Vol 19, No 5 (2017)


HPV-associated diseases of the cervix. Complex therapy options

Abakarova P.R., Prilepskaya V.N.


Human papillomavirus (HPV) is one of the most common groups of viruses that has infected more than 660 million people in the world. It has been proved that the long persistence of HPV in the tissues of the organs of the lower part of the genital tract provokes the development of precancerous and cancerous processes. Since the state of the immune system largely determines the nature of the course of HPV infection, a modern approach to the treatment of HPV-associated diseases involves the use of antiviral and immunomodulatory therapy.
Gynecology. 2017;19(5):4-9
pages 4-9 views

Cardiometabolic disorders and menopausal hormone therapy

Balan V.Y., Ilina L.M., Tikhomirova E.V., Tsarkova A.V., Lazareva I.N., Grigorieva D.V.


The review highlights the role of endo- and exogenous estrogens and androgens in the genesis of cardiometabolic disorders in postmenopausal women and the role of menopausal hormone therapy in their prevention.
Gynecology. 2017;19(5):10-14
pages 10-14 views

Rational choice of tactics in patients with uterine fibroids

Pestrikova T.Y., Yurasova E.A., Yurasov I.V., Chirkov A.V.


In the presented review of the literature questions of epidemiology, pathomorphology, pathogenesis, clinic, diagnostics of uterine myomas are considered. Presented are data accentuating the use of the progesterone receptor antagonist drug mifepristone. The therapy of myoma of the uterus by mifepristone is not inferior in effectiveness or safety to analogs of gonadotropin-releasing hormone agonists, and does not have a negative effect on estrogen-dependent extragenital systems and organs (cardiovascular system, bone tissue, mammary glands, etc.), since the serum Estradiol remains at a level corresponding to the early follicular phase of the menstrual cycle.
Gynecology. 2017;19(5):15-19
pages 15-19 views

Herpes-viral infection: epidemiology, diagnosis, therapy

Dobrokhotova Y.E., Borovkova E.I.


Genital herpes is a common disease diagnosed in 90% of people and is characterized by a recurring lifelong course. Clinical manifestations are diverse and manifest in 20% of infected people. The gold standard for diagnosis is the detection of virus culture and polymerase chain reaction in real time. Conducting oral antiviral therapy significantly reduces the duration, severity of the disease and the risk of infection of the sexual partner. At the initial episode of genital herpes it is necessary to carry out system antiviral therapy with its earliest start. The effectiveness of the use of acyclovir, valaciclovir and famciclovir is comparable, but only with valaciclovir the efficacy of two-fold daily dosing is proved. For patients with 6 or more episodes of exacerbations per year, suppressive therapy is indicated, the drug of choice is valaciclovir. With a relapse rate of less than 6 per year, it is sufficient to conduct episodic antiviral therapy. Clinical trials have demonstrated comparable efficacy of acyclovir, famciclovir and valaciclovir. The three-day course of valaciclovir (500 mg 2 times a day) is most suitable in view of the high bioavailability and rapid relief of viremia.
Gynecology. 2017;19(5):20-25
pages 20-25 views

Diagnostic significance of the determination of peripheral blood lymphocytes for predicting the onset of pregnancy in patients with repeated implant failures in groups with different protocols of the assisted reproductive technology program

Amyan T.S., Krechetova L.V., Perminova S.G., Vtorushina V.V., Selimova F.N.


Purpose of the study. Study of the diagnostic significance of the determination of peripheral blood lymphocytes with phenotypes significantly different from the control values for predicting the onset of pregnancy in groups with different protocols of the assisted reproductive technology program in patients with repeated implant failures. Material and methods. The study included 70 patients with repeated failures of implantation in the in vitro fertilisation program: 33 patients in a protocol with a gonadotropin-releasing hormone antagonist (antHNRH), 37 patients in a cryocycle. Results of the study. Patients in the stimulated cycle showed a high diagnostic significance of the definition of a subpopulation of lymphocytes related to congenital immunity (CD3+CD8+, CD56+), and in patients in the cryotype, on the one hand subpopulation of lymphocytes related to adaptive immunity (CD3+), and on the other CD8+, which includes subpopulations of lymphocytes and congenital, and adaptive immunity. The conclusion. High specificity of these tests allows to identify patients with the prospect of pregnancy.
Gynecology. 2017;19(5):26-29
pages 26-29 views

Prognostic factors of pain syndrome after uterine artery embolization in women with uterine leiomyoma

Sosin S.A., Privorotskiy V.V., Zazerskaya I.E., Kustarov V.N.


