[Modern ways of treating female genital infections].

In article various ways of increase of efficiency of treatment of is mixed the bacterial-virus infection of the bottom department of sexual ways at women by means of application in complex therapy of homologous bacteriophages, pectovit, antiviral -immunomodulation therapies and sated with oxygen (oxygenic) water solutions of antiseptic tanks are considered. The scientifically-practical urgency of this problem is represented and actual for the decision of an important social and economic problem of improvement of quality of life, decrease in number of infectious complications and perfection of the medical help to sick women with frequent recidives an infection of the bottom department of sexual ways.

[Immunohistochemical evaluation of the distribution of vascular endothelial growth factor in the placenta, placental bed in normal pregnancy and in women with preeclampsia].

VEGF expression was immunohistochemically studied in 35 placental fragments and 15 placental bed biopsy specimens in a control group and in 34 placental fragments and 16 biopsy specimens in women with preeclampsia. The female serum concentrations of VEGF and sFlt-I were measured in both groups. There was a drastic reduction in VEGF expression in the placenta (syncytiotrophoblast, free symplasts, syncytial kidneys); the placental bed biopsy specimens showed the impaired rearrangement of maternal-placental arteries with the lower VEGF expression in the cytotrophoblastic cells from women with preeclampsia. The blood displayed a 10-fold reduction in VEGF along with a 3.5-fold increase in SFlt-1 concentrations. Deficiency of free (circulating) VEGF-A that is so essential for normal endothelial function is likely to cause its structural changes that are united under the term "endotheliosis" as one of the leading mechanisms of the pathogenesis of gestosis.

[Clinical and morphological parallels and molecular aspects of the morphogenesis of adenomyosis].

The purpose of the study was to reveal clinical and morphological parallels and to define molecular mechanisms, the regulation of proliferation, apoptosis, neoangiogenesis, and the extent of abnormal tissue in adenomyosis (AM). The surgical material obtained from 492 patients of late reproductive age was examined. The data of clinico-anamnestic and instrumental diagnostic studies and a morphological study with hematoxylin and eosin staining were analyzed. An immunohistochemical study was carried out on serial paraffin sections (n = 115), by applying antibodies to Apo-CAS, Ki67, PCNA, CD-34, MMP-1, MMP-2, MMP-7, MMP-9, TIMP-1, TIMP-3, TIMP-4, and E-cadherin. The specific features of their morphological structure and the clinical course of the disease allowed identification of its active and inactive forms. Immunohistochemically active AM is characterized by high proliferation, diminished apoptosis, and increased expression of MMPs along with lower expression of TIMPs by glandular and stromal cells as compared with inactive AM. At the same time, there was a high activity of stromal cells in the foci of active AM. The results of the study may be used to predict the course of the disease and to elaborate target therapy for AM.

[The role of immune placental inflammation in the genesis of complicated pregnancy].

Immune inflammation is a typical pathophysiological process caused by exogenous and endogenous factors. Fibrinoid necrosis and cell infiltrations are the morphological features of tissue lesion caused by immune inflammation. Tissue lesion in immune inflammation may be connected with immune complex (IC) formation or T-cell aggression. Lesion caused by antigen-antibody complexes develops as a result of direct IC formation in the tissue or their inflow from microcirculation. Potential sources of IC in the placenta are maternal blood flow, the formation of IC between maternal antibodies (AB) and embryonic antigens, and IC formation in fetal blood vessels. After sedimentation in the placenta, circulating IC can cross syncytiotrophoblast tissue with the participation of specific receptors to immunoglobulin Fc-fragment. The process of antifetal AB formation may start in the maternal organism, as a result of which it forms AB to embryonic and placental antigens, including paternal Rh, ABO, and HLA, and some trophoblast antigens. IC are able to initiate inflammatory process through interaction with the compliment system, through the activation of macrophages excreting cytokines (TNF-alpha and IL-1), and through influencing basophiles and thrombocytes (the liberation of vasoactive amines). Gestosis is associated with system inflammatory response with endothelial dysfunction as the main element. As the clinical features of gestosis do not develop before 20 weeks of pregnancy, its clinical manifestation is preceded by increased fetal blood-brain barrier permeability, elevation of the level of neurospecific proteins of fetal origin in maternal circulation, and the formation of specific IC causing acute endotheliosis.

