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Due to the complexity of the diagnosis and treatment of polycystic ovary syndrome (PCOS) in adolescents, studies are currently underway to select targeted therapy to normalize the metabolic and reproductive status of girls, including those at risk for PCOS. There are a lot of researches, that evaluate the effectiveness of inositol therapy in PCOS, ovarian dysfunction, insulin resistance (IR), ovarian hyperandrogenism in both adolescents and adult women, including those in IVF cycles. Currently, the choice of determining the ratio of myo-inositol (MI) and d-chiro-inositol (DCI) for the treatment of PCOS often leads to the physiological proportion of inositols in plasma (40:1), since research results are insufficient to unambiguously confirm it. In this connection, there is a large number of pharmaceuticals without or with a low dosage of DCI, that can’t bypass the defective epimerase activity and achieve an adequate level of DCI in the ovaries. Determination of a fair assessment and dosage of MI/DCI is required for long-term correction of metabolic, endocrinological and clinical manifestations of various PCOS phenotypes. Inositols are promising and safe treatment of hyperandrogenism, obesity, insulin resistance in women of various age groups and can also effectively complement a therapeutic effect of metformin and combined oral contraceptives.

Introduction. Endometriosis is characterised by a chronic course and significantly affects the quality of life of young patients. Aim. To study the features of the clinical picture and pain syndrome in adolescent girls with genital endometriosis against the background of 1 year of therapy.Materials and methods. A prospective longitudinal study included 32 girls (14–17 years old) with a confirmed diagnosis of genital endometriosis. The clinical picture and severity of pain syndrome were assessed against the background of conservative therapy with NSAID (naproxen) to relieve dysmenorrhea and gestagen (dienogest) for 1 year.Results. The main complaint of girls with endometriosis was pain, which appeared on the day before menstruation or in the middle of the cycle since menarche (64%) or increased in 1–1.5 years after menarche (23%) to very intense pain (8.3 ± 1.6 V scale) of a tensive (44%) or clutching (25%) nature. One third of adolescents reported daily pain (24%), the majority (75%) complained of restricted daily activity and performance, gastrointestinal symptoms (44%) and dysuria (22%). After 1 year of treatment with gestagens and NSAIDs patients had a significant decrease in pain on the days of menstruation (p Conclusion. A significant reduction in pain syndrome and clinical manifestations of dysmenorrhea against the background of an improved quality of life was observed in the adolescent patients during 1 year of conservative endometriosis therapy. No intensification or increase in the frequency of headache attacks or significant changes in BMI were observed in the study group, which is indicative of good tolerance and contributes to treatment adherence in young female patients.

In patients with congenital ovarian insufficiency, particularly with gonadal dysgenesis, the retarded bone remodelingprevents the bone tissue from achieving its final, peak density and leads to the lagging of skeletal system maturation. This may result in high risk of limb and backbone fractures.The article analyzes the results of the examination of 142 patients with different forms of gonadal dysgenesis. The treatment included the preparations containing estrogens, which were identical with natural ones (Divina, Divitren, Divigel). The data received substantiate the necessity of eliminating the estrogenic deficit in patients with gonadal dysgenesis earlier than it is usually done.

Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive diseases characterized by a defect in one of the enzymes or transport proteins involved in the cortisol synthesis in the adrenal cortex. The most common form of CAH, which occurs in more than 90% of cases, is a 21-hydroxylase enzyme deficiency. The latter is subdivided into nonclassical and classic (salt-losing and virilizing) forms. The prevalence of classic forms of 21-hydroxylase deficiency ranges from 1: 14,000 to 1:18,000 live births worldwide. According to the data of neonatal screening in the Russian Federation, the prevalence of the disease in some regions ranges from 1: 5000 to 1: 12000, in the country as a whole - 1: 9638 live newborns. The non-classical form of CAH occurs more often - from 1: 500 to 1: 1000 among the general population. In second place is the hypertensive form of CAH - a deficiency of 11β-hydroxylase, which, according to the literature, occurs in about 1 per 100,000 newborns. These clinical guidelines were compiled by a professional community of narrow specialists, approved by the expert council of the Ministry of Health of the Russian Federation, and updated the previous version published in 2016. The clinical guidelines are based on systematic reviews, meta-analyses and original articles, and scientific work on this issue in the Russian Federation and other countries. The purpose of this document is to provide clinicians with the most up-to-date, evidence-based guidelines for the CAH diagnosis and treatment

Despite high prevalence of heavy menstrual bleeding (HMB) in adolescents and young women, most recommendations are not specific for this population, which makes the diagnosis and management challenging. Gynecologists should be able to establish underlying causes of HMB, which most common are nonstructural in adolescents, and the severity of bleeding, to provide early diagnosis, using appropriate therapy for improving quality of life and iron deficiency prevention. First line management consists of hormonal therapy approved for HMB treatment, capable to normalize menstrual blood loss and iron metabolism parameters.

The data on roentgenologic peculiarities o f cranial bones including sella turcica in patients with gonadal dysgenesis are drawn in the paper. Besides that, the authors analyze the changes in size and configuration o f sella turcica under hormonal replacement therapy.

