A method of treating chronic trichomonas of endocervicitis

 

(57) Abstract:

The invention relates to medicine, namely to dermatology and gynecology. A method for treatment of Trichomonas endocervicitis, consisting alternately of vibratory massage with vacuum aspiration of the endocervix and the instillation of 20 ml of 3% hydrogen peroxide solution, 3-5 times for each procedure, and then carrying out the electrophoresis solution of chymotrypsin 5 mg per 100 ml of saline and 1 ml of Dimexidum. The method allows to increase the effectiveness of treatment of chronic Trichomonas of endocervicitis.

The invention relates to medicine, namely to dermatology, and can be used in dermatological, gynecological, physical therapy offices, and the offices of hospitals, polyclinics.

Chronic Trichomonas endocervicitis (HTA) is one of the most commonly diagnosed diseases in dermatological practice. Currently, for the treatment of HTA used combined therapy with the following drugs and methods: causal (metronidazole, tinidazole, tiberal, African, natsagiin, makmiror), immunocorrective (pyrogenes, polyoxidonium, cycloferon, methyluracil and others ), farms the local instillation of drugs), physiotherapy (medicinal electrophoresis, laser therapy and other). [1, 2, 3, 4].

But these methods have significant drawbacks, as HTA, accompanied by cysts of the endocervix, which can serve as a reservoir of latent infection [5], are ineffective due to the inability of the drainage and rehabilitation of these encysted cavities drugs entered as transvaginal (cervical), and applied systemically (oral, parenteral) and physiotherapy.

We conducted an ultrasound of the cervix with the use of transvaginal access (TUSI) has allowed to establish that kitoobraznye the micro-cavities are found in 60% of patients with HTA, and 27% are localized in the upper third of the endocervix.

The authors first developed a method for the treatment of HTA, including etiotropic therapy, instillation of drug substances and medicinal electrophoresis, characterized in that before electrophoresis alternately conduct vibratory massage with vacuum aspiration of the endocervix and the instillation of sterile disinfecting solution 3-5 times each procedure.

For the implementation of vibratory and transcervical vacuum aspiration we bit aetsa as follows.

Position the patient is lying on the gynecological chair. External genitals and the cervix, derived with the help of a mirror Cuzco, processed sterile swab moistened with disinfectant.

After the introduction of sterile cervical tip into the cervical canal, the diameter of which is chosen according to the size of the external OS, include electromassage VP-1 (vibration frequency of 30-50 Hz) and a vacuum pump ALP-02. The magnitude of the underpressure in the cervical tip is adjusted according to the indications of the gauge of the pump and must not exceed 0.4 kg/cm2.

Vibratory massage and vacuum aspiration of the cervical canal carried out alternately with the transcervical instillation of 3% hydrogen peroxide solution and 20 ml disposable syringe through the cervical tip 3-5 times each procedure.

The duration of the treatment 7-10 minutes.

The next step is medicinal electrophoresis solution of chymotrypsin 5 ml (5 mg per 100 ml of physiological solution) and Dimexidum 1 ml using the combined vaginal-cervical electrode.

Side effects and complications are not marked.

The method is atraumatic, ease of implementation and vseobecna technology pathogenetic treatment of HTA is performed prior to and in conjunction with etiotropic therapy.

Contraindications:

- pregnancy;

- menstruation;

- metrorrhagia;

- tumors of the urogenital sphere.

The study included 82 patients with HTA, accompanied by cysts of the endocervix in age from 18 to 46 years, with disease duration from 6 months to 5 years. 40 of them (49%) had PID, 41 people (50%) of the uterine cervix, 42 patients (51%) were unsuccessfully treated with 2 or more different means and Antiprotozoal antibiotic.

Examination of patients included clinical methods, including colposcopy (colposcope COP), TUSI (apparatus Pie Medical 200 with sectoral multiplerows sensor), cytomorphological, microbiological and molecular-genetic (PCR) study of the content of the cervical canal.

Observed were divided into 2 groups of 41.

Patients I (main) group 1 treatment stage (prior to the appointment of Antiprotozoal drugs) HTA before combined vaginal-cervical electrophoresis for dewatering and rehabilitation of the endocervix held vibratory massage and vacuum aspiration of the cervical canal by the developed device Vibraspirit cervical (VAC), alternating with endocervical in the endocervical the instillation of 3% solution of hydrogen peroxide and combined vaginal-cervical electrophoresis solution of chymotrypsin and Dimexidum.

