Vol 21, No 6 (2019)


The first results of a pilot mammoscreening project for the early detection of breast cancer in the Kaluga region

Korzhenkova G.P.


Aim. To increase an effectiveness of early diagnosis of breast cancer under mass mammography examination of the female population. Materials and methods. The study included several stages: creation and practical application of a mobile mammography complex; training of doctors and nurses in a standard mammography examination technique; quality control of mammography examination; elaboration of cloud storage and a computer database for recording patients’ archive; informational media support of a mass mammography examination of the female population; conducting a mass mammography examination of a female population aged over 40. Results. During 8 months of 2018, 17 557 women were examined at mobile mammography complexes. An analysis of X-ray findings in cases of verified breast cancer showed that in his daily practice the radiologist may encounter a variety of radiological criteria indicating malignant changes in the breast tissue. Nodular formations were the most common radiological findings in the examined patients - 54 (69.2%) cases. The second most frequent sign of breast cancer was malignant microcalcifications, which were found in 13 (16.7%) cases. Other signs (stellate disorders of breast tissue architectonics and a focus of density asymmetry) breast cancer were less common - 11 (14.1%) cases. Nodular formations less than 1 cm in size were detected in 33 (42.3%) cases. Conclusions. In order to effectively solve the problem of breast cancer screening, it is necessary to develop a unified state standard for screening and early diagnosis, which will subsequently provide adequate organ-preserving treatment, high quality medical care and an increase in life expectancy.
Consilium Medicum. 2019;21(6):9-12
pages 9-12 views

Iodine and women's health

Bespalov V.G., Tumanian I.A.


The review article examines the physiological role of iodine, the daily need for iodine, food sources of iodine, discusses the problem of iodine deficiency in the world and Russia, and describes iodine deficiency diseases. Practical recommendations are given for diagnosing iodine deficiency by ioduria, thyroid volume, and thyroid status parameters. The important role of iodine during pregnancy and lactation is presented, recommendations are made for filling iodine deficiency in pregnant and lactating women. The effect of iodine on the hormonal balance in a woman’s body, the role of iodine deficiency in the pathology of the mammary glands is considered. Iodine deficiency leads to the development of mastopathy and increases the risk of breast cancer. Practical recommendations are given on the use of iodine preparations in the treatment of benign breast disease and the prevention of breast cancer. The advantages of organically bound iodine over inorganic iodine compounds are discussed. The use of the drug Mamoclam®, containing organically bound iodine, in the treatment of benign breast disease is described.
Consilium Medicum. 2019;21(6):13-21
pages 13-21 views

Realization of the right of patients to be visited by third parties. Rights, duties and responsibilities of the parties

Pishchita A.N.


Communication of patients with their relatives and other persons is an inalienable right of citizens receiving medical care in hospital. The article analyzes the Russian legislation, considers the rights, duties and responsibilities of medical organizations, employees, patients and persons visiting patients. On the basis of the conclusions, recommendations on the prevention of violations of the rights of patients and health workers in the organization of visits to patients in medical organizations.
Consilium Medicum. 2019;21(6):22-25
pages 22-25 views

Iron deficiency anemia in pregnant women is a problem of the past and the present

Sumyatina L.V., Skvortsova M.Y., Denisova T.V.


Anemia remains one of the main extragenital diseases that complicate the course of pregnancy and the postpartum period. Modern possibilities in the diagnosis of iron deficiency states make it possible to predict possible pathology at earlier stages. The currently existing medical prophylaxis and therapy of iron deficiency improve the outcome of pregnancy, childbirth, the postpartum period, which improves the quality of life of woman and the economic cost of inpatient treatment.
Consilium Medicum. 2019;21(6):26-29
pages 26-29 views

Experience of managing patients with reproductive losses in anamnesis

Pestrikova T.Y., Scherbakova O.G., Yurasova E.A., Knyazeva T.P.


Relevance. The issues of preserving and realizing reproductive potential in women remain one of the main problems of modern gynecology. The causes of reproductive loss are multifactorial. One of these factors are disorders in the hemostatic system. Aim. To analyze the effectiveness of control and correction of the hemostatic system in the management of pregnancy in patients with a history of reproductive losses. Materials and methods. A prospective study was conducted from 2014 to 2019. The study included 99 pregnant women with reproductive losses during previous pregnancies, as well as complaints of infertility in marriage. Results. A study of representative groups for the main characteristics showed that all 99 pregnant women had the presence of markers of thrombophilia and the genetics of folate cycle metabolism. In 55 patients who received, for prophylactic purposes, low molecular weight heparin courses throughout pregnancy, the gestational period was statically significantly completed by delivery in time. In 44 women who were not treated with low molecular weight heparins, the pregnancy was nondeveloping, or ended in a spontaneous miscarriage. Conclusions. The presence of defects in the hemostatic system, even those that are not classified as risk factors for the development of thromboembolism, has an adverse effect on the reproductive potential of women.
Consilium Medicum. 2019;21(6):30-37
pages 30-37 views

Hysteroscopic cervical cerclage before embryo transfer for the prevention of preterm birth in polycystic ovary syndrome patient

Petrichenko Y.G., Koloda Y.A., Korennaya V.V., Podzolkova N.M.


