P. Byk, I. G. Kryvorchuk, I. Leschishin, K. Dmitrieva
Purpose - to present and analyze the case of surgical treatment of a patient with secondary giant adenocarcinoma of the right ovary. It is presented a clinical case of a giant metastasis of colorectal cancer to the ovary in a 48-year-old woman, measuring 30×20×15 cm, weighing about 9 kg, which occupied almost the entire volume of the abdominal cavity, pushing the stomach and intestines under the diaphragm with compression of the intestines, right ureter and the presence of ascites with a volume of 1.5 liters. A right-sided hemicolectomy with lymphodissection was performed, and an end-to-end ileotransversoanastmosis was applied. A right adnexectomy, extirpation of the uterus, omentectomy were performed. During the immunohistochemical study, membrane-cytoplasmic expression of cytokeratin (CK) 20 and nuclear expression of CDX2 were revealed. CDX2 is a defining marker for the diagnosis of adenocarcinoma of the gastrointestinal tract, as well as for the differentiation of primary and metastatic ovarian carcinomas. The patient has a lack of expression of receptors for estrogen and CK7 and positive nuclear expression of CDX2, which indicates metastasis of colorectal adenocarcinoma to the ovary. According to the results of the histological examination, which were of decisive importance, the origin of the tumor was determined and, accordingly, the patient’s diagnosis - the tumor of the cecum is G2 adenocarcinoma with germination into the serous membrane, metastases to the right ovary and regional lymphatic nodes 10 out of 10, and areas of tumor growth in the mesentery. Conclusions. In the case of detection of an ovarian neoplasm, the differential diagnosis of primary and secondary tumors is extremely important. Reproductive age at the time of presentation should not interfere with the diagnosis of primary or secondary ovarian malignancy. Metastases of primary colorectal cancer in the ovaries can manifest as pelvic tumors, so preoperative examination of the gastrointestinal tract and removal of the ovarian tumor with immunohistochemical examination is the leading option for choosing an appropriate treatment strategy. Immunohistochemical study of cytokeratin expression markers CK7, CK20 are appropriate for the differential diagnosis of synchronous cancer of the cecum and ovary, and CDX2 protein is a defining marker for the diagnosis of adenocarcinoma of the gastrointestinal tract and for distinguishing between primary and metastatic ovarian carcinomas. Cytoreductive surgery appears to be an important treatment option for metastatic ovarian neoplasia to improve prognosis. A multidisciplinary approach remains key in further examination, determination of the main diagnosis and development of an optimal treatment strategy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for
{"title":"Cytoreductive surgical treatment of giant metastasis of colorectal cancer in the ovary (clinical case)","authors":"P. Byk, I. G. Kryvorchuk, I. Leschishin, K. Dmitrieva","doi":"10.15574/pp.2023.94.128","DOIUrl":"https://doi.org/10.15574/pp.2023.94.128","url":null,"abstract":"Purpose - to present and analyze the case of surgical treatment of a patient with secondary giant adenocarcinoma of the right ovary. It is presented a clinical case of a giant metastasis of colorectal cancer to the ovary in a 48-year-old woman, measuring 30×20×15 cm, weighing about 9 kg, which occupied almost the entire volume of the abdominal cavity, pushing the stomach and intestines under the diaphragm with compression of the intestines, right ureter and the presence of ascites with a volume of 1.5 liters. A right-sided hemicolectomy with lymphodissection was performed, and an end-to-end ileotransversoanastmosis was applied. A right adnexectomy, extirpation of the uterus, omentectomy were performed. During the immunohistochemical study, membrane-cytoplasmic expression of cytokeratin (CK) 20 and nuclear expression of CDX2 were revealed. CDX2 is a defining marker for the diagnosis of adenocarcinoma of the gastrointestinal tract, as well as for the differentiation of primary and metastatic ovarian carcinomas. The patient has a lack of expression of receptors for estrogen and CK7 and positive nuclear expression of CDX2, which indicates metastasis of colorectal adenocarcinoma to the ovary. According to the results of the histological examination, which were of decisive importance, the origin of the tumor was determined and, accordingly, the patient’s diagnosis - the tumor of the cecum is G2 adenocarcinoma with germination into the serous membrane, metastases to the right ovary and regional lymphatic nodes 10 out of 10, and areas of tumor growth in the mesentery. Conclusions. In the case of detection of an ovarian neoplasm, the differential diagnosis of primary and secondary tumors is extremely important. Reproductive age at the time of presentation should not interfere with the diagnosis of primary or secondary ovarian malignancy. Metastases of primary colorectal cancer in the ovaries can manifest as pelvic tumors, so preoperative examination of the gastrointestinal tract and removal of the ovarian tumor with immunohistochemical examination is the leading option for choosing an appropriate treatment strategy. Immunohistochemical study of cytokeratin expression markers CK7, CK20 are appropriate for the differential diagnosis of synchronous cancer of the cecum and ovary, and CDX2 protein is a defining marker for the diagnosis of adenocarcinoma of the gastrointestinal tract and for distinguishing between primary and metastatic ovarian carcinomas. Cytoreductive surgery appears to be an important treatment option for metastatic ovarian neoplasia to improve prognosis. A multidisciplinary approach remains key in further examination, determination of the main diagnosis and development of an optimal treatment strategy. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for ","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127272153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Perinatal experience is an important stage in the life of every mother and her child. The childbirth process can be a source of emotional satisfaction and strengthen the bond between the mother and the newborn baby. However, a negative childbirth experience can create feelings of fear towards future deliveries, the need for cesarean section, the risk of developing post-traumatic stress and postpartum depression, as well as problems with breastfeeding. Purposе - to study the level of women’s satisfaction with childbirth in order to improve perinatal care. Materials and methods. A prospective cohort study was conducted involving 321 mothers who completed the satisfaction scale for childbirth and delivery. Descriptive statistics were utilized for data analysis. It was found that the data distribution deviates from the normal distribution. The median value (Me) and the interquartile range (Q I - Q III) were calculated for the dataset. Results. The satisfaction scale helped identify the advantages and disadvantages of the childbirth experience in four key aspects of vaginal delivery. 