CONTENTSCLINICAL TRIALS OF DRUGS IN GYNECOLOGYLegal aspects of different types of clinical trials of drugs in gynecology are discussed. It is underlined, that there is imperfect legal basis for conducting the trials in gynecology. Suggestion to change some standing orders of current low to improve the quality of clinical trials in gynecology has been introduced. NEW ALGORITHMS OF DIAGNOSIS AND SURGICAL TREATMENT OF PATIENTS WITH COMBINED FORMS OF INCONTINENCE94 women with clinically established diagnosis of incontinence were under complex observation, including cystometry filling, ureter profilometry, uroflowmetry, vaginal 2D and 3D ultrasonic analysis. Independently from the established diagnosis, the treatment was started with the complex of conserva-tive methods. Maintained intermediate and severe incontinence after conservative treatment and stress incontinence were indications for surgical treatment. Algorithms to examine patients with different forms of incontinence were proposed. PROBLEMS OF GESTOSIS AND APPROACHES TO SOLVE THEMIn order to make a prognosis for development of gestosis and arrested development of fetus, the two-stage study was carried out on pregnant women with combined and non-combined gestosis. It was shown that isolation of risk group considering the complex of factors influencing the development of placenta insufficiency and gestosis, rational treatment, based on osmooncotherapy, on-time delivery prevent the increase of severity of gestosis and improve the perinatal outcomes. MECHANISMS OF DEVELOPMENT OF PERINATAL PATHOLOGY AND MORBIDITY OF ADULTSIn order to evaluate the mechanisms of development the perinatal and delayed pathologies in adults, dynamic hormonal, biochemical, genetic, immunological, microbiological, ultrasonic and doplerometric analysis were carried out on 1005 pregnant women. It was found that in case of compli-cated pregnancy, unrelated to the types of pathology, expression of analyzed factors had pathological character. It is suggested that in the protocol of pregnancy course the results of the serum indexes of vasculogenesis stimulators should be included. DEBATABLE ISSUES OF ABDOMINAL DELIVERYThe problem of making choice between physiological delivery and cesarian section was discussed. The role of labor abnormalities, uterine scar and premature birth risk on such choice was evaluated. PROPHYLAXIS OF DEVELOPMENT OF FETUS DISTRESS-SYNDROME DURING CAESARIAN SECTIONClinical and morphological assessment of newborns and their placenta was done on 142 patients delivered by cesarian and 50 patients who had physiological delivery. It was found, that babies delivered by cesarian had two times higher risk of pathological neurological symptoms and longer adaptation period compering with babies delivered physiologically. Placenta morphometry revealed that placenta after cesarian stored much more blood than placenta after physiological delivery. These results can explain the reason to development of fetus distress after cesarian section. To prevent fetus distress, a method of transcranial stimulation of pregnant women 2-3 days before delivery was introduced. THE ETIOLOGICAL ROLE OF UROGENITAL INFECTIONS IN WOMEN WITH TUBAL PREGNANCYMicroflora of fallopian tubes was studied in 170 women with extrauterine pregnancy. It was found that in 85% of the cases the extrauterine pregnancy occurs in women with acute salpingitis. The typical microflora was association of chlamydia, ureaplasma, herpes, Candida and non-specific flora. Typical morphological changes in tissues affected by microorganisms were described. These results are important for rehabilitation of the women and for prevention of reproductive disorders in future. EFFECTS OF CHRONIC UROGENITAL INFECTION ON CHARACTER OF DELIVERY PROCESS358 women with chronic infection inflammatory diseases were under observation for peculiarities of their delivery processes and microbiological characteristics of the uterus. It was found that infectious pathology was accompanied by high frequency of labor abnormalities. The type of these abnormalities was dependent on variant of infectious pathology - mycoplasmatic infections associated with uterine inertia, while chlamydia infection typically associated with uterine hyperactivity. Women with mixture of infectious pathology had different types of uterine abnormalities. These findings should be used to predict the possible risk of labor abnormalities in women with infectious pathology. ADJUVANT AND ALTERNATIVE METHODS TO TREAT PATIENTS WITH HYSTEROMYOMAAdjuvant and alternative methods to treat patients with hysteromyoma were