Treatment Tactics In Patients Research Articles

Coronary Artery Disease with a High Risk of Complications: How to Identify Such Patients and Choose Management Tactics?

Patients with diagnosed coronary artery disease and/or peripheral arterial disease have a high risk of cardiovascular death and disabling vascular events, including stroke, myocardial infarction, and amputation. Secondary prevention in these high-risk patients should include control of modifiable risk factors for the progression of atherosclerosis and antithrombotic therapy to prevent atherothrombosis. Analysis of the literature from the databases PubMed, MEDLINE, HighWire Press was carried out to determine the modern possibilities of assessing the risk of ischemic and hemorrhagic events in a stable course of cardiovascular diseases caused by atherosclerosis, which can be used to determine the categories of patients with the greatest potential benefit from combination antithrombotic therapy. The results of a large randomized study COMPASS, their sub-analyses and the work of other authors, published over the last year, allow us to formulate reasonable conclusions that facilitate the adoption of medical decisions when choosing treatment tactics for patients with a stable course of atherosclerotic cardiovascular diseases. When using low doses of rivaroxaban and aspirin in high-risk groups, the rate of adverse events, including cardiovascular death, myocardial infarction, stroke, and vascular complications of peripheral artery disease, can be significantly reduced. High-risk criteria for severe cardiovascular complications are multifocal atherosclerotic lesions, heart failure, myocardial infarction, diabetes mellitus, or chronic kidney disease. Patients with the highest risk of vascular events will receive the greatest absolute benefit from this treatment. Secondary prevention in patients with chronic coronary syndromes, sinus rhythm and a moderate risk of cardiovascular complications using low doses of rivaroxaban and aspirin is justified, since the ratio of its risk and benefit remains favorable.

Surgical treatment tactics for patients with combined pelvic and femoral injuries

Surgical treatment tactics for patients with combined pelvic and femoral injuries

Analysis of Providing Emergency Care to Patients with Myocardial Infarction without ST Segment Elevation

A high mortality rate due to acute myocardial infarction (AMI) stimulates the analysis of the quality of emergency medical care at the prehospital stage. Firstly, an analysis of the reasons for the treatment of patients with AMI to general practitioners is necessary. Secondly, the quality of the provision of medical services by general practitioners is one of the criteria for the effectiveness of the implementation of patient management protocols, which requires a systematic analysis and relevant studies.The objective: to analyze the provision of emergency medical care to patients with acute myocardial infarction without ST segment elevation (NSTEMI) when they seek medical care.Materials and methods. The referral routes for hospitalization of patients with acute coronary syndrome and clinical manifestations were analyzed among 280 patients with STEMI and 91 patients with NSTEMI. The assessment of treatment tactics in patients with NSTEMI was carried out in the following paragraphs of the emergency medical care protocol: determination of blood saturation, ensuring reliable venous access, administration of nitroglycerin in aerosol (1–2 doses or 0,4–0,8 mg), use of acetylsalicylic acid (ASA ) after chewing 160–325 mg, the use of clopidogrel 300 mg orally; the appointment of β-blocker; narcotic analgesic; anticoagulant. Statistical data processing was carried out using non-parametric criterion χ2.Results. Appeals to primary health care centers were significantly more frequent in patients with NSTEMI, due to the clinical course of the disease.Conclusion. At the stage of medical care by general practitioners, only the appointment of acetylsalicylic acid met the criteria for the implementation of the protocol for the provision of emergency medical care to patients with NSTEMI.

Аналіз надання екстреної медичної допомоги хворим на інфаркт міокарда без елевації сегмента ST при звернені по медичну допомогу

A high mortality rate due to acute myocardial infarction (AMI) stimulates the analysis of the quality of emergency medical care at the prehospital stage. Firstly, an analysis of the reasons for the treatment of patients with AMI to general practitioners is necessary. Secondly, the quality of the provision of medical services by general practitioners is one of the criteria for the effectiveness of the implementation of patient management protocols, which requires a systematic analysis and relevant studies.The objective: to analyze the provision of emergency medical care to patients with acute myocardial infarction without ST segment elevation (NSTEMI) when they seek medical care.Materials and methods. The referral routes for hospitalization of patients with acute coronary syndrome and clinical manifestations were analyzed among 280 patients with STEMI and 91 patients with NSTEMI. The assessment of treatment tactics in patients with NSTEMI was carried out in the following paragraphs of the emergency medical care protocol: determination of blood saturation, ensuring reliable venous access, administration of nitroglycerin in aerosol (1–2 doses or 0,4–0,8 mg), use of acetylsalicylic acid (ASA) after chewing 160–325 mg, the use of clopidogrel 300 mg orally; the appointment of β-blocker; narcotic analgesic; anticoagulant. Statistical data processing was carried out using non-parametric criterion χ2.Results. Appeals to primary health care centers were significantly more frequent in patients with NSTEMI, due to the clinical course of the disease.Conclusion. At the stage of medical care by general practitioners, only the appointment of acetylsalicylic acid met the criteria for the implementation of the protocol for the provision of emergency medical care to patients with NSTEMI.