On the 2nd stage of treatment (7-10 days) patients in both groups were prescribed Antiprotozoal drugs, taking into account the sensitivity of Trichomonas them in vitro.

TUSI-monitoring was performed every 7 days of therapy. Evaluation of the clinical status and the control of the cure trichomoniasis was carried out for 2 menstrual cycles after the end of treatment (smear, culture, PCR).

Conducted comprehensive therapy using the developed method for the treatment of HTA has resulted in patients of the 1st group etiological cure - 37 people (90%), clinical -39 people (95%), disappearance of cysts endocervical 37 people (90%). Patients 2 groups of etiological cure occurred in 20 people (50%), clinical - 31 persons (75%) 39 (95%) remained cysts of the endocervix.

Thus, the application of the developed method for the treatment of one of the steps in the treatment of HTA can significantly improve therapeutic effect, promotes the rehabilitation of patients with PID.

Example 1.

Patient L. K., 26 years old, came in MC "Medical practice" with complaints about dragging pain in the abdomen, the allocation of yellow color from the vagina.

During the year was year 3 and chlamydia.

The single, unprotected sex during the year denies.

Objective examination:

- mirrors: the pseudo diameter of 1.5 cm, pussy discharge from the cervical canal;

- bimanual examination was determined swollen, moderately painful appendages on the left.

Colposcopy: glandular uterine cervix, diffuse colpitis.

When TUSI: the body of the uterus is normal in size 4,83,04,3 see the Contour smooth, homogeneous structure. Cavity linear form. Endometrium 1 cm 2 corresponds to the phase of the cycle (26 day cycle). In the thick of the cervix at the level of the internal OS, anechoic mass with education diameter 5.0 and 6.0 mm (echoprint cysts of the endocervix). The right ovary 3,42,0 cm left ovary 3,32,0 see the Structure of the ovaries is not changed. Volumetric educations in the field of appendages is not revealed.

Smear: the scraping of the cervical canal: Trichomonas, gonorrhea, gardnerelly, fungi of the genus Candida are not detected; the number of leukocytes 20-40-60; the epithelium is a significant number; mucus - a significant number, found bacilli, cocci.

Seeded on tvaginalis: detected Trichomonas, sensitive to the combination of deflamon with makeroom, moderately the růžena DNA of C. trachomatis.

On the basis of complaints, anamnesis and clinical-laboratory examination established the diagnosis of urogenital trichomoniasis, chlamydia complications, chronic left-sided salpingo-oophoritis, endocervicitis, glandular-cystic uterine cervix, cysts of the endocervix.

Held the following treatment:

- Polyoxidonium 0,006/m by day 10.

Vibratory with vacuum aspiration of the endocervix, alternating with endocervical the instillation of 3% hydrogen peroxide solution 3-5 times 1 time per day for 14 days.

- Vaginal-cervical electrophoresis solution of chymotrypsin with Dimexidum 1 time a day for 20 minutes to 14 days.

On the 7th and 14th day of treatment was conducted by TUSI-monitoring.

TUSI on the 7th day: endometrium 1 cm 2 corresponds to the phase of the cycle (day 18 of the cycle). In the thick of the cervix is visualized one anechoic mass with the formation, diameter 4 mm

TUSI on the 14th day: the structure of the cervix homogeneous. Echo signs of cysts of the endocervix is not marked.

Then proceeded to the second stage - etiotropic therapy:

- Deflamon 0.5% of 100 ml 3 times a day/drip in 5 days.

- Makmiror table 2. 2 times inside 10 days.

- Rovamycin 3 million 3 times inside 10 days.

.

- Twice conducted the processing of pseudo-colovaginal.

During two menstrual cycles (day 6) had a control of clinical and laboratory research.

This observed had no complaints, gynecological examination found complete resolution of the inflammatory process in the uterus, the cervix epithelials, which is confirmed by a control colposcopy, TUSI structure cervical homogeneous, smears and crops from the cervical canal and vagina t.vaginalis is not detected by PCR in cervical scrapings C. trachomatis DNA was not detected.

Example 2

Patient T. A., 34, turned in MC "Medical practice complaining of periodic nagging pain in the lower abdomen, mainly in the right iliac region within 6 months.