The pain syndrome after uterine artery embolization can vary from slight to very pronounced. Therefore, choosing an adequate method of anesthesia is extremely important in this method of treatment. Aim of the study: pre-operative prognosis of the severity of the pain syndrome and selection of the optimal managing tactics in postoperative period. Materials and methods. Our study includes 65 patients, the patients are divided into 2 groups depending on the method of anesthesia. For analgesia in the perioperative period, the patients of the first group underwent anesthesia by the method of epidural anesthesia (n=44). In the second group (n=21), the operation was performed under local anesthesia. Results. In group 1, the intensity of the pain syndrome was 5.38 on the 1st day, and 2.36 on the 4th day of the postoperative period. In this case, a clear relationship between fibroid size and the severity of the pain syndrome was revealed. In the second group of patients (n=21) on the 1st day of the postoperative period, the average value of the intensity of the pain syndrome was 7.72. On the 4th day of the postoperative period, the average value of the pain syndrome was 4.95. When analyzing the intensity of the pain syndrome, depending on the size of fibroids, a direct correlation was also found in the patients of this group. Conclusion. Pain syndrome depends primarily on the size of the fibroids. Epidural anesthesia can be considered to be the most effective method of anesthesia. The use of epidural anesthesia is especially justified in the presence of large-sized fibroids (>8 cm). It is advisable to discharge patients not earlier than 4 days after the operation, when a reliable control of the intensity of the pain syndrome is achieved.
Gynecology. 2017;19(5):30-33
pages 30-33 views

Bemiparin in the treatment of a patient with a habitual miscarriage

Tetruashvili N.K., Agadzhanova A.A., Ionanidze T.B.


Clinical observation is outlined - conducting pregnancy in a 43-year-old patient with low-risk thrombophilia, a habitual miscarriage, and venous thrombosis of cerebral vessels in an anamnesis. The results were obtained, indicating a favorable clinical outcome when the drug was administered in therapeutic doses, no side effects were recorded. It was possible to achieve the prolongation of pregnancy until the deadline in the absence of thrombotic and hemorrhagic complications. There were no thromboses during pregnancy and in the postpartum period, thrombocytopenia, bleeding in the II and III trimesters of pregnancy. At delivery, blood loss was 700 ml. Anticoagulant therapy with bemiparin was continued for 6 weeks postpartum period for the prevention of thrombotic complications.
Gynecology. 2017;19(5):34-36
pages 34-36 views

Estimation of the influence of exogenous factors on the vitamin D deficiency in pregnant women in Saint Petersburg

Khazova E.L., Yakovleva N.Y., Belyaeva E.N.


Vitamin D is a precursor of calcitriol, a secosteroid hormone regulating calcium-phosphorus metabolism and a wide range of proliferative and immune responses. Solar UV radiation (290-315 nm) is an initiator of vitamin D production in the human skin. In the northern latitudes, the amount of such radiation reaching the earth's surface is less than in the southern ones, which can be the reason for the wide spread of vitamin D deficiency in the North-West region. Hypovitaminosis takes on particular urgency in women during the pregravid period and during pregnancy, therefore the study of this issue is extremely topical. Materials and methods. The study involved 178 women in the first trimester of pregnancy. The concentration of calcifediol was determined and anthropometric examination was performed. The calendar month of inclusion in the study was taken into account. Women are divided into 2 groups: Group 1 (n = 65) women with a calcifediol level above 30 ng/ml, group 2 (n=113) - below 30 ng/ml. Results. In both groups, the average concentrations of calcifediol were lower in winter. The total variability of the values of calcifediol is not due to the trend, but due to the seasonal component. The seasonal difference of calcifediol fluctuates above and below zero on the graph of the seasonal component, with the "summer vitamin D" season comprising the months from June to September, and the "winter vitamin D" season from October to May. In this period is necessary the exogenous introduction of cholecalciferol or additional irradiation of the skin with UV radiation.
Gynecology. 2017;19(5):37-39
pages 37-39 views

The experience of using progesterone during pregnancy in women with epilepsy

Tsallagova E.V., Generalov V.O., Polyanchikova O.L., Sadykov T.R.


