Vol 18, No 1 (2016)

Articles
Recent tendencies in the prevention and treatment of menopausal syndrome
Prilepskaya V.N., Bogatova I.K., Radzinskiy V.E.
Abstract
The results of a multicenter, double-blind, placebo-controlled randomized study of therapeutic efficacy and safety of peptide structure of Pineamine® in neuro and psycho-emotional manifestations of the climacteric syndrome in women.Materials and methods. We observed 120 women aged 45-60 years in postmenopausal women (more than 1 year after the last menstrual period) with neurovegetative and psycho-emotional symptoms. After the step of screening patients met the criteria for inclusion/non-inclusion were randomized into 3 groups at a ratio of 1:1:2, namely: the placebo group - 30 patients (placebo rate of 1 mg daily, intramuscularly, the duration of 10 days); group Pineamine®-1 (P1) - 30 patients (one course of Pineamine® - 10 mg daily, intramuscularly, the duration of 10 days) and a group of Pineamine®-2 (P2) - 60 patients, with two 10-day courses Pineamine® (10 mg daily, intramuscularly, duration 10 days). On the 90th day all the patients underwent a second 10-day course: the placebo group - a drug placebo 10 mg intramuscularly; group P1 - a drug placebo 10 mg intramuscularly; group P2 - intramuscular Pineamine® - 10 mg. The study conducted 7 visits. The main method of confirming the effectiveness of the drug, is the dynamics of the Kupperman index (vegetative and psycho-emotional symptoms). In addition, we studied the number of adverse events and adverse reactions associated with the use of the drug. We investigated the vital parameters (blood pressure, heart rate, respiratory rate, ECG) and the entire range of standard and special haematological and biochemical indices of the blood levels of thyroid hormones, female hormones, EEG was performed. To closely monitor the condition of the endometrium by ultrasound of the pelvic organs, and according to endocervical cytology (Pap smear). All patients performed densitometry of femur and spine.Results of the study. It was found that the original 3 groups of patients didn't differ by demographic characteristics, severity of menopausal symptoms and laboratory data and instrumental performance. For various reasons, dropped out of the study 19 patients and populations "protocol" amounted to 101 patients. The primary efficacy were evaluated in patients of all groups at 90 and 180 days of treatment. Analysis of the results showed that the primary criteria for efficacy of Pineamine® - reducing the severity of menopausal syndrome (modified Kupperman Index) measured at one or more points from baseline dannymi-achieved in the population of "efficiency", as well as in the population "protocol". Thus, the group of patients receiving drug treatment by Pineamine® (P1 and P2) were significantly different from the vehicle group (in the population of "effectiveness" p=0.04; in the population "protocol" p=0.02). In analyzing the results of the data obtained at day 180 in group P2 (two courses of Pineamine®) there was a clear difference from placebo in a population of "effectiveness", and the population "protocol" (p=0.04). During this period it is determined that the basis of the effectiveness of drug therapy PineaminR of its impact on neurovegetative symptoms of menopausal syndrome (significant dynamics in all populations in the 90 and 180 day).Secondary performance criteria - the dynamics of total score of Kupperman index and the difference compared with its original data - are also achieved in the research process. This indicator of neuroautonomics reaffirmed the role of the segment index (p=0.047). In assessing the data on the tolerability and safety of the drug noted 22cases of adverse events, found mainly in the groups of women who received injections of Pineamine®.Conclusion. Primary and secondary efficacy criteria reliably prove that the domestic product peptide structure of Pineamine® - an effective drug for the treatment of menopausal syndrome. It was established that its mechanism of action is aimed primarily at neurovegetative climacteric syndrome. Security of Pineamine confirmed by the absence of negative results of instrumental - laboratory parameters in all study participants.
Gynecology. 2016;18(1):7-12
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Dyspareunia in women in preand postmenopausal period
Fedorova A.I.
Abstract
The article presents current views on the multiple pathogenetic mechanisms of development of dyspareunia in women in pre - and postmenopausal women with positions of biopsychosocial approach. The importance of the study of mental and sexual status of patients. We discussed current approaches to the treatment of vulvovaginal atrophy underlying dyspareunia. The mixed forms of dyspareunia are represented by a multi-disciplinary, pathogenetic-oriented therapeutic approach, which combines flexibility medication, psychopharmacotherapy, sexological psychotherapy and counseling.