1. Own capacity: a) Advantages: 76% of women felt strong; 79.3% - felt confident; 67.4% - felt happy. b) Disadvantages: 54% - felt that their childbirth experience matched their plans; 76.2% - felt tired. 2. Professional support: a) Advantages: 86.8% - felt they received sufficient attention and information from their caregivers; 84.8% - felt a comfortable and warm atmosphere; 84.8% - felt their needs were understood; 89.3% - felt they received proper care and assistance; b) Disadvantages: None, as the majority of women felt satisfied with the professional support. 3. Perceived safety: a) Advantages: 86% - felt safe; 89% - had trust in the professional abilities of the healthcare team; 68% - had many positive memories, while 1% had many negative memories; b) Disadvantages: 31% - experienced a low level of anxiety, while 16% - experienced a high level of anxiety. 4. Participation: a) Advantages: 67% - had the opportunity to choose a pain relief method; 60% - had the opportunity to change positions, while 21% did not; 86% - felt they received sufficient attention and information from the medical team; b) Disadvantages: Some women did not have the opportunity to choose a pain relief method (33%) or change positions during childbirth (21%). Conclusions. The study of women’s satisfaction with childbirth indicated the need for improvement in the aspect of «perceived safety». «Own capability», «professional support», and «participation» demonstrate high satisfaction, indicating the quality of perinatal care. The level of satisfaction can become a key indicator of the quality of perinatal care, contributing to the improvement of hospital efficiency assessment and quality of medical services». The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethical Committee of the institution specified in the w
{"title":"Women’s experience during the perinatal period","authors":"D. Govsieiev, A. Romanenko","doi":"10.15574/pp.2023.94.51","DOIUrl":"https://doi.org/10.15574/pp.2023.94.51","url":null,"abstract":"Perinatal experience is an important stage in the life of every mother and her child. The childbirth process can be a source of emotional satisfaction and strengthen the bond between the mother and the newborn baby. However, a negative childbirth experience can create feelings of fear towards future deliveries, the need for cesarean section, the risk of developing post-traumatic stress and postpartum depression, as well as problems with breastfeeding. Purposе - to study the level of women’s satisfaction with childbirth in order to improve perinatal care. Materials and methods. A prospective cohort study was conducted involving 321 mothers who completed the satisfaction scale for childbirth and delivery. Descriptive statistics were utilized for data analysis. It was found that the data distribution deviates from the normal distribution. The median value (Me) and the interquartile range (Q I - Q III) were calculated for the dataset. Results. The satisfaction scale helped identify the advantages and disadvantages of the childbirth experience in four key aspects of vaginal delivery. 1. Own capacity: a) Advantages: 76% of women felt strong; 79.3% - felt confident; 67.4% - felt happy. b) Disadvantages: 54% - felt that their childbirth experience matched their plans; 76.2% - felt tired. 2. Professional support: a) Advantages: 86.8% - felt they received sufficient attention and information from their caregivers; 84.8% - felt a comfortable and warm atmosphere; 84.8% - felt their needs were understood; 89.3% - felt they received proper care and assistance; b) Disadvantages: None, as the majority of women felt satisfied with the professional support. 3. Perceived safety: a) Advantages: 86% - felt safe; 89% - had trust in the professional abilities of the healthcare team; 68% - had many positive memories, while 1% had many negative memories; b) Disadvantages: 31% - experienced a low level of anxiety, while 16% - experienced a high level of anxiety. 4. Participation: a) Advantages: 67% - had the opportunity to choose a pain relief method; 60% - had the opportunity to change positions, while 21% did not; 86% - felt they received sufficient attention and information from the medical team; b) Disadvantages: Some women did not have the opportunity to choose a pain relief method (33%) or change positions during childbirth (21%). Conclusions. The study of women’s satisfaction with childbirth indicated the need for improvement in the aspect of «perceived safety». «Own capability», «professional support», and «participation» demonstrate high satisfaction, indicating the quality of perinatal care. The level of satisfaction can become a key indicator of the quality of perinatal care, contributing to the improvement of hospital efficiency assessment and quality of medical services». The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethical Committee of the institution specified in the w","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125919531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Ismailov, A. Kaminskyi, K. Chaika, T. Kolomiichenko
Purpose - to improve the effectiveness of the treatment of miscarriage due to isthmic-cervical insufficiency (ICI) by using improved management tactics for women at high risk of ICI. Materials and methods. A two-stage innovating tactic for the treatment of miscarriage caused by ICI was proposed, including the prediction of the ineffectiveness of vaginal cerclage and the implementation of transabdominal cerclage in certain groups of patients. Starting from the pregravid stage, 30 women at risk of ICI were examined, which were conducted according to the developed scheme. 2 patients with a history of failed vaginal cerclage had abdominal cerclage prior to pregnancy and had not yet become pregnant at the time of writing. In 28 remaining women, the course and results of pregnancy were monitored. 3 patients after trachelectomy for cervical cancer were given abdominal cerclage in early pregnancy. 