Surgical treatment of genital prolapse in combination with endometrial hyperplastic processes in postmenopausal women

Aim. To study the long-term results of surgical treatment of postmenopausal patients with genital prolapse III and IV according to the POP-Q classification in combination with endometrial hyperplastic processes and to assess their quality of life. Materials and methods. Fifty one elderly and senile patients with grade III–IV prolapse according to the POP-Q classification in combination with endometrial hyperplastic processes. 2 groups were formed: 1st – 21 patients after one-stage vaginal extirpation of the uterus with appendages and unilateral sacrospinous fixation of the vaginal stump with a synthetic endoprosthesis-tape in combination with reconstruction of II and III levels of pelvic floor support according to DeLancey; 2nd – 30 patients after one-stage vaginal extirpation of the uterus with appendages and median colporrhaphy using the Lefort and Neugebauer technique. Results. The study was evaluated 1–7 years after surgical treatment. The average age of patients at the time of surgery in group 1 was 63.12±4.32 years, in group 2 – 74.2±3.28 years. The number of women with somatic pathology in the 1st group was 1.7 times less in percentage terms than in the 2nd. The disappearance of symptoms of an overactive bladder after surgery was noted by 4 (50.0%) of 8 patients of the 1st group and 4 (26.7%) of 15 women of the 2nd. Uroflowmetry after surgical treatment showed an increase in the maximum flow rate (Qmax) and a decrease in the volume of residual urine (Vom) in both groups (p0.001). Recurrence of genital prolapse was detected in the apical region in 1 (4.8%) woman, prolapse of the anterior vaginal wall in 1 (4.8%). There were no recurrences of genital prolapse in the 2nd group. A significant improvement in the quality of life after surgery, according to the results of processing the PFDI-20 questionnaire, was noted by 19 (90.5%) women in the 1st group and 29 (96.7%) – in the 2nd. Conclusion. The long-term results of the proposed operational benefits have shown satisfactory results and can be successfully used in the elderly and senile age. The choice of the volume of surgery taking into account age, sexual activity, concomitant gynecological and somatic pathology reduces the number of complications and improves the results of surgical treatment in this category of patients

Non-surgical management of patients with ectopic pregnancy: A review

An ectopic pregnancy is a medical emergency. Currently, surgery is the main method of therapy, and non-surgical management with methotrexate is considered an acceptable alternative. Methotrexate is a folic acid antagonist and has an inhibitory effect on the proliferation of trophoblast cells. There are various methotrexate regimens; the choice is based on the level of β-subunit of human chorionic gonadotropin, the location of the ectopic pregnancy and the patient's adherence to treatment. Therapy of ectopic tubal pregnancy with methotrexate is an effective and safe alternative to surgical treatment, does not affect the ovarian reserve and preserves the woman's fertility

A Copper-Nitroxide Adduct Exhibiting Separate Single Crystal-to-Single Crystal Polymerization-Depolymerization and Spin Crossover Transitions

© 2016 American Chemical Society.A complex cascade of solid-state processes initiated by variation of temperature was found for the heterospin complex [Cu(hfac)2LMe/Et] formed in the reaction of copper(II) hexafluoroacetylacetonate [Cu(hfac)2] with stable nitronyl nitroxide 2-(1-methyl-3-ethyl-1H-pyrazol-4-yl)-4,4,5,5-tetramethyl-4,5-dihydro-1H-imidazole-3-oxide-1-oxyl (LMe/Et). The cooling of the compound below 260 K initiated a solid-state chemical reaction, which led to a depolymerization of chains and formation of a pair heterospin complex [Cu(hfac)2LMe/Et2][[Cu(hfac)2]3LMe/Et2]. Further decrease in temperature below 144 K led to a spin transition accompanied by a drastic decrease in the effective magnetic moment from 2.52 to 2.24 μB. When the compound was heated, the order of effects was reversed: at first, the magnetic moment abruptly increased, and then the molecular fragments of the pair cluster united into polymer chains. Two hysteresis loops correspond to this cascade of temperature-induced structural transformations on the experimental dependence μeff(T): one at high (T ' = 283 K and T " = 260 K) and the other at low (T= 161 K, T = 144 K) temperature. The spin transitions were also recorded for the [[Cu(hfac)2]3LBu/Et2] and [[Cu(hfac)2]5LBu/Et4] molecular complexes, which are models of the trinuclear fragment of the {[Cu(hfac)2]3LMe/Et2} pair cluster

