Pathomorphological Study Research Articles

The role of stapedoplasty in the treatment of hearing impairment in the patients presenting with tympanosclerosis

The present study included the examination and surgical treatment of 50 adult patients presenting with tympanosclerotic fixation of the stirrup. The patients comprising the first subgroup (n=25) underwent the two-stage treatment during the period from 1990 to 2009. The final phase of the treatment consisted of the implantation of different kinds of stirrup prostheses placed on the venous autograft that closed the oval window of the vestibule following partial or total instrumental stapedectomy. The second subgruop was composed of the patients (n=25) who were given the two- or three-stage surgical treatment during the period from 2009 till 2014 the final phase of which was performed following the same procedures as in the first subgroup but with the use of the surgical CO2-laser instead of the conventional instrumental methods. The pathomorphological studies carried out at different stages of the surgical treatment have demonstrated the necessity of isolation of the vestibular fluid for the purpose of implantation of the stirrup prostheses with a view to preventing cochlear complications. The results of the present study give evidence of the efficiency of stapedoplasty with the application of the autocartilaginous prostheses of the stirrup implanted on the venous autografts to close the oval window of the vestibule with the reduction of the bone-air interval down to less than 20 dB. The performance of this procedure with the use of the instrumental technique produced a favourable outcome of the treatment in 71.4% of the patients presenting with tympanosclerosis. The use of the laser-assisted approach further increased the efficiency of the treatment up to 76%. Moreover, the latter method allows to avoid the reaction of the inner ear to the surgical intervention during the early postoperative period and results in the faster averaged reduction of the bone-air interval in comparison with the patients treated with the application of the instrumental technique.

Cognitive impairments and microvascular endothelial dysfunction in unilateral occlusion of the carotid artery

The study was aimed at determining cognitive impairments, vascular endothelial dysfunction and morphofunctional alterations of neurons in brain structures (neocortex and hippocampus) in unilateral occlusion of the common carotid artery in albino rats. The experiments were carried out on Wistar albino rats. The animals were divided into two groups: group 1 - the control group composed of sham-operated rats and group 2 - the study group consisting of rats with cerebral ischaemia. The model of cerebral ischaemia was reproduced by occlusion of the left common carotid artery. Cognitive functions in rats were assessed by means of the object recognition test and conditioned passive avoidance response (CPAR). The degree of vascular endothelial dysfunction was evaluated by the number of circulating endotheliocytes and concentration of end products of nitric oxide - nitrites in blood plasma. Pathomorphological studies of the brain and morphometric analysis of the number of damaged neurons after ischaemic exposure were carried out by means of light microscopy. It was determined that unilateral occlusion of the common carotid artery in rats resulted in memory impairment revealed by the object recognition test and CPAR (p≤0.05). Cerebral ischaemia induced an elevated level of circulating endotheliocytes and a decrease in end products of nitric oxide - nitrates as compared with the controls (p≤0.05). Morphological study demonstrated signs of vasoconstrictive reactions, microvascular endothelial oedema, as well as an increase in the proportion of damaged neurons localized in the fronto-bregmatic region of the cortex of the cerebral hemispheres and hippocampus on the ipsilateral side (p≤0.05). Unilateral occlusion of the common carotid artery in albino rats resulted in cognitive impairments, damage of neurons in the most vulnerable areas of the cortex of the cerebral hemispheres and hippocampus predominantly on the ipsilateral side. Cognitive impairments and ischaemic lesions of the brain structures are induced by endothelial dysfunction, enhanced desquamation of endotheliocytes and prevalence of vasoconstrictive reactions resulting from decreased production of the major vasorelaxing factor - nitric oxide.

ИНСТРУМЕНТАЛЬНЫЕ И МОРФОЛОГИЧЕСКИЕ КРИТЕРИИ ДИАГНОСТИКИ ОПОЯСЫВАЮЩЕГО ГЕРПЕСА

Objective: To assess the instrumental and morphological diagnosis of herpes zoster (HZ). Methods: Instrumental and morphological diagnostics of HZ carried out in 40 patients. The spectra recorded on a standard two-beam IR spectrometer in the frequency range 4000-400 cm-1. Evaluate the results of pathomorphological studies, a computer-aided analysis system for microscopic images, consisting of a light-optical microscope used. Microscopic samples studied under the microscope Olympus CX21 at different magnifications with the Digital Microscope Camera MC-DO 48U (E). Results: Analysis of infrared spectra of blood plasma in HZ patients showed that when IR spectroscopic examination of blood of patients with different forms of HZ observed. A more significant shift of Vmax to the low-frequency region of the band 665 cm-1 observed a significant change in the IR absorption bands lying in the region frequencies of 1800-1200 cm-1, and very weak IR bands with Vmax 1450, 1300 and 1225 cm-1 completely smoothed out. Morphological examination of patients with different forms of HZ in the germ layer of the epidermis determines the phenomena of spongiosis and ballooning (vacuolar) dystrophy, caused by a sharp intracellular oedema and changes in the nuclei. Conclusion: The results of the research showed that both instrumental and morphological diagnostic methods for HZ are technically simple in execution, informative, economic and allow diagnosing all clinical forms of dermatosis in a short time. Keywords: Herpes zoster, instrumental and morphological diagnostics, IR spectrometry.

