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Obstetrics, Gynecology and Reproduction

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Vol 14, No 3 (2020)

ОRIGINAL ARTICLES 

261-268 212
Abstract

Aim: to identify clinical and histological criteria for sex cord ovarian stromal tumors (OSTs).

Materials and Methods. The retrospective non-comparative study was based on the main inclusion such as histologically verified sex cord OSTs. A standard examination algorithm was analyzed (ultrasound, blood tests, CT or MRI of the abdominal and pelvic organs). All clinical data were obtained from patients treated and monitored in clinical units at the Blokhin National Medical Research Center of Oncology and the National Center of Oncology and Hematology of the Kyrgyz Republic.

Results. Data were obtained on the frequency of necrobiotic changes, malignancy, disease stages and their impact on survival in 456 patients. The 10-year survival rate for OSTs patients with vs. without intra-tumor necrobiotic changes was significantly lower (17.2 % and 78.1 %, respectively).

Conclusion. The main factors of unfavorable prognosis in patients with granulosa cell ovarian tumors were disease stage and intra-tumor necrobiotic changes.

269-282 803
Abstract

Aim: to make a comparative evaluation of women with borderline ovarian tumors (BOTs) and surgical menopause (early symptoms) and explore their level of anxiety and depression depending on the age and volume of surgery.

Materials and methods. The prospective comparative study included 117 patients, aged 44.3 ± 6.5 years, after surgical treatment of BOTs: 62 women at reproductive age with surgical menopause after radical treatment (group IА), 24 women at reproductive age after organ-preserving surgery (group IВ), 31 women at perimenopausal age after radical treatment (group II). The severity of menopausal syndrome (modified menopausal Kupperman–Uvarova index), anxiety and depression (Hospital Anxiety and Depression Scale, HADS) were determined 29–59 (36.4 ± 5.6) days after surgery.

Results. Early symptoms of surgical menopause are found in 98.3 % of patients with BOTs. Reproductive age patients after radical surgery (group IA) had moderate neurovegetative (21.7 ± 4.0 points), mild metabolic (5.8 ± 1.8 points), and moderate psychoemotional disorders (8.9 ± 1.4 points). Young women who underwent organ-saving operations with preservation of at least one ovary (group IB), had normal range the indicators of neurovegetative disorders (8.2 ± 3.1 points), metabolic and psychoemotional disorders were regarded as moderate (2.6 ± 1.6 and 5.9 ± 2.3 points, respectively). Disorders due to surgical menopause (early symptoms) at perimenopausal age females (group II) corresponded to a mild degree: neurovegetative – 15.3 ± 2.7 points; metabolic – 6.0 ± 2.2 points; psychoemotional – 5.7 ± 1.5 points. Our data indicate that patients of group IA had moderate surgical menopause (early symptoms) – 36.4 ± 5.4 points, while in groups IB and II the total values were 16.8 ± 5.4 and 27.0 ± 4.3 points, which corresponds to mild severity. Patients with BOTs (one month after antitumor therapy) had early symptoms of surgical menopause (postovariectomy syndrome). The most typical clinical picture was observed among young women after removal of both ovaries.

Conclusion. Surgical menopause affects by somatic and psychological health negatively. This leads to a significant decrease in the quality of life and an increase in the level of disability among patients with gynecological cancer. Therefore, even at the planning treatment, it is necessary to include pre-rehabilitation measures to minimize the negative consequences of cancer therapy.

283-295 213
Abstract

Introduction. Inflammatory diseases of the pelvic organs represent one of the lead causes affecting health status in women of childbearing age. The pathogenetic mechanisms of chronic endometritis (CE) have been extensively studied, but many issues remain debatable. This disease manifests in various clinical pictures, including relapsing course, so a need to conduct combination individualized treatment rises no doubts.

Aim: to assess effectiveness of combination individualized therapy of CE.

Materials and Methods. A comprehensive analysis of clinical data was performed in 107 patients with morphologically verified CE, examining microflora composition in the uterus, cervical canal, urinary tract, and intestine by using a wide range of laboratory research methods; assessing cell subset composition of peripheral blood lymphocytes by using immunocytochemistry (CD3+, CD4+, CD8+, CD19+, CD95+, CD3+CD4+, CD3+CD8+, CD3+CD95+), measuring level of serum cytokines – interleukin-1β, tumor necrosis factor-α, interleukin 8, and interleukin 10. For this, all patients were subdivided into 2 groups: 53 patients (group I, main received treatment according to the original protocol (antibiotics and bacteriophages, immune preparations, herbal medicines), 54 patients (group II, control) received conventional therapy (antibiotics, immunomodulatory drugs, hormones).

