Structure Of Gynecological Pathology Research Articles

ASSESSMENT OF THE MICROBIOTA STATE OF THE REPRODUCTIVE TRACT IN PATIENTS WITH HYPERPLASTIC PROCESSES OF THE ENDOMETRIUM

Hyperplastic processes of the endometrium, in the structure of gynecological pathology, occupy from 15.0% to 50.0% in women of reproductive age, disrupting the reproductive function, manifested by infertility, miscarriage, long, irregular, painful menstruation, high frequency of chronic adnexitis (73.9 %), uterine leiomyomas (45.8%), genital endometriosis (17.7%), cervical erosion (26.0-34%). The development of the disease is associated both with inadequate treatment of the acute altering process and with the primary chronicity of inflammation with a violation of local mechanisms of anti-infective protection. We cannot ignore the important role of inflammatory diseases of the pelvic organs, which causes the increase in the fate of chronic endometritis to 70.0%, and the chronicity of the process, inadequate therapeutic options and resistance to medical measures cause a change in women's field, which, undoubtedly affects the implantation processes.
 The question of the role of an infectious factor in endometrial hyperplasia remains incompletely elucidated and understudied, which preserves the expediency of detailing the pathogenetic mechanisms of endometrial hyperplastic processes.
 The aim of the study: to evaluate the microbiocenosis of the vaginal mucosa in patients with hyperplastic processes of endometrium.
 Materials and methods. A comprehensive clinical and laboratory examination of 80 patients of reproductive age with endometrial hyperplastic processes was performed: 40 patients with endometrial hyperplasia without atypia (group 1), 40 patients with endometrial polyps (group 2). The control group consisted of 30 healthy women without gynecological pathology.
 All patients underwent diagnostic and therapeutic hysteroscopy followed by morphological and immunohistochemical examination. Bacterioscopic and investigation of biomaterial of the reproductive tract was carried out using the "Femoflor" test system in real time. The TORСH-group pathogens were verified by the DNA-PCR method.
 Research results. A significant proportion of menstrual cycle disorders (AUB - 55.0 %, algodismenorrhea - 41.3 %), generative function (infertility - 36.9 %, spontaneous abortions - 18.8 %, missed abortion- 8.8%) and also transferred inflammatory processes of the genitals (dysbiosis, PID, exo-endocervicitis - 75.0%).
 Based on the results of DNA-PCR data evaluation, the following were found: Chlamydia trachomatis — in 24 (30.0%) cases, Mycoplasma genitalium — in 21 (26.3%), Ureaplasma urealyticum — in 17 (21.3%), Candida albicans — in 18 (22.5%), in 37 (46.3%) cases – genital herpes (HSV) types 1 and 2, cytomegalovirus (CMV) and human papillomavirus type 16.18 (HPV) in 23 (28.8%) ), as well as viral (32.5%) and viral-bacterial associations (51.3%). According to the results of the evaluation of the microbiocenosis of the vagina in the examined women with impaired reproductive function against the background of endometrial hyperplasia and endometrial polyps, pronounced dysbiosis prevailed (47.5% and 62.5%, respectively).
 Conclusions. The obtained results confirm the scientific position regarding the important role of an infectious factor in the development of hyperplastic processes of endometrium, and the normalization of the microbiocenosis of the genital tract contributes to the effectiveness of treatment and the prevention of possible relapses.

Key Aspects Of The Development Of The Menstrual And Ovarian Cycle In Adolescent Girls

To determine the causative factors that are etiological factors in the development of menstrual-ovarian cycle disorders in the structure of gynecological pathology among adolescent girls in the Bukhara region and develop recommendations for the early prevention of reproductive dysfunctions. Violation of the harmony of development, lagging pace and timing of the development of secondary sexual characteristics, later than the “menarche” to a certain extent determines the low level of their reproductive health, which dictates the need for a thorough integrated approach and timely correction of premorbid conditions in adolescence. However, already today, starting from adolescence, we can use the possibilities of preventing the above pathologies to really provide, on a population scale, individualized preconception training for each girl and girl, aimed at strengthening the reproductive potential of the country.

