Vol 6, No 1 (2015)

Currently in Russia there is a high frequency of infertile marriages and spontaneous abortions. One of the main causes of fertility for women is endometrial pathology. Structural and functional deficiency of the endometrium caused by pathological inflammatory processes, naturally leads to disruption of implantation and clinically infertility and prenatal losses. Search for solutions to the treatment of endometrial pathology extremely relevant for the prevention of reproductive health of society. The main causes of endometrial pathology is inadequate hormonal regulation, acute and chronic inflammation (endometritis). For chronic endometritis is often characterized by a long asymptomatic and complexity of initial diagnosis. A special place in the course of chronic endometritis belongs herpes infection. Its prevalence among young population is high enough. Herpes infections can affect almost all organs and systems of the host. Diagnostic approaches to verification of chronic endometritis constantly adapting over the past decades. Today, the diagnosis is based on a comprehensive assessment of a number of clinical, morphological, instrumental data. Particular attention is paid to the verification of chronic endometritis immunohistochemical study of the endometrium. This method allows not only to identify the type of infectious agent, but also to establish a process phase that has a significant role in determining treatment strategy. Special role in identifying immunohistochemical viral etiology of chronic endometritis, because this method can reliably detect the presence of antigens to different viral agents.

This paper presents an overview of the modern antenatal and postnatal strategies in brain protection for both preterm and term born infants. It is known, that the two most common causes of neonatal brain injury are prematurity and hypoxic-ischemic encephalopathy (HIE) in the term born infant. Approximately one in nine babies is born before term. Nowadays these preterm born infants more often survive the neonatal period due to developments in treatment options in the last decades. They are however at a high risk for developing brain damage and neurodevelopmental impairment later in life. Approximately 40 % of survivors develop long-term intellectual or physical impairment, including cerebral palsy (CP). Term born infants born after perinatal asphyxia may also survive with a variety of neurocognitive disorders due to brain damage as a result from the hypoxic ischemic encephalopathy (HIE). Untreated, the sequelae of moderate to severe HIE includes a 60 to 65 % risk of mental retardation, CP, hydrocephalus, seizures, or death. The main goal in neonatal care for these surviving but vulnerable infants is to preserve brain function and prevent further brain damage, in order to improve neurocognitive outcome and the subsequent quality of life. In preterm brain protection antenatal strategies besides educating and supporting pregnant women regarding life style and healthy food intake, centralization of care for extreme preterm born infants, fetal monitoring in high risk pregnancies, administration of antenatal steroids for lung maturity, the use of intravenous magnesium sulfate administration to mothers just before preterm delivery are of great importance. In the postnatal strategies setting optimal oxygen saturation, the avoidance of prolonged artificial mechanical ventilation, hypoglycemia, hypocapnia electrolytic imbalances, hyperbilirubinemia, blood pressure shifts, stress and pain, inflammation, necrotizing enterocolitis as well as adequate feeding strongly predict neurocognitive outcome. In the term asphyxiated infants the brain experiences a cascade of problems occurring after energy failure which in fact are the basis of neuroprotective strategies. These strategies consist of anti-oxidative, anti-inflammatory, anti-excitatoxic and anti-apoptotic agents, and in the future possibly neurogenetic approaches, including stem cell therapy. In antenatal strategies prevention of asphyxia starts at promoting a healthy pregnancy and of an early recognition of fetal, placental or perinatal risk factors for hypoxia. Recent experimental trials have shown a possible beneficial effect of antenatal administration of the anti-oxidative agent allopurinol in a HIE. In postnatal strategies two methods to achieve therapeutic hypothermia were evaluated in newborn infants with HIE: whole body cooling and selective head cooling with mild systemic hypothermia with the conclusion: hypothermia should be instituted in term infants with moderate-to-severe hypoxic ischemic encephalopathy if identified before six hours of age. Monitoring of brain activity by means of amplitude integrated electroencephalography to identify infants with HIE is promising. Potential agents with either anti-oxidative, anti-inflammatory, anti-excitatoxic or anti-apoptotic capacities are currently being investigated in various phases of research.

The Up-to-date research of perinatal mortality in Russia has shown change in its structure with increase of proportion of antenatal mortality in the first place, which may be declarative of disorders in fetal vital activities. Reproductive losses in different periods of pregnancy are increasingly frequently united under the term of fetal loss syndrome (FLS), regardless of ethiopathogenic factors. The mostly discussed issue is thrombotic disorders related to inherited and aquired thrombophilia. Research objective was to evaluate the role of adverse allelic variant genes carriage, associated with increased thrombogenesis, in development of FLS. 105 pregnant women with FLS or FLS risk factors in the past have been examined. The women have been affiliated with SPb GBUZ «Women's clininc N 22». The women have been tested for gene mutations in Factor V (FV Leiden), prothrombin, β-subunit of factor I, plasminogen activator inhibitor-I, methylenete-trahydrofolate reductase and glucoprotein IIIa. The study results have shown that 100 per cents of women in the study group with FLS or FLS risk factors in the past have been carriers of at least one allelic variant associated with increased risk of thrombogenesis. A combination of two or more adverse geetic variants (potential risk factors for FLS) have been registered in the overwhelming majority of cases. The incidence of Leiden and genotype 1565CC gene GpIIIa mutations in both study groups was significantly different as compared to the population. The study results demonstrate the necessity to determine adverse allelic variants of the known genes along with the classical deteminants of inherited thrombophilia in everyday obstetrical practice, as it allows to sportlight individual mechnisms of development of FLS and the most commonly seen complications of pregnancy.