Results. It was found that urogenital tract microbiota was profoundly altered in patients with CE, also featured with dysregulated immune system. In addition, associated changes in the leukocyte-lymphocytic arm of the immune system and features of clinical and anamnestic data were obtained, which is important in combination treatment of patients with this pathology. Composition microflora in the vagina, cervical canal and uterine cavity was markedly improved that was confirmed by bacteriology data, vaginal pH value and menstrual function were by 2-fold more often in group 1 vs. group 2. A 12-month follow-up revealed in group 1 no complaints of pelvic pain requiring pain killers, with pronouncedly lowered amount of doctor visits due to inflammatory pathology of the urinary tract additionally confirming effectiveness of individualized treatment.

Conclusion. The data of the study evidence about a need to individualize diagnostic and therapeutic approaches while managing patients with CE. The treatment strategy for patients of childbearing age with CE should be based on minimizing drug aggression, taking into account concomitant pathologies, features of microbiota composition in the genitourinary organs and changes in the immune system. An combination and individualized therapeutic approach provides an opportunity to substantially better results after treatment of CE.

296-313 719
Abstract

Aim: to examine intensity of surgical menopause symptoms (postovariectomy syndrome, POES) in patients with borderline ovarian tumors (BOTs) after radical surgery depending on the postoperative period management; to assess a role for “cancer immunotherapy diet”* as a standalone means in correction of surgical menopause symptoms as well as a part of patient-specific rehabilitation program.

Materials and Methods. A prospective comparative study was conducted with 62 BOTs female patients aged 30 to 48 (42.0 ± 4.1) years underwent radical surgical treatment, subdivided into 3 groups: group I – “active” rehabilitation (29 subjects underwent 12 month-comprehensive personalized rehabilitation); group II – “passive” rehabilitation (17 women with standard management of the postoperative period in accordance with clinical recommendations); group III – 16 patients followed the one-year “cancer immunotherapy diet” (after being consulted by medical specialist and formulation of individual diet program). Patient data obtained after clinical interview, physical, laboratory and instrumental examinations were assessed at four time points: before surgery (visit 0), after 1, 6 and 12 months (visits 1, 2, 3) after antitumor treatment. In addition, every visit required each patient to fill out the modified Kupperman menopausal index (MMI) questionnaire specifically adapted for BOTs patients. Intensity of neurovegetative, psycho-emotional and metabolic manifestations of surgical menopause symptoms was assessed at various stages of post-surgery period and management strategy during post-surgery period.

Results. All BOTs patients one month after radical surgical treatment noted overt signs of surgical menopause. Before surgery, the average MMI score corresponded to normal range – 10.9 (group I), 10.5 (group II), 10.4 (group III), whereas during visit 1 it changed to 37.1, 35.2 and 36.4, respectively evidencing about moderate severity of POES. MMI largely depended on management strategy 6 and 12 months after the onset of therapy: in “active” rehabilitation group it was 27.7 (visit 2) and 22.2 (visit 3), “passive” rehabilitation group – 39.1 (visit 2) and 42.6 (visit 3), “cancer immunotherapy diet” group – 34.1 (visit 2) and 30.8 (visit 3). In addition, distribution of patients based on body mass index (BMI) revealed various types of impaired fat metabolism (IFM) in 59.68 % subjects at visit 0, that increased one month after surgery up to 64.52 %, whereas 6 and 12 months later it decreased down to 62.90 and 61.29 %, respectively. However, end-point results in different groups varied substantially: In particular, at visit 3 in group I 55.17 % (n = 16) subjects had normal BMI, 37.93 % (n = 11) – class I obesity and 6.90 % (n = 2) – class II obesity. The end-point results in group II revealed no patients with normal BMI: 76.47 % (n = 13) and 23.53 % (n = 4) had class I and class II obesity, respectively. Finally, end-point results in group III were at intermediate state: 50.0 % (n = 8) subjects showed normal BMI, whereas 37.5 % (n = 6) and 12.5 % (n = 2) patients demonstrated class I and class II obesity, respectively.