D-chiroinositol (DCI) is one of the 9 inositol isomers that forms inositol phosphoglycans, which are mediators of the action of insulin. The metabolism of DCI and myo-inositol (MI) is impaired against the background of insulin resistance, including the patients with polycystic ovary syndrome (PCOS). Aim. Highlight the most characteristic pharmacological properties of DCI. Materials and methods. Systematic computer analysis of 45 600 publications on the biological roles of inositol by methods of the topological theory of pattern recognition and systems biology analysis of human proteome. Results. A complex of interactions between metabolic disorders of DCI, PCOS, ovulation disorders, obesity associated with numerous hormonal disorders is described. Supplements with DCI and MI increase the sensitivity of cells to insulin and normalize the metabolism of androgens. An important difference between DCI and MI is the presence of DCI in the composition of inositol phosphoglycans that mediate the action of insulin on cells, as well as its participation in the realization of the therapeutic effects of metformin. The use of the MI+DCI combination allows achieving positive dynamics in reducing excess body weight, normalizing blood lipids, glucose and insulin levels, restoring the ovulatory menstrual cycle, improving oocyte quality, and helps prevent gestational diabetes in pregnant women and macrosomia of the fetus. DCI is more effective than MI in reducing the risk of folate-resistant neural tube defects. Conclusion. The therapeutic potential of DCI in combination with MI for treating PCOS and hyperandrogenism is evident. Depending on the therapeutic expediency, various ratios of MI:DCI can be used for the treatment of PCOS and disorders of carbohydrate and lipid metabolism.A

There is significant growth in numbers of patients with congenital disorders of various organs and systems in recent decades. The complexity of this problem is defined by difficulties in diagnostics especially in cases of associative disorders which leads to untimely treatment and numerous complications. This article covers features of management of female patients with malformations of genital organs with menstrual blood outflow defect.

Aim. To study the clinical and anamnestic, and surgical features of patients with genitourinary system malformations. Materials and methods. A retrospective analysis of data from 252 medical records of patients with genitourinary system malformations who were admitted for examination and treatment to the Department of Pediatric and Adolescent Gynecology of the Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation from 2012 to 2019. During analysis, special attention was paid to the data of surgical treatment, clinical and anamnestic data and the intraoperative picture. Results. Developmental anomalies of the genital system are combined with urinary system malformations in 21.1% of cases. Genital malformations in adolescent girls are characterized by a high rate of various complications: hematocolpos (53.6), hematocervix (30%), hematometra (26.2%), hematosalpinx (15.1%), endometriosis (19.2%), masses (16.4%) and adhesions (25.4%). Conclusion. Genital system malformations are often associated with anomalies of the urinary system and are characterized by a high risk of complications, therefore, timely identification and multidisciplinary management of such patients from an early age is extremely important.

The article describe a rare clinical observation of a giant paraovarian cyst in a teenage girl with laparoscopic removal. The presence of giant cyst in the abdominal cavity in adolescent girls requires a multidisciplinary approach, taking into account visual diagnostic methods, preference for MRI, followed by the participation of experienced teams of highly qualified specialists in order to conduct a minimally invasive organ-preserving treatment.

Inositol-containing drugs (stereoisomers of cyclohexane-1,2,3,4,5,6-hexol) are used to compensate insulin resistance, particularly in patients with menstrual and ovarian disorders. Inositols are effective in preventing folate-resistant fetal malformations. Objective. To analyze pharmacological differences between the four main biologically active stereoisomers of inositol: myoinositol (MI), D-chiro-inositol (DCI), neo-inositol (NI), and scylloinositol (SCI) using the comparative chemoreactomic method. Materials and methods. Chemoreactom analysis, PubChem / PHARMGKBb HMDB, STRING databases Results. DCI is more sufficient than MI for (1) processing of branched-chain amino acids, which promotes normalization of glucose metabolism, as well as (2) metabolism of folates, vitamin PP, vitamin B5, and magnesium, (3) activation of insulin-like growth factor 1 (IGF-1) receptor, whose activity is important for the prevention of sarcopenia, (4) antitumor effects (by inhibiting hyperproliferative effects, including those associated with excess glucose and an imbalance of androgens and estrogens), (5) inhibition of proinflammatory proteins (matrix metalloproteinase 15, ICAM1, and IRAK4 that mediate effects of interleukin-1). Conclusion. The profiles of pharmacological activity of DCI and SCI differ significantly from those of MI and NI. Therefore, combinations of MI and DCI are a more promising option to increase the sensitivity of cells to insulin than separate use of MI or DCI. Key words: insulin resistance, hyperandrogenism, polycystic ovary syndrome, post-genomic pharmacology, myo-inositol, D-chiro-inositol, neo-inositol, scylloinositol, Dikirogen

