Цель исследования: повышение эффективности исходов трансцервикальной миомэктомии с использованием современных противоспаечных барьеров. Материал и методы. В исследовании приняли участие 52 пациентки с миомой матки, которым проводилась внутриматочная хирургия – гистероскопическая миомэктомия с помощью биполярного резектоскопа. Пациентки были разделены на две группы. В первую (основную) группу вошли 30 женщин с низкой степенью сложности выполнения гистероскопической миомэктомии, которым была выполнена гистерорезектоскопия с последующим интраоперационным введением геля Антиадгезин внутриматочно. Группу сравнения составили 22 пациентки с миомой матки, также отнесенные к группе низкой сложности выполнения гистероскопической миомэктомии, которым была выполнена только гистерорезектоскопия миоматозного узла. Результаты и выводы. С целью минимизации послеоперационных рисков развития спаечного процесса в полости матки в качестве комплексного лечения следует рекомендовать интраоперационное введение антиадгезивного геля Антиадгезин в дозе 3 г. Введение геля значительно снижает частоту возникновения легких и умеренных внутриматочных синехий, восстанавливает параметры нормального менструального цикла и увеличивает частоту наступления беременности. Purpose of the study: to improve the effectiveness of outcomes of transcervical myomectomy using modern anti-adhesion barriers. Material and methods. The study involved 52 patients with uterine fibroids who underwent intrauterine surgery – hysteroscopic myomectomy using a bipolar resectoscope. The patients were divided into two groups. Group I (main) – 30 women with a low degree of complexity of hysteroscopic myomectomy, who underwent hysteroresectoscopy followed by intraoperative intrauterine administration of Antiadgesin gel. The comparison group consisted of 22 patients with uterine fibroids, also assigned to the group of low complexity of hysteroscopic myomectomy, who underwent only hysteroresectoscopy of the myomatous node. Results and conclusion. In order to minimize the postoperative risks of developing adhesions in the uterine cavity, intraoperative administration of the antiadhesive gel Antiadhesin in a dose of 3 g should be recommended as a complex treatment. The introduction of the gel significantly reduces the incidence of mild and moderate intrauterine synechiae, restores the parameters of the normal menstrual cycle and increases the frequency onset of pregnancy.

В обзоре литературы освещаются актуальные вопросы терапии акне, себореи и гирсутизма у девушек и молодых женщин с применением комбинированных оральных контрацептивов (КОК), содержащих прогестины последнего поколения (дроспиренон, диеногест). Показана связь андрогенозависимой дерматопатии со снижением качества жизни пациенток. Обсуждаются патогенез, виды акне и подходы к их лечению с применением современных КОК, степень антиандрогенного воздействия прогестинов, входящих в состав данных препаратов, для выбора оптимальной комбинации рекомендуемой терапии. Приведены данные отечественных и зарубежных метаанализов и научных исследований, а также клинические рекомендации последних лет. The literature review highlights the relevance of the problem of acne, seborreia and hirsutism therapy in girls and young women using COCs containing last-generation progestins (drospirenone, dienogest). The association of androgen-dependent dermatopathy with a decrease in the quality of life of patients is shown. The pathogenesis, types of acne and approaches to their treatment with the use of COCs, the degree of anti-androgenic effect of progestins included in these drugs for the selection of the optimal combination of the recommended therapy are discussed. The article contains data from domestic and foreign meta-analyzes and scientific research and clinical recommendations of recent years.