[Detection rates of various serotypes of human papilloma virus in atypical glandular hyperplasia and adenocarcinoma of the endometrium and their immunomorphological features in virus-positive cases].

Various virus serotypes were found in 35.3% of cases and their detection rate frequency reducing with age. They were detectable in 35.3 -52.9% of cases of atypical glandular hyperplasia, highly and moderately differentiated adenocarcinoma of the endometrium and only in 17.6% of cases of poorly differentiated adenocarcinomas. Serotypes 58 and 51 were nearly twice more frequently, but serotypes 18 and 52 were not observed. Immunomorphologically virus-positive observations were characterized by pronounced infiltration with T-helper and T-suppressor/killer cells. The endometrium and tumors showed an increased significant proliferative activity (Ki-67 expression) and reduced expression of receptors to progesterone and, to a lesser degree, to estrogen in 47-83% of virus-positive cases. Expression of growth factors did not greatly differ.

[Correlation between proliferation and apoptosis in different histological types of uterine leiomyoma].

75 cases of simple, cellular and mitotically active leiomyoma (LM) were studied immunohistochemically with the use of monoclonal antibodies against bcl-2 ("DAKO", 1:80), bax ("Calbiochem, 1:80), c-myc ("Novocastra", 1:100), CD 95 ("Dianova, 1:50), Ki67 ("Dianova", 1:40), PCNA ("Novacastra", 1:100). Apoptosis was assessed by the Tunnel method (ENZO Apop Detek Cell Death Assay System). Simple LM is characterized by apoptosis domination over proliferation in leiomyocytes. Size increase of such a tumor is probably the result of hypertrophy of leiomyocytes and stromal elements proliferation as well as secondary changes. Cellular LM is characterized by about similar level of tumor cell proliferation and apoptosis. Size increase of cellular LM is related to hypertrophy and leiomyocytes number increase probably due to their life lengthening. Mitotically active LM is characterized by domination of proliferation over apoptosis of tumor cells this being main condition of this tumor growth. Various types of LM differ by their stroma composition: fibrocyte prevailing in a simple LM, angiogenesis in mitotically active LM. Combination of adenomyosis with endometrium hyperplasia results in enhancement of proliferation and apoptosis of tumor cells.

[Morpho- and angiogenetic characteristics of uterine leiomyoma].

Ordinary and cellular leiomyomas of 147 patients (age 23 - 65 years) were studied histologically and immunomorphologically. Five females with rapidly growing tumors were operated after therapy with gonadotropines blockers. Variants with weak and pronounced proliferative activity of neoplastic myocytes and various activity of neoangiogenesis were distinguished. The latter may be either phases of development or different tumour types. Use of gonadotropine blockers inhibits myocyte proliferation and activates formation of stroma.

[The viral and bacterial nature of dysplasia and of cervical carcinoma]. / Virusno-bakterial'naia priroda displazii i raka sheiki matki.

The role of the infection component in etiopathogenesis of dysphasia and cervical carcinoma as well as optimization of their diagnosis and treatment schemes are discussed in the paper. On the basis of published data and authors' independent examinations, a tense relationship between the presence of dysphasia and cervical carcinoma, on the one hand, and sexually-transmitted genital infection and/or bacterial vaginosis present in the medial history, on the other hand, was verified. An intensity of vagina-microflora dysbacteriosis in genital clamidiosis and in dysphasia of cervical carcinoma as observed in women as well as an evaluation of immunoglobulins' levels in vaginal secretions can be a prognosticating criteria for a conducted treatment. A high efficiency and feasibility were shown of adding the recombinant alpha2-interferon to the combined treatment of genital clamidiosis and to preventing it from being chronic as well as to correcting the dysplastic impairments an to preventing the malignant neoplasms in the neck of uterus.

[Factors and conditions affecting the process of infecting the fetus during different pregnancy stages]. / Faktory i usloviia, vliiaiushchie na protsess infitsirovaniia ploda na raznykh srokakh beremennosti.

Etiology, pathogenesis of intrauterine infection of the fetus, factors promoting such infection and the status of the local immune system are elucidated in the paper. A changed reactivity of the immune homeostasis of a pregnant woman with a chronic infection was shown to be potentially an important factor of pathogenesis of defects in her baby. The local immunity factors of the reproductive tract, i.e. the vagina and neck of uterus, are in the forefront of anti-infectious protection, which signal an alert or limit the microorganisms' reproduction; besides, they prevent the microorganisms from penetrating into the upper genitals. The therapeutic-and-preventive schemes applicable to infected women must comprise measures targeted at eliminating an infectious agent and at normalizing the pathological changes in the performance of the immune system activity.