Gynecological morbidity in girls and adolescent girls in a large industrial city

The results of randomized complex clinical andlaboratory examination of 1540 girls and juveniles are drawn, which characterize the rate and the structure of gynecological pathology under conditions of an industrial city. Gynecological morbidity proved to be closely associated with the state of somatic health in girls. Disorders of menstrualfunction occupy the most important place in the structure of gynecological pathology, dysfunctional uterine bleedings prevailing over other kinds of pathology. Anonymous questionnaire of 1700juveniles revealed some peculiarities of their reproductive and contraceptive behavior. The age of the beginning of sexual life at the average comes up to 14,6 0,5 years in the city of Ufa (an average age over Russia 16,1 years), the rate of juveniles who use adequate contraceptives being very low (9,5%). The article gives light to the problems of elaborating the system of organizational and medico-prophy lactic measures for girls and juveniles with gynecological pathology andputtingthem into practice.

The state of hormonal balance in puberty girls with menstrual function disorders on the background of obesity

Menstrual disorders in puberty girls against the background of hormonal imbalance occupy a significant place in the structure of gynecological pathology since in the future, they can lead to stable and irreversible changes in the formation of the reproductive system.The purpose of the work - to study the state of hormonal balance in puberty girls against the background of obesity.Material and methods. 79 adolescent girls with impaired menstrual function on the background of obesity were examined and treated. All subjects were also given a comprehensive examination to determine the level of hormones in the blood serum.Results. It was found that obese adolescent girls have a clear difference in the severity of hyperandrogenic disorders of carbohydrate metabolism and insulin resistance.Conclusion. A clear relationship between the formation of menstrual function and the state of gonadotropic function of the pituitary gland is established. Changes in the hormonal profile of puberty girls were found against the background of obesity, namely hyperleptinemia and leptin resistance, which were corrected by non-drug and drug therapy.

Conservative-surgical treatment of the external-internal endometriosis

Endometriosis as a gynecological disease is becoming a problem of the century, occupying the third place in the structure of gynecological pathology after inflammatory diseases and uterine fibroids. Insufficient effectiveness of treatment, disability and neurotization of women suffering from genital endometriosis, infertility as an important family and state problem. - a short list of troubles. caused by this disease.

Clinical characteristics of women with recurrent pregnancy loss and chronic endometritis

Annotation. The purpose of the work is to analyze the gynecological, somatic, reproductive history, as well as to determine the risk factors and etiopathogenetic factors of miscarriage on the background of endometritis. We examined 98 women of childbearing age who applied to the Innomed Clinic in Vinnytsia during 2019–2020. Patients were divided into two groups: the main group – 68 women (the average age was 27.25±0.29) with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women (the average age was 26.74±0.18) without previous pregnancy loss. Statistical processing, as well as analysis of the obtained data was performed using the program “Microsoft Excel” using the methods of mathematical statistics. Statistical evaluation was performed using the Student’s test. The obtained results were considered reliable at a reliability factor p <0.05 (95% significance level). Distribution of patients of the main group by number of reproductive losses was as follows: twice – 45 women, three times – 15 women, 4 and more – 8 women. Structural distribution of pregnancy losses in women of the main group (n=68) was next: miscarriage – 41, missed abortion – 21, anembryonic pregnancy – 6. The number of reproductive losses in the first trimester was 71.7%. Reproductive losses detected during 13–22 weeks reached 28.3%. Concomitant impressions of extragenital organs and systems were found in 46 (67.6%) women of the main group and 7 (23.3%) women of the control group. The leader of somatic morbidity was endocrine pathology. Among gynecological pathology, chronic endometritis was observed in 100% (n = 68) of the examined women of the main group. In addition, 55 patients (80.9%) of this group in the structure of gynecological pathology had other lesions, among which a significant indicator belongs to chronic salpingo-oophoritis (22 (32.4%)) and various menstrual disorders (18 (26.5%)). The vast majority of women in the main group had a history of instrumental revision of the walls of the uterine cavity for various pregnancy losses in the anamnesis (28 (41.2%)). That is why the qualitative analysis of clinical data of women with habitual miscarriage and chronic endometritis is an important area of research, as it allows to carry out adequate treatment and prevention measures at the stage of pre-pregnancy training.

