[Oxidative stress in perioperative period of cesarean section].

OBJECTIVE: To assess a pro- and antioxidant status in pregnant women at the system level in the perioperative period of cesarean section under regional and general anaesthesia. MATERIAL AND METHODS: 62 pregnant women aged 21 to 37 years (30,9 ± 6,2 y,ears) undergone delivery by cesarean section under general (n = 33) and regional (29) anaesthesia (1-2 class ASA (American Society ofAnesthesiologists). Blood samples were collected immediately after placing patients on an operating table (T1), immediately after suturing the surgical wound (T2), and 12 (T3) and 24 (T4) hours after taking the first sample. We studied following parameters: superoxide dismutase (SOD), glutathione peroxidase (GP). reduced glutathione (RG), total antioxidant activity, active products that react with thiobarbituric acid (TBA-ap). RESULTS: In general anaesthesia cesarean critical period activation ofprooxidant and antlioxidant activity is the period T2. Activation prooxidant activity (TBA-ap) was stored at 12 and 24 hours after surgery. Increased antioxidant activity (SOD, GP) was observed in the period T2. which wass replaced by its inhibition to 24 hours. Reduced glutathione content (RG) was reduced during T2 remains at low values up to 24 hours. Regional anaesthesia did not change observed prooxidant (poorly marked increase antioxidant activity (SOD, GP), which persists up to 24 hours). Reduced glutathione content (RG) was reduced in the period T3. but recovered after 24 hours. CONCLUSION: The use of regional imnaesthesia and spontaneous breathing with atmospheric air during an elective caesarean section helps to avoid induction and manifestations of oxidative stress in pregnant women in the perioperative period and to fully implement the program early activation parturients after cesarean section.

[Angiogenic growth factors in the ceresbropinal liquid of pregnant women during planned cesarean section under combined spinal - epidural anaesthesia].

The content of soluble angiogenic growth factors in cerebrospinal liquid and blood serum in 33 pregnant women aged from 21 to 37 years (30.9 +/- 6.2 years) before spinal - epidural anaesthesia during Cesarean section was studied in observative, prospective, stratificative research. All patients without somatic pathology were divided into 2 groups -control and main. 12 pregnant women with high degree myopia as a main indication for Cesarean section were included in the 1st control group. 21 pregnant women were included in the 2nd main group. This group was divided into 2 subgroups: group 2a--with eukinetic haemodynamics type (12 patients), group 2b--with hyperkinetic haemodynamics type and moderate hypoxemia (9 patients). The indications for planned Cesarean section in patients of the 2nd group were uterine scar and/or pelvis bones pathology. The analysis of angiogenic growth factors content in cerebrospinal liquid revealed differences between group 2b and group 2a. Results of angiogenic growth factors content in cerebrospinal liquid testify hidden intracerebral hypoxemia and can be used for its assessment before anaesthesia and for the testifying of the haemodynamics status and system hypoxemia relationship.

Apoptosis and proliferative activity in endometrium during peritoneal endometriosis.

Apoptosis and proliferative activity of the glandular epithelium and endometrial stroma in patients with peritoneal endometriosis and in women of reproductive age without endometriosis were studied at various stages of menstrual cycle. Differences in the intensity of apoptosis were revealed manifesting in changed expression of proteins in the glandular epithelium of patients with endometriosis during the secretory phase of the menstrual cycle compared to normal. Proliferative activity of the glandular epithelium in the proliferative phase was higher than in the secretory phase. Our results suggest that the imbalance between apoptosis proteins in the endometrium plays a role in the pathogenesis of peritoneal endometriosis.

Proliferative activity of microvessels and angiogenesis in eutopic endometrium in patients with peritoneal endometriosis.