MICRORNA-122 AS A BIOLOGICAL MARKER OF CHRONIC VIRAL HEPATITIS C

New epigenetic markers are being studied in various countries around the world to diagnose, predict, and treat the patients with chronic viral hepatitis C. Epigenetics is currently studying the hereditary changes in gene expression or phenotype that are not related to the changes in DNA sequence. One field of epigenetics is the expression of RNA that does not encode a protein, namely miRNA, which is a molecule 18−22 nucleotides in length that plays a crucial role in regulating gene expression. Circulating miRNAs are a new genetic material that can be isolated from a patient's blood. The expression level of a particular miRNA has different biological and clinical effects. By means of its determination in various miRNAs it is possible to predict development of diseases. In order to study the baseline expression of miRNA−122 in patients with chronic viral hepatitis C with the first HCV genotype, 74 patients were examined. Diagnosis and monitoring of the patients was performed according to the local protocols and bioethical standards. The level of miRNA−122 expression in patients with chronic viral hepatitis C with the first HCV genotype was established by reverse transcription. Studies show that the level of miRNA−122 expression in the patients with HCV and healthy individuals showed significant variability. The obtained data indicate that the expression level of miRNA−122 in patients is 29 times higher than in healthy individuals at p = 0.0001 (U; Z). This can be an additional biomarker as an index of the presence of chronic viral hepatitis C and can be further used in practice. Therefore, the high level of miRNA−122 expression in subjects (≥ 8.771 rel. units (Log10 miR−122 ≥ 0.939 rel. units)) may be the basis for further screening of patients for HCV infection. The prospects of using this index, which will allow to personalize the diagnosis and treatment tactics for patients, that, in turn, will contribute to the implementation of the WHO global strategy for the elimination of viral hepatitis. Key words: chronic viral hepatitis C, miRNA−122, elimination of viral hepatitis, biological marker.

DIFFERENTIATED TREATMENT TACTICS IN PATIENTS WITH RECTAL FOREIGN BODIES

Summary. Patients with rectal foreign body (RFB) are quite rare in the practice of emergency surgeons. There are different techniques for deleting RFB depending on the features of the object being entered. There is still no standardized protocol for the surgical treatment of such patients.
 Aim. To analyze the immediate and long-term results of treatment of patients with RFB. Introduce differentiated therapeutic tactics into the practice of urgent surgeons depending on the characteristics of the foreign body and the presence of complications.
 Materials and research methods. Three patients with RFB were treated in the surgical department of SRCH during 2018-2019. Their average age was (38 ± 3.6) years. The algorithm of the examination consisted of a physical examination, a rectal finger examination, a radiological and a laboratory examination.
 Results and discussion. In two of the patients, the cause of RFB was sexual abuse, and in the third, violent acts. Removed objects: dildo, metal deodorant bottle and glass beaker. RFB in all individuals was diagnosed with a finger rectal examination. In one patient with RFB was removed under local anesthesia, and in two patients used general anesthesia with muscle relaxants. In one case, an attempt to remove RFB was successful, in the other, a laparotomy, colotomy, and preventive sigmostomy were required.
 Conclusions. Patients with RFB need differentiated therapeutic tactics. In most patients, it is possible to remove it in a conservative way, peranally, using local anesthesia or endotracheal narcosis with muscle relaxants. For large, tightly clamped objects that cannot be removed conservatively indicated open laparotomy, colotomy.

Insulin resistance: Unsolved issues of harm and use

Insulin resistance, diagnosed in more than half of cardiac patients, is considered to be a negative factor contributing to further exacerbation of existing metabolic disorders and the progression of cardiovascular diseases (CVD). However, recently, scarce data emerged suggesting that about a quarter of obese people have a favorable prognosis of CVD. These data allowed us to make an assumption that insulin resistance in high-risk patients may represent some kind of a protective mechanism that prevents damage to the organs and tissues of the cardiovascular system. This review discusses the potential protective mechanisms of insulin resistance and the possibilities of their clinical use in choosing the treatment tactics in patients with obesity, type 2 diabetes mellitus, and poorly controlled glycemia.