Aim of the study: evaluation of the effectiveness of the integrated use of the Vagilac line of intimate hygiene products in young women with bacterial vaginosis (BV). Design of the study: prospective randomized intervention open study. Materials and methods: 45 menstruating young women diagnosed with «BW» at the age of 11-17 years, divided into 3 equal groups, were examined. In the 1st group adolescents received oral probiotic with Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® within 15 days, in the 2nd group within 30 days. Group 3 girls, along with probiotic, used liquid soap and Vagilac moisturising gel with lactic acid for intimate hygiene for 30 days. Diagnosis and control of the results were assessed taking into account complaints, vulvovaginoscopy, pH-metry, microscopy and molecular-genetic examination of vaginal microbiocenosis. Results: 1 month after the end of oral probiotic use, the share of Lactobacillus spp. in vaginal TBM in girls who received the probiotic within 15 days was 21.3%, 30 days 53.4%. The parallel use of liquid soap and Vagilac gel for intimate hygiene was manifested by the steady normalization of lactobacillus representation in the vagina. Conclusion: In the case of bacterial vaginosis in young girls, the most appropriate way to restore vaginal normocenosis was to use an oral probiotic with Lactobacillus rhamnosus GR-1® and Lactobacillus reuteri RC-14® for 30 days with the addition of liquid soap and Vagilac moisturising gel for intimate hygiene.

The article presents the results of a study on the effectiveness of using clotrimazole 2% to treat candidal vulvovaginitis in girls. The use of a clotrimazole 2% cream treatment regimen, (100 mg), intravaginally once daily in girls with candidal vulvovaginitis is justified and highly effective. The absence of side effects while taking clotrimazole increases the commitment to this type of therapy.

The article is devoted to current views on risk factors of the vulvovaginitis in girls and the possibility of its prognosis. Survey findings on hygienic skills, the anamnesis, findings of vaginal microbiota of girls and polymorphism of genes of the immune response are provided in the article. Received data allowed to create multidimensional predictive models of risk of vulvovaginitis development in girls depending on the stage of sexual maturation introduced by Tanner.

Relevance: The clinical picture of polycystic ovary syndrome (PCOS) is extremely polymorphic, especially in adolescence. At the same time, the diagnostic criteria of PCOS in adolescence are still under discussion, and the hormonal parameters, including anti-Mullerian hormone range and hyperandrogenism, are not determined. The aim of the present study was to characterize the pivotal clinical and hormonal features of PCOS in adolescents and to establish the age-specific thresholds of the most essential hormonal parameters. Design: A case-control study. Methods: The study included 130 girls with PCOS according to the complete Rotterdam criteria, aged 15 to 17 years. The control group consisted of 30 healthy girls with a regular menstrual cycle of the same age. A complete clinical and laboratory examination, hormonal assays, and ultrasound of the pelvic organs were performed. The serums anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH, prolactin, estradiol, 17&alpha, OH progesterone (17&alpha, OHP), androstenedione, testosterone (T), dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), leptin, and free androgen index (FAI) were analyzed. The diagnostic accuracy of AMH, FAI, LH/FSH, T, and androstenedione levels in predicting PCOS in adolescents was established using a logistic regression model and calculating area under the receiver operator characteristic (ROC) curve (AUC). Results: The serum levels of LH (9.0 (5.4&ndash, 13.8) vs. 3.7 (2.5&ndash, 4.7) IU/L, p &lt, 0.0001), LH/FSH (1.6 (1.0&ndash, 2.3) vs. 0.7 (0.5&ndash, 1.1), 0.0001), 17&alpha, &ndash, OHP (4.1 (3.2&ndash, 5.1) vs. 3.4 (2.7&ndash, 3.8) nmol/L, p = 0.0071), cortisol (464.0 &plusmn, 147.6 vs. 284.0 &plusmn, 129.7 nmol/L, 0.0001), prolactin (266.0 (175.0&ndash, 405.0) vs. 189.0 (142.0&ndash, 269.0) mIU/L, p = 0.0141), T (1.9 (1.2&ndash, 2.5) vs. 0.8 (0.7&ndash, 1.1) nmol/L, 0.0001), androstenedione (15.8 (11.6&ndash, 23.2) vs. 8.3 (6.5&ndash, 10.8) ng/mL, 0.0001), AMH (9.5 (7.5&ndash, 14.9) vs. 5.8 (3.8&ndash, 6.9) ng/mL, 0.0001), FAI (5.5 (2.8&ndash, 7.0) vs. 1.6 (1.1&ndash, 2.3), 0.0001), SHBG (37.0 (24.7&ndash, 55.5) vs. 52.9 (39.0&ndash, 67.6) nmol/L, p = 0.0136), DHEAS (6.8 &plusmn, 3.2 vs. 5.1 &plusmn, 1.5 &mu, mol/L, p = 0.0039), and leptin (38.7 &plusmn, 27.1 vs. 23.7 &plusmn, 14.0 ng/mL, p = 0.0178) were significantly altered in the PCOS patients compared to the controls. Multivariate analysis of all studied hormonal and instrumental parameters of PCOS in adolescents revealed as the most essential: AMH level &gt, 7.20 ng/mL, FAI &gt, 2.75, androstenedione &gt, 11.45 ng/mL, total T &gt, 1.15 nmol/L, LH/FSH ratio &gt, 1.23, and the volume of each ovary &gt, 10.70 cm3 (for each criterion sensitivity &ge, 75.0&ndash, 93.0%, specificity &ge, 83.0&ndash, 93.0%). The diagnostic accuracy of PCOS determination was 90.2&ndash, 91.6% with the combined use of either four detected indexes, which was significantly higher than the use of each index separately. The accuracy of PCOS diagnostics reached 92% using AMH and leptin concentrations when the value of the logistic regression function [85.73 &minus, (1.73 &times, AMH) &minus, (0.12 &times, Leptin)] was less than 70.72. Conclusions: The results of the study estimate the threshold for AMH, FAI, androstenedione, testosterone, LH/FSH, and ovarian volume, which could be suggested for use in the PCOS diagnostics in adolescents with a high sensitivity and specificity. Moreover, the combination of either four determined indexes improved the diagnostic accuracy for the PCOS detection in adolescents.

