Method of treating patients with chronic endometritis and tubal and peritoneal infertility factor

FIELD: medicine.

SUBSTANCE: method involves antibacterial, antimycotic, antiviral therapy taking into account sensitivity and recovered pathogenic flora and/or immune-enhancing therapy. From the 3rd day of the above therapy, local treatment involving the intrauterine insertion of a device for administering a complex of preparations and the prescribed hormone therapy is conducted. The device for administering the complex of preparations is presented by the Foley catheter, which is used to administer Miramistin 5 ml daily, Cefazoline or Ceftriaxone 4-6 minutes later, then Derinate 5 ml 4-6 minutes on even days, Longidaza 3 thousand units on odd days; the procedure is immediately followed by inserting a Miramistin tampon vaginally for 1-2 hours; one capsule of Polygynax is inserted vaginally for the night, whereas the hormone therapy is prescribed after the treatment.

EFFECT: effective treatment of chronic endometritis and prevention of the tubal and peritoneal infertility.

3 ex

 

The invention relates to medicine, namely to gynecology, and relates to the treatment of chronic endometritis and prevention of tubal-peritoneal infertility. Given that patients with chronic endometritis high frequency of tubal-peritoneal infertility, the question arose about the most effective way to treat it. Currently recommended treatment of chronic processes of the pelvic organs during acute or outside for 3 cycles. But applying this therapy does not always produce the expected result and is too expensive for patients.

The known method of treatment of chronic endometritis, comprising administering a therapeutic drug and the subsequent impact on the lower abdomen low-intensity infrared pulsed laser radiation with a wavelength of 0.89 microns, a pulse power of 5 watts, for 10 minutes daily, with the course of treatment 10 treatments. As a therapeutic drug use polyvalent complex pyobacteriophage, which is administered vnutrimatocny in the amount of 4-7 ml, every other day, when the course of treatment 5 treatments, the impact of low-intensity infrared pulsed laser radiation is carried out a frequency of 80 Hz, affecting the radiation and additionally on the projection of the cubital vessels and the jugular notch daily for 2-3 min, when the course of treatment 10 PR�procedures (Patent for invention №: 2493863 Author: Motovilova Tatiana (RU), Kachalina T. Simonova (RU)).

The disadvantage of this method of treatment is that the drug does not fall into the pelvic cavity, which is ineffective for the prevention and treatment of tubal-peritoneal infertility.

The known method of treatment of chronic endometritis with the use of aspiration and washing drainage of the uterine cavity, where the dialyzing solution is used dimexide, hyaluronidase, calendula tincture, solution of novocaine, diphenhydramine (Smetnik V. P., Tumilovich L. G. Non-operative gynecology. A guide for physicians. - M: Medical information Agency, 1998. - 592 p., ill.).

The disadvantage of this method of treatment is that the main constituent of this solution is providing sanitizing action on the mucous membrane of the uterine cavity, is dimexide or dioxidine, which can cause a number of side effects. Dimexide causes nausea, vomiting, bronchospasm, contraindicated in violation of antitoxic liver function, renal function, strokes, may increase the toxicity of certain drugs. Dioxidine gives you a headache, chills, fever, dyspepsia, muscle twitching (Mashkovsky M. D. Medicines: in 2 volumes. Vol. 2. - M.: Medicine, 1990. - 576 p.).

