[The role of the combined balneotherapeutic treatment as the 'add-back therapy' against the background of the anti-hormonal effects of the agonists of gonadotropin-releasing hormone in the women suffering from endometriosis genitalis externa]. / Kompleksnoe bal'neolechenie v kachestve terapii prikrytiia na fone antigormonal'nogo vozdeistviia agonistami gonadotropin-rilizing gormona u zhenshchin s naruzhnym éndometriozom.

BACKGROUND: The use of agonists of gonadotropin-releasing hormone (GnRH) for the rehabilitation treatment of the patients presenting with endometriosis genitalis externa is known to significantly enhance the risk of development of hypoestrogenism. The so-called 'add-back-therapy' is carried out as a preventive measure to eliminate hypoestrogenism caused by the intake of GnRH agonists without detriment to the effectiveness of anti-hormonal therapy. AIM: The objective of the present study was to estimate the effectiveness of the new method ('add-back hormone replacement therapy') in comparison with anti-hormonal therapy with the use of GRH agonists at the stage of the early postoperative medical rehabilitation based on the drinking of mineral waters (MW) and radon therapy (RT) in the patients who had undergone the laparoscopic interventions for the treatment of endometrioid heterotopies of the ovaries (1-3 months post-operatively). MATERIAL AND METHODS: To evaluate the effectiveness of the spa and health resort-based rehabilitation measures, the long-term effects of GnRH agonists have been studied in 2 groups of the patients formed by the of simple randomization method. The main group (MG) was comprised of 45 women received medical rehabilitation under conditions of a spa and health resort setting with the application of medium-salt water from the Pyatigorsk spring and radon therapy in the combination with triptorelin. The group of comparison (CG) was composed of 44 women given the treatment with the use of triptorelin under the out-patient conditions. The assessment of the results of the study included: the estimation of the intensity of pelvic pain syndrome, indicators of the hormonal status and the quality of life (QL), ultrasonic examination of the pelvic organs, and the occurrence of adverse effects of triptorelin. The duration of the study was 3 years (2014-2016). RESULTS: The analysis of the long-term results of the rehabilitative treatment has demonstrated that the rehabilitation activities under the spa and health resort conditions within 1-3 months after the surgical intervention including the application of MW and RT in the combination with an agonist of gonadotropin-releasing hormone (triptorelin) greatly contributed to the stability of the results of the treatment: specifically, only 2.5% of the patients suffered the recurrence of cystic ovarian endometriosis whereas 24.5% (p<0.001) reported the restoration of the reproductive function. The patients comprising the control group experienced the recurrence of the pathologic process in 7.5% of the cases and the restoration of the reproductive function in 15.8% of the cases (p<0.001). Simultaneously, the quality of life in the patients in the main group improved 3.4 times on the average in comparison with the initial level (p<0.001). The 2.2-fold improvement of the quality of life was documented in the control patients (p<0.001). At the same time, the frequency of adverse reactions to the treatment with triptorelin in the control patients was higher than in the main group including pain in the epigastric area, headache, irritability, hyperhidrosis, and instability of arterial blood pressure (ABP) that significantly deteriorated the life quality in these women. CONCLUSION: The comparative analysis of the results of the follow-up observations has demonstrated that the application of drinking mineral water and radon therapy for the treatment of the women suffering from endometriosis genitalis externa can be recommended as 'add-back therapy' against the background of anti-hormonal effects of agonists of gonadotropin-releasing hormone.

[The evaluation of the effectiveness of the application of bischofite-modified yellow clay (an experimental studi)]. / Otsenka éffektivnosti primeneniia zheltoi gliny, modifitsirovannoi bishofitom (éksperimental'noe issledovanie).

BACKGROUND: The topical problems in balneotherapeutics and health resort activities in general are the development of the yellow clay-based preparations enriched in the natural mineral bischofite and the investigation of their therapeutic effects with the purpose of improvement of their curative potential. AIM: The objective of the present study was to evaluate the effectiveness of the course of the experimental therapeutic applications of the yellow clay obtained by the open pit mining of its deposits located in the vicinity of Pyatigorsk and modified by the addition of bischofite. MATERIAL AND METHODS: The experiments were carried out with the use of 57 eugamic Wistar male rats with adjuvant arthritis. The yellow clay supplemented with bischofite in various concentrations was applied in 12 procedures each 15 minutes in duration every other or every two days beginning from the 38th day of experimentally-induced arthritis. The animals were allocated to five groups as follows: group 1 included the healthy animals that served as controls (n=5), groups 2-5 were comprised of the animals with adjuvant arthritis. The animals included in group 2 served as the experimental model of adjuvant arthritis (n=8), those comprising group 3 were treated by the applications of yellow clay without additives (n=14), group 4 was composed of the animals with adjuvant arthritis treated by the applications of yellow clay containing 10% of bischofite (n=15), the animals in group 5 having adjuvant arthritis were treated by the applications of yellow clay containing 20% of bischofite (n=15). RESULTS: The study has demonstrated the reduction of the reactively enhanced relative abundance of, activated T-cells, and B-lymphocytes down to the respective control values in the animals with adjuvant arthritis after the course of applications of the yellow clay preparations. Simultaneously, normalization of the immunoregulatory index, IRI, (the T-helpers to cytotoxic T-lymphocytes ratio) was documented. The treatment was associated with the strong dependence of the interleukin (IL-1ß) contents on the cortisol level and the well apparent relationship between the levels of interleukins and IRI. Specifically, the relation between IL-1ß and IRI following the application of non-modified yellow clay was characterized as (r=+0.8, p=0.03) in comparison with the relation between IL 6 and IRI (r=+0.8, p=0.03) after the treatment with yellow clay containing 10% of bischofite or between IL 6 and IRI (r=+0.8, p=0.004) after the application of yellow clay containing 20% of bischofite. CONCLUSION: The results of the study give evidence of the immunomodulatory action of yellow clay modified by the addition of bischofite. They suggest the promising opportunities for the application of these preparations for the management and rehabilitation of the patients presenting with the diseases of the musculoskeletal system in the future.

[Balneotherapy to the treatment of patients with hysteromyoma].

Patients with hysteromyoma are treated by radon therapy and balneotherapy with the use of iodine-bromine water. Radon therapy is known to produce a more pronounced effect than drinking of iodine-bromine water. At the same time, the latter treatment activates hyperemic processes in the skin and mucous membranes and thereby decreases density of myometrial nodular lesions and compact foci. It is concluded that radon therapy and the use of iodine-bromine water are the methods of choice for balneotherapy of patients with hysteromyoma.

[Effect of radon baths of various concentrations on patients with genital endometriosis]. / Vliianie radonovykh vod raznykh kontsentratsii na sostoianie bol'nykh genital'nym éndometriozom.

The study of the effect of radon water in different concentrations (1.5 and 6.5 kBk/l) on a clinical status and endocrine system of patients with genital endometriosis has detected a positive action of both concentrations. High-concentration radon water more effectively decreased the size and tenderness of endometriotic foci as well as concentration of sex steroids. Therefore, a differential approach is needed to prescription of radon water. Its concentration must be based on endometriosis extension and severity of the process.