Objective - to evaluate the structural features of the external and internal genital organs in girls with aplasia of the vagina and uterus. Materials and methods. The study included 64 adolescent girls aged 15-18. The examination included a general and gynecological with an assessment of the structural features of the perineum, external genital organs and urethra, including using a specially designed measurement scheme for anatomical landmarks. An ultrasound study was performed with the aiming assessment of uterine horns and, when identifying signs of functioning, laparoscopic removal of them with histological study. In order to optimally assess the type of tissue lining the vaginal fossa zone, an analysis was carried out of the material obtained by scraping from the studied zone using liquid cytology. Results. Every third patient (34.3%) was diagnosed with urinary system pathology. In most patients, the external opening of the urethra was typical. Almost everyone had hymen (95%). Gynecological examination showed that in the vast majority of patients in the area of intended vaginal entry, was a blindly ending vaginal fossa (95.3%). The length of the fossa was on the average 1.7±0.1 cm. According to the smear scrapings from the vaginal fossa, flat cells of the superficial, intermediate, and parabasal and basal types were present. Representatives of the lactobacillus and coccal microflora were revealed. A topographic-anatomical analysis of the orientations of the perineum in girls with aplasia of the vagina showed that the depth of the vaginal fossa weakly depended from the age of the patients and did not depend on any of the suggested guide points. According to the results of instrumental methods of investigation of the pelvic organs, 68.75% of the girls had a muscular cord at the uterus place. Moreover, 22% of girls had signs of the functioning of rudimentary horns. Ovaries, as a rule, were located high, at the entrance to the small pelvis. Laparoscopy was performed in all patients with cyclic pain syndrome and closed functioning uterine rudiments, removal of the uterine horns with fallopian tubes were prefered. Histological examination of the obtained preparations was characterized by the detection of endometrial stroma and active endometrial glands. Summary. The authors emphasize that a multilateral examination of this cohort of patients is extremely important for the diagnosis and optimized treatment.

The objective of this study was to evaluate physical, mechanical, and biological properties of the polydioxanone (PDO) monofilament meshes and polyglycolide (PGA) polyfilament meshes in comparison with Permacol® implants. In rat experimental model, a 1.5 × 2.0 cm defect in abdominal wall was reconstructed by using the Permacol surgical implant or knitted meshes produced from either PDO monofilament, or PGA multifilament. The implant sites were assessed for the tensile strength and the extents of material resorption, host inflammatory response and host tissue replacement on days 3, 10, 30, or 60 after the surgery. The PDO and PGA meshes were rapidly pervaded by the host connective tissue with elements of skeletal muscle histogenesis. The degree of adhesions was significantly higher in the Permacol group. All of the prostheses underwent resorption, which correlated with gradual decreases in the overall tensile strength of the site and the Col1a1 gene expression level. Elevated expression of Fgf2 gene maintained longer in the PDO group, and the Mmp9 gene expression level in this group was higher than in the other groups. Gene expression levels of inflammatory cytokines were higher in the Permacol group. The foreign body giant cell numbers were lower in the PDO and Permacol groups than in the PGA group. Minimal macrophage infiltration with predominance of M2 cells was observed in the PDO group. Overall, the PDO prosthesis turned out to be significantly better than the PGA or Permacol prostheses by a number of indicators of biocompatibility and efficacy. © 2018 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 00B: 000-000, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 652-663, 2019.

The article describes a clinical case of the successful management of pregnancy, delivery and post-natal period in the female patient with fibrous cavernous tuberculosis with extensive drug resistance and multiple thoracic surgeries in the past. This clinical case demonstrates that it is possible for a mother with the advanced form of tuberculosis to give birth to a healthy mature newborn.

Among ovarian tumors, germinogenic tumors occur in 25.9% of cases, develop from the polypotent highly specialized germinogenic epithelium of the gonads. Most germinogenic tumors are mature (benign) cystic teratomas (95%), malignant germinogenic tumors occur in only 3-5% of cases. The only reasonable method of treating these tumors is surgery, which is associated with losses of the ovarian reserve. The article presents the clinical and anamnestic characteristics of girls aged 7 to 17 years with ovarian teratomas, describes the structure of the surgical interventions (access, volume of operations) with the analysis of the histological conclusion of the remote formations.