Treatment of uterine bleeding in pubertal girls without application of hormonal therapy on the background of related thyroid pathology

Pubertal uterine bleeding occupies an important place in the structure of gynecological pathology since, in the years, it can lead to persistent and irreversible changes in the process of formation of the reproductive system.The purpose of the work is to investigate the effectiveness of non-hormonal therapy in the treatment of uterine bleeding in adolescent girls against the background of concomitant thyroid pathology.Material and methods. Thirty adolescent girls with pubertal uterine bleeding were examined and treated against the background of concomitant thyroid pathology, which were treated in the gynecological department of the city clinical maternity hospital No. 1 in Chernivtsi. All examined patients also underwent a comprehensive examination to determine the level of hormones in the blood serum and to determine individual indicators of hemostasis.Results. It was established that the complex therapy used in adolescent girls suffering from pubertal uterine bleeding against the background of thyroid pathology is effective, as indicated by the positive feedback mechanism, namely the release of follicle-stimulating hormone in response to an increase in the level of estradiol in peripheral blood.Conclusion. The comprehensive treatment technique developed and used by us in adolescent girls with uterine bleeding with concomitant thyroid pathology contributes to the gradual normalization of the level of sex and thyroid hormones in the blood serum, shortens the treatment period in the hospital, and helps to normalize the overall hormonal profile of the examined girls with concomitant thyroid pathology.

Immunohistochemical features of benign endometrial hyperplasia in premenopausal women

Hyperproliferative diseases of the endometrium play an important role in the structure of gynecological pathology, which are a spectrum of irregular morphological changes. Particularly difficult is evaluation of the phenotypic characteristics of the endometrium hyperplastic processes (EHP) in premenopausal women in the presence of an unstable menstrual cycle. Diagnosis and EHP prognosis remains a difficult task given that it can occur as focal or diffuse lesions with various structural and cytological differences.Objective of the study: to evaluate the immunohistochemical features (phenotypic variants) of benign endometrial hyperplasia in premenopausal women.Material and methods. 33 premenopausal women with abnormal uterine bleeding and verified benign endometrial hyperplasia were examined. Expression of the α-receptors for estrogens type 1 (ER1), progesterone receptors and Ki-67 nuclear protein in the endometrium stroma and glands was analyzed. Micromorphometry was performed and the D-score was calculated.Results. Prevalence of comorbid lesions in patients was the combination of endometrial hyperplasia and fibroids (51.4%), cases of abnormal uterine bleedings against submucosal fibroids (13.5%), endometrial polyps (8.1%), combinations of EHP and peritoneal endometriosis (10.8%), adenomyosis and myoma (8.1%), or other combinations of endometrial and myometrial proliferative pathology. D-score for surgery averaged 1.78 ± 0.11 indicating a low risk of malignancy. There were changes after treatment in the quantitative presentation of the studied proteins in stroma and endometrial glands. Thus, before treatment in the glands was determined up to 100% of cells containing ER1 in large quantities, while after treatment their number decreased by an average of 20%. Similar dynamics was observed with progesterone receptors activity.Conclusions. The main prognostic significant phenotypes of endometrial proliferative pathology have been identified. After removing of pathologically chanced endometrium and subsequent treatment with dydrogesterone during 6 months there is prognostically positive decreasing in the ER1 density as well as the Ki-67 protein expression

The Potential Use of Urinary CtDNA Profiling in the Treatment of Breast Cancer

The most common tumors of the internal genital organs in women include uterine fibroids. In the structure of gynecological pathology, it ranks second after inflammatory diseases. This disease is observed, in general, in European countries in 24 million women, and in North American countries in 20 million patients [1-3].

Indicators of activin A in patients with external genital endometriosis. Materials of 15th International Interdisciplinary Congress on Allergology and Immunology (May 22-24, 2019, Moscow)

Actuality. External genital endometriosis (EGE), leading to functional and structural changes in the reproductive system and infertility, takes the 3rd place in the structure of gynecological pathology. Objective. To determine the local and systemic level of activin A in patients with external genital endometriosis. Materials and methods. The study included 71 patients with EGE, who were divided into two groups: 1 group - patients with I-II stages (n=31); 2 - patients with III-IV stages (n=40). The control group included 24 patients without EGE. The determination of the level of activin A in the serum and peritoneal fluid was performed by enzyme immunoassay using DSL test systems (USA). Results. In the blood serum the level of activin A exceeded in patients of both studied groups compared the control group, but the most evident changes were observed in patients with stage III-IV of EGE. In the study of peritoneal fluid an increase in activin A was found only in patients in the 2nd group. Conclusion. An increase of serum and peritoneal fluid activin A level was associated with the risk of developing of EGE in patients of reproductive age.

