Igor Gladchuk
@onmedu.edu.ua
Obstetrics and Gynecology
Odessa National Medical University
EDUCATION
Ternopil State Medical University, Ukraine
RESEARCH INTERESTS
Endometriosis
Myoma
Oncology
Cerrvix pathology
Endocrinology
Endoscopic surgery
Infertility
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Dmitrii Sumtsov, Georgyi Sumtsov, Nataliia Hyriavenko, Mykola Lyndin, Kateryna Sikora, Nataliia Kalashnik, Svitlana Smiian, and Igor Gladchuk
Springer Science and Business Media LLC
Gulsym S. Manasova, Yana A. Stasy, Vyacheslav V. Kaminsky, Igor Z. Gladchuk, and Ekaterina A. Nitochko
ALUNA
Aim: To make a systematic review and meta-analysis of published data on the study of histological and immunohistochemical features of the placenta in women who had acute coronavirus infection associated with SARS-CoV-2 (“Covid” placentas) during pregnancy. Materials and Methods: The search for literature data is based on the PRISMA methodology); the MEDLINE database (PubMed®) was searched using Medical Subject Headings terms from January 2020 to July 2023. The project was registered in the Open Sience Frame (Project Identifier: DOI 10.17605/OSF.IO/GDR3S, Registration DOI: https://doi.org/10.17605/OSF.IO/H2KPU). Preference was given to studies in which the description of placentas met the requirements of the Amsterdam Placental Workshop Group Consensus Statement. Results: A total of 31 studies were included; the number of participants whose morphological and histological description of the placentas could be subjected to meta-analysis was 2401, respectively, in the group with a “Covid” history and 1910 – conditionally healthy pregnant women. Pathological changes in the placental complex were not detected in 42±19.62% of pregnant women with a history of Covid. Immunohistochemical examination of placentas preferably focuses on the detection of SARS-CoV-2 spike protein or ACE2. According to currently available studies, in the placentas of women who have had COVID-19 during pregnancy, there are no pathognomic histological patterns specific to this infection and direct damage to the placenta is rarely observed. Histological patterns in “covid” placentas are isolated, most often a combination of lesions in both the maternal and fetal malperfusion. Conclusions: According to currently available studies, in the placentas of women who have had COVID-19 during pregnancy, there are no pathognomic histological patterns specific to this infection and direct damage to the placenta is rarely observed. The probability of infection of the intrauterine fetus by the transplacental hematogenous route is the lowest compared to other routes, which, in our opinion, is a possible explanation for the high frequency of MVM without subsequent infection of the fetus.
I.Z. Gladchuk, D.A. Kiriakova, O.E. Sidak, and V.L. Kozhakov
Professional Event, LLC
The article is devoted to a review of scientific publications on the use of the Indocyanine green (ICG) labeling technique in modern pelvic surgery. This dye was developed by Kodak Research Laboratories in 1955 and approved for clinical use in 1959, but has only recently come into widespread use. ICG-enhanced near-infrared fluorescence is introduced to improve visualization and provide more detailed anatomical localization during surgery.The dye binds to blood plasma proteins, it is quickly excreted from the organism and is non-toxic and has no found complications after its administration. Many studies have been conducted on the use of this technique: visualization of sentinel lymph nodes (SLN) in various oncogynecological diseases; visualization of ureters, lymphatic drainage, tissue perfusion, vessels of various sizes, colorectal blood circulation, etc. The high detection rate of SLN (unilateral and bilateral) with ICG compared with other dyes such as radiocolloid and patent blue suggests its effectiveness.The condition of SLN has an important prognostic and therapeutic value, based on the obtained results, a more correct further adjuvant treatment can be prescribed. A sentinel lymph node labeling procedure was performed as an alternative to systemic lymphadenectomy to assess the status of lymphovascular invasion. The use of ICG-marking allows to reduce the risk of intraoperative and postoperative complications. Many experimental studies have been conducted in relation to the assessment of uterine vascularization, preservation of individual vessels, their identification and measurement of blood flow.The article provides data from scientists on the use of the ICG-marking technique in endometrial, cervical, vulva, vaginal, ovarian cancer, as well as in endometriosis and for visualization of the ureters. This technique causes active discussions in the scientific community, requires further research and should be more widely used in various directions of surgical interventions.
