При наличии яичниковых образований, особенно у беременных, важным является не только их своевременное обнаружение, но и определение характера. Известно, что яичниковые образования нередко встречаются во время беременности [1, 2], частота их, по данным одних авторов [1], варьирует от 1:80 до 1:131, по данным других [3, 4],-от 1,14 до 2,3%. Согласно работам отечественных исследователей [2, 3, 5], доброкачественные опухоли наблюдаются в сочетании с беременностью в 4-5 раз чаще, чем
Clinical observations of gastrointestinal (GIT) cancer in pregnant women are presented. It is emphasized that early warning signs, typical of the initial manifestations of gastrointestinal stromal tumors, remains underestimated against the background of pregnancy. Frequently, common stages of the disease (III–IV) are detected accidentally after the manifestation of symptoms (gastrointestinal bleeding, formations palpated through the abdominal wall) or due to the detection of metastatic ovarian tumors, which manifest themselves as an independent disease. Long-term results of treatment of patients with secondary ovarian malignancies remain unfavorable. Conclusion. Pregravid training should be at the forefront and include a complete examination of patients, especially those with untypical complaints, in level 3 institutions with appropriate laboratories and modern methods of instrumental research. Key words: pregnancy, gastrointestinal malignancies, ultrasound
The problem of ovarian tumor differential diagnosis is solved using comprehensive ultrasound examination at different levels of efficiency. However, ultrasound imaging is an operator-dependent technique due to subjective interpretation of results. The study was aimed to assess the ultrasound signs of benign and malignant ovarian germ cell tumors (OGCTs) in pregnant women in order to determine the feasibility of surgical treatment and chemotherapy. The study was carried out using the logistic regression models. A group of 199 pregnant women with benign and malignant OGCTs were enrolled. Of them, 183 patients had benign, and nine patients had malignant tumors. In order to assess menstrual function and fertility, seven pregnant women were enrolled, who had previously received treatment for malignant OGCTs. Pre-operative assessment results were compared with morphological assessment data. Organ-preserving surgical treatment was performed (unilateral adnexectomy); if necessary, the patients received cisplatin-based chemotherapy. Perinatal outcomes were assessed. The median observation time between the malignant OGCT detection and the end of the study was 66 months (12–240 months). It was found that comprehensive ultrasound examination and logistic regression models (sensitivity 100%, specificity 92.3%, overall accuracy 92.8%) enabled differential diagnosis of benign and malignant OGCTs. The number of unnecessary surgical procedures in patients with benign OGCTs was been limited, the pregnancy and childbirth outcomes were improved. Nine pregnant women received organ-preserving surgical treatment for malignant OGCTs, and three patients received chemotherapy after surgery, which allowed the patients to realize their reproductive potential.
Определено количество копий рибосомных повторов (рДНК) в геномах женщин с нормальной и осложненной беременностью, а также женщин, подвергшихся процедуре экстракорпорального оплодотворения (ЭКО). Кроме того, измеряли содержание GC-богатой рДНК в образцах внеклеточной ДНК (вкДНК), полученных от женщин с нормальной и осложненной беременностью. Показано, что геномы более половины женщин с патологией беременности содержали либо больше, либо меньше копий рДНК, чем у любой женщины из контрольной группы. Также обнаружено более высокое содержание рДНК во вкДНК пациенток с осложненной беременностью, что свидетельствует о наличии хронического процесса аномальной гибели клеток в группе женщин с патологией беременности. Можно сделать принципиальный вывод: поскольку беременность является тяжелой нагрузкой на организм женщины, для успешного вынашивания требуется сбалансированный биогенез рибосом. Женщины как с низкой, так и с очень высокой копийностью рДНК имеют более высокую вероятность повышенного уровня апоптоза и попадания в группу риска. Параметр «число копий рДНК в геноме женщины» может служить дополнительным прогностическим маркером потенциальных осложнений беременности у женщины. Женщины с низким или высоким количеством копий рибосомных генов в геноме нуждаются в более внимательном ведении беременности. Показатели количества копий рДНК в геномах женщин с неудачными попытками ЭКО были значимо ниже, чем в геномах двух остальных групп. Этот факт говорит о том, что копийность рДНК в геноме является одним из факторов, влияющих на успех процедуры ЭКО. Если индвивидуальное число копий рДНК в геноме женщины меньше, чем 330, высок риск неудачного ЭКО. Необходимы дальнейшие исследования данного вопроса. As pregnancy is a stressful load for a woman, any stress-resistance factor is relevant to it. According to recent reports, ribosomal gene copy number in the genome is associated with the individual stress-resistance. We determined copy numbers of ribosomal DNA (rDNA) in genomes of pregnant women with normal and complicated pregnancy, and women after in vitro fertilization (IVF) procedure. We also measured the contents of GC-rich rDNA in cell-free DNA (cfDNA) derived from normal controls and complicated pregnancy cases. We have shown that genomes of more than a half of DNA samples from women with pregnancy pathology harbor either more, or less rDNA copies than any woman from the control group. We also found higher rDNA contents in cfDNA isolated from complicated pregnancy cases suggesting the presence of a permanent cell death process in pathology cases. A principal conclusion can be made: women with low rDNA copy numbers and with very high numbers can have higher cell death rates and belong to the risk group. The parameter «rDNA copy number in woman’s genome» can be an additional prognostic marker for eventual pregnancy complications in the woman. The numbers of rDNA copies in the genomes of women with failed IVF attempts was significantly lower than in the genomes of patients with succesfull outcome, suggesting that rDNA copy number in the genome is one of the factors that affect the success of the IVF procedure. If the individual rDNA copy number is under 330, the risk of IVF failure is high. Further studies are warranted.
In order to clarify the significance of various methods for determining the state of the fetus during its hypoxia, we studied the content of placental lactogen (PLH) in the blood and amniotic fluid, the activity of histidase and urocaninase in them, and also studied the cardiac activity of the fetus using the oxytocin test in 109 pregnant women.
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