Background
. Routine use of ultrasound methods does not always allow detecting endometriosis in the early stages. It is necessary to develop more accurate criteria for the diagnosis of endometriosis ...in its initial stages of development. Objective: to assess ultrasound and biological markers of endometriosis “small” forms of different localization in infertile women.
Material and methods
. Ultrasound examination of 208 infertile patients with initial stages of external endometriosis (1–15 points by revised American Fertility Society (rAFS) classificatoon) was performed (main group). The control group consisted of 195 healthy women of childbearing age. To verify the diagnosis, it is suggested to use a panel of biomarkers, including interleukins (IL) 1β and 6, CA125, HE4 as well as the ROMA (Risk of Ovarian Malignancy Algorithm) index in the dynamics of the menstrual cycle.
Results
. On ultrasound scans, 56 (94.9%) patients had small one- and two-sided ovarian cysts corresponding to endometriosis stage 1–2 (rAFS), and in 3 (5.4%) of them, the ultrasound result was questionable. Detectability during the initial ultrasound examination in the Douglas space was 76.9%, in the rest of cases the ultrasound picture was doubtful. Peritoneal endometriosis was detected only in 5 patients. In the remaining cases (88.9%), additional studies were necessary, including surgical (laparoscopy). The average content of CA125 in the main group on days 3–5 of the menstrual cycle was 42.6 (2.1) U/ml, on days 21–23 – 39.6(2.2) U/ml (p=0.32); in the control group, 5.1 (0.4) and 4.8 (0.7) U/ml, respectively (p = 0.71). The increase in CA125 in the main group was almost 8 times higher than in the control group, however, according to the indicators of HE4 and the ROMA index, statistically significant differences in the groups were not obtained. In the dynamics of the menstrual cycle, the content of ILs in the main group significantly decreased by days 21–23 of the cycle, while the content of CA125 and HE4 remained practically unchanged. Such sharp fluctuations of the considered biomarkers were not detected in the control group. However, even on days 21–23 of the cycle, the average content of ILs and CA125 in women of the main group remained statistically significantly higher than in the control group.
Conclusion
. In infertile women with dubious ultrasound criteria of external endometriosis, the use of IL1β and IL-6, which stimulate the immune inflammatory response, as well as tumor markers CA125, HE4 and ROMA index allows to differentiate the disease in the initial stages.
Background . Ovarian heterotopias are quite successfully diagnosed with ultrasound examinations. Considering the high risk of spread of the disease, as well as reproductive consequences (infertility, ...pelvic adhesive processes, chronic pelvic pain syndrome, dysmenorrhea), early differential diagnosis of endometrioid cysts and, accordingly, early initiation of treatment are of particular importance. Objective : to combine ultrasound criteria using 3D visualization and the content of biomarkers to verify stage 1–2 endometrioid ovarian cysts. Material and methods . In 59 infertile women with endometrioid ovarian cysts, in the dynamics of the menstrual cycle, ultrasound examinations were performed using Acuson S2000 (Siemens, Germany) and Voluson E8 (General Electric, USA) with the possibility of Doppler measurements and three-dimensional reconstruction of tissue images. Also, in laboratories “Invitro”, “Hemotest”, “Nauka” (Samara, Russia) the biomarkers were determined: interleukins IL-1β, IL-6, cancer antigen 125 (CA-125), human epididymis protein 4 (HE4) and the index by Risk of Ovarian Malignancy Algorithm (ROMA). The control group included 195 fertile women of reproductive age. In patients with endometrioid cysts, the diagnosis was subsequently confirmed morphologically. Results . Small unilateral and bilateral ovarian cysts corresponding to stage 1–2 endometriosis by revised American Fertility Society classification (rAFS) were clearly differentiated in 56 (94.9%) patients, in 3 (5.4%) of them the ultrasound result was questionable. In 48 (81.4%) women the lesion was unilateral and in 11 (18.6%) it was bilateral. The structure of cystic formations in all cases was hypoechoic, heterogeneous, in 36 (61.0%) cases it was finely cellular, without blood flow. Conclusion . Ovarian endometriomas in “gray scale” are round formations of reduced echogenicity and fine suspension, with an even, clear contour, not fused with the surrounding tissues, avascular, changing size depending on menstrual cycle phase. An ovarian mass may have a capsule with locus signals on Doppler. The sensitivity of ultrasound examination in “gray scale” in the presence of an endometrioid cyst is 94.6%.