Protein CRABP1 as one of the possible prognosis factors in children with high-risk neuroblastoma

Neuroblastoma (NB) is the most common extracranial solid tumor of childhood, accounting for 6—10 % of all malignant neoplasms in children. One of the fundamentally important problems for the clinician is the stratification of the risk group and the definition of treatment tactics for patients with NB. In this work, we studied the dependence of the expression of CRABP1 protein in the primary focus and tumor metastases on the type of genetic disorders (amplification of the MYCN gene, deletion of the 11q23 locus) and the effect of the therapy in patients with NB.

ДИАГНОСТИКА И ВЫБОР ХИРУРГИЧЕСКОЙ ТАКТИКИ ПРИ ШЕЙНО-ЗАГРУДИННОМ ЗОБЕ

Background. The frequency of retrosternal goiter is 10-15% of the total number of surgical thyroid diseases. The main treatment method is surgery. The relevance of the work is determined by the contraventions in algorithm for the preoperative sternotomy risk assessment in this group of patients. Objective: to identify factors that increase the risk of sternotomy in patients with retrosternal goiter. Material and methods. The study was performed in the St. Petersburg City Hospital 26 in 2011–2019. During this period 1156 operations for thyroid diseases were performed. Retrosternal goiter was detected in 227 (19.6%) patients. Results. The clinical picture of the retrosternal goiter was polymorphic and depended on the degree of compression of mediastinal organs and vessels. Long-term compression of the organs of the neck and mediastinum contributes to relative compensation and the asymptomatic course, which was observed in 78 (34.4%) cases. The main diagnostic method for retrosternal goiter was radiological. Computed tomography helped to the mediastinum. The most significant factors in determining the likelihood of sternotomy were: the size of the retrosternal part of the goiter and its relationship with the upper thoracic aperture, localization of the goiter in the anterior or posterior mediastinum, the relations of thyroid tissue with vital organs, large vessels and nerve trunks. Combined cervical access with longitudinal transverse sternotomy was planned in 18 cases, but the real need for it was only in 2 (0.9%) cases. Conclusion. Computed tomography with 3-D reconstruction is the leading method of differential diagnosis and determination of surgical treatment tactics in patients with retrosternal goiter. In most cases, surgery is possible through cervical approach, but it is necessary to foresee the likelihood of sternotomy. Determining only the absolute dimensions of a goiter does not always determine the need for longitudinal-transverse sternotomy. An important role is played by a combination of risk factors.

Modern concepts of human papillomavirus infection: epidemiology and treatment tactics of patients with ano-genital warts

<h3></h3> В статье изложены современные представления об эпидемиологии вируса папилломы человека (ВПЧ). Существует более 200 типов ВПЧ, среди которых выделяют группы низкого и высокого онкогенного риска в зависимости от их онкогенного потенциала. Среди типов ВПЧ высокого риска типы 16 и 18 являются наиболее распространенными и канцерогенными. Показана этиологическая роль отдельных типов ВПЧ в развитии рака шейки матки и злокачественных новообразований других локализаций, включая рак влагалища, вульвы, анального канала, полового члена, опухолей головы и шеи. Кроме того, весьма вероятно, что ВПЧ высокого онкогенного риска могут непосредственно инициировать рак предстательной железы и влиять на онкогенез. Представлены пути и механизмы передачи, а также иммунные механизмы персистенции и элиминации ВПЧ. В целом персистенция ВПЧ на различных эпитопах макроорганизма способна привести к злокачественной трансформации многослойного плоского эпителия практически любой локализации. Большинство типов являются доброкачественными и транзиторными, однако длительность персистенции папилломавирусной инфекции прямо пропорциональна риску возникновения клинических и субклинических ВПЧ-индуцированных поражений кожи и слизистых оболочек. Проанализированы заболеваемость аногенитальными бородавками по возрастным группам в разных странах и современные подходы к терапии больных с аногенитальными бородавками. Приведены клинические примеры высокой эффективности применения крема с имихимодом в терапии аногенитальных бородавок.

