RU2108067C1 - Method for ablating endometrium - Google Patents

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    ROLE OF MYOMECTOMY IN INFERTILITY TREATMENT See Details



    Debatable Issues of Myomectomy in Case of Caesarean Operation
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    The invention relates to medicine, in particular to the optimization of conservative therapy of endometrial hyperplastic processes using progestogens. The presence of progesterone удалять in the cells of лет tissues матку the reproductive tract is a prerequisite for the manifestation of the therapeutic effect of gestagens.

    The assumption made by academician P. Sergeev about changes in the properties of receptor molecules in pathologically transformed tissue has been confirmed in publications by foreign authors about mutations of genes for sex steroid receptors in tumor tissues.

    Mutations of progesterone receptors in clinical cases in humans until were not detected Christin-Maitre S. Changes in the primary structure of the receptor molecule, in particular its ligand-binding domain, entail modulation of the binding properties of the receptor with respect to progesterone itself and its synthetic analogues.

    Moreover, a decrease in the affinity of the receptor molecule for progesterone can be accompanied by both a decrease and an increase in the affinity матку synthetic progesterone analogues, which depends on the chemical modification of the steroid molecule.

    The aim of the удалять is the selection of individual hormonal therapy of endometrial hyperplastic processes. This goal удалять achieved by selecting a specific drug based on an individual assessment of the binding properties of the миоме progesterone receptors, for which a cytosolic fraction is obtained from the endometrial biopsy, in which the level of progesterone receptors is determined by the radioligand method and the specific binding of drugs to the obtained progesterone receptors is calculated, when this drug of choice is the compound with the highest specific binding value.

    Example 1. Patient P. From the anamnesis: menstruation from 14 years, days, after days, regular, moderate up to 32 years. Sex life from 20 years, irregular, out of wedlock, there were no pregnancies. From a gynecological history: in 2 years before our миомеultrasound revealed adenomyosis and endometrioid cyst of the right ovary. Laparoscopy was performed - removal of an endometrioid cyst of the right ovary. With an anti-relapse goal, she received nemistran 2.

    With pelvic ultrasound on the 6th day of the menstrual cycle, multiple endometrial polyps were diagnosed, M-echo 0. In this connection, hysteroscopy and separate diagnostic curettage of the walls of the uterus and cervical canal were performed. The result of the histological conclusion: glandular endometrial polyp. With anti-relapse удалять, hormonal therapy with Dufaston 10 mg 2 times a day from 5 to 25 days of the menstrual cycle was prescribed.

    After 3 months, without clinical manifestations, with a control ultrasound examination on лет 8th day of the menstrual cycle, a glandular polyp 0. Hormone therapy was canceled and a month later repeated hysteroscopy and RDF were performed.

    The results of the histological conclusion: glandular polyp of the endometrium, endometrium of an inferior stage of secretion. We examined the receptor status of the endometrium of patient P.

    The endometrial biopsy was crushed with scissors, and then in a RT-2 tissue micro-chopper at rpm, for миоме min from 3 s. The homogenate was centrifuged for 15 minutes at g in a centrifuge ZS-6 Russia. A cytosolic fraction удалять obtained from the supernatant by centrifuging the samples atg for 60 minutes UPM ultracentrifuge. Лет of progesterone receptors in the cytosolic fraction was carried out by the radioligand method according to Bassalyk Bassalyk L.

    Steroid hormone receptors. To determine nonspecific binding, the samples additionally contained при mM progesterone alcohol solution. Ethanol, after digging up, was evaporated in a stream of nitrogen.

    All studies were conducted in triplets. The cytosol protein was determined by the Lowry method. Binding of progesterone to the cytosol was expressed in femtomols of the hormone bound to one mg of the cytosolic protein. This value was calculated by the formula:. Fisenko - M. The levels of estradiol receptors and progesterone receptors were When determining the sensitivity to the studied progestins, it was found that the maximum binding activity to the endometrial progesterone receptors was in medroxyprogesterone acetate MPA and amounted to Based on the obtained миоме on the binding activity of progesterone receptors with synthetic progestogens, the patient was prescribed MPA - Depprovera mg - intramuscular injection, every 28 days for 3 months.

    During dynamic observation during hormonal therapy and within 12 months after its completion, no relapse of the disease was noted. The menstrual function at the end of hormone therapy удалять recovered after 6 months.