Gynecology. 2016;18(1):13-18
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Modern views on the etiology, pathogenesis, diagnosis, prevention and treatment of vitamin D deficiency in postmenopausal women (literature review)
Pestrikova T.Y., Yachinskaya T.V.
Abstract
In the literary review is presented the modern data showing different forms of vitamin D deficiency and its optimal ways of correction. It specifies the pathway of vitamin D in the body. The paper describes laboratory signs of vitamin D deficiency and indications for screening. Particular emphasis is laid on the place of vitamin D in thetherapy of osteoporosis.
Gynecology. 2016;18(1):19-23
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Menopausal hormone therapy in postmenopausal women: the quality of life today and in the long term
Yureneva S.V., Ilyina L.M., Yakushevskaya O.V.
Abstract
In considering the various aspects of menopause, not enough attention is paid to a significant reduction in the quality of life for women in transition and early postmenopause. Timely administration of menopausal hormone therapy is effective in reducing menopausal symptoms and improves quality of life at a given time, as well as the risk of developing diseases of aging, that can improve the quality of life related to health, and overall well-being of women in the more distant future. The choice of medication should be determined by its composition and clinical characteristics of the particular patient.
Gynecology. 2016;18(1):24-29
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The modern approach to the prevention of complications in the treatment of inflammatory diseases of the genital pelvic organs
Tikhomirov A.L., Manukhin I.B., Kazenashev V.V.
Abstract
The prognosis for pelvic inflammatory diseases defines unresolved inflammation and adhesions, which ultimately can lead to disruption of reproductive function.Integrated anti-bacterial, enzymatic and immunomodulatory therapy reduces the risk of residual complications.
Gynecology. 2016;18(1):30-33
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Role of acute-phase proteins in postpartum endometritis diagnostics (literature review)
Batrakova T.V., Vavilova T.V., Osipova N.A.
Abstract
The modern data and actual specificity of postpartum endometritis diagnostics are shown in this literature review, dynamics of C-reactive protein at physiological puerperas and septic complications.
Gynecology. 2016;18(1):37-39
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The two-step method for treatment of chronic endometritis in perimenopausal women with endometrial hyperplasia
Tkachenko L.V., Sviridova N.I.
Abstract
Sixty-four patients aged 45-55 (48.12±2.15 years) with simple and complex endometrial hyperplasia without atypia associated with chronic endometritis (CE) were enrolled into a comprehensive clinical and laboratory stud. We developed a two-step method for treatment of CE. The study results suggest that the use of the two-step method for treatment of chronic CE in perimenopausal women with endometrial hyperplastic processes can be considered research-based.
Gynecology. 2016;18(1):40-44
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Results of the study of HPV-typing of anogenital area in patients with cervical intraepithelial neoplasia
Sulamanidze L.A., Nazarova N.M., Prilepskaya V.N., Burmenskaya O.V., Demura T.A., Gordeev S.S., Chuprynin V.D., Trofimov D.Y.
Abstract
Objective: to study the prevalence of different types of human papilloma virus (HPV) in cervix and anal canal in patients with HPV-associated cervical intraepithelial neoplasia (CIN) of varying severity.Material and methods: the clinical examination, colposcopy; high resolution anoscopy; cytology; typing of HPV.Results. The study involved 204 women, mean age 30±1.2 years. By results of inspection are formed 2 groups: 1 - 92 (45%) with CIN I-III, 2 - 112 (55%) without CIN. In group 1 in the cervical canal were detected HPV 16, 68 (р<0.05), in anal region 15, 56 (р<0.05). In group 2 in the cervical canal were detected HPV 16 (21.4%), 52(19.6%), 31, 44 (12.5%), 33 (10.7%), in anal region 44 (25%), 31 (19.4%), 53, 6(13.8%), 16, 52, 11, 18 (11.1%). In patients in group 1, 1.5 times more likely was found changes of anal epithelium compared with the group 2. Abnormal anal cytology was found in 12% of patients. High risk HPV cause more severe changes in the anal epithelium similar to the cervix.Conclusion. In patients with HPV-associated diseases of anogenital region revealed differences in the types of HPV in the cervical canal and anal region. The dominant type of HPV in women with CIN in the cervix and anus is the HPV type 16. HPV-associated cervical disease, including CIN, pose a risk of infection and HPV-associated diseases of the anal region, including anal intraepithelial neoplasia.