Clinical characteristics of women with infertility and ovaricovaricocele

Despite numerous studies devoted to the etiological factors and pathogenetic aspects of infertility, the lack of a comprehensive analysis of the causes of ovarian dysfunction and the exact diagnosis leads to the polypharmacy of hormonal drugs and their low effectiveness. One of the less well known and poorly studied factors is pelvic venous complications, including varicose veins of the ovaries. Violation of venous circulation in the pelvic organs plays a significant role in the structure of gynecological pathology, particularly in the development of ovarian dysfunction. The purpose of our study was to analyze the clinical characteristics of women with functional infertility and ovaricovaricocele, namely the features of anamnesis of life, gynecological and somatic anamnesis, the study of which allows to assess and determine the risk factors, possible causes of ovarian dysfunction and the formation of varicose veins. To solve the goals and objectives, were prospectively examined and divided into 2 groups for the comparative analysis 117 pregnant women of reproductive age (21–44 years old) with functional infertility: the main group was 62 women with infertility and varicose veins in the ovaries; comparison group has 55 women with infertility without varicose veins. Patients were examined by a specially designed questionnaire, which included the results of gynecological and somatic anamnesis, anamnesis of life. In the main group of women there is an increased proportion of women with intellectual differentiation of labor and psycho-emotional and physical activity, which may be the basis for the formation of maladaptation syndrome with the subsequent occurrence of functional disorders of the reproductive system. In addition, conditions of work with considerable physical activity can indirectly have a negative effect on venous hemodynamics in the small pelvis. Women with functional infertility and ovaricovaricocele had a high incidence of infectious diseases in childhood — 83.9%. It is precisely at the stage of formation of reproductive function that the action of an infectious factor can be significant in the occurrence of violations of complete oogenesis in the subsequent reproductive life of patients. Attention is drawn to the large number of inflammatory diseases of the internal organs in women as the main group and the comparison group in the study of the somatic anamnesis: from the otolaryngologic organs — 48.3%, respiratory organs – 54.7%, genitourinary system — 43.5% and in the structure of gynecological diseases: inflammation of ovaries — 43.5%, vagina and cervix — 25.8%, suggesting that factors of violations of folliculogenesis in active reproductive age may be inflammatory diseases of the genitals. There is a significant percentage of dyshormonal abnormalities in the form of abnormal uterine bleeding in the structure of gynecological pathology in women with functional infertility and ovaricovaricocele (30.6%) against patients with infertility without structural changes in ovarian veins. Patients with infertility are more likely to point out dysgharmony of sexual life (58.1%), which in patients with varicose veins in the pelvic organs was accompanied by dyspareunia (32.2%), suggesting the role of chronic stress as a risk factor for ovarian dysfunction, which is also exacerbated by the presence pain of syndrome in the lower abdomen in women of the main group (77,4%). The more significant percentage of gynecological pathology of endocrine genesis in women with functional infertility and ovaricovaricocele and the presence of certain extragenital pathology, which affects the formation of pelvic pelvic flooring in comparison with patients with infertility without structural changes in ovarian veins, is established during the analysis of the clinical characteristics of the significant percentage of venous hemodynamics in the functional properties of the ovary and induces further investigation of the role of varicose veins of the pelvic reservoirs, in particular ovariсovariсocele, in the pathogenesis of ovarian dysfunction in order to further develop the methods of therapeutic correction.

NAT2 GENE POLYMORPHISM AS A PREDICTOR OF FAILURE FOR SURGICAL TREATMENT OF PELVIC ORGAN PROLAPSE: RESULTS OF A PROSPECTIVE COHORT CLINICAL STUDY

