[Endometrial morphological characteristics in patients with hysteromyoma and chronic endometritis in infertility]. / Morfologicheskaia kharakteristika éndometriia u patsientok s miomoi matki i khronicheskim éndometritom pri besplodii.

OBJECTIVE: To characterize endometrial structural and functional state and receptivity in women with hysteromyoma (HM) and chronic endometritis (CE) in infertile couples. MATERIAL AND METHODS: A total of 130 patients who had HM and/or CE in an infertile couple were examined. Group 1 included 64 women with HM and CE; Group 2 consisted of 24 patients with HM; group 3 comprised 42 patients with EC. A control group included endometrial biopsy specimens from 20 healthy women planning a pregnancy. RESULTS: Patients with HM and CE were found to develop endometrial dysfunction. Its structural signs were damage to the endometrial surface epithelium; intense stromal fibrosis with the high expression of type III and IV collagens; dysregulated processes of high angiogenesis; impaired maturation of pinopodia by the implantation window; high estrogen receptor (ER) expression in the nuclei of endometrial glandular and stromal cells; low progesterone receptor (PR) expression; and impaired secretory endometrial transformation. CONCLUSION: HM concurrent with CE is responsible for endometrial dysfunction. Its structural manifestations are mainly associated with CE.

[Clinical and morphological characteristics of thyroid tumors in children of the Chelyabinsk Region]. / Kliniko-morfologicheskaia kharakteristika opukholei shchitovidnoi zhelezy u detei Cheliabinskoi oblasti.

OBJECTIVE: To carry out a clinical and morphological analysis of thyroid cancer cases in the children of the Chelyabinsk Region. SUBJECT AND METHODS: Thyroid tumor pathology was verified in 50 of the 196 patients aged 7-17 years, who had been operated on in 2000-2016. Clinical and morphological features, including immunohistochemical and ultrastructural characteristics of thyroid cancer, were studied. RESULTS: Over the past 17 years, there has been a decline in the number of children with surgical thyroid diseases, including thyroid carcinomas. There is a predominance of papillary carcinoma (70%) that is characterized by more aggressive clinical and morphological signs than follicular and medullary thyroid carcinoma. The immunophenotype of follicular cell tumors in children is characterized by the expression of growth factors (TTF-1, EGFR-384) and malignancy markers (mesothelial cell, AMACR (P504S), S 100). CONCLUSION: The vector change (decrease) in the long-term unfavorable trend toward an increasing incidence of thyroid cancer in children of the Chelyabinsk Region is currently accompanied by the pathomorphism of thyroid carcinoma.

[Preventability of perinatal losses by the example of the large industrial cities Chelyabinsk and Novosibirsk]. / Predotvratimost' perinatal'nykh poter' v Cheliabinske i Novosibirske.

Perinatal mortality rate is an indicator that characterizes the quality of medical care, as well as the social and economic situation in the region. OBJECTIVE: to audit perinatal losses in large regional centers of the Russian Federation with a population of over 1 million inhabitants, such as Chelyabinsk and Novosibirsk. MATERIAL AND METHODS: A comprehensive postmortem examination of 309 cases of perinatal losses in 2016 was made, which was supplemented with an assessment of preventability according to the Scandinavian-Baltic classification. RESULTS: The rate of preventable deaths in Chelyabinsk and Novosibirsk amounted to 91 and 81.5% of cases, respectively; the deaths were due to stillbirths at more than 28 weeks' gestation and to dead newborns in almost half of cases. The proportion of intranatal deaths was shown to increase in Chelyabinsk; the number of neonatal deaths at more than 33 weeks' gestation rose in Novosibirsk. CONCLUSION: Supplementing the traditional clinical and postmortem analysis with an assessment of the preventability of perinatal loss makes it possible to ensure a unified approach to evaluating these conditions and the comparability of autopsy results in different subjects of the Russian Federation and to determine regional reserves for reducing perinatal mortality rates.