Polycystic ovary syndrome (PCOS) is a heterogeneous pathology characterized by chronic anovulation, hyperandrogenism, oligomenorrhea, obesity, and infertility. Diagnosis and treatment of infertility in PCOS still is unsolved problem for modern reproductive medicine. Complications of pregnancy after assisted reproductive technologies in patients with PCOS such as miscarriage, premature birth, gestational hypertension and pre-eclampsia, fetal growth retardation and SGA fetus or gestational diabetes mellitus with macrosomia continue to be a huge problem in modern obstetrics. We describe a clinical case of cervical insufficiency in a patient with PCOS and its correction before embryo transfer by with hysteroscopic cervical cerclage.
Consilium Medicum. 2019;21(6):38-41
pages 38-41 views

Clinical and pathogenetic significance of determining the reserve of blood phagocytes and antioxidant system in preeclampsia

Tsakhilova S.G., Sakvarelidze N.U., Kokoeva F.B., Smirnova L.E., Zykova A.S., Morgoeva A.A.


Aim. To study the role of the superoxide-forming function of blood phagocytes and the activity of antioxidant enzymes in pregnant women to predict the development of pre-eclampsia (PE) and the prevention of complications in the postpartum period. Materials and methods. A survey of 100 pregnant women, whose age ranged from 17 to 40 years, and averaged 26.1±3.4 years. The gestational age of the examined pregnant women was 28-39 weeks. Pregnant women were divided into 2 groups: the main group consisted of 78 pregnant women with moderate and severe preeclampsia, the control group - 22 patients with a physiologically proceeding pregnancy. Results. A comparative analysis of the results obtained in pregnant women with pre-eclampsia showed a significant increase in the superoxide-anion-forming function of blood phagocytes (OMG-test - above 210 nmol/l) according to the severity of PE against the background of decreased levels of antioxidant enzymes (SOD). The obtained results can be a prognostic criterion for development PE. Conclusion. 1. A study revealed in pregnant women with PE an increase in blood phagocytic production of superoxide anion radical with a reduced level of superoxide dismutase, which leads to the development of "oxidative stress" and endogenous intoxication. 2. For the first time, the diagnostic significance of the OMG index was determined and the level of superoxide anion radical (210 nmol/l; Cut-toff) was calculated, above which the development of PE was diagnosed, which makes it possible to expand the existing scientific understanding of the pathological role of the blood superoxide anion radical and PE. 3. The data obtained confirmed the feasibility of including patients with PE in the examination scheme. 4. In women with PE, on the first day after the operation, a caesarean section is determined to increase the superoxide anion radical 1.7 times in severe PE and decrease superoxide dismutase (SOD) 1.8 times in PE severe compared to the control group, which indicates the depletion of antioxidant activity protection. On the fourth day of the postoperative period, there is a tendency towards normalization of baseline indicators.
Consilium Medicum. 2019;21(6):42-46
pages 42-46 views

Ulipristal acetate in the treatment of uterine fibroids. How drug treatment changes current paradigms?

Podzolkova N.M., Korennaya V.V., Kuznetsov R.E., Ignatchenko O.Y.


The article presents current data on the mechanisms of influence of the progesterone receptor selective modulator - ulipristal acetate on myomatous nodes and its role in the treatment of uterine fibroids. Issues of efficacy and safety of use, as well as reproductive outcomes of therapy are covered.
Consilium Medicum. 2019;21(6):47-52
pages 47-52 views

Hyperplastic processes of the endometrium: modern tactics of patient management

Gabidullina R.I., Smirnova G.A., Nuhbala F.R., Valeeva E.V., Orlova Y.I., Shakirov A.A.


