Vol 20, No 5 (2018)

Articles
Yubiley doktora meditsinskikh nauk, professora, zasluzhennogo deyatelya nauki RF Very Nikolaevny Prilepskoy
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Abstract
В 2018 г. отмечает юбилей доктор медицинских наук, профессор, заслуженный деятель науки РФ, заместитель директора по научной работе, заведующая научно-поликлиническим отделением ФГБУ «НМИЦ АГП им. акад. В.И.Кулакова», главный редактор журнала «Гинекология» Вера Николаевна Прилепская. Свою профессиональную деятельность, энергию и талант настоящего доктора Вера Николаевна посвящает одной цели - здоровью женщины и будущих поколений.
Gynecology. 2018;20(5):4-5
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Climacteric syndrome and magnesium (literature review)
Prilepskaya V.N., Mgeryan A.N., Mezhevitinova E.A.
Abstract
Magnesium is one of the most important trace elements necessary for the life of the human body. It supports the normal exchange of proteins and nucleic acids (DNA and RNA), reduces spasm of the arteries, both peripheral and coronary, prevents the formation of blood clots, relaxes the uterus with hypertension, restores heart rhythm with tachycardia, contributes to the normal course of pregnancy, etc. Magnesium deficiency has a negative impact on health, especially in women in the menopause. Hypomagnesemia exacerbates the course of the main clinical manifestations and conditions characteristic of climacteric syndrome, and therefore the use of magnesium preparations in this category of patients will improve their health and quality of life.
Gynecology. 2018;20(5):6-8
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Clinical Conference Genitourinary menopausal syndrome - interdisciplinary problem
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Abstract
According to the materials of the XIX All-Russian Scientific-Educational Forum "Mother and Child"
Gynecology. 2018;20(5):9-14
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Clinical Conference Round table on the materials of the XIX All-Russian Scientific and Educational Forum "Mother and Child" "Modern Woman: Quality of Life, Health and Beauty"
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Abstract
Gynecology. 2018;20(5):15-17
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Classical Article Evaluation of health-related quality of life the women with human papillomavirus-associated lesions of the cervical epithelium
Sycheva E.G., Nazarova N.M., Burmenskaya O.V., Prilepskaya V.N.
Abstract
Objective - to evaluate the health-related Quality of life the women with “lesser” abnormalities of cervical epithelium and patients with high grade squamous intraepithelial lesions (HSIL) associated with human papillomavirus (HPV) infection. Materials and methods. The investigation was performed 274 women of reproductive age, divided into two main groups: HPV infection (“lesser” abnormalities 202 patients and with HSIL - 20) and healthy women - 20. All the studied women of health-related quality of life by using the EQ-5D-5L. Results. Revealed a significant reduction in the level of health-related quality of life in the psychological and emotional components of the patients with “lesser” abnormalities of cervical epithelium and patients with HSIL associated with HPV infection (p<0.005). Conclusions. In most cases, patients with HPV infection was involved psychological component of health-related quality of life, anxiety, fear of further fertility affects the overall well-being of patients.
Gynecology. 2018;20(5):18-21
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Clinical Conference Female reproductive health: a man’s view (based on the materials of the XIX All-Russian Scientific and Educational Forum “Mother and Child”)
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Abstract
Gynecology. 2018;20(5):22-26
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International algorithms for the management of patients with uterine cervical dysplasia
Dobrokhotova Y.E., Borovkova E.I.
Abstract
The article presents the algorithms of patient management, depending on the results of smear on oncology and in accordance with the age of the patient.
Gynecology. 2018;20(5):27-32
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To the question about diagnostics, prevention and therapy of pathology of the cervix
Dubrovina S.O., Ardintseva O.A., Krasilnikova L.V., Varicheva M.V., Afrikyan O.A.
Abstract
The review analyzes the latest American clinical guidelines on the effectiveness of cervical cancer screening programs, as well as references on the use of the immunomodulator isoprinosine for the treatment of patients infected with the human papilloma virus (HPV). The high prevalence of HPV and its role in the development of cervical cancer are shown. Isoprinosine belongs to immunomodulators with antiviral activity. It inhibits the replication of viral DNA and RNA by binding to cell ribosomes and changing their stereochemical structure. HPV infection, especially in the early stages, may be successfully cured till the complete elimination of the virus. Inosine Pranobex (Izoprinozin) having dual action and the most abundant evidence base, may be recognized as the optimal treatment option.