Актуальность. Персистирующая инфекция, вызванная вирусом папилломы человека (ВПЧ) высокого риска, является одной из основных причин цервикальных интраэпителиальных неоплазий шейки матки и рака шейки матки, но отдельные гены и другие клинические факторы также оказывают важное влияние на прогрессирование неопластических процессов в шейке матки. Таким образом, разработка индивидуальных планов лечения для разных групп пациентов в соответствии с факторами риска прогрессирования цервикальных интраэпителиальных неоплазий шейки матки может помочь уменьшить заболеваемость раком шейки. Цели. Целью данной работы было оценить эффективность эпигенетической терапии у женщин репродуктивного возраста с цервикальными интраэпителиальными неоплазиями I степени (CIN I) на основании оценки вирусной нагрузки и данных молекулярно-генетического исследования. Материалы и методы. Исследование состояло из двух групп пациенток: I группа – группа контроля (со здоровой шейкой матки); II группа – пациентки с CIN I. Исследование было направлено на нахождение зависимости относительной экспрессии генов, кодирующих никотиновые ацетилхолиновые рецепторы, и вирусной нагрузки до и после лечения препаратом Цервикон®-ДИМ у пациенток с цервикальными интраэпителиальными неоплазиями легкой степени тяжести. Результаты. Через 6 месяцев лечения дииндолилметаном женщин с CIN I происходит снижение уровня вирусной нагрузки с 3,8 lg [3,5; 4,5] до 3,1 lg [2,75; 3,4] (р = 0,009) и изменение экспрессии генов α4-nAChR (р = 0,032), α6-nAChR (р = 0,006), β1-nAChR (р = 0,022) и β2-nAChR (р = 0,001). Выводы. Исходя из полученных данных, можно сделать предположение о том, что для профилактики прогрессирования цервикальных интраэпителиальных неоплазий легкой степени тяжести целесообразно назначение дииндолилметана для снижения уровня вирусной нагрузки. Relevance. Persistent infection with high-risk human papillomavirus (HPV) is one of the main causes of cervical intraepithelial neoplasia of the cervix and cervical cancer, but individual genes and other clinical factors also have an important influence on the progression of neoplastic processes in the cervix. Thus, the development of individual treatment plans for different groups of patients in accordance with risk factors for the progression of cervical intraepithelial neoplasia of the cervix can help reduce the incidence of cervical cancer. Objectives. The aim of this work was to evaluate the effectiveness of epigenetic therapy in women of reproductive age with grade I cervical intraepithelial neoplasia (CIN I) based on an assessment of viral load and data from a molecular genetic study. Materials and methods. The study consisted of 2 groups of patients: group I, the contra group (with a healthy cervix); group II – patients with CIN I. The study was aimed at finding the relationship between the relative expression of genes encoding nicotine acetylcholine receptors and viral load before and after treatment with Cervicon-DIM in patients with mild cervical intraepithelial neoplasia. Results: After 6 months of treatment with diindolylmethane in women with CIN I, the level of viral load decreases from 3.8 lg [3.5; 4.5] to 3.1 lg [2.75; 3.4] (p = 0.009) and changes in the expression of α4-nAChR (p = 0.032), α6-nAChR (p = 0.006), β1-nAChR (p = 0.022) and β2-nAChR (p = 0.001). Conclusions: Based on the data obtained, it can be assumed that in order to prevent the progression of cervical intraepithelial neoplasia of mild severity, it is advisable to prescribe the drug diindolylmethane to reduce the level of viral load.

Background: Patients with ovarian endometriosis (OE) are known to have a 2.5-fold increase in the risk of malignant neoplasms. OE is polymorphic condition histologically subdivided on two forms: “without atypia” and “with atypia”. First form is considered benign, while second one is precursor of ovarian malignant transformation. Aim: Assess of the morphological and immunohistochemical characteristics indicative of the risk of malignant neoplastic transformation of OE atypical lesions. Materials and methods: Seventy-eight fragments of ovarian tissue (resected regarding ovarian endometrioid cists) were studied histologically for determination of cystic ovarian endometriosis foci with and without atypia. Thirty-five histological slides with OE and 8 slides with adenocarcinomas of different types were studied immunohistochemically. Monoclonal antibodies to Ki-67, Всl-2, р53 proteins and polyclonal antibodies to HNF-1β were used. Results were evaluated by means of Histological score (H-score) method. Results: Thirty-five foci of cystic OE without atypia and 32 foci with epithelial atypia were observed. In foci with epithelial atypia, the expression of Ki-67, Bcl-2 and HNF-1β was significantly higher relatively to the foci without atypia, while expression of р53 was the same in foci with and without atypia. From 4 subtypes of studied ovarian adenocarcinomas the expression of HNF-1β was only observed in clear cell adenocarcinoma. Conclusion: Enhanced expression of biomarkers Ki-67, Bcl-2 and HNF-1β in cystic OE with atypia indicates on the risk of malignant transformation of lesions with atypia. Using of these biomarkers can be useful for differential diagnostics of OE with and without atypia and for decision about surgical treatment.

Menstrual disorders, preliminary pregnancy planning require safe prevention and careful support of reproductive function. Bioregulatory therapy based on the principle of activation of intrinsic reserves of the organism meets these requirements.

