[The features of uric acid metabolism in women in climacterium].

The purpose of the study was to establish the prevalence of uric acid (UA) metabolism disturbances as a possible risk factor of urate nephropathy in women of various age groups. The authors carried out a retrospective analysis of 757 case histories and performed uricemia and uricosuria screening in women aged 18 to 69 years. The study revealed significant age-dependent elevation of uricemia, with hyperuricemia (HUE) at the age of 60 to 69 years old. The study also found age-dependent increase of HUE rate with its significant elevation in postmenopausal women (older than 50 years), compared with HUE rate in reproductive age women (18 to 49 years old) -37.9% vs. 11.4%. For the first time the researchers established UA excretion level and found a significant tendency of uricosuria to decrease with age (p < 0.016 between the groups of 40 to 49 and 50 to 59 years old). The highest rate of hyperuricosuria was revealed in women of 40 to 49 years old (22.2%), while in women of 18 to 29 and 60 to 69 years old it was 10.1% to 12.1%. For the first time the authors established the rate of hypouricosuria in women, which culminated in women older than 50 (22% of cases). The increase of HUE rate, which is most prominent in postmenopausal women, is associated with the decrease in UA excretion, accompanied by the decrease of hyperuricosuria rate and increase of hypouricosuria rate. Taking into account high prevalence of UA metabolism disturbances in women older than 50, menopause may be considered a risk factor of HUE and urate nephropathy.

[Principles of hormone replacement therapy in climacteric]. / Printsipy zamestitel'noi gormonoterapii v klimakterii.

With age-specific diminished and excluded ovarian function and estrogen deficiency, 60% of females may develop various systemic disorders (the menopausal syndrome, urogenital and cardiovascular diseases, osteoporosis). In the past 10-15 years, hormone replacement treatment regimens have been developed for climacteric females. Numerous epidemiological surveys have indicated that hormone replacement therapy shows a 50% reduction in the incidence of stroke, myocardial infarction, bone fractures. Therefore, post-menopausal hormone therapy is indicated both for therapeutical and prophylactic purposes, which may increase female longevity.

[Replacement hormonal therapy: effects on ECG parameters in postmenopausal women]. / Vliianie zamestitel'noi gormonal'noi terapii na élektrokardiograficheskie parametry u zhenshchin v postmenopauze.

AIM: To examine postmenopausal women free of organic cardiovascular lesions receiving replacement hormonotherapy (RHT) for ECG abnormalities, control of the detected cardiovascular defects. MATERIALS AND METHODS: ECG was conducted in 61 postmenopausal women before and during RHT with climen and climonorm. RESULTS: ECG registers frequent functional abnormalities in postmenopausal women. A 3-month RHT improved the patients' condition. ECG parameters improved on RHT month 9. CONCLUSION: RHT of postmenopausal women corrects general condition of such patients as well as functional ECG parameters.

[Hormone replacement therapy in women with arterial hypertension in peri- and postmenopause: hemodynamic effects]. / Zamestitel'naia gormonoterapiia u zhenshchin s arterial'noi gipertoniei v peri- i postmenopauze: gemodinamicheskie éffekty.

AIM: To study hemodynamic effects of replacement hormone therapy (RHT) with trisecvens, beta-blocker betaksolol and their combination in perimenopausal and menopausal women with hypertension. MATERIAL AND METHODS: The study was made of 60 menopausal women aged 45-60 with mild and moderate arterial hypertension (AH). The women had no contraindications to either RHT or beta-blockers. They were randomized into three groups: group 1 received trisekvens, group 2--trisekvens plus betaksolol in a dose 10-20 mg/day, group 3--betaksolol. Arterial pressure (AP) and heart rate (HR) were measured before the treatment, in one month and each three months for a year. ECG and echo-CG were registered before treatment and each 3 months of the therapy. AP monitoring covered 50% of the patients of each group before the treatment and after 1 and 3 months of it. The data were analysed according to SAS system. RESULTS: Group 1 patients showed no significant changes in AP and HR. Group 2 and 3 patients' AP lowered, in group 2 the fall of systolic AP being more pronounced. 12-month therapy brought about a 10.3% decrease in left ventricular myocardial mass index in group 2. CONCLUSION: RHT with trisekvens in combination with beta-blocker in long-term use potentiates the effect on systolic AP and reduced hypertrophy of the left ventricle. RHT does not produce a significant effect on AP in women with AH recorded before the menopause.

