Патогенез опущения влагалища с формированием ректоцеле

To carry out a systematic analysis of the data available in the modern literature on the pathogenesis of the formation of vaginal prolapse with the formation of rectocele rectum. The failure of the pelvic floor, namely its posterior compartment with the formation of a rectocele against the background of the lowering of the posterior vaginal wall, continues to be one of the most common gynecological diseases. This article presents an analysis of current literature data on the pathogenesis of pelvic organ prolapse with the formation of rectocele. Analyzing the above-mentioned data, it can be noted that the research data of recent years have significantly expanded the understanding of the etiology and pathogenesis of pelvic organ prolapse in its posterior compartment. However, the issues of etiology and pathogenesis of genital prolapse in patients of reproductive age, the role of individual risk factors and their combinations, pathogenetic mechanisms of development are still far from being resolved. Unfortunately, none of the above theories fully explains all the reasons for the formation of pelvic organ prolapse in its posterior compartment.Проведен систематический анализ данных, имеющихся в современной литературе, относительно патогенеза формирования опущения влагалища с формиро- ванием ректоцеле. Несостоятельность тазового дна, а именно заднего компартмента с формированием ректоцеле на фоне опущения задней стенки влагалища, продолжает оставаться одним из наиболее распространенных гинекологических заболеваний. В статье представлен анализ современных данных литературы о патогенезе пролапса тазовых органов (ПТО) с формированием ректоцеле. Исследования последних лет заметно расширили представления об этиологии и пато- генезе ПТО в его заднем компартменте. Однако вопросы этиологии и патогенеза генитального пролапса у пациенток репродуктивного возраста, роли отдельных факторов риска и их сочетаний, патогенетические механизмы развития все еще далеки от окончательного решения. К сожалению, ни одна из существующих теорий полностью не объясняет все причины формирования ПТО в его заднем компартменте

Efficacy of laser remodeling in the genitourinary syndrome of menopause: A review

The real-world treatment of genitourinary syndrome of menopause has several limitations: contraindications to topical estrogen therapy, which is currently recognized as the "gold standard" treatment for vulvovaginal atrophy (VVA), fear of the systemic effects of topical estrogens or/and carcinophobia, and poor compliance of patients to intravaginal agents. Therefore, there is an unmet need for alternative noninvasive or minimally invasive therapies, mostly non-hormonal. A PubMed, Cochrane Library, Science Direct, and ELibrary databases were searched for the keywords CO2-laser, Er:YAG-laser, vulvovaginal atrophy, genitourinary syndrome of menopause, treatment, postmenopausal age for 20122022. Remodeling microablative laser therapy using carbon dioxide (CO2) is a promising method for treating VVA, acting pathogenetically and symptomatically. CO2 laser relieves VVA symptoms and improves the condition of the vaginal mucosa by enhancing regeneration and restoring vaginal pH. However, evidence of the efficacy and long-term safety of the method, obtained in high-quality studies, is needed before the method can be introduced into widespread clinical practice. Aim. To analyze and summarize the evidence-based and experimental data on the efficacy and safety of laser therapy for VVA and genitourinary syndrome of menopause

Vulvovaginal atrophy in the peri- and post-menopause: relevance and impact on quality of life

Vulvovaginal atrophy (VVA) is detected in more than 50% of postmenopausal women, and at 4049 years of age, 15-19% of women have relevant signs. Atrophic changes in the female urogenital system are associated with hypoestrogenism, which results in the defective synthesis of collagen and elastin due to reduced functional activity of fibroblasts. Although the symptoms of genitourinary syndrome of menopause significantly impair the quality of life, women rarely seek medical help for urogenital symptoms, considering them a normal condition for the period of aging. We searched Cochrane Library, PubMed, Science Direct, and ELibrary databases for the keywords vulvovaginal atrophy, genitourinary syndrome of menopause, quality of life, epidemiology, and postmenopausal age for 20122022. The literature review suggests that the prevalence of VVA is extremely high but underestimated due to the infrequent seeking of medical care by female patients with relevant symptoms. The genitourinary syndrome of menopause dramatically impacts patients' quality of life, but not all women eligible for treatment receive it. One of the reasons for refusing hormonal treatment is patients' fear of the systemic effects of hormonal drugs. There is an unmet need for alternative non-hormonal therapies. The objective is to analyze and systematize the scientific data accumulated over the past ten years on the epidemiology of VVA, its impact on patients' quality of life, and the challenges in diagnosing and treating the disease

Metabesity: pathogenetic bases and predictive capabilities. A review

One of the most pressing problems of our time is obesity, recognized by the WHO as a pandemic of the XXI century. It is important to remember that obesity is a full-fledged nosological entity, but many women think that obesity is just a problem of beauty and aesthetics. It is important to note that this nosology has a number of serious consequences, starting with the development of cardiovascular disease and ending with cancer. However, the “problem in the problem” is the so-called “metabesity” – a new term that reflects a number of diseases, the pathogenesis of which is based on the metabolic syndrome. Obesity, metabolic syndrome and metabesity seem to be different concepts, but the absolute identity of the pathogenetic basis characterizes them as successive stages of one global process. In this regard, it is necessary to highlight the key mechanisms of the development of the described disorders and to consider the concept of clinical management of patients in this cohort