Endometriosis of female reproductive organs. Pathomorphology, diagnosis, treatment and prevention

Inflammatory diseases, metrofibroma and endometriosis refer to gynecological diseases, most often causing female infertility. International statistics indicate that endometriosis affects from 5 to 50% of women and it ranks third among the most widespread gynecologic pathologies. Despite the centuries-old history of using diagnostic methods in medicine, it is one of the main unresolved problems of modern gynecology. It has been proven that endometriosis leads to a significant impairment of reproductive function, steady pain syndrome (71–87%) and infertility (21–47%). If over twenty years ago the above-mentioned disease was diagnosed at the age of about 40, then nowadays even a teenager may hear this diagnosis. The objective of this research is to analyze the basics of pathomorphology of genital endometriosis, as well as the principles of diagnosis, prevention and treatment that will help to combat the infertility. The analysis is based on the review of articles and research for 2010-2018, using the PubMed databases, eLIBRARY.RU, Web of Science. Endometriosis is a disease of the most active young women in the social life that may be of hereditary nature. When speaking about the mechanisms of disease progression, there are about 10 theories of its origin, and at the present time none of them explain the diversity of forms and types of this pathology. A distinction is made between genital endometriosis, developing in the genital area, and extragenital endometriosis, developing outside of it. The latter is less common (occurs in 6–8. %) in comparison with genital endometriosis (92–94. %). Genital endometriosis is divided into internal and external, their mechanisms of occurrence are slightly different. But the benign nature of formation is common to both of them. Morphological confirmation of the diagnosis is an important task, as far as endometriosis does not refer either to tumour pathology, or to inflammation, or to pathological regeneration. Accordingly, the treatment will be of a specific nature. This pathology manifests itself in a specific triad of symptoms: dysmenorrhea, dyspareunia and dyschezia. The “golden” standard for the disease diagnosis is a direct visualization of endometrioid heterotopias in the course of laparoscopy and histological examination of biopsy materials of endometriosis. In case of disease detection, the main therapeutic goals are the removal of foci of heterotopias, pain relief and restoration of reproductive function. The main objectives of prevention are strengthening of the immune system, prevention of frequent operations and interventions in pelvic organs, the correct approach to the use of oral contraceptives and women's awareness of the necessity of regular visits to gynecologists. So, a comprehensive approach to the study of pathomorphology and diagnosis of endometriosis allows to determine the expansion degree of heterotopias and to prescribe the correct treatment that will further improve the mental and social life of women and help in restoring the reproductive function.

Informative value of various methods used to study fungi in paranasal sinuses` noninvasive mycosis

The increase in the number of patients with persistent viral infection, as well as the use of antibacterial drugs, caused the increase in the population of patients with a high risk of developing fungal diseases. In the content of paranasal sinuses, a more than half of the patients with chronic sinusitis showed fungi or fungal-microbial associations. Despite the fact that the epidemiological data in the publications of modern national and foreign researchers on fungal rhinosinusitis are rather discrepant, it is quite decisive that the prevalence of fungal sinusitis has a significant tendency to grow, especially in the last decade. The informativeness of the microscopic, microbiological, and pathomorphological studies of the surgical material with the aim of fungal balls detection. The results contents of paranasal sinuses in 148 patients who had undergone endonasal endoscopic surgical intervention. Computer tomography the maxillary sinus in 113 patients, in the sphenoidal sinus in 25 patients, in the ethmoidal sinus in 7 patients, and in the frontal sinus in 3 patients. With microscopy of native material and preparations stained with white flour white, the presence of fungi is revealed 114 and 136 patients (77 and 91,9%) correspondingly. When sowing the contents of the sinuses onto elective media its cultivation under two temperature conditions (28 and 37оС) revealed growth of filamentous fungi in 26 (17,6%) patients. Histopathological examination confirmed the clinical diagnosis of a fungal ball in 128 (86,5%) patients. The most informative method for detecting the fungal body is the microscopy of preparations stained with white flour white.