Клиническая оценка ультразвуковых маркеров внетубарных форм эктопической беременности: выбор метода оперативного пособия и принципы восстановительного лечения

Aspects of ultrasound diagnostics of extratubal forms of ectopic pregnancy are presented from the standpoint of choosing the optimal treatment tactics for patients, aimed primarily at minimiz-ing surgical procedures. The issues of diagnostics of cervical pregnancy, caesarean scar preg-nancy, ovarian pregnancy, as well as a rare indication of tubal pregnancy – interstitial pregnancy are detailed. In most cases, echography is not only decisive, but, in fact, the only method of pre-operative diagnosis. In this case, color Doppler mapping of blood flow in the vessels of the ec-topic trophoblast is of great importance, which makes it possible to assess the degree of its inva-sion and, thereby, to make adjustments to the surgical tactics. The emphasis is made on the role of rehabilitation treatment. Key words: ectopic pregnancy, extratubar forms, ultrasound diagnostics, treatment tactics, re-habilitation therapy

PREDICTION OF THE DEVELOPMENT OF INSOLVENCY OF ANASTOMOSES ACCORDING TO THE LEVEL OF CRYOBILK

Abstract. The aim of the study was to create individualized surgical treatment tactics in patients who underwent anastomosing intestinal surgery using the express method for determining cryoglobulins. The study was based on a study of the results of treatment in 96 patients who underwent resection of segments of the small intestine with the formation of inter-intestinal anastomoses, in the SI «ZIGUS NAMSU» during the period from 2015 to 2018 years. Using a high-quality rapid method for the determination of cryoglobulinemia (CGE) during surgery can significantly affect surgical tactics: with a low level of cryobilk in blood serum, it can perform a resection of a segment of the small intestine with the formation of primary small intestinal anastomoses; when the level of cryobilk in blood serum is more than 80 mg / l, which corresponds to a positive rapid test for cryobilk, one should refrain from the formation of primary anastomoses, and use the tactics of the formation of “delayed” anastomoses, in severe general condition of patients (and a high level of CGE – more 600 mg/l) – also the formation of the final small intestinal stoma.

Surgical tactics of treatment in patients, suffering an acute arterial ischemia of the lower extremities on background of atherosclerotic arterial affection

Objective. To improve the diagnosis and to optimize a surgical tactics of treatment in patients, suffering an acute ischemia of the lower extremities, severe stage of the extremity ischemia, depending on the prognostic criteria for surgical treatment revealed.Materials and methods. There were examined 70 patients, suffering an acute arterial occlusion: men - 44 (63%), women - 26 (37%) ageing (65.2 ± 3.5) yrs old. The patients were distributed into three groups: the 1st - 32 (45.7%) patients with the arteries embolism revealed, the second - 5 (7.1%) patients with the lower extremities idiopathic arterial thrombosis, and the third - 33 (47.1%) patients with arterial thrombosis, which have developed on background of their atherosclerotic affection. In all the patients there were conducted a general clinical examination, ultrasonographic duplex scanning of the lower extremities arteries, spiral CT with contrasting. In 54 patients a degree of the skeletal muscles damage and a state of the acid-base balance were studied up.&#x0D; Results. In 88% patients a hemodynamically significant atherosclerotic occlusive-stenotic affection of the lower extremities arteries was revealed. The staged tactics of treatment was elaborated for patients, suffering an acute arterial occlusion and atherosclerotic affection of the lower extremities arteries. So on, after performance of thrombectomy the ultrasonographic duplex scanning of the lower extremities arteries is conducted with further application of various methods of revascularization, endovascular and the open-access shunting reconstructive operations on arteries of the lower extremities. Prognostic criteria, determining tactics of treatment in a patient with the extremity vitality preservation, were elaborated.&#x0D; Conclusion. There was established, that while the ischemia duration increase the possibility of the extremity blood flow restoration reduces. A correct tactics selection in patient is promoted due to determination of a rabdomyolisis markers.

Modern views on development mechanisms and tactics for treatment of patients with gallbladder disease associated with metabolic syndrome

The high prevalence of metabolic syndrome in population has led to the cholelithiasis is important problem of modern health care along with coronary heart disease, arterial hypertension and diabetes. The main role in the formation of gallbladder pathology in patients with metabolic syndrome belongs to insulin resistance, atherogenic dyslipidemia, and non‑alcoholic fatty liver disease. Тhe prescription of ursodeoxycholic acid is pathogenetically justified. This article presents modern views on the mechanisms formation of gallstone disease in the conditions of metabolic disorders and management of this patients based on the results own research.