Gynecology. 2016;18(1):45-48
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Clinical and immunological assessment of the state of the cervix after radiosurgical conization and medical prophylaxis of septic complications
Pokul L.V., Chugunova N.A., Penzhoyan I.L.
Abstract
Purpose of the study. Comprehensive assessment of the clinical and immunological changes in cervical epithelium and the vaginal microbiota in patients with cervical intraepithelial neoplasia (CIN) II-III stage after radiosurgical conization and the drug Neo-Penotran Forte L.Materials and methods. The study included 2 groups of sexually active women (n=143) aged 21 to 45 years (mean age - 34.5±6.5 years). They were examined for the presence of genital infections and vector-borne, liquid-based cytology, colposcopy. All patients were treated with radiosurgery method in the amount of conization.Results. Patients treated in the pre - and postoperative period with Neo-Forte Penotran A, were found to have a marked reduction of proinflammatory and anti-inflammatory cytokines increase. Median values analysis has allowed to ascertain the prevalence ofinterleukin indicators (IL)-1a and IL-b in the 2nd group over those in the 1st, when U (Mann-Whitney test)=5.9 and U=7.5, respectively, those p<0.001. Secretion of IL-2 in patients of group exceeded that of patients in Group 1: IL-1a - 2. 6 times and IL-b - 5 times. Results for liquid-based cytology showed no recurrence of CIN. Use of the Neo- Penotran Forte L improved the condition of the stratified squamous epithelium of the cervix according to colposcopic control. In particular, the phenomenon ofprevascular edema, inflammatory infiltration characteristic of coagulation necrosis in group 1 had a significantly less pronounced than in the 2nd: 8.9% (n=7) cases against 32.8% (n=21 ) - if f * (multi-Fischer test) = 3.72, p<0.000; femp *> *fcr. Conclusions.Use of the drug Neo-Penotran Forte L affects the key pathophysiological processes of septic complications, prevents their development and contributes to improved tissue repair in patients after radiosurgical treatment. An integrated pre - and post-operative treatment helps to improve the immune status of the vaginal microecology.
Gynecology. 2016;18(1):49-53
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Use of laser technologies in a complex of arrangements to patients operated for the genital prolapse
Ishchenko A.A., Ishchenko A.I., Shulchina I.V., Muravlev A.I.
Abstract
As the number of surgeries for the genital prolapse is growing, the problem of after-surgery complications is becoming more acute. In this connection there arises a need to develop a rehabilitation program, which would contribute to reducing the number of complications as well as to more effective treatment. The article describes the research embracing 24 patients with pains in the areas of vagina, crotch, groin and the lower part of the abdomen 1 to 6 months after the correction of genital prolapsed with mesh implants. The patients underwent a complex rehabilitation program, including treatment of vagina mucous with the help of laser device SmartXide2 V2LR, with the aim of correcting pain syndrome.
Gynecology. 2016;18(1):54-55
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Empowering organ-preserving treatment of uterine fibroids using ulipristal acetate
Tikhomirov A.L.
Abstract
The choice of treatment of uterine leiomyoma affects different factors: the intensity of the symptoms of fibroids characteristics, age and the need for preservation of the uterus (and fertility). The use of ulipristal acetate may change the orientation of the surgical treatment of uterine fibroids.
Gynecology. 2016;18(1):56-60
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The case of cervical pregnancy with uterine artery embolization
Privorotskiy V.V., Zazerskaya I.E., Zubareva T.M., Ilyin A.B., Kuznetsova L.V., Sosin S.A., Ryabokon N.R., Khuchinaeva L.A.
Abstract
The article presents the clinical observation of the patient's organ-preserving treatment with 31 g of cervical pregnancy. Research methods included MRI to visualize gestational sac, the definition of the boundaries between the chorion and the stroma of the cervix; determining b-subunit of human chorionic gonadotropin in serum; clinical tests. Superselective embolization of uterine artery was successfully performed incombination with subsequent scraping of the cervical canal and uterine cavity. Blood loss was 30 mL. The postoperative period was 5 per bed-day. Organ preserving treatment of cervical pregnancy with uterine artery embolization and subsequent curettage of the cervical canal and the uterine cavity under FSPTS possible to reduce the risk of bleeding and preserve reproductive function in young woman.