[Endothelium and platelets in pregnant women with chronic glomerulonephritis and therapeutic efficacy of acetylsalicylic acid and dipiridamol]. / Sostoianie endoteliia i trombotsitov u beremennykh s khronicheskim glomerulonefritom i lechebnymi vozvozhnosti atsetilsalitsilovoi kisloty i dipiridamola.

AIM: To estimate platelet and endothelial condition in pregnant women with chronic glomerulonephritis (CGN), prognostic value of these changes and efficacy of acetylsalicylic acid (ASA) and dipiridamol in prevention of unfavourable outcomes of pregnancy in CGN. MATERIAL AND METHODS: The examination covered 74 CGN pregnant patients, 14 non-pregnant CGN patients, 11 pregnant women with preeclampsia, 19 healthy pregnant women. The levels of fibronectin, endothelin-1,2, 6-keto-PGF1a, thromboxane B2 (TxB2) secretory beta-thromboglobulin in the blood, activity of intrathrombocytic lactate dehydrogenase (LHG), platelet aggregation. ASA (125 mg/day) was given to 33 CGN pregnant women in combination with dipiridamol (150-225 mg/day). Control group consisted of 32 CGN pregnant women. RESULTS: Content of fibronectin, endothelin, TxB2 and beta-thromboglobulin in blood plasm, aggregation with ADP in CGN pregnant women were higher than in healthy pregnant women and nonpregnant CGN patients. Plasmic 6-keto-PGF1a was low. Preeclampsia was accompanied with elevated fibronectin, TxB2 and beta-thromboglobulin, hyperactive LDH. Platelet aggregation was suppressed. Blood beta-thromboglobulin directly correlated with systolic and diastolic arterial pressure, 24-h proteinuria and blood creatinine. Reverse Correlation was seen in blood beta-thromboglobulin with albuminemia, glomerular filtration rate, body mass of the newborn and term of labor. A direct correlation was found between the activity of intrathrombocytic LDH and systolic and diastolic arterial pressure, a weak reverse correlation--between platelet count in capillary blood and systolic pressure, platelet aggregation with ADP and terms of labor. Of the highest prognostic value were the level of beta-thromboglobulin and fibronectin, the activity of intrathrombocytic LDH and platelet aggregation in response to ADP. ASA and dipiridamol reduced the risk of fetal retardation and fetal loss. CONCLUSION: Pregnant women with CGN have endothelial-thrombocytic dysfunction because of unidirectional influence of both CGN and pregnancy. We think that endothelial-platelet dysfunction connects renal impairment and placental failure in pregnant women with CGN deteriorating a gestational CGN and pregnancy complications. Correction of endothelial-platelet state with ASA and dipiridamol is effective in prevention of fetal retardation and fetal loss in pregnant women with CGN.

[Dynamics of some characteristics of humoral immunity, vaginal interferon status in pregnant women with the relapse of chronic pyelonephritis]. / Nekotorye pokazateli gumoral'nogo immuniteta, interferonovogo statusa vlagalishcha v dinamike u beremennykh s retsidivom khronicheskogo pielonefrita.

65 pregnant women with the exacerbation of chronic pyelonephritis in the III trimester of gestation and 34 healthy pregnant women were examined. The quantitative content of immunoglobulins, the activity of interferon in cervico = vaginal washings and the composition of the vaginal microflora were determined. All patients with the relapse of chronic pyelonephritis exhibited disturbances in the normal microbiocenosis of the genitals and the dysfunction of the local immunity of the genital system, accompanied with a decrease in serum and secretory IgA, an increase in the amount of IgG and IgM, increased interferon activity. Pregnant women with the relapse of chronic pyelonephritis received, in addition to traditional therapy, local treatment with Kipferon suppositories, an immunomodulating preparation. The study revealed that the use of this preparation normalized the characteristics of local immunity, the composition of the microflora' of the genitals and led to the disappearance of the clinical symptoms of the disease.

[Renal and uterine hemodynamics in pregnancy with chronic glomerulonephritis of the hypertonic type]. / Pochechnaia i matochnaia gemodinamika u beremennykh s khronicheskim glomerulonefritom gipertonicheskogo tipa.

