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The objective: to increase the effectiveness of local therapy for recurrent nonspecific vaginitis associated with cervicitis in women of reproductive age on the basis of a comparative evaluation of combined drugs Terzhinan and Neo Penotran Forte. Materials and methods. A prospective, open comparative study included 56 women aged 27.5±2.8 years with recurrent nonspecific vaginitis and cervicitis who were randomized to the main group and comparison group. Patients of the main group (n=28) received the drug Terzhinan® (1 vaginal tablet in the evening, before bed, for 10 days). The comparison group included 28 patients who received Neo-Pentran Forte (1 vaginal suppository in the evening, before bedtime, for 10 days), one vaginal suppository containing 750 mg of metronidazole and 200 mg of miconazole nitrate. The complex clinical-paraclinical examination included the determination of the state of the vaginal microbiota using several methods in parallel: a bacterioscopy of vaginal smears stained by Gram, a bacteriological rapid method using AFGENITAL SYSTEM (Liofilchem®, Italy), real-time PCR (Florocenosis) with detection antigens of chlamydia, herpes simplex virus, human papillomavirus, trichomonads. Results. The main reason for the treatment of patients were abundant pathological discharge from the genital tract (73.2%), pruritus (37.5%) and burning (23.2%) in the vulva, pain during sexual intercourse (8.9%), while 33.9% of women expressed combined complaints. Attention was drawn to the significant frequency of dyshormonal pathology among women with recurrent cervico-vaginal infections. In the examined women, uterine leiomyoma was diagnosed (28.6%), genital endometriosis (19.6%), fibrocystic breast disease (37.5%), combined benign dyshormonal diseases of the genital organs (14.3%). About 21.4% of patients treatment of thyroid gland dysfunction (hypothyroidism). According to the comprehensive examination, in all patients of clinical groups, decompensated vaginal dysbiosis was diagnosed, which was manifested by a sharp decrease in the absence of Lactobacillus spp strains in 39.3% of patients and an increase in the number of isolated opportunistic and pathogenic microorganisms to 1011 CFU/ml with an increase in the number of microorganisms in microbial associations (from 2–3 to 5–6 conditionally pathogenic and pathogenic pathogens) in all the cases analyzed. When using the genital express system in vaginal contents, women of the main group identified Escherichia coli (17.9%), Pseudomonas spp. (10.7%), Gardnerella vaginalis (39.3%), Staphylococcus aureus (17 9%), Enterococcus faecalis (25.0%), Streptococcus Group B (10.7%), Candida spp. (46.4%), Mycoplasma spp./Ureaplasma ur. in the title > 105 (14.0%). In the comparison group, the spectrum of detected pathogenic and conditionally pathogenic microorganisms did not differ significantly from the data of the main group. 92.6% of patients in the main group had a pronounced positive clinical effect, and a positive microbiological effect was achieved in 96.4% of cases that persisted during the next two months of follow-up. Without additional prescription of antifungal agents, a positive effect was achieved in 84.6% of patients in the main group with mixed bacterial-candidiasis vaginitis at 54.5% in the comparison group. The independent recovery of the lactobacilli pool to a titer of 107–109 CFU/ml in 17.9% of patients with a lack of detection of lactobacilli before treatment. A similar effect was not observed in the comparison group. Сonclusion. In a comparative study of the results of the use of Terzhinan and Neo-Penotran Forte in monotherapy in patients with inflammatory diseases of the lower genitalia (nonspecific recurrent vaginitis and cervicitis), the high clinical and microbiological efficacy of Terzhinan has been demonstrated. Key words: mixed vaginitis, cervicitis, Terzhinan, Neo-Penotran Forte.