Gynecology. 2016;18(1):61-63
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Peculiarities of pregnancy and delivery, the state of newborns in case of premature rupture of membranes and preterm pregnancy
Artymuk N.V., Elizarova N.N., Kolesnikova N.B., Pavlovskaya D.V., Chernyaeva V.I.
Abstract
The purpose of our research was to estimate the outcomes of pregnancies, complicated by premature rupture of membranes at 22-36 weeks’ gestation depending on the duration of the latency period. Retrospective, comparative and analytical research was conducted. The inclusion criteria were 117 women’s pregnancies, complicated by PPROM. The research shows complications of pregnancies, deliveries and the state of newborns depending on the duration of the latency period. The approach to the preterm pregnancy complicated by the premature rupture of membranes should be individualized. However, its prolongation more than 7 days should be strictly justified and be under doctor’s supervision.
Gynecology. 2016;18(1):64-67
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Possible therapy of miscarriage
Dobrokhotova Y.E., Dzhokhadze L.S., Kopylova Y.V.
Abstract
The article provides a comparative evaluation of different methods of treatment of preterm labor. It analyzed the effectiveness of therapy, and outcomes of 45 pregnant women who are in therapy as preterm labor carried an acute intravenous tocolysis, and then move on to maintenance tocolysis in combination with the intravaginal application of micronized natural progesterone. A control group comprised 42 patients, who spend only acute tocolysis. We believe that the preferred replacement of pregnant women with acute tocolysis to tocolytic therapy to supportive tablet form while using micronized form of progesterone.
Gynecology. 2016;18(1):68-70
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3D/4D echographic diagnosis of intracranial tumors in the fetus
Voevodin S.M., Shemanaeva T.V.
Abstract
Anomalies of brain development is one of the first places in the structure of malformations in the fetus. The analysis of the volume of intracranial lesions of the brain using 3D/4D ultrasound techniques. Shown a poor prognosis in the presence of true brain tumors in fetuses. 3D/4D multipledata the technique of scanning is a highly informative approach for the differential diagnosis of intracranial neoplasms in the fetus.
Gynecology. 2016;18(1):71-73
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The effect of the combined contraceptive with chlormadinone acetate in the dermatological and psychosocial status of patients with acne
Vorobyova N.E., Tarasova M.A.
Abstract
The article is about assessing the effectiveness of the treatment of acne of varying severity using a combined hormonal contraceptive Belara® and its impact on the indicators of psychological and social status of women of reproductive age. The study included 123 women interested in contraception, aged 18-45 years old with acne on the face of varying severity. A survey on subjective and objective assessment of the condition of the skin and the presence of psychological and social problems associated with acne, after 3 and 6 cycles of using Belara®. It has been shown that the combined oral contraceptive Belara® containing in its composition ethinylestradiol and chlormadinone acetate, is well tolerated and effective in improving skin condition in patients with acne, that has a positive impact on their psychological, emotional and social self-esteem. High satisfaction drug indicated 87% of the patients.
Gynecology. 2016;18(1):74-78
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The impact of different ovarian stimulation protocols on embryological stage and efectiveness of ivf cycles
Andreeva M.G., Syrkasheva A.G., Dolgushina N.V., Kalinina E.A.
