Bowel diseases and constipation in practice of the obstetrician and gynecologist

The aim of review. To present up-to-date data on etiology, pathogenesis and treatment of constipation in women of various age groups and at combined gynecologic diseases.Summary. Prevalence of functional constipation in women is almost twice higher, than in men. Predisposition of women to constipation is predetermined by anatomic, physiological and hormonal factors. In obstetrical practice constipation is associated with pregnancy and postnatal period, inflammatory and noninflammatory gynecologic diseases. This review presents modern management approaches at this pathology from gynecological point of view.Conclusion. Disorders of intestinal function in women are interdisciplinary issue. At constipated female patients detection of intestinal dysfunction etiology and improvement of management, it is necessary to pay attention not only to gastroenterological symptoms, but also to possible relation of symptoms to menstrual cycle, reproductive status and gynecologic pathology. Constipation at gynecologic diseases require treatment because disorders of bowel function in the most cases complicate course of gynecologic disorder and reduces treatment response rate

Justification of the choice of the program of rehabilitation of young children with cystic fibrosis

The problem discussed in this article is medical rehabilitation of early aged children with cystic fi-brosis. The study was conducted in the Children City hospital named after Saint Olga and State Center of cystic fibrosis. Physiotherapy selection criteria, rehabilitation essiciency assessment, kinesitherapy algorithms in early aged children were suggested. It was proved that such rehabilitation programmes were effective in children with cystic fibrosis in the dynamic of one year treatment.В статье обсуждаются проблемы реабилитации детей раннего возраста с муковисцидозом. Исследование проводилось на базе СПбГБуЗ «Детская городская больница имени Святой Ольги» и Городского Центра муковисцидоза. Предложены критерии подбора средств лечебной физкультуры, оценки эффективности реабилитации, алгоритм назначения средств лечебной физкультуры у детей раннего возраста. Доказана эф фективность подобранных программ реабилитации для данных групп детей с муковисцидозом в динамике одного года лечения

Бактериальные инфекции у пациентов детского и подросткового возраста после трансплантации аллогенных гемопоэтических стволовых клеток: этиология, структура, факторы риска

155 children and adolescents who had been diagnosed oncohematological diseases and had undergone allogeneic hemapoetic stem cell transplantation were examined. In post-transplant period 80% of patients developed different bacterial complications. Main risk factors of bacterial infections were acute leukemia (73%), acute «graft versus host disease» (61%), severe infectious complications before HSCT (30%), cytomegaloviral reactivation (51%). Main causative agents were Kl. pneumoniae (15%), Escherichia coli (8%), Enterobacter sp. (7%), Pseudomonas sp. (6,5%), Enterococcus sp. (16,5%), S.еpidermidis (13,5%). Most frequent involved sites are urinary tract (30,6%), lungs (22,5%) and bacteriemia (38,7%). Rise in ciprofloxacin resistans among Entorobactri, aerobic and Gram-positive cocci. General survival rate of patients with bacterial complications was 36,3% (p<0,001). Number of infectious episodes and their severity were statistically significant (both p<0,001) deteriorating factor for general surviral rate.Обследовано 155 пациентов детского и подросткового возраста со злокачественными заболеваниями системы крови после трансплантации аллогенных гемопоэтических стволовых клеток (алло-ТГСК). У 80% больных на разных этапах после алло-ТГСК развились бактериальные осложнения различной степени тяжести. Основными факторами риска бактериальных инфекций были диагноз острого лейкоза (73%), развитие острой «реакции трансплантат против хозяина» (61%), тяжелые инфекционные осложнения в анамнезе до трансплантации (30%), реактивация цитомегаловирусной инфекции (51%). Основные возбудители: Kl. pneumoniae (15%), Escherichia coli (8%), Enterobacter sp. (7%), Pseudomonas sp. (6,5%), Enterococcus sp. (16,5%), S. еpidermidis (13,5%). Наиболее часто возникает поражение мочевыводящих путей (30,6%), легких (22,5%) и бактериемия (38,7%). Отмечен рост резистентности к ципрофлоксацину среди энтеробактерий, аэробной и грам-положительной кокковой флоры. Общая выживаемость больных с развившимися бактериальными осложнениями составила 36,3% (p<0,001). Статистически значимо ухудшает показатели общей выживаемости больных с бактериальными инфекциями количество инфекционных эпизодов (p<0,001) и их тяжесть (p<0,001)

Clinical presentation, diagnosis and treatment of intrahepatic cholestasis of pregnancy

Aim of the lecture. To present the modern concept of etiology and pathogenesis of the intrahepatic cholestasis of pregnancy (ICP) and the modern diagnostic and treatment approaches to gastroenterologists. Summary. The etiology and pathogenesis of ICP are related to disorders of bile acid metabolism caused by hormonal factors (elevation of estrogen and progesterone levels) and genetic predisposition. The leading clinical signs of ICP include pruritus and jaundice that develop most commonly in the third trimester of pregnancy, and characteristic changes of laboratory scores: increase in bile acid level (over 10 mcmol/l) and moderate elevation of transaminase activity. Severity of ICP and complication risk for mother and fetus correlate to the degree of bile acids elevation. The most effective agent for ICP treatment is ursodeoxycholic acid (UDCA). Conclusion. Timely diagnostics of ICP and early UDCA administration, fetus condition control and early delivery at severe ICP cases allows to prevent development of serious complications and to achieve favorable pregnancy outcome

Features of pathogenesis, diagnostics and treatment of gallstone disease at pregnancy