Introduction.
Modern gynecological endocrinology widely discusses various disorders accompanying the onset of menopause. Metabolic disorders are one of the leading risk factors for the development of ...ischemic heart disease and vascular dystonia in menopausal women. That is why the drugs prescribed as part of menopausal hormone therapy are contraindicated for patients with severe metabolic disorders and predisposition to thrombosis. Women with a normal body mass index may develop the menopausal metabolic syndrome, since its presentations largely depend on the total body composition and the specific gravity of visceral adipose tissue.
Aim.
To assess the patterns of clinical presentation of menopause in women with metabolic menopausal syndrome.
Materials and methods.
In the furtherance of that aim, we examined 184 women who were in menopause 1 to 5 years at the age of 52 to 57 years (average age 54.2 ± 0.5 years). Of these, 87 were diagnosed with metabolic syndrome – they were included in the main group. The comparison group included 97 menopausal women without metabolic disorders.
Results and discussion.
We assessed the severity of clinical presentations and the total body composition of the patients in the selected groups. It has been established that the body mass index cannot serve as a criterion for evaluation of metabolic processes, despite the sufficient simplicity of its computation.
Conclusions.
The authentic view of the risks of metabolic disorders in menopausal women requires the study of total body composition.
Introduction.
Cervical cancer holds one of the top positions in the oncological diseases ranking among the female population in the presence of iodine deficiency in the territory of the Republic of ...Bashkortostan. It's commonly believed that it is caused by the development of cervical intraepithelial neoplasia (CIN) associated with highly oncogenic strains of the human papillomavirus (HPV). The article pays special attention to the risk factors for the development of precancerous and cancerous diseases of the cervix and their timely treatment.
The aim of the study
was to improve the diagnosis and therapy of HPV-associated CIN in the presence of iodine deficiency in the Republic of Bashkortostan.
Materials and methods.
256 women aged between 21 and 45 years with identified HPV-associated CIN I were enrolled in our study. The first stage of treatment known as preoperative was carried out in the outpatient setting. At stage 2, the patients were offered a radio-wave surgery treatment of the cervix.
Results and discussion.
The video colposcope analysis showed that the average time of epithelialization of the cervix after exposure to the destruction depended on the age and duration of the disease. For instance, complete epithelialization of the cervix in the group of patients aged between 21 to 38 years was reported in 72% of cases by Day 40, and in 62% of cases in the group of 39-45 years old on Day 40. The complete elimination of the virus was observed in 236 patients out of 256 cases (92%) 70 days after the end of therapy.
Сonclusion.
The study proves the effectiveness of the combination treatment of patients with HPV-associated CIN.
Introduction.
In recent years, more and more attention has been paid to the issues of genital prolapse. This is largely due to the increase in women life expectancy and the need to provide them with ...a decent quality of life, as prolapse is quite often accompanied by dysfunction of the pelvic organs. In recent years, there has been an increasing amount of literature on undifferentiated connective tissue dysplasia (UCTD). However, most of these studies consider therapeutic or vertebro-neurological problems, while the high prevalence rates of this pathology call for additional research on the pathogenetic mechanisms of the effect of UCTD on pelvic organ prolapse, which will allow us to decide on the choice of subsequent treatment.
The purpose and objectives
. Asess the effect of undifferentiated connective tissue dysplasia (UCTD) on the formation of disorders of the somatic, gynecological and reproductive health status in women with genital prolapse.
Materials and methods
. To achieve this goal, we examined 204 women with genital prolapse in the POP-Q classification of stage 2–3, of which 97 were diagnosed with UCTD (the main group), and the remaining 107 patients made up the comparison group.