Abstract
There are controversial data about the effect of different controlled ovarian hyperstimulation (COS) protocols on embryological stage and in vitro fertilization (ivf) outcomes. The aim of our study was to evaluate embryological and clinical outcomes according to COS protocol.Material and methods. This prospective cohort study included 521 patients treated with ivf. The patients were divided into the following 5 groups: group 1 - women treated with gonadotrophin-releasing hormone (GnRH) antagonists: subgroup 1a (n=143) - triggering of final oocyte maturation with human chorionic gonadotropin, subgroup 1b (n=85) - with GnRH agonist. Group 2 (n=119) - women treated with GnRH agonists, group 3 (n=82) - women treated in «modified» natural cycle, group 4 (n=92) - women treated with GnRH antagonists and corifollitropin alfa.Results. The lowest percent of empty follicles (78.9%) was observed in group 2. The proportion of mature oocytes (number of mature oocytes|number of cumulus-oocyte complexes) was highest in groups 1a and 2 in comparison with groups 1b and 4 (87.9 and 87.2% vs. 84.0 and 81.9%, respectively). The fertilization rate was maximal in group of women with «modified» natural cycle. The proportion of embryos with different morphological quality was similar in the groups. A clinical pregnancy was observed in 48 (33.6%) cases in group 1a, in 26 (30.6%) patients in group 1b, in 39 (32.8%) casesin group 2 in 7 (8.5%) cases in group 3 and in 17 (18.5%) cases in group 4 (p<0.0001).Conclusions. The selection of COS protocol has an impact on parameters of folliculo-, oogenesis and embryogenesis, as well as on clinical pregnancy rate in ivf cycles. The clinical pregnancy rate also depends on baseline characteristics of women.
Gynecology. 2016;18(1):79-82
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Choosing trigger of ovulation for optimization of in vitro fertilization programs (literature review)
Eapen S.M., Mishiyeva N.G., Martazanova B.A., Dontsova T.V., Pavlovich S.V.
Abstract
This review presents recent data on the impact of different triggers on the clinical and embryological indicators of the effectiveness of assisted reproductive technology in patients with normal and excessive ovarian response to superovulation. Triggering with gonadotropin releasing hormone agonist can be a real alternative to human chorionic gonadotropin triggering: gonadotropin-releasing hormone agonists trigger reduces the risk of ovarian hyperstimulation syndrome. When modifying the luteal phase, the pregnancy rate after gonadotropin-releasing hormone agonists triggering is comparable with that of human chorionic gonadotropin triggering human chorionic gonadotropin in in vitro fertilization programs.
Gynecology. 2016;18(1):84-87
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Prolonged contraception. Modern possibilities, efficiency and prospects (literature review)
Prilepskaya V.N., Khlebkova Y.S.
Abstract
In modern world, hormonal contraception is a popular method of preventing abortions. Various modes of use of contraceptive drugs are developed. Prolonged application mode allows these drugs to be used not only for the purpose of contraception and the treatment, but also for prevention of a number of gynecological diseases. One of the significant problems of all modes of use of combined hormonal contraceptives is the probability of missed tablets. It is proved that the fact of missing or late they receive may be affected by the emotional component of a woman's life. Currently, the new regime of the drug containing drospirenone (DRSP) and ethinylestradiol - EE (Yaz®): 3 mg DRSP+ 0.02 mg EE - 30 tablets of flex-cartridge device Click for dispensing tablets exists. It has been demonstrated that the flexible prolonged mode provides contraceptive reliability, fewer days of menstrual bleeding compared to traditional mode, proven security, alleviation of diseases associated with the menstrual cycle, and the Click dispenser is a simple and intuitive to use innovative device that helps improve compliance and reduce the number of violations of the receive mode.
Gynecology. 2016;18(1):88-91
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Abortion: special statistics in the federal districts of Russian Federation
Filippov O.S., Tokova Z.Z., Gata A.S., Kuzemin A.A., Gudimova V.V.
Abstract
Materials of the prevalence of abortion in the federal districts of Russia.
Gynecology. 2016;18(1):92-96
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The role of cyclic vitamin therapy as a non-hormonal method of rehabilitation treatment of menstrual disorders after an inflammatory disease of the pelvic organs
Mikhelson A.F.
Abstract
Intensity of generative functions violations depends on the frequency of the transferred inflammatory diseases of the pelvic organs (pelvic inflammatory disease), their etiology, treatment tactics and approaches to rehabilitation. With the increase in the number ofepisodes of the disease increasing, the frequency of tubal infertility and ectopic pregnancy also rises. The most characteristic effects of deferred PID are different forms of menstrual disorders. The inclusion in the program of treatment and prevention of disorders of vitamins and minerals of the menstrual cycle is a promising direction of finding an effective and safe approach to therapy. The results of a prospective study of the effectiveness of the two-phase vitamin-mineral complex Ciklovita® used by patients of reproductive age with oligomenorrhea, which developed after previous PID indicate the feasibility of its application.
Gynecology. 2016;18(1):97-100
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