The closest to the claimed invention is a method for treatment of tubal-peritoneal�Oh forms of infertility in women with chronic endometritis including reconstructive endoscopic surgery in the pelvic cavity, characterized in that under the control of the hysteroscope spend intrauterine installation of a medicinal cocktail according to the following scheme: in the first and third days of treatment vnutrimatocny administered prednisolone 30 mg, dioxidine 0.5% solution in a quantity of 50 ml, metrogyl 5.0 ml, hyaluronidase 32 units, an antibiotic based on the sensitivity of the microflora, as a local therapy for the night vaginally administered candle Macmiror morning to douching of the vagina with a solution of chamomile; the second and fourth days of treatment vnutrimatocny administered prednisolone 30 mg, Instillagel 6-11 ml locally in the posterior fornix of the vagina impose tampon, Vishnevsky ointment containing 20 ml at night; on the fifth, seventh and ninth days vnutrimatocny administered dioxidine 0.5% solution in a quantity of 50 ml, metrogyl 5.0 ml, cycloferon 0.5 ml, hyaluronidase 32 UNITS, an antibiotic based on the sensitivity of microflora, on the night of vaginally administered candle Macmiror morning to douching of the vagina with a solution of chamomile, sixth, eighth and tenth days vnutrimatocny administered Instillagel 6 ml, dimexide 5 ml, in the posterior fornix of the vagina is administered swab containing Vishnevsky ointment in an amount of 20 ml per night, at the same time with 1 day of treatment prescribed Wobenzym 5 tablets 3 times a day, for 14 days and cyclic, hormonally�th therapy for 3 months. Application: 2005107156/14, 14.03.2005 of GOU VPO 'Krasnoyarsk state medical Academy Ministry of Health of the Russian Federation" (EN).

The disadvantage of this method of treatment is a large spread of drugs by day and expensive method of treatment.

The main drawback of intrauterine methods of treatment of chronic endometritis - immediate evacuation of the drug substance from the uterus into the vagina and expensive methods of treatment.

The purpose of the invention: to provide an effective method of treatment of chronic endometritis with the prevention of tubal-peritoneal factor of infertility.

This goal is achieved by conducting antibacterial, antifungal, antiviral therapy based on sensitivity and selected pathogens and/or immunostimulating therapy, and 3-day systemic treatment local treatment is carried out by applying as the device catheter is the Foley balloon with which the patient is daily administered 5 ml of Miramistin, then after 4-6 minutes Cefazolin or Ceftriaxone, and then after 4-6 minutes a day 5 ml Derinat or 3 thousand units of longitute, immediately after the procedure put in the vagina a tampon with Miramistin 20-40 minutes then on the night of the vagina is administered one capsule of polignacs, and hormonal therapy is prescribed after the treatment.

In strips�ü uterine catheter is the Foley balloon instead of a conventional catheter, where the medicinal substance immediately flows out of the vagina, and instead of a hysteroscope, which is not available in all gynecological surgeries and expensive for the patient. After a full examination, which includes a smear on flora, crop on flora and sensitivity to antibiotics from the vagina, cervical canal and uterine cavity, detection of genome possible pathogens HAE using the polymerase chain reaction (PCR) to (chlamydia, Mycoplasma, Ureaplasma, Trichomonas, gonorrhea, Gardnerella, HPV, HSV, CMV), were subjected to systemic and local therapy. Was prescribed antibiotics based on the sensitivity and selected pathogenic flora: one dose-Solutab 1 tab. 2 times a day for 10 days + flameclaw of Solutab on 875/125 mg 2 times a day for 7 days, or vilprafen 500 mg 3 times a day for 10 days + flameclaw of Solutab on 875/125 mg 2 times a day for 7 days. Antifungal therapy based on the sensitivity: fluconazole 50 mg 1 time a day - 7 days, then 150 mg 1 time per week 3 months or pimafuzin 1 t 4 times a day for 5-10 days. Antiviral, immunostimulatory therapy drugs Panavir, Viferon 2, genferon 500 thousand units in the form of suppositories according to the scheme per. rect. Bifiform 2 drops 3 times a day - 2 weeks or normoblast 1 sachet 2 times a day for 10 days. Local debridement was performed with a 3-day treatment. Into the uterine cavity with a catheter the Foley gall�Ute bladder syringe in 3-4 ml, which prevents the outflow of the drug substance in the vagina, and the substance gets into the fallopian tubes and pelvic organs, providing a local therapeutic effect. Injected 5 ml of Miramistin, after 4-6 minutes Cefazolin or Ceftriaxone, 4-6 min on even days administered Derinat 5 ml, and on odd days administered 3 thousand units of Lomidze. The first day the procedure is performed under ultrasound control while checking the patency of the fallopian tubes. The vagina immediately after the procedure, put a tampon with Miramistin, and at night polizhinaks.

