Предраковые заболевания шейки матки

Предраковые заболевания шейки матки (CIN I-III) – морфологическая  характеристика, современные методы диагностики и лечения

1.Precancerous diseases of the cervix (cervical intraepithelial neoplasm CIN I-III)-morphologic characteristics, modern methods of diagnosis and treatment.

a number of pathological conditions, which under certain conditions can be transformed into cervical cancer

These include dysplasia, leukoplakia with atypia, erythroplasty, adenomatosis. In most women, precancerous diseases of the cervix are erased

Dysplasia

The term dysplasia is a morphological term unifying changes of epithelial Dysplasia characterized by Genesis. intense proliferation of cells with advent they atypia, especially nuclei without getting involved in the pathological process the superficial layer of the epithelium. Depending on the intensity of cell proliferation and the appearance of structural and cellular atypia in jepitelialnom formation (lower third or more superficial divisions) distinguish mild, moderate and severe dysplasia (or CIN I, (II), (III) gravity).

Development dysplasia promotes:

∙   early onset of sexual activity;

∙   frequent change of sexual partners;

∙   early first pregnancy;

∙   the prolonged existence of background of pathological cervical processes.

In the occurrence of cervical neoplasia has attached great importance to the viral infection, especially human papilloma virus (serotypes 16 and 18, possessing high oncogenous potential).

The development of dysplasia are usually asymptomatic, complaints typically arise from concomitant gynecological diseases. When inspecting the State mirrors the cervix variable-the cervix may not be changed or taped background process. The diagnosis: can be made after a comprehensive survey, including cytology, colposcopy, biopsy on target with diagnostic curettage of cervical canal.

During colposcopy characteristic for dysplasia is the presence of atypical transformation zone. Colposcopy allows you to refine the topography of pathological and produce targeted biopsy. The main method of diagnosis of dysplasia remains the histological study of the biopsy sample.

In the study of stroke from the surface of the vaginal portion of the cervix in mild dysplasia marked predominantly cell proliferation of basal and parabasal layers, individual cell elements with signs of dyskaryosis. For dysplasia is characterized by changing the size and shape of cells and nuclei: their giperhromatizm, increased mitotic activity, including an increase in the number and range of pathological mitoses, violation of nuclear-cytoplasm ratio, Acanthosis, infiltration of lymphocytes and therefore in combination with pathological angiogenesis in podjepitelialnoj stroma.

When CIN (I) the degree of seriousness (mild) changes are observed in the lower third of the epithelium, with CIN II (cervical dysplasia) is in the lower two-thirds of the epithelium, with CIN III (severe dysplasia and carcinoma of the preinvazivnaja).

     Cervical dysplasia treatment

When CIN I (mild dysplasia), especially among young women, it is acceptable to conservative treatment (background process). In the absence of effective within three months, as well as with CIN II ( cervical dysplasia) and CIN III (severe dysplasia) shows surgical treatment-cone biopsy of LEEP &  cryosurgery of the cervix or after radical treatment is appropriate appointment of immune-modulators, antivirals, correction of micro-biocenosis.

2.Предменструальный синдром – определение, патогенез, клиника,

диагностика, лечение.

2. Premenstrual syndrome-definition, pathogenesis, clinical picture, diagnosis, treatment.

PMS is a complex pathological symptom arising in premenstrual days and reflected neuropsychiatric, vegeto vascular and endocrine-metabolic disorders. Usually PMS symptoms occur for 2-10 days before menstruation and disappear immediately after the onset of menstruation or during the first few days of it.

There are several theories of emergence of PMS: theory of psychosomatic disorders, allergic theory, theory of the role of giperprolaktinemii prostaglandins).

Depending on the predominance of the clinical picture of those or other symptoms are allocated 5 basic forms of PMS:

∙   Neuro-psychic (irritability, depression, fatigue, tearfulness, aggressiveness, numbness of hands, flatulence, bloating mammary glands);

∙   Atypical

∙   Bubonic (bloating and breast tenderness, swelling of the face, legs, fingers, bloating, fatigue, itchy skin, sweating, increased sensitivity to odors);

∙   Cephalgic (headache by type migraine headaches, irritability, nausea, vomiting, hypersensitivity to sounds and smells, dizziness, depression, pain in the heart, sweating, numbness, swelling);

∙   crises (sympathetic -adrenal crises-Ad sense of compression in the sternum, the emergence of fear of death, cold and numbness of limbs, heart rate, usually arise crises in the evening or at night).

Allocate 3 stage (ICP):

∙   Compensated (symptoms not progressive over the years, appearing in the second phase of the menstrual cycle and with the onset of menstruation stop);

∙   Sub-compensated (disease severity over the years is worsening PMS symptoms disappear only with the cessation of menstruation);

∙   De-compensated (symptoms persist for several days after the cessation of menstruation, and "bright" gaps between the end and the emergence of symptoms gradually reduced).

In all clinical forms of PMS, you must test survey of functional diagnostics, as well as the identification of prolactin, E2, progesterone in the blood in both phases of the menstrual cycle.

With neuropsychic form of PMS- neurologist and psychiatrist, kraniografija and EEG.

When the swollen shape of ICP-measurement of diuresis, study excretory functions of the kidneys, measurement of residual nitrogen, creatinine, etc. The pain and nagrubanii of mammary glands-mammography in the first phase of the menstrual cycle.