Background: Pelvic organ prolapse (POP) is the most frequent disease component in the structure of gynecological pathology (from 28 to 38.9%) and its incidence is increasing. Most of the research studies were initiated to develop various kinds of operative treatment for common prolapse cases (POP-Q III−IV); however, a large number of surgical interventions associated with a high percentage of complications and a high rate of relapses confirm the difficulty for problem-solving. In this regard, there is a need to expand ideas about the pathogenesis of the disease and develop approaches to the prediction of recurrence surgical treatment, choosing the correct and timely treatment strategy. Currently, great importance is given to the study of genetic control of connective tissue metabolism. The evidence demonstrated that polymorphism of NAT2 gene results in genetically determined disorders of connective tissue catabolism which increases the possibility of disease development approximately in 2 times. Point mutations in NAT2 lead to the so-called slow-acetylation which determines the predominance of the decay rate of collagen over its synthesis.Aim: Analyze the significance of NAT2 polymorphism as a predictor for failure of surgical treatment of pelvic organ prolapse.Materials and methods: The prospective cohort clinical trial enrolled 140 women of the reproductive age (from 28 to 42 y.o.) with symptomatic prolapse (POP-Q Stage II−III) who were examined and received treatment in the period from 2008 to 2014. All patients underwent surgical treatment of POP. The treatment included colpoperineorrhaphy with levatorplasty. In 12.9% of patients who had stress urinary incontinence — in combination with a loop urethropexies transobturatory access (Transobturator Vaginal Tape, TVT-O). Long-term results of treatment effectiveness were assessed in 3−5 years. Results: The findings revealed that the incidence rate of point mutations of NAT2 gene was 2-fold higher in patients with POP included in the ineffective treatment group (61.8%) if compared to the rate registered in the effective treatment group (30.6%).Conclusions: The obtained data indicate that the presence of point mutations in NAT2 gene is a poor prognostic factor for general types of genital prolapse and a predictor for failure of surgical treatment.

ПРОГНОЗУВАННЯ РЕЦИДИВУ МІОМИ МАТКИ ПІД ЧАС ВАГІТНОСТІ

Міома матки зустрічається у 15–45 % жінок репродуктивного віку, посідаючи, таким чином, друге місце у структурі гінекологічної патології. За даними О. Л. Карякіної, основними чинниками ризику виникнення міоми матки є вік жінки більше 30 років, супутні гінекологічні захворювання, гіперменструальний синдром, більше 2 абортів в анамнезі.Мета дослідження – розробити модель росту міоматозних вузлів під час вагітності.Матеріали і методи. Дослідження проведено на базі Обласного перинатального центру (м. Одеса). Проаналізовано 267 історій пологів жінок, які народжували у термін з 2007 до 2016 р., та мали верифіковану міому матки на прегравідарному етапі, видалену шляхом консервативної міомектомії. Оцінювали результати УЗД, виконаного під час вагітності, за наявності відповідних документальних свідчень – більш ранні УЗД. Враховували кількість міоматозних вузлів, їх розміри на прегравідарному етапі та під час вагітності. Об’єм міоми визначали на підставі ультрасонографічних вимірювань за формулою для еліпсоїда: V=0,52 х a х b х c, де а – висота, b – ширина, c – товщина вузла, 0,52=π/2х3. Статистичну обробку проводили за допомогою регресійного та багатофакторного аналізу з використанням програмного забезпечення Statistica 10.0 (DellStatSoftInc., США).Результати досліджень та їх обговорення. За даними ретроспективного аналізу, середній вік жінок, оперованих на прегравідарному етапі з приводу міоми матки, склав (33,7±2,2) року. Рецидив міоми виник у 89 (33,3 %). Кількість міоматозних вузлів, виявлених під час вагітності, в середньому складала 1,8±0,2. При цьому середні розміри їх були (6,3±0,2) мм х (4,2±0,1) мм х (4,4±0,1) мм, що відповідає середньому об’єму (0,49±0,02) см3. У 49 (55,1 %) вагітних із рецидивом міоми протягом ІІ триместру відбулося збільшення міоматозних вузлів у середньому на (28,6±1,3) %. Цікаво, що найбільші розміри цих вузлів спостерігалися у терміні гестації 20 тижнів, натомість перед пологами розміри пухлини зменшувалися в середньому на (14,8±0,4) %. При розробці моделі розрахунку ризику рецидиву ми враховували дані гормонального профілю жінок, тривалості захворювання, наявності попередніх вагітностей, УЗД, у тому числі доплерометричних характеристик, результати “потрійного” тесту. Після проведених розрахунків одержали таке рівняння: 𝑋𝑋= 𝑒𝑒𝑞𝑞 1+𝑒𝑒𝑞𝑞 , де q = 6,6–0,3 A–0,5 LV–1,5 S–0,9 E + 0,6 PL, де A – вік жінки; LV – лінійна швидкість кровотоку в маткових артеріях; S – сумарний розмір міоматозних вузлів E – співвідношення рівня естріолу та його максимального референтного рівня; PL – співвідношення рівня плацентарного лактогену та його максимального референтного рівня. При значеннях X>1,0 ризик рецидивування міоми під час вагітності є високим. Подальша перевірка коректності моделі показала, що її точність складає 0,94 (χ2=2,8 df=11 Pr>χ2). Це дозволяє рекомендувати її для потреб клінічного прогнозування.Висновки. Найбільш значущими факторами рецидивування міоми під час вагітності є вік жінки, лінійна швидкість кровотоку в маткових артеріях, розмір міоматозних вузлів, рівень секреції естріолу та плацентарного лактогену. Розроблений алгоритм прогнозування дозволяє визначати ризик рецидиву міоми під час вагітності з точністю 0,94.