The proposed method of treatment of patients with chronic endometritis (confirmed morphologically or not) and tubal-peritoneal factor of infertility (inflammatory diseases of the pelvic organs) was used in 50 patients. All women were divided into 2 groups: control (20 people) and basic (30 people). In the 1st control group was used only to systemic drug therapy. Patients of the 2nd group received in addition to the main treatment local therapy as described above. The treatment was given to patients in the acute stage and infertility. The diagnosis was established according to the results of laboratory data, ultrasound of the pelvic organs and velocity imaging, morphological studies. The rate of local therapy was conducted over 10 days. The effect of treatment was observed in �of Directors for 6 months.

Patients of the 1st group was treated for 3 cycles with a change of drugs and still noted the lack of effectiveness of treatment: pain in the abdomen and in the lumbar region decreased, but are still bothering 12 patients, discharge from the genital tract in 4 patients, infertility in 18 patients. Patients of the 2nd group was treated once, while abdominal pain was still present in 2 patients, abnormal discharge from the genital tract in 1 patient. Of the 30 women within 6 months of the pregnancy on their own or by artificial insemination with husband's sperm in 22 women.

Thus, it follows from the foregoing that the effect of combined therapy with local intrauterine treatment, with the obligatory admission of the drug substance in the fallopian tubes and the pelvic cavity superior to conventional drug therapy and reduces the economic costs of the patient, since the treatment of a chronic pelvic appointed for a 3 course.

As an illustration, below are some brief examples:

Example 1

Medoev L. 27 years.

Complaints about the absence of pregnancy within 2 years of regular sexual intercourse, yellowish discharge from the external genital tracts, which appeared about a week ago, pain in the abdomen pulling.

Menstruation from the age of 12, 4-5 days, 30-35 days, regul�rye, moderate, painful the first 2 days.

Sex life from the age of 18. Pregnancy 1, birth alone in 2009.

At the time of inspection the General condition is satisfactory, the skin and visible mucous clean, chronic diseases of the internal organs and systems not noted. Stool, urine output was normal.

Breasts soft, b/WAN.

Gynecological status. NGOs developed correctly, hyperemic; body hair W/type.

In mirrors W/cancer covered the main epithelium; the walls of the vagina and cervix hyperemia, discharge leucorrhoea, profuse.

PV: the Uterus is in ant.fl, mobile, sensitive to palpation, appendages extended from both sides, painful on palpation.

Diagnosis: Infertility 2. Sluggish metroendometritis. Subacute 2-sided oophoritis. Vulvovaginitis. Cervicitis.

Surveyed under the scheme:

The us dated 08.02.13 (day 15 of cycle): M-echo 12, expanding the uterine cavity through the liquid contents of the rights. aicn. - 38*29*30; Lev. aicn. - 39*28*29. Smear: gardn., mucus, yeast. K-CI, cocci. In the crop growth pathog. flora no. The NDP found: - Ureaplasma, Gardnerella VAG.

In scrapings from the uterine cavity by the method of PayPal biopsy for histological analysis of inflammatory infiltrates, consisting mainly of lymphoid elements.

Diagnosis: Subacute 2-sided oophoritis, metroendometritis?

Urogenital ureaplasmosis. The bacteria�territorial vaginosis.

Prescribed treatment:

- One dose-Solutab 1 t * 2 R. in day - 10 days after eating.

- Flameclaw-Solutab 1 t (875/125) 2P. a day to 10 days.

- Fluconazole 50 mg 1 times a day - 7 days. - Bifiform 2 K. * 3 times a day for 10 days.

- Genferon 500 thousand per night.rect to 10 days.

On the third day of systemic therapy started topical treatment for 10 days in the uterine cavity according to the described scheme was introduced: Miramistin - 5 ml, after 5 min - Ceftriaxone 1 gr. divorced in 7-10 ml of physics and R-RA, after 5 minutes, 5 ml of longitute alternated with Derinat 5 ml. every other day. The first day of treatment was carried out under the control of ULTRASOUND studies while checking the patency of the fallopian tubes.

Control tests h-W 4 weeks after treatment.

18.03.13.

No complaints. The condition is satisfactory. Skin and visible mucous clean.

In mirrors: W/cancer clean, mucous, moderate. PV. The uterus is dense, b/WAN, epididymis unremarkable. 21.03.13.

