Vol 20, No 6 (2018)


Anti-age therapy opportunities and perspectives: expert opinion

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В апреле 2018 г. в Самаре прошла ежегодная научно-практическая конференция «Дни МГТ в России - 2018». Хирурги, эндокринологи, гинекологи, геронтологи и другие российские и международные специалисты обсуждали новейшие тенденции в области назначения менопаузальной гормонотерапии, многообразие возможностей anti-age терапии, а также рассматривали принципы подхода к индивидуальному ведению пациенток.
Consilium Medicum. 2018;20(6):8-21
pages 8-21 views

Clinical efficiency of the integrated approach to the diagnosis and treatment of climacteric syndrome in the context of hypovitaminosis D

Pestrikova T.Y., Yachinskaya T.V.


In our research we compared efficacy of menopausal hormone therapy and combination of menopausal hormone therapy with vitamin D in early postmenopause women with neurovegetative and psychoemotional signs of a menopausal syndrome with hypovitaminosis D. Aim of the stady was to prove a need of complex therapy of a menopausal syndrome in women with hypovitaminosis D using menopausal hormone therapy and сoleсaltsiferol to improve health, quality of life and prevent age-related diseases in early postmenopausal period. Materials and methods. Early postmenopausal period 90 female patients with neurovegetative and psychoemotional signs of a menopausal syndrome, who had blood 25(OH) D less 30 ng/ml and no contraindications of menopausal hormonal therapy were involved in this research. In all patients modified menopausal index of Kupperman was calculated. Depression was assessed with Beck's scale. Level of the hormonal status, C-peptide indicators and parathormone were detected initially, then in 3 and 12 months. Results. Menopausal hormone therapy in combination with vitamin D level corrected with сoleсaltsiferol in early menopause period women with climacteric symptoms contributed therapeutic effect showing decrease of seizures (p<0.001), drowsiness (p<0.001), muscular and joint pain (p<0.01), tiredness (p<0.001). Received results allowed to improve mood in our patients (p<0.05). Conclusion. Development of psychoemotional (asthenic, depressive) signs of menopausal syndrome, their expression depends on vitamin D level. Correction of a hypovitaminosis D before normalization of blood 25(OH)D level with сoleсaltsiferol in combination with menopausal hormone therapy allowed to receive statistically significant results in comparison with menopausal hormone therapy usage only (p<0.01).
Consilium Medicum. 2018;20(6):22-25
pages 22-25 views

Ethnogeography of uterine fibroids: epidemiology, age and race differences, types of surgery

Arutyunova E.E., Katkova A.S., Buralkina N.A.


In the article, we highlighted and substantiated certain aspects of the ethnogeography of myoma of the uterus. The work reflects the prevalence of the disease, genetic predisposition, racial differences, the number and structure of operations in different countries around the world.
Consilium Medicum. 2018;20(6):26-30
pages 26-30 views

Cervicitis in pregnancy: a complex approach to diagnosis and treatment

Dobrokhotova Y.E., Borovkova E.I., Zalesskaya S.A.


Cervicitis is an inflammatory process localized in columnar or stratified squamous non-keratinized epithelium of cervix uteri which can be infectious or non-infectious, acute or chronic. Acute cervicitis is associated with specific sexually transmittable causative pathogens as well as with bacterial vaginosis. Cervicitis clinical manifestations are non-specific and are characterized by plentiful puslike leucorrhea and contact bleeding. Elastography is an additional method for cervicitis diagnostics and treatment effectiveness evaluation. Clindamycin is the first-line drug for non-specific cervicitis treatment.
Consilium Medicum. 2018;20(6):31-36
pages 31-36 views

Risk factors and features of treatment biliary sludge during pregnancy

Uspenskaya Y.B., Sheptulin A.A., Kuznetsova I.V.