23 pregnant women were subjected to vaginal cerclage prophylactically or for sonographic or physical indications, these women constituted the main group for evaluating the effectiveness of the proposed treatment regimen for miscarriage in ICI. The comparison group consisted of 80 women with intravaginal cerclage, who were managed according to the protocols of the Ministry of Health of Ukraine. Results. The effectiveness of the proposed tactics for the treatment of miscarriage caused by ICI reflects the frequency of miscarriage and its structure. No cases of late miscarriages were observed. The rate of preterm birth significantly decreased from 37.5% to 21.7% (p<0.05), while no cases of early preterm birth (before 28 weeks) were observed. In the structure of miscarriage, 80.0% is the proportion of preterm births at 34-36 weeks of gestation (against 35.5%; p<0.05). The frequency of premature rupture of membranes decreased by 4 times (8.7% vs. 36.3%; p<0.05). The frequency of birth of children in a state of asphyxia decreased by more than 2 times (17.4% vs. 43.4%; p<0.05), and there was not a single case of birth in a state of severe asphyxia. The incidence of complications in the early neonatal period decreased by 20% (43.5% vs. 63.2%; p<0.05), mainly due to a decrease in the frequency of such dangerous complications as respiratory distress syndrome (13.0% vs. 31.6%; p<0.05) and disorders of central nervous system (17.4% vs. 44.7%; p<0.05). Conclusions. The use of the proposed tactics for the treatment of miscarriage caused by CI made it possible to significantly reduce the frequency of miscarriage and improve its structure, avoid cases of spontaneous miscarriages and neonatal deaths, improve the condition of newborns, which makes it possible to recommend the introduction of this tactic in the practical work of obstetric and gynecological institutions. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of th
目的:通过改进对高危妇女缺血性宫颈功能不全(ICI)的管理策略，提高治疗ICI流产的有效性。材料和方法。提出了一种治疗ICI所致流产的两阶段创新策略，包括预测阴道环扎术无效，以及在特定患者群体中实施经腹环扎术。从孕前阶段开始，根据制定的方案对30名有ICI风险的妇女进行了检查。2例有阴道环扎失败史的患者妊娠前有腹部环扎，撰写本文时尚未怀孕。对其余28名妇女的妊娠过程和结果进行了监测。3例宫颈癌气管切除术后妊娠早期行腹部环扎术。23名孕妇预防性或出于超声或生理适应症行阴道环扎术，这些妇女构成了评估ICI流产治疗方案有效性的主要群体。对照组由80名阴道内结扎的妇女组成，根据乌克兰卫生部的规程对她们进行管理。结果。所提出的治疗ICI引起的流产的策略的有效性反映了流产的频率及其结构。未观察到晚期流产病例。早产率由37.5%降至21.7% (p<0.05)，未见早期早产(28周前)发生。在流产的结构中，34-36周早产的比例为80.0%(对35.5%;p < 0.05)。胎膜早破的发生率降低了4倍(8.7% vs. 36.3%;p < 0.05)。在窒息状态下出生的孩子的频率下降了2倍以上(17.4%比43.4%;P <0.05)，无一例新生儿处于严重窒息状态。新生儿早期并发症发生率下降20% (43.5% vs. 63.2%;P <0.05)，主要是由于呼吸窘迫综合征等危险并发症的发生率降低(13.0%比31.6%;P <0.05)和中枢神经系统疾病(17.4% vs. 44.7%;p < 0.05)。结论。采用拟议的策略来治疗产后流产，可以大大减少流产的频率并改善其结构，避免自然流产和新生儿死亡的情况，改善新生儿的状况，因此有可能建议在产科和妇科机构的实际工作中采用这一策略。这项研究是按照《赫尔辛基宣言》的原则进行的。研究方案经参与机构当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。
{"title":"Perinatal consequences of innovative tactics for the treatment of recurrent miscarriage in isthmic-cervical insufficiency","authors":"R. Ismailov, A. Kaminskyi, K. Chaika, T. Kolomiichenko","doi":"10.15574/pp.2023.94.42","DOIUrl":"https://doi.org/10.15574/pp.2023.94.42","url":null,"abstract":"Purpose - to improve the effectiveness of the treatment of miscarriage due to isthmic-cervical insufficiency (ICI) by using improved management tactics for women at high risk of ICI. Materials and methods. A two-stage innovating tactic for the treatment of miscarriage caused by ICI was proposed, including the prediction of the ineffectiveness of vaginal cerclage and the implementation of transabdominal cerclage in certain groups of patients. Starting from the pregravid stage, 30 women at risk of ICI were examined, which were conducted according to the developed scheme. 2 patients with a history of failed vaginal cerclage had abdominal cerclage prior to pregnancy and had not yet become pregnant at the time of writing. In 28 remaining women, the course and results of pregnancy were monitored. 3 patients after trachelectomy for cervical cancer were given abdominal cerclage in early pregnancy. 23 pregnant women were subjected to vaginal cerclage prophylactically or for sonographic or physical indications, these women constituted the main group for evaluating the effectiveness of the proposed treatment regimen for miscarriage in ICI. The comparison group consisted of 80 women with intravaginal cerclage, who were managed according to the protocols of the Ministry of Health of Ukraine. Results. The effectiveness of the proposed tactics for the treatment of miscarriage caused by ICI reflects the frequency of miscarriage and its structure. No cases of late miscarriages were observed. The rate of preterm birth significantly decreased from 37.5% to 21.7% (p<0.05), while no cases of early preterm birth (before 28 weeks) were observed. In the structure of miscarriage, 80.0% is the proportion of preterm births at 34-36 weeks of gestation (against 35.5%; p<0.05). The frequency of premature rupture of membranes decreased by 4 times (8.7% vs. 36.3%; p<0.05). The frequency of birth of children in a state of asphyxia decreased by more than 2 times (17.4% vs. 43.4%; p<0.05), and there was not a single case of birth in a state of severe asphyxia. The incidence of complications in the early neonatal period decreased by 20% (43.5% vs. 63.2%; p<0.05), mainly due to a decrease in the frequency of such dangerous complications as respiratory distress syndrome (13.0% vs. 31.6%; p<0.05) and disorders of central nervous system (17.4% vs. 44.7%; p<0.05). Conclusions. The use of the proposed tactics for the treatment of miscarriage caused by CI made it possible to significantly reduce the frequency of miscarriage and improve its structure, avoid cases of spontaneous miscarriages and neonatal deaths, improve the condition of newborns, which makes it possible to recommend the introduction of this tactic in the practical work of obstetric and gynecological institutions. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of th","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126915518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose - to analyze data from scientific sources on the causes, consequences, and current views on the correction and prevention of nasal breathing disorders. The authors have provided and systematized information on the peculiarities of the structure and functioning of the upper respiratory tract in children of various ages. The causes and consequences of nasal breathing disorders have been established. From the standpoint of modern international recommendations, the principles of correction of nasal breathing disorders and expanded views on the possibilities of prevention of diseases of the upper respiratory tract are evaluated. Conclusions. Nasal obstruction in childhood is the most common problem that can lead to negative consequences, and the nasal mucosa in young children needs regular care and hygienic cleaning. The use of the new medical product PSHIK MINI allows for high-quality, effective and safe moisturizing and cleansing of the nasal mucosa of children as a preventive and, if necessary, therapeutic procedure. No conflict of interests was declared by the authors.
