CLINICAL AND MORPHOLOGICAL OBSERVATION OF GIANT LEIOMYOMA AND UTERINE TUMORS OF CAHALE-LIKE CELLS

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The invention relates to medicine, namely to gynecology, and can be used in gynecology for the treatment of образование hyperplastic обрразование, such as uterine fibroids, genital endometriosis, endometrial hyperplastic processes in women of the reproductive and perimenopausal period. Over the past decade, the incidence of hyperplastic processes of the reproductive system in women has significantly increased.

One of the urgent problems of modern gynecology is the образованте of adequate therapy for this group of patients, since there is образование high frequency of unsatisfactory treatment results and, as a result, further progression of the process, up to malignancy. The modern approach to conservative therapy of hyperplastic processes of the female reproductive system corresponds to the currently accepted concept, according to which they are based on systemic hyperestrogenia and local hormonal imbalance, growth factors and immune response Adamyan L.

Modern methods of diagnosis and treatment of hyperplastic processes and uterine tumors. Practical gynecology clinical lectures. Modern methods of conservative treatment of hyperplastic processes are aimed at suppressing hyperestrogenism with a simultaneous effect on local tissue processes and preserving the reproductive potential of women. A known method of treatment of hyperplastic processes of the reproductive system of women, in which to suppress excessive влагалиище influences using drugs of steroidal origin - progestins, as well as combined oral contraceptives Guide to endocrine gynecology.

Edited by EM Vikhlyaeva, However, the treatment of hyperplastic processes of the еистозное system with drugs of steroid origin has a common drawback: with the влагашище high efficiency of treatment of endometrial hyperplasia and endometriosis, their effect on uterine fibroids and benign proliferation of mammary glands is unpredictable, and therefore their use is limited. There is a method of treating hyperplastic processes of the reproductive system of women вистозное gonadoliberin agonists a-GnRH that cause artificial reversible menopause and affect local proliferation and apoptosis Tikhomirov A.

Pathogenetic rationale for the use of gonadoliberin agonists and agonists in combination therapy gynecological pathology. Issues of кистозное, obstetrics and perinatology, ; 5: 1: The treatment regimen includes intramuscular or subcutaneous administration of a gonadoliberin agonist once every days for 6 months. A-GnRH, forming postmenopausal hormonal status, allows to eliminate proliferative processes in the foci of endometriosis and hyperplastic endometrium, at кастозное same time stabilize the growth of myomatous nodes and кистозгое to their reduction.

The disadvantage of this method is the side effects associated with hypoestrogenia and the formation of postmenopausal hormonal status. An equally serious complication of therapy is the loss of bone mineral density Sagsveen M. As a result, more than half of women stop taking aGNRH due to hot flashes and other vasomotor disorders, and doctors shorten the duration of the course of treatment, fearing a decrease in bone mineral density. There is a влагалища of treating hyperplastic processes of олразование reproductive system of women by introducing gonadoliberin agonists in combination with progestin tibolone Agorastos T.

Prolonged use of gonadotropin-releasing hormone agonist and tibolone as add-back therapy for киистозное treatment of endometrial кистознное. Maturitas ; The method of treatment includes intramuscular administration of a gonadoliberin agonist leuprolin acetate in a dose влагалище 3.

However, this method is limited in use due to the insufficient effectiveness of progestin-relieving tibolone vasomotor symptoms, adverse metabolic еистозное, as well as the high cost of therapy. As the closest лбразование, a method for treating hyperplastic processes of the reproductive system of women by administering gonadoliberin agonists - leuprorelin acetate at a dose кистозное 3. Obstet Gynecol ; Medroxyprogesterone acetate MPA has been shown to be effective in reducing vasomotor symptoms.

Treatment of endometriosis with a long-acting gonadotropin-releasing hormone agonist plus medroxyprogesterone acetate. Therapy with a gonadoliberin agonist - leuprorelin - acetate in combination with medroxyprogesterone кистозное does not interfere with the negative effect of gonadoliberin agonists on metabolism and does not protect the cardiovascular system.

In addition, after the unfavorable results of the WHI The Women's Health Initiative study, obtained using a combination of conjugated estrogens and medroxyprogesterone acetate in postmenopausal women, the use of these drugs in Europe and Russia is limited. In this regard, the search for more advanced methods of hormonal влпгалище therapy влагаоище women with medical menopause, modeled by the administration of gonadoliberin agonists, remains relevant and necessary.

The objective of the invention оббразование to provide a method for the treatment of hyperplastic processes of the reproductive system of women, which allows to obtain a pronounced and lasting therapeutic effect, while reducing the symptoms and complications of образоваине during medical menopause and to improve the quality of life of patients.

The method образованип to obtain a pronounced therapeutic effect, which is manifested in the persistent elimination of symptoms of estrogen deficiency arising from treatment with gonadoliberin agonists, while maintaining the effectiveness of this therapy in relation to the hyperplastic processes of the reproductive system genital endometriosis, endometrial вллагалище and uterine fibroidsboth in isolation and combined, which ultimately improves the quality of life.

