Hysterectomy among obese patients

This article presents results of laparoscopic hysterectomy among obese patients. Technical aspects, complications rate, operative time, length of hospital stay in relation to BMI were analyzed. Also we present results of international surgical experience of extremely overweight cases

IMMUNOLOGICAL ASPECTS OF ENDOMETRIAL DISEASE

Background: Immunological processes involving peritoneal macrophages could play a critical role in pathophysiology of external genital endometriosis.Aim: To assess levels of MCP-1, RANTES, and C-reactive protein and to identify their correlations with endometriosis.Materials and methods: Seventy two patients were evaluated: 26 healthy controls and 46 with endometriosis. Patients were divided into groups as follows: 17 with superficial endometriosis, 18 with endometriomas and 11 with deep infiltrative endometriosis. All patients underwent a laparoscopy during the proliferative phase of the cycle; levels of peritoneal and serum MCP-1, RANTES and C-reactive protein were measured using standard ELISA assays.Results: There were positive correlations between serum MCP-1 (p = 0.03) and C-reactive protein(p = 0.045) and severity of endometriosis, that could indicate malfunctioning of peritoneal macrophages in advanced stages of endometriosis. Conclusion: MCP-1 and C-reactive protein levels in peripheral blood can be used as markers of endometriosis activity

THE PROCALCITONIN TEST AS A NEARLY CRITERION TO DIAGNOSE SEVERE FORMS OF INTRAUTERINE INFECTIONS AND TO MONITOR ANTIBACTERIAL TREATMENT IN EARLY NEONATAL PERIOD

Background: Research in the field of reliable and available tests to diagnose infectious and inflammatory disorders in newborns in their first two days of life, as well as for determination of indications to antibacterial treatment and its monitoring in the early neonatal period are of utmost importance. Aim: To improve quality of diagnostics of intrauterine infections and to optimize management strategies for newborns with a high risk of infections by means of the procalcitonin test in the early neonatal period.Materials and methods: We assessed 40 normal (on-term) and 10 pre-term newborns born to mothers with infectious and inflammatory urogenital disease. Group 1 (n = 21) included patients with intrauterine pneumonia, group 2 (n = 6), those with intrauterine infection without a clearly defined primary locus, group 3 (n = 13), those with non-infectious disorders and group 4 (n = 10) comprised clinically normal (healthy) newborns. All infants underwent standard clinical and laboratory assessments, including an assessment of procalcitonin level by means of a semi-quantitative procalcitonin express-test (BRAHMS) at days 1, 2 and 3 of life. Results: At day 1, during primary assessment of newborns from group 1, procalcitonin values above 2 ng/mL were measured in 67% (10 of 15) cases; at days 2 and 3 also in 67% (4 of 6). Two patients with low procalcitonin values (below 0.5 ng/mL) had a disease of viral etiology (in 1, enteroviral and in 1, cytomegaloviral). In group 2, procalcitonin values exceeded 2 ng/mL in 3 of 5 newborns. In none of the infants from groups 3 and 4 procalcitonin values exceeded 2 ng/mL during their first 3 days of life. For assessment of efficacy of antibacterial treatment based on procalcitonin levels, all newborns with intrauterine infections were divided into group А (n = 11), where an antibacterial regimen was changed, and group B (n = 16), with no change in antibacterial treatment. During the treatment, 5 newborns from group A (45.5%) had their procalcitonin levels unchanged, whereas in 6 (54.5%) patients it decreased. In group B, 12 (75%) of newborns had their procalcitonin levels unchanged, in 2 (12.5%) it went down and in 2 (12.5%) of patients it went up. Conclusion: A semi-quantitative procalcitonin expresstest is characterized by its high informativity and availability when used in newborns of various gestation ages in the early neonatal period. An increase of procalcitonin level above 2 ng/mL, starting from the first day of life, can be used as an early diagnostic criterion of severe forms of intrauterine infections associated with systemic inflammatory response and symptoms of organ insufficiency. The results of procalcitonin test can be used for monitoring of antibacterial treatment in newborns

COMPLICATIONS AND OUTCOMES OF PREGNANCY IN CHRONIC KIDNEY DISEASE

Pregnancy in women with kidney disorders, even with preserved renal function, is associated with higher than in the population rates of obstetric and perinatal complications, such as eclampsia, preterm delivery, surgical deliveries and intensive care for newborns.This article presents our own data on complications and outcomes of pregnancies in 156 women with various stages of chronic kidney disease (CKD). From these, 87 patients had CKD stage I, 29 with CKD stage II and 40 with CKD stages III, IV, V. For the first time in Russia, the authors summarize their unique experience in management of pregnancy with CKD, underline a high probability (27,5%) of its primary detection during pregnancy, discuss the algorithms of assessment, prevention and treatment of various gestational complications in CKD (pre-eclampsia, urinary tract infections, feto-placental insufficiency, anemia, acute renal damage), as well as the influence of pregnancy on renal function at long-term post-delivery. A direct correlation between the CKD stage, frequency of pre-eclampsia, feto-placental insufficiency, preterm deliveries, surgical deliveries by caesarean section and babies’ status at birth is demonstrated.Based on their ample clinical material, they confirmprobability of favorable pregnancy outcomes in CKD patients with stable renal function without severe arterial hypertension during pregnancy: for a baby in 87%, for the mother in 90% (maintenance of the same CKD stage). The risk of persistent deterioration of renal function during pregnancy and puerperium in women with CKD is higher in CKD stage IV, as well as in the case of early development of pre-eclampsia; it also correlates with severity of the latter.The probability of a favorable obstetric and nephrological outcome is higher when the pregnancy is planned and intensively co-managed by an obstetrician/gynaecologist and a nephrologist from early weeks of gestation onwards