[Vitrum osteomag in prevention of osteoporosis in postmenopausal women: results of the comparative open multicenter trial]. / Vitrum osteomag v profilaktike osteoporoza u zhenshchin v postmenopauze: rezul'taty sravnitel'nogo otkrytogo mnogotsentrovogo issledovaniia.

AIM: To investigate efficacy, tolerance and safety of the drug vitrum osteomag one tablet of which contains 600 mg calcium (1500 mg calcium carbonate), 200 IU of cholecalcepherol, 40 mg of magnesium, zinc (7.5 mg), copper (1 mg), manganese (1.8 mg) and boron (250 mcg) in women with osteopenia for prevention of osteoporosis. MATERIAL AND METHODS: A multicenter comparative open trial of vitrum osteomag influence on mineral bone density (MBD), change of pain syndrome in bones, index of calcium-phosphorous metabolism covered 334 postmenopausal women with osteopenia. MBD was measured in low-back spine and proximal part of the hip with DEXA method. All the patients were divided into 3 groups: 125 women taking 2 tablets of vitrum osteomag daily for 12 months (group 1); 111 women taking 1500 mg calcium carbonate (group 2); 96 women--control group (only observation). RESULTS: Vitrum osteomag relieved pain in the back and joints, had a positive effect on bone density (+1.5%) and proximal parts of the hip (0.6-0.93%) exceeding the effect of calcium carbonate only which preserves the initial MBD in low back spine but does not prevent bone loss in the hip. MBD dynamics in patients given vitrum osteomag differs essentially from one in the control group (from -1.9 to -2.91%) which demonstrates a reliable preventive anti-osteoporotic effect of this medication. The drug increases the level of general and ionized calcium in blood but does not cause hypercalcemia lowering the level of parathormone in blood. The rate of side effects in group 1 was 14.4% and did not differ much from that in group 2 (16.2%). CONCLUSION: The results of the study allow to recommend vitrum osteomag for prophylaxis of a rapid loss of bone tissue mineral density.

[Clinico-genetic aspects of the ovarian failure syndrome]. / Kliniko-geneticheskie aspekty sindroma istoshcheniia iachnikov.

Clinical-genetic examination of 50 patients with menopause praecox syndrome has been performed. The results of the examination show genetic syndrome heterogeneity. Chromosomal and gene mutations take part in the syndrome pathogenesis. Chromosomal abnormalities frequency is 12%. Chromosomal aberrations are presented by different mosaicism types of sex chromosomes. Monogenic syndrome genesis with different inheritance types of the pathologic gene is determined: autosomal-recessive or autosomal-dominant.

Disorders in cytokine gene expression in endometrial hyperplasia and effect of hormone therapy.

We studied local expression of insulin-like growth factor 1, insulin-like growth factor receptor, epithelial growth factor, transforming growth factor beta2, PCNA, TNF-alpha, type I TNF receptor, Fas, FasL, IFN-gamma, IL-1beta, IL-4, IL-6, IL-8, IL-10, and IL-12 genes in intact and hyperplastic endometrium. Endometrial hyperplasia was associated with reduced production of TNF-alpha (p<0.05), PCNA (p<0.05), and epithelial growth factor mRNA and enhanced production of Fas mRNA (p<0.01). The expression of TNF-R1, IL-1beta, and IL-12 genes decreased only in glandular cystic hyperplasia (p<0.05 for all genes), expression of insulin-like growth factor 1 gene decreased only in adenomatous hyperplasia (p<0.05). Dufaston therapy of glandular cystic hyperplasia and zoladex therapy of adenomatous hyperplasia normalized expression of Fas receptor, PCNA, and insulin-like growth factor 1 genes, while the expression of IFN-gamma and IL-6 genes, which was normal in hyperplasia, decreased (p<0.05). Zoladex therapy decreased the production of transforming growth factor beta2 (p<0.05) and IL-1beta (p<0.01) mRNA, dufaston therapy decreased production of TNF-alpha (p<0.05) and IL-4 mRNA (p<0.05). Hence, both apoptosis and proliferative activity were suppressed in endometrial hyperplasia, and hormone therapy created prerequisites for transition of the endometrium into the normal proliferation stage.

