregnancy, enoxaparin sodium was used (in 100% of the cases) in combination with acetylsalicylic acid (ASA) at a dose of 50-100 mg per day (in 69.2% of the cases).

Results. The frequency of all types of autoantibodies was 38.8%. Non-conventional antibodies were detected in 17.6% of the cases (isolated circulation in 11.5% of the cases); with anti-annexin V antibodies (73.0%) prevailed among them. In 39 patients with non-criteria antibodies, after the use of a prophylactic dose of enoxaparin sodium and ASA, live births were the outcome of pregnancy in 84.6% of the cases.

Conclusion. Testing for non-conventional autoantibodies may be appropriate in patients with only APS clinical criteria. Standard treatment of APS prescribed for this group of patients led to a significant increase in the frequency of live births. Further large studies are needed to evaluate the efficacy of medical prophylaxis of adverse pregnancy outcomes in women with non-criteria obstetric ABS.

Hypothesis/aims of study. During pregnancy, hypercoagulation develops and fibrinolysis is inhibited. These changes are particularly pronounced in pregnancy complicated by preeclampsia. The existing techniques to evaluate hemostasis are rather laborious and do not provide a complete information of the volume and density of the fibrin clot. We aimed to conduct comparative studies of the state of the hemostasis system by conventional test-tube and thrombodynamic methods in healthy non-pregnant women and in pregnant women who are suffering and are not suffering from preeclampsia.

Study design, materials, and methods. We examined 40 pregnant women aged 17–33 years (mean age 24.3 ± 3.2 years) at the gestational age of 35–39 weeks. In 18 women, pregnancy was complicated by preeclampsia. The control group consisted of 35 healthy women (mean age 25.1 ± 2.6 years). The thrombodynamic characteristics of the clot were evaluated using the T-2 Thrombodynamics Recorder device (GemaKor Ltd., Russia) using the following parameters: Tlag, clot growth delay; Vi, initial growth rate; Vs, steady growth rate; D, clot density; C₃₀, the size of the main clot in the 30^th minute.

Results. When evaluating the hemostasis system by the thrombodynamic method in healthy pregnant women and in women with preeclampsia compared with non-pregnant women, the onset time of clot formation was significantly reduced, the initial and steady rate of the clot appearance, as well as the clot density and the clot size being increased.

Conclusion. The method for evaluating thrombodynamic properties of the blood clot is objective and visual way to estimate hemostasis. It complements the coagulogram indices and gives a clear view of the hemostasis system.

Hypothesis/aims of study. The current analysis was undertaken to elucidate the role of Factor Va resistance to proteolytic cleavage by activated protein C in FVL(1691)GA female carriers in the development of acute and recurrent thromboses.

Study design, materials and methods. A prospective clinical cohort study of 1100 women of reproductive age was conducted, with the course and outcomes of 2,707 pregnancies analyzed. Two cohorts were specified: the main group consisted of 500 patients with FV(1691)GA genotype, and the control group consisted of 600 patients with FVL(1691)GG genotype.

Results. FVL(1691)GA genotype was significantly associated with the development of venous thromboembolic complications (VTEC) compared to FVL(1691)GG genotype (OR 9.3; p < 0.0001). Episodes of recurrent thrombosis during and outside of pregnancy were registered only in FVL(1691)GA patients (OR 5.7, p = 0.2). In all cases, at the time of the thrombotic event and during the period before the episode of acute or recurrent thrombosis, an APC resistance normalized ratio (NR) value was ≤ 0.49, with no episodes of VTEC registered with an APC resistance NR value ≥ 0.5.

Conclusion. Venous thromboses occur under the condition of expressed APC resistance with underlying FVL(1691)GA carriage. The APC resistance index can serve as an objective biochemical marker to determine the feasibility of thromboprophylaxis within the framework of personalized medicine.