Transient erythroblastopenia of childhood is an acute form of anemia characterized by a transient red blood cell aplasia, of unknown case, in the bone marrow. 39 patients were seen in our paediatric depatment during the period 2010 to 2013. The ages varied from 11 to 66 months. 26 patients had severe anemia, the lowest mean haemoglobin values being 52 (28-69) g/l. The reticulocyte count was low in 29 patients, whereas 10 patiants had reticulocytosis. No underlying haematologic diseases were found. All patients were tested for parvovirus B 19 infection, HHV-6, CMV, EBV, HHV-1,2 infections. No child showed B 19 DNA in serum or bone marrow collected at presentation. 19 patients showed HHV-6 (n = 11), CMV (n = 4), EBV (n = 2), HHV-1,2 (n = 1) DNA in serum or bone marrow collected at presentation. Apart from transfusion of red blood cell in 23 patients. Reticulocytosis, indicating beginning recovery, was observed after a mean interval of 10 days. All patients resolved within 3 weeks, without long-term sequale.

Hyperandrogenism is a pathological process associated with an excessive effect of androgens in a female organism. In addition to the appearance changes hyperandrogenism (HA) can declare itself by some disorders of reproductive system functioning (anovulation, sterility, miscarriage). The causes of hyperandrogenism can be absolutely different by their pathogenesis conditions. Such external (peripheral) manifestations of hyperandrogenism as hirsutism can be determined by the only reason - excess of 5a-reductase enzyme. There are more cases of combined (associated) forms in the clinical practice. The article considers the cases of combinations of various forms of hyperandrogenism with peripheral forms and their influence on the change of clinical and laboratory parameters. The highest frequency of the excess of 5a-reductase enzyme was found in the group of girls with congenital adrenal dysfunction - 75 %, among the girls with a polycystic ovary syndrome the frequency of this pathology was 9,5 %, and among the girls with hypothalamic syndrome of pubertal period - 14,3 %. The combination of any hyperandrogeny form with the excess of 5a-reductase enzyme was accompanied by hirsutism increase, reduction of mammary glands in adolescents, suprarenal hormones level increase - DEA-s and 17-OHPg. In the case of combination of congenital adrenal dysfunction or hypothalamic syndrome of pubertal period with the excess of 5a-reductase enzyme the laboratory parameters of hyperandrogenism (testosterone, index of free testosterone) were expressed more intensively. In the case of the combination of the excessive production of 5a-reductase enzyme with a polycystic ovary syndrome the diagnosis was more complicated because the index of free testosterone was normal. In the case of combined forms polycystic ovary syndrome is not frequently proved by the laboratory hyperandrogenism, more often these are the cases of incomplete polycystic ovary syndrome.

Obesity is a serious medical, social and economic issue in modern society. Relevance it is determined primarily by the high prevalence of obesity. Objective: identify medical and social factors influencing the development of obesity in adolescent girls with menstrual cycle. Materials and methods: questionnaires, analysis of medical records, clinical, laboratory and instrumental examination 167 girls from 14 to 18 years with obesity I degree (28,7 %), obesity degree II (58,1 %), obesity III degree (13.2 %) and their parents, and 211 girls with normal body weight and their parents. Results: artificial feeding from birth had 23,2% of the young women of the main group, in the control group the rate was 7.4 %. The regularity of meals keep 12.5 % of adolescents in primary and 27.1 % of adolescents in the control groups. The prevalence of high-calorie foods noted 21.1 % of girls are obese and only 4.9 % of normal body weight. The average age at onset of menarche in girls with obesity was 10 years and 9 months, which is 11 months earlier than in the con-control group girls. Girls with overweight significantly more often in 80.6 % of identified disorders of lipid compared with a group of girls with normal body weight, in 13.9 % of cases respectively. In the main group was observed hormonal changes, talking about changing the gonadotropic function of the pituitary gland, disorders of the cyclical release of gonadotropins, the absence of physiological “ovulatory peak”, a chaotic secretion of FSH and LH, the violation of physiological ratio of FSH/LH. When conducting USDG in the first group identified dyscirculatory violations arterial bed, in the form of the asymmetry of the flow and signs of venous degenii in the form of increased speed of blood flow in the jugular veins, monophasic flow in the veins, the blood flow in the vertebral veins in a horizontal position. Conclusions: the menstrual cycle occurs under the action of complex factors, such as physical illness, unbalanced diet, chronic stress, bad habits, poor physical living conditions. A survey of adolescent girls who turned over the menstrual cycle and with obesity should be integrated and include in addition to the laboratory, instrumentaltion survey joint management of such patients related-governmental experts.

