[Treatment of infertility in men with pathospermia associated with oxidative stress].

INTRODUCTION: Oxidative stress considered to be the main cause of male infertility. Surgical treatment of varicocele and elimination of the inflammatory process in the male accessory glands can help reduce the level of oxidative stress, however, in most cases, antioxidant therapy is additionally prescribed. Currently, much attention is paid to regulatory peptides as a component of antioxidant therapy due to their antioxidant, anti-inflammatory and immunomodulatory properties. AIM: To evaluate the efficiency of a complex of antimicrobial peptides and cytokines Superlymph for the treatment of male infertility associated with oxidative stress. MATERIALS AND METHODS: A total of 30 patients with elevated levels of reactive oxygen species were recruited in the open, prospective, multicenter study. Ejaculate analysis (WHO-2010), MAR-test, sperm DNA damage testing and reactive oxygen species measurement were performed. All patients received Superlymph 25 IU/day for 60 days. Antibiotics and vitamin D were also prescribed if indicated. In addition, 12 patients took dietary supplements with antioxidant action. Laboratory tests were repeated after the completion of treatment. RESULTS: Superlymph therapy led to an improvement in standard semen parameters as well as decrease in sperm DNA fragmentation and oxidative stress. At the end of treatment, a significant increase in the sperm concentration was observed (46.8 [30; 87] vs. 62 [43-89], p=0.002). After treatment, there was also an increase in the median of sperm cells with normal morphology (3 [1; 7] vs. 4.5 [2; 9], p=0.002). The median sperm DNA fragmentation was lower compared to baseline, but this difference did not reach significant level (19 [14; 26] vs. 15 [10.5; 19.5], p=0.06). A significant decrease in the level of oxidative stress both in patients who took Superlymph as monotherapy (43 [27; 51] vs. 33 [22; 44], p=0.005), and as part of combination therapy with other antioxidants (31 [22; 54] vs. 21 [12; 36], p=0.009) was also observed. CONCLUSION: Superlymph contributes to the improvement of standard ejaculate parameters as well as decrease in the level of sperm DNA fragmentation and oxidative stress.

[Dynamics of sperm indicators in men with chronic prostatitis associated with secondary infertility based on the use of ANDROEXPERT SV1 suppositories].

INTRODUCTION: Chronic prostatitis (CP) is the most common cause of a disorder of not only sexual, but also reproductive functions in men, which is caused by a decrease in the quality of the ejaculate and is confirmed by a deterioration in spermogram parameters, up to oligoasthenoteratozoospermia and azoospermia. In such a situation, the onset of pregnancy in the natural cycle is impossible - even with a completely preserved reproductive function in a woman. As an active substance in the recovery of men with chronic prostatitis associated with secondary infertility, we proposed oxidised dextran in the form of a pharmaceutical composition, which was developed at Federal Research Centre for Fundamental and Translational Medicine, Novosibirsk, Russia; and produced by ANDROEXPERT Research and Manufacturing Company LTD, Novosibirsk, Russia. The purpose of the study was to evaluate the dynamics of spermogram parameters as a result of the use of suppositories with oxidised dextran "ANDROEXPERT SV1" in men with chronic prostatitis associated with secondary infertility. MATERIAL AND METHODS: The study included 52 patients with chronic prostatitis associated with secondary infertility. The mean age of the patients was 32+/-2.2 years. The examination of patients was carried out in accordance with the algorithm recommended by the Russian Society of Urology, the European Urological Association and the standard of primary health care for chronic prostatitis (Appendix to the order of the Ministry of Health of Russia No. 775n of 09.11.2012). The patients were divided into two groups: the 1st group of patients received oxidised dextran rectally once per day for 10 days, then 20 days every other day; The 2nd (comparison group) received a placebo in the form of rectal suppositories consisting of cocoa butter in a similar way. RESULTS: The volume of ejaculate among patients of the 1st group increased from 2.54+/-0.15 to 3.13+/-0.18 (ml), which amounted to 23.23%; p<0.05. The sperm concentration indicator increased from 26.40+/-4.18 to 41.12+/-5.37 (million/ml) - by 55.75%; p<0.05, which led to an increase in the total number of spermatozoa in the ejaculate by 88.5%, from 65.47+/-8.41 to 123.41+/-12.33 (million pieces); p<0.05. The number of leukocytes in the same group decreased by 2.8 times: from 1.25+/-0.17 to 0.44+/-0.10 (million/ml) - by 64.80%; p<0.05. The indicator of the severity of sperm agglutination decreased by 3 times: from 0.52+/-0.07 to 0.17+/-0.03 - by 0.35 arb. units, which was 67.31%; p<0.05. The indicators of the spermogram in patients with chronic prostatitis of the second group did not change in the course of treatment. CONCLUSION: Assessing the dynamics of spermogram parameters as a result of the use of "ANDROEXPERT SV1" in men with chronic prostatitis associated with secondary infertility, there is a decrease in the number of leukocytes and a significant improvement in the parameters of the ejaculate, both its general properties and the main characteristics of spermatozoa. Thus, ANDROEXPERT SV1 suppositories show high clinical efficacy and safety in monotherapy and may be promising when choosing the management tactics for this group of patients.

