Vol 19, No 2 (2017)

Articles
Contraceptive and medical possibilities of estrogen-hestagenic preparations
Ovsiannikova T.V., Kulikov I.A.
Abstract
The article presents data on reproductive health problems in women of late reproductive and perimenorausal age. The indications and optimal methods of contraception in this age period have been refined. It was noted that the individual approach and correctly selected COCs in the late reproductive and perimenopausal periods provide reliable contraception and have a curative effect in endometrial hyperplasia, dysmenorrhea, AMC, hyperandrogenism and PMS. Contraceptive and therapeutic aspects of the use of Lindineth 20 are considered. The use of COC with age, gynecological and extragenital diseases reduces the frequency of the formation of functional ovarian cysts and benign breast diseases and the risks of development of ovarian, endometrial and colorectal cancer in the future.
Gynecology. 2017;19(2):5-8
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Sexual steroids and functions of the brain
Stenyaeva N.N., Chritinin D.F., Grigoriev V.Y., Kusemin A.A.
Abstract
Neurosteroids are endogenous modulators of nervous excitability. There is increasing evidence of sedative, anxiolytic, analgesic and anticonvulsant properties of neurosteroids. Progesterone and allopregnanolol participate in adaptation to stress, and also have immunomodulating activity and cytoprotective properties. Neurosteroids have the potential therapeutic possibilities associated with molecular mechanisms of the epileptogenesis interruption and modulation of neuroinflammation and neurogenesis in the brain.
Gynecology. 2017;19(2):9-14
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Characteristic of the metabolic and nutritional status of patients with functional hypothalamic amenorrhea
Chernukha G.E., Gusev D.V., Moskvicheva Y.B., Tabeeva G.I.
Abstract
The aim of the study - to analyze the nutritional status, fat content and leptin in patients with functional hypothalamic amenorrhea (FHA). Subjects and methods. Clinical and laboratory methods were performed to examine 48 patients with FHA (age 25.8±5.43 years, BMI 19.7±2.01 kg/m2), including an assessment of the nutrient intake, eating behavior, lipid profile, leptin level and body composition by using dual-energy X-ray absorptiometry. Results. Body weight loss was observed in 29.2% of patients, body fat deficiency - in 100% of patients with low and in 58.8% with normal BMI respectively. Hypoleptinemia was detected in 77.1% of patients, hypercholesterolemia without increasin go fatherogenic index in 68.8% of patients. The analysis of the EDI-2 questionnaires showed that 54.2% of patients had drive for thinness, 22.9% of patients had body dissatisfaction. Nutritional examination showed a decrease of caloric intake in 50% of patients, daily carbohydrate intake - in 91.7%, increase protein intake in 70.8%, fats in 62.5% of patients. The ratio of nutrient consumption (proteins, fats, carbohydrates) was 1:1:0.3. Conclusion. The revealed features of the metabolic and nutritional status of patients with FHA point to the need for multidisciplinary interaction of the gynecologist, nutritionist and psychotherapist to normalize eating behavior, energy balance, total body fat percentage and menstrual status.
Gynecology. 2017;19(2):15-18
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Ovarian hyperstimulation: modern tactics of managing patients
Dobrokhotova Y.E., Borovkova E.I.
Abstract
The article presents current data on ovarian hyperstimulation syndrome. Classification, criteria for assessing the severity and in algorithmic form, see diagnostic and treat-ment approach to patients management. Separately theis sues of prevention of thromboembolic complications.
Gynecology. 2017;19(2):19-22
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Polycystic ovary syndrome in the practice of a teenage gynecologist: the possibility of prevention, the principles of therapy
Gogotadze I.N., Fedorova A.I.
Abstract
The article provides statistical information on the syndrome of polycystic ovaries (PCOS) in the morbidity pattern of patients of the SCDC "Juventa" from 2010 to 2015. The complexity of diagnosis of the syndrome in adolescents is indicated. Based on information on the pathogenesis of PCOS, the risk groups for the formation of the syndrome and methods for possible prevention were discussed. The principles of choosing hormonal drugs for conducting corrective hormonal therapy are discussed.The experience of using drugs containing chloromadinone acetate and drospirenone is presented in adolescents.