AIM: To study gestational changes in renal and uterine hemodynamics and their relation to systemic and intracardiac hemodynamics in pregnant hypertensive women with chronic glomerulonephritis (CGN). MATERIAL AND METHODS: Echocardiography, ultrasonic dopplerography of renal and uterine arteries were made in 16 pregnant women with CGN and AH syndrome in trimester II-III and 1-3 months after the delivery. Hemodynamic indices in pregnancy were compared to those after the delivery which were considered baseline. RESULTS: In CGN pregnant women with AH syndrome resistance of renal arteries did not change in pregnancy and were similar postpartum. With advancing pregnancy, the resistance of the uterine arteries diminished. The indices of the resistance in the main trunk of the renal artery correlated with volumetric cardiohemodynamic indices, heart rate and total peripheral resistance in segmental interlobular arteries. No significant correlation were found between uterine, systemic and cardiac hemodynamics though it existed between renal and uterine blood flow. CONCLUSION: Pregnancy does not affect vascular resistance of renal arteries in CGN pregnant women with AH syndrome, but contrary to pregnancy with essential hypertension in that with CGN and AH syndrome renal circulation responds to changes in systemic hemodynamics and volumetric indices of cardiohemodynamics. These findigns may reflect disturbances in autoregulation of renal circulation and additional effects on pregnancy outcome in women with CGN and AH syndrome.

[Renal and uterine hemodynamics in pregnant women with hypertension]. / Pochechnaia i matochnaia gemodinamika u beremennykh s gipertonicheskoi bolezn'iu.

AIM: To study gestational alterations of renal and uterine hemodynamics, their relationships with systemic and intracardiac hemodynamics in pregnant women (PW) with essential hypertension (EH). MATERIAL AND METHODS: Echocardiography, ultrasound dopplerography of renal and uterine arteries, roll-over test were made in the course of trimester II-III and 3 months after the delivery in 48 PW with EH degree 1-2 and control 20 healthy PW. Hemodynamic parameters in pregnancy were compared to postpartum ones. The latter were supposed to be basal. RESULTS: Changes in systemic and intracardiac hemodynamics in EH and control women were in many respects similar but systolic blood pressure in EH changed insignificantly, minute volume increased owing to increased heart rate. PW with EH of the second degree have in the III trimester more frequent positive roll-over test this evidencing for high pressor reactivity of the vascular system. PW with EH showed higher speed of the blood flow in the renal arteries in unchanged resistance. With growing gestation time the resistance of the uterine arteries declined. The resistance of the main stem of the renal artery went up in enhanced cardiac contraction regardless of total peripheral vascular resistance (TPVR). Blood flow in the uterine arteries worsened in elevation of arterial pressure, TPVR, lowering of the heart rate and systolic function of the heart. Renal and uterine hemodynamics were independent. CONCLUSION: Hemodynamic changes in control and EH PW were similar in many respects but higher arterial pressure, abnormal systolic function of the left ventricle, bradycardia disturb uterine blood flow. Renal circulation was independent of systemic and intracardiac hemodynamics and is unrelated to changes in the uterine circulation.

[Morphofunctional disorders of uterine-placenta blood flow in multiple uterine myomas]. / Morfofunktsional'nye narusheniia matochno-platsentarnogo krovotoka pri mnozhestvennykh miomakh matki.

Results of the right uterine artery dopplerometry at pregnancy 39-39 weeks and those of subsequent histotopographic and immunomorphologic study of the placental bed in the amputated uteri were compared in 50 pregnant women. Morphofunctional equivalent of a considerable reduction of the uterine-placental circulation depending on the myomatous tissue spread and particularly in rare observations of "the placenta on the node" were found. Pathogenesis of these disturbances is determined by deficiency of the second wave of interstitial cytotrophoblast invasion, by phenomenon of the uterine-placental circulation decrease due to arterial supply of myomatous nodes and local hormonal changes produced by alterations of cellular-tissular correlations in the uterine-placental bed.

[Thrombocytic disorders in pregnant women with chronic glomerulonephritis and hypertension]. / Trombotsitarnye narusheniia u beremennykh s khronicheskim glomerulonefritom i gipertonicheskoi bolezn'iu.