{"title":"Disorder of nose breathing in children: causes, consequences, modern views on correction and prevention (literature review)","authors":"O. Koloskova, A. Kosakovskyi","doi":"10.15574/pp.2023.94.121","DOIUrl":"https://doi.org/10.15574/pp.2023.94.121","url":null,"abstract":"Purpose - to analyze data from scientific sources on the causes, consequences, and current views on the correction and prevention of nasal breathing disorders. The authors have provided and systematized information on the peculiarities of the structure and functioning of the upper respiratory tract in children of various ages. The causes and consequences of nasal breathing disorders have been established. From the standpoint of modern international recommendations, the principles of correction of nasal breathing disorders and expanded views on the possibilities of prevention of diseases of the upper respiratory tract are evaluated. Conclusions. Nasal obstruction in childhood is the most common problem that can lead to negative consequences, and the nasal mucosa in young children needs regular care and hygienic cleaning. The use of the new medical product PSHIK MINI allows for high-quality, effective and safe moisturizing and cleansing of the nasal mucosa of children as a preventive and, if necessary, therapeutic procedure. No conflict of interests was declared by the authors.","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126949038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There is currently no consensus on the origin of histiocytic necrotising lymphadenitis (HNL), which is traditionally thought to be a self-limited, benign condition that usually resolves within 6 months. It is important to distinguish HNL as a clinical nosology because it can mimic other diseases such as lymphoma, infectious (mostly viral) and autoimmune diseases, including systemic lupus erythematosus. According to one study, HNL is misdiagnosed as lymphoma in 30% of cases. It has seen a similar clinical case in own practice. Purpose - to highlight the thoroughness of the diagnostic algorithm and differential diagnosis in case of suspected HNL. The article presents a clinical case of HNL in a 9-year-old child, which showed the complexity of clinical diagnosis. This observation combined the characteristic symptoms of the disease (fever, lymphadenopathy, hepatomegaly), haematological markers (leukemia, thrombocytopenia, anemia, accelerated erythrocyte sedimentation rate), as well as rare manifestations. There was a progressive development of edematous syndrome, which was manifested first by peripheral manifestations, and then bilateral pleurisy, ascites, soft tissue edema with the development of anasarca progressively increased. The difficulty in the diagnostic algorithm was that the first two histological examinations suggested the possibility of lymphoma in the child, and later immunohistochemical examination of the lymph node allowed to verify the clinical diagnosis. Obviously, a labour-intensive differential diagnosis in HNL requires the exclusion of the subject range of possible diseases of infectious or autoimmune origin. Conclusions. The diagnosis of HNL in the above observation was characterized by the complexity of the interpretation of clinical, morphological, histological studies, and only the result of immunohistochemical examination allowed to establish the diagnosis. In practice, the paediatrician should be properly aware of this pathology in order to refer the child to a paediatric hematologist in a timely manner. In the presence of a complex of clinical symptoms (prolonged fever, lymphadenopathy, rash, neurological symptoms), the possibility of a diagnosis of HNL should be considered. The study was performed in accordance with the Declaration of Helsinki. The informed consent of the child's parents was obtained for the study. The author declares no conflict of interest.
{"title":"Difficulties in the diagnosis of histiocytic necrotizing lymphadenitis","authors":"N. Banadyha","doi":"10.15574/pp.2023.94.135","DOIUrl":"https://doi.org/10.15574/pp.2023.94.135","url":null,"abstract":"There is currently no consensus on the origin of histiocytic necrotising lymphadenitis (HNL), which is traditionally thought to be a self-limited, benign condition that usually resolves within 6 months. It is important to distinguish HNL as a clinical nosology because it can mimic other diseases such as lymphoma, infectious (mostly viral) and autoimmune diseases, including systemic lupus erythematosus. According to one study, HNL is misdiagnosed as lymphoma in 30% of cases. It has seen a similar clinical case in own practice. Purpose - to highlight the thoroughness of the diagnostic algorithm and differential diagnosis in case of suspected HNL. The article presents a clinical case of HNL in a 9-year-old child, which showed the complexity of clinical diagnosis. This observation combined the characteristic symptoms of the disease (fever, lymphadenopathy, hepatomegaly), haematological markers (leukemia, thrombocytopenia, anemia, accelerated erythrocyte sedimentation rate), as well as rare manifestations. There was a progressive development of edematous syndrome, which was manifested first by peripheral manifestations, and then bilateral pleurisy, ascites, soft tissue edema with the development of anasarca progressively increased. The difficulty in the diagnostic algorithm was that the first two histological examinations suggested the possibility of lymphoma in the child, and later immunohistochemical examination of the lymph node allowed to verify the clinical diagnosis. Obviously, a labour-intensive differential diagnosis in HNL requires the exclusion of the subject range of possible diseases of infectious or autoimmune origin. Conclusions. The diagnosis of HNL in the above observation was characterized by the complexity of the interpretation of clinical, morphological, histological studies, and only the result of immunohistochemical examination allowed to establish the diagnosis. In practice, the paediatrician should be properly aware of this pathology in order to refer the child to a paediatric hematologist in a timely manner. In the presence of a complex of clinical symptoms (prolonged fever, lymphadenopathy, rash, neurological symptoms), the possibility of a diagnosis of HNL should be considered. The study was performed in accordance with the Declaration of Helsinki. The informed consent of the child's parents was obtained for the study. The author declares no conflict of interest.","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127006802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Davydova, O.V. Maryasova, A. Lymanska, О.M. Kravets