[Vein morphology after endovenous laser coagulation at different power and similar linear density of energy]. / Morfologiia ven posle éndovenoznoi lazernoi koaguliatsii pri raznoi moshchnosti i odinakovoi lineinoi plotnosti énergii.

The purpose of the study was to assess the depth of damage to the venous wall after endovenous laser coagulation (EVLC) at different power of the unit - 5, 7 and 10 W and similar linear density of energy (LDE) - approximately 70 J/cm. Our prospective comparative morphological study with blinding included a total of 30 patients subjected to EVLC of the great saphenous vein using the unit with a wavelength of 1,470 nm and radial light guides with automatic traction. The patients were divided into three groups, each comprising 10 patients. The unit's power (W) during EVLC and velocity of light guide traction (mm/s) in group one amounted to 5 and 0.7 (LDE - 71.4 J/cm), in group two to 7 and 1.0 (LDE - 70 J/cm) and in group tree to 10 and 1.5 (LDE - 66.7 J/cm), respectively. The coagulated veins were then procured from mini approaches and subjected to three sections made at a distance of 2 mm from each other. Specimens were stained with haematoxylin-eosin and picrofuxin according to the van Gieson technique. Then, in four places of each section (at 3, 6, 9 and 12 hours) we assessed the depth of the damage to the venous wall and calculated the average percentage of alteration - the ratio of the depth of the lesion to the venous wall thickness. The average depth of damage to the venous wall (µm) amounted in the first group to 122.9 ?m, in the second group to 182.9 µm, and in the third group to 267 µmm. The index of alteration (%) averagely amounted: in group one to 25.7, in group two to 37.9 and in group three (at a power of 10 W) to 55.5 (p=0.0001 when comparing each of the groups (the Kruskal-Wallis test)). Hence, despite an inconsiderable decrease of the LDE from the first to the third group, as power increased, the depth and percentage of damage to venous walls increased statistically significantly. It follows from the above-mentioned that: 1) an increase in power (from 5 to 10 W) of the unit during EVLC at comparable LDE (approximately 70 J/cm) leads to a deeper damage of the venous wall; 2) it is necessary to carry out a clinical study aimed at comparing different modes of coagulation, with the assessment of the frequency of recanalization and the level of pain syndrome.

[Efficacy of using rivaroxaban for treatment of heat-induced thrombosis after endovenous laser ablation]. / Effektivnost' primeneniya rivaroksabana dlya lecheniya termoindutsirovannykh trombozov posle endovenoznoi lazernoi koagulyatsii.

AIM: The study was aimed at assessing efficacy of using rivaroxaban for treatment of endothermal heat-induced thrombosis (EHIT) after endovenous laser ablation (EVLA) of saphenous veins. MATERIAL AND METHODS: Our prospective study included a total of 1,326 patients subjected to 1,514 EVLAs. In 1,091 (72.1%) cases the great saphenous vein (GSV) was ablated, in 124 (8.2%) cases the anterior accessory vein (AAV) was treated and in 299 (19.7%) cases the small saphenous vein (SSV) was treated. Heat-induced thrombosis developed in 21 (1.4%) cases: in 19 cases in the basin of the great saphenous vein and in 2 cases in the anterior accessory saphenous vein. No heat-induced thromboses in the basin of the small saphenous vein were observed. In 9 (0.6%) cases there was class 1 EHIT (according to the Kabnick classification), class 2 EHIT was noted in 10 (0.7%) cases and class 3 EHIT was observed in 2 (0.1%) cases. All patients with EHIT were given rivaroxaban: patients with class 1 EHIT received it at a single daily dose of 20 mg, patients with class 2 and 3 EHIT - at a dose of 15 mg twice daily. In one (4.8%) case the drug had to be discontinued on day two due to the development of dyspeptic events. All patients were found to have complete regression of the heat-induced thrombus within 6-25 days. No cases of clinical manifestations of pulmonary artery thromboembolism were observed. A conclusion was drawn that in clinical practice EHIT is an important and insufficiently studied problem. Rivaroxaban may be used as an oral agent for treatment of heat-induced thromboses after EVLA. Further studies are required to examine its efficacy and safety profile.