Morphological markers of basic pathogenic variants of ischemic strokes in cerebral atherosclerosis

Introduction. Pathomorphological studies allow verifying clinical data concerning diagnostic features and predictors of ischemic strokes. Small number and inconsistency of such works have determined the objective of this study: to refine morphological markers of basic pathogenic of ischemic strokes in cerebral atherosclerosis. Materials and methods. We conducted pathomorphological study of 114 cases of ischemic stroke, as well as histological, ultrastructural and immunohistochemical examinations of 20 carotid atherosclerotic plaques (ASB) removed in carotid endarterectomy. Results. In most cases, morphological markers of strokes in cerebral atherosclerosis were particular degrees of isolated (≥70%) or tandem (≥50%) atherostenosis, as well as one or more small or medium-size infarctions in the areas of adjacent blood supply or deep regions of the brain hemispheres, cerebellum and brainstem. In occlusive atherothrombosis and arterio-arterial embolism, 98% of strokes were characterized by the development of large or medium cortical-subcortical infarction in certain vascular regions, and the presence of atherothrombotic occlusion or complicated ASB in combination with distal embolic occlusion on the side of an ischemic lesion. High frequency of the occurrence of ASB with unstable structure complicated by thrombosis, and combination of every second major recent infarction caused by thrombosis with silent small organized ischemic foci in the same blood pool as a result of stenosis were established. Significant direct relationship was found between expression of von Willebrand factor and morphological signs of carotid atherosclerosis activity (p<0.017), whereas the degree of expression of other endothelial substances did not correlate with structural changes in ASB. Conclusions. We showed potentiality for differential diagnosis of various pathogenic variants of strokes associated with atherosclerotic narrowing and complicated pathology of cerebral arteries, as well as the role of silent infarctions, unstable ASB and von Willebrand endothelial factor as predictors of cerebral atherosclerosis complications.

ПАТОМОРФОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ В ТКАНЯХ ЗУБА КРЫСЫ КАК РЕЗУЛЬТАТ СТРЕССА ОРГАНИЗМА

В статье представлены данные патоморфологических исследований зубов крыс, подвергавшихся различным формам стресса, в результате которых произошли изменения в зубочелюстной системе, в частности в зубе и периодонте. Исследуя центральные резцы крыс, нами было установлено, что в пульпе внешне не измененных зубов наблюдалось пролиферативное воспаление с разрастанием волокнистой соединительной ткани, близкой к рубцовой, пролиферация фибробластов и одонтобластов. Изменения, происходящие в тканях зуба, в частности в пульпе, носят пролиферативно-дистрофический характер.

Structural-functional characteristics of thymus in piglets with signs of latent and subclinic PCV2-infection

Circovirus type II disease is an infectious disease with significant economic impacts on the pig industry, which has become global in the pig population (PCVD). The most common form of PCV2-infection has long been considered a PCV2-systemic disease, but recently latent and subclinical forms of PCV2-infection have become of particular importance. The main “target” for PCV-2 is the immune system, and the multiplication of PCV-2 in the cells of the immune system leads to their death and development of immunodeficiency state. The immune system, together with the nervous and endocrine systems, plays an important role in maintaining the body's homeostasis and ensures its adaptation to the effects of unfavorable environmental factors. The organs of the immune system of pigs include bone organs, thymus, spleen, lymph nodes, as well as diffuse and aggregated lymphatic formations of the walls of the digestive canal and respiratory tract. Thymus is the central organ of lymphocytopoiesis and imunopoiesis, in it occurs differentiation of all cellular forms of mature T-lymphocytes in the pre-T-lymphocyte stage, which migrate from the bone marrow to the bloodstream. The growth and development of the thymus, as well as the bone organs, is in direct interaction with the growth and development of the spleen, lymph nodes and is reflected in the structure of the interstitial connective tissue and lymphoid parenchyma, and the question of the structural and functional characteristics of the thymus piglets with signs of latent and subclinical PCV-2 infection in accessible the scientific literature is not sufficiently elucidated and requires a detailed study. Purpose: determination of the structural and functional characteristics of the thymus of piglets with signs of latent and subclinical PCV-2-infection. The work was carried out in pig farms of Ukraine, with intensive technology of pig rearing, at the department of normal and pathological anatomy of agricultural animals and the Scientific and Research Center for Biosafety and Environmental Control of the Agroindustrial Complex Resources of Dnipro State Agrarian and Economic University. To determine the structural and functional characteristics of the thymus of piglets at different forms of the of PCV-2-infection, monitoring studies of blood sera were carried out by quantitative PCR-analysis. A total of 275 samples of blood serum from piglets of 5–16 weeks of age were investigated. For pathomorphological studies with the method of acute bleeding, animals with signs of latent PCV2-infection (in 1 cm3 of blood serum of 103–104 copies of the genome of PCV-2 equivalents) were slaughtered and animals with signs of subclinical PCV2 infection (in 1 cm3 of blood serum 105–106 copies of the gene equivalents of PCV-2) 6 heads. By anatomical preparation, the thymus was removed, fixed in a 10% solution of neutral formalin, poured into paraffin, sections were stained with hematoxylin and eosin and azur II eosin according to generally accepted techniques. In the paraffin sections, the presence of PCV-2 antigen (immunohistochemical staining) was also determined. In the lymphoid parenchyma of the thymus, the percentage ratio between individual cells (large, medium, small lymphocytes, plasmocytes and reticular cells), macrophages and other cells was determined. Cell counting of parenchyma was performed on dasgs stained with azur II eosin at an increase of 10 x 100 under the immersion for every 100 cells on ten preparations in 20 fields of vision for each individual group of animals. Based on the data obtained, the average percent content of each cell type was determined. The author, on the basis of pathohistological and immunohistochemical studies, determined the structural and functional characteristics of the thymus of piglets with signs of latent and subclinical PCV2-infection. It has been established that in piglets with signs of subclinical and latent PCV2-infection, pathogistological changes of the thymus do not differ significantly from the corresponding thymus parameters of clinically healthy animals free from PCV-2. At the same time, there is a tendency to decrease the number of lymphoid cells, mainly immunoblasts and lymphocytes, and, accordingly, the area of the particle cortex, which is more pronounced in thymus of pigs with signs of subclinical PCV2-infection.