В настоящее время эндометриоз поражает около 10% женщин репродуктивного возраста во всём мире. Женщины страдают такими симптомами, как болезненные месячные (дисменорея), хроническая тазовая боль, боль при половом акте (диспареуния) и бесплодие. Он определяется как наличие ткани эндометрия вне полости матки. Диагноз эндометриоза ставится исключительно хирургическим путем, поскольку не существует устойчивых биомаркеров для диагностики заболевания. Лекарства от эндометриоза не существует, и лечение направлено только на симптомы, а не на механизмы, лежащие в основе заболевания. Литература за последние годы расширила наши знания, касающиеся поисков боимаркеров эндометриоза, иммунной дисрегуляции и трансформации эндометриоза в рак яичников. В этом обзоре мы рассматриваем вышеупомянутые темы с целью предоставить читателю обзор и соответствующие ссылки для дальнейшего изучения, чтобы подчеркнуть прогресс, достигнутый в исследованиях эндометриоза, и в заключение остановиться на областях исследований эндометриоза, которые сегодня наиболее актуальны.

Objective: to assess molecular profiles of endometrial hyperplasia and endometrial intraepithelial neoplasia.Materials and methods. We conducted a retrospective study that included 77 patients with a morphologically verified hyperplastic process in the endometrium. Of them, 34 patients had endometrial hyperplasia and 33 patients had endometrial intraepithelial neoplasia. The control group comprised 30 women with no endometrial disorders according to the results of histological examination.Results. Patients with endometrial intraepithelial neoplasia are at high risk of developing cancer. High angiogenic activity, pronounced vascularization, and endometrial hypoxia are believed to be important risk factors contributing to tumor proliferation and transformation. The expression of inhibitors of apoptosis, such as survivin and Bcl-2, is usually increased in atypical cells, which may indicate their involvement in malignant transformation of cells and tumor invasive growth.Conclusion. Our findings confirm the important role of survivin and Bcl-2 in hyperplastic processes in the endometrium.

© Коллектив авторов, 2017 Наиболее эффективным способом профилактики рака шейки матки является ранняя диагностика и своевременное лечение преинвазивных повреждений эпителия шейки матки [1]. Цервикальная интраэпителиальная неоплазия (cervical intraepithelial neoplasia — CIN) характеризуется потенциально предраковой трансформацией и аномальным ростом (дисплазией) плоскоклеточного эпителия на поверхности шейки матки [2]. Различают легкую, умеренную и тяжелую дисплазию шейки матки (CIN 1, CIN 2 и CIN 3 соответственно). Прогрессирование в инвазивный рак происходит примерно в 1% случаев выявления CIN 1, в 5% — при CIN 2 и, по меньшей мере, в 12—15% случаев CIN 3 [3]. Тактика ведения пациенток с CIN легкой степени резко изменилась за последнее десятилетие. Считалось, что лечение пациенток с легкой дисплазией является обязательным и предотвращает развитие рака шейки матки. Однако в последние годы эта теория была опровергнута результатами исследований, в которых было показано, что у женщин с нормальным иммунным ответом и гормональным фоном, при отсутствии хронической воспалительной реакции стромы и низкой вирусной активности в подавляющем большинстве случаев наблюдается спон-

Purpose of the study: evaluation of the quality of life of patients with symptomatic uterine myoma up to 12 weeks of gestation against a background of mifepristone 50 mg daily continuously for 3 months.Material and methods. The prospective study involved 141 patients with uterine myoma who received treatment with mifepristone (Gynestril®) 50 mg continuously for 3 months. In order to evaluate changes in the volume of uterine bleeding, each patient kept a diary where she registered the number of sanitary napkins used. Sonographic examination was used to evaluate the size of the uterus and fibroids. The Visual Analogue Scale (10-point VAS scale) was used to assess the pain intensity. Quality of life of patients and their satisfaction with the therapy was also evaluated by a 10-point VAS scale. The complaints, physical examination data and results of sonographic studies were recorded before and immediately after the end of treatment (1st and 2nd visits).Study results. Drug therapy with Gynestril® (mifepristone 50 mg) for patients with uterine myoma for 3 months helped to obtain a statistically significant (p < 0.001) improvement across all the evaluated parameters: in a large majority of patients, control of menstrual blood loss was achieved (decreased duration and volume of bleeding), while 85 patients (60.3%) achieved reversible drug-induced amenorrhea, and 43 patients (30.5%) - oligomenorrhea; a large majority of patients achieved reduction of pain severity according to VAS, while in 118 (83.7%) patients the parameter was estimated as “slight pain/no pain” after the end of treatment. According to the ultrasound results, a statistically significant decrease was achieved in the number of displayable fibroids (from 2.1 to 1.9 at an average), the volume of the dominant myoma node (on average by 65% from 37.34 to 13.27 cm3) and of the uterus (an average of 35% from 182.71 to 118.09 cm3). In addition, a vast majority of patients - 99.9% - evaluated the quality of life and satisfaction with treatment as high.Conclusions. Therefore, the results of the study demonstrate that Gynestril® is highly effective, safe and promising in the pharmaceutical treatment of uterine fibroids.