The us dated 21.03.13 G. (21 D. M. ö.): M-echo 11, the endometrium is homogeneous with clear contours, epididymis unremarkable. Pnrm. ureal., garden. - no. Smear yeast. to-Ki. ed., flora - palocz.

M-K at o/Cytology and the scrapings from the uterus by the method of PayPal biopsy for histological analysis - without features, hormones in norm.

Appointed: pimafuzin 1 soup. on the night of the vagina 6 days, examined 1 2 T. R. in �tier 16 and 25 day m ö.

After 2 months the patient occurred independent pregnancy.

Example 2

21.09.2012 G. Murieta N.

Complaints about the absence of pregnancy within 3 years of regular sexual intercourse, profuse discharge from the external genital tract, itching, dragging pain in the abdomen.

Menstruation since the age of 14, for 5 days, after 28-30 days, regular, moderate, painful the first few days. P/menstr. 23.08.2012.

Sex life of 25 years. Pregnancy 1, birth alone in 2009.

At the time of inspection the General condition is satisfactory, the skin and visible mucous clean, chronic diseases of the internal organs and systems not noted. Stool, urine output was normal.

Breasts soft, b/painful. NGOs developed correctly, hyperemic; body hair W/type.

In mirrors W/cancer covered the main epithelium; the walls of the vagina and cervix hyperemia, discharge white, cheesy, rich. PV: the Uterus is in ant.fl, mobile, b/bolezn., the epididymis is enlarged on both sides, painful on palpation.

Diagnosis: Infertility 2. Subacute 2-sided oophoritis.

Colpitis (yeast?). Vulvovaginitis.

Recommended:

The treatment of Candida vaginitis:

- fluconazole 50 mg * 1 p/day - 7 days

- pimafuzin 1 St on the night of the vagina - 9 days.

The turnout week after treatment.

27.11.2012. (7-day m. C.) Complaints only on the absence of pregnancy. P�after treatment itching passed, highlight notes.

In the mirrors of the discharge leucorrhoea, W/uterine bleeding when taking tests:

1. Smear flora.

2. Sowing km/flora and sensitivity. to Antibes.

3. PCR for the trash., mimpl. Hom. and genit., ureal., HSV, CMV, HPV.

4. Ultrasound of the pelvic organs.

5. Blood for hormones 1 and phase 2 and 20-22 4-5 days m. C. 07.11.12.

The us dated 28.11.12 G. (M. 8 day cycle): M-echo 6, rights. aicn. - 39*29*31 Phys. - 12 mm.; lion. aicn. - 37*26*27.

Smear: mucus, yeast. K-CI, cocci.

In seeding the growth of E. coli., sensitive to amoxicillin.

In PCR detected: - Ureaplasma

- Mycoplasma genit.

Diagnosis: Infertility 2.

Subacute bilateral oophoritis.

Urogenital Miko-ureaplasmosis. Cervicitis.

Prescribed treatment:

- Vilprafen 1000 1 t * 2 R. in day - 10 days after eating.

- Flameclaw-Solutab 1 g 2 times a day for 10 days with meals.

- Fluconazole 50 mg 1 times a day - 7 days.

- Terzhinan or polizhinaks 1 T. on the night of the vagina.

- Genferon 500 thousand 1 supp. on the night per.rect.

- Bifiform 2 K. * 3 times a day for 10 days.

On the third day of systemic therapy started topical treatment for 10 days. Into the uterine cavity according to the described scheme was introduced: Miramistin - 5 ml, after 5 min - Ceftriaxone 1 g diluted in 7-10 ml of physics and R-RA, after 5 minutes, 5 ml of longitute alternated with Derinat 5 ml a day. The first day of treatment was carried out under the control of ULTRASOUND studies,�simultaneously checking the patency of the fallopian tubes. 1 month after treatment, the patient is taken control tests. All the tests came back normal. No complaints. Was prescribed hormonal therapy (yasmin) for 3 months. After discontinuing pregnancy through insemination with the sperm of the husband at his own insistence.

Example 3

Helleva K.

