Our aim was to evaluate diagnostic and pathogenetic significance of plasma cytokines (IL-20, IL-23, IL-10, TNFα, IFNγ) in the patients with various clinical and histological variants of sclerotic lichen and to assess opportunity for their use as effectiveness criteria of immunotherapy for this disease using a drug based on eukaryotic deoxyribonucleic acid (Derinat). The prospective cohort study included assessment of the clinical manifestations (itching and dyspareunia) and measurement of blood cytokine contents (IL-20, IL-23, IL-10, TNFα, IFNγ) in women (n = 114) with various clinical variants of sclerotic lichen (atrophic, sclerotic and sclerotic-atrophic) before and after immunotherapy with a nucleic acid-based drug (Derinat). Derinat was chosen due to the fact of being an agonist of Toll-like receptors, and a number of immunoregulatory effects, including the ability to modulate cytokine production and to exert a positive influence upon regeneration processes. In addition, based on visual inspection, vulvoscopy and morphohistochemical examination results (evaluation criteria: skin thickness, number of collagen fibers, severity of fibrosis and sclerosis, etc.), the corresponding subgroups were classified within the II group, i.e., 2.1 (minimal sclerotic signs, n = 14), and 2.2 (pronounced sclerotic signs, n = 20). The control group consisted of conditionally healthy women, without history or presence of vulvar pathology (n = 30), with an age ranging from 20 to 50 years. Along with cytokine assessment by enzyme immunoassay, the study used the data of clinical examination (anamnesis collection, examination, palpation, vulvoscopy), as well as complex morphohistochemical evaluation of vulvar tissues. In atrophic variant, we have observed an increase in plasma IL-23 content, along with decreased TNFα; in lichen sclerosis, a maximal increase in IL-20, IL-23, and IFNγ was revealed; in sclerotic form of sclerotic lichen variant with severe sclerotic features, maximally enhanced IL-20, IL-23, TNFα, IFNγ, along with minimal levels of IL-10 was registered, as compared with other groups. Immunotherapy using Derinate resulted into significant reduction in the clinical manifestations in sclerotic lichen, i.e., itching of the vulva and dyspareunia, as well as normalization of cytokine indexes. Our studies have demonstrated an opportunity of using plasma concentrations of IL-20, IL-23, IL-10, TNFα, IFNγ as biomarkers of sclerotic lichen variants, and as laboratory criteria for efficiency of immunotherapy.

Aim. To describe the results of applying citrate dialysis in the complex therapy of a patient with postpartum sepsis.Materials and methods. This paper presents an analysis of a case of the successful treatment of patient P. with the diagnosis “Childbirth 3 urgent. Pfannenstiel laparotomy. Caesarean section in the lower uterine segment. Hypotonic bleeding. Relaparotomy: ligation of the internal iliac arteries, hemostasis. Relaparotomy: additional hemostasis, pelvic tamponade, abdominal cavity tamponade. Hemorrhagic shock of fourth category. Extirpation of the uterus with tubes. Sepsis. Septic shock. DIC syndrome”. Citrate dialysis was included as part of intensive care therapy.Results. Citrate dialysis allowed the patient with multiple organ failure, against the background of complex intensive care therapy, to restore kidney function after 28 sessions of renal replacement therapy. Diuresis was completely restored on day 42. Biochemical parameters, such as urea and creatinine, were normalized on day 45. The duration of treatment in the anesthesiology and resuscitation departments was 47 days, out of which lung mechanical ventilation lasted for 17 days. The total duration of treatment in the hospital was 54 bed days. The patient was discharged in satisfactory condition.Conclusion. The methods of extracorporeal detoxifi cation can signifi cantly improve treatment outcomes in this category of patients and reduce maternal mortality rates.

Aim. The study was designed for the optimization of the approaches to the diagnosis and management of women with background diseases and tumor pathology of the vulva.Materials and methods. The study involved more than a thousand and a half patients from different regions of Russia and CIS countries with precancerous and tumor pathology of the external genitals. A variety of methods were used in the primary diagnosis and monitoring in the treatment and observation, ranging from the banal examination, palpation, laboratory studies and ending with modern morphological studies, CT, MRI and PET diagnostics.Results. The characteristic differences in the background processes of the vulva were revealed, which allowed us to divide them into two groups: the first group – the pathological process occurs against the background of dystrophic changes in the tissues of the external genitals; the second group – the dermis and subcutaneous fat are not changed. Clear morphological criteria of two variants of changes are accompanied by a significantly different clinical picture. Conservative measures had low efficiency in the pathology of the vulva with a neurodystrophic process. Carrying out a photodynamic therapy and laser vaporization is justified only in young and middle-aged women with precancer. It was found that the high efficiency of surgical treatment is combined with a large number of early and late postoperative complications, which in itself causes discomfort, pain, dysuric phenomena, and dyspareunia. It is possible to reduce the frequency of postoperative complications and improve the functional and cosmetic results of the treatment only with the use of reconstructive plastic surgery. We have developed and widely implemented the methods of closing wound defects in everyday practice and evaluated their effectiveness. Conclusion. Over the past 20 years, a lot of work has been done to address the topical issues related to the diagnosis and treatment of background processes, precancer and vulva cancer. However, at present, there is no center where theoretical issues are studied at a serious level, conservative and invasive methods of treatment are developed, and educational and methodical work with doctors is carried out. Without proper attention to these issues, this problem is unlikely to be solved in the near future, both from theoretical and practical points of view.

On the basis of a comprehensive study of the clinical and laboratory parameters of a comparative assessment of the effectiveness of operations subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator and total hysterectomy about benign combined pathology of the cervix and uterine body. Depending on the extent of surgical treatment 2 groups of women were formed, who have had total hysterectomy and subtotal hysterectomy with excision of muco-muscular cervical flap by using transvaginal mortsellyator. As a result of further examination revealed the benefits of subtotal hysterectomy with excision of muco-muscular cervical flap: the duration of the operation, blood loss, and drop in hemoglobin levels after surgery. Preserving the anatomical relationship of the pelvic organ, saving ligament apparatus and cervical innervations save vaginal integrity, reduce the risk of complications in the form of descent and prolapse of the vaginal walls in the late postoperative period, which will undoubtedly improve the quality of life of women.