PHOTODYNAMIC THERAPY IN TREATMENT OF PATIENTS WITH PREMALIGNANT VULVAR DISEASES. FIRST EXPERIENCE OF THE METHOD APPLICATION IN UKRAINE.

The aim of the study is to evaluate the tolerability and effectiveness of photodynamic therapy (PDT) of patients with premalignant diseases of the vulva. The study was performed on 10 patients on the basis of the National Cancer Institute of Ukraine (Kyiv). The age of patients ranged from 31 to 67 years old (mean age: 53.3±3.6 years old). The diagnosis was made on the basis of medical history, complaints and clinical examination of patients, vulvoscopy and the results of morphological examination of pathologically altered vulvar tissues. A drug of the chlorine series "Photolon" (RUE "Belmedpreparaty", Republic of Belarus) in doses from 1 to 2.5 mg/kg was used as a photosensitizer (FS). Photoirradiation of pathologically altered foci was performed 3-4 hours after the end of the infusion of FS using a laser coagulator universal "Lika-surgeon" ("Photonics Plus", Ukraine, λ = 660 nm) with a radiation power of 0.4 W in exposure doses of 100 up to 150 J/cm2. PDT tolerability was assessed basing on the frequency and severity of adverse reactions (CTCAE, version 3.0). The effectiveness of PDT was assessed basing on the presence / absence of complaints, data from visual observation of changes in the area of treated lesions and morphological examination data at 3 and 6 months after treatment (WHO criteria). No serious adverse reactions associated with the introduction of FS and PDT session were observed: no allergic reactions (Quincke's edema, urticaria, drop in blood pressure, bronchospasm), no symptoms of skin phototoxicity. In the specified control patients' observation terms, the remission of disease clinical symptoms (an itch in the area of vulva) in the treated pathological centers as well as high frequency of clinical and morphological regressions were noted. The obtained results indicate the relevance and prospects of further research in the field of laser technology and PDT as options for organ-preserving treatment of premalignant diseases of vulva.

[EFFECT OF MANGANESE AND NICKEL ON PROLACTIN LEVELS IN WOMEN WITH POLYCYSTIC OVARY SYNDROME].

To study the relationship between the level of exposure to manganese and nickel and prolactin levels in the serum in women with рolycystic ovary syndrome (PCOS). 35 women with PCOS and 38 healthy women of reproductive age were examined. All women lived in Kiev. Manganese and nickel indices were determined in serum by the method of an іnductively coupled plasma mass spectrometry. The study of the ecological situation was carried out by analyzing open sources of information. Our study has shown that women with PCOS show an increase in manganese and nickel serum levels. Also significantly higher levels of prolactin was found. In the group of women with PCOS, elevated serum manganese concentrations correlated with an increase in prolactin levels (P=0.0134). There was no correlation between the levels of prolactin and the concentration of nickel in the serum of patients with PCOS. In healthy women, no correlation of prolactin and manganese or nickel levels was found. These results confirm the existing view that exposure to manganese may be the cause of increased levels of prolactin. Nickel exposure does not affect prolactin levels. Women with PCOS show an increase in prolactin levels, that depends on the level of exposure to manganese. This data suggest that an increased level of exposure with manganese can be attributed to factors or co-factors for the occurrence of PCOS. Nickel exposure does not affect prolactin levels.

[COMPARISON OF ULTRASOUND INVESTIGATION METHODS IN POSTMENOPAUSE].

