Vol 23, No 7 (2021)


Reproductive function in persons who have been cured of cancer

Gavrilenko T.F., Valiev T.T., Polikarpova S.B., Ponomarev V.E.


Modern cancer therapy programs allow an increasing number of patients to be cured, and therefore the quality of their subsequent life is an important task of clinical oncology. The ability to realize reproductive potential is one of the main criteria for the quality of life. Nevertheless, chemoradiation therapy used in the treatment of malignant tumors can cause temporary or permanent infertility. Currently, there are options to protect the reproductive system from chemoradiation treatment (administration of ethinylestradiol drugs, gonadotropin-releasing hormone agonists) or harvesting seminal fluid/oocytes, and cryopreservation of ovarian tissue. However, the low awareness of doctors about modern reproductive technologies in the treatment of persons cured from cancer leads to the fact that these methods are not used actively enough. The article presents the main chemotherapy drugs used in the treatment of malignant tumors that can cause an impairment of reproductive function; describes their pathological effects on oocytes and spermatozoa; provides methods of protecting the reproductive function in persons who take chemoradiation therapy or have completed antitumor therapy.
Consilium Medicum. 2021;23(7):533-538
pages 533-538 views

Children born with assisted technology: a focus on parents’ reproductive health

Kinsht D.A., Soboleva M.K.


Aim. To assess the main indicators of the initial reproductive health of parents, somatic health of the mother and their impact on the health of children born with singleton pregnancy ART. Materials and methods. The study included all newborn infants from singleton ART who were born at the Avicenna Medical Center (Novosibirsk) over the period 2006-2017 (n=409) and their parents (n=818). All stages of overcoming infertility (from the moment the parents go to the clinic to the birth of children) are considered in the context of one center, in a relatively homogeneous social group, with ensuring continuity at all stages. The average experience of infertility in couples was 7.2±0.2 years. The groups were formed depending on the type of infertility and the method of assisted reproductive technologies (ART) used: 205 children were born using in vitro fertilization (IVF), 204 children were born using the method of Intracytoplasm Sperm Injection (ICSI). The method of IVF and transfer of embryos into the uterine cavity is more often used in women with tuboperitoneal, endocrine types of infertility (premature ovarian failure syndrome), as well as in infertility associated with endometriosis. More serious reproductive problems (severe forms of male infertility, a combination of several types of infertility) in most cases lead to the use of more serious technological methods of ART, in particular, the addition of IVF and embryo transfer by the ICSI method. The reasons underlying infertility in most cases lead not only to the choice of the ART method, but also determine the characteristics of the course of pregnancy and the development of the intrauterine fetus. Pregnancy in the IVF group is significantly more often complicated by the threat of termination and premature birth, while ICSI pregnancy more often leads to impaired development of the intrauterine fetus. Conclusion. Features of medical support of women during the preparation for ART and, of course, during pregnancy, with a comprehensive, interdisciplinary correction of expected complications in each of the groups, will improve the perinatal outcomes of induced pregnancy and will contribute to the birth of healthy offspring.
Consilium Medicum. 2021;23(7):539-543
pages 539-543 views

Rare case of difficulty in ultrasound diagnosis of ectopic pregnancy after assisted reproductive technologies. Case report

Khasanova V.V., Kukarskaya I.I., Shevlyakova T.P., Legalova T.V., Kukarskaya E.Y.


Ectopic pregnancy is one of the most frequent and serious complications when using assisted reproductive technologies (ART). Difficulties in diagnosing ectopic pregnancy after ART are explained by atypical localization and ambiguous clinical picture. To analyze the clinical case of management and delivery of a pregnant woman words with twins when one of the fetuses is located in rudimentary horn. The retrospective analysis of anamnestic data, results of clinical and instrumental studies pregnant based on the exchange card of the pregnant woman and new mothers, birth history of the perinatal center of Tyumen. The clinical case of atypical placement of the fetus in the rudimentary horn in multiple pregnancies after ART is a fairly rare complication of the gestational period. Difficulties with timely diagnosis were associated with the lack of clear imaging during ultrasound examination. A timely diagnosis, in the current emergency situation, allowed the pregnancy to end favorably, both for the mother and for the fetus.
Consilium Medicum. 2021;23(7):544-547
pages 544-547 views

Ectopic pregnancy as a complication after assisted reproductive techniques. Case report

Kiyok M.A.