The article provides data on the etiology and pathogenesis of genital malformation - vaginal and uterine aplasia (Mayer-Rokitansky-Kustner-Hauser syndrome) at the present stage.

Intravenous infection of C57Bl/6 female mice with M. tuberculosis H37Rv led to involvement of the lungs and dissemination of the tuberculous infection to the abdominal and pelvic organs. M. tuberculosis were detected in the lungs and spleen in 14, 35, and 90 days and in the uterine horns in 90 days after infection. Morphological analysis of organs showed successive development of exudative necrotic tuberculosis of the lungs, acute and chronic nonspecific inflammation in the reproductive organs (vagina, uterus, and uterine horns). The inflammatory process in the reproductive organs was associated with the development of anaerobic dysbiosis, that was most pronounced in 35 days after infection. Antituberculous therapy was followed by reduction of M. tuberculosis count in the lungs and spleen in 60 and 90 days after infection, eliminatation of M. tuberculosis in the uterine horns, arrest of nonspecific inflammation in female reproductive organs, recovery of the balance between aerobic and anaerobic microflora, and development of candidiasis of the urogenital mucosa.

Relevance: Mitochondrial dysfunction and systemic inflammation are believed to play pivotal role in the pathogenesis of polycystic ovary syndrome (PCOS) and related complications of metabolic disorders in adult patients. Though such researches are limited or almost absent in adolescents. The aim of the study is to evaluate the impact of mitochondrial dysfunction and systemic inflammation on PCOS pathogenesis during adolescence with regard to body mass index and insulin resistance. Design: a case-control study. Methods: The study included 95 adolescent girls (15 to 17 years old inclusive) diagnosed with PCOS based on the Rotterdam criteria. The control group consisted of 30 healthy girls of the same age with a regular menstrual cycle. All participants were subjected to a full clinical and instrumental examination, as well as an assessment of the levels of leptin, C-reactive protein (CRP), and malondialdehyde (MDA) as oxidative stress marker. Serum levels of IL-6, IL-10, IL-18, TNF-&alpha, and plasma concentrations of macrophage migration inhibitory factor (MIF), sFas, and sFasL were determined. Patients with PCOS were divided into groups according to the presence of metabolic disorders (MD) (impaired glucose tolerance and/or over insulin resistance) and normal weight or excessive weight (NW or OW). Results: Patients with PCOS of NW in the absence of metabolic disorders (MD&minus, /NW) had a lower concentration of MDA and a higher level of IL-10 compared to healthy girls (p &lt, 0.05). The group (MD&minus, /NW) was characterized with lower levels of CRP, leptin, MDA, and higher levels of sFasL, when compared to OW patients with PCOS in the absence of metabolic disorders (MD&minus, /OW) (p &lt, 0.05). Overweight adolescent girls with PCOS and metabolic disorders (MD+/OW) showed higher CRP, leptin, and a two-fold increase in IL-6 and IL-18 concentrations compared to the control group of healthy girls (p &lt, 0.05 for all parameters). The group (MD+/OW) was also characterized with higher levels of CRP, leptin, MDA, IL-18, MIF (p &lt, 0.05), when compared to overweight patients with PCOS in the absence of metabolic disorders (MD&minus, /NW). In comparison with the MD&minus, /OW group, the obese insulin resistant girls with PCOS (MD+/OW) had a highera level of IL-18 (p &lt, 0.05). Moreover, the MD+/OW girls demonstrated a significant increase in CRP, MDA and IL-18 levels when compared to the MD+/NW group (p &lt, 0.05). OW girls with PCOS without MD (MD&minus, /OW) had lower concentrations of sFasL compared to healthy girls (p &lt, 0.05), and higher levels of MDA compared to MD+/NW (p &lt, 0.05). Adolescent girls of NW with PCOS and with MD (MD+/NW) had lower levels of MDA compared to the control group of healthy girls (p &lt, 0.05). These data are confirmed by a correlation analysis and two-factor ANOVA test. Conclusions: Lean girls with PCOS demonstrate the protective mechanism of decrease in oxidative stress mediated by the activation of antioxidant defense, reduction of lipid peroxidation and systemic inflammation. Excessive weight and metabolic disorders in adolescents with PCOS are the most significant factors in reducing the capacity of antioxidant systems, activation of oxidative stress, mitochondrial dysfunction, and systemic inflammation.

The results of a complex three-dimensional transrectal ultrasound of internal genitals of 83 virgins aged from 14 to 16 years with clinical and the hormonal confirmed polycystic ovary syndrome (PCOS) are hereby discussed. The control group consisted of 20 healthy contemporaries having regular menstruations and normal values of hormones. As a result of complex inspection it was established that in an adolescent with PCOS the volume of ovaries is 3 times higher , than in control group; also, there were 3 times more varicosities of internal vessels of pelvis minor, and 2,1 times more often - a hypervascularization of a stroma of ovaries occurred. Taking into account the sizes and an arrangement of follicles at PCOS we have allocated an equal type (57%) and mixed type (43%) of ovarian structure, contributing to the difference in hormonal status and organ sizes.