Gynecology. 2018;20(5):33-36
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Rehabilitation therapy as a component of the complex approach to the treatment of chronic forms the pelvic inflammatory disease in women
Pestrikova T.Y., Yurasova E.A., Yurasov I.V.
Abstract
Issues of treatment and rehabilitation patients with pelvic's inflammatory diseases are still remain highly relevant, so relapses and chronic inflammation processes are worsen the prognosis for generative function in women, which is an important social and economic problem in modern time. Purpose of the study. Monitoring the effectiveness of therapeutic measures of rehabilitation step in chronic forms of this disease. Materials and methods. We examined 110 patients who handled to the clinic for women with complaints about the absence of pregnancy, of which a survey group was formed. The duration of pelvic inflammatory desiase (PID) in patients of the examination group did not exceed 2 years. The age of the patients was 25-35 years old. In patients of the examination group, according to clinical, laboratory and ultrasound ultrasound, laparoscopy, hysteroscopy and morphological findings, PID was verified including the presence of chronic endometritis and other endometrial pathology (for example, endometrial polyp, simple endometrial hyperplasia). Results. The rehabilitation stage of treatment (6 months) in patients with PID was aimed at restoring the morphofunctional potential of the tissue and eliminating the effects of secondary injuries, which include the restoration of hemodynamics and activity of the endometrial receptors. This stage of treatment is extremely important, especially for reproductive disorders. At this stage, the patients of the examination group were given hormone therapy and treatment with vasoactive drug (dipyridamole). The obtained results testified to the significance of the restoration of the vascular blood flow of the uterus and the functional layer of the endometrium. Conclusion. Rehabilitation therapy in patients with PID was primarily aimed at restoring the functional ability of the endometrium. Hormone therapy was a priority role, but at modern time, role of the vasoactive drugs that affect the blood flow in the uterus is emphasized. One of these drugs is dipyridamole, which contributes to the formation of collaterals (bypass paths) in ischemic zones. The results indicate that at the end of the 6-month rehabilitation phase, than of a three-layer endometrium was diagnosed (according to ultrasound on day 8-10 of the cycle) in 85 (77.27±4.00%) patients in the examination group.
Gynecology. 2018;20(5):37-41
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Features of pregravid preparation in women with connective tissue dysplasia
Ilina I.Y., Dobrokhotova Y.E., Malikova V.O., Chikisheva A.A.
Abstract
The prevalence of multifactorial pathology among the population is manifested by a high frequency of extragenital pathology during pregnancy, contributing to the emergence of various combined pathological processes. Women with connective tissue dysplasia are at high risk for reproductive disorders with respect to a number of complications during pregnancy (threatened miscarriage, preeclampsia, placental insufficiency). In the period of pregravid preparation, in addition to well-known prescriptions, Selzinc® of pronounced antioxidant properties can be recommended for use, this complex has a beneficial effect on the course of pregnancy due to the replenishment of trace elements, the deficiency of which can lead to the development of various complications.
Gynecology. 2018;20(5):42-45
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Comparative assessment of effectiveness of new drugs for targeted therapy of endometriosis by experimental model
Yarmoliskaya M.I., Petrosyan M.A., Florova M.S., Molotkov A.S., Denisova A.S., Suslova E.V., Tkhazaplizheva S.S.