Comparative analysis of the density of microvessels and angiogenic activity in eutopic endometrium during different phases of the menstrual cycle in patients with peritoneal endometriosis showed that peritoneal form of endometriosis is a paracrine disease with dysregulation of angiogenesis processes in the eutopic endometrium. Excessive angiogenesis in this condition promotes implantation of eutopic endometrium on the peritoneum. Angiogenesis in eutopic endometrium can be maintained due to high concentrations of vascular endothelial growth factor A in the peritoneal fluid.

[Indices of endogenic intoxication and protein metabolism in early therapy with ultrasonic frequency currents after urgent gynecological operations in children]. / Pokazateli éndogennoi intoksikatsii i belkovogo obmena pri rannei terapii tokami nadtonal'noi chastoty posle ékstrennykh operatsii v ginekologii detskogo vozrasta.

The examination covered 61 girls (mean age 12.1 +/- 0.5 years) operated urgently by a laparotomy approach for benign tumors and tumor-like lesions of the ovaries with following treatment started 36 hours after surgery. 30 girls were exposed to suprasonic frequency currents (SFC), 11 girls received sham procedures and 20 girls were not exposed to SFC-therapy. SFC-therapy was effective. Serum tests for total proteins, globulins, urea, creatinine, aspartate aminotransferase, medium-size molecules, acid-soluble fraction of nucleic acids have shown that postoperative SFC-therapy promoted lowering of endogenic intoxication and improvement of protein metabolism.

[Computer-assisted monitoring reflecting interrelation of parameters of oxygen transport and lipid peroxidation]. / Komp'iuternyi monitoring, otrazhaiushchii vzaimosviaz' pokazatelei dostavki kisloroda i perekisnogo okisleniia lipidov.

Correctness of a real-time graphic image was checked by a multi-system integral nomogram showing changes in the condition of certain homeostasis parameters with regard for a condition of systemic oxygen transport. Concentrations of TB-active products and of medium-weight molecules were examined at the moment of finding the integral dot of oxygen transport to different quadrants of the nomogram obtained on the basis of blood samples taken from 286 obstetric and gynecological patients. Correctness and timeliness of real-time nomograms' images as well as occurrence of hypo- and hyperoxic conditions as a response to changing parameters of systemic oxygen transport were proven.

Proliferative activity and level of steroid hormone receptors in the myometrium and myoma nodes in different phases of menstrual cycle.

We compared proliferative activity and levels of steroid receptors in the myometrium and myoma nodes in patients with uterine myoma in different phases of menstrual cycle. Maximum proliferative activity was observed at the periphery of myoma nodes in the the secretory phase of the cycle. The content of progesterone receptors at the periphery and in the center of myoma nodes was lower in the proliferative phase of the cycle than in the secretory phase. Steroid regulation of proliferative activity in the myoma nodes in the the secretory phase through modulation of the content of progesterone receptors is hypothesized.

[The effect of n-3 polyunsaturated fatty acids on the lipid spectrum indices in the 2nd-3rd pregnancy trimesters]. / Vliianie n-3 polinenasyshchennykh zhirnykh kislot na pokazateli lipidnogo spektra vo II-III trimestrakh beremennosti.

The effect of picasol (a preparation of n-3 polyunsaturated fatty acids) on the serum lipid spectrum was studied upon administration of the drug to 60 pregnant women with a high-risk of developing placental insufficiency during II-III trimesters of pregnancy in accordance with a program of randomized placebo controlled double blind trial. In the absence of differences in the level of lipid spectrum parameters prior to picasol administration we found in the III trimester a reliably low content of triglycerides and cholesterol of extremely low density lipoproteids in patients who received picasol.

[Acid-base equilibrium and blood gases in pregnant women with habitual abortion after metabolic therapy]. / Kislotno-osnovnoe sostoianie i gazy krovi u beremennykh s privychnym nevynashivaniem na fone metabolicheskoi terapii.