[The use of rectal suppositories with oxidised dextran for calculous prostatitis].

This article presents its own experience of using suppositories with oxidised dextran in the treatment of a patient with recurrent bacterial prostatitis complicated by prostate calcifications, these are the positive effects on the use of suppositories with oxidised dextran: a decrease in the size of calcified areas, a stable elimination of opportunistic microflora and the achievement of long-term remission of the disease.

[Experimental study on the efficiency of rectal suppositories with oxidized dextran in patients with benign prostatic hyperplasia].

AIM: to evaluate therapeutic activity of oxidized dextran after rectal administration in a modified sulpiride model of benign prostatic hyperplasia in mice. MATERIALS AND METHODS: The therapeutic activity of oxidized dextran was studied in an experimental model of benign prostatic hyperplasia in mice (sulpiride model). All in vivo studies were carried out on 30 male BALB/c mice with an average body weight of 30-35 g. RESULTS: It was found that rectal administration of a solution of oxidized dextran effectively neutralizes pathomorphological changes in experimental model of benign prostatic hyperplasia. In the group of animals, which received 2% solution of oxidized dextran as treatment, the most prominent therapeutic effect in an experimental model was seen and it was confirmed by a decrease in the bladder detrusor thickness and the normalization of its lumen.

[Painful diabetic polyneuropathy: focus on life quality improvement of patients]. / Bolevaia forma diabeticheskoi polineiropatii: fokus na uluchshenie kachestva zhizni patsienta.

AIM: To evaluate the efficacy and safety of cytoflavin as an additional agent in the treatment of painful diabetic polyneuropathy and to analyze changes in the life quality of the patients studied. MATERIAL AND METHODS: An analysis of treatment data was carried out in 61 patients with verified painful diabetic polyneuropathy, who were divided into 2 groups depending on the therapy regimen. Patients of the main group (n=36) at the start of the therapy with gabapentin additionally received cytoflavin: intravenously, slowly, 10 ml diluted in 0.9% NaCl 200 ml for 10 days, followed by switching to per os 2 tablets 2 times a day for 25 days. Patients of the comparison group used gabapentin in comparable doses as an analgesic symptomatic therapy. Clinical neurological and anamnestic methods were used to monitor and assess the condition of patients. RESULTS AND CONCLUSION: Cytoflavin inclusion in the standard symptomatic treatment of patients with painful diabetic polyneuropathy contributed to a more pronounced decrease in the subjective assessment of pain (VAS scale) by the 10th day (42.8±2.4 mm versus 58.2±2.1 mm in the comparison group) and its maximum level of decline to 21-25 days. The achieved result was maintained by the 35th day (21.4±1.1 mm against 22.4±1.7 mm in the comparison group). At the same time, the quality of life of patients as assessed by SF-36 was significantly increased after treatment. The results obtained, along with the safety of the drug, allow us to recommend its inclusion in the treatment regimens for patients with this pathology.

[Hormonal feature of the androgen status in different-aged males.]

