[Clinical and morphological characteristics of the atypical placentation spectrum in the uterus]. / Kliniko-morfologicheskaya kharakteristika spektra atipichnoi platsentatsii v matke.

BACKGROUND: The concern of the global community of gynecologists and obstetricians (FIGO) regarding the increase in the number of caesarean sections has resulted in the creation of a new classification, Placenta Accreta Spectrum (PAS), which presents degrees of villus invasion into the uterine wall. OBJECTIVE: Compare the main types of atypical placentation (AP) with the stages of PAS, to supplement and unify the clinical and morphological criteria AP. MATERIAL AND METHODS: Surgical material was examined from 73 women after metroplasty (n=61) and hysterectomies (n=12) from the regions of Russia, Moscow and the Moscow region for ingrown villi and from 10 women with a typical placenta location during the first cesarean section. A targeted cutting of material from the uteroplacental region was used, at least 10-12 pieces, with further H&E and Mallory staining. RESULTS: In the classification of AP, the terms «placenta accreta¼, «increta¼, «percreta¼ should be retained. It is necessary to single out pl. previa as a separate type. Attention is focused on the need to assess the depth of villi invasion accompanied by a layer of fibrinoid, the volume of scar tissue and the degree of disorganization of the myometrial bundles, the state of the vessels in the serous membrane. A new type of AP has been proposed - a sharp thinning of the lower segment of the uterus, due to the scar failure and the pressure of the growing amniotic sac, leading to atrophy and necrosis of the myometrium. CONCLUSION: An integrated approach should be used to classify atypical placentation, taking into account not only the depth of villus invasion, but also anatomical and pathogenic factors in order to develop targeted methods of surgical treatment.

Analysis of Healing of Rat Uterine Wall After Full-Thickness Surgical Incision.

We studied the dynamics of morphological changes in the operated segment of the uterine horn of Sprague-Dawley rats during the first 2 weeks of the wound-healing process after a full-thickness surgical incision with regard to the estrous cycle phase. Morphometric parameters of injured uterine right horn were compared with those in the intact left horn of the same animal as a control of changes determined by the hormonal background. It was found that the uterine epithelium in the focus of injury was restored as soon as on day 2 after surgery under the influence of estrous cycle hormones. By day 4, the wound space was completely filled with the endometrial tissue on the side of the uterine lumen and coved by the attached adipose tissue of the mesentery on the side of the abdominal cavity. The thickness of the uterine wall and the uterine lumen differed most strongly between the operated and intact uterine horns during the first 3 days and on day 6 after surgery. The size of the healing area increased during the first three days and reached the peak value by day 3, but then decreased to minimum by day 6.

Role of Immune Distribution of Tissue Factor in the Development of Hemostasis during the First Trimester of Normal Pregnancy.

Immunohistochemistry of tissue factor, vimentin, and cytokeratin-8 was studied in the medical abortion material at gestation week 5-10 in 20 healthy women. No expression of tissue factor was found in vimentin-positive decidual cells of the parietal endometrium. By contrast, intensive immunostaining of the TF/FVIIα complex was detected in the marginal layer of Rohr fibrinoid and less intense staining was found in vimentin-positive decidual cells adjacent to the walls of modified spiral arteries in the utero-placental region under conditions of invasion of the interstitial and intravascular cytotrophoblast (marker: cytokeratin-8). In the villi, tissue factor was expressed only in the fibrinoid lumps at sites of the syncytiotrophoblast defects. We demonstrated the formation of local hemostasis system in the uteroplacental region at weeks 5-8. This system creates optimal conditions for external thrombogenesis aimed at realization of the cytotrophoblast invasion and subsequent flow of arterial blood between the villi at the end of the first trimester.

[The decisive importance of constitutional interferons in human and animal ontogenesis]. / Opredeliaiushchee znachenie konstitutsional'nykh interferonov v ontogeneze cheloveka i zhivotnykh.

Biomedical publications contain little information on the constitutional (endogenous) interferons (IFNs) produced by different cells without prior exposure to viruses and oncogenic factors. Literature analysis has provided a generalized concept that these interferons play different functional roles according to ontogenetic stages. The maximum production of high-molecular- weight immature forms of IFNα/ß was detected in the embryos of mice, Syrian hamsters, and humans and in the syncytiotrophoblast of placental villi. This is due to the direct involvement of IFNs in embryogenesis and fetogenesis. They also afford first-line antiviral and anti-oncogenic protection. In the late fetal and neonatal periods, IFN levels fall, rising slightly during the second year of life. In human adults, the organs consist of a branched network of cell producers of low concentrations of constitutional IFNs that carry out autocrine priming of cells for rapid and adequate volume synthesis of IFN during viral infection. Main publications on the ontogenesis of the IFN system came out in the 1980-1990; in recent years their number has decreased dramatically. It is necessary to increase the number of such studies, because they are fundamental to many branches of medicine.