Purpose - to evaluate the efficacy and adverse side effects (if any) of intravenous infusion of 1000 mg paracetamol as a method of pain relief in labour during the active phase of labour and in the postoperative period after caesarean section. Materials and methods. 43 pregnant women in the first stage of labor with active labor were studied. The selection criteria were healthy low-risk first-term mothers; aged 18-35 years; with spontaneous onset of labor at 37-40 weeks of pregnancy; the first period of labor with the opening of the cervix by 3-5 cm; one live fruit; main presentation Infulgan inf. solution was chosen as a paracetamol preparation 10 mg/ml per 100 ml. Multimodal anesthesia with a combination of the drugs Infulgan (paracetamol) and Keydex (dexketoprofen) was performed for postoperative analgesia. The pain intensity indicator was determined using the visual analog scale (VAS) - a method of subjective pain assessment. The patient marked a point on a non-graduated ruler 10 cm long, which corresponds to the degree of severity of pain. During the dynamic evaluation of changes in pain intensity, they were considered objective and significant if the true VAS value differed from the previous one by more than 1.3 cm. The comparison group consisted of 20 pregnant women in the 1st stage of labor who did not receive anesthesia at their own request. Also, a study of the effectiveness of complex multimodal anesthesia (Infulgan (paracetamol) and Keydex (dexketoprofen)) was conducted in 5 (11.6%) women in labor after delivery by caesarean section. Results. The use of intravenous paracetamol injection for analgesia during labor is an effective analgesia. There was an initial but significant decrease in the VAS score 30 minutes after Infulgan administration and a statistically significant decrease in pain after 2, 3 and 4 hours compared with the VAS score before treatment. In the group of women who did not undergo analgesia, the intensity of the pain syndrome steadily increased. In the postoperative period, after caesarean section, women underwent combined analgesia with the use of Infulgan (paracetamol) drugs as the basic component of multimodal analgesia and Keydex (dexketoprofen) as a necessary step of multimodal analgesia. The above-mentioned combination of drugs allows for Step-Up analgesia - step-by-step pain therapy. Infulgan was administered in 1 vial (1000 mg) every 6 hours by intravenous injection, and Keydex - in 1 ampoule every 8 hours by intramuscular injection. The addition of Keydex (dexketoprofen) to the analgesia provided an adequate analgesic effect and did not require the administration of opioid analgesics in the postoperative period. Conclusions. Intravenous paracetamol is an effective non-opioid drug for the relief of labor pain without any significant side effects for mother and fetus. The absence of any maternal side effects (sedation, respiratory depression, delayed gastric emptying, nausea and vomiting) or neonatal side effe
{"title":"Peculiarities of pain management in pregnant women and women in labor","authors":"I. Davydova, O.V. Maryasova, A. Lymanska, О.M. Kravets","doi":"10.15574/pp.2023.94.35","DOIUrl":"https://doi.org/10.15574/pp.2023.94.35","url":null,"abstract":"Purpose - to evaluate the efficacy and adverse side effects (if any) of intravenous infusion of 1000 mg paracetamol as a method of pain relief in labour during the active phase of labour and in the postoperative period after caesarean section. Materials and methods. 43 pregnant women in the first stage of labor with active labor were studied. The selection criteria were healthy low-risk first-term mothers; aged 18-35 years; with spontaneous onset of labor at 37-40 weeks of pregnancy; the first period of labor with the opening of the cervix by 3-5 cm; one live fruit; main presentation Infulgan inf. solution was chosen as a paracetamol preparation 10 mg/ml per 100 ml. Multimodal anesthesia with a combination of the drugs Infulgan (paracetamol) and Keydex (dexketoprofen) was performed for postoperative analgesia. The pain intensity indicator was determined using the visual analog scale (VAS) - a method of subjective pain assessment. The patient marked a point on a non-graduated ruler 10 cm long, which corresponds to the degree of severity of pain. During the dynamic evaluation of changes in pain intensity, they were considered objective and significant if the true VAS value differed from the previous one by more than 1.3 cm. The comparison group consisted of 20 pregnant women in the 1st stage of labor who did not receive anesthesia at their own request. Also, a study of the effectiveness of complex multimodal anesthesia (Infulgan (paracetamol) and Keydex (dexketoprofen)) was conducted in 5 (11.6%) women in labor after delivery by caesarean section. Results. The use of intravenous paracetamol injection for analgesia during labor is an effective analgesia. There was an initial but significant decrease in the VAS score 30 minutes after Infulgan administration and a statistically significant decrease in pain after 2, 3 and 4 hours compared with the VAS score before treatment. In the group of women who did not undergo analgesia, the intensity of the pain syndrome steadily increased. In the postoperative period, after caesarean section, women underwent combined analgesia with the use of Infulgan (paracetamol) drugs as the basic component of multimodal analgesia and Keydex (dexketoprofen) as a necessary step of multimodal analgesia. The above-mentioned combination of drugs allows for Step-Up analgesia - step-by-step pain therapy. Infulgan was administered in 1 vial (1000 mg) every 6 hours by intravenous injection, and Keydex - in 1 ampoule every 8 hours by intramuscular injection. The addition of Keydex (dexketoprofen) to the analgesia provided an adequate analgesic effect and did not require the administration of opioid analgesics in the postoperative period. Conclusions. Intravenous paracetamol is an effective non-opioid drug for the relief of labor pain without any significant side effects for mother and fetus. The absence of any maternal side effects (sedation, respiratory depression, delayed gastric emptying, nausea and vomiting) or neonatal side effe","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116524130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose - to determine the dynamics of endothelial progenitor cells (EPCs) and asymmetric dimethylarginine (ADMA) in pregnant women with hypertension as markers of the effectiveness of endothelial dysfunction correction on the background of L-arginine therapy (Tivortin, manufactured by Yuria-Pharm). Materials and methods. The study pregnant women were divided into two groups: women with hypertension at 12-15 weeks of gestation (n=29) and women with congenital heart disease at 12-14 weeks of gestation (n=21). The control group consisted of 40 healthy pregnant women. The examination was conducted before the start of oral L-arginine (Tivortin aspartate) and 7-8 weeks after the start of therapy. Tivortin aspartate was administered orally 1 measuring spoon 5 times a day for 6 weeks. The study of the level of EPCs (CD45+/CD34+ phenotype of peripheral blood) was performed by flow cytometry using reagents for the determination of CD34, CD45 differentiation clusters produced by Beckman Coulter Inc. The results are presented in % of ERC from the total number of leukocytes, as well as in absolute values - the number of cells per 1 ml of blood in absolute values. The level of ADMA in plasma was determined