Abstract
Introduction. The chronic, progressive, recurrent nature of the endometriosis results new avenues of targeted therapy for genital endometriosis with high therapeutic efficacy and minimal side effects must be explored. Nowadays, the standard of prolonged specific therapy for endometriosis is the dienogest 2 mg daily, which has already been proven to be effective in vitro, in vivo and in clinical practice. Purpose: to evaluate the effectiveness of new types of targeted pathogenetic therapy for endometriosis on the model of endometriosis in rats compared to dienogest and without treatment. Materials and methods. Endometriosis was induced on 69 Wistar rats by autotransplantation of uterine fragments onto the inner surface of the abdominal wall. After 14 days, the heterotopies had been measured by laparoscopy and then rats were randomized of into one of 6 experimental groups (dienogest, letrozole, cabergoline, metformin, vitamin D, melatonin) or a control group. All drugs were administered daily orally for three weeks, after which an autopsy and re-measuring of the size of endometrial implants were performed. Results. The most pronounced decrease in the size of endometrial implants was observed in the group of animals treated with dienogest (complete resorption - 48%, regression - 48%, without dynamics - 4%) and letrozole (complete resorption - 44%, regression - 56%) without the statistically significant difference between groups. In other groups, a significant decrease in the size of endometrial implants was demonstrated compared with the control, without a statistically significant difference between the groups. Findings. The presented study confirms the absence at the present time of oral drugs for the treatment of endometriosis, comparable in efficacy and safety with dienogest. Further research are needed to evaluate the different combinations of dopamine agonists, biguanides, vitamin D, melatonin as the supplement to the classic hormone-modulating therapy for endometriosis or as monotherapy in patients with contraindications to standard hormone therapy.
Gynecology. 2018;20(5):46-51
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Transvaginal echography in the diagnosis of localization foci of deep infiltrative endometriosis
Said D.S., Chuprynin V.D., Gus A.I., Lunkov S.S., Melnikov M.V., Asaturova A.V., Buralkina N.A.
Abstract
The goal is to assess the sensitivity and specificity of transvaginal ultrasound (USI) in the diagnosis of localization of foci of deep infiltrative endometriosis. Materials and methods. The study included 142 patients with deep infiltrative endometriosis, who underwent surgery in the surgical department of the V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of Russian Federation in the period 2014-2016. Criteria for inclusion in the study: informed agreement of the patient, the reproductive age (from 18 to 44 years), deep infiltrative endometriosis with a confirmed histological conclusion. Exclusion criteria were malignant tumors of the pelvis and abdomen, refusal to undergo surgical treatment of deep infiltrative endometriosis, and malformations of the urogenital system. Results. Transvaginal echography in identifying the localization of foci of deep infiltrative endometriosis is highly sensitive in the diagnosis of colorectal endometriosis (88.9%) and endometriosis of the bladder (96%) with a relatively low specificity of the study (35%). The sizes of endometrial infiltrates of the intestine, retrocervical endometriosis, and bladder intraoperatively were large in comparison with the data obtained with transvaginal ultrasound. When assessing the accuracy of the diagnostic method, it was found that transvaginal ultrasound evaluates retrocervical endometriosis with an accuracy of 41.5%, endometriosis of the intestine - 37.7%, bladder - 54.8%. Conclusion. Transvaginal echography, based on a quantitative assessment of the characteristic curve by calculating the area under it, the size of the infiltrate and their localization, showed that our study have middle diagnostic quality and visualization of DIE lesions with enough specify.
Gynecology. 2018;20(5):52-55
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Possibilities of preservation and realization of reproductive function in girls with Turner syndrome (analytical review)
Kumykova Z.K., Batyrova Z.K.
Abstract
Turner syndrome (TS) is the most common chromosomal abnormality in females. TS is associated with partial or complete loss of the second X-chromosome in phenotypic females and is associated with increased morbidity and mortality. There are many controversial issues of monitoring, management and counseling of patients with TS. This review emphasizes the need for a multidisciplinary approach to the study of this pathology to enable the realization of reproductive function in patients with TS.
Gynecology. 2018;20(5):56-58
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Efficiency of cryoperenosis depending on various factors
Protopopova N.V., Druzhinina E.B., Mylnikova U.V., Boldonova N.A., Dvoryanov J.A., Krylova K.V., Labygina A.V., Kovalenko I.I.