The article presents a clinical case of cryopreservation of ovarian tissue in a patient 15 years with the bulk formation of a single ovary, is made on the basis of V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation.

Today Russia is facing a difficult situation with the health and well-being of adolescents and young adults caused by the failure of adult family members and community to convey the experience of previous generations and answer specific questions, as well as by the absence of social, educational, psychological and medical services [1].

Characteristics of dermatoglyphic parameters of women with abnormal development of sex organs compared with the dermatoglyphic characteristics of women in a control group were investigated. An inkless method was used for recording fingerprints of the test and control groups, and values of complex dermatoglyphic parameters were defined. This article presents the results of a study that aims to find statistically significant dermatoglyphic parameters to determine presence of congenital abnormalities of sex organs in women.

The article analyzes possibilities of hypoferric anemia in patients with abnormal uterine hemorrhages. Pathogenetic mechanisms of iron carboxymaltosate in therapy of this pathology are described. A clinical observation of a girl of a growing age with hypoferric anemia is presented and its clinical effectiveness is proved.

Adhesion of the labia minora is one of the most complicated diseases in girls at the age beginning with infancy. The occurrence of this condition in population is 0,6–3% of girls. It mainly can be found at the age of from 3 months to 6 years, the age from 12 to 23 months is the peak of disease prevalence. The relapse rate varies from 14 to 39%. During last decade the prevalence of disease has been reported to rise significantly. However there is lack of uniform guidelines of children with this condition management both in Russia and abroad. In this article the problem of management of infant girls with adhesions of the labia minora is highlighted, the advantages and disadvantages of various treatment options are discussed.

Optimum technology for dyeing serge with water-soluble sulfur dyes by the continuous pad-steam method was developed. It was shown that the colors for the background obtained in dyeing with Thiosol Olive and Diresul Olive-green satisfy camouflage requirements only in the daytime. Optimum technology for dyeing serge with Active Olive Special by continuous pad-steam and pad-thermofixation methods was developed. The background colors obtained in dyeing with Active Olive Special ensures camouflage both in the visible and in the IR region of the spectrum.

Обзор посвящен актуальному разделу гинекологии – воспалительным заболеваниям мочеполовой системы, вызванным генитальными микоплазмами. Своевременная диагностика и адекватная терапия данных инфекционных заболеваний позволяют улучшить качество жизни и избежать или восстановить нарушения функции репродуктивной системы у женщин. В обзоре освещены биологические свойства микоплазм, вопросы этиологии и патогенеза, классификации, клиники, дифференциальной диагностики носительства и развития инфекционно-воспалительного процесса. Кроме того, приводится анализ современных методов лечения генитальных микоплазмозов.

Опухолевые и опухолевидные процессы яичников могут возникать в любом возрасте женщины – от периода внутриутробного развития плода до глубокой старости, однако наиболее часто эти образования встречаются в период изменения по тем или иным причинам гонадотропной стимуляции и гормональной функции яичников. У детей такие изменения происходят в пубертатном периоде. Это связано с усилением в этот период гонадотропной стимуляции, которая не всегда бывает адекватной, и, соответственно, началом активного функционирования яичников.Большинство объемных образований яичников, встречающихся в неонатальном периоде и периоде детства, имеет герминогенную или фолликулярную природу. В периоде полового созревания каждое третье образование яичников оказывается представленным опухолевидным образованием (фолликулярные кисты, параовариальные кисты и кисты желтого тела) и герминогенными опухолями, в 3 раза реже встречаются эпителиальные опухоли. Гонадобластомы и опухоли стромы полового тяжа, как правило, выявляются у девочек-подростков с пороками развития яичников. Следует отметить, что опухоль в правом яичнике у девочек встречается гораздо чаще, чем в левом, что подтверждает теорию генетической детерминации более ранней и более высокой функциональной активности правого яичника.Лечение опухолей яичников всегда должно начинаться с операции. Принцип органосохраняющего лечения (удаление придатков матки с одной стороны и резекция большого сальника) удается осуществить у больных с односторонней дисгерминомой, текомой, гранулезоклеточной опухолью, а также с муцинозной цистаденокарциномой. Во всех наблюдениях злокачественных опухолей яичников у детей операция сочетается с полихимиотерапией, а при распространенной дисгерминоме проводится облучение таза и брюшной полости по индивидуальному плану.