The aim of review. To highlight the modern concept of the gallstone disease (GSD) pathogenesis at pregnancy and to discuss modern diagnostic and treatment approaches. Summary. The risk of biliary sludge and cholesterol gallstones at pregnancy is significantly increased that is caused mainly due to elevation of estrogen and progesterone level leading to increased cholesterol synthesis, decreased gallbladder contractility and, as a result, to increased lithogenicity of bile. Clinical presentation of GSD at pregnant patients is similar to that at nonpregnant women. Transabdominal ultrasound investigation play the major role in diagnosis of cholelithiasis at pregnancy. For treatment of symptomatic GSD forms in this the period active surgical approach is becoming more and more common. Laparoscopic cholecystectomy is a method of choice, and the optimal term for its implementation is the second trimester of pregnancy. Prevention and treatment of biliary sludge in pregnancy may be carried out by ursodeoxycholic acid. Conclusion. Increased risk of cholelithiasis at pregnant women requires further improvement of management approach and search for better methods for treatment and prophylaxi

Administration of Sex Hormone Preparations as a Risk Factor in the Development of Intrahepatic Cholestasis of Pregnancy and Biliary Sludge in Pregnant Women

Sex hormone preparations are widely used in obstetrics for the treatment of infertility and miscarriage. Possible adverse effect of sex hormone preparations during pregnancy is their potential adverse impact on the hepatobiliary system. The most common pathology of the liver and gallbladder associated with pregnancy are intrahepatic cholestasis of pregnancy (ICP) and biliary sludge (BS).Aim.  The aim of the study is to evaluate the effect of female sex hormones on the course and effectiveness of treatment of ICP and BS during pregnancy. Materials and methods.  The study included 158 pregnant women (97 patients with ICP and 61 patients with BS). Exogenous hormonal effects were the use of assisted reproductive technologies (ARTs) and in vitro fertilization (IVF) for the onset of conception and/or the use of estrogen and progesterone preparations during pregnancy. ICP was diagnosed on the basis of detection of an elevated level of bile acids (above 8 μmol/L) in the blood serum. Patients underwent clinical, laboratory and instrumental studies (abdominal ultrasound, including the assessment of gallbladder motor-evacuator function initially and after 2 months of treatment, and pelvic ultrasound). Pruritus intensity associated with ICP was assessed using a 0–3 score scale. Patients with BS received treatment with ursodeoxycholic acid (UDCA) in a dose of 250–750 mg and choleretic herbal preparation (artichoke extract) for 2 months. Patients with ICP were treated with UDCA in a dose of 500–2000 mg until delivery. Biochemical laboratory parameters in the ICP group were evaluated after 1 and 2 weeks of treatment.Results.  More than half of patients with BS and ICP were taking sex hormone preparations or had a pregnancy that occurred after the application of ART programs. In patients who became pregnant after ART, the ICP developed at a significantly earlier time than in patients with a naturally occurring pregnancy (p < 0.001). The use of sex hormones proved to be interrelated with a high frequency of cholestasis recurrence after its regression in the course of the treatment (p < 0.001). Patients with pregnancy after ART programs, as well as taking sex hormones, had an increased risk of BS developement. The intake of sex hormones (p = 0.005) in patients with ICP was associated with a more frequent development of preeclampsia and the need for caesarean section (p = 0.003). The use of ART programs and hormonal therapy, as well as the presence of BS in patients with ICP, were interrelated with oxidative stress. BS on the ICP background was associated with the development of intrauterine fetal hypoxia. In pregnant women with BS, the reception of progestins was significantly (p = 0.004) correlated with functional impairment of the motor function of the biliary tract (BT). In the presence of BS, ICP occurs with more severe liver damage, and the patients are inferior to respond to UDCA treatment. Prognostic factors in the insufficient effectiveness of BS treatment: the use of sex hormone preparations during pregnancy, the presence of the polycystic ovary syndrome (PCOS) in the anamnesis, an older age at the time of pregnancy and conception after ART.Conclusion. The use of sex hormone preparations and ART programs are shown to be additional factors contributing to the emergence of ICP and BS during pregnancy. For the pregnant women taking sex hormone preparations and/or becoming pregnant after ART programs, it is important to conduct laboratory and ultrasound screening for early detection and timely treatment of ICP and BS. BC patients of older ages who have become pregnant after ART programs and take sex hormones preparations and/or have a PCOS in an anamnesis may need longer or repeated courses of BS treatment

Bacterial infections in pediatric and adolescent in allogeneic hematopoietic stem cell transplantation recipients: etiology, structure, risk factors

155 children and adolescents who had been diagnosed oncohematological diseases and had undergone allogeneic hemapoetic stem cell transplantation were examined. In post-transplant period 80% of patients developed different bacterial complications. Main risk factors of bacterial infections were acute leukemia (73%), acute «graft versus host disease» (61%), severe infectious complications before HSCT (30%), cytomegaloviral reactivation (51%). Main causative agents were Kl. pneumoniae (15%), Escherichia coli (8%), Enterobacter sp. (7%), Pseudomonas sp. (6,5%), Enterococcus sp. (16,5%), S.еpidermidis (13,5%). Most frequent involved sites are urinary tract (30,6%), lungs (22,5%) and bacteriemia (38,7%). Rise in ciprofloxacin resistans among Entorobactri, aerobic and Gram-positive cocci. General survival rate of patients with bacterial complications was 36,3% (p<0,001). Number of infectious episodes and their severity were statistically significant (both p<0,001) deteriorating factor for general surviral rate