Pregnancy is a proven risk for the development of gallstone disease (GSD) and biliary sludge (BS). The prevalence of GSD among pregnant women, especially at the stage of BS, is high, but in a significant number of cases their spontaneous resolution after delivery appears. Cases of GSD not regressing after childbirth associated with a high degree of complications and surgical interventions. Though the principles of treatment and prevention of GSD and BS during pregnancy are not defined. The aim of the study - to identify the risk factors for the GSD at the BS stage during pregnancy and to work out approaches to its treatment and prevention. Materials and methods. 61 pregnant women with ultrasound signs of BS detected during this pregnancy were included. The control group consisted of 50 healthy pregnant women. Patients were underwent general clinical, ultrasound, laboratory methods of investigation. The basic therapy included an ursodeoxycholic acid in a dose of 250-750 mg for 2 months in the evening single dose. Ultrasound control of the BS`s treatment effectiveness was performed after 2 months of therapy. Results. The risk factors for the formation of BS during pregnancy were heredity for GSD (p=0.008), the sex hormones drugs using during pregnancy (p<0.001), the older age of the patient (p<0.001), the presence of functional disorders of the biliary tract (p=0.003), polycystic ovary syndrome - PCOS (p=0.031), dyslipidemia (p=0.001), use of artificial reproductive technologies programs - ART (p<0.001) and multiple pregnancies (p=0.03). The prognostic factors of insufficient effectiveness of BS treatment with ursodeoxycholic acid drugs during the gestation period were the older age of the patients (p=0.001), the presence of PCOS (p=0.075), the use of progesterone drugs during pregnancy (p<0.001), the ART using (p=0.027), the presence of hyperemesis gravidarum (p<0.001). Conclusion. Early detection of BS in risk groups, adequate dynamic control over its course and a differentiated approach to the management of patients with BS allows to increase the effectiveness of treatment and prevent the development of GSD during pregnancy. Patients with prognostic factors of insufficient effectiveness of BS treatment during gestation require longer therapy with follow-up to prevent its recurrence.
Consilium Medicum. 2018;20(6):37-40
pages 37-40 views

The importance of b-CrossLaps as the marker of remodelling of bony tissue in women after the conservative operation with endometrioid cysts

Feramusova E.E., Gustovarova T.A., Kirakosyan L.S., Krukovskyi S.B.


The conservative surgery consequences on the ovaries are the most controversial in the scientific world. The position of modern authors comes down to the fact that surgical treatment of endometrioid cysts of the ovaries serves as a background for the development of pathology not only of the reproductive system, but also leads to endocrinopathies, including disturbance of a bone metabolism. Aim of the study. The aim of this research is the bone metabolism condition assessment and ovarian reserve of reproductive-aged women after a surgical treatment of endometrioid ovarian cysts and also the study of gestagen preventive therapy effect on changes of the direction of bone metabolism processes. 27 female-patients with endometrioid cysts (the 1st group) were examined and operated. The second (control) group included 50 patients who were healthy. All patients before the operation were carried out a determination of follicle-stimulating and antimullerian hormons and also bone metabolism biochemical markers: osteocalcin and b-CrossLaps in blood serum. The results. The level of b-CrossLaps before operation in the group of patients with endometrioid cysts was almost 1.5 times higher than in the control group (0.495 and 0.371 ng/ml respectively). The bone tissue formation marker of osteocalcin in group 1 was significantly lower (1.2 times) compared to group 2 (20.19 and 23.64 ng/ml respectively). 6 months after the operation, the similar parameters were measured. In group 1, the level of b-CrossLaps decreased significantly in 1.5 times compared to the initial data (0.437 and 0.495 ng/ml respectively), and the osteocalcin index increased significantly compared to the initial data (23.67 and 20.19 ng/ml respectively). In 12 months there was a decrease of b-CrossLaps level (in 1.3 times), which has no statistically significant differences with the control group (0.385 and 0.371 ng/ml respectively). 12 months after the operation the osteocalcin in group 1 significantly increases in 1.3 times (26.07 and 20.19 ng/ml respectively), which is an indicator of the prevalence of bone formation over the osteoresorption. Conclusion. As the result of the study it was established that gestagen preventive therapy slows down osteoresorption processes in a group of women who were removed endometrioid ovarian cysts.
Consilium Medicum. 2018;20(6):41-45
pages 41-45 views

New aspects of the pathogenesis of placental insufficiency

Zefirova T.P., Zhelezova M.E.