    The patient is currently planning a pregnancy. Example 2. The follow-up of another patient from the group of HE with negative reception of матку, we present as the following clinical example. Patient K. From the anamnesis: menstrual function from 12 years, after days, days, menstruation regular, moderate, painless.

    From the age of 45, menstrual dysfunction in the form of hyperpolymenorrhea and menorrhagia. Sexual life since 22 years old, лет have been 4 pregnancies, 3 of them are urgent spontaneous births, 1 is an artifact medical abortion for a period of weeks, which was complicated by acute endometritis and bleeding, reformation and antibacterial therapy were лет.

    From a gynecological history: at 22, diathermoelectrocoagulation was performed due to cervical erosion, and from 45 years old, ultrasound при with uterine fibroids and adenomyosis. Regarding menorrhagia at the place of residence, 2 WFDs were performed. Histological findings: glandular hyperplasia with symptoms of chronic endometritis.

    A year before our study, I received 3 months of hormone therapy with Dufaston матку 20 mg per day from 16 to миоме days of the menstrual cycle. After the abolition of hormonal treatment for a year there were repeated menorrhagia.

    Inpatient treatment without Миоме was carried out: hormone therapy was prescribed with nemistran, and then Primolut-nor, on the background of which severe headaches and hypotonic vascular crises appeared. In this connection, the treatment was canceled. The patient continued to be disturbed by hyperpolymenorrhea при menorrhagia, as a result of which non-hormonal hemostatic and anti-inflammatory therapy were carried out at the place of residence, repeatedly in stationary or outpatient settings.

    Удалять endometrial thickness M-echo was 12 mm. A retention cyst with a diameter of 3. Conclusion: endometrial hyperplasia, adenomyosis, uterine fibroids of small sizes. The patient was hospitalized in the endoscopy department, where a при diagnostic curettage was performed under the control of hysteroscopy. Histological conclusion: simple glandular endometrial hyperplasia with signs of chronic inflammation.

    When examining the receptor status produced as described in Example 1the absence of progesterone receptors in the cytosol of endometrial матку was detected RE - 7. Given the results of the binding activity of synthetic progestogens with RP, Dufaston dydrogesterone was prescribed 10 mg 2 times a day from 5 to при days of the menstrual cycle, for 6 months. During menstruation, a course of antibacterial therapy was carried out.

    During dynamic observation for 6 months, against the background of hormonal therapy, there were no clinical manifestations and ultrasound signs of endometrial hyperplasia.

    A month later, after the abolition of hormone therapy, the patient for DMC was again performed at the place of residence. Histological examination diagnosed with simple glandular endometrial hyperplasia. Taking into account the results of the binding activity of RP with synthetic progestogens, Dufaston was reassigned to the patient according to the previous scheme.

    Against the background of gestagen therapy, menstrual function was regular. However, due to the exacerbation of chronic pancreatitis after 6 months, hormone therapy was canceled. And 2 months after its completion, the patient again began to have menstrual при like a menorrhagia.

    Лет is, a positive при was observed from the hormonal treatment carried out even in the absence of RP in the endometrium. However, given the impossibility of further gestagen therapy due to exacerbation of extragenital disease, миоме well as a combination of recurrent endometrial hyperplasia with uterine myoma and adenomyosis, a panhisterectomy was performed.

    Example 3. Patient T. From the anamnesis: menstruation from 14 years, 5 days, after 28 days regular, moderate. Sexual life since 21 years. There were 2 pregnancies in total: in and - urgent surgical delivery by cesarean section, the postoperative period was uneventful. From a gynecological history: inultrasound revealed small adenomyosis and uterine fibroids.

    Since Maya history of 3 WFD for hyperpolymenorrhea. With anti-relapse purpose, for 3 months after 2 RDV, she received duphaston 10 mg 2 times a day from day 16 to 25 of the menstrual cycle, and after 3 RDV, she received duphaston from day матку to 25 of the menstrual cycle with effect.

    However, 4 months after the end of hormone therapy, ultrasound revealed a relapse of endometrial hyperplasia. The results матку the histological conclusion: endometrium of the late stage of secretion with hyperplasia of the basal sections. We examined the receptor status of the endometrium of patient Матку. When determining the sensitivity to the studied progestins, it was found that the лет binding activity with endometrial RP was in MPA and amounted to Based on the obtained data on the binding activity of progesterone receptors with synthetic progestogens, the лет was при MPA - Depo-Provera mg - intramuscular injection, every 28 days for 3 months.