To assess platelet changes in pregnant women with chronic glomerulonephritis (CGN) and essential hypertension (EH) we estimated platelet lactic dehydrogenase activity (LDH), beta-thromboglobulin and thromboxane B2 (TxB2) plasma levels and ADP-stimulated platelet aggregability. Five groups of gravidae (26-40 weeks of gestation) were studied: with EH (n = 20), with CGN and hypertension (n = 31), with CGN without hypertension (n = 29), with late toxemia (n = 11), nonpregnant CGN women (n = 10) and healthy pregnant women (n = 20). Activation of platelet function was found in gravidae with CGN and EH. Platelet disorders were especially pronounced in pregnant women with CGN and with EH, but they were less pronounced than in control group with late toxemia. We believe that hypertension is more important stimulating factor for platelet activation than renal disease. We suggest that platelet disorders in outpatients are brought about by endothelium damage caused by elevated blood pressure.

[The dynamic importance of proteinuria and arterial pressure for detecting late toxicosis in pregnant women with chronic kidney diseases and hypertension]. / Znachenie dinamiki proteinurii i arterial'nogo davleniia dlia vyiavleniia pozdnego toksikoza u beremennykh s khronicheskimi zabolevaniiami pochek i gipertonicheskoi bolezn'iu.

Time course of 187 pregnancies was followed up in 103 females with chronic renal diseases (CRD), 76 females with essential hypertension (EH) and 14 posteclampsia females. Three variants of arterial pressure (AP) and 5 types of proteinuria changes were recognized in CRD and EH patients. The pattern of these changes was compared to that in posteclampsia patients, the eclampsia being an absolute criterium of late toxicosis. It is shown that neither elevated AP and proteinuria nor their absolute values can serve reliable signs of late gestosis in CRD and EH patients. Only the trend in these parameters is significant. CRD and EH females with late gestosis exhibit rapidly growing proteinuria in line with the onset or exacerbation of EH. Retrospective analysis of the pregnancies has confirmed association of late gestosis in 15% of EH and 7% of chronic glomerulonephritis patients. These estimates are lower than commonly accepted. Early diagnosis of late gestosis in pregnant females with CRD and EH requires not only regular AP registration, but also dynamic, in some cases hourly, evaluation of proteinuria.

[The mechanisms of the development of pregnancy complications in hypertension and glomerulonephritis]. / Mekhanizmy razvitiia oslozhnenii beremennosti pri gipertonicheskoi bolezni i glomerulonefrite.

Pregnancy complications have been analyzed in 124 females suffering from essential hypertension (EH) and chronic glomerulonephritis (CGN). Such complications, as late gestosis (8.9%), ablation placentae (1.6%), premature delivery (14.5%), intrauterine growth retardation (14.5%) occurred more frequently than in population. Pre- and perinatal deaths were encountered with the same frequency as in the population. Morphologically, the placentas had in many cases histological evidence of moderate placental insufficiency (PI). In more than 60% of the patients there were uteroplacental and fetoplacental hemodynamic defects. Placental circulatory disorders and PI ran subclinically in most of the cases as they were compensated. In EH and CGN pregnant women, compared to healthy controls, red cells acquired abnormal forms more frequently, serum thromboxane B2 levels got elevated, lactate hydrogenase activity became enhanced. Erythrocytic damage and platelet activation in EH and CGN pregnant women may indirectly confirm the existence of systemic angiopathy. It is suggested that ischemic placenta may produce endothelial toxin, that systemic endothelial damage in EH, CGN, PI may be synergetic which potentiates its clinical appearance in the form of the above pregnancy complications.

[Surface cytoarchitectonics of maternal and fetal erythrocytes in normal and complicated course of pregnancy and labor]. / Poverkhnostnaia tsitoarkhitektonika éritrotsitov materi i ploda pri normal'nom i oslozhnennom techenii beremennosti i rodov.

Red cell surface architectonics and ultrastructure were studied in pregnant women, their fetuses, and newborns in normal and complicated pregnancy. The results were correlated to dopplerometric blood stream parameters of uterine artery and fetal umbilical artery. The most grave changes in red cell structure were detected in women with medium-severe and grave OPH gestosis: the share of red cell discoid forms was reduced by 21%, that of nontransitional forms ("shrunk ball"-shaped cells, spherocytes, degeneratively changed cells) increased by 17%. Deterioration of blood rheology in complicated pregnancy correlated with reduced fetoplacental and uteroplacental blood stream and with unfavorable perinatal outcomes.