[Prognostic value of uteroplacental circulation impairment in 1st trimester of pregnancy in patients with complicated obstetric history].

UNLABELLED: One of the urgent problems of modern obstetrics is the early detection of irregularities in the development of the uteroplacental vessels system in patients with severe disorders in the history. AIM: To evaluate the predictive value of re-development of obstetric pathology on the basis of the uterine artery Doppler on 11-14 weeks of pregnancy. PATIENTS AND METHODS: 410 patients in I trimester of pregnancy were examined with fetal growth restriction, preeclampsia and/or fetal death and/or a history of preterm delivery were. The influence of physical factors and obstetric history on the state of uterine blood flow in the I trimester of pregnancy was studied. RESULTS: The optimal Doppler indexes was calculated; a high predictive ability of the pulsation index in the uterine arteries with respect to pregnancy complications with early clinical manifestation, severe preeclampsia and combined obstetric complications was detected. CONCLUSIONS: Our data support the possibility of preclinical diagnosis of obstetrical complications in patients with complicated obstetric history.

[Relative binding activity of dydrogesterone with blood mononuclear cells progesterone receptors of women included in the IVF program].

It has been shown that specific binding of dydrogesterone with progesterone receptors in blood mononuclear cells of the patients included in the programs of in vitro fertilization, varies from 0 to 298%, thus at 38% of women dydrogesterone concedes to a progesterone in the competition for receptors of a progesterone, and 62%--exceed. The revealed variations of specific binding dydrogesterone with receptors of a progesterone are a reserve of increase of efficiency of auxiliary reproductive technology at the expense of individual selection of hormonal agents.

[The effect of hypoxia on the urokinase and adenylate cyclase systems in the culture of endothelial cells of the human umbilical vein].

Hypoxia induces angiogenesis in ischemized tissues by means of pro-angiogenic factor expression. The key role in the growth processes and blood vessel functioning belongs to the matrix metalloproteinases, plasminogen, and its activator systems. Effect of hypoxia on expression of the urokinase activating agent plasminogen and its receptor in endothelium was studied in human umbilical vein endothelial cell model. Incubation of the endothelial cells under the conditions of hypoxia proved to reduce both urokinase formation in these cells and its secreting into the culture medium. The hypoxia-induced reduction of urokinase contents was accompanied by enhancement of expression of the urokinase receptor. The hypoxia also entailed reduction of the adenylate cyclase activity and cAMP contents in the endothelial cells. The data obtained suggest that reduction of the adenylate cyclase activity and cAMP contents under the conditions of hypoxia provide basis for suppression of the urokinase expression by the endothelial cells and, consequently, inhibition of blood vessel formation in the ischemized tissue.

[New approaches to the diagnosis and treatment of inflammatory diseases of the adnexa uteri]. / Novye podkhody v diagnostike i lechenii vospalitel'nykh zabolevanii pridatkov matki.

The paper summarizes follow-ups of 2500 patients with inflammatory diseases of the uterine appendages, provides evidence for the benefits of laparoscopic diagnosis and treatment of all types of this condition, which makes it possible to verify the diagnosis and perform less traumatic organ-sparing operations. To use combined antiinflammatory antibiotic therapy in view of the etiology of inflammation, as well as immunomodulators is the requisite condition for treating acute types of a disease. The new approaches to the diagnosis and treatment of inflammatory diseases of the uterine appendages substantially improved therapeutical outcomes and maintained female reproductive function.

[Immunoglobulin G monoclonal human anti-rhesus Rho(D) to prevent rhesus-incompatibility]. / Immunoglobulin G monoklonal'nyi chelovecheskii anti-rezus Rho(D) dlia profilaktiki rezus-nesovmestimosti.

RhD immunisation which follows pregnancy can be prevented by administration to the rhesus-negative mother of 20 micrograms anti-D immunoglobulin per 1 ml of D-positive fetal red cells in the maternal circulation. With the aim of substitution of polyclonal anti-D with monoclonal one we developed human-mouse cell lines producing anti-RhD IgG1 by fusing EBV-transformed human immune lymphocytes with murine myeloma. After several clonings and passages the EBV genome was eliminated from the cell lines. The antibodies were purified from culture supernatants using protein A affinity chromatography and tested for sterility, virus contamination, pyrogenecity, toxicity and DNA content. The monoclonals were compared with the standard polyclonal anti-RhD in in vitro and in vivo assays. In antibody-dependent cell cytotoxicity (ADCC) 2 of 4 studied monoclonals promoted greater RBS lysis than polyclonal anti-D at equivalent concentrations. Detection of binding site number of monoclonals anti-D revealed about 10,000/RBS D-determinants on DCe/dce erythrocyte which agrees with the data for polyclonal anti-D. Best in ADCC monoclonal anti-D sharply increased human autologous 51Cr-labelled rbc sensitised in vitro as well as accelerated clearance of RhD RBS from circulation of Rh-negative volunteers injected with 150 micrograms monoclonal anti-D. After clinical trial using of monoclonal anti-D is permitted in Russia.

[Comparative evaluation of the effectiveness of ofloxacin in comprehensive treatment of acute inflammatory diseases of the uterus and uterine appendages]. / Sravnitel'naia otsenka éffektivnosti ofloksatsina v kompleksnom lechenii ostrykh vospalitel'nykh zabolevanii matki i pridatkov.