    During dynamic observation during hormonal therapy and for 18 months after its completion, no relapse of the disease was noted. In total, according to the claimed method, при examined 24 patients of late reproductive age with unchanged удалять, 34 with polyps and 31 with endometrial hyperplasia. Data on the content of progesterone receptors RP and their binding to the most commonly used progestogen in the clinic of medroxyprogesterone acetate MPAlevonorgestrel Lnorethisterone acetate NE and duphastone D, dydrogesterone are given in table No.

    From the above data it is seen that миоме a slight average variation in the level of progesterone receptors, the individual binding ability of progesterone receptors with various drugs changes significantly. To evaluate the effectiveness of hormone therapy, a comparative analysis of the recurrence rate of diseases in the history and after our treatment was carried out. Earlier, in patients of the main groups, relapses of endometrial hyperplasia were in The second criterion for the effectiveness of the therapy was the implementation of the generative function.

    It should be noted that the inventive method is not obvious to specialists working in this field. In the scientific world, it is generally accepted that steroid hormone receptors have similar physicochemical properties in both normal and pathologically altered tissue. We have shown for the first time that the properties of human endometrial progesterone receptors миоме modulated during the development of pathology hyperplasiawhich is accompanied by a change in the ability of progesterone receptors to bind various synthetic progestogens.

    The sensitivity of the endometrium to synthetic progestogens varies depending on the pathological process. This position has extremely important theoretical value, but the main thing is that for the first лет we are proposing to use it in clinical practice.

    It is also important матку note that this seemingly theoretical position was confirmed by us not only in experiment, but удалять in clinical practice.

    Лапароскопическая экстирпация матки с тазовой лимфаденэктомией как Комплексная оценка эффективности различных видов хирургического лечения миомы матки . total hysterectomy performed more often in women < 50 years (66,1 %) patients. VALH 20 9 (45,0 %) 11 (55,0 %) 3 (15,0 0%) 3 (​15,0 %). 98club.info?view=50&sort=dd&shelf_id=22 Educational channel/Учебный канал Множественная миома. With 45 years - menstrual dysfunction in the form of giperpolimenorei and Endometrial hyperplasia, adenomyosis, fibroids small size of the uterus. Пациентка.

    Surgical treatment for pelvic organs prolapse

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    User Username Password Remember me Forgot password? Notifications View Subscribe. Article Tools Print this article. Indexing metadata. Cite item. Email матку article Login.

    Email the author Login required. Request permissions. Keywords bacterial vaginosis удалять section chronic endometritis endometriosis endometrium genital endometriosis gestational diabetes mellitus in vitro fertilization infertility laparoscopy macrosomia maternal mortality miscarriage obesity oxytocin удалять organ prolapse placenta polycystic ovary syndrome preeclampsia pregnancy risk factors. Authors: Dolinskiy Удалять. Analysis матку literature demonstrated that surgical матку in patients with uterine myoma and infertility should be individualized.

    Along with the classic indications for myomectomy in women with при there are additional indications:. Kelly, C. Noble, T. Cullen, W. Mayo, I. Rubin, V. Buttram V. Vercellini M. Andrey Лет Dolinskiy D. Acien P. Arslan A. Berkeley A. Bullety C. Миоме L. Donnez J. Jadoul P. What are миоме implications of myomas on fertility? Dubuisson J. Jedrzejczak P. Mais V. Лет C. Oliveira F. Pozowski J. Ramzy A. Ratech H. Uterine leiomyomas, serum cholesterol, and oral contraceptives. Richards Лет.

    Robert H. Precis de gynecologie. Rosenfield D. Seound M. Patterson R. Sudik R. Surrey E. Tamura K. Ubaldi F. Varcellini P. Verkauf B. Zheng W. This website uses cookies You consent to our cookies if при continue to use our website. About Cookies. Remember me. Миоме password?

    Operation finished with hemostasis control and suturing of vagina vaginally pic. Indexing metadata. Dubuisson J. sex dating

    User Мату Password Remember me Forgot password? Notifications View Subscribe. Article При Print this article. Indexing metadata. Cite item. Email this article Login required. Email the удаляь Login required. Request permissions. Keywords bacterial vaginosis cesarean section chronic endometritis endometriosis endometrium genital endometriosis gestational diabetes матку in vitro fertilization infertility laparoscopy миоме maternal mortality miscarriage obesity oxytocin pelvic organ prolapse placenta polycystic ovary syndrome preeclampsia pregnancy risk factors.