[State of the bone tissue in women of reproductive age at different periods after ovariectomy]. / Sostoianie kostnoi tkani u zhenshchin reproduktivnogo vozrasta v razlichnye sroki posle ovariéktomii.

Eighty-eight women subjected to total oophorectomy for benign tumors and tumor-like formations in the uterus and tubes were examined. The mean age of the patients was 33.3 +/- 2.4 years. Bone tissue status was assessed by monophoton absorptiometry and computer-aided tomography. A negligible reduction of mineral density of osseous tissue was observed early after oophorectomy, its annual loss being high. In later periods after surgery, vice versa, a more expressed reduction of bone density and a relatively low rate of its annual reduction were observed. Specific features of the processes of osteoporosis in various periods after surgical removal of the ovaries make substitution hormonal therapy advisable for oophorectomized patients in the early periods after surgery, in order to effectively prevent and treat osteoporosis.

[Characteristics of serum lipid state in women with premature failure of the ovarian function]. / Osobennosti lipidnogo sostava syvorotki krovi u zhenshchin s prezhdevremennym vykliucheniem funktsii iaichnikov.

The evidence obtained supports referring women with ovarian amenorrhea and gonadal dysgenesis to a high-risk group for atherosclerosis and cardiovascular diseases. This fact dictates inclusion of the diagnosis of atherogenic dyslipoproteinemia into the complex of check-up measures for women with early nonoperative ovarian amenorrhea as well as prophylaxis of cardiovascular disorders.

[State of the mammary glands in hypergonadotropic amenorrhea]. / Sostoianie molochnykh zhelez pri gipergonadotropnoi amenoree.

This study included 62 women with hypergonadotropic amenorrhea. Clinical, hormonal, genetic, laparoscopic and histologic studies revealed three types of the disease: resistant ovary syndrome, dystrophic ovary syndrome, and "pure" gonadal dysgenesis. Mammary function and architectonics were correlated with gynecologic conditions. Fibrocystic breast disease was identified in 64.9% of patients with resistant ovary syndrome, and fatty glandular degeneration was seen in dystrophic ovary syndrome; pure gonadal dysgenesis was associated with breast hypoplasia, poor structural differentiation and prevalence of adipose tissue in the mammary glands.

[Anatomic and functional characteristics of resistant ovaries]. / Anatomo-funktsional'naia kharakteristika rezistentnykh iaichnikov.

Resistant ovary syndrome has been confirmed in 42 women using clinical, roentgenologic (craniography, hysterosalpingography, pneumogynecography, electroencephalography), genetic, sonographic, endoscopic and histologic studies. Fibrocystic breast disease was identified in 64% and normal ovarian size in 74% of the patients with resistant ovary syndrome. Progesterone test was positive in 84% of the patients. Resistant ovary syndrome was associated with higher serum estradiol levels as compared with ovarian dystrophy and pure gonadal dysgenesis. Diagnosis confirmation requires ovarian biopsy with a histological examination of ovarian specimen, but its outcome is not always significant.

[Polycystic ovary syndrome with excess of prolactin]. / Sindrom polikistoznykh iaichnikov s povyshenniem urovnem prolaktina.

Therapy including parlodel, dexamethasone, clomiphene, norcolut and various combinations of these has been used in order to restore reproductive function of patients with polycystic ovary syndrome and hyperprolactinemia. Pregnancy was induced in 42.3% of the patients, with drug combinations employed in most cases. Application of one of the agents alone was inefficient.

[Characteristics of the functional state of the central nervous system in women during the menstrual cycle and in premenstrual syndrome]. / Osobennosti funktsional'nogo sostoianiia tsentral'noi nervnoi sistemy u zhenshchin v dinamike menstrual'nogo tsikla i u bol'nykh s premenstrual'nym sindromom.