Currently, tamoxifen is the gold standard in the treatment of hormone receptor-positive breast cancer, which reduces recurrent tumor risk by more than 40%. Tamoxifen, which belongs to selective estrogen receptor modulators, can cause endometrial changes in women of different age groups and increase the risk of hyperplasia and endometrial cancer by several times. In clinical practice, the occurrence of various endometrial alterations during tamoxifen treatment often leads to groundless drug withdrawal. Oncology, gynecology and radiology community knowledge related to optimal methods and criteria for diagnosing different tamoxifen-induced endometrial conditions, as well as in choosing the optimal treatment tactics, will be instrumental in the unified and correct approach to managing patients with hormone receptor-positive breast cancer and maintaining tamoxifen therapy due to its high effectiveness.

Type 1 diabetes mellitus is a condition associated with an increased risk of adverse perinatal outcomes such as spontaneous abortions, preterm birth, placental insufficiency, congenital malformations, and perinatal mortality. Diabetes mellitus combined with cardiovascular diseases in women during pregnancy often leads to hypertensive disorders and pre-eclampsia. The severity of the microvascular diabetic complications and frequency of hypoglycemic episodes, particularly in early pregnancy, are related to the risk of pre-eclampsia. We report the case of pregnancy and delivery of a live newborn in a 42-year-old woman with type 1 diabetes mellitus, pre-existing hypertension, heritable thrombophilia, and antiphospholipid syndrome. She had a 40-year history of type 1 diabetes mellitus with well-controlled diabetic nephropathy and retinopathy. The woman had been receiving continuous subcutaneous insulin therapy for the last five years, which allowed maintaining an appropriate glycemic control during pregnancy. Multidisciplinary supervision of course of pregnancy was carried out from the pre-gravidity stage until delivery and postpartum. In spite of the severe pre-eclampsia and preterm delivery by cesarean section at 36 weeks, she and newborn could avoid the intensive unit care and discharge from perinatal center without any complications.

Hypothesis/aims of study. The frequency of adverse intranatal outcomes is significantly increased when the pubic arch angle (PAA) is less than 90°. The accuracy of the manual method for determining PAA depends on a large number of parameters, such as obesity of a woman, as well as stereometric sensation and the experience of a doctor. Determination of PAA using ultrasound and X-ray pelviometry is generally available and reliable; however, it requires special training. The aim of this study was to develop mathematical methods for calculation of PAA.

Study design, materials and methods. The study included a retrospective and prospective analysis of 120 birth histories based on the Regional Clinical Hospital Perinatal Center (the Chita city, the years 2017/2018), which were divided into three equal groups. Group 1 consisted of patients with body weight deficit, group 2 included patients with normal body mass index, and group 3 comprised patients with alimentary constitutional obesity. On the eve of the birth, external pelviometry, the manual method for determining PAA, and ultrasound pelviometry by translabial access were performed.

Results. PAA determined by the manual method was 99.6 ± 11.3° in group 1, 100.1 ± 14.2° in group 2, and 98.2 ± 10.7° in group 3. When ultrasound pelviometry was performed, the value of PAA was 97.4 ± 10.7° in group 1, 104.8 ± 13.8° in group 2, and 104.1 ± 12.3° in group 3. The error of the manual method was 2.2% in group 1, 4.5% in group 2, and 7.6% in group 3. On the basis of mathematical modeling of external pelviometry data, a pattern is defined, which is expressed by the formula: PAA = 180° – arccos (0,5 ∙ S₁S₂/S₁P) – arccos (0,5 ∙ B₁B₂/(B₂S₁ – S₁P), where PAA is the pubic arch angle (°); S₁S₂, Distantia spinarum; S₁P, the distance between the anterior superior spine of the ilium to the lower edge of the symphysis; B₂S₁, the distance between the anterior superior spine of the ilium to the tuberosity of the opposite ischium; B₁B₂, the transverse size of the output plane. The coefficient of determination (R-squared) is 0.82. Thus, mathematical modeling allows determining PAA with a high degree of reliability.

Four hundred and fifty case histories and results of histological studies of patients who underwent surgical treatment with a diagnosis of adenomyosis and uterine fibroids were retrospectively analyzed. Of all the operated patients, the sclerotic type of adenomyosis was detected in three cases according to the histological examination, which was 0.67%. The retrospective analysis allowed us to reveal the clinical, echographic, and histological characteristics of the sclerotic type of adenomyosis in these patients.