[Russian Eligibility Criteria for Prescribing Menopausal Hormone Therapy to Patients With Cardiovascular and Metabolic Diseases. Consensus Document of RSC, RSOG, RAE, EUAT, RAP].

Menopausal symptoms can impair the life of women at the peak of their career and family life. At the present time, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormone therapy is the fear of physicians to do more harm to patients than good. Caution is especially important when it comes to women with concurrent diseases. Moreover, it should be recognized that there is a shortage of high-quality research on the safety of MHT for underlying chronic non-infectious diseases and common comorbidities. The presented consensus analyzed all currently available data from clinical trials of various designs and created a set of criteria for the appropriateness of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, physicians of various specialties who advise menopausal women will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real-life practice.

[Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia].

Menopausal symptoms can disrupt the life course of women at the peak of their career and family life. Currently, the most effective treatment for these manifestations is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases in itself does not exclude the possibility of prescribing MHT to relieve menopausal symptoms and improve quality of life. However, often an obstacle to the use of this type of hormonal therapy is the fear of doctors who are afraid of doing more harm to patients than good. Caution is especially important when it comes to women with underlying health conditions. Moreover, it should be recognized that there is a lack of high-quality research regarding the safety of MHT for major chronic non-infectious diseases and common comorbid conditions. The presented consensus document analyzed all currently available data obtained from clinical trials of various designs and created a set of criteria for the acceptability of prescribing MHT to women with concomitant cardiovascular and metabolic diseases. Based on the presented document, doctors of various specialties who advise women in menopause will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and reasonably prescribe MHT in real practice.

[Combined application of interference therapy and "dry" carbon dioxide baths for the treatment of hemodynamic disorders in patients with implantation failure due to inflammation].

This work was designed to evaluate the influence of different physiotherapeutic modalities on the possibility of implantation, development and outcome of pregnancy in patients with chronic endometriosis and previous failures of implantation. The study confirmed initial sonographic changes and deficit of uterine blood supply as well as gradual improvement of these parameters under effect of adequate physiotherapy. Inclusion of dry carbon dioxide baths in the combined treatment of hemodynamic disorders made it possible to "prepare" endometrium for implantation and optimize blood circulation in the uterine vasculature in order to enhance the probability of implantation, development of pregnancy, and its success.

[Prophylaxis and treatment of severe bleeding in obstetrics (draft guidelines)].

The article represents draft guidelines on severe bleeding in obstetrics which is the major reason of maternal mortality throughout the world. Criteria of estimation the physiological, pathological and massive blood loss are given. Algorithms of conservative and surgical treatment are presented, as well as major indications for administration of anti-fibrinolythics, infusion and transfusion treatment.

[Chronic salpingo-oophoritis: clinical and physiological rationale for therapeutic application of impulse low-frequency electrostatic field].

Significant alterations in arterial and venous circulation, primarily in the vascular bed of the small pelvis, were detected in 63 patients with chronic salpingo-oophoritis. All the women received intensive therapy with impulse low-frequency electrostatic field (ILFEF). In 52 women the exposure was abdominovaginal, in 11 women the exposure was preceded by placebo procedures. ILFEF produced marked and long-term positive effects (up to 18 months): pain relief, reduction of vegetative anxiety, increased uterine motility, softening and better elasticity of the commissures in the regions of the uterine appendages, normalization of the circulation in the vascular bed of the small pelvis. This therapy is pathogenetically sound as it rests on changes in activity of central regulation resultant from trigger stimulation and normalization of hemodynamics in the vascular bed of the small pelvis (in 76.6%) especially in the veins in response to stimulation of the sympathetic nerves in the inflammation focus.

Effects of a phasic oral contraceptive containing desogestrel on facial seborrhea and acne.