Blood oxygen transport, pH, acid-base status, urinary ketone level and urobilinogen were studied in 52 pregnant women in whom pregnancy ran a normal course and in 56 ones with a history of habitual abortions, treated for metabolic disorders. Signs of metabolic acidosis in the presence of respiratory alkalosis at the expense of pulmonary hyperventilation were detected in women with normal pregnancy. Follow-up of acid-base status and gases of blood, aciduria and ketonuria in pregnant women with a history of habitual abortions has revealed in them respiratory alkalosis signs presenting in hypoxemia and reduced oxygen saturation and ketonuria. Metabolic therapy included in combined therapeutic schemes for such patients actively influenced the processes of metabolic acidosis and ketonuria compensation, probably at the expense of its normalizing effect on intracellular metabolism. Metabolic therapy of pregnant women liable to spontaneous abortions, due to ovarian hypofunction had a marked antihypoxic effect, normalized the bicarbonate system status and was therefore conducive to improvement of oxygen transport to maternal tissues and the fetus.

[Analysis of lochial acid-base equilibrium in an uncomplicated course of the postpartum period and in endometritis]. / Analiz kislotno-osnovnogo sostoianiia likhii pri neoslozhnennom techenii poslerodovogo perioda i pri razvitii éndometrita.

Lochial acid-base status was analyzed in 45 puerperants in whom the postpartum period ran an uncomplicated course or was complicated by endometritis. The normal course of the puerperium is associated with the development of metabolic acidosis in the uterine cavity, and this acidosis is completely compensated for at the expense of gas alkalosis. In slight endometritis metabolic acidosis augments, and grave endometritis is associated with the development of marked acidosis at the expense of the development of tissue hypoxia in the presence of metabolic acidosis.

[Status of the feto-placental system in pregnant women with a history of habitual abortion during complex therapy including metabolic correction]. / Sostoianie feto-platsentarnoi sistemy u beremennykh, stradaiushchikh privychnym nevynashivaniem, na fone kompleksnoi terapii s primeneniem metabolicheskoi korrektsii.

Fifty-two women suffering from habitual abortions, referred to high-risk group in respect of placental insufficiency development, were followed up over the course of pregnancy. Metabolic correction was added to the complex of therapy of some of these patients, the rest were administered basic therapy alone. The examinations revealed placental insufficiency signs in 78.8% of these women. Placental insufficiency in the examined group was characterized by enlarged intervillous space and a longer period necessary for filling this space, reduced linear rate of the blood stream in this space, as well as by reduced levels of the fetoplacental hormones and activation of lipid peroxidation. Addition of metabolic therapy to the complex of therapeutic measures helped reduce the incidence of placental insufficiency by 17.4% and reduce more than twofold the incidence of fetal hypoxia and hypotrophy .

[Diagnostic value of lochial pH, pCO2,and pO2 in puerperal endometritis]. / Diagnosticheskoe znachenie opredeleniia pH, pCO2 i pO2 lokhii pri poslerodovom endimetrite.

A new method has been developed for rapid diagnosis of puerperial endometritis, based on measurements of lochial pH, pCO2, and pO2. Endometritis development is associated with acidosis in the uterine cavity (pH 6.8-7.2), elevation of pCO2 to make 40-70 mm Hg, and reduction of pO2 to make 40-80 mm Hg. The degree of these shifts is in direct relationship with the inflammatory process severity. The method is simple, almost noninvasive, and quite reliable.

[Changes in the biochemical indices of parturients with uterine inertia against the background of therapy]. / Izmeneniia biokhimicheskikh pokazatelei u rozhenits so slabost'iu rodovoi deiatel'nosti na fone terapii.

A comparison was made of some biochemical parameters for energy metabolism, acid-base balance, blood gases and uterine contractility in parturients with uterine inertia who were on therapy with or without hyperbaric oxygenation. The presence of hypoxemia and metabolic acidosis in the parturients was found to intensify the processes of lipid peroxidation, to affect the functional status of myometrial biomembranes, to result in hyperenzymemia and disturbed tissue metabolism and lower myometrial contractility. The use of hyperbaric oxygenation in the multimodality therapy for uterine inertia was ascertained to eliminate oxygen deficiency, to increase tissue respiration, contributing to normal labor.