Kazan version of the classification of congenital heart defects of John Kirklin

The article is devoted to the analysis of classifications of congenital heart defects from a practical point of view. The researchers present their classification of congenital heart defects with the substantiation of optimal terms of surgical correction. The proposed classification allows us to predict possible critical hemodynamic conditions in children with heart defects both in the neonatal period and in other age groups. The classification creates the basis for choosing the treatment tactics of patients with congenital heart defects using the known stages of hemodynamic changes, it has been used by the cardiologists and cardiac surgeons in the Republic of Tatarstan for more than 15 years.

Clinical Aspects of Prevention and Management of Primary Inferior Oblique Muscle Overaction

Background. Primary inferior oblique muscle overaction (PIOOA) may occur for various reasons and happens to 72 % patients with infantile esotropia. The criterion for the first surgical step is prevalence of vertical or horizontal deviation. The choice of tactics weakening inferior oblique muscle is ambiguous.Aims: to carry out retrospective analysis of PIOOA frequency in patients with infantile esotropia; to assess influence of esodeviation reduction by a surgical, chemodenervational or prismatic method on the existing PIOOA dynamics; to assess clinical and functional results of PIOOA treatment.Methods and methods. The retrospective analysis of 572 patients’ cases lay in assessment of PIOOA frequency and rate in patients with infantile esotropia that manifested under 9 months, with different treatment tactics. The prospective part of the research included two groups of patients. Group 1 (106 patients, 222 eyes) – studying the influence of surgical treatment of PIOOA. Group 2 (127 patients, 207 eyes) – studying the effectiveness of surgical PIOOA treatment. Conclusion. PIOOA frequency in case of different treatment tactics for patients with infantile esotropia is from 17 to 69 %, and the degree of its clinical manifestation is from 1.2 ± 0.4 to 2.6 ± 0.8. Bilateral weakening of medial rectus muscle reduces its probability up to 17–19 %, and the degree of its manifestation up to 1.2 ± 0.4. In cases of combination of PIOOA with infantile esotropia from 20 to 25° with paretic component, it is reasonable to carry out esodeviation reduction by means of bilateral recession, chemorecession or prismatic correction as the first treatment stage, whereas the rate of existing PIOOA is credibly reduced. In cases of choice of tactics, which is necessary for clinically significant reduction or elimination of PIOOA, it is reasonable to carry out chemorecession, marginal partial myotomy or myectomy depending on the PIOOA manifestation.

The Tactics of Surgical Treatment in Patients with Cerebellar Infarction

The aim of the study is to specify tactics of surgical treatment of cerebellar infarction (CI). Material and methods . The results of treatment of 80 patients with CI were studied. According to the clinical course of stroke, the patients were divided into 2 groups. The group of malicious cerebellar infarction included 55 patients (69%) (Group I), the group cerebellar infarction with benign course included 25 patients (31%) (Group II). Patients of Group I were divided into subgroups, in one of them surgical treatment was performed (surgical subgroup), and in the another one, only conservative (conservative subgroup) treatment was performed. In the surgical subgroup, 16 patients underwent isolated ventriculostomy, 5 - posterior fossa decompression (PFD), 18 - combination of ventriculostomy and PFD. The criteria of efficacy of surgery were recovery of consciousness and/or IV ventricle and the quadrigeminal cistern configurations. Results of treatment were assessed according to the Glasgow Outcome Scale. Results. Malicious cerebellar infarctions occurred more frequently in patients with volume of ischemia exceeding 20 cm 3 in the first day of the disease. The threshold value of mass effect, which may cause further a malocious cerebellar infarction, in the first day of the disease was score 3 according to the M. Jauss scale. In group of patients with malicious cerebellar infarction, surgical treatment reduced the mortality rate of occlusion and dislocation syndrome by 35.8%. The most effective type of intervention was a combination of decompressive trepanation of the posterior cranial fossa and external ventricular drainage. Combined ventriculostomy and PFD were 34 % more effective than just ventriculostomy, and 38 % more effective than just PFD. Conclusion. Patients with cerebellar infarction of more than 20 cm3 and signs of a mass effect in the posterior cranial fossa score 3 or higher according to M. Jauss scale, are prone to developing a malicious course of the disease. After the development of clinical manifestations of occlusive and dislocation syndrome, they need surgical treatment. In the surgical treatment of malignant cerebellar infarction, ventriculostomy with PFD are advisable, as each operation separately does not always provide a necessary effect in decompensation of dislocation syndrome.

