CC BY
1612. Tsvetanova K. The Influence of a Pneumoperitoneum on a Cardiovascular System and Central Hemodynamics in the Medical Cases of Robotic and Laparoscopic Gynecological Surgeries. IJSR, Vol. 5, Issue 4. P. 968-974.
13. Цветанова К., Томов Сл., Цанев Г., Цветкова С., Занфирова Л. Космические технологии в медицине- история, приложение и недостатки роботизированной и лапароскопической хирургии. Евразийский Союс Ученых (ЕСУ), #6, 2016. Стр. 50-60.
14. Цветанова К. Платиканов В., Атанасова М., Занфирова Л. Усложнения в хода на лапароскоп-ските и роботизирани онкогинекологични операции. "Анестезиология и интензивно лечение". Год. XLIV, кн. 1/ 2015. Стр. 28-30.
15. Цветанова К. Постурални хемодинамични промени при роботизирани и лапароскопски операции. Монография. Велес Консулт, София, 2018 г. Стр. 16.
ENDOMETRIAL POLYPOSIS-ASSOCIATED MICROECOLOGY OF THE VAGINAL MUCOSA
Benyuk V.
M.D., Professor,
Head of the Department of Obstetrics and Gynecology No3 Bogomolets National Medical University
Kyiv, Ukraine Lastovetska L.
Ph.D., Associated professor, Department of Obstetrics and Gynecology No3
Bogomolets National Medical University
Kyiv, Ukraine Shcherba О.
Ph.D., Assistant, Department of Obstetrics and Gynecology No3 Bogomolets National Medical University
Kyiv, Ukraine Shako V.
Intern, Department of Obstetrics and Gynecology No3 Bogomolets National Medical University
Kyiv, Ukraine Chania E.
Intern, Department of Obstetrics and Gynecology No3 Bogomolets National Medical University
Kyiv, Ukraine
ABSTRACT
Endometrial polyp is a benign lesions which appear in the uterine cavity. Exact causes of the endometrial polyps development are unknown. In recent times, there are publications about factors contributing the disease development, which include chronic inflammatory process in female genital organs.
Purpose Determine the vaginal and cervical microbiocenosis in women of reproductive age with endometrial polyps.
Materials and methods 60 women of reproductive age were examined, of whom 30 were women with endometrial polyps (main study group) and 30 were gynecologically healthy (control group). In all subjects general clinical investigations, ultrasound, gysteroscopy and bacterioscopic and bacteriological analyses, IEA and PCR were performed with the discharge from the vagina and cervical canal, and uterine cavity as a substrate.
Results and discussion The article describes the assessment of vaginal and cervical biotope aspects in women of reproductive age with endometrial polyps. Clinical studies data were evaluated.
Conclusions. Study data show that women diagnosed with endometrial polyposis have dysbiotic disorders of the vagina and cervix due to the reduction in number of indigenic and increase in opportunistic microflora and viruses.
Keywords: endometrial polyp, microflora of the vagina and cervical canal.
16. Tsvetanova K., Atanasova M., Ivova B/, Tanchev L. Comparative analysis of operative time, length if stay in ICU and estimated blood loss in robotassisted and laparoscopic surgery. Scripta Scientifica Medica. Vol. 48, №1, 2016, pp. 36-42.
17. Цветанова К., Одисеева Е., Занфирова Л., Томов Сл., Димитров Т. Ефективная клубочковая фильтрация и роботизированная хирургия. Sciences of Europe. # 12 (12), 2017. Стр. 102-110.
18. Tsvetanova K., Malkodanski I. The HIFU Technology during the Therapy of Uterine Myoma-First Attemts in Bulgaria. IJSR. Vol. 5, Issue 4, April 2016. P. 293-297.
19. Цветанова К., Одисеева Е., Димитров Т., Томов Сл., Горчев Гр., Танчев Л. Сравнителна характеристика на някои хемодинамични показатели след премедикация с Morphine, Fentayl и Midazolam. Медицински журнал "УМБАЛ "Света Анна", Том II, 2016, № 3. Стр. 17-21.
Today, the value of each pregnancy is steadily increasing, and infertility represents an extremely acute issue, which is often caused by intrauterine pathology [2, p.56; 5, p.88].
One of the most common pathologies of the uterine mucosa is endometrial polyp (EP). Recent studies suggest that EP are diagnosed in about 24-25% of the total population of women, and in recent years their occurrence is rapidly increasing. It should be noted that the occurrence of endometrial adenocarcinomas, which is one of the most common malignant diseases of the female genital organs, remains high and shows a trend to significant increase in many countries worldwide [1, p. 193]. High frequency of the relapses of endometrial heperplasia, probability of their malignant transformation pose the need for improvement of the diagnosis of this pathology and rethinking of the current experience. [3, p. 19; 6, p. 331].