Nivolumab plus Ipilimumab versus Sunitinib in advanced renal-cell carcinoma

BACKGROUND: Nivolumab plus ipilimumab produced objective responses in patients with advanced renal-cell carcinoma in a pilot study. This phase 3 trial compared nivolumab plus ipilimumab with sunitinib for previously untreated clear-cell advanced renal-cell carcinoma. METHODS: We randomly assigned adults in a 1:1 ratio to receive either nivolumab (3 mg per kilogram of body weight) plus ipilimumab (1 mg per kilogram) intravenously every 3 weeks for four doses, followed by nivolumab (3 mg per kilogram) every 2 weeks, or sunitinib (50 mg) orally once daily for 4 weeks (6-week cycle). The coprimary end points were overall survival (alpha level, 0.04), objective response rate (alpha level, 0.001), and progression-free survival (alpha level, 0.009) among patients with intermediate or poor prognostic risk. RESULTS: A total of 1096 patients were assigned to receive nivolumab plus ipilimumab (550 patients) or sunitinib (546 patients); 425 and 422, respectively, had intermediate or poor risk. At a median follow-up of 25.2 months in intermediate- and poor-risk patients, the 18-month overall survival rate was 75% (95% confidence interval [CI], 70 to 78) with nivolumab plus ipilimumab and 60% (95% CI, 55 to 65) with sunitinib; the median overall survival was not reached with nivolumab plus ipilimumab versus 26.0 months with sunitinib (hazard ratio for death, 0.63; P<0.001). The objective response rate was 42% versus 27% (P<0.001), and the complete response rate was 9% versus 1%. The median progression-free survival was 11.6 months and 8.4 months, respectively (hazard ratio for disease progression or death, 0.82; P = 0.03, not significant per the prespecified 0.009 threshold). Treatment-related adverse events occurred in 509 of 547 patients (93%) in the nivolumab-plus-ipilimumab group and 521 of 535 patients (97%) in the sunitinib group; grade 3 or 4 events occurred in 250 patients (46%) and 335 patients (63%), respectively. Treatment-related adverse events leading to discontinuation occurred in 22% and 12% of the patients in the respective groups. CONCLUSIONS: Overall survival and objective response rates were significantly higher with nivolumab plus ipilimumab than with sunitinib among intermediate- and poor-risk patients with previously untreated advanced renal-cell carcinoma

Radiocontrast nephropathy: is it dose related or not?

Objective: To assess the safety of high dose non-ionic contrast media during a single radiological procedure in patients with pre-existing renal impairment.Methods: One hundred eighteen patients, with serum Creatinine greater than 1.3 mg/dl who were undergoing coronary angiography or percutaneous transluminal coronary angiography (PTCA) were included in the study. All patients received the nonionic dye ULTRAVIST (lopromide). Serum creatinine were measured before, 48 hours and 1 week after the administration of contrast agent. An acute contrast induced reduction in renal function was defined as an increase in Serum Creatinine concentration of \u3e=0.5 mg/dl, 48 hours after the administration of contrast agent. All patients with end stage renal disease or patients undergoing coronary bypass surgery within a week after coronary angiography or had any concomitant factors that could cause acute renal failure e.g., sepsis, hypotention, etc., were excluded. Patients receiving a dose of upto 100 ml of contrast agent (low dose group) were separated from those who received greater than 100 ml of contrast agent (high dose group). Patients in both groups had similar characteristics in terms of sex, age, weight and underlying disease. Student\u27s t-test was used for statistical analysis.Results: The mean age of our patients was 62.3+/-8.83 (range 40-84 years). There were 93 (78.8%) males and 25 (21.2%) females. The mean pre-contrast creatinine in the low contrast group was 1.97+/-0.92 and high dose group was 2.16+/-1.90 (p=0.48). The post-contrast Creatinine at 48 hours was 2.11+/-1.11 and 2.06+/-1.39 in the groups receiving low and high dose contrast agents respectively (p=0.830), while at 7 days post-contrast it was 2.17+/-1.28 and 1.95+/-1.43 respectively in the two groups (p=0.391). The contrast-induced reduction in renal function (rise in serum Cr \u3e=0.5 mg/dl above base line) occurred in 14% (n=8) of patients in low dose and in 11% (n=7) in high dose contrast group (p=0.830, insignificant).CONCLUSION: The results of our study confirm that high dose non-ionic contrast is not associated with increased risk of contrast-mediated nephrotoxicity in patients with pre-existing renal insufficiency undergoing cardiac angiography (p=0.830, insignificant)