Possibilities of Ultrasound Dopplerography in Detecting Instability of Atherosclerotic Plaque of Carotid Arteries

Background. Studying the possibilities of ultrasound diagnosis of atherosclerotic lesions of the carotid arteries to determine the treatment tactics of patients with various types of atherosclerotic plaques.Objective. Assessment of the possibilities of ultrasonic triplex research in identifying signs of instability of atherosclerotic plaques of the carotid arteries.Design and methods. The study included 360 patients aged from 28 to 95 years old who were admitted to the St. Petersburg State Budgetary Health Institution “Mariinskaya Hospital” with diagnoses of transient ischemic attack and acute cerebrovascular accident. All patients underwent an ultrasound visualization of the brachiocephalic arteries. Results. Most patients had atherosclerotic plaques of the carotid arteries with a stenosis of up to 75 % and had signs of instability with varying degrees of severity (according to triplex ultrasound). However, it was not possible to reliably assess the presence of hemorrhage in the plaque using a single imaging method.Conclusion. The data obtained indicate the complexity and ambiguity of the studied question. Further detailed examination of the signs of atherosclerotic plaque instability is required using various diagnostic imaging techniques.

Immunohistochemical features of cyclooxygenase-2 expression in endometrial hyperplasia without atypia

Hyperplastic processes of the endometrium without atypia have been an urgent problem for researchers around the world for a long time, given the current position of cancer alertness and violations of reproductive function.Objective. To study immunohistochemically the expression level of the new biomarker - cyclooxygenase-2 (COX-2) in various types of endometrial hyperplasia without atypia in samples of altered endometrial tissue from 30 patients of reproductive age (39.47 ± 1.1 years).Materials and methods. Endometrial hyperplasia manifested as glandular in 17 patients (56.7%), glandular-cystic - in 11 (36.7 %), stromal and cystic-atrophic forms – in one case for each form (3.3 %). The study was carried out according to the standardized protocol of primary monoclonal antibodies COX-2 manufacturer (Thermo Scientific, rabbit, working dilution 1:50-1:100) using the visualization system “UltraVision Quanto Detection System” of the Thermo Scientific company in paraffin sections. Samples were stained with methylene green and mounted using Canadian balsam. In this work we used the methods of optical light microscopy (Olympus BX 51,Japan) and immunohistochemistry. Localization of staining (gland/stroma) and intensity score were determined by the stain intensity (0 – no staining, 1 – weak, 2 – moderate, 3 – strong).Results. The presence of COX-2 expression in the stromal component of the endometrial tissue samples was found from the majority of the examined patients (in 24 cases, 80.0%), however, its levels were recorded only as weakly positive. In glandular endometrial structures, in the presence of endometrial hyperplasia without atypia, the levels of COX-2 expression were characterized by some variability and dependence on structural localization. Thus, in 16 patients (66.7 %) its weakly positive expression was revealed, in 7 examined persons (29.2 %) – moderately stained material. Intensive COX-2 expression was determined in one case (4.1%). COX-2 expression in the hyperplastic endometrium was not detected in 6 samples (20.0%). Morphological signs of chronic endometritis were revealed in 9 investigated samples (30.0 %) – lymphoplasmacytic infiltration, altered pseudostratification of glandular epithelium, lysis of individual epithelial gland structures which were confirmed immunohistochemically: positive expression of CD138 in plasma cells.Conclusions. The study data can serve as one of the criteria for the differential approach to a choice of treatment tactics in patients with a hyperproliferative endometrial pathology including prevention of possible malignant transformation.

Optimization of treatment tactics in patients with abnormal uterine bleeding on the background of benign hyperplastic processes in the uterus

Aim. Optimization of management tactics for patients with abnormal uterine bleeding on the background of benign endometrial and myometrial hyperplastic processes (BEMH) using systemic enzyme therapy. Materials and methods. 90 female patients with BEMH were included. They were divided into three groups: group 1 - women with endometrial hyperplasia, group 2 - women with uterine myoma of small size (6-8 weeks) in combination with endometrial hyperplasia and group 3 - women with endometrial hyperplasia in combination with endometriosis. Systemic enzyme therapy drug was used. Results and conclusions. BEMH are accompanied by inhibition of cellular immunity (pronounced suppression of T-lymphocytes) and excessive activation of humoral immunity. Therefore, an immunomodulatory effect of systemic enzyme therapy at hyperplastic processes is the basis for its prescription for comprehensive treatment of patients with combined endometrial and myometrial hyperplastic processes.