Несмотря на многолетнее изучение и безмерно расширяющийся арсенал фармацевтических препаратов, используемых для лечения дисменореи, каждое новое поколение сталкивается с различными сторонами этой сложной проблемы. Данные о частоте дисменореи очень разнятся, видимо, это связано с невозможностью количественного подсчета боли. Для врача боль – это прежде всего сигнал опасности, симптом болезни. Именно поэтому многие исследователи рассматривают дисменорею как сигнал развившихся нарушений в системах, обеспечивающих и контролирующих процесс отторжения эндометрия.Выделяют этиотропное и патогенетическое лечебное воздействие при болевых синдромах. Назначение этиотропной терапии (например, антиоксиданты) позволяет не только медленно купировать болевой синдром, но и предотвратить развитие вегетативных и трофических расстройств. В соответствии с тем, что в основе дисменореи лежит феномен локальной гиперпродукции эйкосаноидов, применение анальгетиков и спазмолитиков может рассматриваться лишь как паллиативное, но не патогенетическое лечебное воздействие.Базовой терапией любой формы дисменореи должно явиться комбинированное назначение антиоксидантов и препаратов, содержащих соли магния.

Дисменорея представляет собой циклично повторяющийся полиэтиологический нейроэндокринный синдром, значительно снижающий, вплоть до ее полной потери, работоспособность девушки во время менструации, что определяет актуальность проблемы ее адекватной терапии. С целью усовершенствования тактики ведения пациенток с дисменореей нами были обследованы 117 девушек. Благодаря проведенной работе нам удалось выявить структуру дисменореи у подростков, особенности болевого синдрома и динамику его редукции при проведении пробы с НПВП. Полученные данные, осветившие проблему дисменореи у девушек, показали значимость дифференцированного подхода в диагностике и назначении негормональных и различных гормональных препаратов для коррекции разнообразных проявлений дисменореи у девушек. Результаты исследования подняли целый пласт нерешенных вопросов, в их числе необходимость более глубокого изучения истоков формирования вегетососудистых расстройств, нарушения гемодинамики головного мозга и других сопутствующих патологических изменений, напрямую связанных с соединительно-тканными нарушениями и электролитным диссонансом.

Хламидийная инфекция, вызывающая воспалительные заболевания органов репродуктивной системы, является одной из наиболее распространенных инфекций, передаваемых половым путем (ИППП) В последние годы в России также отмечен значительный рост заболеваемости урогенитальным хламидиозом. Это связано как с истинным увеличением числа заболевших, так и с совершенствованием методов диагностики. Сложность терапии хламидийной инфекции обусловлена тем, что неадекватное применение антибактериальных препаратов может привести к хронизации инфекции, появлению L-форм возбудителя, может спровоцировать обострение воспалительного процесса. Лечение урогенитального хламидиоза должно быть комплексным, включающим этиологическое, патогенетическое, симптоматическое лечение и местное воздействие на очаги поражения.

Дисменорея является одним из самых распространенных гинекологических заболеваний среди подростков. Более того, широкое внедрение последних достижений медикаментозной и немедикаментозной терапии не вызвало ожидаемого снижения частоты дисменореи у девушек. Возможно, это обусловлено отсутствием четко очерченного дифференцированного подхода к лечению данных больных и тем, что большинство специалистов под термином "дисменорея" понимают только наличие болезненных менструаций без учета всего широкого спектра нейровегетативных, обменно-эндокринных, психических и эмоциональных отклонений процесса менструации. В соответствии с целью нашего исследования - усовершенствование тактики ведения пациенток с болезненными менструациями, клинические особенности течения дисменореи изучены у 117 девушек в возрасте от 13 до 18 лет. Критериями отбора девушек явилось наличие жалоб на болезненные менструации, сопровождающиеся вегетативными изменениями с пароксизмальным течением. Благодаря проведенной работе, нам удалось выявить структуру дисменореи у подростков, особенности болевого синдрома и динамику его редукции при проведении пробы с НПВП. Полученные данные, осветившие проблему дисменореи у девушек, показали значимость дифференцированного подхода к диагностике и к назначению негормональных и различных гормональных препаратов для коррекции разнообразных проявлений дисменореи у девушек.

Внедрение в практику высокоинформативных методик культивирования микроорганизмов позволило доказать, что влагалище и шейка матки заселены популяцией различных микроорганизмов, которые находятся между собой в непрерывном антагонизме и синергизме. В соответствии с тем, что микроэкосистема половых путей в значительной степени зависит от морфофункциональных и топографоанатомических особенностей, при изучении проблемы воспалительных заболеваний влагалища важно знать индигенную (естественную) микрофлору половых путей здоровых женщин в различные периоды их жизни.