by an indirect enzyme-linked immunosorbent assay using the ADMA ELISA test system (manufactured by Immunodiagnostik AG, Germany). The reference values for pregnant women are 0.26-0.60 μmol/l. Results. After treatment with L-arginine (Tivortin), the ADMA index decreased compared to baseline data in the studied groups of pregnant women. Thus, in pregnant women with hypertension, ADMA decreased by almost 15%, which is a marker of improved endothelial function. The same dynamics was observed in the group of women with congenital heart disease. In both study groups of pregnant women, the number of EPCs increased by almost 10% after the addition of L-arginine (Tivortin) to the treatment complex. There was a positive correlation between a decrease in mean systolic blood pressure, an increase in EPCs and a decrease in ADMA after complex treatment. Studies have shown a direct correlation (r=0.75) between blood pressure and the number of ЕРСs and an inverse correlation (r=-0.68) between blood pressure and ADMA. The reduction in blood pressure during treatment was accompanied by an improvement in endothelial function, namely, an increase in the number of ЕРСs, mainly due to the vasodilation potential of the endothelium. There was also a decrease in ADMA against the background of a decrease in systolic blood pressure during treatment. Conclusions. The clinical relevance of asymmetric dimethylarginine as a specific marker in patients with hypertension has been established: a significant increase in its level is observed in patients with cardiovascular disease, in particular, with hypertension, which confirms the role of endothelial dysfunction as a leading pathogenetic factor in the development of hypertension in the absence of anatomical and pathological changes in the
{"title":"Correction of the function of the endothelium is a new goal of prevention and treatment of arterial hypertension in patients with cardiovascular pathology","authors":"I. Davydova, A. Lymanska","doi":"10.15574/pp.2023.94.7","DOIUrl":"https://doi.org/10.15574/pp.2023.94.7","url":null,"abstract":"Purpose - to determine the dynamics of endothelial progenitor cells (EPCs) and asymmetric dimethylarginine (ADMA) in pregnant women with hypertension as markers of the effectiveness of endothelial dysfunction correction on the background of L-arginine therapy (Tivortin, manufactured by Yuria-Pharm). Materials and methods. The study pregnant women were divided into two groups: women with hypertension at 12-15 weeks of gestation (n=29) and women with congenital heart disease at 12-14 weeks of gestation (n=21). The control group consisted of 40 healthy pregnant women. The examination was conducted before the start of oral L-arginine (Tivortin aspartate) and 7-8 weeks after the start of therapy. Tivortin aspartate was administered orally 1 measuring spoon 5 times a day for 6 weeks. The study of the level of EPCs (CD45+/CD34+ phenotype of peripheral blood) was performed by flow cytometry using reagents for the determination of CD34, CD45 differentiation clusters produced by Beckman Coulter Inc. The results are presented in % of ERC from the total number of leukocytes, as well as in absolute values - the number of cells per 1 ml of blood in absolute values. The level of ADMA in plasma was determined by an indirect enzyme-linked immunosorbent assay using the ADMA ELISA test system (manufactured by Immunodiagnostik AG, Germany). The reference values for pregnant women are 0.26-0.60 μmol/l. Results. After treatment with L-arginine (Tivortin), the ADMA index decreased compared to baseline data in the studied groups of pregnant women. Thus, in pregnant women with hypertension, ADMA decreased by almost 15%, which is a marker of improved endothelial function. The same dynamics was observed in the group of women with congenital heart disease. In both study groups of pregnant women, the number of EPCs increased by almost 10% after the addition of L-arginine (Tivortin) to the treatment complex. There was a positive correlation between a decrease in mean systolic blood pressure, an increase in EPCs and a decrease in ADMA after complex treatment. Studies have shown a direct correlation (r=0.75) between blood pressure and the number of ЕРСs and an inverse correlation (r=-0.68) between blood pressure and ADMA. The reduction in blood pressure during treatment was accompanied by an improvement in endothelial function, namely, an increase in the number of ЕРСs, mainly due to the vasodilation potential of the endothelium. There was also a decrease in ADMA against the background of a decrease in systolic blood pressure during treatment. Conclusions. The clinical relevance of asymmetric dimethylarginine as a specific marker in patients with hypertension has been established: a significant increase in its level is observed in patients with cardiovascular disease, in particular, with hypertension, which confirms the role of endothelial dysfunction as a leading pathogenetic factor in the development of hypertension in the absence of anatomical and pathological changes in the","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134266072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bronchopulmonary dysplasia (BPD) is one of the most frequent outcomes of prematurity. Relatively late diagnosis and development of formidable complications that can affect the quality of life in adulthood, determine the need for early BPD prognosis for the timely appointment of effective therapy. Purpose - identification of informatively significant clinical and anamnestic risk factors of BPD based on retrospective analysis and mathematical model creation for the prediction of chronic respiratory disease risk development in prematurely born children. Materials and methods. A retrospective analysis of the medical histories of 280 prematurely born children who were treated in neonatal units was conducted. With the help of sequential Wald analysis, 53 clinical and anamnestic indicators were analyzed, for each of them the relative risk (RR) and diagnostic coefficient (DC) were calculated. Results. Significant, prognostically unfavorable factors for BPD development are gestational age ≤28 weeks (RR=20.30); birthweight ≤1500 g (RR=3.08); duration of non-invasive combined respiratory support over 18 days (RR=3.74); Apgar score 1-3 at the first minute (RR=4.69) and 4-6 at the fifth minute of life (RR=4.19); newborn anemia (RR=3.12); invasive artificial lung ventilation for more than 13 days (RR=5.12). The probability of BPD increases substantially with the presence of retinopathy of the II and III degrees (RR=16.4 and RR=10.15, respectively). Interestingly, breastfeeding markedly prevented BPD development (RR=0.29). Furthermore, a mathematical model is represented to determine BLD development prediction and to diagnose this disease. Conclusions. High validity indicators and ease of use of the mathematical model for the BPD development prediction in prematurely born children make it possible to recommend it in the practice of neonatologists and pediatricians. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.