Gynecology. 2017;19(2):23-28
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The influence of obesity and dyslipidemia on ghrelin production in women of reproductive age
Vedzizheva E.R., Uspenskaya Y.B., Gitel E.P., Kuznetsova I.V.
Abstract
Adipose tissue fulfills different functions, related to homeostasis, consequently, excess of adipose tissue may have a negative influence on endocrine and metabolic parameters. The relationship of separate components of metabolic disorders with reproductive disturbance remains under-investigated. Notably, the role of dyslipidemia (DL) as an independent risk factor of menstrual function and fertility disorders remains unknown. Objective. To evaluate fertility and menstrual disturbance in women with obesity and/or DL. Patients and methods. 150 women aged 18-37 years were divided into 3 groups: 1st - 50 women with body mass index (BMI)>24.9 kg/m2 and DL, 2nd - 46 women with BMI>24.9 kg/m2 and normal blood lipids; 3rd - 54 women with BMI<25 kg/m2 and DL; control group - 20 healthy women with normal BMI. All women underwent the evaluation of menstrual and reproductive function, standard clinical and laboratory evaluation and assessment of ghrelin and leptin levels. Results. Fertility disorders were found in 69 (75.0%) women: 31 (44.9%) patients in group 1, 13 (18.8%) patients in group 2 and 25 (36.3%) patients in group 3. Menstrual cycle disorders, including oligo/amenorrhea and abnormal uterine bleeding were found in 35 (70.0%) patients in group 1, 13 (28.3%) patients in group 2 and 45 (83.3%) patients in group 3. An increased prevalence of cholelithiasis in patients with dyslipidemia was demonstrated. There was an inverse correlation of ghrelin and leptin levels (r=-0.285; p<0.05) and BMI. Conclusions. A high level of menstrual cycle and fertility disorders is observed in women of childbearing age with DL. DL is a significant risk factor of menstrual cycle disorders and infertility independent of BMI. Obesity promotes an increase of leptin level and decrease of ghrelin level.
Gynecology. 2017;19(2):29-33
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The possibility of allogeneic placental therapy of postovariectomical manifestations in patients with gynecological cancer after antitumor treatment
Pokul L.V., Orazov M.R., Lebedeva M.G., Bebneva T.N., Polikarpova S.R.
Abstract
The results of a clinical-psychological prospective examination of 131 patients with cervical cancer, the uterus body and ovaries of stage I-III according to FIGO, reproductive age in total hysterovectomy and radiation suppression of ovaries isolated in three clinical groups are presented: group I - patients after combined and complex special treatment; Group II - patients after combined radiation treatment and group III - patients after combined and complex treatment, therapy of postovariochemical manifestations of which was carried out by traditional therapy. Identification of personal resources of stress-resistance was carried out using the copy-test of R.Lazarus. The intensity of oxidative processes in blood plasma was judged by the content of their carbonyl derivatives, revealed in the reaction with 2,4-dinitrophenylhydrazine. Results and discussion. For patients in the state of total hysterovarioectomy (groups I and III), the hyperactivity of the strategy "Confrontation" (76.8% and 76.4%, respectively) and "Positive revaluation" (67.8% and 72.6%) are a common phenomenon. "Constructive strategies"; "Distant" (73.8%) and "Acceptance of responsibility" (82.5%) are typical for patients of the II group who are in drug and radiation suppression. In the blood of all patients, increased oxidative potential was determined. Significant changes were demonstrated in the analysis of the intensity of induced (metal-catalyzed) OMB: at λ 370 nm and λ 530 nm in group I and group III (p<0.01): the level of oxidation products was significantly lower in the group II patients after SLT. Changes were demonstrated in the analysis of the intensity of induced (metal-catalyzed) OMB. The level of carbonyl groups was significantly lower in the group of patients II after SLT (p<0.01). After the therapy with allogeneic hydrolyzate of the placenta (AHP) with Melsmon of the APEC for 14 weeks, an objective orientation toward a decrease in the oxidative potential in the blood of patients was manifested. The serum level of the end products of OMB had an active decrease in comparison with the similar values in group I at λ 370 nm (1.3 times) and λ 430 nm (1.5 