Сложность проблемы лечения дисменореи у подростков связана с большим количеством факторов, ее обусловливающих. Сочетание гормональных, нейровегетативных, обменных, психических и эмоциональных отклонений процесса менструального отторжения эндометрия требует поиска комплексного и более дифференцированного подхода к лечению этого заболевания. Проведенные нами исследования показывают, что НПВП избирательного действия и антиоксиданты должны применяться как базисная терапия дисменореи, способствующая снижению ферментативной активности циклооксигеназ (ЦОГ) и, тем самым, уменьшению уровня эйкосаниодов, в частности простагландинов, и ослаблению нежелательных множественных эффектов их гиперпродукции. После пробы с найзом, проведенной в дни болезненной менструации, больным были назначены гормональные препараты. Выбор гормональной терапии у данного контингента девушек осуществляли с учетом возраста, нарушений со стороны гормонального статуса и сексуальной активности пациенток. Приведенные в данной публикации данные свидетельствуют о возможности дифференцированного подхода к назначению гормональных препаратов для лечения дисменореи у девушек с учетом типа вегетоневротических проявлений.Полученные результаты исследования позволяют считать, что препарат "Дюфастон" предпочтительнее назначать в комплексе лечения дисменореи у девушек с нерегулярным ритмом менструаций и наличием в анамнезе межменструальных кровяных выделений, так же как у юных пациенток, реагирующих на болезненное отторжение эндометрия преобладанием симпатического тонуса ВНС.

Несмотря на многолетнее изучение и безмерно расширяющийся арсенал фармацевтических препаратов, используемых для лечения дисменореи, каждое новое поколение сталкивается с различными сторонами этой сложной проблемы. У девушек, живущих половой жизнью, так же как и у пациенток с формирующимися поликистозными яичниками и при нерегулярных, но резко болезненных менструациях, был применен гормональный препарат "Логест". В состав монофазного комбинированного гормонального препарата "Логест" входит этинилэстрадиол в минимально эффективной дозе (20 мкг) и гестоден (75 мкг) со 100% биодоступностью и отличными фармакологическимихарактеристиками.При выборе препарата мы ориентировались на доказанное преимущество современных контрацептивов для наиболее полноценной блокады овуляции. Кроме того, входящий в состав логеста гестоден обладает высокоселективной способностью соединяться с прогестероновыми рецепторами, за счет чего имеет выраженные антиэстрогенные свойства. Поскольку эстрогены усиливают сократительную деятельность маточной мускулатуры, а прогестерон, наоборот, тормозит чрезмерные и болезненные сокращения матки, уравновешенное взаимодействие этих стероидов накануне менструации способствует устранению условий к гиперпродукции простагландинов секреторным эндометрием и обеспечению полноценного и безболезненного его отторжения. Логест является эффективным препаратом для устранения многочисленных проявлений дисменореи у подростков, нуждающихся в высокоэффективной защите от нежелательной беременности, имеющих нерегулярный ритм менструаций на фоне формирующихся поликистозных яичников, а также при выявлении гиперпластических процессов эндометрия или эндометриоза гениталий.

Дисгенезия гонад относится к генетически обусловленным формам задержки полового развития (ЗПР) человека. Несмотря на редкую встречаемость в популяции, проблеме дисгенезии гонад придается важное значение во всем мире В настоящее время широкое распространение для заместительной гормональной терапии (ЗГТ) у женщин перименопаузального периода жизни получили препараты, содержащие так называемые классические или натуральные эстрогены, наиболее идентичные эстрадиолу женского организма. Публикации о результатах применения натуральных эстрогенов у девочек с дисгенезией гонад малочисленны и отрывочны.Среди обследованных нами больных у 126 пациенток с дисгенезией гонад был изучен исходный статус и у 82 девушек - динамика состояния органов-мишеней репродуктивной системы в процессе ЗГТ. ЗГТ назначали с момента постановки диагноза. У больных с У-хромосомой в кариотипе терапию проводили после оперативного удаления гонад. Объективизацию результатов лечебного воздействия производили с учетом динамики гормонального статуса и состояния органов-мишеней. Согласно полученным данным, препараты дивина и дивигель оказывают более полноценное влияние на органы-мишени по сравнению с этинилэстрадиолом в виде микрофоллина и в составе КОК, что позволяет рекомендовать их для длительной заместительной терапии больным с дисгенезией гонад.

Gonadal disgenesis concerns to the genetically caused forms of a delay of sexual development (DSD) in men. Despite of its rare appearance in a population, the large importance all over the world is given to a gonadal disgenesis problem. The results of the carried out research are the convincing the proof of an acceptability and expediency of hormonal replacement therapy assignment in patients with gonadal disgenesis with preparations containing estradiol valeratis in a combination with medroxyprogesteron without a dependence from the form of the diseases.

Представлена краткая информация о значении сохранения репродуктивного здоровья детей в современных условиях развития России. Изложены возможности использования высокотехнологичных методов диагностики и лечения патологических состояний репродуктивной системы девочек. Отменена необходимость соблюдения принципов централизации наиболее сложных и тяжелых больных в крупных лечебно-диагностических центрах, способных оказать своевременную, высокоточную и дорогостоящую специализированную медицинскую помощь девочкам от 0 до 18 лет. Указана целесообразность выполнения лечебно-диагностических технологий в детском возрасте за счет государственных или региональных гарантий оказания бесплатной медицинской помощи.

The effect of concentrated Na and Ca chlorides and their combination, as well as the effect of return water after filter-pressing, on the properties of molding mixtures, suspensions, air-dried intermediate products, and fired high-voltage porcelain articles is considered. It is demonstrated that the use of return water ensures the preservation of the main technical properties of intermediate articles and the quality of porcelain.