[Features of cytotrophoblast invasion in complete placenta previa and increta]. / Osobennosti tsitotrofoblasticheskoi invazii pri polnom predlezhanii i vrastanii platsenty.

AIM: to investigate the characteristics of cytotrophoblast invasion in complete placenta previa and increta. MATERIAL AND METHODS: Three groups of placentas and amputated uteri were examined. These were: 1) 10 placentas at 20-22 weeks' gestation after drug-induced abortion; 2) 4 uteri with typical placentation at 34-36 weeks and wall ruptures; 3) 12 uteri with ultrasound-confirmed complete placenta previa and subsequent hysterectomy (at 34-36 weeks.) due to massive bleeding. In all cases, the sections were stained with hematoxylin and eosin, azan by the Mallory's method; immunovisualization of invasive cells with the marker cytokeratin 8 was also used. In Groups 2 and 3, the uterine distribution density of invasive cells was compared in a standard slice area (×200) separately, within the endometrium and myometrium. RESULTS: Complete placenta previa was found to have the following characteristics: 1) all the uteri exhibited focal or diffuse friable, or thick scars after cesarean section; 2) multiple active anchor villi with villous cytotrophoblast layers, which were characteristic of Group 1 placentas and absent in the uteri women of Group 2; 3) bays diagnosed in the basal endometrium with ingrown villi (placenta increta); 4) a morphometrically significant increase in the distribution density of interstitial cytotrophoblast in the endometrium and only a similar trend in the myometrium. Invasive cells did not penetrate into the area of scars. Failure of the second wave of cytotrophoblast invasion was confirmed by incomplete gestational restructuring and partial obliteration of the myometrial radial arteries. CONCLUSION: Real risks for severe clinical forms of abnormal placentation declare more stringent indications for surgical delivery.

[The intensity of expression of matrix metalloproteinases type 2 and type 9 by invasive trophoblast cells in uncomplicated pregnancy and preeclampsia].

OBJECTIVE: To estimate the intensity of immunoexpression of matrix metalloproteinases type 2 and type 9 (MMP-2 and MMP-9) during cytotrophoblast invasion (CTI) in the uteroplacental region. MATERIALS AND METHODS: There were 6 groups: 1) medical abortions at 7 to 8 weeks' gestation; 2) amputated uteri at 9 to 12 weeks; 3) late medical abortions at 18 to 24 weeks' gestation and amputated uteri at 25 weeks; 4) amputated uteri and biopsies of the placental bed, performed during cesarean section at 38-40 weeks. Two more groups included biopsies from women with preeclampsia: biopsy at 28-33 weeks (Group 5) and 34-38 weeks (Group 6). A total of 49 women were examined. An immunohistochemical method performed using the standard procedure revealed the expression of MMP-2, MMP-9, and cytokeratin in three invasive elements: interstitial cytotrophoblast (IC), multinucleated giant cells (MGCs), and intravascular cytotrophoblast (IVC). RESULTS: The expression of MMP-2 is intensive in all the invasive cells in the first and second trimesters and then decreases in IC and MGCs. The immunoexpression of MMP-9 with its minimal values in the first trimester successively increases in IVC and IC by a full-term gestation. CONCLUSION: MMP-2 hyperproduction in IVC and IC is of the greatest value for the first wave of CTI and high MMP-9 immunoexpression in all the invasive cells is more important for the second wave. In cases of preeclampsia, the least expression of MMP-2 and MMP-9 is recorded in IC and MGCs in the complete absence of IVC.

[Morphometric evaluation of the frequency distribution and diameter of extravillous trophoblast cells in apparently uncomplicated pregnancy].

Special materials were collected from medical abortions at 6 to 11 weeks' gestation (19 cases + 5 amputated uteri), late abortions at 24 to 25 weeks' gestation (n = 5) + 4 uteri and biopsies of the placental bed and uterus during the third trimester for the morphometric evaluation of the cell composition of cytotrophoblast invasion into the uteroplacental area. The interstitial cytotrophoblast (IC) and multinucleated giant cells (MGCs) immunovisualized by cytokeratin 8 were determined in the standard field of view (area 785,000 microm). The maximum IC distribution frequency that was 15-17 times greater than that for MGCs was found during the first trimester of apparently normal pregnancy. These cells' diameters measured in the nuclear cross section were 12-20 microm for IC and 22-28 microm for MGCs. In the mid-gestation (22-25 weeks), the distribution frequency of IC remained high (200-208 cells); it drastically fell to 86-100 cells at 31 weeks and to 27 cells with a tendency for increasing the diameter up to 24 pm in the full-term period. On the contrary, MGCs gradually increased their distribution frequency (from 14 cells at the end of the first trimester to 52 cells in the full-term period). These data characterize the cellular ratios of cytotrophoblast invasion during apparently uncomplicated pregnancy. They are important as the first step for the morphometry of an invasive process in different obstetric abnormalities.