The examined males (n=374) aged from 20 to 69 years were divided into five age groups: the 1st - 20-29 years; the 2nd - 30-39 years; the 3rd - 40-49 years; the 4th - 50-59 years; the 5th - 60-69 years. There was 16,1±7 nmol/l total testosterone level in serum of all aged group. Hormonal signs of androgen deficiency, increased elderly aged groups, were revealed in males of the 2nd group as compared with males of the 1st group. The frequency of androgen deficiency (total testosterone level less than 12,1 nmol/l) in the 1st group was 26,9%; in groups 2, 3 and 4 this index was similar, composed 30,6-33,9%. However, the frequency of androgen deficiency increased and amounted to 44% in the 5th group. The frequency of hypogonadism hormonal signs (total testosterone level less than 8 nmol/l) did not significantly differ in groups 1-4 (6,2-9,3%), and only in group 5 it increased and amounted to 28%. The age-related androgenic deficiency in males was associated with decrease in androgenic function both the gonads, and the adrenal glands, increased level of sex steroid-binding globulin, increased metabolism of testosterone in estradiol and was accompanied by compensatory increase of luteinizing hormone synthesis in the pituitary gland.

[LAPAROSCOPIC SURGERY FOR EARLY OVARIAN CANCER: EXPERIENCE AT THE P. A. HERZEN ONCOLOGY RESEARCH INSTITUTE].

For the period from 2003 to 2014 at the Oncogynecology Department laparoscopic surgery for ovarian cancer was performed in 49 patients aged 19 to 76 years. During the surgical interventions special attention was paid to the principles of oncological radicalism and ablastics, the volume of surgery depended on the extent of tumor process, morphological characteristics of tumor, a patient's age and the desire to preserve reproductive function. In 42 (85.7%) cases laparoscopic procedures were conducted to restaging (after non-radical operations in gynecological hospitals). In all 49 patients a histological form of ovarian tumor corresponded to adenocarcinoma. Mean operative time was 140 ± 10,5 minutes, the average blood loss--80,2 ± 14,3 ml. Postoperative complications (bleeding from the omentum) were recorded in 1 (2%) patient, the need for conversion was occurred in 4 (8.2%) cases due to the adhesive process or signs of dissemination. As a result of laparoscopic surgery an increase in staging of disease was fixed in 14 cases (28.6%). Follow-up median was 45 months, relapses occurred in 5 (10.2%) patients. Of 49 patients 2 (4.1%) died from disease progression. Disease-free and overall survival rates were 89.8% and 95.9%, respectively. Thus, data of world literature and our own experience indicate the potential equivalent of laparoscopic and laparotomy approaches in treatment for early ovarian cancer.

[Intravascular leiomyomatosis].

Intravenous leiomyomatosis is a rare disease from a group of tumors with the indefinite grading potential. The paper describes two cases of intravenous leiomyomatosis with its detailed morphological pattern, molecular genetic findings, and a brief literature review. Losses of heterozygosity of microsatellite repeats thatwere located on chromosome 10 in 10q22.1 and common in uterine leiomyosarcomas were found in both cases. Investigations of the morphological and biological characteristics of leimyomatosis are important to clarify the key molecular mechanisms underlying the development of this nosological entity and to determine etiopathogenetic relationships between intravenous leiomyomatosis and other uterine smooth muscle neoplasms.

[Age-related morphological changes in the aortic wall in dissecting aneurysm].

OBJECTIVE: To reveal the morphological features of the aorta in its dissection in persons of different age groups. MATERIAL AND METHODS: The operative material obtained after resection of the aorta for its dissection was examined. The fragments of the wall of the ascending aorta were fixed in 10% formalin solution immediately following its resection. The material was treated by processing and fixing methods; paraffin sections were stained with hemotoxyllin-eosin, orsein by the Van-Gieson, MSB, and Leigh methods. RESULTS: By analyzing 77 dissecting aortic aneurysm biopsy specimens, the authors presented the structural features of the aortic wall in terms of age-related changes. Examinations were made by light and electron microscopy using special stains. The signs of physiological or premature aging were assessed by elastic skeleton changes. There was a deficiency of collagen and its impaired maturation in all the study cases of vascular aging in the presence of aortic dissection. CONCLUSION: Quantitative and qualitative changes in the smooth muscle cells were due to both patient age and concomitant hypertension. In young patients, aortic dissection was more frequently caused by a genetically determined disorder in the elastic skeleton in obvious substitutive sclerosis.

