The limited efficacy of hormone therapy for endometrial proliferative process (EPP) in postmenopausal patients and its side effects on the immune system functionalities have not been studied in detail. Here we assess the feasibility of hormone therapy for EPP in postmenopausal patients through evaluation of estradiol and progesterone receptor gene expression in endometrial tissue and peripheral blood mononuclear cells (PBMC). The study enrolled 92 postmenopausal patients with EPP, including 37 pts with glandular-fibrous polyps, 7 pts with non-atypical endometrial hyperplasia (EH), 8 pts with atypical endometrial hyperplasia (AEH), 31 pts with moderately differentiated adenocarcinoma and 9 pts with highly differentiated adenocarcinoma. The PBMC isolates and endometrial samples were tested for ER⍺, ERβ, mER, PRA, PRB, mPR and PGRmC1 expression by reverse real time polymerase chain reaction (RT–PCR). Differential changes in PBMC receptor profiles upon in vitro exposure to progesterone or mifepristone were determined for patients with endometrial polyps and healthy women. The results indicate elevated expression of ERα, ERβ, PRA, PRB, mPR and PGRmC1 by endometrial tissues in EH and elevated expression of mER, ER⍺ and PRA by PBMC in AEH, apparently reflecting suppressed functionalities of monocytes, macrophages, Т-cells and natural killer cells. Unaltered expression of the studied genes by PBMC in endometrial adenocarcinoma may reflect the incrementing tumor autonomy. In vitro, mifepristone inhibited ER⍺, ERβ, mPR, PGRmC1, PRA and PRB expression in PBMC isolated from patients with endometrial polyps. We suppose that such effects can mitigate the negative influence of sex steroid hormones on immunocompetent cells.

Objective. To study the state of the myometrium and the endometrium after hysteroscopic myomectomy of uterine fibroid using 2D/3D transvaginal echography in patients of reproductive age. Patients and methods. We examined 90 patients of reproductive age with submucous uterine fibroid, who underwent 117 one-, two- or three-step hysteroscopic resections performed with a new technique of transcervical myomectomy. 3D transvaginal echography was performed in all patients with target assessment of the fibroid type and the intended resection site, and also with subsequent assessment of its changes. Results. A new technique of fibroid resection with rigid loops was elaborated. New options for noninvasive 3D-US in preoperative diagnosis of uterine fibroids have been determined. Owing to 3D-US, the state of the endometrium, myometrium at the «resection site» were studied for the first time. Indications for one-, two- and tree-step resections have been specified. Conclusion. 3D transvaginal echography at the stage of planning hysteroscopic myomectomy allows not only a more precise determination of the fibroid type, assessment of its location and size, but also prediction of the length of operative intervention, the likelihood of multi-step resection and a risk of developing postoperative complications, as well as recommendation of other surgical treatments. Intraoperative ultrasound surgical navigation was introduced, which in combination with an appropriate resection technique permits to enhance the safety of surgical procedure. Depending on the echographic image of the endometrium and myometrium at the «resection site», specific recommendations have been formulated on management of the postoperative period that can permit to prevent the formation of synechiae and to determine precise terms of possible pregnancy occurrence. Key words: infertility, hysteroscopic myomectomy, resection site, uterine fibroid, reproductive age, submucosal fibroid, ultrasound examination, 3D-US

No abstract

No abstract