Pathomorphological and immunohistochemical studies of endometrium were performed. The higher proliferative activity of the VEGF and the higher production of transformation growth factor β1 (TGFβ1), fibronectin and liziloxydaza in patiens with atypical hyperplasia of endometrium and chronic endometritis testifies the presence of cellular hypoxia, disturbance of intercellular and extracellular interaction and can be considered as the negative prognostic factor.

This article reviews recent advance in our understanding of ovarian endometriomas, with special reference of atypical epithelial features (atypical endometriosis) and its relationship to neoplasm. Mainly, two epithelial ovarian carcinoma subtypes, the ovarian clear cell carcinomas and the endometrioid ovarian carcinomas, have been molecularly and epidemiologically linked to endometriosis. The clear cell and endometrioid adenocarcinomas have common immunohistochemical markers, genetic changes are the same as atypical endometriosis. The occurrence of ARID1A mutations and alterations in the PI3K/AKT pathway in endometriosis and endometriosis-associated ovarian carcinomas, as well as the possible functional and clinical implications are discussed in this review. Therefore, development of a screening method that can detect mutations of ARID1A and activation of the PI3K/AKT pathway might enable early diagnosis of endometriosis associated ovarian cancers and endometrial cancers.

Planning of a family and preservation of reproductive health - the important problem of modern medicine. According to recommendations the CART (1994) contraception is recommended to women up to menopaysa and absence menses in a current of year. In a kind of high risk of development or aggravation metabolic and hemostasies infringements for the purpose of hormonal contraception at women late reproductive period and perimenopaysa we had been used the microdosed out preparation Miniziston®20 Fem, containing 0,02 mg etynilestradiol and 0,1 mg levonorgestrel. Results of our research have shown that the given preparation has 100% contraceptive efficiency, provides necessary regulation of menstryal cycle, presence estrogen component promotes improvement of quality of a life of patients and knocking over of clinical symptoms, characteristic for the period perimenopaysa. Besides, Miniziston®20 Fem does not render clinically significant influence on metabolic an exchange and hemostasis system.

This paper describes the classification, etiology, diagnosis and treatment of non-neoplastic diseases of the vulva. Terms and kraurosis leukoplakia of the vulva have no clear morphological equivalents, and display only certain clinical manifestations. Sclerosing shingles and squamous hyperplasia, often combined with each other and, in essence, is a single pathological process - with or without lichenification.

The article presents a literature review on methods of diagnosis, therapy and management of patients with isthmic-cervical insufficiency. Risk factors for the development of isthmic-cervical insufficiency are the acquired and congenital anomalies of the cervix. The diagnosis can be made only during pregnancy. Shortening of cervical length <25 mm before 24 weeks indicates the presence of ICN and the significant risk of miscarriage. Initial evaluation of the cervical length is from 14 weeks. When finding a shortening of the length of the closed part of the cervical canal is less than 25 mm the treatment of choice is surgical correction. When the cervical length more than 25 mm prophylactically from 19 to 32 weeks assigned to micronized progesterone 200 mg vagina. In identifying ICN after 24 weeks, the method of choice is the appointment of micronized progesterone and the installation of an unloading obstetric pessary. The use of a differentiated algorithm of management of patients with ICN reduces the chance of unexpected premature birth and neonatal morbidity and mortality.

Vaginal candidosis is very common disease in patients with immunodeficiency. As vaginal candidosis is often associated with other dysbiotic disturbances of vaginal microcenosis medications with wide spectrum of activities should be indicated for treatment of candidainfections. To assess fenticonazol therapeutical efficacy in treatment of chronic vaginal candidosis 32 patients in age of 22-42 years were examined. Inclusion criteria were: presence of history of 4 or more episodes of vaginal candidosis in an year, absence of sexually transmitted infections at the moment of examination. All patients were assigned to fenticonazol 600 mg for vaginal administration, and to its repeated dose (600 mg) in three days. At the second step of treatment medications normalizing the functions of immune system (interferons) were indicated. The results demonstrated high clinical and microbiological efficacy of feticonazol in chronic vaginal candidosis treatment.