discussed. Basic principals to treat such patients were introduced. Embolization of fallopian tubes was introduced as an alternative to surgical treatment and for maintaining the reproductive function. REPRODUCTIVE POTENTIAL OF TEENA GER GIRLSThe delivery outcomes for baby and mother were studied in women with uterine scar who was given prostaglandin E2 containing gel intracervically and in women with spontaneous delivery. Administration of the drug with the aim to prepare cervix for delivery was successful in 100% of the cases. The natural delivery was induced in 97% of women. Estimation of delivery outcomes revealed the absence of differences between study groups. VAGINAL DELIVERY IN PATIENTS WITH UTERINE SCAR AND UNPREPARED MATERNAL PASSAGESThe delivery outcomes for baby and mother were studied in women with uterine scar who was given prostaglandin E2 containing gel intracervically and in women with spontaneous delivery. Administration of the drug with the aim to prepare cervix for delivery was successful in 100% of the cases. The natural delivery was induced in 97% of women. Estimation of delivery outcomes revealed the absence of differences between study groups. CLINICO-IMMUNOLOGICAL PECULIARITIES OF COURSE AND DIAGNOSIS OF CHRONIC VULVOVAGINITIS IN GIRLS OF PRE-SCHOOL AND EARLY-SCHOOL AGESClinico-immunological peculiarities of course and diagnosis of chronic vulvovaginitis in girls of pre-school and early-school ages were considered. Diagnostic methods of this disease were upgraded for choosing the optimal treatment in case of frequently relapsing course of different etiology. CLINICAL ROLE OF CHECKING THE LEVEL OF REGULATORY AUTOANTIBODIES FOR ESTIMATION OF RISK OF GESTOSISThe prognostic role of evaluation of some regulatory autoantibodies in genesis of gestosis was studied in women with severe gestosis in anamnesis and in women with primary gestosis before development of its clinical signs. Changes of serum regulatory autoantibody levels which were found in women at 16-19 week of pregnancy are considered as an early signs of gestosis. This finding is important for early diagnosis of toxicosis in pregnant women. CLINICO-MORPHOLOGICAL ASPECTS OF CHLAMYDIA LESION OF CERVIX IN WOMENIt was found that women with chlamydia infection have higher frequency of neoplastic processes in cervix. Patients with urogenital chlamydias can be considered as a high risk group for precancer of cervix, and this should be considered for planning of prophylactic measures. PROPHYLAXIS OF DEVELOPMENT OF SECONDARY STERILITY IN PATIENTS WITH TUBAL PREGNANCYEfficacy of single local injection of methotrexate during laparoscopic intervention for prevention of tubal pregnancy was studied. It was found that combined, method including methotrexate injections into the tube close to the place of fetus implantation leads to restoration of reproductive function of fallopian tubes. INTERRELATIONSHIP BETWEEN GYNECOLOGICAL INFLAMMATORY DISEASES AND SYSTEM OF HEMOSTASIS, AND STRATEGY FOR OPTIMIZATION OF INDIVIDUAL TREATMENTState of haemostasis was evaluated in women before and after treatment of inflammatory diseases of genitalia. The relationship between local and systemic inflammatory reaction of genitalia and haemostasis was established. Inhibition of coagulation processes at the beginning of inflammation could be an effective measure to reduce inflammatory response mediated via blood coagulation. PECULIARITIES OF OVARY CANCER MORBIDITY IN ULYANOVSK OBLAST'The morbidity of and mortality from ovary cancer in Ulyanovsk oblast in 1999-2005 were analysed. The role of sex, age and living area of patients as well as morphological type and stage of cancer differentiation was estimated. It was found that there is a tendency to increase the morbidity of and mortality from ovary cancer in all parts of Ulyanovsk oblast, but even higher risk is in the districts where geotectonic fractures is associated with radionuclide pollution. CLINICO-MORPHOLOGICAL ASPECTS OF RENAL DISORDERS IN PATIENTS WITH COARCTATION OF AORTAIn order to find the signs of renal dysfunction and its morphological basis in patients with coarctation of aorta, 111 case history notes and results of 51 autopsy. It was found that coarctation of aorta is associated with remodeling of structure of kidney which was developed as atrophy and sclerosis of renal arteries and glomerulus, as well as dystrophy and necrosis of tubular epithelium. All these disorders lead to loose of proteins, erythrocytes, and leucocytes via tubular system and decrease the concentrating function of kidneys. MORPHOLOGY OF DECOMPENSATION OF HAEMOCIRCULATION