Despite the relatively high level of development of diagnostic methods, there is still no consensus on the origin of EP. One of the most common concepts of EP development is the inflammatory theory [7, p.76].
Normal vaginal biocenosis plays an important role in maintaining homeostasis and preventing infectious diseases of the genital organs [11, p. 24]. As you know, vaginal biocoenosis is normally represented by permanent (indigenic, autochtonic) and transient (allochtonic, random) microflora, the proportion of which does not exceed 2-5% of the microbial pool. The indigenous microflora is represented mainly by Lactobacillus spp. (species of lactoflora grouped under the term "Doder-lein's bacillus"), occupying 95-98% of the entire microbial mass [10, p.19]. The ability of lactobacilli for adhesion to epithelial cells, produce lactic acid, hydrogen peroxide and antibiotic-like substances creates a strong barrier and protection, inhibits reproduction of acido-phobic bacteria, the growth of opportunistic microflora
50 45 40 35 30 25 20 15 10 5 0
46,7
33,3
and the emergence of infectious diseases of the internal genital organs [8, p. 271].
Goal. Determine the vaginal and cervical micro-biocenosis in women of reproductive age with endome-trial polyps.
Materials and methods. 60 patients aged 18-35 years were examined. Of them, 30 patients with endometrial polyps were included in the main group, 30 gy-necologically healthy women formed the control group.
In the main group, the diagnosis was established based on the hysteroscopic examination and confirmed histologically. In healthy women, aspiration biopsy was used to obtain endometrial samples.
To study the quantitative composition of vaginal microflora, Femoflor test system was used, and also bacteriological study of vaginal and cervical canal secretions by the cultivation of aerobic and anaerobic microorganisms on special nutrient media, EIA and PCR were performed.
Statistical processing of the obtained data was performed using Microsoft Word 7.0 software.
Study results and their discussion.Analysis of the obtained data on vaginal microbiocenosis showed that in the main group normocenosis was determined only in 6 (20%) women; intermediate type — in 8 (26.7%) subjects; dysbiosis — in 10 (33.3%) women; vaginitis caused by fungi of the genus Candida spp. — in 4 (13.3%) patients; trichomonadicvaginitis — in 2 (6.7%) examined patients. Chlamydia trachomatis was also isolated from the cervical canal in women of the main group — in 4 (13.3%), Mycoplasma genitalium and Ureaplasma parvum — in 6 (20%) cases.
In vaginal dysbiosis a high content of following anaerobic microorganisms was determined: Eubacte-rium spp., Prevotellabivia, Prevotellamelaninogenica, Prevotela intermedia, Atopobiumvaginae, Porphy-romonas spp., indicating mixed and anaerobic dysbiosis [Fig.1].
33,3
20
0
Normocenosis Intermediate type Vaginal dysbiosis Vaginitis Main group (n=30) ■ Control group (n=30)
Fig.1.
Microscopic characteristics of vaginal biocenosis of examined women (according to E.F. Kira, 1994), (%).
In the control group vaginal normocenosis was registered in 33.3% of women, intermediate type — in 14 (46.7%) subjects, dysbiosis — in 6 (20.0%) subjects.
Women with endometrial polyps were most often diagnosed with herpes simplex virus type 1/2 — in 12 (40%) cases. Also, Epstein-Barr virus was isolated in 1 (3.3%) woman, cytomegalovirus - in 4 (13.3%), HSV in 10 (33.3%) patients of the main group. In 4 (13.3%) women of the control group, viral infections were represented only by herpes simplex viruses of type 1/2, which indicates a significant difference between the control and the main groups.
Taking into account the fact that the cervix is the first barrier to ascending infection, we conducted bacteriological investigations of the cervical canal secretions using PCR and bacterial swab test using aerobic
and anaerobic tests. Data analysis showed that in 24 (80,0%) patients with endometrial polyps a wide spectrum of viral and bacteriological associations of microorganisms of the cervical canal was observed, with prevalence of 2-3-component content. Particular attention is drawn to the presence of such species of aerobes as Prevotela spp., Atopobiumvaginae, Veilonella spp., Peptostreptococcu spp. and such anaerobes as Streptococcus spp., E.Coli. It should be noted that decrease in bacterial concentration (102 - 103 CFU/ml) vs. vaginal biotope was observed. In women in the main group following microorganisms were found: Clamydia trachomatis — in 4 (13,3%) cases, Mycoplasma genitalium and Ureaplasma parvum — in 6 (20%) cases, and Candida albicans — in 6 (20%) cases [Fig. 2].