Placental insufficiency complicates the significant amount of pregnancies and leads to a hypoxia and fetal growth retardation. At uniformity of the clinical manifestations, a placental insufficiency is a multifactorial state. The considerable reason of a placental disfunction is halting of rheological properties of blood. Flowability of blood worsens at an anemic syndrome and a syndrome of hemoconcentration, it is necessary to consider at the choice of therapy at women with similar states. Other reason of alteration of a placenta is an activation of mother’s thrombocytes. Dipiridamole positively influences a hemorheology and reduces activity of thrombocytes therefore it can be used for prevention and treatment of a placental insufficiency to the categories of women listed above.
Consilium Medicum. 2018;20(6):46-49
pages 46-49 views

Dermatological aspects of pruritus vulvae in postmenopause

Dvoryankova E.V., Nevozinskaya Z.A., Korsunskaya I.M.


The article concerns etiology of pruritus vulvae in postmenopausal women in the view of dermatologist. The main dermatoses such as lichen ruber planus, lichen sclerosus et atrophicus, and lichen simplex chronicus as well as irritant and allergic dermatitis are described. Mycotic and bacterial infections often join the primary inflammatory process that makes the diagnostics challenging. The article presents recommendations on management and treatment of these patients.
Consilium Medicum. 2018;20(6):50-52
pages 50-52 views

Prevention of thromboembolism. Rational approach of maintaining patients in the postoperative period (review)

Pestrikova T.Y., Yurasova E.A., Yurasov I.V., Knyazeva T.P., Tkachenko V.A.


Problems of prevention and treatment of thromboses and thromboembolism are a relevant clinical situation. According to a number of researchers, most often thrombosis arises after surgeries. thromboembolism of a pulmonary artery (TEPA) - is one of the most frequent reasons of maternal mortality. To some extent it is promoted by increase the number of operations of Cesarean - section after which a risk of specific complications is 10-15 times higher. After gynecologic operations complications after TEPA arise at 19% of the operated women, and the massive thromboembolism is diagnosed during autopsy - for 11.2% of the dead in gynecologic hospitals. TEPA should consider as the preventable reason of hospital mortality of patients. When carrying out the prevention of TEPA, by means of low-molecular heparins, indicators of frequency of thromboembolism multiply decrease. Among all low-molecular heparins used for treatment and prevention of venous thromboembolism and TEPA attracts attention Bemiparin. The feature of a bemiparin is the only low-molecular heparin which can be used for the prevention of TEPA, both in to- and in the postoperative period. Usual use of low-molecular heparins at daily operations in obstetrics and gynecology will allow not only to reduce mortality in hospitals at gynecological patients, but also to eliminate cases of maternal mortality and cases of near - miss from such complications as thromboembolism and TEPA.
Consilium Medicum. 2018;20(6):53-56
pages 53-56 views

Endometriosis of the postoperative scar (clinical case)

Zakharov I.S., Mozes V.G., Elgina S.I., Rudaeva E.V., Beglova A.Y., Demyanova T.N., Dodonova G.K.