In vitro maturation for fertility preservation in patients with cancer: A review

According to the World Health Organization, the number of patients of reproductive age with cancer steadily increases. Therefore, improving their quality of life is one of the priority tasks of the medical community. It is known that more than 30% of women with cancer at the time of diagnosis have not yet given birth. Therefore, one of the relevant issues is developing and improving methods for preserving reproductive function. In vitro oocyte maturation is a promising technique of oncofertility, which is used as an alternative to traditional cycles of ovulation stimulation followed by the production of mature oocytes. This review aims to study the in vitro maturation procedure and analyze the literature data regarding its effectiveness and safety when used as a part of programs for preserving reproductive material in patients with cancer

Результаты открытого многоцентрового неинтервенционного исследования клинической эффективности и переносимости эторикоксиба при остеоартрите и неспецифической боли в спине с дополнительной оценкой влияния препарата на «центральные» проявления боли

The formation of chronic musculoskeletal pain (MSP) is a multifactorial process, in its pathogenesis mechanism of central sensitization (CS) plays an important role.Objective: to evaluate the effectiveness of etoricoxib at a dose of 60 mg per day in diseases accompanied by moderate/severe chronic MPS, with an additional analysis of the effect of this drug on the manifestations of CS.Patients and methods. An open observational study, 790 patients (71.6% women, mean age 54.5±13.0 years) with osteoarthritis and chronic nonspecific back pain received etoricoxib 60 mg/day for 2 weeks. The dynamics of pain, dysfunction, fatigue, sleep disturbances, general health assessment (GHA) on a numerical rating scale (NRS 0–10), as well as signs of CS according to part A of the CSI questionnaire were assessed.Results and discussion. After 2 weeks, the intensity of pain during movement, at rest and at night decreased on average by 58.8±24.1, 69.7±32.6 and 70.1±32.8% respectively; functional insufficiency by 58.2±22.5%, fatigue by 52.2±25.8%, GHA by 50.0±22.6%, sleep improvement by 54.3±25.8% was observed (p<0.001 for all parameters). There was a decrease in the CSI value by an average of 33.1±14.5% (p<0.001), as well as a decrease in the number of patients with highly probable CS (CSI ≥40) from 35.3 to 10.3% (p<0.001). No serious drug-related complications were recorded. The overall frequency of adverse reactions was 5.9%, with dyspepsia and hypertension being the most common.Conclusion. Etoricoxib is an effective and relatively safe treatment for chronic MSP. It reduces the severity of CS, one of the central mechanisms of the pathogenesis of chronic MSP.Формирование хронической скелетно-мышечной боли (СМБ) – многофакторный процесс, в патогенезе которого существенную роль играет механизм центральной сенситизации (ЦС).Цель исследования – оценка эффективности эторикоксиба в дозе 60 мг/сут при заболеваниях, сопровождающихся умеренно выраженной/выраженной хронической СМБ, с дополнительным анализом влияния этого препарата на проявления ЦС.Пациенты и методы. Было проведено открытое наблюдательное исследование, в котором 790 пациентов (71,6% женщин, средний возраст 54,5±13,0 лет) с остеоартритом и хронической неспецифической болью в спине в течение 2 нед получали эторикоксиб по 60 мг/сут. Оценивалась динамика боли, нарушения функции, усталости, расстройств сна, общей оценки состояния здоровья (ООСЗ) по числовой рейтинговой шкале (ЧРШ, 0–10), а также признаков ЦС по части А опросника CSI.Результаты и обсуждение. Через 2 нед интенсивность боли при движении, в покое и ночью снизилась в среднем соответственно на 58,8±24,1; 69,7±32,6 и 70,1±32,8%, функциональная недостаточность – на 58,2±22,5%, усталость – на 52,2±25,8%, ООСЗ – на 50,0±22,6%, наблюдалось улучшение сна на 54,3±25,8% (р<0,001 для всех параметров). Было отмечено снижение значения CSI в среднем на 33,1±14,5% (р<0,001), а также числа пациентов с высоковероятной ЦС (CSI≥40) с 35,3 до 10,3% (р<0,001). Не было зафиксировано серьезных лекарственных осложнений. Общая частота нежелательных реакций составила 5,9%, наиболее часто встречались диспепсия и артериальная гипертензия.Заключение. Эторикоксиб является эффективным и относительно безопасным средством для контроля хронической СМБ. Он снижает выраженность ЦС – одного из центральных механизмов патогенеза хронической СМБ

Legal and Psychological Aspects of Mediation

The article focuses on gradual innovation of mediation into the practice of social conflict resolution in the light of legal and psychological means of mediation. While mediation is perceived as a conflictological concept and is more widely used in dispute settlement and resolution, a new interdisciplinary field of theoretical knowledge with its own conceptual framework as well as a new professional and practical field are beginning to form both in Russia and in other countries. As theoretical and practical aspects of innovation in mediation require consolidation not only for its national development but also for the guaranteed international cooperation, the article touches upon some of the particular theoretical issues of the topic in question: terminological consistency, consolidation of the system of mediation principles, the phenomenon of juridisation of mediation and its limits