Atopobium vaginae Gardnerella vaginalis Peptostreptococcus spp. Porphyromonas spp.
13,30% ,30%
E. Coli Bifidobacterium spp. Streptococcus spp.
0 30%
0 13
6,60%
20%
20% 20%
6,60% 6,60% 5,00% 10,00%
0,00% 5,00% 10,00% 15,00% 20,00% 25,00%
, , , Tr „ , Peptost Gardne Atopob
Strepto Bifidob _ x Veilon Porphy ^ „
r x . „ _ ..Prevote ,, reptoco rella ium
coccus acteriu E. Coli ella romona
la spp. ccus vaginal vagina
spp. m spp. spp. s spp.
spp. is e
Control group (n=30)
Main group (n=30)
0 0 6,60% 0 0 6,60% 6,60% 20% 20% 13,30%
0 6,60% 6,60%
20% 13,30%13,30%
Fig. 2. Bacterial structure of the cervical canal content according to theresults of bacteriological analysis (%).
Of viral infections, most common are type 1 and 2 herpes simplex virus — in 12 (40%) patients in main and 4 (13,3%) women in control groups, which indicates a reliable difference between control and main groups. Also in cervical canal secretion of women with
endometrial polyps Epstein-Barr virus was isolated in 8 (2,6%) cases, cytomegalovirus — in 4 (13,3%) cases, HPV 33 — in 4 (13,3%) cases, HPV 35 — in 2 (6,6%) cases, HPV 18 — in 4 (13,3%) cases [Fig.3].
40 35 30 25 20 15 10 5 0
40
6,6
3
? ¿F
r.fsss.*
^ Jï J? #
■ Main group ■ Control group (n=30) (n=30)
Fig. 3. Viral and bacterial structure of the cervical canal secretion according to the PCR results (%).
Conclusions:
Study data show that women diagnosed with en-dometrial polyposis have dysbiotic disorders of the vagina and cervix due to the reduction in number of in-digenic and increase in opportunistic microflora and viruses.
References
1. Beniuk, V.O.PROLIFTsystem - a "goldenstandard" of surgical treatment of genital prolapse in women / Beniuk, V.O., ViniarskiyYa.M., Goncharenko V.N. // Women's health, - 2009.- № 9 (45). -C. 193195.
2. L.D. Lastovetskaya, R.V. Dovhalev. Genital prolapse: Modern view on the problem/Lastovetskaya L.D., Dovhalev R.V. // Collection of scientific articles of the Association of Obstetricians and Gynecologists of Ukraine. - Vol. 2 (36) 2015.- p. 56-61.
3. Filipenko PS, MalokayaYu.S. The role of connective tissue dysplasia in the formation of mitral valve prolapse. Wedge. Med., M, 2006; 84 (12): P13-19.
4. Klemenov A.V. Undifferentiated connective tissue dysplasia. M., 2005. 136 p.
5. R.V. Dovhalev. Risk factors in prognosis and diagnostics of genital prolapse / Dovhalev R.V.,Be-niuk, V.O., Nikoniuk T.R. //Tavr.med- biologist. Vesnik.-2012.-T.15, № 2, part 2 (58) .- P. 88-92.
6. V.E. RadzynskyiPerineology. Moscow: Medical Information Agency, 2006. - 331 p.
7. Gasparyan S.A. , AfanasovaStarichenko L.V. // Outpatient practice - new _ M., 2010._P. 75-76
8. Popov A.A. , Manannikova, T.N. Surgical treatment of complicated and uncomplicated forms of thalium genes prolapse / Popov A.A. Manannikova so-called // Proceedings of the 2nd Russian Forum "Mother and Child M. 2000.-P 271
9. Radzinsky V.E. , Petrova V.D. , Babaev V.A. others Correction of genital prolapse using a synthetic implant of the Pelviks system (Linteks Russia) / Radzinsky V.E. , Petrova V.D. , Babaev BA. Vestn. RUDN Ser .: << Medicine. Ginecology., - 2009. - Ne 5. P.64-71
10. Toktar L.R. Surgical correction of the pelvic floor after obstetric injury of the perineum. Author. dis. Cand. honey sciences. _ M., 2005.P.19
11. Shalaev O.N. Surgical treatment of benign diseases of the uterus and genital prolapse using vaginal access: Author. dis. Dr. med. sciences. _ M., 2004. P.24