Ectopic pregnancy (EP) is a rare and severe complication of assisted reproductive techniques (ART). A specific feature of EP after ART is a high frequency of rare atypical forms of EP, the absence of a specific clinical picture and a high probability of recurrent EP, which makes certain difficulties in terms of diagnosis. Interstitial pregnancies occur in 1-6% of all ectopic pregnancies and in 7.3% cases of EB which were the results of in vitro fertilization programs (IVF). The anatomical features of the blood supply in the intramural segment of the fallopian tube provide favorable conditions for the progression of pregnancy on the average up to 10 weeks of gestation, simulating the intra-uterine pregnancy. Chorionic villi, growing into the thickness of the myometrium, create a high risk of profuse intra-abdominal bleeding. The article presents a clinical case of a rare form of ectopic pregnancy in the interstitial segment of the fallopian tube after IVF. The patient had previously undergone a bilateral salpingectomy by tubal pregnancies. This clinical example shows the meaning of precise diagnosis and timely provision of highly qualified specialized medical care.
Consilium Medicum. 2021;23(7):548-551
pages 548-551 views

Experience of uterus-sparing surgical treatment in diffuze (stages III-IV) adenomyosis

Gorpenko A.A., Chuprinin V.D., Asaturova A.V., Smolnova T.Y., Buralkina N.A.


Background. The frequency of adenomyosis varies from 10 to 61%. Currently used methods of surgical treatment of adenomyosis are discussable. A hysterectomy it is not appropriate for women who wish to realize reproductive function or spare the uterus. Now it is very important to perform uterus-sparing surgery for treatment diffuse adenomyosis with severe manifestation of symptoms. Adenomyomecomy with hysteroplasty is modern method of surgical treatment for repair uterus anatomy and functions. Aim. To demonstrate methods of uterus-sparing surgical treatment in diffuse adenomyosis (stages III and IV). Materials and methods. In Surgical Department of Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology since January 2019 till June 2021 we performed 30 uterus-sparing adenomyomectomies with hysteroplasty in women with diffuse adenomyosis (stages III and IV). Results. There are some advantages of adenomyomectomies with hysteroplasty: it is possible to perform this method laparoscopically assisted; also special performing double-flaps recovery of myometrium (like a “frock coat”) allow to avoid uterine scar defects and uterine rapture during pregnancy. Conclusion. One of options of uterus-sparing surgical treatment for women with diffuse adenomyosis who wish to save their uterus and realize reproductive function is adenomyomectomy with hysteroplasty. Women who underwent this method notes pain relief and normalization of menstrual function and improvement life quality.
Consilium Medicum. 2021;23(7):552-557
pages 552-557 views

Chronic kidney disease: risks to mother and fetus (literature review)

Kupina A.D., Petrov Y.A.


The article provides an overview of modern sources of domestic and foreign scientific literature. The article describes the statistical data of chronic kidney disease in women of reproductive age, as well as anatomical and physiological changes in the urinary system in pregnant girls. The role of renal pathology in the pathogenesis of various obstetric and perinatal complications is described in detail. A scheme for optimizing the treatment of this group of patients during gestation is given on the basis of modern research and a recommendation.
Consilium Medicum. 2021;23(7):558-562
pages 558-562 views

Features of gestation, childbirth and the state of health of newborns in pre-pregnant women with chronic arterial hypertension

Petrov Y.A., Podgorny I.V., Chebotaryova Y.Y., Podgorny G.I.


Aim. To analyze the features of the course of pregnancy, childbirth, the condition of newborns in pre-pregnant patients with hypertension. Materials and methods. 65 first-time pregnancies were examined, of which: group 1 (n=35) - first-time pregnancies with chronic arterial hypertension (O10.0 according to ICD X); group 2 (n=30) - first-time pregnancies with physiologically occurring pregnancy. The features of the anamnesis, the course of pregnancy, childbirth, the postpartum period, the condition of newborns were studied. Statistical processing was carried out using the program Statistica 6.0 for Windows. Results. It was revealed that the average age index (M±m) of women of the 1st group (38.6±0.22 years) was significantly higher than that of pregnant women of the 2nd group (26.6±0.22 years); p<0.0001. In women of group 1, pregnancy was complicated by a threatening abortion in the first and second trimesters (34.3 and 40%, respectively), 34.3% of fetuses had intrauterine development delay syndrome. Cesarean section was performed in 12 (34.3%) women of group 1. In group 1, during childbirth through the natural birth canal, in 13 (65.7%) after the birth of the fetus, the afterbirth separated independently in 11 (84.6%), in 2 (15.4%), manual separation and isolation of the afterbirth was performed. Conclusion. In pre-pregnant women with chronic arterial hypertension, pregnancy, childbirth and the postpartum period are complicated, with a high frequency of threatening abortion, cesarean section and increased blood loss in the postpartum period, low indicators of newborn health.
Consilium Medicum. 2021;23(7):563-565
pages 563-565 views