Aim. To study the current state of the problem of endometrial hyperplastic processes. Materials and methods. The article presents a review of the literature on the search results of research in the electronic resources MEDLINE, EMBASE, Cochrane Library and eLIBRARY. Results. The main risk factors for endometrial hyperplastic processes and their malignancy are currently age and obesity. A modern classification of WHO endometrial hyperplasia (2014) and an alternative classification of atypical endometrial hyperplasia EIN are presented. The issues of diagnosis of endometrial hyperplastic processes are covered. According to modern international standards, only the histological assessment of the endometrium allows us to confidently set the diagnosis of endometrial hyperplasia. To improve the visualization of endometrial polyps, a transvaginal ultrasound study should be supplemented with a Doppler study or intrauterine contrasting. Presented tactics of patient management, depending on the histological diagnosis in accordance with modern international recommendations. Prevention of endometrial hyperplastic processes consists in leveling the risk factors for their occurrence, in particular the modification of body weight. Conclusion. This review offers a rational approach to prevention, diagnosis, and treatment of endometrial hyperplastic processes, including hormone therapy and surgical methods.
Consilium Medicum. 2019;21(6):53-58
pages 53-58 views

Experience of using the drug Dimia® for a treatment of abnormal uterine bleeding of puberty

Sibirskaya E.V., Turgunova G.M.


Abnormal uterine bleeding of puberty (AUBP) is pathological bleeding from the uterine body and cervix due to functional or structural changes in the endo- and myometrium in girls aged menarche to 17 years inclusive. Aim. Evaluation of the efficacy of using the drug Dimia® (drospirenone + ethinyl estradiol) for AUBP and improvement of treatment outcomes at uterine bleeding in female adolescents. Materials and methods. A clinical study was conducted in Morozov Children's City Clinical Hospital of the Moscow City Health Department. The study involved 50 female adolescents aged 13-17 years (average 14.7±1.1 years) with various types of AUBP. The main group included 25 patients who received drospirenone + ethinyl estradiol (Dimia®), the control group included 25 (50%) patients who received conservative hemostatic therapy. In the main group, the drug was prescribed according to the standard regimen (1 tablet 2 times a day for 10 days). Results. Evaluation of the therapy efficacy was carried out during the entire course of treatment, i.e. daily for 10 days. With Dimia® therapy in the main group, a decrease in a volume of blood loss was observed on the 2nd day of treatment. In 24 (99%) patients, hemostasis was achieved on the 3rd day of treatment. In 8 (30%) patients of the control group who received conservative therapy, complete hemostasis was achieved by the 10th day of treatment and the remaining patients showed anemia of varying severity due to progressive bleeding. This group of patients was subsequently transferred to hormone therapy with Dimia® along with taking anti-anemic drugs. At the end of treatment, a control blood test showed that the hemoglobin levels averaged 121 g/l (±7 g/l), while the initial levels averaged 103 g/l (±7 g/l). After a 10-day course of treatment, control pelvic ultrasound and assessment of blood parameters were performed in all patients of both groups. In order to fully assess the quality of life of patients with AUBP in the future, all girls in both groups were prescribed maintenance therapy. The main group received supporting therapy with Dimia® according to the contraceptive regimen for 3-6 months; the control group was prescribed cyclic vitamin therapy for 3 months. At the end of therapy, patients of the 1st group noted a significant reduction not only in the duration of menstruation, but also in the volume of blood lost. In addition, these patients observed an improvement in skin condition and an increase in the quality of life. Conclusions. The study showed a significant improvement in treatment outcomes at abnormal uterine bleeding in female adolescents, as well as a decrease in menstrual blood loss. In accordance with the study results, it can be stated that the drug Dimia® (drospirenone + ethinyl estradiol) is effective not only at AUBP, but can also be used as a prevention and treatment for endometrial hyperplastic processes in female adolescents.
Consilium Medicum. 2019;21(6):59-62
pages 59-62 views

A modern overview on the diagnosis and treatment of pelvic inflammatory diseases

Kuznetsov R.E., Skripchenko D.V.


Pelvic inflammatory diseases (PID) is the most common nosology in the structure of gynecological morbidity. The urgency of the problem is due not only to high economic costs associated with the examination and treatment, but also to a high incidence of complications such as infertility, ectopic pregnancy, chronic pelvic pain, generalization of the inflammatory process until the development of sepsis. Modern features of clinical presentation makes it difficult to diagnose PID in time. The article presents a literature review of risk factors, clinical features, diagnosis and treatment of PID.
Consilium Medicum. 2019;21(6):63-67
pages 63-67 views

Pathological vaginal discharge: international healthcare standards

Borovkova E.I.