Dmitrii SUMTSOV, Georgii SUMTSOV, Natalia HYRIAVENKO, Mykola LYNDIN, Kateryna SIKORA, Volodymyr KOLYSHKIN, Yulia REDKO, and Igor GLADCHUK
Galenos Yayinevi
Hemangioma in female reproductive organs, particularly in the fallopian tube (FT), is a sporadic disease. In this report, we describe a case of hidden capillary hemangioma in FT in a 39-year-old woman who suffered from uterine leiomyoma. During the preoperative stage, pelvic sonography, computed tomography, and diagnostic laparoscopy revealed a subserous leiomyomatous nodule located along the posterior wall of the uterus. Despite this, intraoperatively, a benign vascular neoplasm was diagnosed. Histologically, it is characterized by multiple thin-walled vascular spaces lined with a single layer of endothelial cells, in which single mitoses were observed. The diagnosis was then confirmed immunohistochemically by CD31 and CD34 expression in the endothelial cells lining the inner surface of the spaces and the low mitotic activity of the tumor cells. It is virtually impossible to diagnose this asymptomatic neoplasm before and during surgery, which can result in an inadequate number of surgeries. Incorrect interpretation of a benign tumor at a young age can lead to unnecessary radical surgery with a resulting loss of fertility, and an unrevealed malignant process can threaten life.
I. Z. Gladchuk, N. M. Rozhkovska, and O. S. Saleh
Publishing House Helvetica (Publications)
О.С. Салех, D.M. Zhelezov, I.Z. Hladchuk, and A.G. Volyanska
Publishing Office TRILIST
Research objectives: to develop an algorithm for predicting the growth of uterine fibrodis, taking into account the state of epigenetic regulation.Materials and methods. The study was conducted on the basis of clinical divisions of the Department of Obstetrics and Gynecology in 2018–2021. 28 patients with uterine fibroids were examined. Expression of miRNA-29b and miRNA-146a in tumor tissue was determined in all women using real-time PCR. Obtained data were analyzed using the statistical program Statistica 10.0 (StatSoft Inc., USA).Results. The average age of the patients was 39.3 ± 1.0 years. The average number of nodes was 2.7 ± 0.4. The expression levels of microRNA-29b were most frequently determined in the range of 2–7 units and microRNA-146a in the range of 30–67 units in most of the examined tissue samples. The expression of miRNA-29b has the greatest significance for the growth forecast (Wald statistic). According to the logistic regression equation the prognostic factors are patient’s age, estradiol and progesterone level in the I and II phases of the menstrual cycle, diameter of the largest node, expression of miRNA-29b and miRNA-146a.Conclusions. This study shows that the use of miRNA expression profile as an additional marker in the diagnosis and treatment of uterine fibroids is promising and requires more detailed research. Further study of the correlation of clinical and paraclinical parameters can make it possible to predict the course of uterine fibroids, and therefore to apply an effective personalized treatment plan. Theranostics is a new approach to the diagnosis and treatment of patients, based on the uniqueness of each person in order to choose the optimal treatment strategy against the background of the molecular genetic technologies, in particular to determine epigenetic changes in hyperproliferative diseases. The study of miRNA expression may find its place in the theranostics of uterine fibroids in the future.