Use of lubricants to correct sexual dysfunction in women

Oboskalova T.A., Vorontsova A.V., Zvychaynyy M.A.


A literature review focuses on the use of lubricants in women for sexual dysfunction. The use of lubricants is intended to prevent trauma to the lining of the vagina during intercourse and to facilitate the insertion of pessaries. Along with substances that optimize the action of lubricants, they include a number of compounds that can cause negative reaction mechanisms and aggravate existing discomfort. In addition, an increased pH of the lubricant can have a cytotoxic effect on the epithelium of the female genital tract. Unfortunately, the awareness of obstetricians and gynecologists about the properties and range of lubricants is insufficient. Therefore, knowledge of the initial state of a woman, the reasons for the development of sexual dysfunction, the nature of contraception, and no less important, the structure of the composition of the lubricant will competently make it possible to select the optimal means to improve the quality of sexual contacts without developing side effects and improving the condition of a woman.
Consilium Medicum. 2021;23(7):566-570
pages 566-570 views

Properties and safety of combined dietary supplement Uronext in complex treatment of acute (recrudescence of chronic) cystitis in women with bacterial vaginosis

Tevlin K.P., Khanaliev B.V., Tevlin D.K.


Aim. To analyze modern approaches to the conservative therapy of acute (exacerbation of chronic) cystitis in women in combination with bacterial vaginosis. To emphasize the importance of Esherichia coli as the main causative agent of urinary tract infection (UTI) due to the presence of virulence factors that not only affect the affinity of the pathogen to the urothelium, but also hinder the development of an immune response. To emphasize the importance of bacterial vaginosis as a factor contributing to the development and maintenance of acute cystitis in women. To substantiate the need for a differential approach to the appointment of antimicrobial drugs in patients with UTI and bacterial vaginosis, as well as the use of safe natural medicines in the complex therapy of UTI. Materials and methods. The properties and safety of the biologically active additive Uronext (NPO Petrovax Pharm, LLC, Russia) were studied in women with complex, together with medications, treatment of acute (exacerbations of chronic) cystitis against the background of bacterial vaginosis. A post-marketing comparative study was conducted in parallel groups. The study lasted for 4 months and included 60 patients aged 18 to 65 years (average age 39.4 years). Results. The severity of differential symptoms of acute cystitis was significantly lower in the study group compared with the control group - the frequency of the evaluation mode in the study group was significantly higher than in the control group: 29 and 22 respectively (p<0.01). In both groups, there was a significant improvement in the quality of life of patients (ACSS score) after treatment (the median value and the mode of the sum of points in the control group decreased from 7 to 3; p<0.01, in the study group - from 7 to 1; p<0.01). The quality of life of patients in the study group after treatment was significantly higher than in the control group (p<0.01). It is important to note that the frequency of relapses after treatment was significantly lower in the study group compared to the control group (31.6 and 13.3% respectively; p<0.01). Conclusion. Modern dietary supplements as part of the complex therapy of lower urinary tract infection provide a significant reduction in the severity of differentiated symptoms of acute cystitis, as well as a significant improvement in the quality of life of patients.
Consilium Medicum. 2021;23(7):571-578
pages 571-578 views

Actual aspects of the use of thulium laser as a promising method in the treatment of prostatic hyperplasia

Shiryaev A.A., Govorov A.V., Vasilyev A.O., Kolontarev K.B., Pushkar D.Y.


Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most widespread and frequent urological problem among men, affecting about a third of the male population of Russia over 50 years of age. Surgical intervention is the most effective method of treating benign prostatic hyperplasia, and about 75,000 surgical interventions are performed annually in Russia. Today, of all available surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected with a monopolar electrode, has been the preferred surgical method since the 1970s. This method of therapy can significantly improve the maximum urinary flow rate (Qmax), reduce obstructive symptoms assessed on the basis of the international questionnaire on the severity (IPSS) and improve the quality of life of patients. However, monopolar TURP is a rather risky procedure due to the possibility of developing serious complications such as massive bleeding or TURP syndrome (water intoxication syndrome of the body). Consequently, practicing urologists all over the world are faced with the urgent task of developing minimally invasive surgical methods of treatment, the results of which would be at least similar to those after monopolar TURP, while with fewer intra- and postoperative complications, side effects and a shorter recovery period for the patient.
Consilium Medicum. 2021;23(7):579-584
pages 579-584 views

Extrapulmonary tuberculosis during the COVID-19 pandemic: features of detection and course

Kulchavenia E.V.


Background. COVID-19 pandemic caused by novel coronavirus has destabilized the world's health systems, revealing flaws in the organization of work in extreme conditions. Currently, there is limited empirical data on the impact of COVID-19 on tuberculosis outcomes. Materials and methods. Non-interventional comparative retrospective cohort study of the structure of the incidence of extrapulmonary tuberculosis (EPTB) in the Siberian and Far Eastern Federal Districts for the period 1999-2020 was carried out. Data of 13 852 patients were analyzed. Results. Of all 13 852 EPTB patients who were first diagnosed during the study period, the majority of cases (973) were registered in 1999, and the smallest number (550) - in 2017. Then, for 2 years, an increase in EPTB incidence was observed again (582 cases in 2018, and 563 cases in 2019) with a natural reduction by 18.5% in 2020 (459 cases). Over the first year of the COVID-19 epidemic, the incidence of central nervous system tuberculosis decreased by almost half (by 45.9%), the incidence of peripheral lymph nodes tuberculosis remained virtually unchanged, and the number of cases of "other" localizations, mainly abdominal tuberculosis, increased by 55.3%. Overall, in the Siberian and Far Eastern Federal Districts, the detection of isolated forms of EPTB over the first year of the pandemic reduced by 18.5% (from 563 to 459 patients). A large variability of data was found across regions. Thus, in the Novosibirsk, Tomsk and Omsk regions there was a significant decrease in the number of patients diagnosed with isolated EPTB (by 30.2; 47.1 and 64.5%, respectively) while in the Kemerovo and Irkutsk regions, the number of patients with isolated EPTB increased (by 80.9 and 32.3%, respectively). Conclusion. COVID-19 has had a significant negative impact on all services of national and global healthcare, the ultimate losses we have yet to calculate. Diagnostics of any diseases, and particularly EPTB, in the first year of the pandemic was difficult due to the restriction of patient visits to medical and preventive institutions, the closure or re-profiling of some of them, as well as a decrease in the number of specialists due to their selfisolation, re-profiling and COVID-19 disease. Nevertheless, the role of EPTB is still important.
Consilium Medicum. 2021;23(7):585-589
pages 585-589 views

Prevention of post coital cystitis: the role of D-mannose. Case report

Tsukanov A.l.


Recurrent lower urinary tract infections are common among women. One of the important factors of their genesis is sexual activity: there is a positive correlation between sexual intercourse frequency and recurrences of lower urinary tract infections. Post coital cystitis accounts for 30-40% of all chronic recurrent cystitis and occurs in about 25-30% of women of reproductive age. One of the methods for the prevention of post coital cystitis is the use of D-mannose, the effectiveness of which was demonstrated with a clinical example.
Consilium Medicum. 2021;23(7):590-593
pages 590-593 views

Prevention of post coital cystitis: the role of D-mannose. Case report

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Obesity is considered an obvious health hazard and is associated with the risk of serious complications. Weight loss in obese patients is an essential component of complex therapy aimed at improving reproductive potential. Drug therapy is indicated for patients who cannot achieve clinically significant weight loss with non-drug methods of treatment and/or at the stage of maintaining the achieved result. A feature of liraglutide, an analogue of the human glucagon-like peptide, is its effect on reducing appetite, which is a key factor in the fight against obesity.
Consilium Medicum. 2021;23(7):594-596
pages 594-596 views

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