Results
. To evaluate the influence of UCTD on the formation of somatic, gynecological and reproductive health disorders in women with genital prolapse. We analyzed anamnestic indications for somatic, gynecological and reproductive pathology of women, as well as assessed the current state of health of patients with genital prolapse. It was found that it is UCTD that determines the development of a particular form of gynecological pathology and affects the formation of genital prolapse.
Conclusion
. UCTD manifests as various forms of somatic and gynecological health disorders throughout the life of women with genital prolapse.
We analyzed treatment outcomes in patients with pelvic organ prolapse (POP), some of whom had signs of undifferentiated connective tissue dysplasia (uCTD). Women from subgroup 1 used a pessary, ...while women from subgroup 2 underwent electromyostimulation in an outpatient department and performed Kegel exercises. After two treatment courses and pharmacotherapy, all patients demonstrated positive dynamics. Electrostimulation in combination with Kegel exercises was more effective than pessary; the effect was more pronounced in women without uCTD than in patients with uCTD. The results of our study were used for the development of a scale to assess POP severity, which enables a tailored approach to the diagnosis and management of such patients depending on the presence of uCTD.
The paper considers the results of therapy of clinical manifestations of genital prolapse using electromyosymmulation and Kegel exercises. The obtained data allow us to consider this type of ...conservative treatment quite effective. This therapy can be recommended for women with contraindications to surgical correction of prolapse.
Objective: to conduct a comparative assessment of the effectiveness of immunomodulatory drugs in infectious mononucleosis of mixed etiology (EBV and CMV) in children, using the principles of ...evidence-based medicine.Materials and methods: a comprehensive comparative assessment of the effectiveness of immunomodulatory drugs in children with infectious mononucleosis EBV+CMV-etiology in 3 groups: group I-20 patients receiving recombinant interferon α-2β, group II-20 children receiving interferon – meglumin inducer acridonacetate and group III-20 children treated with a synthetic immunomodulator-inosin pranobex. The comparison group (IV) consisted of 20 children who received basic therapy.Results: Analysis of key intervention indicators for the outcome «fever Duration less than 5 days» showed the highest effectiveness of recombinant interferon α-2β, less effective were meglumina acridonacetate and inosine pranobex. According to the outcomes «Reduction of lymph nodes by 2 or more times» and «Reduction of the liver and spleen by 2 or more times», data on the advantage of meglumin acridonacetate were obtained. The recombinant interferon α-2β was the second most effective. All the studied drugs do notsignificantly affect the severity of the hematological syndrome. The expediency of using immunomodulatory therapy in infectious mononucleosis of EBV+CMV-etiology is shown, the deviation from the norm of the integral outcome indicator is significantly higher in the group of children who were on symptomatic therapy. The overall effectiveness of the studied immunomodulatory drugs with all clinical outcomes does not have statistically significant differences.Conclusion: the obtained data allow us to rationally approach the choice of immunomodulatory therapy, taking into account the effectiveness of clinical outcomes and the overall effectiveness of the drug.
Epiglottitis in the adult patient MATHOERA, R. B; WEVER, P. C; VAN DORSTEN, F. R. C ...
Netherlands journal of medicine,
10/2008, Letnik:
66, Številka:
9
Journal Article
Recenzirano
Epiglottitis is an acute disease, which was predominantly caused by Haemophilus influenzae type b in the pre-vaccination era. In the vaccination era, with waning vigilance, adults remain at risk for ...acute epiglottitis according to recent Dutch incidence rates. There is more diversity in the cause of epiglottitis in adults. We describe three patients who presented to the emergency ward of a regional teaching hospital with severe epiglottitis. All three patients had stridor at presentation indicating a compromised airway. Emergency intubation was attempted, but two patients required a tracheotomy and one patient died. Patients received fibreoptic nasal intubation, systemic dexamethasone and antibiotics. Stridor is an important acute sign of upper airway obstruction, which requires vigilance for epiglottitis, regardless of the patient's age. Fibreoptic nasal intubation should preferentially be attempted with the possibility of immediate surgical airway on hand. Timely diagnosis and treatment usually results in a complete recovery. In adults, severe acute epiglottitis and stridor can justify early intubation.
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