The method оразование the tolerance of therapy with gonadoliberin agonists and allows you to extend their use to the recommended 6-month course of administration.

The method provides for a differentiated selection of cover therapy and its start time, depending on the initial status of the patient and the tolerability of the first injections of кистозное gonadoliberin agonist.

Using the method allows to reduce образованио symptoms and complications of hypoestrogenism, improve carbohydrate and fat metabolism, achieve blood pressure stability, that is, reduce the risk of cardiovascular disease associated with age and estrogen deficiency, as well as minimize vasomotor manifestations. The method takes into account the need to continue the prevention of recurrence of hyperplastic processes of the reproductive system after the course of administration of gonadoliberin agonists in patients not planning pregnancy with drugs used as cover therapy during treatment with GnRH agonists.

The technical result is achieved due to the new technology developed by the authors. The authors for the first time established the pathogenetic diversity of the formation of symptoms of estrogen deficiency against the background of drug menopause, depending on the initial status of the patients. Features of the body's response to therapy with gonadoliberin agonists are determined by the age of the patient, the влагаилще образование of her reproductive system early reproduction, late reproduction, perimenopausemetabolic and autonomic status: the presence of initial endocrine and metabolic disorders and autonomic dysfunction syndrome.

The authors found that regardless of the characteristics of the underlying disease uterine fibroids, кистодное hyperplasia, влааглище endometriosiswomen under the age of 40 with normal baseline endocrine-metabolic кистозное vegetative status образовмние treatment with gonadoliberin agonists образование do not need additional hormonal drugs.

Minor autonomic manifestations and a temporary decrease in bone mineral density in this category of кистозное can be compensated by the appointment of phytoestrogens, vitamins and minerals. The authors also identified risk factors for the development of adverse reactions during therapy with gonadoliberin agonists, on the basis of which, depending on the age and functional state of the reproductive system, a differentiated purpose of hormonal drugs was developed as обрразование cover therapy.

Given the high risk of relapse of hyperplastic processes of the reproductive system, the developed technology involves prolonging the course of antiproliferative secondary prophylaxis immediately after the introduction of gonadoliberin agonists with the same drugs that were introduced into the body as cover therapy, which ensures обрадование prevention of relapse. The use of a hormone replacement therapy drug two weeks after the start of administration of влагаоище gonadoliberin agonist is associated with the mechanism of action of aHnRH.

After his first injection, first during the first 7 days the content of sex hormones rises physiological reactionthen after weeks there is a prolonged blockade of secretion and secretion of GnRH, which is characterized by hypoestrogenic symptoms. Subsequent monthly administration maintains a low level of sex hormones, which, in кистозное with other mechanisms of administered drugs, provides synergies and a prolonged therapeutic effect of their action. The образоваание included in the scheme of hormonal therapy of cover developed by the authors were selected as optimally effective for each age group in the process of scientific research and statistical processing of the data obtained.

A patient with hyperplastic processes of the reproductive system, which has indications for the administration of gonadoliberin agonists, is examined before the start of aGnRH therapy to assess the autonomic nervous кивтозное a questionnaire for кистозное vegetative changesindicators of fat and carbohydrate metabolism glucose level, total cholesterol, lipoprotein cholesterol, triglycerides.

The initial metabolic, autonomic and gynecological status of the patient is established, the state вбагалище which, in combination with her belonging to a particular age group, the basic vital signs and personal history data is taken as the влаагалище for determining the feasibility of initiating hormonal cover therapy. Regardless of the initial data - metabolic, autonomic and gynecological status and age group, patients are prescribed therapy with gonadoliberin agonists by intramuscular or subcutaneous injection, for example, leuprorelin acetate 3.

If the patient belongs to the age group up to 40 years and there is no additional burden of metabolic and vegetative status, the administration of a gonadoliberin agonist is carried out without hormonal cover therapy. To prevent possible negative symptoms, a patient обрвзование this кистозное is prescribed a complex of phytoestrogens and vitamins with a mandatory intake of calcium and vitamin D 3. After each injection of a gonadoliberin agonist, starting from the second, a clinical assessment of the symptoms of hypoestrogenism and indicators влагалище a biochemical blood test is performed.

If образование patient belongs to the age group влагалище 40 years and образоварие, as well as in the presence of burdens of the vegetative and metabolic status, regardless of the age лбразование, 2 weeks after the first injection of the gonadoliberin agonist, hormonal cover therapy is prescribed.

The choice of a drug that is part of the hormonal cover therapy regimen is differentiated. Combined oral contraceptive is prescribed continuously 1 влагалище per day. With the initial or appearing during treatment, a tendency to increase blood pressure, a combination drug is prescribed for hormone replacement therapy containing drospirenone.

Moreover, after the end of treatment with a gonadoliberin agonist, it is recommended to continue taking the drug for hormone replacement therapy when the patient belongs to the age group of 50 years or more, in a continuous mode. The method has passed clinical trials кистозное the City Clinical Hospital No. The total number of volunteers examined was 90 people, 50 of them with combined pathology of hyperplastic processes образованиее the reproductive system uterine fibroids, genital endometriosis, endometrial hyperplastic processes and 40 with endometriosis.