The article presents modern classifications of physiological and pathological vaginal discharge as well as a questionnaire table for clarification of various factors that resulted in symptoms onset. Diagnostic and treatment methods for urogenital chlamydiosis, trichomoniasis, bacterial vaginosis, and candida infections are presented according to international protocols and Russian guidelines.
Consilium Medicum. 2019;21(6):68-72
pages 68-72 views

Local antifungal drug sertaconazole: a reserve antimycotic or a first-line medication of empirical therapy for vulvovaginitis?

Fadeev I.E., Poletova T.N., Mass E.E.


The article provides an overview of studies of a clinical and laboratory efficacy of the antifungal drug sertaconazole. Sertaconazole has a number of advantages over other antimycotics. It is effective in inhibiting growth and destroying cells of pathogenic fungi Candida spp., including those resistant to standard therapy, as well as a wide range of pathogenic bacteria and Trichomonas. It also reduces inflammation, and itching, does not cause resistance, does not affect the growth of vaginal lactobacilli, is applied topically, does not penetrates the systemic circulation, its therapeutic concentration in the epithelium is maintained with the regimen of administration once a week. Although obtained laboratory and clinical data allowed to include sertaconazole as a means of choice in the Recommendations of the Russian Society of Obstetricians and Gynecologists on the treatment of candidiasis in pregnant women in the II-III trimester (2019), it seems that this antimycotic drug is still underestimated in clinical practice.
Consilium Medicum. 2019;21(6):73-76
pages 73-76 views

Therapeutic benefit of PRP-therapy in treatment of atrophic vaginitis and vulva lichen sclerosus

Ivanova E.V., Sozaeva L.G.


Preservation of women’s health in different age periods, especially in the time of menopausal changes is one of the pressing problems in gynecology. Genitourinary menopausal syndrome is a complex of symptoms developing in estrogen-dependent tissues in women not only of peri- and postmenopausal age but also at time of lactation amenorrhea and treatment of genitourinary system hormone-associated disorders in reproductive age. The pathogenic basis for syndrome therapy is the use of estrogen-containing preparations for topical use. Although some women have contraindications for estrogens use because of impaired extragenital physical status. Platelet-rich plasma (PRP) therapy is widely used as an alternative treatment method.
Consilium Medicum. 2019;21(6):77-80
pages 77-80 views

Menopausal hormone therapy in the prevention of lipid metabolism disorders

Podzolkova N.M., Podzolkov V.I., Tarzimanova A.I.


Cardiovascular disease is the leading cause of mortality in older women. The progression of these diseases in women is closely related to a natural processes of reproductive function decline. Estrogen deficiency which occurs in postmenopausal women contributes to lipid metabolism disorders: a decrease in anti-atherogenic HDL levels and an increase in levels of pro-atherogenic LDL, especially lipoprotein (a). Currently, there is evidence that menopausal hormone therapy (MHT) can have cardioprotective efficacy, provided that it begins at a time close to the onset of menopause. Randomized clinical trials proved a high efficacy of MHT for the prevention of atherosclerosis in early postmenopausal women. Individualization of MHT, i.e., selection of estrogen and progestogen components, their dose and route of administration which are optimal for a particular woman, is of great importance. The most significant cardioprotective effect of MHT has been proven for the combination of 17b-estradiol and dydrogesterone. One of modern drugs for combined MHT is Femoston®, which exerts beneficial effect on lipid metabolism and reduces insulin resistance.
Consilium Medicum. 2019;21(6):81-85
pages 81-85 views

A comprehensive approach to the treatment of osteoporosis in the postmenopausal period in the context of international clinical guidelines

Zakharov I.S., Kolpinskiy G.I., Shalamanova N.V., Kolesnik I.Y., Lebedeva T.V., Titarenko O.V.


Due to the morpho-functional changes in the woman’s body that occur during the postmenopause, the risk of osteoporotic fractures increases. Given the interdisciplinarity of the problem of osteoporosis, an important role is played by a comprehensive approach to the management of patients with this pathology, including the interaction of various specialists (gynecologist, rheumatologist, endocrinologist). In the correction of osteoporotic changes, it is necessary to adhere to the individual selection of drug therapy, taking into account the benefits and risks of the drugs used. The article presents a modern view on the treatment of osteoporosis in postmenopausal women. The data presented is based on updated clinical guidelines of the European Society of Endocrinology, published in March 2019, as well as on meta-analyzes of recent research on treatment issues. Attention is paid to the selection criteria for the use of a particular group of anti-osteoporotic drugs.
Consilium Medicum. 2019;21(6):86-89
pages 86-89 views

Menopause: issues and solutions

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Consilium Medicum. 2019;21(6):90-96
pages 90-96 views

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