Search

Purpose of research. To analyze reproductive outcomes and relapses of endometriosis in women after surgical treatment of colorectal endometriosis depending on hormonal therapy.Materials and methods. The article includes data on reproductive outcomes and recurrence of endometriosis in women undergoing surgical treatment for colorectal endometriosis in the surgical department of Kulakov National Medical Research Centre for Obstetrics, Gynaecology and Perinatology from 2014 to 2016. As an anti-relapse therapy, the first group of women received dienogest (DNG) at a dose of 2 mg/day, the second group included women who received a combined oral contraceptive containing DNG 2 mg + ethinyl estradiol (EE) 0.03 mg for the period of rehabilitation or prior to planning of pregnancy. The comparison group consisted of women who did not receive hormonal drugs in the postoperative period. Data on side effects and tolerability of the drug are also described.Results. During the follow up period from 12 to 48 months, 51 patients were selected for this study, 14 patients were included in the first group, 18 patients were in the second group, 19 patients were in the comparison group. There were no differences in the overall rate of pregnancy depending on the choice of tactics of postoperative management. The highest number of pregnancies (92.3%) occurred during the first year after surgery, which suggests the effect of the duration of hormone therapy on the probability of pregnancy. The lowest number of relapses was registered in the group of long-term monotherapy of DNG. In the group of DNG monotherapy a greater number of side effects were noted, which in most cases did not cause significant discomfort to patients.Conclusion. Long-term administration of DNG at a dose of 2 mg/day after surgical treatment of colorectal endometriosis is an effective means of preventing relapses with good tolerability. However, in some women planning a pregnancy, it may be rational to abandon hormone therapy in favor of earlier pregnancy planning.

Most of the tens of millions of clinical attacks caused by Plasmodium vivax each year likely originate from dormant liver forms called hypnozoites. We do not systematically attack that reservoir because the only drug available, primaquine, is poorly suited to doing so. Primaquine was licenced for anti-relapse therapy in 1952 and became available despite threatening patients having an inborn deficiency of glucose-6-phosphate dehydrogenase (G6PD) with acute haemolytic anaemia. The standard method for screening G6PD deficiency, the fluorescent spot test, has proved impractical where most malaria patients live. The blind administration of daily primaquine is dangerous, but so too are the relapses invited by withholding treatment. Absent G6PD screening, providers must choose between risking harm by the parasite or its treatment. How did this dilemma escape redress in science, clinical medicine and public health? This review offers critical historic reflection on the neglect of this serious problem in the chemotherapy of P. vivax.