IN LIVER DURING PULMONARY TRUNK STENOSISModel of pulmonary trunk stenosis was used on 25 dogs. Structural changes of liver were studied on 9 dogs with circulatory decompensation and 10 control dogs. It was found that decompensation of pulmonary trunk stenosis lead to relaxation of efferent and deferent liver vessels, decreased the number and degree of adaptation processes. In arterial basin of liver increased the sclerotic processes. Chronic venous plethora occurred as a result of all these changes. PECULIARITIES OF MORPHOLOGICAL INDEXES AND QUANTITY EVALUATION OF PERIPHERAL LYMPHOCYTES INPATIENTS WITH ATOPIC BRONCHIAL ASTHMAQuantity and morphological analysis of peripheral blood lymphocytes was carried out in 66 patients with different degree of atopic bronchial asthma and 15 healthy volunteers. The result of electron-microscopy analysis showed significant differences in morphology of lymphocytes of healthy donors and that of patients with intermittent and severe persistent atopic bronchial asthma. Lymphocytes of patients with intermittent atopic bronchial asthma had features similar to that of apoptotic cells, while in patients with severe persistent asthma disorder of apoptotic processes was established which believed is due to abnormalities of biochemical composition of lymphocytes. POTENTIALS OF OZON-ULTRASONIC INFLUENCE IN THE COMPLEX TREATMENT OF PATIENTS WITH INFECTIOUS PANCREONECROSISResults of surgical treatment of 87 patients with infected pancreonecrosis were analysed. It was found that choice of surgical method was dependent not on patient stratification by criteria of severity of acute pancreatitis based on formalised point scales, but mostly on abdomen lesion index and expansion of injury to parapancreatic and retroperitoneal areas. Advantages to use ozon-ultrasonic exposure during infected pancreonecrosis were shown. TREATMENT OF PATIENTS WITH DISLOCATED FRACTURES OF ACETABULUMEfficacy of two methods of treatment of patients with dislocated fractures of acetabulum was analysed. 52 patients of main group were surgically treated with device created by the author, while 52 other patients were mostly treated conservatively. It was found that the results of active surgical treatment were significantly better than those of conservative group. SOME PATHOPHYSIOLOGICAL ASPECTS OF TIC HYPERKINESIS IN CHILDRENComplex clinico-neurophysiological examination of 29 children at the age of 5-15 years old suffering from local and generalized tics was carried out. The significant reduction of the velocity of distribution via cortico-spinal tract was found using a method of magnet stimulation associated by clinical signs of minimal brain dysfunction. Changes of late components of blinking reflex, reflecting condition of polysynaptic reflectory excitation, indicate about the brainstem dysfunction. The data indicate about the deficit of descending inhibitory control anâ the presence of several variants of polysynaptic reflectory excitation in children with tic hyperkinesis. PECULIARITIES OF INTERPERSONAL CONTACTS OF TEENAGERS LIVING IN IODINE-DEFICIT REGIONPeculiarities of interpersonal psychological indexes were studied in young males under 18 years old living in iodine-deficit area, and their relation to endemic goitre was evaluated. It was found that such youngsters need iodine correction not only for prevention of somatic signs of thyroid dysfunction, but also to normalize their deviant behaviour. A HEAD OF HEALTH CARE DEPARTMENT IN COUNTRY SIDES: SOCIAL CHARACTERISTICS, PECULIARITIES OF HEALTH MANPOWER TRAINING AT THE TIME OF REFORMS OF HEALTH CARE SYSTEMThe social portrait of contemporary leader in health care system was established using results of questioning of medical doctors who were on postgraduate education courses in Kirov State Medical Academy. The opinions of chiefs of rural and city hospitals were comparably analysed. Increasing level of competence of health care organisers was found. EPIDEMIOLOGICAL PECULIARITIES OF DISTRIBUTION OF UROGENITAL HERPES IN A BIG CITYRetrospective epidemiological analysis of urogenital herpes morbidity was carried out using data of Kazan city dermato-venereological hospital by studying 2145 outpatient history notes of 2000-2005 years. The quota of urogenital herpes in all sexual transmitted diseases was evaluated. Analysis of longstanding and over-the-year dynamics was carried out, the risk group and risk factors were determined. It was found that the proportion of urogenital herpes in the structure of sexual transmitted diseases has a tendency to increase. © 1995-2008 Kazan State University |