[Organ-sparing therapy for patients with borderline ovarian tumors].

Contemporary possibilities of organ-sparing therapy for borderline ovarian tumors are considered. World data was analyzed on recurrence rates and fertility rates after different methods of conservative surgery. The experience with ultra-conservative surgery in patients with bilateral borderline ovarian tumors at the Onco-Gynecological clinic of the P.A. Herzen Moscow Research Oncology Institute is presented.

[Hormone therapy alone for pre-cancerous conditions and early endometrial cancer: pros and cons].

The results of conservative treatment of 121 patients with endometrial atypical hyperplasia (EAH) and early endometrial cancer (EC) with preservation of fertility are presented. In EAH (n = 56) for 6 months the intrauterine spiral Mirena was used. The effectiveness was 91%, the recurrence rate 16%, pregnancies occurred in 16% of patients. In EC (n = 65) hormone therapy was conducted for 6 months using the intrauterine spiral Mirena and zoladex. The effectiveness was 79%, recurrence rate 22%, pregnancies occurred in 24% of patients. Based on our data and on the results of other studies, the benefits and risks of hormone therapy alone for EAH and EC are discussed in women of reproductive age.

[Morphological changes in the wall of the aorta in its dissecting aneurysm].

The paper describes 144 autopsy materials and 69 biopsy ones and shows possible morphological changes in the wall of the aorta in its dissecting aneurysm. Examinations were made by light and electron microscopy using special stains. Cases of arterial hypertension without aortic dissection were selected as a group of comparison. Varying degrees of structural changes were found in all layers of the aortic wall. In accordance with the predominant involvement of this or that component, the authors identified three types of changes: 1) those with the predominant involvement of the elastic skeleton; 2) necrotic and dystrophic changes in the smooth muscle cells to give rise to medial laminar and focal necroses; 3) nonspecific diffuse changes in all layers of the aortic wall, which are characteristic of aging processes. Comparison of morphological changes with those in the comparison group revealed those that appeared to be caused by previous aortic wall structural damages that gave rise to impaired elastic and collagen formation not only in patients with previously found connective tissue dysplasias.

[Pathoanatomic criteria for dissecting aortic aneurysm].

The authors present the basic pathoanatomic criteria for the diagnosis of dissecting aortic aneurysm on the basis of an analysis of 144 cases of this abnormality. Its mandatory signs are the inlet (of blind rupture of the wall of the aorta) and channel of its dissection. The inner surface of the dissection channel varies with the time of (rough to smooth) dissection with connective tissue bands. The optional criteria are the outlet that connects the false aortic lumen with the true one, as well as the propagation of dissection to the visceral aortic branches. When the visceral branches are involved in the process of dissection in more than half of all cases, there are no changes in the respective organs. At the same time there are ischemic changes in the organs, the vessels of which are not involved in this process. This is suggestive of complex circulatory disorders in this disease. The main mechanisms of tanatogenesis are due to the rupture of the outer sheet of a false passage, the propagation of dissection to the visceral branches or a combination of these two factors. The optimal autopsy procedure options are shown with regard to the pathoanatomic features of dissecting aortic aneurysm.

[Association of erectile dysfunction with hypogonadism and metabolic syndrome among men of various age groups].

The integrated study included 184 men aged from 22 to 60 years who were formed into two groups, of the first and second period of middle age. The direct relation of both erectile dysfunction frequency and expressiveness from age was developed. The same dependence was found for hypogonadism clinical features, metabolic syndrome and its components, but inverse relation was detected between age and testosterone content in blood. The presence of erectile dysfunction was associated with testosterone level reduction, hypogonadism clinical features frequency, metabolic syndrome and most its components increase without the age. It was shown that first and second period of middle age men with erectile dysfunction did not display the difference in blood testosterone content, metabolic syndrome and its components frequency. Hence, the main risk factors of erectile dysfunction development form qualitatively already in young men; they accumulate quantitatively with age producing the androgenous disorders evolution.