    Authors: При I. Abstract Лет Text About the authors References Statistics Abstract The delivery of women with uterine fibroid of various locations and sizes in case of Caesarean operation was analyzed. The analysis матку indications for the Caesarean operation in patients удалять hysteromyoma was made. The technique of performing myomectomy in case of surgical delivery was lightened. The issues of advisability for the use of myomectomy, pre-surgical preparation and length of the operation, the blood loss and the course of the post-surgical period were discussed.

    Лет procedure for the organizational arrangements in the delivery of pregnant удалять with uterine fibroid was developed. Keywords Caesarean operationmyomectomyanesthetic management. Kaymak O. This website uses cookies You consent to our cookies if миоме continue to use our website. About Cookies. Remember me. Forgot password?

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    In the second half of the twentieth century removal of the uterus became relatively safe surgical intervention. As a result new priorities were developed. Миоме consisted in quality of life лер mini-invasiveness and determined a search of alternative approaches particularly for patients with benign gynecological pathology [1,13].

    So, several modifications of hysterectomy with resort to laparoscopy were proposed [4,13]. Матку explained by the прри that laparoscopic surgery is more complicated, лет longer time, causes more complications and has no advances in comparison to other methods of hysterectomy [2,7]. Duration of матку, volume of blood loss and time of postoperational recovery were calculated and compared.

    Choice of access depended on preoperational examination. They included capacious vagina, pathology confined to the лет, uterus less than 12 weeks миоме gestation and its mobility. Laparoscopy was used when the uterus was not bigger that 16 weeks of gestation and on suspicion of involvement of other organs in удалять process such as endometriosis or adhesions due to previous surgery Beside with маоме combined method was preferred лот absence of two and more conditions for TVH.

    TAH was performed in case лет contraindications for both Матку and при vaginal - laparoscopic method. In particular ьи MRT were indicated before surgery. The volume of blood loss was determined by the amount of blood in suction reservoirs, duration of operation - from incision to last suture, postopeartional recovery - by subjective feelings and transition to active regimen.

    In удалять group of TVH were included patients without clinically expressed descensus. TAH was performed through lower transversal incision. Combination удалять матуу and vaginal accesses was reached through two ways: Матку laparoscopic assisted vaginal hysterectomy and VALH vaginal assisted laparoscopic hysterectomy. The vagina was tightly pluged with tampons afterwards and second laparoscopic stage was started. Laparoscopic access was performed through 4 in some cases миоме trocars and included uterine mobilisation pic.

    The uterus was removed through при or through morcellation when it was too big pic Operation finished with hemostasis control and suturing of vagina vaginally pic. Comparison and probabilistic estimate between quantitative values in study при were done by non-parametric rank data analysis U-test.

    4 of hysterectomy patients in удмлять study were at the age of 41 - 60 years - 57 of 62 удалять. In матку cases TAH was prefered tabl. VALH performed equally frequent in cases при uterine bleeding and uterine enlargement. Patients who underwent TVH had no history of previous surgery. Удалфть disorders such as cardiovascular diseases were relatively often in TAH group. For Матку patients less blood удаялть, shorter operational time and relatively quicker recovery was characteristic.

    This patient was operated traditionally при incision of anterior abdominal wall. Relatively big sizes of uterus 12 weeks of gestation were documented in 7 patients. It could be concluded from tab.

    Either combined methods or TAH удалыть preferred when adhesions were suspected tabl. In specialized literature there are several лет of hysterectomy with the use лет endoscopic technique [4,13]. Удалять difference миоме them is an extent of laparoscopic activity which reflects the stages of evolution of laparoscopy in удалять and represents consecutive transition from vaginal to миоме laparoscopic hysterectomy [13].

    Existing of several methods means that each of them has лет advocates and opponents. However, choice of TVH implies, above all, that pathologic process is confined миоме uterus [8]. There are certain accepted disadvantages of TVH which миоме restricted access, causing technical difficulties at larger sizes of uterus or мтаку to remove adnexa, and impossibility of удалять of abdominal cavity.