Complaints about the absence of pregnancy within 2 years of regular sexual intercourse, yellowish discharge from the external genital tract, abdominal pain pulling.

Menstruation from the age of 12, 4-5 days, 30-35 days, regular, moderate, painful the first 2 days.

Sex life from the age of 18. Pregnancy 1, birth alone in 2010 by cesarean section, complications of postpartum endometritis.

At the time of inspection the General condition is satisfactory, the skin and visible mucous clean, chronic diseases of the internal organs and systems not noted. Stool, urine output was normal.

Breasts soft, b/WAN.

NGOs developed correctly, hyperemic; body hair W/type.

In mirrors W/cancer covered the main epithelium; the walls of the vagina and cervix hyperemia, purulent secretions, rich.

PV: the Uterus is in ant.fl, mobile, sensitive to palpation, appendages extended from both sides, painful on palpation.

Diagnosis: Infertility 2. Sluggish metroendometritis. Subacute 2-sided oophoritis. Vulvovaginitis. �illicit.

Recommended:

1. Smear flora.

2. Sowing km/flora and sensitivity.to Antibes.

3. PCR for the trash., mimpl. Hom. and genit., ureal., HSV, CMV, HPV.

4. Ultrasound of the pelvic organs.

08.02.13.

The us dated 08.02.13 (day 15 of cycle): M-echo 12, expanding the uterine cavity through the liquid contents of the rights. aicn. - 38*29*30; Lev. aicn. - 39*28*29.

Smear: gardn., mucus, yeast. K-CI, cocci.

In the crop growth pathog. flora no. In PCR detected: - Ureaplasma

- Gardnerella VAG.

Diagnosis: Subacute 2-sided oophoritis. Chronic metroendometritis?

Urogenital ureaplasmosis. Bacterial vaginosis. Prescribed treatment:

- One dose-Solutab 1 t * 2 R. in day - 10 days after eating.

- Flags 250 mg * 3 times a day - 5 days with food.

- Terzhinan or polizhinaks 1 T. on the night of the vagina.

- Fluconazole 50 mg 1 times a day - 7 days.

- Bifiform 2 K. * 3 times a day for 10 days.

On the third day of systemic therapy started topical treatment for 10 days. Into the uterine cavity according to the described scheme was introduced: Miramistin - 5 ml, after 5 min - Ceftriaxone 1 g diluted in 7-10 ml of physics and R-RA, after 5 minutes, 5 ml of longitute alternated with Derinat 5 ml a day. The first day of treatment was carried out under the control of ULTRASOUND studies while checking the patency of the fallopian tubes. 1 month after treatment, the patient is taken control tests. All the tests in n�room. No complaints. The pregnancy occurred independently in 4 months after treatment.

Method of treatment of patients with chronic endometritis and tubo-peritoneal factor of infertility, including antibacterial, antifungal, antiviral therapy based on sensitivity and selected pathogens and/or immunostimulating therapy, with the 3rd day of the specified treatments are performed by local treatment, comprising administering to the uterus of the device for the introduction of complex drugs and the prescription of hormonal therapy, as a device for the introduction of complex preparations using the catheter the Foley balloon with which the patient is daily administered 5 ml of Miramistin, after 4-6 minutes Cefazolin or Ceftriaxone, and then after 4-6 minutes on even days injected 5 ml of Derinat, and on odd days 3 thousand units of longitute, immediately after the procedure put in the vagina a tampon with Miramistin for 1-2 hours, overnight in the vagina is administered one capsule of polignacs, and hormonal therapy is prescribed after the treatment.



 

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EFFECT: invention is more flexible, safe and provides the improved dilation and treatment of fibrous damages.

26 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: for treatment and prevention of recurrences of the intrauterine synechiae within the range of pre-implantation preparation of the endometrium, heteroscopy with further installation of the child's Foley catheter into the uterine cavity is performed. The catheter balloon is filled with 2 ml of the physiological solution. The catheter is installed for 7 days, on which instillagel in a dose of 2.5 ml is introduced into the uterine cavity through holes in the distal end of the catheter on 1, 3, 5, 7 day alternating it with introduction of filgrastim in a dose of 100 mcg on 2, 4, 6 days. Instillation is realised at the background of performed hormonal therapy.