[Changes in the functional status of lymphocytes in patients with chronic salpingo-oophoritis treated by normobaric hypoxia]. / Izmenenie funktsional'nogo sostoianiia limfotsitov u bol'nykh khronicheskim sal'pingooforitom pod deistviem lechebnoi normo-baricheskoi gipoksii.

Therapeutic exposure to normobaric hypoxia improves both clinical and laboratory parameters in patients with chronic salpingo-oophoritis. The unidirectional trend of change is due to normalization of major systemic functions, including lymphocyte activity, owing to the recovery of lymphocyte metabolism and redistribution of T cell subpopulations towards a greater proportion of T helper cells. Adaptation to a moderate hypoxic stimulus is a promising physiologic method of improving nonspecific systemic reactivity.

[Use of antilymphocytic gamma globulin to monitor the course of viral hepatitis B]. / Ispol'zovanie antilimfotsitarnogo gamma-globulina dlia kontrolia techeniia virusnogo gepatita B.

The authors suggest a method for immunologic monitoring of the lymphocytic activity in viral hepatitis B (VHB) by the antilymphocytic gammaglobulin (ALG) capacity to inhibit rosette formation with sheep red blood cells. The findings evidence that sensitivity to ALG augments in the majority of VHB patients, this manifesting as an increased titre of this globulin inhibiting activity in the E-rosette formation test. A decreased sensitivity of the lymphocytes to the effects of specific antibodies points to activation of T lymphocytes and is regarded as an unfavourable prognostic sign.

[Interrelation between the enzyme activity indices and the status of the uterine-placental blood flow in pregnant women at high risk for perinatal pathology]. / Vzaimna vruzka mezhdu pokazatelite na aktivnostta na niakoi fermenti i sustoianieto na matochno-platsentarniia kruvotok pri bremenni s visok risk ot perinatalna patologiia.

The aim of the present study was to examine metabolic processes in pregnant women with high risk of perinatal pathology during disturbance in the uterine-placental blood flow (UPF). We determined the following parameters for evaluation of the metabolic disturbances: alanine aminotransferase, hydroxybutyrate dehydrogenase, lactate dehydrogenase, creatine phosphokinase, alkaline phosphatase, thermostable alkaline phosphatase, oxytocinase and lipid peroxidation. The analysis of the obtained data showed that reduction in UPF, limited only in the region of the large uterine-placental blood vessels, was accompanied by a reduction in the activity of HBDH, LDG, CPC, but moderate increase in the whole uterine-placental blood bed was accompanied by the intravillous space, was accompanied by a moderate increase in HBDH, ADG, CPC and AP in comparison with pregnant women without disturbance in UPF, which however occurred in smaller activity of these enzymes both in disturbance in blood flow of intervillous space and in the region of the large uterine-placental blood vessels. These changes as a whole characterized borderline state of energetic metabolism in the organism of the pregnant woman, which in the final analysis assured comparatively favourable outcome of the pregnancy for the fetus.

[Relations between indicators of the activity of several blood enzymes and the state of the utero-placental blood flow in pregnant women at high risk of perinatal pathology]. / Vzaimosviaz' mezhdu pokazateliami aktivnosti nekotorykh fermentov krovi i sostoianiem matochno-platsentarnogo krovotoka u beremennykh s vysokim riskom perinatal'noi patologii.

Studies of the uteroplacental blood flow and of some peripheral blood enzymes activities in 117 pregnant women have revealed that deterioration of the uteroplacental blood flow is associated with an increase of the activities of hydroxybutyrate and lactate dehydrogenases, creatine phosphokinase, and alkaline phosphatase. Exhaustion of the compensatory adaptive mechanisms, that manifests itself by a marked reduction of the blood flow in the intervillous space and by an intrauterine fetal distress is paralleled by a reduction of these enzymes activities.