times); p<0.01. At λ 530 nm - groups I decrease by 1.4 times and II decrease by 1.6 times, p<0.01. The level of OMB in induced oxidation demonstrated a pronounced active decrease, especially at λ 530 (p<0.01). The study of induced AMB in the serum of Group III patients with gynecological cancer, the treatment of which was carried out by traditional methods in the PES did not show any statistical differences. In group I patients, the activity of non-constructive strategies is significantly reduced: confrontation (from 76.8% to 54.2%); flight/avoidance (from 64.2% to 38.6%). More actively, patients began to apply resources to constructive distancing strategies (activity increased from 42.4% to 68.3%); planning of problem solving (from 42.8% to 72.4%). The active decrease in the level of the carbonyl products of protein oxidation correlated with the improvement and stabilization of the psychological status in the form of non-constructive coping strategies "Confrontation", "Escape-avoidance" in patients of group I (r=0.379, r=0.437, p<0.001) and group II (r=0.439, r=0.376, p<0.001). Conclusions. 1. In gynecological cancer cases examined in the PES state , there is an intensification of the processes of free radical oxidation of biomolecules. However, in patients with preserved ovaries, the oxidative processes are somewhat reduced. 2. Decrease in the levels of carbonyl oxidation products against the background of Melsmon therapy in patients with gynecological cancer in the state of PES testifies to the possibility of participation of the drug components in antiradical protection. 3. Evaluation of the results of sonographic monitoring of the abdominal and pelvic organs in patients included in the study did not reveal a worsening of the prognosis of the underlying disease against the background of allogeneic placental therapy. 4. Allogeneic placental therapy with Melsmon helps to improve the psychological status of gynecological cancer patients in the form of stress-overcoming.
Gynecology. 2017;19(2):34-41
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Diffusive breast diseases: a new vector of targeted therapy
Protasova A.E., Vandeeva E.N.
Abstract
The article describes the review of literature risk factors for fibrocystic disease (FCD), the role and place of individual risk factors such as mammographic density and cyclic mastalgia. The evaluation of significant clinical symptoms as a risk factor for breast cancer (BC) was made. The modern possibilities of diagnostics of FCD are considered. The modern recommendations on medical tactics are given. The pathogenetic treatment of FCD aimed at preventing breast cancer is described; The use of a Progestogel® drug for the treatment of FCD and breast cancer prophylaxis.
Gynecology. 2017;19(2):42-49
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Embolization of uterine arteries with emergency assistance in patient leiomyoma with uterine bleeding
Damirov M.M., Kokov L.S., Belozerov G.E., Oleinikova O.N., Titova G.P., Trofimova E.Y., Maiorova O.V., Serzhantova S.G.
Abstract
The results of treatment of 65 patients with uterine leiomyoma (LM) of various sizes received with abundant uterine bleeding are analyzed. All patients underwent endovascular haemostasis by performing uterine artery embolization (EMA). The clinical features of the course of the disease after performing EMA at different tumor sizes were studied. The insufficiently high efficiency of EMA at combined defeat of uterus LM and adenomyosis is noted.
Gynecology. 2017;19(2):50-54
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The role of steroid hormones and chemical carcinogen benzo(a)pyrene in premature rupture of membranes in preterm pregnancy
Artimuk N.V., Elizarova N.N., Polenok E.G.
Abstract
The aim of this study was to investigate the levels of estradiol, progesterone; antibodies Ig classes A and G to them and to benzo(a)pyrene in women with premature rupture of membranes (PROM) at 22-36.6 weeks of gestation and in women without PROM in the same period. A retrospective, comparative, analytical study was taken. The study included 149 patients, group 1 consisted of women with PROM at 22-36.6 weeks of gestation (n=68), group 2 - women with a normal pregnancy without PROM at 22-36.6 weeks of gestation (n=81). Isotype differences in the formation of antibodies (Ig) to estradiol were revealed in women from group I compared with group II. High level of IgA antibodies to estradiol is more common in women with PROM at 22-36.6 weeks of gestation.