EFFECT: effective treatment and prevention of recurrences of the intrauterine synechiae due to activisation of regenerative processes of the endometrium and performing an immunomodulating impact on it with taking into account the terms of ending of a risk of possible adhesion formation.

1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment. A coaxial infusion catheter system comprises a component of an infusion catheter having an infusion section for infusion of a thrombolytic agent into a vascular occlusion or a transplant; as well as a component of an occlusion catheter having an elongated body wherein an expandable occlusion element is attached to a distal end of the elongated body. The expandable occlusion element is made in the form of an unloadable hood comprising two overlapping components and having moveable curtains or overlapping slots. The above components are relatively rotatable and provide depending on a rotation angle either the blood flow in the expanded and closed positions or occlusion of a vessel or the transplant lumen in the expanded and open positions.

EFFECT: providing effective vessel or transplant occlusion in the distal and/or proximal direction in relation to a zone of treatment.

4 cl, 8 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology. The Foley type catheter is introduced into the urinary bladder through the urethra. Inside the urinary bladder a balloon is filled with a solution or gas with a volume not less than 200 ml. A puncture of the anterior abdominal wall, the urinary bladder and the balloon is performed with a trocar in the suprapubic area.

EFFECT: method makes it possible to carry out safe trocar epicystomy in case of extraperitoneal breached integrity of the urinary bladder walls.

2 ex, 6 dwg

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, in particular to vascular surgery, and is intended for transfer of medications onto an internal surface of a vessel wall. A device for transfer of medications onto the internal surface of the vessel wall contains a matrix, made in the form of a polymer film, covered with medication and placed on a flexible framework. The matrix and the framework have specified standard sizes. They are made with a possibility of placement in them of a cellular knitted metal temporary stent and with a possibility to be inside the temporary stent of an inflatable balloon with a fixed diameter and length and a cylindrical or conic shape when blowing under high pressure or a latex balloon with a possibility of filling the entire internal space of the temporary stent when blowing under low pressure.

EFFECT: invention makes it possible to simultaneously perform long-term efficient transfer of medication into the vessel wall with preservation of blood flow and efficient diameter of the affected vessel.

4 cl, 1 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and represents a double-cylinder catheter for obstetrics. The catheter comprises a uterine and vaginal cylinders respectively provided with an axial tube of the uterine cylinder and an axial tube of the vaginal cylinder; the axial tube of the uterine cylinder is coaxial to the axial tube of the vaginal cylinder; it is possible to trace the cylinder distance variations along a longitudinal axis of the device; the vaginal cylinder is attached to a distal end of the axial tube of the vaginal cylinder, while the distal end of the axial tube of the vaginal cylinder is shaped so that to be adjusted to the anatomical cervical contours.

EFFECT: device enables reducing blood loss and collecting the blood lost.

7 cl, 2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for treating sternomediastinitis. That is ensured by introducing a therapeutic mixture prepared ex tempore containing a broad-spectrum antibiotic tropic to bone tissue in a half a compendially recommended average therapeutic daily dose, 1 ml of lidase 32 thousand units, 1 ml of a lincomycine solution in a dose of 0.3 g, 1 ml of ketorolac tromethamine in a dose of 0.03 g, 1 ml of dexamethasone solution in a dose of 0.004 g, 1 ml of a 10% lidocaine solution and 5 ml of a 40% glucose solution. The therapeutic mixture is administered into interspinous ligaments of the spinal column at Th2-Th3, Th3-Th4, Th4-Th5, at a depth of 1.5-2 cm in a dose of 3 ml into each injection point into a patient lying on his/her side with bringing the knees to the stomach and bending the head as forward as possible. The length of treatment makes 12-14 days with the first 3 injections performed daily; the residual injections - every second day, 8-9 injections in total.

EFFECT: invention provides reducing a dose of the administered preparations and a rate of administration as compared to the systemic antibacterial therapy by an ability of the administered mixture to be accumulated in the inflammation centre, providing the therapeutic concentration with the total dose of the administered preparations reduced as compared to the systemic antibiotic therapy.

2 ex

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