Ovarian lesions in children are most frequently diagnosed in pubertal period. That could be associated with increased gonadotropin stimulation in this period. Most of the andexal masses in adolescents are benign. Malignant tumors of the ovary account less than 2 % in girls. Every girl with ovarian tumor and acute abdominal pain requires urgent differential diagnostic intervention and/or surgical treatment. The proportion of ovarian torsion is 2-3 % of all cases of abdominal pain in girls. This condition is an emergent gynecological pathology. One of the main aim of surgical treatment in young is to preserve fertility. Different surgery tactics in cases of ovarian masses in adolescents are reviewed in the article. The reproductive status of women underwent treatment for ovarian masses in childhood requires further investigations.

Hemorrhagic stroke (HS) constitutes 20 % of acute disorders of cerebral circulation. The incidence of HS in different regions varies between 10 and 35 per 100 thousand population. In spite of modern breakthroughs in neurosurgery and neurology cerebral hemorrhages are characteristic of high lethality and invalidization. Lethality level depends on the size of the hematoma. The lethal outcome is more probable in case of hematoma size over 100 cubic centimeters. The survival rate in patients with larger hematomas may increase provided the conventional surgical treatment is as early as possible before the development of pronounces dislocational manifestations. Hematomas over 80 cubic centimeters case death irrespective of the treatment method due to a combination of large size of hematoma and fast development of intracranial hypertension and dislocation syndrome. Lobar hematomas develop in a more benignant manner while mixed ones may be classified prognostically unfavorable: the lethality in this group is considerably higher than in in other hematomas. The lethality and gravity of clinical manifestations in case of medial hematomas is associated with haigh frequency of intraventricular hemorrhages. Considerable variability of hypertension hematomas’ treatment results testifies to an absence of a common approach to surgical treatment. Surgical treatment may demonstrate its convincing advantages only in case of strict approach to selection of patients for surgery which requires an integral scale for the assessment of the patients’ state. Taking into consideration the high demand for surgical treatment of cerebral hematomas in Russian Federation (about 11 000 operations per year) organization measures are necessary to create additional neurosurgical departments for emergency surgical aid for HS patients.

In the diagnosis of ovarian tumors, with the most frequent gystotypes specific to childhood and adolescence, is widely used of tumor markers tests: alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG) and Ca-125. Features of the development of malignancies in children restrict of tumor markers tests in clinical practice. At the same time there are no tumor marker with 100 % specificity for the tumor. The article describes the clinical cases of 13-year-old female patient with appendicular infiltrate and secondary right adnekstumor and 14-year-old girl with hematogenous disseminated tuberculosis and salpingooophorities. The levels of Ca-125 and was an increased in both cases: in the first - to 39.41 IU/ml, in the second - up to 928.1 IU/ml. Thus, it was confirmed that the increase of serum concentration of CA-125 were in direct proportion to the pathological “irritation” of peritoneal serosa. In fact, the Ca-125 had the feature of acute phase proteins, so, its tumor specificity was low. Therefore the use of tumor marker test for Ca-125 is not always makes more easy task of differential diagnosis of the nature of the tumor mass pelvic in girls.

The ability to have a body temperature that is independent of environment temperature is evolutionary acquisition. Thanks to him, organisms can control the intensity of metabolism to increase body temperature. Homoiothermic animals can maintain an optimum body temperature via the heat transfer into the environment. An optimal level of temperature is necessary for activity of most enzymes, the implementation of metabolic reactions in cells. The viscosity of blood and extracellular fluids, the surface tension of the surfactant, swelling colloids of the interstitial space depend on the temperature inside. The excitation of cells, muscle contraction, secretion, absorption, locomotor activity and phagocytic properties of neutrophils also depend on the temperature of the tissues. Fever is pathological process a temporary increasing of body temperature for homoiothermal animals and humans. The process starts due to cytokines exogenous and endogenous origin. Cytokines rebuild the system of thermoregulation. Fever is protective response to damaged but may be redundant. Tachycardia at a fever promotes arrhythmias and may be complicated by the development of acute heart failure. Critical temperature decrease with profuse sweating can cause collapse. Fever in pregnant women in the early stages of placentation provokes violations and defects of the neural tube of the embryo. Fever leads to accumulation of ketonic substances in the blood due to incomplete lipolysis. Ketoacidosis with fever in young patients is the cause of hyperthermic convulsions. The negative effects of fever forced to resort to antipyretic therapy and measures to increase heat dissipation.