Endometriosis of postoperative scar is a fairly rare pathology, the frequency of which, according to various authors, ranges from 0.42 to 4.0% in the overall structure of endometriosis. The leading role in the pathogenetic concept of endometriosis of postoperative scar is the transfer of endometrial tissue to the site of the surgical wound during the surgical intervention associated with the opening of the uterus. Often, the diagnosis of endometriosis of postoperative scar has certain difficulties. The presented article describes the clinical case of extragenital endometriosis in a woman who previously had a caesarean section. It is worth noting that about 8 years have passed since the operation to clinical manifestations of endometriosis of the postoperative scar. Taking into account the peculiarities of pathological formation, the endometriotic focus was removed. A subsequent pathological-histological study confirmed the presence of endometrioid tissue in the macro preparation.
Consilium Medicum. 2018;20(6):57-59
pages 57-59 views

Urination disorders after childbirth: treatment methods

Ilyina I.Y., Dobrohotova Y.E., Chikisheva A.A., Malikova V.O., Goncharov I.Y.


Various types of urination disorders in women, including urinary incontinence, represent a major social and economic problem. Most researchers connect urination disorders development in women of reproductive age with pregnancy and childbirth. According to a number of authors during this physiological period of woman's life stress urinary incontinence comprises from 30 to 85%, pollakiuria, nycturia and urgency - from 22 to 96%, and urge urinary incontinence - from 4 to 13% cases. Objective. Our study was conducted on the basis of obstetrics and gynecology department of N.I.Pirogov RNRMU medical faculty. The aim of the study was to determine the frequency of various urination disturbances development depending on the number of childbirth and delivery method and to evaluate effectiveness of M-cholinolytic (trospium chloride) use in postpartum women. Materials and methods. The study included 42 patients with symptoms of stress urinary incontinence, overactive bladder and mixed incontinence. The patients had either operative or vaginal delivery. Some of the patients received treatment with trospium chloride, in others follow-up was performed. Urination disorders symptoms were reassessed after 2 and 4 months of treatment. Conclusion. After treatment with trospium chloride (if there were no contraindications for its use) a 2-fold decrease of urination disorders incidence was observed after 2 months and a 3.3-fold decrease - after 4 months of treatment due to overactive bladder symptoms reduction. Discussion. Trospium chloride can be recommended for use in postpartum patients who do not breastfeed because of whatever reason and have symptoms of overactive bladder and mixed incontinence. This medication use allows to significantly increase quality of life in postpartum patients.
Consilium Medicum. 2018;20(6):66-69
pages 66-69 views

A modern view on the use of combined oral contraceptives in extended mode (literature review)

Pestrikova T.Y., Yurasova E.A., Yurasov I.V., Kovaleva T.D., Shcherbakova O.G.


The review article presents data about the benefit of prolonged mode using micro-dosed combined oral levonorgestrel-containing contraceptive (91 days), as compared to traditional oral contraceptive mode (21+7). The performance of taking a combined oral contraceptive in a continuous duty in patients with headaches that occur during a break in taking contraceptives according to the standard pattern (21+7) has been demonstrated. In addition, the prolonged regimen of contraceptive use is justified in case of heavy menstruation, epilepsy, diabetes, endometriosis, uterine myoma, polycystic ovary syndrome, anemia, dysmenorrhea. This article focuses on the need to consult patients, in order to explain to her the advantages of standard and prolonged mode. The obligatory task of consulting is the need to provide the patient with freedom of choice. In the case of medical indications for prolonged administration of hormonal contraception, the regime is chosen by the doctor, but this choice should be reasoned ahead of every patient, for which the right to refuse the proposed method and the preference of usual scheme is preserved.
Consilium Medicum. 2018;20(6):70-74
pages 70-74 views

Personalized approach to patients with anogenital warts treatment

Khryanin A.A., Reshetnikov O.V.


Modern ideas are presented concerning the human papillomavirus. The topical issues of the epidemiology of papillomavirus infection are discussed, as well as approaches to the diagnosis and treatment of patients with anogenital warts. Using of inosine pranobex (Isoprinosine) as an immunomodulator that contributes to the eradication of the human papillomavirus, minimizes the frequency of recurrence of anogenital warts, and prevents the persistence of the virus with the subsequent non-probability of epithelial transformation in men and women.
Consilium Medicum. 2018;20(6):75-80
pages 75-80 views

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