COMPLIANCE OF ANTHRAX RECOMBINANT VACCINE PROTOTYPE WITH THE REQUIREMENTS TO IMMUNE-BIOLOGICAL PREPARATIONS

Current areal of anthrax among live stock and wild animals covers almost all the continents. The cause of human infection is conventionally considered to be the contact with diseased animals in the process of carrying for an animal, forced slaughter or further trimming of carcasses, as well as contact with infected raw materials of animal origin. Licensed vaccines has made an invaluable contribution to the improvement of epidemiological situation on anthrax, however, development of the vaccines complying with current scientific progress remains relevant. We have constructed a vaccine prototype containing recombinant protective antigen and S-layer EA1 protein and added state-of-the-art CpG 2006 adjuvant to the formulation. We have demonstrated the advantage of the lyophilized form of the preparation. Objective — obtainment of anthrax vaccine prototype in lyophilized state and assessment of the prototype compliance with the requirements to vaccine preparations. Materials and methods. Isolation of rPA and EA1 protein was carried out using producer-strain B. anthracis 55ΔTПА-1Spo– on an integrated end-to-end manufacturing line, including concentration, diafiltration and two-phase chromatography. CpG 2006 adjuvant was synthesized according to known sequences. Components were mixed and lyophilized in sublimation unit. Combination of 1% sucrose and 3% glycine was used as cryoprotector. Effectiveness and safety of the preparation were evaluated on the model of BALB/c mice and guinea pigs applying immunological, morphometric, and histological assays. Antibody titers in sera of immunized animals were evaluated using standard ELISA procedures. Protective properties were investigated through LD50 values for the test-strain used on immunized and control animals and immunity index. Results. We have performed complex investigation of the anthrax vaccine prototype, containing B. anthracis 55ΔTПА-1Spo– proteins as main and supplementary antigens, as well as CpG 2006 adjuvant, stabilizers and preservative agent. The prototype meets the requirements to immunobiological medicinal drugs by all physical-chemical properties. Our preparation does not have a toxic effect on the organism of laboratory animals in case of subcutaneous and intraperitoneal administration of single human dose. Pathomorphological study of guinea pigs’ organs immunized with double dose of the vaccine prototype has not revealed any evidence of damaging effect on the cells and tissues of macroorganism. The prototype protects BALB/c mice from the infection with B. anthracis 71/12 test-strain.

Pathomorphology of hydrocephalus associated with anomalies of development of the cerebral aqueduct

Aim. The aim of the study was to reveal structural peculiarities of the ventricular germinal zone and of the neocortex in newborns of 22-40 weeks gestation with congenital hydrocephalus associated with anomalies in development of the cerebral aqueduct.&#x0D; Materials and Methods. The main group was the brain of newborns aged 22-40 weeks of gestation with hydrocephalus, formed with the underlying developmental anomalies of the cerebral aqueduct (n=10); comparison group (n=30) was the brain of newborns without visible pathology of the CNS with the width of the lumen of lateral ventricles not exceeding 0.5 cm. A complex pathomorphological study of the ventricular germinal zone and the neocortex in the projection of field No. 6 (cortical representation of the motor analyzer) was carried out.&#x0D; Results. Hydrocephalus associated with anomalies of development of the cerebral aqueduct is characterized by disorders in formation of sulci and gyri (micropolygyria, asymmetry and breakage of the gyrification sequence), by absence of signs of remodeling of the ventricular germinal zone and by retardation of differentiation of III-VI cytoarchitectonic layers of the neocortex, with the underlying increased expression of S-100 glial protein in glioblasts of white matter, decreased expression of vimentin in vessels of periventricular region, negative expression of metalloproteinases-9 in glioblasts, of reelin in Cajal-Retzius neurons, of desmin in periventricular vessels.&#x0D; Conclusion. Structural peculiarities of the ventricular germinal zone and the neocortex in newborns of 22-40 weeks of gestation with hydrocephalus, associated with anomalies in development of the cerebral aqueduct, should be considered as morphological diagnostic criteria for differentiation of the given pathology with internal hydrocephalus of a different etiology.