[Morphofunctional characteristics of impaired endometrial receptivity in chronic endometritis].

OBJECTIVE: To evaluate endometrial receptivity in women with chronic endometritis (CE), by studying the nature of secretory transformations, the number of mature pinopodia in the surface epithelium, the expression of steroid hormone receptors and leukemia inhibitory factor (LIF). SUBJECTS AND METHODS: Endometrium morphology was analyzed in 76 patients with CE (a study group) and 20 gynecologically healthy women (a control group) who sought family planning advice and examined using the uniform scheme. Morphological examination of the endometrium obtained by Pipelle biopsy on days 7-8 after ovulation involved histological and immunohistochemical studies: the number of mature pinopidia and the expression of estrogen and progesterone receptors (ER and PR) were determined, by estimating the PR/ER ratio and the marker of LIF receptivity in the endometrial epithelium and stroma. RESULTS AND DISCUSSION: In the women with CE, the level of surface epitheliocytes with pinopodia was significantly lower than that in the comparison group (mean 37.5 +/- 2.1; p < 0.01). There was an increase in ER expression in the integumentary and glandular epithelium (mean 102.5 +/- 6.8 scores; p < 0.01) and stromal cells (110.2 +/- 8.3 scores; p > 0.05). In the control group, the intensity of PR expression was, on the contrary, significantly lower in both the integumentary epithelium and glandulocytes (mean 104.7 +/- 5.5 scores; p < 0.01) and stromal cells (178.5 +/- 11.3 scores; p < 0.01). In the study group, the PR/ER ratio was less than 2 in all cases: the mean PR/ER ratio was 1.1 +/- 0.09 for surface epitheliocytes and glandulocytes and 1.6 +/- 0.1 for stromal cells. In CE, the intensity of LIF expression was dramatically reduced and equal to 0.95 +/- 1.3 scores (p < 0.01). The found regularities suggest that CE is accompanied by an almost 4-fold decrease in LIF expression, which is evidence for significantly suppressed endometrial receptivity and may be regarded as a prognostic marker of failed implantation. CONCLUSION: The patients with CE were found to have an endometrial receptivity disorder involving the damaged surface epithelium of the uterine mucosa, pinopodia immaturity by the implantation window, decreased LIF expression, and ER hyperexpression. This may give rise to reproductive dysfunction in women with CE.

[Giant chorioangioma of the placenta].

The paper describes a case of giant (123 x 109 x 70-mm) placental chorioangioma that is a capillary hemangioma in structure, which led to significantly impaired placental-fetal blood flow to give rise to non-immune hydrops and right heart failure in the fetus at 33 weeks' gestation; obvious polyhydramnios developed. This served as an indication for preterm one-stage cesarean delivery. A premature live girl was born with a weight of 2430 g, a height of 44 cm, Apgar score 6-7. Dynamic echographic monitoring makes it possible to record increased placental tumor sizes and fetal abnormalities and to make a timely decision on delivery, which promotes perinatal death prevention. At 11-month follow-up, the child's physical and mental developments were for age.

[Primary involvement of the dura mater spinalis in Hodgkin's lymphoma].

The paper describes a case of Hodgkin's lymphoma at a very rare site (primary, solitary involvement of the dura mater spinalis) with its immunohistochemically verified diagnosis in a 38-year-old man.

[Uterine mucosal morphofunctional characteristics in women with early miscarriages of infectious genesis].