History: determe-electrocoagulation of uterine cervical cancer, chronic salpingo-oophoritis. Married. Menstrual function is not compromised. Husband suffers urogenital trichomoniasis, chronic uretroprostatitis. Undergoing treatment.

An objective examination:

- mirrors: multiple Ovuli Nabothi;

- bimanual study found discard malinich sizes 5,73,85,2 see The contour smooth, homogeneous structure. Cavity linear form. Endometrium 1 cm 2 corresponds to the phase of the cycle (day 16 of cycle). In the thick of the cervix is visualized anechoic mass with a single education: in the upper third of 4 mm, in the middle third of 3 mm, in the lower third 5 mm (echoprint cysts of the endocervix). The right ovary 3,42,0 see the Left ovary is not signed.

Smear: the scraping of the cervical canal: Trichomonas, gonorrhea, gardnerelly, fungi of the genus Candida are not detected; the number of leukocytes 60-70; epithelium - moderate amount; mucus - a significant number, found bacilli, cocci.

Seeded on t.vaginalis was detected Trichomonas, sensitive to the combination of macmiror with Nakajima, tiberal, tinidazole, deflamon; moderately resistant to the combination of macmiror with africanum.

On the basis of complaints, anamnesis and clinical-laboratory examination established the diagnosis of urogenital trichomoniasis with complications, chronic oophoritis right, cystic uterine cervix of the uterus.

Held the following treatment:

- Pyrogenes with 15 µg/m by day according to the scheme 5.

Vibratory with vacuum aspiration of the endocervix, alternating with endocervical the instillation of 3% solution pepsin with Dimexidum with the aforementioned method 1 times a day for 20 minutes to 10 days.

On the 7th day of therapy conducted by TUSI-monitoring: the structure of the cervix uniform.

Then proceeded to the second stage - etiotropic therapy:

- Tinidazole-table 2. 2 times a day inside 4 days.

- Makmiror table 2. 2 times a day inside 10 days.

- Ginalyn 1 table. 1 times a day vaginally 10 days.

- Kanamycin 1.0 g/m 2 times a day for 5 days.

- After tinidazole tiberal 1 table. 2 times a day inside 5 days.

- Vaginal swabs with levamisole, Dimexidum, metrogram 10 days.

- Conducted diheteropogon surface narodowych cysts.

During two menstrual cycles (day 6) had a control of clinical and laboratory research.

This observed had no complaints, gynecological examination found complete resolution of the inflammatory process in the uterus, on TUSI structure cervical homogeneous, smears and crops from the cervical canal and vagina t.vaginalis is not found.

Thus, this method of treatment allows you to:

1) drain and sanitize the cervical canal, to eliminate non-operative by cysts in the endocervix, which are often accessible on the locsite microcirculation and lymphatic drainage, to eliminate lymphostasis and venous hyperemia, which has a positive effect on the trophic tissue and regenerative processes in the cervix;

3) promotes the resorption of encysted foci, penetration into them of drugs entered as transcervical and systemically (oral, parenteral);

4) release of cervical cancer from the products of inflammation and pathogenic microflora;

5) remove the fluid with a pathological content of the cervical canal without its passage through the vaginal mucosa, thus preventing contamination.

Sources of information

1. Skripkin Y. K., Mordova Century. N. Skin and venereal disease. A guide for physicians. M, Medicine, 1999, T. 1; 652-653.

2. Borisenko, K. K.. Diagnosis, treatment and prevention of sexually transmitted diseases. Instructional materials, M., Sanam, 1998; 99-100.

3. Adaskevich Century. P. sexually transmitted Infections. A guide for physicians. Nizhny Novgorod, C, M, Medical book, 1999; 184-187.

4. Malevich, K. N., Rusakevich P... Treatment and rehabilitation of gynecological diseases. The Handbook. Mn.: Enter. HQ., 1994, 128-129, 208-218.

5. Hakurozan SG. Ultrasound in gynecology. Symptoms. Diag is kiuchumi etiotropic therapy the instillation of drug substances and medicinal electrophoresis, characterized in that 3-5 times for each procedure is carried out alternately vibratory massage with vacuum aspiration of the endocervix and the instillation of 20 ml of 3% hydrogen peroxide solution, followed by electrophoresis solution of chymotrypsin 5 mg per 100 ml of saline and 1 ml of Dimexidum.

 

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