Abstract
Materials and methods. The article presents an assessment of the influence of factors on the effectiveness of cryoprenoses. Scientists conducted a retrospective analysis of 149 cryogenic transfer on the basis of the department of Auxiliary reproductive technologies of the Irkutsk Regional Perinatal Center for 2017. Patients signed voluntary consent to participate, the patients were divided into 4 groups, depending on the duration of storage of embryos: group 1 - 57 people, with a shelf life of 1-3 months, group 2 - 29 people, storage period 4-6 months, group 3 - 25 people, the shelf life is 7-11 months, group 4 - 38 people, the shelf life is 12 months or more. The average age of women is 30.69±2.9 years. Selection criteria for research: tubal factor of infertility, frozen embryos. Results. The analysis of cryopreference showed that the age of patients, the quality of transferred devitrified embryos and the duration of storage of cryopreserved embryos have a more important influence.
Gynecology. 2018;20(5):59-62
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Modern approaches to endovascular treatment of uterine leiomyoma
Kokov L.S., Damirov M.M., Belozerov G.E., Oleynikova O.N.
Abstract
Individual features of the blood supply to the uterus and ovaries in 20-25% of cases cause failures in endovascular treatment of patients with uterine leiomyoma (ULM) and are forced to return to traditional surgical methods. The purpose of the study is to assess the possibilities of preventing iatrogenic complications of endovascular treatment of ULM through the use of separating occlusion of the uterine arteries, taking into account the characteristics of the blood supply to the uterus and ovaries. Materials and methods. The work is based on the analysis of the results. X-ray endovascular occlusion of the uterine arteries for ULM performed in 88 women aged 34-46 years (mean age 38.8 ± 2.5 years). The patients were divided into 2 groups: the 1st group comprised 65 patients without visible uterine-ovarian interarterial anastomoses. They performed standard embolization of the uterine arteries (EUA) using spherical PVA microemboli (COOK, USA), Embosphere (Merit Medical, USA) with a diameter of 500-700 microns. The second group consisted of 23 patients in whom utero-ovarian inter-arterial anastomoses were detected. In patients of this group, EUAs were produced with Embox cylindrical emboli (Plastis-M, Russia) with a length of 10 mm and a diameter of 500-700 μm, which occlude only the bed of the uterine arteries and are not capable of to overcome utero-ovarian inter-arterial anastomoses. In the 2nd group of EUA patients wore the character of occlusion, separating the uterine and ovarian arteries. The original EUA protocol was applied, which includes, in addition to the standard stages of selective arteriography of the uterine arteries, performing preliminary abdominal aortography to visualize the ovarian arteries and pelvic arteriography to assess pelvic vascular anatomy and identify utero-ovarian interarterial anastomoses. The results of the study. A total angiographic examination of the ovarian and uterine arteries, including a review angiography of the infrarenal section and bifurcation of the aorta, ileal vessels. In 23 (26.1%) patients with angiographic examination, uterine-ovarian arterio-arterial anastomoses. In 13 patients (56.5% of the detected anastomoses), these were type 1 anastomoses. In 10 patients (43.5% of the detected anastomoses), type 3 anastomoses were detected. Endovascular occlusion of the uterine arteries was performed in all patients. In 5 (7.69%) patients from the 1st group after EUA, amenorrhea occurred. In contrast, in all 23 patients from the 2nd group in the postembolization period, no observation of ovarian function was observed in any of the observations. Conclusion. For endovascular treatment of ULM in the presence of pronounced utero-ovarian interarterial anastomoses, the method of separating uterine artery occlusion is a safe and effective way to prevent ischemic damage to the ovaries.
Gynecology. 2018;20(5):63-67
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Vitamin D deficiency: a modern approach to pathogenesis and therapy
Lomova N.A., Karapetyan T.E., Dolgopolova E.L., Malbakhova E.T.
Abstract
During pregnancy and breastfeeding, the needs of the woman's body increase. Food substances entering the body are used both for feeding the mother's body and for building the organs (structures) of the fetus and its life support. Deficit states contribute to the development of various obstetric complications, pathological course of pregnancy and childbirth, adversely affect the formation of the placenta, the transmission through it of micronutrients from mother to child, increase the risk of deficiency in the child, violations of early neonatal adaptation and the formation of abnormalities in the health of children at the stage of postnatal ontogenesis. Daily vitamin D supplementation throughout pregnancy has a preventive effect and may reduce the risk of preeclampsia, endothelial dysfunction, gestational diabetes, preterm birth, neonatal hypocalcemia.
Gynecology. 2018;20(5):68-70
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