Ofloxacin was used in the complex therapy of acute inflammatory diseases of the uterus and uterine appendages. The patients were divided into 2 groups. Group 1 included 15 patients treated with ofloxacin in a dose of 200 mg administered intravenously twice a day for 4 to 6 days. After that period the drug was used orally in the same dosage for 4 to 6 days. Group II was control and included 20 patients treated with some other broad spectrum antibiotics such as amplox, gentamicin and 3rd generation cephalosporins. Because of the disease severity in 33 patients they were subjected to surgical operations. The clinical recovery was stated in all the 35 patients. However, by a complex of the indices the efficacy of ofloxacin was higher than that of the other antibiotics. An improvement of the general state (no headache or weakness and normalization of the body temperature) was observed in the patients of group I 2-3 days earlier as compared to the patients of group II. Purulent discharge from the genitalia ceased 3-4 days earlier in the patients of group I by comparison with the control patients. Good tolerance of ofloxacin was observed and no severe adverse reactions were recorded.

[The prevention of the adhesive process after surgical interventions in gynecological patients in the reproductive period]. / Profilaktiki spaechnogo protsessa posle khirurgicheskikh vmeshatel'stv u ginekologicheskikh bol'nykh v reproduktivnom periode.

Dynamic laparoscopy making use of special tubes was carried out in 149 patients (30 with acute inflammatory diseases of the uterine tubes, 80 following reconstructive surgery on the tubes suffering from tuboperitoneal sterility, 9 operated on the internal genitals). Repeated laparoscopic examinations were carried out in the course of 14 days, every 2-3 days. The course of the postoperative period was assessed by the presence of adhesions, hyperemia, edema, and exudation. Adhesions were separated, during mixtures were delivered including antibiotics, corticosteroids, enzymes, rheopolygluquins; chromohydrotubations was carried out. Dynamic laparoscopy in patients with inflammatory diseases of the internal genitals helped detect positive results 2-3 days after intensive care was started and prevent adhesions. This method appears to be particularly valuable if used after inflammatory processes and interventions on the internal genitals in young, more so in nulliparous women planning to have children in future.

[Diagnosis and treatment of juvenile uterine hemorrhage]. / Diagnostika i lechenie iuvenil'nykh matochnykh krovotechenii.

The authors demonstrate the usefulness of supplementary methods of investigation (echography and hysteroscopy) for the diagnosis and treatment of juvenile uterine bleedings. Hemorrhages developing at the onset of puberty are not associated with noticeable shifts in the hormonal status. Dysfunction of the hypophyseo-ovarian system is detectable at the end of this period; therefore the authors suggest a specific therapeutic approach to such patients. Blood coagulation disorders were revealed in 21.7% of the patients.

[An immunochemical analysis of the function of the hemato-encephalic barrier in acute fetal hypoxia and asphyxia neonatorum]. / Immunokhimicheskii analiz sostoianiia gematoéntsefalicheskogo bar'era pri ostroi gipoksii plodov i asfiksii novorozhdennykh.

The neurospecific protein alpha 1-globulin has been assayed in serum in order to evaluate the blood-brain barrier in newborns with acute intrapartum hypoxia. The study involved 35 term newborns with birth asphyxia of variable severity. The alpha 1-globulin levels correlated with severity of condition at birth, duration of intrauterine exposure to hypoxia and the presence of obstetric complications and clinical severity of cerebral circulatory disorders. A normal early adaptation and effective therapy reduced serum alpha 1-globulin levels 4-8-fold on the 3rd postnatal day and 6-16-fold on the 5th day. Deterioration of neurological symptoms was parallelled by a significant increase in protein levels (to 6400 ng/ml) at day 5. This evidence may confirm the fact that permeability of the blood-brain barrier is impaired by intrapartum hypoxia.

[Dynamic laparoscopy in patients with gynecologic diseases]. / Dinamicheskaia laparoskopiia u ginekologicheskikh bol'nykh.

Follow-up laparoscopy is of great help in the evaluation of progress of inflammatory pelvic disease and postoperative course in patients operated on for tubal and peritoneal infertility. The use of special cannulas allows repeat laparoscopies in a patient at any time, without new abdominal punctures. Follow-up laparoscopy enables drug administration into the inflammatory site, laparoscope-guided water insufflation and early abolition of adhesions.

[The estrogen receptors of the endometrial plasma membranes in proliferative processes in the postmenopause]. / Retseptory éstrogenov plazmaticheskikh membran éndometriia pri proliferativnykh protsessakh v postmenopauze.

Estradiol receptors of plasma membranes (PM), PM lipids, the activity of membrane-bound enzymes and plasma levels of hormones have been tested in patients of postmenopausal ages with various endometrial diseases (glandular fibrous and glandular cystic polyps, highly, moderately and poorly differentiated adenocarcinomas). Test findings were similar in patients with the glandular cystic polyps and poorly and moderately differentiated adenocarcinomas. Therefore, the patients with the glandular cystic endometrial polyps are at high risk of endometrial cancer. Since the risk increases with higher estrogen plasma levels, the patients with proliferative endometrial conditions may benefit from intake of antiestrogens.

[Current concepts of the possibility of correcting blood coagulation disorders in late pregnancy toxemia]. / Sovremennye poniatiia o vozmozhnostiakh korrektsii narushenii gemokoaguliatsii pri pozdnikh toksikozakh beremennykh.

Based on the reported data and their own experience the authors suggested that immediate effect of anticoagulative drug heparin was necessary for the correction of hemo- and homeostatic disorders in females with late gestosis.