Vol 90, No 3 (2014)

Goal of the study. To compare expression of matrix metalloproteinase-2 (MMP-2) in the nuclei and cytoplasm of tumor cells and assess the mutual relation between the localization of MMP-2 expression and different clinical and morphologic criteria in patients with a skin melanoma. Materials and methods. Tumor samples obtained from paraffin blocks taken from patients suffering from a skin melanoma and treated at the Krasnoyarsk Territorial Oncologic Dispensary served as the object of the study. Skin tissue samples taken from patients suffering from a skin melanoma (n = 44) were obtained from the Krasnoyarsk Territorial Pathological Anatomy Bureau. Immunohistochemistry was performed based on a standard technique using primary anti-matrix metalloproteinase-2 antibodies. Results. MMP-2 expression was revealed in the nuclei of tumor cells of a skin melanoma in 43.1% of cases and in the cytoplasm in 56.9% of cases. No significant differences in MMP-2 expression in the nuclei and cytoplasm were revealed (p = 0.33). Patients with nuclear expression in tumor cells are characterized by a more favorable prognosis than patients with cytoplasmic enzyme expression in tumor complexes. No dependence of the intracellular localization of MMP-2 expression on the patient sex or age, tumor localization, Clark level of invasion, Breslow’s thickness, particular features of tumor lymphocyte infiltration, tumor growth phase, histological subtype, pigmentation, tumor ulceration and tumor stage according to AJCC (American Joint Committee on Cancer) was revealed. Conclusion. MMP-2 located in the nuclei can be related to hypoxia in the tumor tissue as well as increased peroxynitrite level, which, in its turn, can have an effect on the function and regulation of matrix metalloproteinases. Moreover, MMP-2 with an atypical localization can be related to tumor cells with different biological characteristics within the same tumor, which characterize the intratumoral heterogeneity of neoplasms. The biological and clinical role of changes in the intracellular localization of the enzyme needs further explanation.

The article discusses the results of a study aimed at determining the frequency of different genetic variants of U. parvum in women with inflammatory diseases of the urogenital system and clinically healthy subjects. Molecular typing of 40 samples of U. parvum taken from women with different forms of inflammatory diseases of the urogenital system was performed for the mba gene. The authors revealed a relationship between clinical manifestations of inflammatory diseases of the urogenital system caused by U. parvum and different U. parvum serovars. An infection with 6 U. parvum serovar results in the development of inflammatory processes in the form of cervicitis or vaginitis accompanied by subjective manifestations more frequently than an infection with other serovars under examination (1 and 3) (p < 0.05).

The authors describe two clinical cases of a malignant giant condyloma (Buschke - Lowenstein tumor), one of which resulted in a lethal outcome. Despite its benign histology, this neoplasm demonstrates evident aggressive and malignant clinical characteristics. The development of this tumor is associated with the papilloma viral infection. Immunodeficiency was diagnosed in the patients in both cases. The lethal outcome was a result of severe anemia, intoxication and local complications. Surgery was the main method of treatment. However, the results were unsatisfactory in view of a weak response to treatment and high risk of relapses. Administration of up-to-date topical immunopotentiators such as Imiquimod seems to be promising because in addition to its principal immunopotentiating effect it may also have a haemostatic action.

Goal of the study. To study the dependence of the clinical course of the papilloma viral infection and cytological characteristics of lesions in the cervical mucosa on the quantitative indices of human papilloma virus (HPV). Materials and methods. The study involved 175 female patients with HPV of a high carcinogenic risk including 125 subjects with clinical forms of the papilloma viral infection (PVI) and 50 subjects with subclinical and latent forms of the disease. Laboratory tests were carried out with the use of the polymerase chain reaction including real-time PCR for the quantitative determination of HPV. Cytological examinations of scrapes from the exocervical and endocervical mucosa were carried out according to Leishman I, and the results were interpreted according to Bethesda. Results. The authors established an association between clinical forms of PVI and infection with two or more HPV genotypes, and latent and subclinical forms of the disease and infection with one HPV genotype; HPV Genotype 16 prevails within the structure of HPV of a high carcinogenic risk. It was shown that patients infected with two or more HPV genotypes as well as subjects with subclinical and latent forms of the disease underwent reliably higher viral loads than subjects with anogenital warts and patients infected with one HPV genotype only. A higher HPV viral load was also noted in case of a persisting course of PVI and in patients with high-grade squamous intraepithelial lesions (H-SIL). Conclusion. Women with latent and subclinical forms, persistent PVI course and infected with two or more HPV genotypes of a high carcinogenic risk belong to the high-risk group developing expressed epithelial affections in the cervical mucosa. Quantitative HPV indices exceeding 5 lg of copies of HPV DNA per 100,000 cells belong to unfavorable predictors for the development of intraepithelial affections in the cervical mucosa and stipulate the need to conduct an additional examination (colposcopy or cytology) to exclude their development.

Hereditary epidermolysis bullosa is a big group of hereditary diseases with the main manifestations in the form of blisters on the skin and mucous coat after slight mechanical injuries. It is not always possible to diagnose this disease based on the clinical picture. The article discusses current laboratory diagnostics methods for hereditary epidermolysis bullosa including immunofluorescence antigen mapping (IFM), transmission electron microscopy (TEM) and genetic analysis (molecular or DNA diagnostics) as well as their advantages and disadvantages. TEM determines the micro splitting level and nature of ultrafine changes in the area of the dermoepidermal junction; at the same time, such tests need special expensive equipment. Substantial experience is also needed to analyze the resulting submicroscopic images. IFM determines whether expression of the affected protein related to the disease development is reduced or absent; however, invalid (false positive or false negative) results can be obtained in patients with the reduced expression of the affected protein. Genetic analysis plays a key role for prenatal diagnostics. Therefore, to make an exact diagnosis of hereditary epidermolysis bullosa, it is expedient to apply IFM, TEM and genetic analysis. The need to set an exact diagnosis of the disease is related to the fact that the promising treatment methods being currently developed are aimed at treating patients with certain forms of the disease.

The results of direct open-label study of efficacy and portability of combination therapy with topical betamethasone dipropionate and mupirocin are presented. Material and methods. Twenty two patients with pyoderma complicated eczema were treated with ointment for external use (betamethasone dipropionate and mupirocin) 2 times a day for 14 days. Clinical efficacy was assessed by the reliability decrease of index EASI and dermatological symptoms scale index (DSSI). Results. Clinical convalescense was achieved in all patients by the 14th day of therapy. There was a statistically significant decrease in the indices EASI, DSSI. Portability were well. Conclusion. Our study results showed clinical efficacy and portability of topical combination therapy of betamethasone dipropionate and mupirocin in patients with pyoderma complicated eczema.

The article analyzes the recent data concerning the new trends in the treatment of acne vulgaris of moderate severity using tetracyclines. Low-dose regimen of doxycycline is highly effective against inflammatory and noninflammatory lesions in patients with moderate acne on the face with a minority of side effects.

Acting on the basis of studying regulatory, legal and reporting documents in the field of high-end medical aid, review of operations of certain federal patient care institutions and results of the authors’ clinical studies, the authors attempted to assess the efficacy of a regular stage in high-end medical aid in the field of dermatovenerology at the expense of the federal budget. The article also provides a brief description of directions for further improvement of high-end medical technologies.