I.A. Ancheva, I.Z. Gladchuk, E.M. Mokriienko, N.V. Movlyanova, and N.V. Lazor
Professional Event, LLC
Today, in the education system, an important opportunity for higher education applicants is the right to form an individual educational trajectory according to the relevant qualification level. Higher education seekers have received not only academic mobility but also the opportunity to study disciplines to consciously choose their specialty and study it more deeply. The skills of ultrasound diagnostics increase the professional level of a doctor of any specialization and open wide diagnostic possibilities.The article reveals the peculiarity of studying one of the subjects of free choice by medical higher education applicants on the basis of Odesa National Medical University – “Ultrasound Diagnostics in Obstetrics and Gynaecology”. The adaptation of the educational process in a mixed format with the possibility of using digital learning technologies and mastering professional skills on ultrasound machines of different classes is described. In the course of studying the discipline, the necessary basic digital skills of using an ultrasound scanner and knowledge of the main visualization modes, adjustment principles, as well as sets of functional capabilities inherent in all modern devices are formed.The method of presentation of theoretical information and the use of case scenarios during the discussion of clinical tasks with mandatory visualization of ultrasound video recordings is described. The applicants’ digital skills are directly related to the course being studied and are necessary to master the proposed professional field. The possibility of learning using the latest medical equipment in combination with the use of digital learning tools and video resources contributes to the acquisition of professional competence and the formation of responsibility and interest of students. In the process of training manual scanning skills, the doctor’s thinking and the ability to analyze and interpret the received ultrasound data are formed. Practical classes help to discuss the most interesting issues for this specific group of higher education applicants in a comfortable and trusting environment. The use of a combined approach in the presentation of the material, the author’s style and the format of the transfer of professional skills by experienced teachers who are engaged in constant practical activities motivate, improve the training process and give a high result.
I.Z. Hladchuk, N.M. Rozhkovska, V.H. Marichereda, I.S. Lomakina, I.V. Shpak, and D.M. Zhelezov
Publishing Office TRILIST
Objectives: evaluation of changes in the endometrial-myometrial junction (EMJ) in the combined pathology of the endometrium and myometrium.Materials and methods. 50 perimenopausal women with combined pathology of the endometrium and myometrium (main group) were examined. The control group consisted of 30 practically healthy women of the same age who were examined for the male factor of infertility. All patients underwent a comprehensive examination, which included clinical and paraclinical research methods.Patients were examined using transvaginal ultrasound. The DEERS (Diseases of Endometrium – Evaluation and Risk scoring System) index was used for the integral assessment of the endometrium and myometrium state.Results. The average age of women was 43.4 ± 1.2 years. The combination of endometrial hyperplasia (EH) and intramural uterine myoma was found in 58.0% of cases, EH and submucous uterine myoma – in 14.0%, EH and endometrial polyps – in 10.0%, EH and external peritoneal endometriosis – in 12.0%, EH and adenomyosis – in 4.0%, EH, adenomyosis and uterine fibroids – in 2.0%.The blood flow rate in the uterine arteries in the main group was 38.8 ± 0.6 cm/s, resistance index – 0.8 ± 0.04, pulsation index – 1.3 ± 0.1. In the control group the blood flow rate in the uterine arteries was 42.2 ± 0.8 cm/s without a clear difference of the sides, the resistance index – 0.9 ± 0.1, the pulsation index – 1.2 ± 0.1 (p > 0.05).The total DEERS score in the main group was 13.2 ± 0.4 points, in the control group it was 7.3 ± 0.7 points. In the vast majority of cases (88.0%) EMJ was not involved in the pathological process. The average thickness of the EMJ in women from the control group was 0.45 ± 0.05 cm, in the main group – 0.42 ± 0.03 cm. At the same time, 36 (72.0%) women with combined pathology of the endometrium and myometrium had signs of hypomobility EMJ.Conclusions. EMJ was not involved in the pathological process in the vast majority of patients with combined pathology of the endometrium and myometrium. At the same time, some women with combined pathology of the endometrium and myometrium showed signs of hypomobility of the EMJ.