The aim of the study is to improve the diagnostic approach in assessing the state of the endometrium with the help of ultrasonic endometrial diagnostics in accordance with the IETА criteria in combination with three-dimensional Doppler indices, calculating the volume of the endometrium, and the 3D reconstruction in postmenopausal women. 167 postmenopausal women underwent a 2D pelvic ultrasound examination and a combined three-dimensional complex pelvic ultrasound examination that included calculation of the volume of the endometrium, three-dimensional dopplerometric indices (vascularization index, blood flow index and vascularization ratio), and 3D-reconstruction mode. In the second stage, the patients underwent hysteroscopy/endometrial bipyroscopy with morphological evaluation of tissue samples, which retrospectively performed analysis of echographic and dopplerometric criteria in patients with benign changes in the endometrium and their comparison with atrophic endometrium. In addition, a comparative analysis of the 2D ultrasound method and its combination with a complex 3D study was carried out. Most of the echographic criteria between the groups of hyperproliferative pathology and endometrial atrophy had statistical differences, but there were no significant differences in comparison with the group of synechia of the uterine cavity and cystic atrophy. While the analysis of Dopplerometric criteria both in the two-dimensional mode and with its combination with trimer techniques demonstrated a statistical difference between the indices in the groups of the endometrial hyperpliphyral pathology and the endometrium atrophy, including its cystic form, and also the synechia of the uterine cavity. Based on the results of the comparative analysis of the ultrasound modes, the combination of 2D study with a complex 3D study increases the sensitivity of the method by 12%, and the specificity by 13%. Three-dimensional echography with the determination of dopplerometric indices and volume of endometrium and 3D reconstruction is highly accurate in the diagnosis of endometrial pathology, its wide practical application at the preoperative stage will allow to improve the quality of diagnostics and to formulate clear criteria for hysteroscopy in postmenopausal women. The results of the study show that the thickness of the endometrium is not an absolute criterion in determining the pathology of the endometrium. The main criterion in the diagnosis of hyperproliferative changes in the endometrium in postmenopause is the presence in it of vascularization.

[ON THE ISSUE OF AUTOIMMUNE OVARY DAMAGE DURING PUBERTY].

The aim of the study was to ascertain the influence of AІТ on the formation of autoimmune damage to ovaries by determining the connections between the levels of AOAB, ATPO, gonadotropic and sex hormone levels, and the functional state of the ovaries and thyroid gland. 198 girls age 10-18 were studied: 166 with AIT (AIT+ Group), и 32- without AIT (the AIT- Group). A defined difference between TTH. and ATPO, was revealed, which is explained by the presence of thyroid pathology in the AIT+ Group. Prolactin levels and ovarian volume were notably higher, while Progesterone levels were lower in the AIT+ Group. No discernable differences among levels of AOAB, sex hormones, Estrogen, Testosterone or antral follicules were observed. A direct correlation was revealed between AOAB levels and the girls' age both in the AIT+ and AIT- groups. AOAB data was divided into three tertials in order to study links with various hormonal homeostasis. Analysis of data obtained showed numerous correlative links between ATPO, AOAB, gonadotropins, sex hormones, TTH and ovarian volume in all tertials of both the AIT+ and AIT- groups; correlative links were found, too, between AOAB and ATPO in the III tertial groups AIT+ and AIT-. In adolescents with AIT disbalance occurs at all levels of hormonal homeostasis as well as in ovarian structure. Such changes and the presence of ATPO and AOAB may be associated with emerging autoimmune ovary damage.

Immune disorders in women with premature ovarian failure in initial period.

PROBLEM: Premature ovarian failure (POF) may be considered as an autoimmune endocrine disease. Autoantibodies and lymphocyte subset changes are associated with premature ovarian failure. Immune cell parameters were studied in relation with anticardiolipin antibodies (ACAB) classes M and G in the initial period of POF. METHODS: Two-color flow cytometry was used to determine lymphocyte subsets and enzyme-linked immunosorbent assay (ELISA) was used to detect ACAB and hormones in the peripheral blood of 68 POF patients, 32 women with normal menopause (NM) and 13 healthy women as a normal control (NC). RESULTS: Patients in the initial period of POF had decreased levels of CD3+, CD19+, CD3+8+, and CD8+57+ lymphocytes and a high percentage of CD5 positive in CD19+ cell population compared to the control; frequencies of IgM ACAB in POF patients were significantly higher than both IgG ACAB and IgM ACAB in NC; correlation between lymphocyte subsets and hormone levels was absent. Women with early NM showed a low number of CD3+, CD3+4+, and CD3+8+ lymphocytes, a high number of CD3 + DR, and elevation of the percentage of CD5 positive in CD19+ lymphocytes compared with the control. The frequencies of both IgM and IgG ACAB were high; the levels of lymphocyte subsets had correlations with progesterone and estradiol concentrations. CONCLUSIONS: An increase of autoantibody producing B cells (CD5+19+) and a low number of effector suppressor/cytotoxic lymphocytes (CD8+57+) with active production of anticardiolipin autoantibodies class M were found. This suggested a primary autoimmune process in the initial period of POF. Autoimmune defeat of the ovary could be the primary cause of POF, whereas in NM autoimmunity is a result of hormone dysfunction.

A new instrument for inserting a U tube.

A new instrument for the placement of U tubes through malignant and benign biliary strictures consists of a 3 mm Bakes dilator modified by a circumferential groove and a small hole through its tip.