Eighty-two reproductive-aged patients who had early miscarriages of infectious genesis were examined. Group I comprised 56 women who had a history of one spontaneous miscarriage; Group 2 included 26 patients with a history of 2 spontaneous miscarriages or more. The examination used a set of diagnostic tools for the identification of genital infections and histological, histochemical, and statistical studies. Group 2 patients were ascertained to have more frequently infectious inflammatory genital diseases. In the women of both groups, chronic endometritis of mainly Ureaplasma, Mycoplasma, and viral etiologies was recorded in 100% of cases while that of mixed etiology was observed in 57%. Moreover, the signs of endometrial stromal fibrosis and atrophy, receptor apparatus lesion, and suppressed tissue protective immune reactions were significantly more evident in Group 2 patients.

[The characteristics of the epithelium and endometrial extracellular matrix in miscarriage during early pregnancy associated with chronic endometritis].

In miscarriage associated with chronic endometritis, the uterine mucosa was found to have a lower expression of TGFR-beta, gelatinases and a higher exposure of TIMP-1 and EGFR, which confirms a pathogenetic association between the imbalance of growth factors, endoproteases and their inhibitors and points to the active involvement of these cytokines and endopeptidases in the inflammatory, reparative processes and remodeling of tissues. The imbalance of growth factors, proteases, and antiproteases is likely to be a cause of uterine mucosal remodeling with progressive collagenogenesis and atrophy of the glandular apparatus along with pathogen persistence, which may be one of the factors predisposing to miscarriage. This makes it necessary to eliminate the causative agent of the endometrial infectious-inflammatory process in the earliest periods of the onset of disease and permits the drawing up of approaches to targeted drug therapy for some pathogenetic links of disease.

[Role of matrix metalloproteinases and their tissue inhibitor in the morphogenesis of chronic Helicobacter pylori-associated gastritis in children].

The authors examined gastric biopsy specimens in 40 children aged 7 to 15 years: 30 children with the clinical diagnosis of chronic Helicobacter pylori (HP)-associated chronic gastritis (CG) and 10 children with functional dyspepsia (FD). In HP-associated CG, the gastric mucosa (GM) showed higher levels of matrix metalloproteinases (MMP) and their tissue inhibitor in the antral and fundal stomach than those in FD. There was an increased exposure of the markers MMP-9 and MMP-2, which was most evident in the fundal GM and correlated with the activity of inflammation. The significant elevation of TIMP-1 suggests that compensatory reactions are tense and may cause GM remodeling with enhanced collagen generation. The increased synthesis and activation of MMP-9 and MMP-2 can stimulate the realization of ulcerogenic properties of these metalloproteinases. The findings revealed the points of application of target drugs to some links of the pathogenesis of HP-associated CG in children.

[Significance of some growth factors in the pathogenesis of chronic gastritis in children].

Gastric biopsy specimens taken from 44 children aged 7 to 15 years who had a clinical diagnosis of chronic gastritis (CG) were studied. In Helicobacter pylori (Hp)-associated CG (n = 24), there were accelerated cell regeneration processes in the antral and fundal mucosae as compared with the rate of proliferation and apoptosis in Hp-unassociated CG (n = 20). The increased proliferation of gastric mucosal (GM) elements has been shown to be associated with the high density of EGFR, in Hp-associated CG in particular, which is generally observed in the insufficient level of TGFR-beta. The authors have ascertained the important role and heterodirectional functional load of EGFR and NGFR-beta in the pathogenesis of CG. This disease is characterized by the maximum EGRF expression that is directly correlated with the rate of cell regeneration processes and the activity of an inflammatory process. Moreover, the rate of proliferation and apoptosis are associated with the increased expression of EGRF on the other hand and with the inadequate reperesenation of TGFR-beta on the GM cell membranes, which is particularly prominent in children with Hp-associated CG.

[A case of dirofilariasis in the town of Magnitogorsk of the Cheliabinsk region]. / Sluchai dirofilliarioza v g.Magnitogorske Cheliabinskoi oblasti.