I.Z. Hladchuk, N.M. Rozhkovska, V.O. Sytnikova, I.V. Shpak, and S.M. Syvyi
Publishing Office TRILIST
Оbjectives: to assess the clinical and pathomorphological features of ovarian endometriosis and adenomyosis in women of reproductive age in order to determine possible causes of fertility disorders and ways to correct them.Materials and methods. 87 patients were examined and divided into 2 groups. The first group included 45 (51.7%) patients with adenomyosis with or without concomitant pathology. The second group included 42 (48.3%) women with ovarian endometriomas. The control group consisted of 30 healthy women of childbearing age who were screened for male infertility.Results. Clinical examination of the patients revealed a high frequency of gynecological (uterine fibroids, endometrial hyperplasia, infertility) and extragenital pathology. Obstetric and gynecological history was burdened by reproductive losses (involuntary and medical abortions, ectopic pregnancy), premature birth, preeclampsia, abnormal uterine and obstetric bleeding, and pelvic surgery. All patients underwent endoscopic treatment (laparoscopy, hysteroscopy). Morphological examination revealed features of the structure of endometrioid cysts, which explains the decrease in ovarian reserve, active adenomyosis, reactive hyperplasia and chronic endometritis, distortion of the uterine cavity by fibroids. This may play an important role in implantation and placentation.Conclusions. Features of morphogenesis of ovarian endometrioma, found by us cystic and glandular-cystic forms may form the basis of endometrial microperforation pathogenesis, development of adhesions of the pelvic organs (in every third woman), ectopic pregnancy, fibrotic adjacent endometrioid tissue and reduction of ovarian reserve. The peculiarities of the uterus histostructure in adenomyosis, frequent combination with uterine fibroids, endometrial hyperplasia, chronic endometritis, ovarian endometriosis, deep infiltrative endometriosis, old age, aggravated obstetric anamnesis and the history of obstetric disorders may be related.
I.Z. Gladchuk, N.M. Rozhkovska, and N.M. Kashtalian
SE Dnipropetrovsk Medical Academy of Health Ministry of Ukraine
The last decades showed the worldwide tendency to finding consensus between diagnostics improvement and constant increase of cost of medical services in conditions of restricted financing. The aim of the article was to analyze the diagnostic value of p16 and Ki-67 biomarkers in diagnostics of precancerous diseases of cervix. Data of 80 patients with cervical dysplasia of varying degree who received excisional treatment were analyzed. It was shown that cytological study has a high sensitivity (79.17%) for the diagnosis of CIN 2-3, but low specificity (53.57%). The p16 immunocytochemical biomarker has a high sensitivity for the diagnosis of CIN 2 (0.92; 95% CI: 0.76-0.98) with good specificity (0.78; 95% CI: 0.67-0.82), for the diagnosis of CIN 3 both sensitivity (0.93; 95% CI: 0.82-0.98) and specificity (0.93; 95% CI: 0.82-0.98) is high. The immunocytochemical biomarker Ki-67 has a high sensitivity for CIN 2 (0.92; 95% CI: 0.65-0.99), but insufficient specificity (0.62; 95% CI: 0.54-0.64), for the diagnosis of CIN 3 the sensitivity is very high (0.96; 95% CI: 0.80-0.99) as well as specificity (0.78; 95% CI: 0.69-0.81). The combined use of p16 and Ki-67 biomarkers can significantly increase the diagnostic accuracy of the diagnosis of high-grade precancerous pathology of cervix and justify timely surgical intervention. Such an approach for the differential diagnosis of severe dysplasia, on the one hand, may contribute to a decrease in the risk of developing cervical cancer, and on the other hand, it will allow to avoid unnecessary operations and preserve reproductive function of women, reduce the economic costs of treatment.
