The book contains 235 eponymous symptoms and samples, 163 syndromes and diseases related to obstetrics and gynecology. The publication consists of two parts, the first part refers to the semiotics of gynecological diseases and presents symptoms and signs. The second part includes nosological units and symptom complexes, which are systematized in alphabetical order. Their explanation, historical information, data on disease epidemiology, etiology, pathogenesis and clinical picture are presented. From the standpoint of modern evidence-based medicine provides information on the diagnosis, treatment and prevention of major diseases encountered in the practice of obstetrician-gynecologist. It is intended for students of medical universities as information about the meaning of eponymous terms that they face in the process of learning, practical work and in the study of special medical literature. It will be useful to researchers, teachers of higher medical school, obstetricians and gynecologists.
The obesity pandemia linked metabolic syndrome (MS) connected with it acquires not only medical, but also increasing social importance. This state has unfavorable action on human organism and is the serious diseases risk factor. Special importance MS available in the women of childbearing age. There are described some literature data about the special features of MS pathogenesis in women and the possibilities of its correction with sibutramine and by the combined medication Reduxin® (sibutramine + cellulose microcrystalline). Our own data of the experience of treatment by the Reduxin® 53 women in reproductive age with MS are cited, opsomenorrhea and with a formation of polycystic ovarian syndrome. Patients took the medication during 12 weeks. Mean body weight loss was 13% and 27 patients had weight loss more than 5% at the end the period of observation. Circle of waist was also the decreased on the average on 6±2 cm. 43 women had a normalization of rhythm, duration and intensity of menstrual hemorrhages. Remaining patients it was required the designation of gestagen in the cyclic regime. An improvement of the blood lipid profile was detect: the average value of atherogenic index triglycerides/ high density lipoproteins cholesterol was improved to 35,8%. The maximum decrease of the cardiovascular disease risk factors was marked in the patients, who had weight loss more than 10%.
Aim. To confirm that dysbiosis of the urinary tract or gut may be associated with endometriosis course. Materials and methods. We analyzed the samples of vaginal, cervical and intestinal epithelial cell scrapes in 32 patients with a confirmed intraoperative diagnosis of stage III and IV endometriosis and 25 healthy patients as a control group. A wide range of pathogenic and opportunistic microorganisms was evaluated using polymerase-chain reaction (PCR) method to determine real-time results. We found fundamental differences between the samples of microflora in the investigated group and the control group. The lack of opportunistic gram-positive Atopobium vaginae in the vaginal and cervical secretions of women with stage IIIIV endometriosis was statistically significant (p 0.05). In the samples of cervical canal of epithelial scrapes of patients with stage IIIIV endometriosis, there were detected clinically significant amounts (more than 104 million copies of DNA/ml) of opportunistic and pathogenic microorganisms Gardnerella vaginalis, Porphimonas spp. Opportunistic strains Gardnerella vaginalis, Prevotella bivia, Escherichia colli, Streptococcus spp. dominated in the rectal scrapes of the patients of the investigated group. On the basis of the obtained data of microbiota studying, individual correction of the detected dysbiosis was carried out. Results. The obtained data demonstrated an altered microflora of the urogenital tract and gut in patients with stage III and IV endometriosis. After therapy, the groups ceased to differ in the frequency of detection of normocenosis, moderate dysbiosis and severe dysbiosis that testifies to the normalization of urogenital tract and intestinal microflora in patients with moderate and severe courses of ovarian endometriosis. Further research is needed to examine whether dysbiosis is a consequence of the development of moderate and severe endometriosis or dysbiosis is a concomitant background pathology that contributes to the formation of endometriosis of this degree of severity.
Aim - the purpose of the study is the development of a method for prevention of pathological pregnancy syndrome from the perspective of integral genesis, determined by morphological and functional abnormalities in the fetoplacental system, assessing the effectiveness of methodological standards of evidence-based medicine. Materials and methods. Prospective study of 435 women with high risk of decompensation of placental insufficiency was conducted. Depending on the method of prevention of gestational complications 4 groups were formed: 1st group included 145 pregnant women, who were prescribed dydrogesterone on the 6-20 weeks of gestation, and starting with the 21st week - highly-purified diosmin 600 mg as vasoprotective; in the 2nd group 118 women received a course of preventive treatment with low doses of acetylsalicylic acid; 3rd group included 102 patients who underwent a course of preventive monotherapy with magnesium; 4th group comprised 70 pregnant women who refused preventive treatment. A control group encompassed 30 healthy pregnant women. Dynamic survey included definition of markers of endothelial and hemostasiological dysfunction, vascular-platelet dysfunction elements, apoptosis, inflammatory response, total reactive capacity of the organism, magnesium and carbon dioxide concentrations; a hystostereometric study of placenta was conducted. Standards of evidence-based medicine were applied for the objectification of the effectiveness of the developed method. Results. Method of preventing great obstetric syndromes by successive appointment of progestogen dydrogesterone on the early stage of pregnancy followed by vasoprotective diosmin 600 mg in the 2nd half of pregnancy showed high efficiency (NNT 1.4 (95% CI 1.1 -1.7); OSH 5.3 (95% CI 4.7 -5.8), namely reducing pre-eclampsia by 93%, placental insufficiency with intrauterine growth restriction and/or chronic fetal hypoxia - 95%, preterm birth - 86%, and no premature abruption of normally situated placenta, severe forms of pre-eclampsia and placental insufficiency. Higher clinical effectiveness of the proposed method of prophylaxis of pathological pregnancy syndrome, compared to the use of low-dose acetylsalicylic acid and preparation of magnesium, can be explained by the normalizing effect of dydrogesterone and highly-purified diosmin 600 mg on the immune and biochemical homeostasis, apoptosis and angiogenesis, activation of endothelial and hemostasiological system, adaptive compensatory reactions in the placenta. Conclusion. The method of choice for the prevention of pathological pregnancy syndrome at high risk of fetoplacental system decompensation is the application of progestogen dydrogesterone and vasoprotective diosmin according to the developed method. The study revealed the potential of targeted selection of preventive methods depending on special needs of pregnant women.
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