MODERN METHODS OF COMPLEX CORRECTION OF PSYCHOSOMATIC DISORDERS IN PATIENTS WITH EXTERNAL GENITAL ENDOMETRIOSIS.

OBJECTIVE: The aim: About 10% of socially active women of reproductive age suffer from endometriosis, is determined by the frequent occurrence of menstrual and reproductive functions disorders, and pelvic pain syndrome in patients. The difficulties of therapeutic treatment of chronic pain syndrome in external genital endometriosis (EGE) are associated with polymorphism of pain mechanisms, and delayed diagnosis and treatment. The aim of the study is to improve the effectiveness of the treatment of external genital endometriosis. PATIENTS AND METHODS: Material and methods: We examined 60 female patients of reproductive age, 40 - with histologically verified diagnosis of external genital endometriosis and 20 healthy women. We used the following methods of examination: general clinical, instrumental, endoscopic, morphological, the Visual Analogue Scale (VAS) to quantify pain, the Beck Depression Scale and the SF-36 questionnaire. RESULTS: Results: Before the treatment of patients with EGE, VAS scale scores indicated pain in 100% of patients, the indicators of depression and level of anxiety go beyond the normative. The results of the pre-treatment questionnaire indicated lower quality of life scores on the scales of physical and mental health components. As a result of treatment there was significant decrease in the manifestations of pain, depression and anxiety, with women receiving complex therapy (hormone therapy got antidepressants and non-drug correction methods). CONCLUSION: Сonclusions: Chronic pelvic pain syndrome associated with EGE and accompanied by an unfavorable psychological state, depressive states, anxiety symptoms, and psychosomatic disorders. New approaches to the treatment of clinical manifestations of EGE are needed, taking into account patients' psycho-emotional status and the life quality analysis. We pathogenetically justified the use of drugs that affect the psychosomatic status of patients with EGE and showed that they could significantly improve the quality of life.

[Features of local immunity in local inflammatory reactions in pregnant, depending on the implementation of intrauterine infection].

OBJECTIVE: Introduction: Vaginal protective systems function independently of other systemic mechanisms and impairments of local immune mechanisms of the vaginal mucosa are the cause of infectious disorders of the reproductive system The aim: To assess characteristics of local immunity in local inflammatory reactions in pregnant, depending on the implementation of intrauterine infection. PATIENTS AND METHODS: Materials and methods: The study comprised Group 1 of pregnant women with the presence of bacterial infections with and without implementation of IUI, Group 2 with the presence of viral infections with and without implementation of IUI, Group 3 with the presence of infections of combined polyetiological structure with and without implementation of IUI and control group included pregnant women with physiological pregnancy. The study implied evaluation of the number of leukocytes in vaginal contents, concentration of IgA, IgM, IgG, sIgA, concentration of cytokines-IL-1 ß , IL-6, IL-10, TNF- α in vaginal swabs. RESULTS: Results: Women with the presence of an infectious process without its implementation, regardless of the etiologic factor, were found to have more expressed inflammatory reactions. In the presence of a viral infection, changes in the humoral link of local immunity were less expressed. In Group 1 without implementation of IUI, the concentration of IL-1 ß was (73.68 ± 10.23) pg / ml, IL-6 was (53.3 ± 6.8) pg / ml. In Group 2 with implementation of IUI, concentration of IL-10 was (26.72 ± 4.35) pg / ml. In Group 2 without implementation of IUI, the content of TNF-α was (575.25 ± 69.03) pg / ml. CONCLUSION: Conclusions: The study showed the differences between the groups of pregnant women with different outcome of IUI in the content of proinflammatory and anti-inflammatory cytokines.

The state of immunity in pregnancies complicated by intrauterine infection of the fetus.

OBJECTIVES: To study the state of immunity in pregnancies associated with urogenital infection and complicated by intrauterine infection. MATERIAL AND METHODS: The comparative study involved the examination of 250 pregnant women with urogenital infection and ultrasonographic signs of intrauterine infection and their newborns in order to assess the state of cellular and humoral immunity components and nonspecific resistance. A direct prospective examination of pregnant women was carried out in the 2nd and 3rd trimesters of gestation. Depending on the outcome of each pregnancy on the basis of the follow-up of newborns, performed on the first day after birth, the patients were retrospectively divided into two groups. The study group included 93 (37.2%) pregnant women who developed intrauterine infection. The comparison group (n=157 (62.8%)) comprised pregnant-carriers of perinatally significant infection who gave birth to conditionally healthy children. The control group consisted of 50 healthy women with a physiological pregnancy. RESULTS: In the gestation period under investigation, the development of intrauterine infection in pregnant women with urogenital infections was found to be associated with a deficiency of T-helpers / inducers, an increase in thymus-dependent lymphocyte killer activity, a high content of IL-1ß, TNF-α in the systemic circulation, and a decrease in the level of IL-10 secondary to the oppression of the effector link of phagocytic neutrophils of peripheral blood. CONCLUSIONS: An increased concentration of systemic proinflammatory cytokines IL-1ß, IL-6 and TNFα with a simultaneous decrease in the IL-10 content and suppression of the killing activity of peripheral blood phagocytes reflects the presence of an active inflammatory process in the mother-placenta-fetus system and can be one of the factors affecting the development of intrauterine infection in pregnancy, complicated by urogenital infection.