The diagnostic significance and clustering of parameters of systemic humoral immunity under acute endometritis.

The acute endometritis is an actual medical problem in the structure of gynecological pathology and its complications result in incapacitation, infertility and lethality. The purpose of study is to ameliorate laboratory diagnostic of acute endometritis at the expense of selection of diagnostically significant and similar clusters of systemic humoral immunity. he analysis was carried out concerning parameters of systemichumoral immunity in 154 patients with post-natal acute endometritis and 103 patients with non-complicated post-natal period using the radial immunodiffusion technique. The selection of diagnostically significant parameters was implemented at the basis of indices of shifting, disintegration and cluster analysis method. The leading value for laboratory diagnostic of acute endometritis according indices of shifting, disintegration and cluster analysis among parameters of systemic humoral immunity keep content of IgA in blood, absolute number of SD20+ and circulating immune complexes. The selection of diagnostically significant and similar indices of humoral immunity permits to decrease number of detecting parameters at the diagnostic of acute endometritis.

INCREASED CHANCES OF PREGNANCY AFTER MYOMECTOMY IN ART PROGRAMS

Myoma of the uterus occupies the third place in the structure of gynecological pathology, second only to inflammatory diseases, the main symptoms of uterine fibroids are profuse menstruation, pelvic pain, infertility, impaired function of neighboring organs characteristic of tumors of large sizes. Treatment of uterine fibroids «an urgent problem of modern gynecology», despite the variety of therapeutic techniques. Uterine myoma is a frequent cause of infertility, the pathogenesis of which is not fully understood. Recently, as a drug of choice for the purpose of adjuvant therapy of uterine fibroids, the drug mifepristone has been widely used, which has a high therapeutic efficiency, which contributes to the realization of the reproductive function in the conduct of organ-saving operations.

Morphological Features of Pregnancy of Uterine Leiomyomas

Introduction/ Background According to numerous publications of diseases among women of reproductive age, uterine leiomyoma are in the second place in the structure of gynecological pathology. Uterine leiomyoma - a benign, well-encapsulated tumor limitation, the source of which are the smooth muscle cells of the body of the uterus or cervix. According to different authors, in 0,4-3,9% of cases, the presence of tumor is diagnosed during pregnancy. Presence of myomas nodes leads to the threat of termination of pregnancy, missed abortion, the threat of fetal hypoxia, early and late gestosis, bleeding during pregnancy and childbirth . Moreover, the nature of complications depends on the size and morphological features of tumor’s myoma nodes. Aims To study the morphological features of leiomyomas during pregnancy given the size of tumors and secondary changes in it. Methods Morphological examination of myomas was conducted in 25 cases of pregnancies completed caesarean section in 36-39 weeks of gestation with subsequent enucleation nodes. All myomas were divided into 2 groups: a core group of 10 nodes (more than 5 cm) and a control group of 15 nodes (less than 5 cm). On gross examination of tumors taken into consideration the number, size, texture, color, structure and the presence of degenerative changes. In each case of leyomioma nodes excised tissue portions from the central zone and the edge of the paracentral. The fragments of tissue were fixed in neutral formalin, followed by pouring into paraffin. With each produced histological preparations stained hematoxylin and eosin, and van Gieson’s stain. Microscopic investigations were conducted on increasing × 100 × 400 with a microscope Primo Star (Carl Zeiss, Germany). Results At external examination of uterine control group were tightly-elastic and dense consistency. In the main group was uneven consistency of nodes, with the presence of foci of softening. In the main group tumor size reached 5.0 cm to 17.0 cm in diameter, these nodes along with portions of white or grayish white color observed small or large grayish yellow necrotic foci, and cystic formation was observed, and red degeneration, calcification. In the control group the size of myomas nodes were ranging from 0.5 cm to 4.5 cm in diameter, usually have multiple nodes localization. Grossly it had tumors pale pink, fibrous structure. Histological examination of the control group has some parts of the tumor that are rich in blood vessels and the cells that were in a state of hypertrophy, as observed focal stromal edema. While in the main group was characterized by not only the presence of necrosis, as well as defined areas of circulatory disorders, foci of hemorrhage, edema, or hyalinosis of tissue. This research showed a high variability of macroscopic and microscopic characteristics of leiomyomas and the presence of secondary changes of varying severity. There is every reason to believe that the size of the tumor nodes and pathologic features of leiomyomas may be an important marker for assessing the severity of disorders of homeostasis in utero-placental complex, and should be considered in the monitoring of pregnancy and childbirth.