I.Z. Gladchuk, I.Z. Gladchuk, and N.M. Kashtalian
Publishing Office TRILIST
Aim of the study. Comparative analysis of the results of cervical epithelial neoplasia (CIN) I and II levels (p16ink4a-negative) (LSIL in LAST terminology) treatment against the background of highly oncogenic HPV infection using cold plasma ablation and immunomodulatory therapy with Аllokin-alpha.Materials and methods. We examined 60 women who received treatment for CIN I and CIN II (p16ink 4A negative) at the Multidisciplinary Medical Center of Odessa National Medical University. All women were of reproductive age, had mild dysplasia, high-risk HPV infection (HPV 16, 18, 31, 45) and histological confirmation of CIN I and CIN II (p16ink 4A negative). The patients were divided into 2 groups: 1 (main) group consisted of 30 women who received cold plasma ablation of cervical dysplasia in combination with immunomodulatory therapy with Аllokin-alpha (1 mg subcutaneously every other day, 3 injections before surgery and 3 injections after ablation), Group 2 (control) consisted of 30 patients who received standard cold plasma ablative treatment without prescribing immunomodulators. All women underwent cytomorphological examination of the cervical epithelium, HPV testing by RealTime PCR and colposcopy with mandatory targeted biopsy at the preoperative stage.Results. The use of combined cold plasma ablative treatment of CIN I and CIN II (p16ink 4A negative) in combination with the administration of the immunomodulator Аllokin-alpha significantly reduced the duration of discharge after ablation to 5.44 ± 1.03 days (95% CI: 4.96–6.05), the timing of epithelialization is up to 29.31 ± 1.12 days (95% CI: 26.81–32.32), and to exclude cases of recurrence of genital warts and cervical keratosis. Chances of HPV elimination 6 months after treatment (OR – 5.48; 95% CI: 1.56–29.03; p = 0.0075) and 12 months after treatment (OR – 15.48; 95% CI : 2.05–136.45; p = 0.0094), significantly higher with the combined with immunomodulation method of treatment, in contrast to only cold plasma ablation.Conclusion. Combined, with the use of cold plasma ablation and immunomodulation by perioperative management of Аllokin-alpha, LSIL treatment against the background of highly oncogenic HPV infection in women of reproductive age is accompanied by better functional results, compared with the use of cold plasma ablation alone: reduction in the duration of discharge, acceleration of epithelialization, normalization of the colposcopic and cytologic picture, decrease in the frequency of relapses, a significant increase in the frequency of HPV elimination.
I. Z. Gladchuk, V. G. Marichereda, V. P. Mishchenko, N. M. Rozhkovska, G. S. Manasova, and M. V. Shapoval
Odessa National Medical University
This year the Department of Obstetrics and Gynecology of Odesa National Medical University celebrates 120 years of its foundation. The Department of Obstetrics, Women’s and Children’s Diseases was organized on June 13, 1902 on the basis of the Medical Faculty of Novorossiysk University and became the first department in the south of Ukraine. During this historical period, the Department of Obstetrics and Gynecology has undergone significant changes, but its glorious history has always been detected to development of obstetrics and gynecology in the country. Today it is one of the most famous departments not only in Ukraine, but also in the whole obstetric and gynecological community of European and world scientific circles. The traditions of the predecessors are now continued by scientists of the department. Key words: Odesa National Medical University, Department of Obstetrics and Gynecology, 120 years.