BACKGROUND: The combined oral contraceptive containing ethinylestradiol and the selective progestogen, desogestrel, in a phasic regimen (DSG-OC, Tri-merci) has been shown to reduce facial oiliness. OBJECTIVE: This study was designed to evaluate further the effects of this OC on the skin of women with facial seborrhea and mild or moderate acne. DESIGN AND METHODS: This was an open, noncomparative, bicenter study in 60 healthy Russian women, aged 18-30 years, with facial seborrhea and mild or moderate facial acne, who wished to use oral contraception. All women received the OC containing desogestrel (50/100/150 microg) and ethinylestradiol (35/30/30 microg) for three phases of 7 days followed by a 7-day pill-free interval, for six cycles. Seborrhea was assessed using the Sebutape technique, in which strips of adhesive microporous polymeric film pressed onto facial sites are used to assess sebaceous activity. Acne was assessed by counting facial lesions. Subjective evaluations of skin and hair condition, patients' feelings to them and satisfaction with the OC were made using a visual analogue scale (VAS). Assessments were made at baseline, and after one, three and six treatment cycles. RESULTS: Sebutape assessments of seborrhea were significantly improved, on the right and left cheeks, after one treatment cycle, and on the forehead after three treatment cycles. These improvements increased steadily and were much larger at the end of Cycle 6. Acne grades were significantly improved after three and six treatment cycles. VAS scores in response to questions dealing with self-esteem and self-confidence were significantly improved after three cycles and in some cases after just one cycle. The women's views of their skin and hair (greasiness) were correspondingly significantly improved. Subjective assessments indicated that after one, three and six cycles, 69%, 93% and 98%, respectively, of women were satisfied or very satisfied with the DSG-OC. CONCLUSION: In women with facial seborrhea and mild or moderate acne, the use of DSG-OC appears to improve seborrhea after just one cycle and acne grades after three cycles. These improvements are accompanied by increases in self-esteem and confidence.

[Endotoxin and antiendotoxin immunity in pelvioperitonitis]. / Endotoksin i antiéndotoksinovyi immunitet pri pel'vioperitonitakh.

The levels of bacterial blood endotoxin, antiendotoxin antibodies and the overall immunity were studied in 48 females with inflammatory genital diseases complicated by pelvioperitonitis. The severest pelvioperitonitis-complicated abnormality was shown to characterized by high concentrations of endotoxin and low levels of antibodies. Endotoxinemia was found to be of diagnostic and prognostic value.

Heterogeneity of serum activities of matrix metalloproteinases in chronic endometritis.

Matrix metalloproteinases belong to the key molecules of tissue remodeling involved in physiological and pathological processes of the female reproductive system. Adequate levels of their expression in the endometrium are essential for effective implantation and uneventful pregnancy. Chronic inflammatory process in the endometrium is associated with low tissue expression of metalloproteinase-9. Histologically verified chronic endometritis is associated with low serum activities of metalloproteinases 2 and 9, which are restored after combined etiotropic therapy. We measured serum levels of metalloproteinases in patients with chronic endometritis concomitant with sterility and its changes during the first days after magnetotherapy.

[Informative value of various biochemical parameters of homeostasis in the formation of endometrial cancer risk groups]. / Informativnost' nekotorykh pokazatelei gomeostaza v formirovanii grupp riska po razvitiiu raka éndometriia.

A total of 97 patients suffering from endometrial polyposis, hyperplasia, adenomatous hyperplasia, and carcinoma were examined. The levels of malonic dialdehyde as an index of lipid peroxidation, average-mass molecules, C peptide, humoral immunity parameters were studied. The content of circulating immune complexes were also determined. Specific changes which might be an auxiliary factor in predicting the therapy and forming cancer risk groups were identified.

NetWork: an interactive interface to the tools for analysis of genetic network structure and dynamics.

We designed a Java applet called NetWork which enables a user to interactively construct and visualize a genetic network of interest, and to and to evaluate and explore its dynamics in the framework of a Boolean network model. NetWork displays the mechanism of gene interactions at the level of gene expression and enables the visualization of large genetic networks. NetWork can serve as an interactive interface to tools for the analysis of genetic network structure and behavior.

[Reserves in decreasing maternal mortality due to obstetrical hemorrhages]. / Rezervy snizheniia materinskoi smertnosti ot akusherskikh krovotechenii.

Analysis of 542 lethal cases at pregnancy terms 28 weeks and more, of parturients and puerperae in Russia over 1987-1991 has shown that obstetrical bleedings were responsible for 42.2% of deaths, being the most frequent causes of lethal outcomes. Analysis of records documenting 283 lethal cases has shown a high incidence of somatic (90.9%) and obstetrical diseases (95.5%). Assessment of medica care quality has shown inadequate care of pregnant women and parturients and inadequate emergency care. Prevention of massive blood loss should involve hemostasis studies in pregnant women and parturients and its correction; if a bleeding occurs, comprehensive intensive care and surgical interventions are indicated.

[Clinical and morphological aspects of abruptio placentae with hemorrhagic shock]. / Osobennosti kliniki i morfologii pri prezhdevremennoi otsloike normal'no raspolozhennoi platsenty s gemorrhagicheskim shokom.