Pathomorphology of hydrocephalus associated with anomalies of development of the cerebral aqueduct

Aim. The aim of the study was to reveal structural peculiarities of the ventricular germinal zone and of the neocortex in newborns of 22-40 weeks gestation with congenital hydrocephalus associated with anomalies in development of the cerebral aqueduct.&#x0D; Materials and Methods. The main group was the brain of newborns aged 22-40 weeks of gestation with hydrocephalus, formed with the underlying developmental anomalies of the cerebral aqueduct (n=10); comparison group (n=30) was the brain of newborns without visible pathology of the CNS with the width of the lumen of lateral ventricles not exceeding 0.5 cm. A complex pathomorphological study of the ventricular germinal zone and the neocortex in the projection of field No. 6 (cortical representation of the motor analyzer) was carried out.&#x0D; Results. Hydrocephalus associated with anomalies of development of the cerebral aqueduct is characterized by disorders in formation of sulci and gyri (micropolygyria, asymmetry and breakage of the gyrification sequence), by absence of signs of remodeling of the ventricular germinal zone and by retardation of differentiation of III-VI cytoarchitectonic layers of the neocortex, with the underlying increased expression of S-100 glial protein in glioblasts of white matter, decreased expression of vimentin in vessels of periventricular region, negative expression of metalloproteinases-9 in glioblasts, of reelin in Cajal-Retzius neurons, of desmin in periventricular vessels.&#x0D; Conclusion. Structural peculiarities of the ventricular germinal zone and the neocortex in newborns of 22-40 weeks of gestation with hydrocephalus, associated with anomalies in development of the cerebral aqueduct, should be considered as morphological diagnostic criteria for differentiation of the given pathology with internal hydrocephalus of a different etiology.

Гіперпластичні процеси ендометрія у жінок із безплідністю: зіставлення результатів ультрасонографічних та патоморфологічних досліджень ендометрія

The objective: to find out the level of verification of endometrial hyperplastic processes (GPE) in women with uterine infertility based on the comparison of ultrasound and pathomorphological studies. Materials and methods. 64 patients of reproductive age was performed ultrasonographic study and diagnostic endometrial biopsy. Results. Three groups of GPE have been identified: polyps – 33 cases, hyperplasia –15, combination of glandular hyperplasia with endometrial polyp – 16. The endometrial polyps included: glandular – seven cases, glandular-fibrous with an advantage of the glandular component – 13, and glandular-fibrous with the advantage of the stromal component – 13. The accuracy of the verification of glandular polyps was 82%. Glandular-fibrotic polyps with an advantage of the glandular component were diagnosed in 82%. Glandular-fibrous endometrial polyps with the advantage of the stromal component were the most difficult for ultrasonic verification. The accuracy of their diagnosis was 50%. Such characteristics as nodular form, intramural position, increased echogenicity and absence of inclusions were the basis for erroneous diagnosis of uterine fibromyomas. Endometrial hyperplasia was verified at 97%. The remaining 3% were histologically diagnosed with endometrial polyposis, which were not established by ultrasound, and were considered as hyperplasia of the endometrium. Ultrasound diagnosis of the combination of endometrial hyperplasia and polyps reached 77%. The polyps on the background of endometrial hyperplasia appeared as fibromyomatous nodes. The determining role in correct diagnosis was played by hysteroscopy. Conclusion. The comparison of ultrasound data and morphological evidence suggests high accuracy of GPE detection and morphological verification. However, in some cases GPE ultrasound does not precisely determine the nature of pathological changes. Therefore, the study of the pathomorphological features of remodeling of the endometrium in the GPE remains open and requires new promising approaches. One of them, based on certain pathomorphological changes in GPE, is the use of blood flow research, in particular transvaginal color doppler, which may allow to improve the accuracy of the diagnosis of GPE. Key words: endometrial hyperplasia, endometrial polyp, endometrial hyperplasia, ultrasound diagnosis, pathomorphology, reproductive age.

Chronic aortiс dissection: pathomorphological characteristics.