Electroencephalographic examination of the function of the central nervous system in 30 healthy women and in 15 ones suffering from the premenstrual syndrome, carried out over both phases of the menstrual cycle, has revealed clear-cut differences between the two groups. 46% of the patients developed pathologic shifts at the level of the brain stem, 37% of the hypothalamic level, and 17% combined involvement of these portions of the brain. Triggering of the compensatory defense mechanisms already during the follicular phase of the cycle indicates failure of the adaptation mechanisms in the patients with the premenstrual syndrome.

[Characteristics of the functional state of different sections of the autonomic nervous system and their role in the pathogenesis of oligomenorrhea]. / Osobennosti funktsional'nogo sostoianiia razlichnykh otdelov vegatativnoi nervnoi sistemy i ikh rol' v patogeneze oligomenorei.

Analysis of the clinical picture of oligomenorrhea and of the results of studies of the function of various sections of the autonomic nervous system (ANS) in 58 patients of a reproductive age has revealed differences in these functions, related to the time of menstrual disorders onset. Oligomenorrhea patients with menarche complained of cardiovascular, respiratory, and emotional-motivational disorders, examinations have revealed in them dysfunctional disorders and reduced reserve potentials of both ANS sections. In oligomenorrhea patients in whom the condition developed at the age of 18-25 after a period of regular menstruations the effects of various stress factors resulted in reduction of the functional activity of the ergotropic (sympathoadrenal) section of the ANS. Differences in the pathogenetic mechanisms of oligomenorrhea development in the two groups of patients are discussed.

[Characteristics of the ACTH-adrenal cortex system in women of reproductive age after ovariectomy]. / Osobennosti sostoianiia sistemy AKTG-kora nadpochechnikov u zhenshchin reproduktivnogo vozrasta posle ovariéktomii.

The examination of the function of the ACTH-adrenal cortex system in females of reproductive age following ovariectomy revealed certain hormonal relationships in terms of the clinical course of the disease: in persistent autonomic vascular and psychoemotional disorders there was a reduction or an increase in blood levels of ACTH (depending on the presence or absence of hypertension), cortisol and a decrease in blood testosterone levels, whereas in regression of the disorders there was a decrease in ACTH and cortisol and an elevation of testosterone levels. The development of the postcastration syndrome is likely to depend on the function and response of the ACTH-adrenal cortex system to a definite extent.

[Functional state of the hypothalamo-hypophyseal-ovarian system in female patients with tuberculosis of the genital organs]. / Funktsiia gipotalamo-gipofizarno-iaichnikovoi sistemy u bol'nykh tuberkulezom zhenskikh polovykh organov.

Blood concentrations of LH, FSH, estradiol, prolactin, growth hormone, cortisol, testosterone and progesterone have been examined in 76 patients with active tuberculosis of the internal genitalia (group 1), 18 patients with longterm sequelae of clinically asymptomatic tuberculosis (group 2) and 41 patients with nontuberculous diseases of the internal genitalia. Abnormalities were identified in 56.5% of group 1 patients, 33% of group 2 and 46.4% of group 3 patients. The patients with active tuberculosis characteristically had a low gonadotropin and estradiol secretion. High prolactin levels were related to pituitary adenoma or tuberculous infection; polycystic ovaries were a cause of testosterone and stress of examination of cortisol elevation.

[The pathogenetic mechanisms of hyperthermia in patients with the premenstrual syndrome]. / Nekotorye patogeneticheskie mekhanizmy gipertermii u bol'nykh s predmenstrual'nym sindromom.

Functional status of the central and autonomic nervous system was analyzed in 28 patients with the premenstrual syndrome one of whose manifestations was disordered thermoregulation. The examinations were carried out during both cycle phases. Analysis of the EEG data and clinical findings has shown different patterns of autonomic thermoregulation disturbances in three groups of patients and permitted the authors to suggest that changed activity of certain neurotransmitter systems connected with hormonal secretion over the course of the cycle was responsible for these disturbances.