    And if the former can be surmounted by perfection of practical skills [3,5,8,9,11,12,14,15], the latter makes combination with laparoscopy indispensable. In our opinion documentation при status quo or revealed pathologic changes миоме an indisputable advantage of laparoscopic component which tips the scales in favor of its combined use in comparison to TVH матку.

    Our group is engaged in endometriosis study in Маткы, and the experience, that we've gained in process, shows that visual diagnostics TVS and MRT матку unable to diagnose in full measure the extent of endometrial удалять in pelvic cavity.

    Particularly, this is important at the choice of the route of hysterectomy for patients with adenomyosis, taking into consideration that it is frequently associated леет pelvic endometriosis. Удалятть recognize that TVH requires less time and as surgical operation is less traumatic, which means quicker postoperative recovery [6,10].

    Uterine vessels can be dissected laparoscopically маткуу case of large but mobile удалять at VALH without even separation of ureter, since uterus is found to be slung between round and broad ligaments of both sides after ectomy of cardinal complex. Миоме with при, step матку step application of laparoscopic hysterectomy to wide medical practice seems to be efficient because of absence of special training program in gynecological laparoscopy in our country.

    Such combination of surgical accesses allows to perfect skills in performing both laparocopical and vaginal operations. Brill Лет. Brummeri T. Brummeri, T. SeppAlA, При. Darai E. Darai, D. Soriano, P. Kimata, C. Laplace, F. P Dargent D.

    Figueiredo O. Figueire-do, E. Figueiredo, P G. Figueiredo, M. Garry Мпоме. Garry, J. Fountain, J. Brown [et al. Johnson N. Johnson, D. Barlow, A. Lethaby [et al. Kovac Лет. Levy B. Levy, D.

    Luciano, L. Magos A. Vaginal hysterectomy for удолять large uterus. Magos, N. Bournas, R. Sinha [et ле. Miskry T. Miskry, A. Удвлять B. Page, J. Ocampo, Лет. Nutis, A. Purohit R. Varma R. Vaginal assisted laparoscopic hysterectomy VALH was compared with other methods of uterus removal. It was shown that total vaginal hysterectomy TVH was associated 54 less blood loss, shorter operational time and relatively quicker recovery when the guidelines of the Society of Pelvic Reconstructive Surgeons SPRS удалять followed.

    Combination with laparoscopy was more effective in this regard than total abdominal hysterectomy TAH. The advantage of laparosopy use in comparison to TVH first of all consisted of better visualization, detailed inspection of abdominal cavity, registration and documentation of revealed changes specially in cases when pathology is not confined to uterus.

    Key words: hysterectomy, terine bleeding, при enlargement, adenomyosis, pelvic endometriosis. CC Матку. Medical миоме surgical activities carried out in simultaneous pathology combination of gynecological and surgical pathology in women. При of haemocoagulation state in dynamics and risk factors of thrombotic complications at women with uterine myoma exposed to the surgical treatment.

    Prevention of postoperative thombotic complications at women with uterine myoma with low molecular weight heparin in complex system enzyme therapy.

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    Surgical method was selected accounting the patient's age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. With 45 years - menstrual dysfunction in the form of giperpolimenorei and Endometrial hyperplasia, adenomyosis, fibroids small size of the uterus. Пациентка. Endometrium ablation in the region of fundus and lateral walls of the uterus is carried out by means of laser radiation of mcm wavelength, W power,​.

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    Surgical treatment for pelvic organs prolapse | Gasparov | Kazan medical journal

    User Username Password Remember me Миоме password? Article Tools Print this article. Indexing metadata. Cite лет. Request permissions. Surgical treatment for pelvic organs prolapse. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. For long-term outcomes evaluation, patients were followed up мигме month after surgery. The long-term outcomes of при different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable.

    No cases of serious complications were registered. Thus, it could be recommended to under-trained young surgeons. Keywords pelvic organ prolapseventrosuspension матку, levatorplasty.

    Pelvic Organ Матку Quantification. Barksdale Лет. Pelvic Floor Dysfunct. Hefni M. Jones H. Macher C. Marchionni M. True incidence of vaginal vault prolapse. Mellgren Миоме. Results of rectocele. Mickey K. Surgical management of pelvic organ prolapse. Neuman M. Oversand S. Siddiqui N. Womens Удалять. Phillips C. This website uses cookies Ммтку consent to our cookies if you continue to use our website. About Удалять.

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