[Anchoring villi are sources of cytotrophoblastic invasion in the second trimester of physiologic pregnancy].

The basal laminas and fixed on them anchoring villi after late abortion on 18-28 weeks of pregnancy have been studied. The pregnancies were without complication and abortions were activated by "Enzaprost" injection. 4 types of anchoring villi were studied: without cytotrophoblastic invasion, with maximal, medium and minimal density of cytotrophoblastic distribution and depth of its invasion into endometrium from villi's base. The maximum of its migration activity was in 18-20 and 22-23 weeks of pregnancy. The activity decay of cytotrophoblastic invasion was been found in the end of the second trimester Anatomic contact of villi's base with endometrium increased by them parallel attachment or horseshoe-shaped form. The estimation of villi's quantity and density of cytotrophoblastic distribution in their base can use for definition of cytotrophoblastic invasion rate in the adjacent myometrium of pregnant women on the second trimester.

[Non-developing pregnancy: histological and immunohistochemical markers of endocrine disorders in endometrial scrapes].

Histological and immunohistological (monoclonal antibodies against desmin, vimentin, glycodelin, IGFBP-1, estrogen receptors and progesterone receptors) studies were carried out to examine uterine scrapes from 47 healthy women - medical abortions from 6 to 10 weeks of conception and from 44 patients after non-developing pregnancy in the first trimester (recurrent miscarriage), which had been induced by verified endocrine disorders. Among them, three isolated pathogenetic types were identified: 1) uterine gland retardation as preserved islets of cylindrical glands with a narrow lumen or, on the contrary, areas with enlarged glands and atrophic epitheliocytes; immunohistochemically, they exhibited a drastic reduction in the expression of glycodelin, the major local immunosuppressor; 2) incomplete decidualization when it in the presence of progesterone deficiency was delayed at the state of predecidual and decidual cells retaining the smooth muscle cell marker - desmin; 3) verified progesterone receptor insufficiency. Each of the given clinical and morphological types of endocrine causes of non-developing pregnancy requires that an individual approach be applied to examining and treating these patients.

[Endometrial decidualization as a factor that regulates cytothrophoblastic invasion during the first trimester of pregnancy].

Endometrial stromal cell decidualization is a multistage process that starts with the late secretory phase of a menstrual cycle and then continues in the first months of pregnancy. Under the influence of the hormone progesterone, precursor cells undergo a unique structural and functional transformation from the adventitional cells of spiral arteries containing a marker of smooth muscles (desmin) through pre-decidual cells to the decidual intermediate cells expressing a marker of the extraembryonic mesoderm (vimentin), and IGFBR-1 and then to the typical epithelioid decidual cells.

[Secretory humoral immunity in children with chronic viral diseases of the liver]. / Sekretornyi gumoral'nyi immunitet pri khronicheskikh virusnykh zabolevaniiakh pecheni u detei.

The content of IgE, IgG, IgM and secretory IgA was measured in the stomatopharyngeal secretion (saliva) and in the intestinal secretion (coprofiltrates) of 58 patients aged 3 to 15 years suffering from chronic viral hepatitis and liver cirrhosis. It has been established that in addition to hyperimmunoglobulinemia, children with chronic viral diseases of the liver manifested elevated synthesis of immunoglobulins in the system of local immunity, including a high content of IgE in the alimentary secretions, thus pointing to enhanced antigenic stimulation occurring in this pathology.

[Indicators of local and general immunity in children with gastroduodenitis during its complex treatment]. / Pokazateli mestnogo i obshchego immuniteta pri kompleksnom lechenii gastroduodenita u detei.

The authors describe the time-course of changes in local and general immunity as influenced by multimodality treatment in different groups of patients suffering from CGD and concomitant pancreatoduodenal pathology. It has been found that associated microbial and inflammatory process in the biliary system exerts a pronounced effect on the changes in immunologic parameters and that antibacterial therapy produces a beneficial action on the normalization of the parameters under consideration.

[Features of the hormonal regulation of water-electrolyte balance in patients with tumors of the chiasmatic-sellar area in the early postoperative period]. / Osobennosti gormonal'noi reguliatsii vodno-élektrolitnogo obmena u bol'nykh s opukholiami khiazmal'no-selliarnoi oblasti v rannem posleoperatsionnom periode.

The response of water-electrolyte metabolism regulating hormones to neurosurgical stress was studied in 54 patients with tumors of the chiasma-sellar area of the brain. Three types of responses of hormones (the activity of renin, aldosterone, cortisol, and vasopressin) were revealed. Type I was characterised by a sharp activation of the hormones studied, type II by an absence of a response, type III by activation of renin and aldosterone and a decrease in vasopressin activity. Responses of types II and III were attended by deep disorders of water-electrolyte balance. The work substantiates the necessity of taking into account the state of the humoral mechanisms of regulation in conducting intensive therapy in neurosurgical patients.