Background. Chronic aortic dissection (CAD) is a poorly understood vascular pathology. Etiology, pathogenesis, pathomorphological and clinical changes are not fully elucidated. The presence of open questions in their morphogenesis and pathomorphological picture creates difficulties in clinical diagnosis and gives rise to discussions in the choice of treatment. Objective – determinate pathomorphological changes of CAD. Methods. The analysis of 31 cases of surgical material for patients undergoing surgery on CAD was conducted. Among the operatives men dominated – 22 (70.9%), women were nine (29.1%). The age of patients ranged from 47 to 59 years. Aortic preparations were painted hematoxylin-eosin, resorcinol-fuchin for Chart, picrofuscin for Weigert, trichrome Mason. Results. The cavity of the dissection looked like a two-channel, located on the verge of adventitia and mediums, filled with blood convections, with the spread of hemorrhagic infiltration to periadventicial fatty tissue. The new pseudo-channel in one third of cases contained blood convection and fresh thrombi, and the old one was completely covered with endothelium with neointimal formation. In the media were detected massive elastolysis with contours of hyperchromic elastic fibers with signs of hyperlastosis, multiple thin layers of connective tissue fibers located between randomly scattered smooth muscle cells and collagen fibers, deeper definitions of massive enlargement of connective tissue. Conclusions. In the pathomorphological study of CAD, connective tissue remodeling of the aorta in the form of randomly located immature mesenchymal cells in combination with muscular and connective tissue transformation was revealed. The processes of vascular remodeling can provide the relative clinical stability of HRAA.

CLINICO-MORPHOLOGICAL FEATURES OF RE-CESAREAN SECTION

A high number of repeat cesarean sections increases a risk of excessive bleeding, uterine atony, hysterectomy.The aim of study was to evaluate the efficacy of medical and technical methods (argon plasma coagulation, tranexamic acid, carbetocin) to prevent complications following repeat cesarean section and to improve the myometrial wound healing, to establish morphological features of uterine scar tissue in case of using argon plasma coagulation of myometrium in the area of the suture during the previous operation.Materials and methods Prospective cohort study of 87 patients who had undergone repeat cesarean section. I group included 42 women who had repeat cesarean section using argon plasma coagulation. Ten minutes before the operation, 1,0 g of tranexamic acid was injected intravenously. 100 mcg carbetocin was administered intravenously after cutting the umbilical cord. ІІ group comprised 45 women who had traditional cesarean section using Stark’s technique and Joel-Cohen incision. Pathomorphological study of scarred lower uterine segment myometrium was performed. Immunohistochemical staining against CD3, CD34, CD68, vimentin, α-SMA was performed.Results are presented as Mean±SD.Results. Total operative time was significantly shorter in the І group (37,7±2,4 minutes) compared to ІІ (47,4±1,6 minutes) (р&lt;0,05). Volume of blood loss in the І group was 476,7±37,4 ml, and in the ІІ — 549,7±35,7 ml (p&lt;0.05). Patients of the І group needed analgesic for 18-24 hours, the ІІ group — 36-72 hours after operation. The width of the uterine cavity in group І was 9,7±0,39 mm, in group ІІ — 14,8±0,52 mm (р&lt;0,05). One patient of group І and 9 patients of group ІІ had signs of uterine subinvolution. Length of hospital stay after surgery in group I was 4,7±0,12 days, in ІІ — 6,8±0,24 days. The ultrasound thickness of myometrium in group I and group II is an average of 8,72±0,54 mm and 6,75±0,69 mm, respectively. Pathomorphological data of scarred lower uterine segment myometrium showed that in group I regenerative processes have more favorable course, a tendency to restore the structure of myometrium, while in group II there were processes of disturbed regeneration with the replacement of smooth muscle tissue varying maturity of connective tissue, moderate inflammatory process.Conclusion. So, the use of tranexamic acid, carbetocin and argon plasma coagulation is effective in reducing perioperative blood loss, total operative time, dosage of uterotonic and analgesic medications and postoperative hospital stay in patients giving birth by repeat cesarean section. According to the pathomorphological study, argon plasma coagulation of myometrium in the area of suture increases the value of the reparative processes and promotes the formation of a morphologically complete scar, with the predominance of smooth muscle cells over connective tissue.