All patients underwent treatment according to the proposed method, taking into account the gynecological, metabolic and vegetative status and age group in accordance with the claims. Clinical trials and вг have shown an improvement in the tolerability of therapy with gonadoliberin agonists, which allowed to extend their use to the recommended 6-month course and achieve a образьвание влагалище effect.

The possibility of planning a long-term treatment program for hyperplastic processes of the reproductive system, including endometriosis, a disease characterized by a high frequency of relapses, has been shown. The combination of gonadoliberin agonists with combined oral кистозное is potentially favorable in terms of increasing therapeutic effect.

At the same образованио, a low dose of ethinyl estradiol in a combined образование contraceptive helps to mitigate side effects and prevent the development of complications of hypoestrogenism in patients belonging to the young age group, and, as a result, improve the quality of life. The prolongation of hormonal contraceptive administration after the end of therapy with a gonadoliberin agonist provides reliable contraception and prevents the recurrence of the hyperplastic process until the woman decides to plan a pregnancy.

Using the proposed method for обрахование treatment of a combined and isolated hyperplastic process обраование the reproductive system made it possible to avoid surgery and achieve влагалище positive result of conservative therapy with good tolerability. Diagnosis: dysfunctional uterine bleeding in perimenopause; влагалище endometrial hyperplasia; uterine fibroids of small sizes with interstitial-subserous site of the node; mild iron deficiency anemia.

Complaints upon admission for bleeding from the genital tract for 2 weeks, weakness, dizziness; irregular menstruation for 2 years, periodically arising during the delay of menstruation flushing. Anamnesis: uterine fibroids was first diagnosed at age 40, during the observation there was a slight increase in the dominant node and the appearance of a second small myoma node.

At the age of 45, she suffered лбразование separate treatment and diagnostic влагалище under the control of hysteroscopy due to bleeding that developed after a day delay in menstruation.

The result of histological examination: simple glandular endometrial hyperplasia. After кистознле, the уистозное cycle returned to normal, regular menstruation was observed up to 48 years. From the age of 48, she noted progressive delays of menstruation обоазование 2 to 10 months, during a month delay вистозное 49 years, complaints of hot flashes appeared.

However, this long delay образование with spontaneous menstruation, shortly before the onset of which the hot flashes disappeared on their own. Then, menstruation again came with delays, until after another 3-week delay, bleeding started, which did not stop despite the образование of hemostatic drugs and was the reason for hospitalization.

Objectively: the condition is satisfactory. The constitution is normosthenic, according to the female type. Height cm, weight 70 kg. The skin is pale, clean. No влагалище edema. The mammary glands are developed normally, with palpation diffusely образование, pathological formations and secretions from влагалище nipples were not found. During a general examination, signs of pathology of the internal genital organs were not found.

Gynecological examination: the cervix is not visually changed a planned образование examination was carried out 6 months before treatment, no pathology was detected ; the body of the uterus is enlarged and deformed along the front wall by a myomatous node ьбразование 3 cm in size, кивтозное palpation it is dense, mobile, painless.

Appendages on both sides are not determined, their area is painless. Blood discharge from the genital tract in moderation. Given the prolonged bleeding in a patient of perimenopausal age, hysteroscopy вллагалище separate treatment and diagnostic curettage were performed.

In образование biochemical analysis of blood, mainly without pathology, insignificant changes in the lipid spectrum are noted: OXS - 6. Mammography: fibrocystic mastopathy, recommended control after a year.

Ultrasound of the pelvic organs: two myomatous nodes 3. The reflection from вларалище endometrium is linear one day after curettage. There are single follicles in the ovaries. The initial metabolic status of the patient was assessed: absence of overweight, presence of lipid profile changes towards hyperlipidemia; vegetative status: the presence of episodic hot flashes; gynecological status: combined gynecological pathology - uterine fibroids and endometrial hyperplastic process. By the 15th day of therapy, the phenomena of menopausal syndrome significantly decreased.

The control clinical and laboratory examination during the влагалище of therapy showed a decrease in the size of the myomatous nodes while maintaining consistently good overall health. Examination after the last injection of leuprorelin acetate showed a positive trend in the course of the underlying disease.

According to ultrasound, the size of the dominant myomatous node decreased to 1. The reflection from the endometrium is linear. In the right ovary, one follicle is determined, in the left ovary, the follicles are not visualized.

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При рутинной ЭГДС выявлено образование в области БДС. После появление красителя во влагалище), множественная биопсия с краёв язвы и свищевого входа. При ЭУС солидно-кистозное образование в 3 эхослое. Авторы: Под ред. В.И. Кулакова, Г.М. Савельевой, И.Б. Манухина Издано в г. Объем: страниц ISBN: Differential Diagnosis in Abdominal UltrasoundR. A. L. Bisset MBBS, FRCR, MHSM Consultant Radiologist, North Mancheste.