Correction of iron deficiency anemia in patients with obstetric and gynecological pathology (pharmacoeconomic comparative analysis)

Correction of iron deficiency anemia in patients with obstetric and gynecological pathology (pharmacoeconomic comparative analysis) Dobrohotova Yu.E., Markova E. A. Pirogov Russian National Research Medical University, Moscow The authors provide a systematic comparative analysis of data on the clinical and cost effectiveness of ferrous iron preparation (Tardyferon®, Pierre Fabre Medicament Production, France) and its analogues and preparations of ferric iron in the treatment of iron deficiency anemia (IDA) in patients in obstetric and gynecological practice. The review of foreign and Russian articles, published in Pubmed over the past 15 years, is given. Modern data on the comparative effectiveness of iron preparations for the correction of IDA with their clinical and pharmacoeconomic evaluation are presented. Ferrous iron (ferrous sulfate) with retarded release (Tardyferon®, Pierre Fabre Medication Production, France) has a more pronounced effect on the dynamics of hematological parameters in comparison with its analogues and ferric iron preparations. Pharmacoeconomic analysis showed the advisability of using ferrous iron with retarded release for the correction of IDA in patients with obstetric and gynecological pathology. The optimal ratio of efficiency, price, availability, convenience&nbsp; of the drug regimen ensures a high compliance of patients to the treatment, which allows achieving high clinical results in the treatment of IDA. Key words: pharmacoeconomic analysis, iron deficiency anemia, iron preparations, pregnancy, iron deficiency, Tardyferon. For citation: Dobrohotova Yu.E., Markova E.A. Correction of iron deficiency anemia in patients with obstetric and gynecological pathology (pharmacoeconomic comparative analysis) // RMJ. 2018. № 2(I). P. 29–33.<br

Antiseptics... Renaissance in the therapy of vulvovaginal infections or new perspectives and expectations?

Antiseptics… Renaissance in the therapy of vulvovaginal infections or new perspectives and expectations? Dobrokhotova Yu.E., Semioshina O. E. Pirogov Russian National Research Medical University, Moscow Vulvovaginal infections are one of the most common obstetric and gynecological diseases and one of the main causes of applying to the gynecologist. In recent years, the prevalence of mixed infections has become a characteristic feature. However, the preventive administration of antibiotics as the first line therapy is erroneous and unacceptable, given the rapidly decreasing effectiveness of antibacterial drugs and constantly increasing resistance of microorganisms. A good alternative to the initial (and sometimes – the only) stage of treatment of mixed vulvovaginal infections may be the use of antiseptic drugs, in particular, based on iodine, which has a number of significant advantages (pluripotent effect, good penetrating power, including biofilm penetrating, low acquired resistance formation, good local tolerance, etc.). To neutralize the strong oxidative effect of the iodine molecule on healthy cells and body tissues, a complex compound of halogen and an inert synthetic polymer of polyvinylpyrrolidone (Betadine) was created. Vaginal suppositories Betadine can be used as an initial step in the therapy of vaginal infections even before the results of bacteriological cultures test are obtained. Key words: vaginal biocenosis, disbiosis, vulvovaginal infections, vaginitis, antiseptics, povidone – iodine, alternative to antibacterial drugs, antibiotic resistance, combination drugs, pluripotent effect. For citation: Dobrokhotova Yu.E., Semioshina O.E. Antiseptics… Renaissance in the therapy of vulvovaginal infections or new perspectives and expectations ? // RMJ. 2018. № 2(I). P. 39–42.<br

Uterine fibroids in premenopausal women

Uterine fibroids are one of the commonest benign pelvic tumours with an estimated incidence of 20–40% in women during their reproductive years. Incidence rates for uterine fibroid diagnoses were highest in premenopausal age. The gynecologists are frequently faced with need for the administration of menopausal hormone therapy (MHT) in this group of patients with the onset of symptoms associated with estrogen deficiency; however, uterine fibroids represent a relative contraindication for the administration of MHT. In the present paper, we point out the need for conservative therapy of uterine fibroids in premenopausal patients to prepare for the administration of MHT. The paper reflects the efficacy of the drug treatment of uterine fibroids using antigestagens (gynestril)

Contraception in premenopausal women

The article tells about methods of contraception for women in premenopausal age. Levonorgestrel intrauterine device (LNG-IUD) is a highly effective method of contraception in this age group. Locally acting levonorgestrel reduces the duration of bleeding during menstruation and has a therapeutic benefit in the treatment of endometrial hyperplasia