Conclusion. Adjuvant therapy of surgical menopause symptoms represents an important component in rehabilitation program for BOTs patients underwent radical surgery. A personalized rehabilitation program demonstrates peak efficacy in correcting surgical menopause symptoms (essential to include “cancer immunotherapy diet” therein). Even isolated administration of diet therapy profoundly reduces intensity of surgical menopause symptoms, thereby improving the quality of woman’s life.

REVIEW ARTICLES 

314-326 410
Abstract
The problem of sepsis and septic shock has recently become more and more actual. In obstetrics and gynaecology, the number of cases of sepsis has more than doubled over the past 10 years. The review examines the clinical forms of septic conditions, risk factors, pathogenesis of sepsis and septic shock, the main pathogens of septic conditions. Special attention is paid to neonatal sepsis. The relationship between septic shock and viral infections is considered in the context of the novel coronavirus infection caused by SARS-CoV-2 (COVID-19) pandemic. Hemostasis abnormalities have been demonstrated in patients with septic shock, including disseminated intravascular coagulation (DIC). The importance of determining the level of ADAMTS-13 to refine the forecast is discussed.
328-345 320
Abstract

In this review we summarize current data on prevalence, etiology and pathogenesis resulting in premature ovarian insufficiency (POI). In particular, genetic, autoimmune, metabolic, iatrogenic disorders as well as unfavorable impact of environmental factors represent key pathogenetic mechanisms underlying POI development. Clinical picture of this disease is mainly manifested by oligo- and amenorrhea as well as genitourinary menopausal syndrome (GUMS). Special attention is paid to a link between such clinical signs and psychosocial discomfort not being a life-threatening condition but still able to markedly lower quality of woman’s life and considered as a comorbidity with type 2 diabetes mellitus, osteoporosis and cardiovascular diseases. Hormone replacement therapy (HRT) serves as the first-line therapeutic approach for treating POI, which is performed according to the principles similar to those used to perform menopausal hormone therapy (MHT) in case of natural menopause that should be continued until reaching at least the average age for the onset of menopause. Topical estriol therapy eliminates GUMS symptoms, which in turn positively affects sexual function and woman’s psychosocial status and contributes to improved quality of life. The data from recent studies examining topical estriol therapy in POI demonstrated high efficacy and safety. Finally, we also discuss diverse strategies to support reproductive function in women with POI.

347-360 208
Abstract
The results of the evaluation of 7-hydroximatairesinol (7-HMR) properties in comparison with control molecules (17-estradiol, phytoestrogen β-sytostirol, epigallocatechin-3-gallate) are presented. The results of chemoreactomic modeling allowed to formulate the molecular mechanisms of 7-HMR pharmacological effects for anti-inflammatory (inhibition of 5-lipoxygenase, matrix metalloproteinase MMR2, mitogen-activated kinase p38-alpha, leukotriene-b4 receptor, prostacyclin receptor), antitumor (antioxidant effect due to inhibition of hemoxygenase-2, inhibition of cyclin dependent kinases 3 and 4, epidermis growth factor, protein mTOR), vasodilator (inhibition of adrenoreceptors and renin), antibacterial and antiviral (inhibition of viral proteases 3C) properties of 7-HMR molecule.
361-373 184
Abstract

Materials and Methods. A systematic analysis of publications retrieved from PubMed/MEDLINE database as well as in the list of primary sources of the identified scientific papers was carried out by using current methods for large data analysis within the framework of topological and metric approaches applied for data recognition/classification. A map of molecular-pathophysiological processes was compiled followed by performing analysis of metric condensations.

Results. Three clusters of terms describing an impact of various biological processes into the pathophysiology of hot flushes were identified: inflammation combined with insulin resistance (cluster 1), the presence of chronic comorbid pathologies in patients (cluster 2), and disorders of serotonin metabolism (cluster 3). The use of menopausal hormone therapy (MHT) is not accepted for all patients. A promising direction in treatment of mild and moderate hot flushes is based on using nutraceuticals: vitamins, trace elements and substances obtained from plant extracts (isoflavones, phytoestrogens, etc.). Here, this set of interactions between pathophysiology of hot flushes and deficiency of certain micronutrients, inflammation, insulin resistance, chronic comorbid pathologies and disorders of serotonin metabolism is described. Replenished deficiency of vitamins C, E, A, B2, PP, B6, B12, and folates aids to reduce chronic inflammation, insulin resistance and normalize functioning of the autonomic nervous system. Natural and synthetic agonists of GABA receptors and tryptophan derivatives are necessary for serotonin biosynthesis and elimination of other neurotransmitter imbalances in order to normalize activity of the hypothalamic thermoregulatory region.