The article examines the dependence of the course of epilepsy on the concentration of progesterone in the blood serum during pregnancy. A case history of 36-year-old patient with symptomatic focal occipital epilepsy on the background of neoplasm of the brain is described. At 11 weeks of pregnancy, she was found to have a decrease in the level of progesterone to 21.7 nmol/l at a concentration of levetiracetam 31.2 μg/ml. The addition of progesterone to the therapy of 600 mg/day allowed to gradually increase the concentration of progesterone to a sufficient level of 440 nmol/l, which was accompanied by an increase in the concentration of levetiracetam in the blood to 49.8 μg/ml without increasing the dose of the anticonvulsant drug. As a practical conclusion, it is recommended to use during pregnancy correction of the level of progesterone in the blood as a measure to prevent the recurrence of epileptic seizures.
Gynecology. 2017;19(5):40-43
pages 40-43 views

Pregravid preparation and management of pregnancy in patients with connective tissue dysplasia

Dobrokhotova Y.E., Borovkova E.I.


Connective tissue dysplasia is a genetically determined condition characterized by a violation of the structural organization and synthesis of the main components of connective tissue. The prevalence of non-syndromic forms is extremely high and to 46.6-72.0% is due to cofactor deficiency of magnesium. Typical obstetric complications in Ehlers-Danlos syndrome are bleeding, early formation of isthmicocervical insufficiciency, premature and rapid delivery, delayed fetal growth, symphysiopathy, rupture of the pubic joint, rupture of the perineum, spontaneous ruptures of the skin, vagina and internal organs, postpartum bleeding and incompetence of the pelvic floor muscles, bladder, urethra and rectum. Marfan syndrome in 40% of cases develop premature rupture of membranes, premature birth and miscarriage at an early age. Maternal mortality is 0.74 per 100 000 births and is associated with lamination (1%) or rupture of the aortic aneurysm (3%). With nonsynthetic forms of connective tissue dysplasia at the stage of pregravid preparation and throughout pregnancy, the appointment of magnesium preparations is indicated.
Gynecology. 2017;19(5):44-49
pages 44-49 views

Menopausal hormone therapy: a course to improve the effectiveness

Unanyan A.L., Sidorova I.S., Aminova L.N., Alimov V.A., Nikonets A.D., Chushkov Y.V., Shchukina A.V., Baburin D.V.


This publication is devoted to one of the most relevant areas of gynecological practice - menopausal hormone therapy. The information is presented in the form of an analytical review of international studies on the benefits and risks of menopausal hormone therapy. Given the rapid growth in the number of women in middle and middle age, it is extremely important to identify the benefits and risks of menopausal therapy in order to optimize the quality of life and long-term well-being.
Gynecology. 2017;19(5):50-56
pages 50-56 views

Effective application of pneumo-vibro-massage in aesthetic gynecology

Apolikhina I.A., Saidova A.S., Chochueva A.S., Churakov A.A.


The use of gynecological pneumo-vibro-massage as monotherapy, or in combination with other methods of physiotherapy helps to strengthen the entire complex of metabolic and trophic processes, improve the activity of regulatory systems, and to suspend the development of muscle atrophy and sclerotic changes. Our own experience in the application of this method for gynecological diseases, showed an improvement in tissue trophism, regeneration and restoration of functions. Gynecological pneumo-vibro-massage using MKV-01 "Ivavita" in a complex treatment of various diseases can take a significant place in restorative medicine and rehabilitation.
Gynecology. 2017;19(5):57-62
pages 57-62 views

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