Seven histories of deliveries, complicated with abruptio placentae with hemorrhagic shock, and fetal autopsy protocols were examined, while the placentas and the uteri, removed at surgery were studied morphologically. Pregnancy had been complicated by gestosis in all patients. Placental abruption developed by 35-37 weeks of pregnancy in 5 patients, and near term in 2. All patients underwent urgent cesarean section followed by supravaginal amputation and extirpation of the uterus. Uterine, placental and fetal morphologic changes were qualified as shock-related. It is concluded that progressive abruptio placentae is an indication for abdominal delivery.

[Differential correction of disorders of colloid-oncotic blood pressure in pregnant women and puerperants with suppurative-septic diseases]. / Differentsirovannaia korrektsiia narushenii kolloidno-onkoticheskogo davleniia krovi u beremennykh i rodil'nits s gnoino-septicheskimi zabolevaniiami.

The measurement of colloid-oncotic pressure (COP) in 160 women with pyoseptic disease (pyodermia, soft-tissue abscesses, suppurative mastitis, endometritis, sepsis) has demonstrated a regular pattern of change, depending on the clinical condition. A classification of COP disorders has been proposed, identifying the hyperoncotic state (COP above 3.29 kPa), normoncotic state (COP between 2.84 and 3.29 kPa) and hypo-oncotic state (COP below 2.84 kPa), on which a differential remedial therapy is based. A reliable assessment of COP values during the infusion therapy can only be made by means of oncometry, since estimations of any kind lead to considerable error.

[Mitral commissurotomy during pregnancy]. / Mitral'naia komissurotomiia vo vremia beremennosti.

Relying on studies into the features of the gestation course, immediate and late results, instrumental investigation findings in 91 patients with mitral stenosis prior to a surgery and in the readaptive period, indications and relative contraindications for mitral commissurotomy during pregnancy were specified and supplemented. Differential strategy was also developed for delivery of such patients.

[Birth injuries and lesions of the spinal cord in the perinatal period]. / O rodovykh travmakh i povrezhdeniiakh spinnogo mozga v perinatal'nom periode.

The paper presents a clinical and pathological analysis of 40 deliveries, autopsy findings in fetuses and newborns with combined birth injury of the brain and spinal cord, perinatal disease entities associated with intrapartum spinal lesions and disease entities which entail secondary spinal lesions. A subgroup of newborns with intraventricular hemorrhage showed at autopsy diffuse subarachnoidal hemorrhage of the cervical and thoracic spinal segments as a function of its extension into the cerebrospinal fluid system. Guidelines for pathological diagnosis in the pediatric practice are offered.

[Hyperplastic ovarian processes from the clinico-morphological aspect]. / Giperplasticheskie protsessy iaichnikov v kliniko-morfologicheskom aspekte.

Clinico-morphologic analysis was carried out in 93 patients with hyperplastic changes in the ovaries (stromal hyperplasia, thecomatosis, interstitial gland, etc.) and endometrial hyperplasia (glandular, atypical, etc.). A relationship was revealed between endometrial hyperplasia and ovarian hormone-producing structures, but the intensity of proliferation and structural rearrangement of glandular epithelium did not correlate with the activity of gonadal hormone-producing structures determined by morphofunctional studies, nor did it correlate with blood plasma estradiol level. Ineffective hormonal therapy of patients with hyperplasia of the endometrium may be caused by hyperplastic processes in the ovaries.

[Congenital cytomegalic inclusion disease--clinico-anatomical characteristics]. / Vrozhdennaia tsitomegaliia--kliniko-anatomicheskaia kharakteristika.

Analysis of labor histories, case histories, and autopsy records over a decade, 1980-1990, has revealed 32 cases of cytomegalic inclusion disease in children. Eleven placentas of seropositive mothers were histologically examined. The findings evidence that cytomegaloviral infection was mostly combined with other bacterial and viral diseases. The central nervous system, kidneys, and lungs were the most sensitive to the virus effects. The DIC syndrome was present in all the cases.

[Measurement of the oncotic pressure of blood (methodology and analysis of errors)]. / Izmerenie onkoticheskogo davleniia krovi (metodika u analiz oshibok).

The authors give their practical recommendations on improving the accuracy of the blood plasma colloid osmometry by standardizing the methods for the collection, treatment, and storage of the samples and the oncometry procedure per se. The recommendations are based on literature data and the authors' experience.