RELEVANCE. The problem of treating thoracic endometriosis complicated by recurrent spontaneous catamenial pneumothorax is associated with the widespread prevalence of endometriosis, the complexity of its treatment and unsatisfactory long-term outcomes. The diagnosis of catamenial pneumothorax can only be established with a carefully collected history and confirmation of its recurrent nature. Favorable results are achieved with complex therapy carried out by the thoracic surgeon and gynecologist, consisting of an adequate volume of surgical intervention and hormonal therapy with gonadotropin releasing hormone agonists.AIM OF STUDY. To improve the diagnosis of thoracic endometriosis and recurrent catamenial and endometriosis-related spontaneous pneumothorax. To optimize the currently available treatment tactics by reducing the incidence of early relapses of catamenial pneumothorax and creating favorable conditions for the formation of reliable pleurodesis.MATERIAL AND METHODS. We studied the immediate outcomes of complex treatment of 30 patients (14.7%) with right-sided recurrent catamenial (28) and endometriosis-related spontaneous pneumothorax (2), with a median age of 41 (37;44) years, for the period from 2011 to the first half of 2023. Surgical treatment via video-assisted thoracoscopic access was performed in 26 patients (86.7%). After surgery, all the patients were recommended a six-month course of hormonal therapy with gonadotropin releasing hormone agonists.RESULTS. Various types of mechanical pleurodesis were performed in 25 patients (96.1%), resection of the diaphragm — in 17 (65.4%), alloplastic reconstruction with a synthetic mesh implant — in 12 patients (46.1%), pulmonary resection — in 9 (34.6%). In 12 of 26 patients (46.1%) in the early postoperative period, 6 (3; 6.75) days after surgery, a recurrence of catamenial pneumothorax developed, which subsequently required repeated interventions. In 5 patients, the relapse clearly coincided with the menstrual cycle. Early recurrence of pneumothorax required repeated drainage of the pleural cavity in all the patients, chemical pleurodesis in 2, and prolonged drainage of the pleural cavity in 1.CONCLUSION. Surgeries involving resection and reconstruction of the diaphragm with a mesh implant, pleurectomy, lung resection do not ensure the removal of all endometrioid heterotopias of the diaphragm and lung, therefore, during the first mensis after surgery, in the early postoperative period, 46.1% of the patients had a recurrence of catamenial pneumothorax, with no formed pleurodesis, which contributes to the possibility of further recurrences of pneumothorax. Improving the immediate outcomes of complex treatment of catamenial pneumothorax is possible with the preventive administration of hormonal therapy 1.5–2 months before the planned surgical intervention, which requires a multidisciplinary approach of the thoracic surgeon and gynecologist.

The article presents a clinical observation of an extremely rare in gynecological practice androgen insensitivity syndrome (AIS). The authors give data on the pathogenesis of the disease, modern classification and terminology of various forms of this pathology. The phenotypic manifestations of the disease, the results of clinical and instrumental studies and surgical treatment are described. The results of the study show the possibility of clinical diagnosis of AIS and timely surgical treatment of patients with this pathology, due to the high risk of gonadal malignancy.

ИССЛЕДОВАНИЯ АПОПТОЗА КЛЕТОК ЭНДОМЕТРИЯ У БОЛЬНЫХ С ГИПЕРПЛАСТИЧЕСКИМИ ПРОЦЕССАМИ ЭНДОМЕТРИЯ Н.В.Боровкова 1,2 , М.М.Дамиров 1 , О.Н.Олейникова 1 , Г.П.Титова 1 , Ю.В.Андреев 1 , Г