Gynecology. 2017;19(2):55-58
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Current state of the problem of habitual loss of pregnancy: discussion questions of causes and risk factors, tactics of periconceptive management
Skvortsova M.Y., Prilutskaia S.G.
Abstract
The literary review presents modern views on the problem of habitual loss of pregnancy. Questions of terminology, causes and risk factors, strategic directions of pre-survey examination and per-conceptual management of patients with this pathology are discussed. The causes of habitual loss of pregnancy are extremely diverse and, as a rule, are interrelated. These are genetic causes (chromosomal abnormalities of the embryo or one or both parents), endocrine disorders (the endpoint of which is a violation of the functional and structural state of the endometrium), immunological factors (realized at the level of local disruption of the production of various cytokines, normally providing implantation and placentation processes) and hemotaziologic disorders (the most studied of which is AFS). An important role of pre-gestational detection and correction of risk factors for pregnancy loss in a married couple is shown.
Gynecology. 2017;19(2):59-65
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Effect of local preparations containing glucocorticoids on local immunity parameters and activity of human papillomavirus
Borovkova E.I., Fedotova A.S.
Abstract
The aim of the study was to investigate the effects of topical application of preparations containing glucocorticoids on the replicative activity of human papillomavirus oncogenic type. Prospective study included 160 patients of reproductive age. The examination included microbiological testing, qualitative and quantitative screening for human papilloma virus high-risk group (HPV-PCR and Digene-test), immunological study of cervical secret (immunoglobulins class A, M, G and secretory IgA). Was shown that the vaginal microbiocenosis in patients with nonspecific vaginitis presents a wide range of opportunistic microorganisms, such as Staphylococcus, Streptococcus, Peptostreptococcus, Bacteroides, Bacillus, Actinomyces, Corynebacterium, Prevotella. A number of typical representatives of the indigenous microflora is significantly reduced, or absent. The prevalence of concomitant viral infection was approximately 29%, the most frequently detected viruses 16, 31 and 18. The use of local therapy drug containing a glucocorticoid qualitative and quantitative changes in HPV have been no identified. Evaluation of indicators of local immunity showed an imbalance in the production of immunoglobulins with a predominance of IgA, secretory IgA and IgG in patients on the background of nonspecific vaginitis.
Gynecology. 2017;19(2):66-68
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Noncontraceptive effects of combined oral contraceptives: benefits and risks of use
Unanyan A.L., Nikonets A.D., Aminova L.N., Alimov V.A., Chushkov Y.V., Shchukina A.V., Kudrina E.A., Baburin D.V.
Abstract
This publication is devoted to one of the most relevant areas of gynecological practice - the use of combined oral contraceptives (COCs), taking into account their positive non-contraceptive properties. The issue of how to use COCs with the benefit of reproductive health of women, with what to combine them and how to prevent the risks associated with taking hormonal drugs, is reflected in detail. The information is presented in the form of an analytical review of international studies on the benefits and risks of using COCs.
Gynecology. 2017;19(2):69-74
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Medical termination of pregnancy in patients with malignant diseases
Dobrokhotova Y.E., Arakelov S.E., Danelian S.Z., Borovkova E.I., Shaidullina E.V.
Abstract
The prevalence and detection rate of tumors associated with pregnancy, is growing steadily. Detection of malignant neoplasms has always put the doctor before the need for a decision about the possibility and desirability of pregnancy. The fundamental issue is the nature and stage of pathologic process and duration of pregnancy. According to the Ministry of health and social development of the Russian Federation from December 3, 2007 N736 "On approval of the list of medical indications for artificial interruption of pregnancy", in the case of neoplasms that require chemotherapy or radiotherapy to the pelvic area when the code of the disease C51-58, shows the termination of pregnancy. In all other cases, the question of abortion is solved individually by the doctors. The article presents clinical cases of medical termination of pregnancy in patients with gestational age up to 20 weeks.
Gynecology. 2017;19(2):75-78
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