[On ultrasound follow-up of patients after pelvic lymphadenectomy].

Ultrasound examination of the peritoneal cavity, small pelvis, iliac lymph nodes and femoral blood vessels (downstream of the blood flow) was performed in 346 patients who had undergone pelvic lymphadenectomy. Post-operative lymphocele developed in 302 (7.2%). However, treatment was required in 98 (28.3%) only. Our strategy of follow-up after pelvic lymphadenectomy facilitated diagnosis and effective excision of lymphocele without resorting to laparotomy due to an improved procedure of ultrasound monitoring.

[Radical abdominal tracheolectomy: technical aspects].

P.A. Herzen Research Institute of Oncology, Moscow The paper presents our experience with radical tracheolectomy carried out in 54 patients with invasive cervical carcinoma to preserve fertility. An original procedure designed to assure adequate uterine blood supply was used. Short-term oncological and functional results are discussed.

[The use of biologically controlled ultrasound therapy for the combined treatment of primary open-angle glaucoma].

The present study included 160 patients (206 eyes) presenting with the initial and advanced stages of primary open-angle glaucoma. 120 patients (157 eyes) were treated using biologically controlled ultrasound therapy besides traditional medicamentous therapy, the remaining 40 ones (49 eyes) were given only conventional medication. Results of the treatment were evaluated based on a set of commonly used hydrodynamic and electrophysiological characteristics of the quality of visual function. Biologically controlled massage of trabecular structures of the affected eyes made it possible to stabilize and improve major hydrodynamic characteristics of the eyeball drainage system, visual function, and electrophysiological parameters. Biologically controlled ultrasound therapy proved to produce a more pronounced beneficial effect on ocular hydrodynamics than the traditional ultrasonic treatment. The positive action of biologically controlled therapy persisted during 8 months; its repeated sessions prolonged this period up to 2 years.

Photodynamic therapy of virus-associated precancer and early stages cancer of cervix uteri.

We have analyzed the results of photodynamic therapy using light-sensitizing agent "Photogem" in 72 patients - 56 women with pre-cancerous lesions of cervix and 16 women with early cervical cancer (group 1); Photosens in 47 patients - 35 women with pre-cancerous lesions (CIN III), 12 women with non-invasive cervical cancer (carcinoma in situ) (group 2); and Alasens in 22 patients - 8 women with virus-associated pre-cancerous lesions (high-grade CIN III), 14 with virus-associated early cervical cancer (carcinoma in situ, cervical cancer 1A1) (group 3). The results were as follows: group 1 - complete regression of CIN III and non-invasive cervical cancer (carcinoma in situ) was achieved in 50 (89.2%) and 11 (68.8%) cases, significant regression was achieved in 2 cases (3.6%) and in 2 cases (12.5%), stabilization was achieved in 2 cases (3.6%) and in 2 cases (12.5%), progression was achieved in 2 cases (3.6%) and in 1 case (6.2%) accordingly. In the group of patients after PDT using Photosens complete regression of CIN III and non-invasive cervical cancer (carcinoma in situ) was achieved in 33 cases (94.2%) and in 10 cases (83.4%) cases, significant regression was achieved in 1 case (2.9%) and in 1 case (8.3%), stabilization was achieved in 1 cases (2.9%) and in 1 cases (8.3%). In the group of women after surgical treatment anti-viral efficacy was assessed. It s necessary to note that not a single relapse was observed. Anti-viral effect was registered in 49 (90.4%) cases The longest HPV-free period that we observed was 5 years. 12 women with CIN III and 4 women with carcinoma in situ became pregnant.

[Organ-saving and function-conserving procedures in the treatment of cervical carcinoma].

The paper presents our data on conservative treatment of early cervical carcinoma using laser, ultrasound, electrocautery scissors and electrosurgical conization. Also, menstrual and reproductive function in cured patients as well as frequency of tumor recurrence are discussed. An original procedure for ovarian transposition used in combined treatment of invasive cervical carcinoma is suggested. Potential and methods of monitoring transposed appendages are validated. Findings on 5-year survival are presented. The methods of conservative treatment are evaluated as promising further achievements in oncogynecology.