Imitators of severe preeclampsia: on differential diagnosis and multidisciplinary management

Preeclampsia (PE) is not only a disease of pregnant women, but also a disease with lifelong consequences for mother and child. Making an early diagnosis and differential diagnosis of PE is crucial yet challenging, since PE can be mistaken for other internal diseases or surgical conditions. Despite the variety of clinical symptoms of thrombotic microangiopathy that may manifest in a non-typical picture of PE, progressive multiple organ failure develops in all cases. It seems promising to study the role of matrix metalloproteinases and determine the genetic predisposition to early and severe PE. The forecast and prevention attempts must begin from the fertile cycle. A better knowledge of biochemical and genetic markers along with the clinical and instrumental tests will reduce the morbidity and mortality in PE patients

Early predicting of preeclampsia in pregnant women after assisted reproductive technologies

Aim: to identify new prognostic criteria of potential preeclampsia (PE) in pregnant women after assisted reproductive technologies (ART) for timely PE prophylaxis.Materials and methods. A prospective study of 85 patients who entered the program of ART was conducted. All patients were examined for possible hemostatic abnormalities (genetic thrombophilia and chronic hypercoagulation) and also for granulocytemacrophage colony-stimulating factor (GM-CSF) in the serum during the most critical periods (4–6, 12–14, 22–24 и and 30–32 weeks) of the fetoplacental complex formation.Results. The lowest level of GM-CSF was observed in patients with hemostatic disorders. Thus, in pregnant women who later developed PE, there was a decrease in GM-CSF level below the physiological: in those diagnosed with genetic thrombophilia – by 79.4 %, and those with hypercoagulation – by 63.6 %.Conclusion. The determination of serum GM-CSF and identification of hemostatic abnormalities in pregnant women after ART has a prognostic importance for potential PE. This result is significant for the understanding of the pathogenesis of PE and also has a practical value: it allows the doctor to attribute the patient to a high risk group from the first trimester of her pregnancy and start preventive therapy rather early

Vulvovaginal infections in the postantibiotic era. How to avoid aggression?

High incidence of recurring aerobic/nonspecific vaginitis is associated with the formation of stable pathological biofilm. The increasing antibiotic resistance does not allow to eliminate associations of conditionally pathogenic microorganisms and inhibits the growth of lactobacilli. Vaginal use of bacteriophages is a targeted antibiotic therapy. The study showed that multivalent bacteriophage (Sextaphage®) used as vaginal monotherapy is comparable with antibiotic in terms of treatment efficacy of aerobic vaginitis, does not reduce the level of lactobacilli and has a high compliance

Magnetic-pulsed resistance welding-forming of shell structures

Translated from Russian (Svar. Proizvod. 2000 (11) p. 37-39)SIGLEAvailable from British Library Document Supply Centre-DSC:9023.190(9787)T / BLDSC - British Library Document Supply CentreGBUnited Kingdo

TREATMENT OUTCOMES OF PROXIMAL GASTRIC CANCER DEPENDING ON THE EXTENT OF SURGICAL RESECTION

Surgical resection for proximal gastric cancer remains an important problem of oncology. Personalized surgical management represents one of the main challenges in treating gastric cancer. The aim of the study was to analyze surgical outcomes of proximal gastric cancer depending on the tumor spread, extent of surgery and the presence of intraperitoneal free cancer cells. Material and Methods. The study included 68 patients with morphologically verified locally advanced proximal gastric cancer. The patients were divided into 2 groups. Group I consisted 37 patients, who underwent total gastrectomy of 31 patients; Group II comprised who underwent proximal subtotal gastrectomy. Results. The overall three-year survival was 48.7 ± 16.9 % in Group I and 66.4 ± 13.2 % in Group II patients. The 3-year progressive-free survival rate was 51.5 ± 18.5 % after proximal subtotal gastrectomy and 34.8 ± 25.6 % after total gastrectomy. The presence of tumor cells in the abdominal cavity was proven to lead to early carcinomatosis. Thus, the 2-year overall survival rate was 26.7 ± 42.8 % in patients in whom free cancer cells were found in peritoneal washings and 69.8 ± 9.0 % in patients with negative cytology findings from washings. Conclusion. Proximal subtotal gastrectomy provides better survival rates compared to total gastrectomy in patients with locally advanced proximal gastric cancer. Local spread of the tumor, which is known to significantly increase the risk of lymph node metastasis and contamination of the peritoneal cavity with cancer cells, is one of the main unfavorable prognostic factors

Association between placental insufficiency and manifestations of preeclampsia

Aim. Provide evidence for the connection between placental insufficiency and preeclampsia and rationalize a unified approach to the prevention of placenta associated disorders. Materials and methods. The study was carried out in two stages. At the first (clinical statistical) stage, the incidence rates of preeclampsia (PE) and placental insufficiency (PI) were compared based on the data from Rosstat and from a regional perinatal center for the past 25 years; the most informative predictors of PI and PE were compared using the known clinical epidemiological tests. At the second stage, a prospective study of 140 high-risk pregnant patients with severe PI was carried out to confirm and generalize the hypothesis on the common predictors of PI and PE. Two groups of patients were compared: I – 68 women with isolated PI and II – 72 women with PI combined with earlyor late-onset PE. The control group included 30 women with uncomplicated pregnancy. Immunoenzyme assays, immunofluorescence, biochemical analyses, and morphological studies of placenta were used. Results. The incidence rates of PI and PE, both in the communities and in the tertiary care hospital, pointed to their intercorrelation. This similarity of informative values of PI and PE predictors related to the most important operational characteristics of clinical epidemiology indicates the lack of pathognomonic significance of the early predictors and, on the other hand, supports the concept of the common mechanisms of placenta-associated pregnancy complications. In pregnant women with a high risk of PI decompensation, PE developed in 51% of cases (early-onset – 72%, late-onset – 28%); of those, 18% were diagnosed with severe PE, and 33% – with moderate PE. The obtained data confirm that the manifestation of early-onset PE is pathogenetically related to structural and functional disorders of the early fetoplacental complex (FPC), while late-onset PE is associated with FPC changes in the subsequent stages of pregnancy, and with a synergistic effect of extragenital and obstetrical pathology. The proposed predictive model of PE connects the manifestation of PE with the status of the placenta. Conclusion. The knowledge of pathogenetically significant risk factors allows for stratifying pregnant women in order to conduct a common preventive monotherapy of placenta associated disorders. The present approach to the management of high-risk pregnancy is in line with the principles of 4Р-medicine

A novel approach to the differential prognosis of early and late preeclampsia

In the present review, a new approach to studying the pathogenesis and predicting the development of preeclampsia (PE) – namely, the determination of matrix metalloproteinases (MMPs) – is discussed. Currently, the major cause of PE is thought to be an incomplete remodeling of spiral arteries because of an insufficient number of invading cytotrophoblasts or the absence/inactivation of crucial lysing enzymes, i.e. matrix metalloproteinases. The role of MMP-1, MМP-2, MМP-3, MМP-7, MМP-9 in the placenta formation, the development of oxidative stress and endothelial dysfunction is described. We propose that in the future, the MMPs may be used for differentially predicting early and late PE