[Reproductive function in cancer patients. How to preserve the ability to have children].
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Biomedical subjects
Publications and source records attributed to L V Adamian.
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One-stage combined surgery in a female patient with total extrophy of the urinary bladder after uretherosigmostomy was performed for the first time with participation of surgeons, gynecologists and urologists. Corrective surgeries in these patients must be performed for the purpose of creation of isolated urinary reservoir for prophylaxis of pyelonephritis and chronic renal insufficiency. Correction of symphysis defect was carried out with polypropylene endograft. This surgery was performed to provide quality of life and reproductive function of the patient.
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In a group of patients with endometriosis and in a control group of healthy women, the polymorphism of the following systems were studied: ABO and RH blood-group systems; serum proteins haptoglobin (HP), transferrin (TF), vitamin D-transporting protein (GC), protease inhibitor (PI), and the third component of the complement (C3); serum enzymes-amylase of the loci 1 and 2 (AMY1 and AMY2), pseudocholinesterase (E2), and alkaline phosphatase (PP); erythrocytic enzymes-acid phosphatase (ACP1), phosphoglucomutase (PGM1), superoxide dismutase (SOD-A), esterase D (ESD), and glyoxalase (GLO1). Statistically significant differences between the groups compared were established for five genetic systems: ABO, E2, C3, TF, and PGM1. Among patient with endometriosis, the rare alleles of the locus ESD-ESD5 and ESD7-were found, along with ESD 5-5 homozygotes. Several genetic loci can be involved in the pathogenesis of endometriosis; their products can be specifically realized due to peculiarities of biochemical reactions in the organisms of people predisposed to this pathology.
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Clinical status, the major parameters characterizing the course of surgery, early postoperative period, immediate and late results of treatment are analyzed in 261 patients. Besides the routine methods, endoscopic methods (laparoscopy and hysteroresectoscopy) were used at the principal stages of the operation in 97 patients, and in 18 more patients CO2 laser was used for metroplasty. Use of present-day equipment and methods facilitates surgical repair of developmental defects of the genitals, reduces the duration of the operation, decreases blood loss, shortens hospital stay, appreciably improves the efficacy of surgical treatment, and places the operations for correction of developmental defects among those available for surgeons who mastered the endoscopic methods. Hence, modern endoscopic methods may be effectively used for both the differential diagnosis of developmental defects of the genitals and for surgical repair thereof.
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Clinical data, the findings of biorhythmologic studies and the results of kymographic perturbation evidence the efficacy of early restorative treatment with the use of preformed physical factors early (starting from the first day) after reconstructive microsurgery. Such treatment accelerates the postoperative adaptation of the body, improves the anatomy and function of the uterine tubes and promises a more favorable prognosis for the reproductive function recovery. Criteria for the differentiated application of 3 physical factors are presented, intermittent low-frequency magnetic field, supersonic current, low-frequency monopolar rectangular pulses for electrostimulation of the uterine tubes.
The study of the efficacy of the use of different materials recommended for the adhesion prevention was carried out in 15 white rats. On the parietal front-lateral peritoneum of the abdomen, adhesion formation was induced using an adhesion induction model of 10--nodes suture (catgut 3/0) both sides. In the experimental group, fibrin glue FG1 produced at the Surgery Centre of the Russian Academy of Medical Sciences, and oxidized cellulose barrier-Interceed, manufactured by the Johnson & Johnson company (USA); were applied while the control group was made up of the untreated rodents. 5 days after the operation, these animals were opened and the degree of the spread, type, intensity and rigidity of the formed adhesion were studied using the grade system. It was observed, that fibrin glue and Interceed barrier never caused any tissue reaction; a reduction in the frequency of adhesion formation was also noted in the treated group.
30 rabbits were operated on by sigmoidal ovarian resection during which one side was treated with fibrin glue, and alternative with different suturing materials (prolene 7/0, catgut 3/0). Macroscopic investigations and determination of generative functions of postoperative animals, in a 3 weeks after coupling with male rabbits, were carried out. It was discovered that the application of fibrin glue promotes the reduction of in inflammatory and sclerotic changes. The frequency of occurred postoperative adhesions and preservation of increasing the ovarian size and weight tendency with the maintained functional conditions in comparison with those treated with suture materials. Prolene has certain advantages when compared with catgut, like macroscopic changes in the ovarian tissues, resulting in decrease of ovarian size and weight, increase of formation of postoperative adhesions and unbalance the whole generative system. In clinics fibrin glue was applied to 7 patients during different operations on ovary. Preliminary clinical data confirmed the experimental results.
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Presents data on the clinical course and surgical treatment of 26 patients with retroperitoneal tumors and hemangiomas of the pelvis. The diagnosis was confirmed by x-ray, echographic, computer tomographic, and angiographic data on pelvic vessels. To prevent bleedings, embolization of the internal iliac arteries and their branches as far as the 3-4th order was carried out in 9 patients with angiodysplasias and 4 with retroperitoneal pelvic tumors. Endovascular occlusion of the main vessels not only permitted surgery with the minimal blood loss, but was conducive to better visualization of the tissues and made the operation less traumatic.
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