Hysteroscopic, morphofunctional and immunohistochemical endometriun features in women with uterine leiomyoma after different types of organ-preserving treatment

Uterus leiomyoma is the most common benign tumor that takes one of the leading places in the structure of gynecological pathology. According to different authors proportion of this disease in the infertility structure is 48–55.3%, in the structure of pregnancy miscarriage – 14–18%, in pregnancy and childbirth complications – 10–30%. Uterus leiomyoma reduces in vitro fertilization results from 29% to 9% in cases of submucous nodus localization, lowers pregnancy rate to 28.2% against 63.4% after hysteroscopic node resection. The authors performed a study to improve the efficiency of uterine fibroids treatment through the development of methods to improve the functional state of the endometrium after use of different types of organ-preserving surgery. Following data were received after various types of organ saving surgical procedures: patients with normal endometrium structure (73.33%) dominated at first group. Endometrial hypoplasia was found in 20% cases of the identified pathology. Endometrial fibro-glandular type polyps were found in 6.67% of cases. The main features of this group were uneven focal estrogen receptor down regulation, disturbance of natural killer cells CD16 and CD56 and CD45 expression, compared to the control group. Immunohistochemical study showed positive expression of CD138 (plasma) in 25% of cases in endometrium of women after uterine artery embolization, indicating the presence of chronic endometritis in this group. Immunohistochemical studies of endometrium in the third group showed high level expression of inflammatory markers (CD45, CD16 and CD56). It was detected a significant increase in expression of the proliferation marker Ki-67 in endometrial stroma in the IIIb group, indicating a potential risk of hyper proliferation against a background of inflammatory process of the endometrium. Thus, endometrium changes after organ saving surgical treatment of uterine leiomyoma, such as uterine artery embolization, conservative myomectomy, hysteroscopic resection of node determines the need for the prevention of endometrial dysfunction after surgery.

Analysis of gynecological morbidity in girls suffering from chronic decompensated extragenital diseases

In recent years the Russian Federation among the causes of maternal mortality extragenital diseases occupy the first place (37.7 % in 2012). There is an increasing group of children with chronic diseases. Objective: to make an analysis of the gynecological pathology in girls with decompensated chronic extragenital pathology. Methods. A total of 1682 patients aged under 18 years who are treated in the Saint Petersburg State Pediatric Medical University’s multidisciplinary clinic and directed clinicians to consult a gynecologist. We used anamnestic, clinical and laboratory methods of investigation and analysis of medical records. Results. As a result of analysis, we found that the structure of gynecological pathology identified in patients with decompensated extragenital diseases, 44 % are menstrual disorders, 37.9 % - an inflammatory disease, 14.2 % - non-inflammatory problems, 12.7 % - other. In this case, gynecological pathology, of course, is associated with somatic. So, the girls suffering from connective tissue, often recorded long and heavy menstruation (38.9 %), diseases of the gastrointestinal tract and urinary system - painful (45.9 and 55 %, respectively), endocrine pathology often accompanied by rare, scanty menses (56.8 %). Conclusions. Given the importance of extragenital pathology in the implementation of fertility, it is important to pay particular attention to: a) development of an algorithm for monitoring, treatment, rehabilitation of girls suffering from extragenital pathology, which should include a compulsory inspection gynecologist; b) the participation of gynecologist in the regular medical check observation girls with chronic extragenital pathology in the case of existing combinations with gynecological diseases. Such an approach should be further consolidated when transferring patients under the supervision of an adult network.

Modern technology in the treatment of patients with purulent inflammatory diseases of uterine appendages

Inflammatory diseases of the uterus continues to occupy first place in the structure of gynecological pathology. In Russia, they are detected in 60–65% of outpatients and 30% of hospitalized patients, while 4–15% of women are diagnosed with purulent inflammation of the uterine appendages (PIDUA). Violations of the reproductive system appear almost in every second patient, and the frequency of ectopic pregnancy increased by 10 times.