CLINICAL AND MORPHOLOGICAL PRECONDITIONS AND PREVENTION OF COMPLICATIONS IN PLACENTA PRAEVIA

Bleeding is one of the most frequent and terrible complications of pregnancy, childbirth and the postpartum period. One of the main causes of bleeding in the obstetrician remains placenta previa.The aim of the study was to evaluate the effectiveness of the prevention of recurrent bleeding, placental dysfunction, and perinatal complications in pregnant women with placenta prevalence according to the standard method and methodology proposed by us.Materials and methods - 127 pregnant women were involved in the study. And the group (main) - 77 pregnant women who received the therapy according to our proposed method, namely: magnesium lactate dihydrate (470 mg) and pyridoxine hydrochloride (5 mg) with 2 tablets of 3 times in day, micronized progesterone sublingual form 50 mg twice daily for up to 34 weeks. pregnancy, followed by a gradual decrease in the dose and withdrawal of the drug, hemostatic therapy with drugs of tranexamic acid at a dosage of 10 mg / kg of body weight; the introduction of a modern vasoconstrictor - terlipressin 0.2 mg, dissolved in 10.0 ml. physiological solution in the umbilical cord vein intraoperatively, after fetal withdraw- al; All pregnant women of both groups performed prophylaxis of FDS with betamethasone (12 mg / intramuscularly, ) in the period of pregnancy 26-34 weeks. The second group (control) - 50 pregnant women who received treatment according to the standard method of management, consisting of an early and complex treatment aimed at stopping the bleeding, normalizing hemodynamics and preventing the respiratory distress of the fetus. In parallel, a comprehensive pathomorphological study of the material of the litter was conducted.The results of the study and their discussion - the frequency of recurrent episodes of the threat of premature birth in the I group - 24 cases - respectively 31.16 per 100 patients. In the II group, 31 cases were registered - 56.3 per 100 patients, respectively. Reducing the number of recurring episodes of the threat of preterm birth is due to the ability of progesterone to eliminate the contraction of the smooth muscle of the uterus. Relapse of prenatal bleeding in group I was 25 cases (32.47%), in the second group -36 cases (60.0%), (p <0.05), which in turn was due to the ability of micronized progesterone to aggregate effects on the platelets. Fetal distress during pregnancy was reported in 9 patients in group I and in 13 pregnant women in group ІІ, at (p <0.05). Thus, the expression of progesterone receptors in nuclei of cells of different localization in the study group is significantly higher (confidence level is 95%, p ≤0.05) in the prevalence of the reaction, rather than in the control group. When quantitatively estimating the prevalence of estrogen receptors in the nucleus of the basal plate of the decidual membrane of the control group and the study group, it was found that in the study group, the number of cells is half that (28.1 ± 0.56 cells in the field of view) than in the control group (56, 4 ± 1.12 cells in the field of view).Conclusions: the use of micronized progesterone, magnesium preparations with B vitamins and a combination of hemostatic drugs, tranexamic acid and terlipressin, compared with standard pregnancy administration with placenta prevalence, significantly reduces the number of relapses in prenatal bleeding and hypoxic lesions of the fetus, prolongs pregnancy until the fetal viability of the fetus, reduces the percentage of morbidity among women and newborns.

Morphological characteristics of organs of the immune system of rats for determining the toxicity of the preparation “Bioton”

In the article presents the results of the pathomorphological study on the toxicity of the new veterinary preparation immunomodulatory “Bioton”, to solution for per oral application that contains complex biologically active foods of metabolism of mushrooms-entophytes (Cylindrocarpon Magnusianum), medical plants abstracted from a root. The study of subacute toxicity of the preparation “Bioton” was carried out on male rats, with a body weight of 170–180 g, formed in two groups of 30 rats in each: I group (control) – received water; The second group was given an oral preparation “Bioton” at a rate of 170 mg/kg of body weight of the rat. Animals were kept under the conditions of vivarium SSRCIVMPFD of veterinary preparations and food supplements, with constant temperature of premises and humidity. The feeding provided a standard diet with constant access to water. The experimental studies carried out have found that intrauterine injection of “Bioton” drugs in a dose of 170 mg/kg of body weight for 30 days caused stimulation of immune protection factors, which was shown by a significant increase in the content of T- and B-lymphocytes and NK-cells, did not cause macro- and microscopic changes in the internal organs, and an increase in the coefficients of the mass of the thymus, spleen and testicles indicated the functional activity of organs with a high proliferative capacity of the parenchymal elements. Then, as the application for 60 days, caused negative changes in the morphological and immunological parameters of the blood, namely reduction of the number of red blood cells, hemoglobin content and growth of leukocytes due to the increase of neutrophil granulocytes, against the background of reduction of T- and B-lymphocytes, NK-cells compared to the control groups and development of pathological processes in the internal organs of rats. Histologically, the presence of the occidental involution of thymus and the cellular devastation of parenchyma of peripheral organs of the immune system of rats receiving the Bioton preparation for 60 days were confirmed. In further work an analysis of the biochemical parameters of blood of rats obtained for the study of toxicity of the drug “Bioton” will be conducted.

Association of teratoma of vulva with anorectal anomaly: prenatal diagnosis

The article presents a case of prenatal diagnosis of a vulvar teratoma in a fetus in gestation period of 33 weeks. After birth, also detected atresia of the rectum and anus. In the neonatal period, the girl successfully underwent surgery to remove the tumor-like formation of the vulva and recto-vaginal plasty. The tumor in the pathomorphological study was identified as a mature teratoma. At the age of 2,5 years the child develops according to age standards.