Синдром поликистозных яичников и ожирение: современная парадигма

Polycystic ovary syndrome is a heterogeneous endocrine disease that affects women of childbearing age. The pathogenesis of polycystic ovary syndrome has not been fully studied to date, its paradigm considers the genetic determinism of the manifestation of hormonal and metabolic disorders, which are considered to be criteria for the verification of the disease (hyperandrogenism, oligo/anovulation and/or polycystic ovarian transformation during ultrasound examination (ultrasound). This review discusses the main ways of interaction between hyperandrogenism, insulin resistance and obesity and their role in the pathogenesis of polycystic ovary syndrome, as well as possible methods of treatment for this category of patients. The review analyzes the role of hyperandrogenism and insulin resistance in the implementation of the genetic scenario of polycystic ovary syndrome and finds out the reasons why women with polycystic ovary syndrome often demonstrate the presence of a «metabolic trio» - hyperinsulinemia, insulin resistance and type 2 diabetes mellitus. It is noted that obesity is not included in the criteria for the diagnosis of polycystic ovary syndrome, but epidemiological data confirm the existence of a relationship between these diseases. Obesity, especially visceral, which is often found in women with polycystic ovary syndrome, enhances and worsens metabolic and reproductive outcomes with polycystic ovary syndrome, as well as increases insulin resistance and compensatory hyperinsulinemia, which, in turn, stimulates adipogenesis and suppresses lipolysis. Obesity increases the sensitivity of tech cells to luteinizing hormone stimulation and enhances functional hyperandrogenism of the ovaries, increasing the production of androgens by the ovaries. Excess body weight is associated with a large number of inflammatory adipokines, which, in turn, contribute to the growth of insulin resistance and adipogenesis. Obesity and insulin resistance exacerbate the symptoms of hyperandrogenism, forming a vicious circle that contributes to the development of polycystic ovary syndrome. These data allow us to conclude that bariatric surgery can become an alternative to drugs (metformin, thiazolidinedione analogs of glucagon-like peptide-1), which has shown positive results in the treatment of patients with polycystic ovary syndrome and obesity.Синдром поликистозных яичников представляет собой гетерогенное эндокринное заболевание, которым страдают женщины детородного возраста. Патогенез синдрома поликистозных яичников на сегодняшний день до конца не изучен, его парадигма рассматривает генетическую детерминированность манифестации гормональных и метаболических нарушений, которые принято считать критериями верификации заболевания (гиперандрогения, олиго/ановуляция и/или поликистозная трансформация яичников при ультразвуковом исследовании. В данном обзоре рассмотрены основные пути взаимодействия гиперандрогении, инсулинорезистентности и ожирения и их роль в патогенезе синдрома поликистозных яичников, а также возможные методы лечения данной категории пациенток. В обзоре анализируется роль гиперандрогении, и инсулинорезистентности в реализации генетического сценария синдрома поликистозных яичников и выясняются причины, почему женщины с синдромом поликистозных яичников часто демонстрируют наличие «метаболического трио» - гиперинсулинемии, резистентности к инсулину и сахарного диабета 2 типа. Отмечается, что ожирение не входит в критерии постановки диагноза синдрома поликистозных яичников, но эпидемиологические данные подтверждают наличие взаимосвязи между этими заболеваниями. Ожирение, особенно висцеральное, которое часто встречается у женщин с синдромом поликистозных яичников, усиливает и ухудшает метаболические и репродуктивные исходы при синдроме поликистозных яичников, а также увеличивает резистентность к инсулину и компенсаторную гиперинсулинемию, что, в свою очередь, стимулирует адипогенез и подавляет липолиз. Ожирение повышает чувствительность тека-клеток к стимуляции лютеонизирующим гормоном и усиливает функциональную гиперандрогению яичников, повышая выработку андрогенов яичниками. Избыток массы тела ассоциирован с большим количеством воспалительных адипокинов, которые, в свою очередь, способствуют росту резистентности к инсулину и адипогенез. Ожирение и инсулинорезистентность усугубляют симптомы гиперандрогении, образуя порочный круг, способствующий развитию синдрома поликистозных яичников. Приведенные данные позволяют сделать вывод, что альтернативой лекарственным средствам (метформин, тиазолидиндионоы аналоги глюкагоноподобного пептида-1) может стать бариатрическая хирургия, показавшая положительные результаты лечения пациенток с синдромом поликистозных яичников и ожирением

Extra temporal involvement in herpes simplex encephalitis

Temporal lobe abnormalities on brain imaging have been described as strong evidence for herpes simplex encephalitis (HSE) in appropriate clinical settings. Extra temporal abnormalities are less well described in these patients. We retrospectively reviewed 20 patients of HSE and found extra temporal involvement in 11 (55%) patients. Three patients (15 %) had pure extra temporal abnormalities. Twelve patients (60%) had temporal lobe involvement, four patients (20%) had pure temporal lobe involvement and five patients (25%) had normal CT/MRI scans. Our study suggests that extra temporal involvement on brain imaging is common in HSE and in a significant minority of the patients this can even be the sole abnormality