Cervical ectopy is one of the most common benign processes, characterized by relatively high recurrence rate, and in the case of vaginal microbiota violations in the conditions of HPV infection combination deserves the aimed attention, particularly in the context of reproductive health care and cancer prevention. The objective: to study the vaginal microbiota features in patients withcervical ectopy relapsein the conditions of HPV infection. Materials and methods. The study included 98 women of reproductive age (18 to 46 years). Three groups were formed: a control group (n=30), in which conditionally healthy women were included, group 1 (n=33) – patients with firstly diagnosed cervical ectopy, group 2 (n=35) – patients with cervical ectopy relapse. All women wereexamined with a bacterioscopic, cytological, microbiological study of the vaginal biocenosis, as well as a determination of the vaginal environmentpH level. Results. In patients with cervical ectopy relapse the pH of the vaginal environmentwas significantly higher than that in women of the control group (p<0.001) and of the group 1 patients (p<0.05). About 9% of patients in both study groups had signs of bacterial vaginosis; in about 70% of group 2 patients the signs of mild and moderate severity aerobic vaginitis were found, significantly (p<0.05) more often than in patients with firstly diagnosed cervical ectopy. In group 2 patients a significant polymorphism of infects was detected in 40.00±8.28% of cases, the associations of 3 or more microorganisms determined simultaneously were significantly (p<0.001) more often foundin group 2 in comparison with patients with firstly diagnosed cervical ectopy. Сonclusion. The use of the short-term test system A.F.GENITAL SYSTEM (Liofilchem®, Italy) has a number of advantages for clinical practice: results being ready in short time, the detection of a wide range of infections, the possibility of quantifying M. hominis and U. urealyticum, and then determining the sensitivity to the most frequently used antibacterial drugs. Recurrent cervical ectopy often occurs in the conditions of colpitis, vaginitis, vaginal microbiota disorders with significant polymorphism of microorganisms and alkalization of the vaginal environment, which complicates the processes of ectopy epithelialization and can predispose to its recurrence. The observed cytological features in this cohort of patients suggest that long-term violations of the vaginal biocenosis in combination with the inflammatory processes of the vagina and cervix create favorable conditions for the realization of dysplastic changes caused by HPV. When determining the tactics of treatment of recurrent cervical ectopy, in particular in the conditions of HPV infection, first of all it is necessary to achieve both the cytological norm and the normalization of the vaginal biocenosis before any intervention, if necessary. Key words: relapse of cervical ectopy, vaginal biocenosis, vaginitis, cervicitis, HPV.

Zusammenfassung Hintergrund Langstreckige ossäre Defekte der Extremitäten nach Trauma und Tumorresektion stellen eine große Herausforderung an das plastisch-rekonstruktiv tätige Chirurgenteam dar. Die Defektrekonstruktion mittels freier mikrochirurgischer Fibulatransplantation ist eine Standardmethode, bleibt jedoch mit einer nicht unerheblichen Komplikationsrate behaftet. Ziel der vorliegenden Arbeit ist es, eine aktuelle Übersicht zu den diversen Rekonstruktionsverfahren zu geben und anhand einer persönlichen Fallserie die eigenen Erfahrungen mit der freien Fibulatransplantation mitzuteilen. Patienten und Methoden Die Literaturrecherche zum Thema erfolgte über Pubmed und Web of Science, die retrospektive Datenerhebung des Eigenkollektivs des Seniorautors (MS) unter Einbeziehung von klinischen und radiologischen Daten. Ergebnisse Von 2007 bis 2018 wurde bei 11 Patienten eine freie Fibulatransplantation durchgeführt. In 4 Fällen war eine Pseudarthrose, in 3 eine Osteitis und in 2 Fällen ein Tumor für die Defektentstehung an den Extremitätenknochen ursächlich. Bei 2 Patienten lag eine Defektfraktur infolge eines Hochenergietraumas vor. In 9 Fällen war die obere, in 2 die untere Extremität betroffen. Bei 4 Patienten wurde ein osteoseptokutanes Transplantat entnommen, bei 2 davon kam es zum Verlust der Hautinsel postoperativ. Die Längen der Fibulatransplantate betrugen zwischen 5 und 22 cm. In allen Fällen war die knöcherne Integration des Transplantats vollständig. Das nach Physiotherapie erzielte Bewegungsausmaß der betroffenen Extremität war sehr gut bis befriedigend. Schlussfolgerung Die langstreckige ossäre Defektrekonstruktion mittels freier Fibula ist zweifelsohne eine Standardmethode, bedarf bei beschriebener hoher Komplikationsrate eine strenge Indikationsstellung unter Berücksichtigung alternativer Verfahren. Eine enge Kooperation zwischen plastisch-rekonstruktiven und unfallchirurgisch-orthopädischen Disziplinen ist unverzichtbar.

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