支气管肺发育不良(BPD)是早产最常见的结果之一。相对较晚的诊断和可影响成年期生活质量的可怕并发症的发展，决定了早期BPD预后需要及时预约有效的治疗。目的:通过回顾性分析和建立数学模型，识别具有重要信息意义的BPD临床和记忆危险因素，用于预测早产儿慢性呼吸系统疾病的风险发展。材料和方法。回顾性分析了280例早产儿在新生儿病房接受治疗的病史。采用序贯Wald分析，对53项临床及记忆指标进行分析，计算各指标的相对危险度(relative risk, RR)和诊断系数(diagnostic coefficient, DC)。结果。妊娠期≤28周(RR=20.30)是影响BPD预后的重要不利因素;出生体重≤1500 g (RR=3.08);无创联合呼吸支持持续时间超过18天(RR=3.74);第1分钟Apgar评分1-3分(RR=4.69)，第5分钟Apgar评分4-6分(RR=4.19);新生儿贫血(RR=3.12);有创人工肺通气超过13天(RR=5.12)。伴有II级和III级视网膜病变，BPD的发生概率显著增加(RR=16.4, RR=10.15)。有趣的是，母乳喂养明显阻止BPD的发展(RR=0.29)。此外，还建立了预测BLD发展和诊断该病的数学模型。结论。该数学模型在预测早产儿BPD发展方面具有较高的效度指标和易于使用的特点，可在新生儿和儿科医生的实践中推荐使用。这项研究是按照《赫尔辛基宣言》的原则进行的。研究方案经参与机构当地伦理委员会批准。获得患者的知情同意进行研究。作者未声明存在利益冲突。
{"title":"Bronchopulmonary dysplasia risk prediction in prematurely born children","authors":"A. Tovarnytska","doi":"10.15574/pp.2023.94.91","DOIUrl":"https://doi.org/10.15574/pp.2023.94.91","url":null,"abstract":"Bronchopulmonary dysplasia (BPD) is one of the most frequent outcomes of prematurity. Relatively late diagnosis and development of formidable complications that can affect the quality of life in adulthood, determine the need for early BPD prognosis for the timely appointment of effective therapy. Purpose - identification of informatively significant clinical and anamnestic risk factors of BPD based on retrospective analysis and mathematical model creation for the prediction of chronic respiratory disease risk development in prematurely born children. Materials and methods. A retrospective analysis of the medical histories of 280 prematurely born children who were treated in neonatal units was conducted. With the help of sequential Wald analysis, 53 clinical and anamnestic indicators were analyzed, for each of them the relative risk (RR) and diagnostic coefficient (DC) were calculated. Results. Significant, prognostically unfavorable factors for BPD development are gestational age ≤28 weeks (RR=20.30); birthweight ≤1500 g (RR=3.08); duration of non-invasive combined respiratory support over 18 days (RR=3.74); Apgar score 1-3 at the first minute (RR=4.69) and 4-6 at the fifth minute of life (RR=4.19); newborn anemia (RR=3.12); invasive artificial lung ventilation for more than 13 days (RR=5.12). The probability of BPD increases substantially with the presence of retinopathy of the II and III degrees (RR=16.4 and RR=10.15, respectively). Interestingly, breastfeeding markedly prevented BPD development (RR=0.29). Furthermore, a mathematical model is represented to determine BLD development prediction and to diagnose this disease. Conclusions. High validity indicators and ease of use of the mathematical model for the BPD development prediction in prematurely born children make it possible to recommend it in the practice of neonatologists and pediatricians. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129151562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The frequency of the development of adhesion disease after surgical interventions on the abdominal cavity is 63-93%. In women who have complications, in the form of confirmed adhesion disease, there is infertility and miscarriage, menstrual cycle disorders in 60% of cases. It should be noted that among women with adhesions, 8.02% had ectopic pregnancies. In addition, every fifth woman with adhesions in the abdominal cavity has endometriosis - 3.08% of cases. Postoperative complications in patients operated on for acute appendicitis are 4-15%, and the mortality rate of acute appendicitis is 0.1-10%. Purpose - to analyze the level of postoperative complications in girls operated on for acute surgical pathology of the pelvic organs by laparoscopic or laparotomy methods. Materials and methods. An analysis of the treatment of 297 girls who were undergoing inpatient treatment for surgical pathology of the pelvic organs at the Pediatric Surgery Clinic of National Pirogov Memorial Medical University, Vinnytsia, Ukraine on the basis of the Vinnytsia Regional Pediatric Clinical Hospital of the Vinnytsia Regional Council during 2018-2022. Results. In children who underwent laparoscopic appendectomy, the rate of postoperative complications was 8 times lower compared to open methods. The use of laparoscopic technologies in the treatment of gynecological pathology in girls, in particular, in teenagers, allowed to reduce the number of postoperative complications by 5 times. Conclusions. In general, it should be recommended, according to indications, to introduce into clinical practice laparoscopic methods of diagnosis and treatment of surgical pathology of the abdominal cavity and pelvic cavity. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.