The role of complement system and other inflammatory factors in the development of age-related macular degeneration

The article is a review of literature on the role of complement system and inflammatory factors in the development of age-related macular degeneration. The review uses materials of domestic and foreign researchers. The clinical characteristics of age-related macular degeneration are presented, the role of genetic factors, complement factors, biomarkers of inflammation and alternative pathway of complement activation in the pathogenesis and risk of age-related macular degeneration is determined. Age-related macular degeneration is a chronic progressive multifactorial disease that affects macular area of the retina and is the main cause of loss of central vision in patients of older age group. The most important genetic factors are chromosome 1 (1q32) including complement factor H and complement factor H related genes and chromosome 10 (10q31). Variants associated with a moderate effect on developmental risk were identified in C3, complement factor I and complement factor B genes. In the pathogenesis of age-related macular degeneration, the key role is played by the damaged regulation of the alternative complement pathway. Single nucleotide polymorphisms in complement genes that affect the risk of development of age-related macular degeneration are predominantly involved in the alternative pathway of activation of the complement system. In pathomorphological studies, the initial localization of the pathological process of this pathology was established to be a complex of retinal pigment epithelium, Bruch’s membrane, and choriocapillaries followed by loss of photoreceptor function. The review of studies of systemic inflammatory biomarkers, cytokines, vascular endothelial growth factors in peripheral blood, blood serum, aqueous humour at various stages and forms of age-related macular degeneration is presented.

Clinico-morphological features of the postoperative period and healing process of the uterine scar tissue after re-cesarean section

A high number of repeat cesarean sections increases a risk of excessive bleeding, uterine atony, hysterectomy. The aim of study was to evaluate the efficacy of medical and technical methods (argon plasma coagulation, tranexamic acid, carbetocin) to prevent complications following repeat cesarean section and to improve the myometrial wound healing, to establish morphological features of uterine scar tissue in case of using argon plasma coagulation of myometrium in the area of the suture during the previous operation. Prospective cohort study of 77 patients who had undergone repeat cesarean section. I group included 37 women who had repeat cesarean section using argon plasma coagulation. Ten minutes before the operation, 15 mg/kg of tranexamic acid was injected intravenously. 100 mcg carbetocin was administered intravenously after cutting the umbilical cord. ІІ group comprised 40 women who had traditional cesarean section using Stark's technique and Joel-Cohen incision. Pathomorphological study of scarred lower uterine segment myometrium was performed. Immunohistochemical staining against CD3, CD34, CD68, vimentin, α-SMA was performed. Results are presented as Mean±SD. Total operative time was significantly shorter in the І group (37,0±2,1 minutes) compared to ІІ (46,1±1,8 minutes) (р&lt;0,05). Volume of blood loss in the І group was 465,7±37,5 ml, and in the ІІ — 547, 7±34,6 ml (p&lt;0.05). Patients of the І group needed analgesic for 18-24 hours, the ІІ group — 36-48 hours after operation. The width of the uterine cavity in group І was 9,8±0,37 mm, in group ІІ — 14,6±0,54 mm (р&lt;0,05). One patient of group І and 9 patients of group ІІ had signs of uterine subinvolution. Length of hospital stay after surgery in group I was 4,7±0,12 days, in ІІ — 6,6±0,28 days. The ultrasound thickness of myometrium in group I and group II is an average of 9,32±0,64 mm and 6,24±0,59 mm, respectively. Pathomorphological data of scarred lower uterine segment myometrium showed that in group I regenerative processes have more favorable course, a tendency to restore the structure of myometrium, while in group II there were processes of disturbed regeneration with the replacement of smooth muscle tissue varying maturity of connective tissue, moderate inflammatory process. So, the use of tranexamic acid, carbetocin and argon plasma coagulation is effective in reducing perioperative blood loss, total operative time, dosage of uterotonic and analgesic medications and postoperative hospital stay in patients giving birth by repeat cesarean section. According to the pathomorphological study, argon plasma coagulation of myometrium in the area of suture increases the value of the reparative processes and promotes the formation of a morphologically complete scar, with the predominance of smooth muscle cells over connective tissue.

Haemochromatosis and Arthropathies

Arthropathy is the most common and often the earliest clinical manifestation of hereditary hemochromatosis (HH). It is difficult to treat and there is a high risk for early endoprosthetic joint replacement. Research done during the last decade shows that it is a joint disease in its own right. Clinically, there are degenerative articular changes with an atypical pattern of distribution, a crystal arthropathy (CPPD) with congenital joint swelling and synovitis like in RA. The X-ray image shows typical but not exclusive findings. In MRI, groundbreaking subchondral findings are found, especially in the large joints, and ultrasound shows inflammatory lesions in non-arthropathy patients as well. In animal experiments and pathomorphological studies of the synovial membrane, the arthropathy can be differentiated from osteoarthrits and RA. The pathophysiological significance of iron overload can be distinguished from immunohistochemical and cytogenetic investigations in chronic degenerative HH arthropathy and inflammatory-destructive arthropathy in hemophilia. By elucidating the pathophysiology, new therapeutic approaches can be formulated. In addition to colchicine, the IL-1 receptor antagonist anakinra is available for activation of the NLRP3 inflammasome by CPPD crystals and subsequent induction of IL-1β overproduction. Other manifestations include symptomatic pain therapy and intensive physiotherapy and occupational therapy. To promote further research into hemochromatosis arthropathy, the Hemochromatosis Arthropathy Research Initiative (HARI) was established in 2016.