The study objective Is to present a clinical observation, describe the diagnostics and treatment of acute transmural myocardial infarction in a patient on the 8th day after childbirth Material and methods A 31-year-old patient was hospitalized 3 hours after the onset of the disease on the 8th day after urgent spontaneous delivery at 38-39 weeks of gestation with a clinic of acute myocardial infarction in the intensive care unit. Based on the data of anamnesis, complaints, physical examination, results of instrumental and laboratory examination, the following clinical diagnosis was made: ischemic heart disease: acute transmural myocardial infarction of the anterior wall, septum and apex of the left ventricle; atherosclerosis of the aorta and coronary arteries. On an emergency basis, the patient underwent coronary angiography, pronounced atherosclerotic changes in the coronary arteries were revealed: acute occlusion of the anterior interventricular artery in the middle third, stenosis of the diagonal branch up to 70% in the orifice, stenosis of the circumflex branch up to 70% in the middle third, extended stenosis up to 79% in the middle third of the right coronary artery. Results The patient underwent percutaneous coronary intervention (pci) on a symptom-dependent artery: mechanical recanalization and stenting of the anterior descending artery (ada) by a drug-eluting stent. Conclusion An increase in the incidence of acute coronary syndrome in pregnant women and postpartum women requires the development of an algorithm for additional examination of late reproductive age patients at the stage of pregnancy planning, in case of identification of possible risk factors for the development of cardiovascular diseases — observation of a cardiologist during pregnancy and in the postpartum period.

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization. Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli. Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II. Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

Relevance. Ectopic pregnancy is an urgent condition which may lead to intraabdominal hemorrhage and woman death. In recent years, the frequency of this pathology is significantly increasing. However, morphological changes in the fallopian tubes in patients with this disease remain understudied. Aim. To study morphological changes in the fallopian tubes in patients with ectopic pregnancy with various variants of the clinical course. Materials and methods. The morphological study included 130 patients who had laparoscopic surgery for ectopic pregnancy. Comprehensive morphological study of the fallopian tubes removed during surgery was conducted. Results and discussion. The article presents the morphological changes in the fallopian tubes in patients with ectopic pregnancy. Implantation of a fertilized egg in the fallopian tube led to significant changes in its macro- and microstructure, which were due to invasion of the chorionic villi and involved all layers of the tube wall, differing only in depth and prevalence. The most pronounced morphological changes in various segments of the tube were revealed in the endosalpinx. Conclusion. The combination of morphological changes in different layers of the tube is related to a chronic non-specific productive endomyosalpingitis with luminal deformation, which was one of the main causes of this disease development.

We report results of treatment for 72 patients with uterine leiomyoma (LM) of various sizes and location, who had arrived with excessive uterine bleeding. All patients underwent urgent or urgently-delayed endovascular hemostasis by performing uterine arteries embolization (UAE). We analyzed clinical features of the disease after UAE in various sizes of tumors and studied immediate and long-term results of UAE in patients with LM.

The article presents the literature data on the regulation of endometrial cells apoptosis in health and proliferative diseases of the uterus. It is noted that throughout the menstrual cycle the cells apoptosis and regeneration take place in strictly controlled sequence and depend on the phase of the cycle and hormonal changes. The expression of Bcl-2 (inhibitor of apoptosis) in cells also varies cyclically in endometrial glandular cells, peaking in the late proliferative phase, and then decreasing to a minimum at the end of the secretory phase and within the menstruation phase. In endometriosis, the apoptosis index in endometrial functional layer is significantly lower than in healthy women. The weakened apoptosis is associated with the disturbance of its regulation. The expression of Bcl-2 increased with the progress of the disease in the endometrial tissue, while the expression of bax (apoptosis activator) corresponded to figures in healthy women. The increase in the expression of Bcl-2 was observed in the cells of myomatous fibroids. Thus, in patients with uterine myoma the ratio Bcl-2/Bax is more important. It is noted that the weakened apoptosis of endometrial cells and disorders of apoptosis regulation are leading pathogenic mechanisms for the development of proliferative diseases of the uterus. This is the basis of a new search for the effective diagnosis, prognosis and treatment of this widespread disease.

ABSTRACT. The article describes the basic pathogenetic mechanisms of uterine bleeding occurrence in patients with uterine leiomyoma (UL). The pathogenesis of this disease is difficult and multi-factorial. Significant changes in the architectonics of the uterine vasculature are noted. Modern approaches to management of patients with UL and uterine bleeding are discussed from a clinical point of view using conservative, minimally invasive and surgical methods of treatment.

The study of microcirculation is one of the most growing diagnostic areas. The article summarizes the literature on microcirculation disorders in gynecological patients. Modern methods of microcirculation disorders diagnostics have been analyzed. We also described techniques of laser Doppler fl owmetry (LDF) to assess changes in local microcirculation of the pelvic organs. The results of the clinical use of this technique in patients with various gynecological diseases are reported.