D.G. Sumtsov, I.Z. Gladchuk, G.O. Sumtsov, N.I. Hyriavenko, M.S. Lyndin, V.V. Sikora, and V.M. Zaporozhan
Publishing Office TRILIST
To date, the reliable diagnoses primary fallopian tube cancer (PFTC) before surgery range from 0% to 10–15%. Number of misdiagnosis even during operations reaches 30–50% and PFTC is often disguised as innocent hydro-hematosalpinx or other diseases.Research objective: to study the possibilities of PFTC diagnosis during laparotomy and laparoscopy, macroscopic examination of removed macrodrugs, suboperative use of morphological studies, problems of histological interpretation of PFTC after surgery.Materials and methods. During the period from 1966 to 2020 authors of article selected and retrospectively studied quite informative medical histories of 105 patients with PFTC aged 34 to 78 years (mean age 55.8 years). All patients were operated. Revision of the pelvic organs and abdominal cavity was performed during operations. Removed macrodrugs were examined macroscopically and histologically. According to the indications during operations histological and cytological methods of rapid diagnosis were used. Immunohistochemical methods were used to interpret rare and difficult to diagnose tumors after surgery.Results. Only 7 (6.6%) from 105 patients with PFTC was not recognized during surgery, and 18 (17.1%) were diagnosed only after suboperative histological examination. Errors during operations in the initial PFTC forms (without careful study of macrodrugs and suboperative morphological examination) can reach 23.8%. Problems with the primary lession interpretation, which arose in 11 (10.5%) patients with a pronounced tumor process, did not prevent the choice of adequate surgery. The tumor dissemination of the fallopian tube outside was detected in 69 (72.4%) patients, in 25 (26.2%) among them there were lymph node metastases.Conclusion. Careful revision of the abdominal organs and macroscopic examination of removed drugs using suboperative morphological studies avoids errors in the diagnosis and surgical treatment of patients with PFTC.
Dmytro H. Sumtsov, Igor Z. Gladchuk, Nataliia M. Kashtalian, and Georgiy O. Sumtsov
ALUNA
The aim: To analyze contemporary practical means to improve diagnostics of primary fallopian tube cancer. Materials and methods: Authors analyzed specifics of clinical signs and anamnesis in 152 PFTC patients. Diagnostic capacity of cytological analysis of pathologic vaginal discharge, X-ray contrast methods of examination, sonography, tumor markers, and computed tomography was studied. Own results of PFTC diagnostics using different methods and world practice using MRI, PET-CT and laparoscopy were discussed. Results: Using own observations authors conclude that clinical analysis and complex use of the listed methods allows to mainly determine high risk group patients and set correct preoperative diagnosis in 35% and preliminary diagnosis in 20% of PFTC patients. Conclusions: Complex examination allows to recognize primary fallopian tube cancer on preoperative stage and to avoid inadequate surgical interventions in majority of PFTC patients.
Igor Z Gladchuk, Igor V Shpak, Yuriy V Herman, and Darya O Hrhurko
ALUNA
Introduction: According to the WHO, obstetric bleeding keeps a leading position among the top three causes of maternal mortality. The incidence of abnormal blood loss (BL) varies widely from 1.5% to 22%, and the incidence of acute blood loss reaches up to 1,7%, with the variation from 0% to 4%. Every year, this complication causes death in 128 women that amounts to 1.7% per 1,000 deliveries The aim of this study is a comparative analysis of intraoperative blood loss during the classical cesarean section described by M. Stark and modified cesarean section was performed. Materials and metods: The study has been conducted on the basis of the Obstetrics department of the Kherson regional clinical hospital. Patients were selected according to the type of surgery (the classical technique described by M. Stark or the modified method) for the period from 2015 to 2018. The formation of the clinical groups was performed in accordance with the retrospective data retrieved from the labor and delivery records of 205 patients, who delivered via cesarean section. The comparative estimation of intraoperative blood loss volumes was carried out using a direct (gravimetric) method. Results: The proposed modification of abdominal delivery is based on the rational teamwork of a surgeon and an assistant, with the modernization of the surgical stages allowed halving the surgery duration as compared to the classical cesarean section technique introduced by M. Stark. Аnd the improved surgical technique of abdominal delivery contributes to the reduction in the volume of intraoperative blood loss by 200 ml (p < 0,001). Conclusions: Modified cesarean section allows avoiding massive obstetric hemorrhage, thereby creating an additional reserve for improving the safety of the operative delivery in general.
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INDUSTRY EXPERIENCE
35 years as ObGyn specialist
30 years in science of ObGyn speciality
SOCIAL, ECONOMIC, or ACADEMIC BENEFITS
In 2009 was awarded the Order of Merit, III degree