[An interaction between an obstetrician-gynecologist and a urologist in the gynecological practice].

The article is devoted to the interaction of a gynecologist and a urologist in a gynecological hospital, based on the experience of the gynecological department at the Clinic of obstetrics and gynecology of the Clinical Center of Sechenov University. The most common clinical scenarios were identified when the participation of a urologist in evaluation and treatment is urgently needed, including large pelvis mass, endometriosis with an involvement of pelvic organs, genital prolapse, small pelvis adhesions as a result of previous surgical procedures and postoperative urinary disorders. A close interaction between two specialties, which are dedicated to pelvic organs disorders, namely gynecology and urology, is extremely popular in modern clinical practice and allows to significantly reduce the number of intra- and postoperative complications, carry out a comprehensive examination and determine individual treatment tactics in a gynecological hospital, which increases quality of medical care.

[Echinococcosis and pregnancy: approaches to the treatment]. / Ékhinokokkoz i beremennost': podkhody k taktike lecheniia.

AIM: To develop treatment strategy in pregnant women with liver echinococcosis. MATERIAL AND METHODS: There were 21 women with confirmed diagnosis of liver echinococcosis who were divided into 2 groups. Group I consisted of 17 patients with cysts Charbi grade I-III. They underwent percutaneous puncture and antiparasitic management of the cyst under intravenous sedation. Group II included 4 patients with cysts grade IV-V and those with multiple cysts. They underwent conventional surgery. RESULTS: In one patient, fetal death occurred in 20 hours after surgery and it was not associated with the procedure. There were no complications in other patients. Uneventful childbirth was noted in all of them. CONCLUSION: Percutaneous puncture in the second trimester of pregnancy is effective and safe procedure for prevention of complications of echinococcosis in late pregnancy and childbirth. Conventional surgery is alternative if percutaneous intervention is not advisable.

[Method of Surgical Management of Genital Prolapse with Cervical Elongation].

Objectives: According to different authors, the percentage of genital prolapse among gynaecological diseases that require surgical correction reaches 28−38,9%. Pelvic muscle wasting is a special kind of pelvic prolapse, often leading to cervical elongation and hypertrophy. Contemporary methods of treatment for this condition have the high rate of relapse­ 8,9−22%, thus urging to improve the existing techniques. Purpose: This research was to estimate the effectiveness of novel modification of Manchester operation in comparison with classic Manchester operation in the management of pelvic prolapse with cervical elongation. Methods: We enrolled 83 patients with pelvic prolapse and cervical elongation and divided them into two groups. In GroupI (n=47) we used the novel surgical method, supplementing original Manchester procedure with cervical stump fixation and other improvements. In GroupII we used original Manchester procedure. We compared laboratory measures as well as surgery duration, blood loss, incidence of complications, and duration of post-operational hospital stay. Patients were followed-up for 2years to estimate long-term effectiveness of surgical intervention. Statistical analysis was performed in SPSS 17.0. Results: Surgery duration in GroupII was significantly longer (47,8±26,2 vs 57,5±35,1 minutes, p<0.05). There were no significant differences in lab tests, post-operational hospital stay (5,2±0,9 vs 7,3±1,2) and incidence of post-operational complications (3 vs 4 cases). Over the 2 years of follow-up we registered 1 case of relapse in Group I and 3 cases of relapse in Group II, thus estimating the effectiveness of surgery as 97,9 vs 91,7%, a non-significant difference. We noticed that all relapsed women had signs of systemic dysplasia of connective tissue. Conclusion: Suggested modification of Manchester operation improves duration of surgical intervention itself, while providing a comparable level of effectiveness.

[Molecular biological aspects of the pathogenesis of adenomyosis].

The review of literature concerns some aspects of the pathogenesis of adenomyosis in terms of occurring molecular biological processes. It pools the literature data on endometrial capacity to be plunged into the deep myometrial layers--the expression of adhesive molecules, endometrial proteolytic activity, angiogenetic factors, and apoptosis-proliferation relationships. Evidence for the metaplastic theory of the disease is also presented. Emphasis is laid on the characteristics of a subendometrial zone whose pathology plays an important role in adenomyosis.

[Morphological and immunohistochemical characteristics in endometrial hyperplasia].

The development of different types of endometrial hyperplasia is associated with the changes in the proliferation/apoptosis ratio, with the former being predominant in the presence of increased neoangiogenesis and altered endometrial cell receptor status.

[Specific course of neurocirculatory dystonia in pregnancy].

AIM: To study specific features of a course of neurocirculatory dystonia (NCD) in pregnancy, effects of NCD on a gestational process. MATERIAL AND METHODS: The examination of 50 pregnant women with NCD and 30 healthy pregnant women in trimesters I, II and III included clinical, laboratory, ultrasonic, dopplerometric and cardiotocographic investigations. RESULTS: Pregnancy deteriorates NCD by enhancing such clinical syndromes as respiratory, asthenic, hemorrhagic, aggravating peripheral vascular disorders. NCD women develop gestosis, placental insufficiency, had spontaneous abortions more frequently. Neonates have abnormal neonatal adaptation. CONCLUSION: In spite of enhanced clinical symptoms, pregnancy for NCD patients is not contraindicated. Management of pregnancy in NCD women should be conducted by an obstetrician together with a therapist (cardiologist).

[A role of growth factors in development of various histological types of uterine leiomyoma].

The following growth factors play a role in the development of uterine leiomyoma: EFR- epidermal growth factor, EFR-R- receptor of EFR, TGF- thrombocytic growth factor, TGFb- transforming growth factor beta, ILGF1 - insulin-like growth factor of the 1st type. These factors stimulate proliferation of cells, stroma and angiogenesis in the tumor. Mitotically active leiomyoma is characterized by a higher content of these growth factors vs ordinary and cellular leiomyomas. Treatment of uterine leiomyoma should be concentrated on removal of tumor cells from the body as leiomyomas especially its mitotically active variant produce growth factors which are able to stimulate tumor growth by the autocrine mechanism.

[Utilization of the new synthetic dissolving sutures caproag in obstetrics and gynecology]. / Opyt primeneniia novykh sinteticheskikh rassasyvaiushchikhsia shovnykh nitei kaproag v akusherstve i ginekologii.

The paper deals with the experience with synthetic resolving Caproag suture threads which have antibacterial properties for suturing the uterine section during Caesarean and other gynecological operations. There is evidence for its high efficacy in optimal tissue regeneration. Caproag was used in the most life-threatening infectious and septic complications. With this, a reduction has been achieved in the incidence of postoperative pyo-inflammatory diseases, which makes Caproag compare favourably with the conventional suture threads catgut and vicryl.

[Double contrasting in the ultrasonic study of the area of the suture on the uterus following cesarean section]. / Dvoinoe kontrastirovanie pri ul'trazvukovom issledovanii oblasti shva na matke posle operatsii kesareva secheniia.

Ultrasonic examination of the suture site on the uterus was carried out in 7-10 days following a cesarean section in 73 women. Several types of characteristic echograms were distinguished, evidencing the adequacy of the reparative processes at the site of suture on the uterus. The authors find the double-contrast echoscopic examination of the postoperative uterus highly effective, and much more informative than common ultrasonic examination. Synthetic suture material is recommended.