Conclusion. Plant isoflavones (including phytoestrogens) together with vitamins and other micronutrients help to overcome estrogen-dependent withdrawal symptoms and eliminate dysfunction of autonomic nervous system

LETTER TO THE EDITORS 

374-383 332
Abstract

An issue of habitual miscarriage poses a high social importance especially during COVID-19 pandemic. Meanwhile, healthcareworkers faced a mass media campaign against using micronized progesterone upon habitual miscarriage, which, as viewed by us, displays signs of prejudiced data manipulation and may disorient practitioners. In this Letter we provide objective information on accumulated data regarding gestagenes efficacy and safety. We invoke healthcare professionals to make decisions deserving independent primary source trust presented by original scientific papers published in peer-reviewed journals, clinical recommendations proposed by professional medical communities as well as treatment standards and protocols.

CLINICAL CASE 

384-394 310
Abstract

Aim: to demonstrate the role and importance of prenatal diagnosis of abnormally invasive placenta.
Materials and methods. Retrospective analysis of 3 clinical cases of the delivery in Health Center Medina. All women were diagnosed with the complete placenta praevia and invasion of chorion in the myometrium, the last was confirmed by the results of histological examination. Anamnesis data, extragenital pathology and results of examination during pregnancy were analyzed. In the prenatal period the diagnosis was confirmed by the results of ultrasound examination and MRI in two women.
Results. All women were diagnosed with the different degree of placenta praevia, 2 women had a cesarean section in the past history. All patients had unifetal pregnancy without complications and no extragenital pathology was noted. 2 women were diagnosed with the placenta praevia using ultrasound scan and MRI, were estimated the degree and topography of placental invasion. Both women had planned caesarean section. During operation was performed autohemotransfusion using a Cell Saver system. In one of the cases urgent c-section was performed due to the massive bleeding, presence of placental invasion was diagnosed intraoperatively. Hysterectomy was performed in all 3 cases, total blood loss was 950–1450 ml in patients with the prenatally diagnosed invasive placentation. Iliac artery ligation was performed to the third patient, due to excessive bleeding and development of coagulopathy, 1200 ml of fresh frozen plasma has been transfused for correction of coagulopathy, as well as transfusion of donor erythrocyte mass.
Conclusion. Probably the development of placental invasion abnormalities along with other factors is mostly affected by presence of placenta previa and cesarean section in the patient’s past history. Prenatal assessment of presence and degree of the abnormal placental invasion is important factor for planning of delivery: gestational age, method and the hospital level.

BOOK REVIEW 

395-399 120
Abstract

Currently, a number of court hearings regarding potential crimes in delivering health-care services have been exponentially increased. Some of them receive publicity and launch public debates, but many more of those stay beyond the information field. A number of medical doctors are targeted in the investigation as defendants and sentence to actual jail time. Numerous medical workers envisioning a threat to their professional carrier, and even freedom, may now avoid of risky manipulations and interventions, which may eventually negatively affect patient’s prognosis. In such situation, increasing awareness about rights of medical workers acquires special relevance. In the mean time, professional publications dedicated to this topic are sharply demanded that might be useful and written in plain Russian. Among them, it may be highlighted a book “Medical Doctor’s Rights”, by A.A. Ponkina and I.V. Ponkin thoroughly elucidating professional rights and providing tools necessary for their defense. Although we believe that it’s scarcely describes causes, real-life cases it is excusable for this otherwise brilliant book. We recommend it for careful examination both for law enforcement officers involved in such lawsuits and a wide audience of healthcare workers as well as medical students.

HISTORIC CASES 

400-410 128
Abstract

The article highlights aspects of the topic a mother and a child in fine arts of the Renaissance. Paintings by Dutch artists Robert Campen and Jan Van Eyck, Italian paintings by Leonardo da Vinci, Michelangelo, Sandro Botticelli, Raphael, as well as paintings by Diego de Silva y Velazquez, Peter Paul Rubens and Rembrandt are presented.



ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)