A local case of dirofilariasis was first reported in a 70-year-old female in Magnitogorsk, Chelyabinsk Region, in November 2002. The primary diagnosis is atheroma of the skin of the forehead. A round mass having a smooth surface and slightly solid gray-whitish walls was surgically excised, which yielded a mobile rolled nematode measuring 7 cm in length and 0.8 mm in width. The parasitological diagnosis is an immature Dirofilaria repense female. It has been found that the female has neither dogs nor cats in her flat and she had not been left Mangitogorsk for approximately 18 years. A histological examination of the fibrotic capsule around the parasite revealed inflammation in the inner layer of the capsule, which was regarded as proliferative and having no signs of a granulomatous process. Fragments of cuticles of a round helminth having a well-defined alimentary tube was found. To encode the case, the authors have used Category B74.8 "Other types of filarisis (dirofilariasis)" of the first class, ICD-10.

[Primary echinococcosis of the heart in pulmonary tuberculosis]. / Pervichnyi ékhinokokkoz serdtsa pri tuberkuleze legkikh.

The paper presents a sectional case of primary cardiac Echinococcus infection in a patient with fibrocavernous pulmonary tuberculosis. A whitish thin-wall round-oval cyst, 2 cm across, was detected in the thickness of the lateral left ventricular wall at autopsy. The tinctorial properties of the cyst sheath suggested that the parasite might be viable. The internal germinal layer of its sheath showed minor filial vesicles provided with scolexes. An extensive area of tissue detritis was perifocally detectable near the cystic wall, then peripherally there was a fibrous capsule with developed plethoric vessels and polymorphically cellular inflammatory infiltrate with a predominance of lymphocytes, macrophages, eosinophilic leukocytes, and fibroblasts. Parasitic cardiac damage along with tuberculous infection of respiratory organs had played an important role in the decompensation of performance of the hypertrophic heart and referred to the unified category of the second malaise in the mixed underlying disease.

[Immunopathological responses in women with chronic inflammatory diseases of the uterus and appendages and their therapeutic correction]. / Immunopatologicheskie reaktsii pri khronicheskikh vospalitel'nykh zabolevaniiakh matki i pridatkov i vozmozhnosti ikh terapevticheskoi korrektsii.

A total of 145 women with chronic inflammatory diseases of uterus and appendages (IDUA) were examined. Bacterioscopy of smears and culture of vaginal, cervical canal and uterine cavity contents were performed in all patients. Direct immunofluorescence and PCR were used for detection of chlamydiae in scrapes and smears and in biopsy specimens taken from endometrium. The number of T lymphocytes and their subpopulations, B lymphocytes as well as the level of plasmatic cells synthesizing IgA, IgM and IgG and secretory IgA (sIgA), immune complexes and C3 component of the complement were determined in biopsy specimens of the endometrium. Pathomorphological examination revealed structural changes characteristic of the immunocomplex disease (secondary deficiency of sIgA, pronounced suppression of IgA production by plasmocytes along with an essential increase in the number of IgG synthesizing cells and immune complexes fixed to the venule endothelium) were detected. Lectin-histochemical study revealed considerable changes in secretory activity of endometrial epitheliocytes manifested by severe suppression of bactericidal activity of the uterine mucus. The detected disturbances of local protective reactions in the endometrium of women IDUA gave grounds for including immunomodulators into the traditional treatment scheme. The latter made it possible to increase essentially the therapeutic effect.

[A rare complication after surgical correction of the rupture of Valsalva's sinus aneurysm into the right heart ventricle]. / Redkoe oslozhnenie khirurgicheskoi korrektsii proryva anevrizmy sinusaVal'sal'vy v pravyi zheludochek serdtsa]

Postsurgical myocardial infarction in a 68-year-old female was observed after occasional compression of the coronary artery by a teflon gasket when P-like suture was applied on the anterior wall of the right ventricle in the course of surgical intervention for closure of the aortic-right-ventricular fistula. The latter had formed after the rupture of Valsalva's sinus aneurysm into the right ventricle this being the cause of the surgery. The authors propose how to document the diagnosis and medical death certificate in similar cases.