{"title":"Level of postoperative complications in surgical pathology of the abdominal cavity and pelvic cavity in girls","authors":"V. Konoplitsky, S. Klymenko, Y. Korobko","doi":"10.15574/pp.2023.94.57","DOIUrl":"https://doi.org/10.15574/pp.2023.94.57","url":null,"abstract":"The frequency of the development of adhesion disease after surgical interventions on the abdominal cavity is 63-93%. In women who have complications, in the form of confirmed adhesion disease, there is infertility and miscarriage, menstrual cycle disorders in 60% of cases. It should be noted that among women with adhesions, 8.02% had ectopic pregnancies. In addition, every fifth woman with adhesions in the abdominal cavity has endometriosis - 3.08% of cases. Postoperative complications in patients operated on for acute appendicitis are 4-15%, and the mortality rate of acute appendicitis is 0.1-10%. Purpose - to analyze the level of postoperative complications in girls operated on for acute surgical pathology of the pelvic organs by laparoscopic or laparotomy methods. Materials and methods. An analysis of the treatment of 297 girls who were undergoing inpatient treatment for surgical pathology of the pelvic organs at the Pediatric Surgery Clinic of National Pirogov Memorial Medical University, Vinnytsia, Ukraine on the basis of the Vinnytsia Regional Pediatric Clinical Hospital of the Vinnytsia Regional Council during 2018-2022. Results. In children who underwent laparoscopic appendectomy, the rate of postoperative complications was 8 times lower compared to open methods. The use of laparoscopic technologies in the treatment of gynecological pathology in girls, in particular, in teenagers, allowed to reduce the number of postoperative complications by 5 times. Conclusions. In general, it should be recommended, according to indications, to introduce into clinical practice laparoscopic methods of diagnosis and treatment of surgical pathology of the abdominal cavity and pelvic cavity. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123885817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose - to evaluate the effectiveness of weight loss after bariatric surgery (BS) in women with morbid obesity (MO) on the recovery of menstruation and the realization of reproductive functions. Materials and methods. Changes in menstrual and reproductive functions were analyzed in 51 women with MO and accompanying metabolic syndrome (MS), aged 22 to 55 years, who underwent BV. Women with a higher body mass (BMI) underwent biliopancreatic bypass (BPS) in the Hess-Marceau modification (I clinical group - 21 women), patients with a lower body mass index (BMI) - longitudinal gastric resection (LGR) - II clinical group (30 patients). The duration of observation in the postoperative period ranged from 3 to 7 years. The BMI of women ranged from 29.2 kg/m2 to 62.1 kg/m2 and averaged 44.0±1.0 kg/m2. The experience of obesity varied from 5 to 21 years. Results. Menstrual cycle disorders (MC) were observed in 100% of cases. 16 out of 24 (66.7%) women under the age of 40 had reproductive plans (RP) in the postoperative period. In 18 (75.0%) of them, we were talking about chronic anovulatory cycles. Endometrial and myometrial pathology was noted in 14 (27.5%) women. Analysis of the dynamics of MO indicators during the first 3 years after BS showed general trends towards a probable (p<0.001) decrease in BM and BMI indicators in patients of all clinical groups already after 3 months from the start of treatment. Regular MC in women under 40 years of age was restored within 1.5 years against the background of a decrease in MT without medical intervention. Spontaneous pregnancy occurred in 7 (43.8%) women with RP 3 years after BS and in 5 (31.3%) - with the help of assisted reproductive technologies. Conclusions. An intense decrease in body weight and, accordingly, BMI, is observed within 12 months after operative treatment using the combined BPS method and in the period of 3-6 months in patients after PRS. Achieving statistical comparability of BMI indicators in both groups (p>0.05) occurs already after 6 months. Stabilization of average BMI indicators in subsequent years occurs in the range (95% CI) of 25.7 - 32.1 kg/m2, regardless of the method of surgical intervention. Weight loss improved reproductive potential in women with MS by 42%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
{"title":"Analysis of the effectiveness of bariatric interventions in women with morbid obesity on the restoration of their menstrual and reproductive function","authors":"R. Duka, Y. Bereznitsky, Y. Duka","doi":"10.15574/pp.2023.94.13","DOIUrl":"https://doi.org/10.15574/pp.2023.94.13","url":null,"abstract":"Purpose - to evaluate the effectiveness of weight loss after bariatric surgery (BS) in women with morbid obesity (MO) on the recovery of menstruation and the realization of reproductive functions. Materials and methods. Changes in menstrual and reproductive functions were analyzed in 51 women with MO and accompanying metabolic syndrome (MS), aged 22 to 55 years, who underwent BV. Women with a higher body mass (BMI) underwent biliopancreatic bypass (BPS) in the Hess-Marceau modification (I clinical group - 21 women), patients with a lower body mass index (BMI) - longitudinal gastric resection (LGR) - II clinical group (30 patients). The duration of observation in the postoperative period ranged from 3 to 7 years. The BMI of women ranged from 29.2 kg/m2 to 62.1 kg/m2 and averaged 44.0±1.0 kg/m2. The experience of obesity varied from 5 to 21 years. Results. Menstrual cycle disorders (MC) were observed in 100% of cases. 16 out of 24 (66.7%) women under the age of 40 had reproductive plans (RP) in the postoperative period. In 18 (75.0%) of them, we were talking about chronic anovulatory cycles. Endometrial and myometrial pathology was noted in 14 (27.5%) women. Analysis of the dynamics of MO indicators during the first 3 years after BS showed general trends towards a probable (p<0.001) decrease in BM and BMI indicators in patients of all clinical groups already after 3 months from the start of treatment. Regular MC in women under 40 years of age was restored within 1.5 years against the background of a decrease in MT without medical intervention. Spontaneous pregnancy occurred in 7 (43.8%) women with RP 3 years after BS and in 5 (31.3%) - with the help of assisted reproductive technologies. Conclusions. An intense decrease in body weight and, accordingly, BMI, is observed within 12 months after operative treatment using the combined BPS method and in the period of 3-6 months in patients after PRS. Achieving statistical comparability of BMI indicators in both groups (p>0.05) occurs already after 6 months. Stabilization of average BMI indicators in subsequent years occurs in the range (95% CI) of 25.7 - 32.1 kg/m2, regardless of the method of surgical intervention. Weight loss improved reproductive potential in women with MS by 42%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.","PeriodicalId":330226,"journal":{"name":"UKRAINIAN JOURNAL OF PERINATOLOGY AND PEDIATRICS","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130087371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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